CERT Resiliency Engineering Framework

DTIC Science & Technology

2007-03-01

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

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

NASA Technical Reports Server (NTRS)

Ray, Paul S.

2002-01-01

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

Continuous Risk Management: A NASA Program Initiative

NASA Technical Reports Server (NTRS)

Hammer, Theodore F.; Rosenberg, Linda

1999-01-01

NPG 7120.5A, "NASA Program and Project Management Processes and Requirements" enacted in April, 1998, requires that "The program or project manager shall apply risk management principles..." The Software Assurance Technology Center (SATC) at NASA GSFC has been tasked with the responsibility for developing and teaching a systems level course for risk management that provides information on how to comply with this edict. The course was developed in conjunction with the Software Engineering Institute at Carnegie Mellon University, then tailored to the NASA systems community. This presentation will briefly discuss the six functions for risk management: (1) Identify the risks in a specific format; (2) Analyze the risk probability, impact/severity, and timeframe; (3) Plan the approach; (4) Track the risk through data compilation and analysis; (5) Control and monitor the risk; (6) Communicate and document the process and decisions.

How family members manage risk around functional decline: the autonomy management process in households facing dementia.

PubMed

Berry, Brandon; Apesoa-Varano, Ester Carolina; Gomez, Yarin

2015-04-01

Most dementia research investigates the social context of declining ability through studies of decision-making around medical treatment and end-of-life care. This study seeks to fill an important gap in research about how family members manage the risks of functional decline at home. Drawing on three waves of in-depth interviewing in 2012-2014, it investigates how family members in US households manage decline in an affected individual's natural range of daily activities over time. The findings show that early on in the study period affected individuals were perceived to have awareness of their decline and routinely drew on family members for support. Support transformed when family members detected that the individual's deficit awareness had diminished, creating a corresponding increase in risk of self-harm around everyday activities. With a loss of confidence in the individual's ability to regulate his or her own activities to avoid these risks, family members employed unilateral practices to manage the individual's autonomy around his or her activity involvements. These practices typically involved various deceits and ruses to discourage elders from engaging in activities perceived as potentially dangerous. The study concludes by discussing the implications that the social context of interpretive work around awareness and risk plays an important role in how families perceive an elder's functional ability and manage his or her activity involvements. Copyright © 2015 Elsevier Ltd. All rights reserved.

How family members manage risk around functional decline: The autonomy management process in households facing dementia

PubMed Central

Berry, Brandon; Apesoa-Varano, Ester Carolina; Gomez, Yarin

2015-01-01

Most dementia research investigates the social context of declining ability through studies of decision-making around medical treatment and end-of-life care. This study seeks to fill an important gap in research about how family members manage the risks of functional decline at home. Drawing on three waves of retrospective interviewing in 2012–2014, it investigates how family members in US households manage decline in an affected individual’s natural range of daily activities over time. The findings show that early on in the study period affected individuals were perceived to have awareness of their decline and routinely drew on family members for support. Support transformed when family members detected that the individual’s deficit awareness had diminished, creating a corresponding increase in risk of self-harm around everyday activities. With a loss of confidence in the individual’s ability to regulate his or her own activities to avoid these risks, family members employed unilateral practices to manage the individual’s autonomy around his or her activity involvements. These practices typically involved various deceits and ruses to discourage elders from engaging in activities perceived as potentially dangerous. The study concludes by discussing the implications that the social context of interpretive work around awareness and risk plays an important role in how families perceive an elder’s functional ability and manage his or her activity involvements. PMID:25697634

Adapting risk management and computational intelligence network optimization techniques to improve traffic throughput and tail risk analysis.

DOT National Transportation Integrated Search

2014-04-01

Risk management techniques are used to analyze fluctuations in uncontrollable variables and keep those fluctuations from impeding : the core function of a system or business. Examples of this are making sure that volatility in copper and aluminum pri...

Risk Management in Biologics Technology Transfer.

PubMed

Toso, Robert; Tsang, Jonathan; Xie, Jasmina; Hohwald, Stephen; Bain, David; Willison-Parry, Derek

Technology transfer of biological products is a complex process that is important for product commercialization. To achieve a successful technology transfer, the risks that arise from changes throughout the project must be managed. Iterative risk analysis and mitigation tools can be used to both evaluate and reduce risk. The technology transfer stage gate model is used as an example tool to help manage risks derived from both designed process change and unplanned changes that arise due to unforeseen circumstances. The strategy of risk assessment for a change can be tailored to the type of change. In addition, a cross-functional team and centralized documentation helps maximize risk management efficiency to achieve a successful technology transfer. © PDA, Inc. 2016.

77 FR 35719 - Self-Regulatory Organizations; BATS Exchange, Inc.; Notice of Filing and Immediate Effectiveness...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-14

... Change To Adopt Rules Related to Risk Management Functionality for BATS Options June 8, 2012. Pursuant to... serves an important risk management purpose, it operates consistent with the firm quote obligations of a... Change The Exchange proposes to adopt Rule 21.16, entitled ``Risk Monitor Mechanism'', to codify the risk...

Designing new institutions for implementing integrated disaster risk management: key elements and future directions.

PubMed

Gopalakrishnan, Chennat; Okada, Norio

2007-12-01

The goal of integrated disaster risk management is to promote an overall improvement in the quality of safety and security in a region, city or community at disaster risk. This paper presents the case for a thorough overhaul of the institutional component of integrated disaster risk management. A review of disaster management institutions in the United States indicates significant weaknesses in their ability to contribute effectively to the implementation of integrated disaster risk management. Our analysis and findings identify eight key elements for the design of dynamic new disaster management institutions. Six specific approaches are suggested for incorporating the identified key elements in building new institutions that would have significant potential for enhancing the effective implementation of integrated disaster risk management. We have developed a possible blueprint for effective design and construction of efficient, sustainable and functional disaster management institutions.

The quality assurance-risk management interface.

PubMed

Little, N

1992-08-01

Involvement with both risk management and quality assurance programs has led many authors to the conclusion that the fundamental differences between these activities are, in fact, very small. "At the point of overlap, it is almost impossible to distinguish the purposes and methods of both functions from one another." "Good risk management includes real improvement in patient care through organized quality assurance activities." The interface between a proactive risk management program and a quality assurance program is dynamic and can serve the legitimate interests of both. There is little to be gained by thinking of them as separate entities and much to be gained by sharing the lessons of both. If one thinks of risk management in terms of "risk" to quality patient care, and that "assuring quality" is the most productive type of risk management, then there is no practical reason to separate one from the other.

Design of a secure remote management module for a software-operated medical device.

PubMed

Burnik, Urban; Dobravec, Štefan; Meža, Marko

2017-12-09

Software-based medical devices need to be maintained throughout their entire life cycle. The efficiency of after-sales maintenance can be improved by managing medical systems remotely. This paper presents how to design the remote access function extensions in order to prevent risks imposed by uncontrolled remote access. A thorough analysis of standards and legislation requirements regarding safe operation and risk management of medical devices is presented. Based on the formal requirements, a multi-layer machine design solution is proposed that eliminates remote connectivity risks by strict separation of regular device functionalities from remote management service, deploys encrypted communication links and uses digital signatures to prevent mishandling of software images. The proposed system may also be used as an efficient version update of the existing medical device designs.

Identification of general risk-management countermeasures for unsafe driving actions. Volume 1, Description and analysis of promising countermeasures

DOT National Transportation Integrated Search

1981-02-01

A series of general risk-management countermeasures for speed Unsafe Driving Actions (UDAs) are described. First, countermeasure elements in three functional areas, detection, information, and action, are identified. Three comprehensive countermeasur...

78 FR 64957 - Joint Meeting of the Gastrointestinal Drugs Advisory Committee and the Drug Safety and Risk...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-30

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2013-N-0001] Joint Meeting of the Gastrointestinal Drugs Advisory Committee and the Drug Safety and Risk Management... Committee and the Drug Safety and Risk Management Advisory Committee. General Function of the Committees: To...

Using ecological production functions to link ecological processes to ecosystem services.

EPA Science Inventory

Ecological production functions (EPFs) link ecosystems, stressors, and management actions to ecosystem services (ES) production. Although EPFs are acknowledged as being essential to improve environmental management, their use in ecological risk assessment has received relatively ...

[Radiotherapy quality and risk manager role optimization in 2017].

PubMed

Ponsard, N; Brusadin, G; Schick, U

2017-10-01

The quality and risk manager works in a regulated framework, which delimits its missions. Nevertheless, the variety among the centers generates heterogeneous situations regarding the positioning and the range of action. A well-defined framework is needed in order to ratify the legitimacy and the recognition of quality and risk manager's main function. Copyright © 2017 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

The role of exercise in the management of rheumatoid arthritis.

PubMed

Metsios, George S; Stavropoulos-Kalinoglou, Antonis; Kitas, George D

2015-01-01

Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with significant functional impairment and increased risk for cardiovascular disease. Along with pharmacological therapy, exercise seems to be a very promising intervention to improve disease-related outcomes, including functional ability and systemic manifestations, such as the increased cardiovascular risk. In this review, we discuss the physiological mechanisms by which exercise improves inflammation, cardiovascular risk and psychological health in patients with rheumatoid arthritis (RA) and describe in detail how exercise can be incorporated in the management of this disease using real examples from our clinical practice.

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

PubMed

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

2000-07-01

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

Reducing Risk for the Next Generation Nuclear Plant

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

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

2010-07-01

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

Principles of disease management in neonatology.

PubMed

Bowen, F W; Gwiazdowski, S

1998-06-01

This article emphasizes the emerging facets of disease-management practice that impact directly on establishing a measured care system that can produce the information needed to establish a continuous quality improvement program. The areas discussed are risk assessment, clinical management guidelines and carepaths, and the measurement of system output known as clinical outcomes. The remainder of the article details the aspects of risk assessment, guideline function, and outcome assessment, critical in a disease-managed measured care system.

A Risk Radar driven by Internet of intelligences serving for emergency management in community.

PubMed

Huang, Chongfu; Wu, Tong; Renn, Ortwin

2016-07-01

Today, most of the commercial risk radars only have the function to show risks, as same as a set of risk matrixes. In this paper, we develop the Internet of intelligences (IOI) to drive a risk radar monitoring dynamic risks for emergency management in community. An IOI scans risks in a community by 4 stages: collecting information and experience about risks; evaluating risk incidents; verifying; and showing risks. Employing the information diffusion method, we optimized to deal with the effective information for calculating risk value. Also, a specific case demonstrates the reliability and practicability of risk radar. Copyright © 2016 Elsevier Inc. All rights reserved.

78 FR 33876 - Self-Regulatory Organizations; The Depository Trust Company; Notice of Filing of Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-05

... functionalities allow receiving DTC participants (``Participants'') to exercise control over which transactions to... without regard to risk management controls, the Participant that initiated the original delivery versus... Participant and to the Corporation.\\5\\ \\5\\ DTC's risk management controls, including Collateral Monitor and...

[Crisis management in pediatric anesthesia].

PubMed

Takeuchi, Mamoru; Otsuka, Yoji; Taga, Naoyuki; Sato, Yuki; Iwai, Hidetaka; Okada, Osamu

2009-05-01

We describe the risk management of pediatric anesthesia. The most important risk management of pediatric anesthesia is airway and temperature management. Neonates and infants easily become hypoxic due to their insufficient functional residual capacity. Therefore airway management is most important not only during induction of anesthesia but also during maintenance of anesthesia and extubation. The management of patients' temperature, including control of room temperature should be taken into consideration. In addition, careful attention should be paid not to introduce air bubbles in any lines, especially in patients with congenital heart diseases.

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

PubMed

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

2014-05-01

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

Ecosystem Risk Assessment Using the Comprehensive Assessment of Risk to Ecosystems (CARE) Tool

NASA Astrophysics Data System (ADS)

Battista, W.; Fujita, R.; Karr, K.

2016-12-01

Effective Ecosystem Based Management requires a localized understanding of the health and functioning of a given system as well as of the various factors that may threaten the ongoing ability of the system to support the provision of valued services. Several risk assessment models are available that can provide a scientific basis for understanding these factors and for guiding management action, but these models focus mainly on single species and evaluate only the impacts of fishing in detail. We have developed a new ecosystem risk assessment model - the Comprehensive Assessment of Risk to Ecosystems (CARE) - that allows analysts to consider the cumulative impact of multiple threats, interactions among multiple threats that may result in synergistic or antagonistic impacts, and the impacts of a suite of threats on whole-ecosystem productivity and functioning, as well as on specific ecosystem services. The CARE model was designed to be completed in as little as two hours, and uses local and expert knowledge where data are lacking. The CARE tool can be used to evaluate risks facing a single site; to compare multiple sites for the suitability or necessity of different management options; or to evaluate the effects of a proposed management action aimed at reducing one or more risks. This analysis can help users identify which threats are the most important at a given site, and therefore where limited management resources should be targeted. CARE can be applied to virtually any system, and can be modified as knowledge is gained or to better match different site characteristics. CARE builds on previous ecosystem risk assessment tools to provide a comprehensive assessment of fishing and non-fishing threats that can be used to inform environmental management decisions across a broad range of systems.

Ecosystem Risk Assessment Using the Comprehensive Assessment of Risk to Ecosystems (CARE) Tool

NASA Astrophysics Data System (ADS)

Battista, W.; Fujita, R.; Karr, K.

2016-02-01

Effective Ecosystem Based Management requires a localized understanding of the health and functioning of a given system as well as of the various factors that may threaten the ongoing ability of the system to support the provision of valued services. Several risk assessment models are available that can provide a scientific basis for understanding these factors and for guiding management action, but these models focus mainly on single species and evaluate only the impacts of fishing in detail. We have developed a new ecosystem risk assessment model - the Comprehensive Assessment of Risk to Ecosystems (CARE) - that allows analysts to consider the cumulative impact of multiple threats, interactions among multiple threats that may result in synergistic or antagonistic impacts, and the impacts of a suite of threats on whole-ecosystem productivity and functioning, as well as on specific ecosystem services. The CARE model was designed to be completed in as little as two hours, and uses local and expert knowledge where data are lacking. The CARE tool can be used to evaluate risks facing a single site; to compare multiple sites for the suitability or necessity of different management options; or to evaluate the effects of a proposed management action aimed at reducing one or more risks. This analysis can help users identify which threats are the most important at a given site, and therefore where limited management resources should be targeted. CARE can be applied to virtually any system, and can be modified as knowledge is gained or to better match different site characteristics. CARE builds on previous ecosystem risk assessment tools to provide a comprehensive assessment of fishing and non-fishing threats that can be used to inform environmental management decisions across a broad range of systems.

Pharmacological Management of Cardiorenal Syndromes

PubMed Central

House, Andrew A.; Haapio, Mikko; Lassus, Johan; Bellomo, Rinaldo; Ronco, Claudio

2011-01-01

Cardiorenal syndromes are disorders of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other. The pharmacological management of Cardiorenal syndromes may be complicated by unanticipated or unintended effects of agents targeting one organ on the other. Hence, a thorough understanding of the pathophysiology of these disorders is paramount. The treatment of cardiovascular diseases and risk factors may affect renal function and modify the progression of renal injury. Likewise, management of renal disease and associated complications can influence heart function or influence cardiovascular risk. In this paper, an overview of pharmacological management of acute and chronic Cardiorenal Syndromes is presented, and the need for high-quality future studies in this field is highlighted. PMID:21660311

A risk-factor analysis of medical litigation judgments related to fall injuries in Korea.

PubMed

Kim, Insook; Won, Seonae; Lee, Mijin; Lee, Won

2018-01-01

The aim of this study was to find out the risk factors through analysis of seven medical malpractice judgments related to fall injuries. The risk factors were analysed by using the framework that approaches falls from a systems perspective and comprised people, organisational or environmental factors, with each factor being comprised of subfactors. The risk factors found in each of the seven judgments were aggregated into one framework. The risk factors related to patients (i.e. the people factor) were age, pain, related disease, activities and functional status, urination state, cognitive function impairment, past history of fall, blood transfusion, sleep endoscopy state and uncooperative attitude. The risk factors related to the medical staff and caregivers (i.e. people factor) were observation negligence, no fall prevention activities and negligence in managing high-risk group for fall. Organisational risk factors were a lack of workforce, a lack of training, neglecting the management of the high-risk group, neglecting the management of caregivers and the absence of a fall prevention procedure. Regarding the environment, the risk factors were found to be the emergency room, chairs without a backrest and the examination table. Identifying risk factors is essential for preventing fall accidents, since falls are preventable patient-safety incidents. Falls do not happen as a result of a single risk factor. Therefore, a systems approach is effective to identify risk factors, especially organisational and environmental factors.

75 FR 32189 - Joint Meeting of the Endocrinologic and Metabolic Drugs Advisory Committee and the Drug Safety...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-07

... Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee. General Function of...] Joint Meeting of the Endocrinologic and Metabolic Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice...

78 FR 22270 - Joint Meeting of the Endocrinologic and Metabolic Drugs Advisory Committee and the Drug Safety...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-15

... Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee. General Function of...] Joint Meeting of the Endocrinologic and Metabolic Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice...

Intensive case management for high-risk patients with first-episode psychosis: service model and outcomes.

PubMed

Brewer, Warrick J; Lambert, Timothy J; Witt, Katrina; Dileo, John; Duff, Cameron; Crlenjak, Carol; McGorry, Patrick D; Murphy, Brendan P

2015-01-01

The first episode of psychosis is a crucial period when early intervention can alter the trajectory of the young person's ongoing mental health and general functioning. After an investigation into completed suicides in the Early Psychosis Prevention and Intervention Centre (EPPIC) programme, the intensive case management subprogramme was developed in 2003 to provide assertive outreach to young people having a first episode of psychosis who are at high risk owing to risk to self or others, disengagement, or suboptimal recovery. We report intensive case management model development, characterise the target cohort, and report on outcomes compared with EPPIC treatment as usual. Inclusion criteria, staff support, referral pathways, clinical review processes, models of engagement and care, and risk management protocols are described. We compared 120 consecutive referrals with 50 EPPIC treatment as usual patients (age 15-24 years) in a naturalistic stratified quasi-experimental real-world design. Key performance indicators of service use plus engagement and suicide attempts were compared between EPPIC treatment as usual and intensive case management, and psychosocial and clinical measures were compared between intensive case management referral and discharge. Referrals were predominately unemployed males with low levels of functioning and educational attainment. They were characterised by a family history of mental illness, migration and early separation, with substantial trauma, history of violence, and forensic attention. Intensive case management improved psychopathology and psychosocial outcomes in high-risk patients and reduced risk ratings, admissions, bed days, and crisis contacts. Characterisation of intensive case management patients validated the clinical research focus and identified a first episode of psychosis high-risk subgroup. In a real-world study, implementation of an intensive case management stream within a well-established first episode of psychosis service showed significant improvement in key service outcomes. Further analysis is needed to determine cost savings and effects on psychosocial outcomes. Targeting intensive case management services to high-risk patients with unmet needs should reduce the distress associated with pathways to care for patients, their families, and the community. National Health & Medical Research Council and the Colonial Foundation. Copyright © 2015 Elsevier Ltd. All rights reserved.

A Functional Model of Quality Assurance for Psychiatric Hospitals and Corresponding Staffing Requirements.

ERIC Educational Resources Information Center

Kamis-Gould, Edna; And Others

1991-01-01

A model for quality assurance (QA) in psychiatric hospitals is described. Its functions (general QA, utilization review, clinical records, evaluation, management information systems, risk management, and infection control), subfunctions, and corresponding staffing requirements are reviewed. This model was designed to foster standardization in QA…

A model study of the Haihe river passenger ferry risk based on AHP

NASA Astrophysics Data System (ADS)

Du, Jinyin; Xu, Yanming; Du, Chunzhi; Jin, Zhenhua

2017-05-01

The core function of maritime is water safety supervision, whose emphasis and difficulty is ferry. In combination with the practical situation of Haihe river passenger ferry operation management, this paper analyzes Haihe river passenger ferry risk from four aspects "human, machinery, environment and management", and establishes the ferry risk index system. By using AHP (Analytic Hierarchy Process), the ferry risk evaluation model is established. By using the ferry model, the application of Ferry Zhengyanfa7 in Tianjin Haihe river crossing is evaluated, whose safety situation is verified to be between "relatively high risk" and "high risk".

75 FR 12767 - Joint Meeting of the Anesthetic and Life Support Drugs Advisory Committee and the Drug Safety and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-17

... Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee. General Function of...] Joint Meeting of the Anesthetic and Life Support Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice...

78 FR 2677 - Joint Meeting of the Advisory Committee for Reproductive Health Drugs and the Drug Safety and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-14

... Reproductive Health Drugs and the Drug Safety and Risk Management Advisory Committee. General Function of the...] Joint Meeting of the Advisory Committee for Reproductive Health Drugs and the Drug Safety and Risk Management Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice...

76 FR 59143 - Joint Meeting of the Advisory Committee for Reproductive Health Drugs and the Drug Safety and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-23

... Reproductive Health Drugs and the Drug Safety and Risk Management Advisory Committee. General Function of the...] Joint Meeting of the Advisory Committee for Reproductive Health Drugs and the Drug Safety and Risk Management Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice...

76 FR 59142 - Joint Meeting of the Advisory Committee for Reproductive Health Drugs and the Drug Safety and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-23

... Reproductive Health Drugs and the Drug Safety and Risk Management Advisory Committee. General Function of the...] Joint Meeting of the Advisory Committee for Reproductive Health Drugs and the Drug Safety and Risk Management Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice...

78 FR 16271 - Joint Meeting of the Advisory Committee for Reproductive Health Drugs and the Drug Safety and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-14

... Reproductive Health Drugs and the Drug Safety and Risk Management Advisory Committee. General Function of the...] Joint Meeting of the Advisory Committee for Reproductive Health Drugs and the Drug Safety and Risk Management Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice...

75 FR 32188 - Joint Meeting of the Anesthetic and Life Support Drugs Advisory Committee and the Drug Safety and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-07

... Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee. General Function of...] Joint Meeting of the Anesthetic and Life Support Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice...

75 FR 59730 - Joint Meeting of the Anesthetic and Life Support Drugs Advisory Committee and the Drug Safety and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-28

... Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee. General Function of...] Joint Meeting of the Anesthetic and Life Support Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee; Notice of Meeting AGENCY: Food and Drug Administration, HHS. ACTION: Notice...

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

PubMed

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

2008-01-01

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

Management mechanisms for development of personnel professional competencies at a loading and haulage company

NASA Astrophysics Data System (ADS)

Shishkina, S. V.; Pristupa, Yu D.; Pavlova, L. D.; Fryanov, V. N.

2018-05-01

The necessity for development a management mechanism for development of personnel professional competencies at a loading and haulage company in order to ensuring the compliance of competencies with labor functions, regulated by the current professional standards, is substantiated. A functional diagram of the organizational and technical system of the loading and haulage company was developed, that includes the interaction mechanism between the personnel and the objects of the main production. The problem of algorithm development to assess the correspondence of communicative competencies and labor functions of loading and haulage companies, ensuring the achievement of the management goal with a minimum risk of an emergency situation or an accident, was set and solved. The idea of management problem solving consists in the operational development and implementation of anticipatory measures at each deviation in personnel actions from normative or target indicators. The dependence of the risk of imbalance of communicative competences and labor functions in a given period of time is established. The effectiveness of the developed and implemented mechanism is confirmed by the positive dynamics of the test results.

Risk Perception as the Quantitative Parameter of Ethics and Responsibility in Disaster Study

NASA Astrophysics Data System (ADS)

Kostyuchenko, Yuriy; Movchan, Dmytro

2014-05-01

Intensity of impacts of natural disasters is increasing with climate and ecological changes spread. Frequency of disasters is increasing, and recurrence of catastrophes characterizing by essential spatial heterogeneity. Distribution of losses is fundamentally non-linear and reflects complex interrelation of natural, social and environmental factor in the changing world on multi scale range. We faced with new types of risks, which require a comprehensive security concept. Modern understanding of complex security, and complex risk management require analysis of all natural and social phenomena, involvement of all available data, constructing of advanced analytical tools, and transformation of our perception of risk and security issues. Traditional deterministic models used for risk analysis are difficult applicable for analysis of social issues, as well as for analysis of multi scale multi-physics phenomena quantification. Also parametric methods are not absolutely effective because the system analyzed is essentially non-ergodic. The stochastic models of risk analysis are applicable for quantitative analysis of human behavior and risk perception. In framework of risk analysis models the risk perception issues were described. Risk is presented as the superposition of distribution (f(x,y)) and damage functions (p(x,y)): P →δΣ x,yf(x,y)p(x,y). As it was shown risk perception essentially influents to the damage function. Basing on the prospect theory and decision making under uncertainty on cognitive bias and handling of risk, modification of damage function is proposed: p(x,y|α(t)). Modified damage function includes an awareness function α(t), which is the system of risk perception function (rp) and function of education and log-term experience (c) as: α(t) → (c - rp). Education function c(t) describes the trend of education and experience. Risk perception function rp reflects security concept of human behavior, is the basis for prediction of socio-economic and socio-ecological processes. Also there is important positive feedback of risk perception function to distribution function. Risk perception is essentially depends of short-term recent events impact in multi agent media. This is managed function. The generalized view of awareness function is proposed: α(t) = δΣ ic - rpi. Using this form separate parameters has been calculated. For example, risk perception function is about 15-55% of awareness function depends of education, age and social status of people. Also it was estimated that fraction of awareness function in damage function, and so in function of risk is about 15-20%. It means that no less than 8-12% of direct losses depend of short-term responsible behavior of 'information agents': social activity of experts, scientists, correct discussions on ethical issues in geo-sciences and media. Other 6-9% of losses are connected with level of public and professional education. This area is also should be field of responsibility of geo-scientists.

Integrated frameworks for assessing and managing health risks in the context of managed aquifer recharge with river water.

PubMed

Assmuth, Timo; Simola, Antti; Pitkänen, Tarja; Lyytimäki, Jari; Huttula, Timo

2016-01-01

Integrated assessment and management of water resources for the supply of potable water is increasingly important in light of projected water scarcity in many parts of the world. This article develops frameworks for regional-level waterborne human health risk assessment of chemical and microbiological contamination to aid water management, incorporating economic aspects of health risks. Managed aquifer recharge with surface water from a river in Southern Finland is used as an illustrative case. With a starting point in watershed governance, stakeholder concerns, and value-at-risk concepts, we merge common methods for integrative health risk analysis of contaminants to describe risks and impacts dynamically and broadly. This involves structuring analyses along the risk chain: sources-releases-environmental transport and fate-exposures-health effects-socio-economic impacts-management responses. Risks attributed to contaminants are embedded in other risks, such as contaminants from other sources, and related to benefits from improved water quality. A set of models along this risk chain in the case is presented. Fundamental issues in the assessment are identified, including 1) framing of risks, scenarios, and choices; 2) interaction of models and empirical information; 3) time dimension; 4) distributions of risks and benefits; and 5) uncertainties about risks and controls. We find that all these combine objective and subjective aspects, and involve value judgments and policy choices. We conclude with proposals for overcoming conceptual and functional divides and lock-ins to improve modeling, assessment, and management of complex water supply schemes, especially by reflective solution-oriented interdisciplinary and multi-actor deliberation. © 2015 SETAC.

Utilising Enterprise Risk Management Strategies to Develop a Governance and Operations Framework for a New Research Complex: A Case Study

ERIC Educational Resources Information Center

Clyde-Smith, Jodi

2014-01-01

Enterprise risk management strategies were used to develop a regulatory and operational framework for a new multi-partner Research Institute that will house up to 900 staff from four different institutions in Queensland, Australia. The Institute will operate in a business environment while functioning as a research resource for the higher…

Gestational trophoblastic disease.

PubMed

Soper, John T

2006-07-01

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

Technical Elements, Demonstration Projects, and Fiscal Models in Medicaid Managed Care for People with Developmental Disabilities.

ERIC Educational Resources Information Center

Kastner, Theodore A.; Walsh, Kevin K.; Criscione, Teri

1997-01-01

Presents a general model of the structure and functioning of managed care and describes elements (provider networks, fiscal elements, risk estimation, case-mix, management information systems, practice parameters, and quality improvement) critical to people with developmental disabilities. Managed care demonstration projects and a hypothetical…

Prophylactic Management of Contrast-Induced Acute Kidney Injury in High-Risk Patients.

PubMed

Nahar, Diya

2017-01-01

Contrast-induced acute kidney injury (CI-AKI) has been linked to morbidity and mortality, especially in high-risk patients whose kidney function is compromised. Recently, many studies have been conducted to search for more novel, preventative methods of decreasing CI-AKI. Through a detailed analysis of recent studies, this article discusses recommendations for hydration, N-acetylcysteine, and statin therapy in relation to the prophylactic management of CI-AKI in high-risk patients. Copyright© by the American Nephrology Nurses Association.

Designing Flood Management Systems for Joint Economic and Ecological Robustness

NASA Astrophysics Data System (ADS)

Spence, C. M.; Grantham, T.; Brown, C. M.; Poff, N. L.

2015-12-01

Freshwater ecosystems across the United States are threatened by hydrologic change caused by water management operations and non-stationary climate trends. Nonstationary hydrology also threatens flood management systems' performance. Ecosystem managers and flood risk managers need tools to design systems that achieve flood risk reduction objectives while sustaining ecosystem functions and services in an uncertain hydrologic future. Robust optimization is used in water resources engineering to guide system design under climate change uncertainty. Using principles introduced by Eco-Engineering Decision Scaling (EEDS), we extend robust optimization techniques to design flood management systems that meet both economic and ecological goals simultaneously across a broad range of future climate conditions. We use three alternative robustness indices to identify flood risk management solutions that preserve critical ecosystem functions in a case study from the Iowa River, where recent severe flooding has tested the limits of the existing flood management system. We seek design modifications to the system that both reduce expected cost of flood damage while increasing ecologically beneficial inundation of riparian floodplains across a wide range of plausible climate futures. The first robustness index measures robustness as the fraction of potential climate scenarios in which both engineering and ecological performance goals are met, implicitly weighting each climate scenario equally. The second index builds on the first by using climate projections to weight each climate scenario, prioritizing acceptable performance in climate scenarios most consistent with climate projections. The last index measures robustness as mean performance across all climate scenarios, but penalizes scenarios with worse performance than average, rewarding consistency. Results stemming from alternate robustness indices reflect implicit assumptions about attitudes toward risk and reveal the tradeoffs between using structural and non-structural flood management strategies to ensure economic and ecological robustness.

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

NASA Astrophysics Data System (ADS)

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

2010-05-01

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

Risky Business

NASA Technical Reports Server (NTRS)

Yarbrough, Katherine

2015-01-01

During my internship I worked on two major projects, recommending improvements for the Center's Risk Management Workshop and helping with the strategic planning efforts for Safety and Mission Assurance (S&MA). The risk management improvements is the key project I worked on this semester through my internship, while the strategic planning is the secondary assignment. S&MA Business Office covers both aspects in its delegation, getting both spans some of the work done in the office. A risk is a future event with a negative consequence that has some probability of occurring. Safety and Mission Assurance identifies, analyzes, plans, and tracks risk. The directorate offers the Center a Risk Management Workshop, and part of the ongoing efforts of S&MA is to make continuous improvements to the RM Workshop. By using the Project Management Institute's (PMI) Standard for Risk Management, I performed a gap analysis to make improvements for our materials. I benchmarked the PMI's Risk Management Standard, compared our Risk Management Workshop materials to PMI's standard, and identified any gaps in our material. My major findings were presented to the Business Office of S&MA for a decision on whether or not to incorporate the improvements. These suggestions were made by attending JSC working group meetings, Health, Safety and Environment (HSE) panel reviews and various risk review meetings. The improvements provide better understanding of risk management processes and enhanced risk tracking knowledge and skills. Risk management is an integral part of any engineering discipline, getting exposed to this section of engineering will greatly help shape my career in the future. Johnson Space Center is a world leader in risk management processes; learning risk management here gives me a huge advantage over my peers, as well as understanding decision making in the context of risk management will help me to be a well-rounded engineer. Strategic planning is an area I had not previously studied. Helping with the strategic planning efforts in S&MA has taught me how organizations think and function as a whole. S&MA is adopting a balanced scorecard approach to strategic planning. As part of this planning method strategic themes, objectives, and initiatives are formed. I attended strategic theme team workshops that formed the strategy map for the directorate and gave shape to the plan. Also during these workshops the objectives were discussed and built. Learning the process for strategic planning has helped me better understand how organizations and businesses function, which also helps me to be a more effective employee. Other assignments I had during my internship included completing the Safety and Mission Assurance Technical Excellent Program (STEP) Level 1, as well as doing a two week rotation through the Space Exploration division in S&MA, specifically working with a thermal protection systems (TPS) engineer. While working there, I learned about the Orion capsule and the SpaceX Dragon cargo capsule. I attended meetings to prepare the engineers for the upcoming Critical Design Reviews for both capsules and reviewed test data. Learning risk management, strategic planning, and working in the Space Exploration division has taught me about many aspects of S&MA. My internship at NASA has given me new experiences and taught me numerous subjects that I would have otherwise not learned. This opportunity has expanded my educational horizons and is helping me to become a more useful engineer and employee.

Risk transfer and accountability in managed care organizations' carve-out contracts.

PubMed

Garnick, D W; Horgan, C M; Hodgkin, D; Merrick, E L; Goldin, D; Ritter, G; Skwara, K C

2001-11-01

This study examined characteristics of contracts between managed care organizations (MCOs) and managed behavioral health organizations (MBHOs) in terms of delegation of functions, financial arrangements between the MCO and the MBHO, and the use of performance standards. Nationally representative administrative and clinical information about the three largest types of commercial products offered by 434 MCOs in 60 market areas was gathered by telephone survey. These products comprised services provided by health maintenance organizations, preferred provider organizations, and point-of-service plans. Chi square tests were performed between pairings of all three types of products to ascertain differences in the degree to which claims processing, maintenance of provider networks, utilization management, case management, and quality improvement were delegated to MBHOs through specialty contracts among the various types of products. Contractual specifications about capitation arrangements, risk sharing, the use of performance standards, and final utilization review decisions were also compared. For all types of products, almost all the major functions were contracted by the MCO to the MBHO. Although most contracts assigned some risk for the costs of services to the MBHO, the degree of this risk varied by product type. Except in the case of preferred-provider organizations, a large number of performance standards were identified in MCOs' contracts with MBHOs, although financial incentives were rarely tied to such standards. MCOs that contract with MBHOs place major responsibility, both financial and administrative, on the vendors.

Framework conditions and requirements to ensure the technical functional safety of reprocessed medical devices.

PubMed

Kraft, Marc

2008-09-03

Testing and restoring technical-functional safety is an essential part of medical device reprocessing. Technical functional tests have to be carried out on the medical device in the course of the validation of reprocessing procedures. These ensure (in addition to the hygiene tests) that the reprocessing procedure is suitable for the medical device. Functional tests are, however, also a part of reprocessing procedures. As a stage in the reprocessing, they ensure for the individual medical device that no damage or other changes limit the performance. When determining which technical-functional tests are to be carried out, the current technological standard has to be taken into account in the form of product-specific and process-oriented norms. Product-specific norms primarily define safety-relevant requirements. The risk management method described in DIN EN ISO 14971 is the basis for recognising hazards; the likelihood of such hazards arising can be minimised through additional technical-functional tests, which may not yet have been standardised. Risk management is part of a quality management system, which must be bindingly certified for manufacturers and processors of critical medical devices with particularly high processing demands by a body accredited by the competent authority.

Framework conditions and requirements to ensure the technical functional safety of reprocessed medical devices

PubMed Central

Kraft, Marc

2008-01-01

Testing and restoring technical-functional safety is an essential part of medical device reprocessing. Technical functional tests have to be carried out on the medical device in the course of the validation of reprocessing procedures. These ensure (in addition to the hygiene tests) that the reprocessing procedure is suitable for the medical device. Functional tests are, however, also a part of reprocessing procedures. As a stage in the reprocessing, they ensure for the individual medical device that no damage or other changes limit the performance. When determining which technical-functional tests are to be carried out, the current technological standard has to be taken into account in the form of product-specific and process-oriented norms. Product-specific norms primarily define safety-relevant requirements. The risk management method described in DIN EN ISO 14971 is the basis for recognising hazards; the likelihood of such hazards arising can be minimised through additional technical-functional tests, which may not yet have been standardised. Risk management is part of a quality management system, which must be bindingly certified for manufacturers and processors of critical medical devices with particularly high processing demands by a body accredited by the competent authority. PMID:20204095

Toward a Responsibility-Catering Prioritarian Ethical Theory of Risk.

PubMed

Wikman-Svahn, Per; Lindblom, Lars

2018-03-05

Standard tools used in societal risk management such as probabilistic risk analysis or cost-benefit analysis typically define risks in terms of only probabilities and consequences and assume a utilitarian approach to ethics that aims to maximize expected utility. The philosopher Carl F. Cranor has argued against this view by devising a list of plausible aspects of the acceptability of risks that points towards a non-consequentialist ethical theory of societal risk management. This paper revisits Cranor's list to argue that the alternative ethical theory responsibility-catering prioritarianism can accommodate the aspects identified by Cranor and that the elements in the list can be used to inform the details of how to view risks within this theory. An approach towards operationalizing the theory is proposed based on a prioritarian social welfare function that operates on responsibility-adjusted utilities. A responsibility-catering prioritarian ethical approach towards managing risks is a promising alternative to standard tools such as cost-benefit analysis.

Fall risk and function in older women after gynecologic surgery.

PubMed

Miller, Karen L; Richter, Holly E; Graybill, Charles S; Neumayer, Leigh A

2017-11-01

To examine change in balance-related fall risk and daily functional abilities in the first 2 post-operative weeks and up to 6 weeks after gynecologic surgery. Prospective cohort study in gynecologic surgery patients age 65 and older. Balance confidence (Activities-specific Balance Confidence Scale) and functional status (basic and instrumental activities of daily living) were recorded pre- and post-operatively daily for 1 week and twice the second week. Physical performance balance and functional mobility were measured pre- and 1 week post-operatively using the Tinetti Fall Risk Scale, Timed Up and Go, and 6-Minute Walk test. Measures were repeated 6 weeks after surgery. Non-parametric tests for paired data were used comparing scores baseline to post-operative (POD) 7 and to POD 42. Median age was 72 years (range 65-88). Fall risk was elevated during the first 2 post-operative weeks, greatest on the median discharge day, POD 2 (p<0.01). Balance performance and functional mobility at 1 week were significantly lower than baseline (p<0.01). Functional abilities declined, including new dependence in medication management at home in 22% of these independent and cognitively intact women. After gynecologic surgery, older women's fall risk is highest on POD 2 and remains elevated from baseline for 2 weeks. Functional limitations in the early home recovery period include the anticipated (bathing, cooking, etc.) and some unanticipated (medication management) ones. This information may help with post-operative discharge planning. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

Implementation of infants risk detection sensing system using IoT

NASA Astrophysics Data System (ADS)

Yang, Youseok; Lee, Taeo; Lee, Yechan; Choi, Jaehyeon; Park, Eunju; Lim, Hankyu

2017-06-01

Infants are vulnerable to surrounding environment and they receive large influence from even a small change. As their body composition is not complete yet, infants receive huge impact from small pressure. Small change can cause disease or even death of infants. This paper designed and implemented a risk-detection system for infants. In addition to the fundamental function of safety management system, the risk-detection system implemented in this paper in corporate child-caring function by using a variety of sensors.

Towards integrative risk management and more resilient societies

NASA Astrophysics Data System (ADS)

Al-Khudhairy, D.; Axhausen, K.; Bishop, S.; Herrmann, H.; Hu, B.; Kröger, W.; Lewis, T.; MacIntosh, J.; Nowak, A.; Pickl, S.; Stauffacher, D.; Tan, E.

2012-11-01

Society depends decisively on the availability of infrastructure systems such as energy, telecommunication, transportation, banking and finance, health care and governmental and public administration. Even selective damages of one of these infrastructures may result in disruptions of governmental, industrial or public functions. Vulnerability of infrastructures therefore provides spectacular leverage for natural disasters as well as criminal and terrorist actions. Threats and risks are part of the technological, economical, and societal development. This article focuses on the development and characterization of an integrative risk-management which, from the perspective of "resilient systems", can be seen as an innovative and pro-active crisis management approach dealing with the increasing amount of complexity in societies in a comprehensive, agile and adaptive way.

Prototype development of a web-based participative decision support platform in risk management

NASA Astrophysics Data System (ADS)

Aye, Zar Chi; Olyazadeh, Roya; Jaboyedoff, Michel; Derron, Marc-Henri

2014-05-01

This paper discusses the proposed background architecture and prototype development of an internet-based decision support system (DSS) in the field of natural hazards and risk management using open-source geospatial software and web technologies. It is based on a three-tier, client-server architecture with the support of boundless (opengeo) framework and its client side SDK application environment using customized gxp components and data utility classes. The main purpose of the system is to integrate the workflow of risk management systematically with the diverse involvement of stakeholders from different organizations dealing with natural hazards and risk for evaluation of management measures through the active online participation approach. It aims to develop an adaptive user friendly, web-based environment that allows the users to set up risk management strategies based on actual context and data by integrating web-GIS and DSS functionality associated with process flow and other visualization tools. Web-GIS interface has been integrated within the DSS to deliver maps and provide certain geo-processing capabilities on the web, which can be easily accessible and shared by different organizations located in case study sites of the project. This platform could be envisaged not only as a common web-based platform for the centralized sharing of data such as hazard maps, elements at risk maps and additional information but also to ensure an integrated platform of risk management where the users could upload data, analyze risk and identify possible alternative scenarios for risk reduction especially for floods and landslides, either quantitatively or qualitatively depending on the risk information provided by the stakeholders in case study regions. The level of involvement, access to and interaction with the provided functionality of the system varies depending on the roles and responsibilities of the stakeholders, for example, only the experts (planners, geological services, etc.) can have access to the alternative definition component to formulate the risk reduction measures. The development of such a participative platform would finally lead to an integrated risk management approach highlighting the needs to deal with involved experts and civil society in the decision-making process for evaluation of risk management measures through the active participation approach. The system will be applied and evaluated in four case study areas of the CHANGES project in Europe: Romania, North Eastern Italy, French Alps and Poland. However, the framework of the system is designed in a generic way so as to be applicable in other regions to achieve the high adaptability and flexibility of the system. The research has been undertaken as a part of the CHANGES project funded by the European Commission's 7th framework program.

Does nurse-based case management for aged myocardial infarction patients improve risk factors, physical functioning and mental health? The KORINNA trial.

PubMed

Hunger, Matthias; Kirchberger, Inge; Holle, Rolf; Seidl, Hildegard; Kuch, Bernhard; Wende, Rupert; Meisinger, Christine

2015-04-01

Older patients with acute myocardial infarction (MI) are often lacking optimal support to continue rehabilitation after discharge from hospital. The objective of the study was to examine whether a home-based case management programme led by nurses can improve atherogenic risk factors, physical functioning, and mental health in the first year following discharge. The KORINNA study is a randomized two-armed parallel group trial including 329 patients (aged 65-92 years) from the Augsburg Hospital in southern Germany. The intervention consisted of an individualized follow-up programme with a duration of 1 year, including home visits and telephone calls. The control group received usual care. Secondary outcome measures included clinical parameters (blood pressure, lipid parameters), functional status measures, cognitive status, depressive symptoms, and nutrition risk. At 1-year follow up, patients in the intervention group (n = 116) had significantly better low-density lipoprotein cholesterol levels (-8.4 mg/dl, 95% CI -16.4 to -0.4), hand grip strength (+2.53 kg, 95% CI 0.56 to 4.50), and SCREEN-II nutrition risk scores (+2.03, 95% CI 0.58 to 3.48) than patients in the control group (n = 136). The intervention group also had better mean scores with regard to self-reported disability, activities in daily living, and mental health, but differences were not always significant and meaningful. The results of the KORINNA study indicate that nurse-based case management can improve blood lipid levels, functional status, and nutrition risk of aged patients with MI. © The European Society of Cardiology 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Effects of a 3-year nurse-based case management in aged patients with acute myocardial infarction on rehospitalisation, mortality, risk factors, physical functioning and mental health. a secondary analysis of the randomized controlled KORINNA study.

PubMed

Kirchberger, Inge; Hunger, Matthias; Stollenwerk, Björn; Seidl, Hildegard; Burkhardt, Katrin; Kuch, Bernhard; Meisinger, Christa; Holle, Rolf

2015-01-01

Home-based secondary prevention programs led by nurses have been proposed to facilitate patients' adjustment to acute myocardial infarction (AMI). The objective of this study was to conduct secondary analyses of the three-year follow-up of a nurse-based case management for elderly patients discharged from hospital after an AMI. In a single-centre randomized two-armed parallel group trial of hospitalized patients with AMI ≥65 years, patients hospitalized between September 2008 and May 2010 in the Hospital of Augsburg, Germany, were randomly assigned to case management or usual care. The case-management intervention consisted of a nurse-based follow-up for three years including home visits and telephone calls. Study endpoints were time to first unplanned readmission or death, clinical parameters, functional status, depressive symptoms and malnutrition risk. Persons who assessed three-year outcomes and validated readmission data were blinded. The intention-to-treat approach was applied to the statistical analyses which included Cox Proportional Hazards models. Three hundred forty patients were allocated to receive case-management (n = 168) or usual care (n = 172). During three years, in the intervention group there were 80 first unplanned readmissions and 6 deaths, while the control group had 111first unplanned readmissions and 3 deaths. The intervention did not significantly affect time to first unplanned readmission or death (Hazard Ratio 0.89, 95% confidence interval (CI) 0.67-1.19; p = 0.439), blood pressure, cholesterol level, instrumental activities of daily life (IADL) (only for men), and depressive symptoms. However, patients in the intervention group had a significantly better functional status, as assessed by the HAQ Disability Index, IADL (only for women), and hand grip strength, and better SCREEN-II malnutrition risk scores than patients in the control group. A nurse-based management among elderly patients with AMI did not significantly affect time to unplanned readmissions or death during a three-year follow-up. However, the results indicate that functional status and malnutrition risk can be improved. Current Controlled Trials ISRCTN02893746.

[Risks and control of complete market-oriented reforms of medical institutions].

PubMed

Ding, Jiannong; Tian, Yongquan

2014-04-01

Marketization has become the mainstream since the new public management emerges globally in second half of the 20th century. Some countries infuse private capital into medical institutions which used to be managed by the government originally, and cause the medical industry reforms to be market-oriented. Market-oriented reforms of medical institutions may have risks in the following aspects: the risk of uneven distribution of medical resources, the risk of market failure, the moral risk of government renting-seeking and corruption and the decay of social justice values. Measures of controlling these risks include defining the function orientation of the government, completing the institution-building of healthcare system, improving primary medical system and strengthening social consciousness of hospitals.

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

PubMed

Dowdle, Walter R

2006-01-01

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

An inexact mixed risk-aversion two-stage stochastic programming model for water resources management under uncertainty.

PubMed

Li, W; Wang, B; Xie, Y L; Huang, G H; Liu, L

2015-02-01

Uncertainties exist in the water resources system, while traditional two-stage stochastic programming is risk-neutral and compares the random variables (e.g., total benefit) to identify the best decisions. To deal with the risk issues, a risk-aversion inexact two-stage stochastic programming model is developed for water resources management under uncertainty. The model was a hybrid methodology of interval-parameter programming, conditional value-at-risk measure, and a general two-stage stochastic programming framework. The method extends on the traditional two-stage stochastic programming method by enabling uncertainties presented as probability density functions and discrete intervals to be effectively incorporated within the optimization framework. It could not only provide information on the benefits of the allocation plan to the decision makers but also measure the extreme expected loss on the second-stage penalty cost. The developed model was applied to a hypothetical case of water resources management. Results showed that that could help managers generate feasible and balanced risk-aversion allocation plans, and analyze the trade-offs between system stability and economy.

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

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-06

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

Exercise and Sports Science Australia (ESSA) position statement on exercise prescription for the prevention and management of osteoporosis.

PubMed

Beck, Belinda R; Daly, Robin M; Singh, Maria A Fiatarone; Taaffe, Dennis R

2017-05-01

Osteoporotic fractures are associated with substantial morbidity and mortality. Although exercise has long been recommended for the prevention and management of osteoporosis, existing guidelines are often non-specific and do not account for individual differences in bone health, fracture risk and functional capacity. The aim of the current position statement is to provide health practitioners with specific, evidence-based guidelines for safe and effective exercise prescription for the prevention or management of osteoporosis, accommodating a range of potential comorbidities. Position statement. Interpretation and application of research reports describing the effects of exercise interventions for the prevention and management of low bone mass, osteoporosis and osteoporotic fracture. Evidence from animal and human trials indicates that bone responds positively to impact activities and high intensity progressive resistance training. Furthermore, the optimisation of muscle strength, balance and mobility minimises the risk of falls (and thereby fracture), which is particularly relevant for individuals with limited functional capacity and/or a very high risk of osteoporotic fracture. It is important that all exercise programs be accompanied by sufficient calcium and vitamin D, and address issues of comorbidity and safety. For example, loaded spine flexion is not recommended, and impact activities may require modification in the presence of osteoarthritis or frailty. Specific guidelines for safe and effective exercise for bone health are presented. Individual exercise prescription must take into account existing bone health status, co-morbidities, and functional or clinical risk factors for falls and fracture. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Risk management in inpatient units in the Czech Republic from the point of view of nurses in leadership positions.

PubMed

Prokešová, Radka; Brabcová, Iva; Pokojová, Radka; Bártlová, Sylva

2016-12-01

The goal of this study was to assess specific features of risk management from the point of view of nurses in leadership positions in inpatient units in Czech hospitals. The study was performed using a quantitative research strategy, i.e., a questionnaire. The data sample was analyzed using SPSS v. 23.0. Pearson's chi-square and analysis of adjusted residues were used for identifying the existence associations of nominal and/or ordinal quantities. 315 nurses in leadership positions working in inpatient units of Czech hospitals were included in the sample. The sample was created using random selection by means of quotas. Based on the study results, statistically significant relations between the respondents' education and the utilization of methods to identify risks were identified. Furthermore, statistically significant relationships were found between a nurse's functional role within the system and regular analysis and evaluation of risks and between the type of the healthcare facility and the degree of patient involvement in risk management. The study found statistically significant correlations that can be used to increase the effectiveness of risk management in inpatient units of Czech hospitals. From this perspective, the fact that patient involvement in risk management was only reported by 37.8% of respondents seems to be the most notable problem.

Risk management and lessons learned solutions for satellite product assurance

NASA Astrophysics Data System (ADS)

Larrère, Jean-Luc

2004-08-01

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

Risk Management in ETS-8 Project

NASA Astrophysics Data System (ADS)

Homma, M.

2002-01-01

Engineering Test Satellite - 8 (ETS-8) is the Japanese largest geo-synchronous satellite of 3 tons in mass, of which mission is mobile communications and navigation experiment. It is now in the flight model manufacturing phase. This paper introduces the risk management taken in this project as a reference. The mission success criteria of ETS-8 are described at first. All the risk management activities are planned taking these criteria into consideration. ETS-8 consists of many new technologies such as the large deployable antenna (19m x 17m), 64-bit MPU, 100 V solar paddle and so on. We have to pay attention to control these risk through each phase of development. In system design of ETS - 8, almost components have redundancy and there is some back-up function to avoid fatal failure. What kind of back-up function should be taken is one of the hot issues in this project. The consideration process is described as an actual case. In addition to conventional risk management procedure, FMEA and identification of the critical items so on, we conducted the validation experiment in space by use of a scale model that was launched on Ariane 5. The decision to conduct this kind of experiment is taken after evaluation between risk and cost, because it takes a lot of resources of project. The effect of this experiment is also presented. Failure detection, isolation and reconfiguration in the flight software are more important as the satellite system becomes large and complicated. We did the independent verification and validation to the software. Some remarks are noted with respect to its effectiveness.

Revised ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. Implications for preoperative clinical evaluation.

PubMed

Guarracino, F; Baldassarri, R; Priebe, H J

2015-02-01

Each year, an increasing number of elderly patients with cardiovascular disease undergoing non-cardiac surgery require careful perioperative management to minimize the perioperative risk. Perioperative cardiovascular complications are the strongest predictors of morbidity and mortality after major non-cardiac surgery. A Joint Task Force of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA) has recently published revised Guidelines on the perioperative cardiovascular management of patients scheduled to undergo non-cardiac surgery, which represent the official position of the ESC and ESA on various aspects of perioperative cardiac care. According to the Guidelines effective perioperative cardiac management includes preoperative risk stratification based on preoperative assessment of functional capacity, type of surgery, cardiac risk factors, and cardiovascular function. The ESC/ESA Guidelines discourage indiscriminate routine preoperative cardiac testing, because it is time- and cost-consuming, resource-limiting, and does not improve perioperative outcome. They rather emphasize the importance of individualized preoperative cardiac evaluation and the cooperation between anesthesiologists and cardiologists. We summarize the relevant changes of the 2014 Guidelines as compared to the previous ones, with particular emphasis on preoperative cardiac testing.

Risk management for sulfur dioxide abatement under multiple uncertainties

NASA Astrophysics Data System (ADS)

Dai, C.; Sun, W.; Tan, Q.; Liu, Y.; Lu, W. T.; Guo, H. C.

2016-03-01

In this study, interval-parameter programming, two-stage stochastic programming (TSP), and conditional value-at-risk (CVaR) were incorporated into a general optimization framework, leading to an interval-parameter CVaR-based two-stage programming (ICTP) method. The ICTP method had several advantages: (i) its objective function simultaneously took expected cost and risk cost into consideration, and also used discrete random variables and discrete intervals to reflect uncertain properties; (ii) it quantitatively evaluated the right tail of distributions of random variables which could better calculate the risk of violated environmental standards; (iii) it was useful for helping decision makers to analyze the trade-offs between cost and risk; and (iv) it was effective to penalize the second-stage costs, as well as to capture the notion of risk in stochastic programming. The developed model was applied to sulfur dioxide abatement in an air quality management system. The results indicated that the ICTP method could be used for generating a series of air quality management schemes under different risk-aversion levels, for identifying desired air quality management strategies for decision makers, and for considering a proper balance between system economy and environmental quality.

The United South and Eastern Tribe (USET) Proper Functioning Condition (PFC) and Tribal Focused Environmental Risk and Sustainability Tool (Tribal-FERST) Train the Trainers Workshop.October 6-9, 2014, in Nashville, Tennessee: PFC Assessment for Management and Monitoring

EPA Science Inventory

The maintenance of wildlife and aquatic habitat is dependent on the development of a riparian area management strategy, which considers and adapts to certain basic ecological and economic relationships. These relationships are functions of riparian and terrestrial ecosystems, gro...

Modifying Risk Factors in the Management of Erectile Dysfunction: A Review

PubMed Central

DeLay, Kenneth J; Haney, Nora

2016-01-01

Erectile dysfunction (ED) is prevalent among men and its presence is often an indicator of systemic disease. Risk factors for ED include cardiovascular disease, hypertension, diabetes mellitus (DM), tobacco use, hyperlipidemia, hypogonadism, lower urinary tract symptoms, metabolic syndrome, and depression. Addressing the modifiable risk factors frequently improves a patient's overall health and increases lifespan. The literature suggests that smoking cessation, treatment of hyperlipidemia, and increasing physical activity will improve erectile function in many patients. How the treatment of DM, depression, and hypogonadism impacts erectile function is less clear. Clinicians need to be aware that certain antihypertensive agents can adversely impact erectile function. The treatment of men with ED needs to address the underlying risk factors to ameliorate the disease process. PMID:27574592

Preeclampsia Risks in Kidney Donors and Recipients.

PubMed

Shah, Pratik B; Samra, Manpreet; Josephson, Michelle A

2018-06-08

To review the studies and practice guidelines on the preeclampsia risks in kidney donors and recipients. There is a small increased risk of gestational hypertension and preeclampsia in pregnancies that follow kidney donation. Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guideline (2017) and the 2015 American Society of Transplantation (AST) consensus conference statement recommends counseling kidney donors about this increased risk. There is no observed increase in fetal complications or eclampsia post-kidney donation. Preeclampsia is more commonly observed in kidney transplant recipients than the general population and these patients should be co-managed with an obstetrician with experience in managing high risk pregnancies. Although preeclampsia has not been found to have a deleterious effect on renal graft function, it can cause premature delivery. Risk calculators have been proposed and an elevated pre-pregnancy creatinine seems to be an important risk. KDIGO Clinical Practice Guidelines (2009) recommends attempting pregnancy when kidney function is stable with proteinuria of less than 1 g per day. The use of novel biomarkers for preeclampsia has not been published in this population. Preeclampsia is an important concern for female kidney donors and recipients of child-bearing age. These individuals should be appropriately counseled.

Toward an HRD Auditing Protocol: Assessing HRD Risk Management Practices

ERIC Educational Resources Information Center

Clardy, Alan

2004-01-01

Even though HRD-related programs and activities carry risks that should be monitored and assessed, there is little literature on how auditing applies to the HRD function; the existing literature on the topic defines HRD auditing in widely different ways. The nature of risk for organizational process is discussed, followed by a review of the…

Wildland fire management policy: Learning from the past and present and responding to future challenges

Treesearch

Tom Zimmerman

2009-01-01

Since its origin as a defined functional activity, wildland fire management has been the natural resource management program with the highest risk, complexity, and greatest potential for serious negative outcomes. During this time, this program has continually grown in temporal and spatial extent, operational complexity, ecological significance, social, economic, and...

Territory management an appropriate approach for taking into account dynamic risks

NASA Astrophysics Data System (ADS)

Fernandez, M.; Ruegg, J.

2012-04-01

The territorial approach in risk analysis is well established in scientific communications in recent years, especially in the francophone literature. It is an especially appropriate approach for exploring a large number of criteria and factors influencing, on the territory, the composition of the vulnerabilities and risks. In these sense, this approach is appropriate to identify not only risks due to natural hazards but also social and environmental risks. Our case study explores the catastrophic landslide, a collapse of 6 millions cubic meters of rock in Los Chorros, in the municipality of San Cristobal Verapaz-Guatemala, in January 2009. We demonstrate that the same natural hazard has different consequences within this territory and may also increase or even create new vulnerabilities and risks for the population. The analysis shows that the same event can endanger various aspects of the territory: resources, functions (agriculture, or houses uses for example) and allocations and highlights the different types of vulnerabilities that land users (i.e., farmers, merchants transport drivers) face. To resolve a post-disaster situation, the actors choose one vulnerability among a set of vulnerabilities (in a multi-vulnerability context) and with this choice they define their own acceptable risk limits. To give an example, the transport driver choose to reduce the economic vulnerability when going to the local market and crossing the landslide (physical vulnerability). In the context of a developing country with weak development and limited resources, land users that become the Risk managers after the disaster are compelled to prioritize between different actions for reducing risks This study provides a novel approach to risk management by adding a political science and geography dimension through the territory approach for improving our understanding of multi-hazard and multi-risk management. Based on findings from this case study, this work asserts that risk is not unequivocal. On the contrary, in the case of the Los Chorros, the "primary" risk (the landslide), as evaluated by the authorities, was not perceived as such by the local community, which prioritized economic risks by creating their own road through the landslide area in defiance of authorities. In other words, certain attributes and characteristics of risk will be emphasized by some actors over others, (i.e. economic considerations over the perceived probability of another landslide). Their priorities will depend on their needs and mandates and as priorities change, so individual definitions of risk may change over time. This paper demonstrates that the risk is not uniform, that multiple risks persist especially in a developing country context becomes diffuse, changes or endures because it depends on the implications on the territory and on the risk definition made by the actors. The risk is variable, the result of a choice because its existence is attributed by the characteristics or criteria of vulnerability fostered by actors in their territories. Finally, the case study demonstrates that in developing countries, actors are forced to address and prioritize multiple risks due to limited resources. In this context, the challenge for managers of natural hazards is to move from risk management in the strict sense (i.e., pure hazard approach) to a broader risk management, taking into consideration what is important for the society and for the functioning of systems. Territory management in this sense is an appropriate approach for taking into account multiple stakeholder priorities, their relationships, available resources and limitations.

Airway management in cervical spine injury

PubMed Central

Austin, Naola; Krishnamoorthy, Vijay; Dagal, Arman

2014-01-01

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

Uncertainty and Risk Management in Cyber Situational Awareness

NASA Astrophysics Data System (ADS)

Li, Jason; Ou, Xinming; Rajagopalan, Raj

Handling cyber threats unavoidably needs to deal with both uncertain and imprecise information. What we can observe as potential malicious activities can seldom give us 100% confidence on important questions we care about, e.g. what machines are compromised and what damage has been incurred. In security planning, we need information on how likely a vulnerability can lead to a successful compromise to better balance security and functionality, performance, and ease of use. These information are at best qualitative and are often vague and imprecise. In cyber situational awareness, we have to rely on such imperfect information to detect real attacks and to prevent an attack from happening through appropriate risk management. This chapter surveys existing technologies in handling uncertainty and risk management in cyber situational awareness.

[Cardiovascular assessment and management before non-cardiac surgery].

PubMed

Schwarz, Stefanie; Bernheim, Alain M

2015-05-06

The preoperative cardiovascular risk management accounts for patient-related risk factors, the circumstances leading to the surgical procedure, and the risk of the operation. While urgent operations should not be delayed for cardiac testing, an elective surgical intervention should be postponed in unstable cardiac conditions. In stable cardiac situations, prophylactic coronary interventions to reduce the risk of perioperative complications are rarely indicated. Therefore, in most cases, the planned operation can be performed without previous cardiac stress testing or coronary angiography. Preoperative imaging stress testing is recommended for patients with poor functional capacities that are at high cardiovascular risk prior to a high-risk operation. According to the literature, preoperative prophylactic administration of betablockers and aspirin is controversial. Preoperative discontinuation of dual anti-platelet therapy within six months following drug-eluting stent implantation is not recommended.

Development of economic consequence methodology for process risk analysis.

PubMed

Zadakbar, Omid; Khan, Faisal; Imtiaz, Syed

2015-04-01

A comprehensive methodology for economic consequence analysis with appropriate models for risk analysis of process systems is proposed. This methodology uses loss functions to relate process deviations in a given scenario to economic losses. It consists of four steps: definition of a scenario, identification of losses, quantification of losses, and integration of losses. In this methodology, the process deviations that contribute to a given accident scenario are identified and mapped to assess potential consequences. Losses are assessed with an appropriate loss function (revised Taguchi, modified inverted normal) for each type of loss. The total loss is quantified by integrating different loss functions. The proposed methodology has been examined on two industrial case studies. Implementation of this new economic consequence methodology in quantitative risk assessment will provide better understanding and quantification of risk. This will improve design, decision making, and risk management strategies. © 2014 Society for Risk Analysis.

The Resilient Economy: Integrating Competitiveness and Security

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

Debbie van Opstal

2009-01-07

Globalization, technological complexity, interdependence, terrorism, climate and energy volatility, and pandemic potential are increasing the level of risk that societies and organizations now face. Risks also are increasingly interrelated; disruptions in one area can cascade in multiple directions. The ability to manage emerging risks, anticipate the interactions between different types of risk, and bounce back from disruption will be a competitive differentiator for companies and countries alike in the 21st century. What Policymakers Should Know The national objective is not just homeland protection, but economic resilience: the ability to mitigate and recover quickly from disruption. Businesses must root the casemore » for investment in resilience strategies to manage a spectrum of risks, not just catastrophic ones. Making a business case for investment in defenses against low-probability events (even those with high impact) is difficult. However, making a business case for investments that assure business continuity and shareholder value is not a heavy lift. There are an infinite number of disruption scenarios, but only a finite number of outcomes. Leading organizations do not manage specific scenarios, rather they create the agility and flexibility to cope with turbulent situations. The investments and contingency plans these leading companies make to manage a spectrum of risk create a capability to respond to high-impact disasters as well. Government regulations tend to stovepipe different types of risk, which impedes companies abilities to manage risk in an integrated way. Policies to strengthen risk management capabilities would serve both security and competitiveness goals. What CEOs and Boards Should Know Operational risks are growing rapidly and outpacing many companies abilities to manage them. Corporate leadership has historically viewed operational risk management as a back office control function. But managing operational risks increasingly affects real-time financial performance. The 835 companies that announced a supply chain disruption between 1989 and 2000 experienced 33 percent to 40 percent lower stock returns than their industry peers. Twenty-five percent of companies that experienced an IT outage of two to six days went bankrupt immediately. Ninety-three percent of companies that lost their data center for 10 days or more filed for bankruptcy within a year.« less

Managing $50 Million.

ERIC Educational Resources Information Center

Rainsford, George N.

1981-01-01

Trustees need to understand that they have an entrepreneurial function governed by the law of corporations, as well as governed by the law of trusts. The entrepreneurial function involves risks but its presence is seen as essential. Institutions must be looked at as businesses. (MLW)

Mediterranean Storms: An Integrated Approach of Risk Management

NASA Astrophysics Data System (ADS)

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

2010-09-01

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

Strategic wholesale pricing for an incumbent supplier facing with a competitive counterpart.

PubMed

Sun, Jianwu

2014-01-01

We introduce a wholesale pricing strategy for an incumbent supplier facing with a competitive counterpart. We propose a profit function which considers both the present loss and future loss from a wholesale price and then study the optimal wholesale prices for different objectives about this profit function for the incumbent supplier. First, we achieve an optimal wholesale price for the incumbent supplier to maximize his expected profit. Then, to reduce the risk originating from the fluctuation in the competitive supplier's wholesale price, we integrate the conditional value-at-risk (CVaR) measure in financial risk management into this study and derive an optimal wholesale price to maximize CVaR about profit for the incumbent supplier. Besides, the properties of the two optimal wholesale prices are discussed. Finally, some management insights are suggested for the incumbent supplier in a competitive setting.

Strategic Wholesale Pricing for an Incumbent Supplier Facing with a Competitive Counterpart

PubMed Central

Sun, Jianwu

2014-01-01

We introduce a wholesale pricing strategy for an incumbent supplier facing with a competitive counterpart. We propose a profit function which considers both the present loss and future loss from a wholesale price and then study the optimal wholesale prices for different objectives about this profit function for the incumbent supplier. First, we achieve an optimal wholesale price for the incumbent supplier to maximize his expected profit. Then, to reduce the risk originating from the fluctuation in the competitive supplier's wholesale price, we integrate the conditional value-at-risk (CVaR) measure in financial risk management into this study and derive an optimal wholesale price to maximize CVaR about profit for the incumbent supplier. Besides, the properties of the two optimal wholesale prices are discussed. Finally, some management insights are suggested for the incumbent supplier in a competitive setting. PMID:25614891

Developing objectives with multiple stakeholders: adaptive management of horseshoe crabs and Red Knots in the Delaware Bay

USGS Publications Warehouse

McGowan, Conor P.; Lyons, James E.; Smith, David

2015-01-01

Structured decision making (SDM) is an increasingly utilized approach and set of tools for addressing complex decisions in environmental management. SDM is a value-focused thinking approach that places paramount importance on first establishing clear management objectives that reflect core values of stakeholders. To be useful for management, objectives must be transparently stated in unambiguous and measurable terms. We used these concepts to develop consensus objectives for the multiple stakeholders of horseshoe crab harvest in Delaware Bay. Participating stakeholders first agreed on a qualitative statement of fundamental objectives, and then worked to convert those objectives to specific and measurable quantities, so that management decisions could be assessed. We used a constraint-based approach where the conservation objectives for Red Knots, a species of migratory shorebird that relies on horseshoe crab eggs as a food resource during migration, constrained the utility of crab harvest. Developing utility functions to effectively reflect the management objectives allowed us to incorporate stakeholder risk aversion even though different stakeholder groups were averse to different or competing risks. While measurable objectives and quantitative utility functions seem scientific, developing these objectives was fundamentally driven by the values of the participating stakeholders.

Developing Objectives with Multiple Stakeholders: Adaptive Management of Horseshoe Crabs and Red Knots in the Delaware Bay

NASA Astrophysics Data System (ADS)

McGowan, Conor P.; Lyons, James E.; Smith, David R.

2015-04-01

Structured decision making (SDM) is an increasingly utilized approach and set of tools for addressing complex decisions in environmental management. SDM is a value-focused thinking approach that places paramount importance on first establishing clear management objectives that reflect core values of stakeholders. To be useful for management, objectives must be transparently stated in unambiguous and measurable terms. We used these concepts to develop consensus objectives for the multiple stakeholders of horseshoe crab harvest in Delaware Bay. Participating stakeholders first agreed on a qualitative statement of fundamental objectives, and then worked to convert those objectives to specific and measurable quantities, so that management decisions could be assessed. We used a constraint-based approach where the conservation objectives for Red Knots, a species of migratory shorebird that relies on horseshoe crab eggs as a food resource during migration, constrained the utility of crab harvest. Developing utility functions to effectively reflect the management objectives allowed us to incorporate stakeholder risk aversion even though different stakeholder groups were averse to different or competing risks. While measurable objectives and quantitative utility functions seem scientific, developing these objectives was fundamentally driven by the values of the participating stakeholders.

A critical analysis of the South African Disaster Management Act and Policy Framework.

PubMed

van Niekerk, Dewald

2014-10-01

The promulgation of the South African Disaster Management Act No. 57 of 2002 and the National Disaster Management Policy Framework of 2005 placed South Africa at the international forefront by integrating disaster risk reduction into all spheres of government through a decentralised approach. Yet, good policy and legislation do not necessarily translate into good practice. This paper provides a critical analysis of the Act and Policy Framework. Using qualitative research methods, it analyses the attitudes and perceptions of senior public officials on all levels of government, the private sector and academia. The study finds that one of the weakest aspects of the Act and Framework is the absence of clear guidance to local municipalities. The placement of the disaster risk management function on all tiers of government remains problematic, funding is inadequate and overall knowledge and capacities for disaster risk reduction are insufficient. © 2014 The Author(s). Disasters © Overseas Development Institute, 2014.

A framework for understanding risk perception, explored from the perspective of the water practitioner.

PubMed

Dobbie, Meredith Frances; Brown, Rebekah Ruth

2014-02-01

Sustainable urban water systems are likely to be hybrids of centralized and decentralized infrastructure, managed as an integrated system in water-sensitive cities. The technology for many of these systems is available. However, social and institutional barriers, which can be understood as deeply embedded risk perceptions, have impeded their implementation. Risk perceptions within the water sector are often unrecognized or unacknowledged, despite their role in risk management generally in informing value judgments and specifically in ranking risks to achieve management objectives. There has been very little examination of the role of these risk perceptions in advancing more sustainable water supply management through the adoption of alternative sources. To address this gap, this article presents a framework that can be used as a tool for understanding risk perceptions. The framework is built on the relational theory of risk and presents the range of human phenomena that might influence the perception of an "object at risk" in relation to a "risk object." It has been synthesized from a critical review of theoretical, conceptual, and empirical studies of perception broadly and risk perception specifically, and interpreted in relation to water practitioners. For a water practitioner, the risk object might be an alternative water system, a component, a process, or a technology, and the object at risk could be public or environmental health, profitability, or professional reputation. This framework has two important functions: to allow practitioners to understand their own and others' risk perceptions, which might differ, and to inform further empirical research. © 2013 Society for Risk Analysis.

Standardized emergency management system and response to a smallpox emergency.

PubMed

Kim-Farley, Robert J; Celentano, John T; Gunter, Carol; Jones, Jessica W; Stone, Rogelio A; Aller, Raymond D; Mascola, Laurene; Grigsby, Sharon F; Fielding, Jonathan E

2003-01-01

The smallpox virus is a high-priority, Category-A agent that poses a global, terrorism security risk because it: (1) easily can be disseminated and transmitted from person to person; (2) results in high mortality rates and has the potential for a major public health impact; (3) might cause public panic and social disruption; and (4) requires special action for public health preparedness. In recognition of this risk, the Los Angeles County Department of Health Services (LAC-DHS) developed the Smallpox Preparedness, Response, and Recovery Plan for LAC to prepare for the possibility of an outbreak of smallpox. A unique feature of the LAC-DHS plan is its explicit use of the Standardized Emergency Management System (SEMS) framework for detailing the functions needed to respond to a smallpox emergency. The SEMS includes the Incident Command System (ICS) structure (management, operations, planning/intelligence, logistics, and finance/administration), the mutual-aid system, and the multi/interagency coordination required during a smallpox emergency. Management for incident command includes setting objectives and priorities, information (risk communications), safety, and liaison. Operations includes control and containment of a smallpox outbreak including ring vaccination, mass vaccination, adverse events monitoring and assessment, management of confirmed and suspected smallpox cases, contact tracing, active surveillance teams and enhanced hospital-based surveillance, and decontamination. Planning/intelligence functions include developing the incident action plan, epidemiological investigation and analysis of smallpox cases, and epidemiological assessment of the vaccination coverage status of populations at risk. Logistics functions include receiving, handling, inventorying, and distributing smallpox vaccine and vaccination clinic supplies; personnel; transportation; communications; and health care of personnel. Finally, finance/administration functions include monitoring costs related to the smallpox emergency, procurement, and administrative aspects that are not handled by other functional divisions of incident command systems. The plan was developed and is under frequent review by the LAC-DHS Smallpox Planning Working Group, and is reviewed periodically by the LAC Bioterrorism Advisory Committee, and draws upon the Smallpox Response Plan and Guidelines of the Centers for Disease Control and Prevention (CDC) and recommendations of the Advisory Committee on Immunization Practices (ACIP). The Smallpox Preparedness, Response, and Recovery Plan, with its SEMS framework and ICS structure, now is serving as a model for the development of LAC-DHS plans for responses to other terrorist or natural-outbreak responses.

Drivers and barriers among householders to managing domestic wastewater treatment systems in the Republic of Ireland; implications for risk prevention behaviour

NASA Astrophysics Data System (ADS)

Devitt, Catherine; O'Neill, Eoin; Waldron, Richard

2016-04-01

Septic systems that are malfunctioning, improperly sited or designed, present a contamination risk to drinking water sources, and subsequently, to human health. However, the international literature identifies gaps in householder knowledge regarding the function and maintenance requirements of septic systems, and also the potential health and environmental risk implications. Allied with householder fears related to the financial cost of risk management, these factors tend to reduce concern to recognise a malfunctioning system. In the Republic of Ireland, three-quarters of households in rural areas utilise an individual domestic wastewater treatment system (or septic system). Consequently, a significant portion of rural households that rely on groundwater sources via private-well use are at risk. Ireland reports one of the highest crude incidence rates of Verotoxigenic Escherichia coli (VTEC) infection in the European Union, and waterborne transmission related to contact with untreated or poorly treated water from private water sources is a factor in its transmission. Following recent Irish legislative change that places a duty of care on individual householders to ensure a proper system functioning, this exploratory study examines perceptions towards the risk management of septic systems among Irish householders. Using qualitative research methods, four focus groups selected on the basis of geographical variation, and two semi-structured interviews were conducted. While most householders agreed that poorly maintained septic systems represented a threat to the environment and to public health, none reported to having a regular maintenance routine in place. Thematic analysis revealed the drivers and barriers to septic system maintenance, and preferences of householders pertaining to communication on septic systems. The Health Belief Model is employed to help understand results. Results suggest that householder capacity to engage in regular risk management is reduced by limited perceptions of risk susceptibility and severity, impeding cues to action and barrier concerns. Understanding societal perceptions is central to effectively engaging with the public, and informing an improved approach to future pro-environmental engagement and behaviour.

Assessment of the quality of fall detection and management in primary care in the Netherlands based on the ACOVE quality indicators.

PubMed

Askari, M; Eslami, S; van Rijn, M; Medlock, S; Moll van Charante, E P; van der Velde, N; de Rooij, S E; Abu-Hanna, A

2016-02-01

We determined adherence to nine fall-related ACOVE quality indicators to investigate the quality of management of falls in the elderly population by general practitioners in the Netherlands. Our findings demonstrate overall low adherence to these indicators, possibly indicating insufficiency in the quality of fall management. Most indicators showed a positive association between increased risk for functional decline and adherence, four of which with statistical significance. This study aims to investigate the quality of detection and management of falls in the elderly population by general practitioners in the Netherlands, using the Assessing Care of Vulnerable Elders (ACOVE) quality indicators. Community-dwelling persons aged 70 years or above, registered in participating general practices, were asked to fill in a questionnaire designed to determine general practitioner (GP) adherence to fall-related indicators. We used logistic regression to estimate the association between increased risk for functional decline-quantified by the Identification of Seniors At Risk for Primary Care score-and adherence. We then cross-validated the self-reported falls with medical records. Of the 950 elders responding to our questionnaire, only 10.6 % reported that their GP proactively asked them about falls. Of the 160 patients who reported two or more falls, or one fall for which they visited the GP, only 23.1 % had fall documentation in their records. Adherence ranged between 13.6 and 48.6 %. There was a significant positive association between the ISAR-PC scores and adherence in four QIs. Documentation of falls was highest (36.7 %) in patients whom the GP had proactively asked about falls. Based on patient self-reports, adherence to the ACOVE fall-related indicators was poor, suggesting that the quality of evaluation and management of falls in community-dwelling older persons in the Netherlands is poor. The documentation of falls and fall-related risk factors was also poor. However, for most QIs, adherence to them increased with the increase in the risk of functional decline.

European regulations on nutraceuticals, dietary supplements and functional foods: a framework based on safety.

PubMed

Coppens, Patrick; da Silva, Miguel Fernandes; Pettman, Simon

2006-04-03

This article describes the legislation that is relevant in the marketing of functional foods in the European Union (EU), how this legislation was developed as well as some practical consequences for manufacturers, marketers and consumers. It also addresses some concrete examples of how the EU's safety requirements for food products have impacted a range of product categories. In the late nineties, research into functional ingredients was showing promising prospects for the use of such ingredients in foodstuffs. Due mainly to safety concerns, these new scientific developments were accompanied by an urgent call for legislation. The European Commission 2000 White Paper on Food Safety announced some 80 proposals for new and improved legislation in this field. Among others, it foresaw the establishment of a General Food Law Regulation, laying down the principles of food law and the creation of an independent Food Authority endowed with the task of giving scientific advice on issues based upon scientific risk assessment with clearly separated responsibilities for risk assessment, risk management and risk communication. Since then, more than 90% of the White Paper proposals have been implemented. However, there is not, as such, a regulatory framework for 'functional foods' or 'nutraceuticals' in EU Food Law. The rules to be applied are numerous and depend on the nature of the foodstuff. The rules of the general food law Regulation are applicable to all foods. In addition, legislation on dietetic foods, on food supplements or on novel foods may also be applicable to functional foods depending on the nature of the product and on their use. Finally, the two proposals on nutrition and health claims and on the addition of vitamins and minerals and other substances to foods, which are currently in the legislative process, will also be an important factor in the future marketing of 'nutraceuticals' in Europe. The cornerstone of EU legislation on food products, including functional foods and nutraceuticals is 'safety'. Decisions on the safety-basis of legislation are based on risk analysis, in which scientific risk assessment is performed by the European Food Safety Authority and risk management is performed by the European Commission, the Member States, and in case of legislation, together with the European Parliament. In the risk management phase, both the precautionary principle and other legitimate factors may be considered in choosing the best way of dealing with an issue. Due to the numerous pieces of legislation applying and to the different procedures to be followed, the process of having 'functional foods' ready for the market is certainly a costly and time-consuming task. However, it may also be clearly worth it in terms of market success and improved consumer health.

Influence of kidney function on risk of supratherapeutic international normalized ratio-related hemorrhage in warfarin users: a prospective cohort study

USDA-ARS?s Scientific Manuscript database

Background: Anticoagulation management is difficult in chronic kidney disease, with frequent supratherapeutic international normalized ratios (INRs >/= 4) increasing hemorrhagic risk. We evaluated whether the interaction of INR and lower estimated glomerular filtration rate (eGFR) increases hemorrha...

Ecological Production Functions Linking Multiple Stressors to Ecosystem Services – A Case Study

EPA Science Inventory

The ecosystem services concept is being used to frame environmental protection goals that guide management of the risks of chemicals. Ecosystem services link changes in ecological systems to the benefits received by people. The use of ecosystem services in risk assessments and th...

Emergent Risks In Critical Infrastructures

NASA Astrophysics Data System (ADS)

Dynes, Scott

Firms cannot function successfully without managing a host of internal and external organizational and process interdependencies. Part of this involves business continuity planning, which directly aects how resilient arm and its business sector are in the face of disruptions. This paper presents the results of eld studies related to information risk management practices in the health care and retail sectors. The studies explore information risk management coordinating signals within and across rms in these sectors as well as the potential eects of cyber disruptions on the rms as stand-alone entities and as part of a critical infrastructure. The health care case study investigates the impact of the Zotob worm on the ability to deliver medical care and treatment. The retail study examines the resilience of certain elements of the food supply chain to cyber disruptions.

Understanding risks and complications in the management of ankle fractures

PubMed Central

Mehta, Saurabh Sagar; Rees, Kishan; Cutler, Lucy; Mangwani, Jitendra

2014-01-01

Ankle fracture (AF) is a common injury with potentially significant morbidity associated with it. The most common age groups affected are young active patients, sustaining high energy trauma and elderly patients with comorbidities. Both these groups pose unique challenges for appropriate management of these injuries. Young patients are at risk of developing posttraumatic osteoarthritis, with a significant impact on quality of life due to pain and impaired function. Elderly patients, especially with poorly controlled diabetes and osteoporosis are at increased risk of wound complications, infection and failure of fixation. In the most severe cases, this can lead to amputation and mortality. Therefore, individualized approach to the management of AF is vital. This article highlights commonly encountered complications and discusses the measures needed to minimize them when dealing with these injuries. PMID:25298549

Strengthening insurance partnerships in the face of climate change - Insights from an agent-based model of flood insurance in the UK.

PubMed

Crick, Florence; Jenkins, Katie; Surminski, Swenja

2018-04-25

Multisectoral partnerships are increasingly cited as a mechanism to deliver and improve disaster risk management. Yet, partnerships are not a panacea and more research is required to understand the role that they can play in disaster risk management and particularly disaster risk reduction. This paper investigates how partnerships can incentivise flood risk reduction by focusing on the UK public-private partnership on flood insurance. Developing the right flood insurance arrangements to incentivise flood risk reduction and adaptation to climate change is a key challenge. In the face of rising flood risks due to climate change and socio-economic development insurance partnerships can no longer afford to focus only on the risk transfer function. However, while expectations of the insurance industry have traditionally been high when it comes to flood risk management, the insurance industry alone will not provide the solution to the challenge of rising risks. The case of flood insurance in the UK illustrates this: even national government and industry together cannot fully address these risks and other actors need to be involved to create strong incentives for risk reduction. Using an agent-based model focused on surface water flood risk in London we analyse how other partners could strengthen the insurance partnership by reducing flood risk and thus helping to maintain affordable insurance premiums. Our findings are relevant for wider discussions on the potential of insurance schemes to incentivise flood risk management and climate adaptation in the UK and also internationally. Copyright © 2018. Published by Elsevier B.V.

Childhood functional abdominal pain: mechanisms and management.

PubMed

Korterink, Judith; Devanarayana, Niranga Manjuri; Rajindrajith, Shaman; Vlieger, Arine; Benninga, Marc A

2015-03-01

Chronic abdominal pain is one of the most common clinical syndromes encountered in day to day clinical paediatric practice. Although common, its definition is confusing, predisposing factors are poorly understood and the pathophysiological mechanisms are not clear. The prevailing viewpoint in the pathogenesis involves the inter-relationship between changes in hypersensitivity and altered motility, to which several risk factors have been linked. Making a diagnosis of functional abdominal pain can be a challenge, as it is unclear which further diagnostic tests are necessary to exclude an organic cause. Moreover, large, well-performed, high-quality clinical trials for effective agents are lacking, which undermines evidence-based treatment. This Review summarizes current knowledge regarding the epidemiology, pathophysiology, risk factors and diagnostic work-up of functional abdominal pain. Finally, management options for children with functional abdominal pain are discussed including medications, dietary interventions, probiotics and psychological and complementary therapies, to improve understanding and to maximize the quality of care for children with this condition.

Managing the difficult penile prosthesis patient.

PubMed

Trost, Landon W; Baum, Neil; Hellstrom, Wayne J G

2013-04-01

Inflatable penile prostheses (IPPs) are associated with excellent long-term outcomes and patient/partner satisfaction. A small percentage of patients remain dissatisfied, despite acceptable surgical results. This study aims to evaluate factors associated with patient satisfaction and dissatisfaction, define patient characteristics, which may identify elevated risk of postoperative dissatisfaction, and describe management strategies to optimize functional and psychological patient outcomes. A review of urologic and non-urologic cosmetic surgery literature was performed to identify factors associated with patient satisfaction/dissatisfaction. Emphasis was placed on articles defining "high risk" or psychologically challenging patients. Preoperative factors associated with patient satisfaction/dissatisfaction and character traits, which may identify elevated risk of postoperative dissatisfaction or otherwise indicate a psychologically challenging patient. Contemporary patient and partner satisfaction rates following IPP are 92-100% and 91-95%, respectively. Factors associated with satisfaction include decreased preoperative expectations, favorable female partner sexual function, body mass index ≤30, and absence of Peyronie's disease or prior prostatectomy. Determinants of dissatisfaction include perceived/actual loss of penile length, decreased glanular engorgement, altered erectile/ejaculatory sensation, pain, diminished cosmetic outcome, difficulty with device function, partner dissatisfaction and perception of unnatural sensation, complications, and extent of alternative treatments offered. Personality characteristics which may indicate psychologically challenging IPP patients include obsessive/compulsive tendencies, unrealistic expectations, patients undergoing revision surgery, those seeking multiple surgical opinions, feeling of entitlement, patients in denial of their prior erectile/sexual function and current disease status, or those with other psychiatric disorders. The mnemonic CURSED Patient is presented: "Compulsive/obsessive, Unrealistic, Revision, Surgeon Shopping, Entitled, Denial, and Psychiatric." Although the majority of IPP patients experience excellent, durable satisfaction and outcomes, a challenging subset of patients may be at increased risk of postoperative dissatisfaction. Appropriate recognition/prevention and management of this cohort may help to establish and strengthen relationships, reduce physical, emotional, and legal risk, and ultimately enhance patient satisfaction. © 2013 International Society for Sexual Medicine.

Expert consensus of the French Society of Geriatrics and Gerontology and the French Society of Cardiology on the management of atrial fibrillation in elderly people.

PubMed

Hanon, Olivier; Assayag, Patrick; Belmin, Joel; Collet, Jean Philippe; Emeriau, Jean Paul; Fauchier, Laurent; Forette, Françoise; Friocourt, Patrick; Gentric, Armelle; Leclercq, Christophe; Komajda, Michel; Le Heuzey, Jean Yves

2013-05-01

Atrial fibrillation (AF) is a common and serious condition in the elderly. AF affects between 600,000 and one million patients in France, two-thirds of whom are aged above 75 years. AF is a predictive factor for mortality in the elderly and a major risk factor for stroke. Co-morbidities are frequent and worsen the prognosis. The management of AF in the elderly should involve a comprehensive geriatric assessment (CGA), which analyses both medical and psychosocial elements, enabling evaluation of the patient's functional status and social situation and the identification of co-morbidities. The CGA enables the detection of "frailty" using screening tools assessing cognitive function, risk of falls, nutritional status, mood disorders, autonomy and social environment. The objectives of AF treatment in the elderly are to prevent AF complications, particularly stroke, and improve quality of life. Specific precautions for treatment must be taken because of the co-morbidities and age-related changes in pharmacokinetics or pharmacodynamics. Preventing AF complications relies mainly on anticoagulant therapy. Anticoagulants are recommended in patients with AF aged 75 years or above after assessing the bleeding risk using the HEMORR2HAGES or HAS-BLED scores. Novel oral anticoagulants (NOACs) are promising treatments, especially due to a lower risk of intracerebral haemorrhage. However, their prescriptions should take into account renal function (creatinine clearance assessed with Cockcroft formula) and cognitive function (for adherence to treatment). Studies including frail patients in "real life" are necessary to evaluate tolerance of NOACs. Management of AF also involves the treatment of underlying cardiomyopathy and heart rate control rather than a rhythm-control strategy as first-line therapy for elderly patients, especially if they are paucisymptomatic. Antiarrhythmic drugs should be used carefully in elderly patients because of the frequency of metabolic abnormalities and higher risk of drug interactions and bradycardia. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Anesthesia and ventilation strategies in children with asthma: part I - preoperative assessment.

PubMed

Regli, Adrian; von Ungern-Sternberg, Britta S

2014-06-01

Asthma is a common disease in the pediatric population, and anesthetists are increasingly confronted with asthmatic children undergoing elective surgery. This first of this two-part review provides a brief overview of the current knowledge on the underlying physiology and pathophysiology of asthma and focuses on the preoperative assessment and management in children with asthma. This also includes preoperative strategies to optimize lung function of asthmatic children undergoing surgery. The second part of this review focuses on the immediate perioperative anesthetic management including ventilation strategies. Multiple observational trials assessing perioperative respiratory adverse events in healthy and asthmatic children provide the basis for identifying risk factors in the patient's (family) history that aid the preoperative identification of at-risk children. Asthma treatment outside anesthesia is well founded on a large body of evidence. Optimization and to some extent intensifying asthma treatment can optimize lung function, reduce bronchial hyperreactivity, and minimize the risk of perioperative respiratory adverse events. To minimize the considerable risk of perioperative respiratory adverse events in asthmatic children, a good understanding of the underlying physiology is vital. Furthermore, a thorough preoperative assessment to identify children who may benefit of an intensified medical treatment thereby minimizing airflow obstruction and bronchial hyperreactivity is the first pillar of a preventive perioperative management of asthmatic children. The second pillar, an individually adjusted anesthesia management aiming to reduce perioperative adverse events, is discussed in the second part of this review.

[Forensic psychiatry. Its relations to clinical psychiatry and criminology].

PubMed

Kröber, H-L

2005-11-01

A basic task of psychiatry is to identify and treat mentally disordered persons at risk of committing crimes. Psychiatry has an important function in preserving social peace, law, and order. How the psychiatric world handles this duty has changed with time. There have been very important changes from asylums to mental hospitals and from voluntary or involuntary inpatient treatment to outpatient care; but clinical psychiatry cannot give up forensic psychiatry. As a result of developments, inpatient care in mental hospitals often concentrates on crisis management, risk assessment, and risk management. On the other hand, forensic psychiatry has made great efforts in recent decades with special therapies for mentally disturbed criminals and collaborated closely with criminologists in developing instruments for risk assessment and prognosis of repeat offenses.

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

PubMed

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

2012-01-01

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

An analytical framework for quantifying wildland fire risk and fuel treatment benefit

Treesearch

Joe H. Scott

2006-01-01

Federal wildland fire management programs have readily embraced the practice of fuel treatment. Wildland fire risk is quantified as expected annual loss ($ yr –1 or $ yr –1 ac –1). Fire risk at a point on the landscape is a function of the probability of burning at that point, the relative frequency...

Towards low flow risk maps

NASA Astrophysics Data System (ADS)

Blauhut, Veit; Stölzle, Michael; Stahl, Kerstin

2017-04-01

Drought induced low flow extremes, despite a variety of management strategies, can cause direct and indirect impacts on socio economic and ecological functions of rivers. These negative effects determine local risk and are a function of the regional drought hazard and the river system's vulnerability. Whereas drought risk analysis is known to be essential for drought management, risk analysis for low flow is less common. Where no distributed hydrological models exist, merely the local hazard at gauging stations is available to represent the entire catchment. Vulnerability information are only sparsely available. Hence, a comprehensive understanding of the drivers of low flow risk along the longitudinal river profile is often lacking. For two different rivers in southwestern Germany, this study analysed major low flow events of the past five decades. Applying a transdisciplinary approach, the hazard component is assessed by hydro-climatic analysis, hydrological modelling and forward looking stress test scenarios; the vulnerability component is estimated by a combination of impact assessment and vulnerability estimation, based on stakeholder workshops, questionnaires and regional characteristics. The results show distinct differences in low flow risk between the catchments and along the river. These differences are due to: hydrogeological characteristics that govern groundwater-surface water interaction, catchment-specific anthropogenic stimuli such as low flow decrease by near-stream groundwater pumping for public water supply or low flow augmentation by treatment plant discharge. Thus, low flow risk is anthropogenically influenced in both ways: positive and negative. Furthermore, the measured longitudinal profiles highlight the impracticability of single gauges to represent quantitative and qualitative conditions of entire rivers. Hence, this work calls for a comprehensive spatially variable consideration of flow characteristics and human influences to analyse low flow risk as the basis for an adequate low flow management.

On the complex quantification of risk: systems-based perspective on terrorism.

PubMed

Haimes, Yacov Y

2011-08-01

This article highlights the complexity of the quantification of the multidimensional risk function, develops five systems-based premises on quantifying the risk of terrorism to a threatened system, and advocates the quantification of vulnerability and resilience through the states of the system. The five premises are: (i) There exists interdependence between a specific threat to a system by terrorist networks and the states of the targeted system, as represented through the system's vulnerability, resilience, and criticality-impact. (ii) A specific threat, its probability, its timing, the states of the targeted system, and the probability of consequences can be interdependent. (iii) The two questions in the risk assessment process: "What is the likelihood?" and "What are the consequences?" can be interdependent. (iv) Risk management policy options can reduce both the likelihood of a threat to a targeted system and the associated likelihood of consequences by changing the states (including both vulnerability and resilience) of the system. (v) The quantification of risk to a vulnerable system from a specific threat must be built on a systemic and repeatable modeling process, by recognizing that the states of the system constitute an essential step to construct quantitative metrics of the consequences based on intelligence gathering, expert evidence, and other qualitative information. The fact that the states of all systems are functions of time (among other variables) makes the time frame pivotal in each component of the process of risk assessment, management, and communication. Thus, risk to a system, caused by an initiating event (e.g., a threat) is a multidimensional function of the specific threat, its probability and time frame, the states of the system (representing vulnerability and resilience), and the probabilistic multidimensional consequences. © 2011 Society for Risk Analysis.

Improving Synchronization and Functional Connectivity in Autism Spectrum Disorders Through Plasticity-Induced Rehabilitation

DTIC Science & Technology

2013-08-01

Waiter GD, Gilchrist A, Perrett DI, Murray AD, Whiten A. Neural mechanisms of imitation and ‘mirror neuron’ functioning in autistic spectrum...or risk factor associated with the onset of ASD, the inherent heterogeneity of endophenotypical presentation makes clinical management challenging. In

Case discussion: impaired renal function and tolerance to high altitude.

PubMed

2002-01-01

A 58-year-old woman who plans a trek in the Himalayas at altitudes from 4500 to 5000 m is known to have the loss of about 50% of renal function based on glomerular filtration studies and renal biopsy. Possible risks and management are discussed.

[Influence of skeletal muscles on the risk of falling in old age].

PubMed

Schöne, D; Freiberger, E; Sieber, C C

2017-04-01

Falls in older adults are a major public health problem, affecting 1 in 3 persons aged 65 and over at least once a year. Consequences of falling include death, injuries, fear of falling, and subsequent loss of independence. The age-related loss of muscle mass and function (sarcopenia) as well as muscle strength are markers of the frailty syndrome. In addition, they are associated with physical function and are a risk factor for falling. Older adults should be screened for falls at least annually. If evaluated as at-risk, a comprehensive falls assessment should be conducted to determine an individual's risk profile. Physical exercise with balance and strength training play a key role in the prevention and management of functional decline and fall risk. Multifactorial interventions are indicated in at-risk individuals. In sarcopenic individuals, sufficient intake of protein must be taken into account and supplementation in combination with exercise appears to be useful.

Asset management to support urban land and subsurface management.

PubMed

Maring, Linda; Blauw, Maaike

2018-02-15

Pressure on urban areas increases by demographic and climate change. To enable healthy, adaptive and liveable urban areas different strategies are needed. One of the strategies is to make better use of subsurface space and its functions. Asset management of the Subsurface (AMS) contributes to this. Asset management provides transparency of trade-offs between performance, cost and risks throughout the entire lifecycle of these assets. AMS is based on traditional asset management methods, but it does not only take man-made assets in the subsurface into account. AMS also considers the natural functions that the subsurface, including groundwater, has to offer (ecosystem services). A Dutch community of practice consisting of national and municipal authorities, a consultancy-engineering and a research institute are developing AMS in practice in order to 1) enhance the urban underground space planning (using its benefits, avoiding problems) and 2) use, manage and maintain the (urban) subsurface and its functions. The method is currently still under development. Copyright © 2017 Elsevier B.V. All rights reserved.

Designing health care risk management on-line:meeting regulators' concerns for fixed-hour curriculum.

PubMed

Hyer, Kathryn; Taylor, Heidi H; Nanni, Kennith

2004-01-01

This paper describes the experience of creating a continuing professional education on-line risk management program that is designed to meet Florida's educational requirements for licensure as a risk manager in health-care settings and details the challenges faced when the in-class didactic program of 15 eight-hour sessions is reformatted as an on-line program. Structuring instructor/learner interactivity remains a challenge, especially if the program allows learner control and is a key feature in marketing the program. The article presents the dilemmas for state regulators as they work to determine if the on-line program meets legislative intent and statutory requirements because the learning platform does not have a clock function that accumulates time for each learner. While some details reflect the uniqueness of the 120-hour educational requirements for risk managers in Florida, the experience of the authors provides insight into the development of continuing professional education distance learning programs that are multidisciplinary and move primarily from a time-based format into a curriculum that uses time as only one dimension of the evaluation of learning.

Health Risk Management for Bioenvironmental Engineering

DTIC Science & Technology

2013-06-01

success. • Health Risk Estimate ( HRE ). HRE is the probability and severity of loss from exposure to the health threat ( HRE is a function of...probability and severity; when either or both increase the HRE increases). The HRE is also referred to as a health risk level. An HRE is a measure of the...assessments) OEH threats in populations or at locations over time (HRA = f [(health risk) “+” ( HRE ) “+” (COA)]). The HRA “product” is the validated

Fall-Risk Evaluation and Management: Challenges in Adopting Geriatric Care Practices

ERIC Educational Resources Information Center

Tinetti, Mary E.; Gordon, Catherine; Sogolow, Ellen; Lapin, Pauline; Bradley, Elizabeth H.

2006-01-01

One third of older adults fall each year, placing them at risk for serious injury, functional decline, and health care utilization. Despite the availability of effective preventive approaches, policy and clinical efforts at preventing falls among older adults have been limited. In this article we present the burden of falls, review evidence…

Postgraduate Clinical Psychology Students' Perceptions of an Acceptance and Commitment Therapy Stress Management Intervention and Clinical Training

ERIC Educational Resources Information Center

Pakenham, Kenneth I.; Stafford-Brown, Johanna

2013-01-01

Background: Research into stress management interventions for clinical psychology trainees (CPTs) is limited, despite evidence indicating that these individuals are at risk for elevated stress, which can negatively impact personal and professional functioning. This study explored: (1) CPTs' perceptions of a previously evaluated Acceptance and…

Direct oral anticoagulants and digestive bleeding: therapeutic management and preventive measures.

PubMed

Deutsch, David; Boustière, Christian; Ferrari, Emile; Albaladejo, Pierre; Morange, Pierre-Emmanuel; Benamouzig, Robert

2017-06-01

The use of direct oral anticoagulants (DOACs) was an important step forward in the management of atrial fibrillation and venous thromboembolism (VTE). The DOACs, anti-IIa for dabigatran and anti-Xa for rivaroxaban, apixaban and edoxaban, all have a rapid onset of action and a short half life. There is no need for routine hemostasis testing for treatment monitoring of a DOAC. Compared with vitamin K antagonists (VKAs), DOACs may increase the risk of gastrointestinal bleeding (relative risk 1.25). Withholding the DOAC treatment, evaluating the time of the last intake and estimating the patient's renal function are the first steps in the management of gastrointestinal bleeding. For patients without impaired renal function, achieving low coagulation takes around 24 h after the last intake of a DOAC. The use of DOAC antagonists will be helpful in controlling bleeding in the most severe and urgent situations. Idarucizumab is available for clinical use for dabigatran and andexanet is currently being reviewed by drug agencies for rivaroxaban, apixaban and edoxaban. It is important to assess the bleeding risk associated with the planned procedure, and the patient's renal function before withholding DOAC therapy for a scheduled intervention. It is mandatory to strengthen the local hemostasis strategies in DOAC-treated patients undergoing a therapeutic endoscopic procedure. Resuming or not resuming anticoagulation with a DOAC after bleeding or a risky procedure depends on the thrombotic and bleeding risk as well as the procedure involved. This discussion should always involve the cardiologist and decisions should be taken by a pluridisciplinary team.

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

PubMed

Trevisani, M; Rosmini, R

2008-09-01

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

Defining the Process of a Cardiovascular Risk Assessment Program: Lessons Learnt From Cardiac Assessment of Elite Soccer Players in the United Kingdom.

PubMed

Speers, Christopher; Seth, Ajai Narain; Patel, Kiran Chhaganbhai; Rakhit, Dhrubo Jyoti; Gillett, Mark James

2017-12-14

Retrospectively analyze the cardiac assessment process for elite soccer players, and provide team physicians with a systematic guide to managing longitudinal cardiac risk. Descriptive Epidemiology Study. Cardiac assessments incorporating clinical examination, 12-lead ECG, echocardiography, and health questionnaire. Soccer players at 5 professional clubs in England, the United Kingdom. Data was retrospectively collected, inspected, and analyzed to determine their clinical management and subsequent follow-up. Over 2 years, 265 soccer players, aged 13 to 37 years with 66% of white European ethnicity, were included in the cohort. Eleven percent had "not-normal" assessments, of these assessments, 83% were considered gray screens, falling into three broad categories: structural cardiac features (including valvular abnormalities), functional cardiac features, and electrocardiogram changes. After cardiology consultation, all assessments were grouped into low, enhanced and high-risk categories for ongoing longitudinal risk management. Overall clear-cut pathology was identified in 2%. Cardiovascular assessment is a vital tool in identifying athletes at risk of sudden cardiac death to mitigate their risk through surveillance, intervention, or participation restriction. The decision whether a player is fit to play or not requires a robust risk assessment followed by input from a multidisciplinary team that includes both the team physician and cardiologist. This educational article proposes a clinical management pathway to aid clinicians with this process. Sudden cardiac death is the important medical cause of death during exercise. The team physician should assume responsibility for the management of the longitudinal risk of their players' cardiac assessments in conjunction with sports cardiologist.

Community-Based Disaster Management: A Lesson Learned From Community Emergency Response Management in Banyumas, Indonesia

NASA Astrophysics Data System (ADS)

Pratama, A. Y.; Sariffuddin, S.

2018-02-01

This article aimed to review community-based disaster management in terms of its independent coordination and disaster management. Community resilience was tested during disaster emergency. While panic, the community is required to be viable and able to evacuate, manage logistic, collect data on damage and the victim, and coordinate with outsiders independently. The community in Gununglurah Village, Banyumas Regency which was hit by a landslide in 2015 provides a lesson learned about community based disaster management. This research used qualitative descriptive methodology with in-depth interview with 23 informants from the community, donor institution, village officers, and government officers. Through traditional and informal methods, the community implemented disaster management that was categorized into 3 mechanisms that were social, functional, and sequential mechanism. These mechanisms controlled different portion in which social mechanism holds the most important role in disaster management, then functional mechanism and sequential mechanism. Various community activities in the village equipped the community with organizational experience to manage logistic, human resource and other coordination. In 2007, in fact, there was vulnerability risk assessment done by the local government, which recommended efforts to be done by the community to reduce the disaster risk, yet it was not implemented. It was interesting to note that in spite of the independent disaster management there was a scientific assessment neglected. Based on this research, a new discussion on how to synchronize the endogenous knowledge with scientific modern knowledge was opened.

Management of Service Projects in Support of Space Flight Research

NASA Technical Reports Server (NTRS)

Love, J.

2009-01-01

Goal:To provide human health and performance countermeasures, knowledge, technologies, and tools to enable safe, reliable, and productive human space exploration . [HRP-47051] Specific Objectives: 1) Develop capabilities, necessary countermeasures, and technologies in support of human space exploration, focusing on mitigating the highest risks to human health and performance. 2) Define and improve human spaceflight medical, environmental, and human factors standards. 3) Develop technologies that serve to reduce medical and environmental risks, to reduce human systems resource requirements (mass, volume, power, data, etc.) and to ensure effective human-system integration across exploration systems. 4) Ensure maintenance of Agency core competencies necessary to enable risk reduction in the following areas: A. Space medicine B. Physiological and behavioral effects of long duration spaceflight on the human body C. Space environmental effects, including radiation, on human health and performance D. Space "human factors" [HRP-47051]. Service projects can form integral parts of research-based project-focused programs to provide specialized functions. Traditional/classic project management methodologies and agile approaches are not mutually exclusive paradigms. Agile strategies can be combined with traditional methods and applied in the management of service projects functioning in changing environments. Creative collaborations afford a mechanism for mitigation of constrained resource limitations.

Risk Assessment and Hierarchical Risk Management of Enterprises in Chemical Industrial Parks Based on Catastrophe Theory

PubMed Central

Chen, Yu; Song, Guobao; Yang, Fenglin; Zhang, Shushen; Zhang, Yun; Liu, Zhenyu

2012-01-01

According to risk systems theory and the characteristics of the chemical industry, an index system was established for risk assessment of enterprises in chemical industrial parks (CIPs) based on the inherent risk of the source, effectiveness of the prevention and control mechanism, and vulnerability of the receptor. A comprehensive risk assessment method based on catastrophe theory was then proposed and used to analyze the risk levels of ten major chemical enterprises in the Songmu Island CIP, China. According to the principle of equal distribution function, the chemical enterprise risk level was divided into the following five levels: 1.0 (very safe), 0.8 (safe), 0.6 (generally recognized as safe, GRAS), 0.4 (unsafe), 0.2 (very unsafe). The results revealed five enterprises (50%) with an unsafe risk level, and another five enterprises (50%) at the generally recognized as safe risk level. This method solves the multi-objective evaluation and decision-making problem. Additionally, this method involves simple calculations and provides an effective technique for risk assessment and hierarchical risk management of enterprises in CIPs. PMID:23208298

Prospective Quality of Life Outcomes for Low-Risk Prostate Cancer: Active Surveillance versus Radical Prostatectomy

PubMed Central

Jeldres, Claudio; Cullen, Jennifer; Hurwitz, Lauren M.; Wolff, Erika M.; Levie, Katherine; Odem-Davis, Katherine; Johnston, Richard B.; Pham, Khanh N.; Rosner, Inger L; Brand, Timothy C.; L’Esperance, James O.; Sterbis, Joseph R.; Etzioni, Ruth B.; Porter, Christopher R.

2015-01-01

Background For low-risk prostate cancer (PCa), active surveillance (AS) may confer comparable oncological outcomes to radical prostatectomy (RP). Health-related quality of life (HRQoL) outcomes are important to consider, yet few studies have examined HRQoL for patients managed with AS. This study compared longitudinal HRQoL in a prospective, racially diverse, and contemporary cohort of patients who underwent RP or AS for low-risk PCa. Methods Beginning in 2007, HRQoL data from validated questionnaires (EPIC and SF-36) were collected by the Center for Prostate Disease Research in a multi-center national database. Patients aged ≤75 that were diagnosed with low-risk PCa and elected RP or AS for initial disease management were followed for three years. Mean scores were estimated using generalized estimating equations, adjusting for baseline HRQoL, demographic and clinical patient characteristics. Results Of the patients with low-risk PCa, 228 underwent RP and 77 underwent AS. Multivariable analysis revealed that RP patients had significantly worse sexual function, sexual bother, and urinary function at all time points compared to patients on AS. Differences in mental health between groups were below the threshold for clinical significance at one year. Conclusions This study found no differences in mental health outcomes but worse urinary and sexual HRQoL for RP patients compared to AS patients for up to three years. These data offer support for management of low risk PCa with AS as a means for postponing the morbidity associated with RP without concomitant mental health declines. PMID:25845467

Enhancing the Characterization of Epistemic Uncertainties in PM2.5 Risk Analyses.

PubMed

Smith, Anne E; Gans, Will

2015-03-01

The Environmental Benefits Mapping and Analysis Program (BenMAP) is a software tool developed by the U.S. Environmental Protection Agency (EPA) that is widely used inside and outside of EPA to produce quantitative estimates of public health risks from fine particulate matter (PM2.5 ). This article discusses the purpose and appropriate role of a risk analysis tool to support risk management deliberations, and evaluates the functions of BenMAP in this context. It highlights the importance in quantitative risk analyses of characterization of epistemic uncertainty, or outright lack of knowledge, about the true risk relationships being quantified. This article describes and quantitatively illustrates sensitivities of PM2.5 risk estimates to several key forms of epistemic uncertainty that pervade those calculations: the risk coefficient, shape of the risk function, and the relative toxicity of individual PM2.5 constituents. It also summarizes findings from a review of U.S.-based epidemiological evidence regarding the PM2.5 risk coefficient for mortality from long-term exposure. That review shows that the set of risk coefficients embedded in BenMAP substantially understates the range in the literature. We conclude that BenMAP would more usefully fulfill its role as a risk analysis support tool if its functions were extended to better enable and prompt its users to characterize the epistemic uncertainties in their risk calculations. This requires expanded automatic sensitivity analysis functions and more recognition of the full range of uncertainty in risk coefficients. © 2014 Society for Risk Analysis.

Effectiveness of fuel treatments for mitigating wildfire risk and sequestering forest carbon: a case study in the Lake Tahoe Basin

Treesearch

Louise Loudermilk; Alison Stanton; Robert M. Scheller; Thomas E. Dilts; Peter J. Weisberg; Carl Skinner; Jian Yang

2014-01-01

Fuel-reduction treatments are used extensively to reduce wildfire risk and restore forest diversity and function. In the near future, increasing regulation of carbon (C) emissions may force forest managers to balance the use of fuel treatments for reducing wildfire risk against an alternative goal of C sequestration. The objective of this study was to evaluate how long...

Mitigating risks related to facilities management.

PubMed

O'Neill, Daniel P; Scarborough, Sydney

2013-07-01

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

Modeling Limited Foresight in Water Management Systems

NASA Astrophysics Data System (ADS)

Howitt, R.

2005-12-01

The inability to forecast future water supplies means that their management inevitably occurs under situations of limited foresight. Three modeling problems arise, first what type of objective function is a manager with limited foresight optimizing? Second how can we measure these objectives? Third can objective functions that incorporate uncertainty be integrated within the structure of optimizing water management models? The paper reviews the concepts of relative risk aversion and intertemporal substitution that underlie stochastic dynamic preference functions. Some initial results from the estimation of such functions for four different dam operations in northern California are presented and discussed. It appears that the path of previous water decisions and states influences the decision-makers willingness to trade off water supplies between periods. A compromise modeling approach that incorporates carry-over value functions under limited foresight within a broader net work optimal water management model is developed. The approach uses annual carry-over value functions derived from small dimension stochastic dynamic programs embedded within a larger dimension water allocation network. The disaggregation of the carry-over value functions to the broader network is extended using the space rule concept. Initial results suggest that the solution of such annual nonlinear network optimizations is comparable to, or faster than, the solution of linear network problems over long time series.

Comprehensive quality-of-life outcomes in the setting of a multidisciplinary, equal access prostate cancer clinic.

PubMed

Rice, Kevin; Hudak, Jane; Peay, Kimberly; Elsamanoudi, Sally; Travis, Judith; Lockhart, Robbin; Cullen, Jennifer; Black, Libby; Houge, Susan; Brassell, Stephen

2010-11-01

To identify racial and demographic factors that influence treatment choice and its resulting impact on health-related quality of life (HRQoL) for prostate cancer patients. Patients presenting to an equal access, military, multidisciplinary prostate cancer clinic composed the study group. The Expanded Prostate Cancer Index Composite (EPIC), EPIC Demographic, and Medical Outcomes Study Short Form 36 were the instruments used. Evaluation was performed before treatment and every 3 months after treatment. The study group comprised 665 patients. Caucasians were 3-fold more likely to choose surgery (radical prostatectomy [RP]) over external beam radiation therapy (EBRT). Patients who earned more than $100,000 annually disproportionately chose RP (P < .0001). Similarly, those having a graduate school degree disproportionally chose RP (P < .0001). Patients undergoing RP had the greatest risk of urinary function decline (P < .0001) and sexual bother (P = .0003). African Americans (AA) had a greater risk of urinary function decline irrespective of treatment choice. Patients undergoing EBRT had equivalent urinary function to expectant management (EM) at 12 months (P < .0001). Brachytherapy was the only treatment that posed an increased risk of urinary bother decline when compared with EM (P = .0217). EBRT alone did not show significant decrement in sexual function when compared with EM. RP was chosen by patients of Caucasian ethnicity and patients with higher income and education level, despite providing the greatest risk of HRQoL decline. EBRT had no significant impact on urinary function, sexual function, or sexual bother scores at 12 months. EBRT may be offered to older patients with minimal HRQoL impact. Pretreatment counseling of HRQoL outcomes is essential to overall prostate cancer management. Published by Elsevier Inc.

A Dental Hygienist's and Therapist's Guide to the Management of Tooth Erosion.

PubMed

Ariyanayagam, Yana

2016-08-01

Dental care professionals can support patients to prevent and manage tooth erosion. The role of the dentist is to restore the structure and function of teeth damaged by acid erosion, while the role of the dental hygienist therapist is to work alongside the dentist to help manage and reduce the risk of tooth erosion. This article will highlight how the dental hygienist or therapist can identify tooth erosion. It will describe the features of tooth erosion and outline the causes. This article will discuss preventative care options for patients who are at risk of tooth erosion, including specific oral hygiene instructions, fluoride advice and use of other dental products.

Integrated risk management

NASA Technical Reports Server (NTRS)

Hunsucker, J. L.

1993-01-01

The purpose of this report is to first present a basis or foundation for the building of an integrated risk management plan and them to present the plan. The integration referred to is across both the temporal and the hierarchical dimensions. Complexity, consequence, and credibility seem to be driving the need for the consideration of risk. Reduction of personal bias and reproducibility of the decision making process seem to be driving the consideration of a formal risk plan. While risk can be used as either a selection tool or a control tool, this paper concentrates on the selection usage. Risk relies on stated purpose. The tightness of the definition of purpose and success is directly reflected in the definition and control of risk. Much of a risk management plan could be designed by the answers to the questions of why, what, who, when, and where. However, any plan must provide the following information about a threat or risk: likelihood, consequence, predictability, reliability, and reproducibility. While the environment at NASA is seen as warm, but not hot, for the introduction of a risk program, some encouragement is seen if the following problems are addressed: no champion, no commitment of resource, confused definitions, lack of direction and focus, a hard sell, NASA culture, many choices of assessment methods, and cost. The plan is designed to follow the normal method of doing work and is structured to follow either the work break down structure or a functional structure very well. The parts of the plan include: defining purpose and success, initial threat assessment, initial risk assessment, reconciling threats and parameters, putting part of the information down and factoring the information back into the decision process as it comes back up, and developing inferences. Two major suggestions are presented. One is to build an office of risk management to be used as a resource by managers in doing the risk process. Another is to form a pilot program to try out the details in the plan and modify the method where needed.

Approach to risk identification in undifferentiated mental disorders

PubMed Central

Silveira, José; Rockman, Patricia; Fulford, Casey; Hunter, Jon

2016-01-01

Abstract Objective To provide primary care physicians with a novel approach to risk identification and related clinical decision making in the management of undifferentiated mental disorders. Sources of information We conducted a review of the literature in PubMed, CINAHL, PsycINFO, and Google Scholar using the search terms diagnostic uncertainty, diagnosis, risk identification, risk assessment/methods, risk, risk factors, risk management/methods, cognitive biases and psychiatry, decision making, mental disorders/diagnosis, clinical competence, evidence-based medicine, interviews as topic, psychiatry/education, psychiatry/methods, documentation/methods, forensic psychiatry/education, forensic psychiatry/methods, mental disorders/classification, mental disorders/psychology, violence/prevention and control, and violence/psychology. Main message Mental disorders are a large component of practice in primary care and often present in an undifferentiated manner, remaining so for prolonged periods. The challenging search for a diagnosis can divert attention from risk identification, as diagnosis is commonly presumed to be necessary before treatment can begin. This might inadvertently contribute to preventable adverse events. Focusing on salient aspects of the patient presentation related to risk should be prioritized. This article presents a novel approach to organizing patient information to assist risk identification and decision making in the management of patients with undifferentiated mental disorders. Conclusion A structured approach can help physicians to manage the clinical uncertainty common to risk identification in patients with mental disorders and cope with the common anxiety and cognitive biases that affect priorities in risk-related decision making. By focusing on risk, functional impairments, and related symptoms using a novel framework, physicians can meet their patients’ immediate needs while continuing the search for diagnostic clarity and long-term treatment. PMID:27965330

Approach to risk identification in undifferentiated mental disorders.

PubMed

Silveira, José; Rockman, Patricia; Fulford, Casey; Hunter, Jon

2016-12-01

To provide primary care physicians with a novel approach to risk identification and related clinical decision making in the management of undifferentiated mental disorders. We conducted a review of the literature in PubMed, CINAHL, PsycINFO, and Google Scholar using the search terms diagnostic uncertainty, diagnosis, risk identification, risk assessment/methods, risk, risk factors, risk management/methods, cognitive biases and psychiatry, decision making, mental disorders/diagnosis, clinical competence, evidence-based medicine, interviews as topic, psychiatry/education, psychiatry/methods, documentation/methods, forensic psychiatry/education, forensic psychiatry/methods, mental disorders/classification, mental disorders/psychology, violence/prevention and control, and violence/psychology. Mental disorders are a large component of practice in primary care and often present in an undifferentiated manner, remaining so for prolonged periods. The challenging search for a diagnosis can divert attention from risk identification, as diagnosis is commonly presumed to be necessary before treatment can begin. This might inadvertently contribute to preventable adverse events. Focusing on salient aspects of the patient presentation related to risk should be prioritized. This article presents a novel approach to organizing patient information to assist risk identification and decision making in the management of patients with undifferentiated mental disorders. A structured approach can help physicians to manage the clinical uncertainty common to risk identification in patients with mental disorders and cope with the common anxiety and cognitive biases that affect priorities in risk-related decision making. By focusing on risk, functional impairments, and related symptoms using a novel framework, physicians can meet their patients' immediate needs while continuing the search for diagnostic clarity and long-term treatment. Copyright© the College of Family Physicians of Canada.

Debt-maturity structures should match risk preferences.

PubMed

Gapenski, L C

1999-12-01

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

Older adult awareness of the influence of cardiovascular disease risk factors on cognitive function.

PubMed

Wright, Regina S; Ford, Cassandra; Sniscak, Courtney R

2017-03-01

The aims of the current study were to (i) assess older people's awareness of the association between CVD risk factors and cognitive function; and (ii) examine whether awareness varies as a function of demographic factors. Cardiovascular disease (CVD) risk factors have been linked to subtle deficits in cognitive function. CVD risk factors increase the risk of cognitive decline and dementia. The association between cardiovascular disease (CVD) risk factors and cognitive decrements has been well documented among older people; however, we are unaware of any studies that have measured older people's awareness of this relationship in an effort to assess educational needs. A descriptive, cross-sectional survey design was employed. Community-based older adults aged 60 and older completed a survey that assessed their knowledge of the association between CVD risk factors and cognitive function. One hundred fifty older adults, with a mean age of 72.88 years, completed the survey. Results showed that over 75% of the sample was aware that CVD risk factors affect cognitive function. White older adults and older adults with greater perceived financial well-being tended to be more aware of these relationships than non-White participants with less perceived financial well-being. Results suggest that many, but not all older people have awareness of this relationship. As such, there is a need for increased education about the cognitive effects of CVD risk factors, particularly among older people who are already at risk for developing CVD and those with lesser financial well-being. Appropriate educational strategies can expose older patients to the importance of healthy lifestyle and self-care to maintain cognitive function. Nurses can incorporate education into care by identifying patients that would benefit from tailored interventions and providing information to at-risk patients about how to maintain their cognitive function through management of specific CVD risk factors. © 2016 John Wiley & Sons Ltd.

Management of the ocular surface and tear film before, during, and after laser in situ keratomileusis.

PubMed

Albietz, Julie M; Lenton, Lee M

2004-01-01

To identify evidence-based, best practice strategies for managing the ocular surface and tear film before, during, and after laser in situ keratomileusis (LASIK). After a comprehensive review of relevant published literature, evidence-based recommendations for best practice management strategies are presented. Symptoms of ocular irritation and signs of dysfunction of the integrated lacrimal gland/ocular surface functional gland unit are common before and after LASIK. The status of the ocular surface and tear film before LASIK can impact surgical outcomes in terms of potential complications during and after surgery, refractive outcome, optical quality, patient satisfaction, and the severity and duration of dry eye after LASIK. Before LASIK, the health of the ocular surface should be optimized and patients selected appropriately. Dry eye before surgery and female gender are risk factors for developing chronic dry eye after LASIK. Management of the ocular surface during LASIK can minimize ocular surface damage and the risk of adverse outcomes. Long-term management of the tear film and ocular surface after LASIK can reduce the severity and duration of dry eye symptoms and signs. Strategies to manage the integrated ocular surface/lacrimal gland functional unit before, during, and after LASIK can optimize outcomes. As problems with the ocular surface and tear film are relatively common, attention should focus on the use and improvement of evidence-based management strategies.

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

PubMed

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

2017-04-01

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

Plant sterol enriched functional food and atherosclerosis.

PubMed

Köhler, Jürgen; Teupser, Daniel; Elsässer, Albrecht; Weingärtner, Oliver

2017-06-01

Hypercholesterolaemia is a major cardiovascular risk factor. A healthy diet and a healthy lifestyle reduces cardiovascular risk. 'Functional foods' supplemented with phytosterols are recommended for the management of hypercholesterolaemia and have become a widely used non-prescription approach to lower plasma cholesterol levels. Two billion euros are spent world-wide each year on various functional foods, which have regulator-approved health claims for the management of elevated cholesterol levels. While international societies, such as the European Atherosclerosis Society or the National Heart Foundation in Australia, still advise phytosterols as an additional dietary option in the management of hypercholesterolaemia, recently released guidelines such as those from the National Institute of Health and Clinical Excellence in the United Kingdom are more critical of food supplementation with phytosterols and draw attention to significant safety issues. This review challenges whether an intervention with phytosterol supplements is beneficial. We summarize the current evidence from genetic diseases, genetic association studies, clinical trial data and data from animal studies. This article is part of a themed section on Principles of Pharmacological Research of Nutraceuticals. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.11/issuetoc. © 2017 The British Pharmacological Society.

Plant sterol enriched functional food and atherosclerosis

PubMed Central

Köhler, Jürgen; Teupser, Daniel; Elsässer, Albrecht

2017-01-01

Hypercholesterolaemia is a major cardiovascular risk factor. A healthy diet and a healthy lifestyle reduces cardiovascular risk. ‘Functional foods’ supplemented with phytosterols are recommended for the management of hypercholesterolaemia and have become a widely used non‐prescription approach to lower plasma cholesterol levels. Two billion euros are spent world‐wide each year on various functional foods, which have regulator‐approved health claims for the management of elevated cholesterol levels. While international societies, such as the European Atherosclerosis Society or the National Heart Foundation in Australia, still advise phytosterols as an additional dietary option in the management of hypercholesterolaemia, recently released guidelines such as those from the National Institute of Health and Clinical Excellence in the United Kingdom are more critical of food supplementation with phytosterols and draw attention to significant safety issues. This review challenges whether an intervention with phytosterol supplements is beneficial. We summarize the current evidence from genetic diseases, genetic association studies, clinical trial data and data from animal studies. Linked Articles This article is part of a themed section on Principles of Pharmacological Research of Nutraceuticals. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.11/issuetoc PMID:28253422

Risk Assessment as an Environmental Management Tool: Considerations for Freshwater Wetlands

Treesearch

A. Dennis Lemly

1997-01-01

This paper presents a foundation for improving the risk assessment process for freshwater wetlands. Integrating wetland science, i.e., use of an ecosystem-based approach, is the key concept. Each biotic and abiotic wetland component should be identified and its contribution to ecosystem functions and societal values determined when deciding whether a stressor poses an...

Patient-reported sleep difficulty and cognitive function during the first year of dialysis.

PubMed

Kutner, Nancy G; Zhang, Rebecca; Huang, Yijian; Bliwise, Donald L

2008-01-01

Research in the general population indicates that sleep fragmentation is detrimental for cognitive function, but little attention has been given to this issue in dialysis patients. We hypothesized that patients with self-reported persistent sleep difficulty would have an increased risk of scoring lower on a cognitive function measure at follow-up compared to their score at baseline. Sleep difficulty and cognitive function were reported by a large national patient cohort near the start of dialysis and at a 9- to 12-month follow-up. Logistic regression was used to investigate the risk of scoring lower on a cognitive function measure at follow-up as a function of self-reported sleep difficulty, controlling for patients' sociodemographic, clinical and treatment characteristics, including depressed mood. At follow-up, cognitive function scores were lower among 35.8% of the cohort. Patients with self-reported persistent sleep difficulty had the lowest average cognitive function score. Men with reported persistent sleep difficulty, regardless of presence of depressed mood, had a significantly increased risk of a lower cognitive function score at follow-up. Women with reported persistent sleep difficulty as well as depressed mood had significantly increased risk of a lower cognitive function score. The potential impact of sleep difficulty and depressed mood on the cognitive function of dialysis patients emphasizes the importance of evaluating and treating these risks and highlights the value of continued research to improve our understanding and management of these issues.

40 CFR 33.503 - How does a recipient calculate MBE and WBE participation for reporting purposes?

Code of Federal Regulations, 2011 CFR

2011-07-01

... attributable to the MBE or WBE. If an MBE's or WBE's risk of loss, control or management responsibilities is... ENTERPRISES IN UNITED STATES ENVIRONMENTAL PROTECTION AGENCY PROGRAMS Recordkeeping and Reporting § 33.503 How... performing a commercially useful function: (1) The MBE or WBE must be responsible for the management and...

40 CFR 33.503 - How does a recipient calculate MBE and WBE participation for reporting purposes?

Code of Federal Regulations, 2010 CFR

2010-07-01

... attributable to the MBE or WBE. If an MBE's or WBE's risk of loss, control or management responsibilities is... ENTERPRISES IN UNITED STATES ENVIRONMENTAL PROTECTION AGENCY PROGRAMS Recordkeeping and Reporting § 33.503 How... performing a commercially useful function: (1) The MBE or WBE must be responsible for the management and...

76 FR 31363 - Solicitation for a Cooperative Agreement: Document-Tools in Assessing Inmates' Risks & Needs: The...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-31

... more accurately. This document will be written in the context of inmate behavior management, which is... knowledge of the purpose, functions, and operational complexities of local jails, (2) awareness of the... knowledge of the six elements of inmate behavior management, as defined by NIC, and (4) ability to develop...

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

NASA Astrophysics Data System (ADS)

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

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

A challenge for land and risk managers: differents stakeholders, differents definitions of the risks

NASA Astrophysics Data System (ADS)

Fernandez, M.; Ruegg, J.

2012-04-01

In developing countries, mountain populations and territories are subject to multiple risks and vulnerabilities. In addition, they face even greater challenges than developed countries due to lack of knowledge, resources and technology. There are many different types of actors in society that manage risk at various scales and levels (i.e. engineers, geologists, administrators, land use planners, merchants and local indigenous and non-indigenous people). Because of limited resources and possibilities to reduce all types of risk, these different actors, or 'risk managers' have to choose and compete to prioritize which types of risks to address. This paper addresses a case study from San Cristobal Altaverapaz, Guatemala where a large landslide "Los Chorros", a catastrophic collapse of 6 millions cubic meters of rock, is affecting several communities and one of the country's main west-east access highways. In this case, the government established that the "primary" risk is the landslide, whereas other local stakeholders consider the primary risks to be economic This paper, situated at the cross section between political science, geography and disaster risk management, addresses the social conflict and competition for priorities and solutions for risk management, depending on the group of actors based on the on-going Los Chorros, Guatemala landslide mitigation process. This work is based on the analysis of practices, (Practical Science), policies and institutions in order to understand how the inclusion of multiple stakeholders in determining risk priorities can lead to more sustainable risk management in a given territory. The main objective of this investigation is first to identify and understand the juxtaposition of different readings of the risk equation, usually considered the interface between vulnerability, exposure and hazards. Secondly, it is to analyze the mechanisms of actions taken by various stakeholders, or risk managers. The analysis focuses on the various solutions proposed for reducing vulnerabilities (and consequentially their risks). To resolve a post-disaster situation, the actors prioritize one main type of vulnerability to address a set of vulnerabilities (in a multi-vulnerability context). With this choice, they define their own acceptable risk limits and the type of action that is most relevant. In doing so, they have to determine what elements can be changed and improved and which elements must be considered essential and preserved or the priority variables. These may include: equipment, production facilities, networks, services, modes of production and organizations, etc. or various economic and social capitals upon which individuals and groups rely for recovering from a post-disaster situation. Depending on the actor, certain factors will be will be emphasized over others and these may change over time. Linked with this political, institutional and geographical analysis of risk management, this work also questions who are the legitimate actors and the right criteria to prioritize risk reduction actions using public funds criteria and finally, which motivations are satisfied. In this sense, the challenge for managers of natural hazards is to move from risk management in the strict sense, which focuses mainly on hazards only, to a broader risks management, taking into consideration what is important for society and for the functioning of systems (what have not be vulnerable in a territorial system). In a context where risk and risk management is produced and managed by both formal and informal stakeholders, the main issue is how to engage the various stakeholders and evaluate different priorities of risk in order to determine which actions are best suited for a more balanced approach to risk management. This case study demonstrates that reducing landslide risk is subject to interpretation depending on the stakeholder and the result of priorities, providing on the role of each actor, their needs and range of action with a territory.

Managing cardiovascular risks with Tai Chi in people with coronary artery disease.

PubMed

Park, In Sook; Song, Rhayun; Oh, Kyong Ok; So, Hee Young; Kim, Dal Sook; Kim, Jong Im; Kim, Tae Sook; Kim, Hyun Li; Ahn, Suk Hee

2010-02-01

The paper is a report of the study to determine the effects of the cardiovascular risk management programme with Tai Chi on cardiovascular risks, health behaviours and quality of life in individuals with coronary artery disease. Many eligible patients with coronary artery disease do not participate in programmes for cardiovascular risk management, mainly because of lack of motivation, high cost or limited accessibility. Tai Chi has been introduced by health professionals to promote cardiovascular functioning and quality of life. A quasi-experimental design with a non-equivalent control group was used. Eighty-five people with a mean age of 66 years completed pretest and 6-month follow-up measures in the following three groups: Tai Chi with education (n = 33), Tai Chi only (n = 19) and control (n = 33). Analysis of covariance was used to compare outcome variables with pretest variables as covariates to adjust for baseline differences. The data were collected in 2005-2006. In the Tai-Chi-with-education group there were statistically significant reductions in modifiable cardiovascular risk factors (F = 3.49, P = 0.035) and improvements in health behaviours (F = 6.12, P = 0.003), mental scores (F = 3.96, P = 0.023), and in the role-emotional (F = 7.30, P = 0.001) and vitality (F = 3.81, P = 0.026) dimensions of quality of life. Tai Chi was safely implemented as an alternative form of exercise in a cardiovascular risk management programme. Whether the beneficial effects of Tai Chi in cardiovascular risk management are comparable with those induced by other types of aerobic exercise requires further investigation.

Perceptions of Risk and Vulnerability Following Exposure to a Major Natural Disaster: The Calgary Flood of 2013.

PubMed

Tanner, Alexa; Árvai, Joseph

2018-03-01

Many studies have examined the general public's flood risk perceptions in the aftermath of local and regional flooding. However, relatively few studies have focused on large-scale events that affect tens of thousands of people within an urban center. Similarly, in spite of previous research on flood risks, unresolved questions persist regarding the variables that might influence perceptions of risk and vulnerability, along with management preferences. In light of the opportunities presented by these knowledge gaps, the research reported here examined public perceptions of flood risk and vulnerability, and management preferences, within the city of Calgary in the aftermath of extensive flooding in 2013. Our findings, which come from an online survey of residents, reveal that direct experience with flooding is not a differentiating factor for risk perceptions when comparing evacuees with nonevacuees who might all experience future risks. However, we do find that judgments about vulnerability-as a function of how people perceive physical distance-do differ according to one's evacuation experience. Our results also indicate that concern about climate change is an important predictor of flood risk perceptions, as is trust in government risk managers. In terms of mitigation preferences, our results reveal differences in support for large infrastructure projects based on whether respondents feel they might actually benefit from them. © 2017 Society for Risk Analysis.

Workshop on Aeronautical Decision Making (ADM). Volume 2. Plenary Session with Presentations and Proposed Action Plan

DTIC Science & Technology

1992-08-01

programs have several common functional components dealing with: attention , crew, stress, mental attitude, and risk issues. The role which the five...five interrelated concept areas furnish "rules and tools" to help prevent common errors. For instance: 1. Attention management issues include...pilots must manage his/her attention in a timely manor and sequentially employ the other cockpit management tools (for controlling stress etc.). The text

[The ethics of dental records].

PubMed

Prinsloo, P M

2000-01-01

This article highlights five aspects of necessary record-keeping in practices: ethicolegal requirements, confidentiality and disclosure, risk management and consent, accounts and practice management, and forensic functions. Patient records therefore have ethical, moral, legal and management implications. Unfortunately, they are often underestimated or ignored by practitioners. In the light of increasing litigation and disciplinary hearings, it is necessary to remind practitioners that every clinical action also contains an administrative component which has to fulfill many requirements.

Special Education at the Crossroad: An Identity Crisis and the Need for a Scientific Reconstruction

ERIC Educational Resources Information Center

Kauffman, James M.; Anastasiou, Dimitris; Maag, John W.

2017-01-01

Special education is losing its identity--its visibility, distinctiveness, budget, and basic functions are all at risk. Special education functions include (a) sorting, categorizing, and labeling students who need it; (b) making the right comparisons; (c) honoring diversity but changing "particular" differences; (d) managing stigma; (e)…

Risk-adapted management of pulmonary embolism.

PubMed

Barco, Stefano; Konstantinides, Stavros V

2017-03-01

The presence and severity of right ventricular (RV) dysfunction is a key determinant of prognosis in the acute phase of pulmonary embolism (PE). Risk-adapted treatment strategies continue to evolve, tailoring initial management to the clinical presentation and the functional status of the RV. Beyond pharmacological and, if necessary, mechanical circulatory support, systemic thrombolysis remains the mainstay of treatment for hemodynamically unstable patients; in contrast, it is not routinely recommended for intermediate-risk PE. Catheter-directed pharmacomechanical reperfusion treatment represents a promising option for minimizing bleeding risk; for reduced-dose intravenous thrombolysis, the data are still preliminary. Non-vitamin K-dependent oral anticoagulants, directly inhibiting factor Xa (rivaroxaban, apixaban, edoxaban) or thrombin (dabigatran), have simplified initial and long-term anticoagulation for PE while reducing major bleeding risk. Use of vena cava filters should be restricted to selected patients with absolute contraindications to anticoagulation, or PE recurrence despite adequately dosed anticoagulants. © 2017 Elsevier Ltd. All rights reserved.

Nurse practitioners: leadership behaviors and organizational climate.

PubMed

Jones, L C; Guberski, T D; Soeken, K L

1990-01-01

The purpose of this article is to examine the relationships of individual nurse practitioners' perceptions of the leadership climate in their organizations and self-reported formal and informal leadership behaviors. The nine climate dimensions (Structure, Responsibility, Reward, Perceived Support of Risk Taking, Warmth, Support, Standard Setting, Conflict, and Identity) identified by Litwin and Stringer in 1968 were used to predict five leadership dimensions (Meeting Organizational Needs, Managing Resources, Leadership Competence, Task Accomplishment, and Communications). Demographic variables of age, educational level, and percent of time spent performing administrative functions were forced as a first step in each multiple regression analysis and used to explain a significant amount of variance in all but one analysis. All leadership dimensions were predicted by at least one organizational climate dimension: (1) Meeting Organizational Needs by Risk and Reward; (2) Managing Resources by Risk and Structure; (3) Leadership Competence by Risk and Standards; (4) Task Accomplishment by Structure, Risk, and Standards; and (5) Communication by Rewards.

Flood Risk and Probabilistic Benefit Assessment to Support Management of Flood-Prone Lands: Evidence From Candaba Floodplains, Philippines

NASA Astrophysics Data System (ADS)

Juarez, A. M.; Kibler, K. M.; Sayama, T.; Ohara, M.

2016-12-01

Flood management decision-making is often supported by risk assessment, which may overlook the role of coping capacity and the potential benefits derived from direct use of flood-prone land. Alternatively, risk-benefit analysis can support floodplain management to yield maximum socio-ecological benefits for the minimum flood risk. We evaluate flood risk-probabilistic benefit tradeoffs of livelihood practices compatible with direct human use of flood-prone land (agriculture/wild fisheries) and nature conservation (wild fisheries only) in Candaba, Philippines. Located north-west to Metro Manila, Candaba area is a multi-functional landscape that provides a temporally-variable mix of possible land uses, benefits and ecosystem services of local and regional value. To characterize inundation from 1.3- to 100-year recurrence intervals we couple frequency analysis with rainfall-runoff-inundation modelling and remotely-sensed data. By combining simulated probabilistic floods with both damage and benefit functions (e.g. fish capture and rice yield with flood intensity) we estimate potential damages and benefits over varying probabilistic flood hazards. We find that although direct human uses of flood-prone land are associated with damages, for all the investigated magnitudes of flood events with different frequencies, the probabilistic benefits ( 91 million) exceed risks by a large margin ( 33 million). Even considering risk, probabilistic livelihood benefits of direct human uses far exceed benefits provided by scenarios that exclude direct "risky" human uses (difference of 85 million). In addition, we find that individual coping strategies, such as adapting crop planting periods to the flood pulse or fishing rather than cultivating rice in the wet season, minimize flood losses ( 6 million) while allowing for valuable livelihood benefits ($ 125 million) in flood-prone land. Analysis of societal benefits and local capacities to cope with regular floods demonstrate the relevance of accounting for the full range of flood events and their relation to both potential damages and benefits in risk assessments. Management measures may thus be designed to reflect local contexts and support benefits of natural hydrologic processes, while minimizing flood damage.

Effect of a multifactorial fall-and-fracture risk assessment and management program on gait and balance performances and disability in hospitalized older adults: a controlled study.

PubMed

Trombetti, A; Hars, M; Herrmann, F; Rizzoli, R; Ferrari, S

2013-03-01

This controlled intervention study in hospitalized oldest old adults showed that a multifactorial fall-and-fracture risk assessment and management program, applied in a dedicated geriatric hospital unit, was effective in improving fall-related physical and functional performances and the level of independence in activities of daily living in high-risk patients. Hospitalization affords a major opportunity for interdisciplinary cooperation to manage fall-and-fracture risk factors in older adults. This study aimed at assessing the effects on physical performances and the level of independence in activities of daily living (ADL) of a multifactorial fall-and-fracture risk assessment and management program applied in a geriatric hospital setting. A controlled intervention study was conducted among 122 geriatric inpatients (mean ± SD age, 84 ± 7 years) admitted with a fall-related diagnosis. Among them, 92 were admitted to a dedicated unit and enrolled into a multifactorial intervention program, including intensive targeted exercise. Thirty patients who received standard usual care in a general geriatric unit formed the control group. Primary outcomes included gait and balance performances and the level of independence in ADL measured 12 ± 6 days apart. Secondary outcomes included length of stay, incidence of in-hospital falls, hospital readmission, and mortality rates. Compared to the usual care group, the intervention group had significant improvements in Timed Up and Go (adjusted mean difference [AMD] = -3.7s; 95 % CI = -6.8 to -0.7; P = 0.017), Tinetti (AMD = -1.4; 95 % CI = -2.1 to -0.8; P < 0.001), and Functional Independence Measure (AMD = 6.5; 95 %CI = 0.7-12.3; P = 0.027) test performances, as well as in several gait parameters (P < 0.05). Furthermore, this program favorably impacted adverse outcomes including hospital readmission (hazard ratio = 0.3; 95 % CI = 0.1-0.9; P = 0.02). A multifactorial fall-and-fracture risk-based intervention program, applied in a dedicated geriatric hospital unit, was effective and more beneficial than usual care in improving physical parameters related to the risk of fall and disability among high-risk oldest old patients.

Potential oil spill risk from shipping and the implications for management in the Caribbean Sea.

PubMed

Singh, Asha; Asmath, Hamish; Chee, Candice Leung; Darsan, Junior

2015-04-15

The semi enclosed Caribbean Sea is ranked as having one of the most intense maritime traffic in the world. These maritime activities have led to significant oil pollution. Simultaneously, this sea supports many critical habitats functioning as a Large Marine Ecosystem (LME). While the impacts of oil pollution are recognised, a number of management challenges remain. This study applies spatial modelling to identify critical areas potentially at risk from oil spills in the form of a potential oil spill risk (POSR) model. The model indicates that approximately 83% of the sea could be potentially impacted by oil spills due to shipping. The results from this study collectively support a management framework for minimising ship generated oil pollution in the Caribbean Sea. Among the recommended components are a common policy, surveillance and monitoring controls, standards, monitoring programmes, data collection and greater rates of convention ratifications. Copyright © 2015 Elsevier Ltd. All rights reserved.

Integrated risk and recovery monitoring of ecosystem restorations on contaminated sites

USGS Publications Warehouse

Hooper, Michael J.; Glomb, Stephen J.; Harper, David; Hoelzle, Timothy B.; McIntosh, Lisa M.; Mulligan, David R.

2016-01-01

Ecological restorations of contaminated sites balance the human and ecological risks of residual contamination with the benefits of ecological recovery and the return of lost ecological function and ecosystem services. Risk and recovery are interrelated dynamic conditions, changing as remediation and restoration activities progress through implementation into long-term management and ecosystem maturation. Monitoring restoration progress provides data critical to minimizing residual contaminant risk and uncertainty, while measuring ecological advancement toward recovery goals. Effective monitoring plans are designed concurrently with restoration plan development and implementation and are focused on assessing the effectiveness of activities performed in support of restoration goals for the site. Physical, chemical, and biotic measures characterize progress toward desired structural and functional ecosystem components of the goals. Structural metrics, linked to ecosystem functions and services, inform restoration practitioners of work plan modifications or more substantial adaptive management actions necessary to maintain desired recovery. Monitoring frequency, duration, and scale depend on specific attributes and goals of the restoration project. Often tied to restoration milestones, critical assessment of monitoring metrics ensures attainment of risk minimization and ecosystem recovery. Finally, interpretation and communication of monitoring findings inform and engage regulators, other stakeholders, the scientific community, and the public. Because restoration activities will likely cease before full ecosystem recovery, monitoring endpoints should demonstrate risk reduction and a successional trajectory toward the condition established in the restoration goals. A detailed assessment of the completed project's achievements, as well as unrealized objectives, attained through project monitoring, will determine if contaminant risk has been minimized, if injured resources have recovered, and if ecosystem services have been returned. Such retrospective analysis will allow better planning for future restoration goals and strengthen the evidence base for quantifying injuries and damages at other sites in the future.

ISPD Cardiovascular and Metabolic Guidelines in Adult Peritoneal Dialysis Patients Part I - Assessment and Management of Various Cardiovascular Risk Factors.

PubMed

Wang, Angela Yee Moon; Brimble, K Scott; Brunier, Gillian; Holt, Stephen G; Jha, Vivekanand; Johnson, David W; Kang, Shin-Wook; Kooman, Jeroen P; Lambie, Mark; McIntyre, Chris; Mehrotra, Rajnish; Pecoits-Filho, Roberto

2015-01-01

Cardiovascular disease contributes significantly to the adverse clinical outcomes of peritoneal dialysis (PD) patients. Numerous cardiovascular risk factors play important roles in the development of various cardiovascular complications. Of these, loss of residual renal function is regarded as one of the key cardiovascular risk factors and is associated with an increased mortality and cardiovascular death. It is also recognized that PD solutions may incur significant adverse metabolic effects in PD patients. The International Society for Peritoneal Dialysis (ISPD) commissioned a global workgroup in 2012 to formulate a series of recommendations regarding lifestyle modification, assessment and management of various cardiovascular risk factors, as well as management of the various cardiovascular complications including coronary artery disease, heart failure, arrhythmia (specifically atrial fibrillation), cerebrovascular disease, peripheral arterial disease and sudden cardiac death, to be published in 2 guideline documents. This publication forms the first part of the guideline documents and includes recommendations on assessment and management of various cardiovascular risk factors. The documents are intended to serve as a global clinical practice guideline for clinicians who look after PD patients. The ISPD workgroup also identifies areas where evidence is lacking and further research is needed. Copyright © 2015 International Society for Peritoneal Dialysis.

How short should short-term risk assessment be? Determining the optimum interval for START reassessment in a secure mental health service.

PubMed

Dickens, G L; O'Shea, L E

2015-08-01

The Short-Term Assessment of Risk and Treatability (START) is a tool used in some mental health services to assess patients to see if they are at risk of violence, self-harm, self-neglect or victimization. The recommended time between assessments is 3 months but there is currently no evidence to show that this is best practice. We have investigated whether assessing at 1- or 2-month intervals would be more accurate and therefore facilitate more individualized risk management interventions. We found that many patients who were rated as low risk had been involved in risk behaviours before 3 months had passed; some patients who were rated at increased risk did not get involved in risk behaviours at all. Results are mixed for different outcomes but on balance, we think that the recommendation to conduct START assessment every 3 months is supported by the evidence. However, reassessment should be considered if risk behaviours are not prevented and teams should always consider whether risk management practices are too restrictive. The Short-Term Assessment of Risk and Treatability (START) guides assessment of potential adverse outcomes. Assessment is recommended every 3 months but there is no evidence for this interval. We aimed to inform whether earlier reassessment was warranted. We collated START assessments for N = 217 adults in a secure mental health hospital, and subsequent aggressive, self-harm, self-neglect and victimization incidents. We used receiver operating characteristic analysis to assess predictive validity; survival function analysis to examine differences between low-, medium-, and high-risk groups; and hazard function analysis to determine the optimum interval for reassessment. The START predicted aggression and self-harm at 1, 2 and 3 months. At-risk individuals engaged in adverse outcomes earlier than low-risk patients. About half warranted reassessment before 3 months due to engagement in risk behaviour before that point despite a low-risk rating, or because of non-engagement by that point despite an elevated risk rating. Risk assessment should occur at appropriate intervals so that management strategies can be individually tailored. Assessment at 3-month intervals is supported by the evidence. START assessments should be revisited earlier if risk behaviours are not prevented; teams should constantly re-evaluate the need for restrictive practices. © 2015 John Wiley & Sons Ltd.

Integrated wildfire risk assessment: framework development and application on the Lewis and Clark National Forest in Montana, USA.

PubMed

Thompson, Matthew P; Scott, Joe; Helmbrecht, Don; Calkin, Dave E

2013-04-01

The financial, socioeconomic, and ecological impacts of wildfire continue to challenge federal land management agencies in the United States. In recent years, policymakers and managers have increasingly turned to the field of risk analysis to better manage wildfires and to mitigate losses to highly valued resources and assets (HVRAs). Assessing wildfire risk entails the interaction of multiple components, including integrating wildfire simulation outputs with geospatial identification of HVRAs and the characterization of fire effects to HVRAs. We present an integrated and systematic risk assessment framework that entails 3 primary analytical components: 1) stochastic wildfire simulation and burn probability modeling to characterize wildfire hazard, 2) expert-based modeling to characterize fire effects, and 3) multicriteria decision analysis to characterize preference structures across at-risk HVRAs. We demonstrate application of this framework for a wildfire risk assessment performed on the Little Belts Assessment Area within the Lewis and Clark National Forest in Montana, United States. We devote particular attention to our approach to eliciting and encapsulating expert judgment, in which we: 1) adhered to a structured process for using expert judgment in ecological risk assessment, 2) used as our expert base local resource scientists and fire/fuels specialists who have a direct connection to the specific landscape and HVRAs in question, and 3) introduced multivariate response functions to characterize fire effects to HVRAs that consider biophysical variables beyond fire behavior. We anticipate that this work will further the state of wildfire risk science and will lead to additional application of risk assessment to inform land management planning. Copyright © 2012 SETAC.

Long-term efficacy of a rural community-based integrated intervention for prevention and management of chronic obstructive pulmonary disease: a cluster randomized controlled trial in China's rural areas.

PubMed

Yuan, X; Tao, Y; Zhao, J P; Liu, X S; Xiong, W N; Xie, J G; Ni, W; Xu, Y J; Liu, H G

2015-11-01

This study aimed to assess the efficacy of a rural community-based integrated intervention for early prevention and management of chronic obstructive pulmonary disease (COPD) in China. This 18-year cluster-randomized controlled trial encompassing 15 villages included 1008 patients (454 men and 40 women in the intervention group [mean age, 54 ± 10 years]; 482 men and 32 women in the control group [mean age, 53 ± 10 years]) with confirmed COPD or at risk for COPD. Villages were randomly assigned to the intervention or the control group, and study participants residing within the villages received treatment accordingly. Intervention group patients took part in a program that included systematic health education, smoking cessation counseling, and education on management of COPD. Control group patients received usual care. The groups were compared after 18 years regarding the incidence of COPD, decline in lung function, and mortality of COPD. COPD incidence was lower in the intervention group than in the control group (10% vs 16%, <0.05). A decline in lung function was also significantly delayed in the intervention group compared to the control group of COPD and high-risk patients. The intervention group showed significant improvement in smoking cessation compared with the control group, and smokers in the intervention group had lower smoking indices than in the control group (350 vs 450, <0.05). The intervention group also had a significantly lower cumulative COPD-related death rate than the control group (37% vs 47%, <0.05). A rural community-based integrated intervention is effective in reducing the incidence of COPD among those at risk, delaying a decline in lung function in COPD patients and those at risk, and reducing mortality of COPD.

How do I manage an acute injury to the facial nerve?

PubMed

Colbert, Serryth; Coombes, Daryl; Godden, Daryl; Cascarini, Luke; Kerawala, Cyrus; Brennan, Peter A

2014-01-01

Paralysis of the facial nerve is a cause of considerable functional and aesthetic disfigurement. Damage to the upper trunk can result in eye complications with the risk of exposure keratitis. Numerous factors influence the therapeutic strategy: the cause of the injury, the time elapsed since injury, functional impairment, and the likelihood of recovery. We discuss the management of an acute injury to the facial nerve and focus on the surgical options. Copyright © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Between Oais and Agile a Dynamic Data Management Approach

NASA Astrophysics Data System (ADS)

Bennett, V. L.; Conway, E. A.; Waterfall, A. M.; Pepler, S.

2015-12-01

In this paper we decribe an approach to the integration of existing archival activities which lies between compliance with the more rigid OAIS/TRAC standards and a more flexible "Agile" approach to the curation and preservation of Earth Observation data. We provide a high level overview of existing practice and discuss how these procedures can be extended and supported through the description of preservation state. The aim of which is to facilitate the dynamic controlled management of scientific data through its lifecycle. While processes are considered they are not statically defined but rather driven by human interactions in the form of risk management/review procedure that produce actionable plans, which are responsive to change. We then proceed by describing the feasibility testing of extended risk management and planning procedures which integrate current practices. This was done through the CEDA Archival Format Audit which inspected British Atmospheric Data Centre and NERC Earth Observation Data Centre Archival holdings. These holdings are extensive, comprising of around 2 Petabytes of data and 137 million individual files, which were analysed and characterised in terms of format, based risk. We are then able to present an overview of the format based risk burden faced by a large scale archive attempting to maintain the usability of heterogeneous environmental data sets We continue by presenting a dynamic data management information model and provide discussion of the following core model entities and their relationships: Aspirational entities, which include Data Entity definitions and their associated Preservation Objectives. Risk entities, which act as drivers for change within the data lifecycle. These include Acquisitional Risks, Technical Risks, Strategic Risks and External Risks Plan entities, which detail the actions to bring about change within an archive. These include Acquisition Plans, Preservation Plans and Monitoring plans which support responsive interactions with the community. The Result entities describe the outcomes of the plans. This includes Acquisitions. Mitigations and Accepted Risks. With risk acceptance permitting imperfect but functional solutions that can be realistically supported within an archives resource levels

Megacity Indicator System for Disaster Risk Management in Istanbul (MegaIST)

NASA Astrophysics Data System (ADS)

Yahya Menteşe, Emin; Kılıç, Osman; Baş, Mahmut; Khazai, Bijan; Ergün Konukcu, Betul; Emre Basmacı, Ahmet

2017-04-01

Decision makers need tools to understand the priorities and to set up benchmarks and track progress in their disaster risk reduction activities, so that they can justify their decisions and investments. In this regard, Megacity Indicator System for Disaster Risk Management (MegaIST), is developed in order to be used in disaster risk management studies, for decision makers and managers to establish right strategies and proper risk reduction actions, enhance resource management and investment decisions, set priorities, monitor progress in DRM and validate decisions taken with the aim of helping disaster oriented urban redevelopment, inform investors about risk profile of the city and providing a basis for dissemination and sharing of risk components with related stakeholders; by Directorate of Earthquake and Ground Research of Istanbul Metropolitan Municipality (IMM). MegaIST achieves these goals by analyzing the earthquake risk in three separate but complementary sub-categories consisting of "urban seismic risk, coping capacity and disaster risk management index" in an integrated way. MegaIST model fosters its analyses by presenting the outputs in a simple and user friendly format benefiting from GIS technology that ensures the adoptability of the model's use. Urban seismic risk analysis includes two components, namely; Physical Risk and Social Vulnerability Analysis. Physical risk analysis is based on the possible physical losses (such as building damage, casualties etc.) due to an earthquake while social vulnerability is considered as a factor that increases the results of the physical losses in correlation with the level of education, health, economic status and disaster awareness/preparedness of society. Coping capacity analysis is carried out with the aim of understanding the readiness of the Municipality to respond and recover from a disaster in Istanbul can be defined both in terms of the Municipality's operational capacities - the capacity of the Municipality in terms of the demand on its resources to respond to emergencies and restore services - as well as functional capacities - the policies and planning measures at the Municipality which lead to reduction of risk and protection of people. Disaster Risk Management Index (DRMI) is used as "control system" within the conceptual framework of MegaIST. This index has been developed to understand impact of corporate governance and enforcement structures and policies on total Urban Seismic Risk and in order to make the performance evaluation. Also, DRMI is composed of macro indicators that are developed in order to monitor progress in reducing disaster risk management of institution. They are presented in four broad indicator groups: Legal and Institutional Requirements, Risk Reduction Implementation and Preparedness Activities, Readiness to Respond and Recover, and Strategy and Coordination. As a result; in MegaIST, with the identification and analysis of physical and social vulnerabilities along with coping capacity and disaster risk management performance indicators; an integrated and analytical decision support system has been established to enhance DRM process and reach to a disaster resilient urban environment.

Pre-operative endoscopic ultrasonography can optimise the management of patients undergoing laparoscopic cholecystectomy with abnormal liver function tests as the sole risk factor for choledocholithiasis: a prospective study.

PubMed

Meroni, E; Bisagni, P; Bona, S; Fumagalli, U; Zago, M; Rosati, R; Malesci, A

2004-01-01

Pre-operative endosonography has been proposed as a cost-effective procedure in the management of patients who undergo laparoscopic cholecystectomy having an intermediate risk of common bile duct stones. We prospectively evaluated the impact of pre-operative endosonography on the management of patients facing laparoscopic cholecystectomy with abnormal liver function tests as the sole risk factor for choledocolithiasis. Among 587 consecutive patients scheduled for laparoscopic cholecystectomy, 47 (8%) patients having one or more abnormal liver function tests but a normal appearance of common bile duct at abdominal ultrasound, underwent pre-operative endosonography. In patients with endosonography-detected common bile duct stones, a pre-operative endoscopic retrograde cholangiography was performed, or an intra-operative endoscopic retrograde cholangiography was scheduled. In all endosonography-negative patients, an intra-operative trans-cystic cholangiography was performed. Endosonography detected common bile duct stones in nine patients (19%) but only in five of them stones were radiologically confirmed (PPV 0.55). Endosonography-detected stones were confirmed in four of four (100%) patients in whom cholangiography was performed within 1 week, but only in one of five (20%) patients in whom radiology was further delayed (P < 0.05). In three of four cases (75%), stones detected at endosonography but not confirmed at X-rays, were smaller than 2.0 mm. Among 38 patients with negative endosonography, common bile duct stones were found in two patients (NPV 0.95), whereas unplanned endoscopic stone extraction was needed only in one patient (NPV 0.97). Pre-operative endosonography can spare unnecessary pre-operative endoscopic retrograde cholangiography as well as inappropriate scheduling of intra-operative endoscopic retrograde cholangiography in patients undergoing laparoscopic cholecystectomy with abnormal liver function tests. To maximise the impact of endosonography on the management of these patients, the procedure should be performed immediately before laparoscopic cholecystectomy.

Imaging in children with unilateral ureteropelvic junction obstruction: time to reduce investigations?

PubMed

Abadir, Nadin; Schmidt, Maria; Laube, Guido F; Weitz, Marcus

2017-09-01

The objective of the study was the development of an abridged risk-stratified imaging algorithm for the management of children with unilateral ureteropelvic junction obstruction (UPJO). Data on timing, frequency and duration of diagnostic imaging in children with unilateral UPJO was extracted retrospectively. Based on these findings, an abridged imaging algorithm was developed without changing the intended management by the clinicians and the outcome of the individual patient. The potential reduction of imaging studies was analysed and stratified by risk and management groups. The reduction in imaging studies, seen for ultrasound (US) and functional imaging (FI), was 45% each. On average, this is equivalent to 3 US and 1 FI studies less for every patient within the study period. The change was more pronounced in the low-risk groups. Progression of UPJO never occurred after 2 years of age and all secondary surgeries were carried out until the age of 3. Although our findings need to be validated by further prospective research, the developed imaging algorithm represents a risk-stratified approach towards less imaging studies in children with unilateral UPJO, and a follow-up beyond 3 years of age should be considered only in selected cases at the discretion of the clinician. What is Known: • ultrasound and functional imaging represent an integral part of therapeutic decision-making in children with unilateral ureteropelvic junction obstruction • imaging studies cannot accurately assess which patients are in need of surgical intervention, therefore close, serial imaging is preferred What is New: • a new, risk-stratified imaging algorithm was developed for the first 3 years of life • applying this algorithm could lead to a considerable reduction of imaging studies, and also the associated risks and health-care costs.

The role and functionality of Veterinary Services in food safety throughout the food chain.

PubMed

McKenzie, A I; Hathaway, S C

2006-08-01

Both national Veterinary Services and international standard-setting organisations have now embraced risk assessment as an essential tool for achieving their goals. Veterinarians have key roles in all aspects of the control of food-borne hazards of animal origin, but additional specialist skills are necessary for assessing, managing and communicating risk. Further, the deployment of Veterinary Services must reflect the multi-functional aspects of public and animal health activities. A generic risk management framework provides a systematic process whereby food safety standards and other measures are chosen and implemented on the basis of knowledge of risk and evaluation of other factors relevant to protecting human health and promoting non-discriminatory trade practices. In this context, a number of countries are exploring new administrative and structural arrangements for competent authorities. The traditional focus of veterinary involvement in food safety has been in meat hygiene at the level of the slaughterhouse. While this role continues, the emerging 'risk-based' approach to food control requires increased involvement in other segments of the meat food chain, as well as other areas such as production of milk and fish. This more extensive role requires a wider skill base and establishment of effective networks with a different range of stakeholders.

A Bayesian network model to assess the public health risk associated with wet weather sewer overflows discharging into waterways.

PubMed

Goulding, R; Jayasuriya, N; Horan, E

2012-10-15

Overflows from sanitary sewers during wet weather, which occur when the hydraulic capacity of the sewer system is exceeded, are considered a potential threat to the ecological and public health of the waterways which receive these overflows. As a result, water retailers in Australia and internationally commit significant resources to manage and abate sewer overflows. However, whilst some studies have contributed to an increased understanding of the impacts and risks associated with these events, they are relatively few in number and there still is a general lack of knowledge in this area. A Bayesian network model to assess the public health risk associated with wet weather sewer overflows is presented in this paper. The Bayesian network approach is shown to provide significant benefits in the assessment of public health risks associated with wet weather sewer overflows. In particular, the ability for the model to account for the uncertainty inherent in sewer overflow events and subsequent impacts through the use of probabilities is a valuable function. In addition, the paper highlights the benefits of the probabilistic inference function of the Bayesian network in prioritising management options to minimise public health risks associated with sewer overflows. Copyright © 2012. Published by Elsevier Ltd.

Anterior Shoulder Instability in the Military Athlete.

PubMed

Waterman, Brian; Owens, Brett D; Tokish, John M

Given its young, predominately male demographics and intense physical demands, the US military remains an ideal cohort for the study of anterior shoulder instability. A literature search of PubMed, MEDLINE, and the Cochrane Database was performed to identify all peer-reviewed publications from 1950 to 2016 from US military orthopaedic surgeons focusing on the management of anterior shoulder instability. Clinical review. Level 4. The incidence of anterior shoulder instability events in the military occurs at an order of magnitude greater than in civilian populations, with rates as high as 3% per year among high-risk groups. With more than 90% risk of a Bankart lesion and high risk for instability recurrence, the military has advocated for early intervention of first-time shoulder instability while documenting up to 76% relative risk reduction versus nonoperative treatment. Preoperative evaluation with advanced radiographic imaging should be used to evaluate for attritional bone loss or "off-track" engaging defects to guide comprehensive surgical management. With complex recurrent shoulder instability and/or cases of clinically significant osseous lesions, potential options such as remplissage, anterior open capsular procedures, or bone augmentation procedures may be preferentially considered. Careful risk stratification, clinical evaluation, and selective surgical management for at-risk military patients with anterior shoulder instability can optimize the recurrence risk and functional outcome in this population.

Parental Responses to Infant Crying: The Influence of Child Physical Abuse Risk and Hostile Priming

ERIC Educational Resources Information Center

Crouch, Julie L.; Skowronski, John J.; Milner, Joel S.; Harris, Benjamin

2008-01-01

Objective: Managing a crying infant is a challenge universally faced by new parents. This study examined whether parental interpretations, feelings, and behaviors following exposure to a 2-minute videotaped segment of a crying infant varied as a function of child physical abuse (CPA) risk and exposure to cues of hostility (i.e., hostile priming).…

[Barriers and challenges of the functional healthcare risk management units in hospitals of Madrid health service].

PubMed

Pardo-Hernández, A; Navarro-Royo, C; Arguedas-Sanz, R; Albeniz-Lizarraga, C; Morón-Merchante, J

2014-01-01

To identify the barriers and challenges for the effective development of risk management units in hospitals of the Madrid Health Service. Descriptive cross-sectional study aimed at the management teams and members of the functional units of 31 hospitals in the Madrid Health Service. A self-administered questionnaire requesting answers in free text was used, identifying up to five barriers and challenges, and their prioritization by awarding from 1-5 points according to their importance. A discourse analysis was then conducted, grouping common themes and sorting them according to their score. The overall response rate was 94%. The most frequently identified barriers were lack of time (21%), inadequate safety culture (13%), lack of publication of their activities (10%), and lack of training (10%). The most important challenge was developing the training (18%), followed by improving the culture (17%), communication of safety activities (11%), and achieve leadership from the managers of the services (11%). According to the study conditions, the main identified barrier identified was the lack of available time, and the principal challenge found was promoting a proactive learning culture. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

An Information Architect's View of Earth Observations for Disaster Risk Management

NASA Astrophysics Data System (ADS)

Moe, K.; Evans, J. D.; Cappelaere, P. G.; Frye, S. W.; Mandl, D.; Dobbs, K. E.

2014-12-01

Satellite observations play a significant role in supporting disaster response and risk management, however data complexity is a barrier to broader use especially by the public. In December 2013 the Committee on Earth Observation Satellites Working Group on Information Systems and Services documented a high-level reference model for the use of Earth observation satellites and associated products to support disaster risk management within the Global Earth Observation System of Systems context. The enterprise architecture identified the important role of user access to all key functions supporting situational awareness and decision-making. This paper focuses on the need to develop actionable information products from these Earth observations to simplify the discovery, access and use of tailored products. To this end, our team has developed an Open GeoSocial API proof-of-concept for GEOSS. We envision public access to mobile apps available on smart phones using common browsers where users can set up a profile and specify a region of interest for monitoring events such as floods and landslides. Information about susceptibility and weather forecasts about flood risks can be accessed. Users can generate geo-located information and photos of local events, and these can be shared on social media. The information architecture can address usability challenges to transform sensor data into actionable information, based on the terminology of the emergency management community responsible for informing the public. This paper describes the approach to collecting relevant material from the disasters and risk management community to address the end user needs for information. The resulting information architecture addresses the structural design of the shared information in the disasters and risk management enterprise. Key challenges are organizing and labeling information to support both online user communities and machine-to-machine processing for automated product generation.

[Management of vascular risk factors in patients older than 80].

PubMed

Gómez-Huelgas, Ricardo; Martínez-Sellés, Manuel; Formiga, Francesc; Alemán Sánchez, José Juan; Camafort, Miguel; Galve, Enrique; Gil, Pedro; Lobos, José María

2014-08-04

The number of patients older than 80 years is steadily increasing and it represents the main basis for increasing population figures in developed countries. Cardiovascular diseases are the leading causes of mortality and disability causes result in a huge burden of disease in elderly people. However, available scientific evidence to support decision-making on cardiovascular prevention in elderly patients is scarce. Currently available risk assessment scales cannot be applied to elderly people. They are focused on cardiovascular mortality risk and do not provide information on factors with a proven prognostic value in the very old (functioning disability, dementia). Elderly people are a highly heterogeneous population, with a variety of co-morbidities, as well as several functional and cognitive impairment degrees. Furthermore, aging-associated physiological changes and common use of multiple drugs result in an increased risk of adverse drug reactions. Thus, drug use should always be based on a risk/benefit assessment in the elderly. Therefore, therapeutic decision-making in the very old must be an individually tailored and based on an appropriate clinical judgement and a comprehensive geriatric assessment. The current consensus report aims to present a proposal for clinical practices in the primary and secondary cardiovascular prevention in the very old and to provide a number of recommendations on lifestyle changes and drug therapy for the management of major cardiovascular risk factors. Copyright © 2014 Elsevier España, S.L. All rights reserved.

MERINOVA: Meteorological risks as drivers of environmental innovation in agro-ecosystem management

NASA Astrophysics Data System (ADS)

Gobin, Anne; Oger, Robert; Marlier, Catherine; Van De Vijver, Hans; Vandermeulen, Valerie; Van Huylenbroeck, Guido; Zamani, Sepideh; Curnel, Yannick; Mettepenningen, Evi

2013-04-01

The BELSPO funded project 'MERINOVA' deals with risks associated with extreme weather phenomena and with risks of biological origin such as pests and diseases. The major objectives of the proposed project are to characterise extreme meteorological events, assess the impact on Belgian agro-ecosystems, characterise their vulnerability and resilience to these events, and explore innovative adaptation options to agricultural risk management. The project comprises of five major parts that reflect the chain of risks: (i) Hazard: Assessing the likely frequency and magnitude of extreme meteorological events by means of probability density functions; (ii) Impact: Analysing the potential bio-physical and socio-economic impact of extreme weather events on agro-ecosystems in Belgium using process-based modelling techniques commensurate with the regional scale; (iii) Vulnerability: Identifying the most vulnerable agro-ecosystems using fuzzy multi-criteria and spatial analysis; (iv) Risk Management: Uncovering innovative risk management and adaptation options using actor-network theory and fuzzy cognitive mapping techniques; and, (v) Communication: Communicating to research, policy and practitioner communities using web-based techniques. The different tasks of the MERINOVA project require expertise in several scientific disciplines: meteorology, statistics, spatial database management, agronomy, bio-physical impact modelling, socio-economic modelling, actor-network theory, fuzzy cognitive mapping techniques. These expertises are shared by the four scientific partners who each lead one work package. The MERINOVA project will concentrate on promoting a robust and flexible framework by demonstrating its performance across Belgian agro-ecosystems, and by ensuring its relevance to policy makers and practitioners. Impacts developed from physically based models will not only provide information on the state of the damage at any given time, but also assist in understanding the links between different factors causing damage and determining bio-physical vulnerability. Socio-economic impacts will enlarge the basis for vulnerability mapping, risk management and adaptation options. A strong expert and end-user network will be established to help disseminating and exploiting project results to meet user needs.

Managing Water-Food-Energy Futures in the Canadian Prairies

NASA Astrophysics Data System (ADS)

Wheater, H. S.; Hassanzadeh, E.; Nazemi, A.; Elshorbagy, A. A.

2016-12-01

The water-food-energy nexus is a convenient phrase to highlight competing societal uses for water and the need for cross-sectoral policy integration, but this can lead to oversimplification of the multiple dimensions of water (and energy) management. In practice, water managers must balance (and prioritize) demands for water for many uses, including environmental flows, and reservoir operation often involves managing conflicting demands, for example to maximize retention for supply, reduce storage to facilitate flood control, and constrain water levels and releases for habitat protection. Agriculture and water quality are also inextricably linked: irrigated agriculture requires appropriate water quality for product quality and certification, but agriculture can be a major source of nutrient pollution, with impacts on human and ecosystem health, drinking water treatment and amenity. And energy-water interactions include energy production (hydropower and cooling water for thermal power generation) and energy consumption (e.g. for pumping and water and wastewater treatment). These dependencies are illustrated for the Canadian prairies, and a risk-based approach to the management of climate change is presented. Trade-offs between economic benefits of hydropower and irrigation are illustrated for alternative climate futures, including implications for freshwater habitats. The results illustrate that inter-sector interactions vary as a function of climate and its variability, and that there is a need for policy to manage inter-sector allocations as a function of economic risk.

Self- and Social-Regulation in Type 1 Diabetes Management During Late Adolescence and Emerging Adulthood.

PubMed

Wiebe, Deborah J; Berg, Cynthia A; Mello, Daniel; Kelly, Caitlin S

2018-03-21

This paper aims to examine how self-regulation (i.e., cognition, emotion) and social-regulation (i.e., parents, friends, romantic partners) are interrelated risk and protective factors for type 1 diabetes management during late adolescence and emerging adulthood. Problems in cognitive (e.g., executive function) and emotional (e.g., depressive symptoms) self-regulation are associated with poorer management, both at the between- and within-person levels. Better management occurs when parents are supportive and when individuals actively regulate the involvement of others (e.g., seek help, minimize interference). Friends both help and hinder self-regulation, while research on romantic partners is limited. Facets of self- and social-regulation are important risk and protective factors for diabetes management during emerging adulthood. At this time when relationships are changing, the social context of diabetes may need to be regulated to support diabetes management. Interventions targeting those with self-regulation problems and facilitating self- and social-regulation in daily life may be useful.

Development of a GIS-based spill management information system.

PubMed

Martin, Paul H; LeBoeuf, Eugene J; Daniel, Edsel B; Dobbins, James P; Abkowitz, Mark D

2004-08-30

Spill Management Information System (SMIS) is a geographic information system (GIS)-based decision support system designed to effectively manage the risks associated with accidental or intentional releases of a hazardous material into an inland waterway. SMIS provides critical planning and impact information to emergency responders in anticipation of, or following such an incident. SMIS couples GIS and database management systems (DBMS) with the 2-D surface water model CE-QUAL-W2 Version 3.1 and the air contaminant model Computer-Aided Management of Emergency Operations (CAMEO) while retaining full GIS risk analysis and interpretive capabilities. Live 'real-time' data links are established within the spill management software to utilize current meteorological information and flowrates within the waterway. Capabilities include rapid modification of modeling conditions to allow for immediate scenario analysis and evaluation of 'what-if' scenarios. The functionality of the model is illustrated through a case study of the Cheatham Reach of the Cumberland River near Nashville, TN.

An Integrated Web-based Decision Support System in Disaster Risk Management

NASA Astrophysics Data System (ADS)

Aye, Z. C.; Jaboyedoff, M.; Derron, M. H.

2012-04-01

Nowadays, web based decision support systems (DSS) play an essential role in disaster risk management because of their supporting abilities which help the decision makers to improve their performances and make better decisions without needing to solve complex problems while reducing human resources and time. Since the decision making process is one of the main factors which highly influence the damages and losses of society, it is extremely important to make right decisions at right time by combining available risk information with advanced web technology of Geographic Information System (GIS) and Decision Support System (DSS). This paper presents an integrated web-based decision support system (DSS) of how to use risk information in risk management efficiently and effectively while highlighting the importance of a decision support system in the field of risk reduction. Beyond the conventional systems, it provides the users to define their own strategies starting from risk identification to the risk reduction, which leads to an integrated approach in risk management. In addition, it also considers the complexity of changing environment from different perspectives and sectors with diverse stakeholders' involvement in the development process. The aim of this platform is to contribute a part towards the natural hazards and geosciences society by developing an open-source web platform where the users can analyze risk profiles and make decisions by performing cost benefit analysis, Environmental Impact Assessment (EIA) and Strategic Environmental Assessment (SEA) with the support of others tools and resources provided. There are different access rights to the system depending on the user profiles and their responsibilities. The system is still under development and the current version provides maps viewing, basic GIS functionality, assessment of important infrastructures (e.g. bridge, hospital, etc.) affected by landslides and visualization of the impact-probability matrix in terms of socio-economic dimension.

Combination of uncertainty theories and decision-aiding methods for natural risk management in a context of imperfect information

NASA Astrophysics Data System (ADS)

Tacnet, Jean-Marc; Dupouy, Guillaume; Carladous, Simon; Dezert, Jean; Batton-Hubert, Mireille

2017-04-01

In mountain areas, natural phenomena such as snow avalanches, debris-flows and rock-falls, put people and objects at risk with sometimes dramatic consequences. Risk is classically considered as a combination of hazard, the combination of the intensity and frequency of the phenomenon, and vulnerability which corresponds to the consequences of the phenomenon on exposed people and material assets. Risk management consists in identifying the risk level as well as choosing the best strategies for risk prevention, i.e. mitigation. In the context of natural phenomena in mountainous areas, technical and scientific knowledge is often lacking. Risk management decisions are therefore based on imperfect information. This information comes from more or less reliable sources ranging from historical data, expert assessments, numerical simulations etc. Finally, risk management decisions are the result of complex knowledge management and reasoning processes. Tracing the information and propagating information quality from data acquisition to decisions are therefore important steps in the decision-making process. One major goal today is therefore to assist decision-making while considering the availability, quality and reliability of information content and sources. A global integrated framework is proposed to improve the risk management process in a context of information imperfection provided by more or less reliable sources: uncertainty as well as imprecision, inconsistency and incompleteness are considered. Several methods are used and associated in an original way: sequential decision context description, development of specific multi-criteria decision-making methods, imperfection propagation in numerical modeling and information fusion. This framework not only assists in decision-making but also traces the process and evaluates the impact of information quality on decision-making. We focus and present two main developments. The first one relates to uncertainty and imprecision propagation in numerical modeling using both classical Monte-Carlo probabilistic approach and also so-called Hybrid approach using possibility theory. Second approach deals with new multi-criteria decision-making methods which consider information imperfection, source reliability, importance and conflict, using fuzzy sets as well as possibility and belief function theories. Implemented methods consider information imperfection propagation and information fusion in total aggregation methods such as AHP (Saaty, 1980) or partial aggregation methods such as the Electre outranking method (see Soft Electre Tri ) or decisions in certain but also risky or uncertain contexts (see new COWA-ER and FOWA-ER- Cautious and Fuzzy Ordered Weighted Averaging-Evidential Reasoning). For example, the ER-MCDA methodology considers expert assessment as a multi-criteria decision process based on imperfect information provided by more or less heterogeneous, reliable and conflicting sources: it mixes AHP, fuzzy sets theory, possibility theory and belief function theory using DSmT (Dezert-Smarandache Theory) framework which provides powerful fusion rules.

[Climate change risk of nature reserve and its assessment: A case study of Dalinuoer National Nature Reserve in Inner Mongolia Autonomous Region].

PubMed

Zhao, Wei; Shen, Wei Shou; Liu, Hai Yue

2016-12-01

According to the theoretical framework of addressing climate change based on risk mana-gement and the challenge to nature reserve management under climate change, climate change risk of nature reserve was analyzed and defined. Focus on birds and water habitat, grassland habitat, forest habitat, wetland habitat in Dalinuoer Nature Reserve, risk assessment method of nature reserve under climate change was formulated, climate change risks to Dalinuoer Nature Reserve and its habitats were assessed and predicted. The results showed that, during the period from 1997 to 2010, there was significant volatility in dynamic changes of climate change risks to Dalinuoer Nature Reserve and waterbody, grassland, forest, wetland in the region, Dalinuoer Nature Reserve and its habitats were in status of risk in 1999, 2001, 2005 and 2008, wetland habitat was also in status of risk in 2002 and 2004. Under scenario A, B and C, climate change risks to Dalinuoer Nature Reserve and waterbody, grassland, forest, wetland in the region would be more serious in 2020 and 2030, compared with the 2010 level. Climate change risks to different habitats were different significantly, with most serious climate change risk to wetland habitat due to its sensitivity to climate change and rich bird resources. The effect of climate change on nature reserve and related risk would be aggravated by excess utilization of water resource and grassland resource. As climate change risks had appeared in Dalinuoer Nature Reserve, risk management associated with climate change could greatly help to maintain and enhance biodiversity protection function of nature reserves.

The limits of poverty reduction in support of climate change adaptation

NASA Astrophysics Data System (ADS)

Nelson, Donald R.; Lemos, Maria Carmen; Eakin, Hallie; Lo, Yun-Jia

2016-09-01

The relationship between poverty and climate change vulnerability is complex and though not commensurate, the distinctions between the two are often blurred. There is widespread recognition of the need to better understand poverty-vulnerability dynamics in order to improve risk management and poverty reduction investments. This is challenging due to the latent nature of adaptive capacities, frequent lack of baseline data, and the need for high-resolution studies. Here we respond to these challenges by analyzing household-level data in Northeast Brazil to compare drought events 14 years apart. In the period between droughts, the government implemented an aggressive anti-poverty program that includes financial and human capital investments. Poverty declined significantly, but the expected reduction in vulnerability did not occur, in part because the households were not investing in risk management strategies. Our findings complement other research that shows that households make rational decisions that may not correspond with policymaker expectations. We emphasize the need for complementary investments to help channel increased household wealth into risk reduction, and to ensure that the public sector itself continues to prioritize the public functions of risk management, especially in areas where the social cost of climatic risk is high.

Erectile dysfunction in the cardiovascular patient.

PubMed

Vlachopoulos, Charalambos; Jackson, Graham; Stefanadis, Christodoulos; Montorsi, Piero

2013-07-01

Erectile dysfunction is common in the patient with cardiovascular disease. It is an important component of the quality of life and it also confers an independent risk for future cardiovascular events. The usual 3-year time period between the onset of erectile dysfunction symptoms and a cardiovascular event offers an opportunity for risk mitigation. Thus, sexual function should be incorporated into cardiovascular disease risk assessment for all men. A comprehensive approach to cardiovascular risk reduction (comprising of both lifestyle changes and pharmacological treatment) improves overall vascular health, including sexual function. Proper sexual counselling improves the quality of life and increases adherence to medication. This review explores the critical connection between erectile dysfunction and cardiovascular disease and evaluates how this relationship may influence clinical practice. Algorithms for the management of patient with erectile dysfunction according to the risk for sexual activity and future cardiovascular events are proposed.

Precipitation Nonstationarity Effects on Water Infrastructure and Risk Management

EPA Science Inventory

The non-stationary precipitation regime, as increasingly recognized, affects the engineering basis and service functions of drinking water, wastewater, and stormwater infrastructures in urban centers. Small, yet significant rates of temporal precipitation change and diverse spat...

A Methodology for Writing High Quality Requirement Specifications and for Evaluating Existing Ones

NASA Technical Reports Server (NTRS)

Rosenberg, Linda; Hammer, Theodore

1999-01-01

Requirements development and management have always been critical in the implementation of software systems-engineers are unable to build what analysts can not define. It is generally accepted that the earlier in the life cycle potential risks are identified the easier it is to eliminate or manage the conditions that introduce that risk. Problems that are not found until testing are approximately 14 times more costly to fix than if the problem was found in the requirement phase. The requirements specification, as the first tangible representation of the capability to be produced, establishes the basis for all of the project's engineering management and assurance functions. If the quality of the requirements specification is poor it can give rise to risks in all areas of the project. Recently, automated tools have become available to support requirements management. The use of these tools not only provides support in the definition and tracing of requirements, but it also opens the door to effective use of metrics in characterizing and assessing the quality of the requirement specifications.

A Methodology for Writing High Quality Requirements Specification and Evaluating Existing Ones

NASA Technical Reports Server (NTRS)

Rosenberg, Linda; Hammer, Theodore

1999-01-01

Requirements development and management have always been critical in the implementation of software systems; engineers are unable to build what analysts can't define. It is generally accepted that the earlier in the life cycle potential risks are identified the easier it is to eliminate or manage the conditions that introduce that risk. Problems that are not found until testing are approximately 14 times more costly to fix than if the problem was found in the requirement phase. The requirements specification, as the first tangible representation of the capability to be produced, establishes the basis for all of the project's engineering management and assurance functions. If the quality of the requirements specification is poor it can give rise to risks in all areas of the project. Recently, automated tools have become available to support requirements management. The use of these tools not only provides support in the definition and tracing of requirements, but it also opens the door to effective use of metrics in characterizing and assessing the quality of the requirement specifications.

Hazard identification and risk assessment for biologics targeting the immune system.

PubMed

Weir, Andrea B

2008-01-01

Biologic pharmaceuticals include a variety of products, such as monoclonal antibodies, fusion proteins and cytokines. Products in those classes include immunomodulatory biologics, which are intended to enhance or diminish the activity of the immune system. Immunomodulatory biologics have been approved by the U.S. FDA for a variety of indications, including cancer and inflammatory conditions. Prior to gaining approval for marketing, sponsoring companies for all types of products must demonstrate a product's safety in toxicology studies conducted in animals and show safety and efficacy in clinical trials conducted in patients. The overall goal of toxicology studies, which applies to immunomodulatory and other product types, is to identify the hazards that products pose to humans. Because biologics are generally highly selective for specific targets (receptors/epitopes), conducting toxicology studies in animal models with the target is essential. Such animals are referred to as pharmacologically relevant. Endpoints routinely included in toxicology studies, such as hematology, organ weight and histopathology, can be used to assess the effect of a product on the structure of the immune system. Additionally, specialized endpoints, such as immunophenotyping and immune function tests, can be used to define effects of immunomodulatory products on the immune system. Following hazard identification, risks posed to patients are assessed and managed. Risks can be managed through clinical trial design and risk communication, a practice that applies to immunomodulatory and other product types. Examples of risk management in clinical trial design include establishing a safe starting dose, defining the appropriate patient population and establishing appropriate patient monitoring. Risk communication starts during clinical trials and continues after product approval. A combination of hazard identification, risk assessment and risk management allows for drug development to proceed with minimum risks to patients.

Hurricane risk management and climate information gatekeeping in southeast Florida

NASA Astrophysics Data System (ADS)

Treuer, G.; Bolson, J.

2013-12-01

Tropical storms provide fresh water necessary for healthy economies and health ecosystems. Hurricanes, massive tropical storms, threaten catastrophic flooding and wind damage. Sea level rise exacerbates flooding risks from rain and storm surge for coastal communities. Climate change adaptation measures to manage this risk must be implemented locally, but actions at other levels of government and by neighboring communities impact the options available to local municipalities. When working on adaptation local decision makers must balance multiple types of risk: physical or scientifically described risks, legal risks, and political risks. Generating usable or actionable climate science is a goal of the academic climate community. To do this we need to expand our analysis to include types of risk that constrain the use of objective science. Integrating physical, legal, and political risks is difficult. Each requires specific expertise and uses unique language. An opportunity exists to study how local decision makers manage all three on a daily basis and how their risk management impacts climate resilience for communities and ecosystems. South Florida's particular vulnerabilities make it an excellent case study. Besides physical vulnerabilities (low elevation, intense coastal development, frequent hurricanes, compromised ecosystems) it also has unique legal and political challenges. Federal and state property rights protections create legal risks for government action that restricts land use to promote climate adaptation. Also, a lack of cases that deal with climate change creates uncertainty about the nature of these legal risks. Politically Florida is divided ideologically and geographically. The regions in the southeast which are most vulnerable are predominantly Hispanic and under-represented at the state level, where leadership on climate change is functionally nonexistent. It is conventional wisdom amongst water managers in Florida that little climate adaptation will not occur until a major hurricane hits the region, despite the cost effectiveness of preemptive interventions. It is assumed that after a hurricane the political risks will shift. New policies will be tried and new infrastructure will be built. Many municipalities and agencies are creating "shovel ready" plans in advance to take advantage of post-catastrophe funds. How do the design of these plans reflect perceptions of legal and political risk? Will they do a good job of reducing scientific risk by addressing long term physical threats? In this study we identify specific challenges to climate adaptation in Florida and explore how local and regional water management decision makers balance physical, legal, and political risks in their planning. A primary risk management tool is the strategic use of information. Through targeted interviews with stakeholders we identify key information gatekeepers and their strategies for reducing multiple types of risk.

Weight management and its role in breast cancer rehabilitation.

PubMed

Demark-Wahnefried, Wendy; Campbell, Kristin L; Hayes, Sandra C

2012-04-15

Overweight and obesity are risk factors for postmenopausal breast cancer, and many women diagnosed with breast cancer, irrespective of menopausal status, gain weight after diagnosis. Weight management plays an important role in rehabilitation and recovery because obesity and/or weight gain may lead to poorer breast cancer prognosis, as well as prevalent comorbid conditions (eg, cardiovascular disease and diabetes), poorer surgical outcomes (eg, increased operating and recovery times, higher infection rates, and poorer healing), lymphedema, fatigue, functional decline, and poorer health and overall quality of life. Health care professionals should encourage weight management at all phases of the cancer care continuum as a means to potentially avoid adverse sequelae and late effects, as well as to improve overall health and possibly survival. Comprehensive approaches that involve dietary and behavior modification, and increased aerobic and strength training exercise have shown promise in either preventing weight gain or promoting weight loss, reducing biomarkers associated with inflammation and comorbidity, and improving lifestyle behaviors, functional status, and quality of life in this high-risk patient population. Copyright © 2012 American Cancer Society.

Using ecological production functions to link ecological ...

EPA Pesticide Factsheets

Ecological production functions (EPFs) link ecosystems, stressors, and management actions to ecosystem services (ES) production. Although EPFs are acknowledged as being essential to improve environmental management, their use in ecological risk assessment has received relatively little attention. Ecological production functions may be defined as usable expressions (i.e., models) of the processes by which ecosystems produce ES, often including external influences on those processes. We identify key attributes of EPFs and discuss both actual and idealized examples of their use to inform decision making. Whenever possible, EPFs should estimate final, rather than intermediate, ES. Although various types of EPFs have been developed, we suggest that EPFs are more useful for decision making if they quantify ES outcomes, respond to ecosystem condition, respond to stressor levels or management scenarios, reflect ecological complexity, rely on data with broad coverage, have performed well previously, are practical to use, and are open and transparent. In an example using pesticides, we illustrate how EPFs with these attributes could enable the inclusion of ES in ecological risk assessment. The biggest challenges to ES inclusion are limited data sets that are easily adapted for use in modeling EPFs and generally poor understanding of linkages among ecological components and the processes that ultimately deliver the ES. We conclude by advocating for the incorporation into E

Ontology-based, multi-agent support of production management

NASA Astrophysics Data System (ADS)

Meridou, Despina T.; Inden, Udo; Rückemann, Claus-Peter; Patrikakis, Charalampos Z.; Kaklamani, Dimitra-Theodora I.; Venieris, Iakovos S.

2016-06-01

Over the recent years, the reported incidents on failed aircraft ramp-ups or the delayed production in small-lots have increased substantially. In this paper, we present a production management platform that combines agent-based techniques with the Service Oriented Architecture paradigm. This platform takes advantage of the functionality offered by the semantic web language OWL, which allows the users and services of the platform to speak a common language and, at the same time, facilitates risk management and decision making.

Towards River Rehabilitation as AN Integrated Approach to Flood Management in Asian Cities

NASA Astrophysics Data System (ADS)

Higgitt, David L.

Flood management in Asian cities has conventionally been approached through structural intervention where floods are regarded as a threat requiring control through engineering infrastructure. Such a command and control paradigm represents a marked transition from the way that monsoon flood regimes have been traditionally perceived across Asia. Rapid urbanization and climate change has imposed increasingly difficult flood management challenges as an extension of impermeable surfaces generates rapid runoff and flash flooding, while cities expand into flood-prone areas. Property and communities are placed at enhanced risk. Urbanization reallocates risk as channel and floodplain modification influences flood regimes, while demands for flood protection at certain locations can redistribute risk to other areas. An increasing concern about flood hazard across Asian cities questions whether conventional solutions reliant on structural intervention are sustainable. Such questioning is mirrored by an alternative paradigm of rehabilitation in integrated river basin management — a recognition that restoring and sustaining functional river ecosystems with high biodiversity is one of the greatest challenges facing society. Rehabilitation initiatives demand a new approach to river basin management which encourage interdisciplinary activity, particularly between engineers, hydrologists, geomorphologists and ecologists. The paper sets out some preliminary ideas from a research project investigating the potential for river rehabilitation as a central tenet of flood management, with a particular focus on Asian cities.

The politics of risk in the Philippines: comparing state and NGO perceptions of disaster management.

PubMed

Bankoff, Greg; Hilhorst, Dorothea

2009-10-01

It is now generally appreciated that what constitutes vulnerability to one person is not necessarily perceived as such by the next. Different actors 'see' disasters as different types of events and as a result they prepare for, manage and record them in very different ways. This paper explores what different perceptions of vulnerability mean in terms of the understanding and practices of two significant sets of actors and stakeholders involved in disaster preparedness and management in the Philippines: the state and NGOs. Approaches to disaster are not just a function of people's perceptions of disaster risk but also of their understanding of the prevailing social order and social relations. Despite a shared vocabulary-which increasingly presents disasters as processes rather than events, takes a proactive rather than a reactive approach, and favours the inclusion of stakeholders rather than solely relying on technocratic management-different realities continue to make for different responses.

Neurocognitive Impairment and HIV Risk Factors: A Reciprocal Relationship

PubMed Central

Anand, Pria; Springer, Sandra A.; Copenhaver, Michael M.

2010-01-01

Cognitive impairment among populations at risk for HIV poses a significant barrier to managing risk behaviors. The impact of HIV and several cofactors, including substance abuse and mental illness, on cognitive function is discussed in the context of HIV risk behaviors, medication adherence, and risk-reduction interventions. Literature suggests that cognitive impairment is intertwined in a close, reciprocal relationship with both risk behaviors and medication adherence. Not only do increased risk behaviors and suboptimal adherence exacerbate cognitive impairment, but cognitive impairment also reduces the effectiveness of interventions aimed at optimizing medication adherence and reducing risk. In order to be effective, risk-reduction interventions must therefore take into account the impact of cognitive impairment on learning and behavior. PMID:20232242

Contemporary Role of Radiotherapy in the Management of Primary Penile Tumors and Metastatic Disease.

PubMed

Crook, Juanita

2016-11-01

Squamous cell cancer of the penis is a radiocurable malignancy all too often managed solely by partial or total penectomy. Effective management of the primary tumor while preserving penile morphology and function is a priority. External radiotherapy and brachytherapy have a role to play in the definitive management of the primary tumor. Surgical nodal staging remains a cornerstone of management because it is the strongest predictor of survival, and inguinal status determines pelvic management. Postoperative radiotherapy of the regional nodes for high-risk pathology is indicated. Chemoradiotherapy should be considered as neoadjuvant treatment for unresectable nodes or as definitive management. Copyright © 2016 Elsevier Inc. All rights reserved.

Time-based collision risk modeling for air traffic management

NASA Astrophysics Data System (ADS)

Bell, Alan E.

Since the emergence of commercial aviation in the early part of last century, economic forces have driven a steadily increasing demand for air transportation. Increasing density of aircraft operating in a finite volume of airspace is accompanied by a corresponding increase in the risk of collision, and in response to a growing number of incidents and accidents involving collisions between aircraft, governments worldwide have developed air traffic control systems and procedures to mitigate this risk. The objective of any collision risk management system is to project conflicts and provide operators with sufficient opportunity to recognize potential collisions and take necessary actions to avoid them. It is therefore the assertion of this research that the currency of collision risk management is time. Future Air Traffic Management Systems are being designed around the foundational principle of four dimensional trajectory based operations, a method that replaces legacy first-come, first-served sequencing priorities with time-based reservations throughout the airspace system. This research will demonstrate that if aircraft are to be sequenced in four dimensions, they must also be separated in four dimensions. In order to separate aircraft in four dimensions, time must emerge as the primary tool by which air traffic is managed. A functional relationship exists between the time-based performance of aircraft, the interval between aircraft scheduled to cross some three dimensional point in space, and the risk of collision. This research models that relationship and presents two key findings. First, a method is developed by which the ability of an aircraft to meet a required time of arrival may be expressed as a robust standard for both industry and operations. Second, a method by which airspace system capacity may be increased while maintaining an acceptable level of collision risk is presented and demonstrated for the purpose of formulating recommendations for procedures regulating air traffic management methods and industry standards governing performance requirements for avionics designed to support trajectory based operations.

Factors affecting aging cognitive function among community-dwelling older adults.

PubMed

Kim, Chun-Ja; Park, JeeWon; Kang, Se-Won; Schlenk, Elizabeth A

2017-08-01

The study purpose was to determine factors affecting aging cognitive function of 3,645 community-dwelling older adults in Korea. The Hasegawa Dementia Scale assessed aging cognitive function, blood analyses and anthropometrics assessed cardio-metabolic risk factors, and the Geriatric Depression Scale Short Form Korean Version assessed depressive symptoms. Participants with poor aging cognitive function were more likely to be in the late age group (≥75 y) and currently smoking and have a medical history of stroke, high body mass index, and high level of depressive symptoms; they were also less likely to engage in regular meals and physical activities. Regular meals and physical activities may be primary factors for clinical assessment to identify older adults at risk for aging cognitive function. With aging, depressive symptoms and other unhealthy lifestyle behaviours should be managed to prevent cognitive function disorders. © 2017 John Wiley & Sons Australia, Ltd.

Longitudinal Social-Interpersonal Functioning among Higher-risk Responders to Acute-phase Cognitive Therapy for Recurrent Major Depressive Disorder

PubMed Central

Vittengl, Jeffrey R.; Clark, Lee Anna; Thase, Michael E.; Jarrett, Robin B.

2016-01-01

Background Social-interpersonal dysfunction increases disability in major depressive disorder (MDD). Here we clarified the durability of improvements in social-interpersonal functioning made during acute-phase cognitive therapy (CT), whether continuation CT (C-CT) or fluoxetine (FLX) further improved functioning, and relations of functioning with depressive symptoms and relapse/recurrence. Method Adult outpatients (N=241) with recurrent MDD who responded to acute-phase CT with higher risk of relapse (due to unstable or partial remission) were randomized to 8 months of C-CT, FLX, or pill placebo plus clinical management (PBO) and followed 24 additional months. We analyzed repeated measures of patients’ social adjustment, interpersonal problems, dyadic adjustment, depressive symptoms, and major depressive relapse/recurrence. Results Large improvements in social-interpersonal functioning occurring during acute-phase CT (median d=1.4) were maintained, with many patients (median=66%) scoring in normal ranges for 32 months. Social-interpersonal functioning did not differ significantly among C-CT, FLX, and PBO arms. Beyond concurrently measured residual symptoms, deterioration in social-interpersonal functioning preceded and predicted upticks in depressive symptoms and major depressive relapse/recurrence. Limitations Results may not generalize to other patient populations, treatment protocols, or measures of social-interpersonal functioning. Mechanisms of risk connecting poorer social-interpersonal functioning with depression were not studied. Conclusions Average improvements in social-interpersonal functioning among higher-risk responders to acute phase CT are durable for 32 months. After acute-phase CT, C-CT or FLX may not further improve social-interpersonal functioning. Among acute-phase CT responders, deteriorating social-interpersonal functioning provides a clear, measurable signal of risk for impending major depressive relapse/recurrence and opportunity for preemptive intervention. PMID:27104803

Longitudinal social-interpersonal functioning among higher-risk responders to acute-phase cognitive therapy for recurrent major depressive disorder.

PubMed

Vittengl, Jeffrey R; Clark, Lee Anna; Thase, Michael E; Jarrett, Robin B

2016-07-15

Social-interpersonal dysfunction increases disability in major depressive disorder (MDD). Here we clarified the durability of improvements in social-interpersonal functioning made during acute-phase cognitive therapy (CT), whether continuation CT (C-CT) or fluoxetine (FLX) further improved functioning, and relations of functioning with depressive symptoms and relapse/recurrence. Adult outpatients (N=241) with recurrent MDD who responded to acute-phase CT with higher risk of relapse (due to unstable or partial remission) were randomized to 8 months of C-CT, FLX, or pill placebo plus clinical management (PBO) and followed 24 additional months. We analyzed repeated measures of patients' social adjustment, interpersonal problems, dyadic adjustment, depressive symptoms, and major depressive relapse/recurrence. Large improvements in social-interpersonal functioning occurring during acute-phase CT (median d=1.4) were maintained, with many patients (median=66%) scoring in normal ranges for 32 months. Social-interpersonal functioning did not differ significantly among C-CT, FLX, and PBO arms. Beyond concurrently measured residual symptoms, deterioration in social-interpersonal functioning preceded and predicted upticks in depressive symptoms and major depressive relapse/recurrence. Results may not generalize to other patient populations, treatment protocols, or measures of social-interpersonal functioning. Mechanisms of risk connecting poorer social-interpersonal functioning with depression were not studied. Average improvements in social-interpersonal functioning among higher-risk responders to acute phase CT are durable for 32 months. After acute-phase CT, C-CT or FLX may not further improve social-interpersonal functioning. Among acute-phase CT responders, deteriorating social-interpersonal functioning provides a clear, measurable signal of risk for impending major depressive relapse/recurrence and opportunity for preemptive intervention. Copyright © 2016 Elsevier B.V. All rights reserved.

Nutrition Interventions in Chronic Kidney Disease.

PubMed

Anderson, Cheryl A M; Nguyen, Hoang Anh; Rifkin, Dena E

2016-11-01

Dietary modification is recommended in the management of chronic kidney disease (CKD). Individuals with CKD often have multiple comorbidities, such as high blood pressure, diabetes, obesity, and cardiovascular disease, for which dietary modification is also recommended. As CKD progresses, nutrition plays an important role in mitigating risk for cardiovascular disease and decline in kidney function. The objectives of nutrition interventions in CKD include management of risk factors, ensuring optimal nutritional status throughout all stages of CKD, preventing buildup of toxic metabolic products, and avoiding complications of CKD. Recommended dietary changes should be feasible, sustainable, and suited for patients' food preferences and clinical needs. Copyright © 2016 Elsevier Inc. All rights reserved.

Scale and structure of capitated physician organizations in California.

PubMed

Rosenthal, M B; Frank, R G; Buchanan, J L; Epstein, A M

2001-01-01

Physician organizations in California broke new ground in the 1980s by accepting capitated contracts and taking on utilization management functions. In this paper we present new data that document the scale, structure, and vertical affiliations of physician organizations that accept capitation in California. We provide information on capitated enrollment, the share of revenue derived by physician organizations from capitation contracts, and the scope of risk sharing with health maintenance organizations (HMOs). Capitation contracts and risk sharing dominate payment arrangements with HMOs. Physician organizations appear to have responded to capitation by affiliating with hospitals and management companies, adopting hybrid organizational structures, and consolidating into larger entities.

Mountain torrents: Quantifying vulnerability and assessing uncertainties

PubMed Central

Totschnig, Reinhold; Fuchs, Sven

2013-01-01

Vulnerability assessment for elements at risk is an important component in the framework of risk assessment. The vulnerability of buildings affected by torrent processes can be quantified by vulnerability functions that express a mathematical relationship between the degree of loss of individual elements at risk and the intensity of the impacting process. Based on data from the Austrian Alps, we extended a vulnerability curve for residential buildings affected by fluvial sediment transport processes to other torrent processes and other building types. With respect to this goal to merge different data based on different processes and building types, several statistical tests were conducted. The calculation of vulnerability functions was based on a nonlinear regression approach applying cumulative distribution functions. The results suggest that there is no need to distinguish between different sediment-laden torrent processes when assessing vulnerability of residential buildings towards torrent processes. The final vulnerability functions were further validated with data from the Italian Alps and different vulnerability functions presented in the literature. This comparison showed the wider applicability of the derived vulnerability functions. The uncertainty inherent to regression functions was quantified by the calculation of confidence bands. The derived vulnerability functions may be applied within the framework of risk management for mountain hazards within the European Alps. The method is transferable to other mountain regions if the input data needed are available. PMID:27087696

Surgical treatment of ulcerative colitis: ileorectal vs ileal pouch-anal anastomosis.

PubMed

Scoglio, Daniele; Ahmed Ali, Usama; Fichera, Alessandro

2014-10-07

Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the current gold standard in the surgical treatment of ulcerative colitis (UC) refractory to medical management. A procedure of significant magnitude carries its own risks including anastomotic failure, pelvic sepsis and a low rate of neoplastic degeneration overtime. Recent studies have shown that total colectomy with ileorectal anastomosis (IRA) has been associated with good long-term functional results in a selected group of UC patients amenable to undergo a strict surveillance for the relatively high risk of cancer in the rectum. This manuscript will review and compare the most recent literature on IRA and IPAA as it pertains to postoperative morbidity and mortality, failure rates, functional outcomes and cancer risk.

Surgical treatment of ulcerative colitis: Ileorectal vs ileal pouch-anal anastomosis

PubMed Central

Scoglio, Daniele; Ahmed Ali, Usama; Fichera, Alessandro

2014-01-01

Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the current gold standard in the surgical treatment of ulcerative colitis (UC) refractory to medical management. A procedure of significant magnitude carries its own risks including anastomotic failure, pelvic sepsis and a low rate of neoplastic degeneration overtime. Recent studies have shown that total colectomy with ileorectal anastomosis (IRA) has been associated with good long-term functional results in a selected group of UC patients amenable to undergo a strict surveillance for the relatively high risk of cancer in the rectum. This manuscript will review and compare the most recent literature on IRA and IPAA as it pertains to postoperative morbidity and mortality, failure rates, functional outcomes and cancer risk. PMID:25309058

The risk of establishment of aquatic invasive species: joining invasibility and propagule pressure

PubMed Central

Leung, Brian; Mandrak, Nicholas E

2007-01-01

Invasive species are increasingly becoming a policy priority. This has spurred researchers and managers to try to estimate the risk of invasion. Conceptually, invasions are dependent both on the receiving environment (invasibility) and on the ability to reach these new areas (propagule pressure). However, analyses of risk typically examine only one or the other. Here, we develop and apply a joint model of invasion risk that simultaneously incorporates invasibility and propagule pressure. We present arguments that the behaviour of these two elements of risk differs substantially—propagule pressure is a function of time, whereas invasibility is not—and therefore have different management implications. Further, we use the well-studied zebra mussel (Dreissena polymorpha) to contrast predictions made using the joint model to those made by separate invasibility and propagule pressure models. We show that predictions of invasion progress as well as of the long-term invasion pattern are strongly affected by using a joint model. PMID:17711834

The risk of establishment of aquatic invasive species: joining invasibility and propagule pressure.

PubMed

Leung, Brian; Mandrak, Nicholas E

2007-10-22

Invasive species are increasingly becoming a policy priority. This has spurred researchers and managers to try to estimate the risk of invasion. Conceptually, invasions are dependent both on the receiving environment (invasibility) and on the ability to reach these new areas (propagule pressure). However, analyses of risk typically examine only one or the other. Here, we develop and apply a joint model of invasion risk that simultaneously incorporates invasibility and propagule pressure. We present arguments that the behaviour of these two elements of risk differs substantially--propagule pressure is a function of time, whereas invasibility is not--and therefore have different management implications. Further, we use the well-studied zebra mussel (Dreissena polymorpha) to contrast predictions made using the joint model to those made by separate invasibility and propagule pressure models. We show that predictions of invasion progress as well as of the long-term invasion pattern are strongly affected by using a joint model.

Disease management and medication compliance.

PubMed

Cohen, Joshua; Christensen, Kathyrn; Feldman, Lanna

2012-02-01

Lack of medication compliance is harmful to health care systems from both a clinical and economic perspective. This study examines the methods that disease management organizations employ to identify nonadherent patients and to measure effectiveness of compliance programs for patients with diabetes, hyperlipidemia, and cystic fibrosis. In addition, this study investigates the degree to which disease managers assume risk in their contracts, and whether compliance strategies are being coordinated with payers' use of value-based insurance design, in which patient cost sharing is a function of the relative value of pharmaceuticals. This study's findings suggest that disease management may be falling short in terms of: (a) comprehensive commitment to expert-recommended at-home devices used to self-diagnose and measure health indicators; (b) early adoption of expert-recommended new technologies to measure and improve compliance; (c) intensity of use of standard tests in outpatient clinics; (d) coordination of compliance strategies with payers' use of value-based insurance design; and (e) the proportion of risk assumed in disease management contracts.

Resilience and risk management in the urban project

NASA Astrophysics Data System (ADS)

Veyron, Jessica; Becue, Vincent; El Meouche, Rani; Barroca, Bruno

2017-04-01

Our study focus on the recourse of resilience concept in an urban environment coupled with risk management concerns. The urban resilience is subject to interpretation according to the expertise fields and the using context. It brings underlying concepts of time and space out. For its part, the urban environment is complex because of the elements multitude which makes up it on a dense area as much humanly, structurally, materially as functionally. The resilience polysemy rediscovers within the risk management and is confronted with the operational expectation that she arouses in this field. Between absorption, recovery, adaptability or else effectiveness, the level of requirement of the urban area could be abundant and varied to a system to another and in front of a risk to another. The capability of the urban systems to integrate the outstanding risk scope could be reinforce through the use of spatialisation tools. The access to these knowledge more and more widespread makes the changing of spatial and temporal scales thought easier in the urban project approach along with the sharing of citizen and territorial actions and innovations. Our work gets into position between resilience and urban planning. Based on bibliography and urban planning feedback in front of risks, we envisage to study the achievement of the urban planning in the field of vulnerable districts or buildings. Our aim tends torwards characterise urban resilience in risk field through spatialisation tool setting up.

Coordinating ecological restoration options analysis and risk assessment to improve environmental outcomes.

PubMed

Kapustka, Lawrence A; Bowers, Keith; Isanhart, John; Martinez-Garza, Cristina; Finger, Susan; Stahl, Ralph G; Stauber, Jenny

2016-04-01

Ecological risk assessment as currently practiced has hindered consideration of ecosystem services endpoints and restoration goals in the environmental management process. Practitioners have created barriers between procedures to clean up contaminated areas and efforts to restore ecosystem functions. In this article, we examine linkages between contaminant risk assessment approaches and restoration efforts with the aim of identifying ways to improve environmental outcomes. We advocate that project managers and other stakeholders use an ecological planning framework, with restoration options included upfront in the risk assessment. We also considered the opportunities to incorporate ecosystem services as potential assessment endpoints in the Problem Formulation stages of a risk assessment. Indeed, diverse perspectives of stakeholders are central to understand the relevance of social, cultural, economic, and regional ecology as influences on future use options for the landscape being restored. The measurement endpoints used to characterize the existing ecological conditions for selected ecosystem services can also be used to evaluate restoration success. A regional, landscape, or seascape focus is needed throughout the risk assessment process, so that restoration efforts play a more prominent role in enhancing ecosystem services. In short, we suggest that practitioners begin with the question of "how can the ecological risk assessment inform the decision on how best to restore the ecosystem?" © 2015 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of SETAC.

Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of low-risk upper tract urothelial carcinoma.

PubMed

Mandalapu, Rao S; Remzi, Mesut; de Reijke, Theo M; Margulis, Vitaly; Palou, J; Kapoor, A; Yossepowitch, Ofer; Coleman, Jonathan; Traxer, Olivier; Anderson, J Kyle; Catto, James; de la Rosette, Jean; O'Brien, Timothy; Zlotta, Anthony; Matin, Surena F

2017-03-01

The conservative management of upper tract urothelial carcinoma (UTUC) has historically been offered to patients with imperative indications. The recent International Consultation on Urologic Diseases (ICUD) publication on UTUC stratified treatment allocations based on high- and low-risk groups. This report updates the conservative management of the low-risk group. The ICUD for low-risk UTUC working group performed a thorough review of the literature with an assessment of the level of evidence and grade of recommendation for a variety of published studies in this disease space. We update these publications and provide a summary of that original report. There are no prospective randomized controlled studies to support surgical management guidelines. A risk-stratified approach based on clinical, endoscopic, and biopsy assessment allows selection of patients who could benefit from kidney-preserving procedures with oncological outcomes potentially similar to radical nephroureterectomy with bladder cuff excision, with the added benefit of renal function preservation. These treatments are aided by the development of high-definition flexible digital URS, multi-biopsies with the aid of access sheaths and other tools, and promising developments in the use of adjuvant topical therapy. Recent developments in imaging, minimally invasive techniques, multimodality approaches, and adjuvant topical regimens and bladder cancer prevention raise the hope for improved risk stratification and may greatly improve the endoscopic treatment for low-risk UTUC.

Cognitive simulation of incident risks in the structure of loading and transport enterprise

NASA Astrophysics Data System (ADS)

Shishkina, S. V.; Pristupa, Yu D.; Pavlova, L. D.; Fryanov, V. N.

2017-09-01

Organizational and technical system of a manufacturing enterprise was identified, which includes three subsystems: main production, industrial and social infrastructure. Based on the results of cognitive modeling, significant system concepts were identified that reduce the risks of incidents. The internal control influences formed in accordance with level of competence of heads of services, departments, sections, dispatchers, acting on the basis of regulations, job profiles. The second concept influencing the enterprise management system is personnel, which is assessed by the compliance of competencies of crane operators, loader operators, slingers, loaders, and acceptance/delivery agents to job responsibilities and labor functions. At a low level of professional competencies, the personnel does not fully comply with job duties and labor functions, the risk of an incident is maximal. The application of cognitive modeling allows us to identify the essential elements that ensure stable functioning of the system as a whole.

Status quo of management of the human tissue banks in Taiwan.

PubMed

Chou, Ching-Pang; Chou, Szu-Cheng; Chen, Ying-Hua; Chen, Yu-Hsuan; Lee, Ming-Shin

2017-03-01

As the technologies associated with transplantation and biological tissue engineering continue to advance, human cells and tissues form an integral part to the practice of regenerative medicine. The patient's use of tissues entails the risk of introducing, transmitting and spreading communicable diseases. To prevent such risk and to ensure that the human organs, tissues and cells remain intact and functional after being handled and processed, the transplanted tissues must be subject to good management standards through all stages of collection, screening, processing, storage and distribution as the safety of the users is of the utmost importance. On February 2009, the government of Taiwan promulgated the Regulations for Administration on Human Organ Bank that requires all human tissues banks to adhere to the Good Tissue Practice for Human Organ, Tissue and Cell in terms of establishment and operation in order to cope with the international management trend and the development and management need of the domestic industry. Six years have passed since the law became effective. This article seeks to introduce the current management mechanism and status quo of management of human tissue banks in Taiwan. We also conducted statistical analysis of the data relating to the tissue banks to identify potential risks and the room for improvement. The study concludes that human tissue banks in Taiwan are on the right track with their management practice, leading to a state of steady development and progress.

Can chronic disease management plans including occupational therapy and physiotherapy services contribute to reducing falls risk in older people?

PubMed

Mackenzie, Lynette; Clemson, Lindy

2014-04-01

Exercise and home modifications are effective interventions for preventing falls. Chronic disease management (CDM) items are one way for general practitioners (GPs) to access these interventions. This study aimed to evaluate the outcomes and feasibility of using CDM items for occupational therapy (OT) and physiotherapy (PT) sessions to address falls risk. A pre-post pilot study design was used to evaluate five collaborative sessions shared by a private OT and PT using CDM items and a GP management plan. Pre and post intervention measures were used to evaluate outcomes for eight patients aged ≥75 years from two GP practices. At 2 months post-intervention there were significant improvements in everyday functioning (P = 0.04), physical capacity (P = 0.01) and falls efficacy (P =0.01). Adherence to the intervention was excellent. Falls prevention interventions can be effective in primary care settings and sustainable pathways need to be developed to ensure access for older people at risk.

Clinical review: Neuromonitoring - an update

PubMed Central

2013-01-01

Critically ill patients are frequently at risk of neurological dysfunction as a result of primary neurological conditions or secondary insults. Determining which aspects of brain function are affected and how best to manage the neurological dysfunction can often be difficult and is complicated by the limited information that can be gained from clinical examination in such patients and the effects of therapies, notably sedation, on neurological function. Methods to measure and monitor brain function have evolved considerably in recent years and now play an important role in the evaluation and management of patients with brain injury. Importantly, no single technique is ideal for all patients and different variables will need to be monitored in different patients; in many patients, a combination of monitoring techniques will be needed. Although clinical studies support the physiologic feasibility and biologic plausibility of management based on information from various monitors, data supporting this concept from randomized trials are still required. PMID:23320763

Identification of water quality management policy of watershed system with multiple uncertain interactions using a multi-level-factorial risk-inference-based possibilistic-probabilistic programming approach.

PubMed

Liu, Jing; Li, Yongping; Huang, Guohe; Fu, Haiyan; Zhang, Junlong; Cheng, Guanhui

2017-06-01

In this study, a multi-level-factorial risk-inference-based possibilistic-probabilistic programming (MRPP) method is proposed for supporting water quality management under multiple uncertainties. The MRPP method can handle uncertainties expressed as fuzzy-random-boundary intervals, probability distributions, and interval numbers, and analyze the effects of uncertainties as well as their interactions on modeling outputs. It is applied to plan water quality management in the Xiangxihe watershed. Results reveal that a lower probability of satisfying the objective function (θ) as well as a higher probability of violating environmental constraints (q i ) would correspond to a higher system benefit with an increased risk of violating system feasibility. Chemical plants are the major contributors to biological oxygen demand (BOD) and total phosphorus (TP) discharges; total nitrogen (TN) would be mainly discharged by crop farming. It is also discovered that optimistic decision makers should pay more attention to the interactions between chemical plant and water supply, while decision makers who possess a risk-averse attitude would focus on the interactive effect of q i and benefit of water supply. The findings can help enhance the model's applicability and identify a suitable water quality management policy for environmental sustainability according to the practical situations.

A randomised controlled trial testing a web-based, computer-tailored self-management intervention for people with or at risk for chronic obstructive pulmonary disease: a study protocol

PubMed Central

2013-01-01

Background Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality. Effective self-management support interventions are needed to improve the health and functional status of people with COPD or at risk for COPD. Computer-tailored technology could be an effective way to provide this support. Methods/Design This paper presents the protocol of a randomised controlled trial testing the effectiveness of a web-based, computer-tailored self-management intervention to change health behaviours of people with or at risk for COPD. An intervention group will be compared to a usual care control group, in which the intervention group will receive a web-based, computer-tailored self-management intervention. Participants will be recruited from an online panel and through general practices. Outcomes will be measured at baseline and at 6 months. The primary outcomes will be smoking behaviour, measuring the 7-day point prevalence abstinence and physical activity, measured in minutes. Secondary outcomes will include dyspnoea score, quality of life, stages of change, intention to change behaviour and alternative smoking behaviour measures, including current smoking behaviour, 24-hour point prevalence abstinence, prolonged abstinence, continued abstinence and number of quit attempts. Discussion To the best of our knowledge, this will be the first randomised controlled trial to test the effectiveness of a web-based, computer-tailored self-management intervention for people with or at risk for COPD. The results will be important to explore the possible benefits of computer-tailored interventions for the self-management of people with or at risk for COPD and potentially other chronic health conditions. Dutch trial register NTR3421 PMID:23742208

Inflammatory and Other Biomarkers: Role in Pathophysiology and Prediction of Gestational Diabetes Mellitus

PubMed Central

Abell, Sally K.; De Courten, Barbora; Boyle, Jacqueline A.; Teede, Helena J.

2015-01-01

Understanding pathophysiology and identifying mothers at risk of major pregnancy complications is vital to effective prevention and optimal management. However, in current antenatal care, understanding of pathophysiology of complications is limited. In gestational diabetes mellitus (GDM), risk prediction is mostly based on maternal history and clinical risk factors and may not optimally identify high risk pregnancies. Hence, universal screening is widely recommended. Here, we will explore the literature on GDM and biomarkers including inflammatory markers, adipokines, endothelial function and lipids to advance understanding of pathophysiology and explore risk prediction, with a goal to guide prevention and treatment of GDM. PMID:26110385

NASA's Risk Management System

NASA Technical Reports Server (NTRS)

Perera, Jeevan S.

2011-01-01

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

Risk Management Issues - An Aerospace Perspective

NASA Technical Reports Server (NTRS)

Perera, Jeevan S.

2011-01-01

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

Modern Initial Management of Severe Limbs Trauma in War Surgery: Orthopaedic Damage Control

DTIC Science & Technology

2010-04-01

avoid fat embolism , allow an optimal nursing and medical evacuation without any secondary functional consequences [3]. 2.2.1 Indications: The...decrease the risk of fat embolism . Modern Initial Management of Severe Limbs Trauma in War Surgery: “Orthopaedic Damage Control” RTO-MP-HFM-182 17...injuries. Orthopaedic Imperious: Multiple open shaft fractures with blood loss, complex epiphysal fractures requiring a long difficult surgical bloody

Can species traits predict the susceptibility of riverine fish to water resource development? An Australian case study.

PubMed

Rolls, Robert J; Sternberg, David

2015-06-01

Water resource developments alter riverine environments by disrupting longitudinal connectivity, transforming lotic habitats, and modifying in-stream hydraulic conditions. Effective management of anthropogenic disturbances therefore requires an understanding of the range of potential ecosystem effects and the inherent traits symptomatic of elevated vulnerability to disturbance. Using 42 riverine fish native to South Eastern Australia as a case study, we quantified six morphological, behavioral, and life-history traits to classify species into groups reflecting potential differences in their response to ecosystem changes as a result of water resource development. Classification analysis identified five strategies based on fish life-history dispersal requirements, climbing potential, and habitat preference. These strategies in turn highlight the potential species at risk from the separate impacts of water resource development and inform management decisions to mitigate those risks. Swimming ability did not contribute to distinguishing species into functional groups, likely due to methodological inconsistencies in quantifying swimming performance that may ultimately hinder the ability of fish passage facilities to function within the physical capabilities of species at risk of habitat fragmentation. This study improves our ability to predict the performance of groups of species at risk from the multiple environmental changes imposed by humans and goes beyond broad-scale dispersal requirements as a predictor of individual species response.

The risk of bronchospasm in asthmatics undergoing general anaesthesia and/or intravascular administration of radiographic contrast media. physiopatology and clinical/functional evaluation.

PubMed

Liccardi, G; Salzillo, A; Piccolo, A; De Napoli, I; D'Amato, G

2010-10-01

It is well known that patients suffering from bronchial asthma undergoing to surgical procedures requiring general anaesthesia (GA) or the administration of water soluble radiographic contrast media (RCM) experience a risk of potentially severe bronchospasm. Nevertheless, little attention has been devoted on the possible preventive measures to reduce the occurrence of this potentially life-threatening event. It has been shown that the most important risk factor for bronchospasm during GA induction and/or the use of RCM is represented by a high degree of bronchial hyperreactivity with airway instability not adequately controlled by long-term anti-inflammatory treatment. The aim of this review is to underline the need for an accurate clinical and functional evaluation of asthmatics (especially those with a relevant degree of asthma severity) undergoing GA or administration of RCM. Guidelines shared by pulmonologists, allergologists, anesthesiologists and radiologists should be produced in the future for a better evaluation and management of these patients. General practitioner plays an important role in managing asthmatic patients in "Real Life". It is likely that "Real Life"--optimally controlled asthmatics could undergo GA/RCM with lower risks especially in emergency conditions when it is not possible to perform any preoperative evaluation.

Fall management in Alzheimer-related dementia: a case study.

PubMed

Mirolsky-Scala, Gail; Kraemer, Theresa

2009-01-01

Nursing home residents with dementia are at an increased risk of falls. This case report describes a physical therapist's approach to fall management in a patient with Alzheimer's disease in a long-term care facility. An 85-year-old female with Alzheimer's disease began to experience impaired balance and weakness resulting in gait deviations and falls. The combination of clinical findings, scores on several clinical measures, and fall history classified her as being at high risk for future falls. The physical therapy fall management program included lower extremity and core therapeutic exercise, balance, gait, and assistive device training, and caregiver instruction in the form of a functional maintenance program (FMP) with focus on activities that activated the implicit memory system while emphasizing aspects of communication that are typically preserved in patients with dementia. After 4 weeks of twelve 30 minute sessions, the patient's Tinetti Assessment Tool score increased from 8/28 to 16/28 and Berg Balance Scale score from 7/56 to 19/56. The number of documented incident reports related to falls decreased from 2 to 0 in a 4-week period of time. On the International Classification of Functioning, Disability, and Health, the patient improved in 4 areas of the Impairments of Body Functions domain, in 12 areas of the Activity Limitations and Participation Restriction domain, and in 3 areas of the Environmental Factors domain. Positive functional outcomes were achieved through a modification of typical fall prevention interventions that took into consideration the patient's decreased cognition, communication deficits, and behavior problems.

Impacts of hospitals' innovativeness on information system outsourcing decisions.

PubMed

Park, Jae Sung

2014-04-01

The purpose of this study was to identify the effects of hospitals' innovativeness on outsourcing decision-making regarding four information system (IS) functions, namely, software programs, network maintenance, hardware systems, and PC/printer maintenance. Using the 2011 roster of the Korean Hospital Association, this study selected 311 general hospitals as a study population. After identifying the managers who were in charge of outsourcing, this study administered questionnaires. A total of 103 hospitals responded. Of the responding hospitals, 55.34% outsourced at least one IS function, whereas 88.35% outsourced at least one managerial function. IS outsourcing was motivated by the need for outside experts, but other managerial functions were outsourced for cost savings. Innovative and early adopter hospitals were 4.52 and 4.91 times more likely to outsource IS functions related with work processes (i.e., software and network maintenance) than early and late majority hospitals, respectively. IT outsourcing effectiveness significantly influenced the outsourcing decisions regarding four IS functions. Hospitals that had perceived more risks of outsourcing significantly preferred non-outsourcing on their hardware systems, but the risks of outsourcing were not significant for outsourcing decisions regarding the other IS functions. Hospitals' innovativeness also significantly explained the quantity of innovation adoptions. Innovative and early adopter hospitals did more outsourcing than early and late majority hospitals. Hospitals' innovativeness influences decision-making regarding outsourcing. Innovative hospitals are more likely to outsource their work-process-related IS functions. Thus, organizational traits, especially hospitals' innovativeness, should be considered as a key success factor for IS management.

Risks with older adults in acute care settings: UK occupational therapists' and physiotherapists' perceptions of risks associated with discharge and professional practice.

PubMed

Atwal, Anita; McIntyre, Anne; Wiggett, Claire

2012-06-01

Internationally, there is evidence that hospital discharge to home for older adults is a complex and challenging process that is dependent upon multidisciplinary team working. At the centre of the discharge process is the management of risk, which involves occupational therapists and other healthcare professionals managing perceived dangers and determining why some dangers are seen as presenting risks while others are not. This study did not aim to explore interprofessional differences but to ascertain a greater understanding of professionals' perceptions of risk in acute care settings. This qualitative study utilised 12 semi-structured interviews with seven occupational therapists and five physiotherapists in the United Kingdom (UK). During the interview, therapists were asked to read and answer questions on a validated vignette. The interview data were subjected to thematic content analysis and the vignettes to template analysis. Our research is one of the first studies to explore therapists' perceptions of risk with older adults in acute care settings. Our study has highlighted that perception of risk does have an impact on discharge decision-making and location. Therapists used negative terminology to refer to patients who wanted to take risks, which could be a reflection of the therapists' anxiety. Mental capacity, and patients' functioning and safety were key factors in risk decision-making with older adults. Our research has highlighted the potential value of multidisciplinary working to manage risk situations and the need for reflection and discussion regarding how persons who do not have capacity wishes are managed within acute care settings. There is a need to develop an interprofessional care pathway to guide clinicians through the risk decision-making process which needs to ensure that the client's opinions and wishes are taken into account throughout. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.

17 CFR 200.2 - Statutory functions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... AND ETHICS; AND INFORMATION AND REQUESTS Organization and Program Management § 200.2 Statutory... Commission subject themselves to the risk of fine or imprisonment or both; and the issuing company, its... a comprehensive regulatory framework for investment companies and subjects their activities to...

17 CFR 200.2 - Statutory functions.

Code of Federal Regulations, 2013 CFR

2013-04-01

... AND ETHICS; AND INFORMATION AND REQUESTS Organization and Program Management § 200.2 Statutory... Commission subject themselves to the risk of fine or imprisonment or both; and the issuing company, its... a comprehensive regulatory framework for investment companies and subjects their activities to...

17 CFR 200.2 - Statutory functions.

Code of Federal Regulations, 2014 CFR

2014-04-01

... AND ETHICS; AND INFORMATION AND REQUESTS Organization and Program Management § 200.2 Statutory... Commission subject themselves to the risk of fine or imprisonment or both; and the issuing company, its... a comprehensive regulatory framework for investment companies and subjects their activities to...

Therapeutic risk management of the suicidal patient: augmenting clinical suicide risk assessment with structured instruments.

PubMed

Homaifar, Beeta; Matarazzo, Bridget; Wortzel, Hal S

2013-09-01

This column is the second in a series presenting a model for therapeutic risk management of the suicidal patient. As discussed in the first part of the series, the model involves several elements including augmenting clinical risk assessment with structured instruments, stratifying risk in terms of both severity and temporality, and developing and documenting a safety plan. This column explores in more detail how to augment clinical risk assessment with structured instruments. Unstructured clinical interviews have the potential to miss important aspects of suicide risk assessment. By augmenting the free-form clinical interview with structured instruments that demonstrate reliability and validity, a more nuanced and multifaceted approach to suicide risk assessment is achieved. Incorporating structured instruments into practice also serves a medicolegal function, since these instruments may become a living part of the medical record, establishing baseline levels of suicidal thoughts and behaviors and facilitating future clinical determinations regarding safety needs. We describe several instruments used in a multidisciplinary suicide consultation service, each of which has demonstrated relevance to suicide risk assessment and screening, ease of administration, and strong psychometric properties. In addition, we emphasize the importance of viewing suicide risk assessment as an ongoing process rather than as a singular event. Finally, we discuss special considerations in the evolving practice of risk assessment.

NASA's Risk Management System

NASA Technical Reports Server (NTRS)

Perera, Jeevan S.

2013-01-01

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

Online assessment of risk factors for dementia and cognitive function in healthy adults.

PubMed

Huntley, J; Corbett, A; Wesnes, K; Brooker, H; Stenton, R; Hampshire, A; Ballard, C

2018-02-01

Several potentially modifiable risk factors for cognitive decline and dementia have been identified, including low educational attainment, smoking, diabetes, physical inactivity, hypertension, midlife obesity, depression, and perceived social isolation. Managing these risk factors in late midlife and older age may help reduce the risk of dementia; however, it is unclear whether these factors also relate to cognitive performance in older individuals without dementia. Data from 14 201 non-demented individuals aged >50 years who enrolled in the online PROTECT study were used to examine the relationship between cognitive function and known modifiable risk factors for dementia. Multivariate regression analyses were conducted on 4 cognitive outcomes assessing verbal and spatial working memory, visual episodic memory, and verbal reasoning. Increasing age was associated with reduced performance across all tasks. Higher educational achievement, the presence of a close confiding relationship, and moderate alcohol intake were associated with benefits across all 4 cognitive tasks, and exercise was associated with better performance on verbal reasoning and verbal working memory tasks. A diagnosis of depression was negatively associated with performance on visual episodic memory and working memory tasks, whereas being underweight negatively affected performance on all tasks apart from verbal working memory. A history of stroke was negatively associated with verbal reasoning and working memory performance. Known modifiable risk factors for dementia are associated with cognitive performance in non-demented individuals in late midlife and older age. This provides further support for public health interventions that seek to manage these risk factors across the lifespan. Copyright © 2017 John Wiley & Sons, Ltd.

Risk-cost-benefit analysis of atrazine in drinking water from agricultural activities and policy implications

NASA Astrophysics Data System (ADS)

Tesfamichael, Aklilu A.; Caplan, Arthur J.; Kaluarachchi, Jagath J.

2005-05-01

This study provides an improved methodology for investigating the trade-offs between the health risks and economic benefits of using atrazine in the agricultural sector by incorporating public attitude to pesticide management in the analysis. Regression models are developed to predict finished water atrazine concentration in high-risk community water supplies in the United States. The predicted finished water atrazine concentrations are then used in a health risk assessment. The computed health risks are compared with the total economic surplus in the U.S. corn market for different atrazine application rates using estimated demand and supply functions developed in this work. Analysis of different scenarios with consumer price premiums for chemical-free and reduced-chemical corn indicate that if the society is willing to pay a price premium, risks can be reduced without a large reduction in the total economic surplus and net benefits may be higher. The results also show that this methodology provides an improved scientific framework for future decision making and policy evaluation in pesticide management.

Neurocognition, Health-Related Reading Literacy, and Numeracy in Medication Management for HIV Infection

PubMed Central

Jones, Deborah Lynne; Gould, Felicia; Kumar, Mahendra; Ownby, Raymond L.

2010-01-01

Abstract Successful medication management is an essential ingredient for effective treatment for HIV. Risk factors for poor medication adherence, including neurocognitive impairment and low health literacy, are common in HIV patients. To better understand the most salient risks for poor management of HIV medications, we tested the interrelation of neurocognitive functioning, reading literacy for health related information, and numeracy and their effect on self-management of a simulated HIV medication regimen. Cross-sectional data on 191 HIV-positive men and women recruited from HIV outpatient clinics in South Florida were collected. Exploratory factor analysis was conducted with literacy, numeracy, and neurocognitive scores and suggested that four factors were present representing executive skill, verbal memory, planning, and motor speed. Both the literacy and numeracy scores loaded on the executive factor. Adjusted analyses showed that executive and planning skills were significantly related to medication management. Findings suggest that patients must rely on higher order cognitive skills to successfully navigate medication self-management, and that efforts to simplify health information that merely lowers readability are likely to meet with limited success. PMID:20662594

A prospective study of health-related quality-of-life outcomes for patients with low-risk prostate cancer managed by active surveillance or radiation therapy.

PubMed

Banerji, John S; Hurwitz, Lauren M; Cullen, Jennifer; Wolff, Erika M; Levie, Katherine E; Rosner, Inger L; Brand, Timothy C; LʼEsperance, James O; Sterbis, Joseph R; Porter, Christopher R

2017-05-01

Patients with low-risk prostate cancer (PCa) often have excellent oncologic outcomes. However, treatment with curative intent can lead to decrements in health-related quality of life (HRQoL). Patients treated with radical prostatectomy have been shown to suffer declines in urinary and sexual HRQoL as compared to those managed with active surveillance (AS). Similarly, patients treated with external-beam radiation therapy (EBRT) are hypothesized to experience greater declines in bowel HRQoL. As health-related quality-of-life (HRQoL) concerns are paramount when selecting among treatment options for low-risk PCa, this study examined HRQoL outcomes in men undergoing EBRT as compared to AS in a prospective, racially diverse cohort. A prospective study of HRQoL in patients with PCa enrolled in the Center for Prostate Disease Research (CPDR) Multicenter National Database was initiated in 2007. The current study included patients diagnosed through April 2014. HRQoL was assessed with the Expanded Prostate Cancer Index Composite (EPIC) and the Medical Outcomes Study Short Form (SF-36). Temporal changes in HRQoL were compared for patients with low-risk PCa managed on AS vs. EBRT at baseline, 1-, 2-, and 3 years post-PCa diagnosis. Longitudinal patterns were modeled using linear regression models fitted with generalized estimating equations (GEE), adjusting for baseline HRQoL, demographic, and clinical patient characteristics. Of the 499 eligible patients with low-risk PCa, 103 (21%) selected AS and 60 (12%) were treated with EBRT. Demographic characteristics of the treatment groups were similar, though a greater proportion of patients in the EBRT group were African American (P = 0.0003). At baseline, both treatment groups reported comparable HRQoL. EBRT patients experienced significantly worse bowel function and bother at 1 year (adjusted mean score: 87 vs. 95, P = 0.001 and 89 vs. 95, P = 0.008, respectively) and 2 years (87 vs. 93, P = 0.007 and 87 vs. 96, P = 0.002, respectively) compared to patients managed on AS. In contrast to those on AS, more than half the number of patients who received EBRT experienced a decline in bowel function (52% vs. 17%, p=0.003) and bother (52% vs. 15%, P = 0.002) from baseline to 1 year. Patients who received EBRT were significantly more likely to experience a decrease in more than one functional domain (urinary, sexual, bowel, or hormonal) at 1 year when compared with those on AS (60% vs. 28%, P = 0.004). Patients receiving EBRT for low-risk prostate cancer suffer declines in bowel HRQoL. These declines are not experienced by patients on AS, suggesting that management of low-risk prostate cancer with AS may offer a means for preserving HRQoL following prostate cancer diagnosis. Copyright © 2017 Elsevier Inc. All rights reserved.

Physical health-related quality of life predicts stroke in the EPIC-Norfolk.

PubMed

Myint, P K; Surtees, P G; Wainwright, N W J; Luben, R N; Welch, A A; Bingham, S A; Wareham, N J; Khaw, K-T

2007-12-11

To examine the relationship between Short Form (SF)-36 physical functional health-related quality of life and incident stroke. A total of 13,615 men and women participating in the European Prospective Investigation into Cancer-Norfolk who were free of stroke, myocardial infarction, and cancer at baseline were included in the study. Participants completed a health and lifestyle questionnaire and attended a health examination during 1993 to 1997. Self-reported physical functional health was assessed using physical component summary scores of SF-36 18 months later. Stroke incidence was ascertained by death certification and hospital record linkage up to 2005. There were 244 incident strokes (total person years = 99,191). People who reported better physical functional health had significantly lower risk of incident stroke. Using Cox proportional hazard models adjusting for age, sex, body mass index, systolic blood pressure, cholesterol, smoking, diabetes, physical activity, social class, alcohol consumption, and respiratory function, men and women who were in the top quartile of SF-36 physical component summary scores had half the risk of stroke (RR = 0.50 [0.31, 0.78]) compared to the people in the bottom quartile. The relationships remained unchanged after excluding strokes occurring within the first 2 years of follow-up. Physical functional health-related quality of life measured as Short Form-36 predicts subsequent stroke risk independently of known risk factors in a general population. Poor physical functional health may indicate a high-risk population for stroke who may benefit most from targeted preventive interventions such as management of known risk factors.

A risk analysis approach for using discriminant functions to manage logging-related landslides on granitic terrain

Treesearch

Raymond M. Rice; Norman H. Pillsbury; Kurt W. Schmidt

1985-01-01

Abstract - A linear discriminant function, developed to predict debris avalanches after clearcut logging on a granitic batholith in northwestern California, was tested on data from two batholiths. The equation was inaccurate in predicting slope stability on one of them. A new equation based on slope, crown cover, and distance from a stream (retained from the original...

[The role of a specialised risk analysis group in the Veterinary Services of a developing country].

PubMed

Urbina-Amarís, M E

2003-08-01

Since the World Trade Organization (WTO) Agreement on the Application of Sanitary and Phytosanitary Measures was established, risk analysis in trade, and ultimately in Veterinary and Animal Health Services, has become strategically important. Irrespective of their concept (discipline, approach, method, process), all types of risk analysis in trade involve four periods or phases:--risk identification-- risk assessment--risk management--risk information or communication. All veterinarians involved in a risk analysis unit must have in-depth knowledge of statistics and the epidemiology of transmissible diseases, as well as a basic knowledge of veterinary science, economics, mathematics, data processing and social communication, to enable them to work with professionals in these disciplines. Many developing countries do not have enough well-qualified professionnals in these areas to support a risk analysis unit. This will need to be rectified by seeking strategic alliances with other public or private sectors that will provide the required support to run the unit properly. Due to the special nature of its risk analysis functions, its role in supporting decision-making, and the criteria of independence and transparency that are so crucial to its operations, the hierarchical position of the risk analysis unit should be close to the top management of the Veterinary Service. Due to the shortage of personnel in developing countries with the required training and scientific and technical qualifications, countries with organisations responsible for both animal and plant health protection would be advised to set up integrated plant and animal risk analysis units. In addition, these units could take charge of all activities relating to WTO agreements and regional agreements on animal and plant health management.

Analysis of good practice of public health Emergency Operations Centers.

PubMed

Xu, Min; Li, Shi-Xue

2015-08-01

To study the public health Emergency Operations Centers (EOCs)in the US, the European Union, the UK and Australia, and summarize the good practice for the improvement of National Health Emergency Response Command Center in Chinese National Health and Family Planning Commission. Literature review was conducted to explore the EOCs of selected countries. The study focused on EOC function, organizational structure, human resources and information management. The selected EOCs had the basic EOC functions of coordinating and commanding as well as the public health related functions such as monitoring the situation, risk assessment, and epidemiological briefings. The organizational structures of the EOCs were standardized, scalable and flexible. Incident Command System was the widely applied organizational structure with a strong preference. The EOCs were managed by a unit of emergency management during routine time and surge staff were engaged upon emergencies. The selected EOCs had clear information management framework including information collection, assessment and dissemination. The performance of National Health Emergency Response Command Center can be improved by learning from the good practice of the selected EOCs, including setting clear functions, standardizing the organizational structure, enhancing the human resource capacity and strengthening information management. Copyright © 2015 Hainan Medical College. Production and hosting by Elsevier B.V. All rights reserved.

Prospective Memory Deficits Are Associated With Poorer Everyday Functioning in Parkinson’s Disease

PubMed Central

Pirogovsky, Eva; Woods, Steven Paul; Filoteo, J. Vincent; Gilbert, Paul E.

2013-01-01

Although individuals with Parkinson’s disease (PD) evidence moderate deficits in prospective memory (PM), it is not known whether PM deficits confer an increased risk of poorer everyday functioning. In the current study, 33 individuals with PD and 26 demographically similar normal controls (NC) were administered performance-based and self-report measures of PM and everyday functioning, including medication and financial management. As compared to NC, PD participants demonstrated significantly lower scores on performance-based measures of PM and financial capacity, worse performance at a trend level on performance-based medication management and endorsed significantly greater self-reported declines in PM and instrumental activities of daily living (iADLs). In the PD sample, the laboratory measure of PM significantly correlated with performance-based measures of financial capacity and medication management and a self-report measure of medication management. Self-reported PM failures significantly correlated with perceived declines in iADLs, worse medication management, and poorer health-related quality of life. Although future studies are needed to examine the incremental ecological validity of PM in PD, findings from this study extend prior research by providing preliminary evidence that PM impairment may play a significant role in a range of critical everyday functions in PD. PMID:22846463

Overview of practice management in child and adolescent psychiatry.

PubMed

Schreter, Robert K

2010-01-01

The manager of a psychiatric practice must create and direct a clinical delivery system, design and oversee the administrative services necessary to support the system, and guide the business operations that contribute to its success. Regardless of the size of the practice, the psychiatrist administrator must handle seven core administrative responsibilities and oversee individual functions and capabilities within each domain. These responsibilities include practice development, clinical services management, medical office operations, clinical management, information management, business management, and risk management. This article provides a roadmap for creating and sustaining successful clinical and administrative endeavors. It can also be used by existing practices as an audit instrument to provide a snapshot of current capabilities so that strengths as well as opportunities for continued growth can be identified.

The cost-effectiveness of a new disease management model for frail elderly living in homes for the elderly, design of a cluster randomized controlled clinical trial

PubMed Central

Boorsma, Marijke; van Hout, Hein PJ; Frijters, Dinnus H; Ribbe, Miel W; Nijpels, Giel

2008-01-01

Background The objective of this article is to describe the design of a study to evaluate the clinical and economic effects of a Disease Management model on functional health, quality of care and quality of life of persons living in homes for the elderly. Methods This study concerns a cluster randomized controlled clinical trial among five intervention homes and five usual care homes in the North-West of the Netherlands with a total of over 500 residents. All persons who are not terminally ill, are able to be interviewed and sign informed consent are included. For cognitively impaired persons family proxies will be approached to provide outcome information. The Disease Management Model consists of several elements: (1) Trained staff carries out a multidimensional assessment of the patients functional health and care needs with the interRAI Long Term Care Facilities instrument (LTCF). Computerization of the LTCF produces immediate identification of problem areas and thereby guides individualized care planning. (2) The assessment outcomes are discussed in a Multidisciplinary Meeting (MM) with the nurse, primary care physician, nursing home physician and Psychotherapist and if necessary other members of the care team. The MM presents individualized care plans to manage or treat modifiable disabilities and risk factors. (3) Consultation by an nursing home physician and psychotherapist is offered to the frailest residents at risk for nursing home admission (according to the interRAI LTCF). Outcome measures are Quality of Care indicators (LTCF based), Quality Adjusted Life Years (Euroqol), Functional health (SF12, COOP-WONCA), Disability (GARS), Patients care satisfaction (QUOTE), hospital and nursing home days and mortality, health care utilization and costs. Discussion This design is unique because no earlier studies were performed to evaluate the effects and costs of this Disease Management Model for disabled persons in homes for the elderly on functional health and quality of care. Trail registration number ISRCTN11076857 PMID:18606020

The cost-effectiveness of a new disease management model for frail elderly living in homes for the elderly, design of a cluster randomized controlled clinical trial.

PubMed

Boorsma, Marijke; van Hout, Hein P J; Frijters, Dinnus H; Ribbe, Miel W; Nijpels, Giel

2008-07-07

The objective of this article is to describe the design of a study to evaluate the clinical and economic effects of a Disease Management model on functional health, quality of care and quality of life of persons living in homes for the elderly. This study concerns a cluster randomized controlled clinical trial among five intervention homes and five usual care homes in the North-West of the Netherlands with a total of over 500 residents. All persons who are not terminally ill, are able to be interviewed and sign informed consent are included. For cognitively impaired persons family proxies will be approached to provide outcome information. The Disease Management Model consists of several elements: (1) Trained staff carries out a multidimensional assessment of the patients functional health and care needs with the interRAI Long Term Care Facilities instrument (LTCF). Computerization of the LTCF produces immediate identification of problem areas and thereby guides individualized care planning. (2) The assessment outcomes are discussed in a Multidisciplinary Meeting (MM) with the nurse, primary care physician, nursing home physician and Psychotherapist and if necessary other members of the care team. The MM presents individualized care plans to manage or treat modifiable disabilities and risk factors. (3) Consultation by an nursing home physician and psychotherapist is offered to the frailest residents at risk for nursing home admission (according to the interRAI LTCF). Outcome measures are Quality of Care indicators (LTCF based), Quality Adjusted Life Years (Euroqol), Functional health (SF12, COOP-WONCA), Disability (GARS), Patients care satisfaction (QUOTE), hospital and nursing home days and mortality, health care utilization and costs. This design is unique because no earlier studies were performed to evaluate the effects and costs of this Disease Management Model for disabled persons in homes for the elderly on functional health and quality of care. TRAIL REGISTRATION NUMBER: ISRCTN11076857.

Lipids and lipid changes with synthetic and biologic disease-modifying antirheumatic drug therapy in rheumatoid arthritis: implications for cardiovascular risk.

PubMed

Myasoedova, Elena

2017-05-01

To highlight recently published studies addressing lipid changes with disease-modifying antirheumatic drug use and outline implications on cardiovascular outcomes in rheumatoid arthritis (RA). Growing evidence suggests lower lipid levels are present in patients with active RA vs. general population, and significant modifications of lipid profile with inflammation suppression. Increase in lipid levels in patients with RA on synthetic and biological disease-modifying antirheumatic drugs may be accompanied by antiatherogenic changes in lipid composition and function. The impact of lipid changes on cardiovascular outcomes in RA is a subject of active research. The role of lipids in cardiovascular risk in RA may be overpowered by the benefits of inflammation suppression with antirheumatic medication use. Recommendations on lipid management in RA are evolving but uncertainty exists regarding frequency of lipid testing and goals of treatment. Knowledge about quantitative and qualitative lipid changes in RA is expanding. The relative role of lipids in cardiovascular risk in the context of systemic inflammation and antirheumatic therapy remains uncertain, delaying development of effective strategies for cardiovascular risk management in RA. Studies are underway to address these knowledge gaps and may be expected to inform cardiovascular risk management in RA and the general population.

Reference dose (RfD): description and use in health risk assessments

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

Barnes, D.G.; Dourson, M.

1988-12-01

For many years the concept of the acceptable daily intake has served the toxicological and regulatory fields quite well. However, as approaches to assessing the health significance of exposures to noncarcinogenic substances receive greater scrutiny, some difficulties with this traditional approach have become more apparent. Consequently, the concept of the reference dose is introduced in order to avoid use of prejudicial terms (e.g., safety and acceptable), to promote greater consistency in the assessment of noncarcinogenic chemicals, and to maintain the functional separation between risk assessment and risk management.

Adolescent Females and Their Mothers

PubMed Central

Volkman, Julie E.; Silk, Kami J.

2010-01-01

Recent research indicates environmental factors and personal behaviors are related to breast cancer risk, but adopting a healthy lifestyle as early as adolescence can serve a protective function. To investigate perceptions of breast cancer risk and the environment, 10 focus groups (N = 91) were conducted with adolescent females (n = 55) and mothers (n = 36) across four counties in the Midwest, USA. The Uncertainty Management Theory provides a framework for discussing statements, and results suggest that uncertainty is maintained through ambiguity about environmental risk factors and breast cancer. Recommendations for prevention messages are presented. PMID:18987091

Emphysematous pyelonephritis: Our experience with conservative management in 14 cases.

PubMed

Sharma, Pramod Kumar; Sharma, Ritu; Vijay, Mukesh K; Tiwari, Punit; Goel, Amit; Kundu, Anup K

2013-07-01

Emphysematous pyelonephritis (EPN) is a rare, severe, acute, necrotizing infection of the kidney. In this study, we present the clinical details, the management strategies, and the outcome of fourteen patients of EPN managed at our center. A retrospective analysis of the hospital records was done. A total of fourteen patients with EPN were admitted in our hospital from August 2007 to February 2011. All the patients were managed conservatively. Follow-up ranged from six months to one year. Of the fourteen patients, four belonged to class I, five to class II, four to class IIIA and one to class IIIB. All the patients had history of fever, 43% had localized flank pain while 36% had vague abdominal discomfort. Renal angle tenderness was the most common sign, seen in 86% of the patients. E. coli was the most common bacteria, which was isolated from urine in 57% of the patients. On the risk factor stratification, three patients had simultaneous presence of 2 or more risk factors (thrombocytopenia-2 patients; renal function impairment-7 patients; shock-1 patient). All the patients were initially managed with aggressive fluid and electrolyte resuscitation, control of blood sugar levels, and broad spectrum antibiotics. Intervention, in the form of percutaneous drainage or DJ stenting, was done in six patients. One patient failed to respond to this minimally invasive modality of treatment and had to undergo an open drainage. Thus, the acute episode was managed with conservative management strategies in all the patients; however, three patients underwent nephrectomy due to poorly-functioning kidney during follow-up. EPN is now being more readily diagnosed, at an early stage, making conservative management of EPN a safe, effective, and feasible option.

Emphysematous pyelonephritis: Our experience with conservative management in 14 cases

PubMed Central

Sharma, Pramod Kumar; Sharma, Ritu; Vijay, Mukesh K.; Tiwari, Punit; Goel, Amit; Kundu, Anup K.

2013-01-01

Context: Emphysematous pyelonephritis (EPN) is a rare, severe, acute, necrotizing infection of the kidney. In this study, we present the clinical details, the management strategies, and the outcome of fourteen patients of EPN managed at our center. Materials and Methods: A retrospective analysis of the hospital records was done. A total of fourteen patients with EPN were admitted in our hospital from August 2007 to February 2011. All the patients were managed conservatively. Follow-up ranged from six months to one year. Results: Of the fourteen patients, four belonged to class I, five to class II, four to class IIIA and one to class IIIB. All the patients had history of fever, 43% had localized flank pain while 36% had vague abdominal discomfort. Renal angle tenderness was the most common sign, seen in 86% of the patients. E. coli was the most common bacteria, which was isolated from urine in 57% of the patients. On the risk factor stratification, three patients had simultaneous presence of 2 or more risk factors (thrombocytopenia-2 patients; renal function impairment-7 patients; shock-1 patient). All the patients were initially managed with aggressive fluid and electrolyte resuscitation, control of blood sugar levels, and broad spectrum antibiotics. Intervention, in the form of percutaneous drainage or DJ stenting, was done in six patients. One patient failed to respond to this minimally invasive modality of treatment and had to undergo an open drainage. Thus, the acute episode was managed with conservative management strategies in all the patients; however, three patients underwent nephrectomy due to poorly-functioning kidney during follow-up. Conclusions: EPN is now being more readily diagnosed, at an early stage, making conservative management of EPN a safe, effective, and feasible option. PMID:24049377

Improving interMediAte Risk management. MARK study

PubMed Central

2011-01-01

Background Cardiovascular risk functions fail to identify more than 50% of patients who develop cardiovascular disease. This is especially evident in the intermediate-risk patients in which clinical management becomes difficult. Our purpose is to analyze if ankle-brachial index (ABI), measures of arterial stiffness, postprandial glucose, glycosylated hemoglobin, self-measured blood pressure and presence of comorbidity are independently associated to incidence of vascular events and whether they can improve the predictive capacity of current risk equations in the intermediate-risk population. Methods/Design This project involves 3 groups belonging to REDIAPP (RETICS RD06/0018) from 3 Spanish regions. We will recruit a multicenter cohort of 2688 patients at intermediate risk (coronary risk between 5 and 15% or vascular death risk between 3-5% over 10 years) and no history of atherosclerotic disease, selected at random. We will record socio-demographic data, information on diet, physical activity, comorbidity and intermittent claudication. We will measure ABI, pulse wave velocity and cardio ankle vascular index at rest and after a light intensity exercise. Blood pressure and anthropometric data will be also recorded. We will also quantify lipids, glucose and glycosylated hemoglobin in a fasting blood sample and postprandial capillary glucose. Eighteen months after the recruitment, patients will be followed up to determine the incidence of vascular events (later follow-ups are planned at 5 and 10 years). We will analyze whether the new proposed risk factors contribute to improve the risk functions based on classic risk factors. Discussion Primary prevention of cardiovascular diseases is a priority in public health policy of developed and developing countries. The fundamental strategy consists in identifying people in a high risk situation in which preventive measures are effective and efficient. Improvement of these predictions in our country will have an immediate, clinical and welfare impact and a short term public health effect. Trial Registration Clinical Trials.gov Identifier: NCT01428934 PMID:21992621

Risk and Resilience in Military Children and Families

DTIC Science & Technology

2011-11-01

score not assoc with child or family functioning • Spouses positive parenting and SM’s positive family problem solving assoc with child prosocial ...CI Seven Core Components Family focused care management (e.g. ensuring instrumental support/attention to complications) Emotion regulation skill

Real-World Impact of Neurocognitive Deficits in Acute and Early HIV Infection

PubMed Central

Doyle, Katie L.; Morgan, Erin E.; Morris, Sheldon; Smith, Davey M.; Little, Susan; Iudicello, Jennifer E.; Blackstone, Kaitlin; Moore, David J.; Grant, Igor; Letendre, Scott L.; Woods, Steven Paul

2013-01-01

The acute and early period of HIV-1 infection (AEH) is characterized by neuroinflammatory and immunopathogenic processes that can alter the integrity of neural systems and neurocognitive functions. However, the extent to which central nervous system changes in AEH confer increased risk of real-world functioning (RWF) problems is not known. In the present study, 34 individuals with AEH and 39 seronegative comparison participants completed standardized neuromedical, psychiatric, and neurocognitive research evaluations, alongside a comprehensive assessment of RWF that included cognitive symptoms in daily life, basic and instrumental activities of daily living, clinician-rated global functioning, and employment. Results showed that AEH was associated with a significantly increased risk of dependence in RWF, which was particularly elevated among AEH persons with global neurocognitive impairment (NCI). Among those with AEH, NCI (i.e., deficits in learning and information processing speed), mood disorders (i.e., Bipolar Disorder), and substance dependence (e.g., methamphetamine dependence) were all independently predictive of RWF dependence. Findings suggest that neurocognitively impaired individuals with AEH are at notably elevated risk of clinically significant challenges in normal daily functioning. Screening for neurocognitive, mood, and substance use disorders in AEH may facilitate identification of individuals at high risk of functional dependence who may benefit from psychological and medical strategies to manage their neuropsychiatric conditions. PMID:24277439

Functional foods for dyslipidaemia and cardiovascular risk prevention.

PubMed

Sirtori, Cesare R; Galli, Claudio; Anderson, James W; Sirtori, Elena; Arnoldi, Anna

2009-12-01

A food can be regarded as 'functional' if it can demonstrate a beneficial efficacy on one or more target functions in the body in a convincing way. Beyond adequate nutritional qualities, functional foods should either improve the state of health and wellbeing and/or reduce the risk of disease. Functional foods that are marketed with claims of heart disease reduction focus primarily on the major risk factors, i.e. cholesterol, diabetes and hypertension. Some of the most innovative products are designed to be enriched with 'protective' ingredients, believed to reduce risk. They may contain, for example, soluble fibre (from oat and psyllium), useful both for lowering cholesterol and blood pressure, or fructans, effective in diabetes. Phytosterols and stanols lower LDL-cholesterol in a dose-dependent manner. Soya protein is more hypocholesterolaemic in subjects with very high initial cholesterol and recent data indicate also favourable activities in the metabolic syndrome. n-3 Fatty acids appear to exert significant hypotriacylglycerolaemic effects, possibly partly responsible for their preventive activity. Dark chocolate is gaining much attention for its multifunctional activities, useful both for the prevention of dyslipidaemia as well as hypertension. Finally, consensus opinions about tea and coffee have not emerged yet, and the benefits of vitamin E, garlic, fenugreek and policosanols in the management of dyslipidaemia and prevention of arterial disease are still controversial.

[Screening of the risk of functional decline performed by an inpatient geriatric consultation team in a general hospital].

PubMed

Benoît, F; Bertiaux, M; Schouterden, R; Huard, E; Segers, K; Decorte, L; Robberecht, J; Simonetti, C; Surquin, M

2013-01-01

The Mobile Geriatric Team (MGT) is part of the Geriatric Care Program and aims to provide interdisciplinary geriatric expertise to other professionals for old patients hospitalized outside geriatric department. Our hospital has a MGT since 2008. Our objective is to retrospectively describe the population of patients of 75 years and older hospitalized outside the geriatric ward and screened for the risk of functional decline by the MGT between 1 October 2009 and 30 September 2011. We recorded the risk of functional decline, as indicated by the Identification of Senior At Risk score (ISAR) performed within 48 h after admission, place of living, discharge destination, Mini Mental State Examination (MMSE) and Geriatric Depression Scale (GDS) scores. In two years, 1.568 patients > or = 75 Y were screened with the ISAR score (mean age 82.5 Y, 60.7% of women). We identified 833 patients with a high-risk of functional decline (ISAR > or = 3). The majority of high-risk subjects (78%) were living at home before hospitalization and 58.7% returned home after discharge. Depression and cognitive impairment were identified among respectively 41% and 59% of high-risk subjects. Only 128 patients were admitted for fall. Most of the faller patients were living at home prior hospitalization and had an ISAR score > or = 3. The MGT allowed identifying many patients > or = 75 Y living at home and presenting with high-risk of functional decline and geriatric syndromes, confirming that good screening procedures are necessary to optimize management of hospitalized olders. Most of faller patients have an ISAR score > or = 3 and should benefit a comprehensive geriatric assessment.

Bacterial Pneumonia in Patients with Cancer: Novel Risk Factors and Management.

PubMed

Wong, Justin L; Evans, Scott E

2017-06-01

Bacterial pneumonias exact unacceptable morbidity on patients with cancer. Although the risk is often most pronounced among patients with treatment-induced cytopenias, the numerous contributors to life-threatening pneumonias in cancer populations range from derangements of lung architecture and swallow function to complex immune defects associated with cytotoxic therapies and graft-versus-host disease. These structural and immunologic abnormalities often make the diagnosis of pneumonia challenging in patients with cancer and impact the composition and duration of therapy. This article addresses host factors that contribute to pneumonia susceptibility, summarizes diagnostic recommendations, and reviews current guidelines for management of bacterial pneumonia in patients with cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

Improving Care Transitions Management: Examining the Role of Accountable Care Organization Participation and Expanded Electronic Health Record Functionality.

PubMed

Huber, Thomas P; Shortell, Stephen M; Rodriguez, Hector P

2017-08-01

Examine the extent to which physician organization participation in an accountable care organization (ACO) and electronic health record (EHR) functionality are associated with greater adoption of care transition management (CTM) processes. A total of 1,398 physician organizations from the third National Study of Physician Organization survey (NSPO3), a nationally representative sample of medical practices in the United States (January 2012-May 2013). We used data from the third National Study of Physician Organization survey (NSPO3) to assess medical practice characteristics, including CTM processes, ACO participation, EHR functionality, practice type, organization size, ownership, public reporting, and pay-for-performance participation. Multivariate linear regression models estimated the extent to which ACO participation and EHR functionality were associated with greater CTM capabilities, controlling for practice size, ownership, public reporting, and pay-for-performance participation. Approximately half (52.4 percent) of medical practices had a formal program for managing care transitions in place. In adjusted analyses, ACO participation (p < .001) and EHR functionality (p < .001) were independently associated with greater use of CTM processes among medical practices. The growth of ACOs and similar provider risk-bearing arrangements across the country may improve the management of care transitions by physician organizations. © Health Research and Educational Trust.

Pregnancy with Portal Hypertension

PubMed Central

Aggarwal, Neelam; Negi, Neha; Aggarwal, Aakash; Bodh, Vijay; Dhiman, Radha K.

2014-01-01

Even though pregnancy is rare with cirrhosis and advanced liver disease, but it may co-exist in the setting of non-cirrhotic portal hypertension as liver function is preserved but whenever encountered together is a complex clinical dilemma. Pregnancy in a patient with portal hypertension presents a special challenge to the obstetrician as so-called physiological hemodynamic changes associated with pregnancy, needed for meeting demands of the growing fetus, worsen the portal hypertension thereby putting mother at risk of potentially life-threatening complications like variceal hemorrhage. Risks of variceal bleed and hepatic decompensation increase many fold during pregnancy. Optimal management revolves round managing the portal hypertension and its complications. Thus management of such cases requires multi-speciality approach involving obstetricians experienced in dealing with high risk cases, hepatologists, anesthetists and neonatologists. With advancement in medical field, pregnancy is not contra-indicated in these women, as was previously believed. This article focuses on the different aspects of pregnancy with portal hypertension with special emphasis on specific cause wise treatment options to decrease the variceal bleed and hepatic decompensation. Based on extensive review of literature, management from pre-conceptional period to postpartum is outlined in order to have optimal maternal and perinatal outcomes. PMID:25755552

Beneficial role of vitamin K supplementation on insulin sensitivity, glucose metabolism, and the reduced risk of type 2 diabetes: A review.

PubMed

Manna, Prasenjit; Kalita, Jatin

2016-01-01

Micronutrients are gaining acceptance as an important nutritional therapy for the prevention and/or management of diabetes and its associated health risks. Although a very small quantity of micronutrients are required for specific functions in our bodies, moderate deficiencies can lead to serious health issues. Impaired insulin sensitivity and glucose intolerance play a major role in the development of diabetic pathophysiology. Vitamin K is well known for its function in blood coagulation. Moreover, several human studies reported the beneficial role of vitamin K supplementation in improving insulin sensitivity and glucose tolerance, preventing insulin resistance, and reducing the risk of type 2 diabetes (T2 D). Both animal and human studies have suggested that vitamin K-dependent protein (osteocalcin [OC]), regulation of adipokine levels, antiinflammatory properties, and lipid-lowering effects may mediate the beneficial function of vitamin K in insulin sensitivity and glucose tolerance. This review for the first time provides an overview of the currently available preclinical and clinical evidences on the effect of vitamin K supplementation in the management of insulin sensitivity and glucose tolerance. The outcome of this review will increase understanding for the development of a novel adjuvant therapy to achieve better control of glycemia and improve the lives of diabetic patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Functional Foods and Lifestyle Approaches for Diabetes Prevention and Management

PubMed Central

Alkhatib, Ahmad; Tsang, Catherine; Tiss, Ali; Bahorun, Theeshan; Arefanian, Hossein; Barake, Roula; Khadir, Abdelkrim; Tuomilehto, Jaakko

2017-01-01

Functional foods contain biologically active ingredients associated with physiological health benefits for preventing and managing chronic diseases, such as type 2 diabetes mellitus (T2DM). A regular consumption of functional foods may be associated with enhanced anti-oxidant, anti-inflammatory, insulin sensitivity, and anti-cholesterol functions, which are considered integral to prevent and manage T2DM. Components of the Mediterranean diet (MD)—such as fruits, vegetables, oily fish, olive oil, and tree nuts—serve as a model for functional foods based on their natural contents of nutraceuticals, including polyphenols, terpenoids, flavonoids, alkaloids, sterols, pigments, and unsaturated fatty acids. Polyphenols within MD and polyphenol-rich herbs—such as coffee, green tea, black tea, and yerba maté—have shown clinically-meaningful benefits on metabolic and microvascular activities, cholesterol and fasting glucose lowering, and anti-inflammation and anti-oxidation in high-risk and T2DM patients. However, combining exercise with functional food consumption can trigger and augment several metabolic and cardiovascular protective benefits, but it is under-investigated in people with T2DM and bariatric surgery patients. Detecting functional food benefits can now rely on an “omics” biological profiling of individuals’ molecular, genetics, transcriptomics, proteomics, and metabolomics, but is under-investigated in multi-component interventions. A personalized approach for preventing and managing T2DM should consider biological and behavioral models, and embed nutrition education as part of lifestyle diabetes prevention studies. Functional foods may provide additional benefits in such an approach. PMID:29194424

Functional Foods and Lifestyle Approaches for Diabetes Prevention and Management.

PubMed

Alkhatib, Ahmad; Tsang, Catherine; Tiss, Ali; Bahorun, Theeshan; Arefanian, Hossein; Barake, Roula; Khadir, Abdelkrim; Tuomilehto, Jaakko

2017-12-01

Functional foods contain biologically active ingredients associated with physiological health benefits for preventing and managing chronic diseases, such as type 2 diabetes mellitus (T2DM). A regular consumption of functional foods may be associated with enhanced anti-oxidant, anti-inflammatory, insulin sensitivity, and anti-cholesterol functions, which are considered integral to prevent and manage T2DM. Components of the Mediterranean diet (MD)-such as fruits, vegetables, oily fish, olive oil, and tree nuts-serve as a model for functional foods based on their natural contents of nutraceuticals, including polyphenols, terpenoids, flavonoids, alkaloids, sterols, pigments, and unsaturated fatty acids. Polyphenols within MD and polyphenol-rich herbs-such as coffee, green tea, black tea, and yerba maté-have shown clinically-meaningful benefits on metabolic and microvascular activities, cholesterol and fasting glucose lowering, and anti-inflammation and anti-oxidation in high-risk and T2DM patients. However, combining exercise with functional food consumption can trigger and augment several metabolic and cardiovascular protective benefits, but it is under-investigated in people with T2DM and bariatric surgery patients. Detecting functional food benefits can now rely on an "omics" biological profiling of individuals' molecular, genetics, transcriptomics, proteomics, and metabolomics, but is under-investigated in multi-component interventions. A personalized approach for preventing and managing T2DM should consider biological and behavioral models, and embed nutrition education as part of lifestyle diabetes prevention studies. Functional foods may provide additional benefits in such an approach.

[Executive summary of the recommendations on the evaluation and management of renal disease in human immunodeficiency virus-infected patients].

PubMed

Gorriz, José L; Gutiérrez, Félix; Trullàs, Joan C; Arazo, Piedad; Arribas, Jose R; Barril, Guillermina; Cervero, Miguel; Cofán, Frederic; Domingo, Pere; Estrada, Vicente; Fulladosa, Xavier; Galindo, María J; Gràcia, Sílvia; Iribarren, José A; Knobel, Hernando; López-Aldeguer, José; Lozano, Fernando; Martínez-Castelao, Alberto; Martínez, Esteban; Mazuecos, Maria A; Miralles, Celia; Montañés, Rosario; Negredo, Eugenia; Palacios, Rosario; Pérez-Elías, María J; Portilla, Joaquín; Praga, Manuel; Quereda, Carlos; Rivero, Antonio; Santamaría, Juan M; Sanz, José; Sanz, Jesús; Miró, José M

2014-11-01

The aim of this article is to update the 2010 recommendations on the evaluation and management of renal disease in human immunodeficiency virus (HIV)-infected patients. Renal function should be monitored in all HIV-infected patients. The basic renal work-up should include measurements of serum creatinine, estimated glomerular filtration rate by CKD-EPI, urine protein-to-creatinine ratio, and urinary sediment. Tubular function tests should include determination of serum phosphate levels and urine dipstick for glycosuria. In the absence of abnormal values, renal screening should be performed annually. In patients treated with tenofovir, or with risk factors for chronic kidney disease (CKD), more frequent renal screening is recommended. In order to prevent disease progression, potentially nephrotoxic antiretroviral drugs are not recommended in patients with CKD or risk factors for CKD. The document provides indications for renal biopsy and advises on the optimal time for referral of a patient to the nephrologist. The indications for and evaluation and management of dialysis and renal transplantation are also addressed. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

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

NASA Astrophysics Data System (ADS)

Xu, Jun

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

Cardiovascular disease in spinal cord injury: an overview of prevalence, risk, evaluation, and management.

PubMed

Myers, Jonathan; Lee, Matthew; Kiratli, Jenny

2007-02-01

Cardiovascular disease is a growing concern for the spinal cord-injured (SCI) population. For long-term SCI, morbidity and mortality from cardiovascular causes now exceeds that caused by renal and pulmonary conditions, the primary causes of mortality in previous decades. Although risk estimates commonly used for ambulatory individuals have not been established from follow-up studies in SCI, nearly all risk factors tend to be more prevalent in SCI subjects compared with ambulatory subjects. These risks include a greater prevalence of obesity, lipid disorders, metabolic syndrome, and diabetes. Daily energy expenditure is significantly lower in SCI individuals, not only because of a lack of motor function, but also because of a lack of accessibility and fewer opportunities to engage in physical activity. Autonomic dysfunction caused by SCI is also associated with several conditions that contribute to heightened cardiovascular risk, including abnormalities in blood pressure, heart rate variability, arrhythmias, and a blunted cardiovascular response to exercise that can limit the capacity to perform physical activity. Thus, screening, recognition, and treatment of cardiovascular disease should be an essential component of managing individuals with SCI, and judicious treatment of risk factors can play an important role in minimizing the incidence of cardiovascular disease in these individuals. This article reviews the cardiovascular consequences of chronic SCI, including the prevalence of cardiovascular disease and risk factors unique to these individuals, and provides a synopsis of management of cardiovascular disease in this population.

Towards integrated hygiene and food safety management systems: the Hygieneomic approach.

PubMed

Armstrong, G D

1999-09-15

Integrated hygiene and food safety management systems in food production can give rise to exceptional improvements in food safety performance, but require high level commitment and full functional involvement. A new approach, named hygieneomics, has been developed to assist management in their introduction of hygiene and food safety systems. For an effective introduction, the management systems must be designed to fit with the current generational state of an organisation. There are, broadly speaking, four generational states of an organisation in their approach to food safety. They comprise: (i) rules setting; (ii) ensuring compliance; (iii) individual commitment; (iv) interdependent action. In order to set up an effective integrated hygiene and food safety management system a number of key managerial requirements are necessary. The most important ones are: (a) management systems must integrate the activities of key functions from research and development through to supply chain and all functions need to be involved; (b) there is a critical role for the senior executive, in communicating policy and standards; (c) responsibilities must be clearly defined, and it should be clear that food safety is a line management responsibility not to be delegated to technical or quality personnel; (d) a thorough and effective multi-level audit approach is necessary; (e) key activities in the system are HACCP and risk management, but it is stressed that these are ongoing management activities, not once-off paper generating exercises; and (f) executive management board level review is necessary of audit results, measurements, status and business benefits.

Managing Lunar and Mars Mission Radiation Risks. Part 1; Cancer Risks, Uncertainties, and Shielding Effectiveness

NASA Technical Reports Server (NTRS)

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

2005-01-01

This document addresses calculations of probability distribution functions (PDFs) representing uncertainties in projecting fatal cancer risk from galactic cosmic rays (GCR) and solar particle events (SPEs). PDFs are used to test the effectiveness of potential radiation shielding approaches. Monte-Carlo techniques are used to propagate uncertainties in risk coefficients determined from epidemiology data, dose and dose-rate reduction factors, quality factors, and physics models of radiation environments. Competing mortality risks and functional correlations in radiation quality factor uncertainties are treated in the calculations. The cancer risk uncertainty is about four-fold for lunar and Mars mission risk projections. For short-stay lunar missins (<180 d), SPEs present the most significant risk, but one effectively mitigated by shielding. For long-duration (>180 d) lunar or Mars missions, GCR risks may exceed radiation risk limits. While shielding materials are marginally effective in reducing GCR cancer risks because of the penetrating nature of GCR and secondary radiation produced in tissue by relativisitc particles, polyethylene or carbon composite shielding cannot be shown to significantly reduce risk compared to aluminum shielding. Therefore, improving our knowledge of space radiobiology to narrow uncertainties that lead to wide PDFs is the best approach to ensure radiation protection goals are met for space exploration.

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

NASA Technical Reports Server (NTRS)

Johnson, Paul W.

2008-01-01

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

Probability concepts in quality risk management.

PubMed

Claycamp, H Gregg

2012-01-01

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

COST EFFECTIVE CONTROL OF HEXAVALENT CHROMIUM AIR EMISSIONS FROM FUNCTIONAL CHROMIUM ELECTROPLATING

EPA Science Inventory

This paper will summrize thie pollution prevention (p2) method to control stack emissions from hard chromium plating operations performed by the USEPA's National Risk Management Research Laboratory (NRMRL) over the last four years. During literature research and user surveys, it...

Vertical Integration Spurs American Health Care Revolution.

ERIC Educational Resources Information Center

Phillips, Richard C.

1986-01-01

Under new "managed health care systems," the classical functional separation of risk taker, claims payor, and provider are vertically integrated into a common entity. This evolution should produce a competitive environment with medical care rendered to all Americans on a more cost-effective basis. (CJH)

Identifying synergies between water resource protection and farm business objectives: the role of soil management

NASA Astrophysics Data System (ADS)

Stoate, Chris

2017-04-01

We use a 3,000 ha BACI experiment on clay soils in central England as a focus for exploring synergies between Water Framework Directive targets for water quality (sediment, nutrients and pesticides) and crop production objectives of farm businesses. Based on base of catchment annual sediment loads, we estimate annual soil loss from farmland to be in the order of 0.3 - 0.6 tonnes per hectare. This has impacts on aquatic ecology, reservoir storage capacity and downstream flood risk through sedimentation of drainage channels. Soil loss is relatively low in a European context but reflects poorly functioning soils with high runoff risk, and poor crop performance due to compaction, low organic matter, waterlogging, and competition from the grass weed, blackgrass (Alopecuris alopoides). We use a range of mechanisms to increase farmers' awareness, understanding and motivation for improving soil management to meet multiple public and private benefits of soil function and present results for soil organic matter testing, earthworm surveying, and horizontal and vertical soil compaction mapping.

The United South and Eastern Tribe (USET) Proper ...

EPA Pesticide Factsheets

The maintenance of wildlife and aquatic habitat is dependent on the development of a riparian area management strategy, which considers and adapts to certain basic ecological and economic relationships. These relationships are functions of riparian and terrestrial ecosystems, growth and reproduction of woody and herbaceous plant communities, hydrologic and geomorphic conditions and processes, soils, sediment, water quality and quantity, recovery rates, upland conditions, cultural, recreation and domestic uses. The class participants determined functional ratings, using the Proper Functioning Condition protocol for each field site visited. The methods used in this Workshop were found to work equally well in both eastern and western ecosystems in the United States. One of the many goals of a Tribe’s environmental and natural resource department is to maintain and restore functionality of stream and wetland riparian and upland areas, which could protect Tribal beneficial uses and values for those water bodies. Disturbances occurring within a watershed, or adjacent to a stream corridor, typically cause effects that may temporarily or permanently alter environmental and ecological risk factors. Focusing on where and how water moves and vegetation/soil trends in the riparian system can often determine if important Tribal goals and objectives are being met. It can then be determined what management changes are needed to move the environmental and ecosystem risk facto

Assessment and management of nutrition in older people and its importance to health.

PubMed

Ahmed, Tanvir; Haboubi, Nadim

2010-08-09

Nutrition is an important element of health in the older population and affects the aging process. The prevalence of malnutrition is increasing in this population and is associated with a decline in: functional status, impaired muscle function, decreased bone mass, immune dysfunction, anemia, reduced cognitive function, poor wound healing, delayed recovery from surgery, higher hospital readmission rates, and mortality. Older people often have reduced appetite and energy expenditure, which, coupled with a decline in biological and physiological functions such as reduced lean body mass, changes in cytokine and hormonal level, and changes in fluid electrolyte regulation, delay gastric emptying and diminish senses of smell and taste. In addition pathologic changes of aging such as chronic diseases and psychological illness all play a role in the complex etiology of malnutrition in older people. Nutritional assessment is important to identify and treat patients at risk, the Malnutrition Universal Screening Tool being commonly used in clinical practice. Management requires a holistic approach, and underlying causes such as chronic illness, depression, medication and social isolation must be treated. Patients with physical or cognitive impairment require special care and attention. Oral supplements or enteral feeding should be considered in patients at high risk or in patients unable to meet daily requirements.

Surgical indication for functional tricuspid regurgitation at initial operation: judging from long term outcomes.

PubMed

Pozzoli, Alberto; Lapenna, Elisabetta; Vicentini, Luca; Alfieri, Ottavio; De Bonis, Michele

2016-09-01

The assessment and management of tricuspid valve disease have evolved substantially during the past several years. Whereas tricuspid stenosis is uncommon, tricuspid regurgitation is frequently encountered and it is most often secondary due to annular dilatation and leaflet tethering from right ventricular remodelling. The indications for tricuspid valve surgery to treat tricuspid regurgitation are several and mainly related to the underlying disease, to the severity of insufficiency and to the right ventricular function. Surgical tricuspid repair has been avoided for years, because of the misleading concept that tricuspid regurgitation should disappear once the primary left-sided problem has been eliminated. Instead, during the last decade, many investigators have reported evidence in favor of a more aggressive surgical approach to functional tricuspid regurgitation, recognising the risk of progressive tricuspid insufficiency in patients with moderate or lesser degrees of tricuspid regurgitation and tricuspid annular dilatation. This concept, along with the long-term outcomes of principal surgical repair techniques are reported and discussed. Last, novel transcatheter therapies have begun to emerge for the treatment of severe tricuspid regurgitation in high-risk patients. Hence, very preliminary pre-clinical and clinical experiences are illustrated. The scope of this review is to explore the anatomic basis, the pathophysiology, the outcomes and the new insights in the management of functional tricuspid regurgitation.

Adherence monitoring with chronic opioid therapy for persistent pain: a biopsychosocial-spiritual approach to mitigate risk.

PubMed

Matteliano, Deborah; St Marie, Barbara J; Oliver, June; Coggins, Candace

2014-03-01

Opioids represent a mainstay in the pharmacologic management of persistent pain. Although these drugs are intended to support improved comfort and function, the inherent risk of abuse or addiction must be considered in the delivery of care. The experience of living with persistent pain often includes depression, fear, loss, and anxiety, leading to feelings of hopelessness, helplessness, and spiritual crisis. Collectively, these factors represent an increased risk for all patients, particularly those with a history of substance abuse or addiction. This companion article to the American Society for Pain Management Nursing "Position Statement on Pain Management in Patients with Substance Use Disorders" (2012) focuses on the intersection of persistent pain, substance use disorder (SUD), and chronic opioid therapy and the clinical implications of monitoring adherence with safe use of opioids for those with persistent pain. This paper presents an approach to the comprehensive assessment of persons with persistent pain when receiving opioid therapy by presenting an expansion of the biopsychosocial model to include spiritual factors associated with pain and SUD, thus formulating a biopsychosocial-spiritual approach to mitigate risk. Key principles are provided for adherence monitoring using the biopsychosocial-spiritual assessment model developed by the authors as a means of promoting sensitive and respectful care. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

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

PubMed

Moorman, Jessica D; Harrison, Kristen

2016-09-01

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

Patterns of adaptation to children's food allergies.

PubMed

Fedele, D A; McQuaid, E L; Faino, A; Strand, M; Cohen, S; Robinson, J; Atkins, D; Hourihane, J O'B; Klinnert, M D

2016-04-01

Families with food allergy (FA) are at risk of reduced quality of life and elevated anxiety. A moderate level of anxiety may be beneficial to sustain vigilance for food avoidance; however, excessive anxiety may increase risk for burden and maladjustment. The current study presents a framework for understanding the patterns of adaptation to FA across families and to identify typologies of families that would benefit from intervention. Participants included 57 children, 6-12 years old with documented FA, and their mothers. Families were assessed using the Food Allergy Management and Adaptation Scale. Families also completed measures of quality of life, anxiety, FA management, and psychosocial impairment. A hierarchical cluster analysis revealed that 56 of the 57 families of food-allergic children were categorized into four groups that differed on their adequacy of family FA management, levels of anxiety, and balanced psychosocial functioning: balanced responders (n = 23; 41%), high responders (n = 25; 45%), and low responders (n = 3; 5%). The fourth group, anxious high responders (n = 5; 9%), was characterized by extremely high maternal FA anxiety scores and low scores for balanced integration of FA management and psychosocial functioning. Families in clusters differed across illness and psychosocial outcome variables. Families with FA were characterized by patterns of FA management, anxiety, and ability to integrate FA demands into daily life. Identified adaptation patterns correspond with clinical impressions and provide a framework for identifying families in need of intervention. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Post-fracture management of patients with hip fracture: a perspective.

PubMed

Bruyere, O; Brandi, M-L; Burlet, N; Harvey, N; Lyritis, G; Minne, H; Boonen, S; Reginster, J-Y; Rizzoli, R; Akesson, K

2008-10-01

Hip fracture creates a worldwide morbidity, mortality and economic burden. After surgery, many patients experience long-term disability or die as a consequence of the fracture. A fracture is a major risk factor for a subsequent fracture, which may occur within a short interval. A literature search on post-fracture management of patients with hip fracture was performed on the Medline database. Key experts convened to develop a consensus document. Management of hip-fracture patients to optimize outcome after hospital discharge requires several stages of care co-ordinated by a multidisciplinary team from before admission through to discharge. Further studies that specifically assess prevention and post-fracture management of hip fracture are needed, as only one study to date has assessed an osteoporosis medication in patients with a recent hip fracture. Proper nutrition is vital to assist bone repair and prevent further falls, particularly in malnourished patients. Vitamin D, calcium and protein supplementation is associated with an increase in hip BMD and reduction in falls. Rehabilitation is essential to improve functional disabilities and survival rates. Fall prevention and functional recovery strategies should include patient education and training to improve balance and increase muscle strength and mobility. Appropriate management can prevent further fractures and it is critical that high-risk patients are identified and treated. To foster this process, clinical pathways have been established to support orthopaedic surgeons. Although hip fracture is generally associated with poor outcomes, appropriate management can ensure optimal recovery and survival, and should be prioritized after a hip fracture to avoid deterioration of health and prevent subsequent fracture.

InteractInteraction mechanism of emergency response in geological hazard perception and risk management: a case study in Zhouqu county

NASA Astrophysics Data System (ADS)

Qi, Yuan; Zhao, Hongtao

2017-04-01

China is one of few several natural disaster prone countries, which has complex geological and geographical environment and abnormal climate. On August 8, 2010, a large debris flow disaster happened in Zhouqu Country, Gansu province, resulting in more than 1700 casualties and more than 200 buildings damaged. In order to percept landslide and debris flow, an early warning system was established in the county. Spatial information technologies, such as remote sensing, GIS, and GPS, play core role in the early warning system, due to their functions in observing, analyzing, and locating geological disasters. However, all of these spatial information technologies could play an important role only guided by the emergency response mechanism. This article takes the establishment of Zhouqu Country's Disaster Emergency Response Interaction Mechanism (DERIM) as an example to discuss the risk management of country-level administrative units. The country-level risk management aims to information sharing, resources integration, integrated prevention and unified command. Then, nine subsystems support DERIM, which included disaster prevention and emergency data collection and sharing system, joint duty system, disaster verification and evaluation system, disaster consultation system, emergency warning and information release system, emergency response system, disaster reporting system, plan management system, mass prediction and prevention management system. At last, an emergency command platform in Zhouqu Country built up to realize DERIM. The core mission of the platform consists of daily management of disaster, monitoring and warning, comprehensive analysis, information release, consultation and decision-making, emergency response, etc. Five functional modules, including module of disaster information management, comprehensive monitoring module (geological monitoring, meteorological monitoring, water conservancy and hydrological monitoring), alarm management module, emergency command and disaster dispatching management module are developed on the basis of this platform. Based on the internet technology, an web-based office platform is exploited for the nodes scattered in departments and towns, which includes daily business, monitoring and warning, alarm notification, alarm recording, personnel management and update in disaster region, query and analysis of real-time observation data, etc. The platform experienced 3 years' test of the duty in flood period since 2013, and two typical disaster cases during this period fully illustrates the effectiveness of the DERIM and the emergency command platform.

Project Risk Management

NASA Technical Reports Server (NTRS)

Jr., R. F. Miles

1995-01-01

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

A prospective cohort study of long-term cognitive changes in older Medicare beneficiaries.

PubMed

Wolinsky, Fredric D; Bentler, Suzanne E; Hockenberry, Jason; Jones, Michael P; Weigel, Paula A; Kaskie, Brian; Wallace, Robert B

2011-09-20

Promoting cognitive health and preventing its decline are longstanding public health goals, but long-term changes in cognitive function are not well-documented. Therefore, we first examined long-term changes in cognitive function among older Medicare beneficiaries in the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD), and then we identified the risk factors associated with those changes in cognitive function. We conducted a secondary analysis of a prospective, population-based cohort using baseline (1993-1994) interview data linked to 1993-2007 Medicare claims to examine cognitive function at the final follow-up interview which occurred between 1995-1996 and 2006-2007. Besides traditional risk factors (i.e., aging, age, race, and education) and adjustment for baseline cognitive function, we considered the reason for censoring (entrance into managed care or death), and post-baseline continuity of care and major health shocks (hospital episodes). Residual change score multiple linear regression analysis was used to predict cognitive function at the final follow-up using data from telephone interviews among 3,021 to 4,251 (sample size varied by cognitive outcome) baseline community-dwelling self-respondents that were ≥ 70 years old, not in managed Medicare, and had at least one follow-up interview as self-respondents. Cognitive function was assessed using the 7-item Telephone Interview for Cognitive Status (TICS-7; general mental status), and the 10-item immediate and delayed (episodic memory) word recall tests. Mean changes in the number of correct responses on the TICS-7, and 10-item immediate and delayed word recall tests were -0.33, -0.75, and -0.78, with 43.6%, 54.9%, and 52.3% declining and 25.4%, 20.8%, and 22.9% unchanged. The main and most consistent risks for declining cognitive function were the baseline values of cognitive function (reflecting substantial regression to the mean), aging (a strong linear pattern of increased decline associated with greater aging, but with diminishing marginal returns), older age at baseline, dying before the end of the study period, lower education, and minority status. In addition to aging, age, minority status, and low education, substantial and differential risks for cognitive change were associated with sooner vs. later subsequent death that help to clarify the terminal drop hypothesis. No readily modifiable protective factors were identified.

Impacts of Hospitals' Innovativeness on Information System Outsourcing Decisions

PubMed Central

2014-01-01

Objectives The purpose of this study was to identify the effects of hospitals' innovativeness on outsourcing decision-making regarding four information system (IS) functions, namely, software programs, network maintenance, hardware systems, and PC/printer maintenance. Methods Using the 2011 roster of the Korean Hospital Association, this study selected 311 general hospitals as a study population. After identifying the managers who were in charge of outsourcing, this study administered questionnaires. A total of 103 hospitals responded. Results Of the responding hospitals, 55.34% outsourced at least one IS function, whereas 88.35% outsourced at least one managerial function. IS outsourcing was motivated by the need for outside experts, but other managerial functions were outsourced for cost savings. Innovative and early adopter hospitals were 4.52 and 4.91 times more likely to outsource IS functions related with work processes (i.e., software and network maintenance) than early and late majority hospitals, respectively. IT outsourcing effectiveness significantly influenced the outsourcing decisions regarding four IS functions. Hospitals that had perceived more risks of outsourcing significantly preferred non-outsourcing on their hardware systems, but the risks of outsourcing were not significant for outsourcing decisions regarding the other IS functions. Hospitals' innovativeness also significantly explained the quantity of innovation adoptions. Innovative and early adopter hospitals did more outsourcing than early and late majority hospitals. Conclusions Hospitals' innovativeness influences decision-making regarding outsourcing. Innovative hospitals are more likely to outsource their work-process-related IS functions. Thus, organizational traits, especially hospitals' innovativeness, should be considered as a key success factor for IS management. PMID:24872912

Assessing surface water flood risk and management strategies under future climate change: Insights from an Agent-Based Model.

PubMed

Jenkins, K; Surminski, S; Hall, J; Crick, F

2017-10-01

Climate change and increasing urbanization are projected to result in an increase in surface water flooding and consequential damages in the future. In this paper, we present insights from a novel Agent Based Model (ABM), applied to a London case study of surface water flood risk, designed to assess the interplay between different adaptation options; how risk reduction could be achieved by homeowners and government; and the role of flood insurance and the new flood insurance pool, Flood Re, in the context of climate change. The analysis highlights that while combined investment in property-level flood protection and sustainable urban drainage systems reduce surface water flood risk, the benefits can be outweighed by continued development in high risk areas and the effects of climate change. In our simulations, Flood Re is beneficial in its function to provide affordable insurance, even under climate change. However, the scheme does face increasing financial pressure due to rising surface water flood damages. If the intended transition to risk-based pricing is to take place then a determined and coordinated strategy will be needed to manage flood risk, which utilises insurance incentives, limits new development, and supports resilience measures. Our modelling approach and findings are highly relevant for the ongoing regulatory and political approval process for Flood Re as well as for wider discussions on the potential of insurance schemes to incentivise flood risk management and climate adaptation in the UK and internationally. Copyright © 2017 Elsevier B.V. All rights reserved.

Construct validity of the Heart Failure Screening Tool (Heart-FaST) to identify heart failure patients at risk of poor self-care: Rasch analysis.

PubMed

Reynolds, Nicholas A; Ski, Chantal F; McEvedy, Samantha M; Thompson, David R; Cameron, Jan

2018-02-14

The aim of this study was to psychometrically evaluate the Heart Failure Screening Tool (Heart-FaST) via: (1) examination of internal construct validity; (2) testing of scale function in accordance with design; and (3) recommendation for change/s, if items are not well adjusted, to improve psychometric credential. Self-care is vital to the management of heart failure. The Heart-FaST may provide a prospective assessment of risk, regarding the likelihood that patients with heart failure will engage in self-care. Psychometric validation of the Heart-FaST using Rasch analysis. The Heart-FaST was administered to 135 patients (median age = 68, IQR = 59-78 years; 105 males) enrolled in a multidisciplinary heart failure management program. The Heart-FaST is a nurse-administered tool for screening patients with HF at risk of poor self-care. A Rasch analysis of responses was conducted which tested data against Rasch model expectations, including whether items serve as unbiased, non-redundant indicators of risk and measure a single construct and that rating scales operate as intended. The results showed that data met Rasch model expectations after rescoring or deleting items due to poor discrimination, disordered thresholds, differential item functioning, or response dependence. There was no evidence of multidimensionality which supports the use of total scores from Heart-FaST as indicators of risk. Aggregate scores from this modified screening tool rank heart failure patients according to their "risk of poor self-care" demonstrating that the Heart-FaST items constitute a meaningful scale to identify heart failure patients at risk of poor engagement in heart failure self-care. © 2018 John Wiley & Sons Ltd.

Modifiable Disease Risk, Readiness to Change, and Psychosocial Functioning Improve With Integrative Medicine Immersion Model

PubMed Central

Wolever, Ruth Q.; Webber, Daniel M.; Meunier, Justin P.; Greeson, Jeffrey M.; Lausier, Evangeline R.; Gaudet, Tracy W.

2013-01-01

Background Stroke, diabetes, and coronary heart disease (CHD) remain leading causes of death in the United States and are largely attributable to lifestyle behaviors. Integrative medicine can provide a supportive partnership that focuses on improving health by identifying and implementing lifestyle changes based upon personal values and goals. Objective This prospective observational study was designed to assess the effectiveness of an integrative medicine intervention on modifiable disease risk, patient activation, and psychosocial risk factors for stroke, diabetes, and CHD. Design Sixty-three adults participated in a 3-day comprehensive, multimodal health immersion program at Duke Integrative Medicine, Duke University Medical Center, Durham, North Carolina. Participants received follow-up education, physician support, and telephonic health coaching between the immersion program and the endpoint 7 to 9 months later. Primary Outcome Measures Psychosocial functioning, read iness to change health behaviors, and risk of developing diabetes, stroke, and CHD were assessed at baseline and endpoint. Results Although cardiac risk remained unchanged (P = .19) during the study period, risk of diabetes (P = .02) and stroke (P < .01) decreased significantly. Perceived stress remained unchanged, but improvements were seen in mood (P < .05) and relationship satisfaction (P < .004). Patients became more activated towards self-management of health (P <.001), endorsed greater readiness to change health behaviors (P <.01), and reported increased aerobic exercise (P <.001) and stretching (P = .006) following the intervention. Conclusion An integrative health model can help patients become more engaged in self-management of health and support them in making and maintaining healthy lifestyle changes. These findings provide support for use of an integrative health model in adult disease risk reduction. PMID:22314632

Shale gas wastewater management under uncertainty.

PubMed

Zhang, Xiaodong; Sun, Alexander Y; Duncan, Ian J

2016-01-01

This work presents an optimization framework for evaluating different wastewater treatment/disposal options for water management during hydraulic fracturing (HF) operations. This framework takes into account both cost-effectiveness and system uncertainty. HF has enabled rapid development of shale gas resources. However, wastewater management has been one of the most contentious and widely publicized issues in shale gas production. The flowback and produced water (known as FP water) generated by HF may pose a serious risk to the surrounding environment and public health because this wastewater usually contains many toxic chemicals and high levels of total dissolved solids (TDS). Various treatment/disposal options are available for FP water management, such as underground injection, hazardous wastewater treatment plants, and/or reuse. In order to cost-effectively plan FP water management practices, including allocating FP water to different options and planning treatment facility capacity expansion, an optimization model named UO-FPW is developed in this study. The UO-FPW model can handle the uncertain information expressed in the form of fuzzy membership functions and probability density functions in the modeling parameters. The UO-FPW model is applied to a representative hypothetical case study to demonstrate its applicability in practice. The modeling results reflect the tradeoffs between economic objective (i.e., minimizing total-system cost) and system reliability (i.e., risk of violating fuzzy and/or random constraints, and meeting FP water treatment/disposal requirements). Using the developed optimization model, decision makers can make and adjust appropriate FP water management strategies through refining the values of feasibility degrees for fuzzy constraints and the probability levels for random constraints if the solutions are not satisfactory. The optimization model can be easily integrated into decision support systems for shale oil/gas lifecycle management. Copyright © 2015 Elsevier Ltd. All rights reserved.

[The Chinese experts' consensus on the evaluation and management of asthma exacerbation].

PubMed

2018-01-01

Asthma exacerbations can do a lot of harm to the patients and consume large amounts of medical resources. This consensus is based on the domestic and foreign guidelines and literatures to standardize the evaluation and management of asthma exacerbations in China. Asthma exacerbations are characterized by a progressive increase in symptoms of shortness of breath, cough, wheezing or chest tightness and progressive decrease in lung function, and usually require modification of treatment. Recognizing risk factors and triggering factors of asthma exacerbations is helpful for the prevention and long-term management. Evaluation of asthma exacerbations is based on symptoms, lung function, and arterial blood gas. Management is stratified according to the severity of disease. Different regimens to treat asthma exacerbations are discussed in this consensus. Glucocorticoids should be used properly. Overuse of antibiotics should be avoided. Management of life-threatening asthma is discussed separately. Special attention should be paid in some special respects, such as asthma during peri-operation period, gestation period, and childhood. Diagnosis and management of complications are also of great significance and are discussed in details.

[Organisational responsibility versus individual responsibility: safety culture? About the relationship between patient safety and medical malpractice law].

PubMed

Hart, Dieter

2009-01-01

The contribution is concerned with the correlations between risk information, patient safety, responsibility and liability, in particular in terms of liability law. These correlations have an impact on safety culture in healthcare, which can be evaluated positively if--in addition to good quality of medical care--as many sources of error as possible can be identified, analysed, and minimised or eliminated by corresponding measures (safety or risk management). Liability influences the conduct of individuals and enterprises; safety is (probably) also a function of liability; this should also apply to safety culture. The standard of safety culture does not only depend on individual liability for damages, but first of all on strict enterprise liability (system responsibility) and its preventive effects. Patient safety through quality and risk management is therefore also an organisational programme of considerable relevance in terms of liability law.

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

USGS Publications Warehouse

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

2018-01-01

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

An Introduction to the Mission Risk Diagnostic for Incident Management Capabilities (MRD-IMC)

DTIC Science & Technology

2014-05-01

objectives. Analysts applying the MRD- IMC evaluate a set of systemic risk factors (called drivers) to aggregate decision-making data and provide decision...function is in position to achieve its mission and objective(s) [Alberts 2012]. To accomplish this goal, analysts applying the MRD- IMC evaluate a...005 | 3 evaluation of IM processes and capabilities. The MRD- IMC comprises the following three core tasks: 1. Identify the mission and objective(s

An Extensible Information Grid for Risk Management

NASA Technical Reports Server (NTRS)

Maluf, David A.; Bell, David G.

2003-01-01

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

Overactive bladder in the vulnerable elderly

PubMed Central

Wolff, Gillian F; Kuchel, George A; Smith, Phillip P

2014-01-01

Overactive bladder (OAB) is a common problem that may occur in individuals of all ages. It has a considerable impact on patient quality of life, and although moderately effective management strategies do exist, this condition often remains undiagnosed and untreated. OAB needs to be viewed as a symptom complex. Its presentation and management are complicated in the vulnerable elderly by the presence of baseline frailty and multiple coexisting chronic conditions. Furthermore, and beyond a simple understanding of symptomatology, providers must address patient goals and motivations as well as the expectations of caretakers. These multiple levels of perception, function, expectations, and treatment efficacy/risks must be tailored to the individual patient. While the vulnerable elderly patient may often have evidence of urinary tract dysfunction, OAB and urge urinary incontinence in this population must be understood as a multifactorial geriatric syndrome and viewed in the context of medical and functional baseline and precipitating risk factors. Expectations and goals must be tailored to the resources of vulnerable elderly patients and their caregivers, and care must be coordinated with other medical care providers. The management of OAB in the vulnerable elderly often poses significant management challenges. Nonetheless, with a thoughtful approach and an aim towards future research specifically for this population, significant reductions in morbidity and mortality long with enhancement in health-related quality of life are possible. PMID:25328867

Understanding What Is in Your Insurance Policies.

ERIC Educational Resources Information Center

Kahn, Steven P.

This document outlines the various types of insurance policies and their functions to help school administrators improve their management of risk. Eight exhibits highlight information on the following topics: the five basic sections of all insurance policies; key property insurance clauses; general liability; school board legal liability; the…

Asset deterioration and discolouration in water distribution systems.

PubMed

Husband, P S; Boxall, J B

2011-01-01

Water Distribution Systems function to supply treated water safe for human consumption and complying with increasingly stringent quality regulations. Considered primarily an aesthetic issue, discolouration is the largest cause of customer dissatisfaction associated with distribution system water quality. Pro-active measures to prevent discolouration are sought yet network processes remain insufficiently understood to fully justify and optimise capital or operational strategies to manage discolouration risk. Results are presented from a comprehensive fieldwork programme in UK water distribution networks that have determined asset deterioration with respect to discolouration. This is achieved by quantification of material accumulating as cohesive layers on pipe surfaces that when mobilised are acknowledged as the primary cause of discolouration. It is shown that these material layers develop ubiquitously with defined layer strength characteristics and at a consistent and repeatable rate dependant on water quality. For UK networks iron concentration in the bulk water is shown as a potential indicator of deterioration rate. With material layer development rates determined, management decisions that balance discolouration risk and expenditure to maintain water quality integrity can be justified. In particular the balance between capital investment such as improving water treatment output or pipe renewal and operational expenditure such as the frequency of network maintenance through flushing may be judged. While the rate of development is shown to be a function of water quality, the magnitude (peak or average turbidity) of discolouration incidents is shown to be dominated by hydraulic conditions. From this it can be proposed that network hydraulic management, such as regular periodic 'stressing', is a potential strategy in reducing discolouration risk. The ultimate application of this is the hydraulic design of self-cleaning networks to maintain discolouration risk below acceptable levels. Copyright © 2010 Elsevier Ltd. All rights reserved.

Gradual weaning and oral care management of prolonged breast-feeding based on family preferences.

PubMed

Hernandez, Purnima; Kisamore, April N

2017-06-01

There are no guidelines about when breast-feeding (BF) should be discontinued. In addition, investigators have not examined patient-provider communication regarding weaning strategies based on function and oral care management during prolonged BF. Suggestions to wean do not include strategies about how to achieve discontinuance. The authors conducted this case study to assist care providers in facilitation of such discussions with parents to minimize the risk of developing dental caries in older children who are breast-fed. The authors conducted a functional behavior assessment of BF and used the results to inform strategy development. The parent successfully implemented the suggested strategies to wean the child from BF with minimal problem behavior by the child. From the outcome of this case report, the authors developed an algorithm based on family preferences and behavioral functions to assist parents with gradual weaning and oral care management during prolonged BF. Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.

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

EPA Pesticide Factsheets

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

Improving Project Management with Simulation and Completion Distribution Functions

NASA Technical Reports Server (NTRS)

Cates, Grant R.

2004-01-01

Despite the critical importance of project completion timeliness, management practices in place today remain inadequate for addressing the persistent problem of project completion tardiness. A major culprit in late projects is uncertainty, which most, if not all, projects are inherently subject to. This uncertainty resides in the estimates for activity durations, the occurrence of unplanned and unforeseen events, and the availability of critical resources. In response to this problem, this research developed a comprehensive simulation based methodology for conducting quantitative project completion time risk analysis. It is called the Project Assessment by Simulation Technique (PAST). This new tool enables project stakeholders to visualize uncertainty or risk, i.e. the likelihood of their project completing late and the magnitude of the lateness, by providing them with a completion time distribution function of their projects. Discrete event simulation is used within PAST to determine the completion distribution function for the project of interest. The simulation is populated with both deterministic and stochastic elements. The deterministic inputs include planned project activities, precedence requirements, and resource requirements. The stochastic inputs include activity duration growth distributions, probabilities for events that can impact the project, and other dynamic constraints that may be placed upon project activities and milestones. These stochastic inputs are based upon past data from similar projects. The time for an entity to complete the simulation network, subject to both the deterministic and stochastic factors, represents the time to complete the project. Repeating the simulation hundreds or thousands of times allows one to create the project completion distribution function. The Project Assessment by Simulation Technique was demonstrated to be effective for the on-going NASA project to assemble the International Space Station. Approximately $500 million per month is being spent on this project, which is scheduled to complete by 2010. NASA project stakeholders participated in determining and managing completion distribution functions produced from PAST. The first result was that project stakeholders improved project completion risk awareness. Secondly, using PAST, mitigation options were analyzed to improve project completion performance and reduce total project cost.

Spatiotemporal Visualization of Tsunami Waves Using Kml on Google Earth

NASA Astrophysics Data System (ADS)

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

2017-09-01

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

Determination of Nursing Diagnoses in Children of Agricultural Laborer Families in South Eastern Regions of Turkey.

PubMed

Karatas, Hulya; Müller-Staub, Maria; Erdemir, Firdevs

2018-01-01

Identifying functional health patterns and nursing diagnoses of migrant agricultural laborer families. Interpretative-qualitative study based on interviews with 162 mothers of 0- to 2-year-old children in two Turkish provinces. Health perception-health management: growth and development, risk for being delayed; health maintenance, ineffective; health behavior, risk-prone; risk for contamination; risk for sudden infant death syndrome; and risk for injury. Nutritional-metabolic: Risk for infection; and breastfeeding, interrupted. Self-perception: risk for chronic low self-esteem, disturbed self-esteem; and powerlessness. Role-relationship: impaired parenting; and dysfunctional family process. Coping-stress tolerance: coping, disabled family; violence, risk for other-directed. Cognitive-perceptive: knowledge deficit CONCLUSIONS: Nursing diagnoses of this population were reported for the first time. Addressing agricultural laborer families' diagnoses will positively affect maternal-child health. © 2016 NANDA International, Inc.

What impact will EPPO's new resistance risk assessment guideline have on selection pressure in the European Union?

PubMed

Leonard, Paul K; Dutton, Robert

2002-09-01

This paper examines practical and regulatory implications, including both costs and benefits, resulting from implementation of EPPO's new resistance risk analysis guideline. Crop-protection companies operating in Europe are preparing risk analyses and management strategies, and are monitoring for resistance. However, this is a complex and expensive process involving technical, commercial and regulatory functions. The actual cost of filling these data gaps is consequently greater than many would have anticipated. The agrochemical industry has a vested interest in managing resistance and is committed to maintaining the essential contribution of crop-protection products to sustainable agriculture. However, with increasing regulatory costs, it is important that regulatory authorities concentrate requirements for resistance risk analyses, management strategies and monitoring where these are most needed. Should these requirements be applied indiscriminately, crop-protection companies will have to consider whether or not it is economically justifiable to make these investments, or whether to remove less profitable uses from product labels. In such situations, minor crops stand to be disproportionately effected. One year after publication, it is too early to measure the guideline's impact on selection pressure. It is already clear that the guideline represents an unprecedented step forward in the regulation and harmonisation of resistance management. There are, however, valid arguments against regulation of resistance management. One of the most important criticisms that is levelled against the latter approach is that, with the best motivation and with appropriate use restrictions on labels, these actions alone do not solve the problem. It is critical that all stakeholders in the crop protection process are made aware of the importance of resistance management and of complying with prescribed strategies.

Assessing and managing multiple risks in a changing world ...

EPA Pesticide Factsheets

Roskilde University (Denmark) hosted a November 2015 workshop, Environmental Risk—Assessing and Managing Multiple Risks in a Changing World. This Focus article presents the consensus recommendations of 30 attendees from 9 countries regarding implementation of a common currency (ecosystem services) for holistic environmental risk assessment and management; improvements to risk assessment and management in a complex, human-modified, and changing world; appropriate development of protection goals in a 2-stage process; dealing with societal issues; risk-management information needs; conducting risk assessment of risk management; and development of adaptive and flexible regulatory systems. The authors encourage both cross-disciplinary and interdisciplinary approaches to address their 10 recommendations: 1) adopt ecosystem services as a common currency for risk assessment and management; 2) consider cumulative stressors (chemical and nonchemical) and determine which dominate to best manage and restore ecosystem services; 3) fully integrate risk managers and communities of interest into the risk-assessment process; 4) fully integrate risk assessors and communities of interest into the risk-management process; 5) consider socioeconomics and increased transparency in both risk assessment and risk management; 6) recognize the ethical rights of humans and ecosystems to an adequate level of protection; 7) determine relevant reference conditions and the proper ecological c

Pharmaceutical supply chain risks: a systematic review.

PubMed

Jaberidoost, Mona; Nikfar, Shekoufeh; Abdollahiasl, Akbar; Dinarvand, Rassoul

2013-12-19

Supply of medicine as a strategic product in any health system is a top priority. Pharmaceutical companies, a major player of the drug supply chain, are subject to many risks. These risks disrupt the supply of medicine in many ways such as their quantity and quality and their delivery to the right place and customers and at the right time. Therefore risk identification in the supply process of pharmaceutical companies and mitigate them is highly recommended. In this study it is attempted to investigate pharmaceutical supply chain risks with perspective of manufacturing companies. Scopus, PubMed, Web of Science bibliographic databases and Google scholar scientific search engines were searched for pharmaceutical supply chain risk management studies with 6 different groups of keywords. All results found by keywords were reviewed and none-relevant articles were excluded by outcome of interests and researcher boundaries of study within 4 steps and through a systematic method. Nine articles were included in the systematic review and totally 50 main risks based on study outcome of interest extracted which classified in 7 categories. Most of reported risks were related to supply and supplier issues. Organization and strategy issues, financial, logistic, political, market and regulatory issues were in next level of importance. It was shown that the majority of risks in pharmaceutical supply chain were internal risks due to processes, people and functions mismanagement which could be managed by suitable mitigation strategies.

Cognitive, social, and neural determinants of diminished decision-making and financial exploitation risk in aging and dementia: A review and new model.

PubMed

Spreng, R Nathan; Karlawish, Jason; Marson, Daniel C

2016-01-01

In this article we will briefly review how changes in brain and in cognitive and social functioning, across the spectrum from normal to pathological aging, can lead to decision-making impairments that increase abuse risk in many life domains (e.g., health care, social engagement, financial management). The review will specifically focus on emerging research identifying neural, cognitive, and social markers of declining financial decision-making capacity in older adults. We will highlight how these findings are opening avenues for early detection and new interventions to reduce exploitation risk.

Risk analysis of Safety Service Patrol (SSP) systems in Virginia.

PubMed

Dickey, Brett D; Santos, Joost R

2011-12-01

The transportation infrastructure is a vital backbone of any regional economy as it supports workforce mobility, tourism, and a host of socioeconomic activities. In this article, we specifically examine the incident management function of the transportation infrastructure. In many metropolitan regions, incident management is handled primarily by safety service patrols (SSPs), which monitor and resolve roadway incidents. In Virginia, SSP allocation across highway networks is based typically on average vehicle speeds and incident volumes. This article implements a probabilistic network model that partitions "business as usual" traffic flow with extreme-event scenarios. Results of simulated network scenarios reveal that flexible SSP configurations can improve incident resolution times relative to predetermined SSP assignments. © 2011 Society for Risk Analysis.

Hemiplegic shoulder pain: a common clinical consequence of stroke.

PubMed

Coskun Benlidayi, Ilke; Basaran, Sibel

2014-04-01

Hemiplegic shoulder pain is common in stroke survivors, developing in up to 54% of patients. The underlying mechanisms include soft tissue lesions, impaired motor function and central nervous system-related phenomena. Hemiplegic shoulder pain has many underlying causes and is challenging to manage, requiring a team approach, including physicians, therapists and caregivers. The management strategy must target the underlying causes. Preventative measures, such as positioning and handling, can reduce the risk of developing hemiplegic shoulder pain. We have reviewed the literature on hemiplegic shoulder pain, and used this to categorise the underlying mechanisms, and to explore the best management strategies.

Percutaneous treatment of tricuspid regurgitation: A new therapeutic horizon.

PubMed

Vilela, Eduardo M; Ribeiro, José; Almeida, João; Fonseca, Marlene; Dias, Adelaide; Primo, João; Braga, Pedro; Gama, Vasco

2018-03-01

Functional tricuspid regurgitation is a prevalent disease, especially among patients with other valve disorders, and is associated with significant morbidity and mortality. Its management is challenging, and many patients deemed at high surgical risk are managed conservatively. Despite optimization of pharmacological treatment, many patients continue to be symptomatic, thus leading to interest in percutaneous interventional techniques. The Mitralign system has recently been used for the treatment of functional tricuspid regurgitation, with favorable clinical and imaging results. We report the first case in Portugal to our knowledge of percutaneous tricuspid regurgitation treatment with the Mitralign system. Copyright © 2018 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

Cyanosis and Stroke due to Functional Cor Triatriatum Dexter in a Neonate.

PubMed

León, Rachel L; Zaban, Nicholas B; Schamberger, Marcus S; Ho, Chang Y; Mietzsch, Ulrike

2018-01-01

Small remnants of the right valve of the sinus venosus are commonly found in adults, but the incidence and risk associated with these embryonic remnants in neonates are not well studied. The following report describes a cyanotic neonate with a large Eustachian valve remnant creating a functional cor triatriatum dexter who was initially diagnosed with persistent pulmonary hypertension of the newborn. The cyanosis in this infant improved over the first postnatal week with conservative management, but she suffered multifocal subcortical stroke, likely related to her intracardiac shunt. The clinical presentation and questions regarding long-term management of this rare diagnosis are explored. © 2018 S. Karger AG, Basel.

A framework for responding to coral disease outbreaks that facilitates adaptive management.

PubMed

Beeden, Roger; Maynard, Jeffrey A; Marshall, Paul A; Heron, Scott F; Willis, Bette L

2012-01-01

Predicted increases in coral disease outbreaks associated with climate change have implications for coral reef ecosystems and the people and industries that depend on them. It is critical that coral reef managers understand these implications and have the ability to assess and reduce risk, detect and contain outbreaks, and monitor and minimise impacts. Here, we present a coral disease response framework that has four core components: (1) an early warning system, (2) a tiered impact assessment program, (3) scaled management actions and (4) a communication plan. The early warning system combines predictive tools that monitor the risk of outbreaks of temperature-dependent coral diseases with in situ observations provided by a network of observers who regularly report on coral health and reef state. Verified reports of an increase in disease prevalence trigger a tiered response of more detailed impact assessment, targeted research and/or management actions. The response is scaled to the risk posed by the outbreak, which is a function of the severity and spatial extent of the impacts. We review potential management actions to mitigate coral disease impacts and facilitate recovery, considering emerging strategies unique to coral disease and more established strategies to support reef resilience. We also describe approaches to communicating about coral disease outbreaks that will address common misperceptions and raise awareness of the coral disease threat. By adopting this framework, managers and researchers can establish a community of practice and can develop response plans for the management of coral disease outbreaks based on local needs. The collaborations between managers and researchers we suggest will enable adaptive management of disease impacts following evaluating the cost-effectiveness of emerging response actions and incrementally improving our understanding of outbreak causation.

A Framework for Responding to Coral Disease Outbreaks that Facilitates Adaptive Management

NASA Astrophysics Data System (ADS)

Beeden, Roger; Maynard, Jeffrey A.; Marshall, Paul A.; Heron, Scott F.; Willis, Bette L.

2012-01-01

Predicted increases in coral disease outbreaks associated with climate change have implications for coral reef ecosystems and the people and industries that depend on them. It is critical that coral reef managers understand these implications and have the ability to assess and reduce risk, detect and contain outbreaks, and monitor and minimise impacts. Here, we present a coral disease response framework that has four core components: (1) an early warning system, (2) a tiered impact assessment program, (3) scaled management actions and (4) a communication plan. The early warning system combines predictive tools that monitor the risk of outbreaks of temperature-dependent coral diseases with in situ observations provided by a network of observers who regularly report on coral health and reef state. Verified reports of an increase in disease prevalence trigger a tiered response of more detailed impact assessment, targeted research and/or management actions. The response is scaled to the risk posed by the outbreak, which is a function of the severity and spatial extent of the impacts. We review potential management actions to mitigate coral disease impacts and facilitate recovery, considering emerging strategies unique to coral disease and more established strategies to support reef resilience. We also describe approaches to communicating about coral disease outbreaks that will address common misperceptions and raise awareness of the coral disease threat. By adopting this framework, managers and researchers can establish a community of practice and can develop response plans for the management of coral disease outbreaks based on local needs. The collaborations between managers and researchers we suggest will enable adaptive management of disease impacts following evaluating the cost-effectiveness of emerging response actions and incrementally improving our understanding of outbreak causation.

Risk Management.

ERIC Educational Resources Information Center

Randal, L. Nathan

This chapter of "Principles of School Business Management" presents an overview of risk management for school districts. The chapter first discusses four fundamental elements of risk management: (1) identifying and measuring risks; (2) reducing or eliminating risks; (3) transferring unassumable risks; and (4) assuming remaining risks.…

Prevention, Detection and Management of Coronary Artery Disease in Minority Females.

PubMed

Bullock-Palmer, Renée P

2015-11-05

Heart disease is the leading cause of death for women living in the United States; this disease claims more female lives than all cancers combined. Additionally, according to the Centers of Disease Control data between the years 1979 and 2006, while cardiac-related mortality among men decreased significantly, only a modest decline was found among women. This disparity is greatest among minority females including Blacks and Hispanics who have an even greater prevalence of CVD and its risk factors. There are several risk factors for coronary artery disease (CAD). Modifiable risk factors include: tobacco smoking, hypertension, diabetes, hyperlipidemia, obesity and physical inactivity. The prevention of CAD is grounded in decreasing or removing these modifiable risk factors. Accurately diagnosing CAD is dependent on an accurate assessment of the patient's pre-test probability to determine the best diagnostic approach to pursue. The patient's functional status, resting EKG and cardiac risk factors also assist in determining the best non-invasive cardiac test to pursue. The goals and mainstay in the management of minority females with stable CAD includes surveillance for CAD symptoms, management of hypertension, diabetes mellitus and hyperlipidemia, as well as encouraging healthy habits. Heart disease remains the leading cause of death in minority females. Providers must be diligent to aggressively decrease patients' cardiovascular risk and, when patients do present with cardiovascular symptoms, providers must be aggressive in accurately diagnosing and treating these patients to decrease cardiac morbidity and mortality.

75 FR 12559 - Statement of Organization, Functions and Delegations of Authority

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-16

... National, State and local professional organizations to promote quality assurance efforts and deter fraud... publishes State Board compliance reports; (3) conducts audits to ensure validity of data in the banks; (4) develops programs of research on trends in data, quality assurance, risk management, medical liability and...

Argument for a Joint Safety Reporting System

DTIC Science & Technology

2015-02-13

Process Manager for the HQ AF Safety Center (AFSEC) at Kirtland AFB, New Mexico . His primary duties included leadership and oversight of the day-to...Military Mishaps Functional Lead and Navy-Marine Corps Subject Matter Expert ( SME ) for the SIMWG, the DOD Force Risk Reduction system rolls up the service

78 FR 25743 - Statement of Organization, Functions, and Delegations of Authority

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-02

... Accounting and the Office of Budget. Specifically, the OCFO: (1) Manages the financial risk of the agency, (2... the agency's financial activities and accounting practices; (5) performs reviews and training in high... implements CDC-wide budgetary, accounting, and fiscal systems and procedures and prepares financial reports...

Conserving biodiversity using risk management: hoax or hope?

Treesearch

Susan Hummel; Geoffrey H. Donovan; Thomas A. Spies; Miles A. Hemstrom

2008-01-01

Biodiversity has been called a form of ecosystem insurance. According to the "insurance hypothesis", the presence of many species protects against system decline, because built-in redundancies guarantee that some species will maintain key functions even if others fail. The hypothesis might have merit, but calling it "insurance" promotes an ambiguous...

Communicating Risk to Program Managers

NASA Technical Reports Server (NTRS)

Shivers, C. Herbert

2005-01-01

Program Managers (PM) can protect program resources and improve chances of success by anticipating, understanding and managing risks. Understanding the range of potential risks helps one to avoid or manage the risks. A PM must choose which risks to accept to reduce fire fighting, must meet the expectations of stakeholders consistently, and avoid falling into costly "black holes" that may open. A good risk management process provides the PM more confidence to seize opportunities save money, meet schedule, even improve relationships with people important to the program. Evidence of managing risk and sound internal controls can mean better support from superiors for the program by building a trust and reputation from being on top of issues. Risk managers have an obligation to provide the PM with the best information possible to allow the benefits to be realized (Small Business Consortium, 2004). The Institute for Chartered Accountants in England and Wales sees very important benefits for companies in providing better information about what they do to assess and manage key business risks. Such information will: a) provide practical forward-looking information; b) reduce the cost of capital; c) encourage better risk management; and d) improve accountability for stewardship, investor protection and the usefulness of financial reporting. We are particularly convinced that enhanced risk reporting will help listed companies obtain capital at the lowest possible cost (The Institute of Chartered Accountants in England &Wales, June 2002). Risk managers can take a significant role in quantifying the success of their department and communicating those figures to executive (program) management levels while pushing for a broader risk management role. Overall, risk managers must show that risk management work matters in the most crucial place-the bottom line- as they prove risk management can be a profit center (Sullivan, 2004).

A survival strategy for an academic psychiatry department in a managed care environment.

PubMed

Harris, E S; Neufeld, J; Hales, R E; Hilty, D

2001-12-01

The changing economics of medical practice have had a profound effect on the educational, research, and service missions of academic departments of psychiatry across the country. The authors describe the development of a managed behavioral health care organization in their parent academic health system as a survival strategy for allowing their department to function in a managed care environment. They present a series of lessons learned in this effort to adapt to a highly volatile managed behavioral health care market: know how you fit into your market as well as your institution, form cooperative alliances within and outside of your institution, provide incentives to manage risk, focus on core competencies, innovate in your areas of strength, and collect data.

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

NASA Astrophysics Data System (ADS)

Perera, Jeevan; Holsomback, Jerry D.

2005-12-01

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

Risk Management Structured for Today's Environment

NASA Technical Reports Server (NTRS)

Greenfield, Michael A.

1998-01-01

In NPG (NASA Procedures and Guidelines) 7120.5A, we define risk management as "an organized, systematic decision-making process that efficiently identifies, analyzes, plans, tracks, controls, and communicates and documents risk in order to increase the likelihood of achieving program/project goals." Effective risk management depends upon a thorough understanding of the concept of risk, the principles of risk management and the formation of a disciplined risk management process. In human spaceflight programs, NASA has always maintained a rigorous and highly structured risk management effort. When lives are at stake, NASA's missions must be 100% safe; the risk management approach used in human spaceflight has always been comprehensive.

Surgeon's guide to anticoagulant and antiplatelet medications part two: antiplatelet agents and perioperative management of long-term anticoagulation

PubMed Central

Yeung, Louise Y Y; Sarani, Babak; Weinberg, Jordan A; McBeth, Paul B; May, Addison K

2016-01-01

An increasing number of potent antiplatelet and anticoagulant medications are being used for the long-term management of cardiac, cerebrovascular, and peripheral vascular conditions. Management of these medications in the perioperative and peri-injury settings can be challenging for surgeons, mandating an understanding of these agents and the risks and benefits of various management strategies. In this two part review, agents commonly encountered by surgeons in the perioperative and peri-injury settings are discussed and management strategies for patients on long-term antiplatelet and anticoagulant therapy reviewed. In part one, we review warfarin and the new direct oral anticoagulants. In part two, we review antiplatelet agents and assessment of platelet function and the perioperative management of long-term anticoagulation and antiplatelet therapy. PMID:29767644

Cognitive mapping tools: review and risk management needs.

PubMed

Wood, Matthew D; Bostrom, Ann; Bridges, Todd; Linkov, Igor

2012-08-01

Risk managers are increasingly interested in incorporating stakeholder beliefs and other human factors into the planning process. Effective risk assessment and management requires understanding perceptions and beliefs of involved stakeholders, and how these beliefs give rise to actions that influence risk management decisions. Formal analyses of risk manager and stakeholder cognitions represent an important first step. Techniques for diagramming stakeholder mental models provide one tool for risk managers to better understand stakeholder beliefs and perceptions concerning risk, and to leverage this new understanding in developing risk management strategies. This article reviews three methodologies for assessing and diagramming stakeholder mental models--decision-analysis-based mental modeling, concept mapping, and semantic web analysis--and assesses them with regard to their ability to address risk manager needs. © 2012 Society for Risk Analysis.

A systematic review of the effectiveness of knowledge translation interventions for chronic noncancer pain management.

PubMed

Ospina, Maria B; Taenzer, Paul; Rashiq, Saifee; MacDermid, Joy C; Carr, Eloise; Chojecki, Dagmara; Harstall, Christa; Henry, James L

2013-01-01

Reliable evidence detailing effective treatments and management practices for chronic noncancer pain exists. However, little is known about which knowledge translation (KT) interventions lead to the uptake of this evidence in practice. To conduct a systematic review of the effectiveness of KT interventions for chronic noncancer pain management. Comprehensive searches of electronic databases, the gray literature and manual searches of journals were undertaken. Randomized controlled trials, controlled clinical trials and controlled before-and-after studies of KT interventions were included. Data regarding interventions and primary outcomes were categorized using a standard taxonomy; a risk-of-bias approach was adopted for study quality. A narrative synthesis of study results was conducted. More than 8500 titles and abstracts were screened, with 230 full-text articles reviewed for eligibility. Nineteen studies were included, of which only a small proportion were judged to be at low risk of bias. Interactive KT education for health care providers has a positive effect on patients' function, but its benefits for other health provider- and patient-related outcomes are inconsistent. Interactive education for patients leads to improvements in knowledge and function. Little research evidence supports the effectiveness of structural changes in health systems and quality improvement processes or coordination of care. KT interventions incorporating interactive education in chronic noncancer pain led to positive effects on patients' function and knowledge about pain. Future studies should provide implementation details and use consistent theoretical frameworks to better estimate the effectiveness of such interventions.

Corporate financial decision makers' perceptions of their company's safety performance, programs and personnel: Do company size and industry injury risk matter?

PubMed

DeArmond, Sarah; Huang, Yueng-Hsiang; Chen, Peter Y; Courtney, Theodore K

2010-01-01

Top-level managers make important decisions about safety-related issues, yet little research has been done involving these individuals. The current study explored corporate financial decisions makers' perceptions of their company's safety and their justifications for these perceptions. This study also explored whether their perceptions and justifications varied as a function of company size or industry injury risk. A total of 404 individuals who were the most senior managers responsible for making decisions about property and casualty risk at their companies participated in this study. The participants took part in a telephone survey. The results suggest that corporate financial decision makers have positive views of safety at their companies relative to safety at other companies within their industries. Further, many believe their company's safety is influenced by the attention/emphasis placed on safety and the selection and training of safety personnel. Participants' perceptions varied somewhat based on the size of their company and the level of injury risk in their industry. While definitive conclusions about corporate financial decision makers' perceptions of safety cannot be reached as a result of this single study, this work does lay groundwork for future research aimed at better understanding the perceptions top-level managers.

Adherence Monitoring with Chronic Opioid Therapy for Persistent Pain: A Biopsychosocial-spiritual Approach to Mitigate Risk

PubMed Central

Matteliano, Deborah; St. Marie, Barbara J.; Oliver, June

2013-01-01

Opioids represent a mainstay in the pharmacological management of persistent pain. While these drugs are intended to support improved comfort and function, the inherent risk of abuse or addiction must be considered in the delivery of care. The experience of living with persistent pain often includes depression, fear, loss, and anxiety, leading to feelings of hopelessness, helplessness, and spiritual crisis. Collectively, these factors represent an increased risk for all patients, particularly those with a past history of substance abuse or addiction. This companion article to the American Society for Pain Management Nursing (ASPMN) Position Statement on Pain Management in Patients with Substance Use Disorders (2012) focuses on the intersection of persistent pain, SUD, and chronic opioid therapy and the clinical implications of monitoring adherence with safe use of opioids for those with persistent pain. This paper presents an approach to the comprehensive assessment of persons with persistent pain when receiving opioid therapy by presenting an expansion of the biopsychosocial model to now include spiritual factors associated with pain and SUD, thus formulating a biopsychosocial-spiritual approach to mitigate risk. Key principles are provided for adherence monitoring using the biopsychosocial-spiritual assessment model developed by the authors as a means of promoting sensitive and respectful care. PMID:24602442

Enhanced Capabilities for Subcritical Experiments (ECSE) Risk Management Plan

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

Urban, Mary Elizabeth

Risk is a factor, element, constraint, or course of action that introduces an uncertainty of outcome that could impact project objectives. Risk is an inherent part of all activities, whether the activity is simple and small, or large and complex. Risk management is a process that identifies, evaluates, handles, and monitors risks that have the potential to affect project success. The risk management process spans the entire project, from its initiation to its successful completion and closeout, including both technical and programmatic (non-technical) risks. This Risk Management Plan (RMP) defines the process to be used for identifying, evaluating, handling, andmore » monitoring risks as part of the overall management of the Enhanced Capabilities for Subcritical Experiments (ECSE) ‘Project’. Given the changing nature of the project environment, risk management is essentially an ongoing and iterative process, which applies the best efforts of a knowledgeable project staff to a suite of focused and prioritized concerns. The risk management process itself must be continually applied throughout the project life cycle. This document was prepared in accordance with DOE O 413.3B, Program and Project Management for the Acquisition of Capital Assets, its associated guide for risk management DOE G 413.3-7, Risk Management Guide, and LANL ADPM AP-350-204, Risk and Opportunity Management.« less

A Semantic Approach with Decision Support for Safety Service in Smart Home Management

PubMed Central

Huang, Xiaoci; Yi, Jianjun; Zhu, Xiaomin; Chen, Shaoli

2016-01-01

Research on smart homes (SHs) has increased significantly in recent years because of the convenience provided by having an assisted living environment. The functions of SHs as mentioned in previous studies, particularly safety services, are seldom discussed or mentioned. Thus, this study proposes a semantic approach with decision support for safety service in SH management. The focus of this contribution is to explore a context awareness and reasoning approach for risk recognition in SH that enables the proper decision support for flexible safety service provision. The framework of SH based on a wireless sensor network is described from the perspective of neighbourhood management. This approach is based on the integration of semantic knowledge in which a reasoner can make decisions about risk recognition and safety service. We present a management ontology for a SH and relevant monitoring contextual information, which considers its suitability in a pervasive computing environment and is service-oriented. We also propose a rule-based reasoning method to provide decision support through reasoning techniques and context-awareness. A system prototype is developed to evaluate the feasibility, time response and extendibility of the approach. The evaluation of our approach shows that it is more effective in daily risk event recognition. The decisions for service provision are shown to be accurate. PMID:27527170

A Semantic Approach with Decision Support for Safety Service in Smart Home Management.

PubMed

Huang, Xiaoci; Yi, Jianjun; Zhu, Xiaomin; Chen, Shaoli

2016-08-03

Research on smart homes (SHs) has increased significantly in recent years because of the convenience provided by having an assisted living environment. The functions of SHs as mentioned in previous studies, particularly safety services, are seldom discussed or mentioned. Thus, this study proposes a semantic approach with decision support for safety service in SH management. The focus of this contribution is to explore a context awareness and reasoning approach for risk recognition in SH that enables the proper decision support for flexible safety service provision. The framework of SH based on a wireless sensor network is described from the perspective of neighbourhood management. This approach is based on the integration of semantic knowledge in which a reasoner can make decisions about risk recognition and safety service. We present a management ontology for a SH and relevant monitoring contextual information, which considers its suitability in a pervasive computing environment and is service-oriented. We also propose a rule-based reasoning method to provide decision support through reasoning techniques and context-awareness. A system prototype is developed to evaluate the feasibility, time response and extendibility of the approach. The evaluation of our approach shows that it is more effective in daily risk event recognition. The decisions for service provision are shown to be accurate.

12 CFR 1710.19 - Compliance and risk management programs; compliance with other laws.

Code of Federal Regulations, 2011 CFR

2011-01-01

... management program. (1) An Enterprise shall establish and maintain a risk management program that is reasonably designed to manage the risks of the operations of the Enterprise. (2) The risk management program... executive officer of the Enterprise. The risk management officer shall report regularly to the board of...

Pre-operative anaemia.

PubMed

Clevenger, B; Richards, T

2015-01-01

Pre-operative anaemia is a relatively common finding, affecting a third of patients undergoing elective surgery. Traditionally associated with chronic disease, management has historically focused on the use of blood transfusion as a solution for anaemia in the peri-operative period. Data from large series now suggest that anaemia is an independent risk associated with poor outcome in both cardiac and non-cardiac surgery. Furthermore, blood transfusion does not appear to ameliorate this risk, and in fact may increase the risk of postoperative complications and hospital length of stay. Consequently, there is a need to identify, diagnose and manage pre-operative anaemia to reduce surgical risk. Discoveries in the pathways of iron metabolism have found that chronic disease can cause a state of functional iron deficiency leading to anaemia. The key iron regulatory protein hepcidin, activated in response to inflammation, inhibits absorption of iron from the gastrointestinal tract and further reduces bioavailability of iron stores for red cell production. Consequently, although iron stores (predominantly ferritin) may be normal, the transport of iron either from the gastrointestinal tract or iron stores to the bone marrow is inhibited, leading to a state of 'functional' iron deficiency and subsequent anaemia. Since absorption from the gastrointestinal tract is blocked, increasing oral iron intake is ineffective, and studies are now looking at the role of intravenous iron to treat anaemia in the surgical setting. In this article, we review the incidence and impact of anaemia on the pre-operative patient. We explain how anaemia may be caused by functional iron deficiency, and how iron deficiency anaemia may be diagnosed and treated. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

Information Management Functional Economic Analysis for Finance Workstations to the Defense Information Technology Services Organization

DTIC Science & Technology

1993-03-01

values themselves. The Wools perform risk-adjusted present-value comparisons and compute the ROI using discount factors. The assessment of risk in a...developed X Window system, the de facto industry standard window system in the UNIX environment. An X- terminal’s use is limited to display. It has no...2.1 IT HARDWARE The DOS-based PC used in this analysis costs $2,060. It includes an ASL 486DX-33 Industry Standard Architecture (ISA) computer with 8

Competition, Speculative Risks, and IT Security Outsourcing

NASA Astrophysics Data System (ADS)

Cezar, Asunur; Cavusoglu, Huseyin; Raghunathan, Srinivasan

Information security management is becoming a more critical and, simultaneously, a challenging function for many firms. Even though many security managers are skeptical about outsourcing of IT security, others have cited reasons that are used for outsourcing of traditional IT functions for why security outsourcing is likely to increase. Our research offers a novel explanation, based on competitive externalities associated with IT security, for firms' decisions to outsource IT security. We show that if competitive externalities are ignored, then a firm will outsource security if and only if the MSSP offers a quality (or a cost) advantage over in-house operations, which is consistent with the traditional explanation for security outsourcing. However, a higher quality is neither a prerequisite nor a guarantee for a firm to outsource security. The competitive risk environment and the nature of the security function outsourced, in addition to quality, determine firms' outsourcing decisions. If the reward from the competitor's breach is higher than the loss from own breach, then even if the likelihood of a breach is higher under the MSSP the expected benefit from the competitive demand externality may offset the loss from the higher likelihood of breaches, resulting in one or both firms outsourcing security. The incentive to outsource security monitoring is higher than that of infrastructure management because the MSSP can reduce the likelihood of breach on both firms and thus enhance the demand externality effect. The incentive to outsource security monitoring (infrastructure management) is higher (lower) if either the likelihood of breach on both firms is lower (higher) when security is outsourced or the benefit (relative to loss) from the externality is higher (lower). The benefit from the demand externality arising out of a security breach is higher when more of the customers that leave the breached firm switch to the non-breached firm.

Enabling Civilian Low-Altitude Airspace and Unmanned Aerial System (UAS) Operations

NASA Technical Reports Server (NTRS)

Kopardekar, Parimal

2014-01-01

UAS operations will be safer if a UTM system is available to support the functions associated with Airspace management and geo-fencing (reduce risk of accidents, impact to other operations, and community concerns); Weather and severe wind integration (avoid severe weather areas based on prediction); Predict and manage congestion (mission safety);Terrain and man-made objects database and avoidance; Maintain safe separation (mission safety and assurance of other assets); Allow only authenticated operations (avoid unauthorized airspace use).

Results of an Aboriginal community-based renal disease management program incorporating point of care testing for urine albumin:creatinine ratio.

PubMed

Shephard, M D S; Allen, G G; Paizis, K; Barbara, J A J; Batterham, M; Vanajek, A

2006-01-01

There has been a significant increase in the burden of renal disease among Aboriginal Australians over the past 15 years. Urine albumin:creatinine ratio (ACR) is a well-established marker of microalbuminuria and can be conveniently performed on the DCA 2000 point-of-care testing (POCT) analyser (Bayer Australia; Melbourne, VIC, Australia) with an on-site result available in 7 min. The application of the urine ACR POCT for renal disease risk assessment was pioneered by our group in the Umoona Kidney Project. This article describes the results of the management arm of the Umoona Kidney Project, which used point-of-care urine ACR testing for the first time within a management framework to monitor albuminuria in patients at highest risk of renal disease. The article also examines the analytical quality of POCT results and overall community acceptance of the Umoona Kidney Project. Adults clinically assessed by Flinders Medical Centre renal specialists as being at greatest risk for renal disease were offered the ACE inhibitor (ACEI) perindopril on a voluntary basis. Selected renal markers, including POCT urine ACR (conducted on-site by Umoona's Aboriginal health worker team), plasma electrolytes, urea, creatinine, calculated glomerular filtration rate and blood pressure were measured six monthly. Regular quality control testing was undertaken to monitor the analytical performance of the POCT analyser. A culturally appropriate questionnaire was designed and implemented to assess community satisfaction with the project. In all, 231 patient management consultations were conducted over a two year period, with over 70% of patients having four or more (up to a maximum of eight) consultations; 35 patients (mean age 49.2 [+/-2.3] years, 54% males) participated voluntarily in the management arm. All were overtly hypertensive, hypertensive with other risk factors or had diabetes. The renal status of these patients was followed for a mean of 63 +/- 4.5 weeks. In total, 111 POCT urine ACR tests were performed for patient management (mean 3.2 tests per patient). There was no significant difference in POCT urine ACR in the study period with a median (and inter-quartile range) of 5.7 mg/mmol (1.2-15.2) pre-ACEI and 4.3 mg/mmol (1.3-16.7) post-ACEI treatment (p = 0.50, Wilcoxon signed ranks test). The calculated glomerular filtration rate altered from 110 to 118 mL/min (p = 0.019, paired t-test). There was no change in the group plasma potassium, urea and creatinine. Collectively these results indicate a stabilisation in renal function among the management group. Blood pressure (both lying and standing) fell significantly in the study period. The imprecision for urine ACR quality control POCT conducted during the management program was within nationally and internationally accepted precision goals for urine albumin, creatinine and ACR. Fifty community members completed the satisfaction questionnaire. Three-quarters of respondents felt there were no cultural barriers in providing a urine sample for urine ACR POCT. The management arm of the Umoona Kidney Project was effective in stabilising the renal function and improving the blood pressure of community members identified to be at greatest risk of kidney disease. POCT urine ACR testing can be utilised, not only for community risk assessment, but also for patient management. The Umoona Kidney Project was well accepted by the health service and community members.

An Online Risk Monitor System (ORMS) to Increase Safety and Security Levels in Industry

NASA Astrophysics Data System (ADS)

Zubair, M.; Rahman, Khalil Ur; Hassan, Mehmood Ul

2013-12-01

The main idea of this research is to develop an Online Risk Monitor System (ORMS) based on Living Probabilistic Safety Assessment (LPSA). The article highlights the essential features and functions of ORMS. The basic models and modules such as, Reliability Data Update Model (RDUM), running time update, redundant system unavailability update, Engineered Safety Features (ESF) unavailability update and general system update have been described in this study. ORMS not only provides quantitative analysis but also highlights qualitative aspects of risk measures. ORMS is capable of automatically updating the online risk models and reliability parameters of equipment. ORMS can support in the decision making process of operators and managers in Nuclear Power Plants.

Study of space shuttle orbiter system management computer function. Volume 1: Analysis, baseline design

NASA Technical Reports Server (NTRS)

1975-01-01

A system analysis of the shuttle orbiter baseline system management (SM) computer function is performed. This analysis results in an alternative SM design which is also described. The alternative design exhibits several improvements over the baseline, some of which are increased crew usability, improved flexibility, and improved growth potential. The analysis consists of two parts: an application assessment and an implementation assessment. The former is concerned with the SM user needs and design functional aspects. The latter is concerned with design flexibility, reliability, growth potential, and technical risk. The system analysis is supported by several topical investigations. These include: treatment of false alarms, treatment of off-line items, significant interface parameters, and a design evaluation checklist. An in-depth formulation of techniques, concepts, and guidelines for design of automated performance verification is discussed.

Integrating human health and ecological concerns in risk assessments.

PubMed

Cirone, P A; Bruce Duncan, P

2000-11-03

The interconnections between ecosystems, human health and welfare have been increasingly recognized by the US government, academia, and the public. This paper continues this theme by addressing the use of risk assessment to integrate people into a single assessment. In a broad overview of the risk assessment process we stress the need to build a conceptual model of the whole system including multiple species (humans and other ecological entities), stressors, and cumulative effects. We also propose converging landscape ecology and evaluation of ecosystem services with risk assessment to address these cumulative responses. We first look at how this integration can occur within the problem formulation step in risk assessment where the system is defined, a conceptual model created, a subset of components and functions selected, and the analytical framework decided in a context that includes the management decisions. A variety of examples of problem formulations (salmon, wild insects, hyporheic ecosystems, ultraviolet (UV) radiation, nitrogen fertilization, toxic chemicals, and oil spills) are presented to illustrate how treating humans as components of the landscape can add value to risk assessments. We conclude that the risk assessment process should help address the urgent needs of society in proportion to importance, to provide a format to communicate knowledge and understanding, and to inform policy and management decisions.

Assessing and managing multiple risks in a changing world-The Roskilde recommendations.

PubMed

Selck, Henriette; Adamsen, Peter B; Backhaus, Thomas; Banta, Gary T; Bruce, Peter K H; Burton, G Allen; Butts, Michael B; Boegh, Eva; Clague, John J; Dinh, Khuong V; Doorn, Neelke; Gunnarsson, Jonas S; Hauggaard-Nielsen, Henrik; Hazlerigg, Charles; Hunka, Agnieszka D; Jensen, John; Lin, Yan; Loureiro, Susana; Miraglia, Simona; Munns, Wayne R; Nadim, Farrokh; Palmqvist, Annemette; Rämö, Robert A; Seaby, Lauren P; Syberg, Kristian; Tangaa, Stine R; Thit, Amalie; Windfeld, Ronja; Zalewski, Maciej; Chapman, Peter M

2017-01-01

Roskilde University (Denmark) hosted a November 2015 workshop, Environmental Risk-Assessing and Managing Multiple Risks in a Changing World. This Focus article presents the consensus recommendations of 30 attendees from 9 countries regarding implementation of a common currency (ecosystem services) for holistic environmental risk assessment and management; improvements to risk assessment and management in a complex, human-modified, and changing world; appropriate development of protection goals in a 2-stage process; dealing with societal issues; risk-management information needs; conducting risk assessment of risk management; and development of adaptive and flexible regulatory systems. The authors encourage both cross-disciplinary and interdisciplinary approaches to address their 10 recommendations: 1) adopt ecosystem services as a common currency for risk assessment and management; 2) consider cumulative stressors (chemical and nonchemical) and determine which dominate to best manage and restore ecosystem services; 3) fully integrate risk managers and communities of interest into the risk-assessment process; 4) fully integrate risk assessors and communities of interest into the risk-management process; 5) consider socioeconomics and increased transparency in both risk assessment and risk management; 6) recognize the ethical rights of humans and ecosystems to an adequate level of protection; 7) determine relevant reference conditions and the proper ecological context for assessments in human-modified systems; 8) assess risks and benefits to humans and the ecosystem and consider unintended consequences of management actions; 9) avoid excessive conservatism or possible underprotection resulting from sole reliance on binary, numerical benchmarks; and 10) develop adaptive risk-management and regulatory goals based on ranges of uncertainty. Environ Toxicol Chem 2017;36:7-16. © 2016 SETAC. © 2016 SETAC.

Optimization of Landscape Services under Uncoordinated Management by Multiple Landowners

PubMed Central

Porto, Miguel; Correia, Otília; Beja, Pedro

2014-01-01

Landscapes are often patchworks of private properties, where composition and configuration patterns result from cumulative effects of the actions of multiple landowners. Securing the delivery of services in such multi-ownership landscapes is challenging, because it is difficult to assure tight compliance to spatially explicit management rules at the level of individual properties, which may hinder the conservation of critical landscape features. To deal with these constraints, a multi-objective simulation-optimization procedure was developed to select non-spatial management regimes that best meet landscape-level objectives, while accounting for uncoordinated and uncertain response of individual landowners to management rules. Optimization approximates the non-dominated Pareto frontier, combining a multi-objective genetic algorithm and a simulator that forecasts trends in landscape pattern as a function of management rules implemented annually by individual landowners. The procedure was demonstrated with a case study for the optimum scheduling of fuel treatments in cork oak forest landscapes, involving six objectives related to reducing management costs (1), reducing fire risk (3), and protecting biodiversity associated with mid- and late-successional understories (2). There was a trade-off between cost, fire risk and biodiversity objectives, that could be minimized by selecting management regimes involving ca. 60% of landowners clearing the understory at short intervals (around 5 years), and the remaining managing at long intervals (ca. 75 years) or not managing. The optimal management regimes produces a mosaic landscape dominated by stands with herbaceous and low shrub understories, but also with a satisfactory representation of old understories, that was favorable in terms of both fire risk and biodiversity. The simulation-optimization procedure presented can be extended to incorporate a wide range of landscape dynamic processes, management rules and quantifiable objectives. It may thus be adapted to other socio-ecological systems, particularly where specific patterns of landscape heterogeneity are to be maintained despite imperfect management by multiple landowners. PMID:24465833

A contemporary perspective on capitated reimbursement for imaging services.

PubMed

Schwartz, H W

1995-01-01

Capitation ensures predictability of healthcare costs, requires acceptance of a premium in return for providing all required medical services and defines the actual dollar amount paid to a physician or hospital on a per member per month basis for a service or group of services. Capitation is expected to dramatically affect the marketplace in the near future, as private enterprise demands lower, more stable healthcare costs. Capitation requires detailed quantitative and financial data, including: eligibility and benefits determination, encounter processing, referral management, claims processing, case management, physician compensation, insurance management functions, outcomes reporting, performance management and cost accounting. It is important to understand actuarial risk and capitation marketing when considering a capitation contract. Also, capitated payment methodologies may vary to include modified fee-for-service, incentive pay, risk pool redistributions, merit, or a combination. Risk is directly related to the ability to predict utilization and unit cost of imaging services provided to a specific insured population. In capitated environments, radiologists will have even less control over referrals than they have today and will serve many more "covered lives"; long-term relationships with referring physicians will continue to evaporate; and services will be provided under exclusive, multi-year contracts. In addition to intensified use of technology for image transfer, telecommunications and sophisticated data processing and tracking systems, imaging departments must continue to provide the greatest amount of appropriate diagnostic information in a timely fashion at the lowest feasible cost and risk to the patient.

Constructing definitions of safety risks while nurses care for hospitalised older people: Secondary analysis of qualitative data.

PubMed

Dahlke, Sherry; Hall, Wendy A; Baumbusch, Jennifer

2017-09-01

The aim of this secondary qualitative descriptive analysis was to examine how nurses construct a definition of older peoples' safety risks and provide care while working within organisational contexts that are focused on diminishing patient risks. Numbers of older patients are increasing in acute hospital contexts-contexts that place their focus on patient safety. Nurses need to manage tensions between older peoples' risks, evidence-informed practice decisions, limited resources and organisational emphases on patient falls. To date, their practice dilemmas have not been well examined. A secondary qualitative descriptive analysis was conducted using data that were collected between June 2010 and May 2011 to examine nursing practice with hospitalised older people. All field notes and transcribed data were reviewed to generate themes representing 18 Registered Nurses' perceptions about safe care for hospitalised older people. The first author generated categories that described how nurses construct definitions of safety risks for older people. All authors engaged in an iterative analytic process that resulted in themes capturing nurses' efforts to provide care in limited resource environments while considering older peoples' safety risks. Nurses constructed definitions of patient safety risks in the context of institutional directives. Nurses provided care using available resources as efficiently as possible and accessing co-worker support. They also minimised the importance of older people's functional abilities by setting priorities for medically delegated tasks and immobilising their patients to reduce their risks. Nurses' definitions of patient risk, which were shaped by impoverished institutional resources and nurses' lack of valuing of functional abilities, contributed to suboptimal care for older adults. Nurses' definitions of risk as physical injury reduced their attention to patients' functional abilities, which nurses reported suffered declines as a result. Leaders need to examine how organisational emphases on particular areas of patient safety and resource constraints contribute to suboptimal care of older people. Nurses understanding of patient risk must incorporate older patients' functional abilities. © 2017 John Wiley & Sons Ltd.

Risk Management for Human Support Technology Development

NASA Technical Reports Server (NTRS)

jones, Harry

2005-01-01

NASA requires continuous risk management for all programs and projects. The risk management process identifies risks, analyzes their impact, prioritizes them, develops and carries out plans to mitigate or accept them, tracks risks and mitigation plans, and communicates and documents risk information. Project risk management is driven by the project goal and is performed by the entire team. Risk management begins early in the formulation phase with initial risk identification and development of a risk management plan and continues throughout the project life cycle. This paper describes the risk management approach that is suggested for use in NASA's Human Support Technology Development. The first step in risk management is to identify the detailed technical and programmatic risks specific to a project. Each individual risk should be described in detail. The identified risks are summarized in a complete risk list. Risk analysis provides estimates of the likelihood and the qualitative impact of a risk. The likelihood and impact of the risk are used to define its priority location in the risk matrix. The approaches for responding to risk are either to mitigate it by eliminating or reducing the effect or likelihood of a risk, to accept it with a documented rationale and contingency plan, or to research or monitor the risk, The Human Support Technology Development program includes many projects with independently achievable goals. Each project must do independent risk management, considering all its risks together and trading them against performance, budget, and schedule. Since the program can succeed even if some projects fail, the program risk has a complex dependence on the individual project risks.

Managing Risk for Cassini During Mission Operations and Data Analysis (MOandDA)

NASA Technical Reports Server (NTRS)

Witkowski, Mona M.

2002-01-01

A Risk Management Process has been tailored for Cassini that not only satisfies the requirements of NASA and JPL, but also allows the Program to proactively identify and assess risks that threaten mission objectives. Cassini Risk Management is a team effort that involves both management and engineering staff. The process is managed and facilitated by the Mission Assurance Manager (MAM), but requires regular interactions with Program Staff and team members to instill the risk management philosophy into the day to day mission operations. While Risk Management is well defined for projects in the development phase, it is a relatively new concept for Mission Operations. The Cassini team has embraced this process and has begun using it in an effective, proactive manner, to ensure mission success. It is hoped that the Cassini Risk Management Process will form the basis by which risk management is conducted during MO&DA on future projects. proactive in identifying, assessing and mitigating risks before they become problems. Cost ehtiveness is achieved by: Comprehensively identifying risks Rapidly assessing which risks require the expenditure of pruject cewums Taking early actions to mitigate these risks Iterating the process frequently, to be responsive to the dynamic internal and external environments The Cassini Program has successfully implemented a Risk Management Process for mission operations, The initial SRL has been developed and input into he online tool. The Risk Management webbased system has been rolled out for use by the flight team and risk owners we working proactive in identifying, assessing and mitigating risks before they become problems. Cost ehtiveness is achieved by: Comprehensively identifying risks Rapidly assessing which risks require the expenditure of pruject cewums Taking early actions to mitigate these risks Iterating the process frequently, to be responsive to the dynamic internal and external environments The Cassini Program has successfully implemented a Risk Management Process for mission operations, The initial SRL has been developed and input into he online tool. The Risk Management webbased system has been rolled out for use by the flight team and risk owners we working put into place will become visible and will be illusmted in future papers.

Contrasting Eutrophication Risks and Countermeasures in Different Water Bodies: Assessments to Support Targeted Watershed Management.

PubMed

Li, Tong; Chu, Chunli; Zhang, Yinan; Ju, Meiting; Wang, Yuqiu

2017-06-29

Eutrophication is a major problem in China. To combat this issue, the country needs to establish water quality targets, monitoring systems, and intelligent watershed management. This study explores a new watershed management method. Water quality is first assessed using a single factor index method. Then, changes in total nitrogen/total phosphorus (TN/TP) are analyzed to determine the limiting factor. Next, the study compares the eutrophication status of two water function districts, using a comprehensive nutritional state index method and geographic information system (GIS) visualization. Finally, nutrient sources are qualitatively analyzed. Two functional water areas in Tianjin, China were selected and analyzed: Qilihai National Wetland Nature Reserve and Yuqiao Reservoir. The reservoir is a drinking water source. Results indicate that total nitrogen (TN) and total phosphorus (TP) pollution are the main factors driving eutrophication in the Qilihai Wetland and Yuqiao Reservoir. Phosphorus was the limiting factor in the Yuqiao Reservoir; nitrogen was the limiting factor in the Qilihai Wetland. Pollution in Qilihai Wetland is more serious than in Yuqiao Reservoir. The study found that external sources are the main source of pollution. These two functional water areas are vital for Tianjin; as such, the study proposes targeted management measures.

Risk Management

DTIC Science & Technology

2011-06-02

actively attack the risks, they will actively attack you.” -Tom Gib Why do Risk Management? 8 “The first step in the risk management process is to...opportunities to manage and improve our chances of success. - Roger Vanscoy “If you do not actively attack the risks, they will actively attack ...our risks provides opportunities to manage and improve our chances of success. - Roger Vanscoy “If you do not actively attack the risks, they will

Risk management modeling and its application in maritime safety

NASA Astrophysics Data System (ADS)

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

2008-12-01

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

A review of risk management process in construction projects of developing countries

NASA Astrophysics Data System (ADS)

Bahamid, R. A.; Doh, S. I.

2017-11-01

In the construction industry, risk management concept is a less popular technique. There are three main stages in the systematic approach to risk management in construction industry. These stages include: a) risk response; b) risk analysis and evaluation; and c) risk identification. The high risk related to construction business affects each of its participants; while operational analysis and management of construction related risks remain an enormous task to practitioners of the industry. This paper tends towards reviewing the existing literature on construction project risk managements in developing countries specifically on risk management process. The literature lacks ample risk management process approach capable of capturing risk impact on diverse project objectives. This literature review aims at discovering the frequently used techniques in risk identification and analysis. It also attempts to identify response to clarifying the different classifications of risk sources in the existing literature of developing countries, and to identify the future research directions on project risks in the area of construction in developing countries.

78 FR 49663 - Enhanced Risk Management Standards for Systemically Important Derivatives Clearing Organizations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-15

... objectives and principles for these risk management standards are to: (1) Promote risk management; (2... international risk management standards set by CPSS-IOSCO's Principles and Recommendations.\\64\\ The Board did... COMMODITY FUTURES TRADING COMMISSION 17 CFR Part 39 RIN 3038-AC98 Enhanced Risk Management...

Sustaining a Mature Risk Management Process: Ensuring the International Space Station for a Vibrant Future

NASA Technical Reports Server (NTRS)

Raftery, Michael; Carter-Journet, Katrina

2013-01-01

The International Space Station (ISS) risk management methodology is an example of a mature and sustainable process. Risk management is a systematic approach used to proactively identify, analyze, plan, track, control, communicate, and document risks to help management make risk-informed decisions that increase the likelihood of achieving program objectives. The ISS has been operating in space for over 14 years and permanently crewed for over 12 years. It is the longest surviving habitable vehicle in low Earth orbit history. Without a mature and proven risk management plan, it would be increasingly difficult to achieve mission success throughout the life of the ISS Program. A successful risk management process must be able to adapt to a dynamic program. As ISS program-level decision processes have evolved, so too has the ISS risk management process continued to innovate, improve, and adapt. Constant adaptation of risk management tools and an ever-improving process is essential to the continued success of the ISS Program. Above all, sustained support from program management is vital to risk management continued effectiveness. Risk management is valued and stressed as an important process by the ISS Program.

Commitment to and preparedness for sustainable supply chain management in the oil and gas industry.

PubMed

Wan Ahmad, Wan Nurul K; Rezaei, Jafar; Tavasszy, Lóránt A; de Brito, Marisa P

2016-09-15

Our current dependency on the oil and gas (O&G) industry for economic development and social activities necessitates research into the sustainability of the industry's supply chains. At present, studies on sustainable supply chain management (SSCM) practices in the industry do not include firm-internal factors that affect the sustainability strategies employed by different functional areas of its supply chains. Our study aims to address this gap by identifying the relevant internal factors and exploring their relationship with SSCM strategies. Specifically, we discuss the commitment to and preparedness for sustainable practices of companies that operate in upstream and downstream O&G supply chain. We study the impact of these factors on their sustainability strategies of four key supply chain functions: supplier management, production management, product stewardship and logistics management. The analyses of data collected through a survey among 81 companies show that management preparedness may enhance sustainable supply chain strategies in the O&G industry more than commitment does. Among the preparedness measures, management of supply chain operational risks is found to be vital to the sustainability of all supply chain functions except for production management practices. The findings also highlight the central importance of supplier and logistics management to the achievement of sustainable O&G supply chains. Companies must also develop an organizational culture that encourages, for example, team collaboration and proactive behaviour to finding innovative sustainability solutions in order to translate commitment to sustainable practices into actions that can produce actual difference to their SSCM practices. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Adult Respiratory Distress Syndrome Cognitive Outcomes Study

PubMed Central

Christie, Jason D.; Lanken, Paul N.; Biester, Rosette C.; Thompson, B. Taylor; Bellamy, Scarlett L.; Localio, A. Russell; Demissie, Ejigayehu; Hopkins, Ramona O.; Angus, Derek C.

2012-01-01

Rationale: Cognitive and psychiatric morbidity is common and potentially modifiable after acute lung injury (ALI). However, practical measures of neuropsychological function for use in multicenter trials are lacking. Objectives: To determine whether a validated telephone-based neuropsychological test battery is feasible in a multicenter trial. To determine the frequency and risk factors for long-term neuropsychological impairment. Methods: As an adjunct study to the Acute Respiratory Distress Syndrome Clinical Trials Network Fluid and Catheter Treatment Trial, we assessed neuropsychological function at 2 and 12 months post–hospital discharge. Measurements and Main Results: Of 406 eligible survivors, we approached 261 to participate and 213 consented. We tested 122 subjects at least once, including 102 subjects at 12 months. Memory, verbal fluency, and executive function were impaired in 13% (12 of 92), 16% (15 of 96), and 49% (37 of 76) of long-term survivors. Long-term cognitive impairment was present in 41 of the 75 (55%) survivors who completed cognitive testing. Depression, post-traumatic stress disorder, or anxiety was present in 36% (37 of 102), 39% (40 of 102), and 62% (63 of 102) of long-term survivors. Enrollment in a conservative fluid-management strategy (P = 0.005) was associated with cognitive impairment and lower partial pressure of arterial oxygen during the trial was associated with cognitive (P = 0.02) and psychiatric impairment (P = 0.02). Conclusions: Neuropsychological function can be assessed by telephone in a multicenter trial. Long-term neuropsychological impairment is common in survivors of ALI. Hypoxemia is a risk factor for long-term neuropsychological impairment. Fluid management strategy is a potential risk factor for long-term cognitive impairment; however, given the select population studied and an unclear mechanism, this finding requires confirmation. PMID:22492988

Suit study - The impact of VMS in subsystem integration

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

Hill, B.; Watts, R.

1992-02-01

One of the thrusts of the Wright Laboratory/FIVE-sponsored Subsystem Integration Technology (SUIT) study is to investigate the impact of emerging vehicle management system (VMS) concepts on subsystem integration. This paper summarizes the issues relating to VMS/subsystem integration as examined during the Northrop SUIT study. Projected future weapon system requirements are identified and their impact on VMS and subsystem design interpreted. Integrated VMS/subsystem control and management functions are proposed. A candidate system VMS architecture satisfying the aforementioned weapon system requirements and providing the identified control and management functions is proposed. This architecture is used, together with the environmental control system, asmore » an illustrative subsystem example, to address the risks associated with the design, development, procurement, integration and testing of integrated VMS/subsystem concepts. The conclusion is that the development process requires an airframer to adopt the role of subsystem integrator, the consequences of which are discussed. 2 refs.« less

Risk management.

PubMed

Chambers, David W

2010-01-01

Every plan contains risk. To proceed without planning some means of managing that risk is to court failure. The basic logic of risk is explained. It consists in identifying a threshold where some corrective action is necessary, the probability of exceeding that threshold, and the attendant cost should the undesired outcome occur. This is the probable cost of failure. Various risk categories in dentistry are identified, including lack of liquidity; poor quality; equipment or procedure failures; employee slips; competitive environments; new regulations; unreliable suppliers, partners, and patients; and threats to one's reputation. It is prudent to make investments in risk management to the extent that the cost of managing the risk is less than the probable loss due to risk failure and when risk management strategies can be matched to type of risk. Four risk management strategies are discussed: insurance, reducing the probability of failure, reducing the costs of failure, and learning. A risk management accounting of the financial meltdown of October 2008 is provided.

Calysto: Risk Management for Commercial Manned Spaceflight

NASA Technical Reports Server (NTRS)

Dillaman, Gary

2012-01-01

The Calysto: Risk Management for Commercial Manned Spaceflight study analyzes risk management in large enterprises and how to effectively communicate risks across organizations. The Calysto Risk Management tool developed by NASA's Kennedy Space Center's SharePoint team is used and referenced throughout the study. Calysto is a web-base tool built on Microsoft's SharePoint platform. The risk management process at NASA is examined and incorporated in the study. Using risk management standards from industry and specific organizations at the Kennedy Space Center, three methods of communicating and elevating risk are examined. Each method describes details of the effectiveness and plausibility of using the method in the Calysto Risk Management Tool. At the end of the study suggestions are made for future renditions of Calysto.

[Design, implementation and evaluation of a management model of patient safety in hospitals in Catalonia, Spain].

PubMed

Saura, Rosa Maria; Moreno, Pilar; Vallejo, Paula; Oliva, Glòria; Alava, Fernando; Esquerra, Miquel; Davins, Josep; Vallès, Roser; Bañeres, Joaquim

2014-07-01

Since its inception in 2006, the Alliance for Patient Safety in Catalonia has played a major role in promoting and shaping a series of projects related to the strategy of the Ministry of Health, Social Services and Equality, for improving patient safety. One such project was the creation of functional units or committees of safety in hospitals in order to facilitate the management of patient safety. The strategy has been implemented in hospitals in Catalonia which were selected based on criteria of representativeness. The intervention was based on two lines of action, one to develop the model framework and the other for its development. Firstly the strategy for safety management based on EFQM (European Foundation for Quality Management) was defined with the development of standards, targets and indicators to implement security while the second part involved the introduction of tools, methodologies and knowledge to the management support of patient safety and risk prevention. The project was developed in four hospital areas considered higher risk, each assuming six goals for safety management. Some of these targets such as the security control panel or system of adverse event reporting were shared. 23 hospitals joined the project in Catalonia. Despite the different situations in each centre, high compliance was achieved in the development of the objectives. In each of the participating areas the security control panel was developed. Stable structures for safety management were established or strengthened. Training in patient safety played and important role, 1415 professionals participated. Through these kind of projects not only have been introduced programs of proven effectiveness in reducing risks, but they also provide to the facilities a work system that allows autonomy in diagnosis and analysis of the different risk situations or centre specific safety issues. Copyright © 2014. Published by Elsevier Espana.

Influence of green supply chain risk management on performance of Chinese manufacturing enterprises

NASA Astrophysics Data System (ADS)

Zhang, Dongying; Yuting, Duan; Junyi, Shen

2017-12-01

This paper briefly introduces the background of the research on the impact of green supply chain risk management on corporate performance, reviews the relevant research literature at home and abroad, and uses the gray relational analysis to analyze the impact of the green supply chain risk management on enterprise performance based on 26 industry-related statistical data, from purchasing risk management performance,manufacturing risk management performance and marketing risk management performance.

Comparative Analysis of Cervical Spine Management in a Subset of Severe Traumatic Brain Injury Cases Using Computer Simulation

PubMed Central

Carter, Kimbroe J.; Dunham, C. Michael; Castro, Frank; Erickson, Barbara

2011-01-01

Background No randomized control trial to date has studied the use of cervical spine management strategies in cases of severe traumatic brain injury (TBI) at risk for cervical spine instability solely due to damaged ligaments. A computer algorithm is used to decide between four cervical spine management strategies. A model assumption is that the emergency room evaluation shows no spinal deficit and a computerized tomogram of the cervical spine excludes the possibility of fracture of cervical vertebrae. The study's goal is to determine cervical spine management strategies that maximize brain injury functional survival while minimizing quadriplegia. Methods/Findings The severity of TBI is categorized as unstable, high risk and stable based on intracranial hypertension, hypoxemia, hypotension, early ventilator associated pneumonia, admission Glasgow Coma Scale (GCS) and age. Complications resulting from cervical spine management are simulated using three decision trees. Each case starts with an amount of primary and secondary brain injury and ends as a functional survivor, severely brain injured, quadriplegic or dead. Cervical spine instability is studied with one-way and two-way sensitivity analyses providing rankings of cervical spine management strategies for probabilities of management complications based on QALYs. Early collar removal received more QALYs than the alternative strategies in most arrangements of these comparisons. A limitation of the model is the absence of testing against an independent data set. Conclusions When clinical logic and components of cervical spine management are systematically altered, changes that improve health outcomes are identified. In the absence of controlled clinical studies, the results of this comparative computer assessment show that early collar removal is preferred over a wide range of realistic inputs for this subset of traumatic brain injury. Future research is needed on identifying factors in projecting awakening from coma and the role of delirium in these cases. PMID:21544239

Understanding growers' decisions to manage invasive pathogens at the farm level.

PubMed

Breukers, Annemarie; van Asseldonk, Marcel; Bremmer, Johan; Beekman, Volkert

2012-06-01

Globalization causes plant production systems to be increasingly threatened by invasive pests and pathogens. Much research is devoted to support management of these risks. Yet, the role of growers' perceptions and behavior in risk management has remained insufficiently analyzed. This article aims to fill this gap by addressing risk management of invasive pathogens from a sociopsychological perspective. An analytical framework based on the Theory of Planned Behavior was used to explain growers' decisions on voluntary risk management measures. Survey information from 303 Dutch horticultural growers was statistically analyzed, including regression and cluster analysis. It appeared that growers were generally willing to apply risk management measures, and that poor risk management was mainly due to perceived barriers, such as high costs and doubts regarding efficacy of management measures. The management measures applied varied considerably among growers, depending on production sector and farm-specific circumstances. Growers' risk perception was found to play a role in their risk management, although the causal relation remained unclear. These results underscore the need to apply a holistic perspective to farm level management of invasive pathogen risk, considering the entire package of management measures and accounting for sector- and farm-specific circumstances. Moreover, they demonstrate that invasive pathogen risk management can benefit from a multidisciplinary approach that incorporates growers' perceptions and behavior.

Role of cytogenetic biomarkers in management of chronic kidney disease patients: A review.

PubMed

Khan, Zeba; Pandey, Manoj; Samartha, Ravindra M

2016-10-01

Chronic kidney disease (CKD) is much more common than people recognize, and habitually goes undetected and undiagnosed until the disease is well advanced or when their kidney functions is down to 25% of normal function. Genetic and non-genetic factors contribute to cause CKD. Non-genetic factors include hypertension, High level of DNA damage due to the production of reactive oxygen species and nucleic acid oxidation has been reported in CKD patients. Main genetic factor which causes CKD is diabetic nephropathy. A three- to nine-fold greater risk of End Stage Renal Disease (ESRD) is observed in individuals with a family history of ESRD. This greater risk have led researchers to search for genes linked to diabetic and other forms of nephropathy for the management of CKD. Multicenter consortia are currently recruiting large numbers of multiplex diabetic families with index cases having nephropathy for linkage and association analyses using various cytogenetic techniques. In addition, large-scale screening studies are underway, with the goals of better defining the overall prevalence of chronic kidney disease, as well as educating the population about risk factors for nephropathy, including family history. Cytogenetic biomarkers play an imperative role for the linkage study using G banding and detection of genomic instability in CKD patients. Classical and molecular cytogenetic tools with cytogenetic biomarkers provide remarkable findings in CKD patients. The aim of the present review is to draw outline of classical and molecular cytogenetic findings in CKD patients and their possible role in management to reduce genomic instability in CKD patients.

[Morbidity and mortality after intensive care management of hemorrhagic stroke in Djibouti].

PubMed

Benois, A; Raynaud, L; Coton, T; Petitjeans, F; Hassan, A; Ilah, A; Sergent, H; Grassin, F; Leberre, J

2009-02-01

Prospective data on management and outcome of stroke in Africa is scarce. The purpose of this prospective descriptive study is to present epidemiologic, clinical and outcome data for a series of patients with hemorrhagic stroke in Djibouti. All patients admitted to the intensive care unit of the Bouffard Medical-Surgical Center in Djibouti for cerebral hemorrhage documented by CT-scan of the brain were recruited in this study. A total of 18 patients including 16 men were enrolled. The median patient age in this series was 51.5 years [range, 20-72]. The median duration of intensive care was 3 days [range, 1-38]. Mean Glasgow score at time of admission was 9 [range, 3-14]. Five patients were brought in by emergency medical airlift. The main risk factors for stroke were arterial hypertension, smoking, and regular khat use. Mechanical ventilation was performed in 10 patients with a survival rate of 40%. Six patients (33%) died in the intensive care unit. Hospital mortality within one month was 39% and mortality at 6 months was 44.4%. One-year survival for patients with a Glasgow score < or = 7 at the time of admission was 33%. Arterial hypertension, khat use, and smoking appeared to be major risk factors for male Djiboutians. Neurologic intensive care techniques provided hospital mortality rates similar to those reported in hospitals located in Western countries. Functional outcome in local survivors appeared to be good despite the absence of functional intensive care. These data argue against the passive, fatalistic approach to management of hemorrhagic stroke and for primary prevention of cardiovascular risk factors.

Low weight and overweightness in older adults: risk and clinical management.

PubMed

Jahangir, Eiman; De Schutter, Alban; Lavie, Carl J

2014-01-01

The prevalence of individuals who are overweight or obese is growing exponentially in the United States and worldwide. This growth is concerning, as both overweightness and obesity lead to impaired physical function, decreased quality of life, and increased risk of chronic diseases. Additionally, overweightness and obesity are related to increased mortality among young and middle-aged adults. This weight-related risk of mortality is more ambiguous among older adults. In fact, obesity may be protective in this population, a relationship described as the "obesity paradox". In this review we discuss the effects of overweightness and obesity among the elderly on cardiovascular disease and all-cause mortality, along with the risks of low weight. We conclude by discussing the goal of weight management among older adults, focusing particularly on benefits of preserving lean body mass and muscular strength while stabilizing body fat. Ideally, overweight or mildly obese elderly individuals should devise a plan with their physicians to maintain their weight, while increasing lean body mass through a plan of healthy diet, behavioral therapy, and physical activity. Copyright © 2014 Elsevier Inc. All rights reserved.

Femoral Nerve Block versus Adductor Canal Block for Analgesia after Total Knee Arthroplasty

PubMed Central

Koh, In Jun; Choi, Young Jun; Kim, Man Soo; Koh, Hyun Jung; Kang, Min Sung; In, Yong

2017-01-01

Inadequate pain management after total knee arthroplasty (TKA) impedes recovery, increases the risk of postoperative complications, and results in patient dissatisfaction. Although the preemptive use of multimodal measures is currently considered the principle of pain management after TKA, no gold standard pain management protocol has been established. Peripheral nerve blocks have been used as part of a contemporary multimodal approach to pain control after TKA. Femoral nerve block (FNB) has excellent postoperative analgesia and is now a commonly used analgesic modality for TKA pain control. However, FNB leads to quadriceps muscle weakness, which impairs early mobilization and increases the risk of postoperative falls. In this context, emerging evidence suggests that adductor canal block (ACB) facilitates postoperative rehabilitation compared with FNB because it primarily provides a sensory nerve block with sparing of quadriceps strength. However, whether ACB is more appropriate for contemporary pain management after TKA remains controversial. The objective of this study was to review and summarize recent studies regarding practical issues for ACB and comparisons of analgesic efficacy and functional recovery between ACB and FNB in patients who have undergone TKA. PMID:28545172

Femoral Nerve Block versus Adductor Canal Block for Analgesia after Total Knee Arthroplasty.

PubMed

Koh, In Jun; Choi, Young Jun; Kim, Man Soo; Koh, Hyun Jung; Kang, Min Sung; In, Yong

2017-06-01

Inadequate pain management after total knee arthroplasty (TKA) impedes recovery, increases the risk of postoperative complications, and results in patient dissatisfaction. Although the preemptive use of multimodal measures is currently considered the principle of pain management after TKA, no gold standard pain management protocol has been established. Peripheral nerve blocks have been used as part of a contemporary multimodal approach to pain control after TKA. Femoral nerve block (FNB) has excellent postoperative analgesia and is now a commonly used analgesic modality for TKA pain control. However, FNB leads to quadriceps muscle weakness, which impairs early mobilization and increases the risk of postoperative falls. In this context, emerging evidence suggests that adductor canal block (ACB) facilitates postoperative rehabilitation compared with FNB because it primarily provides a sensory nerve block with sparing of quadriceps strength. However, whether ACB is more appropriate for contemporary pain management after TKA remains controversial. The objective of this study was to review and summarize recent studies regarding practical issues for ACB and comparisons of analgesic efficacy and functional recovery between ACB and FNB in patients who have undergone TKA.

NASA System Safety Handbook. Volume 2: System Safety Concepts, Guidelines, and Implementation Examples

NASA Technical Reports Server (NTRS)

Dezfuli, Homayoon; Benjamin, Allan; Everett, Christopher; Feather, Martin; Rutledge, Peter; Sen, Dev; Youngblood, Robert

2015-01-01

This is the second of two volumes that collectively comprise the NASA System Safety Handbook. Volume 1 (NASASP-210-580) was prepared for the purpose of presenting the overall framework for System Safety and for providing the general concepts needed to implement the framework. Volume 2 provides guidance for implementing these concepts as an integral part of systems engineering and risk management. This guidance addresses the following functional areas: 1.The development of objectives that collectively define adequate safety for a system, and the safety requirements derived from these objectives that are levied on the system. 2.The conduct of system safety activities, performed to meet the safety requirements, with specific emphasis on the conduct of integrated safety analysis (ISA) as a fundamental means by which systems engineering and risk management decisions are risk-informed. 3.The development of a risk-informed safety case (RISC) at major milestone reviews to argue that the systems safety objectives are satisfied (and therefore that the system is adequately safe). 4.The evaluation of the RISC (including supporting evidence) using a defined set of evaluation criteria, to assess the veracity of the claims made therein in order to support risk acceptance decisions.

Understanding safety and production risks in rail engineering planning and protection.

PubMed

Wilson, John R; Ryan, Brendan; Schock, Alex; Ferreira, Pedro; Smith, Stuart; Pitsopoulos, Julia

2009-07-01

Much of the published human factors work on risk is to do with safety and within this is concerned with prediction and analysis of human error and with human reliability assessment. Less has been published on human factors contributions to understanding and managing project, business, engineering and other forms of risk and still less jointly assessing risk to do with broad issues of 'safety' and broad issues of 'production' or 'performance'. This paper contains a general commentary on human factors and assessment of risk of various kinds, in the context of the aims of ergonomics and concerns about being too risk averse. The paper then describes a specific project, in rail engineering, where the notion of a human factors case has been employed to analyse engineering functions and related human factors issues. A human factors issues register for potential system disturbances has been developed, prior to a human factors risk assessment, which jointly covers safety and production (engineering delivery) concerns. The paper concludes with a commentary on the potential relevance of a resilience engineering perspective to understanding rail engineering systems risk. Design, planning and management of complex systems will increasingly have to address the issue of making trade-offs between safety and production, and ergonomics should be central to this. The paper addresses the relevant issues and does so in an under-published domain - rail systems engineering work.

Designing sustainable soils in Earth's critical zone

NASA Astrophysics Data System (ADS)

Banwart, Steven Allan; de Souza, Danielle Maia; Menon, Manoj; Nikolaidis, Nikolaos; Panagos, Panos; Vala Ragnardsdottir, Kristin; Rousseva, Svelta; van Gaans, Pauline

2014-05-01

The demographic drivers of increasing human population and wealth are creating tremendous environmental pressures from growing intensity of land use, resulting in soil and land degradation worldwide. Environmental services are provided through multiple soil functions that include biomass production, water storage and transmission, nutrient transformations, contaminant attenuation, carbon and nitrogen storage, providing habitat and maintaining the genetic diversity of the land environment. One of the greatest challenges of the 21st century is to identify key risks to soil, and to design mitigation strategies to manage these risks and to enhance soil functions that can last into the future. The scientific study of Earth's Critical Zone (CZ), the thin surface layer that extends vertically from the top of the tree canopy to the bottom of aquifers, provides an essential integrating scientific framework to study, protect and enhance soil functions. The research hypothesis is that soil structure, the geometric architecture of solids, pores and biomass, is a critical indicator and essential factor of productive soil functions. The experimental design selects a network of Critical Zone Observatories (CZOs) as advanced field research sites along a gradient of land use intensity in order to quantify soil structure and soil processes that dictate the flows and transformations of material and energy as soil functions. The CZOs focus multidisciplinary expertise on soil processes, field observation and data interpretation, management science and ecological economics. Computational simulation of biophysical processes provides a quantitative method of integration for the range of theory and observations that are required to quantify the linkages between changes in soil structure and soil functions. Key results demonstrate that changes in soil structure can be quantified through the inputs of organic carbon and nitrogen from plant productivity and microbial activity, coupled with particle aggregation dynamics and organic matter mineralization. Simulation results show that soil structure is highly dynamic and is sensitive to organic matter production and minearlisation rates as influenced by vegetation, tillage and organic carbon amendments. These results point to a step-change in the capability to design soil management and land use through computational simulation. This approach of "sustainability by design" describes the mechanistic process linkages that exist between the above-ground inputs to the CZ and the internal processes that produce soil functions. This approach provides a rational, scientific approach to selecting points of intervention with the CZ in order to design methods to mitigate soil threats and to enhance and sustain vital soil functions. Furthermore, this approach provides a successful pilot study to the use of international networks of CZOs as a planetary-scale laboratory to test the response of CZ process rates along gradients of global environmental change - and to test adaptation strategies to manage the risks arising from the CZ impacts. Acknowledgements. The authors acknowledge the substantial contributions of the entire team of investigators and funding of the SoilTrEC project (EC FP7, agreement no. 244118; www.soiltrec.eu).

Predicting landslides in clearcut patches

Treesearch

Raymond M. Rice; Norman H. Pillsbury

1982-01-01

Abstract - Accelerated erosion in the form of landslides can be an undesirable consequence of clearcut logging on steep slopes. Forest managers need a method of predicting the risk of such erosion. Data collected after logging in a granitic area of northwestern California were used to develop a predictive equation. A linear discriminant function was developed that...

Strategic management of livestock to improve biodiversity conservation in African savannahs: A conceptual basis for wildlife-livestock coexistence

USDA-ARS?s Scientific Manuscript database

African savannas are complex socio-ecological systems with diverse wild and domestic herbivore assemblages, which utilize functional heterogeneity of habitats to adapt to intra- and inter-annual variation in forage quantity and quality, predation and disease risks. As African savannas become increas...

[The management of arteriovenous fistula for dialysis patients].

PubMed

Lopez, Teodoro; Casino, Francesco

2014-01-01

A well-functioning vascular access is a basic requirement for a good dialysis treatment. Among the vascular accesses, the Artero-venous fistula (FAV) with native vessels is preferred for increasing survival rate, reducing risk of infection and with fewer complications. This review examines some aspects concerning the preparation and the surveillance of AVF.

Adverse effects of anticancer agents that target the VEGF pathway.

PubMed

Chen, Helen X; Cleck, Jessica N

2009-08-01

Antiangiogenesis agents that target the VEGF/VEGF receptor pathway have become an important part of standard therapy in multiple cancer indications. With expanded clinical experience with this class of agents has come the increasing recognition of the diverse adverse effects related to disturbance of VEGF-dependent physiological functions and homeostasis in the cardiovascular and renal systems, as well as wound healing and tissue repair. Although most adverse effects of VEGF inhibitors are modest and manageable, some are associated with serious and life-threatening consequences, particularly in high-risk patients and in certain clinical settings. This Review examines the toxicity profiles of anti-VEGF antibodies and small-molecule inhibitors. The potential mechanisms of the adverse effects, risk factors, and the implications for selection of patients and management are discussed.

The diagnosis and management of cerebrovascular disease in diabetes.

PubMed

Phipps, Michael S; Jastreboff, Ania M; Furie, Karen; Kernan, Walter N

2012-06-01

Cerebrovascular disease is a leading cause of morbidity and mortality in diabetes. Compared with nondiabetic patients, diabetic patients have at least twice the risk for stroke, earlier onset of symptoms, and worse functional outcomes. Approximately 20 % of diabetic patients will die from stroke, making it one of the leading causes of death in this population. Effective strategies for primary and secondary prevention of stroke have been developed in research cohorts that included both diabetic and nondiabetic patients. Nevertheless, prevention in diabetes has some specific considerations. In this paper, we summarize evidence to guide the diagnosis and management of stroke in diabetic patients. We propose that diabetic stroke patients should have a robust risk assessment to target interventions, like other patients with cerebrovascular disease, but with special attention to glycemic control and lifestyle modification.

Potential economic value of drought information to support early warning in Africa

NASA Astrophysics Data System (ADS)

Quiroga, S.; Iglesias, A.; Diz, A.; Garrote, L.

2012-04-01

We present a methodology to estimate the economic value of advanced climate information for food production in Africa under climate change scenarios. The results aim to facilitate better choices in water resources management. The methodology includes 4 sequential steps. First two contrasting management strategies (with and without early warning) are defined. Second, the associated impacts of the management actions are estimated by calculating the effect of drought in crop productivity under climate change scenarios. Third, the optimal management option is calculated as a function of the drought information and risk aversion of potential information users. Finally we use these optimal management simulations to compute the economic value of enhanced water allocation rules to support stable food production in Africa. Our results show how a timely response to climate variations can help reduce loses in food production. The proposed framework is developed within the Dewfora project (Early warning and forecasting systems to predict climate related drought vulnerability and risk in Africa) that aims to improve the knowledge on drought forecasting, warning and mitigation, and advance the understanding of climate related vulnerability to drought and to develop a prototype operational forecasting.

A Risk Management Method for the Operation of a Supply-Chain without Storage:

NASA Astrophysics Data System (ADS)

Kobayashi, Yasuhiro; Manabe, Yuuji; Nakata, Norimasa; Kusaka, Satoshi

A business risk management method has been developed for a supply-chain without a storage function under demand uncertainty. Power supply players in the deregulated power market face the need to develop the best policies for power supply from self-production and reserved purchases to balance demand, which is predictable with error. The proposed method maximizes profit from the operation of the supply-chain under probabilistic demand uncertainty on the basis of a probabilistic programming approach. Piece-wise linear functions are employed to formulate the impact of under-booked or over-booked purchases on the supply cost, and constraints on over-demand probability are introduced to limit over-demand frequency on the basis of the demand probability distribution. The developed method has been experimentally applied to the supply policy of a power-supply-chain, the operation of which is based on a 3-stage pricing purchase contract and on 28 time zones. The characteristics of the obtained optimal supply policy are successfully captured in the numerical results, which suggest the applicability of the proposed method.

[Early detection, prevention and management of renal failure in liver transplantation].

PubMed

Castells, Lluís; Baliellas, Carme; Bilbao, Itxarone; Cantarell, Carme; Cruzado, Josep Maria; Esforzado, Núria; García-Valdecasas, Juan Carlos; Lladó, Laura; Rimola, Antoni; Serón, Daniel; Oppenheimer, Federico

2014-10-01

Renal failure is a frequent complication in liver transplant recipients and is associated with increased morbidity and mortality. A variety of risk factors for the development of renal failure in the pre- and post-transplantation periods have been described, as well as at the time of surgery. To reduce the negative impact of renal failure in this population, an active approach is required for the identification of those patients with risk factors, the implementation of preventive strategies, and the early detection of progressive deterioration of renal function. Based on published evidence and on clinical experience, this document presents a series of recommendations on monitoring RF in LT recipients, as well as on the prevention and management of acute and chronic renal failure after LT and referral of these patients to the nephrologist. In addition, this document also provides an update of the various immunosuppressive regimens tested in this population for the prevention and control of post-transplantation deterioration of renal function. Copyright © 2013 Elsevier España, S.L.U. and AEEH y AEG. All rights reserved.

A descriptive study on evaluation of bio-medical waste management in a tertiary care public hospital of North India

PubMed Central

2014-01-01

Background Proper management of Biomedical waste (BMW) generated in a healthcare facility is one of the most important functions of a healthcare worker (HCW) as its improper management not only poses risk to human beings and environment, but may also invite legal action against HCW as well as hospital administration. This study was carried out to evaluate quality of BMW management in 1100-bedded hospital attached to a tertiary care public institute in North India. Methods A checklist, including 29 parameters related to various functions to be carried out at source of generation by a HCW for BMW management was prepared by researcher and used after validation to record observations in all the 70 areas of hospital. A total of 6 visits were made to each area and mean percentage score was calculated for each area and each category of waste management. Results It was found that summated mean percentage score of ‘Treatment Room of Wards’, which were used exclusively by resident doctors, was significantly lower than Operation Theatres (p value: 0.033) and ‘Central Waste Collection Points of Wards’ (p value: 0.018) for the function of ‘mutilation of recyclable waste’ and it was significantly lower than all other areas (p value: 0.006 to 0.017) for the function of ‘disinfection of waste’. Conclusion It is concluded that more emphasis needs to be laid on ‘mutilation of recyclable waste’ and disinfection of waste’ by HCWs especially resident doctors. PMID:24742274

Risk Management Implementation Tool

NASA Technical Reports Server (NTRS)

Wright, Shayla L.

2004-01-01

Continuous Risk Management (CM) is a software engineering practice with processes, methods, and tools for managing risk in a project. It provides a controlled environment for practical decision making, in order to assess continually what could go wrong, determine which risk are important to deal with, implement strategies to deal with those risk and assure the measure effectiveness of the implemented strategies. Continuous Risk Management provides many training workshops and courses to teach the staff how to implement risk management to their various experiments and projects. The steps of the CRM process are identification, analysis, planning, tracking, and control. These steps and the various methods and tools that go along with them, identification, and dealing with risk is clear-cut. The office that I worked in was the Risk Management Office (RMO). The RMO at NASA works hard to uphold NASA s mission of exploration and advancement of scientific knowledge and technology by defining and reducing program risk. The RMO is one of the divisions that fall under the Safety and Assurance Directorate (SAAD). I worked under Cynthia Calhoun, Flight Software Systems Engineer. My task was to develop a help screen for the Continuous Risk Management Implementation Tool (RMIT). The Risk Management Implementation Tool will be used by many NASA managers to identify, analyze, track, control, and communicate risks in their programs and projects. The RMIT will provide a means for NASA to continuously assess risks. The goals and purposes for this tool is to provide a simple means to manage risks, be used by program and project managers throughout NASA for managing risk, and to take an aggressive approach to advertise and advocate the use of RMIT at each NASA center.

The superior effect of nature based solutions in land management for enhancing ecosystem services.

PubMed

Keesstra, Saskia; Nunes, Joao; Novara, Agata; Finger, David; Avelar, David; Kalantari, Zahra; Cerdà, Artemi

2018-01-01

The rehabilitation and restoration of land is a key strategy to recover services -goods and resources- ecosystems offer to the humankind. This paper reviews key examples to understand the superior effect of nature based solutions to enhance the sustainability of catchment systems by promoting desirable soil and landscape functions. The use of concepts such as connectivity and the theory of system thinking framework allowed to review coastal and river management as a guide to evaluate other strategies to achieve sustainability. In land management NBSs are not mainstream management. Through a set of case studies: organic farming in Spain; rewilding in Slovenia; land restoration in Iceland, sediment trapping in Ethiopia and wetland construction in Sweden, we show the potential of Nature based solutions (NBSs) as a cost-effective long term solution for hydrological risks and land degradation. NBSs can be divided into two main groups of strategies: soil solutions and landscape solutions. Soil solutions aim to enhance the soil health and soil functions through which local eco-system services will be maintained or restored. Landscape solutions mainly focus on the concept of connectivity. Making the landscape less connected, facilitating less rainfall to be transformed into runoff and therefore reducing flood risk, increasing soil moisture and reducing droughts and soil erosion we can achieve the sustainability. The enhanced eco-system services directly feed into the realization of the Sustainable Development Goals of the United Nations. Copyright © 2017 Elsevier B.V. All rights reserved.

Post-transplantation diabetes in kidney transplant recipients: an update on management and prevention.

PubMed

Conte, Caterina; Secchi, Antonio

2018-04-04

Post-transplantation diabetes mellitus (PTDM) may severely impact both short- and long-term outcomes of kidney transplant recipients in terms of graft and patient survival. However, PTDM often goes undiagnosed is underestimated or poorly managed. A diagnosis of PTDM should be delayed until the patient is on stable maintenance doses of immunosuppressive drugs, with stable kidney graft function and in the absence of acute infections. Risk factors for PTDM should be assessed during the pre-transplant evaluation period, in order to reduce the likelihood of developing diabetes. The oral glucose tolerance test is considered as the gold standard for diagnosing PTDM, whereas HbA1c is not reliable during the first months after transplantation. Glycaemic targets should be individualised, and comorbidities such as dyslipidaemia and hypertension should be treated with drugs that have the least possible impact on glucose metabolism, at doses that do not interact with immunosuppressants. While insulin is the preferred agent for treating inpatient hyperglycaemia in the immediate post-transplantation period, little evidence is available to guide therapeutic choices in the management of PTDM. Metformin and incretins may offer some advantage over other glucose-lowering agents, particularly with respect to risk of hypoglycaemia and weight gain. Tailoring immunosuppressive regimens may be of help, although maintenance of good kidney function should be prioritised over prevention/treatment of PTDM. The aim of this narrative review is to provide an overview of the available evidence on management and prevention of PTDM, with a focus on the available therapeutic options.

Quantifying the economic risks of climate change

NASA Astrophysics Data System (ADS)

Diaz, Delavane; Moore, Frances

2017-11-01

Understanding the value of reducing greenhouse-gas emissions matters for policy decisions and climate risk management, but quantification is challenging because of the complex interactions and uncertainties in the Earth and human systems, as well as normative ethical considerations. Current modelling approaches use damage functions to parameterize a simplified relationship between climate variables, such as temperature change, and economic losses. Here we review and synthesize the limitations of these damage functions and describe how incorporating impacts, adaptation and vulnerability research advances and empirical findings could substantially improve damage modelling and the robustness of social cost of carbon values produced. We discuss the opportunities and challenges associated with integrating these research advances into cost-benefit integrated assessment models, with guidance for future work.

Information Risk Management and Resilience

NASA Astrophysics Data System (ADS)

Dynes, Scott

Are the levels of information risk management efforts within and between firms correlated with the resilience of the firms to information disruptions? This paper examines the question by considering the results of field studies of information risk management practices at organizations and in supply chains. The organizations investigated differ greatly in the degree of coupling from a general and information risk management standpoint, as well as in the levels of internal awareness and activity regarding information risk management. The comparison of the levels of information risk management in the firms and their actual or inferred resilience indicates that a formal information risk management approach is not necessary for resilience in certain sectors.

Pharmaceutical supply chain risks: a systematic review

PubMed Central

2013-01-01

Introduction Supply of medicine as a strategic product in any health system is a top priority. Pharmaceutical companies, a major player of the drug supply chain, are subject to many risks. These risks disrupt the supply of medicine in many ways such as their quantity and quality and their delivery to the right place and customers and at the right time. Therefore risk identification in the supply process of pharmaceutical companies and mitigate them is highly recommended. Objective In this study it is attempted to investigate pharmaceutical supply chain risks with perspective of manufacturing companies. Methods Scopus, PubMed, Web of Science bibliographic databases and Google scholar scientific search engines were searched for pharmaceutical supply chain risk management studies with 6 different groups of keywords. All results found by keywords were reviewed and none-relevant articles were excluded by outcome of interests and researcher boundaries of study within 4 steps and through a systematic method. Results Nine articles were included in the systematic review and totally 50 main risks based on study outcome of interest extracted which classified in 7 categories. Most of reported risks were related to supply and supplier issues. Organization and strategy issues, financial, logistic, political, market and regulatory issues were in next level of importance. Conclusion It was shown that the majority of risks in pharmaceutical supply chain were internal risks due to processes, people and functions mismanagement which could be managed by suitable mitigation strategies. PMID:24355166

The profound effect of harmful cyanobacterial blooms: From food-web and management perspectives.

PubMed

Šulčius, Sigitas; Montvydienė, Danguolė; Mazur-Marzec, Hanna; Kasperovičienė, Jūratė; Rulevičius, Rokas; Cibulskaitė, Živilė

2017-12-31

Sustainable and effective water management plans must have a reliable risk assessment strategies for harmful cyanobacterial blooms (HABs) that would enable timely decisions to be made, thus avoiding the trespassing of ecological thresholds, leading to the collapse of ecosystem structure and function. Such strategies are usually based on cyanobacterial biomass and/or on the monitoring of known toxins, which may, however, in many cases, under- or over-represent the actual toxicity of the HAB. Therefore, in this study, by the application of growth-inhibition assays using different bacteria, algae, zooplankton and fish species, we assessed the toxicological potential of two cyanobacterial blooms that differed in total cyanobacterial biomass, species composition and cyanopeptide profiles. We demonstrated that neither cyanobacterial community composition nor its relative abundance, nor indeed concentrations of known toxins reflected the potential risk of HAB based on growth-inhibition assays. We discuss our findings in the context of food-web dynamics and ecosystem management, and suggest that toxicological tests should constitute a key element in the routine monitoring of water bodies so as to prevent under-/over-estimation of potential HAB risk for both ecosystem and public health. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Designing an agricultural vegetative waste-management system under uncertain prices of treatment-technology output products.

PubMed

Broitman, D; Raviv, O; Ayalon, O; Kan, I

2018-05-01

Setting up a sustainable agricultural vegetative waste-management system is a challenging investment task, particularly when markets for output products of waste-treatment technologies are not well established. We conduct an economic analysis of possible investments in treatment technologies of agricultural vegetative waste, while accounting for fluctuating output prices. Under a risk-neutral approach, we find the range of output-product prices within which each considered technology becomes most profitable, using average final prices as the exclusive factor. Under a risk-averse perspective, we rank the treatment technologies based on their computed certainty-equivalent profits as functions of the coefficient of variation of the technologies' output prices. We find the ranking of treatment technologies based on average prices to be robust to output-price fluctuations provided that the coefficient of variation of the output prices is below about 0.4, that is, approximately twice as high as that of well-established recycled-material markets such as glass, paper and plastic. We discuss some policy implications that arise from our analysis regarding vegetative waste management and its associated risks. Copyright © 2018 Elsevier Ltd. All rights reserved.

Dynamic decision making for dam-break emergency management - Part 1: Theoretical framework

NASA Astrophysics Data System (ADS)

Peng, M.; Zhang, L. M.

2013-02-01

An evacuation decision for dam breaks is a very serious issue. A late decision may lead to loss of lives and properties, but a very early evacuation will incur unnecessary expenses. This paper presents a risk-based framework of dynamic decision making for dam-break emergency management (DYDEM). The dam-break emergency management in both time scale and space scale is introduced first to define the dynamic decision problem. The probability of dam failure is taken as a stochastic process and estimated using a time-series analysis method. The flood consequences are taken as functions of warning time and evaluated with a human risk analysis model (HURAM) based on Bayesian networks. A decision criterion is suggested to decide whether to evacuate the population at risk (PAR) or to delay the decision. The optimum time for evacuating the PAR is obtained by minimizing the expected total loss, which integrates the time-related probabilities and flood consequences. When a delayed decision is chosen, the decision making can be updated with available new information. A specific dam-break case study is presented in a companion paper to illustrate the application of this framework to complex dam-breaching problems.

Research on Risk Manage of Power Construction Project Based on Bayesian Network

NASA Astrophysics Data System (ADS)

Jia, Zhengyuan; Fan, Zhou; Li, Yong

With China's changing economic structure and increasingly fierce competition in the market, the uncertainty and risk factors in the projects of electric power construction are increasingly complex, the projects will face huge risks or even fail if we don't consider or ignore these risk factors. Therefore, risk management in the projects of electric power construction plays an important role. The paper emphatically elaborated the influence of cost risk in electric power projects through study overall risk management and the behavior of individual in risk management, and introduced the Bayesian network to the project risk management. The paper obtained the order of key factors according to both scene analysis and causal analysis for effective risk management.

A surgeon's guide to anticoagulant and antiplatelet medications part one: warfarin and new direct oral anticoagulant medications

PubMed Central

McBeth, Paul B; Weinberg, Jordan A; Sarani, Babak; Yeung, Louise Y Y; May, Addison K

2016-01-01

An increasing number of potent antiplatelet and anticoagulant medications are being used for the long-term management of cardiac, cerebrovascular, and peripheral vascular conditions. Management of these medications in the perioperative and peri-injury settings can be challenging for surgeons, mandating an understanding of these agents and the risks and benefits of various management strategies. In this two-part review, agents commonly encounter by surgeons in the perioperative and peri-injury settings are discussed and management strategies for patients on long-term antiplatelet and anticoagulant therapy reviewed. In part I, we review warfarin and the new direct oral anticoagulants. In part II, we review antiplatelet agents and assessment of platelet function and the perioperative management of long-term anticoagulant and antiplatelet therapy. PMID:29767647

Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association

PubMed Central

Florez, Hermes; Huang, Elbert S.; Kalyani, Rita R.; Mupanomunda, Maria; Pandya, Naushira; Swift, Carrie S.; Taveira, Tracey H.; Haas, Linda B.

2016-01-01

Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tailored based on comorbidities, delineates key issues to consider when using glucose-lowering agents in this population, and provides recommendations on how to replace SSI in LTC facilities. As these patients transition from one setting to another, or from one provider to another, their risk for adverse events increases. Strategies are presented to reduce these risks and ensure safe transitions. This article addresses diabetes management at end of life and in those receiving palliative and hospice care. The integration of diabetes management into LTC facilities is important and requires an interprofessional team approach. To facilitate this approach, acceptance by administrative personnel is needed, as are protocols and possibly system changes. It is important for clinicians to understand the characteristics, challenges, and barriers related to the older population living in LTC facilities as well as the proper functioning of the facilities themselves. Once these challenges are identified, individualized approaches can be designed to improve diabetes management while lowering the risk of hypoglycemia and ultimately improving quality of life. PMID:26798150

The Climate-Agriculture-Modeling and Decision Tool (CAMDT) for Climate Risk Management in Agriculture

NASA Astrophysics Data System (ADS)

Ines, A. V. M.; Han, E.; Baethgen, W.

2017-12-01

Advances in seasonal climate forecasts (SCFs) during the past decades have brought great potential to improve agricultural climate risk managements associated with inter-annual climate variability. In spite of popular uses of crop simulation models in addressing climate risk problems, the models cannot readily take seasonal climate predictions issued in the format of tercile probabilities of most likely rainfall categories (i.e, below-, near- and above-normal). When a skillful SCF is linked with the crop simulation models, the informative climate information can be further translated into actionable agronomic terms and thus better support strategic and tactical decisions. In other words, crop modeling connected with a given SCF allows to simulate "what-if" scenarios with different crop choices or management practices and better inform the decision makers. In this paper, we present a decision support tool, called CAMDT (Climate Agriculture Modeling and Decision Tool), which seamlessly integrates probabilistic SCFs to DSSAT-CSM-Rice model to guide decision-makers in adopting appropriate crop and agricultural water management practices for given climatic conditions. The CAMDT has a functionality to disaggregate a probabilistic SCF into daily weather realizations (either a parametric or non-parametric disaggregation method) and to run DSSAT-CSM-Rice with the disaggregated weather realizations. The convenient graphical user-interface allows easy implementation of several "what-if" scenarios for non-technical users and visualize the results of the scenario runs. In addition, the CAMDT also translates crop model outputs to economic terms once the user provides expected crop price and cost. The CAMDT is a practical tool for real-world applications, specifically for agricultural climate risk management in the Bicol region, Philippines, having a great flexibility for being adapted to other crops or regions in the world. CAMDT GitHub: https://github.com/Agro-Climate/CAMDT

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

USGS Publications Warehouse

Linder, G.; Little, E.E.

2009-01-01

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

Organ dysfunction, injury and failure in acute heart failure: from pathophysiology to diagnosis and management. A review on behalf of the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC).

PubMed

Harjola, Veli-Pekka; Mullens, Wilfried; Banaszewski, Marek; Bauersachs, Johann; Brunner-La Rocca, Hans-Peter; Chioncel, Ovidiu; Collins, Sean P; Doehner, Wolfram; Filippatos, Gerasimos S; Flammer, Andreas J; Fuhrmann, Valentin; Lainscak, Mitja; Lassus, Johan; Legrand, Matthieu; Masip, Josep; Mueller, Christian; Papp, Zoltán; Parissis, John; Platz, Elke; Rudiger, Alain; Ruschitzka, Frank; Schäfer, Andreas; Seferovic, Petar M; Skouri, Hadi; Yilmaz, Mehmet Birhan; Mebazaa, Alexandre

2017-07-01

Organ injury and impairment are commonly observed in patients with acute heart failure (AHF), and congestion is an essential pathophysiological mechanism of impaired organ function. Congestion is the predominant clinical profile in most patients with AHF; a smaller proportion presents with peripheral hypoperfusion or cardiogenic shock. Hypoperfusion further deteriorates organ function. The injury and dysfunction of target organs (i.e. heart, lungs, kidneys, liver, intestine, brain) in the setting of AHF are associated with increased risk for mortality. Improvement in organ function after decongestive therapies has been associated with a lower risk for post-discharge mortality. Thus, the prevention and correction of organ dysfunction represent a therapeutic target of interest in AHF and should be evaluated in clinical trials. Treatment strategies that specifically prevent, reduce or reverse organ dysfunction remain to be identified and evaluated to determine if such interventions impact mortality, morbidity and patient-centred outcomes. This paper reflects current understanding among experts of the presentation and management of organ impairment in AHF and suggests priorities for future research to advance the field. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

Prognostic implications of serial risk score assessments in patients with pulmonary arterial hypertension: a Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) analysis.

PubMed

Benza, Raymond L; Miller, Dave P; Foreman, Aimee J; Frost, Adaani E; Badesch, David B; Benton, Wade W; McGoon, Michael D

2015-03-01

Data from the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) were used previously to develop a risk score calculator to predict 1-year survival. We evaluated prognostic implications of changes in the risk score and individual risk-score parameters over 12 months. Patients were grouped by decreased, unchanged, or increased risk score from enrollment to 12 months. Kaplan-Meier estimates of subsequent 1-year survival were made based on change in the risk score during the initial 12 months of follow-up. Cox regression was used for multivariable analysis. Of 2,529 patients in the analysis cohort, the risk score was decreased in 800, unchanged in 959, and increased in 770 at 12 months post-enrollment. Six parameters (functional class, systolic blood pressure, heart rate, 6-minute walk distance, brain natriuretic peptide levels, and pericardial effusion) each changed sufficiently over time to improve or worsen risk scores in ≥5% of patients. One-year survival estimates in the subsequent year were 93.7%, 90.3%, and 84.6% in patients with a decreased, unchanged, and increased risk score at 12 months, respectively. Change in risk score significantly predicted future survival, adjusting for risk at enrollment. Considering follow-up risk concurrently with risk at enrollment, follow-up risk was a much stronger predictor, although risk at enrollment maintained a significant effect on future survival. Changes in REVEAL risk scores occur in most patients with pulmonary arterial hypertension over a 12-month period and are predictive of survival. Thus, serial risk score assessments can identify changes in disease trajectory that may warrant treatment modifications. Copyright © 2015 International Society for Heart and Lung Transplantation. All rights reserved.

Nematode Damage Functions: The Problems of Experimental and Sampling Error

PubMed Central

Ferris, H.

1984-01-01

The development and use of pest damage functions involves measurement and experimental errors associated with cultural, environmental, and distributional factors. Damage predictions are more valuable if considered with associated probability. Collapsing population densities into a geometric series of population classes allows a pseudo-replication removal of experimental and sampling error in damage function development. Recognition of the nature of sampling error for aggregated populations allows assessment of probability associated with the population estimate. The product of the probabilities incorporated in the damage function and in the population estimate provides a basis for risk analysis of the yield loss prediction and the ensuing management decision. PMID:19295865

"Staying safe" - a narrative review of falls prevention in people with Parkinson's - "PDSAFE".

PubMed

Hulbert, Sophia; Rochester, Lynn; Nieuwboer, Alice; Goodwin, Vicki; Fitton, Carolyn; Chivers-Seymour, Kim; Ashburn, Ann

2018-05-18

Parkinson's disease demonstrates a spectrum of motor and non-motor symptoms. Falling is common and disabling. Current medical management shows minimal impact to reduce falls or fall-related risk factors, such as deficits in gait, strength, and postural instability. Despite evidence supporting rehabilitation in reducing fall risk factors, the most appropriate intervention to reduce overall fall rate remains inconclusive. This article aims to 1) synthesise current evidence and conceptual models of falls rehabilitation in Parkinson's in a narrative review; and based on this evidence, 2) introduce the treatment protocol used in the falls prevention and multi-centre clinical trial "PDSAFE". Search of four bibliographic databases using the terms "Parkinson*" and "Fall*" combined with each of the following; "Rehab*, Balanc*, Strength*, Strateg*and Exercis*" and a framework for narrative review was followed. A total of 3557 papers were identified, 416 were selected for review. The majority report the impact of rehabilitation on isolated fall risk factors. Twelve directly measure the impact on overall fall rate. Results were used to construct a narrative review with conceptual discussion based on the "International Classification of Functioning", leading to presentation of the "PDSAFE" intervention protocol. Evidence suggests training single, fall risk factors may not affect overall fall rate. Combining with behavioural and strategy training in a functional, personalised multi-dimensional model, addressing all components of the "International Classification of Functioning" is likely to provide a greater influence on falls reduction. "PDSAFE" is a multi-dimensional, physiotherapist delivered, individually tailored, progressive, home-based programme. It is designed with a strong evidence-based approach and illustrates a model for the clinical delivery of the conceptual theory discussed. Implications for Rehabilitation Parkinson's disease demonstrates a spectrum of motor and non-motor symptoms, where falling is common and disabling. Current medical and surgical management have minimal impact on falls, rehabilitation of falls risk factors has strong evidence but the most appropriate intervention to reduce overall fall rate remains inconclusive. Addressing all components of the International Classification of Function in a multifactorial model when designing falls rehabilitation interventions may be more effective at reducing fall rates in people with Parkinson's than treating isolated risk factors. The clinical model for falls rehabilitation in people with Parkinson's should be multi-dimensional.

Antidepressant use and functional limitations in U.S. older adults.

PubMed

An, Ruopeng; Lu, Lingyun

2016-01-01

The upsurge in prevalence and long-term use of antidepressants among older adults might have profound health implications beyond depressive symptom management. This study examined the relationship between antidepressant use and functional limitation onset in U.S. older adults. Study sample came from 2006 and 2008 waves of the Health and Retirement Study, in combination with data from 2005 and 2007 Prescription Drug Study. Self-reported antidepressant use was identified based on the therapeutic classification of Cerner Multum's Lexicon. Functional limitations were classified into those pertaining to physical mobility, large muscle function, activities of daily living, gross motor function, fine motor function, and instrumental activities of daily living. Cox proportional hazard models were performed to assess the effects of antidepressant use on future functional limitation onset by limitation category, antidepressant type, and length of use, adjusted by depression status and other individual characteristics. Antidepressant use for one year and longer was associated with an increase in the risk of functional limitation by 8% (95% confidence interval=4%-12%), whereas the relationship between antidepressant use less than a year and function limitation was statistically nonsignificant. Antidepressant use was associated with an increase in the risk of functional limitation by 8% (3%-13%) among currently nondepressed participants but not currently depressed participants. Long-term antidepressant use in older adults should be prudently evaluated and regularly monitored to reduce the risk of functional limitation. Future research is warranted to examine the health consequences of extended and/or off-label antidepressant use in absence of depressive symptoms. Copyright © 2015 Elsevier Inc. All rights reserved.

12 CFR 917.3 - Risk management.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 8 2012-01-01 2012-01-01 false Risk management. 917.3 Section 917.3 Banks and Banking FEDERAL HOUSING FINANCE BOARD GOVERNANCE AND MANAGEMENT OF THE FEDERAL HOME LOAN BANKS POWERS AND RESPONSIBILITIES OF BANK BOARDS OF DIRECTORS AND SENIOR MANAGEMENT § 917.3 Risk management. (a) Risk management...

12 CFR 917.3 - Risk management.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 8 2013-01-01 2013-01-01 false Risk management. 917.3 Section 917.3 Banks and Banking FEDERAL HOUSING FINANCE BOARD GOVERNANCE AND MANAGEMENT OF THE FEDERAL HOME LOAN BANKS POWERS AND RESPONSIBILITIES OF BANK BOARDS OF DIRECTORS AND SENIOR MANAGEMENT § 917.3 Risk management. (a) Risk management...

12 CFR 917.3 - Risk management.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Risk management. 917.3 Section 917.3 Banks and Banking FEDERAL HOUSING FINANCE BOARD GOVERNANCE AND MANAGEMENT OF THE FEDERAL HOME LOAN BANKS POWERS AND RESPONSIBILITIES OF BANK BOARDS OF DIRECTORS AND SENIOR MANAGEMENT § 917.3 Risk management. (a) Risk management...

12 CFR 917.3 - Risk management.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Risk management. 917.3 Section 917.3 Banks and Banking FEDERAL HOUSING FINANCE BOARD GOVERNANCE AND MANAGEMENT OF THE FEDERAL HOME LOAN BANKS POWERS AND RESPONSIBILITIES OF BANK BOARDS OF DIRECTORS AND SENIOR MANAGEMENT § 917.3 Risk management. (a) Risk management...

Ecological and socio-cultural factors influencing plant management in Náhuatl communities of the Tehuacán Valley, Mexico.

PubMed

Blancas, José; Casas, Alejandro; Pérez-Salicrup, Diego; Caballero, Javier; Vega, Ernesto

2013-06-02

Management types and their intensity may vary according to indicators such as: (1) practices complexity, (2) degree of techniques specialization, (3) occurrence and types of social regulations, (4) artificial selection intensity, (5) energy invested, (6) tools types, and (7) amounts of resources obtained. Management types of edible plants were characterized and analyzed in Náhuatl communities of the Tehuacán Valley. We expected that both natural and human pressures generate risk on plant resources availability, influencing human responses of management directed to decrease risk. We particularly hypothesized that magnitude of risk would be a direct function of human pressures favored by cultural and economic value and ecological factors such as scarcity (restricted distribution and abundance). Management practices may decrease risk of plant resources, more effectively when they are more intense; however, absence or insufficiency of management practices on endangered plants may favor loss of their populations. Understanding current management motives and their consequences on the purpose of ensuring availability of plant resources might allow us to understand similar processes occurring in the past. This issue is particularly important to be studied in the Tehuacán Valley, where archaeologists documented possible scenarios motivating origins of plant management by agriculture during prehistory. Through ethnobotanical collecting, 55 semi-structured and free listing interviews we inventoried edible plant species used in five villages of Coyomeapan, Mexico. We identified: (1) native plant species whose products are obtained exclusively through simple gathering, (2) native species involving simple gathering and other management types, and (3) non-native species managed by agricultural management. We conducted in depth studies on the 33 native species managed through gathering and other types of practices. We carried out a total of 660 sessions of detailed interviews to 20 households randomly selected. We showed to people voucher specimens and photos of the sample of species chosen and documented their cultural and economic values. Spatial availability of these plant species was evaluated through vegetation sampling. Values for each cultural, economic, and ecological indicator were codified and averaged or summed and weighed according to frequency of interviewees' responses or ecological conditions per plant species. With the standardized values of these indicators we performed a PCA and scores of the first principal component were considered as a risk index, which summarizes information of thirteen indicators of human use, demand and scarcity of each plant species. Similarly, eleven indicators of energy invested, complexity, tools and management strategies were used for performing PCA and scores of the first principal component were considered as management intensity index for each plant species. A linear regression analysis was performed to analyze the relation between risk and management intensity indexes. Amounts of variation of management data explained by ecological, cultural and economic information, as well as their risk level were analyzed through canonical correspondence analyses (CCA). A total of 122 edible plant species were recorded, nearly 30% of them were introduced domesticated plants, 51 were wild species obtained exclusively by simple gathering and 33 were native species obtained by simple gathering and other management practices, these latter were the ones more deeply studied. People recognized variants in 21 of these latter 33 species, the variants receiving differential use, management, artificial selection and incipient domestication. The lowest values of management intensity corresponded to species under simple gathering and tolerance, mostly annual abundant plants, occasionally consumed by few people. The highest management intensity values were recorded in species with economic importance, mostly perennial with recognized variants whose management requires using tools, and which are protected by collective regulations. The regression analysis indicated significant value R² = 0.433 (P < 0.001) between risk and management indexes. CCA explained 65.5% of variation of management intensity, mainly by socio-cultural factors (32.6%), whereas ecological data explained 21.3% and the intersection of all factors 11.6%. Variation of management intensity is 67.6% explained by risk variables. Length-span of life cycle, reproductive system type, distribution, number of parts used, number of management and use forms and type of regulations were statistically significant. People manage plant resources according to the role these play in households' subsistence, the quantity available and the quality of their useful products; particularly important is the balance between resources availability and demand. Management responses to risk are also influenced by the ease to propagate or manipulate individual plants and time requiring the construction of manipulation strategies and techniques.

Ecological and socio-cultural factors influencing plant management in Náhuatl communities of the Tehuacán Valley, Mexico

PubMed Central

2013-01-01

Background Management types and their intensity may vary according to indicators such as: (1) practices complexity, (2) degree of techniques specialization, (3) occurrence and types of social regulations, (4) artificial selection intensity, (5) energy invested, (6) tools types, and (7) amounts of resources obtained. Management types of edible plants were characterized and analyzed in Náhuatl communities of the Tehuacán Valley. We expected that both natural and human pressures generate risk on plant resources availability, influencing human responses of management directed to decrease risk. We particularly hypothesized that magnitude of risk would be a direct function of human pressures favored by cultural and economic value and ecological factors such as scarcity (restricted distribution and abundance). Management practices may decrease risk of plant resources, more effectively when they are more intense; however, absence or insufficiency of management practices on endangered plants may favor loss of their populations. Understanding current management motives and their consequences on the purpose of ensuring availability of plant resources might allow us to understand similar processes occurring in the past. This issue is particularly important to be studied in the Tehuacán Valley, where archaeologists documented possible scenarios motivating origins of plant management by agriculture during prehistory. Methods Through ethnobotanical collecting, 55 semi-structured and free listing interviews we inventoried edible plant species used in five villages of Coyomeapan, Mexico. We identified: (1) native plant species whose products are obtained exclusively through simple gathering, (2) native species involving simple gathering and other management types, and (3) non-native species managed by agricultural management. We conducted in depth studies on the 33 native species managed through gathering and other types of practices. We carried out a total of 660 sessions of detailed interviews to 20 households randomly selected. We showed to people voucher specimens and photos of the sample of species chosen and documented their cultural and economic values. Spatial availability of these plant species was evaluated through vegetation sampling. Values for each cultural, economic, and ecological indicator were codified and averaged or summed and weighed according to frequency of interviewees’ responses or ecological conditions per plant species. With the standardized values of these indicators we performed a PCA and scores of the first principal component were considered as a risk index, which summarizes information of thirteen indicators of human use, demand and scarcity of each plant species. Similarly, eleven indicators of energy invested, complexity, tools and management strategies were used for performing PCA and scores of the first principal component were considered as management intensity index for each plant species. A linear regression analysis was performed to analyze the relation between risk and management intensity indexes. Amounts of variation of management data explained by ecological, cultural and economic information, as well as their risk level were analyzed through canonical correspondence analyses (CCA). Results A total of 122 edible plant species were recorded, nearly 30% of them were introduced domesticated plants, 51 were wild species obtained exclusively by simple gathering and 33 were native species obtained by simple gathering and other management practices, these latter were the ones more deeply studied. People recognized variants in 21 of these latter 33 species, the variants receiving differential use, management, artificial selection and incipient domestication. The lowest values of management intensity corresponded to species under simple gathering and tolerance, mostly annual abundant plants, occasionally consumed by few people. The highest management intensity values were recorded in species with economic importance, mostly perennial with recognized variants whose management requires using tools, and which are protected by collective regulations. The regression analysis indicated significant value R2 = 0.433 (P < 0.001) between risk and management indexes. CCA explained 65.5% of variation of management intensity, mainly by socio-cultural factors (32.6%), whereas ecological data explained 21.3% and the intersection of all factors 11.6%. Variation of management intensity is 67.6% explained by risk variables. Length-span of life cycle, reproductive system type, distribution, number of parts used, number of management and use forms and type of regulations were statistically significant. Conclusion People manage plant resources according to the role these play in households’ subsistence, the quantity available and the quality of their useful products; particularly important is the balance between resources availability and demand. Management responses to risk are also influenced by the ease to propagate or manipulate individual plants and time requiring the construction of manipulation strategies and techniques. PMID:23725379

Developing a ubiquitous health management system with healthy diet control for metabolic syndrome healthcare in Taiwan.

PubMed

Kan, Yao-Chiang; Chen, Kai-Hong; Lin, Hsueh-Chun

2017-06-01

Self-management in healthcare can allow patients managing their health data anytime and everywhere for prevention of chronic diseases. This study established a prototype of ubiquitous health management system (UHMS) with healthy diet control (HDC) for people who need services of metabolic syndrome healthcare in Taiwan. System infrastructure comprises of three portals and a database tier with mutually supportive components to achieve functionality of diet diaries, nutrition guides, and health risk assessments for self-health management. With the diet, nutrition, and personal health database, the design enables the analytical diagrams on the interactive interface to support a mobile application for diet diary, a Web-based platform for health management, and the modules of research and development for medical care. For database integrity, dietary data can be stored at offline mode prior to transformation between mobile device and server site at online mode. The UHMS-HDC was developed by open source technology for ubiquitous health management with personalized dietary criteria. The system integrates mobile, internet, and electronic healthcare services with the diet diary functions to manage healthy diet behaviors of users. The virtual patients were involved to simulate the self-health management procedure. The assessment functions were approved by capturing the screen snapshots in the procedure. The proposed system development was capable for practical intervention. This approach details the expandable framework with collaborative components regarding the self-developed UHMS-HDC. The multi-disciplinary applications for self-health management can support the healthcare professionals to reduce medical resources and improve healthcare effects for the patient who requires monitoring personal health condition with diet control. The proposed system can be practiced for intervention in the hospital. Copyright © 2017 Elsevier B.V. All rights reserved.

Risk Management in EVA

NASA Technical Reports Server (NTRS)

Hall, Jonathan; Lutomski, M.

2006-01-01

This viewgraph presentation reviews the use of risk management in Extravehicular Activities (EVA). The contents include: 1) EVA Office at NASA - JSC; 2) EVA Project Risk Management: Why and When; 3) EVA Office Risk Management: How; 4) Criteria for Closing a Risk; 5) Criteria for Accepting a Risk; 6) ISS IRMA Reference Card Data Entry Requirement s; 7) XA/ EVA Office Risk Activity Summary; 8) EVA Significant Change Summary; 9) Integrated Risk Management Application (XA) Matrix, March 31, 2004; 10) ISS Watch Item: 50XX Summary Report; and 11) EVA Project RM Usefulness

Managing Fault Management Development

NASA Technical Reports Server (NTRS)

McDougal, John M.

2010-01-01

As the complexity of space missions grows, development of Fault Management (FM) capabilities is an increasingly common driver for significant cost overruns late in the development cycle. FM issues and the resulting cost overruns are rarely caused by a lack of technology, but rather by a lack of planning and emphasis by project management. A recent NASA FM Workshop brought together FM practitioners from a broad spectrum of institutions, mission types, and functional roles to identify the drivers underlying FM overruns and recommend solutions. They identified a number of areas in which increased program and project management focus can be used to control FM development cost growth. These include up-front planning for FM as a distinct engineering discipline; managing different, conflicting, and changing institutional goals and risk postures; ensuring the necessary resources for a disciplined, coordinated approach to end-to-end fault management engineering; and monitoring FM coordination across all mission systems.

An Evidence-Based Review Literature About Risk Indicators and Management of Unknown-Origin Xerostomia

PubMed Central

Agha-Hosseini, Farzaneh; Moosavi, Mahdieh-Sadat

2013-01-01

This evidence-based article reviews risk indicators and management of unknown-origin xerostomia. Xerostomia and hyposalivation refer to different aspects of dry mouth. Xerostomia is a subjective sensation of dry mouth, whilst hyposalivation is defined as an objective assessment of reduced salivary flow rate. About 30% of the elderly (65 years and older) experience xerostomia and hyposalivation. Structural and functional factors, or both may lead to salivary gland dysfunction. The EBM literature search was conducted by using the medical literature database MEDLINE via PubMed and OvidMedline search engines. Results were limited to English language articles (1965 to present) including clinical trials (CT), randomized controlled trials (RCT), systematic reviews and review articles. Case control or cohort studies were included for the etiology. Neuropathic etiology such as localized oral alteration of thermal sensations, saliva composition change (for example higher levels of K, Cl, Ca, IgA, amylase, calcium, PTH and cortisol), lower levels of estrogen and progesterone, smaller salivary gland size, and illnesses such as lichen planus, are risk indicators for unknown-origin xerostomia. The management is palliative and preventative. Management of symptoms includes drug administration (systemic secretogogues, saliva substitutes and bile secretion-stimulator), night guard, diet and habit modifications. Other managements may be indicated to treat adverse effects. Neuropathic etiology, saliva composition change, smaller salivary gland size, and illnesses such as oral lichen planus can be suggestive causes for unknown-origin xerostomia. However, longitudinal studies will be important to elucidate the causes of unknown-origin xerostomia. PMID:25512755

Extinction vulnerability of coral reef fishes.

PubMed

Graham, Nicholas A J; Chabanet, Pascale; Evans, Richard D; Jennings, Simon; Letourneur, Yves; Aaron Macneil, M; McClanahan, Tim R; Ohman, Marcus C; Polunin, Nicholas V C; Wilson, Shaun K

2011-04-01

With rapidly increasing rates of contemporary extinction, predicting extinction vulnerability and identifying how multiple stressors drive non-random species loss have become key challenges in ecology. These assessments are crucial for avoiding the loss of key functional groups that sustain ecosystem processes and services. We developed a novel predictive framework of species extinction vulnerability and applied it to coral reef fishes. Although relatively few coral reef fishes are at risk of global extinction from climate disturbances, a negative convex relationship between fish species locally vulnerable to climate change vs. fisheries exploitation indicates that the entire community is vulnerable on the many reefs where both stressors co-occur. Fishes involved in maintaining key ecosystem functions are more at risk from fishing than climate disturbances. This finding is encouraging as local and regional commitment to fisheries management action can maintain reef ecosystem functions pending progress towards the more complex global problem of stabilizing the climate. © 2011 Blackwell Publishing Ltd/CNRS.

Extinction vulnerability of coral reef fishes

PubMed Central

Graham, Nicholas A J; Chabanet, Pascale; Evans, Richard D; Jennings, Simon; Letourneur, Yves; Aaron MacNeil, M; McClanahan, Tim R; Öhman, Marcus C; Polunin, Nicholas V C; Wilson, Shaun K

2011-01-01

With rapidly increasing rates of contemporary extinction, predicting extinction vulnerability and identifying how multiple stressors drive non-random species loss have become key challenges in ecology. These assessments are crucial for avoiding the loss of key functional groups that sustain ecosystem processes and services. We developed a novel predictive framework of species extinction vulnerability and applied it to coral reef fishes. Although relatively few coral reef fishes are at risk of global extinction from climate disturbances, a negative convex relationship between fish species locally vulnerable to climate change vs. fisheries exploitation indicates that the entire community is vulnerable on the many reefs where both stressors co-occur. Fishes involved in maintaining key ecosystem functions are more at risk from fishing than climate disturbances. This finding is encouraging as local and regional commitment to fisheries management action can maintain reef ecosystem functions pending progress towards the more complex global problem of stabilizing the climate. PMID:21320260

Update on the Management of Thyroid Disease during Pregnancy.

PubMed

Yim, Chang Hoon

2016-09-01

Thyroid dysfunction during pregnancy can result in serious complications for both the mother and infant; however, these complications can be prevented by optimal treatment of maternal overt thyroid dysfunction. Although several studies have demonstrated that maternal subclinical hypothyroidism is associated with obstetric complications and neurocognitive impairments in offspring, there is limited evidence that levothyroxine treatment can improve these complications. Therefore, most professional societies do not recommend universal screening for thyroid dysfunction during pregnancy, and instead recommend a case-finding approach in which only high-risk women are tested. However, recent studies have estimated that targeted thyroid function testing misses approximately 30% to 55% of hypothyroidism cases in pregnant women, and some associations and researchers have recommended universal screening of pregnant women to facilitate the early detection and treatment of overt hypothyroidism. This review summarizes recent data on thyroid function test changes, thyroid functional disorder management, and thyroid screening during pregnancy.

Developing a Comprehensive Approach Could Help DOD Better Manage National Security Risks in the Supply Chain

DTIC Science & Technology

2016-02-01

functionality in weapon system components. Many steps in the rare earths supply chain, such as mining , are conducted in China, a situation that may pose...functionality in weapon systems components.1 Many steps in the rare earths supply chain, such as mining and refining the ore, are primarily conducted outside...are difficult and costly to mine and process. Rare earth elements are Page 5 GAO-16-161 Rare Earth Materials often classified as either

Managing health and safety risks: Implications for tailoring health and safety management system practices.

PubMed

Willmer, D R; Haas, E J

2016-01-01

As national and international health and safety management system (HSMS) standards are voluntarily accepted or regulated into practice, organizations are making an effort to modify and integrate strategic elements of a connected management system into their daily risk management practices. In high-risk industries such as mining, that effort takes on added importance. The mining industry has long recognized the importance of a more integrated approach to recognizing and responding to site-specific risks, encouraging the adoption of a risk-based management framework. Recently, the U.S. National Mining Association led the development of an industry-specific HSMS built on the strategic frameworks of ANSI: Z10, OHSAS 18001, The American Chemistry Council's Responsible Care, and ILO-OSH 2001. All of these standards provide strategic guidance and focus on how to incorporate a plan-do-check-act cycle into the identification, management and evaluation of worksite risks. This paper details an exploratory study into whether practices associated with executing a risk-based management framework are visible through the actions of an organization's site-level management of health and safety risks. The results of this study show ways that site-level leaders manage day-to-day risk at their operations that can be characterized according to practices associated with a risk-based management framework. Having tangible operational examples of day-to-day risk management can serve as a starting point for evaluating field-level risk assessment efforts and their alignment to overall company efforts at effective risk mitigation through a HSMS or other processes.

Premium variation in the individual health insurance market.

PubMed

Herring, B; Pauly, M V

2001-03-01

Recent proposals to decrease the number of uninsured in the U.S. indicate that the individual health insurance market's role may increase. Amid fears of possible risk-segmentation in individual insurance, there exists limited information of the functioning of such markets. This paper examines the relationship between expected medical expense and actual paid premiums for households with individual insurance in the 1996-1997 Community Tracking Study's Household Survey. We find that premiums vary less than proportionately with expected expense and vary only with certain risk characteristics. We also explore how the relationship between risk and premiums is affected by local regulations and market characteristics. We find that premiums vary significantly less strongly with risk for persons insured by HMOs and in markets dominated by managed care insurers.

Risk management frameworks for human health and environmental risks.

PubMed

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

2003-01-01

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

[Global risk management].

PubMed

Sghaier, W; Hergon, E; Desroches, A

2015-08-01

Risk management is a fundamental component of any successful company, whether it is in economic, societal or environmental aspect. Risk management is an especially important activity for companies that optimal security challenge of products and services is great. This is the case especially for the health sector institutions. Risk management is therefore a decision support tool and a means to ensure the sustainability of an organization. In this context, what methods and approaches implemented to manage the risks? Through this state of the art, we are interested in the concept of risk and risk management processes. Then we focus on the different methods of risk management and the criteria for choosing among these methods. Finally we highlight the need to supplement these methods by a systemic and global approach including through risk assessment by the audits. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

12 CFR 615.5182 - Interest rate risk management by associations and other Farm Credit System institutions other...

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 6 2011-01-01 2011-01-01 false Interest rate risk management by associations... OPERATIONS, AND FUNDING OPERATIONS Risk Assessment and Management § 615.5182 Interest rate risk management by... shall comply with the requirements of §§ 615.5180 and 615.5181. The interest rate risk management...

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

Treesearch

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

2013-01-01

Federal policy has embraced risk management as an appropriate paradigm for wildfire management. Economic theory suggests that over repeated wildfire events, potential economic costs and risks of ecological damage are optimally balanced when management decisions are free from biases, risk aversion, and risk seeking. Of primary concern in this article is how managers...

12 CFR 615.5182 - Interest rate risk management by associations and other Farm Credit System institutions other...

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Interest rate risk management by associations... OPERATIONS, AND FUNDING OPERATIONS Risk Assessment and Management § 615.5182 Interest rate risk management by... shall comply with the requirements of §§ 615.5180 and 615.5181. The interest rate risk management...

The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease

PubMed Central

Nehra, Ajay; Jackson, Graham; Miner, Martin; Billups, Kevin L.; Burnett, Arthur L.; Buvat, Jacques; Carson, Culley C.; Cunningham, Glenn R.; Ganz, Peter; Goldstein, Irwin; Guay, Andre T.; Hackett, Geoff; Kloner, Robert A.; Kostis, John; Montorsi, Piero; Ramsey, Melinda; Rosen, Raymond; Sadovsky, Richard; Seftel, Allen D.; Shabsigh, Ridwan; Vlachopoulos, Charalambos; Wu, Frederick C.W.

2012-01-01

The Princeton Consensus (Expert Panel) Conference is a multispecialty collaborative tradition dedicated to optimizing sexual function and preserving cardiovascular health. The third Princeton Consensus met November 8 to 10, 2010, and had 2 primary objectives. The first objective focused on the evaluation and management of cardiovascular risk in men with erectile dysfunction (ED) and no known cardiovascular disease (CVD), with particular emphasis on identification of men with ED who may require additional cardiologic work-up. The second objective focused on reevaluation and modification of previous recommendations for evaluation of cardiac risk associated with sexual activity in men with known CVD. The Panel's recommendations build on those developed during the first and second Princeton Consensus Conferences, first emphasizing the use of exercise ability and stress testing to ensure that each man's cardiovascular health is consistent with the physical demands of sexual activity before prescribing treatment for ED, and second highlighting the link between ED and CVD, which may be asymptomatic and may benefit from cardiovascular risk reduction. PMID:22862865

The relationship of illness management and recovery to state hospital readmission.

PubMed

Bartholomew, Tom; Zechner, Michelle

2014-09-01

The current study examined the association between number of hours attended of the Illness Management and Recovery (IMR) program and psychiatric readmission rates after discharge from a state psychiatric hospital. The study used archival data, N = 1186, from a large northeastern state psychiatric hospital in the United States. A Cox's regression survival analyses was conducted, adjusting for extreme outliers and controlling for sociodemographic covariates, to examine the association between different amounts of IMR and the risk for returning to the hospital. After controlling for the client characteristics of age, sex, marital status, psychiatric diagnosis, and Global Assessment of Functioning score at discharge, as well as controlling for mean daily dose of generic hospital programming and the number of days of hospitalization, it was found that, for each hour of IMR, there was an associated 1.1% reduction in the risk for returning to the hospital. This suggests that participation in IMR while in inpatient settings may assist individuals in reducing their risk for returning to the hospital.

[Alcohol and work: the role of the company physician in the occupational health and safety management systems].

PubMed

Patussi, V; Muran, A

2010-01-01

The organization of safety in the working places and the increasing attention to behaviours and life styles of workers that may lead to increasing occupational risks are the pick innovative aspects of the recent changes in our country's legislation about occupational safety. In this organization, the role of the company physician is becoming more and more important and his work of evaluation beginning with the knowledge both of the working places and of the workers's lifestyles, is irreplaceable. His role in organizing the managing standards of occupational safety and health cannot be limited to health supervision but must be an essential element in risk assessment in the prevision of workplaces and of safe working conditions, in workers training and information, in organizing the control system of each business. The present paper examines--referring to the current regulation--the duties and functions of a company physician when facing the problems concerning the working risks tied to alcohol assumption.

NASA's Approach to Software Assurance

NASA Technical Reports Server (NTRS)

Wetherholt, Martha

2015-01-01

NASA defines software assurance as: the planned and systematic set of activities that ensure conformance of software life cycle processes and products to requirements, standards, and procedures via quality, safety, reliability, and independent verification and validation. NASA's implementation of this approach to the quality, safety, reliability, security and verification and validation of software is brought together in one discipline, software assurance. Organizationally, NASA has software assurance at each NASA center, a Software Assurance Manager at NASA Headquarters, a Software Assurance Technical Fellow (currently the same person as the SA Manager), and an Independent Verification and Validation Organization with its own facility. An umbrella risk mitigation strategy for safety and mission success assurance of NASA's software, software assurance covers a wide area and is better structured to address the dynamic changes in how software is developed, used, and managed, as well as it's increasingly complex functionality. Being flexible, risk based, and prepared for challenges in software at NASA is essential, especially as much of our software is unique for each mission.

Alternative Perspectives on Risk

NASA Technical Reports Server (NTRS)

Davison, Jeannie; Orasanu, J.; Connors, Mary M. (Technical Monitor)

1997-01-01

The goal of the commercial air transport system is to provide air transportation to the flying public at an acceptable cost with minimal risk. in an ideal situation these three goals would support each other. In fact, it is sometimes the case that the goals conflict: getting passengers to their destinations on time may conflict with fixing a minor mechanical malfunction that may or may not impact safety; flying a route that will avoid turbulence, thereby providing passengers with a more comfortable ride, may consume more fuel; managing traffic density may mean aircraft are delayed or must use an approach that will result in a long taxi to their gates, costing time and fuel. Various players in the system--pilots, dispatchers, controllers, as well as managers in the airline carriers and traffic management system--make decisions every day that involve trade-offs of benefits and costs. The prospect of revisions in the air traffic management system, with shifts in responsibilities from controllers to users, including airline operations center personnel and pilots, means that individuals may be performing either new jobs or old jobs under new guidance. It will be essential to know how the various players (a) perceive the risks and benefits associated with the decisions they will make under the old and new control structures, and (b) how much risk they are willing to accept in making decisions. Risk is here defined as the probability and magnitude of negative events (after Slovic, 1987). Of primary interest are risks associated with traffic, weather, and operational factors such as schedule, fuel consumption, and passenger service. Previous research has documented differences between groups in perceptions of risks associated with both everyday and aviation related situations. Risk perception varies as a function of familiarity with the situation, degree to which one is potentially affected by the risk, the level of control one has over the situation, and one's level of experience and responsibility in the situation. In our presentation we will consider several factors that may influence differences in risk perception, risk tolerance and risk management among the three major categories of participants in the aviation system (pilots, dispatchers, and controllers). Primary factors that may affect risk attitudes (the collective term we will use for the three components of risk) include: expertise or job-specific knowledge or training, personal involvement or vulnerability to consequences, goals, time horizon (imminence of consequences), span of control and type of control, and information or technology support. These will be considered in the context of five different types of risk (physical threat, economic, social, legal, and ethical). A study designed to study differences between pilots and controllers in their perceptions and responses to traffic risks under the present and a user-preferred control situation will be described. Future studies involving dispatchers' risk perceptions regarding various types of risk will be discussed.

Latest developments in peri-operative monitoring of the high-risk major surgery patient.

PubMed

Green, David; Paklet, Lise

2010-01-01

Peri-operative monitoring technology has made great strides in the last 20 years with the introduction of minimally invasive devices to measure inter alia stroke volume, cardiac output, depth of anaesthesia and cerebral and tissue oxygen monitoring. Despite these technological advances, peri-operative management of the high risk major surgery patient has remained virtually unchanged. The vast majority of patients undergo a pre-operative assessment which is neither designed to quantify functional capacity nor predict outcome. Anaesthetists then usually monitor these patients using the same technology (e.g. pulse oximetry (SpO2), invasive systemic BP and CVP, end tidal carbon dioxide (etCO2) and anaesthetic agent monitoring) that was available in the early 1980s. Conventional intra-operative management can result in occult low levels of blood flow and oxygen delivery that lead to complications that only occur days or weeks following surgery and give false re-assurance to the anaesthetist that he or she is doing a "good job". Post-operative management then often takes place in an environment with reduced levels of both monitoring equipment and staff expertise. It is perhaps not surprising that outcome still remains poor in high-risk patients.(1) In this review, we will briefly describe the role of peri-operative optimization, some of the available monitors and indicate how their combined use might be beneficial in managing the high-risk surgical patient. We believe that although there is now evidence to suggest that the use of individual new monitors (such as assessment of fluid status, depth of anaesthesia, tissue oxygenation and blood flow) can influence outcome, it will only be their combination that will radically improve the peri-operative management and outcome of high-risk surgical patients. It is a matter of some urgency that large scale, prospective and collaborative studies be designed, funded and executed to prove or disprove this hypothesis. Copyright 2009 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

77 FR 9237 - Agency Information Collection Activities; Proposed Collection; Comment Request; Risk Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-16

... Activities; Proposed Collection; Comment Request; Risk Management Program Requirements and Petitions To..., non-chemical manufacturers, etc. Title: Risk Management Program Requirements and Petitions to Modify... regulated substance in a process develop and implement a risk management program and submit a risk...

Potential impact of single-risk-factor versus total risk management for the prevention of cardiovascular events in Seychelles.

PubMed

Ndindjock, Roger; Gedeon, Jude; Mendis, Shanthi; Paccaud, Fred; Bovet, Pascal

2011-04-01

To assess the prevalence of cardiovascular (CV) risk factors in Seychelles, a middle-income African country, and compare the cost-effectiveness of single-risk-factor management (treating individuals with arterial blood pressure ≥ 140/90 mmHg and/or total serum cholesterol ≥ 6.2 mmol/l) with that of management based on total CV risk (treating individuals with a total CV risk ≥ 10% or ≥ 20%). CV risk factor prevalence and a CV risk prediction chart for Africa were used to estimate the 10-year risk of suffering a fatal or non-fatal CV event among individuals aged 40-64 years. These figures were used to compare single-risk-factor management with total risk management in terms of the number of people requiring treatment to avert one CV event and the number of events potentially averted over 10 years. Treatment for patients with high total CV risk (≥ 20%) was assumed to consist of a fixed-dose combination of several drugs (polypill). Cost analyses were limited to medication. A total CV risk of ≥ 10% and ≥ 20% was found among 10.8% and 5.1% of individuals, respectively. With single-risk-factor management, 60% of adults would need to be treated and 157 cardiovascular events per 100000 population would be averted per year, as opposed to 5% of adults and 92 events with total CV risk management. Management based on high total CV risk optimizes the balance between the number requiring treatment and the number of CV events averted. Total CV risk management is much more cost-effective than single-risk-factor management. These findings are relevant for all countries, but especially for those economically and demographically similar to Seychelles.

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

PubMed

Zwikael, Ofer; Ahn, Mark

2011-01-01

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

[Paired kidneys in transplant].

PubMed

Regueiro López, Juan C; Leva Vallejo, Manuel; Prieto Castro, Rafael; Anglada Curado, Francisco; Vela Jiménez, Francisco; Ruiz García, Jesús

2009-02-01

Many factors affect the graft and patient survival on the renal transplant outcome. These factors depend so much of the recipient and donor. We accomplished a study trying to circumvent factors that depend on the donor. We checked the paired kidneys originating of a same donor cadaver. We examined the risk factors in the evolution and follow-up in 278 couples of kidney transplant. We describe their differences, significance, the graft and patient survival, their functionality in 3 and 5 years and the risk factors implicated in their function. We study immunogenic and no immunogenic variables, trying to explain the inferior results in the grafts that are established secondly. We regroup the paired kidneys in those that they did not show paired initial function within the same couple. The results yield a discreet deterioration in the graft and patient survival for second group establish, superior creatinina concentration, without obtaining statistical significance. The Cox regression study establishes the early rejection (inferior to three months) and DR incompatibility values like risk factors. This model of paired kidneys would be able to get close to best-suited form for risk factors analysis in kidney transplant from cadaver donors, if more patients examine themselves in the same way. The paired kidneys originating from the same donor do not show the same function in spite of sharing the same conditions of the donor and perioperative management.

Decisionmaking under risk in invasive species management: risk management theory and applications

Treesearch

Shefali V. Mehta; Robert G. Haight; Frances R. Homans

2010-01-01

Invasive species management is closely entwined with the assessment and management of risk that arises from the inherently random nature of the invasion process. The theory and application of risk management for invasive species with an economic perspective is reviewed in this synthesis. Invasive species management can be delineated into three general categories:...

Analysis of interactions among barriers in project risk management

NASA Astrophysics Data System (ADS)

Dandage, Rahul V.; Mantha, Shankar S.; Rane, Santosh B.; Bhoola, Vanita

2018-03-01

In the context of the scope, time, cost, and quality constraints, failure is not uncommon in project management. While small projects have 70% chances of success, large projects virtually have no chance of meeting the quadruple constraints. While there is no dearth of research on project risk management, the manifestation of barriers to project risk management is a less dwelt topic. The success of project management is oftentimes based on the understanding of barriers to effective risk management, application of appropriate risk management methodology, proactive leadership to avoid barriers, workers' attitude, adequate resources, organizational culture, and involvement of top management. This paper represents various risk categories and barriers to risk management in domestic and international projects through literature survey and feedback from project professionals. After analysing the various modelling methods used in project risk management literature, interpretive structural modelling (ISM) and MICMAC analysis have been used to analyse interactions among the barriers and prioritize them. The analysis indicates that lack of top management support, lack of formal training, and lack of addressing cultural differences are the high priority barriers, among many others.

Managing risks and hazardous in industrial operations

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

Almaula, S.C.

1996-12-31

The main objective of this paper is to demonstrate that it makes good business sense to identify risks and hazards of an operation and take appropriate steps to manage them effectively. Developing and implementing an effective risk and hazard management plan also contibutes to other industry requirements and standards. Development of a risk management system, key elements of a risk management plan, and hazards and risk analysis methods are outlined. Comparing potential risk to the cost of prevention is also discussed. It is estimated that the cost of developing and preparing the first risk management plan varies between $50,000 tomore » $200,000. 3 refs., 2 figs., 1 tab.« less

[The relevance of clinical risk management].

PubMed

Gulino, Matteo; Vergallo, Gianluca Montanari; Frati, Paola

2011-01-01

Medical activity includes a risk of possible injury or complications for the patients, that should drive the Health Care Institutions to introduce and/ or improve clinical Risk management instruments. Although Italy is still lacking a National project of Clinical Risk Management, a number of efforts have been made by different Italian Regions to introduce instruments of risk management. In addition, most of National Health Care Institutions include actually a Department specifically in charge to manage the clinical risk. Despite the practical difficulties, the results obtained until now suggest that the risk management may represent a useful instrument to contribute to the reduction of errors in clinical conduct. Indeed, the introduction of adequate instruments of prevention and management of clinical risk may help to ameliorate the quality of health care Institution services.

RiskScape: a new tool for comparing risk from natural hazards (Invited)

NASA Astrophysics Data System (ADS)

Stirling, M. W.; King, A.

2010-12-01

The Regional RiskScape is New Zealand’s joint venture between GNS Science & NIWA, and represents a comprehensive and easy-to-use tool for multi-hazard-based risk and impact analysis. It has basic GIS functionality, in that it has Import/Export functions to use with GIS software. Five natural hazards have been implemented in Riskscape to date: Flood (river), earthquake, volcano (ash), tsunami and wind storm. The software converts hazard exposure information into the likely impacts for a region, for example, damage and replacement costs, casualties, economic losses, disruption, and number of people affected. It therefore can be used to assist with risk management, land use planning, building codes and design, risk identification, prioritization of risk-reduction/mitigation, determination of “best use” risk-reduction investment, evacuation and contingency planning, awareness raising, public information, realistic scenarios for exercises, and hazard event response. Three geographically disparate pilot regions have been used to develop and triall Riskscape in New Zealand, and each region is exposed to a different mix of natural hazards. Future (phase II) development of Riskscape will include the following hazards: Landslides (both rainfall and earthquake triggered), storm surges, pyroclastic flows and lahars, and climate change effects. While Riskscape developments have thus far focussed on scenario-based risk, future developments will advance the software into providing probabilistic-based solutions.

Systematic review of early surgery for chronic pancreatitis: impact on pain, pancreatic function, and re-intervention.

PubMed

Yang, Catherine J; Bliss, Lindsay A; Schapira, Emily F; Freedman, Steven D; Ng, Sing Chau; Windsor, John A; Tseng, Jennifer F

2014-10-01

Surgical intervention has traditionally been reserved as the last management option for pain in chronic pancreatitis. Recently, there has been a call for surgery to be offered earlier in the disease process. The objectives of this review were to evaluate the effect of early surgery on postoperative pain, pancreatic function, and re-intervention rates in chronic pancreatitis. A systematic literature search through EMBASE, Cochrane Review, and PubMed from January 1950 to January 2014 was conducted. Citations found in relevant papers are hand-searched. Data which could be pooled were analyzed using Revman (v5.2). Risk of bias analysis was conducted. Of the 2,886 potentially eligible studies identified, 11 studies met the inclusion criteria. There was large heterogeneity in the study designs, and studies were conducted over a lengthy time span. Seven studies examined pain, three studies examined pancreatic function, and three studies examined rates of re-intervention. Meta-analysis of the three studies with comparative raw data regarding complete pain relief showed that early surgery was associated with an increased likelihood of complete postoperative pain relief (RR = 1.67, 95% CI 1.09-2.56, p = 0.02). Early surgery was also associated with reduced risk of pancreatic insufficiency and low re-intervention rates. Data from this study supports considering early surgery for pain management in patients with chronic pancreatitis, with the potential of a reduced risk of pancreatic insufficiency and the need for further intervention. Further prospective randomized studies are warranted comparing early surgery against conservative step-up approaches.

A systematic review of the effectiveness of knowledge translation interventions for chronic noncancer pain management

PubMed Central

Ospina, Maria B; Taenzer, Paul; Rashiq, Saifee; MacDermid, Joy C; Carr, Eloise; Chojecki, Dagmara; Harstall, Christa; Henry, James L

2013-01-01

BACKGROUND: Reliable evidence detailing effective treatments and management practices for chronic noncancer pain exists. However, little is known about which knowledge translation (KT) interventions lead to the uptake of this evidence in practice. OBJECTIVES: To conduct a systematic review of the effectiveness of KT interventions for chronic noncancer pain management. METHODS: Comprehensive searches of electronic databases, the gray literature and manual searches of journals were undertaken. Randomized controlled trials, controlled clinical trials and controlled before-and-after studies of KT interventions were included. Data regarding interventions and primary outcomes were categorized using a standard taxonomy; a risk-of-bias approach was adopted for study quality. A narrative synthesis of study results was conducted. RESULTS: More than 8500 titles and abstracts were screened, with 230 full-text articles reviewed for eligibility. Nineteen studies were included, of which only a small proportion were judged to be at low risk of bias. Interactive KT education for health care providers has a positive effect on patients’ function, but its benefits for other health provider- and patient-related outcomes are inconsistent. Interactive education for patients leads to improvements in knowledge and function. Little research evidence supports the effectiveness of structural changes in health systems and quality improvement processes or coordination of care. CONCLUSIONS: KT interventions incorporating interactive education in chronic noncancer pain led to positive effects on patients’ function and knowledge about pain. Future studies should provide implementation details and use consistent theoretical frameworks to better estimate the effectiveness of such interventions. PMID:24308029

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

NASA Astrophysics Data System (ADS)

Beliakov, Sergei

2018-03-01

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

42 CFR 441.476 - Risk management.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Risk management. 441.476 Section 441.476 Public... Self-Directed Personal Assistance Services Program § 441.476 Risk management. (a) The State must... plan for how identified risks will be mitigated. (d) The State must ensure that the risk management...

42 CFR 441.476 - Risk management.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Risk management. 441.476 Section 441.476 Public... Self-Directed Personal Assistance Services Program § 441.476 Risk management. (a) The State must... plan for how identified risks will be mitigated. (d) The State must ensure that the risk management...

42 CFR 441.476 - Risk management.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Risk management. 441.476 Section 441.476 Public... Self-Directed Personal Assistance Services Program § 441.476 Risk management. (a) The State must... plan for how identified risks will be mitigated. (d) The State must ensure that the risk management...

42 CFR 441.476 - Risk management.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Risk management. 441.476 Section 441.476 Public... Self-Directed Personal Assistance Services Program § 441.476 Risk management. (a) The State must... plan for how identified risks will be mitigated. (d) The State must ensure that the risk management...

76 FR 76103 - Privacy Act; Notice of Proposed Rulemaking: State-78, Risk Analysis and Management Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-06

... Rulemaking: State-78, Risk Analysis and Management Records SUMMARY: Notice is hereby given that the... portions of the Risk Analysis and Management (RAM) Records, State-78, system of records contain criminal...) * * * (2) * * * Risk Analysis and Management Records, STATE-78. * * * * * (b) * * * (1) * * * Risk Analysis...

42 CFR 441.476 - Risk management.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Risk management. 441.476 Section 441.476 Public... Self-Directed Personal Assistance Services Program § 441.476 Risk management. (a) The State must... plan for how identified risks will be mitigated. (d) The State must ensure that the risk management...

12 CFR 704.6 - Credit risk management.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Credit risk management. 704.6 Section 704.6... CREDIT UNIONS § 704.6 Credit risk management. (a) Policies. A corporate credit union must operate according to a credit risk management policy that is commensurate with the investment risks and activities...

12 CFR 563.176 - Interest-rate-risk-management procedures.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 5 2011-01-01 2011-01-01 false Interest-rate-risk-management procedures. 563... ASSOCIATIONS-OPERATIONS Financial Management Policies § 563.176 Interest-rate-risk-management procedures... association's management of that risk. (b) The board of directors shall formerly adopt a policy for the...

12 CFR 563.176 - Interest-rate-risk-management procedures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Interest-rate-risk-management procedures. 563... ASSOCIATIONS-OPERATIONS Financial Management Policies § 563.176 Interest-rate-risk-management procedures... association's management of that risk. (b) The board of directors shall formerly adopt a policy for the...

Marine and Hydrokinetic Technology Development Risk Management Framework

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

Snowberg, David; Weber, Jochem

2015-09-01

Over the past decade, the global marine and hydrokinetic (MHK) industry has suffered a number of serious technological and commercial setbacks. To help reduce the risks of industry failures and advance the development of new technologies, the U.S. Department of Energy (DOE) and the National Renewable Energy Laboratory (NREL) developed an MHK Risk Management Framework. By addressing uncertainties, the MHK Risk Management Framework increases the likelihood of successful development of an MHK technology. It covers projects of any technical readiness level (TRL) or technical performance level (TPL) and all risk types (e.g. technological risk, regulatory risk, commercial risk) over themore » development cycle. This framework is intended for the development and deployment of a single MHK technology—not for multiple device deployments within a plant. This risk framework is intended to meet DOE’s risk management expectations for the MHK technology research and development efforts of the Water Power Program (see Appendix A). It also provides an overview of other relevant risk management tools and documentation.1 This framework emphasizes design and risk reviews as formal gates to ensure risks are managed throughout the technology development cycle. Section 1 presents the recommended technology development cycle, Sections 2 and 3 present tools to assess the TRL and TPL of the project, respectively. Section 4 presents a risk management process with design and risk reviews for actively managing risk within the project, and Section 5 presents a detailed description of a risk registry to collect the risk management information into one living document. Section 6 presents recommendations for collecting and using lessons learned throughout the development process.« less

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

Glantz, C.S.; DiMassa, F.V.; Pelto, P.J.

The Western Area Power Administration (Western) views environmental protection and compliance as a top priority as it manages the construction, operation, and maintenance of its vast network of transmission lines, substations, and other facilities. A recent Department of Energy audit of Western`s environmental management activities recommends that Western adopt a formal environmental risk program. To accomplish this goal, Western, in conjunction with Pacific Northwest Laboratory, is in the process of developing a centrally coordinated environmental risk program. This report presents the results of this design effort, and indicates the direction in which Western`s environmental risk program is heading. Western`s environmentalmore » risk program will consist of three main components: risk communication, risk assessment, and risk management/decision making. Risk communication is defined as an exchange of information on the potential for threats to human health, public safety, or the environment. This information exchange provides a mechanism for public involvement, and also for the participation in the risk assessment and management process by diverse groups or offices within Western. The objective of risk assessment is to evaluate and rank the relative magnitude of risks associated with specific environmental issues that are facing Western. The evaluation and ranking is based on the best available scientific information and judgment and serves as input to the risk management process. Risk management takes risk information and combines it with relevant non-risk factors (e.g., legal mandates, public opinion, costs) to generate risk management options. A risk management tool, such as decision analysis, can be used to help make risk management choices.« less

Human-induced changes in landscape configuration influence individual movement routines: lessons from a versatile, highly mobile species.

PubMed

Camacho, Carlos; Palacios, Sebastián; Sáez, Pedro; Sánchez, Sonia; Potti, Jaime

2014-01-01

Landscape conversion by humans may have detrimental effects on animal populations inhabiting managed ecosystems, but human-altered areas may also provide suitable environments for tolerant species. We investigated the spatial ecology of a highly mobile nocturnal avian species-the red-necked nightjar (Caprimulgus ruficollis)-in two contrastingly managed areas in Southwestern Spain to provide management recommendations for species having multiple habitat requirements. Based on habitat use by radiotagged nightjars, we created maps of functional heterogeneity in both areas so that the movements of breeding individuals could be modeled using least-cost path analyses. In both the natural and the managed area, nightjars used remnants of native shrublands as nesting sites, while pinewood patches (either newly planted or natural mature) and roads were selected as roosting and foraging habitats, respectively. Although the fraction of functional habitat was held relatively constant (60.9% vs. 74.1% in the natural and the managed area, respectively), landscape configuration changed noticeably. As a result, least-cost routes (summed linear distances) from nest locations to the nearest roost and foraging sites were three times larger in the natural than in the managed area (mean ± SE: 1356±76 m vs. 439±32 m). It seems likely that the increased proximity of functional habitats in the managed area relative to the natural one is underlying the significantly higher abundances of nightjars observed therein, where breeders should travel shorter distances to link together essential resources, thus likely reducing their energy expenditure and mortality risks. Our results suggest that landscape configuration, but not habitat availability, is responsible for the observed differences between the natural and the managed area in the abundance and movements of breeding nightjars, although no effect on body condition was detected. Agricultural landscapes could be moderately managed to preserve small native remnants and to favor the juxtaposition of functional habitats to benefit those farm species relying on patchy resources.

Outcome Measures Used to Report Kidney Function in Studies Investigating Surgical Management of Kidney Tumours: A Systematic Review.

PubMed

Ellis, Robert J; Cho, Yeoungjee; Del Vecchio, Sharon J; McStea, Megan; Morais, Christudas; Coombes, Jeff S; Wood, Simon T; Gobe, Glenda C; Francis, Ross S

2018-05-01

Most practice decisions relevant to preserving kidney function in patients managed surgically for kidney tumours are driven by observational studies. A wide range of outcome measures are used in these studies, which reduces comparability and increases the risk of reporting bias. To comprehensively and succinctly describe the outcomes used to evaluate kidney function in studies evaluating surgical management of kidney tumours. Electronic search of the PubMed database was conducted to identify studies with at least one measure of kidney function in patients managed surgically for kidney tumours, published between January 2000 and September 2017. Abstracts were initially screened for eligibility. Full texts of articles were then evaluated in more detail for inclusion. A narrative synthesis of the evidence was conducted. A total of 312 studies, involving 127905 participants, were included in this review. Most were retrospective (n=274) studies and conducted in a single centre (n=264). Overall, 78 unique outcome measures were identified, which were grouped into six outcome categories. Absolute postoperative kidney function (n=187), relative kidney function (n=181), and postoperative chronic kidney disease (n=131) were most frequently reported. Kidney function was predominantly quantified using estimated glomerular filtration rate or creatinine clearance (n=255), most using the modification of diet in renal disease equation (n=182). Only 70 studies provided rationale for specific outcome measures used. There is significant variability in the reporting and quantification of kidney function in studies evaluating patients managed surgically for kidney tumours. A standardised approach to measuring and reporting kidney function will increase the effectiveness of outcomes reported and improve relevance of research findings within a clinical context. Although we know that the removal of a kidney can reduce kidney function, clinical significance of various approaches is a matter of debate. This article demonstrates significant variability in the way kidney function was reported across all studies of patients with kidney cancer undergoing surgery, indicating a need for standardisation. Copyright © 2018 European Association of Urology. All rights reserved.

Surgical errors and risks – the head and neck cancer patient

PubMed Central

Harréus, Ulrich

2013-01-01

Head and neck surgery is one of the basic principles of head and neck cancer therapy. Surgical errors and malpractice can have fatal consequences for the treated patients. It can lead to functional impairment and has impact in future chances for disease related survival. There are many risks for head and neck surgeons that can cause errors and malpractice. To avoid surgical mistakes, thorough preoperative management of patients is mandatory. As there are ensuring operability, cautious evaluation of preoperative diagnostics and operative planning. Moreover knowledge of anatomical structures of the head and neck, of the medical studies and data as well as qualification in modern surgical techniques and the surgeons ability for critical self assessment are basic and important prerequisites for head and neck surgeons in order to make out risks and to prevent from mistakes. Additionally it is important to have profound knowledge in nutrition management of cancer patients, wound healing and to realize and to be able to deal with complications, when they occur. Despite all precaution and surgical care, errors and mistakes cannot always be avoided. For that it is important to be able to deal with mistakes and to establish an appropriate and clear communication and management for such events. The manuscript comments on recognition and prevention of risks and mistakes in the preoperative, operative and postoperative phase of head and neck cancer surgery. PMID:24403972

Landslide risk mitigation by means of early warning systems

NASA Astrophysics Data System (ADS)

Calvello, Michele

2017-04-01

Among the many options available to mitigate landslide risk, early warning systems may be used where, in specific circumstances, the risk to life increases above tolerable levels. A coherent framework to classify and analyse landslide early warning systems (LEWS) is herein presented. Once the objectives of an early warning strategy are defined depending on the scale of analysis and the type of landslides to address, the process of designing and managing a LEWS should synergically employ technical and social skills. A classification scheme for the main components of LEWSs is proposed for weather-induced landslides. The scheme is based on a clear distinction among: i) the landslide model, i.e. a functional relationship between weather characteristics and landslide events considering the geotechnical, geomorphological and hydro-geological characterization of the area as well as an adequate monitoring strategy; ii) the warning model, i.e. the landslide model plus procedures to define the warning events and to issue the warnings; iii) the warning system, i.e. the warning model plus warning dissemination procedures, communication and education tools, strategies for community involvement and emergency plans. Each component of a LEWS is related to a number of actors involved with their deployment, operational activities and management. For instance, communication and education, community involvement and emergency plans are all significantly influenced by people's risk perception and by operational aspects system managers need to address in cooperation with scientists.

Integrating service user and practitioner expertise within a web-based system for collaborative mental-health risk and safety management.

PubMed

Buckingham, Christopher D; Adams, Ann; Vail, Laura; Kumar, Ashish; Ahmed, Abu; Whelan, Annie; Karasouli, Eleni

2015-10-01

To develop a decision support system (DSS), myGRaCE, that integrates service user (SU) and practitioner expertise about mental health and associated risks of suicide, self-harm, harm to others, self-neglect, and vulnerability. The intention is to help SUs assess and manage their own mental health collaboratively with practitioners. An iterative process involving interviews, focus groups, and agile software development with 115 SUs, to elicit and implement myGRaCE requirements. Findings highlight shared understanding of mental health risk between SUs and practitioners that can be integrated within a single model. However, important differences were revealed in SUs' preferred process of assessing risks and safety, which are reflected in the distinctive interface, navigation, tool functionality and language developed for myGRaCE. A challenge was how to provide flexible access without overwhelming and confusing users. The methods show that practitioner expertise can be reformulated in a format that simultaneously captures SU expertise, to provide a tool highly valued by SUs. A stepped process adds necessary structure to the assessment, each step with its own feedback and guidance. The GRiST web-based DSS (www.egrist.org) links and integrates myGRaCE self-assessments with GRiST practitioner assessments for supporting collaborative and self-managed healthcare. Copyright © 2015. Published by Elsevier Ireland Ltd.

[Hospitality for elderly patients in the emergency department].

PubMed

Boulet, Marie-Claude; Dami, Fabrice; Hugli, Olivier; Renard, Delphine; Foucault, Eliane; Carron, Pierre-Nicolas

2015-12-09

Demographic evolution results in a growing use of emergency department by elderly patients. They require special care to avoid any further degradation of cognitive and functional abilities already compromised by the disease or injury that led them to hospital in the first place. Through a clinical case, we list the risks related to the care of these particular patients in the emergency department. Early recognition of those risks and careful management of these patients' specific needs can significantly contribute to reduce lengths of stay, an important outcome from both the individual patient's and society's perspective.

Cross-Cutting Risk Framework: Mining Data for Common Risks Across the Portfolio

NASA Technical Reports Server (NTRS)

Klein, Gerald A., Jr.; Ruark, Valerie

2017-01-01

The National Aeronautics and Space Administration (NASA) defines risk management as an integrated framework, combining risk-informed decision making and continuous risk management to foster forward-thinking and decision making from an integrated risk perspective. Therefore, decision makers must have access to risks outside of their own project to gain the knowledge that provides the integrated risk perspective. Through the Goddard Space Flight Center (GSFC) Flight Projects Directorate (FPD) Business Change Initiative (BCI), risks were integrated into one repository to facilitate access to risk data between projects. With the centralized repository, communications between the FPD, project managers, and risk managers improved and GSFC created the cross-cutting risk framework (CCRF) team. The creation of the consolidated risk repository, in parallel with the initiation of monthly FPD risk managers and risk governance board meetings, are now providing a complete risk management picture spanning the entire directorate. This paper will describe the challenges, methodologies, tools, and techniques used to develop the CCRF, and the lessons learned as the team collectively worked to identify risks that FPD programs projects had in common, both past and present.

Application of a risk management system to improve drinking water safety.

PubMed

Jayaratne, Asoka

2008-12-01

The use of a comprehensive risk management framework is considered a very effective means of managing water quality risks. There are many risk-based systems available to water utilities such as ISO 9001 and Hazard Analysis and Critical Control Point (HACCP). In 2004, the World Health Organization's (WHO) Guidelines for Drinking Water Quality recommended the use of preventive risk management approaches to manage water quality risks. This paper describes the framework adopted by Yarra Valley Water for the development of its Drinking Water Quality Risk Management Plan incorporating HACCP and ISO 9001 systems and demonstrates benefits of Water Safety Plans such as HACCP. Copyright IWA Publishing 2008.

The role of business process reengineering in health care.

PubMed

Kohn, D

1994-02-01

Business process reengineering (BPR) is a management philosophy capturing attention in health care. It combines some new, old, and recycled management philosophies, and, more often than not, is yielding positive results. BPR's emphasis is on the streamlining of cross-functional processes to significantly reduce time and/or cost, increase revenue, improve quality and service, and reduce risk. Therefore, it has many applications in health care. This article provides an introduction to the concept of BPR, including the definition of BPR, its origin, its champions, and factors for its success.

Appraising longitudinal trends in the strategic risks cited by risk managers in the international water utility sector, 2005-2015.

PubMed

Chalker, Rosemary T C; Pollard, Simon J T; Leinster, Paul; Jude, Simon

2018-03-15

We report dynamic changes in the priorities for strategic risks faced by international water utilities over a 10year period, as cited by managers responsible for managing them. A content analysis of interviews with three cohorts of risk managers in the water sector was undertaken. Interviews probed the focus risk managers' were giving to strategic risks within utilities, as well as specific questions on risk analysis tools (2005); risk management cultures (2011) and the integration of risk management with corporate decision-making (2015). The coding frequency of strategic (business, enterprise, corporate) risk terms from 18 structured interviews (2005) and 28 semi-structured interviews (12 in 2011; 16 in 2015) was used to appraise changes in the perceived importance of strategic risks within the sector. The aggregated coding frequency across the study period, and changes in the frequency of strategic risks cited at three interview periods identified infrastructure assets as the most significant risk over the period and suggests an emergence of extrinsic risk over time. Extended interviews with three utility risk managers (2016) from the UK, Canada and the US were then used to contextualise the findings. This research supports the ongoing focus on infrastructure resilience and the increasing prevalence of extrinsic risk within the water sector, as reported by the insurance sector and by water research organisations. The extended interviews provided insight into how strategic risks are now driving the implementation agenda within utilities, and into how utilities can secure tangible business value from proactive risk governance. Strategic external risks affecting the sector are on the rise, involve more players and are less controllable from within a utility's own organisational boundaries. Proportionate risk management processes and structures provide oversight and assurance, whilst allowing a focus on the tangible business value that comes from managing strategic risks well. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

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 Merapi and Bromo. Keywords: Risk management, volcanoes hazard, Merapi and Bromo Volcano Indonesia

Uncertainty and Sensitivity of Direct Economic Flood Damages: the FloodRisk Free and Open-Source Software

NASA Astrophysics Data System (ADS)

Albano, R.; Sole, A.; Mancusi, L.; Cantisani, A.; Perrone, A.

2017-12-01

The considerable increase of flood damages in the the past decades has shifted in Europe the attention from protection against floods to managing flood risks. In this context, the expected damages assessment represents a crucial information within the overall flood risk management process. The present paper proposes an open source software, called FloodRisk, that is able to operatively support stakeholders in the decision making processes with a what-if approach by carrying out the rapid assessment of the flood consequences, in terms of direct economic damage and loss of human lives. The evaluation of the damage scenarios, trough the use of the GIS software proposed here, is essential for cost-benefit or multi-criteria analysis of risk mitigation alternatives. However, considering that quantitative assessment of flood damages scenarios is characterized by intrinsic uncertainty, a scheme has been developed to identify and quantify the role of the input parameters in the total uncertainty of flood loss model application in urban areas with mild terrain and complex topography. By the concept of parallel models, the contribution of different module and input parameters to the total uncertainty is quantified. The results of the present case study have exhibited a high epistemic uncertainty on the damage estimation module and, in particular, on the type and form of the utilized damage functions, which have been adapted and transferred from different geographic and socio-economic contexts because there aren't depth-damage functions that are specifically developed for Italy. Considering that uncertainty and sensitivity depend considerably on local characteristics, the epistemic uncertainty associated with the risk estimate is reduced by introducing additional information into the risk analysis. In the light of the obtained results, it is evident the need to produce and disseminate (open) data to develop micro-scale vulnerability curves. Moreover, the urgent need to push forward research into the implementation of methods and models for the assimilation of uncertainties in decision-making processes emerges.

Continuous Risk Management Course. Revised

NASA Technical Reports Server (NTRS)

Hammer, Theodore F.

1999-01-01

This document includes a course plan for Continuous Risk Management taught by the Software Assurance Technology Center along with the Continuous Risk Management Guidebook of the Software Engineering Institute of Carnegie Mellon University and a description of Continuous Risk Management at NASA.

Rethinking 'risk' and self-management for chronic illness.

PubMed

Morden, Andrew; Jinks, Clare; Ong, Bie Nio

2012-02-01

Self-management for chronic illness is a current high profile UK healthcare policy. Policy and clinical recommendations relating to chronic illnesses are framed within a language of lifestyle risk management. This article argues the enactment of risk within current UK self-management policy is intimately related to neo-liberal ideology and is geared towards population governance. The approach that dominates policy perspectives to 'risk' management is critiqued for positioning people as rational subjects who calculate risk probabilities and act upon them. Furthermore this perspective fails to understand the lay person's construction and enactment of risk, their agenda and contextual needs when living with chronic illness. Of everyday relevance to lay people is the management of risk and uncertainty relating to social roles and obligations, the emotions involved when encountering the risk and uncertainty in chronic illness, and the challenges posed by social structural factors and social environments that have to be managed. Thus, clinical enactments of self-management policy would benefit from taking a more holistic view to patient need and seek to avoid solely communicating lifestyle risk factors to be self-managed.

Earliest functional declines in Huntington disease

PubMed Central

Beglinger, Leigh J.; O'Rourke, Justin J.F.; Wang, Chiachi; Langbehn, Douglas R.; Duff, Kevin; Paulsen, Jane S.

2013-01-01

We examined the gold standard for Huntington disease (HD) functional assessment, the Unified Huntington's Disease Rating Scale (UHDRS), in a group of at-risk participants not yet diagnosed but who later phenoconverted to manifest HD. We also sought to determine which skill domains first weaken and the clinical correlates of declines. Using the UHDRS Total Functional Capacity (TFC) and Functional Assessment Scale (FAS), we examined participants from Huntington Study Group clinics who were not diagnosed at their baseline visit but were diagnosed at a later visit (N = 265). Occupational decline was the most common with 65.1% (TFC) and 55.6% (FAS) reporting some loss of ability to engage in their typical work. Inability to manage finances independently (TFC 49.2%, FAS 35.1%) and drive safely (FAS 33.5%) were also found. Functional decline was significantly predicted by motor, cognitive, and depressive symptoms. The UHDRS captured early functional losses in individuals with HD prior to formal diagnosis, however, fruitful areas for expanded assessment of early functional changes are performance at work, ability to manage finances, and driving. These are also important areas for clinical monitoring and treatment planning as up to 65% experienced loss in at least one area prior to diagnosis. PMID:20471695

A best-practice position statement on pregnancy after kidney transplantation: focusing on the unsolved questions. The Kidney and Pregnancy Study Group of the Italian Society of Nephrology.

PubMed

Gianfranca, Cabiddu; Donatella, Spotti; Giuseppe, Gernone; Domenico, Santoro; Gabriella, Moroni; Gina, Gregorini; Franca, Giacchino; Rossella, Attini; Monica, Limardo; Linda, Gammaro; Tullia, Todros; Piccoli, Giorgina Barbara

2018-06-14

Kidney transplantation (KT) is often considered to be the method best able to restore fertility in a woman with chronic kidney disease (CKD). However, pregnancies in KT are not devoid of risks (in particular prematurity, small for gestational age babies, and the hypertensive disorders of pregnancy). An ideal profile of the potential KT mother includes "normal" or "good" kidney function (usually defined as glomerular filtration rate, GFR ≥ 60 ml/min), scant or no proteinuria (usually defined as below 500 mg/dl), normal or well controlled blood pressure (one drug only and no sign of end-organ damage), no recent acute rejection, good compliance and low-dose immunosuppression, without the use of potentially teratogen drugs (mycophenolic acid and m-Tor inhibitors) and an interval of at least 1-2 years after transplantation. In this setting, there is little if any risk of worsening of the kidney function. Less is known about how to manage "non-ideal" situations, such as a pregnancy a short time after KT, or one in the context of hypertension or a failing kidney. The aim of this position statement by the Kidney and Pregnancy Group of the Italian Society of Nephrology is to review the literature and discuss what is known about the clinical management of CKD after KT, with particular attention to women who start a pregnancy in non-ideal conditions. While the experience in such cases is limited, the risks of worsening the renal function are probably higher in cases with markedly reduced kidney function, and in the presence of proteinuria. Well-controlled hypertension alone seems less relevant for outcomes, even if its effect is probably multiplicative if combined with low GFR and proteinuria. As in other settings of kidney disease, superimposed preeclampsia (PE) is differently defined and this impairs calculating its real incidence. No specific difference between non-teratogen immunosuppressive drugs has been shown, but calcineurin inhibitors have been associated with foetal growth restriction and low birth weight. The clinical choices in cases at high risk for malformations or kidney function impairment (pregnancies under mycophenolic acid or with severe kidney-function impairment) require merging clinical and ethical approaches in which, beside the mother and child dyad, the grafted kidney is a crucial "third element".

5 CFR 930.301 - Information systems security awareness training program.

Code of Federal Regulations, 2011 CFR

2011-01-01

... training in system/application life cycle management, risk management, and contingency planning. (4) Chief... security management, system/application life cycle management, risk management, and contingency planning..., risk management, and contingency planning. (b) Provide the Federal information systems security...

5 CFR 930.301 - Information systems security awareness training program.

Code of Federal Regulations, 2010 CFR

2010-01-01

... training in system/application life cycle management, risk management, and contingency planning. (4) Chief... security management, system/application life cycle management, risk management, and contingency planning..., risk management, and contingency planning. (b) Provide the Federal information systems security...

People's Risk Recognition Preceding Evacuation and Its Role in Demand Modeling and Planning.

PubMed

Urata, Junji; Pel, Adam J

2018-05-01

Evacuation planning and management involves estimating the travel demand in the event that such action is required. This is usually done as a function of people's decision to evacuate, which we show is strongly linked to their risk awareness. We use an empirical data set, which shows tsunami evacuation behavior, to demonstrate that risk recognition is not synonymous with objective risk, but is instead determined by a combination of factors including risk education, information, and sociodemographics, and that it changes dynamically over time. Based on these findings, we formulate an ordered logit model to describe risk recognition combined with a latent class model to describe evacuation choices. Our proposed evacuation choice model along with a risk recognition class can evaluate quantitatively the influence of disaster mitigation measures, risk education, and risk information. The results obtained from the risk recognition model show that risk information has a greater impact in the sense that people recognize their high risk. The results of the evacuation choice model show that people who are unaware of their risk take a longer time to evacuate. © 2017 Society for Risk Analysis.

Taking Risk Assessment and Management to the Next Level: Program-Level Risk Analysis to Enable Solid Decision-Making on Priorities and Funding

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

Nelson, J. G.; Morton, R. L.; Castillo, C.

2011-02-01

A multi-level (facility and programmatic) risk assessment was conducted for the facilities in the Nevada National Security Site (NNSS) Readiness in Technical Base and Facilities (RTBF) Program and results were included in a new Risk Management Plan (RMP), which was incorporated into the fiscal year (FY) 2010 Integrated Plans. Risks, risk events, probability, consequence(s), and mitigation strategies were identified and captured, for most scope areas (i.e., risk categories) during the facilitated risk workshops. Risk mitigations (i.e., efforts in addition to existing controls) were identified during the facilitated risk workshops when the risk event was identified. Risk mitigation strategies fell intomore » two broad categories: threats or opportunities. Improvement projects were identified and linked to specific risks they mitigate, making the connection of risk reduction through investments for the annual Site Execution Plan. Due to the amount of that was collected, analysis to be performed, and reports to be generated, a Risk Assessment/ Management Tool (RAMtool) database was developed to analyze the risks in real-time, at multiple levels, which reinforced the site-level risk management process and procedures. The RAMtool database was developed and designed to assist in the capturing and analysis of the key elements of risk: probability, consequence, and impact. The RAMtool calculates the facility-level and programmatic-level risk factors to enable a side-by-side comparison to see where the facility manager and program manager should focus their risk reduction efforts and funding. This enables them to make solid decisions on priorities and funding to maximize the risk reduction. A more active risk management process was developed where risks and opportunities are actively managed, monitored, and controlled by each facility more aggressively and frequently. risk owners have the responsibility and accountability to manage their assigned risk in real-time, using the RAMtool database.« less

Cardiovascular risk factors and dementia.

PubMed

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

2008-06-01

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

Assessment of mean annual flood damage using simple hydraulic modeling and Monte Carlo simulation

NASA Astrophysics Data System (ADS)

Oubennaceur, K.; Agili, H.; Chokmani, K.; Poulin, J.; Marceau, P.

2016-12-01

Floods are the most frequent and the most damaging natural disaster in Canada. The issue of assessing and managing the risk related to this disaster has become increasingly crucial for both local and national authorities. Brigham, a municipality located in southern Quebec Province, is one of the heavily affected regions by this disaster because of frequent overflows of the Yamaska River reaching two to three times per year. Since Irene Hurricane which struck the region in 2011, causing considerable socio-economic damage, the implementation of mitigation measures has become a major priority for this municipality. To do this, a preliminary study to evaluate the risk to which this region is exposed is essential. Conventionally, approaches only based on the characterization of the hazard (e.g. floodplains extensive, flood depth) are generally adopted to study the risk of flooding. In order to improve the knowledge of this risk, a Monte Carlo simulation approach combining information on the hazard with vulnerability-related aspects has been developed. This approach integrates three main components: (1) hydrologic modelling aiming to establish a probability-discharge function which associate each measured discharge to its probability of occurrence (2) hydraulic modeling that aims to establish the relationship between the discharge and the water stage at each building (3) damage study that aims to assess the buildings damage using damage functions. The damage is estimated according to the water depth defined as the difference between the water level and the elevation of the building's first floor. The application of the proposed approach allows estimating the annual average cost of damage caused by floods on buildings. The obtained results will be useful for authorities to support their decisions on risk management and prevention against this disaster.

What's New: Acquatic Stabilization: Aquatic Rehabilitation Strategies for the Lumbar Spine and Risk Management for the Aquatic Therapist.

ERIC Educational Resources Information Center

Moschettti, Marilou

Through dynamic aquatic stabilization techniques, patients will develop the ability to characterize sensory distractions and develop self-awareness and sensitivity to movement in the water, which will relate directly to improved motor function. Aquatic therapy is a systematic method of treatment, with programs developed by a licensed physical…

Individual, Family, and Neighborhood Factors Distinguish Resilient from Non-Resilient Maltreated Children: A Cumulative Stressors Model

ERIC Educational Resources Information Center

Jaffee, Sara R.; Caspi, Avshalom; Moffitt, Terrie E.; Polo-Tomas, Monica; Taylor, Alan

2007-01-01

Objective: Children who are physically maltreated are at risk of a range of adverse outcomes in childhood and adulthood, but some children who are maltreated manage to function well despite their history of adversity. Which individual, family, and neighborhood characteristics distinguish resilient from non-resilient maltreated children? Do…

A methodology for urban flood resilience assessment

NASA Astrophysics Data System (ADS)

Lhomme, Serge; Serre, Damien; Diab, Youssef; Laganier, Richard

2010-05-01

In Europe, river floods have been increasing in frequency and severity [Szöllösi-Nagy and Zevenbergen, 2005]. Moreover, climate change is expected to exacerbate the frequency and intensity of hydro meteorological disaster [IPCC, 2007]. Despite efforts made to maintain the flood defense assets, we often observe levee failures leading to finally increase flood risk in protected area. Furthermore, flood forecasting models, although benefiting continuous improvements, remain partly inaccurate due to uncertainties arising all along data calculation processes. In the same time, the year 2007 marks a turning point in history: half of the world population now lives in cities (UN-Habitat, 2007). Moreover, the total urban population is expected to double from two to four billion over the next 30 to 35 years (United Nations, 2006). This growing rate is equivalent to the creation of a new city of one million inhabitants every week, and this during the next four decades [Flood resilience Group]. So, this quick urban development coupled with technical failures and climate change have increased flood risk and corresponding challenges to urban flood risk management [Ashley et al., 2007], [Nie et al., 2009]. These circumstances oblige to manage flood risk by integrating new concepts like urban resilience. In recent years, resilience has become a central concept for risk management. This concept has emerged because a more resilient system is less vulnerable to risk and, therefore, more sustainable [Serre et al., 2010]. But urban flood resilience is a concept that has not yet been directly assessed. Therefore, when decision makers decide to use the resilience concept to manage urban flood, they have no tool to help them. That is why this paper proposes a methodology to assess urban flood resilience in order to make this concept operational. Networks affect the well-being of the people and the smooth functioning of services and, more generally, of economical activities. Yet, multiple networks that innervate the city are particularly sensitive to flooding, through their structures and geographic constraints. Because societal functions are highly dependent on networked systems and the operability of these systems can be vulnerable to disasters, there is a need to understand how networked systems are resilient. That is why, considering that networks can be regarded as the "flood gateway" [Lhomme et al., 2009], we will focus on the resilience assessment of these critical networks before urban resilience assessment. The first part of this paper introduce resilience concept to well understand the importance of this concept to manage flood risk and of assessing this resilience. In a second part, this paper presents the use of safety methods to model network system dysfunctions during flood and then to produce resilience indicators. Finally it presents use of graph theory to assess adaptive capacity of these networks. These researches are the first steps toward the development of a GIS tool to optimize preparedness and recovery after a flood event.

Applying the Heuristic to the Risk Assessment within the Automotive Industry Supply Chain

NASA Astrophysics Data System (ADS)

Marasova, Daniela; Andrejiova, Miriam; Grincova, Anna

2017-03-01

Risk management facilitates risk identification, evaluation, control, and by means of appropriate set of measures, risk reduction or complete elimination. Therefore, the risk management becomes a strategic factor for a company's success. Properly implemented risk management system does not represent a tool to avoid the risk; it is used to understand the risk and provide the bases for strategic decision-making. Risk management represents a key factor for the supply chain operations. Managing the risks is crucial for achieving the customer satisfaction and thus also a company's success. The subject-matter of the article is the assessment of the supply chain in the automobile industry, in terms of risks. The topicality of this problem is even higher, as after the economic crisis it is necessary to revaluate the readiness of the supply chain for prospective risk conditions. One advantage of this article is the use of the Saaty method as a tool for the risk management within the supply chain.

Risk preferences, probability weighting, and strategy tradeoffs in wildfire management

Treesearch

Michael S. Hand; Matthew J. Wibbenmeyer; Dave Calkin; Matthew P. Thompson

2015-01-01

Wildfires present a complex applied risk management environment, but relatively little attention has been paid to behavioral and cognitive responses to risk among public agency wildfire managers. This study investigates responses to risk, including probability weighting and risk aversion, in a wildfire management context using a survey-based experiment administered to...

12 CFR 1710.19 - Compliance and risk management programs; compliance with other laws.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Compliance and risk management programs... Practices and Procedures § 1710.19 Compliance and risk management programs; compliance with other laws. (a... management program. (1) An Enterprise shall establish and maintain a risk management program that is...

[Application of risk grading and classification for occupational hazards in risk management for a shipbuilding project].

PubMed

Zeng, Wenfeng; Tan, Qiang; Wu, Shihua; Deng, Yingcong; Liu, Lifen; Wang, Zhi; Liu, Yimin

2015-12-01

To investigate the application of risk grading and classification for occupational hazards in risk management for a shipbuilding project. The risk management for this shipbuilding project was performed by a comprehensive application of MES evaluation, quality assessment of occupational health management, and risk grading and classification for occupational hazards, through the methods of occupational health survey, occupational health testing, and occupational health examinations. The results of MES evaluation showed that the risk of occupational hazards in this project was grade 3, which was considered as significant risk; Q value calculated by quality assessment of occupational health management was 0.52, which was considered to be unqualified; the comprehensive evaluation with these two methods showed that the integrated risk rating for this shipbuilding project was class D, and follow- up and rectification were needed with a focus on the improvement in health management. The application of MES evaluation and quality assessment of occupational health management in risk management for occupational hazards can achieve objective and reasonable conclusions and has good applicability.

Risk Assessment in the UK Health and Safety System: Theory and Practice.

PubMed

Russ, Karen

2010-09-01

In the UK, a person or organisation that creates risk is required to manage and control that risk so that it is reduced 'So Far As Is Reasonably Practicable' (SFAIRP). How the risk is managed is to be determined by those who create the risk. They have a duty to demonstrate that they have taken action to ensure all risk is reduced SFAIRP and must have documentary evidence, for example a risk assessment or safety case, to prove that they manage the risks their activities create. The UK Health and Safety Executive (HSE) does not tell organisations how to manage the risks they create but does inspect the quality of risk identification and management. This paper gives a brief overview of where responsibility for occupational health and safety lies in the UK, and how risk should be managed through risk assessment. The focus of the paper is three recent major UK incidents, all involving fatalities, and all of which were wholly avoidable if risks had been properly assessed and managed. The paper concludes with an analysis of the common failings of risk assessments and key actions for improvement.

Proprotein convertase subtilisin/kexin type 9 inhibition: a new therapeutic mechanism for reducing cardiovascular disease risk.

PubMed

Bergeron, Nathalie; Phan, Binh An P; Ding, Yunchen; Fong, Aleyna; Krauss, Ronald M

2015-10-27

Proprotein convertase subtilisin/kexin type 9 (PCSK9) plays an important role in the regulation of cholesterol homeostasis. By binding to hepatic low-density lipoprotein (LDL) receptors and promoting their lysosomal degradation, PCSK9 reduces LDL uptake, leading to an increase in LDL cholesterol concentrations. Gain-of-function mutations in PCSK9 associated with high LDL cholesterol and premature cardiovascular disease have been causally implicated in the pathophysiology of autosomal-dominant familial hypercholesterolemia. In contrast, the more commonly expressed loss-of-function mutations in PCSK9 are associated with reduced LDL cholesterol and cardiovascular disease risk. The development of therapeutic approaches that inhibit PCSK9 function has therefore attracted considerable attention from clinicians and the pharmaceutical industry for the management of hypercholesterolemia and its associated cardiovascular disease risk. This review summarizes the effects of PCSK9 on hepatic and intestinal lipid metabolism and the more recently explored functions of PCSK9 in extrahepatic tissues. Therapeutic approaches that prevent interaction of PCSK9 with hepatic LDL receptors (monoclonal antibodies, mimetic peptides), inhibit PCSK9 synthesis in the endoplasmic reticulum (antisense oligonucleotides, siRNAs), and interfere with PCSK9 function (small molecules) are also described. Finally, clinical trials testing the safety and efficacy of monoclonal antibodies to PCSK9 are reviewed. These have shown dose-dependent decreases in LDL cholesterol (44%-65%), apolipoprotein B (48%-59%), and lipoprotein(a) (27%-50%) without major adverse effects in various high-risk patient categories, including those with statin intolerance. Initial reports from 2 of these trials have indicated the expected reduction in cardiovascular events. Hence, inhibition of PCSK9 holds considerable promise as a therapeutic option for decreasing cardiovascular disease risk. © 2015 American Heart Association, Inc.

Development of an effective risk management system in a teaching hospital.

PubMed

Adibi, Hossein; Khalesi, Nader; Ravaghi, Hamid; Jafari, Mahdi; Jeddian, Ali Reza

2012-09-21

Unsafe health care provision is a main cause of increased mortality rate amongst hospitalized patients all over the world. A system approach to medical error and its reduction is crucial that is defined by clinical and administrative activities undertaken to identify, evaluate, and reduce the risk of injury. The aim of this study was to develop and implement a risk management system in a large teaching hospital in Iran, especially of the basis of WHO guidelines and patient safety context. WHO draft guideline and patient safety reports from different countries were reviewed for defining acceptable framework of risk management system. Also current situation of mentioned hospital in safety matter and dimensions of patient safety culture was evaluated using HSOPSC questionnaire of AHRQ. With adjustment of guidelines and hospital status, the conceptual framework was developed and next it was validated in expert panel. The members of expert panel were selected according to their role and functions and also their experiences in risk management and patient safety issues. The validated framework consisted of designating a leader and coordinator core, defining communications, and preparing the infrastructure for patient safety education and culture-building. That was developed on the basis of some values and commitments and included reactive and proactive approaches. The findings of reporting activities demonstrated that at least 3.6 percent of hospitalized patients have experienced adverse events and 5.3 percent of all deaths in the hospital related with patient safety problems. Beside the average score of 12 dimensions of patient safety culture was 46.2 percent that was considerably low. The "non-punitive responses to error" had lowest positive score with 21.2 percent. It is of paramount importance for all health organizations to lay necessary foundations in order to identify safety risks and improve the quality of care. Inadequate participation of staff in education, reporting and analyzing, underreporting and uselessness of aggregated data, limitation of human and financial resources, punitive directions and management challenges for solutions were the main executive problems which could affect the effectiveness of system.

Cardiovascular risk outcome and program evaluation of a cluster randomised controlled trial of a community-based, lay peer led program for people with diabetes.

PubMed

Riddell, M A; Dunbar, J A; Absetz, P; Wolfe, R; Li, H; Brand, M; Aziz, Z; Oldenburg, B

2016-08-24

The 2013 Global Burden of Disease Study demonstrated the increasing burden of diabetes and the challenge it poses to the health systems of all countries. The chronic and complex nature of diabetes requires active self-management by patients in addition to clinical management in order to achieve optimal glycaemic control and appropriate use of available clinical services. This study is an evaluation of a "real world" peer support program aimed at improving the control and management of type 2 diabetes (T2DM) in Australia. The trial used a randomised cluster design with a peer support intervention and routine care control arms and 12-month follow up. Participants in both arms received a standardised session of self-management education at baseline. The intervention program comprised monthly community-based group meetings over 12 months led by trained peer supporters and active encouragement to use primary health care and other community resources and supports related to diabetes. Clinical, behavioural and other measures were collected at baseline, 6 and 12 months. The primary outcome was the predicted 5 year cardiovascular disease risk using the United Kingdom Prospective Diabetes Study (UKPDS) Risk Equation at 12 months. Secondary outcomes included clinical measures, quality of life, measures of support, psychosocial functioning and lifestyle measures. Eleven of 12 planned groups were successfully implemented in the intervention arm. Both the usual care and the intervention arms demonstrated a small reduction in 5 year UKPDS risk and the mean values for biochemical and anthropometric outcomes were close to target at 12 months. There were some small positive changes in self-management behaviours. The positive changes in self-management behaviours among intervention participants were not sufficient to reduce cardiovascular risk, possibly because approximately half of the study participants already had quite well controlled T2DM at baseline. Future research needs to address how to enhance community based programs so that they reach and benefit those most in need of resources and supports to improve metabolic control and associated clinical outcomes. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12609000469213 . Registered 16 June 2009.

Assessing the benefits and risks of translocations in changing environments: a genetic perspective

PubMed Central

Weeks, Andrew R; Sgro, Carla M; Young, Andrew G; Frankham, Richard; Mitchell, Nicki J; Miller, Kim A; Byrne, Margaret; Coates, David J; Eldridge, Mark D B; Sunnucks, Paul; Breed, Martin F; James, Elizabeth A; Hoffmann, Ary A

2011-01-01

Translocations are being increasingly proposed as a way of conserving biodiversity, particularly in the management of threatened and keystone species, with the aims of maintaining biodiversity and ecosystem function under the combined pressures of habitat fragmentation and climate change. Evolutionary genetic considerations should be an important part of translocation strategies, but there is often confusion about concepts and goals. Here, we provide a classification of translocations based on specific genetic goals for both threatened species and ecological restoration, separating targets based on ‘genetic rescue’ of current population fitness from those focused on maintaining adaptive potential. We then provide a framework for assessing the genetic benefits and risks associated with translocations and provide guidelines for managers focused on conserving biodiversity and evolutionary processes. Case studies are developed to illustrate the framework. PMID:22287981

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

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...

A tri-reference point theory of decision making under risk.

PubMed

Wang, X T; Johnson, Joseph G

2012-11-01

The tri-reference point (TRP) theory takes into account minimum requirements (MR), the status quo (SQ), and goals (G) in decision making under risk. The 3 reference points demarcate risky outcomes and risk perception into 4 functional regions: success (expected value of x ≥ G), gain (SQ < × < G), loss (MR ≤ x < SQ), and failure (x < MR). The psychological impact of achieving or failing to achieve these reference points is rank ordered as MR > G > SQ. We present TRP assumptions and value functions and a mathematical formalization of the theory. We conducted empirical tests of crucial TRP predictions using both explicit and implicit reference points. We show that decision makers consider both G and MR and give greater weight to MR than G, indicating failure aversion (i.e., the disutility of a failure is greater than the utility of a success in the same task) in addition to loss aversion (i.e., the disutility of a loss is greater than the utility of the same amount of gain). Captured by a double-S shaped value function with 3 inflection points, risk preferences switched between risk seeking and risk aversion when the distribution of a gamble straddled a different reference point. The existence of MR (not G) significantly shifted choice preference toward risk aversion even when the outcome distribution of a gamble was well above the MR. Single reference point based models such as prospect theory cannot consistently account for these findings. The TRP theory provides simple guidelines for evaluating risky choices for individuals and organizational management. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

Harnessing Private-Sector Innovation to Improve Health Insurance Exchanges

PubMed Central

Gresenz, Carole Roan; Hoch, Emily; Eibner, Christine; Rudin, Robert S.; Mattke, Soeren

2016-01-01

Abstract Overhauling the individual health insurance market—including through the creation of health insurance exchanges—was a key component of the Patient Protection and Affordable Care Act's multidimensional approach to addressing the long-standing problem of the uninsured in the United States. Despite succeeding in enrolling millions of Americans, the exchanges still face several challenges, including poor consumer experience, high operational and development costs, and incomplete market penetration. In light of these challenges, analysts considered a different model for the exchanges—privately facilitated exchanges—which could address these challenges and deepen the Affordable Care Act's impact. In this model, the government retains control over sovereign exchange functions but allows the private sector to assume responsibility for more-peripheral exchange functions, such as developing and sustaining exchange websites. Although private-sector entities have already undertaken exchange-related functions on a limited basis, privately facilitated exchanges could conceivably relieve the government of its responsibility for front-end website operations and consumer decision-support functions entirely. A shift to privately facilitated exchanges could improve the consumer experience, increase enrollment, and lower costs for state and federal governments. A move to such a model requires, nonetheless, managing its risks, such as reduced consumer protection, increased consumer confusion, and the possible lack of a viable revenue base for privately facilitated exchanges, especially in less populous states. On net, the benefits are large enough and the risks sufficiently manageable to seriously consider such a shift. This paper provides background information and more detail on the analysts' assessment. PMID:28083414

Harnessing Private-Sector Innovation to Improve Health Insurance Exchanges.

PubMed

Gresenz, Carole Roan; Hoch, Emily; Eibner, Christine; Rudin, Robert S; Mattke, Soeren

2016-05-09

Overhauling the individual health insurance market-including through the creation of health insurance exchanges-was a key component of the Patient Protection and Affordable Care Act's multidimensional approach to addressing the long-standing problem of the uninsured in the United States. Despite succeeding in enrolling millions of Americans, the exchanges still face several challenges, including poor consumer experience, high operational and development costs, and incomplete market penetration. In light of these challenges, analysts considered a different model for the exchanges-privately facilitated exchanges-which could address these challenges and deepen the Affordable Care Act's impact. In this model, the government retains control over sovereign exchange functions but allows the private sector to assume responsibility for more-peripheral exchange functions, such as developing and sustaining exchange websites. Although private-sector entities have already undertaken exchange-related functions on a limited basis, privately facilitated exchanges could conceivably relieve the government of its responsibility for front-end website operations and consumer decision-support functions entirely. A shift to privately facilitated exchanges could improve the consumer experience, increase enrollment, and lower costs for state and federal governments. A move to such a model requires, nonetheless, managing its risks, such as reduced consumer protection, increased consumer confusion, and the possible lack of a viable revenue base for privately facilitated exchanges, especially in less populous states. On net, the benefits are large enough and the risks sufficiently manageable to seriously consider such a shift. This paper provides background information and more detail on the analysts' assessment.

Lupus nephritis with preserved kidney function associated with poorer cardiovascular risk control: A call for more awareness.

PubMed

Todolí-Parra, J A; Tung-Chen, Y; Micó, L; Gutiérrez, J; Hernández-Jaras, J; Ruiz-Cerda, J L

2018-01-27

Despite the improvement in the prognosis of lupus nephritis (LN), the cardiovascular morbimortality remains high. The early recognition and remission of flares, while trying to avoid the metabolic adverse effects of medication, must be mandatory. The aim of our study was to assess the cardiovascular (CV) risk profile in a cohort of lupus patients with preserved kidney function after a nephritis episode, compared to patients without a nephritis flare. 130 patients diagnosed of SLE (32 with previous nephritis flare and 98 without) were studied in order to evaluate the CV risk profile, despite the preserved kidney function. The most prevalent risk factors were sedentary lifestyle (57.6%), overweight/obesity (38.3%) and dyslipidemia (36%), followed by smoking (32%) and hypertension (16%). Though more than a half (53.1%) was taking CV medication, a high percentage did not reach a therapeutic target value, especially regarding obesity (11.5%) and cholesterol levels (LDL-C of 16%). The prevalence of dyslipidemia (53.1% vs 30.6%), smoking (46.6% vs 27.5%), left ventricular hypertrophy (LVH) (21.4% vs 6.4%) and lower HDL-C (48.6mg/dL vs 55.4mg/dL) were significantly different in the group with previous nephritis flare. Moreover, young patients with lupus nephritis, received more pulses of corticosteroids and cyclophosphamide, had higher prevalence of hypertension, LVH, higher proteinuria, hospital admissions and waist circumference, constituting the subgroup of patients with greater aggregation of CV risk factors. Patients with previous nephritis flare showed a poor control of CV risk factors despite the preserved renal function, these patients would require a closer therapeutic management. Copyright © 2017 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

Contrasting Eutrophication Risks and Countermeasures in Different Water Bodies: Assessments to Support Targeted Watershed Management

PubMed Central

Li, Tong; Chu, Chunli; Zhang, Yinan; Ju, Meiting; Wang, Yuqiu

2017-01-01

Eutrophication is a major problem in China. To combat this issue, the country needs to establish water quality targets, monitoring systems, and intelligent watershed management. This study explores a new watershed management method. Water quality is first assessed using a single factor index method. Then, changes in total nitrogen/total phosphorus (TN/TP) are analyzed to determine the limiting factor. Next, the study compares the eutrophication status of two water function districts, using a comprehensive nutritional state index method and geographic information system (GIS) visualization. Finally, nutrient sources are qualitatively analyzed. Two functional water areas in Tianjin, China were selected and analyzed: Qilihai National Wetland Nature Reserve and Yuqiao Reservoir. The reservoir is a drinking water source. Results indicate that total nitrogen (TN) and total phosphorus (TP) pollution are the main factors driving eutrophication in the Qilihai Wetland and Yuqiao Reservoir. Phosphorus was the limiting factor in the Yuqiao Reservoir; nitrogen was the limiting factor in the Qilihai Wetland. Pollution in Qilihai Wetland is more serious than in Yuqiao Reservoir. The study found that external sources are the main source of pollution. These two functional water areas are vital for Tianjin; as such, the study proposes targeted management measures. PMID:28661417

Simulation Training for the Office-Based Anesthesia Team.

PubMed

Ritt, Richard M; Bennett, Jeffrey D; Todd, David W

2017-05-01

An OMS office is a complex environment. Within such an environment, a diverse scope of complex surgical procedures is performed with different levels of anesthesia, ranging from local anesthesia to general anesthesia, on patients with varying comorbidities. Optimal patient outcomes require a functional surgical and anesthetic team, who are familiar with both standard operational principles and emergency recognition and management. Offices with high volume and time pressure add further stress and potential risk to the office environment. Creating and maintaining a functional surgical and anesthetic team that is competent with a culture of patient safety and risk reduction is a significant challenge that requires time, commitment, planning, and dedication. This article focuses on the role of simulation training in office training and preparation. Copyright © 2017 Elsevier Inc. All rights reserved.

The role of antisense oligonucleotide therapy in patients with familial hypercholesterolemia: risks, benefits, and management recommendations.

PubMed

Agarwala, Anandita; Jones, Peter; Nambi, Vijay

2015-01-01

Antisense oligonucleotide therapy is a promising approach for the treatment of a broad variety of medical conditions. It functions at the cellular level by interfering with RNA function, often leading to degradation of specifically targeted abnormal gene products implicated in the disease process. Mipomersen is a novel antisense oligonucleotide directed at apolipoprotein (apoB)-100, the primary apolipoprotein associated with low-density lipoprotein cholesterol (LDL-C), which has recently been approved for the treatment of familial hypercholesterolemia. A number of clinical studies have demonstrated its efficacy in lowering LDL-C and apoB levels in patients with elevated LDL-C despite maximal medical therapy using conventional lipid-lowering agents. This review outlines the risks and benefits of therapy and provides recommendations on the use of mipomersen.