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Sample records for risk evaluation euroscore

  1. Comparison of original EuroSCORE, EuroSCORE II and STS risk models in a Turkish cardiac surgical cohort†

    PubMed Central

    Kunt, Ayse Gul; Kurtcephe, Murat; Hidiroglu, Mete; Cetin, Levent; Kucuker, Aslihan; Bakuy, Vedat; Ruchan Akar, Ahmet; Sener, Erol

    2013-01-01

    OBJECTIVES The aim of this study was to compare additive and logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE), EuroSCORE II and the Society of Thoracic Surgeons (STS) models in calculating mortality risk in a Turkish cardiac surgical population. METHODS The current patient population consisted of 428 patients who underwent isolated coronary artery bypass grafting (CABG) between 2004 and 2012, extracted from the TurkoSCORE database. Observed and predicted mortalities were compared for the additive/logistic EuroSCORE, EuroSCORE II and STS risk calculator. The area under the receiver operating characteristics curve (AUC) values were calculated for these models to compare predictive power. RESULTS The mean patient age was 74.5 ± 3.9 years at the time of surgery, and 35.0% were female. For the entire cohort, actual hospital mortality was 7.9% (n = 34; 95% confidence interval [CI] 5.4–10.5). However, the additive EuroSCORE-predicted mortality was 6.4% (P = 0.23 vs observed; 95% CI 6.2–6.6), logistic EuroSCORE-predicted mortality was 7.9% (P = 0.98 vs observed; 95% CI 7.3–8.6), EuroSCORE II- predicted mortality was 1.7% (P = 0.00 vs observed; 95% CI 1.6–1.8) and STS predicted mortality was 5.8% (P = 0.10 vs observed; 95% CI 5.4–6.2). The mean predictive performance of the analysed models for the entire cohort was fair, with 0.7 (95% CI 0.60–0.79). AUC values for additive EuroSCORE, logistic EuroSCORE, EuroSCORE II and STS risk calculator were 0.70 (95% CI 0.60–0.79), 0.70 (95% CI 0.59–0.80), 0.72 (95% CI 0.62–0.81) and 0.62 (95% CI 0.51–0.73), respectively. CONCLUSIONS EuroSCORE II significantly underestimated mortality risk for Turkish cardiac patients, whereas additive and logistic EuroSCORE and STS risk calculators were well calibrated. PMID:23403767

  2. Limitations of EuroSCORE for measurement of risk-stratified mortality in aortic arch surgery using selective cerebral perfusion: is advanced age no longer a risk?

    PubMed

    Matsuura, Kaoru; Ogino, Hitoshi; Matsuda, Hitoshi; Minatoya, Kenji; Sasaki, Hiroaki; Yagihara, Toshikatsu; Kitamura, Soichiro

    2006-06-01

    The European system for cardiac operative risk evaluation (EuroSCORE) is a risk stratification tool for perioperative mortality of cardiothoracic surgery that was developed in Europe and validated in North America in more than 500,000 patients. The operative mortality of aortic arch surgery has been improved by various novel operative techniques and adjuncts, whereas the number of such procedures for elderly patients has recently been increasing. The aim of this study was to examine the usefulness of the EuroSCORE, and our modification of it regarding age, in predicting mortality after aortic arch repair performed with selective cerebral perfusion. We reviewed 358 consecutive patients with a mean age of 69 +/- 10 years undergoing aortic arch repair with selective cerebral perfusion between January 1993 and February 2004. Observed in-hospital mortality was compared with predicted mortality as determined by both additive and logistic EuroSCOREs. We also evaluated a version of the EuroSCORE modified for age, which was obtained by subtracting the contribution of age from the original EuroSCORE. Score validities were assessed by calculating the areas under receiver operating characteristic curves. Overall hospital mortality was 6.2% compared with 7.7% (additive EuroSCORE) and 11.8% (logistic EuroSCORE). Area under the receiver operating characteristic curve was 0.58 for the additive EuroSCORE and 0.58 for the logistic EuroSCORE as well. The overall age-unrelated EuroSCOREs were 5.1% (additive) and 5.2% (logistic), respectively, and areas under the receiver operating characteristic curve were 0.70 for additive and 0.69 for logistic. The original additive and logistic EuroSCOREs overpredicted mortality in this patient group, whereas the age-unrelated EuroSCORE was better in predicting mortality.

  3. Combination of European System for Cardiac Operative Risk Evaluation (EuroSCORE) and Cardiac Surgery Score (CASUS) to Improve Outcome Prediction in Cardiac Surgery.

    PubMed

    Doerr, Fabian; Heldwein, Matthias B; Bayer, Ole; Sabashnikov, Anton; Weymann, Alexander; Dohmen, Pascal M; Wahlers, Thorsten; Hekmat, Khosro

    2015-08-17

    BACKGROUND We hypothesized that the combination of a preoperative and a postoperative scoring system would improve the accuracy of mortality prediction and therefore combined the preoperative 'additive EuroSCORE' (European system for cardiac operative risk evaluation) with the postoperative 'additive CASUS' (Cardiac Surgery Score) to form the 'modified CASUS'. MATERIAL AND METHODS We included all consecutive adult patients after cardiac surgery during January 2007 and December 2010 in our prospective study. Our single-centre study was conducted in a German general referral university hospital. The original additive and the 'modified CASUS' were tested using calibration and discrimination statistics. We compared the area under the curve (AUC) of the receiver characteristic curves (ROC) by DeLong's method and calculated overall correct classification (OCC) values. RESULTS The mean age among the total of 5207 patients was 67.2 ± 10.9 years. Whilst the ICU mortality was 5.9% we observed a mean length of ICU stay of 4.6 ± 7.0 days. Both models demonstrated excellent discriminatory power (mean AUC of 'modified CASUS': ≥ 0.929; 'additive CASUS': ≥ 0.920), with no significant differences according to DeLong. Neither model showed a significant p-value (<0.05) in calibration. We detected the best OCC during the 2nd day (modified: 96.5%; original: 96.6%). CONCLUSIONS Our 'additive' and 'modified' CASUS are reasonable overall predictors. We could not detect any improvement in the accuracy of mortality prediction in cardiac surgery by combining a preoperative and a postoperative scoring system. A separate calculation of the two individual elements is therefore recommended.

  4. Impact of type of procedure and surgeon on EuroSCORE operative risk validation

    PubMed Central

    Atik, Fernando A.; da Cunha, Claudio Ribeiro

    2014-01-01

    Objective EuroSCORE has been used in cardiac surgery operative risk assessment, despite important variables were not included. The objective of this study was to validate EuroSCORE on mortality prediction in a Brazilian cardiovascular surgery center, defining the influence of type of procedure and surgical team. Methods Between January 2006 and June 2011, 2320 consecutive adult patients were studied. According to additive EuroSCORE, patients were divided into low risk (score<2), medium risk (3 - 5), high risk (6 - 11) and very high risk (>12). The relation between observed mortality (O) and expected mortality (E) according to logistic EuroSCORE was calculated for each of the groups, types of procedures and surgeons with > 150 operations, and analyzed by logistic regression. Results EuroSCORE correlated to the observed mortality (O/E=0.94; P<0.0001; area under the curve 0.78). However, it overestimated the mortality in very high risk patients (O/E=0.74; P=0.001). EuroSCORE tended to overestimate isolated myocardial revascularization mortality (O/E=0.81; P=0.0001) and valve surgery mortality (O/E=0.89; P=0.007) and it tended to underestimate combined procedures mortality (O/E=1.09; P<0.0001). EuroSCORE overestimated surgeon A mortality (O/E=0.46; P<0.0001) and underestimated surgeon B mortality (O/E=1.3; P<0.0001), in every risk category. Conclusion In the present population, EuroSCORE overestimates mortality in very high risk patients, being influenced by type of procedure and surgical team. The most appropriate surgical team may minimize risks imposed by preoperative profiles. PMID:25140461

  5. Validation of EuroSCORE II risk model for coronary artery bypass surgery in high-risk patients

    PubMed Central

    Adademir, Taylan; Tasar, Mehmet; Ecevit, Ata Niyazi; Karaca, Okay Guven; Salihi, Salih; Buyukbayrak, Fuat; Ozkokeli, Mehmet

    2014-01-01

    Introduction Determining operative mortality risk is mandatory for adult cardiac surgery. Patients should be informed about the operative risk before surgery. There are some risk scoring systems that compare and standardize the results of the operations. These scoring systems needed to be updated recently, which resulted in the development of EuroSCORE II. In this study, we aimed to validate EuroSCORE II by comparing it with the original EuroSCORE risk scoring system in a group of high-risk octogenarian patients who underwent coronary artery bypass grafting (CABG). Material and methods The present study included only high-risk octogenarian patients who underwent isolated coronary artery bypass grafting in our center between January 2000 and January 2010. Redo procedures and concomitant procedures were excluded. We compared observed mortality with expected mortality predicted by EuroSCORE (logistic) and EuroSCORE II scoring systems. Results We considered 105 CABG operations performed in octogenarian patients between January 2000 and January 2010. The mean age of the patients was 81.43 ± 2.21 years (80-89 years). Thirty-nine (37.1%) of them were female. The two scales showed good discriminative capacity in the global patient sample, with the AUC (area under the curve) being higher for EuroSCORE II (AUC 0.772, 95% CI: 0.673-0.872). The goodness of fit was good for both scales. Conclusions We conclude that EuroSCORE II has better AUC (area under the ROC curve) compared to the original EuroSCORE, but both scales showed good discriminative capacity and goodness of fit in octogenarian patients undergoing isolated coronary artery bypass grafting. PMID:26336431

  6. Combination of European System for Cardiac Operative Risk Evaluation (EuroSCORE) and Cardiac Surgery Score (CASUS) to Improve Outcome Prediction in Cardiac Surgery

    PubMed Central

    Doerr, Fabian; Heldwein, Matthias B.; Bayer, Ole; Sabashnikov, Anton; Weymann, Alexander; Dohmen, Pascal M.; Wahlers, Thorsten; Hekmat, Khosro

    2015-01-01

    Background We hypothesized that the combination of a preoperative and a postoperative scoring system would improve the accuracy of mortality prediction and therefore combined the preoperative ‘additive EuroSCORE‘ (European system for cardiac operative risk evaluation) with the postoperative ‘additive CASUS’ (Cardiac Surgery Score) to form the ‘modified CASUS’. Material/Methods We included all consecutive adult patients after cardiac surgery during January 2007 and December 2010 in our prospective study. Our single-centre study was conducted in a German general referral university hospital. The original additive and the ‘modified CASUS’ were tested using calibration and discrimination statistics. We compared the area under the curve (AUC) of the receiver characteristic curves (ROC) by DeLong’s method and calculated overall correct classification (OCC) values. Results The mean age among the total of 5207 patients was 67.2±10.9 years. Whilst the ICU mortality was 5.9% we observed a mean length of ICU stay of 4.6±7.0 days. Both models demonstrated excellent discriminatory power (mean AUC of ‘modified CASUS’: ≥0.929; ‘additive CASUS’: ≥0.920), with no significant differences according to DeLong. Neither model showed a significant p-value (<0.05) in calibration. We detected the best OCC during the 2nd day (modified: 96.5%; original: 96.6%). Conclusions Our ‘additive’ and ‘modified’ CASUS are reasonable overall predictors. We could not detect any improvement in the accuracy of mortality prediction in cardiac surgery by combining a preoperative and a postoperative scoring system. A separate calculation of the two individual elements is therefore recommended. PMID:26279053

  7. Risk stratification analysis of operative mortality in isolated coronary artery bypass graft patients in Pakistan: comparison between additive and logistic EuroSCORE models.

    PubMed

    Qadir, Irfan; Perveen, Shazia; Furnaz, Shumaila; Shahabuddin, Syed; Sharif, Hasanat

    2011-08-01

    We compared the performances of the additive and logistic EuroSCORE in predicting mortality in patients undergoing isolated coronary artery bypass grafting at a single institution in Pakistan. Both models were applied to 2004 patients, operated upon at the Aga Khan University Hospital from January 2006 to July 2010. The actual mortality (3.8%) was significantly different from the additive (4.35%) and the logistic (6.41%) estimates. On the basis of degree of risk, actual mortality was 0.6% in the low-risk (additive EuroSCORE 0-4), 4.2% in the medium-risk (EuroSCORE 5-9) and 19.1% in the high-risk (EuroSCORE 10-19) group. With the low risks, both systems slightly overestimated mortality, with the logistic EuroSCORE being more accurate. At a EuroSCORE of between 10 and 19, the additive EuroSCORE underestimated and logistic EuroSCORE overestimated mortality. Both models satisfactorily discriminated outcomes (receiver operating characteristics areas of 0.866 and 0.859 for the additive and the logistic model, respectively). The Hosmer-Lemeshow test showed that calibration was good for the additive model (P=0.424) but turned out to be inadequate for the logistic model (P<0.001). We conclude that the additive EuroSCORE is a more accurate model for risk assessment compared to the logistics model in the Pakistani population.

  8. The novel EuroSCORE II algorithm predicts the hospital mortality of thoracic aortic surgery in 461 consecutive Japanese patients better than both the original additive and logistic EuroSCORE algorithms.

    PubMed

    Nishida, Takahiro; Sonoda, Hiromichi; Oishi, Yasuhisa; Tanoue, Yoshihisa; Nakashima, Atsuhiro; Shiokawa, Yuichi; Tominaga, Ryuji

    2014-04-01

    The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II was developed to improve the overestimation of surgical risk associated with the original (additive and logistic) EuroSCOREs. The purpose of this study was to evaluate the significance of the EuroSCORE II by comparing its performance with that of the original EuroSCOREs in Japanese patients undergoing surgery on the thoracic aorta. We have calculated the predicted mortalities according to the additive EuroSCORE, logistic EuroSCORE and EuroSCORE II algorithms in 461 patients who underwent surgery on the thoracic aorta during a period of 20 years (1993-2013). The actual in-hospital mortality rates in the low- (additive EuroSCORE of 3-6), moderate- (7-11) and high-risk (≥11) groups (followed by overall mortality) were 1.3, 6.2 and 14.4% (7.2% overall), respectively. Among the three different risk groups, the expected mortality rates were 5.5 ± 0.6, 9.1 ± 0.7 and 13.5 ± 0.2% (9.5 ± 0.1% overall) by the additive EuroSCORE algorithm, 5.3 ± 0.1, 16 ± 0.4 and 42.4 ± 1.3% (19.9 ± 0.7% overall) by the logistic EuroSCORE algorithm and 1.6 ± 0.1, 5.2 ± 0.2 and 18.5 ± 1.3% (7.4 ± 0.4% overall) by the EuroSCORE II algorithm, indicating poor prediction (P < 0.0001) of the mortality in the high-risk group, especially by the logistic EuroSCORE. The areas under the receiver operating characteristic curves of the additive EuroSCORE, logistic EuroSCORE and EuroSCORE II algorithms were 0.6937, 0.7169 and 0.7697, respectively. Thus, the mortality expected by the EuroSCORE II more closely matched the actual mortality in all three risk groups. In contrast, the mortality expected by the logistic EuroSCORE overestimated the risks in the moderate- (P = 0.0002) and high-risk (P < 0.0001) patient groups. Although all of the original EuroSCOREs and EuroSCORE II appreciably predicted the surgical mortality for thoracic aortic surgery in Japanese patients, the EuroSCORE II best predicted the mortalities in all

  9. Agreement between the new EuroSCORE II, the Logistic EuroSCORE and the Society of Thoracic Surgeons score: implications for transcatheter aortic valve implantation.

    PubMed

    Arangalage, Dimitri; Cimadevilla, Claire; Alkhoder, Soleiman; Chiampan, Andrea; Himbert, Dominique; Brochet, Eric; Iung, Bernard; Nataf, Patrick; Depoix, Jean-Pol; Vahanian, Alec; Messika-Zeitoun, David

    2014-01-01

    The Logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the Society of Thoracic Surgeons (STS) score are routinely used to identify patients at high surgical risk as potential candidates for transcatheter aortic valve implantation (TAVI). To compare the new EuroSCORE II with the Logistic EuroSCORE and the STS score. From October 2006 to June 2011, patients with severe symptomatic aortic stenosis who underwent a TAVI were enrolled prospectively. Among 272 patients, the EuroSCORE II was significantly lower and moderately correlated with the Logistic EuroSCORE (9±8% vs. 23±14%, P<0.01; r=0.61, P<0.001), but similar to and poorly correlated with the STS (10±9%, P=0.10; r=0.25, P<0.001). Based on recommended high-risk thresholds (Logistic EuroSCORE≥20%; STS≥10%), a EuroSCORE II≥7% provided the best diagnostic value. However, using the EuroSCORE II, Logistic EuroSCORE or STS score, only 51%, 58% and 37% of patients, respectively, reached these thresholds. Contingency analyses showed that agreements between the EuroSCORE II and the Logistic EuroSCORE or the STS score were modest or poor, respectively, with a risk assessment different in 28% and 36% of patients, respectively. A EuroSCORE II≥7% corresponded to a Logistic EuroSCORE≥20% or STS score≥10%, but correlations and agreements were at best modest and only approximately half of the patients reached these thresholds. Our results highlight the limits of current scoring systems and reinforce the European guidelines stressing the importance of clinical judgment in addition to risk scores. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  10. Meta-Analysis Comparing Established Risk Prediction Models (EuroSCORE II, STS Score, and ACEF Score) for Perioperative Mortality During Cardiac Surgery.

    PubMed

    Sullivan, Patrick G; Wallach, Joshua D; Ioannidis, John P A

    2016-11-15

    A wide variety of multivariable risk models have been developed to predict mortality in the setting of cardiac surgery; however, the relative utility of these models is unknown. This study investigated the literature related to comparisons made between established risk prediction models for perioperative mortality used in the setting of cardiac surgery. A systematic review was conducted to capture studies in cardiac surgery comparing the relative performance of at least 2 prediction models cited in recent guidelines (European System for Cardiac Operative Risk Evaluation [EuroSCORE II], Society for Thoracic Surgeons 2008 Cardiac Surgery Risk Models [STS] score, and Age, Creatinine, Ejection Fraction [ACEF] score) for the outcomes of 1-month or inhospital mortality. For articles that met inclusion criteria, we extracted information on study design, predictive performance of risk models, and potential for bias. Meta-analyses were conducted to calculate a summary estimate of the difference in AUCs between models. We identified 22 eligible studies that contained 33 comparisons among the above models. Meta-analysis of differences in AUCs revealed that the EuroSCORE II and STS score performed similarly (with a summary difference in AUC = 0.00), while outperforming the ACEF score (with summary differences in AUC of 0.10 and 0.08, respectively, p <0.05). Other metrics of discrimination and calibration were presented less consistently, and no study presented any metric of reclassification. Small sample size and absent descriptions of missing data were common in these studies. In conclusion, the EuroSCORE II and STS score outperform the ACEF score on discrimination. Copyright © 2016. Published by Elsevier Inc.

  11. Improvement in Risk Stratification in Transcatheter Aortic Valve Implantation Using a Combination of the Tumor Marker CA125 and the Logistic EuroSCORE.

    PubMed

    Husser, Oliver; Núñez, Julio; Burgdorf, Christof; Holzamer, Andreas; Templin, Christian; Kessler, Thorsten; Bodi, Vicente; Sanchis, Juan; Pellegrini, Costanza; Luchner, Andreas; Maier, Lars S; Schmid, Christof; Lüscher, Thomas F; Schunkert, Heribert; Kastrati, Adnan; Hilker, Michael; Hengstenberg, Christian

    2017-03-01

    Conventional risk scores have not been accurate in predicting peri- and postprocedural risk of patients undergoing transcatheter aortic valve implantation (TAVI). Elevated levels of the tumor marker carbohydrate antigen 125 (CA125) have been linked to adverse outcomes after TAVI. We studied the additional value of CA125 to that of the EuroSCORE in predicting long-term mortality after TAVI. During a median follow-up of 59 weeks, 115 of 422 patients (27%) died after TAVI. Mortality was higher with elevated CA125 (> 30 U/mL) and EuroSCORE (> median) (47% vs 20%, P<.001 and 38% vs 16%, P<.001, respectively). In the multivariable analysis, CA125 (> 30 U/mL) remained an independent predictor of mortality (hazard ratio [HR], 2.16; 95% confidence interval [95%CI], 1.48-3.15; P<.001) and improved the predictive capability of the model (C-statistic: 0.736 vs 0.731) and the net reclassification index (51% 95%CI, 33-73) with an integrated discriminative improvement of 3.5% (95%CI, 0.5-8.4). A new variable (CA125-EuroSCORE) was created, with the combinations of the 2 possible binary states of these variables (+, elevated, -, not elevated; C1: CA125- EuroSCORE-; C2: CA125+ EuroSCORE-; C3: CA125- EuroSCORE+; C4: CA125+ EuroSCORE+). Patients in C1 exhibited the lowest cumulative mortality rate (14% [26 of 181]). Mortality was intermediate for C2 (CA125 > 30 U/mL and EuroSCORE ≤ median) and C3 (CA125 ≤ 30 U/mL and EuroSCORE > median): 27% (8 of 30) and 28% (37 of 131), respectively. Patients in C4 (CA125 > 30 U/mL and EuroSCORE > median) exhibited the highest mortality (55% [44 of 80], P-value for trend<.001). CA125 offers additional prognostic information beyond that obtained by the EuroSCORE. Elevation of both markers was associated with a poor prognosis. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  12. Dynamic trends in cardiac surgery: why the logistic EuroSCORE is no longer suitable for contemporary cardiac surgery and implications for future risk models.

    PubMed

    Hickey, Graeme L; Grant, Stuart W; Murphy, Gavin J; Bhabra, Moninder; Pagano, Domenico; McAllister, Katherine; Buchan, Iain; Bridgewater, Ben

    2013-06-01

    Progressive loss of calibration of the original EuroSCORE models has necessitated the introduction of the EuroSCORE II model. Poor model calibration has important implications for clinical decision-making and risk adjustment of governance analyses. The objective of this study was to explore the reasons for the calibration drift of the logistic EuroSCORE. Data from the Society for Cardiothoracic Surgery in Great Britain and Ireland database were analysed for procedures performed at all National Health Service and some private hospitals in England and Wales between April 2001 and March 2011. The primary outcome was in-hospital mortality. EuroSCORE risk factors, overall model calibration and discrimination were assessed over time. A total of 317 292 procedures were included. Over the study period, mean age at surgery increased from 64.6 to 67.2 years. The proportion of procedures that were isolated coronary artery bypass grafts decreased from 67.5 to 51.2%. In-hospital mortality fell from 4.1 to 2.8%, but the mean logistic EuroSCORE increased from 5.6 to 7.6%. The logistic EuroSCORE remained a good discriminant throughout the study period (area under the receiver-operating characteristic curve between 0.79 and 0.85), but calibration (observed-to-expected mortality ratio) fell from 0.76 to 0.37. Inadequate adjustment for decreasing baseline risk affected calibration considerably. Patient risk factors and case-mix in adult cardiac surgery change dynamically over time. Models like the EuroSCORE that are developed using a 'snapshot' of data in time do not account for this and can subsequently lose calibration. It is therefore important to regularly revalidate clinical prediction models.

  13. Dynamic trends in cardiac surgery: why the logistic EuroSCORE is no longer suitable for contemporary cardiac surgery and implications for future risk models

    PubMed Central

    Hickey, Graeme L.; Grant, Stuart W.; Murphy, Gavin J.; Bhabra, Moninder; Pagano, Domenico; McAllister, Katherine; Buchan, Iain; Bridgewater, Ben

    2013-01-01

    OBJECTIVES Progressive loss of calibration of the original EuroSCORE models has necessitated the introduction of the EuroSCORE II model. Poor model calibration has important implications for clinical decision-making and risk adjustment of governance analyses. The objective of this study was to explore the reasons for the calibration drift of the logistic EuroSCORE. METHODS Data from the Society for Cardiothoracic Surgery in Great Britain and Ireland database were analysed for procedures performed at all National Health Service and some private hospitals in England and Wales between April 2001 and March 2011. The primary outcome was in-hospital mortality. EuroSCORE risk factors, overall model calibration and discrimination were assessed over time. RESULTS A total of 317 292 procedures were included. Over the study period, mean age at surgery increased from 64.6 to 67.2 years. The proportion of procedures that were isolated coronary artery bypass grafts decreased from 67.5 to 51.2%. In-hospital mortality fell from 4.1 to 2.8%, but the mean logistic EuroSCORE increased from 5.6 to 7.6%. The logistic EuroSCORE remained a good discriminant throughout the study period (area under the receiver-operating characteristic curve between 0.79 and 0.85), but calibration (observed-to-expected mortality ratio) fell from 0.76 to 0.37. Inadequate adjustment for decreasing baseline risk affected calibration considerably. DISCUSSIONS Patient risk factors and case-mix in adult cardiac surgery change dynamically over time. Models like the EuroSCORE that are developed using a ‘snapshot’ of data in time do not account for this and can subsequently lose calibration. It is therefore important to regularly revalidate clinical prediction models. PMID:23152436

  14. Use of EuroSCORE as a predictor of morbidity after cardiac surgery

    PubMed Central

    Andrade, Isaac Newton Guimarães; de Moraes Neto, Fernando Ribeiro; Andrade, Tamirys Guimarães

    2014-01-01

    Objective To evaluate the use of the EuroSCORE as a predictor of postoperative morbidity after cardiac surgery. Methods We retrospectively analyzed the charts of 900 patients operated on and admitted to the intensive care unit postoperatively at the Royal Portuguese Hospital of Recife. We included all patients with complete medical records, excluding those who died during surgery, underwent transplantation or correction of congenital heart disease. We evaluated the development of respiratory infection, cerebrovascular accident, and dialysis-dependent renal failure, and the EuroSCORE was compared in terms of the three complications using the Mann-Whitney test. The calibration model for predicting the morbidities being studied was evaluated using the test set of Homer-Lemeshow goodness. The accuracy of the model was assessed using the area under the ROC curve (AUROC). Results The model showed good calibration in predicting respiratory infection, acute renal failure and stroke (P=0.285, P=0.789, P=0.45, respectively), with good accuracy for respiratory infection (AUROC=0.710 and P<0.001) and dialysis-dependent renal failure (AUROC=0.834 and P<0.001), but no accuracy to predict stroke (AUROC=0.519). The high-risk patients were more likely to develop respiratory infection (OR=9.05, P<0.001) and dialysis-dependent renal failure (OR=39.6, P<0.001). The probability of developing respiratory infection and dialysis-dependent renal failure was less than 10% with EuroSCORE up to 7 and more than 70% with EuroSCORE greater than 15. Conclusion EuroSCORE proved to be a good predictor of major postoperative morbidity in cardiac surgery: respiratory and dialysis-dependent renal failure. PMID:24896157

  15. Correlation of the EuroSCORE with the onset of postoperative acute kidney injury in cardiac surgery

    PubMed Central

    de Moura, Edmilson Bastos; Bernardes Neto, Saint-Clair Gomes; Amorim, Fábio Ferreira; Viscardi, Renato Camargo

    2013-01-01

    Objective The objective of this study was to assess the correlation between the European System for Cardiac Operative Risk Evaluation (EuroSCORE) score and the risk of developing acute kidney injury in cardiac surgery patients. Methods This retrospective study was conducted at a tertiary hospital on consecutive cardiac surgery patients (e.g., valvular, ischemic and congenital heart diseases) between October 2010 and July 2011. Results One hundred patients were assessed. Among the 100 patients, six were excluded, including five because of prior kidney disease or dialysis therapy and one because of incomplete medical records. The primary surgical indications were myocardial revascularization in 55 patients (58.5% of cases) and valve replacement in 28 patients (29.8%). According to the EuroSCORE, 55 patients were classified as high risk (58.5%), 27 patients as medium risk (28.7%) and 12 patients as low risk (12.8%). In the postoperative period, patients were classified with the Risk, Injury, Failure, Loss and End-stage kidney disease (RIFLE) score. Among the 31 patients (33%) who displayed an increase in serum creatinine, 18 patients (19.1%) were classified as RIFLE "R" (risk), seven patients (7.4%) were classified as RIFLE "I" (injury) and six patients (6.5%) were classified as RIFLE "F" (failure). Among the patients who were considered to be high risk according to the EuroSCORE criteria, 24 patients (43.6%) showed acute kidney injury. Among the patients who were classified as medium or low risk, acute kidney injury occurred in 18.5 and 16.6% of the cases, respectively. The correlations between risk stratification (low, medium and high) and the EuroSCORE and postoperative RIFLE scores were statistically significant (p=0.03). Conclusion In the studied population, there was a statistically significant correlation between the EuroSCORE and the risk of developing acute kidney injury in the postoperative period after cardiac surgery. PMID:24213087

  16. Recursive and non-linear logistic regression: moving on from the original EuroSCORE and EuroSCORE II methodologies.

    PubMed

    Poullis, Michael

    2014-11-01

    EuroSCORE II, despite improving on the original EuroSCORE system, has not solved all the calibration and predictability issues. Recursive, non-linear and mixed recursive and non-linear regression analysis were assessed with regard to sensitivity, specificity and predictability of the original EuroSCORE and EuroSCORE II systems. The original logistic EuroSCORE, EuroSCORE II and recursive, non-linear and mixed recursive and non-linear regression analyses of these risk models were assessed via receiver operator characteristic curves (ROC) and Hosmer-Lemeshow statistic analysis with regard to the accuracy of predicting in-hospital mortality. Analysis was performed for isolated coronary artery bypass grafts (CABGs) (n = 2913), aortic valve replacement (AVR) (n = 814), mitral valve surgery (n = 340), combined AVR and CABG (n = 517), aortic (n = 350), miscellaneous cases (n = 642), and combinations of the above cases (n = 5576). The original EuroSCORE had an ROC below 0.7 for isolated AVR and combined AVR and CABG. None of the methods described increased the ROC above 0.7. The EuroSCORE II risk model had an ROC below 0.7 for isolated AVR only. Recursive regression, non-linear regression, and mixed recursive and non-linear regression all increased the ROC above 0.7 for isolated AVR. The original EuroSCORE had a Hosmer-Lemeshow statistic that was above 0.05 for all patients and the subgroups analysed. All of the techniques markedly increased the Hosmer-Lemeshow statistic. The EuroSCORE II risk model had a Hosmer-Lemeshow statistic that was significant for all patients (P < 0.0001), and very close to significant for isolated CABG (P = 0.05) and for isolated AVR (P = 0.06). Non-linear regression failed to improve on the original Hosmer-Lemeshow statistic. The mixed recursive and non-linear regression using the EuroSCORE II risk model was the only model that produced an ROC of 0.7 or above for all patients and procedures and had a Hosmer-Lemeshow statistic that was highly non

  17. Predictive Power and Implication of EuroSCORE, EuroSCORE II and STS Score for Isolated Repeated Aortic Valve Replacement.

    PubMed

    Holinski, Sebastian; Jessen, Sören; Neumann, Konrad; Konertz, Wolfgang

    2015-01-01

    We evaluated the predictive power of the EuroSCORE, EuroSCORE II and Society of Thoracic Surgeons (STS) score for isolated redo aortic valve replacement. 78 consecutive patients underwent the aforementioned procedure mainly with a stentless valve prosthesis at our institution. Observed mortality was compared to the predicted mortality, Receiver Operating Characteristics (ROC) curves were calculated and the area under the curve (AUC) analyzed. Observed mortality was 11.5%. EuroSCORE and EuroScore II predicted a mortality of 28.2 ± 21.6% (p <0.001) and 10.2 ± 11.8% (p = 0.75), respectively. AUC of the EuroSCORE was 0.74 (95% CI: 0.62-0.83), p = 0.009 and of the EuroSCORE II 0.86 (95% CI: 0.76-0.93), p <0.0001. Optimal Youden index of the EuroSCORE II was 0.59 referring to a predicted mortality of 9.9% (sensitivity: 77.8% and specificity: 81.2%). Predicted mortality of STS score was 17.8 ± 10.6% (p = 0.08) and AUC was 0.64 (95% CI: 0.53-0.75), p = 0.06. EuroSCORE II calculation was not only superior to EuroSCORE and STS score but led to a very realistic mortality prediction for this special procedure at our institution. A EuroSCORE II greater 10 should encourage to consider an alternative treatment.

  18. Relationship between the logistic EuroSCORE and the Society of Thoracic Surgeons Predicted Risk of Mortality score in patients implanted with the CoreValve ReValving system--a Bern-Rotterdam Study.

    PubMed

    Piazza, Nicolo; Wenaweser, Peter; van Gameren, Menno; Pilgrim, Thomas; Tzikas, Apostolos; Tsikas, Apostolos; Otten, Amber; Nuis, Rutger; Onuma, Yoshinobu; Cheng, Jin Ming; Kappetein, A Pieter; Boersma, Eric; Juni, Peter; de Jaegere, Peter; Windecker, Stephan; Serruys, Patrick W

    2010-02-01

    Surgical risk scores, such as the logistic EuroSCORE (LES) and Society of Thoracic Surgeons Predicted Risk of Mortality (STS) score, are commonly used to identify high-risk or "inoperable" patients for transcatheter aortic valve implantation (TAVI). In Europe, the LES plays an important role in selecting patients for implantation with the Medtronic CoreValve System. What is less clear, however, is the role of the STS score of these patients and the relationship between the LES and STS. The purpose of this study is to examine the correlation between LES and STS scores and their performance characteristics in high-risk surgical patients implanted with the Medtronic CoreValve System. All consecutive patients (n = 168) in whom a CoreValve bioprosthesis was implanted between November 2005 and June 2009 at 2 centers (Bern University Hospital, Bern, Switzerland, and Erasmus Medical Center, Rotterdam, The Netherlands) were included for analysis. Patient demographics were recorded in a prospective database. Logistic EuroSCORE and STS scores were calculated on a prospective and retrospective basis, respectively. Observed mortality was 11.1%. The mean LES was 3 times higher than the mean STS score (LES 20.2% +/- 13.9% vs STS 6.7% +/- 5.8%). Based on the various LES and STS cutoff values used in previous and ongoing TAVI trials, 53% of patients had an LES > or =15%, 16% had an STS > or =10%, and 40% had an LES > or =20% or STS > or =10%. Pearson correlation coefficient revealed a reasonable (moderate) linear relationship between the LES and STS scores, r = 0.58, P < .001. Although the STS score outperformed the LES, both models had suboptimal discriminatory power (c-statistic, 0.49 for LES and 0.69 for STS) and calibration. Clinical judgment and the Heart Team concept should play a key role in selecting patients for TAVI, whereas currently available surgical risk score algorithms should be used to guide clinical decision making. Copyright (c) 2010 Mosby, Inc. All rights

  19. Sampling time error in EuroSCORE II.

    PubMed

    Poullis, Michael; Fabri, Brian; Pullan, Mark; Chalmers, John

    2012-05-01

    Seasonal variation in mortality after cardiac surgery exists. EuroSCORE II accrued data over a 12-week period from May to July 2010. We investigated whether the accrual period for EuroSCORE II had a different mortality rate compared with the rest of the year. We found in a study population of 18,706 that the accrual period of EuroSCORE II may introduce bias into the predicted mortality, potentially reducing the accuracy of the new model.

  20. Performance of European system for cardiac operative risk evaluation in Veterans General Hospital Kaohsiung cardiac surgery.

    PubMed

    Shih, Hsin-Hung; Kang, Pei-Luen; Pan, Jun-Yen; Wu, Tung-Ho; Wu, Chieh-Ten; Lin, Chun-Yao; Lin, Yu-Hsin; Chou, Wan-Ting

    2011-03-01

    The European System for Cardiac Operative Risk Evaluation (EuroSCORE) model is a widely-used risk prediction algorithm for in-hospital or 30-day mortality in adult cardiac surgery patients. Recent studies indicated that EuroSCORE tends to overpredict mortality. The aim of our study is to evaluate the validity of EuroSCORE in Veterans General Hospital Kaohsiung (VGHKS) cardiac surgery including a number of different surgical and risk subgroups. From January 2006 to December 2009, 1,240 adult patients who underwent cardiac surgery in VGHKS were included in this study. The study was followed the guidelines of the Ethics Committee of Kaohsiung Veterans General Hospital, Taiwan. Both additive and logistic score of all patients were calculated depending on the formula in the official EuroSCORE website. The entire cohort, different surgical type and risk stratification subgroups were analyzed. Model discrimination was tested by determining the area under receiver operating characteristic (ROC) curve. Model calibration was tested by the Hosmer-Lemeshow chi-square test. Clinical performance of model was assessed by comparing the observed and predicted mortality rates. There were significant differences between the VGHKS and European cardiac surgical populations. The additive score and logistic score for the overall group were 7.16% and 12.88%, respectively. Observed mortality was 10.72% overall, 5.68% for isolated coronary artery bypass grafting (CABG), 4.67% for the mitral valve only and 4.25% for the aortic valve only group. The discriminative ability EuroSCORE was very good in all and various surgical subgroups, with area under the ROC curve from 0.75 to 0.87. The addictive and logistic models of EuroSCORE showed excellent accuracy, 0.839 and 0.845, respectively. Good calibration power was recognized by p value higher than 0.05 for the entire cohort and all subgroups of patients except for isolated CABG. The logistic EuroSCORE model overestimated mortality to different

  1. Mortality prediction in Indian cardiac surgery patients: Validation of European System for Cardiac Operative Risk Evaluation II

    PubMed Central

    Kar, Prachi; Geeta, Kanithi; Gopinath, Ramachandran; Durga, Padmaja

    2017-01-01

    Background and Aims: Risk Stratification has an important place in cardiac surgery to identify high-risk cases and optimally allocate resources. Hence various risk scoring systems have been tried to predict mortality. The aim of the present study was to validate the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) in Indian cardiac surgical patients. Methods: After obtaining ethics committee clearance, data on EuroSCORE II variables were collected for all patients >18 years undergoing on-pump coronary artery bypass graft (CABG), valve surgery and mixed (CABG + valve) procedures between January 2011 and December 2012. Mortality prediction was done using the online calculator from the site www.euroscore.org. The calibration of the EuroSCORE II model was analysed using the Hosmer–Lemeshow test and discrimination was analysed by plotting receiver operating characteristic curves (ROC) and calculating area under the curve (AUC). The analysis was done in the total sample, CABG, valve surgery and in mixed procedures. Results: The overall observed mortality was 5.7% in the total sample, 6.6% in CABG, 4.2% in valve surgeries and 10.2% in mixed procedures whereas the predicted mortality was 2.9%, 3.1%, 2.4%, 5.1% in total sample, CABG, valve surgery and mixed procedure, respectively. The significance (P value) of Hosmer–Lemeshow test was 0.292, 0.45, 0.56 and 1 for the total sample, CABG, valve surgery and mixed procedure, respectively, indicating good calibration. The AUC of ROC was 0.76, 0.70, 0.83 and 0.78 for total sample, CABG, valve surgery and mixed procedure, respectively. Conclusion: Mortality of the sample was under-predicted by EuroSCORE II. Calibration of the EuroSCORE II model was good for total sample as well as for all surgical subcategories. Discrimination was good in the total sample and in the mixed procedure population, acceptable in CABG patients and excellent in valve surgeries. PMID:28250485

  2. Performance of the European System for Cardiac Operative Risk Evaluation II: a meta-analysis of 22 studies involving 145,592 cardiac surgery procedures.

    PubMed

    Guida, Pietro; Mastro, Florinda; Scrascia, Giuseppe; Whitlock, Richard; Paparella, Domenico

    2014-12-01

    A systematic review of the European System for Cardiac Operative Risk Evaluation (euroSCORE) II performance for prediction of operative mortality after cardiac surgery has not been performed. We conducted a meta-analysis of studies based on the predictive accuracy of the euroSCORE II. We searched the Embase and PubMed databases for all English-only articles reporting performance characteristics of the euroSCORE II. The area under the receiver operating characteristic curve, the observed/expected mortality ratio, and observed-expected mortality difference with their 95% confidence intervals were analyzed. Twenty-two articles were selected, including 145,592 procedures. Operative mortality occurred in 4293 (2.95%), whereas the expected events according to euroSCORE II were 4802 (3.30%). Meta-analysis of these studies provided an area under the receiver operating characteristic curve of 0.792 (95% confidence interval, 0.773-0.811), an estimated observed/expected ratio of 1.019 (95% confidence interval, 0.899-1.139), and observed-expected difference of 0.125 (95% confidence interval, -0.269 to 0.519). Statistical heterogeneity was detected among retrospective studies including less recent procedures. Subgroups analysis confirmed the robustness of combined estimates for isolated valve procedures and those combined with revascularization surgery. A significant overestimation of the euroSCORE II with an observed/expected ratio of 0.829 (95% confidence interval, 0.677-0.982) was observed in isolated coronary artery bypass grafting and a slight underestimation of predictions in high-risk patients (observed/expected ratio 1.253 and observed-expected difference 1.859). Despite the heterogeneity, the results from this meta-analysis show a good overall performance of the euroSCORE II in terms of discrimination and accuracy of model predictions for operative mortality. Validation of the euroSCORE II in prospective populations needs to be further studied for a continuous

  3. A Comparison of a Machine Learning Model with EuroSCORE II in Predicting Mortality after Elective Cardiac Surgery: A Decision Curve Analysis.

    PubMed

    Allyn, Jérôme; Allou, Nicolas; Augustin, Pascal; Philip, Ivan; Martinet, Olivier; Belghiti, Myriem; Provenchere, Sophie; Montravers, Philippe; Ferdynus, Cyril

    2017-01-01

    The benefits of cardiac surgery are sometimes difficult to predict and the decision to operate on a given individual is complex. Machine Learning and Decision Curve Analysis (DCA) are recent methods developed to create and evaluate prediction models. We conducted a retrospective cohort study using a prospective collected database from December 2005 to December 2012, from a cardiac surgical center at University Hospital. The different models of prediction of mortality in-hospital after elective cardiac surgery, including EuroSCORE II, a logistic regression model and a machine learning model, were compared by ROC and DCA. Of the 6,520 patients having elective cardiac surgery with cardiopulmonary bypass, 6.3% died. Mean age was 63.4 years old (standard deviation 14.4), and mean EuroSCORE II was 3.7 (4.8) %. The area under ROC curve (IC95%) for the machine learning model (0.795 (0.755-0.834)) was significantly higher than EuroSCORE II or the logistic regression model (respectively, 0.737 (0.691-0.783) and 0.742 (0.698-0.785), p < 0.0001). Decision Curve Analysis showed that the machine learning model, in this monocentric study, has a greater benefit whatever the probability threshold. According to ROC and DCA, machine learning model is more accurate in predicting mortality after elective cardiac surgery than EuroSCORE II. These results confirm the use of machine learning methods in the field of medical prediction.

  4. How does EuroSCORE II perform in UK cardiac surgery; an analysis of 23 740 patients from the Society for Cardiothoracic Surgery in Great Britain and Ireland National Database.

    PubMed

    Grant, Stuart William; Hickey, Graeme Lee; Dimarakis, Ioannis; Trivedi, Uday; Bryan, Alan; Treasure, Tom; Cooper, Graham; Pagano, Domenico; Buchan, Iain; Bridgewater, Ben

    2012-11-01

    The original EuroSCORE models are poorly calibrated for predicting mortality in contemporary cardiac surgery. EuroSCORE II has been proposed as a new risk model. The objective of this study was to assess the performance of EuroSCORE II in UK cardiac surgery. A cross-sectional analysis of prospectively collected multi-centre clinical audit data, from the Society for Cardiothoracic Surgery in Great Britain and Ireland Database. All NHS hospitals, and some UK private hospitals performing adult cardiac surgery. 23 740 procedures at 41 hospitals between July 2010 and March 2011. The main outcome measure was in-hospital mortality. Model calibration (Hosmer-Lemeshow test, calibration plot) and discrimination (area under receiver operating characteristic curve) were assessed in the overall cohort and clinically defined sub-groups. The mean age at procedure was 67.1 years (SD 11.8) and 27.7% were women. The overall mortality was 3.1% with a EuroSCORE II predicted mortality of 3.4%. Calibration was good overall but the model failed the Hosmer-Lemeshow test (p=0.003) mainly due to over-prediction in the highest and lowest-risk patients. Calibration was poor for isolated coronary artery bypass graft surgery (Hosmer-Lemeshow, p<0.001). The model had good discrimination overall (area under receiver operating characteristic curve 0.808, 95% CI 0.793 to 0.824) and in all clinical sub-groups analysed. EuroSCORE II performs well overall in the UK and is an acceptable contemporary generic cardiac surgery risk model. However, the model is poorly calibrated for isolated coronary artery bypass graft surgery and in both the highest and lowest risk patients. Regular revalidation of EuroSCORE II will be needed to identify calibration drift or clinical inconsistencies, which commonly emerge in clinical prediction models.

  5. A Comparison of a Machine Learning Model with EuroSCORE II in Predicting Mortality after Elective Cardiac Surgery: A Decision Curve Analysis

    PubMed Central

    Allyn, Jérôme; Allou, Nicolas; Augustin, Pascal; Philip, Ivan; Martinet, Olivier; Belghiti, Myriem; Provenchere, Sophie; Montravers, Philippe; Ferdynus, Cyril

    2017-01-01

    Background The benefits of cardiac surgery are sometimes difficult to predict and the decision to operate on a given individual is complex. Machine Learning and Decision Curve Analysis (DCA) are recent methods developed to create and evaluate prediction models. Methods and finding We conducted a retrospective cohort study using a prospective collected database from December 2005 to December 2012, from a cardiac surgical center at University Hospital. The different models of prediction of mortality in-hospital after elective cardiac surgery, including EuroSCORE II, a logistic regression model and a machine learning model, were compared by ROC and DCA. Of the 6,520 patients having elective cardiac surgery with cardiopulmonary bypass, 6.3% died. Mean age was 63.4 years old (standard deviation 14.4), and mean EuroSCORE II was 3.7 (4.8) %. The area under ROC curve (IC95%) for the machine learning model (0.795 (0.755–0.834)) was significantly higher than EuroSCORE II or the logistic regression model (respectively, 0.737 (0.691–0.783) and 0.742 (0.698–0.785), p < 0.0001). Decision Curve Analysis showed that the machine learning model, in this monocentric study, has a greater benefit whatever the probability threshold. Conclusions According to ROC and DCA, machine learning model is more accurate in predicting mortality after elective cardiac surgery than EuroSCORE II. These results confirm the use of machine learning methods in the field of medical prediction. PMID:28060903

  6. Addition of albumin to Traditional Risk Score Improved Prediction of Mortality in Individuals Undergoing Transcatheter Aortic Valve Replacement.

    PubMed

    Grossman, Yoni; Barbash, Israel M; Fefer, Paul; Goldenberg, Ilan; Berkovitch, Anat; Regev, Ehud; Fink, Noam; Ben-Zekry, Sagit; Brodov, Yafim; Kogan, Alexander; Guetta, Victor; Raanani, Ehud; Segev, Amit

    2017-09-23

    The ability of the Society of Thoracic Surgeons (STS) and European System for Cardiac Operative Risk Evaluation (EuroSCORE)-2 scores to predict outcomes after transcatheter aortic valve replacement (TAVR) is insufficient. Frailty and serum albumin as a frailty marker were shown to correlate with prognosis after TAVR. We sought to evaluate the additive value of serum albumin to STS and EuroSCORE-2 scores to predict mortality in individuals undergoing TAVR. Retrospective analysis. Tertiary-care hospital prospective registry. Individuals who underwent TAVR (N = 426). We compared survival rates according to median baseline albumin levels (4 g/dL), STS score (4.5%), and EuroSCORE-2 (3.45%). Participants were divided into four groups according to median serum albumin and median STS and EuroSCORE-2 scores (high vs low), and 1-year survival rates were compared. A category-free net reclassification index (NRI) was calculated to compare the ability of a model of STS or EuroSCORE-2 alone to classify mortality risk with and without the addition of baseline serum albumin. Participants with low albumin levels had higher mortality (hazard ratio (HR) = 3.03, 95% confidence interval (CI) = 1.66-5.26, P < .001). Participants with low serum albumin and a high STS (HR = 4.55, 95% CI = 2.21-9.38, P < .001) or EuroSCORE-2 (HR = 2.72, 95% CI = 1.48-5.06, P = .001) score had higher mortality. Using NRI analysis, a model that included albumin in addition to STS correctly reclassified 42% of events (NRI = 0.58) and a model that included albumin in addition to EuroSCORE-2 correctly reclassified 44% of events (NRI = 0.64). Serum albumin, as a marker of frailty, can significantly improve the ability of STS and EuroSCORE-2 scores to predict TAVR-related mortality. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  7. Gaming in risk-adjusted mortality rates: effect of misclassification of risk factors in the benchmarking of cardiac surgery risk-adjusted mortality rates.

    PubMed

    Siregar, Sabrina; Groenwold, Rolf H H; Versteegh, Michel I M; Noyez, Luc; ter Burg, Willem Jan P P; Bots, Michiel L; van der Graaf, Yolanda; van Herwerden, Lex A

    2013-03-01

    Upcoding or undercoding of risk factors could affect the benchmarking of risk-adjusted mortality rates. The aim was to investigate the effect of misclassification of risk factors on the benchmarking of mortality rates after cardiac surgery. A prospective cohort was used comprising all adult cardiac surgery patients in all 16 cardiothoracic centers in The Netherlands from January 1, 2007, to December 31, 2009. A random effects model, including the logistic European system for cardiac operative risk evaluation (EuroSCORE) was used to benchmark the in-hospital mortality rates. We simulated upcoding and undercoding of 5 selected variables in the patients from 1 center. These patients were selected randomly (nondifferential misclassification) or by the EuroSCORE (differential misclassification). In the random patients, substantial misclassification was required to affect benchmarking: a 1.8-fold increase in prevalence of the 4 risk factors changed an underperforming center into an average performing one. Upcoding of 1 variable required even more. When patients with the greatest EuroSCORE were upcoded (ie, differential misclassification), a 1.1-fold increase was sufficient: moderate left ventricular function from 14.2% to 15.7%, poor left ventricular function from 8.4% to 9.3%, recent myocardial infarction from 7.9% to 8.6%, and extracardiac arteriopathy from 9.0% to 9.8%. Benchmarking using risk-adjusted mortality rates can be manipulated by misclassification of the EuroSCORE risk factors. Misclassification of random patients or of single variables will have little effect. However, limited upcoding of multiple risk factors in high-risk patients can greatly influence benchmarking. To minimize "gaming," the prevalence of all risk factors should be carefully monitored. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  8. Creatinine clearance versus serum creatinine as a risk factor in cardiac surgery.

    PubMed

    Walter, Jörg; Mortasawi, Amir; Arnrich, Bert; Albert, Alexander; Frerichs, Inez; Rosendahl, Ulrich; Ennker, Jürgen

    2003-06-17

    Renal impairment is one of the predictors of mortality in cardiac surgery. Usually a binarized value of serum creatinine is used to assess the renal function in risk models. Creatinine clearance can be easily estimated by the Cockcroft and Gault equation from serum creatinine, gender, age and body weight. In this work we examine whether this estimation of the glomerular filtration rate can advantageously replace the serum creatinine in the EuroSCORE preoperative risk assessment. In a group of 8138 patients out of a total of 11878 patients, who underwent cardiac surgery in our hospital between January 1996 and July 2002, the 18 standard EuroSCORE parameters could retrospectively be determined and logistic regression analysis performed. In all patients scored, creatinine clearance was calculated according to Cockcroft and Gault. The relationship between the predicted and observed 30-days mortality was evaluated in systematically selected intervals of creatinine clearance and significance values computed by employing Monte Carlo methods. Afterwards, risk scoring was performed using a continuous or a categorical value of creatinine clearance instead of serum creatinine. The predictive ability of several risk score models and the individual contribution of their predictor variables were studied using ROC curve analysis. The comparison between the expected and observed 30-days mortalities, which were determined in different intervals of creatinine clearance, revealed the best threshold value of 55 ml/min. A significantly higher 30-days mortality was observed below this threshold and vice versa (both with p < 0.001). The local adaptation of the EuroSCORE is better than the standard EuroSCORE and was further improved by replacing serum creatinine (SC) by creatinine clearance (CC). Differential ROC analysis revealed that CC is superior to SC in providing predictive power within the logistic regression. Variable rank comparison identified CC as the best single variable

  9. Evaluating Health Risk Models

    PubMed Central

    2010-01-01

    SUMMARY Interest in targeted disease prevention has stimulated development of models that assign risks to individuals, using their personal covariates. We need to evaluate these models and quantify the gains achieved by expanding a model to include additional covariates. This paper reviews several performance measures and shows how they are related. Examples are used to show that appropriate performance criteria for a risk model depend upon how the model is used. Application of the performance measures to risk models for hypothetical populations and for US women at risk of breast cancer illustrate two additional points. First, model performance is constrained by the distribution of risk-determining covariates in the population. This complicates the comparison of two models when applied to populations with different covariate distributions. Second, all summary performance measures obscure model features of relevance to its utility for the application at hand, such as performance in specific subgroups of the population. In particular, the precision gained by adding covariates to a model can be small overall, but large in certain subgroups. We propose new ways to identify these subgroups and to quantify how much they gain by measuring the additional covariates. Those with largest gains could be targeted for cost-efficient covariate assessment. PMID:20623821

  10. Assessment of Euroscore and SAPS III as hospital mortality predicted in cardiac surgery.

    PubMed

    Mateos-Pañero, B; Sánchez-Casado, M; Castaño-Moreira, B; Paredes-Astillero, I; López-Almodóvar, L F; Bustos-Molina, F

    2017-05-01

    To perform an external validation of Euroscore I, Euroscore II and SAPS III. Retrospective cohort study over three years on all adult patients who underwent cardiac surgery. We reviewed the clinical data, following the patient until outcome or discharge from hospital (dead, alive). We computed the predicted mortality by Euroscore I (EI), II (EII) and SAPS III. The model validation was assessed by discrimination: area under curve ROC; and calibration (Hosmer-Lemeshow test). 866 patients were included. 62.5% of them male, with a median age of 69 years, 6.1% died during hospitalization. Predicted mortality: E I 7.94%, E II 3.54, SAPS III 12.1%. Area under curve (95% IC): E I 0.862 (0.812-0.912); E II 0.861 (0.806-0.915); SAPS III 0.692 (0.601-0.784). Hosmer-Lemeshow test: E I 14.0046 (P=.08164); E II 33.67 (P=.00004660); SAPS III 11.57 (P=.171). EII had good discrimination, but the calibration was not good with predicted mortality lower than the real mortality. E I showed the best discrimination with good calibration and a tendency to overestimate the mortality. SAPS III showed poor discrimination with good calibration and a tendency to greatly overestimate the predicted mortality. We saw no improvement in the predictive performance of EII over I and we reject the use of SAPS III in this kind of patient. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Comparison of transcatheter aortic valve replacement risk score against currently accepted surgical risk models as predictors of 30-day mortality in transcatheter aortic valve replacement.

    PubMed

    Yatsynovich, Yan; Khattak, Himad; Ali, Mohammed; Schwartz, Brian; Pak, Stella; Chen, Tian

    2017-09-20

    Aim of the study was to assess the predictive capability of Transcatheter Aortic Valve Replacement Risk Score (TAVR-RS) in comparison with Society of Thoracic Surgeon-Predicted Risk of Mortality (STS PROM) and European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) on 30-day mortality following TAVR. With exponentially increasing use of TAVR, a risk stratification model to accurately predict mortality risks in patients undergoing TAVR is urgently warranted. Retrospective analysis of 182 TAVRs between 2014 and 2017, 179 by transfemoral, 3 by subclavian approach. Clinical, laboratory and echocardiography variables were collected. The performance of risk models was evaluated using equivalence tests, receiver operating characteristic (ROC) and area under the ROC curve (AUC). Outcome was 30-day mortality prediction. Observed 30-day mortality was 5.49%. TAVR-RS underestimated (4.0%) while surgical models (STS PROM and EuroSCORE II) overestimated mortality, 7.24% and 8.14%, respectively. The TAVR-RS was found to have statistically significant correlation with both individual and group mortalities. AUC was highest for TAVR-RS 0.66 (95%CI: 0.31-0.96), but no difference in 30-day mortality prediction was found in comparison with STS PROM (P = 0.06) or EuroSCORE II (P = 0.2161). The TAVR-RS was a better predictor of both group and individual mortality at 30 days. The outcomes were comparable on pairwise testing against surgical risk models, although TAVR-RS was on verge of significance when compared to STS PROM. This study supports the current dogma that a risk model specifically tailored for TAVR population should be implemented to obtain a better patient selection. © 2017, Wiley Periodicals, Inc.

  12. Risk factors for prolonged mechanical ventilation after total aortic arch replacement for acute DeBakey type I aortic dissection.

    PubMed

    Li, Cheng-Nan; Chen, Lei; Ge, Yi-Peng; Zhu, Jun-Ming; Liu, Yong-Min; Zheng, Jun; Liu, Wei; Ma, Wei-Guo; Sun, Li-Zhong

    2014-09-01

    EuroSCORE II is an objective risk scoring model. The aim of this study was to assess the performance of EuroSCORE II in the prediction of prolonged mechanical ventilation following total aortic arch replacement for acute DeBakey type I aortic dissection and evaluate the risk factors for prolonged mechanical ventilation. Between February 2009 to February 2012, data from 240 patients who underwent total aortic arch replacement for acute DeBakey type I aortic dissection were collected retrospectively. Mechanical ventilation after the surgery longer than 48 hours was defined as postoperative prolonged mechanical ventilation. EuroSCORE II was applied to predict prolonged mechanical ventilation. A C statistic (receiver operating characteristic curve) was used to test discrimination of the model. Calibration was assessed with a Hosmer-Lemeshow goodness-of-fit statistic. Multiple logistic regression analysis was used to identify the final risk factors of prolonged mechanical ventilation. The overall mortality was 10%. The mean length of mechanical ventilation after total aortic arch replacement was 42.72 ± 51.45 hours. Total 74 patients needed prolonged mechanical ventilation. EuroSCORE II showed poor discriminatory ability (C statistic 0.52) and calibration (Hosmer-Lemeshow, p<0.05) in predicting prolonged mechanical ventilation. On multivariate analysis, independent risk factors for postoperative prolonged mechanical ventilation were age ≥ 48.5 years (p<0.001, OR=3.85), preoperative leukocyte count ≥ 13.5 × 10⁹/L (p<0.001, OR=4.05) and symptom onset before the surgery less than one week (p=0.002, OR=3.75). EuroSCORE II could not predict prolonged mechanical ventilation following total aortic arch replacement for acute DeBakey type I aortic dissection. Preoperative high level of leukocyte, age and surgical period from symptom onset are risk factors for prolonged mechanical ventilation. Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic

  13. Preoperative Risk Levels and Vascular Access in Transcatheter Aortic Valve Implantation-A Single-Institute Analysis.

    PubMed

    Kawaguchi, Akira T; Collet, Jean Philippe; Cluzel, Philippe; Makri, Ralouka; Laali, Mojgan; DeFrance, Catherine; Furuya, Hiroyuki; Murakami, Akira; Leprince, Pascal

    2017-02-01

    Although transcatheter aortic valve implantation (TAVI) has been indicated for patients with high surgical risk, indications for or against the procedure become more difficult as vascular access becomes more proximal and/or invasive in order to accommodate patients with even higher risks. We compared preoperative factors including the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and Society of Thoracic Surgeons Predicted Risk of Mortality (STS) score with postoperative survival in 195 patients undergoing TAVI during 2.5 years (January 2010 to June 2012), when vascular access routes were developed from iliofemoral (IL/Fm access, n = 149), axillo-clavicular, apical, and direct aortic approaches (alternative access, n = 46). Logistic regression analyses showed that alternative access was associated with reduced 30-day survival (P = 0.024), while high surgical risk (>15% in both EuroSCORE and STS score) was associated with reduced 1-year survival (P = 0.046). Thus, patients treated via IL/Fm access had acceptable outcome regardless of preoperative risk levels while patients with low surgical risk (<15%) had favorable outcome irrespective of access route. Since the remaining patients with combined risk factors, high preoperative risk level (>15%) requiring alternative access, had a prohibitive risk in our experience, they might have been considered untreatable or not amenable even to TAVI and offered medical or alternative managements.

  14. Software design for professional risk evaluation

    NASA Astrophysics Data System (ADS)

    Ionescu, V.; Calea, G.; Amza, G.; Iacobescu, G.; Nitoi, D.; Dimitrescu, A.

    2016-08-01

    Professional risk evaluation represents a complex activity involving each economic operator, with important repercussion upon health and security in work. Article represents an innovative study method, regarding professional risk analyze in which cumulative working posts are evaluated. Work presents a new software that helps in putting together all the working positions from a complex organizational system and analyzing them in order to evaluate the possible risks. Using this software, a multiple analysis can be done like: risk estimation, risk evaluation, estimation of residual risks and finally searching of risk reduction measures.

  15. Changes in quality of life associated with surgical risk in elderly patients undergoing cardiac surgery.

    PubMed

    Romero, Paola Severo; de Souza, Emiliane Nogueira; Rodrigues, Juliane; Moraes, Maria Antonieta

    2015-10-01

    The study aims to verify quality of life of elderly patients submitted to cardiac surgery, and correlating surgical risk to health-related quality of life instrument domains. Prospective cohort study, performed at a cardiology hospital. It included elderly patients who had undergone elective cardiac surgery. Pre- and postoperative quality of life was evaluated by applying the World Health Organization Quality of Life-Old (WHOQOL-OLD) scale and the Short-Form Health Survey (SF-36) questionnaire. Surgical risk was stratified using the European System for Cardiac Operative Risk Evaluation (EuroSCORE). Fifty-four patients, mostly men (64.8%), were included, with a mean age of 69.3 ± 5.7 years. The eight domains of the SF-36 questionnaire, and the four facets presented for the WHOQOL-OLD scale showed improved quality of life 6 months after surgery (P < 0.001). No difference was found in the association of EuroSCORE with the domains of the health-related quality of life instruments. The data showed improved quality of life of elderly people submitted to cardiac surgery, unrelated to surgical risk. © 2014 Wiley Publishing Asia Pty Ltd.

  16. Probabilistic Approaches for Evaluating Space Shuttle Risks

    NASA Technical Reports Server (NTRS)

    Vesely, William

    2001-01-01

    The objectives of the Space Shuttle PRA (Probabilistic Risk Assessment) are to: (1) evaluate mission risks; (2) evaluate uncertainties and sensitivities; (3) prioritize contributors; (4) evaluate upgrades; (5) track risks; and (6) provide decision tools. This report discusses the significance of a Space Shuttle PRA and its participants. The elements and type of losses to be included are discussed. The program and probabilistic approaches are then discussed.

  17. LSST Painting Risk Evaluation Memo

    SciTech Connect

    Wolfe, Justin E.

    2016-11-10

    The optics subsystem is required to paint the edges of optics black where possible. Due to the risks in applying the paint LSST requests a review of the impact of removing this requirement for the filters and L3.

  18. Prevalence of post-operative morbidity risk factors following cardiac surgery in patients with chronic viral hepatitis: a retrospective study.

    PubMed

    Hsieh, W C; Chen, P C; George, G; Tinica, G; Corciova, F-C

    2015-01-01

    Current cardiac risk assessments such as EuroSCORE II and the STS-Score do not take liver dysfunction into account. The purpose of this study was to evaluate the prevalence and post-operative morbidity risk factors following cardiac surgery of patients with chronic viral hepatitis. The study group consisted of 105 patients with documented chronic viral hepatitis who were subject to elective cardiac surgery from 2001 to 2012. Subjects were evaluated for pre-operative liver dysfunction according to the MELD score. The average MELD score of the study group was 10.00 ± 6.00. The average EuroSCORE ii of the study group was 2.07% ± 1.62%. The primary post-operative complication was cardiac complications (n=57, 54.3%). Analysis showed significant differences in meld score, bilirubin and smoking. Multivariate logistic regression analysis showed that the variables entering into the model included such risk factors with a significant or near significant (p < 0.2) influence on hospital morbidity and consisted in valve vs. coronary artery disease, valve/cad, aortic valve replacement vs. Coronary artery bypass graft, and bilirubin (mg/dl). it is vital that liver dysfunction is added to the risk models which are currently utilized to predict the post-operative morbidity of cardiac surgery patients.

  19. Evaluation of protective action risks

    SciTech Connect

    Witzig, W.F.; Shillenn, J.K.

    1987-06-01

    The purpose of this study is to determine how the risks of the protective action of evacuation compare with the radiological risks from a radiation release if no protective actions are taken. Evacuation risks of death and injury have been determined by identifying from newspapers and other sources 902 possible evacuation events which occurred in the US during the period January 1, 1973 through April 30, 1986. A survey form was developed to determine evacuation risks and other information relating to the evacuation events and sent to local emergency management personnel located in the vicinity of 783 events. There were 310 completed surveys received and the data summarized. This study found that the key factors for a successful evacuation included an emergency plan, good communications and coordination, practice drills, and defined authority. Few successful evacuations used the emergency broadcasting system or warning sirens to communicate the need to evacuate. Reports of panic and traffic jams during an evacuation were very few. Traffic jams occurring during reentry were more likely than during the evacuation exodus. A summary of potential societal consequences of evacuation is included in this study. 5 refs., 9 figs., 20 tabs.

  20. Risk effectiveness evaluation of surveillance testing

    SciTech Connect

    Martorell, S.; Kim, I.S.; Samanta, P.K.; Vesely, W.E.

    1992-07-20

    In nuclear power plants surveillance tests are required to detect failures in standby safety system components as a means of assuring their availability in case of an accident. However, the performance of surveillance tests at power may have adverse impact on safety as evidenced by the operating experience of the plants. The risk associated with a test includes two different aspects: (1) a positive aspect, i.e., risk contribution detected by the test, that results from the detection of failures which occur between tests and are detected by the test, and (2) a negative aspect, i.e., risk contribution caused by the test, that includes failures and degradations which are caused by the test or are related to the performance of the test. In terms of the two different risk contributions, the risk effectiveness of a test can be simply defined as follows: a test is risk effective if the risk contribution detected by the test is greater than the risk contribution caused by the test; otherwise it is risk ineffective. The methodology presentation will focus on two important kinds of negative test risk impacts, that is, the risk impacts of test-caused transients and equipment wear-out. The evaluation results of the risk effectiveness of the test will be presented in the full paper along with the risk assessment methodology and the insights from the sensitivity analysis. These constitute the core of the NUREG/CR-5775.

  1. D & D screening risk evaluation guidance

    SciTech Connect

    Robers, S.K.; Golden, K.M.; Wollert, D.A.

    1995-09-01

    The Screening Risk Evaluation (SRE) guidance document is a set of guidelines provided for the uniform implementation of SREs performed on decontamination and decommissioning (D&D) facilities. Although this method has been developed for D&D facilities, it can be used for transition (EM-60) facilities as well. The SRE guidance produces screening risk scores reflecting levels of risk through the use of risk ranking indices. Five types of possible risk are calculated from the SRE: current releases, worker exposures, future releases, physical hazards, and criticality. The Current Release Index (CRI) calculates the current risk to human health and the environment, exterior to the building, from ongoing or probable releases within a one-year time period. The Worker Exposure Index (WEI) calculates the current risk to workers, occupants and visitors inside contaminated D&D facilities due to contaminant exposure. The Future Release Index (FRI) calculates the hypothetical risk of future releases of contaminants, after one year, to human health and the environment. The Physical Hazards Index (PHI) calculates the risks to human health due to factors other than that of contaminants. Criticality is approached as a modifying factor to the entire SRE, due to the fact that criticality issues are strictly regulated under DOE. Screening risk results will be tabulated in matrix form, and Total Risk will be calculated (weighted equation) to produce a score on which to base early action recommendations. Other recommendations from the screening risk scores will be made based either on individual index scores or from reweighted Total Risk calculations. All recommendations based on the SRE will be made based on a combination of screening risk scores, decision drivers, and other considerations, as determined on a project-by-project basis.

  2. Abandoned metal mine stability risk evaluation.

    PubMed

    Bétournay, Marc C

    2009-10-01

    The abandoned mine legacy is critical in many countries around the world, where mine cave-ins and surface subsidence disruptions are perpetual risks that can affect the population, infrastructure, historical legacies, land use, and the environment. This article establishes abandoned metal mine failure risk evaluation approaches and quantification techniques based on the Canadian mining experience. These utilize clear geomechanics considerations such as failure mechanisms, which are dependent on well-defined rock mass parameters. Quantified risk is computed using probability of failure (probabilistics using limit-equilibrium factors of safety or applicable numerical modeling factor of safety quantifications) times a consequence impact value. Semi-quantified risk can be based on failure-case-study-based empirical data used in calculating probability of failure, and personal experience can provide qualified hazard and impact consequence assessments. The article provides outlines for land use and selection of remediation measures based on risk.

  3. Evaluating Potential Health Risks in Relocatable Classrooms.

    ERIC Educational Resources Information Center

    Katchen, Mark; LaPierre, Adrienne; Charlin, Cary; Brucker, Barry; Ferguson, Paul

    2001-01-01

    Only limited data exist describing potential exposures to chemical and biological agents when using portable classrooms or outlining how to assess and reduce associated health risks. Evaluating indoor air quality involves examining ventilating rates, volatile organic compounds, and microbiologicals. Open communication among key stakeholders is…

  4. Evaluating Potential Health Risks in Relocatable Classrooms.

    ERIC Educational Resources Information Center

    Katchen, Mark; LaPierre, Adrienne; Charlin, Cary; Brucker, Barry; Ferguson, Paul

    2001-01-01

    Only limited data exist describing potential exposures to chemical and biological agents when using portable classrooms or outlining how to assess and reduce associated health risks. Evaluating indoor air quality involves examining ventilating rates, volatile organic compounds, and microbiologicals. Open communication among key stakeholders is…

  5. Risk evaluation mitigation strategies: the evolution of risk management policy.

    PubMed

    Hollingsworth, Kristen; Toscani, Michael

    2013-04-01

    The United States Food and Drug Administration (FDA) has the primary regulatory responsibility to ensure that medications are safe and effective both prior to drug approval and while the medication is being actively marketed by manufacturers. The responsibility for safe medications prior to marketing was signed into law in 1938 under the Federal Food, Drug, and Cosmetic Act; however, a significant risk management evolution has taken place since 1938. Additional federal rules, entitled the Food and Drug Administration Amendments Act, were established in 2007 and extended the government's oversight through the addition of a Risk Evaluation and Mitigation Strategy (REMS) for certain drugs. REMS is a mandated strategy to manage a known or potentially serious risk associated with a medication or biological product. Reasons for this extension of oversight were driven primarily by the FDA's movement to ensure that patients and providers are better informed of drug therapies and their specific benefits and risks prior to initiation. This article provides an historical perspective of the evolution of medication risk management policy and includes a review of REMS programs, an assessment of the positive and negative aspects of REMS, and provides suggestions for planning and measuring outcomes. In particular, this publication presents an overview of the evolution of the REMS program and its implications.

  6. Risk variables in evaluation of transport projects

    NASA Astrophysics Data System (ADS)

    Vařbuchta, Petr; Kovářová, Hana; Hromádka, Vít; Vítková, Eva

    2017-09-01

    Depending on the constantly increasing demands on assessment of investment projects, especially assessment of large-scale projects in transport and important European projects with wide impacts, there is constantly increasing focus on risk management, whether to find mitigations, creating corrective measures or their implementation in assessment, especially in the context of Cost-Benefit analysis. To project assessment is often used implementation of certain risk variables, which can generate negative impacts of project outputs in framework of assess. Especially in case of transportation infrastructure projects is taken much emphasis on the influence of risk variables. However, currently in case of assessment of transportation projects is in Czech Republic used a few risk variables, which occur in the most projects. This leads to certain limitation in framework of impact assessment of risk variables. This papers aims to specify a new risk variables and process of applying them to already executed project assessment. Based on changes generated by new risk variables will be evaluated differences between original and adapted assessment.

  7. Two criteria for evaluating risk prediction models.

    PubMed

    Pfeiffer, R M; Gail, M H

    2011-09-01

    We propose and study two criteria to assess the usefulness of models that predict risk of disease incidence for screening and prevention, or the usefulness of prognostic models for management following disease diagnosis. The first criterion, the proportion of cases followed PCF (q), is the proportion of individuals who will develop disease who are included in the proportion q of individuals in the population at highest risk. The second criterion is the proportion needed to follow-up, PNF (p), namely the proportion of the general population at highest risk that one needs to follow in order that a proportion p of those destined to become cases will be followed. PCF (q) assesses the effectiveness of a program that follows 100q% of the population at highest risk. PNF (p) assess the feasibility of covering 100p% of cases by indicating how much of the population at highest risk must be followed. We show the relationship of those two criteria to the Lorenz curve and its inverse, and present distribution theory for estimates of PCF and PNF. We develop new methods, based on influence functions, for inference for a single risk model, and also for comparing the PCFs and PNFs of two risk models, both of which were evaluated in the same validation data.

  8. Gasbuggy Site Assessment and Risk Evaluation

    SciTech Connect

    2011-03-01

    This report describes the geologic and hydrologic conditions and evaluates potential health risks to workers in the natural gas industry in the vicinity of the Gasbuggy, New Mexico, site, where the U.S. Atomic Energy Commission detonated an underground nuclear device in 1967. The 29-kiloton detonation took place 4,240 feet below ground surface and was designed to evaluate the use of a nuclear detonation to enhance natural gas production from the Pictured Cliffs Formation in the San Juan Basin, Rio Arriba County, New Mexico, on land administered by Carson National Forest. A site-specific conceptual model was developed based on current understanding of the hydrologic and geologic environment. This conceptual model was used for establishing plausible contaminant exposure scenarios, which were then evaluated for human health risk potential. The most mobile and, therefore, the most probable contaminant that could result in human exposure is tritium. Natural gas production wells were identified as having the greatest potential for bringing detonation-derived contaminants (tritium) to the ground surface in the form of tritiated produced water. Three exposure scenarios addressing potential contamination from gas wells were considered in the risk evaluation: a gas well worker during gas-well-drilling operations, a gas well worker performing routine maintenance, and a residential exposure. The residential exposure scenario was evaluated only for comparison; permanent residences on national forest lands at the Gasbuggy site are prohibited

  9. Preoperative Evaluation: Estimation of Pulmonary Risk.

    PubMed

    Lakshminarasimhachar, Anand; Smetana, Gerald W

    2016-03-01

    Postoperative pulmonary complications (PPCs) are common after major non-thoracic surgery and associated with significant morbidity and high cost of care. A number of risk factors are strong predictors of PPCs. The overall goal of the preoperative pulmonary evaluation is to identify these potential, patient and procedure-related risks and optimize the health of the patients before surgery. A thorough clinical examination supported by appropriate laboratory tests will help guide the clinician to provide optimal perioperative care. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Modified risk evaluation method. Revision 1

    SciTech Connect

    Udell, C.J.; Tilden, J.A.; Toyooka, R.T.

    1993-08-01

    The purpose of this paper is to provide a structured and cost-oriented process to determine risks associated with nuclear material and other security interests. Financial loss is a continuing concern for US Department of Energy contractors. In this paper risk is equated with uncertainty of cost impacts to material assets or human resources. The concept provides a method for assessing the effectiveness of an integrated protection system, which includes operations, safety, emergency preparedness, and safeguards and security. The concept is suitable for application to sabotage evaluations. The protection of assets is based on risk associated with cost impacts to assets and the potential for undesirable events. This will allow managers to establish protection priorities in terms of the cost and the potential for the event, given the current level of protection.

  11. Risk evaluation: A cost-oriented approach

    SciTech Connect

    Rogers, B.H.

    1998-02-03

    This method provides a structured and cost-oriented way to determine risks associated with loss and destruction of industrial security interests consisting of material assets and human resources. Loss and destruction are assumed to be adversary perpetrated, high-impact events in which the health and safety of people or high-value property is at risk. This concept provides a process for: (1) assessing effectiveness of all integrated protection system, which includes facility operations, safety, emergency and security systems, and (2) a qualitative prioritization scheme to determine the level of consequence relative to cost and subsequent risk. The method allows managers the flexibility to establish asset protection appropriate to programmatic requirements and priorities and to decide if funding is appropriate. The evaluation objectives are to: (1) provide for a systematic, qualitative tabletop process to estimate the potential for an undesirable event and its impact; and (2) identify ineffective protection and cost-effective solutions.

  12. Credit risk evaluation based on social media.

    PubMed

    Yang, Yang; Gu, Jing; Zhou, Zongfang

    2016-07-01

    Social media has been playing an increasingly important role in the sharing of individuals' opinions on many financial issues, including credit risk in investment decisions. This paper analyzes whether these opinions, which are transmitted through social media, can accurately predict enterprises' future credit risk. We consider financial statements oriented evaluation results based on logit and probit approaches as the benchmarks. We then conduct textual analysis to retrieve both posts and their corresponding commentaries published on two of the most popular social media platforms for financial investors in China. Professional advice from financial analysts is also investigated in this paper. We surprisingly find that the opinions extracted from both posts and commentaries surpass opinions of analysts in terms of credit risk prediction. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Evaluation of the "medication fall risk score".

    PubMed

    Yazdani, Cyrus; Hall, Scott

    2017-01-01

    Results of a study evaluating the predictive validity of a fall screening tool in hospitalized patients are reported. Administrative claims data from two hospitals were analyzed to determine the discriminatory ability of the "medication fall risk score" (RxFS), a medication review fall-risk screening tool that is designed for use in conjunction with nurse-administered tools such as the Morse Fall Scale (MFS). Through analysis of data on administered medications and documented falls in a population of adults who underwent fall-risk screening at hospital admission over a 15-month period (n = 33,058), the predictive value of admission MFS scores, alone or in combination with retrospectively calculated RxFS-based risk scores, was assessed. Receiver operating characteristic (ROC) curve analysis and net reclassification improvement (NRI) analysis were used to evaluate improvements in risk prediction with the addition of RxFS data to the prediction model. The area under the ROC curve for the predictive model for falls compromising both MFS and RxFS scores was computed as 0.8014, which was greater than the area under the ROC curve associated with use of the MFS alone (0.7823, p = 0.0030). Screening based on MFS scores alone had 81.25% sensitivity and 61.37% specificity. Combined use of RxFS and MFS scores resulted in 82.42% sensitivity and 66.65% specificity (NRI = 0.0587, p = 0.0003). Reclassification of fall risk based on coadministration of the MFS and the RxFS tools resulted in a modest improvement in specificity without compromising sensitivity. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  14. [Evaluating individual occupational risk in teachers].

    PubMed

    Stepanov, E G; Ishmukhametov, I B

    2012-01-01

    The authors analyzed work conditions of comprehensive school teachers according to workplace assessment. Additional studies covered opportunistic pathogens content of air in classrooms. Auxiliary medical examination evaluated health state of the teachers. Individual occupational risk was calculated with consideration of actual work conditions and health state. Comprehensive school teacher's work is characterized by constant or transitory influence by complex of occupational and work hazards that are mostly (according to to workplace assessment) increased work intensity, noise and inadequate illumination parameters. Ambient air of classrooms constantly contains high number of opportunistic pathogens, that could decrease immune system parameters and cause more droplet infections. Individual occupational risk of teachers, calculated with consideration of work conditions and health state parameters, appears to be high and proves high possibility of teachers' health damage at work. Recommendations cover evaluation of biologic factors within the workplace assessment, obligatory preliminary (before employment) and periodic medical examinations for comprehensive school teachers as for workers exposed to occupational hazards.

  15. [Evaluation of noise risk in roadmen].

    PubMed

    Giorgianni, C; Trimboli, K; Tanzariello, G; Fontana, G; Abbate, S; Callipari, S; Galtieri, G

    2007-01-01

    The activity of roadman is not much knowed. The evalutation of the risk evidences the noise and vibrations as the principal polluter. The aim of our study is to go into the knowledge of the working risk of that job. The study was leaded on a sample of 287 roadmen. It was carried out an evalutation of noise exposure of the workers and a biologic evaluation that included: Medical check. Othorhin.laryngoiatric examination. Audiometric examination. Impedenzometric examination. The audiometric exam was conduced in a silent box and with a acoustic rest at least 16 h. The audiometric test were classified in conformity with Merluzzi-Pira-Bosio method. The phonometric evaluations point out, in roadmans examinated, hight exposure to noise with mean Lep d > 90 db. Biological evaluation, through medical check, showed data similar with that of a general group homogeneous for age and sex. Audiometric evaluation showed a noise acoustic trama in 60% of sample. Inpedenzometric exam confirmed the absence of transmissive damage in almost whole sample. In conclusion we can adfirm that noise is a strong factor for roadmen, with evident damage to exposed workers.

  16. Veterinary drugs: disposition, biotransformation and risk evaluation.

    PubMed

    Fink-Gremmels, J; van Miert, A S

    1994-12-01

    Veterinary drugs may only be produced, distributed and administered after being licensed. This implies that, prior to marketing, a critical evaluation of the pharmaceutical quality, the clinical efficacy and the over-all pharmacological and toxicological properties of the active substances will be performed by national and/or supranational authorities. However, despite a sophisticated legal (harmonized) framework, a number of factors involved in residue formation and safety assessment remain unpredictable or dependant on the current 'state of the art' in the understanding of molecular pharmacology and toxicology. For example, drug disposition and residue formation in the target animal species may be influenced by a broad variety of physiological parameters including age, sex and diet, as well as by pathological conditions especially the acute phase response to infection. These factors affect both drug disposition and metabolite formation. Furthermore, current thinking in toxicological risk assessment is influenced by recent developments in molecular toxicology and thus by an increased but still incomplete understanding of the interaction of a toxic compound with the living organism. General recognized principles in the evaluation of potential toxicants are applied in the recommendation of withdrawal times and the establishment of maximum residue limits (MRL values). Apart from toxicological-based assessment, increasing awareness is directed to other than toxicological responses, especially the potential risk of effects of antimicrobial residues on human gastrointestinal microflora. Thus, the methodology of risk assessment is discussed in the context of the recently established legal framework within the European Union.

  17. Febrile seizures: risks, evaluation, and prognosis.

    PubMed

    Graves, Reese C; Oehler, Karen; Tingle, Leslie E

    2012-01-15

    Febrile seizures are common in the first five years of life, and many factors that increase seizure risk have been identified. Initial evaluation should determine whether features of a complex seizure are present and identify the source of fever. Routine blood tests, neuroimaging, and electroencephalography are not recommended, and lumbar puncture is no longer recommended in patients with uncomplicated febrile seizures. In the unusual case of febrile status epilepticus, intravenous lorazepam and buccal midazolam are first-line agents. After an initial febrile seizure, physicians should reassure parents about the low risk of long-term effects, including neurologic sequelae, epilepsy, and death. However, there is a 15 to 70 percent risk of recurrence in the first two years after an initial febrile seizure. This risk is increased in patients younger than 18 months and those with a lower fever, short duration of fever before seizure onset, or a family history of febrile seizures. Continuous or intermittent antiepileptic or antipyretic medication is not recommended for the prevention of recurrent febrile seizures.

  18. [Thermal comfort in perioperatory risk's evaluation].

    PubMed

    Masia, M D; Dettori, M; Liperi, G; Deriu, G M; Posadino, S; Maida, G; Mura, I

    2009-01-01

    Studies till now conducted about operating rooms' microclimate have been focused mainly on operators' thermal comfort, considering that uneasiness conditions may compromise their working performance. In last years, nevertheless, the anesthesiologic community recalled attention on patients' risks determined by perioperatory variations of normothermia, underlining the necessity of orientating studies to individuate microclimate characteristics act to guarantee thermal comfort of the patient too. Looking at these considerations, a study has been conducted in the operating rooms of the hospital-university Firm and the n.1 USL of Sassari, finalized, on one hand, to determinate microclimate characteristics of the operating blocks and to evaluate operators' and patients' thermal comfort, on the other to individuate, through a software simulation, microclimate conditions that ensure contemporarily thermal comfort for both the categories. Results confirm the existence of a thermal "gap" among operators and patients, these last constantly submitted to "cold-stress", sometimes very accentuated. So, we underline microclimate's importance in operating rooms, because there are particular situations that can condition perioperatory risks. Moreover it can be useful to integrate risk's classes of the American Society of Anestesiology (ASA) with a score attributed to the PMV/PPD variation, reaching more real operatory risk indicators.

  19. Gasbuggy Site Assessment and Risk Evaluation

    SciTech Connect

    2011-03-01

    The Gasbuggy site is in northern New Mexico in the San Juan Basin, Rio Arriba County (Figure 1-1). The Gasbuggy experiment was designed to evaluate the use of a nuclear detonation to enhance natural gas production from the Pictured Cliffs Formation, a tight, gas-bearing sandstone formation. The 29-kiloton-yield nuclear device was placed in a 17.5-inch wellbore at 4,240 feet (ft) below ground surface (bgs), approximately 40 ft below the Pictured Cliffs/Lewis shale contact, in an attempt to force the cavity/chimney formed by the detonation up into the Pictured Cliffs Sandstone. The test was conducted below the southwest quarter of Section 36, Township 29 North, Range 4 West, New Mexico Principal Meridian. The device was detonated on December 10, 1967, creating a 335-ft-high chimney above the detonation point and a cavity 160 ft in diameter. The gas produced from GB-ER (the emplacement and reentry well) during the post-detonation production tests was radioactive and diluted, primarily by carbon dioxide. After 2 years, the energy content of the gas had recovered to 80 percent of the value of gas in conventionally developed wells in the area. There is currently no technology capable of remediating deep underground nuclear detonation cavities and chimneys. Consequently, the U.S. Department of Energy (DOE) must continue to manage the Gasbuggy site to ensure that no inadvertent intrusion into the residual contamination occurs. DOE has complete control over the 1/4 section (160 acres) containing the shot cavity, and no drilling is permitted on that property. However, oil and gas leases are on the surrounding land. Therefore, the most likely route of intrusion and potential exposure would be through contaminated natural gas or contaminated water migrating into a producing natural gas well outside the immediate vicinity of ground zero. The purpose of this report is to describe the current site conditions and evaluate the potential health risks posed by the most plausible

  20. Production Risk Evaluation Program (PREP) - summary

    SciTech Connect

    Kjeldgaard, E.A.; Saloio, J.H.; Vannoni, M.G.

    1997-03-01

    Nuclear weapons have been produced in the US since the early 1950s by a network of contractor-operated Department of Energy (DOE) facilities collectively known as the Nuclear Weapon Complex (NWC). Recognizing that the failure of an essential process might stop weapon production for a substantial period of time, the DOE Albuquerque Operations office initiated the Production Risk Evaluation Program (PREP) at Sandia National Laboratories (SNL) to assess quantitatively the potential for serious disruptions in the NWC weapon production process. PREP was conducted from 1984-89. This document is an unclassified summary of the effort.

  1. Designs for Risk Evaluation and Management

    SciTech Connect

    2015-12-01

    The Designs for Risk Evaluation and Management (DREAM) tool was developed as part of the effort to quantify the risk of geologic storage of carbon dioxide (CO2) under the U.S. Department of Energy's National Risk Assessment Partnership (NRAP). DREAM is an optimization tool created to identify optimal monitoring schemes that minimize the time to first detection of CO2 leakage from a subsurface storage formation. DREAM acts as a post-processer on user-provided output from subsurface leakage simulations. While DREAM was developed for CO2 leakage scenarios, it is applicable to any subsurface leakage simulation of the same output format. The DREAM tool is comprised of three main components: (1) a Java wizard used to configure and execute the simulations, (2) a visualization tool to view the domain space and optimization results, and (3) a plotting tool used to analyze the results. A secondary Java application is provided to aid users in converting common American Standard Code for Information Interchange (ASCII) output data to the standard DREAM hierarchical data format (HDF5). DREAM employs a simulated annealing approach that searches the solution space by iteratively mutating potential monitoring schemes built of various configurations of monitoring locations and leak detection parameters. This approach has proven to be orders of magnitude faster than an exhaustive search of the entire solution space. The user's manual illustrates the program graphical user interface (GUI), describes the tool inputs, and includes an example application.

  2. Evaluation of residue drum storage safety risks

    SciTech Connect

    Conner, W.V.

    1994-06-17

    A study was conducted to determine if any potential safety problems exist in the residue drum backlog at the Rocky Flats Plant. Plutonium residues stored in 55-gallon drums were packaged for short-term storage until the residues could be processed for plutonium recovery. These residues have now been determined by the Department of Energy to be waste materials, and the residues will remain in storage until plans for disposal of the material can be developed. The packaging configurations which were safe for short-term storage may not be safe for long-term storage. Interviews with Rocky Flats personnel involved with packaging the residues reveal that more than one packaging configuration was used for some of the residues. A tabulation of packaging configurations was developed based on the information obtained from the interviews. A number of potential safety problems were identified during this study, including hydrogen generation from some residues and residue packaging materials, contamination containment loss, metal residue packaging container corrosion, and pyrophoric plutonium compound formation. Risk factors were developed for evaluating the risk potential of the various residue categories, and the residues in storage at Rocky Flats were ranked by risk potential. Preliminary drum head space gas sampling studies have demonstrated the potential for formation of flammable hydrogen-oxygen mixtures in some residue drums.

  3. Designs for Risk Evaluation and Management

    SciTech Connect

    2015-12-01

    The Designs for Risk Evaluation and Management (DREAM) tool was developed as part of the effort to quantify the risk of geologic storage of carbon dioxide (CO2) under the U.S. Department of Energy’s National Risk Assessment Partnership (NRAP). DREAM is an optimization tool created to identify optimal monitoring schemes that minimize the time to first detection of CO2 leakage from a subsurface storage formation. DREAM acts as a post-processer on user-provided output from subsurface leakage simulations. While DREAM was developed for CO2 leakage scenarios, it is applicable to any subsurface leakage simulation of the same output format. The DREAM tool is comprised of three main components: (1) a Java wizard used to configure and execute the simulations, (2) a visualization tool to view the domain space and optimization results, and (3) a plotting tool used to analyze the results. A secondary Java application is provided to aid users in converting common American Standard Code for Information Interchange (ASCII) output data to the standard DREAM hierarchical data format (HDF5). DREAM employs a simulated annealing approach that searches the solution space by iteratively mutating potential monitoring schemes built of various configurations of monitoring locations and leak detection parameters. This approach has proven to be orders of magnitude faster than an exhaustive search of the entire solution space. The user’s manual illustrates the program graphical user interface (GUI), describes the tool inputs, and includes an example application.

  4. Medication Exposure in Pregnancy Risk Evaluation Program.

    PubMed

    Andrade, Susan E; Davis, Robert L; Cheetham, T Craig; Cooper, William O; Li, De-Kun; Amini, Thushi; Beaton, Sarah J; Dublin, Sascha; Hammad, Tarek A; Pawloski, Pamala A; Raebel, Marsha A; Smith, David H; Staffa, Judy A; Toh, Sengwee; Dashevsky, Inna; Haffenreffer, Katherine; Lane, Kimberly; Platt, Richard; Scott, Pamela E

    2012-10-01

    To describe a program to study medication safety in pregnancy, the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP). MEPREP is a multi-site collaborative research program developed to enable the conduct of studies of medication use and outcomes in pregnancy. Collaborators include the U.S. Food and Drug Administration and researchers at the HMO Research Network, Kaiser Permanente Northern and Southern California, and Vanderbilt University. Datasets have been created at each site linking healthcare data for women delivering an infant between January 1, 2001 and December 31, 2008 and infants born to these women. Standardized data files include maternal and infant characteristics, medication use, and medical care at 11 health plans within 9 states; birth certificate data were obtained from the state departments of public health. MEPREP currently involves more than 20 medication safety researchers and includes data for 1,221,156 children delivered to 933,917 mothers. Current studies include evaluations of the prevalence and patterns of use of specific medications and a validation study of data elements in the administrative and birth certificate data files. MEPREP can support multiple studies by providing information on a large, ethnically and geographically diverse population. This partnership combines clinical and research expertise and data resources to enable the evaluation of outcomes associated with medication use during pregnancy.

  5. Medication Exposure in Pregnancy Risk Evaluation Program

    PubMed Central

    Andrade, Susan E.; Davis, Robert L.; Cheetham, T. Craig; Cooper, William O.; Li, De-Kun; Amini, Thushi; Beaton, Sarah J.; Dublin, Sascha; Hammad, Tarek A.; Pawloski, Pamala A.; Raebel, Marsha A.; Smith, David H.; Staffa, Judy A.; Toh, Sengwee; Dashevsky, Inna; Haffenreffer, Katherine; Lane, Kimberly; Platt, Richard; Scott, Pamela E.

    2011-01-01

    To describe a program to study medication safety in pregnancy, the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP). MEPREP is a multi-site collaborative research program developed to enable the conduct of studies of medication use and outcomes in pregnancy. Collaborators include the U.S. Food and Drug Administration and researchers at the HMO Research Network, Kaiser Permanente Northern and Southern California, and Vanderbilt University. Datasets have been created at each site linking healthcare data for women delivering an infant between January 1, 2001 and December 31, 2008 and infants born to these women. Standardized data files include maternal and infant characteristics, medication use, and medical care at 11 health plans within 9 states; birth certificate data were obtained from the state departments of public health. MEPREP currently involves more than 20 medication safety researchers and includes data for 1,221,156 children delivered to 933,917 mothers. Current studies include evaluations of the prevalence and patterns of use of specific medications and a validation study of data elements in the administrative and birth certificate data files. MEPREP can support multiple studies by providing information on a large, ethnically and geographically diverse population. This partnership combines clinical and research expertise and data resources to enable the evaluation of outcomes associated with medication use during pregnancy. PMID:22002179

  6. The Children, Youth, and Families at Risk (CYFAR) Evaluation Collaboration.

    ERIC Educational Resources Information Center

    Marek, Lydia I.; Byrne, Richard A. W.; Marczak, Mary S.; Betts, Sherry C.; Mancini, Jay A.

    1999-01-01

    The Cooperative Extension Service's Children, Youth, and Families at Risk initiative is being assessed by the Evaluation Collaboration's three projects: state-strengthening evaluation project (resources to help states evaluate community programs); NetCon (evaluation of electronic and other networks); and National Youth at Risk Sustainability Study…

  7. Evaluating Process Effectiveness to Reduce Risk

    NASA Technical Reports Server (NTRS)

    Shepherd, Christena C.

    2017-01-01

    security; loss of confidence in government; failure of publicly funded projects; damage to the environment; ethics violations, and the list goes on; with local, national and even international consequences. The Plan-Do-Check-Act process, also known as the "process approach" can be used at any time to establish and standardize a process, and it can also be used to check periodically for "process creep" (i.e., informal, unauthorized changes that have occurred over time), any necessary updates and improvements. While ISO 9001 compliance is not mandated for all government agencies, if interpreted correctly, it can be useful in establishing a framework and implementing effective management systems and processes.4 Another method that can be used to evaluate effectiveness is the scorecard definitions in Mallory's Process Management Standard5 as a basis for evaluating work on the process level on effective, and continuously improved and improving processes. With processes on the lower end of the scale, agencies are vulnerable to a great many risks, with employees and managers making up many of the rules as they go, leading to the above listed negative results. Without clear guidance for nominal operations, off-nominal situations can, and do, increase the likelihood of chaos. In an increasingly technical environment, with inter-agency communication and collaboration becoming the norm, agencies need to come to grips with the fact that processes can become rapidly outdated, and that the technical community should take on an increased role in the maturation of the agency's processes. Industry has long known that effective processes are also efficient, and process improvement methods such as Kaizen, Lean, Six Sigma, 5S, and mistake proofing lead to increased productivity, improved quality, and decreased cost. Again, government agencies have different concerns, but inefficiencies and mistakes can have dire and wide reaching consequences for the public that they serve. While no one goes

  8. Evaluation of Cardiovascular Risk Scores Applied to NASA's Astronant Corps

    NASA Technical Reports Server (NTRS)

    Jain, I.; Charvat, J. M.; VanBaalen, M.; Lee, L.; Wear, M. L.

    2014-01-01

    In an effort to improve cardiovascular disease (CVD) risk prediction, this analysis evaluates and compares the applicability of multiple CVD risk scores to the NASA Astronaut Corps which is extremely healthy at selection.

  9. RISK MANAGEMENT EVALUATION FOR CONCENTRATED ANIMAL FEEDING OPERATIONS

    EPA Science Inventory

    The National Risk Management Research Laboratory (NRMRL) developed a Risk Management Evaluation (RME) to provide information needed to help plan future research in the Laboratory dealing with the environmental impact of concentrated animal feeding operations (CAFOs). Agriculture...

  10. RISK MANAGEMENT EVALUATION FOR CONCENTRATED ANIMAL FEEDING OPERATIONS

    EPA Science Inventory

    The National Risk Management Research Laboratory (NRMRL) developed a Risk Management Evaluation (RME) to provide information needed to help plan future research in the Laboratory dealing with the environmental impact of concentrated animal feeding operations (CAFOs). Agriculture...

  11. At-Risk Youth Appearance and Job Performance Evaluation

    ERIC Educational Resources Information Center

    Freeburg, Beth Winfrey; Workman, Jane E.

    2008-01-01

    The goal of this study was to identify the relationship of at-risk youth workplace appearance to other job performance criteria. Employers (n = 30; each employing from 1 to 17 youths) evaluated 178 at-risk high school youths who completed a paid summer employment experience. Appearance evaluations were significantly correlated with evaluations of…

  12. Risk Evaluation of Endocrine-Disrupting Chemicals

    PubMed Central

    Gioiosa, Laura; Palanza, Paola; vom Saal, Frederick S.

    2015-01-01

    We review here our studies on early exposure to low doses of the estrogenic endocrine-disrupting chemical bisphenol A (BPA) on behavior and metabolism in CD-1 mice. Mice were exposed in utero from gestation day (GD) 11 to delivery (prenatal exposure) or via maternal milk from birth to postnatal day 7 (postnatal exposure) to 10 µg/kg body weight/d of BPA or no BPA (controls). Bisphenol A exposure resulted in long-term disruption of sexually dimorphic behaviors. Females exposed to BPA pre- and postnatally showed increased anxiety and behavioral profiles similar to control males. We also evaluated metabolic effects in prenatally exposed adult male offspring of dams fed (from GD 9 to 18) with BPA at doses ranging from 5 to 50 000 µg/kg/d. The males showed an age-related significant change in a number of metabolic indexes ranging from food intake to glucose regulation at BPA doses below the no observed adverse effect level (5000 µg/kg/d). Consistent with prior findings, low but not high BPA doses produced significant effects for many outcomes. These findings provide further evidence of the potential risks that developmental exposure to low doses of the endocrine disrupter BPA may pose to human health, with fetuses and infants being highly vulnerable. PMID:26740806

  13. A comparison of off-pump and on-pump coronary bypass surgery in patients with low EuroSCORE

    PubMed Central

    2014-01-01

    Background The aim of the present study was to evaluate and compare postoperative short-term, mid-term and long-term outcomes of coronary artery bypass surgery performed with or without cardiopulmonary bypass in patients with a low European System for Cardiac Operative Risk Evaluation score. Methods A retrospective analysis of 478 consecutive low risk patients undergoing coronary bypass surgery between January 2002 and December 2007 was performed. Of these patients, 83 cases had undergone on-pump and 395 cases had undergone off-pump coronary bypass surgery. The patients were assessed in terms peri-operative complications, survival, mortality due to cardiac events, need for rehospitalization and repeated coronary revascularization. Results There was no significant difference between the two groups in terms of preoperative characteristics, except for chronic obstructive pulmonary disease. The number of distal anastomosis per patient was significantly lower in the off-pump group than in the on-pump group (2.66 ± 0.74 vs. 3.21 ± 0.85, p < 0.001). Early mortality rates were similar in both groups (1.01% for the off-pump group and 1.2% for the on-pump group, p = 0.687). Neurological complications were significantly lower in the off-pump group than in the on-pump group (1.1% vs. 6%, p = 0.01). The mean follow-up period was 80 ± 19.1 months (range, 3–112 months). The need for revascularization during long-term follow-up was 10.1% in the off-pump group and 7.2% in the on-pump group (p = 0.416). The 5-year survival was 95.2 ± 1.1% and 95.5 ± 2.7% in the off-pump and on-pump groups, respectively (p = 0.8), whereas the 7-year survival was 91.9 ± 1.6% and 84.7 ± 6.8% in the off-pump and on-pump groups, respectively (p = 0.274). The 5-year revascularization-free period was 89.5 ± 1.6% and 89.7 ± 3.5% in the off-pump and on-pump groups, respectively (p = 0.785). The 7-year revascularization-free period

  14. Evaluating emergency risk communications: a dialogue with the experts.

    PubMed

    Thomas, Craig W; Vanderford, Marsha L; Crouse Quinn, Sandra

    2008-10-01

    Evaluating emergency risk communications is fraught with challenges since communication can be approached from both a systemic and programmatic level. Therefore, one must consider stakeholders' perspectives, effectiveness issues, standards of evidence and utility, and channels of influence (e.g., mass media and law enforcement). Evaluation issues related to timing, evaluation questions, methods, measures, and accountability are raised in this dialogue with emergency risk communication specialists. Besides the usual evaluation competencies, evaluators in this area need to understand and work collaboratively with stakeholders and be attuned to the dynamic contextual nature of emergency risk communications. Sample resources and measures are provided here to aid in this emerging and exciting field of evaluation.

  15. Roadmap to risk evaluation and mitigation strategies (REMS) success

    PubMed Central

    Balian, John D.; Malhotra, Rachpal; Perentesis, Valerie

    2010-01-01

    Medical safety-related risk management is a rapidly evolving and increasingly important aspect of drug approval and market longevity. To effectively meet the challenges of this new era, we describe a risk management roadmap that proactively yet practically anticipates risk-management requirements, provides the foundation for enduring yet appropriately flexible risk-management practices, and leverages these techniques to efficiently and effectively utilize risk evaluation and mitigation strategies (REMS)/risk minimization programs as market access enablers. This fully integrated risk-management paradigm creates exciting opportunities for newer tools, techniques, and approaches to more successfully optimize product development, approval, and commercialization, with patients as the ultimate beneficiaries. PMID:25083193

  16. EPA's Policy on Evaluating Risk to Children

    EPA Pesticide Factsheets

    It is the policy of EPA to consider the risks to infants and children consistently and explicitly as a part of risk assessments generated during its decision making process, including the setting of standards to protect public health and the environment.

  17. USING BIOASSAYS TO EVALUATE THE PERFORMANCE OF RISK MANAGEMENT TECHNIQUES

    EPA Science Inventory

    Often, the performance of risk management techniques is evaluated by measuring the concentrations of the chemials of concern before and after risk management effoprts. However, using bioassays and chemical data provides a more robust understanding of the effectiveness of risk man...

  18. Risk Quantified Structural Design and Evaluation

    DTIC Science & Technology

    2009-09-01

    Other industries, such as nuclear power and offshore oil , have developed a risk quantification process for deciding if a given structure should be...airworthiness of an aircraft. Other industries, such as nuclear power and offshore oil , have developed a risk quantification process for deciding if...Other industries, such as nuclear power and offshore oil , offer alternatives to the current build- and-test paradigm. In both industries

  19. Consumer evaluations of food risk management quality in Europe.

    PubMed

    Van Kleef, E; Houghton, J R; Krystallis, A; Pfenning, U; Rowe, G; Van Dijk, H; Van der Lans, I A; Frewer, L J

    2007-12-01

    In developing and implementing appropriate food risk management strategies, it is important to understand how consumers evaluate the quality of food risk management practices. The aim of this study is to model the underlying psychological factors influencing consumer evaluations of food risk management quality using structural equation modeling techniques (SEM), and to examine the extent to which the influence of these factors is country-specific (comparing respondents from Denmark, Germany, Greece, Slovenia, and the United Kingdom). A survey was developed to model the factors that drive consumer evaluations of food risk management practices and their relative importance (n= 2,533 total respondents). The measurement scales included in the structural model were configurally and metrically invariant across countries. Results show that some factors appear to drive perceptions of effective food risk management in all the countries studied, such as proactive consumer protection, which was positively related to consumers' evaluation of food risk management quality, while opaque and reactive risk management was negatively related to perceived food risk management quality. Other factors appeared to apply only in certain countries. For example, skepticism in risk assessment and communication practices was negatively related to food risk management quality, particularly so in the UK. Expertise of food risk managers appeared to be a key factor in consumers' evaluation of food risk management quality in some countries. However, trust in the honesty of food risk managers did not have a significant effect on food risk management quality. From the results, policy implications for food risk management are discussed and important directions for future research are identified.

  20. Evaluating the Risks of Clinical Research: Direct Comparative Analysis

    PubMed Central

    Abdoler, Emily; Roberson-Nay, Roxann; Pine, Daniel S.; Wendler, David

    2014-01-01

    Abstract Objectives: Many guidelines and regulations allow children and adolescents to be enrolled in research without the prospect of clinical benefit when it poses minimal risk. However, few systematic methods exist to determine when research risks are minimal. This situation has led to significant variation in minimal risk judgments, raising concern that some children are not being adequately protected. To address this concern, we describe a new method for implementing the widely endorsed “risks of daily life” standard for minimal risk. This standard defines research risks as minimal when they do not exceed the risks posed by daily life activities or routine examinations. Methods: This study employed a conceptual and normative analysis, and use of an illustrative example. Results: Different risks are composed of the same basic elements: Type, likelihood, and magnitude of harm. Hence, one can compare the risks of research and the risks of daily life by comparing the respective basic elements with each other. We use this insight to develop a systematic method, direct comparative analysis, for implementing the “risks of daily life” standard for minimal risk. The method offers a way of evaluating research procedures that pose the same types of risk as daily life activities, such as the risk of experiencing anxiety, stress, or other psychological harm. We thus illustrate how direct comparative analysis can be applied in practice by using it to evaluate whether the anxiety induced by a respiratory CO2 challenge poses minimal or greater than minimal risks in children and adolescents. Conclusions: Direct comparative analysis is a systematic method for applying the “risks of daily life” standard for minimal risk to research procedures that pose the same types of risk as daily life activities. It thereby offers a method to protect children and adolescents in research, while ensuring that important studies are not blocked because of unwarranted concerns about

  1. Evaluation of effect of different membership functions on risk assessment.

    PubMed

    Atalay, Kumru Didem; Can, Gülin Feryal; Eraslan, Ergün

    2017-03-23

    This study aims to define the relationship between risk degrees and risk indexes on different functional structures with the assumption that, risk degrees may not always present linear relationship with the risk indexes. In this wise, risk indexes; suitable for expert evaluation of working conditions and computed by using three different membership functions are determined. Among the membership functions used, one of them is preferred as linear and the others are preferred as nonlinear. Additionally, a new fuzzy risk assessment (RA) algorithm is developed by using these three membership functions. With this new fuzzy RA algorithm, a more flexible and precise process becomes available, while information loss during the determination of the risk index of danger sources is prevented. As a result, nonlinear increasing membership function is selected as the most suitable one for the expression of relationship between risk degrees and risk indexes.

  2. Approaches for assessing risks to sensitive populations: Lessons learned from evaluating risks in the pediatric populations*

    EPA Science Inventory

    Assessing the risk profiles of potentially sensitive populations requires a 'tool chest' of methodological approaches to adequately characterize and evaluate these populations. At present, there is an extensive body of literature on methodologies that apply to the evaluation of...

  3. Approaches for Assessing Risks to Sensitive Populations: Lessons Learned from Evaluating Risks in the Pediatric Population

    EPA Science Inventory

    Assessing the risk profiles of potentially sensitive populations requires a "tool chest" of methodological approaches to adequately characterize and evaluate these populations. At present, there is an extensive body of literature on methodologies that apply to the evaluation of t...

  4. A Scalable Distribution Network Risk Evaluation Framework via Symbolic Dynamics

    PubMed Central

    Yuan, Kai; Liu, Jian; Liu, Kaipei; Tan, Tianyuan

    2015-01-01

    Background Evaluations of electric power distribution network risks must address the problems of incomplete information and changing dynamics. A risk evaluation framework should be adaptable to a specific situation and an evolving understanding of risk. Methods This study investigates the use of symbolic dynamics to abstract raw data. After introducing symbolic dynamics operators, Kolmogorov-Sinai entropy and Kullback-Leibler relative entropy are used to quantitatively evaluate relationships between risk sub-factors and main factors. For layered risk indicators, where the factors are categorized into four main factors – device, structure, load and special operation – a merging algorithm using operators to calculate the risk factors is discussed. Finally, an example from the Sanya Power Company is given to demonstrate the feasibility of the proposed method. Conclusion Distribution networks are exposed and can be affected by many things. The topology and the operating mode of a distribution network are dynamic, so the faults and their consequences are probabilistic. PMID:25789859

  5. Radiological risk evaluation for risk-based design criteria of the multiple canister overpack packaging

    SciTech Connect

    Green, J.R., Westinghouse Hanford

    1996-07-18

    The Multiple Canister Overpack (MCO) cask will be used in the transportation of irradiated nuclear fuel from the K Basins to a Canister Storage Building. This report presents the radiological risk evaluation, which is used in the development of the design criteria for the MCO cask. The radiological risk evaluation ensures compliance with the onsite transportation safety program.

  6. Cardiac risk evaluation for elementary school children.

    PubMed

    Purath, J; Lansinger, T; Ragheb, C

    1995-06-01

    This study examined cardiac risk factors in school-age children. Specific risk factors focused on were smoking, hypertension, elevated blood cholesterol, obesity, physical inactivity, and nutritional imbalances. All consenting students in grades one through five participated. Components of the study included screenings and a questionnaire. Children (N = 357) were screened for height/weight, resting pulse, blood pressure, cholesterol, skin-fold thickness, and fitness. The questionnaire included an assessment of family diseases and family health practices. Results showed no significant relationships between cholesterol and family history of hypercholesterolemia or coronary heart disease, cholesterol and overweight, cholesterol and amount of time students exercised and the amount of time student's mothers exercised (r = -0.25, p = .0028), cholesterol elevation and exercise (r = -0.25, p-value = 0.007), and exercise and the frequency of eating out in a restaurant (r = -0.18, p-value = 0.03).

  7. Dynamic risk factors: the Kia Marama evaluation.

    PubMed

    Hudson, Stephen M; Wales, David S; Bakker, Leon; Ward, Tony

    2002-04-01

    Risk assessment is an essential part of clinical practice. Each of the three aspects of risk (static, stable, and acute dynamic) are important at various points of contact between the man and the systems that are responsible for providing service. Dynamic factors, the typical treatment and supervision targets, have received less research attention than static factors. This paper examined the extent to which pretreatment, posttreatment and change scores were associated with reoffending among men incarcerated for sexually molesting. The results were generally supportive of change in prooffending attitudes as the key to not reoffending and suggested that the perspective-taking component of empathy and the use of fantasy may be important mechanisms. Affect scales generally failed to show any relationship with reoffending, outside decreases in trait and suppressed anger. Moreover, these data suggest that we could improve our assessments and treatment through increased sensitivity to offense pathways.

  8. Evaluating the benefits of risk prevention initiatives

    NASA Astrophysics Data System (ADS)

    Di Baldassarre, G.

    2012-04-01

    The likelihood and adverse impacts of water-related disasters, such as floods and landslides, are increasing in many countries because of changes in climate and land-use. This presentation illustrates some preliminary results of a comprehensive demonstration of the benefits of risk prevention measures, carried out within the European FP7 KULTURisk project. The study is performed by using a variety of case studies characterised by diverse socio-economic contexts, different types of water-related hazards (floods, debris flows and landslides, storm surges) and space-time scales. In particular, the benefits of state-of-the-art prevention initiatives, such as early warning systems, non-structural options (e.g. mapping and planning), risk transfer strategies (e.g. insurance policy), and structural measures, are showed. Lastly, the importance of homogenising criteria to create hazard inventories and build memory, efficient risk communication and warning methods as well as active dialogue with and between public and private stakeholders, is highlighted.

  9. A framework for risk-benefit evaluations in biomedical research.

    PubMed

    Rid, Annette; Wendler, David

    2011-06-01

    Essentially all guidelines and regulations require that biomedical research studies have an acceptable risk-benefit profile. However, these documents offer little concrete guidance for implementing this requirement and determining when it is satisfied. As a result, those charged with risk-benefit evaluations currently assess the risk-benefit profile of biomedical research studies in unsystematic ways, raising concern that some research participants are not being protected from excessive risks and that some valuable studies involving acceptable risk are being rejected. The present paper aims to address this situation by delineating the first comprehensive framework, which is based on existing guidelines and regulations as well as the relevant literature, for risk-benefit evaluations in biomedical research.

  10. Risk score for cardiac surgery in active left-sided infective endocarditis.

    PubMed

    Olmos, Carmen; Vilacosta, Isidre; Habib, Gilbert; Maroto, Luis; Fernández, Cristina; López, Javier; Sarriá, Cristina; Salaun, Erwan; Di Stefano, Salvatore; Carnero, Manuel; Hubert, Sandrine; Ferrera, Carlos; Tirado, Gabriela; Freitas-Ferraz, Afonso; Sáez, Carmen; Cobiella, Javier; Bustamante-Munguira, Juan; Sánchez-Enrique, Cristina; García-Granja, Pablo Elpidio; Lavoute, Cecile; Obadia, Benjamin; Vivas, David; Gutiérrez, Ángela; San Román, José Alberto

    2017-09-01

    To develop and validate a calculator to predict the risk of in-hospital mortality in patients with active infective endocarditis (IE) undergoing cardiac surgery. Thousand two hundred and ninety-nine consecutive patients with IE were prospectively recruited (1996-2014) and retrospectively analysed. Left-sided patients who underwent cardiac surgery (n=671) form our study population and were randomised into development (n=424) and validation (n=247) samples. Variables statistically significant to predict in-mortality were integrated in a multivariable prediction model, the Risk-Endocarditis Score (RISK-E). The predictive performance of the score and four existing surgical scores (European System for Cardiac Operative Risk Evaluation (EuroSCORE) I and II), Prosthesis, Age ≥70, Large Intracardiac Destruction, Staphylococcus, Urgent Surgery, Sex (Female) (PALSUSE), EuroSCORE ≥10) and Society of Thoracic Surgeons's Infective endocarditis score (STS-IE)) were assessed and compared in our cohort. Finally, an external validation of the RISK-E in a separate population was done. Variables included in the final model were age, prosthetic infection, periannular complications, Staphylococcus aureus or fungi infection, acute renal failure, septic shock, cardiogenic shock and thrombocytopaenia. Area under the receiver operating characteristic curve in the validation sample was 0.82 (95% CI 0.75 to 0.88). The accuracy of the other surgical scores when compared with the RISK-E was inferior (p=0.010). Our score also obtained a good predictive performance, area under the curve 0.76 (95% CI 0.64 to 0.88), in the external validation. IE-specific factors (microorganisms, periannular complications and sepsis) beside classical variables in heart surgery (age, haemodynamic condition and renal failure) independently predicted perioperative mortality in IE. The RISK-E had better ability to predict surgical mortality in patients with IE when compared with other surgical scores. © Article

  11. Evaluating microcystin exposure risk through fish consumption

    PubMed Central

    Poste, Amanda E.; Hecky, Robert E.; Guildford, Stephanie J.

    2011-01-01

    Microcystin is a cyanobacterial hepatotoxin that is found worldwide, and poses a serious threat to the ecological communities in which it is found as well as to those who rely on these waters for drinking, sanitation, or as a food source. Microcystin is known to accumulate in fish and other aquatic biota, however the prevalence of microcystin in fish tissue and the human health risks posed by microcystin exposure through fish consumption remain poorly resolved. Here we show that microcystin is pervasive in water and fish from several tropical (Ugandan) and temperate (North American) lakes, including lakes that support some of the largest freshwater fisheries in the world. We establish that fish consumption can be an important and sometimes dominant route of microcystin exposure for humans, and can cause consumers to exceed recommended total daily intake guidelines for microcystin. These results highlight the importance of monitoring microcystin concentrations in fish, and the need to consider potential exposure to microcystin through fish consumption in order to adequately assess human exposure risk. PMID:21671629

  12. Evaluating microcystin exposure risk through fish consumption.

    PubMed

    Poste, Amanda E; Hecky, Robert E; Guildford, Stephanie J

    2011-07-01

    Microcystin is a cyanobacterial hepatotoxin that is found worldwide, and poses a serious threat to the ecological communities in which it is found as well as to those who rely on these waters for drinking, sanitation, or as a food source. Microcystin is known to accumulate in fish and other aquatic biota, however the prevalence of microcystin in fish tissue and the human health risks posed by microcystin exposure through fish consumption remain poorly resolved. Here we show that microcystin is pervasive in water and fish from several tropical (Ugandan) and temperate (North American) lakes, including lakes that support some of the largest freshwater fisheries in the world. We establish that fish consumption can be an important and sometimes dominant route of microcystin exposure for humans, and can cause consumers to exceed recommended total daily intake guidelines for microcystin. These results highlight the importance of monitoring microcystin concentrations in fish, and the need to consider potential exposure to microcystin through fish consumption in order to adequately assess human exposure risk.

  13. Diagnosis and Tests: Evaluating a Fall or Risk of Falling

    MedlinePlus

    ... illnesses Your fear of falling and your mood Memory and brain functioning Risks in your home environment. Tests Your ... assess bone strength Heart assessments such as echocardiography Brain imaging such as CT ... therapy assessment A home safety evaluation. ...

  14. Credit Risk Evaluation of Power Market Players with Random Forest

    NASA Astrophysics Data System (ADS)

    Umezawa, Yasushi; Mori, Hiroyuki

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

  15. EVALUATING RISK IN OLDER ADULTS USING PHYSIOLOGICALLY BASED PHARMACOKINETIC MODELS

    EPA Science Inventory

    The rapid growth in the number of older Americans has many implications for public health, including the need to better understand the risks posed by environmental exposures to older adults. An important element for evaluating risk is the understanding of the doses of environment...

  16. EVALUATING RISK IN OLDER ADULTS USING PHYSIOLOGICALLY BASED PHARMACOKINETIC MODELS

    EPA Science Inventory

    The rapid growth in the number of older Americans has many implications for public health, including the need to better understand the risks posed by environmental exposures to older adults. An important element for evaluating risk is the understanding of the doses of environment...

  17. Evaluation of volcanic risk management in Merapi and Bromo Volcanoes

    NASA Astrophysics Data System (ADS)

    Bachri, S.; Stöetter, J.; Sartohadi, J.; Setiawan, M. A.

    2012-04-01

    Merapi (Central Java Province) and Bromo (East Java Province) volcanoes have human-environmental systems with unique characteristics, thus causing specific consequences on their risk management. Various efforts have been carried out by many parties (institutional government, scientists, and non-governmental organizations) to reduce the risk in these areas. However, it is likely that most of the actions have been done for temporary and partial purposes, leading to overlapping work and finally to a non-integrated scheme of volcanic risk management. This study, therefore, aims to identify and evaluate actions of risk and disaster reduction in Merapi and Bromo Volcanoes. To achieve this aims, a thorough literature review was carried out to identify earlier studies in both areas. Afterward, the basic concept of risk management cycle, consisting of risk assessment, risk reduction, event management and regeneration, is used to map those earlier studies and already implemented risk management actions in Merapi and Bromo. The results show that risk studies in Merapi have been developed predominantly on physical aspects of volcanic eruptions, i.e. models of lahar flows, hazard maps as well as other geophysical modeling. Furthermore, after the 2006 eruption of Merapi, research such on risk communication, social vulnerability, cultural vulnerability have appeared on the social side of risk management research. Apart from that, disaster risk management activities in the Bromo area were emphasizing on physical process and historical religious aspects. This overview of both study areas provides information on how risk studies have been used for managing the volcano disaster. This result confirms that most of earlier studies emphasize on the risk assessment and only few of them consider the risk reduction phase. Further investigation in this field work in the near future will accomplish the findings and contribute to formulate integrated volcanic risk management cycles for both

  18. Trust-level risk evaluation and risk control guidance in the NHS East of England.

    PubMed

    Card, Alan J; Ward, James R; Clarkson, P John

    2014-08-01

    In recent years, the healthcare sector has adopted the use of operational risk assessment tools to help understand the systems issues that lead to patient safety incidents. But although these problem-focused tools have improved the ability of healthcare organizations to identify hazards, they have not translated into measurable improvements in patient safety. One possible reason for this is a lack of support for the solution-focused process of risk control. This article describes a content analysis of the risk management strategies, policies, and procedures at all acute (i.e., hospital), mental health, and ambulance trusts (health service organizations) in the East of England area of the British National Health Service. The primary goal was to determine what organizational-level guidance exists to support risk control practice. A secondary goal was to examine the risk evaluation guidance provided by these trusts. With regard to risk control, we found an almost complete lack of useful guidance to promote good practice. With regard to risk evaluation, the trusts relied exclusively on risk matrices. A number of weaknesses were found in the use of this tool, especially related to the guidance for scoring an event's likelihood. We make a number of recommendations to address these concerns. The guidance assessed provides insufficient support for risk control and risk evaluation. This may present a significant barrier to the success of risk management approaches in improving patient safety.

  19. Injury risk evaluation in sport climbing.

    PubMed

    Neuhof, A; Hennig, F F; Schöffl, I; Schöffl, V

    2011-10-01

    The aim of this study was to quantify and rate acute sport climbing injuries. Acute sport climbing injuries occurring from 2002 to 2006 were retrospectively assessed with a standardized web based questionnaire. A total number of 1962 climbers reported 699 injuries, which is equivalent to 0.2 injuries per 1 000 h of sport participation. Most (74.4%) of the injuries were of minor severity rated NACA I or NACA II. Injury distribution between the upper (42.6%) and lower extremities (41.3%) was similar, with ligament injuries, contusions and fractures being the most common injury types. Years of climbing experience (p<0.01), difficulty level (p<0.01), climbing time per week during summer (p<0.01) and winter (p<0.01) months were correlated with the injury rate. Age (p<0.05 (p=0.034)), years of climbing experience (p<0.01) and average climbing level (p<0.01) were correlated to the injury severity rated through NACA scores. The risk of acute injuries per 1 000 h of sport participation in sport climbing was lower than in previous studies on general rock climbing and higher than in studies on indoor climbing. In order to perform inter-study comparisons of future studies on climbing injuries, the use of a systematic and standardized scoring system (UIAA score) is essential. © Georg Thieme Verlag KG Stuttgart · New York.

  20. Risk evaluation and monitoring in multiple sclerosis therapeutics

    PubMed Central

    Wolinsky, Jerry S; Ashton, Raymond J; Hartung, Hans-Peter; Reingold, Stephen C

    2014-01-01

    Background: Risk for multiple sclerosis (MS) disease-modifying therapies (DMT) must be assessed on an ongoing basis. Early concerns regarding the first-approved DMTs for MS have been mitigated, but recently licensed therapies have been linked to possibly greater risks. Objectives: The objective of this review is to discuss risk assessment in MS therapeutics based on an international workshop and comprehensive literature search and recommend strategies for risk assessment/monitoring. Results: Assessment and perception of therapeutic risks vary between patients, doctors and regulators. Acceptability of risk depends on the magnitude of risk and the demonstrated clinical benefits of any agent. Safety signals must be distinguishable from chance occurrences in a clinical trial and in long-term use of medications. Post-marketing research is crucial for assessing longer-term safety in large patient cohorts. Reporting of adverse events is becoming more proactive, allowing more rapid identification of risks. Communication about therapeutic risks and their relationship to clinical benefit must involve patients in shared decision making. Conclusions: It is difficult to produce a general risk-assessment algorithm for all MS therapies. Specific algorithms are required for each DMT in every treated-patient population. New and evolving risks must be evaluated and communicated rapidly to allow patients and physicians to be well informed and able to share treatment decisions. PMID:24293456

  1. Primer for evaluating ecological risk at petroleum release sites.

    PubMed

    Claff, R

    1999-02-01

    Increasingly, risk-based approaches are being used to guide decision making at sites such as service stations and petroleum product terminals, where petroleum products have been inadvertently released to the soil. For example, the API Decision Support System software, DSS, evaluates site human health risk along six different routes of exposure. The American Society for Testing and Materials' Risk-Based Corrective Action (RBCA) standard, ASTM 1739, establishes a tiered framework for evaluating petroleum release sites on the basis of human health risk. Though much of the risk assessment focus has been on human health risk, regulatory agencies recognize that protection of human health may not fully protect the environment; and EPA has developed guidance on identifying ecological resources to be protected through risk-based decision making. Not every service station or petroleum product terminal site warrants a detailed ecological risk assessment. In some cases, a simple preliminary assessment will provide sufficient information for decision making. Accordingly, the American Petroleum Institute (API) is developing a primer for site managers, to assist them in conducting this preliminary assessment, and in deciding whether more detailed ecological risk assessments are warranted. The primer assists the site manager in identifying relevant ecological receptors and habitats, in identifying chemicals and exposure pathways of concern, in developing a conceptual model of the site to guide subsequent actions, and in identifying conditions that may warrant immediate response.

  2. The evaluation of volcanic risk in the Vesuvian area

    NASA Astrophysics Data System (ADS)

    Scandone, Roberto; Arganese, Giovanni; Galdi, Flavio

    1993-11-01

    Volcanic Risk has been defined as the product: R = Value × Vulnerability × Hazard, where value is the total amount of lives or properties at risk for a volcani eruption, the vulnerability is the percentage of value at risk for a given volcanic event, and the hazard is the probability that a given area may be affected by a certain volcanic phenomenon. We used this definition to evaluate the Risk of loss of human lives for volcanic eruptions of Vesuvius. Value has been determined based on the total number of inhabitants living in areas that could be affected by an eruption. Vulnerability is based on the relative probability of deaths as a result of different volcanic phenomena (tephra fall, pyroclastic flows, etc.). Hazard is evaluated based on the absolute probability of a given phenomenon in a certain area. This last parameter is the most difficult to evaluate. We subdivided the activity of Vesuvius, that produces risk of loss of human lives, into three classes of eruptions, based on the Volcanic Explosivity Index. We assume that the events of each class are distributed according to a poissonian distribution (this is demonstrated for VEI = 3, and inferred for the other classes), so that we can evaluate the absolute probability of an eruption for each class within a given time span. We use a time window of 10 years and evaluate the probabilities of occurrence of at least one eruption for VEI = 3, 4, 5; the probability is respectively: P3 = 0.09896, P4 = 0.01748, P5 = 0.00298 We have made a hazard evaluation for the entire Vesuvian area as well as an evaluation of Volcanic Risk. The obtained map shows that the areas with higher risk are on the southern side of Vesuvius, in the coastal region where each town is characterized by an average Risk of ˜ 1000 inhabitants/10 years. The risk regularly decreases with increasing distance from the volcano. The risk is mostly due to the events with VEI = 3 and 4, as the most destructive effects of VEI = 5 are counterbalanced

  3. Seismic risk evaluation aided by IR thermography

    NASA Astrophysics Data System (ADS)

    Grinzato, E.; Cadelano, G.; Bison, P.; Petracca, A.

    2009-05-01

    Conservation of buildings in areas at seismic risk must take prevention into account. The safeguard architectonic heritage is an ambitious objective, but a priority for planning programmes at varying levels of decision making. Preservation and restoration activities must be optimized to cover a vast and widespread historical and architectonic heritage present in many countries. Masonry buildings requires an adequate level of knowledge based on the importance of structural geometry, which may include the damage, details of construction and properties of materials. For identification and classification of masonry is necessary to find shape, type and size of the elements, texture, size of mortar joints, assemblage. The recognition can be done through a visual inspection of the surface of walls, which can be examined, where is not visible, removing a layer of plaster. Thermography is an excellent tool for a fast survey and collection of vital information for this purpose, but it is extremely important define a precise procedure in the development of more efficient monitoring tools. Thermography is a non-destructive method that allows recognizing the structural damage below plaster, detecting the presence of discontinuity in masonry, for added storeys, cavity, filled openings, and repairs. Furthermore, the fast identification of subsurface state allows to select areas where other methods either more penetrating or partially destructive have to be applied. The paper reports experimental results achieved in the mainframe of the European project RECES Modiquus. The main aim of the project is to improve methods, techniques and instruments for facing antiseismic options. Both passive and active thermographic techniques have been applied in different weather conditions and time schemes. A dedicated algorithm has been developed to enhance the visibility of wall bonding.

  4. Food and Drug Administration Evaluation and Cigarette Smoking Risk Perceptions

    ERIC Educational Resources Information Center

    Kaufman, Annette R.; Waters, Erika A.; Parascandola, Mark; Augustson, Erik M.; Bansal-Travers, Maansi; Hyland, Andrew; Cummings, K. Michael

    2011-01-01

    Objectives: To examine the relationship between a belief about Food and Drug Administration (FDA) safety evaluation of cigarettes and smoking risk perceptions. Methods: A nationally representative, random-digit-dialed telephone survey of 1046 adult current cigarette smokers. Results: Smokers reporting that the FDA does not evaluate cigarettes for…

  5. Computerized Ultrasound Risk Evaluation (CURE): First Clinical Results

    NASA Astrophysics Data System (ADS)

    Duric, N.; Littrup, P.; Rama, O.; Holsapple, E.

    The Karmanos Cancer Institute has developed an ultrasound (US) tomography system, known as Computerized Ultrasound Risk Evaluation (CURE), for detecting and evaluating breast cancer, with the eventual goal of providing improved differentiation of benign masses from cancer. We report on our first clinical findings with CURE.

  6. Food and Drug Administration Evaluation and Cigarette Smoking Risk Perceptions

    ERIC Educational Resources Information Center

    Kaufman, Annette R.; Waters, Erika A.; Parascandola, Mark; Augustson, Erik M.; Bansal-Travers, Maansi; Hyland, Andrew; Cummings, K. Michael

    2011-01-01

    Objectives: To examine the relationship between a belief about Food and Drug Administration (FDA) safety evaluation of cigarettes and smoking risk perceptions. Methods: A nationally representative, random-digit-dialed telephone survey of 1046 adult current cigarette smokers. Results: Smokers reporting that the FDA does not evaluate cigarettes for…

  7. Rape prevention with college men: evaluating risk status.

    PubMed

    Stephens, Kari A; George, William H

    2009-06-01

    This study evaluates the effectiveness of a theoretically based rape prevention intervention with college men who were at high or low risk to perpetrate sexually coercive behavior. Participants (N = 146) are randomly assigned to the intervention or control group. Outcomes include rape myth acceptance, victim empathy, attraction to sexual aggression, sex-related alcohol expectancies, and behavioral indicators, measured across three time points. Positive effects are found for rape myth acceptance, victim empathy, attraction to sexual aggression, and behavioral intentions to rape. Only rape myth acceptance and victim empathy effects sustain at the 5-week follow-up. High-risk men are generally unaffected by the intervention although low-risk men produced larger effects than the entire sample. Results suggest rape prevention studies must assess risk status moderation effects to maximize prevention for high-risk men. More research is needed to develop effective rape prevention with men who are at high risk to rape.

  8. Evaluation of cluster recovery for small area relative risk models.

    PubMed

    Rotejanaprasert, Chawarat

    2014-12-01

    The analysis of disease risk is often considered via relative risk. The comparison of relative risk estimation methods with "true risk" scenarios has been considered on various occasions. However, there has been little examination of how well competing methods perform when the focus is clustering of risk. In this paper, a simulated evaluation of a range of potential spatial risk models and a range of measures that can be used for (a) cluster goodness of fit, (b) cluster diagnostics are considered. Results suggest that exceedence probability is a poor measure of hot spot clustering because of model dependence, whereas residual-based methods are less model dependent and perform better. Local deviance information criteria measures perform well, but conditional predictive ordinate measures yield a high false positive rate.

  9. Evaluation of a matrix to calculate fungicide resistance risk.

    PubMed

    Grimmer, Michael K; van den Bosch, Frank; Powers, Stephen J; Paveley, Neil D

    2014-06-01

    In the European Union, assessments of resistance risk are required by the regulatory authorities for each fungicide product and are used to guide the extent of anti-resistance strategies. This paper reports an evaluation of a widely used 'risk matrix', to determine its predictive value. Sixty-seven unique cases of fungicide resistance in Europe were identified for testing the risk assessment scheme, where each case was the first occurrence of resistance in a pathogen species against a fungicide group. In most cases, high-, moderate- and low-risk categories for fungicide, pathogen and agronomic systems were each associated with significant differences in the number of years from fungicide introduction to the first detection of resistance (FDR time). The combined risk, calculated by multiplying the individual risk factors using the risk matrix, had useful predictive power (72.8% of FDR time variance accounted for; VAF) for all fungicides, but only limited predictive power (25.8% VAF) for single-site acting fungicides (the predominant type). The resistance risk matrix has significant, but limited, predictive value. New fungicide modes of action, or pathogens that have become newly prevalent, cannot be assigned to risk categories until new methods of resistance risk assessment are developed. © 2013 Society of Chemical Industry.

  10. Risk assessment for transboundary rivers using fuzzy synthetic evaluation technique

    NASA Astrophysics Data System (ADS)

    Rai, Subash P.; Sharma, Nayan; Lohani, A. K.

    2014-11-01

    Large scale urbanization has resulted in greater withdrawals of shared waters and this withdrawal has been largely dependent on the hegemony of the riparian's. The last few decades has seen the upward surge of many countries in terms of development as well as hegemony. Existing structures of established water sharing framework typically evaluate only parameters related to historic water use such as historic water demand and supply, contribution to flow, and hydrology. Water conflicts and cooperation is affected by various issues related with development and hegemony. Characterization and quantification of development and hegemony parameters is a very complex process. This paper establishes a novel approach to predict river basins at risk; the approach addresses the issue of water conflict and cooperation within a methodologically more rigorous predictive framework. Fuzzy synthetic evaluation technique is used in this paper to undertake the risk assessment of international transboundary rivers. In this paper the fuzzy domain of risk consists of two fuzzy sets - hegemony and development, indices of which are developed with the help of fuzzy synthetic evaluation techniques. Then the compositional rule-base is framed to ascertain the fuzzy risk. This fuzzy risk can be further used to prioritize all the international river basins which can help in the identification of potentially high risk basins. Risk identification of international river basins is not only scientifically valuable, but also practically highly useful. Identifying those basins that are likely to be particularly prone to conflict or cooperation is of high interest to policy makers.

  11. Development and evaluation of a genetic risk score for obesity.

    PubMed

    Belsky, Daniel W; Moffitt, Terrie E; Sugden, Karen; Williams, Benjamin; Houts, Renate; McCarthy, Jeanette; Caspi, Avshalom

    2013-01-01

    Multi-locus profiles of genetic risk, so-called "genetic risk scores," can be used to translate discoveries from genome-wide association studies into tools for population health research. We developed a genetic risk score for obesity from results of 16 published genome-wide association studies of obesity phenotypes in European-descent samples. We then evaluated this genetic risk score using data from the Atherosclerosis Risk in Communities (ARIC) cohort GWAS sample (N = 10,745, 55% female, 77% white, 23% African American). Our 32-locus GRS was a statistically significant predictor of body mass index (BMI) and obesity among ARIC whites [for BMI, r = 0.13, p<1 × 10(-30); for obesity, area under the receiver operating characteristic curve (AUC) = 0.57 (95% CI 0.55-0.58)]. The GRS predicted differences in obesity risk net of demographic, geographic, and socioeconomic information. The GRS performed less well among African Americans. The genetic risk score we derived from GWAS provides a molecular measurement of genetic predisposition to elevated BMI and obesity.[Supplemental materials are available for this article. Go to the publisher's online edition of Biodemography and Social Biology for the following resource: Supplement to Development & Evaluation of a Genetic Risk Score for Obesity.].

  12. Evaluation of Enhanced Risk Monitors for Use on Advanced Reactors

    SciTech Connect

    Ramuhalli, Pradeep; Veeramany, Arun; Bonebrake, Christopher A.; Ivans, William J.; Coles, Garill A.; Hirt, Evelyn H.

    2016-09-26

    This study provides an overview of the methodology for integrating time-dependent failure probabilities into nuclear power reactor risk monitors. This prototypic enhanced risk monitor (ERM) methodology was evaluated using a hypothetical probabilistic risk assessment (PRA) model, generated using a simplified design of a liquid-metal-cooled advanced reactor (AR). Component failure data from industry compilation of failures of components similar to those in the simplified AR model were used to initialize the PRA model. Core damage frequency (CDF) over time were computed and analyzed. In addition, a study on alternative risk metrics for ARs was conducted. Risk metrics that quantify the normalized cost of repairs, replacements, or other operations and management (O&M) actions were defined and used, along with an economic model, to compute the likely economic risk of future actions such as deferred maintenance based on the anticipated change in CDF due to current component condition and future anticipated degradation. Such integration of conventional-risk metrics with alternate-risk metrics provides a convenient mechanism for assessing the impact of O&M decisions on safety and economics of the plant. It is expected that, when integrated with supervisory control algorithms, such integrated-risk monitors will provide a mechanism for real-time control decision-making that ensure safety margins are maintained while operating the plant in an economically viable manner.

  13. A Risk-Based Approach to Test and Evaluation

    DTIC Science & Technology

    2012-05-01

    is it to occur (probability, frequency), and what will be the outcome (consequences)? The SAPHIRE software tool also is introduced as a way to...develop those risk concepts dealing with event trees, fault trees, and desired end states. SAPHIRE is a probabilistic risk, and reliability assessment...software tool. SAPHIRE stands for Systems Analysis Programs for Hands-on Integrated Reliability Evaluations and was developed for the U.S. Nuclear

  14. Approach for evaluating inundation risks in urban drainage systems

    NASA Astrophysics Data System (ADS)

    Zhu, Z.; Chen, Z.

    2016-12-01

    Urban inundation is a serious challenge that increasingly confronts the residents of many cities, as well as policymakers. Hence, inundation evaluation is becoming increasingly important around the world. This comprehensive assessment involves numerous indices in urban catchments, but the high-dimensional and non-linear relationship between the indices and the risk presents an enormous challenge for accurate evaluation. Therefore, an approach is hereby proposed to qualitatively and quantitatively evaluate inundation risks in urban drainage systems based on a storm water management model, the projection pursuit method, the ordinary kriging method and the K-means clustering method. This approach is tested using a residential district in Guangzhou, China. Seven evaluation indices were selected and twenty rainfall-runoff events were used to calibrate and validate the parameters of the rainfall-runoff model. The inundation risks in the study area drainage system were evaluated under different rainfall scenarios. The following conclusions are reached. (1) The proposed approach, without subjective factors, can identify the main driving factors, i.e., inundation duration, largest water flow and total flood amount in this study area. (2) The inundation risk of each manhole can be qualitatively analyzed and quantitatively calculated. There are 1, 8, 11, 14, 21, and 21 manholes at risk under the return periods of 1-yr, 5-yr, 10-yr, 20-yr, 50-yr and 100-yr, respectively. (3) The areas of levels Ⅲ, Ⅳ and Ⅴ increase with increasing rainfall return period based on analyzing the inundation risks for a variety of characteristics. (4) The relationships between rainfall intensity and inundation-affected areas are revealed by a logarithmic model. This study proposes a novel and successful approach to assessing risk in urban drainage systems and provides guidance for improving urban drainage systems and inundation preparedness.

  15. Approach for evaluating inundation risks in urban drainage systems.

    PubMed

    Zhu, Zhihua; Chen, Zhihe; Chen, Xiaohong; He, Peiying

    2016-05-15

    Urban inundation is a serious challenge that increasingly confronts the residents of many cities, as well as policymakers. Hence, inundation evaluation is becoming increasingly important around the world. This comprehensive assessment involves numerous indices in urban catchments, but the high-dimensional and non-linear relationship between the indices and the risk presents an enormous challenge for accurate evaluation. Therefore, an approach is hereby proposed to qualitatively and quantitatively evaluate inundation risks in urban drainage systems based on a storm water management model, the projection pursuit method, the ordinary kriging method and the K-means clustering method. This approach is tested using a residential district in Guangzhou, China. Seven evaluation indices were selected and twenty rainfall-runoff events were used to calibrate and validate the parameters of the rainfall-runoff model. The inundation risks in the study area drainage system were evaluated under different rainfall scenarios. The following conclusions are reached. (1) The proposed approach, without subjective factors, can identify the main driving factors, i.e., inundation duration, largest water flow and total flood amount in this study area. (2) The inundation risk of each manhole can be qualitatively analyzed and quantitatively calculated. There are 1, 8, 11, 14, 21, and 21 manholes at risk under the return periods of 1-year, 5-years, 10-years, 20-years, 50-years and 100-years, respectively. (3) The areas of levels III, IV and V increase with increasing rainfall return period based on analyzing the inundation risks for a variety of characteristics. (4) The relationships between rainfall intensity and inundation-affected areas are revealed by a logarithmic model. This study proposes a novel and successful approach to assessing risk in urban drainage systems and provides guidance for improving urban drainage systems and inundation preparedness.

  16. CDER risk assessment exercise to evaluate potential risks from the use of nanomaterials in drug products.

    PubMed

    Cruz, Celia N; Tyner, Katherine M; Velazquez, Lydia; Hyams, Kenneth C; Jacobs, Abigail; Shaw, Arthur B; Jiang, Wenlei; Lionberger, Robert; Hinderling, Peter; Kong, Yoon; Brown, Paul C; Ghosh, Tapash; Strasinger, Caroline; Suarez-Sharp, Sandra; Henry, Don; Van Uitert, Maat; Sadrieh, Nakissa; Morefield, Elaine

    2013-07-01

    The Nanotechnology Risk Assessment Working Group in the Center for Drug Evaluation and Research (CDER) within the United States Food and Drug Administration was established to assess the possible impact of nanotechnology on drug products. The group is in the process of performing risk assessment and management exercises. The task of the working group is to identify areas where CDER may need to optimize its review practices and to develop standards to ensure review consistency for drug applications that may involve the application of nanotechnology. The working group already performed risk management exercises evaluating the potential risks from administering nanomaterial active pharmaceutical ingredients (API) or nanomaterial excipients by various routes of administration. This publication outlines the risk assessment and management process used by the working group, using nanomaterial API by the oral route of administration as an example.

  17. Conceptual Model of Offshore Wind Environmental Risk Evaluation System

    SciTech Connect

    Anderson, Richard M.; Copping, Andrea E.; Van Cleve, Frances B.; Unwin, Stephen D.; Hamilton, Erin L.

    2010-06-01

    In this report we describe the development of the Environmental Risk Evaluation System (ERES), a risk-informed analytical process for estimating the environmental risks associated with the construction and operation of offshore wind energy generation projects. The development of ERES for offshore wind is closely allied to a concurrent process undertaken to examine environmental effects of marine and hydrokinetic (MHK) energy generation, although specific risk-relevant attributes will differ between the MHK and offshore wind domains. During FY10, a conceptual design of ERES for offshore wind will be developed. The offshore wind ERES mockup described in this report will provide a preview of the functionality of a fully developed risk evaluation system that will use risk assessment techniques to determine priority stressors on aquatic organisms and environments from specific technology aspects, identify key uncertainties underlying high-risk issues, compile a wide-range of data types in an innovative and flexible data organizing scheme, and inform planning and decision processes with a transparent and technically robust decision-support tool. A fully functional version of ERES for offshore wind will be developed in a subsequent phase of the project.

  18. Risk evaluation and mitigation strategies: a focus on belatacept.

    PubMed

    Sam, Teena; Gabardi, Steven; Tichy, Eric M

    2013-03-01

    To review the elements and components of the risk evaluation and mitigation strategies (REMS) for the costimulation blocker belatacept and associated implications for health care providers working with transplant recipients. The MEDLINE and EMBASE databases (January 1990 to March 2012) were searched by using risk evaluation and mitigation strategies, REMS, belatacept, and organ transplant as search terms (individual organs were also searched). Retrieved articles were supplemented with analysis of information obtained from the Federal Register, the Food and Drug Administration, and the manufacturer of belatacept. REMS are risk-management strategies implemented to ensure that a product's benefits outweigh its known safety risks. Although belatacept offers a novel strategy in maintenance immunosuppression and was associated with superior renal function compared with cyclosporine in phase 2 and 3 trials, belatacept is also associated with increased risk of posttransplant lymphoproliferative disorder and central nervous system infections. The Food and Drug Administration required development of a REMS program as part of belatacept's approval process to ensure safe and appropriate use of the medication and optimization of its risk-benefit profile. Elements of the belatacept REMS include a medication guide that must be dispensed with each infusion and a communication plan. In the management of a complex population of patients, it is essential that those who care for transplant recipients, and patients, recognize the implications of potential and known risks of belatacept. The REMS program aims to facilitate careful selection and education of patients and vigilant monitoring.

  19. Sex differences in self-reported risk-taking propensity on the Evaluation of Risks scale.

    PubMed

    Killgore, William D S; Grugle, Nancy L; Killgore, Desiree B; Balkin, Thomas J

    2010-06-01

    The Evaluation of Risks scale was recently developed as a self-report inventory for assessing risk-taking propensity, but further validation is necessary because most studies have predominantly included male subjects. Because males commonly exhibit greater risk-taking propensity than females, evidence of such a sex difference on the scale would further support its construct validity. 29 men and 25 women equated for age (range: 18 to 36 years) completed the scale. Internal consistency of the scale was generally modest, particularly among women. Men scored significantly higher than women on four of nine indices of risk-taking propensity, including Danger Seeking, Energy, Invincibility, and Total Risk-Propensity. Factors measuring thrill seeking and danger seeking correlated positively with a concurrent measure of sensation seeking. Although the higher scores exhibited by men are consistent with prior research on other measures of risk-taking, further research on this scale with samples including women is warranted.

  20. Risk evaluation of liquefaction on the site of Damien (Haiti)

    NASA Astrophysics Data System (ADS)

    Jean, B. J.; Boisson, D.; Thimus, J.; Schroeder, C.

    2013-12-01

    Under the proposed relocation of all faculties to the campus of Damien, owned by Université d'Etat d'Haïti (UEH), the Unité de Recherche en Géotechnique (URGéo) of the Faculté des Sciences (FDS) of UEH conducted several operations whose objective was to evaluate the risk of liquefaction on this site. This abstract presents a comprehensive and coherent manner the entire processus of assessing the risk of liquefaction. This evaluation was conducted mainly from seismic thechniques, laboratory tests and the response of a one-dimensional soil column. Then, we summarize the results of this evaluation on the various techniques through synthetic maps interpretations of MASW 1D and H/V and also measures on site response to seismic loading from the SPT test applied to evaluation of liquefaction potential.

  1. Experimental approaches for evaluating the invasion risk of biofuel crops

    NASA Astrophysics Data System (ADS)

    Flory, S. Luke; Lorentz, Kimberly A.; Gordon, Doria R.; Sollenberger, Lynn E.

    2012-12-01

    There is growing concern that non-native plants cultivated for bioenergy production might escape and result in harmful invasions in natural areas. Literature-derived assessment tools used to evaluate invasion risk are beneficial for screening, but cannot be used to assess novel cultivars or genotypes. Experimental approaches are needed to help quantify invasion risk but protocols for such tools are lacking. We review current methods for evaluating invasion risk and make recommendations for incremental tests from small-scale experiments to widespread, controlled introductions. First, local experiments should be performed to identify conditions that are favorable for germination, survival, and growth of candidate biofuel crops. Subsequently, experimental introductions in semi-natural areas can be used to assess factors important for establishment and performance such as disturbance, founder population size, and timing of introduction across variable habitats. Finally, to fully characterize invasion risk, experimental introductions should be conducted across the expected geographic range of cultivation over multiple years. Any field-based testing should be accompanied by safeguards and monitoring for early detection of spread. Despite the costs of conducting experimental tests of invasion risk, empirical screening will greatly improve our ability to determine if the benefits of a proposed biofuel species outweigh the projected risks of invasions.

  2. A neural network model for credit risk evaluation.

    PubMed

    Khashman, Adnan

    2009-08-01

    Credit scoring is one of the key analytical techniques in credit risk evaluation which has been an active research area in financial risk management. This paper presents a credit risk evaluation system that uses a neural network model based on the back propagation learning algorithm. We train and implement the neural network to decide whether to approve or reject a credit application, using seven learning schemes and real world credit applications from the Australian credit approval datasets. A comparison of the system performance under the different learning schemes is provided, furthermore, we compare the performance of two neural networks; with one and two hidden layers following the ideal learning scheme. Experimental results suggest that neural networks can be effectively used in automatic processing of credit applications.

  3. Evaluation of forest management systems under risk of wildfire

    Treesearch

    Kari Hyytiainen; Robert G. Haight

    2010-01-01

    We evaluate the economic efficiency of even- and uneven-aged management systems under risk of wildfire. The management problems are formulated for a mixed-conifer stand and approximations of the optimal solutions are obtained using simulation optimization. The Northern Idaho variant of the Forest Vegetation Simulator and its Fire and Fuels Extension is used to predict...

  4. Rape Prevention with College Men: Evaluating Risk Status

    ERIC Educational Resources Information Center

    Stephens, Kari A.; George, William H.

    2009-01-01

    This study evaluates the effectiveness of a theoretically based rape prevention intervention with college men who were at high or low risk to perpetrate sexually coercive behavior. Participants (N = 146) are randomly assigned to the intervention or control group. Outcomes include rape myth acceptance, victim empathy, attraction to sexual…

  5. Rape Prevention with College Men: Evaluating Risk Status

    ERIC Educational Resources Information Center

    Stephens, Kari A.; George, William H.

    2009-01-01

    This study evaluates the effectiveness of a theoretically based rape prevention intervention with college men who were at high or low risk to perpetrate sexually coercive behavior. Participants (N = 146) are randomly assigned to the intervention or control group. Outcomes include rape myth acceptance, victim empathy, attraction to sexual…

  6. Field Evaluation of an Avian Risk Assessment Model

    EPA Science Inventory

    We conducted two laboratory subacute dietary toxicity tests and one outdoor subacute dietary toxicity test to determine the effectiveness of the U.S. Environmental Protection Agency's deterministic risk assessment model for evaluating the potential of adverse effects to birds in ...

  7. Developing and Evaluating a Cardiovascular Risk Reduction Project.

    ERIC Educational Resources Information Center

    Brownson, Ross C.; Mayer, Jeffrey P.; Dusseault, Patricia; Dabney, Sue; Wright, Kathleen; Jackson-Thompson, Jeannette; Malone, Bernard; Goodman, Robert

    1997-01-01

    Describes the development and baseline evaluation data from the Ozark Heart Health Project, a community-based cardiovascular disease risk reduction program in rural Missouri that targeted smoking, physical inactivity, and poor diet. Several Ozark counties participated in either intervention or control groups, and researchers conducted surveillance…

  8. Developing and Evaluating a Cardiovascular Risk Reduction Project.

    ERIC Educational Resources Information Center

    Brownson, Ross C.; Mayer, Jeffrey P.; Dusseault, Patricia; Dabney, Sue; Wright, Kathleen; Jackson-Thompson, Jeannette; Malone, Bernard; Goodman, Robert

    1997-01-01

    Describes the development and baseline evaluation data from the Ozark Heart Health Project, a community-based cardiovascular disease risk reduction program in rural Missouri that targeted smoking, physical inactivity, and poor diet. Several Ozark counties participated in either intervention or control groups, and researchers conducted surveillance…

  9. Field Evaluation of an Avian Risk Assessment Model

    EPA Science Inventory

    We conducted two laboratory subacute dietary toxicity tests and one outdoor subacute dietary toxicity test to determine the effectiveness of the U.S. Environmental Protection Agency's deterministic risk assessment model for evaluating the potential of adverse effects to birds in ...

  10. Processes for Risk Evaluation and Chemical Prioritization for Risk Evaluation under the Amended Toxic Substances Control Act; Notice of Public Meetings and Opportunities for Public Comment

    EPA Pesticide Factsheets

    This notice provides information for two public meetings to obtain input into the Agency’s development of processes for risk evaluation and chemical prioritization for risk evaluation under amended TSCA.

  11. [Evaluation of the embryotoxic risk of industrial chemicals in pregnancy].

    PubMed

    Spielmann, H

    1986-06-01

    For the first time exposure levels during pregnancy have been evaluated for industrial chemicals in the German list of "Maximal occupational exposure limits and biological tolerance levels of occupational chemicals 1985" (MAK-Werte-Liste). According to this evaluation only a single substance (methylmercury) is embryotoxic in man, a prenatal risk cannot be excluded for eight chemicals, and 18 chemicals are safe at occupational exposure limits (MAK-Werte). Furthermore, pregnant women should avoid exposure to any of the 112 carcinogenic chemicals of the list and to 26 substances which are under evaluation for embryotoxic properties. Occupational chemicals are subdivided into four pregnancy riskgroups and discussed with respect to prenatal counselling.

  12. Evaluation of the reproductive and developmental risks of caffeine.

    PubMed

    Brent, Robert L; Christian, Mildred S; Diener, Robert M

    2011-04-01

    A risk analysis of in utero caffeine exposure is presented utilizing epidemiological studies and animal studies dealing with congenital malformation, pregnancy loss, and weight reduction. These effects are of interest to teratologists, because animal studies are useful in their evaluation. Many of the epidemiology studies did not evaluate the impact of the "pregnancy signal," which identifies healthy pregnancies and permits investigators to identify subjects with low pregnancy risks. The spontaneous abortion epidemiology studies were inconsistent and the majority did not consider the confounding introduced by not considering the pregnancy signal. The animal studies do not support the concept that caffeine is an abortafacient for the wide range of human caffeine exposures. Almost all the congenital malformation epidemiology studies were negative. Animal pharmacokinetic studies indicate that the teratogenic plasma level of caffeine has to reach or exceed 60 µg/ml, which is not attainable from ingesting large amounts of caffeine in foods and beverages. No epidemiological study described the "caffeine teratogenic syndrome." Six of the 17 recent epidemiology studies dealing with the risk of caffeine and fetal weight reduction were negative. Seven of the positive studies had growth reductions that were clinically insignificant and none of the studies cited the animal literature. Analysis of caffeine's reproductive toxicity considers reproducibility and plausibility of clinical, epidemiological, and animal data. Moderate or even high amounts of beverages and foods containing caffeine do not increase the risks of congenital malformations, miscarriage or growth retardation. Pharmacokinetic studies markedly improve the ability to perform the risk analyses.

  13. The evaluation of natural attenuation processes in ecological risk assessments

    SciTech Connect

    Swindoll, C.M.; Dziuk, L.J. |

    1994-12-31

    The intent of the ecological risk assessment (ERA) process is to provide the scientific basis for making remediation decisions that are protective of the environment. In some instances, remedial actions may result in more damage to area flora and fauna than is warranted based on the long-term risk of the chemical stressor; this is particularly true of wetlands. To minimize the potential for putting the site`s ecosystem at greater risk because of remediation, the ERA should include an evaluation of ``no action`` and ``nondestructive`` scenarios. An essential component of this evaluation is an assessment of the natural attenuation of the chemical stressor. Natural processes including biodegradation, hydrolysis, photodegradation, speciation, and complexation can be important to the mitigation of long-term ecological impact of chemical substances. The importance of natural processes for the attenuation of contaminants in aquifers is recognized by both the regulatory and scientific communities and has been adopted by several states as a viable remedial alternative. The potential for natural attenuation to reduce environmental risk is greater for surface environments than for the subsurface. The rationale, methodology, and tools available for evaluating natural attenuation in the context of the ERA process will be presented. Specific examples of implementing this approach at several industrial sites and benefits, including the effective utilization of limited regulatory and industrial resources, will be discussed.

  14. Comparison of contemporary risk scores for predicting outcomes after surgery for active infective endocarditis.

    PubMed

    Wang, Tom Kai Ming; Oh, Timothy; Voss, Jamie; Gamble, Greg; Kang, Nicholas; Pemberton, James

    2015-03-01

    Decision making regarding surgery for acute bacterial endocarditis is complex given its heterogeneity and often fatal course. Few studies have investigated the utility of operative risk scores in this setting. Endocarditis-specific scores have recently been developed. We assessed the prognostic utility of contemporary risk scores for mortality and morbidity after endocarditis surgery. Additive and logistic EuroSCORE I, EuroSCORE II, additive Society of Thoracic Surgeon's (STS) Endocarditis Score and additive De Feo-Cotrufo Score were retrospectively calculated for patients undergoing surgery for endocarditis during 2005-2011. Pre-specified primary outcomes were operative mortality, composite morbidity and mortality during follow-up. A total of 146 patients were included with an operative mortality of 6.8 % followed for 4.1 ± 2.4 years. Mean scores were additive EuroSCORE I: 8.0 ± 2.5, logistic EuroSCORE I: 13.2 ± 10.1 %, EuroSCORE II: 9.1 % ± 9.4 %, STS Score: 32.2 ± 13.5 and De Feo-Cotrufo Score: 14.6 ± 9.2. Corresponding areas under curve (AUC) for operative mortality 0.653, 0.645, 0.656, 0.699 and 0.744; for composite morbidity were 0.623, 0.625, 0.720, 0.714 and 0.774; and long-term mortality 0.588, 0.579, 0.686, 0.735 and 0.751. The best tool for post-operative stroke was EuroSCORE II: AUC 0.837; for ventilation >24 h and return to theatre the De Feo-Cotrufo Scores were: AUC 0.821 and 0.712. Pre-operative inotrope or intra-aortic balloon pump treatment, previous coronary bypass grafting and dialysis were independent predictors of operative and long-term mortality. In conclusion, risk models developed specifically from endocarditis surgeries and incorporating endocarditis variables have improved prognostic ability of outcomes, and can play an important role in the decision making towards surgery for endocarditis.

  15. Novel Bedside Phonetic Evaluation to Identify Dysphagia and Aspiration Risk.

    PubMed

    Festic, Emir; Soto, Jose Soto; Pitre, Lisa A; Leveton, Marilu; Ramsey, Danielle M; Freeman, William D; Heckman, Michael G; Lee, Augustine S

    2016-03-01

    There is a need for improved clinical identification of hospitalized patients at risk of aspiration. We evaluated our novel phonetic test in a broad spectrum of patients at risk of aspiration in the ICU or intermediate care unit. We prospectively enrolled 60 hospitalized patients with aspiration risk, between December 2009 and September 2011, who subsequently underwent audio-recorded three-component phonetic bedside evaluation. The recordings were scored by two blinded speech-language pathologists. The institutional dysphagia admission screening test was performed by a bedside nurse. The primary outcomes, dysphagia and aspiration, were assessed by a videofluoroscopic swallowing study, fiber-optic endoscopic evaluation of swallowing, or both. We assessed the short- and long-term clinical outcomes (length of stay, subsequent aspiration pneumonia and respiratory failure, survival) and how these were associated with the phonetic and swallow assessments. Statistically significant linear associations with dysphagia were noted for all three individual phonetic components. Also, there were statistically significant linear associations with aspiration for diadochokinesis (P = .050) and consensus auditory-perceptual evaluation of voice (P = .025). Diadochokinesis alone predicted dysphagia (area under the curve [AUC], 0.74; P = .001) and aspiration (AUC, 0.67; P = .012). Its predictive ability improved when combined with normalized dysphagia admission screening test results (AUC, 0.79; P = .001). The short- and long-term clinical outcomes were adversely affected by the worse phonetic/swallowing scores, although they were not statistically different. Abnormal phonation among ICU and intermediate care unit patients is associated with dysphagia and aspiration. Future investigative efforts should uncover the most effective combination of evaluations for accurate bedside detection of dysphagia and aspiration risk in a broad spectrum of patients. Copyright © 2016 American College

  16. Evaluating biomarkers to model cancer risk post cosmic ray exposure.

    PubMed

    Sridharan, Deepa M; Asaithamby, Aroumougame; Blattnig, Steve R; Costes, Sylvain V; Doetsch, Paul W; Dynan, William S; Hahnfeldt, Philip; Hlatky, Lynn; Kidane, Yared; Kronenberg, Amy; Naidu, Mamta D; Peterson, Leif E; Plante, Ianik; Ponomarev, Artem L; Saha, Janapriya; Snijders, Antoine M; Srinivasan, Kalayarasan; Tang, Jonathan; Werner, Erica; Pluth, Janice M

    2016-06-01

    Robust predictive models are essential to manage the risk of radiation-induced carcinogenesis. Chronic exposure to cosmic rays in the context of the complex deep space environment may place astronauts at high cancer risk. To estimate this risk, it is critical to understand how radiation-induced cellular stress impacts cell fate decisions and how this in turn alters the risk of carcinogenesis. Exposure to the heavy ion component of cosmic rays triggers a multitude of cellular changes, depending on the rate of exposure, the type of damage incurred and individual susceptibility. Heterogeneity in dose, dose rate, radiation quality, energy and particle flux contribute to the complexity of risk assessment. To unravel the impact of each of these factors, it is critical to identify sensitive biomarkers that can serve as inputs for robust modeling of individual risk of cancer or other long-term health consequences of exposure. Limitations in sensitivity of biomarkers to dose and dose rate, and the complexity of longitudinal monitoring, are some of the factors that increase uncertainties in the output from risk prediction models. Here, we critically evaluate candidate early and late biomarkers of radiation exposure and discuss their usefulness in predicting cell fate decisions. Some of the biomarkers we have reviewed include complex clustered DNA damage, persistent DNA repair foci, reactive oxygen species, chromosome aberrations and inflammation. Other biomarkers discussed, often assayed for at longer points post exposure, include mutations, chromosome aberrations, reactive oxygen species and telomere length changes. We discuss the relationship of biomarkers to different potential cell fates, including proliferation, apoptosis, senescence, and loss of stemness, which can propagate genomic instability and alter tissue composition and the underlying mRNA signatures that contribute to cell fate decisions. Our goal is to highlight factors that are important in choosing

  17. Evaluating biomarkers to model cancer risk post cosmic ray exposure

    NASA Astrophysics Data System (ADS)

    Sridharan, Deepa M.; Asaithamby, Aroumougame; Blattnig, Steve R.; Costes, Sylvain V.; Doetsch, Paul W.; Dynan, William S.; Hahnfeldt, Philip; Hlatky, Lynn; Kidane, Yared; Kronenberg, Amy; Naidu, Mamta D.; Peterson, Leif E.; Plante, Ianik; Ponomarev, Artem L.; Saha, Janapriya; Snijders, Antoine M.; Srinivasan, Kalayarasan; Tang, Jonathan; Werner, Erica; Pluth, Janice M.

    2016-06-01

    Robust predictive models are essential to manage the risk of radiation-induced carcinogenesis. Chronic exposure to cosmic rays in the context of the complex deep space environment may place astronauts at high cancer risk. To estimate this risk, it is critical to understand how radiation-induced cellular stress impacts cell fate decisions and how this in turn alters the risk of carcinogenesis. Exposure to the heavy ion component of cosmic rays triggers a multitude of cellular changes, depending on the rate of exposure, the type of damage incurred and individual susceptibility. Heterogeneity in dose, dose rate, radiation quality, energy and particle flux contribute to the complexity of risk assessment. To unravel the impact of each of these factors, it is critical to identify sensitive biomarkers that can serve as inputs for robust modeling of individual risk of cancer or other long-term health consequences of exposure. Limitations in sensitivity of biomarkers to dose and dose rate, and the complexity of longitudinal monitoring, are some of the factors that increase uncertainties in the output from risk prediction models. Here, we critically evaluate candidate early and late biomarkers of radiation exposure and discuss their usefulness in predicting cell fate decisions. Some of the biomarkers we have reviewed include complex clustered DNA damage, persistent DNA repair foci, reactive oxygen species, chromosome aberrations and inflammation. Other biomarkers discussed, often assayed for at longer points post exposure, include mutations, chromosome aberrations, reactive oxygen species and telomere length changes. We discuss the relationship of biomarkers to different potential cell fates, including proliferation, apoptosis, senescence, and loss of stemness, which can propagate genomic instability and alter tissue composition and the underlying mRNA signatures that contribute to cell fate decisions. Our goal is to highlight factors that are important in choosing

  18. Evaluating biomarkers to model cancer risk post cosmic ray exposure

    PubMed Central

    Sridhara, Deepa M.; Asaithamby, Aroumougame; Blattnig, Steve R.; Costes, Sylvain V.; Doetsch, Paul W.; Dynan, William S.; Hahnfeldt, Philip; Hlatky, Lynn; Kidane, Yared; Kronenberg, Amy; Naidu, Mamta D.; Peterson, Leif E.; Plante, Ianik; Ponomarev, Artem L.; Saha, Janapriya; Snijders, Antoine M.; Srinivasan, Kalayarasan; Tang, Jonathan; Werner, Erica; Pluth, Janice M.

    2017-01-01

    Robust predictive models are essential to manage the risk of radiation-induced carcinogenesis. Chronic exposure to cosmic rays in the context of the complex deep space environment may place astronauts at high cancer risk. To estimate this risk, it is critical to understand how radiation-induced cellular stress impacts cell fate decisions and how this in turn alters the risk of carcinogenesis. Exposure to the heavy ion component of cosmic rays triggers a multitude of cellular changes, depending on the rate of exposure, the type of damage incurred and individual susceptibility. Heterogeneity in dose, dose rate, radiation quality, energy and particle flux contribute to the complexity of risk assessment. To unravel the impact of each of these factors, it is critical to identify sensitive biomarkers that can serve as inputs for robust modeling of individual risk of cancer or other long-term health consequences of exposure. Limitations in sensitivity of biomarkers to dose and dose rate, and the complexity of longitudinal monitoring, are some of the factors that increase uncertainties in the output from risk prediction models. Here, we critically evaluate candidate early and late biomarkers of radiation exposure and discuss their usefulness in predicting cell fate decisions. Some of the biomarkers we have reviewed include complex clustered DNA damage, persistent DNA repair foci, reactive oxygen species, chromosome aberrations and inflammation. Other biomarkers discussed, often assayed for at longer points post exposure, include mutations, chromosome aberrations, reactive oxygen species and telomere length changes. We discuss the relationship of biomarkers to different potential cell fates, including proliferation, apoptosis, senescence, and loss of stemness, which can propagate genomic instability and alter tissue composition and the underlying mRNA signatures that contribute to cell fate decisions. Our goal is to highlight factors that are important in choosing

  19. Thrombocytosis: Diagnostic Evaluation, Thrombotic Risk Stratification, and Risk-Based Management Strategies

    PubMed Central

    Bleeker, Jonathan S.; Hogan, William J.

    2011-01-01

    Thrombocytosis is a commonly encountered clinical scenario, with a large proportion of cases discovered incidentally. The differential diagnosis for thrombocytosis is broad and the diagnostic process can be challenging. Thrombocytosis can be spurious, attributed to a reactive process or due to clonal disorder. This distinction is important as it carries implications for evaluation, prognosis, and treatment. Clonal thrombocytosis associated with the myeloproliferative neoplasms, especially essential thrombocythemia and polycythemia vera, carries a unique prognostic profile, with a markedly increased risk of thrombosis. This risk is the driving factor behind treatment strategies in these disorders. Clinical trials utilizing targeted therapies in thrombocytosis are ongoing with new therapeutic targets waiting to be explored. This paper will outline the mechanisms underlying thrombocytosis, the diagnostic evaluation of thrombocytosis, complications of thrombocytosis with a special focus on thrombotic risk as well as treatment options for clonal processes leading to thrombocytosis, including essential thrombocythemia and polycythemia vera. PMID:22084665

  20. [Microscopic hematuria : Reasonable and risk-adapted diagnostic evaluation].

    PubMed

    Löbig, N; Wezel, F; Martini, T; Schröppel, B; Bolenz, C

    2017-06-22

    Microscopic hematuria that is not explained by an obvious underlying condition is a frequent and often an incidental finding that commonly triggers urological or nephrological evaluation. Potential underlying conditions range from benign to severe malignant diseases of the kidneys and urinary tract. A nonsystematic literature search was performed, focusing on potential urological and nephrological causes of hematuria. National and international guidelines were considered and diagnostic as well as follow-up strategies are discussed. We provide a recommendation for practices in the clinical evaluation of hematuria. The overall prevalence for microscopic hematuria is estimated at approximately 2%, whereas risk populations show an increase to around 30%. In 13-35% of patients presenting with microscopic hematuria, a medical or surgical intervention is required. Malignant tumors of the kidneys or urinary tract can be diagnosed in 2.6-4% of all patients and in up to 25.8% of at-risk populations. "Idiopathic microscopic hematuria" without an obvious underlying medical condition accounts for approximately 80% of patients with asymptomatic hematuria. After exclusion of nephrological diseases, standard diagnostic procedures by means of medical history, physical and laboratory examination as well as ultrasound of the kidneys and the urinary tract should be performed. In the presence of risk factors, an extended diagnostic work-up using cystoscopy, urinary cytology, and cross-sectional imaging of the upper urinary tract is indicated. Evidence-based strategies of a risk-adapted diagnostic evaluation for microscopic hematuria are not available. The development of reliable clinical and molecular markers offers great potential for the identification of patients at higher risk for harboring severe diseases.

  1. Kennedy space center cardiovascular disease risk reduction program evaluation

    PubMed Central

    Calderon, Kristine S; Smallwood, Charles; Tipton, David A

    2008-01-01

    This program evaluation examined the Kennedy Space Center (KSC) Cardiovascular Disease (CVD) Risk Reduction Program which aims to identify CVD risk factors and reduce these risk factors through health education phone counseling. High risk participants (those having two or more elevated lipid values) are identified from monthly voluntary CVD screenings and counseled. Phone counseling consists of reviewing lab values with the participant, discussing dietary fat intake frequency using an intake questionnaire, and promoting the increase in exercise frequency. The participants are followed-up at two-months and five-months for relevant metrics including blood pressure, weight, body mass index (BMI), total cholesterol, high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol, triglycerides, dietary fat intake, and exercise frequency. Data for three years of the KSC CVD Program included 366 participants, average age of 49 years, 75% male, and 25% female. For those with complete two and five month follow-up data, significant baseline to two-month follow-up comparisons included decreases in systolic blood pressure (p = 0.03); diastolic blood pressure (p = 0.002); total cholesterol, LDL cholesterol and dietary fat intake (all three at p < 0.0001) as well as a significant increase in exercise frequency (p = 0.04). Significant baseline to five-month follow-up comparisons included decreases in triglycerides (p = 0.05); and total cholesterol, LDL cholesterol and dietary intake (all three at p < 0.0001). These program evaluation results indicate that providing brief phone health education counseling and information at the worksite to high risk CVD participants may impact CVD risk factors. PMID:18561517

  2. Rapid Risk-Based Evaluation of Competing Conceptual Designs

    SciTech Connect

    Bott, T.F.; Butner, J.M.

    1999-08-22

    In this paper, the authors have shown how a qualitative analysis can provide good input to a risk reduction design problem. Traditionally qualitative analyses such as the FMEA can be supplemented by qualitative fault trees and event trees to produce logic models of the accident sequences for the different design options. These models can be compared using rule-based manipulations of qualitative branch point probabilities. A qualitative evaluation of other considerations such as collateral safety effects, operational impacts and worker-safety impacts can provide a more complete picture of the trade-off between options. The authors believe that their risk-reduction analysis approach that combines logic models with qualitative and possibility metrics provides an excellent tool for incorporating safety concerns rapidly and effectively into a conceptual design evaluation.

  3. Evaluation of high-risk living kidney donors.

    PubMed

    Tangdhanakanond, Kawin; Mandelbrot, Didier

    2015-01-01

    Careful evaluation of potential living kidney donors is crucial to assure the well being of the donors, especially because they do not gain any direct medical benefit from donation. This process also helps assess the quality and safety of the organs donated to the recipients. While all programs share these goals, donor selection criteria vary significantly among U.S. transplant centers. In part, this is due to the limited data that exists as to long-term outcomes among donors who are medically complex, or at higher risk for complications, such as those with hypertension, obesity, or lower kidney function. This article reviews available evidence regarding outcomes after living donation and current trends in U.S. practices, and seeks to provide practical guidance in evaluating high-risk potential living kidney donors.

  4. Preoperative evaluation and risk factors of lung cancer.

    PubMed

    Gaballo, Annarita; Corbo, Giuseppe M; Valente, Salvatore; Ciappi, Giuliano

    2004-01-01

    Based on a review of the literature on resectable lung cancer, pulmonary risk factors before, during and after surgery are discussed. The role of preoperative evaluation in order to determine the patient ability to withstand radical resection is considered. Spirometric indexes as forced expired volume (FEV1) and diffusing lung carbon monoxide capacity (DLCO) should be measured first. If FEV1 and DLCO are > 60% of predicted, patients are at low risk for complications and can undergo pulmonary resection. However, if FEV1 and DLCO are <60% of predicted, further evaluation with a quantitative lung scan is required. If predicted postoperative values for FEV1 and DLCO are >40%, patients can undergo lung resection, otherwise exercise testing is necessary. If the latter shows maximal oxygen uptake (VO2max) of > 15ml/Kg, surgery can be performed; if VO2max is <15 ml/Kg, patients are inoperable.

  5. [Hypertension and cardiovascular risk evaluation of Chinese cardiovascular physicians].

    PubMed

    Li, She-Chang; Yu, Jin-Ming; Zhang, Li-Jun; Zhan, Yi-Qiang; Zhang, Fen; Hu, Da-Yi

    2011-03-01

    To observe the prevalence, awareness, treatment and control rate of hypertension and to evaluate the 10-year absolute risk of coronary heart disease(CHD) and ischemic cardiovascular disease(ICVD) in Chinese cardiovascular physicians. A total of 4032 cardiovascular physicians (28 to 79 years old) from 386 hospitals in 31 provinces, autonomous regions and municipalities were randomly selected and received an epidemiologic survey of prevalence, awareness, and control of hypertension and evaluations of CHD and ICVD risk. The prevalence of hypertension in Chinese cardiovascular physicians was 13.1%. The awareness rate of hypertension in Chinese cardiovascular physicians was 81.7%. Hypertension treatment rate was 69.6% and blood pressure control rate was 44.6%. The prevalence of hypertension was higher in male physicians than in female physicians before the age of 55 years old. Ten-year absolute risk of CHD and ICVD was 0.08 and 0.03 in hypertensive physicians compared to 0.03 and 0.01 in non-hypertensive physicians. The results show suboptimal awareness, treatment and control rate in Chinese cardiovascular physicians for their own hypertension status.Physicians suffering from hypertension face higher risk for cardiovascular disease. It is therefore necessary to improve the self-monitoring of blood pressure in Chinese cardiovascular physicians.

  6. Female sex is not a risk factor for post procedural mortality in coronary bypass surgery in the elderly: A secondary analysis of the GOPCABE trial.

    PubMed

    Faerber, Gloria; Zacher, Michael; Reents, Wilko; Boergermann, Jochen; Kappert, Utz; Boening, Andreas; Diegeler, Anno; Doenst, Torsten

    2017-01-01

    Female sex is considered a significant risk in cardiac surgery and is included in the majority of scores for risk assessment. However, the evidence is controversial and older women undergoing cardiac surgery have not specifically been investigated. We assessed the influence of female sex on surgical risk (30-day mortality) in a secondary analysis of the GOPCABE trial (German Off-Pump Coronary Artery Bypass grafting in the Elderly (GOPCABE) trial, comparing on- to off-pump) and also evaluated its impact on risk prediction from commonly used risk scores. We performed logistic regression analyses on the GOPCABE trial population, where patients were randomized to either on- or off-pump CABG. The study was performed in 12 cardiac surgery centers in Germany and analyzed 2394 patients having undergone CABG at age ≥75 years (1187 on-pump, 1207 off-pump). Of the 2394 patients, 755 (32%) were women. The logistic EuroSCORE and the German KCH score were calculated as expected (E) mortality and values were compared to observed (O) 30-day mortality (O/E ratio). There was no difference in mortality or major cardiovascular adverse events after 30 days between men and women for both on- and off-pump CABG (men: on- vs. off-pump OR = 0.90, 95%-CI: [0.63;1.27]; women: on- vs. off-pump OR = 1.07, 95%-CI: [0.62;1.87]). Therefore, groups were combined for further analyses. Both men and women had considerable and similar comorbidities. Expected mortality was significantly higher for women than for men (logistic EuroSCORE: 8.88±6.71% vs. 7.99±6.69%, p = 0.003; KCH score: 4.42±3.97% vs. 3.57±3.65%, p = 0.001). However, observed mortality rates (O) tended to be even lower in women (2.1% vs. 3.0%). The O/E ratio was closer to 1 in men than in women (0.84 vs. 0.47). Excluding female sex from the risk models increased O/E ratio to 0.69. Female sex is not a risk factor in coronary bypass surgery in the GOPCABE population. The result is the same for on- and off-pump surgery. Since female

  7. Field evaluation of an avian risk assessment model

    USGS Publications Warehouse

    Vyas, N.B.; Spann, J.W.; Hulse, C.S.; Borges, S.L.; Bennett, R.S.; Torrez, M.; Williams, B.I.; Leffel, R.

    2006-01-01

    We conducted two laboratory subacute dietary toxicity tests and one outdoor subacute dietary toxicity test to determine the effectiveness of the U.S. Environmental Protection Agency's deterministic risk assessment model for evaluating the potential of adverse effects to birds in the field. We tested technical-grade diazinon and its D Z N- 50W (50% diazinon active ingredient wettable powder) formulation on Canada goose (Branta canadensis) goslings. Brain acetylcholinesterase activity was measured, and the feathers and skin, feet. and gastrointestinal contents were analyzed for diazinon residues. The dose-response curves showed that diazinon was significantly more toxic to goslings in the outdoor test than in the laboratory tests. The deterministic risk assessment method identified the potential for risk to birds in general, but the factors associated with extrapolating from the laboratory to the field, and from the laboratory test species to other species, resulted in the underestimation of risk to the goslings. The present study indicates that laboratory-based risk quotients should be interpreted with caution.

  8. Evaluation of Risk Factors Associated with First Episode Febrile Seizure.

    PubMed

    Sharawat, Indar Kumar; Singh, Jitender; Dawman, Lesa; Singh, Amitabh

    2016-05-01

    Febrile seizure (FS) is the single most common type of seizure seen in children between 6 months to 5 years of age. The purpose of our study was to identify the risk factors associated with the first episode of febrile seizures, which would help in the better management and preventive measures in children at risk for FS episodes. To evaluate the risk factors associated with the first episode of febrile seizures in Indian children. This was a hospital based, case control study. The purpose of this study was to identify the risk factors associated with the first FS episode in children. Seventy (70) children between age 6 months to 5 years with their first episode of FS were compared with 70 children with fever but without seizures based on various risk factors. The mean age was 24.90±16.11 months in cases and 26.34±16.93 months in controls. Male: female ratio was 2:1. A positive family history was found in 31.4% of first degree and 11.4% in second degree relatives. Mean maximum temperature was 102.06±1.1°F and URI (upper respiratory infection) was most common cause of fever. Antenatal complication was significantly higher in the case group. RBC (Red Blood Cells) indices like lower mean haemoglobin, MCV (Mean Corpuscular Volume), MCH (Mean Corpuscular Haemoglobin concentration) and higher RDW (Red Cell Distribution Width) values were seen in patients. Serum sodium, Serum calcium and random blood sugar values of the cases were significantly lower than those of controls (p<0.05). Our study shows that male gender, family history of febrile seizures, peak body temperature, underlying cause of fever, antenatal complications, low serum calcium, sodium, blood sugar and microcytic hypochromic anaemia are the risk factors associated with the occurrence of first episode of febrile seizure and, thus, preventive measures in removing these risk factors could lead to a decrease in incidence of FS.

  9. Development and evaluation of an automated fall risk assessment system.

    PubMed

    Lee, Ju Young; Jin, Yinji; Piao, Jinshi; Lee, Sun-Mi

    2016-04-01

    Fall risk assessment is the first step toward prevention, and a risk assessment tool with high validity should be used. This study aimed to develop and validate an automated fall risk assessment system (Auto-FallRAS) to assess fall risks based on electronic medical records (EMRs) without additional data collected or entered by nurses. This study was conducted in a 1335-bed university hospital in Seoul, South Korea. The Auto-FallRAS was developed using 4211 fall-related clinical data extracted from EMRs. Participants included fall patients and non-fall patients (868 and 3472 for the development study; 752 and 3008 for the validation study; and 58 and 232 for validation after clinical application, respectively). The system was evaluated for predictive validity and concurrent validity. The final 10 predictors were included in the logistic regression model for the risk-scoring algorithm. The results of the Auto-FallRAS were shown as high/moderate/low risk on the EMR screen. The predictive validity analyzed after clinical application of the Auto-FallRAS was as follows: sensitivity = 0.95, NPV = 0.97 and Youden index = 0.44. The validity of the Morse Fall Scale assessed by nurses was as follows: sensitivity = 0.68, NPV = 0.88 and Youden index = 0.28. This study found that the Auto-FallRAS results were better than were the nurses' predictions. The advantage of the Auto-FallRAS is that it automatically analyzes information and shows patients' fall risk assessment results without requiring additional time from nurses. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  10. Evaluations of Risks from the Lunar and Mars Radiation Environments

    NASA Technical Reports Server (NTRS)

    Kim, Myung-Hee; Hayat, Matthew J.; Feiveson, Alan H.; Cucinotta, Francis A.

    2008-01-01

    Protecting astronauts from the space radiation environments requires accurate projections of radiation in future space missions. Characterization of the ionizing radiation environment is challenging because the interplanetary plasma and radiation fields are modulated by solar disturbances and the radiation doses received by astronauts in interplanetary space are likewise influenced. The galactic cosmic radiation (GCR) flux for the next solar cycle was estimated as a function of interplanetary deceleration potential, which has been derived from GCR flux and Climax neutron monitor rate measurements over the last 4 decades. For the chaotic nature of solar particle event (SPE) occurrence, the mean frequency of SPE at any given proton fluence threshold during a defined mission duration was obtained from a Poisson process model using proton fluence measurements of SPEs during the past 5 solar cycles (19-23). Analytic energy spectra of 34 historically large SPEs were constructed over broad energy ranges extending to GeV. Using an integrated space radiation model (which includes the transport codes HZETRN [1] and BRYNTRN [2], and the quantum nuclear interaction model QMSFRG[3]), the propagation and interaction properties of the energetic nucleons through various media were predicted. Risk assessment from GCR and SPE was evaluated at the specific organs inside a typical spacecraft using CAM [4] model. The representative risk level at each event size and their standard deviation were obtained from the analysis of 34 SPEs. Risks from different event sizes and their frequency of occurrences in a specified mission period were evaluated for the concern of acute health effects especially during extra-vehicular activities (EVA). The results will be useful for the development of an integrated strategy of optimizing radiation protection on the lunar and Mars missions. Keywords: Space Radiation Environments; Galactic Cosmic Radiation; Solar Particle Event; Radiation Risk; Risk

  11. Evaluation of the Reproductive and Developmental Risks of Caffeine

    PubMed Central

    Brent, Robert L; Christian, Mildred S; Diener, Robert M

    2011-01-01

    A risk analysis of in utero caffeine exposure is presented utilizing epidemiological studies and animal studies dealing with congenital malformation, pregnancy loss, and weight reduction. These effects are of interest to teratologists, because animal studies are useful in their evaluation. Many of the epidemiology studies did not evaluate the impact of the “pregnancy signal,” which identifies healthy pregnancies and permits investigators to identify subjects with low pregnancy risks. The spontaneous abortion epidemiology studies were inconsistent and the majority did not consider the confounding introduced by not considering the pregnancy signal. The animal studies do not support the concept that caffeine is an abortafacient for the wide range of human caffeine exposures. Almost all the congenital malformation epidemiology studies were negative. Animal pharmacokinetic studies indicate that the teratogenic plasma level of caffeine has to reach or exceed 60 µg/ml, which is not attainable from ingesting large amounts of caffeine in foods and beverages. No epidemiological study described the “caffeine teratogenic syndrome.” Six of the 17 recent epidemiology studies dealing with the risk of caffeine and fetal weight reduction were negative. Seven of the positive studies had growth reductions that were clinically insignificant and none of the studies cited the animal literature. Analysis of caffeine's reproductive toxicity considers reproducibility and plausibility of clinical, epidemiological, and animal data. Moderate or even high amounts of beverages and foods containing caffeine do not increase the risks of congenital malformations, miscarriage or growth retardation. Pharmacokinetic studies markedly improve the ability to perform the risk analyses. Birth Defects Res (Part B) 92:152–187, 2011. © 2011 Wiley-Liss, Inc. PMID:21370398

  12. Evaluation of the meningitis epidemics risk model in Africa.

    PubMed

    Savory, E C; Cuevas, L E; Yassin, M A; Hart, C A; Molesworth, A M; Thomson, M C

    2006-10-01

    Meningitis epidemics have a strong environmental component in Africa with the most severe epidemics occurring in the Sahelian region known as the Meningitis Belt. The objective of this study is to evaluate an ecological model based on absolute humidity and land cover type to predict the location of these epidemics. The risk model is evaluated prospectively based on epidemics occurring in Africa from January 2000 to April 2004. Seventy-one epidemics occurred during this time period affecting 22% of continental African districts. The model predicted their location with a sensitivity of 88%. The evaluation also suggests that epidemics may be extending south of the Sahel, which is consistent with environmental changes in the region. This model could be used to select priority areas for the introduction of the newly developed conjugate meningococcal vaccines. Further studies are needed to enhance our understanding of the complex relationship between meningitis epidemics and the environment.

  13. Risk evaluation and mitigation strategies (REMS): educating the prescriber.

    PubMed

    Nicholson, Susan C; Peterson, Janet; Yektashenas, Behin

    2012-02-01

    The US FDA Amendments Act of 2007 was signed into law on 27 September 2007. A provision of this law granted the FDA new powers to enhance drug safety by requiring the pharmaceutical industry to develop Risk Evaluation and Mitigation Strategies (REMS). REMS are deemed necessary when a question exists as to whether the benefits of a drug outweigh its risks. REMS constitute a safety plan with several potential components, including a medication guide, a communication plan, elements to ensure safe use and an implementation system to help guide the prescribers, pharmacists and patients. This applies to existing drugs on the market, new drug applications (NDAs), abbreviated NDAs (generics) and biologics licence applications. REMS represent an 'upgrade' from previously required risk minimization action plans, based on the strengthening of FDA powers of authority and enforceability to incur monetary penalties against individuals representing the pharmaceutical industry who fail to comply. For illustrative purposes, we chose the drug romiplostim (Nplate®) to present an REMS, as all components were utilized to help assuage risks associated with the drug. Romiplostim is an FDA-approved drug used to treat thrombocytopenia in patients with chronic immune (idiopathic) thrombocytopenic purpura that has a significant adverse safety profile based on the risk of changes in bone marrow reticulin formation and bone marrow fibroses, and other associated risks. This review of current REMS policy is intended to provide the prescriber with a better understanding of current modalities in FDA-mandated drug safety programmes, which will impact day-to-day healthcare provider practices.

  14. Evaluation of the carcinogenic risks at the influence of POPs.

    PubMed

    Nazhmetdinova, Aiman; Kassymbayev, Adlet; Chalginbayeva, Altinay

    2017-08-30

    Kazakhstan is included in the list of environmentally vulnerable countries and Kyzylorda oblast in particular. This is due to its geographical, spatial and temporal and socioeconomic features. As part of the program "Integrated approaches in the management of public health in the Aral region", we have carried out an expertise on many samples of natural environments and products. Samples were selected in accordance with sampling procedures according to regulatory documents by specialists of the Pesticide Toxicology Laboratory. It is accredited by the State Standard of the Republic of Kazakhstan, for compliance with ST RK ISO/IEC 17025-2007 "General requirements for the competence of test and calibration laboratories". Gas chromatograph was used for the determination of residues of organochlorine pesticides. For the determination of dioxins, polychlorinated biphenyl was conducted on the gas chromatomass spectrometer with quadruple detector produce by Agilent Company, USA. To assess the risk, we carried out the mathematical calculations according to the risk of chemicals polluting (No P 2.1.10.1920-04, Russia). Calculation of the carcinogenic risk was carried out with the use of data on the size of the exposure and meanings of carcinogenic potential factors (slope factor and unit risk). The evaluation of persistent organic pollutants (POPs), based on the previous results of the research concerning water, soil and food products, was held in five population settlements in Kyzylorda oblast villages: Ayteke bi, Zhalagash, Zhosaly, Shieli and Aralsk town. Pollution with the POPs in the environmental objects by means of exposition and evaluation of the carcinogenic risk to human health is confirmed by the data of the statistical reporting about some morbidity in Kyzylorda oblast, such as skin diseases and subcutaneous tissue, endocrine system diseases, pregnancy complications etc. The received levels of carcinogenic risks, which were first carried out in the Republic of

  15. Evaluating the risk-reduction benefits of wind energy

    SciTech Connect

    Brower, M.C.; Bell, K.; Bernow, S.; Duckworth, M.; Spinney P.

    1996-12-31

    This paper presents preliminary results of a study to evaluate the risk-reduction benefits of wind power for a case study utility system using decision analysis techniques. The costs and risks of two alternative decisions-whether to build a 400 MW gas-fired combined cycle plant or a 1600 MW wind plant in 2003-were compared through computer simulations as fuel prices, environmental regulatory costs, wind and conventional power plant availability, and load growth were allowed to vary. Three different market scenarios were examined: traditional regulation, a short-term power pool, and fixed-price contracts of varying duration. The study concludes that, from the perspective of ratepayers, wind energy provides a net levelized risk-reduction benefit of $3.4 to $7.8/MWh under traditional regulation, and less in the other scenarios. From the perspective of the utility plant owners, wind provides a significant risk benefit in the unregulated market scenarios but none in a regulated market. The methodology and findings should help inform utility resource planning and industry restructuring efforts. 2 figs., 3 tabs.

  16. Evaluation of Incident Risks in a Repository for Radioactive Waste

    SciTech Connect

    Grundler, D.; Mariae, D.; Muller, W.; Boetsch, W.; Thiel, J.

    2008-07-01

    A probabilistic safety assessment of the operation phase of a repository for radioactive waste requires the knowledge of incident risks. These are evaluated from generic observations. The present method accounts for the uncertainty (1) of whether an incident occurs, (2) of the incident rate, (3) of the duration of generic observation, and (4) of the duration of operation phase of the repository. It yields a mean risk and its standard deviation from a minimum of generic data, comprising only the number of observed incidents and the duration of the observation, as more comprehensive generic data are seldom available. It was shown that incidents sharing a common generic observation must be either merged together to a total incident or the generic observation must be split up in sub-observations, one for each such incident. The method was tested on the example of the German Konrad repository for low-level waste in a deep geological formation. (authors)

  17. Nanoparticle risk management and cost evaluation: a general framework

    NASA Astrophysics Data System (ADS)

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

    2011-07-01

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

  18. Teratological risk evaluation and prevention of voluntary abortion.

    PubMed

    De Santis, M; Straface, G; Cavaliere, A F; Cinque, B; Carducci, B; Caruso, A

    2006-04-01

    Many women exposed to completely innocuous agents during pregnancy have a high perception of adverse effects to such an extent that they may interrupt their pregnancy. The objective of our study is to evaluate the importance of the perception of the risk level in making the decision to end the pregnancy and the relevance that a teratology consultation can have in preventing unmotivated terminations of pregnancy We carried out a survey on 350 women in Rome who voluntarily interrupted their pregnancy to evaluate the prevalence due to presumed teratogen. Contemporarily we studied the pregnancy outcomes, the clinical, the psychological and the socio-economic factors of 142 women who contacted our Teratology Information Service (TIS) in the 1(st)trimester of pregnancy because suspected of teratogen exposure: 72 decided to terminate their pregnancy, whereas 70 were used as a control group. On 350 women who voluntarily interrupted their pregnancy, 4 cases (1.4%) reported exposure to a suspected teratogen, but our evaluation determined only 1 case. On 72 women decided to terminate their pregnancy and who contacted our TIS, after counselling 73% continued their pregnancy with respect to 97% of the control group. Those women who interrupted their pregnancy did so because of personal reasons independently to or the type of exposure or the risk attributed by us. From our data it appears that a percentage of voluntary abortions is related to suspected teratogen exposure and that TIS are effective in the prevention of this kind of voluntary abortions caused by groundless fears.

  19. A Conceptual Framework for the Evaluation of Emergency Risk Communications.

    PubMed

    Savoia, Elena; Lin, Leesa; Gamhewage, Gaya M

    2017-09-01

    To articulate a conceptual framework in support of evaluation activities in emergency risk communications (ERC). The framework proposed is based on a systematic review of the scientific literature (2001-2016) combined with data derived from a series of semistructured interviews with experts and practitioners in ERC, and it is designed to support local, national, and international public health organizations in implementing evaluation studies in ERC. We identified a list of ERC outcomes from the full-text review of 152 articles and categorized these into 3 groups, depending upon the level at which the outcome was measured: (1) information environment, (2) population, and (3) public health system. We analyzed interviewees' data from 18 interviews to identify practices and processes related to the effectiveness of ERC and included these as key structural components and processes in the developed evaluation framework. Researchers and public health practitioners interested in the evaluation of ERC can use the conceptual framework described in this article to guide the development of evaluation studies and methods for assessing communication outcomes related to public health emergencies.

  20. A Conceptual Framework for the Evaluation of Emergency Risk Communications

    PubMed Central

    Lin, Leesa; Gamhewage, Gaya M.

    2017-01-01

    Objectives. To articulate a conceptual framework in support of evaluation activities in emergency risk communications (ERC). Methods. The framework proposed is based on a systematic review of the scientific literature (2001–2016) combined with data derived from a series of semistructured interviews with experts and practitioners in ERC, and it is designed to support local, national, and international public health organizations in implementing evaluation studies in ERC. Results. We identified a list of ERC outcomes from the full-text review of 152 articles and categorized these into 3 groups, depending upon the level at which the outcome was measured: (1) information environment, (2) population, and (3) public health system. We analyzed interviewees’ data from 18 interviews to identify practices and processes related to the effectiveness of ERC and included these as key structural components and processes in the developed evaluation framework. Conclusions. Researchers and public health practitioners interested in the evaluation of ERC can use the conceptual framework described in this article to guide the development of evaluation studies and methods for assessing communication outcomes related to public health emergencies. PMID:28892436

  1. [Guidance of FDA risk evaluation and mitigation strategy and enlightenment to drug risk management of post-marketing Chinese medicine].

    PubMed

    Li, Yuanyuan; Xie, Yanming

    2011-10-01

    The FDA risk evaluation and mitigation strategy (REMS) aims to drugs or biological products known or potential serious risk management. Analysis with the example of the content of the Onsolis REMS named FOCOS. Our country can be reference for the analysis of relevant experience and establish a scientific evaluation mechanism, strengthen the drug risk consciousness, promote the rational drug use, organic combined with the before-marketing and post-marketing evaluation of traditional Chinese medicine, and promote the evaluation of risk management of the drug development and improvement.

  2. Comprehensive safeguards evaluation methods and societal risk analysis

    SciTech Connect

    Richardson, J.M.

    1982-03-01

    Essential capabilities of an integrated evaluation methodology for analyzing safeguards systems are discussed. Such a methodology must be conceptually meaningful, technically defensible, discriminating and consistent. A decompostion of safeguards systems by function is mentioned as a possible starting point for methodology development. The application of a societal risk equation to safeguards systems analysis is addressed. Conceptual problems with this approach are discussed. Technical difficulties in applying this equation to safeguards systems are illustrated through the use of confidence intervals, information content, hypothesis testing and ranking and selection procedures.

  3. Statistical methods to monitor risk factors in a clinical database: example of a national cardiac surgery registry.

    PubMed

    Siregar, Sabrina; Roes, Kit C B; van Straten, Albert H M; Bots, Michiel L; van der Graaf, Yolanda; van Herwerden, Lex A; Groenwold, Rolf H H

    2013-01-01

    Comparison of outcomes requires adequate risk adjustment for differences in patient risk and the type of intervention performed. Both unintentional and intentional misclassification (also called gaming) of risk factors might lead to incorrect benchmark results. Therefore, misclassification of risk factors should be detected. We investigated the use of statistical process control techniques to monitor the frequency of risk factors in a clinical database. A national population-based study was performed using simulation and statistical process control. All patients who underwent cardiac surgery between January 1, 2007, and December 31, 2009, in all 16 cardiothoracic surgery centers in the Netherlands were included. Data on 46 883 consecutive cardiac surgery interventions were extracted. The expected risk factor frequencies were based on 2007 and 2008 data. Monthly frequency rates of 18 risk factors in 2009 were monitored using a Shewhart control chart, exponentially weighted moving average chart, and cumulative sum chart. Upcoding (ie, gaming) in random patients was simulated and detected in 100% of the simulations. Subtle forms of gaming, involving specifically high-risk patients, were more difficult to identify (detection rate of 44%). However, the accompanying rise in mean logistic European system for cardiac operative risk evaluation (EuroSCORE) was detected in all simulations. Statistical process control in the form of a Shewhart control chart, exponentially weighted moving average, and cumulative sum charts provide a means to monitor changes in risk factor frequencies in a clinical database. Surveillance of the overall expected risk in addition to the separate risk factors ensures a high sensitivity to detect gaming. The use of statistical process control for risk factor surveillance is recommended.

  4. USING BIOASSAYS TO EVALUATE THE PERFORMANCE OF EDC RISK MANAGEMENT METHODS

    EPA Science Inventory

    In Superfund risk management research, the performance of risk management techniques is typically evaluated by measuring "the concentrations of the chemicals of concern before and after risk management efforts. However, using bioassays and chemical data provides a more robust und...

  5. USING BIOASSAYS TO EVALUATE THE PERFORMANCE OF EDC RISK MANAGEMENT METHODS

    EPA Science Inventory

    In Superfund risk management research, the performance of risk management techniques is typically evaluated by measuring "the concentrations of the chemicals of concern before and after risk management efforts. However, using bioassays and chemical data provides a more robust und...

  6. Assessment of Risk Evaluation and Mitigation Strategies in Oncology: Summary of the Oncology Risk Evaluation and Mitigation Strategies Workshop

    PubMed Central

    Frame, James N.; Jacobson, Joseph O.; Vogel, Wendy H.; Griffith, Niesha; Wariabharaj, Darshan; Garg, Rekha; Zon, Robin; Stephens, Cyntha L.; Bialecki, Alison M.; Bruinooge, Suanna S.; Allen, Steven L.

    2013-01-01

    To address oncology community stakeholder concerns regarding implementation of the Risk Evaluation and Mitigation Strategies (REMS) program, ASCO sponsored a workshop to gather REMS experiences from representatives of professional societies, patient organizations, pharmaceutical companies, and the US Food and Drug Administration (FDA). Stakeholder presentations and topical panel discussions addressed REMS program development, implementation processes, and practice experiences, as well as oncology drug safety processes. A draft REMS decision tool prepared by the ASCO REMS Steering Committee was presented for group discussion with facilitated, goal-oriented feedback. The workshop identified several unintended consequences resulting from current oncology REMS: (1) the release of personal health information to drug sponsors as a condition for gaining access to a needed drug; (2) risk information that is not tailored—and therefore not accessible—to all literacy levels; (3) exclusive focus on drug risk, thereby affecting patient-provider treatment discussion; (4) REMS elements that do not consider existing, widely practiced oncology safety standards, professional training, and experience; and (5) administrative burdens that divert the health care team from direct patient care activities and, in some cases, could limit patient access to important therapies. Increased provider and professional society participation should form the basis of ongoing and future REMS standardization discussions with the FDA to work toward overall improvement of risk communication. PMID:23814522

  7. Assessment of risk evaluation and mitigation strategies in oncology: summary of the oncology risk evaluation and mitigation strategies workshop.

    PubMed

    Frame, James N; Jacobson, Joseph O; Vogel, Wendy H; Griffith, Niesha; Wariabharaj, Darshan; Garg, Rekha; Zon, Robin; Stephens, Cyntha L; Bialecki, Alison M; Bruinooge, Suanna S; Allen, Steven L

    2013-03-01

    To address oncology community stakeholder concerns regarding implementation of the Risk Evaluation and Mitigation Strategies (REMS) program, ASCO sponsored a workshop to gather REMS experiences from representatives of professional societies, patient organizations, pharmaceutical companies, and the US Food and Drug Administration (FDA). Stakeholder presentations and topical panel discussions addressed REMS program development, implementation processes, and practice experiences, as well as oncology drug safety processes. A draft REMS decision tool prepared by the ASCO REMS Steering Committee was presented for group discussion with facilitated, goal-oriented feedback. THE WORKSHOP IDENTIFIED SEVERAL UNINTENDED CONSEQUENCES RESULTING FROM CURRENT ONCOLOGY REMS: (1) the release of personal health information to drug sponsors as a condition for gaining access to a needed drug; (2) risk information that is not tailored-and therefore not accessible-to all literacy levels; (3) exclusive focus on drug risk, thereby affecting patient-provider treatment discussion; (4) REMS elements that do not consider existing, widely practiced oncology safety standards, professional training, and experience; and (5) administrative burdens that divert the health care team from direct patient care activities and, in some cases, could limit patient access to important therapies. Increased provider and professional society participation should form the basis of ongoing and future REMS standardization discussions with the FDA to work toward overall improvement of risk communication.

  8. A risk evaluation model and its application in online retailing trustfulness

    NASA Astrophysics Data System (ADS)

    Ye, Ruyi; Xu, Yingcheng

    2017-08-01

    Building a general model for risks evaluation in advance could improve the convenience, normality and comparability of the results of repeating risks evaluation in the case that the repeating risks evaluating are in the same area and for a similar purpose. One of the most convenient and common risks evaluation models is an index system including of several index, according weights and crediting method. One method to build a risk evaluation index system that guarantees the proportional relationship between the resulting credit and the expected risk loss is proposed and an application example is provided in online retailing in this article.

  9. 76 FR 57767 - Proposed Generic Communication; Draft NRC Generic Letter 2011-XX: Seismic Risk Evaluations for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-16

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Proposed Generic Communication; Draft NRC Generic Letter 2011-XX: Seismic Risk Evaluations for... NRC Generic Letter 2011- XX: Seismic Risk Evaluations for Operating Reactors. This action is...

  10. Documentation Protocols to Generate Risk Indicators Regarding Degradation Processes for Cultural Heritage Risk Evaluation

    NASA Astrophysics Data System (ADS)

    Kioussi, A.; Karoglou, M.; Bakolas, A.; Labropoulos, K.; Moropoulou, A.

    2013-07-01

    Sustainable maintenance and preservation of cultural heritage assets depends highly on its resilience to external or internal alterations and to various hazards. Risk assessment of a heritage asset's can be defined as the identification of all potential hazards affecting it and the evaluation of the asset's vulnerability (building materials and building structure conservation state).Potential hazards for cultural heritage are complex and varying. The risk of decay and damage associated with monuments is not limited to certain long term natural processes, sudden events and human impact (macroscale of the heritage asset) but is also a function of the degradation processes within materials and structural elements due to physical and chemical procedures. Obviously, these factors cover different scales of the problem. The deteriorating processes in materials may be triggered by external influences or caused because of internal chemical and/or physical variations of materials properties and characteristics. Therefore risk evaluation should be dealt in the direction of revealing the specific active decay and damage mechanism both in mesoscale [type of decay and damage] and microscale [decay phenomenon mechanism] level. A prerequisite for risk indicators identification and development is the existence of an organised source of comparable and interoperable data about heritage assets under observation. This unified source of information offers a knowledge based background of the asset's vulnerability through the diagnosis of building materials' and building structure's conservation state, through the identification of all potential hazards affecting these and through mapping of its possible alterations during its entire life-time. In this framework the identification and analysis of risks regarding degradation processes for the development of qualitative and quantitative indicators can be supported by documentation protocols. The data investigated by such protocols help

  11. Societal Risk Evaluation Scheme (SRES): Scenario-Based Multi-Criteria Evaluation of Synthetic Biology Applications.

    PubMed

    Cummings, Christopher L; Kuzma, Jennifer

    2017-01-01

    Synthetic biology (SB) applies engineering principles to biology for the construction of novel biological systems designed for useful purposes. From an oversight perspective, SB products come with significant uncertainty. Yet there is a need to anticipate and prepare for SB applications before deployment. This study develops a Societal Risk Evaluation Scheme (SRES) in order to advance methods for anticipatory governance of emerging technologies such as SB. The SRES is based upon societal risk factors that were identified as important through a policy Delphi study. These factors range from those associated with traditional risk assessment, such as health and environmental consequences, to broader features of risk such as those associated with reversibility, manageability, anticipated levels of public concern, and uncertainty. A multi-disciplinary panel with diverse perspectives and affiliations assessed four case studies of SB using the SRES. Rankings of the SRES components are compared within and across the case studies. From these comparisons, we found levels of controllability and familiarity associated with the cases to be important for overall SRES rankings. From a theoretical standpoint, this study illustrates the applicability of the psychometric paradigm to evaluating SB cases. In addition, our paper describes how the SRES can be incorporated into anticipatory governance models as a screening tool to prioritize research, information collection, and dialogue in the face of the limited capacity of governance systems. To our knowledge, this is the first study to elicit data on specific cases of SB with the goal of developing theory and tools for risk governance.

  12. Societal Risk Evaluation Scheme (SRES): Scenario-Based Multi-Criteria Evaluation of Synthetic Biology Applications

    PubMed Central

    2017-01-01

    Synthetic biology (SB) applies engineering principles to biology for the construction of novel biological systems designed for useful purposes. From an oversight perspective, SB products come with significant uncertainty. Yet there is a need to anticipate and prepare for SB applications before deployment. This study develops a Societal Risk Evaluation Scheme (SRES) in order to advance methods for anticipatory governance of emerging technologies such as SB. The SRES is based upon societal risk factors that were identified as important through a policy Delphi study. These factors range from those associated with traditional risk assessment, such as health and environmental consequences, to broader features of risk such as those associated with reversibility, manageability, anticipated levels of public concern, and uncertainty. A multi-disciplinary panel with diverse perspectives and affiliations assessed four case studies of SB using the SRES. Rankings of the SRES components are compared within and across the case studies. From these comparisons, we found levels of controllability and familiarity associated with the cases to be important for overall SRES rankings. From a theoretical standpoint, this study illustrates the applicability of the psychometric paradigm to evaluating SB cases. In addition, our paper describes how the SRES can be incorporated into anticipatory governance models as a screening tool to prioritize research, information collection, and dialogue in the face of the limited capacity of governance systems. To our knowledge, this is the first study to elicit data on specific cases of SB with the goal of developing theory and tools for risk governance. PMID:28052080

  13. Software Supportability Risk Assessment in OT&E (Operational Test and Evaluation): An Evaluation of Risk Methodologies.

    DTIC Science & Technology

    1984-08-31

    DISTRIBUTION: UNIMITED) ELC 0 AUUST 31, M94 Wd/A 8 4 496-TR wwvw WW CORPORATION 1801 RANDOLPH ROAD. S.E * ALSUQUERQUE. NEW MEXICO 87106 *(505) 848-5=0...Road, S.E., Albuquerque, New Mexico , 87106, to the Air Force Operational Test and Evaluation Center, Kirtland Air Force Base, New Mexico , 87117. This...metrics described in section 3.4 should be reported in a storyboard fashion. This technique would act as a summary of the ri.sk assessment process

  14. 76 FR 69294 - Proposed Generic Communication Draft Generic Letter on Seismic Risk Evaluations for Operating...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-08

    ... COMMISSION Proposed Generic Communication Draft Generic Letter on Seismic Risk Evaluations for Operating... public comment Draft Generic Letter 2011-XX: Seismic Risk Evaluations for Operating Reactors. The public... for public comment Draft Generic Letter 2011-XX: Seismic Risk Evaluations for Operating Reactors...

  15. Using the Framingham Risk Score to Evaluate Immigrant Effect on Cardiovascular Disease Risk in Mexican Americans

    PubMed Central

    Salinas, Jennifer J.; Abdelbary, Bassent; Wilson, Jeffrey; Hossain, Monir; Fisher-Hoch, Susan; McCormick, Joseph

    2013-01-01

    Background This study uses the Framingham Risk Score (FRS) for 10-year cardiovascular disease (CVD) to evaluate differences between Mexican American immigrants and the U.S.-born population. Methods and Results Data from the Cameron County Hispanic Cohort (N=1,559). Average total risk scores were generated by age group for each gender. Regression analysis was conducted adjusting for covariates and interaction effects. Both women and men in the CCHC sample who were long-term immigrant residents (mean FRS scores women 4.2 with p<.001 vs. men 4.0 with p<.001) or born in the U.S. (mean FRS scores women 4.6 with p<.001 vs. men 3.3 with p<.001) had significantly higher risk scores than immigrants who had only been in this country for less than 10 years. The interaction model indicates that differences between immigrant and native-born Mexican Americans are most greatly felt at lowest levels of socioeconomic status for men in the CCHC. Conclusions This study suggests that in terms of immigrant advantage in CVD risk, on whom, where, and how the comparisons are being made have important implications for the degree of difference observed. PMID:22643615

  16. A framework and case studies for evaluation of enzyme ontogeny in children's health risk evaluation.

    PubMed

    Ginsberg, Gary; Vulimiri, Suryanarayana V; Lin, Yu-Sheng; Kancherla, Jayaram; Foos, Brenda; Sonawane, Babasaheb

    2017-01-01

    Knowledge of the ontogeny of Phase I and Phase II metabolizing enzymes may be used to inform children's vulnerability based upon likely differences in internal dose from xenobiotic exposure. This might provide a qualitative assessment of toxicokinetic (TK) variability and uncertainty pertinent to early lifestages and help scope a more quantitative physiologically based toxicokinetic (PBTK) assessment. Although much is known regarding the ontogeny of metabolizing systems, this is not commonly utilized in scoping and problem formulation stage of human health risk evaluation. A framework is proposed for introducing this information into problem formulation which combines data on enzyme ontogeny and chemical-specific TK to explore potential child/adult differences in internal dose and whether such metabolic differences may be important factors in risk evaluation. The framework is illustrated with five case study chemicals, including some which are data rich and provide proof of concept, while others are data poor. Case studies for toluene and chlorpyrifos indicate potentially important child/adult TK differences while scoping for acetaminophen suggests enzyme ontogeny is unlikely to increase early-life risks. Scoping for trichloroethylene and aromatic amines indicates numerous ways that enzyme ontogeny may affect internal dose which necessitates further evaluation. PBTK modeling is a critical and feasible next step to further evaluate child-adult differences in internal dose for a number of these chemicals.

  17. Evaluation of Periodontal Risk in Adult Patients using Two Different Risk Assessment Models – A Pilot Study

    PubMed Central

    Bade, Shruthi; Bollepalli, Appaiah Chowdary; Katuri, Kishore Kumar; Devulapalli, Narasimha Swamy; Swarna, Chakrapani

    2015-01-01

    Objective: The aim of the present study was to evaluate the periodontal risk of individuals using periodontal risk assessment (PRA) model and modified PRA model. Materials and Methods: A total of 50 patients with chronic periodontitis, age 30-60 years were selected randomly and charting of the periodontal status was performed and those who met the inclusion criteria were enrolled in the study. Parameters recorded were- percentage of sites with bleeding on probing (BOP), number of sites with pocket depths (PD) ≥ 5mm, number of the teeth lost, bone loss (BL)/age ratio, Clinical attachment loss(CAL)/age ratio, diabetic and smoking status, dental status, systemic factors like diabetes were assessed. All the risk factors were plotted on the radar chart in (PRA) and (mPRA) models, using Microsoft excel and periodontal risk were categorized as low, moderate and high risk. Results: Among 50 patients 31 were in low risk, 9 in moderate risk, and 10 in high risk identified by modified (PRA) model, whereas 28 patients were in low risk, 13 in moderate risk and 9 in high risk identified by (PRA). Statistical analysis demonstrated that there was no significant difference between the risk scores (X2 = 0.932 with degree of freedom = 2, P = 0.627). Conclusion: Both the periodontal risk models are effective in evaluating the risk factors and can be useful tool for predicting proper diagnosis, disease progression and therapeutic strategies during the supportive periodontal therapy. PMID:25859520

  18. Evaluation of ergonomic risk factors among veterinary ultrasonographers.

    PubMed

    Randall, Elissa; Hansen, Chad; Gilkey, David; Patil, Anuja; Bachand, Annette; Rosecrance, John; Douphrate, David

    2012-01-01

    Between 65% and 91% of human-patient sonographers report musculoskeletal symptoms related to their work activities. Ergonomic risk factors associated with musculoskeletal symptoms and musculoskeletal disorders (MSDs) include force, repetition, and awkward postures of the upper extremities. We hypothesized that veterinary sonographers experience similar risk factor exposures as their colleagues in human-patient sonography, and that work-related exposures may lead to similar prevalence of musculoskeletal symptoms and disorders. The Occupational Safety and Health Administration and Society of Diagnostic Medical Sonography published MSD prevention guidelines in 2003. Similar guidance for sonographers examining animal patients does not exist. This cross-sectional study was designed to evaluate the prevalence of musculoskeletal symptoms among veterinary sonographers and identify reported risk factors. A 59-item survey questionnaire was administered via email to veterinary specialists likely to perform ultrasound. Musculoskeletal pain related to performing ultrasound exams was reported by 62% of the respondents. Musculoskeletal symptoms were significantly associated with female gender (odds ratio [OR], 4.55; 95% confidence interval [CI], 2.04-10.19), age (OR, 1.06; 95% CI, 1.01, 1.10), previous work-related trauma (OR, 6.86; 95% CI, 1.71, 27.40), not consistently using a normal height chair (OR, 2.63; 95% CI, 1.19, 5.80), and 15°-45° abduction of shoulder (OR, 2.34; 95% CI, 1.11, 4.92) . It was concluded that the prevalence of musculoskeletal symptoms among veterinary sonographers was similar to that occurring in human-patient sonographers. © 2012 Veterinary Radiology & Ultrasound. © 2012 Veterinary Radiology & Ultrasound.

  19. Vaccine safety evaluation: Practical aspects in assessing benefits and risks.

    PubMed

    Di Pasquale, Alberta; Bonanni, Paolo; Garçon, Nathalie; Stanberry, Lawrence R; El-Hodhod, Mostafa; Tavares Da Silva, Fernanda

    2016-12-20

    Vaccines are different from most medicines in that they are administered to large and mostly healthy populations including infants and children, so there is a low tolerance for potential risks or side-effects. In addition, the long-term benefits of immunisation in reducing or eliminating infectious diseases may induce complacency due to the absence of cases. However, as demonstrated in recent measles outbreaks in Europe and United States, reappearance of the disease occurs as soon as vaccine coverage falls. Unfounded vaccine scares such as those associating the combined measles-mumps-rubella vaccine with autism, and whole-cell pertussis vaccines with encephalopathy, can also have massive impacts, resulting in reduced vaccine uptake and disease resurgence. The safety assessment of vaccines is exhaustive and continuous; beginning with non-clinical evaluation of their individual components in terms of purity, stability and sterility, continuing throughout the clinical development phase and entire duration of use of the vaccine; including post-approval. The breadth and depth of safety assessments conducted at multiple levels by a range of independent organizations increases confidence in the rigour with which any potential risks or side-effects are investigated and managed. Industry, regulatory agencies, academia, the medical community and the general public all play a role in monitoring vaccine safety. Within these stakeholder groups, the healthcare professional and vaccine provider have key roles in the prevention, identification, investigation and management of adverse events following immunisation (AEFI). Guidelines and algorithms aid in determining whether AEFI may have been caused by the vaccine, or whether it is coincidental to it. Healthcare providers are encouraged to rigorously investigate AEFIs and to report them via local reporting processes. The ultimate objective for all parties is to ensure vaccines have a favourable benefit-risk profile. Copyright

  20. Risk stratification of children being evaluated for intussusception.

    PubMed

    Weihmiller, Sarah N; Buonomo, Carlo; Bachur, Richard

    2011-02-01

    Intussusception is the most common cause of intestinal obstruction in young children, and delayed diagnosis may lead to bowel perforation. To determine predictive clinical criteria and develop a decision tree to risk-stratify children with possible intussusception. This is a prospective observational cohort study of children aged 1 month to 6 years who presented with possible intussusception. A data-collection form was completed before knowledge of any advanced imaging. Univariate analysis was performed, and decision trees were developed using recursive partitioning. In the study, 310 patients were enrolled, including 38 (12.3%) with intussusception. The median age was 21.1 months and 61% were male. Univariate predictors of intussusception included age older than 6 months (P = 0.04), male gender (P = .007), history of lethargy (P = .001), and abnormal plain x-ray (P = .0001). Multivariate analysis through recursive partitioning identified decision trees (with and without the result of a plain abdominal x-ray) and allowed identification of patients at low risk. The decision tree based on the results of an abdominal x-ray (negative or positive), age (≤ 5 or >5 months), diarrhea (present or absent), and bilious emesis (present or absent) had the best test performance (sensitivity: 97% [95% confidence interval (CI): 86-100]; negative predictive value: 99% [95% CI: 93-100]; negative likelihood ratio: 0.08 [95% CI: 0.01-0.6]). Among children who were being evaluated for intussusception, we prospectively determined clinical criteria and developed a decision tree to risk-stratify children with possible intussusception.

  1. Risk evaluation of uranium mining: A geochemical inverse modelling approach

    NASA Astrophysics Data System (ADS)

    Rillard, J.; Zuddas, P.; Scislewski, A.

    2011-12-01

    It is well known that uranium extraction operations can increase risks linked to radiation exposure. The toxicity of uranium and associated heavy metals is the main environmental concern regarding exploitation and processing of U-ore. In areas where U mining is planned, a careful assessment of toxic and radioactive element concentrations is recommended before the start of mining activities. A background evaluation of harmful elements is important in order to prevent and/or quantify future water contamination resulting from possible migration of toxic metals coming from ore and waste water interaction. Controlled leaching experiments were carried out to investigate processes of ore and waste (leached ore) degradation, using samples from the uranium exploitation site located in Caetité-Bahia, Brazil. In experiments in which the reaction of waste with water was tested, we found that the water had low pH and high levels of sulphates and aluminium. On the other hand, in experiments in which ore was tested, the water had a chemical composition comparable to natural water found in the region of Caetité. On the basis of our experiments, we suggest that waste resulting from sulphuric acid treatment can induce acidification and salinization of surface and ground water. For this reason proper storage of waste is imperative. As a tool to evaluate the risks, a geochemical inverse modelling approach was developed to estimate the water-mineral interaction involving the presence of toxic elements. We used a method earlier described by Scislewski and Zuddas 2010 (Geochim. Cosmochim. Acta 74, 6996-7007) in which the reactive surface area of mineral dissolution can be estimated. We found that the reactive surface area of rock parent minerals is not constant during time but varies according to several orders of magnitude in only two months of interaction. We propose that parent mineral heterogeneity and particularly, neogenic phase formation may explain the observed variation of the

  2. Evaluation of Attention-Deficit Hyperactivity Disorder Risk Factors

    PubMed Central

    Golmirzaei, Javad; Namazi, Shole; Amiri, Shahrokh; Zare, Shahram; Rastikerdar, Najme; Hesam, Ali Akbar; Rahami, Zahra; Ghasemian, Fatemeh; Namazi, Seyyed Shojaeddin; Paknahad, Abbas; Mahmudi, Forugh; Mahboobi, Hamidreza; Khorgoei, Tahereh; Niknejad, Bahareh; Dehghani, Fatemeh; Asadi, Shima

    2013-01-01

    Background. Attention-deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders among children. The aim of this study was to evaluate risk factors for ADHD in children. Method. In this case-control study, 404 children between 4 and 11 years old were selected by cluster sampling method from preschool children (208 patients as cases and 196 controls). All the participants were interviewed by a child and adolescent psychiatrist to survey risk factors of ADHD. Results. Among cases, 59.3% of children were boys and 38.4% were girls, which is different to that in control group with 40.7% boys and 61.6% girls. The chi-square showed statistically significance (P value < 0.0001). The other significant factors by chi-square were fathers' somatic or psychiatric disease (P value < 0.0001), history of trauma and accident during pregnancy (P value = 0.039), abortion proceeds (P value < 0.0001), unintended pregnancy (P value < 0.0001), and history of head trauma (P value < 0.0001). Conclusions. Findings of our study suggest that maternal and paternal adverse events were associated with ADHD symptoms, but breast feeding is a protective factor. PMID:24319465

  3. Evaluation of the risks of chemotherapy in dogs with thrombocytopenia.

    PubMed

    Finlay, J; Wyatt, K; Black, M

    2017-03-01

    Thrombocytopenia is commonly encountered in veterinary oncology. Currently, there are no standard guidelines regarding the administration of chemotherapy to the patients with thrombocytopenia. This observational epidemiological cohort study aimed to determine whether thrombocytopenic dogs were at increased risk of gastrointestinal adverse effects (vomiting, diarrhoea, inappetence) or haemorrhage following administration of standard doses of chemotherapy. The adverse effects following 77 prospectively identified episodes of thrombocytopenia (platelet count, <200 000 µL(-1) ) were compared with the adverse effects experienced in a retrospective cohort (platelet count >200 000 µL(-1) ), and evaluated by statistical analysis. Overall, there was no statistically significant difference in the incidence of gastrointestinal adverse effects or haemorrhage between thrombocytopenic and control dogs. The control group of dogs with lymphoma were statistically more likely to experience vomiting as an adverse effect of chemotherapy (P = 0.028). The results presented here showed no evidence for an increased risk of gastrointestinal adverse effects or haemorrhage in thrombocytopenic dogs after receiving standard doses of chemotherapy. © 2015 John Wiley & Sons Ltd.

  4. Evaluating the risk of Schistosoma mansoni transmission in mainland China.

    PubMed

    Qu, Guoli; Wang, Wei; Lu, Xiaomin; Dai, Jianrong; Li, Xiaoheng; Liang, Yousheng

    2016-12-01

    Biomphalaria straminea, an intermediate host of Schistosoma mansoni, is predominantly distributed in the South Americas and Caribbean; however, this snail, as an invasive species, was introduced to Shenzhen, southern China, in 1981, and recent epidemiologic surveys demonstrate that the distribution of B. straminea has expanded across the Zhujiang River Basin, South China. In the presence of continuous importation of S. mansoni-infected cases, there is a growing concern about the transmission of S. mansoni in China. To evaluate the risk of S. mansoni transmission in China, we tested the compatibility of B. straminea captured from the snail habitats in southern China with S. mansoni in laboratory. We detected no S. mansoni infections in B. straminea following exposure to the parasite larvae at snail/miracidium ratios of 1:5, 1:10, 1:20, 1:40, and 1:80, while 6.7 to 66.7 % infections occurred in the control Biomphalaria glabrata depending on the ratio. The results of the present study demonstrate that the invasive B. straminea snails seem to be incompatible with S. mansoni, suggesting a low risk of S. mansoni transmission in mainland China.

  5. Evaluation of Risk Perception and Risk-Comparison Information Regarding Dietary Radionuclides after the 2011 Fukushima Nuclear Power Plant Accident.

    PubMed

    Murakami, Michio; Nakatani, Jun; Oki, Taikan

    2016-01-01

    In the wake of the 2011 Fukushima Daiichi Nuclear Power Station accident, to facilitate evidence-based risk communication we need to understand radiation risk perception and the effectiveness of risk-comparison information. We measured and characterized perceptions of dread risks and unknown risks regarding dietary radionuclides in residents of Fukushima, Tokyo, and Osaka to identify the primary factors among location, evacuation experience, gender, age, employment status, absence/presence of spouse, children and grandchildren, educational background, humanities/science courses, smoking habits, and various types of trustworthy information sources. We then evaluated the effects of these factors and risk-comparison information on multiple outcomes, including subjective and objective understanding, perceived magnitude of risk, perceived accuracy of information, backlash against information, and risk acceptance. We also assessed how risk-comparison information affected these multiple outcomes for people with high risk perception. Online questionnaires were completed by people (n = 9249) aged from 20 to 69 years in the three prefectures approximately 5 years after the accident. We gave each participant one of 15 combinations of numerical risk data and risk-comparison information, including information on standards, smoking-associated risk, and cancer risk, in accordance with Covello's guidelines. Dread-risk perception among Fukushima residents with no experience of evacuation was much lower than that in Osaka residents, whereas evacuees had strikingly higher dread-risk perception, irrespective of whether their evacuation had been compulsory or voluntary. We identified location (distance from the nuclear power station), evacuation experience, and trust of central government as primary factors. Location (including evacuation experience) and trust of central government were significantly associated with the multiple outcomes above. Only information on "cancer risk from

  6. Evaluation of the Dutch environmental risk limits for metals by application of the added risk approach

    SciTech Connect

    Crommentuijn, T.; Polder, M.; Sijm, D.; Bruijn, J. De; Plassche, E. Van De

    2000-06-01

    Recently, environmental quality standards (EQSs) that include background concentrations for metals have been set in The Netherlands. These EQSs are based on environmental risk limits and applying the added risk approach. the add risk approach was developed to incorporate the background concentration of naturally occurring substances such as metals in environmental risk limits. The original approach discriminates between the bioavailable and unavailable fraction and calculates a permissible concentration that can be added to a background concentration, i.e., the maximum permissible addition (MPA). This MPA includes the effects caused by the bioavailable fraction of the background concentration. The new EQSs in The Netherlands assume the bioavailable fraction of background metals is mathematically equal to zero. The rationale for this assumption is that, from an environmental policy perspective, background-related effects that in reality do exist, are desirable because they may in theory lead to increased ecosystem variability or biodiversity. Moreover, there is little information on the bioavailability of background concentrations of metals. This paper presents a theoretical exercise in which the effects of varying background bioavailability on MPA values for cadmium, copper, lead, and zinc in water and soil are evaluated. The results show that, for these metals, bioavailability does not affect or only slightly affects the MPAs. Only the terrestrial MPAs for copper, lead, and zinc are sensitive to bioavailability. This minor influence of assumed percentage bioavailability on the MPAs, coupled with a policy-driven assumption that effects of background concentrations should be ignored, explain the current policy in The Netherlands that the bioavailability of background concentrations of metals should be assumed to be zero.

  7. Screening for colorectal cancer: possible improvements by risk assessment evaluation?

    PubMed

    Nielsen, Hans J; Jakobsen, Karen V; Christensen, Ib J; Brünner, Nils

    2011-11-01

    Emerging results indicate that screening improves survival of patients with colorectal cancer. Therefore, screening programs are already implemented or are being considered for implementation in Asia, Europe and North America. At present, a great variety of screening methods are available including colono- and sigmoidoscopy, CT- and MR-colonography, capsule endoscopy, DNA and occult blood in feces, and so on. The pros and cons of the various tests, including economic issues, are debated. Although a plethora of evaluated and validated tests even with high specificities and reasonable sensitivities are available, an international consensus on screening procedures is still not established. The rather limited compliance in present screening procedures is a significant drawback. Furthermore, some of the procedures are costly and, therefore, selection methods for these procedures are needed. Current research into improvements of screening for colorectal cancer includes blood-based biological markers, such as proteins, DNA and RNA in combination with various demographically and clinically parameters into a "risk assessment evaluation" (RAE) test. It is assumed that such a test may lead to higher acceptance among the screening populations, and thereby improve the compliances. Furthermore, the involvement of the media, including social media, may add even more individuals to the screening programs. Implementation of validated RAE and progressively improved screening methods may reform the cost/benefit of screening procedures for colorectal cancer. Therefore, results of present research, validating RAE tests, are awaited with interest.

  8. Probabilistic evaluation of uncertainties and risks in aerospace components

    NASA Technical Reports Server (NTRS)

    Shah, A. R.; Shiao, M. C.; Nagpal, V. K.; Chamis, C. C.

    1992-01-01

    This paper summarizes a methodology developed at NASA Lewis Research Center which computationally simulates the structural, material, and load uncertainties associated with Space Shuttle Main Engine (SSME) components. The methodology was applied to evaluate the scatter in static, buckling, dynamic, fatigue, and damage behavior of the SSME turbo pump blade. Also calculated are the probability densities of typical critical blade responses, such as effective stress, natural frequency, damage initiation, most probable damage path, etc. Risk assessments were performed for different failure modes, and the effect of material degradation on the fatigue and damage behaviors of a blade were calculated using a multi-factor interaction equation. Failure probabilities for different fatigue cycles were computed and the uncertainties associated with damage initiation and damage propagation due to different load cycle were quantified. Evaluations on the effects of mistuned blades on a rotor were made; uncertainties in the excitation frequency were found to significantly amplify the blade responses of a mistuned rotor. The effects of the number of blades on a rotor were studied. The autocorrelation function of displacements and the probability density function of the first passage time for deterministic and random barriers for structures subjected to random processes also were computed. A brief discussion was included on the future direction of probabilistic structural analysis.

  9. Evaluation of Risk Perception and Risk-Comparison Information Regarding Dietary Radionuclides after the 2011 Fukushima Nuclear Power Plant Accident

    PubMed Central

    Murakami, Michio; Nakatani, Jun; Oki, Taikan

    2016-01-01

    In the wake of the 2011 Fukushima Daiichi Nuclear Power Station accident, to facilitate evidence-based risk communication we need to understand radiation risk perception and the effectiveness of risk-comparison information. We measured and characterized perceptions of dread risks and unknown risks regarding dietary radionuclides in residents of Fukushima, Tokyo, and Osaka to identify the primary factors among location, evacuation experience, gender, age, employment status, absence/presence of spouse, children and grandchildren, educational background, humanities/science courses, smoking habits, and various types of trustworthy information sources. We then evaluated the effects of these factors and risk-comparison information on multiple outcomes, including subjective and objective understanding, perceived magnitude of risk, perceived accuracy of information, backlash against information, and risk acceptance. We also assessed how risk-comparison information affected these multiple outcomes for people with high risk perception. Online questionnaires were completed by people (n = 9249) aged from 20 to 69 years in the three prefectures approximately 5 years after the accident. We gave each participant one of 15 combinations of numerical risk data and risk-comparison information, including information on standards, smoking-associated risk, and cancer risk, in accordance with Covello’s guidelines. Dread-risk perception among Fukushima residents with no experience of evacuation was much lower than that in Osaka residents, whereas evacuees had strikingly higher dread-risk perception, irrespective of whether their evacuation had been compulsory or voluntary. We identified location (distance from the nuclear power station), evacuation experience, and trust of central government as primary factors. Location (including evacuation experience) and trust of central government were significantly associated with the multiple outcomes above. Only information on “cancer risk from

  10. Control of Risks Through the Use of Procedures: A Method for Evaluating the Change in Risk

    NASA Technical Reports Server (NTRS)

    Praino, Gregory T.; Sharit, Joseph

    2010-01-01

    not. The model used for describing the Failure Likelihood considers how well a task was established by evaluating that task on five components. The components selected to define a well established task are: that it be defined, assigned to someone capable, that they be trained appropriately, that the actions be organized to enable proper completion and that some form of independent monitoring be performed. Validation of the method was based on the information provided by a group of experts in Space Shuttle ground processing when they were presented with 5 scenarios that identified a clause from a procedure. For each scenario, they recorded their perception of how important the associated rule was and how likely it was to fail. They then rated the components of Control Value and Failure Likelihood for all the scenarios. The order in which each reviewer ranked the scenarios Control Value and Failure Likelihood was compared to the order in which they ranked the scenarios for each of the associated components; inevitability and opportunity for Control Value and definition, assignment, training, organization and monitoring for Failure Likelihood. This order comparison showed how the components contributed to a relative relationship to the substitute risk element. With the relationship established for Space Shuttle ground processing, this method can be used to gauge if the introduction or removal of a particular rule will increase or decrease the .risk associated with the hazard it is intended to control.

  11. Midregional Proadrenomedullin Improves Risk Stratification beyond Surgical Risk Scores in Patients Undergoing Transcatheter Aortic Valve Replacement

    PubMed Central

    Schuetz, Philipp; Huber, Andreas; Müller, Beat; Maisano, Francesco; Taramasso, Maurizio; Moarof, Igal; Obeid, Slayman; Stähli, Barbara E.; Cahenzly, Martin; Binder, Ronald K.; Liebetrau, Christoph; Möllmann, Helge; Kim, Won-Keun; Hamm, Christian; Lüscher, Thomas F.

    2015-01-01

    Background Conventional surgical risk scores lack accuracy in risk stratification of patients undergoing transcatheter aortic valve replacement (TAVR). Elevated levels of midregional proadrenomedullin (MR-proADM) levels are associated with adverse outcome not only in patients with manifest chronic disease states, but also in the general population. Objectives We investigated the predictive value of MR-proADM for mortality in an unselected contemporary TAVR population. Methods We prospectively included 153 patients suffering from severe aortic stenosis who underwent TAVR from September 2013 to August 2014. This population was compared to an external validation cohort of 205 patients with severe aortic stenosis undergoing TAVR. The primary endpoint was all cause mortality. Results During a median follow-up of 258 days, 17 out of 153 patients who underwent TAVR died (11%). Patients with MR-proADM levels above the 75th percentile (≥ 1.3 nmol/l) had higher mortality (31% vs. 4%, HR 8.9, 95% CI 3.0–26.0, P < 0.01), whereas patients with EuroSCORE II scores above the 75th percentile (> 6.8) only showed a trend towards higher mortality (18% vs. 9%, HR 2.1, 95% CI 0.8–5.6, P = 0.13). The Harrell’s C-statistic was 0.58 (95% CI 0.45–0.82) for the EuroSCORE II, and consideration of baseline MR-proADM levels significantly improved discrimination (AUC = 0.84, 95% CI 0.71–0.92, P = 0.01). In bivariate analysis adjusted for EuroSCORE II, MR-proADM levels ≥1.3 nmol/l persisted as an independent predictor of mortality (HR 9.9, 95% CI (3.1–31.3), P <0.01) and improved the model’s net reclassification index (0.89, 95% CI (0.28–1.59). These results were confirmed in the independent validation cohort. Conclusions Our study identified MR-proADM as a novel predictor of mortality in patients undergoing TAVR. In the future, MR-proADM should be added to the commonly used EuroSCORE II for better risk stratification of patients suffering from severe aortic stenosis. PMID

  12. Proposal of a risk-factor-based analytical approach for integrating occupational health and safety into project risk evaluation.

    PubMed

    Badri, Adel; Nadeau, Sylvie; Gbodossou, André

    2012-09-01

    Excluding occupational health and safety (OHS) from project management is no longer acceptable. Numerous industrial accidents have exposed the ineffectiveness of conventional risk evaluation methods as well as negligence of risk factors having major impact on the health and safety of workers and nearby residents. Lack of reliable and complete evaluations from the beginning of a project generates bad decisions that could end up threatening the very existence of an organization. This article supports a systematic approach to the evaluation of OHS risks and proposes a new procedure based on the number of risk factors identified and their relative significance. A new concept called risk factor concentration along with weighting of risk factor categories as contributors to undesirable events are used in the analytical hierarchy process multi-criteria comparison model with Expert Choice(©) software. A case study is used to illustrate the various steps of the risk evaluation approach and the quick and simple integration of OHS at an early stage of a project. The approach allows continual reassessment of criteria over the course of the project or when new data are acquired. It was thus possible to differentiate the OHS risks from the risk of drop in quality in the case of the factory expansion project.

  13. Evaluation of Risk Factors Associated with Endometriosis in Infertile Women

    PubMed Central

    Ashrafi, Mahnaz; Sadatmahalleh, Shahideh Jahanian; Akhoond, Mohammad Reza; Talebi, Mehrak

    2016-01-01

    Background Endometriosis affects women’s physical and mental wellbeing. Symptoms include dyspareunia, dysmenorrhea, pelvic pain, and infertility. The purpose of this study is to assess the correlation between some relevant factors and symptoms and risk of an endometriosis diagnosis in infertile women. Materials and Methods A retrospective study of 1282 surgical patients in an infertility Institute, Iran between 2011 and 2013 were evaluated by laparoscopy. Of these, there were 341 infertile women with endometriosis (cases) and 332 infertile women with a normal pelvis (comparison group). Chi-square and t tests were used to compare these two groups. Logistic regression was done to build a prediction model for an endometriosis diagnosis. Results Gravidity [odds ratio (OR): 0.8, confidence interval (CI): 0.6-0.9, P=0.01], parity (OR: 0.7, CI: 0.6-0.9, P=0.01), family history of endometriosis (OR: 4.9, CI: 2.1-11.3, P<0.001), history of galactorrhea (OR: 2.3, CI: 1.5-3.5, P=0.01), history of pelvic surgery (OR: 1.9, CI: 1.3-2.7, P<0.001), and shorter menstrual cycle length (OR: 0.9, CI: 0.9-0.9, P=0.04) were associated with endometriosis. Duration of natural menstruation and age of menarche were not correlated with subsequent risk of endometriosis (P>0.05). Fatigue, diarrhea, constipation, dysmenorrhea, dyspareunia, pelvic pain and premenstrual spotting were more significant among late-stage endometriosis patients than in those with early-stage endometriosis and more prevalent among patients with endometriosis than that of the comparison group. In the logistic regression model, gravidity, family history of endometriosis, history of galactorrhea, history of pelvic surgery, dysmenorrhoea, pelvic pain, dysparaunia, premenstrual spotting, fatigue, and diarrhea were significantly associated with endometriosis. However, the number of pregnancies was negatively related to endometriosis. Conclusion Endometriosis is a considerable public health issue because it affects many

  14. 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.

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

    PubMed

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

    2017-08-04

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

  16. METHODOLOGY FOR THE EVALUATION OF CUMULATIVE EPISODIC EXPOSURE TO CHEMICAL STRESSORS IN AQUATIC RISK ASSESSMENT.

    EPA Science Inventory

    An ecological risk assessment method was developed to evaluate the magnitude, duration, and episodic nature of chemical stressors on aquatic communities. The percent of an ecosystem's species at risk from a designated chemical exposure scenario is generated. In effects assessment...

  17. METHODOLOGY FOR THE EVALUATION OF CUMULATIVE EPISODIC EXPOSURE TO CHEMICAL STRESSORS IN AQUATIC RISK ASSESSMENT.

    EPA Science Inventory

    An ecological risk assessment method was developed to evaluate the magnitude, duration, and episodic nature of chemical stressors on aquatic communities. The percent of an ecosystem's species at risk from a designated chemical exposure scenario is generated. In effects assessment...

  18. Interactive graphics for expressing health risks: development and qualitative evaluation.

    PubMed

    Ancker, Jessica S; Chan, Connie; Kukafka, Rita

    2009-01-01

    Recent findings suggest that interactive game-like graphics might be useful in communicating probabilities. We developed a prototype for a risk communication module, focusing on eliciting users' preferences for different interactive graphics and assessing usability and user interpretations. Feedback from five focus groups was used to design the graphics. The final version displayed a matrix of square buttons; clicking on any button allowed the user to see whether the stick figure underneath was affected by the health outcome. When participants used this interaction to learn about a risk, they expressed more emotional responses, both positive and negative, than when viewing any static graphic or numerical description of a risk. Their responses included relief about small risks and concern about large risks. The groups also commented on static graphics: arranging the figures affected by disease randomly throughout a group of figures made it more difficult to judge the proportion affected but often was described as more realistic. Interactive graphics appear to have potential for expressing risk magnitude as well as the feeling of risk. This affective impact could be useful in increasing perceived threat of high risks, calming fears about low risks, or comparing risks. Quantitative studies are planned to assess the effect on perceived risks and estimated risk magnitudes.

  19. Relative risk site evaluations for Yakima Training Center

    SciTech Connect

    Smith, R.M.; Whelan, G.

    1996-11-01

    All 20 U.S. Army Yakima Training Center (YTC) sites evaluated were given a `low` relative risk. At Solid Waste Management Unit (SWMU) 22, a `minimum` soils contaminant hazard factor was assigned even though 6,700 mg/kg TPH-diesel was found in surface soil. SWMU 22 is physically located on top of and with the fence surrounding Area of Concern (AOC) 4. Because the diesel is most likely associated with AOC 4, and plans are to clean up AOC 4, any further actions regarding these contaminated soils should be addressed as part of the planned actions for AOC 4. Contaminant hazard factors of `moderate` were assigned to the soil pathway for SWMUs 4 and 7 because dieldrin and arsenic, respectively, were found in surface soil samples at concentrations exceeding standards. A `moderate` contaminant hazard factor was also assigned to the sediment pathway for AOC 1 because arsenic detected in sediments in `Larry`s Swimming Pool` exceeded the standard. All other contaminant hazard factors were rated as minimal. The receptor factor for all sites and pathways was rated `limited,` except for SWMU 54 in which the groundwater receptor factor was rated `potential.` A `potential` rating was assigned to the groundwater pathway at this site to be conservative. The site is located on the south side of the syncline axis where the unconfined aquifer may be present and there are no monitoring wells at the site to confirm or deny the presence of groundwater contamination.

  20. Validation of transcatheter aortic valve implantation risk scores in relation to early and mid-term survival: a single-centre study

    PubMed Central

    Collas, Valérie M.; Van De Heyning, Caroline M.; Paelinck, Bernard P.; Rodrigus, Inez E.; Vrints, Christiaan J.; Bosmans, Johan M.

    2016-01-01

    OBJECTIVES The aim of this study was to validate recently proposed risk scores for the prediction of mortality up to 1 year after transcatheter aortic valve implantation (TAVI), using a self-expandable valve (CoreValve). METHODS In this single-centre study, 225 consecutive patients with severe symptomatic aortic valve stenosis, who underwent TAVI between December 2007 and January 2015, were included. Conventional surgical risk scores (logistic EuroSCORE, EuroSCORE II and STS score) were calculated as well as newly proposed TAVI risk scores (TAVI2-SCORe, STT Score and OBSERVANT score). Medium-term survival of the patients was assessed up to 1 year after TAVI. RESULTS The median age was 82 (77–86) years and 45.3% were male. Patients were categorized into ‘non-high risk’ or ‘high risk’ according to logistic EuroSCORE >20%, EuroSCORE II >8%, STS score >10%, TAVI2-SCORe >2, STT score >12% and OBSERVANT score >6. Thirty-day and 1-year survival rates were significantly different between ‘non-high-risk’ and ‘high-risk’ patients according to the STS score (1 year: low: 84.4% vs high: 67.0%, P = 0.010) and according to OBSERVANT score (1 year: low: 85.2% vs high: 68.4%, P = 0.005). In contrast, TAVI2-SCORe and STT score did not discriminate ‘non-high-risk’ and ‘high-risk’ patients. This was confirmed by Cox regression analysis [STS score >10%: hazard ratio: 2.484 (1.206–5.115), P = 0.014; OBSERVANT score >6: hazard ratio: 2.532 (1.295–4.952), P = 0.007]. CONCLUSIONS In this single-centre study, OBSERVANT and STS score most accurately predicted early and mid-term survival in patients undergoing TAVI, using a self-expandable valve (CoreValve). PMID:26689444

  1. Occupational health and safety: Designing and building with MACBETH a value risk-matrix for evaluating health and safety risks

    NASA Astrophysics Data System (ADS)

    Lopes, D. F.; Oliveira, M. D.; Costa, C. A. Bana e.

    2015-05-01

    Risk matrices (RMs) are commonly used to evaluate health and safety risks. Nonetheless, they violate some theoretical principles that compromise their feasibility and use. This study describes how multiple criteria decision analysis methods have been used to improve the design and the deployment of RMs to evaluate health and safety risks at the Occupational Health and Safety Unit (OHSU) of the Regional Health Administration of Lisbon and Tagus Valley. ‘Value risk-matrices’ (VRMs) are built with the MACBETH approach in four modelling steps: a) structuring risk impacts, involving the construction of descriptors of impact that link risk events with health impacts and are informed by scientific evidence; b) generating a value measurement scale of risk impacts, by applying the MACBETH-Choquet procedure; c) building a system for eliciting subjective probabilities that makes use of a numerical probability scale that was constructed with MACBETH qualitative judgments on likelihood; d) and defining a classification colouring scheme for the VRM. A VRM built with OHSU members was implemented in a decision support system which will be used by OHSU members to evaluate health and safety risks and to identify risk mitigation actions.

  2. Evaluation of severe accident risks: Quantification of major input parameters

    SciTech Connect

    Harper, F.T.; Breeding, R.J.; Brown, T.D.; Gregory, J.J.; Jow, H.N.; Payne, A.C.; Gorham, E.D. ); Amos, C.N. ); Helton, J. ); Boyd, G. )

    1992-06-01

    In support of the Nuclear Regulatory Commission's (NRC's) assessment of the risk from severe accidents at commercial nuclear power plants in the US reported in NUREG-1150, the Severe Accident Risk Reduction Program (SAARP) has completed a revised calculation of the risk to the general public from severe accidents at five nuclear power plants: Surry, Sequoyah, Zion, Peach Bottom and Grand Gulf. The emphasis in this risk analysis was not on determining a point estimate of risk, but to determine the distribution of risk, and to assess the uncertainties that account for the breadth of this distribution. Off-site risk initiation by events, both internal to the power station and external to the power station. Much of this important input to the logic models was generated by expert panels. This document presents the distributions and the rationale supporting the distributions for the questions posed to the Source Term Panel.

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

    SciTech Connect

    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. 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.

  4. Systematic Review of Health Economic Impact Evaluations of Risk Prediction Models: Stop Developing, Start Evaluating.

    PubMed

    van Giessen, Anoukh; Peters, Jaime; Wilcher, Britni; Hyde, Chris; Moons, Carl; de Wit, Ardine; Koffijberg, Erik

    2017-04-01

    Although health economic evaluations (HEEs) are increasingly common for therapeutic interventions, they appear to be rare for the use of risk prediction models (PMs). To evaluate the current state of HEEs of PMs by performing a comprehensive systematic review. Four databases were searched for HEEs of PM-based strategies. Two reviewers independently selected eligible articles. A checklist was compiled to score items focusing on general characteristics of HEEs of PMs, model characteristics and quality of HEEs, evidence on PMs typically used in the HEEs, and the specific challenges in performing HEEs of PMs. After screening 791 abstracts, 171 full texts, and reference checking, 40 eligible HEEs evaluating 60 PMs were identified. In these HEEs, PM strategies were compared with current practice (n = 32; 80%), to other stratification methods for patient management (n = 19; 48%), to an extended PM (n = 9; 23%), or to alternative PMs (n = 5; 13%). The PMs guided decisions on treatment (n = 42; 70%), further testing (n = 18; 30%), or treatment prioritization (n = 4; 7%). For 36 (60%) PMs, only a single decision threshold was evaluated. Costs of risk prediction were ignored for 28 (46%) PMs. Uncertainty in outcomes was assessed using probabilistic sensitivity analyses in 22 (55%) HEEs. Despite the huge number of PMs in the medical literature, HEE of PMs remains rare. In addition, we observed great variety in their quality and methodology, which may complicate interpretation of HEE results and implementation of PMs in practice. Guidance on HEE of PMs could encourage and standardize their application and enhance methodological quality, thereby improving adequate use of PM strategies. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  5. Risk perception, risk evaluation and human values: Cognitive bases acceptability of a radioactive waste repository

    NASA Astrophysics Data System (ADS)

    Earle, T. C.; Lindell, M. K.; Rankin, W. L.; Nealey, S. M.

    1981-07-01

    Public acceptance of radioactive waste management alternatives depends in part on public perception of the associated risks. Three aspects of those perceived risks were explored: (1) synthetic measures of risk perception based on judgments of probability and consequences; (2) acceptability of hypothetical radioactive waste policies; and (3) effects of human values on risk perception. Both the work on synthetic measures of risk perception and on the acceptability of hypothetical policies included investigations of three categories of risk: short term public risk (affecting persons living when the wastes are created), long term public risk (affecting persons living after the time the wastes were created), and occupational risk (affecting persons working with the radioactive wastes). The human values work related to public risk perception in general, across categories of persons affected. Respondents were selected according to a purposive sampling strategy.

  6. Risk perception, risk evaluation and human values: cognitive bases of acceptability of a radioactive waste repository

    SciTech Connect

    Earle, T.C.; Lindell, M.K.; Rankin, W.L.

    1981-07-01

    Public acceptance of radioactive waste management alternatives depends in part on public perception of the associated risks. Three aspects of those perceived risks were explored in this study: (1) synthetic measures of risk perception based on judgments of probability and consequences; (2) acceptability of hypothetical radioactive waste policies, and (3) effects of human values on risk perception. Both the work on synthetic measures of risk perception and on the acceptability of hypothetical policies included investigations of three categories of risk: (1) Short-term public risk (affecting persons living when the wastes are created), (2) Long-term public risk (affecting persons living after the time the wastes were created), and (3) Occupational risk (affecting persons working with the radioactive wastes). The human values work related to public risk perception in general, across categories of persons affected. Respondents were selected according to a purposive sampling strategy.

  7. Evaluation of skin cancer risk for lunar and Mars missions

    NASA Astrophysics Data System (ADS)

    Kim, M. Y.; George, K. A.; Cucinotta, F. A.

    Methods for estimating the probability of excess incidence of skin cancer from space radiation exposure, must consider the variability of skin doses at specific anatomical areas, and the individual factors that may contribute to risk projection models, including skin pigment, and synergistic effects from combined ionizing radiation and UV exposure. Using the multiplicative risk model for transferring the Japanese survivor data to the US population, epidemiological data for the increased risk for skin locations exposed to combined UV and ionizing radiation, and models of space radiation environments, transport, and anatomical shielding, we estimate the skin cancer risk for future lunar and Mars missions. Our model projects that individual variations in the probability for increased skin cancer risk varies more than 10-fold and that an excess cancer risk greater than 1% could occur for astronauts with light skin and hair color exposed to medium class solar particle events during future lunar base operations, or from galactic cosmic rays on Mars missions.

  8. Evaluation of risk communication in a mammography patient decision aid.

    PubMed

    Klein, Krystal A; Watson, Lindsey; Ash, Joan S; Eden, Karen B

    2016-07-01

    We characterized patients' comprehension, memory, and impressions of risk communication messages in a patient decision aid (PtDA), Mammopad, and clarified perceived importance of numeric risk information in medical decision making. Participants were 75 women in their forties with average risk factors for breast cancer. We used mixed methods, comprising a risk estimation problem administered within a pretest-posttest design, and semi-structured qualitative interviews with a subsample of 21 women. Participants' positive predictive value estimates of screening mammography improved after using Mammopad. Although risk information was only briefly memorable, through content analysis, we identified themes describing why participants value quantitative risk information, and obstacles to understanding. We describe ways the most complicated graphic was incompletely comprehended. Comprehension of risk information following Mammopad use could be improved. Patients valued receiving numeric statistical information, particularly in pictograph format. Obstacles to understanding risk information, including potential for confusion between statistics, should be identified and mitigated in PtDA design. Using simple pictographs accompanied by text, PtDAs may enhance a shared decision-making discussion. PtDA designers and providers should be aware of benefits and limitations of graphical risk presentations. Incorporating comprehension checks could help identify and correct misapprehensions of graphically presented statistics. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Evaluation of risk communication in a mammography patient decision aid

    PubMed Central

    Klein, Krystal A.; Watson, Lindsey; Ash, Joan S.; Eden, Karen B.

    2016-01-01

    Objectives We characterized patients’ comprehension, memory, and impressions of risk communication messages in a patient decision aid (PtDA), Mammopad, and clarified perceived importance of numeric risk information in medical decision making. Methods Participants were 75 women in their forties with average risk factors for breast cancer. We used mixed methods, comprising a risk estimation problem administered within a pretest–posttest design, and semi-structured qualitative interviews with a subsample of 21 women. Results Participants’ positive predictive value estimates of screening mammography improved after using Mammopad. Although risk information was only briefly memorable, through content analysis, we identified themes describing why participants value quantitative risk information, and obstacles to understanding. We describe ways the most complicated graphic was incompletely comprehended. Conclusions Comprehension of risk information following Mammopad use could be improved. Patients valued receiving numeric statistical information, particularly in pictograph format. Obstacles to understanding risk information, including potential for confusion between statistics, should be identified and mitigated in PtDA design. Practice implications Using simple pictographs accompanied by text, PtDAs may enhance a shared decision-making discussion. PtDA designers and providers should be aware of benefits and limitations of graphical risk presentations. Incorporating comprehension checks could help identify and correct misapprehensions of graphically presented statistics PMID:26965020

  10. Prospective Evaluation of Risk Factors for Male Breast Cancer

    PubMed Central

    Richesson, Douglas A.; Gierach, Gretchen L.; Lacey, James V.; Park, Yikyung; Hollenbeck, Albert R.; Schatzkin, Arthur

    2008-01-01

    Most risk factors for male breast cancer have been derived from retrospective studies that may reflect selective recall. In the prospective National Institutes of Health–AARP Diet and Health Study, we studied 324 920 men, among whom 121 developed breast cancer. Men who reported a first-degree relative with breast cancer had an increased risk of breast cancer (relative risk [RR] = 1.92, 95% confidence interval [CI] = 1.19 to 3.09). Among the medical conditions examined, a new finding emerged regarding increased male breast cancer risk associated with a history of a bone fracture (RR = 2.20, 95% CI = 1.24 to 3.91). Obesity was positively related to risk (RR = 1.79, 95% CI = 1.10 to 2.91, for body mass indices of ≥30 vs <25 kg/m2) and physical activity inversely related, even after adjustment for body mass index. Smokers were at somewhat elevated risk, although trends with smoking characteristics were inconsistent. Alcohol consumption was not related to risk. The identified risk factors show some commonalities with female breast cancer and indicate the importance of hormonal mechanisms. Differences in risk factors may reflect unique mechanisms associated with androgens and their ratio to bioavailable estrogens. PMID:18840816

  11. Diagnosis, risk stratification, and response evaluation in classical myeloproliferative neoplasms.

    PubMed

    Rumi, Elisa; Cazzola, Mario

    2017-02-09

    Philadelphia-negative classical myeloproliferative neoplasms (MPNs) include polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). The 2016 revision of the WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues includes new criteria for the diagnosis of these disorders. Somatic mutations in the 3 driver genes, that is, JAK2, CALR, and MPL, represent major diagnostic criteria in combination with hematologic and morphological abnormalities. PV is characterized by erythrocytosis with suppressed endogenous erythropoietin production, bone marrow panmyelosis, and JAK2 mutation. Thrombocytosis, bone marrow megakaryocytic proliferation, and presence of JAK2, CALR, or MPL mutation are the main diagnostic criteria for ET. PMF is characterized by bone marrow megakaryocytic proliferation, reticulin and/or collagen fibrosis, and presence of JAK2, CALR, or MPL mutation. Prefibrotic myelofibrosis represents an early phase of myelofibrosis, and is characterized by granulocytic/megakaryocytic proliferation and lack of reticulin fibrosis in the bone marrow. The genomic landscape of MPNs is more complex than initially thought and involves several mutant genes beyond the 3 drivers. Comutated, myeloid tumor-suppressor genes contribute to phenotypic variability, phenotypic shifts, and progression to more aggressive disorders. Patients with myeloid neoplasms are at variable risk of vascular complications, including arterial or venous thrombosis and bleeding. Current prognostic models are mainly based on clinical and hematologic parameters, but innovative models that include genetic data are being developed for both clinical and trial settings. In perspective, molecular profiling of MPNs might also allow for accurate evaluation and monitoring of response to innovative drugs that target the mutant clone.

  12. Evaluating the Allergic Risk of Genetically Modified Soybean

    PubMed Central

    Kim, Sang-Ha; Kim, Hyun-Mi; Ye, Young-Min; Kim, Seung-Hyun; Nahm, Dong-Ho; Ryu, Sang-Ryeol; Lee, Bou-Oung

    2006-01-01

    Genetically modified (GM) soybean (carrying the EPSPS transgene) is the most common GM food in Korea. In order to assess whether genetic modification increases the allergenic risk of soybeans, the allergenicity and IgE-reactive components of wild-type and GM soybean extracts were compared in allergic adults who had been sensitized to soybeans. We enrolled 1,716 adult allergy patients and 40 healthy, non-atopic controls. Skin prick tests and IgE enzyme linked immunosorbent assays (ELISAs) were performed using wild-type and GM soybean extracts, along with other common inhaled allergens. The specificities of serum IgE antibodies from allergic patients and the identities of the IgE-reactive components of the soybean extracts were compared using ELISA inhibition testing, 2-dimensional gel electrophoresis, and IgE immunoblotting. To evaluate the effects of digestive enzymes and heat treatment, the soybean extracts were heated or pre- incubated with or without simulated gastric and intestinal fluids. The IgE sensitization rates to wild-type and GM soybeans were identical (3.8% of allergic adults), and circulating IgE antibodies specific for the two extracts were comparable. The results of the ELISA inhibition test, SDS-PAGE, and IgE immunoblotting showed a similar composition of IgE-binding components within the wild-type and GM extracts, which was confirmed using two-dimensional gel electrophoresis, IgE immunoblotting, and amino acid sequencing. None of the subjects had a positive response to purified EPSPS protein in the skin prick test, ELISA, or IgE immunoblot analysis. These findings suggest that the IgE sensitization rate to GM soybean extracts is identical to that of wild-type soybean extracts in adult allergy patients. In addition, based on both in vivo and in vitro methods, the allergenicity of wild type and GM soybean extracts was identical. PMID:16941740

  13. Diagnosis, risk stratification, and response evaluation in classical myeloproliferative neoplasms

    PubMed Central

    2017-01-01

    Philadelphia-negative classical myeloproliferative neoplasms (MPNs) include polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). The 2016 revision of the WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues includes new criteria for the diagnosis of these disorders. Somatic mutations in the 3 driver genes, that is, JAK2, CALR, and MPL, represent major diagnostic criteria in combination with hematologic and morphological abnormalities. PV is characterized by erythrocytosis with suppressed endogenous erythropoietin production, bone marrow panmyelosis, and JAK2 mutation. Thrombocytosis, bone marrow megakaryocytic proliferation, and presence of JAK2, CALR, or MPL mutation are the main diagnostic criteria for ET. PMF is characterized by bone marrow megakaryocytic proliferation, reticulin and/or collagen fibrosis, and presence of JAK2, CALR, or MPL mutation. Prefibrotic myelofibrosis represents an early phase of myelofibrosis, and is characterized by granulocytic/megakaryocytic proliferation and lack of reticulin fibrosis in the bone marrow. The genomic landscape of MPNs is more complex than initially thought and involves several mutant genes beyond the 3 drivers. Comutated, myeloid tumor-suppressor genes contribute to phenotypic variability, phenotypic shifts, and progression to more aggressive disorders. Patients with myeloid neoplasms are at variable risk of vascular complications, including arterial or venous thrombosis and bleeding. Current prognostic models are mainly based on clinical and hematologic parameters, but innovative models that include genetic data are being developed for both clinical and trial settings. In perspective, molecular profiling of MPNs might also allow for accurate evaluation and monitoring of response to innovative drugs that target the mutant clone. PMID:28028026

  14. Packaging and transportation risk management and evaluation plan

    SciTech Connect

    Rhyne, W.R.

    1993-09-01

    Shipments of radioactive materials and hazardous chemicals at the Los Alamos National Laboratory (LANL) are governed by a variety of Federal and state regulations, industrial standards, and LANL processes and procedures. Good judgement is exercised in situations that are not covered by regulations. As a result, the safety record for transporting hazardous materials at LANL has been excellent. However, future decisions should be made such that the decision-making process produces a defensible record of the safety of onsite shipments. This report proposes the development of a risk management tool to meet this need. First, the application of quantitative risk analysis methodology to transportation is presented to provide a framework of understanding. Risk analysis definitions, the basic quantitative risk analysis procedure, quantitative methodologies, transportation data bases, and risk presentation techniques are described. Quantitative risk analysis is frequently complex; but simplified approaches can be used as a management tool to make good decisions. Second, a plan to apply the use of risk management principles to the selection of routes, special administrative controls, and containers for hazardous material transportation at LANL is provided. A risk management tool is proposed that can be used by MAT-2 without substantial support from specialized safety and risk analysis personnel, e.g., HS-3. A workbook approach is proposed that can be automated at a later date. The safety of some types of onsite shipments at LANL is not well documented. Documenting that shipments are safe, i.e., present acceptable risks, will likely require elaborate analyses that should be thoroughly reviewed by safety and risk professionals. These detailed analyses are used as benchmarks and as examples for the use of the proposed tool by MAT-2. Once the benchmarks are established, the workbook can be used by MAT-2 to quantify that safety goals are met by similar shipments.

  15. Evaluating Determinants of Environmental Risk Perception for Risk Management in Contaminated Sites

    PubMed Central

    Janmaimool, Piyapong; Watanabe, Tsunemi

    2014-01-01

    Understanding the differences in the risk judgments of residents of industrial communities potentially provides insights into how to develop appropriate risk communication strategies. This study aimed to explore citizens’ fundamental understanding of risk-related judgments and to identify the factors contributing to perceived risks. An exploratory model was created to investigate the public’s risk judgments. In this model, the relationship between laypeople’s perceived risks and the factors related to the physical nature of risks (such as perceived probability of environmental contamination, probability of receiving impacts, and severity of catastrophic consequences) were examined by means of multiple regression analysis. Psychological factors, such as the ability to control the risks, concerns, experiences, and perceived benefits of industrial development were also included in the analysis. The Maptaphut industrial area in Rayong Province, Thailand was selected as a case study. A survey of 181 residents of communities experiencing different levels of hazardous gas contamination revealed rational risk judgments by inhabitants of high-risk and moderate-risk communities, based on their perceived probability of contamination, probability of receiving impacts, and perceived catastrophic consequences. However, risks assessed by people in low-risk communities could not be rationally explained and were influenced by their collective experiences. PMID:24937530

  16. 75 FR 51815 - National Toxicology Program (NTP); Center for the Evaluation of Risks to Human Reproduction...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-23

    ... (NTP); Center for the Evaluation of Risks to Human Reproduction (CERHR); Evaluation of the Health... reproduction and/or development and provide opinion on whether these substances are hazardous for humans...

  17. HDL cholesterol, leptin and interleukin-6 predict high risk coronary anatomy assessed by CT angiography in patients with stable chest pain.

    PubMed

    Caselli, Chiara; De Graaf, Michiel A; Lorenzoni, Valentina; Rovai, Daniele; Marinelli, Martina; Del Ry, Silvia; Giannessi, Daniela; Bax, Jeroen J; Neglia, Danilo; Scholte, Arthur J

    2015-07-01

    Coronary computed tomography angiography (CTA) describes several features of coronary plaques, i.e. location, severity, and composition. Integrated CTA scores are able to identify individual patterns of higher risk. We sought to test whether circulating biomarkers related with metabolism and inflammation could predict high risk coronary anatomy at CTA in patients with stable chest pain. We evaluated a panel of 17 biomarkers in 429 patients (60.3 ± 0.4 years, 268 males) with stable chest pain who underwent coronary CTA having been enrolled in the Evaluation of Integrated Cardiac Imaging (EVINCI) study. The individual CTA risk score was calculated combining plaque extent, severity, composition, and location. The presence and distribution of non-calcified, mixed and calcified plaques were analyzed in each patient. After adjustment for age, sex and medical treatment, high-density lipoprotein (HDL) cholesterol, leptin, and interleukin-6 (IL-6) were independent predictors of CTA risk score at multivariate analysis (P = 0.050, 0.002, and 0.007, respectively). Integrating these biomarkers with common clinical variables, a model was developed which showed a better discriminating ability than the Framingham Risk Score and the Euro-SCORE in identifying the patients with higher CTA risk score (area under the receiver-operating characteristics curve = 0.81, 0.63 and 0.71, respectively, P < 0.001). These three biomarkers were significantly altered in patients with mixed or non-calcified plaques. In patients with stable chest pain, low HDL cholesterol, low leptin and high IL-6 are independent predictors of high risk coronary anatomy as defined by an integrated CTA risk score. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  18. Clinical Evaluation of a Novel and Mobile Autism Risk Assessment

    ERIC Educational Resources Information Center

    Duda, Marlena; Daniels, Jena; Wall, Dennis P.

    2016-01-01

    The Mobile Autism Risk Assessment (MARA) is a new, electronically administered, 7-question autism spectrum disorder (ASD) screen to triage those at highest risk for ASD. Children 16 months-17 years (N = 222) were screened during their first visit in a developmental-behavioral pediatric clinic. MARA scores were compared to diagnosis from the…

  19. Evaluation of the Recognizing and Responding to Suicide Risk Training

    ERIC Educational Resources Information Center

    Jacobson, Jodi Michelle; Osteen, Philip; Jones, Andrea; Berman, Alan

    2012-01-01

    Changes in attitudes, confidence, and practice behaviors were assessed among 452 clinicians who completed the training, Recognizing and Responding to Suicide Risk, and who work with clients at risk for suicide. Data were collected at three time points. Scores on measures of attitudes toward suicide prevention and confidence to work with clients at…

  20. Evaluation of the Recognizing and Responding to Suicide Risk Training

    ERIC Educational Resources Information Center

    Jacobson, Jodi Michelle; Osteen, Philip; Jones, Andrea; Berman, Alan

    2012-01-01

    Changes in attitudes, confidence, and practice behaviors were assessed among 452 clinicians who completed the training, Recognizing and Responding to Suicide Risk, and who work with clients at risk for suicide. Data were collected at three time points. Scores on measures of attitudes toward suicide prevention and confidence to work with clients at…

  1. Clinical Evaluation of a Novel and Mobile Autism Risk Assessment

    ERIC Educational Resources Information Center

    Duda, Marlena; Daniels, Jena; Wall, Dennis P.

    2016-01-01

    The Mobile Autism Risk Assessment (MARA) is a new, electronically administered, 7-question autism spectrum disorder (ASD) screen to triage those at highest risk for ASD. Children 16 months-17 years (N = 222) were screened during their first visit in a developmental-behavioral pediatric clinic. MARA scores were compared to diagnosis from the…

  2. Evaluation of Risk Management Strategies for a Low-Cost, High-Risk Project

    NASA Technical Reports Server (NTRS)

    Shishko, Robert; Jorgensen, Edward J.

    1996-01-01

    This paper summarizes work in progress to define and implement a risk management process tailored to a low-cost, high-risk, NASA mission -the Microrover Flight Experiment (MFEX, commonly called the Mars microrover).

  3. Evaluation of Risk Management Strategies for a Low-Cost, High-Risk Project

    NASA Technical Reports Server (NTRS)

    Shishko, Robert; Jorgensen, Edward J.

    1996-01-01

    This paper summarizes work in progress to define and implement a risk management process tailored to a low-cost, high-risk, NASA mission -the Microrover Flight Experiment (MFEX, commonly called the Mars microrover).

  4. The National Cross-Site Evaluation of High-Risk Youth Programs: Understanding Risk, Protection, and Substance Use among High-Risk Youth. Monograph Series.

    ERIC Educational Resources Information Center

    Springer, J. Fred; Sambrano, Soledad; Sale, Elizabeth; Kasim, Rafa; Hermann, Jack

    This document summarizes findings from the Center for Substance Abuse Prevention's National Cross-Site Evaluation of High-Risk Youth Programs, which identified characteristics associated with strong substance abuse prevention outcomes in 48 prevention programs. Major findings include: as youth age, levels of risk and protection shift considerably,…

  5. Evaluating the Investment Benefit of Multinational Enterprises' International Projects Based on Risk Adjustment: Evidence from China

    ERIC Educational Resources Information Center

    Chen, Chong

    2016-01-01

    This study examines the international risks faced by multinational enterprises to understand their impact on the evaluation of investment projects. Moreover, it establishes a 'three-dimensional' theoretical framework of risk identification to analyse the composition of international risk indicators of multinational enterprises based on the theory…

  6. Evaluating the Investment Benefit of Multinational Enterprises' International Projects Based on Risk Adjustment: Evidence from China

    ERIC Educational Resources Information Center

    Chen, Chong

    2016-01-01

    This study examines the international risks faced by multinational enterprises to understand their impact on the evaluation of investment projects. Moreover, it establishes a 'three-dimensional' theoretical framework of risk identification to analyse the composition of international risk indicators of multinational enterprises based on the theory…

  7. Evaluating Ecological Risk to Invertebrate Receptors from PAHs in Sediments at Hazardous Waste Sites (Final Report)

    EPA Science Inventory

    EPA's Ecological Risk Assessment Support Center (ERASC) announced the release of the final report, Evaluating Ecological Risk to Invertebrate Receptors from PAHs in Sediments at Hazardous Waste Sites. The report provides an overview of an approach for assessing risk to ...

  8. CERTS; A Comparative Evaluation Method for Risk Management Methodologies and Tools

    DTIC Science & Technology

    1990-03-01

    This thesis develops a comparative evaluation method for computer security risk management methodologies and tools. The subjective biases inherent to...current comparison practices are reduced by measuring unique characteristics of computer security risk management methodologies. Standardized...methodologies and tools to each other. As a demonstration of its effectiveness, our method is applied to four distinct risk management methodologies and

  9. Evaluating Ecological Risk to Invertebrate Receptors from PAHs in Sediments at Hazardous Waste Sites (Final Report)

    EPA Science Inventory

    EPA's Ecological Risk Assessment Support Center (ERASC) announced the release of the final report, Evaluating Ecological Risk to Invertebrate Receptors from PAHs in Sediments at Hazardous Waste Sites. The report provides an overview of an approach for assessing risk to ...

  10. Evaluation of polygenic risks for narcolepsy and essential hypersomnia.

    PubMed

    Yamasaki, Maria; Miyagawa, Taku; Toyoda, Hiromi; Khor, Seik-Soon; Liu, Xiaoxi; Kuwabara, Hitoshi; Kano, Yukiko; Shimada, Takafumi; Sugiyama, Toshiro; Nishida, Hisami; Sugaya, Nagisa; Tochigi, Mamoru; Otowa, Takeshi; Okazaki, Yuji; Kaiya, Hisanobu; Kawamura, Yoshiya; Miyashita, Akinori; Kuwano, Ryozo; Kasai, Kiyoto; Tanii, Hisashi; Sasaki, Tsukasa; Honda, Yutaka; Honda, Makoto; Tokunaga, Katsushi

    2016-10-01

    In humans, narcolepsy is a sleep disorder that is characterized by sleepiness, cataplexy and rapid eye movement (REM) sleep abnormalities. Essential hypersomnia (EHS) is another type of sleep disorder that is characterized by excessive daytime sleepiness without cataplexy. A human leukocyte antigen (HLA) class II allele, HLA-DQB1*06:02, is a major genetic factor for narcolepsy. Almost all narcoleptic patients are carriers of this HLA allele, while 30-50% of EHS patients and 12% of all healthy individuals in Japan carry this allele. The pathogenesis of narcolepsy and EHS is thought to be partially shared. To evaluate the contribution of common single-nucleotide polymorphisms (SNPs) to narcolepsy onset and to assess the common genetic background of narcolepsy and EHS, we conducted a polygenic analysis that included 393 narcoleptic patients, 38 EHS patients with HLA-DQB1*06:02, 119 EHS patients without HLA-DQB1*06:02 and 1582 healthy individuals. We also included 376 individuals with panic disorder and 213 individuals with autism to confirm whether the results were biased. Polygenic risks in narcolepsy were estimated to explain 58.1% (PHLA-DQB1*06:02=2.30 × 10(-48), Pwhole genome without HLA-DQB1*06:02=6.73 × 10(-2)) including HLA-DQB1*06:02 effects and 1.3% (Pwhole genome without HLA-DQB1*06:02=2.43 × 10(-2)) excluding HLA-DQB1*06:02 effects. The results also indicated that small-effect SNPs contributed to the development of narcolepsy. Reported susceptibility SNPs for narcolepsy in the Japanese population, CPT1B (carnitine palmitoyltransferase 1B), TRA@ (T-cell receptor alpha) and P2RY11 (purinergic receptor P2Y, G-protein coupled, 11), were found to explain 0.8% of narcolepsy onset (Pwhole genome without HLA-DQB1*06:02=9.74 × 10(-2)). EHS patients with HLA-DQB1*06:02 were estimated to have higher shared genetic background to narcoleptic patients than EHS patients without HLA-DQB1*06:02 even when the effects of HLA-DQB1*06:02 were excluded (EHS with HLA-DQB1

  11. Evaluating Risk Communication After the Fukushima Disaster Based on Nudge Theory.

    PubMed

    Murakami, Michio; Tsubokura, Masaharu

    2017-03-01

    Using nudge theory and some examples of risk communication that followed the Fukushima disaster, this article discusses the influences and justifications of risk communication, in addition to how risk communication systems are designed. To assist people in making decisions based on their own value systems, we provide three suggestions, keeping in mind that people can be influenced (ie, "nudged") depending on how risk communication takes place: (1) accumulate knowledge on the process of evaluating how the method of risk communication and a system's default design could impact people; (2) clarify the purpose and outcomes of risk communication; and (3) see what risk communication might be ethically unjustifiable. Quantitative studies on risk communication and collective narratives will provide some ideas for how to design better risk communication systems and to help people make decisions. Furthermore, we have shown examples of unjustifiable risk communication.

  12. A Method for Evaluating Competency in Assessment and Management of Suicide Risk

    ERIC Educational Resources Information Center

    Hung, Erick K.; Binder, Renee L.; Fordwood, Samantha R.; Hall, Stephen E.; Cramer, Robert J.; McNiel, Dale E.

    2012-01-01

    Objective: Although health professionals increasingly are expected to be able to assess and manage patients' risk for suicide, few methods are available to evaluate this competency. This report describes development of a competency-assessment instrument for suicide risk-assessment (CAI-S), and evaluates its use in an objective structured clinical…

  13. A Method for Evaluating Competency in Assessment and Management of Suicide Risk

    ERIC Educational Resources Information Center

    Hung, Erick K.; Binder, Renee L.; Fordwood, Samantha R.; Hall, Stephen E.; Cramer, Robert J.; McNiel, Dale E.

    2012-01-01

    Objective: Although health professionals increasingly are expected to be able to assess and manage patients' risk for suicide, few methods are available to evaluate this competency. This report describes development of a competency-assessment instrument for suicide risk-assessment (CAI-S), and evaluates its use in an objective structured clinical…

  14. Evaluating and mitigating fracture risk in established rheumatoid arthritis.

    PubMed

    Mullen, Matthew B; Saag, Kenneth G

    2015-01-01

    Patients with rheumatoid arthritis are predisposed to systemic bone loss, and they are at an increased risk of fractures. Although there are similarities in the patient demographics between rheumatoid arthritis patients and the general population of osteoporosis patients, there are factors, particularly the use of glucocorticoids, which are specific to rheumatoid arthritis. These factors can lead to an increased risk of bone loss and fracture. Given that fractures are often very debilitating, especially in elderly patients, it is of paramount importance for the practicing rheumatologist to be aware of ways to reduce the risk of fracture in patients with rheumatoid arthritis. This review discusses currently available modalities for fracture risk assessment as well as pharmacologic and lifestyle interventions available to treat and prevent bone loss in rheumatoid arthritis patients.

  15. Evaluation of Human Performance Issues for Fire Risk

    SciTech Connect

    Bley, Dennis C.; Cooper, Susan E.; Forester, John A.; Kolaczkowski, Alan M.; Ramey-Smith, Ann; Thompson, Catherine M.; Whitehead, Donnie W.; Wreathall, John

    1999-05-04

    This paper summarizes the current status of the treatment of human reliability in fire risk analyses for nuclear power plants and identifies areas that need to be addressed. A new approach is suggested to improve the modeling.

  16. Fuzzy Comprehensive Evaluation Method Applied in the Real Estate Investment Risks Research

    NASA Astrophysics Data System (ADS)

    ML(Zhang Minli), Zhang; Wp(Yang Wenpo), Yang

    Real estate investment is a high-risk and high returned of economic activity, the key of real estate analysis is the identification of their types of investment risk and the risk of different types of effective prevention. But, as the financial crisis sweeping the world, the real estate industry also faces enormous risks, how effective and correct evaluation of real estate investment risks becomes the multitudinous scholar concern[1]. In this paper, real estate investment risks were summarized and analyzed, and comparative analysis method is discussed and finally presented fuzzy comprehensive evaluation method, not only in theory has the advantages of science, in the application also has the reliability, for real estate investment risk assessment provides an effective means for investors in real estate investing guidance on risk factors and forecasts.

  17. Evaluation of the quality of life and risk of suicide

    PubMed Central

    de Medeiros Alves, Verônica; de Lima Francisco, Leilane Camila Ferreira; Belo, Flaviane Maria Pereira; de-Melo-Neto, Valfrido Leão; Barros, Vinicius Gomes; Nardi, Antonio E

    2016-01-01

    OBJECTIVE: To identify the socio-demographic profiles, suicidal ideation, the presence of mental disorders and the quality of life of patients using mental health services in Arapiraca, Alagoas, Brazil. METHOD: Interviews were conducted in family health units and the Psychosocial Attention Center. The sample included 202 mental disorder patients with a risk of suicide attempts, 207 mental disorder patients without a risk of suicide attempts and 196 controls. This study used an identification questionnaire, the abbreviated World Health Organization Quality of Life questionnaire, Beck‘s Suicidal Ideation Scale and the Mini International Neuropsychiatric Interview. RESULTS: Patients who had a mental disorder and a risk of suicide attempts tended to be single, had less education and lower family income, were not working and showed lower scores in quality of life domains; 73 of these patients had suicidal ideation in the previous week. Depressive disorders, manic episodes, hypomanic episodes, social phobias, obsessive compulsive disorder, post-traumatic stress disorder, psychotic syndromes and generalized anxiety disorder were more frequent and statistically significant for patients at risk for suicide attempts. CONCLUSION: The management of patients with a risk of suicide attempts must focus on individual patients because this risk is directly linked to changes in quality of life and the improvement of these patients' prognosis. PMID:27074173

  18. Evaluation of skin cancer risk for lunar and Mars missions

    NASA Astrophysics Data System (ADS)

    Kim, Myung-Hee Y.; George, Kerry A.; Cucinotta, Francis A.

    Methods used to estimate the probability of excess incidence of skin cancer from space radiation exposure must take into consideration the variability of dose to different areas of the body and the individual factors that may contribute to increased risk, including skin pigment and synergistic effects from combined ionizing and UV exposure. We have estimated the skin cancer risk for future lunar and Mars missions using: (1) the multiplicative risk model for transferring the Japanese survivor data to the US population, (2) epidemiological data for the increased risk for skin locations exposed to combined UV and ionizing radiation, and (3) models of space radiation environments, transport, and anatomical shielding for 5260 skin loci. We have estimated that the probability for increased skin cancer risk from solar particle events varies more than 10-fold depending on the individual and area of skin exposed. We show that a skin cancer risk greater than 1% could occur for astronauts with light skin and hair color following exposure to medium or large class solar particle events during future lunar base operations, or from exposure to galactic cosmic rays during Mars missions.

  19. Risk Evaluation in the Pre-Phase A Conceptual Design of Spacecraft

    NASA Technical Reports Server (NTRS)

    Fabisinski, Leo L., III; Maples, Charlotte Dauphne

    2010-01-01

    Typically, the most important decisions in the design of a spacecraft are made in the earliest stages of its conceptual design the Pre-Phase A stages. It is in these stages that the greatest number of design alternatives is considered, and the greatest number of alternatives is rejected. The focus of Pre-Phase A conceptual development is on the evaluation and comparison of whole concepts and the larger-scale systems comprising those concepts. This comparison typically uses general Figures of Merit (FOMs) to quantify the comparative benefits of designs and alternative design features. Along with mass, performance, and cost, risk should be one of the major FOMs in evaluating design decisions during the conceptual design phases. However, risk is often given inadequate consideration in conceptual design practice. The reasons frequently given for this lack of attention to risk include: inadequate mission definition, lack of rigorous design requirements in early concept phases, lack of fidelity in risk assessment methods, and under-evaluation of risk as a viable FOM for design evaluation. In this paper, the role of risk evaluation in early conceptual design is discussed. The various requirements of a viable risk evaluation tool at the Pre-Phase A level are considered in light of the needs of a typical spacecraft design study. A technique for risk identification and evaluation is presented. The application of the risk identification and evaluation approach to the conceptual design process is discussed. Finally, a computational tool for risk profiling is presented and applied to assess the risk for an existing Pre-Phase A proposal. The resulting profile is compared to the risks identified for the proposal by other means.

  20. Evaluation of severe accident risks and the potential for risk reduction: Surry Power Station, Unit 1: Draft report for comment

    SciTech Connect

    Benjamin, A.S.; Boyd, G.J.; Kunsman, D.M.; Murfin, W.B.; Williams, D.C.

    1987-02-01

    The Severe Accident Risk Reduction Program (SARRP) has completed a rebaselining of the risks to the public from a particular pressurized water reactor with a subatmospheric containment (Surry, Unit 1). Emphasis was placed on determining the magnitude and character of the uncertainties, rather than focusing on a point estimate. The risk-reduction potential of a set of proposed safety option backfits was also studied, and their costs and benefits were also evaluated. It was found that the risks from internal events are generally lower than previously evaluated in the Reactor Safety Study (RSS). However, certain unresolved issues (such as direct containment heating) caused the top of the uncertainty band to appear at a level that is comparable with the RSS point estimate. None of the postulated safety options appears to be cost effective for the Surry power plant. This work supports the Nuclear Regulatory Commission's assessment of severe accidents in NUREG-1150.

  1. Risk factors and outcome analysis after surgical management of ventricular septal rupture complicating acute myocardial infarction: a retrospective analysis.

    PubMed

    Huang, Shih-Ming; Huang, Shu-Chien; Wang, Chih-Hsien; Wu, I-Hui; Chi, Nai-Hsin; Yu, Hsi-Yu; Hsu, Ron-Bin; Chang, Chung-I; Wang, Shoei-Shen; Chen, Yih-Sharng

    2015-05-04

    Ventricular septal rupture (VSR) is an uncommon but well-recognized mechanical complication of acute myocardial infarction (AMI). The outcome of VSR remains poor even in the era of reperfusion therapy. We reviewed our experience with surgical repair of post-infarction VSR and analyzed outcomes in an attempt to identify prognostic factors. From October 1995 to December 2013, data from 47 consecutive patients (mean age, 68 ± 9.5 years) with post-infarction VSR who underwent surgical repair at our institute were retrospectively reviewed. The preoperative conditions, morbidity and surgical mortality were analyzed. Multivariate analysis was subsequently carried out by constructing a logistic regression model in order to identify independent predictors of postoperative mortality. Long term survival function were estimated using the Kaplan-Meier method and compared using the log-rank test. Percutaneous coronary intervention was performed in 17 (36.2%) patients, intra-aortic balloon pump (IABP) was used in 34 (72.3%), and six (12.8%) were supported with extracorporeal membrane oxygenation (ECMO) preoperatively. Forty-one (87.2%) patients received emergent surgical treatment. Concomitant coronary artery bypass grafting was performed in 27 (57.4%) patients. Operative mortality was 36.2% (17 of 47). The survival rate was 59.3% with concomitant CABG and 70% without concomitant CABG (p = 14). Multivariate analysis revealed that the survivors had higher preoperative left ventricular ejection fractions (LVEFs) compared with those who died (51 ± 13.7% vs. 36.6 ± 6.4% , respectively; p < 0.001) and lower European system for cardiac operative risk evaluation II (EuroSCORE II) (22.9 ± 14.9 vs. 38.3 ± 13.9, respectively; p < 0.001). The patients receiving total revascularization has long term survival benefit (p = 0.028). Post-infarction VSR remains a serious and challenging complication of AMI in the modern surgical era. The EuroSCORE II can

  2. Qualitative risk evaluation of environmental restoration programs at Brookhaven National Laboratory

    SciTech Connect

    Morris, S.C.

    1996-05-01

    This report documents the evaluation of risks associated with environmental restoration activities at Brookhaven National Laboratory using two tools supplied by DOE to provide a consistent set of risk estimates across the DOE complex: Risk Data Sheets (RDS) and Relative Risk Ranking. The tools are described, the process taken characterized, results provided and discussed. The two approaches are compared and recommendations provided for continuing improvement of the process.

  3. Risk Evaluation of Bogie System Based on Extension Theory and Entropy Weight Method

    PubMed Central

    Du, Yanping; Zhang, Yuan; Zhao, Xiaogang; Wang, Xiaohui

    2014-01-01

    A bogie system is the key equipment of railway vehicles. Rigorous practical evaluation of bogies is still a challenge. Presently, there is overreliance on part-specific experiments in practice. In the present work, a risk evaluation index system of a bogie system has been established based on the inspection data and experts' evaluation. Then, considering quantitative and qualitative aspects, the risk state of a bogie system has been evaluated using an extension theory and an entropy weight method. Finally, the method has been used to assess the bogie system of four different samples. Results show that this method can assess the risk state of a bogie system exactly. PMID:25574159

  4. Evaluating genetic risk for prostate cancer among Japanese and Latinos

    PubMed Central

    Cheng, Iona; Chen, Gary K.; Nakagawa, Hidewaki; He, Jing; Wan, Peggy; Laurie, Cathy; Shen, Jess; Sheng, Xin; Pooler, Loreall C.; Crenshaw, Andrew T.; Mirel, Daniel B.; Takahashi, Atsushi; Kubo, Michiaki; Nakamura, Yusuke; Al Olama, Ali Amin; Benlloch, Sara; Donovan, Jenny L.; Guy, Michelle; Hamdy, Freddie C.; Kote-Jarai, Zsofia; Neal, David E.; Wilkens, Lynne R.; Monroe, Kristine R.; Stram, Daniel O.; Muir, Kenneth; Eeles, Rosalind A.; Easton, Douglas F.; Kolonel, Laurence N.; Henderson, Brian E.; Le Marchand, Loïc; Haiman, Christopher A.

    2012-01-01

    Background There have been few genome-wide association studies (GWAS) of prostate cancer among diverse populations. To search for novel prostate cancer risk variants, we conducted GWAS of prostate cancer in Japanese and Latinos. In addition, we tested prostate cancer risk variants and developed genetic risk models of prostate cancer for Japanese and Latinos. Methods Our first stage GWAS of prostate cancer included Japanese (cases/controls=1,033/1,042) and Latino (cases/controls=1,043/1,057) from the Multiethnic Cohort. Significant associations from stage 1 (P < 1.0×10−4) were examined in silico in GWAS of prostate cancer (stage 2) in Japanese (cases/controls=1,583/3,386) and Europeans (cases/controls=1,854/1,894). Results No novel stage 1 SNPs outside of known risk regions reached genome-wide significance. For Japanese, in stage 1, the most notable putative novel association was seen with 10 SNPs (P<8.0. x10−6) at chromosome 2q33; however, this was not replicated in stage 2. For Latinos, the most significant association was observed with rs17023900 at the known 3p12 risk locus (stage 1: OR=1.45; P=7.01×10−5 and stage 2: OR=1.58; P =3.05×10−7). The majority of the established risk variants for prostate cancer, 79% and 88%, were positively associated with prostate cancer in Japanese and Latinos (stage I), respectively. The cumulative effects of these variants significantly influence prostate cancer risk (OR per allele=1.10; P = 2.71×10−25 and OR=1.07; P = 1.02×10−16 for Japanese and Latinos, respectively). Conclusion and Impact Our GWAS of prostate cancer did not identify novel genome-wide significant variants. However, our findings demonstrate that established risk variants for prostate cancer significantly contribute to risk among Japanese and Latinos. PMID:22923026

  5. Estimating Skin Cancer Risk: Evaluating Mobile Computer-Adaptive Testing

    PubMed Central

    Djaja, Ngadiman; Janda, Monika; Olsen, Catherine M; Whiteman, David C

    2016-01-01

    Background Response burden is a major detriment to questionnaire completion rates. Computer adaptive testing may offer advantages over non-adaptive testing, including reduction of numbers of items required for precise measurement. Objective Our aim was to compare the efficiency of non-adaptive (NAT) and computer adaptive testing (CAT) facilitated by Partial Credit Model (PCM)-derived calibration to estimate skin cancer risk. Methods We used a random sample from a population-based Australian cohort study of skin cancer risk (N=43,794). All 30 items of the skin cancer risk scale were calibrated with the Rasch PCM. A total of 1000 cases generated following a normal distribution (mean [SD] 0 [1]) were simulated using three Rasch models with three fixed-item (dichotomous, rating scale, and partial credit) scenarios, respectively. We calculated the comparative efficiency and precision of CAT and NAT (shortening of questionnaire length and the count difference number ratio less than 5% using independent t tests). Results We found that use of CAT led to smaller person standard error of the estimated measure than NAT, with substantially higher efficiency but no loss of precision, reducing response burden by 48%, 66%, and 66% for dichotomous, Rating Scale Model, and PCM models, respectively. Conclusions CAT-based administrations of the skin cancer risk scale could substantially reduce participant burden without compromising measurement precision. A mobile computer adaptive test was developed to help people efficiently assess their skin cancer risk. PMID:26800642

  6. Evaluation of risk factors for fatal acute pancreatitis in dogs.

    PubMed

    Hess, R S; Kass, P H; Shofer, F S; Van Winkle, T J; Washabau, R J

    1999-01-01

    To identify risk factors associated with fatal acute pancreatitis in dogs. Case-control study. 70 case dogs with clinical evidence and histopathologic confirmation of fatal acute pancreatitis and 104 control dogs that had trauma, underwent necropsy, and did not have histologic evidence of acute pancreatitis. Information on signalment, weight, body condition, medical history, concurrent disease, and results of histopathologic examination was obtained by reviewing medical records. Logistic regression analysis included calculation of univariate and multivariate (adjusted) odds ratios and 95% confidence intervals. RESULTS AND CLINICAL IMPLICATIONS: Dogs with fatal acute pancreatitis were largely middle- to older-aged dogs. Risk of developing fatal acute pancreatitis was increased by overweight body condition, diabetes mellitus, hyperadrenocorticism, hypothyroidism, prior gastrointestinal tract disease, and epilepsy. Additionally, Yorkshire Terriers were at increased risk, and Labrador Retrievers and Miniature Poodles were at decreased risk, of developing fatal acute pancreatitis. Males and neutered females appeared to have an increased risk of developing fatal acute pancreatitis, compared with sexually intact females. Thrombus formation was more likely in dogs that developed fatal acute pancreatitis than in control dogs.

  7. Estimating Skin Cancer Risk: Evaluating Mobile Computer-Adaptive Testing.

    PubMed

    Djaja, Ngadiman; Janda, Monika; Olsen, Catherine M; Whiteman, David C; Chien, Tsair-Wei

    2016-01-22

    Response burden is a major detriment to questionnaire completion rates. Computer adaptive testing may offer advantages over non-adaptive testing, including reduction of numbers of items required for precise measurement. Our aim was to compare the efficiency of non-adaptive (NAT) and computer adaptive testing (CAT) facilitated by Partial Credit Model (PCM)-derived calibration to estimate skin cancer risk. We used a random sample from a population-based Australian cohort study of skin cancer risk (N=43,794). All 30 items of the skin cancer risk scale were calibrated with the Rasch PCM. A total of 1000 cases generated following a normal distribution (mean [SD] 0 [1]) were simulated using three Rasch models with three fixed-item (dichotomous, rating scale, and partial credit) scenarios, respectively. We calculated the comparative efficiency and precision of CAT and NAT (shortening of questionnaire length and the count difference number ratio less than 5% using independent t tests). We found that use of CAT led to smaller person standard error of the estimated measure than NAT, with substantially higher efficiency but no loss of precision, reducing response burden by 48%, 66%, and 66% for dichotomous, Rating Scale Model, and PCM models, respectively. CAT-based administrations of the skin cancer risk scale could substantially reduce participant burden without compromising measurement precision. A mobile computer adaptive test was developed to help people efficiently assess their skin cancer risk.

  8. Pediatricians’ assessments of caries risk and need for a dental evaluation in preschool aged children

    PubMed Central

    2012-01-01

    Background Risk-based prioritization of dental referrals during well-child visits might improve dental access for infants and toddlers. This study identifies pediatrician-assessed risk factors for early childhood caries (ECC) and their association with the need for a dentist’s evaluation. Methods A priority oral health risk assessment and referral tool (PORRT) for children < 36 months was developed collaboratively by physicians and dentists and used by 10 pediatricians during well-child visits. PORRT documented behavioral, clinical, and child health risks for ECC. Pediatricians also assessed overall ECC risk on an 11-point scale and determined the need for a dental evaluation. Logistic regression models calculated the odds for evaluation need for each risk factor and according to a 3-level risk classification. Results In total 1,288 PORRT forms were completed; 6.8% of children were identified as needing a dentist evaluation. Behavioral risk factors were prevalent but not strong predictors of the need for an evaluation. The child’s overall caries risk was the strongest predictor of the need for an evaluation. Cavitated (OR = 17.5; 95% CI = 8.08, 37.97) and non-cavitated (OR = 6.9; 95% CI = 4.47, 10.82) lesions were the strongest predictors when the caries risk scale was excluded from the analysis. Few patients (6.3%) were classified as high risk, but their probability of needing an evaluation was only 0.36. Conclusions Low referral rates for children with disease and prior to disease onset but at elevated risk, indicate interventions are needed to help improve the dental referral rates of physicians. PMID:22559270

  9. Problems With Risk Reclassification Methods for Evaluating Prediction Models

    PubMed Central

    Pepe, Margaret S.

    2011-01-01

    For comparing the performance of a baseline risk prediction model with one that includes an additional predictor, a risk reclassification analysis strategy has been proposed. The first step is to cross-classify risks calculated according to the 2 models for all study subjects. Summary measures including the percentage of reclassification and the percentage of correct reclassification are calculated, along with 2 reclassification calibration statistics. The author shows that interpretations of the proposed summary measures and P values are problematic. The author's recommendation is to display the reclassification table, because it shows interesting information, but to use alternative methods for summarizing and comparing model performance. The Net Reclassification Index has been suggested as one alternative method. The author argues for reporting components of the Net Reclassification Index because they are more clinically relevant than is the single numerical summary measure. PMID:21555714

  10. Evaluation of Polygenic Risk Scores for Breast and Ovarian Cancer Risk Prediction in BRCA1 and BRCA2 Mutation Carriers

    PubMed Central

    Kuchenbaecker, Karoline B.; McGuffog, Lesley; Barrowdale, Daniel; Lee, Andrew; Soucy, Penny; Healey, Sue; Dennis, Joe; Lush, Michael; Robson, Mark; Spurdle, Amanda B.; Ramus, Susan J.; Mavaddat, Nasim; Terry, Mary Beth; Neuhausen, Susan L.; Hamann, Ute; Southey, Melissa; John, Esther M.; Chung, Wendy K.; Daly, Mary B.; Buys, Saundra S.; Goldgar, David E.; Dorfling, Cecilia M.; van Rensburg, Elizabeth J.; Ding, Yuan Chun; Ejlertsen, Bent; Gerdes, Anne-Marie; Hansen, Thomas V. O.; Slager, Susan; Hallberg, Emily; Benitez, Javier; Osorio, Ana; Cohen, Nancy; Lawler, William; Weitzel, Jeffrey N.; Peterlongo, Paolo; Pensotti, Valeria; Dolcetti, Riccardo; Barile, Monica; Bonanni, Bernardo; Azzollini, Jacopo; Manoukian, Siranoush; Peissel, Bernard; Radice, Paolo; Savarese, Antonella; Papi, Laura; Giannini, Giuseppe; Fostira, Florentia; Konstantopoulou, Irene; Adlard, Julian; Brewer, Carole; Cook, Jackie; Davidson, Rosemarie; Eccles, Diana; Eeles, Ros; Ellis, Steve; Frost, Debra; Hodgson, Shirley; Izatt, Louise; Lalloo, Fiona; Ong, Kai-ren; Godwin, Andrew K.; Arnold, Norbert; Dworniczak, Bernd; Engel, Christoph; Gehrig, Andrea; Hahnen, Eric; Hauke, Jan; Kast, Karin; Meindl, Alfons; Niederacher, Dieter; Schmutzler, Rita Katharina; Varon-Mateeva, Raymonda; Wang-Gohrke, Shan; Wappenschmidt, Barbara; Barjhoux, Laure; Collonge-Rame, Marie-Agnès; Elan, Camille; Golmard, Lisa; Barouk-Simonet, Emmanuelle; Lesueur, Fabienne; Mazoyer, Sylvie; Sokolowska, Joanna; Stoppa-Lyonnet, Dominique; Isaacs, Claudine; Claes, Kathleen B. M.; Poppe, Bruce; de la Hoya, Miguel; Garcia-Barberan, Vanesa; Aittomäki, Kristiina; Nevanlinna, Heli; Ausems, Margreet G. E. M.; de Lange, J. L.; Gómez Garcia, Encarna B.; Hogervorst, Frans B. L.; Kets, Carolien M.; Meijers-Heijboer, Hanne E. J.; Oosterwijk, Jan C.; Rookus, Matti A.; van Asperen, Christi J.; van den Ouweland, Ans M. W.; van Doorn, Helena C.; van Os, Theo A. M.; Kwong, Ava; Olah, Edith; Diez, Orland; Brunet, Joan; Lazaro, Conxi; Teulé, Alex; Gronwald, Jacek; Jakubowska, Anna; Kaczmarek, Katarzyna; Lubinski, Jan; Sukiennicki, Grzegorz; Barkardottir, Rosa B.; Chiquette, Jocelyne; Agata, Simona; Montagna, Marco; Teixeira, Manuel R.; Park, Sue Kyung; Olswold, Curtis; Tischkowitz, Marc; Foretova, Lenka; Gaddam, Pragna; Vijai, Joseph; Pfeiler, Georg; Rappaport-Fuerhauser, Christine; Singer, Christian F.; Tea, Muy-Kheng M.; Greene, Mark H.; Loud, Jennifer T.; Rennert, Gad; Imyanitov, Evgeny N.; Hulick, Peter J.; Hays, John L.; Piedmonte, Marion; Rodriguez, Gustavo C.; Martyn, Julie; Glendon, Gord; Mulligan, Anna Marie; Andrulis, Irene L.; Toland, Amanda Ewart; Jensen, Uffe Birk; Kruse, Torben A.; Pedersen, Inge Sokilde; Thomassen, Mads; Caligo, Maria A.; Teo, Soo-Hwang; Berger, Raanan; Friedman, Eitan; Laitman, Yael; Arver, Brita; Borg, Ake; Ehrencrona, Hans; Rantala, Johanna; Olopade, Olufunmilayo I.; Ganz, Patricia A.; Nussbaum, Robert L.; Bradbury, Angela R.; Domchek, Susan M.; Nathanson, Katherine L.; Arun, Banu K.; James, Paul; Karlan, Beth Y.; Lester, Jenny; Simard, Jacques; Pharoah, Paul D. P.; Offit, Kenneth; Couch, Fergus J.; Chenevix-Trench, Georgia; Easton, Douglas F.

    2017-01-01

    Background: Genome-wide association studies (GWAS) have identified 94 common single-nucleotide polymorphisms (SNPs) associated with breast cancer (BC) risk and 18 associated with ovarian cancer (OC) risk. Several of these are also associated with risk of BC or OC for women who carry a pathogenic mutation in the high-risk BC and OC genes BRCA1 or BRCA2. The combined effects of these variants on BC or OC risk for BRCA1 and BRCA2 mutation carriers have not yet been assessed while their clinical management could benefit from improved personalized risk estimates. Methods: We constructed polygenic risk scores (PRS) using BC and OC susceptibility SNPs identified through population-based GWAS: for BC (overall, estrogen receptor [ER]–positive, and ER-negative) and for OC. Using data from 15 252 female BRCA1 and 8211 BRCA2 carriers, the association of each PRS with BC or OC risk was evaluated using a weighted cohort approach, with time to diagnosis as the outcome and estimation of the hazard ratios (HRs) per standard deviation increase in the PRS. Results: The PRS for ER-negative BC displayed the strongest association with BC risk in BRCA1 carriers (HR = 1.27, 95% confidence interval [CI] = 1.23 to 1.31, P = 8.2×10−53). In BRCA2 carriers, the strongest association with BC risk was seen for the overall BC PRS (HR = 1.22, 95% CI = 1.17 to 1.28, P = 7.2×10−20). The OC PRS was strongly associated with OC risk for both BRCA1 and BRCA2 carriers. These translate to differences in absolute risks (more than 10% in each case) between the top and bottom deciles of the PRS distribution; for example, the OC risk was 6% by age 80 years for BRCA2 carriers at the 10th percentile of the OC PRS compared with 19% risk for those at the 90th percentile of PRS. Conclusions: BC and OC PRS are predictive of cancer risk in BRCA1 and BRCA2 carriers. Incorporation of the PRS into risk prediction models has promise to better inform decisions on cancer risk management. PMID

  11. Evaluating the risk-reduction benefits of wind energy

    SciTech Connect

    Brower, M.C.; Bell, K.; Spinney, P.

    1997-05-01

    The question of uncertainty and risk in electric utility resource planning has received considerable attention in recent years. During the 1980s, many utilities suffered financial losses because of unexpectedly high plant construction costs and low growth in electricity demand. In addition, the introduction of competition to the electric industry is creating new risks for power companies. No longer will utilities be able to count on regulatory protections and a base of captive consumers to provide a stable market and adequate return on their investments. Alternative risk management strategies will have to be considered instead. One approach to managing risk is for a utility company to invest in diverse power sources such as wind power plants. Since wind plants consume no fuel, can be built in relatively small increments with short construction lead times, and generate no pollutants, it is often said that they offer significant protection from risks associated with conventional fossil-fuel power plants. So far there have been few efforts to quantify these benefits, however. The study compares the costs and risks of two competing resource options, a gas-fired combined cycle plant and a wind plant, both utility-owned, through decision analysis. The case study utility is Texas Utilities Electric, a very large investor-owned company serving an area with substantial, high-quality wind resources. The authors chose a specific moment in the future - the year 2003 - when the utility currently plans to build a large fossil-fueled power plant, and examined the implications for the utility`s expected revenues, costs, and profits if a wind plant were to be built instead.

  12. Evaluating the Risk of Child Abuse: The Child Abuse Risk Assessment Scale (CARAS)

    ERIC Educational Resources Information Center

    Chan, Ko Ling

    2012-01-01

    The present study developed the Child Abuse Risk Assessment Scale (CARAS), an actuarial instrument for the assessment of the risk of physical child abuse. Data of 2,363 Chinese parents (47.7% male) living in Hong Kong were used in the analyses. Participants were individually interviewed with a questionnaire assessing their perpetration of child…

  13. Evaluating the Risk of Child Abuse: The Child Abuse Risk Assessment Scale (CARAS)

    ERIC Educational Resources Information Center

    Chan, Ko Ling

    2012-01-01

    The present study developed the Child Abuse Risk Assessment Scale (CARAS), an actuarial instrument for the assessment of the risk of physical child abuse. Data of 2,363 Chinese parents (47.7% male) living in Hong Kong were used in the analyses. Participants were individually interviewed with a questionnaire assessing their perpetration of child…

  14. Single particle effects, Biostack, and risk evaluation - Studies on the radiation risk from Galactic cosmic rays

    NASA Technical Reports Server (NTRS)

    Curtis, Stanley B.

    1993-01-01

    The possible health risks posed by Galactic cosmic rays, especially the possible heightened cancer risk, are examined. The results of the Biostack studies of the biological effects of high-energy cosmic rays are discussed. The biological mechanisms involved in possible harm due to cosmic rays are considered.

  15. Single particle effects, Biostack, and risk evaluation - Studies on the radiation risk from Galactic cosmic rays

    NASA Technical Reports Server (NTRS)

    Curtis, Stanley B.

    1993-01-01

    The possible health risks posed by Galactic cosmic rays, especially the possible heightened cancer risk, are examined. The results of the Biostack studies of the biological effects of high-energy cosmic rays are discussed. The biological mechanisms involved in possible harm due to cosmic rays are considered.

  16. Risk evaluation of land subsidence and its application to metro safety operation in Shanghai

    NASA Astrophysics Data System (ADS)

    Liu, J.; Wang, H.; Yan, X.

    2015-11-01

    Based on sufficiently investigating characteristics and risk connotation of land subsidence, a risk evaluation index system for land subsidence disaster is established, which is combined with the sensitivity feature of the hazard bearing body to land subsidence. An appropriate evaluation method system is established by using an improved fuzzy analytic hierarchy process method. So risk evaluation is developed for providing theoretical basis and technical support for the regional management of land subsidence prevention and control. On this basis, as a case of Shanghai metro, firstly, the paper studies the identifying risk sources of the metro. According to metro linear characteristics, external indexes of representing subsidence risk are obtained. Studying the subsidence risk of the metro, relevant achievement has provided the technical basis for daily main monitoring, early warning and work arrangement.

  17. [Evaluation and prognosis of occupational risk in workers of nonferrous metallurgy enterprises].

    PubMed

    Shliapnikov, D M; Kostarev, V G

    2014-01-01

    The article deals with results of a priori and a posteriori evaluation of occupational risk for workers' health. Categories of a priori occupational risk for workers are estimated as high to very high (intolerable) risk. Findings are that work conditions in nonferrous metallurgy workshop result in upper respiratory tract diseases (medium degree of occupational conditionality). Increased prevalence of such diseases among the workers is connected with length of service. The authors revealed priority factors for occupationally conditioned diseases. A promising approach in occupational medicine is creation of methods to evaluate and forecast occupational risk, that enable to specify goal parameters for prophylactic measures. For example, modelling the risk of occupationally conditioned diseases via changes in exposure to occupational factor and length of service proved that decrease of chemical concentrations in air of workplace to maximally allowable ones lowers risk of respiratory diseases from 14 to 6 cases per year, for length of service of 5 years and population risk.

  18. Evaluating Risk Awareness in Undergraduate Students Studying Mechanical Engineering

    ERIC Educational Resources Information Center

    Langdon, G. S.; Balchin, K.; Mufamadi, P.

    2010-01-01

    This paper examines the development of risk awareness among undergraduate students studying mechanical engineering at a South African university. A questionnaire developed at the University of Liverpool was modified and used on students from the first, second and third year cohorts to assess their awareness in the areas of professional…

  19. DEVELOPING TOOLS FOR EVALUATING RISK MANAGEMENT OF ENDOCRINE DISRUPTING CHEMICALS

    EPA Science Inventory

    The goal of endocrine disrupting chemical (EDC) risk management (RM) is to minimize the release of EDCs into the environment or to minimize the exposure of humans or wildlife to EDCs already present in the environment. RM research projects may involve: substituting more innocuous...

  20. A Research into Evaluation of Basketball Athletes' Risk Perception Level

    ERIC Educational Resources Information Center

    Karatas, Ozgur

    2016-01-01

    The aim of this study is to compare the risk perception levels of Basketball athletes in Turkish League teams according to some variables. In this research the "general screening model," which is one of the descriptive screening methods, was used. While the population of the study consists of athletes actively engaged in the Turkish…

  1. Risk in Enterprise Cloud Computing: Re-Evaluated

    ERIC Educational Resources Information Center

    Funmilayo, Bolonduro, R.

    2016-01-01

    A quantitative study was conducted to get the perspectives of IT experts about risks in enterprise cloud computing. In businesses, these IT experts are often not in positions to prioritize business needs. The business experts commonly known as business managers mostly determine an organization's business needs. Even if an IT expert classified a…

  2. Pedophilia: an evaluation of diagnostic and risk prediction methods.

    PubMed

    Wilson, Robin J; Abracen, Jeffrey; Looman, Jan; Picheca, Janice E; Ferguson, Meaghan

    2011-06-01

    One hundred thirty child sexual abusers were diagnosed using each of following four methods: (a) phallometric testing, (b) strict application of Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision [DSM-IV-TR]) criteria, (c) Rapid Risk Assessment of Sex Offender Recidivism (RRASOR) scores, and (d) "expert" diagnoses rendered by a seasoned clinician. Comparative utility and intermethod consistency of these methods are reported, along with recidivism data indicating predictive validity for risk management. Results suggest that inconsistency exists in diagnosing pedophilia, leading to diminished accuracy in risk assessment. Although the RRASOR and DSM-IV-TR methods were significantly correlated with expert ratings, RRASOR and DSM-IV-TR were unrelated to each other. Deviant arousal was not associated with any of the other methods. Only the expert ratings and RRASOR scores were predictive of sexual recidivism. Logistic regression analyses showed that expert diagnosis did not add to prediction of sexual offence recidivism over and above RRASOR alone. Findings are discussed within a context of encouragement of clinical consistency and evidence-based practice regarding treatment and risk management of those who sexually abuse children.

  3. Risk in Enterprise Cloud Computing: Re-Evaluated

    ERIC Educational Resources Information Center

    Funmilayo, Bolonduro, R.

    2016-01-01

    A quantitative study was conducted to get the perspectives of IT experts about risks in enterprise cloud computing. In businesses, these IT experts are often not in positions to prioritize business needs. The business experts commonly known as business managers mostly determine an organization's business needs. Even if an IT expert classified a…

  4. Evaluating risks and benefits of wildland fire at landscape scales

    Treesearch

    Carol Miller; Peter B. Landres; Paul B. Alaback

    2000-01-01

    Fire suppression has resulted in severe management challenges, especially in the wildland-urban interface zone. Fire managers seek to reduce fuels and risks in the interface zone, while striving to return the natural role of fire to wildland ecosystems. Managers must balance the benefits of wildland fire on ecosystem health against the values that need to be protected...

  5. DEVELOPING TOOLS FOR EVALUATING RISK MANAGEMENT OF ENDOCRINE DISRUPTING CHEMICALS

    EPA Science Inventory

    The goal of endocrine disrupting chemical (EDC) risk management (RM) is to minimize the release of EDCs into the environment or to minimize the exposure of humans or wildlife to EDCs already present in the environment. RM research projects may involve: substituting more innocuous...

  6. A Bridge Course for High-Risk Freshman: Evaluating Outcomes.

    ERIC Educational Resources Information Center

    Hardy, Dorothy C.; Karathanos, Demetrius

    1992-01-01

    Examines outcomes of a "bridge" course for first-year college students that emphasizes personal and psychological adjustment to the university experience to enhance the likelihood of academic success. Findings from 59 high-risk students who completed course suggest that goal of enhancing likelihood of academic success for such students was…

  7. Integrative Approaches to Evaluating Neurotoxicity Data for Risk Assessment.

    EPA Science Inventory

    Risk assessment classically has been based on single adverse outcomes identified as the Lowest Observable Adverse Effect Level (LOAEL) or the highest dose level in a credible study producing a No Observable Adverse Effect Level (NOAEL). While this approach has been useful overal...

  8. Evaluating Risk Awareness in Undergraduate Students Studying Mechanical Engineering

    ERIC Educational Resources Information Center

    Langdon, G. S.; Balchin, K.; Mufamadi, P.

    2010-01-01

    This paper examines the development of risk awareness among undergraduate students studying mechanical engineering at a South African university. A questionnaire developed at the University of Liverpool was modified and used on students from the first, second and third year cohorts to assess their awareness in the areas of professional…

  9. Integrative Approaches to Evaluating Neurotoxicity Data for Risk Assessment.

    EPA Science Inventory

    Risk assessment classically has been based on single adverse outcomes identified as the Lowest Observable Adverse Effect Level (LOAEL) or the highest dose level in a credible study producing a No Observable Adverse Effect Level (NOAEL). While this approach has been useful overal...

  10. A risk evaluation for the fuel retrieval sub-project

    SciTech Connect

    Carlisle, B.S.

    1996-10-11

    This study reviews the technical, schedule and budget baselines of the sub-project to assure all significant issues have been identified on the sub-project issues management list. The issue resolution dates are identified and resolution plans established. Those issues that could adversely impact procurement activities have been uniquely identified on the list and a risk assessment completed.

  11. Evaluation of an inpatient fall risk screening tool to identify the most critical fall risk factors in inpatients.

    PubMed

    Hou, Wen-Hsuan; Kang, Chun-Mei; Ho, Mu-Hsing; Kuo, Jessie Ming-Chuan; Chen, Hsiao-Lien; Chang, Wen-Yin

    2017-03-01

    To evaluate the accuracy of the inpatient fall risk screening tool and to identify the most critical fall risk factors in inpatients. Variations exist in several screening tools applied in acute care hospitals for examining risk factors for falls and identifying high-risk inpatients. Secondary data analysis. A subset of inpatient data for the period from June 2011-June 2014 was extracted from the nursing information system and adverse event reporting system of an 818-bed teaching medical centre in Taipei. Data were analysed using descriptive statistics, receiver operating characteristic curve analysis and logistic regression analysis. During the study period, 205 fallers and 37,232 nonfallers were identified. The results revealed that the inpatient fall risk screening tool (cut-off point of ≥3) had a low sensitivity level (60%), satisfactory specificity (87%), a positive predictive value of 2·0% and a negative predictive value of 99%. The receiver operating characteristic curve analysis revealed an area under the curve of 0·805 (sensitivity, 71·8%; specificity, 78%). To increase the sensitivity values, the Youden index suggests at least 1·5 points to be the most suitable cut-off point for the inpatient fall risk screening tool. Multivariate logistic regression analysis revealed a considerably increased fall risk in patients with impaired balance and impaired elimination. The fall risk factor was also significantly associated with days of hospital stay and with admission to surgical wards. The findings can raise awareness about the two most critical risk factors for falls among future clinical nurses and other healthcare professionals and thus facilitate the development of fall prevention interventions. This study highlights the needs for redefining the cut-off points of the inpatient fall risk screening tool to effectively identify inpatients at a high risk of falls. Furthermore, inpatients with impaired balance and impaired elimination should be closely

  12. [Risk-benefit evaluation of medicinal products. An element of Health Technology Assessment].

    PubMed

    Hart, D

    2005-02-01

    This paper aims to further develop and specify the method and the process of risk-benefit evaluation for determining the safety of medicinal products in national and European pharmaceutical law. The term "safety" (Unbedenklichkeit=the relationship between efficacy and harmfulness) is one of the central categories of national and European pharmaceutical law. The guaranteeing of the safety of pharmaceuticals is not a static but a dynamic and process oriented objective. It aims to preserve what has been approved on the one hand, and to increase the standard of safety by innovation on the other. A medicinal product is only found to be safe if the result of the risk-benefit evaluation is a positive risk-benefit balance. Safety must be guaranteed permanently through the entire lifecycle of the medicinal product. One must differentiate between absolute safety, which is related to the individual product, and relative safety, which is related to already available medicinal products of the same indication. The process of risk-benefit evaluation is determined by the indication of the medicinal product. The different types of medicinal products or their different mechanisms of action require different risk-benefit evaluations. The established, estimated and evaluated benefit has to be compared with the established, estimated and evaluated risks of the medicinal product. The comparative risk-benefit evaluation requires a procedural optimisation of benefits as well as minimisation of risks and a reciprocal optimisation of both requirements. If the comparison of the benefits and risks of the product results in a negative risk-benefit balance, the product is rated absolutely unsafe. The product is relatively unsafe if its standard of safety is lower than that of already available pharmaceuticals of the same indication and the existing safety gap (increased benefit or lesser risks) is deemed considerable. Differences in benefit and/or differences in risk between the medicinal

  13. Development and Evaluation of a Genetic Risk Score for Obesity

    PubMed Central

    Belsky, Daniel W.; Moffitt, Terrie E.; Sugden, Karen; Williams, Benjamin; Houts, Renate; McCarthy, Jeanette; Caspi, Avshalom

    2013-01-01

    Background Results from genome-wide association studies (GWAS) represent a potential resource for etiological and treatment research. GWAS of obesity-related phenotypes have been especially successful. To translate this success into a research tool, we developed and tested a “genetic risk score” (GRS) that summarizes an individual’s genetic predisposition to obesity. Methods Different GWAS of obesity-related phenotypes report different sets of single nucleotide polymorphisms (SNPs) as the best genomic markers of obesity risk. Therefore, we applied a 3-stage approach that pooled results from multiple GWAS to select SNPs to include in our GRS: The 3 stages are (1) Extraction. SNPs with evidence of association are compiled from published GWAS; (2) Clustering. SNPs are grouped according to patterns of linkage disequilibrium; (3) Selection. Tag SNPs are selected from clusters that meet specific criteria. We applied this 3-stage approach to results from 16 GWAS of obesity-related phenotypes in European-descent samples to create a GRS. We then tested the GRS in the Atherosclerosis Risk in the Communities (ARIC) Study cohort (N=10,745, 55% female, 77% white, 23% African American). Results Our 32-locus GRS was a statistically significant predictor of body mass index (BMI) and obesity among ARIC whites (for BMI, r=0.13, p<1×10−30; for obesity, area under the receiver operating characteristic curve (AUC)=0.57 [95% CI 0.55–0.58]). The GRS improved prediction of obesity (as measured by delta-AUC and integrated discrimination index) when added to models that included demographic and geographic information. FTO- and MC4R-linked SNPs, and a non-genetic risk assessment consisting of a socioeconomic index (p<0.01 for all comparisons). The GRS also predicted increased mortality risk over 17 years of follow-up. The GRS performed less well among African Americans. Conclusions The obesity GRS derived using our 3-stage approach is not useful for clinical risk prediction, but

  14. Negative appearance evaluation is associated with skin cancer risk behaviors among American men and women.

    PubMed

    Blashill, Aaron J; Williams, Alison; Grogan, Sarah; Clark-Carter, David

    2015-01-01

    The current study aimed to examine links between appearance evaluation and skin cancer risk behaviors in men and women. Data (N = 1,535; men, n = 873; women, n = 662) were extracted from Wave 4 of the National Longitudinal Study of Adolescent Health, a nationally representative, longitudinal dataset of U.S. adolescents and young adults. Skin cancer risk (i.e., number of hours spent outside for those with a history of severe sunburn and who were unlikely to use sunscreen) was significantly associated with participant gender, appearance evaluation, and their interaction. Both men and women who negatively evaluated their appearance were at significantly increased skin cancer risk, and this was particularly true for men. Negative appearance evaluation appears to be a correlate of engaging in behaviors that place individuals at risk of developing skin cancer. Future research may benefit from skin cancer prevention interventions that directly address appearance-based evaluations.

  15. Negative Appearance Evaluation Is Associated With Skin Cancer Risk Behaviors Among American Men and Women

    PubMed Central

    Blashill, Aaron J.; Williams, Alison; Grogan, Sarah; Clark-Carter, David

    2015-01-01

    Objective The current study aimed to examine links between appearance evaluation and skin cancer risk behaviors in men and women. Method Data (N = 1,535; men, n = 873; women, n = 662) were extracted from Wave 4 of the National Longitudinal Study of Adolescent Health, a nationally representative, longitudinal dataset of U.S. adolescents and young adults. Results Skin cancer risk (i.e., number of hours spent outside for those with a history of severe sunburn and who were unlikely to use sunscreen) was significantly associated with participant gender, appearance evaluation, and their interaction. Both men and women who negatively evaluated their appearance were at significantly increased skin cancer risk, and this was particularly true for men. Conclusions Negative appearance evaluation appears to be a correlate of engaging in behaviors that place individuals at risk of developing skin cancer. Future research may benefit from skin cancer prevention interventions that directly address appearance-based evaluations. PMID:25133823

  16. [Pollution Evaluation and Risk Assessment of Heavy Metals from Atmospheric Deposition in the Parks of Nanjing].

    PubMed

    Wang, Cheng; Qian, Xin; Li, Hui-ming; Sun, Yi-xuan; Wang, Jin-hua

    2016-05-15

    Contents of heavy metals involving As, Cd, Cr, Cu, Ni, Pb and Zn from atmospheric deposition in 10 parks of Nanjing were analyzed. The pollution level, ecological risk and health risk were evaluated using Geoaccumulation Index, Potential Ecological Risk Index and the US EPA Health Risk Assessment Model, respectively. The results showed that the pollution levels of heavy metals in Swallow Rock Park, Swallow Rock Park and Mochou Lake Park were higher than the others. Compared to other cities such as Changchun, Wuhan and Beijing, the contents of heavy metals in atmospheric deposition of parks in Nanjing were higher. The evaluation results of Geoaccumulation Index showed that Pb was at moderate pollution level, Zn and Cu were between moderate and serious levels, while Cd was between serious and extreme levels. The ecological risk level of Cd was high. The assessment results of Health Risk Assessment Model indicated that there was no non-carcinogenic risk for all the seven heavy metals. For carcinogenic risk, the risks of Cd, Cr and Ni were all negligible (Risk < 1 x 10⁻⁶), whereas As had carcinogenic risk possibility but was considered to be acceptable (10⁻⁶ < Risk < 10⁻⁴).

  17. A new approach to risk evaluation and management: risk-based, precaution-based, and discourse-based strategies.

    PubMed

    Klinke, Andreas; Renn, Ortwin

    2002-12-01

    Our concept of nine risk evaluation criteria, six risk classes, a decision tree, and three management categories was developed to improve the effectiveness, efficiency, and political feasibility of risk management procedures. The main task of risk evaluation and management is to develop adequate tools for dealing with the problems of complexity, uncertainty. and ambiguity. Based on the characteristics of different risk types and these three major problems, we distinguished three types of management--risk-based, precaution-based, and discourse-based strategies. The risk-based strategy--is the common solution to risk problems. Once the probabilities and their corresponding damage potentials are calculated, risk managers are required to set priorities according to the severity of the risk, which may be operationalized as a linear combination of damage and probability or as a weighted combination thereof. Within our new risk classification, the two central components have been augmented with other physical and social criteria that still demand risk-based strategies as long as uncertainty is low and ambiguity absent. Risk-based strategies are best solutions to problems of complexity and some components of uncertainty, for example, variation among individuals. If the two most important risk criteria, probability of occurrence and extent of damage, are relatively well known and little uncertainty is left, the traditional risk-based approach seems reasonable. If uncertainty plays a large role, in particular, indeterminacy or lack of knowledge, the risk-based approach becomes counterproductive. Judging the relative severity of risks on the basis of uncertain parameters does not make much sense. Under these circumstances, management strategies belonging to the precautionary management style are required. The precautionary approach has been the basis for much of the European environmental and health protection legislation and regulation. Our own approach to risk management

  18. First-passage and risk evaluation under stochastic volatility

    NASA Astrophysics Data System (ADS)

    Masoliver, Jaume; Perelló, Josep

    2009-07-01

    We solve the first-passage problem for the Heston random diffusion model. We obtain exact analytical expressions for the survival and the hitting probabilities to a given level of return. We study several asymptotic behaviors and obtain approximate forms of these probabilities which prove, among other interesting properties, the nonexistence of a mean-first-passage time. One significant result is the evidence of extreme deviations—which implies a high risk of default—when certain dimensionless parameter, related to the strength of the volatility fluctuations, increases. We confront the model with empirical daily data and we observe that it is able to capture a very broad domain of the hitting probability. We believe that this may provide an effective tool for risk control which can be readily applicable to real markets both for portfolio management and trading strategies.

  19. First-passage and risk evaluation under stochastic volatility.

    PubMed

    Masoliver, Jaume; Perelló, Josep

    2009-07-01

    We solve the first-passage problem for the Heston random diffusion model. We obtain exact analytical expressions for the survival and the hitting probabilities to a given level of return. We study several asymptotic behaviors and obtain approximate forms of these probabilities which prove, among other interesting properties, the nonexistence of a mean-first-passage time. One significant result is the evidence of extreme deviations-which implies a high risk of default-when certain dimensionless parameter, related to the strength of the volatility fluctuations, increases. We confront the model with empirical daily data and we observe that it is able to capture a very broad domain of the hitting probability. We believe that this may provide an effective tool for risk control which can be readily applicable to real markets both for portfolio management and trading strategies.

  20. Preface to the Special Issue on High-Risk, Critical-Skills Training Evaluation.

    ERIC Educational Resources Information Center

    Cantor, Jeffrey A.

    1992-01-01

    Summarizes the six articles included in this special issue, which discuss evaluation of human performance in critical skills occupations; strategic planning for safety in high-risk occupations; performance and training effectiveness decisions; performance indicators for training evaluation; evaluation of a nuclear training program; and a model for…

  1. Evaluating risk using bounding calculations and limited data

    SciTech Connect

    COWLEY, W.L.

    1999-05-27

    This paper describes a methodology for estimating the potential risk to workers and the public from igniting organic solvents in any of the 177 underground waste storage tanks at the Hanford Site in southeastern Washington state. The Hanford Site is one of the U.S. Department of Energy's former production facilities for nuclear materials. The tanks contain mixed radioactive wastes. Risk is measured by calculating toxicological and radiological accident consequences and frequencies and comparing the results to established regulatory guidelines. Available sample data is insufficient to adequately characterize the waste and solvent, so a model that maximizes releases from the tanks (bounding case) is used. Maximizing releases (and thus consequences) is a standard technique used in safety analysis to compensate for lack of information. The model predicts bounding values of fire duration, the time at which the fire extinguishes because of lack of oxygen, and a pressure history of a fire in a tank. The model output is used to calculate mass and volume release rates of material from the tanks. The mass and volume release rates permit calculation of radiological and toxicological consequences. The resulting consequence calculations demonstrate that risk from an organic solvent fire in the tanks is within regulatory guidelines.

  2. Evaluating changes in driver behaviour: a risk profiling approach.

    PubMed

    Ellison, Adrian B; Bliemer, Michiel C J; Greaves, Stephen P

    2015-02-01

    New road safety strategies continue to be devised by researchers and policy makers with pay-as-you-drive (PAYD) schemes gaining increasing attention. However, empirically measuring the effectiveness of these strategies is challenging due to the influence of the road environment and other factors external to the driver. The analysis presented here applies Temporal and Spatial Identifiers to control for the road environment and Driver Behaviour Profiles to provide a common measure of driving behaviour based on the risk of a casualty crash for assessing the effectiveness of a PAYD scheme on reducing driving risks. The results show that in many cases personalised feedback alone is sufficient to induce significant changes, but the largest reductions in risk are observed when drivers are also awarded a financial incentive to change behaviour. Importantly, the more frequent the exposure to the speeding information, the greater the magnitude of the change. However, the changes are disproportionately associated with those that were already safer drivers in the baseline period suggesting that some drivers may be predisposed to changing their behaviour. These results suggest that it would be beneficial to provide real-time or daily feedback on speeding behaviour in conjunction with a financial reward scheme, potentially as a component of insurance premiums.

  3. Risk-based evaluation of Allowed Outage Times (AOTs) considering risk of shutdown

    SciTech Connect

    Mankamo, T. ); Kim, I.S.; Samanta, P.K. )

    1992-01-01

    When safety systems fail during power operation, Technical Specifications (TS) usually limit the repair within Allowed Outage Time (AOT). If the repair cannot be completed within the AOT, or no AOT is allowed, the plant is required to be shut down for the repair. However, if the capability to remove decay heat is degraded, shutting down the plant with the need to operate the affected decay-heat removal systems may impose a substantial risk compared to continued power operation over a usual repair time. Thus, defining a proper AOT in such situations can be considered as a risk-comparison between the repair in frill power state with a temporarily increased level of risk, and the altemative of shutting down the plant for the repair in zero power state with a specific associated risk. The methodology of the risk-comparison approach, with a due consideration of the shutdown risk, has been further developed and applied to the AOT considerations of residual heat removal and standby service water systems of a boiling water reactor (BWR) plant. Based on the completed work, several improvements to the TS requirements for the systems studied can be suggested.

  4. Risk-based evaluation of Allowed Outage Times (AOTs) considering risk of shutdown

    SciTech Connect

    Mankamo, T.; Kim, I.S.; Samanta, P.K.

    1992-12-31

    When safety systems fail during power operation, Technical Specifications (TS) usually limit the repair within Allowed Outage Time (AOT). If the repair cannot be completed within the AOT, or no AOT is allowed, the plant is required to be shut down for the repair. However, if the capability to remove decay heat is degraded, shutting down the plant with the need to operate the affected decay-heat removal systems may impose a substantial risk compared to continued power operation over a usual repair time. Thus, defining a proper AOT in such situations can be considered as a risk-comparison between the repair in frill power state with a temporarily increased level of risk, and the altemative of shutting down the plant for the repair in zero power state with a specific associated risk. The methodology of the risk-comparison approach, with a due consideration of the shutdown risk, has been further developed and applied to the AOT considerations of residual heat removal and standby service water systems of a boiling water reactor (BWR) plant. Based on the completed work, several improvements to the TS requirements for the systems studied can be suggested.

  5. Development of a relative risk model for evaluating ecological risk of water environment in the Haihe River Basin estuary area.

    PubMed

    Chen, Qiuying; Liu, Jingling; Ho, Kin Chung; Yang, Zhifeng

    2012-03-15

    Ecological risk assessment for water environment is significant to water resource management of basin. Effective environmental management and systems restoration such as the Haihe River Basin require holistic understanding of the relative importance of various stressor-related impacts throughout the basin. As an effective technical tool for evaluating the ecological risk, relative risk model (RRM) was applied in regional scale successfully. In this study, the risk transfer from upstream of basin was considered and the RRM was developed through introducing the source-stressor-habitat exposure filter (SSH), the endpoint-habitat exposure filter (EH) and the stressor-endpoint effect filter (SE) to reflect the meaning of exposure and effect more explicit. Water environment which includes water quality, water quantity and aquatic ecosystems was selected as the assessment endpoints. We created a conceptual model which depicting potential and effect pathways from source to stressor to habitat to endpoint. The Haihe River Basin estuary (HRBE) was selected as the model case. The results showed that there were two low risk regions, one medium risk region and two high risk regions in the HRBE. The results also indicated that urbanization was the biggest source, the second was shipping and the third was industry, their risk scores are 5.65, 4.71 and 3.68 respectively. Furthermore, habitat destruction was the largest stressor with the risk scores (2.66), the second was oxygen consuming organic pollutants (1.75) and the third was pathogens (1.75). So these three stressors were the main influencing factors of the ecological pressure in the study area. For habitats, open waters (9.59) and intertidal mudflat were enduring the bigger pressure and should be taken considerable attention. Ecological service values damaged (30.54) and biodiversity decreased were facing the biggest risk pressure.

  6. [Comparison of early retinal microvascular changes and microalbuminuria as indicators for increased cardioascular risk].

    PubMed

    Huchzermeyer, C; Schaller, B; Schmid, K; Schmieder, R E; Michelson, G

    2011-11-01

    Prevention of cardiovascular disease is an important goal in clinical medicine and public health. In the process, the diagnosis of early end-organ damage is a priority beside the treatment of classic cardiovascular risk factors. To achieve this, the ophthalmoscopic examination of the retinal vessels plays a prominent role. Alternatively, the quantification of low quantities of albumin in the urine (microalbuminuria) allows the detection of early vascular damage in the kidney. The question is addressed as to whether these two methods are interchangeable or are rather complementary. We examined 226 members of the staff of the University Hospital Erlangen who volunteered to participate in a preventive campaign. A comprehensive history was taken, and height, weight and blood pressure were measured. Analysis of serum lipids and determination of the urinary albumin/creatinine ratio were performed. Fotos of the central fundus were taken with a non-mydriatic camera and analysed by an experienced ophthalmologist in a standardised fashion. The risk for cardiovascular mortality within the next ten years was estimated from age, sex, blood pressure and serum cholesterol using the euroSCORE tables for Germany. There was no signficant correlation between the arteriovenous ratio of the retinal vessels and the urinary albumin/creatinine ratio. Neither parameter correlated with the euroSCORE Germany. Arteriovenous crossings and focal narrowing of the retinal vessels were associated signficantly with an elevated euroSCORE risk. In large population-based studies, the arteriovenous ratio and the urinary albumin/creatinine ratio have been confirmed as markers of cardiovascular risk. In our study, there was no correlation between these two parameters. Thus, they seem to present independent risk markers. The presence of arteriovenous crossings and focal narrowing seems to be linked more closely to the classic cardiovascular risk factors from which the euroSCORE is calculated. The

  7. Evaluation of risk prioritization and budget allocation methods for pollution prevention activities

    SciTech Connect

    Daniels, J.; Jones, E.; Lmont, A.; Ladmn, T.; Watz, J.

    1997-01-01

    This study reviews the structure of two main risk prioritization budget allocation methods developed by the DOE Risk-Based Priority Mode (RPM) and Management Evaluation Matrix (MEM). It identifies potential augmentations to the process that will address both risk reduction and cost-effective investments of finite resources for future Environmental Management activities. The evaluation was performed in accordance with the EM ten-year vision and principles for site cleanup. The evaluation and recommendations in this report strive to reflect four key principles, namely to eliminate the most urgent risks, reduce mortgage and support costs to make funds available for further risk reduction, protect worker health and safety, and reduce the generation of wastes.

  8. EVALUATING INTERNAL STAKEHOLDER PERSPECTIVES ON RISK-INFORMED REGULATORY PRACTICES FOR THE NUCLEAR REGULATORY COMMISSION

    SciTech Connect

    Peterson, L.K.; Wight, E.H.; Caruso, M.A.

    2003-02-27

    The U.S. Nuclear Regulatory Commission's (NRC) Office of Nuclear Reactor Regulation has begun a program to create a risk-informed environment within the reactor program. The first step of the process is to evaluate the existing environment and internal NRC stakeholder perceptions of risk-informed regulatory practices. This paper reports on the results of the first phase of this evaluation: assessing the current environment, including the level of acceptance of risk-informed approaches throughout the reactor program, the level of integration, areas of success, and areas of difficulty. The other two phases of the evaluation will identify barriers to the integration of risk into NRC activities and gather input on how to move to a risk-informed environment.

  9. Evaluating Ecological Risk to Invertebrate Receptors from PAHs in Sediments at Hazardous Waste Sites (External Review Draft)

    EPA Science Inventory

    In March 2004, ORD's Ecological Risk Assessment Support Center (ERASC) received a request from the Ecological Risk Assessment Forum (ERAF) relating to the evaluation of ecological risk to vertebrate and benthic invertebrate receptors from polycyclic aromatic hydrocarbon compounds...

  10. Evaluating Ecological Risk to Invertebrate Receptors from PAHs in Sediments at Hazardous Waste Sites (External Review Draft)

    EPA Science Inventory

    In March 2004, ORD's Ecological Risk Assessment Support Center (ERASC) received a request from the Ecological Risk Assessment Forum (ERAF) relating to the evaluation of ecological risk to vertebrate and benthic invertebrate receptors from polycyclic aromatic hydrocarbon compounds...

  11. Evaluating the potential risks of bubble studies during echocardiography.

    PubMed

    Bassett, G C; Lin, J W; Tran, M M; Sistino, J J

    2015-04-01

    Cardiac shunts are often identified using bubble studies in echocardiography, with agitated saline. Previous studies have recommended various safe amounts of agitated saline. This poses a potential risk for air microembolism. The purpose of this study was to quantify the bubbles created by various quantities of agitated saline. A closed circuit was constructed with a HeartMate pneumatic ventricular assist pump and a cardiotomy reservoir to remove air during recirculation. One empty 10 mL syringe and one 10 mL syringe containing 1 mL of air and 9 mL of saline were attached to a three-way stopcock. The air/saline bolus was then agitated between the two syringes five times to create bubbles and injected into the tubing proximal to the HeartMate. An EDAC bubble detector sensor was attached prior to the saline injection site and distal to the HeartMate I to measure the size and volume of the bubbles. This technique was repeated using 0.5 mL of air and 9.5 mL of saline bolus and 2 mL of air and 8 mL of saline bolus. Each bolus was tested 20 times. This study identifies the potential risks of air administration and proposes a safer air volume to agitate for the administration of a bubble study. Further studies should be conducted to create either a guideline or a standard for agitated saline administration by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL) in order to minimize the risk of air microembolism. © The Author(s) 2014.

  12. Use of risk assessment to evaluate effects and plan remediation of abandoned mines

    USGS Publications Warehouse

    Boyle, T.P.

    2000-01-01

    A framework of risk assessment is elaborated for the evaluation of the effects of abandoned mines and mills. Steps in this process include environmental description, identification and characterization of sources, assessment of exposure, assessment of effects, risk characterization, and risk management of remediation. The development and use of ecological end-points for remediation is discussed in terms of the chemical constituents, toxicity tests and the biological community.

  13. Evaluation of the oil spill risk analysis as presented in St. George Basin Sale 89 EIS

    SciTech Connect

    Not Available

    1985-05-31

    The report describes and evaluates the current approach to the oil-spill risk analysis as conducted for St. George Basin Sale 89. An oil spill trajectory analysis (OTSA) model was developed for the U.S. Minerals Management Service to calculate the risk of oil spills damaging environmentally sensitive resources. The purpose of the report is to review the Minerals Management Service oil-spill risk analysis as presented in the Lease Sale 89 EIS.

  14. Risk factors and stuttering: evaluating the evidence for clinicians.

    PubMed

    Ward, David

    2013-06-01

    This paper summarizes and discusses some of the key issues raised in the other four manuscripts in this special edition of Journal of Fluency Disorders. All the four pieces examine risk factors in developmental stuttering from different perspectives and all provide stand-alone contributions to knowledge on the subject. Thus, rather than review, the focus of the present paper is to highlight those matters, which, from a clinical perspective might be seen as either (a) of the greatest contention, (b) of particular relevance to clinicians, or (c) requiring greater emphasis in future research, on the basis of the conclusions from the authors involved. This paper provides an overview of points of particular clinical interest arising from the four contributions to this special edition. Readers will be able to (a) understand arguments for and against whole word repetitions being included as moments of stuttering in the SSI-3 assessment, (b) understand arguments relating to psychological components in early onset stuttering, (c) understand some of the complexities in interpreting data pertaining to recovery from stuttering, (d) understand where future efforts in research into risk of stuttering should be placed. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Evaluating Anthropogenic Risk of Grassland and Forest Habitat Degradation Using Land-Cover Data

    EPA Science Inventory

    The effects of landscape context on habitat quality are receiving increased attention in conservation biology. The objective of this research is to demonstrate an approach to mapping and evaluating the anthropogenic risks of grassland and forest habitat degradation by examining ...

  16. 78 FR 8522 - Chlorpyrifos Registration Review; Preliminary Evaluation of the Potential Risk From...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-06

    ... AGENCY Chlorpyrifos Registration Review; Preliminary Evaluation of the Potential Risk From Volatilization... review of chlorpyrifos and opens a public comment period on this document. Registration review is EPA's... has completed a preliminary volatilization assessment for chlorpyrifos uses. After reviewing...

  17. Evaluating Anthropogenic Risk of Grassland and Forest Habitat Degradation Using Land-Cover Data

    EPA Science Inventory

    The effects of landscape context on habitat quality are receiving increased attention in conservation biology. The objective of this research is to demonstrate an approach to mapping and evaluating the anthropogenic risks of grassland and forest habitat degradation by examining ...

  18. Nutritional risk and anthropometric evaluation in pediatric liver transplantation

    PubMed Central

    Zamberlan, Patrícia; Leone, Cláudio; Tannuri, Uenis; de Carvalho, Werther Brunow; Delgado, Artur Figueiredo

    2012-01-01

    OBJECTIVE: To analyze the nutritional status of pediatric patients after orthotopic liver transplantation and the relationship with short-term clinical outcome. METHOD: Anthropometric evaluations of 60 children and adolescents after orthotopic liver transplantation, during the first 24 hours in a tertiary pediatric intensive care unit. Nutritional status was determined from the Z score for the following indices: weight/age, height/age or length/age, weight/height or weight/length, body mass index/age, arm circumference/age and triceps skinfold/age. The severity of liver disease was evaluated using one of the two models which was adequated to the patients' age: 1. Pediatric End-stage Liver Disease, 2. Model for End-Stage Liver Disease. RESULTS: We found 50.0% undernutrition by height/age; 27.3% by weight/age; 11.1% by weight/height or weight/length; 10.0% by body mass index/age; 61.6% by arm circumference/age and 51.0% by triceps skinfold/age. There was no correlation between nutritional status and Pediatric End-stage Liver Disease or mortality. We found a negative correlation between arm circumference/age and length of hospitalization. CONCLUSION: Children with chronic liver diseases experience a significant degree of undernutrition, which makes nutritional support an important aspect of therapy. Despite the difficulties in assessment, anthropometric evaluation of the upper limbs is useful to evaluate nutritional status of children before or after liver transplantation. PMID:23295591

  19. Federal Register Notice Announcing Public Meetings on Chemical Prioritization and Risk Evaluation Processes under the Amended TSCA

    EPA Pesticide Factsheets

    Pre-publication version of the Federal Register notice announcing public meetings on Processes for Risk Evaluation and Chemical Prioritization for Risk Evaluation under the Amended Toxic Substances Control Act.

  20. Obesity, physical activity and cancer risks: Results from the Cancer, Lifestyle and Evaluation of Risk Study (CLEAR).

    PubMed

    Nunez, Carlos; Bauman, Adrian; Egger, Sam; Sitas, Freddy; Nair-Shalliker, Visalini

    2017-04-01

    Physical activity (PA) has been associated with lower risk of cardiovascular diseases, but the evidence linking PA with lower cancer risk is inconclusive. We examined the independent and interactive effects of PA and obesity using body mass index (BMI) as a proxy for obesity, on the risk of developing prostate (PC), postmenopausal breast (BC), colorectal (CRC), ovarian (OC) and uterine (UC) cancers. We estimated odds ratios (OR) and 95% confidence intervals (CI), adjusting for cancer specific confounders, in 6831 self-reported cancer cases and 1992 self-reported cancer-free controls from the Cancer Lifestyle and Evaluation of Risk Study, using unconditional logistic regression. For women, BMI was positively associated with UC risk; specifically, obese women (BMI≥30kg/m(2)) had nearly twice the risk of developing UC compared to women with healthy-BMI-range (<25kg/m(2)) (OR=1.99;CI:1.31-3.03). For men, BMI was also positively associated with the risk of developing any cancer type, CRC and PC. In particular, obese men had 37% (OR=1.37;CI:1.11-1.70), 113% (OR=2.13;CI:1.55-2.91) and 51% (OR=1.51;CI:1.17-1.94) higher risks of developing any cancer, CRC and PC respectively, when compared to men with healthy-BMI-range (BMI<25kg/m(2)). Among women, PA was inversely associated with the risks of CRC, UC and BC. In particular, the highest level of PA (versus nil activity) was associated with reduced risks of CRC (OR=0.60;CI:0.44-0.84) and UC (OR=0.47;CI:0.27-0.80). Reduced risks of BC were associated with low (OR=0.66;CI:0.51-0.86) and moderate (OR=0.72;CI:0.57-0.91) levels of PA. There was no association between PA levels and cancer risks for men. We found no evidence of an interaction between BMI and PA in the CLEAR study. These findings suggest that PA and obesity are independent cancer risk factors. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Assessing risk propensity in American soldiers: preliminary reliability and validity of the Evaluation of Risks (EVAR) scale--English version.

    PubMed

    Killgore, William D S; Vo, Alexander H; Castro, Carl A; Hoge, Charles W

    2006-03-01

    Risk-taking propensity is a critical component of judgment and decision-making in military operations. The Evaluation of Risks scale (EVAR) was recently developed to measure state and trait aspects of risk proneness. The scale, however, was psychometrically normed in French and no data are available for the English translation. We administered the English version of the EVAR to 165 U.S. soldiers to obtain reliability, validity, and normative data for English-speaking respondents. Confirmatory factor analysis suggested that the factor structure of the English EVAR differs from that obtained in the French studies. Instead, a three-factor solution, including recklessness/impulsivity, self-confidence, and need for control, emerged. Internal consistency was comparable to the French version. EVAR scores correlated with age, military rank, and years of service, and discriminated soldiers with histories of high-risk behavior. The data support the reliability and validity of the English version of the EVAR for evaluating risk propensity in U.S. soldiers.

  2. EVALUATION OF RISKS AND WASTE CHARACTERIZATION REQUIREMENTS FOR THE TRANSURANIC WASTE EMPLACED IN WIPP DURING 1999

    SciTech Connect

    Channell, J.K.; Walker, B.A.

    2000-05-01

    Specifically this report: 1. Compares requirements of the WAP that are pertinent from a technical viewpoint with the WIPP pre-Permit waste characterization program, 2. Presents the results of a risk analysis of the currently emplaced wastes. Expected and bounding risks from routine operations and possible accidents are evaluated; and 3. Provides conclusions and recommendations.

  3. PHILADELPHIA AIR TOXICS STUDY: EVALUATION OF RISK MANAGEMENT OPTIONS USING MIRA

    EPA Science Inventory

    Evaluation of risk management options usually takes place within single programs at the U.S. EPA. This can produce inadvertent tradeoffs among important criteria by risk managers and other decision makers; resulting in decision surprises. This study is a demonstration of a diff...

  4. Perceived Risk in College Selection: Differences in Evaluative Criteria Used by Students and Parents

    ERIC Educational Resources Information Center

    Warwick, Jacquelyn; Mansfield, Phylis M.

    2003-01-01

    Students and parents base college selection on how well the college will overcome the perceived financial, social, psychological, physical, and functional risks associated with the college experience. Nineteen criteria associated with these risks were evaluated for significant differences between students and parents as well as for their level of…

  5. Development of risk matrices for evaluating climatic change responses of forested habitats

    Treesearch

    Louis R. Iverson; Stephen N. Matthews; Anantha M. Prasad; Matthew P. Peters; Gary. Yohe

    2012-01-01

    We present an approach to assess and compare risk from climate change among multiple species through a risk matrix, in which managers can quickly prioritize for species that need to have strategies developed, evaluated further, or watched. We base the matrix upon earlier work towards the National Climate Assessment for potential damage to infrastructures from climate...

  6. Improving Ascertainment of Risk Factors for HIV Infection: Results of a Group-Randomized Evaluation

    ERIC Educational Resources Information Center

    Harrison, Kathleen McDavid; Pals, Sherri L.; Sajak, Tammy; Chase, Jennifer; Kajese, Tebitha

    2010-01-01

    To allow appropriate allocation of prevention and care funding, HIV/AIDS surveillance data must include risk factor information, currently available for less than 70% of cases reported in the United States. The authors evaluated an intervention consisting of provider training and materials to improve risk factor reporting. Facilities were matched…

  7. Improving Ascertainment of Risk Factors for HIV Infection: Results of a Group-Randomized Evaluation

    ERIC Educational Resources Information Center

    Harrison, Kathleen McDavid; Pals, Sherri L.; Sajak, Tammy; Chase, Jennifer; Kajese, Tebitha

    2010-01-01

    To allow appropriate allocation of prevention and care funding, HIV/AIDS surveillance data must include risk factor information, currently available for less than 70% of cases reported in the United States. The authors evaluated an intervention consisting of provider training and materials to improve risk factor reporting. Facilities were matched…

  8. PHILADELPHIA AIR TOXICS STUDY: EVALUATION OF RISK MANAGEMENT OPTIONS USING MIRA

    EPA Science Inventory

    Evaluation of risk management options usually takes place within single programs at the U.S. EPA. This can produce inadvertent tradeoffs among important criteria by risk managers and other decision makers; resulting in decision surprises. This study is a demonstration of a diff...

  9. Development and evaluation of a risk communication curriculum for medical students.

    PubMed

    Han, Paul K J; Joekes, Katherine; Elwyn, Glyn; Mazor, Kathleen M; Thomson, Richard; Sedgwick, Philip; Ibison, Judith; Wong, John B

    2014-01-01

    To develop, pilot, and evaluate a curriculum for teaching clinical risk communication skills to medical students. A new experience-based curriculum, "Risk Talk," was developed and piloted over a 1-year period among students at Tufts University School of Medicine. An experimental study of 2nd-year students exposed vs. unexposed to the curriculum was conducted to evaluate the curriculum's efficacy. Primary outcome measures were students' objective (observed) and subjective (self-reported) risk communication competence; the latter was assessed using an Observed Structured Clinical Examination (OSCE) employing new measures. Twenty-eight 2nd-year students completed the curriculum, and exhibited significantly greater (p<.001) objective and subjective risk communication competence than a convenience sample of 24 unexposed students. New observational measures of objective competence in risk communication showed promising evidence of reliability and validity. The curriculum was resource-intensive. The new experience-based clinical risk communication curriculum was efficacious, although resource-intensive. More work is needed to develop the feasibility of curriculum delivery, and to improve the measurement of competence in clinical risk communication. Risk communication is an important advanced communication skill, and the Risk Talk curriculum provides a model educational intervention and new assessment tools to guide future efforts to teach and evaluate this skill. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  10. Biomechanical evaluation of dancers and assessment of their risk of injury.

    PubMed

    Schoene, Lisa M

    2007-01-01

    Professional dancers have a 90% risk of injury during their career. The lower extremity is involved in approximately 75% of the injuries sustained by dancers. Proper biomechanical evaluation, risk assessment, and prevention-oriented treatment are necessary to minimize future problems and promote a full and lasting recovery when an injury is sustained. This article outlines the in-office evaluation process and discusses backstage care.

  11. The value-at-risk evaluation of Brent's crude oil market

    NASA Astrophysics Data System (ADS)

    Cheong, Chin Wen; Isa, Zaidi; Ying, Khor Chia; Lai, Ng Sew

    2014-06-01

    This study investigates the market risk of the Brent's crude oil market. First the long memory time-varying volatility is modelled under the Chung's specification. Second, for model adequacy evaluations on the heavy-tailed, long memory and endogenously estimated power transformation models indicated superior performance in out-of-sample forecasts. Lastly, these findings are further applied in the long and short trading positions of market risk evaluations of the Brent's market.

  12. Basin Scale Water Infrastructure Investment Evaluation Considering Climate Risk

    NASA Astrophysics Data System (ADS)

    Kaheil, Y. H.; Lall, U.

    2009-12-01

    Water storage infrastructure has historically been a primary means of addressing vulnerability to climate risk. Rainfall, and streamflow fluctuate at many time scales, rendering supply unreliable unless a mechanism for surface or subsurface storage is provided. Irrigated agriculture typically provides dramatically higher yields relative to rain fed agriculture, by ensuring a regular, when needed water supply. Irrigation is also typically the dominant water user in most parts of the world. Addressing storage-irrigation infrastructure needs is thus a critical piece in developing a strategy for regional water and food security in the face of a changing climate. In the 20th century, large reservoir and canal system projects were funded and developed in many regions. It is argued that these played a significant role in facilitating the Green Revolution in India, Pakistan and elsewhere. However, this notion has been challenged, and many negative environmental and socio-economic impacts of such projects have been highlighted. Governance and maintenance of such hydraulic infrastructure has also been a challenge, and a paradigm of Integrated Water Resources Management (IWRM) and participatory processes has been argued for. In the last decade or so, considerable interest has been directed towards local or on-farm decentralized storage development, i.e., towards small scale reservoir and use systems where governance may be less of an issue. There has been government support of such activities in countries such as India, leading to a rapid proliferation of such systems in some areas. Questions about the effect of such development on the regional hydrologic balance and as to their resilience in a changing climate arise. Further, in the spirit of IWRM, one needs to consider the potential use of water as well as the development and management of supply. In the current context, a central question that can be posed is the identification of the best mix of centralized and

  13. SCOPE of Pain: An Evaluation of an Opioid Risk Evaluation and Mitigation Strategy Continuing Education Program

    PubMed Central

    Zisblatt, Lara; Ng, Pamela; Hayes, Sean M.; Peloquin, Sophie; Hardesty, Ilana; White, Julie L.

    2016-01-01

    Objective. Due to the high prevalence of prescription opioid misuse, the US Food and Drug Administration (FDA) mandated a Risk Evaluation and Mitigation Strategy (REMS) requiring manufacturers of extended-release/long-acting (ER/LA) opioid analgesics to fund continuing education based on a FDA Blueprint. This article describes the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) program, an ER/LA opioid analgesic REMS program, and its impact on clinician knowledge, confidence, attitudes, and self-reported clinical practice. Method. Participants of the 3-h SCOPE of Pain training completed pre-, immediate post- and 2-month post-assessments. Subjects. The primary target group (n = 2,850), and a subset (n = 476) who completed a 2-month post-assessment, consisted of clinicians licensed to prescribe ER/LA opioid analgesics, who care for patients with chronic pain and who completed the 3-h training between February 28, 2013 and June 13, 2014. Results. Immediately post-program, there was a significant increase in correct responses to knowledge questions (60% to 84%, P ≤ 0.02) and 87% of participants planned to make practice changes. At 2-months post-program, there continued to be a significant increase in correct responses to knowledge questions (60% to 69%, P ≤ 0.03) and 67% reported increased confidence in applying safe opioid prescribing care and 86% reported implementing practice changes. There was also an improvement in alignment of desired attitudes toward safe opioid prescribing. Conclusions. The SCOPE of Pain program improved knowledge, attitudes, confidence, and self-reported clinical practice in safe opioid prescribing. This national REMS program holds potential to improve the safe use of opioids for the treatment of chronic pain. PMID:26304703

  14. SCOPE of Pain: An Evaluation of an Opioid Risk Evaluation and Mitigation Strategy Continuing Education Program.

    PubMed

    Alford, Daniel P; Zisblatt, Lara; Ng, Pamela; Hayes, Sean M; Peloquin, Sophie; Hardesty, Ilana; White, Julie L

    2016-01-01

    Due to the high prevalence of prescription opioid misuse, the US Food and Drug Administration (FDA) mandated a Risk Evaluation and Mitigation Strategy (REMS) requiring manufacturers of extended-release/long-acting (ER/LA) opioid analgesics to fund continuing education based on a FDA Blueprint. This article describes the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) program, an ER/LA opioid analgesic REMS program, and its impact on clinician knowledge, confidence, attitudes, and self-reported clinical practice. Participants of the 3-h SCOPE of Pain training completed pre-, immediate post- and 2-month post-assessments. The primary target group (n = 2,850), and a subset (n = 476) who completed a 2-month post-assessment, consisted of clinicians licensed to prescribe ER/LA opioid analgesics, who care for patients with chronic pain and who completed the 3-h training between February 28, 2013 and June 13, 2014. Immediately post-program, there was a significant increase in correct responses to knowledge questions (60% to 84%, P ≤ 0.02) and 87% of participants planned to make practice changes. At 2-months post-program, there continued to be a significant increase in correct responses to knowledge questions (60% to 69%, P ≤ 0.03) and 67% reported increased confidence in applying safe opioid prescribing care and 86% reported implementing practice changes. There was also an improvement in alignment of desired attitudes toward safe opioid prescribing. The SCOPE of Pain program improved knowledge, attitudes, confidence, and self-reported clinical practice in safe opioid prescribing. This national REMS program holds potential to improve the safe use of opioids for the treatment of chronic pain. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. 2016. This work is written by US Government employees and is in the public domain in the US.

  15. Emerging technologies in healthcare: navigating risks, evaluating rewards.

    PubMed

    McGrady, Elizabeth; Conger, Sue; Blanke, Sandra; Landry, Brett J L

    2010-01-01

    The purpose of this prescriptive research is to help decision makers become better informed about three technologies emerging in the healthcare arena by providing a basic description of the technology and describing their current applications, future healthcare deployment, potential risks, and related managerial issues. Two of the technologies, radio frequency identification (RFID) and global positioning systems (GPS), are currently available to healthcare organizations and appear capable of decreasing cost but may require significant initial investment and have disruptive potential. The third technology, nanotechnology, has limited current use but may revolutionize both the delivery of medicine and hospital infrastructure management. With cautious attention to managerial issues and meticulous attention to implementation details, healthcare organizations that can successfully navigate the coming technologically driven paradigm shifts will emerge more resilient organizations.

  16. Methods to evaluate the nutrition risk in hospitalized patients

    PubMed Central

    Erkan, Tülay

    2014-01-01

    The rate of malnutrition is substantially high both in the population and in chronic patients hospitalized because of different reasons. The rate of patients with no marked malnutrition at the time of hospitalization who develop malnutrition during hospitalization is also substantially high. Therefore, there are currently different screening methods with different targets to prevent malnutrition and its overlook. These methods should be simple and reliable and should not be time-consuming in order to be used in daily practice. Seven nutrition risk screening methods used in children have been established until the present time. However, no consensus has been made on any method as in adults. It should be accepted that interrogation of nutrition is a part of normal examination to increase awareness on this issue and to draw attention to this issue. PMID:26078678

  17. Evaluation of a novel periodontal risk assessment model in patients presenting for dental care.

    PubMed

    Chandra, R Viswa

    2007-01-01

    The present study was designed to develop a new periodontal risk assessment model based on the periodontal risk assessment (PRA) model by Lang and Tonetti, and to evaluate the risk assessment capability of the proposed model. Twenty-six patients diagnosed with chronic periodontitis were selected randomly and a thorough examination and charting of the periodontal status was performed. An intra-oral periapical radiograph of the area with the deepest probing depth was also taken. The following parameters were recorded: percentage of sites with BOP, number of sites with pocket depths > or = 5mm, number of teeth lost, bone loss/age ratio, attachment loss/age ratio, diabetic and smoking status, dental status, other systemic factors and risk determinants. Using Microsoft Excel, the parameters were plotted on the radar chart as per the original and the proposed model. Of the cases identified by the original model, 42.3% were high-risk cases and 30.8% of the cases were low-risk cases. In the proposed model, 46.2% of high-risk cases and 46.2% of low-risk cases were identified. Only 7.7% of the cases identified with the new model were moderate-risk cases. Statistical analysis demonstrated that there was no significant difference between the risk scores of the two models. The results suggest that risk assessment by this model does not vary significantly as compared to the original model, and both are equally adept at detecting potential risk groups.

  18. Evaluation of risk factors for advanced glaucoma in Ghanaian patients.

    PubMed

    Ntim-Amponsah, C T; Amoaku, W M K; Ewusi, R K; Idirisuriya-Khair, R; Nyatepe-Coo, E; Ofosu-Amaah, S

    2005-05-01

    This study was to determine factors associated with individuals presenting late with advanced glaucomatous optic nerve damage. A case-control study recruiting 123 patients with early features of primary open angle glaucoma (control) and 93 patients with advanced glaucoma (cases) was carried out for risk-factor analysis. Exposures of interest included those already established as major risk factors for glaucoma. These were initial intraocular pressure (IOP), age, and family history. In addition, occupation, ethnic origin, history of diagnosis of diabetes mellitus, hypertension, sickle cell disease, and previous eye examination were of interest. Univariate analysis showed that initial IOP>31 mmHg, age of > 60 years, absence of family history of glaucoma, occupational grouping, ethnicity, and male sex were associated with advanced glaucoma at presentation. Adjusted odds ratio or by multiple logistic regression model showed that initial IOP>31 mmHg in a patient was more likely to present with advanced glaucoma (OR 2.66, 95% confidence interval (CI) 1.45, 4.91; P-value 0.0017) than lower pressures. Patients aged 60-69 years (OR 2.53, 95% CI 1.01, 6.31; P-value 0.0473) and 70-90 years (OR 5.16, 95% CI 1.97, 13.51; P-value 0.0008) were more likely to present with advanced glaucoma than younger ones Subjects with initial IOP>31 mmHg were nearly three times more likely to present with advanced glaucoma than those with IOP<32 mmHg. Subjects over the age of 60 years were more than two times likely to present with advanced glaucoma than younger subjects.

  19. Evaluation of awareness of risk factors for kidney cancer among patients presenting to a urology clinic.

    PubMed

    Parker, Alexander S; Arnold, Michelle L; Diehl, Nancy D; Hassan, Lauren; Thiel, David D

    2014-06-01

    This study aimed to evaluate awareness of risk factors for kidney cancer among patients presenting to a urology clinic. Smoking, obesity and hypertension are widely accepted as risk factors for kidney cancer; however, there are limited data regarding awareness of these risk factors. The researchers prospectively identified 172 patients presenting to a urology clinic between 1 May 2009 and 31 August 2009. Each patient completed a questionnaire that requested responses to whether certain lifestyle factors increased the risk of a variety of cancers. Information on demographics and other covariates was collected via questionnaires and medical chart abstraction. To estimate and compare risk factor awareness levels for different cancers, 95% confidence intervals (95% CIs) were constructed and Fisher's exact tests performed. Logistic regression analysis was used to evaluate covariates associated with risk factor awareness. The percentage reporting that smoking increases the risk of kidney cancer (36%, 95% CI 29-44%) was lower than for lung cancer (96%, 95% CI 92-99%). Similarly, the percentage reporting that obesity increases the risk of kidney cancer (32%, 95% CI 25-40%) was lower than for colon cancer (45%, 95% CI 37-53% CI). Only 18% (95% CI 13-25%) identified hypertension as a risk factor for kidney cancer. Female gender and younger age were associated with increased levels of awareness of the association with smoking and obesity, respectively. The data support a low level of awareness of kidney cancer risk factors and underscore an opportunity for urologists to engage in education efforts.

  20. Developing a new Bayesian Risk Index for risk evaluation of soil contamination.

    PubMed

    Albuquerque, M T D; Gerassis, S; Sierra, C; Taboada, J; Martín, J E; Antunes, I M H R; Gallego, J R

    2017-12-15

    Industrial and agricultural activities heavily constrain soil quality. Potentially Toxic Elements (PTEs) are a threat to public health and the environment alike. In this regard, the identification of areas that require remediation is crucial. In the herein research a geochemical dataset (230 samples) comprising 14 elements (Cu, Pb, Zn, Ag, Ni, Mn, Fe, As, Cd, V, Cr, Ti, Al and S) was gathered throughout eight different zones distinguished by their main activity, namely, recreational, agriculture/livestock and heavy industry in the Avilés Estuary (North of Spain). Then a stratified systematic sampling method was used at short, medium, and long distances from each zone to obtain a representative picture of the total variability of the selected attributes. The information was then combined in four risk classes (Low, Moderate, High, Remediation) following reference values from several sediment quality guidelines (SQGs). A Bayesian analysis, inferred for each zone, allowed the characterization of PTEs correlations, the unsupervised learning network technique proving to be the best fit. Based on the Bayesian network structure obtained, Pb, As and Mn were selected as key contamination parameters. For these 3 elements, the conditional probability obtained was allocated to each observed point, and a simple, direct index (Bayesian Risk Index-BRI) was constructed as a linear rating of the pre-defined risk classes weighted by the previously obtained probability. Finally, the BRI underwent geostatistical modeling. One hundred Sequential Gaussian Simulations (SGS) were computed. The Mean Image and the Standard Deviation maps were obtained, allowing the definition of High/Low risk clusters (Local G clustering) and the computation of spatial uncertainty. High-risk clusters are mainly distributed within the area with the highest altitude (agriculture/livestock) showing an associated low spatial uncertainty, clearly indicating the need for remediation. Atmospheric emissions, mainly

  1. Evaluation of risk for type 2 diabetes mellitus in medical students using Indian Diabetes Risk Score.

    PubMed

    Ashok, Pranita; Kharche, Jayshree S; Joshi, Aniruddha R

    2011-01-01

    According to World Health Organisation, type 2 diabetes mellitus [type 2 D. M] has recently escalated in all age groups and is now being identified in younger age groups. This underscores the need for mass awareness and screening programs to detect diabetes at an early stage. For this purpose we have used a simplified Indian Diabetes Risk Score (IDRS) for prediction of diabetes in undergraduate medical students. To screen and to identify 1st MBBS students at risk for developing type 2 D. M using IDRS. 261 undergraduates (1st MBBS students) were scored using IDRS which includes age, family history of diabetes, exercise status, and waist circumference. After scoring them, we assessed random capillary blood glucose (RCBG) in students with high IDRS score. Students with RCBG ≥ 113 mg/dl are followed for definitive tests for diagnosis of prediabetes and diabetes. We have assessed 261 students till now. It was observed that 5%, 55%, and 38% students in High, Moderate, and Low risk group, respectively, for developing type 2 D. M. The mean abdominal obesity in high risk students was 101.95 ± 5.76 as compared to 79.17 ± 11.08 in moderate and low risk students (P < 0.0001). 63% students were having sedentary lifestyle. Family history of diabetes in either or both parents was present in 25% students. Mean RCBG in students having score more than 50 was 97.33 ± 9.68 mg/dl. Also, two students were having RCBG > 113 mg/dl in which one student found to have prediabetic. This underscores the need for further investigations to detect diabetes at an early stage and to overcome the disease burden of diabetes in future. Prevention of obesity and promotion of physical activity have to be the future plan of action which can be suggested in the form of regular exercise and diet planning for the students as part of an integrated approach.

  2. Applicability of Two International Risk Scores in Cardiac Surgery in a Reference Center in Brazil

    PubMed Central

    Garofallo, Silvia Bueno; Machado, Daniel Pinheiro; Rodrigues, Clarissa Garcia; Bordim, Odemir; Kalil, Renato A. K.; Portal, Vera Lúcia

    2014-01-01

    Background The applicability of international risk scores in heart surgery (HS) is not well defined in centers outside of North America and Europe. Objective To evaluate the capacity of the Parsonnet Bernstein 2000 (BP) and EuroSCORE (ES) in predicting in-hospital mortality (IHM) in patients undergoing HS at a reference hospital in Brazil and to identify risk predictors (RP). Methods Retrospective cohort study of 1,065 patients, with 60.3% patients underwent coronary artery bypass grafting (CABG), 32.7%, valve surgery and 7.0%, CABG combined with valve surgery. Additive and logistic scores models, the area under the ROC (Receiver Operating Characteristic) curve (AUC) and the standardized mortality ratio (SMR) were calculated. Multivariate logistic regression was performed to identify the RP. Results Overall mortality was 7.8%. The baseline characteristics of the patients were significantly different in relation to BP and ES. AUCs of the logistic and additive BP were 0.72 (95% CI, from 0.66 to 0.78 p = 0.74), and of ES they were 0.73 (95% CI; 0.67 to 0.79 p = 0.80). The calculation of the SMR in BP was 1.59 (95% CI; 1.27 to 1.99) and in ES, 1.43 (95% CI; 1.14 to 1.79). Seven RP of IHM were identified: age, serum creatinine > 2.26 mg/dL, active endocarditis, systolic pulmonary arterial pressure > 60 mmHg, one or more previous HS, CABG combined with valve surgery and diabetes mellitus. Conclusion Local scores, based on the real situation of local populations, must be developed for better assessment of risk in cardiac surgery. PMID:25004415

  3. Utility of Bayesian networks in QMRA-based evaluation of risk reduction options for recycled water.

    PubMed

    Beaudequin, Denise; Harden, Fiona; Roiko, Anne; Mengersen, Kerrie

    2016-01-15

    Quantitative microbial risk assessment (QMRA), the current method of choice for evaluating human health risks associated with disease-causing microorganisms, is often constrained by issues such as availability of required data, and inability to incorporate the multitude of factors influencing risk. Bayesian networks (BNs), with their ability to handle data paucity, combine quantitative and qualitative information including expert opinions, and ability to offer a systems approach to characterisation of complexity, are increasingly recognised as a powerful, flexible tool that overcomes these limitations. We present a QMRA expressed as a Bayesian network (BN) in a wastewater reuse context, with the objective of demonstrating the utility of the BN method in health risk assessments, particularly for evaluating a range of exposure and risk mitigation scenarios. As a case study, we examine the risk of norovirus infection associated with wastewater-irrigated lettuce. A Bayesian network was developed following a QMRA approach, using published data, and reviewed by domain experts using a participatory process. Employment of a BN facilitated rapid scenario evaluations, risk minimisation, and predictive comparisons. The BN supported exploration of conditions required for optimal outcomes, as well as investigation of the effect on the reporting nodes of changes in 'upstream' conditions. A significant finding was the indication that if maximum post-treatment risk mitigation measures were implemented, there was a high probability (0.84) of a low risk of infection regardless of fluctuations in other variables, including norovirus concentration in treated wastewater. BNs are useful in situations where insufficient empirical data exist to satisfy QMRA requirements and they are exceptionally suited to the integration of risk assessment and risk management in the QMRA context. They allow a comprehensive visual appraisal of major influences in exposure pathways, and rapid interactive

  4. Regional Risk Evaluation of Flood Disasters for the Trunk-Highway in Shaanxi, China.

    PubMed

    Qi, Hong-Liang; Tian, Wei-Ping; Li, Jia-Chun

    2015-10-29

    Due to the complicated environment there are various types of highway disasters in Shaanxi Province (China). The damages caused are severe, losses are heavy, and have rapidly increased over the years, especially those caused by flood disasters along the rivers in mountainous areas. Therefore, research on risk evaluations, which play important roles in the prevention and mitigation of highway disasters are very important. An evaluation model was established based on the superposition theory of regional influencing factors to highway flood disasters. Based on the formation mechanism and influencing factors of highway flood disasters, the main influencing factors were selected. These factors include rainstorms, terrain slopes, soil types, vegetation coverage and regional river density, which are based on evaluation indexes from climate conditions and underlying surface of the basin. A regional risk evaluation of highway flood disasters in Shaanxi was established using GIS. The risk index was divided into five levels using statistical methods, in accordance with the regional characteristics of highway flood disasters. Considering the difference in upfront investments, road grade, etc, between expressways and trunk-highways in China, a regional risk evaluation of trunk-highway flood disasters was completed. The evaluation results indicate that the risk evaluation is consistent with the actual situation.

  5. Regional Risk Evaluation of Flood Disasters for the Trunk-Highway in Shaanxi, China

    PubMed Central

    Qi, Hong-Liang; Tian, Wei-Ping; Li, Jia-Chun

    2015-01-01

    Due to the complicated environment there are various types of highway disasters in Shaanxi Province (China). The damages caused are severe, losses are heavy, and have rapidly increased over the years, especially those caused by flood disasters along the rivers in mountainous areas. Therefore, research on risk evaluations, which play important roles in the prevention and mitigation of highway disasters are very important. An evaluation model was established based on the superposition theory of regional influencing factors to highway flood disasters. Based on the formation mechanism and influencing factors of highway flood disasters, the main influencing factors were selected. These factors include rainstorms, terrain slopes, soil types, vegetation coverage and regional river density, which are based on evaluation indexes from climate conditions and underlying surface of the basin. A regional risk evaluation of highway flood disasters in Shaanxi was established using GIS. The risk index was divided into five levels using statistical methods, in accordance with the regional characteristics of highway flood disasters. Considering the difference in upfront investments, road grade, etc, between expressways and trunk-highways in China, a regional risk evaluation of trunk-highway flood disasters was completed. The evaluation results indicate that the risk evaluation is consistent with the actual situation. PMID:26528994

  6. Stroke and bleeding risk evaluation in atrial fibrillation: results of the European heart rhythm association survey.

    PubMed

    Larsen, Torben Bjerregaard; Potpara, Tatjana; Dagres, Nikolaos; Pison, Laurent; Estner, Heidi; Blomström-Lundqvist, Carina

    2014-05-01

    The aim of this European Heart Rhythm Association (EHRA) survey was to assess clinical practice in relation to stroke and bleeding risk evaluation in atrial fibrillation, particularly regarding the use of risk evaluation schemes, among members of the EHRA electrophysiology (EP) research network. In this EP Wire survey, we have provided some insights into current practice in Europe for the use of these risk assessment schemes. There were some obvious practice differences. However, reassuring information on current practice in Europe was evident, but more focus on renal function is warranted, especially facing the fact that novel oral anticoagulants are used for antithrombotic therapy.

  7. Dental fluorosis in Chilean children: evaluation of risk factors.

    PubMed

    Villa, A E; Guerrero, S; Icaza, G; Villalobos, J; Anabalón, M

    1998-10-01

    The purpose of this case-control study was to determine the association between very-mild-to-moderate enamel fluorosis and exposure during early childhood to fluoridated water, mainly through ingestion of powdered milk. Analysis was performed on 136 residents of the optimally fluoridated community of San Felipe in the Chilean Fifth Region, who were categorised into one of three groups according to their age when water fluoridation was introduced in 1986: Group I was born after 1986; Group II was 16-24 months old in 1986; and Group III was >24 months of age. The case and control subjects were selected on the basis of a clinical examination given in July 1996. Dean's scoring system was used to determine fluorosis status. Risk factor exposure was ascertained by a questionnaire used in interviews with mothers of participating children. Logistic regression analysis, after adjustment for confounding variables, revealed that very-mild-to-moderate enamel fluorosis of permanent central maxillary incisors (CMI) was strongly associated both with the age of the subjects when water fluoridation began and with breast-feeding duration for children belonging to Group I. Subjects in Group I were 20.44 times more likely (95% CI: 5.00-93.48) to develop CMI fluorosis than children who were older than 24 months (Group III) when fluoridation began. Subjects who were between 16 and 24 months old when water fluoridation began were 4.15 times more likely (95% CI: 1.05-16.43) to have CMI fluorosis than children older than 24 months. An inverse association was found with breastfeeding duration (OR=0.86, 95% CI: 0.75-0.98) among Group I subjects but not in Groups II and III. Results obtained suggest that the current fluoride concentration in drinking water may be contributing to fluorosis. Further studies will be necessary to determine the relative competing risks of dental fluorosis and dental caries in Chilean children in order to establish the most appropriate water fluoridation level in

  8. Balloon aortic valvuloplasty as a bridge-to-decision in high risk patients with aortic stenosis: a new paradigm for the heart team decision making

    PubMed Central

    Saia, Francesco; Moretti, Carolina; Dall'Ara, Gianni; Ciuca, Cristina; Taglieri, Nevio; Berardini, Alessandra; Gallo, Pamela; Cannizzo, Marina; Chiarabelli, Matteo; Ramponi, Niccolò; Taffani, Linda; Bacchi-Reggiani, Maria Letizia; Marrozzini, Cinzia; Rapezzi, Claudio; Marzocchi, Antonio

    2016-01-01

    Background Whilst the majority of the patients with severe aortic stenosis can be directly addressed to surgical aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI), in some instances additional information may be needed to complete the diagnostic workout. We evaluated the role of balloon aortic valvuloplasty (BAV) as a bridge-to-decision (BTD) in selected high-risk patients. Methods Between 2007 and 2012, the heart team in our Institution required BTD BAV in 202 patients. Very low left ventricular ejection fraction, mitral regurgitation grade ≥ 3, frailty, hemodynamic instability, serious comorbidity, or a combination of these factors were the main drivers for this strategy. We evaluated how BAV influenced the final treatment strategy in the whole patient group and in each specific subgroup. Results Mean logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 23.5% ± 15.3%, age 81 ± 7 years. In-hospital mortality was 4.5%, cerebrovascular accident 1% and overall vascular complications 4% (0.5% major; 3.5% minor). Of the 193 patients with BTD BAV who survived and received a second heart team evaluation, 72.6% were finally deemed eligible for definitive treatment (25.4% for AVR; 47.2% for TAVI): 96.7% of patients with left ventricular ejection fraction recovery; 70.5% of patients with mitral regurgitation reduction; 75.7% of patients who underwent BAV in clinical hemodynamic instability; 69.2% of frail patients and 68% of patients who presented serious comorbidities. Conclusions Balloon aortic valvuloplasty can be considered as bridge-to-decision in high-risk patients with severe aortic stenosis who cannot be immediate candidates for definitive transcatheter or surgical treatment. PMID:27582761

  9. [From risk charts to guidelines: tools for evaluation and management of cardiovascular risk].

    PubMed

    Castello, Cristina; Colivicchi, Furio; Sclavo, Mariagrazia; Uguccioni, Massimo; Ebert, Alberto Genovesi; Abrignani, Maurizio G; Faggiano, Pompilio; Riccio, Carmine

    2006-03-01

    Despite the wide improvement of diagnostic techniques and the introduction of effective pharmacological and instrumental therapeutic strategies aimed to the treatment of cardiovascular diseases, their incidence and lethality are still elevated, with economic implications increasingly less sustainable by the public medical systems. The modern practice of cardiovascular prevention requires, thus, that diagnostic and therapeutic interventions, both at population level and on the single patient, should be more and more precise, effective, and appropriate. From this point of view, a correct global cardiovascular risk stratification assumes a preponderant relevance, in order to allow an adequate therapeutical response. For this purpose several work instruments, as risk charts and guidelines, namely dedicated to arterial hypertension and dyslipidemias, were developed and offered to clinicians interested in cardiovascular prevention. The aim of this review is to illustrate, in synthesis, those instruments, aiming to facilitate their implementation, thus reducing the actual gap between theoretical indications and the real world.

  10. Risk evaluation and mitigation strategies: a focus on the mycophenolic acid preparations.

    PubMed

    Rostas, Sara; Kim, Miae; Gabardi, Steven

    2014-03-01

    To review risks associated with mycophenolic acid (MPA) preparations and evaluate their required risk evaluation and mitigation strategies (REMS) elements. Articles were identified through a non-date-limited MEDLINE and EMBASE search using the terms fetal toxicity, teratogenicity, risk evaluation and mitigation strategies, REMS, MPA, mycophenolate mofetil, entericcoated MPA, and organ transplant. Information from the Food and Drug Administration (FDA) and the manufacturers of the MPA preparations was also evaluated. The MPA preparations are associated with several potential risks, including gastrointestinal disturbances and myelosuppression; however, their impact on the fetus in pregnant patients taking 1 of these agents poses the greatest risk. The FDA approved REMS programs for all MPA products, both innovator and generic preparations, in September 2012. With evidence of increased risk of miscarriage and birth defects associated with MPA use, the FDA instituted a REMS program that contains both a medication guide and elements to assure safe use (ETASU). The medication guides for the MPA products, which were previously FDA approved, should continue to be distributed to patients who get either an initial prescription filled or a refill. The ETASU requires prescribers to complete training and obtain patient signatures on the Patient-Prescriber Acknowledgment Form. A single, national, voluntary pregnancy registry specific to this medication has been established, and pregnant patients should be encouraged to participate. Although the impact of the MPA REMS on clinical practice is not clear, it is a step toward increasing the understanding of fetal risks with MPA.

  11. Retinal image analysis for automated glaucoma risk evaluation

    NASA Astrophysics Data System (ADS)

    Nyúl, László G.

    2009-10-01

    Images of the eye ground not only provide an insight to important parts of the visual system but also reflect the general state of health of the entire human body. Automatic retina image analysis is becoming an important screening tool for early detection of certain risks and diseases. Glaucoma is one of the most common causes of blindness and is becoming even more important considering the ageing society. Robust mass-screening may help to extend the symptom-free life of affected patients. Our research is focused on a novel automated classification system for glaucoma, based on image features from fundus photographs. Our new data-driven approach requires no manual assistance and does not depend on explicit structure segmentation and measurements. First, disease independent variations, such as nonuniform illumination, size differences, and blood vessels are eliminated from the images. Then, the extracted high-dimensional feature vectors are compressed via PCA and combined before classification with SVMs takes place. The technique achieves an accuracy of detecting glaucomatous retina fundus images comparable to that of human experts. The "vessel-free" images and intermediate output of the methods are novel representations of the data for the physicians that may provide new insight into and help to better understand glaucoma.

  12. Risk evaluation - conventional and low level effects of radiation

    SciTech Connect

    Bond, V.P.; Varma, M.N.

    1984-04-01

    Any discussion of the risk of exposure to potentially-hazardous agents in the environment inevitably involves the question of whether the dose effect curve is of the threshold or linear, non-threshold type. A principal objective of this presentation is to show that the function is actually two separate relationships, each representing distinctly different functions with differing variables on the axes, and each characteristic of quite different functions with differing variables on the axes, and each characteristic of quite different disciplines (i.e., the threshold function, of Pharmacology, Toxicology and Medicine (PTM); the linear, non-threshold function, of Public Health including safety and accident statistics (PHS)). It is shown that low-level exposure (LLE) to radiation falls clearly in the PHS category. A function for cell dose vs. the fraction of single cell quantal responses is characterized, which reflects the absolute and relative sensitivities of cells. Acceptance of this function would obviate any requirement for the use in Radiation Protection of the concepts of a standard radiation, Q, dose equivalent and rem. 9 references, 4 figures.

  13. Probabilistic risk assessment for comparative evaluation of security features

    NASA Astrophysics Data System (ADS)

    Saksena, Anshu; Lucarelli, Dennis

    2004-06-01

    A systematic approach for comparing the effectiveness of counterfeit deterrence features in banknotes, credit cards, digital media, etc. was previously presented. That approach built a probabilistic model around the expert identification of the most efficient process by which a counterfeiter can gain sufficient information to replicate a particular feature. We have extended the scope and functionality of that approach to encompass the entire counterfeiting process from the learning phase to the production of counterfeits. The extended approach makes determining the probabilities more straightforward by representing a more detailed model of the counterfeiting process, including many probable counterfeiting scenarios rather than just representing the least costly successful scenario. It uses the counterfeiter's probability of succeeding and level of effort as metrics to perform feature comparisons. As before, these metrics are evaluated for a security feature and presented in a way that facilitates comparison with other security features similarly evaluated. Based on this representation, the cost and laboratory procedures necessary for succeeding may be recovered by a dynamic programming technique. This information may be useful in forensic profiling of potential counterfeiters.

  14. Evaluating the Risk and Attractiveness of Romantic Partners When Confronted with Contradictory Cues

    PubMed Central

    Hennessy, Michael; Fishbein, Martin; Curtis, Brenda; Barrett, Daniel W.

    2010-01-01

    Research shows that people engage in “risky” sex with “safe” partners and in “safer” sex with “riskier” partners. How is the determination of “risky” or “safe” status made? Factorial survey methodology was used to randomly construct descriptions of romantic partners based on attractive and/or risky characteristics. Respondents evaluated 20 descriptions for attractiveness, health risk, likelihood of going on a date, likelihood of unprotected sex, and likelihood of STD/HIV infection. Respondents were most attracted to and perceived the least risk from attractive descriptions and were least attracted to and perceived the most risk from the risky descriptions. The differences between the “conflicting information” descriptions are attributable to a primacy effect: descriptions that began with attractiveness information but end with risk information were evaluated more positively than those that began with risk and ended with attractive information. PMID:17028997

  15. The Application of a Residual Risk Evaluation Technique Used for Expendable Launch Vehicles

    NASA Technical Reports Server (NTRS)

    Latimer, John A.

    2009-01-01

    This presentation provides a Residual Risk Evaluation Technique (RRET) developed by Kennedy Space Center (KSC) Safety and Mission Assurance (S&MA) Launch Services Division. This technique is one of many procedures used by S&MA at KSC to evaluate residual risks for each Expendable Launch Vehicle (ELV) mission. RRET is a straight forward technique that incorporates the proven methodology of risk management, fault tree analysis, and reliability prediction. RRET derives a system reliability impact indicator from the system baseline reliability and the system residual risk reliability values. The system reliability impact indicator provides a quantitative measure of the reduction in the system baseline reliability due to the identified residual risks associated with the designated ELV mission. An example is discussed to provide insight into the application of RRET.

  16. [Theoretical evaluation of the risk of decompression illness during simulated extravehicular activity].

    PubMed

    Nikolaev, V P

    2008-01-01

    Theoretical analysis of the risk of decompression illness (DI) during extravehicular activity following the Russian and NASA decompression protocols (D-R and D-US, respectively) was performed. In contrast to the tradition approach to decompression stress evaluation by the factor of tissue supersaturation with nitrogen, our probabilistic theory of decompression safety provides a completely reasoned evaluation and comparison of the levels of hazard of these decompression protocols. According to this theory, the function of cumulative DI risk is equal to the sum of functions of cumulative risk of lesion of all body tissues by gas bubbles and their supersaturation by solute gases. Based on modeling of dynamics of these functions, growth of the DI cumulative risk in the course of D-R and D-US follows essentially similar trajectories within the time-frame of up to 330 minutes. However, further extension of D-US but not D-R raises the risk of DI drastically.

  17. Fuzzy comprehensive evaluation-based disaster risk assessment of desertification in Horqin Sand Land, China.

    PubMed

    Wang, Yongfang; Zhang, Jiquan; Guo, Enliang; Sun, Zhongyi

    2015-02-03

    Desertification is a typical disaster risk event in which human settlements and living environments are destroyed. Desertification Disaster Risk Assessment can control and prevent the occurrence and development of desertification disasters and reduce their adverse influence on human society. This study presents the methodology and procedure for risk assessment and zoning of desertification disasters in Horqin Sand Land. Based on natural disaster risk theory and the desertification disaster formation mechanism, the Desertification Disaster Risk Index (DDRI) combined hazard, exposure, vulnerability and restorability factors and was developed mainly by using multi-source data and the fuzzy comprehensive evaluation method. The results showed that high risk and middle risk areas account for 28% and 23% of the study area, respectively. They are distributed with an "S" type in the study area. Low risk and very low risk areas account for 21% and 10% of the study area, respectively. They are distributed in the west-central and southwestern parts. Very high risk areas account for 18% of the study area and are distributed in the northeastern parts. The results can be used to know the desertification disaster risk level. It has important theoretical and practical significance to prevention and control of desertification in Horqin Sand Land and even in Northern China.

  18. Fuzzy Comprehensive Evaluation-Based Disaster Risk Assessment of Desertification in Horqin Sand Land, China

    PubMed Central

    Wang, Yongfang; Zhang, Jiquan; Guo, Enliang; Sun, Zhongyi

    2015-01-01

    Desertification is a typical disaster risk event in which human settlements and living environments are destroyed. Desertification Disaster Risk Assessment can control and prevent the occurrence and development of desertification disasters and reduce their adverse influence on human society. This study presents the methodology and procedure for risk assessment and zoning of desertification disasters in Horqin Sand Land. Based on natural disaster risk theory and the desertification disaster formation mechanism, the Desertification Disaster Risk Index (DDRI) combined hazard, exposure, vulnerability and restorability factors and was developed mainly by using multi-source data and the fuzzy comprehensive evaluation method. The results showed that high risk and middle risk areas account for 28% and 23% of the study area, respectively. They are distributed with an “S” type in the study area. Low risk and very low risk areas account for 21% and 10% of the study area, respectively. They are distributed in the west-central and southwestern parts. Very high risk areas account for 18% of the study area and are distributed in the northeastern parts. The results can be used to know the desertification disaster risk level. It has important theoretical and practical significance to prevention and control of desertification in Horqin Sand Land and even in Northern China. PMID:25654772

  19. Evaluation of Historical and Projected Agricultural Climate Risk Over the Continental US

    NASA Astrophysics Data System (ADS)

    Zhu, X.; Troy, T. J.; Devineni, N.

    2016-12-01

    Food demands are rising due to an increasing population with changing food preferences, which places pressure on agricultural systems. In addition, in the past decade climate extremes have highlighted the vulnerability of our agricultural production to climate variability. Quantitative analyses in the climate-agriculture research field have been performed in many studies. However, climate risk still remains difficult to evaluate at large scales yet shows great potential of help us better understand historical climate change impacts and evaluate the future risk given climate projections. In this study, we developed a framework to evaluate climate risk quantitatively by applying statistical methods such as Bayesian regression, distribution fitting, and Monte Carlo simulation. We applied the framework over different climate regions in the continental US both historically and for modeled climate projections. The relative importance of any major growing season climate index, such as maximum dry period or heavy precipitation, was evaluated to determine what climate indices play a role in affecting crop yields. The statistical modeling framework was applied using county yields, with irrigated and rainfed yields separated to evaluate the different risk. This framework provides estimates of the climate risk facing agricultural production in the near-term that account for the full uncertainty of climate occurrences, range of crop response, and spatial correlation in climate. In particular, the method provides robust estimates of importance of irrigation in mitigating agricultural climate risk. The results of this study can contribute to decision making about crop choice and water use in an uncertain climate.

  20. Chemical mixtures: Evaluation of risk for child-specific exposures in a multi-stressor environment

    SciTech Connect

    Pohl, H.R. Abadin, H.G.

    2008-11-15

    Evaluating the health impact from exposure to chemical mixtures is multifaceted. One component is exposure. Exposure, and consequently risk assessment for mixtures and chemicals in general, are often viewed in terms of a given exposure to a given population at a given location over a given time period. However, environmental exposures are present throughout human lifetime. As a result, an evaluation of risk must include the distinctive characteristics related to chemical exposures which will impact risk depending upon the particular life stage where exposure occurs. Risks to offspring may be associated with unique exposures in utero, during infancy, childhood, or adolescent periods. For example, exposure of infants to anthropogenic chemicals via breast milk may be of concern. The Agency for Toxic Substances and Disease Registry's (ATSDR's) approach to evaluating risks associated with exposure to mixtures of chemicals is presented. In addition to the breast milk issues, indoor exposure to combined air pollutants, drinking water contaminants, and soil and dust contaminants are discussed. The difference between a mixture's risk evaluation for children and adults is in the distinct exposure scenarios resulting from variations in behavior, physiology, and/or pharmacokinetics between adults and children rather than in the method for the specific mixtures evaluation per se.

  1. Evaluation of a risk index for advanced proximal neoplasia of the colon.

    PubMed

    Ruco, Arlinda; Stock, David; Hilsden, Robert J; McGregor, S Elizabeth; Paszat, Lawrence F; Saskin, Refik; Rabeneck, Linda

    2015-01-01

    A clinical risk index that uses distal colorectal findings at flexible sigmoidoscopy (FS) in conjunction with easily determined risk factors for advanced proximal neoplasia (APN) may be useful for tailoring or prioritizing screening with colonoscopy. To conduct an external evaluation of a previously published risk index in a large, well-characterized cohort. Cross-sectional. Teaching hospital and colorectal cancer screening center. A total of 5139 asymptomatic persons aged 50 to 74 (54.9% women) with a mean age (±SD) of 58.3 (±6.2) years. Between 2003 and 2011, all participants underwent a complete screening colonoscopy and removal of all polyps. Participants were classified as low, intermediate, or high risk for APN, based on their composite risk index scores. The concordance or c-statistic was used to measure discriminating ability of the risk index. A total of 167 persons (3.2%) had APN. The prevalence of those with APN among low-, intermediate-, and high-risk categories was 2.1%, 2.9%, and 6.5%, respectively. High-risk individuals were 3.2 times more likely to have APN compared with those in the low-risk category. The index did not discriminate well between those in the low- and intermediate-risk categories. The c-statistic for the overall index was 0.62 (95% confidence interval, 0.58-0.66). Distal colorectal findings were derived from colonoscopies and not FS itself. The risk index discriminated between those at low risk and those at high risk, but it had limited ability to discriminate between low- and intermediate-risk categories for prevalent APN. Information on other risk factors may be needed to tailor, or prioritize, access to screening colonoscopy. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  2. Evaluation of suicide risk in children: psychometric properties of the Spanish version of the Risk of Suicide Questionnaire (RSQ).

    PubMed

    Robles-Garcia, R; Páez Agraz, F; Ascensio Guirado, M; Mercado Salcedo, E; Hernández Muñoz, L

    2005-01-01

    Risk of Suicide Questionnaire (RSQ) is a useful self-administered tool to assess suicide risk among children. The aim of this study was to translate RSQ into Spanish and determine its validity and reliability among Mexican children. After a culturally sensitive RSQ items translation, all fifth and sixth grade elementary school students of both genders, from a private educational Institution in Guadalajara (Mexico) whose parents gave informed consent to participate, completed the RSQ Spanish version and the Beck's Depression and Hopelessness Inventories. The parents of the children who had a suicide risk were contacted and invited to come with their child to a subsequent appointment for evaluation and free treatment in the Jalisciense Mental Health Institute. For correlation analysis, item number 9 related to suicide was eliminated. A total sample of 88 students participated. Their mean age was 11.23 +- 0.78 years old, and 55.7 % were male. Mean total scales were as follows: RSQ: 8.3 +- 9.05; depression: 7.4 +- 6.7, and hopelessness: 18 +- 3.3. Cronbach's alpha for RSQ was 0.68. Intra class coefficients correlations between RSQ and depression and hopelessness inventories were 0.74 and 0.52, respectively. Only one of the 56 minors considered to have a certain suicide risk (n=56) came to a professional evaluation with their parents. The Spanish version of the RSQ showed adequate validity and reliability in Mexican students.

  3. Risk Assessment of Physical Hazards in Greek Hospitals Combining Staff's Perception, Experts' Evaluation and Objective Measurements

    PubMed Central

    Sourtzi, Panayiota; Kalokairinou, Athina; Sgourou, Evi; Koumoulas, Emmanouel; Velonakis, Emmanouel

    2011-01-01

    Objectives The promotion of health and safety (H&S) awareness among hospital staff can be applied through various methods. The aim of this study was to assess the risk level of physical hazards in the hospital sector by combining workers' perception, experts' evaluation and objective measurements. Methods A cross-sectional study was designed using multiple triangulation. Hospital staff (n = 447) filled in an H&S questionnaire in a general hospital in Athens and an oncology one in Thessaloniki. Experts observed and filled in a checklist on H&S in the various departments of the two hospitals. Lighting, noise and microclimate measurements were performed. Results The staff's perception of risk was higher than that of the experts in many cases. The measured risk levels were low to medium. In cases of high-risk noise and lighting, staff and experts agreed. Staff's perception of risk was influenced by hospital's department, hospital's service, years of working experience and level of education. Therefore, these factors should be taken into account in future studies aimed at increasing the participation of hospital workers. Conclusion This study confirmed the usefulness of staff participation in the risk assessment process, despite the tendency for staff to overestimate the risk level of physical hazards. The combination of combining staff perception, experts' evaluation and objective measures in the risk assessment process increases the efficiency of risk management in the hospital environment and the enforcement of relevant legislation. PMID:22953210

  4. Outdoor sports and risk of ultraviolet radiation-related skin lesions in children: evaluation of risks and prevention.

    PubMed

    Mahé, E; Beauchet, A; de Paula Corrêa, M; Godin-Beekmann, S; Haeffelin, M; Bruant, S; Fay-Chatelard, F; Jégou, F; Saiag, P; Aegerter, P

    2011-08-01

    Excessive ultraviolet (UV) radiation exposure can cause skin cancers, skin photoageing and cataracts. Children are targeted by sun-protection campaigns because high sun exposure and sunburn in childhood increase the risk of melanoma in adulthood. Little information is available about UV radiation risk and exposure in children who take part in outdoor sports. To evaluate the risk of developing UV radiation-induced skin lesions run by children who practise outdoor sports, and UV radiation exposure and sun-protection measures during a soccer tournament. Firstly, we evaluated the relationship between melanocytic naevus - a skin lesion linked with exposure to UV radiation - and outdoor sports in 660 11-year-old children. Secondly, we used the occasion of a 1-day soccer tournament held in the spring to evaluate UV radiation-protective measures used by soccer players and the public. We also evaluated the UV radiation index and cloud cover during the tournament, and calculated the UV radiation dose and minimal erythema dose depending on skin phototype. The naevus count and acquired naevus count measured over the 2 years of the study were higher in the 344 children who practised outdoor sports. Sun-protective measures were insufficient for soccer players and the public. This study shows that outdoor sports increase the risk of developing UV radiation-induced skin lesions in childhood. During a 1-day soccer tournament held in the spring, children and their parents were inadequately protected against the sun. These results suggest that sun-protection campaigns should be aimed at children who practise popular outdoor sports. © 2011 The Authors. BJD © 2011 British Association of Dermatologists 2011.

  5. Chemical/Radiation Hormesis Database, Evaluation of Hormetic Mechanisms and their Biomedical and Risk Assessment Implications

    DTIC Science & Technology

    2008-03-01

    independent of biological model, endpoint measured and chemical class evaluated. These findings have potential implications with respect to drug discovery ... drug development and clinical evaluation as well as inhuman toxicology and risk assessment. The completed findings have been subjected to peer-review

  6. Long-Term Outcomes of Conventional Aortic Valve Replacement in High-Risk Patients: Where Do We Stand?

    PubMed Central

    Fortuna, Daniela; Contini, Giovanni Andrea; Pacini, Davide; Gabbieri, Davide; De Palma, Rossana; Gherli, Tiziano

    2016-01-01

    Purpose: The introduction of transcatheter aortic valves has focused attention on the results of conventional aortic valve surgery in high-risk patients. The aim of the study was to evaluate 5-years outcomes in this category of patients in the current surgical era. Methods: This is an observational retrospective study of 581 high-risk patients undergoing aortic valve replacement from 2008 to 2013, with a mean logistic EuroSCORE of 26.6% ± 14.6%. Data were prospectively collected in a database of Emilia-Romagna region (Italy). Results: Overall 30-day mortality was 9.3%. Stroke rate was 1.5%. At 1-, 3-, and 5-years overall mortality was 18.2%, 30.4%, and 42.2%, cardiac death rate was 3.9%, 9.2%, and 12.9%, stroke rate 2.5%, 7.7%, and 10.2%, re-operation occurrence 0.2%, 0.9% and 1.3%, and new pacemaker implantation was 2.3%, 5.1% and 7.8%. At multivariate analysis, urgency, hemodynamic instability, LVEF ≤30%, NYHA III-IV, severe chronic obstructive pulmonary disease (COPD), extra-cardiac arteriopathy, cerebrovascular disease, and creatinine >2.0 mg/dL remained independent predictors of 5-year mortality. Conclusion: The results of the current study add weight to the evidence that traditional aortic valve replacement can be performed in high-risk patients with satisfactory 5-year mortality and morbidity. Our study may help to improve decision-making in this category of high-risk patients with aortic valve disease. PMID:27645551

  7. An approach to evaluating competence in assessing and managing violence risk.

    PubMed

    McNiel, Dale E; Hung, Erick K; Cramer, Robert J; Hall, Stephen E; Binder, Renee L

    2011-01-01

    The authors developed and evaluated a tool for assessing competency in violence risk assessment and management. The Competency Assessment Instrument for Violence Risk (CAI-V) was based on the literature on violence risk assessment, which was complemented by feedback from faculty focus groups. In an objective structured clinical examination, 31 faculty observers used the CAI-V to rate the performance of 31 learners' (26 psychiatry residents and five psychology interns) risk assessments of standardized (simulated) patients. In an interrater reliability study, six faculty members rated video-recorded risk assessments. The CAI-V had good internal consistency reliability (α=.93). Senior learners performed better on the CAI-V than junior learners, supporting the instrument's concurrent validity. Interrater reliability was good (intraclass correlation coefficient=.93). Participants reported that the CAI-V provided a helpful structure for feedback and supervision. The results supported the potential of this new approach for appraising competency in violence risk assessment and management.

  8. Evaluation of dysphagia risk, nutritional status and caloric intake in elderly patients with Alzheimer's.

    PubMed

    Goes, Vanessa Fernanda; Mello-Carpes, Pâmela Billig; de Oliveira, Lilian Oliveira; Hack, Jaqueline; Magro, Marcela; Bonini, Juliana Sartori

    2014-01-01

    to evaluate the risk of dysphagia and its relationship with the stage of Alzheimer's Disease, as well as the relationship between the risk of dysphagia and nutritional status and caloric intake in elderly people with Alzheimer's disease. the sample consisted of 30 subjects of both genders with probable Alzheimer's disease. The stage of the disease, nutritional status, energy intake, and risk of dysphagia were assessed. it was found that increased risk of dysphagia is associated with the advance in the stages of Alzheimer's disease and that even patients in the early stages of disease have a slight risk of developing dysphagia. No association was found between nutritional status and the risk of dysphagia. High levels of inadequate intake of micronutrients were also verified in the patients. an association between dysphagia and the development of Alzheimer's disease was found. The results indicate the need to monitor the presence of dysphagia and the micronutrient intake in patients with Alzheimer's disease.

  9. Social stability and HIV risk behavior: evaluating the role of accumulated vulnerability.

    PubMed

    German, Danielle; Latkin, Carl A

    2012-01-01

    This study evaluated a cumulative and syndromic relationship among commonly co-occurring vulnerabilites (homelessness, incarceration, low-income, residential transition) in association with HIV-related risk behaviors among 635 low-income women in Baltimore. Analysis included descriptive statistics, logistic regression, latent class analysis and latent class regression. Both methods of assessing multidimensional instability showed significant associations with risk indicators. Risk of multiple partners, sex exchange, and drug use decreased significantly with each additional domain. Higher stability class membership (77%) was associated with decreased likelihood of multiple partners, exchange partners, recent drug use, and recent STI. Multidimensional social vulnerabilities were cumulatively and synergistically linked to HIV risk behavior. Independent instability measures may miss important contextual determinants of risk. Social stability offers a useful framework to understand the synergy of social vulnerabilities that shape sexual risk behavior. Social policies and programs aiming to enhance housing and overall social stability are likely to be beneficial for HIV prevention.

  10. Evaluation of unit risk factors in support of the Hanford Remedial Action Environmental Impact Statement

    SciTech Connect

    Strenge, D.L.; Chamberlain, P.J. II

    1994-11-01

    This report describes the generation of unit risk factors for use with the Graphical Information System (GIS) being developed by Advanced Sciences, Inc. for the Hanford Remedial Action Environmental Impact Statement. The GIS couples information on source inventory and environmental transport with unit risk factors to estimate the potential risk from contamination at all locations on the Hanford Site. The major components of the effort to generate the unit risk factors were: determination of pollutants to include in the study, definition of media of concern, and definition of exposure assessment scenarios, methods, and parameters. The selection of pollutants was based on inventory lists which indicated the pollutants likely to be encountered at the known waste sites. The final pollutants selected included 47 chemical pollutants and 101 radionuclides. Unit risk factors have been generated for all 148 pollutants per unit initial concentration in five media: soil (per unit mass), soil (per unit area), air, groundwater, and surface water. The exposure scenarios were selected as the basis for the unit risk factor generation. The endpoint in the exposure assessment analysis is expressed as risk of developing cancer for radionuclides and carcinogenic chemicals. For noncarcinogenic chemicals, the risk endpoint is the hazard quotient. The cancer incidence and hazard quotient values are evaluated for all exposure pathways, pollutants, and scenarios. The hazard index values and unit risk values are used by the GIS to produce maps of risk for the Hanford Site.

  11. Retinal vein occlusion: evaluation of "classic" and "emerging" risk factors and treatment.

    PubMed

    Turello, Marina; Pasca, Samantha; Daminato, Roberto; Dello Russo, Patrizia; Giacomello, Roberta; Venturelli, Ugo; Barillari, Giovanni

    2010-05-01

    Retinal vein occlusion (RVO) is the second most common retinal vein disease and an important cause of blindness and visual morbidity. Systemic risk factors are commonly associated with RVO, while unclear it is the role of the thrombophilic and coagulation disorders. To evaluate "classic" and "emerging" risk factors, and to establish a good treatment for RVO. Fifty patients, 31 males and 19 females, with RVO were selected for our study. RVO patients were divided into two groups: those with central retinal vein occlusion (CRVO) and those with branch retinal vein occlusion (BRVO). All patients were subjected to an anamnestic investigation and were tested for thrombophilia, coagulation disorders and hyperlipidemia. Treatment and prophylaxis were evaluated. We have named "classic" the systemic risk factors associated with RVO and "emerging" those risk factors, haemostasis related, not clearly associated with RVO. RVO occurs more commonly in patients aged over 50. "Emerging" risk factors were more frequent in CRVO, "classic" in BRVO. Hyperhomocysteinemia is the most common "emerging" risk factor related to RVO. 71.4% of tested patients had hypercholesterolemia. Treatment with LMWH would appear to be safe and effective, but the small number of patients considered not allow us a definitive evaluation of its efficacy. Although our study has shown the correlation between RVO and the "emerging" risk factors, more studies are necessary to better know the real role of thrombophilic and coagulation disorders in this disease and to determine a specific protocol for the treatment and prophylaxis of RVO.

  12. Multi Criteria Evaluation Module for RiskChanges Spatial Decision Support System

    NASA Astrophysics Data System (ADS)

    Olyazadeh, Roya; Jaboyedoff, Michel; van Westen, Cees; Bakker, Wim

    2015-04-01

    Multi-Criteria Evaluation (MCE) module is one of the five modules of RiskChanges spatial decision support system. RiskChanges web-based platform aims to analyze changes in hydro-meteorological risk and provides tools for selecting the best risk reduction alternative. It is developed under CHANGES framework (changes-itn.eu) and INCREO project (increo-fp7.eu). MCE tool helps decision makers and spatial planners to evaluate, sort and rank the decision alternatives. The users can choose among different indicators that are defined within the system using Risk and Cost Benefit analysis results besides they can add their own indicators. Subsequently the system standardizes and prioritizes them. Finally, the best decision alternative is selected by using the weighted sum model (WSM). The Application of this work is to facilitate the effect of MCE for analyzing changing risk over the time under different scenarios and future years by adopting a group decision making into practice and comparing the results by numeric and graphical view within the system. We believe that this study helps decision-makers to achieve the best solution by expressing their preferences for strategies under future scenarios. Keywords: Multi-Criteria Evaluation, Spatial Decision Support System, Weighted Sum Model, Natural Hazard Risk Management

  13. [Integrated risk evaluation of multiple disasters affecting longyan yield in Fujian Province, East China].

    PubMed

    Chen, Jia-Jin; Wang, Jia-Yi; Li, Li-Chun; Lin, Jing; Yang, Kai; Ma, Zhi-Guo; Xu, Zong-Huan

    2012-03-01

    In this study, an index system for the integrated risk evaluation of multiple disasters on the Longyan production in Fujian Province was constructed, based on the analysis of the major environmental factors affecting the Longyan growth and yield, and from the viewpoints of potential hazard of disaster-causing factors, vulnerability of hazard-affected body, and disaster prevention and mitigation capability of Longyan growth regions in the Province. In addition, an integrated evaluation model of multiple disasters was established to evaluate the risks of the major agro-meteorological disasters affecting the Longyan yield, based on the yearly meteorological data, Longyan planting area and yield, and other socio-economic data in Longyan growth region in Fujian, and by using the integral weight of risk indices determined by AHP and entropy weight coefficient methods. In the Province, the Longyan growth regions with light integrated risk of multiple disasters were distributed in the coastal counties (except Dongshan County) with low elevation south of Changle, the regions with severe and more severe integrated risk were mainly in Zhangping of Longyan, Dongshan, Pinghe, Nanjin, and Hua' an of Zhangzhou, Yongchun and Anxi of Quanzhou, north mountainous areas of Putian and Xianyou, Minqing, Minhou, Luoyuan, and mountainous areas of Fuzhou, and Fuan, Xiapu, and mountainous areas of Ninde, among which, the regions with severe integrated risk were in Dongshan, Zhangping, and other mountainous areas with high altitudes, and the regions with moderate integrated risk were distributed in the other areas of the Province.

  14. Uncertainties in evaluation of hazard and seismic risk

    NASA Astrophysics Data System (ADS)

    Marmureanu, Gheorghe; Marmureanu, Alexandru; Ortanza Cioflan, Carmen; Manea, Elena-Florinela

    2015-04-01

    Two methods are commonly used for seismic hazard assessment: probabilistic (PSHA) and deterministic(DSHA) seismic hazard analysis.Selection of a ground motion for engineering design requires a clear understanding of seismic hazard and risk among stakeholders, seismologists and engineers. What is wrong with traditional PSHA or DSHA ? PSHA common used in engineering is using four assumptions developed by Cornell in 1968:(1)-Constant-in-time average occurrence rate of earthquakes; (2)-Single point source; (3).Variability of ground motion at a site is independent;(4)-Poisson(or "memory - less") behavior of earthquake occurrences. It is a probabilistic method and "when the causality dies, its place is taken by probability, prestigious term meant to define the inability of us to predict the course of nature"(Nils Bohr). DSHA method was used for the original design of Fukushima Daichii, but Japanese authorities moved to probabilistic assessment methods and the probability of exceeding of the design basis acceleration was expected to be 10-4-10-6 . It was exceeded and it was a violation of the principles of deterministic hazard analysis (ignoring historical events)(Klügel,J,U, EGU,2014, ISSO). PSHA was developed from mathematical statistics and is not based on earthquake science(invalid physical models- point source and Poisson distribution; invalid mathematics; misinterpretation of annual probability of exceeding or return period etc.) and become a pure numerical "creation" (Wang, PAGEOPH.168(2011),11-25). An uncertainty which is a key component for seismic hazard assessment including both PSHA and DSHA is the ground motion attenuation relationship or the so-called ground motion prediction equation (GMPE) which describes a relationship between a ground motion parameter (i.e., PGA,MMI etc.), earthquake magnitude M, source to site distance R, and an uncertainty. So far, no one is taking into consideration strong nonlinear behavior of soils during of strong earthquakes. But

  15. Instruments for the assessment of suicide risk: A systematic review evaluating the certainty of the evidence.

    PubMed

    Runeson, Bo; Odeberg, Jenny; Pettersson, Agneta; Edbom, Tobias; Jildevik Adamsson, Ingalill; Waern, Margda

    2017-01-01

    Instruments have been developed to facilitate suicide risk assessment. We aimed to evaluate the evidence for these instruments including assessment of risk of bias and diagnostic accuracy for suicide and suicide attempt. PubMed (NLM), PsycInfo, Embase, Cinahl and the Cochrane Library databases were searched until December 2014. We assessed risk of bias with QUADAS-2. The average sensitivity and specificity of each instrument was estimated and the certainty of the evidence was assessed with GRADE. We considered instruments with a sensitivity > 80% and a specificity > 50% to have sufficient diagnostic accuracy. Thirty-five relevant studies were identified but 14 were considered to have high risk of bias, leaving 21 studies evaluating altogether 15 risk assessment instruments. We could carry out meta-analyses for five instruments. For the outcome suicide attempt SAD PERSONS Scale had a sensitivity of 15% (95% CI 8-24) and specificity of 97% (96-98), and the Manchester Self-Harm Rule (MSHR) a sensitivity of 97% (97-97) and a specificity of 20% (20-21). ReACT, which is a modification of MSHR, had a similar low specificity, as did the Sodersjukhuset Self Harm Rule. For the outcome suicide, the Beck Hopelessness Scale had a sensitivity of 89% (78-95) and specificity of 42% (40-43). Most suicide risk assessment instruments were supported by too few studies to allow for evaluation of accuracy. Among those that could be evaluated, none fulfilled requirements for sufficient diagnostic accuracy.

  16. NASA's New Approach for Evaluating Risk Reduction Due to Space Shuttle Upgrades

    NASA Technical Reports Server (NTRS)

    Safie, Fayssal M.; Belyeu, Rebecca L.

    2000-01-01

    As part of NASA's intensive effort to incorporate quantitative risk assessment (QRA) tools in the Agency's decision-making process concerning Space Shuttle risk, NASA has developed a powerful risk assessment tool called the Quantitative Risk Assessment System (QRAS). The QRAS is a tool designed to estimate Space Shuttle risk and evaluate Space Shuttle upgrades. This paper presents an overview of the QRAS with focus on its application for evaluating the risk reduction due to proposed Space Shuttle upgrades. The application includes a case study from the Space Shuttle main engine (SSME). The QRAS overview section of the paper includes the QRAS development process, the technical approach to model development, the QRA quantification methods and techniques, and observations concerning the complex modeling involved in QRAS. The application section of the paper describes a practical case study using QRAS models for evaluating critical Space Shuttle Program upgrades, specifically a proposed SSME nozzle upgrade. This paper presents the method for evaluating the proposed upgrade by comparing the current nozzle (old design with well-established probabilistic models) to the channel wall nozzle (new design at the preliminary design level).

  17. Clinical Evaluation of a New Pressure Ulcer Risk Assessment Instrument, the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE T).

    PubMed

    Coleman, Susanne; Smith, Isabelle L; McGinnis, Elizabeth; Keen, Justin; Muir, Delia; Wilson, Lyn; Stubbs, Nikki; Dealey, Carol; Brown, Sarah; Nelson, E Andrea; Nixon, Jane

    2017-08-23

    To test the psychometric properties and clinical usability of a new Pressure Ulcer Risk Assessment Instrument including inter-rater and test-retest reliability, convergent validity and data completeness. Methodological and practical limitations associated with traditional Pressure Ulcer Risk Assessment Instruments, prompted a programme to work to develop a new instrument, as part of the National Institute for Health Research funded, Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056). Observational field test. For this clinical evaluation 230 patients were purposefully sampled across four broad levels of pressure ulcer risk with representation from 4 secondary care and 4 community NHS Trusts in England. Blinded and simultaneous paired (ward/community nurse and expert nurse) PURPOSE-T assessments were undertaken. Follow-up retest was undertaken by the expert nurse. Field notes of PURPOSE-T use were collected. Data were collected October 2012-Jan 2013. The clinical evaluation demonstrated 'very good' (kappa) inter-rater and test-retest agreement for PURPOSE-T assessment decision overall. The percentage agreement for 'problem/no problem' was over 75% for the main risk factors. Convergent validity demonstrated moderate to high associations with other measures of similar constructs. The PURPOSE-T evaluation facilitated the initial validation and clinical usability of the instrument and demonstrated that PURPOSE-T is suitable of use in clinical practice. Further study is needed to evaluate the impact of using the instrument on care processes and outcomes. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  18. Multicenter evaluation of high-risk mitral valve operations: implications for novel transcatheter valve therapies.

    PubMed

    LaPar, Damien J; Isbell, James M; Crosby, Ivan K; Kern, John; Lim, D Scott; Fonner, Edwin; Speir, Alan M; Rich, Jeffrey B; Kron, Irving L; Ailawadi, Gorav

    2014-12-01

    The MitraClip REALISM (Abbott Vascular, Menlo Park, CA) trial included several inclusion criteria to identify patients at high risk for conventional mitral valve (MV) surgery. This study evaluated contemporary surgical outcomes for high-risk surgical patients who met these defined criteria to serve as a benchmark to evaluate appropriateness in treatment allocation between surgical and percutaneous MV repair. A statewide Society for Thoracic Surgeons (STS) database was queried for patients undergoing isolated mitral valve surgery over a 12-year study period from 17 different hospitals. Patients were stratified into high-risk (HR) versus non-high-risk (non-HR) cohorts based upon clinical criteria similar to those utilized in the REALISM trial. Mixed effects multivariable regression modeling was used to evaluate study endpoints including mortality, morbidity, and resource utilization. Of 2,440 isolated mitral operations, 29% (n = 698) were HR per REALISM criteria. Median STS Predicted Risk of Mortality (PROM) for HR patients was 6.6% compared with 1.6% for non-HR patients (p < 0.001). The HR patients more commonly underwent MV replacement as well as urgent (30% vs 19%, p < 0.001) operations. High-risk patients incurred higher morbidity and mortality (7% vs 1.6%) with longer intensive care unit (48 vs 41 hours) and hospital stays (7 vs 6 days, all p < 0.001). Among REALISM criteria, STS PROM 12% or greater and high-risk STS criteria were the only criteria associated with mortality. Select REALISM criteria, including reoperation with patent grafts and functional MR with ejection fraction less than 0.40, may not identify patients truly at high risk of death with surgery. In addition to conventional STS criteria, risk assessment by surgeons is essential to direct appropriate treatment allocation for high-risk mitral disease. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  19. Multicenter Evaluation of High-Risk Mitral Valve Operations: Implications for Novel Transcatheter Valve Therapies

    PubMed Central

    LaPar, Damien J.; Isbell, James M.; Crosby, Ivan K.; Kern, John; Lim, D. Scott; Fonner, Edwin; Speir, Alan M.; Rich, Jeffrey B.; Kron, Irving L.; Ailawadi, Gorav

    2016-01-01

    Background The MitraClip REALISM (Abbott Vascular, Menlo Park, CA) trial included several inclusion criteria to identify patients at high risk for conventional mitral valve (MV) surgery. This study evaluated contemporary surgical outcomes for high-risk surgical patients who met these defined criteria to serve as a benchmark to evaluate appropriateness in treatment allocation between surgical and percutaneous MV repair. Methods A statewide Society for Thoracic Surgeons (STS) database was queried for patients undergoing isolated mitral valve surgery over a 12-year study period from 17 different hospitals. Patients were stratified into high-risk (HR) versus non-high-risk (non-HR) cohorts based upon clinical criteria similar to those utilized in the REALISM trial. Mixed effects multivariable regression modeling was used to evaluate study endpoints including mortality, morbidity, and resource utilization. Results Of 2,440 isolated mitral operations, 29% (n = 698) were HR per REALISM criteria. Median STS Predicted Risk of Mortality (PROM) for HR patients was 6.6% compared with 1.6% for non-HR patients (p < 0.001). The HR patients more commonly underwent MV replacement as well as urgent (30% vs 19%, p < 0.001) operations. High-risk patients incurred higher morbidity and mortality (7% vs 1.6%) with longer intensive care unit (48 vs 41 hours) and hospital stays (7 vs 6 days, all p < 0.001). Among REALISM criteria, STS PROM 12% or greater and high-risk STS criteria were the only criteria associated with mortality. Conclusions Select REALISM criteria, including reoperation with patent grafts and functional MR with ejection fraction less than 0.40, may not identify patients truly at high risk of death with surgery. In addition to conventional STS criteria, risk assessment by surgeons is essential to direct appropriate treatment allocation for high-risk mitral disease. PMID:25282165

  20. Research and Evaluations of the Health Aspects of Disasters, Part IX: Risk-Reduction Framework.

    PubMed

    Birnbaum, Marvin L; Daily, Elaine K; O'Rourke, Ann P; Loretti, Alessandro

    2016-06-01

    A disaster is a failure of resilience to an event. Mitigating the risks that a hazard will progress into a destructive event, or increasing the resilience of a society-at-risk, requires careful analysis, planning, and execution. The Disaster Logic Model (DLM) is used to define the value (effects, costs, and outcome(s)), impacts, and benefits of interventions directed at risk reduction. A Risk-Reduction Framework, based on the DLM, details the processes involved in hazard mitigation and/or capacity-building interventions to augment the resilience of a community or to decrease the risk that a secondary event will develop. This Framework provides the structure to systematically undertake and evaluate risk-reduction interventions. It applies to all interventions aimed at hazard mitigation and/or increasing the absorbing, buffering, or response capacities of a community-at-risk for a primary or secondary event that could result in a disaster. The Framework utilizes the structure provided by the DLM and consists of 14 steps: (1) hazards and risks identification; (2) historical perspectives and predictions; (3) selection of hazard(s) to address; (4) selection of appropriate indicators; (5) identification of current resilience standards and benchmarks; (6) assessment of the current resilience status; (7) identification of resilience needs; (8) strategic planning; (9) selection of an appropriate intervention; (10) operational planning; (11) implementation; (12) assessments of outputs; (13) synthesis; and (14) feedback. Each of these steps is a transformation process that is described in detail. Emphasis is placed on the role of Coordination and Control during planning, implementation of risk-reduction/capacity building interventions, and evaluation. Birnbaum ML , Daily EK , O'Rourke AP , Loretti A . Research and evaluations of the health aspects of disasters, part IX: Risk-Reduction Framework. Prehosp Disaster Med. 2016;31(3):309-325.

  1. Evaluation of risks from contaminated waters-demystification of the process

    SciTech Connect

    Staples, C.A.; Kimerle, R.A.

    1988-01-01

    Understanding the impacts of chemicals on human or environmental health requires explanation of the interactions of chemical effects with chemical exposure. Whether anthropogenic or redistributed naturally occurring substances are being evaluated, the process is the same; both effects and exposure need to be considered simultaneously to understand and quantify human or environmental health impacts. The process of evaluating and quantifying health impacts is called risk assessment. The process of risk assessment couples chemical exposure concentrations with toxicological information in the same calculation procedure. Often assumptions are made to simplify the process; in other cases, sufficient data may be present to avoid possibly indefensible assumptions. The risk assessment calculation procedures available today have been developed primarily for regulatory decision making and allow both a direct measure of risk and a relative scaling of risk. The presentation made here will cover the basic aspects of the risk assessment process. The calculation procedures, assumptions and interpretation of risk analysis results will be explained. Demystification of the risk assessment process should make it a more useful and viable tool for decision makers.

  2. Risk assessments for energy systems and role of preliminary degree-of-hazard evaluations

    SciTech Connect

    Habegger, L.J.; Fingleton, D.J.

    1985-11-01

    The appropriate approach to risk or hazard assessment can vary considerably, depending on various factors, including the intended application of the results and the time other resources available to conduct the assessment. This paper illustrates three types of interrelated assessments. Although they can be mutually supportive, they have fundamentally different objectives, which require major differences in approach. The example of the overall risk assessment of alternative major energy technologies illustrates the compilation of a wide range of available risk data applicable to these systems. However, major uncertainties exist in the assessments, and public perception of their importance could play an important role in final system evaluations. A more narrowly defined risk assessment, often focusing on an individual component of a larger system, is the most commonly used approach in regulatory applications. The narrow scope allows in-depth analysis of risks and associated uncertainties, but it may also contribute to a loss of perspective on the magnitude of the assessed risk relative to that of the unassessed risks. In some applications, it is useful to conduct semiquantitative degree-of-hazard evaluations as a means of setting priorities for detailed risk assessment. The MAHAS procedure described in this paper provides a means of rapidly ranking relative hazards from various sources using easily accessible data. However, these rankings should not be used as definitive input for selecting technology alternatives or developing regulations. 25 refs., 6 tabs.

  3. Exploring risk communication - results of a research project focussed on effectiveness evaluation

    NASA Astrophysics Data System (ADS)

    Charrière, Marie; Bogaard, Thom; Junier, Sandra; Mostert, Erik

    2016-04-01

    The need for effective science communication and outreach efforts is widely acknowledged in the academic community. In the field of Disaster Risk Reduction, the importance of communication is clearly stressed, e.g. in the newly adopted Sendai Framework for Disaster Risk Reduction 2015-2030 (under the 1st priority of action: understanding disaster risk). Consequently, we see increasing risk communication activities. However, the effectiveness of these activities is rarely evaluated. To address this gap, several research activities were conducted in the context of the Marie Curie Initial Training Network "Changes", the results of which we will present and discuss. First, results of a literature review show, among others, that research on effectiveness is mainly focussed on the assessment of users' needs and their ability to understand the content, rather than on the final impact of the risk communication efforts. Moreover, lab-environment research is more often undertaken than assessment of real communication efforts. Second, a comparison between perceptions of risk managers and the general public of risk communication in a French Alps Valley highlighted a gap between the two groups in terms of amount of information needed (who wants more), the important topics to address (what) and the media to use (how). Third, interviews with developers of smartphone applications for disseminating avalanche risk information showed a variety of current practices and the absence of measurements of real their effectiveness. However, our analysis allowed identifying good practices that can be an inspiration for risk communication related to other hazards. Fourth, an exhibition has been set up following a collaborative approached based on stakeholder engagement. Using a pre/post-test design, the immediate impact of the exhibition, which aimed at increasing the risk awareness of the population (Ubaye Valley, France), was measured. The data obtained suggests that visiting the exhibition

  4. Evaluation of rear-end crash risk at work zone using work zone traffic data.

    PubMed

    Meng, Qiang; Weng, Jinxian

    2011-07-01

    This paper aims to evaluate the rear-end crash risk at work zone activity area and merging area, as well as analyze the impacts of contributing factors by using work zone traffic data. Here, the rear-end crash risk is referred to as the probability that a vehicle is involved in a rear-end crash accident. The deceleration rate to avoid the crash (DRAC) is used in measuring rear-end crash risk. Based on work zone traffic data in Singapore, three rear-end crash risk models are developed to examine the relationship between rear-end crash risk at activity area and its contributing factors. The fourth rear-end crash risk model is developed to examine the effects of merging behavior on crash risk at merging area. The ANOVA results show that the rear-end crash risk at work zone activity area is statistically different from lane positions. Model results indicate that rear-end crash risk at work zone activity area increases with heavy vehicle percentage and lane traffic flow rate. An interesting finding is that the lane closer to work zone is strongly associated with higher rear-end crash risk. A truck has much higher probability involving in a rear-end accident than a car. Further, the expressway work zone activity area is found to have much larger crash risk than arterial work zone activity area. The merging choice has the dominated effect on risk reduction, suggesting that encouraging vehicles to merge early may be the most effective method to reduce rear-end crash risk at work zone merging area.

  5. Risk Evaluation for CO2 Geosequestration in the Knox Supergroup, Illinois Basin Final Report

    SciTech Connect

    Hnottavange-Telleen, Ken; Leetaru, Hannes

    2014-09-30

    This report describes a process and provides seed information for identifying and evaluating risks pertinent to a hypothetical carbon dioxide (CO2) capture and sequestration (CCS) project. In the envisioned project, the target sequestration reservoir rock is the Potosi Formation of the Knox Supergroup. The Potosi is identified as a potential target formation because (1) at least locally, it contains vuggy to cavernous layers that have very high porosity, and (2) it is present in areas where the deeper Mt. Simon Sandstone (a known potential reservoir unit) is absent or nonporous. The key report content is discussed in Section 3.3, which describes two lists of Features, Events, and Processes (FEPs) that should be considered during the design stage of such a project. These lists primarily highlight risk elements particular to the establishment of the Potosi as the target formation in general. The lists are consciously incomplete with respect to risk elements that would be relevant for essentially all CCS projects regardless of location or geology. In addition, other risk elements specific to a particular future project site would have to be identified. Sources for the FEPs and scenarios listed here include the iconic Quintessa FEPs list developed for the International Energy Agency Greenhouse Gas (IEAGHG) Programme; previous risk evaluation projects executed by Schlumberger Carbon Services; and new input solicited from experts currently working on aspects of CCS in the Knox geology. The projects used as sources of risk information are primarily those that have targeted carbonate reservoir rocks similar in age, stratigraphy, and mineralogy to the Knox-Potosi. Risks of using the Potosi Formation as the target sequestration reservoir for a CCS project include uncertainties about the levels of porosity and permeability of that rock unit; the lateral consistency and continuity of those properties; and the ability of the project team to identify suitable (i.e., persistently

  6. Risk Evaluation for CO{sub 2} Geosequestration in the Knox Supergroup

    SciTech Connect

    Leetaru, Hannes

    2014-01-31

    This report describes a process and provides seed information for identifying and evaluating risks pertinent to a hypothetical carbon dioxide (CO{sub 2}) capture and sequestration (CCS) project. In the envisioned project, the target sequestration reservoir rock is the Potosi Formation of the Knox Supergroup. The Potosi is identified as a potential target formation because (1) at least locally, it contains vuggy to cavernous layers that have very high porosity, and (2) it is present in areas where the deeper Mt. Simon Sandstone (a known potential reservoir unit) is absent or nonporous. The key report content is discussed in Section 3.3, which describes two lists of Features, Events, and Processes (FEPs) that should be considered during the design stage of such a project. These lists primarily highlight risk elements particular to the establishment of the Potosi as the target formation in general. The lists are consciously incomplete with respect to risk elements that would be relevant for essentially all CCS projects regardless of location or geology. In addition, other risk elements specific to a particular future project site would have to be identified. Sources for the FEPs and scenarios listed here include the iconic Quintessa FEPs list developed for the International Energy Agency Greenhouse Gas (IEAGHG) Programme; previous risk evaluation projects executed by Schlumberger Carbon Services; and new input solicited from experts currently working on aspects of CCS in the Knox geology. The projects used as sources of risk information are primarily those that have targeted carbonate reservoir rocks similar in age, stratigraphy, and mineralogy to the Knox-Potosi. Risks of using the Potosi Formation as the target sequestration reservoir for a CCS project include uncertainties about the levels of porosity and permeability of that rock unit; the lateral consistency and continuity of those properties; and the ability of the project team to identify suitable (i

  7. Benefit-risk Evaluation for Diagnostics: A Framework (BED-FRAME).

    PubMed

    Evans, Scott R; Pennello, Gene; Pantoja-Galicia, Norberto; Jiang, Hongyu; Hujer, Andrea M; Hujer, Kristine M; Manca, Claudia; Hill, Carol; Jacobs, Michael R; Chen, Liang; Patel, Robin; Kreiswirth, Barry N; Bonomo, Robert A

    2016-09-15

    The medical community needs systematic and pragmatic approaches for evaluating the benefit-risk trade-offs of diagnostics that assist in medical decision making. Benefit-Risk Evaluation of Diagnostics: A Framework (BED-FRAME) is a strategy for pragmatic evaluation of diagnostics designed to supplement traditional approaches. BED-FRAME evaluates diagnostic yield and addresses 2 key issues: (1) that diagnostic yield depends on prevalence, and (2) that different diagnostic errors carry different clinical consequences. As such, evaluating and comparing diagnostics depends on prevalence and the relative importance of potential errors. BED-FRAME provides a tool for communicating the expected clinical impact of diagnostic application and the expected trade-offs of diagnostic alternatives. BED-FRAME is a useful fundamental supplement to the standard analysis of diagnostic studies that will aid in clinical decision making.

  8. Evaluating criticality safety of TRU waste with NDA measurements and risk analyses

    SciTech Connect

    Hochel, R.C.; Hofstetter, K.J.; Sigg, R.A.; Winn, W.G.; Chay, S.C.

    1994-09-01

    The criticality safety of {sup 239}Pu in 55-gal. drums stored in TRU waste containers (concrete culverts) was evaluated using NDA neutron and gamma measurements and risk analyses. The neutron measurements yielded a {sup 239}Pu mass and k{sub eff} for a culvert, which contains up to 14 drums. The gamma measurements helped reveal and correct for any interfering neutron sources in the waste. Conservation probabilistic risk analyses were developed for both drums and culverts.

  9. Aortic valve surgery in octogenarians: Risk factors and long-term impact.

    PubMed

    Carrascal, Y; Valenzuela, H; Laguna, G; Pareja, P; Blanco, M; Ortega, C

    2015-04-01

    To understand the risk factors and long-term impact and results of aortic valve surgery in patients over age 80. We consecutively evaluated 255 octogenarians who were operated on between 2000 and 2013 and referred for aortic valve disease (isolated or combined with coronary artery disease), which, even when associated with other diseases, was the primary cause of the patient's functional limitation. The mortality rate decreased from 14.08% (2000-2004) to 7.7% (isolated valve surgery, 4.4%; with coronary bypass, 3.3%) (2010-2013). The independent risk factors associated with mortality were urgent surgery, combined procedures, peripheral vascular disease, a postsurgery hematocrit level <24% and the need for transfusion. More than 50% of the patients experienced a postoperative complication. Blood product transfusions were associated with renal and respiratory failure, and preoperative anemia was associated with an increased rate of myocardial infarction and stroke. Survival at 1, 3, 5 and 10 years was 79.5, 74.3, 63.6 and 30.5%, respectively, with 91.5% of patients in NYHA functional class I-II. Long-term survival was lower for cases of preoperative left ventricular dysfunction. The EuroSCORE I logistics score was not useful for our population as a predictor of mortality or of medium to long-term survival. The morbidity and mortality of aortic valve surgery for patients over age 80 has decreased in recent years, although it remains higher when valve surgery is combined with coronary surgery. The presence of preoperative left ventricular dysfunction decreases long-term survival. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  10. Can Mitochondria DNA Provide a Novel Biomarker for Evaluating the Risk and Prognosis of Colorectal Cancer?

    PubMed Central

    Shuwen, Han; Xi, Yang

    2017-01-01

    Colorectal cancer (CRC) was one of the most frequent cancers worldwide. Accurate risk and prognosis evaluation could obtain better quality of life and longer survival time for the patients. Current research hotspot was focus on the gene biomarker to evaluate the risk and prognosis. Mitochondrion contains its own DNA and regulates self-replicating so that it can be as a candidate biomarker for evaluating the risk and prognosis of colorectal cancer. But there were already huge controversies on this issue. The review was to summarize current viewpoints of the controversial issues and described our understanding from the four aspects including mtDNA copy number, mitochondrial displacement loop, mtDNA variation, and mtDNA microsatellite instability, wishing the summary of the mtDNA in colorectal cancer could provide a meaningful reference or a valuable direction in the future studies. PMID:28408773

  11. Decision theory and the evaluation of risks and benefits of clinical trials.

    PubMed

    Bernabe, Rosemarie D C; van Thiel, Ghislaine J M W; Raaijmakers, Jan A M; van Delden, Johannes J M

    2012-12-01

    Research ethics committees (RECs) are tasked to assess the risks and the benefits of a clinical trial. In previous studies, it was shown that RECs find this task difficult, if not impossible, to do. The current approaches to benefit-risk assessment (i.e. Component Analysis and the Net Risk Test) confound the various risk-benefit tasks, and as such, make balancing impossible. In this article, we show that decision theory, specifically through the expected utility theory and multiattribute utility theory, enable for an explicit and ethically weighted risk-benefit evaluation. This makes a balanced ethical justification possible, and thus a more rationally defensible decision making. Copyright © 2012 Elsevier Ltd. All rights reserved.

  12. Evaluating the Control Banding Nanotool: a qualitative risk assessment method for controlling nanoparticle exposures

    NASA Astrophysics Data System (ADS)

    Zalk, David M.; Paik, Samuel Y.; Swuste, Paul

    2009-10-01

    Control banding (CB) strategies offer simplified processes for controlling worker exposures in the absence of firm toxicological and exposure information. The nanotechnology industry is an excellent candidate for applying such strategies with overwhelming uncertainties of work-related health risks posed by nanomaterials. A recent survey shows that a majority of nanomaterial producers are not performing a basic risk assessment of their product in use. The CB Nanotool, used internationally, was developed to conduct qualitative risk assessments to control nanoparticle exposures. Nanotoxicology experts have requested standardization of toxicological parameters to ensure better utility and consistency of research. Such standardization would fit well in the CB Nanotool's severity and probability risk matrix, therefore enhancing the protection of nanotechnology industry workers. This article further evaluates the CB Nanotool for structure, weighting of risk factors, and utility for exposure mitigation, and suggests improvements for the CB Nanotool and the research needed to bolster its effectiveness.

  13. Risk assessment of supply chain for pharmaceutical excipients with AHP-fuzzy comprehensive evaluation.

    PubMed

    Li, Maozhong; Du, Yunai; Wang, Qiyue; Sun, Chunmeng; Ling, Xiang; Yu, Boyang; Tu, Jiasheng; Xiong, Yerong

    2016-04-01

    As the essential components in formulations, pharmaceutical excipients directly affect the safety, efficacy, and stability of drugs. Recently, safety incidents of pharmaceutical excipients posing seriously threats to the patients highlight the necessity of controlling the potential risks. Hence, it is indispensable for the industry to establish an effective risk assessment system of supply chain. In this study, an AHP-fuzzy comprehensive evaluation model was developed based on the analytic hierarchy process and fuzzy mathematical theory, which quantitatively assessed the risks of supply chain. Taking polysorbate 80 as the example for model analysis, it was concluded that polysorbate 80 for injection use is a high-risk ingredient in the supply chain compared to that for oral use to achieve safety application in clinic, thus measures should be taken to control and minimize those risks.

  14. Risk assessment of supply chain for pharmaceutical excipients with AHP-fuzzy comprehensive evaluation.

    PubMed

    Li, Maozhong; Du, Yunai; Wang, Qiyue; Sun, Chunmeng; Ling, Xiang; Yu, Boyang; Tu, Jiasheng; Xiong, Yerong

    2016-01-01

    As the essential components in formulations, pharmaceutical excipients directly affect the safety, efficacy, and stability of drugs. Recently, safety incidents of pharmaceutical excipients posing seriously threats to the patients highlight the necessity of controlling the potential risks. Hence, it is indispensable for the industry to establish an effective risk assessment system of supply chain. In this study, an AHP-fuzzy comprehensive evaluation model was developed based on the analytic hierarchy process and fuzzy mathematical theory, which quantitatively assessed the risks of supply chain. Taking polysorbate 80 as the example for model analysis, it was concluded that polysorbate 80 for injection use is a high-risk ingredient in the supply chain compared to that for oral use to achieve safety application in clinic, thus measures should be taken to control and minimize those risks.

  15. Committee to evaluate Sandia`s risk expertise: Final report. Volume 1: Presentations

    SciTech Connect

    Dudley, E.C.

    1998-05-01

    On July 1--2, 1997, Sandia National Laboratories hosted the External Committee to Evaluate Sandia`s Risk Expertise. Under the auspices of SIISRS (Sandia`s International Institute for Systematic Risk Studies), Sandia assembled a blue-ribbon panel of experts in the field of risk management to assess their risk programs labs-wide. Panelists were chosen not only for their own expertise, but also for their ability to add balance to the panel as a whole. Presentations were made to the committee on the risk activities at Sandia. In addition, a tour of Sandia`s research and development programs in support of the US Nuclear Regulatory Commission was arranged. The panel attended a poster session featuring eight presentations and demonstrations for selected projects. Overviews and viewgraphs from the presentations are included in Volume 1 of this report. Presentations are related to weapons, nuclear power plants, transportation systems, architectural surety, environmental programs, and information systems.

  16. Evaluation of digital dermoscopy in a pigmented lesion clinic: clinician versus computer assessment of malignancy risk.

    PubMed

    Boldrick, Jennifer C; Layton, Christle J; Nguyen, Josephine; Swetter, Susan M

    2007-03-01

    Digital dermoscopy systems employ computer-based algorithms to quantitate features of pigmented skin lesions (PSLs) and provide an assessment of malignancy risk. We evaluated interobserver concordance of PSL malignancy risk between a pigmented lesion specialist and an artificial neural network (ANN)-based automated digital dermoscopy system. While digital dermoscopy provides a reliable means of image capture, storage, and comparison of PSLs over time, the ANN algorithm requires further training and validation before the malignancy risk assessment feature can be widely used in clinical practice.

  17. Research on Liquidity Risk Evaluation of Chinese A-Shares Market Based on Extension Theory

    NASA Astrophysics Data System (ADS)

    Bai-Qing, Sun; Peng-Xiang, Liu; Lin, Zhang; Yan-Ge, Li

    This research defines the liquidity risk of stock market in matter-element theory and affair-element theory, establishes the indicator system of the forewarning for liquidity risks,designs the model and the process of early warning using the extension set method, extension dependent function and the comprehensive evaluation model. And the paper studies empirically A-shares market through the data of 1A0001, which prove that the model can better describe liquidity risk of China’s A-share market. At last, it gives the corresponding policy recommendations.

  18. Development and evaluation of the "BRISK Scale," a brief observational measure of risk communication competence.

    PubMed

    Han, Paul K J; Joekes, Katherine; Mills, Greg; Gutheil, Caitlin; Smith, Kahsi; Cochran, Nancy E; Elwyn, Glyn

    2016-12-01

    To develop and evaluate a brief observational measure of clinical risk communication competence. A 4-item checklist-type measure, the BRISK (Brief Risk Information Skill) Scale, was developed by selecting and refining items from a more comprehensive measure of clinical risk communication competence. Six volunteer raters received brief training on the measure and then used the BRISK Scale to evaluate 52 video-recorded encounters between 2nd-year medical students and standardized patients conducted as part of an Observed Structured Clinical Examination (OSCE) involving a risk communication task. Internal consistency reliability, inter-rater reliability, and criterion validity were assessed. Raters reported no difficulties using the BRISK Scale; scores across all raters and subjects ranged from 0 to 16 with a mean score of 6.49 (SD=3.17). The BRISK Scale showed good internal consistency reliability (α=0.64), and inter-rater reliability at the scale level (Intraclass Correlation Coefficient (ICC)=0.79 for consistency, and 0.75 for absolute agreement) and individual-item level (ICC range: 0.62-.91). Novice raters' BRISK Scale scores were highly correlated (r=0.84, p<0.01) with expert raters' scores on the Risk Communication Content measure, a more comprehensive measure of risk communication competence. The BRISK Scale is a promising new brief observational measure of clinical risk communication competence. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  19. Evaluation of genetic variants in association with colorectal cancer risk and survival in Asians.

    PubMed

    Wang, Nan; Lu, Yingchang; Khankari, Nikhil K; Long, Jirong; Li, Hong-Lan; Gao, Jing; Gao, Yu-Tang; Xiang, Yong-Bing; Shu, Xiao-Ou; Zheng, Wei

    2017-09-15

    Genome-wide association studies (GWAS) have identified over 40 genetic loci associated with colorectal cancer (CRC) risk. The association of single nucleotide polymorphisms (SNPs) at these loci with CRC risk and survival has not been adequately evaluated in East Asians. GWAS-identified CRC risk variants were used to construct weighted genetic risk scores (GRSs). We evaluated these GRSs in association with CRC risk in 3,303 CRC cases and 3,553 controls using logistic regression models. Associations with overall and CRC-specific survival were assessed in 731 CRC patients using Cox regression models. The association between the GRSs (overall and Asian-specific) and CRC risk was approximately twofold (highest vs. lowest quintile), and the shape of the dose-response was linear (ptrend  = 1.24 × 10(-13) and 3.02 × 10(-14) for overall GRS and Asian-specific GRS, respectively). The association of the GRS with CRC risk was stronger among those with a family history of CRC (pinteraction  = 0.007). Asian-specific GRS using previously reported survival SNPs increased risk for mortality and the shape of the dose-response was linear for CRC-specific and all-cause mortality (ptrend  = 0.01 and 0.006, respectively). Furthermore, the minor alleles of rs6983267 and rs1957636 were associated with worse CRC-specific and overall survival. We show that GRSs constructed using GWAS-identified common variants are strongly associated with CRC risk in Asians. We confirm previous findings for the possible association between some SNPs with survival, and provide evidence for two additional CRC risk variants that may be related to CRC survival. © 2017 UICC.

  20. Zika Virus in Ontario: Evaluating a Rapid Risk Assessment Tool for Emerging Infectious Disease Threats.

    PubMed

    Van Meer, Ryan; Hohenadel, Karin; Fitzgerald-Husek, Alanna; Warshawsky, Bryna; Sider, Doug; Schwartz, Brian; Nelder, Mark P

    To determine the Ontario-specific risk of local and travel-related Zika virus transmission in the context of a public health emergency of international concern, Public Health Ontario (PHO) completed a rapid risk assessment (RRA) on January 29, 2016, using a newly developed RRA guidance tool. The RRA concluded that risk of local mosquito-borne transmission was low, with a high risk of imported cases through travel. The RRA was updated 3 times based on predetermined triggers. An independent evaluation assessed both the application of the RRA guidance tool (process evaluation) and the usefulness of the RRA (outcome evaluation). We conducted face-to-face, semi-structured interviews with 7 individuals who participated in the creation or review of the Zika virus RRA and 4 end-users at PHO and the Ministry of Health and Long-Term Care. An inductive thematic analysis of responses was undertaken, whereby themes were directly informed by the data. The process evaluation determined that most steps outlined in the RRA guidance tool were adhered to, including forming a cross-functional writing team, clarifying the scope and describing context, completing the RRA summary report, and updating the RRA based on predefined triggers. The outcome evaluation found that end-users judged the Zika virus RRA as evidence-informed, useful, consistent, and timely. The evaluation established that the locally tailored guidance tool, adapted from national and international approaches to RRAs, facilitated a systematic, evidence-informed, and timely formal RRA process at PHO for the Zika virus RRA, which met the needs of end-users. Based on the evaluation, PHO will modify future RRAs by incorporating some flexibility into the literature review process to support timeliness of the RRA, explicitly describing the limitations of studies used to inform the RRA, and refining risk algorithms to better suit emerging infectious disease threats. It is anticipated that these refinements will improve upon the

  1. U.S. Department of Energy worker health risk evaluation methodology for assessing risks associated with environmental restoration and waste management

    SciTech Connect

    Blaylock, B.P.; Legg, J.; Travis, C.C.; Simek, M.A.; Sutherland, J.; Scofield, P.A.

    1995-06-01

    This document describes a worker health risk evaluation methodology for assessing risks associated with Environmental Restoration (ER) and Waste Management (WM). The methodology is appropriate for estimating worker risks across the Department of Energy (DOE) Complex at both programmatic and site-specific levels. This document supports the worker health risk methodology used to perform the human health risk assessment portion of the DOE Programmatic Environmental Impact Statement (PEIS) although it has applications beyond the PEIS, such as installation-wide worker risk assessments, screening-level assessments, and site-specific assessments.

  2. Risk evaluation and mitigation strategies: a focus on the mammalian target of rapamycin inhibitors.

    PubMed

    Gabardi, Steven

    2013-03-01

    To review the history of risk evaluation and mitigation strategies (REMS) with the mammalian target of rapamycin (mToR) inhibitors, evaluate their required REMS elements, and delineate the reasons for them being released from their REMS requirements. Articles were identified through a literature search of MEDLINE and EMBASE (January 2007-July 2012) using the search terms: risk evaluation and mitigation strategies, REMS, everolimus, sirolimus and organ transplant (individual organs also were searched). Information from the Federal Register, the Food and Drug Administration, and the manufacturers of the mToR inhibitors was also evaluated. REMS are strategies implemented to manage known or potential risks associated with medications and to ensure ongoing pharmacovigilance throughout the life of a pharmaceutical product. The mToR inhibitors have been associated with several potential risks, including proteinuria, graft thrombosis, and wound-healing complications. The Food and Drug Administration approved REMS programs for both sirolimus and everolimus. The manufacturers of both medications complied with the components of their approved REMS, but after less than 2 years, both medications have been relieved of their REMS obligations. The only element of the sirolimus REMS was a medication guide, whereas the everolimus REMS consisted of a medication guide and a communication plan. The sirolimus REMS was implemented more than 10 years after its initial approval by the Food and Drug Administration, but was released from its REMS requirement within 7 months of its implementation. The everolimus REMS was instituted upon initial approval and was removed approximately 2 years later. Both medications' REMS were always intended to educate health care providers and patients about the potential risks associated with this transplant immunosuppressant. Transplant practitioners should be familiar with the mToR inhibitors' associated risks and properly educate patients regarding the

  3. Evaluation of Head and Brain Injury Risk Functions Using Sub-Injurious Human Volunteer Data.

    PubMed

    Sanchez, Erin J; Gabler, Lee F; McGhee, James S; Olszko, Ardyn V; Chancey, V Carol; Crandall, Jeff R; Panzer, Matthew B

    2017-08-15

    Risk assessment models are developed to estimate the probability of brain injury during head impact using mechanical response variables such as head kinematics and brain tissue deformation. Existing injury risk functions have been developed using different datasets based on human volunteer and scaled animal injury responses to impact. However, many of these functions have not been independently evaluated with respect to laboratory-controlled human response data. In this study, the specificity of 14 existing brain injury risk functions was assessed by evaluating their ability to correctly predict non-injurious response using previously conducted sled tests with well-instrumented human research volunteers. Six degrees-of-freedom head kinematics data were obtained for 335 sled tests involving subjects in frontal, lateral, and oblique sled conditions up to 16 Gs peak sled acceleration. A review of the medical reports associated with each individual test indicated no clinical diagnosis of mild or moderate brain injury in any of the cases evaluated. Kinematic-based head and brain injury risk probabilities were calculated directly from the kinematic data, while strain-based risks were determined through finite element model simulation of the 335 tests. Several injury risk functions substantially over predict the likelihood of concussion and diffuse axonal injury; proposed maximum principal strain-based injury risk functions predicted nearly 80 concussions and 14 cases of severe diffuse axonal injury out of the 335 non-injurious cases. This work is an important first step in assessing the efficacy of existing brain risk functions and highlights the need for more predictive injury assessment models.

  4. Prospective multi-institutional study evaluating the performance of prostate cancer risk calculators.

    PubMed

    Nam, Robert K; Kattan, Michael W; Chin, Joseph L; Trachtenberg, John; Singal, Rajiv; Rendon, Ricardo; Klotz, Laurence H; Sugar, Linda; Sherman, Christopher; Izawa, Jonathan; Bell, David; Stanimirovic, Aleksandra; Venkateswaran, Vasundara; Diamandis, Eleftherios P; Yu, Changhong; Loblaw, D Andrew; Narod, Steven A

    2011-08-01

    Prostate cancer risk calculators incorporate many factors to evaluate an individual's risk for prostate cancer. We validated two common North American-based, prostate cancer risk calculators. We conducted a prospective, multi-institutional study of 2,130 patients who underwent a prostate biopsy for prostate cancer detection from five centers. We evaluated the performance of the Sunnybrook nomogram-based prostate cancer risk calculator (SRC) and the Prostate Cancer Prevention Trial (PCPT) -based risk calculator (PRC) to predict the presence of any cancer and high-grade cancer. We examined discrimination, calibration, and decision curve analysis techniques to evaluate the prediction models. Of the 2,130 patients, 867 men (40.7%) were found to have cancer, and 1,263 (59.3%) did not have cancer. Of the patients with cancer, 403 (46.5%) had a Gleason score of 7 or more. The area under the [concentration-time] curve (AUC) for the SRC was 0.67 (95% CI, 0.65 to 0.69); the AUC for the PRC was 0.61 (95% CI, 0.59 to 0.64). The AUC was higher for predicting aggressive disease from the SRC (0.72; 95% CI, 0.70 to 0.75) compared with that from the PRC (0.67; 95% CI, 0.64 to 0.70). Decision curve analyses showed that the SRC performed better than the PRC for risk thresholds of more than 30% for any cancer and more than 15% for aggressive cancer. The SRC performed better than the PRC, but neither one added clinical benefit for risk thresholds of less than 30%. Further research is needed to improve the AUCs of the risk calculators, particularly for higher-grade cancer.

  5. Evaluating Uncertainty to Strengthen Epidemiologic Data for Use in Human Health Risk Assessments

    PubMed Central

    Burns, Carol J.; Wright, J. Michael; Bateson, Thomas F.; Burstyn, Igor; Goldstein, Daniel A.; Klaunig, James E.; Luben, Thomas J.; Mihlan, Gary; Ritter, Leonard; Schnatter, A. Robert; Symons, J. Morel; Don Yi, Kun

    2014-01-01

    Background: There is a recognized need to improve the application of epidemiologic data in human health risk assessment especially for understanding and characterizing risks from environmental and occupational exposures. Although there is uncertainty associated with the results of most epidemiologic studies, techniques exist to characterize uncertainty that can be applied to improve weight-of-evidence evaluations and risk characterization efforts. Methods: This report derives from a Health and Environmental Sciences Institute (HESI) workshop held in Research Triangle Park, North Carolina, to discuss the utility of using epidemiologic data in risk assessments, including the use of advanced analytic methods to address sources of uncertainty. Epidemiologists, toxicologists, and risk assessors from academia, government, and industry convened to discuss uncertainty, exposure assessment, and application of analytic methods to address these challenges. Synthesis: Several recommendations emerged to help improve the utility of epidemiologic data in risk assessment. For example, improved characterization of uncertainty is needed to allow risk assessors to quantitatively assess potential sources of bias. Data are needed to facilitate this quantitative analysis, and interdisciplinary approaches will help ensure that sufficient information is collected for a thorough uncertainty evaluation. Advanced analytic methods and tools such as directed acyclic graphs (DAGs) and Bayesian statistical techniques can provide important insights and support interpretation of epidemiologic data. Conclusions: The discussions and recommendations from this workshop demonstrate that there are practical steps that the scientific community can adopt to strengthen epidemiologic data for decision making. Citation: Burns CJ, Wright JM, Pierson JB, Bateson TF, Burstyn I, Goldstein DA, Klaunig JE, Luben TJ, Mihlan G, Ritter L, Schnatter AR, Symons JM, Yi KD. 2014. Evaluating uncertainty to strengthen

  6. Prediction impact curve is a new measure integrating intervention effects in the evaluation of risk models.

    PubMed

    Campbell, William; Ganna, Andrea; Ingelsson, Erik; Janssens, A Cecile J W

    2016-01-01

    We propose a new measure of assessing the performance of risk models, the area under the prediction impact curve (auPIC), which quantifies the performance of risk models in terms of their average health impact in the population. Using simulated data, we explain how the prediction impact curve (PIC) estimates the percentage of events prevented when a risk model is used to assign high-risk individuals to an intervention. We apply the PIC to the Atherosclerosis Risk in Communities (ARIC) Study to illustrate its application toward prevention of coronary heart disease. We estimated that if the ARIC cohort received statins at baseline, 5% of events would be prevented when the risk model was evaluated at a cutoff threshold of 20% predicted risk compared to 1% when individuals were assigned to the intervention without the use of a model. By calculating the auPIC, we estimated that an average of 15% of events would be prevented when considering performance across the entire interval. We conclude that the PIC is a clinically meaningful measure for quantifying the expected health impact of risk models that supplements existing measures of model performance. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Evaluation of eye injury risk from projectile shooting toys using the focus headform - biomed 2009.

    PubMed

    Bisplinghoff, Jill A; Duma, Stefan M

    2009-01-01

    Half of eye injuries in the United States are caused by a blunt impact and more specifically, eye injuries effecting children often result from projectile shooting toys. The purpose of this study is to evaluate the risk of eye injuries of currently available projectile shooting toys. In order to assess the risk of each toy, a Facial and Ocular Countermeasure Safety (FOCUS) headform was used to measure the force applied to the eye during each hit for a total of 18 tests. The selected toys included a dart gun, a foam launcher, and a ball launcher. The force ranged from 4-93 N and was analyzed using the injury risk function for globe rupture for the FOCUS headform. Projectile characteristics were also examined using normalized energy to determine risk of corneal abrasion, hyphema, lens dislocation, retinal damage and globe rupture. It was found that the three toys tested produced peak loads corresponding with risk of globe rupture between 0% and 17.3%. The normalized energy results show no risk of hyphema, lens dislocation, retinal damage or globe rupture and a maximum risk of corneal abrasion of 5.9%. This study concludes that although there are many eye injuries caused by projectiles, the selected toys show a very low risk of eye injury.

  8. Environmental and social risk evaluation of overseas investment under the China-Pakistan Economic Corridor.

    PubMed

    Zhang, Ruilian; Andam, Francis; Shi, Guoqing

    2017-06-01

    Along with the further implementation of the "One Belt, One Road" initiative and the promotion of the China-Pakistan Economic Corridor (CPEC), the construction of the CPEC will likely face challenges owing to differences between China and Pakistan in politics, economics, culture, religion, language, customs, environmental management systems, environmental protection laws, social management systems, and social management regulations. To address potential environmental and social risks associated with Chinese enterprises as they invest in the CPEC region, this paper examines previous studies addressing topics such as the environmental and social safeguards of international institutions and Pakistan's domestic environmental and social management requirements. We then systematically identify the environmental and social risk factors involved in CPEC construction, which cover risks regarding water, air, soil, noise, biodiversity, politics, economics, culture, technology, and individuals. By establishing and calculating these risks and using a multi-fuzzy comprehensive evaluation model, we found that noise and individual risks belong to a medium risk category, while others belong to a higher risk category. In view of these risks, the Chinese government must create a friendly and peaceful environment for Chinese enterprises to invest in the CPEC region, and Chinese enterprises must adopt a development strategy of strength and capacity building and establish enterprises capable of addressing environmental and social issues during the investment process. All stakeholders must understand that if no determined and diligent steps are taken, CPEC construction might be doomed for failure from the start.

  9. Evaluation of the predictability of real-time crash risk models.

    PubMed

    Xu, Chengcheng; Liu, Pan; Wang, Wei

    2016-09-01

    The primary objective of the present study was to investigate the predictability of crash risk models that were developed using high-resolution real-time traffic data. More specifically the present study sought answers to the following questions: (a) how to evaluate the predictability of a real-time crash risk model; and (b) how to improve the predictability of a real-time crash risk model. The predictability is defined as the crash probability given the crash precursor identified by the crash risk model. An equation was derived based on the Bayes' theorem for estimating approximately the predictability of crash risk models. The estimated predictability was then used to quantitatively evaluate the effects of the threshold of crash precursors, the matched and unmatched case-control design, and the control-to-case ratio on the predictability of crash risk models. It was found that: (a) the predictability of a crash risk model can be measured as the product of prior crash probability and the ratio between sensitivity and false alarm rate; (b) there is a trade-off between the predictability and sensitivity of a real-time crash risk model; (c) for a given level of sensitivity, the predictability of the crash risk model that is developed using the unmatched case-controlled sample is always better than that of the model developed using the matched case-controlled sample; and (d) when the control-to-case ratio is beyond 4:1, the increase in control-to-case ratio does not lead to clear improvements in predictability.

  10. The TEAM evaluation approach to Project FAMUS, a pan-Canadian risk register for primary care.

    PubMed Central

    Grant, A.; Lussier, Y.; Delisle, E.; Dubois, S.; Bernier, R.

    1992-01-01

    The application of the TEAM--Total Evaluation and Acceptance Methodology--to the development of Project FAMUS--Family Medicine, University of Sherbrooke--is described. Project FAMUS is concerned with the establishment of a pan-Canadian risk register, the data being provided from a network of 800 family physicians distributed across Canada. Emphasis is on the first phase of the project and the overall evaluation strategy. PMID:1482968

  11. DE-CERTS: A Decision Support System for a Comparative Evaluation Method for Risk Management Methodologies and Tools

    DTIC Science & Technology

    1991-09-01

    Patton , Michael Quinn . Qualitative Evaluation Methods . Sage, 1980. Pfleeger, Charles P...the research and indicates directions for further research . 6 II. CERTS: A COMPARATIVE EVALUATION METHOD FOR RISK MANAGDENT METHODOLOGIES AND TOOLS A...A DECISION SUPPORT SYSTEM FOR A COMPARATIVE EVALUATION METHOD FOR RISK MANAGEMENT METHODOLOGIES AND TOOLS by Leonard A. Crump Jr. and James G.

  12. Risk-Based Evaluation of Total Petroleum Hydrocarbons in Vapor Intrusion Studies

    PubMed Central

    Brewer, Roger; Nagashima, Josh; Kelley, Michael; Heskett, Marvin; Rigby, Mark

    2013-01-01

    This paper presents a quantitative method for the risk-based evaluation of Total Petroleum Hydrocarbons (TPH) in vapor intrusion investigations. Vapors from petroleum fuels are characterized by a complex mixture of aliphatic and, to a lesser extent, aromatic compounds. These compounds can be measured and described in terms of TPH carbon ranges. Toxicity factors published by USEPA and other parties allow development of risk-based, air and soil vapor screening levels for each carbon range in the same manner as done for individual compounds such as benzene. The relative, carbon range makeup of petroleum vapors can be used to develop weighted, site-specific or generic screening levels for TPH. At some critical ratio of TPH to a targeted, individual compound, the overwhelming proportion of TPH will drive vapor intrusion risk over the individual compound. This is particularly true for vapors associated with diesel and other middle distillate fuels, but can also be the case for low-benzene gasolines or even for high-benzene gasolines if an adequately conservative, target risk is not applied to individually targeted chemicals. This necessitates a re-evaluation of the reliance on benzene and other individual compounds as a stand-alone tool to evaluate vapor intrusion risk associated with petroleum. PMID:23765191

  13. Risk-based evaluation of total petroleum hydrocarbons in vapor intrusion studies.

    PubMed

    Brewer, Roger; Nagashima, Josh; Kelley, Michael; Heskett, Marvin; Rigby, Mark

    2013-06-13

    This paper presents a quantitative method for the risk-based evaluation of Total Petroleum Hydrocarbons (TPH) in vapor intrusion investigations. Vapors from petroleum fuels are characterized by a complex mixture of aliphatic and, to a lesser extent, aromatic compounds. These compounds can be measured and described in terms of TPH carbon ranges. Toxicity factors published by USEPA and other parties allow development of risk-based, air and soil vapor screening levels for each carbon range in the same manner as done for individual compounds such as benzene. The relative, carbon range makeup of petroleum vapors can be used to develop weighted, site-specific or generic screening levels for TPH. At some critical ratio of TPH to a targeted, individual compound, the overwhelming proportion of TPH will drive vapor intrusion risk over the individual compound. This is particularly true for vapors associated with diesel and other middle distillate fuels, but can also be the case for low-benzene gasolines or even for high-benzene gasolines if an adequately conservative, target risk is not applied to individually targeted chemicals. This necessitates a re-evaluation of the reliance on benzene and other individual compounds as a stand-alone tool to evaluate vapor intrusion risk associated with petroleum.

  14. Evaluation of Chair-Side Assays in High Microbiological Caries-Risk Subjects.

    PubMed

    Saravia, Marta Estela; Silva, Lea Assed Bezerra; Silva, Raquel Assed Bezerra; Lucisano, Marília Pacífico; Echevarría, Andrea Uribe; Echevarría, Jorge Uribe; Nelson-Filho, Paulo

    2015-01-01

    The aim of this study was to evaluate the commercial chair-side assays Saliva-Check Mutans and ClinproTM Cario L-PopTM in high microbiological caries-risk dental students compared with conventional semi-quantitative colony counting culture-based technique as the reference method. Saliva samples from 93 subjects of both sexes aged 18-26 years were seeded (Köhler and Bratthall method) on plates containing SB-20M culture medium method and 12 subjects with high caries risk were selected. These 12 individuals were subjected to determination of caries risk using two commercial rapid detection chair-side assays (Saliva-Check Mutans and ClinproTM Cario L-PopTM) according to the manufacturers' instructions. The results were analyzed by the Kappa correlation test using SAS statistical software. There was a perfect agreement (Kappa=1) among the three caries risk evaluation methods - chair-side assays and semi-quantitative CFU count (control) - in all subjects. The results suggest that the commercial chair-side assays evaluated in this study may be practical and useful to identify high microbiological caries-risk subjects.

  15. [Psychosocial Risk Evaluation in the Workplace: Expert-based Development of a Checklist for Occupational Physicians].

    PubMed

    Weigl, M; Müller, A; Angerer, P; Petru, R

    2016-03-01

    The implementation of psychosocial risk assessment at the workplace often fails in practice. One reason is the lack of competence of those who are in charge of the process. We present a checklist for the effective implementation of psychosocial risk assessment at workplace. This tool shall support occupational physicians in the preparation, planning and implementation of a psychosocial risks assessment process. Based on a stepwise development and validation process, specific steps and factors for the successful implementation were identified qualitatively with 15 occupational physicians and experts. This was conducted in a 2-stage Delphi study. In the following, the identified steps and factors were transferred into a checklist. Subsequently, the checklist was evaluated in a focus group of occupational physicians (user evaluation). Thereafter, the contents were subjected to an expert evaluation. Our checklist for the effective implementation of the process of psychosocial risk management in the workplace aims to strengthen the competence of occupational physicians, especially in the implementation of risk assessments in small and medium-sized enterprises (SMEs). © Georg Thieme Verlag KG Stuttgart · New York.

  16. Evaluation of functional deficits and falls risk in the elderly--methods for preventing falls.

    PubMed

    Narayanan, Michael R; Scalzi, Maria Elena; Redmond, Stephen J; Lord, Steven R; Celler, Branko G; Lovell, Nigel H

    2009-01-01

    Falls in the elderly have a profound impact on their quality of life through injury, increased fear of falling, reduced confidence to perform daily tasks and loss of independence. Falls come at a substantial economic cost. Tools to quantify falls risk and evaluate functional deficits allow interventions to be targeted to those at increased risk of falling and tailored to correct deficits with the aim of reducing falls rate and reducing ones risk of falling. We describe a system to evaluate falls risk and functional deficits in the elderly. The system is based on the evaluation of performance in a simple set of controlled movements known as the directed routine (DR). We present preliminary results of the DR in a cohort of 68 subjects using features extracted from the DR. Linear least-squares models were trained to estimate falls risk, knee-extension strength, proprioception, mediolateral body sway, anteroposterior body sway and contrast sensitivity. The model estimates provided good to fair correlations with (r=0.76 p<0.001), (r=0.65 p<0.001), (r=0.35 p<0.01), (r=0.53 p<0.001), (r=0.48 p<0.001) and (r=0.37 p<0.01) respectively.

  17. Clinical decision support software for diabetic foot risk stratification: development and formative evaluation.

    PubMed

    Schoen, Deborah E; Glance, David G; Thompson, Sandra C

    2015-01-01

    Identifying people at risk of developing diabetic foot complications is a vital step in prevention programs in primary healthcare settings. Diabetic foot risk stratification systems predict foot ulceration. The aim of this study was to explore the views and experiences of potential end users during development and formative evaluations of an electronic diabetic foot risk stratification tool based on evidence-based guidelines and determine the accuracy of the tool. Formative evaluation of the risk tool occurred in five stages over an eight-month period and employed a mixed methods research design consisting of semi-structured interviews, focus group and participant observation, online survey, expert review, comparison to the Australian Guidelines and clinical testing. A total of 43 healthcare practitioners trialled the computerised clinical decision support system during development, with multiple software changes made as a result of feedback. Individual and focus group participants exposed critical design flaws. Live testing revealed risk stratification errors and functional limitations providing the basis for practical improvements. In the final product, all risk calculations and recommendations made by the clinical decision support system reflect current Australian Guidelines. Development of the computerised clinical decision support system using evidence-based guidelines can be optimised by a multidisciplinary iterative process of feedback, testing and software adaptation by experts in modern development technologies.

  18. A quantitative risk assessment model to evaluate effective border control measures for rabies prevention

    PubMed Central

    Weng, Hsin-Yi; Wu, Pei-I; Yang, Ping-Cheng; Tsai, Yi-Lun; Chang, Chao-Chin

    2009-01-01

    Border control is the primary method to prevent rabies emergence. This study developed a quantitative risk model incorporating stochastic processes to evaluate whether border control measures could efficiently prevent rabies introduction through importation of cats and dogs using Taiwan as an example. Both legal importation and illegal smuggling were investigated. The impacts of reduced quarantine and/or waiting period on the risk of rabies introduction were also evaluated. The results showed that Taiwan’s current animal importation policy could effectively prevent rabies introduction through legal importation of cats and dogs. The median risk of a rabid animal to penetrate current border control measures and enter Taiwan was 5.33 × 10−8 (95th percentile: 3.20 × 10−7). However, illegal smuggling may pose Taiwan to the great risk of rabies emergence. Reduction of quarantine and/or waiting period would affect the risk differently, depending on the applied assumptions, such as increased vaccination coverage, enforced custom checking, and/or change in number of legal importations. Although the changes in the estimated risk under the assumed alternatives were not substantial except for completely abolishing quarantine, the consequences of rabies introduction may yet be considered to be significant in a rabies-free area. Therefore, a comprehensive benefit-cost analysis needs to be conducted before recommending these alternative measures. PMID:19822125

  19. Environmental risks in the developing world: exposure indicators for evaluating interventions, programmes, and policies

    PubMed Central

    Ezzati, M.; Utzinger, J.; Cairncross, S.; Cohen, A.; Singer, B.

    2005-01-01

    Background: Monitoring and empirical evaluation are essential components of evidence based public health policies and programmes. Consequently, there is a growing interest in monitoring of, and indicators for, major environmental health risks, particularly in the developing world. Current large scale data collection efforts are generally disconnected from micro-scale studies in health sciences, which in turn have insufficiently investigated the behavioural and socioeconomic factors that influence exposure. Study design: A basic framework is proposed for development of indicators of exposure to environmental health risks that would facilitate the (a) assessment of the health effects of risk factors, (b) design and evaluation of interventions and programmes to deliver the interventions, and (c) appraisal and quantification of inequalities in health effects of risk factors, and benefits of intervention programmes and policies. Specific emphasis is put on the features of environmental risks that should guide the choice of indicators, in particular the interactions of technology, the environment, and human behaviour in determining exposure. The indicators are divided into four categories: (a) access and infrastructure, (b) technology, (c) agents and vectors, and (d) behaviour. The study used water and sanitation, indoor air pollution from solid fuels, urban ambient air pollution, and malaria as illustrative examples for this framework. Conclusions: Organised and systematic indicator selection and monitoring can provide an evidence base for design and implementation of more effective and equitable technological interventions, delivery programmes, and policies for environmental health risks in resource poor settings. PMID:15598721

  20. Development of evaluation metod of flood risk in Tokyo metropolitan area

    NASA Astrophysics Data System (ADS)

    Hirano, J.; Dairaku, K.

    2012-12-01

    Flood is one of the most significant natural hazards in Japan. In particular, the Tokyo metropolitan area has been affected by several large flood disasters. Investigating potential flood risk in Tokyo metropolitan area is important for development of climate change adaptation strategy. We aim to develop a method for evaluating flood risk in Tokyo Metropolitan area by considering effect of historical land use and land cover change, socio-economic change, and climatic change. Ministry of land, infrastructure, transport and tourism in Japan published "Statistics of flood", which contains data for flood causes, number of damaged houses, area of wetted surface, and total amount of damage for each flood at small municipal level. Based on these flood data, we constructed a flood database system for Tokyo metropolitan area for the period from 1961 to 2008 by using ArcGIS software.Based on these flood data , we created flood risk curve, representing the relation ship between damage and exceedbability of flood for the period 1976-2008. Based on the flood risk cruve, we aim to evaluate potential flood risk in the Tokyo metropolitan area and clarify the cause of regional difference in flood risk at Tokyo metropolitan area by considering effect of socio-economic change and climate change

  1. Evaluation of vegetable production management practices to reduce the ecological risk of pesticides.

    PubMed

    Rice, Pamela J; Hapeman, Cathleen J; McConnell, Laura L; Sadeghi, Ali M; Teasdale, John R; Coffman, C Benjamin; McCarty, Gregory W; Abdul-Baki, Aref A; Starr, James L

    2007-11-01

    The ability of agricultural management practices to reduce the ecological risks of pesticides was evaluated. Risk quotients, a mathematical description of the relationship between exposure and toxicity, and hazard ratings, a rank of the potential risk of pesticides to aquatic environments, were calculated for conventional and alternative cultivation practices for tomatoes: Poly-Bare, raised beds covered with polyethylene mulch with bare-soil furrows; Poly-Rye, raised beds covered with polyethylene mulch with cereal rye (Secale cereale) grown in the furrows; and Vetch, raised beds and furrows planted with hairy vetch seed (Vicia villosa). Evaluations were conducted using measured pesticide concentrations in runoff at the edge-of-field and estimated environmental concentrations in an adjacent creek and a theoretical pond receiving the runoff. Runoff from Poly-Bare presented the greatest risk to ecosystem health and to sensitive organisms, whereas the use of Vetch minimized these risks. Previous studies have shown that harvest yields were maintained and that runoff volume, soil loss, and off-site transport of pesticides measured in runoff were reduced using the alternative management practices (Poly-Rye and Vetch). Together, these results indicate that the alternative management practices (Poly-Rye and Vetch) have a less adverse impact on the environment than the conventional management practice (Poly-Bare) while providing growers with an acceptable economic return. In addition, the present study demonstrates the need to consider the management practice when assessing the potential risks and hazards for certain pesticides.

  2. User Perceptions and Reactions to an Online Cancer Risk Assessment Tool: a Process Evaluation of Cancer Risk Check.

    PubMed

    Hovick, Shelly R; Bevers, Therese B; Vidrine, Jennifer Irvin; Kim, Stephanie; Dailey, Phokeng M; Jones, Lovell A; Peterson, Susan K

    2017-03-01

    Online cancer risk assessment tools, which provide personalized cancer information and recommendations based on personal data input by users, are a promising cancer education approach; however, few tools have been evaluated. A randomized controlled study was conducted to compare user impressions of one tool, Cancer Risk Check (CRC), to non-personalized educational information delivered online as series of self-advancing slides (the control). CRC users (N = 1452) rated the tool to be as interesting as the control (p > .05), but users were more likely to report that the information was difficult to understand and not applicable to them (p < .05). Information seeking and sharing also were lower among CRC users; thus, although impressions of CRC were favorable, it was not shown to be superior to existing approaches. We hypothesized CRC was less effective because it contained few visual and graphical elements; therefore, CRC was compared to a text-based control (online PDF file) post hoc. CRC users rated the information to be more interesting, less difficult to understand, and better able to hold their attention (p < .05). Post hoc results suggest the visual presentation of risk is critical to tool success.

  3. Risk Stratification for Athletes and Adventurers in High-Altitude Environments: Recommendations for Preparticipation Evaluation.

    PubMed

    Campbell, Aaron D; McIntosh, Scott E; Nyberg, Andy; Powell, Amy P; Schoene, Robert B; Hackett, Peter

    2015-12-01

    High-altitude athletes and adventurers face a number of environmental and medical risks. Clinicians often advise participants or guiding agencies before or during these experiences. Preparticipation evaluation (PPE) has the potential to reduce risk of high-altitude illnesses in athletes and adventurers. Specific conditions susceptible to high-altitude exacerbation also important to evaluate include cardiovascular and lung diseases. Recommendations by which to counsel individuals before participation in altitude sports and adventures are few and of limited focus. We reviewed the literature, collected expert opinion, and augmented principles of a traditional sport PPE to accommodate the high-altitude wilderness athlete/adventurer. We present our findings with specific recommendations on risk stratification during a PPE for the high-altitude athlete/adventurer.

  4. Neurophysiologic Evaluation of Early Cognitive Development in High-Risk Infants and Toddlers

    ERIC Educational Resources Information Center

    deRegnier, Raye-Ann

    2005-01-01

    New knowledge of the perceptual, discriminative, and memory capabilities of very young infants has opened the door to further evaluation of these abilities in infants who have risk factors for cognitive impairments. A neurophysiologic technique that has been very useful in this regard is the recording of event-related potentials (ERPs). The…

  5. Evaluation of a Training Program for Street Children and Adolescents At Risk in Brazil.

    ERIC Educational Resources Information Center

    Bandeira, Denise R.; And Others

    An experience in evaluating a program which is designed to help high risk adolescents is described. The program attempts to develop basic work and social skills of adolescents (N=40) living in slums or on the streets in Brazil. Psychological and social effects of the program were assessed by means of interviews and psychological tests…

  6. 75 FR 2545 - National Toxicology Program (NTP); Center for the Evaluation of Risks to Human Reproduction...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-15

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Toxicology Program (NTP); Center for the Evaluation of Risks to Human Reproduction (CERHR); Availability of the Final Expert Panel Report on...

  7. 7 CFR 319.59-3 - Articles prohibited importation pending risk evaluation.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 5 2011-01-01 2011-01-01 false Articles prohibited importation pending risk evaluation. 319.59-3 Section 319.59-3 Agriculture Regulations of the Department of Agriculture (Continued... pollards) other than flour; and (2) Seeds of Melilotus indica (annual yellow sweetclover) and seeds of...

  8. 76 FR 36544 - Scientific Evaluation of Modified Risk Tobacco Product Applications; Public Workshop; Request for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-22

    ... produced by the consumption of that tobacco product, that may affect a disease or health-related condition... HUMAN SERVICES Food and Drug Administration Scientific Evaluation of Modified Risk Tobacco Product... of public workshop; request for comments. The Food and Drug Administration (FDA), Center for...

  9. Evaluation of a Ropes Course Experience for At-Risk Secondary School Students

    ERIC Educational Resources Information Center

    Conley, Laura; Caldarella, Paul; Young, Ellie

    2007-01-01

    This study evaluated the effects of a one-day ropes course on students' classroom involvement and affiliation. Middle and junior high school students who participated in the ropes course were from classes designed for students at risk for emotional and behavioral disorders. Using the Classroom Environment Scale (CES) Short Form, students evaluated…

  10. 75 FR 34453 - Risk Evaluation and Mitigation Strategies; Notice of Public Meeting; Reopening of Comment Period

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-17

    ... HUMAN SERVICES Food and Drug Administration Risk Evaluation and Mitigation Strategies; Notice of Public Meeting; Reopening of Comment Period AGENCY: Food and Drug Administration, HHS. ACTION: Notice of public meeting; reopening of comment period. SUMMARY: The Food and Drug Administration (FDA) is announcing a...

  11. Discomfort Intolerance: Evaluation of a Potential Risk Factor for Anxiety Psychopathology

    ERIC Educational Resources Information Center

    Schmidt, Norman B.; Richey, J. Anthony; Cromer, Kiara R.; Buckner, Julia D.

    2007-01-01

    Discomfort intolerance, defined as an individual difference in the capacity to tolerate unpleasant bodily sensations, is a construct recently posited as a risk factor for panic and anxiety psychopathology. The present report used a biological challenge procedure to evaluate whether discomfort intolerance predicts fearful responding beyond the…

  12. Neurophysiologic Evaluation of Early Cognitive Development in High-Risk Infants and Toddlers

    ERIC Educational Resources Information Center

    deRegnier, Raye-Ann

    2005-01-01

    New knowledge of the perceptual, discriminative, and memory capabilities of very young infants has opened the door to further evaluation of these abilities in infants who have risk factors for cognitive impairments. A neurophysiologic technique that has been very useful in this regard is the recording of event-related potentials (ERPs). The…

  13. Evaluation of an Alcohol Risk Reduction Program (PRIME for Life) in Young Swedish Military Conscripts

    ERIC Educational Resources Information Center

    Hallgren, Mats A.; Kallmen, Hakan; Leifman, Hakan; Sjolund, Torbjorn; Andreasson, Sven

    2009-01-01

    Purpose: The purpose of this paper is to evaluate the effectiveness of the PRIME for Life risk reduction program in reducing alcohol consumption and improving knowledge and attitudes towards alcohol use in male Swedish military conscripts, aged 18 to 22 years. Design/methodology/approach: A quasi-experimental design was used in which 1,371…

  14. Discomfort Intolerance: Evaluation of a Potential Risk Factor for Anxiety Psychopathology

    ERIC Educational Resources Information Center

    Schmidt, Norman B.; Richey, J. Anthony; Cromer, Kiara R.; Buckner, Julia D.

    2007-01-01

    Discomfort intolerance, defined as an individual difference in the capacity to tolerate unpleasant bodily sensations, is a construct recently posited as a risk factor for panic and anxiety psychopathology. The present report used a biological challenge procedure to evaluate whether discomfort intolerance predicts fearful responding beyond the…

  15. Evaluation of the "Respect Not Risk" Firearm Safety Lesson for 3rd-Graders

    ERIC Educational Resources Information Center

    Liller, Karen D.; Perrin, Karen; Nearns, Jodi; Pesce, Karen; Crane, Nancy B.; Gonzalez, Robin R.

    2003-01-01

    The purpose of this study was to evaluate the MORE HEALTH "Respect Not Risk" Firearm Safety Lesson for 3rd-graders in Pinellas County, Florida. Six schools representative of various socioeconomic levels were selected as the test sites. Qualitative and quantitative data were collected. A total of 433 matched pretests/posttests were used…

  16. Serving the Needs of At-Risk Refugee Youth: A Program Evaluation

    ERIC Educational Resources Information Center

    McBrien, J. Lynn

    2006-01-01

    Refugee students, although frequently subsumed under the "immigrant" heading, often suffer from effects of significant trauma that can make them more vulnerable than children of voluntary immigrant families. This study evaluated a program created specifically for refugee youth at-risk for academic failure and "social death." The program goals…

  17. Evaluation of an Alcohol Risk Reduction Program (PRIME for Life) in Young Swedish Military Conscripts

    ERIC Educational Resources Information Center

    Hallgren, Mats A.; Kallmen, Hakan; Leifman, Hakan; Sjolund, Torbjorn; Andreasson, Sven

    2009-01-01

    Purpose: The purpose of this paper is to evaluate the effectiveness of the PRIME for Life risk reduction program in reducing alcohol consumption and improving knowledge and attitudes towards alcohol use in male Swedish military conscripts, aged 18 to 22 years. Design/methodology/approach: A quasi-experimental design was used in which 1,371…

  18. A Formative Evaluation of the Children, Youth, and Families at Risk Coaching Model

    ERIC Educational Resources Information Center

    Olson, Jonathan R.; Smith, Burgess; Hawkey, Kyle R.; Perkins, Daniel F.; Borden, Lynne M.

    2016-01-01

    In this article, we describe the results of a formative evaluation of a coaching model designed to support recipients of funding through the Children, Youth, and Families at Risk (CYFAR) initiative. Results indicate that CYFAR coaches draw from a variety of types of coaching and that CYFAR principle investigators (PIs) are generally satisfied with…

  19. Evaluating anthropogenic risk of grassland and forest habitat degradation using land-cover data

    Treesearch

    Kurt Riitters; James Wickham; Timothy Wade

    2009-01-01

    The effects of landscape context on habitat quality are receiving increased attention in conservation biology. The objective of this research is to demonstrate a landscape-level approach to mapping and evaluating the anthropogenic risks of grassland and forest habitat degradation by examining habitat context as defined by intensive anthropogenic land uses at multiple...

  20. A Formative Evaluation of the Children, Youth, and Families at Risk Coaching Model

    ERIC Educational Resources Information Center

    Olson, Jonathan R.; Smith, Burgess; Hawkey, Kyle R.; Perkins, Daniel F.; Borden, Lynne M.

    2016-01-01

    In this article, we describe the results of a formative evaluation of a coaching model designed to support recipients of funding through the Children, Youth, and Families at Risk (CYFAR) initiative. Results indicate that CYFAR coaches draw from a variety of types of coaching and that CYFAR principle investigators (PIs) are generally satisfied with…

  1. Evaluation of the "Respect Not Risk" Firearm Safety Lesson for 3rd-Graders

    ERIC Educational Resources Information Center

    Liller, Karen D.; Perrin, Karen; Nearns, Jodi; Pesce, Karen; Crane, Nancy B.; Gonzalez, Robin R.

    2003-01-01

    The purpose of this study was to evaluate the MORE HEALTH "Respect Not Risk" Firearm Safety Lesson for 3rd-graders in Pinellas County, Florida. Six schools representative of various socioeconomic levels were selected as the test sites. Qualitative and quantitative data were collected. A total of 433 matched pretests/posttests were used…

  2. FRAMEWORK FOR EVALUATION OF PHYSIOLOGICALLY-BASED PHARMACOKINETIC MODELS FOR USE IN SAFETY OR RISK ASSESSMENT

    EPA Science Inventory

    ABSTRACT

    Proposed applications of increasingly sophisticated biologically-based computational models, such as physiologically-based pharmacokinetic (PBPK) models, raise the issue of how to evaluate whether the models are adequate for proposed uses including safety or risk ...

  3. Some Methodological Problems, Solutions and Findings from Evaluating Risk Reduction Projects.

    ERIC Educational Resources Information Center

    Goldstein, Harris K.; Di Nitto, Diana

    1982-01-01

    Reports three methodological problems found in evaluating five risk reduction projects in Florida. Found that activities aimed at producing positive self-awareness and exposure to rewarding nondrug activities taught with a mixture of didactic and discussion methods and exercises are best. (Author/JAC)

  4. FRAMEWORK FOR EVALUATION OF PHYSIOLOGICALLY-BASED PHARMACOKINETIC MODELS FOR USE IN SAFETY OR RISK ASSESSMENT

    EPA Science Inventory

    ABSTRACT

    Proposed applications of increasingly sophisticated biologically-based computational models, such as physiologically-based pharmacokinetic (PBPK) models, raise the issue of how to evaluate whether the models are adequate for proposed uses including safety or risk ...

  5. Program Evaluation of Growin' to Win: A Latchkey and Summer Program for At-Risk Youth.

    ERIC Educational Resources Information Center

    James, William H.; And Others

    This document presents an evaluation of the effectiveness of the Growin' to Win Project, an after-school and summer program targeted at elementary and middle school aged youth at high risk of substance abuse and gang involvement. Growin' to Win is an expansion of a model latchkey program piloted at two Tacoma (Washington) schools in 1990. The…

  6. An Evaluation of Close Reading with At-Risk Fourth-Grade Students in Science Content

    ERIC Educational Resources Information Center

    Boudreaux-Johnson, Marcy; Mooney, Paul; Lastrapes, Renée E.

    2017-01-01

    The study's primary purpose was to evaluate the effectiveness of a widely promoted close reading instructional routine for elementary grades students at risk for reading failure. Close reading is designed to help students read complex text independently and proficiently. Participants were six fourth-grade students receiving supplemental…

  7. Evaluating the risk of patient re-identification from adverse drug event reports

    PubMed Central

    2013-01-01

    Background Our objective was to develop a model for measuring re-identification risk that more closely mimics the behaviour of an adversary by accounting for repeated attempts at matching and verification of matches, and apply it to evaluate the risk of re-identification for Canada’s post-marketing adverse drug event database (ADE).Re-identification is only demonstrably plausible for deaths in ADE. A matching experiment between ADE records and virtual obituaries constructed from Statistics Canada vital statistics was simulated. A new re-identification risk is considered, it assumes that after gathering all the potential matches for a patient record (all records in the obituaries that are potential matches for an ADE record), an adversary tries to verify these potential matches. Two adversary scenarios were considered: (a) a mildly motivated adversary who will stop after one verification attempt, and (b) a highly motivated adversary who will attempt to verify all the potential matches and is only limited by practical or financial considerations. Methods The mean percentage of records in ADE that had a high probability of being re-identified was computed. Results Under scenario (a), the risk of re-identification from disclosing the province, age at death, gender, and exact date of the report is quite high, but the removal of province brings down the risk significantly. By only generalizing the date of reporting to month and year and including all other variables, the risk is always low. All ADE records have a high risk of re-identification under scenario (b), but the plausibility of that scenario is limited because of the financial and practical deterrent even for highly motivated adversaries. Conclusions It is possible to disclose Canada’s adverse drug event database while ensuring that plausible re-identification risks are acceptably low. Our new re-identification risk model is suitable for such risk assessments. PMID:24094134

  8. Follicular Thyroid Carcinoma: Disease Response Evaluation Using American Thyroid Association Risk Assessment Guidelines.

    PubMed

    Hassan, Aamna; Khalid, Madeeha; Riaz, Saima; Nawaz, M Khalid; Bashir, Humayun

    2015-12-01

    To evaluate the overall and progression-free survival for follicular thyroid carcinoma (FTC) based on the American Thyroid Association (ATA) staging system for recurrence risk assessment and the TNM staging system. A clinical review of FTC patients between 1995 and 2014 was conducted at a single center. The data was classified using the TNM staging system into low, intermediate, and high risk of recurrence as per the ATA risk assessment. Over the course of 19 years, 114 (11.9%) of all of the thyroid cancer patients presenting to our hospital had FTC (i.e. 78 females and 36 males). The age range was 15-80 years. Ninety-four tumors were resectable and 18 were unresectable. Sixteen patients were excluded due to insufficient information on their recurrence risk. Based on the ATA categorization, 36 patients had a low recurrence risk. All patients were alive at the time of categorization, and 1 showed progressive disease. Thirty-eight patients had an intermediate recurrence risk. One patient died and 2 showed progression. Twenty-four had a high recurrence risk. Seven patients died and 6 showed progression. In terms of TNM stages, 2 (3.2%) stage I, 3 (17.6%) stage II, 1 (14%) stage III, and 2 (12.5%) stage IV patients died during follow-up. Both ATA risk classification and TNM staging were significant predictors of disease-free survival. On bivariate analysis, the ATA classification (HR  4.67; 95% CI 1.74-12.5, p  =  0.002) was a better predictor of survival compared to the TNM classification (HR 1.26; 95% CI 0.98-1.62, p = 0.063). ATA risk stratification predicts the disease recurrence rate and survival better than TNM staging. Age does not have an association; the risk category with dynamic reassessment effectively better predicts the course of disease in FTC.

  9. Evaluating Immunogenicity Risk Due to Host Cell Protein Impurities in Antibody-Based Biotherapeutics.

    PubMed

    Jawa, Vibha; Joubert, Marisa K; Zhang, Qingchun; Deshpande, Meghana; Hapuarachchi, Suminda; Hall, Michael P; Flynn, Gregory C

    2016-11-01

    A potential risk factor for immunogenicity of a biotherapeutic is the low levels of host cell protein (HCP) impurities that remain in the product following the purification process. During process development, significant attention has been devoted to removing HCPs due to their potential safety risk. Samples from different purification steps of several monoclonal antibodies (mAbs) purified by one type of platform were evaluated for their residual Chinese Hamster Ovary (CHO) cell-derived HCP content. HCPs in both in-process (high levels of HCP) and highly purified (low levels of HCP) samples were identified and quantitated by proteomic analysis via mass spectrometry. The responses to HCPs were evaluated in an in vitro assay using PBMC from a population of healthy and disease state individuals. Results indicated that samples with up to 4000 ppm HCP content (levels 200 times greater than the drug substance) did not pose a higher immunogenicity risk than highly purified mAb samples. As an orthogonal method to predict immunogenicity risk, in silico algorithms that probe amino acid sequence for foreign epitope content were used to evaluate over 20 common HCPs (identified in the different mAb samples). Only a few HCPs were identified as high risk by the algorithms; however, the in vitro assay results indicated that the concentration of these HCPs from in-process biotherapeutic mAb samples was not sufficient to stimulate an immune response. This suggests that high levels of HCP in mAb biotherapeutics purified by this type of platform do not increase the potential risk of immunogenicity of these molecules. Insights from these studies can be applied to HCP control and risk assessment strategies.

  10. Evaluating the Framingham Hypertension Risk Prediction Model in Young Adults: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

    PubMed Central

    Carson, April P.; Lewis, Cora E.; Jacobs, David R.; Peralta, Carmen A.; Steffen, Lyn M.; Bower, Julie K.; Person, Sharina D.; Muntner, Paul

    2014-01-01

    A prediction model was developed in the Framingham Heart Study (FHS) to evaluate short-term risk of hypertension. Our goal was to determine the predictive ability of the FHS hypertension model in a cohort of young adults advancing into middle age and compare it with the predictive ability of prehypertension, and individual components of the FHS model. We studied 4,388 participants, age 18-30 years without hypertension at baseline, enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) Study who participated in 2 consecutive exams occurring 5 years apart between the baseline (1985-1986) and Year 25 examination (2010-2011). Weibull regression was used to assess the association of the FHS model overall, individual components of the FHS model, and prehypertension with incident hypertension. Over the 25 year follow-up period, 1179 participants developed incident hypertension. The FHS hypertension model (c-index=0.84, 95% CI=0.83, 0.85) performed well in discriminating those who did and did not develop hypertension and was better than prehypertension alone (c-index=0.71, 95% CI=0.70, 0.73). The predicted risk from the FHS hypertension model was systematically lower than the observed hypertension incidence initially (χ2= 249.4; p<0.001), but demonstrated a good fit after recalibration (χ2= 14.6; p=0.067). In summary, the FHS model performed better than prehypertension and may be a useful tool for identifying young adults with a high risk for developing hypertension. PMID:24041951

  11. Evaluating the Framingham hypertension risk prediction model in young adults: the Coronary Artery Risk Development in Young Adults (CARDIA) study.

    PubMed

    Carson, April P; Lewis, Cora E; Jacobs, David R; Peralta, Carmen A; Steffen, Lyn M; Bower, Julie K; Person, Sharina D; Muntner, Paul

    2013-12-01

    A prediction model was developed in the Framingham Heart Study (FHS) to evaluate the short-term risk of hypertension. Our goal was to determine the predictive ability of the FHS hypertension model in a cohort of young adults advancing into middle age and compare it with the predictive ability of prehypertension and individual components of the FHS model. We studied 4388 participants, aged 18 to 30 years without hypertension at baseline, enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) Study, who participated in 2 consecutive examinations occurring 5 years apart between the baseline (1985-1986) and year 25 examination (2010-2011). Weibull regression was used to assess the association of the FHS model overall, individual components of the FHS model, and prehypertension with incident hypertension. During the 25-year follow-up period, 1179 participants developed incident hypertension. The FHS hypertension model (c-index=0.84; 95% confidence interval, 0.83-0.85) performed well in discriminating those who did and did not develop hypertension and was better than prehypertension alone (c-index=0.71; 95% confidence interval, 0.70-0.73). The predicted risk from the FHS hypertension model was systematically lower than the observed hypertension incidence initially (χ(2)=249.4; P<0.001) but demonstrated a good fit after recalibration (χ(2)=14.6; P=0.067). In summary, the FHS model performed better than prehypertension and may be a useful tool for identifying young adults with a high risk for developing hypertension.

  12. A method for evaluating competency in assessment and management of suicide risk.

    PubMed

    Hung, Erick K; Binder, Renée L; Fordwood, Samantha R; Hall, Stephen E; Cramer, Robert J; McNiel, Dale E

    2012-01-01

    Although health professionals increasingly are expected to be able to assess and manage patients' risk for suicide, few methods are available to evaluate this competency. This report describes development of a competency-assessment instrument for suicide risk-assessment (CAI-S), and evaluates its use in an objective structured clinical examination (OSCE). The authors developed the CAI-S on the basis of the literature on suicide risk-assessment and management, and consultation with faculty focus groups from three sites in a large academic psychiatry department. The CAI-S structures faculty ratings regarding interviewing and data collection, case formulation and presentation, treatment-planning, and documentation. To evaluate the CAI-S, 31 faculty members used it to rate the performance of 31 learners (26 psychiatric residents and 5 clinical psychology interns) who participated in an OSCE. After interviewing a standardized patient, learners presented their risk-assessment findings and treatment plans. Faculty used the CAI-S to structure feedback to the learners. In a subsidiary study of interrater reliability, six faculty members rated video-recorded suicide risk-assessments. The CAI-S showed good internal consistency, reliability, and interrater reliability. Concurrent validity was supported by the finding that CAI-S ratings were higher for senior learners than junior learners, and were higher for learners with more clinical experience with suicidal patients than learners with less clinical experience. Faculty and learners rated the method as helpful for structuring feedback and supervision. The findings support the usefulness of the CAI-S for evaluating competency in suicide risk-assessment and management.

  13. Evaluation of index-overlay methods for groundwater vulnerability and risk assessment in Kathmandu Valley, Nepal.

    PubMed

    Shrestha, Sangam; Kafle, Ranjana; Pandey, Vishnu Prasad

    2017-01-01

    This study aimed at evaluating three index-overlay methods of vulnerability assessment (i.e., DRASTIC, GOD, and SI) for estimating risk to pollution of shallow groundwater aquifer in the Kathmandu Valley, Nepal. The Groundwater Risk Assessment Model (GRAM) model was used to compute the risk to groundwater pollution. Results showed that DRASTIC and SI methods are comparable for vulnerability assessment as both methods delineate around 80% of the groundwater basin area under high vulnerable zone. From the perspective of risk to pollution results, DRASTIC and GOD methods are comparable. Nevertheless, all the three methods estimate that at least 60% of the groundwater basin is under moderate risk to NO3-N pollution, which goes up to 75% if DRASTIC or GOD-based vulnerabilities are considered as exposure pathways. Finally, based on strength and significance of correlation between the estimated risk and observed NO3-N concentrations, it was found that SI method is a better-suited one to assess the vulnerability and risk to groundwater pollution in the study area. Findings from this study are useful to design strategies and actions aimed to prevent nitrate pollution in groundwater of Kathmandu Valley in Nepal.

  14. Practitioner evaluation of a novel online integrated oral health and risk assessment tool: a practice pilot.

    PubMed

    Busby, M; Chapple, E; Matthews, R; Chapple, I L C

    2013-08-01

    To report the development and evaluation of an evidence-based, online, patient assessment tool, capable of measuring oral health status, future disease risk and capitation fee guidance. An online integrated oral health and risk assessment tool called DEPPA was developed, incorporating 1) PreViser(™) risk scores for periodontal disease, caries, non-carious tooth surface loss and oral cancer, 2) revised versions of Denplan Excel's Oral Health Score and 3) capitation fee guidance score. DEPPA was piloted by 25 dentists who provided quantitative and qualitative feedback. Six hundred and forty assessments were performed. There was strong agreement on the need for such a tool, that it constituted a comprehensive assessment and supported good patient communication. The validity of the system was perceived as sound and the revised capitation fee guidance broadly welcomed. While some deemed the caries risk scoring algorithm to be too sensitive, the 30% high/very high risk rating is consistent with current rates of active caries in UK adults. A viable online oral health and risk-assessment tool has been developed (DEPPA) that will allow dental teams to measure oral health status, future disease risk and receive ongoing guidance on capitation fee setting. The indications are that DEPPA could be a valuable audit, care planning and patient communication tool.

  15. Evaluating the operational risks of biomedical waste using failure mode and effects analysis.

    PubMed

    Chen, Ying-Chu; Tsai, Pei-Yi

    2017-06-01

    The potential problems and risks of biomedical waste generation have become increasingly apparent in recent years. This study applied a failure mode and effects analysis to evaluate the operational problems and risks of biomedical waste. The microbiological contamination of biomedical waste seldom receives the attention of researchers. In this study, the biomedical waste lifecycle was divided into seven processes: Production, classification, packaging, sterilisation, weighing, storage, and transportation. Twenty main failure modes were identified in these phases and risks were assessed based on their risk priority numbers. The failure modes in the production phase accounted for the highest proportion of the risk priority number score (27.7%). In the packaging phase, the failure mode 'sharp articles not placed in solid containers' had the highest risk priority number score, mainly owing to its high severity rating. The sterilisation process is the main difference in the treatment of infectious and non-infectious biomedical waste. The failure modes in the sterilisation phase were mainly owing to human factors (mostly related to operators). This study increases the understanding of the potential problems and risks associated with biomedical waste, thereby increasing awareness of how to improve the management of biomedical waste to better protect workers, the public, and the environment.

  16. Evaluation of the performance of existing non-laboratory based cardiovascular risk assessment algorithms

    PubMed Central

    2013-01-01

    Background The high burden and rising incidence of cardiovascular disease (CVD) in resource constrained countries necessitates implementation of robust and pragmatic primary and secondary prevention strategies. Many current CVD management guidelines recommend absolute cardiovascular (CV) risk assessment as a clinically sound guide to preventive and treatment strategies. Development of non-laboratory based cardiovascular risk assessment algorithms enable absolute risk assessment in resource constrained countries. The objective of this review is to evaluate the performance of existing non-laboratory based CV risk assessment algorithms using the benchmarks for clinically useful CV risk assessment algorithms outlined by Cooney and colleagues. Methods A literature search to identify non-laboratory based risk prediction algorithms was performed in MEDLINE, CINAHL, Ovid Premier Nursing Journals Plus, and PubMed databases. The identified algorithms were evaluated using the benchmarks for clinically useful cardiovascular risk assessment algorithms outlined by Cooney and colleagues. Results Five non-laboratory based CV risk assessment algorithms were identified. The Gaziano and Framingham algorithms met the criteria for appropriateness of statistical methods used to derive the algorithms and endpoints. The Swedish Consultation, Framingham and Gaziano algorithms demonstrated good discrimination in derivation datasets. Only the Gaziano algorithm was externally validated where it had optimal discrimination. The Gaziano and WHO algorithms had chart formats which made them simple and user friendly for clinical application. Conclusion Both the Gaziano and Framingham non-laboratory based algorithms met most of the criteria outlined by Cooney and colleagues. External validation of the algorithms in diverse samples is needed to ascertain their performance and applicability to different populations and to enhance clinicians’ confidence in them. PMID:24373202

  17. Evaluation of the performance of existing non-laboratory based cardiovascular risk assessment algorithms.

    PubMed

    Kariuki, Jacob K; Stuart-Shor, Eileen M; Leveille, Suzanne G; Hayman, Laura L

    2013-12-28

    The high burden and rising incidence of cardiovascular disease (CVD) in resource constrained countries necessitates implementation of robust and pragmatic primary and secondary prevention strategies. Many current CVD management guidelines recommend absolute cardiovascular (CV) risk assessment as a clinically sound guide to preventive and treatment strategies. Development of non-laboratory based cardiovascular risk assessment algorithms enable absolute risk assessment in resource constrained countries.The objective of this review is to evaluate the performance of existing non-laboratory based CV risk assessment algorithms using the benchmarks for clinically useful CV risk assessment algorithms outlined by Cooney and colleagues. A literature search to identify non-laboratory based risk prediction algorithms was performed in MEDLINE, CINAHL, Ovid Premier Nursing Journals Plus, and PubMed databases. The identified algorithms were evaluated using the benchmarks for clinically useful cardiovascular risk assessment algorithms outlined by Cooney and colleagues. Five non-laboratory based CV risk assessment algorithms were identified. The Gaziano and Framingham algorithms met the criteria for appropriateness of statistical methods used to derive the algorithms and endpoints. The Swedish Consultation, Framingham and Gaziano algorithms demonstrated good discrimination in derivation datasets. Only the Gaziano algorithm was externally validated where it had optimal discrimination. The Gaziano and WHO algorithms had chart formats which made them simple and user friendly for clinical application. Both the Gaziano and Framingham non-laboratory based algorithms met most of the criteria outlined by Cooney and colleagues. External validation of the algorithms in diverse samples is needed to ascertain their performance and applicability to different populations and to enhance clinicians' confidence in them.

  18. Considerations in the evaluation and determination of minimal risk in pragmatic clinical trials.

    PubMed

    Lantos, John D; Wendler, David; Septimus, Edward; Wahba, Sarita; Madigan, Rosemary; Bliss, Geraldine

    2015-10-01

    Institutional review boards, which are charged with overseeing research, must classify the riskiness of proposed research according to a federal regulation known as the Common Rule (45 CFR 46, Subpart A) and by regulations governing the US Food and Drug Administration codified in 21 CFR 50. If an institutional review board determines that a clinical trial constitutes "minimal risk," there are important practical implications: the institutional review board may then allow a waiver or alteration of the informed consent process; the study may be carried out in certain vulnerable populations; or the study may be reviewed by institutional review boards using an expedited process. However, it is unclear how institutional review boards should assess the risk levels of pragmatic clinical trials. Such trials typically compare existing, widely used medical therapies or interventions in the setting of routine clinical practice. Some of the therapies may be considered risky of themselves but the study comparing them may or may not add to that pre-existing level of risk. In this article, we examine the common interpretations of research regulations regarding minimal-risk classifications and suggest that they are marked by a high degree of variability and confusion, which in turn may ultimately harm patients by delaying or hindering potentially beneficial research. We advocate for a clear differentiation between the risks associated with a given therapy and the incremental risk incurred during research evaluating those therapies as a basic principle for evaluating the risk of a pragmatic clinical trial. We then examine two pragmatic clinical trials and consider how various factors including clinical equipoise, practice variation, research methods such as cluster randomization, and patients' perspectives may contribute to current and evolving concepts of minimal-risk determinations, and how this understanding in turn affects the design and conduct of pragmatic clinical trials.

  19. A spatial assessment framework for evaluating flood risk under extreme climates.

    PubMed

    Chen, Yun; Liu, Rui; Barrett, Damian; Gao, Lei; Zhou, Mingwei; Renzullo, Luigi; Emelyanova, Irina

    2015-12-15

    Australian coal mines have been facing a major challenge of increasing risk of flooding caused by intensive rainfall events in recent years. In light of growing climate change concerns and the predicted escalation of flooding, estimating flood inundation risk becomes essential for understanding sustainable mine water management in the Australian mining sector. This research develops a spatial multi-criteria decision making prototype for the evaluation of flooding risk at a regional scale using the Bowen Basin and its surroundings in Queensland as a case study. Spatial gridded data, including climate, hydrology, topography, vegetation and soils, were collected and processed in ArcGIS. Several indices were derived based on time series of observations and spatial modeling taking account of extreme rainfall, evapotranspiration, stream flow, potential soil water retention, elevation and slope generated from a digital elevation model (DEM), as well as drainage density and proximity extracted from a river network. These spatial indices were weighted using the analytical hierarchy process (AHP) and integrated in an AHP-based suitability assessment (AHP-SA) model under the spatial risk evaluation framework. A regional flooding risk map was delineated to represent likely impacts of criterion indices at different risk levels, which was verified using the maximum inundation extent detectable by a time series of remote sensing imagery. The result provides baseline information to help Bowen Basin coal mines identify and assess flooding risk when making adaptation strategies and implementing mitigation measures in future. The framework and methodology developed in this research offers the Australian mining industry, and social and environmental studies around the world, an effective way to produce reliable assessment on flood risk for managing uncertainty in water availability under climate change.

  20. Risk management, financial evaluation and funding for wastewater and stormwater reuse projects.

    PubMed

    Furlong, Casey; De Silva, Saman; Gan, Kein; Guthrie, Lachlan; Considine, Robert

    2017-04-15

    This paper has considered risk management, financial evaluation and funding in seven Australian wastewater and stormwater reuse projects. From the investigated case studies it can be seen that responsible parties have generally been well equipped to identify potential risks. In relation to financial evaluation methods some serious discrepancies, such as time periods for analysis, and how stormwater benefits are valued, have been identified. Most of the projects have required external, often National Government, funding to proceed. As National funding is likely to become less common in the future, future reuse projects may need to be funded internally by the water industry. In order to enable this the authors propose that the industry requires (1) a standard project evaluation process, and (2) an infrastructure funders' forum (or committee) with representation from both utilities and regulators, in order to compare and prioritise future reuse projects against each other. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Meeting the Needs of USGS's Science Application for Risk Reduction Group through Evaluation Research

    NASA Astrophysics Data System (ADS)

    Ritchie, L.; Campbell, N. M.; Vickery, J.; Madera, A.

    2016-12-01

    The U.S. Geological Survey's (USGS) Science Application for Risk Reduction (SAFRR) group aims to support innovative collaborations in hazard science by uniting a broad range of stakeholders to produce and disseminate knowledge in ways that are useful for decision-making in hazard mitigation, planning, and preparedness. Since 2013, an evaluation team at the Natural Hazards Center (NHC) has worked closely with the SAFRR group to assess these collaborations and communication efforts. In contributing to the nexus between academia and practice, or "pracademia," we use evaluation research to provide the USGS with useful feedback for crafting relevant information for practitioners and decision-makers. This presentation will highlight how the NHC team has varied our methodological and information design approaches according to the needs of each project, which in turn assist the SAFRR group in meeting the needs of practitioners and decision-makers. As the foci of our evaluation activities with SAFRR have evolved, so have our efforts to ensure that our work appropriately matches the information needs of each scenario project. We draw upon multiple projects, including evaluation work on the SAFRR Tsunami Scenario, "The First Sue Nami" tsunami awareness messaging, and their most recent project concerning a hypothetical M7 earthquake on the Hayward fault in the Bay Area (HayWired scenario). We have utilized various qualitative and quantitative methodologies—including telephone interviews, focus groups, online surveys, nonparticipant observation, and in-person survey distribution. The findings generated from these series of evaluations highlight the ways in which evaluation research can be used by researchers and academics to more appropriately address the needs of practitioners. Moreover, they contribute to knowledge enhancement surrounding disaster preparedness and risk communication, and, more generally, the limited body of knowledge about evaluation-focused disaster

  2. Evaluation of Major Online Diabetes Risk Calculators and Computerized Predictive Models

    PubMed Central

    Stiglic, Gregor; Pajnkihar, Majda

    2015-01-01

    Classical paper-and-pencil based risk assessment questionnaires are often accompanied by the online versions of the questionnaire to reach a wider population. This study focuses on the loss, especially in risk estimation performance, that can be inflicted by direct transformation from the paper to online versions of risk estimation calculators by ignoring the possibilities of more complex and accurate calculations that can be performed using the online calculators. We empirically compare the risk estimation performance between four major diabetes risk calculators and two, more advanced, predictive models. National Health and Nutrition Examination Survey (NHANES) data from 1999–2012 was used to evaluate the performance of detecting diabetes and pre-diabetes. American Diabetes Association risk test achieved the best predictive performance in category of classical paper-and-pencil based tests with an Area Under the ROC Curve (AUC) of 0.699 for undiagnosed diabetes (0.662 for pre-diabetes) and 47% (47% for pre-diabetes) persons selected for screening. Our results demonstrate a significant difference in performance with additional benefits for a lower number of persons selected for screening when statistical methods are used. The best AUC overall was obtained in diabetes risk prediction using logistic regression with AUC of 0.775 (0.734) and an average 34% (48%) persons selected for screening. However, generalized boosted regression models might be a better option from the economical point of view as the number of selected persons for screening of 30% (47%) lies significantly lower for diabetes risk assessment in comparison to logistic regression (p < 0.001), with a significantly higher AUC (p < 0.001) of 0.774 (0.740) for the pre-diabetes group. Our results demonstrate a serious lack of predictive performance in four major online diabetes risk calculators. Therefore, one should take great care and consider optimizing the online versions of questionnaires that were

  3. Ethnic Background and Genetic Variation in the Evaluation of Cancer Risk: A Systematic Review

    PubMed Central

    Jing, Lijun; Su, Li; Ring, Brian Z.

    2014-01-01

    The clinical use of genetic variation in the evaluation of cancer risk is expanding, and thus understanding how determinants of cancer susceptibility identified in one population can be applied to another is of growing importance. However there is considerable debate on the relevance of ethnic background in clinical genetics, reflecting both the significance and complexity of genetic heritage. We address this via a systematic review of reported associations with cancer risk for 82 markers in 68 studies across six different cancer types, comparing association results between ethnic groups and examining linkage disequilibrium between risk alleles and nearby genetic loci. We find that the relevance of ethnic background depends on the question. If asked whether the association of variants with disease risk is conserved across ethnic boundaries, we find that the answer is yes, the majority of markers show insignificant variability in association with cancer risk across ethnic groups. However if the question is whether a significant association between a variant and cancer risk is likely to reproduce, the answer is no, most markers do not validate in an ethnic group other than the discovery cohort’s ancestry. This lack of reproducibility is not attributable to studies being inadequately populated due to low allele frequency in other ethnic groups. Instead, differences in local genomic structure between ethnic groups are associated with the strength of association with cancer risk and therefore confound interpretation of the implied physiologic association tracked by the disease allele. This suggest that a biological association for cancer risk alleles may be broadly consistent across ethnic boundaries, but reproduction of a clinical study in another ethnic group is uncommon, in part due to confounding genomic architecture. As clinical studies are increasingly performed globally this has important implications for how cancer risk stratifiers should be studied and

  4. Application of a score system to evaluate the risk of malnutrition in a multiple hospital setting

    PubMed Central

    2013-01-01

    Background An increased but unpredictable risk of malnutrition is associated with hospitalization, especially in children with chronic diseases. We investigated the applicability of Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids), an instrument proposed to estimate the risk of malnutrition in hospitalized children. We also evaluated the role of age and co-morbidities as risk for malnutrition. Methods The STRONGkids consists of 4 items providing a score that classifies a patient in low, moderate, high risk for malnutrition. A prospective observational multi-centre study was performed in 12 Italian hospitals. Children 1–18 years consecutively admitted and otherwise unselected were enrolled. Their STRONGkids score was obtained and compared with the actual nutritional status expressed as BMI and Height for Age SD-score. Results Of 144 children (75 males, mean age 6.5 ± 4.5 years), 52 (36%) had an underlying chronic disease. According to STRONGkids, 46 (32%) children were at low risk, 76 (53%) at moderate risk and 22 (15%) at high risk for malnutrition. The latter had significantly lower Height for Age values (mean SD value -1.07 ± 2.08; p = 0.008) and BMI values (mean SD-values -0.79 ± 2.09; p = 0.0021) in comparison to other groups. However, only 29 children were actually malnourished. Conclusions The STRONGkids is easy to administer. It is highly sensitive but not specific. It may be used as a very preliminary screening tool to be integrated with other clinical data in order to reliably predict the risk of malnutrition. PMID:24373709

  5. Risk assessment of groundwater contamination: a multilevel fuzzy comprehensive evaluation approach based on DRASTIC model.

    PubMed

    Zhang, Qiuwen; Yang, Xiaohong; Zhang, Yan; Zhong, Ming

    2013-01-01

    Groundwater contamination is a serious threat to water supply. Risk assessment of groundwater contamination is an effective way to protect the safety of groundwater resource. Groundwater is a complex and fuzzy system with many uncertainties, which is impacted by different geological and hydrological factors. In order to deal with the uncertainty in the risk assessment of groundwater contamination, we propose an approach with analysis hierarchy process and fuzzy comprehensive evaluation integrated together. Firstly, the risk factors of groundwater contamination are identified by the sources-pathway-receptor-consequence method, and a corresponding index system of risk assessment based on DRASTIC model is established. Due to the complexity in the process of transitions between the possible pollution risks and the uncertainties of factors, the method of analysis hierarchy process is applied to determine the weights of each factor, and the fuzzy sets theory is adopted to calculate the membership degrees of each factor. Finally, a case study is presented to illustrate and test this methodology. It is concluded that the proposed approach integrates the advantages of both analysis hierarchy process and fuzzy comprehensive evaluation, which provides a more flexible and reliable way to deal with the linguistic uncertainty and mechanism uncertainty in groundwater contamination without losing important information.

  6. Risk Assessment of Groundwater Contamination: A Multilevel Fuzzy Comprehensive Evaluation Approach Based on DRASTIC Model

    PubMed Central

    Zhang, Yan; Zhong, Ming

    2013-01-01

    Groundwater contamination is a serious threat to water supply. Risk assessment of groundwater contamination is an effective way to protect the safety of groundwater resource. Groundwater is a complex and fuzzy system with many uncertainties, which is impacted by different geological and hydrological factors. In order to deal with the uncertainty in the risk assessment of groundwater contamination, we propose an approach with analysis hierarchy process and fuzzy comprehensive evaluation integrated together. Firstly, the risk factors of groundwater contamination are identified by the sources-pathway-receptor-consequence method, and a corresponding index system of risk assessment based on DRASTIC model is established. Due to the complexity in the process of transitions between the possible pollution risks and the uncertainties of factors, the method of analysis hierarchy process is applied to determine the weights of each factor, and the fuzzy sets theory is adopted to calculate the membership degrees of each factor. Finally, a case study is presented to illustrate and test this methodology. It is concluded that the proposed approach integrates the advantages of both analysis hierarchy process and fuzzy comprehensive evaluation, which provides a more flexible and reliable way to deal with the linguistic uncertainty and mechanism uncertainty in groundwater contamination without losing important information. PMID:24453883

  7. Epidemiological geomatics in evaluation of mine risk education in Afghanistan: introducing population weighted raster maps

    PubMed Central

    Andersson, Neil; Mitchell, Steven

    2006-01-01

    Evaluation of mine risk education in Afghanistan used population weighted raster maps as an evaluation tool to assess mine education performance, coverage and costs. A stratified last-stage random cluster sample produced representative data on mine risk and exposure to education. Clusters were weighted by the population they represented, rather than the land area. A "friction surface" hooked the population weight into interpolation of cluster-specific indicators. The resulting population weighted raster contours offer a model of the population effects of landmine risks and risk education. Five indicator levels ordered the evidence from simple description of the population-weighted indicators (level 0), through risk analysis (levels 1–3) to modelling programme investment and local variations (level 4). Using graphic overlay techniques, it was possible to metamorphose the map, portraying the prediction of what might happen over time, based on the causality models developed in the epidemiological analysis. Based on a lattice of local site-specific predictions, each cluster being a small universe, the "average" prediction was immediately interpretable without losing the spatial complexity. PMID:16390549

  8. Cancer risk evaluation of brick kiln workers exposed to dust bound PAHs in Punjab province (Pakistan).

    PubMed

    Kamal, Atif; Malik, Riffat Naseem; Martellini, Tania; Cincinelli, Alessandra

    2014-09-15

    Principal objective of this study was to evaluate the health risks of brick kiln workers to dust bound PAHs exposure in Punjab province (Pakistan). To this aim, surface dust samples were collected from brick kiln units located in Chung Khurd (Lahore city), Gujranwala city and Sohra village (in the vicinity of Gujranwala). The highest ΣPAH levels were measured in the dust samples collected in Sohdra village (mean 2578 ng g(-1) d.w., range 302-6757 ng g(-1) d.w.) followed by Gujranwala city (mean 957, range 16.1-1963 ng g(-1) d.w.) and Chung Khurd (mean 882, range 692-1007 ng g(-1) d.w.). Source identification using diagnostic ratios and principal component analysis identified coal and wood combustion as the major PAHs sources. The cancer risk model (CR-Model 1) and the Incremental Lifetime Cancer Risk model (ILCR-Model 2) were used to evaluate the cancer risk assessment via ingestion, inhalation and dermal contact pathways. Both models suggested that brick kiln workers (including adults and children) were exposed to high-potential carcinogenic risk via both ingestion and dermal contact pathways during the brick making process. This study also emphasizes the need for pollution control in the brick kiln industry of Pakistan. Copyright © 2014 Elsevier B.V. All rights reserved.

  9. Identification by ultrasound evaluation of the carotid and femoral arteries of high-risk subjects missed by three validated cardiovascular disease risk algorithms.

    PubMed

    Postley, John E; Luo, Yanting; Wong, Nathan D; Gardin, Julius M

    2015-11-15

    Atherosclerotic cardiovascular disease (ASCVD) events are the leading cause of death in the United States and globally. Traditional global risk algorithms may miss 50% of patients who experience ASCVD events. Noninvasive ultrasound evaluation of the carotid and femoral arteries can identify subjects at high risk for ASCVD events. We examined the ability of different global risk algorithms to identify subjects with femoral and/or carotid plaques found by ultrasound. The study population consisted of 1,464 asymptomatic adults (39.8% women) aged 23 to 87 years without previous evidence of ASCVD who had ultrasound evaluation of the carotid and femoral arteries. Three ASCVD risk algorithms (10-year Framingham Risk Score [FRS], 30-year FRS, and lifetime risk) were compared for the 939 subjects who met the algorithm age criteria. The frequency of femoral plaque as the only plaque was 18.3% in the total group and 14.8% in the risk algorithm groups (n = 939) without a significant difference between genders in frequency of femoral plaque as the only plaque. Those identified as high risk by the lifetime risk algorithm included the most men and women who had plaques either femoral or carotid (59% and 55%) but had lower specificity because the proportion of subjects who actually had plaques in the high-risk group was lower (50% and 35%) than in those at high risk defined by the FRS algorithms. In conclusion, ultrasound evaluation of the carotid and femoral arteries can identify subjects at risk of ASCVD events missed by traditional risk-predicting algorithms. The large proportion of subjects with femoral plaque only supports the use of including both femoral and carotid arteries in ultrasound evaluation. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. [Evaluation of metabolic rate for a correct risk assessment of thermal environments].

    PubMed

    Del Ferraro, Simona; Molinaro, V

    2010-01-01

    The new law n.81/2008 recognises microclimate as one of physical agents for which risk assessment becomes obligatory. To achieve this it is necessary to evaluate suitable indices, based on heat balance equation, which depend on six parameters: the first four are related to thermal environment and the last two are related to the worker (metabolic rate and thermal insulation). The first four parameters are directly measurable in situ by using a multiple data acquisition unit provided with suitable sensors. Parameters related to the worker are not directly measurable. This aspect represents one of the problems which can lead to an inaccurate risk assessment. Aim of the paper was to identify a method which leads to a correct evaluation of the metabolic rate related to the worker under study. It was decided to follow the procedures described by the standard UNI EN ISO 8996:2005 which presents four different levels to evaluate metabolic rate, each one with an increasing degree of accuracy. Seven workers were selected: three performed light tasks and the other four did heavy work. The study showed that the results appear to be in acceptable agreement in the case of light work while there were detectable differences in value for heavy tasks. The Authors believe it is necessary to stress the importance of a suitable estimation of the metabolic rate in order to carry out a correct risk assessment which quantifies the risk exactly.

  11. Mentoring nurses in familial cancer risk assessment and counseling: lessons learned from a formative evaluation.

    PubMed

    Masny, Agnes; Ropka, Mary E; Peterson, Candace; Fetzer, Dominique; Daly, Mary B

    2008-04-01

    As familial cancer genetic services moves into community practice increased numbers of trained health professionals are needed to counsel individuals seeking cancer risk information. Nurses have been targeted to provide cancer risk assessment and counseling. To help prepare nurses for this role, a 5-day training in familial cancer risk assessment and counseling followed by a long-distance mentorship to support continued skill development in the work environment was conducted by Fox Chase Cancer Center, Philadelphia, PA. Four cohorts (N = 41) have completed the training and were randomized to either an immediate or delayed mentorship. A formative evaluation assessed the nurse's ability to consult with other genetic health professionals and build self-efficacy in counseling skills via responses to questionnaire. A post-mentorship interview evaluated the usefulness, timing and length of the mentorship. For both groups, there was a statistically significant improvement in self-efficacy for all skills from baseline to 6 months and an increased number of nurses consulting with genetic health professionals. All the nurses reported the value of the mentorship and those with less cancer risk counseling experience prior to the training needed support and resources for further skill and program development. Lessons learned from this formative evaluation are provided.

  12. Evaluation of the pressure ulcers risk scales with critically ill patients: a prospective cohort study 1

    PubMed Central

    Borghardt, Andressa Tomazini; do Prado, Thiago Nascimento; de Araújo, Thiago Moura; Rogenski, Noemi Marisa Brunet; Bringuente, Maria Edla de Oliveira

    2015-01-01

    AIMS: to evaluate the accuracy of the Braden and Waterlow risk assessment scales in critically ill inpatients. METHOD: this prospective cohort study, with 55 patients in intensive care units, was performed through evaluation of sociodemographic and clinical variables, through the application of the scales (Braden and Waterlow) upon admission and every 48 hours; and through the evaluation and classification of the ulcers into categories. RESULTS: the pressure ulcer incidence was 30.9%, with the Braden and Waterlow scales presenting high sensitivity (41% and 71%) and low specificity (21% and 47%) respectively in the three evaluations. The cut off scores found in the first, second and third evaluations were 12, 12 and 11 in the Braden scale, and 16, 15 and 14 in the Waterlow scale. CONCLUSION: the Braden scale was shown to be a good screening instrument, and the Waterlow scale proved to have better predictive power. PMID:25806628

  13. Developing a multi-component immune model for evaluating the risk of respiratory illness in athletes.

    PubMed

    Gleeson, Maree; Pyne, David B; Elkington, Lisa J; Hall, Sharron T; Attia, John R; Oldmeadow, Christopher; Wood, Lisa G; Callister, Robin

    2017-01-01

    Clinical and laboratory identification of the underlying risk of respiratory illness in athletes has proved problematic. The aim of this study was to determine whether clinical data, combined with immune responses to standardised exercise protocols and genetic cytokine polymorphism status, could identify the risk of respiratory illness (symptoms) in a cohort of highly-trained athletes. Male endurance athletes (n=16; VO2max 66.5 ± 5.1 mL.kg-1.min-1) underwent a clinical evaluation of known risk factors by a physician and comprehensive laboratory analysis of immune responses both at rest and after two cycling ergometer tests: 60 min at 65% VO2max (LONG); and 6 x 3 min intervals at 90% VO2max (INTENSE). Blood tests were performed to determine Epstein Barr virus (EBV) status and DNA was genotyped for a panel of cytokine gene polymorphisms. Saliva was collected for measurement of IgA and detection of EBV DNA. Athletes were then followed for 9 months for self-reported episodes of respiratory illness, with confirmation of the underlying cause by a sports physician. There were no associations with risk of respiratory illness identified for any parameter assessed in the clinical evaluations. The laboratory parameters associated with an increased risk of respiratory illnesses in highly-trained athletes were cytokine gene polymorphisms for the high expression of IL-6 and IFN-ɣ; expression of EBV-DNA in saliva; and low levels of salivary IgA concentration. A genetic risk score was developed for the cumulative number of minor alleles for the cytokines evaluated. Athletes prone to recurrent respiratory illness were more likely to have immune disturbances that allow viral reactivation, and a genetic predisposition to pro-inflammatory cytokine responses to intense exercise. Copyright © 2016 International Society of Exercise and Immunology. All rights reserved.

  14. Determining Risk - How to Evaluate the Environmental Effects of Marine and Hydrokinetic Energy Development

    NASA Astrophysics Data System (ADS)

    Copping, A. E.; Blake, K.; Zdanski, L.

    2011-12-01

    As marine and hydrokinetic (MHK) energy development projects progress towards early deployments in the U.S., the process of determining the risks to aquatic animals, habitats, and ecosystem processes from these engineered systems continues to be a significant barrier to efficient siting and permitting. Understanding the risk of MHK installations requires that the two elements of risk - consequence and probability - be evaluated. However, standard risk assessment methodologies are not easily applied to MHK interactions with marine and riverine environment as there are few data that describe the interaction of stressors (MHK devices, anchors, foundations, mooring lines and power cables) and receptors (aquatic animals, habitats and ecosystem processes). The number of possible combinations and permutations of stressors and receptors in MHK systems is large: there are many different technologies designed to harvest energy from the tides, waves and flowing rivers; each device is planned for a specific waterbody that supports an endemic ecosystem of animals and habitats, tied together by specific physical and chemical processes. With few appropriate analogue industries in the oceans and rivers, little information on the effects of these technologies on the living world is available. Similarly, without robust data sets of interactions, mathematical probability models are difficult to apply. Pacific Northwest National Laboratory scientists are working with MHK developers, researchers, engineers, and regulators to rank the consequences of planned MHK projects on living systems, and exploring alternative methodologies to estimate probabilities of these encounters. This paper will present the results of ERES, the Environmental Risk Evaluation System, which has been used to rank consequences for major animal groups and habitats for five MHK projects that are in advanced stages of development and/or early commercial deployment. Probability analyses have been performed for high

  15. Risk and information evaluation of prioritized genes for complex traits: application to bipolar disorder.

    PubMed

    Kao, Chung-Feng; Chuang, Li-Chung; Kuo, Po-Hsiu

    2014-10-01

    Many susceptibility genes for complex traits were identified without conclusive findings. There is a strong need to integrate rapidly accumulated genomic data from multi-dimensional platforms, and to conduct risk evaluation for potential therapeutic and diagnostic usages. We set up an algorithm to computationally search for optimal weight-vector for various data sources, while minimized potential noises. Through gene-prioritization framework, combined scores for the resulting prioritized gene-set were calculated using a genome-wide association (GWA) dataset, following with evaluation using weighted genetic risk score and risk-attributed information using an independent GWA dataset. The significance of association of GWA data was corrected for gene length. Enriched functional pathways were identified for the prioritized gene-set using the Gene Ontology analysis. We illustrated our framework with bipolar disorder. 233 prioritized genes were identified from 10,830 candidates that curated from six platforms. The prioritized genes were significantly enriched (P(adjusted) < 1 × 10(-5)) in 18 biological functions and molecular mechanisms including membrane, synaptic transmission, transmission of nerve impulse, integral to membrane, and plasma membrane. Our risk evaluation demonstrated higher weighted genetic risk score in bipolar patients than controls (P-values ranged from 0.002 to 3.8 × 10(-6)). Substantial risk-information (71%) was extracted from prioritized genes for bipolar illness than other candidate-gene sets. Our evidence-based prioritized gene-set provides opportunity to explore the complex network and to conduct follow-up basic and clinical studies for complex traits.

  16. Deep sternal wound infection after coronary artery bypass surgery: management and risk factor analysis for mortality.

    PubMed

    Yumun, Gunduz; Erdolu, Burak; Toktas, Faruk; Eris, Cuneyt; Ay, Derih; Turk, Tamer; As, Ahmet Kagan

    2014-08-01

    Deep sternal wound infection is a life-threatening complication after cardiac surgery. The aim of this study was to investigate the factors leading to mortality, and to explore wound management techniques on deep sternal wound infection after coronary artery bypass surgery. Between 2008 and 2013, 58 patients with deep sternal wound infection were analyzed. Risk factors for mortality and morbidity including age, gender, body mass index, smoking status, chronic renal failure, hypertension, diabetes, and treatment choice were investigated. In this study, 19 patients (32.7%) were treated by primary surgical closure (PSC), and 39 patients (67.3%) were treated by delayed surgical closure following a vacuum-assisted closure system (VAC). Preoperative patient characteristics were similar between the groups. Fourteen patients (24.1%) died in the postoperative first month. The mortality rate and mean duration of hospitalization in the PSC group was higher than in the VAC group (P = .026, P = .034). Significant risk factors for mortality were additional operation, diabetes mellitus, and a high level of EuroSCORE. Delayed surgical closure following VAC therapy may be associated with shorter hospitalization and lower mortality in patients with deep sternal wound infection. Additional operation, diabetes mellitus, and a high level of EuroSCORE were associated with mortality.

  17. Evaluating the Risks of High Altitude Travel in Chronic Liver Disease Patients.

    PubMed

    Luks, Andrew M; Swenson, Erik R

    2015-06-01

    Luks, Andrew M., and Erik R. Swenson. Clinician's Corner: Evaluating the risks of high altitude travel in chronic liver disease patients. High Alt Med Biol 16:80-88, 2015.--With improvements in the quality of health care, people with chronic medical conditions are experiencing better quality of life and increasingly participating in a wider array of activities, including travel to high altitude. Whenever people with chronic diseases travel to this environment, it is important to consider whether the physiologic responses to hypobaric hypoxia will interact with the underlying medical condition such that the risk of acute altitude illness is increased or the medical condition itself may worsen. This review considers these questions as they pertain to patients with chronic liver disease. While the limited available evidence suggests there is no evidence of liver injury or dysfunction in normal individuals traveling as high as 5000 m, there is reason to suspect that two groups of cirrhosis patients are at increased risk for problems, hepatopulmonary syndrome patients, who are at risk for severe hypoxemia following ascent, and portopulmonary hypertension patients who may be at risk for high altitude pulmonary edema and acute right ventricular dysfunction. While liver transplant patients may tolerate high altitude exposure without difficulty, no information is available regarding the risks of long-term residence at altitude with chronic liver disease. All travelers with cirrhosis require careful pre-travel evaluation to identify conditions that might predispose to problems at altitude and develop risk mitigation strategies for these issues. Patients also require detailed counseling about recognition, prevention, and treatment of acute altitude illness and may require different medication regimens to prevent or treat altitude illness than used in healthy individuals.

  18. Developing and evaluating an automated appendicitis risk stratification algorithm for pediatric patients in the emergency department

    PubMed Central

    Deleger, Louise; Brodzinski, Holly; Zhai, Haijun; Li, Qi; Lingren, Todd; Kirkendall, Eric S; Alessandrini, Evaline; Solti, Imre

    2013-01-01

    Objective To evaluate a proposed natural language processing (NLP) and machine-learning based automated method to risk stratify abdominal pain patients by analyzing the content of the electronic health record (EHR). Methods We analyzed the EHRs of a random sample of 2100 pediatric emergency department (ED) patients with abdominal pain, including all with a final diagnosis of appendicitis. We developed an automated system to extract relevant elements from ED physician notes and lab values and to automatically assign a risk category for acute appendicitis (high, equivocal, or low), based on the Pediatric Appendicitis Score. We evaluated the performance of the system against a manually created gold standard (chart reviews by ED physicians) for recall, specificity, and precision. Results The system achieved an average F-measure of 0.867 (0.869 recall and 0.863 precision) for risk classification, which was comparable to physician experts. Recall/precision were 0.897/0.952 in the low-risk category, 0.855/0.886 in the high-risk category, and 0.854/0.766 in the equivocal-risk category. The information that the system required as input to achieve high F-measure was available within the first 4 h of the ED visit. Conclusions Automated appendicitis risk categorization based on EHR content, including information from clinical notes, shows comparable performance to physician chart reviewers as measured by their inter-annotator agreement and represents a promising new approach for computerized decision support to promote application of evidence-based medicine at the point of care. PMID:24130231

  19. An improved method for risk evaluation in failure modes and effects analysis of CNC lathe

    NASA Astrophysics Data System (ADS)

    Rachieru, N.; Belu, N.; Anghel, D. C.

    2015-11-01

    Failure mode and effects analysis (FMEA) is one of the most popular reliability analysis tools for identifying, assessing and eliminating potential failure modes in a wide range of industries. In general, failure modes in FMEA are evaluated and ranked through the risk priority number (RPN), which is obtained by the multiplication of crisp values of the risk factors, such as the occurrence (O), severity (S), and detection (D) of each failure mode. However, the crisp RPN method has been criticized to have several deficiencies. In this paper, linguistic variables, expressed in Gaussian, trapezoidal or triangular fuzzy numbers, are used to assess the ratings and weights for the risk factors S, O and D. A new risk assessment system based on the fuzzy set theory and fuzzy rule base theory is to be applied to assess and rank risks associated to failure modes that could appear in the functioning of Turn 55 Lathe CNC. Two case studies have been shown to demonstrate the methodology thus developed. It is illustrated a parallel between the results obtained by the traditional method and fuzzy logic for determining the RPNs. The results show that the proposed approach can reduce duplicated RPN numbers and get a more accurate, reasonable risk assessment. As a result, the stability of product and process can be assured.

  20. A spatial evaluation of global wildfire-water risks to human and natural systems.

    PubMed

    Robinne, François-Nicolas; Bladon, Kevin D; Miller, Carol; Parisien, Marc-André; Mathieu, Jérôme; Flannigan, Mike D

    2018-01-01

    The large mediatic coverage of recent massive wildfires across the world has emphasized the vulnerability of freshwater resources. The extensive hydrogeomorphic effects from a wildfire can impair the ability of watersheds to provide safe drinking water to downstream communities and high-quality water to maintain riverine ecosystem health. Safeguarding water use for human activities and ecosystems is required for sustainable development; however, no global assessment of wildfire impacts on water supply is currently available. Here, we provide the first global evaluation of wildfire risks to water security, in the form of a spatially explicit index. We adapted the Driving forces-Pressure-State-Impact-Response risk analysis framework to select a comprehensive set of indicators of fire activity and water availability, which we then aggregated to a single index of wildfire-water risk using a simple additive weighted model. Our results show that water security in many regions of the world is potentially vulnerable, regardless of socio-economic status. However, in developing countries, a critical component of the risk is the lack of socio-economic capability to respond to disasters. Our work highlights the importance of addressing wildfire-induced risks in the development of water security policies; the geographic differences in the components of the overall risk could help adapting those policies to different regional contexts. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

  1. Evaluating karst geotechnical risk in the urbanized area of Sete Lagoas, Minas Gerais, Brazil

    NASA Astrophysics Data System (ADS)

    Galvão, Paulo; Halihan, Todd; Hirata, Ricardo

    2015-11-01

    An increase in groundwater consumption in the municipality of Sete Lagoas (Minas Gerais, Brazil) has induced subsidence and collapse in the last three decades. The area is associated with natural karst conditions. The primary objective of this research was to evaluate and identify the potential subsidence or collapse risk zones. Aerial photographs, lithologic well profiles, optical well logs, and geologic mapping were utilized to categorize risk factors influencing karst subsidence and collapse, which were then applied to an index system. The study showed that the majority of the urbanized area overlies mantled limestone from the Sete Lagoas Formation covered with unconsolidated sediments, contained within a graben, resulting in barrier boundaries for groundwater flow. This structure, together with natural karst processes, explains the location of solutionally enlarged bedding-plane conduits and high hydraulic conductivity in the limestone. Five risks zones in the municipality were identified (negligible, low, moderate, considerable, and high risks) related to geologic and hydrologic risk factors. The urbanized area is located largely in the high risk zone where the majority of the collapse features are located. Additional intensive groundwater extraction in that area will likely generate additional events.

  2. Evaluation of dysphagia risk, nutritional status and caloric intake in elderly patients with Alzheimer's

    PubMed Central

    Goes, Vanessa Fernanda; Mello-Carpes, Pâmela Billig; de Oliveira, Lilian Oliveira; Hack, Jaqueline; Magro, Marcela; Bonini, Juliana Sartori

    2014-01-01

    Objective to evaluate the risk of dysphagia and its relationship with the stage of Alzheimer's Disease, as well as the relationship between the risk of dysphagia and nutritional status and caloric intake in elderly people with Alzheimer's disease. Methods the sample consisted of 30 subjects of both genders with probable Alzheimer's disease. The stage of the disease, nutritional status, energy intake, and risk of dysphagia were assessed. Results it was found that increased risk of dysphagia is associated with the advance in the stages of Alzheimer's disease and that even patients in the early stages of disease have a slight risk of developing dysphagia. No association was found between nutritional status and the risk of dysphagia. High levels of inadequate intake of micronutrients were also verified in the patients. Conclusion an association between dysphagia and the development of Alzheimer's disease was found. The results indicate the need to monitor the presence of dysphagia and the micronutrient intake in patients with Alzheimer's disease. PMID:26107841

  3. Toward a risk assessment of the spent fuel and high-level nuclear waste disposal system. Risk assessment requirements, literature review, methods evaluation: an interim report

    SciTech Connect

    Hamilton, L.D.; Hill, D.; Rowe, M.D.; Stern, E.

    1986-04-01

    This report provides background information for a risk assessment of the disposal system for spent nuclear fuel and high-level radioactive waste (HLW). It contains a literature review, a survey of the statutory requirements for risk assessment, and a preliminary evaluation of methods. The literature review outlines the state of knowledge of risk assessment and accident consequence analysis in the nuclear fuel cycle and its applicability to spent fuel and HLW disposal. The survey of statutory requirements determines the extent to which risk assessment may be needed in development of the waste-disposal system. The evaluation of methods reviews and evaluates merits and applicabilities of alternative methods for assessing risks and relates them to the problems of spent fuel and HLW disposal. 99 refs.

  4. Evaluation of Species Distribution Model Algorithms For Fine-Scale Container Breeding Mosquito Risk Prediction

    PubMed Central

    Khatchikian, C.; Sangermano, F.; Kendell, D.; Livdahl, T.

    2010-01-01

    The present work evaluates the use of species distribution model (SDM) algorithms to classify high density of small container Aedes mosquitoes at a fine scale, in the Bermuda islands. Weekly ovitrap data collected by the Health Department of Bermuda (UK) for the years 2006 and 2007 were used for the models. The models evaluated included the following algorithms: Bioclim, Domain, GARP, logistic regression, and MaxEnt. Models were evaluated according to performance and robustness. The area Receiver Operating Characteristic (ROC) curve was used to evaluate each model’s performance, and robustness was assessed considering the spatial correlation between classification risks for the two datasets. Relative to the other algorithms, logistic regression was the best model for classifying high risk areas, and the maximum entropy approach (MaxEnt) presented the second best performance. We report the importance of covariables for these two models, and discuss the utility of SDMs for vector control efforts and the potential for the development of scripts that automate the task of creating risk assessment maps. PMID:21198711

  5. Examination of risk evaluation and mitigation strategies and drug safety in the US.

    PubMed

    Rodriguez-Monguio, Rosa; Spielberger, Kerry; Seoane-Vazquez, Enrique

    2014-01-01

    The Food and Drug Administration Amendment Act of 2007 (FDAAA 2007) enabled the US Food and Drug Administration (FDA) to require risk evaluation and mitigation strategies (REMS) for a drug or biologic to ensure that its benefits outweigh the risks. This study sought to evaluate REMS approved and released by the FDA since the program inception in 2008, to assess the characteristics of REMS approved and to calculate the time lag between FDA drug application approval and REMS approval. Data were derived from Approved Drug Products with Therapeutic Equivalence Evaluations, Approved REMS and Drugs@FDA. Data included generic availability, application type and approval date, therapeutic class and FDA review class, orphan designation, priority review and market status. The FDA approved REMS for 259 marketing applications (217 new drug applications -NDAs, 10 abbreviated NDAs, and 32 biologic license applications) in the study period. The FDA granted orphan designation to 11.4% of active ingredients with REMS and priority review to 38.4% of the NDAs with REMS. The largest number of REMS approvals was for nervous system products (31.8% of total approved REMS) and antineoplastic and immunomodulating agents (15.3%). The FDA approved REMS for one in three biologics and one in thirteen chemical entities available in the market. A pharmaceutical product can be in the market for an average of 14 years before the FDA identifies and evaluates the risk problems that warrant the approval of a REMS. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Evaluation of the risk of venous thromboembolism after quadrivalent human papillomavirus vaccination among US females.

    PubMed

    Yih, W Katherine; Greene, Sharon K; Zichittella, Lauren; Kulldorff, Martin; Baker, Meghan A; de Jong, Jill L O; Gil-Prieto, Ruth; Griffin, Marie R; Jin, Robert; Lin, Nancy D; McMahill-Walraven, Cheryl N; Reidy, Megan; Selvam, Nandini; Selvan, Mano S; Nguyen, Michael D

    2016-01-02

    After the Food and Drug Administration (FDA) licensed quadrivalent human papillomavirus vaccine (HPV4) in 2006, reports suggesting a possible association with venous thromboembolism (VTE) emerged from the Vaccine Adverse Event Reporting System and the Vaccine Safety Datalink. Our objective was to determine whether HPV4 increased VTE risk. The subjects were 9-26-year-old female members of five data partners in the FDA's Mini-Sentinel pilot project receiving HPV4 during 2006-2013. The outcome was radiologically confirmed first-ever VTE among potential cases identified by diagnosis codes in administrative data during Days 1-77 after HPV4 vaccination. With a self-controlled risk interval design, we compared counts of first-ever VTE in risk intervals (Days 1-28 and Days 1-7 post-vaccination) and control intervals (Days 36-56 for Dose 1 and Days 36-63 for Doses 2 and 3). Combined hormonal contraceptive use was treated as a potential confounder. The main analyses were: (1) unadjusted for time-varying VTE risk from contraceptive use, (2) unadjusted but restricted to cases without such time-varying risk, and (3) adjusted by incorporating the modeled risk of VTE by week of contraceptive use in the analysis. Of 279 potential VTE cases identified following 1,423,399 HPV4 doses administered, 225 had obtainable charts, and 53 were confirmed first-ever VTE. All 30 with onsets in risk or control intervals had known risk factors for VTE. VTE risk was not elevated in the first 7 or 28 days following any dose of HPV in any analysis (e.g. relative risk estimate (95% CI) from both unrestricted analyses, for all-doses, 28-day risk interval: 0.7 (0.3-1.4)). Temporal scan statistics found no clustering of VTE onsets after any dose. Thus, we found no evidence of an increased risk of VTE associated with HPV4 among 9-26-year-old females. A particular strength of this evaluation was its control for both time-invariant and contraceptive-related time-varying potential confounding.

  7. Evaluation of the risk of noise-induced hearing loss among unscreened male industrial workers

    NASA Astrophysics Data System (ADS)

    Prince, Mary M.; Gilbert, Stephen J.; Smith, Randall J.; Stayner, Leslie T.

    2003-02-01

    Variability in background risk and distribution of various risk factors for hearing loss may explain some of the diversity in excess risk of noise-induced hearing loss (NIHL). This paper examines the impact of various risk factors on excess risk estimates of NIHL using data from the 1968-1972 NIOSH Occupational Noise and Hearing Survey (ONHS). Previous analyses of a subset of these data focused on 1172 highly ``screened'' workers. In the current analysis, an additional 894 white males (609 noise-exposed and 285 controls), who were excluded for various reasons (i.e., nonoccupational noise exposure, otologic or medical conditions affecting hearing, prior occupational noise exposure) have been added (n=2066) to assess excess risk of noise-induced material impairment in an unscreened population. Data are analyzed by age, duration of exposure, and sound level (8-h TWA) for four different definitions of noise-induced hearing impairment, defined as the binaural pure-tone average (PTA) hearing threshold level greater than 25 dB for the following frequencies: (a) 1-4 kHz (PTA1234), (b) 1-3 kHz (PTA123), (c) 0.5, 1, and 2 kHz (PTA512), and (d) 3, 4, and 6 kHz (PTA346). Results indicate that populations with higher background risks of hearing loss may show lower excess risks attributable to noise relative to highly screened populations. Estimates of lifetime excess risk of hearing impairment were found to be significantly different between screened and unscreened population for noise levels greater than 90 dBA. Predicted age-related risk of material hearing impairment in the ONHS unscreened population was similar to that predicted from Annex B and C of ANSI S3.44 for ages less than 60 years. Results underscore the importance of understanding differential risk patterns for hearing loss and the use of appropriate reference (control) populations when evaluating risk of noise-induced hearing impairment among contemporary industrial populations.

  8. How social context moderates the self-evaluative emotions experienced due to health risk behaviour.

    PubMed

    Grob, Judith D M; Dijkstra, Arie; de Groot, Carla

    2011-10-01

    When people are confronted with the potential negative physical outcomes of their own health risk behaviour, they experience a self-threat. This threat is felt as negative self-evaluative emotions. We hypothesise that the threat will lead to more private self-evaluative emotions (e.g. regret) in a private social context, whereas more public self-evaluative emotions (e.g. embarrassment) will be felt in a public social context with negative norms. Consistent with our hypotheses, we show that participants anticipate feeling more private self-evaluative emotions when confronted with the negative consequences of their unhealthy behaviour when alone, and more public self-evaluative emotions when in a group (Study 1). They further anticipate more public self-evaluative emotions in response to a health self-threat when the group norm is negative, and more private self-evaluative emotions when the group norm is lenient (Study 2). Finally, in a cross-sectional study amongst smokers, we show that private but not public negative self-evaluative emotions concerning their own smoking habits are positively correlated with the intent to quit smoking (Study 3). These studies show that a distinction needs to be made between public and private self-evaluative emotions, in terms of their antecedents and effects. Theoretical implications and further lines of research are discussed.

  9. [Evaluation of the cardiac risks in non-cardiac surgery in patients with heart failure].

    PubMed

    Pinaud, M

    2002-02-01

    Cardiac insufficiency represents a major risk factor in patients about to undergo non-cardiac surgery. The post-operative mortality is linked to the severity of the pre-operative functional impairment: rising from 4% in NYHA class 1 to 67% in class IV. The operative risk is greater when the cardiac insufficiency is more disabling, the patient is older (> 70 years) and if there is a history of acute pulmonary oedema and a gallop bruit on auscultation. The use of metabolic equivalents (Duke Activity Status Index) is recommended: the functional capacity is defined as excellent if > 7 MET, moderate between 4 and 7, or poor if < 4. A non-invasive evaluation of left ventricular function is necessary in each patient with obvious congestive cardiac insufficiency or poor control under the American consensus, but it is rare that the patient has not already been seen by a cardiologist. The degree of per-operative haemodynamic constraint is linked to the surgical technique and is stratified according to the type of surgical intervention and whether or not it is performed as an emergency. An intervention duration > 5 hours is associated with an increased peri-operative risk of congestive cardiac insufficiency and non-cardiac death. Deaths from a cardiac cause are thus twice as frequent after intra-abdominal, non-cardiac thoracic or aortic surgery and the post-operative cardiac complications are six times more frequent. Numerous studies have attempted to document the impact of different anaesthetic techniques on the prognosis for the population at increased risk of post-operative cardiovascular complications. It is advisable to opt for peripheral nerve blocks. The cardiovascular morbidity and overall mortality do not differ between general anaesthetic, epidural anaesthetic or spinal nerve block. The ASA (American Society of Anesthesiologists) classification is widely used to determine the overall risk. The ASA class and the age are however too coarse as methods of evaluation for

  10. Periodontal risk and recall interval evaluation after a program of comprehensive supragingival plaque control.

    PubMed

    Butze, Juliane Pereira; Angst, Patrícia Daniela Melchiors; Oppermann, Rui Vicente; Gomes, Sabrina Carvalho

    2015-10-01

    To investigate if a comprehensive supragingival control can modify the periodontal risk and suggested recall interval over time, using an adaptation of an available model of periodontal risk assessment (PRA, Perio-Tools® website). Single-arm clinical trial data (visible plaque and gingival bleeding indexes, periodontal probing depth, bleeding on probing, and clinical attachment level from baseline (day 0, T0), day 30 (T1), and day 180 (T2) from 50 moderate-to-severe periodontitis patients (25 never-smokers; 25 smokers) submitted to a comprehensive supragingival plaque control regimen for 180 days were subjected to a secondary analysis using an adaptation of the PRA. The periodontal risk (high, medium, or low) and suggested recall interval were calculated per patient and at each experimental time. General linear models and the Cochran test were used for statistical analysis, considering the dependence of the data. All patients were at high risk at baseline. At T1, 20% migrated to medium-risk (P = .002). At T2, 38% and 8% exhibited medium- and low-risk, respectively (P ≤ .001). The reduction between T1 and T2 was significant (P = .001). The mean recall interval increased from 3.0 ± 0.0 (T0) to 3.6 ± 1.2 (T1), and 4.9 ± 2.6 months at T2 (P < .003). The effect that smoking habit exerted on risk was limited to the first 30 days, and no effect on recall interval was observed. The oral hygiene condition is an important indicator that influences the risk and the recall interval over time, thus deserving attention when evaluating the individual periodontal prognosis.

  11. Evaluating life-safety risk of fieldwork at New Zealand's active volcanoes

    NASA Astrophysics Data System (ADS)

    Deligne, Natalia; Jolly, Gill; Taig, Tony; Webb, Terry

    2014-05-01

    Volcano observatories monitor active or potentially active volcanoes. Although the number and scope of remote monitoring instruments and methods continues to grow, in-person field data collection is still required for comprehensive monitoring. Fieldwork anywhere, and especially in mountainous areas, contains an element of risk. However, on volcanoes with signs of unrest, there is an additional risk of volcanic activity escalating while on site, with potentially lethal consequences. As an employer, a volcano observatory is morally and sometimes legally obligated to take reasonable measures to ensure staff safety and to minimise occupational risk. Here we present how GNS Science evaluates life-safety risk for volcanologists engaged in fieldwork on New Zealand volcanoes with signs of volcanic unrest. Our method includes several key elements: (1) an expert elicitation for how likely an eruption is within a given time frame, (2) quantification of, based on historical data when possible, given a small, moderate, or large eruption, the likelihood of exposure to near-vent processes, ballistics, or surge at various distances from the vent, and (3) estimate of fatality rate given exposure to these volcanic hazards. The final product quantifies hourly fatality risk at various distances from a volcanic vent; various thresholds of risk (for example, zones with more than 10-5 hourly fatality risk) trigger different levels of required approval to undertake work. Although an element of risk will always be present when conducting fieldwork on potentially active volcanoes, this is a first step towards providing objective guidance for go/no go decisions for volcanic monitoring.

  12. Computer simulation of microgravity long-term effects and risk evaluation

    NASA Astrophysics Data System (ADS)

    Perez-Poch, Antoni

    The objective of this work is to analyse and simulate possible long-term effects of microgravity on the human pulmonary function. It is also studied the efficacy of long-term regular exercise on relevant cardiovascular parameters when the human body is also exposed to microgravity. Little is known today about what long-term effects microgravity may cause on pulmonary function. It does not exist a complete explanation of the possible risks involved, although some experiments are under way on the ISS in order to evaluate them. Computer simulations are an important tool which may be used to predict and analyse these possible effects, and compare them with in-flight experiments. We based our study on a previous computer model (NELME: Numerical Evaluation of Long-term Microgravity Effects) which was developed in our laboratory and validated with the available data, focusing on the cardiovascular parameters affected by changes in gravity exposure. In thi