Research and Evaluations of the Health Aspects of Disasters, Part IX: Risk-Reduction Framework.

PubMed

Birnbaum, Marvin L; Daily, Elaine K; O'Rourke, Ann P; Loretti, Alessandro

2016-06-01

A disaster is a failure of resilience to an event. Mitigating the risks that a hazard will progress into a destructive event, or increasing the resilience of a society-at-risk, requires careful analysis, planning, and execution. The Disaster Logic Model (DLM) is used to define the value (effects, costs, and outcome(s)), impacts, and benefits of interventions directed at risk reduction. A Risk-Reduction Framework, based on the DLM, details the processes involved in hazard mitigation and/or capacity-building interventions to augment the resilience of a community or to decrease the risk that a secondary event will develop. This Framework provides the structure to systematically undertake and evaluate risk-reduction interventions. It applies to all interventions aimed at hazard mitigation and/or increasing the absorbing, buffering, or response capacities of a community-at-risk for a primary or secondary event that could result in a disaster. The Framework utilizes the structure provided by the DLM and consists of 14 steps: (1) hazards and risks identification; (2) historical perspectives and predictions; (3) selection of hazard(s) to address; (4) selection of appropriate indicators; (5) identification of current resilience standards and benchmarks; (6) assessment of the current resilience status; (7) identification of resilience needs; (8) strategic planning; (9) selection of an appropriate intervention; (10) operational planning; (11) implementation; (12) assessments of outputs; (13) synthesis; and (14) feedback. Each of these steps is a transformation process that is described in detail. Emphasis is placed on the role of Coordination and Control during planning, implementation of risk-reduction/capacity building interventions, and evaluation. Birnbaum ML , Daily EK , O'Rourke AP , Loretti A . Research and evaluations of the health aspects of disasters, part IX: Risk-Reduction Framework. Prehosp Disaster Med. 2016;31(3):309-325.

Five-year healthcare utilization and costs among lower-risk drinkers following alcohol treatment.

PubMed

Kline-Simon, Andrea H; Weisner, Constance M; Parthasarathy, Sujaya; Falk, Daniel E; Litten, Raye Z; Mertens, Jennifer R

2014-02-01

Lower-risk drinking is increasingly being examined as a treatment outcome for some patients following addiction treatment. However, few studies have examined the relationship between drinking status (lower-risk drinking in particular) and healthcare utilization and cost, which has important policy implications. Participants were adults with alcohol dependence and/or abuse diagnoses who received outpatient alcohol and other drug treatment in a private, nonprofit integrated healthcare delivery system and had a follow-up interview 6 months after treatment entry (N = 995). Associations between past 30-day drinking status at 6 months (abstinence, lower-risk drinking defined as nonabstinence and no days of 5+ drinking, and heavy drinking defined as 1 or more days of 5+ drinking) and repeated measures of at least 1 emergency department (ED), inpatient or primary care visit, and their costs over 5 years were examined using mixed-effects models. We modeled an interaction between time and drinking status to examine trends in utilization and costs over time by drinking group. Heavy drinkers and lower-risk drinkers were not significantly different from the abstainers in their cost or utilization at time 0 (i.e., 6 months postintake). Heavy drinkers had increasing odds of inpatient (p < 0.01) and ED (p < 0.05) utilization over 5 years compared with abstainers. Lower-risk drinkers and abstainers did not significantly differ in their service use in any category over time. No differences were found in changes in primary care use among the 3 groups over time. The cost analyses paralleled the utilization results. Heavy drinkers had increasing ED (p < 0.05) and inpatient (p < 0.001) costs compared with the abstainers; primary care costs did not significantly differ. Lower-risk drinkers did not have significantly different medical costs compared with those who were abstinent over 5 years. However, post hoc analyses found lower-risk drinkers and heavy drinkers to not significantly differ in their ED use or costs over time. Performance measures for treatment settings that consider treatment outcomes may need to take into account both abstinence and reduction to nonheavy drinking. Future research should examine whether results are replicated in harm reduction treatment, or whether such outcomes are found only in abstinence-based treatment. Copyright © 2013 by the Research Society on Alcoholism.

Skills training versus health education to prevent STDs/HIV in heterosexual women: a randomized controlled trial utilizing biological outcomes.

PubMed

Baker, Sharon A; Beadnell, Blair; Stoner, Susan; Morrison, Diane M; Gordon, Judith; Collier, Cheza; Knox, Kay; Wickizer, Lauren; Stielstra, Sorrel

2003-02-01

We compared the effectiveness of two different 16-session group interventions for reducing new STD infection among heterosexual women. Two hundred twenty-nine at-risk heterosexual women were randomly assigned to skills training (ST) based on the relapse prevention model or health education (HE). Participants were monitored during the year following intervention for STD acquisition, self-reports of sexual behavior, and risk reduction skills. Participants in the ST intervention were significantly less likely to be diagnosed with a STD in the year following intervention and demonstrated superior risk reduction skills at 12-month follow-up. Both conditions showed statistically significant reductions in self reports of risky sexual behavior following intervention and at 12-month follow-up. In this sample, the ST intervention was superior to HE for reducing STD acquisition.

The Wild Wild West: A Framework to Integrate mHealth Software Applications and Wearables to Support Physical Activity Assessment, Counseling and Interventions for Cardiovascular Disease Risk Reduction

PubMed Central

Lobelo, Felipe; Kelli, Heval M.; Tejedor, Sheri Chernetsky; Pratt, Michael; McConnell, Michael V.; Martin, Seth S.; Welk, Gregory J.

2017-01-01

Physical activity (PA) interventions constitute a critical component of cardiovascular disease (CVD) risk reduction programs. Objective mobile health (mHealth) software applications (apps) and wearable activity monitors (WAMs) can advance both assessment and integration of PA counseling in clinical settings and support community-based PA interventions. The use of mHealth technology for CVD risk reduction is promising, but integration into routine clinical care and population health management has proven challenging. The increasing diversity of available technologies and the lack of a comprehensive guiding framework are key barriers for standardizing data collection and integration. This paper reviews the validity, utility and feasibility of implementing mHealth technology in clinical settings and proposes an organizational framework to support PA assessment, counseling and referrals to community resources for CVD risk reduction interventions. This integration framework can be adapted to different clinical population needs. It should also be refined as technologies and regulations advance under an evolving health care system landscape in the United States and globally. PMID:26923067

The Wild Wild West: A Framework to Integrate mHealth Software Applications and Wearables to Support Physical Activity Assessment, Counseling and Interventions for Cardiovascular Disease Risk Reduction.

PubMed

Lobelo, Felipe; Kelli, Heval M; Tejedor, Sheri Chernetsky; Pratt, Michael; McConnell, Michael V; Martin, Seth S; Welk, Gregory J

2016-01-01

Physical activity (PA) interventions constitute a critical component of cardiovascular disease (CVD) risk reduction programs. Objective mobile health (mHealth) software applications (apps) and wearable activity monitors (WAMs) can advance both assessment and integration of PA counseling in clinical settings and support community-based PA interventions. The use of mHealth technology for CVD risk reduction is promising, but integration into routine clinical care and population health management has proven challenging. The increasing diversity of available technologies and the lack of a comprehensive guiding framework are key barriers for standardizing data collection and integration. This paper reviews the validity, utility and feasibility of implementing mHealth technology in clinical settings and proposes an organizational framework to support PA assessment, counseling and referrals to community resources for CVD risk reduction interventions. This integration framework can be adapted to different clinical population needs. It should also be refined as technologies and regulations advance under an evolving health care system landscape in the United States and globally. Copyright © 2016 Elsevier Inc. All rights reserved.

Twitter as a Potential Disaster Risk Reduction Tool. Part II: Descriptive Analysis of Identified Twitter Activity during the 2013 Hattiesburg F4 Tornado

PubMed Central

Cooper, Guy Paul; Yeager, Violet; Burkle, Frederick M.; Subbarao, Italo

2015-01-01

Background: This article describes a novel triangulation methodological approach for identifying twitter activity of regional active twitter users during the 2013 Hattiesburg EF-4 Tornado. Methodology: A data extraction and geographically centered filtration approach was utilized to generate Twitter data for 48 hrs pre- and post-Tornado. The data was further validated using six sigma approach utilizing GPS data. Results: The regional analysis revealed a total of 81,441 tweets, 10,646 Twitter users, 27,309 retweets and 2637 tweets with GPS coordinates. Conclusions: Twitter tweet activity increased 5 fold during the response to the Hattiesburg Tornado.  Retweeting activity increased 2.2 fold. Tweets with a hashtag increased 1.4 fold. Twitter was an effective disaster risk reduction tool for the Hattiesburg EF-4 Tornado 2013.  PMID:26203396

Emergency Water Planning for Natural and Man-Made Emergencies: An Analytical Bibliography.

DTIC Science & Technology

1987-04-01

provide for fast recovery from disaster damages. The most frequently considered elements of such plans include (1) establishing emergency...which utilities may restrict the supply of water available to customers by manipulating the physical system: (1) pressure reduction, (2) intermittent ...shutoff, and (3) complete shutoff. Both pressure reduction and intermittent shutoff pose the risk of damages to the" system resulting from negative

Linearity and Nonlinearity in HIV/STI Transmission: Implications for the Evaluation of Sexual Risk Reduction Interventions

ERIC Educational Resources Information Center

Pinkerton, Steven D.; Chesson, Harrell W.; Crosby, Richard A.; Layde, Peter M.

2011-01-01

A mathematical model of HIV/sexually transmitted infections (STI) transmission was used to examine how linearity or nonlinearity in the relationship between the number of unprotected sex acts (or the number of sex partners) and the risk of acquiring HIV or a highly infectious STI (such as gonorrhea or chlamydia) affects the utility of sexual…

Real-time assessment of fog-related crashes using airport weather data: a feasibility analysis.

PubMed

Ahmed, Mohamed M; Abdel-Aty, Mohamed; Lee, Jaeyoung; Yu, Rongjie

2014-11-01

The effect of reduction of visibility on crash occurrence has recently been a major concern. Although visibility detection systems can help to mitigate the increased hazard of limited-visibility, such systems are not widely implemented and many locations with no systems are experiencing considerable number of fatal crashes due to reduction in visibility caused by fog and inclement weather. On the other hand, airports' weather stations continuously monitor all climate parameters in real-time, and the gathered data may be utilized to mitigate the increased risk for the adjacent roadways. This study aims to examine the viability of using airport weather information in real-time road crash risk assessment in locations with recurrent fog problems. Bayesian logistic regression was utilized to link six years (2005-2010) of historical crash data to real-time weather information collected from eight airports in the State of Florida, roadway characteristics and aggregate traffic parameters. The results from this research indicate that real-time weather data collected from adjacent airports are good predictors to assess increased risk on highways. Copyright © 2014 Elsevier Ltd. All rights reserved.

Evaluating the impact of prioritization of antiretroviral pre-exposure prophylaxis (PrEP) in New York City

PubMed Central

Kessler, Jason; Myers, Julie E.; Nucifora, Kimberly A.; Mensah, Nana; Toohey, Christopher; Khademi, Amin; Cutler, Blayne; Braithwaite, R. Scott

2015-01-01

Objective To compare the value and effectiveness of different prioritization strategies of pre-exposure prophylaxis (PrEP) in New York City (NYC). Design Mathematical modeling utilized as clinical trial is not feasible. Methods Using a model accounting for both sexual and parenteral transmission of HIV we compare different prioritization strategies (PPS) for PrEP to two scenarios—no PrEP and PrEP for all susceptible at-risk individuals. The PPS included PrEP for all MSM, only high-risk MSM, high-risk heterosexuals, and injection drug users, and all combinations of these four strategies. Outcomes included HIV infections averted, and incremental cost effectiveness (per-infection averted) ratios. Initial assumptions regarding PrEP included a 44% reduction in HIV transmission, 50% uptake in the prioritized population and an annual cost per person of $9,762. Sensitivity analyses on key parameters were conducted. Results Prioritization to all MSM results in a 19% reduction in new HIV infections. Compared to PrEP for all persons at-risk this PPS retains 79% of the preventative effect at 15% of the total cost. PrEP prioritized to only high-risk MSM results in a reduction in new HIV infections of 15%. This PPS retains 60% of the preventative effect at 6% of the total cost. There are diminishing returns when PrEP utilization is expanded beyond this group. Conclusions PrEP implementation is relatively cost-inefficient under our initial assumptions. Our results suggest that PrEP should first be promoted among MSM who are at particularly high-risk of HIV acquisition. Further expansion beyond this group may be cost-effective, but is unlikely to be cost-saving. PMID:25493594

ExMC Work Prioritization Process

NASA Technical Reports Server (NTRS)

Simon, Matthew

2015-01-01

Last year, NASA's Human Research Program (HRP) introduced the concept of a "Path to Risk Reduction" (PRR), which will provide a roadmap that shows how the work being done within each HRP element can be mapped to reducing or closing exploration risks. Efforts are currently underway within the Exploration Medical Capability (ExMC) Element to develop a structured, repeatable process for prioritizing work utilizing decision analysis techniques and risk estimation tools. The goal of this effort is to ensure that the work done within the element maximizes risk reduction for future exploration missions in a quantifiable way and better aligns with the intent and content of the Path to Risk Reduction. The Integrated Medical Model (IMM) will be used to identify those conditions that are major contributors of medical risk for a given design reference mission. For each of these conditions, potential prevention, screening, diagnosis, and treatment methods will be identified. ExMC will then aim to prioritize its potential investments in these mitigation methods based upon their potential for risk reduction and other factors such as vehicle performance impacts, near term schedule needs, duplication with external efforts, and cost. This presentation will describe the process developed to perform this prioritization and inform investment discussions in future element planning efforts. It will also provide an overview of the required input information, types of process participants, figures of merit, and the expected outputs of the process.

Eliciting affect via immersive virtual reality: a tool for adolescent risk reduction.

PubMed

Hadley, Wendy; Houck, Christopher D; Barker, David H; Garcia, Abbe Marrs; Spitalnick, Josh S; Curtis, Virginia; Roye, Scott; Brown, Larry K

2014-04-01

A virtual reality environment (VRE) was designed to expose participants to substance use and sexual risk-taking cues to examine the utility of VR in eliciting adolescent physiological arousal. 42 adolescents (55% male) with a mean age of 14.54 years (SD = 1.13) participated. Physiological arousal was examined through heart rate (HR), respiratory sinus arrhythmia (RSA), and self-reported somatic arousal. A within-subject design (neutral VRE, VR party, and neutral VRE) was utilized to examine changes in arousal. The VR party demonstrated an increase in physiological arousal relative to a neutral VRE. Examination of individual segments of the party (e.g., orientation, substance use, and sexual risk) demonstrated that HR was significantly elevated across all segments, whereas only the orientation and sexual risk segments demonstrated significant impact on RSA. This study provides preliminary evidence that VREs can be used to generate physiological arousal in response to substance use and sexual risk cues.

Fall risk assessment and prevention.

PubMed

Kline, Nancy E; Davis, Mary Elizabeth; Thom, Bridgette

2011-02-01

Patient falls are a common cause of morbidity and are the leading cause of injury deaths in adults age 65 years and older. Injuries sustained as result of falls in a cancer hospital are often severe, regardless of patient age, due to the nature of the underlying cancer. Falls are a nursing-sensitive indicator and nurses are in a unique position to assess, design, implement, and evaluate programs for fall risk reduction. We analyzed our nursing processes related to falls and fall prevention in conjunction with an evidence-based review, a research study to improve our fall risk-assessment process, and development of a comprehensive fall-reduction program. This article outlines how our institution developed a fall risk assessment for the oncology patient population, and utilized this assessment in a comprehensive nursing approach to fall prevention in both inpatient and outpatient settings.

Impact of Publicly Financed Health Insurance Schemes on Healthcare Utilization and Financial Risk Protection in India: A Systematic Review.

PubMed

Prinja, Shankar; Chauhan, Akashdeep Singh; Karan, Anup; Kaur, Gunjeet; Kumar, Rajesh

2017-01-01

Several publicly financed health insurance schemes have been launched in India with the aim of providing universalizing health coverage (UHC). In this paper, we report the impact of publicly financed health insurance schemes on health service utilization, out-of-pocket (OOP) expenditure, financial risk protection and health status. Empirical research studies focussing on the impact or evaluation of publicly financed health insurance schemes in India were searched on PubMed, Google scholar, Ovid, Scopus, Embase and relevant websites. The studies were selected based on two stage screening PRISMA guidelines in which two researchers independently assessed the suitability and quality of the studies. The studies included in the review were divided into two groups i.e., with and without a comparison group. To assess the impact on utilization, OOP expenditure and health indicators, only the studies with a comparison group were reviewed. Out of 1265 articles screened after initial search, 43 studies were found eligible and reviewed in full text, finally yielding 14 studies which had a comparator group in their evaluation design. All the studies (n-7) focussing on utilization showed a positive effect in terms of increase in the consumption of health services with introduction of health insurance. About 70% studies (n-5) studies with a strong design and assessing financial risk protection showed no impact in reduction of OOP expenditures, while remaining 30% of evaluations (n-2), which particularly evaluated state sponsored health insurance schemes, reported a decline in OOP expenditure among the enrolled households. One study which evaluated impact on health outcome showed reduction in mortality among enrolled as compared to non-enrolled households, from conditions covered by the insurance scheme. While utilization of healthcare did improve among those enrolled in the scheme, there is no clear evidence yet to suggest that these have resulted in reduced OOP expenditures or higher financial risk protection.

Impact of Publicly Financed Health Insurance Schemes on Healthcare Utilization and Financial Risk Protection in India: A Systematic Review

PubMed Central

Chauhan, Akashdeep Singh; Karan, Anup; Kaur, Gunjeet; Kumar, Rajesh

2017-01-01

Several publicly financed health insurance schemes have been launched in India with the aim of providing universalizing health coverage (UHC). In this paper, we report the impact of publicly financed health insurance schemes on health service utilization, out-of-pocket (OOP) expenditure, financial risk protection and health status. Empirical research studies focussing on the impact or evaluation of publicly financed health insurance schemes in India were searched on PubMed, Google scholar, Ovid, Scopus, Embase and relevant websites. The studies were selected based on two stage screening PRISMA guidelines in which two researchers independently assessed the suitability and quality of the studies. The studies included in the review were divided into two groups i.e., with and without a comparison group. To assess the impact on utilization, OOP expenditure and health indicators, only the studies with a comparison group were reviewed. Out of 1265 articles screened after initial search, 43 studies were found eligible and reviewed in full text, finally yielding 14 studies which had a comparator group in their evaluation design. All the studies (n-7) focussing on utilization showed a positive effect in terms of increase in the consumption of health services with introduction of health insurance. About 70% studies (n-5) studies with a strong design and assessing financial risk protection showed no impact in reduction of OOP expenditures, while remaining 30% of evaluations (n-2), which particularly evaluated state sponsored health insurance schemes, reported a decline in OOP expenditure among the enrolled households. One study which evaluated impact on health outcome showed reduction in mortality among enrolled as compared to non-enrolled households, from conditions covered by the insurance scheme. While utilization of healthcare did improve among those enrolled in the scheme, there is no clear evidence yet to suggest that these have resulted in reduced OOP expenditures or higher financial risk protection. PMID:28151946

Endoscopic sinus surgery reduces antibiotic utilization in rhinosinusitis

PubMed Central

Bhandarkar, Naveen D.; Mace, Jess C.; Smith, Timothy L.

2011-01-01

Background Antibiotics are a mainstay of treatment for chronic rhinosinusitis (CRS) and recurrent acute rhinosinusitis (RARS). Although quality-of-life outcomes following endoscopic sinus surgery (ESS) have been previously studied, the change in antibiotic utilization following ESS is less well known. Objective We aimed to determine the effect of ESS on antibiotic utilization in CRS and RARS. Methods A multi-institutional, prospective cohort of patients with CRS and RARS was enrolled between January, 2001 and January, 2009. Patients completed the medication subscale of the Chronic Sinusitis Survey, and the Wilcoxon signed-rank test was used to compare differences in the overall reported time of antibiotic between preoperative and postoperative time points. Results 503 patients were followed for an average 17.3 months. Overall, patients reported a 57.2% reduction in time on antibiotics following ESS. The majority of patients (60.4%) reported significantly less antibiotic utilization after ESS (p<0.001) consisting of an 83.7% reduction in the time on antibiotics. Subgroup analysis also revealed a significant reduction in antibiotic utilization for patients with and without nasal polyposis (59.0% and 58.2%; both p<0.001) as well as RARS (61.2%; p=0.001). Conclusion ESS significantly reduces antibiotic utilization for CRS and RARS. This finding demonstrates potential for lower health care expenditures related to antibiotics, as well as reduced risk of both antibiotic related morbidity and development of bacterial resistance. PMID:21666846

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

PubMed

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

2017-09-01

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

Community-based harm reduction substance abuse treatment with methamphetamine-using men who have sex with men.

PubMed

Carrico, Adam W; Flentje, Annesa; Gruber, Valerie A; Woods, William J; Discepola, Michael V; Dilworth, Samantha E; Neilands, Torsten B; Jain, Jennifer; Siever, Michael D

2014-06-01

Harm reduction approaches endeavor to assist individuals with avoiding the most detrimental consequences of risk taking behaviors, but limited research has documented the outcomes of harm reduction substance abuse treatment. In total, 211 methamphetamine-using men who have sex with men (MSM) enrolled in two outcome studies of substance abuse treatment programs that were implementing an evidence-based, cognitive-behavioral intervention (i.e., the Matrix Model) from a harm reduction perspective. Study 1 (N = 123) examined changes in self-reported substance use, Addiction Severity Index (ASI) composite scores, and HIV care indicators over a 12-month follow-up. Study 2 (N = 88) assessed changes in substance use, sexual risk taking, and HIV care indicators over a 6-month follow-up. Participants in study 1 reported reductions in cocaine/crack use as well as decreases in the ASI drug and employment composite scores. Among HIV-positive participants in study 1 (n = 75), 47 % initiated or consistently utilized anti-retroviral therapy and this was paralleled by significant increases in self-reported undetectable HIV viral load. Study 2 participants reported reductions in methamphetamine use, erectile dysfunction medication use in combination with other substances, and sexual risk-taking behavior while using methamphetamine. Participants in both studies reported concurrent increases in marijuana use. Taken together, these studies are among the first to observe that clients may reduce stimulant use and concomitant sexual risk-taking behavior during harm reduction substance abuse treatment. Randomized controlled trials are needed to examine the differential effectiveness of harm reduction and abstinence-based approaches to substance abuse treatment.

Stochastic optimal generation bid to electricity markets with emissions risk constraints.

PubMed

Heredia, F-Javier; Cifuentes-Rubiano, Julián; Corchero, Cristina

2018-02-01

There are many factors that influence the day-ahead market bidding strategies of a generation company (GenCo) within the framework of the current energy market. Environmental policy issues are giving rise to emission limitation that are becoming more and more important for fossil-fueled power plants, and these must be considered in their management. This work investigates the influence of the emissions reduction plan and the incorporation of the medium-term derivative commitments in the optimal generation bidding strategy for the day-ahead electricity market. Two different technologies have been considered: the high-emission technology of thermal coal units and the low-emission technology of combined cycle gas turbine units. The Iberian Electricity Market (MIBEL) and the Spanish National Emissions Reduction Plan (NERP) defines the environmental framework for dealing with the day-ahead market bidding strategies. To address emission limitations, we have extended some of the standard risk management methodologies developed for financial markets, such as Value-at-Risk (VaR) and Conditional Value-at-Risk (CVaR), thus leading to the new concept of Conditional Emission at Risk (CEaR). This study offers electricity generation utilities a mathematical model for determining the unit's optimal generation bid to the wholesale electricity market such that it maximizes the long-term profits of the utility while allowing it to abide by the Iberian Electricity Market rules as well as the environmental restrictions set by the Spanish National Emissions Reduction Plan. We analyze the economic implications for a GenCo that includes the environmental restrictions of this National Plan as well as the NERP's effects on the expected profits and the optimal generation bid. Copyright © 2017 Elsevier Ltd. All rights reserved.

Facilitating risk reduction among homeless and street-involved youth.

PubMed

Busen, Nancy H; Engebretson, Joan C

2008-11-01

The purposes of this evaluation project were to describe a group of homeless adolescents and street-involved youth who utilized a mobile unit that provided medical and mental healthcare services and to assess the efficacy of the services provided in reducing their health risk behaviors. The records of 95 youth aged 15-25 years who used the medical mobile unit for an average of 14 months were examined and evaluated according to the national health indicators related to risk reduction. Current literature related to health risk behavior among homeless youth was reviewed, synthesized, and provided the background for this article. Data were obtained from the records of mostly heterosexual youth with a mean age of 20.5 years. Approximately one third of the participants were high school graduates and most were without health insurance. Living situations were transient including friends, shelters, crash pads, or the streets. Abuse accounted for the majority leaving home. Psychiatric conditions and substance abuse were common. Medical conditions were related to transient living situations, substance abuse, and sexual activity. Success of the program was associated with sustained counseling, stabilizing youth on psychotropic medications, decreasing substance use, providing birth control and immunizations, and treating medical conditions. Homeless youth are one of the most underserved vulnerable populations in the United States with limited access and utilization of appropriate healthcare services. Nurse practitioners often serve as care providers but are also in a position to effectively lobby to improve health care for homeless youth through professional organizations and community activism. Furthermore, when designing and evaluating healthcare services, multidisciplinary teams need to consider risk reduction for homeless youth in the context of their environment.

The pharmacoeconomic benefits of cholesterol reduction.

PubMed

Gonzalez, E R

1998-02-01

Recent studies show that cholesterol-lowering therapy can reduce morbidity and mortality in hypercholesterolemic patients without preexisting coronary heart disease (primary prevention) and with coronary heart disease (secondary prevention). The high cost of treatment per event prevented, especially for primary prevention, raises concerns about widespread use of cholesterol-lowering therapy. Does cholesterol reduction reduce utilization of healthcare resources, and can society afford to pay for reducing cholesterol in all patients with hypercholesterolemia, irrespective of risk factors? Is cost-effectiveness of therapy affected by differing cholesterol levels, age of the patients, the duration of therapy, or the presence of risk factors? Current pharmacoeconomic studies support the use of the statins for secondary prevention, and primary prevention in high-risk patients, and provide key information for policy decision making in the treatment of patients with hypercholesterolemia.

Recent innovation of geospatial information technology to support disaster risk management and responses

NASA Astrophysics Data System (ADS)

Une, Hiroshi; Nakano, Takayuki

2018-05-01

Geographic location is one of the most fundamental and indispensable information elements in the field of disaster response and prevention. For example, in the case of the Tohoku Earthquake in 2011, aerial photos taken immediately after the earthquake greatly improved information sharing among different government offices and facilitated rescue and recovery operations, and maps prepared after the disaster assisted in the rapid reconstruction of affected local communities. Thanks to the recent development of geospatial information technology, this information has become more essential for disaster response activities. Advancements in web mapping technology allows us to better understand the situation by overlaying various location-specific data on base maps on the web and specifying the areas on which activities should be focused. Through 3-D modelling technology, we can have a more realistic understanding of the relationship between disaster and topography. Geospatial information technology can sup-port proper preparation and emergency responses against disasters by individuals and local communities through hazard mapping and other information services using mobile devices. Thus, geospatial information technology is playing a more vital role on all stages of disaster risk management and responses. In acknowledging geospatial information's vital role in disaster risk reduction, the Sendai Framework for Disaster Risk Reduction 2015-2030, adopted at the Third United Nations World Conference on Disaster Risk Reduction, repeatedly reveals the importance of utilizing geospatial information technology for disaster risk reduction. This presentation aims to report the recent practical applications of geospatial information technology for disaster risk management and responses.

Colorectal cancer mortality reduction is associated with having at least 1 colonoscopy within the previous 10 years among a population-wide cohort of screening age.

PubMed

Stock, David; Paszat, Lawrence F; Rabeneck, Linda

2016-07-01

Colonoscopy has been demonstrated to be effective in colorectal cancer (CRC) mortality reduction, although current screening guidelines have yet to be evaluated. We assessed the protective benefit of colonoscopy within the previous 10 years and whether this effect is maintained with age. We used administrative data to compare risk of CRC death (CCD) across colonoscopy utilization among a population-wide cohort comprising individuals aged 60 to 80 years (N = 1,509,423). Baseline and time-dependent colonoscopy exposure models were assessed in the context of competing "other causes of death" (OCDs). Cumulative incidence of CCD and OCD across colonoscopy exposure, over follow-up, was estimated. Relative hazards were computed by age strata (60-69 years, 70-74 years, 75+ years) and proximal and distal cancer subsites. At least 1 colonoscopy during 10 years before baseline was estimated to provide a 51% reduced hazard of CCD (hazard ratio [HR] 0.49; 95% confidence interval [CI], 0.45-0.54) over the following 8 years. When colonoscopy was modeled as a time-dependent covariate, the risk of CCD was further diminished (multivariable-adjusted HR 0.36; 95% CI, 0.33-0.38). Stratified analyses suggested moderately attenuated CCD risk reduction among the oldest age group; however, consideration of OCDs suggest that this is related to competing risks. CCD risk reduction related to colonoscopy was lower for proximal cancers. Colonoscopy within the previous 10 years provides substantial protective benefit for average-risk individuals over 60 years. CCD risk reduction may be maintained well beyond 74 years, a common upper age limit recommended by screening guidelines. Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Applying Systems Thinking to Law Enforcement Safety: Recommendation for a Comprehensive Safety Management Framework

DTIC Science & Technology

2015-12-01

Occupational Injuries COPS Community Oriented Policing Services CRM Crew Resource Management DA Department of the Army FEMA Federal Emergency...establishes composite risk management ( CRM ), also known as crew resource management, “as the Army’s principal risk reduction methodology and assures...regulatory and statutory compliance.”106 CRM , also utilized by other branches within the military and by the aviation industry, is intended “to minimize

Reductions in employee productivity impairment observed after implementation of web-based worksite health promotion programs.

PubMed

Silberman, Jordan; Schwartz, Steven; Giuseffi, Danielle L; Wang, Chun; Nevedal, Dana; Bedrosian, Richard

2011-12-01

To assess changes in employee productivity impairment observed after the implementation of several Web-based health promotion programs. Health risk assessments and self-report measures of productivity impairment were administered on-line to more than 43,000 participants of Web-based health promotion programs. Reductions in productivity impairment were observed after 1 month of program utilization. Productivity impairment at 90- and 180-day follow-ups also decreased relative to baseline. Improvements in employee health were associated with reductions in employee productivity impairment. The use of Web-based health promotion programs was associated with reductions in productivity impairment and improvements in employee health. After the implementation of Web-based health promotion programs, reductions in productivity impairment may be observed before reductions in direct health care costs.

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

PubMed

Kobayashi, Yuta; Mori, Akira S

2017-05-01

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

Risk Reduction via Greener Synthesis of Noble Metal Nanostructures and Nanocomposites (Presentation)

EPA Science Inventory

A brief account of greener production of nanoparticles which reduces or eliminates the use and generation of hazardous substances is presented. The utility of vitamins B1 and B2, which can function both as reducing and capping agents, provides an extremely simple, one-pot, greene...

Greener Synthesis of Nanomaterials: Risk Reduction Strategies and Environmental Applications

EPA Science Inventory

A brief account of a greener preparation of nanoparticles which reduces or eliminates the use and generation of hazardous substances is presented. The utility of vitamins B1, B2, and C which can function both as reducing and capping agents, provides an extremely simple and greene...

Are prenatal care resources distributed efficiently across high-risk and low-risk mothers?

PubMed

Mukhopadhyay, Sankar; Wendel, Jeanne

2008-09-01

The Institute for Clinical Systems Improvement recommends reducing the number of prenatal care visits recommended for low-risk women, citing evidence from a randomized clinical trial indicating that the reduction would not adversely impact infant health. We investigate the implicit hypothesis that prenatal care resources are not distributed efficiently across high-risk and low-risk women. Using clinic-reported prenatal care and an inclusive measure of infant health, we report evidence indicating inefficient resource utilization: prenatal care only boosts infant health when mothers have specific pre-existing diagnoses, but women with high potential to benefit from care do not obtain more care than other women.

Eliciting Affect via Immersive Virtual Reality: A Tool for Adolescent Risk Reduction

PubMed Central

Houck, Christopher D.; Barker, David H.; Garcia, Abbe Marrs; Spitalnick, Josh S.; Curtis, Virginia; Roye, Scott; Brown, Larry K.

2014-01-01

Objective A virtual reality environment (VRE) was designed to expose participants to substance use and sexual risk-taking cues to examine the utility of VR in eliciting adolescent physiological arousal. Methods 42 adolescents (55% male) with a mean age of 14.54 years (SD = 1.13) participated. Physiological arousal was examined through heart rate (HR), respiratory sinus arrhythmia (RSA), and self-reported somatic arousal. A within-subject design (neutral VRE, VR party, and neutral VRE) was utilized to examine changes in arousal. Results The VR party demonstrated an increase in physiological arousal relative to a neutral VRE. Examination of individual segments of the party (e.g., orientation, substance use, and sexual risk) demonstrated that HR was significantly elevated across all segments, whereas only the orientation and sexual risk segments demonstrated significant impact on RSA. Conclusions This study provides preliminary evidence that VREs can be used to generate physiological arousal in response to substance use and sexual risk cues. PMID:24365699

ASRS Reports on Wake Vortex Encounters

NASA Technical Reports Server (NTRS)

Connell, Linda J.; Taube, Elisa Ann; Drew, Charles Robert; Barclay, Tommy Earl

2010-01-01

ASRS is conducting a structured callback research project of wake vortex incidents reported to the ASRS at all US airports, as well as wake encounters in the enroute environment. This study has three objectives: (1) Utilize the established ASRS supplemental data collection methodology and provide ongoing analysis of wake vortex encounter reports; (2) Document event dynamics and contributing factors underlying wake vortex encounter events; and (3) Support ongoing FAA efforts to address pre-emptive wake vortex risk reduction by utilizing ASRS reporting contributions.

Combined circular external fixation and open reduction internal fixation with pro-syndesmotic screws for repair of a diabetic ankle fracture

PubMed Central

Facaros, Zacharia; Ramanujam, Crystal L.; Stapleton, John J.

2010-01-01

The surgical management of ankle fractures among the diabetic population is associated with higher complication rates compared to the general population. Efforts toward development of better methods in prevention and treatment are continuously evolving for these injuries. The presence of peripheral neuropathy and the possible development of Charcot neuroarthropathy in this high risk patient population have stimulated much surgical interest to create more stable osseous constructs when open reduction of an ankle fracture/dislocation is required. The utilization of multiple syndesmotic screws (pro-syndesmotic screws) to further stabilize the ankle mortise has been reported by many foot and ankle surgeons. In addition, transarticular Steinmann pins have been described as an adjunct to traditional open reduction with internal fixation (ORIF) of the ankle to better stabilize the talus, thus minimizing risk of further displacement, malunion, and Charcot neuroarthropathy. The authors present a unique technique of ORIF with pro-syndesmotic screws and the application of a multi-plane circular external fixator for management of a neglected diabetic ankle fracture that prevented further deformity while allowing a weight-bearing status. This techniqu may be utilized for the management of complex diabetic ankle fractures that are prone to future complications and possible limb loss. PMID:22396812

Health Care Utilization, Barriers to Care, and Hormone Usage Among Male-to-Female Transgender Persons in New York City

PubMed Central

Sanchez, John P.; Danoff, Ann

2009-01-01

Objectives. We investigated health care utilization, barriers to care, and hormone use among male-to-female transgender persons residing in New York City to determine whether current care is in accord with the World Professional Association for Transgender Health and the goals of Healthy People 2010. Methods. We conducted interviews with 101 male-to-female transgender persons from 3 community health centers in 2007. Results. Most participants reported having health insurance (77%; n = 78) and seeing a general practitioner in the past year (81%; n = 82). Over 25% of participants perceived the cost of medical care, access to specialists, and a paucity of transgender-friendly and transgender-knowledgeable providers as barriers to care. Being under a physician's care was associated with high-risk behavior reduction, including smoking cessation (P = .004) and obtaining needles from a licensed physician (P = .002). Male-to-female transgender persons under a physician's care were more likely to obtain hormone therapies from a licensed physician (P < .001). Conclusions. Utilization of health care providers by male-to-female transgender persons is associated with their reduction of some high-risk behaviors, but it does not result in adherence to standard of care recommendations for transgender individuals. PMID:19150911

Combination of BTrackS and Geri-Fit as a targeted approach for assessing and reducing the postural sway of older adults with high fall risk

PubMed Central

Goble, Daniel J; Hearn, Mason C; Baweja, Harsimran S

2017-01-01

Atypically high postural sway measured by a force plate is a known risk factor for falls in older adults. Further, it has been shown that small, but significant, reductions in postural sway are possible with various balance exercise interventions. In the present study, a new low-cost force-plate technology called the Balance Tracking System (BTrackS) was utilized to assess postural sway of older adults before and after 90 days of a well-established exercise program called Geri-Fit. Results showed an overall reduction in postural sway across all participants from pre- to post-intervention. However, the magnitude of effects was significantly influenced by the amount of postural sway demonstrated by individuals prior to Geri-Fit training. Specifically, more participants with atypically high postural sway pre-intervention experienced an overall postural sway reduction. These reductions experienced were typically greater than the minimum detectable change statistic for the BTrackS Balance Test. Taken together, these findings suggest that BTrackS is an effective means of identifying older adults with elevated postural sway, who are likely to benefit from Geri-Fit training to mitigate fall risk. PMID:28228655

Combination of BTrackS and Geri-Fit as a targeted approach for assessing and reducing the postural sway of older adults with high fall risk.

PubMed

Goble, Daniel J; Hearn, Mason C; Baweja, Harsimran S

2017-01-01

Atypically high postural sway measured by a force plate is a known risk factor for falls in older adults. Further, it has been shown that small, but significant, reductions in postural sway are possible with various balance exercise interventions. In the present study, a new low-cost force-plate technology called the Balance Tracking System (BTrackS) was utilized to assess postural sway of older adults before and after 90 days of a well-established exercise program called Geri-Fit. Results showed an overall reduction in postural sway across all participants from pre- to post-intervention. However, the magnitude of effects was significantly influenced by the amount of postural sway demonstrated by individuals prior to Geri-Fit training. Specifically, more participants with atypically high postural sway pre-intervention experienced an overall postural sway reduction. These reductions experienced were typically greater than the minimum detectable change statistic for the BTrackS Balance Test. Taken together, these findings suggest that BTrackS is an effective means of identifying older adults with elevated postural sway, who are likely to benefit from Geri-Fit training to mitigate fall risk.

Image Sharing Technologies and Reduction of Imaging Utilization: A Systematic Review and Meta-analysis.

PubMed

Vest, Joshua R; Jung, Hye-Young; Ostrovsky, Aaron; Das, Lala Tanmoy; McGinty, Geraldine B

2015-12-01

Image sharing technologies may reduce unneeded imaging by improving provider access to imaging information. A systematic review and meta-analysis were conducted to summarize the impact of image sharing technologies on patient imaging utilization. Quantitative evaluations of the effects of PACS, regional image exchange networks, interoperable electronic heath records, tools for importing physical media, and health information exchange systems on utilization were identified through a systematic review of the published and gray English-language literature (2004-2014). Outcomes, standard effect sizes (ESs), settings, technology, populations, and risk of bias were abstracted from each study. The impact of image sharing technologies was summarized with random-effects meta-analysis and meta-regression models. A total of 17 articles were included in the review, with a total of 42 different studies. Image sharing technology was associated with a significant decrease in repeat imaging (pooled effect size [ES] = -0.17; 95% confidence interval [CI] = [-0.25, -0.09]; P < .001). However, image sharing technology was associated with a significant increase in any imaging utilization (pooled ES = 0.20; 95% CI = [0.07, 0.32]; P = .002). For all outcomes combined, image sharing technology was not associated with utilization. Most studies were at risk for bias. Image sharing technology was associated with reductions in repeat and unnecessary imaging, in both the overall literature and the most-rigorous studies. Stronger evidence is needed to further explore the role of specific technologies and their potential impact on various modalities, patient populations, and settings. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Image Sharing Technologies and Reduction of Imaging Utilization: A Systematic Review and Meta-analysis

PubMed Central

Vest, Joshua R.; Jung, Hye-Young; Ostrovsky, Aaron; Das, Lala Tanmoy; McGinty, Geraldine B.

2016-01-01

Introduction Image sharing technologies may reduce unneeded imaging by improving provider access to imaging information. A systematic review and meta-analysis were conducted to summarize the impact of image sharing technologies on patient imaging utilization. Methods Quantitative evaluations of the effects of PACS, regional image exchange networks, interoperable electronic heath records, tools for importing physical media, and health information exchange systems on utilization were identified through a systematic review of the published and gray English-language literature (2004–2014). Outcomes, standard effect sizes (ESs), settings, technology, populations, and risk of bias were abstracted from each study. The impact of image sharing technologies was summarized with random-effects meta-analysis and meta-regression models. Results A total of 17 articles were included in the review, with a total of 42 different studies. Image sharing technology was associated with a significant decrease in repeat imaging (pooled effect size [ES] = −0.17; 95% confidence interval [CI] = [−0.25, −0.09]; P < .001). However, image sharing technology was associated with a significant increase in any imaging utilization (pooled ES = 0.20; 95% CI = [0.07, 0.32]; P = .002). For all outcomes combined, image sharing technology was not associated with utilization. Most studies were at risk for bias. Conclusions Image sharing technology was associated with reductions in repeat and unnecessary imaging, in both the overall literature and the most-rigorous studies. Stronger evidence is needed to further explore the role of specific technologies and their potential impact on various modalities, patient populations, and settings. PMID:26614882

Social Media Use and Sexual Risk Reduction Behavior Among Minority Youth: Seeking Safe Sex Information.

PubMed

Stevens, Robin; Gilliard-Matthews, Stacia; Dunaev, Jamie; Todhunter-Reid, Abigail; Brawner, Bridgette; Stewart, Jennifer

Sexual health is an important area of study-particularly for minority youth and youth living in disadvantaged neighborhoods. The purpose of the research was to examine the sources of sexual health information associated with youth adopting sexual risk reduction behaviors. Data collection took place in a small city in the Northeastern United States using cross-sectional behavioral surveys and modified venue-based sampling. Participants included 249 African American and Latino youth aged 13-24. Participants reported their sources of information about contraception and human immunodeficiency virus/sexually transmitted disease, such as TV/movies, parents, social media; their intentions to have sex; and condom and contraception use during their last sexual activity. Social media use, past pregnancy experience, past sexual history, age, and gender were also measured. Standard tests of bivariate association (chi-square and F tests) were used to examine initial associations between sexual risk reduction behavior and exposure to sexual risk reduction information on social media. Logistic regression models were used to test multivariate relationships between information sources and sexual risk reduction behavior. Youth who were exposed to sexual health messages on social media were 2.69 times (p < .05) and 2.49 times (p < .08) more likely to have used contraception or a condom at last intercourse, respectively. Parents, schools, or traditional media as information sources were not significantly associated with contractive use or condom use at last intercourse. Youth sexual behavior is increasingly informed by social media messages. Health practitioners should utilize social media as an important health promotion tool.

7 CFR 2.47 - Administrator, Rural Utilities Service.

Code of Federal Regulations, 2014 CFR

2014-01-01

... U.S.C. 9601 et seq.). (13) Administer the Distance Learning and Medical Link Programs (7 U.S.C... access requests and orders; compliance with Federal health and safety standards and wage and labor... (42 U.S.C. 9604(i)(11)), with respect to the reduction of exposure to significant risk to human health...

Risk Reduction in the Synthesis of Nanomaterials: Green Approach to Noble Metal Nanostructures and Nanocomposites

EPA Science Inventory

A brief account of greener production of nanoparticles which reduces or eliminates the use and generation of hazardous substances is presented. The utility of vitamins B₁ and B₂, which can function both as reducing and capping agents, provides an extremely s...

Further analysis of PREVAIL: enzalutamide use in chemotherapy-naïve men with metastatic castration-resistant prostate cancer

PubMed Central

Aragon-Ching, Jeanny B

2014-01-01

PREVAIL was a phase III multinational, double-blind, placebo-controlled trial that enrolled chemotherapy-naïve men with metastatic castration-resistant prostate cancer (mCRPC), which showed remarkable improvement in co-primary endpoints with an overall 81% reduction in the risk of radiographic progression, as well as 29% reduction in the risk of death in favor of the enzalutamide arm over placebo. All secondary endpoints including time to subsequent chemotherapy initiation and prostate specific antigen (PSA) progression were in favor of the enzalutamide arm. The results of PREVAIL shows the utility of enzalutamide that would likely soon expand the indication to asymptomatic or minimally symptomatic men with mCRPC not previously treated with chemotherapy. PMID:25080931

Further analysis of PREVAIL: enzalutamide use in chemotherapy-naïve men with metastatic castration-resistant prostate cancer.

PubMed

Aragon-Ching, Jeanny B

2014-01-01

PREVAIL was a phase III multinational, double-blind, placebo-controlled trial that enrolled chemotherapy-naïve men with metastatic castration-resistant prostate cancer (mCRPC), which showed remarkable improvement in co-primary endpoints with an overall 81% reduction in the risk of radiographic progression, as well as 29% reduction in the risk of death in favor of the enzalutamide arm over placebo. All secondary endpoints including time to subsequent chemotherapy initiation and prostate specific antigen (PSA) progression were in favor of the enzalutamide arm. The results of PREVAIL shows the utility of enzalutamide that would likely soon expand the indication to asymptomatic or minimally symptomatic men with mCRPC not previously treated with chemotherapy.

Salud Para Su Corazon (health for your heart) community health worker model: community and clinical approaches for addressing cardiovascular disease risk reduction in Hispanics/Latinos.

PubMed

Balcazar, H; Alvarado, M; Ortiz, G

2011-01-01

This article describes 6 Salud Para Su Corazon (SPSC) family of programs that have addressed cardiovascular disease risk reduction in Hispanic communities facilitated by community health workers (CHWs) or Promotores de Salud (PS). A synopsis of the programs illustrates the designs and methodological approaches that combine community-based participatory research for 2 types of settings: community and clinical. Examples are provided as to how CHWs can serve as agents of change in these settings. A description is presented of a sustainability framework for the SPSC family of programs. Finally, implications are summarized for utilizing the SPSC CHW/PS model to inform ambulatory care management and policy.

Workers' compensation loss prevention representative contact and risk of lost-time injury in construction policyholders.

PubMed

Schofield, Katherine E; Alexander, Bruce H; Gerberich, Susan G; MacLehose, Richard F

2017-09-01

Insurance loss prevention (LP) representatives have access and contact with businesses and employees to provide targeted safety and health resources. Construction firms, especially those smaller in size, are a high-risk population. This research evaluated the association between LP rep contact and risk for lost-time injuries in construction policyholders. Workers' compensation data were utilized to track LP rep contact with policyholders and incidence of lost-time injury over time. Survival analysis with repeated events modeling calculated hazard ratios (HR) and 95% confidence intervals (CI). Compared no LP contact, one contact was associated with a 27% reduction of risk (HR=0.73, CI=0.65-0.82), two with a 41% (HR=0.59, CI=0.51-0.68), and three or more contacts with a 28% reduction of risk (HR=0.72, CI=0.65-0.81). LP reps appear to be a valuable partner in efforts to reduce injury burden. Their presence or contact with policyholders is consistent with reduction in overall incidence of lost-time injuries. Reduction in lost-time injuries, resulting in reduced workers' compensation costs for policyholders and insurance companies, builds a business-case for safety and injury prevention. LP reps are often a low or no-cost benefit for insurance policyholders and may be an important injury prevention resource for small firms and/or those with lack of safety resources and staff. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Effect of Statin Intensity on the Risk of Epilepsy After Ischaemic Stroke: Real-World Evidence from Population-Based Health Claims.

PubMed

Lin, Fang-Ju; Lin, Hung-Wei; Ho, Yunn-Fang

2018-04-01

Statins possess neuroprotective effects. However, real-world evidence supporting their utility in post-stroke epilepsy (PSE) prevention is limited. The association between statin use, including timing of prescribing (pre-stroke vs post-stroke), type (lipophilicity, intensity of therapy) and dose intensity, and risk of developing PSE were investigated by studying Taiwanese health claims (2003-2013). Patients with new-onset ischaemic stroke were identified. The main outcome was a diagnosis of epilepsy after ischaemic stroke. According to pre-stroke statin use, groups of current users, former users, and non-users were compared using ANOVA. An extended Cox regression model was utilized to estimate the hazard ratio (HR) of PSE, with post-stroke statin use and certain comedications as time-dependent variables. Serial sensitivity analyses were performed to ensure study robustness. Of the 20,858 ischaemic stroke patients, 954 (4.6%) developed PSE. Post-stroke statin use (adjusted HR (aHR) 0.55; 95% confidence interval 0.46-0.67, p < 0.001), but not pre-stroke statin use was associated with a significantly reduced risk of developing PSE. A dose-response correlation was also observed between PSE risk reduction and quartiles of the statin cumulative defined daily dose (cDDD) (aHR 0.84, 0.67, 0.53, and 0.50 for the lowest, second, third, and highest quartiles of cDDD, respectively). Risk predictors and protectors against PSE were also characterized. The post-stroke use of statins after ischaemic stroke was associated with PSE risk reduction in a cDDD-dependent manner. Further clinical studies on the potential applications of statins for PSE prophylaxis, particularly among at-risk patients, are warranted.

How the Military Health System Can Fulfill the Promise. An Analysis of the Federal Employees Health Benefit Program for the DOD

DTIC Science & Technology

2007-04-01

over the other. If DoD utilized FEHBP, advantages of size, shifting financial risk to insurers, keeping the health benefit up to date, and improved... advantages in size, reduction of administrative costs, unifying the benefit , shifting financial risk to insurers, keeping the benefit up to date...FEDERAL EMPLOYEES HEALTH BENEFIT PROGRAM FOR THE DOD by Daniel E. Lee, Major, USAF A Research Report Submitted to the Faculty In Partial

Young people who use drugs engaged in harm reduction programs in New York City: Overdose and other risks.

PubMed

Calvo, Michele; MacFarlane, Jessica; Zaccaro, Heather; Curtis, Matthew; Cabán, María; Favaro, Jamie; Passannante, Marian R; Frost, Taeko

2017-09-01

Little is known about the engagement of young people who use drugs (PWUD) in harm reduction programs (HRPs), and few studies have included non-opioid users and non-injectors. While HRPs have effectively engaged PWUD, young people are under-represented in their services. The Injection Drug Users Health Alliance Citywide Study (IDUCS) is the largest community-based study of PWUD in HRPs in the US. From 2014-2015, 2421 HRP participants across New York City (NYC) completed a cross-sectional survey. We investigated differences in socio-demographics, service utilization, and risk behaviors between young (aged 18-30) and older participants and examined factors associated with overdose among young participants. The study included 257 young participants. They were significantly more likely than older participants to be white, educated, uninsured, unstably housed or homeless, and have a history of incarceration and residential drug treatment. They were more likely to report recent overdose but less likely to report knowledge of naloxone. Young participants also had higher rates of alcohol, marijuana, benzodiazepine, and injection drug use, and related risk behaviors such as public injection. Factors associated with past year overdose among young participants included experiencing symptoms of psychological distress (AOR=9.71), being unstably housed or homeless (AOR=4.39), and utilizing detox (AOR=4.20). Young PWUD who access services at HRPs in NYC differ significantly from their older counterparts. New York City and other urban centers that attract young PWUD should consider implementing harm reduction oriented services tailored to the unique needs of young people. Copyright © 2017. Published by Elsevier B.V.

Proceedings of Conference XIII, evaluation of regional seismic hazards and risk

USGS Publications Warehouse

Charonnat, Barbara B.

1981-01-01

The participants in the conference concluded that a great deal of useful research has been performed in the national Earthquake Hazards Reduction Program by USGS and non-USGS scientists and engineers and that the state-of-knowledge concerning the evaluation of seismic hazards and risk has been advanced substantially. Many of the technical issues raised during the conference are less controversial now because of new information and insights gained during the first three years of the expanded research program conducted under the Earthquake Hazards Reduction Act. Utilization of research results by many groups of users has also improved during this period and further improvement in utilization appears likely. Additional research is still required to resolve more completely the many complex technical issues summarized above and described in the papers contained in the proceedings. Improved certainty of research results on the evaluation of regional seismic hazards and risk is required before full utilization can be made by state and local governments who deal. with people frequently having a different perception of the hazard and its risk to them than that perceived by scientists or engineers. Each of the papers contained in the proceedings contain throughtful recommendations for improving the state-of-knowledge. Two papers, in particular, focussed on this particular theme. The first was presented by Lynn Sykes in the Geologic Keynote Address. He identified geographic areas throughout the world which may be considered as counterparts or analogues of seismic zones in the United States. He concluded that much can be learned about prediction, tectonic settings, earthquake hazards, and earthquake risk for sites in the United States by studying their tectonic analogues in other countries. The second paper was presented by John Blume in the Engineering Keynote Address. He suggested 20 specific research topics that, in his opinion, will significantly advance the state-of-the-art in earthquakeresistant design. The papers by Sykes and Blume are presented in the front of the proceedings.

The estimated effect of mass or footprint reduction in recent light-duty vehicles on U.S. societal fatality risk per vehicle mile traveled.

PubMed

Wenzel, Tom

2013-10-01

The National Highway Traffic Safety Administration (NHTSA) recently updated its 2003 and 2010 logistic regression analyses of the effect of a reduction in light-duty vehicle mass on US societal fatality risk per vehicle mile traveled (VMT; Kahane, 2012). Societal fatality risk includes the risk to both the occupants of the case vehicle as well as any crash partner or pedestrians. The current analysis is the most thorough investigation of this issue to date. This paper replicates the Kahane analysis and extends it by testing the sensitivity of his results to changes in the definition of risk, and the data and control variables used in the regression models. An assessment by Lawrence Berkeley National Laboratory (LBNL) indicates that the estimated effect of mass reduction on risk is smaller than in Kahane's previous studies, and is statistically non-significant for all but the lightest cars (Wenzel, 2012a). The estimated effects of a reduction in mass or footprint (i.e. wheelbase times track width) are small relative to other vehicle, driver, and crash variables used in the regression models. The recent historical correlation between mass and footprint is not so large to prohibit including both variables in the same regression model; excluding footprint from the model, i.e. allowing footprint to decrease with mass, increases the estimated detrimental effect of mass reduction on risk in cars and crossover utility vehicles (CUVs)/minivans, but has virtually no effect on light trucks. Analysis by footprint deciles indicates that risk does not consistently increase with reduced mass for vehicles of similar footprint. Finally, the estimated effects of mass and footprint reduction are sensitive to the measure of exposure used (fatalities per induced exposure crash, rather than per VMT), as well as other changes in the data or control variables used. It appears that the safety penalty from lower mass can be mitigated with careful vehicle design, and that manufacturers can reduce mass as a strategy to increase their vehicles' fuel economy and reduce greenhouse gas emissions without necessarily compromising societal safety. Published by Elsevier Ltd.

Global and local scale flood discharge simulations in the Rhine River basin for flood risk reduction benchmarking in the Flagship Project

NASA Astrophysics Data System (ADS)

Gädeke, Anne; Gusyev, Maksym; Magome, Jun; Sugiura, Ai; Cullmann, Johannes; Takeuchi, Kuniyoshi

2015-04-01

The global flood risk assessment is prerequisite to set global measurable targets of post-Hyogo Framework for Action (HFA) that mobilize international cooperation and national coordination towards disaster risk reduction (DRR) and requires the establishment of a uniform flood risk assessment methodology on various scales. To address these issues, the International Flood Initiative (IFI) has initiated a Flagship Project, which was launched in year 2013, to support flood risk reduction benchmarking at global, national and local levels. In the Flagship Project road map, it is planned to identify the original risk (1), to identify the reduced risk (2), and to facilitate the risk reduction actions (3). In order to achieve this goal at global, regional and local scales, international research collaboration is absolutely necessary involving domestic and international institutes, academia and research networks such as UNESCO International Centres. The joint collaboration by ICHARM and BfG was the first attempt that produced the first step (1a) results on the flood discharge estimates with inundation maps under way. As a result of this collaboration, we demonstrate the outcomes of the first step of the IFI Flagship Project to identify flood hazard in the Rhine river basin on the global and local scale. In our assessment, we utilized a distributed hydrological Block-wise TOP (BTOP) model on 20-km and 0.5-km scales with local precipitation and temperature input data between 1980 and 2004. We utilized existing 20-km BTOP model, which is applied globally, and constructed the local scale 0.5-km BTOP model for the Rhine River basin. For the BTOP model results, both calibrated 20-km and 0.5-km BTOP models had similar statistical performance and represented observed flood river discharges, epecially for 1993 and 1995 floods. From 20-km and 0.5-km BTOP simulation, the flood discharges of the selected return period were estimated using flood frequency analysis and were comparable to the the river gauging station data at the German part of the Rhine river basin. This is an important finding that both 0.5-km and 20-km BTOP models produce similar flood peak discharges although the 0.5-km BTOP model results indicate the importance of scale in the local flood hazard assessment. In summary, we highlight that this study serves as a demonstrative example of institutional collaboration and is stepping stone for the next step implementation of the IFI Flagship Project.

Cost effectiveness of drug eluting coronary artery stenting in a UK setting: cost-utility study.

PubMed

Bagust, A; Grayson, A D; Palmer, N D; Perry, R A; Walley, T

2006-01-01

To assess the cost effectiveness of drug eluting stents (DES) compared with conventional stents for treatment of symptomatic coronary artery disease in the UK. Cost-utility analysis of audit based patient subgroups by means of a simple economic model. Tertiary care. 12 month audit data for 2884 patients receiving percutaneous coronary intervention with stenting at the Cardiothoracic Centre Liverpool between January 2000 and December 2002. Risk of repeat revascularisation within 12 months of index procedure and reduction in risk from use of DES. Economic modelling was used to estimate the cost-utility ratio and threshold price premium. Four factors were identified for patients undergoing elective surgery (n = 1951) and two for non-elective surgery (n = 933) to predict risk of repeat revascularisation within 12 months. Most patients fell within the subgroup with lowest risk (57% of the elective surgery group with 5.6% risk and 91% of the non-elective surgery group with 9.9% risk). Modelled cost-utility ratios were acceptable for only one group of high risk patients undergoing non-elective surgery (only one patient in audit data). Restricting the number of DES for each patient improved results marginally: 4% of stents could then be drug eluting on economic grounds. The threshold price premium justifying 90% substitution of conventional stents was estimated to be 112 pound sterling (212 USD, 162 pound sterling) (sirolimus stents) or 89 pound sterling (167 USD, 130 pound sterling) (paclitaxel stents). At current UK prices, DES are not cost effective compared with conventional stents except for a small minority of patients. Although the technology is clearly effective, general substitution is not justified unless the price premium falls substantially.

Selected winglet and mixed flow long duct nacelle development for DC-10 derivative aircraft

NASA Technical Reports Server (NTRS)

Taylor, A. B.

1980-01-01

The high speed cruise drag effects of the installation of winglets and a wing tip extension and a mixed flow long duct nacelle are investigated. The winglet program utilized a 4.7 percent semispan model in an eight foot transonic wind tunnel. Winglets provided approximately twice the cruise drag reduction of wing tip extensions for about the same increase in bending moment at the wing-fuselage juncture. The long duct nacelle interference drag program utilized the same model, without the winglets, in the 11 foot transonic wind tunnel. The long duct nacelle, installed in the same position as the current short duct nacelle and with the current production symmetric pylon, was a relatively low risk installation. A pylon with an addition small rearward fairing was also tested and showed some drag reduction potential over the current pylon.

Dyslipidemia: management using optimal lipid-lowering therapy.

PubMed

Ito, Matthew K

2012-10-01

To evaluate current approaches and explore emerging research related to dyslipidemia management. MEDLINE (2004-April 2012) was searched for randomized controlled trials using the terms dyslipidemia and lipid-lowering therapy or statin (>1000 hits). Separate searches (MEDLINE, Google) identified meta-analyses (2010-2011), disease prevalence statistics, and current consensus guidelines (2004-July 2011). Additional references were identified from the publications reviewed. English-language articles on large multicenter trials were evaluated. National Cholesterol Education Program Adult Treatment Panel III guidelines for the reduction of cardiovascular risk recommend the attainment of specific low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) target values, based on an individual's 10-year risk of coronary heart disease or global risk. For most patients unable to achieve recommended lipid level goals with therapeutic lifestyle changes, statins are the first option for treatment. Results of large, well-controlled clinical trials have demonstrated that statins are effective in primary and secondary prevention of cardiovascular disease in diverse populations, including patients with diabetes and the elderly, and that intensive statin therapy provides more effective lipid goal attainment and significantly greater risk reduction in patients with coronary artery disease. Statin therapy is generally well tolerated but may increase the risk of myopathy. Statin use has been associated with increases in hepatic transaminases and an increased risk of diabetes, although the absolute risk of diabetes is low compared with the risk reduction benefit. Combination therapy including a statin may be appropriate for certain populations, but the risk reduction benefits of combination therapy remain unclear. Ezetimibe is an important treatment option for patients with hypercholesterolemia who do not tolerate intensive statin therapy. Although fibrates or niacin improves overall lipid profiles in patients with hypertriglyceridemia or dyslipidemia who are receiving statin therapy, their efficacy in reducing cardiovascular risk remains questionable and their use raises safety and tolerability concerns. Intensifying lifestyle changes and statin dose should be utilized first in patients not achieving their LDL-C and non-HDL-C goals.

Association Between Number of Preventive Care Guidelines and Preventive Care Utilization by Patients.

PubMed

Taksler, Glen B; Pfoh, Elizabeth R; Stange, Kurt C; Rothberg, Michael B

2018-05-08

The number of preventive care guidelines is rapidly increasing. It is unknown whether the number of guideline-recommended preventive services is associated with utilization. The authors used Poisson regression of 390,778 person-years of electronic medical records data from 2008 to 2015, in 80,773 individuals aged 50-75 years. Analyses considered eligibility for 11 preventive services most closely associated with guidelines: tobacco cessation; control of obesity, hypertension, lipids, or blood glucose; influenza vaccination; and screening for breast, cervical, or colorectal cancers, abdominal aortic aneurysm, or osteoporosis. The outcome was the rate of preventive care utilization over the following year. Results were adjusted for demographics and stratified by the number of disease risk factors (smoking, obesity, hypertension, hyperlipidemia, diabetes). Data were collected in 2016 and analyzed in 2017. Preventive care utilization was lower when the number of guideline-recommended preventive services was higher. The adjusted rate of preventive care utilization decreased from 38.67 per 100 (95% CI=38.16, 39.18) in patients eligible for one guideline-recommended service to 31.59 per 100 (95% CI=31.29, 31.89) in patients eligible for two services and 25.43 per 100 (95% CI=24.68, 26.18) in patients eligible for six or more services (p-trend<0.001). Results were robust to disease risk factors and observed for all but two services (tobacco cessation, obesity reduction). However, for any given number of guideline-recommended services, patients with more disease risk factors had higher utilization rates. The rate of preventive care utilization was lower when the number of guideline-recommended services was higher. Prioritizing recommendations might improve utilization of high-value services. Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Linking Syndemic Stress and Behavioral Indicators of Main Partner HIV Transmission Risk in Gay Male Couples.

PubMed

Starks, Tyrel J; Tuck, Andrew N; Millar, Brett M; Parsons, Jeffrey T

2016-02-01

The purpose of the current study was to examine whether syndemic stress in partnered gay men might undermine communication processes essential to the utilization of negotiated safety and other harm reduction strategies that rely on partners' HIV status disclosure. Participants included 100 gay male couples (N = 200 individuals) living in the U.S., who responded to an online survey. Participants completed measures of five syndemic factors (depression, poly-drug use, childhood sexual abuse, intimate partner violence, and sexual compulsivity). They also reported on whether condoms were used during first intercourse together and the timing of first condomless anal intercourse (CAI) relative to HIV disclosure in their relationship. Results of binary logistic regression analyses supported the hypothesis that the sum of partners' syndemic stress was negatively associated with condom use at first intercourse and with HIV disclosure prior to first CAI. Syndemic stress may contribute to HIV transmission risk between main partners in part because it accelerates the progression to CAI and interferes with communication processes central to harm reduction strategies utilized by gay men in relationships. Implications for prevention strategies and couples interventions, such as couples HIV counseling and testing, that facilitate communication skill-building, are discussed.

Linking syndemic stress and behavioral indicators of main partner HIV transmission risk in gay male couples

PubMed Central

Starks, Tyrel J.; Tuck, Andrew N.; Millar, Brett M.; Parsons, Jeffrey T.

2016-01-01

The purpose of the current study was to examine whether syndemic stress in partnered gay men might undermine communication processes essential to the utilization of negotiated safety and other harm reduction strategies that rely on partners’ HIV status disclosure. Participants included 100 gay male couples (N = 200 individuals) living in the U.S., who responded to an online survey. Participants completed measures of five syndemic factors (depression, poly-drug use, childhood sexual abuse, intimate partner violence, and sexual compulsivity). They also reported on whether condoms were used during first intercourse together and the timing of first condomless anal intercourse (CAI) relative to HIV disclosure in their relationship. Results of binary logistic regression analyses supported the hypothesis that the sum of partners’ syndemic stress was negatively associated with condom use at first intercourse and with HIV disclosure prior to first CAI. Syndemic stress may contribute to HIV transmission risk between main partners in part because it accelerates the progression to CAI and interferes with communication processes central to harm reduction strategies utilized by gay men in relationships. Implications for prevention strategies and couples interventions, such as couples HIV counseling and testing, that facilitate communication skill-building, are discussed. PMID:26552658

Nursing, Pharmacy, and Prescriber Knowledge and Perceptions of High-Alert Medications in a Large, Academic Medical Hospital

PubMed Central

Engels, Melanie J.

2015-01-01

Background: High-alert medications pose a greater risk of causing significant harm to patients if used in error. The Joint Commission requires that hospitals define institution-specific high-alert medications and implement processes to ensure safe medication use. Method: Nursing, pharmacy, and prescribers were asked to voluntarily complete a 34-question survey to assess their knowledge, experience, and perceptions regarding high-alert medications in an academic hospital. Results: The majority of respondents identified the organization’s high-alert medications, the consequences of an error involving a high-alert medication, and the reversal agent. Most of the risk-reduction strategies within the institution were viewed as being effective by respondents. Forty-five percent of the respondents utilized a high-alert medication in the previous 24 hours. Only 14.2% had experienced an error with a high-alert medication in the previous 12 months, with 46% being near misses. The survey found the 5 rights for medication administration were not being utilized consistently. Respondents indicated that work experience or hospital orientation is the preferred learning experience for high-alert medications. Conclusions: This study assessed all disciplines involved in the medication use process. Perceptions about high-alert medications differ between disciplines. Ongoing discipline-specific education is required to ensure that individuals accept accountability in the medication use process and to close knowledge gaps on high-alert medications and risk-reduction strategies. PMID:26446747

Accuracy of point-of-care serum creatinine devices for detecting patients at risk of contrast-induced nephropathy: a critical overview.

PubMed

Martínez Lomakin, Felipe; Tobar, Catalina

2014-12-01

Contrast-induced nephropathy (CIN) is a common event in hospitals, with reported incidences ranging from 1 to 30%. Patients with underlying kidney disease have an increased risk of developing CIN. Point-of-care (POC) creatinine devices are handheld devices capable of providing quantitative data on a patient's kidney function that could be useful in stratifying preventive measures. This overview aims to synthesize the current evidence on diagnostic accuracy and clinical utility of POC creatinine devices in detecting patients at risk of CIN. Five databases were searched for diagnostic accuracy studies or clinical trials that evaluated the usefulness of POC devices in detecting patients at risk of CIN. Selected articles were critically appraised to assess their individual risk of bias by the use of standard criteria; 13 studies were found that addressed the diagnostic accuracy or clinical utility of POC creatinine devices. Most studies incurred a moderate to high risk of bias. Overall concordance between POC devices and reference standards (clinical laboratory procedures) was found to be moderate, with 95% limits of agreement often lying between -35.4 and +35.4 µmol/L (-0.4 and +0.4 mg/dL). Concordance was shown to decrease with worsening kidney function. Data on the clinical utility of these devices were limited, but a significant reduction in time to diagnosis was reported in two studies. Overall, POC creatinine devices showed a moderate concordance with standard clinical laboratory creatinine measurements. Several biases could have induced optimism in these estimations. Results obtained from these devices may be unreliable in cases of severe kidney failure. Randomized trials are needed to address the clinical utility of these devices.

Clinical and economic evaluation of an evidence-based institutional epoetin-utilization management program.

PubMed

Buckley, Mitchell S; Kane-Gill, Sandra L; Patel, Shardool A

2013-03-01

Anemia is common in several patient populations, including those with chronic kidney disease, cancer, and HIV/AIDS, and may require treatment with erythropoietin-stimulating agents (ESAs). Given the potential risks of the ESA, epoetin, and the significant costs associated with this agent, a large teaching medical institution developed a the drug-utilization management program using evidence-based guidelines on appropriate use. This study was designed to determine the clinical and financial impact of the drug-utilization management program. This retrospective cohort study was conducted at the medical institution that implemented the program using clinical pharmacists. Patients were included if epoetin was administered during their hospital stay (evaluation period, December 1, 2010, to December 31, 2011). The rate of inappropriate epoetin prescribing and the economic impact of guideline implementation were evaluated using comparisons of data from cohorts prescribed epoetin before and after guideline implementation. Data from 796 patients were included in the analyses (pre-implementation, 496; post-implementation, 300). The proportion of patients prescribed epoetin was significantly smaller after guideline implementation (2.4% vs 1.6%; P < 0.001). The reduction in the total number of epoetin units administered was 45%. The significant reduction (25%) in inappropriate prescribing after guideline implementation was primarily attributed to a 17% decrease in epoetin use in nonspecific anemia. The reduction in inappropriate epoetin prescribing translated into a 23.8% reduction in costs (P < 0.001) associated with inappropriate epoetin use. The estimated annual cost-savings of this program was $198,352 ($16,529/mo). The implementation of a drug-utilization management program using clinical pharmacists who evaluated epoetin was associated with a decrease in inappropriate epoetin prescribing and with significant cost-savings. Copyright © 2013 Elsevier HS Journals, Inc. All rights reserved.

Cost-utility analysis of eprosartan compared to enalapril in primary prevention and nitrendipine in secondary prevention in Europe--the HEALTH model.

PubMed

Schwander, Björn; Gradl, Birgit; Zöllner, York; Lindgren, Peter; Diener, Hans-Christoph; Lüders, Stephan; Schrader, Joachim; Villar, Fernando Antoñanzas; Greiner, Wolfgang; Jönsson, Bengt

2009-09-01

To investigate the cost-utility of eprosartan versus enalapril (primary prevention) and versus nitrendipine (secondary prevention) on the basis of head-to-head evidence from randomized controlled trials. The HEALTH model (Health Economic Assessment of Life with Teveten for Hypertension) is an object-oriented probabilistic Monte Carlo simulation model. It combines a Framingham-based risk calculation with a systolic blood pressure approach to estimate the relative risk reduction of cardiovascular and cerebrovascular events based on recent meta-analyses. In secondary prevention, an additional risk reduction is modeled for eprosartan according to the results of the MOSES study ("Morbidity and Mortality after Stroke--Eprosartan Compared to Nitrendipine for Secondary Prevention"). Costs and utilities were derived from published estimates considering European country-specific health-care payer perspectives. Comparing eprosartan to enalapril in a primary prevention setting the mean costs per quality adjusted life year (QALY) gained were highest in Germany (Euro 24,036) followed by Belgium (Euro 17,863), the UK (Euro 16,364), Norway (Euro 13,834), Sweden (Euro 11,691) and Spain (Euro 7918). In a secondary prevention setting (eprosartan vs. nitrendipine) the highest costs per QALY gained have been observed in Germany (Euro 9136) followed by the UK (Euro 6008), Norway (Euro 1695), Sweden (Euro 907), Spain (Euro -2054) and Belgium (Euro -5767). Considering a Euro 30,000 willingness-to-pay threshold per QALY gained, eprosartan is cost-effective as compared to enalapril in primary prevention (patients >or=50 years old and a systolic blood pressure >or=160 mm Hg) and cost-effective as compared to nitrendipine in secondary prevention (all investigated patients).

Workplace health promotion and utilization of health services: follow-up data findings.

PubMed

Deitz, Diane; Cook, Royer; Hersch, Rebekah

2005-01-01

This article reports findings from a workplace substance abuse prevention program designed to investigate best practices. The study sought to assess the effects of the worksite wellness program and employee assistance program (EAP) on healthcare utilization and costs, identify predictors of outpatient costs and visits, and assess the effect of the intervention on health attitudes, behaviors, and behavioral health-related costs and visits. Results indicated that visits to the EAP increased as did overall healthcare visits, that utilization of healthcare services and costs were higher in the population receiving substance abuse prevention intervention, and that employees in the substance abuse prevention intervention reported lower heavy drinking and binge drinking. Data suggest that substance abuse prevention may result in higher healthcare costs and utilization in the short term, but a reduction in health risk behaviors such as heavy drinking may result in lower healthcare costs and utilization in the long term.

Community food environment measures in the Alabama Black Belt: Implications for cancer risk reduction

PubMed Central

Gyawu, Rebecca; Quansah, Joseph E.; Fall, Souleymane; Gichuhi, Peter N.; Bovell-Benjamin, Adelia C.

2015-01-01

In-store measures were utilized to evaluate the availability of healthy food choices and nutrition/health promotion messages for cancer risk reduction in the selected Alabama Black Belt counties/cities. Sixty one retail food outlets (RFOs) were audited in 12 Alabama Black Belt cities. Store types included convenience stores (49.2%), restaurants (19.7%), fast food restaurants (16.4%), small supermarkets (8.2%), and large supermarket and farmers' markets (3.3 %), respectively. Although there were low numbers of farmers' markets/street stands and large supermarkets, these had significantly (p < 0.0001) higher health scores than the other store types. A few health promotion messages were highly visible or obscurely positioned in some RFOs. The Alabama Black Belt food environment had limited opportunities for healthy food choices. PMID:26844138

Long-Term International Space Station (ISS) Risk Reduction Activities

NASA Astrophysics Data System (ADS)

Fodroci, M. P.; Gafka, G. K.; Lutomski, M. G.; Maher, J. S.

2012-01-01

As the assembly of the ISS nears completion, it is worthwhile to step back and review some of the actions pursued by the Program in recent years to reduce risk and enhance the safety and health of ISS crewmembers, visitors, and space flight participants. While the initial ISS requirements and design were intended to provide the best practicable levels of safety, it is always possible to further reduce risk - given the determination, commitment, and resources to do so. The following is a summary of some of the steps taken by the ISS Program Manager, by our International Partners, by hardware and software designers, by operational specialists, and by safety personnel to continuously enhance the safety of the ISS, and to reduce risk to all crewmembers. While years of work went into the development of ISS requirements, there are many things associated with risk reduction in a Program like the ISS that can only be learned through actual operational experience. These risk reduction activities can be divided into roughly three categories: Areas that were initially noncompliant which have subsequently been brought into compliance or near compliance (i.e., Micrometeoroid and Orbital Debris [MMOD] protection, acoustics) Areas where initial design requirements were eventually considered inadequate and were subsequently augmented (i.e., Toxicity Hazard Level- 4 [THL] materials, emergency procedures, emergency equipment, control of drag-throughs) Areas where risks were initially underestimated, and have subsequently been addressed through additional mitigation (i.e., Extravehicular Activity [EVA] sharp edges, plasma shock hazards) Due to the hard work and cooperation of many parties working together across the span of more than a decade, the ISS is now a safer and healthier environment for our crew, in many cases exceeding the risk reduction targets inherent in the intent of the original design. It will provide a safe and stable platform for utilization and discovery for years to come.

Long-Term International Space Station (ISS) Risk Reduction Activities

NASA Technical Reports Server (NTRS)

Forroci, Michael P.; Gafka, George K.; Lutomski, Michael G.; Maher, Jacilyn S.

2011-01-01

As the assembly of the ISS nears completion, it is worthwhile to step back and review some of the actions pursued by the Program in recent years to reduce risk and enhance the safety and health of ISS crewmembers, visitors, and space flight participants. While the initial ISS requirements and design were intended to provide the best practicable levels of safety, it is always possible to further reduce risk given the determination, commitment, and resources to do so. The following is a summary of some of the steps taken by the ISS Program Manager, by our International Partners, by hardware and software designers, by operational specialists, and by safety personnel to continuously enhance the safety of the ISS, and to reduce risk to all crewmembers. While years of work went into the development of ISS requirements, there are many things associated with risk reduction in a Program like the ISS that can only be learned through actual operational experience. These risk reduction activities can be divided into roughly three categories: Areas that were initially noncompliant which have subsequently been brought into compliance or near compliance (i.e., Micrometeoroid and Orbital Debris [MMOD] protection, acoustics) Areas where initial design requirements were eventually considered inadequate and were subsequently augmented (i.e., Toxicity hazard level-4 materials, emergency procedures, emergency equipment, control of drag-throughs) Areas where risks were initially underestimated, and have subsequently been addressed through additional mitigation (i.e., Extravehicular Activity [EVA] sharp edges, plasma shock hazards). Due to the hard work and cooperation of many parties working together across the span of more than a decade, the ISS is now a safer and healthier environment for our crew, in many cases exceeding the risk reduction targets inherent in the intent of the original design. It will provide a safe and stable platform for utilization and discovery for years to come.

Modelling risk aversion to support decision-making for controlling zoonotic livestock diseases.

PubMed

van Asseldonk, M A P M; Bergevoet, R H M; Ge, L

2013-12-01

Zoonotic infectious livestock diseases are becoming a significant burden for both animal and human health and are rapidly gaining the attention of decision-makers who manage public health programmes. If control decisions have only monetary components, governments are generally regarded as being risk-neutral and the intervention strategy with the highest expected benefit (lowest expected net costs) should be preferred. However, preferences will differ and alternative intervention plans will prevail if (human) life and death outcomes are involved. A rational decision framework must therefore consider risk aversion in the decision-maker and controversial values related to public health. In the present study, risk aversion and its impact on both the utility for the monetary component and the utility for the non-monetary component is shown to be an important element when dealing with emerging zoonotic infectious livestock diseases and should not be ignored in the understanding and support of decision-making. The decision framework was applied to several control strategies for the reduction of human cases of brucellosis (Brucella melitensis) originating from sheep in Turkey.

Drugs and the dance music scene: a survey of current drug use patterns among a sample of dance music enthusiasts in the UK.

PubMed

Winstock, A R; Griffiths, P; Stewart, D

2001-09-01

This study explores the utility of a self-completion survey method to quickly and cheaply generate information on patterns and trends among regular "recreational" drug consumers. Data is reported here from 1151 subjects accessed through a dance music publication. In keeping with previous studies of drug use within the dance scene polysubstance use was the norm. Many of those reporting use of "ecstasy" were regularly using multiple tablets often consumed in combination with other substances thus exposing themselves to serious health risks, in particular the risk of dose related neurotoxic effects. Seventy percent were drinking alcohol at hazardous levels. Subjects' patterns of drug purchasing also put them at risk of severe criminal sanction. Data supported evidence that cocaine use had become increasing popular in the UK, but contrasted with some commentators' views that ecstasy use was in decline. The utility of this method and how the results should be interpreted is discussed, as are the data's implications for harm and risk reduction activities.

Outcomes of a Behavioral Intervention to Reduce HIV Risk among Drug-involved Female Sex Workers

PubMed Central

Surratt, Hilary L.; O’Grady, Catherine; Kurtz, Steven P.; Levi-Minzi, Maria A.; Chen, Minxing

2014-01-01

Although street-based female sex workers (FSWs) are highly vulnerable to HIV, they often lack access to needed health services and medical care. This paper reports the results of a recently completed randomized intervention trial for FSWs in Miami, Florida, which tested the relative efficacy of two case management interventions that aimed to link underserved FSWs with health services and to reduce risk behaviors for HIV. Participants were recruited using targeted sampling strategies and were randomly assigned to: a Strengths-Based/Professional Only (PO) or a Strengths-Based/Professional-Peer condition (PP). Follow-up data were collected 3 and 6 months post-baseline. Outcome analyses indicated that both intervention groups displayed significant reductions in HIV risk behaviors and significant increases in services utilization; the Professional-Peer condition provided no added benefit. HIV seropositive FSWs responded particularly well to the interventions, suggesting the utility of brief strengths-based case management interventions for this population in future initiatives. PMID:24558098

Endocrine therapy for breast cancer prevention in high-risk women: clinical and economic considerations.

PubMed

Groom, Amy G; Younis, Tallal

2016-01-01

The global burden of breast cancer highlights the need for primary prevention strategies that demonstrate both favorable clinical benefit/risk profile and good value for money. Endocrine therapy with selective estrogen-receptor modulators (SERMs) or aromatase inhibitors (AIs) has been associated with a favorable clinical benefit/risk profile in the prevention of breast cancer in women at high risk of developing the disease. The available endocrine therapy strategies differ in terms of their relative reductions of breast cancer risk, potential side effects, and upfront drug acquisition costs, among others. This review highlights the clinical trials of SERMs and AIs for the primary prevention of breast cancer, and the cost-effectiveness /cost-utility studies that have examined their "value for money" in various health care jurisdictions.

Pharmacist managed diabetes and cardiovascular risk reduction clinic in kidney transplant recipients: bridging the gap in care transition.

PubMed

Pinelli, Nicole R; Clark, Lindsey M; Carrington, Anne C; Carrington, Julia L; Malinzak, Lauren; Patel, Anita

2014-12-01

The purpose was to assess the feasibility of a care transition intervention for kidney transplant recipients (KTRs) with diabetes. Results document improved quality indicators and reduced resource utilization. These findings imply that a care transition intervention for KTRs with diabetes is feasible and associated with improved patient outcomes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Spare parts management for nuclear power generation facilities

NASA Astrophysics Data System (ADS)

Scala, Natalie Michele

With deregulation, utilities in the power sector face a much more urgent imperative to emphasize cost efficiencies as compared to the days of regulation. One major opportunity for cost savings is through reductions in spare parts inventories. Most utilities are accustomed to carrying large volumes of expensive, relatively slow-moving parts because of a high degree of risk-averseness. This attitude towards risk is rooted in the days of regulation. Under regulation, companies recovered capital inventory costs by incorporating them into the base rate charged to their customers. In a deregulated environment, cost recovery is no longer guaranteed. Companies must therefore reexamine their risk profile and develop policies for spare parts inventory that are appropriate for a competitive business environment. This research studies the spare parts inventory management problem in the context of electric utilities, with a focus on nuclear power. It addresses three issues related to this problem: criticality, risk, and policy. With respect to criticality and risk, a methodology is presented that incorporates the use of influence diagrams and the Analytic Hierarchy Process (AHP). A new method is developed for group aggregation in the AHP when Saaty and Vargas' (2007) dispersion test fails and decision makers are unwilling or unable to revise their judgments. With respect to policy, a quantitative model that ranks the importance of keeping a part in inventory and recommends a corresponding stocking policy through the use of numerical simulation is developed. This methodology and its corresponding models will enable utilities that have transitioned from a regulated to a deregulated environment become more competitive in their operations while maintaining safety and reliability standards. Furthermore, the methodology developed is general enough so that other utility plants, especially those in the nuclear sector, will be able to use this approach. In addition to regulated utilities, other industries, such as aerospace, and the military can also benefit from extensions to these models, as risk profiles and subsequent policies can be adjusted to align with the business environment in which each industry or company operates.

Feedback to providers improves evidence-based implantable cardioverter-defibrillator programming and reduces shocks.

PubMed

Silver, Marc T; Sterns, Laurence D; Piccini, Jonathan P; Joung, Boyoung; Ching, Chi-Keong; Pickett, Robert A; Rabinovich, Rafael; Liu, Shufeng; Peterson, Brett J; Lexcen, Daniel R

2015-03-01

Implantable cardioverter-defibrillator (ICD) shocks are associated with increased anxiety, health care utilization, and potentially mortality. The purpose of the Shock-Less Study was to determine if providing feedback reports to physicians on their adherence to evidence-based shock reduction programming could improve their programming behavior and reduce shocks. Shock-Less enrolled primary prevention (PP) and secondary prevention (SP) ICD patients between 2009 and 2012 at 118 study centers worldwide and followed patients longitudinally after their ICD implant. Center-specific therapy programming reports (TPRs) were delivered to each center 9 to 12 months after their first enrollment. The reports detailed adherence to evidence-based programming targets: number of intervals to detect ventricular fibrillation (VF NID), longest treatment interval (LTI), supraventricular tachycardia (SVT) discriminators (Wavelet, PR Logic), SVT limit, Lead Integrity Alert (LIA), and antitachycardia pacing (ATP). Clinicians programmed ICDs at their discretion. The primary outcome measure was the change in utilization of evidence-based shock reduction programming before (phase I, n = 2694 patients) and after initiation of the TPR (phase II, n = 1438 patients). Patients implanted after feedback reports (phase II) were up to 20% more likely to have their ICDs programmed in line with evidence-based shock reduction programming (eg, VF NID in PP patients 30/40 in 33.5% vs 18.6%, P < .0001). Patients implanted in phase II had a lower risk of all-cause shock (adjusted hazard ratio 0.72, 95% confidence interval 0.58-0.90, P = .003). Providing programming feedback reports improves adherence to evidence-based shock reduction programming and is associated with lower risk of ICD shocks. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

The prevalence of, and factors related to, compliance with glove utilization among nurses in Hospital Universiti Sains Malaysia.

PubMed

Naing, L; Nordin, R; Musa, R

2001-09-01

Increasing risk of HIV infections among health care workers has been a continuing concern. The study was designed to identify the compliance of glove utilization, and factors related to non-compliance. A sample of 150 staff nurses were recruited from the study population of 550 nurses in Hospital Universiti Sains Malaysia. Data were collected by using a structured self-administered questionnaires. The response rate was 98.4%. The study revealed a low compliance (13.5%) of glove utilization (for all 9 procedures), which varied among different procedures (27-97%). Younger nurses and those with shorter duration of working experience had better knowledge of Universal Precautions. Nurses in intensive care unit and operation theatre were better in both knowledge and compliance of glove utilization. The three commonest misconceptions were identified as "selective use of gloves for high risk groups and suspected cases", and "tendency to depend on HIV prevalence". Nurses reported practical problems including administrative and personal related such as "stock irregularity" (46%), "glove not available at the emergency sites" (44%), and "reduction of tactile sensation" (39%). It was concluded that poor knowledge and practical problems were possible responsible factors for the low compliance. A good training for nurses comprising principle and practice of Universal Precautions, updated knowledge of blood and body fluid borne infections and risk and its management, will probably improve the compliance.

A perspective on cost-effectiveness of greenhouse gas reduction solutions in water distribution systems

NASA Astrophysics Data System (ADS)

Hendrickson, Thomas P.; Horvath, Arpad

2014-01-01

Water distribution systems (WDSs) face great challenges as aging infrastructures require significant investments in rehabilitation, replacement, and expansion. Reducing environmental impacts as WDSs develop is essential for utility managers and policy makers. This study quantifies the existing greenhouse gas (GHG) footprint of common WDS elements using life-cycle assessment (LCA) while identifying the greatest opportunities for emission reduction. This study addresses oversights of the related literature, which fails to capture several WDS elements and to provide detailed life-cycle inventories. The life-cycle inventory results for a US case study utility reveal that 81% of GHGs are from pumping energy, where a large portion of these emissions are a result of distribution leaks, which account for 270 billion l of water losses daily in the United States. Pipe replacement scheduling is analyzed from an environmental perspective where, through incorporating leak impacts, a tool reveals that optimal replacement is no more than 20 years, which is in contrast to the US average of 200 years. Carbon abatement costs (CACs) are calculated for different leak reduction scenarios for the case utility that range from -130 to 35 t-1 CO2(eq). Including life-cycle modeling in evaluating pipe materials identified polyvinyl chloride (PVC) and cement-lined ductile iron (DICL) as the Pareto efficient options, however; utilizing PVC presents human health risks. The model developed for the case utility is applied to California and Texas to determine the CACs of reducing leaks to 5% of distributed water. For California, annual GHG savings from reducing leaks alone (3.4 million tons of CO2(eq)) are found to exceed California Air Resources Board’s estimate for energy efficiency improvements in the state’s water infrastructure.

Treatment in a Preventive Cardiology Clinic Utilizing Advanced Practice Providers (APPs) Effectively Closes Atherosclerotic Cardiovascular Disease (ASCVD) Risk Management Gaps Amongst a Primary Prevention Population Compared with a Propensity-Matched Primary Care Cohort: A Team Based Care Model and its Impact on Lipid and Blood Pressure Management.

PubMed

Fentanes, Emilio; Vande Hei, Anthony G; Holuby, R Scott; Suarez, Norma; Slim, Yousif; Slim, Jennifer N; Slim, Ahmad M; Thomas, Dustin

2018-04-17

Advanced Practice Providers (APPs) can fill access to care gaps created by physician shortages and improve adherence/compliance with preventive atherosclerotic cardiovascular disease (ASCVD) interventions. We retrospectively reviewed data on 595 patients enrolled in a preventive cardiology clinic (PCC) utilizing APPs compared with a propensity-matched cohort (PMC) of 595 patients enrolled in primary care clinics alone. PCC patients were risk stratified using Framingham risk scoring (FRS) and coronary artery calcium scoring (CACS) and treated based on published guideline-based algorithms. Baseline demographics were well balanced between the groups. CACS was more commonly obtained in PCC patients (p<0.001) resulting in reclassification of 30.6% patients to a higher risk category, including statin therapy in 26.6% of low FRS PCC patients with CACS ≥75 th MESA percentile. Aspirin initiation was higher for high and intermediate FRS patients in the PCC (p <0.001). Post-intervention mean LDL, non-HDL, and triglycerides (all p<0.05) were lower in the PCC group. Compliance with appropriate lipid treatment was higher in intermediate to high FRS patients (p=0.004) in the PCC group. Aggressive LDL and non-HDL treatment goals <70mg/dL (p=0.005) and <130mg/dL (p<0.001), respectively, were more commonly achieved in high FRS PCC patients. Median post-intervention SBP was lower amongst intermediate and low FRS patients (p=0.001 & p<0.001, respectively). Cumulatively, this resulted in a reduction in median post-intervention PCC FRS across all initial FRS risk categories (p<0.001 for all). APPs within a preventive cardiology clinic effectively risk stratify and aggressively manage ASCVD risk factors resulting in a reduction in post-intervention FRS. This article is protected by copyright. All rights reserved.

Impact of Florida's prescription drug monitoring program and pill mill law on high-risk patients: A comparative interrupted time series analysis.

PubMed

Chang, Hsien-Yen; Murimi, Irene; Faul, Mark; Rutkow, Lainie; Alexander, G Caleb

2018-04-01

We quantified the effects of Florida's prescription drug monitoring program and pill mill law on high-risk patients. We used QuintilesIMS LRx Lifelink data to identify patients receiving prescription opioids in Florida (intervention state, N: 1.13 million) and Georgia (control state, N: 0.54 million). The preintervention, intervention, and postintervention periods were July 2010 to June 2011, July 2011 to September 2011, and October 2011 to September 2012. We identified 3 types of high-risk patients: (1) concomitant users: patients with concomitant use of benzodiazepines and opioids; (2) chronic users: long-term, high-dose, opioid users; and (3) opioid shoppers: patients receiving opioids from multiple sources. We compared changes in opioid prescriptions between Florida and Georgia before and after policy implementation among high-risk/low-risk patients. Our monthly measures included (1) average morphine milligram equivalent per transaction, (2) total opioid volume across all prescriptions, (3) average days supplied per transaction, and (4) total number of opioid prescriptions dispensed. Among opioid-receiving individuals in Florida, 6.62% were concomitant users, 1.96% were chronic users, and 0.46% were opioid shoppers. Following policy implementation, Florida's high-risk patients experienced relative reductions in morphine milligram equivalent (opioid shoppers: -1.08 mg/month, 95% confidence interval [CI] -1.62 to -0.54), total opioid volume (chronic users: -4.58 kg/month, CI -5.41 to -3.76), and number of dispensed opioid prescriptions (concomitant users: -640 prescriptions/month, CI -950 to -340). Low-risk patients generally did not experience statistically significantly relative reductions. Compared with Georgia, Florida's prescription drug monitoring program and pill mill law were associated with large relative reductions in prescription opioid utilization among high-risk patients. Copyright © 2018 John Wiley & Sons, Ltd.

Impact of mandatory motorcycle helmet wearing legislation on head injuries in Viet Nam: results of a preliminary analysis.

PubMed

Passmore, Jonathon; Tu, Nguyen Thi Hong; Luong, Mai Anh; Chinh, Nguyen Duc; Nam, Nguyen Phuong

2010-04-01

To compare estimated prevalence of head injuries among road traffic injury patients admitted to hospitals, before and after the introduction of a mandatory helmet law in the Socialist Republic of Viet Nam. Before and after study of all road traffic injury patients with head injuries admitted to 20 provincial and central hospitals 3 months before and after the new law came into effect on 15 December 2007. Relative risk was computed and comparison made for the periods of 3 months before and after the new law. The study found a 16 percent reduction in the risk of road traffic head injuries (4683 to 3522; relative risk [RR] 0.84; 95% confidence interval [CI] 0.81-0.87) and an 18 percent reduction in the risk of road traffic death (deaths in hospital plus injured patients discharged to die at home; 566 to 417; RR 0.82; 95% CI 0.73-0.93). Over the first 3 months of the comprehensive mandatory helmet legislation there has been a significant reduction in the risk of road traffic head injuries among patients admitted to 20 hospitals. The Viet Nam Government's decision to require all motorcycle riders and passengers to wear helmets is suspected of leading to positive road safety benefits and should be seen as a policy example for other low- and middle-income countries with a high utilization of motorcycles for transport.

Long-term reduction of health care costs & utilization after epilepsy surgery

PubMed Central

Schiltz, Nicholas K.; Kaiboriboon, Kitti; Koroukian, Siran M.; Singer, Mendel E.; Love, Thomas E.

2015-01-01

SUMMARY Objective To assess long-term direct medical costs, health care utilization, and mortality following resective surgery in persons with uncontrolled epilepsy. Methods Retrospective longitudinal cohort study of Medicaid beneficiaries with epilepsy from 2000 - 2008. The study population included 7,835 persons with uncontrolled focal epilepsy age 18 to 64 years, with an average follow-up time of 5 years. Of these, 135 received surgery during the study period. To account for selection bias, we used risk-set optimal pairwise matching on a time-varying propensity score, and inverse probability of treatment weighting. Repeated measures generalized linear models were used to model utilization and cost outcomes. Cox proportional hazard was used to model survival. Results The mean direct medical cost difference between the surgical group and control group was $6,806 after risk-set matching. The incidence rate ratio of inpatient, emergency room, and outpatient utilization was lower among the surgical group in both unadjusted and adjusted analyses. There was no significant difference in mortality after adjustment. Among surgical cases, mean annual costs per subject were on average $6,484 lower, and all utilization measures were lower after surgery compared to before. Significance Subjects that underwent epilepsy surgery had lower direct medical care costs and health care utilization. These findings support that epilepsy surgery yield substantial health care cost savings. PMID:26693701

The association between modifiable well-being risks and productivity: a longitudinal study in pooled employer sample.

PubMed

Shi, Yuyan; Sears, Lindsay E; Coberley, Carter R; Pope, James E

2013-04-01

To examine the longitudinal relationship between modifiable well-being risks and productivity. A total of 19,121 employees from five employers participated in baseline and follow-up well-being assessment surveys. Multivariate regressions assessed whether changes in absenteeism, presenteeism, and job performance were associated with changes in 19 modifiable well-being risks. Over time, a 5% reduction in total count of well-being risks was significantly associated with 0.74% decrease in absenteeism, 2.38% decrease in presenteeism, and 0.24% increase in performance. High blood pressure, recurring pain, unhealthy diet, inadequate exercise, poor emotional health, poor supervisor relationship, not utilizing strengths doing job, and organization unsupportive of well-being had greater independent contributions in explaining productivity impairment. The often-ignored well-being risks such as work-related and financial health risks provided incremental explanation of longitudinal productivity variations beyond traditional measures of health-related risks.

Sandwich Structure Risk Reduction in Support of the Payload Adapter Fitting

NASA Technical Reports Server (NTRS)

Nettles, A. T.; Jackson, J. R.; Guin, W. E.

2018-01-01

Reducing risk for utilizing honeycomb sandwich structure for the Space Launch System payload adapter fitting includes determining what parameters need to be tested for damage tolerance to ensure a safe structure. Specimen size and boundary conditions are the most practical parameters to use in damage tolerance inspection. The effect of impact over core splices and foreign object debris between the facesheet and core is assessed. Effects of enhanced damage tolerance by applying an outer layer of carbon fiber woven cloth is examined. A simple repair technique for barely visible impact damage that restores all compression strength is presented.

Advances in the Development of a WCl6 CVD System for Coating UO2 Powders with Tungsten

NASA Technical Reports Server (NTRS)

Mireles, Omar R.; Tieman, Alyssa; Broadway, Jeramie; Hickman, Robert

2013-01-01

W-UO2 CERMET fuels are under development to enable Nuclear Thermal Propulsion (NTP) for deep space exploration. Research efforts with an emphasis on fuel fabrication, testing, and identification of potential risks is underway. One primary risk is fuel loss due to CTE mismatch between W and UO2 and the grain boundary structure of W particles resulting in higher thermal stresses. Mechanical failure can result in significant reduction of the UO2 by hot hydrogen. Fuel loss can be mitigated if the UO2 particles are coated with a layer of high density tungsten before the consolidation process. This paper discusses the work to date, results, and advances of a fluidized bed chemical vapor deposition (CVD) system that utilizes the H2-WCl6 reduction process. Keywords: Space, Nuclear, Thermal, Propulsion, Fuel, CERMET, CVD, Tungsten, Uranium

Plasma α-synuclein and cognitive impairment in the Parkinson's Associated Risk Syndrome: A pilot study.

PubMed

Wang, Hua; Atik, Anzari; Stewart, Tessandra; Ginghina, Carmen; Aro, Patrick; Kerr, Kathleen F; Seibyl, John; Jennings, Danna; Jensen, Poul Henning; Marek, Kenneth; Shi, Min; Zhang, Jing

2018-04-27

Plasma total and nervous system derived exosomal (NDE) α-synuclein have been determined as potential biomarkers of Parkinson's disease (PD). To explore the utility of plasma α-synuclein in the prodromal phase of PD, plasma total and NDE α-synuclein were evaluated in baseline and 2-year follow-up samples from 256 individuals recruited as part of the Parkinson's Associated Risk Syndrome (PARS) study. The results demonstrated that baseline and longitudinal increases in total α-synuclein predicted progression of cognitive decline in hyposmic individuals with dopamine transporter (DAT) binding reduction. On the other hand, a longitudinal decrease in NDE α-synuclein predicted worsening cognitive scores in hyposmic individuals with DAT binding reduction. Finally, in individuals with faster DAT progression, decreasing NDE/total α-synuclein ratio was associated with a larger reduction in DAT from baseline to follow-up. These results suggest that, though underlying mechanisms remain to be defined, alterations in plasma total and NDE α-synuclein concentrations are likely associated with PD progression, especially in the aspect of cognitive impairment, at early stages of the disease. Copyright © 2018. Published by Elsevier Inc.

Robotic Lunar Lander Development Status

NASA Technical Reports Server (NTRS)

Ballard, Benjamin; Cohen, Barbara A.; McGee, Timothy; Reed, Cheryl

2012-01-01

NASA Marshall Space Flight Center and John Hopkins University Applied Physics Laboratory have developed several mission concepts to place scientific and exploration payloads ranging from 10 kg to more than 200 kg on the surface of the moon. The mission concepts all use a small versatile lander that is capable of precision landing. The results to date of the lunar lander development risk reduction activities including high pressure propulsion system testing, structure and mechanism development and testing, and long cycle time battery testing will be addressed. The most visible elements of the risk reduction program are two fully autonomous lander flight test vehicles. The first utilized a high pressure cold gas system (Cold Gas Test Article) with limited flight durations while the subsequent test vehicle, known as the Warm Gas Test Article, utilizes hydrogen peroxide propellant resulting in significantly longer flight times and the ability to more fully exercise flight sensors and algorithms. The development of the Warm Gas Test Article is a system demonstration and was designed with similarity to an actual lunar lander including energy absorbing landing legs, pulsing thrusters, and flight-like software implementation. A set of outdoor flight tests to demonstrate the initial objectives of the WGTA program was completed in Nov. 2011, and will be discussed.

NASA's Robotic Lunar Lander Development Program

NASA Technical Reports Server (NTRS)

Ballard, Benjamin W.; Reed, Cheryl L. B.; Artis, David; Cole, Tim; Eng, Doug S.; Kubota, Sanae; Lafferty, Paul; McGee, Timothy; Morese, Brian J.; Chavers, Gregory;

Application of the Bethesda System for Reporting Thyroid Cytopathology in the Eastern Province of Saudi Arabia: A Follow-Up Study.

PubMed

Alabdulqader, Noof A; Shareef, Sameera Q; Ali, Jassim A; Yousef, Mohammad M; Al-Abbadi, Mousa A

2015-01-01

This is a follow-up study to our previous analysis of thyroid aspirates utilizing the Bethesda System for Reporting Thyroid Cytology (BSRTC). The same study design was utilized for 2 years comparing 2 periods. A total of 251 thyroid aspirates from 218 patients were reviewed and deemed comparable to the previous cohort. The variance and consequently the number of interpretations dropped from 26 to 11 with a statistically significant 58% reduction and more consistency. Our unsatisfactory rate dropped from 22 to 10% (reduction of 55%). The risk of malignancy in this follow-up study showed a similar trend: an increase in risk with each step up in the BSRTC categories starting from the 'nondiagnostic' and up to 'malignant'. Few of our benign cases ended up with resection. We noticed sensitivity to the word 'follicular' in this benign category; therefore we propose a modification of the current BSRTC system by omitting the word 'follicular' from the benign category. We strongly believe that this modification harbors no serious damage to the intentions of BSRTC. This follow-up study has shown that the previous awareness campaign about the implementation has worked and can be considered a valid performance improvement program. © 2015 S. Karger AG, Basel.

[Features of oxygen utilization by the body of patients with arterial hypertension in the days of magnetic storms depending on the psychosomatic status and treatment options].

PubMed

Usenko, G A; Usenko, A G; Vasendin, D V

2015-01-01

During magnetic storms the observed increase in γ-background environment and the reduction of the rate of oxygen utilization by the tissues, but the increase in the number of angina attacks per day to magnetic storms the choleric, in the days of magnetic storms in sanguine, for 3-4 days at a phlegmatic, and 4-5 days in the melancholic especially in groups high anxiety phlegmatic and melancholic. Last-risk group severe arterial hypertension and ischemic heart disease. Antihypertensive therapy based on the blockade of the features of the psychosomatic status, significantly reduced the number of attacks and brought the values of the utilization of oxygen and coefficient of oxygen utilization bu the tissues of all the days to those in healthy individual relevant anxiety and temperament.

Reducing eating disorder risk factors: A pilot effectiveness trial of a train-the-trainer approach to dissemination and implementation.

PubMed

Greif, Rebecca; Becker, Carolyn Black; Hildebrandt, Tom

2015-12-01

Impediments limit dissemination and implementation of evidence-based interventions (EBIs), including lack of sufficient training. One strategy to increase implementation of EBIs is the train-the-trainer (TTT) model. The Body Project is a peer-led body image program that reduces eating disorder (ED) risk factors. This study examined the effectiveness of a TTT model at reducing risk factors in Body Project participants. Specifically, this study examined whether a master trainer could train a novice trainer to train undergraduate peer leaders to administer the Body Project such that individuals who received the Body Project (i.e., participants) would evidence comparable outcomes to previous trials. We hypothesized that participants would evidence reductions in ED risk factors, with effect sizes similar to previous trials. Utilizing a TTT model, a master trainer trained a novice trainer to train undergraduate peer leaders to administer the Body Project to undergraduate women. Undergraduate women aged 18 years or older who received the Body Project intervention participated in the trial and completed measures at baseline, post-treatment, and five-month follow-up. Primary outcomes included body dissatisfaction, thin ideal internalization, negative affect, and ED pathology. Participants demonstrated significant reductions in thin ideal internalization, ED pathology and body dissatisfaction at post-treatment and 5-month follow-up. At 5 months, using three different strategies for managing missing data, effect sizes were larger or comparable to earlier trials for 3 out of 4 variables. Results support a TTT model for Body Project implementation and the importance of utilizing sensitivity analyses for longitudinal datasets with missing data. © 2015 Wiley Periodicals, Inc.

Analyzing Beach Recreationists' Preferences for the Reduction of Jellyfish Blooms: Economic Results from a Stated-Choice Experiment in Catalonia, Spain.

PubMed

Nunes, Paulo A L D; Loureiro, Maria L; Piñol, Laia; Sastre, Sergio; Voltaire, Louinord; Canepa, Antonio

2015-01-01

Jellyfish outbreaks and their consequences appear to be on the increase around the world, and are becoming particularly relevant in the Mediterranean. No previous studies have quantified tourism losses caused by jellyfish outbreaks. We used a stated-choice questionnaire and a Random Utility Model to estimate the amount of time respondents would be willing to add to their journey, in terms of reported extra travel time, in order to reduce the risk of encountering jellyfish blooms in the Catalan coast. The estimation results indicated that the respondents were willing to spend on average an additional 23.8% of their travel time to enjoy beach recreation in areas with a lower risk of jellyfish blooms. Using as a reference the opportunity cost of time, we found that the subsample of individuals who made a trade-off between the disutility generated by travelling longer in order to lower the risk of jellyfish blooms, and the utility gained from reducing this risk, are willing to pay on average €3.20 per beach visit. This estimate, combined with the respondents' mean income, yielded annual economic gains associated with reduction of jellyfish blooms on the Catalan coast around €422.57 million, or about 11.95% of the tourism expenditures in 2012. From a policy-making perspective, this study confirms the importance of the economic impacts of jellyfish blooms and the need for mitigation strategies. In particular, providing daily information using social media applications or other technical devices may reduce these social costs. The current lack of knowledge about jellyfish suggests that providing this information to beach recreationists may be a substantially effective policy instrument for minimising the impact of jellyfish blooms.

Analyzing Beach Recreationists’ Preferences for the Reduction of Jellyfish Blooms: Economic Results from a Stated-Choice Experiment in Catalonia, Spain

PubMed Central

Nunes, Paulo A. L. D.; Loureiro, Maria L.; Piñol, Laia; Sastre, Sergio; Voltaire, Louinord; Canepa, Antonio

2015-01-01

Jellyfish outbreaks and their consequences appear to be on the increase around the world, and are becoming particularly relevant in the Mediterranean. No previous studies have quantified tourism losses caused by jellyfish outbreaks. We used a stated-choice questionnaire and a Random Utility Model to estimate the amount of time respondents would be willing to add to their journey, in terms of reported extra travel time, in order to reduce the risk of encountering jellyfish blooms in the Catalan coast. The estimation results indicated that the respondents were willing to spend on average an additional 23.8% of their travel time to enjoy beach recreation in areas with a lower risk of jellyfish blooms. Using as a reference the opportunity cost of time, we found that the subsample of individuals who made a trade-off between the disutility generated by travelling longer in order to lower the risk of jellyfish blooms, and the utility gained from reducing this risk, are willing to pay on average €3.20 per beach visit. This estimate, combined with the respondents’ mean income, yielded annual economic gains associated with reduction of jellyfish blooms on the Catalan coast around €422.57 million, or about 11.95% of the tourism expenditures in 2012. From a policy-making perspective, this study confirms the importance of the economic impacts of jellyfish blooms and the need for mitigation strategies. In particular, providing daily information using social media applications or other technical devices may reduce these social costs. The current lack of knowledge about jellyfish suggests that providing this information to beach recreationists may be a substantially effective policy instrument for minimising the impact of jellyfish blooms. PMID:26053674

Clinical utility of lenalidomide in the treatment of myelodysplastic syndromes

PubMed Central

Abou Zahr, Abdallah; Saad Aldin, Ehab; Komrokji, Rami S; Zeidan, Amer M

2015-01-01

Myelodysplastic syndromes (MDS) represent a heterogeneous group of acquired clonal hematopoietic disorders characterized by peripheral blood cytopenias, paradoxical BM hypercellularity, ineffective hematopoiesis, and increased risk of leukemic transformation. Risk stratification, using different prognostic scores and markers, is at the core of MDS management. Deletion 5q [del(5q)] MDS is a distinct class of MDS characterized by the haploinsufficiency of specific genes, microRNAs, and proteins, which has been linked to increased sensitivity to the drug lenalidomide. Phase II and III clinical trials have demonstrated the efficacy of lenalidomide in improving clinical outcomes of patients with del(5q) MDS, including reduction in red blood cell transfusion requirements and improvements in quality of life. Lenalidomide has also demonstrated some activity in non-del(5q) lower-risk MDS as well as higher-risk MDS, especially in combination with other agents. In this paper, we review the pathogenesis of del(5q) MDS, the proposed mechanisms of action of lenalidomide, the major clinical trials that documented the activity of lenalidomide in different MDS populations, potential predictors of benefit from the drug and suggested mechanisms of resistance, and the use of combination strategies to expand the clinical utility of lenalidomide in MDS. PMID:25565910

Academic-Community Partnership to Develop a Patient-Centered Breast Cancer Risk Reduction Program for Latina Primary Care Patients.

PubMed

Castañeda, Sheila F; Giacinto, Rebeca E; Medeiros, Elizabeth A; Brongiel, Ilana; Cardona, Olga; Perez, Patricia; Talavera, Gregory A

2016-06-01

This collaborative study sought to address Latina breast cancer (BC) disparities by increasing health literacy (HL) in a community health center situated on the US-Mexico border region of San Diego County. An academic-community partnership conducted formative research to develop a culturally tailored promotora-based intervention with 109 individuals. The Spanish language program, entitled Nuestra Cocina: Mesa Buena, Vida Sana (Our Kitchen: Good Table, Healthy Life), included six sessions targeting HL, women's health, BC risk reduction, and patient-provider communication; sessions include cooking demonstrations of recipes with cancer-risk-reducing ingredients. A pilot study with 47 community health center Latina patients was conducted to examine the program's acceptability, feasibility, and ability to impact knowledge and skills. Pre- and post-analyses demonstrated that participants improved their self-reported cancer screening, BC knowledge, daily fruit and vegetable intake, and ability to read a nutrition label (p < 0.05). Results of the pilot study demonstrate the importance of utilizing patient-centered culturally appropriate noninvasive means to educate and empower Latina patients.

Academic-Community Partnership to Develop a Patient-Centered Breast Cancer Risk Reduction Program for Latina Primary Care Patients

PubMed Central

Castañeda, Sheila F.; Giacinto, Rebeca E.; Medeiros, Elizabeth A.; Brongiel, Ilana; Cardona, Olga; Perez, Patricia; Talavera, Gregory A.

2015-01-01

This collaborative study sought to address Latina breast cancer (BC) disparities by increasing health literacy (HL) in a community health center situated on the US-Mexico border region of San Diego County. An academic-community partnership conducted formative research to develop a culturally tailored promotora-based intervention with 109 individuals. The Spanish language program, entitled Nuestra Cocina: Mesa Buena, Vida Sana (Our Kitchen: Good Table, Healthy Life), included six sessions targeting HL, women’s health, BC risk reduction, and patient-provider communication; sessions include cooking demonstrations of recipes with cancer-risk-reducing ingredients. A pilot study with 47 community health center Latina patients was conducted to examine the program’s acceptability, feasibility, and ability to impact knowledge and skills. Pre- and post-analyses demonstrated that participants improved their self-reported cancer screening, BC knowledge, daily fruit and vegetable intake, and ability to read a nutrition label (p<0.05). Results of the pilot study demonstrate the importance of utilizing patient-centered culturally appropriate noninvasive means to educate and empower Latina patients. PMID:27271058

Wealth inhomogeneity applied to crash rate theory.

PubMed

Shuler, Robert L

2015-11-01

A crash rate theory based on corporate economic utility maximization is applied to individual behavior in U.S. and German motorway death rates, by using wealth inhomogeneity data in ten-percentile bins to account for variations of utility maximization in the population. Germany and the U.S. have similar median wealth figures, a well-known indicator of accident risk, but different motorway death rates. It is found that inhomogeneity in roughly the 10(th) to 30(th) percentile, not revealed by popular measures such as the Gini index which focus on differences at the higher percentiles, provides a satisfactory explanation of the data. The inhomogeneity analysis reduces data disparity from a factor of 2.88 to 1.75 as compared with median wealth assumed homogeneity, and further to 1.09 with average wealth assumed homogeneity. The first reduction from 2.88 to 1.75 is attributable to inequality at lower percentiles and suggests it may be as important in indicating socioeconomic risk as extremes in the upper percentile ranges, and that therefore the U.S. socioeconomic risk may be higher than generally realized.

International Space Station (ISS) Risk Reduction Activities

NASA Technical Reports Server (NTRS)

Fodroci, Michael

2011-01-01

As the assembly of the ISS nears completion, it is worthwhile to step back and review some of the actions pursued by the Program in recent years to reduce risk and enhance the safety and health of ISS crewmembers, visitors, and space flight participants. While the ISS requirements and initial design were intended to provide the best practicable levels of safety, it is always possible to reduce risk -- given the determination and commitment to do so. The following is a summary of some of the steps taken by the ISS Program Manager, by our International Partners, by hardware and software designers, by operational specialists, and by safety personnel to continuously enhance the safety of the ISS. While decades of work went into developing the ISS requirements, there are many things in a Program like the ISS that can only be learned through actual operational experience. These risk reduction activities can be divided into roughly three categories: (1) Areas that were initially noncompliant which have subsequently been brought into compliance or near compliance (i.e., Micrometeoroid and Orbital Debris [MMOD] protection, acoustics) (2) Areas where initial design requirements were eventually considered inadequate and were subsequently augmented (i.e., Toxicity Level 4 materials, emergency hardware and procedures) (3) Areas where risks were initially underestimated, and have subsequently been addressed through additional mitigation (i.e., Extravehicular Activity [EVA] sharp edges, plasma shock hazards) Due to the hard work and cooperation of many parties working together across the span of nearly a decade, the ISS is now a safer and healthier environment for our crew, in many cases exceeding the risk reduction targets inherent in the intent of the original design. It will provide a safe and stable platform for utilization and discovery.

Evaluation of the Reproductive and Developmental Risks of Caffeine

PubMed Central

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

2011-01-01

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

Comparative cost-effectiveness of metformin-based dual therapies associated with risk of cardiovascular diseases among Chinese patients with type 2 diabetes: Evidence from a population-based national cohort in Taiwan.

PubMed

Ou, Huang-Tz; Chen, Yen-Ting; Liu, Ya-Ming; Wu, Jin-Shang

2016-06-01

To assess the cost-effectiveness of metformin-based dual therapies associated with cardiovascular disease (CVD) risk in a Chinese population with type 2 diabetes. We utilized Taiwan's National Health Insurance Research Database (NHIRD) 1997-2011, which is derived from the claims of National Health Insurance, a mandatory-enrollment single-payer system that covers over 99% of Taiwan's population. Four metformin-based dual therapy cohorts were used, namely a reference group of metformin plus sulfonylureas (Metformin-SU) and metformin plus acarbose, metformin plus thiazolidinediones (Metformin-TZD), and metformin plus glinides (Metformin-glinides). Using propensity scores, each subject in a comparison cohort was 1:1 matched to a referent. The effectiveness outcome was CVD risk. Only direct medical costs were included. The Markov chain model was applied to project lifetime outcomes, discounted at 3% per annum. The bootstrapping technique was performed to assess uncertainty in analysis. Metformin-glinides was most cost-effective in the base-case analysis; Metformin-glinides saved $194 USD for one percentage point of reduction in CVD risk, as compared to Metformin-SU. However, for the elderly or those with severe diabetic complications, Metformin-TZD, especially pioglitazone, was more suitable; as compared to Metformin-SU, Metformin-TZD saved $840.1 USD per percentage point of reduction in CVD risk. Among TZDs, Metformin-pioglitazone saved $1831.5 USD per percentage point of associated CVD risk reduction, as compared to Metformin-rosiglitazone. When CVD is considered an important clinical outcome, Metformin-pioglitazone is cost-effective, in particular for the elderly and those with severe diabetic complications. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

24 CFR 245.416 - Initial submission of materials to HUD: Conversion from project-paid utilities to tenant-paid...

Code of Federal Regulations, 2010 CFR

2010-04-01

... HUD: Conversion from project-paid utilities to tenant-paid utilities or a reduction in tenant utility... Covered Action § 245.416 Initial submission of materials to HUD: Conversion from project-paid utilities to tenant-paid utilities or a reduction in tenant utility allowances. In the case of a conversion from...

The Effects of Medicare on Medical Expenditure Risk and Financial Strain†

PubMed Central

Barcellos, Silvia Helena; Jacobson, Mireille

2016-01-01

Medicare offers substantial protection from medical expenditure risk, protection that has increased in recent years. At age 65, out-of-pocket expenditures drop by 33 percent at the mean and 53 percent at the ninety-fifth percentile. Medical-related financial strain, such as difficulty paying bills and collections agency contact, is dramatically reduced. Nonetheless, using a stylized expected utility framework, the gain from reducing out-of-pocket expenditures accounts for only 18 percent of the social costs of financing Medicare. This calculation ignores any direct health benefits from Medicare or any indirect health effects due to reductions in financial stress. PMID:27928462

Skin cancer and inorganic arsenic: uncertainty-status of risk.

PubMed

Brown, K G; Guo, H R; Kuo, T L; Greene, H L

1997-02-01

The current U.S. EPA standard for inorganic arsenic in drinking water is 50 ppb (microgram/L), dating to the National Interim Primary Drinking Water Regulation of 1976. The current EPA risk analysis predicts an increased lifetime skin cancer risk on the order of 3 or 4 per 1000 from chronic exposure at that concentration. Revision of the standard to only a few ppb, perhaps even less than 1 ppb, may be indicated by the EPA analysis to reduce the lifetime risk to an acceptable level. The cost to water utilities, and ultimately to their consumers, to conform to such a large reduction in the standard could easily reach several billion dollars, so it is particularly important to assess accurately the current risk and the risk reduction that would be achieved by a lower standard. This article addresses the major sources of uncertainty in the EPA analysis with respect to this objective. Specifically, it focuses on uncertainty and variability in the exposure estimates for the landmark study of Tseng and colleagues in Taiwan, analyzed using a reconstruction of the their exposure data. It is concluded that while the available dataset is suitable to establish the hazard of skin cancer, it is too highly summarized for reliable dose-response assessment. A new epidemiologic study is needed, designed for the requirements of dose-response assessment.

Favorable Risk Selection in Medicare Advantage: Trends in Mortality and Plan Exits Among Nursing Home Beneficiaries

PubMed Central

Goldberg, Elizabeth M.; Trivedi, Amal N.; Mor, Vincent; Jung, Hye-Young; Rahman, Momotazur

2016-01-01

The 2003 Medicare Modernization Act (MMA) increased payments to Medicare Advantage plans and instituted a new risk-adjustment payment model to reduce plans' incentives to enroll healthier Medicare beneficiaries and avoid those with higher costs. Whether the MMA reduced risk selection remains debatable. This study uses mortality differences, nursing home utilization, and switch rates to assess whether the MMA successfully decreased risk selection from 2000 to 2012. We found no decrease in the mortality difference or adjusted difference in nursing home use between plan beneficiaries pre- and post the MMA. Among beneficiaries with nursing home use, disenrollment from Medicare Advantage plans declined from 20% to 12%, but it remained 6 times higher than the switch rate from traditional Medicare to Medicare Advantage. These findings suggest that the MMA was not associated with reductions in favorable risk selection, as measured by mortality, nursing home use, and switch rates. PMID:27516452

Aligning population-based care management with chronic disease complexity.

PubMed

Hewner, Sharon; Seo, Jin Young; Gothard, Sandra E; Johnson, Barbara J

2014-01-01

Risk-stratified care management requires knowledge of the complexity of chronic disease and comorbidity, information that is often not readily available in the primary care setting. The purpose of this article was to describe a population-based approach to risk-stratified care management that could be applied in primary care. Three populations (Medicaid, Medicare, and privately insured) at a regional health plan were divided into risk-stratified cohorts based on chronic disease and complexity, and utilization was compared before and after the implementation of population-specific care management teams of nurses. Risk-stratified care management was associated with reductions in hospitalization rates in all three populations, but the opportunities to avoid admissions were different. Knowledge of population complexity is critical to the development of risk-stratified care management in primary care, and a complexity matrix can help nurses identify gaps in care and align interventions to cohort and population needs. Copyright © 2014 Elsevier Inc. All rights reserved.

Adverse Effects of Plasma Transfusion

PubMed Central

Pandey, Suchitra; Vyas, Girish N.

2012-01-01

Plasma utilization has increased over the last two decades, and there is a growing concern that many plasma transfusions are inappropriate. Plasma transfusion is not without risk, and certain complications are more likely with plasma than other blood components. Clinical and laboratory investigations of the patients suffering reactions following infusion of fresh frozen plasma (FFP) define the etiology and pathogenesis of the panoply of adverse effects. We review here the pathogenesis, diagnosis, and management of the risks associated with plasma transfusion. Risks commonly associated with FFP include: (1) transfusion related acute lung injury; (2) transfusion associated circulatory overload, and (3) allergic/anaphylactic reactions. Other less common risks include (1) transmission of infections, (2) febrile non-hemolytic transfusion reactions, (3) RBC allo-immunization, and (4) hemolytic transfusion reactions. The affect of pathogen inactivation/reduction methods on these risks are also discussed. Fortunately, a majority of the adverse effects are not lethal and are adequately treated in clinical practice. PMID:22578374

Patterns of substance use and correlates of lifetime and active injection drug use among women in Malaysia.

PubMed

Wickersham, Jeffrey A; Loeliger, Kelsey B; Marcus, Ruthanne; Pillai, Veena; Kamarulzaman, Adeeba; Altice, Frederick L

2016-01-01

While drug use is associated with HIV risk in Southeast Asia, little is known about substance use behaviors among women, including drug injection. To describe patterns of substance use among women using alcohol and drugs in Malaysia and identify correlates of lifetime and active drug injection, a risk factor for HIV transmission. A survey of 103 women who used drugs in the last 12 months assessed drug use history and frequency, including drug injection and drug use during pregnancy, self-reported HIV-status, childhood and adulthood physical and sexual abuse, and access to and utilization of harm reduction services, including needle-syringe exchange programs (NSEP) and opioid agonist maintenance therapy (OAT). Principal component analyses (PCA) were conducted to assess drug use grouping. Amphetamine-type substances (ATS; 82.5%), alcohol (75.7%) and heroin (71.8%) were the most commonly used drugs across the lifetime. Drug injection was reported by 32.0% (n = 33) of participants with 21.4% (n = 22) having injected in the last 30 days. PCA identified two groups of drug users: opioids/benzodiazepines and club drugs. Lifetime drug injection was significantly associated with lower education, homelessness, prior criminal justice involvement, opioid use, polysubstance use, childhood physical and sexual abuse, and being HIV-infected, but not with prior OAT. Women who use drugs in Malaysia report high levels of polysubstance use and injection-related risk behaviors, including sharing of injection equipment and being injected by others. Low OAT utilization suggests the need for improved access to OAT services and other harm reduction measures that prioritize women.

A new method for examining the cost savings of reducing COPD exacerbations.

PubMed

Mapel, Douglas W; Schum, Michael; Lydick, Eva; Marton, Jeno P

2010-01-01

Some treatments for chronic obstructive pulmonary disease (COPD) can reduce exacerbations, and thus could have a favourable impact on overall healthcare costs. To evaluate a new method for assessing the potential cost savings of COPD controller medications based on the incidence of exacerbations and their related resource utilization in the general population. Patients with COPD (n = 1074) enrolled in a regional managed care system in the US were identified using administrative data and divided by their medication use into three groups (salbutamol, ipratropium and salmeterol). Exacerbations were captured using International Classification of Diseases, Ninth Edition (ICD-9) and current procedural terminology (CPT) codes, then logistic regression models were created that described the risk of exacerbations for each comparator group and exacerbation type over a 6-month period. A Monte Carlo simulation was then applied 1000 times to provide the range of potential exacerbation reductions and cost consequences in response to a range of hypothetical examples of COPD controller medications. Exacerbation events for each group could be modelled such that the events predicted by the Monte Carlo estimates were very close to the actual prevalences. The estimated cost per exacerbation avoided depended on the incidence of exacerbation in the various subpopulations, the assumed relative risk reduction, the projected daily cost for new therapy, and the costs of exacerbation treatment. COPD exacerbation events can be accurately modelled from the healthcare utilization data of a defined cohort with sufficient accuracy for cost-effectiveness analysis. Treatments that reduce the risk or severity of exacerbations are likely to be cost effective among those patients who have frequent exacerbations and hospitalizations.

Vorapaxar: The Current Role and Future Directions of a Novel Protease-Activated Receptor Antagonist for Risk Reduction in Atherosclerotic Disease.

PubMed

Gryka, Rebecca J; Buckley, Leo F; Anderson, Sarah M

2017-03-01

Despite the current standard of care, patients with cardiovascular disease remain at a high risk for recurrent events. Inhibition of thrombin-mediated platelet activation through protease-activated receptor-1 antagonism may provide reductions in atherosclerotic disease beyond those achievable with the current standard of care. Our primary objective is to evaluate the clinical literature regarding the role of vorapaxar (Zontivity™) in the reduction of cardiovascular events in patients with a history of myocardial infarction and peripheral artery disease. In particular, we focus on the potential future directions for protease-activating receptor antagonists in the treatment of a broad range of atherosclerotic diseases. A literature search of PubMed and EBSCO was conducted to identify randomized clinical trials from August 2005 to June 2016 using the search terms: 'vorapaxar', 'SCH 530348', 'protease-activated receptor-1 antagonist', and 'Zontivity™'. Bibliographies were searched and additional resources were obtained. Vorapaxar is a first-in-class, protease-activated receptor-1 antagonist. The Thrombin Receptor Antagonist for Clinical Event Reduction (TRACER) trial did not demonstrate a significant reduction in a broad primary composite endpoint. However, the Thrombin-Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events (TRA 2°P-TIMI 50) trial examined a more traditional composite endpoint and found a significant benefit with vorapaxar. Vorapaxar significantly increased bleeding compared with standard care. Ongoing trials will help define the role of vorapaxar in patients with peripheral arterial disease, patients with diabetes mellitus, and other important subgroups. The use of multivariate modeling may enable the identification of subgroups with maximal benefit and minimal harm from vorapaxar. Vorapaxar provides clinicians with a novel mechanism of action to further reduce the burden of ischemic heart disease. Identification of patients with a high ischemic risk and low bleeding risk would enable clinicians to maximize the utility of this unique agent.

Reduction of risk of Salmonella infection from kitchen cleaning clothes by use of sodium hypochlorite disinfectant cleaner.

PubMed

Chaidez, C; Soto-Beltran, M; Gerba, C P; Tamimi, A H

2014-11-01

The objective of this study was to evaluate the reduction of infection risk due to exposure to Salmonella sp. in kitchen cleaning clothes by the use of a bleach (sodium hypochlorite) cleaner utilizing a continuous-time dynamic exposure model. The only route of exposure considered was hand contamination during cloth use. The occurrence and numbers of Salmonella was studied in 60 homes over a 6-week period in which half disinfected kitchen cleaning clothes with a sodium hypochlorite based disinfectant cleaner. This study demonstrated that a significant risk exists for Salmonella infection from kitchen cleaning clothes in Mexican homes and that this risk can be reduced by almost 100-fold by soaking cleaning clothes in a bleach product. The risks of infection and illness could likely be further reduced by developing a more effective procedure for reducing Salmonella in cleaning clothes treated twice a day with a sodium hypochlorite disinfectant (i.e. longer soaking time) or using a greater concentration of the disinfectant. Hygiene intervention is a key strategy to reduce the potential risk of disease-causing micro-organisms in households. There is a lack of understanding of the human health risk associated with the use of contaminated kitchen cleaning cloths. The study used a quantitative microbial risk assessment to estimate the risk associated with the use of kitchen cleaning clothes by using disinfectant products. The results showed that the use of prescribe protocols can reduce the risk of Salmonella infections in household kitchens. © 2014 The Society for Applied Microbiology.

Achieving Effective Risk Management Reduction Throughout Decommissioning at the Columbus Closure Project

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

Anderson, K.D.

2006-07-01

Nuclear facility decontamination, dismantlement, and demolition activities provide a myriad of challenges along the path to reaching a safe, effective, and compliant decommissioning. Among the challenges faced during decommissioning, is the constant management and technical effort to eliminate, mitigate, or minimize the potential of risks of radiation exposures and other hazards to the worker, the surrounding community, and the environment. Management strategies to eliminate, mitigate, or minimize risks include incorporating strong safety and As Low As Reasonably Achievable (ALARA) principles into an integrated work planning process. Technical and operational strategies may include utilizing predictive risk analysis tools to establish contaminationmore » limits for demolition and using remote handling equipment to reduce occupational and radiation exposures to workers. ECC and E2 Closure Services, LLC (Closure Services) have effectively utilized these management and technical tools to eliminate, mitigate, and reduce radiation exposures under contract to the U.S. Department of Energy (DOE) for the decontamination and decommissioning Columbus Closure Project (CCP). In particular, Closure Services achieved significant dose reduction during the dismantling, decontamination, and demolition activities for Building JN-1. Management strategies during the interior dismantlement, decontamination, and demolition of the facility demanded an integrated work planning processes that involved project disciplines. Integrated planning processes identified multiple opportunities to incorporate the use of remote handling equipment during the interior dismantling and demolition activities within areas of high radiation. Technical strategies employed predictive risk analysis tools to set upper bounding contamination limits, allowed for the radiological demolition of the building without exceeding administrative dose limits to the worker, general public, and the environment. Adhering to management and technical strategies during the dismantlement, decontamination, and demolition of Building JN-1 enabled Closure Services to achieve strong ALARA performance, maintain absolute compliance under the regulatory requirements and meeting licensing conditions for decommissioning. (authors)« less

From event analysis to global lessons: disaster forensics for building resilience

NASA Astrophysics Data System (ADS)

Keating, Adriana; Venkateswaran, Kanmani; Szoenyi, Michael; MacClune, Karen; Mechler, Reinhard

2016-04-01

With unprecedented growth in disaster risk, there is an urgent need for enhanced learning about and understanding disasters, particularly in relation to the trends in the drivers of increasing risk. Building on the disaster forensics field, we introduce the Post Event Review Capability (PERC) methodology for systematically and holistically analyzing disaster events, and identifying actionable recommendations. PERC responds to a need for learning about the successes and failures in disaster risk management and resilience, and uncovers the underlying drivers of increasing risk. We draw generalizable insights identified from seven applications of the methodology to date, where we find that across the globe policy makers and practitioners in disaster risk management face strikingly similar challenges despite variations in context, indicating encouraging potential for mutual learning. These lessons highlight the importance of integrated risk reduction strategies. We invite others to utilize the freely available PERC approach and contribute to building a repository of learnings on disaster risk management and resilience.

Financial vulnerability of the electricity sector to drought, and the impacts of changes in generation mix

NASA Astrophysics Data System (ADS)

Kern, J.

2015-12-01

Electric power utilities are increasingly cognizant of the risks water scarcity and rising temperatures pose for generators that use water as a "fuel" (i.e., hydroelectric dams) and generators that use water for cooling (i.e., coal, natural gas and nuclear). At the same time, utilities are under increasing market and policy pressure to retire coal-fired generation, the primary source of carbon emissions in the electric power sector. Due to falling costs of renewables and low natural gas prices, retiring coal fired generation is mostly being replaced with combined cycle natural gas, wind and solar. An immediate benefit of this shift has been a reduction in water withdrawals per megawatt-hour and reduced thermal impacts in surface water systems. In the process of retiring older coal-fired power plants, many of which use water intensive open-loop cooling systems, utilities are making their systems less vulnerable to water scarcity and higher water temperatures. However, it is not clear whether financial risks from water scarcity will decrease as result of this change. In particular, the choice to replace coal with natural gas combined cycle plants leaves utilities financially exposed to natural gas prices, especially during droughts when natural gas generation is used to replace lost hydropower production. Utility-scale solar, while more expensive than natural gas combined cycle generation, gives utilities an opportunity to simultaneously reduce their exposure to water scarcity and fuel price risk. In this study, we assess how switching from coal to natural gas and solar changes a utility's financial exposure to drought. We model impacts on retail prices and a utility's rate of return under current conditions and non-stationarity in natural gas prices and temperature and streamflows to determine whether increased exposure to natural gas prices offsets corresponding gains in water use efficiency. We also evaluate whether utility scale solar is an effective hedge against the combined effects of drought and natural gas price volatility—one that increases costs on average but reduces exposure to large drought-related losses.

Meditation and Cardiovascular Risk Reduction: A Scientific Statement From the American Heart Association.

PubMed

Levine, Glenn N; Lange, Richard A; Bairey-Merz, C Noel; Davidson, Richard J; Jamerson, Kenneth; Mehta, Puja K; Michos, Erin D; Norris, Keith; Ray, Indranill Basu; Saban, Karen L; Shah, Tina; Stein, Richard; Smith, Sidney C

2017-09-28

Despite numerous advances in the prevention and treatment of atherosclerosis, cardiovascular disease remains a leading cause of morbidity and mortality. Novel and inexpensive interventions that can contribute to the primary and secondary prevention of cardiovascular disease are of interest. Numerous studies have reported on the benefits of meditation. Meditation instruction and practice is widely accessible and inexpensive and may thus be a potential attractive cost-effective adjunct to more traditional medical therapies. Accordingly, this American Heart Association scientific statement systematically reviewed the data on the potential benefits of meditation on cardiovascular risk. Neurophysiological and neuroanatomical studies demonstrate that meditation can have long-standing effects on the brain, which provide some biological plausibility for beneficial consequences on the physiological basal state and on cardiovascular risk. Studies of the effects of meditation on cardiovascular risk have included those investigating physiological response to stress, smoking cessation, blood pressure reduction, insulin resistance and metabolic syndrome, endothelial function, inducible myocardial ischemia, and primary and secondary prevention of cardiovascular disease. Overall, studies of meditation suggest a possible benefit on cardiovascular risk, although the overall quality and, in some cases, quantity of study data are modest. Given the low costs and low risks of this intervention, meditation may be considered as an adjunct to guideline-directed cardiovascular risk reduction by those interested in this lifestyle modification, with the understanding that the benefits of such intervention remain to be better established. Further research on meditation and cardiovascular risk is warranted. Such studies, to the degree possible, should utilize randomized study design, be adequately powered to meet the primary study outcome, strive to achieve low drop-out rates, include long-term follow-up, and be performed by those without inherent bias in outcome. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

The potential of crowdsourcing and mobile technology to support flood disaster risk reduction

NASA Astrophysics Data System (ADS)

See, Linda; McCallum, Ian; Liu, Wei; Mechler, Reinhard; Keating, Adriana; Hochrainer-Stigler, Stefan; Mochizuki, Junko; Fritz, Steffen; Dugar, Sumit; Arestegui, Michael; Szoenyi, Michael; Laso-Bayas, Juan-Carlos; Burek, Peter; French, Adam; Moorthy, Inian

2016-04-01

The last decade has seen a rise in citizen science and crowdsourcing for carrying out a variety of tasks across a number of different fields, most notably the collection of data such as the identification of species (e.g. eBird and iNaturalist) and the classification of images (e.g. Galaxy Zoo and Geo-Wiki). Combining human computing with the proliferation of mobile technology has resulted in vast amounts of geo-located data that have considerable value across multiple domains including flood disaster risk reduction. Crowdsourcing technologies, in the form of online mapping, are now being utilized to great effect in post-disaster mapping and relief efforts, e.g. the activities of Humanitarian OpenStreetMap, complementing official channels of relief (e.g. Haiti, Nepal and New York). Disaster event monitoring efforts have been further complemented with the use of social media (e.g. twitter for earthquakes, flood monitoring, and fire detection). Much of the activity in this area has focused on ex-post emergency management while there is considerable potential for utilizing crowdsourcing and mobile technology for vulnerability assessment, early warning and to bolster resilience to flood events. This paper examines the use of crowdsourcing and mobile technology for measuring and monitoring flood hazards, exposure to floods, and vulnerability, drawing upon examples from the literature and ongoing projects on flooding and food security at IIASA.

Benefits of Using a Mars Forward Strategy for Lunar Surface Systems

NASA Technical Reports Server (NTRS)

Mulqueen, Jack; Griffin, Brand; Smitherman, David; Maples, Dauphne

2009-01-01

This paper identifies potential risk reduction, cost savings and programmatic procurement benefits of a Mars Forward Lunar Surface System architecture that provides commonality or evolutionary development paths for lunar surface system elements applicable to Mars surface systems. The objective of this paper is to identify the potential benefits for incorporating a Mars Forward development strategy into the planned Project Constellation Lunar Surface System Architecture. The benefits include cost savings, technology readiness, and design validation of systems that would be applicable to lunar and Mars surface systems. The paper presents a survey of previous lunar and Mars surface systems design concepts and provides an assessment of previous conclusions concerning those systems in light of the current Project Constellation Exploration Architectures. The operational requirements for current Project Constellation lunar and Mars surface system elements are compared and evaluated to identify the potential risk reduction strategies that build on lunar surface systems to reduce the technical and programmatic risks for Mars exploration. Risk reduction for rapidly evolving technologies is achieved through systematic evolution of technologies and components based on Moore's Law superimposed on the typical NASA systems engineering project development "V-cycle" described in NASA NPR 7120.5. Risk reduction for established or slowly evolving technologies is achieved through a process called the Mars-Ready Platform strategy in which incremental improvements lead from the initial lunar surface system components to Mars-Ready technologies. The potential programmatic benefits of the Mars Forward strategy are provided in terms of the transition from the lunar exploration campaign to the Mars exploration campaign. By utilizing a sequential combined procurement strategy for lunar and Mars exploration surface systems, the overall budget wedges for exploration systems are reduced and the costly technological development gap between the lunar and Mars programs can be eliminated. This provides a sustained level of technological competitiveness as well as maintaining a stable engineering and manufacturing capability throughout the entire duration of Project Constellation.

Incorporating Social Determinants into a Groundwater Risk Framework

NASA Astrophysics Data System (ADS)

Simpson, M.; Allen, D. M.; Journeay, M.; Korteling, B.

2009-12-01

The remediation of polluted groundwater is often very costly, therefore water managers utilize various proactive measures, such as wellhead protection planning, to prevent contamination events. With limited available resources, it is essential to prioritize where these measures are introduced; systematic and integrated methodologies of assessing risk to groundwater can be utilized for this prioritization. To quantify the resistance of the physical system to pollution, Aquifer Vulnerability is commonly mapped for the area of interest. This information is useful for focusing monitoring efforts and identifying data gaps, but is a relative measure of contaminant risk. To more accurately assess the probability of contamination, an inventory of hazards can be integrated with intrinsic vulnerability of the physical system. This Threat indicator links land-use with chemicals and quantifies the risk based on the toxicity and environmental fate of these substances. Local knowledge of the quantity stored and likelihood of release can be utilized to further assess these threats. Both of these steps form part of an existing frameworks for assessing risk to groundwater. In this study, a groundwater risk framework is developed and tested in two study areas; Pender Island and the Lower Fraser Valley in British Columbia, Canada. Enhancements of a basic groundwater risk framework include not only incorporating points sources such as septic systems, landfills and fuel storage, but also various social determinants of risk. These social determinants include the Resistance of a community, which represents the planning and protection initiatives designed to safeguard the resource. These include items such as land-use planning that consider groundwater vulnerability and best management practices enforced by local governments. The ability to recover following an event is the Capacity of a community; indicators include the presence or absence of spill response plans, treatment systems or an alternative supply of water. The determinant of Loss quantifies the financial impact of this work. This indicator may be altered in future applications to include loss associated with human health and/or that stemming from a reduction in ecosystem health.

Latent Class Analysis of HIV Risk Behaviors Among Russian Women at Risk for Alcohol-Exposed Pregnancies.

PubMed

Bohora, Som; Chaffin, Mark; Shaboltas, Alla; Bonner, Barbara; Isurina, Galina; Batluk, Julia; Bard, David; Tsvetkova, Larissa; Skitnevskaya, Larissa; Volkova, Elena; Balachova, Tatiana

2017-11-01

The number of HIV cases attributed to heterosexual contact and the proportion of women among HIV positive individuals has increased worldwide. Russia is a country with the highest rates of newly diagnosed HIV infections in the region, and the infection spreads beyond traditional risk groups. While young women are affected disproportionately, knowledge of HIV risk behaviors in women in the general population remains limited. The objectives of this study were to identify patterns of behaviors that place women of childbearing age at high risk for HIV transmission and determine whether socio-demographic characteristics and alcohol use are predictive of the risk pattern. A total of 708 non-pregnant women, aged between 18 and 44 years, who were at risk for an alcohol-exposed pregnancy were enrolled in two regions in Russia. Participants completed a structured interview focused on HIV risk behaviors, including risky sexual behavior and alcohol and drug use. Latent class analysis was utilized to examine associations between HIV risk and other demographic and alcohol use characteristics and to identify patterns of risk among women. Three classes were identified. 34.93% of participants were at high risk, combining their risk behaviors, e.g., having multiple sexual partners, with high partner's risk associated with partner's drug use (class I). Despite reporting self-perceived risk for HIV/STI, this class of participants was unlikely to utilize adequate protection (i.e., condom use). The second high risk class included 13.19% of participants who combined their risky sexual behaviors, i.e., multiple sexual partners and having STDs, with partner's risk that included partner's imprisonment and partner's sex with other women (class II). Participants in this class were likely to utilize protection/condoms. Finally, 51.88% of participants were at lower risk, which was associated primarily with their partners' risk, and these participants utilized protection (class III). The odds of being in class I compared with class III were 3.3 (95% CI [1.06, 10.38]) times higher for those women who had Alcohol Use Disorders Identification Test scores ≥ 8 than those who had lower scores, and were 3.9 (95% CI [1.69, 8.97]) times higher for those who used alcohol before sex than those who did not. In addition, women who drank more days per week were 1.36 times more likely to be in class II than in class III. The study informs prevention by identifying specific population groups and targets for interventions. Alcohol use is a significant predictor and an overarching factor of HIV risk in women. Since at-risk drinking is common among young Russian women, alcohol risk reduction should be an essential component of HIV prevention efforts.

Nowcasting Earthquakes: A Comparison of Induced Earthquakes in Oklahoma and at the Geysers, California

NASA Astrophysics Data System (ADS)

Luginbuhl, Molly; Rundle, John B.; Hawkins, Angela; Turcotte, Donald L.

2018-01-01

Nowcasting is a new method of statistically classifying seismicity and seismic risk (Rundle et al. 2016). In this paper, the method is applied to the induced seismicity at the Geysers geothermal region in California and the induced seismicity due to fluid injection in Oklahoma. Nowcasting utilizes the catalogs of seismicity in these regions. Two earthquake magnitudes are selected, one large say M_{λ } ≥ 4, and one small say M_{σ } ≥ 2. The method utilizes the number of small earthquakes that occurs between pairs of large earthquakes. The cumulative probability distribution of these values is obtained. The earthquake potential score (EPS) is defined by the number of small earthquakes that has occurred since the last large earthquake, the point where this number falls on the cumulative probability distribution of interevent counts defines the EPS. A major advantage of nowcasting is that it utilizes "natural time", earthquake counts, between events rather than clock time. Thus, it is not necessary to decluster aftershocks and the results are applicable if the level of induced seismicity varies in time. The application of natural time to the accumulation of the seismic hazard depends on the applicability of Gutenberg-Richter (GR) scaling. The increasing number of small earthquakes that occur after a large earthquake can be scaled to give the risk of a large earthquake occurring. To illustrate our approach, we utilize the number of M_{σ } ≥ 2.75 earthquakes in Oklahoma to nowcast the number of M_{λ } ≥ 4.0 earthquakes in Oklahoma. The applicability of the scaling is illustrated during the rapid build-up of injection-induced seismicity between 2012 and 2016, and the subsequent reduction in seismicity associated with a reduction in fluid injections. The same method is applied to the geothermal-induced seismicity at the Geysers, California, for comparison.

The Impact of Big Data on Chronic Disease Management.

PubMed

Bhardwaj, Niharika; Wodajo, Bezawit; Spano, Anthony; Neal, Symaron; Coustasse, Alberto

Population health management and specifically chronic disease management depend on the ability of providers to prevent development of high-cost and high-risk conditions such as diabetes, heart failure, and chronic respiratory diseases and to control them. The advent of big data analytics has potential to empower health care providers to make timely and truly evidence-based informed decisions to provide more effective and personalized treatment while reducing the costs of this care to patients. The goal of this study was to identify real-world health care applications of big data analytics to determine its effectiveness in both patient outcomes and the relief of financial burdens. The methodology for this study was a literature review utilizing 49 articles. Evidence of big data analytics being largely beneficial in the areas of risk prediction, diagnostic accuracy and patient outcome improvement, hospital readmission reduction, treatment guidance, and cost reduction was noted. Initial applications of big data analytics have proved useful in various phases of chronic disease management and could help reduce the chronic disease burden.

The Preventable Admissions Care Team (PACT): A Social Work-Led Model of Transitional Care.

PubMed

Basso Lipani, Maria; Holster, Kathleen; Bussey, Sarah

2015-10-01

In 2010, the Preventable Admissions Care Team (PACT), a social work-led transitional care model, was developed at Mount Sinai to reduce 30-day readmissions among high-risk patients. PACT begins with a comprehensive bedside assessment to identify the psychosocial drivers of readmission. In partnership with the patient and family, a patient-centered action plan is developed and carried out through phone calls, accompaniments, navigations and home visits, as needed, in the first 30 days following discharge. 620 patients were enrolled during the pilot from September 2010-August 2012. Outcomes demonstrated a 43% reduction in inpatient utilization and a 54% reduction in emergency department visits among enrollees. In addition, 93% of patients had a follow-up appointment within 7-10 days of discharge and 90% of patients attended the appointment. The success of PACT has led to additional funding from the Centers for Medicare and Medicaid Services under the Community-based Care Transitions Program and several managed care companies seeking population health management interventions for high risk members.

A case at last for age-phased reduction in equity.

PubMed Central

Samuelson, P A

1989-01-01

Maximizing expected utility over a lifetime leads one who has constant relative risk aversion and faces random-walk securities returns to be "myopic" and hold the same fraction of portfolio in equities early and late in life--a defiance of folk wisdom and casual introspection. By assuming one needs to assure at retirement a minimum ("subsistence") level of wealth, the present analysis deduces a pattern of greater risk-taking when young than when old. When a subsistence minimum is needed at every period of life, the rentier paradoxically is least risk tolerant in youth--the Robert C. Merton paradox that traces to the decline with age of the present discounted value of the subsistence-consumption requirements. Conversely, the decline with age of capitalized human capital reverses the Merton effect. PMID:2813438

Randomized controlled trial of a cognitive-behavioral intervention for HIV-positive persons: an investigation of treatment effects on psychosocial adjustment.

PubMed

Carrico, Adam W; Chesney, Margaret A; Johnson, Mallory O; Morin, Stephen F; Neilands, Torsten B; Remien, Robert H; Rotheram-Borus, Mary Jane; Lennie Wong, F

2009-06-01

Questions remain regarding the clinical utility of psychological interventions for HIV-positive persons because randomized controlled trials have utilized stringent inclusion criteria and focused extensively on gay men. The present randomized controlled trial examined the efficacy of a 15-session, individually delivered cognitive-behavioral intervention (n = 467) compared to a wait-list control (n = 469) in a diverse sample of HIV-positive persons who reported HIV transmission risk behavior. Five intervention sessions that dealt with executing effective coping responses were delivered between baseline and the 5 months post-randomization. Additional assessments were completed through 25 months post-randomization. Despite previously documented reductions in HIV transmission risk, no intervention-related changes in psychosocial adjustment were observed across the 25-month investigation period. In addition, there were no intervention effects on psychosocial adjustment among individuals who presented with mild to moderate depressive symptoms. More intensive mental health interventions may be necessary to improve psychosocial adjustment among HIV-positive individuals.

Strategies Chosen by YMSM during Goal Setting to Reduce Risk for HIV & Other STIs: Results from the Keep It Up! 2.0 Prevention Trial

PubMed Central

Motley, Darnell N.; Hammond, Sydney; Mustanski, Brian

2018-01-01

Although there have been great advances in the prevention of HIV in the last two decades, young men who have sex with men (YMSM) continue to be disproportionately impacted. Utilizing qualitative data from a sample of YMSM (N = 292) engaged in a randomized controlled trial testing the efficacy of an internet-based HIV prevention program, we examined YMSM’s goals for sexual risk reduction. Goals tended to focus on strategies used to prepare for safer sex or strategies to be used during sex. In both areas, five categories of strategies were identified: skill-related, intrapersonal, social, contextual, and instrumental. Findings suggest opportunities for more tailored eHealth intervention by focusing on strategies in domains of most use to the individual. Future research should include longitudinal assessment of barriers and facilitators to goal adherence, utility of goals in increasing safer sex behaviors, and changes to goals over time. PMID:28195780

Strategies Chosen by YMSM During Goal Setting to Reduce Risk for HIV and Other Sexually Transmitted Infections: Results From the Keep It Up! 2.0 Prevention Trial.

PubMed

Motley, Darnell N; Hammond, Sydney; Mustanski, Brian

2017-02-01

Although there have been great advances in the prevention of HIV in the last two decades, young men who have sex with men (YMSM) continue to be disproportionately impacted. Utilizing qualitative data from a sample of YMSM (N = 292) engaged in a randomized controlled trial testing the efficacy of an internet-based HIV prevention program, we examined YMSM's goals for sexual risk reduction. Goals tended to focus on strategies used to prepare for safer sex or strategies to be used during sex. In both areas, five categories of strategies were identified: skill-related, intrapersonal, social, contextual, and instrumental. Findings suggest opportunities for more tailored eHealth intervention by focusing on strategies in domains of most use to the individual. Future research should include longitudinal assessment of barriers and facilitators to goal adherence, utility of goals in increasing safer sex behaviors, and changes to goals over time.

CT Dose Optimization in Pediatric Radiology: A Multiyear Effort to Preserve the Benefits of Imaging While Reducing the Risks.

PubMed

Greenwood, Taylor J; Lopez-Costa, Rodrigo I; Rhoades, Patrick D; Ramírez-Giraldo, Juan C; Starr, Matthew; Street, Mandie; Duncan, James; McKinstry, Robert C

2015-01-01

The marked increase in radiation exposure from medical imaging, especially in children, has caused considerable alarm and spurred efforts to preserve the benefits but reduce the risks of imaging. Applying the principles of the Image Gently campaign, data-driven process and quality improvement techniques such as process mapping and flowcharting, cause-and-effect diagrams, Pareto analysis, statistical process control (control charts), failure mode and effects analysis, "lean" or Six Sigma methodology, and closed feedback loops led to a multiyear program that has reduced overall computed tomographic (CT) examination volume by more than fourfold and concurrently decreased radiation exposure per CT study without compromising diagnostic utility. This systematic approach involving education, streamlining access to magnetic resonance imaging and ultrasonography, auditing with comparison with benchmarks, applying modern CT technology, and revising CT protocols has led to a more than twofold reduction in CT radiation exposure between 2005 and 2012 for patients at the authors' institution while maintaining diagnostic utility. (©)RSNA, 2015.

The impact of realignment on utilization and cost of community-based mental health services in California.

PubMed

Scheffler, R; Zhang, A; Snowden, L

2001-11-01

Decentralization of California's public mental health system under program realignment has changed the utilization and cost of community-based mental health services. This study examined a sample of 75,951 users, representing 1.5 million adults who visited California's public mental health services during a 6-year period (FY 1988-1990 and FY 1992-1994). Regression analysis was performed to examine cost and utilization reduction over time, across regions, and across psychiatric diagnoses. Overall utilization and cost of community-based mental health services dropped significantly after the implementation of realignment. They were significantly lower for (a) 24-hour services in the urban industrialized Southern Region and (b) outpatient services in the agricultural Central Region of the state. Users diagnosed with mood disorders took a greater portion, but were associated with significantly less treatment and cost than other users in the post-realignment period. When local communities bear the financial risks and rewards, they find more efficient methods of delivering community-based mental health services.

Risk Assessment Using the Three Dimensions of Probability (Likelihood), Severity, and Level of Control

NASA Technical Reports Server (NTRS)

Watson, Clifford

2010-01-01

Traditional hazard analysis techniques utilize a two-dimensional representation of the results determined by relative likelihood and severity of the residual risk. These matrices present a quick-look at the Likelihood (Y-axis) and Severity (X-axis) of the probable outcome of a hazardous event. A three-dimensional method, described herein, utilizes the traditional X and Y axes, while adding a new, third dimension, shown as the Z-axis, and referred to as the Level of Control. The elements of the Z-axis are modifications of the Hazard Elimination and Control steps (also known as the Hazard Reduction Precedence Sequence). These steps are: 1. Eliminate risk through design. 2. Substitute less risky materials for more hazardous materials. 3. Install safety devices. 4. Install caution and warning devices. 5. Develop administrative controls (to include special procedures and training.) 6. Provide protective clothing and equipment. When added to the twodimensional models, the level of control adds a visual representation of the risk associated with the hazardous condition, creating a tall-pole for the least-well-controlled failure while establishing the relative likelihood and severity of all causes and effects for an identified hazard. Computer modeling of the analytical results, using spreadsheets and threedimensional charting gives a visual confirmation of the relationship between causes and their controls

Risk Assessment Using the Three Dimensions of Probability (Likelihood), Severity, and Level of Control

NASA Technical Reports Server (NTRS)

Watson, Clifford C.

2011-01-01

Traditional hazard analysis techniques utilize a two-dimensional representation of the results determined by relative likelihood and severity of the residual risk. These matrices present a quick-look at the Likelihood (Y-axis) and Severity (X-axis) of the probable outcome of a hazardous event. A three-dimensional method, described herein, utilizes the traditional X and Y axes, while adding a new, third dimension, shown as the Z-axis, and referred to as the Level of Control. The elements of the Z-axis are modifications of the Hazard Elimination and Control steps (also known as the Hazard Reduction Precedence Sequence). These steps are: 1. Eliminate risk through design. 2. Substitute less risky materials for more hazardous materials. 3. Install safety devices. 4. Install caution and warning devices. 5. Develop administrative controls (to include special procedures and training.) 6. Provide protective clothing and equipment. When added to the two-dimensional models, the level of control adds a visual representation of the risk associated with the hazardous condition, creating a tall-pole for the least-well-controlled failure while establishing the relative likelihood and severity of all causes and effects for an identified hazard. Computer modeling of the analytical results, using spreadsheets and three-dimensional charting gives a visual confirmation of the relationship between causes and their controls.

Dissonance-based Interventions for the Prevention of Eating Disorders: Using Persuasion Principles to Promote Health

PubMed Central

Stice, Eric; Shaw, Heather; Becker, Carolyn Black; Rohde, Paul

2008-01-01

The limited efficacy of prior eating disorder (ED) prevention programs led to the development of dissonance-based interventions (DBI) that utilize dissonance-based persuasion principles from social psychology. Although DBIs have been used to change other attitudes and behaviors, only recently have they been applied to ED prevention. This article reviews the theoretical rationale and empirical support for this type of prevention program. Relative to assessment-only controls, DBIs have produced greater reductions in ED risk factors, ED symptoms, future risk for onset of threshold or subthreshold EDs, future risk for obesity onset, and mental health utilization, with some effects persisting through 3-year follow-up. DBIs have also produced significantly stronger effects than alternative interventions for many of these outcomes, though these effects typically fade more quickly. A meta-analysis indicated that the average effects for DBIs were significantly stronger than those for non-DBI ED prevention programs that have been evaluated. DBIs have produced effects when delivered to high-risk samples and unselected samples, as well as in efficacy and effectiveness trials conducted by six independent labs, suggesting that the effects are robust and that DBIs should be considered for the prevention of other problems, such as smoking, substance abuse, HIV, and diabetes care. PMID:18506621

Risk Presentation Using the Three Dimensions of Likelihood, Severity, and Level of Control

NASA Technical Reports Server (NTRS)

Watson, Clifford

2010-01-01

Traditional hazard analysis techniques utilize a two-dimensional representation of the results determined by relative likelihood and severity of the residual risk. These matrices present a quick-look at the Likelihood (Y-axis) and Severity (X-axis) of the probable outcome of a hazardous event. A three-dimensional method, described herein, utilizes the traditional X and Y axes, while adding a new, third dimension, shown as the Z-axis, and referred to as the Level of Control. The elements of the Z-axis are modifications of the Hazard Elimination and Control steps (also known as the Hazard Reduction Precedence Sequence). These steps are: 1. Eliminate risk through design. 2. Substitute less risky materials for more hazardous materials. 3. Install safety devices. 4. Install caution and warning devices. 5. Develop administrative controls (to include special procedures and training.) 6. Provide protective clothing and equipment. When added to the two-dimensional models, the level of control adds a visual representation of the risk associated with the hazardous condition, creating a tall-pole for the leastwell-controlled failure while establishing the relative likelihood and severity of all causes and effects for an identified hazard. Computer modeling of the analytical results, using spreadsheets and three-dimensional charting gives a visual confirmation of the relationship between causes and their controls.

Risk ranking of LANL nuclear material storage containers for repackaging prioritization.

PubMed

Smith, Paul H; Jordan, Hans; Hoffman, Jenifer A; Eller, P Gary; Balkey, Simon

2007-05-01

Safe handling and storage of nuclear material at U.S. Department of Energy facilities relies on the use of robust containers to prevent container breaches and subsequent worker contamination and uptake. The U.S. Department of Energy has no uniform requirements for packaging and storage of nuclear materials other than those declared excess and packaged to DOE-STD-3013-2000. This report describes a methodology for prioritizing a large inventory of nuclear material containers so that the highest risk containers are repackaged first. The methodology utilizes expert judgment to assign respirable fractions and reactivity factors to accountable levels of nuclear material at Los Alamos National Laboratory. A relative risk factor is assigned to each nuclear material container based on a calculated dose to a worker due to a failed container barrier and a calculated probability of container failure based on material reactivity and container age. This risk-based methodology is being applied at LANL to repackage the highest risk materials first and, thus, accelerate the reduction of risk to nuclear material handlers.

Robust Derivation of Risk Reduction Strategies

NASA Technical Reports Server (NTRS)

Richardson, Julian; Port, Daniel; Feather, Martin

2007-01-01

Effective risk reduction strategies can be derived mechanically given sufficient characterization of the risks present in the system and the effectiveness of available risk reduction techniques. In this paper, we address an important question: can we reliably expect mechanically derived risk reduction strategies to be better than fixed or hand-selected risk reduction strategies, given that the quantitative assessment of risks and risk reduction techniques upon which mechanical derivation is based is difficult and likely to be inaccurate? We consider this question relative to two methods for deriving effective risk reduction strategies: the strategic method defined by Kazman, Port et al [Port et al, 2005], and the Defect Detection and Prevention (DDP) tool [Feather & Cornford, 2003]. We performed a number of sensitivity experiments to evaluate how inaccurate knowledge of risk and risk reduction techniques affect the performance of the strategies computed by the Strategic Method compared to a variety of alternative strategies. The experimental results indicate that strategies computed by the Strategic Method were significantly more effective than the alternative risk reduction strategies, even when knowledge of risk and risk reduction techniques was very inaccurate. The robustness of the Strategic Method suggests that its use should be considered in a wide range of projects.

HIV in Indian MSM: reasons for a concentrated epidemic & strategies for prevention.

PubMed

Thomas, Beena; Mimiaga, Matthew J; Kumar, Senthil; Swaminathan, Soumya; Safren, Steven A; Mayer, Kenneth H

2011-12-01

Men who have sex with men (MSM) in India are disproportionately likely to be HIV-infected, and face distinct psychosocial challenges. Understanding the unique socio-cultural issues of MSM in India and how they relate to HIV risk could maximize the utility of future prevention efforts. This review discusses: (i) the importance of addressing co-occurring mental health issues, such as depression, which may interfere with MSM's ability to benefit from traditional risk reduction counselling, (ii) reducing HIV-related stigma among health providers, policymakers and the lay public, and (iii) the role for non-governmental organizations that work with the community to play in providing culturally relevant HIV prevention programmes for MSM.

Decreased rates of shoulder dystocia and brachial plexus injury via an evidence-based practice bundle.

PubMed

Sienas, Laura E; Hedriana, Herman L; Wiesner, Suzanne; Pelletreau, Barbara; Wilson, Machelle D; Shields, Laurence E

2017-02-01

To evaluate whether a standardized approach to identify pregnant women at risk for shoulder dystocia (SD) is associated with reduced incidence of SD and brachial plexus injury (BPI). Between 2011 and 2015, prospective data were collected from 29 community-based hospitals in the USA during implementation of an evidence-based practice bundle, including an admission risk assessment, required "timeout" before operative vaginal delivery (OVD), and low-fidelity SD drills. All women with singleton vertex pregnancies admitted for vaginal delivery were included. Rates of SD, BPI, OVD, and cesarean delivery were compared between a baseline period (January 2011-September 2013) and an intervention period (October 2013-June 2015), during which there was a system-wide average bundle compliance of 90%. There was a significant reduction in the incidence of SD (17.6%; P=0.028), BPI (28.6%; P=0.018), and OVD (18.0%; P<0.001) after implementation of the evidence-based practice bundle. There was a nonsignificant reduction in primary (P=0.823) and total (P=0.396) cesarean rates, but no association between SD drills and incidence of BPI. Implementation of a standard evidence-based practice bundle was found to be associated with a significant reduction in the incidence of SD and BPI. Utilization of low-fidelity drills was not associated with a reduction in BPI. © 2016 International Federation of Gynecology and Obstetrics.

Risk Reduction Therapy for Adolescents: Targeting Substance Use and HIV/STI-Risk Behaviors

PubMed Central

McCart, Michael R.; Sheidow, Ashli J.; Letourneau, Elizabeth J.

2014-01-01

This paper describes a family-based intervention for addressing both substance use and unprotected sexual behavior in adolescents presenting for outpatient substance use treatment. The intervention combines contingency management (CM) for adolescent substance use, which is a behavioral intervention modeled on the Community Reinforcement Approach, with a sexual risk reduction protocol that mirrors aspects of the CM model. As a family-based intervention, caregivers attend every session and actively collaborate with the therapist to address their youth’s behavior problems. The treatment is criterion-based with treatment duration determined by the youth’s achievement of reduced substance use and unprotected sexual behavior goals. A case study describes the implementation of this treatment with an adolescent presenting a history of polysubstance use and unprotected sexual intercourse. Following the adolescent and caregiver’s participation in weekly sessions, the adolescent demonstrated improvements in substance use, unprotected sexual behavior, and other behavior problems. Clinical summary data from two outpatient clinics reveal similar positive outcomes for youth receiving the intervention. This paper illustrates the potential utility of an integrated treatment approach targeting substance use and unprotected sexual behavior in an adolescent population. PMID:25419101

Prevention of infections in an ART laboratory: a reflection on simplistic methods.

PubMed

Huyser, C

2014-01-01

Preventative measures combined with reactive remedial actions are generic management tools to optimize and protect an entity's core businesses. Differences between assisted reproduction technology (ART) laboratories in developing versus developed countries include restricted access to, or availability of resources, and the prevalence of pathological conditions that are endemic or common in non-industrialized regions. The aim of this paper is to discuss the prevention of infections in an ART laboratory in a low to middle-income country, with reference to simplistic risk reduction applications to avoid the introduction and transmission of pathogens. Diagnostic and procedural phases will be examined, i.e. (i) screening for microbes during patient evaluation, and (ii-iii) prevention of environmental and procedural contamination. Preventative action is enabled by knowledge of threats and the degree of risk involved. Awareness and understanding of the vulnerabilities in an ART system, wherein laboratory personnel operate, are invaluable assets when unforeseen equipment failure occurs or instant decisions have to be made to safeguard procedures. An inter-connective team approach to patient treatment, biosafety training and utilization of practical procedures such as semen decontamination, are fundamental tools in a laboratory's risk-reduction armoury to prevent and eliminate infectious elements.

Removal Efficiency and Risk Assessment of Polycyclic Aromatic Hydrocarbons in a Typical Municipal Wastewater Treatment Facility in Guangzhou, China.

PubMed

Liu, Zhineng; Li, Qing; Wu, Qihang; Kuo, Dave T F; Chen, Shejun; Hu, Xiaodong; Deng, Mingjun; Zhang, Haozhi; Luo, Min

2017-08-01

The loading and removal efficiency of 16 US EPA polycyclic aromatic hydrocarbons (PAHs) were examined in an inverted A²/O wastewater treatment plant (WWTP) located in an urban area in China. The total PAH concentrations were 554.3 to 723.2 ng/L in the influent and 189.6 to 262.7 ng/L in the effluent. The removal efficiencies of ∑PAHs in the dissolved phase ranged from 63 to 69%, with the highest observed in naphthalene (80% removal). Concentration and distribution of PAHs revealed that the higher molecular weight PAHs became more concentrated with treatment in both the dissolved phase and the dewatered sludge. The sharpest reduction was observed during the pretreatment and the biological phase. Noncarcinogenic risk, carcinogenic risk, and total health risk of PAHs found in the effluent and sewage sludge were also assessed. The effluent BaP toxic equivalent quantities ( TEQ BaP ) were above, or far above, standards in countries. The potential toxicities of PAHs in sewage effluent were approximately 10 to 15 times higher than the acceptable risk level in China. The health risk associated with the sewage sludge also exceeded international recommended levels and was mainly contributed from seven carcinogenic PAHs. Given that WWTP effluent is a major PAH contributor to surface water bodies in China and better reduction efficiencies are achievable, the present study highlights the possibility of utilizing WWTPs for restoring water quality in riverine and coastal regions heavily impacted by PAHs contamination.

Fat utilization and arterial hypertension in overweight/obese subjects.

PubMed

Ferro, Yvelise; Gazzaruso, Carmine; Coppola, Adriana; Romeo, Stefano; Migliaccio, Valeria; Giustina, Andrea; Pujia, Arturo; Montalcini, Tiziana

2013-07-02

The Respiratory Quotient is a parameter reflecting the utilization of the nutrients by a subject. It is associated with an high rate of subsequent weight gain and with the atherosclerosis. Subjects tending to burn less fat have an increased Respiratory Quotient. Aim of this study was to investigate on the relationship between the Respiratory Quotient and the cardiovascular risk factors. In this cross-sectional study we enrolled 223 individuals of both sexes aged 45-75 ys that were weight stable, receiving a balanced diet, and not affected by debilitating disease or cardiovascular disease. The Respiratory Quotient was measured by Indirect Calorimetry. The measurement of the Blood Pressure was obtained by a mercury sphygmomanometer. We enrolled 133 female and 90 male. Systolic blood pressure only was positively correlated to the Respiratory Quotient in univariate and multivariate regression analysis (p=0,017). The prevalence of hypertension was significatively different between the quartiles of the Respiratory Quotient, with the highest prevalence in the IV quartile (p=0,024). High value of the Respiratory Quotient, an index of nutrients utilization, is associated to an high prevalence of Hypertension. It is possible that in the subjects with high Respiratory Quotient and high body mass index, the activation of the renin angiotensin system, in concert to the reduction of the utilization of the endogenous fat stores, could increase the risk of hypertension.

Patterns of Substance Use and Correlates of Lifetime and Active Injection Drug Use Among Women in Malaysia

PubMed Central

Wickersham, Jeffrey A.; Loeliger, Kelsey B.; Marcus, Ruthanne; Pillai, Veena; Kamarulzaman, Adeeba; Altice, Frederick L.

2016-01-01

Background While drug use is associated with HIV risk in Southeast Asia, little is known about substance use behaviors among women, including drug injection. Objectives To describe patterns of substance use among women using alcohol and drugs in Malaysia and identify correlates of lifetime and active drug injection, a risk factor for HIV transmission. Methods A survey of 103 women who used drugs in the last 12 months assessed drug use history and frequency, including drug injection and drug use during pregnancy, self-reported HIV-status, childhood and adulthood physical and sexual abuse, and access to and utilization of harm reduction services, including needle-syringe exchange programs (NSEP) and opioid agonist maintenance therapy (OAT). Principal component analyses (PCA) were conducted to assess drug use grouping. Results Amphetamine-type substances (ATS; 82.5%), alcohol (75.7%) and heroin (71.8%) were the most commonly used drugs across the lifetime. Drug injection was reported by 32.0% (n=33) of participants with 21.4% (n=22) having injected in the last 30 days. PCA identified two groups of drug users: opioids/benzodiazepines and club drugs. Lifetime drug injection was significantly associated with lower education, homelessness, prior criminal justice involvement, opioid use, polysubstance use, childhood physical and sexual abuse, and being HIV-infected, but not with prior OAT. Conclusion Women who use drugs in Malaysia report high levels of polysubstance use and injection-related risk behaviors, including sharing of injection equipment and being injected by others. Low OAT utilization suggests the need for improved access to OAT services and other harm reduction measures that prioritize women. PMID:26636885

Utilization and costs of HIV antiretroviral drugs in Europe during the last ten years: Impact of generic antiretroviral drugs on cost reduction.

PubMed

Rwagitinywa, Joseph; Sommet, Agnès; Palmaro, Aurore; Montastruc, Jean-Louis; Lapeyre-Mestre, Maryse

2018-03-01

Simulation studies showed that generic antiretroviral (ARV) drug utilization could lead to significant cost reduction of HIV treatment in developed world. This study aimed to quantify ARV utilization and costs in European countries between 2006 and 2015. We also assessed the impact of generic ARV drug utilization on cost reduction in real-life. ARV drug utilization in 14 European countries (France, Italy, Germany, Denmark, Netherlands, Norway, Sweden, Finland, Iceland, Croatia, Czech Republic, Estonia, Latvia, and Lithuania) were analysed using defined daily dose (DDD)/1000 inhabitants/year. ARV drug cost was estimated in million euro/year and euro/1000 inhabitants/year. The impact of generics on cost reduction was assessed in three countries: France, Denmark, and Czech Republic, using four parameters: expected savings, observed savings, brand price-reduction savings and overall savings. Between 2006 and 2015, median ARV drug utilization increased from 234 DDDs per 1000 inhabitants per year (IQR 124-388) to 385 (229-670). The median cost increased from €3751/1000 inhabitants/year (1109-4681) to €9158 (3269-10,646). Between 2013 and 2015, overall savings of €0.9, €1.6, and €33.7 million were respectively observed in Denmark, Czech Republic, and France. Overall savings observed in real-life from generic ARV drugs in Denmark were related to high rate of low-price generic utilization, contrarily to France and Czech Republic where these were more related to brand price-reduction than generic utilization itself. Copyright © 2018 Elsevier B.V. All rights reserved.

Meeting the Needs of USGS's Science Application for Risk Reduction Group through Evaluation Research

NASA Astrophysics Data System (ADS)

Ritchie, L.; Campbell, N. M.; Vickery, J.; Madera, A.

2016-12-01

The U.S. Geological Survey's (USGS) Science Application for Risk Reduction (SAFRR) group aims to support innovative collaborations in hazard science by uniting a broad range of stakeholders to produce and disseminate knowledge in ways that are useful for decision-making in hazard mitigation, planning, and preparedness. Since 2013, an evaluation team at the Natural Hazards Center (NHC) has worked closely with the SAFRR group to assess these collaborations and communication efforts. In contributing to the nexus between academia and practice, or "pracademia," we use evaluation research to provide the USGS with useful feedback for crafting relevant information for practitioners and decision-makers. This presentation will highlight how the NHC team has varied our methodological and information design approaches according to the needs of each project, which in turn assist the SAFRR group in meeting the needs of practitioners and decision-makers. As the foci of our evaluation activities with SAFRR have evolved, so have our efforts to ensure that our work appropriately matches the information needs of each scenario project. We draw upon multiple projects, including evaluation work on the SAFRR Tsunami Scenario, "The First Sue Nami" tsunami awareness messaging, and their most recent project concerning a hypothetical M7 earthquake on the Hayward fault in the Bay Area (HayWired scenario). We have utilized various qualitative and quantitative methodologies—including telephone interviews, focus groups, online surveys, nonparticipant observation, and in-person survey distribution. The findings generated from these series of evaluations highlight the ways in which evaluation research can be used by researchers and academics to more appropriately address the needs of practitioners. Moreover, they contribute to knowledge enhancement surrounding disaster preparedness and risk communication, and, more generally, the limited body of knowledge about evaluation-focused disaster preparedness and risk communication. Finally, they call attention to the need to adapt evaluation findings for a variety of audiences to ensure accessibility and utility for enhancing future practice.

Management of cardiovascular disease in African-American women: utility of the metabolic syndrome guidelines.

PubMed

Blevins, Lisa P; Berry, Diane; Barksdale, Debra J

2008-07-01

Cardiovascular disease (CVD) is the leading cause of death in the Unites States and is disproportionately more prevalent among African-American women than members of other ethnic groups. The National Cholesterol Education Adult Treatment Panel III (ATP III) metabolic syndrome guidelines are useful in clinical practice to identify individuals who are at risk for developing CVD. Amendments to the ATP III criteria might be indicated to enhance early identification of CVD risk factors among African-American women, even when only one or two of the criteria are met. The addition of body mass index (BMI) and the identification of acanthosis nigricans as a marker of insulin resistance to the ATP III metabolic syndrome guidelines might facilitate early CVD risk identification, strategy implementation, and reduction of premature morbidity and mortality within this population.

Adding Liver Stiffness Measurement to the Routine Evaluation of Hepatocellular Carcinoma Resectability Can Optimize Clinical Outcome.

PubMed

Cucchetti, Alessandro; Cescon, Matteo; Colecchia, Antonio; Neri, Flavia; Cappelli, Alberta; Ravaioli, Matteo; Mazzotti, Federico; Ercolani, Giorgio; Festi, Davide; Pinna, Antonio Daniele

2017-10-01

Purpose  Liver stiffness (LS) has been shown to be of use in chronic liver disease patients but its utility in surgical judgment still needs to be proven. A decision-making approach was applied to evaluate whether LS measurement before surgery of hepatocellular carcinoma (HCC) can be useful in avoiding post-hepatectomy liver failure (PHLF). Materials and Methods  Decision curve analysis (DCA) was applied to 202 HCC patients (2008 - 14) with LS measurement prior to hepatectomy to verify whether the occurrence of PHLF grades B/C should be reduced through a decision-making approach with LS.  Results  Within 90 days of surgery, 4 patients died (2 %) and grades B/C PHLF occurred in 29.7 % of cases. Ascites and/or pleural effusion, treatable with medical therapy, were the most frequent complications. DCA showed that using the "expected utility theory" LS measurement can reduce up to 39 % of cases of PHLF without the exclusion of any patient from surgery that duly undergoes an uncomplicated postoperative course. LS measurement does not add any information to normal clinical judgment for patients with a low (< 10 %) risk of PHLF. Conclusion  LS measurement can determine a reduction of PHLF under "expected utility theory" fulfilment. However, the degree of PHLF can be minor and "risk seeking" individuals can accept such a risk on the basis of surgical benefits. © Georg Thieme Verlag KG Stuttgart · New York.

Evaluating the Effectiveness of an Antimicrobial Stewardship Program on Reducing the Incidence Rate of Healthcare-Associated Clostridium difficile Infection: A Non-Randomized, Stepped Wedge, Single-Site, Observational Study.

PubMed

DiDiodato, Giulio; McArthur, Leslie

2016-01-01

The incidence rate of healthcare-associated Clostridium difficile infection (HA-CDI) is estimated at 1 in 100 patients. Antibiotic exposure is the most consistently reported risk factor for HA-CDI. Strategies to reduce the risk of HA-CDI have focused on reducing antibiotic utilization. Prospective audit and feedback is a commonly used antimicrobial stewardship intervention (ASi). The impact of this ASi on risk of HA-CDI is equivocal. This study examines the effectiveness of a prospective audit and feedback ASi on reducing the risk of HA-CDI. Single-site, 339 bed community-hospital in Barrie, Ontario, Canada. Primary outcome is HA-CDI incidence rate. Daily prospective and audit ASi is the exposure variable. ASi implemented across 6 wards in a non-randomized, stepped wedge design. Criteria for ASi; any intravenous antibiotic use for ≥ 48 hrs, any oral fluoroquinolone or oral second generation cephalosporin use for ≥ 48 hrs, or any antimicrobial use for ≥ 5 days. HA-CDI cases and model covariates were aggregated by ward, year and month starting September 2008 and ending February 2016. Multi-level mixed effect negative binomial regression analysis was used to model the primary outcome, with intercept and slope coefficients for ward-level random effects estimated. Other covariates tested for inclusion in the final model were derived from previously published risk factors. Deviance residuals were used to assess the model's goodness-of-fit. The dataset included 486 observation periods, of which 350 were control periods and 136 were intervention periods. After accounting for all other model covariates, the estimated overall ASi incidence rate ratio (IRR) was 0.48 (95% 0.30, 0.79). The ASi effect was independent of antimicrobial utilization. The ASi did not seem to reduce the risk of Clostridium difficile infection on the surgery wards (IRR 0.87, 95% CI 0.45, 1.69) compared to the medicine wards (IRR 0.42, 95% CI 0.28, 0.63). The ward-level burden of Clostridium difficile as measured by the ward's previous month's total CDI cases (CDI Lag) and the ward's current month's community-associated CDI cases (CA-CDI) was significantly associated with an increased risk of HA-CDI, with the estimated CDI Lag IRR of 1.21 (95% 1.15, 1.28) and the estimated CA-CDI IRR of 1.10 (95% CI 1.01, 1.20). The ward-level random intercept and slope coefficients were not significant. The final model demonstrated good fit. In this study, a daily prospective audit and feedback ASi resulted in a significant reduction in the risk of HA-CDI on the medicine wards, however, this effect was independent of an overall reduction in antibiotic utilization. In addition, the ward-level burden of Clostridium difficile was shown to significantly increase the risk of HA-CDI, reinforcing the importance of the environment as a source of HA-CDI.

The Economic Impact of Closed-Incision Negative-Pressure Therapy in High-Risk Abdominal Incisions: A Cost-Utility Analysis.

PubMed

Chopra, Karan; Gowda, Arvind U; Morrow, Chris; Holton, Luther; Singh, Devinder P

2016-04-01

Complex abdominal wall reconstruction is beset by postoperative complications. A recent meta-analysis comparing the use of closed-incision negative-pressure therapy to standard dressings found a statistically significant reduction in surgical-site infection. The use of closed-incision negative-pressure therapy is gaining acceptance in this population; however, the economic impact of this innovative dressing remains unknown. In this study, a cost-utility analysis was performed assessing closed-incision negative-pressure therapy and standard dressings following closure of abdominal incisions in high-risk patients. Cost-utility methodology involved reviewing literature related to closed-incision negative-pressure therapy in abdominal wall surgery, obtaining utility estimates to calculate quality-adjusted life-year scores for successful surgery and surgery complicated by surgical-site infection, summing costs using Medicare Current Procedural Terminology codes, and creating a decision tree illuminating the most cost-effective dressing strategy. One-way sensitivity analysis was performed to assess the robustness of the results. The aforementioned meta-analysis comparing closed-incision negative-pressure therapy to standard dressings included a subset of five studies assessing abdominal wall surgery in 829 patients (260 closed-incision negative-pressure therapy and 569 standard dressings). Decision tree analysis revealed an estimated savings of $1546.52 and a gain of 0.0024 quality-adjusted life-year with closed-incision negative-pressure therapy compared with standard dressings; therefore, closed-incision negative-pressure therapy is a dominant treatment strategy. One-way sensitivity analysis revealed that closed-incision negative-pressure therapy is a cost-effective option when the surgical-site infection rate is greater than 16.39 percent. The use of closed-incision negative-pressure therapy is cost-saving following closure of abdominal incisions in high-risk patients.

A Pilot Study to Reduce Computed Tomography Utilization for Pediatric Mild Head Injury in the Emergency Department Using a Clinical Decision Support Tool and a Structured Parent Discussion Tool.

PubMed

Engineer, Rakesh S; Podolsky, Seth R; Fertel, Baruch S; Grover, Purva; Jimenez, Heather; Simon, Erin L; Smalley, Courtney M

2018-05-15

The American College of Emergency Physicians embarked on the "Choosing Wisely" campaign to avoid computed tomographic (CT) scans in patients with minor head injury who are at low risk based on validated decision rules. We hypothesized that a Pediatric Mild Head Injury Care Path could be developed and implemented to reduce inappropriate CT utilization with support of a clinical decision support tool (CDST) and a structured parent discussion tool. A quality improvement project was initiated for 9 weeks to reduce inappropriate CT utilization through 5 interventions: (1) engagement of leadership, (2) provider education, (3) incorporation of a parent discussion tool to guide discussion during the emergency department (ED) visit between the parent and the provider, (4) CDST embedded in the electronic medical record, and (5) importation of data into the note to drive compliance. Patients prospectively were enrolled when providers at a pediatric and a freestanding ED entered data into the CDST for decision making. Rate of care path utilization and head CT reduction was determined for all patients with minor head injury based on International Classification of Diseases, Ninth Revision codes. Targets for care path utilization and head CT reduction were established a priori. Results were compared with baseline data collected from 2013. The CDST was used in 176 (77.5%) of 227 eligible patients. Twelve patients were excluded based on a priori criteria. Adherence to recommendations occurred in 162 (99%) of 164 patients. Head CT utilization was reduced from 62.7% to 22% (odds ratio, 0.17; 95% confidence interval, 0.12-0.24) where CDST was used by the provider. There were no missed traumatic brain injuries in our study group. A Pediatric Mild Head Injury Care Path can be implemented in a pediatric and freestanding ED, resulting in reduced head CT utilization and high levels of adherence to CDST recommendations.

Effects of antiviral treatment on influenza-related complications over four influenza seasons: 2006-2010.

PubMed

Spagnuolo, Philip J; Zhang, Mengxi; Xu, Yaping; Han, Jian; Liu, Shuqian; Liu, Jinan; Lichtveld, Maureen; Shi, Lizheng

2016-08-01

The objective of the study is to evaluate the effect of antiviral treatment, pre-existing diseases, and sociodemographic factors on the risk of influenza-related complications and healthcare utilization. Case data was obtained from U.S. MarketScan Research Databases. Cases had a clinical diagnosis of influenza between 2006 and 2010 and continuous healthcare insurance from 90 days before to 30 days after diagnosis. Logistic regression models were applied to explore the impact of antiviral treatment on complications and healthcare utilization. Modified generalized estimating equation regression models in propensity score matched samples were used to address the robustness of the study. Analyses included 1,557,437 cases from four influenza seasons. In each season, 34.82%-43.42% of patients received antiviral treatment, mostly oseltamivir. On average, 1.86% of patients were hospitalized, 9.56% visited the emergency room and 41.14% made ≥2 outpatient visits. The incidence of complications ranged from 17.62 to 19.67 per 100 patient-months. The relative risk of complications was increased in patients aged 0-4 years and those with pre-existing diseases, including asthma, Parkinson's disease, and cystic fibrosis. Overall, patients receiving antiviral treatment had an 11% reduction in the risk of complications. Among oseltamivir-treated patients, the risk of complications was significantly reduced by 81% in those treated ≤2 days after diagnosis compared with later. Antiviral treatment significantly reduced the risk of hospitalization, emergency room visits and need for ≥2 outpatient visits by 29%, 24% and 11%, respectively. The propensity score matching method improved the strength of the study. Early treatment with antivirals, and specifically oseltamivir, significantly reduced the risk of influenza-related complications and healthcare utilization. However, lacking information about disease severity and the time from onset of symptoms to fulfillment of a prescription may bias the outcomes.

Impact of a Sequential Intervention on Albumin Utilization in Critical Care.

PubMed

Lyu, Peter F; Hockenberry, Jason M; Gaydos, Laura M; Howard, David H; Buchman, Timothy G; Murphy, David J

2016-07-01

Literature generally finds no advantages in mortality risk for albumin over cheaper alternatives in many settings. Few studies have combined financial and nonfinancial strategies to reduce albumin overuse. We evaluated the effect of a sequential multifaceted intervention on decreasing albumin use in ICU and explore the effects of different strategies. Prospective prepost cohort study. Eight ICUs at two hospitals in an academic healthcare system. Adult patients admitted to study ICUs from September 2011 to August 2014 (n = 22,004). Over 2 years, providers in study ICUs participated in an intervention to reduce albumin use involving monthly feedback and explicit financial incentives in the first year and internal guidelines and order process changes in the second year. Outcomes measured were albumin orders per ICU admission, direct albumin costs, and mortality. Mean (SD) utilization decreased 37% from 2.7 orders (6.8) per admission during the baseline to 1.7 orders (4.6) during the intervention (p < 0.001). Regression analysis revealed that the intervention was independently associated with 0.9 fewer orders per admission, a 42% relative decrease. This adjusted effect consisted of an 18% reduction in the probability of using any albumin (p < 0.001) and a 29% reduction in the number of orders per admission among patients receiving any (p < 0.001). Secondary analysis revealed that probability reductions were concurrent with internal guidelines and order process modification while reductions in quantity occurred largely during the financial incentives and feedback period. Estimated cost savings totaled $2.5M during the 2-year intervention. There was no significant difference in ICU or hospital mortality between baseline and intervention. A sequential intervention achieved significant reductions in ICU albumin use and cost savings without changes in patient outcomes, supporting the combination of financial and nonfinancial strategies to align providers with evidence-based practices.

AHP for Risk Management Based on Expected Utility Theory

NASA Astrophysics Data System (ADS)

Azuma, Rumiko; Miyagi, Hayao

This paper presents a model of decision-making considering the risk assessment. The conventional evaluation in AHP is considered to be a kind of utility. When dealing with the risk, however, it is necessary to consider the probability of damage. In order to take risk into decision-making problem, we construct AHP based on expected utility. The risk is considered as a related element of criterion rather than criterion itself. The expected utility is integrated, considering that satisfaction is positive utility and damage by risk is negative utility. Then, evaluation in AHP is executed using the expected utility.

Assessment of NHTSA’s Report “Relationships Between Fatality Risk, Mass, and Footprint in Model Year 2004-2011 Passenger Cars and LTVs” (LBNL Phase 1)

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

Wenzel, Tom P.

In its 2012 report NHTSA simulated the effect four fleetwide mass reduction scenarios would have on the change in annual fatalities. NHTSA estimated that the most aggressive of these scenarios (reducing mass 5.2% in heavier light trucks and 2.6% in all other vehicles types except lighter cars) would result in a small reduction in societal fatalities. LBNL replicated the methodology NHTSA used to simulate six mass reduction scenarios, including the mass reductions recommended in the 2015 NRC committee report, and estimated in 2021 and 2025 by EPA in the TAR, using the updated data through 2012. The analysis indicates thatmore » the estimated x change in fatalities under each scenario based on the updated analysis is comparable to that in the 2012 analysis, but less beneficial or more detrimental than that in the 2016 analysis. For example, an across the board 100-lb reduction in mass would result in an estimated 157 additional annual fatalities based on the 2012 analysis, but would result in only an estimated 91 additional annual fatalities based on the 2016 analysis, and an additional 87 fatalities based on the current analysis. The mass reductions recommended by the 2015 NRC committee report6 would result in a 224 increase in annual fatalities in the 2012 analysis, a 344 decrease in annual fatalities in the 2016 analysis, and a 141 increase in fatalities in the current analysis. The mass reductions EPA estimated for 2025 in the TAR7 would result in a 203 decrease in fatalities based on the 2016 analysis, but an increase of 39 fatalities based on the current analysis. These results support NHTSA’s conclusion from its 2012 study that, when footprint is held fixed, “no judicious combination of mass reductions in the various classes of vehicles results in a statistically significant fatality increase and many potential combinations are safety-neutral as point estimates.”Like the previous NHTSA studies, this updated report concludes that the estimated effect of mass reduction while maintaining footprint on societal U.S. fatality risk is small, and not statistically significant at the 95% or 90% confidence level for all vehicle types based on the jack-knife method NHTSA used. This report also finds that the estimated effects of other control variables, such as vehicle type, specific safety technologies, and crash conditions such as whether the crash occurred at night, in a rural county, or on a high-speed road, on risk are much larger, in some cases two orders of magnitude larger, than the estimated effect of mass or footprint reduction on risk. Finally, this report shows that after accounting for the many vehicle, driver, and crash variables NHTSA used in its regression analyses, there remains a wide variation in risk by vehicle make and model, and this variation is unrelated to vehicle mass. Although the purpose of the NHTSA and LBNL reports is to estimate the effect of vehicle mass reduction on societal risk, this is not exactly what the regression models are estimating. Rather, they are estimating the recent historical relationship between mass and risk, after accounting for most measurable differences between vehicles, drivers, and crash times and locations. In essence, the regression models are comparing the risk of a 2600-lb Dodge Neon with that of a 2500-lb Honda Civic, after attempting to account for all other differences between the two vehicles. The models are not estimating the effect of literally removing 100 pounds from the Neon, leaving everything else unchanged. In addition, the analyses are based on the relationship of vehicle mass and footprint on risk for recent vehicle designs (model year 2004 to 2011). These relationships may or may not continue into the future as manufacturers utilize new vehicle designs and incorporate new technologies, such as more extensive use of strong lightweight materials and specific safety technologies. Therefore, throughout this report we use the phrase “the estimated effect of mass (or footprint) reduction on risk” as shorthand for “the estimated change in risk as a function of its relationship to mass (or footprint) for vehicle models of recent design.”« less

Efficacy of sacubitril/valsartan vs. enalapril at lower than target doses in heart failure with reduced ejection fraction: the PARADIGM-HF trial.

PubMed

Vardeny, Orly; Claggett, Brian; Packer, Milton; Zile, Michael R; Rouleau, Jean; Swedberg, Karl; Teerlink, John R; Desai, Akshay S; Lefkowitz, Martin; Shi, Victor; McMurray, John J V; Solomon, Scott D

2016-10-01

In this analysis, we utilized data from PARADIGM-HF to test the hypothesis that participants who exhibited any dose reduction during the trial would have similar benefits from lower doses of sacubitril/valsartan relative to lower doses of enalapril. In a post-hoc analysis from PARADIGM-HF, we characterized patients by whether they received the maximal dose (200 mg sacubitril/valsartan or 10 mg enalapril twice daily) throughout the trial or had any dose reduction to lower doses (100/50/0 mg sacubitril/valsartan or 5/2.5/0 mg enalapril twice daily). The treatment effect for the primary outcome was estimated, stratified by dose level using time-updated Cox regression models. In the two treatment arms, participants with a dose reduction (43% of those randomized to enalapril and 42% of those randomized to sacubitril/valsartan) had similar baseline characteristics and similar baseline predictors of the need for dose reduction. In a time-updated analysis, any dose reduction was associated with a higher subsequent risk of the primary event [hazard ratio (HR) 2.5, 95% confidence interval (CI) 2.2-2.7]. However, the treatment benefit of sacubitril/valsartan over enalapril following a dose reduction was similar (HR 0.80, 95% CI 0.70-0.93, P < 0.001) to that observed in patients who had not experienced any dose reduction (HR 0.79, 95% CI 0.71-0.88, P < 0.001). In PARADIGM-HF, study medication dose reduction identified patients at higher risk of a major cardiovascular event. The magnitude of benefit for patients on lower doses of sacubitril/valsartan relative to those on lower doses of enalapril was similar to that of patients who remained on target doses of both drugs. © 2016 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Efficiency and Accuracy in Thermal Simulation of Powder Bed Fusion of Bulk Metallic Glass

NASA Astrophysics Data System (ADS)

Lindwall, J.; Malmelöv, A.; Lundbäck, A.; Lindgren, L.-E.

2018-05-01

Additive manufacturing by powder bed fusion processes can be utilized to create bulk metallic glass as the process yields considerably high cooling rates. However, there is a risk that reheated material set in layers may become devitrified, i.e., crystallize. Therefore, it is advantageous to simulate the process to fully comprehend it and design it to avoid the aforementioned risk. However, a detailed simulation is computationally demanding. It is necessary to increase the computational speed while maintaining accuracy of the computed temperature field in critical regions. The current study evaluates a few approaches based on temporal reduction to achieve this. It is found that the evaluated approaches save a lot of time and accurately predict the temperature history.

Drag reduction using slippery liquid infused surfaces

NASA Astrophysics Data System (ADS)

Hultmark, Marcus; Stone, Howard; Smits, Alexander; Jacobi, Ian; Samaha, Mohamed; Wexler, Jason; Shang, Jessica; Rosenberg, Brian; Hellström, Leo; Fan, Yuyang

2013-11-01

A new method for passive drag reduction is introduced. A surface treatment inspired by the Nepenthes pitcher plant, previously developed by Wong et al. (2011), is utilized and its design parameters are studied for increased drag reduction and durability. Nano- and micro-structured surfaces infused with a lubricant allow for mobility within the lubricant itself when the surface is exposed to flow. The mobility causes slip at the fluid-fluid interface, which drastically reduces the viscous friction. These new surfaces are fundamentally different from the more conventional superhydrophobic surfaces previously used in drag reduction studies, which rely on a gas-liquid interface. The main advantage of the liquid infused surfaces over the conventional surfaces is that the lubricant adheres more strongly to the surface, decreasing the risk of failure when exposed to turbulence and other high-shear flows. We have shown that these surfaces can reduce viscous drag up to 20% in both Taylor-Couette flow and in a parallel plate rheometer. Supported under ONR Grants N00014-12-1-0875 and N00014-12-1-0962 (program manager Ki-Han Kim).

Cost-effectiveness analysis of risk-reduction measures to reach water safety targets.

PubMed

Lindhe, Andreas; Rosén, Lars; Norberg, Tommy; Bergstedt, Olof; Pettersson, Thomas J R

2011-01-01

Identifying the most suitable risk-reduction measures in drinking water systems requires a thorough analysis of possible alternatives. In addition to the effects on the risk level, also the economic aspects of the risk-reduction alternatives are commonly considered important. Drinking water supplies are complex systems and to avoid sub-optimisation of risk-reduction measures, the entire system from source to tap needs to be considered. There is a lack of methods for quantification of water supply risk reduction in an economic context for entire drinking water systems. The aim of this paper is to present a novel approach for risk assessment in combination with economic analysis to evaluate risk-reduction measures based on a source-to-tap approach. The approach combines a probabilistic and dynamic fault tree method with cost-effectiveness analysis (CEA). The developed approach comprises the following main parts: (1) quantification of risk reduction of alternatives using a probabilistic fault tree model of the entire system; (2) combination of the modelling results with CEA; and (3) evaluation of the alternatives with respect to the risk reduction, the probability of not reaching water safety targets and the cost-effectiveness. The fault tree method and CEA enable comparison of risk-reduction measures in the same quantitative unit and consider costs and uncertainties. The approach provides a structured and thorough analysis of risk-reduction measures that facilitates transparency and long-term planning of drinking water systems in order to avoid sub-optimisation of available resources for risk reduction. Copyright © 2010 Elsevier Ltd. All rights reserved.

NASA's J-2X Engine Builds on the Apollo Program for Lunar Return Missions

NASA Technical Reports Server (NTRS)

Snoddy, Jimmy R.

2006-01-01

In January 2006, NASA streamlined its U.S. Vision for Space Exploration hardware development approach for replacing the Space Shuttle after it is retired in 2010. The revised CLV upper stage will use the J-2X engine, a derivative of NASA s Apollo Program Saturn V s S-II and S-IVB main propulsion, which will also serve as the Earth Departure Stage (EDS) engine. This paper gives details of how the J- 2X engine effort mitigates risk by building on the Apollo Program and other lessons learned to deliver a human-rated engine that is on an aggressive development schedule, with first demonstration flight in 2010 and human test flights in 2012. It is well documented that propulsion is historically a high-risk area. NASA s risk reduction strategy for the J-2X engine design, development, test, and evaluation is to build upon heritage hardware and apply valuable experience gained from past development efforts. In addition, NASA and its industry partner, Rocketdyne, which originally built the J-2, have tapped into their extensive databases and are applying lessons conveyed firsthand by Apollo-era veterans of America s first round of Moon missions in the 1960s and 1970s. NASA s development approach for the J-2X engine includes early requirements definition and management; designing-in lessons learned from the 5-2 heritage programs; initiating long-lead procurement items before Preliminary Desi& Review; incorporating design features for anticipated EDS requirements; identifying facilities for sea-level and altitude testing; and starting ground support equipment and logistics planning at an early stage. Other risk reduction strategies include utilizing a proven gas generator cycle with recent development experience; utilizing existing turbomachinery ; applying current and recent main combustion chamber (Integrated Powerhead Demonstrator) and channel wall nozzle (COBRA) advances; and performing rigorous development, qualification, and certification testing of the engine system, with a philosophy of "test what you fly, and fly what you test". These and other active risk management strategies are in place to deliver the J-2X engine for LEO and lunar return missions as outlined in the U.S. Vision for Space Exploration.

The impact of a microsavings intervention on reducing violence against women engaged in sex work: a randomized controlled study.

PubMed

Tsai, Laura Cordisco; Carlson, Catherine E; Aira, Toivgoo; Norcini Pala, Andrea; Riedel, Marion; Witte, Susan S

2016-10-28

Women who engage in sex work are at risk for experiencing violence from numerous perpetrators, including paying partners. Empirical evidence has shown mixed results regarding the impact of participation in microfinance interventions on women's experiences of violence, with some studies demonstrating reductions in intimate partner violence (IPV) and others showing heightened risk for IPV. The current study reports on the impact of participation in a microsavings intervention on experiences of paying partner violence among women engaged in sex work in Mongolia. Between 2011 and 2013, we conducted a two-arm, non-blinded randomized controlled trial (RCT) comparing an HIV/STI risk reduction intervention (HIVSRR) (control condition) to a combined microsavings and HIVSRR intervention (treatment condition). Eligible women (aged 18 or older, reported having engaged in unprotected sex with paying partner in past 90 days, expressed interest in microsavings intervention) were invited to participate. One hundred seven were randomized, including 50 in the control and 57 in the treatment condition. Participants completed assessments at baseline, immediate post-test following HIVSRR, and at 3-months and 6-months after completion of the treatment group intervention. Outcomes for the current study include any violence (physical and/or sexual), sexual violence, and physical violence from paying partners in the past 90 days. An intention-to-treat approach was utilized. Linear growth models revealed significant reductions over time in both conditions for any violence (β = -0.867, p < 0.001), physical violence (β = -0.0923, p < 0.001), and sexual violence (β = -1.639, p = 0.001) from paying partners. No significant differences between groups were found for any violence (β = 0.118, p = 0.389), physical violence (β = 0.091, p = 0.792), or sexual violence (β = 0.379, p = 0.114) from paying partners. Microsavings participation did not significantly impact women's risk for paying partner violence. Qualitative research is recommended to understand the cause for reductions in paying partner violence in both study conditions. Evaluating a Microfinance Intervention for High Risk Women in Mongolia; NCT01861431 ; May 20, 2013.

Critical factors in case management: practical lessons from a cardiac case management program.

PubMed

Stafford, Randall S; Berra, Kathy

2007-08-01

Case management (CM) is an important strategy for chronic disease care. By utilizing non-physician providers for conditions requiring ongoing care and follow-up, CM can facilitate guideline-concordant care, patient empowerment, and improvement in quality of life. We identify a series of critical factors required for successful CM implementation. Heart to Heart is a clinical trial evaluating CM for coronary heart disease (CHD) risk reduction in a multiethnic, low-income population. Patients at elevated cardiac risk were randomized to CM plus primary care (212 patients) or to primary care alone (207). Over a mean follow-up of 17 months, patients received face-to-face nurse and dietitian visits. Mean contact time was 14 hours provided at an estimated cost of $1250 per patient for the 341 (81%) patients completing follow-up. Visits emphasized behavior change, risk-factor monitoring, self-management skills, and guideline-based pharmacotherapy. A statistically significant reduction in mean Framingham risk probability occurred in CM plus primary care relative to primary care alone (1.6% decrease in 10-year CHD risk, p = 0.007). Favorable changes were noted across individual risk factors. Our findings suggest that successful CM implementation relies on choosing appropriate case managers and investing in training, integrating CM into existing care systems, delineating the scope and appropriate levels of clinical decision making, using information systems, and monitoring outcomes and costs. While our population, setting, and intervention model are unique, these insights are broadly relevant. If implemented with attention to critical factors, CM has great potential to improve the process and outcomes of chronic disease care.

Removal Efficiency and Risk Assessment of Polycyclic Aromatic Hydrocarbons in a Typical Municipal Wastewater Treatment Facility in Guangzhou, China

PubMed Central

Liu, Zhineng; Li, Qing; Wu, Qihang; Chen, Shejun; Hu, Xiaodong; Deng, Mingjun; Zhang, Haozhi; Luo, Min

2017-01-01

The loading and removal efficiency of 16 US EPA polycyclic aromatic hydrocarbons (PAHs) were examined in an inverted A2/O wastewater treatment plant (WWTP) located in an urban area in China. The total PAH concentrations were 554.3 to 723.2 ng/L in the influent and 189.6 to 262.7 ng/L in the effluent. The removal efficiencies of ∑PAHs in the dissolved phase ranged from 63 to 69%, with the highest observed in naphthalene (80% removal). Concentration and distribution of PAHs revealed that the higher molecular weight PAHs became more concentrated with treatment in both the dissolved phase and the dewatered sludge. The sharpest reduction was observed during the pretreatment and the biological phase. Noncarcinogenic risk, carcinogenic risk, and total health risk of PAHs found in the effluent and sewage sludge were also assessed. The effluent BaP toxic equivalent quantities (TEQBaP) were above, or far above, standards in countries. The potential toxicities of PAHs in sewage effluent were approximately 10 to 15 times higher than the acceptable risk level in China. The health risk associated with the sewage sludge also exceeded international recommended levels and was mainly contributed from seven carcinogenic PAHs. Given that WWTP effluent is a major PAH contributor to surface water bodies in China and better reduction efficiencies are achievable, the present study highlights the possibility of utilizing WWTPs for restoring water quality in riverine and coastal regions heavily impacted by PAHs contamination. PMID:28763031

Prescription copay reduction program for diabetic employees: impact on medication compliance and healthcare costs and utilization.

PubMed

Nair, Kavita V; Miller, Kerri; Saseen, Joseph; Wolfe, Pamela; Allen, Richard Read; Park, Jinhee

2009-01-01

To examine the impact of a value-based benefit design on utilization and expenditures. This benefit design involved all diabetes-related drugs and testing supplies placed on the lowest copay tier for 1 employer group. The sample of diabetic members were enrolled from a 9-month preperiod and for 2 years after the benefit design was implemented. Measured outcomes included prescription drug utilization for diabetes and medical utilization. Generalized measures were used to estimate differences between years 1 and 2 and the preperiod adjusting for age, gender, and comorbidity risk. Diabetes prescription drug use increased by 9.5% in year 1 and by 5.5% in year 2, and mean adherence increased by 7% to 8% in year 1 and fell slightly in year 2 compared with the preperiod. Pharmacy expenditures increased by 47% and 53% and expenditures for diabetes services increased by 16% and 32% in years 1 and 2, respectively. Increases in adherence and use of diabetes medications were observed. There were no compensatory cost-savings for the employer through lower utilization of medical expenditures in the first 2 years. Adherent patients had fewer emergency department visits than nonadherent patients after the implementation of this benefit design.

Potential Lunar In-Situ Resource Utilization Experiments and Mission Scenarios

NASA Technical Reports Server (NTRS)

Sanders, Gerald B.

2010-01-01

The extraction and use of resources on the Moon, known as In-Situ Resource Utilization (ISRU), can potentially reduce the cost and risk of human lunar exploration while also increasing science achieved. By not having to bring all of the shielding and mission consumables from Earth and being able to make products on the Moon, missions may require less mass to accomplish the same objectives, carry more science equipment, go to more sites of exploration, and/or provide options to recover from failures not possible with delivery of spares and consumables from Earth alone. While lunar ISRU has significant potential for mass, cost, and risk reduction for human lunar missions, it has never been demonstrated before in space. To demonstrate that ISRU can meet mission needs and to increase confidence in incorporating ISRU capabilities into mission architectures, terrestrial laboratory and analog field testing along with robotic precursor missions are required. A stepwise approach with international collaboration is recommended. This paper will outline the role of ISRU in future lunar missions, and define the approach and possible experiments to increase confidence in ISRU applications for future human lunar exploration

A simple rapid approach using coupled multivariate statistical methods, GIS and trajectory models to delineate areas of common oil spill risk

NASA Astrophysics Data System (ADS)

Guillen, George; Rainey, Gail; Morin, Michelle

2004-04-01

Currently, the Minerals Management Service uses the Oil Spill Risk Analysis model (OSRAM) to predict the movement of potential oil spills greater than 1000 bbl originating from offshore oil and gas facilities. OSRAM generates oil spill trajectories using meteorological and hydrological data input from either actual physical measurements or estimates generated from other hydrological models. OSRAM and many other models produce output matrices of average, maximum and minimum contact probabilities to specific landfall or target segments (columns) from oil spills at specific points (rows). Analysts and managers are often interested in identifying geographic areas or groups of facilities that pose similar risks to specific targets or groups of targets if a spill occurred. Unfortunately, due to the potentially large matrix generated by many spill models, this question is difficult to answer without the use of data reduction and visualization methods. In our study we utilized a multivariate statistical method called cluster analysis to group areas of similar risk based on potential distribution of landfall target trajectory probabilities. We also utilized ArcView™ GIS to display spill launch point groupings. The combination of GIS and multivariate statistical techniques in the post-processing of trajectory model output is a powerful tool for identifying and delineating areas of similar risk from multiple spill sources. We strongly encourage modelers, statistical and GIS software programmers to closely collaborate to produce a more seamless integration of these technologies and approaches to analyzing data. They are complimentary methods that strengthen the overall assessment of spill risks.

QuEST: Qualifying Environmentally Sustainable Technologies. Volume 4

NASA Technical Reports Server (NTRS)

Lewis, Pattie L.

2009-01-01

In 2004, in one of their first collaborative efforts, Centro Para Prevencao da Poluicao (Portuguese Center for Pollution Prevention or C3P). teamed with Technology Evaluation for Environmental Risk Mitigation Principal Center (TEERM) and two Portuguese entities, TAP Portugal (Portuguese National Airline) and OGMA Indtistria Aeron utica de Portugal (Portuguese Aeronautics Industry), to target the reduction of hexavalent chromium, cadmium, and volatile organic compounds (VOCs) in aircraft maintenance operations. This project focused on two coating systems that utilize non-chrome pretreatments and low-VOC primers and topcoats.

Summary

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

Powell, Danny H; Elwood Jr, Robert H

2011-01-01

An effective risk assessment system is needed to address the threat posed by an active or passive insider who, acting alone or in collusion, could attempt diversion or theft of nuclear material. The material control and accountability (MC&A) system effectiveness tool (MSET) is a self-assessment or inspection tool utilizing probabilistic risk assessment (PRA) methodology to calculate the system effectiveness of a nuclear facility's material protection, control, and accountability (MPC&A) system. The MSET process is divided into four distinct and separate parts: (1) Completion of the questionnaire that assembles information about the operations of every aspect of the MPC&A system; (2)more » Conversion of questionnaire data into numeric values associated with risk; (3) Analysis of the numeric data utilizing the MPC&A fault tree and the SAPHIRE computer software; and (4) Self-assessment using the MSET reports to perform the effectiveness evaluation of the facility's MPC&A system. The process should lead to confirmation that mitigating features of the system effectively minimize the threat, or it could lead to the conclusion that system improvements or upgrades are necessary to achieve acceptable protection against the threat. If the need for system improvements or upgrades is indicated when the system is analyzed, MSET provides the capability to evaluate potential or actual system improvements or upgrades. A facility's MC&A system can be evaluated at a point in time. The system can be reevaluated after upgrades are implemented or after other system changes occur. The total system or specific subareas within the system can be evaluated. Areas of potential system improvement can be assessed to determine where the most beneficial and cost-effective improvements should be made. Analyses of risk importance factors show that sustainability is essential for optimal performance and reveals where performance degradation has the greatest impact on total system risk. The risk importance factors show the amount of risk reduction achievable with potential upgrades and the amount of risk reduction achieved after upgrades are completed. Applying the risk assessment tool gives support to budget prioritization by showing where budget support levels must be sustained for MC&A functions most important to risk. Results of the risk assessment are also useful in supporting funding justifications for system improvements that significantly reduce system risk. The functional model, the system risk assessment tool, and the facility evaluation questionnaire are valuable educational tools for MPC&A personnel. These educational tools provide a framework for ongoing dialogue between organizations regarding the design, development, implementation, operation, assessment, and sustainability of MPC&A systems. An organization considering the use of MSET as an analytical tool for evaluating the effectiveness of its MPC&A system will benefit from conducting a complete MSET exercise at an existing nuclear facility.« less

Tonsillectomy Versus Watchful Waiting for Recurrent Throat Infection: A Systematic Review

PubMed Central

Morad, Anna; Sathe, Nila A.; Francis, David O.; McPheeters, Melissa L.

2017-01-01

CONTEXT: The effectiveness of tonsillectomy or adenotonsillectomy (“tonsillectomy”) for recurrent throat infection compared with watchful waiting is uncertain. OBJECTIVE: To compare sleep, cognitive, behavioral, and health outcomes of tonsillectomy versus watchful waiting in children with recurrent throat infections. DATA SOURCES: MEDLINE, Embase, and the Cochrane Library. STUDY SELECTION: Two investigators independently screened studies against predetermined criteria. DATA EXTRACTION: One investigator extracted data with review by a second. Investigators independently assessed risk of bias and strength of evidence (SOE) and confidence in the estimate of effects. RESULTS: Seven studies including children with ≥3 infections in the previous 1 to 3 years addressed this question. In studies reporting baseline data, number of infections/sore throats decreased from baseline in both groups, with greater decreases in sore throat days, clinician contacts, diagnosed group A streptococcal infections, and school absences in tonsillectomized children in the short term (<12 months). Quality of life was not markedly different between groups at any time point. LIMITATIONS: Few studies fully categorized infection/sore throat severity; attrition was high. CONCLUSIONS: Throat infections, utilization, and school absences improved in the first postsurgical year in tonsillectomized children versus children not receiving surgery. Benefits did not persist over time; longer-term outcomes are limited. SOE is moderate for reduction in short-term throat infections and insufficient for longer-term reduction. SOE is low for no difference in longer-term streptococcal infection reduction. SOE is low for utilization and missed school reduction in the short term, low for no difference in longer-term missed school, and low for no differences in quality of life. PMID:28096515

Tonsillectomy Versus Watchful Waiting for Recurrent Throat Infection: A Systematic Review.

PubMed

Morad, Anna; Sathe, Nila A; Francis, David O; McPheeters, Melissa L; Chinnadurai, Sivakumar

2017-02-01

The effectiveness of tonsillectomy or adenotonsillectomy ("tonsillectomy") for recurrent throat infection compared with watchful waiting is uncertain. To compare sleep, cognitive, behavioral, and health outcomes of tonsillectomy versus watchful waiting in children with recurrent throat infections. MEDLINE, Embase, and the Cochrane Library. Two investigators independently screened studies against predetermined criteria. One investigator extracted data with review by a second. Investigators independently assessed risk of bias and strength of evidence (SOE) and confidence in the estimate of effects. Seven studies including children with ≥3 infections in the previous 1 to 3 years addressed this question. In studies reporting baseline data, number of infections/sore throats decreased from baseline in both groups, with greater decreases in sore throat days, clinician contacts, diagnosed group A streptococcal infections, and school absences in tonsillectomized children in the short term (<12 months). Quality of life was not markedly different between groups at any time point. Few studies fully categorized infection/sore throat severity; attrition was high. Throat infections, utilization, and school absences improved in the first postsurgical year in tonsillectomized children versus children not receiving surgery. Benefits did not persist over time; longer-term outcomes are limited. SOE is moderate for reduction in short-term throat infections and insufficient for longer-term reduction. SOE is low for no difference in longer-term streptococcal infection reduction. SOE is low for utilization and missed school reduction in the short term, low for no difference in longer-term missed school, and low for no differences in quality of life. Copyright © 2017 by the American Academy of Pediatrics.

Assessment of sulfide production risk in soil during the infiltration of domestic wastewater treated by a sulfur-utilizing denitrification process.

PubMed

Ghorbel, L; Coudert, L; Gilbert, Y; Mercier, G; Blais, J F

2016-10-01

This study aimed to determine the potential of sulfide generation during infiltration through soil of domestic wastewater treated by a sulfur-utilizing denitrification process. Three types of soil with different permeability rates (K s = 0.028, 0.0013, and 0.00015 cm/s) were investigated to evaluate the potential risk of sulfur generation during the infiltration of domestic wastewater treated by a sulfur-utilizing denitrification system. These soils were thoroughly characterized and tested to assess their capacity to be used as drainages for wastewaters. Experiments were conducted under two operating modes (saturated and unsaturated). Sulfate, sulfide, and chemical oxygen demand (COD) levels were determined over a period of 100 days. Despite the high concentration of sulfates (200 mg/L) under anaerobic conditions (ORP = -297 mV), no significant amount of sulfide was generated in the aqueous (<0.2 mg/L) or gaseous (<0.15 ppm) phases. Furthermore, the soil permeability did not have a noticeable effect on the infiltration of domestic wastewater treated by a sulfur-utilizing denitrification system due to low contents of organic matter (i.e., dissolved organic carbon, DOC). The autotrophic denitrification process used to treat the domestic wastewater allowed the reduction of the concentration of biochemical oxygen demand (BOD5) below 5 mg/L, of DOC below 7 mg/L, and of COD below 100 mg/L.

Clarifying the relationship between nonradiologists' financial interest in imaging and their utilization of imaging.

PubMed

Bhargavan, Mythreyi; Sunshine, Jonathan H; Hughes, Danny R

2011-11-01

Several limitations and deficiencies have been identified in existing studies of physician financial interest in imaging that show financial interest is associated with more imaging. We conducted extensive quantitative analysis of seven deficiencies that have been identified. Using Symmetry's Episode Grouper, we created episodes of care from all the 2004-2007 health care claims for a random 5% sample of Medicare fee-for-service beneficiaries. We compared utilization of imaging in nonhospital episodes having a nonradiologist physician who had a financial interest in imaging with utilization in episodes with no such physician. We studied 23 combinations of medical conditions with imaging modalities commonly used for these conditions. Across four different definitions of financial interest and the 23 combinations, the relative probability (risk ratio) of imaging was uniformly higher for episodes of physicians with a financial interest, predominantly at p < 0.001. The mean relative probability was 1.87. This mean was little affected by the definition of financial interest used or the definition of the physician deemed responsible for the imaging. Controlling for patient characteristics, illness severity, and physician specialty likewise had little effect. Physicians who had acquired a financial interest averaged a 49% increase in the odds of imaging relative to physicians who had not. Physicians with a financial interest in an imaging modality used other modalities more than did physicians without a financial interest in the index modality. The Deficit Reduction Act's 2007 payment reductions had little effect. A financial interest in imaging is associated with higher utilization, probably causally. Limiting nonradiologists' financial interest in imaging may be desirable.

Alendronate for fracture prevention in postmenopause.

PubMed

Holder, Kathryn K; Kerley, Sara Shelton

2008-09-01

Osteoporosis is an abnormal reduction in bone mass and bone deterioration leading to increased fracture risk. Alendronate (Fosamax) belongs to the bisphosphonate class of drugs, which act to inhibit bone resorption by interfering with the activity of osteoclasts. To assess the effectiveness of alendronate in the primary and secondary prevention of osteoporotic fractures in postmenopausal women. The authors searched Central, Medline, and EMBASE for relevant randomized controlled trials published from 1966 to 2007. The authors undertook study selection and data abstraction in duplicate. The authors performed meta-analysis of fracture outcomes using relative risks, and a relative change greater than 15 percent was considered clinically important. The authors assessed study quality through reporting of allocation concealment, blinding, and withdrawals. Eleven trials representing 12,068 women were included in the review. Relative and absolute risk reductions for the 10-mg dose were as follows. For vertebral fractures, a 45 percent relative risk reduction was found (relative risk [RR] = 0.55; 95% confidence interval [CI], 0.45 to 0.67). This was significant for primary prevention, with a 45 percent relative risk reduction (RR = 0.55; 95% CI, 0.38 to 0.80) and 2 percent absolute risk reduction; and for secondary prevention, with 45 percent relative risk reduction (RR = 0.55; 95% CI, 0.43 to 0.69) and 6 percent absolute risk reduction. For nonvertebral fractures, a 16 percent relative risk reduction was found (RR = 0.84; 95% CI, 0.74 to 0.94). This was significant for secondary prevention, with a 23 percent relative risk reduction (RR = 0.77; 95% CI, 0.64 to 0.92) and a 2 percent absolute risk reduction, but not for primary prevention (RR = 0.89; 95% CI, 0.76 to 1.04). There was a 40 percent relative risk reduction in hip fractures (RR = 0.60; 95% CI, 0.40 to 0.92), but only secondary prevention was significant, with a 53 percent relative risk reduction (RR = 0.47; 95% CI, 0.26 to 0.85) and a 1 percent absolute risk reduction. The only significance found for wrist fractures was in secondary prevention, with a 50 percent relative risk reduction (RR = 0.50; 95% CI, 0.34 to 0.73) and a 2 percent absolute risk reduction. For adverse events, the authors found no statistically significant difference in any included study. However, observational data raise concerns about potential risk for upper gastrointestinal injury and, less commonly, osteonecrosis of the jaw. At 10 mg of alendronate per day, clinically important and statistically significant reductions in vertebral, nonvertebral, hip, and wrist fractures were observed for secondary prevention. The authors found no statistically significant results for primary prevention, with the exception of vertebral fractures, for which the reduction was clinically important.

41 CFR 102-80.50 - Are Federal agencies responsible for identifying/estimating risks and for appropriate risk...

Code of Federal Regulations, 2010 CFR

2010-07-01

... identify and estimate safety and environmental management risks and appropriate risk reduction strategies... responsible for identifying/estimating risks and for appropriate risk reduction strategies? 102-80.50 Section... Environmental Management Risks and Risk Reduction Strategies § 102-80.50 Are Federal agencies responsible for...

Gender identity, healthcare access, and risk reduction among Malaysia’s mak nyah community

PubMed Central

Gibson, Britton A.; Brown, Shan-Estelle; Rutledge, Ronnye; Wickersham, Jeffrey A.; Kamarulzaman, Adeeba; Altice, Frederick L.

2016-01-01

Transgender women (TGW) face compounded levels of stigma and discrimination, resulting in multiple health risks and poor health outcomes. TGW identities are erased by forcing them into binary sex categories in society or treating them as men who have sex with men (MSM). In Malaysia, where both civil and religious law criminalize them for their identities, many TGW turn to sex work with inconsistent prevention methods, which increases their health risks. This qualitative study aims to understand how the identities of TGW sex workers shapes their healthcare utilization patterns and harm reduction behaviours. In-depth, semi-structured interviews were conducted with 21 male-to-female transgender (mak nyah) sex workers in Malaysia. Interviews were transcribed, translated into English, and analysed using thematic coding. Results suggest that TGW identity is shaped at an early age followed by incorporation into the mak nyah community where TGW were assisted in gender transition and introduced to sex work. While healthcare was accessible, it failed to address the multiple healthcare needs of TGW. Pressure for gender-affirming health procedures and fear of HIV and sexually transmitted infection screening led to potentially hazardous health behaviours. These findings have implications for developing holistic, culturally-sensitive prevention and healthcare services for TGW. PMID:26824463

Complications during intrahospital transport of critically ill patients: Focus on risk identification and prevention

PubMed Central

Knight, Patrick H; Maheshwari, Neelabh; Hussain, Jafar; Scholl, Michael; Hughes, Michael; Papadimos, Thomas J; Guo, Weidun Alan; Cipolla, James; Stawicki, Stanislaw P; Latchana, Nicholas

2015-01-01

Intrahospital transportation of critically ill patients is associated with significant complications. In order to reduce overall risk to the patient, such transports should well organized, efficient, and accompanied by the proper monitoring, equipment, and personnel. Protocols and guidelines for patient transfers should be utilized universally across all healthcare facilities. Care delivered during transport and at the site of diagnostic testing or procedure should be equivalent to the level of care provided in the originating environment. Here we review the most common problems encountered during transport in the hospital setting, including various associated adverse outcomes. Our objective is to make medical practitioners, nurses, and ancillary health care personnel more aware of the potential for various complications that may occur during patient movement from the intensive care unit to other locations within a healthcare facility, focusing on risk reduction and preventive strategies. PMID:26807395

Industrial Fungal Enzymes: An Occupational Allergen Perspective

PubMed Central

Green, Brett J.; Beezhold, Donald H.

2011-01-01

Occupational exposure to high-molecular-weight allergens is a risk factor for the development and pathogenesis of IgE-mediated respiratory disease. In some occupational environments, workers are at an increased risk of exposure to fungal enzymes used in industrial production. Fungal enzymes have been associated with adverse health effects in the work place, in particular in baking occupations. Exposure-response relationships have been demonstrated, and atopic workers directly handling fungal enzymes are at an increased risk for IgE-mediated disease and occupational asthma. The utilization of new and emerging fungal enzymes in industrial production will present new occupational exposures. The production of antibody-based immunoassays is necessary for the assessment of occupational exposure and the development of threshold limit values. Allergen avoidance strategies including personal protective equipment, engineering controls, protein encapsulation, and reduction of airborne enzyme concentrations are required to mitigate occupational exposure to fungal enzymes. PMID:21747869

The influence of physical activity in 1,2 dimethylhydrazine induced colon carcinogenesis in the rat.

PubMed

Andrianopoulos, G; Nelson, R L; Bombeck, C T; Souza, G

1987-01-01

Recent epidemiologic findings indicate that relative risk of colon cancer is augmented with increasing proportion of time spent on sedentary occupations, and reduced with occupations requiring high levels of work-related physical activity. Therefore, the influence of exercise on experimental colon carcinogenesis was investigated. Spontaneous running wheel activity was related to incidence of 1,2 dimethylhydrazine (DMH) colon tumor induction. Colon tumor incidence was significantly reduced in animals that were allowed spontaneous wheel activity throughout the period of DMH tumor induction vs standard housed controls (p less than 0.05), indicating that, in the rat, physical activity protects against colon tumorigenesis. Further comparisons reveal a mild positive association (p = 0.07) between activity and incidence of tumors in the left colon. These results are in accord with epidemiologic findings indicating reduced colon cancer risk with increased physical activity. Possible mechanisms for the protective influence of physical activity on tumorigenesis include reduction in fecal pH, body weight and increased antioxidant enzyme activity. To the extent that epidemiologic associations between colon cancer and activity are inclusive of the multidimensional nature of physical activity, animal models such as that utilized in this experiment can be utilized for investigating the etiologic potential, or strength of association in variables that have been epidemiologically associated with colon cancer risk.

Welfare and Generational Equity in Sustainable Unfunded Pension Systems

PubMed Central

Auerbach, Alan J.; Lee, Ronald

2011-01-01

Using stochastic simulations we analyze how public pension structures spread the risks arising from demographic and economic shocks across generations. We consider several actual and hypothetical sustainable PAYGO pension structures, including: (1) versions of the US Social Security system with annual adjustments of taxes or benefits to maintain fiscal balance; (2) Sweden’s Notional Defined Contribution system and several variants developed to improve fiscal stability; and (3) the German system, which also includes annual adjustments to maintain fiscal balance. For each system, we present descriptive measures of uncertainty in representative outcomes for a typical generation and across generations. We then estimate expected utility for generations based on simplifying assumptions and incorporate these expected utility calculations in an overall social welfare measure. Using a horizontal equity index, we also compare the different systems’ performance in terms of how neighboring generations are treated. While the actual Swedish system smoothes stochastic fluctuations more than any other and produces the highest degree of horizontal equity, it does so by accumulating a buffer stock of assets that alleviates the need for frequent adjustments. In terms of social welfare, this accumulation of assets leads to a lower average rate of return that more than offsets the benefits of risk reduction, leaving systems with more frequent adjustments that spread risks broadly among generations as those most preferred. PMID:21818166

Benefit and harm of intensive blood pressure treatment: Derivation and validation of risk models using data from the SPRINT and ACCORD trials

PubMed Central

Denton, Brian T.; Hayward, Rodney A.

2017-01-01

Background Intensive blood pressure (BP) treatment can avert cardiovascular disease (CVD) events but can cause some serious adverse events. We sought to develop and validate risk models for predicting absolute risk difference (increased risk or decreased risk) for CVD events and serious adverse events from intensive BP therapy. A secondary aim was to test if the statistical method of elastic net regularization would improve the estimation of risk models for predicting absolute risk difference, as compared to a traditional backwards variable selection approach. Methods and findings Cox models were derived from SPRINT trial data and validated on ACCORD-BP trial data to estimate risk of CVD events and serious adverse events; the models included terms for intensive BP treatment and heterogeneous response to intensive treatment. The Cox models were then used to estimate the absolute reduction in probability of CVD events (benefit) and absolute increase in probability of serious adverse events (harm) for each individual from intensive treatment. We compared the method of elastic net regularization, which uses repeated internal cross-validation to select variables and estimate coefficients in the presence of collinearity, to a traditional backwards variable selection approach. Data from 9,069 SPRINT participants with complete data on covariates were utilized for model development, and data from 4,498 ACCORD-BP participants with complete data were utilized for model validation. Participants were exposed to intensive (goal systolic pressure < 120 mm Hg) versus standard (<140 mm Hg) treatment. Two composite primary outcome measures were evaluated: (i) CVD events/deaths (myocardial infarction, acute coronary syndrome, stroke, congestive heart failure, or CVD death), and (ii) serious adverse events (hypotension, syncope, electrolyte abnormalities, bradycardia, or acute kidney injury/failure). The model for CVD chosen through elastic net regularization included interaction terms suggesting that older age, black race, higher diastolic BP, and higher lipids were associated with greater CVD risk reduction benefits from intensive treatment, while current smoking was associated with fewer benefits. The model for serious adverse events chosen through elastic net regularization suggested that male sex, current smoking, statin use, elevated creatinine, and higher lipids were associated with greater risk of serious adverse events from intensive treatment. SPRINT participants in the highest predicted benefit subgroup had a number needed to treat (NNT) of 24 to prevent 1 CVD event/death over 5 years (absolute risk reduction [ARR] = 0.042, 95% CI: 0.018, 0.066; P = 0.001), those in the middle predicted benefit subgroup had a NNT of 76 (ARR = 0.013, 95% CI: −0.0001, 0.026; P = 0.053), and those in the lowest subgroup had no significant risk reduction (ARR = 0.006, 95% CI: −0.007, 0.018; P = 0.71). Those in the highest predicted harm subgroup had a number needed to harm (NNH) of 27 to induce 1 serious adverse event (absolute risk increase [ARI] = 0.038, 95% CI: 0.014, 0.061; P = 0.002), those in the middle predicted harm subgroup had a NNH of 41 (ARI = 0.025, 95% CI: 0.012, 0.038; P < 0.001), and those in the lowest subgroup had no significant risk increase (ARI = −0.007, 95% CI: −0.043, 0.030; P = 0.72). In ACCORD-BP, participants in the highest subgroup of predicted benefit had significant absolute CVD risk reduction, but the overall ACCORD-BP participant sample was skewed towards participants with less predicted benefit and more predicted risk than in SPRINT. The models chosen through traditional backwards selection had similar ability to identify absolute risk difference for CVD as the elastic net models, but poorer ability to correctly identify absolute risk difference for serious adverse events. A key limitation of the analysis is the limited sample size of the ACCORD-BP trial, which expanded confidence intervals for ARI among persons with type 2 diabetes. Additionally, it is not possible to mechanistically explain the physiological relationships explaining the heterogeneous treatment effects captured by the models, since the study was an observational secondary data analysis. Conclusions We found that predictive models could help identify subgroups of participants in both SPRINT and ACCORD-BP who had lower versus higher ARRs in CVD events/deaths with intensive BP treatment, and participants who had lower versus higher ARIs in serious adverse events. PMID:29040268

Valuing health risk in agriculture: a choice experiment approach to pesticide use in China.

PubMed

Jin, Jianjun; Wang, Wenyu; He, Rui; Gong, Haozhou

2017-07-01

This paper presents a choice experiment approach to investigate farmers' valuations for health risk changes associated with pesticide use in Anqiu County, China. An empirical comparison on the disparity between farmers' willingness to pay (WTP) for a health risk reduction and willingness to accept (WTA) for the same risk increase is also conducted. Respondents were randomly assigned into the WTP group or the WTA group. Four attributes (health consequence, baseline risk, risk change size, and price) were identified and included. The results show that cancer consequence due to pesticide use decreases the utility of the farmer. A higher baseline risk has a higher WTP to reduce the risk and a higher probability of receiving compensation. If the health risk change size is bigger, it will result in a higher WTP and higher compensation. Household income, education, and age have significant and positive impacts on farmers' WTP. Farmers who are more educated or female are more likely to accept the compensation scheme if health risks increase. The marginal WTA for the same risk change is about two times higher than the marginal WTP. The findings of this study can contribute to the literature comparing people's WTP and WTA in a discrete choice experiment on valuing health risk changes associated with pesticide use.

Impact of standardized clinical assessment and management plans on resource utilization and costs in children after the arterial switch operation.

PubMed

Rathod, Rahul H; Jurgen, Brittney; Hamershock, Rose A; Friedman, Kevin G; Marshall, Audrey C; Samnaliev, Mihail; Graham, Dionne A; Jenkins, Kathy; Lock, James E; Powell, Andrew J

2017-12-01

Standardized Clinical Assessment and Management Plans (SCAMPs) are a quality improvement initiative designed to reduce unnecessary utilization, decrease practice variation, and improve patient outcomes. We created a novel methodology, the SCAMP managed episode of care (SMEOC), which encompasses multiple encounters to assess the impact of the arterial switch operation (ASO) SCAMP on total costs. All ASO SCAMP patients (dates March 2009 to July 2015) were compared to a control group of ASO patients (January 2001 to February 2009). Patients were divided into "younger" (<2 years) and "older" (2-18 years) subgroups. Utilization included all cardiology visits, tests, and procedures. Standardized costs were applied to each unit of utilization. There were 100 historical and 63 SCAMP patients in the younger subgroup, and 163 historical and 165 SCAMP patients in the older subgroup. In the younger subgroup, the SCAMP had a 28% reduction in outpatient clinic visits (P < .001), a 52% reduction in chest radiographs (P < .001), a 21% reduction in electrocardiograms (P < .001), and a 30% total reduction in costs. In the older subgroup, the SCAMP had a 21% reduction in outpatient clinic visits (P < .001), a 20% reduction in chest radiographs (P = .05), a 10% reduction in echocardiograms (P = .05), a 25% reduction in exercise stress tests (P = .01), and a 14% total reduction in costs. The total cost savings of the ASO SCAMP was $216 649 in the first 6 years of the SCAMP. There was no difference in clinical outcomes between the historical and SCAMP cohorts. SCAMPs can improve resource utilization and reduce costs after the ASO operation while maintaining quality of care. © 2017 Wiley Periodicals, Inc.

Design risk assessment for burst-prone mines: Application in a Canadian mine

NASA Astrophysics Data System (ADS)

Cheung, David J.

A proactive stance towards improving the effectiveness and consistency of risk assessments has been adopted recently by mining companies and industry. The next 10-20 years forecasts that ore deposits accessible using shallow mining techniques will diminish. The industry continues to strive for success in "deeper" mining projects in order to keep up with the continuing demand for raw materials. Although the returns are quite profitable, many projects have been sidelined due to high uncertainty and technical risk in the mining of the mineral deposit. Several hardrock mines have faced rockbursting and seismicity problems. Within those reported, mines in countries like South Africa, Australia and Canada have documented cases of severe rockburst conditions attributed to the mining depth. Severe rockburst conditions known as "burst-prone" can be effectively managed with design. Adopting a more robust design can ameliorate the exposure of workers and equipment to adverse conditions and minimize the economic consequences, which can hinder the bottom line of an operation. This thesis presents a methodology created for assessing the design risk in burst-prone mines. The methodology includes an evaluation of relative risk ratings for scenarios with options of risk reduction through several design principles. With rockbursts being a hazard of seismic events, the methodology is based on research in the area of mining seismicity factoring in rockmass failure mechanisms, which results from a combination of mining induced stress, geological structures, rockmass properties and mining influences. The methodology was applied to case studies at Craig Mine of Xstrata Nickel in Sudbury, Ontario, which is known to contain seismically active fault zones. A customized risk assessment was created and applied to rockburst case studies, evaluating the seismic vulnerability and consequence for each case. Application of the methodology to Craig Mine demonstrates that changes in the design can reduce both exposure risk (personnel and equipment), and economical risk (revenue and costs). Fatal and catastrophic consequences can be averted through robust planning and design. Two customized approaches were developed to conduct risk assessment of case studies at Craig Mine. Firstly, the Brownfield Approach utilizes the seismic database to determine the seismic hazard from a rating system that evaluates frequency-magnitude, event size, and event-blast relation. Secondly, the Greenfield Approach utilizes the seismic database, focusing on larger magnitude events, rocktype, and geological structure. The customized Greenfield Approach can also be applied in the evaluation of design risk in deep mines with the same setting and condition as Craig Mine. Other mines with different settings and conditions can apply the principles in the methodology to evaluate design alternatives and risk reduction strategies for burst-prone mines.

Insurance, Public Assistance, and Household Flood Risk Reduction: A Comparative Study of Austria, England, and Romania.

PubMed

Hanger, Susanne; Linnerooth-Bayer, Joanne; Surminski, Swenja; Nenciu-Posner, Cristina; Lorant, Anna; Ionescu, Radu; Patt, Anthony

2018-04-01

In light of increasing losses from floods, many researchers and policymakers are looking for ways to encourage flood risk reduction among communities, business, and households. In this study, we investigate risk-reduction behavior at the household level in three European Union Member States with fundamentally different insurance and compensation schemes. We try to understand if and how insurance and public assistance influence private risk-reduction behavior. Data were collected using a telephone survey (n = 1,849) of household decisionmakers in flood-prone areas. We show that insurance overall is positively associated with private risk-reduction behavior. Warranties, premium discounts, and information provision with respect to risk reduction may be an explanation for this positive relationship in the case of structural measures. Public incentives for risk-reduction measures by means of financial and in-kind support, and particularly through the provision of information, are also associated with enhancing risk reduction. In this study, public compensation is not negatively associated with private risk-reduction behavior. This does not disprove such a relationship, but the negative effect may be mitigated by factors related to respondents' capacity to implement measures or social norms that were not included in the analysis. The data suggest that large-scale flood protection infrastructure creates a sense of security that is associated with a lower level of preparedness. Across the board there is ample room to improve both public and private policies to provide effective incentives for household-level risk reduction. © 2017 The Authors Risk Analysis published by Wiley Periodicals, Inc. on behalf of Society for Risk Analysis.

Modeling the Impact of Nutrition Interventions on Birth Outcomes in the Lives Saved Tool (LiST).

PubMed

Heidkamp, Rebecca; Clermont, Adrienne; Phillips, Erica

2017-11-01

Background: Negative birth outcomes [small-for-gestational age (SGA) and preterm birth (PTB)] are common in low- and middle-income countries and have important subsequent health and developmental impacts on children. There are numerous nutritional and non-nutritional interventions that can decrease the risk of negative birth outcomes and reduce subsequent risk of mortality and growth faltering. Objective: The objective of this article was to review the current evidence for the impact of nutritional interventions in pregnancy [calcium supplementation, iron and folic acid supplementation, multiple micronutrient (MMN) supplementation, and balanced energy supplementation (BES)] and risk factors (maternal anemia) on birth outcomes, with the specific goal of determining which intervention-outcome linkages should be included in the Lives Saved Tool (LiST) software. Methods: A literature search was conducted by using the WHO e-Library of Evidence for Nutrition Actions as the starting point. Recent studies, meta-analyses, and systematic reviews were reviewed for inclusion on the basis of their relevance to LiST. Results: On the basis of the available scientific evidence, the following linkages were found to be supported for inclusion in LiST: calcium supplementation on PTB (12% reduction), MMN supplementation on SGA (9% reduction), and BES on SGA (21% reduction among food-insecure women). Conclusions: The inclusion of these linkages in LiST will improve the utility of the model for users who seek to estimate the impact of antenatal nutrition interventions on birth outcomes. Scaling up these interventions should lead to downstream impacts in reducing stunting and child mortality. © 2017 American Society for Nutrition.

Perceptions of climate-related risk among water sector professionals in Africa-Insights from the 2016 African Water Association Congress.

PubMed

Connolly, Katherine; Mbutu, Mwaura; Bartram, Jamie; Fuente, David

2018-06-01

The ability of water and wastewater utilities to provide safe and reliable water and sanitation services now and in the future will be determined, in part, by their resilience to climate change. Investment in infrastructure, planning, and operational practices that increase resilience are affected, in turn, by how water sector professionals perceive the risks posed to utilities by climate change and its related impacts. We surveyed water sector professionals at the 2016 African Water Association's Congress in Nairobi, Kenya to assess their perceptions of climate-specific and general risks that may disrupt utility service. We find that water sector professionals are most concerned about climate-specific and general risks that affect utility water supplies (quantity), followed by adequacy of utility infrastructure. We also find that professionals tend to rank climate-specific risks as less concerning than general risks facing utilities. Furthermore, non-utility professionals are more concerned about climate-specific risks and climate change in general than utility professionals. These findings highlight the multiple, competing risks utilities face and the need for adaptation strategies that simultaneously address climate-specific and general concerns of utilities. Copyright © 2018 Elsevier GmbH. All rights reserved.

Multiple risk factor interventions for primary prevention of coronary heart disease

PubMed Central

Ebrahim, Shah; Beswick, Andrew; Burke, Margaret; Smith, George Davey

2014-01-01

Background Primary prevention programmes in many countries attempt to reduce mortality and morbidity due to coronary heart disease (CHD) through risk factor modification. It is widely believed that multiple risk factor intervention using counselling and educational methods is efficacious and cost-effective and should be expanded. Recent trials examining risk factor changes have cast considerable doubt on the effectiveness of these multiple risk factor interventions. Objectives To assess the effects of multiple risk factor intervention for reducing cardiovascular risk factors, total mortality, and mortality from CHD among adults without clinical evidence of established cardiovascular disease. Search strategy MEDLINE was searched for the original review to 1995. This was updated by searching the Cochrane Central Register of Controlled Trials on The Cochrane Library Issue 3 2001, MEDLINE(2000 to September 2001) and EMBASE (1998 to September 2001). Selection criteria Intervention studies using counselling or education to modify more than one cardiovascular risk factor in adults from general populations, occupational groups, or high risk groups. Trials of less than 6 months duration were excluded. Data collection and analysis Data were extracted by two reviewers independently. Investigators were contacted to obtain missing information. Main results A total of 39 trials were found of which ten reported clinical event data. In the ten trials with clinical event end-points, the pooled odds ratios for total and CHD mortality were 0.96 (95% confidence intervals (CI) 0.92 to 1.01) and 0.96 (95% CI 0.89 to 1.04) respectively. Net changes in systolic and diastolic blood pressure, and blood cholesterol were (weighted mean differences) −3.6 mmHg (95% CI −3.9 to −3.3 mmHg), −2.8 mmHg (95% CI −2.9 to −2.6 mmHg) and −0.07 mMol/l (95% CI −0.8 to −0.06 mMol/l) respectively. Odds of reduction in smoking prevalence was 20% (95% CI 8% to 31%). Statistical heterogeneity between the studies with respect to mortality and risk factor changes was due to trials focusing on hypertensive participants and those using considerable amounts of drug treatment. Authors’ conclusions The pooled effects suggest multiple risk factor intervention has no effect on mortality. However, a small, but potentially important, benefit of treatment (about a 10% reduction in CHD mortality) may have been missed. Risk factor changes were relatively modest, were related to the amount of pharmacological treatment used, and in some cases may have been over-estimated because of regression to the mean effects, lack of intention to treat analyses, habituation to blood pressure measurement, and use of self-reports of smoking. Interventions using personal or family counselling and education with or without pharmacological treatments appear to be more effective at achieving risk factor reduction and consequent reductions in mortality in high risk hypertensive populations. The evidence suggests that such interventions have limited utility in the general population. PMID:17054138

A market systems analysis of the U.S. Sport Utility Vehicle market considering frontal crash safety technology and policy.

PubMed

Hoffenson, Steven; Frischknecht, Bart D; Papalambros, Panos Y

2013-01-01

Active safety features and adjustments to the New Car Assessment Program (NCAP) consumer-information crash tests have the potential to decrease the number of serious traffic injuries each year, according to previous studies. However, literature suggests that risk reductions, particularly in the automotive market, are often accompanied by adjusted consumer risk tolerance, and so these potential safety benefits may not be fully realized due to changes in consumer purchasing or driving behavior. This article approaches safety in the new vehicle market, particularly in the Sport Utility Vehicle and Crossover Utility Vehicle segments, from a market systems perspective. Crash statistics and simulations are used to predict the effects of design and policy changes on occupant crash safety, and discrete choice experiments are conducted to estimate the values consumers place on vehicle attributes. These models are combined in a market simulation that forecasts how consumers respond to the available vehicle alternatives, resulting in predictions of the market share of each vehicle and how the change in fleet mixture influences societal outcomes including injuries, fuel consumption, and firm profits. The model is tested for a scenario where active safety features are implemented across the new vehicle fleet and a scenario where the U.S. frontal NCAP test speed is modified. While results exhibit evidence of consumer risk adjustment, they support adding active safety features and lowering the NCAP frontal test speed, as these changes are predicted to improve the welfare of both firms and society. Copyright © 2012 Elsevier Ltd. All rights reserved.

Relationships among trust in messages, risk perception, and risk reduction preferences based upon avian influenza in Taiwan.

PubMed

Fang, David; Fang, Chen-Ling; Tsai, Bi-Kun; Lan, Li-Chi; Hsu, Wen-Shan

2012-08-01

Improvements in communications technology enable consumers to receive information through diverse channels. In the case of avian influenza, information repeated by the mass media socially amplifies the consumer awareness of risks. Facing indeterminate risks, consumers may feel anxious and increase their risk perception. When consumers trust the information published by the media, their uncertainty toward avian influenza may decrease. Consumers might take some actions to reduce risk. Therefore, this study focuses on relationships among trust in messages, risk perception and risk reduction preferences. This study administered 525 random samples and consumer survey questionnaires in different city of Taiwan in 2007. Through statistical analysis, the results demonstrate: (1) the higher the trust consumers have in messages about avian influenza, the lower their risk perceptions are; (2) the higher the consumers' risk perceptions are and, therefore, the higher their desired level of risk reductive, the more likely they are to accept risk reduction strategies; (3) consumer attributes such as age, education level, and marital status correlate with significant differences in risk perception and risk reduction preferences acceptance. Gender has significant differences only in risk reduction preferences and not in risk perception.

Relationships among Trust in Messages, Risk Perception, and Risk Reduction Preferences Based upon Avian Influenza in Taiwan

PubMed Central

Fang, David; Fang, Chen-Ling; Tsai, Bi-Kun; Lan, Li-Chi; Hsu, Wen-Shan

2012-01-01

Improvements in communications technology enable consumers to receive information through diverse channels. In the case of avian influenza, information repeated by the mass media socially amplifies the consumer awareness of risks. Facing indeterminate risks, consumers may feel anxious and increase their risk perception. When consumers trust the information published by the media, their uncertainty toward avian influenza may decrease. Consumers might take some actions to reduce risk. Therefore, this study focuses on relationships among trust in messages, risk perception and risk reduction preferences. This study administered 525 random samples and consumer survey questionnaires in different city of Taiwan in 2007. Through statistical analysis, the results demonstrate: (1) the higher the trust consumers have in messages about avian influenza, the lower their risk perceptions are; (2) the higher the consumers’ risk perceptions are and, therefore, the higher their desired level of risk reductive, the more likely they are to accept risk reduction strategies; (3) consumer attributes such as age, education level, and marital status correlate with significant differences in risk perception and risk reduction preferences acceptance. Gender has significant differences only in risk reduction preferences and not in risk perception. PMID:23066394

Net reclassification index at event rate: properties and relationships.

PubMed

Pencina, Michael J; Steyerberg, Ewout W; D'Agostino, Ralph B

2017-12-10

The net reclassification improvement (NRI) is an attractively simple summary measure quantifying improvement in performance because of addition of new risk marker(s) to a prediction model. Originally proposed for settings with well-established classification thresholds, it quickly extended into applications with no thresholds in common use. Here we aim to explore properties of the NRI at event rate. We express this NRI as a difference in performance measures for the new versus old model and show that the quantity underlying this difference is related to several global as well as decision analytic measures of model performance. It maximizes the relative utility (standardized net benefit) across all classification thresholds and can be viewed as the Kolmogorov-Smirnov distance between the distributions of risk among events and non-events. It can be expressed as a special case of the continuous NRI, measuring reclassification from the 'null' model with no predictors. It is also a criterion based on the value of information and quantifies the reduction in expected regret for a given regret function, casting the NRI at event rate as a measure of incremental reduction in expected regret. More generally, we find it informative to present plots of standardized net benefit/relative utility for the new versus old model across the domain of classification thresholds. Then, these plots can be summarized with their maximum values, and the increment in model performance can be described by the NRI at event rate. We provide theoretical examples and a clinical application on the evaluation of prognostic biomarkers for atrial fibrillation. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Cost-Benefit Analysis of Green Infrastructures on Community Stormwater Reduction and Utilization: A Case of Beijing, China.

PubMed

Liu, Wen; Chen, Weiping; Feng, Qi; Peng, Chi; Kang, Peng

2016-12-01

Cost-benefit analysis is demanded for guiding the plan, design and construction of green infrastructure practices in rapidly urbanized regions. We developed a framework to calculate the costs and benefits of different green infrastructures on stormwater reduction and utilization. A typical community of 54,783 m 2 in Beijing was selected for case study. For the four designed green infrastructure scenarios (green space depression, porous brick pavement, storage pond, and their combination), the average annual costs of green infrastructure facilities are ranged from 40.54 to 110.31 thousand yuan, and the average of the cost per m 3 stormwater reduction and utilization is 4.61 yuan. The total average annual benefits of stormwater reduction and utilization by green infrastructures of the community are ranged from 63.24 to 250.15 thousand yuan, and the benefit per m 3 stormwater reduction and utilization is ranged from 5.78 to 11.14 yuan. The average ratio of average annual benefit to cost of four green infrastructure facilities is 1.91. The integrated facilities had the highest economic feasibility with a benefit to cost ratio of 2.27, and followed by the storage pond construction with a benefit to cost ratio of 2.14. The results suggested that while the stormwater reduction and utilization by green infrastructures had higher construction and maintenance costs, their comprehensive benefits including source water replacements benefits, environmental benefits and avoided cost benefits are potentially interesting. The green infrastructure practices should be promoted for sustainable management of urban stormwater.

Risk mapping and tsunami mitigation in Gunungkidul area, Yogyakarta

NASA Astrophysics Data System (ADS)

Mardiatno, Djati; Sunarto, WF, Lies Rahayu; Saptadi, Gatot; Ayuningtyas, Efrinda Ari

2015-04-01

Coastal area of Gunungkidul Regency is one of the areas prone to tsunami in Indonesia. In contrary, currently, this area is very intensively developed as one of the favourite tourism destination. This paper is aimed at explaining tsunami risk and a mitigation type in Gunungkidul Area, Yogyakarta. Digital elevation model (DEM) and coastal morphology were used to generate tsunami hazard map. Vulnerability was analysed by utilizing land use data. Information from previous studies (e.g. from GTZ) were also considered for analysis. Tsunami risk was classified into three classes, i.e. high risk, medium risk, and low risk and visualized in the form of tsunami risk map. Tsunami risk map is a tool which can be used as disaster reduction instrument, such as for evacuation routes planning. Based on the preliminary results of this research, it is clear that tsunami risk in this area is varied depend on the morphological condition of the location. There are five coastal area selected as the location, i.e. Ngrenehan, Baron, Sepanjang, PulangSawal, and Sadeng. All locations have the high risk zone to tsunami, especially for bay area. Evacuation routes were generated for all locations by considering the local landscape condition. There are several differences of evacuation ways for each location.

Utility functions predict variance and skewness risk preferences in monkeys

PubMed Central

Genest, Wilfried; Stauffer, William R.; Schultz, Wolfram

2016-01-01

Utility is the fundamental variable thought to underlie economic choices. In particular, utility functions are believed to reflect preferences toward risk, a key decision variable in many real-life situations. To assess the validity of utility representations, it is therefore important to examine risk preferences. In turn, this approach requires formal definitions of risk. A standard approach is to focus on the variance of reward distributions (variance-risk). In this study, we also examined a form of risk related to the skewness of reward distributions (skewness-risk). Thus, we tested the extent to which empirically derived utility functions predicted preferences for variance-risk and skewness-risk in macaques. The expected utilities calculated for various symmetrical and skewed gambles served to define formally the direction of stochastic dominance between gambles. In direct choices, the animals’ preferences followed both second-order (variance) and third-order (skewness) stochastic dominance. Specifically, for gambles with different variance but identical expected values (EVs), the monkeys preferred high-variance gambles at low EVs and low-variance gambles at high EVs; in gambles with different skewness but identical EVs and variances, the animals preferred positively over symmetrical and negatively skewed gambles in a strongly transitive fashion. Thus, the utility functions predicted the animals’ preferences for variance-risk and skewness-risk. Using these well-defined forms of risk, this study shows that monkeys’ choices conform to the internal reward valuations suggested by their utility functions. This result implies a representation of utility in monkeys that accounts for both variance-risk and skewness-risk preferences. PMID:27402743

Utility functions predict variance and skewness risk preferences in monkeys.

PubMed

Genest, Wilfried; Stauffer, William R; Schultz, Wolfram

2016-07-26

Utility is the fundamental variable thought to underlie economic choices. In particular, utility functions are believed to reflect preferences toward risk, a key decision variable in many real-life situations. To assess the validity of utility representations, it is therefore important to examine risk preferences. In turn, this approach requires formal definitions of risk. A standard approach is to focus on the variance of reward distributions (variance-risk). In this study, we also examined a form of risk related to the skewness of reward distributions (skewness-risk). Thus, we tested the extent to which empirically derived utility functions predicted preferences for variance-risk and skewness-risk in macaques. The expected utilities calculated for various symmetrical and skewed gambles served to define formally the direction of stochastic dominance between gambles. In direct choices, the animals' preferences followed both second-order (variance) and third-order (skewness) stochastic dominance. Specifically, for gambles with different variance but identical expected values (EVs), the monkeys preferred high-variance gambles at low EVs and low-variance gambles at high EVs; in gambles with different skewness but identical EVs and variances, the animals preferred positively over symmetrical and negatively skewed gambles in a strongly transitive fashion. Thus, the utility functions predicted the animals' preferences for variance-risk and skewness-risk. Using these well-defined forms of risk, this study shows that monkeys' choices conform to the internal reward valuations suggested by their utility functions. This result implies a representation of utility in monkeys that accounts for both variance-risk and skewness-risk preferences.

Regulatory Approval of Cancer Risk-reducing (Chemopreventive) Drugs: Moving What We Have Learned into the Clinic

PubMed Central

Meyskens, Frank L.; Curt, Gregory A.; Brenner, Dean E.; Gordon, Gary; Herberman, Ronald B.; Finn, Olivera; Kelloff, Gary J.; Khleif, Samir N.; Sigman, Caroline C.; Szabo, Eva

2010-01-01

This paper endeavors to clarify the current requirements and status of regulatory approval for chemoprevention (risk reduction) drugs and discusses possible improvements to the regulatory pathway for chemoprevention. Covering a wide range of topics in as much depth as space allows, this report is written in a style to facilitate the understanding of non-scientists and to serve as a framework for informing the directions of experts engaged more deeply with this issue. Key topics we cover here are as follows: a history of definitive cancer chemoprevention trials and their influence on the evolution of regulatory assessments; a brief review of the long-standing success of pharmacologic risk reduction of cardiovascular diseases and its relevance to approval for cancer risk reduction drugs; the use and limitations of biomarkers for developing and the approval of cancer risk reduction drugs; the identification of individuals at a high(er) risk for cancer and who are appropriate candidates for risk reduction drugs; business models that should incentivize pharmaceutical-industry investment in cancer risk reduction; a summary of scientific and institutional barriers to development of cancer risk reduction drugs; and a summary of major recommendations that should help facilitate the pathway to regulatory approval for pharmacologic cancer risk reduction drugs. PMID:21372031

A benchmark system to optimize our defense against an attack on the US food supply using the Risk Reduction Effectiveness and Capabilities Assessment Program.

PubMed

Hodoh, Ofia; Dallas, Cham E; Williams, Paul; Jaine, Andrew M; Harris, Curt

2015-01-01

A predictive system was developed and tested in a series of exercises with the objective of evaluating the preparedness and effectiveness of the multiagency response to food terrorism attacks. A computerized simulation model, Risk Reduction Effectiveness and Capabilities Assessment Program (RRECAP), was developed to identify the key factors that influence the outcomes of an attack and quantify the relative reduction of such outcomes caused by each factor. The model was evaluated in a set of Tabletop and Full-Scale Exercises that simulate biological and chemical attacks on the food system. More than 300 participants representing more than 60 federal, state, local, and private sector agencies and organizations. The exercises showed that agencies could use RRECAP to identify and prioritize their advance preparation to mitigate such attacks with minimal expense. RRECAP also demonstrated the relative utility and limitations of the ability of medical resources to treat patients if responders do not recognize and mitigate the attack rapidly, and the exercise results showed that proper advance preparation would reduce these deficiencies. Using computer simulation prediction of the medical outcomes of food supply attacks to identify optimal remediation activities and quantify the benefits of various measures provides a significant tool to agencies in both the public and private sector as they seek to prepare for such an attack.

Active surveillance for localized prostate cancer: an analysis of patient contacts and utilization of healthcare resources.

PubMed

Thomsen, Frederik B; Berg, Kasper D; Røder, M Andreas; Iversen, Peter; Brasso, Klaus

2015-02-01

Evidence supports active surveillance (AS) as a means to reduce overtreatment of low-risk prostate cancer (PCa). The consequences of close and long-standing follow-up with regard to outpatient visits, tests and repeated biopsies are widely unknown. This study investigated the trajectory and costs of AS in patients with localized PCa. In total, 317 PCa patients were followed in a prospective, single-arm AS cohort. The primary outcomes were number of patient contacts, prostate-specific antigen (PSA) tests, biopsies, hospital admissions due to biopsy complications and patients eventually undergoing curative treatment. The secondary outcome was cost. The 5 year cumulative incidence of discontinued AS in a competing-risk model was 40%. During the first 5 years of AS patients underwent a median of two biopsy sets, and patients were seen in an outpatient clinic including PSA testing three to four times annually. In total, 38 of the 406 biopsy sessions led to hospital admission and 87 of the 317 patients required treatment for bladder outlet obstruction (BOO). With a median of 3.7 years' follow-up, the total cost of AS was euro (€) 1,240,286. Assuming all patients had otherwise undergone primary radical prostatectomy, the cost difference favoured AS with a net benefit of €662,661 (35% reduction). AS entails a close clinical follow-up with a considerable risk of rebiopsy complication, treatment of BOO and subsequent delayed definitive therapy. This risk should be weighed against a potential economic benefit and reduction in the risk of overtreatment compared to immediate radical treatment.

Dual-Spool Turbine Facility Design Overview

NASA Technical Reports Server (NTRS)

Giel, Paul; Pachlhofer, Pete

2003-01-01

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

Evaluating the Characteristics of Social Vulnerability to Wildfire: Demographics, Perceptions, and Parcel Characteristics.

PubMed

Paveglio, Travis B; Prato, Tony; Edgeley, Catrin; Nalle, Darek

2016-09-01

A large body of research focuses on identifying patterns of human populations most at risk from hazards and the factors that help explain performance of mitigations that can help reduce that risk. One common concept in such studies is social vulnerability-human populations' potential exposure to, sensitivity from and ability to reduce negative impacts from a hazard. While there is growing interest in social vulnerability for wildfire, few studies have critically evaluated the characteristics that scholars often indicate influence social vulnerability to that hazard. This research utilizes surveys, wildfire simulations, and GIS data to test the relationships between select demographic, perceptual and parcel characteristics of property owners against empirically simulated metrics for wildfire exposure or wildfire-related damages and their performance of mitigation actions. Our results from Flathead County, MT, USA, suggest that parcel characteristics such as property value, building value, and the year structures were built explaining a significant amount of the variance in elements of social vulnerability. Demographic characteristics commonly used in social vulnerability analysis did not have significant relationships with measures of wildfire exposure or vulnerability. Part-time or full-time residency, age, perceived property risk, and year of development were among the few significant determinants of residents' performance of fuel reduction mitigations, although the significance of these factors varied across the levels of fuel reduction performed by homeowners. We use these and other results to argue for a renewed focus on the finer-scale characteristics that expose some populations to wildfire risk more than others.

Evaluating the Characteristics of Social Vulnerability to Wildfire: Demographics, Perceptions, and Parcel Characteristics

NASA Astrophysics Data System (ADS)

Paveglio, Travis B.; Prato, Tony; Edgeley, Catrin; Nalle, Darek

2016-09-01

A large body of research focuses on identifying patterns of human populations most at risk from hazards and the factors that help explain performance of mitigations that can help reduce that risk. One common concept in such studies is social vulnerability—human populations' potential exposure to, sensitivity from and ability to reduce negative impacts from a hazard. While there is growing interest in social vulnerability for wildfire, few studies have critically evaluated the characteristics that scholars often indicate influence social vulnerability to that hazard. This research utilizes surveys, wildfire simulations, and GIS data to test the relationships between select demographic, perceptual and parcel characteristics of property owners against empirically simulated metrics for wildfire exposure or wildfire-related damages and their performance of mitigation actions. Our results from Flathead County, MT, USA, suggest that parcel characteristics such as property value, building value, and the year structures were built explaining a significant amount of the variance in elements of social vulnerability. Demographic characteristics commonly used in social vulnerability analysis did not have significant relationships with measures of wildfire exposure or vulnerability. Part-time or full-time residency, age, perceived property risk, and year of development were among the few significant determinants of residents' performance of fuel reduction mitigations, although the significance of these factors varied across the levels of fuel reduction performed by homeowners. We use these and other results to argue for a renewed focus on the finer-scale characteristics that expose some populations to wildfire risk more than others.

Investigation of Cost and Energy Optimization of Drinking Water Distribution Systems.

PubMed

Cherchi, Carla; Badruzzaman, Mohammad; Gordon, Matthew; Bunn, Simon; Jacangelo, Joseph G

2015-11-17

Holistic management of water and energy resources through energy and water quality management systems (EWQMSs) have traditionally aimed at energy cost reduction with limited or no emphasis on energy efficiency or greenhouse gas minimization. This study expanded the existing EWQMS framework and determined the impact of different management strategies for energy cost and energy consumption (e.g., carbon footprint) reduction on system performance at two drinking water utilities in California (United States). The results showed that optimizing for cost led to cost reductions of 4% (Utility B, summer) to 48% (Utility A, winter). The energy optimization strategy was successfully able to find the lowest energy use operation and achieved energy usage reductions of 3% (Utility B, summer) to 10% (Utility A, winter). The findings of this study revealed that there may be a trade-off between cost optimization (dollars) and energy use (kilowatt-hours), particularly in the summer, when optimizing the system for the reduction of energy use to a minimum incurred cost increases of 64% and 184% compared with the cost optimization scenario. Water age simulations through hydraulic modeling did not reveal any adverse effects on the water quality in the distribution system or in tanks from pump schedule optimization targeting either cost or energy minimization.

Sexual harm reduction practices of HIV-seropositive gay and bisexual men: serosorting, strategic positioning, and withdrawal before ejaculation.

PubMed

Parsons, Jeffrey T; Schrimshaw, Eric W; Wolitski, Richard J; Halkitis, Perry N; Purcell, David W; Hoff, Colleen C; Gómez, Cynthia A

2005-04-01

This study assessed unprotected anal and oral sex behaviors of HIV-positive gay and bisexual men in New York City and San Francisco with their main and non-main sexual partners. Here we focus on the use of three harm reduction strategies (serosorting, strategic positioning, and withdrawal before ejaculation) in order to decrease transmission risk. The data from a baseline assessment of 1168 HIV-positive gay and bisexual men in the two cities were utilized. Men were recruited from a variety of community-based venues, through advertising and other techniques. City differences were identified, with more men in San Francisco reporting sexual risk behaviors across all partner types compared with men in New York City. Serosorting was identified, with men reporting significantly more oral and anal sex acts with other HIV-positive partners than with HIV-negative partners. However, men also reported more unprotected sex with partners of unknown status compared with their other partners. Some evidence of strategic positioning was identified, although differences were noted across cities and across different types of partners. Men in both cities reported more acts of oral sex without ejaculation than with ejaculation, but the use of withdrawal as a harm reduction strategy for anal sex was more common among men from San Francisco. Overall, evidence for harm reduction was identified; however, significant differences across the two cities were found. The complicated nature of the sexual practices of gay and bisexual men are discussed, and the findings have important implications for prevention efforts and future research studies.

Utility company views of geothermal development

NASA Technical Reports Server (NTRS)

Hinrichs, T. C.

1974-01-01

The views of geothermal development from a utility company standpoint are presented. The impediments associated with such developments as required reliability and identification of risks are discussed. The utility industry historically is not a risk-taking industry. Support of rapid geothermal development by the utility industry requires identification and elimination of risks or absorption of the risks by other agencies. Suggestions as to the identification and minimization of risks are made.

Risk and utility in portfolio optimization

NASA Astrophysics Data System (ADS)

Cohen, Morrel H.; Natoli, Vincent D.

2003-06-01

Modern portfolio theory (MPT) addresses the problem of determining the optimum allocation of investment resources among a set of candidate assets. In the original mean-variance approach of Markowitz, volatility is taken as a proxy for risk, conflating uncertainty with risk. There have been many subsequent attempts to alleviate that weakness which, typically, combine utility and risk. We present here a modification of MPT based on the inclusion of separate risk and utility criteria. We define risk as the probability of failure to meet a pre-established investment goal. We define utility as the expectation of a utility function with positive and decreasing marginal value as a function of yield. The emphasis throughout is on long investment horizons for which risk-free assets do not exist. Analytic results are presented for a Gaussian probability distribution. Risk-utility relations are explored via empirical stock-price data, and an illustrative portfolio is optimized using the empirical data.

A Cost-Effectiveness Evaluation of Germline BRCA1 and BRCA2 Testing in UK Women with Ovarian Cancer.

PubMed

Eccleston, Anthony; Bentley, Anthony; Dyer, Matthew; Strydom, Ann; Vereecken, Wim; George, Angela; Rahman, Nazneen

2017-04-01

To evaluate the long-term cost-effectiveness of germline BRCA1 and BRCA2 (collectively termed "BRCA") testing in women with epithelial ovarian cancer, and testing for the relevant mutation in first- and second-degree relatives of BRCA mutation-positive individuals, compared with no testing. Female BRCA mutation-positive relatives of patients with ovarian cancer could undergo risk-reducing mastectomy and/or bilateral salpingo-oophorectomy. A cost-effectiveness model was developed that included the risks of breast and ovarian cancer; the costs, utilities, and effects of risk-reducing surgery on cancer rates; and the costs, utilities, and mortality rates associated with cancer. BRCA testing of all women with epithelial ovarian cancer each year is cost-effective at a UK willingness-to-pay threshold of £20,000/quality-adjusted life-year (QALY) compared with no testing, with an incremental cost-effectiveness ratio of £4,339/QALY. The result was primarily driven by fewer cases of breast cancer (142) and ovarian cancer (141) and associated reductions in mortality (77 fewer deaths) in relatives over the subsequent 50 years. Sensitivity analyses showed that the results were robust to variations in the input parameters. Probabilistic sensitivity analysis showed that the probability of germline BRCA mutation testing being cost-effective at a threshold of £20,000/QALY was 99.9%. Implementing germline BRCA testing in all patients with ovarian cancer would be cost-effective in the United Kingdom. The consequent reduction in future cases of breast and ovarian cancer in relatives of mutation-positive individuals would ease the burden of cancer treatments in subsequent years and result in significantly better outcomes and reduced mortality rates for these individuals. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Taking stock of decentralized disaster risk reduction in Indonesia

NASA Astrophysics Data System (ADS)

Grady, Anthony; Gersonius, Berry; Makarigakis, Alexandros

2016-09-01

The Sendai Framework, which outlines the global course on disaster risk reduction until 2030, places strong importance on the role of local government in disaster risk reduction. An aim of decentralization is to increase the influence and authority of local government in decision making. Yet, there is limited empirical evidence of the extent, character and effects of decentralization in current disaster risk reduction implementation, and of the barriers that are most critical to this. This paper evaluates decentralization in relation to disaster risk reduction in Indonesia, chosen for its recent actions to decentralize governance of DRR coupled with a high level of disaster risk. An analytical framework was developed to evaluate the various dimensions of decentralized disaster risk reduction, which necessitated the use of a desk study, semi-structured interviews and a gap analysis. Key barriers to implementation in Indonesia included: capacity gaps at lower institutional levels, low compliance with legislation, disconnected policies, issues in communication and coordination and inadequate resourcing. However, any of these barriers are not unique to disaster risk reduction, and similar barriers have been observed for decentralization in other developing countries in other public sectors.

Hyperkalemia of the blood-primed ECLS circuit does not result in post-initiation hyperkalemia in infants < 10 kg.

PubMed

Fleming, Geoffrey M; Remenapp, Robert T; Bartlett, Robert H; Annich, Gail M

2006-05-01

To assess the risk of hyperkalemia with blood-primed extracorporeal life support (ECLS) circuits in infants < 10 kg. Retrospective cohort study of all neonatal and pediatric patients < 10 kg placed on ECLS from May 1998 to April 2001. Data collection including patient weight, patient potassium levels pre- and post-initiation of ECLS, potassium level of the primed ECLS circuit, age of the packed red blood cell (PRBC) unit, type of preservative, and preservative reduction status. Seventy-six circuits were available for the analysis. The age of the PRBC unit and preservative reduction status significantly affected the potassium level of the primed ECLS circuit. Multivariate linear regression analysis showed no significant effect on the post-ECLS initiation patient potassium level with respect to the PRBC age, the preservative reduction status, the patient potassium level prior to ECLS initiation, and the potassium level of the primed ECLS circuit. Initiation of ECLS in infants < 10 kg should not be delayed unnecessarily to perform preservative reduction or to utilize PRBC units of a specific age, as hyperkalemia of the primed ECLS circuit is not associated with systemic hyperkalemia in the patient post-initiation of ECLS.

Sharing of Needles and Syringes among Men Who Inject Drugs: HIV Risk in Northwest Bangladesh.

PubMed

Pasa, M Kamal; Alom, Kazi Robiul; Bashri, Zubaida; Vermund, Sten H

2016-01-01

Injection drug use is prevalent in northwestern Bangladesh. We sought to explore the context of needle/syringe sharing among persons who inject drugs (PWID), examining risk exposures to blood-borne infections like the human immunodeficiency virus (HIV) and hepatitis in a region where these dual epidemics are likely to expand. We used a qualitative research approach to learn about injection practices, conducting 60 in-depth interviews among PWID. We then conducted 12 focus group discussions (FGDs) that generated a checklist of salient issues, and followed up with personal observations of typical days at the drug-use venues. Content and interpretative frameworks were used to analyze qualitative information and socio-demographic information, using SPSS software. We found that needle/syringe-sharing behaviours were integrated into the overall social and cultural lives of drug users. Sharing behaviours were an central component of PWID social organization. Sharing was perceived as an inherent element within reciprocal relationships, and sharing was tied to beliefs about drug effects, economic adversity, and harassment due to their drug user status. Carrying used needles/syringes to drug-use venues was deemed essential since user-unfriendly needle-syringe distribution schedules of harm reduction programmes made it difficult to access clean needles/syringes in off-hours. PWID had low self-esteem. Unequal power relationships were reported between the field workers of harm reduction programmes and PWID. Field workers expressed anti-PWID bias and judgmental attitudes, and also had had misconceptions about HIV and hepatitis transmission. PWID were especially disturbed that no assistance was forthcoming from risk reduction programme staff when drug users manifested withdrawal symptoms. Interventions must take social context into account when scaling up programmes in diverse settings. The social organization of PWID include values that foster needle-syringe sharing. Utilization and impact of risk reduction programmes might be improved with expanded clean needle/syringe distribution at times and venues convenient for PWID, better trained and non-judgmental staff, and medical assistance for health problems, including drug withdrawal symptoms.

The evening versus morning polypill utilization study: the TEMPUS rationale and design.

PubMed

Lafeber, Melvin; Grobbee, Diederick E; Bots, Michiel L; Thom, Simon; Webster, Ruth; Rodgers, Anthony; Visseren, Frank L J; Spiering, Wilko

2014-04-01

In clinical practice, blood pressure (BP)-lowering agents are generally prescribed for use in the morning, whereas (short-acting) statins are recommended for use in the evening. There is evidence that the reduction in LDL cholesterol (LDL-c) achieved with short-acting statins is superior when taken in the evening and reported improvement in BP control when aspirin and BP-lowering agents are taken in the evening. However, it is unclear whether the additional reduction in LDL-c and BP is offset by a reduction in adherence, given that taking medication in the evening may be less typical or convenient. There is therefore uncertainty concerning the best timing of administration of a cardiovascular combination pill such as the polypill. The aim of TEMPUS (NCT01506505), a prospective randomized open blinded endpoint (PROBE) crossover trial, is to evaluate whether there is a difference in LDL-c levels or 24-hour ambulatory BP in individuals at increased risk of cardiovascular disease when the cardiovascular polypill is taken in the evening compared to the morning. An additional aim is to assess the effect of the polypill on LDL-c and BP compared to the administration of separate pills of identically dosed components of the polypill. In total 75 participants with established cardiovascular disease or an intermediate to high risk for cardiovascular disease are randomly allocated to the sequence of three different treatments of 6-8 weeks: (1) the cardiovascular polypill (aspirin 75 mg, simvastatin 40 mg, lisinopril 10 mg, and hydrochlorothiazide 12.5 mg) in the evening; (2) the polypill in the morning; and (3) the use of the identically dosed agents in separate pills taken at different time points during the day. The primary endpoint is the difference in LDL-c and mean 24-hour ambulatory systolic BP. Secondary outcomes are the difference in relative risk reduction, biochemistry, platelet function and pulse wave analysis, participants' adherence, and acceptability. TEMPUS will evaluate the effect of timing of the administration of a cardiovascular polypill on LDL-c and BP measurements in patients with an intermediate or high risk for cardiovascular disease.

76 FR 40320 - Risk Reduction Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-08

... identifying and analyzing applicable hazards and (2) develops plans to mitigate that risk. Each RRP is...-2009-0038] RIN 2130-AC11 Risk Reduction Program AGENCY: Federal Railroad Administration (FRA... certain railroads to develop a Risk Reduction Program (RRP). The Rail Safety Improvement Act of 2008...

Navigating complexity through knowledge coproduction: Mainstreaming ecosystem services into disaster risk reduction.

PubMed

Reyers, Belinda; Nel, Jeanne L; O'Farrell, Patrick J; Sitas, Nadia; Nel, Deon C

2015-06-16

Achieving the policy and practice shifts needed to secure ecosystem services is hampered by the inherent complexities of ecosystem services and their management. Methods for the participatory production and exchange of knowledge offer an avenue to navigate this complexity together with the beneficiaries and managers of ecosystem services. We develop and apply a knowledge coproduction approach based on social-ecological systems research and assess its utility in generating shared knowledge and action for ecosystem services. The approach was piloted in South Africa across four case studies aimed at reducing the risk of disasters associated with floods, wildfires, storm waves, and droughts. Different configurations of stakeholders (knowledge brokers, assessment teams, implementers, and bridging agents) were involved in collaboratively designing each study, generating and exchanging knowledge, and planning for implementation. The approach proved useful in the development of shared knowledge on the sizable contribution of ecosystem services to disaster risk reduction. This knowledge was used by stakeholders to design and implement several actions to enhance ecosystem services, including new investments in ecosystem restoration, institutional changes in the private and public sector, and innovative partnerships of science, practice, and policy. By bringing together multiple disciplines, sectors, and stakeholders to jointly produce the knowledge needed to understand and manage a complex system, knowledge coproduction approaches offer an effective avenue for the improved integration of ecosystem services into decision making.

Navigating complexity through knowledge coproduction: Mainstreaming ecosystem services into disaster risk reduction

PubMed Central

Reyers, Belinda; Nel, Jeanne L.; O’Farrell, Patrick J.; Sitas, Nadia; Nel, Deon C.

2015-01-01

Achieving the policy and practice shifts needed to secure ecosystem services is hampered by the inherent complexities of ecosystem services and their management. Methods for the participatory production and exchange of knowledge offer an avenue to navigate this complexity together with the beneficiaries and managers of ecosystem services. We develop and apply a knowledge coproduction approach based on social–ecological systems research and assess its utility in generating shared knowledge and action for ecosystem services. The approach was piloted in South Africa across four case studies aimed at reducing the risk of disasters associated with floods, wildfires, storm waves, and droughts. Different configurations of stakeholders (knowledge brokers, assessment teams, implementers, and bridging agents) were involved in collaboratively designing each study, generating and exchanging knowledge, and planning for implementation. The approach proved useful in the development of shared knowledge on the sizable contribution of ecosystem services to disaster risk reduction. This knowledge was used by stakeholders to design and implement several actions to enhance ecosystem services, including new investments in ecosystem restoration, institutional changes in the private and public sector, and innovative partnerships of science, practice, and policy. By bringing together multiple disciplines, sectors, and stakeholders to jointly produce the knowledge needed to understand and manage a complex system, knowledge coproduction approaches offer an effective avenue for the improved integration of ecosystem services into decision making. PMID:26082541

Evaluation of 4-poster acaricide applicators to manage tick populations associated with disease risk in a Tennessee retirement community.

PubMed

Harmon, Jessica R; Hickling, Graham J; Scott, M Cathy; Jones, Carl J

2011-12-01

In 1993, four residents of a retirement community in middle Tennessee were hospitalized with symptoms of ehrlichiosis causing community managers to implement mitigation methods to reduce tick numbers. For the past four years, managers have utilized 4-poster acaricide applicators that aim to reduce disease risk to residents by killing ticks that feed on deer. To determine the efficacy of this technique, we assessed Amblyomma americanum abundance in the vicinity of the devices by dragging 400 m vegetation transects once per month while ticks were active. In 2009, adult tick activity peaked in May, nymphal tick activity peaked in June, and larval activity peaked in September. Close to 4-poster devices, larval, nymphal, and adult tick abundances were reduced by 91%, 68%, and 49%, respectively (larval and nymphal p<0.001, adult p=0.005), relative to nearby untreated areas. No significant reduction in nymphal or adult A. americanum ticks was evident >300 m from 4-poster devices, however a ∼90% reduction in larvae was observed to our sampling limit (400 m). At the low density at which these devices are currently being used (average distance between devices = 6.6 km), we conclude that they will have little large-scale effect on the health risk posed by ticks in this community. © 2011 The Society for Vector Ecology.

Practice Innovation, Health Care Utilization and Costs in a Network of Federally Qualified Health Centers and Hospitals for Medicaid Enrollees.

PubMed

Johnson, Tricia J; Jones, Art; Lulias, Cheryl; Perry, Anthony

2018-06-01

State Medicaid programs need cost-effective strategies to provide high-quality care that is accessible to individuals with low incomes and limited resources. Integrated delivery systems have been formed to provide care across the continuum, but creating a shared vision for improving community health can be challenging. Medical Home Network was created as a network of primary care providers and hospital systems providing care to Medicaid enrollees, guided by the principles of egalitarian governance, practice-level care coordination, real-time electronic alerts, and pay-for-performance incentives. This analysis of health care utilization and costs included 1,189,195 Medicaid enrollees. After implementation of Medical Home Network, a risk-adjusted increase of $9.07 or 4.3% per member per month was found over the 2 years of implementation compared with an increase of $17.25 or 9.3% per member per month, before accounting for the cost of care management fees and other financial incentives, for Medicaid enrollees within the same geographic area with a primary care provider outside of Medical Home Network. After accounting for care coordination fees paid to providers, the net risk-adjusted cost reduction was $11.0 million.

Enhancing empowerment in eating disorder prevention: Another examination of the REbeL peer education model.

PubMed

Breithaupt, Lauren; Eickman, Laura; Byrne, Catherine E; Fischer, Sarah

2017-04-01

Previously validated eating disorder (ED) prevention programs utilize either a targeted or universal approach. While both approaches have shown to be efficacious, implementing either style of program within a school setting remains a challenge. The current study describes an enhanced version of REbeL, a module based, continuous ED prevention program which utilizes a self-selection model of prevention in high school settings. The purpose of this study was to determine if an enhanced empowerment model of REbeL could increase feelings of empowerment and reduce eating disorder risk. We also aimed to assess the feasibility and acceptability of the intervention. High school peer-educators self-selected into the semi-manualized dissonance based intervention. Following feedback from a pilot trailed, enhanced peer-led group activities, designed to critique the thin ideal and designed to empower macro-changes in societal structures that emphasize the thin ideal, were added. The study (N=83) indicates that the program appears to be effective at reducing eating disorder risk factors and increasing empowerment. Participants reported reductions in body checking and internalization of the thin ideal. Copyright © 2016 Elsevier Ltd. All rights reserved.

Innovative techniques for the production of energetic radicals for lunar processing including cold plasma processing of local planetary ores

NASA Technical Reports Server (NTRS)

Bullard, D.; Lynch, D. C.

1992-01-01

Hydrogen reduction of ilmenite has been studied by a number of investigators as a potential means for recovery of oxygen from lunar soil. Interest in this process has always rested with the simplicity of the flow diagram and the utilization of established technology. Effective utilization of hydrogen in the reduction process at temperatures of 1200 C and below has always been disappointing and, as such, has led other investigators to focus attention on other systems. Effective utilization of hydrogen in the reduction of ilmenite can be significantly enhanced in the presence of a non-equilibrium hydrogen plasma. Ilmenite at solid specimen temperatures of 600 C to 970 C were reacted in a hydrogen plasma. Those experiments revealed that hydrogen utilization can be significantly enhanced. At a specimen temperature of 850 C the fraction of H2 reacted was 24 percent compared to the 7 percent theoretical limit calculated with thermodynamic theory for the same temperature. An added advantage for a hydrogen plasma involves further reduction of TiO2. Reduction of the iron oxide in ilmenite yields TiO2 and metallic iron as by products. Titanium forms a number of oxides including TiO, Ti2O3, Ti3O5 and the Magneli oxides (Ti4O7 to Ti50O99). In conventional processing of ilmenite with hydrogen it is possible to reduce TiO2 to Ti7O13 within approximately an hour, but with poor utilization of hydrogen on the order of one mole of H2 per thousand. In the cold or non-equilibrium plasma TiO2 can be rapidly reduced to Ti2O3 with hydrogen utilization exceeding 10 percent. Based on design considerations of the plasma reactor greater utilization of the hydrogen in the reduction of TiO2 is possible.

HIV and injecting drug use in Indonesia: epidemiology and national response.

PubMed

Afriandi, Irvan; Aditama, Tjandra Yoga; Mustikawati, Dyah; Oktavia, Martiani; Alisjahbana, Bachti; Riono, Pandu

2009-07-01

Indonesia is facing one of the most rapidly growing HIV-epidemics in Asia. Risk behaviour associated with injecting drug use, such as sharing contaminated needles, is the main risk factor for HIV infection. Among the general population the prevalence of HIV-infection is still low (0.2%), but up to 50% or more of the estimated 145.000 - 170.000 injecting drug users are already HIV-positive. Overrepresentation of injecting drug users and continued risk behavior inside Indonesian prisons contribute to spread of HIV. Through sexual contacts, HIV is transmitted from current or previous injecting drug users to their non-injecting sexual partners; 10-20% of this group may already be infected. The national response targeted to limit spread of HIV through injecting drug use has included needle and syringe program (NSP), methadone maintenance treatment (MMT), voluntary counseling and testing (VCT), and outreach program as priority programs. However coverage and utilization of the harm reduction services is still limited, but effective integration with HIV testing and treatment is expanding. By 2008, there were 110 service points for NSP and 24 operational MMT clinics. Nevertheless, utilization of these services has been less satisfactory and their effectiveness has been questioned. Besides effective prevention, HIV- testing and earlier treatment of HIV-seropositve individuals, including those with a history of injecting drug use, will help control the growing HIV-epidemic in Indonesia.

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

PubMed

Li, Pei-Chiun; Ma, Hwong-Wen

2016-01-25

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

Costs and Resource Utilization Among Medicaid Patients with Schizophrenia Treated with Paliperidone Palmitate or Oral Atypical Antipsychotics.

PubMed

Pesa, Jacqueline A; Muser, Erik; Montejano, Leslie B; Smith, David M; Meyers, Oren I

Non-adherence to antipsychotic therapy among patients with schizophrenia is a key driver of relapse, which can lead to costly inpatient stays. Long-acting injectables (LAIs) may improve adherence, thus reducing hospitalizations, but inpatient cost reductions need to be balanced against higher drug acquisition costs of LAIs. Real-world evidence is needed to help quantify the economic value of oral atypical antipsychotics compared with LAIs. The objective of this study was to compare healthcare costs and resource utilization between once-monthly paliperidone palmitate (PP) and oral antipsychotic therapy (OAT) in a population of Medicaid beneficiaries with schizophrenia. A retrospective, observational study was performed using Truven Health MarketScan Medicaid claims data from 2009 to 2012. Marginal structural modeling, a form of weighted repeated measures analysis to control for differences between cohorts and time-varying confounding, was used to estimate monthly costs of care in 2012 US dollars and resource utilization over a 12-month period for patients in each cohort. While per-month mental-health prescription costs were US$1019 higher in the PP cohort, approximately 55 % of this premium was offset by lower inpatient and outpatient care costs, producing a mean monthly total cost differential of US$434 (95 % CI 298-569, p  < 0.0001) for all-cause costs and US$463 (95 % CI 374-552, p  < 0.0001) for mental-health-related costs. Use of PP also resulted in a 0.44 and 0.47 reduction in the odds of all-cause and mental-health-related hospitalizations and a 0.09 reduction in the odds of all-cause emergency department visits ( p  < 0.0001, p  < 0.0001, and p  = 0.0134, respectively) over the 12-month follow-up period. Treatment with long-acting injectable antipsychotics, such as PP, may reduce inpatient and outpatient healthcare services utilization and associated costs. These findings also suggest that patients with schizophrenia taking once-monthly PP may stand a lower risk of hospitalization than patients on OAT.

Measuring utilities of severe facial disfigurement and composite tissue allotransplantation of the face in patients with severe face and neck burns from the perspectives of the general public, medical experts and patients.

PubMed

Chuback, Jennifer; Yarascavitch, Blake; Yarascavitch, Alec; Kaur, Manraj Nirmal; Martin, Stuart; Thoma, Achilleas

2015-11-01

In an otherwise healthy patient with severe facial disfigurement secondary to burns, composite tissue allotransplantation (CTA) results in life-long immunosuppressive therapy and its associated risk. In this study, we assess the net gain of CTA of face (in terms of utilities) from the perspectives of patient, general public and medical expert, in comparison to the risks. Using the standard gamble (SG) and time-trade off (TTO) techniques, utilities were obtained from members of general public, patients with facial burns, and medical experts (n=25 for each group). The gain (or loss) in utility and quality adjusted life years (QALY) were estimated using face-to-face interviews. A sensitivity analysis using variable life expectancy was conducted. From the patient perspective, severe facial burn was associated with a health utility value of 0.53, and 27.1 QALYs as calculated by SG, and a health utility value of 0.57, and 28.9 QALYs as calculated by TTO. In comparison, CTA of the face was associated with a health utility value of 0.64, and 32.3 QALYs (or 18.2 QALYs years per sensitivity analysis) as calculated by SG, and a health utility value of 0.67, and 34.1 QALYs (or 19.2QALYs per sensitivity analysis) as calculated by TTO. However, a loss of 8.9 QALYs (by SG method) to 9.5 QALYs (by TTO method) was observed when the life expectancy was decreased in the sensitivity analysis. Similar results were obtained from the general population and medical experts perspectives. We found that severe facial disfigurement is associated with a significant reduction in the health-related quality of life, and CTA has the potential to improve this. Further, we found that a trade-off exists between the life expectancy and gain in the QALYs, i.e. if life expectancy following CTA of face is reduced, the gain in QALY is also diminished. This trade-off needs to be validated in future studies. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Probabilistic Risk Assessment for Astronaut Post Flight Bone Fracture

NASA Technical Reports Server (NTRS)

Lewandowski, Beth; Myers, Jerry; Licata, Angelo

2015-01-01

Introduction: Space flight potentially reduces the loading that bone can resist before fracture. This reduction in bone integrity may result from a combination of factors, the most common reported as reduction in astronaut BMD. Although evaluating the condition of bones continues to be a critical aspect of understanding space flight fracture risk, defining the loading regime, whether on earth, in microgravity, or in reduced gravity on a planetary surface, remains a significant component of estimating the fracture risks to astronauts. This presentation summarizes the concepts, development, and application of NASA's Bone Fracture Risk Module (BFxRM) to understanding pre-, post, and in mission astronaut bone fracture risk. The overview includes an assessment of contributing factors utilized in the BFxRM and illustrates how new information, such as biomechanics of space suit design or better understanding of post flight activities may influence astronaut fracture risk. Opportunities for the bone mineral research community to contribute to future model development are also discussed. Methods: To investigate the conditions in which spaceflight induced changes to bone plays a critical role in post-flight fracture probability, we implement a modified version of the NASA Bone Fracture Risk Model (BFxRM). Modifications included incorporation of variations in physiological characteristics, post-flight recovery rate, and variations in lateral fall conditions within the probabilistic simulation parameter space. The modeled fracture probability estimates for different loading scenarios at preflight and at 0 and 365 days post-flight time periods are compared. Results: For simple lateral side falls, mean post-flight fracture probability is elevated over mean preflight fracture probability due to spaceflight induced BMD loss and is not fully recovered at 365 days post-flight. In the case of more energetic falls, such as from elevated heights or with the addition of lateral movement, the contribution of space flight quality changes is much less clear, indicating more granular assessments, such as Finite Element modeling, may be needed to further assess the risks in these scenarios.

A Pilot RCT of an Internet Intervention to Reduce the Risk of Alcohol-Exposed Pregnancy.

PubMed

Ingersoll, Karen; Frederick, Christina; MacDonnell, Kirsten; Ritterband, Lee; Lord, Holly; Jones, Brogan; Truwit, Lauren

2018-06-01

Preventing alcohol-exposed pregnancies (AEPs) could reduce the incidence of fetal alcohol spectrum disorders. Previous face-to-face interventions significantly reduced risk for AEP, but a scalable intervention is needed to reach more women at risk. This study compared a 6 Core automated, interactive, and tailored Internet intervention, the Contraception and Alcohol Risk Reduction Internet Intervention (CARRII), to a static patient education (PE) website for its effect on AEP risk. Participants were recruited online to a pilot randomized clinical trial (RCT) with baseline, 9 weeks posttreatment, and 6-month (6-M) follow-up assessments. Seventy-one women completed online questionnaires and telephone interviews and were randomized to CARRII (n = 36) or PE (n = 35). Primary outcomes were rates of risky drinking, unprotected sex episodes, and AEP risk, collected from online prospective diaries. CARRII participants showed significant reductions in rate of unprotected sex from pretreatment (88.9%) to posttreatment (70.6%) (p < 0.04) and to 6-M follow-up (51.5%) (p = 0.001); rate of risky drinking from pretreatment (75.0%) to posttreatment (50.0%) (p < 0.02), but insignificant change from pretreatment to 6-M follow-up (57.6%) (p < 0.09); and rate of AEP risk from pretreatment (66.7%) to posttreatment (32.4%) (p = 0.001) and to 6-M follow-up (30.3%) (p = 0.005). PE participants demonstrated no significant changes on all 3 variables across all time points. Intent-to-treat group-by-time tests were not significant, but power was limited by missing diaries. Over 72% of CARRII participants completed all 6 Cores. Exploratory analyses suggest that higher program utilization is related to change. These data show that CARRII was acceptable, feasible, promising to reduce AEP risk, and merits further testing in a fully powered RCT. Copyright © 2018 by the Research Society on Alcoholism.

Valuing Drinking Water Risk Reductions Using the Contingent Valuation Method: A Methodological Study of Risks from THM and Giardia (1986)

EPA Pesticide Factsheets

This study develops contingent valuation methods for measuring the benefits of mortality and morbidity drinking water risk reductions. The major effort was devoted to developing and testing a survey instrument to value low-level risk reductions.

Space Launch System NASA Research Announcement Advanced Booster Engineering Demonstration and/or Risk Reduction

NASA Technical Reports Server (NTRS)

Crumbly, Christopher M.; Craig, Kellie D.

2011-01-01

The intent of the Advanced Booster Engineering Demonstration and/or Risk Reduction (ABEDRR) effort is to: (1) Reduce risks leading to an affordable Advanced Booster that meets the evolved capabilities of SLS (2) Enable competition by mitigating targeted Advanced Booster risks to enhance SLS affordability. Key Concepts (1) Offerors must propose an Advanced Booster concept that meets SLS Program requirements (2) Engineering Demonstration and/or Risk Reduction must relate to the Offeror s Advanced Booster concept (3) NASA Research Announcement (NRA) will not be prescriptive in defining Engineering Demonstration and/or Risk Reduction

e-Care for heart wellness: a feasibility trial to decrease blood pressure and cardiovascular risk.

PubMed

Green, Beverly B; Anderson, Melissa L; Cook, Andrea J; Catz, Sheryl; Fishman, Paul A; McClure, Jennifer B; Reid, Robert J

2014-04-01

Pharmacist- or nurse-led team care decreases patient blood pressure (BP) and cardiovascular disease (CVD) risk. To evaluate whether a Web-based dietitian-led (WD) team care intervention was feasible and resulted in decreased BP, CVD risk, and weight compared to usual care (UC). Electronic health record (EHR) data identified patients aged 30-69 years with BMI >26, elevated BP, and 10%-25% 10-year Framingham CVD risk who were registered patient website users. Patients with uncontrolled BP at screening were randomized to UC or WD, which included a home BP monitor, scale, and dietitian team care. WD participants had a single in-person dietitian visit to obtain baseline information and create a plan to reduce CVD risk. Planned follow-up occurred via secure messaging to report BP, weight, and fruit and vegetable intake and receive ongoing feedback. If needed, dietitians encouraged patients and their physicians to intensify antihypertensive and lipid-lowering medications. Primary outcomes were change in systolic BP and weight loss ≥4 kg at 6 months. Feasibility outcomes included intervention utilization and satisfaction. Between 2010 and 2011, a total of 90 of 101 participants completed 6-month follow-ups. The WD group had higher rates of secure messaging utilization and patient satisfaction. The WD group lost significantly more weight than the UC group (adjusted net difference=-3.2 kg, 95% CI=-5.0, -1.5, p<0.001) and was more likely to lose ≥4 kg (adjusted relative risk [RRadj]=2.96, 95% CI=1.16, 7.53). BP control and CVD risk reduction were greater in WD than UC, but differences were not statistically significant. WD intervention was feasible and resulted in decreased weight, BP, and CVD risk. A larger trial is justified. Trial Registration Number: NCT01077388. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Reducing the costs of meeting regional water demand through risk-based transfer agreements.

PubMed

Palmer, Reed N; Characklis, Gregory W

2009-04-01

Transfers of treated water among inter-connected utilities is becoming more common as the cost of developing new supplies grows, and transfer agreements require well developed rules describing when and how much water will be transferred. The nature of the decision rules governing an agreement must also be coordinated with respect to the treatment and conveyance capacity required to execute the transfers. This study explores different combinations of infrastructure and agreement type that define three different transfer programs, describing the frequency and volume of transfers associated with each, as well as their costs. The agreements are described in terms of the type of decision rule employed: Take-or-Pay, where the timing and quantity of transfers is fixed; Days of Supply Remaining (DSR), which uses a static hydrologic indicator to trigger transfers; and Risk-of-Failure, a probability-based decision rule that involves consideration of both supply and demand. This analysis is conducted within the context of the Research Triangle area of North Carolina (USA), a rapidly growing area that is beginning to approach the practical limits of water resource development. The Risk-of-Failure agreement is shown to reduce the average volume of transfers by over 80% compared to a Take-or-Pay agreement and by roughly half relative to the DSR agreement, leading to significant cost reductions. A utility's willingness to accept something less than guaranteed access to a specified quantity of water (i.e. an interruption) also has a significant impact on cost. Interruptions do not necessarily lead to lower reliability, but rather to the purchasing utility acquiring more water during off-peak periods when the seller has excess treatment capacity available. The lowest cost guaranteed agreement is 40-50% more expensive than the lowest cost interruptible contract.

Benefit-cost estimation for alternative drinking water maximum contaminant levels

NASA Astrophysics Data System (ADS)

Gurian, Patrick L.; Small, Mitchell J.; Lockwood, John R.; Schervish, Mark J.

2001-08-01

A simulation model for estimating compliance behavior and resulting costs at U.S. Community Water Suppliers is developed and applied to the evaluation of a more stringent maximum contaminant level (MCL) for arsenic. Probability distributions of source water arsenic concentrations are simulated using a statistical model conditioned on system location (state) and source water type (surface water or groundwater). This model is fit to two recent national surveys of source waters, then applied with the model explanatory variables for the population of U.S. Community Water Suppliers. Existing treatment types and arsenic removal efficiencies are also simulated. Utilities with finished water arsenic concentrations above the proposed MCL are assumed to select the least cost option compatible with their existing treatment from among 21 available compliance strategies and processes for meeting the standard. Estimated costs and arsenic exposure reductions at individual suppliers are aggregated to estimate the national compliance cost, arsenic exposure reduction, and resulting bladder cancer risk reduction. Uncertainties in the estimates are characterized based on uncertainties in the occurrence model parameters, existing treatment types, treatment removal efficiencies, costs, and the bladder cancer dose-response function for arsenic.

The VIDA Framework as an Education Tool: Leveraging Volcanology Data for Educational Purposes

NASA Astrophysics Data System (ADS)

Faied, D.; Sanchez, A.

2009-04-01

The VIDA Framework as an Education Tool: Leveraging Volcanology Data for Educational Purposes Dohy Faied, Aurora Sanchez (on behalf of SSP08 VAPOR Project Team) While numerous global initiatives exist to address the potential hazards posed by volcanic eruption events and assess impacts from a civil security viewpoint, there does not yet exist a single, unified, international system of early warning and hazard tracking for eruptions. Numerous gaps exist in the risk reduction cycle, from data collection, to data processing, and finally dissemination of salient information to relevant parties. As part of the 2008 International Space University's Space Studies Program, a detailed gap analysis of the state of volcano disaster risk reduction was undertaken, and this paper presents the principal results. This gap analysis considered current sensor technologies, data processing algorithms, and utilization of data products by various international organizations. Recommendations for strategies to minimize or eliminate certain gaps are also provided. In the effort to address the gaps, a framework evolved at system level. This framework, known as VIDA, is a tool to develop user requirements for civil security in hazardous contexts, and a candidate system concept for a detailed design phase. While the basic intention of VIDA is to support disaster risk reduction efforts, there are several methods of leveraging raw science data to support education across a wide demographic. Basic geophysical data could be used to educate school children about the characteristics of volcanoes, satellite mappings could support informed growth and development of societies in at-risk areas, and raw sensor data could contribute to a wide range of university-level research projects. Satellite maps, basic geophysical data, and raw sensor data are combined and accessible in a way that allows the relationships between these data types to be explored and used in a training environment. Such a resource naturally lends itself to research efforts in the subject but also research in operational tools, system architecture, and human/machine interaction in civil protection or emergency scenarios.

Reducing Contingency through Sampling at the Luckey FUSRAP Site - 13186

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

Frothingham, David; Barker, Michelle; Buechi, Steve

2013-07-01

Typically, the greatest risk in developing accurate cost estimates for the remediation of hazardous, toxic, and radioactive waste sites is the uncertainty in the estimated volume of contaminated media requiring remediation. Efforts to address this risk in the remediation cost estimate can result in large cost contingencies that are often considered unacceptable when budgeting for site cleanups. Such was the case for the Luckey Formerly Utilized Sites Remedial Action Program (FUSRAP) site near Luckey, Ohio, which had significant uncertainty surrounding the estimated volume of site soils contaminated with radium, uranium, thorium, beryllium, and lead. Funding provided by the American Recoverymore » and Reinvestment Act (ARRA) allowed the U.S. Army Corps of Engineers (USACE) to conduct additional environmental sampling and analysis at the Luckey Site between November 2009 and April 2010, with the objective to further delineate the horizontal and vertical extent of contaminated soils in order to reduce the uncertainty in the soil volume estimate. Investigative work included radiological, geophysical, and topographic field surveys, subsurface borings, and soil sampling. Results from the investigative sampling were used in conjunction with Argonne National Laboratory's Bayesian Approaches for Adaptive Spatial Sampling (BAASS) software to update the contaminated soil volume estimate for the site. This updated volume estimate was then used to update the project cost-to-complete estimate using the USACE Cost and Schedule Risk Analysis process, which develops cost contingencies based on project risks. An investment of $1.1 M of ARRA funds for additional investigative work resulted in a reduction of 135,000 in-situ cubic meters (177,000 in-situ cubic yards) in the estimated base volume estimate. This refinement of the estimated soil volume resulted in a $64.3 M reduction in the estimated project cost-to-complete, through a reduction in the uncertainty in the contaminated soil volume estimate and the associated contingency costs. (authors)« less

Traditional Chinese medicine as adjunctive therapy improves the long-term survival of lung cancer patients.

PubMed

Liao, Yueh-Hsiang; Li, Chia-Ing; Lin, Cheng-Chieh; Lin, Jaung-Geng; Chiang, Jen-Huai; Li, Tsai-Chung

2017-12-01

Traditional Chinese medicine is one of the popular alternative treatments for cancer, mainly enhancing host immune response and reducing adverse effect of chemotherapy. This study first explored traditional Chinese medicine treatment effect on long-term survival of lung cancer patients. This study evaluated whether traditional Chinese medicine combined with conventional cancer treatment improved overall survival of lung cancer patients. We had conducted a retrospective cohort study on 111,564 newly diagnosed lung cancer patients in 2000-2009 from National Health Insurance Program database. A total of 23,803 (21.31%) patients used traditional Chinese medicine for lung cancer care. Eligible participants were followed up until 2011 with a mean follow-up period of 1.96 years (standard deviation 2.55) for non-TCM users and 3.04 years (2.85) for traditional Chinese medicine users. Patients with traditional Chinese medicine utilization were significantly more likely to have a 32% decreased risk of death [hazard ratio = 0.62; 95% confidence interval = 0.61-0.63], compared with patients without traditional Chinese medicine utilization after multivariate adjustment. We also observed a similar significant reduction risk across various subgroups of chronic lung diseases. Qing Zao Jiu Fei Tang was the most effective traditional Chinese medicine agent for mortality reduction both in the entire lung cancer (0.81; 0.72-0.91) and matched populations (0.86; 0.78-0.95). This study demonstrated adjunctive therapy with traditional Chinese medicine may improve overall survival of lung cancer patients. This study also suggested traditional Chinese medicine may be used as an adjunctive therapy for cancer treatment. These observational findings need being validated by future randomized controlled trials to rule out the possibility of effect due to holistic care.

Conditional Economic Incentives for Reducing HIV Risk Behaviors: Integration of Psychology and Behavioral Economics

PubMed Central

Operario, Don; Kuo, Caroline C.; Sosa-Rubí, Sandra G.; Gálarraga, Omar

2014-01-01

Objective This paper reviews psychology and behavioral economic approaches to HIV prevention, and examines the integration and application of these approaches in conditional economic incentive (CEI) programs for reducing HIV risk behavior. Methods We discuss the history of HIV prevention approaches, highlighting the important insights and limitations of psychological theories. We provide an overview of the theoretical tenets of behavioral economics that are relevant to HIV prevention, and utilize CEIs as an illustrative example of how traditional psychological theories end behavioral economics can be combined into new approaches for HIV prevention. Results Behavioral economic interventions can complement psychological frameworks for reducing HIV risk by introducing unique theoretical understandings about the conditions under which risky decisions are amenable to intervention. Findings from illustrative CEI programs show mixed but generally promising effects of economic interventions on HIV and STI prevalence, HIV testing, HIV medication adherence, and drug use. Conclusion CEI programs can complement psychological interventions for HIV prevention and behavioral risk reduction. To maximize program effectiveness, CEI programs must be designed according to contextual and population-specific factors that may determine intervention applicability and success. PMID:24001243

Proposing a Universal Framework for Resilience: Optimizing Risk and Combating Human Vulnerabilities

NASA Astrophysics Data System (ADS)

Sarkar, Arunima

2017-04-01

In the recent years we have seen a massive impact of loss created to urban settlements and critical infrastructure as a result of disasters. The disaster risk associates itself vulnerabilities and many complexities which can disrupt the functioning of human society. The uncertain loss created by disasters can present unforeseeable risk which remain unaccounted to human understanding. It is imperative to note that human urbanization and development is correlated with human vulnerabilities and challenges posed by disasters. Disaster risks are aggravated by improper planning of cities, weak framework for urban governance and regulatory regimes and lack of equalities amongst the citizens. The international agenda on disaster risk reduction talks about increasing losses due to disasters associated with development and urbanization. The United Nations announced that the year 1990 was the International Decade for Natural Disaster Reduction. In relation to this, the "Yokohama Strategy and Plan of Action" was adopted at the first United Nations World Conference on Disaster Reduction. The United Nations Educational, Scientific and Cultural Organization's (UNESCO) Intergovernmental Oceanic Commission coordinated the World Conference on Disaster Reduction in 2005 where the Hyogo Framework for Action was adopted. The Hyogo Framework for Action: Building the resilience of communities to disaster was adopted by 168 nations after the massive loss caused by Indian ocean tsunami in 2005. The Hyogo Framework proposes to focus on implementation of risk and reliability system to shield disasters, proposes global scientific and community platform for disaster prevention and mitigation etc. The early warning system and its importance as an effective tool for reduction of human vulnerabilities for disaster management was majorly emphasized. It is imperative to highlight that resilience framework is important in order to minimize cost of disruption caused to critical infrastructure and to strengthen and optimize the decision making skill and platform for a better sustainable society. The resilience framework provides a cross-sector and multi-level analysis to tackle the vulnerabilities which can be caused to essential utilities like power, water, transport and various machineries that are essential for human sustainability. The direction of resilience framework focuses on prevention of damage and disruption of disaster, mitigate the loss caused to human society and provide the best response for disaster resilience. Thus, the basic pillars which are important for the implementation of resilience is proper governance framework and transparency which takes into account various cost and risk analysis. Thus a common and universal framework for resilience is the main requirement for mass accessibility. The aim of resilience framework focuses on universal adaptability, coherence and validation. A mixed method analysis has been undertaken in this research paper which focuses on the following issues: • Legal, Institutional and community framework for integrating resilience framework of global north and global south. • Spatial as well as statistical analysis to structuralize disaster risk and resilient framework for disaster management. • Early warning system and emergency response in a comparative scale to analyse the various models of risk and resilience framework implemented in USA, China, Nepal and India for proposing an integrated resilience strategy.

Beyond Criminalization: Toward a Criminologically Informed Framework for Mental Health Policy and Services Research

PubMed Central

Silver, Eric; Wolff, Nancy

2010-01-01

The problems posed by persons with mental illness involved with the criminal justice system are vexing ones that have received attention at the local, state and national levels. The conceptual model currently guiding research and social action around these problems is shaped by the “criminalization” perspective and the associated belief that reconnecting individuals with mental health services will by itself reduce risk for arrest. This paper argues that such efforts are necessary but possibly not sufficient to achieve that reduction. Arguing for the need to develop a services research framework that identifies a broader range of risk factors for arrest, we describe three potentially useful criminological frameworks—the “life course,” “local life circumstances” and “routine activities” perspectives. Their utility as platforms for research in a population of persons with mental illness is discussed and suggestions are provided with regard to how services research guided by these perspectives might inform the development of community-based services aimed at reducing risk of arrest. PMID:16791518

Improved Cardiovascular Risk among Hispanic Border Participants of the Mi Corazón Mi Comunidad Promotores De Salud Model: The HEART II Cohort Intervention Study 2009-2013.

PubMed

de Heer, Hendrik Dirk; Balcazar, Hector G; Wise, Sherrie; Redelfs, Alisha H; Rosenthal, E Lee; Duarte, Maria O

2015-01-01

Community resources (parks, recreational facilities) provide opportunities for health promotion, but little is known about how to promote utilization of these resources and their impact on cardiovascular disease risk (CVD). This cohort study evaluated the impact of an intervention called Mi Corazon Mi Comunidad (MiCMiC), which consisted of promoting use of community physical activity and nutrition resources by Promotoras de Salud/Community Health Workers. Participants were assessed at baseline and following the 4-month intervention. Attendance records were objectively collected to assess utilization of intervention programing. A total of five consecutive cohorts were recruited between 2009 and 2013. Participants were mostly females (86.0%), on average 46.6 years old, and 81% were low in acculturation. Participants who completed follow-up (n = 413) showed significant improvements in reported health behaviors and body composition. Higher attendance significantly predicted greater improvements. The baseline to 4-month change for the highest vs. the lowest attendance quartiles were for weight (-5.2 vs. +0.01 lbs, p < 0.001), waist circumference (-1.20 vs. -0.56 inches, p = 0.047), hip circumference (-1.13 vs. -0.41 inches, p < 0.001); hours of exercise/week (+3.87 vs. +0.81 hours, p < 0.001), proportion of participants eating five servings of fruits and vegetables/day (+54.7 vs. 14.7%, p < 0.001). Following the Promotora-led MiCMiC intervention, substantial improvements in health behaviors and modest improvements in cardiovascular risk factors were found. Greater utilization of community resources was associated with more favorable changes. This study provided preliminary evidence for the effectiveness of Promotora-led interventions for promoting use of existing community resources in CVD risk reduction.

40 CFR 73.20 - Phase II early reduction credits.

Code of Federal Regulations, 2013 CFR

2013-07-01

... utility, including generators that are not fossil fuel-fired) that has decreased its total coal-fired... reductions in sulfur dioxide emissions; and (2) A report listing all units in the utility system, each fossil... total electrical generation for calendar years 1980 and 1985 (including all generators, whether fossil...

40 CFR 73.20 - Phase II early reduction credits.

Code of Federal Regulations, 2011 CFR

2011-07-01

... utility, including generators that are not fossil fuel-fired) that has decreased its total coal-fired... reductions in sulfur dioxide emissions; and (2) A report listing all units in the utility system, each fossil... total electrical generation for calendar years 1980 and 1985 (including all generators, whether fossil...

40 CFR 73.20 - Phase II early reduction credits.

Code of Federal Regulations, 2010 CFR

2010-07-01

... utility, including generators that are not fossil fuel-fired) that has decreased its total coal-fired... reductions in sulfur dioxide emissions; and (2) A report listing all units in the utility system, each fossil... total electrical generation for calendar years 1980 and 1985 (including all generators, whether fossil...

40 CFR 73.20 - Phase II early reduction credits.

Code of Federal Regulations, 2014 CFR

2014-07-01

... utility, including generators that are not fossil fuel-fired) that has decreased its total coal-fired... reductions in sulfur dioxide emissions; and (2) A report listing all units in the utility system, each fossil... total electrical generation for calendar years 1980 and 1985 (including all generators, whether fossil...

24 CFR 990.185 - Utilities expense level: Incentives for energy conservation/rate reduction.

Code of Federal Regulations, 2012 CFR

2012-04-01

... the energy conservation measures and other direct costs related to the energy project under the... for energy conservation/rate reduction. 990.185 Section 990.185 Housing and Urban Development... Calculating Formula Expenses § 990.185 Utilities expense level: Incentives for energy conservation/rate...

24 CFR 990.185 - Utilities expense level: Incentives for energy conservation/rate reduction.

Code of Federal Regulations, 2013 CFR

2013-04-01

... the energy conservation measures and other direct costs related to the energy project under the... for energy conservation/rate reduction. 990.185 Section 990.185 Housing and Urban Development... Calculating Formula Expenses § 990.185 Utilities expense level: Incentives for energy conservation/rate...

24 CFR 990.185 - Utilities expense level: Incentives for energy conservation/rate reduction.

Code of Federal Regulations, 2014 CFR

2014-04-01

... the energy conservation measures and other direct costs related to the energy project under the... for energy conservation/rate reduction. 990.185 Section 990.185 Housing and Urban Development... Calculating Formula Expenses § 990.185 Utilities expense level: Incentives for energy conservation/rate...

40 CFR 73.20 - Phase II early reduction credits.

Code of Federal Regulations, 2012 CFR

2012-07-01

... utility, including generators that are not fossil fuel-fired) that has decreased its total coal-fired... quality of fuel being burned. (c) Initial certification of eligibility. The designated representative of a... reductions in sulfur dioxide emissions; and (2) A report listing all units in the utility system, each fossil...

The relationship between health risks and health and productivity costs among employees at Pepsi Bottling Group.

PubMed

Henke, Rachel M; Carls, Ginger S; Short, Meghan E; Pei, Xiaofei; Wang, Shaohung; Moley, Susan; Sullivan, Mark; Goetzel, Ron Z

2010-05-01

To evaluate relationships between modifiable health risks and costs and measure potential cost savings from risk reduction programs. Health risk information from active Pepsi Bottling Group employees who completed health risk assessments between 2004 and 2006 (N = 11,217) were linked to medical care, workers' compensation, and short-term disability cost data. Ten health risks were examined. Multivariate analyses were performed to estimate costs associated with having high risk, holding demographics, and other risks constant. Potential savings from risk reduction were estimated. High risk for weight, blood pressure, glucose, and cholesterol had the greatest impact on total costs. A one-percentage point annual reduction in the health risks assessed would yield annual per capita savings of $83.02 to $103.39. Targeted programs that address modifiable health risks are expected to produce substantial cost reductions in multiple benefit categories.

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

PubMed

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

2013-09-15

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

Allergic reactions to iodinated contrast media: premedication considerations for patients at risk.

PubMed

Schopp, Jennifer G; Iyer, Ramesh S; Wang, Carolyn L; Petscavage, Jonelle M; Paladin, Angelisa M; Bush, William H; Dighe, Manjiri K

2013-08-01

The objectives of this article are to review allergy-type reactions to iodinated contrast media and the protocols utilized to prevent or reduce the occurrence of these adverse reactions in high-risk patients. We will begin by discussing the types or classifications of the adverse reactions to iodinated contrast media. We will then discuss reaction mechanisms, identify the patients at highest risk for adverse reactions, and clarify common misperceptions about the risk. Finally, we will discuss the actions of the medications used to help reduce or prevent allergy-type reactions to iodinated contrast media, the protocols used to help reduce or prevent contrast reactions in high-risk patients, and the potential side effects of these medications. We will also discuss the high-risk patient who has received premedication due to a prior index reaction and discuss the risk of having a subsequent reaction, termed "breakthrough reaction." Identifying patient at high risk for an "allergy-type" reaction to contrast media is an essential task of the radiologist. Prevention of or reduction of the risk of an adverse reaction is critical to patient safety. If an examination can be performed without contrast in a patient at high risk for an allergy-type reaction, it may be appropriate to avoid contrast. However, there are situations where contrast media is necessary, and the radiologist plays a vital role in preventing or mitigating an allergy-type reaction.

POLLUTION PREVENTION RESEARCH ONGOING - EPA'S RISK REDUCTION ENGINEERING LABORATORY

EPA Science Inventory

The mission of the Risk Reduction Engineering Laboratory is to advance the understanding, development and application of engineering solutions for the prevention or reduction of risks from environmental contamination. This mission is accomplished through basic and applied researc...

Assessing the feasibility of harm reduction services for MSM: the late night breakfast buffet study

PubMed Central

Rose, Valerie J; Raymond, H Fisher; Kellogg, Timothy A; McFarland, Willi

2006-01-01

Background Despite the leveling off in new HIV infections among men who have sex with men (MSM) in San Francisco, new evidence suggests that many recent HIV infections are linked with the use of Methamphetamine (MA). Among anonymous HIV testers in San Francisco, HIV incidence among MA users was 6.3% compared to 2.1% among non-MA users. Of particular concern for prevention programs are frequent users and HIV positive men who use MA. These MSM pose a particular challenge to HIV prevention efforts due to the need to reach them during very late night hours. Methods The purpose of the Late Night Breakfast Buffet (LNBB) was to determine the feasibility and uptake of harm reduction services by a late night population of MSM. The "buffet" of services included: needle exchange, harm reduction information, oral HIV testing, and urine based sexually transmitted infection (STI) testing accompanied by counseling and consent procedures. The study had two components: harm reduction outreach and a behavioral survey. For 4 months during 2004, we provided van-based harm reduction services in three neighborhoods in San Francisco from 1 – 5 a.m. for anyone out late at night. We also administered a behavioral risk and service utilization survey among MSM. Results We exchanged 2000 needles in 233 needle exchange visits, distributed 4500 condoms/lubricants and provided 21 HIV tests and 12 STI tests. Fifty-five MSM enrolled in the study component. The study population of MSM was characterized by low levels of income and education whose ages ranged from 18 – 55. Seventy-eight percent used MA in the last 3 months; almost 25% used MA every day in the same time frame. Of the 65% who ever injected, 97% injected MA and 13% injected it several times a day. MA and alcohol were strong influences in the majority of unprotected sexual encounters among both HIV negative and HIV positive MSM. Conclusion We reached a disenfranchised population of MA-using MSM who are at risk for acquiring or transmitting HIV infection through multiple high risk behaviors, and we established the feasibility and acceptability of late night harm reduction for MSM and MSM who inject drugs. PMID:17018154

Economic Burden of Atopic Dermatitis in High-Risk Infants Receiving Cow's Milk or Partially Hydrolyzed 100% Whey-Based Formula.

PubMed

Bhanegaonkar, Abhijeet; Horodniceanu, Erica G; Ji, Xiang; Detzel, Patrick; Boguniewicz, Mark; Chamlin, Sarah; Lake, Alan; Czerkies, Laura A; Botteman, Marc F; Saavedra, José M

2015-05-01

To estimate the health and economic impact of feeding partially hydrolyzed formula-whey (PHF-W) instead of standard cow's milk formula (CMF) for the first 4 months of life among US infants at high risk for developing atopic dermatitis (AD). A Markov model was developed integrating published data, a survey of US pediatricians, costing sources and market data, and expert opinion. Key modeled outcomes included reduction in AD risk, time spent post AD diagnosis, days without AD flare, and AD-related costs. Costs and clinical consequences were discounted at 3% annually. An estimated absolute 14-percentage point reduction in AD risk was calculated with the use of PHF-W compared with CMF (95% CI for difference, 3%-22%). Relative to CMF, PHF-W decreased the time spent post-AD diagnosis by 8.3 months (95% CI, 2.78-13.31) per child and increased days without AD flare by 39 days (95% CI, 13-63) per child. The AD-related, 6-year total cost estimate was $495 less (95% CI, -$813 to -$157) per child with PHF-W ($724 per child; 95% CI, $385-$1269) compared with CMF ($1219 per child; 95% CI, $741-$1824). Utilization of PHF-W in place of CMF as the initial infant formula administered to high-risk US infants not exclusively breastfed during the first 4 months of life may reduce the incidence and economic burden of AD. Broad implementation of this strategy could result in a minimum savings of $355 million per year to society. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

A novel applicator design for intracavitary brachytherapy of the nasopharynx: Simulated reconstruction, image-guided adaptive brachytherapy planning, and dosimetry.

PubMed

Bacorro, Warren R; Agas, Ryan Anthony F; Cabrera, Stellar Marie R; Bojador, Maureen R; Sogono, Paolo G; Mejia, Michael Benedict A; Sy Ortin, Teresa T

2018-05-11

In nasopharyngeal cancer, brachytherapy is given as boost in primary treatment or as salvage for recurrent or persistent disease. The Rotterdam nasopharyngeal applicator (RNA) allows for suboptimal reduction of soft palate radiation dose, based on image-guided brachytherapy plans. Building on the RNA, we propose a novel design, the Benavides nasopharyngeal applicator (BNA). The virtual BNA was reconstructed on two cases (one T1, one T2) previously treated with intracavitary brachytherapy using the RNA. Dose was prescribed to the high-risk clinical target volumes (CTVs) and optimization was such that high-risk CTV D90 ≥ 100% of prescribed dose (PD), intermediate-risk-CTV D90 ≥ 75% PD, and soft palate D2cc ≤ 120% PD. The optimized RNA and BNA image-guided brachytherapy plans were compared in terms of CTV coverage and organs-at-risk sparing. Optimization objectives were more easily met with the BNA. For the T1 case, all three planning objectives were easily achieved in both the RNA and BNA, but with 18-19% lower soft palate doses with the BNA. For the T2 case, the CTV planning objectives were achieved in both the RNA and BNA, but the soft palate constraint was only achieved with the BNA, with 38-41% lower soft palate doses. Compared to the RNA, the BNA permits easier optimization and improves therapeutic ratio by a significant reduction of soft palate doses, based on simulation using a proposed system for CTV/organs-at-risk delineation, prescription, and optimization for image-guided adaptive brachytherapy. Clinical piloting using a prototype is necessary to evaluate its feasibility and utility. Copyright © 2018 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

School-based primary NCD risk reduction: education and public health perspectives.

PubMed

Bay, Jacquie L; Hipkins, Rosemary; Siddiqi, Kamran; Huque, Rumana; Dixon, Robyn; Shirley, Debra; Tairea, Karen; Yaqona, Delaney; Mason-Jones, Amanda; Vickers, Mark H

2017-04-01

The rising global burden of noncommunicable diseases (NCDs) has heightened awareness of the necessity for primary risk prevention programmes. These aim to facilitate long-term behaviour changes in children and adolescents that can reduce NCD risk factors and disease onset in later-life. School-based programmes designed to improve childhood and adolescent health behaviours and wellbeing contribute to this; however, design and impact assessment of these is complex. These programmes should be multidisciplinary, utilizing both educational and health expertise. Health outcomes may not be evident in the short term, but may occur with learning-related behaviour modifications, highly effective when sustained over a lifetime. Thus assessment must analyse short-term learning and behaviour impacts as well as long-term capability, behaviour and health outcomes.The focus of assessment measures in the health and education sectors differs and often lacks depth in one or other area. Educators generally focus on identifying evidence of learning related to capability, attitude and/or behaviour changes, while public health practitioners typically focus on health measures (e.g. body mass index (BMI), mental health, or risk behaviours).We argue that multidisciplinary approaches incorporating education and health viewpoints clarify issues relating to the potential value of schools as a setting to facilitate primary NCD risk reduction. To demonstrate this, we need to: 1) build stronger understandings of the features of effective learning for behavioural change and the best way to evaluate these, and 2) convincingly correlate these measures with long-term metabolic health indicators by tracking learner behaviour and health over time. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Infection Risk Reduction in the Intensive Care Nursery: A Review of Patient Care Practices That Impact the Infection Risk in Global Care of the Hospitalized Neonates.

PubMed

Lefrak, Linda

2016-01-01

Neonates are at high risk for developing an infection during their hospital stay in the neonatal intensive care unit. Increased risk occurs because of immaturity of the neonate's immune system, lower gestational age, severity of illness, surgical procedures, and instrumentation with life support devices such as vascular catheters. Neonates become colonized with bacteria prior to or at delivery and also during their hospital stay. They can then become infected with those bacteria if there is a breakdown in the primary defenses such as tissue injury due to skin breakdown, nasal erosion, or trauma to the respiratory tract. Neonates are also at high risk for bacterial translocation due to the altered permeability of the intestinal mucosa, loss of commensal flora, and bacterial overgrowth. The unit-based neonatal care team must implement global care delivery and safety practices, utilize published care guidelines, know and apply evidence-based practices from collaborative quality improvement efforts and other sources, and use auditing and monitoring practices that can identify risks and lead to better practice options to prevent infections. This article presents several aspects of global neonatal care delivery, including vascular access, which may reduce the risk of systemic infection during the hospitalization.

Utility of a perioperative nutritional intervention on postoperative outcomes in high-risk head & neck cancer patients.

PubMed

Rowan, Nicholas R; Johnson, Jonas T; Fratangelo, Christina E; Smith, Brenda K; Kemerer, Patricia A; Ferris, Robert L

2016-03-01

Investigate both the utility and feasibility of perioperative nutritional supplementation with an arginine-enriched immunonutrition formula to high-risk head and neck cancer surgical patients and examine its effects on acute post-operative clinical outcomes. This prospective, non-randomized, interventional cohort study compared high-risk head and neck cancer surgical patients who consumed a pre- and post-operative arginine-based nutritional supplement to those that did not. Outcome measures included post-operative complications, length of hospitalization, readmission rates and measurement of nutritional biomarkers. 195 high-risk head and neck cancer surgical patients were enrolled. 59% of the patients used the nutritional supplement, 41% did not. Of the 80 patients who did not receive the immunonutrition formula, 38 (47.5%) experienced post-operative complications of all types as compared to 29 of the 115 (25.2%) patients who did consume the product (p=0.0021). Pharyngeal leaks or fistulas were the most common post-operative complications in both groups and more common in patients who did not receive supplementation (p=0.007). Length of stay was on average 2.8 days longer in patients who did not have enhanced nutrition (p=0.02), while readmission rates between the two groups were similar (p=0.91). Measurements of nutritional biomarkers were not reported secondary to low collection rates. Enhanced perioperative nutrition may result in significant reductions of post-operative fistula formations and decreased length of stay in a high-risk head and neck cancer population, even in the setting of poor compliance. The potential quality improvement in both patient care and healthcare cost is both real and significant. Copyright © 2016 Elsevier Ltd. All rights reserved.

Innovative practice model to optimize resource utilization and improve access to care for high-risk and BRCA+ patients.

PubMed

Head, Linden; Nessim, Carolyn; Usher Boyd, Kirsty

2017-02-01

Bilateral prophylactic mastectomy (BPM) has demonstrated breast cancer risk reduction in high-risk/ BRCA + patients. However, priority of active cancers coupled with inefficient use of operating room (OR) resources presents challenges in offering BPM in a timely manner. To address these challenges, a rapid access prophylactic mastectomy and immediate reconstruction (RAPMIR) program was innovated. The purpose of this study was to evaluate RAPMIR with regards to access to care and efficiency. We retrospectively reviewed the cases of all high-risk/ BRCA + patients having had BPM between September 2012 and August 2014. Patients were divided into 2 groups: those managed through the traditional model and those managed through the RAPMIR model. RAPMIR leverages 2 concurrently running ORs with surgical oncology and plastic surgery moving between rooms to complete 3 combined BPMs with immediate reconstruction in addition to 1-2 independent cases each operative day. RAPMIR eligibility criteria included high-risk/ BRCA + status; BPM with immediate, implant-based reconstruction; and day surgery candidacy. Wait times, case volumes and patient throughput were measured and compared. There were 16 traditional patients and 13 RAPMIR patients. Mean wait time (days from referral to surgery) for RAPMIR was significantly shorter than for the traditional model (165.4 v. 309.2 d, p = 0.027). Daily patient throughput (4.3 v. 2.8), plastic surgery case volume (3.7 v. 1.6) and surgical oncology case volume (3.0 v. 2.2) were significantly greater in the RAPMIR model than the traditional model ( p = 0.003, p < 0.001 and p = 0.015, respectively). A multidisciplinary model with optimized scheduling has the potential to improve access to care and optimize resource utilization.

Innovative practice model to optimize resource utilization and improve access to care for high-risk and BRCA+ patients

PubMed Central

Head, Linden; Nessim, Carolyn; Boyd, Kirsty Usher

2017-01-01

Background Bilateral prophylactic mastectomy (BPM) has shown breast cancer risk reduction in high-risk/BRCA+ patients. However, priority of active cancers coupled with inefficient use of operating room (OR) resources presents challenges in offering BPM in a timely manner. To address these challenges, a rapid access prophylactic mastectomy and immediate reconstruction (RAPMIR) program was innovated. The purpose of this study was to evaluate RAPMIR with regards to access to care and efficiency. Methods We retrospectively reviewed the cases of all high-risk/BRCA+ patients having had BPM between September 2012 and August 2014. Patients were divided into 2 groups: those managed through the traditional model and those managed through the RAPMIR model. RAPMIR leverages 2 concurrently running ORs with surgical oncology and plastic surgery moving between rooms to complete 3 combined BPMs with immediate reconstruction in addition to 1–2 independent cases each operative day. RAPMIR eligibility criteria included high-risk/BRCA+ status; BPM with immediate, implant-based reconstruction; and day surgery candidacy. Wait times, case volumes and patient throughput were measured and compared. Results There were 16 traditional patients and 13 RAPMIR patients. Mean wait time (days from referral to surgery) for RAPMIR was significantly shorter than for the traditional model (165.4 v. 309.2 d, p = 0.027). Daily patient throughput (4.3 v. 2.8), plastic surgery case volume (3.7 v. 1.6) and surgical oncology case volume (3.0 v. 2.2) were significantly greater in the RAPMIR model than the traditional model (p = 0.003, p < 0.001 and p = 0.015, respectively). Conclusion A multidisciplinary model with optimized scheduling has the potential to improve access to care and optimize resource utilization. PMID:28234588

Innovative practice model to optimize resource utilization and improve access to care for high-risk and BRCA+ patients.

PubMed

Head, Linden; Nessim, Carolyn; Usher Boyd, Kirsty

2016-12-01

Bilateral prophylactic mastectomy (BPM) has demonstrated breast cancer risk reduction in high-risk/ BRCA + patients. However, priority of active cancers coupled with inefficient use of operating room (OR) resources presents challenges in offering BPM in a timely manner. To address these challenges, a rapid access prophylactic mastectomy and immediate reconstruction (RAPMIR) program was innovated. The purpose of this study was to evaluate RAPMIR with regards to access to care and efficiency. We retrospectively reviewed the cases of all high-risk/ BRCA + patients having had BPM between September 2012 and August 2014. Patients were divided into 2 groups: those managed through the traditional model and those managed through the RAPMIR model. RAPMIR leverages 2 concurrently running ORs with surgical oncology and plastic surgery moving between rooms to complete 3 combined BPMs with immediate reconstruction in addition to 1-2 independent cases each operative day. RAPMIR eligibility criteria included high-risk/ BRCA + status; BPM with immediate, implant-based reconstruction; and day surgery candidacy. Wait times, case volumes and patient throughput were measured and compared. There were 16 traditional patients and 13 RAPMIR patients. Mean wait time (days from referral to surgery) for RAPMIR was significantly shorter than for the traditional model (165.4 v. 309.2 d, p = 0.027). Daily patient throughput (4.3 v. 2.8), plastic surgery case volume (3.7 v. 1.6) and surgical oncology case volume (3.0 v. 2.2) were significantly greater in the RAPMIR model than the traditional model ( p = 0.003, p < 0.001 and p = 0.015, respectively). A multidisciplinary model with optimized scheduling has the potential to improve access to care and optimize resource utilization.

Climate Change Mitigation Challenge for Wood Utilization-The Case of Finland.

PubMed

Soimakallio, Sampo; Saikku, Laura; Valsta, Lauri; Pingoud, Kim

2016-05-17

The urgent need to mitigate climate change invokes both opportunities and challenges for forest biomass utilization. Fossil fuels can be substituted by using wood products in place of alternative materials and energy, but wood harvesting reduces forest carbon sink and processing of wood products requires material and energy inputs. We assessed the extended life cycle carbon emissions considering substitution impacts for various wood utilization scenarios over 100 years from 2010 onward for Finland. The scenarios were based on various but constant wood utilization structures reflecting current and anticipated mix of wood utilization activities. We applied stochastic simulation to deal with the uncertainty in a number of input variables required. According to our analysis, the wood utilization decrease net carbon emissions with a probability lower than 40% for each of the studied scenarios. Furthermore, large emission reductions were exceptionally unlikely. The uncertainty of the results were influenced clearly the most by the reduction in the forest carbon sink. There is a significant trade-off between avoiding emissions through fossil fuel substitution and reduction in forest carbon sink due to wood harvesting. This creates a major challenge for forest management practices and wood utilization activities in responding to ambitious climate change mitigation targets.

The Community-based Participatory Intervention Effect of “HIV-RAAP”

PubMed Central

Yancey, Elleen M.; Mayberry, Robert; Armstrong-Mensah, Elizabeth; Collins, David; Goodin, Lisa; Cureton, Shava; Trammell, Ella H.; Yuan, Keming

2012-01-01

Objectives To design and test HIV-RAAP (HIV/AIDS Risk Reduction Among Heterosexually Active African American Men and Women: A Risk Reduction Prevention Intervention) a coeducational, culture- and gender-sensitive community-based participatory HIV risk reduction intervention. Methods A community-based participatory research process included intervention development and implementation of a 7-session coeducational curriculum conducted over 7 consecutive weeks. Results The results indicated a significant intervention effect on reducing sexual behavior risk (P=0.02), improving HIV risk knowledge (P=0.006), and increasing sexual partner conversations about HIV risk reduction (P= 0.001). Conclusions The HIV-RAAP intervention impacts key domains of heterosexual HIV transmission. PMID:22488405

The community-based participatory intervention effect of "HIV-RAAP".

PubMed

Yancey, Elleen M; Mayberry, Robert; Armstrong-Mensah, Elizabeth; Collins, David; Goodin, Lisa; Cureton, Shava; Trammell, Ella H; Yuan, Keming

2012-07-01

To design and test HIV-RAAP (HIV/AIDS Risk Reduction Among Heterosexually Active African American Men and Women: A Risk Reduction Prevention Intervention) a coeducational, culture- and gender-sensitive community-based participatory HIV risk reduction intervention. A community-based participatory research process included intervention development and implementation of a 7-session coeducational curriculum conducted over 7 consecutive weeks. The results indicated a significant intervention effect on reducing sexual behavior risk (P=0.02), improving HIV risk knowledge (P=0.006), and increasing sexual partner conversations about HIV risk reduction (P= 0.001). The HIV-RAAP intervention impacts key domains of heterosexual HIV transmission.

Nowcasting Induced Seismicity at the Groningen Gas Field in the Netherlands

NASA Astrophysics Data System (ADS)

Luginbuhl, M.; Rundle, J. B.; Turcotte, D. L.

2017-12-01

The Groningen natural gas field in the Netherlands has recently been a topic of controversy for many residents in the surrounding area. The gas field provides energy for the majority of the country; however, for a minority of Dutch citizens who live nearby, the seismicity induced by the gas field is a cause for major concern. Since the early 2000's, the region has seen an increase in both number and magnitude of events, the largest of which was a magnitude 3.6 in 2012. Earthquakes of this size and smaller easily cause infrastructural damage to older houses and farms built with single brick walls. Nowcasting is a new method of statistically classifying seismicity and seismic risk. In this paper, the method is applied to the induced seismicity at the natural gas fields in Groningen, Netherlands. Nowcasting utilizes the catalogs of seismicity in these regions. Two earthquake magnitudes are selected, one large say , and one small say . The method utilizes the number of small earthquakes that occur between pairs of large earthquakes. The cumulative probability distribution of these values is obtained. The earthquake potential score (EPS) is defined by the number of small earthquakes that have occurred since the last large earthquake, the point where this number falls on the cumulative probability distribution of interevent counts defines the EPS. A major advantage of nowcasting is that it utilizes "natural time", earthquake counts, between events rather than clock time. Thus, it is not necessary to decluster aftershocks and the results are applicable if the level of induced seismicity varies in time, which it does in this case. The application of natural time to the accumulation of the seismic hazard depends on the applicability of Gutenberg-Richter (GR) scaling. The increasing number of small earthquakes that occur after a large earthquake can be scaled to give the risk of a large earthquake occurring. To illustrate our approach, we utilize the number of earthquakes in Groningen to nowcast the number of earthquakes in Groningen. The applicability of the scaling is illustrated during the rapid build up of seismicity between 2004 and 2016. It can now be used to forecast the expected reduction in seismicity associated with reduction in gas production.

Effect of Combined Manual Acupuncture and Massage on Body Weight and Body Mass Index Reduction in Obese and Overweight Women: A Randomized, Short-term Clinical Trial.

PubMed

He, Junfeng; Zhang, Xing; Qu, Yating; Huang, Huiyong; Liu, Xia; Du, Jia; Guo, Shengtong

2015-04-01

Obesity is one of the leading health risk factors worldwide and is associated with several other risk factors and health problems. Acupuncture is utilized to treat a variety of health problems, one of which is obesity. Fifty-six obese women with body mass index (BMI) ≥25 kg/m(2) were recruited for this trial and were randomly divided into two groups, one with combined manual acupuncture and massage therapy (MAMT), and the other with only manual acupuncture therapy (MAT). In addition, 40 overweight women with BMI 23-25 kg/m(2) were randomly divided into two groups, one with MAMT and the other with MAT. Therapy was carried out once per day for 21 days, and the body weights and the BMIs were recorded every day. The results showed that both MAMT and MAT could reduce body weight and BMI significantly, compared with the pretreatment values, for all the participants (p < 0.001); however, the differences in body weight and BMI reductions between pre- and posttreatment for the MAMT and the MAT groups were not statistically significant. The optimal periods for reductions in both body weight and in BMI were the first 4 days. Accounting for the economic strategy (time and money) in alternative therapy, MAT alone may present a reasonable option in the treatment of overweight and obesity in adults. Copyright © 2015. Published by Elsevier B.V.

[Utility of treatment with atorvastatin 40 mg plus ezetimibe 10 mg versus atorvastatin 80 mg in reducing the levels of LDL cholesterol in patients with ischaemic stroke or transient ischaemic attack].

PubMed

Palacio, Enrique; Viadero-Cervera, Raquel; Revilla, Marián; Larrosa-Campo, Davinia; Acha-Salazar, Olga; Novo-Robledo, Francisco; Oterino, Agustín

2016-03-01

After an ischaemic stroke, to reduce LDL cholesterol (LDLc) levels decreases the risk of recurrence. The risk of recurrence is lower with more intense reductions in LDLc levels. To evaluate the efficacy and security of atorvastatin 40 mg plus ezetimibe 10 mg after ischaemic stroke or transient ischaemic attack (TIA). We retrospectively evaluated stroke or TIA patients admitted to our hospital who received atorvastatin 40 mg plus ezetimibe 10 mg (n = 34) or atorvastatin 80 mg (n = 52) at discharge. We analyzed changes in lipid parameters and established as a primary outcome LDLc <= 70 mg/dL and/or reduction in LDLc >= 50%. Furthermore, safety parameters were assessed. Predictors associated with primary outcome achievement were treatment with atorvastatin 40 mg plus ezetimibe 10 mg (odds ratio: 11.94; 95% CI: 2.82-50.64; p = 0.001) and male (odds ratio: 4.76; 95% CI: 1.35-16.67; p = 0.02). Treatment with atorvastatin 40 mg plus ezetimibe 10 mg achieved significantly greater reductions in LDLc (p < 0.001), total cholesterol (p < 0.001) and non-HDLc (p < 0.001). Both treatments were safe and well tolerated, with a low number of secondary effects. Compared with atorvastatin 80 mg, atorvastatin 40 mg plus ezetimibe 10 mg increases the likelihood of achieving LDLc goals after ischaemic stroke or transient ischaemic attack. Both treatments were safe and well tolerated.

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.

Risk-adaptive radiotherapy

NASA Astrophysics Data System (ADS)

Kim, Yusung

Currently, there is great interest in integrating biological information into intensity-modulated radiotherapy (IMRT) treatment planning with the aim of boosting high-risk tumor subvolumes. Selective boosting of tumor subvolumes can be accomplished without violating normal tissue complication constraints using information from functional imaging. In this work we have developed a risk-adaptive optimization-framework that utilizes a nonlinear biological objective function. Employing risk-adaptive radiotherapy for prostate cancer, it is possible to increase the equivalent uniform dose (EUD) by up to 35.4 Gy in tumor subvolumes having the highest risk classification without increasing normal tissue complications. Subsequently, we have studied the impact of functional imaging accuracy, and found on the one hand that loss in sensitivity had a large impact on expected local tumor control, which was maximal when a low-risk classification for the remaining low risk PTV was chosen. While on the other hand loss in specificity appeared to have a minimal impact on normal tissue sparing. Therefore, it appears that in order to improve the therapeutic ratio a functional imaging technique with a high sensitivity, rather than specificity, is needed. Last but not least a comparison study between selective boosting IMRT strategies and uniform-boosting IMRT strategies yielding the same EUD to the overall PTV was carried out, and found that selective boosting IMRT considerably improves expected TCP compared to uniform-boosting IMRT, especially when lack of control of the high-risk tumor subvolumes is the cause of expected therapy failure. Furthermore, while selective boosting IMRT, using physical dose-volume objectives, did yield similar rectal and bladder sparing when compared its equivalent uniform-boosting IMRT plan, risk-adaptive radiotherapy, utilizing biological objective functions, did yield a 5.3% reduction in NTCP for the rectum. Hence, in risk-adaptive radiotherapy the therapeutic ratio can be increased over that which can be achieved with conventional selective boosting IMRT using physical dose-volume objectives. In conclusion, a novel risk-adaptive radiotherapy strategy is proposed and promises increased expected local control for locoregionally advanced tumors with equivalent or better normal tissue sparing.

Examining the Impact of Suicide Attempt Function and Perceived Effectiveness in Predicting Reattempt for Emergency Medicine Patients.

PubMed

O'Connor, Stephen S; Comtois, Katherine Anne; Atkins, David C; Kerbrat, Amanda H

2017-01-01

While previous studies have examined motivational aspects of self-directed violence, few studies have included specific motivations in predictive models for future suicide attempts. The current study utilized a sample of 160 individuals treated in an acute emergency setting following a suicide attempt who completed an interview battery that included an assessment of functional aspects of the index suicide attempt. A follow-up interview was conducted at 6 months to ascertain subsequent suicide attempts. The functional domains of suicide attempts were labeled as reduction-of-distress, communication, perceived better alternative to living, and self-loathing. Above and beyond other known risk factors, including history and highest lethality of previous self-injury, suicide attempts that served a communication function (OR = 0.18, p = .02, CI = 0.04, 0.73) and higher ratings of clinical dysfunction (OR = 3.41, p = .05, CI = 1.02, 11.36) were associated with a significant reduction in likelihood to engage in a suicide attempt during the 6-month follow-up window. Including the perceived effectiveness of the index suicide attempt in getting one's needs met strengthened the overall model predicting a suicide attempt in the follow-up window and was an independent risk factor above and beyond other variables in the model OR = 1.75, p = .04, CI = 1.02, 3.01). Assessment of functional aspects of suicide attempt is feasible and may improve formulation of risk in a population where typical risk factors for suicide are ubiquitous. Copyright © 2016. Published by Elsevier Ltd.

Interactive and Indirect Effects of Anxiety and Negative Urgency on Alcohol-Related Problems

PubMed Central

Menary, Kyle R.; Corbin, William R.; Leeman, Robert F.; Fucito, Lisa M.; Toll, Benjamin A.; DeMartini, Kelly; O’Malley, Stephanie S.

2015-01-01

Background Although drinking for tension reduction has long been posited as a risk factor for alcohol-related problems, studies investigating anxiety in relation to risk for alcohol problems have returned inconsistent results, leading researchers to search for potential moderators. Negative urgency (the tendency to become behaviorally dysregulated when experiencing negative affect) is a potential moderator of theoretical interest because it may increase risk for alcohol problems among those high in negative affect. The present study tested a cross-sectional mediated moderation hypothesis whereby an interactive effect of anxiety and negative urgency on alcohol problems is mediated through coping-related drinking motives. Method The study utilized baseline data from a hazardously drinking sample of young adults (N = 193) evaluated for participation in a randomized controlled trial of naltrexone and motivational interviewing for drinking reduction. Results The direct effect of anxiety on physiological dependence symptoms was moderated by negative urgency such that the positive association between anxiety and physiological dependence symptoms became stronger as negative urgency increased. Indirect effects of anxiety and negative urgency on alcohol problems (operating through coping motives) were also observed. Conclusions Although results of the current cross-sectional study require replication using longitudinal data, the findings suggest that the simultaneous presence of anxiety and negative urgency may be an important indicator of risk for AUDs via both direct interactive effects and indirect additive effects operating through coping motives. These findings have potentially important implications for prevention/intervention efforts for individuals who become disinhibited in the context of negative emotional states. PMID:26031346

Estimated cardiovascular relative risk reduction from fixed-dose combination pill (polypill) treatment in a wide range of patients with a moderate risk of cardiovascular disease.

PubMed

Lafeber, Melvin; Webster, Ruth; Visseren, Frank Lj; Bots, Michiel L; Grobbee, Diederick E; Spiering, W; Rodgers, Anthony

2016-08-01

Recent data indicate that fixed-dose combination (FDC) pills, polypills, can produce sizeable risk factor reductions. There are very few published data on the consistency of the effects of a polypill in different patient populations. It is unclear for example whether the effects of the polypill are mainly driven by the individuals with high individual risk factor levels. The aim of the present study is to examine whether baseline risk factor levels modify the effect of polypill treatment on low-density lipoprotein (LDL)-cholesterol, blood pressure (BP), calculated cardiovascular relative risk reduction and adverse events. This paper describes a post-hoc analysis of a randomised, placebo-controlled trial of a polypill (containing aspirin 75 mg, simvastatin 20 mg, lisinopril 10 mg and hydrochlorothiazide 12.5 mg) in 378 individuals without an indication for any component of the polypill, but who had an estimated five-year risk for cardiovascular disease ≥7.5%. The outcomes considered were effect modification by baseline risk factor levels on change in LDL-cholesterol, systolic BP, calculated cardiovascular relative risk reduction and adverse events. The mean LDL-cholesterol in the polypill group was 0.9 mmol/l (95% confidence interval (CI): 0.8-1.0) lower compared with the placebo group during follow-up. Those with a baseline LDL-cholesterol >3.6 mmol/l achieved a greater absolute LDL-cholesterol reduction with the polypill compared with placebo, than patients with an LDL-cholesterol ≤3.6 mmol/l (-1.1 versus -0.6 mmol/l, respectively). The mean systolic BP was 10 mm Hg (95% CI: 8-12) lower in the polypill group. In participants with a baseline systolic BP >135 mm Hg the polypill resulted in a greater absolute systolic BP reduction with the polypill compared with placebo, than participants with a systolic BP ≤ 135 mm Hg (-12 versus -7 mm Hg, respectively). Calculated from individual risk factor reductions, the mean cardiovascular relative risk reduction was 48% (95% CI: 43-52) in the polypill group. Both baseline LDL-cholesterol and estimated cardiovascular risk were significant modifiers of the estimated cardiovascular relative risk reduction caused by the polypill. Adverse events did not appear to be related to baseline risk factor levels or the estimated cardiovascular risk. This study demonstrated that the effect of a cardiovascular polypill on risk factor levels is modified by the level of these risk factors. Groups defined by baseline LDL-cholesterol or systolic BP had large differences in risk factor reductions but only moderate differences in estimated cardiovascular relative risk reduction, suggesting also that patients with mildly increased risk factor levels but an overall raised cardiovascular risk benefit from being treated with a polypill. © The European Society of Cardiology 2016.

SU-C-BRF-01: Correlation of DIBH Breath Hold Amplitude with Dosimetric Sparing of Heart and Left Anterior Descending Artery in Left Breast Radiotherapy

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

Kim, Taeho; Reardon, Kelli; Sukovich, Kaitlyn

Purpose: A 7.4% increase in major coronary events per 1 Gy increase in mean heart dose has been reported from the population-based analysis of radiation-induced cardiac toxicity following treatment of left sided breast cancer. Deep inhalation breath-hold (DIBH) is clinically utilized to reduce radiation dose to heart and left anterior descending artery (LAD). We investigated the correlation of dose sparing in heart and LAD with internal DIBH amplitude to develop a quantitative predictive model for expected dose to heart and LAD based on internal breath hold amplitude. Methods: A treatment planning study (Prescription Dose = 50 Gy) was performed onmore » 50 left breast cancer patients underwent DIBH whole breast radiotherapy. Two CT datasets, free breathing (FB) and DIBH, were utilized for treatment planning and for determination of the internal anatomy DIBH amplitude (difference between sternum position at FB and DIBH). The heart and LAD dose between FB and DIBH plans was compared and dose to the heart and LAD as a function of breath hold amplitude was determined. Results: Average DIBH amplitude using internal anatomy was 13.9±4.2 mm. The DIBH amplitude-mean dose reduction correlation is 20%/5mm (0.3 Gy/5mm) for the heart and 18%/5mm (1.1 Gy/5mm) for LAD. The correlation with max dose reduction is 12%/5mm (3.8 Gy/5mm) for the heart and 16%/5mm (3.2 Gy/5mm) for LAD. We found that average dose reductions to LAD from 6.0±6.5 Gy to 2.0±1.6 Gy with DIBH (4.0 Gy reduction: -67%, p < 0.001) and average dose reduction to the heart from 1.3±0.7 Gy to 0.7±0.2 Gy with DIBH (0.6 Gy reduction: -46%, p < 0.001). That suggests using DIBH may reduce the risk of the major coronary event for left sided breast cancer patients. Conclusion: The correlation between breath hold amplitude and dosimetric sparing suggests that dose sparing linearly increases with internal DIBH amplitude.« less

Mobilizing for change: a case study of a campus and community coalition to reduce high-risk drinking.

PubMed

Linowski, Sally A; DiFulvio, Gloria T

2012-06-01

Campus and community coalitions include a partnership between campus leaders and community stakeholders and can effectively address the environment that may promote high-risk drinking. Despite evidence suggesting that coalitions may be effective vehicles for producing sustainable changes in college drinking, few campuses work within such a structure. The purpose of this study was to examine the effectiveness of a campus and community coalition to implement environmental changes and thereby reduce high-risk drinking and associated consequences. This study utilized a case study method to tell the story of a campus and community coalition (CCC) implemented on a large university campus in the Northeast. The study employed multiple methods including archival document review, review of campus and community level data (i.e. alcohol-related arrests and sanctions) and analysis of student level data. The case study discusses the strategies employed, the environmental changes that occurred and the impact these changes have had on student drinking and consequences. Since implementing the campus and community coalition, the campus has seen an increase in enforcement by campus and local police, changes in community by-laws, and significant reductions in student drinking and consequences. The data provide evidence that a comprehensive approach to reducing high-risk drinking can have an impact on the campus and community environment, which in turn impacts student drinking and associated consequences. The CCC utilized a strategic and comprehensive approach to substance abuse prevention, allowing all participants to have a shared understanding of the challenges and best practices. Implications for research and practice are also discussed.

Tradeoffs in Risk and Return of Financial Hedging Solutions to Mitigate Drought-Related Financial Risks for Water Utilities

NASA Astrophysics Data System (ADS)

Baum, R.; Characklis, G. W.

2016-12-01

Financial hedging solutions have been examined as tools for effectively mitigating water scarcity related financial risks for water utilities, and have become more prevalent as conservation (resulting in reduced revenues) and water transfers (resulting in increased costs) play larger roles in drought management. Individualized financial contracts (i.e. designed for a single utility) provide evidence of the potential benefits of financial hedging. However, individualized contracts require substantial time and information to develop, limiting their widespread implementation. More generalized contracts have also shown promise, and would allow the benefits of risk pooling to be more effectively realized, resulting in less expensive contracts. Risk pooling reduces the probability of an insurer making payouts that deviate significantly from the mean, but given that the financial risks of drought are spatially correlated amongst utilities, these more extreme "fat tail" risks remain. Any group offering these hedging contracts, whether a third-party insurer or a "mutual" comprised of many utilities, will need to balance the costs (i.e. additional risk) and benefits (i.e. returns) of alternative approaches to managing the extreme risks (e.g. through insurance layers). The balance of these different approaches will vary depending on the risk pool being considered, including the number, size and exposure of the participating utilities. This work first establishes a baseline of the tradeoffs between risk and expected return in insuring against the financial risks of water scarcity without alternative hedging approaches for water utilities across all climate divisions of the United States. Then various scenarios are analyzed to provide insight into how to maximize returns for risk pooling portfolios at various risk levels through balancing different insurance layers and hedging approaches. This analysis will provide valuable information for designing optimal financial risk management strategies for water utilities across the United States.

Development of risk reduction behavioral counseling for Ebola virus disease survivors enrolled in the Sierra Leone Ebola Virus Persistence Study, 2015-2016.

PubMed

Abad, Neetu; Malik, Tasneem; Ariyarajah, Archchun; Ongpin, Patricia; Hogben, Matthew; McDonald, Suzanna L R; Marrinan, Jaclyn; Massaquoi, Thomas; Thorson, Anna; Ervin, Elizabeth; Bernstein, Kyle; Ross, Christine; Liu, William J; Kroeger, Karen; Durski, Kara N; Broutet, Nathalie; Knust, Barbara; Deen, Gibrilla F

2017-09-01

During the 2014-2016 West Africa Ebola Virus Disease (EVD) epidemic, the public health community had concerns that sexual transmission of the Ebola virus (EBOV) from EVD survivors was a risk, due to EBOV persistence in body fluids of EVD survivors, particularly semen. The Sierra Leone Ebola Virus Persistence Study was initiated to investigate this risk by assessing EBOV persistence in numerous body fluids of EVD survivors and providing risk reduction counseling based on test results for semen, vaginal fluid, menstrual blood, urine, rectal fluid, sweat, tears, saliva, and breast milk. This publication describes implementation of the counseling protocol and the key lessons learned. The Ebola Virus Persistence Risk Reduction Behavioral Counseling Protocol was developed from a framework used to prevent transmission of HIV and other sexually transmitted infections. The framework helped to identify barriers to risk reduction and facilitated the development of a personalized risk-reduction plan, particularly around condom use and abstinence. Pre-test and post-test counseling sessions included risk reduction guidance, and post-test counseling was based on the participants' individual test results. The behavioral counseling protocol enabled study staff to translate the study's body fluid test results into individualized information for study participants. The Ebola Virus Persistence Risk Reduction Behavioral Counseling Protocol provided guidance to mitigate the risk of EBOV transmission from EVD survivors. It has since been shared with and adapted by other EVD survivor body fluid testing programs and studies in Ebola-affected countries.

Improvement in spine bone density and reduction in risk of vertebral fractures during treatment with antiresorptive drugs.

PubMed

Cummings, Steven R; Karpf, David B; Harris, Fran; Genant, Harry K; Ensrud, Kristine; LaCroix, Andrea Z; Black, Dennis M

2002-03-01

To estimate how much the improvement in bone mass accounts for the reduction in risk of vertebral fracture that has been observed in randomized trials of antiresorptive treatments for osteoporosis. After a systematic search, we conducted a meta-analysis of 12 trials to describe the relation between improvement in spine bone mineral density and reduction in risk of vertebral fracture in postmenopausal women. We also used logistic models to estimate the proportion of the reduction in risk of vertebral fracture observed with alendronate in the Fracture Intervention Trial that was due to improvement in bone mineral density. Across the 12 trials, a 1% improvement in spine bone mineral density was associated with a 0.03 decrease (95% confidence interval [CI]: 0.02 to 0.05) in the relative risk (RR) of vertebral fracture. The reductions in risk were greater than predicted from improvement in bone mineral density; for example, the model estimated that treatments predicted to reduce fracture risk by 20% (RR = 0.80), based on improvement in bone mineral density, actually reduce the risk of fracture by about 45% (RR = 0.55). In the Fracture Intervention Trial, improvement in spine bone mineral density explained 16% (95% CI: 11% to 27%) of the reduction in the risk of vertebral fracture with alendronate. Improvement in spine bone mineral density during treatment with antiresorptive drugs accounts for a predictable but small part of the observed reduction in the risk of vertebral fracture.

Association of Epsilon-Aminocaproic Acid With Blood Loss and Risk of Transfusion After Periacetabular Osteotomy: A Retrospective Cohort Study.

PubMed

McLawhorn, Alexander S; Levack, Ashley E; Fields, Kara G; Sheha, Evan D; DelPizzo, Kathryn R; Sink, Ernest L

2016-03-01

Periacetabular osteotomy (PAO) reorients the acetabular cartilage through a complex series of pelvic osteotomies, which risks significant blood loss often necessitating blood transfusion. Therefore, it is important to identify effective strategies to manage blood loss and decrease morbidity after PAO. The purpose of this study was to determine the association of epsilon-aminocaproic acid (EACA), an antifibrinolytic agent, with blood loss from PAO. Ninety-three patients out of 110 consecutive patients that underwent unilateral PAO for acetabular dysplasia met inclusion criteria. Fifty patients received EACA intraoperatively. Demographics, autologous blood predonation, anesthetic type, intraoperative estimated blood loss (EBL), cell-saver utilization, and transfusions were recorded. Total blood loss was calculated. Two-sample t-test and chi-square or Fisher's exact test were used as appropriate. The associations between EACA administration and calculated EBL, cell-saver utilization, intraoperative EBL, and maximum difference in postoperative hemoglobin were assessed via multiple regression, adjusting for confounders. Post hoc power analysis demonstrated sufficient power to detect a 250-mL difference in calculated EBL between groups. Alpha level was 0.05 for all tests. No demographic differences existed between groups. Mean blood loss and allogeneic transfusion rates were not statistically significant between groups (P = .093 and .170, respectively). There were no differences in cell-saver utilization, intraoperative EBL, and/or postoperative hemoglobin. There was a higher rate of autologous blood utilization in the group not receiving EACA because of a clinical practice change. EACA administration was not associated with a statistically significant reduction in blood loss or allogeneic transfusion in patients undergoing PAO. Copyright © 2016 Elsevier Inc. All rights reserved.

Intracerebral hemorrhage location and outcome among INTERACT2 participants.

PubMed

Delcourt, Candice; Sato, Shoichiro; Zhang, Shihong; Sandset, Else Charlotte; Zheng, Danni; Chen, Xiaoying; Hackett, Maree L; Arima, Hisatomi; Hata, Jun; Heeley, Emma; Al-Shahi Salman, Rustam; Robinson, Thompson; Davies, Leo; Lavados, Pablo M; Lindley, Richard I; Stapf, Christian; Chalmers, John; Anderson, Craig S

2017-04-11

To clarify associations between intracerebral hemorrhage (ICH) location and clinical outcomes among participants of the main phase Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). Associations between ICH sites and poor outcomes (death [6] or major disability [3-5] of modified Rankin Scale) and European Quality of Life Scale (EQ-5D) utility scores at 90 days were assessed in logistic regression models. Of 2,066 patients included in the analyses, associations were identified between ICH sites and poor outcomes: involvement of posterior limb of internal capsule increased risks of death or major disability (odds ratio [OR] 2.10) and disability (OR 1.81); thalamic involvement increased risks of death or major disability (OR 2.24) and death (OR 1.97). Involvement of the posterior limb of the internal capsule, thalamus, and infratentorial sites were each associated with poor EQ-5D utility score (≤0.7 [median]; OR 1.87, 2.14, and 2.81, respectively). Posterior limb of internal capsule involvement was strongly associated with low scores across all health-related quality of life domains. ICH encompassing the thalamus and posterior limb of internal capsule were associated with death or major disability, major disability, and poor EQ-5D utility score (OR 1.72, 2.26, and 1.71, respectively). Poor clinical outcomes are related to ICH affecting the posterior limb of internal capsule, thalamus, and infratentorial sites. The highest association with death or major disability and poor EQ-5D utility score was seen in ICH encompassing the thalamus and posterior limb of internal capsule. NCT00716079. Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

Dopamine Reward Prediction Error Responses Reflect Marginal Utility

PubMed Central

Stauffer, William R.; Lak, Armin; Schultz, Wolfram

2014-01-01

Summary Background Optimal choices require an accurate neuronal representation of economic value. In economics, utility functions are mathematical representations of subjective value that can be constructed from choices under risk. Utility usually exhibits a nonlinear relationship to physical reward value that corresponds to risk attitudes and reflects the increasing or decreasing marginal utility obtained with each additional unit of reward. Accordingly, neuronal reward responses coding utility should robustly reflect this nonlinearity. Results In two monkeys, we measured utility as a function of physical reward value from meaningful choices under risk (that adhered to first- and second-order stochastic dominance). The resulting nonlinear utility functions predicted the certainty equivalents for new gambles, indicating that the functions’ shapes were meaningful. The monkeys were risk seeking (convex utility function) for low reward and risk avoiding (concave utility function) with higher amounts. Critically, the dopamine prediction error responses at the time of reward itself reflected the nonlinear utility functions measured at the time of choices. In particular, the reward response magnitude depended on the first derivative of the utility function and thus reflected the marginal utility. Furthermore, dopamine responses recorded outside of the task reflected the marginal utility of unpredicted reward. Accordingly, these responses were sufficient to train reinforcement learning models to predict the behaviorally defined expected utility of gambles. Conclusions These data suggest a neuronal manifestation of marginal utility in dopamine neurons and indicate a common neuronal basis for fundamental explanatory constructs in animal learning theory (prediction error) and economic decision theory (marginal utility). PMID:25283778

The utility of the apolipoprotein A1 remnant ratio in predicting incidence coronary heart disease in a primary prevention cohort: The Jackson Heart Study.

PubMed

May, Heidi T; Nelson, John R; Lirette, Seth T; Kulkarni, Krishnaji R; Anderson, Jeffrey L; Griswold, Michael E; Horne, Benjamin D; Correa, Adolfo; Muhlestein, Joseph B

2016-05-01

Dyslipidemia plays a significant role in the progression of cardiovascular disease. The apolipoprotein (apo) A1 remnant ratio (apo A1/VLDL3-C + IDL-C) has recently been shown to be a strong predictor of death/myocardial infarction risk among women >50 years undergoing angiography. However, whether this ratio is associated with coronary heart disease risk among other populations is unknown. We evaluated the apo A1 remnant ratio and its components for coronary heart disease incidence. Observational. Participants (N = 4722) of the Jackson Heart Study were evaluated. Baseline clinical characteristics and lipoprotein subfractions (Vertical Auto Profile method) were collected. Cox hazard regression analysis, adjusted by standard cardiovascular risk factors, was utilized to determine associations of lipoproteins with coronary heart disease. Those with new-onset coronary heart disease were older, diabetic, smokers, had less education, used more lipid-lowering medication, and had a more atherogenic lipoprotein profile. After adjustment, the apo A1 remnant ratio (hazard ratio = 0.67 per 1-SD, p = 0.002) was strongly associated with coronary heart disease incidence. This association appears to be driven by the IDL-C denominator (hazard ratio = 1.23 per 1-SD, p = 0.007). Remnants (hazard ratio = 1.21 per 1-SD, p = 0.017), but not apo A1 (hazard ratio = 0.85 per 1-SD, p = 0.121) or VLDL3-C (hazard ratio = 1.13 per 1-SD, p = 0.120) were associated with coronary heart disease. Standard lipids were not associated with coronary heart disease incidence. We found the apo A1 remnant ratio to be strongly associated with coronary heart disease. This ratio appears to better stratify risk than standard lipids, apo A1, and remnants among a primary prevention cohort of African Americans. Its utility requires further study as a lipoprotein management target for risk reduction. © The European Society of Cardiology 2015.

Hydrogen Fuel Cell on a Helicopter: A System Engineering Approach

NASA Astrophysics Data System (ADS)

Nesheiwat, Rod

Hydrogen fuel cells have been previously investigated as a viable replacement to traditional gas turbine auxiliary power unit onboard fixed wing commercial jets. However, so far no study has attempted to extend their applicability to rotary wing aircrafts. To aid in the advancement of such innovative technologies, a holistic technical approach is required to ensure risk reduction and cost effectiveness throughout the product lifecycle. This paper will evaluate the feasibility of replacing a gas turbine auxiliary power unit on a helicopter with a direct hydrogen, air breathing, proton exchange membrane fuel cell, all while emphasizing a system engineering approach that utilize a specialized set of tools and artifacts.

Dual-eligibles with Mental Disorders and Medicare Part D: How are they faring?

PubMed Central

Donohue, Julie M.; Huskamp, Haiden A.; Zuvekas, Samuel H.

2009-01-01

In 2006, 6 million beneficiaries who were dually eligible for Medicare and Medicaid switched from Medicaid to Medicare Part D coverage of their prescription drugs. This change led to a significant expansion of Medicare’s role in financing psychotropic medications for this group. A reduction in the number of plans serving dual-eligibles and an increase in utilization restrictions for some psychotropics since 2006 raises concerns about medication access for dual-eligibles with mental disorders and point to potential problems with adverse selection. To improve access to medication for this population, Medicare might consider changes to the enrollment and risk-sharing systems. PMID:19414883

Coronary intervention in thrombus-rich lesions: beyond stents and glycoprotein IIb/IIIa inhibitors.

PubMed

Halkin, Amir; Keren, Gad; Stone, Gregg W; Holmes, David R; Rosenschein, Uri

2003-11-01

Despite widespread use of stents and GP IIb/IIIa antagonists, complications following percutaneous treatment of thrombus-rich lesions continue to plague patients with ACS. In these patients the angiographically evident coronary thrombosis may represent a high degree of thrombus burden, which leads to a higher level of microembolization and its clinical sequelae. New catheter-based thrombus burden reduction systems and distal protection devices show promise for improving the prognosis of these high risk patients by decreasing distal microembolization, and thereby preventing myonecrosis. Careful procedural timing and patient selection are also likely to improve outcomes and resource utilization in the management of ACS patients.

41 CFR 102-80.55 - Are Federal agencies responsible for managing the execution of risk reduction projects?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Management Risks and Risk Reduction Strategies § 102-80.55 Are Federal agencies responsible for managing the... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Are Federal agencies responsible for managing the execution of risk reduction projects? 102-80.55 Section 102-80.55 Public...

Reductions in Transmission Risk Behaviors in HIV-Positive Clients Receiving Prevention Case Management Services: Findings from a Community Demonstration Project

ERIC Educational Resources Information Center

Gasiorowicz, Mari; Llanas, Michelle R.; DiFranceisco, Wayne; Benotsch, Eric G.; Brondino, Michael J.; Catz, Sheryl L.; Hoxie, Neil J.; Reiser, William J.; Vergeront, James M.

2005-01-01

Prevention case management (PCM) for HIV-infected persons is an HIV risk reduction intervention designed to assist clients who are aware of their HIV infection and who continue to engage in risk transmission behaviors. PCM combines individual risk reduction counseling with case management to address the psychosocial factors affecting HIV…

A cost/utility analysis of open reduction and internal fixation versus cast immobilization for acute nondisplaced mid-waist scaphoid fractures.

PubMed

Davis, Erika N; Chung, Kevin C; Kotsis, Sandra V; Lau, Frank H; Vijan, Sandeep

2006-04-01

Open reduction and internal fixation and cast immobilization are both acceptable treatment options for nondisplaced waist fractures of the scaphoid. The authors conducted a cost/utility analysis to weigh open reduction and internal fixation against cast immobilization in the treatment of acute nondisplaced mid-waist scaphoid fractures. The authors used a decision-analytic model to calculate the outcomes and costs of open reduction and internal fixation and cast immobilization, assuming the societal perspective. Utilities were assessed from 50 randomly selected medical students using the time trade-off method. Outcome probabilities taken from the literature were factored into the calculation of quality-adjusted life-years associated with each treatment. The authors estimated medical costs using Medicare reimbursement rates, and costs of lost productivity were estimated by average wages obtained from the U.S. Bureau of Labor Statistics. Open reduction and internal fixation offers greater quality-adjusted life-years compared with casting, with an increase ranging from 0.21 quality-adjusted life-years for the 25- to 34-year age group to 0.04 quality-adjusted life-years for the > or =65-year age group. Open reduction and internal fixation is less costly than casting ($7940 versus $13,851 per patient) because of a longer period of lost productivity with casting. Open reduction and internal fixation is therefore the dominant strategy. When considering only direct costs, the incremental cost/utility ratio for open reduction and internal fixation ranges from $5438 per quality-adjusted life-year for the 25- to 34-year age group to $11,420 for the 55- to 64-year age group, and $29,850 for the > or =65-year age group. Compared with casting, open reduction and internal fixation is cost saving from the societal perspective ($5911 less per patient). When considering only direct costs, open reduction and internal fixation is cost-effective relative to other widely accepted interventions.

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

PubMed

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

2017-09-01

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

Harm reduction with pharmacotherapy for homeless people with alcohol dependence: Protocol for a randomized controlled trial

PubMed Central

Collins, Susan E.; Saxon, Andrew J.; Duncan, Mark H.; Smart, Brian F.; Merrill, Joseph O.; Malone, Daniel K.; Jackson, T. Ron; Clifasefi, Seema L.; Joesch, Jutta; Ries, Richard K.

2014-01-01

Background Interventions requiring abstinence from alcohol are neither preferred by nor shown to be highly effective with many homeless individuals with alcohol dependence. It is therefore important to develop lower-threshold, patient-centered interventions for this multimorbid and high-utilizing population. Harm-reduction counseling requires neither abstinence nor use reduction and pairs a compassionate style with patient-driven goal-setting. Extended-release naltrexone (XR-NTX), a monthly injectable formulation of an opioid receptor antagonist, reduces craving and may support achievement of harm-reduction goals. Together, harm-reduction counseling and XR-NTX may support alcohol harm reduction and quality-of-life improvement. Aims Study aims include testing: a) the relative efficacy of XR-NTX and harm-reduction counseling compared to a community-based, supportive-services-as-usual control, b) theory-based mediators of treatment effects, and c) treatment effects on publicly funded service costs. Methods This RCT involves four arms: a) XR-NTX+harm-reduction counseling, b) placebo+harm-reduction counseling, c) harm-reduction counseling only, and d) community-based, supportive-services-as-usual control conditions. Participants are currently/formerly homeless, alcohol dependent individuals (N=300). Outcomes include alcohol variables (i.e., craving, quantity/frequency, problems and biomarkers), health-related quality of life, and publicly funded service utilization and associated costs. Mediators include 10-point motivation rulers and the Penn Alcohol Craving Scale. XR-NTX and harm-reduction counseling are administered every 4 weeks over the 12-week treatment course. Follow-up assessments are conducted at weeks 24 and 36. Discussion If found efficacious, XR-NTX and harm-reduction counseling will be well-positioned to support reductions in alcohol-related harm, decreases in costs associated with publicly funded service utilization, and increases in quality of life among homeless, alcohol-dependent individuals. PMID:24846619

Harm reduction with pharmacotherapy for homeless people with alcohol dependence: protocol for a randomized controlled trial.

PubMed

Collins, Susan E; Saxon, Andrew J; Duncan, Mark H; Smart, Brian F; Merrill, Joseph O; Malone, Daniel K; Jackson, T Ron; Clifasefi, Seema L; Joesch, Jutta; Ries, Richard K

2014-07-01

Interventions requiring abstinence from alcohol are neither preferred by nor shown to be highly effective with many homeless individuals with alcohol dependence. It is therefore important to develop lower-threshold, patient-centered interventions for this multimorbid and high-utilizing population. Harm-reduction counseling requires neither abstinence nor use reduction and pairs a compassionate style with patient-driven goal-setting. Extended-release naltrexone (XR-NTX), a monthly injectable formulation of an opioid receptor antagonist, reduces craving and may support achievement of harm-reduction goals. Together, harm-reduction counseling and XR-NTX may support alcohol harm reduction and quality-of-life improvement. Study aims include testing: a) the relative efficacy of XR-NTX and harm-reduction counseling compared to a community-based, supportive-services-as-usual control, b) theory-based mediators of treatment effects, and c) treatment effects on publicly funded service costs. This RCT involves four arms: a) XR-NTX+harm-reduction counseling, b) placebo+harm-reduction counseling, c) harm-reduction counseling only, and d) community-based, supportive-services-as-usual control conditions. Participants are currently/formerly homeless, alcohol dependent individuals (N=300). Outcomes include alcohol variables (i.e., craving, quantity/frequency, problems and biomarkers), health-related quality of life, and publicly funded service utilization and associated costs. Mediators include 10-point motivation rulers and the Penn Alcohol Craving Scale. XR-NTX and harm-reduction counseling are administered every 4weeks over the 12-week treatment course. Follow-up assessments are conducted at weeks 24 and 36. If found efficacious, XR-NTX and harm-reduction counseling will be well-positioned to support reductions in alcohol-related harm, decreases in costs associated with publicly funded service utilization, and increases in quality of life among homeless, alcohol-dependent individuals. Copyright © 2014 Elsevier Inc. All rights reserved.

Risks associated with antiretroviral treatment for human immunodeficiency virus (HIV): qualitative analysis of social media data and health state utility valuation.

PubMed

Matza, Louis S; Chung, Karen C; Kim, Katherine J; Paulus, Trena M; Davies, Evan W; Stewart, Katie D; McComsey, Grace A; Fordyce, Marshall W

2017-07-01

Despite benefits of antiretroviral therapies (ART), people with HIV infection have increased risk of cardiovascular disease, kidney disease, and low bone mineral density. Some ARTs increase risk of these events. The purpose of this study was to examine patients' perspectives of these risks and estimate health state utilities associated with these risks for use in cost-utility models. Qualitative thematic analysis was conducted to examine messages posted to the POZ/AIDSmeds Internet community forums, focusing on bone, kidney, and cardiovascular side effects and risks of HIV/AIDS medications. Then, health state vignettes were drafted based on this qualitative analysis, literature review, and clinician interviews. The health states (representing HIV, plus treatment-related risks) were valued in time trade-off interviews with general population participants in the UK. Qualitative analysis of the Internet forums documented patient concerns about ART risks, as well as treatment decisions made because of these risks. A total of 208 participants completed utility interviews (51.4% female; mean age 44.6 years). The mean utility of the HIV health state (virologically suppressed, treated with ART) was 0.86. Adding a description of risk resulted in statistically significant disutility (i.e., utility decreases): renal risk (disutility = -0.02), bone risk (-0.03), and myocardial infarction risk (-0.05). Patient concerns and treatment decisions were documented via qualitative analysis of Internet forum discussions, and the impact of these concerns was quantified in terms of health state utilities. The resulting disutilities may be useful for differentiating among ARTs in economic modeling of treatment for patients with HIV.

Reading the Tea Leaves: How Utilities in the West Are Managing Carbon Regulatory Risk in their Resource Plans

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

Barbose, Galen; Wiser, Ryan; Phadke, Amol

2008-02-01

The long economic lifetime and development lead-time of many electric infrastructure investments requires that utility resource planning consider potential costs and risks over a lengthy time horizon. One long-term -- and potentially far-reaching -- risk currently facing the electricity industry is the uncertain cost of future carbon dioxide (CO2) regulations. Recognizing the importance of this issue, many utilities (sometimes spurred by state regulatory requirements) are beginning to actively assess carbon regulatory risk within their resource planning processes, and to evaluate options for mitigating that risk. However, given the relatively recent emergence of this issue and the rapidly changing political landscape,more » methods and assumptions used to analyze carbon regulatory risk, and the impact of this analysis on the selection of a preferred resource portfolio, vary considerably across utilities. In this study, we examine the treatment of carbon regulatory risk in utility resource planning, through a comparison of the most-recent resource plans filed by fifteen investor-owned and publicly-owned utilities in the Western U.S. Together, these utilities account for approximately 60percent of retail electricity sales in the West, and cover nine of eleven Western states. This report has two related elements. First, we compare and assess utilities' approaches to addressing key analytical issues that arise when considering the risk of future carbon regulations. Second, we summarize the composition and carbon intensity of the preferred resource portfolios selected by these fifteen utilities and compare them to potential CO2 emission benchmark levels.« less

The Impact of Seat belts and Airbags on High Grade Renal Injuries and Nephrectomy Rates in Motor Vehicle Collisions

PubMed Central

Bjurlin, Marc A; Fantus, Richard J.; Mellett, Michele M.; Fantus, Richard J.; Villines, Dana

2015-01-01

Purpose Motor vehicle collisions (MVCs) are the most common cause of blunt genitourinary trauma. We compared renal injuries with no protective device to those with seat belts and/or airbags utilizing the National Trauma Data Bank (NTDB). Our primary endpoint was a reduction in high-grade renal injuries (grades III-V) with a secondary endpoint of reduction in nephrectomy rate. Materials and Methods The NTDB research datasets, admission year 2010, 2011, and 2012, were queried for MVC occupants with renal injury. Subjects were stratified by protective device and airbag deployment. Abbreviated Injury Score was converted to American Association for the Surgery of Trauma renal injury grade and nephrectomy rates were evaluated. Intergroup comparisons were analyzed for renal injury grades, nephrectomy, length of stay, and mortality with chi-square or one-way ANOVA. Protective device relative risk reduction was determined. Results A review of 466,028 MVCs revealed 3,846 renal injuries. Injured occupants without a protective device had a higher rate of high grade renal injury (45.1%) compared to those with seat belts (39.9%, p=0.008), airbags (42.3%, p=0.317), and seat belts with airbags (34.7%, p<0.001). Seat belts (20.0%, p<0.001), airbags (10.5% p<0.001), and seat belts with airbags (13.3%, p<0.001) reduced the rate of nephrectomy compared to no protective device (56.2%). The combination of seatbelts and airbags also reduced total hospital length of stay (p<0.001) and ICU days (p=0.005). Relative risk reduction of high-grade renal injuries (23.1%) and nephrectomy (39.9%) were highest for combined protective devices. Conclusions Occupants of MVCs with protective devices have reduced rates of high-grade renal injury and nephrectomy. Reduction appears most pronounced with the combination of seat belts and airbags. PMID:24846798

Removal of human pathogenic viruses in a down-flow hanging sponge (DHS) reactor treating municipal wastewater and health risks associated with utilization of the effluent for agricultural irrigation.

PubMed

Kobayashi, Naohiro; Oshiki, Mamoru; Ito, Toshihiro; Segawa, Takahiro; Hatamoto, Masashi; Kato, Tsuyoshi; Yamaguchi, Takashi; Kubota, Kengo; Takahashi, Masanobu; Iguchi, Akinori; Tagawa, Tadashi; Okubo, Tsutomu; Uemura, Shigeki; Harada, Hideki; Motoyama, Toshiki; Araki, Nobuo; Sano, Daisuke

2017-03-01

A down-flow hanging sponge (DHS) reactor has been developed as a cost-effective wastewater treatment system that is adaptable to local conditions in low-income countries. A pilot-scale DHS reactor previously demonstrated stable reduction efficiencies for chemical oxygen demand (COD) and ammonium nitrogen over a year at ambient temperature, but the pathogen reduction efficiency of the DHS reactor has yet to be investigated. In the present study, the reduction efficiency of a pilot-scale DHS reactor fed with municipal wastewater was investigated for 10 types of human pathogenic viruses (norovirus GI, GII and GIV, aichivirus, astrovirus, enterovirus, hepatitis A and E viruses, rotavirus, and sapovirus). DHS influent and effluent were collected weekly or biweekly for 337 days, and concentrations of viral genomes were determined by microfluidic quantitative PCR. Aichivirus, norovirus GI and GII, enterovirus, and sapovirus were frequently detected in DHS influent, and the log 10 reduction (LR) of these viruses ranged from 1.5 to 3.7. The LR values for aichivirus and norovirus GII were also calculated using a Bayesian estimation model, and the average LR (±standard deviation) values for aichivirus and norovirus GII were estimated to be 1.4 (±1.5) and 1.8 (±2.5), respectively. Quantitative microbial risk assessment was conducted to calculate a threshold reduction level for norovirus GII that would be required for the use of DHS effluent for agricultural irrigation, and it was found that LRs of 2.6 and 3.7 for norovirus GII in the DHS effluent were required in order to not exceed the tolerable burden of disease at 10 -4 and 10 -6 disability-adjusted life years loss per person per year, respectively, for 95% of the exposed population during wastewater reuse for irrigation. Copyright © 2016 Elsevier Ltd. All rights reserved.

Additive Manufacturing and 3D Printing in NASA: An Overview of Current Projects and Future Initiatives for Space Exploration

NASA Technical Reports Server (NTRS)

Clinton, R. G., Jr.

2014-01-01

NASA, including each Mission Directorate, is investing in, experimenting with, and/or utilizing AM across a broad spectrum of applications and projects; Centers have created and are continuing to create partnerships with industry, other Government Agencies, other Centers, and Universities; In-house additive manufacturing capability enables rapid iteration of the entire design, development and testing process, increasing innovation and reducing risk and cost to projects; For deep space exploration, AM offers significant reduction to logistics costs and risk by providing ability to create on demand; There are challenges: Overwhelming message from recent JANNAF AM for Propulsion Applications TIM was "certification."; NASA will continue to work with our partners to address this and other challenges to advance the state of the art in AM and incorporate these capabilities into an array of applications from aerospace to science missions to deep space exploration.

Risk of defeats in the central nervous system during deep space missions.

PubMed

Kokhan, Viktor S; Matveeva, Marina I; Mukhametov, Azat; Shtemberg, Andrey S

2016-12-01

Space flight factors (SFF) significantly affect the operating activity of astronauts during deep space missions. Gravitational overloads, hypo-magnetic field and ionizing radiation are the main SFF that perturb the normal activity of the central nervous system (CNS). Acute and chronic CNS risks include alterations in cognitive abilities, reduction of motor functions and behavioural changes. Multiple experimental works have been devoted to the SFF effects on integrative functional activity of the brain; however, the model parameters utilized have not always been ideal and consistent. Even less is known regarding the combined effects of these SFF in a real interplanetary mission, for example to Mars. Our review aims to systemize and analyse the last advancements in astrobiology, with a focus on the combined effects of SFF; as well as to discuss on unification of the parameters for ground-based models of deep space missions. Copyright © 2016 Elsevier Ltd. All rights reserved.

Remote Sensing Contributions to Prediction and Risk Assessment of Natural Disasters Caused by Large Scale Rift Valley Fever Outbreaks

NASA Technical Reports Server (NTRS)

Anyamba, Assaf; Linthicum, Kenneth J.; Small, Jennifer; Britch, S. C.; Tucker, C. J.

2012-01-01

Remotely sensed vegetation measurements for the last 30 years combined with other climate data sets such as rainfall and sea surface temperatures have come to play an important role in the study of the ecology of arthropod-borne diseases. We show that epidemics and epizootics of previously unpredictable Rift Valley fever are directly influenced by large scale flooding associated with the El Ni o/Southern Oscillation. This flooding affects the ecology of disease transmitting arthropod vectors through vegetation development and other bioclimatic factors. This information is now utilized to monitor, model, and map areas of potential Rift Valley fever outbreaks and is used as an early warning system for risk reduction of outbreaks to human and animal health, trade, and associated economic impacts. The continuation of such satellite measurements is critical to anticipating, preventing, and managing disease epidemics and epizootics and other climate-related disasters.

Effect of vehicle type on the performance of second generation air bags for child occupants.

PubMed

Arbogast, Kristy B; Durbin, Dennis R; Kallan, Michael J; Winston, Flaura K

2003-01-01

Passenger air bags experienced considerable design modification in the late 1990s, principally to mitigate risks to child passengers. This study utilized Data from the Partners for Child Passenger Safety study, a large-scale child-focused crash surveillance system, to examine the effect of vehicle type on the differential performance of first and second generation air bags on injuries to restrained children in frontal impact crashes. Our results show that the benefit of second-generation air bags was seen in passenger cars - those children exposed to second-generation air bags were half as likely to sustain a serious injury - and minivans. However, in SUVs the data suggest no reduction in injury risk with the new designs. This field data provides crucial real-world experience to the automotive industry as they work towards the next generation of air bag designs.

Effect of Vehicle type on the Performance of Second Generation Air Bags for Child Occupants

PubMed Central

Arbogast, Kristy B.; Durbin, Dennis R.; Kallan, Michael J.; Winston, Flaura K.

2003-01-01

Passenger air bags experienced considerable design modification in the late 1990s, principally to mitigate risks to child passengers. This study utilized Data from the Partners for Child Passenger Safety study, a large-scale child-focused crash surveillance system, to examine the effect of vehicle type on the differential performance of first and second generation air bags on injuries to restrained children in frontal impact crashes. Our results show that the benefit of second-generation air bags was seen in passenger cars – those children exposed to second-generation air bags were half as likely to sustain a serious injury – and minivans. However, in SUVs the data suggest no reduction in injury risk with the new designs. This field data provides crucial real-world experience to the automotive industry as they work towards the next generation of air bag designs. PMID:12941218

Prenatal care and infant birth outcomes among Medicaid recipients.

PubMed

Guillory, V James; Samuels, Michael E; Probst, Janice C; Sharp, Glynda

2003-05-01

Infant morbidity due to low birth weight and preterm births results in emotional suffering and significant direct and indirect costs. African American infants continue to have worse birth outcomes than white infants. This study examines relationships between newborn hospital costs, maternal risk factors, and prenatal care in Medicaid recipients in an impoverished rural county in South Carolina. Medicaid African American mothers gave birth to fewer preterm infants than did non-Medicaid African American mothers. No differences in the rates of preterm infants were noted between white and African American mothers in the Medicaid group. Access to Medicaid services may have contributed to this reduction in disparities due to race. Early initiation of prenatal care compared with later initiation did not improve birth outcomes. Infants born to mothers who initiated prenatal care early had increased morbidity with increased utilization of hospital services, suggesting that high-risk mothers are entering prenatal care earlier.

Computer-facilitated rapid HIV testing in emergency care settings: provider and patient usability and acceptability.

PubMed

Spielberg, Freya; Kurth, Ann E; Severynen, Anneleen; Hsieh, Yu-Hsiang; Moring-Parris, Daniel; Mackenzie, Sara; Rothman, Richard

2011-06-01

Providers in emergency care settings (ECSs) often face barriers to expanded HIV testing. We undertook formative research to understand the potential utility of a computer tool, "CARE," to facilitate rapid HIV testing in ECSs. Computer tool usability and acceptability were assessed among 35 adult patients, and provider focus groups were held, in two ECSs in Washington State and Maryland. The computer tool was usable by patients of varying computer literacy. Patients appreciated the tool's privacy and lack of judgment and their ability to reflect on HIV risks and create risk reduction plans. Staff voiced concerns regarding ECS-based HIV testing generally, including resources for follow-up of newly diagnosed people. Computer-delivered HIV testing support was acceptable and usable among low-literacy populations in two ECSs. Such tools may help circumvent some practical barriers associated with routine HIV testing in busy settings though linkages to care will still be needed.

Impact of physical activity, cardiorespiratory fitness, and exercise training on markers of inflammation.

PubMed

Lavie, Carl J; Church, Timothy S; Milani, Richard V; Earnest, Conrad P

2011-01-01

Physical activity and exercise training (ET) enhance overall cardiorespiratory fitness (ie, fitness), thus producing many benefits in the primary and secondary prevention of cardiovascular diseases. Substantial evidence also indicates that acute and chronic inflammation is involved in the development and progression of atherosclerosis and major cardiovascular events. The most commonly utilized marker of inflammation is C-reactive protein (CRP). In this review, we discuss the importance of inflammation, especially CRP, as a cardiovascular risk marker by reviewing an abundant cross-sectional and clinical intervention literature providing evidence that physical activity, enhanced fitness, and ET are inversely associated with CRP and that being overweight or obese is directly related with inflammation/CRP. Although we discuss the controversy regarding whether or not ET reduces CRP independent of weight loss, clearly physical activity, improved fitness, and ET are associated with reductions in inflammation and overall cardiovascular risk in both primary and secondary prevention.

Propulsion and Cryogenics Advanced Development (PCAD) Project Propulsion Technologies for the Lunar Lander

NASA Technical Reports Server (NTRS)

Klem, Mark D.; Smith, Timothy D.

2008-01-01

The Propulsion and Cryogenics Advanced Development (PCAD) Project in the Exploration Technology Development Program is developing technologies as risk mitigation for Orion and the Lunar Lander. An integrated main and reaction control propulsion system has been identified as a candidate for the Lunar Lander Ascent Module. The propellants used in this integrated system are Liquid Oxygen (LOX)/Liquid Methane (LCH4) propellants. A deep throttle pump fed Liquid Oxygen (LOX)/Liquid Hydrogen (LH2) engine system has been identified for the Lunar Lander Descent Vehicle. The propellant combination and architecture of these propulsion systems are novel and would require risk reduction prior to detailed design and development. The PCAD Project addresses the technology requirements to obtain relevant and necessary test data to further the technology maturity of propulsion hardware utilizing these propellants. This plan and achievements to date will be presented.

Reduction in Sexual Risk Behaviors among College Students Following a Comprehensive Health Education Intervention.

ERIC Educational Resources Information Center

Turner, James C.; And Others

1993-01-01

Researchers studied college students' sexual behavior and the association of a comprehensive health education program with subsequent sexual risk behavior modifications. Pre- and postintervention surveys indicated the intervention created short-term reduction in sexual risk behaviors, but the reduction varied according to gender. (SM)

Estimating risk reduction required to break even in a health promotion program.

PubMed

Ozminkowski, Ronald J; Goetzel, Ron Z; Santoro, Jan; Saenz, Betty-Jo; Eley, Christine; Gorsky, Bob

2004-01-01

To illustrate a formula to estimate the amount of risk reduction required to break even on a corporate health promotion program. A case study design was implemented. Base year (2001) health risk and medical expenditure data from the company, along with published information on the relationships between employee demographics, health risks, and medical expenditures, were used to forecast demographics, risks, and expenditures for 2002 through 2011 and estimate the required amount of risk reduction. Motorola. 52,124 domestic employees. Demographics included age, gender, race, and job type. Health risks for 2001 were measured via health risk appraisal. Risks were noted as either high or low and related to exercise/eating habits, body weight, blood pressure, blood sugar levels, cholesterol levels, depression, stress, smoking/drinking habits, and seat belt use. Medical claims for 2001 were used to calculate medical expenditures per employee. Assuming a dollar 282 per employee program cost, Motorola employees would need to reduce their lifestyle-related health risks by 1.08% to 1.42% per year to break even on health promotion programming, depending upon the discount rate. Higher or lower program investments would change the risk reduction percentages. Employers can use information from published studies, along with their own data, to estimate the amount of risk reduction required to break even on their health promotion programs.

Dopamine reward prediction error responses reflect marginal utility.

PubMed

Stauffer, William R; Lak, Armin; Schultz, Wolfram

2014-11-03

Optimal choices require an accurate neuronal representation of economic value. In economics, utility functions are mathematical representations of subjective value that can be constructed from choices under risk. Utility usually exhibits a nonlinear relationship to physical reward value that corresponds to risk attitudes and reflects the increasing or decreasing marginal utility obtained with each additional unit of reward. Accordingly, neuronal reward responses coding utility should robustly reflect this nonlinearity. In two monkeys, we measured utility as a function of physical reward value from meaningful choices under risk (that adhered to first- and second-order stochastic dominance). The resulting nonlinear utility functions predicted the certainty equivalents for new gambles, indicating that the functions' shapes were meaningful. The monkeys were risk seeking (convex utility function) for low reward and risk avoiding (concave utility function) with higher amounts. Critically, the dopamine prediction error responses at the time of reward itself reflected the nonlinear utility functions measured at the time of choices. In particular, the reward response magnitude depended on the first derivative of the utility function and thus reflected the marginal utility. Furthermore, dopamine responses recorded outside of the task reflected the marginal utility of unpredicted reward. Accordingly, these responses were sufficient to train reinforcement learning models to predict the behaviorally defined expected utility of gambles. These data suggest a neuronal manifestation of marginal utility in dopamine neurons and indicate a common neuronal basis for fundamental explanatory constructs in animal learning theory (prediction error) and economic decision theory (marginal utility). Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Infectious helminth ova in wastewater and sludge: A review on public health issues and current quantification practices.

PubMed

Gyawali, P

2018-02-01

Raw and partially treated wastewater has been widely used to maintain the global water demand. Presence of viable helminth ova and larvae in the wastewater raised significant public health concern especially when used for agriculture and aquaculture. Depending on the prevalence of helminth infections in communities, up to 1.0 × 10 3 ova/larvae can be presented per litre of wastewater and 4 gm (dry weight) of sludge. Multi-barrier approaches including pathogen reduction, risk assessment, and exposure reduction have been suggested by health regulators to minimise the potential health risk. However, with a lack of a sensitive and specific method for the quantitative detection of viable helminth ova from wastewater, an accurate health risk assessment is difficult to achieve. As a result, helminth infections are difficult to control from the communities despite two decades of global effort (mass drug administration). Molecular methods can be more sensitive and specific than currently adapted culture-based and vital stain methods. The molecular methods, however, required more and thorough investigation for its ability with accurate quantification of viable helminth ova/larvae from wastewater and sludge samples. Understanding different cell stages and corresponding gene copy numbers is pivotal for accurate quantification of helminth ova/larvae in wastewater samples. Identifying specific genetic markers including protein, lipid, and metabolites using multiomics approach could be utilized for cheap, rapid, sensitive, specific and point of care detection tools for helminth ova and larva in the wastewater.

Development of risk reduction behavioral counseling for Ebola virus disease survivors enrolled in the Sierra Leone Ebola Virus Persistence Study, 2015-2016

PubMed Central

Malik, Tasneem; Ariyarajah, Archchun; Ongpin, Patricia; Hogben, Matthew; McDonald, Suzanna L. R.; Marrinan, Jaclyn; Massaquoi, Thomas; Thorson, Anna; Ervin, Elizabeth; Bernstein, Kyle; Ross, Christine; Liu, William J.; Kroeger, Karen; Durski, Kara N.; Broutet, Nathalie; Knust, Barbara; Deen, Gibrilla F.

2017-01-01

Background During the 2014–2016 West Africa Ebola Virus Disease (EVD) epidemic, the public health community had concerns that sexual transmission of the Ebola virus (EBOV) from EVD survivors was a risk, due to EBOV persistence in body fluids of EVD survivors, particularly semen. The Sierra Leone Ebola Virus Persistence Study was initiated to investigate this risk by assessing EBOV persistence in numerous body fluids of EVD survivors and providing risk reduction counseling based on test results for semen, vaginal fluid, menstrual blood, urine, rectal fluid, sweat, tears, saliva, and breast milk. This publication describes implementation of the counseling protocol and the key lessons learned. Methodology/Principal findings The Ebola Virus Persistence Risk Reduction Behavioral Counseling Protocol was developed from a framework used to prevent transmission of HIV and other sexually transmitted infections. The framework helped to identify barriers to risk reduction and facilitated the development of a personalized risk-reduction plan, particularly around condom use and abstinence. Pre-test and post-test counseling sessions included risk reduction guidance, and post-test counseling was based on the participants’ individual test results. The behavioral counseling protocol enabled study staff to translate the study’s body fluid test results into individualized information for study participants. Conclusions/Significance The Ebola Virus Persistence Risk Reduction Behavioral Counseling Protocol provided guidance to mitigate the risk of EBOV transmission from EVD survivors. It has since been shared with and adapted by other EVD survivor body fluid testing programs and studies in Ebola-affected countries. PMID:28892490

Application of fuel cells with heat recovery for integrated utility systems

NASA Technical Reports Server (NTRS)

Shields, V.; King, J. M., Jr.

1975-01-01

This paper presents the results of a study of fuel cell powerplants with heat recovery for use in an integrated utility system. Such a design provides for a low pollution, noise-free, highly efficient integrated utility. Use of the waste heat from the fuel cell powerplant in an integrated utility system for the village center complex of a new community results in a reduction in resource consumption of 42 percent compared to conventional methods. In addition, the system has the potential of operating on fuels produced from waste materials (pyrolysis and digester gases); this would provide further reduction in energy consumption.

Changes in diet, cardiovascular risk factors and modelled cardiovascular risk following diagnosis of diabetes: 1-year results from the ADDITION-Cambridge trial cohort.

PubMed

Savory, L A; Griffin, S J; Williams, K M; Prevost, A T; Kinmonth, A-L; Wareham, N J; Simmons, R K

2014-02-01

To describe change in self-reported diet and plasma vitamin C, and to examine associations between change in diet and cardiovascular disease risk factors and modelled 10-year cardiovascular disease risk in the year following diagnosis of Type 2 diabetes. Eight hundred and sixty-seven individuals with screen-detected diabetes underwent assessment of self-reported diet, plasma vitamin C, cardiovascular disease risk factors and modelled cardiovascular disease risk at baseline and 1 year (n = 736) in the ADDITION-Cambridge trial. Multivariable linear regression was used to quantify the association between change in diet and cardiovascular disease risk at 1 year, adjusting for change in physical activity and cardio-protective medication. Participants reported significant reductions in energy, fat and sodium intake, and increases in fruit, vegetable and fibre intake over 1 year. The reduction in energy was equivalent to an average-sized chocolate bar; the increase in fruit was equal to one plum per day. There was a small increase in plasma vitamin C levels. Increases in fruit intake and plasma vitamin C were associated with small reductions in anthropometric and metabolic risk factors. Increased vegetable intake was associated with an increase in BMI and waist circumference. Reductions in fat, energy and sodium intake were associated with reduction in HbA1c , waist circumference and total cholesterol/modelled cardiovascular disease risk, respectively. Improvements in dietary behaviour in this screen-detected population were associated with small reductions in cardiovascular disease risk, independently of change in cardio-protective medication and physical activity. Dietary change may have a role to play in the reduction of cardiovascular disease risk following diagnosis of diabetes. © 2013 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.

Reduction in promotor methylation utilizing EGCG (epigallocatechin-3-gallate) restores RXRα expression in human colon cancer cells.

PubMed

Morris, Jay; Moseley, Vondina R; Cabang, April B; Coleman, Katie; Wei, Wei; Garrett-Mayer, Elizabeth; Wargovich, Michael J

2016-06-07

Silencing of regulatory genes through hypermethylation of CpG islands is an important mechanism in tumorigenesis. In colon cancer, RXRα, an important dimerization partner with other nuclear transcription factors, is silenced through this mechanism. We previously found that colon tumors in ApcMin/+ mice had diminished levels of RXRα protein and expression levels of this gene were restored by treatment with a green tea intervention, due to reduced promoter methylation of RXRα. We hypothesized that CIMP+ cell lines, which epigenetically silence key regulatory genes would also evidence silencing of RXRα and EGCG treatment would restore its expression. We indeed found EGCG to restore RXRα activity levels in the human cell lines, in a dose dependent manner and reduced RXRα promoter methylation. EGCG induced methylation changes in several other colon cancer related genes but did not cause a decrease in global methylation. Numerous epidemiological reports have shown the benefits of green tea consumption in reducing colon cancer risk but to date no studies have shown that the risk reduction may be related to the epigenetic restoration by tea polyphenols. Our results show that EGCG modulates the reversal of gene silencing involved in colon carcinogenesis providing a possible avenue for colon cancer prevention and treatment.

Understanding Acceptable Level of Risk: Incorporating the Economic Cost of Under-Managing Invasive Species.

PubMed

Davidson, Alisha D; Hewitt, Chad L; Kashian, Donna R

2015-01-01

Management of nonindigenous species includes prevention, early detection and rapid response and control. Early detection and rapid response depend on prioritizing and monitoring sites at risk for arrival or secondary spread of nonindigenous species. Such monitoring efforts require sufficient biosecurity budgets to be effective and meet management or policy directives for reduced risk of introduction. Such consideration of risk reduction is rarely considered, however. Here, we review the concepts of acceptable level of risk (ALOR) and associated costs with respect to nonindigenous species and present a framework for aligning risk reduction priorities with available biosecurity resources. We conclude that available biosecurity resources may be insufficient to attain stated and desired risk reduction. This outcome highlights the need to consider policy and management directives when beginning a biosecurity program to determine the feasibility of risk reduction goals, given available resources.

Guidelines for contingency planning NASA (National Aeronautics and Space Administration) ADP security risk reduction decision studies

NASA Technical Reports Server (NTRS)

Tompkins, F. G.

1984-01-01

Guidance is presented to NASA Computer Security Officials for determining the acceptability or unacceptability of ADP security risks based on the technical, operational and economic feasibility of potential safeguards. The risk management process is reviewed as a specialized application of the systems approach to problem solving and information systems analysis and design. Reporting the results of the risk reduction analysis to management is considered. Report formats for the risk reduction study are provided.

Modeling a 15-min extravehicular activity prebreathe protocol using NASA's exploration atmosphere (56.5 kPa/34% O2)

NASA Astrophysics Data System (ADS)

Abercromby, Andrew F. J.; Conkin, Johnny; Gernhardt, Michael L.

2015-04-01

NASA's plans for future human exploration missions utilize a new atmosphere of 56.5 kPa (8.2 psia), 34% O2, 66% N2 to enable rapid extravehicular activity (EVA) capability with minimal gas losses; however, existing EVA prebreathe protocols to mitigate risk of decompression sickness (DCS) are not applicable to the new exploration atmosphere. We provide preliminary analysis of a 15-min prebreathe protocol and examine the potential benefits of intermittent recompression (IR) and an abbreviated N2 purge on crew time and gas consumables usage. A probabilistic model of decompression stress based on an established biophysical model of DCS risk was developed, providing significant (p<0.0001) prediction and goodness-of-fit with 84 cases of DCS in 668 human altitude exposures including a variety of pressure profiles. DCS risk for a 15-min prebreathe protocol was then estimated under different exploration EVA scenarios. Estimated DCS risk for all EVA scenarios modeled using the 15-min prebreathe protocol ranged between 6.1% and 12.1%. Supersaturation in neurological tissues (5- and 10-min half-time compartments) is prevented and tissue tensions in faster half-time compartments (≤40 min), where the majority of whole-body N2 is located, are reduced to about the levels (30.0 vs. 27.6 kPa) achieved during a standard Shuttle prebreathe protocol. IR reduced estimated DCS risk from 9.7% to 7.9% (1.8% reduction) and from 8.4% to 6.1% (2.3% reduction) for the scenarios modeled; the penalty of N2 reuptake during IR may be outweighed by the benefit of decreased bubble size. Savings of 75% of purge gas and time (0.22 kg gas and 6 min of crew time per person per EVA) are achievable by abbreviating the EVA suit purge to 20% N2 vs. 5% N2 at the expense of an increase in estimated DCS risk from 9.7% to 12.1% (2.4% increase). A 15-min prebreathe protocol appears feasible using the new exploration atmosphere. IR between EVAs may enable reductions in suit purge and prebreathe requirements, decompression stress, and/or suit operating pressures. Ground trial validation is required before operational implementation.

Relationship among Food-Safety Knowledge, Beliefs, and Risk-Reduction Behavior in University Students in Japan

ERIC Educational Resources Information Center

Takeda, Sayaka; Akamatsu, Rie; Horiguchi, Itsuko; Marui, Eiji

2011-01-01

Objective: To identify whether university students who have both food-safety knowledge and beliefs perform risk-reduction behaviors. Design: Cross-sectional research using a questionnaire that included food-safety knowledge, perceptions, risk-reduction behavior, stages for the selection of safer food based on the Transtheoretical Model, and…

Modifiable Prostate Cancer Risk Reduction and Early Detection Behaviors in Black Men

ERIC Educational Resources Information Center

Odedina, Folakemi T.; Scrivens, John J., Jr.; Larose-Pierre, Margareth; Emanuel, Frank; Adams, Angela Denise; Dagne, Getachew A.; Pressey, Shannon Alexis; Odedina, Oladapo

2011-01-01

Objective: To explore the personal factors related to modifiable prostate cancer risk-reduction and detection behaviors among black men. Methods: Three thousand four hundred thirty (3430) black men were surveyed and structural equation modeling employed to test study hypotheses. Results: Modifiable prostate cancer risk-reduction behavior was found…

A randomized controlled trial targeting alcohol use and sexual assault risk among college women at high risk for victimization.

PubMed

Gilmore, Amanda K; Lewis, Melissa A; George, William H

2015-11-01

Sexual assault risk reduction programs do not target alcohol use despite the widespread knowledge that alcohol use is a risk factor for being victimized. The current study assessed the effectiveness of a web-based combined sexual assault risk and alcohol use reduction program using a randomized control trial. A total of 207 college women between the ages of 18 and 20 who engaged in heavy episodic drinking were randomized to one of five conditions: full assessment only control condition, sexual assault risk reduction condition, alcohol use reduction condition, combined sexual assault risk and alcohol use reduction condition, and a minimal assessment only condition. Participants completed a 3-month follow-up survey on alcohol-related sexual assault outcomes, sexual assault outcomes, and alcohol use outcomes. Significant interactions revealed that women with higher severity of sexual assault at baseline experienced less incapacitated attempted or completed rapes, less severity of sexual assaults, and engaged in less heavy episodic drinking compared to the control condition at the 3-month follow-up. Web-based risk reduction programs targeting both sexual assault and alcohol use may be the most effective way to target the highest risk sample of college students for sexual assault: those with a sexual assault history and those who engage in heavy episodic drinking. Copyright © 2015 Elsevier Ltd. All rights reserved.

A Randomized Controlled Trial Targeting Alcohol Use and Sexual Assault Risk among College Women at High Risk for Victimization

PubMed Central

Gilmore, Amanda K.; Lewis, Melissa A.; George, William H.

2015-01-01

Current sexual assault risk reduction programs do not target alcohol use despite the widespread knowledge that alcohol use is a risk factor for being victimized. The current study assessed the effectiveness of a web-based combined sexual assault risk and alcohol use reduction program using a randomized control trial. A total of 207 college women between the ages of 18 and 20 who engaged in heavy episodic drinking were randomized to one of five conditions: full assessment only control condition, sexual assault risk reduction condition, alcohol use reduction condition, combined sexual assault risk and alcohol use reduction condition, and a minimal assessment only condition. Participants completed a 3-month follow-up survey on alcohol-related sexual assault outcomes, sexual assault outcomes, and alcohol use outcomes. Significant interactions revealed that women with higher incidence and severity of sexual assault at baseline experienced less incapacitated attempted or completed rapes, less incidence/severity of sexual assaults, and engaged in less heavy episodic drinking compared to the control condition at the 3-month follow-up. Web-based risk reduction programs targeting both sexual assault and alcohol use may be the most effective way to target the highest risk sample of college students for sexual assault: those with a sexual assault history and those who engage in heavy episodic drinking. PMID:26408290

76 FR 44301 - Information Collection; Homeowner Risk Reduction Behaviors Concerning Wildfire Risks and Climate...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-25

... Behaviors Concerning Wildfire Risks and Climate Change Impacts AGENCY: Forest Service, USDA. ACTION: Notice... collection, Homeowner Risk Reduction Behaviors Concerning Wildfire Risks and Climate Change Impacts. The... undertake, and factors that influence these choices, particularly factors related to climate change impacts...

24 CFR 990.185 - Utilities expense level: Incentives for energy conservation/rate reduction.

Code of Federal Regulations, 2011 CFR

2011-04-01

...) Utility benchmarking. HUD will pursue benchmarking utility consumption at the project level as part of the... convene a meeting with representation of appropriate stakeholders to review utility benchmarking options so that HUD may determine whether or how to implement utility benchmarking to be effective in FY 2011...

24 CFR 990.185 - Utilities expense level: Incentives for energy conservation/rate reduction.

Code of Federal Regulations, 2010 CFR

2010-04-01

...) Utility benchmarking. HUD will pursue benchmarking utility consumption at the project level as part of the... convene a meeting with representation of appropriate stakeholders to review utility benchmarking options so that HUD may determine whether or how to implement utility benchmarking to be effective in FY 2011...

Risk-dependent reward value signal in human prefrontal cortex

PubMed Central

Tobler, Philippe N.; Christopoulos, George I.; O'Doherty, John P.; Dolan, Raymond J.; Schultz, Wolfram

2009-01-01

When making choices under uncertainty, people usually consider both the expected value and risk of each option, and choose the one with the higher utility. Expected value increases the expected utility of an option for all individuals. Risk increases the utility of an option for risk-seeking individuals, but decreases it for risk averse individuals. In 2 separate experiments, one involving imperative (no-choice), the other choice situations, we investigated how predicted risk and expected value aggregate into a common reward signal in the human brain. Blood oxygen level dependent responses in lateral regions of the prefrontal cortex increased monotonically with increasing reward value in the absence of risk in both experiments. Risk enhanced these responses in risk-seeking participants, but reduced them in risk-averse participants. The aggregate value and risk responses in lateral prefrontal cortex contrasted with pure value signals independent of risk in the striatum. These results demonstrate an aggregate risk and value signal in the prefrontal cortex that would be compatible with basic assumptions underlying the mean-variance approach to utility. PMID:19369207

Dishonest Academic Conduct: From the Perspective of the Utility Function.

PubMed

Sun, Ying; Tian, Rui

Dishonest academic conduct has aroused extensive attention in academic circles. To explore how scholars make decisions according to the principle of maximal utility, the author has constructed the general utility function based on the expected utility theory. The concrete utility functions of different types of scholars were deduced. They are as follows: risk neutral, risk averse, and risk preference. Following this, the assignment method was adopted to analyze and compare the scholars' utilities of academic conduct. It was concluded that changing the values of risk costs, internal condemnation costs, academic benefits, and the subjective estimation of penalties following dishonest academic conduct can lead to changes in the utility of academic dishonesty. The results of the current study suggest that within scientific research, measures to prevent and govern dishonest academic conduct should be formulated according to the various effects of the above four variables.

The Value of Risk Pooling for Mitigating Water Utility Financial Risks Arising From Water Scarcity

NASA Astrophysics Data System (ADS)

Baum, R.; Characklis, G. W.; Hughes, J.; Eskaf, S.

2015-12-01

Water utilities across the United States face growing supply risks as demand growth and extreme weather events make water scarcity more common. As it has become more difficult and expensive to build new supply capacity to accommodate these events, many utility managers respond by either imposing conservation measures, which reduces revenues, or acquiring additional water from other sources, which increases costs. These actions lead to changing financial trends that are difficult to predict and that utilities are currently ill-equipped to manage. As a result, adaptation strategies and tools are being developed to reduce utility vulnerabilities, ensuring both financial stability and continued access to low cost financing, a critical consideration for a capital intensive industry. Previous work in this area has involved the development of utility specific financial hedging tools. However, the time and informational requirements associated with developing these individualized strategies may be a limiting factor for widespread implementation. The objective of this research is to develop more generalized hedging instruments that can be applied simultaneously to multiple utilities across the United States, thereby increasing the potential for widespread implementation. This work first analyzes the financial risks of water scarcity for a large set of water utilities across the country and then proposes a financial hedging solution to mitigate these risks through hydrologic index-based financial insurance. Results provide insights into the most effective indices, the potential for risk pooling to reduce insurance costs, and the performance of these contracts in managing utility financial risk arising from drought.

"We don't want our clothes to smell smoke": changing malaria control practices and opportunities for integrated community-based management in Baringo, Kenya.

PubMed

Amadi, Jacinter A; Olago, Daniel O; Ong'amo, George O; Oriaso, Silas O; Nyamongo, Isaac K; Estambale, Benson B A

2018-05-09

The decline in global malaria cases is attributed to intensified utilization of primary vector control interventions and artemisinin-based combination therapies (ACTs). These strategies are inadequate in many rural areas, thus adopting locally appropriate integrated malaria control strategies is imperative in these heterogeneous settings. This study aimed at investigating trends and local knowledge on malaria and to develop a framework for malaria control for communities in Baringo, Kenya. Clinical malaria cases obtained from four health facilities in the riverine and lowland zones were used to analyse malaria trends for the 2005-2014 period. A mixed method approach integrating eight focus group discussions, 12 key informant interviews, 300 survey questionnaires and two stakeholders' consultative forums were used to assess local knowledge on malaria risk and develop a framework for malaria reduction. Malaria cases increased significantly during the 2005-2014 period (tau = 0.352; p < 0.001) in the riverine zone. March, April, May, June and October showed significant increases compared to other months. Misconceptions about the cause and mode of malaria transmission existed. Gender-segregated outdoor occupation such as social drinking, farm activities, herding, and circumcision events increased the risk of mosquito bites. A positive relationship occurred between education level and opinion on exposure to malaria risk after dusk (χ 2  = 2.70, p < 0.05). There was over-reliance on bed nets, yet only 68% (204/300) of respondents owned at least one net. Complementary malaria control measures were under-utilized, with 90% of respondents denying having used either sprays, repellents or burnt cow dung or plant leaves over the last one year before the study was conducted. Baraza, radios, and mobile phone messages were identified as effective media for malaria information exchange. Supplementary strategies identified included unblocking canals, clearing Prosopis bushes, and use of community volunteers and school clubs to promote social behaviour change. The knowledge gap on malaria transmission should be addressed to minimize the impacts and enhance uptake of appropriate malaria management mechanisms. Implementing community-based framework can support significant reductions in malaria prevalence by minimizing both indoor and outdoor malaria transmissions.

Social Support and HIV-related Risk Behaviors: A Systematic Review of the Global Literature

PubMed Central

Li, Xiaoming; Stanton, Bonita

2013-01-01

Existing empirical evidence has well documented the role of social support in both physical and psychological well-being among various populations. In the context of HIV prevention, the rapid increase of studies on social support merits a systematic review to synthesize the current global literature on association between social support and HIV-related risk behaviors. The current review reveals a complex picture of this relationship across diverse populations. Existing studies indicate that higher levels of social support are related to fewer HIV-related risk behaviors among female sex workers and people living with HIV/AIDS and heterosexual adults in general. However, influences of social support on HIV-related risk behaviors are inconsistent within drug users, men who have sex with men and adolescents. These variations in findings may be attributed to different measurement of social support in different studies, specific context of social support for diverse population, or various characteristics of the social networks the study population obtained support from. Future studies are needed to explore the mechanism of how social support affects HIV-related risk behaviors. HIV prevention intervention efforts need to focus on the positive effect of social support for various vulnerable and at-risk populations. Future efforts also need to incorporate necessary structure change and utilize technical innovation in order to maximize the protective role of social support in HIV risk prevention or reduction. PMID:23921582

Fat reduction to prevent prostate cancer: waiting for more evidence?

PubMed

Moyad, M A

2001-09-01

Complementary medicine has become an important area of interest for patients and researchers around the world. The utilization of some of these therapies by many individuals makes it imperative to understand whether they have any role in treatment of cancer or other diseases. Some of such therapies may play a role in the prevention of prostate cancer. Clinical trials are addressing this issue, and whether these products could also improve prognosis of prostate cancer. That dietary fat reduction may help to prevent prostate cancer is supported by numerous case-control studies reported over the past several decades, but recent prospective studies suggest that the impact of fat reduction in this regard may not be great. Clinicians should be careful not to suggest such a benefit until more research provides a better picture of the situation. Breast cancer is probably the best example of why more research into dietary changes for reduction in cancer risk is needed. Once believed to play a significant role, recent prospective studies suggest that dietary fat reduction may have little effect on breast cancer prevention, although some interesting insights have been gained with regard to the method of meat preparation and the influence of genetics. Fat reduction, together with soy products or other plant estrogen foods, may have a symbiotic relationship. Numerous healthy lifestyle changes incorporated and practiced at one time (healthy diet, attainment and maintenance of normal weight, soy consumption, among others) may hold some promise in the area of cancer prevention. In the meantime any healthy lifestyle or dietary change should be encouraged, because it may reduce the risk of cardiovascular disease, which is still the number one cause of mortality. It is also an important cause of morbidity and mortality in cancer patients. Regardless, complementary medicine should probably be discussed with any patient who is initiating or undergoing conventional treatment, because of the cardiovascular benefits and overall potential impact on all-cause mortality. Whether such therapies impact on prostate carcinoma remains to be determined through additional prospective investigations.

Climate change air toxic co-reduction in the context of macroeconomic modelling.

PubMed

Crawford-Brown, Douglas; Chen, Pi-Cheng; Shi, Hsiu-Ching; Chao, Chia-Wei

2013-08-15

This paper examines the health implications of global PM reduction accompanying greenhouse gas emissions reductions in the 180 national economies of the global macroeconomy. A human health effects module based on empirical data on GHG emissions, PM emissions, background PM concentrations, source apportionment and human health risk coefficients is used to estimate reductions in morbidity and mortality from PM exposures globally as co-reduction of GHG reductions. These results are compared against the "fuzzy bright line" that often underlies regulatory decisions for environmental toxics, and demonstrate that the risk reduction through PM reduction would usually be considered justified in traditional risk-based decisions for environmental toxics. It is shown that this risk reduction can be on the order of more than 4 × 10(-3) excess lifetime mortality risk, with global annual cost savings of slightly more than $10B, when uniform GHG reduction measures across all sectors of the economy form the basis for climate policy ($2.2B if only Annex I nations reduce). Consideration of co-reduction of PM-10 within a climate policy framework harmonized with other environmental policies can therefore be an effective driver of climate policy. An error analysis comparing results of the current model against those of significantly more spatially resolved models at city and national scales indicates errors caused by the low spatial resolution of the global model used here may be on the order of a factor of 2. Copyright © 2013 Elsevier Ltd. All rights reserved.

Perchlorate Reduction by Yeast for Mars Exploration

NASA Technical Reports Server (NTRS)

Sharma, Alaisha

2015-01-01

Martian soil contains high levels (0.6 percentage by mass) of calcium perchlorate (Ca(ClO4)2), which readily dissociates into calcium and the perchlorate ion (ClO4-) in water. Even in trace amounts, perchlorates are toxic to humans and have been implicated in thyroid dysfunction. Devising methods to lessen perchlorate contamination is crucial to minimizing the health risks associated with human exploration and colonization of Mars. We designed a perchlorate reduction pathway, which sequentially reduces perchlorate to chloride (Cl-) and oxygen (O2), for implementation in the yeast Saccharomyces cerevisiae. Using genes obtained from perchlorate reducing bacteria Azospira oryzae and Dechloromonas aromatica, we plan to assemble this pathway directly within S. cerevisiae through recombinational cloning. A perchlorate reduction pathway would enable S. cerevisiae to lower perchlorate levels and produce oxygen, which may be harvested or used directly by S. cerevisiae for aerobic growth and compound synthesis. Moreover, using perchlorate as an external electron acceptor could improve the efficiency of redox-imbalanced production pathways in yeast. Although several perchlorate reducing bacteria have been identified and utilized in water treatment systems on Earth, the widespread use of S. cerevisiae as a synthetic biology platform justifies the development of a perchlorate reducing strain for implementation on Mars.

Did Health Care Reform Help Kentucky Address Disparities in Coverage and Access to Care among the Poor?

PubMed

Benitez, Joseph A; Adams, E Kathleen; Seiber, Eric E

2018-06-01

To evaluate the impact of Kentucky's full rollout of the Affordable Care Act on disparities in access to care due to poverty. Restricted version of the Behavioral Risk Factor Surveillance System (BRFSS) for Kentucky and years 2011-2015. We use a difference-in-differences framework to compare trends before and after implementation of the Affordable Care Act (ACA) in health insurance coverage, several access measures, and health care utilization for residents in higher versus lower poverty ZIP codes. Much of the reduction in Kentucky's uninsured rate appears driven by large uptakes in coverage from areas with higher concentrations of poverty. Residents in high-poverty communities experienced larger reductions, 8 percentage points (pp) in uninsured status and 7.5 pp in reporting unmet needs due to costs, than residents of lower poverty areas. These effects helped remove pre-ACA disparities in uninsured rates across these areas. Because we observe positive effects on coverage and reductions in financial barriers to care among those from poorer communities, our findings suggest that expanding Medicaid helps address the health care needs of the impoverished. © Health Research and Educational Trust.

Research and Development Project Summaries, October 1991

DTIC Science & Technology

1991-10-01

delivery methods, training cost reduction, demonstration of technology’ effectiveness, and the reduction of acquisition risk . The majority of the work...demonstrations, risk reduction developments, and cost-effectiveness investigations in simulator and training technologzv. This advanced development program is a...systems. The program is organized around specific demonstration tasks that target critical technical risks that confront future weapons system

Reducing intimate and paying partner violence against women who exchange sex in Mongolia: results from a randomized clinical trial.

PubMed

Carlson, Catherine E; Chen, Jiehua; Chang, Mingway; Batsukh, Altantsetseg; Toivgoo, Aira; Riedel, Marion; Witte, Susan S

2012-07-01

Women who exchange sex for money or other goods, that is, female sex workers, are at increased risk of experiencing physical and sexual violence from both paying and intimate partners. Exposure to violence can be exacerbated by alcohol use and HIV/STI risk. The purpose of this study is to examine the efficacy of a HIV/STI risk reduction and enhanced HIV/STI risk reduction intervention at decreasing paying and intimate partner violence against Mongolian women who exchange sex and engage in harmful alcohol use. Women are recruited and randomized to either (a) four sessions of a relationship-based HIV/STI risk reduction intervention (n = 49), (b) the same HIV/STI risk reduction intervention plus two additional motivational interviewing sessions (n = 58), or (c) a four session control condition focused on wellness promotion (n = 59). All the respondents complete assessments at baseline (preintervention) as well as at immediate posttest, 3 and 6 months postintervention. A multilevel logistic model finds that women who participated in the HIV/STI risk reduction group (OR = 0.14, p < .00), HIV/STI risk reduction and motivational interview group (OR = 0.46, p = .02), and wellness (OR = 0.20, p < .00) group reduced their exposure to physical and sexual violence in the past 90 days. No significant differences in effects are observed between conditions. This study demonstrates the efficacy of a relationship-based HIV/STI risk reduction intervention, a relationship-based HIV/STI risk reduction intervention combined with motivational interviewing, and a wellness promotion intervention in reducing intimate and paying partner violence against women who exchange sex in Mongolia. The findings have significant implications for the impact of minimal intervention and the potential role of peer networks and social support in reducing women's experiences of violence in resource poor settings.

The efficacy of serostatus disclosure for HIV Transmission risk reduction.

PubMed

O'Connell, Ann A; Reed, Sandra J; Serovich, Julianne A

2015-02-01

Interventions to assist HIV+ persons in disclosing their serostatus to sexual partners can play an important role in curbing rates of HIV transmission among men who have sex with men (MSM). Based on the methods of Pinkerton and Galletly (AIDS Behav 11:698-705, 2007), we develop a mathematical probability model for evaluating effectiveness of serostatus disclosure in reducing the risk of HIV transmission and extend the model to examine the impact of serosorting. In baseline data from 164 HIV+ MSM participating in a randomized controlled trial of a disclosure intervention, disclosure is associated with a 45.0 % reduction in the risk of HIV transmission. Accounting for serosorting, a 61.2 % reduction in risk due to disclosure was observed in serodisconcordant couples. The reduction in risk for seroconcordant couples was 38.4 %. Evidence provided supports the value of serostatus disclosure as a risk reduction strategy in HIV+ MSM. Interventions to increase serostatus disclosure and that address serosorting behaviors are needed.

The Efficacy of Serostatus Disclosure for HIV Transmission Risk Reduction

PubMed Central

O’Connell, Ann A.; Serovich, Julianne A.

2015-01-01

Interventions to assist HIV+ persons in disclosing their serostatus to sexual partners can play an important role in curbing rates of HIV transmission among men who have sex with men (MSM). Based on the methods of Pinkerton and Galletly (AIDS Behav 11:698–705, 2007), we develop a mathematical probability model for evaluating effectiveness of serostatus disclosure in reducing the risk of HIV transmission and extend the model to examine the impact of serosorting. In baseline data from 164 HIV+ MSM participating in a randomized controlled trial of a disclosure intervention, disclosure is associated with a 45.0 % reduction in the risk of HIV transmission. Accounting for serosorting, a 61.2 % reduction in risk due to disclosure was observed in serodisconcordant couples. The reduction in risk for seroconcordant couples was 38.4 %. Evidence provided supports the value of serostatus disclosure as a risk reduction strategy in HIV+ MSM. Interventions to increase serostatus disclosure and that address serosorting behaviors are needed. PMID:25164375

Communication about melanoma and risk reduction after melanoma diagnosis.

PubMed

Rodríguez, Vivian M; Berwick, Marianne; Hay, Jennifer L

2017-12-01

Melanoma patients are advised to perform regular risk-reduction practices, including sun protection as well as skin self-examinations (SSEs) and physician-led examinations. Melanoma-specific communication regarding family risk and screening may promote such behaviors. To this end, associations between patients' melanoma-specific communication and risk reduction were examined. Melanoma patients (N = 169) drawn from a population-based cancer registry reported their current risk-reduction practices, perceived risk of future melanoma, and communication with physicians and relatives about melanoma risk and screening. Patients were, on average, 56 years old and 6.7 years' post diagnosis; 51% were male, 93% reported "fair/very fair" skin color, 75% completed at least some college, and 22% reported a family history of melanoma. Patients reported varying levels of regular (always/nearly always) sun protection: sunscreen use (79%), shade seeking (60%), hat use (54%), and long-sleeve shirt use (30%). Only 28% performed thorough SSE regularly, whereas 92% reported undergoing physician-led skin examinations within the past year. Participants who were female, younger, and had a higher perceived risk of future melanoma were more likely to report past communication. In adjusted analyses, communication remained uniquely associated with increased sunscreen use and SSE. Encouraging melanoma patients to have a more active role in discussions concerning melanoma risk and screening with relatives and physicians alike may be a useful strategy to promote 2 key risk-reduction practices post melanoma diagnosis and treatment. Future research is needed to identify additional strategies to improve comprehensive risk reduction in long-term melanoma patients. Copyright © 2016 John Wiley & Sons, Ltd.

Violent Behaviors, Weapon Carrying, and Firearm Homicide Trends in African American Adolescents, 2001-2015.

PubMed

Khubchandani, Jagdish; Price, James H

2018-04-07

African American youths have the highest risk for firearm and other weapon related homicides. This study utilized the national Youth Risk Behavior Surveys from 2001 to 2015 to assess trends in violence related behaviors and weapon carrying of African American adolescents. Our analyses found statistically significant reductions in physical fighting and weapon carrying among African American male adolescents from 2007 to 2015. Planning suicide increased in both male and female African American adolescents since 2007. In addition, the number of firearm homicides increased in African American males. African American females and males had groups of items highly predictive of weapon carrying behaviors: alcohol, tobacco, and other drug use and violent risk behaviors. Both female and male students who made mostly A's or B's in school were significantly less likely to carry weapons in and out of school. Our findings indicate that firearm homicides have increased in African American adolescents, but weapon carrying in school going adolescents has significantly declined. School engagement and satisfactory school performance seems to have a significant protective effect on firearm homicides and violent behavior risks in African American adolescents.

Primary prevention of colorectal cancer: myth or reality?

PubMed

Crosara Teixeira, Marcela; Braghiroli, Maria Ignez; Sabbaga, Jorge; Hoff, Paulo M

2014-11-07

Colorectal cancer incidence has been rising strongly in parallel with economic development. In the past few decades, much has been learned about the lifestyle, dietary and medication risk factors for this malignancy. With respect to lifestyle, compelling evidence indicates that prevention of weight gain and maintenance of a reasonable level of physical activity can positively influence in lowering the risk. Although there is controversy about the role of specific nutritional factors, consideration of dietary pattern as a whole appears useful for formulating recommendations. Though quite often recommended, the role for many supplements, including omega-3, vitamin D, folate, and vitamin B6, remains unsettled. Only calcium and vitamin D supplementation appear to add a modest benefit, particularly in those with a low daily intake. With regard to chemoprevention, medications such as aspirin and nonsteroidal anti-inflammatory drugs, and postmenopausal hormonal replacement for women might be associated with substantial reductions in colorectal cancer risk, though their utility is affected by their side effect profile. However, the role of agents such as statins, bisphosphonates and antioxidants have yet to be determined. Ultimately, primary prevention strategies focusing on modifying environmental, lifestyle risk factors, and chemopreventive drugs are options that have already been tested, and may impact on colon cancer incidence.

Conditional economic incentives for reducing HIV risk behaviors: integration of psychology and behavioral economics.

PubMed

Operario, Don; Kuo, Caroline; Sosa-Rubí, Sandra G; Gálarraga, Omar

2013-09-01

This article reviews psychology and behavioral economic approaches to HIV prevention, and examines the integration and application of these approaches in conditional economic incentive (CEI) programs for reducing HIV risk behavior. We discuss the history of HIV prevention approaches, highlighting the important insights and limitations of psychological theories. We provide an overview of the theoretical tenets of behavioral economics that are relevant to HIV prevention, and utilize CEIs as an illustrative example of how traditional psychological theories and behavioral economics can be combined into new approaches for HIV prevention. Behavioral economic interventions can complement psychological frameworks for reducing HIV risk by introducing unique theoretical understandings about the conditions under which risky decisions are amenable to intervention. Findings from illustrative CEI programs show mixed but generally promising effects of economic interventions on HIV and sexually transmitted infection (STI) prevalence, HIV testing, HIV medication adherence, and drug use. CEI programs can complement psychological interventions for HIV prevention and behavioral risk reduction. To maximize program effectiveness, CEI programs must be designed according to contextual and population-specific factors that may determine intervention applicability and success. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Can theory predict the process of suicide on entry to prison? Predicting dynamic risk factors for suicide ideation in a high-risk prison population.

PubMed

Slade, Karen; Edelman, Robert

2014-01-01

Each year approximately 110,000 people are imprisoned in England and Wales and new prisoners remain one of the highest risk groups for suicide across the world. The reduction of suicide in prisoners remains difficult as assessments and interventions tend to rely on static risk factors with few theoretical or integrated models yet evaluated. To identify the dynamic factors that contribute to suicide ideation in this population based on Williams and Pollock's (2001) Cry of Pain (CoP) model. New arrivals (N = 198) into prison were asked to complete measures derived from the CoP model plus clinical and prison-specific factors. It was hypothesized that the factors of the CoP model would be predictive of suicide ideation. Support was provided for the defeat and entrapment aspects of the CoP model with previous self-harm, repeated times in prison, and suicide-permissive cognitions also key in predicting suicide ideation for prisoners on entry to prison. An integrated and dynamic model was developed that has utility in predicting suicide in early-stage prisoners. Implications for both theory and practice are discussed along with recommendations for future research.

Anionic surfactants in treated sewage and sludges: risk assessment to aquatic and terrestrial environments.

PubMed

Mungray, Arvind Kumar; Kumar, Pradeep

2008-05-01

Compared to low concentrations of anionic surfactants (AS) in activated sludge process effluents (ASP) (<0.2 mg/L), upflow anaerobic sludge blanket-polishing pond (UASB-PP) effluents were found to contain very high concentrations of AS (>3.5 mg/L). AS (or linear alkylbenzen sulfonate, LAS) removals >99% have been found for ASP while in case of UASB-PP it was found to be < or = 30%. AS concentrations averaged 7347 and 1452 mg/kg dry wt. in wet UASB and dried sludges, respectively. Treated sewage from UASB based sewage treatment plants (STPs) when discharged to aquatic ecosystems are likely to generate substantial risk. Post-treatment using 1-1.6d detention, anaerobic, non-algal polishing ponds was found ineffective. Need of utilizing an aerobic method of post-treatment of UASB effluent in place of an anaerobic one has been emphasized. Natural drying of UASB sludges on sludge drying beds (SDBs) under aerobic conditions results in reduction of adsorbed AS by around 80%. Application of UASB sludges on SDBs was found simple, economical and effective. While disposal of treated UASB effluent may cause risk to aquatic ecosystems, use of dried UASB sludges is not likely to cause risk to terrestrial ecosystems.

Reducing the risk of surgical site infections: did we really think SCIP was going to lead us to the promised land?

PubMed

Edmiston, Charles E; Spencer, Maureen; Lewis, Brian D; Brown, Kellie R; Rossi, Peter J; Henen, Cindy R; Smith, Heidi W; Seabrook, Gary R

2011-06-01

Surgical site infections (SSIs) are associated with substantial patient morbidity and death. It is estimated that 750,000-1 million SSIs occur in the U.S. each year, utilizing 3.7 million extra hospital days and costing more than $1.6 billion in excess hospital charges. Review of pertinent English-language literature. The Surgical Care Improvement Project (SCIP) was embraced as a "one-size-fits-all" strategy to reduce postoperative infectious morbidity 25% by 2010. Unfortunately, the evidence suggests that SCIP by itself has had little efficacy in reducing the overall risk of SSI. Whereas the SCIP initiative represents a first national effort to focus on reducing postoperative infectious morbidity and deaths, it fails to consider salient risk factors such as body mass index and selected surgical practices, including tourniquet application prior to incision. Rather than focus on a single risk-reduction strategy, future efforts to improve surgical outcomes should embrace a "SCIP-plus" multi-faceted, tiered interventional strategy that includes pre-admission antiseptic showering, state-of-the-art skin antisepsis, innovative antimicrobial technology, active staphylococcal surveillance, and pharmacologic-physiologic considerations unique to selective patient populations.

When parents disclose BRCA1/2 test results: their communication and perceptions of offspring response.

PubMed

Bradbury, Angela R; Patrick-Miller, Linda; Egleston, Brian L; Olopade, Olufunmilayo I; Daly, Mary B; Moore, Cynthia W; Sands, Colleen B; Schmidheiser, Helen; Kondamudi, Preethi K; Feigon, Maia; Ibe, Comfort N; Daugherty, Christopher K

2012-07-01

BRCA1/2 testing is not recommended for children, as risk reduction measures and screening are not generally recommended before 25 years old (YO). Little is known about the prevalence and predictors of parent communication to offspring and how offspring respond to this communication. Semi-structured interviews were conducted with parents who had BRCA1/2 testing and at least 1 child <25 YO. Logistic regressions were utilized to evaluate associations with communication. Framework analysis was utilized to analyze open-ended responses. A total of 253 parents completed interviews (61% response rate), reporting on 505 offspring. Twenty-nine percent of parents were BRCA1/2 mutation carriers. Three hundred thirty-four (66%) offspring learned of their parent's test result. Older offspring age (P ≤ .01), offspring gender (female, P = .05), parents' negative test result (P = .03), and parents' education (high school only, P = .02) were associated with communication to offspring. The most frequently reported initial offspring responses were neutral (41%) or relief (28%). Thirteen percent of offspring were reported to experience concern or distress (11%) in response to parental communication of their test results. Distress was more frequently perceived among offspring learning of their parent's BRCA1/2 positive or variant of uncertain significance result. Many parents communicate their BRCA1/2 test results to young offspring. Parents' perceptions of offspring responses appear to vary by offspring age and parent test result. A better understanding of how young offspring respond to information about hereditary risk for adult cancer could provide opportunities to optimize adaptive psychosocial responses to risk information and performance of health behaviors, in adolescence and throughout an at-risk life span. Copyright © 2012 American Cancer Society.

Status of geothermal direct use in Poland

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

Bujakowski, W.

1997-12-31

Geothermal Energy uses the natural heat of the Earth. It is a local energy source, competitive, renewable and acceptable from the ecological and social points of view, which is used either for the electricity production, or for direct application such as a district heating. A great number of operating geothermal installations are found in Europe. European Community energy programs foresee in the coming years a great reduction of conventional fuel consumption, due to the risks that dependency on imported fuels implies and to the future environmental problems, which a mass exploitation of these fuels can lead to. Thus, EC energymore » policy is aimed at a drastic reduction of oil consumption and at diversification of primary energy sources. This paper will present the results from the exploration and evaluation of geothermal water resources in Poland. Herewith, a short description of performed projects, examples of designed geothermal water utilization, some economical, sociological, ecological and political aspects of present out and future projects will be presented.« less

Reducing catheter-related thrombosis using a risk reduction tool centered on catheter to vessel ratio.

PubMed

Spencer, Timothy R; Mahoney, Keegan J

2017-11-01

In vascular access practices, the internal vessel size is considered important, and a catheter to vessel ratio (CVR) is recommended to assist clinicians in selecting the most appropriate-sized device for the vessel. In 2016, new practice recommendations stated that the CVR can increase from 33 to 45% of the vessels diameter. There has been evidence on larger diameter catheters and increased thrombosis risk in recent literature, while insufficient information established on what relationship to vessel size is appropriate for any intra-vascular device. Earlier references to clinical standards and guidelines did not clearly address vessel size in relation to the area consumed or external catheter diameter. The aim of this manuscript is to present catheter-related thrombosis evidence and develop a standardized process of ultrasound-guided vessel assessment, integrating CVR, Virchow's triad phenomenon and vessel health and preservation strategies, empowering an evidence-based approach to device placement. Through review, calculation and assessment on the areas of the 33 and 45% rule, a preliminary clinical tool was developed to assist clinicians make cognizant decisions when placing intravascular devices relating to target vessel size, focusing on potential reduction in catheter-related thrombosis. Increasing the understanding and utilization of CVRs will lead to a safer, more consistent approach to device placement, with potential thrombosis reduction strategies. The future of evidence-based data relies on the clinician to capture accurate vessel measurements and device-related outcomes. This will lead to a more dependable data pool, driving the relationship of catheter-related thrombosis and vascular assessment.

Artificial neural network modeling using clinical and knowledge independent variables predicts salt intake reduction behavior

PubMed Central

Isma’eel, Hussain A.; Sakr, George E.; Almedawar, Mohamad M.; Fathallah, Jihan; Garabedian, Torkom; Eddine, Savo Bou Zein

2015-01-01

Background High dietary salt intake is directly linked to hypertension and cardiovascular diseases (CVDs). Predicting behaviors regarding salt intake habits is vital to guide interventions and increase their effectiveness. We aim to compare the accuracy of an artificial neural network (ANN) based tool that predicts behavior from key knowledge questions along with clinical data in a high cardiovascular risk cohort relative to the least square models (LSM) method. Methods We collected knowledge, attitude and behavior data on 115 patients. A behavior score was calculated to classify patients’ behavior towards reducing salt intake. Accuracy comparison between ANN and regression analysis was calculated using the bootstrap technique with 200 iterations. Results Starting from a 69-item questionnaire, a reduced model was developed and included eight knowledge items found to result in the highest accuracy of 62% CI (58-67%). The best prediction accuracy in the full and reduced models was attained by ANN at 66% and 62%, respectively, compared to full and reduced LSM at 40% and 34%, respectively. The average relative increase in accuracy over all in the full and reduced models is 82% and 102%, respectively. Conclusions Using ANN modeling, we can predict salt reduction behaviors with 66% accuracy. The statistical model has been implemented in an online calculator and can be used in clinics to estimate the patient’s behavior. This will help implementation in future research to further prove clinical utility of this tool to guide therapeutic salt reduction interventions in high cardiovascular risk individuals. PMID:26090333

Optimising health care within given budgets: primary prevention of cardiovascular disease in different regions of Sweden.

PubMed

Löfroth, Emil; Lindholm, Lars; Wilhelmsen, Lars; Rosén, Måns

2006-01-01

This study investigated the consequences of applying strict health maximisation to the choice between three different interventions with a defined budget. We analysed three interventions of preventing cardiovascular diseases, through doctor's advice on smoking secession, through blood-pressure-lowering drugs, and through lipid-lowering drugs. A state transition model has been used to estimate the cost-utility ratios for entire population in three different county councils in Sweden, where the populations were stratified into mutually excluding risk groups. The incremental cost-utility ratios are being presented in a league table and combined with the local resources and the local epidemiological data as a proxy for need for treatment. All interventions with an incremental cost-utility ratio exceeding the threshold ratios are excluded from being funded. The threshold varied between 1687 Euro and 6192 Euro. The general reallocation of resources between the three interventions was a 60% reduction of blood-pressure-lowering drugs with redistribution of resources to advice on smoking secession and to lipid-lowering drugs. One advantage of this method is that the results are very concrete. Recommendations can thereby be more precise which hopefully will create a public debate between decision-makers, practising physicians and patient groups.

Perspectives on the utilization of aquaculture coproduct in Europe and Asia: prospects for value addition and improved resource efficiency.

PubMed

Newton, Richard; Telfer, Trevor; Little, Dave

2014-01-01

Aquaculture has often been criticized for its environmental impacts, especially efficiencies concerning global fisheries resources for use in aquafeeds among others. However, little attention has been paid to the contribution of coproducts from aquaculture, which can vary between 40% and 70% of the production. These have often been underutilized and could be redirected to maximize the efficient use of resource inputs including reducing the burden on fisheries resources. In this review, we identify strategies to enhance the overall value of the harvested yield including noneffluent processing coproducts for three of the most important global aquaculture species, and discuss the current and prospective utilization of these resources for value addition and environmental impact reduction. The review concludes that in Europe coproducts are often underutilized because of logistical reasons such as the disconnected nature of the value chain, and perceived legislative barriers. However, in Asia, most coproducts are used, often innovatively but not to their full economic potential and sometimes with possible human health and biosecurity risks. These include possible spread of diseased material and low traceability in some circumstances. Full economic and environmental appraisal is long overdue for the current and potential strategies available for coproduct utilization.

The effects of electric power industry restructuring on the safety of nuclear power plants in the United States

NASA Astrophysics Data System (ADS)

Butler, Thomas S.

Throughout the United States the electric utility industry is restructuring in response to federal legislation mandating deregulation. The electric utility industry has embarked upon an extraordinary experiment by restructuring in response to deregulation that has been advocated on the premise of improving economic efficiency by encouraging competition in as many sectors of the industry as possible. However, unlike the telephone, trucking, and airline industries, the potential effects of electric deregulation reach far beyond simple energy economics. This dissertation presents the potential safety risks involved with the deregulation of the electric power industry in the United States and abroad. The pressures of a competitive environment on utilities with nuclear power plants in their portfolio to lower operation and maintenance costs could squeeze them to resort to some risky cost-cutting measures. These include deferring maintenance, reducing training, downsizing staff, excessive reductions in refueling down time, and increasing the use of on-line maintenance. The results of this study indicate statistically significant differences at the .01 level between the safety of pressurized water reactor nuclear power plants and boiling water reactor nuclear power plants. Boiling water reactors exhibited significantly more problems than did pressurized water reactors.

Effects of a cardiovascular risk reduction intervention with psychobehavioral strategies for Korean adults with type 2 diabetes and metabolic syndrome.

PubMed

Kim, Chun-Ja; Kim, Dae-Jung; Park, Hyung-Ran

2011-01-01

Type 2 diabetes mellitus (DM) and metabolic syndrome are associated with high risk of cardiovascular disease (CVD) and depression. Although lifestyle modifications including regular exercise and weight control are recommended as a primary approach to glycemic control and CVD risk reduction for people with DM and/or metabolic syndrome, little is known concerning the effects of CVD risk reduction interventions using psychobehavioral strategies in this population. This pilot study investigated the effects of a 16-week CVD risk reduction intervention in Korean adults with type 2 DM and metabolic syndrome. A prospective, pretest and posttest, controlled, quasi-experimental design enrolled a convenience sample of 43 Korean adults with type 2 DM and metabolic syndrome at a university hospital. The adults in the intervention group participated in a 16-week CVD risk reduction intervention consisting of 150 minutes of regular exercise per week; 200- to 300-kcal reduced daily diet for weight control; one-on-one psychobehavioral counseling based on constructs from the Transtheoretical Model such as processes of change, self-efficacy, and decisional balance; and telephone coaching for behavioral modification. Participants in the control group received a booklet with basic diabetic education as part of their routine care. Repeated-measures analysis of variance was used for analyzing the effects of the CVD risk reduction intervention on cardiometabolic risk factors including the UK Prospective Diabetes Study score for 10-year CVD risk, glycated hemoglobin (HbA1c), and depression. The intervention group showed significant reductions (P < .05) at 16 weeks, compared with the control group on the UK Prospective Diabetes Study fatal risk scale (-1.73% vs -0.04%), triglycerides (-38.5 vs -15.1 mg/dL), fasting plasma glucose (-29.24 vs +1.77 mg/dL), HbA1c (-0.37% vs +0.17%), and depression (score, -3.24 vs 1.40) measurements. This pilot study yielded evidence for the beneficial impact of the CVD risk reduction intervention for Korean adults with type 2 DM and metabolic syndrome on improved glycemic control, reduced CVD risk, and depression.

29 CFR 1919.76 - Safe working load reduction.

Code of Federal Regulations, 2010 CFR

2010-07-01

... load reduction. (a) If the operation in which equipment is engaged never utilizes more than a fraction... physically capable of operation at the original load rating and the load reduction is not for the purpose of...

Beyond optimality: Multistakeholder robustness tradeoffs for regional water portfolio planning under deep uncertainty

NASA Astrophysics Data System (ADS)

Herman, Jonathan D.; Zeff, Harrison B.; Reed, Patrick M.; Characklis, Gregory W.

2014-10-01

While optimality is a foundational mathematical concept in water resources planning and management, "optimal" solutions may be vulnerable to failure if deeply uncertain future conditions deviate from those assumed during optimization. These vulnerabilities may produce severely asymmetric impacts across a region, making it vital to evaluate the robustness of management strategies as well as their impacts for regional stakeholders. In this study, we contribute a multistakeholder many-objective robust decision making (MORDM) framework that blends many-objective search and uncertainty analysis tools to discover key tradeoffs between water supply alternatives and their robustness to deep uncertainties (e.g., population pressures, climate change, and financial risks). The proposed framework is demonstrated for four interconnected water utilities representing major stakeholders in the "Research Triangle" region of North Carolina, U.S. The utilities supply well over one million customers and have the ability to collectively manage drought via transfer agreements and shared infrastructure. We show that water portfolios for this region that compose optimal tradeoffs (i.e., Pareto-approximate solutions) under expected future conditions may suffer significantly degraded performance with only modest changes in deeply uncertain hydrologic and economic factors. We then use the Patient Rule Induction Method (PRIM) to identify which uncertain factors drive the individual and collective vulnerabilities for the four cooperating utilities. Our framework identifies key stakeholder dependencies and robustness tradeoffs associated with cooperative regional planning, which are critical to understanding the tensions between individual versus regional water supply goals. Cooperative demand management was found to be the key factor controlling the robustness of regional water supply planning, dominating other hydroclimatic and economic uncertainties through the 2025 planning horizon. Results suggest that a modest reduction in the projected rate of demand growth (from approximately 3% per year to 2.4%) will substantially improve the utilities' robustness to future uncertainty and reduce the potential for regional tensions. The proposed multistakeholder MORDM framework offers critical insights into the risks and challenges posed by rising water demands and hydrological uncertainties, providing a planning template for regions now forced to confront rapidly evolving water scarcity risks.

Disseminating Childhood Home Injury Risk Reduction Information in Pakistan: Results from a Community-Based Pilot Study

PubMed Central

Chandran, Aruna; Khan, Uzma Rahim; Zia, Nukhba; Feroze, Asher; de Ramirez, Sarah Stewart; Huang, Cheng-Ming; Razzak, Junaid A.; Hyder, Adnan A.

2013-01-01

Background: Most childhood unintentional injuries occur in the home; however, very little home injury prevention information is tailored to developing countries. Utilizing our previously developed information dissemination tools and a hazard assessment checklist tailored to a low-income neighborhood in Pakistan, we pilot tested and compared the effectiveness of two dissemination tools. Methods: Two low-income neighborhoods were mapped, identifying families with a child aged between 12 and 59 months. In June and July 2010, all enrolled households underwent a home hazard assessment at the same time hazard reduction education was being given using an in-home tutorial or a pamphlet. A follow up assessment was conducted 4–5 months later. Results: 503 households were enrolled; 256 received a tutorial and 247 a pamphlet. The two groups differed significantly (p < 0.01) in level of maternal education and relationship of the child to the primary caregiver. However, when controlling for these variables, those receiving an in-home tutorial had a higher odds of hazard reduction than the pamphlet group for uncovered vats of water (OR 2.14, 95% CI: 1.28, 3.58), an open fire within reach of the child (OR 3.55, 95% CI: 1.80, 7.00), and inappropriately labeled cooking fuel containers (OR 1.86, 95% CI: 1.07, 3.25). Conclusions: This pilot project demonstrates the potential utility of using home-visit tutorials to decrease home hazards in a low-income neighborhood in Pakistan. A longer-term randomized study is needed to assess actual effectiveness of the use of allied health workers for home-based injury education and whether this results in decreased home injuries. PMID:23502323

Randomized controlled trial of contingency management for stimulant use in community mental health patients with serious mental illness.

PubMed

McDonell, Michael G; Srebnik, Debra; Angelo, Frank; McPherson, Sterling; Lowe, Jessica M; Sugar, Andrea; Short, Robert A; Roll, John M; Ries, Richard K

2013-01-01

The primary objective of this study was to determine whether contingency management was associated with increased abstinence from stimulant drug use in stimulant-dependent patients with serious mental illness treated in a community mental health center. Secondary objectives were to determine whether contingency management was associated with reductions in use of other substances, psychiatric symptoms, HIV risk behavior, and inpatient service utilization. A randomized controlled design was used to compare outcomes of 176 outpatients with serious mental illness and stimulant dependence. Participants were randomly assigned to receive 3 months of contingency management for stimulant abstinence plus treatment as usual or treatment as usual with reinforcement for study participation only. Urine drug tests and self report, clinician-report, and service utilization outcomes were assessed during the 3-month treatment period and the 3-month follow-up period. Although participants in the contingency management condition were significantly less likely to complete the treatment period than those assigned to the control condition (42% compared with 65%), they were 2.4 times (95% CI=1.9–3.0)more likely to submit a stimulant-negative urine test during treatment. Compared with participants in the control condition,they had significantly lower levels of alcohol use, injection drug use, and psychiatric symptoms and were one-fifth as likely as those assigned to the control condition to be admitted for psychiatric hospitalization during treatment. They also reported significantly fewer days of stimulant drug use during the 3-month follow-up. When added to treatment as usual, contingency management is associated with large reductions in stimulant,injection drug, and alcohol use.Reductions in psychiatric symptoms and hospitalizations are important secondary benefits.

A randomized controlled trial of contingency management for psycho-stimulant use in community mental health outpatients with co-occurring serious mental illness

PubMed Central

McDonell, Michael G.; Srebnik, Debra; Angelo, Frank; McPherson, Sterling; Lowe, Jessica M.; Sugar, Andrea; Short, Robert A.; Roll, John M.; Ries, Richard K.

2014-01-01

Objective The primary objective of this study was to determine if contingency management was associated with increased stimulant drug abstinence in community mental health outpatients with serious mental illness and stimulant dependence. Secondary objectives were to determine if contingency management was associated with reductions in use of other substances, psychiatric symptoms, HIV-risk behavior, and inpatient service utilization. Method A randomized controlled design compared outcomes of 176 outpatients with serious mental illness and stimulant dependence. Participants were randomized to three months of contingency management for stimulant abstinence plus treatment-as-usual or treatment-as-usual with reinforcement for study participation only. Urine drug tests, self-report, clinician-report, and service utilization outcomes were assessed during three-month treatment and three-month follow-up periods. Results While participants in the contingency management condition were less likely to complete the treatment period (n=38; 42%) than those assigned to the control condition (n=55; 65%), X2(1)=9.8, p=0.02; those assigned to the contingency management condition were 2.4 (CI=1.9-3.0) times more likely to submit a stimulant-negative urine test during treatment. Participants assigned to contingency management experienced significantly lower levels of alcohol use, injection drug use, psychiatric symptoms, and were five times less likely than those assigned to the control condition to be admitted for psychiatric hospitalization, X2(1)=5.4, p=0.02. Contingency management participants reported significantly fewer days of stimulant drug use, relative to controls during the three-month follow-up. Conclusions When added to treatment-as-usual, contingency management is associated with large reductions in stimulant, injection drug, and alcohol use. Reductions in psychiatric symptoms and hospitalizations were important secondary benefits. PMID:23138961

Patients' willingness to trade off between the duration and frequency of rheumatoid arthritis treatments.

PubMed

Poulos, Christine; Hauber, A Brett; González, Juan Marcos; Turpcu, Adam

2014-07-01

Biologic treatments for rheumatoid arthritis (RA) vary widely in both the time required to administer treatment and treatment frequency. This study aimed to quantify the rate at which RA patients are willing to trade off between the time required to administer treatment (duration) and treatment frequency. Respondents with a self-reported physician diagnosis of moderate to severe RA completed an online discrete choice experiment survey (also known as conjoint analysis). Respondents were presented with a series of treatment-choice questions. Each hypothetical treatment included 6 attributes: response rate, mode of administration, treatment duration, treatment frequency, and the risks of immediate mild and serious treatment reactions. Preference weights, also called marginal utilities or relative importances, were estimated using mixed-logit methods and then used to calculate the marginal rates of substitution between attributes, including treatment duration and treatment frequency. Among the 901 respondents, 505 were in the RA Information, Service, and Education group (www.risesupport.com) and 396 were members of an online panel. The marginal utility of changes in treatment features was largest for a 1-hour change in treatment duration, while a 1-unit change in the annual frequency of treatment was the second least important change. The marginal utility of changes in annual treatment frequency depends on the treatment duration and vice versa. Respondents would accept treatments with lower efficacy and greater risk to achieve lower duration and frequency. Previous studies have linked patient preferences to treatment adherence, suggesting that reductions in duration or frequency could improve adherence and health outcomes. Copyright © 2014 by the American College of Rheumatology.

Health Hazard Appraisal Counseling—Continuing Evaluation

PubMed Central

LaDou, Joseph; Sherwood, John N.; Hughes, Lewis

1979-01-01

A program of annual health examinations was expanded to include counseling based on a computerized appraisal of individual patients' specific health risk factors. Data obtained from a specially designed questionnaire, laboratory tests and a physical examination yielded a health hazard appraisal showing a number of weighted risk factors and their relation to ten leading causes of death as determined for that patient. From all of this information, a “risk age” was developed which could then be compared with the patient's “true age.” The results were reviewed with each patient, and methods of correcting health hazards were stressed. The first annual retesting of a group of 107 examinees showed a net risk age reduction of 1.4 years (formerly reported in this journal). The longer term follow-up reported in this paper showed a net risk reduction of 2.38 years in a group of 26 examinees. The net risk age reduction in the two groups represented 32 and 40 percent, respectively, of the achievable risk age reduction when patients comply with suggestions made during risk reduction counseling. These findings indicate that health hazard appraisal counseling is an effective method of altering priorities of health practices. PMID:425518

Assessment of the Efficiency of Sediment Deposition Reduction in the Zengwen River Watershed in Taiwan

NASA Astrophysics Data System (ADS)

Wu, M.; Tan, H. N.; Lo, W. C.; Tsai, C. T.

2015-12-01

The river upstream of watersheds in Taiwan is very steep, where soil and rock are often unstable so that the river watershed typically has the attribute of high sand yield and turbid runoff due to the excessive erosion in the heavy rainfall seasons. If flood water overflows the river bank, it would lead to a disaster in low-altitude plains. When flood retards or recesses, fine sediment would deposit. Over recent decades, many landslides arise in the Zengwen river watershed due to climate changes, earthquakes, and typhoons. The rocks and sands triggered by these landslides would move to the river channel through surface runoff, which may induce sediment disasters and also render an impact on the stability and sediment transport of the river channel. The risk of the sediment disaster could be reduced by implementing dredging works. However, because of the nature of the channel, the dredged river sections may have sediment depositions back; thus, causing an impact on flood safety. Therefore, it is necessary to evaluate the effectiveness of dredged works from the perspectives of hydraulic, sediment transport, and flood protection to achieve the objective of both disaster prevention and river bed stability. We applied the physiographic soil erosion-deposition (PSED) model to simulate the sediment yield, the runoff, and sediment transport rate of the Zengwen river watershed corresponding to one-day rainstorms of the return periods of 25, 50, and 100 year. The potential of sediment deposition and erosion in the river sections of the Zengwen river could be simulated by utilizing the alluvial river-movable bed two dimensional (ARMB-2D) model. The results reveal that the tendency for the potential of river sediment deposition and erosion obtained from these two models is agreeable. Furthermore, in order to evaluate the efficiency of sediment deposition reduction, two quantized values, the rate of sediment deposition reduction and the ratio of sediment deposition reduction were utilized. According to the simulation results obtained from the PESD and ARMB-2D models, the river sections with severe sediment depositions and high efficiency of sediment deposition reduction will be referred to as the dredging-to-be areas.

Relationship among food-safety knowledge, beliefs, and risk-reduction behavior in university students in Japan.

PubMed

Takeda, Sayaka; Akamatsu, Rie; Horiguchi, Itsuko; Marui, Eiji

2011-01-01

To identify whether university students who have both food-safety knowledge and beliefs perform risk-reduction behaviors. Cross-sectional research using a questionnaire that included food-safety knowledge, perceptions, risk-reduction behavior, stages for the selection of safer food based on the Transtheoretical Model, and demographic characteristics. Four universities in eastern Japan and 2 universities in western Japan. University students (n = 799). Food-safety knowledge, beliefs, and risk-reduction behaviors. Answers on measures assessing risk perception and food-safety knowledge were combined to form 4 groups of participants. Relationships among demographic characteristics, the 4 groups, risk-reduction behaviors, stage of change, and severity and susceptibility were assessed. The proportion of students who had more knowledge of food safety and a belief that "there are no 100% safe food items" was high in the group that frequently performed risk-reduction behaviors, as it was in the group who had taken a basic class about food or health care and who had, or were working toward, a food or nutrition qualification. University students who thought that there were no 100% safe food items and who had more knowledge about food safety were more likely to confirm food-safety information when selecting food. Copyright © 2011 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Themes in the literature related to cardiovascular disease risk reduction.

PubMed

Cohen, Shannon Munro; Kataoka-Yahiro, Merle

2009-01-01

This article aimed to identify themes in the literature related to patient-healthcare provider beliefs, barriers to adherence, and interventions pertaining to cardiovascular disease risk reduction. Twenty quantitative and qualitative primary research studies including 2 meta-analyses published between 1995 and 2008 were analyzed for themes and practice implications to synthesize existing research on cardiovascular disease risk reduction. Databases searched included EBSCO, CINAHL, MEDLINE, ScienceDirect, HealthSource, and PsychLit using the search terms patient- provider adherence, adherence and shared decision making, adherence and decision support, patient- provider goal setting, and cardiovascular disease risk reduction. The emergent themes found in this literature review included (1) complex medication regimens; (2) risk perception, quality of life, and competing priorities; (3) motivation for change; (4) provider clinical inertia; and (5) goal setting, feedback, and reminders. Studies reporting the highest rates of adherence to cardiovascular disease risk reduction recommendations incorporated patient-provider goal setting and decision support, self-management techniques, and personalized printed communication. Goal setting in cardiovascular disease risk reduction is a relatively unexplored area and is an important component of shared decision making and adherence to cardiovascular disease health recommendations. The following review will address the 5 themes identified in more detail and provide a basis for improved clinical practice.

Update on the clinical utility of fenofibrate in mixed dyslipidemias: mechanisms of action and rational prescribing

PubMed Central

Farnier, Michel

2008-01-01

Mixed dyslipidemia is a common lipid disorder characterized by the presence of an atherogenic lipoprotein phenotype due to abnormalities in various atherogenic and anti-atherogenic lipoproteins. Despite the link between the decrease of LDL-cholesterol by statin treatment and the prevention of cardiovascular disease, a high residual risk is observed in statin trials. This residual risk is partly explained by lipoprotein abnormalities other than LDL. Fenofibrate exerts a favorable effect on the atherogenic lipid profile of mixed dyslipidemia and can effectively reduce cardiovascular disease in patients with mixed dyslipidemia. Fenofibrate may offer important treatment alternatives as a second-line therapy in several circumstances: in combination with a statin for patients with mixed dyslipidemias not at goals on statin mono-therapy; in monotherapy for patients intolerant or with contraindication to statin therapy; and in combination with other drugs (ezetimibe, colesevelam) for patients with mixed dyslipidemias, known intolerance, or contraindication to statin and not at goals on fenofibrate monotherapy. However, the role of fenofibrate-statin therapy and of other therapies involving fenofibrate in cardiovascular risk reduction strategies remains to be established. PMID:19183747

Excess mortality among 10-year survivors of classical Hodgkin lymphoma in adolescents and young adults.

PubMed

Xavier, Ana C; Epperla, Narendranath; Taub, Jeffrey W; Costa, Luciano J

2018-02-01

Adolescents and young adults (AYA) surviving classical Hodgkin lymphoma (cHL) risk long term fatal treatment-related toxicities. We utilized the Surveillance, Epidemiology and End Results (SEER) program to compare excess mortality rate (EMR-observed minus expected mortality) for 10-year survivors of AYA cHL diagnosed in 1973-1992 and 1993-2003 eras. The 15-year EMR reduced from 4.88% to 2.19% while the 20-year EMR reduced from 9.46% to 4.07% between eras. Survivors of stages 1-2 had lower EMR than survivors of stages 3-4 cHL in the 1993-2003 but not in the 1973-1992 era. There was an overall decline in risk of death between 10 and 15 years from diagnosis, driven mostly by second neoplasms and cardiovascular mortality. Despite reduction in fatal second neoplasms and cardiovascular disease with more current therapy, long term survivors of AYA cHL still have a higher risk of death than the general population highlighting the need for safer therapies. © 2017 Wiley Periodicals, Inc.

DXA utilization between 2006 and 2012 in commercially insured younger postmenopausal women

PubMed Central

Overman, Robert A.; Farley, Joel F.; Curtis, Jeffrey R.; Zhang, Jie; Gourlay, Margaret L.; Deal, Chad L.

2015-01-01

Introduction Reimbursement for dual energy x-ray absorptiometry (DXA) scans in the outpatient setting has declined significantly since 2006. Research through 2011 has suggested reimbursement reductions for DXA scans have corresponded with an overall decreased utilization of DXA. This study updates utilization estimates for DXAs through 2012 in patients with commercial insurance and compares DXA rates before and after reimbursement changes. Methods We evaluated DXA utilization for women age 50–64 from Marketscan Commercial Claims and Encounter database between January 2006 and December 2012 based on CPT codes. We estimated utilization rates per 1,000 person years. We also employed segmented regression analysis of monthly rates to evaluate the change in utilization rates after a proposed reimbursement reduction in July 2009. Results In women aged 50–64; 451,656 DXAs were performed in 2006, a rate of 144 DXAs per 1,000 person years. This rate increased to 149 DXAs per 1,000 person years in 2009 before decreasing to 110 DXAs per 1,000 person years or 667,982 scans in 2012. DXA utilization increased by 2.24 per 1,000 person years until July 2009 then declined by 12.98 DXAs per 1,000 persons, resulting in 37.5 DXAs per person year fewer performed in 2012 compared to 2006. Conclusion Since July 2009 a significant decline in DXA utilization occurred in a younger postmenopausal commercially insured population. This decline corresponds with a time period of reductions in Medicare DXA reimbursement. PMID:25700662

[Early invasive strategy in diabetic patients with non-ST-segment elevation acute coronary syndromes].

PubMed

Baeza Román, Anna; Latour Pérez, Jaime; de Miguel Balsa, Eva; Pino Izquierdo, Karel; Coves Orts, Francisco Javier; García Ochando, Luis; de la Torre Fernández, Maria José

2014-05-20

In the management of non-ST-segment elevation acute coronary syndromes (NSTE-ACS), several studies have shown a reduction in mortality with the use of an invasive strategy in high-risk patients, including diabetic patients. Paradoxically, other studies have shown an under-utilization of this invasive strategy in these patients. The aim of this study is to determine the characteristics of patients managed conservatively and identify determinants of the use of invasive or conservative strategy. Retrospective cohort study conducted in diabetic patients with NSTE-ACS included in the ARIAM-SEMICYUC registry (n=531) in 2010 and 2011. We performed crude and adjusted unconditional logistic regression. We analyzed 531 diabetic patients, 264 (49.7%) of which received invasive strategy. Patients managed conservatively were a subgroup characterized by older age and cardiovascular comorbidity, increased risk of bleeding and the absence of high-risk electrocardiogram (ECG). In diabetic patients with NSTE-ACS, independent predictors associated with conservative strategy were low-risk ECG, initial Killip class>1, high risk of bleeding and pretreatment with clopidogrel. The fear of bleeding complications or advanced coronary lesions could be the cause of the underutilization of an invasive strategy in diabetic patients with NSTE-ACS. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Minimizing metastatic risk in radiotherapy fractionation schedules

NASA Astrophysics Data System (ADS)

Badri, Hamidreza; Ramakrishnan, Jagdish; Leder, Kevin

2015-11-01

Metastasis is the process by which cells from a primary tumor disperse and form new tumors at distant anatomical locations. The treatment and prevention of metastatic cancer remains an extremely challenging problem. This work introduces a novel biologically motivated objective function to the radiation optimization community that takes into account metastatic risk instead of the status of the primary tumor. In this work, we consider the problem of developing fractionated irradiation schedules that minimize production of metastatic cancer cells while keeping normal tissue damage below an acceptable level. A dynamic programming framework is utilized to determine the optimal fractionation scheme. We evaluated our approach on a breast cancer case using the heart and the lung as organs-at-risk (OAR). For small tumor α /β values, hypo-fractionated schedules were optimal, which is consistent with standard models. However, for relatively larger α /β values, we found the type of schedule depended on various parameters such as the time when metastatic risk was evaluated, the α /β values of the OARs, and the normal tissue sparing factors. Interestingly, in contrast to standard models, hypo-fractionated and semi-hypo-fractionated schedules (large initial doses with doses tapering off with time) were suggested even with large tumor α/β values. Numerical results indicate the potential for significant reduction in metastatic risk.

Differences in Health Care Costs and Utilization among Adults with Selected Lifestyle-Related Risk Factors.

ERIC Educational Resources Information Center

Tucker, Larry A.; Clegg, Alan G.

2002-01-01

Examined the relationship between lifestyle-related health risks and health care costs and utilization among young adults. Data collected at a primarily white collar worksite in over 2 years indicated that health risks, particularly obesity, stress, and general lifestyle, were significant predictors of health care costs and utilization among these…

Salud Para Su Corazon (Health for Your Heart) Community Health Worker Model

PubMed Central

Balcazar, H.; Alvarado, M.; Ortiz, G.

2012-01-01

This article describes 6 Salud Para Su Corazon (SPSC) family of programs that have addressed cardiovascular disease risk reduction in Hispanic communities facilitated by community health workers (CHWs) or Promotores de Salud (PS). A synopsis of the programs illustrates the designs and methodological approaches that combine community-based participatory research for 2 types of settings: community and clinical. Examples are provided as to how CHWs can serve as agents of change in these settings. A description is presented of a sustainability framework for the SPSC family of programs. Finally, implications are summarized for utilizing the SPSC CHW/PS model to inform ambulatory care management and policy. PMID:21914992

Routine brief risk-reduction counseling with biannual STD testing reduces STD incidence among HIV-infected men who have sex with men in care.

PubMed

Patel, Pragna; Bush, Tim; Mayer, Kenneth; Milam, Joel; Richardson, Jean; Hammer, John; Henry, Keith; Overton, Turner; Conley, Lois; Marks, Gary; Brooks, John T

2012-06-01

We evaluated whether routine biannual sexually transmitted disease (STD) testing coupled with brief risk-reduction counseling reduces STD incidence and high-risk behaviors. The SUN study is a prospective observational HIV cohort study conducted in 4 US cities. At enrollment and every 6 months thereafter, participants completed a behavioral survey and were screened for STDs, and if diagnosed, were treated. Medical providers conducted brief risk-reduction counseling with all patients. Among men who have sex with men (MSM), we examined trends in STD incidence and rates of self-reported risk behaviors before and after exposure to the risk-reduction intervention. The "preintervention" visit was the study visit that was at least 6 months after enrollment STD screening and treatment and at which the participant was first exposed to the intervention. The "postintervention" visit was 12 months later. Among 216 MSM with complete STD and behavioral data, median age was 44.5 years; 77% were non-Hispanic white; 83% were on highly active antiretroviral treatment; 84% had an HIV RNA level <400 copies/mL and the median CD4 (cluster of differentiation 4) count was 511 cells/mm. Twelve months after first exposure to the risk-reduction intervention, STD incidence declined from 8.8% to 4.2% (P = 0.041). Rates of unprotected receptive or insertive anal intercourse with HIV-positive partners increased (19% to 25%, P = 0.024), but did not change with HIV-negative partners or partners of unknown HIV status (24% to 22%, P = 0.590). STD incidence declined significantly among HIV-infected MSM after implementing frequent, routine STD testing coupled with risk-reduction counseling. These findings support adoption of routine STD screening and risk-reduction counseling for HIV-infected MSM.

Comparative Effectiveness of Personalized Lifestyle Management Strategies for Cardiovascular Disease Risk Reduction.

PubMed

Chu, Paula; Pandya, Ankur; Salomon, Joshua A; Goldie, Sue J; Hunink, M G Myriam

2016-03-29

Evidence shows that healthy diet, exercise, smoking interventions, and stress reduction reduce cardiovascular disease risk. We aimed to compare the effectiveness of these lifestyle interventions for individual risk profiles and determine their rank order in reducing 10-year cardiovascular disease risk. We computed risks using the American College of Cardiology/American Heart Association Pooled Cohort Equations for a variety of individual profiles. Using published literature on risk factor reductions through diverse lifestyle interventions-group therapy for stopping smoking, Mediterranean diet, aerobic exercise (walking), and yoga-we calculated the risk reduction through each of these interventions to determine the strategy associated with the maximum benefit for each profile. Sensitivity analyses were conducted to test the robustness of the results. In the base-case analysis, yoga was associated with the largest 10-year cardiovascular disease risk reductions (maximum absolute reduction 16.7% for the highest-risk individuals). Walking generally ranked second (max 11.4%), followed by Mediterranean diet (max 9.2%), and group therapy for smoking (max 1.6%). If the individual was a current smoker and successfully quit smoking (ie, achieved complete smoking cessation), then stopping smoking yielded the largest reduction. Probabilistic and 1-way sensitivity analysis confirmed the demonstrated trend. This study reports the comparative effectiveness of several forms of lifestyle modifications and found smoking cessation and yoga to be the most effective forms of cardiovascular disease prevention. Future research should focus on patient adherence to personalized therapies, cost-effectiveness of these strategies, and the potential for enhanced benefit when interventions are performed simultaneously rather than as single measures. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

The contribution of indigenous knowledge to disaster risk reduction activities in Zimbabwe: A big call to practitioners

PubMed Central

Munsaka, Edson

2018-01-01

This article examined the contribution of indigenous knowledge to disaster risk reduction activities in Zimbabwe. The current discourse underrates the use of indigenous knowledge of communities by practitioners when dealing with disasters’, as the knowledge is often viewed as outdated and primitive. This study, which was conducted in 2016, sought to examine this problem through analysing the potential contribution of indigenous knowledge as a useful disaster risk reduction intervention. Tsholotsho district in Matabeleland, North province of Zimbabwe, which frequently experiences perennial devastating floods, was used as a case study. Interviews and researcher observations were used to gather data from 40 research participants. The findings were that communities understand weather patterns and could predict imminent flooding after studying trees and clouds, and the behaviours of certain animal species. Local communities also use available local resources to put structural measures in place as part of disaster risk reduction interventions. Despite this important potential, the study found that the indigenous knowledge of disaster risk reduction of the communities is often shunned by practitioners. The practitioners claim that indigenous knowledge lacks documentation, it is not found in all generational classes, it is contextualised to particular communities and the knowledge cannot be scientifically validated. The study concluded that both local communities and disaster risk reduction practitioners can benefit from the indigenous knowledge of communities. This research has the potential to benefit communities, policymakers and disaster risk reduction practitioners.

The effect of recent trends in vehicle design on U.S. societal fatality risk per vehicle mile traveled, and their projected future relationship with vehicle mass.

PubMed

Wenzel, Tom

2013-07-01

The National Highway Traffic Safety Administration (NHTSA) recently updated its 2003 and 2010 logistic regression analyses of the effect of a reduction in light-duty vehicle mass on US fatality risk per vehicle mile traveled (VMT). The current NHTSA analysis is the most thorough investigation of this issue to date. LBNL's assessment of the analysis indicates that the estimated effect of mass reduction on risk is smaller than in the previous studies, and statistically non-significant for all but the lightest cars. The effects three recent trends in vehicle designs and technologies have on societal fatality risk per VMT are estimated, and whether these changes might affect the relationship between vehicle mass and fatality risk in the future. Side airbags are found to reduce fatality risk in cars, but not necessarily light trucks or CUVs/minivans, struck in the side by another light-duty vehicle; reducing the number of fatalities in cars struck in the side is predicted to reduce the estimated detrimental effect of footprint reduction, but increase the detrimental effect of mass reduction, in cars on societal fatality risk. Better alignment of light truck bumpers with those of other vehicles appears to result in a statistically significant reduction in risk imposed on car occupants; however, reducing this type of fatality will likely have little impact on the estimated effect of mass or footprint reduction on risk. Finally, shifting light truck drivers into safer, car-based vehicles, such as sedans, CUVs, and minivans, would result in larger reductions in societal fatalities than expected from even substantial reductions in the masses of light trucks. A strategy of shifting drivers from truck-based to car-based vehicles would reduce fuel use and greenhouse gas emissions, while improving societal safety. Copyright © 2013 Elsevier Ltd. All rights reserved.

Evaluating Personalized Feedback Intervention Framing with a Randomized Controlled Trial to Reduce Young Adult Alcohol-Related Sexual Risk Taking.

PubMed

Lewis, Melissa A; Rhew, Isaac C; Fairlie, Anne M; Swanson, Alex; Anderson, Judyth; Kaysen, Debra

2018-03-06

The purpose of this study was to evaluate personalized feedback intervention (PFI) framing with two web-delivered PFIs aimed to reduce young adult alcohol-related risky sexual behavior (RSB). Combined PFIs typically use an additive approach whereby independent components on drinking and components on RSB are presented without the discussion of the influence of alcohol on RSB. In contrast, an integrated PFI highlights the RSB-alcohol connection by presenting integrated alcohol and RSB components that focus on the role of intoxication as a barrier to risk reduction in sexual situations. In a randomized controlled trial, 402 (53.98% female) sexually active young adults aged 18-25 were randomly assigned to a combined PFI, an integrated PFI, or attention control. All assessment and intervention procedures were web-based. At the 1-month follow-up, those randomly assigned to the integrated condition had a lower likelihood of having any casual sex partners compared to those in the control group. At the 6-month follow-up, the combined condition had a lower likelihood of having any casual sex partners compared to those in the control group. When examining alcohol-related RSB, at the 1-month follow-up, both interventions showed a lower likelihood of any drinking prior to sex compared to the control group. When examining alcohol-related sexual consequences, results showed a reduction in the non-zero count of consequences in the integrated condition compared to the control at the 1-month follow-up. For typical drinks per week, those in the combined condition showed a greater reduction in the non-zero count of drinks than those in the control condition at the 1-month follow-up. While there were no significant differences between the two interventions, the current findings highlight the utility of two efficacious web-based alcohol and RSB interventions among a national sample of at-risk young adults.

Development of a national system for prevention and mitigation of earthquake damages to people and properties, and the reduction of costs related to earthquakes for the Italian Government

NASA Astrophysics Data System (ADS)

Console, R.; Greco, M.; Colangelo, A.; Cioè, A.; Trivigno, L.; Chiappini, M.; Ponzo, F.

2015-12-01

Recognizing that the Italian territory is prone to disasters in connection with seismic and hydro-geological risk, it has become necessary to define novel regulations and viable solutions aimed at conveying the economical resources of the Italian Government, too often utilized for the management of post-event situations, towards prevention activities. The work synthetically presents the project developed by the CGIAM together with the INGV, and open to collaboration with other Italian and International partners. This project is aimed at the development of a National System for prevention and mitigation of the earthquakes damages, through the definition of a model that achieves the mitigation of the building collapsing risk and the consequent reduction of casualties. Such a model is based on two main issues a) a correct evaluation of risk, defined as a reliable assessment of the hazard expected at a given site and of the vulnerability of civil and industrial buildings, b) setting up of novel strategies for the safety of buildings. The hazard assessment is pursued through the application of innovative multidisciplinary geophysical methodologies and the application of a physically based earthquake simulator. The structural vulnerability of buildings is estimated by means of simplified techniques based on few representative parameters (such as different structural typologies, dynamic soil-structure interaction, etc.) and, for detailed studies, standard protocols for model updating techniques. We analyze, through numerical and experimental approaches, new solutions for the use of innovative materials, and new techniques for the reduction of seismic vulnerability of structural, non-structural and accessorial elements, including low cost type. The project activities are initially implemented on a study area in Southern Italy (Calabria) selected because of its tectonic complexity. The results are expected to be applicable for other hazardous seismic areas of Italy.

Chronic opioid therapy risk reduction initiative: impact on urine drug testing rates and results.

PubMed

Turner, Judith A; Saunders, Kathleen; Shortreed, Susan M; Rapp, Suzanne E; Thielke, Stephen; LeResche, Linda; Riddell, Kim M; Von Korff, Michael

2014-02-01

In response to epidemic levels of prescription opioid overdose, abuse, and diversion, routine urine drug tests (UDTs) are recommended for patients receiving chronic opioid therapy (COT) for chronic pain. However, UDT ordering for COT patients is inconsistent in primary care, and little is known about how to increase UDT ordering or the impact of increased testing on rates of aberrant results. To compare rates and results of UDTs for COT patients before versus after implementation of an opioid risk reduction initiative in a large healthcare system. Pre-post observational study. Group Health patients on COT October 2008-September 2009 (N = 4,821), October 2009-September 2010 (N = 5,081), and October 2010-September 2011 (N = 5,498). Multi-faceted opioid risk reduction initiative. Annual rates of UDTs and UDT results. Half of COT patients received at least one UDT in the year after the initiative was implemented, compared to only 7 % 2 years prior. The adjusted odds of COT patients having at least one UDT in the first year of the opioid initiative were almost 16 times (adjusted OR = 15.79; 95 % CI: 13.96-17.87) those 2 years prior. The annual rate of UDT detection of marijuana and illicit drugs did not change (12.6 % after initiative implementation), and largely reflected marijuana use (detected in 11.1 % of all UDTs in the year after initiative implementation). In the year after initiative implementation, 10.7 % of UDTs were negative for opioids. The initiative appeared to dramatically increase urine drug testing of COT patients in the healthcare system without impacting rates of aberrant results. The large majority of aberrant results reflected marijuana use or absence of opioids in the urine. The utility of increased urine drug testing for COT patient safety and prevention of diversion remains uncertain.

Can I Count on Getting Better? Association between Math Anxiety and Poorer Understanding of Medical Risk Reductions.

PubMed

Rolison, Jonathan J; Morsanyi, Kinga; O'Connor, Patrick A

2016-10-01

Lower numerical ability is associated with poorer understanding of health statistics, such as risk reductions of medical treatment. For many people, despite good numeracy skills, math provokes anxiety that impedes an ability to evaluate numerical information. Math-anxious individuals also report less confidence in their ability to perform math tasks. We hypothesized that, independent of objective numeracy, math anxiety would be associated with poorer responding and lower confidence when calculating risk reductions of medical treatments. Objective numeracy was assessed using an 11-item objective numeracy scale. A 13-item self-report scale was used to assess math anxiety. In experiment 1, participants were asked to interpret the baseline risk of disease and risk reductions associated with treatment options. Participants in experiment 2 were additionally provided a graphical display designed to facilitate the processing of math information and alleviate effects of math anxiety. Confidence ratings were provided on a 7-point scale. Individuals of higher objective numeracy were more likely to respond correctly to baseline risks and risk reductions associated with treatment options and were more confident in their interpretations. Individuals who scored high in math anxiety were instead less likely to correctly interpret the baseline risks and risk reductions and were less confident in their risk calculations as well as in their assessments of the effectiveness of treatment options. Math anxiety predicted confidence levels but not correct responding when controlling for objective numeracy. The graphical display was most effective in increasing confidence among math-anxious individuals. The findings suggest that math anxiety is associated with poorer medical risk interpretation but is more strongly related to confidence in interpretations. © The Author(s) 2015.

Investigation into the risk perceptions of investors in the securities of nuclear-dependent electric utilities

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

Spudeck, R.E.

1983-01-01

Two weeks prior to the Three Mile Island accident, March 15, 1979, the Nuclear Regulatory Commission ordered five operating nuclear plants shut down in order to reexamine safety standards in these plants. Reports in the popular and trade press during this time suggested that these events, particularly the accident at Three Mile Island, caused investors in the securities of electric utilities that had nuclear-generation facilities to revise their risk perceptions. This study was designed to examine the impact of both the Nuclear Regulatory Commission order and the accident at Three Mile Island on investor risk perceptions. Selected categories of electricmore » utilities were chosen to examine any differential risk effects resulting from these events. An asset pricing model devoid of many of the restrictive assumptions of more familiar models was used to model investor behavior. The findings suggest that the events described did cause investors to revise upward their perceptions of systematic risk regarding different categories of electric utilities. More specifically, those electric utilities that were operating nuclear plants in 1979 experienced the largest and most sustained increase in systematic risk. However, electric utilities that in 1979 had no operating nuclear plants, but had planned and committed funds for nuclear plants in the future, also experienced increases in systematic risk.« less

[Differences in influenza vaccination coverage among subgroups of adult immigrants residing in Italy at risk for complications (2012-2013)].

PubMed

Fabiani, Massimo; Di Napoli, Anteo; Riccardo, Flavia; Gargiulo, Lidia; Declich, Silvia; Petrelli, Alessio

2017-01-01

to evaluate differences in influenza vaccination coverage (IVC) in immigrants at risk for influenza-related complications, according to their area of origin and length of stay in Italy. cross-sectional survey conducted on the sample of foreign citizens included in the survey on health conditions and use of health services of the Italian resident population (Italian national institute of statistics, 2012-2013). analysis conducted on 885 foreign adult citizens (≥18 years) at risk for influenza-related complications (elderly residents ≥65 years and residents with specific chronic diseases). vaccination coverage ratios (VCR) comparison between long-term immigrants (≥10 years) and recent immigrants (<10 years), and between non-African and African immigrants, adjusted by demographic and socioeconomic characteristics and level of health services utilization. IVC among immigrants was 15.6%, significantly higher in long-term immigrants (18.3%) compared to recent immigrants (10.2%) (VCR: 1.79; 95%CI 1.21-2.66), and in non-African immigrants (17.1%) compared to African immigrants (9.4%) (VCR: 1.82; 95%CI 1.04-3.17). After adjusting on the basis of demographic and socioeconomic characteristics and for level of health services utilization between the compared subgroups, the difference in IVC according to the length of stay was greatly reduced (VCR: 1.41; 95%CI 0.94- 2.10), while IVC difference reduction according to area of origin was less relevant (VCR: 1.66; 95%CI 0.95-2.91). demographic and socioeconomic characteristics and level of health services utilization explained part of the difference in IVC between the compared subgroups, particularly between long-term and recent immigrants. The difference in IVC between African immigrants and immigrants from other areas remained quite pronounced even after adjusting on the basis of these factors. This suggests that IVC, especially in African immigrants, is affected by other informal barriers, such as cultural and linguistic barriers, that need to be addressed when planning effective immunization access strategies.

Scoping out the literature on mobile needle and syringe programs-review of service delivery and client characteristics, operation, utilization, referrals, and impact.

PubMed

Strike, Carol; Miskovic, Miroslav

2018-02-08

Needle and syringe program (NSP) service delivery models encompass fixed sites, mobile services, vending machines, pharmacies, peer NSPs, street outreach, and inter-organizational agreements to add NSP services to other programs. For programs seeking to implement or improve mobile services, access to a synthesis of the evidence related to mobile services is beneficial, but lacking. We used a scoping study method to search MEDLINE, PSYCHInfo, Embase, Scopus, and Sociological for relevant literature. We identified 39 relevant manuscripts published between 1975 and November 2017 after removing duplicates and non-relevant manuscripts from the 1313 identified by the search. Charting of the data showed that these publications reported findings related to the service delivery model characteristics, client characteristics, service utilization, specialized interventions offered on mobile NSPs, linking clients to other services, and impact on injection risk behaviors. Mobile NSPs are implemented in high-, medium-, and low-income countries; provide equipment distribution and many other harm reduction services; face limitations to service complement, confidentiality, and duration of interactions imposed by physical space; adapt to changes in locations and types of drug use; attract people who engage in high-risk/intensity injection behavior and who are often not reached by other service models; and may lead to reduced injection-related risks. It is not clear from the literature reviewed, what are, or if there are, a "core and essential" complement of services that mobile NSPs should offer. Decisions about service complement for mobile NSPs need to be made in relation to the context and also other available services. Reports of client visits to mobile NSP provide a picture of the volume and frequency of utilization but are difficult to compare given varied measures and reference periods. Mobile NSPs have an important role to play in improving HIV and HCV prevention efforts across the world. However, more work is needed to create clearer assessment metrics and to improve access to NSP services across the world.

Moral Hazard: How The National Flood Insurance Program Is Limiting Risk Reduction

DTIC Science & Technology

2016-12-01

Management and Budget, Paperwork Reduction Project (0704-0188) Washington DC 20503. 1. AGENCY USE ONLY (Leave blank) 2. REPORT DATE December...assessment, floodplain management , and flood insurance. A study of the NFIP concludes that aspects of the program limit risk reduction...floodplain management , risk assessment, disaster recovery, flood insurance claim, pre-flood insurance rate map 15. NUMBER OF PAGES 123 16. PRICE CODE

Failure mode and effect analysis in blood transfusion: a proactive tool to reduce risks.

PubMed

Lu, Yao; Teng, Fang; Zhou, Jie; Wen, Aiqing; Bi, Yutian

2013-12-01

The aim of blood transfusion risk management is to improve the quality of blood products and to assure patient safety. We utilize failure mode and effect analysis (FMEA), a tool employed for evaluating risks and identifying preventive measures to reduce the risks in blood transfusion. The failure modes and effects occurring throughout the whole process of blood transfusion were studied. Each failure mode was evaluated using three scores: severity of effect (S), likelihood of occurrence (O), and probability of detection (D). Risk priority numbers (RPNs) were calculated by multiplying the S, O, and D scores. The plan-do-check-act cycle was also used for continuous improvement. Analysis has showed that failure modes with the highest RPNs, and therefore the greatest risk, were insufficient preoperative assessment of the blood product requirement (RPN, 245), preparation time before infusion of more than 30 minutes (RPN, 240), blood transfusion reaction occurring during the transfusion process (RPN, 224), blood plasma abuse (RPN, 180), and insufficient and/or incorrect clinical information on request form (RPN, 126). After implementation of preventative measures and reassessment, a reduction in RPN was detected with each risk. The failure mode with the second highest RPN, namely, preparation time before infusion of more than 30 minutes, was shown in detail to prove the efficiency of this tool. FMEA evaluation model is a useful tool in proactively analyzing and reducing the risks associated with the blood transfusion procedure. © 2013 American Association of Blood Banks.

Risk avoidance versus risk reduction: a framework and segmentation profile for understanding adolescent sexual activity.

PubMed

Hopkins, Christopher D; Tanner, John F; Raymond, Mary Anne

2004-01-01

The teen birthrate in the United States is twice that of other industrialized nations. Adolescents in the U.S. are among high-risk groups for HIV/AIDS and other sexually transmitted diseases. As a result, the Department of Health and Human Services changed its policy on the promotion of abstinence to teenagers from a focus on a risk reduction strategy to a focus on a risk avoidance strategy. In order to create more effective risk avoidance as well as risk reduction campaigns, this study proposes a framework to illustrate the distinction that teens make between spontaneous sexual activity and planned sexual activity, as well as those teens that make a commitment to abstinence versus abstinence by default. Furthermore, this study classifies teens into three behavior segments (abstemious, promiscuous and monogamous) and then assesses specific differences that exist within these groups relative to their attitudes and perceptions concerning abstinence, sexual activity, contraception, fear and norms. This change in focus from a risk reduction to a risk avoidance strategy has important implications for social marketing, public policy and marketing theory.

Improved efficacy for ezetimibe and rosuvastatin by attenuating the induction of PCSK9[S

PubMed Central

Ason, Brandon; Tep, Samnang; Davis, Harry R.; Xu, Yiming; Tetzloff, Glen; Galinski, Beverly; Soriano, Ferdie; Dubinina, Natalya; Zhu, Lei; Stefanni, Alice; Wong, Kenny K.; Tadin-Strapps, Marija; Bartz, Steven R.; Hubbard, Brian; Ranalletta, Mollie; Sachs, Alan B.; Flanagan, W. Michael; Strack, Alison; Kuklin, Nelly A.

2011-01-01

Reducing circulating LDL-cholesterol (LDL-c) reduces the risk of cardiovascular disease in people with hypercholesterolemia. Current approaches to reduce circulating LDL-c include statins, which inhibit cholesterol synthesis, and ezetimibe, which blocks cholesterol absorption. Both elevate serum PCSK9 protein levels in patients, which could attenuate their efficacy by reducing the amount of cholesterol cleared from circulation. To determine whether PCSK9 inhibition could enhance LDL-c lowering of both statins and ezetimibe, we utilized small interfer­ing RNAs (siRNAs) to knock down Pcsk9, together with ezetimibe, rosuvastatin, and an ezetimibe/rosuvastatin combination in a mouse model with a human-like lipid profile. We found that ezetimibe, rosuvastatin, and ezetimibe/rosuvastatin combined lower serum cholesterol but induce the expression of Pcsk9 as well as the Srebp-2 hepatic cholesterol biosynthesis pathway. Pcsk9 knockdown in combination with either treatment led to greater reductions in serum non-HDL with a near-uniform reduction of all LDL-c subfractions. In addition to reducing serum cholesterol, the combined rosuvastatin/ezetimibe/Pcsk9 siRNA treatment exhibited a significant reduction in serum APOB protein and triglyceride levels. Taken together, these data provide evidence that PCSK9 inhibitors, in combination with current therapies, have the potential to achieve greater reductions in both serum cholesterol and triglycerides. PMID:21262787

Application of Autonomous Smart Inverter Volt-VAR Function for Voltage Reduction Energy Savings and Power Quality in Electric Distribution Systems: Preprint

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

Ding, Fei; Nagarajan, Adarsh; Baggu, Murali

This paper evaluated the impact of smart inverter Volt-VAR function on voltage reduction energy saving and power quality in electric power distribution systems. A methodology to implement the voltage reduction optimization was developed by controlling the substation LTC and capacitor banks, and having smart inverters participate through their autonomous Volt-VAR control. In addition, a power quality scoring methodology was proposed and utilized to quantify the effect on power distribution system power quality. All of these methodologies were applied to a utility distribution system model to evaluate the voltage reduction energy saving and power quality under various PV penetrations and smartmore » inverter densities.« less

Root restriction: A tool for improving volume utilization efficiency in bioregenerative life-support systems

NASA Astrophysics Data System (ADS)

Graham, Thomas; Wheeler, Raymond

2016-06-01

The objective of this study was to evaluate root restriction as a tool to increase volume utilization efficiency in spaceflight crop production systems. Bell pepper plants (Capsicum annuum cv. California Wonder) were grown under restricted rooting volume conditions in controlled environment chambers. The rooting volume was restricted to 500 ml and 60 ml in a preliminary trial, and 1500 ml (large), 500 ml (medium), and 250 ml (small) for a full fruiting trial. To reduce the possible confounding effects of water and nutrient restrictions, care was taken to ensure an even and consistent soil moisture throughout the study, with plants being watered/fertilized several times daily with a low concentration soluble fertilizer solution. Root restriction resulted in a general reduction in biomass production, height, leaf area, and transpiration rate; however, the fruit production was not significantly reduced in the root restricted plants under the employed environmental and horticultural conditions. There was a 21% reduction in total height and a 23% reduction in overall crown diameter between the large and small pot size in the fruiting study. Data from the fruiting trial were used to estimate potential volume utilization efficiency improvements for edible biomass in a fixed production volume. For fixed lighting and rooting hardware situations, the majority of improvement from root restriction was in the reduction of canopy area per plant, while height reductions could also improve volume utilization efficiency in high stacked or vertical agricultural systems.

Root restriction: A tool for improving volume utilization efficiency in bioregenerative life-support systems.

PubMed

Graham, Thomas; Wheeler, Raymond

2016-06-01

The objective of this study was to evaluate root restriction as a tool to increase volume utilization efficiency in spaceflight crop production systems. Bell pepper plants (Capsicum annuum cv. California Wonder) were grown under restricted rooting volume conditions in controlled environment chambers. The rooting volume was restricted to 500ml and 60ml in a preliminary trial, and 1500ml (large), 500ml (medium), and 250ml (small) for a full fruiting trial. To reduce the possible confounding effects of water and nutrient restrictions, care was taken to ensure an even and consistent soil moisture throughout the study, with plants being watered/fertilized several times daily with a low concentration soluble fertilizer solution. Root restriction resulted in a general reduction in biomass production, height, leaf area, and transpiration rate; however, the fruit production was not significantly reduced in the root restricted plants under the employed environmental and horticultural conditions. There was a 21% reduction in total height and a 23% reduction in overall crown diameter between the large and small pot size in the fruiting study. Data from the fruiting trial were used to estimate potential volume utilization efficiency improvements for edible biomass in a fixed production volume. For fixed lighting and rooting hardware situations, the majority of improvement from root restriction was in the reduction of canopy area per plant, while height reductions could also improve volume utilization efficiency in high stacked or vertical agricultural systems. Copyright © 2016 The Committee on Space Research (COSPAR). All rights reserved.

Alcohol Use and Sexual Risk Behaviors in a Migrant Worker Community.

PubMed

McCoy, H Virginia; Shehadeh, Nancy; Rubens, Muni

2016-06-01

There are not many studies exploring the association between alcohol use and risky sexual behaviors among migrant workers. This study analyzed how changes in alcohol use was associated with changes in risky sexual behavior and psychosocial variables. Data for this study was drawn from an HIV risk reduction project. Repeated measures ANOVA and Linear mixed model statistical method was conducted to find changes and association between alcohol use, sexual risk and psychosocial variables over time. The sample (n = 203) was composed of African Americans (33.0 %) and Hispanics (77.0 %) men. Both groups, over time, showed reduction in sexual risk in accordance with reduction in alcohol use. Changes in alcohol use and psychosocial variables showed significant association with sexual risk changes over time. Psychological strategies like building social support should be considered for HIV risk reduction intervention directed towards high alcohol consuming migrant workers.

Parental Attitudes Regarding School-Based Sexuality Education in Utah

ERIC Educational Resources Information Center

Steadman, Mindy; Crookston, Benjamin; Page, Randy; Hall, Cougar

2014-01-01

Sexuality education programs can be broadly categorized as either risk-avoidance or risk-reduction approaches. Health educators in Utah public schools must teach a state mandated risk-avoidance curriculum which prohibits the advocacy or encouragement of contraception. Multiple national surveys indicate that parents prefer a risk-reduction approach…

Program evaluation of remote heart failure monitoring: healthcare utilization analysis in a rural regional medical center.

PubMed

Riley, William T; Keberlein, Pamela; Sorenson, Gigi; Mohler, Sailor; Tye, Blake; Ramirez, A Susana; Carroll, Mark

2015-03-01

Remote monitoring for heart failure (HF) has had mixed and heterogeneous effects across studies, necessitating further evaluation of remote monitoring systems within specific healthcare systems and their patient populations. "Care Beyond Walls and Wires," a wireless remote monitoring program to facilitate patient and care team co-management of HF patients, served by a rural regional medical center, provided the opportunity to evaluate the effects of this program on healthcare utilization. Fifty HF patients admitted to Flagstaff Medical Center (Flagstaff, AZ) participated in the project. Many of these patients lived in underserved and rural communities, including Native American reservations. Enrolled patients received mobile, broadband-enabled remote monitoring devices. A matched cohort was identified for comparison. HF patients enrolled in this program showed substantial and statistically significant reductions in healthcare utilization during the 6 months following enrollment, and these reductions were significantly greater compared with those who declined to participate but not when compared with a matched cohort. The findings from this project indicate that a remote HF monitoring program can be successfully implemented in a rural, underserved area. Reductions in healthcare utilization were observed among program participants, but reductions were also observed among a matched cohort, illustrating the need for rigorous assessment of the effects of HF remote monitoring programs in healthcare systems.

A strategy for selecting sexual partners believed to pose little/no risks for HIV: serosorting and its implications for HIV transmission.

PubMed

Eaton, Lisa A; Kalichman, Seth C; O'Connell, Daniel A; Karchner, William D

2009-10-01

A common HIV/AIDS risk reduction strategy among men who have sex with men (MSM) is to limit their unprotected sex partners to those who are of the same HIV status, a practice referred to as serosorting. Decisions to serosort for HIV risk reduction are based on personal impressions and beliefs, and there is limited guidance offered on this community derived strategy from public health services. This paper reviews research on serosorting for HIV risk reduction and offers an evidence-based approach to serosorting guidance. Following a comprehensive electronic and manual literature search, we reviewed 51 studies relating to the implications of serosorting. Studies showed that HIV negative MSM who select partners based on HIV status are inadvertently placing themselves at risk for HIV. Infrequent HIV testing, lack of HIV status disclosure, co-occurring sexually transmitted infections, and acute HIV infection impede the potential protective benefits of serosorting. Public health messages should continue to encourage reductions in numbers of sexual partners and increases in condom use. Risk reduction messages should also highlight the limitations of relying on one's own and partner's HIV status in making sexual risk decisions.

[Effects of a lower body weight or waist circumference on cardiovascular risk].

PubMed

Labraña, Ana María; Durán, Eliana; Martínez, María Adela; Leiva, Ana María; Garrido-Méndez, Alex; Díaz, Ximena; Salas, Carlos; Celis-Morales, Carlos

2017-05-01

Overall and central obesity are important risk factors for cardiovascular disease. To investigate the association of body weight, body mass index (BMI) and waist circumference (WC) with cardiovascular risk factors in Chile. We included 5,157 participants from the National Health Survey 2009-2010. Prevalence of type 2 diabetes, hypertension, metabolic syndrome and dyslipidemia (high total cholesterol and triglyceride levels and low HDL-cholesterol) were defined using international recommendations. BMI and WC were measured using standardized protocols. A five percent lower body weight, BMI and WC were associated with a significant reduction in cardiovascular risk factors. For each 5% reduction in body weight, the risk for hypertension decreased by 8 and 9% in women and men respectively. Similar risk reductions were observed for diabetes (9 and 11% respectively), metabolic syndrome (23 and 30% respectively), low HDL cholesterol (13 and 13% respectively), high triglyceride levels (16 and 18% respectively) and total cholesterol (8 and 10% respectively). Similar findings were observed for BMI and WC. Lower body weight, BMI or WC are associated with important reductions in cardiovascular risk factors. A 5% reduction in these adiposity markers could be a perfectly feasible goal for lifestyle interventions.

Pathway to Prevention of Nosocomial Clostridium difficile Infection.

PubMed

Goldstein, Ellie J C; Johnson, Stuart; Maziade, Pierre-Jean; McFarland, Lynne V; Trick, William; Dresser, Linda; Millette, Mathieu; Mazloum, Hadi; Low, Donald E

2015-05-15

To address the significant morbidity and mortality rates associated with nosocomial Clostridium difficile-associated diarrhea (CDAD), a series of recommendations and a pathway to prevention were developed. An expert panel of infectious disease (ID) specialists participated in a modified Delphi process with specific objectives: (1) conduct a review for CDAD and prevention; (2) develop statements based upon panel members' opinions; (3) hold a panel meeting during the 2012 IDWeek; and (4) review the final recommendations and prevention pathway prior to submission for publication. The panel voted on (1) antibiotic stewardship (7 of 8 panelists); (2) reduction of other potentially modifiable risk factors (variable); (3) utilization of specific probiotics to prevent C. difficile overgrowth (8/8); (4) staff education regarding CDAD preventive measures (8/8); (5) appropriate hand hygiene for everyone (7/8); (6) environmental cleaning (8/8); (7) medical equipment disinfection (7/8); (8) early detection of CDAD in symptomatic patients (7/8); (9) usage of protective clothing/gloves (8/8); (10) proper measures during outbreak (8/8); and (11) surveillance to monitor efficacy data of preventive measures (8/8). The panel members agreed with 11 of 17 recommendations presented. The additional recommendations by the panel were proton pump inhibitor use as a risk factor and the use of adjunctive therapy with specific probiotic, as it was approved by Health Canada for the risk reduction of CDAD in hospitalized patients. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Individual Differences in Subjective Utility and Risk Preferences: The Influence of Hedonic Capacity and Trait Anxiety

PubMed Central

Howlett, Jonathon R.; Paulus, Martin P.

2017-01-01

Individual differences in decision-making are important in both normal populations and psychiatric conditions. Variability in decision-making could be mediated by different subjective utilities or by other processes. For example, while traditional economic accounts attribute risk aversion to a concave subjective utility curve, in practice other factors could affect risk behavior. This distinction may have important implications for understanding the biological basis of variability in decision-making and for developing interventions to improve decision-making. Another aspect of decision-making that may vary between individuals is the sensitivity of subjective utility to counterfactual outcomes (outcomes that could have occurred, but did not). We investigated decision-making in relation to hedonic capacity and trait anxiety, two traits that relate to psychiatric conditions but also vary in the general population. Subjects performed a decision-making task, in which they chose between low- and high-risk gambles to win 0, 20, or 40 points on each trial. Subjects then rated satisfaction after each outcome on a visual analog scale, indicating subjective utility. Hedonic capacity was positively associated with the subjective utility of winning 20 points but was not associated with the concavity of the subjective utility curve (constructed using the mean subjective utility of winning 0, 20, or 40 points). Consistent with economic theory, concavity of the subjective utility curve was associated with risk aversion. Hedonic capacity was independently associated with risk seeking (i.e., not mediated by the shape of the subjective utility curve), while trait anxiety was unrelated to risk preferences. Contrary to our expectations, counterfactual sensitivity was unrelated to hedonic capacity and trait anxiety. Nevertheless, trait anxiety was associated with a self-report measure of regret-proneness, suggesting that counterfactual influences may occur via a pathway that is separate from immediate counterfactual processing biases. Taken together, our results show that hedonic capacity but not trait anxiety affects risk-taking through a mechanism that appears independent of the shape of the subjective utility curve, while hedonic capacity and trait anxiety do not affect the influence of counterfactual outcomes on subjective utility. The results have implications for understanding the underlying mechanisms of variable decision-making and for developing interventions to improve decision-making. PMID:28588508

Individual Differences in Subjective Utility and Risk Preferences: The Influence of Hedonic Capacity and Trait Anxiety.

PubMed

Howlett, Jonathon R; Paulus, Martin P

2017-01-01

Individual differences in decision-making are important in both normal populations and psychiatric conditions. Variability in decision-making could be mediated by different subjective utilities or by other processes. For example, while traditional economic accounts attribute risk aversion to a concave subjective utility curve, in practice other factors could affect risk behavior. This distinction may have important implications for understanding the biological basis of variability in decision-making and for developing interventions to improve decision-making. Another aspect of decision-making that may vary between individuals is the sensitivity of subjective utility to counterfactual outcomes (outcomes that could have occurred, but did not). We investigated decision-making in relation to hedonic capacity and trait anxiety, two traits that relate to psychiatric conditions but also vary in the general population. Subjects performed a decision-making task, in which they chose between low- and high-risk gambles to win 0, 20, or 40 points on each trial. Subjects then rated satisfaction after each outcome on a visual analog scale, indicating subjective utility. Hedonic capacity was positively associated with the subjective utility of winning 20 points but was not associated with the concavity of the subjective utility curve (constructed using the mean subjective utility of winning 0, 20, or 40 points). Consistent with economic theory, concavity of the subjective utility curve was associated with risk aversion. Hedonic capacity was independently associated with risk seeking (i.e., not mediated by the shape of the subjective utility curve), while trait anxiety was unrelated to risk preferences. Contrary to our expectations, counterfactual sensitivity was unrelated to hedonic capacity and trait anxiety. Nevertheless, trait anxiety was associated with a self-report measure of regret-proneness, suggesting that counterfactual influences may occur via a pathway that is separate from immediate counterfactual processing biases. Taken together, our results show that hedonic capacity but not trait anxiety affects risk-taking through a mechanism that appears independent of the shape of the subjective utility curve, while hedonic capacity and trait anxiety do not affect the influence of counterfactual outcomes on subjective utility. The results have implications for understanding the underlying mechanisms of variable decision-making and for developing interventions to improve decision-making.

Work Truck Idling Reduction

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

None

2017-03-01

Hybrid utility trucks, with auxiliary power sources for on-board equipment, significantly reduce unnecessary idling resulting in fuel costs savings, less engine wear, and reduction in noise and emissions.

[Smoking fewer cigarettes per day may determine a significant risk reduction in developing smoking attributable diseases? Is there a risk reduction for e-cigarette users?].

PubMed

Pieri, Luca; Chellini, Elisabetta; Gorini, Giuseppe

2014-01-01

Among Italian smokers--about 10 millions in 2013--about 600,000 began using electronic cigarettes (e-cigs) in last years. About 10% of e-cig users quitted smoking tobacco, whereas the 90% was dual users. Among them, about three out of four decreased the number of cigarettes smoked per day (cig/day), but did not quit. How many fewer cigarettes a smoker has to smoke to obtain significant health benefits? Is there a threshold? In order to observe a significant 27% reduction in the risk of developing lung cancer, a smoker must reduce the number of cig/day by at least 50%, while for the other smoking-related diseases (acute myocardial infarction - AMI, stroke, chronic obstructive pulmonary diseases), halving the number of cig/day did not drive to a significant risk reduction. Even smoking 5 cig/day increases the risk of AMI, whereas it significantly lowers the risk of lung cancer. Obviously, quitting smoking is the best choice to highly reduce risks for all smoking-related diseases. Therefore, in order to achieve significant risk reductions, e-cig users should quit smoking as first choice, or, if they feel it is impossible to them, reduce the consumption of traditional cigarettes to less than 5 cig/day.

Developing an Integrated, Brief Biobehavioral HIV Prevention Intervention for High-Risk Drug Users in Treatment: The Process and Outcome of Formative Research

PubMed Central

Shrestha, Roman; Altice, Frederick; Karki, Pramila; Copenhaver, Michael

2017-01-01

To date, HIV prevention efforts have largely relied on singular strategies (e.g., behavioral or biomedical approaches alone) with modest HIV risk-reduction outcomes for people who use drugs (PWUD), many of whom experience a wide range of neurocognitive impairments (NCI). We report on the process and outcome of our formative research aimed at developing an integrated biobehavioral approach that incorporates innovative strategies to address the HIV prevention and cognitive needs of high-risk PWUD in drug treatment. Our formative work involved first adapting an evidence-based behavioral intervention—guided by the Assessment–Decision–Administration–Production–Topical experts–Integration–Training–Testing model—and then combining the behavioral intervention with an evidence-based biomedical intervention for implementation among the target population. This process involved eliciting data through structured focus groups (FGs) with key stakeholders—members of the target population (n = 20) and treatment providers (n = 10). Analysis of FG data followed a thematic analysis approach utilizing several qualitative data analysis techniques, including inductive analysis and cross-case analysis. Based on all information, we integrated the adapted community-friendly health recovery program—a brief evidence-based HIV prevention behavioral intervention—with the evidence-based biomedical component [i.e., preexposure prophylaxis (PrEP)], an approach that incorporates innovative strategies to accommodate individuals with NCI. This combination approach—now called the biobehavioral community-friendly health recovery program—is designed to address HIV-related risk behaviors and PrEP uptake and adherence as experienced by many PWUD in treatment. This study provides a complete example of the process of selecting, adapting, and integrating the evidence-based interventions—taking into account both empirical evidence and input from target population members and target organization stakeholders. The resultant brief evidence-based biobehavioral approach could significantly advance primary prevention science by cost-effectively optimizing PrEP adherence and HIV risk reduction within common drug treatment settings. PMID:28553295

National trends and differences in morbidity among surgical approaches for radical prostatectomy in Germany.

PubMed

Stolzenburg, Jens Uwe; Kyriazis, Iason; Fahlenbrach, Claus; Gilfrich, Christian; Günster, Christian; Jeschke, Elke; Popken, Gralf; Weißbach, Lothar; von Zastrow, Christoph; Leicht, Hanna

2016-11-01

In this study, we document trends in radical prostatectomy (RP) employment in Germany during the period 2005-2012 and compare the morbidity of open (ORP), laparoscopic and robotic-assisted RP based on nationwide administrative data of Allgemeine Ortskrankenkassen (AOK) German local healthcare funds. Administrative claims data of all AOK patients subjected to RP during 2005-2012 (57,156 cases) were used to evaluate the employment of minimally invasive RP (MIRP) procedures, pelvic lymph node dissection (PLND) and nerve-sparing approaches during this period. In addition, data from the most recent three-year period of our dataset (2010-2012) were used to compare the morbidity among the different surgical approaches. Study end points comprised 30-day mortality, 30-day transfusion, 1-year reintervention and 30-day adverse events, as well as 1-year overall complications. A 20 % reduction in RP utilization from 2007 to 2012 was documented. ORP remained the predominant RP approach in Germany. MIRP approaches carried a lower risk of 30-day transfusions, 1-year reinterventions and 1-year overall complications than ORP when adjusting for confounding factors. PLND was associated with an increased risk of complications, while age in the highest quintile and the presence of comorbidities were independent risk factors for morbidity and mortality. Lack of pathological data was the main limitation of the study. RP utilization in Germany is dropping, but the use of MIRP has risen steadily during the years 2005-2012, which is expected to have a positive impact on the morbidity of the operation.

Osteoporosis in men.

PubMed

Binkley, Neil

2006-08-01

Osteoporosis is defined as "a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture". Approximately 40-50% of women sustain osteoporotic fractures in their lifetime; as such, it is appropriate that studies initially focused upon females. Despite an increased recognition of osteoporotic fractures in men, there continues to be neglect of this disease in males. This ongoing neglect is inappropriate as 25-33% of men in some populations will sustain osteoporotic fractures in their lifetime. Testosterone plays an important role in male skeletal health. However, recent data suggest that estrogen may in fact be the dominant hormone regulating skeletal status in both men and women. BMD measurement may be utilized for osteoporosis diagnosis and to assist with fracture risk prediction in men prior to their sustaining a fracture. Recognizing this need, the International Society for Clinical Densitometry (ISCD) recommended and recently reaffirmed use of a BMD T-score of -2.5 or below be utilized to diagnose osteoporosis in men. Androgen therapy of hypogonadal men may be considered with the caveat that data do not exist to document that this treatment reduces fracture risk. At this time, the data is inadequate to support use of androgen treatment in eugonadal men with osteoporosis. Parathyroid hormone treatment does increase BMD; existing studies have not been of adequate size or duration to document fracture reduction efficacy. Bisphosphonate therapy increases BMD, reduces vertebral fracture risk and is considered the standard of care for osteoporotic men at this point in time.

RELATIONSHIPS BETWEEN OXIDATION-REDUCTION, OXIDANT, AND PH IN DRINKING WATER

EPA Science Inventory

Oxidation and reduction (redox) reactions are very important in drinking water. Oxidation-reduction potential (ORP) measurements reflect the redox state of water. Redox measurements are not widely made by drinking water utilities in part because they are not well understood. The ...

Reflections from the interface between seismological research and earthquake risk reduction

NASA Astrophysics Data System (ADS)

Sargeant, S.

2012-04-01

Scientific understanding of earthquakes and their attendant hazards is vital for the development of effective earthquake risk reduction strategies. Within the global disaster reduction policy framework (the Hyogo Framework for Action, overseen by the UN International Strategy for Disaster Reduction), the anticipated role of science and scientists is clear, with respect to risk assessment, loss estimation, space-based observation, early warning and forecasting. The importance of information sharing and cooperation, cross-disciplinary networks and developing technical and institutional capacity for effective disaster management is also highlighted. In practice, the degree to which seismological information is successfully delivered to and applied by individuals, groups or organisations working to manage or reduce the risk from earthquakes is variable. The challenge for scientists is to provide fit-for-purpose information that can be integrated simply into decision-making and risk reduction activities at all levels of governance and at different geographic scales, often by a non-technical audience (i.e. people without any seismological/earthquake engineering training). The interface between seismological research and earthquake risk reduction (defined here in terms of both the relationship between the science and its application, and the scientist and other risk stakeholders) is complex. This complexity is a function of a range issues that arise relating to communication, multidisciplinary working, politics, organisational practices, inter-organisational collaboration, working practices, sectoral cultures, individual and organisational values, worldviews and expectations. These factors can present significant obstacles to scientific information being incorporated into the decision-making process. The purpose of this paper is to present some personal reflections on the nature of the interface between the worlds of seismological research and risk reduction, and the implications for scientists and information delivery.

Disaster risk reduction capacity assessment for precarious settlements in Guatemala City.

PubMed

Miles, Scott B; Green, Rebekah A; Svekla, Walter

2012-07-01

This study presents findings of an institutional capacity analysis of urban disaster risk reduction for informal settlements in the Guatemala Metropolitan Region. It uses a resource access perspective of vulnerability, actor-network theory, and qualitative data collection. The analysis reveals that there is interest in disaster risk reduction for the informal settlements; however, there is little in the way of direct financial or oversight relationships between informal settlement residents and all other actors. Respondents observed that informal settlements would probably remain inhabited; thus, there is a need for disaster risk reduction within these settlements. Disaster risk reduction capacity for informal settlements exists and can be further leveraged, as long as steps are taken to ensure appropriate access to and control of resources and oversight. Further, the nascent institutional arrangements should be strengthened through increased communication and coordination between actors, a decentralization of oversight and financial relationships, and mediation of identified resource conflicts. © 2012 The Author(s). Journal compilation © Overseas Development Institute, 2012.

Risk analysis for U.S. offshore wind farms: the need for an integrated approach.

PubMed

Staid, Andrea; Guikema, Seth D

2015-04-01

Wind power is becoming an increasingly important part of the global energy portfolio, and there is growing interest in developing offshore wind farms in the United States to better utilize this resource. Wind farms have certain environmental benefits, notably near-zero emissions of greenhouse gases, particulates, and other contaminants of concern. However, there are significant challenges ahead in achieving large-scale integration of wind power in the United States, particularly offshore wind. Environmental impacts from wind farms are a concern, and these are subject to a number of on-going studies focused on risks to the environment. However, once a wind farm is built, the farm itself will face a number of risks from a variety of hazards, and managing these risks is critical to the ultimate achievement of long-term reductions in pollutant emissions from clean energy sources such as wind. No integrated framework currently exists for assessing risks to offshore wind farms in the United States, which poses a challenge for wind farm risk management. In this "Perspective", we provide an overview of the risks faced by an offshore wind farm, argue that an integrated framework is needed, and give a preliminary starting point for such a framework to illustrate what it might look like. This is not a final framework; substantial work remains. Our intention here is to highlight the research need in this area in the hope of spurring additional research about the risks to wind farms to complement the substantial amount of on-going research on the risks from wind farms. © 2015 Society for Risk Analysis.

Preferences for breast cancer risk reduction among BRCA1/BRCA2 mutation carriers: a discrete-choice experiment.

PubMed

Liede, Alexander; Mansfield, Carol A; Metcalfe, Kelly A; Price, Melanie A; Snyder, Carrie; Lynch, Henry T; Friedman, Sue; Amelio, Justyna; Posner, Joshua; Narod, Steven A; Lindeman, Geoffrey J; Evans, D Gareth

2017-09-01

Unaffected women who carry BRCA1 or BRCA2 mutations face difficult choices about reducing their breast cancer risk. Understanding their treatment preferences could help us improve patient counseling and inform drug trials. The objective was to explore preferences for various risk-reducing options among women with germline BRCA1/2 mutations using a discrete-choice experiment survey and to compare expressed preferences with actual behaviors. A discrete-choice experiment survey was designed wherein women choose between hypothetical treatments to reduce breast cancer risk. The hypothetical treatments were characterized by the extent of breast cancer risk reduction, treatment duration, impact on fertility, hormone levels, risk of uterine cancer, and ease and mode of administration. Data were analyzed using a random-parameters logit model. Women were also asked to express their preference between surgical and chemoprevention options and to report on their actual risk-reduction actions. Women aged 25-55 years with germline BRCA1/2 mutations who were unaffected with breast or ovarian cancer were recruited through research registries at five clinics and a patient advocacy group. Between January 2015 and March 2016, 622 women completed the survey. Breast cancer risk reduction was the most important consideration expressed, followed by maintaining fertility. Among the subset of women who wished to have children in future, the ability to maintain fertility was the most important factor, followed by the extent of risk reduction. Many more women said they would take a chemoprevention drug than had actually taken chemoprevention. Women with BRCA1/2 mutations indicated strong preferences for breast cancer risk reduction and maintaining fertility. The expressed desire to have a safe chemoprevention drug available to them was not met by current chemoprevention options.

The number needed to treat: a clinically useful measure of treatment effect.

PubMed Central

Cook, R. J.; Sackett, D. L.

1995-01-01

The relative benefit of an active treatment over a control is usually expressed as the relative risk, the relative risk reduction, or the odds ratio. These measures are used extensively in both clinical and epidemiological investigations. For clinical decision making, however, it is more meaningful to use the measure "number needed to treat." This measure is calculated on the inverse of the absolute risk reduction. It has the advantage that it conveys both statistical and clinical significance to the doctor. Furthermore, it can be used to extrapolate published findings to a patient at an arbitrary specified baseline risk when the relative risk reduction associated with treatment is constant for all levels of risk. PMID:7873954

Nuclear Thermal Propulsion Development Risks

NASA Technical Reports Server (NTRS)

Kim, Tony

2015-01-01

There are clear advantages of development of a Nuclear Thermal Propulsion (NTP) for a crewed mission to Mars. NTP for in-space propulsion enables more ambitious space missions by providing high thrust at high specific impulse ((is) approximately 900 sec) that is 2 times the best theoretical performance possible for chemical rockets. Missions can be optimized for maximum payload capability to take more payload with reduced total mass to orbit; saving cost on reduction of the number of launch vehicles needed. Or missions can be optimized to minimize trip time significantly to reduce the deep space radiation exposure to the crew. NTR propulsion technology is a game changer for space exploration to Mars and beyond. However, 'NUCLEAR' is a word that is feared and vilified by some groups and the hostility towards development of any nuclear systems can meet great opposition by the public as well as from national leaders and people in authority. The public often associates the 'nuclear' word with weapons of mass destruction. The development NTP is at risk due to unwarranted public fears and clear honest communication of nuclear safety will be critical to the success of the development of the NTP technology. Reducing cost to NTP development is critical to its acceptance and funding. In the past, highly inflated cost estimates of a full-scale development nuclear engine due to Category I nuclear security requirements and costly regulatory requirements have put the NTP technology as a low priority. Innovative approaches utilizing low enriched uranium (LEU). Even though NTP can be a small source of radiation to the crew, NTP can facilitate significant reduction of crew exposure to solar and cosmic radiation by reducing trip times by 3-4 months. Current Human Mars Mission (HMM) trajectories with conventional propulsion systems and fuel-efficient transfer orbits exceed astronaut radiation exposure limits. Utilizing extra propellant from one additional SLS launch and available energy in the NTP fuel, HMM radiation exposure can be reduced significantly.

Case Study of Cardiovascular Risk Reduction in the Northwest Region and TRICARE Region 11

DTIC Science & Technology

2003-11-01

and TRICARE Region 11. The second employee is not directly hired for cardiovascular risk reduction , but for tobacco cessation classes and consultation...Canadians with diabetes mellitus . Advances in Cardiovascular Risk Reduction 67 Experimental Medicine and Biology, 373-380...does not display a currently valid OMB control number. 1. REPORT DATE JUN 2003 2 . REPORT TYPE Final 3. DATES COVERED Jul 2002 - Jul 2003 4

78 FR 70915 - Information Collection Activity; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-27

... DEPARTMENT OF AGRICULTURE Rural Utilities Service Information Collection Activity; Comment Request AGENCY: Rural Utilities Service, USDA. ACTION: Notice and request for comments. SUMMARY: In accordance with the Paperwork Reduction Act of 1995 (44 U.S.C. Chapter 35, as amended), the Rural Utilities...

75 FR 51977 - Information Collection Activity; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-24

... DEPARTMENT OF AGRICULTURE Rural Utilities Service Information Collection Activity; Comment Request AGENCY: Rural Utilities Service, USDA. ACTION: Notice and request for comments. SUMMARY: In accordance with the Paperwork Reduction Act of 1995 (44 U.S.C. Chapter 35, as amended), the Rural Utilities...

Colorectal Cancer Awareness for Women via Facebook: A Pilot Study.

PubMed

Brittain, Kelly; Pennings Kamp, Kendra J; Salaysay, Zachary

Colorectal cancer is the third leading cause of cancer death among U.S. women. Women report being screened for colorectal cancer less often than men, and if colorectal cancer screening guidelines were routinely followed, approximately 60% of colorectal cancer deaths could be prevented. Many colorectal cancer screening interventions have not used Facebook, which is the most popular social media site among women. Little is known about engaging women in colorectal cancer screening and risk reduction information using Facebook. The "Colorectal Cancer Screening Awareness for Women" Facebook page was created to promote colorectal cancer screening and risk reduction awareness among women. Facebook posts targeted women aged 45-64 years and highlighted colorectal cancer screening methods, guidelines, and colorectal cancer risk reduction strategies. Demographics and data about the women's interactions with the page were collected using Facebook analytics and analyzed. The majority of the 391 users of the Colorectal Cancer Screening Awareness for Women Facebook page were women aged 45-54 years (56.5%). The most "liked" posts were related to colorectal cancer risk reduction behaviors. In an effort to increase routine colorectal cancer screening and colorectal cancer risk reduction behaviors, gastroenterology nurses and practices should consider Facebook as a good method to regularly engage women in colorectal cancer screening and colorectal cancer risk reduction information.

Effect of Using Different Vehicle Weight Groups on the Estimated Relationship Between Mass Reduction and U.S. Societal Fatality Risk per Vehicle Miles of Travel

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

Wenzel, Tom P.

This report recalculates the estimated relationship between vehicle mass and societal fatality risk, using alternative groupings by vehicle weight, to test whether the trend of decreasing fatality risk from mass reduction as case vehicle mass increases, holds over smaller increments of the range in case vehicle masses. The NHTSA baseline regression model estimates the relationship using for two weight groups for cars and light trucks; we re-estimated the mass reduction coefficients using four, six, and eight bins of vehicle mass. The estimated effect of mass reduction on societal fatality risk was not consistent over the range in vehicle masses inmore » these weight bins. These results suggest that the relationship indicated by the NHTSA baseline model is a result of other, unmeasured attributes of the mix of vehicles in the lighter vs. heavier weight bins, and not necessarily the result of a correlation between mass reduction and societal fatality risk. An analysis of the average vehicle, driver, and crash characteristics across the various weight groupings did not reveal any strong trends that might explain the lack of a consistent trend of decreasing fatality risk from mass reduction in heavier vehicles.« less

Do As I Say: Using Communication Role-Plays to Assess Sexual Assertiveness Following an Intervention

PubMed Central

Mercer Kollar, Laura M.; Davis, Teaniese L.; Monahan, Jennifer L.; Samp, Jennifer A.; Coles, Valerie B.; Bradley, Erin L. P.; Sales, Jessica McDermott; Comer, Sarah K.; Worley, Timothy; Rose, Eve; DiClemente, Ralph J.

2016-01-01

Sexual risk reduction interventions are often ineffective for women who drink alcohol. The present study examines whether an alcohol-related sexual risk reduction intervention successfully trains women to increase assertive communication behaviors and decrease aggressive communication behaviors. Women demonstrated their communication skills during interactive role-plays with male role-play partners. Young, unmarried, and nonpregnant African American women (N = 228, ages 18–24) reporting unprotected vaginal or anal sex and greater than three alcoholic drinks in the past 90 days were randomly assigned to a control, a sexual risk reduction, or a sexual and alcohol risk reduction (NLITEN) condition. Women in the NLITEN condition significantly increased assertive communication behavior compared to women in the control condition, yet use of aggressive communicative behaviors was unchanged. These data suggest assertive communication training is an efficacious component of a sexual and alcohol risk reduction intervention. Public health practitioners and health educators may benefit from group motivational enhancement therapy (GMET) training and adding a GMET module to existing sexual health risk reduction interventions. Future research should examine GMET’s efficacy in combination with other evidence-based interventions within other populations and examine talking over and interrupting one’s sexual partner as an assertive communication behavior within sexual health contexts. PMID:27164847

Do As I Say: Using Communication Role-Plays to Assess Sexual Assertiveness Following an Intervention.

PubMed

Mercer Kollar, Laura M; Davis, Teaniese L; Monahan, Jennifer L; Samp, Jennifer A; Coles, Valerie B; Bradley, Erin L P; Sales, Jessica McDermott; Comer, Sarah K; Worley, Timothy; Rose, Eve; DiClemente, Ralph J

2016-12-01

Sexual risk reduction interventions are often ineffective for women who drink alcohol. The present study examines whether an alcohol-related sexual risk reduction intervention successfully trains women to increase assertive communication behaviors and decrease aggressive communication behaviors. Women demonstrated their communication skills during interactive role-plays with male role-play partners. Young, unmarried, and nonpregnant African American women (N = 228, ages 18-24) reporting unprotected vaginal or anal sex and greater than three alcoholic drinks in the past 90 days were randomly assigned to a control, a sexual risk reduction, or a sexual and alcohol risk reduction (NLITEN) condition. Women in the NLITEN condition significantly increased assertive communication behavior compared to women in the control condition, yet use of aggressive communicative behaviors was unchanged. These data suggest assertive communication training is an efficacious component of a sexual and alcohol risk reduction intervention. Public health practitioners and health educators may benefit from group motivational enhancement therapy (GMET) training and adding a GMET module to existing sexual health risk reduction interventions. Future research should examine GMET's efficacy in combination with other evidence-based interventions within other populations and examine talking over and interrupting one's sexual partner as an assertive communication behavior within sexual health contexts. © 2016 Society for Public Health Education.

Discount rates in risk versus money and money versus money tradeoffs.

PubMed

Alberini, Anna; Chiabai, Aline

2007-04-01

We use data from a survey of residents of five Italian cities conducted in late spring 2004 to estimate the discount rates implicit in (1) money versus future risk reductions and (2) money versus money tradeoffs. We find that the mean personal discount rate is 0.3-1.7% in (1) and 8.7% in (2). The latter is lower than the discount rates estimated in comparable situations in many recent studies, greater than market interest rates in Italy at the time, and exhibits modest variation with age and gender. The discount rate implicit in money versus risk tradeoffs is within the range of estimates from studies in the United States and Europe, and does not depend on observable individual characteristics. We use split samples to investigate whether a completely abstract risk reduction - one where the risk reduction delivery has been stripped of all specifics, so that respondents should focus on the risks without being distracted by details - results in WTP and discount figures comparable to those from an identified delivery mechanism (a medical test). We find that while WTP for an immediate risk reduction is 42-73% higher with the abstract risk reduction, the discount rate in the money versus risk tradeoffs and the variance of the error term in the WTP equation are the same across the two variants of the questionnaire.

An absolute scale for measuring the utility of money

NASA Astrophysics Data System (ADS)

Thomas, P. J.

2010-07-01

Measurement of the utility of money is essential in the insurance industry, for prioritising public spending schemes and for the evaluation of decisions on protection systems in high-hazard industries. Up to this time, however, there has been no universally agreed measure for the utility of money, with many utility functions being in common use. In this paper, we shall derive a single family of utility functions, which have risk-aversion as the only free parameter. The fact that they return a utility of zero at their low, reference datum, either the utility of no money or of one unit of money, irrespective of the value of risk-aversion used, qualifies them to be regarded as absolute scales for the utility of money. Evidence of validation for the concept will be offered based on inferential measurements of risk-aversion, using diverse measurement data.

Substance Use, Depression and Sociodemographic Determinants of HIV Sexual Risk Behavior in Outpatient Substance Abuse Treatment Patients.

PubMed

Tross, Susan; Feaster, Daniel J; Thorens, Gabriel; Duan, Rui; Gomez, Zoilyn; Pavlicova, Martina; Hu, Mei Chen; Kyle, Tiffany; Erickson, Sarah; Spector, Anya; Haynes, Louise; Metsch, Lisa R

2015-01-01

The NIDA Clinical Trials Network trial of rapid HIV testing/counseling in 1281 patients was a unique opportunity to examine relationships among substance use, depressive symptoms, and sex risk behavior. Past 6-month substance use; substance use severity (Drug Abuse Screening Test - 10); depressive symptoms (Quick Inventory of Depressive Symptomatology); and three types of sex risk behavior (unprotected sex occasions [USOs] with primary partners; USOs with nonprimary partners; and USOs while high/drunk) were assessed. Zero-inflated negative binomial analyses provided: probability and rate of sex risk behavior (in risk behavior subsample). Levels of sexual risk behavior were high, while variable across the three types of sex risk behaviors. Among the patients, 50.4% had engaged in USOs with primary partners, 42% in sex while drunk or high, and 23.8% in USOs with nonprimary partners. Similar factors were significantly associated with all three types of sex risk behaviors. For all types, problem drinking, cocaine use, and substance use severity had an exacerbating effect. Older age was associated with lower risk behavior; other relationship categories (eg, married, separated/divorced, cohabitating) were associated with greater risk behavior than was single status. Depressive symptoms were associated with decreased likelihood of USOs with a primary partner. Sexual risk behavior is common among individuals in outpatient substance abuse treatment. Results highlight problem drinking (eg, up to three-fold) and cocaine (eg, up to twice) in increasing sex risk behavior. They demonstrate the utility of distinguishing between partner types and presence/absence of alcohol/drugs during sex. Findings argue for the need to integrate sex risk reduction into drug treatment.

Risk Reduction and Resource Pooling on a Cooperation Task

ERIC Educational Resources Information Center

Pietras, Cynthia J.; Cherek, Don R.; Lane, Scott D.; Tcheremissine, Oleg

2006-01-01

Two experiments investigated choice in adult humans on a simulated cooperation task to evaluate a risk-reduction account of sharing based on the energy-budget rule. The energy-budget rule is an optimal foraging model that predicts risk-averse choices when net energy gains exceed energy requirements (positive energy budget) and risk-prone choices…

Waiting for Disasters: A Risk Reduction Assessment of Technological Disasters

NASA Astrophysics Data System (ADS)

Rovins, Jane; Winningham, Sam

2010-05-01

This session provides a risk reduction/mitigation assessment of natural hazards causation of technological disasters and possible solution. People use technology in an attempt to not only control their environment but nature itself in order to make them feel safe and productive. Most strategies for managing hazards followed a traditional planning model i.e. study the problem, identify and implement a solution, and move on to the next problem. This approach is often viewed as static model and risk reduction is more of an upward, positive, linear trend. However, technological disasters do not allow risk reduction action to neatly fit this upward, positive, linear trend with actual or potential threats to the environment and society. There are different types of technological disasters, including industrial accidents; pipeline ruptures; accidents at power, water and heat supply systems and other lines of communication; sudden collapse of buildings and mines; air crashes; shipwrecks; automobile and railway accidents to name a few. Natural factors can play an essential role in triggering or magnifying technological disasters. They can result from the direct destruction of given technical objects by a hazardous natural process such as the destruction of an atomic power plant or chemical plant due to an earthquake. Other examples would include the destruction of communications or infrastructure systems by heavy snowfalls, strong winds, avalanches. Events in the past ten years clearly demonstrate that natural disasters and the technological disasters that accompany them are not problems that can be solved in isolation and risk reduction can play an important part. Risk reduction was designed to head off the continuing rising financial and structural tolls from disasters. All Hazard Risk Reduction planning was supposed to include not only natural, but technological, and human-made disasters as well. The subsequent disaster risk reduction (DRR) indicators were to provide the corner stone to sustained risk reduction. We are able to look at the ongoing work by UNISDR and other partners to develop DRR indicators to track progress toward the goals outlined in the Hyogo Framework for Action adopted by 168 countries in Kobe, Japan in January 2005. In addition, we can look at various global examples. Therefore the true question we shall address is whether or not the DRR indicators form a virtuous circle was created with risk reduction with a series of positive events triggering a self-perpetuating pattern of other positive occurrences or a vicious circle.

Poverty Reduction in Zambia: A Conceptual Analysis of the Zambian Poverty Reduction Strategy Paper

ERIC Educational Resources Information Center

Imboela, Bruce Lubinda

2005-01-01

Poverty reduction strategy papers (PRSPs) present a recipient country's program of intent for the utilization of World Bank loans and grants to alleviate debt under the bank's programs of action for poverty reduction in highly indebted poor countries (HIPCs). This article argues that structural transformation is a prerequisite for poverty…

RELATIONSHIPS BETWEEN OXIDATION-REDUCTION POTENTIAL, OXIDANT, AND PH IN DRINKING WATER

EPA Science Inventory

Oxidation and reduction (redox) reactions are very important in drinking water. Oxidation-reduction potential (ORP) measurements reflect the redox state of water. Redox measurements are not widely made by drinking water utilities in part because they are not well understood. The ...

Treatment of power utilities exhaust

DOEpatents

Koermer, Gerald [Basking Ridge, NJ

2012-05-15

Provided is a process for treating nitrogen oxide-containing exhaust produced by a stationary combustion source by the catalytic reduction of nitrogen oxide in the presence of a reductant comprising hydrogen, followed by ammonia selective catalytic reduction to further reduce the nitrogen oxide level in the exhaust.

A randomized controlled trial of an Internet delivered dialectical behavior therapy skills training for suicidal and heavy episodic drinkers.

PubMed

Wilks, Chelsey R; Lungu, Anita; Ang, Sin Yee; Matsumiya, Brandon; Yin, Qingqing; Linehan, Marsha M

2018-05-01

Given that alcohol misuse elevates risk of suicide death among ideators, the paucity of treatment outcome research for individuals presenting with both suicide ideation and problem drinking is particularly troubling. Dialectical behavior therapy (DBT) skills training, which effectively targets behaviors associated with emotion dysregulation including addictive and suicidal behaviors, provides a fitting model amenable to computerization. As stigma and scarcity stand as potential barriers to treatment, online dissemination platforms provide means for efficient treatment delivery that can augment the utility of suitable interventions. This pilot RCT sought to evaluate the feasibility, acceptability, and preliminary efficacy of an Internet-delivered DBT skills training intervention (iDBT-ST) for suicidal individuals who engage in heavy episodic drinking METHODS: Participants (N = 59) were randomized to receive iDBT-ST immediately or after an 8-week waiting period. Clinical outcomes were suicide ideation, alcohol use, and emotion dysregulation. Participants on average saw a significant reduction in all outcomes over the four-month study period. Compared to waitlist controls, individuals who received iDBT-ST immediately showed faster reductions in alcohol consumption. Preliminary results suggest that iDBT-ST may be a viable resource for the high-risk and underserved group represented in this study, and pathways for future development are suggested. There was difficulty retaining and engaging participants due to technological barriers. Copyright © 2018 Elsevier B.V. All rights reserved.

Moving from Outsider to Insider: Peer Status and Partnerships between Electricity Utilities and Residential Consumers

PubMed Central

Morris, Peter; Buys, Laurie; Vine, Desley

2014-01-01

An electricity demand reduction project based on comprehensive residential consumer engagement was established within an Australian community in 2008. By 2011, both the peak demand and grid supplied electricity consumption had decreased to below pre-intervention levels. This case study research explored the relationship developed between the utility, community and individual consumer from the residential customer perspective through qualitative research of 22 residential households. It is proposed that an energy utility can be highly successful at peak demand reduction by becoming a community member and a peer to residential consumers and developing the necessary trust, access, influence and partnership required to create the responsive environment to change. A peer-community approach could provide policymakers with a pathway for implementing pro-environmental behaviour for low carbon communities, as well as peak demand reduction, thereby addressing government emission targets while limiting the cost of living increases from infrastructure expenditure. PMID:24979234

Moving from outsider to insider: peer status and partnerships between electricity utilities and residential consumers.

PubMed

Morris, Peter; Buys, Laurie; Vine, Desley

2014-01-01

An electricity demand reduction project based on comprehensive residential consumer engagement was established within an Australian community in 2008. By 2011, both the peak demand and grid supplied electricity consumption had decreased to below pre-intervention levels. This case study research explored the relationship developed between the utility, community and individual consumer from the residential customer perspective through qualitative research of 22 residential households. It is proposed that an energy utility can be highly successful at peak demand reduction by becoming a community member and a peer to residential consumers and developing the necessary trust, access, influence and partnership required to create the responsive environment to change. A peer-community approach could provide policymakers with a pathway for implementing pro-environmental behaviour for low carbon communities, as well as peak demand reduction, thereby addressing government emission targets while limiting the cost of living increases from infrastructure expenditure.

Judging Statistical Models of Individual Decision Making under Risk Using In- and Out-of-Sample Criteria

PubMed Central

Drichoutis, Andreas C.; Lusk, Jayson L.

2014-01-01

Despite the fact that conceptual models of individual decision making under risk are deterministic, attempts to econometrically estimate risk preferences require some assumption about the stochastic nature of choice. Unfortunately, the consequences of making different assumptions are, at present, unclear. In this paper, we compare three popular error specifications (Fechner, contextual utility, and Luce error) for three different preference functionals (expected utility, rank-dependent utility, and a mixture of those two) using in- and out-of-sample selection criteria. We find drastically different inferences about structural risk preferences across the competing functionals and error specifications. Expected utility theory is least affected by the selection of the error specification. A mixture model combining the two conceptual models assuming contextual utility provides the best fit of the data both in- and out-of-sample. PMID:25029467

Judging statistical models of individual decision making under risk using in- and out-of-sample criteria.

PubMed

Drichoutis, Andreas C; Lusk, Jayson L

2014-01-01

Despite the fact that conceptual models of individual decision making under risk are deterministic, attempts to econometrically estimate risk preferences require some assumption about the stochastic nature of choice. Unfortunately, the consequences of making different assumptions are, at present, unclear. In this paper, we compare three popular error specifications (Fechner, contextual utility, and Luce error) for three different preference functionals (expected utility, rank-dependent utility, and a mixture of those two) using in- and out-of-sample selection criteria. We find drastically different inferences about structural risk preferences across the competing functionals and error specifications. Expected utility theory is least affected by the selection of the error specification. A mixture model combining the two conceptual models assuming contextual utility provides the best fit of the data both in- and out-of-sample.

Cardiovascular health promotion for children: a model for a Parish (County)-wide program (implementation and preliminary results).

PubMed

Berenson, Gerald S

2010-01-01

Cardiovascular (CV) risk factors in childhood result in a lifetime burden on the CV system. The Bogalusa Heart Study, a prevention program for children, addresses behaviors and lifestyles associated with CV risk. This prevention program utilizes the substructure of a Parish (County) that can be a model for other areas. All aspects in educating school children-the classroom, physical activity, cafeteria, teachers, and parents with community involvement-are included. The program requires cooperation of parents, schools, physicians, and political and business personnel. Their collaboration helps implement and sustain the program. Understanding the origin of coronary artery disease, hypertension, diabetes, and now the obesity epidemic shows the need to develop a framework for improving lifestyles and behaviors beginning in childhood. In addition to nutrition and exercise, the program addresses tobacco, alcohol, and drug use, and societal problems such as dropping out of school, violent behavior, and teenage pregnancy. An initial accomplishment is the entry into all elementary schools, representing approximately 7000 children. Early results show reduction in obesity, increased physical activity, improved decision making, and healthy attitudes. This public health model is inexpensive by utilizing prior research findings and integrating into community resources. Health education of children is an important aspect of preventive cardiology with a need for pediatric and adult cardiologists' involvement. 2009 Wiley Periodicals, Inc.

A systematic review of help-seeking and mental health service utilization among military service members.

PubMed

Hom, Melanie A; Stanley, Ian H; Schneider, Matthew E; Joiner, Thomas E

2017-04-01

Research has demonstrated that military service members are at elevated risk for a range of psychiatric problems, and mental health services use is a conduit to symptom reduction and remission. Nonetheless, there is a notable underutilization of mental health services in this population. This systematic review aimed to identify and critically examine: (1) rates of service use; (2) barriers and facilitators to care; and (3) programs and interventions designed to enhance willingness to seek care and increase help-seeking behaviors among current military personnel (e.g., active duty, National Guard, Reserve). Overall, 111 peer-reviewed articles were identified for inclusion. Across studies, the rate of past-year service use among service members with mental health problems during the same time frame was 29.3% based on weighted averages. Studies identified common barriers to care (e.g., concerns regarding stigma, career impact) and facilitators to care (e.g., positive attitudes toward treatment, family/friend support, military leadership support) among this population. Although programs (e.g., screening, gatekeeper training) have been developed to reduce these barriers, leverage facilitators, and encourage service use, further research is needed to empirically test the effectiveness of these interventions in increasing rates of service utilization. Critical areas for future research on treatment engagement among this high-risk population are discussed. Copyright © 2017 Elsevier Ltd. All rights reserved.

The cardiovascular event reduction tool (CERT)--a simplified cardiac risk prediction model developed from the West of Scotland Coronary Prevention Study (WOSCOPS).

PubMed

L'Italien, G; Ford, I; Norrie, J; LaPuerta, P; Ehreth, J; Jackson, J; Shepherd, J

2000-03-15

The clinical decision to treat hypercholesterolemia is premised on an awareness of patient risk, and cardiac risk prediction models offer a practical means of determining such risk. However, these models are based on observational cohorts where estimates of the treatment benefit are largely inferred. The West of Scotland Coronary Prevention Study (WOSCOPS) provides an opportunity to develop a risk-benefit prediction model from the actual observed primary event reduction seen in the trial. Five-year Cox model risk estimates were derived from all WOSCOPS subjects (n = 6,595 men, aged 45 to 64 years old at baseline) using factors previously shown to be predictive of definite fatal coronary heart disease or nonfatal myocardial infarction. Model risk factors included age, diastolic blood pressure, total cholesterol/ high-density lipoprotein ratio (TC/HDL), current smoking, diabetes, family history of fatal coronary heart disease, nitrate use or angina, and treatment (placebo/ 40-mg pravastatin). All risk factors were expressed as categorical variables to facilitate risk assessment. Risk estimates were incorporated into a simple, hand-held slide rule or risk tool. Risk estimates were identified for 5-year age bands (45 to 65 years), 4 categories of TC/HDL ratio (<5.5, 5.5 to <6.5, 6.5 to <7.5, > or = 7.5), 2 levels of diastolic blood pressure (<90, > or = 90 mm Hg), from 0 to 3 additional risk factors (current smoking, diabetes, family history of premature fatal coronary heart disease, nitrate use or angina), and pravastatin treatment. Five-year risk estimates ranged from 2% in very low-risk subjects to 61% in the very high-risk subjects. Risk reduction due to pravastatin treatment averaged 31%. Thus, the Cardiovascular Event Reduction Tool (CERT) is a risk prediction model derived from the WOSCOPS trial. Its use will help physicians identify patients who will benefit from cholesterol reduction.

Impact of comprehensive cardiovascular risk reduction programme on risk factor clustering associated with elevated blood pressure in an Indian industrial population.

PubMed

Jeemon, Panniyammakal; Prabhakaran, Dorairaj; Goenka, Shifalika; Ramakrishnan, Lakshmy; Padmanabhan, Sandosh; Huffman, Mark; Joshi, Prashant; Sivasankaran, Sivasubramonian; Mohan, B V M; Ahmed, F; Ramanathan, Meera; Ahuja, R; Sinha, Nakul; Thankappan, K R; Reddy, K S

2012-04-01

Cardiovascular risk factors clustering associated with blood pressure (BP) has not been studied in the Indian population. This study was aimed at assessing the clustering effect of cardiovascular risk factors with suboptimal BP in Indian population as also the impact of risk reduction interventions. Data from 10543 individuals collected in a nation-wide surveillance programme in India were analysed. The burden of risk factors clustering with blood pressure and coronary heart disease (CHD) was assessed. The impact of a risk reduction programmme on risk factors clustering was prospectively studied in a sub-group. Mean age of participants was 40.9 ± 11.0 yr. A significant linear increase in number of risk factors with increasing blood pressure, irrespective of stratifying using different risk factor thresholds was observed. While hypertension occurred in isolation in 2.6 per cent of the total population, co-existence of hypertension and >3 risk factors was observed in 12.3 per cent population. A comprehensive risk reduction programme significantly reduced the mean number of additional risk factors in the intervention population across the blood pressure groups, while it continued to be high in the control arm without interventions (both within group and between group P<0.001). The proportion of 'low risk phenotype' increased from 13.4 to 19.9 per cent in the intervention population and it was decreased from 27.8 to 10.6 per cent in the control population (P<0.001). The proportion of individuals with hypertension and three more risk factors decreased from 10.6 to 4.7 per cent in the intervention arm while it was increased from 13.3 to 17.8 per cent in the control arm (P<0.001). Our findings showed that cardiovascular risk factors clustered together with elevated blood pressure and a risk reduction programme significantly reduced the risk factors burden.

Primary Prevention of Colorectal Cancer

PubMed Central

Chan, Andrew T.; Giovannucci, Edward L.

2010-01-01

Colorectal cancer has been strongly associated with a Western lifestyle. In the past several decades, much has been learned about the dietary, lifestyle, and medication risk factors for this malignancy. Although there is controversy about the role of specific nutritional factors, consideration of the dietary pattern as a whole appears useful for formulating recommendations. For example, several studies have shown that high intake of red and processed meats, highly refined grains and starches, and sugars is related to increased risk of colorectal cancer. Replacing these factors with poultry, fish, and plant sources as the primary source of protein; unsaturated fats as the primary source of fat; and unrefined grains, legumes and fruits as the primary source of carbohydrates is likely to lower risk of colorectal cancer. Although a role for supplements, including vitamin D, folate, and vitamin B6, remains uncertain, calcium supplementation is likely to be at least modestly beneficial. With respect to lifestyle, compelling evidence indicates that avoidance of smoking and heavy alcohol use, prevention of weight gain, and the maintenance of a reasonable level of physical activity are associated with markedly lower risks of colorectal cancer. Medications such as aspirin and non-steroidal anti-inflammatory drugs and post-menopausal hormones for women are associated with significant reductions in colorectal cancer risk, though their utility is affected by associated risks. Taken together, modifications in diet and lifestyle should substantially reduce the risk of colorectal cancer and could complement screening in reducing colorectal cancer incidence. PMID:20420944

Mothers' knowledge and attitudes to sudden infant death syndrome risk reduction messages: results from a UK survey.

PubMed

Pease, Anna S; Blair, Peter S; Ingram, Jenny; Fleming, Peter J

2018-01-01

To investigate mothers' knowledge of reducing the risks for sudden infant death syndrome (SIDS) and attitudes towards safer sleep practices. A cross-sectional survey was carried out in deprived areas of Bristol, UK. Recruitment took place in 2014 at local health visitor-led baby clinics. Of 432 mothers approached, 400 (93%) completed the face-to-face survey. Participants with infants at 'higher' risk of SIDS (using an algorithm based on a previous observational study) were compared with those at 'lower' risk. The survey asked participants to recall three SIDS risk reduction strategies (unprompted), and scored responses to 14 SIDS risk-related infant sleep scenarios (prompted). Overall, 48/400 (12%) mothers were classified as higher risk. Mothers in the higher risk group were less likely to breast feed (multivariate OR=3.59(95% CI 1.46 to 8.86)), less likely to be able to cite two or more unprompted correct SIDS risk reduction strategies (multivariate OR=2.05(95% CI 1.02 to 4.13)) and scored lower on prompted safer sleep scenarios overall.Notably, only 206/400 (52%) of all mothers surveyed (33% in the higher risk group) from these deprived areas in Bristol identified infant sleep position as a risk reduction strategy for SIDS, despite 25 years of campaigns. Mothers in the higher risk group were disadvantaged when it came to some aspects of knowledge of SIDS risk reduction and attitudes to safer sleep. The initial 'Back-to Sleep' message that dramatically reduced these deaths a generation ago needs more effective promotion for today's generation of mothers. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Trends in resource utilization associated with the inpatient treatment of neonatal congenital heart disease.

PubMed

Smith, Andrew H; Gay, James C; Patel, Neal R

2014-01-01

While neonates account for a significant proportion of health care expenditures related to inpatient care for congenital heart disease, key drivers of resource utilization among this population are poorly defined. Data from 2005 through 2011 were extracted from the Pediatric Health Information System for patients assigned a discharge All Patient Refined Diagnosis Related Group of 630 (neonates with birthweight >2499 g undergoing a major cardiovascular procedure). Mortality risk adjustment for patients undergoing operative interventions was performed with the Risk Adjusment in Congenital Heart Surgery (RACHS-1) score. A total of 13 156 cases were included in the analysis. Despite only a 3% increase in case mix index and no significant change in operative acuity over the study period (RACHS classifications of 3 or greater 67% in 2005 vs. 66% in 2011, P = .64), there were inflation-adjusted increases in both total estimated cost per case of (50% to $151 760 in 2011, P < .001), and mean charge per case (33% to $433 875 in 2011, P < .001). Pharmacy charges increased by 16% (P < .001), with agents including chlorothiazide and albumin accounting for the highest patient charges over the study period. Imaging charges increased by 42% (P < .001), with an average of 5.7 echocardiograms and $6517 in associated charges per case by 2011. While the proportion of patients receiving nitric oxide remained consistent, mean duration of administration increased by 25% to 6.6 days by 2011, accounting for average charges of $52 141 per patient exposed. Among neonates with serious congenital heart disease, increases in both institutional costs and charges to the patient are associated with relatively consistent utilization practices in recent years. Multiinstitutional collaboration may prove useful in aligning evidence-based reductions in practice variation with limitations in resource utilization without compromising the quality of care. © 2013 Wiley Periodicals, Inc.

RiskChanges Spatial Decision Support system for the analysis of changing multi-hazard risk

NASA Astrophysics Data System (ADS)

van Westen, Cees; Zhang, Kaixi; Bakker, Wim; Andrejchenko, Vera; Berlin, Julian; Olyazadeh, Roya; Cristal, Irina

2015-04-01

Within the framework of the EU FP7 Marie Curie Project CHANGES and the EU FP7 Copernicus project INCREO a spatial decision support system was developed with the aim to analyse the effect of risk reduction planning alternatives on reducing the risk now and in the future, and support decision makers in selecting the best alternatives. Central to the SDSS are the stakeholders. The envisaged users of the system are organizations involved in planning of risk reduction measures, and that have staff capable of visualizing and analyzing spatial data at a municipal scale. The SDSS should be able to function in different countries with different legal frameworks and with organizations with different mandates. These could be subdivided into Civil protection organization with the mandate to design disaster response plans, Expert organizations with the mandate to design structural risk reduction measures (e.g. dams, dikes, check-dams etc), and planning organizations with the mandate to make land development plans. The SDSS can be used in different ways: analyzing the current level of risk, analyzing the best alternatives for risk reduction, the evaluation of the consequences of possible future scenarios to the risk levels, and the evaluation how different risk reduction alternatives will lead to risk reduction under different future scenarios. The SDSS is developed based on open source software and following open standards, for code as well as for data formats and service interfaces. Code development was based upon open source software as well. The architecture of the system is modular. The various parts of the system are loosely coupled, extensible, using standards for interoperability, flexible and web-based. The Spatial Decision Support System is composed of a number of integrated components. The Risk Assessment component allows to carry out spatial risk analysis, with different degrees of complexity, ranging from simple exposure (overlay of hazard and assets maps) to quantitative analysis (using different hazard types, temporal scenarios and vulnerability curves) resulting into risk curves. The platform does not include a component to calculate hazard maps, and existing hazard maps are used as input data for the risk component. The second component of the SDSS is a risk reduction planning component, which forms the core of the platform. This component includes the definition of risk reduction alternatives (related to disaster response planning, risk reduction measures and spatial planning) and links back to the risk assessment module to calculate the new level of risk if the measure is implemented, and a cost-benefit (or cost-effectiveness/ Spatial Multi Criteria Evaluation) component to compare the alternatives and make decision on the optimal one. The third component of the SDSS is a temporal scenario component, which allows to define future scenarios in terms of climate change, land use change and population change, and the time periods for which these scenarios will be made. The component doesn't generate these scenarios but uses input maps for the effect of the scenarios on the hazard and assets maps. The last component is a communication and visualization component, which can compare scenarios and alternatives, not only in the form of maps, but also in other forms (risk curves, tables, graphs)

Sexual health risk reduction interventions for people with severe mental illness: a systematic review.

PubMed

Pandor, Abdullah; Kaltenthaler, Eva; Higgins, Agnes; Lorimer, Karen; Smith, Shubulade; Wylie, Kevan; Wong, Ruth

2015-02-12

Despite variability in sexual activity among people with severe mental illness, high-risk sexual behavior (e.g. unprotected intercourse, multiple partners, sex trade and illicit drug use) is common. Sexual health risk reduction interventions (such as educational and behavioral interventions, motivational exercises, counselling and service delivery), developed and implemented for people with severe mental illness, may improve participants' knowledge, attitudes, beliefs behaviors or practices (including assertiveness skills) and could lead to a reduction in risky sexual behavior. This systematic review evaluates the effectiveness of sexual health risk reduction interventions for people with severe mental illness. Thirteen electronic databases (including MEDLINE, EMBASE and PsycINFO) were searched to August 2014, and supplemented by hand-searching relevant articles and contacting experts. All controlled trials (randomized or non-randomized) comparing the effectiveness of sexual health risk reduction interventions with usual care for individuals living in the community with severe mental illness were included. Outcomes included a range of biological, behavioral and proxy endpoints. Narrative synthesis was used to combine the evidence. Thirteen controlled trials (all from the USA) were included. Although there was no clear and consistent evidence that interventions reduce the total number of sex partners or improved behavioral intentions in sexual risk behavior, positive effects were generally observed in condom use, condom protected intercourse and on measures of HIV knowledge, attitudes to condom use and sexual behaviors and practices. However, the robustness of these findings is low due to the large between study variability, small sample sizes and low-to-moderate quality of included studies. There is insufficient evidence at present to fully support or reject the identified sexual health risk reduction interventions for people with severe mental illness. Given the serious consequences of high-risk sexual behaviors, there is an urgent need for well-designed UK based trials, as well as training and support for staff implementing sexual health risk reduction interventions. PROSPERO CRD42013003674 .

Blood Pressure Reduction and Secondary Stroke Prevention: A Systematic Review and Metaregression Analysis of Randomized Clinical Trials.

PubMed

Katsanos, Aristeidis H; Filippatou, Angeliki; Manios, Efstathios; Deftereos, Spyridon; Parissis, John; Frogoudaki, Alexandra; Vrettou, Agathi-Rosa; Ikonomidis, Ignatios; Pikilidou, Maria; Kargiotis, Odysseas; Voumvourakis, Konstantinos; Alexandrov, Anne W; Alexandrov, Andrei V; Tsivgoulis, Georgios

2017-01-01

Current recommendations do not specifically address the optimal blood pressure (BP) reduction for secondary stroke prevention in patients with previous cerebrovascular events. We conducted a systematic review and metaregression analysis on the association of BP reduction with recurrent stroke and cardiovascular events using data from randomized controlled clinical trials of secondary stroke prevention. For all reported events during each eligible study period, we calculated the corresponding risk ratios to express the comparison of event occurrence risk between patients randomized to antihypertensive treatment and those randomized to placebo. On the basis of the reported BP values, we performed univariate metaregression analyses according to the achieved BP values under the random-effects model (Method of Moments) for those adverse events reported in ≥10 total subgroups of included randomized controlled clinical trials. In pairwise meta-analyses, antihypertensive treatment lowered the risk for recurrent stroke (risk ratio, 0.73; 95% confidence interval, 0.62-0.87; P<0.001), disabling or fatal stroke (risk ratio, 0.71; 95% confidence interval, 0.59-0.85; P<0.001), and cardiovascular death (risk ratio, 0.85; 95% confidence interval, 0.75-0.96; P=0.01). In metaregression analyses, systolic BP reduction was linearly related to the lower risk of recurrent stroke (P=0.049), myocardial infarction (P=0.024), death from any cause (P=0.001), and cardiovascular death (P<0.001). Similarly, diastolic BP reduction was linearly related to a lower risk of recurrent stroke (P=0.026) and all-cause mortality (P=0.009). Funnel plot inspection and Egger statistical test revealed no evidence of publication bias. The extent of BP reduction is linearly associated with the magnitude of risk reduction in recurrent cerebrovascular and cardiovascular events. Strict and aggressive BP control seems to be essential for effective secondary stroke prevention. © 2016 American Heart Association, Inc.

Adaptation and Refinement of the HIV Knowledge Questionnaire for Use With Adolescent Girls

PubMed Central

Volpe, Ellen M.; Nelson, LaRon E.; Kraus, Rachel A.; Morrison-Beedy, Dianne

2008-01-01

The number of adolescent girls becoming infected with HIV has dramatically escalated to the point where they now represent one of the groups most at risk for this infection. As a component of addressing this pandemic, there is a need for psychometrically sound, tailored measures to assess an adolescent girl's level of knowledge regarding transmission and prevention of HIV. The purpose of this research was to modify an existing HIV knowledge measure used in the general adult population (brief HIV Knowledge Questionnaire [HIV-KQ]) and increase its utility by making it developmentally- and gender-specific for adolescent girls. The revised version with additional items underwent item and scale analysis to confirm psychometric properties with a sample of 62 adolescent girls. HIV-related knowledge is assessed extensively in clinical practice and educational settings and is an important component for monitoring change in successful HIV risk-reduction interventions. The final HIV-KQ for adolescent girls is a practical, specific, and appropriate instrument for use with adolescent girls in these settings. PMID:17889326

Female Condom Skill and Attitude: Results from a NIDA Clinical Trials Network Gender-specific HIV Risk Reduction Study

PubMed Central

Campbell, Aimee N. C.; Tross, Susan; Hu, Mei-Chen; Pavlicova, Martina; Kenney, Jennifer; Nunes, Edward V.

2011-01-01

The female condom is effective in reducing unprotected sexual acts; however it remains underutilized in the U.S. This study examined whether a 5-session HIV prevention intervention (Safer Sex Skills Building (SSB)), including presentation, discussion, and practice with female condoms, improved female condom skills and attitude among women in outpatient substance abuse treatment. Mixed-effects modeling was used to test the effect of SSB on skills and attitude over 3- and 6-month post treatment among 515 randomized women. SSB was significantly associated with increases in skills and attitude, and the female condom demonstration session was primarily responsible for skills improvement. Attitude was a partial mediator of the intervention effect in reducing unprotected sex. Findings emphasize the utility of integrating female condom messages targeting proximal behavioral outcomes into HIV prevention. The study supports the use of female condom skill instruction via brief, hands-on exercises, as well as further research to enhance attitudinal change to reduce sexual risk. PMID:21861607

Correlates of Trading Sex for Methamphetamine in a Sample of HIV-Negative Heterosexual Methamphetamine Users

PubMed Central

Semple, Shirley J.; Strathdee, Steffanie A.; Zians, Jim; Patterson, Thomas L.

2012-01-01

While many studies have examined correlates of trading sex for money, few have examined factors associated with exclusive trading of sex for drugs. We identified sociodemographic, behavioral, and psychological correlates of trading sex for methamphetamine in a sample of HIV-negative heterosexual men and women who were enrolled in a sexual risk reduction intervention in San Diego, California. Of 342 participants, 26% overall (21% of males and 31% of females) reported trading sex for methamphetamine in the past two months. Multiple logistic regression analysis revealed that recently trading sex for methamphetamine was independently associated with being female, homeless, binging on methamphetamine, sexual victimization in the past two months, engaging in anal sex 24 or more times in the past two months, and higher sexual compulsivity scores. Effective interventions for this high-risk population should consider gender-focused counseling for sexual abuse, motivational enhancement therapy, social-cognitive skills training, as well as enhanced access and utilization of social services, including drug treatment. PMID:21858954

Correlates of trading sex for methamphetamine in a sample of HIV-negative heterosexual methamphetamine users.

PubMed

Semple, Shirley J; Strathdee, Steffanie A; Zians, Jim; Patterson, Thomas L

2011-01-01

While many studies have examined correlates of trading sex for money, few have examined factors associated with exclusive trading of sex for drugs. We identified sociodemographic, behavioral, and psychological correlates of trading sex for methamphetamine in a sample of HIV-negative heterosexual men and women who were enrolled in a sexual risk reduction intervention in San Diego, California. Of 342 participants, 26% overall (21% of males and 31% of females) reported trading sex for methamphetamine in the past two months. Multiple logistic regression analysis revealed that recently trading sex for methamphetamine was independently associated with being female, homeless, binging on methamphetamine, sexual victimization in the past two months, engaging in anal sex 24 or more times in the past two months, and higher sexual compulsivity scores. Effective interventions for this high-risk population should consider gender-focused counseling for sexual abuse, motivational enhancement therapy, social-cognitive skills training, as well as enhanced access and utilization of social services, including drug treatment.

Promoting the University Social Responsibility in the Capacity Development Program for Landslide Risk Reduction in Indonesia

NASA Astrophysics Data System (ADS)

Karnawati, D.; Wilopo, W.; Verrier, M.; Fathani, T. F.; Andayani, B.

2011-12-01

One of the most challenges efforts for landslides disaster risk reduction in Indonesia is to provide an effective program for capacity development of the community living in the vulnerable area. Limited access for appropriate information and knowledge about the geology and landslide phenomena as well as the social-security constrains are the major challenges in capacity development program in the landslide prone area. Accordingly, an action for conducting community-based research and education program with respect to landslide mitigation and disaster risk reduction at the village level was established by implementing the University Social Responsibility Program. Such program has been conducted regularly in every academic semester as a part of the formal academic program at Universitas Gadjah Mada , Indonesia. Twenty students with multi-discipline backgrounds and supported by their lectures/advisers have to be deployed at the village for two months to carry out such mission. This action is also conducted under the coordination with the local/ national Government together with the local community, and may also with the private sectors. A series of research actions such as landslide investigation and hazard-risk mapping, social mapping and development of landslide early warning system were carried out in parallel with public education and evacuation drill for community empowerment and landslide risk reduction. A Community Task Force for Disaster Risk Reduction was also established during the community empowerment program, in order to guarantee the affectivity and sustainability of the disaster risk reduction program at the village level. It is crucial that this program is not only beneficial for empowering the village community to tackle the landslide problems, but also important to support the education for sustainable development program at the disaster prone area. Indeed, this capacity development program may also be considered as one best practice for transforming the knowledge into action and the action into knowledge enhancement, with respect to landslide disaster risk reduction.
Scope of problems and the actions conducted by Universitas Gadjah Mada as The University Social Responsibility Program for Landslide Disaster Risk Reduction in Indonesia

Impact of type 2 diabetes medication cost sharing on patient outcomes and health plan costs.

PubMed

Thornton Snider, Julia; Seabury, Seth; Lopez, Janice; McKenzie, Scott; Goldman, Dana P

2016-06-01

To study the association between cost sharing for diabetes medications, adherence, hospitalization rates, and healthcare costs, with relationship to patient risk. A retrospective claims analysis of data from 35 large, private, self-insured employers (2004 to 2012). We examined outcomes for 92,410 patients aged 18 to 64 years with a type 2 diabetes (T2D) diagnosis who filled at least 1 T2D prescription. First, we examined the relationship between adherence, measured as the proportion of days covered, and cost sharing, measured as the out-of-pocket cost to purchase a pre-specified bundle of T2D prescriptions. We then examined the association between adherence and hospital days. Simulations showed the effect of increased cost sharing on adherence and inpatient utilization. A $10 increase in out-of-pocket cost was associated with a 1.9% reduction in adherence (P < .01). In turn, a 10% reduction in adherence was associated with a 15% increase in per-patient hospital days (0.17 days; P < .01). For the average plan, switching from low to high cost sharing reduced per-patient medication costs by $242 and increased per-patient hospitalization costs by $342, for a net increase of $100 in plan costs. Increases in per-patient costs were greater for high-risk patients, such as those with heart failure ($1328). Increased cost sharing for T2D medication was associated with reductions in pharmacy costs, but higher total costs for patients with T2D. This problem is particularly acute for patients with 1 or more cardiovascular comorbidities. The results suggest that increased diabetes cost sharing may hamper efforts to lower the total cost of diabetes care.

Parental History of Anxiety and Alcohol-Use Disorders and Alcohol Expectancies as Predictors of Alcohol-Related Problems*

PubMed Central

Morean, Meghan E.; Corbin, William R.; Sinha, Rajita; O'Malley, Stephanie S.

2009-01-01

Objective: Research has consistently identified a family history of alcoholism as a risk factor for alcohol-related problems, and global positive expectancies have been found to moderate this association. High rates of comorbidity between alcohol use and anxiety disorders suggest that a family history of anxiety disorders may also increase risk. Further, expectations of negative reinforcement (e.g., tension reduction) have been found to moderate the influence of anxiety-related traits. The current study sought to extend previous research by examining the influence of parental history of alcoholism, anxiety disorders, and the combination, as predictors of alcohol-related problems. Expectancies of global positive changes and tension reduction were hypothesized to moderate the influence of parental history of alcoholism and anxiety, respectively. Method: Direct interviews with parents assessed their history of alcoholism and anxiety for 144 offspring (ages 18-32; 53.5% male) creating four groups: those with a parental history of alcoholism (27.80%), anxiety (22.20%), both alcoholism and anxiety (33.30%), and no history of psychopathology (16.70%). Established measures assessed the offsprings'alcohol expectancies, alcohol use, and alcohol-related problems. Results: Although expected interactions between parental alcoholism and global positive expectancies and between parental anxiety and tension-reduction expectancies were not found, global positive expectancies were associated with alcohol-related problems among the group with parental history of both alcoholism and anxiety. Conclusions: The results suggest that the relation between parental history of alcoholism and global positive expectancies observed in previous studies may be strongest among individuals with a comorbid parental history of alcohol and anxiety disorders. Incorporating expectancies into interventions targeting individuals with a comorbid parental history of alcohol and anxiety disorders may have utility. PMID:19261234

Randomized Controlled Trial of a Web-Delivered Personalized Normative Feedback Intervention to Reduce Alcohol-Related Risky Sexual Behavior among College Students

PubMed Central

Lewis, Melissa A.; Patrick, Megan E.; Litt, Dana. M.; Atkins, David C.; Kim, Theresa; Blayney, Jessica A.; Norris, Jeanette; George, William H.; Larimer, Mary E.

2014-01-01

Objective The purpose of this study was to evaluate the efficacy of personalized normative feedback (PNF) on college student alcohol-related risky sexual behavior (RSB). Method In a randomized controlled trial, 480 (57.6% female) sexually-active college students were stratified by gender and level of drinking and randomly assigned to an alcohol only intervention, an alcohol-related RSB only intervention, a combined alcohol and alcohol-related RSB intervention, or control. All assessment and intervention procedures were web-based. Results Results indicated a significant reduction in drinking outcomes for the alcohol only and the combined alcohol and alcohol-related RSB interventions relative to control. Findings further demonstrated a significant reduction in alcohol-related RSB outcomes for the alcohol-related RSB only and the combined alcohol and alcohol-related RSB interventions relative to control. There were no significant intervention effects on alcohol-related negative consequences. These findings demonstrate that the combined alcohol and alcohol-related RSB intervention was the only intervention successful at reducing both drinking and alcohol-related RSB outcomes relative to control. There were no significant differences when comparing the combined alcohol and alcohol-related RSB intervention to the alcohol only intervention or the alcohol-related RSB only intervention. Finally, results suggested that the intervention effects on high-risk behaviors were mediated by reductions in descriptive normative perceptions. Conclusions These findings demonstrate that PNF specific to drinking in sexual situations was needed to reduce alcohol-related RSB. Furthermore, this study highlights the potential utility of a brief intervention that can be delivered via the Internet to reduce high-risk drinking and alcohol-related RSB among college students. PMID:24491076

Hypothesizing that a Pro-Dopaminergic Regulator (KB220z™ Liquid Variant) can Induce “Dopamine Homeostasis” and Provide Adjunctive Detoxification Benefits in Opiate/Opioid Dependence

PubMed Central

Blum, Kenneth; Whitney, Debra; Fried, Lye; Febo, Marcelo; Waite, Roger L; Braverman, Eric R; Dushaj, Kristina; Li, Mona; Giordano, John; Demetrovics, Zsolt; Badgaiyan, Rajendra D

2017-01-01

In order to explore the initiation of detoxification of addictive patients to opiates/opioids (along with some other anti-withdrawal agents), we developed a protocol to be utilized in treatment centers particularly with heavily dependent opiate/opioid subjects. Out of 17 subjects, only three received Buprenorphine/Naloxone (Bup/nx) along with KB220Z. In this pilot, we first used a dose of KB220Z of 2 oz twice daily before meals along with clonidine and benzodiazepines and other anti-nausea and sleep aids including Gabapentin. The dose of KB220Z was maintained for 6 days in five individuals. In a second scenario, we utilized a higher dose of 4 oz every 6 hours, over a 6-day period. The higher dose was employed in another 12 patients. It is noteworthy that only 3 people have relapsed utilizing these two protocols during the first two weeks of the study, allowing for the remaining 82% to be maintained on KB220Z. The patients have been maintained without any additional Bup/nx for a minimum of 120 days and in one subject, 214 days. We are in the process of testing this hypothesis in multiple treatment centers across the United Sates utilizing data from the Clinical opiate Withdrawal Scale (COWS) pre and post KB220Z. We are in the process of testing this hypothesis in multiple treatment centers across the United Sates. While this does not constitute an acceptable controlled experiment, it does provide some preliminary evidence that agrees with an earlier study. Moreover, because of the utilization of standard detoxifying agents in this detoxification protocol, we cannot make any inference to KB220Z’s effects. However, out of 17 subjects, only three required Bup/nx suggesting an interesting finding. If further confirmed in larger studies, the utilization for opiate/opioid detoxification may provide a novel way to eliminate the need for addictive opioids during withdrawal and detoxification. This paradigm shift may translate to a reduction in utilizing powerful and addictive opioids like buprenorphine and methadone (especially in these patients at high genetic risk for addiction) as not only detoxifying agents, but also maintenance drugs. While extensive research is required, this pilot paves the way for future investigations that could assist in the reduction of addictive opiate/opioid use and mortalities amongst both the young and old in America. PMID:29034323

An assessment of national risk: General concepts and overall approach. [carbon fiber utilization in commercial aviation

NASA Technical Reports Server (NTRS)

Kalelkar, A. S.

1979-01-01

The analysis of risk presented by carbon fiber utilization in commercial aviation is reported. The discussion is presented in three parts: (1) general concepts; (2) overall approach; and (3) risk evaluation and perspective.

Evaluation of biodiesel’s impact on real-world occupational and environmental particulate matter exposures at a municipal facility in Keene, NH

PubMed Central

Thelen, Brett Amy; Ingalls, Jaime Kathryn; Treadwell, Melinda Dawn

2016-01-01

Many organizations are interested in biodiesel as a renewable, domestic energy source for use in transportation and heavy-duty equipment. Although numerous biodiesel emission studies exist, biodiesel exposure studies are nearly absent from the literature. This study compared the impact of petroleum diesel fuel and a B20 blend (20% soy-based biodiesel/80% petroleum diesel) on occupational and environmental exposures at a rural municipal facility in Keene, NH. For each fuel type, we measured concentrations of fine particulate matter (PM2.5), elemental carbon (EC), and organic carbon (OC) at multiple locations (in-cabin, work area, and near-field) at a materials recovery facility utilizing non-road equipment. B20 fuel use resulted in significant reductions in PM2.5 mass (56–76%), reductions in EC (5–29%), and increases in OC (294–467%). Concentrations of PM2.5 measured during petroleum diesel use were up to four times higher than PM2.5 concentrations during B20 use. Further analysis of the EC and OC fractions of total carbon also indicated substantial differences between fuels. Our results demonstrate that biodiesel blends significantly reduced PM2.5 exposure compared to petroleum diesel fuel in a workplace utilizing non-road construction-type equipment. While this suggests that biodiesel may reduce health risks associated with exposure to fine particulate matter mass, more exposure research is needed to better understand biodiesel-related changes in particulate matter composition and other exposure metrics.

Recent advances in the management of chronic stable angina II. Anti-ischemic therapy, options for refractory angina, risk factor reduction, and revascularization

PubMed Central

Kones, Richard

2010-01-01

The objectives in treating angina are relief of pain and prevention of disease progression through risk reduction. Mechanisms, indications, clinical forms, doses, and side effects of the traditional antianginal agents – nitrates, β-blockers, and calcium channel blockers – are reviewed. A number of patients have contraindications or remain unrelieved from anginal discomfort with these drugs. Among newer alternatives, ranolazine, recently approved in the United States, indirectly prevents the intracellular calcium overload involved in cardiac ischemia and is a welcome addition to available treatments. None, however, are disease-modifying agents. Two options for refractory angina, enhanced external counterpulsation and spinal cord stimulation (SCS), are presented in detail. They are both well-studied and are effective means of treating at least some patients with this perplexing form of angina. Traditional modifiable risk factors for coronary artery disease (CAD) – smoking, hypertension, dyslipidemia, diabetes, and obesity – account for most of the population-attributable risk. Individual therapy of high-risk patients differs from population-wide efforts to prevent risk factors from appearing or reducing their severity, in order to lower the national burden of disease. Current American College of Cardiology/American Heart Association guidelines to lower risk in patients with chronic angina are reviewed. The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial showed that in patients with stable angina, optimal medical therapy alone and percutaneous coronary intervention (PCI) with medical therapy were equal in preventing myocardial infarction and death. The integration of COURAGE results into current practice is discussed. For patients who are unstable, with very high risk, with left main coronary artery lesions, in whom medical therapy fails, and in those with acute coronary syndromes, PCI is indicated. Asymptomatic patients with CAD and those with stable angina may defer intervention without additional risk to see if they will improve on optimum medical therapy. For many patients, coronary artery bypass surgery offers the best opportunity for relieving angina, reducing the need for additional revascularization procedures and improving survival. Optimal medical therapy, percutaneous coronary intervention, and surgery are not competing therapies, but are complementary and form a continuum, each filling an important evidence-based need in modern comprehensive management. PMID:20859545

Insurance data as way to evaluate the performance of a sustainable urban drainage system (SUDS) in Augustenborg, Malmö

NASA Astrophysics Data System (ADS)

Sörensen, Johanna; Emilsson, Tobias

2017-04-01

Sustainable Urban Drainage Systems (SUDS) has been put forward as a concept to improve stormwater management in urban areas. The damage reduction due to reduced flooding and storm water detention during extreme events is one of many important features of SUDS. As extreme events are rare, few assessments have earlier been made to evaluate the risk reduction. So far, most assessments have been done by hydraulic modelling, rather than analyses based on data from real flood events. In 2014, Malmö was hit with an extreme rainfall event which led to severe flooding in most parts of the city. This event gave an opportunity to evaluate the efficiency of SUDS during extreme events. In this study, flood claim data were analysed to evaluate flood risk reduction by the SUDS system in Augustenborg. Flood claim data were collected from both an insurance company, as well as the water utility company of Malmö for 5 neighbourhoods in close proximity in Malmö. The study uses the Augustenborg neighbourhood as an example of a retrofitted neighbourhood with an open SUDS. Augustenborg (Malmö, Sweden) was retrofitted 15 years ago using a combination of hard infrastructure and naturebased solutions, to alleviate basement flooding, to reduce combined sewer overflows (CSO) and to increase the ecological and aesthetical values of the area. The introduction of ponds, channels and green roofs dramatically changed the appearance of the area and the more or less regular floods were stopped. Augustenborg and its sustainable drainage system was compared with five similar neighbourhoods nearby. The long-term development of reported insurance claims in the selected neighbourhoods showed a reduction of flooding in Augustenborg compared to the nearby areas. Pre- and post-installation data showed a direct effect of the refurbishment with SUDS. Even though a few properties were flooded in Augustenborg, it was shown that the SUDS performed successfully during the extreme storm event that was the most severe flooding in Malmö in modern history. In conclusion, the SUDS in Augustenborg, Malmö, has been efficient in flood reduction during minor as well as severe flood events.

Nonvitamin-K-antagonist oral anticoagulants versus warfarin in patients with atrial fibrillation and previous stroke or transient ischemic attack: An updated systematic review and meta-analysis of randomized controlled trials.

PubMed

Ntaios, George; Papavasileiou, Vasileios; Diener, Hans-Chris; Makaritsis, Konstantinos; Michel, Patrik

2017-08-01

Background In a previous systematic review and meta-analysis, we assessed the efficacy and safety of nonvitamin-K antagonist oral anticoagulants versus warfarin in patients with atrial fibrillation and stroke or transient ischemic attack. Since then, new information became available. Aim The aim of the present work was to update the results of the previous systematic review and meta-analysis. Methods We searched PubMed until 24 August 2016 for randomized controlled trials using the following search items: "atrial fibrillation" and "anticoagulation" and "warfarin" and "previous stroke or transient ischemic attack." Eligible studies had to be phase III trials in patients with atrial fibrillation comparing warfarin with nonvitamin-K antagonist oral anticoagulants currently on the market or with the intention to be brought to the market in North America or Europe. The outcomes assessed in the efficacy analysis included stroke or systemic embolism, stroke, ischemic or unknown stroke, disabling or fatal stroke, hemorrhagic stroke, cardiovascular death, death from any cause, and myocardial infarction. The outcomes assessed in the safety analysis included major bleeding, intracranial bleeding, and major gastrointestinal bleeding. We performed fixed effects analyses on intention-to-treat basis. Results Among 183 potentially eligible articles, four were included in the meta-analysis. In 20,500 patients, compared to warfarin, nonvitamin-K antagonist oral anticoagulants were associated with a significant reduction of stroke/systemic embolism (relative risk reduction: 13.7%, absolute risk reduction: 0.78%, number needed to treat to prevent one event: 127), hemorrhagic stroke (relative risk reduction: 50.0%, absolute risk reduction: 0.63%, number needed to treat: 157), any stroke (relative risk reduction: 13.1%, absolute risk reduction: 0.7%, number needed to treat: 142), and intracranial hemorrhage (relative risk reduction: 46.1%, absolute risk reduction: 0.88%, number needed to treat: 113) over 1.8-2.8 years. Conclusions This updated meta-analysis in 20,500 atrial fibrillation patients with previous stroke or transient ischemic attack shows that compared to warfarin non-vitamin-K antagonist oral anticoagulants are associated with a significant reduction of stroke, stroke or systemic embolism, hemorrhagic stroke, and intracranial bleeding.

Cost-effectiveness of febrile neutropenia prevention with primary versus secondary G-CSF prophylaxis for adjuvant chemotherapy in breast cancer: a systematic review.

PubMed

Younis, T; Rayson, D; Jovanovic, S; Skedgel, C

2016-10-01

The adoption of primary (PP) versus secondary prophylaxis (SP) of febrile neutropenia (FN), with granulocyte colony-stimulating factors (G-CSF), for adjuvant chemotherapy (AC) regimens in breast cancer (BC) could be affected by its "value for money". This systematic review examined (i) cost-effectiveness of PP versus SP, (ii) FN threshold at which PP is cost-effective including the guidelines 20 % threshold and (iii) potential impact of G-CSF efficacy assumptions on outcomes. The systematic review identified all cost-effectiveness/cost-utility analyses (CEA/CUA) involving PP versus SP G-CSF for AC in BC that met predefined inclusion/exclusion criteria. Five relevant CEA/CUA were identified. These CEA/CUA examined different AC regimens (TAC = 2; FEC-D = 1; TC = 2) and G-CSF formulations (filgrastim "F" = 4; pegfilgrastim "P" = 4) with varying baseline FN-risk (range 22-32 %), mortality (range 1.4-6.0 %) and utility (range 0.33-0.47). The potential G-CSF benefit, including FN risk reduction with P versus F, varied among models. Overall, relative to SP, PP was not associated with good value for money, as per commonly utilized CE thresholds, at the baseline FN rates examined, including the consensus 20 % FN threshold, in most of these studies. The value for money associated with PP versus SP was primarily dependent on G-CSF benefit assumptions including reduced FN mortality and improved BC survival. PP G-CSF for FN prevention in BC patients undergoing AC may not be a cost-effective strategy at the guidelines 20 % FN threshold.

Cost-Utility Analysis of Lurasidone Versus Aripiprazole in Adults with Schizophrenia.

PubMed

Rajagopalan, Krithika; Trueman, David; Crowe, Lydia; Squirrell, Daniel; Loebel, Antony

2016-07-01

In 2014, lurasidone, an atypical antipsychotic, was approved for the treatment of schizophrenia in adults. It is an alternative treatment option to aripiprazole, and when compared with aripiprazole, lurasidone was associated with improved symptom reduction and reduced risk of weight gain and relapse. We conducted a cost-utility analysis of lurasidone versus aripiprazole from the perspective of healthcare services, using Scotland and Wales as specific case studies. A 10-year Markov model, incorporating a 6-week acute phase and a maintenance phase across three health states (discontinuation, relapse, death) was constructed. Six-week probabilities of discontinuation and adverse events were based on a published independent mixed-treatment comparison; long-term risks of relapse and discontinuation were from an indirect comparison. Costs included drug therapy, relapse, and outpatient, primary and residential care. Costs and benefits were discounted at 3.5 %. Utility estimates were taken from published literature, and cost effectiveness was expressed as total 10-year incremental costs and quality-adjusted life-years (QALYs). Lurasidone yielded a cost saving of £3383 and an improvement of 0.005 QALYs versus aripiprazole, in Scotland. Deterministic sensitivity analysis demonstrated that results were sensitive to relapse rates, while probabilistic sensitivity analysis suggested that lurasidone had the highest expected net benefit at willingness-to-pay thresholds of £20,000-30,000 per QALY. The probability that lurasidone was a cost-effective treatment strategy was approximately 75 % at all willingness-to-pay thresholds, with similar results being obtained for the Welsh analysis. Our analysis suggests that lurasidone would provide an effective, cost-saving alternative for the healthcare service in the treatment of adult patients with schizophrenia.

HIV risk reduction intervention among traditionally circumcised young men in South Africa: a cluster randomized control trial.

PubMed

Peltzer, Karl; Simbayi, Leickness; Banyini, Mercy; Kekana, Queen

2011-01-01

The aim of this study was to test a 180-minute group HIV risk-reduction counseling intervention trial with men undergoing traditional circumcision in South Africa to reduce behavioral disinhibition (false security) as a result of the procedure. A cluster randomized controlled trial design was employed using a sample of 160 men, 80 in the experimental group and 80 in the control group. Comparisons between baseline and 3-month follow-up assessments on key behavioral outcomes were completed. We found that behavioral intentions, risk-reduction skills, and male role norms did not change in the experimental compared to the control condition. However, HIV-related stigma beliefs were significantly reduced in both conditions over time. These findings show that one small-group HIV risk-reduction intervention did not reduce sexual risk behaviors in recently traditionally circumcised men at high risk for behavioral disinhibition. Copyright © 2011 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

Disaster Risk Reduction in Myanmar: A Need for Focus on Community Preparedness and Improved Evaluation of Initiatives.

PubMed

Smith, Andrew D; Chan, Emily Y Y

2017-11-20

Myanmar is a country in political and economic transition. Facing a wide-variety of natural hazards and ongoing conflict, the country's under-developed infrastructure has resulted in high disaster risk. Following the devastation of Cyclone Nargis in 2008 and increased global focus on disaster management and risk reduction, Myanmar has begun development of national disaster policies. Myanmar's Action Plan for Disaster Risk Reduction addressed multiple stages of disaster development and has made progress towards national projects, however, has struggled to implement community-based preparedness and response initiatives. This article analyses Myanmar's disaster strategy, though the use of a disaster development framework and suggests areas for possible improvement. In particular, the article aims to generate discussion regarding methods of supporting objective evaluation of risk reduction initiatives in developing countries. (Disaster Med Public Health Preparedness. 2017;page 1 of 5).

A 12-week multidomain intervention versus active control to reduce risk of Alzheimer’s disease: study protocol for a randomized controlled trial

PubMed Central

2013-01-01

Background Disappointing results from clinical trials of disease-modifying interventions for Alzheimer’s dementia (AD), along with reliable identification of modifiable risk factors in mid life from epidemiological studies, have contributed to calls to invest in risk-reduction interventions. It is also well known that AD-related pathological processes begin more than a decade before the development of clinical signs. These observations suggest that lifestyle interventions might be most effective when targeting non-symptomatic adults at risk of AD. To date, however, the few dementia risk-reduction programs available have targeted individual risk factors and/or were restricted to clinical settings. The current study describes the development of an evidence-based, theoretically-driven multidomain intervention to reduce AD risk in adults at risk. Method The design of Body Brain Life (BBL) is a randomized controlled trial (RCT) to evaluate a 12-week online AD risk-reduction intervention. Eligible participants with several modifiable risk factors on the Australian National University (ANU) AD Risk Index (ANU-ADRI) are randomly allocated to an online only group, an online and face-to-face group, or an active control group. We aim to recruit 180 participants, to undergo a comprehensive cognitive and physical assessment at baseline, post-intervention, and 6-month follow-up assessment. The intervention comprises seven online modules (dementia literacy, risk factor education, engagement in physical, social, and cognitive lifestyles, nutrition, and health monitoring) designed using contemporary models of health behavior change. Discussion The BBL program is a novel online intervention to reduce the risk of AD in middle-aged adults at risk. The trial is currently under way. It is hypothesized that participants in the intervention arms will make lifestyle changes in several domains, and that this will lead to a reduction in their AD risk profile. We also expect to show that health behavior change is underpinned by changes in psychological determinants of behavior. If successful, the findings will contribute to the development of further dementia risk reduction interventions, and thus contribute to the urgent need to lower dementia risk factors in the population to alter future projections of disease prevalence. Longer follow-up of BBL participants and replications using large samples are required to examine whether reduction in AD risk factors will be associated with reduced prevalence. Trial registration Reg. no. ACTRN12612000147886 PMID:23442574

On mitigating rapid onset natural disasters: Project THRUST (Tsunami Hazards Reduction Utilizing Systems Technology)

NASA Astrophysics Data System (ADS)

Bernard, E. N.; Behn, R. R.; Hebenstreit, G. T.; Gonzalez, F. I.; Krumpe, P.; Lander, J. F.; Lorca, E.; McManamon, P. M.; Milburn, H. B.

Rapid onset natural hazards have claimed more than 2.8 million lives worldwide in the past 20 years. This category includes such events as earthquakes, landslides, hurricanes, tornados, floods, volcanic eruptions, wildfires, and tsunamis. Effective hazard mitigation is particularly difficult in such cases, since the time available to issue warnings can be very short or even nonexistent. This paper presents the concept of a local warning system that exploits and integrates the existing technologies of risk evaluation, environmental measurement, and telecommunications. We describe Project THRUST, a successful implementation of this general, systematic approach to tsunamis. The general approach includes pre-event emergency planning, real-time hazard assessment, and rapid warning via satellite communication links.

A randomized comparison of patients' understanding of number needed to treat and other common risk reduction formats.

PubMed

Sheridan, Stacey L; Pignone, Michael P; Lewis, Carmen L

2003-11-01

Commentators have suggested that patients may understand quantitative information about treatment benefits better when they are presented as numbers needed to treat (NNT) rather than as absolute or relative risk reductions. To determine whether NNT helps patients interpret treatment benefits better than absolute risk reduction (ARR), relative risk reduction (RRR), or a combination of all three of these risk reduction presentations (COMBO). Randomized cross-sectional survey. University internal medicine clinic. Three hundred fifty-seven men and women, ages 50 to 80, who presented for health care. Subjects were given written information about the baseline risk of a hypothetical "disease Y" and were asked (1) to compare the benefits of two drug treatments for disease Y, stating which provided more benefit; and (2) to calculate the effect of one of those drug treatments on a given baseline risk of disease. Risk information was presented to each subject in one of four randomly allocated risk formats: NNT, ARR, RRR, or COMBO. When asked to state which of two treatments provided more benefit, subjects who received the RRR format responded correctly most often (60% correct vs 43% for COMBO, 42% for ARR, and 30% for NNT, P =.001). Most subjects were unable to calculate the effect of drug treatment on the given baseline risk of disease, although subjects receiving the RRR and ARR formats responded correctly more often (21% and 17% compared to 7% for COMBO and 6% for NNT, P =.004). Patients are best able to interpret the benefits of treatment when they are presented in an RRR format with a given baseline risk of disease. ARR also is easily interpreted. NNT is often misinterpreted by patients and should not be used alone to communicate risk to patients.

Synthesis of Conjugated Polymers Containing cis-Phenylenevinylenes by Titanium Mediated Reductions

PubMed Central

Moslin, Ryan M.; Espino, Christine G.; Swager, Timothy M.

2009-01-01

The utility of Sato's titanium-mediated reduction of alkynes towards the synthesis of all cis-poly(phenylenevinylene)s (PPVs) is demonstrated by the syn-selective reduction of a variety of model diynes as well as a tetrayne. This technique was then applied to the reduction of a poly(phenyleneethynylene) (PPE) to provide the corresponding all-cis PPV polymer. PMID:20827441

Reductions in indoor black carbon concentrations from improved biomass stoves in rural India.

PubMed

Patange, Omkar S; Ramanathan, Nithya; Rehman, I H; Tripathi, Sachi Nand; Misra, Amit; Kar, Abhishek; Graham, Eric; Singh, Lokendra; Bahadur, Ranjit; Ramanathan, V

2015-04-07

Deployment of improved biomass burning cookstoves is recognized as a black carbon (BC) mitigation measure that has the potential to achieve health benefits and climate cobenefits. Yet, few field based studies document BC concentration reductions (and resulting human exposure) resulting from improved stove usage. In this paper, data are presented from 277 real-world cooking sessions collected during two field studies to document the impacts on indoor BC concentrations inside village kitchens as a result of switching from traditional stoves to improved forced draft (FD) stoves. Data collection utilized new low-cost cellphone methods to monitor BC, cooking duration, and fuel consumption. A cross sectional study recorded a reduction of 36% in BC during cooking sessions. An independent paired sample study demonstrated a statistically significant reduction of 40% in 24 h BC concentrations when traditional stoves were replaced with FD stoves. Reductions observed in these field studies differ from emission factor reductions (up to 99%) observed under controlled conditions in laboratory studies. Other nonstove sources (e.g., kerosene lamps, ambient concentrations) likely offset the reductions. Health exposure studies should utilize reductions determined by field measurements inside village kitchens, in conjunction with laboratory data, to assess the health impacts of new cooking technologies.

Body contouring surgery following bariatric surgery and dietetically induced massive weight reduction: a risk analysis.

PubMed

de Kerviler, S; Hüsler, R; Banic, A; Constantinescu, M A

2009-05-01

This study analyzed the impact of weight reduction method, preoperative, and intraoperative variables on the outcome of reconstructive body contouring surgery following massive weight reduction. All patients presenting with a maximal BMI >/=35 kg/m(2) before weight reduction who underwent body contouring surgery of the trunk following massive weight loss (excess body mass index loss (EBMIL) >/= 30%) between January 2002 and June 2007 were retrospectively analyzed. Incomplete records or follow-up led to exclusion. Statistical analysis focused on weight reduction method and pre-, intra-, and postoperative risk factors. The outcome was compared to current literature results. A total of 104 patients were included (87 female and 17 male; mean age 47.9 years). Massive weight reduction was achieved through bariatric surgery in 62 patients (59.6%) and dietetically in 42 patients (40.4%). Dietetically achieved excess body mass index loss (EBMIL) was 94.20% and in this cohort higher than surgically induced reduction EBMIL 80.80% (p < 0.01). Bariatric surgery did not present increased risks for complications for the secondary body contouring procedures. The observed complications (26.9%) were analyzed for risk factors. Total tissue resection weight was a significant risk factor (p < 0.05). Preoperative BMI had an impact on infections (p < 0.05). No impact on the postoperative outcome was detected in EBMIL, maximal BMI, smoking, hemoglobin, blood loss, body contouring technique or operation time. Corrective procedures were performed in 11 patients (10.6%). The results were compared to recent data. Bariatric surgery does not increase risks for complications in subsequent body contouring procedures when compared to massive dietetic weight reduction.

New Tools and Methods for Assessing Risk-Management Strategies

DTIC Science & Technology

2004-03-01

Theories to evaluate the risks and benefits of various acquisition alternatives and allowed researchers to monitor the process students used to make a...revealed distinct risk-management strategies. 15. SUBJECT TERMS risk managements, acquisition process, expected value theory , multi-attribute utility theory ...Utility Theories to evaluate the risks and benefits of various acquisition alternatives, and allowed us to monitor the process subjects used to arrive at

Cover crops impact on excess rainfall and soil erosion rates in orchards and potato fields, Israel

NASA Astrophysics Data System (ADS)

Egozi, Roey; Gil, Eshel

2015-04-01

Bare soil and high drainage densities are common characteristics of intensive agriculture land. The couplings of these characteristics lead to high runoff and eroded soil volumes leaving the field or the orchard via the local drainage system into the fluvial system. This process increase flood risk due to massive deposition of the coarse fraction of the eroded soil and therefore reduces channel capacity to discharge the increase volumes of concentrated runoff. As a result drainage basin authorities are forced to invest large amount of money in maintaining and enlarging the drainage network. However this approach is un-sustainable. On the other hand, implementing cover crops (CC) and modification to current agricultural practices over the contributing area of the watershed seems to have more benefits and provide sustainable solution. A multi-disciplinary approach applied in commercial potatoes fields and orchards that utilize the benefit of CC shows great success as means of soil and water conservation and weed disinfestation without reduction in the yield, its quality or its profitability. The results indicate that it is possible to grow potatoes and citrus trees under CC with no reduction in yield or nutrient uptake, with more than 95% reduction in soil loss and more than 60% in runoff volumes and peak discharges.

Stages and Processes of Change Utilized by Female Sex Workers Participating in an Alcohol-Reduction Intervention in Mombasa, Kenya.

PubMed

Velloza, Jennifer; L'Engle, Kelly; Mwarogo, Peter; Chokwe, Jackie; Magaria, Loice; Sinkele, William; Kingola, Nzioki

2015-01-01

According to the transtheoretical model (TTM) behavior change occurs through a series of steps when an individual becomes aware of a behavior, prepares to change, and executes those changes using certain processes. This model has not yet been used to describe alcohol-reduction behavior change processes in resource-limited settings. This qualitative analysis aimed to describe and characterize the stages and processes of change employed by female sex workers in Mombasa, Kenya during the course of their participation in a 6-month alcohol reduction intervention. In 2011-2012, clinical interviews were conducted with 45 female sex workers. One interview was conducted each month during the intervention period, resulting in a total of six transcripts per participant. During each interview, the counselor noted the participant's stage of change and recent alcohol use. The clinical notes were analyzed via qualitative coding techniques and organized into matrices to classify alcohol reduction strategies discussed by participants. Participants discussed using the stage-specific processes of change described by the TTM to reduce their alcohol use and maintain the behavior change. Participants who were HIV-positive at the start of the intervention seemed to progress to the action/maintenance stage more quickly than HIV-negative participants. Results suggest that the TTM constructs may be relevant in understanding the alcohol reduction behavior change process of an at-risk population in a resource-limited setting. Future quantitative research should seek to validate the TTM's application internationally. Alcohol interventions should consider tailoring content to participants' stages of change and HIV-status for increased effectiveness.

Electric portfolio modeling with stochastic water - climate interactions: Implications for co-management of water and electric utilities

NASA Astrophysics Data System (ADS)

Woldeyesus, Tibebe Argaw

Water supply constraints can significantly restrict electric power generation, and such constraints are expected to worsen with future climate change. The overarching goal of this thesis is to incorporate stochastic water-climate interactions into electricity portfolio models and evaluate various pathways for water savings in co-managed water-electric utilities. Colorado Springs Utilities (CSU) is used as a case study to explore the above issues. The thesis consists of three objectives: Characterize seasonality of water withdrawal intensity factors (WWIF) for electric power generation and develop a risk assessment framework due to water shortages; Incorporate water constraints into electricity portfolio models and evaluate the impact of varying capital investments (both power generation and cooling technologies) on water use and greenhouse gas emissions; Compare the unit cost and overall water savings from both water and electric sectors in co-managed utilities to facilitate overall water management. This thesis provided the first discovery and characterization of seasonality of WWIF with distinct summertime and wintertime variations of +/-17% compared to the power plant average (0.64gal/kwh) which itself is found to be significantly higher than the literature average (0.53gal/kwh). Both the streamflow and WWIF are found to be highly correlated with monthly average temperature (r-sq = 89%) and monthly precipitation (r-sq of 38%) enabling stochastic simulation of future WWIF under moderate climate change scenario. Future risk to electric power generation also showed the risk to be underestimated significantly when using either the literature average or the power plant average WWIF. Seasonal variation in WWIF along with seasonality in streamflow, electricity demand and other municipal water demands along with storage are shown to be important factors for more realistic risk estimation. The unlimited investment in power generation and/or cooling technologies is also found to save water and GHG emissions by 68% and 75% respectively at a marginal levelized cost increase of 12%. In contrast, the zero investment scenarios (which optimizes exiting technologies to address water scarcity constraints on power generation) shows 50% water savings and 23% GHG emissions reduction at a relatively high marginal levelized cost increase of 37%. Water saving strategies in electric sector show very high cost of water savings (48,000 and 200,000)/Mgal-year under unlimited investment and zero investment scenarios respectively, but they have greater water saving impacts of 6% to CSU municipal water demand; while the individual water saving strategies from water sector have low cost of water savings ranging from (37-1,500)/Mgal-year but with less than 0.5% water reduction impact to CSU due to their low penetration. On the other hand, use of reclaimed water for power plant cooling systems have shown great water savings of up to 92% against the BAU and cost of water saving from (0-73,000)/Mgal-year when integrated with unlimited investment and zero investment water minimizing scenarios respectively in the electric sector. Overall, cities need to focus primarily on use of reclaimed water and in new generation technologies' investment including cooling system retrofits while focusing on expanding the penetration rate of individual water saving strategies in the water sector.

Return to drug use and overdose after release from prison: a qualitative study of risk and protective factors.

PubMed

Binswanger, Ingrid A; Nowels, Carolyn; Corsi, Karen F; Glanz, Jason; Long, Jeremy; Booth, Robert E; Steiner, John F

2012-01-01

Former inmates are at high risk for death from drug overdose, especially in the immediate post-release period. The purpose of the study is to understand the drug use experiences, perceptions of overdose risk, and experiences with overdose among former prisoners. This qualitative study included former prison inmates (N=29) who were recruited within two months after their release. Interviewers conducted in-person, semi-structured interviews which explored participants' experiences and perceptions. Transcripts were analyzed utilizing a team-based method of inductive analysis. The following themes emerged: 1) Relapse to drugs and alcohol occurred in a context of poor social support, medical co-morbidity and inadequate economic resources; 2) former inmates experienced ubiquitous exposure to drugs in their living environments; 3) intentional overdose was considered "a way out" given situational stressors, and accidental overdose was perceived as related to decreased tolerance; and 4) protective factors included structured drug treatment programs, spirituality/religion, community-based resources (including self-help groups), and family. Former inmates return to environments that strongly trigger relapse to drug use and put them at risk for overdose. Interventions to prevent overdose after release from prison may benefit from including structured treatment with gradual transition to the community, enhanced protective factors, and reductions of environmental triggers to use drugs.

Potential benefits of eicosapentaenoic acid on atherosclerotic plaques.

PubMed

Nelson, J R; Wani, O; May, H T; Budoff, M

2017-04-01

Residual cardiovascular (CV) risk remains in some patients despite optimized statin therapy and may necessitate add-on therapy to reduce this risk. Eicosapentaenoic acid (EPA), an omega-3 polyunsaturated fatty acid, lowers plasma triglyceride levels without raising low-density lipoprotein cholesterol levels and has potential beneficial effects on atherosclerotic plaques. Animal studies have shown that EPA reduces levels of pro-inflammatory cytokines and chemokines. In clinical trials utilizing a wide spectrum of plaque imaging modalities, EPA has shown beneficial effects on plaque characteristics. Studies of patients with coronary artery disease receiving statin therapy suggest that EPA may decrease plaque vulnerability and prevent plaque progression. EPA also decreased pentraxin-3 and macrophage accumulation. A large, randomized, Japanese study reported that EPA plus a statin resulted in a 19% relative reduction in major coronary events at 5years versus a statin alone in patients with hypercholesterolemia (P=0.011). Icosapent ethyl, a high-purity prescription form of EPA ethyl ester, has been shown to reduce triglyceride levels and markers of atherosclerotic inflammation. Results of an ongoing CV outcomes study will further define the potential clinical benefits of icosapent ethyl in reducing CV risk in high-risk patients receiving statin therapy. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Stimulus Equalization: Temporary Reduction of Stimulus Complexity to Facilitate Discrimination Learning.

ERIC Educational Resources Information Center

Hoko, J. Aaron; LeBlanc, Judith M.

1988-01-01

Because disabled learners may profit from procedures using gradual stimulus change, this study utilized a microcomputer to investigate the effectiveness of stimulus equalization, an error reduction procedure involving an abrupt but temporary reduction of dimensional complexity. The procedure was found to be generally effective and implications for…

The Three R's of Utility Savings: Rate Reduction, Rebates and Retrofit.

ERIC Educational Resources Information Center

Petiunas, Raymond V.

1993-01-01

An effective way to increase electricity energy savings for school districts is to integrate rate case participation (rate reduction) with conservation and load-management efforts (rebates) and retrofit operations, to obtain a total energy cost reduction package. Describes how a Pennsylvania consortium of school districts saved its member…

Mediation Analysis of the Efficacy of the Eban HIV/STD Risk-Reduction Intervention for African American HIV Serodiscordant Couples.

PubMed

El-Bassel, Nabila; Jemmott, John B; Bellamy, Scarlett L; Pequegnat, Willo; Wingood, Gina M; Wyatt, Gail E; Landis, J Richard; Remien, Robert H

2016-06-01

Targeting couples is a promising behavioral HIV risk-reduction strategy, but the mechanisms underlying the effects of such interventions are unknown. We report secondary analyses testing whether Social-Cognitive-Theory variables mediated the Eban HIV-risk-reduction intervention's effects on condom-use outcomes. In a multisite randomized controlled trial conducted in four US cities, 535 African American HIV-serodiscordant couples were randomized to the Eban HIV risk-reduction intervention or attention-matched control intervention. Outcomes were proportion condom-protected sex, consistent condom use, and frequency of unprotected sex measured pre-, immediately post-, and 6 and 12 months post-intervention. Potential mediators included Social-Cognitive-Theory variables: outcome expectancies and self-efficacy. Mediation analyses using the product-of-coefficients approach in a generalized-estimating-equations framework revealed that condom-use outcome expectancy, partner-reaction outcome expectancy, intention, self-efficacy, and safer-sex communication improved post-intervention and mediated intervention-induced improvements in condom-use outcomes. These findings underscore the importance of targeting outcome expectancies, self-efficacy, and safer-sex communication in couples-level HIV risk-reduction interventions.

Nation-building policies in Timor-Leste: disaster risk reduction, including climate change adaptation.

PubMed

Mercer, Jessica; Kelman, Ilan; do Rosario, Francisco; de Deus de Jesus Lima, Abilio; da Silva, Augusto; Beloff, Anna-Maija; McClean, Alex

2014-10-01

Few studies have explored the relationships between nation-building, disaster risk reduction and climate change adaptation. Focusing on small island developing states, this paper examines nation-building in Timor-Leste, a small island developing state that recently achieved independence. Nation-building in Timor-Leste is explored in the context of disaster risk reduction, which necessarily includes climate change adaptation. The study presents a synopsis of Timor-Leste's history and its nation-building efforts as well as an overview of the state of knowledge of disaster risk reduction including climate change adaptation. It also offers an analysis of significant gaps and challenges in terms of vertical and horizontal governance, large donor presence, data availability and the integration of disaster risk reduction and climate change adaptation for nation-building in Timor-Leste. Relevant and applicable lessons are provided from other small island developing states to assist Timor-Leste in identifying its own trajectory out of underdevelopment while it builds on existing strengths. © 2014 The Author(s). Disasters © Overseas Development Institute, 2014.

Exposure Perception as a Key Indicator of Risk Perception and Acceptance of Sources of Radio Frequency Electromagnetic Fields.

PubMed

Freudenstein, Frederik; Wiedemann, Peter M; Brown, Tim W C

2015-01-01

The presented survey was conducted in six European countries as an online study. A total of 2454 subjects participated. Two main research questions were investigated: firstly, how does the cognitive, moral, and affective framing of radio frequency electromagnetic field (RF EMF) exposure perception influence RF EMF risk perception? Secondly, can the deployment of mobile phone base stations have greater acceptance with RF EMF exposure reduction? The findings with respect to the first question clearly indicated that the cognitive framed exposure perception is the main determinant of RF EMF risk perception. The concomitant sensitivity to exposure strength offers an opportunity to improve the acceptance of base stations by exposure reduction. A linear regression analysis supported this assumption: in a fictional test situation, exposure reduction improved the acceptance of base stations, operationalized as the requested distance of the base station from one's own home. Furthermore, subjects with high RF EMF risk perception were most sensitive to exposure reduction. On average, a 70% exposure reduction reduced the requested distance from about 2000 meters to 1000 meters. The consequences for risk communication are discussed.

Changes in Breast Cancer Risk Distribution Among Vermont Women Using Screening Mammography

PubMed Central

Bolton, Kenyon C.; Mace, John L.; Vacek, Pamela M.; Herschorn, Sally D.; James, Ted A.; Tice, Jeffrey A.; Kerlikowske, Karla; Geller, Berta M.; Weaver, Donald L.

2014-01-01

Background Screening mammography utilization in Vermont has declined since 2009 during a time of changing screening guidelines and increased interest in personalized screening regimens. This study evaluates whether the breast cancer risk distribution of the state’s screened population changed during the observed decline. Methods We examined the breast cancer risk distribution among screened women between 2001 and 2012 using data from the Vermont Breast Cancer Surveillance System. We estimated each screened woman’s 5-year risk of breast cancer using the Breast Cancer Surveillance Consortium risk calculator. Annual screening counts by risk group were normalized and age-adjusted to the Vermont female population by direct standardization. Results The normalized rate of low-risk (5-year breast cancer risk of <1%) women screened increased 8.3% per year (95% confidence interval [CI] = 4.8 to 11.9) between 2003 and 2008 and then declined by −5.4% per year (95% CI = −8.1 to −2.6) until 2012. When stratified by age group, the rate of low-risk women screened declined −4.4% per year (95% CI = −8.8 to 0.1; not statistically significant) for ages 40 to 49 years and declined a statistically significant −7.1% per year (95% CI = −12.1 to −2.0) for ages 50 to 74 years during 2008 to 2012. These declines represented the bulk of overall decreases in screening after 2008, with rates for women categorized in higher risk levels generally exhibiting small annual changes. Conclusions The observed decline in women screened in Vermont in recent years is largely attributable to reductions in screening visits by women who are at low risk of developing breast cancer. PMID:24957223

Geothermal Risk Reduction via Geothermal/Solar Hybrid Power Plants. Final Report

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

Wendt, Daniel; Mines, Greg; Turchi, Craig

There are numerous technical merits associated with a renewable geothermal-solar hybrid plant concept. The performance of air-cooled binary plants is lowest when ambient temperatures are high due to the decrease in air-cooled binary plant performance that occurs when the working fluid condensing temperature, and consequently the turbine exhaust pressure, increases. Electrical power demand is generally at peak levels during periods of elevated ambient temperature and it is therefore especially important to utilities to be able to provide electrical power during these periods. The time periods in which air-cooled binary geothermal power plant performance is lowest generally correspond to periods ofmore » high solar insolation. Use of solar heat to increase air-cooled geothermal power plant performance during these periods can improve the correlation between power plant output and utility load curves. While solar energy is a renewable energy source with long term performance that can be accurately characterized, on shorter time scales of hours or days it can be highly intermittent. Concentrating solar power (CSP), aka solar-thermal, plants often incorporate thermal energy storage to ensure continued operation during cloud events or after sunset. Hybridization with a geothermal power plant can eliminate the need for thermal storage due to the constant availability of geothermal heat. In addition to the elimination of the requirement for solar thermal storage, the ability of a geothermal/solar-thermal hybrid plant to share a common power block can reduce capital costs relative to separate, stand-alone geothermal and solar-thermal power plant installations. The common occurrence of long-term geothermal resource productivity decline provides additional motivation to consider the use of hybrid power plants in geothermal power production. Geothermal resource productivity decline is a source of significant risk in geothermal power generation. Many, if not all, geothermal resources are subject to decreasing productivity manifested in the form of decreasing production fluid temperature, flow rate, or both during the life span of the associated power generation project. The impacts of geothermal production fluid temperature decline on power plant performance can be significant; a reduction in heat input to a power plant not only decreases the thermal energy available for conversion to electrical power, but also adversely impacts the power plant efficiency. The impact of resource productivity decline on power generation project economics can be equally detrimental. The reduction in power generation is directly correlated to a reduction in revenues from power sales. Further, projects with Power Purchase Agreement (PPA) contracts in place may be subject to significant economic penalties if power generation falls below a specified default level. While the magnitude of PPA penalties varies on a case-by-case basis, it is not unrealistic for these penalties to be on the order of the value of the deficit power sales such that the utility may purchase the power elsewhere. This report evaluates the use of geothermal/solar-thermal hybrid plant technology for mitigation of resource productivity decline, which has not been a primary topic of investigation in previous analyses in the open literature.« less

Utility of de-escalatory confidence-building measures

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

Nation, J.

1989-06-01

This paper evaluates the utility of specific confidence-building de-escalatory measures and pays special attention to the evaluation of measures which place restrictions on or establish procedures for strategic forces. Some measures appear more promising than others. Potentially useful confidence-building measures largely satisfy defined criteria and include the phased return of strategic nuclear forces to peacetime bases and operations, the termination of interference with communications and NTMs (National Technical Means) and the termination of civil defense preparations. Less-promising CBMs include the standing down of supplemental early warning systems, the establishment of SSBN keep-out zones, and decreases in bomber alert rates. Establishmentmore » of SSBN keep-out zones and reduction in bomber rates are difficult to verify, while the standing-down of early warning systems provides little benefit at potentially large costs. Particular confidence-building measures (CBMs) may be most useful in building superpower confidence at specific points in the crisis termination phase. For example, a decrease in strategic bomber alert rates may provide some decrease in perception of the likelihood of war, but its potential costs, particularly in increasing bomber vulnerability, may limit its utility and implementation to the final crisis stages when the risks of re-escalation and surprise attack are lower.« less

17 CFR 18.04 - Statement of reporting trader.

Code of Federal Regulations, 2011 CFR

2011-04-01

... the reduction of risks in the conduct and management of a commercial enterprise: (i) Commercial... appropriate to the reduction of risks in the conduct and management of a commercial enterprise: (i) Commercial..., merchandising or processing of a cash commodity, asset or liability risk management by depository institutions...

78 FR 28892 - Hazardous Fire Risk Reduction, East Bay Hills, CA

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-16

... DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency [Docket ID FEMA 2010-0037] Hazardous Fire Risk Reduction, East Bay Hills, CA AGENCY: Federal Emergency Management Agency, DHS. ACTION..., limbing and mowing, thinning, and grazing techniques as appropriate to reduce the risk of fire hazard...

Sexual Victimization and Health-Risk Behaviors: A Prospective Analysis of College Women

ERIC Educational Resources Information Center

Gidycz, Christine A.; Orchowski, Lindsay M.; King, Carrie R.; Rich, Cindy L.

2008-01-01

The present study utilizes the National College Health Risk Behavior Survey to examine the relationship between health-risk behaviors and sexual victimization among a sample of college women. A prospective design is utilized to examine the relationship between health-risk behaviors as measured at baseline and sexual victimization during a 3-month…

Personality Traits, Perceived Risk, and Risk-Reduction Behaviors: A Further Study of Smoking and Radon

PubMed Central

Hampson, Sarah E.; Andrews, Judy A.; Barckley, Maureen; Lichtenstein, Edward; Lee, Michael E.

2008-01-01

Personality traits and risk perceptions were examined as predictors of changes in smoking behavior. Participants (N = 697) were part of a randomized controlled trial of interventions to reduce exposure to the combined hazard of radon and cigarette smoke. Participants with higher perceived risk at baseline for the combination of smoking and radon were more likely to have a more restrictive household smoking ban in place at 12 months follow-up (p <. 05). Risk perceptions also predicted reductions in the total number of cigarettes smoked in the home for participants in the video intervention who had high or moderate levels of Extraversion (p <.001). Greater perceived risk predicted quitting for highly or moderately conscientious women (p <.05). The moderating effects of personality traits should be considered when evaluating risk-reduction interventions. PMID:16846328

The Effects of Variability and Risk in Selection Utility Analysis: An Empirical Comparison.

ERIC Educational Resources Information Center

Rich, Joseph R.; Boudreau, John W.

1987-01-01

Investigated utility estimate variability for the selection utility of using the Programmer Aptitude Test to select computer programmers. Comparison of Monte Carlo results to other risk assessment approaches (sensitivity analysis, break-even analysis, algebraic derivation of the distribtion) suggests that distribution information provided by Monte…

First Evaluation of a Contingency Management Intervention Addressing Adolescent Substance Use and Sexual Risk Behaviors: Risk Reduction Therapy for Adolescents.

PubMed

Letourneau, Elizabeth J; McCart, Michael R; Sheidow, Ashli J; Mauro, Pia M

2017-01-01

There is a need for interventions that comprehensively address youth substance use disorders (SUD) and sexual risk behaviors. Risk Reduction Therapy for Adolescents (RRTA) adapts a validated family-focused intervention for youth SUD to include sexual risk reduction components in a single intervention. In this first evaluation of RRTA, drug court involved youth were randomly assigned to RRTA (N=45) or usual services (US; N=60) and followed through 12-months post-baseline. RRTA included weekly cognitive behavior therapy and behavior management training and contingency-contracting with a point earning system managed by caregivers targeting drug use and sexual risk antecedents. Longitudinal models estimated within-group change and between-group differences through 6- and 12-month follow-up on outcomes for substance use, sexual risk behaviors, and protective HIV behaviors. Robust effects of the intervention were not detected under conditions of the study that included potent background interventions by the juvenile drug court. Considerations about future development and testing of sexual risk reduction therapy for youth are discussed, including the potential role of contingency management in future interventions. Copyright © 2016 Elsevier Inc. All rights reserved.

First Evaluation of a Contingency Management Intervention Addressing Adolescent Substance Use and Sexual Risk Behaviors: Risk Reduction Therapy for Adolescents

PubMed Central

Letourneau, Elizabeth J.; McCart, Michael R.; Sheidow, Ashli J.; Mauro, Pia M.

2016-01-01

There is a need for interventions that comprehensively address youth substance use disorders (SUD) and sexual risk behaviors. Risk Reduction Therapy for Adolescents (RRTA) adapts a validated family-focused intervention for youth SUD to include sexual risk reduction components in a single intervention. In this first evaluation of RRTA, drug court involved youth were randomly assigned to RRTA (N = 45) or usual services (US; N = 60) and followed through 12-months post-baseline. RRTA included weekly cognitive behavior therapy and behavior management training and contingency-contracting with a point earning system managed by caregivers targeting drug use and sexual risk antecedents. Longitudinal models estimated within-group change and between-group differences through 6- and 12-month follow-up on outcomes for substance use, sexual risk behaviors, and protective HIV behaviors. Robust effects of the intervention were not detected under conditions of the study that included potent background interventions by the juvenile drug court. Considerations about future development and testing of sexual risk reduction therapy for youth are discussed, including the potential role of contingency management in future interventions. PMID:27629581

Risk Reduction from Minimization of Persistent, Bioaccumulative, and Toxic Waste Materials Within the U.S. Industrial Solid Waste Management System

EPA Science Inventory

This study addressed three questions of interest in national-scale solid and hazardous waste management decision-making within the United States: 1) can we quantify the reduction in risk to human and ecological receptors resulting from the reduction of certain industrial waste s...

Development of a risk-adjustment model for antimicrobial utilization data in 21 public hospitals in Queensland, Australia (2006-11).

PubMed

Rajmokan, M; Morton, A; Marquess, J; Playford, E G; Jones, M

2013-10-01

Making valid comparisons of antimicrobial utilization between hospitals requires risk adjustment for each hospital's case mix. Data on individual patients may be unavailable or difficult to process. Therefore, risk adjustment for antimicrobial usage frequently needs to be based on a hospital's services. This study evaluated such a strategy for hospital antimicrobial utilization. Data were obtained on five broad subclasses of antibiotics [carbapenems, β-lactam/β-lactamase inhibitor combinations (BLBLIs), fluoroquinolones, glycopeptides and third-generation cephalosporins] from the Queensland pharmacy database (MedTrx) for 21 acute public hospitals (2006-11). Eleven clinical services and a variable for hospitals from the tropical region were employed for risk adjustment. Multivariable regression models were used to identify risk and protective services for these antibiotics. Funnel plots were used to display hospitals' antimicrobial utilization. Total inpatient antibiotic utilization for these antibiotics increased from 130.6 defined daily doses (DDDs)/1000 patient-days in 2006 to 155.8 DDDs/1000 patient-days in 2011 (P < 0.0001). Except for third-generation cephalosporins, the average utilization rate was higher for intensive care, renal/nephrology, cardiac, burns/plastic surgery, neurosurgery, transplant and acute spinal services than for the respective reference group (no service). In addition, oncology, high-activity infectious disease and coronary care services were associated with higher utilization of carbapenems, BLBLIs and glycopeptides. Our model predicted antimicrobial utilization rates by hospital services. The funnel plots displayed hospital utilization data after adjustment for variation among the hospitals. However, the methodology needs to be validated in other populations, ideally using a larger group of hospitals.

The Global Earthquake Model and Disaster Risk Reduction

NASA Astrophysics Data System (ADS)

Smolka, A. J.

2015-12-01

Advanced, reliable and transparent tools and data to assess earthquake risk are inaccessible to most, especially in less developed regions of the world while few, if any, globally accepted standards currently allow a meaningful comparison of risk between places. The Global Earthquake Model (GEM) is a collaborative effort that aims to provide models, datasets and state-of-the-art tools for transparent assessment of earthquake hazard and risk. As part of this goal, GEM and its global network of collaborators have developed the OpenQuake engine (an open-source software for hazard and risk calculations), the OpenQuake platform (a web-based portal making GEM's resources and datasets freely available to all potential users), and a suite of tools to support modelers and other experts in the development of hazard, exposure and vulnerability models. These resources are being used extensively across the world in hazard and risk assessment, from individual practitioners to local and national institutions, and in regional projects to inform disaster risk reduction. Practical examples for how GEM is bridging the gap between science and disaster risk reduction are: - Several countries including Switzerland, Turkey, Italy, Ecuador, Papua-New Guinea and Taiwan (with more to follow) are computing national seismic hazard using the OpenQuake-engine. In some cases these results are used for the definition of actions in building codes. - Technical support, tools and data for the development of hazard, exposure, vulnerability and risk models for regional projects in South America and Sub-Saharan Africa. - Going beyond physical risk, GEM's scorecard approach evaluates local resilience by bringing together neighborhood/community leaders and the risk reduction community as a basis for designing risk reduction programs at various levels of geography. Actual case studies are Lalitpur in the Kathmandu Valley in Nepal and Quito/Ecuador. In agreement with GEM's collaborative approach, all projects are undertaken with strong involvement of local scientific and risk reduction communities. Open-source software and careful documentation of the methodologies create full transparency of the modelling process, so that results can be reproduced any time by third parties.

Ecohydrology of agroecosystems: probabilistic description of yield reduction risk under limited water availability

NASA Astrophysics Data System (ADS)

Vico, Giulia; Porporato, Amilcare

2013-04-01

Supplemental irrigation represents one of the main strategies to mitigate the effects of climate variability and stabilize yields. Irrigated agriculture currently provides 40% of food production and its relevance is expected to further increase in the near future, in face of the projected alterations of rainfall patterns and increase in food, fiber, and biofuel demand. Because of the significant investments and water requirements involved in irrigation, strategic choices are needed to preserve productivity and profitability, while maintaining a sustainable water management - a nontrivial task given the unpredictability of the rainfall forcing. To facilitate decision making under uncertainty, a widely applicable probabilistic framework is proposed. The occurrence of rainfall events and irrigation applications are linked probabilistically to crop development during the growing season and yields at harvest. Based on these linkages, the probability density function of yields and corresponding probability density function of required irrigation volumes, as well as the probability density function of yields under the most common case of limited water availability are obtained analytically, as a function of irrigation strategy, climate, soil and crop parameters. The full probabilistic description of the frequency of occurrence of yields and water requirements is a crucial tool for decision making under uncertainty, e.g., via expected utility analysis. Furthermore, the knowledge of the probability density function of yield allows us to quantify the yield reduction hydrologic risk. Two risk indices are defined and quantified: the long-term risk index, suitable for long-term irrigation strategy assessment and investment planning, and the real-time risk index, providing a rigorous probabilistic quantification of the emergence of drought conditions during a single growing season in an agricultural setting. Our approach employs relatively few parameters and is thus easily and broadly applicable to different crops and sites, under current and future climate scenarios. Hence, the proposed probabilistic framework provides a quantitative tool to assess the impact of irrigation strategy and water allocation on the risk of not meeting a certain target yield, thus guiding the optimal allocation of water resources for human and environmental needs.

Gemitis : an integrated and participative risk reduction strategy for the sustainable development of cities

NASA Astrophysics Data System (ADS)

Masure, P.

2003-04-01

The GEMITIS method has been implemented since 1995 into a global and integrated Risk Reduction Strategy for improving the seismic risk-assessment effectiveness in urban areas, including the generation of crisis scenarios and mid- to long term- seismic impact assessment. GEMITIS required us to provide more precise definitions of notions in common use by natural-hazard specialists, such as elements at risk and vulnerability. Until then, only the physical and human elements had been considered, and analysis of their vulnerability referred to their fragility in the face of aggression by nature. We have completed this approach by also characterizing the social and cultural vulnerability of a city and its inhabitants, and, with a wider scope, the functional vulnerability of the "urban system". This functional vulnerability depends upon the relations between the system elements (weak links in chains, functional relays, and defense systems) and upon the city's relations with the outside world (interdependence). Though well developed in methods for evaluating industrial risk (fault-tree analysis, event-tree analysis, multiple defense barriers, etc.), this aspect had until now been ignored by the "hard-science" specialists working on natural hazards. Based on the implementation of an Urban System Exposure methodology, we were able to identify specific human, institutional, or functional vulnerability factors for each urban system, which until had been very little discussed by risk-analysis and civil-protection specialists. In addition, we have defined the new concept of "main stakes" of the urban system, ranked by order of social value (or collective utility). Obviously, vital or strategic issues must be better resistant or protected against natural hazards than issues of secondary importance. The ranking of exposed elements of a city in terms of "main stakes" provides a very useful guide for adapting vulnerability studies and for orienting preventive actions. For this, GEMITIS is based on a systemic approach of the city and on value analysis of exposed elements. It facilitates a collective expertise for the definition of a preventive action plan based on the participation of the main urban actors (crisis preparedness, construction, land-use, etc.).

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

PubMed Central

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

2015-01-01

Background Patient safety and quality care remain major challenges to Ghana’s healthcare system. Like many health systems in Africa, this is largely because demand for healthcare is outstripping available human and material resource capacity of healthcare facilities and new investment is insufficient. In the light of these demand and supply constraints, systematic community engagement (SCE) in healthcare quality assessment can be a feasible and cost effective option to augment existing quality improvement interventions. SCE entails structured use of existing community groups to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements identified and rewards provided if the quality gaps are closed. Purpose This paper evaluates whether or not SCE, through the assessment of health service quality, improves patient safety and risk reduction efforts by staff in healthcare facilities. Methods A randomized control trail was conducted in 64 primary healthcare facilities in the Greater Accra and Western regions of Ghana. Patient risk assessments were conducted in 32 randomly assigned intervention and control facilities. Multivariate multiple regression test was used to determine effect of the SCE interventions on staff efforts towards reducing patient risk. Spearman correlation test was used to ascertain associations between types of community groups engaged and risk assessment scores of healthcare facilities. Findings Clinic staff efforts towards increasing patient safety and reducing risk improved significantly in intervention facilities especially in the areas of leadership/accountability (Coef. = 10.4, p<0.05) and staff competencies (Coef. = 7.1, p<0.05). Improvement in service utilization and health resources could not be attributed to the interventions because these were outside the control of the study and might have been influenced by institutional or national level developments between the baseline and follow-up period. Community groups that were gender balanced, religious/faith-based, and had structured leadership appeared to be better options for effective SCE in healthcare quality assessment. Conclusion Community engagement in healthcare quality assessment is a feasible client-centered quality improvement option that should be discussed for possible scale-up in Ghana and other resource poor countries in Africa. PMID:26619143

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

PubMed

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

2015-01-01

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

Surgical treatment of intra-articular calcaneal fractures.

PubMed

Stapleton, John J; Zgonis, Thomas

2014-10-01

Most intra-articular calcaneal fractures are a result of high-energy trauma. The operative management of calcaneal fractures has been based on achieving anatomic reduction and minimizing complications of the compromised soft tissue envelope. The traditional extensile lateral approach offers advantages of achieving adequate fracture reduction with the risk of wound-healing complications and infection. Limited open reduction and internal fixation techniques with or without using external fixation focuses on achieving fracture reduction with less risk of wound complications but higher risk of malunion. This article discusses key points of operative management for various intra-articular calcaneal fracture patterns and clinical presentations. Copyright © 2014 Elsevier Inc. All rights reserved.

The Tous Dam Disaster of 1982: Risk communication and the origins of integrated flood risk management in Spain

NASA Astrophysics Data System (ADS)

Serra-Llobet, A.; Tàbara, J.; Sauri, D.

2012-12-01

The failure of Tous dam on the Júcar River near Valencia in 1982 was one of the most important socio-natural disasters in 20th century Spain. The death toll of 25 would have been much greater had not a local dam manager anticipated the failure and alerted mayors of a failure, before it actually occurred. The Tous Dam failure occurred a week before the first democratic elections in Spain after the Franco dictatorship, it received extensive coverage in the media. As a result, this disaster triggered a paradigm change in the way disaster risks were perceived and managed at multiple levels of government in Spain. Many factors, often of a qualitative and organisational nature, affect (vertical and horizontal) communication in disaster risk reduction learning and planning at the community level. Through interviews with key actors and stakeholders, content analysis of scientific literature, review of historical and media accounts, and analysis of legislation and regulation, we documented changes that resulted from the Tous Dam failure: (1) A process of institutional development, which led to the growth, and increase in complexity of the organisations involved both in vertical and horizontal communication of disaster risk reduction. (2) Actions taken and experiences gained in dealing with disaster risk reduction in the Tous area were used as a benchmark to develop new strategies, as well as new mechanisms for communication and planning in other territories and other risk domains in Spain.We identify three main stages from 1980s to present in the evolution of disaster risk reduction planning in the area, which show a progressive shift towards a more integrated and preventative approach: (1) After the collapse of the Tous Dam, disaster risk reduction strategies in Spain focused on improving preparedness in order to reduce short-term risks. (2) Disaster management in the 1990s was strongly influenced by international initiatives (e.g. the UN International Decade for Natural Disaster Reduction), which emphasized the contextualization of risk and the importance in long-term disaster risk reduction measures such as land use planning. (3) The European Water Framework Directive (2000) and, more recently, the Flood Directive (2007) are exerting a strong influence on the development of a new Spanish flood policy that focuses on preventive measures and integrates, for the first time, ecological concerns and climate change adaptation in flood management strategies.

A Framework for Organizing Current and Future Electric Utility Regulatory and Business Models

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

Satchwell, Andrew; Cappers, Peter; Schwartz, Lisa

In this report, we will present a descriptive and organizational framework for incremental and fundamental changes to regulatory and utility business models in the context of clean energy public policy goals. We will also discuss the regulated utility's role in providing value-added services that relate to distributed energy resources, identify the "openness" of customer information and utility networks necessary to facilitate change, and discuss the relative risks, and the shifting of risks, for utilities and customers.

Special Diabetes Program for Indians: Retention in Cardiovascular Risk Reduction

ERIC Educational Resources Information Center

Manson, Spero M.; Jiang, Luohua; Zhang, Lijing; Beals, Janette; Acton, Kelly J.; Roubideaux, Yvette

2011-01-01

Purpose: This study examined the associations between participant and site characteristics and retention in a multisite cardiovascular disease risk reduction project. Design and Methods: Data were derived from the Special Diabetes Program for Indians Healthy Heart Demonstration Project, an intervention to reduce cardiovascular risk among American…

Efforts Toward an Early Warning Crop Monitor for Countries at Risk

NASA Astrophysics Data System (ADS)

Budde, M. E.; Verdin, J. P.; Barker, B.; Humber, M. L.; Becker-Reshef, I.; Justice, C. O.; Magadzire, T.; Galu, G.; Rodriguez, M.; Jayanthi, H.

2015-12-01

Assessing crop growing conditions is a crucial aspect of monitoring food security in the developing world. One of the core components of the Group on Earth Observations - Global Agricultural Monitoring (GEOGLAM) targets monitoring Countries at Risk (component 3). The Famine Early Warning Systems Network (FEWS NET) has a long history of utilizing remote sensing and crop modeling to address food security threats in the form of drought, floods, pest infestation, and climate change in some of the world's most at risk countries. FEWS NET scientists at the U.S. Geological Survey Earth Resources Observation and Science (EROS) Center and the University of Maryland Department of Geography have undertaken efforts to address component 3, by promoting the development of a collaborative Early Warning Crop Monitor (EWCM) that would specifically address Countries at Risk. A number of organizations utilize combinations of satellite earth observations, field campaigns, network partner inputs, and crop modeling techniques to monitor crop conditions throughout the world. Agencies such as the Food and Agriculture Organization of the United Nations (FAO), United Nations World Food Programme (WFP), and the European Commission's Joint Research Centre (JRC) provide agricultural monitoring information and reporting across a broad number of areas at risk and in many cases, organizations routinely report on the same countries. The latter offers an opportunity for collaboration on crop growing conditions among agencies. The reduction of uncertainty and achievement of consensus will help strengthen confidence in decisions to commit resources for mitigation of acute food insecurity and support for resilience and development programs. In addition, the development of a collaborative global EWCM will provide each of the partner agencies with the ability to quickly gather crop condition information for areas where they may not typically work or have access to local networks. Using a framework developed by GEOGLAM for monitoring crop conditions in support of the Agricultural Market Information System, we developed an EWCM system for countries at risk. We present the current status of that implementation and highlight achievements to date along with future plans to support the needs of the global agricultural monitoring community.

DECHLORINATION OF TRICHLOROETHYLENE USING ELECTROCHEMICAL METHODS

EPA Science Inventory

Electrochemical degradation (ECD) is used to decontaminate organic and inorganic contaminants through oxidative or reductive processes. The ECD of Trichloroethylene (TCE) dechlorinates TCE through electric reduction. TCE dechlorination presented in the literature utilized electro...

Brief communication: Sendai framework for disaster risk reduction - success or warning sign for Paris?

NASA Astrophysics Data System (ADS)

Mysiak, Jaroslav; Surminski, Swenja; Thieken, Annegret; Mechler, Reinhard; Aerts, Jeroen

2016-09-01

In March 2015, a new international blueprint for disaster risk reduction (DRR) was adopted in Sendai, Japan, at the end of the Third UN World Conference on Disaster Risk Reduction (WCDRR, 14-18 March 2015). We review and discuss the agreed commitments and targets, as well as the negotiation leading the Sendai Framework for DRR (SFDRR) and discuss briefly its implication for the later UN-led negotiations on sustainable development goals and climate change.

Early Risk Reduction Phase 1 FLIR/Laser Designator Window. Revision

DTIC Science & Technology

1991-12-31

Sandwich-Type FLIR Windows," Air Force AFWAL-TR-83- 4122, Nov 1983. 4-1 Hughes Danbury Optical Systems Final Report, "ATA Window Technology Program," PRBll...Risk Reduction -- Phase I, Optical Properties Measurement Techniques of Three Wide Band Window Materials," 22 August 1991. xii I i 86PR0869 30... Optical Systems, Lexington, MA, 02173, 1 Feb 1991. 5-7 McDonnell Aircraft Company Technical Memorandum TM 256.91.0056.01, "Early Risk Reduction -- Phase