Integrating payer and provider risk through capitation.

PubMed

Barth, S M

1997-01-01

Capitation payment mechanisms promote conservative use of medical resources by transferring risk to the decision maker, the physician. However, there is another view of capitation: defining common risk between provider-driven organizations (i.e., physician/hospital organizations (PHOs) or integrated delivery systems (IDS), and risk-managing entities such as HMOs or insurance companies. This article discusses a strategy to align provider and risk manager incentives to share the risks and rewards for a total book of business or population.

An integrated optimization method for river water quality management and risk analysis in a rural system.

PubMed

Liu, J; Li, Y P; Huang, G H; Zeng, X T; Nie, S

2016-01-01

In this study, an interval-stochastic-based risk analysis (RSRA) method is developed for supporting river water quality management in a rural system under uncertainty (i.e., uncertainties exist in a number of system components as well as their interrelationships). The RSRA method is effective in risk management and policy analysis, particularly when the inputs (such as allowable pollutant discharge and pollutant discharge rate) are expressed as probability distributions and interval values. Moreover, decision-makers' attitudes towards system risk can be reflected using a restricted resource measure by controlling the variability of the recourse cost. The RSRA method is then applied to a real case of water quality management in the Heshui River Basin (a rural area of China), where chemical oxygen demand (COD), total nitrogen (TN), total phosphorus (TP), and soil loss are selected as major indicators to identify the water pollution control strategies. Results reveal that uncertainties and risk attitudes have significant effects on both pollutant discharge and system benefit. A high risk measure level can lead to a reduced system benefit; however, this reduction also corresponds to raised system reliability. Results also disclose that (a) agriculture is the dominant contributor to soil loss, TN, and TP loads, and abatement actions should be mainly carried out for paddy and dry farms; (b) livestock husbandry is the main COD discharger, and abatement measures should be mainly conducted for poultry farm; (c) fishery accounts for a high percentage of TN, TP, and COD discharges but a has low percentage of overall net benefit, and it may be beneficial to cease fishery activities in the basin. The findings can facilitate the local authority in identifying desired pollution control strategies with the tradeoff between socioeconomic development and environmental sustainability.

What is killing? People's knowledge about coronary heart disease, attitude towards prevention and main risk reduction barriers in Ismailia, Egypt (descriptive cross-sectional study).

PubMed

Seef, Sameh; Jeppsson, Anders; Stafström, Martin

2013-01-01

Cardiovascular diseases are a public health concern everywhere, especially ischemic or coronary heart diseases (CHD) which are on top of causes list of mortality and morbidity in both genders globally. From which nearly 80% can be because of modifiable risks. In Egypt, there is a lack of studies on the knowledge of people about coronary heart diseases and its modifiable risks. So, this research reported here we designed to measure the dimensions of peoples knowledge about CHD and their attitude towards prevention, and to identify the main risk reduction barriers. By using comprehensive cross-sectional, descriptive research design, all adult individuals attending the family health clinic at Suez Canal University Hospital were eligible for inclusion with total number 125 participants. An interview questionnaire designed and used to collect data. The study revealed that (10.4%) of participants had a history of CHD, and (7.2%) had a family history of CHD. 79.2% Had a satisfactory total knowledge about CHD, and (94.4%) had a positive total attitude towards prevention. Risk reduction barriers as a medical setting barriers were (24%), patient related barriers were (22.4%). Community-societal barriers were almost the same as knowledge barriers which were around (16%). At last the systemic-organizational barriers were (9.6%). The findings settled that, total knowledge about CHD was satisfactory but lower than the level total of attitude. More effort the health system needs to improve the settings and engage patients in their plans and breaking related barriers, with development of health education programs based on needs assessment. Further studies we recommend to explore the reasons and follow up the changes.

Pharmaceutical supply chain risk assessment in Iran using analytic hierarchy process (AHP) and simple additive weighting (SAW) methods.

PubMed

Jaberidoost, Mona; Olfat, Laya; Hosseini, Alireza; Kebriaeezadeh, Abbas; Abdollahi, Mohammad; Alaeddini, Mahdi; Dinarvand, Rassoul

2015-01-01

Pharmaceutical supply chain is a significant component of the health system in supplying medicines, particularly in countries where main drugs are provided by local pharmaceutical companies. No previous studies exist assessing risks and disruptions in pharmaceutical companies while assessing the pharmaceutical supply chain. Any risks affecting the pharmaceutical companies could disrupt supply medicines and health system efficiency. The goal of this study was the risk assessment in pharmaceutical industry in Iran considering process's priority, hazard and probability of risks. The study was carried out in 4 phases; risk identification through literature review, risk identification in Iranian pharmaceutical companies through interview with experts, risk analysis through a questionnaire and consultation with experts using group analytic hierarchy process (AHP) method and rating scale (RS) and risk evaluation of simple additive weighting (SAW) method. In total, 86 main risks were identified in the pharmaceutical supply chain with perspective of pharmaceutical companies classified in 11 classes. The majority of risks described in this study were related to the financial and economic category. Also financial management was found to be the most important factor for consideration. Although pharmaceutical industry and supply chain were affected by current political conditions in Iran during the study time, but half of total risks in the pharmaceutical supply chain were found to be internal risks which could be fixed by companies, internally. Likewise, political status and related risks forced companies to focus more on financial and supply management resulting in less attention to quality management.

12 CFR 225.23 - Expedited action for certain nonbanking proposals by well-run bank holding companies.

Code of Federal Regulations, 2010 CFR

2010-01-01

... (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM BANK HOLDING COMPANIES AND CHANGE IN BANK..., total capital, total assets or risk-weighted assets change as a result of the transaction, the total... procedure. The procedure in this section is available only if: (1) Well-capitalized organization—(i) Bank...

Localized Scleroderma, Systemic Sclerosis and Cardiovascular Risk: A Danish Nationwide Cohort Study.

PubMed

Hesselvig, Jeanette Halskou; Kofoed, Kristian; Wu, Jashin J; Dreyer, Lene; Gislason, Gunnar; Ahlehoff, Ole

2018-03-13

Recent findings indicate that patients with systemic sclerosis have an increased risk of cardiovascular disease. To determine whether patients with systemic sclerosis or localized scleroderma are at increased risk of cardiovascular disease, a cohort study of the entire Danish population aged ≥ 18 and ≤ 100 years was conducted, followed from 1997 to 2011 by individual-level linkage of nationwide registries. Multivariable adjusted Cox regression models were used to estimate the hazard ratios (HRs) for a composite cardiovascular disease endpoint. A total of 697 patients with localized scleroderma and 1,962 patients with systemic sclerosis were identified and compared with 5,428,380 people in the reference population. In systemic sclerosis, the adjusted HR was 2.22 (95% confidence interval 1.99-2.48). No association was seen between patients with localized scleroderma and cardiovascular disease. In conclusion, systemic sclerosis is a significant cardiovascular disease risk factor, while patients with localized scleroderma are not at increased risk of cardiovascular disease.

A Risk Score Model for Evaluation and Management of Patients with Thyroid Nodules.

PubMed

Zhang, Yongwen; Meng, Fanrong; Hong, Lianqing; Chu, Lanfang

2018-06-12

The study is aimed to establish a simplified and practical tool for analyzing thyroid nodules. A novel risk score model was designed, risk factors including patient history, patient characteristics, physical examination, symptoms of compression, thyroid function, ultrasonography (US) of thyroid and cervical lymph nodes were evaluated and classified into high risk factors, intermediate risk factors, and low risk factors. A total of 243 thyroid nodules in 162 patients were assessed with risk score system and Thyroid Imaging-Reporting and Data System (TI-RADS). The diagnostic performance of risk score system and TI-RADS was compared. The accuracy in the diagnosis of thyroid nodules was 89.3% for risk score system, 74.9% for TI-RADS respectively. The specificity, accuracy and positive predictive value (PPV) of risk score system were significantly higher than the TI-RADS system (χ 2 =26.287, 17.151, 11.983; p <0.05), statistically significant differences were not observed in the sensitivity and negative predictive value (NPV) between the risk score system and TI-RADS (χ 2 =1.276, 0.290; p>0.05). The area under the curve (AUC) for risk score diagnosis system was 0.963, standard error 0.014, 95% confidence interval (CI)=0.934-0.991, the AUC for TI-RADS diagnosis system was 0.912 with standard error 0.021, 95% CI=0.871-0.953, the AUC for risk score system was significantly different from that of TI-RADS (Z=2.02; p <0.05). Risk score model is a reliable, simplified and cost-effective diagnostic tool used in diagnosis of thyroid cancer. The higher the score is, the higher the risk of malignancy will be. © Georg Thieme Verlag KG Stuttgart · New York.

12 CFR 8.2 - Semiannual assessment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... system (which rates risk management, operational controls, compliance, and asset quality) at its most... follows: If the bank's total assets (consolidated domestic and foreign subsidiaries) are: Over— But not.... The excess is assessed at the marginal rate shown in Column D. (3) The total semiannual assessment is...

The role of risk-based prioritization in total quality management

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

Bennett, C.T.

1994-10-01

The climate in which government managers must make decisions grows more complex and uncertain. All stakeholders - the public, industry, and Congress - are demanding greater consciousness, responsibility, and accountability of programs and their budgets. Yet, managerial decisions have become multifaceted, involve greater risk, and operate over much longer time periods. Over the last four or five decades, as policy analysis and decisions became more complex, scientists from psychology, operations research, systems science, and economics have developed a more or less coherent process called decision analysis to aid program management. The process of decision analysis - a systems theoretic approachmore » - provides the backdrop for this paper. The Laboratory Integrated Prioritization System (LIPS) has been developed as a systems analytic and risk-based prioritization tool to aid the management of the Tri-Labs` (Lawrence Livermore, Los Alamos, and Sandia) operating resources. Preliminary analyses of the effects of LIPS has confirmed the practical benefits of decision and systems sciences - the systematic, quantitative reduction in uncertainty. To date, the use of LIPS - and, hence, its value - has been restricted to resource allocation within the Tri-Labs` operations budgets. This report extends the role of risk-based prioritization to the support of DOE Total Quality Management (TQM) programs. Furthermore, this paper will argue for the requirement to institutionalize an evolutionary, decision theoretic approach to the policy analysis of the Department of Energy`s Program Budget.« less

75 FR 18205 - Total Coliform Rule Revisions-Notice of Stakeholder Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-09

... Coliform Rule (RTCR) and the Distribution Systems Research and Information Collection Partnership... reviewing the methods approved to analyze drinking water samples to determine the presence of total... ( [email protected] , (202) 564-1781, Standards and Risk Management Division, Office of Ground Water and...

PRA (Probabilistic Risk Assessment) Applications Program for inspection at Oconee Unit 3

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

Gore, B.F.; Vo, T.V.; Harris, M.S.

1987-10-01

The extensive Oconee-3 PRA performed by EPRI has been analyzed to identify plant systems and components important to minimizing public risk, and to identify the primary failure modes of these components. This information has been tabulated, and correlated with inspection modules from the NRC Inspection and Enforcement Manual. The report presents a series of tables, organized by system and prioritized by public risk (in person-rem per year), which identify components associated with 98% of the inspectable risk due to plant operation. External events (earthquakes, tornadoes, fires and floods) are not addressed because inspections cannot directly minimize the risks from thesemore » events; however, flooding caused by the breach of internal systems is addressed. The systems addressed, in descending order of risk importance, are: Reactor Building Spray, R B Cooling, Condenser Circulating Water, Safety Relief Valves, Low Pressure Injection, Standby Shutdown Facility-High Pressure Injection, Low-Pressure Service Water, and Emergency Feedwater. This ranking is based on the Fussel-Vesely measure of risk importance, i.e., the fraction of the total risk which involves failures of the system of interest. 8 refs., 25 tabs.« less

Propeptide big-endothelin, N-terminal-pro brain natriuretic peptide and mortality. The Ludwigshafen risk and cardiovascular health (LURIC) study.

PubMed

Gergei, Ingrid; Krämer, Bernhard K; Scharnagl, Hubert; Stojakovic, Tatjana; März, Winfried; Mondorf, Ulrich

The endothelin system (Big-ET-1) is a key regulator in cardiovascular (CV) disease and congestive heart failure (CHF). We have examined the incremental value of Big-ET-1 in predicting total and CV mortality next to the well-established CV risk marker N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP). Big-ET-1 and NT-proBNP were determined in 2829 participants referred for coronary angiography (follow-up 9.9 years). Big-ET-1 is an independent predictor of total, CV mortality and death due to CHF. The conjunct use of Big-ET-1 and NT-proBNP improves the risk stratification of patients with intermediate to high risk of CV death and CHF. Big-ET-1improves risk stratification in patients referred for coronary angiography.

A risk-based decision support framework for selection of appropriate safety measure system for underground coal mines.

PubMed

Samantra, Chitrasen; Datta, Saurav; Mahapatra, Siba Sankar

2017-03-01

In the context of underground coal mining industry, the increased economic issues regarding implementation of additional safety measure systems, along with growing public awareness to ensure high level of workers safety, have put great pressure on the managers towards finding the best solution to ensure safe as well as economically viable alternative selection. Risk-based decision support system plays an important role in finding such solutions amongst candidate alternatives with respect to multiple decision criteria. Therefore, in this paper, a unified risk-based decision-making methodology has been proposed for selecting an appropriate safety measure system in relation to an underground coal mining industry with respect to multiple risk criteria such as financial risk, operating risk, and maintenance risk. The proposed methodology uses interval-valued fuzzy set theory for modelling vagueness and subjectivity in the estimates of fuzzy risk ratings for making appropriate decision. The methodology is based on the aggregative fuzzy risk analysis and multi-criteria decision making. The selection decisions are made within the context of understanding the total integrated risk that is likely to incur while adapting the particular safety system alternative. Effectiveness of the proposed methodology has been validated through a real-time case study. The result in the context of final priority ranking is seemed fairly consistent.

Association Between Markers of Inflammation and Total Stroke by Hypertensive Status Among Women

PubMed Central

Rexrode, Kathryn M.; Kotler, Gregory; Everett, Brendan M.; Glynn, Robert J.; Lee, I-Min; Buring, Julie E.; Ridker, Paul M.; Sesso, Howard D.

2016-01-01

BACKGROUND Markers of systemic inflammation (high-sensitivity C-reactive protein [hsCRP], soluble intercellular adhesion molecule 1 [sICAM-1], and fibrinogen) have been associated with a greater risk of total and ischemic stroke, in addition to elevated blood pressure. However, the role of these inflammatory markers on stroke pathophysiology by hypertension status is uncertain. METHODS Blood samples were collected and assayed for hsCRP, sICAM-1, and fibrinogen among 27,330 initially healthy women from the Women’s Health Study, and women were followed up from 1992 to 2013. Prior to randomization, the baseline questionnaire collected self-reported hypertension status, cardiovascular risk factors, and lifestyle factors. New cases of total, ischemic, and hemorrhagic stroke were updated annually through questionnaires and confirmed by medical records according to the National Survey of Stroke criteria. Multivariable Cox models estimated overall associations between each inflammatory marker and stroke and separately stratified by hypertension status. RESULTS We observed 629 incident total strokes over 477,278 person-years. In adjusted analyses, extreme quartiles of hsCRP and sICAM-1 were each associated with a significantly greater risk of total stroke (hsCRP: hazard ratios [HR] = 1.77, 95% confidence interval [CI]: 1.39–2.26; sICAM-1: HR = 1.28, 95% CI: 1.00–1.63). Fibrinogen was not associated with a significantly greater stroke risk. In analyses stratified by hypertension status, elevated hsCRP was associated with a nonstatistically significant greater risk of total stroke among prehypertensive and hypertensive women. CONCLUSIONS These data indicate that hsCRP and sICAM-1 are associated with hypertension status and stroke risk among women. Further work should examine the role of inflammatory markers on ischemic stroke subtypes and clarify mechanisms. PMID:27235695

[RADAR: a program for the prevention of suicide in adolescents in the region of Aysen, Chile, preliminary results].

PubMed

Bustamante, Francisco; Urquidi, Cinthya; Florenzano, Ramón; Barrueto, Carolina; de Los Hoyos, Jaime; Ampuero, Karla; Terán, Laura; Figueroa, María Inés; Farías, Magdalena; Rueda, María Livia; Giacaman, Eduardo

2018-02-01

We present the preliminary results of the implementation of RADAR: a community suicide prevention program in adolescents implemented in two high schools in a south region of Chile. In a pilot study, during 2016, we implemented RADAR in two high schools of Puerto Aysen, in in the Region of Aysen of Chile. A total of 409 actors were trained (among students, school teachers, caregivers and health professionals) for the screening and referral of high suicide risk adolescents. Out of a total of 144 students who passed the RADAR screening systems, 29 cases were detected as suicide risk (20%) and 27 of them were opportunely referred to the Emergency Service of the Hospital of Puerto Aysen. In the second RADAR screening campaign, 3 months later, 90% of the cases no longer presented suicide risk. These results show the high proportion of ado lescents at risk of suicide who are not visible by the health system and the feasibility of implementing RADAR in the community as an effective suicide prevention intervention.

METAL SPECIATION IN SOIL, SEDIMENT, AND WATER SYSTEMS VIA SYNCHROTRON RADIATION RESEARCH

EPA Science Inventory

Metal contaminated environmental systems (soils, sediments, and water) have challenged researchers for many years. Traditional methods of analysis have employed extraction methods to determine total metal content and define risk based on the premise that as metal concentration in...

Knee Replacement: MedlinePlus Health Topic

MedlinePlus

... Surgery for a Total Knee System (BroadcastMed) - University Orthopedics Center, State College, PA, 8/21/2014 Statistics and Research Commonly Prescribed Blood Thinner Associated with Higher Risk ...

Effect of balance training on postural balance control and risk of fall in children with diplegic cerebral palsy.

PubMed

El-Shamy, Shamekh Mohamed; Abd El Kafy, Ehab Mohamed

2014-01-01

The purpose of this study was to evaluate the effects of balance training on postural control and fall risk in children with diplegic cerebral palsy. Thirty spastic diplegic cerebral palsied children (10-12 years) were included in this study. Children were randomly assigned into two equal-sized groups: control and study groups. Participants in both groups received a traditional physical therapy exercise program. The study group additionally received balance training on the Biodex balance system. Treatment was provided 30 min/d, 3 d/week for 3 successive months. To evaluate the limit of stability and fall risk, participated children received baseline and post-treatment assessments using the Biodex balance system. Overall directional control, total time to complete the test, overall stability index of the fall risk test and total score of the pediatric balance scale were measured. Children in both groups showed significant improvements in the mean values of all measured variables post-treatment (p < 0.05). The results also showed significantly better improvement in the measured parameters for the study group, as compared to the control group (p < 0.05). Balance training on Biodex system is a useful tool that can be used in improving postural balance control in children with diplegic cerebral palsy.

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

PubMed

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

2017-06-01

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

Potential Applications for AQUATOX

EPA Pesticide Factsheets

AQUATOX has a myriad of potential applications to water management issues and programs, including water quality criteria and standards, TMDLs (Total Maximum Daily Loads), and ecological risk assessments of aquatic systems.

AQUATOX Model Validation Reports

EPA Pesticide Factsheets

AQUATOX has a myriad of potential applications to water management issues and programs, including water quality criteria and standards, TMDLs (Total Maximum Daily Loads), and ecological risk assessments of aquatic systems.

Real-time web-based assessment of total population risk of future emergency department utilization: statewide prospective active case finding study.

PubMed

Hu, Zhongkai; Jin, Bo; Shin, Andrew Y; Zhu, Chunqing; Zhao, Yifan; Hao, Shiying; Zheng, Le; Fu, Changlin; Wen, Qiaojun; Ji, Jun; Li, Zhen; Wang, Yong; Zheng, Xiaolin; Dai, Dorothy; Culver, Devore S; Alfreds, Shaun T; Rogow, Todd; Stearns, Frank; Sylvester, Karl G; Widen, Eric; Ling, Xuefeng B

2015-01-13

An easily accessible real-time Web-based utility to assess patient risks of future emergency department (ED) visits can help the health care provider guide the allocation of resources to better manage higher-risk patient populations and thereby reduce unnecessary use of EDs. Our main objective was to develop a Health Information Exchange-based, next 6-month ED risk surveillance system in the state of Maine. Data on electronic medical record (EMR) encounters integrated by HealthInfoNet (HIN), Maine's Health Information Exchange, were used to develop the Web-based surveillance system for a population ED future 6-month risk prediction. To model, a retrospective cohort of 829,641 patients with comprehensive clinical histories from January 1 to December 31, 2012 was used for training and then tested with a prospective cohort of 875,979 patients from July 1, 2012, to June 30, 2013. The multivariate statistical analysis identified 101 variables predictive of future defined 6-month risk of ED visit: 4 age groups, history of 8 different encounter types, history of 17 primary and 8 secondary diagnoses, 8 specific chronic diseases, 28 laboratory test results, history of 3 radiographic tests, and history of 25 outpatient prescription medications. The c-statistics for the retrospective and prospective cohorts were 0.739 and 0.732 respectively. Integration of our method into the HIN secure statewide data system in real time prospectively validated its performance. Cluster analysis in both the retrospective and prospective analyses revealed discrete subpopulations of high-risk patients, grouped around multiple "anchoring" demographics and chronic conditions. With the Web-based population risk-monitoring enterprise dashboards, the effectiveness of the active case finding algorithm has been validated by clinicians and caregivers in Maine. The active case finding model and associated real-time Web-based app were designed to track the evolving nature of total population risk, in a longitudinal manner, for ED visits across all payers, all diseases, and all age groups. Therefore, providers can implement targeted care management strategies to the patient subgroups with similar patterns of clinical histories, driving the delivery of more efficient and effective health care interventions. To the best of our knowledge, this prospectively validated EMR-based, Web-based tool is the first one to allow real-time total population risk assessment for statewide ED visits.

Cardiovascular disease risk profiles among 'healthy' siblings of patients with early-onset cardiovascular disease: application of the new SCORE system.

PubMed

Horan, Paul G; Kamaruddin, Muhammad S; Moore, Michael J; McCarty, David; Spence, Mark S; McGlinchey, Paul G; Murphy, Gillian; Jardine, Tracy C L; Patterson, Chris C; McKeown, Pascal P

2007-08-01

Cardiovascular disease (CVD) occurs more frequently in individuals with a family history of premature CVD. Within families the demographics of CVD are poorly described. We examined the risk estimation based on the Systematic Coronary Risk Evaluation (SCORE) system and the Joint British Guidelines (JBG) for older unaffected siblings of patients with premature CVD (onset

Polycyclic aromatic hydrocarbons (PAH) in superficial water from a tropical estuarine system: Distribution, seasonal variations, sources and ecological risk assessment.

PubMed

Santos, Ewerton; Souza, Michel R R; Vilela Junior, Antônio R; Soares, Laiane S; Frena, Morgana; Alexandre, Marcelo R

2018-02-01

This study aimed to evaluate the PAH distribution, sources, seasonal variations and ecological risk assessment in superficial water from the Japaratuba River, Brazil. PAH concentrations ranged from 4 to 119ngL -1 . It was observed that the PAH total concentrations and profiles showed significant differences when comparing the dry season (summer) with the rainy season (winter). Furthermore, most of the PAH originated from pyrogenic sources in the winter, whereas a mixture of sources was observed in the summer. PAH concentration levels found in this study were considered lower than those obtained in other estuarine systems. Ecological risk assessment was determined for individual PAH, based on the risk quotient (RQ) to evaluate the risk of aquatic biota's exposure to PAH. Results suggested that the Japaratuba River has achieved a moderate degree of ecological risk for high molecular weight, showing the importance of identifying these carcinogenic and mutagenic compounds in aquatic systems. Copyright © 2017 Elsevier Ltd. All rights reserved.

Lack of any association between insertion/deletion (I/D) polymorphisms in the angiotensin-converting enzyme gene and digestive system cancer risk: a meta-analysis.

PubMed

Liu, Jin-Fei; Xie, Hao-Jun; Cheng, Tian-Ming

2013-01-01

To investigate the association between the gene polymorphisms of angiotensin-converting enzyme (ACE) and digestive system cancer risk. A search was performed in Pubmed, Medline, ISI Web of Science and Chinese Biomedical (CBM) databases, covering all studies until Sep 1st, 2013. Statistical analysis was performed by using Revman5.2 and STATA 12.0. A total of 15 case-control studies comprising 2,390 digestive system cancer patients and 9,706 controls were identified. No significant association was found between the I/D polymorphism and digestive cancer risk (OR =0.93, 95%CI = (0.75, 1.16), P =0.53 for DD+DI vs. II). In the subgroup analysis by ethnicity and cancer type, no significant associations were found for the comparison of DD+DI vs. II. Results from other comparative genetic models also indicated a lack of associations between this polymorphism and digestive system cancer risks. This meta-analysis suggested that the ACE D/I polymorphism might not contribute to the risk of digestive system cancer.

Assessment of total cardiovascular risk using WHO/ISH risk prediction charts in three low and middle income countries in Asia

PubMed Central

2013-01-01

Background Recent research has used cardiovascular risk scores intended to estimate “total cardiovascular disease (CVD) risk” in individuals to assess the distribution of risk within populations. The research suggested that the adoption of the total risk approach, in comparison to treatment decisions being based on the level of a single risk factor, could lead to reductions in expenditure on preventive cardiovascular drug treatment in low- and middle-income countries. So that the patient benefit associated with savings is highlighted. Methods This study used data from national STEPS surveys (STEPwise Approach to Surveillance) conducted between 2005 and 2010 in Cambodia, Malaysia and Mongolia of men and women aged 40–64 years. The study compared the differences and implications of various approaches to risk estimation at a population level using the World Health Organization/International Society of Hypertension (WHO/ISH) risk score charts. To aid interpretation and adjustment of scores and inform treatment in individuals, the charts are accompanied by practice notes about risk factors not included in the risk score calculations. Total risk was calculated amongst the populations using the charts alone and also adjusted according to these notes. Prevalence of traditional single risk factors was also calculated. Results The prevalence of WHO/ISH “high CVD risk” (≥20% chance of developing a cardiovascular event over 10 years) of 6%, 2.3% and 1.3% in Mongolia, Malaysia and Cambodia, respectively, is in line with recent research when charts alone are used. However, these proportions rise to 33.3%, 20.8% and 10.4%, respectively when individuals with blood pressure > = 160/100 mm/Hg and/or hypertension medication are attributed to “high risk”. Of those at “moderate risk” (10- < 20% chance of developing a cardio vascular event over 10 years), 100%, 94.3% and 30.1%, respectively are affected by at least one risk-increasing factor. Of all individuals, 44.6%, 29.0% and 15.0% are affected by hypertension as a single risk factor (systolic ≥ 140 mmHg or diastolic ≥ 90 mmHg or medication). Conclusions Used on a population level, cardiovascular risk scores may offer useful insights that can assist health service delivery planning. An approach based on overall risk without adjustment of specific risk factors however, may underestimate treatment needs. At the individual level, the total risk approach offers important clinical benefits. However, countries need to develop appropriate clinical guidelines and operational guidance for detection and management of CVD risk using total CVD-risk approach at different levels of health system. Operational research is needed to assess implementation issues. PMID:23734670

77 FR 75679 - Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-21

... register, upon Commission approval, as an OTC derivatives dealer to develop and maintain an internal risk management system based on Value-at-Risk (``VaR'') models. It is anticipated that a total of four (4) broker..., Washington, DC 20549-0213. Extension: Appendix F to Rule 15c3-1; SEC File No. 270-440; OMB Control No. 3235...

Cardiovascular risk profile in burn survivors.

PubMed

Leung, Becky; Younger, John F; Stockton, Kellie; Muller, Michael; Paratz, Jennifer

2017-11-01

Burn patients have prolonged derangements in metabolic, endocrine, cardiac and psychosocial systems, potentially impacting on their cardiovascular health. There are no studies on the risk of cardiovascular disease (CVD) after-burn. The aim of our study was to record lipid values and evaluate CVD risk in adult burn survivors. In a cross-sectional study patients ≥18 years with burn injury between 18-80% total burn surface area (TBSA) from 1998 to 2012 had total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL) and triglycerides measured via finger prick. Means were compared to optimal ranges. Multivariate regression models were performed to assess the association of lipids with age, years after-burn and total body surface area % (TBSA). A p value <0.05 was considered significant. The Framingham General Cardiovascular Risk Score (FGCRS) was calculated. Fifty patients were included in the study. Compared to optimal values, patients had low HDL and high triglycerides. Greater %TBSA was associated with statistically significant elevation of triglycerides (p=0.007) and total cholesterol/HDL ratio (p=0.027). The median FGCRS was 3.9% (low) 10-year risk of CVD with 82% of patients in the low-risk category. Patients involved in medium/high level of physical activity had optimal values of HDL, TC/HDL and triglycerides despite the magnitude of TBSA%. Adult burn survivors had alterations in lipid profile proportional to TBSA, which could be modified by exercise, and no increase in overall formally predicted CVD risk in this cross sectional study. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Flood Risk Analysis in Denpasar City, Bali, Indonesia

NASA Astrophysics Data System (ADS)

Kusmiyarti, T. B.; Wiguna, P. P. K.; Ratna Dewi, N. K. R.

2018-02-01

Denpasar city is a Capital City of Bali Province and one of the leading tourist destinations in Indonesia. Denpasar area is relatively flat with high rain fall intensity with the domince of settlement. This makes Denpasar City becomes prone area of flood. The aim of this research is to find out the spatial distribution flood hazard and the risk of population which are affected to the flood hazard. Weighting, scoring and overlaying method were used in this research. Six indicators were used to analyze the flood hazard: landuse, rainfall, type of soil, slope, altitute and drainage density. The vulnerability is analyzed per Desa or Kelurahan (Rustic/Neighborhood) with the indicator of age, education and population density. Risk was calculated by multiplied hazard with vulnerability and divided with coping capacity. In this research, coping capacity is determined by the amount of internal budget for each Desa or Kelurahan for development purpose. Flood risk in Denpasar city is divided into five classes, very low risk, low risk, medium risk, high risk and very high risk. Total population with very high risk reached 202478 people or 13.16% of total population. The total area is 780.7 ha or 16.02% from total settlement in Denpasar city. Total population with high risk reached 202478 people or 13.16% of total population. The total area is 780.7 ha or 16.02% from total settlement in Denpasar city. The number of population with medium risk reached 202478 people or 33.51% of total population which occupied 22.95% of total settlements or 1118.18 ha. The total number of population with low risk reached 79435 people or 13.14% of total population with area of low flood risk is 716.89 ha or 14.71% of total settlements in Denpasar City. Very low flood risk with total population at risk reached 19184 people or 31.74% of total population and occupied 2003.54 areas or 41.12% of total areas of settlements.

Youth Actuarial Risk Assessment Tool (Y-ARAT): The development of an actuarial risk assessment instrument for predicting general offense recidivism on the basis of police records.

PubMed

van der Put, Claudia E

2014-06-01

Estimating the risk for recidivism is important for many areas of the criminal justice system. In the present study, the Youth Actuarial Risk Assessment Tool (Y-ARAT) was developed for juvenile offenders based solely on police records, with the aim to estimate the risk of general recidivism among large groups of juvenile offenders by police officers without clinical expertise. On the basis of the Y-ARAT, juvenile offenders are classified into five risk groups based on (combinations of) 10 variables including different types of incidents in which the juvenile was a suspect, total number of incidents in which the juvenile was a suspect, total number of other incidents, total number of incidents in which co-occupants at the youth's address were suspects, gender, and age at first incident. The Y-ARAT was developed on a sample of 2,501 juvenile offenders and validated on another sample of 2,499 juvenile offenders, showing moderate predictive accuracy (area under the receiver-operating-characteristic curve = .73), with little variation between the construction and validation sample. The predictive accuracy of the Y-ARAT was considered sufficient to justify its use as a screening instrument for the police. © The Author(s) 2013.

Trades Between Opposition and Conjunction Class Trajectories for Early Human Missions to Mars

NASA Technical Reports Server (NTRS)

Mattfeld, Bryan; Stromgren, Chel; Shyface, Hilary; Komar, David R.; Cirillo, William; Goodliff, Kandyce

2014-01-01

Candidate human missions to Mars, including NASA's Design Reference Architecture 5.0, have focused on conjunction-class missions with long crewed durations and minimum energy trajectories to reduce total propellant requirements and total launch mass. However, in order to progressively reduce risk and gain experience in interplanetary mission operations, it may be desirable that initial human missions to Mars, whether to the surface or to Mars orbit, have shorter total crewed durations and minimal stay times at the destination. Opposition-class missions require larger total energy requirements relative to conjunction-class missions but offer the potential for much shorter mission durations, potentially reducing risk and overall systems performance requirements. This paper will present a detailed comparison of conjunction-class and opposition-class human missions to Mars vicinity with a focus on how such missions could be integrated into the initial phases of a Mars exploration campaign. The paper will present the results of a trade study that integrates trajectory/propellant analysis, element design, logistics and sparing analysis, and risk assessment to produce a comprehensive comparison of opposition and conjunction exploration mission constructs. Included in the trade study is an assessment of the risk to the crew and the trade offs between the mission duration and element, logistics, and spares mass. The analysis of the mission trade space was conducted using four simulation and analysis tools developed by NASA. Trajectory analyses for Mars destination missions were conducted using VISITOR (Versatile ImpulSive Interplanetary Trajectory OptimizeR), an in-house tool developed by NASA Langley Research Center. Architecture elements were evaluated using EXploration Architecture Model for IN-space and Earth-to-orbit (EXAMINE), a parametric modeling tool that generates exploration architectures through an integrated systems model. Logistics analysis was conducted using NASA's Human Exploration Logistics Model (HELM), and sparing allocation predictions were generated via the Exploration Maintainability Analysis Tool (EMAT), which is a probabilistic simulation engine that evaluates trades in spacecraft reliability and sparing requirements based on spacecraft system maintainability and reparability.

Evaluation of exposure to airborne heavy metals at gun shooting ranges.

PubMed

Lach, Karel; Steer, Brian; Gorbunov, Boris; Mička, Vladimír; Muir, Robert B

2015-04-01

Aerosols formed during shooting events were studied with various techniques including the wide range size resolving sampling system Nano-ID(®) Select, followed by inductively coupled plasma mass spectrometry chemical analysis, scanning electron microscopy, and fast mobility particle sizing. The total lead mass aerosol concentration ranged from 2.2 to 72 µg m(-3). It was shown that the mass concentration of the most toxic compound lead is much lower than the total mass concentration. The deposition fraction in various compartments of the respiratory system was calculated using the ICRP lung deposition model. It was found that the deposition fraction in the alveolar range varies by a factor >3 for the various aerosols collected, depending on the aerosol size distribution and total aerosol concentration, demonstrating the importance of size resolved sampling in health risk evaluation. The proportion of the total mass of airborne particles deposited in the respiratory tract varies from 34 to 70%, with a median of 55.9%, suggesting the health risk based upon total mass significantly overestimates the accumulated dose and therefore the health risk. A comparison between conventional and so called 'green' ammunition confirmed significant lowering of concentrations of lead and other toxic metals like antimony in the atmosphere of indoor shooting ranges using 'green' ammunition, although higher concentrations of manganese and boron were measured. These metals are likely to be the constituents of new types of primers. They occur predominantly in the size fraction <250 nm of aerosols. © The Author 2014. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.

STAT4 and the Risk of Rheumatoid Arthritis and Systemic Lupus Erythematosus

PubMed Central

Remmers, Elaine F.; Plenge, Robert M.; Lee, Annette T.; Graham, Robert R.; Hom, Geoffrey; Behrens, Timothy W.; de Bakker, Paul I.W.; Le, Julie M.; Lee, Hye-Soon; Batliwalla, Franak; Li, Wentian; Masters, Seth L.; Booty, Matthew G.; Carulli, John P.; Padyukov, Leonid; Alfredsson, Lars; Klareskog, Lars; Chen, Wei V.; Amos, Christopher I.; Criswell, Lindsey A.; Seldin, Michael F.; Kastner, Daniel L.

2009-01-01

BACKGROUND Rheumatoid arthritis is a chronic inflammatory disease with a substantial genetic component. Susceptibility to disease has been linked with a region on chromosome 2q. METHODS We tested single-nucleotide polymorphisms (SNPs) in and around 13 candidate genes within the previously linked chromosome 2q region for association with rheumatoid arthritis. We then performed fine mapping of the STAT1-STAT4 region in a total of 1620 case patients with established rheumatoid arthritis and 2635 controls, all from North America. Implicated SNPs were further tested in an independent case-control series of 1529 patients with early rheumatoid arthritis and 881 controls, all from Sweden, and in a total of 1039 case patients and 1248 controls from three series of patients with systemic lupus erythematosus. RESULTS A SNP haplotype in the third intron of STAT4 was associated with susceptibility to both rheumatoid arthritis and systemic lupus erythematosus. The minor alleles of the haplotype-defining SNPs were present in 27% of chromosomes of patients with established rheumatoid arthritis, as compared with 22% of those of controls (for the SNP rs7574865, P = 2.81×10-7; odds ratio for having the risk allele in chromosomes of patients vs. those of controls, 1.32). The association was replicated in Swedish patients with recent-onset rheumatoid arthritis (P = 0.02) and matched controls. The haplotype marked by rs7574865 was strongly associated with lupus, being present on 31% of chromosomes of case patients and 22% of those of controls (P = 1.87×10-9; odds ratio for having the risk allele in chromosomes of patients vs. those of controls, 1.55). Homozygosity of the risk allele, as compared with absence of the allele, was associated with a more than doubled risk for lupus and a 60% increased risk for rheumatoid arthritis. CONCLUSIONS A haplotype of STAT4 is associated with increased risk for both rheumatoid arthritis and systemic lupus erythematosus, suggesting a shared pathway for these illnesses. PMID:17804842

STAT4 and the risk of rheumatoid arthritis and systemic lupus erythematosus.

PubMed

Remmers, Elaine F; Plenge, Robert M; Lee, Annette T; Graham, Robert R; Hom, Geoffrey; Behrens, Timothy W; de Bakker, Paul I W; Le, Julie M; Lee, Hye-Soon; Batliwalla, Franak; Li, Wentian; Masters, Seth L; Booty, Matthew G; Carulli, John P; Padyukov, Leonid; Alfredsson, Lars; Klareskog, Lars; Chen, Wei V; Amos, Christopher I; Criswell, Lindsey A; Seldin, Michael F; Kastner, Daniel L; Gregersen, Peter K

2007-09-06

Rheumatoid arthritis is a chronic inflammatory disease with a substantial genetic component. Susceptibility to disease has been linked with a region on chromosome 2q. We tested single-nucleotide polymorphisms (SNPs) in and around 13 candidate genes within the previously linked chromosome 2q region for association with rheumatoid arthritis. We then performed fine mapping of the STAT1-STAT4 region in a total of 1620 case patients with established rheumatoid arthritis and 2635 controls, all from North America. Implicated SNPs were further tested in an independent case-control series of 1529 patients with early rheumatoid arthritis and 881 controls, all from Sweden, and in a total of 1039 case patients and 1248 controls from three series of patients with systemic lupus erythematosus. A SNP haplotype in the third intron of STAT4 was associated with susceptibility to both rheumatoid arthritis and systemic lupus erythematosus. The minor alleles of the haplotype-defining SNPs were present in 27% of chromosomes of patients with established rheumatoid arthritis, as compared with 22% of those of controls (for the SNP rs7574865, P=2.81x10(-7); odds ratio for having the risk allele in chromosomes of patients vs. those of controls, 1.32). The association was replicated in Swedish patients with recent-onset rheumatoid arthritis (P=0.02) and matched controls. The haplotype marked by rs7574865 was strongly associated with lupus, being present on 31% of chromosomes of case patients and 22% of those of controls (P=1.87x10(-9); odds ratio for having the risk allele in chromosomes of patients vs. those of controls, 1.55). Homozygosity of the risk allele, as compared with absence of the allele, was associated with a more than doubled risk for lupus and a 60% increased risk for rheumatoid arthritis. A haplotype of STAT4 is associated with increased risk for both rheumatoid arthritis and systemic lupus erythematosus, suggesting a shared pathway for these illnesses. Copyright 2007 Massachusetts Medical Society.

Industrial water resources management based on violation risk analysis of the total allowable target on wastewater discharge.

PubMed

Yue, Wencong; Cai, Yanpeng; Xu, Linyu; Yang, Zhifeng; Yin, Xin'An; Su, Meirong

2017-07-11

To improve the capabilities of conventional methodologies in facilitating industrial water allocation under uncertain conditions, an integrated approach was developed through the combination of operational research, uncertainty analysis, and violation risk analysis methods. The developed approach can (a) address complexities of industrial water resources management (IWRM) systems, (b) facilitate reflections of multiple uncertainties and risks of the system and incorporate them into a general optimization framework, and (c) manage robust actions for industrial productions in consideration of water supply capacity and wastewater discharging control. The developed method was then demonstrated in a water-stressed city (i.e., the City of Dalian), northeastern China. Three scenarios were proposed according to the city's industrial plans. The results indicated that in the planning year of 2020 (a) the production of civilian-used steel ships and machine-made paper & paperboard would reduce significantly, (b) violation risk of chemical oxygen demand (COD) discharge under scenario 1 would be the most prominent, compared with those under scenarios 2 and 3, (c) the maximal total economic benefit under scenario 2 would be higher than the benefit under scenario 3, and (d) the production of rolling contact bearing, rail vehicles, and commercial vehicles would be promoted.

External Validity of a Risk Stratification Score Predicting Early Distant Brain Failure and Salvage Whole Brain Radiation Therapy After Stereotactic Radiosurgery for Brain Metastases.

PubMed

Press, Robert H; Boselli, Danielle M; Symanowski, James T; Lankford, Scott P; McCammon, Robert J; Moeller, Benjamin J; Heinzerling, John H; Fasola, Carolina E; Burri, Stuart H; Patel, Kirtesh R; Asher, Anthony L; Sumrall, Ashley L; Curran, Walter J; Shu, Hui-Kuo G; Crocker, Ian R; Prabhu, Roshan S

2017-07-01

A scoring system using pretreatment factors was recently published for predicting the risk of early (≤6 months) distant brain failure (DBF) and salvage whole brain radiation therapy (WBRT) after stereotactic radiosurgery (SRS) alone. Four risk factors were identified: (1) lack of prior WBRT; (2) melanoma or breast histologic features; (3) multiple brain metastases; and (4) total volume of brain metastases <1.3 cm 3 , with each factor assigned 1 point. The purpose of this study was to assess the validity of this scoring system and its appropriateness for clinical use in an independent external patient population. We reviewed the records of 247 patients with 388 brain metastases treated with SRS between 2010 at 2013 at Levine Cancer Institute. The Press (Emory) risk score was calculated and applied to the validation cohort population, and subsequent risk groups were analyzed using cumulative incidence. The low-risk (LR) group had a significantly lower risk of early DBF than did the high-risk (HR) group (22.6% vs 44%, P=.004), but there was no difference between the HR and intermediate-risk (IR) groups (41.2% vs 44%, P=.79). Total lesion volume <1.3 cm 3  (P=.004), malignant melanoma (P=.007), and multiple metastases (P<.001) were validated as predictors for early DBF. Prior WBRT and breast cancer histologic features did not retain prognostic significance. Risk stratification for risk of early salvage WBRT were similar, with a trend toward an increased risk for HR compared with LR (P=.09) but no difference between IR and HR (P=.53). The 3-level Emory risk score was shown to not be externally valid, but the model was able to stratify between 2 levels (LR and not-LR [combined IR and HR]) for early (≤6 months) DBF. These results reinforce the importance of validating predictive models in independent cohorts. Further refinement of this scoring system with molecular information and in additional contemporary patient populations is warranted. Copyright © 2017 Elsevier Inc. All rights reserved.

Seasonality of water quality and diarrheal disease counts in urban and rural settings in south India

NASA Astrophysics Data System (ADS)

Kulinkina, Alexandra V.; Mohan, Venkat R.; Francis, Mark R.; Kattula, Deepthi; Sarkar, Rajiv; Plummer, Jeanine D.; Ward, Honorine; Kang, Gagandeep; Balraj, Vinohar; Naumova, Elena N.

2016-02-01

The study examined relationships among meteorological parameters, water quality and diarrheal disease counts in two urban and three rural sites in Tamil Nadu, India. Disease surveillance was conducted between August 2010 and March 2012; concurrently water samples from street-level taps in piped distribution systems and from household storage containers were tested for pH, nitrate, total dissolved solids, and total and fecal coliforms. Methodological advances in data collection (concurrent prospective disease surveillance and environmental monitoring) and analysis (preserving temporality within the data through time series analysis) were used to quantify independent effects of meteorological conditions and water quality on diarrheal risk. The utility of a local calendar in communicating seasonality is also presented. Piped distribution systems in the study area showed high seasonal fluctuations in water quality. Higher ambient temperature decreased and higher rainfall increased diarrheal risk with temperature being the predominant factor in urban and rainfall in rural sites. Associations with microbial contamination were inconsistent; however, disease risk in the urban sites increased with higher median household total coliform concentrations. Understanding seasonal patterns in health outcomes and their temporal links to environmental exposures may lead to improvements in prospective environmental and disease surveillance tailored to addressing public health problems.

Sport, sex and age increase risk of illness at the Rio 2016 Summer Paralympic Games: a prospective cohort study of 51 198 athlete days.

PubMed

Derman, Wayne; Schwellnus, Martin P; Jordaan, Esme; Runciman, Phoebe; Blauwet, Cheri; Webborn, Nick; Lexell, Jan; Van de Vliet, Peter; Tuakli-Wosornu, Yetsa; Kissick, James; Stomphorst, Jaap

2018-01-01

To describe the epidemiology of illness at the Rio 2016 Summer Paralympic Games. A total of 3657 athletes from 78 countries, representing 83.5% of all athletes at the Games, were monitored on the web-based injury and illness surveillance system (WEB-IISS) over 51 198 athlete days during the Rio 2016 Summer Paralympic Games. Illness data were obtained daily from teams with their own medical support through the WEB-IISS electronic data capturing systems. The total number of illnesses was 511, with an illness incidence rate (IR) of 10.0 per 1000 athlete days (12.4%). The highest IRs were reported for wheelchair fencing (14.9), para swimming (12.6) and wheelchair basketball (12.5) (p<0.05). Female athletes and older athletes (35-75 years) were also at higher risk of illness (both p<0.01). Illnesses in the respiratory, skin and subcutaneous and digestive systems were the most common (IRs of 3.3, 1.8 and 1.3, respectively). (1) The rate of illness was lower than that reported for the London 2012 Summer Paralympic Games; (2) the sports with the highest risk were wheelchair fencing, para swimming and wheelchair basketball; (3) female and older athletes (35-75 years) were at increased risk of illness; and (4) the respiratory system, skin and subcutaneous system and digestive system were most affected by illness. These results allow for comparison at future Games. © 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.

Is there a role for robotic totally endoscopic coronary artery bypass in patients with a colostomy?

PubMed

Gibber, Marc; Lehr, Eric J; Kon, Zachary N; Wehman, P Brody; Griffith, Bartley P; Bonatti, Johannes

2014-01-01

Preoperative colostomy presents a significant risk of sternal wound complications, mediastinitis, and ostomy injury in patients requiring coronary artery bypass grafting. Less invasive procedures in coronary surgery have a potential to reduce the risk of sternal wound healing problems. Robotic totally endoscopic coronary artery bypass grafting in patients with a colostomy has not been reported. We describe a case of completely endoscopic coronary surgery using the da Vinci Si system in a patient with a transverse colostomy. Single left internal mammary artery grafting to the left anterior coronary artery was performed successfully on the beating heart. We regard this technique as the least invasive method of surgical coronary revascularization with a potential to reduce the risk of surgical site infection and mediastinitis in patients with a colostomy.

Conversion of Questionnaire Data

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

Powell, Danny H; Elwood Jr, Robert H

During the survey, respondents are asked to provide qualitative answers (well, adequate, needs improvement) on how well material control and accountability (MC&A) functions are being performed. These responses can be used to develop failure probabilities for basic events performed during routine operation of the MC&A systems. The failure frequencies for individual events may be used to estimate total system effectiveness using a fault tree in a probabilistic risk analysis (PRA). Numeric risk values are required for the PRA fault tree calculations that are performed to evaluate system effectiveness. So, the performance ratings in the questionnaire must be converted to relativemore » risk values for all of the basic MC&A tasks performed in the facility. If a specific material protection, control, and accountability (MPC&A) task is being performed at the 'perfect' level, the task is considered to have a near zero risk of failure. If the task is performed at a less than perfect level, the deficiency in performance represents some risk of failure for the event. As the degree of deficiency in performance increases, the risk of failure increases. If a task that should be performed is not being performed, that task is in a state of failure. The failure probabilities of all basic events contribute to the total system risk. Conversion of questionnaire MPC&A system performance data to numeric values is a separate function from the process of completing the questionnaire. When specific questions in the questionnaire are answered, the focus is on correctly assessing and reporting, in an adjectival manner, the actual performance of the related MC&A function. Prior to conversion, consideration should not be given to the numeric value that will be assigned during the conversion process. In the conversion process, adjectival responses to questions on system performance are quantified based on a log normal scale typically used in human error analysis (see A.D. Swain and H.E. Guttmann, 'Handbook of Human Reliability Analysis with Emphasis on Nuclear Power Plant Applications,' NUREG/CR-1278). This conversion produces the basic event risk of failure values required for the fault tree calculations. The fault tree is a deductive logic structure that corresponds to the operational nuclear MC&A system at a nuclear facility. The conventional Delphi process is a time-honored approach commonly used in the risk assessment field to extract numerical values for the failure rates of actions or activities when statistically significant data is absent.« less

Potential impact of single-risk-factor versus total risk management for the prevention of cardiovascular events in Seychelles.

PubMed

Ndindjock, Roger; Gedeon, Jude; Mendis, Shanthi; Paccaud, Fred; Bovet, Pascal

2011-04-01

To assess the prevalence of cardiovascular (CV) risk factors in Seychelles, a middle-income African country, and compare the cost-effectiveness of single-risk-factor management (treating individuals with arterial blood pressure ≥ 140/90 mmHg and/or total serum cholesterol ≥ 6.2 mmol/l) with that of management based on total CV risk (treating individuals with a total CV risk ≥ 10% or ≥ 20%). CV risk factor prevalence and a CV risk prediction chart for Africa were used to estimate the 10-year risk of suffering a fatal or non-fatal CV event among individuals aged 40-64 years. These figures were used to compare single-risk-factor management with total risk management in terms of the number of people requiring treatment to avert one CV event and the number of events potentially averted over 10 years. Treatment for patients with high total CV risk (≥ 20%) was assumed to consist of a fixed-dose combination of several drugs (polypill). Cost analyses were limited to medication. A total CV risk of ≥ 10% and ≥ 20% was found among 10.8% and 5.1% of individuals, respectively. With single-risk-factor management, 60% of adults would need to be treated and 157 cardiovascular events per 100000 population would be averted per year, as opposed to 5% of adults and 92 events with total CV risk management. Management based on high total CV risk optimizes the balance between the number requiring treatment and the number of CV events averted. Total CV risk management is much more cost-effective than single-risk-factor management. These findings are relevant for all countries, but especially for those economically and demographically similar to Seychelles.

A scheme to scientifically and accurately assess cadmium pollution of river sediments, through consideration of bioavailability when assessing ecological risk.

PubMed

Song, Zhixin; Tang, Wenzhong; Shan, Baoqing

2017-10-01

Evaluating heavy metal pollution status and ecological risk in river sediments is a complex task, requiring consideration of contaminant pollution levels, as well as effects of biological processes within the river system. There are currently no simple or low-cost approaches to heavy metal assessment in river sediments. Here, we introduce a system of assessment for pollution status of heavy metals in river sediments, using measurements of Cd in the Shaocun River sediments as a case study. This system can be used to identify high-risk zones of the river that should be given more attention. First, we evaluated the pollution status of Cd in the river sediments based on their total Cd content, and calculated a risk assessment, using local geochemical background values at various sites along the river. Using both acetic acid and ethylenediaminetetraacetic acid to extracted the fractions of Cd in sediments, and used DGT to evaluate the bioavailability of Cd. Thus, DGT provided a measure of potentially bioavailable concentrations of Cd concentrations in the sediments. Last, we measured Cd contents in plant tissue collected at the same site to compare with our other measures. A Pearson's correlation analysis showed that Cd-Plant correlated significantly with Cd-HAc, (r = 0.788, P < 0.01), Cd-EDTA (r = 0.925, P < 0.01), Cd-DGT (r = 0.976, P < 0.01), and Cd-Total (r = 0.635, P < 0.05). We demonstrate that this system of assessment is a useful means of assessing heavy metal pollution status and ecological risk in river sediments. Copyright © 2017 Elsevier Ltd. All rights reserved.

Water Safety Plan on cruise ships: a promising tool to prevent waterborne diseases.

PubMed

Mouchtouri, Varvara A; Bartlett, Christopher L R; Diskin, Arthur; Hadjichristodoulou, Christos

2012-07-01

Legionella spp. and other waterborne pathogens have been isolated from various water systems on land based premises as well as on ships and cases of Legionnaires' disease have been associated with both sites. Peculiarities of cruise ships water systems make the risk management a challenging process. The World Health Organization suggests a Water Safety Plan (WSP) as the best approach to mitigate risks and hazards such as Legionella spp. and others. To develop WSP on a cruise ship and discuss challenges, perspectives and key issues to success. Hazards and hazardous events were identified and risk assessment was conducted of the ship water system. Ship company management, policies and procedures were reviewed, site visits were conducted, findings and observations were recorded and discussed with engineers and key crew members were interviewed. A total of 53 hazards and hazardous events were taken into consideration for the risk assessment and additional essential barriers were established when needed. Most of them concerned control measures for biofilm development and Legionella spp. contamination. A total of 29 operational limits were defined. Supplementary verification and supportive programs were established. Application of the WSP to ship water systems, including potable water, recreational water facilities and decorative water features and fountains, is expected to improve water management on ships. The success of a WSP depends on support from senior management, commitment of the Captain and crew members, correct execution of all steps of a risk assessment and practicality and applicability in routine operation. The WSP provides to shipping industry a new approach and a move toward evidence based water safety policy. Copyright © 2012 Elsevier B.V. All rights reserved.

Stapler Esophageal Closure During Total Laryngectomy.

PubMed

Ismi, Onur; Unal, Murat; Vayisoglu, Yusuf; Yesilova, Mesut; Helvaci, Ilter; Gorur, Kemal; Ozcan, Cengiz

2017-01-01

Mechanical esophageal closure with stapler during total laryngectomy has been used by various authors to decrease the surgical time and pharyngocutaneous fistula (PCF) rates. In a few of the studies, surgical site infection (SSI) rates are mentioned and none of the studies emphasize the effect of decreased surgical time on postoperative cardiovascular and cerebrovascular complications. In this study, the authors compared the PCF rates, SSI rates, operation times between 30 mechanical stapler and 40 manual esophageal closure during total laryngectomy for laryngeal cancer patients. National Nasocomial Infections Surveillance system (NNISS) scores were recorded and compared between groups. Total laryngectomy and total operation times were lower in the stapler group patients (P < 0.001 for total laryngectomy time, P = 0.024 for total operation time). There were lower rates of pharyngocutaneous fistula (P = 0.032), surgical site infection (P = 0.019), and NNISS scores (P = 0.009) in the stapler group. There was no statistically significant difference between groups regarding postoperative systemic complications (P = 0.451). In conclusion, stapler esophageal closure decreases operation time, PCF, SSI rates, and NNISS scores but not the systemic complication rates. Comorbid illnesses and prolonged surgical time are risk factors for postoperative systemic complications in total laryngectomy patients, but patients with additional illnesses must not encourage the surgeon to use stapler for decreasing postoperative systemic complications.

Assessment of three risk evaluation systems for patients aged ≥70 in East China: performance of SinoSCORE, EuroSCORE II and the STS risk evaluation system.

PubMed

Shan, Lingtong; Ge, Wen; Pu, Yiwei; Cheng, Hong; Cang, Zhengqiang; Zhang, Xing; Li, Qifan; Xu, Anyang; Wang, Qi; Gu, Chang; Zhang, Yangyang

2018-01-01

To assess and compare the predictive ability of three risk evaluation systems (SinoSCORE, EuroSCORE II and the STS risk evaluation system) in patients aged ≥70, and who underwent coronary artery bypass grafting (CABG) in East China. Three risk evaluation systems were applied to 1,946 consecutive patients who underwent isolated CABG from January 2004 to September 2016 in two hospitals. Patients were divided into two subsets according to their age: elderly group (age ≥70) with a younger group (age <70) used for comparison. The outcome of interest in this study was in-hospital mortality. The entire cohort and subsets of patients were analyzed. The calibration and discrimination in total and in subsets were assessed by the Hosmer-Lemeshow and the C statistics respectively. Institutional overall mortality was 2.52%. The expected mortality rates of SinoSCORE, EuroSCORE II and the STS risk evaluation system were 0.78(0.64)%, 1.43(1.14)% and 0.78(0.77)%, respectively. SinoSCORE achieved the best discrimination (the area under the receiver operating characteristic curve (AUC) = 0.829), followed by the STS risk evaluation system (AUC = 0.790) and EuroSCORE II (AUC = 0.769) in the entire cohort. In the elderly group, the observed mortality rate was 4.82% while it was 1.38% in the younger group. SinoSCORE (AUC = .829) also achieved the best discrimination in the elderly group, followed by the STS risk evaluation system (AUC = .730) and EuroSCORE II (AUC = 0.640) while all three risk evaluation systems all had good performances in the younger group. SinoSCORE, EuroSCORE II and the STS risk evaluation system all achieved positive calibrations in the entire cohort and subsets. The performance of the three risk evaluation systems was not ideal in the entire cohort. In the elderly group, SinoSCORE appeared to achieve better predictive efficiency than EuroSCORE II and the STS risk evaluation system.

Individualized Risk Model for Venous Thromboembolism After Total Joint Arthroplasty.

PubMed

Parvizi, Javad; Huang, Ronald; Rezapoor, Maryam; Bagheri, Behrad; Maltenfort, Mitchell G

2016-09-01

Venous thromboembolism (VTE) after total joint arthroplasty (TJA) is a potentially fatal complication. Currently, a standard protocol for postoperative VTE prophylaxis is used that makes little distinction between patients at varying risks of VTE. We sought to develop a simple scoring system identifying patients at higher risk for VTE in whom more potent anticoagulation may need to be administered. Utilizing the National Inpatient Sample data, 1,721,806 patients undergoing TJA were identified, among whom 15,775 (0.9%) developed VTE after index arthroplasty. Among the cohort, all known potential risk factors for VTE were assessed. An initial logistic regression model using potential predictors for VTE was performed. Predictors with little contribution or poor predictive power were pruned from the data, and the model was refit. After pruning of variables that had little to no contribution to VTE risk, using the logistic regression, all independent predictors of VTE after TJA were identified in the data. Relative weights for each factor were determined. Hypercoagulability, metastatic cancer, stroke, sepsis, and chronic obstructive pulmonary disease had some of the highest points. Patients with any of these conditions had risk for postoperative VTE that exceeded the 3% rate. Based on the model, an iOS (iPhone operating system) application was developed (VTEstimator) that could be used to assign patients into low or high risk for VTE after TJA. We believe individualization of VTE prophylaxis after TJA can improve the efficacy of preventing VTE while minimizing untoward risks associated with the administration of anticoagulation. Copyright © 2016 Elsevier Inc. All rights reserved.

Minutes of the Explosives Safety Seminar (20th) Held at OMNI international Hotel, Norfolk, Virginia on 24-26 August 1982. Volume I

DTIC Science & Technology

1982-08-01

between one that provides for total protection of life and property and one that per- mits operators to conduct activities in a " laisse - faire " manner...Workers. AD-PO00 456 General Risk Analysis Methodological Implications to Explosives Risk Management Systems. AD-PO0O 457 Risk Analysis for Explosives...THE EFFECTS OF THE HEALTH AND SAFETY AT WORK ACT, 1974, ON MILITARY EXPLOSIVES SAFETY MANAGEMENT IN THE UNITED KINGDOM ........................ 7 Air

International Space Station (ISS) Orbital Replaceable Unit (ORU) Wet Storage Risk Assessment

NASA Technical Reports Server (NTRS)

Squire, Michael D.; Rotter, Henry A.; Lee, Jason; Packham, Nigel; Brady, Timothy K.; Kelly, Robert; Ott, C. Mark

2014-01-01

The International Space Station (ISS) Program requested the NASA Engineering and Safety Center (NESC) to evaluate the risks posed by the practice of long-term wet storage of ISS Environmental Control and Life Support (ECLS) regeneration system orbital replacement units (ORUs). The ISS ECLS regeneration system removes water from urine and humidity condensate and converts it into potable water and oxygen. A total of 29 ORUs are in the ECLS system, each designed to be replaced by the ISS crew when necessary. The NESC assembled a team to review the ISS ECLS regeneration system and evaluate the potential for biofouling and corrosion. This document contains the outcome of the evaluation.

Economics of human performance and systems total ownership cost.

PubMed

Onkham, Wilawan; Karwowski, Waldemar; Ahram, Tareq Z

2012-01-01

Financial costs of investing in people is associated with training, acquisition, recruiting, and resolving human errors have a significant impact on increased total ownership costs. These costs can also affect the exaggerate budgets and delayed schedules. The study of human performance economical assessment in the system acquisition process enhances the visibility of hidden cost drivers which support program management informed decisions. This paper presents the literature review of human total ownership cost (HTOC) and cost impacts on overall system performance. Economic value assessment models such as cost benefit analysis, risk-cost tradeoff analysis, expected value of utility function analysis (EV), growth readiness matrix, multi-attribute utility technique, and multi-regressions model were introduced to reflect the HTOC and human performance-technology tradeoffs in terms of the dollar value. The human total ownership regression model introduces to address the influencing human performance cost component measurement. Results from this study will increase understanding of relevant cost drivers in the system acquisition process over the long term.

RT-MATRIX: Measuring Total Organic Carbon by Photocatalytic Oxidation of Volatile Organic Compounds

NASA Technical Reports Server (NTRS)

2008-01-01

Volatile organic compounds (VOCs) inevitably accumulate in enclosed habitats such as the International Space Station and the Crew Exploration Vehicle (CEV) as a result of human metabolism, material off-gassing, and leaking equipment. Some VOCs can negatively affect the quality of the crew's life, health, and performance; and consequently, the success of the mission. Air quality must be closely monitored to ensure a safe living and working environment. Currently, there is no reliable air quality monitoring system that meets NASA's stringent requirements for power, mass, volume, or performance. The ultimate objective of the project -- the development of a Real-Time, Miniaturized, Autonomous Total Risk Indicator System (RT.MATRIX).is to provide a portable, dual-function sensing system that simultaneously determines total organic carbon (TOC) and individual contaminants in air streams.

Total Risk Integrated Methodology (TRIM) - TRIM.FaTE

EPA Pesticide Factsheets

TRIM.FaTE is a spatially explicit, compartmental mass balance model that describes the movement and transformation of pollutants over time, through a user-defined, bounded system that includes both biotic and abiotic compartments.

Renin–angiotensin–aldosterone system related gene polymorphisms and urinary total arsenic is related to chronic kidney disease

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

Chen, Wei-Jen; Huang, Ya-Li; Shiue, Horng-Sheng

A recent study demonstrated that an increased risk of chronic kidney disease (CKD) was associated with high urinary total arsenic levels. However, whether genomic instability is related to CKD remains unclear. An association between CKD and genetic polymorphisms of regulation enzymes of the renin–angiotensin–aldosterone system (RAAS), such as angiotensin-converting enzyme (ACE), angiotensinogen (AGT), angiotensin II type I receptor (AT1R), and aldosterone synthase (CYP11B2) has not been shown. The aim of the present study was to investigate the relationship between arsenic, genetic polymorphisms of RAAS enzymes and CKD. A total of 233 patients and 449 age- and gender-matched controls were recruitedmore » from the Taipei Medical University Hospital, Taipei Municipal Wan Fang Hospital and the Shin Kong Wu Ho-Su Memorial Hospital. Concentrations of urinary arsenic were determined by a high-performance liquid chromatography-linked hydride generator, and atomic absorption spectrometry. Polymorphisms of ACE(I/D), AGT(A[− 20]C), (T174M), (M235T), AT1R(A1166C) and CYP11B2(C[− 344]T) were examined by polymerase chain reaction and restriction fragment length polymorphism. Subjects carrying the CYP11B2 TT genotype had a higher odds ratio (OR), 1.39 (0.96–2.01), of CKD; while those with the AGT(A[− 20]C) CC genotype had an inverse OR of CKD (0.20 (0.05–0.81)), and a high-risk genotype was defined as A/A + A/C for AGT(A[− 20C]) and T/T for CYP11B2(C[− 344]T). The trend test showed a higher OR for CKD in patients who had either high urinary total arsenic levels or carried the high-risk genotype, or both, compared to patients with low urinary total arsenic levels, who carried the low-risk genotype, and could also be affected by the hypertension or diabetes status. - Highlights: • AGT(− 20 C) and CYP11B2(− 344 T) genotypes were significantly associated with CKD. • Combined effect of high-risk genotypes and high urinary total arsenic on OR of CKD. • Combined effect on the CKD was modified by the hypertension and diabetes status.« less

Mother-Infant Dyadic State Behaviour: Dynamic Systems in the Context of Risk

ERIC Educational Resources Information Center

Coburn, Shayna S.; Crnic, Keith A.; Ross, Emily K.

2015-01-01

Dynamic systems methods offer invaluable insight into the nuances of the early parent-child relationship. This prospective study aimed to highlight the characteristics of mother-infant dyadic behavior at 12?weeks post-partum using state space grid analysis (total n?=?322). We also examined whether maternal prenatal depressive symptoms and…

Different Approaches for Ensuring Performance/Reliability of Plastic Encapsulated Microcircuits (PEMs) in Space Applications

NASA Technical Reports Server (NTRS)

Gerke, R. David; Sandor, Mike; Agarwal, Shri; Moor, Andrew F.; Cooper, Kim A.

2000-01-01

Engineers within the commercial and aerospace industries are using trade-off and risk analysis to aid in reducing spacecraft system cost while increasing performance and maintaining high reliability. In many cases, Commercial Off-The-Shelf (COTS) components, which include Plastic Encapsulated Microcircuits (PEMs), are candidate packaging technologies for spacecrafts due to their lower cost, lower weight and enhanced functionality. Establishing and implementing a parts program that effectively and reliably makes use of these potentially less reliable, but state-of-the-art devices, has become a significant portion of the job for the parts engineer. Assembling a reliable high performance electronic system, which includes COTS components, requires that the end user assume a risk. To minimize the risk involved, companies have developed methodologies by which they use accelerated stress testing to assess the product and reduce the risk involved to the total system. Currently, there are no industry standard procedures for accomplishing this risk mitigation. This paper will present the approaches for reducing the risk of using PEMs devices in space flight systems as developed by two independent Laboratories. The JPL procedure involves primarily a tailored screening with accelerated stress philosophy while the APL procedure is primarily, a lot qualification procedure. Both Laboratories successfully have reduced the risk of using the particular devices for their respective systems and mission requirements.

Amoeba-related health risk in drinking water systems: could monitoring of amoebae be a complementary approach to current quality control strategies?

PubMed

Codony, Francesc; Pérez, Leonardo Martín; Adrados, Bárbara; Agustí, Gemma; Fittipaldi, Mariana; Morató, Jordi

2012-01-01

Culture-based methods for fecal indicator microorganisms are the standard protocol to assess potential health risk from drinking water systems. However, these traditional fecal indicators are inappropriate surrogates for disinfection-resistant fecal pathogens and the indigenous pathogens that grow in drinking water systems. There is now a range of molecular-based methods, such as quantitative PCR, which allow detection of a variety of pathogens and alternative indicators. Hence, in addition to targeting total Escherichia coli (i.e., dead and alive) for the detection of fecal pollution, various amoebae may be suitable to indicate the potential presence of pathogenic amoeba-resisting microorganisms, such as Legionellae. Therefore, monitoring amoeba levels by quantitative PCR could be a useful tool for directly and indirectly evaluating health risk and could also be a complementary approach to current microbial quality control strategies for drinking water systems.

State High-Risk Pools: An Update on the Minnesota Comprehensive Health Association

PubMed Central

Spencer, Donna; Burke, Courtney E.

2011-01-01

State health insurance high-risk pools are a key component of the US health care system's safety net, because they provide health insurance to the “uninsurable.” In 2007, 34 states had individual high-risk pools, which covered more than 200 000 people at a total cost of $1.8 billion. We examine the experience of the largest and oldest pool in the nation, the Minnesota Comprehensive Health Association, to document key issues facing state high-risk pools in enrollment and financing. We also considered the role and future of high-risk pools in light of national health care finance reform. PMID:21228286

Pre-Pregnancy BMI, Gestational Weight Gain, and the Risk of Hypertensive Disorders of Pregnancy: A Cohort Study in Wuhan, China

PubMed Central

Hu, Ronghua; Zhang, Yiming; Bassig, Bryan A.; Triche, Elizabeth; Yang, Shaoping; Qiu, Lin; Zhang, Yaqi; Yao, Cong; Xu, Shunqing; Wang, Youjie; Xia, Wei; Qian, Zhengmin; Zheng, Tongzhang; Zhang, Bin

2015-01-01

Background Hypertensive disorders of pregnancy (HDP) are major causes of maternal death worldwide and the risk factors are not fully understood. Few studies have investigated the risk factors for HDP among Chinese women. A cohort study involving 84,656 women was conducted to investigate pre-pregnancy BMI, total gestational weight gain (GWG), and GWG during early pregnancy as risk factors for HDP among Chinese women. Methods The study was conducted between 2011–2013 in Wuhan, China, utilizing data from the Maternal and Children Healthcare Information Tracking System of Wuhan. A total of 84,656 women with a live singleton pregnancy were included. Multiple unconditional logistic regression was conducted to evaluate associations between putative risk factors and HDP. Results Women who were overweight or obese before pregnancy had an elevated risk of developing HDP (overweight: OR = 2.66, 95% CI = 2.32–3.05; obese: OR = 5.53, 95% CI = 4.28–7.13) compared to their normal weight counterparts. Women with total GWG above the Institute of Medicine (IOM) recommendation had an adjusted OR of 1.72 (95% CI = 1.54–1.93) for HDP compared to women who had GWG within the IOM recommendation. Women with gestational BMI gain >10 kg/m2 during pregnancy had an adjusted OR of 3.35 (95% CI = 2.89–3.89) for HDP, compared to women with a gestational BMI gain <5 kg/m2. The increased risk of HDP was also observed among women with higher early pregnancy (up to 18 weeks of pregnancy) GWG (>600g/wk: adjusted OR = 1.48, 95% CI = 1.19–1.84). Conclusion The results from this study show that maternal pre-pregnancy BMI, early GWG, and total GWG are positively associated with the risk of HDP. Weight control efforts before and during pregnancy may help to reduce the risk of HDP. PMID:26305565

Pre-Pregnancy BMI, Gestational Weight Gain, and the Risk of Hypertensive Disorders of Pregnancy: A Cohort Study in Wuhan, China.

PubMed

Zhou, Aifen; Xiong, Chao; Hu, Ronghua; Zhang, Yiming; Bassig, Bryan A; Triche, Elizabeth; Yang, Shaoping; Qiu, Lin; Zhang, Yaqi; Yao, Cong; Xu, Shunqing; Wang, Youjie; Xia, Wei; Qian, Zhengmin; Zheng, Tongzhang; Zhang, Bin

2015-01-01

Hypertensive disorders of pregnancy (HDP) are major causes of maternal death worldwide and the risk factors are not fully understood. Few studies have investigated the risk factors for HDP among Chinese women. A cohort study involving 84,656 women was conducted to investigate pre-pregnancy BMI, total gestational weight gain (GWG), and GWG during early pregnancy as risk factors for HDP among Chinese women. The study was conducted between 2011-2013 in Wuhan, China, utilizing data from the Maternal and Children Healthcare Information Tracking System of Wuhan. A total of 84,656 women with a live singleton pregnancy were included. Multiple unconditional logistic regression was conducted to evaluate associations between putative risk factors and HDP. Women who were overweight or obese before pregnancy had an elevated risk of developing HDP (overweight: OR = 2.66, 95% CI = 2.32-3.05; obese: OR = 5.53, 95% CI = 4.28-7.13) compared to their normal weight counterparts. Women with total GWG above the Institute of Medicine (IOM) recommendation had an adjusted OR of 1.72 (95% CI = 1.54-1.93) for HDP compared to women who had GWG within the IOM recommendation. Women with gestational BMI gain >10 kg/m2 during pregnancy had an adjusted OR of 3.35 (95% CI = 2.89-3.89) for HDP, compared to women with a gestational BMI gain <5 kg/m2. The increased risk of HDP was also observed among women with higher early pregnancy (up to 18 weeks of pregnancy) GWG (>600g/wk: adjusted OR = 1.48, 95% CI = 1.19-1.84). The results from this study show that maternal pre-pregnancy BMI, early GWG, and total GWG are positively associated with the risk of HDP. Weight control efforts before and during pregnancy may help to reduce the risk of HDP.

A sudden death risk score specifically for hypertension: based on 25 648 individual patient data from six randomized controlled trials.

PubMed

Le, Hai-Ha; Subtil, Fabien; Cerou, Marc; Marchant, Ivanny; Al-Gobari, Muaamar; Fall, Mor; Mimouni, Yanis; Kassaï, Behrouz; Lindholm, Lars; Thijs, Lutgarde; Gueyffier, François

2017-11-01

To construct a sudden death risk score specifically for hypertension (HYSUD) patients with or without cardiovascular history. Data were collected from six randomized controlled trials of antihypertensive treatments with 8044 women and 17 604 men differing in age ranges and blood pressure eligibility criteria. In total, 345 sudden deaths (1.35%) occurred during a mean follow-up of 5.16 years. Risk factors of sudden death were examined using a multivariable Cox proportional hazards model adjusted on trials. The model was transformed to an integer system, with points added for each factor according to its association with sudden death risk. Antihypertensive treatment was not associated with a reduction of the sudden death risk and had no interaction with other factors, allowing model development on both treatment and placebo groups. A risk score of sudden death in 5 years was built with seven significant risk factors: age, sex, SBP, serum total cholesterol, cigarette smoking, diabetes, and history of myocardial infarction. In terms of discrimination performance, HYSUD model was adequate with areas under the receiver operating characteristic curve of 77.74% (confidence interval 95%, 74.13-81.35) for the derivation set, of 77.46% (74.09-80.83) for the validation set, and of 79.17% (75.94-82.40) for the whole population. Our work provides a simple risk-scoring system for sudden death prediction in hypertension, using individual data from six randomized controlled trials of antihypertensive treatments. HYSUD score could help assessing a hypertensive individual's risk of sudden death and optimizing preventive therapeutic strategies for these patients.

Corrigendum to "Chemical composition and acidity of size-fractionated inorganic aerosols of 2013-14 winter haze in Shanghai and associated health risk of toxic elements" [Atmos. Environ. (2015) 259-271

NASA Astrophysics Data System (ADS)

Behera, Sailesh N.; Cheng, Jinping; Huang, Xian; Zhu, Qiongyu; Liu, Ping; Balasubramanian, Rajasekhar

2018-03-01

The authors regret that the sources from which the RfC (reference concentration) and the IUR (inhalation unit risk) values were obtained for estimation of RfD (reference dose, presented in Table 2) and SF (slope factor, presented in Table 3) were not clearly indicated in the published article due to an oversight. The revised tables with improved clarity are given below. a The Risk Assessment Information System (https://rais.ornl.gov/) b USEPA Integrated Risk Information System (IRIS) (http://www.epa.gov/iris) c The California EPA, the office of Environmental Health Hazard Assessment (OEHHA) (https://www.oehha.gov.gov/) d Behera, S.N., Xian, H. and Balasubramanian, R., 2014. Human health risk associated with exposure to toxic elements in mainstream and sidestream cigarette smoke. Science of the Total Environment, 472, pp.947-956.

Current Status and Future Challenges in Risk-Based Radiation Engineering

NASA Technical Reports Server (NTRS)

Pellish, Jonathan A.

2017-01-01

This presentation covers the basis and challenges for radiation effects in electronic systems. The three main types of radiation effects in electronics are: 1) total ionizing dose (TID), 2) total non-ionizing dose (TNID) / displacement damage dose (DDD), and 3) single-event effect (SEE). Some content on relevant examples of effects, current concerns, and possible environmental model-driven solutions are also included.

Space Transportation System Liftoff Debris Mitigation Process Overview

NASA Technical Reports Server (NTRS)

Mitchell, Michael; Riley, Christopher

2011-01-01

Liftoff debris is a top risk to the Space Shuttle Vehicle. To manage the Liftoff debris risk, the Space Shuttle Program created a team with in the Propulsion Systems Engineering & Integration Office. The Shutt le Liftoff Debris Team harnesses the Systems Engineering process to i dentify, assess, mitigate, and communicate the Liftoff debris risk. T he Liftoff Debris Team leverages off the technical knowledge and expe rtise of engineering groups across multiple NASA centers to integrate total system solutions. These solutions connect the hardware and ana lyses to identify and characterize debris sources and zones contribut ing to the Liftoff debris risk. The solutions incorporate analyses sp anning: the definition and modeling of natural and induced environmen ts; material characterizations; statistical trending analyses, imager y based trajectory analyses; debris transport analyses, and risk asse ssments. The verification and validation of these analyses are bound by conservative assumptions and anchored by testing and flight data. The Liftoff debris risk mitigation is managed through vigilant collab orative work between the Liftoff Debris Team and Launch Pad Operation s personnel and through the management of requirements, interfaces, r isk documentation, configurations, and technical data. Furthermore, o n day of launch, decision analysis is used to apply the wealth of ana lyses to case specific identified risks. This presentation describes how the Liftoff Debris Team applies Systems Engineering in their proce sses to mitigate risk and improve the safety of the Space Shuttle Veh icle.

Agile patency system eliminates risk of capsule retention in patients with known intestinal strictures who undergo capsule endoscopy.

PubMed

Herrerias, Juan M; Leighton, Jonathan A; Costamagna, Guido; Infantolino, Anthony; Eliakim, Rami; Fischer, Doron; Rubin, David T; Manten, Howard D; Scapa, Eitan; Morgan, Douglas R; Bergwerk, Ari J; Koslowsky, Binyamin; Adler, Samuel N

2008-05-01

Capsule endoscopy (CE) of the small bowel has become a standard diagnostic tool, but there have been concerns regarding the risk of capsule retention in certain high-risk groups. The Agile patency system, an ingestible and dissolvable capsule with an external scanner, was developed to allow physicians to perform CE with greater confidence that the capsule will be safely excreted in patients at risk for capsule retention. Our purpose was to assess the ability of the device to help physicians identify which patients with known strictures may safely undergo CE. Patients with known strictures ingested the new patency capsule and underwent periodic scanning until it was excreted. The intestinal tract was considered to be sufficiently patent if the capsule was excreted intact or if the capsule was not detected by the scanner at 30 hours after ingestion. If patency was established, then standard CE was performed. International multicenter study. A total of 106 patients with known strictures. Agile patency system. Performance and safety of Agile patency system. A total of 106 patients ingested the patency capsule. Fifty-nine (56%) excreted it intact and subsequently underwent CE. There were no cases of capsule retention. Significant findings on CE were found in 24 (41%). There were 3 severe adverse events. These results suggest that the Agile patency system is a useful tool for physicians to use before CE in patients with strictures to avoid retention. This group of patients may have a high yield of clinically significant findings at CE. This capsule may determine whether patients who have a contraindication to CE may safely undergo CE and obtain useful diagnostic information.

Total coliform and Escherichia coli contamination in rural well water: analysis for passive surveillance.

PubMed

Invik, Jesse; Barkema, Herman W; Massolo, Alessandro; Neumann, Norman F; Checkley, Sylvia

2017-10-01

With increasing stress on our water resources and recent waterborne disease outbreaks, understanding the epidemiology of waterborne pathogens is crucial to build surveillance systems. The purpose of this study was to explore techniques for describing microbial water quality in rural drinking water wells, based on spatiotemporal analysis, time series analysis and relative risk mapping. Tests results for Escherichia coli and coliforms from private and small public well water samples, collected between 2004 and 2012 in Alberta, Canada, were used for the analysis. Overall, 14.6 and 1.5% of the wells were total coliform and E. coli-positive, respectively. Private well samples were more often total coliform or E. coli-positive compared with untreated public well samples. Using relative risk mapping we were able to identify areas of higher risk for bacterial contamination of groundwater in the province not previously identified. Incorporation of time series analysis demonstrated peak contamination occurring for E. coli in July and a later peak for total coliforms in September, suggesting a temporal dissociation between these indicators in terms of groundwater quality, and highlighting the potential need to increase monitoring during certain periods of the year.

Combined effects of prenatal medication use and delivery type are associated with eczema at age 2 years.

PubMed

Wegienka, G; Havstad, S; Zoratti, E M; Kim, H; Ownby, D R; Johnson, C C

2015-03-01

Separately, prenatal antibiotics and Caesarian delivery have been found to be associated with increased risk of allergic diseases. It is not clear whether these factors may modify the effect of each other. To assess whether the associations between delivery types and eczema, sensitization and total IgE at age 2 years were modified by maternal use of prenatal medications. Prenatal charts of women enrolled in the WHEALS birth cohort were reviewed for delivery mode and medications prescribed and administered throughout their entire pregnancy, including systemic antibiotics and vaginally applied antifungal medications. The associations between the delivery mode and select medications and, eczema, sensitization (≥ 1 of 10 allergen-specific IgE ≥ 0.35 IU/mL) and total IgE at age 2 years were assessed. There was a lower risk of eczema among vaginally vs. c-section born children (relative risk adjusted for race = aRR = 0.77, 95% CI 0.56, 1.05). Although not statistically significantly different, this association was stronger among the subset of children born vaginally to a mother who did not use systemic antibiotics or vaginal antifungal medications (aRR = 0.69, 95% CI 0.44, 1.08) compared to those born vaginally to mothers who used systemic antibiotics or vaginal antifungals (aRR = 0.81, 95% CI 0.57, 1.14). A protective association between vaginal birth and sensitization (aRR = 0.86, 95% CI 0.72, 1.03) was similar for those children born vaginally to a mother who did not (aRR = 0.87, 95% CI 0.69, 1.10) and who did (RR = 0.85, 95% CI 0.70, 1.04) use systemic antibiotics or vaginal antifungal medications. There were no associations with total IgE. Children born vaginally had lower risk of eczema and sensitization compared with those born via c-section; however, the protective association with eczema may be slightly weakened when mothers took systemic antibiotics or vaginally applied medications during pregnancy. © 2014 John Wiley & Sons Ltd.

The KULTURisk Regional Risk Assessment methodology for water-related natural hazards - Part 2: Application to the Zurich case study

NASA Astrophysics Data System (ADS)

Ronco, P.; Bullo, M.; Torresan, S.; Critto, A.; Olschewski, R.; Zappa, M.; Marcomini, A.

2014-07-01

The main objective of the paper is the application of the KULTURisk Regional Risk Assessment (KR-RRA) methodology, presented in the companion paper (Part 1, Ronco et al., 2014), to the Sihl River valley, in Switzerland. Through a tuning process of the methodology to the site-specific context and features, flood related risks have been assessed for different receptors lying on the Sihl River valley including the city of Zurich, which represents a typical case of river flooding in urban area. After characterizing the peculiarities of the specific case study, risk maps have been developed under a 300 years return period scenario (selected as baseline) for six identified relevant targets, exposed to flood risk in the Sihl valley, namely: people, economic activities (including buildings, infrastructures and agriculture), natural and semi-natural systems and cultural heritage. Finally, the total risk index map, which allows to identify and rank areas and hotspots at risk by means of Multi Criteria Decision Analysis tools, has been produced to visualize the spatial pattern of flood risk within the area of study. By means of a tailored participative approach, the total risk maps supplement the consideration of technical experts with the (essential) point of view of the relevant stakeholders for the appraisal of the specific scores and weights related to the receptor-relative risks. The total risk maps obtained for the Sihl River case study are associated with the lower classes of risk. In general, higher relative risks are concentrated in the deeply urbanized area within and around the Zurich city centre and areas that rely just behind to the Sihl River course. Here, forecasted injuries and potential fatalities are mainly due to high population density and high presence of old (vulnerable) people; inundated buildings are mainly classified as continuous and discontinuous urban fabric; flooded roads, pathways and railways, the majority of them referring to the Zurich main train station (Hauptbahnhof), are at high risk of inundation, causing huge indirect damages. The analysis of flood risk to agriculture, natural and semi-natural systems and cultural heritage have pointed out that these receptors could be relatively less impacted by the selected flood scenario mainly because their scattered presence. Finally, the application of the KR-RRA methodology to the Sihl River case study as well as to several other sites across Europe (not presented here), has demonstrated its flexibility and possible adaptation to different geographical and socio-economic contexts, depending on data availability and peculiarities of the sites, as well as for other hazard scenarios.

Potential impact of single-risk-factor versus total risk management for the prevention of cardiovascular events in Seychelles

PubMed Central

Ndindjock, Roger; Gedeon, Jude; Mendis, Shanthi; Paccaud, Fred

2011-01-01

Abstract Objective To assess the prevalence of cardiovascular (CV) risk factors in Seychelles, a middle-income African country, and compare the cost-effectiveness of single-risk-factor management (treating individuals with arterial blood pressure ≥ 140/90 mmHg and/or total serum cholesterol ≥ 6.2 mmol/l) with that of management based on total CV risk (treating individuals with a total CV risk ≥ 10% or ≥ 20%). Methods CV risk factor prevalence and a CV risk prediction chart for Africa were used to estimate the 10-year risk of suffering a fatal or non-fatal CV event among individuals aged 40–64 years. These figures were used to compare single-risk-factor management with total risk management in terms of the number of people requiring treatment to avert one CV event and the number of events potentially averted over 10 years. Treatment for patients with high total CV risk (≥ 20%) was assumed to consist of a fixed-dose combination of several drugs (polypill). Cost analyses were limited to medication. Findings A total CV risk of ≥ 10% and ≥ 20% was found among 10.8% and 5.1% of individuals, respectively. With single-risk-factor management, 60% of adults would need to be treated and 157 cardiovascular events per 100 000 population would be averted per year, as opposed to 5% of adults and 92 events with total CV risk management. Management based on high total CV risk optimizes the balance between the number requiring treatment and the number of CV events averted. Conclusion Total CV risk management is much more cost-effective than single-risk-factor management. These findings are relevant for all countries, but especially for those economically and demographically similar to Seychelles. PMID:21479093

Risk score for predicting long-term mortality after coronary artery bypass graft surgery.

PubMed

Wu, Chuntao; Camacho, Fabian T; Wechsler, Andrew S; Lahey, Stephen; Culliford, Alfred T; Jordan, Desmond; Gold, Jeffrey P; Higgins, Robert S D; Smith, Craig R; Hannan, Edward L

2012-05-22

No simplified bedside risk scores have been created to predict long-term mortality after coronary artery bypass graft surgery. The New York State Cardiac Surgery Reporting System was used to identify 8597 patients who underwent isolated coronary artery bypass graft surgery in July through December 2000. The National Death Index was used to ascertain patients' vital statuses through December 31, 2007. A Cox proportional hazards model was fit to predict death after CABG surgery using preprocedural risk factors. Then, points were assigned to significant predictors of death on the basis of the values of their regression coefficients. For each possible point total, the predicted risks of death at years 1, 3, 5, and 7 were calculated. It was found that the 7-year mortality rate was 24.2 in the study population. Significant predictors of death included age, body mass index, ejection fraction, unstable hemodynamic state or shock, left main coronary artery disease, cerebrovascular disease, peripheral arterial disease, congestive heart failure, malignant ventricular arrhythmia, chronic obstructive pulmonary disease, diabetes mellitus, renal failure, and history of open heart surgery. The points assigned to these risk factors ranged from 1 to 7; possible point totals for each patient ranged from 0 to 28. The observed and predicted risks of death at years 1, 3, 5, and 7 across patient groups stratified by point totals were highly correlated. The simplified risk score accurately predicted the risk of mortality after coronary artery bypass graft surgery and can be used for informed consent and as an aid in determining treatment choice.

A Proactive Approach to High Risk Delirium Patients Undergoing Total Joint Arthroplasty.

PubMed

Duque, Andres F; Post, Zachary D; Orozco, Fabio R; Lutz, Rex W; Ong, Alvin C

2018-04-01

Delirium is a common complication among elderly patients undergoing total joint arthroplasty (TJA). Its incidence has been reported from 4% to 53%. The Centers for Medicare and Medicaid Services consider delirium following TJA a "never-event." The purpose of this study is to evaluate a simple perioperative protocol used to identify delirium risk patients and prevent its incidence following TJA. Our group developed a protocol to identify and prevent delirium in patients undergoing TJA. All patients were screened and scored in the preoperative assessment, on criteria such as age, history of forgetfulness, history of agitation or visual hallucinations, history of falls, history of postoperative confusion, and inability to perform higher brain functions. Patients were scored on performance in a simple mental examination. The patients were classified as low, medium, or high risk. Patients who were identified as high risk were enrolled in a delirium avoidance protocol that minimized narcotics and emphasized nursing involvement and fluids administration. Five of 7659 (0.065%) consecutive TJA patients from 2010 to 2015 developed delirium. A total of 422 patients were identified as high risk. All 5 patients who suffered delirium were within the high risk group. No low or medium risk patients suffered a delirium complication. Three (0.039%) patients suffered drug-induced delirium, 1 (0.013%) had delirium related to alcohol withdrawal, and 1 (0.013%) had delirium after a systemic infection. This protocol is effective in identifying patients at high delirium risk and diminishing the incidence of this complication by utilizing a simple screening tool and perioperative protocol. Copyright © 2017 Elsevier Inc. All rights reserved.

Effects of an Encapsulated Fruit and Vegetable Juice Concentrate on Obesity-Induced Systemic Inflammation: A Randomised Controlled Trial

PubMed Central

Williams, Evan J.; Baines, Katherine J.; Berthon, Bronwyn S.; Wood, Lisa G.

2017-01-01

Phytochemicals from fruit and vegetables reduce systemic inflammation. This study examined the effects of an encapsulated fruit and vegetable (F&V) juice concentrate on systemic inflammation and other risk factors for chronic disease in overweight and obese adults. A double-blinded, parallel, randomized placebo-controlled trial was conducted in 56 adults aged ≥40 years with a body mass index (BMI) ≥28 kg/m2. Before and after eight weeks daily treatment with six capsules of F&V juice concentrate or placebo, peripheral blood gene expression (microarray, quantitative polymerase chain reaction (qPCR)), plasma tumour necrosis factor (TNF)α (enzyme-linked immunosorbent assay (ELISA)), body composition (Dual-energy X-ray absorptiometry (DEXA)) and lipid profiles were assessed. Following consumption of juice concentrate, total cholesterol, low-density lipoprotein (LDL) cholesterol and plasma TNFα decreased and total lean mass increased, while there was no change in the placebo group. In subjects with high systemic inflammation at baseline (serum C-reactive protein (CRP) ≥3.0 mg/mL) who were supplemented with the F&V juice concentrate (n = 16), these effects were greater, with decreased total cholesterol, LDL cholesterol and plasma TNFα and increased total lean mass; plasma CRP was unchanged by the F&V juice concentrate following both analyses. The expression of several genes involved in lipogenesis, the nuclear factor-κB (NF-κB) and 5′ adenosine monophosphate-activated protein kinase (AMPK) signalling pathways was altered, including phosphomevalonate kinase (PMVK), zinc finger AN1-type containing 5 (ZFAND5) and calcium binding protein 39 (CAB39), respectively. Therefore, F&V juice concentrate improves the metabolic profile, by reducing systemic inflammation and blood lipid profiles and, thus, may be useful in reducing the risk of obesity-induced chronic disease. PMID:28208713

Identification of Major Risk Sources for Surface Water Pollution by Risk Indexes (RI) in the Multi-Provincial Boundary Region of the Taihu Basin, China

PubMed Central

Yao, Hong; Li, Weixin; Qian, Xin

2015-01-01

Environmental safety in multi-district boundary regions has been one of the focuses in China and is mentioned many times in the Environmental Protection Act of 2014. Five types were categorized concerning the risk sources for surface water pollution in the multi-provincial boundary region of the Taihu basin: production enterprises, waste disposal sites, chemical storage sites, agricultural non-point sources and waterway transportations. Considering the hazard of risk sources, the purification property of environmental medium and the vulnerability of risk receptors, 52 specific attributes on the risk levels of each type of risk source were screened out. Continuous piecewise linear function model, expert consultation method and fuzzy integral model were used to calculate the integrated risk indexes (RI) to characterize the risk levels of pollution sources. In the studied area, 2716 pollution sources were characterized by RI values. There were 56 high-risk sources screened out as major risk sources, accounting for about 2% of the total. The numbers of sources with high-moderate, moderate, moderate-low and low pollution risk were 376, 1059, 101 and 1124, respectively, accounting for 14%, 38%, 5% and 41% of the total. The procedure proposed could be included in the integrated risk management systems of the multi-district boundary region of the Taihu basin. It could help decision makers to identify major risk sources in the risk prevention and reduction of surface water pollution. PMID:26308032

Identification of Major Risk Sources for Surface Water Pollution by Risk Indexes (RI) in the Multi-Provincial Boundary Region of the Taihu Basin, China.

PubMed

Yao, Hong; Li, Weixin; Qian, Xin

2015-08-21

Environmental safety in multi-district boundary regions has been one of the focuses in China and is mentioned many times in the Environmental Protection Act of 2014. Five types were categorized concerning the risk sources for surface water pollution in the multi-provincial boundary region of the Taihu basin: production enterprises, waste disposal sites, chemical storage sites, agricultural non-point sources and waterway transportations. Considering the hazard of risk sources, the purification property of environmental medium and the vulnerability of risk receptors, 52 specific attributes on the risk levels of each type of risk source were screened out. Continuous piecewise linear function model, expert consultation method and fuzzy integral model were used to calculate the integrated risk indexes (RI) to characterize the risk levels of pollution sources. In the studied area, 2716 pollution sources were characterized by RI values. There were 56 high-risk sources screened out as major risk sources, accounting for about 2% of the total. The numbers of sources with high-moderate, moderate, moderate-low and low pollution risk were 376, 1059, 101 and 1124, respectively, accounting for 14%, 38%, 5% and 41% of the total. The procedure proposed could be included in the integrated risk management systems of the multi-district boundary region of the Taihu basin. It could help decision makers to identify major risk sources in the risk prevention and reduction of surface water pollution.

Legionella species colonization of water distribution systems, pools and air conditioning systems in cruise ships and ferries

PubMed Central

Goutziana, Georgia; Mouchtouri, Varvara A; Karanika, Maria; Kavagias, Antonios; Stathakis, Nikolaos E; Gourgoulianis, Kostantinos; Kremastinou, Jenny; Hadjichristodoulou, Christos

2008-01-01

Background Legionnaires' disease continues to be a public health concern in passenger ships. This study was scheduled in order to investigate Legionella spp. colonization of water distribution systems (WDS), recreational pools, and air-conditioning systems on board ferries and cruise ships in an attempt to identify risk factors for Legionella spp. colonization associated with ship water systems and water characteristics. Methods Water systems of 21 ferries and 10 cruise ships including WDS, air conditioning systems and pools were investigated for the presence of Legionella spp. Results The 133 samples collected from the 10 cruise ships WDS, air conditioning systems and pools were negative for Legionella spp. Of the 21 ferries WDS examined, 14 (66.7%) were legionellae-positive. A total of 276 samples were collected from WDS and air conditioning systems. Legionella spp. was isolated from 37.8% of the hot water samples and 17.5% of the cold water samples. Of the total 96 positive isolates, 87 (90.6%) were L. pneumophila. Legionella spp. colonization was positively associated with ship age. The temperature of the hot water samples was negatively associated with colonization of L. pneumophila serogroup (sg) 1 and that of L. pneumophila sg 2 to 14. Increases in pH ≥7.8 and total plate count ≥400 CFU/L, correlated positively with the counts of L. pneumophila sg 2 to 14 and Legionella spp. respectively. Free chlorine of ≥0.2 mg/L inhibited colonization of Legionella spp. Conclusion WDS of ferries can be heavily colonized by Legionella spp. and may present a risk of Legionnaires' disease for passengers and crew members. Guidelines and advising of Legionnaires' disease prevention regarding ferries are needed, in particular for operators and crew members. PMID:19025638

Legionella species colonization of water distribution systems, pools and air conditioning systems in cruise ships and ferries.

PubMed

Goutziana, Georgia; Mouchtouri, Varvara A; Karanika, Maria; Kavagias, Antonios; Stathakis, Nikolaos E; Gourgoulianis, Kostantinos; Kremastinou, Jenny; Hadjichristodoulou, Christos

2008-11-24

Legionnaires' disease continues to be a public health concern in passenger ships. This study was scheduled in order to investigate Legionella spp. colonization of water distribution systems (WDS), recreational pools, and air-conditioning systems on board ferries and cruise ships in an attempt to identify risk factors for Legionella spp. colonization associated with ship water systems and water characteristics. Water systems of 21 ferries and 10 cruise ships including WDS, air conditioning systems and pools were investigated for the presence of Legionella spp. The 133 samples collected from the 10 cruise ships WDS, air conditioning systems and pools were negative for Legionella spp. Of the 21 ferries WDS examined, 14 (66.7%) were legionellae-positive. A total of 276 samples were collected from WDS and air conditioning systems. Legionella spp. was isolated from 37.8% of the hot water samples and 17.5% of the cold water samples. Of the total 96 positive isolates, 87 (90.6%) were L. pneumophila. Legionella spp. colonization was positively associated with ship age. The temperature of the hot water samples was negatively associated with colonization of L. pneumophila serogroup (sg) 1 and that of L. pneumophila sg 2 to 14. Increases in pH >/=7.8 and total plate count > or =400 CFU/L, correlated positively with the counts of L. pneumophila sg 2 to 14 and Legionella spp. respectively. Free chlorine of > or =0.2 mg/L inhibited colonization of Legionella spp. WDS of ferries can be heavily colonized by Legionella spp. and may present a risk of Legionnaires' disease for passengers and crew members. Guidelines and advising of Legionnaires' disease prevention regarding ferries are needed, in particular for operators and crew members.

A risk scoring system for prediction of haemorrhagic stroke.

PubMed

Zodpey, S P; Tiwari, R R

2005-01-01

The present pair-matched case control study was carried out at Government Medical College Hospital, Nagpur, India, a tertiary care hospital with the objective to devise and validate a risk scoring system for prediction of hemorrhagic stroke. The study consisted of 166 hospitalized CT scan proved cases of hemorrhagic stroke (ICD 9, 431-432), and a age and sex matched control per case. The controls were selected from patients who attended the study hospital for conditions other than stroke. On conditional multiple logistic regression five risk factors- hypertension (OR = 1.9. 95% Cl = 1.5-2.5). raised scrum total cholesterol (OR = 2.3, 95% Cl = 1.1-4.9). use of anticoagulants and antiplatelet agents (OR = 3.4, 95% Cl =1.1-10.4). past history of transient ischaemic attack (OR = 8.4, 95% Cl = 2.1- 33.6) and alcohol intake (OR = 2.1, 95% Cl = 1.3-3.6) were significant. These factors were ascribed statistical weights (based on regression coefficients) of 6, 8, 12, 21 and 8 respectively. The nonsignificant factors (diabetes mellitus, physical inactivity, obesity, smoking, type A personality, history of claudication, family history of stroke, history of cardiac diseases and oral contraceptive use in females) were not included in the development of scoring system. ROC curve suggested a total score of 21 to be the best cut-off for predicting haemorrhag stroke. At this cut-off the sensitivity, specificity, positive predictivity and Cohen's kappa were 0.74, 0.74, 0.74 and 0.48 respectively. The overall predictive accuracy of this additive risk scoring system (area under ROC curve by Wilcoxon statistic) was 0.79 (95% Cl = 0.73-0.84). Thus to conclude, if substantiated by further validation, this scorincy system can be used to predict haemorrhagic stroke, thereby helping to devise effective risk factor intervention strategy.

Multi-angle Indicators System of Non-point Pollution Source Assessment in Rural Areas: A Case Study Near Taihu Lake

NASA Astrophysics Data System (ADS)

Huang, Lei; Ban, Jie; Han, Yu Ting; Yang, Jie; Bi, Jun

2013-04-01

This study aims to identify key environmental risk sources contributing to water eutrophication and to suggest certain risk management strategies for rural areas. The multi-angle indicators included in the risk source assessment system were non-point source pollution, deficient waste treatment, and public awareness of environmental risk, which combined psychometric paradigm methods, the contingent valuation method, and personal interviews to describe the environmental sensitivity of local residents. Total risk values of different villages near Taihu Lake were calculated in the case study, which resulted in a geographic risk map showing which village was the critical risk source of Taihu eutrophication. The increased application of phosphorus (P) and nitrogen (N), loss vulnerability of pollutant, and a lack of environmental risk awareness led to more serious non-point pollution, especially in rural China. Interesting results revealed by the quotient between the scores of objective risk sources and subjective risk sources showed what should be improved for each study village. More environmental investments, control of agricultural activities, and promotion of environmental education are critical considerations for rural environmental management. These findings are helpful for developing targeted and effective risk management strategies in rural areas.

Prediction and warning system of SEP events and solar flares for risk estimation in space launch operations

NASA Astrophysics Data System (ADS)

García-Rigo, Alberto; Núñez, Marlon; Qahwaji, Rami; Ashamari, Omar; Jiggens, Piers; Pérez, Gustau; Hernández-Pajares, Manuel; Hilgers, Alain

2016-07-01

A web-based prototype system for predicting solar energetic particle (SEP) events and solar flares for use by space launch operators is presented. The system has been developed as a result of the European Space Agency (ESA) project SEPsFLAREs (Solar Events Prediction system For space LAunch Risk Estimation). The system consists of several modules covering the prediction of solar flares and early SEP Warnings (labeled Warning tool), the prediction of SEP event occurrence and onset, and the prediction of SEP event peak and duration. In addition, the system acquires data for solar flare nowcasting from Global Navigation Satellite Systems (GNSS)-based techniques (GNSS Solar Flare Detector, GSFLAD and the Sunlit Ionosphere Sudden Total Electron Content Enhancement Detector, SISTED) as additional independent products that may also prove useful for space launch operators.

Cardiovascular risk estimation by professionally active cardiovascular nurses: results from the Basel 2005 Nurses Cohort.

PubMed

Scholte op Reimer, Wilma J M; Moons, Philip; De Geest, Sabina; Fridlund, Bengt; Heikkilä, Johanna; Jaarsma, Tiny; Lenzen, Mattie; Martensson, Jan; Norekvål, Tone M; Smith, Karen; Stewart, Simon; Strömberg, Anna; Thompson, David R

2006-12-01

Nurses play a key role in the prevention of cardiovascular disease (CVD) and one would, therefore, expect them to have a heightened awareness of the need for systematic screening and their own CVD risk profile. The aim of this study was to examine personal awareness of CVD risk among a cohort of cardiovascular nurses attending a European conference. Of the 340 delegates attending the 5th annual Spring Meeting on Cardiovascular Nursing (Basel, Switzerland, 2005), 287 (83%) completed a self-report questionnaire to assess their own risk factors for CVD. Delegates were also asked to give an estimation of their absolute total risk of experiencing a fatal CVD event in the next 10 years. Level of agreement between self-reported CVD risk estimation and their actual risk according to the SCORE risk assessment system was compared by calculating weighted Kappa (kappa(w)). Overall, 109 responders (38%) self-reported having either pre-existing CVD (only 2%), one or more markedly raised CVD risk factors, a high total risk of fatal CVD (> or =5% in 10 years) or a strong family history of CVD. About half of this cohort (53%) did not know their own total cholesterol level. Less than half (45%) reported having a 10-year risk of fatal CVD of <1%, while 13% reported having a risk > or =5%. Based on the SCORE risk function, the estimated 10-year risk of a fatal CVD event was <1% for 96% of responders: only 2% had a > or =5% risk of such an event. Overall, less than half (46%) of this cohort's self-reported CVD risk corresponded with that calculated using the SCORE risk function (kappa(w)=0.27). Most cardiovascular nurses attending a European conference in 2005 poorly understood their own CVD risk profile, and the agreement between their self-reported 10-year risk of a fatal CVD and their CVD risk using SCORE was only fair. Given the specialist nature of this conference, our findings clearly demonstrate a need to improve overall nursing awareness of the role and importance of systematic CVD risk assessment.

Health Conditions and Passive Suicidal Ideation in the Survey of Health, Ageing, and Retirement in Europe

PubMed Central

Morton, Kimberly; Turiano, Nicholas A.; Fiske, Amy

2016-01-01

Objectives: To examine the associations between health conditions and passive suicidal ideation in middle-aged and older adults. Method: Multivariate logistic regression analyses were conducted on data from 35,664 middle-aged and older adults from the Survey of Health, Ageing, and Retirement in Europe. Mediation analyses were also conducted to test the roles of disability and depression in risk of ideation. Results: After including demographic variables, disability, depression, and other health conditions as covariates, heart attack, diabetes/high blood sugar, chronic lung disease, arthritis, ulcer, and hip/femoral fractures were associated with increased odds of passive suicidal ideation. When grouped by organ systems, conditions affecting the endocrine, respiratory, and musculoskeletal systems were associated with increased odds of passive suicidal ideation, as was the total number of conditions. Individuals with greater numbers of health conditions exhibited greater levels of disability and depression, which partially explained the increased risk of passive suicidal ideation among those with more health conditions. Discussion: Certain specific health conditions, as well as total number of conditions, are associated with passive suicidal ideation in middle age and older adulthood. Health is a critical risk factor for suicidal ideation in late life and should be further studied in this particularly at-risk population. PMID:27013533

Phthalate esters in soil, plastic film, and vegetable from greenhouse vegetable production bases in Beijing, China: Concentrations, sources, and risk assessment.

PubMed

Li, Cheng; Chen, Jiayi; Wang, Jihua; Han, Ping; Luan, Yunxia; Ma, Xupu; Lu, Anxiang

2016-10-15

The increased use of plastic film in greenhouse vegetable production (GVP) could result in phthalate ester (PAE) contamination in vegetables. However, limited information is currently available on their occurrence and associated potential risks in GVP systems. The present study documents the occurrence and composition of 15 PAEs in soil, plastic film, and vegetable samples from eight large-scale GVP bases in Beijing, China. Results showed that PAEs are ubiquitous contaminants in these GVP bases. Total PAE concentrations ranged from 0.14 to 2.13mg/kg (mean 0.99mg/kg) in soils and from 0.15 to 6.94mg/kg (mean 1.49mg/kg) in vegetables. Di (2-ethylhexyl) phthalate, di-n-butyl phthalate, and diisobutyl phthalate were the most abundant components, which accounted for >90% of the total PAEs. This investigation also indicated that the widespread application of plastic film in GVP systems may be the primary source of these PAEs. The non-cancer and carcinogenic risks of target PAEs were estimated based on the exposures of vegetable intake. The hazard quotients of PAE in all vegetable samples were lower than 1 and the carcinogenic risks were also at acceptable levels for consumers. The data in this study can provide valuable information to understand the status of potential pollutants, specifically PAEs, in GVP systems. Copyright © 2016 Elsevier B.V. All rights reserved.

Modeling Environment for Total Risk-4M

EPA Science Inventory

MENTOR-4M uses an integrated, mechanistically consistent, source-to-dose modeling framework to quantify simultaneous exposures and doses of individuals and populations to multiple contaminants. It is an implementation of the MENTOR system for exposures to Multiple contaminants fr...

Impact of particles on sediment accumulation in a drinking water distribution system.

PubMed

Vreeburg, J H G; Schippers, D; Verberk, J Q J C; van Dijk, J C

2008-10-01

Discolouration of drinking water is one of the main reasons customers complain to their water company. Though corrosion of cast iron is often seen as the main source for this problem, the particles originating from the treatment plant play an important and potentially dominant role in the generation of a discolouration risk in drinking water distribution systems. To investigate this thesis a study was performed in a drinking water distribution system. In two similar isolated network areas the effect of particles on discolouration risk was studied with particle counting, the Resuspension Potential Method (RPM) and assessment of the total accumulated sediment. In the 'Control Area', supplied with normal drinking water, the discolouration risk was regenerated within 1.5 year. In the 'Research Area', supplied with particle-free water, this will take 10-15 years. An obvious remedy for controlling the discolouration risk is to improve the treatment with respect to the short peaks that are caused by particle breakthrough.

Biocides in the Yangtze River of China: spatiotemporal distribution, mass load and risk assessment.

PubMed

Liu, Wang-Rong; Zhao, Jian-Liang; Liu, You-Sheng; Chen, Zhi-Feng; Yang, Yuan-Yuan; Zhang, Qian-Qian; Ying, Guang-Guo

2015-05-01

Nineteen biocides were investigated in the Yangtze River to understand their spatiotemporal distribution, mass loads and ecological risks. Fourteen biocides were detected, with the highest concentrations up to 166 ng/L for DEET in surface water, and 54.3 ng/g dry weight (dw) for triclocarban in sediment. The dominant biocides were DEET and methylparaben, with their detection frequencies of 100% in both phases. An estimate of 152 t/y of 14 biocides was carried by the Yangtze River to the East China Sea. The distribution of biocides in the aquatic environments was significantly correlated to Gross Domestic Product (GDP), total phosphorus (TP) and total nitrogen (TN), suggesting dominant input sources from domestic wastewater of the cities along the river. Risk assessment showed high ecological risks posed by carbendazim in both phases and by triclosan in sediment. Therefore, proper measures should be taken to reduce the input of biocides into the river systems. Copyright © 2015 Elsevier Ltd. All rights reserved.

Peritumoral Artery Scoring System: a Novel Scoring System to Predict Renal Function Outcome after Laparoscopic Partial Nephrectomy.

PubMed

Zhang, Ruiyun; Wu, Guangyu; Huang, Jiwei; Shi, Oumin; Kong, Wen; Chen, Yonghui; Xu, Jianrong; Xue, Wei; Zhang, Jin; Huang, Yiran

2017-06-06

The present study aimed to assess the impact of peritumoral artery characteristics on renal function outcome prediction using a novel Peritumoral Artery Scoring System based on computed tomography arteriography. Peritumoral artery characteristics and renal function were evaluated in 220 patients who underwent laparoscopic partial nephrectomy and then validate in 51 patients with split and total glomerular filtration rate (GFR). In particular, peritumoral artery classification and diameter were measured to assign arteries into low, moderate, and high Peritumoral Artery Scoring System risk categories. Univariable and multivariable logistic regression analyses were then used to determine risk factors for major renal functional decline. The Peritumoral Artery Scoring System and four other nephrometry systems were compared using receiver operating characteristic curve analysis. The Peritumoral Artery Scoring System was significantly superior to the other systems for predicting postoperative renal function decline (p < 0.001). In receiver operating characteristic analysis, our category system was a superior independent predictor of estimated glomerular filtration rate (eGFR) decline (area-under-the-curve = 0.865, p < 0.001) and total GFR decline (area-under-the-curve = 0.796, p < 0.001), and split GFR decline (area-under-the-curve = 0.841, p < 0.001). Peritumoral artery characteristics were independent predictors of renal function outcome after laparoscopic partial nephrectomy.

Total coliform and E. coli in public water systems using undisinfected ground water in the United States.

PubMed

Messner, Michael J; Berger, Philip; Javier, Julie

2017-06-01

Public water systems (PWSs) in the United States generate total coliform (TC) and Escherichia coli (EC) monitoring data, as required by the Total Coliform Rule (TCR). We analyzed data generated in 2011 by approximately 38,000 small (serving fewer than 4101 individuals) undisinfected public water systems (PWSs). We used statistical modeling to characterize a distribution of TC detection probabilities for each of nine groupings of PWSs based on system type (community, non-transient non-community, and transient non-community) and population served (less than 101, 101-1000 and 1001-4100 people). We found that among PWS types sampled in 2011, on average, undisinfected transient PWSs test positive for TC 4.3% of the time as compared with 3% for undisinfected non-transient PWSs and 2.5% for undisinfected community PWSs. Within each type of PWS, the smaller systems have higher median TC detection than the larger systems. All TC-positive samples were assayed for EC. Among TC-positive samples from small undisinfected PWSs, EC is detected in about 5% of samples, regardless of PWS type or size. We evaluated the upper tail of the TC detection probability distributions and found that significant percentages of some system types have high TC detection probabilities. For example, assuming the systems providing data are nationally-representative, then 5.0% of the ∼50,000 small undisinfected transient PWSs in the U.S. have TC detection probabilities of 20% or more. Communities with such high TC detection probabilities may have elevated risk of acute gastrointestinal (AGI) illness - perhaps as great or greater than the attributable risk to drinking water (6-22%) calculated for 14 Wisconsin community PWSs with much lower TC detection probabilities (about 2.3%, Borchardt et al., 2012). Published by Elsevier GmbH.

Sociotechnical factors influencing unsafe use of hospital information systems: A qualitative study in Malaysian government hospitals.

PubMed

Salahuddin, Lizawati; Ismail, Zuraini; Hashim, Ummi Rabaah; Raja Ikram, Raja Rina; Ismail, Nor Haslinda; Naim Mohayat, Mohd Hariz

2018-03-01

The objective of this study is to identify factors influencing unsafe use of hospital information systems in Malaysian government hospitals. Semi-structured interviews with 31 medical doctors in three Malaysian government hospitals implementing total hospital information systems were conducted between March and May 2015. A thematic qualitative analysis was performed on the resultant data to deduce the relevant themes. A total of five themes emerged as the factors influencing unsafe use of a hospital information system: (1) knowledge, (2) system quality, (3) task stressor, (4) organization resources, and (5) teamwork. These qualitative findings highlight that factors influencing unsafe use of a hospital information system originate from multidimensional sociotechnical aspects. Unsafe use of a hospital information system could possibly lead to the incidence of errors and thus raises safety risks to the patients. Hence, multiple interventions (e.g. technology systems and teamwork) are required in shaping high-quality hospital information system use.

NASA Human System Risk Assessment Process

NASA Technical Reports Server (NTRS)

Francisco, D.; Romero, E.

2016-01-01

NASA utilizes an evidence based system to perform risk assessments for the human system for spaceflight missions. The center of this process is the multi-disciplinary Human System Risk Board (HSRB). The HSRB is chartered from the Chief Health and Medical Officer (OCHMO) at NASA Headquarters. The HSRB reviews all human system risks via an established comprehensive risk and configuration management plan based on a project management approach. The HSRB facilitates the integration of human research (terrestrial and spaceflight), medical operations, occupational surveillance, systems engineering and many other disciplines in a comprehensive review of human system risks. The HSRB considers all factors that influence human risk. These factors include pre-mission considerations such as screening criteria, training, age, sex, and physiological condition. In mission factors such as available countermeasures, mission duration and location and post mission factors such as time to return to baseline (reconditioning), post mission health screening, and available treatments. All of the factors influence the total risk assessment for each human risk. The HSRB performed a comprehensive review of all potential inflight medical conditions and events and over the course of several reviews consolidated the number of human system risks to 30, where the greatest emphasis is placed for investing program dollars for risk mitigation. The HSRB considers all available evidence from human research and, medical operations and occupational surveillance in assessing the risks for appropriate mitigation and future work. All applicable DRMs (low earth orbit for 6 and 12 months, deep space for 30 days and 1 year, a lunar mission for 1 year, and a planetary mission for 3 years) are considered as human system risks are modified by the hazards associated with space flight such as microgravity, exposure to radiation, distance from the earth, isolation and a closed environment. Each risk has a summary two-page assessment representing the state of knowledge/evidence of that risk, available risk mitigations, traceability to the Space Flight Human System Standards (SFHSS) and program requirements, and future work required. These data then can drive coordinated budgets across the Human Research Program, the International Space Station, Crew Health and Safety and Advanced Exploration System budgets to provide the most economical and timely mitigations. The risk assessments were completed for the 6 DRMs and serve as the baseline for which subsequent research and technology development and crew health care portfolios can be assessed. The HSRB reviews each risk at least annually or when new evidence/information is available that adds to the body of evidence. The current status of each risk can be reported to program management for operations, budget reviews and general oversight of the human system risk management program.

Effects of tofacitinib on cardiovascular risk factors and cardiovascular outcomes based on phase III and long-term extension data in patients with plaque psoriasis.

PubMed

Wu, Jashin J; Strober, Bruce E; Hansen, Peter R; Ahlehoff, Ole; Egeberg, Alexander; Qureshi, Abrar A; Robertson, Debbie; Valdez, Hernan; Tan, Huaming; Wolk, Robert

2016-11-01

Psoriasis is a systemic inflammatory condition that is associated with a higher risk of cardiovascular (CV) disease. Tofacitinib is being investigated as a treatment for psoriasis. We sought to evaluate the effects of tofacitinib on CV risk factors and major adverse CV events (MACEs) in patients with plaque psoriasis. Changes in select CV risk factors and the incidence rate (IR) of MACEs were evaluated in patients who were treated with tofacitinib. Tofacitinib treatment was associated with small, dose-dependent increases in total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol, while the total/HDL cholesterol ratio was unchanged. There were no changes in blood pressure and glycated hemoglobin levels; C-reactive protein levels decreased. The IRs of a MACE were low and similar for both tofacitinib doses. Among 3623 subjects treated with tofacitinib, the total patient-years of exposure was 5204, with a median follow-up of 527 days, and the IR of MACEs was 0.37 (95% confidence interval, 0.22-0.57) patients with events per 100 patient-years. There was relatively short follow-up time for patients who had MACEs. While treatment with tofacitinib is associated with a small increase in cholesterol levels, the total/HDL cholesterol ratio does not change, there are no unfavorable changes in several CV risk factors, and the incidence of MACEs is low. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Risk of central nervous system defects in offspring of women with and without mental illness.

PubMed

Ayoub, Aimina; Fraser, William D; Low, Nancy; Arbour, Laura; Healy-Profitós, Jessica; Auger, Nathalie

2018-02-22

We sought to determine the relationship between maternal mental illness and the risk of having an infant with a central nervous system defect. We analyzed a cohort of 654,882 women aged less than 20 years between 1989 and 2013 who later delivered a live born infant in any hospital in Quebec, Canada. The primary exposure was mental illness during pregnancy or hospitalization for mental illness before pregnancy. The outcomes were neural and non-neural tube defects of the central nervous system in any offspring. We computed risk ratios (RR) and 95% confidence intervals (CI) for the association between mental disorders and risk of central nervous system defects in log-binomial regression models adjusted for age at delivery, total parity, comorbidity, socioeconomic deprivation, place of residence, and time period. Maternal mental illness was associated with an increased risk of nervous system defects in offspring (RR 1.76, 95% CI 1.64-1.89). Hospitalization for any mental disorder was more strongly associated with non-neural tube (RR 1.84, 95% CI 1.71-1.99) than neural tube defects (RR 1.31, 95% CI 1.08-1.59). Women at greater risk of nervous system defects in offspring tended to be diagnosed with multiple mental disorders, have more than one hospitalization for mental disease, or be 17 or older at first hospitalization. A history of mental illness is associated with central nervous system defects in offspring. Women hospitalized for mental illness may merit counseling at first symptoms to prevent central nervous system defects at pregnancy.

Controlling costs without compromising quality: paying hospitals for total knee replacement.

PubMed

Pine, Michael; Fry, Donald E; Jones, Barbara L; Meimban, Roger J; Pine, Gregory J

2010-10-01

Unit costs of health services are substantially higher in the United States than in any other developed country in the world, without a correspondingly healthier population. An alternative payment structure, especially for high volume, high cost episodes of care (eg, total knee replacement), is needed to reward high quality care and reduce costs. The National Inpatient Sample of administrative claims data was used to measure risk-adjusted mortality, postoperative length-of-stay, costs of routine care, adverse outcome rates, and excess costs of adverse outcomes for total knee replacements performed between 2002 and 2005. Empirically identified inefficient and ineffective hospitals were then removed to create a reference group of high-performance hospitals. Predictive models for outcomes and costs were recalibrated to the reference hospitals and used to compute risk-adjusted outcomes and costs for all hospitals. Per case predicted costs were computed and compared with observed costs. Of the 688 hospitals with acceptable data, 62 failed to meet effectiveness criteria and 210 were identified as inefficient. The remaining 416 high-performance hospitals had 13.4% fewer risk-adjusted adverse outcomes (4.56%-3.95%; P < 0.001; χ) and 9.9% lower risk-adjusted total costs ($12,773-$11,512; P < 0.001; t test) than all study hospitals. Inefficiency accounted for 96% of excess costs. A payment system based on the demonstrated performance of effective, efficient hospitals can produce sizable cost savings without jeopardizing quality. In this study, 96% of total excess hospital costs resulted from higher routine costs at inefficient hospitals, whereas only 4% was associated with ineffective care.

Risk factors for sensitisation to methyltetrahydrophthalic anhydride.

PubMed

Yokota, K; Johyama, Y; Yamaguchi, K; Fujiki, Y; Takeshita, T; Morimoto, K

1997-09-01

To examine an association between specific IgE to methyltetrahydrophthalic anhydride (MTHPA) and exposure time, atopic history, smoking habits, and total IgE concentrations. A cross sectional survey was carried out on a population of 148 workers from two condenser plants using epoxy resin with MTHPA, an acid anhydride curing agent known to cause allergy. Using a Pharmacia CAP system with a MTHPA human serum albumin conjugate, specific IgE antibody was detected in serum from 97 (66%) out of the 148 workers exposed to MTHPA. Stepwise multiple linear regression analysis showed a striking relation between log concentrations of specific and total IgE (P < 0.0001). Furthermore, when the workers were divided into two groups according to a cut-off point (100 IU/ml) between low and high total IgE, current smoking was significantly (P = 0.025) associated with specific IgE production only in the group with low total IgE (< 100 IU/ml). Smoking is the most significant risk factor for raising specific IgE to MTHPA in the group with low total IgE concentrations.

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.

Evaluation and identification of priority air pollutants for environmental management on the basis of risk analysis in Russia.

PubMed

Golub, Alexander; Strukova, Elena

2008-01-01

Since 1997, more than 30 health-risk analyses were conducted using Russian data sets. These studies demonstrated that air pollution is the most important environmental contributor toward morbidity and mortality risk in Russia, with 90% of the total human health risk coming from the criteria pollutants total suspended particulate (TSP), SO2, and NO(x). This article contributes to the ongoing discussion of the magnitude of this health issue in Russia by providing an estimate of both the mortality rate attributed to airborne pollutants and the associated economic damages. The 90% confidence interval of mortality is 46,000-132,000, and the associated economic damages are between 2.6 and 6.5% of gross domestic product (GDP). The largest source of uncertainty in mortality is the concentration-response parameter, accounting for 50-60% of the total variability in the estimate. The point estimate of 87,000 implies that mortality due to airborne pollutants is threefold higher than reported due to tuberculosis, twofold due to transportation accidents, and about the same as that from suicide and homicide combined. By 2002 there was enough evidence regarding potential health hazard and air pollution exposure in Russia to start environmental management reform. In 2004 Russia officially adopted guidelines for health risk analysis associated with air pollution. The next step is to use this health-risk assessment approach as a lead for sensible reforms of the emissions-permit system and environmental finance.

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

PubMed

Bambach, M R; Mitchell, R J

2015-01-01

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

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

NASA Technical Reports Server (NTRS)

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

2016-01-01

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

Skin complications in deep brain stimulation for Parkinson's disease: frequency, time course, and risk factors.

PubMed

Sixel-Döring, Friederike; Trenkwalder, Claudia; Kappus, Christoph; Hellwig, Dieter

2010-02-01

Deep brain stimulation (DBS) has been recognized as an efficacious treatment for movement disorders. Its beneficial effects however may be lost due to skin complications such as erosions or infections over the implanted foreign material. We sought to document skin complications in the entire Parkinson's disease patient population who received a DBS system at the Marburg/Kassel implantation centre since the start of our DBS program in January 2002 to analyze frequency, time course, and possible risk factors. We investigated 85 consecutive patients with Parkinson's disease (PD) from a single center/single surgeon DBS series for the occurrence of skin complications and analyzed localization, time course, and possible risk factors. Mean follow-up was 3 years (range 1-7 years). In total, 21/85 patients (24.7%) suffered a total of 30 single skin complications. Sixty percent of all incidents occurred within the first post-operative year. Forty percent of all incidents occurred later than the first year following primary implantation. Complications involved the burr hole cap in 37%, the course of the cables in 33%, and the impulse generator (IPG) site in 30%. Six of 21 patients suffered recurring skin complications. Eight patients permanently lost their DBS system. Factor analysis for age, gender, disease duration, disease severity, the incidence of hypertension or diabetes as well as a 2-day period with externalized electrodes for continuous test stimulation did not have any statistically significant impact on skin complications. We conclude that (1) PD patients have a risk for skin complications after DBS as long as the system remains in situ and (2) there are at present no identifiable risk factors for skin complications after DBS, other than PD itself.

Costs and Difficulties of Interstellar 'Messaging' and the Need for International Debate on Potential Risks

NASA Astrophysics Data System (ADS)

Billingham, J.; Benford, James

We advocate international consultations on societal and technical issues to address the risk of Messaging to Extraterrestrial Intelligence (METI) transmissions, and a moratorium on future transmissions until such issues are resolved. Instead, we recommend continuing to conduct SETI by listening, with no innate risk, while using powerful new search systems to give a better total probability of detection of beacons and messages than METI for the same cost, and with no need for a long obligatory wait for a response. Realistically, beacons are costly. In light of recent work on the economics of contact by radio, we offer alternatives to the current standard methods of SETI searches. METI transmissions to date are faint and very unlikely to be detected, even by nearby stars. We show that historical leakage from Earth has been undetectable for Earth-scale receiver systems. Future space microwave and laser power systems will likely be more detectable.

Central hemodynamics and arterial stiffness in idiopathic and multiple system atrophy.

PubMed

Franzen, Klaas; Fliegen, Sabine; Koester, Jelena; Martin, Rafael Campos; Deuschl, Günther; Reppel, Michael; Mortensen, Kai; Schneider, Susanne A

2017-02-01

Blood pressure is commonly abnormal in parkinsonian disorders, but central hemodynamics and arterial stiffness, well-established predictors of total cardiovascular risk, have rarely been studied in these disorders. 32 patients [27 with idiopathic Parkinson's disease (iPD); 5 with multiple system atrophy (MSA)] and 15 controls matched for cardiac risk factors underwent 24 h-ambulatory blood pressure recordings using an I.E.M. device (Mobil-O-Graph™), measuring peripheral pressure and calculating central pressures and arterial stiffness. Mean augmentation indices corrected for heart rate (AIx@75) were significantly lower and pulse wave velocities were significantly elevated in patients compared to controls. Central systolic blood pressure, cardiac output and daytime total vascular resistance were significantly elevated in patients. Mean nocturnal systolic peripheral blood pressure and nocturnal heart rates were also significantly higher; 56.3% of patients had nocturnal hypertension (80% of the MSA group); 85.2% showed non-dipping. This supports previous findings of reduced vulnerability to systemic atherosclerosis and end-organ damage in treated PD. Yet, hemodynamic abnormalities were common and often remained asymptomatic.

Mercury transport and bioaccumulation in riverbank communities of the Alvarado Lagoon System, Veracruz State, Mexico.

PubMed

Guentzel, Jane L; Portilla, Enrique; Keith, Katherine M; Keith, Edward O

2007-12-15

The Alvarado Lagoon System (ALS) is located within the Papaloapan River Basin in southern Veracruz, Mexico. The ALS is a shallow system (2 m) connected to the Gulf of Mexico through a narrow sea channel. There are a large number of riverbank communities within the ALS that are dependent upon its biological productivity for comestible and economic subsistence. The purpose of this project was to determine the levels of mercury in water, sediment, fish, and hair samples from within the Papaloapan River Basin and to characterize the risk of Hg exposure to the individuals that reside in these communities. Water and fish samples were collected during the wet (September 2005) and dry (March 2003 and 2005) seasons. Hair samples, dietary surveys, and sediment samples were obtained during the wet and dry seasons of 2005. Total Hg in the water column ranged from 1.0 to 12.7 ng/L. A strong correlation (R(2)=0.82; p<0.001) between total Hg and total suspended solids in the water column suggests that particulate matter is a transport mechanism for Hg within the lagoon system. Total Hg in the sediments ranged from 27.5 to 90.5 ng Hg/g dry weight with no significant difference between the 2005 wet and dry seasons. There was a mild, but significant, correlation between total Hg and % carbon for the March 2005 sediment samples (R(2)=0.435; p=0.020), suggesting that Hg is associated with organic matter on the solid phase. Concentrations of total Hg in fish and shellfish harvested from the ALS ranged from 0.01 to 0.35 microg Hg/g wet. The levels of total Hg in hair ranged from 0.10 to 3.36 microg Hg/g (n=47) and 58% of the samples were above 1.00 microg Hg/g. The findings from this study suggest that individuals who frequently consume fish and shell fish containing low levels of Hg (<0.3 microg/g) can accumulate low to moderate body burdens of Hg, as indicated by hair Hg concentrations>1.0 microg/g, and may be at risk for experiencing low dose mercury toxicity.

The skin function: a factor of anti-metabolic syndrome.

PubMed

Zhou, Shi-Sheng; Li, Da; Zhou, Yi-Ming; Cao, Ji-Min

2012-04-26

The body's total antioxidant capacity represents a sum of the antioxidant capacity of various tissues/organs. A decrease in the body's antioxidant capacity may induce oxidative stress and subsequent metabolic syndrome, a clustering of risk factors for type 2 diabetes and cardiovascular disease. The skin, the largest organ of the body, is one of the major components of the body's total antioxidant defense system, primarily through its xenobiotic/drug biotransformation system, reactive oxygen species-scavenging system, and sweat glands- and sebaceous glands-mediated excretion system. Notably, unlike other contributors, the skin contribution is variable, depending on lifestyles and ambient temperature or seasonal variations. Emerging evidence suggests that decreased skin's antioxidant and excretory functions (e.g., due to sedentary lifestyles and low ambient temperature) may increase the risk for metabolic syndrome. This review focuses on the relationship between the variability of skin-mediated detoxification and elimination of exogenous and endogenous toxic substances and the development of metabolic syndrome. The potential role of sebum secretion in lipid and cholesterol homeostasis and its impact on metabolic syndrome, and the association between skin disorders (acanthosis nigricans, acne, and burn) and metabolic syndrome are also discussed.

Does unbelted safety requirement affect protection for belted occupants?

PubMed

Hu, Jingwen; Klinich, Kathleen D; Manary, Miriam A; Flannagan, Carol A C; Narayanaswamy, Prabha; Reed, Matthew P; Andreen, Margaret; Neal, Mark; Lin, Chin-Hsu

2017-05-29

Federal regulations in the United States require vehicles to meet occupant performance requirements with unbelted test dummies. Removing the test requirements with unbelted occupants might encourage the deployment of seat belt interlocks and allow restraint optimization to focus on belted occupants. The objective of this study is to compare the performance of restraint systems optimized for belted-only occupants with those optimized for both belted and unbelted occupants using computer simulations and field crash data analyses. In this study, 2 validated finite element (FE) vehicle/occupant models (a midsize sedan and a midsize SUV) were selected. Restraint design optimizations under standardized crash conditions (U.S.-NCAP and FMVSS 208) with and without unbelted requirements were conducted using Hybrid III (HIII) small female and midsize male anthropomorphic test devices (ATDs) in both vehicles on both driver and right front passenger positions. A total of 10 to 12 design parameters were varied in each optimization using a combination of response surface method (RSM) and genetic algorithm. To evaluate the field performance of restraints optimized with and without unbelted requirements, 55 frontal crash conditions covering a greater variety of crash types than those in the standardized crashes were selected. A total of 1,760 FE simulations were conducted for the field performance evaluation. Frontal crashes in the NASS-CDS database from 2002 to 2012 were used to develop injury risk curves and to provide the baseline performance of current restraint system and estimate the injury risk change by removing the unbelted requirement. Unbelted requirements do not affect the optimal seat belt and airbag design parameters in 3 out of 4 vehicle/occupant position conditions, except for the SUV passenger side. Overall, compared to the optimal designs with unbelted requirements, optimal designs without unbelted requirements generated the same or lower total injury risks for belted occupants depending on statistical methods used for the analysis, but they could also increase the total injury risks for unbelted occupants. This study demonstrated potential for reducing injury risks to belted occupants if the unbelted requirements are eliminated. Further investigations are necessary to confirm these findings.

Frequency and risk factors for donor reactions in an anonymous blood donor survey.

PubMed

Goldman, Mindy; Osmond, Lori; Yi, Qi-Long; Cameron-Choi, Keltie; O'Brien, Sheila F

2013-09-01

Adverse donor reactions can result in injury and decrease the likelihood of donor return. Reaction reports captured in the blood center's database provide an incomplete picture of reaction rates and risk factors. We performed an anonymous survey, mailed to 40,000 donors in 2008, including questions about symptoms, height, weight, sex, and donation status. Reaction rates were compared to those recorded in our database. Possible risk factors were assessed for various reactions. The response rate was 45.5%. A total of 32% of first-time and 14% of repeat donors reported having any adverse symptom, most frequently bruising (84.9 per 1000 donors) or feeling faint or weak (66.2 per 1000). Faint reactions were two to eight times higher than reported in our database, although direct comparison was difficult. Younger age, female sex, and first-time donation status were risk factors for systemic and arm symptoms. In females, low estimated blood volume (EBV) was a risk factor for systemic symptoms. Only 51% of donors who consulted an outside physician also called Canadian Blood Services. A total of 10% of first-time donors with reactions found adverse effects information inadequate. This study allowed us to collect more information about adverse reactions, including minor symptoms and delayed reactions. Based on our findings of the risk factors and frequency of adverse reactions, we are implementing more stringent EBV criteria for younger donors and providing more detailed information to donors about possible adverse effects and their management. © 2012 American Association of Blood Banks.

Analysis of autosomal genes reveals gene-sex interactions and higher total genetic risk in men with systemic lupus erythematosus.

PubMed

Hughes, Travis; Adler, Adam; Merrill, Joan T; Kelly, Jennifer A; Kaufman, Kenneth M; Williams, Adrienne; Langefeld, Carl D; Gilkeson, Gary S; Sanchez, Elena; Martin, Javier; Boackle, Susan A; Stevens, Anne M; Alarcón, Graciela S; Niewold, Timothy B; Brown, Elizabeth E; Kimberly, Robert P; Edberg, Jeffrey C; Ramsey-Goldman, Rosalind; Petri, Michelle; Reveille, John D; Criswell, Lindsey A; Vilá, Luis M; Jacob, Chaim O; Gaffney, Patrick M; Moser, Kathy L; Vyse, Timothy J; Alarcón-Riquelme, Marta E; James, Judith A; Tsao, Betty P; Scofield, R Hal; Harley, John B; Richardson, Bruce C; Sawalha, Amr H

2012-05-01

Systemic lupus erythematosus (SLE) is a sexually dimorphic autoimmune disease which is more common in women, but affected men often experience a more severe disease. The genetic basis of sexual dimorphism in SLE is not clearly defined. A study was undertaken to examine sex-specific genetic effects among SLE susceptibility loci. A total of 18 autosomal genetic susceptibility loci for SLE were genotyped in a large set of patients with SLE and controls of European descent, consisting of 5932 female and 1495 male samples. Sex-specific genetic association analyses were performed. The sex-gene interaction was further validated using parametric and non-parametric methods. Aggregate differences in sex-specific genetic risk were examined by calculating a cumulative genetic risk score for SLE in each individual and comparing the average genetic risk between male and female patients. A significantly higher cumulative genetic risk for SLE was observed in men than in women. (P=4.52x10-8) A significant sex-gene interaction was seen primarily in the human leucocyte antigen (HLA) region but also in IRF5, whereby men with SLE possess a significantly higher frequency of risk alleles than women. The genetic effect observed in KIAA1542 is specific to women with SLE and does not seem to have a role in men. The data indicate that men require a higher cumulative genetic load than women to develop SLE. These observations suggest that sex bias in autoimmunity could be influenced by autosomal genetic susceptibility loci.

Assessing the risk for dengue fever based on socioeconomic and environmental variables in a geographical information system environment.

PubMed

Khormi, Hassan M; Kumar, Lalit

2012-05-01

An important option in preventing the spread of dengue fever (DF) is to control and monitor its vector (Aedes aegypti) as well as to locate and destroy suitable mosquito breeding environments. The aim of the present study was to use a combination of environmental and socioeconomic variables to model areas at risk of DF. These variables include clinically confirmed DF cases, mosquito counts, population density in inhabited areas, total populations per district, water access, neighbourhood quality and the spatio-temporal risk of DF based on the average, weekly frequency of DF incidence. Out of 111 districts investigated, 17 (15%), covering a total area of 121 km2, were identified as of high risk, 25 (22%), covering 133 km2, were identified as of medium risk, 18 (16%), covering 180 km2, were identified as of low risk and 51 (46%), covering 726 km2, were identified as of very low risk. The resultant model shows that most areas at risk of DF were concentrated in the central part of Jeddah county, Saudi Arabia. The methods used can be implemented as routine procedures for control and prevention. A concerted intervention in the medium- and high-risk level districts identified in this study could be highly effective in reducing transmission of DF in the area as a whole.

The rate of and risk factors for frequent hospitalization in systemic lupus erythematosus: results from the Korean lupus network registry.

PubMed

Lee, J W; Park, D J; Kang, J H; Choi, S E; Yim, Y R; Kim, J E; Lee, K E; Wen, L; Kim, T J; Park, Y W; Sung, Y K; Lee, S S

2016-11-01

Objectives The survival rate of patients with systemic lupus erythematosus has improved in the last few decades, but the rate of hospitalization and health care costs for these patients remain higher than in the general population. Thus, we evaluated the rate of hospitalization and associated risk factors in an inception cohort of Korean patients with lupus. Methods Of the 507 patients with systemic lupus erythematosus enrolled in the KORean lupus NETwork, we investigated an inception cohort consisting of 196 patients with systemic lupus erythematosus presenting within 6 months of diagnosis based on the American College of Rheumatology classification criteria. We evaluated the causes of hospitalization, demographic characteristics, and laboratory and clinical data at the time of systemic lupus erythematosus diagnosis of hospitalized patients and during a follow-up period. We calculated the hospitalization rate as the number of total hospitalizations divided by the disease duration, and defined "frequent hospitalization" as hospitalization more than once per year. Results Of the 196 patients, 117 (59.6%) were admitted to hospital a total of 257 times during the 8-year follow-up period. Moreover, 22 (11.2%) patients were hospitalized frequently. The most common reasons for hospitalization included disease flares, infection, and pregnancy-related morbidity. In the univariate regression analysis, malar rash, arthritis, pericarditis, renal involvement, fever, systemic lupus erythematosus disease activity index > 12, hemoglobin level < 10 mg/dl, albumin level < 3.5 mg/dl, and anti-Sjögren's syndrome A positivity were associated with frequent hospitalization. Finally, multivariate analysis showed that arthritis, pericarditis, and anti-Sjögren's syndrome A antibody positivity at the time of diagnosis were risk factors for frequent hospitalization. Conclusions Our results showed that frequent hospitalization occurred in 11.2% of hospitalized patients and arthritis, pericarditis, and anti-Sjögren's syndrome A antibody positivity at the time of diagnosis were risk factors for frequent hospitalization.

Modelling the ability of source control measures to reduce inundation risk in a community-scale urban drainage system

NASA Astrophysics Data System (ADS)

Mei, Chao; Liu, Jiahong; Wang, Hao; Shao, Weiwei; Xia, Lin; Xiang, Chenyao; Zhou, Jinjun

2018-06-01

Urban inundation is a serious challenge that increasingly confronts the residents of many cities, as well as policymakers, in the context of rapid urbanization and climate change worldwide. In recent years, source control measures (SCMs) such as green roofs, permeable pavements, rain gardens, and vegetative swales have been implemented to address flood inundation in urban settings, and proven to be cost-effective and sustainable. In order to investigate the ability of SCMs on reducing inundation in a community-scale urban drainage system, a dynamic rainfall-runoff model of a community-scale urban drainage system was developed based on SWMM. SCMs implementing scenarios were modelled under six design rainstorm events with return period ranging from 2 to 100 years, and inundation risks of the drainage system were evaluated before and after the proposed implementation of SCMs, with a risk-evaluation method based on SWMM and analytic hierarchy process (AHP). Results show that, SCMs implementation resulting in significantly reduction of hydrological indexes that related to inundation risks, range of reduction rates of average flow, peak flow, and total flooded volume of the drainage system were 28.1-72.1, 19.0-69.2, and 33.9-56.0 %, respectively, under six rainfall events with return periods ranging from 2 to 100 years. Corresponding, the inundation risks of the drainage system were significantly reduced after SCMs implementation, the risk values falling below 0.2 when the rainfall return period was less than 10 years. Simulation results confirm the effectiveness of SCMs on mitigating inundation, and quantified the potential of SCMs on reducing inundation risks in the urban drainage system, which provided scientific references for implementing SCMs for inundation control of the study area.

A genetic fuzzy system for unstable angina risk assessment.

PubMed

Dong, Wei; Huang, Zhengxing; Ji, Lei; Duan, Huilong

2014-02-18

Unstable Angina (UA) is widely accepted as a critical phase of coronary heart disease with patients exhibiting widely varying risks. Early risk assessment of UA is at the center of the management program, which allows physicians to categorize patients according to the clinical characteristics and stratification of risk and different prognosis. Although many prognostic models have been widely used for UA risk assessment in clinical practice, a number of studies have highlighted possible shortcomings. One serious drawback is that existing models lack the ability to deal with the intrinsic uncertainty about the variables utilized. In order to help physicians refine knowledge for the stratification of UA risk with respect to vagueness in information, this paper develops an intelligent system combining genetic algorithm and fuzzy association rule mining. In detail, it models the input information's vagueness through fuzzy sets, and then applies a genetic fuzzy system on the acquired fuzzy sets to extract the fuzzy rule set for the problem of UA risk assessment. The proposed system is evaluated using a real data-set collected from the cardiology department of a Chinese hospital, which consists of 54 patient cases. 9 numerical patient features and 17 categorical patient features that appear in the data-set are selected in the experiments. The proposed system made the same decisions as the physician in 46 (out of a total of 54) tested cases (85.2%). By comparing the results that are obtained through the proposed system with those resulting from the physician's decision, it has been found that the developed model is highly reflective of reality. The proposed system could be used for educational purposes, and with further improvements, could assist and guide young physicians in their daily work.

Cardiovascular risk in systemic lupus erythematosus--evidence of increased oxidative stress and dyslipidaemia.

PubMed

Nuttall, S L; Heaton, S; Piper, M K; Martin, U; Gordon, C

2003-06-01

Systemic lupus erythematosus (SLE) is associated with severe and premature cardiovascular disease, which is not explained by traditional risk factors alone. This study aimed to investigate markers of oxidative stress, lipid metabolism and inflammation as potential cardiovascular risk factors in women with SLE. Venous blood samples were taken from 53 female Caucasian patients with SLE and from healthy age- and sex-matched controls. Samples were analysed for markers of oxidative stress, lipid metabolism [including low-density lipoprotein (LDL) subfraction profile] and C-reactive protein (CRP). Female SLE patients had an atherogenic lipid profile characterized by raised total cholesterol and triglycerides, and the presence of small, dense LDL subfractions compared with healthy controls. These changes were associated with increased oxidative damage and a moderately raised CRP. The results provide evidence for free radical and inflammatory activity in SLE and suggest potential targets to reduce the risk of cardiovascular disease in these patients.

Cardiovascular risk determination: discrepancy between total cholesterol evaluation and two compound laboratory indices in Norway.

PubMed Central

Berg, J E; Høstmark, A T

1994-01-01

OBJECTIVE--To compare group classification of cardiovascular risk by two compound laboratory indices with classification according to the serum total cholesterol concentration alone. DESIGN--Healthy employees were defined as low and high cardiovascular risk subjects according to their total cholesterol concentration or two compound indices of blood lipid components-the total cholesterol: high density lipoprotein (HDL) cholesterol ratio and an atherogenic index defined as ([total cholesterol-HDL cholesterol]*[apolipoprotein B])/([HDL cholesterol]*[apolipoprotein A-I]). Cut off values to distinguish between low and high risk subjects were as follows: total cholesterol 6.5 mmol/l, HDL cholesterol 0.9 mmol/l, apolipoprotein A = 1.8 g/l, and apolipoprotein B = 1.3 g/l. These gave total: HDL cholesterol ratio and atherogenic index cut off values of 7.2 and 4.5 respectively. SETTING--An occupational health service in a non-manufacturing company in Norway. PARTICIPANTS--A total of 112 male and 117 female employees. The mean body mass index values were 25.6 and 23.6 kg/m2 and the mean ages 39.8 and 40.1 years in men and women respectively. Those with cardiovascular, diabetic, or renal diseases were excluded. MEAN OUTCOME MEASURES--Serum total cholesterol, HDL cholesterol, apolipoproteins A-I and B, lipid peroxidation, blood pressure, smoking, physical activity, and fruit, vegetables, and salt in the diet were determined. RESULTS--The cut off values allocated 19%, 7%, and 40% as high risk subjects according to total cholesterol, total: HDL cholesterol, and the atherogenic index respectively. The mean age was two to four years higher in the high risk groups. Cardiovascular risk in siblings and no reported physical activity were more prevalent in those high risk groups defined by the compound indices than by total cholesterol alone, as was a high body mass index and a measure of lipid peroxidation. Grouping according to total cholesterol failed to allocate heavy smokers mainly to the high risk group. Diet variables did not demarcate clearly between indices. CONCLUSIONS--There is considerable variability in classification into high and low risk subjects when using the total cholesterol concentration alone compared with compound risk indices. Smoking was more prevalent in the high risk groups defined by the compound indices than by total cholesterol. These findings call for caution when total cholesterol is used to estimate cardiovascular risk in epidemiological studies, and even more so at individual counselling in occupational or primary health care settings. PMID:7964330

Development and validation of an automated delirium risk assessment system (Auto-DelRAS) implemented in the electronic health record system.

PubMed

Moon, Kyoung-Ja; Jin, Yinji; Jin, Taixian; Lee, Sun-Mi

2018-01-01

A key component of the delirium management is prevention and early detection. To develop an automated delirium risk assessment system (Auto-DelRAS) that automatically alerts health care providers of an intensive care unit (ICU) patient's delirium risk based only on data collected in an electronic health record (EHR) system, and to evaluate the clinical validity of this system. Cohort and system development designs were used. Medical and surgical ICUs in two university hospitals in Seoul, Korea. A total of 3284 patients for the development of Auto-DelRAS, 325 for external validation, 694 for validation after clinical applications. The 4211 data items were extracted from the EHR system and delirium was measured using CAM-ICU (Confusion Assessment Method for Intensive Care Unit). The potential predictors were selected and a logistic regression model was established to create a delirium risk scoring algorithm to construct the Auto-DelRAS. The Auto-DelRAS was evaluated at three months and one year after its application to clinical practice to establish the predictive validity of the system. Eleven predictors were finally included in the logistic regression model. The results of the Auto-DelRAS risk assessment were shown as high/moderate/low risk on a Kardex screen. The predictive validity, analyzed after the clinical application of Auto-DelRAS after one year, showed a sensitivity of 0.88, specificity of 0.72, positive predictive value of 0.53, negative predictive value of 0.94, and a Youden index of 0.59. A relatively high level of predictive validity was maintained with the Auto-DelRAS system, even one year after it was applied to clinical practice. Copyright © 2017. Published by Elsevier Ltd.

[The cost of tobacco-related diseases for Brazil's Unified National Health System].

PubMed

Pinto, Márcia; Ugá, Maria Alicia Domínguez

2010-06-01

This study aimed to identify the direct costs of hospitalizations due to three smoking-related groups of diseases - cancer and circulatory and respiratory diseases - in Brazil's Unified National Health System (SUS) in 2005. For cancer, the cost of chemotherapy was also included. The study derived cost estimates using administrative databases, relative risks, smoking prevalence, and smoking-attributable fraction. According to the estimates, smoking- attributable medical expenditures for the three disease groups amounted to R$338,692,516.02 (approximately U$185 million), accounting for 27.6% of total medical expenditures. Considering all hospitalizations and chemotherapy provided by the National Health System, tobacco-related diseases accounted for 7.7% of total medical expenditures. These costs also represented 0.9% of expenditures by federally funded public health services. This study provides a conservative estimate of smoking-related costs and suggests the need for continued research on comprehensive approaches to measure the total burden of smoking for society.

Flavonoid intake and all-cause mortality.

PubMed

Ivey, Kerry L; Hodgson, Jonathan M; Croft, Kevin D; Lewis, Joshua R; Prince, Richard L

2015-05-01

Flavonoids are bioactive compounds found in foods such as tea, chocolate, red wine, fruit, and vegetables. Higher intakes of specific flavonoids and flavonoid-rich foods have been linked to reduced mortality from specific vascular diseases and cancers. However, the importance of flavonoids in preventing all-cause mortality remains uncertain. The objective was to explore the association between flavonoid intake and risk of 5-y mortality from all causes by using 2 comprehensive food composition databases to assess flavonoid intake. The study population included 1063 randomly selected women aged >75 y. All-cause, cancer, and cardiovascular mortalities were assessed over 5 y of follow-up through the Western Australia Data Linkage System. Two estimates of flavonoid intake (total flavonoidUSDA and total flavonoidPE) were determined by using food composition data from the USDA and the Phenol-Explorer (PE) databases, respectively. During the 5-y follow-up period, 129 (12%) deaths were documented. Participants with high total flavonoid intake were at lower risk [multivariate-adjusted HR (95% CI)] of 5-y all-cause mortality than those with low total flavonoid consumption [total flavonoidUSDA: 0.37 (0.22, 0.58); total flavonoidPE: 0.36 (0.22, 0.60)]. Similar beneficial relations were observed for both cardiovascular disease mortality [total flavonoidUSDA: 0.34 (0.17, 0.69); flavonoidPE: 0.32 (0.16, 0.61)] and cancer mortality [total flavonoidUSDA: 0.25 (0.10, 0.62); flavonoidPE: 0.26 (0.11, 0.62)]. Using the most comprehensive flavonoid databases, we provide evidence that high consumption of flavonoids is associated with reduced risk of mortality in older women. The benefits of flavonoids may extend to the etiology of cancer and cardiovascular disease. © 2015 American Society for Nutrition.

48 CFR 1515.404-470 - Policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Section 1515.404-470 Federal Acquisition Regulations System ENVIRONMENTAL PROTECTION AGENCY CONTRACTING METHODS AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Contract Pricing 1515.404-470 Policy. (a) The Agency... to be performed, the contractor's input to the total performance, and the risks assumed by the...

Modeling Environment for Total Risk-2E

EPA Science Inventory

MENTOR-2E uses an integrated, mechanistically consistent source-to-dose-to-response modeling framework to quantify inhalation exposure and doses resulting from emergency events. It is an implementation of the MENTOR system that is focused towards modeling of the impacts of rele...

Osteoporosis risk factors and association with somatotypes in males.

PubMed

Saitoglu, Mahmut; Ardicoglu, Ozge; Ozgocmen, Salih; Kamanli, Ayhan; Kaya, Arzu

2007-10-01

Osteoporosis is a systemic and metabolic skeletal disease characterized by reduced bone mass, changes in microarchitecture, and consequential increased fracture risk. Previous reports described a relationship between bone content with fat mass and lean body mass. In this study, we assessed osteoporosis risk factors and the association with somatotypes in males aged 45-65 years. Standard axial spine and proximal femur bone mineral density (BMD) were measured using dual x-ray (DXA) absorptiometry in 70 healthy men. Heath-Carter procedure was followed to assess individual's somatotype. All body types were grouped as endomorphy, mesomorphy, and ectomorphy. Moderate to weak correlations were found between lumbar BMD with endomorphy and mesomorphy. Negative correlation was found between lumbar BMD and ectomorphy. Total femur BMD correlated positively with endomorphy and mesomorphy and negatively correlated with ectomorphy. Body mass index correlated weakly with lumbar, femur neck, and total femur BMD. Multiple regression analysis revealed that endomorphy was significantly related to BMD measurements at lumbar spine (standardized coefficient, SC = 0.51, p = 0.001), femur neck (SC = 0.52, p = 0.001), and total femur BMD (SC = 0.41, p = 0.01). Lumbar BMD and age, hand grip strength, smoking, tea and coffee consumption, calorie expenditure, calcium intake, PTH, albumin, total protein, sex hormone-binding globulin, and testosterone were not significantly correlated. Endomorphy seems related to high BMD values at the lumbar spine and the proximal femur in middle-aged men. Somatotype together with daily calorie expenditure may be taken into account when assessing risk factors for male osteoporosis.

Occurrence and health risk assessment of selected metals in drinking water from two typical remote areas in China.

PubMed

Geng, Menghan; Qi, Hongjuan; Liu, Xuelin; Gao, Bo; Yang, Zhan; Lu, Wei; Sun, Rubao

2016-05-01

The potential contaminations of 16 trace elements (Cr, Mn, Ni, Cu, Zn, As, Cd, Sb, Ba, Pb, Co, Be, V, Ti, Tl, Al) in drinking water collected in two remote areas in China were analyzed. The average levels of the trace elements were lower than the allowable concentrations set by national agencies, except for several elements (As, Sb, Mn, and Be) in individual samples. A health risk assessment model was conducted and carcinogenic and non-carcinogenic risks were evaluated separately. The results indicated that the total carcinogenic risks were higher than the maximum allowed risk level set by most organizations (1 × 10(-6)). Residents in both study areas were at risk of carcinogenic effects from exposure to Cr, which accounted for 80-90 % of the total carcinogenic risks. The non-carcinogenic risks (Cu, Zn, Ni) were lower than the maximum allowance levels. Among the four population groups, infants incurred the highest health risks and required special attention. Correlation analysis revealed significant positive associations among most trace elements, indicating the likelihood of a common source. The results of probabilistic health risk assessment of Cr based on Monte-Carlo simulation revealed that the uncertainty of system parameters does not affect the decision making of pollution prevention and control. Sensitivity analysis revealed that ingestion rate of water and concentration of Cr showed relatively high sensitivity to the health risks.

Temperament and risk for exercise dependence: results of a pilot study in female patients with eating disorders compared to elite athletes.

PubMed

Müller, Astrid; Claes, Laurence; Wos, Katharina; Kerling, Arno; Wünsch-Leiteritz, Wally; Cook, Brian; de Zwaan, Martina

2015-01-01

The present pilot study investigated the relationship between temperament and the risk for exercise dependence (EXD). A total of 32 female patients with eating disorders (potentially at risk for secondary EXD) and 29 female elite athletes without eating disturbances (potentially at risk for primary EXD) answered the Eating Disorder Examination-Questionnaire (EDE-Q), the Exercise Dependence Scale-German version (EDS-G), the Behavioral Inhibition System/Behavioral Activation System (BIS/BAS) scales, and the effortful control subscale of the Adult Temperament Questionnaire (ATQ-EC). There were significant positive correlations of the EDS-G with the BIS in women with an eating disorder and with the BAS in elite athletes. No significant association was found between the EDS-G and effortful control. The results indicate that the risk for EXD is associated with avoidance tendencies in women with eating disorders and with approach tendencies in elite athletes. Implications for secondary and primary EXD are discussed. © 2015 S. Karger AG, Basel.

Adherence to recommended electronic health record safety practices across eight health care organizations.

PubMed

Sittig, Dean F; Salimi, Mandana; Aiyagari, Ranjit; Banas, Colin; Clay, Brian; Gibson, Kathryn A; Goel, Ashutosh; Hines, Robert; Longhurst, Christopher A; Mishra, Vimal; Sirajuddin, Anwar M; Satterly, Tyler; Singh, Hardeep

2018-04-26

The Safety Assurance Factors for EHR Resilience (SAFER) guides were released in 2014 to help health systems conduct proactive risk assessment of electronic health record (EHR)- safety related policies, processes, procedures, and configurations. The extent to which SAFER recommendations are followed is unknown. We conducted risk assessments of 8 organizations of varying size, complexity, EHR, and EHR adoption maturity. Each organization self-assessed adherence to all 140 unique SAFER recommendations contained within 9 guides (range 10-29 recommendations per guide). In each guide, recommendations were organized into 3 broad domains: "safe health IT" (total 45 recommendations); "using health IT safely" (total 80 recommendations); and "monitoring health IT" (total 15 recommendations). The 8 sites fully implemented 25 of 140 (18%) SAFER recommendations. Mean number of "fully implemented" recommendations per guide ranged from 94% (System Interfaces-18 recommendations) to 63% (Clinical Communication-12 recommendations). Adherence was higher for "safe health IT" domain (82.1%) vs "using health IT safely" (72.5%) and "monitoring health IT" (67.3%). Despite availability of recommendations on how to improve use of EHRs, most recommendations were not fully implemented. New national policy initiatives are needed to stimulate implementation of these best practices.

U.S. program assessing nuclear waste disposal in space - A 1981 status report

NASA Technical Reports Server (NTRS)

Rice, E. E.; Edgecombe, D. S.; Best, R. E.; Compton, P. R.

1982-01-01

Concepts, current studies, and technology and equipment requirements for using the STS for space disposal of selected nuclear wastes as a complement to geological storage are reviewed. An orbital transfer vehicle carried by the Shuttle would kick the waste cannister into a 0.85 AU heliocentric orbit. One flight per week is regarded as sufficient to dispose of all high level wastes chemically separated from reactor fuel rods from 200 GWe nuclear power capacity. Studies are proceeding for candidate wastes, the STS system suited to each waste, and the risk/benefits of a space disposal system. Risk assessments are being extended to total waste disposal risks for various disposal programs with and without a space segment, and including side waste streams produced as a result of separating substances for launch.

Predictors for Perioperative Outcomes following Total Laryngectomy: A University HealthSystem Consortium Discharge Database Study.

PubMed

Rutledge, Jonathan W; Spencer, Horace; Moreno, Mauricio A

2014-07-01

The University HealthSystem Consortium (UHC) database collects discharge information on patients treated at academic health centers throughout the United States. We sought to use this database to identify outcome predictors for patients undergoing total laryngectomy. A secondary end point was to assess the validity of the UHC's predictive risk mortality model in this cohort of patients. Retrospective review. Academic medical centers (tertiary referral centers) and their affiliate hospitals in the United States. Using the UHC discharge database, we retrieved and analyzed data for 4648 patients undergoing total laryngectomy who were discharged between October 2007 and January 2011 from all of the member institutions. Demographics, comorbidities, institutional data, and outcomes were retrieved. The length of stay and overall costs were significantly higher among female patients (P < .0001), while age was a predictor of intensive care unit stay (P = .014). The overall complication rate was higher among Asians (P = .019) and in patients with anemia and diabetes compared with other comorbidities. The average institutional case load was 1.92 cases/mo; we found an inverse correlation (R = -0.47) between the institutional case load and length of stay (P < .0001). The UHC admit mortality risk estimator was found to be an accurate predictor not only of mortality (P < .0002) but also of intensive care unit admission and complication rate (P < .0001). This study provides an overview of laryngectomy outcomes in a contemporary cohort of patients treated at academic health centers. UHC admit mortality risk is an excellent outcome predictor and a valuable tool for risk stratification in these patients. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

Environmental- and health-risk-induced remediation design for benzene-contaminated groundwater under parameter uncertainty: a case study in Western Canada.

PubMed

Fan, X; He, L; Lu, H W; Li, J

2014-09-01

This study proposes an environmental- and health-risk-induced remediation design approach for benzene-contaminated groundwater. It involves exposure frequency and intake rates that are important but difficult to be exactly quantified as breakthrough point. Flexible health-risk control is considered in the simulation and optimization work. The proposed approach is then applied to a petroleum-contaminated site in western Canada. Different situations about remediation durations, public concerns, and satisfactory degrees are addressed by the approach. The relationship between environmental standards and health-risk limits is analyzed, in association with their effect on remediation costs. Insights of three uncertain factors (i.e. exposure frequency, intake rate and health-risk threshold) for the remediation system are also explored, on a basis of understanding their impacts on health risk as well as their importance order. The case study results show that (1) nature attenuation plays a more important role in long-term remediation scheme than the pump-and-treat system; (2) carcinogenic risks have greater impact on total pumping rates than environmental standards for long-term remediation; (3) intake rates are the second important factor affecting the remediation system's performance, followed by exposure frequency; (4) the 10-year remediation scheme is the most robust choice when environmental and health-risk concerns are not well quantified. Copyright © 2014 Elsevier Ltd. All rights reserved.

Predicting the occurrence of embolic events: an analysis of 1456 episodes of infective endocarditis from the Italian Study on Endocarditis (SEI).

PubMed

Rizzi, Marco; Ravasio, Veronica; Carobbio, Alessandra; Mattucci, Irene; Crapis, Massimo; Stellini, Roberto; Pasticci, Maria Bruna; Chinello, Pierangelo; Falcone, Marco; Grossi, Paolo; Barbaro, Francesco; Pan, Angelo; Viale, Pierluigi; Durante-Mangoni, Emanuele

2014-04-29

Embolic events are a major cause of morbidity and mortality in patients with infective endocarditis. We analyzed the database of the prospective cohort study SEI in order to identify factors associated with the occurrence of embolic events and to develop a scoring system for the assessment of the risk of embolism. We retrospectively analyzed 1456 episodes of infective endocarditis from the multicenter study SEI. Predictors of embolism were identified. Risk factors identified at multivariate analysis as predictive of embolism in left-sided endocarditis, were used for the development of a risk score: 1 point was assigned to each risk factor (total risk score range: minimum 0 points; maximum 2 points). Three categories were defined by the score: low (0 points), intermediate (1 point), or high risk (2 points); the probability of embolic events per risk category was calculated for each day on treatment (day 0 through day 30). There were 499 episodes of infective endocarditis (34%) that were complicated by ≥ 1 embolic event. Most embolic events occurred early in the clinical course (first week of therapy: 15.5 episodes per 1000 patient days; second week: 3.7 episodes per 1000 patient days). In the total cohort, the factors associated with the occurrence of embolism at multivariate analysis were prosthetic valve localization (odds ratio, 1.84), right-sided endocarditis (odds ratio, 3.93), Staphylococcus aureus etiology (odds ratio, 2.23) and vegetation size ≥ 13 mm (odds ratio, 1.86). In left-sided endocarditis, Staphylococcus aureus etiology (odds ratio, 2.1) and vegetation size ≥ 13 mm (odds ratio, 2.1) were independently associated with embolic events; the 30-day cumulative incidence of embolism varied with risk score category (low risk, 12%; intermediate risk, 25%; high risk, 38%; p < 0.001). Staphylococcus aureus etiology and vegetation size are associated with an increased risk of embolism. In left-sided endocarditis, a simple scoring system, which combines etiology and vegetation size with time on antimicrobials, might contribute to a better assessment of the risk of embolism, and to a more individualized analysis of indications and contraindications for early surgery.

Chapter 5. Assessment of undiscovered conventional oil and gas resources-Lower Cretaceous Travis Peak and Hosston formations, Jurassic Smackover interior salt basins total petroleum system, in the East Texas basin and Louisiana-Mississippi salt basins provinces.

USGS Publications Warehouse

Dyman, T.S.; Condon, S.M.

2006-01-01

The petroleum assessment of the Travis Peak and Hosston Formations was conducted by using a total petroleum system model. A total petroleum system includes all of the important elements of a hydrocarbon fluid system needed to develop oil and gas accumulations, including source and reservoir rocks, hydrocarbon generation, migration, traps and seals, and undiscovered accumulations. A total petroleum system is mappable and may include one or more assessment units. For each assessment unit, reservoir rocks contain similar geology, exploration characteristics, and risk. The Jurassic Smackover Interior Salt Basins Total Petroleum System is defined for this assessment to include (1) Upper Jurassic Smackover carbonates and calcareous shales and organic-rich shales of the Upper Jurassic Bossier Shale of the Cotton Valley Group and (2) Lower Cretaceous Travis Peak and Hosston Formations. The Jurassic Smackover Interior Salt Basins Total Petroleum System includes three conventional Travis Peak-Hosston assessment units: Travis Peak-Hosston Gas and Oil (AU 50490205), Travis Peak-Hosston Updip Oil (AU 50490206), and Travis Peak-Hosston Hypothetical Updip Oil (AU 50490207). A fourth assessment unit, the Hosston Hypothetical Slope-Basin Gas Assessment Unit, was named and numbered (AU 50490208) but not geologically defined or quantitatively assessed owing to a lack of data. Together, assessment units 50490205 to 50490207 are estimated to contain a mean undiscovered conventional resource of 29 million barrels of oil, 1,136 billion cubic feet of gas, and 22 million barrels of natural gas liquids.

[Health Risk Assessment of Drinking Water Quality in Tianjin Based on GIS].

PubMed

Fu, Gang; Zeng, Qiang; Zhao, Liang; Zhang, Yue; Feng, Bao-jia; Wang, Rui; Zhang, Lei; Wang, Yang; Hou, Chang-chun

2015-12-01

This study intends to assess the potential health hazards of drinking water quality and explore the application of geographic information system( GIS) in drinking water safety in Tianjin. Eight hundred and fifty water samples from 401 sampling points in Tianjin were measured according to the national drinking water standards. The risk assessment was conducted using the environmental health risk assessment model recommended by US EAP, and GIS was combined to explore the information visualization and risk factors simultaneously. The results showed that the health risks of carcinogens, non-carcinogens were 3.83 x 10⁻⁵, 5.62 x 10⁻⁹ and 3.83 x 10⁻⁵ for total health risk respectively. The rank of health risk was carcinogen > non-carcinogen. The rank of carcinogens health risk was urban > new area > rural area, chromium (VI) > cadmium > arsenic > trichlormethane > carbon tetrachloride. The rank of non-carcinogens health risk was rural area > new area > urban, fluoride > cyanide > lead > nitrate. The total health risk level of drinking water in Tianjin was lower than that of ICRP recommended level (5.0 x 10⁻⁵), while was between US EPA recommended level (1.0 x 10⁻⁴-1.0 x 10⁻⁶). It was at an acceptable level and would not cause obvious health hazards. The main health risks of drinking water came from carcinogens. More attentions should be paid to chromium (VI) for carcinogens and fluoride for non-carcinogens. GIS can accomplish information visualization of drinking water risk assessment and further explore of risk factors.

The Effect of Vitamin A on Fracture Risk: A Meta-Analysis of Cohort Studies

PubMed Central

Zhang, Xinge; Zhang, Rui; Wang, Yueqiao; Yan, Hanyi; Wu, Yingru; Tan, Anran; Fu, Jialin; Shen, Ziqiong; Qin, Guiyu; Li, Rui; Chen, Guoxun

2017-01-01

This meta-analysis evaluated the influence of dietary intake and blood level of vitamin A (total vitamin A, retinol or β-carotene) on total and hip fracture risk. Cohort studies published before July 2017 were selected through English-language literature searches in several databases. Relative risk (RR) with corresponding 95% confidence interval (CI) was used to evaluate the risk. Heterogeneity was checked by Chi-square and I2 test. Sensitivity analysis and publication bias were also performed. For the association between retinol intake and total fracture risk, we performed subgroup analysis by sex, region, case ascertainment, education level, age at menopause and vitamin D intake. R software was used to complete all statistical analyses. A total of 319,077 participants over the age of 20 years were included. Higher dietary intake of retinol and total vitamin A may slightly decrease total fracture risk (RR with 95% CI: 0.95 (0.91, 1.00) and 0.94 (0.88, 0.99), respectively), and increase hip fracture risk (RR with 95% CI: 1.40 (1.02, 1.91) and 1.29 (1.06, 1.57), respectively). Lower blood level of retinol may slightly increase total fracture risk (RR with 95% CI: 1.11 (0.94, 1.30)) and hip fracture risk (RR with 95% CI: 1.27 (1.05, 1.53)). In addition, higher β-carotene intake was weakly associated with the increased risk of total fracture (RR with 95% CI: 1.07 (0.97, 1.17)). Our data suggest that vitamin A intake and level may differentially influence the risks of total and hip fractures. Clinical trials are warranted to confirm these results and assess the clinical applicability. PMID:28891953

ASSESSING POPULATION EXPOSURES TO MULTIPLE AIR POLLUTANTS USING A MECHANISTIC SOURCE-TO-DOSE MODELING FRAMEWORK

EPA Science Inventory

The Modeling Environment for Total Risks studies (MENTOR) system, combined with an extension of the SHEDS (Stochastic Human Exposure and Dose Simulation) methodology, provide a mechanistically consistent framework for conducting source-to-dose exposure assessments of multiple pol...

Environmental risk assessment of a genetically-engineered microorganism: Erwinia carotovora

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

Orvos, D.R.

1989-01-01

Environmental use of genetically-engineered microorganisms (GEMs) has raised concerns over potential ecological impact. Development of microcosm systems useful in preliminary testing for risk assessment will provide useful information for predicting potential structural, functional, and genetic effects of GEM release. This study was executed to develop techniques that may be useful in risk assessment and microbial ecology, to ascertain which parameters are useful in determining risk and to predict risk from releasing an engineered strain of Erwinia carotovora. A terrestrial microcosm system for use in GEM risk assessment studies was developed for use in assessing alterations of microbial structure and functionmore » that may be caused by introducing the engineered strain of E. carotovora. This strain is being developed for use as a biological control agent for plant soft rot. Parameters that were monitored included survival and intraspecific competition of E. carotovora, structural effects upon both total bacterial populations and numbers of selected bacterial genera, effects upon activities of dehydrogenase and alkaline phosphatase, effects upon soil nutrients, and potential for gene transfer into or out of the engineered strain.« less

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

PubMed

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

2015-02-01

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

Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies.

PubMed

Aune, Dagfinn; Keum, NaNa; Giovannucci, Edward; Fadnes, Lars T; Boffetta, Paolo; Greenwood, Darren C; Tonstad, Serena; Vatten, Lars J; Riboli, Elio; Norat, Teresa

2016-06-14

 To quantify the dose-response relation between consumption of whole grain and specific types of grains and the risk of cardiovascular disease, total cancer, and all cause and cause specific mortality.  PubMed and Embase searched up to 3 April 2016.  Prospective studies reporting adjusted relative risk estimates for the association between intake of whole grains or specific types of grains and cardiovascular disease, total cancer, all cause or cause specific mortality.  Summary relative risks and 95% confidence intervals calculated with a random effects model.  45 studies (64 publications) were included. The summary relative risks per 90 g/day increase in whole grain intake (90 g is equivalent to three servings-for example, two slices of bread and one bowl of cereal or one and a half pieces of pita bread made from whole grains) was 0.81 (95% confidence interval 0.75 to 0.87; I(2)=9%, n=7 studies) for coronary heart disease, 0.88 (0.75 to 1.03; I(2)=56%, n=6) for stroke, and 0.78 (0.73 to 0.85; I(2)=40%, n=10) for cardiovascular disease, with similar results when studies were stratified by whether the outcome was incidence or mortality. The relative risks for morality were 0.85 (0.80 to 0.91; I(2)=37%, n=6) for total cancer, 0.83 (0.77 to 0.90; I(2)=83%, n=11) for all causes, 0.78 (0.70 to 0.87; I(2)=0%, n=4) for respiratory disease, 0.49 (0.23 to 1.05; I(2)=85%, n=4) for diabetes, 0.74 (0.56 to 0.96; I(2)=0%, n=3) for infectious diseases, 1.15 (0.66 to 2.02; I(2)=79%, n=2) for diseases of the nervous system disease, and 0.78 (0.75 to 0.82; I(2)=0%, n=5) for all non-cardiovascular, non-cancer causes. Reductions in risk were observed up to an intake of 210-225 g/day (seven to seven and a half servings per day) for most of the outcomes. Intakes of specific types of whole grains including whole grain bread, whole grain breakfast cereals, and added bran, as well as total bread and total breakfast cereals were also associated with reduced risks of cardiovascular disease and/or all cause mortality, but there was little evidence of an association with refined grains, white rice, total rice, or total grains.  This meta-analysis provides further evidence that whole grain intake is associated with a reduced risk of coronary heart disease, cardiovascular disease, and total cancer, and mortality from all causes, respiratory diseases, infectious diseases, diabetes, and all non-cardiovascular, non-cancer causes. These findings support dietary guidelines that recommend increased intake of whole grain to reduce the risk of chronic diseases and premature mortality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies

PubMed Central

Keum, NaNa; Giovannucci, Edward; Fadnes, Lars T; Boffetta, Paolo; Greenwood, Darren C; Tonstad, Serena; Vatten, Lars J; Riboli, Elio; Norat, Teresa

2016-01-01

Objective To quantify the dose-response relation between consumption of whole grain and specific types of grains and the risk of cardiovascular disease, total cancer, and all cause and cause specific mortality. Data sources PubMed and Embase searched up to 3 April 2016. Study selection Prospective studies reporting adjusted relative risk estimates for the association between intake of whole grains or specific types of grains and cardiovascular disease, total cancer, all cause or cause specific mortality. Data synthesis Summary relative risks and 95% confidence intervals calculated with a random effects model. Results 45 studies (64 publications) were included. The summary relative risks per 90 g/day increase in whole grain intake (90 g is equivalent to three servings—for example, two slices of bread and one bowl of cereal or one and a half pieces of pita bread made from whole grains) was 0.81 (95% confidence interval 0.75 to 0.87; I2=9%, n=7 studies) for coronary heart disease, 0.88 (0.75 to 1.03; I2=56%, n=6) for stroke, and 0.78 (0.73 to 0.85; I2=40%, n=10) for cardiovascular disease, with similar results when studies were stratified by whether the outcome was incidence or mortality. The relative risks for morality were 0.85 (0.80 to 0.91; I2=37%, n=6) for total cancer, 0.83 (0.77 to 0.90; I2=83%, n=11) for all causes, 0.78 (0.70 to 0.87; I2=0%, n=4) for respiratory disease, 0.49 (0.23 to 1.05; I2=85%, n=4) for diabetes, 0.74 (0.56 to 0.96; I2=0%, n=3) for infectious diseases, 1.15 (0.66 to 2.02; I2=79%, n=2) for diseases of the nervous system disease, and 0.78 (0.75 to 0.82; I2=0%, n=5) for all non-cardiovascular, non-cancer causes. Reductions in risk were observed up to an intake of 210-225 g/day (seven to seven and a half servings per day) for most of the outcomes. Intakes of specific types of whole grains including whole grain bread, whole grain breakfast cereals, and added bran, as well as total bread and total breakfast cereals were also associated with reduced risks of cardiovascular disease and/or all cause mortality, but there was little evidence of an association with refined grains, white rice, total rice, or total grains. Conclusions This meta-analysis provides further evidence that whole grain intake is associated with a reduced risk of coronary heart disease, cardiovascular disease, and total cancer, and mortality from all causes, respiratory diseases, infectious diseases, diabetes, and all non-cardiovascular, non-cancer causes. These findings support dietary guidelines that recommend increased intake of whole grain to reduce the risk of chronic diseases and premature mortality. PMID:27301975

From Bad to Worse: Anemia on Admission and Hospital-Acquired Anemia.

PubMed

Koch, Colleen G; Li, Liang; Sun, Zhiyuan; Hixson, Eric D; Tang, Anne S; Phillips, Shannon C; Blackstone, Eugene H; Henderson, J Michael

2017-12-01

Anemia at hospitalization is often treated as an accompaniment to an underlying illness, without active investigation, despite its association with morbidity. Development of hospital-acquired anemia (HAA) has also been associated with increased risk for poor outcomes. Together, they may further heighten morbidity risk from bad to worse. The aims of this study were to (1) examine mortality, length of stay, and total charges in patients with present-on-admission (POA) anemia and (2) determine whether these are exacerbated by development of HAA. In this cohort investigation, from January 1, 2009, to August 31, 2011, a total of 44,483 patients with POA anemia were admitted to a single health system compared with a reference group of 48,640 without POA anemia or HAA. Data sources included the University HealthSystem Consortium database and electronic medical records. Risk-adjustment methods included logistic and linear regression models for mortality, length of stay, and total charges. Present-on-admission anemia was defined by administrative coding. Hospital-acquired anemia was determined by changes in hemoglobin values from the electronic medical record. Approximately one-half of the patients experienced worsening of anemia with development of HAA. Risk for death and resource use increased with increasing severity of HAA. Those who developed severe HAA had 2-fold greater odds for death; that is, mild POA anemia with development of severe HAA resulted in greater mortality (odds ratio, 2.57; 95% confidence interval, 2.08-3.18; P < 0.001), increased length of stay (2.23; 2.16-2.31; P < 0.001), and higher charges (2.09; 2.03-2.15; P < 0.001). Present-on-admission anemia is associated with increased mortality and resource use. This risk is further increased from bad to worse when patients develop HAA. Efforts to address POA anemia and HAA deserve attention.

Arsenic in the water-soil-plant system and the potential health risks in the coastal part of Chianan Plain, Southwestern Taiwan

NASA Astrophysics Data System (ADS)

Kar, Sandeep; Das, Suvendu; Jean, Jiin-Shuh; Chakraborty, Sukalyan; Liu, Chia-Chuan

2013-11-01

The present study investigates the bioavailability, soil to plant transfer and health risks of arsenic (As) in the coastal part of Chianan Plain in southwestern Taiwan. Groundwater used for irrigation, surface soils from agricultural lands and locally grown foodstuffs were collected from eight locations and analyzed for As to assess the risks associated with consuming these items. The concentration of As in groundwater ranged from 13.8 to 881 μg/L, whereas surface soil showed total As content in the range of 7.92-12.7 mg/kg. The available As content in surface soil accounted for 0.06-6.71% of the total As content, and was significantly correlated with it (R2 = 0.65, p < 0.05). Among the leachable fraction, the organic matter (3.23-54.8%) and exchangeable portions of oxides (6.03-38.4%) appear to be the major binding phases of As. The average As content in fourteen studied crops and vegetables varied from 10.3 to 151 μg/kg with maximum in mustard and minimum in radish. All the plants showed considerably higher As content (21.5 ± 3.64-262 ± 36.2 μg/kg) in their roots compared to the edible parts (9.15 ± 1.44-75.8 ± 22.9 μg/kg). The bioaccumulation factor (BAF) based on total As (ranging from 0.0009 to 0.144) and available As in soil (ranging from 0.039 to 0.571) indicate that mustard, rice, amaranth and spinach are the highest accumulators of As. Although the health risk index (HRI) of the studied crops and vegetables ranged from only 0.0068-0.454, with the maximum in rice, the combined HRI indicates an alarming value of 0.88. Therefore, the possible health risks due to long-term consumption of rice and other As-rich foodstuffs could be overcome by controlling the contamination pathways in the water-soil-plant system.

Cost effectiveness analysis of a smoke alarm giveaway program in Oklahoma City, Oklahoma.

PubMed

Haddix, A C; Mallonee, S; Waxweiler, R; Douglas, M R

2001-12-01

To estimate the cost effectiveness of the Lifesavers Residential Fire and Injury Prevention Program (LRFIPP), a smoke alarm giveaway program. In 1990, the LRFIPP distributed over 10,000 smoke alarms in an area of Oklahoma City at high risk for residential fire injuries. The program also included fire prevention education and battery replacement components. A cost effectiveness analysis was conducted from the societal and health care systems perspectives. The study compared program costs with the total costs of medical treatment and productivity losses averted over a five year period. Fatal and non-fatal residential fire related injuries prevented were estimated from surveillance data. Medical costs were obtained from chart reviews of patients with fire related injuries that occurred during the pre-intervention period. During the five years post-intervention, it is estimated that the LRFIPP prevented 20 fatal and 24 non-fatal injuries. From the societal perspective, the total discounted cost of the program was $531,000. Total discounted net savings exceeded $15 million. From the health care system perspective, the total discounted net savings were almost $1 million and would have a net saving even if program effectiveness was reduced by 64%. The program was effective in reducing fatal and non-fatal residential fire related injuries and was cost saving. Similar programs in other high risk areas would be good investments even if program effectiveness was lower than that achieved by the LRFIPP.

A novel air pollution index based on the relative risk of daily mortality associated with short-term exposure to common air pollutants

NASA Astrophysics Data System (ADS)

Cairncross, Eugene K.; John, Juanette; Zunckel, Mark

Communication of the complex relationship between air pollutant exposure and ill health is essential to an air pollution information system. We propose a novel air pollution index (API) system based on the relative risk of the well-established increased daily mortality associated with short-term exposure to common air pollutants: particulate matter (PM 10, PM 2.5), sulphur dioxide, ozone, nitrogen dioxide and carbon monoxide. To construct our index system, the total incremental daily mortality risk of exposure to these pollutants was associated with an index value ranging from 0 to 10. The index scale is linear with respect to incremental risk. The index is open ended, although, for convenience, an index of 10 is assigned for exposures yielding indices ⩾10. To illustrate the application of this API system, a set of published relative risk factors are used to calculate sub-index values for each pollutant, in the range of air pollutant concentrations commonly experienced in urban areas. To account for the reality of ubiquitous simultaneous exposure to a mixture of the common air pollutants, the final API is the sum of the normalised values of the individual indices for PM 10, PM 2.5, sulphur dioxide, ozone, nitrogen dioxide and carbon monoxide. This establishes a self-consistent index system where a given index value corresponds to the same daily mortality risk associated with the combined exposure to the common air pollutants. To facilitate health-risk communication, index values are colour coded and associated with broad health-risk descriptors. The utility of the proposed API is illustrated by applying it to monitored ambient concentration data for the City of Cape Town, South Africa.

Concussions From Youth Football: Results From NEISS Hospitals Over an 11-Year Time Frame, 2002-2012.

PubMed

Jacobson, Nathan A; Buzas, David; Morawa, Lawrence G

2013-12-01

Youth football programs across the United States represent an at-risk population of approximately 3.5 million athletes for sports-related concussions. The frequency of concussions in this population is not known. Descriptive epidemiology study. Over an 11-year span from January 2002 to December 2012, the authors reviewed the concussions sustained by athletes aged 5 to 13 years while playing football, as evaluated in emergency departments (EDs) in the United States and captured by the National Electronic Injury Surveillance System (NEISS) database of the US Consumer Product Safety Commission. There were 2028 (national estimate, 49,185) young football players evaluated in NEISS EDs with concussion from 2002 to 2012. There were 1987 (97.9%) males and 41 (2.1%) females, with a mean age of 11.2 years. The total number of concussions reported increased with age and by year. The majority of concussions were treated in the outpatient setting, with 1878 (91.7%) being treated and released. The total number of head-to-head injury mechanisms mirrored the total number of concussions by year, which increased throughout the 11-year span. The total number of players experiencing a loss of consciousness increased throughout the study period but did not match the total number of concussions over the 11-year time period. Fractures occurred in 11 (0.5%) patients, with 2 being severe (1 skull fracture and 1 thoracic compression fracture). Within the 5- to 13-year age range, there were a significant number of young athletes who presented to EDs with concussion as a result of playing organized football. Older children may be at greater risk for sustaining concussions, fractures, and catastrophic injuries while playing football when compared with younger children. Younger children are more susceptible to long-term sequelae from head injuries, and thus, improved monitoring systems for these athletes are needed to assist in monitoring patterns of injury, identifying risk factors, and driving the development of evidence-based prevention programs.

Anticholinergic Risk and Frequency of Anticholinergic Drug Prescriptions in a Population Older Than 65.

PubMed

Machado-Alba, Jorge Enrique; Castro-Rodríguez, Alejandro; Álzate-Piedrahita, John Alexander; Hoyos-Pulgarín, Julián Andrés; Medina-Morales, Diego Alejandro

2016-03-01

To determine the risk and frequency of anticholinergic drug prescriptions in a population affiliated with the Colombian General System of Social Security in Health. A cross-sectional study was conducted in 2013. Patients older than 65 years who received drugs with the potential to block cholinergic receptors, in accordance with an anticholinergic risk scale. The total anticholinergic load was determined by the sum of the risk of each prescribed drug. The study included a total of 27,654 patients with a mean age of 76.1 ± 7.6 years, and 61.9% were women. A total of 9.1% of the population older than 65 years had received a prescription of at least one of these drugs, and the prevalence of these prescriptions was 112.5 per 1000 members. The average number of drugs prescribed per patient was 1.4, and the drugs most frequently prescribed contained trazodone, methocarbamol, and loratadine. Being prescribed by practitioners of surgical or related specialties was the only variable significantly associated with prescriptions with high anticholinergic risk in the multivariate analysis (odds ratio 1.61; 95% confidence interval 1.335-1.934; P < .001). We found a high frequency of prescription medications with some degree of anticholinergic load, and in almost half of the patients, the anticholinergic risk score was very high. The prevalence of prescription of these drugs falls in the range of that reported globally. It is essential to educate prescribers about the risk to their patients. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

A literature review of the cardiovascular risk-assessment tools: applicability among Asian population.

PubMed

Liau, Siow Yen; Mohamed Izham, M I; Hassali, M A; Shafie, A A

2010-01-01

Cardiovascular diseases, the main causes of hospitalisations and death globally, have put an enormous economic burden on the healthcare system. Several risk factors are associated with the occurrence of cardiovascular events. At the heart of efficient prevention of cardiovascular disease is the concept of risk assessment. This paper aims to review the available cardiovascular risk-assessment tools and its applicability in predicting cardiovascular risk among Asian populations. A systematic search was performed using keywords as MeSH and Boolean terms. A total of 25 risk-assessment tools were identified. Of these, only two risk-assessment tools (8%) were derived from an Asian population. These risk-assessment tools differ in various ways, including characteristics of the derivation sample, type of study, time frame of follow-up, end points, statistical analysis and risk factors included. Very few cardiovascular risk-assessment tools were developed in Asian populations. In order to accurately predict the cardiovascular risk of our population, there is a need to develop a risk-assessment tool based on local epidemiological data.

Design a Fuzzy Rule-based Expert System to Aid Earlier Diagnosis of Gastric Cancer.

PubMed

Safdari, Reza; Arpanahi, Hadi Kazemi; Langarizadeh, Mostafa; Ghazisaiedi, Marjan; Dargahi, Hossein; Zendehdel, Kazem

2018-01-01

Screening and health check-up programs are most important sanitary priorities, that should be undertaken to control dangerous diseases such as gastric cancer that affected by different factors. More than 50% of gastric cancer diagnoses are made during the advanced stage. Currently, there is no systematic approach for early diagnosis of gastric cancer. to develop a fuzzy expert system that can identify gastric cancer risk levels in individuals. This system was implemented in MATLAB software, Mamdani inference technique applied to simulate reasoning of experts in the field, a total of 67 fuzzy rules extracted as a rule-base based on medical expert's opinion. 50 case scenarios were used to evaluate the system, the information of case reports is given to the system to find risk level of each case report then obtained results were compared with expert's diagnosis. Results revealed that sensitivity was 92.1% and the specificity was 83.1%. The results show that is possible to develop a system that can identify High risk individuals for gastric cancer. The system can lead to earlier diagnosis, this may facilitate early treatment and reduce gastric cancer mortality rate.

Psychiatric disorders, acne and systemic retinoids: comparison of risks.

PubMed

Le Moigne, M; Bulteau, S; Grall-Bronnec, Marie; Gerardin, M; Fournier, Jean-Pascal; Jonville-Bera, A P; Jolliet, Pascale; Dreno, Brigitte; Victorri-Vigneau, C

2017-09-01

The link between isotretinoin, treatment of a severe form of acne, and psychiatric disorders remains controversial, as acne itself could explain the occurrence of psychiatric disorders. This study aims at assessing the disproportionality of psychiatric adverse events reported with isotretinoin in the French National PharmacoVigilance Database, compared with other systemic acne treatments and systemic retinoids. Data were extracted from the French National PharmacoVigilance Database for systemic acne treatments, systemic retinoids and drugs used as comparators. Each report was subjected to double-blind analysis by two psychiatric experts. A disproportionality analysis was performed, calculating the number of psychiatric ADRs divided by the total number of notifications for each drug of interest. Concerning acne systemic treatments: all 71 reports of severe psychiatric disorders involved isotretinoin, the highest proportion of mild/moderate psychiatric adverse events was reported with isotretinoin (14.1%). Among systemic retinoids, the highest proportion of severe and mild/moderate psychiatric events occurred with isotretinoin and alitretinoin. Our study raises the hypothesis that psychiatric disorders associated with isotretinoin are related to a class effect of retinoids, as a signal emerges for alitretinoin. Complementary studies are necessary to estimate the risk and further determine at-risk populations.

Modelling and genetic algorithm based optimisation of inverse supply chain

NASA Astrophysics Data System (ADS)

Bányai, T.

2009-04-01

The design and control of recycling systems of products with environmental risk have been discussed in the world already for a long time. The main reasons to address this subject are the followings: reduction of waste volume, intensification of recycling of materials, closing the loop, use of less resource, reducing environmental risk [1, 2]. The development of recycling systems is based on the integrated solution of technological and logistic resources and know-how [3]. However the financial conditions of recycling systems is partly based on the recovery, disassembly and remanufacturing options of the used products [4, 5, 6], but the investment and operation costs of recycling systems can be characterised with high logistic costs caused by the geographically wide collection system with more collection level and a high number of operation points of the inverse supply chain. The reduction of these costs is a popular area of the logistics researches. These researches include the design and implementation of comprehensive environmental waste and recycling program to suit business strategies (global system), design and supply all equipment for production line collection (external system), design logistics process to suit the economical and ecological requirements (external system) [7]. To the knowledge of the author, there has been no research work on supply chain design problems that purpose is the logistics oriented optimisation of inverse supply chain in the case of non-linear total cost function consisting not only operation costs but also environmental risk cost. The antecedent of this research is, that the author has taken part in some research projects in the field of closed loop economy ("Closing the loop of electr(on)ic products and domestic appliances from product planning to end-of-life technologies), environmental friendly disassembly (Concept for logistical and environmental disassembly technologies) and design of recycling systems of household appliances (Recycling of household appliances with emphasis on reuse options). The purpose of this paper is the presentation of a possible method for avoiding the unnecessary environmental risk and landscape use through unprovoked large supply chain of collection systems of recycling processes. In the first part of the paper the author presents the mathematical model of recycling related collection systems (applied especially for wastes of electric and electronic products) and in the second part of the work a genetic algorithm based optimisation method will be demonstrated, by the aid of which it is possible to determine the optimal structure of the inverse supply chain from the point of view economical, ecological and logistic objective functions. The model of the inverse supply chain is based on a multi-level, hierarchical collection system. In case of this static model it is assumed that technical conditions are permanent. The total costs consist of three parts: total infrastructure costs, total material handling costs and environmental risk costs. The infrastructure-related costs are dependent only on the specific fixed costs and the specific unit costs of the operation points (collection, pre-treatment, treatment, recycling and reuse plants). The costs of warehousing and transportation are represented by the material handling related costs. The most important factors determining the level of environmental risk cost are the number of out of time recycled (treated or reused) products, the number of supply chain objects and the length of transportation routes. The objective function is the minimization of the total cost taking into consideration the constraints. However a lot of research work discussed the design of supply chain [8], but most of them concentrate on linear cost functions. In the case of this model non-linear cost functions were used. The non-linear cost functions and the possible high number of objects of the inverse supply chain leaded to the problem of choosing a possible solution method. By the aid of analytical methods, the problem can not be solved, so a genetic algorithm based heuristic optimisation method was chosen to find the optimal solution. The input parameters of the optimisation are the followings: specific fixed, unit and environmental risk costs of the collection points of the inverse supply chain, specific warehousing and transportation costs and environmental risk costs of transportation. The output parameters are the followings: the number of objects in the different hierarchical levels of the collection system, infrastructure costs, logistics costs and environmental risk costs from used infrastructures, transportation and number of products recycled out of time. The next step of the research work was the application of the above mentioned method. The developed application makes it possible to define the input parameters of the real system, the graphical view of the chosen optimal solution in the case of the given input parameters, graphical view of the cost structure of the optimal solution, determination of the parameters of the algorithm (e.g. number of individuals, operators and termination conditions). The sensibility analysis of the objective function and the test results showed that the structure of the inverse supply chain depends on the proportion of the specific costs. Especially the proportion of the specific environmental risk costs influences the structure of the system and the number of objects at each hierarchical level of the collection system. The sensitivity analysis of the total cost function was performed in three cases. In the first case the effect of the proportion of specific infrastructure and logistics costs were analysed. If the infrastructure costs are significantly lower than the total costs of warehousing and transportation, then almost all objects of the first hierarchical level of the collection (collection directly from the users) were set up. In the other case of the proportion of costs the first level of the collection is not necessary, because it is replaceable by the more expensive transportation directly to the objects of the second or lower hierarchical level. In the second case the effect of the proportion of the logistics and environmental risk costs were analysed. In this case the analysis resulted to the followings: if the logistics costs are significantly higher than the total environmental risk costs, then because of the constant infrastructure costs the preference of logistics operations depends on the proportion of the environmental risk costs caused by of out of time recycled products and transportation. In the third case of the analysis the effect of the proportion of infrastructure and environmental risk costs were examined. If the infrastructure costs are significantly lower than the environmental risk costs, then almost all objects of the first hierarchical level of the collection (collection directly from the users) were set up. In the other case of the proportion of costs the first collection phase will be shifted near to the last hierarchical level of the supply chain to avoid a very high infrastructure set up and operation cost. The advantages of the presented model and solution method can be summarised in the followings: the model makes it possible to decide the structure of the inverse supply chain (which object to open or close); reduces infrastructure cost, especially for supply chain with high specific fixed costs; reduces the environmental risk cost through finding an optimal balance between number of objects of the system and out of time recycled products, reduces the logistics costs through determining the optimal quantitative parameters of material flow operations. The future of this research work is the use of differentiated lead-time, which makes it possible to take into consideration the above mentioned non-linear infrastructure, transportation, warehousing and environmental risk costs in the case of a given product portfolio segmented by lead-time. This publication was supported by the National Office for Research and Technology within the frame of Pázmány Péter programme. Any opinions, findings and conclusions or recommendations expressed in this material are those of the author and do not necessarily reflect the views of the National Office for Research and Technology. Literature: [1] H. F. Lund: McGraw-Hill Recycling Handbook. McGraw-Hill. 2000. [2] P. T. Williams: Waste Treatment and Disposal. John Wiley and Sons Ltd. 2005. [3] M. Christopher: Logistics & Supply Chain Management: creating value-adding networks. Pearson Education [4] A. Gungor, S. M. Gupta: Issues in environmentally conscious manufacturing and product recovery: a survey. Computers & Industrial Engineering. Volume 36. Issue 4. 1999. pp. 811-853. [5] H. C. Zhang, T. C. Kuo, H. Lu, S. H. Huang: Environmentally conscious design and manufacturing: A state-of-the-art survey. Journal of Manufacturing Systems. Volume 16. Issue 5. 1997. pp. 352-371. [6] P. Veerakamolmal, S. Gupta: Design for Disassembly, Reuse, and Recycling. Green Electronics/Green Bottom Line. 2000. pp. 69-82. [7] A. Rushton, P. Croucher, P. Baker: The Handbook of Logistics and Distribution Management. Kogan P.page Limited. 2006. [8] H. Stadtler, C. Kilger: Supply Chain Management and Advanced Planning: Concepts, Models, Software, and Case Studies. Springer. 2005.

Quantitative risk assessment model of canine rabies introduction: application to the risk to the European Union from Morocco.

PubMed

Napp, S; Casas, M; Moset, S; Paramio, J L; Casal, J

2010-11-01

Although rabies incidence in humans in Western Europe is low, the repeated importation of rabid animals from enzootic areas threatens the rabies-free status of terrestrial animals and challenges the public health systems in this area. Most rabid animals imported into the European Union (EU) in recent years came from Morocco. The aim of this study was to develop a probabilistic risk assessment model to estimate the probability of rabies introduction, which was applied to the risk to the EU from dogs coming from Morocco. The mean annual probability of rabies introduction was 0.21 (90% CI 0.02-0.65). The pathways that contributed the most to this probability were: (a) EU citizens who adopted a dog in Morocco (59% of the total probability) and (b) EU citizens who travelled with their dog to Morocco by ferry (34% of the total probability). The model showed a marked seasonality in the risk of rabies with almost 40% of the annual probability occurring during the months of July and August. The application of stricter border controls (assuming 100% compliance) would result in a >270-fold reduction in the likelihood of rabies introduction into the EU from Morocco.

[C-section rate in low-risk women: a useful indicator to compare hospitals attending deliveries with different risks].

PubMed

Librero, Julián; Peiró, Salvador; Belda, Ana; Calabuig, Julia

2014-01-01

the C-section rate has been criticized as a performance indicator for not considering that different hospitals manage deliveries with diverse risks. In this work we explore the characteristics of a new indicator restricted to low C-section risk deliveries. retrospective cohort of all births (n=214,611) in all public hospitals during 2005-2010 in the Valencia Region, Spain (source: minimum basic dataset). A low-risk subpopulation consisting of women under-35, no history of c-section, between 37 and 41 gestational weeks, and with a single fetus, with cephalic presentation and normal weight (2500-3999 g) was constructed. We analyzed variability in the new indicator, its correlation with the crude indicator and, using multilevel logistic regression models, the presence of residual risks. a total of 117 589 births (58.4% of the whole deliveries) were identified as low C-section risk. The c-section rate in these women was 11.9% (24.4% for all deliveries) ranging between hospitals from 7.0% to 28.9%. The c-section rate in low-risk and total deliveries correlated strongly (r=0.88). The remaining risks in the population of low risk did not alter the hospital effect on the c-section rate. the percentage of C-section in low risk women include a high volume of deliveries, correlated with the crude indicator and residual risks are not differentially influenced by hospitals, being a useful indicator for monitoring the quality of obstetric care in the National Health System.

Identifying increased risk of post-infarct people with diabetes using multi-lag Tone-Entropy analysis.

PubMed

Karmakar, Chandan; Jelinek, Herbert; Khandoker, Ahsan; Tulppo, Mikko; Makikallio, Timo; Kiviniemi, Antti; Huikuri, Heikki; Palaniswami, Marimuthu

2012-01-01

Diabetes mellitus is associated with multi-organ system dysfunction. One of the key causative factors is the increased blood sugar level that leads to an increase in free radical activity and organ damage including the cardiovascular and nervous system. Heart rhythm is extrinsically modulated by the autonomic nervous system and cardiac autonomic neuropathy or dysautonomia has been shown to lead to sudden cardiac death in people with diabetes due to the decrease in heart rate variability (HRV). Current algorithms for determining HRV describe only beat-to-beat variation and therefore do not consider the ability of a heart beat to influence a train of succeeding beats. Therefore mortality risk analysis based on HRV has often not been able to discern the presence of an increased risk. This study used a novel innovation of the tone-entropy algorithm by incorporating increased lag intervals and found that both the sympatho-vagal balance and total activity changed at larger lag intervals. Tone-Entropy was found to be better risk identifier of cardiac mortality in people with diabetes at lags higher than one and best at lag seven.

Validation of the Behavioral Risk Factor Surveillance System Sleep Questions

PubMed Central

Jungquist, Carla R.; Mund, Jaime; Aquilina, Alan T.; Klingman, Karen; Pender, John; Ochs-Balcom, Heather; van Wijngaarden, Edwin; Dickerson, Suzanne S.

2016-01-01

Study Objective: Sleep problems may constitute a risk for health problems, including cardiovascular disease, depression, diabetes, poor work performance, and motor vehicle accidents. The primary purpose of this study was to assess the validity of the current Behavioral Risk Factor Surveillance System (BRFSS) sleep questions by establishing the sensitivity and specificity for detection of sleep/ wake disturbance. Methods: Repeated cross-sectional assessment of 300 community dwelling adults over the age of 18 who did not wear CPAP or oxygen during sleep. Reliability and validity testing of the BRFSS sleep questions was performed comparing to BFRSS responses to data from home sleep study, actigraphy for 14 days, Insomnia Severity Index, Epworth Sleepiness Scale, and PROMIS-57. Results: Only two of the five BRFSS sleep questions were found valid and reliable in determining total sleep time and excessive daytime sleepiness. Conclusions: Refinement of the BRFSS questions is recommended. Citation: Jungquist CR, Mund J, Aquilina AT, Klingman K, Pender J, Ochs-Balcom H, van Wijngaarden E, Dickerson SS. Validation of the behavioral risk factor surveillance system sleep questions. J Clin Sleep Med 2016;12(3):301–310. PMID:26446246

Model evaluation of potential impacts of on-site wastewater systems on phosphorus in Turkey creek watershed.

PubMed

Geza, Mengistu; McCray, John E; Murray, Kyle E

2010-01-01

Nutrient loading to surface water systems has traditionally been associated with agricultural sources. Sources such as on-site wastewater systems (OWS) may be of concern especially in rural, nonagricultural watersheds. The impact of various point and nonpoint sources including OWS in Turkey Creek Watershed was evaluated using the Watershed Analysis Risk Management Framework, which was calibrated using 10 yr of observed stream flow and total P concentrations. Doubling the population in the watershed or OWS septic tank effluent P concentration increased mean stream total P concentration by a factor of 1.05. Converting all the OWS to a conventional sewer system with a removal efficiency of 93% at the wastewater treatment plant increased the mean total P concentration at the watershed outlet by a factor of 1.26. Reducing the soil adsorption capacity by 50% increased the mean stream total P concentration by a factor of 3.2. Doubling the initial P concentration increased the mean stream total P concentration by a factor of 1.96. Stream flow and sediment transport also substantially affected stream P concentration. The results suggest that OWS contribution to stream P in this watershed is minimal compared with other factors within the simulated time frame of 10 yr.

Does Atrial Septal Defect Increase the Risk of Stroke Following Total Hip and Knee Arthroplasty?

PubMed

Chughtai, Morad; Perfetti, Dean C; Khlopas, Anton; Sultan, Assem A; Sodhi, Nipun; Newman, Jared M; Gwam, Chukwuweike U; Maheshwari, Aditya V; Mont, Michael A

2017-12-22

Atrial septal defect (ASD) is a common asymptomatic congenital heart condition that predisposes patients to paradoxical emboli in the cerebral vasculature. In this study, we evaluated the prevalence of ASD and risk of stroke for patients with ASD undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). We used the New York Statewide Planning and Research Cooperative System to identify 258,911 elective primary THA/TKA between 2005 and 2014, including 140 patients with ASD. Logistic regression models calculated odds ratios (OR) and 95% confidence intervals (CI) and controlled for demographic and medical risk factors for stroke. The prevalence of ASD was 54 per 100,000 patients undergoing THA/TKA. The rate of stroke within 30 days of surgery was 5.7% (95% CI: 2.5%, 11.0%) for patients with ASD, and 0.1% (95% CI: 0.1%, 0.1%) for all other patients. In regression models, the risk of stroke was 70 times greater (OR: 70.0, 95% CI: 32.9, 148.9) for patients with ASD compared to patients without this condition (p<0.001). Patients with ASD undergoing THA and TKA are predisposed to stroke in the postoperative period. Orthopaedic surgeons indicating patients for surgery and internists performing preoperative medical clearance should be aware of these risks and discuss them prior to surgery. The efficacy of pharmacological and surgical measures to reduce postoperative stroke within this patient population should be topics of future investigation.

Dietary Antioxidant Capacity and Its Association with Preeclampsia.

PubMed

Sheikhi, Mahdiyeh; Sharifi-Zahabi, Elham; Paknahad, Zamzam

2017-01-01

Preeclampsia (PE) is one of the major disorders in pregnancy leading to many adverse maternal outcomes. Although the etiology of PE is not fully understood, resent studies suggest that an imbalance between free radicals production and the antioxidant defense system might have key role. Our aim of the current study was to evaluate the association between dietary total antioxidant capacity (TAC), serum TAC and risk of PE in women with preeclampsia and normal pregnancy. This case-control study conducted on 55 women with preeclampsia and 93 with normal pregnancy. Dietary intakes were obtained by a semi-quantitative food frequency questionnaire (FFQ) with 168 itmes. Dietary TAC was assessed according to United States Department of Agriculture (USDA) Database for oxygen radical absorbance capacity (ORAC), Release 2. Serum TAC was measured by a double-antibody sandwich enzyme-linked immunesorbent assay (ELISA). After adjusting for energy, pre-pregnant body mass index (BMI) and history of PE, no relationship was found between intake of hydrophilic-ORAC (H-ORAC), lipophilic-ORAC (L-ORAC), total phenolics (TP), total-ORAC (T-ORAC), and PE risk. However, serum TAC had a significant positive relationship with the risk of PE after adjusting for energy (odds ratio [OR], 0.07; 95% confidence interval [CI], 0.16-0.35), BMI and history of PE (OR, 0.04; 95% CI, 0.01-0.32). Findings of this study indicate that serum TAC is positively associated with the risk of PE but no association was found between intake of antioxidant indices and PE risk.

Noise Exposure in TKA Surgery; Oscillating Tip Saw Systems vs Oscillating Blade Saw Systems.

PubMed

Peters, Michiel P; Feczko, Peter Z; Tsang, Karel; van Rietbergen, Bert; Arts, Jacobus J; Emans, Peter J

2016-12-01

Historically it has been suggested that noise-induced hearing loss (NIHL) affects approximately 50% of the orthopedic surgery personnel. This noise may be partially caused by the use of powered saw systems that are used to make the bone cuts. The first goal was to quantify and compare the noise emission of these different saw systems during total knee arthroplasty (TKA) surgery. A second goal was to estimate the occupational NIHL risk for the orthopedic surgery personnel in TKA surgery by quantifying the total daily noise emission spectrum during TKA surgery and to compare this to the Dutch Occupational Health Organization guidelines. A conventional sagittal oscillating blade system with a full oscillating blade and 2 newer oscillating tip saw systems (handpiece and blade) were compared. Noise level measurements during TKA surgery were performed during cutting and hammering, additionally surgery noise profiles were made. The noise level was significantly lower for the oscillating tip saw systems compared to the conventional saw system, but all were in a range that can cause NIHL. The conventional system handpiece produced a considerable higher noise level compared to oscillating tip handpiece. NIHL is an underestimated problem in the orthopedic surgery. Solutions for decreasing the risk of hearing loss should be considered. The use of oscillating tip saw systems have a reduced noise emission in comparison with the conventional saw system. The use of these newer systems might be a first step in decreasing hearing loss among the orthopedic surgery personnel. Copyright © 2016 Elsevier Inc. All rights reserved.

Ranking Mammal Species for Conservation and the Loss of Both Phylogenetic and Trait Diversity.

PubMed

Redding, David W; Mooers, Arne O

2015-01-01

The 'edge of existence' (EDGE) prioritisation scheme is a new approach to rank species for conservation attention that aims to identify species that are both isolated on the tree of life and at imminent risk of extinction as defined by the World Conservation Union (IUCN). The self-stated benefit of the EDGE system is that it effectively captures unusual 'unique' species, and doing so will preserve the total evolutionary history of a group into the future. Given the EDGE metric was not designed to capture total evolutionary history, we tested this claim. Our analyses show that the total evolutionary history of mammals preserved is indeed much higher if EDGE species are protected than if at-risk species are chosen randomly. More of the total tree is also protected by EDGE species than if solely threat status or solely evolutionary distinctiveness were used for prioritisation. When considering how much trait diversity is captured by IUCN and EDGE prioritisation rankings, interestingly, preserving the highest-ranked EDGE species, or indeed just the most threatened species, captures more total trait diversity compared to sets of randomly-selected at-risk species. These results suggest that, as advertised, EDGE mammal species contribute evolutionary history to the evolutionary tree of mammals non-randomly, and EDGE-style rankings among endangered species can also capture important trait diversity. If this pattern holds for other groups, the EDGE prioritisation scheme has greater potential to be an efficient method to allocate scarce conservation effort.

Dietary fibre intake and risk of ischaemic and haemorrhagic stroke in the UK Women's Cohort Study.

PubMed

Threapleton, D E; Burley, V J; Greenwood, D C; Cade, J E

2015-04-01

Stroke risk is modifiable through many risk factors, one being healthy dietary habits. Fibre intake was associated with a reduced stroke risk in recent meta-analyses; however, data were contributed by relatively few studies, and few examined different stroke types. A total of 27,373 disease-free women were followed up for 14.4 years. Diet was assessed with a 217-item food frequency questionnaire and stroke cases were identified using English Hospital Episode Statistics and mortality records. Survival analysis was applied to assess the risk of total, ischaemic or haemorrhagic stroke in relation to fibre intake. A total of 135 haemorrhagic and 184 ischaemic stroke cases were identified in addition to 138 cases where the stroke type was unknown or not recorded. Greater intake of total fibre, higher fibre density and greater soluble fibre, insoluble fibre and fibre from cereals were associated with a significantly lower risk for total stroke. For total stroke, the hazard ratio per 6 g/day total fibre intake was 0.89 (95% confidence intervals: 0.81-0.99). Different findings were observed for haemorrhagic and ischaemic stroke in healthy-weight or overweight women. Total fibre, insoluble fibre and cereal fibre were inversely associated with haemorrhagic stroke risk in overweight/obese participants, and in healthy-weight women greater cereal fibre was associated with a lower ischaemic stroke risk. In non-hypertensive women, higher fibre density was associated with lower ischaemic stroke risk. Greater total fibre and fibre from cereals are associated with a lower stroke risk, and associations were more consistent with ischaemic stroke. The different observations by stroke type, body mass index group or hypertensive status indicates potentially different mechanisms.

The tumor necrosis factor-α-238 polymorphism and digestive system cancer risk: a meta-analysis.

PubMed

Hui, Ming; Yan, Xiaojuan; Jiang, Ying

2016-08-01

Many studies have reported the association between tumor necrosis factor-α (TNF-α)-238 polymorphism and digestive system cancer susceptibility, but the results were inconclusive. We performed a meta-analysis to derive a more precise estimation of the relationship between TNF-α-238 G/A polymorphism and digestive system cancer risk. Pooled analysis for the TNF-α-238 G/A polymorphism contained 26 studies with a total of 4849 cases and 8567 controls. The meta-analysis observed a significant association between TNF-α-238 G/A polymorphism and digestive system cancer risk in the overall population (GA vs GG: OR 1.19, 95 % CI 1.00-1.40, P heterpgeneity = 0.016; A vs G: OR 1.19, 95 % CI 1.03-1.39, P heterpgeneity = 0.015; dominant model: OR 1.20, 95 % CI 1.02-1.41, P heterpgeneity = 0.012). In the analysis of the ethnic subgroups, however, similar results were observed only in the Asian population, but not in the Caucasian population. Therefore, this meta-analysis suggests that TNF-α-238 G/A polymorphism is associated with a significantly increased risk of digestive system cancer. Further large and well-designed studies are needed to confirm these findings.

Effect of central ventilation and air conditioner system on the concentration and health risk from airborne polycyclic aromatic hydrocarbons.

PubMed

Lv, Jinze; Zhu, Lizhong

2013-03-01

Central ventilation and air conditioner systems are widely utilized nowadays in public places for air exchange and temperature control, which significantly influences the transfer of pollutants between indoors and outdoors. To study the effect of central ventilation and air conditioner systems on the concentration and health risk from airborne pollutants, a spatial and temporal survey was carried out using polycyclic aromatic hydrocarbons (PAHs) as agent pollutants. During the period when the central ventilation system operated without air conditioning (AC-off period), concentrations of 2-4 ring PAHs in the model supermarket were dominated by outdoor levels, due to the good linearity between indoor air and outdoor air (r(p) > 0.769, p < 0.05), and the slopes (1.2-4.54) indicated that ventilating like the model supermarket increased the potential health risks from low molecular weight PAHs. During the period when the central ventilation and air conditioner systems were working simultaneously (AC-on period), although the total levels of PAHs were increased, the concentrations and percentage of the particulate PAHs indoors declined significantly. The BaP equivalency (BaPeq) concentration indicated that utilization of air conditioning reduced the health risks from PAHs in the model supermarket.

Coronary artery disease risk assessment from unstructured electronic health records using text mining.

PubMed

Jonnagaddala, Jitendra; Liaw, Siaw-Teng; Ray, Pradeep; Kumar, Manish; Chang, Nai-Wen; Dai, Hong-Jie

2015-12-01

Coronary artery disease (CAD) often leads to myocardial infarction, which may be fatal. Risk factors can be used to predict CAD, which may subsequently lead to prevention or early intervention. Patient data such as co-morbidities, medication history, social history and family history are required to determine the risk factors for a disease. However, risk factor data are usually embedded in unstructured clinical narratives if the data is not collected specifically for risk assessment purposes. Clinical text mining can be used to extract data related to risk factors from unstructured clinical notes. This study presents methods to extract Framingham risk factors from unstructured electronic health records using clinical text mining and to calculate 10-year coronary artery disease risk scores in a cohort of diabetic patients. We developed a rule-based system to extract risk factors: age, gender, total cholesterol, HDL-C, blood pressure, diabetes history and smoking history. The results showed that the output from the text mining system was reliable, but there was a significant amount of missing data to calculate the Framingham risk score. A systematic approach for understanding missing data was followed by implementation of imputation strategies. An analysis of the 10-year Framingham risk scores for coronary artery disease in this cohort has shown that the majority of the diabetic patients are at moderate risk of CAD. Copyright © 2015 Elsevier Inc. All rights reserved.

Effects of an Encapsulated Fruit and Vegetable Juice Concentrate on Obesity-Induced Systemic Inflammation: A Randomised Controlled Trial.

PubMed

Williams, Evan J; Baines, Katherine J; Berthon, Bronwyn S; Wood, Lisa G

2017-02-08

Phytochemicals from fruit and vegetables reduce systemic inflammation. This study examined the effects of an encapsulated fruit and vegetable (F&V) juice concentrate on systemic inflammation and other risk factors for chronic disease in overweight and obese adults. A double-blinded, parallel, randomized placebo-controlled trial was conducted in 56 adults aged ≥40 years with a body mass index (BMI) ≥28 kg/m². Before and after eight weeks daily treatment with six capsules of F&V juice concentrate or placebo, peripheral blood gene expression (microarray, quantitative polymerase chain reaction (qPCR)), plasma tumour necrosis factor (TNF)α (enzyme-linked immunosorbent assay (ELISA)), body composition (Dual-energy X-ray absorptiometry (DEXA)) and lipid profiles were assessed. Following consumption of juice concentrate, total cholesterol, low-density lipoprotein (LDL) cholesterol and plasma TNFα decreased and total lean mass increased, while there was no change in the placebo group. In subjects with high systemic inflammation at baseline (serum C-reactive protein (CRP) ≥3.0 mg/mL) who were supplemented with the F&V juice concentrate ( n = 16), these effects were greater, with decreased total cholesterol, LDL cholesterol and plasma TNFα and increased total lean mass; plasma CRP was unchanged by the F&V juice concentrate following both analyses. The expression of several genes involved in lipogenesis, the nuclear factor-κB (NF-κB) and 5' adenosine monophosphate-activated protein kinase (AMPK) signalling pathways was altered, including phosphomevalonate kinase (PMVK), zinc finger AN1-type containing 5 (ZFAND5) and calcium binding protein 39 (CAB39), respectively. Therefore, F&V juice concentrate improves the metabolic profile, by reducing systemic inflammation and blood lipid profiles and, thus, may be useful in reducing the risk of obesity-induced chronic disease.

Validity of a portable glucose, total cholesterol, and triglycerides multi-analyzer in adults.

PubMed

Coqueiro, Raildo da Silva; Santos, Mateus Carmo; Neto, João de Souza Leal; Queiroz, Bruno Morbeck de; Brügger, Nelson Augusto Jardim; Barbosa, Aline Rodrigues

2014-07-01

This study investigated the accuracy and precision of the Accutrend Plus system to determine blood glucose, total cholesterol, and plasma triglycerides in adults and evaluated its efficiency in measuring these blood variables. The sample consisted of 53 subjects (≥ 18 years). For blood variable laboratory determination, venous blood samples were collected and processed in a Labmax 240 analyzer. To measure blood variables with the Accutrend Plus system, samples of capillary blood were collected. In the analysis, the following tests were included: Wilcoxon and Student's t-tests for paired samples, Lin's concordance coefficient, Bland-Altman method, receiver operating characteristic curve, McNemar test, and k statistics. The results show that the Accutrend Plus system provided significantly higher values (p ≤ .05) of glucose and triglycerides but not of total cholesterol (p > .05) as compared to the values determined in the laboratory. However, the system showed good reproducibility (Lin's coefficient: glucose = .958, triglycerides = .992, total cholesterol = .940) and high concordance with the laboratory method (Lin's coefficient: glucose = .952, triglycerides = .990, total cholesterol = .944) and high sensitivity (glucose = 80.0%, triglycerides = 90.5%, total cholesterol = 84.4%) and specificity (glucose = 100.0%, triglycerides = 96.9%, total cholesterol = 95.2%) in the discrimination of high values of the three blood variables analyzed. It could be concluded that despite the tendency to overestimate glucose and triglyceride levels, a portable multi-analyzer is a valid alternative for the monitoring of metabolic disorders and cardiovascular risk factors. © The Author(s) 2013.

Infection after pacemaker implantation: infection rates and risk factors associated with infection in a population-based cohort study of 46299 consecutive patients

PubMed Central

Johansen, Jens Brock; Jørgensen, Ole Dan; Møller, Mogens; Arnsbo, Per; Mortensen, Peter Thomas; Nielsen, Jens Cosedis

2011-01-01

Aims Infection is a serious complication of pacemaker (PM) systems. Although the rate of infection has been debated, the figures are largely unknown. We therefore studied the incidence of PM infection and its associated risk factors in the Danish population. Methods and results Since 1982, all PM implantation and removal procedures performed in Denmark have been prospectively recorded in the Danish Pacemaker Register. All patients (n = 46299) who underwent implantation between 1982 and 2007 were included. The total length of surveillance was 236 888 PM-years. The incidence of infection was calculated according to the total number of PM-years. The incidence of surgical site infection (≤365 days after PM implantation) was compared with later infection in first implant and replacement procedures. Multiple-record and multiple-event-per-subject proportional hazards analyses were used to identify the independent risk factors of PM infection. Surgical site infection occurred in 192 cases after first implantation (incidence rate 4.82/1000 PM-years), and in 133 cases after replacement (12.12/1000 PM-years). Infections occurring more than 365 days after the first implantation occurred in 153 cases (1.02/1000 PM-years), and in 118 cases after replacement (3.26/1000 PM-years). Independent factors associated with an increased risk of PM infection were a greater number of PM operations (including replacements), male sex, younger age, implantation during the earliest part of the study period, and absence of antibiotics (P< 0.001). Conclusion The overall risk of infection after PM implantation was low. A greater number of operations augmented the risk of infection. This should be taken into account when considering revisions of PM systems. PMID:21252172

Efficacy and safety of direct oral anticoagulants approved for cardiovascular indications: Systematic review and meta-analysis.

PubMed

Makam, Raghavendra Charan P; Hoaglin, David C; McManus, David D; Wang, Victoria; Gore, Joel M; Spencer, Frederick A; Pradhan, Richeek; Tran, Hoang; Yu, Hong; Goldberg, Robert J

2018-01-01

Direct oral anticoagulants (DOACs) have emerged as promising alternatives to vitamin K antagonists (VKAs) for patients with non-valvular atrial fibrillation (NVAF) or venous thromboembolism (VTE). Few meta-analyses have included all DOACs that have received FDA approval for these cardiovascular indications, and their overall comparisons against VKAs have shortcomings in data and methods. We provide an updated overall assessment of the efficacy and safety of those DOACs at dosages currently approved for NVAF or VTE, in comparison with VKAs. We used data from Phase 3 randomized trials that compared an FDA-approved DOAC with VKA for primary prevention of stroke in patients with NVAF or for treatment of acute VTE. Among trial participants with NVAF, DOAC recipients had a lower risk of stroke or systemic embolism [Pooled Odds Ratio (OR) 0.76, 95% Confidence Interval (CI) (0.68-0.84)], any stroke (0.80, 0.73-0.88), systemic embolism (0.56, 0.34-0.93), and total mortality (0.89, 0.84-0.95). Safety outcomes also showed a lower risk of fatal, major, and intracranial bleeding but higher risk for gastrointestinal bleeding (GIB). Patients with acute VTE randomized to DOACs had comparable risk of recurrent VTE and death (OR 0.88, 95% CI 0.75-1.03), recurrent DVT (0.83, 0.66-1.05), recurrent non-fatal PE (0.97, 0.75-1.25), and total mortality (0.94, 0.79-1.12). Safety outcomes for DOACs showed a lower risk of major, fatal, and intracranial bleeding, but similar risk of GIB. Patients receiving DOACs for NVAF had predominantly superior efficacy and safety. Patients who were treated with DOACs for acute VTE had non-inferior efficacy, but an overall superior safety profile.

Effect of agro-ecological zone and grazing system on incidence of East Coast Fever in calves in Mbale and Sironko Districts of Eastern Uganda.

PubMed

Rubaire-Akiiki, Christopher M; Okello-Onen, Joseph; Musunga, David; Kabagambe, Edmond K; Vaarst, Mettee; Okello, David; Opolot, Charles; Bisagaya, A; Okori, C; Bisagati, C; Ongyera, S; Mwayi, M T

2006-08-17

Between May 2002 and February 2003 a longitudinal survey was carried out in Mbale and Sironko Districts of Eastern Uganda to determine the influence of agro-ecological zones (AEZ) and grazing systems on tick infestation patterns and incidence of East Coast Fever (ECF) in bovine calves. The study area was stratified into AEZ (lowland, midland and upland) and grazing systems {zero grazing (ZG), restricted-outdoor grazing (ROG) and communal grazing (CG)}, whose strata had previously been shown to influence the prevalence of ECF, babesiosis and anaplasmosis. One hundred and eighty-five smallholder dairy farms with a total of 198 calves of both sexes, between the ages of 1 day and 6 weeks, were purposively selected from the AEZ-grazing system strata. Nine dynamic cohorts (11-51 calves in each) of these calves were examined and sampled monthly. Ticks infesting the calves were counted from one side of the animal body and categorized into the different species, sex and feeding status. Sera were collected at recruitment and monthly thereafter and antibodies against Theileria parva, T. mutans, Babesia bigemina, B. bovis and Anaplasma marginale were measured using ELISA. Tick challenge (total and specific) varied with AEZ and grazing system. The risk of infection with T. parva was higher in the lowland zone compared to the upland zone (hazard ratio (HR)=2.59; 95% CI: 1.00-6.34). The risk of infection with T. parva was higher in the CG system than the ZG system (HR=10.00; 95% CI: 3.61-27.92). The incidence risk for sero-conversion, over the 10 months study period, was 62, 16 and 9% in the lowland, midland and upland zones, respectively. Ninety-eight percent of the calves in lowland-CG stratum sero-converted by the age of 6 months, while 56 and 8% did so in the lowland-ROG and the lowland-ZG stratum, respectively. The results of this study show the need to consider farm circumstances and the variation in ECF risk, both spatially and temporally when designing control strategies for ECF.

Incidence, types, geographical distribution, and risk factors of congenital anomalies in Al-Ramadi Maternity and Children's Teaching Hospital, Western Iraq.

PubMed

Al-Ani, Zaid R; Al-Haj, Shaker A; Al-Ani, Muhammad M; Al-Dulaimy, Khamees M; Al-Maraie, Ayad Kh; Al-Ubaidi, Belal Kh

2012-09-01

To study the incidence, types, geographical distribution, and risk factors of congenital anomalies (CAs) in a teaching hospital. A total of 5864 neonates were examined for CAs between October 2010 and October 2011 in Al-Ramadi Maternity and Children's Teaching Hospital, Al-Ramadi, Western Iraq. Data include: neonate's name, gender, weight, and type of CAs, mother's age, residence, education, parity, consanguinity, smoking, illness, drugs, and ultrasound (U/S) results, father's age and smoking, and family recurrence of CAs. For every case, 2 controls were selected. Types and incidence of CAs was calculated. Odds ratio and confidence interval was utilized for risk factors evaluation. Overall CA incidences were 40.5/1000 for total births, 40.8/1000 live births, and 270.0/1000 for stillbirths. Twenty percent of CAs was found as multiple, 80% single, 63.8% major, and 36.2% minor. The cardiovascular system was found most affected, followed by genito-urinary system. Low birth weight, male gender, maternal smoking, consanguinity, parity, and CAs family recurrence were found to be significant risk factors, and oligohydramnios, polyhydramnios, and positive CAs by U/S, found as significant co-factors associated with CAs, while parental age, and maternal education were not considered risk factors. Although the incidence of CAs was lower than the Al-Fallujah rate, it is still higher than many developed and developing countries. Amniotic fluid volume changes in U/S may hide an ominous CA, and maternal smoking exposure during pregnancy and consanguinity may expose the family to a congenitally anomalous delivery.

Alcohol Intake During Pregnancy and Offspring's Atopic Eczema Risk.

PubMed

Wada, Keiko; Konishi, Kie; Tamura, Takashi; Shiraki, Makoto; Iwasa, Shinichi; Nagata, Chisato

2016-05-01

Although alcohol consumption has been suggested to have an effect on the immune system, it is unknown whether alcohol consumption has a role in developing allergic diseases. We aimed to examine the associations of total alcohol intake during pregnancy with the risks of childhood asthma and atopic eczema in a birth cohort in Japan. Pregnant women were recruited at a maternal clinic from May 2000 to October 2001. The children who were born to these mothers were followed until November 2007. Total alcohol intake, including alcohol as a cooking ingredient, was assessed using 5-day dietary records. Mother reports of physician-diagnosed asthma and atopic eczema were annually obtained from the questionnaires. Asthma assessed by the American Thoracic Society Division of Lung Diseases questionnaire and atopic eczema assessed by International Study of Asthma and Allergies in Childhood questions were also obtained in 2007. A total of 350 children participated in the follow-up survey. Maternal total alcohol intake during pregnancy was associated with increased risks of atopic eczema before age 3. The positive association with atopic eczema was also observed when it was defined as before age 5. In the high versus the low tertile of maternal total alcohol intake, the estimated hazard ratios (HRs) of child's eczema were 1.90 (95% CI: 0.96 to 3.76) before age 3 and 1.74 (95% CI: 0.93 to 3.24) before age 5, respectively. The estimated HRs of child's asthma before age 3 was 1.61 (95% CI: 0.70 to 3.69) in the high versus the low of maternal total alcohol intake and 2.11 (95% CI: 0.93 to 4.81) among children having drinking mothers versus nondrinking mothers in pregnancy, although maternal alcohol intake during pregnancy was not significantly associated with the risk of asthma before age 5. Alcohol consumption during pregnancy might have an effect on developing atopic eczema in offspring. Copyright © 2016 by the Research Society on Alcoholism.

Accumulation, Allocation, and Risk Assessment of Polycyclic Aromatic Hydrocarbons (PAHs) in Soil-Brassica chinensis System

PubMed Central

Zhang, Juan; Fan, Shukai; Du, Xiaoming; Yang, Juncheng; Wang, Wenyan; Hou, Hong

2015-01-01

Farmland soil and leafy vegetables accumulate more polycyclic aromatic hydrocarbons (PAHs) in suburban sites. In this study, 13 sampling areas were selected from vegetable fields in the outskirts of Xi’an, the largest city in northwestern China. The similarity of PAH composition in soil and vegetation was investigated through principal components analysis and redundancy analysis (RDA), rather than discrimination of PAH congeners from various sources. The toxic equivalent quantity of PAHs in soil ranged from 7 to 202 μg/kg d.w., with an average of 41 μg/kg d.w., which exceeded the agricultural/horticultural soil acceptance criteria for New Zealand. However, the cancer risk level posed by combined direct ingestion, dermal contact, inhalation of soil particles, and inhalation of surface soil vapor met the rigorous international criteria (1×10−6). The concentration of total PAHs was (1052±73) μg/kg d.w. in vegetation (mean±standard error). The cancer risks posed by ingestion of vegetation ranged from 2×10−5 to 2×10−4 with an average of 1.66×10−4, which was higher than international excess lifetime risk limits for carcinogens (1×10−4). The geochemical indices indicated that the PAHs in soil and vegetables were mainly from vehicle and crude oil combustion. Both the total PAHs in vegetation and bioconcentration factor for total PAHs (the ratio of total PAHs in vegetation to total PAHs in soil) increased with increasing pH as well as decreasing sand in soil. The total variation in distribution of PAHs in vegetation explained by those in soil reached 98% in RDA, which was statistically significant based on Monte Carlo permutation. Common pollution source and notable effects of soil contamination on vegetation would result in highly similar distribution of PAHs in soil and vegetation. PMID:25679782

Ecological Risk of Heavy Metals and a Metalloid in Agricultural Soils in Tarkwa, Ghana

PubMed Central

Bortey-Sam, Nesta; Nakayama, Shouta M. M.; Akoto, Osei; Ikenaka, Yoshinori; Baidoo, Elvis; Mizukawa, Hazuki; Ishizuka, Mayumi

2015-01-01

Heavy metals and a metalloid in agricultural soils in 19 communities in Tarkwa were analyzed to assess the potential ecological risk. A total of 147 soil samples were collected in June, 2012 and analyzed for As, Cd, Co, Cr, Cu, Hg, Ni, Pb and Zn. Mean concentrations (mg/kg dw) of heavy metals in the communities decreased in order of Zn (39) ˃ Cr (21) ˃ Pb (7.2) ˃ Cu (6.2) ˃ As (4.4) ˃ Ni (3.7) ˃ Co (1.8) ˃ Hg (0.32) ˃ Cd (0.050). Correlations among heavy metals and soil properties indicated that soil organic matter could have substantial influence on the total contents of these metals in soil. From the results, integrated pollution (Cdeg) in some communities such as, Wangarakrom (11), Badukrom (13) and T–Tamso (17) indicated high pollution with toxic metals, especially from As and Hg. Potential ecological risk (RI) indices indicated low (Mile 7) to high risks (Wangarakrom; Badukrom) of metals. Based on pollution coefficient (Cif), Cdeg, monomial ecological risk (Eir) and RI, the investigated soils fall within low to high contamination and risk of heavy metals to the ecological system especially plants, soil invertebrates and/or mammalian wildlife. This represented moderate potential ecological risk in the study area, and mining activities have played a significant role. PMID:26378563

Epidemiological burden of invasive pneumococcal disease in children and adolescents with predisposing risk factors.

PubMed

Falleiros-Arlant, Luiza Helena; Berezin, Eitan Naaman; Avila-Aguero, Maria Luisa; Pirez, Maria Catalina; Gentile, Angela; Richardson, Vesta; Brea, Jose; Mariño, Cristina

2015-09-01

Some medical conditions constitute important risk factors for the development of invasive pneumococcal diseases in children and adolescents aged from 5 to 19 years. Conjugate vaccines have potential efficacy in this scenario, but are not available in many Latin American public healthcare systems for this age group. This study aimed to estimate the preventable fraction of invasive pneumococcal diseases among individuals aged from 5 to 19 years with associated risk factors for its development. Data regarding the Latin America population, risk factors prevalence and conjugate vaccines efficacy were obtained from the literature. Total population at risk ranged from 17.3 to 64.6 million of individuals and asthma was the most impacting risk factor. According to SIREVA, PCV13 provided a 62.9% serotypes coverage in individuals from 5 to 29 years in 2012, potentially increasing the covered population from [8,338,457-31,057,620] with PCV10 to [10,906,356-40,622,078] with PCV13. To date, according to available efficacy data, the hypothetically immunized population ranged from 11.4 to 42.4 million, representing 7.0% to 26.0% of the total population in this age group. Vaccination in risk groups should be encouraged, as it potentially contributes to the reduction in the number of cases of invasive pneumococcal disease. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Intra-event variability of Escherichia coli and total suspended solids in urban stormwater runoff.

PubMed

McCarthy, D T; Hathaway, J M; Hunt, W F; Deletic, A

2012-12-15

Sediment levels are important for environmental health risk assessments of surface water bodies, while faecal pollution can introduce significant public health risks for users of these systems. Urban stormwater is one of the largest sources of contaminants to surface waters, yet the fate and transport of these contaminants (especially those microbiological) have received little attention in the literature. Stormwater runoff from five urbanized catchments were monitored for pathogen indicator bacteria and total suspended solids in two developed countries. Multiple discrete samples were collected during each storm event, allowing an analysis of intra-event characteristics such as initial concentration, peak concentration, maximum rate of change, and relative confidence interval. The data suggest that a catchment's area influences pollutant characteristics, as larger catchments have more complex stormwater infrastructure and more variable pollutant sources. The variability of total suspended solids for many characteristics was similar to Escherichia coli, indicating that the variability of E. coli may not be substantially higher than that of other pollutants as initially speculated. Further, variations in E. coli appeared to be more commonly correlated to antecedent climate, while total suspended solids were more highly correlated to rainfall/runoff characteristics. This emphasizes the importance of climate on microbial persistence and die off in urban systems. Discrete intra-event concentrations of total suspended solids and, to a lesser extent E. coli, were correlated to flow, velocity, and rainfall intensity (adjusted by time of concentrations). Concentration changes were found to be best described by adjusted rainfall intensity, as shown by other researchers. This study has resulted in an increased understanding of the magnitude of intra-event variations of total suspended solids and E. coli and what physical and climatic parameters influence these variations. Copyright © 2012 Elsevier Ltd. All rights reserved.

Engine management during NTRE start up

NASA Technical Reports Server (NTRS)

Bulman, Mel; Saltzman, Dave

1993-01-01

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

Reduction of Total Ownership Cost

DTIC Science & Technology

2003-09-30

preparation of the Technology Development Strategy, which addresses technology risk for a new weapon system. If there is a misstep...requirements for a new system may be transfixed by the technical performance and may not clearly establish requirements for ownership cost to achieve...important to the PM than TOC goals that will not be realized until long after the PM has departed for a new assignment or retired. If PMs and their

Failure mode and effect analysis oriented to risk-reduction interventions in intraoperative electron radiation therapy: the specific impact of patient transportation, automation, and treatment planning availability.

PubMed

López-Tarjuelo, Juan; Bouché-Babiloni, Ana; Santos-Serra, Agustín; Morillo-Macías, Virginia; Calvo, Felipe A; Kubyshin, Yuri; Ferrer-Albiach, Carlos

2014-11-01

Industrial companies use failure mode and effect analysis (FMEA) to improve quality. Our objective was to describe an FMEA and subsequent interventions for an automated intraoperative electron radiotherapy (IOERT) procedure with computed tomography simulation, pre-planning, and a fixed conventional linear accelerator. A process map, an FMEA, and a fault tree analysis are reported. The equipment considered was the radiance treatment planning system (TPS), the Elekta Precise linac, and TN-502RDM-H metal-oxide-semiconductor-field-effect transistor in vivo dosimeters. Computerized order-entry and treatment-automation were also analyzed. Fifty-seven potential modes and effects were identified and classified into 'treatment cancellation' and 'delivering an unintended dose'. They were graded from 'inconvenience' or 'suboptimal treatment' to 'total cancellation' or 'potentially wrong' or 'very wrong administered dose', although these latter effects were never experienced. Risk priority numbers (RPNs) ranged from 3 to 324 and totaled 4804. After interventions such as double checking, interlocking, automation, and structural changes the final total RPN was reduced to 1320. FMEA is crucial for prioritizing risk-reduction interventions. In a semi-surgical procedure like IOERT double checking has the potential to reduce risk and improve quality. Interlocks and automation should also be implemented to increase the safety of the procedure. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Residential exposure to extremely low-frequency magnetic fields and risk of childhood leukaemia, CNS tumour and lymphoma in Denmark.

PubMed

Pedersen, Camilla; Johansen, Christoffer; Schüz, Joachim; Olsen, Jørgen H; Raaschou-Nielsen, Ole

2015-11-03

We previously reported that children exposed to elevated extremely low-frequency magnetic fields (ELF-MF) had a five to six times higher risk of leukaemia, central nervous system (CNS) tumour and malignant lymphoma. Here we extend the study from 1968 to 1986 through 2003. We included 3277 children with leukaemia, CNS tumour or malignant lymphoma during 1968-2003 recorded in the Danish Cancer Registry and 9129 controls randomly selected from the Danish childhood population. ELF-MF from 50 to 400 kV facilities were calculated at the residences. For recently diagnosed cases (1987-2003), the relative risk (RR) was 0.88 (95% confidence interval (CI): 0.32-2.42), while for the total period (1968-2003) it was 1.63 (95% CI: 0.77-3.46) for leukaemia, CNS tumour and malignant lymphoma combined for exposures ⩾0.4 μT compared with <0.1 μT. These results were based on five cases (recent period) and 11 cases (total period) in the highest exposure group. We did not confirm the previous finding of a five- to six-fold higher risk for leukaemia, CNS tumour and malignant lymphoma when including data from the more recent time period. For the total time period, the results for childhood leukaemia were in line with large pooled analyses showing RRs between 1.5 and 2.

New algorithms for optimal reduction of technical risks

NASA Astrophysics Data System (ADS)

Todinov, M. T.

2013-06-01

The article features exact algorithms for reduction of technical risk by (1) optimal allocation of resources in the case where the total potential loss from several sources of risk is a sum of the potential losses from the individual sources; (2) optimal allocation of resources to achieve a maximum reduction of system failure; and (3) making an optimal choice among competing risky prospects. The article demonstrates that the number of activities in a risky prospect is a key consideration in selecting the risky prospect. As a result, the maximum expected profit criterion, widely used for making risk decisions, is fundamentally flawed, because it does not consider the impact of the number of risk-reward activities in the risky prospects. A popular view, that if a single risk-reward bet with positive expected profit is unacceptable then a sequence of such identical risk-reward bets is also unacceptable, has been analysed and proved incorrect.

An in-depth assessment of a diagnosis-based risk adjustment model based on national health insurance claims: the application of the Johns Hopkins Adjusted Clinical Group case-mix system in Taiwan.

PubMed

Chang, Hsien-Yen; Weiner, Jonathan P

2010-01-18

Diagnosis-based risk adjustment is becoming an important issue globally as a result of its implications for payment, high-risk predictive modelling and provider performance assessment. The Taiwanese National Health Insurance (NHI) programme provides universal coverage and maintains a single national computerized claims database, which enables the application of diagnosis-based risk adjustment. However, research regarding risk adjustment is limited. This study aims to examine the performance of the Adjusted Clinical Group (ACG) case-mix system using claims-based diagnosis information from the Taiwanese NHI programme. A random sample of NHI enrollees was selected. Those continuously enrolled in 2002 were included for concurrent analyses (n = 173,234), while those in both 2002 and 2003 were included for prospective analyses (n = 164,562). Health status measures derived from 2002 diagnoses were used to explain the 2002 and 2003 health expenditure. A multivariate linear regression model was adopted after comparing the performance of seven different statistical models. Split-validation was performed in order to avoid overfitting. The performance measures were adjusted R2 and mean absolute prediction error of five types of expenditure at individual level, and predictive ratio of total expenditure at group level. The more comprehensive models performed better when used for explaining resource utilization. Adjusted R2 of total expenditure in concurrent/prospective analyses were 4.2%/4.4% in the demographic model, 15%/10% in the ACGs or ADGs (Aggregated Diagnosis Group) model, and 40%/22% in the models containing EDCs (Expanded Diagnosis Cluster). When predicting expenditure for groups based on expenditure quintiles, all models underpredicted the highest expenditure group and overpredicted the four other groups. For groups based on morbidity burden, the ACGs model had the best performance overall. Given the widespread availability of claims data and the superior explanatory power of claims-based risk adjustment models over demographics-only models, Taiwan's government should consider using claims-based models for policy-relevant applications. The performance of the ACG case-mix system in Taiwan was comparable to that found in other countries. This suggested that the ACG system could be applied to Taiwan's NHI even though it was originally developed in the USA. Many of the findings in this paper are likely to be relevant to other diagnosis-based risk adjustment methodologies.

KULTURisk regional risk assessment methodology for water-related natural hazards - Part 2: Application to the Zurich case study

NASA Astrophysics Data System (ADS)

Ronco, P.; Bullo, M.; Torresan, S.; Critto, A.; Olschewski, R.; Zappa, M.; Marcomini, A.

2015-03-01

The aim of this paper is the application of the KULTURisk regional risk assessment (KR-RRA) methodology, presented in the companion paper (Part 1, Ronco et al., 2014), to the Sihl River basin, in northern Switzerland. Flood-related risks have been assessed for different receptors lying on the Sihl River valley including Zurich, which represents a typical case of river flooding in an urban area, by calibrating the methodology to the site-specific context and features. Risk maps and statistics have been developed using a 300-year return period scenario for six relevant targets exposed to flood risk: people; economic activities: buildings, infrastructure and agriculture; natural and semi-natural systems; and cultural heritage. Finally, the total risk index map has been produced to visualize the spatial pattern of flood risk within the target area and, therefore, to identify and rank areas and hotspots at risk by means of multi-criteria decision analysis (MCDA) tools. Through a tailored participatory approach, risk maps supplement the consideration of technical experts with the (essential) point of view of relevant stakeholders for the appraisal of the specific scores weighting for the different receptor-relative risks. The total risk maps obtained for the Sihl River case study are associated with the lower classes of risk. In general, higher (relative) risk scores are spatially concentrated in the deeply urbanized city centre and areas that lie just above to river course. Here, predicted injuries and potential fatalities are mainly due to high population density and to the presence of vulnerable people; flooded buildings are mainly classified as continuous and discontinuous urban fabric; flooded roads, pathways and railways, most of them in regards to the Zurich central station (Hauptbahnhof) are at high risk of inundation, causing severe indirect damage. Moreover, the risk pattern for agriculture, natural and semi-natural systems and cultural heritage is relatively less important mainly because the scattered presence of these assets. Finally, the application of the KR-RRA methodology to the Sihl River case study, as well as to several other sites across Europe (not presented here), has demonstrated its flexibility and the possible adaptation of it to different geographical and socioeconomic contexts, depending on data availability and particulars of the sites, and for other (hazard) scenarios.

Impact of care management processes and integration of care on blood pressure control in diabetes.

PubMed

Wong, Ken; Boulanger, Luke; Smalarz, Amy; Wu, Ning; Fraser, Kimberly; Wogen, Jenifer

2013-02-27

Fragmentation within health care systems may negatively impact the quality of chronic disease patient care. We sought to evaluate the relationship between care management processes (CMP), integration of services, and blood pressure (BP) control among diabetic patients. Retrospective chart reviews were performed for a random sample of adult diabetic hypertensive patients (n = 2,162) from 28 physician organizations in the United States (US). A modified version of the Physician Practice Connection Readiness Survey (PPC-RS) was completed by the chief medical officer at each site. The PPC-RS measured health system organization, delivery system redesign, decision support, clinical information systems, and self-management support, and an integration scale measured structure, functions, and financial risk. Correlations between PPC and integration scores and BP outcomes were assessed using Spearman correlation coefficients. Approximately 39.9% of diabetic patients had controlled BP. Mean total PPC score across sites was 55, with highest mean scores for health system organization (81), followed by design support (60), clinical information systems (57), self-management support (39), and delivery system redesign (39). Mean integration score was 46 (SD 27, range 4-93), and means of subscores were 64 for structure, 33 for financial risk, and 42 for function. Clinical information systems subscore was correlated with uncontrolled BP (r = -0.38, p < 0.05), while association with total PPC score was strong but not significant at p < 0.05 (r = -0.32). Total integration score and the structure subscore were significantly correlated with BP control (r = 0.38, p < 0.05, and r = 0.49, p < 0.01). This study suggests that CMP and service integration may be associated with better outcomes in diabetes, though results were mixed and limited by a small number of participating sites. Primary care implementation of integrated electronic medical records may have a beneficial effect on patient outcomes for diabetes and other chronic diseases.

Injury risk in British Columbia, Canada, 1986 to 2009: are Aboriginal children and youth over-represented?

PubMed

George, M Anne; Jin, Andrew; Brussoni, Mariana; Lalonde, Christopher E; McCormick, Rod

2015-12-01

Children and youth worldwide are at high risk of injury resulting in morbidity, disability or mortality. Disparities in risk exist between and within countries, and by sex and ethnicity. Our aim is to contribute data on disparities of injury rates for Aboriginal children and youth compared with those of the general population in British Columbia (BC), Canada, by examining risks for the two populations, utilizing provincial administrative data over a 24-year period. Hospital discharge records from the provincial health care database for children and youth were used to identify injury for the years 1986 to 2009. Within the total BC population, the Aboriginal population was identified. Crude rates and standardized relative risks (SRR) of hospitalization were calculated, by year and category of injury type and external cause, and compared to the total BC population for males and females under age 25 years. Over the 24-year period, substantive decreases were found in hospitalization injury risks for children and youth in both Aboriginal and total populations, for both sexes, and for most categories and types of injuries. Risk in overall injury dropped by 69% for the Aboriginal population and by 66% for the total BC population, yet in every year, the Aboriginal population had a higher risk than the total BC population. There were over 70% declines in risks among females of intentionally inflicted injury by another, among both the Aboriginal and total BC populations. Risk of injury caused by transport vehicles has decreased by an overwhelming 83% and 72% for the Aboriginal male population and for the total BC male population, respectively. The over 70% declines in risks for females of intentionally inflicted injury by another, among both the Aboriginal and total BC populations is excellent news. Risk of injury caused by transport vehicles for males decreased overwhelmingly for both populations. Disparities in rates between the Aboriginal population and total BC population remain because of similarity in the proportional reductions among the two populations. Since the Aboriginal population started at a much higher risk, in absolute terms, the gap between the two populations is shrinking.

Six Sigma Quality Management System and Design of Risk-based Statistical Quality Control.

PubMed

Westgard, James O; Westgard, Sten A

2017-03-01

Six sigma concepts provide a quality management system (QMS) with many useful tools for managing quality in medical laboratories. This Six Sigma QMS is driven by the quality required for the intended use of a test. The most useful form for this quality requirement is the allowable total error. Calculation of a sigma-metric provides the best predictor of risk for an analytical examination process, as well as a design parameter for selecting the statistical quality control (SQC) procedure necessary to detect medically important errors. Simple point estimates of sigma at medical decision concentrations are sufficient for laboratory applications. Copyright © 2016 Elsevier Inc. All rights reserved.

Comparing the performance of English mental health providers in achieving patient outcomes.

PubMed

Moran, Valerie; Jacobs, Rowena

2015-09-01

Evidence on provider payment systems that incorporate patient outcomes is limited for mental health care. In England, funding for mental health care services is changing to a prospective payment system with a future objective of linking some part of provider payment to outcomes. This research examines performance of mental health providers offering hospital and community services, in order to investigate if some are delivering better outcomes. Outcomes are measured using the Health of the Nation Outcome Scales (HoNOS) - a clinician-rated routine outcome measure (CROM) mandated for national use. We use data from the Mental Health Minimum Data Set (MHMDS) - a dataset on specialist mental health care with national coverage - for the years 2011/12 and 2012/13 with a final estimation sample of 305,960 observations with follow-up HoNOS scores. A hierarchical ordered probit model is used and outcomes are risk adjusted with independent variables reflecting demographic, need, severity and social indicators. A hierarchical linear model is also estimated with the follow-up total HoNOS score as the dependent variable and the baseline total HoNOS score included as a risk-adjuster. Provider performance is captured by a random effect that is quantified using Empirical Bayes methods. We find that worse outcomes are associated with severity and better outcomes with older age and social support. After adjusting outcomes for various risk factors, variations in performance are still evident across providers. This suggests that if the intention to link some element of provider payment to outcomes becomes a reality, some providers may gain financially whilst others may lose. The paper contributes to the limited literature on risk adjustment of outcomes and performance assessment of providers in mental health in the context of prospective activity-based payment systems. Copyright © 2015 Elsevier Ltd. All rights reserved.

Total mercury in infant food, occurrence and exposure assessment in Portugal.

PubMed

Martins, Carla; Vasco, Elsa; Paixão, Eleonora; Alvito, Paula

2013-01-01

Commercial infant food labelled as from organic and conventional origin (n = 87) was analysed for total mercury content using a direct mercury analyser (DMA). Median contents of mercury were 0.50, 0.50 and 0.40 μg kg⁻¹ for processed cereal-based food, infant formulae and baby foods, respectively, with a maximum value of 19.56 μg kg⁻¹ in a baby food containing fish. Processed cereal-based food samples showed statistically significant differences for mercury content between organic and conventional analysed products. Consumption of commercial infant food analysed did not pose a risk to infants when the provisionally tolerable weekly intake (PTWI) for food other than fish and shellfish was considered. By the contrary, a risk to some infants could not be excluded when using the PTWI for fish and shellfish. This is the first study reporting contents of total mercury in commercial infant food from both farming systems and the first on exposure assessment of children to mercury in Portugal.

Risk contracting and operational capabilities in large medical groups during national healthcare reform.

PubMed

Mechanic, Robert E; Zinner, Darren

2016-06-01

Little is known about the scope of alternative payment models outside of Medicare. This study measures the full complement of public and private payment arrangements in large, multi-specialty group practices as a barometer of payment reform among advanced organizations. We collected information from 33 large, multi-specialty group practices about the proportion of their total revenue in 7 payment models, physician compensation strategies, and the implementation of selected performance management initiatives. We grouped respondents into 3 categories based on the proportion of their revenue in risk arrangements: risk-based (45%-100%), mixed (10%-35%), and fee-for-service (FFS) (0%-10%). We analyzed changes in contracting and operating characteristics between 2011 and 2013. In 2013, 68% of groups' total patient revenue was from FFS payments and 32% was from risk arrangements (unweighted average). Risk-based groups had 26% FFS revenue, whereas mixed-payment and FFS groups had 75% and 98%, respectively. Between 2011 and 2013, 9 groups increased risk contract revenue by about 15 percentage points and 22 reported few changes. Risk-based groups reported more advanced implementation of performance management strategies and were more likely to have physician financial incentives for quality and patient experience. The groups in this study are well positioned to manage risk-based contracts successfully, but less than one-third receive a majority of their revenue from risk arrangements. The experience of these relatively advanced groups suggests that expanding risk-based arrangements across the US health system will likely be slower and more challenging than many people assume.

To risk or not to risk: Anxiety and the calibration between risk perception and danger mitigation.

PubMed

Notebaert, Lies; Masschelein, Stijn; Wright, Bridget; MacLeod, Colin

2016-06-01

Anxiety prepares an organism for dealing with threats by recruiting cognitive resources to process information about the threat, and by engaging physiological systems to prepare a response. Heightened trait anxiety is associated with biases in both these processes: high trait-anxious individuals tend to report heightened risk perceptions, and inappropriate engagement in danger mitigation behavior. However, no research has addressed whether the calibration between risk perception and danger mitigation behavior is affected by anxiety, though it is well recognized that this calibration is crucial for adaptive functioning. The current study aimed to examine whether anxiety is characterized by better or worse calibration of danger mitigation behavior to variations in risk magnitude. Low and high trait-anxious participants were presented with information about the likelihood and severity of a danger (loud noise burst) on each trial. Participants could decide to mitigate this danger by investing a virtual coin, at the cost of losing danger mitigation ability on subsequent trials. Importantly, level of risk likelihood and severity were varied independently, and the multiplicative relationship between the 2 defined total danger. Multilevel modeling showed that the magnitude of total danger predicted the probability of coin investments, over and above the effects of risk likelihood and severity, suggesting that participants calibrated their danger mitigation behavior to integrated risk information. Crucially, this calibration was affected by trait anxiety, indicating better calibration in high trait-anxious individuals. These results are discussed in light of existing knowledge and models of the effect of anxiety on risk perception and decision-making. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Manned space flight nuclear system safety. Volume 3: Reactor system preliminary nuclear safety analysis. Part 3: Nuclear Safety Analysis Document (NSAD)

NASA Technical Reports Server (NTRS)

1972-01-01

Nuclear safety analysis as applied to a space base mission is presented. The nuclear safety analysis document summarizes the mission and the credible accidents/events which may lead to nuclear hazards to the general public. The radiological effects and associated consequences of the hazards are discussed in detail. The probability of occurrence is combined with the potential number of individuals exposed to or above guideline values to provide a measure of accident and total mission risk. The overall mission risk has been determined to be low with the potential exposure to or above 25 rem limited to less than 4 individuals per every 1000 missions performed. No radiological risk to the general public occurs during the prelaunch phase at KSC. The most significant risks occur from prolonged exposure to reactor debris following land impact generally associated with the disposal phase of the mission where fission product inventories can be high.

Two-stage stochastic unit commitment model including non-generation resources with conditional value-at-risk constraints

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

Huang, Yuping; Zheng, Qipeng P.; Wang, Jianhui

2014-11-01

tThis paper presents a two-stage stochastic unit commitment (UC) model, which integrates non-generation resources such as demand response (DR) and energy storage (ES) while including riskconstraints to balance between cost and system reliability due to the fluctuation of variable genera-tion such as wind and solar power. This paper uses conditional value-at-risk (CVaR) measures to modelrisks associated with the decisions in a stochastic environment. In contrast to chance-constrained modelsrequiring extra binary variables, risk constraints based on CVaR only involve linear constraints and con-tinuous variables, making it more computationally attractive. The proposed models with risk constraintsare able to avoid over-conservative solutions butmore » still ensure system reliability represented by loss ofloads. Then numerical experiments are conducted to study the effects of non-generation resources ongenerator schedules and the difference of total expected generation costs with risk consideration. Sen-sitivity analysis based on reliability parameters is also performed to test the decision preferences ofconfidence levels and load-shedding loss allowances on generation cost reduction.« less

Environmental sensitivity mapping and risk assessment for oil spill along the Chennai Coast in India.

PubMed

Kankara, R S; Arockiaraj, S; Prabhu, K

2016-05-15

Integration of oil spill modeling with coastal resource information could be useful for protecting the coastal environment from oil spills. A scenario-based risk assessment and sensitivity indexing were performed for the Chennai coast by integrating a coastal resource information system and an oil spill trajectory model. The fate analysis of spilled oil showed that 55% of oil out of a total volume of 100m(3) remained in the water column, affecting 800m of the shoreline. The seasonal scenarios show major impact during the southwest (SW) and northeast (NE) monsoons and more fatal effects on marine pelagic organisms during SW monsoon. The Oil Spill Risk Assessment Modeler tool was constructed in a geographic information systems (GIS) platform to analyze the risks, sensitivity mapping, and priority indexing of resources that are likely to be affected by oil spills along the Chennai coast. The results of sensitivity mapping and the risk assessment results can help organizations take measures to combat oil spills in a timely manner. Copyright © 2016 Elsevier Ltd. All rights reserved.

The effects of patient cost sharing on inpatient utilization, cost, and outcome.

PubMed

Xu, Yuan; Li, Ning; Lu, Mingshan; Dixon, Elijah; Myers, Robert P; Jelley, Rachel J; Quan, Hude

2017-01-01

Health insurance and provider payment reforms all over the world beg a key empirical question: what are the potential impacts of patient cost-sharing on health care utilization, cost and outcomes? The unique health insurance system and rich electronic medical record (EMR) data in China provides us a unique opportunity to study this topic. Four years (2010 to 2014) of EMR data from one medical center in China were utilized, including 10,858 adult patients with liver diseases. We measured patient cost-sharing using actual reimbursement ratio (RR) which is allowed us to better capture financial incentive than using type of health insurance. A rigorous risk adjustment method was employed with both comorbidities and disease severity measures acting as risk adjustors. Associations between RR and health use, costs and outcome were analyzed by multivariate analyses. After risk adjustment, patients with more generous health insurance coverage (higher RR) were found to have longer hospital stay, higher total cost, higher medication cost, and higher ratio of medication to total cost, as well as higher number and likelihood that specific procedures were performed. Our study implied that patient cost-sharing affects health care services use and cost. This reflects how patients and physicians respond to financial incentives in the current healthcare system in China, and the responses could be a joint effect of both demand and supply side moral hazard. In order to contain cost and improve efficiency in the system, reforming provide payment and insurance scheme is urgently needed.

Effects of butter from mountain-pasture grazing cows on risk markers of the metabolic syndrome compared with conventional Danish butter: a randomized controlled study.

PubMed

Werner, Louise B; Hellgren, Lars I; Raff, Marianne; Jensen, Søren K; Petersen, Rikke A; Drachmann, Tue; Tholstrup, Tine

2013-07-10

There is considerable interest in dairy products from low-input systems, such as mountain-pasture grazing cows, because these products are believed to be healthier than products from high-input conventional systems. This may be due to a higher content of bioactive components, such as phytanic acid, a PPAR-agonist derived from chlorophyll. However, the effects of such products on human health have been poorly investigated. To compare the effect of milk-fat from mountain-pasture grazing cows (G) and conventionally fed cows (C) on risk markers of the metabolic syndrome. In a double-blind, randomized, 12-week, parallel intervention study, 38 healthy subjects replaced part of their habitual dietary fat intake with 39 g fat from test butter made from milk from mountain-pasture grazing cows or from cows fed conventional winter fodder. Glucose-tolerance and circulating risk markers were analysed before and after the intervention. No differences in blood lipids, lipoproteins, hsCRP, insulin, glucose or glucose-tolerance were observed. Interestingly, strong correlations between phytanic acid at baseline and total (P<0.0001) and LDL cholesterol (P=0.0001) were observed. Lack of effects on blood lipids and inflammation indicates that dairy products from mountain-pasture grazing cows are not healthier than products from high-input conventional systems. Considering the strong correlation between LDL cholesterol and phytanic acid at baseline, it may be suggested that phytanic acid increases total and LDL cholesterol. ClinicalTrials.gov, NCT01343589.

Saturated fat, carbohydrates and cardiovascular disease.

PubMed

Kuipers, R S; de Graaf, D J; Luxwolda, M F; Muskiet, M H A; Dijck-Brouwer, D A J; Muskiet, F A J

2011-09-01

The dietary intake of saturated fatty acids (SAFA) is associated with a modest increase in serum total cholesterol, but not with cardiovascular disease (CVD). Replacing dietary SAFA with carbohydrates (CHO), notably those with a high glycaemic index, is associated with an increase in CVD risk in observational cohorts, while replacing SAFA with polyunsaturated fatty acids (PUFA) is associated with reduced CVD risk. However, replacing a combination of SAFA and trans-fatty acids with n-6 PUFA (notably linoleic acid) in controlled trials showed no indication of benefit and a signal toward increased coronary heart disease risk, suggesting that n-3 PUFA may be responsible for the protective association between total PUFA and CVD. High CHO intakes stimulate hepatic SAFA synthesis and conservation of dietary SAFA . Hepatic de novo lipogenesis from CHO is also stimulated during eucaloric dietary substitution of SAFA by CHO with high glycaemic index in normo-insulinaemic subjects and during hypocaloric high-CHO/low-fat diets in subjects with the metabolic syndrome. The accumulation of SAFA stimulates chronic systemic low-grade inflammation through its mimicking of bacterial lipopolysaccharides and÷or the induction of other pro-inflammatory stimuli. The resulting systemic low-grade inflammation promotes insulin resistance, reallocation of energy-rich substrates and atherogenic dyslipidaemia that concertedly give rise to increased CVD risk. We conclude that avoidance of SAFA accumulation by reducing the intake of CHO with high glycaemic index is more effective in the prevention of CVD than reducing SAFA intake per se.

New Insights into the Management of Hypertension and Cardiovascular Risk with Angiotensin Receptor Blockers: Observational Studies Help Us?

PubMed Central

Goudev, Assen

2014-01-01

Post-marketing observational studies are valuable for establishing the real-world effectiveness of treatment regimens in routine clinical practice as they typically monitor a diverse population of patients over many months. This article reviews recent observational studies of angiotensin receptor blockers (ARBs) for the management of hypertension: the 6-month eprosartan POWER study (n~29,400), the 3-month valsartan translational research programme (n~19,500), the 9-month irbesartan Treat to Target study (n=14,200), the 6-month irbesartan DO-IT survey (n~3300) and the 12-week candesartan CHILI survey programme (n=4600). Reduction in blood pressure with ARBs reported across these studies appears to be comparable for the different agents, although direct comparisons between studies cannot be made owing to different treatment durations and baseline patient demographics. Of these studies, the eprosartan POWER study, 2 of the 7 studies in the valsartan translational research programme, and the candesartan CHILI Triple T study measured total cardiovascular risk, as recommended in the 2013 European Society of Cardiology-European Society of Hypertension guidelines. The POWER study confirmed the value of the Systemic Coronary Risk Evaluation (SCORE) to accurately assess total cardiovascular risk. With the advent of new healthcare practices, such as the use of electronic health records (EHRs), observational studies in larger patient populations will become possible. In the future, algorithms embedded in EHR systems could evolve as decision support tools to inform on patient care. PMID:24847388

Identifying a rainfall event threshold triggering herbicide leaching by preferential flow

NASA Astrophysics Data System (ADS)

McGrath, G. S.; Hinz, C.; Sivapalan, M.; Dressel, J.; Pütz, T.; Vereecken, H.

2010-02-01

How can leaching risk be assessed if the chemical flux and/or the toxicity is highly uncertain? For many strongly sorbing pesticides it is known that their transport through the unsaturated zone occurs intermittently through preferential flow, triggered by significant rainfall events. In these circumstances the timing and frequency of these rainfall events may allow quantification of leaching risk to overcome the limitations of flux prediction. In this paper we analyze the leaching behavior of bromide and two herbicides, methabenzthiazuron and ethidimuron, using data from twelve uncropped lysimeters, with high-resolution climate data, in order to identify the rainfall controls on rapid solute leaching. A regression tree analysis suggested that a coarse-scale fortnightly to monthly water balance was a good predictor of short-term increases in drainage and bromide transport. Significant short-term herbicide leaching, however, was better predicted by the occurrence of a single storm with a depth greater than a 19 mm threshold. Sampling periods where rain events exceeded this threshold accounted for between 38% and 56% of the total mass of herbicides leached during the experiment. The same threshold only accounted for between 1% and 10% of the total mass of bromide leached. On the basis of these results, we conclude that in this system, the leaching risks of strongly sorbing chemicals can be quantified by the timing and frequency of these large rainfall events. Empirical and modeling approaches are suggested to apply this frequentist approach to leaching risk assessment to other soil-climate systems.

Assessment of the ecotoxicological risk of combined sewer overflows for an aquatic system using a coupled "substance and bioassay" approach.

PubMed

Gooré Bi, Eustache; Monette, Frederic; Gasperi, Johnny; Perrodin, Yves

2015-03-01

Very few tools are available for assessing the impact of combined sewer overflows (CSOs) on receiving aquatic environments. The main goal of the study was to assess the ecotoxicological risk of CSOs for a surface aquatic ecosystem using a coupled "substance and bioassay" approach. Wastewater samples from the city of Longueuil, Canada CSO were collected for various rainfall events during one summer season and analyzed for a large panel of substances (n = 116). Four bioassays were also conducted on representative organisms of surface aquatic systems (Pimephales promelas, Ceriodaphnia dubia, Daphnia magna, and Oncorhynchus mykiss). The analytical data did not reveal any ecotoxicological risk for St. Lawrence River organisms, mainly due to strong effluent dilution. However, the substance approach showed that, because of their contribution to the ecotoxicological hazard posed by the effluent, total phosphorus (Ptot), aluminum (Al), total residual chlorine, chromium (Cr), copper (Cu), pyrene, ammonia (N-NH4 (+)), lead (Pb), and zinc (Zn) require more targeted monitoring. While chronic ecotoxicity tests revealed a potential impact of CSO discharges on P. promelas and C. dubia, acute toxicity tests did not show any effect on D. magna or O. mykiss, thus underscoring the importance of chronic toxicity tests as part of efforts aimed at characterizing effluent toxicity. Ultimately, the study leads to the conclusion that the coupled "substance and bioassay" approach is a reliable and robust method for assessing the ecotoxicological risk associated with complex discharges such as CSOs.

Complete surgical resection improves outcome in INRG high-risk patients with localized neuroblastoma older than 18 months.

PubMed

Fischer, Janina; Pohl, Alexandra; Volland, Ruth; Hero, Barbara; Dübbers, Martin; Cernaianu, Grigore; Berthold, Frank; von Schweinitz, Dietrich; Simon, Thorsten

2017-08-04

Although several studies have been conducted on the role of surgery in localized neuroblastoma, the impact of surgical timing and extent of primary tumor resection on outcome in high-risk patients remains controversial. Patients from the German neuroblastoma trial NB97 with localized neuroblastoma INSS stage 1-3 age > 18 months were included for retrospective analysis. Imaging reports were reviewed by two independent physicians for Image Defined Risk Factors (IDRF). Operation notes and corresponding imaging reports were analyzed for surgical radicality. The extent of tumor resection was classified as complete resection (95-100%), gross total resection (90-95%), incomplete resection (50-90%), and biopsy (<50%) and correlated with local control rate and outcome. Patients were stratified according to the International Neuroblastoma Risk Group (INRG) staging system. Survival curves were estimated according to the method of Kaplan and Meier and compared by the log-rank test. A total of 179 patients were included in this study. 77 patients underwent more than one primary tumor operation. After best surgery, 68.7% of patients achieved complete resection of the primary tumor, 16.8% gross total resection, 14.0% incomplete surgery, and 0.5% biopsy only. The cumulative complication rate was 20.3% and the surgery associated mortality rate was 1.1%. Image defined risk factors (IDRF) predicted the extent of resection. Patients with complete resection had a better local-progression-free survival (LPFS), event-free survival (EFS) and OS (overall survival) than the other groups. Subgroup analyses showed better EFS, LPFS and OS for patients with complete resection in INRG high-risk patients. Multivariable analyses revealed resection (complete vs. other), and MYCN (non-amplified vs. amplified) as independent prognostic factors for EFS, LPFS and OS. In patients with localized neuroblastoma age 18 months or older, especially in INRG high-risk patients harboring MYCN amplification, extended surgery of the primary tumor site improved local control rate and survival with an acceptable risk of complications.

Risk perception and condom-use among Thai youths: findings from Kanchanaburi Demographic Surveillance System site in Thailand.

PubMed

Haque, Mohammad Raisul; Soonthorndhada, Amara

2009-12-01

Youths, aged 15-24 years, comprise a large fragment of the total population in Thailand, and unsafe sexual behaviours are increasing, nowadays, among young people. The study was conducted to explore the characteristics of youths and other conducive, facilitating and reinforcing factors associated with risk perception of sexually transmitted infections (STIs) among the study population. Data employed in this study were derived from the site of the Kanchanaburi Demographic Surveillance System of Thailand 2004 using a stratified systemic design. The study population was mainly young current condom-users aged 15-24 years, and cross-sectional analysis was done on this populace. The findings revealed that youths who fell into the single (unmarried) category having temporary partners were more likely to perceive the risks associated with STIs in relation to using condom. A greater proportion of unmarried youths was engaged in sexual activity before the age of 20 years and that condom-use was also inconsistent. Youths having temporary partners were more likely to perceive risk and reason for using a condom than when with their regular partner. Education played a significant role in risk perception of STIs. Risk perception was increasing with the increasing level of education. Other conducive and facilitating factors, such as household wealth, living in urban or semi-urban areas, and access to mass media such as television, also had a positive influence on risk perception. The odds ratio showed that condom-users who had indulgence in liquor were less likely to perceive the risk of STIs. Overall, socioeconomic status had a great influence on risk perception of STIs. Finally, youths exhibiting high-risk sexual behaviour need realistic risk assessments and positive ways of incorporating condom into their sexual lives.

Continuous decline in mortality from coronary heart disease in Japan despite a continuous and marked rise in total cholesterol: Japanese experience after the Seven Countries Study.

PubMed

Sekikawa, Akira; Miyamoto, Yoshihiro; Miura, Katsuyuki; Nishimura, Kunihiro; Willcox, Bradley J; Masaki, Kamal H; Rodriguez, Beatriz; Tracy, Russell P; Okamura, Tomonori; Kuller, Lewis H

2015-10-01

The Seven Countries Study in the 1960s showed very low mortality from coronary heart disease (CHD) in Japan, which was attributed to very low levels of total cholesterol. Studies of migrant Japanese to the USA in the 1970s documented increase in CHD rates, thus CHD mortality in Japan was expected to increase as their lifestyle became Westernized, yet CHD mortality has continued to decline since 1970. This study describes trends in CHD mortality and its risk factors since 1980 in Japan, contrasting those in other selected developed countries. We selected Australia, Canada, France, Japan, Spain, Sweden, the UK and the USA. CHD mortality between 1980 and 2007 was obtained from WHO Statistical Information System. National data on traditional risk factors during the same period were obtained from literature and national surveys. Age-adjusted CHD mortality continuously declined between 1980 and 2007 in all these countries. The decline was accompanied by a constant fall in total cholesterol except Japan where total cholesterol continuously rose. In the birth cohort of individuals currently aged 50-69 years, levels of total cholesterol have been higher in Japan than in the USA, yet CHD mortality in Japan remained the lowest: >67% lower in men and > 75% lower in women compared with the USA. The direction and magnitude of changes in other risk factors were generally similar between Japan and the other countries. Decline in CHD mortality despite a continuous rise in total cholesterol is unique. The observation may suggest some protective factors unique to Japanese. © The Author 2015; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

Legionella species colonization in cooling towers: risk factors and assessment of control measures.

PubMed

Mouchtouri, Varvara A; Goutziana, Georgia; Kremastinou, Jenny; Hadjichristodoulou, Christos

2010-02-01

Cooling towers can be colonized by Legionella spp, and inhalation of aerosols generated by their operation may cause Legionnaires' disease in susceptible hosts. Environmental investigations of Legionnaires' disease outbreaks linked with cooling towers have revealed poorly maintained systems, lack of control measures, and failure of system equipment. The purpose of this study was to identify Legionella-contaminated cooling towers, identify risk factors for contamination, and assess the effectiveness of control measures. A total of 96 cooling towers of public buildings were registered and inspected, and 130 samples were collected and microbiologically tested. Microbiological test results were associated with characteristics of cooling towers, water samples, inspection results, and maintenance practices. Of the total 96 cooling towers examined, 47 (48.9%) were colonized by Legionella spp, and 22 (22.9%) required remedial action. A total of 65 samples (50.0%) were positive (> or = 500 cfu L(-1)), and 30 (23%) were heavily contaminated (> or = 10(4) cfu L(-1)). Of the 69 isolates identified, 55 strains (79.7.%) were L pneumophila. Legionella colonization was positively associated with the absence of training on Legionella control (relative risk [RR] = 1.66; P = .02), absence of regular Legionella testing (RR = 2.07: P = .002), absence of sunlight protection (RR = 1.63: P = .02), with samples in which the free residual chlorine level in the water sample was < 0.5 mg/L (RR = 2.23; P = .01), and with total plate count (P =.001). Colonization was negatively associated with chemical disinfection (RR = 0.2; P = .0003) and with the presence of a risk assessment and management plan (RR = 0.12; P = .0005). A statistically significant higher age (P =.01) was found in legionellae-positive cooling towers (median, 17 years; interquartile range [IQR] =5.0 to 26.0 years) compared with noncolonized cooling towers (median age, 6 years; IQR =1.0 to 13.5 years). After the 22 legionellae-positive cooling towers were disinfected with chlorine, 2 (9%) of them remained positive for Legionella spp with a concentration > or = 1000 cfu L(-1). Cooling towers can be heavily colonized by Legionella spp and thus present a potential risk for infection. This study demonstrates the importance of a risk assessment and management plan. Water chlorination effectively reduces legionellae contamination. Proper training of cooling tower operators is paramount. Copyright 2010 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

No Evidence for Disease History as a Risk Factor for Narcolepsy after A(H1N1)pdm09 Vaccination.

PubMed

Lamb, Favelle; Ploner, Alexander; Fink, Katharina; Maeurer, Markus; Bergman, Peter; Piehl, Fredrik; Weibel, Daniel; Sparén, Pär; Dahlström, Lisen Arnheim

2016-01-01

To investigate disease history before A(H1N1)pdm09 vaccination as a risk factor for narcolepsy. Case-control study in Sweden. Cases included persons referred for a Multiple Sleep Latency Test between 2009 and 2010, identified through diagnostic sleep centres and confirmed through independent review of medical charts. Controls, selected from the total population register, were matched to cases on age, gender, MSLT-referral date and county of residence. Disease history (prescriptions and diagnoses) and vaccination history was collected through telephone interviews and population-based healthcare registers. Conditional logistic regression was used to investigate disease history before A(H1N1)pdm09 vaccination as a risk-factor for narcolepsy. In total, 72 narcolepsy cases and 251 controls were included (range 3-69 years mean19-years). Risk of narcolepsy was increased in individuals with a disease history of nervous system disorders (OR range = 3.6-8.8) and mental and behavioural disorders (OR = 3.8, 95% CI 1.6-8.8) before referral. In a second analysis of vaccinated individuals only, nearly all initial associations were no longer statistically significant and effect sizes were smaller (OR range = 1.3-2.6). A significant effect for antibiotics (OR = 0.4, 95% CI 0.2-0.8) and a marginally significant effect for nervous system disorders was observed. In a third case-only analysis, comparing cases referred before vaccination to those referred after; prescriptions for nervous system disorders (OR = 26.0 95% CI 4.0-170.2) and ADHD (OR = 35.3 95% CI 3.4-369.9) were statistically significant during the vaccination period, suggesting initial associations were due to confounding by indication. The findings of this study do not support disease history before A(H1N1)pdm09 vaccination as a risk factor for narcolepsy.

Effectiveness of perioperative antiepileptic drug prophylaxis for early and late seizures following oncologic neurosurgery: a meta-analysis.

PubMed

Joiner, Evan F; Youngerman, Brett E; Hudson, Taylor S; Yang, Jingyan; Welch, Mary R; McKhann, Guy M; Neugut, Alfred I; Bruce, Jeffrey N

2018-04-27

OBJECTIVE The purpose of this meta-analysis was to evaluate the impact of perioperative antiepileptic drug (AED) prophylaxis on short- and long-term seizure incidence among patients undergoing brain tumor surgery. It is the first meta-analysis to focus exclusively on perioperative AED prophylaxis among patients undergoing brain tumor surgery. METHODS The authors searched PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials, clinicaltrials.gov, and the System for Information on Gray Literature in Europe for records related to perioperative AED prophylaxis for patients with brain tumors. Risk of bias in the included studies was assessed using the Cochrane risk of bias tool. Incidence rates for early seizures (within the first postoperative week) and total seizures were estimated based on data from randomized controlled trials. A Mantel-Haenszel random-effects model was used to analyze pooled relative risk (RR) of early seizures (within the first postoperative week) and total seizures associated with perioperative AED prophylaxis versus control. RESULTS Four RCTs involving 352 patients met the criteria of inclusion. The results demonstrated that perioperative AED prophylaxis for patients undergoing brain tumor surgery provides a statistically significant reduction in risk of early postoperative seizures compared with control (RR = 0.352, 95% confidence interval 0.130-0.949, p = 0.039). AED prophylaxis had no statistically significant effect on the total (combined short- and long-term) incidence of seizures. CONCLUSIONS This meta-analysis demonstrates for the first time that perioperative AED prophylaxis for brain tumor surgery provides a statistically significant reduction in early postoperative seizure risk.

Birth-Weight, Pregnancy Term, Pre-Natal and Natal Complications Related to Child's Dental Anomalies.

PubMed

Prokocimer, T; Amir, E; Blumer, S; Peretz, B

2015-01-01

This cross-sectional study was aimed at determining whether certain pre-natal and natal conditions can predict specific dental anomalies. The conditions observed were: low birth-weight, preterm birth, pre-natal & natal complications. The dental anomalies observed were: enamel defects, total number of decayed, missing and filled teeth (total DMFT), disturbances in the tooth shape and disturbances in the number of teeth. Out of more than 2000 medical files of children aged 2-17 years old which were reviewed, 300 files met the selection criteria. Information recorded from the files included: age, gender, health status (the ASA physical status classification system by the American Society of Anesthesiologists), birth week, birth weight, total DMFT, hypomineralization, abnormal tooth shape, abnormal number of teeth and hypoplasia. Twenty one children out of 300 (7%) were born after a high-risk pregnancy, 25 children (8.3%) were born after high-risk birth, 20 children (6.7%) were born preterm - before week 37, and 29 children (9.7%) were born with a low birth weight (LBW) - 2500 grams or less. A relationship between a preterm birth and LBW to hypomineralization was found. And a relationship between a preterm birth and high-risk pregnancy to abnormal number of teeth was found. No relationship was found between birth (normal/high-risk) and the other parameters inspected. Preterm birth and LBW may predict hypomineralization in both primary and permanent dentitions. Furthermore, the study demonstrated that preterm birth and high-risk pregnancy may predict abnormal number of teeth in both dentitions.

Resolving a double standard for risk management of thalidomide: an evaluation of two different risk management programmes in Japan.

PubMed

Ooba, Nobuhiro; Sato, Tsugumichi; Watanabe, Hikaru; Kubota, Kiyoshi

2010-01-01

Thalidomide, once withdrawn because of its teratogenicity, has now been re-launched worldwide. In Japan, thalidomide has been imported by individual doctors since around the year 2000. In October 2008, it was approved for the treatment of multiple myeloma (MM) by the Ministry of Health, Labour and Welfare (MHLW) on the condition that the manufacturer implemented a risk management programme termed the Thalidomide Education and Risk Management System (TERMS). It is likely that the imports of thalidomide will be used off-label to treat diseases other than MM. Thus, the MHLW is also planning to introduce a web-based registration system, referred to as the Safety Management System for Unapproved Drugs (SMUD), for thalidomide imported by individual doctors. To evaluate the difference between TERMS and SMUD and establish a way to resolve the 'double standard' for risk management of thalidomide treatment in Japan. The fraction of patients with disorders other than MM was estimated by the volume of annual imports obtained from the MHLW and records of the imports for patients with MM, other oncological diseases (ODs) and non-ODs in 2007 through a major supplier covering 63% of the total imported thalidomide. The information for TERMS was obtained from web pages of the manufacturer and the MHLW. The components of TERMS were compared with those in SMUD. Provided that the distribution of the indication for thalidomide (MM) in 2007, estimated from the records of imports through the major supplier, is representative of the entire nation, it is estimated that on average 866 patients, including 851 (98.3%) with MM, are using thalidomide on any one day. However, if the major supplier's imports, which account for 63% of the total imports, are not representative of the nation as a whole, possibly only half of the patients treated with thalidomide in Japan have MM. This would be the case in a scenario where the remaining 37% of imports are exclusively used to treat disorders other than MM. TERMS consists of tools for education and registration of patients, and has the potential for real-time intervention. SMUD is a system for registration of patients and exchange of safety information between health professionals, but has some mandatory components that encourage patient registration. TERMS and SMUD are different in nature, and they impose different criteria that doctors and patients should satisfy in order to use thalidomide. To eliminate this double standard, implementation of a single system would be desirable. However, improvement of SMUD may be the second best option by developing tools for patient education, enhancing the potential for real-time intervention and monitoring thalidomide usage by each patient. On average, a total of about 1000 patients are estimated to be using thalidomide on any one day in Japan. It is likely that those patients are placed under one of two different risk management programmes. SMUD should be improved so that all patients are monitored in a way that results in a similar level of risk management.

Seroprevalence and potential risk of bovine brucellosis in zerograzing and pastoral dairy systems in Uganda.

PubMed

Magona, J W; Walubengo, J; Galiwango, T; Etoori, A

2009-12-01

A cross-sectional study was conducted in Uganda between November 2006 and February 2007 to assess the seroprevalence and risk of brucellosis in zerograzing and pastoral dairy systems; two major sources of milk in Uganda, 80% of which is sold unpasteurized to consumers through informal channels. A total of 723 cattle comprised of 497 animals from the pastoral system and 226 animals from the zerograzing system were tested for antibodies against natural B. abortus infection using the competitive enzyme-linked immunosorbent assay (C-ELISA). Herd-level seroprevalence was 100% in the pastoral system and 5.5% (95% CI: 1.8, 9.2) in the zerograzing system. The animal-level seroprevalence and within-herd range of brucellosis in cattle in the pastoral system were 34.0% (95% CI: 29.9, 38.1) and 8.1-75.9%, while for those in the zerograzing system were 3.3% (95% CI: 0.9, 5.7) and 0-9.0%. Abortion rates of 23% and 0% among seropositive cows vis-à-vis 5.4% and 1.9% among seronegative cows were recorded in the pastoral and zerograzing systems, respectively. The risk of natural B. abortus infection was higher among older cattle (>24 m) (Odds ratio [OR] = 1.83, 95% CI: 1.25-2.67) and dry cows (OR = 2.01, 95% CI: 1.23-3.31) in the pastoral system, and in calves aged 0-6 m (OR = 5.72, 95% CI: 1.04-31.41) in the zerograzing system. Implementing a culling program in the zerograzing system to eliminate the existing low risk of brucellosis and targeting calves in the pastoral systems for vaccination could avert the cost-related limitation of brucellosis control in Uganda.

Inventory Control System for a Healthcare Apparel Service Centre with Stockout Risk: A Case Analysis

PubMed Central

Hui, Chi-Leung

2017-01-01

Based on the real-world inventory control problem of a capacitated healthcare apparel service centre in Hong Kong which provides tailor-made apparel-making services for the elderly and disabled people, this paper studies a partial backordered continuous review inventory control problem in which the product demand follows a Poisson process with a constant lead time. The system is controlled by an (Q,r) inventory policy which incorporate the stockout risk, storage capacity, and partial backlog. The healthcare apparel service centre, under the capacity constraint, aims to minimize the inventory cost and achieving a low stockout risk. To address this challenge, an optimization problem is constructed. A real case-based data analysis is conducted, and the result shows that the expected total cost on an order cycle is reduced substantially at around 20% with our proposed optimal inventory control policy. An extensive sensitivity analysis is conducted to generate additional insights. PMID:29527283

Electronic Nicotine Delivery Systems (ENDS): What Nurses Need to Know.

PubMed

Essenmacher, Carol; Naegle, Madeline; Baird, Carolyn; Vest, Bridgette; Spielmann, Rene; Smith-East, Marie; Powers, Leigh

Efforts to decrease adverse effects of tobacco use are affected by emergence of new nicotine delivery products. Advertising, product promotion, and social media promote use of these products, yet a lack of evidence regarding safety leaves nurses unprepared to counsel patients. To critically evaluate current research, reviews of literature, expert opinion, and stakeholder policy proposals on use and safety of electronic nicotine delivery systems (ENDS). A targeted examination of literature generated by key stakeholders and subject matter experts was conducted using key words, modified by risk factors, and limited to the past 8 years. Current knowledge gaps in research literature and practice implications of the literature are discussed. The safety of ENDS is questionable and unclear. There are clear health risks of nicotine exposure to developing brains. Potential health risks of ENDS secondhand emissions exposure exist. Using ENDS to facilitate total tobacco cessation is not proven.

Inventory Control System for a Healthcare Apparel Service Centre with Stockout Risk: A Case Analysis.

PubMed

Pan, An; Hui, Chi-Leung

2017-01-01

Based on the real-world inventory control problem of a capacitated healthcare apparel service centre in Hong Kong which provides tailor-made apparel-making services for the elderly and disabled people, this paper studies a partial backordered continuous review inventory control problem in which the product demand follows a Poisson process with a constant lead time. The system is controlled by an ( Q , r ) inventory policy which incorporate the stockout risk, storage capacity, and partial backlog. The healthcare apparel service centre, under the capacity constraint, aims to minimize the inventory cost and achieving a low stockout risk. To address this challenge, an optimization problem is constructed. A real case-based data analysis is conducted, and the result shows that the expected total cost on an order cycle is reduced substantially at around 20% with our proposed optimal inventory control policy. An extensive sensitivity analysis is conducted to generate additional insights.

Neuroprosthetics and the science of patient input

PubMed Central

Civillico, Eugene F.

2017-01-01

Safe and effective neuroprosthetic systems are of great interest to both DARPA and CDRH, due to their innovative nature and their potential to aid severely disabled populations. By expanding what is possible in human-device interaction, these devices introduce new potential benefits and risks. Therefore patient input, which is increasingly important in weighing benefits and risks, is particularly relevant for this class of devices. FDA has been a significant contributor to an ongoing stakeholder conversation about the inclusion of the patient voice, working collaboratively to create a new framework for a patient-centered approach to medical device development. This framework is evolving through open dialogue with researcher and patient communities, investment in the science of patient input, and policymaking that is responsive to patient-centered data throughout the total product life cycle. In this commentary, we will discuss recent developments in patient-centered benefit-risk assessment and their relevance to the development of neural prosthetic systems. PMID:27456271

Neuroprosthetics and the science of patient input.

PubMed

Benz, Heather L; Civillico, Eugene F

2017-01-01

Safe and effective neuroprosthetic systems are of great interest to both DARPA and CDRH, due to their innovative nature and their potential to aid severely disabled populations. By expanding what is possible in human-device interaction, these devices introduce new potential benefits and risks. Therefore patient input, which is increasingly important in weighing benefits and risks, is particularly relevant for this class of devices. FDA has been a significant contributor to an ongoing stakeholder conversation about the inclusion of the patient voice, working collaboratively to create a new framework for a patient-centered approach to medical device development. This framework is evolving through open dialogue with researcher and patient communities, investment in the science of patient input, and policymaking that is responsive to patient-centered data throughout the total product life cycle. In this commentary, we will discuss recent developments in patient-centered benefit-risk assessment and their relevance to the development of neural prosthetic systems. Published by Elsevier Inc.

Development of economic consequence methodology for process risk analysis.

PubMed

Zadakbar, Omid; Khan, Faisal; Imtiaz, Syed

2015-04-01

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

Predicting the occurrence of embolic events: an analysis of 1456 episodes of infective endocarditis from the Italian Study on Endocarditis (SEI)

PubMed Central

2014-01-01

Background Embolic events are a major cause of morbidity and mortality in patients with infective endocarditis. We analyzed the database of the prospective cohort study SEI in order to identify factors associated with the occurrence of embolic events and to develop a scoring system for the assessment of the risk of embolism. Methods We retrospectively analyzed 1456 episodes of infective endocarditis from the multicenter study SEI. Predictors of embolism were identified. Risk factors identified at multivariate analysis as predictive of embolism in left-sided endocarditis, were used for the development of a risk score: 1 point was assigned to each risk factor (total risk score range: minimum 0 points; maximum 2 points). Three categories were defined by the score: low (0 points), intermediate (1 point), or high risk (2 points); the probability of embolic events per risk category was calculated for each day on treatment (day 0 through day 30). Results There were 499 episodes of infective endocarditis (34%) that were complicated by ≥ 1 embolic event. Most embolic events occurred early in the clinical course (first week of therapy: 15.5 episodes per 1000 patient days; second week: 3.7 episodes per 1000 patient days). In the total cohort, the factors associated with the occurrence of embolism at multivariate analysis were prosthetic valve localization (odds ratio, 1.84), right-sided endocarditis (odds ratio, 3.93), Staphylococcus aureus etiology (odds ratio, 2.23) and vegetation size ≥ 13 mm (odds ratio, 1.86). In left-sided endocarditis, Staphylococcus aureus etiology (odds ratio, 2.1) and vegetation size ≥ 13 mm (odds ratio, 2.1) were independently associated with embolic events; the 30-day cumulative incidence of embolism varied with risk score category (low risk, 12%; intermediate risk, 25%; high risk, 38%; p < 0.001). Conclusions Staphylococcus aureus etiology and vegetation size are associated with an increased risk of embolism. In left-sided endocarditis, a simple scoring system, which combines etiology and vegetation size with time on antimicrobials, might contribute to a better assessment of the risk of embolism, and to a more individualized analysis of indications and contraindications for early surgery. PMID:24779617

Dental caries experience and association to risk indicators of remote rural populations.

PubMed

Cook, Sean L; Martinez-Mier, E Angeles; Dean, Jeffrey A; Weddell, James A; Sanders, Brian J; Eggertsson, Hafsteinn; Ofner, Susan; Yoder, Karen

2008-07-01

Dental caries continues to be the most common infectious disease of childhood; however, it is no longer pandemic, but endemic in specific sectors of populations. Therefore, it is important to identify and target patients at risk of developing caries in order to develop specific preventive measures. This study aims to test dental caries risk indicators for significant associations with caries severity. Five separate, small, isolated rural villages in Mexico with varying degrees of caries prevalence were selected for this observational study. A total of 248 children were examined. Risk indicators were assessed via questionnaire and water and salt fluoride analysis. Caries severity was measured by the International Caries Detection and Assessment System (ICDAS-I). Prevalence of caries ranged from 95% to 100% for the five villages. Mean total DMFS (decayed, missing, or filled surfaces-permanent teeth) and dmfs (decayed, missing, or filled surfaces-primary teeth) scores ranged from 2.5 to 5.0 and from 11.3 to 16.9, respectively. Multivariable models showed age and drinking soda between meals to be significantly associated with DMFS, and drinking juice and being female were significantly associated with dmfs. DMFS and dmfs were high in each village, significantly different between villages, and associated with specific risk indicators.

Covariance versus correlation in capacitated vehicle routing problem-investment fund allocation problem

NASA Astrophysics Data System (ADS)

Mamat, Nur Jumaadzan Zaleha; Jaaman, Saiful Hafizah; Ahmad, Rokiah@Rozita

2017-04-01

Capacitated Vehicle Routing Problem-Investment Fund Allocation Problem (CVRP-IFAP) provides investors with a sequence of assets to allocate their funds into. To minimize total risks of investment in CVRP-IFAP covariance values measure the risks between two assets. Another measure of risks are correlation values between returns. The correlation values can be used to diversify the risk of investment loss in order to optimize expected return against a certain level of risk. This study compares the total risk obtained from CVRP-IFAP when using covariance values and correlation values. Results show that CVRP-IFAP with covariance values provides lesser total risks and a significantly better measure of risk.

Trace Elements Contamination and Human Health Risk Assessment in Drinking Water from the Agricultural and Pastoral Areas of Bay County, Xinjiang, China.

PubMed

Turdi, Muyessar; Yang, Linsheng

2016-09-23

Tap water samples were collected from 180 families in four agricultural (KYR: Keyir, KRW: Kariwak, YTR: Yatur, DW: Dawanqi) and two pastoral areas (B: Bulong and Y: Yangchang) in Bay County, Xinjiang, China, and levels of seven trace elements (Cd, Cr, As Ni, Pb, Zn, Se) were analyzed using inductively-coupled plasma mass spectrometry (ICP-MS) to assess potential health risks. Remarkable spatial variations of contamination were observed. Overall, the health risk was more severe for carcinogenic versus non-carcinogenic pollutants due to heavy metal. The risk index was greater for children overall (Cr > As > Cd and Zn > Se for carcinogenic and non-carcinogenic elements, respectively). The total risk index was greater in agricultural areas (DW > KYR > YTR > KRW > B > Y). Total risk indices were greater where well water was the source versus fountain water; for the latter, the total health risk index was greater versus glacier water. Main health risk factors were Cr and As in DW, KYR, YTR, KRW, and B, and Zn, Cr, and As in the Y region. Overall, total trace element-induced health risk (including for DW adults) was higher than acceptable (10(-6)) and lower than priority risk levels (10(-4)) (KYR, YTR, KRW, Y, and B). For DW children, total health risk reached 1.08 × 10(-4), higher than acceptable and priority risk levels (10(-4)).

DEVELOPMENT OF NORMAL HUMAN COLON CELL CULTURES TO IDENTIFY UNREGULATED DISINFECTION BY-PRODUCTS (DBPS) WITH CARCINOGENIC POTENTIAL.

EPA Science Inventory

Epidemiological studies have linked the consumption of chlorinated surface waters to an increased risk of colorectal cancer. Approximately 600 DBPs, less than half of the total organic carbon in drinking water have been identified. We are developing an in vitro system to i...

Evaluation of air-displacement plethysmography for body composition assessment in preterm infants

USDA-ARS?s Scientific Manuscript database

Adiposity may contribute to the future risk of disease. The aim of this study was to evaluate the accuracy and reliability of an air-displacement plethysmography (ADP) system to estimate percentage fat mass (%FM) in preterm infants and to evaluate interdevice reliability in infants. A total of 70 pr...

12 CFR 327.12 - Prepayment of quarterly risk-based assessments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... (b)(2) and (3) of this section shall be determined based upon data in the FDIC's computer systems as of December 24, 2009. Changes to data underlying an institution's adjusted total base assessment rate... data changes as provided in paragraph (b)(4) of this section. (d) Payment of prepaid assessment. Each...

Assessing introduction risk using species’ rank-abundance distributions

PubMed Central

Chan, Farrah T.; Bradie, Johanna; Briski, Elizabeta; Bailey, Sarah A.; Simard, Nathalie; MacIsaac, Hugh J.

2015-01-01

Mixed-species assemblages are often unintentionally introduced into new ecosystems. Analysing how assemblage structure varies during transport may provide insights into how introduction risk changes before propagules are released. Characterization of introduction risk is typically based on assessments of colonization pressure (CP, the number of species transported) and total propagule pressure (total PP, the total abundance of propagules released) associated with an invasion vector. Generally, invasion potential following introduction increases with greater CP or total PP. Here, we extend these assessments using rank-abundance distributions to examine how CP : total PP relationships change temporally in ballast water of ocean-going ships. Rank-abundance distributions and CP : total PP patterns varied widely between trans-Atlantic and trans-Pacific voyages, with the latter appearing to pose a much lower risk than the former. Responses also differed by taxonomic group, with invertebrates experiencing losses mainly in total PP, while diatoms and dinoflagellates sustained losses mainly in CP. In certain cases, open-ocean ballast water exchange appeared to increase introduction risk by uptake of new species or supplementation of existing ones. Our study demonstrates that rank-abundance distributions provide new insights into the utility of CP and PP in characterizing introduction risk. PMID:25473007

Sex hormone concentrations and the risk of breast cancer recurrence in postmenopausal women without hot flashes.

PubMed

Emond, Jennifer A; Patterson, Ruth E; Natarajan, Loki; Laughlin, Gail A; Gold, Ellen B; Pierce, John P

2011-05-01

We examined if the reduced risk of breast cancer events seen among women without baseline hot flash symptoms in the Women's Healthy Eating and Living (WHEL) dietary intervention trial was related to changes in sex hormone concentrations. Baseline and year one concentrations of total and bioavailable estradiol, and testosterone and sex hormone-binding globulin (SHBG) were compared by intervention arm among 447 postmenopausal women without hot flashes. Cox proportional hazard models tested interaction terms between study arm and baseline hormone concentrations adjusted for study site, antiestrogen use, positive nodes, tumor size, oophorectomy status, and hormone replacement therapy use. Sex hormone concentrations did not differ by study arm at baseline nor at year one. Twenty-two (9.8%) events occurred in the intervention arm versus 42 (18.9%) in the comparison arm (P = 0.009). Baseline bioavailable testosterone was significantly, positively associated with additional events (HR 1.69, 95% CI: 1.00-2.84; P = 0.049). There were significant interactions between the intervention and total (P = 0.015), and bioavailable (P = 0.050) testosterone: the intervention was more protective among participants with higher baseline total (HR 0.3, 95% CI: 0.2-0.7) or bioavailable (HR 0.4, 95% CI: 0.2-0.7) testosterone than for participants with lower baseline total (HR 0.8, 95% CI: 0.4-1.5) or bioavailable (HR 0.8, 95% CI: 0.4-1.5) testosterone. No significant effects were seen for estradiol or SHBG. The WHEL dietary intervention may have modified other risk factors of recurrence correlated with testosterone. Sex hormones should be considered as part of a larger biological system related to the risk of breast cancer recurrence. ©2011 AACR.

Relation of total sugars, fructose and sucrose with incident type 2 diabetes: a systematic review and meta-analysis of prospective cohort studies

PubMed Central

Tsilas, Christine S.; de Souza, Russell J.; Mejia, Sonia Blanco; Mirrahimi, Arash; Cozma, Adrian I.; Jayalath, Viranda H.; Ha, Vanessa; Tawfik, Reem; Di Buono, Marco; Jenkins, Alexandra L.; Leiter, Lawrence A.; Wolever, Thomas M.S.; Beyene, Joseph; Khan, Tauseef; Kendall, Cyril W.C.; Jenkins, David J.A.; Sievenpiper, John L.

2017-01-01

BACKGROUND: Sugar-sweetened beverages are associated with type 2 diabetes. To assess whether this association holds for the fructose-containing sugars they contain, we conducted a systematic review and meta-analysis of prospective cohort studies. METHODS: We searched MEDLINE, Embase, CINAHL and the Cochrane Library (through June 2016). We included prospective cohort studies that assessed the relation of fructose-containing sugars with incident type 2 diabetes. Two independent reviewers extracted relevant data and assessed risk of bias. We pooled risk ratios (RRs) using random effects meta-analyses. The overall quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS: Fifteen prospective cohort studies (251 261 unique participants, 16 416 cases) met the eligibility criteria, comparing the highest intake (median 137, 35.2 and 78 g/d) with the lowest intake (median 65, 9.7 and 25.8 g/d) of total sugars, fructose and sucrose, respectively. Although there was no association of total sugars (RR 0.91, 95% confidence interval [CI] 0.76–1.09) or fructose (RR 1.04, 95% CI 0.84–1.29) with type 2 diabetes, sucrose was associated with a decreased risk of type 2 diabetes (RR 0.89, 95% CI 0.80–0.98). Our confidence in the estimates was limited by evidence of serious inconsistency between studies for total sugars and fructose, and serious imprecision in the pooled estimates for all 3 sugar categories. INTERPRETATION: Current evidence does not allow us to conclude that fructose-containing sugars independent of food form are associated with increased risk of type 2 diabetes. Further research is likely to affect our estimates. Trial registration: ClinicalTrials.gov, no. NCT01608620 PMID:28536126

Relation of total sugars, fructose and sucrose with incident type 2 diabetes: a systematic review and meta-analysis of prospective cohort studies.

PubMed

Tsilas, Christine S; de Souza, Russell J; Mejia, Sonia Blanco; Mirrahimi, Arash; Cozma, Adrian I; Jayalath, Viranda H; Ha, Vanessa; Tawfik, Reem; Di Buono, Marco; Jenkins, Alexandra L; Leiter, Lawrence A; Wolever, Thomas M S; Beyene, Joseph; Khan, Tauseef; Kendall, Cyril W C; Jenkins, David J A; Sievenpiper, John L

2017-05-23

Sugar-sweetened beverages are associated with type 2 diabetes. To assess whether this association holds for the fructose-containing sugars they contain, we conducted a systematic review and meta-analysis of prospective cohort studies. We searched MEDLINE, Embase, CINAHL and the Cochrane Library (through June 2016). We included prospective cohort studies that assessed the relation of fructose-containing sugars with incident type 2 diabetes. Two independent reviewers extracted relevant data and assessed risk of bias. We pooled risk ratios (RRs) using random effects meta-analyses. The overall quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Fiffeen prospective cohort studies (251 261 unique participants, 16 416 cases) met the eligibility criteria, comparing the highest intake (median 137, 35.2 and 78 g/d) with the lowest intake (median 65, 9.7 and 25.8 g/d) of total sugars, fructose and sucrose, respectively. Although there was no association of total sugars (RR 0.91, 95% confidence interval [CI] 0.76-1.09) or fructose (RR 1.04, 95% CI 0.84-1.29) with type 2 diabetes, sucrose was associated with a decreased risk of type 2 diabetes (RR 0.89, 95% CI 0.80-0.98). Our confidence in the estimates was limited by evidence of serious inconsistency between studies for total sugars and fructose, and serious imprecision in the pooled estimates for all 3 sugar categories. Current evidence does not allow us to conclude that fructose-containing sugars independent of food form are associated with increased risk of type 2 diabetes. Further research is likely to affect our estimates. ClinicalTrials.gov, no. NCT01608620. © 2017 Canadian Medical Association or its licensors.

Real-time colour pictorial radiation monitoring during coronary angiography: effect on patient peak skin and total dose during coronary angiography.

PubMed

Wilson, Sharon M; Prasan, Ananth M; Virdi, Amy; Lassere, Marissa; Ison, Glenn; Ramsay, David R; Weaver, James C

2016-10-10

The aim of this study was to evaluate whether a real-time (RT) colour pictorial radiation dose monitoring system reduces patient skin and total radiation dose during coronary angiography and intervention. Patient demographics, procedural variables and radiation parameters were recorded before and after institution of the RT skin dose recording system. Peak skin dose as well as traditionally available measures of procedural radiation dose were compared. A total of 1,077 consecutive patients underwent coronary angiography, of whom 460 also had PCI. Institution of the RT skin dose recording system resulted in a 22% reduction in peak skin dose after accounting for confounding variables. Radiation dose reduction was most pronounced in those having PCI but was also seen over a range of subgroups including those with prior coronary artery bypass surgery, high BMI, and with radial arterial access. This was associated with a significant reduction in the number of patients placed at risk of skin damage. Similar reductions in parameters reflective of total radiation dose were also demonstrated after institution of RT radiation monitoring. Institution of an RT skin dose recording reduced patient peak skin and total radiation dose during coronary angiography and intervention. Consideration should be given to widespread adoption of this technology.

Risk factors for the development of heterotopic ossification in seriously burned adults: A National Institute on Disability, Independent Living and Rehabilitation Research burn model system database analysis.

PubMed

Levi, Benjamin; Jayakumar, Prakash; Giladi, Avi; Jupiter, Jesse B; Ring, David C; Kowalske, Karen; Gibran, Nicole S; Herndon, David; Schneider, Jeffrey C; Ryan, Colleen M

2015-11-01

Heterotopic ossification (HO) is a debilitating complication of burn injury; however, incidence and risk factors are poorly understood. In this study, we use a multicenter database of adults with burn injuries to identify and analyze clinical factors that predict HO formation. Data from six high-volume burn centers, in the Burn Injury Model System Database, were analyzed. Univariate logistic regression models were used for model selection. Cluster-adjusted multivariate logistic regression was then used to evaluate the relationship between clinical and demographic data and the development of HO. Of 2,979 patients in the database with information on HO that addressed risk factors for development of HO, 98 (3.5%) developed HO. Of these 98 patients, 97 had arm burns, and 96 had arm grafts. When controlling for age and sex in a multivariate model, patients with greater than 30% total body surface area burn had 11.5 times higher odds of developing HO (p < 0.001), and those with arm burns that required skin grafting had 96.4 times higher odds of developing HO (p = 0.04). For each additional time a patient went to the operating room, odds of HO increased by 30% (odds ratio, 1.32; p < 0.001), and each additional ventilator day increased odds by 3.5% (odds ratio, 1.035; p < 0.001). Joint contracture, inhalation injury, and bone exposure did not significantly increase odds of HO. Risk factors for HO development include greater than 30% total body surface area burn, arm burns, arm grafts, ventilator days, and number of trips to the operating room. Future studies can use these results to identify highest-risk patients to guide deployment of prophylactic and experimental treatments. Prognostic study, level III.

Longitudinal study on morbidity and mortality in white veal calves in Belgium

PubMed Central

2012-01-01

Background Mortality and morbidity are hardly documented in the white veal industry, despite high levels of antimicrobial drug use and resistance. The objective of the present study was to determine the causes and epidemiology of morbidity and mortality in dairy, beef and crossbred white veal production. A total of 5853 calves, housed in 15 production cohorts, were followed during one production cycle. Causes of mortality were determined by necropsy. Morbidity was daily recorded by the producers. Results The total mortality risk was 5,3% and was significantly higher in beef veal production compared to dairy or crossbreds. The main causes of mortality were pneumonia (1.3% of the calves at risk), ruminal disorders (0.7%), idiopathic peritonitis (0.5%), enterotoxaemia (0.5%) and enteritis (0.4%). Belgian Blue beef calves were more likely to die from pneumonia, enterotoxaemia and arthritis. Detection of bovine viral diarrhea virus at necropsy was associated with chronic pneumonia and pleuritis. Of the calves, 25.4% was treated individually and the morbidity rate was 1.66 cases per 1000 calf days at risk. The incidence rate of respiratory disease, diarrhea, arthritis and otitis was 0.95, 0.30, 0.11 and 0.07 cases per 1000 calf days at risk respectively. Morbidity peaked in the first three weeks after arrival and gradually declined towards the end of the production cycle. Conclusions The present study provided insights into the causes and epidemiology of morbidity and mortality in white veal calves in Belgium, housed in the most frequent housing system in Europe. The necropsy findings, identified risk periods and differences between production systems can guide both veterinarians and producers towards the most profitable and ethical preventive and therapeutic protocols. PMID:22414223

A novel scoring system for gastric cancer risk assessment based on the expression of three CLIP4 DNA methylation-associated genes

PubMed Central

Hu, Chenggong; Zhou, Yongfang; Liu, Chang; Kang, Yan

2018-01-01

Gastric cancer (GC) is the fifth most common cancer and the third leading cause of cancer-associated mortality worldwide. In the current study, comprehensive bioinformatic analyses were performed to develop a novel scoring system for GC risk assessment based on CAP-Gly domain containing linker protein family member 4 (CLIP4) DNA methylation status. Two GC datasets with methylation sequencing information and mRNA expression profiling were downloaded from the The Cancer Genome Atlas and Gene Expression Omnibus databases. Differentially expressed genes (DEGs) between the CLIP4 hypermethylation and CLIP4 hypomethylation groups were screened using the limma package in R 3.3.1, and survival analysis of these DEGs was performed using the survival package. A risk scoring system was established via regression factor-weighted gene expression based on linear combination to screen the most important genes associated with CLIP4 methylation and prognosis. Genes associated with high/low-risk value were selected using the limma package. Functional enrichment analysis of the top 500 DEGs that positively and negatively associated with risk values was performed using DAVID 6.8 online and the gene set enrichment analysis (GSEA) software. In total, 35 genes were identified to be that significantly associated with prognosis and CLIP4 DNA methylation, and three prognostic signature genes, claudin-11 (CLDN11), apolipoprotein D (APOD), and chordin like 1 (CHRDL1), were used to establish a risk assessment system. The prognostic scoring system exhibited efficiency in classifying patients with different prognoses, where the low-risk groups had significantly longer overall survival times than those in the high-risk groups. CLDN11, APOD and CHRDL1 exhibited reduced expression in the hypermethylation and low-risk groups compare with the hypomethylation and high-risk groups, respectively. Multivariate Cox analysis indicated that risk value could be used as an independent prognostic factor. In functional analysis, six functional gene ontology terms and five GSEA pathways were associated with CLDN11, APOD and CHRDL1. The results established the credibility of the scoring system in this study. Additionally, these three genes, which were significantly associated with CLIP4 DNA methylation and GC risk assessment, were identified as potential prognostic biomarkers. PMID:29901187

Exposure to drinking water disinfection by-products and pregnancy loss.

PubMed

Savitz, David A; Singer, Philip C; Herring, Amy H; Hartmann, Katherine E; Weinberg, Howard S; Makarushka, Christina

2006-12-01

Previous research has suggested that exposure to elevated levels of drinking water disinfection by-products (DBPs) may cause pregnancy loss. In 2000-2004, the authors conducted a study in three US locations of varying DBP levels and evaluated 2,409 women in early pregnancy to assess their tap water DBP concentrations, water use, other risk factors, and pregnancy outcome. Tap water concentrations were measured in the distribution system weekly or biweekly. The authors considered DBP concentration and ingested amount and, for trihalomethanes only, bathing/showering and integrated exposure that included ingestion. On the basis of 258 pregnancy losses, they did not find an increased risk of pregnancy loss in relation to trihalomethane, haloacetic acid, or total organic halide concentrations; ingested amounts; or total exposure. In contrast to a previous study, pregnancy loss was not associated with high personal trihalomethane exposure (> or =75 micro g/liter and > or =5 glasses of water/day) (odds ratio = 1.1, 95% confidence interval: 0.7, 1.7). Sporadic elevations in risk were found across DBPs, most notably for ingested total organic halide (odds ratio = 1.5, 95% confidence interval: 1.0, 2.2 for the highest exposure quintile). These results provide some assurance that drinking water DBPs in the range commonly encountered in the United States do not affect fetal survival.

Dynamic Risk Stratification in Stage I Papillary Thyroid Cancer Patients Younger Than 45 Years of Age.

PubMed

Sung, Tae-Yon; Cho, Jae Won; Lee, Yu-Mi; Lee, Yi Ho; Kwon, Hyemi; Jeon, Min Ji; Kim, Won Gu; Choi, Young Jun; Song, Dong Eun; Chung, Ki-Wook; Yoon, Jong Ho; Hong, Suck Joon

2017-11-01

This study validated the dynamic risk stratification (DRS) system with regard to its association with structural recurrence and risk factors associated with non-excellent responses in patients <45 years with stage I classical papillary thyroid cancer (PTC). This historical cohort study included 598 patients with stage I classical PTC <45 years of age treated with total thyroidectomy followed by radioactive iodine remnant ablation (n = 440), total thyroidectomy without radioactive iodine remnant ablation (n = 23), and thyroid lobectomy alone (n = 135). The median follow-up period was 123 months. Structural recurrence occurred in 4.2% (n = 18/432) of the patients with an excellent response, 17.1% (18/105) of patients with an indeterminate response, 44.7% (17/38) of patients with a biochemically incomplete response, and 82.6% (19/23) of patients with a structurally incomplete response (p < 0.001) during the follow-up. The disease-free survival curves of each response showed significant differences (p < 0.001). Extensive extrathyroidal extension and extranodal extension were the independent risk factors associated with non-excellent response (p < 0.05). DRS may reduce unnecessary additional treatments by reclassifying initial risk estimates of structural recurrence. Furthermore, applying the risk factors associated with non-excellent response to initial therapy may be a more useful and viable surrogate of the risk for structural recurrence in stage I PTC patients <45 years of age.

Higher intake of omega-3 polyunsaturated fatty acids is associated with a decreased risk of a first clinical diagnosis of central nervous system demyelination: Results from the Ausimmune Study.

PubMed

Hoare, Samuel; Lithander, Fiona; van der Mei, Ingrid; Ponsonby, Anne-Louise; Lucas, Robyn

2016-06-01

There is contradictory evidence for a role of dietary fat in risk of multiple sclerosis (MS). To examine the association between usual fat intake (total, saturated, monounsaturated (MUFA), polyunsaturated (PUFA), omega-3 and omega-6) and risk of a first clinical diagnosis of CNS demyelination (FCD). Multi-centre incident case-control study in four regions of Australia during 2003-2006. Cases were aged 18-59 years and had a FCD; controls were matched to a case on age, sex and location. Dietary data were collected using a validated food frequency questionnaire. In 267 cases and 517 controls with dietary data, higher intake (per g/day) of omega-3 PUFA (adjusted odds ratio, AOR=0.61 (95% CI 0.40-0.93)), and particularly that derived from fish (AOR=0.54 (95% CI 0.31-0.93)) rather than from plants (AOR=0.75 (95% CI 0.39-1.43)) was associated with a decreased risk of FCD. Total fat intake and intake of other types of fat were not associated with FCD risk. There was a significant decrease in FCD risk with higher intake of omega-3 PUFA, particularly that originating from fish. There was no evidence to indicate that the intake of other types of dietary fat or fat quantity in the previous 12 months was associated with an altered risk of FCD. © The Author(s), 2015.

Cardiovascular risk assessment of South Asians in a religious setting: a feasibility study.

PubMed

Rao, N; Eastwood, S V; Jain, A; Shah, M; Leurent, B; Harvey, D; Robertson, L; Walters, K; Persaud, J W; Mikhailidis, D P; Nair, D R

2012-03-01

South Asians in the UK have high cardiovascular disease (CVD) mortality. Therefore, this population is likely to benefit from screening programmes. To address this issue, an initiative was set up between the Royal Free Hampstead NHS Trust, H.E.A.R.T. UK and two Hindu temples in North London to provide screening for CVD risk factors in the community. A total of 434 individuals of Gujarati Indian origin were screened. Measurements included anthropometry, blood pressure and lipid profiles. Three different scoring systems: Framingham, Joint British Societies' 2 and QRISK2 were used to estimate CVD risk. At least one modifiable CVD risk factor was present in 92% of the individuals screened; 52% were hypertensive, 40% were obese, 75% had central adiposity and 10% had total cholesterol/high density lipoprotein cholesterol ratio > 6. In addition, 37% of a subset of 104 individuals with a fasting sample fulfilled the diagnostic criteria for metabolic syndrome. Overall, 15% of participants screened had a 10-year CV risk score > 20% using QRISK2. The three risk score calculators showed moderate agreement: QRISK2 and JBS2 (kappa 0.61, 95% CI 0.54-0.67), QRISK2 and Framingham (kappa 0.63, 95% CI 0.57-0.70) and JBS2 and Framingham (kappa 0.70, 95% CI 0.64-0.75). A high prevalence of modifiable risk factors for CVD was detected in the population screened. © 2011 Blackwell Publishing Ltd.

Bone mineral density in subjects using central nervous system-active medications.

PubMed

Kinjo, Mitsuyo; Setoguchi, Soko; Schneeweiss, Sebastian; Solomon, Daniel H

2005-12-01

Decreased bone mineral density defines osteoporosis according to the World Health Organization and is an important predictor of future fractures. The use of several types of central nervous system-active drugs, including benzodiazepines, anticonvulsants, antidepressants, and opioids, have all been associated with increased risk of fracture. However, it is unclear whether such an increase in risk is related to an effect of bone mineral density or to other factors, such as increased risk of falls. We sought to examine the relationship between bone mineral density and the use of benzodiazepines, anticonvulsants, antidepressants, and opioids in a representative US population-based sample. We analyzed data on adults aged 17 years and older from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). Total femoral bone mineral density of 7114 male and 7532 female participants was measured by dual-energy x-ray absorptiometry. Multivariable linear regression models were used to quantify the relation between central nervous system medication exposure and total femoral bone mineral density. Models controlled for relevant covariates, including age, sex, and body mass index. In linear regression models, significantly reduced bone mineral density was found in subjects taking anticonvulsants (0.92 g/cm2; 95% confidence interval [CI]: 0.89 to 0.94) and opioids (0.92 g/cm2; 95% CI: 0.88 to 0.95) compared with nonusers (0.95 g/cm2; 95% CI: 0.95 to 0.95) after adjusting for several potential confounders. The other central nervous system-active drugs--benzodiazepines or antidepressants--were not associated with significantly reduced bone mineral density. In cross-sectional analysis of NHANES III, anticonvulsants and opioids (but not benzodiazepines or antidepressants) were associated with significantly reduced bone mineral density. These findings have implications for fracture-prevention strategies.

Preliminary stochastic model for managing Vibrio parahaemolyticus and total viable bacterial counts in a Pacific oyster (Crassostrea gigas) supply chain.

PubMed

Fernandez-Piquer, Judith; Bowman, John P; Ross, Tom; Estrada-Flores, Silvia; Tamplin, Mark L

2013-07-01

Vibrio parahaemolyticus can accumulate and grow in oysters stored without refrigeration, representing a potential food safety risk. High temperatures during oyster storage can lead to an increase in total viable bacteria counts, decreasing product shelf life. Therefore, a predictive tool that allows the estimation of both V. parahaemolyticus populations and total viable bacteria counts in parallel is needed. A stochastic model was developed to quantitatively assess the populations of V. parahaemolyticus and total viable bacteria in Pacific oysters for six different supply chain scenarios. The stochastic model encompassed operations from oyster farms through consumers and was built using risk analysis software. Probabilistic distributions and predictions for the percentage of Pacific oysters containing V. parahaemolyticus and high levels of viable bacteria at the point of consumption were generated for each simulated scenario. This tool can provide valuable information about V. parahaemolyticus exposure and potential control measures and can help oyster companies and regulatory agencies evaluate the impact of product quality and safety during cold chain management. If coupled with suitable monitoring systems, such models could enable preemptive action to be taken to counteract unfavorable supply chain conditions.

XPA A23G polymorphism and risk of digestive system cancers: a meta-analysis.

PubMed

He, Lei; Deng, Tao; Luo, Hesheng

2015-01-01

Several studies have reported an association between the A23G polymorphism (rs 1800975) in the xeroderma pigmentosum group A (XPA) gene and risk of digestive system cancers. However, the results are inconsistent. In this study, we performed a meta-analysis to assess the association between XPA A23G polymorphism and the risk of digestive system cancers. Relevant studies were identified using the PubMed, Web of Science, China National Knowledge Infrastructure, WanFang, and VIP databases up to August 30, 2014. The pooled odds ratio (OR) with a 95% confidence interval (CI) was calculated using the fixed or random effects model. A total of 18 case-control studies from 16 publications with 4,170 patients and 6,929 controls were included. Overall, no significant association was found between XPA A23G polymorphism and the risk of digestive system cancers (dominant model: GA + AA versus GG, OR 0.89, 95% CI 0.74-1.08; recessive model: AA versus GA + GG, OR 0.94, 95% CI 0.74-1.20; GA versus GG, OR 0.89, 95% CI 0.77-1.03; and AA versus GG, OR 0.87, 95% CI 0.64-1.19). When the analysis was stratified by ethnicity, similar results were observed among Asians and Caucasians in all genetic models. In stratified analysis based on tumor type, we also failed to detect any association between XPA A23G polymorphism and the risk of esophageal, gastric, or colorectal cancers. This meta-analysis indicates that the XPA A23G polymorphism is not associated with a risk of digestive system cancers.

Cost-benefit analysis of biopsy methods for suspicious mammographic lesions; discussion 994-5.

PubMed

Fahy, B N; Bold, R J; Schneider, P D; Khatri, V; Goodnight, J E

2001-09-01

Stereotactic core biopsy (SCB) is more cost-effective than needle-localized biopsy (NLB) for evaluation and treatment of mammographic lesions. A computer-generated mathematical model was developed based on clinical outcome modeling to estimate costs accrued during evaluation and treatment of suspicious mammographic lesions. Total costs were determined for evaluation and subsequent treatment of cancer when either SCB or NLB was used as the initial biopsy method. Cost was estimated by the cumulative work relative value units accrued. The risk of malignancy based on the Breast Imaging Reporting Data System (BIRADS) score and mammographic suspicion of ductal carcinoma in situ were varied to simulate common clinical scenarios. Total cost accumulated during evaluation and subsequent surgical therapy (if required). Evaluation of BIRADS 5 lesions (highly suggestive, risk of malignancy = 90%) resulted in equivalent relative value units for both techniques (SCB, 15.54; NLB, 15.47). Evaluation of lesions highly suspicious for ductal carcinoma in situ yielded similar total treatment relative value units (SCB, 11.49; NLB, 10.17). Only for evaluation of BIRADS 4 lesions (suspicious abnormality, risk of malignancy = 34%) was SCB more cost-effective than NLB (SCB, 7.65 vs. NLB, 15.66). No difference in cost-benefit was found when lesions highly suggestive of malignancy (BIRADS 5) or those suspicious for ductal carcinoma in situ were evaluated initially with SCB vs. NLB, thereby disproving the hypothesis. Only for intermediate-risk lesions (BIRADS 4) did initial evaluation with SCB yield a greater cost savings than with NLB.

Strategic supply system design - a holistic evaluation of operational and production cost for a biorefinery supply chain

DOE PAGES

Lamers, Patrick; Tan, Eric C. D.; Searcy, Erin M.; ...

2015-08-20

Here, pioneer cellulosic biorefineries across the United States rely on a conventional feedstock supply system based on one-year contracts with local growers, who harvest, locally store, and deliver feed-stock in low-density format to the conversion facility. While the conventional system is designed for high biomass yield areas, pilot scale operations have experienced feedstock supply shortages and price volatilities due to reduced harvests and competition from other industries. Regional supply dependency and the inability to actively manage feedstock stability and quality, provide operational risks to the biorefinery, which translate into higher investment risk. The advanced feedstock supply system based on amore » network of depots can mitigate many of these risks and enable wider supply system benefits. This paper compares the two concepts from a system-level perspective beyond mere logistic costs. It shows that while processing operations at the depot increase feedstock supply costs initially, they enable wider system benefits including supply risk reduction (leading to lower interest rates on loans), industry scale-up, conversion yield improvements, and reduced handling equipment and storage costs at the biorefinery. When translating these benefits into cost reductions per liter of gasoline equivalent (LGE), we find that total cost reductions between -0.46 to -0.21 per LGE for biochemical and -0.32 to -0.12 per LGE for thermochemical conversion pathways are possible. Naturally, these system level benefits will differ between individual actors along the feedstock supply chain. Further research is required with respect to depot sizing, location, and ownership structures.« less

Strategic supply system design - a holistic evaluation of operational and production cost for a biorefinery supply chain

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

Lamers, Patrick; Tan, Eric C. D.; Searcy, Erin M.

Here, pioneer cellulosic biorefineries across the United States rely on a conventional feedstock supply system based on one-year contracts with local growers, who harvest, locally store, and deliver feed-stock in low-density format to the conversion facility. While the conventional system is designed for high biomass yield areas, pilot scale operations have experienced feedstock supply shortages and price volatilities due to reduced harvests and competition from other industries. Regional supply dependency and the inability to actively manage feedstock stability and quality, provide operational risks to the biorefinery, which translate into higher investment risk. The advanced feedstock supply system based on amore » network of depots can mitigate many of these risks and enable wider supply system benefits. This paper compares the two concepts from a system-level perspective beyond mere logistic costs. It shows that while processing operations at the depot increase feedstock supply costs initially, they enable wider system benefits including supply risk reduction (leading to lower interest rates on loans), industry scale-up, conversion yield improvements, and reduced handling equipment and storage costs at the biorefinery. When translating these benefits into cost reductions per liter of gasoline equivalent (LGE), we find that total cost reductions between -0.46 to -0.21 per LGE for biochemical and -0.32 to -0.12 per LGE for thermochemical conversion pathways are possible. Naturally, these system level benefits will differ between individual actors along the feedstock supply chain. Further research is required with respect to depot sizing, location, and ownership structures.« less

The introduction of an acute physiological support service for surgical patients is an effective error reduction strategy.

PubMed

Clarke, D L; Kong, V Y; Naidoo, L C; Furlong, H; Aldous, C

2013-01-01

Acute surgical patients are particularly vulnerable to human error. The Acute Physiological Support Team (APST) was created with the twin objectives of identifying high-risk acute surgical patients in the general wards and reducing both the incidence of error and impact of error on these patients. A number of error taxonomies were used to understand the causes of human error and a simple risk stratification system was adopted to identify patients who are particularly at risk of error. During the period November 2012-January 2013 a total of 101 surgical patients were cared for by the APST at Edendale Hospital. The average age was forty years. There were 36 females and 65 males. There were 66 general surgical patients and 35 trauma patients. Fifty-six patients were referred on the day of their admission. The average length of stay in the APST was four days. Eleven patients were haemo-dynamically unstable on presentation and twelve were clinically septic. The reasons for referral were sepsis,(4) respiratory distress,(3) acute kidney injury AKI (38), post-operative monitoring (39), pancreatitis,(3) ICU down-referral,(7) hypoxia,(5) low GCS,(1) coagulopathy.(1) The mortality rate was 13%. A total of thirty-six patients experienced 56 errors. A total of 143 interventions were initiated by the APST. These included institution or adjustment of intravenous fluids (101), blood transfusion,(12) antibiotics,(9) the management of neutropenic sepsis,(1) central line insertion,(3) optimization of oxygen therapy,(7) correction of electrolyte abnormality,(8) correction of coagulopathy.(2) CONCLUSION: Our intervention combined current taxonomies of error with a simple risk stratification system and is a variant of the defence in depth strategy of error reduction. We effectively identified and corrected a significant number of human errors in high-risk acute surgical patients. This audit has helped understand the common sources of error in the general surgical wards and will inform on-going error reduction initiatives. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Helminth eggs as parasitic indicators of fecal contamination in agricultural irrigation water, biosolids, soils and pastures.

PubMed

Campos, María Claudia; Beltrán, Milena; Fuentes, Nancy; Moreno, Gerardo

2018-03-15

A very common practice in agriculture is the disposal of wastewater and biosolids from water treatment systems due to their high nutrient content, which substantially improves crop yields. However, the presence of pathogens of fecal origin creates a sanitary risk to farmers and consumers. To determine the presence and concentration of helminth eggs in irrigation waters, biosolids, agricultural soils, and pastures. Water, biosolids, soil, and pasture samples were collected and analyzed for helminth egg detection, total eggs and viable eggs counts. The behavior of helminth eggs was evaluated in irrigation waters and dairy cattle grassland, where biosolids had been used as an organic amendment. Concentrations between 0.1-3 total helminth eggs/L, and 0.1-1 viable helminth eggs/L were found in water. In biosolids and soil, we found 3-22 total helminth eggs/4 g of dry weight, and 2-12 viable helminth eggs/4 g of dry weight, and in grass, we found <2-9 total helminth eggs/g of fresh weight, and <1-3 viable helminth eggs/g of fresh weight. The presence of helminth eggs in each matrix varied from days to months, which may represent a sanitary risk to farmers as well as to consumers. The presence of helminth eggs in the assessed matrixes confirms the sanitary risk of such practices. Therefore, it is important to control and incorporate regulations related to the use of wastewater and biosolids in agriculture.

Preseason Workload Volume and High-Risk Periods for Noncontact Injury Across Multiple Australian Football League Seasons.

PubMed

Colby, Marcus J; Dawson, Brian; Heasman, Jarryd; Rogalski, Brent; Rosenberg, Michael; Lester, Leanne; Peeling, Peter

2017-07-01

Colby, MJ, Dawson, B, Heasman, J, Rogalski, B, Rosenberg, M, Lester, L, and Peeling, P. Preseason workload volume and high-risk periods for noncontact injury across multiple Australian Football League seasons. J Strength Cond Res 31(7): 1821-1829, 2017-The purpose of this study was to assess the association between preseason workloads and noncontact injury risk in Australian football players. Individual player injury data were recorded over 4 full seasons (2012-15) from one professional club. Noncontact injury incidence (per 1,000 "on legs" field training and game hours) was compared across the preseason, precompetition, and in-season phases to determine relative noncontact injury risk. Preseason workloads (global positioning system-derived total distance run and sprint distance) and individual (fixed) injury risk factors (age, previous injury history) were incorporated into the analysis. A generalized estimating equation with a binary logistic function modeled potential risk factors with noncontact injury for selected periods across the annual cycle. Odds ratios were calculated to determine the relative injury risk. The (preseason) precompetition phase (19.1 injuries per 1,000 hours) and (in-season) rounds 12-17 (16.0 injuries per 1,000 hours) resulted in the highest injury incidence. Low cumulative total distances in late preseason (<108 km) and precompetition (76-88 km) periods were associated with significantly (p ≤ 0.05) greater injury risk during the in-season phase. In conclusion, these results suggest players are at the greatest injury risk during the precompetition period, with low preseason cumulative workloads associated with increased in-season injury risk. Therefore, strength and conditioning staff should place particular emphasis on achieving at least moderate training loads during and leading into this phase, where competitive game play is first introduced.

High serum total cholesterol is a long-term cause of osteoporotic fracture.

PubMed

Trimpou, P; Odén, A; Simonsson, T; Wilhelmsen, L; Landin-Wilhelmsen, K

2011-05-01

Risk factors for osteoporotic fractures were evaluated in 1,396 men and women for a period of 20 years. Serum total cholesterol was found to be an independent osteoporotic fracture risk factor whose predictive power improves with time. The purpose of this study was to evaluate long-term risk factors for osteoporotic fracture. A population random sample of men and women aged 25-64 years (the Gothenburg WHO MONICA project, N = 1,396, 53% women) was studied prospectively. The 1985 baseline examination recorded physical activity at work and during leisure time, psychological stress, smoking habits, coffee consumption, BMI, waist/hip ratio, blood pressure, total, HDL and LDL cholesterol, triglycerides, and fibrinogen. Osteoporotic fractures over a period of 20 years were retrieved from the Gothenburg hospital registers. Poisson regression was used to analyze the predictive power for osteoporotic fracture of each risk factor. A total number of 258 osteoporotic fractures occurred in 143 participants (10.2%). As expected, we found that previous fracture, smoking, coffee consumption, and lower BMI each increase the risk for osteoporotic fracture independently of age and sex. More unexpectedly, we found that the gradient of risk of serum total cholesterol to predict osteoporotic fracture significantly increases over time (p = 0.0377). Serum total cholesterol is an independent osteoporotic fracture risk factor whose predictive power improves with time. High serum total cholesterol is a long-term cause of osteoporotic fracture.

Collagen content as a risk factor in breast cancer? A pilot clinical study

NASA Astrophysics Data System (ADS)

Pifferi, Antonio; Quarto, Giovanna; Abbate, Francesca; Balestreri, Nicola; Menna, Simona; Cassano, Enrico; Cubeddu, Rinaldo; Taroni, Paola

2015-07-01

A retrospective pilot clinical study on time domain multi-wavelength (635 to 1060 nm) optical mammography was exploited to assess collagen as a breast-cancer risk factor on a total of 109 subjects (53 healthy and 56 with malignant lesions). An increased cancer occurrence is observed on the 15% subset of patients with higher age-matched collagen content. Further, a similar clustering based on the percentage breast density leads to a different set of patients, possibly indicating collagen as a new independent breast cancer risk factor. If confirmed statistically and on larger numbers, these results could have huge impact on personalized diagnostics, health care systems, as well as on basic research.

Feasibility of using the International Classification of Functioning, Disability and Health Core Set for evaluation of fall-related risk factors in acute rehabilitation settings.

PubMed

Huang, Shih W; Lin, Li F; Chou, Lin C; Wu, Mei J; Liao, Chun D; Liou, Tsan H

2016-04-01

Previously, we reported the use of an International Classification of Functioning (ICF) core set that can provide a holistic framework for evaluating the risk factors of falls; however, data on the feasibility of applying this core set are lacking. To investigate the feasibility of applying the fall-related ICF risk-factor core set in the case of patients in an acute-rehabilitation setting. A cross-sectional and descriptive correlational design. Acute-rehabilitation ward. A total of 273 patients who experienced fall at acute-rehabilitation ward. The data on falls were collected from the hospital's Nursing Information System (NIS) and the fall-reporting system (Adverse Event Reporting System, AERS) between 2010 and 2013. The relationship of both systems to the fall-related ICF core set was analyzed to assess the feasibility of their clinical application. We evaluated the feasibility of using the fall-related ICF risk-factor core set by using the frequency and the percentage of the fall patients in of the listed categories. The fall-related ICF risk-factor core set category b735 (muscle tone functions) exhibited a high feasibility (85.95%) for clinical application, and the category b730 (muscle power functions) covered 77.11% of the patients. The feasibility of application of the category d410 (change basic body position) was also high in the case of all fall patients (81.69%). In the acute-rehabilitation setting, the feasibility of application of the fall-related ICF risk-factor core set is high. The fall-related ICF risk-factor core set can help multidisciplinary teams develop fall-prevention strategies in acute rehabilitation wards.

Systemic Inflammation-Based Biomarkers and Survival in HIV-Positive Subject With Solid Cancer in an Italian Multicenter Study.

PubMed

Raffetti, Elena; Donato, Francesco; Pezzoli, Chiara; Digiambenedetto, Simona; Bandera, Alessandra; Di Pietro, Massimo; Di Filippo, Elisa; Maggiolo, Franco; Sighinolfi, Laura; Fornabaio, Chiara; Castelnuovo, Filippo; Ladisa, Nicoletta; Castelli, Francesco; Quiros Roldan, Eugenia

2015-08-15

Recently, some systemic inflammation-based biomarkers have been demonstrated useful for predicting risk of death in patients with solid cancer independently of tumor characteristics. This study aimed to investigate the prognostic role of systemic inflammation-based biomarkers in HIV-infected patients with solid tumors and to propose a risk score for mortality in these subjects. Clinical and pathological data on solid AIDS-defining cancer (ADC) and non-AIDS-defining cancer (NADC), diagnosed between 1998 and 2012 in an Italian cohort, were analyzed. To evaluate the prognostic role of systemic inflammation- and nutrition-based markers, univariate and multivariable Cox regression models were applied. To compute the risk score equation, the patients were randomly assigned to a derivation and a validation sample. A total of 573 patients (76.3% males) with a mean age of 46.2 years (SD = 10.3) were enrolled. 178 patients died during a median of 3.2 years of follow-up. For solid NADCs, elevated Glasgow Prognostic Score, modified Glasgow Prognostic Score, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and Prognostic Nutritional Index were independently associated with risk of death; for solid ADCs, none of these markers was associated with risk of death. For solid NADCs, we computed a mortality risk score on the basis of age at cancer diagnosis, intravenous drug use, and Prognostic Nutritional Index. The areas under the receiver operating characteristic curve were 0.67 (95% confidence interval: 0.58 to 0.75) in the derivation sample and 0.66 (95% confidence interval: 0.54 to 0.79) in the validation sample. Inflammatory biomarkers were associated with risk of death in HIV-infected patients with solid NADCs but not with ADCs.

Why the Eurocontrol Safety Regulation Commission Policy on Safety Nets and Risk Assessment is Wrong

NASA Astrophysics Data System (ADS)

Brooker, Peter

2004-05-01

Current Eurocontrol Safety Regulation Commission (SRC) policy says that the Air Traffic Management (ATM) system (including safety minima) must be demonstrated through risk assessments to meet the Target Level of Safety (TLS) without needing to take safety nets (such as Short Term Conflict Alert) into account. This policy is wrong. The policy is invalid because it does not build rationally and consistently from ATM's firm foundations of TLS and hazard analysis. The policy is bad because it would tend to retard safety improvements. Safety net policy must rest on a clear and rational treatment of integrated ATM system safety defences. A new safety net policy, appropriate to safe ATM system improvements, is needed, which recognizes that safety nets are an integrated part of ATM system defences. The effects of safety nets in reducing deaths from mid-air collisions should be fully included in hazard analysis and safety audits in the context of the TLS for total system design.

Portfolio analysis of layered security measures.

PubMed

Chatterjee, Samrat; Hora, Stephen C; Rosoff, Heather

2015-03-01

Layered defenses are necessary for protecting the public from terrorist attacks. Designing a system of such defensive measures requires consideration of the interaction of these countermeasures. In this article, we present an analysis of a layered security system within the lower Manhattan area. It shows how portfolios of security measures can be evaluated through portfolio decision analysis. Consideration is given to the total benefits and costs of the system. Portfolio diagrams are created that help communicate alternatives among stakeholders who have differing views on the tradeoffs between security and economic activity. © 2014 Society for Risk Analysis.

Risk management for the Space Exploration Initiative

NASA Technical Reports Server (NTRS)

Buchbinder, Ben

1993-01-01

Probabilistic Risk Assessment (PRA) is a quantitative engineering process that provides the analytic structure and decision-making framework for total programmatic risk management. Ideally, it is initiated in the conceptual design phase and used throughout the program life cycle. Although PRA was developed for assessment of safety, reliability, and availability risk, it has far greater application. Throughout the design phase, PRA can guide trade-off studies among system performance, safety, reliability, cost, and schedule. These studies are based on the assessment of the risk of meeting each parameter goal, with full consideration of the uncertainties. Quantitative trade-off studies are essential, but without full identification, propagation, and display of uncertainties, poor decisions may result. PRA also can focus attention on risk drivers in situations where risk is too high. For example, if safety risk is unacceptable, the PRA prioritizes the risk contributors to guide the use of resources for risk mitigation. PRA is used in the Space Exploration Initiative (SEI) Program. To meet the stringent requirements of the SEI mission, within strict budgetary constraints, the PRA structure supports informed and traceable decision-making. This paper briefly describes the SEI PRA process.

Trace Elements Contamination and Human Health Risk Assessment in Drinking Water from the Agricultural and Pastoral Areas of Bay County, Xinjiang, China

PubMed Central

Turdi, Muyessar; Yang, Linsheng

2016-01-01

Tap water samples were collected from 180 families in four agricultural (KYR: Keyir, KRW: Kariwak, YTR: Yatur, DW: Dawanqi) and two pastoral areas (B: Bulong and Y: Yangchang) in Bay County, Xinjiang, China, and levels of seven trace elements (Cd, Cr, As Ni, Pb, Zn, Se) were analyzed using inductively-coupled plasma mass spectrometry (ICP-MS) to assess potential health risks. Remarkable spatial variations of contamination were observed. Overall, the health risk was more severe for carcinogenic versus non-carcinogenic pollutants due to heavy metal. The risk index was greater for children overall (Cr > As > Cd and Zn > Se for carcinogenic and non-carcinogenic elements, respectively). The total risk index was greater in agricultural areas (DW > KYR > YTR > KRW > B > Y). Total risk indices were greater where well water was the source versus fountain water; for the latter, the total health risk index was greater versus glacier water. Main health risk factors were Cr and As in DW, KYR, YTR, KRW, and B, and Zn, Cr, and As in the Y region. Overall, total trace element–induced health risk (including for DW adults) was higher than acceptable (10−6) and lower than priority risk levels (10−4) (KYR, YTR, KRW, Y, and B). For DW children, total health risk reached 1.08 × 10−4, higher than acceptable and priority risk levels (10−4). PMID:27669274

Cancer Seeding Risk from an Epidural Blood Patch in Patients with Leukemia or Lymphoma.

PubMed

Demaree, Christopher J; Soliz, Jose M; Gebhardt, Rodolfo

2017-04-01

Lumber punctures are a common procedure in patients with cancer. However, a potential complication of a lumbar puncture is a postdural puncture headache. The risk of neoplastic seeding to the central nervous system has led to concern over performing epidural blood patches (EBPs) for the treatment of postdural puncture headaches in patients with cancer. The goal of this retrospective study was to evaluate cancer seeding in the central nervous system in patients diagnosed with leukemia or lymphoma. Institutional electronic records were queried over a 13-year period from 2000 to 2013 for patients with leukemia and/or lymphoma and who received at least one EBP. Demographic and procedural data, cancer treatments, and mortality were all examined. Patient records were reviewed for evidence of new-onset neoplastic central nervous system seeding after an epidural blood patch. A total of 80 patients were identified for review. Eighteen patients had a diagnosis of leukemia, and 62 had lymphoma. Following an EBP, none of the patients experienced new cancer or cancer seeding in the central nervous system following an epidural blood patch at a median follow-up of 3.74 years. Though the risks of EBP in the cancer patient population have been hypothesized, no previous studies have assessed the risk of seeding cancer to the central nervous system. Based on our results, an epidural blood patch bears low risk of cancer seeding when used to treat postdural puncture headache that is unresponsive to conservative treatments. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

The risk of upcoding in casemix systems: a comparative study.

PubMed

Steinbusch, Paul J M; Oostenbrink, Jan B; Zuurbier, Joost J; Schaepkens, Frans J M

2007-05-01

With the introduction of a diagnosis related group (DRG) classification system in the Netherlands in 2005 it has become relevant to investigate the risk of upcoding. The problem of upcoding in the US casemix system is substantial. In 2004, the US Centres for Medicare and Medicaid estimated that the total number of improper Medicare payments for the Prospective Payment system for acute inpatient care (both short term and long term) amounted to US$ 4.8 billion (5.2%). By comparing the casemix systems in the US, Australian and Dutch healthcare systems, this article illustrates why certain casemix systems are more open to the risk of upcoding than other systems. This study identifies various market, control and casemix characteristics determining the weaknesses of a casemix reimbursement system to upcoding. It can be concluded that fewer opportunities for upcoding occur in casemix systems that do not allow for-profit ownership and in which the coder's salary does not depend on the outcome of the classification process. In addition, casemix systems in which the first point in time of registration is at the beginning of the care process and in which there are a limited number of occasions to alter the registration are less vulnerable to the risk of upcoding. Finally, the risk of upcoding is smaller in casemix systems that use classification criteria that are medically meaningful and aligned with clinical practice. Comparing the US, Australian and Dutch systems the following conclusions can be drawn. Given the combined occurrences of for-profit hospitals and the use of the secondary diagnosis criterion to classify DRGs, the US casemix system tends to be more open to upcoding than the Australian system. The strength of the Dutch system is related to the detailed classification scheme, using medically meaningful classification criteria. Nevertheless, the detailed classification scheme also causes a weakness, because of its increased complexity compared with the US and Australian system. It is recommended that researchers and policy makers carefully consider all relevant market, control and casemix characteristics when developing and restructuring casemix reimbursement systems.

Automated systems to identify relevant documents in product risk management

PubMed Central

2012-01-01

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

Program risk analysis handbook

NASA Technical Reports Server (NTRS)

Batson, R. G.

1987-01-01

NASA regulations specify that formal risk analysis be performed on a program at each of several milestones. Program risk analysis is discussed as a systems analysis approach, an iterative process (identification, assessment, management), and a collection of techniques. These techniques, which range from extremely simple to complex network-based simulation, are described in this handbook in order to provide both analyst and manager with a guide for selection of the most appropriate technique. All program risk assessment techniques are shown to be based on elicitation and encoding of subjective probability estimates from the various area experts on a program. Techniques to encode the five most common distribution types are given. Then, a total of twelve distinct approaches to risk assessment are given. Steps involved, good and bad points, time involved, and degree of computer support needed are listed. Why risk analysis should be used by all NASA program managers is discussed. Tools available at NASA-MSFC are identified, along with commercially available software. Bibliography (150 entries) and a program risk analysis check-list are provided.

SAFE LOCALIZATION FOR PLACEMENT OF PERCUTANEOUS PINS IN THE CALCANEUS.

PubMed

Labronici, Pedro José; Pereira, Diogo do Nascimento; Pilar, Pedro Henrique Vargas Moreira; Franco, José Sergio; Serra, Marcos Donato; Cohen, José Carlos; Bitar, Rogério Carneiro

2012-01-01

To determine the areas presenting risk in six zones of the calcaneus, and to quantify the risks of injury to the anatomical structures (artery, vein, nerve and tendon). Fifty-three calcanei from cadavers were used, divided into three zones and each subdivided in two areas (upper and lower) by means of a longitudinal line through the calcaneus. The risk of injury to the anatomical structures in relation to each Kirschner wire was determined using a graded system according to the Licht classification. The total risk of injury to the anatomical structures through placement of more than one wire was quantified using the additive law of probabilities and the product law for independent events. The injury risk calculation according to the Licht classification showed that the highest risk of injury to the artery or vein was in zone IA (43%), in relation to injuries to nerves and tendons (13% and 0%, respectively). This study made it possible to identify the most vulnerable anatomical structures and quantify the risk of injury to the calcaneus.

Assessing for suicidal behavior in youth using the Achenbach System of Empirically Based Assessment.

PubMed

Van Meter, Anna R; Algorta, Guillermo Perez; Youngstrom, Eric A; Lechtman, Yana; Youngstrom, Jen K; Feeny, Norah C; Findling, Robert L

2018-02-01

This study investigated the clinical utility of the Achenbach System of Empirically Based Assessment (ASEBA) for identifying youth at risk for suicide. Specifically, we investigated how well the Total Problems scores and the sum of two suicide-related items (#18 "Deliberately harms self or attempts suicide" and #91 "Talks about killing self") were able to distinguish youth with a history of suicidal behavior. Youth (N = 1117) aged 5-18 were recruited for two studies of mental illness. History of suicidal behavior was assessed by semi-structured interviews (K-SADS) with youth and caregivers. Youth, caregivers, and a primary teacher each completed the appropriate form (YSR, CBCL, and TRF, respectively) of the ASEBA. Areas under the curve (AUCs) from ROC analyses and diagnostic likelihood ratios (DLRs) were used to measure the ability of both Total Problems T scores, as well as the summed score of two suicide-related items, to identify youth with a history of suicidal behavior. The Suicide Items from the CBCL and YSR performed well (AUCs = 0.85 and 0.70, respectively). The TRF Suicide Items did not perform better than chance, AUC = 0.45. The AUCs for the Total Problems scores were poor-to-fair (0.33-0.65). The CBCL Suicide Items outperformed all other scores (ps = 0.04 to <0.0005). Combining the CBCL and YSR items did not lead to incremental improvement in prediction over the CBCL alone. The sum of two questions from a commonly used assessment tool can offer important information about a youth's risk for suicidal behavior. The low burden of this approach could facilitate wide-spread screening for suicide in an increasingly at-risk population.

Retention for Stoploss reinsurance to minimize VaR in compound Poisson-Lognormal distribution

NASA Astrophysics Data System (ADS)

Soleh, Achmad Zanbar; Noviyanti, Lienda; Nurrahmawati, Irma

2015-12-01

Automobile insurance is one of the emerging general insurance's product in Indonesia. Fluctuation in total premium revenues and total claim expenses leads to a risk that insurance company can not be able to pay consumer's claims, thus reinsurance is needeed. Reinsurance is a risk transfer mechanism from the insurance company to another company called reinsurer, one of the reinsurance type is Stoploss. Because reinsurer charges premium to the insurance company, it is important to determine the retention or the total claims to be retain solely by the insurance company. Thus, retention is determined using Value at Risk (VaR) which minimize the total risk of the insurance company in the presence of Stoploss reinsurance. Retention depends only on the distribution of total claims and reinsurance loading factor. We use the compound Poisson distribution and the Log-Normal Distribution to illustrate the retention value in a collective risk model.

Field drains as a route of rapid nutrient export from agricultural land receiving biosolids.

PubMed

Heathwaite, A L; Burke, S P; Bolton, L

2006-07-15

We report research on the environmental risk of incidental nutrient transfers from land to water for biosolids amended soils. We show that subsurface (drainflow) pathways of P transport may result in significant concentrations, up to 10 mg total P l(-1), in the drainage network of an arable catchment when a P source (recent biosolids application) coincides with a significant and active transport pathway (rainfall event). However, the high P concentrations were short-lived, with drainage ditch total P concentrations returning to pre-storm concentrations within a few days of the storm event. In the case of the drainflow concentrations reported here, the results are unusual in that they describe an 'incidental event' for a groundwater catchment where such events might normally be expected to be rare owing to the capacity of the hydrological system to attenuate nutrient fluxes for highly adsorbed elements such as P. Consequently, there is a potential risk of P transfers to shallow groundwater systems. We suggest that the findings are not specific to biosolids-alone, which is a highly regulated industry, but that similar results may be anticipated had livestock waste or mineral fertilizer been applied, although the magnitude of losses may differ. The risk appears to be more one of timing and the availability of a rapid transport pathway than of P source.

Effects of butter from mountain-pasture grazing cows on risk markers of the metabolic syndrome compared with conventional Danish butter: a randomized controlled study

PubMed Central

2013-01-01

Background There is considerable interest in dairy products from low-input systems, such as mountain-pasture grazing cows, because these products are believed to be healthier than products from high-input conventional systems. This may be due to a higher content of bioactive components, such as phytanic acid, a PPAR-agonist derived from chlorophyll. However, the effects of such products on human health have been poorly investigated. Objective To compare the effect of milk-fat from mountain-pasture grazing cows (G) and conventionally fed cows (C) on risk markers of the metabolic syndrome. Design In a double-blind, randomized, 12-week, parallel intervention study, 38 healthy subjects replaced part of their habitual dietary fat intake with 39 g fat from test butter made from milk from mountain-pasture grazing cows or from cows fed conventional winter fodder. Glucose-tolerance and circulating risk markers were analysed before and after the intervention. Results No differences in blood lipids, lipoproteins, hsCRP, insulin, glucose or glucose-tolerance were observed. Interestingly, strong correlations between phytanic acid at baseline and total (P<0.0001) and LDL cholesterol (P=0.0001) were observed. Conclusions Lack of effects on blood lipids and inflammation indicates that dairy products from mountain-pasture grazing cows are not healthier than products from high-input conventional systems. Considering the strong correlation between LDL cholesterol and phytanic acid at baseline, it may be suggested that phytanic acid increases total and LDL cholesterol. Trial registration ClinicalTrials.gov, NCT01343589 PMID:23842081

Ethnic differences in risk factors and total risk of cardiovascular disease based on the Norwegian CONOR study.

PubMed

Rabanal, Kjersti S; Lindman, Anja S; Selmer, Randi M; Aamodt, Geir

2013-12-01

Risk of cardiovascular disease varies between ethnic groups and the aim of this study was to investigate differences in cardiovascular risk factors, and total cardiovascular risk between ethnic groups in Norway. Cross-sectional study using data from the Cohort of Norway (CONOR). A sample of 62,145 participants, 40-65 years of age, originating from 11 geographical regions, were included in our study. Self-reported variables, blood samples and physical measurements were used to estimate age- and time-adjusted mean values of cardiovascular risk factors for different ethnic groups. The 10-year risks of cardiovascular mortality and cardiovascular events were calculated using the Framingham and NORRISK risk models. We observed differences between ethnic groups for cardiovascular risk factors and both Framingham and NORRISK risk scores. NORRISK showed significant differences by ethnicity in women only. Immigrants from the Indian subcontinent had the lowest high-density lipoprotein (HDL) levels, the highest levels of blood glucose, triglycerides, total cholesterol/HDL ratio, waist hip ratio and diabetes prevalence. Immigrants from the former Yugoslavia had the highest Framingham scores, high blood pressure, high total cholesterol/HDL ratio, overweight measures and smoking. Low cardiovascular risk was observed among East Asian immigrants. The previously reported excess cardiovascular risk among immigrants from the Indian subcontinent was supported in this study. We also showed that immigrants from the former Yugoslavian countries had a higher total 10-year risk of cardiovascular events than other ethnic groups. This study adds information about ethnic groups in Norway which needs to be addressed in further research and targeted prevention strategies.

Risks for fishborne zoonotic trematodes in tilapia production systems in Guangdong province, China.

PubMed

Li, Kang; Clausen, Jesper Hedegaard; Murrell, K Darwin; Liu, Liping; Dalsgaard, Anders

2013-11-15

Guangdong province is the most important region for tilapia culture in China. However, it is also an endemic region for fishborne zoonotic trematodes (FZT), which pose a risk to human food safety and health. A study was designed to assess the status of trematode parasite infections in tilapia aquaculture systems as an indicator of potential risks from FZT associated with consumption of tilapia. Tilapia from nursery and grow-out ponds were sampled from monoculture, polyculture and integrated aquaculture systems. The results from 388 tilapia examined revealed a very low prevalence (1.5%) of trematode infections (Heterophyidae and Echinostomatidae). Integrated systems using animal manure and latrine wastes as fertilizer did not show a higher prevalence of FZT. Because it was not clear whether the low risk of infection was attributable to existing effective pond management practices or a low risk of spillover of FZT from area sylvatic reservoir hosts, a survey of local wild-caught fish was conducted. Five species of FZT were discovered from a total of 271 wild-caught fish and a mean infection density of 4.0 metacercariae/100g; FZT discovered included intestinal flukes (Haplorchis spp., Procerovum varium, and Metagonimus spp.) and metacercariae tentatively identified as Clonorchis sinenesis. The common occurrence of FZT in wild-caught fish suggests that the presence of FZT in local wild animal reservoirs is substantial, and that although the current aquaculture management systems for tilapia are generally effective in preventing transmission of these parasites into tilapia production systems, the improvement of pond management practices and biosecurity must be maintained at a high level. Copyright © 2013 Elsevier B.V. All rights reserved.

Risk factors associated with xerostomia in haemodialysis patients.

PubMed

López-Pintor, R-M; López-Pintor, L; Casañas, E; de Arriba, L; Hernández, G

2017-03-01

To determine the prevalence of xerostomia and hyposalivation in Haemodialysis (HD) patients, to clarify risk factors, assess patient's quality of life, and to establish a possible correlation among interdialytic weight gain (IDWG) and xerostomia. This study was performed on a group of 50 HD patients. Data were collected using a questionnaire containing demographic and clinical variables, a visual analogue scale (VAS) for xerostomia, IDWG, and an oral health impact profile questionnaire (OHIP-14). Unstimulated whole saliva (UWS) and stimulated whole saliva (SWS) were collected. A total of 28 HD patients (56%) suffered xerostomia. Dry mouth was associated with hypertension (OR, 5.24; 95% CI, 1.11-24.89) and benzodiazepine consumption (OR, 5.96; 95% CI, 1.05-33.99). The mean xerostomia VAS and OHIP-14 scores were 31.74±14.88 and 24.38±11.98, respectively. No significant correlation was observed between IDWG% and VAS and OHIP total score. Nonetheless, a positive correlation between VAS level of thirst and IDWG% was found (r=0.48 p=0.0001). UWS and SWS means (determined in 30 patients) were 0.16±0.17 and 1.12±0.64, respectively. Decreased values of UWS and SWS were reported in 53.33% and 36.66% of HD patients. Xerostomia in HD has a multifactorial aetiology due to accumulative risks as advanced age, systemic disorders, drugs, fluid intake restriction, and salivary parenchymal fibrosis and atrophy. Therefore, it is important to detect possible xerostomia risk factors to treat correctly dry mouth in HD patients and avoid systemic complications.

Systematic review of current prognostication systems for primary gastrointestinal stromal tumors.

PubMed

Khoo, Chun Yuet; Chai, Xun; Quek, Richard; Teo, Melissa C C; Goh, Brian K P

2018-04-01

The advent of tyrosine kinase inhibitors as adjuvant therapy has revolutionized the management of GIST and emphasized the need for accurate prognostication systems. Numerous prognostication systems have been proposed for GIST but at present it remains unknown which system is superior. The present systematic review aims to summarize current prognostication systems for primary treatment-naive GIST. A literature review of the Pubmed and Embase databases was performed to identify all published articles in English, from the 1st January 2002 to 28th Feb 2017, reporting on clinical prognostication systems of GIST. Twenty-three articles on GIST prognostication systems were included. These systems were classified as categorical systems, which stratify patients into risk groups, or continuous systems, which provide an individualized form of risk assessment. There were 16 categorical systems in total. There were 4 modifications of the National Institute of Health (NIH) system, 2 modifications of Armed Forces Institute of Pathology (AFIP) criteria and 3 modifications of Joensuu (modified NIH) criteria. Of the 7 continuous systems, there were 3 prognostic nomograms, 3 mathematical models and 1 prognostic heat/contour maps. Tumor size, location and mitotic count remain the main variables used in these systems. Numerous prognostication systems have been proposed for the risk stratification of GISTs. The most widely used systems today are the NIH, Joensuu modified NIH, AFIP and the Memorial Sloan Kettering Cancer Center nomogram. More validation and comparison studies are required to determine the optimal prognostication system for GIST. Copyright © 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

The Association Between Renin-Angiotensin System Blockade and Long-term Outcomes in Renal Transplant Recipients: The Wisconsin Allograft Recipient Database (WisARD).

PubMed

Shin, Jung-Im; Palta, Mari; Djamali, Arjang; Kaufman, Dixon B; Astor, Brad C

2016-07-01

Renin-angiotensin system (RAS) blockade reduces mortality in the general population and among non-dialysis-dependent patients with chronic kidney disease. The RAS blockade also decreases proteinuria and protects renal function in non-transplant patients with chronic kidney disease. It remains controversial, however, whether this translates to improved patient or graft survival among transplant recipients. We analyzed 2684 primary kidney transplant recipients at the University of Wisconsin in 1994 to 2010 who had a functioning graft at 6 months after transplantation. We assessed the association of RAS blockade with patient and graft survival using time-dependent Cox and marginal structural models. Three hundred seventy-seven deaths and 329 graft failures before death (638 total graft losses) occurred during a median of 5.4 years of follow-up. The RAS blockade was associated with an adjusted-hazard ratio of 0.63 (95% confidence interval, 0.53-0.75) for total graft loss, 0.69 (0.55-0.86) for death, and 0.62 (0.49-0.78) for death-censored graft failure. The associations of RAS blockade with a lower risk of total graft loss and mortality were stronger with more severe proteinuria. The RAS blockade was associated with a 2-fold higher risk of hyperkalemia. Our findings suggest RAS blockade is associated with better patient and graft survival in renal transplant recipients.

Potentially functional COX-2-1195G>A polymorphism increases the risk of digestive system cancers: a meta-analysis.

PubMed

Dong, Jing; Dai, Juncheng; Zhang, Mingfeng; Hu, Zhibin; Shen, Hongbing

2010-06-01

Three potentially functional polymorphisms: -765G>C, -1195G>A, and 8473T>C in the cyclooxygenase-2 (COX-2) gene were identified and proposed to be associated with cancer susceptibility. The aim of this meta-analysis was to evaluate the association between these three polymorphisms and the risk of cancer in diverse populations. All case-control studies published up to November 2009 on the association between the three polymorphisms of COX-2 and cancer risk were identified by searching PubMed. The cancer risk associated with the three polymorphisms of the COX-2 gene was estimated for each study by OR together with its 95% confidence interval (CI), respectively. A total of 47 case-control studies were included, and variant genotypes GA/AA of -1195G>A were associated with a significantly increased cancer risk (GA/AA vs GG: odds ratio [OR], 1.29; 95% CI, 1.18-1.41; P(heterogeneity) = 0.113), and this significant association was mainly observed within cancers of the digestive system (e.g. colorectal, gastric, esophageal, oral, biliary tract, gallbladder, and pancreatic) without between-study heterogeneity (GA/AA vs GG: OR, 1.36; 95% CI; 1.23-1.51; P(heterogeneity) = 0.149). Furthermore, a stratification analysis showed that the risk of COX-2-1195G>A associated with cancers in the digestive system was more evident among Asians than Caucasians. However, for COX-2-765G>C and 8473T>C, no convincing association between the two polymorphisms and risk of cancer or cancer type was observed. The effect of three potentially functional polymorphisms (-765G>C, -1195G>A, and 8473T>C) in the COX-2 gene on cancer risk provided evidence that the COX-2-1195G>A polymorphism was significantly associated with increased risk of digestive system cancers, especially among Asian populations.

Managing total corporate electricity/energy market risks

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

Henney, A.; Keers, G.

1998-10-01

The banking industry has developed a tool kit of very useful value at risk techniques for hedging risk, but these techniques must be adapted to the special complexities of the electricity market. This paper starts with a short history of the use of value-at-risk (VAR) techniques in banking risk management and then examines the specific and, in many instances, complex risk management challenges faced by electric companies from the behavior of prices in electricity markets and from the character of generation and electric retailing risks. The third section describes the main methods for making VAR calculations along with an analysismore » of their suitability for analyzing the risks of electricity portfolios and the case for using profit at risk and downside risk as measures of risk. The final section draws the threads together and explains how to look at managing total corporate electricity market risk, which is a big step toward managing total corporate energy market risk.« less

Total cholesterol as a risk factor for coronary heart disease and stroke in women compared with men: A systematic review and meta-analysis.

PubMed

Peters, Sanne A E; Singhateh, Yankuba; Mackay, Diana; Huxley, Rachel R; Woodward, Mark

2016-05-01

Raised total cholesterol is a strong risk factor for cardiovascular disease (CVD). It remains unknown whether sex differences exist in the relationship between total cholesterol and CVD outcomes. PubMed was searched in December 2014 for cohort studies reporting on the relationship between total cholesterol and coronary heart disease (CHD) and total stroke, separately in men and women. Random effects meta-analyses with inverse variance weighting were used to obtain adjusted pooled sex-specific relative risks (RR) and women-to-men ratio of RRs (RRRs). Data from 97 cohorts, 1,022,276 individuals, and 20,176 CHD and 13,067 stroke cases were included. The pooled RR (95% confidence interval) for CHD associated with a 1-mmol/L increase in total cholesterol was 1.20 (1.16; 1.24) in women and 1.24 (1.20; 1.28) in men, resulting in a RRR of 0.96 (0.93; 0.99). Corresponding RRs for the risk of total stroke were 1.01 (0.98; 1.05) in women, and 1.03 (1.00; 1.05) in men, with a pooled RRR of 0.99 (0.93; 1.04). Pooled RRRs (95% CI) comparing individuals in the highest TC category to those in the lowest, such as the highest versus lowest third, were 0.87 (0.79; 0.96) for CHD and 0.86 (0.76; 0.97) for total stroke. Raised total cholesterol is a strong risk factor for CHD, with evidence of a small, but significantly stronger, effect in men compared to women. Raised total cholesterol had little effect on the risk of total stroke in both sexes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Risk of waterborne illness via drinking water in the United States.

PubMed

Reynolds, Kelly A; Mena, Kristina D; Gerba, Charles P

2008-01-01

Outbreaks of disease attributable to drinking water are not common in the U.S., but they do still occur and can lead to serious acute, chronic, or sometimes fatal health consequences, particularly in sensitive and immunocompromised populations. From 1971 to 2002, there were 764 documented waterborne outbreaks associated with drinking water, resulting in 575,457 cases of illness and 79 deaths (Blackburn et al. 2004; Calderon 2004); however, the true impact of disease is estimated to be much higher. If properly applied, current protocols in municipal water treatment are effective at eliminating pathogens from water. However, inadequate, interrupted, or intermittent treatment has repeatedly been associated with waterborne disease outbreaks. Contamination is not evenly distributed but rather affected by the number of pathogens in the source water, the age of the distribution system, the quality of the delivered water, and climatic events that can tax treatment plant operations. Private water supplies are not regulated by the USEPA and are generally not treated or monitored, although very few of the municipal systems involved in documented outbreaks exceeded the USEPA's total coliform standard in the preceding 12 mon (Craun et al. 2002). We provide here estimates of waterborne infection and illness risks in the U.S. based on the total number of water systems, source water type, and total populations exposed. Furthermore, we evaluated all possible illnesses associated with the microbial infection and not just gastroenteritis. Our results indicate that 10.7 M infections/yr and 5.4 M illnesses/yr occur in populations served by community groundwater systems; 2.2 M infections/yr and 1.1 M illnesses/yr occur in noncommunity groundwater systems; and 26.0 M infections/yr and 13.0 M illnesses/yr occur in municipal surface water systems. The total estimated number of waterborne illnesses/yr in the U.S. is therefore estimated to be 19.5 M/yr. Others have recently estimated waterborne illness rates of 12M cases/yr (Colford et al. 2006) and 16 M cases/yr (Messner et al. 2006), yet our estimate considers all health outcomes associated with exposure to pathogens in drinking water rather than only gastrointestinal illness. Drinking water outbreaks exemplify known breaches in municipal water treatment and distribution processes and the failure of regulatory requirements to ensure water that is free of human pathogens. Water purification technologies applied at the point-of-use (POU) can be effective for limiting the effects of source water contamination, treatment plant inadequacies, minor intrusions in the distribution system, or deliberate posttreatment acts (i.e., bioterrorism). Epidemiological studies are conflicting on the benefits of POU water treatment. One prospective intervention study found that consumers of reverse-osmosis (POU) filtered water had 20%-35% less gastrointestinal illnesses than those consuming regular tap water, with an excess of 14% of illness due to contaminants introduced in the distribution system (Payment 1991, 1997). Two other studies using randomized, blinded, controlled trials determined that the risks were equal among groups supplied with POU-treated water compared to untreated tap water (Hellard et al. 2001; Colford et al. 2003). For immunocompromised populations, POU water treatment devices are recommended by the CDC and USEPA as one treatment option for reducing risks of Cryptosporidium and other types of infectious agents transmitted by drinking water. Other populations, including those experiencing "normal" life stages such as pregnancy, or those very young or very old, might also benefit from the utilization of additional water treatment options beyond the current multibarrier approach of municipal water treatment.

Reference-material system for estimating health and environmental risks of selected material cycles and energy systems

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

Crowther, M.A.; Moskowitz, P.D.

1981-07-01

Sample analyses and detailed documentation are presented for a Reference Material System (RMS) to estimate health and environmental risks of different material cycles and energy systems. Data inputs described include: end-use material demands, efficiency coefficients, environmental emission coefficients, fuel demand coefficients, labor productivity estimates, and occupational health and safety coefficients. Application of this model permits analysts to estimate fuel use (e.g., Btu), occupational risk (e.g., fatalities), and environmental emissions (e.g., sulfur oxide) for specific material trajectories or complete energy systems. Model uncertainty is quantitatively defined by presenting a range of estimates for each data input. Systematic uncertainty not quantified relatesmore » to the boundaries chosen for analysis and reference system specification. Although the RMS can be used to analyze material system impacts for many different energy technologies, it was specifically used to examine the health and environmental risks of producing the following four types of photovoltaic devices: silicon n/p single-crystal cells produced by a Czochralski process; silicon metal/insulator/semiconductor (MIS) cells produced by a ribbon-growing process; cadmium sulfide/copper sulfide backwall cells produced by a spray deposition process; and gallium arsenide cells with 500X concentrator produced by a modified Czochralski process. Emission coefficients for particulates, sulfur dioxide and nitrogen dioxide; solid waste; total suspended solids in water; and, where applicable, air and solid waste residuals for arsenic, cadmium, gallium, and silicon are examined and presented. Where data are available the coefficients for particulates, sulfur oxides, and nitrogen oxides include both process and on-site fuel-burning emissions.« less

From the Medical Board of the National Psoriasis Foundation: Perioperative management of systemic immunomodulatory agents in patients with psoriasis and psoriatic arthritis.

PubMed

Choi, Young M; Debbaneh, Maya; Weinberg, Jeffrey M; Yamauchi, Paul S; Van Voorhees, Abby S; Armstrong, April W; Siegel, Michael; Wu, Jashin J

2016-10-01

Treatment with systemic immunomodulatory agents is indicated for patients with moderate to severe plaque psoriasis and psoriatic arthritis. In these patients, surgery may confer an increased risk of infectious or surgical complications. We conducted a literature review to examine studies addressing the use of methotrexate, cyclosporine, and targeted immunomodulatory agents (tumor necrosis factor-alfa inhibitors, interleukin [IL]-12/23 inhibitors, IL-17 inhibitors) in patients undergoing surgery. We examined 46 total studies; the majority were retrospective studies in patients with rheumatoid arthritis and inflammatory bowel disease. One study in patients with psoriasis and psoriatic arthritis reviewed 77 procedures and did not find an elevated risk of postoperative complications with tumor necrosis factor-alfa and IL-12/23 inhibitors even with major surgeries. Based on level III evidence, infliximab, adalimumab, etanercept, methotrexate, and cyclosporine can be safely continued through low-risk operations in patients with psoriasis and psoriatic arthritis. For moderate- and high-risk surgeries, a case-by-case approach should be taken based on the patient's individual risk factors and comorbidities. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

A decision framework for managing risk to airports from terrorist attack.

PubMed

Shafieezadeh, Abdollah; Cha, Eun J; Ellingwood, Bruce R

2015-02-01

This article presents an asset-level security risk management framework to assist stakeholders of critical assets with allocating limited budgets for enhancing their safety and security against terrorist attack. The proposed framework models the security system of an asset, considers various threat scenarios, and models the sequential decision framework of attackers during the attack. Its novel contributions are the introduction of the notion of partial neutralization of attackers by defenders, estimation of total loss from successful, partially successful, and unsuccessful actions of attackers at various stages of an attack, and inclusion of the effects of these losses on the choices made by terrorists at various stages of the attack. The application of the proposed method is demonstrated in an example dealing with security risk management of a U.S. commercial airport, in which a set of plausible threat scenarios and risk mitigation options are considered. It is found that a combination of providing blast-resistant cargo containers and a video surveillance system on the airport perimeter fence is the best option based on minimum expected life-cycle cost considering a 10-year service period. © 2014 Society for Risk Analysis.

Concept for Space Technology Advancement

NASA Astrophysics Data System (ADS)

Hansen, Jeremiah J.

2005-02-01

The space industry is based on an antiquated concept of disposable rockets, earth construction, and non-repairable satellites. Current space vehicle concepts hearken from a time of Cold War animosity and expeditiousness. Space systems are put together in small, single-purpose chunks that are launched with mighty, single-use rockets. Spacecraft need to change to a more versatile, capable, reusable, and mission efficient design. The Crew Exploration Vehicle (CEV) that President Bush put forward in his space initiative on Jan. 14, 2004 is a small first step. But like all first steps, the risk of eventual failure is great without a complementary set of steps, a reliable handhold, and a goal, which are outlined in this paper. The system for space access and development needs to be overhauled to allow for the access to space to complement the building in space, which promotes the production of goods in space, which enhances the exploitation of space resources… and the list goes on. Without supplemental and complementary infrastructure, all political, scientific, and idealistic endeavors to explore and exploit the near solar system will result in quagmires of failures and indecision. Renewed focus on fundamentals, integration, total-system consideration, and solid engineering can avoid catastrophe. Mission success, simple solutions, mission efficiency, and proper testing all seem to have been lost in the chase for the nickels and dimes. These items will increase capabilities available from a system or combination of systems. New propulsion options and materials will enable vehicles previously unachievable. Future spacecraft should exploit modular designs for repeatability and reduced cost. Space construction should use these modular systems on major components built in orbit. All vehicles should apply smart designs and monitoring systems for increased reliability and system awareness. Crew safety systems must use this awareness in alerting the crew, aiding collision detection and avoidance, damage control and mitigation, and crew ejection systems. These systems, working together, will greatly increase survivability of crewed systems. Implicit in this varied list of technology and integration is industry risk. Aerospace industry must relearn to accept risk in space technology development in order to advance capability. All of these items wrap up in a total system view that will allow for more advanced, reliable capability in space.

The Epidemiology of Physical Training Injuries in U.S. Army Infantry Trainees: Methodology, Population, and Risk Factors

DTIC Science & Technology

1988-11-01

of the weight of the individual, as is the measure of caloric expenditure per minute (kCal/min). METs and kCal/min may be converted to one another if...Fitness Measures as Risk Factors for Injury TABLE 19. Quintiles and Ranges of Total METs Expenditures as Risk Factors for Injury TABLE 20...lifted overhead. ## MLWRATIO: Maximum lift/body weight. 23 TABLE 19. Quintiles# and Ranges of Total METs Expenditures as Risk Factors for Injury. Total

Groundwater arsenic in Chimaltenango, Guatemala.

PubMed

Lotter, Jason T; Lacey, Steven E; Lopez, Ramon; Socoy Set, Genaro; Khodadoust, Amid P; Erdal, Serap

2014-09-01

In the Municipality of Chimaltenango, Guatemala, we sampled groundwater for total inorganic arsenic. In total, 42 samples were collected from 27 (43.5%) of the 62 wells in the municipality, with sites chosen to achieve spatial representation throughout the municipality. Samples were collected from household faucets used for drinking water, and sent to the USA for analysis. The only site found to have a concentration above the 10 μg/L World Health Organization provisional guideline for arsenic in drinking water was Cerro Alto, where the average concentration was 47.5 μg/L. A health risk assessment based on the arsenic levels found in Cerro Alto showed an increase in noncarcinogenic and carcinogenic risks for residents as a result of consuming groundwater as their primary drinking water source. Using data from the US Geological Survey and our global positioning system data of the sample locations, we found Cerro Alto to be the only site sampled within the tertiary volcanic rock layer, a known source of naturally occurring arsenic. Recommendations were made to reduce the levels of arsenic found in the community's drinking water so that the health risks can be managed.

Rock slope instabilities in Norway: First systematic hazard and risk classification of 22 unstable rock slopes

NASA Astrophysics Data System (ADS)

Böhme, Martina; Hermanns, Reginald L.; Oppikofer, Thierry; Penna, Ivanna

2016-04-01

Unstable rock slopes that can cause large failures of the rock-avalanche type have been mapped in Norway for almost two decades. Four sites have earlier been characterized as high-risk objects based on expertise of few researchers. This resulted in installing continuous monitoring systems and set-up of an early-warning system for those four sites. Other unstable rock slopes have not been ranked related to their hazard or risk. There are ca. 300 other sites known of which 70 sites were installed for periodic deformation measurements using multiple techniques (Global Navigation Satellite Systems, extensometers, measurement bolts, and others). In 2012 a systematic hazard and risk classification system for unstable rock slopes was established in Norway and the mapping approach adapted to that in 2013. Now, the first 22 sites were classified for hazard, consequences and risk using this classification system. The selection of the first group of sites to be classified was based on an assumed high hazard or risk and importance given to the sites by Norwegian media and the public. Nine of the classified 22 unstable rock slopes are large sites that deform inhomogeneously or are strongly broken up in individual blocks. This suggests that different failure scenarios are possible that need to be analyzed individually. A total of 35 failure scenarios for those nine unstable rock slopes were considered. The hazard analyses were based on 9 geological parameters defined in the classification system. The classification system will be presented based on the Gamanjunni unstable rock slope. This slope has a well developed back scarp that exposes 150 m preceding displacement. The lateral limits of the unstable slope are clearly visible in the morphology and InSAR displacement data. There have been no single structures observed that allow sliding kinematically. The lower extend of the displacing rock mass is clearly defined in InSAR data and by a zone of higher rock fall activity. Yearly average displacement rates of up to 6 cm are measured with differential GNSS and InSAR. Cosmogenic nuclide dating suggests an acceleration of the present displacement compared to the average displacement since the initiation of the gravitational movement approximately 7000 years ago. Furthermore, there exists a pre-historic rock avalanche 3 km north along the same slope. These characteristics result in a very high hazard for the Gamanjunni unstable rock slope. The consequence analyses focus on the possibility of life loss only. For this the number of persons in the area that can be affected by either the rock slope failure itself and/or its secondary consequence of a displacement wave in case that a rock slope failure would hit a water body is estimated. For Gamanjunni the direct consequences are approximately 40 casualties, representing medium consequences. A total of 48 scenarios were finally analyzed for hazard, consequences and risk. The results are plotted in a risk matrix with 5 hazard and 5 consequence classes, leading to 4 risk classes. One unstable rock slope was classified as very high hazard, 9 scenarios as high hazard, 25 as medium hazard and 13 as low hazard, while none were classified as very low hazard. The consequence analyses for those scenarios resulted in 5 scenarios with very high consequences (>1000 potential casualties), 13 scenarios with high consequences (100-1000 casualties), 9 scenarios with medium consequences (10-100 casualties), 6 scenarios with low consequences (1-10 casualties) and 15 scenarios with very low consequences (0-1 casualties). This resulted in a high risk for 6 scenarios, medium to high risk for 16 scenarios, medium risk for 7 scenarios and low risk for 19 scenarios. These results allow determining which unstable rock slopes do not require further follow-up and on which further investigations and/or mitigation measures should be considered.

The New York State risk score for predicting in-hospital/30-day mortality following percutaneous coronary intervention.

PubMed

Hannan, Edward L; Farrell, Louise Szypulski; Walford, Gary; Jacobs, Alice K; Berger, Peter B; Holmes, David R; Stamato, Nicholas J; Sharma, Samin; King, Spencer B

2013-06-01

This study sought to develop a percutaneous coronary intervention (PCI) risk score for in-hospital/30-day mortality. Risk scores are simplified linear scores that provide clinicians with quick estimates of patients' short-term mortality rates for informed consent and to determine the appropriate intervention. Earlier PCI risk scores were based on in-hospital mortality. However, for PCI, a substantial percentage of patients die within 30 days of the procedure after discharge. New York's Percutaneous Coronary Interventions Reporting System was used to develop an in-hospital/30-day logistic regression model for patients undergoing PCI in 2010, and this model was converted into a simple linear risk score that estimates mortality rates. The score was validated by applying it to 2009 New York PCI data. Subsequent analyses evaluated the ability of the score to predict complications and length of stay. A total of 54,223 patients were used to develop the risk score. There are 11 risk factors that make up the score, with risk factor scores ranging from 1 to 9, and the highest total score is 34. The score was validated based on patients undergoing PCI in the previous year, and accurately predicted mortality for all patients as well as patients who recently suffered a myocardial infarction (MI). The PCI risk score developed here enables clinicians to estimate in-hospital/30-day mortality very quickly and quite accurately. It accurately predicts mortality for patients undergoing PCI in the previous year and for MI patients, and is also moderately related to perioperative complications and length of stay. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

The ERICE-score: the new native cardiovascular score for the low-risk and aged Mediterranean population of Spain.

PubMed

Gabriel, Rafael; Brotons, Carlos; Tormo, M José; Segura, Antonio; Rigo, Fernando; Elosua, Roberto; Carbayo, Julio A; Gavrila, Diana; Moral, Irene; Tuomilehto, Jaakko; Muñiz, Javier

2015-03-01

In Spain, data based on large population-based cohorts adequate to provide an accurate prediction of cardiovascular risk have been scarce. Thus, calibration of the EuroSCORE and Framingham scores has been proposed and done for our population. The aim was to develop a native risk prediction score to accurately estimate the individual cardiovascular risk in the Spanish population. Seven Spanish population-based cohorts including middle-aged and elderly participants were assembled. There were 11800 people (6387 women) representing 107915 person-years of follow-up. A total of 1214 cardiovascular events were identified, of which 633 were fatal. Cox regression analyses were conducted to examine the contributions of the different variables to the 10-year total cardiovascular risk. Age was the strongest cardiovascular risk factor. High systolic blood pressure, diabetes mellitus and smoking were strong predictive factors. The contribution of serum total cholesterol was small. Antihypertensive treatment also had a significant impact on cardiovascular risk, greater in men than in women. The model showed a good discriminative power (C-statistic=0.789 in men and C=0.816 in women). Ten-year risk estimations are displayed graphically in risk charts separately for men and women. The ERICE is a new native cardiovascular risk score for the Spanish population derived from the background and contemporaneous risk of several Spanish cohorts. The ERICE score offers the direct and reliable estimation of total cardiovascular risk, taking in consideration the effect of diabetes mellitus and cardiovascular risk factor management. The ERICE score is a practical and useful tool for clinicians to estimate the total individual cardiovascular risk in Spain. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Haloacetic acids in drinking water and risk for stillbirth

PubMed Central

King, W; Dodds, L; Allen, A; Armson, B; Fell, D; Nimrod, C

2005-01-01

Aims: To investigate the effects of haloacetic acid (HAA) compounds in drinking water on stillbirth risk. Methods: A population based case-control study was conducted in Nova Scotia and Eastern Ontario, Canada. Estimates of daily exposure to total and specific HAAs were based on household water samples and questionnaire information on water consumption at home and work. Results: The analysis included 112 stillbirth cases and 398 live birth controls. In analysis without adjustment for total THM exposure, a relative risk greater than 2 was observed for an intermediate exposure category for total HAA and dichloroacetic acid measures. After adjustment for total THM exposure, the risk estimates for intermediate exposure categories were diminished, the relative risk associated with the highest category was in the direction of a protective effect, and all confidence intervals included the null value. Conclusions: No association was observed between HAA exposures and stillbirth risk after controlling for THM exposures. PMID:15657195

Neck circumference as a predictor of metabolic syndrome, insulin resistance and low-grade systemic inflammation in children: the ACFIES study.

PubMed

Gomez-Arbelaez, Diego; Camacho, Paul Anthony; Cohen, Daniel Dylan; Saavedra-Cortes, Sandra; Lopez-Lopez, Cristina; Lopez-Jaramillo, Patricio

2016-03-08

The current study aims to evaluate the association between neck circumference (NC) and several cardio-metabolic risk factors, to compare it with well-established anthropometric indices, and to determine the cut-off point value of NC for predicting children at increased risk of metabolic syndrome, insulin resistance and low-grade systemic inflammation. A total of 669 school children, aged 8-14, were recruited. Demographic, clinical, anthropometric and biochemical data from all patients were collected. Correlations between cardio-metabolic risk factors and NC and other anthropometric variables were evaluated using the Spearman's correlation coefficient. Multiple linear regression analysis was applied to further examine these associations. We then determined by receiver operating characteristic (ROC) analyses the optimal cut-off for NC for identifying children with elevated cardio-metabolic risk. NC was positively associated with fasting plasma glucose and triglycerides (p = 0.001 for all), and systolic and diastolic blood pressure, C-reactive protein, insulin and HOMA-IR (p < 0.001 for all), and negatively with HDL-C (p = 0.001). Whereas, other anthropometric indices were associated with fewer risk factors. NC could be used as clinically relevant and easy to implement indicator of cardio-metabolic risk in children.

Prevalence and distribution of Legionella spp in potable water systems in Germany, risk factors associated with contamination, and effectiveness of thermal disinfection.

PubMed

Kruse, Eva-Brigitta; Wehner, Arno; Wisplinghoff, Hilmar

2016-04-01

Worldwide, Legionella spp are a common cause of community-acquired pneumonia. Potable water systems are a main reservoir; however, exposure in the community is unknown. Water samples from 718 buildings in Germany were collected. Possible risk factors were prospectively recorded. All samples were tested for Legionella spp using cultural microbiologic methods. Samples were assigned to 1 of 5 levels of contamination. Statistical analysis was performed to determine the influence of risk factors for contamination and, in a subgroup of buildings, for unsuccessful thermal disinfection. In total, 4,482 water samples from 718 different water supply systems were analyzed. In 233 buildings (32.7%), Legionella spp were identified, 148 (63.5%) of which had a medium or higher level of contamination. The most common species was Legionella pneumophila (94%). Contamination was strongly associated with temperature in the circulation, but not with the size of the building, time of the year, or transport time to the laboratory. Thermal disinfection was successful in fewer than half of the buildings. There is relevant exposure to Legionella spp in the community. Water systems are not always up to current technical standards. Although microbiological risk assessment remains a challenge, there is a case for monitoring for Legionella spp outside of hospitals. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Nest predation and circulating corticosterone levels within and among species

USGS Publications Warehouse

Fontaine, Joseph J.; Arriero, Elena; Schwabl, Hubert; Martin, Thomas E.

2011-01-01

Variation in the risk of predation to offspring can influence the expression of reproductive strategies both within and among species. Appropriate expression of reproductive strategies in environments that differ in predation risk can have clear advantages for fitness. Although adult-predation risk appears to influence glucocorticosteroid levels, leading to changes in behavioral and life-history strategies, the influence of offspring-predation risk on adult glucocorticosteroid levels remains unclear. We compared total baseline corticosterone concentrations in Gray-headed Juncos (Junco hyemalis dorsalis) nesting on plots with and without experimentally reduced risk of nest predation. Despite differences in risk between treatments, we failed to find differences in total baseline corticosterone concentrations. When we examined corticosterone concentrations across a suite of sympatric species, however, higher risk of nest predation correlated with higher total baseline corticosterone levels. As found previously, total baseline corticosterone was negatively correlated with body condition and positively correlated with date of sampling. However, we also found that corticosterone levels increased seasonally, independent of stage of breeding. Nest predation can alter the expression of birds' reproductive strategies, but our findings suggest that total baseline corticosterone is not the physiological mechanism regulating these responses.

Nest predation and circulating corticosterone levels within and among species

USGS Publications Warehouse

Fontaine, J.J.; Arriero, E.; Schwabl, H.; Martin, T.E.

2011-01-01

Variation in the risk of predation to offspring can influence the expression of reproductive strategies both within and among species. Appropriate expression of reproductive strategies in environments that differ in predation risk can have clear advantages for fitness. Although adult-predation risk appears to influence glucocorticosteroid levels, leading to changes in behavioral and life-history strategies, the influence of offspring-predation risk on adult glucocorticosteroid levels remains unclear. We compared total baseline corticosterone concentrations in Gray-headed Juncos (Junco hyemalis dorsalis) nesting on plots with and without experimentally reduced risk of nest predation. Despite differences in risk between treatments, we failed to find differences in total baseline corticosterone concentrations. When we examined corticosterone concentrations across a suite of sympatric species, however, higher risk of nest predation correlated with higher total baseline corticosterone levels. As found previously, total baseline corticosterone was negatively correlated with body condition and positively correlated with date of sampling. However, we also found that corticosterone levels increased seasonally, independent of stage of breeding. Nest predation can alter the expression of birds' reproductive strategies, but our findings suggest that total baseline corticosterone is not the physiological mechanism regulating these responses. ?? The Cooper Ornithological Society 2011.

Contract Design: Risk Management and Evaluation.

PubMed

Mühlbacher, Axel C; Amelung, Volker E; Juhnke, Christin

2018-01-12

Effective risk adjustment is an aspect that is more and more given weight on the background of competitive health insurance systems and vital healthcare systems. The risk structure of the providers plays a vital role in Pay for Performance. A prerequisite for optimal incentive-based service models is a (partial) dependence of the agent's returns on the provider's gain level. Integrated care systems as well as accountable care organisations (ACOs) in the US and similar concepts in other countries are advocated as an effective method of improving the performance of healthcare systems. These systems outline a payment and care delivery model that intends to tie provider reimbursements to predefined quality metrics. By this the total costs of care shall be reduced. Little is known about the contractual design and the main challenges of delegating "accountability" to these new kinds of organisations and/or contracts. The costs of market utilisation are highly relevant for the conception of healthcare contracts; furthermore information asymmetries and contract-specific investments are an obstacle to the efficient operation of ACOs. A comprehensive literature review on methods of designing contracts in Integrated Care was conducted. The research question in this article focuses on how reimbursement strategies, evaluation of measures and methods of risk adjustment can best be integrated in healthcare contracting. Each integrated care contract includes challenges for both payers and providers without having sufficient empirical data on both sides. These challenges are clinical, administrative or financial nature. Risk adjusted contracts ensure that the reimbursement roughly matches the true costs resulting from the morbidity of a population. If reimbursement of care provider corresponds to the actual expenses for an individual/population the problem of risk selection is greatly reduced. The currently used methods of risk adjustment have widely differing model and forecast accuracy. For this reason, it is necessary to clearly regulate the method of risk adjustment in the integrated care contract. The series of three articles on contract design has shown that coordination and motivation problems in designing healthcare contracts cannot be solved at no-costs. Moreover, it became clear, that complete contracts in healthcare are unrealistic and that contracts do always include certain uncertainties. These are based on the risk of random, and no contracting party can control these risks completely. It is also not possible to fully integrate these risks in the contract or to eliminate these risks by the parties.

Heavy metal exposure from cooked rice grain ingestion and its potential health risks to humans from total and bioavailable forms analysis.

PubMed

Praveena, S M; Omar, N A

2017-11-15

Heavy metal in rice studies has attracted a greater concern worldwide. However, there have been limited studies on marketed rice samples although it represents a vital ingestion portion for a real estimation of human health risk. This study was aimed to determine both total and bioaccessible of trace elements and heavy metals (Cd, Cr, Cu, Co, Al, Zn, As, Pb and Fe) in 22 varieties of cooked rice using an inductively coupled plasma-optical emission spectroscopy. Both total and bioaccessible of trace elements and heavy metals were digested using closed-nitric acid digestion and Rijksinstituut voor Volksgezondheid en Milieu (RIVM) in vitro digestion model, respectively. Human health risks via Health Risk Assessment (HRA) were conducted to understand exposure risks involving adults and children representing Malaysian population. Zinc was the highest while As was the lowest contents for total and in their bioavailable forms. Four clusters were identified: (1) Pb, As, Co, Cd and Cr; (2) Cu and Al; (3) Fe and (4) Zn. For HRA, there was no any risks found from single element exposure. While potential carcinogenic health risks present for both adult and children from single As exposure (Life time Cancer Risk, LCR>1×10 -4 ). Total Hazard Quotient values for adult and children were 27.0 and 18.0, respectively while total LCR values for adult and children were 0.0049 and 0.0032, respectively. Copyright © 2017 Elsevier Ltd. All rights reserved.

Environmental contaminants in freshwater fish and their risk to piscivorous wildlife based on a national monitoring program

USGS Publications Warehouse

Hinck, J.E.; Schmitt, C.J.; Chojnacki, K.A.; Tillitt, D.E.

2009-01-01

Organochlorine chemical residues and elemental concentrations were measured in piscivorous and benthivorous fish at 111 sites from large U.S. river basins. Potential contaminant sources such as urban and agricultural runoff, industrial discharges, mine drainage, and irrigation varied among the sampling sites. Our objectives were to provide summary statistics for chemical contaminants and to determine if contaminant concentrations in the fish were a risk to wildlife that forage at these sites. Concentrations of dieldrin, total DDT, total PCBs, toxaphene, TCDD-EQ, cadmium, chromium, mercury, lead, selenium, and zinc exceeded toxicity thresholds to protect fish and piscivorous wildlife in samples from at least one site; most exceedences were for total PCBs, mercury, and zinc. Chemical concentrations in fish from the Mississippi River Basin exceeded the greatest number of toxicity thresholds. Screening level wildlife risk analysis models were developed for bald eagle and mink using no adverse effect levels (NOAELs), which were derived from adult dietary exposure or tissue concentration studies and based primarily on reproductive endpoints. No effect hazard concentrations (NEHC) were calculated by comparing the NOAEL to the food ingestion rate (dietary-based NOAEL) or biomagnification factor (tissue-based NOAEL) of each receptor. Piscivorous wildlife may be at risk from a contaminant if the measured concentration in fish exceeds the NEHC. Concentrations of most organochlorine residues and elemental contaminants represented no to low risk to bald eagle and mink at most sites. The risk associated with pentachloroanisole, aldrin, Dacthal, methoxychlor, mirex, and toxaphene was unknown because NOAELs for these contaminants were not available for bald eagle or mink. Risk differed among modeled species and sites. Our screening level analysis indicates that the greatest risk to piscivorous wildlife was from total DDT, total PCBs, TCDD-EQ, mercury, and selenium. Bald eagles were at greater risk to total DDT and total PCBs than mink, whereas risks of TCDD-EQ, mercury, and selenium were greater to mink than bald eagle. ?? Springer Science+Business Media B.V. 2008.

The costs of overweight and obesity-related diseases in the Brazilian public health system: cross-sectional study

PubMed Central

2012-01-01

Background Obesity is a major global epidemic and a burden to society and health systems. It is well known risk factor for a number of chronic medical conditions with high morbidity and mortality. This study aimed to provide an estimate of the direct costs associated to outpatient and inpatient care of overweight and obesity related diseases in the perspective of the Brazilian Health System (SUS). Methods Population attributable risk (PAR) was calculated for selected diseases related to overweight and obesity and with the following parameters: Relative risk (RR) ≥ 1.20 or RR ≥1.10 and < 1.20, but important problem of public health due its high prevalence. After a broad search in the literature, two meta-analysis were selected to provide RR for PAR calculation. The prevalence rates of overweight and obesity in Brazilians with ≥18 years were obtained from large national survey. The national health database (DATASUS) was used to estimate the annual cost of the Brazilian Unified Health System (SUS) with the diseases included in the analysis. The extracted values were stratified by sex, type of service (inpatient or outpatient care) and year. Data were collected from 2008 to 2010 and the results reflect the average of 3 years. Brazilian costs were converted into US dollars during the analysis using a purchasing power parity basis (2010). Results The estimated total costs in one year with all diseases related to overweight and obesity are US$ 2,1 billion; US$ 1,4 billion (68.4% of total costs) due to hospitalizations and US$ 679 million due to ambulatory procedures. Approximately 10% of these cost is attributable to overweight and obesity. Conclusion The results confirm that overweight and obesity carry a great economic burden for Brazilian health system and for the society. The knowledge of these costs will be useful for future economic analysis of preventive and treatment interventions. PMID:22713624

Validation of chronic kidney disease risk categorization system in Chinese patients with kidney disease: A cohort study.

PubMed

Liu, Qingyan; Lv, Jicheng; Li, Haixia; Jiao, Lili; Yang, Hongyun; Song, Yinan; Xu, Guobin

2015-12-01

To validate the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines risk stratification system based on the combination of estimated glomerular filtration rate (eGFR) and proteinuria. This was a cohort study. A total of 1219 study population were recruited. Estimated GFR and proteinuria measured by using 24 h urine protein excretion rate (PER) were predictors. Adverse outcomes included all-cause mortality (ACM) and end-stage renal disease (ESRD). Follow-up was done by regular visit, telephone interview and electronic medical records. Over a median follow-up of 4.6 years, 153 (12.6%) and 43 (3.5%) patients experienced ESRD and ACM, respectively. On multivariable analysis, the adjusted hazard ratio for ESRD and ACM (compared with patients with eGFR > 60 mL/min per 1.7  m²) was of 29.8 and 3.6 for those with eGFR of 15-29 mL/min per 1.73 m², respectively. The adjusted hazard ratio for ESRD and ACM (compared with patients with PER < 150 mg/24h) was of 15.9 and 3.9 for those with PER > 500 mg/24h. Higher KDIGO guidelines risk categories (indicating lower eGFR or higher proteinuria) were associated with a graded increase in the risk for the ESRD (P < 0.001) and ACM (P < 0.001). Reclassification of KDIGO guidelines risk categories yielded net reclassification improvements for those with ESRD or ACM event (NRIevents ) of 33.3% or 30.2%. Lower eGFR and higher proteinuria are risk factors for ESRD and ACM in Chinese patients. The KDIGO guidelines risk categorization system assigned patients who went on to have the event to more appropriate CKD risk categories. © 2015 Asian Pacific Society of Nephrology.

Development of a low risk augmentation system for an energy efficient transport having relaxed static stability

NASA Technical Reports Server (NTRS)

Sizlo, T. R.; Berg, R. A.; Gilles, D. L.

1979-01-01

An augmentation system for a 230 passenger, twin engine aircraft designed with a relaxation of conventional longitudinal static stability was developed. The design criteria are established and candidate augmentation system control laws and hardware architectures are formulated and evaluated with respect to reliability, flying qualities, and flight path tracking performance. The selected systems are shown to satisfy the interpreted regulatory safety and reliability requirements while maintaining the present DC 10 (study baseline) level of maintainability and reliability for the total flight control system. The impact of certification of the relaxed static stability augmentation concept is also estimated with regard to affected federal regulations, system validation plan, and typical development/installation costs.

[Risk Assessment of Trihalomethane Production Using the Beijiang River and the Pearl River, Guangzhou as Drinking Water Sources].

PubMed

Zhong, Hui-zhou; Wei, Chao-hai

2015-04-01

In order to investigate the risk of trihalomethane formation potential (THMFP) in finished waters as drinking water sources, 70 samples, 114 samples, and 70 samples were collected in November 2013, April 2014 and July 2014, respectively from different locations in the Beijiang River and the Pearl River. After filtration by 0.45 μm filter membrane, a total of 254 samples were chlorinated using Uniform Formation Condition (UFC) method for determining their THM Formation Potential (THMFP). The cancer risk and non-cancer risk of THMs were estimated using USEPA risk assessment model while dominant factors for total risk potential were estimated using sensitivity analysis. Among four THM species, chloroform( CF) was the highest ranging from 101.92-2 590.85 μg x L(-1), followed by bromodichloromethane (BDCM), dibromochloromethane (DBCM) and bromoform (BF). Chloroform, the major THMs speciation, accounted for 96.17% of total THMs. Non-cancer and cancer risk from ingesting THMs was estimated. The result indicated that non-cancer risk of THMs level ranged from 2.03 x 10(-7) to 1.00 x 10(-5) and was not more than 1.0 x 10(-5), the minimum or negligible non-cancer risk level defined by the USEPA. The average cancer risk of THMs was 2.91 x 10(-4) for male and 3.30 x 10(-4) for female in the two rivers, respectively, exceeding the minimum or negligible risk level defined by the USEPA (1. 0 x 10 ~6). The difference of cancer risk between the two rivers was that BDCM ranging from 2.50 x 10(-5) to 6.37 x 10(-4) was approximately twice that of CF in Beijing River. BDCM played an important role in the total risk in the Beijiang River while CF played an important role in the total risk in the Pearl River, Guangzhou. Sensitivity analysis showed that CF played an important role in the estimation of total risk potential, and that the direct utilization of water sources from Beijiang River and the Pearl River Guangzhou is dangerous, thus pretreatment is necessary before chlorination.

Association between traditional clinical high-risk features and gene expression profile classification in uveal melanoma.

PubMed

Nguyen, Brandon T; Kim, Ryan S; Bretana, Maria E; Kegley, Eric; Schefler, Amy C

2018-02-01

To evaluate the association between traditional clinical high-risk features of uveal melanoma patients and gene expression profile (GEP). This was a retrospective, single-center, case series of patients with uveal melanoma. Eighty-three patients met inclusion criteria for the study. Patients were examined for the following clinical risk factors: drusen/retinal pigment epithelium (RPE) changes, vascularity on B-scan, internal reflectivity on A-scan, subretinal fluid (SRF), orange pigment, apical tumor height/thickness, and largest basal dimensions (LBD). A novel point system was created to grade the high-risk clinical features of each tumor. Further analyses were performed to assess the degree of association between GEP and each individual risk factor, total clinical risk score, vascularity, internal reflectivity, American Joint Committee on Cancer (AJCC) tumor stage classification, apical tumor height/thickness, and LBD. Of the 83 total patients, 41 were classified as GEP class 1A, 17 as class 1B, and 25 as class 2. The presence of orange pigment, SRF, low internal reflectivity and vascularity on ultrasound, and apical tumor height/thickness ≥ 2 mm were not statistically significantly associated with GEP class. Lack of drusen/RPE changes demonstrated a trend toward statistical association with GEP class 2 compared to class 1A/1B. LBD and advancing AJCC stage was statistically associated with higher GEP class. In this cohort, AJCC stage classification and LBD were the only clinical features statistically associated with GEP class. Clinicians should use caution when inferring the growth potential of melanocytic lesions solely from traditional funduscopic and ultrasonographic risk factors without GEP data.

A Non-Contact Measurement System for the Range of Motion of the Hand

PubMed Central

Pham, Trieu; Pathirana, Pubudu N.; Trinh, Hieu; Fay, Pearse

2015-01-01

An accurate and standardised tool to measure the active range of motion (ROM) of the hand is essential to any progressive assessment scenario in hand therapy practice. Goniometers are widely used in clinical settings for measuring the ROM of the hand. However, such measurements have limitations with regard to inter-rater and intra-rater reliability and involve direct physical contact with the hand, possibly increasing the risk of transmitting infections. The system proposed in this paper is the first non-contact measurement system utilising Intel Perceptual Technology and a Senz3D Camera for measuring phalangeal joint angles. To enhance the accuracy of the system, we developed a new approach to achieve the total active movement without measuring three joint angles individually. An equation between the actual spacial position and measurement value of the proximal inter-phalangeal joint was established through the measurement values of the total active movement, so that its actual position can be inferred. Verified by computer simulations, experimental results demonstrated a significant improvement in the calculation of the total active movement and successfully recovered the actual position of the proximal inter-phalangeal joint angles. A trial that was conducted to examine the clinical applicability of the system involving 40 healthy subjects confirmed the practicability and consistency in the proposed system. The time efficiency conveyed a stronger argument for this system to replace the current practice of using goniometers. PMID:26225976

[Dose loads on and radiation risk values for cosmonauts on a mission to Mars estimated from actual Martian vehicle engineering development].

PubMed

Shafirkin, A V; Kolomenskiĭ, A V; Mitrikas, V G; Petrov, V M

2010-01-01

The current design philosophy of a Mars orbiting vehicle, takeoff and landing systems and the transport return vehicle was taken into consideration for calculating the equivalent doses imparted to cosmonaut's organs and tissues by galactic cosmic rays, solar rays and the Earth's radiation belts, values of the total radiation risk over the lifespan following the mission and over the whole career period, and possible shortening of life expectancy. There are a number of uncertainties that should be evaluated, and radiation limits specified before setting off to Mars.

Mission operations and command assurance: Flight operations quality improvements

NASA Technical Reports Server (NTRS)

Welz, Linda L.; Bruno, Kristin J.; Kazz, Sheri L.; Potts, Sherrill S.; Witkowski, Mona M.

1994-01-01

Mission Operations and Command Assurance (MO&CA) is a Total Quality Management (TQM) task on JPL projects to instill quality in flight mission operations. From a system engineering view, MO&CA facilitates communication and problem-solving among flight teams and provides continuous solving among flight teams and provides continuous process improvement to reduce risk in mission operations by addressing human factors. The MO&CA task has evolved from participating as a member of the spacecraft team, to an independent team reporting directly to flight project management and providing system level assurance. JPL flight projects have benefited significantly from MO&CA's effort to contain risk and prevent rather than rework errors. MO&CA's ability to provide direct transfer of knowledge allows new projects to benefit from previous and ongoing flight experience.

A Web-Based System for Bayesian Benchmark Dose Estimation.

PubMed

Shao, Kan; Shapiro, Andrew J

2018-01-11

Benchmark dose (BMD) modeling is an important step in human health risk assessment and is used as the default approach to identify the point of departure for risk assessment. A probabilistic framework for dose-response assessment has been proposed and advocated by various institutions and organizations; therefore, a reliable tool is needed to provide distributional estimates for BMD and other important quantities in dose-response assessment. We developed an online system for Bayesian BMD (BBMD) estimation and compared results from this software with U.S. Environmental Protection Agency's (EPA's) Benchmark Dose Software (BMDS). The system is built on a Bayesian framework featuring the application of Markov chain Monte Carlo (MCMC) sampling for model parameter estimation and BMD calculation, which makes the BBMD system fundamentally different from the currently prevailing BMD software packages. In addition to estimating the traditional BMDs for dichotomous and continuous data, the developed system is also capable of computing model-averaged BMD estimates. A total of 518 dichotomous and 108 continuous data sets extracted from the U.S. EPA's Integrated Risk Information System (IRIS) database (and similar databases) were used as testing data to compare the estimates from the BBMD and BMDS programs. The results suggest that the BBMD system may outperform the BMDS program in a number of aspects, including fewer failed BMD and BMDL calculations and estimates. The BBMD system is a useful alternative tool for estimating BMD with additional functionalities for BMD analysis based on most recent research. Most importantly, the BBMD has the potential to incorporate prior information to make dose-response modeling more reliable and can provide distributional estimates for important quantities in dose-response assessment, which greatly facilitates the current trend for probabilistic risk assessment. https://doi.org/10.1289/EHP1289.

Vitamin A and retinol intakes and the risk of fractures among participants of the Women's Health Initiative Observational Study123

PubMed Central

Ritenbaugh, Cheryl; Wactawski-Wende, Jean; Snetselaar, Linda G; Chen, Zhao

2009-01-01

Background: Excessive intakes of vitamin A have been shown to have adverse skeletal effects in animals. High vitamin A intake may lead to an increased risk of fracture in humans. Objective: The objective was to evaluate the relation between total vitamin A and retinol intakes and the risk of incident total and hip fracture in postmenopausal women. Design: A total of 75,747 women from the Women's Health Initiative Observational Study participated. The risk of hip and total fractures was determined using Cox proportional hazards models according to different intakes of vitamin A and retinol. Results: In the analysis adjusted for some covariates (age; protein, vitamin D, vitamin K, calcium, caffeine, and alcohol intakes; body mass index; hormone therapy use; smoking; metabolic equivalents hours per week; ethnicity; and region of clinical center), the association between vitamin A intake and the risk of fracture was not statistically significant. Analyses for retinol showed similar trends. When the interaction term was analyzed as categorical, the highest intake of retinol with vitamin D was significant (P = 0.033). Women with lower vitamin D intake (≤11 μg/d) in the highest quintile of intake of both vitamin A (hazard ratio: 1.19; 95% CI: 1.04, 1.37; P for trend: 0.022) and retinol (hazard ratio: 1.15; 95% CI: 1.03, 1.29; P for trend: 0.056) had a modest increased risk of total fracture. Conclusions: No association between vitamin A or retinol intake and the risk of hip or total fractures was observed in postmenopausal women. Only a modest increase in total fracture risk with high vitamin A and retinol intakes was observed in the low vitamin D–intake group. PMID:19056568

A classification of freshwater Louisiana lakes based on water quality and user perception data.

PubMed

Burden, D G; Malone, R F

1987-09-01

An index system developed for Louisiana lakes was based on correlations between measurable water quality parameters and perceived lake quality. Support data was provided by an extensive monitoring program of 30 lakes coordinated with opinion surveys undertaken during summer 1984. Lakes included in the survey ranged from 4 to 735 km(2) in surface area with mean depths ranging from 0.5 to 8.0 m. Water quality data indicated most of these lakes are eutrophic, although many have productive fisheries and are considered recreational assets. Perception ratings of fishing quality and its associated water quality were obtained by distributing approximately 1200 surveys to Louisiana Bass Club Associaton members. The ability of Secchi disc transparency, total organic carbon, total Kjeldahl nitrogen, total phosphorus, and chlorophyll a to discriminate between perception classes was examined using probability distributions and multivariate analyses. Secchi disc and total organic carbon best reflected perceived lake conditions; however, these parameters did not provide the discrimination necessary for developing a quantitative risk assessment of lake trophic state. Consequently, an interim lakes index system was developed based on total organic carbon and perceived lake conditions. The developed index system will aid State officials in interpretating and evaluating regularly collected lake quality data, recognizing potential problem areas, and identifying proper management policies for protecting fisheries usage within the State.

The application of seismic risk-benefit analysis to land use planning in Taipei City.

PubMed

Hung, Hung-Chih; Chen, Liang-Chun

2007-09-01

In the developing countries of Asia local authorities rarely use risk analysis instruments as a decision-making support mechanism during planning and development procedures. The main purpose of this paper is to provide a methodology to enable planners to undertake such analyses. We illustrate a case study of seismic risk-benefit analysis for the city of Taipei, Taiwan, using available land use maps and surveys as well as a new tool developed by the National Science Council in Taiwan--the HAZ-Taiwan earthquake loss estimation system. We use three hypothetical earthquakes to estimate casualties and total and annualised direct economic losses, and to show their spatial distribution. We also characterise the distribution of vulnerability over the study area using cluster analysis. A risk-benefit ratio is calculated to express the levels of seismic risk attached to alternative land use plans. This paper suggests ways to perform earthquake risk evaluations and the authors intend to assist city planners to evaluate the appropriateness of their planning decisions.

Assessing the Impact of Chlorinated-Solvent Sites on Metropolitan Groundwater Resources

PubMed Central

Brusseau, Mark L.; Narter, Matthew

2014-01-01

Chlorinated-solvent compounds are among the most common groundwater contaminants in the U.S.A. The majority of the many sites contaminated by chlorinated-solvent compounds are located in metropolitan areas, and most such areas have one or more chlorinated-solvent contaminated sites. Thus, contamination of groundwater by chlorinated-solvent compounds may pose a potential risk to the sustainability of potable water supplies for many metropolitan areas. The impact of chlorinated-solvent sites on metropolitan water resources was assessed for Tucson, AZ, by comparing the aggregate volume of extracted groundwater for all pump-and-treat systems associated with contaminated sites in the region to the total regional groundwater withdrawal. The analysis revealed that the aggregate volume of groundwater withdrawn for the pump-and-treat systems operating in Tucson, all of which are located at chlorinated-solvent contaminated sites, was 20% of the total groundwater withdrawal in the city for the study period. The treated groundwater was used primarily for direct delivery to local water supply systems or for reinjection as part of the pump-and-treat system. The volume of the treated groundwater used for potable water represented approximately 13% of the total potable water supply sourced from groundwater, and approximately 6% of the total potable water supply. This case study illustrates the significant impact chlorinated-solvent contaminated sites can have on groundwater resources and regional potable-water supplies. PMID:24116872

Social networks and mortality based on the Komo-Ise cohort study in Japan.

PubMed

Iwasaki, Motoki; Otani, Tetsuya; Sunaga, Rumiko; Miyazaki, Hiroko; Xiao, Liu; Wang, Naren; Yosiaki, Sasazawa; Suzuki, Shosuke

2002-12-01

No prospective studies have examined the association between social networks and all-cause and cause-specific mortality among middle-aged Japanese. The study of varied populations may contribute to clarifying the robustness of the observed effects of social networks and extend their generalizability. To clarify the association between social networks and mortality among middle-aged and elderly Japanese, a community-based prospective study, the Komo-Ise Study, was conducted in two areas of Gunma Prefecture, Japan. A total of 11 565 subjects aged 40-69 years at baseline in 1993 completed a self-administered questionnaire. During the 7-year follow-up period, 335 men and 155 women died and the relative risk (RR) of each social network item was estimated by the Cox proportional hazard model. Single women had significantly increased risks of all-cause (multivariate RR = 2.2), and all circulatory system disease (age-area adjusted RR = 2.6) mortality. Men who did not participate in hobbies, club activities, or community groups had significantly higher multivariate RR for all-cause (RR = 1.5), all circulatory system disease (RR = 1.6) and non-cancer and non-circulatory system disease (RR = 2.3) mortality. Urban women who rarely or never met close relatives had significantly elevated risks of all-cause (RR = 2.4), all cancer (RR = 2.6), and non-cancer and non-circulatory system disease (RR = 2.7) mortality after adjustment for established risk factors. This study provides evidence that social networks are an important predictor of mortality risk for middle-aged and elderly Japanese men and women. Lack of participation, for men, and being single and lack of meeting close relatives, for women, were independent risk factors for mortality.

Impact of a robotic surgical system on treatment choice for men with clinically organ-confined prostate cancer.

PubMed

Kobayashi, Takashi; Kanao, Kent; Araki, Motoo; Terada, Naoki; Kobayashi, Yasuyuki; Sawada, Atsuro; Inoue, Takahiro; Ebara, Shin; Watanabe, Toyohiko; Kamba, Tomomi; Sumitomo, Makoto; Nasu, Yasutomo; Ogawa, Osamu

2018-04-01

Introducing a new surgical technology may affect behaviors and attitudes of patients and surgeons about clinical practice. Robot-assisted laparoscopic radical prostatectomy (RALP) was approved in 2012 in Japan. We investigated whether the introduction of this system affected the treatment of organ-confined prostate cancer (PCa) and the use of radical prostatectomy (RP). We conducted a retrospective multicenter study on 718 patients with clinically determined organ-confined PCa treated at one of three Japanese academic institutions in 2011 (n = 338) or 2013 (n = 380). Two patient groups formed according to the treatment year were compared regarding the clinical characteristics of PCa, whether referred or screened at our hospital, comorbidities and surgical risk, and choice of primary treatment. Distribution of PCa risk was not changed by the introduction of RALP. Use of RP increased by 70% (from 127 to 221 cases, p < 0.0001), whereas the number of those undergoing radiotherapy or androgen deprivation therapy decreased irrespective of the disease risk of PCa. Increased use of RP (from 34 to 100 cases) for intermediate- or high-risk PCa patients with mild perioperative risk (American Society of Anesthesiologists score 2) accounted for 70% of the total RP increase, whereas the number of low- or very low-risk PCa patients with high comorbidity scores (Charlson Index ≥ 4) increased from 8 to 25 cases, accounting for 18%. Use of expectant management (active surveillance, watchful waiting) in very low-risk PCa patients was 15% in 2011 and 12% in 2013 (p = 0.791). Introduction of a robotic surgical system had little effect on the risk distribution of PCa. Use of RP increased, apparently due to increased indications in patients who are candidates for RP but have mild perioperative risk. Although small, there was an increase in the number of RPs performed on patients with severe comorbidities but with low-risk or very low-risk PCa.

Survivorship and relative risk of revision in computer-navigated versus conventional total knee replacement at 8-year follow-up.

PubMed

Dyrhovden, Gro S; Fenstad, Anne M; Furnes, Ove; Gøthesen, Øystein

2016-12-01

Background and purpose - The long-term effects of computer-assisted surgery in total knee replacement (CAS) compared to conventionally operated knee replacement (CON) are still not clear. We compared survivorship and relative risk of revision in CAS and CON based on data from the Norwegian Arthroplasty Register. Patients and methods - We assessed primary total knee replacements without patellar resurfacing reported to the Norwegian Arthroplasty Register from 2005 through 2014. The 5 most used implants and the 3 most common navigation systems were included. The groups (CAS, n = 3,665; CON, n = 20,019) were compared using a Cox regression analysis adjusted for age, sex, ASA category, prosthesis brand, fixation method, previous surgery, and diagnosis with the risk of revision for any reason as endpoint. Secondary outcomes were reasons for revision and effects of prosthesis brand, fixation method, age (± 65 years), and hospital volume. Results - Prosthesis survival and risk of revision were similar for CAS and CON. CAS had significantly fewer revisions due to malalignment. Otherwise, no statistically significant difference was found between the groups in analyses of secondary outcomes. Mean operating time was 13 minutes longer in CAS. Interpretation - At 8 years of follow-up, CAS and CON had similar rates of overall revision, but CAS had fewer revisions due to malalignment. According to our findings, the benefits of CAS at medium-term follow-up are limited. Further research may identify subgroups that benefit from CAS, and it should also emphasize patient-reported outcomes.

Survivorship and relative risk of revision in computer-navigated versus conventional total knee replacement at 8-year follow-up

PubMed Central

Dyrhovden, Gro S; Fenstad, Anne M; Furnes, Ove; Gøthesen, Øystein

2016-01-01

Background and purpose The long-term effects of computer-assisted surgery in total knee replacement (CAS) compared to conventionally operated knee replacement (CON) are still not clear. We compared survivorship and relative risk of revision in CAS and CON based on data from the Norwegian Arthroplasty Register. Patients and methods We assessed primary total knee replacements without patellar resurfacing reported to the Norwegian Arthroplasty Register from 2005 through 2014. The 5 most used implants and the 3 most common navigation systems were included. The groups (CAS, n = 3,665; CON, n = 20,019) were compared using a Cox regression analysis adjusted for age, sex, ASA category, prosthesis brand, fixation method, previous surgery, and diagnosis with the risk of revision for any reason as endpoint. Secondary outcomes were reasons for revision and effects of prosthesis brand, fixation method, age (± 65 years), and hospital volume. Results Prosthesis survival and risk of revision were similar for CAS and CON. CAS had significantly fewer revisions due to malalignment. Otherwise, no statistically significant difference was found between the groups in analyses of secondary outcomes. Mean operating time was 13 minutes longer in CAS. Interpretation At 8 years of follow-up, CAS and CON had similar rates of overall revision, but CAS had fewer revisions due to malalignment. According to our findings, the benefits of CAS at medium-term follow-up are limited. Further research may identify subgroups that benefit from CAS, and it should also emphasize patient-reported outcomes. PMID:27775460

Comparative observations on levels of mercury in scalp hair of humans from different Islands

NASA Astrophysics Data System (ADS)

Renzoni, Aristeo

1992-09-01

Following the Minamata events, an extraordinary number of studies concerning mercury toxicity and human health have been undertaken. Particular attention has been given to the evaluation of the dose-response relationship, i.e., the body burden at which (evaluated through the mercury analyses in blood or hair) the risk of poisoning begins. The results of a comparative study concerning levels of mercury in the hair of fishermen living in small islands who eat seafood more than four times per week show that in two areas only, and only in a few cases in these areas, the mercury in the hair exceeds the limit at which a possible risk could exist. In fact, the limit of 50 mg/g of total mercury in the hair (indicated as the lower limit above which a possible risk could occur) is surpassed by nine fishermen out of a total of 39 at station 1 and by four fishermen out of a total of 26 at station 3. The average value at station 1 is 36.38 mg/g and that at station 3 is 30.31 mg. Many countries have set legal limits of mercury for seafood, but evidently the system does not offer a true protection for man. Only the provisional tolerable weekly intake (PTWI), as repeatedly suggested by WHO, should be considered the best guideline to prevent possibly harmful consequences.

Vegetables, but not pickled vegetables, are negatively associated with the risk of breast cancer.

PubMed

Yu, Hyejin; Hwang, Ji-Yun; Ro, Jungsil; Kim, Jeongseon; Chang, Namsoo

2010-01-01

This study investigated the association between pickled vegetable consumption and the risk of breast cancer using a validated food frequency questionnaire. A total of 358 patients with breast cancer who were matched to 360 healthy controls by age (using a 5-yr age distribution) were recruited from the National Cancer Center in South Korea. After adjusting for nondietary risk factors, total vegetable intake was inversely associated with risk of breast cancer. However, unlike nonpickled vegetables, pickled vegetable intake and its proportion relative to total vegetables were positively associated with the risk of breast cancer, and this association was more profound and consistent when pickled vegetable intake was considered as a proportion relative to total vegetables (odds ratio [OR] = 6.24, 95% confidence interval [CI] = 3.55-10.97; P for trend <0.001 for highest vs. lowest quartiles of intake) than as the absolute consumed amount (OR = 2.47, 95% CI = 1.45-4.21; P for trend = 0.015 for highest vs. lowest quartiles of intake). These results suggest that not only the amount of total vegetable intake but also the amounts of different types of vegetable (i.e., pickled or nonpickled) and their proportions relative to total vegetables are significantly associated with the risk of breast cancer.

Latex allergy symptoms among health care workers: results from a university health and safety surveillance system.

PubMed

Epling, Carol; Duncan, Jacqueline; Archibong, Emma; Østbye, Truls; Pompeii, Lisa A; Dement, John

2011-01-01

We sought to describe risk factors for latex glove allergy symptoms among health care workers by combining data from an active clinical surveillance program and a comprehensive occupational health surveillance system. A total of 4,584 employers completed a latex allergy questionnaire. Six percent (n = 276) of subjects reported symptoms consistent with latex allergy. Years of latex glove use was a significant risk factor for latex allergy symptoms even after controlling for the effects of atopy, gender, age, race, fruit, and other allergies. Nurses, medical or lab technicians, physician's assistants, other clinical professionals, and housekeepers had the highest prevalence of latex glove allergy symptoms. Forty subjects (0.87%) who were confirmed as having latex sensitization. Sensitizsation may have been underestimated due to use of specific IgE antibody, less sensitive than skin-prick testing, and tiered design leading to laboratory assessment on a subset of the cohort. This surveillance program identified risk factors for latex allergy symptoms. Our findings provide a basis for tailoring future prevention strategies.

Process Control Migration of 50 LPH Helium Liquefier

NASA Astrophysics Data System (ADS)

Panda, U.; Mandal, A.; Das, A.; Behera, M.; Pal, Sandip

2017-02-01

Two helium liquefier/refrigerators are operational at VECC while one is dedicated for the Superconducting Cyclotron. The first helium liquefier of 50 LPH capacity from Air Liquide has already completed fifteen years of operation without any major trouble. This liquefier is being controlled by Eurotherm PC3000 make PLC. This PLC has become obsolete since last seven years or so. Though we can still manage to run the PLC system with existing spares, risk of discontinuation of the operation is always there due to unavailability of spare. In order to eliminate the risk, an equivalent PLC control system based on Siemens S7-300 was thought of. For smooth migration, total programming was done keeping the same field input and output interface, nomenclature and graphset. New program is a mix of S7-300 Graph, STL and LAD languages. One to one program verification of the entire process graph was done manually. The total program was run in simulation mode. Matlab mathematical model was also used for plant control simulations. EPICS based SCADA was used for process monitoring. As of now the entire hardware and software is ready for direct replacement with minimum required set up time.

Effects of glyphosate at environmentally relevant concentrations on the growth of and microcystin production by Microcystis aeruginosa.

PubMed

Zhang, Quan; Zhou, Hang; Li, Zhe; Zhu, Jianqiang; Zhou, Cong; Zhao, Meirong

2016-11-01

The use of glyphosate, which is a well-known sterilant herbicide, has been growing rapidly because the area under the cultivation of genetically modified crops that are tolerant to this herbicide has increased. Glyphosate can enter into aquatic systems through many different ways. However, information on the potential risks of glyphosate at environmentally relevant levels to aquatic systems is still limited. In this study, we selected the cyanobacterium Microcystis aeruginosa FACHB-905 (M. aeruginosa) as a model organism to evaluate the effects of glyphosate at environmentally relevant concentrations on the former's growth and microcystin (MC) production. Our results show that low levels of glyphosate stimulate the growth of M. aeruginosa. Subsequently, there was significant increase in the total MC-LR and intracellular MC-LR, but not in extracellular MC-LR, after exposure to 0.1-2 mg/L of glyphosate. The increase in total MC-LR is mainly due to the effects of glyphosate on the cell density of M. aeruginosa. The data provided here show that low level of glyphosate in a water body is a potential environmental risk factor that stimulates the growth and enhances MC production in M. aeruginosa, which should arouse great concern.

Selenium and hazardous elements distribution in plant-soil-water system and human health risk assessment of Lower Cambrian, Southern Shaanxi, China.

PubMed

Du, Yajun; Luo, Kunli; Ni, Runxiang; Hussain, Rahib

2018-03-01

The natural selenium poisoning due to toxic Se levels in food chain had been observed in humans and animals in Lower Cambrian outcrop areas in Southern Shaanxi, China. To find out the distribution pattern of selenium and other hazardous elements in the plant, soil and water of Lower Cambrian in Southern Shaanxi, China, and their possible potential health risk, a total of 30 elements were analyzed and the health risk assessment of 18 elements was calculated. Results showed that the soil, plant and natural water of Lower Cambrian all had relatively high Se levels. In Lower Cambrian, the soil was enriched with Se, As, Ba, Cu, Mo, Ni, Zn, Ga, Cd and Cr (1.68 < I geo  < 4.48, I geo ; geo-accumulation index). In same plants, the contents of Se, Cd and Zn (except Cd in corn and rice, Zn in potato and corn) of Lower Cambrian were higher than that of the other strata. Ba and Ga in natural water were higher than that of the other strata, while K and Cs were opposite. The health risk assessment results showed that the people living in outcrop areas of Lower Cambrian had both high total non-carcinogenic risk of 18 elements (HI = 16.12, acceptable range: < 1) and carcinogenic risk of As (3.98E-04, acceptable range: 10 -6 -10 -4 ). High contents of Se, As, Mo and Tl of Lower Cambrian may pose a health risk to local people, and food intake was the major pathway. For minimizing potential health risk, the local inhabitants should use the mix-imported food with local growing foods.

The AAHKS Clinical Research Award: Intraosseous Regional Prophylaxis Provides Higher Tissue Concentrations in High BMI Patients in Total Knee Arthroplasty: A Randomized Trial.

PubMed

Chin, Seung Joon; Moore, Grant A; Zhang, Mei; Clarke, Henry D; Spangehl, Mark J; Young, Simon W

2018-07-01

Obesity is an established risk factor for periprosthetic joint infections after total knee arthroplasty (TKA). In obese patients, a larger dose of prophylactic vancomycin based on actual body weight is required to reach therapeutic concentrations. It is unclear how tissue concentrations are affected when intraosseous regional administration (IORA) is used in this population. This study compared tissue concentrations of low-dose vancomycin via IORA vs actual body weight-adjusted systemic intravenous (IV) dose in primary TKA. Twenty-two patients with a body mass index (BMI) >35 undergoing TKA were randomized into 2 groups. The IV group received 15 mg/kg (maximum of 2 g) of systemic IV vancomycin and the IORA group received 500 mg vancomycin into the tibia. Subcutaneous fat and bone samples were taken at regular intervals. Tissue antibiotic concentrations were measured using liquid chromatography coupled with tandem mass spectrometry. A blood sample was taken 1 to 2 hours after tourniquet deflation to measure systemic concentration. The mean BMI was 41.1 in the IORA group and 40.1 in the IV systemic group. The overall mean tissue concentration in subcutaneous fat was 39.3 μg/g in the IORA group and 4.4 μg/g in the IV systemic group (P < .01). Mean tissue concentrations in bones were 34.4 μg/g in the IORA group and 6.1 μg/g in the IV systemic group (P < .01). Low-dose IORA was effective in the high-BMI population group, providing tissue concentrations of vancomycin 5-9 times higher than systemic administration. IORA optimizes timing of vancomycin administration and provides high tissue antibiotic concentrations during TKA in this high-risk patient group. Copyright © 2018 Elsevier Inc. All rights reserved.

The microbiological quality of air improves when using air conditioning systems in cars.

PubMed

Vonberg, Ralf-Peter; Gastmeier, Petra; Kenneweg, Björn; Holdack-Janssen, Hinrich; Sohr, Dorit; Chaberny, Iris F

2010-06-01

Because of better comfort, air conditioning systems are a common feature in automobiles these days. However, its impact on the number of particles and microorganisms inside the vehicle--and by this its impact on the risk of an allergic reaction--is yet unknown. Over a time period of 30 months, the quality of air was investigated in three different types of cars (VW Passat, VW Polo FSI, Seat Alhambra) that were all equipped with a automatic air conditioning system. Operation modes using fresh air from outside the car as well as circulating air from inside the car were examined. The total number of microorganisms and the number of mold spores were measured by impaction in a high flow air sampler. Particles of 0.5 to 5.0 microm diameter were counted by a laser particle counter device. Overall 32 occasions of sampling were performed. The concentration of microorganisms outside the cars was always higher than it was inside the cars. Few minutes after starting the air conditioning system the total number of microorganisms was reduced by 81.7%, the number of mold spores was reduced by 83.3%, and the number of particles was reduced by 87.8%. There were no significant differences neither between the types of cars nor between the types of operation mode of the air conditioning system (fresh air vs. circulating air). All parameters that were looked for in this study improved during utilization of the car's air conditioning system. We believe that the risk of an allergic reaction will be reduced during use also. Nevertheless, we recommend regular maintenance of the system and replacement of older filters after defined changing intervals.

The microbiological quality of air improves when using air conditioning systems in cars

PubMed Central

2010-01-01

Background Because of better comfort, air conditioning systems are a common feature in automobiles these days. However, its impact on the number of particles and microorganisms inside the vehicle - and by this its impact on the risk of an allergic reaction - is yet unknown. Methods Over a time period of 30 months, the quality of air was investigated in three different types of cars (VW Passat, VW Polo FSI, Seat Alhambra) that were all equipped with a automatic air conditioning system. Operation modes using fresh air from outside the car as well as circulating air from inside the car were examined. The total number of microorganisms and the number of mold spores were measured by impaction in a high flow air sampler. Particles of 0.5 to 5.0 μm diameter were counted by a laser particle counter device. Results Overall 32 occasions of sampling were performed. The concentration of microorganisms outside the cars was always higher than it was inside the cars. Few minutes after starting the air conditioning system the total number of microorganisms was reduced by 81.7%, the number of mold spores was reduced by 83.3%, and the number of particles was reduced by 87.8%. There were no significant differences neither between the types of cars nor between the types of operation mode of the air conditioning system (fresh air vs. circulating air). All parameters that were looked for in this study improved during utilization of the car's air conditioning system. Conclusions We believe that the risk of an allergic reaction will be reduced during use also. Nevertheless, we recommend regular maintenance of the system and replacement of older filters after defined changing intervals. PMID:20515449

Early Components of the Complement Classical Activation Pathway in Human Systemic Autoimmune Diseases

PubMed Central

Lintner, Katherine E.; Wu, Yee Ling; Yang, Yan; Spencer, Charles H.; Hauptmann, Georges; Hebert, Lee A.; Atkinson, John P.; Yu, C. Yung

2016-01-01

The complement system consists of effector proteins, regulators, and receptors that participate in host defense against pathogens. Activation of the complement system, via the classical pathway (CP), has long been recognized in immune complex-mediated tissue injury, most notably systemic lupus erythematosus (SLE). Paradoxically, a complete deficiency of an early component of the CP, as evidenced by homozygous genetic deficiencies reported in human, are strongly associated with the risk of developing SLE or a lupus-like disease. Similarly, isotype deficiency attributable to a gene copy-number (GCN) variation and/or the presence of autoantibodies directed against a CP component or a regulatory protein that result in an acquired deficiency are relatively common in SLE patients. Applying accurate assay methodologies with rigorous data validations, low GCNs of total C4, and heterozygous and homozygous deficiencies of C4A have been shown as medium to large effect size risk factors, while high copy numbers of total C4 or C4A as prevalent protective factors, of European and East-Asian SLE. Here, we summarize the current knowledge related to genetic deficiency and insufficiency, and acquired protein deficiencies for C1q, C1r, C1s, C4A/C4B, and C2 in disease pathogenesis and prognosis of SLE, and, briefly, for other systemic autoimmune diseases. As the complement system is increasingly found to be associated with autoimmune diseases and immune-mediated diseases, it has become an attractive therapeutic target. We highlight the recent developments and offer a balanced perspective concerning future investigations and therapeutic applications with a focus on early components of the CP in human systemic autoimmune diseases. PMID:26913032

A non-stationary cost-benefit analysis approach for extreme flood estimation to explore the nexus of 'Risk, Cost and Non-stationarity'

NASA Astrophysics Data System (ADS)

Qi, Wei

2017-11-01

Cost-benefit analysis is commonly used for engineering planning and design problems in practice. However, previous cost-benefit based design flood estimation is based on stationary assumption. This study develops a non-stationary cost-benefit based design flood estimation approach. This approach integrates a non-stationary probability distribution function into cost-benefit analysis, and influence of non-stationarity on expected total cost (including flood damage and construction costs) and design flood estimation can be quantified. To facilitate design flood selections, a 'Risk-Cost' analysis approach is developed, which reveals the nexus of extreme flood risk, expected total cost and design life periods. Two basins, with 54-year and 104-year flood data respectively, are utilized to illustrate the application. It is found that the developed approach can effectively reveal changes of expected total cost and extreme floods in different design life periods. In addition, trade-offs are found between extreme flood risk and expected total cost, which reflect increases in cost to mitigate risk. Comparing with stationary approaches which generate only one expected total cost curve and therefore only one design flood estimation, the proposed new approach generate design flood estimation intervals and the 'Risk-Cost' approach selects a design flood value from the intervals based on the trade-offs between extreme flood risk and expected total cost. This study provides a new approach towards a better understanding of the influence of non-stationarity on expected total cost and design floods, and could be beneficial to cost-benefit based non-stationary design flood estimation across the world.

Quantitation of total homocysteine in human plasma by derivatization to its N(O,S)-propoxycarbonyl propyl ester and gas chromatography-mass spectrometry analysis.

PubMed

Sass, J O; Endres, W

1997-08-01

Much evidence supports the hypothesis that mild or moderate hyperhomocysteinaemia represents an important and independent risk factor for occlusive vascular diseases. Therefore, the accurate and reliable determination of total plasma homocysteine has gained major importance for risk assessment. Furthermore, it can help in the detection of folate and vitamin B12 deficiency. This has prompted us to develop a sensitive gas chromatography-mass spectrometry (GC-MS) method in order to quantify total homocysteine in human plasma. Prior to chromatography, reduced homocysteine was released from disulfide bonds by incubation with excess dithiothreitol and converted into its N(O,S)-propoxycarbonyl propyl ester by derivatization with n-propyl chloroformate. Aminoethylcysteine served as internal standard. The method proved to be highly linear over the entire concentration range examined (corresponding to 0-266 microM homocysteine) and showed intra-assay and inter-assay variation (relative standard deviations) of approximately 5 and 5-10%, respectively. External quality control by comparison with duplicate analysis performed on a HPLC-based system revealed satisfactory correlation. The newly developed GC-MS based method provides simple, reliable and fast quantification of total homocysteine and requires only inexpensive chemicals, which are easy to obtain.

The role of total fats, saturated/unsaturated fatty acids and cholesterol content in chicken meat as cardiovascular risk factors.

PubMed

Milićević, Dragan; Vranić, Danijela; Mašić, Zoran; Parunović, Nenad; Trbović, Dejana; Nedeljković-Trailović, Jelena; Petrović, Zoran

2014-03-03

The objective of the study was to present information about the chemical composition, the fatty acids profile, and cholesterol content of chicken meat in order to investigate the impact of chicken meat consumption on cardiovascular risk in the general population. A total of 48 6-wk-old broiler chickens broilers from two farms in June to November of 2012, and February of 2013, were used in this trial. Total lipid content was determined by extraction of fat by petrol ether (Soxhlet) after acid hydrolysis of samples. Fatty acids were determined by capillary gas chromatography. Cholesterol determination was performed by using HPLC/PDA system. The results indicate that the total free cholesterol content in raw breast and drumstick of chickens was in the range of 37,41-79,9 mg/100 g and 48,35-99,5 mg/100 g, respectively. The main fatty acids identified in all cuts were C18:1c9, C18:2n6, C16:0, C18:0, and C16:1. Decreasing the dietary n-6/n-3 clearly decreased the content in breast and drumstick muscle of C18:2n6, C18:3n3, and C20: 3n6, but increased that of C16:0, C18:0, and C20:2. Also, the major saturated fatty acid (SFA) (C16:0 and C18:0) was significantly differ among the four treatments. Our study shows that dietary fat and fatty acid composition influence the concentrations of total cholesterol content, total fat content, and fatty acid composition in broiler muscle. This information will aid in determining the burden of chicken meat as a cardiovascular risk factors disease and act as a planning tool for public-health Programmes.

The role of total fats, saturated/unsaturated fatty acids and cholesterol content in chicken meat as cardiovascular risk factors

PubMed Central

2014-01-01

Background The objective of the study was to present information about the chemical composition, the fatty acids profile, and cholesterol content of chicken meat in order to investigate the impact of chicken meat consumption on cardiovascular risk in the general population. Methods A total of 48 6-wk-old broiler chickens broilers from two farms in June to November of 2012, and February of 2013, were used in this trial. Total lipid content was determined by extraction of fat by petrol ether (Soxhlet) after acid hydrolysis of samples. Fatty acids were determined by capillary gas chromatography. Cholesterol determination was performed by using HPLC/PDA system. Results The results indicate that the total free cholesterol content in raw breast and drumstick of chickens was in the range of 37,41–79,9 mg/100 g and 48,35-99,5 mg/100 g, respectively. The main fatty acids identified in all cuts were C18:1c9, C18:2n6, C16:0, C18:0, and C16:1. Decreasing the dietary n-6/n-3 clearly decreased the content in breast and drumstick muscle of C18:2n6, C18:3n3, and C20: 3n6, but increased that of C16:0, C18:0, and C20:2. Also, the major saturated fatty acid (SFA) (C16:0 and C18:0) was significantly differ among the four treatments. Conclusion Our study shows that dietary fat and fatty acid composition influence the concentrations of total cholesterol content, total fat content, and fatty acid composition in broiler muscle. This information will aid in determining the burden of chicken meat as a cardiovascular risk factors disease and act as a planning tool for public-health Programmes. PMID:24588940

Proposed algorithm for management of patients with thyroid nodules/focal lesions, based on ultrasound (US) and fine-needle aspiration biopsy (FNAB); our own experience

PubMed Central

2013-01-01

Background The standard management in patients with thyroid nodules is to assess the risk of malignancy, based on cytological examination. On the other hand, there are thyroid patterns of ultrasound (US) image, associated with an increased risk of malignancy. The aim of our study was to create a diagnostic algorithm that would employ both data from US examination (expressed by a total score, according to our scoring system) and FNAB results, classified according to Bethesda system (The Bethesda System for Reporting Thyroid Cytopathology - TBSRTC categories). Material and methods 100 thyroid cancer foci (94 papillary carcinomas, 4 medullary carcinomas, 2 undifferentiated carcinomas) and 100 benign focal lesions were selected during postoperative histopathological examination of thyroid glands excised during surgery from 111 patients. The corresponding US images of each lesion – performed in the course of preoperative diagnostics – were evaluated for the presence of seven (7) different features in US image, suggesting a malignant character of lesion, viz. vascularity, i.e., the increased central intranodular blood flows, microcalcifications, “taller-than-wide” orientation, solid composition, hypoechogenicity, irregular margin and either absence of peripheral halo or the presence of outer shell of uneven thickness, surrounding the lesion. The sensitivity, specificity, positive predictive values, negative predictive values and odds ratios for each US feature were calculated. Results In US image of the analyzed cancer foci, we obtained the following values of odds ratio for each of the above mentioned features suggesting malignancy: “taller-than-wide” orientation - odds ratio - 301.0, microcalcifications - 24.67, increased intranodular vascularity - 20.44, hypoechogenicity - 18.61, irregular margins - 7.81, absence of halo - 5.88, and solid composition - 4.16. Taking into account our own experience and the present data, in juxtaposition with the opinions of other authors, we propose a division of US features into 3 groups of different prognostic importance, expressed by a total score calculated based on our scoring system. Accordingly, microcalcifications, “taller-than-wide” orientation, the increased intranodular vascularity, and hypoechogenicity constitute one group - each of the features in this group is awarded 1 point. In turn, the characteristics of minor prognostic importance, such as irregular margin, absence of halo, solid composition, and large size (a diameter longer than 3.0 cm) - are associated with the granting 0.5 points each. The most important prognostic features – a rapid growth (enlargement) of nodules/focal lesions and a presence of pathologically altered lymph nodes are associated with the granting 3 points for each. Our scoring system can be applied in order to better assessment of thyroid US patterns in whole. In patients with a total score ranging from 0 < 4 points there is US pattern of a low risk of malignancy, with ≥ 4 < 7 points - intermediate risk, and in patients with a score ≥ 7 points – a high risk in question. Conclusion Complementary use of our scoring system and FNAB TBSRTC categories can help to make optimal clinical decisions as regards the selection of treatment strategy. PMID:23601166

Proposed algorithm for management of patients with thyroid nodules/focal lesions, based on ultrasound (US) and fine-needle aspiration biopsy (FNAB); our own experience.

PubMed

Adamczewski, Zbigniew; Lewiński, Andrzej

2013-01-01

The standard management in patients with thyroid nodules is to assess the risk of malignancy, based on cytological examination. On the other hand, there are thyroid patterns of ultrasound (US) image, associated with an increased risk of malignancy. The aim of our study was to create a diagnostic algorithm that would employ both data from US examination (expressed by a total score, according to our scoring system) and FNAB results, classified according to Bethesda system (The Bethesda System for Reporting Thyroid Cytopathology - TBSRTC categories). 100 thyroid cancer foci (94 papillary carcinomas, 4 medullary carcinomas, 2 undifferentiated carcinomas) and 100 benign focal lesions were selected during postoperative histopathological examination of thyroid glands excised during surgery from 111 patients. The corresponding US images of each lesion - performed in the course of preoperative diagnostics - were evaluated for the presence of seven (7) different features in US image, suggesting a malignant character of lesion, viz. vascularity, i.e., the increased central intranodular blood flows, microcalcifications, "taller-than-wide" orientation, solid composition, hypoechogenicity, irregular margin and either absence of peripheral halo or the presence of outer shell of uneven thickness, surrounding the lesion. The sensitivity, specificity, positive predictive values, negative predictive values and odds ratios for each US feature were calculated. IN US IMAGE OF THE ANALYZED CANCER FOCI, WE OBTAINED THE FOLLOWING VALUES OF ODDS RATIO FOR EACH OF THE ABOVE MENTIONED FEATURES SUGGESTING MALIGNANCY: "taller-than-wide" orientation - odds ratio - 301.0, microcalcifications - 24.67, increased intranodular vascularity - 20.44, hypoechogenicity - 18.61, irregular margins - 7.81, absence of halo - 5.88, and solid composition - 4.16. Taking into account our own experience and the present data, in juxtaposition with the opinions of other authors, we propose a division of US features into 3 groups of different prognostic importance, expressed by a total score calculated based on our scoring system. Accordingly, microcalcifications, "taller-than-wide" orientation, the increased intranodular vascularity, and hypoechogenicity constitute one group - each of the features in this group is awarded 1 point. In turn, the characteristics of minor prognostic importance, such as irregular margin, absence of halo, solid composition, and large size (a diameter longer than 3.0 cm) - are associated with the granting 0.5 points each. The most important prognostic features - a rapid growth (enlargement) of nodules/focal lesions and a presence of pathologically altered lymph nodes are associated with the granting 3 points for each. Our scoring system can be applied in order to better assessment of thyroid US patterns in whole. In patients with a total score ranging from 0 < 4 points there is US pattern of a low risk of malignancy, with ≥ 4 < 7 points - intermediate risk, and in patients with a score ≥ 7 points - a high risk in question. Complementary use of our scoring system and FNAB TBSRTC categories can help to make optimal clinical decisions as regards the selection of treatment strategy.

Intake of Trace Metals and the Risk of Incident Kidney Stones.

PubMed

Ferraro, Pietro Manuel; Gambaro, Giovanni; Curhan, Gary C; Taylor, Eric N

2018-06-01

The association between the intake of trace metals and the risk of incident stones has not been longitudinally investigated. We performed a prospective analysis of 193,551 participants in the Health Professionals Follow-up Study, and the Nurses' Health Study I and II. During a followup of 3,316,580 person-years there was a total of 6,576 incident stones. We used multivariate regression models to identify associations of the intake of zinc, iron, copper and manganese with the risk of stones. In a subset of participants with 24-hour urine collections we examined the association between the intake of trace metals and urine composition. After multivariate adjustment total and dietary intakes of zinc and iron were not significantly associated with incident stones. A higher intake of manganese was associated with a lower risk of stones. The pooled HR of the highest quintile of total manganese intake compared with the lowest intake was 0.82 (95% CI 0.68-0.98, p = 0.02). Total but not dietary copper intake was marginally associated with a higher risk of stones (pooled HR 1.14, 95% CI 1.02-1.28, p = 0.01). There were no statistically significant associations of the total intake of manganese and copper with urinary supersaturation. Zinc and iron intake was not associated with a risk of stones. Copper intake may be associated with a higher risk in some individuals. Higher total manganese intake was associated with a lower risk of stones but not with traditional 24-hour urinary composite markers of stone risk. Further research is needed to elucidate the mechanisms by which manganese may reduce kidney stone formation. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Whole-Grain Intake and Mortality from All Causes, Cardiovascular Disease, and Cancer: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies.

PubMed

Benisi-Kohansal, Sanaz; Saneei, Parvane; Salehi-Marzijarani, Mohammad; Larijani, Bagher; Esmaillzadeh, Ahmad

2016-11-01

No conclusive information is available about the relation between the consumption of whole grains and the risk of mortality. We aimed to conduct a meta-analysis of prospective cohort studies to summarize the relation between whole-grain intake and risk of mortality from all causes, cardiovascular disease, and total and specific cancers. A systematic search of the literature published earlier than March 2015 was conducted in Medline and PubMed, SCOPUS, EMBASE, and Cochrane Library to identify relevant articles. Prospective cohort studies that examined the association of total whole-grain intake or specific whole-grain foods with risk of mortality from all causes, cardiovascular disease, and total and specific cancers were considered. Twenty prospective cohort studies were included in the systematic review: 9 studies reported total whole-grain intake and 11 others reported specific whole-grain food intake. In a follow-up period of 5.5 to 26 y, there were 191,979 deaths (25,595 from cardiovascular disease, 32,746 from total cancers, and 2671 from specific cancers) in 2,282,603 participants. A greater intake of both total whole grains and specific whole-grain foods was significantly associated with a lower risk of all-cause mortality in the meta-analysis. The pooled RR for all-cause mortality for an increase of 3 servings total whole grains/d (90 g/d) was 0.83 (95% CI: 0.79, 0.88). Total whole-grain intake (0.84; 95% CI: 0.76, 0.93) and specific whole-grain foods (0.82; 95% CI: 0.75, 0.90) were also associated with a reduced risk of mortality from cardiovascular disease. Each additional 3 servings total whole grains/d was associated with a 25% lower risk of mortality from cardiovascular disease. An inverse association was observed between whole-grain intake and risk of mortality from total cancers (0.94; 95% CI: 0.91, 0.98). We found an inverse association between whole-grain intake and mortality from all causes, cardiovascular disease, and total cancers. © 2016 American Society for Nutrition.

Whole-Grain Intake and Mortality from All Causes, Cardiovascular Disease, and Cancer: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies123

PubMed Central

Benisi-Kohansal, Sanaz; Saneei, Parvane; Salehi-Marzijarani, Mohammad; Larijani, Bagher; Esmaillzadeh, Ahmad

2016-01-01

No conclusive information is available about the relation between the consumption of whole grains and the risk of mortality. We aimed to conduct a meta-analysis of prospective cohort studies to summarize the relation between whole-grain intake and risk of mortality from all causes, cardiovascular disease, and total and specific cancers. A systematic search of the literature published earlier than March 2015 was conducted in Medline and PubMed, SCOPUS, EMBASE, and Cochrane Library to identify relevant articles. Prospective cohort studies that examined the association of total whole-grain intake or specific whole-grain foods with risk of mortality from all causes, cardiovascular disease, and total and specific cancers were considered. Twenty prospective cohort studies were included in the systematic review: 9 studies reported total whole-grain intake and 11 others reported specific whole-grain food intake. In a follow-up period of 5.5 to 26 y, there were 191,979 deaths (25,595 from cardiovascular disease, 32,746 from total cancers, and 2671 from specific cancers) in 2,282,603 participants. A greater intake of both total whole grains and specific whole-grain foods was significantly associated with a lower risk of all-cause mortality in the meta-analysis. The pooled RR for all-cause mortality for an increase of 3 servings total whole grains/d (90 g/d) was 0.83 (95% CI: 0.79, 0.88). Total whole-grain intake (0.84; 95% CI: 0.76, 0.93) and specific whole-grain foods (0.82; 95% CI: 0.75, 0.90) were also associated with a reduced risk of mortality from cardiovascular disease. Each additional 3 servings total whole grains/d was associated with a 25% lower risk of mortality from cardiovascular disease. An inverse association was observed between whole-grain intake and risk of mortality from total cancers (0.94; 95% CI: 0.91, 0.98). We found an inverse association between whole-grain intake and mortality from all causes, cardiovascular disease, and total cancers. PMID:28140323

Development of the Connecticut Airway Risk Evaluation (CARE) system to improve handoff communication in pediatric patients with tracheotomy.

PubMed

Lawrason Hughes, Amy; Murray, Nicole; Valdez, Tulio A; Kelly, Raeanne; Kavanagh, Katherine

2014-01-01

National attention has focused on the importance of handoffs in medicine. Our practice during airway patient handoffs is to communicate a patient-specific emergency plan for airway reestablishment; patients who are not intubatable by standard means are at higher risk for failure. There is currently no standard classification system describing airway risk in tracheotomized patients. To introduce and assess the interrater reliability of a simple airway risk classification system, the Connecticut Airway Risk Evaluation (CARE) system. We created a novel classification system, the CARE system, based on ease of intubation and the need for ventilation: group 1, easily intubatable; group 2, intubatable with special equipment and/or maneuvers; group 3, not intubatable. A "v" was appended to any group number to indicate the need for mechanical ventilation. We performed a retrospective medical chart review of patients aged 0 to 18 years who were undergoing tracheotomy at our tertiary care pediatric hospital between January 2000 and April 2011. INTERVENTIONS Each patient's medical history, including airway disease and means of intubation, was reviewed by 4 raters. Patient airways were separately rated as CARE groups 1, 2, or 3, each group with or without a v appended, as appropriate, based on the available information. After the patients were assigned to an airway group by each of the 4 raters, the interrater reliability was calculated to determine the ease of use of the rating system. We identified complete data for 155 of 169 patients (92%), resulting in a total of 620 ratings. Based on the patient's ease of intubation, raters categorized tracheotomized patients into group 1 (70%, 432 of 620); group 2 (25%, 157 of 620); or group 3 (5%, 29 of 620), each with a v appended if appropriate. The interrater reliability was κ = 0.95. We propose an airway risk classification system for tracheotomized patients, CARE, that has high interrater reliability and is easy to use and interpret. As medical providers and national organizations place more focus on improvements in interprovider communication, the creation of an airway handoff tool is integral to improving patient safety and airway management strategies following tracheotomy complications.

Levonorgestrel-releasing intrauterine system and the risk of breast cancer: A nationwide cohort study.

PubMed

Soini, Tuuli; Hurskainen, Ritva; Grénman, Seija; Mäenpää, Johanna; Paavonen, Jorma; Joensuu, Heikki; Pukkala, Eero

2016-01-01

Prolonged steroid hormone therapy increases the risk of breast cancer, especially the risk of lobular cancer, but the effect of the levonorgestrel-releasing intrauterine system (LNG-IUS) use is controversial. In this study we aimed to test the hypothesis that risk for lobular breast cancer is elevated among LNG-IUS users. We identified from the national Medical Reimbursement Registry of Finland the women aged 30-49 who had used LNG-IUS for the treatment or prevention of menorrhagia in 1994-2007, and from the Finnish Cancer Registry breast cancers diagnosed before the age of 55 and by the end of 2012. A total of 2015 women had breast cancer diagnosed in a cohort of 93 843 LNG-IUS users during follow-up consisting of 1 032 767 women-years. The LNG-IUS users had an increased risk for both ductal breast cancer [standardized incidence ratio (SIR) 1.20, 95% confidence interval (CI) 1.14-1.25] and for lobular breast cancer (SIR 1.33, 95% CI 1.20-1.46), as compared with the general female population. The highest risk was found in LNG-IUS users who purchased the device at least twice, whose SIR for lobular cancer was 1.73 (95% CI 1.37-2.15). The results imply that intrauterine administration of levonorgestrel is not only related to an excess risk of lobular breast cancer but also, in contrary to previous assumptions, to an excess risk of ductal breast cancer.

Methods for analyzing matched designs with double controls: excess risk is easily estimated and misinterpreted when evaluating traffic deaths.

PubMed

Redelmeier, Donald A; Tibshirani, Robert J

2018-06-01

To demonstrate analytic approaches for matched studies where two controls are linked to each case and events are accumulating counts rather than binary outcomes. A secondary intent is to clarify the distinction between total risk and excess risk (unmatched vs. matched perspectives). We review past research testing whether elections can lead to increased traffic risks. The results are reinterpreted by analyzing both the total count of individuals in fatal crashes and the excess count of individuals in fatal crashes, each time accounting for the matched double controls. Overall, 1,546 individuals were in fatal crashes on the 10 election days (average = 155/d), and 2,593 individuals were in fatal crashes on the 20 control days (average = 130/d). Poisson regression of total counts yielded a relative risk of 1.19 (95% confidence interval: 1.12-1.27). Poisson regression of excess counts yielded a relative risk of 3.22 (95% confidence interval: 2.72-3.80). The discrepancy between analyses of total counts and excess counts replicated with alternative statistical models and was visualized in graphical displays. Available approaches provide methods for analyzing count data in matched designs with double controls and help clarify the distinction between increases in total risk and increases in excess risk. Copyright © 2018 Elsevier Inc. All rights reserved.

Different Choices of Drinking Water Source and Different Health Risks in a Rural Population Living Near a Lead/Zinc Mine in Chenzhou City, Southern China.

PubMed

Huang, Xiao; He, Liping; Li, Jun; Yang, Fei; Tan, Hongzhuan

2015-11-12

This study aimed to describe the households' choices of drinking water sources, and evaluate the risk of human exposure to heavy metals via different drinking water sources in Chenzhou City of Hunan Province, Southern China. A cross-sectional face-to-face survey of 192 householders in MaTian and ZhuDui village was conducted. The concentrations of heavy metals in their drinking water sources were analyzed. Carcinogenic and non-carcinogenic risk assessment was performed according to the method recommended by the United States Environmental Protection Agency. In total, 52.60% of the households used hand-pressed well water, and 34.89% used barreled water for drinking. In total, 6.67% of the water samples exceeded the Chinese drinking water standards. The total health risk of five metals is 5.20 × 10(-9)~3.62 × 10(-5). The total health risk of five metals was at acceptable levels for drinking water sources. However, the total risk of using hand-pressed well water's highest value is 6961 times higher than the risk of using tap water. Household income level was significantly associated with drinking water choices. Arsenic (As) and lead (Pb) are priority controlled pollutants in this region. Using safe drinking water (tap water, barreled water and so on) can remarkably reduce the risk of ingesting heavy metals.

[Epidemic situation of oversea imported schistosomiasis in China and thinking about its prevention and control].

PubMed

Zhu, Rong; Xu, Jing

2014-04-01

The imported schistosomiasis cases in the Chinese literature and reports from the infectious disease monitoring information system from 1979 to 2013 were collected and compiled. Totally 365 cases were reported to be infected with outside schistosomiasis, including 239 cases of schistosomiasis haematobia (74.0%) and 71 cases of schistosomiasis mansoni (22.0%), and 42 foreigners (11.5%) and 323 Chinese (88.5%). The infection areas involved 15 countries and regions in Africa. Totally 74.92% of patients worked in the construction or geological prospecting in the wild field. According to the analysis of these cases, we found that the management system of prevention and control of imported schistosomiasis cases was not perfect including the high missing re-port rate, high misdiagnosis rate, and no standard diagnostic criteria. We suggest that all the levels of CDC or health administrative authorities should adopt the following relevant control measures to strengthen the imported schistosomiasis prevention and control in order to reduce the damage to the public health and the risk of the spread of African schistosomiasis in China: (1) to establish and perfect the imported schistosomiasis monitoring and control system in China; (2) to integrate the dynamic information platform of labor export and establish the comprehensive prevention and control management system of infectious diseases; (3) to standardize the diagnosis and treatment of oversea imported schistosomiasis; (4) to strengthen the research on the transmission risk of imported schistosomiasis in the territory of China.

Mortality After Total Knee and Total Hip Arthroplasty in a Large Integrated Health Care System.

PubMed

Inacio, Maria C S; Dillon, Mark T; Miric, Alex; Navarro, Ronald A; Paxton, Elizabeth W

2017-01-01

The number of excess deaths associated with elective total joint arthroplasty in the US is not well understood. To evaluate one-year postoperative mortality among patients with elective primary and revision arthroplasty procedures of the hip and knee. A retrospective analysis was conducted of hip and knee arthroplasties performed in 2010. Procedure type, procedure volume, patient age and sex, and mortality were obtained from an institutional total joint replacement registry. An integrated health care system population was the sampling frame for the study subjects and was the reference group for the study. Standardized 1-year mortality ratios (SMRs) and 95% confidence intervals (CIs) were calculated. A total of 10,163 primary total knee arthroplasties (TKAs), 4963 primary total hip arthroplasties (THAs), 606 revision TKAs, and 496 revision THAs were evaluated. Patients undergoing primary THA (SMR = 0.6, 95% CI = 0.4-0.7) and TKA (SMR = 0.4, 95% CI = 0.3-0.5) had lower odds of mortality than expected. Patients with revision TKA had higher-than-expected mortality odds (SMR = 1.8, 95% CI = 1.1-2.5), whereas patients with revision THA (SMR = 0.9, 95% CI = 0.4-1.5) did not have higher-than-expected odds of mortality. Understanding excess mortality after joint surgery allows clinicians to evaluate current practices and to determine whether certain groups are at higher-than-expected mortality risk after surgery.

Effects of acute hyperinsulinaemia on total and high-molecular-weight adiponectin concentration in metabolically healthy but obese postmenopausal women: a Montreal-Ottawa New Emerging Team (MONET) study.

PubMed

Elisha, B; Karelis, A D; Imbeault, P; Rabasa-Lhoret, R

2010-09-01

The aim of this study was to determine the differences and changes in total and high-molecular-weight (HMW) adiponectin levels among metabolically healthy but obese (MHO) postmenopausal women in response to acute hyperinsulinaemia. In this cross-sectional study, 55 non-diabetic overweight and obese postmenopausal women underwent a hyperinsulinaemic-euglycaemic clamp test to evaluate insulin sensitivity. Subjects within the upper tertile of insulin sensitivity were described as 'MHO' (n=18), whereas those within the lowest tertile were considered 'at risk' (n=18). Plasma total and HMW adiponectin levels were measured by ELISA at 0 (baseline), 90, 160 and 180 min during the clamp. At baseline and at all time points during the clamp, MHO individuals had significantly higher total and HMW adiponectin levels than at-risk subjects (AUC: total adiponectin=2506 ± 1010 vs 1616 ± 830; HMW adiponectin=909 ± 307 vs 604 ± 349; P<0.05). In addition, a significant reduction in total adiponectin was observed at 160 min and 180 min in at-risk and MHO subjects, respectively, while HMW adiponectin significantly decreased at 160 min in at-risk subjects, and at 90 min as well as 160 min in MHO women. MHO postmenopausal women had higher levels of plasma total and HMW adiponectin than at-risk subjects at baseline and during the clamp. Furthermore, significant decreases in total and HMW adiponectin were observed at certain time points in both the MHO and at-risk subjects. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Association of Nut Consumption with Cardiometabolic Risk Factors in the 2008/2009 New Zealand Adult Nutrition Survey

PubMed Central

Brown, Rachel C.; Tey, Siew Ling; Gray, Andrew R.; Chisholm, Alexandra; Smith, Claire; Fleming, Elizabeth; Parnell, Winsome

2015-01-01

Nut consumption has been associated with improvements in risk factors for chronic disease in populations within North America, Europe and Iran. This relationship has not been investigated in New Zealand (NZ). The associations between nut consumption and cardiometabolic risk factors among New Zealanders were examined. Data from the 24-h diet recalls of 4721 participants from the NZ Adult Nutrition Survey 2008/2009 (2008/2009 NZANS) were used to determine whole and total nut intake. Anthropometric data and blood pressure were collected, as well as blood samples analysed for total cholesterol (total-C) and HDL cholesterol (HDL-C), glycated haemoglobin (HbA1c), C-reactive protein (CRP) and folate. Participants were classified according to their five-year cardiovascular disease (CVD) risk. Both whole and total nut consumers had significantly lower weight, body mass index (BMI), waist circumference and central adiposity than non-nut consumers (all p ≤ 0.044). Whole blood, serum and red blood cell folate concentrations were significantly higher among whole nut consumers compared to non-whole nut consumers (all p ≤ 0.014), with only serum folate higher in total nut consumers compared to non-total nut consumers (p = 0.023). There were no significant differences for blood pressure, total-C, HDL-C and HbA1c; however, significant negative associations between total nut consumption and CVD risk category (p < 0.001) and CRP (p = 0.045) were apparent. Nut consumption was associated with more favourable body composition and a number of risk factors, which could collectively reduce chronic disease. PMID:26371037

A preliminary risk assessment of organochlorines accumulated in fish to the Indo-Pacific humpback dolphin (Sousa chinensis) in the Northwestern waters of Hong Kong.

PubMed

Hung, C L H; Xu, Y; Lam, J C W; Connell, D W; Lam, M H W; Nicholson, S; Richardson, B J; Lam, P K S

2006-11-01

The Indo-Pacific humpback dolphin is considered threatened due to several factors including pollution in Hong Kong and the risks due to consumption of fish tainted with polychlorinated biphenyls (PCBs) and organochlorine pesticides were assessed. Six species of fish Collichthys lucida, Pseudosciaena crocea, Johnius sp., Thryssa sp., Mugil sp. and Trichiurus sp., which comprise the main prey species of humpback dolphins were collected for analyses. Risks due to total PCBs, total TEQs, PCB 118 and the pesticides were assessed with the use of toxicity reference values as the threshold reference benchmarks. The calculated risk quotients (RQs) showed that the risks associated with organochlorines were generally low. The highest RQ was associated with total TEQs suggesting that dioxin-like PCBs may pose the highest risk to the dolphins. The HCHs, total PCBs and heptachlor had comparatively high RQs and thus they should also be the priority organochlorines that would require further investigation.

Promoting patient safety through prospective risk identification: example from peri-operative care.

PubMed

Smith, A; Boult, M; Woods, I; Johnson, S

2010-02-01

Investigation of patient safety incidents has focused on retrospective analyses once incidents have occurred. Prospective risk analysis techniques complement this but have not been widely used in healthcare. Prospective risk identification of non-operative risks associated with adult elective surgery under general anaesthesia using a customised structured "what if" checklist and development of risk matrix. Prioritisation of recommendations arising by cost, ease and likely speed of implementation. Groups totalling 20 clinical and administrative healthcare staff involved in peri-operative care and risk experts convened by the UK National Patient Safety Agency. 102 risks were identified and 95 recommendations made. The top 20 recommendations together were judged to encompass about 75% of the total estimated risk attributable to the processes considered. Staffing and organisational issues (21% of total estimated risk) included recommendations for removing distractions from the operating theatre, ensuring the availability of senior anaesthetists and promoting standards and flexible working among theatre staff. Devices and equipment (19% of total estimated risk) could be improved by training and standardisation; airway control and temperature monitoring were identified as two specific areas. Pre-assessment of patients before admission to hospital (12% of estimated risk) could be improved by defining a data set for adequate pre-assessment and making this available throughout the NHS. This technique can be successfully applied by healthcare staff but expert facilitation of groups is advisable. Such wider-ranging processes can potentially lead to more comprehensive risk reduction than "single-issue" risk alerts.

Micropollutants removal and health risk reduction in a water reclamation and ecological reuse system.

PubMed

Ma, Xiaoyan Y; Li, Qiyuan; Wang, Xiaochang C; Wang, Yongkun; Wang, Donghong; Ngo, Huu Hao

2018-07-01

As reclaimed water use is increasing, its safety attracts growing attention, particularly with respect to the health risks associated with the wide range of micropollutants found in the reclaimed water. In this study, sophisticated analysis was conducted for water samples from a water reclamation and ecological reuse system where domestic wastewater was treated using an anaerobic-anoxic-oxic unit followed by a membrane bioreactor (A 2 O-MBR), and the reclaimed water was used for replenishing a landscape lake. A total of 58 organic micropollutants were detected in the system, consisting of 13 polycyclic aromatic hydrocarbons (PAHs), 16 phenols, 3 pesticides, and 26 pharmaceuticals and personal care products (PPCPs). After treatment by the A 2 O-MBR process, effective removal of pesticides and phenols was achieved, while when the reclaimed water entered the landscape lake, PPCPs were further removed. From the physicochemical properties of micropollutants, it could be inferred that phenols and dichlorphos (the only pesticide with considerable concentration in the influent) would have been mainly removed by biodegradation and/or volatilization in the biological treatment process. Additionally, it is probable that sludge adsorption also contributed to the removal of dichlorphos. For the predominant PPCP removal in the landscape lake, various actions, such as adsorption, biodegradation, photolysis, and ecologically mediated processes (via aquatic plants and animals), would have played significant roles. However, according to their logK oc , logK ow and logD (pH = 8) values, it could be concluded that adsorption by suspended solids might be an important action. Although carcinogenic and non-carcinogenic risks associated with all the detected micropollutants were at negligible levels, the hazard quotients (HQs) of PPCPs accounted for 92.03%-97.23% of the HQ Total . With the significant removal of PPCPs through the ecological processes in the landscape lake, the safety of reclaimed water use could be improved. Therefore, the introduction of ecological unit into the water reclamation and reuse system could be an effective measure for health risk reduction posed by micropollutants. Copyright © 2018 Elsevier Ltd. All rights reserved.

Sub-classification of Advanced-Stage Hepatocellular Carcinoma: A Cohort Study Including 612 Patients Treated with Sorafenib.

PubMed

Yoo, Jeong-Ju; Chung, Goh Eun; Lee, Jeong-Hoon; Nam, Joon Yeul; Chang, Young; Lee, Jeong Min; Lee, Dong Ho; Kim, Hwi Young; Cho, Eun Ju; Yu, Su Jong; Kim, Yoon Jun; Yoon, Jung-Hwan

2018-04-01

Advanced hepatocellular carcinoma (HCC) is associated with various clinical conditions including major vessel invasion, metastasis, and poor performance status. The aim of this study was to establish a prognostic scoring system and to propose a sub-classification of the Barcelona-Clinic Liver Cancer (BCLC) stage C. This retrospective study included consecutive patientswho received sorafenib for BCLC stage C HCC at a single tertiary hospital in Korea. A Cox proportional hazard model was used to develop a scoring system, and internal validationwas performed by a 5-fold cross-validation. The performance of the model in predicting risk was assessed by the area under the curve and the Hosmer-Lemeshow test. A total of 612 BCLC stage C HCC patients were sub- classified into strata depending on their performance status. Five independent prognostic factors (Child-Pugh score, α-fetoprotein, tumor type, extrahepatic metastasis, and portal vein invasion) were identified and used in the prognostic scoring system. This scoring system showed good discrimination (area under the receiver operating characteristic curve, 0.734 to 0.818) and calibration functions (both p < 0.05 by the Hosmer-Lemeshow test at 1 month and 12 months, respectively). The differences in survival among the different risk groups classified by the total score were significant (p < 0.001 by the log-rank test in both the Eastern Cooperative Oncology Group 0 and 1 strata). The heterogeneity of patientswith BCLC stage C HCC requires sub-classification of advanced HCC. A prognostic scoring system with five independent factors is useful in predicting the survival of patients with BCLC stage C HCC.

Cause-specific mortality according to urine albumin creatinine ratio in the general population.

PubMed

Skaaby, Tea; Husemoen, Lise Lotte Nystrup; Ahluwalia, Tarunveer Singh; Rossing, Peter; Jørgensen, Torben; Thuesen, Betina Heinsbæk; Pisinger, Charlotta; Rasmussen, Knud; Linneberg, Allan

2014-01-01

Urine albumin creatinine ratio, UACR, is positively associated with all-cause mortality, cardiovascular disease and diabetes in observational studies. Whether a high UACR is also associated with other causes of death is unclear. We investigated the association between UACR and cause-specific mortality. We included a total of 9,125 individuals from two population-based studies, Monica10 and Inter99, conducted in 1993-94 and 1999-2001, respectively. Urine albumin creatinine ratio was measured from spot urine samples by standard methods. Information on causes of death was obtained from The Danish Register of Causes of Death until 31 December 2010. There were a total of 920 deaths, and the median follow-up was 11.3 years. Multivariable Cox regression analyses with age as underlying time axis showed statistically significant positive associations between UACR status and risk of all-cause mortality, endocrine nutritional and metabolic diseases, mental and behavioural disorders, diseases of the circulatory system, and diseases of the respiratory system with hazard ratios 1.56, 6.98, 2.34, 2.03, and 1.91, for the fourth UACR compared with the first, respectively. Using UACR as a continuous variable, we also found a statistically significant positive association with risk of death caused by diseases of the digestive system with a hazard ratio of 1.02 per 10 mg/g higher UACR. We found statistically significant positive associations between baseline UACR and death from all-cause mortality, endocrine nutritional and metabolic diseases, and diseases of the circulatory system and possibly mental and behavioural disorders, and diseases of the respiratory and digestive system.

Serine/threonine kinase 15 gene polymorphism and risk of digestive system cancers: A meta-analysis.

PubMed

Luo, Jianfei; Yan, Ruicheng; Zou, Li

2015-01-01

Previous studies have reported an association between the two coding polymorphisms (91T>A and 169G>A) of the serine/threonine kinase 15 (STK15) gene and the risk of digestive system cancers; however, the results are inconsistent. In the present study, a meta-analysis was carried out to assess the association between the two STK15 polymorphisms and the risk of digestive system cancers. Relevant studies were identified using PubMed, Web of Science, China National Knowledge Infrastructure, WanFang and VIP databases up to February 18, 2014. The pooled odds ratio (OR) with a 95% confidence interval (CI) was calculated using the fixed or random effects model. A total of 15 case-control studies from 14 publications were included. Of these, 15 studies concerned the 91T>A polymorphism and included 7,619 cases and 7,196 controls and four studies concerned the 161G>A polymorphism and included 826 cases and 713 controls. A significantly increased risk of digestive system cancers was observed for the 91T>A polymorphism (recessive model: OR, 1.19; 95% CI, 1.07-1.31). In subgroup analysis by ethnicity, a significant association was detected in Asian populations (recessive model: OR, 1.21; 95% CI, 1.08-1.36) but not in Caucasian and mixed populations. Stratification by tumor type indicated that the 91T>A polymorphism was associated with an increased risk of esophageal and colorectal cancers under the recessive model (OR, 1.19; 95% CI, 1.03-1.38; and OR, 1.24; 95% CI, 1.04-1.46; respectively); however, no significant association was observed between the 169G>A polymorphism and the risk of digestive system cancers in any of the genetic models. Furthermore, in subgroup analysis by ethnicity, similar results were observed in the Asian and Caucasian populations. The present meta-analysis demonstrated that the STK15 gene 91T>A polymorphism, but not the 169G>A polymorphism, may be a risk factor for digestive system cancers, particularly for esophageal and colorectal cancers.

[A prospective follow-up study on the association between serum level of C-reactive protein and risk of digestive system cancers in Chinese women].

PubMed

Wang, G; Cao, L Y; Chen, S H; Xie, S H; Feng, X S; Lyu, Z Y; Guo, L W; Li, F; Su, K; Chang, S; Ren, J S; Dai, M; Li, N; Wu, S L; He, J

2016-11-23

Objective: It has been reported by some prospective studies that C-reactive protein (CRP) is associated with cancer risk. However, the correlation between CRP and digestive system cancers has not been evaluated in Chinese females. We conducted a large population-based cohort study to investigate whether elevated level of CRP in serum is associated with an increased risk of digestive system cancers in Chinese women. Methods: From the Chinese Kailuan Female Cohort, 19, 437 women were enrolled in this study in July 2006, and all of the subjects were followed up through 2014. At the baseline investigation, the serum levels of high-sensitivity CRP (hsCRP) were tested for all subjects, and demographic information and risk factor data were collected. Multivariable Cox proportional hazards regression model was used to calculate the hazard ratios ( HR ) and 95% confidence intervals (95% CI ) for the baseline levels of hsCRP after adjusting for age, marital status, smoking, drinking, body mass index (BMI), diabetes and physical activity, and risk of digestive system tumors (including colorectal cancer, stomach cancer, pancreas cancer, liver and gallbladder cancer, and other cancers). Results: By Dec 31, 2014, a total of 100 incident cancer cases were observed, including 47 colorectal cancers, 17 stomach cancers, and altogether 29 pancreas, liver and gallbladder cancers. All the subjects investigated were divided into three groups according to the level of hsCRP (<1 mg/L, 1-3 mg/L and >3 mg/L). The 8-year cumulative incidence of digestive system cancers were 405/100 000, 520/100 000 and 787/100 000 in these 3 groups, respectively (Log rank test χ 2 = 8.37, P =0.015). Compared to those with lower hsCRP levels (<1 mg/L), the women with higher hsCRP (>3 mg/L) had a significantly increased risk of pancreas, liver and gallbladder cancers ( HR = 2.70, 95% CI = 1.06-6.91; P trend = 0.036). Conclusions: Elevated levels of hsCRP at baseline may be associated with increased risk of certain digestive system cancers.

The Growing Season, but Not the Farming System, Is a Food Safety Risk Determinant for Leafy Greens in the Mid-Atlantic Region of the United States

PubMed Central

Marine, Sasha C.; Pagadala, Sivaranjani; Wang, Fei; Pahl, Donna M.; Melendez, Meredith V.; Kline, Wesley L.; Oni, Ruth A.; Walsh, Christopher S.; Everts, Kathryne L.; Buchanan, Robert L.

2015-01-01

Small- and medium-size farms in the mid-Atlantic region of the United States use varied agricultural practices to produce leafy greens during spring and fall, but the impact of preharvest practices on food safety risk remains unclear. To assess farm-level risk factors, bacterial indicators, Salmonella enterica, and Shiga toxin-producing Escherichia coli (STEC) from 32 organic and conventional farms were analyzed. A total of 577 leafy greens, irrigation water, compost, field soil, and pond sediment samples were collected. Salmonella was recovered from 2.2% of leafy greens (n = 369) and 7.7% of sediment (n = 13) samples. There was an association between Salmonella recovery and growing season (fall versus spring) (P = 0.006) but not farming system (organic or conventional) (P = 0.920) or region (P = 0.991). No STEC was isolated. In all, 10% of samples were positive for E. coli: 6% of leafy greens, 18% of irrigation water, 10% of soil, 38% of sediment, and 27% of compost samples. Farming system was not a significant factor for levels of E. coli or aerobic mesophiles on leafy greens but was a significant factor for total coliforms (TC) (P < 0.001), with higher counts from organic farm samples. Growing season was a factor for aerobic mesophiles on leafy greens (P = 0.004), with higher levels in fall than in spring. Water source was a factor for all indicator bacteria (P < 0.001), and end-of-line groundwater had marginally higher TC counts than source samples (P = 0.059). Overall, the data suggest that seasonal events, weather conditions, and proximity of compost piles might be important factors contributing to microbial contamination on farms growing leafy greens. PMID:25616798

Risk factors associated with xerostomia in haemodialysis patients

PubMed Central

López-Pintor, Lucía; Casañas, Elisabeth; de Arriba, Lorenzo; Hernández, Gonzalo

2017-01-01

Background To determine the prevalence of xerostomia and hyposalivation in Haemodialysis (HD) patients, to clarify risk factors, assess patient´s quality of life, and to establish a possible correlation among interdialytic weight gain (IDWG) and xerostomia. Material and Methods This study was performed on a group of 50 HD patients. Data were collected using a questionnaire containing demographic and clinical variables, a visual analogue scale (VAS) for xerostomia, IDWG, and an oral health impact profile questionnaire (OHIP-14). Unstimulated whole saliva (UWS) and stimulated whole saliva (SWS) were collected. Results A total of 28 HD patients (56%) suffered xerostomia. Dry mouth was associated with hypertension (OR, 5.24; 95% CI, 1.11-24.89) and benzodiazepine consumption (OR, 5.96; 95% CI, 1.05-33.99). The mean xerostomia VAS and OHIP-14 scores were 31.74±14.88 and 24.38±11.98, respectively. No significant correlation was observed between IDWG% and VAS and OHIP total score. Nonetheless, a positive correlation between VAS level of thirst and IDWG% was found (r=0.48 p=0.0001). UWS and SWS means (determined in 30 patients) were 0.16±0.17 and 1.12±0.64, respectively. Decreased values of UWS and SWS were reported in 53.33% and 36.66% of HD patients. Conclusions Xerostomia in HD has a multifactorial aetiology due to accumulative risks as advanced age, systemic disorders, drugs, fluid intake restriction, and salivary parenchymal fibrosis and atrophy. Therefore, it is important to detect possible xerostomia risk factors to treat correctly dry mouth in HD patients and avoid systemic complications. Key words:Haemodialysis patients, xerostomia, salivary flow rate, hyposalivation, interdialytic weight gain, oral health-related quality of life. PMID:28160594

The Prognostic Role of Circulating Tumor Cells (CTC) in High-risk Non-muscle-invasive Bladder Cancer.

PubMed

Busetto, Gian Maria; Ferro, Matteo; Del Giudice, Francesco; Antonini, Gabriele; Chung, Benjamin I; Sperduti, Isabella; Giannarelli, Diana; Lucarelli, Giuseppe; Borghesi, Marco; Musi, Gennaro; de Cobelli, Ottavio; De Berardinis, Ettore

2017-08-01

The purpose of this study was to evaluate the impact of circulating tumor cells (CTCs) as a prognostic marker in patients with high-risk non-muscle-invasive bladder cancer (NMIBC) and assess the efficacy and reliability of 2 different CTC isolation methods. Globally, 155 patients with a pathologically confirmed diagnosis of high-risk NMIBC were included (pT1G3 with or without carcinoma in situ) and underwent transurethral resection of bladder tumor (TURB) after a blood withdrawal for CTC evaluation. A total of 101 patients (Group A) had their samples analyzed with the CellSearch automated system, and 54 (Group B) had their samples analyzed with the CELLection Dynabeads manual system. Patients were followed for 28 months, and during this interval, there were a total of 65 (41.9%) recurrences, 27 (17.4%) disease progressions, and 9 (5.8%) lymph node and/or bone metastasis. In our CTC analysis, there were 20 (19.8%) positive patients in Group A and 24 in Group B (44.4%). In our analysis, we found a strong correlation between CTC presence and time to first recurrence; in Group A, we observed an incidence of recurrence in 75% of CTC-positive patients and in Group B of 83% of CTC-positive patients. The time to progression was also strongly correlated with CTCs: 65% and 29%, respectively, of those patients who progressed in those with CTCs in Group A and B. The study demonstrates the potential role of CTCs as a prognostic marker for risk stratification in patients with NMIBC, to predict both recurrence and progression. Copyright © 2017 Elsevier Inc. All rights reserved.

Work environment and occupational risk assessment for small animal Portuguese veterinary activities.

PubMed

Macedo, Angela C; Mota, Vânia T; Tavares, João M; Machado, Osvaldo L; Malcata, Francisco X; Cristo, Marinela P; Mayan, Olga N

2018-03-01

The professional work of small animal veterinary staff encompasses a wide diversity of demanding tasks. This has prompted a number of studies covering physical, chemical, biological, ergonomic, or psychological hazards, as well as their health effects upon veterinary workers. However, such results were obtained from self-reported surveys (via paper or online). This study reports the identification of potential hazards and provides a risk assessment of 15 veterinary clinics based on data from walk-through surveys, interviews with workers, and quantification of indoor air quality parameters including concentration of volatile organic compounds (total, isoflurane, and glutaraldehyde). The risk arising from X-ray exposure was unacceptable in seven clinics; X-ray examination should be discontinued in the absence of isolated radiation rooms, poor safety practices, and lack of personal protective equipment. Ergonomic-related hazards and work practices should be revised as soon as possible, considering that improper postures, as well as moving and lifting heavy animals are major causes of musculoskeletal disorders. The risk levels were, in general, small or medium (acceptable) with regard to exposure to physical hazards (such as bites, scratches, cuts, and burns) and biological hazards. It was observed that the indoor air quality parameters including temperature, respirable particulate matter and total volatile organic compounds do not indicate a comfortable workplace environment, requiring clinics' attention to keep the safe environment. The veterinarians and nurses were exposed to isoflurane (above 2 ppm) during surgery if an extractor system for waste gas was used instead of a scavenging system. Finally, veterinary workers did not possess any type of training on occupational safety and health issues, even though they recognized its importance.

BSE situation and establishment of Food Safety Commission in Japan

PubMed Central

Kim, Chi-Kyeong

2006-01-01

Eight major policies were implemented by Japanese Government since Oct. 2001, to deal with bovine spongiform encephalopathy (BSE). These are; 1) Surveillance in farm by veterinarian, 2) Prion test at healthy 1.3mi cows/yr, by veterinarian, 3) Elimination of specified risk material (SRM), 4) Ban of MBM for production, sale use, 5) Prion test for fallen stocks, 6) Transparent information and traceability, 7) New Measures such as Food Safety Basic Law, and 8) Establish of Food Safety Commission in the Cabinet Office. At this moment, the extent of SRM risk has only been indicated by several reports employing tests with a limited sensitivity. There is still a possibility that the items in the SRM list will increase in the future, and this indiscriminately applies to Japanese cattle as well. Although current practices of SRM elimination partially guarantee total food safety, additional latent problems and imminent issues remain as potential headaches to be addressed. If the index of SRM elimination cannot guarantee reliable food safety, we have but to resort to total elimination of tissues from high risk-bearing and BSE-infected animals. However, current BSE tests have their limitations and can not yet completely detect high-risk and/or infected animals. Under such circumstances, tissues/wastes and remains of diseased, affected fallen stocks and cohort animals have to be eliminated to prevent BSE invading the human food chain systems. The failure to detect any cohort should never be allowed to occur, and with regular and persistent updating of available stringent records, we are at least adopting the correct and useful approach as a reawakening strategy to securing food safety. In this perspective, traceability based on a National Identification System is required. PMID:16434842

Five-year decreased incidence of surgical site infections following gastrectomy and prosthetic joint replacement surgery through active surveillance by the Korean Nosocomial Infection Surveillance System.

PubMed

Choi, H J; Adiyani, L; Sung, J; Choi, J Y; Kim, H B; Kim, Y K; Kwak, Y G; Yoo, H; Lee, Sang-Oh; Han, S H; Kim, S R; Kim, T H; Lee, H M; Chun, H K; Kim, J-S; Yoo, J D; Koo, H-S; Cho, E H; Lee, K W

2016-08-01

Surveillance of healthcare-associated infection has been associated with a reduction in surgical site infection (SSI). To evaluate the Korean Nosocomial Infection Surveillance System (KONIS) in order to assess its effects on SSI since it was introduced. SSI data after gastrectomy, total hip arthroplasty (THA), and total knee arthroplasty (TKA) between 2008 and 2012 were analysed. The pooled incidence of SSI was calculated for each year; the same analyses were also conducted from hospitals that had participated in KONIS for at least three consecutive years. Standardized SSI rates for each year were calculated by adjusting for SSI risk factors. SSI trends were analysed using the Cochran-Armitage test. The SSI rate following gastrectomy was 3.12% (522/16,918). There was a significant trend of decreased crude SSI rates over five years. This trend was also evident in analysis of hospitals that had participated for more than three years. The SSI rate for THA was 2.05% (157/7656), which decreased significantly from 2008 to 2012. The risk factors for SSI after THA included the National Nosocomial Infections Surveillance risk index, trauma, reoperation, and age (60-69 years). The SSI rate for TKA was 1.90% (152/7648), which also decreased significantly during a period of five years. However, the risk-adjusted analysis of SSI did not show a significant decrease for all surgical procedures. The SSI incidence of gastrectomy and prosthetic joint replacement declined over five years as a result of active surveillance by KONIS. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Bioaccessibility and human health risk assessment of lead in soil from Daye City

NASA Astrophysics Data System (ADS)

Li, Q.; Li, F.; Xiao, M. S.; Cai, Y.; Xiong, L.; Huang, J. B.; Fu, J. T.

2018-01-01

Lead (Pb) in soil from 4 sampling sites of Daye City was studied. Bioaccessibilities of Pb in soil were determined by the method of simplified bioaccessible extraction test (SBET). Since traditional health risk assessment was built on the basis of metal total content, the risk may be overestimated. Modified human health risk assessment model considering bioaccessibility was built in this study. Health risk of adults and children exposure to Pb based on total contents and bioaccessible contents were evaluated. The results showed that bioaccessible content of Pb in soil was much lower than its total content, and the average bioaccessible factor (BF) was only 25.37%. The hazard indexes (HIs) for adults and children calculated by two methods were all lower than 1. It indicated that there were no no-carcinogenic risks of Pb for human in Daye. By comparing with the results, the average bioaccessible HIs for adults and children were lower than the total one, which was due to the lower hazard quotient (HQ). Proportions of non-carcinogenic risk exposure to Pb via different pathways have also changed. Particularly, the most main risk exposure pathway for adults turned from the oral ingestion to the inhalation.

Estimation of physiologic ability and surgical stress (E-PASS) scoring system could provide preoperative advice on whether to undergo laparoscopic surgery for colorectal cancer patients with a high physiological risk

PubMed Central

Zhang, Ao; Liu, Tingting; Zheng, Kaiyuan; Liu, Ningbo; Huang, Fei; Li, Weidong; Liu, Tong; Fu, Weihua

2017-01-01

Abstract Laparoscopic colorectal surgery had been widely used for colorectal cancer patient and showed a favorable outcome on the postoperative morbidity rate. We attempted to evaluate physiological status of patients by mean of Estimation of physiologic ability and surgical stress (E-PASS) system and to analyze the difference variation of postoperative morbidity rate of open and laparoscopic colorectal cancer surgery in patients with different physiological status. In total 550 colorectal cancer patients who underwent surgery treatment were included. E-PASS and some conventional scoring systems were reviewed to examine their mortality prediction ability. The preoperative risk score (PRS) in the E-PASS system was used to evaluate the physiological status of patients. The difference of postoperative morbidity rate between open and laparoscopic colorectal cancer surgeries was analyzed respectively in patients with different physiological status. E-PASS had better prediction ability than other conventional scoring systems in colorectal cancer surgeries. Postoperative morbidities were developed in 143 patients. The parameters in the E-PASS system had positive correlations with postoperative morbidity. The overall postoperative morbidity rate of laparoscopic surgeries was lower than open surgeries (19.61% and 28.46%), but the postoperative morbidity rate of laparoscopic surgeries increased more significantly than in open surgery as PRS increased. When PRS was more than 0.7, the postoperative morbidity rate of laparoscopic surgeries would exceed the postoperative morbidity rate of open surgeries. The E-PASS system was capable to evaluate the physiological and surgical risk of colorectal cancer surgery. PRS could assist preoperative decision-making on the surgical method. Colorectal cancer patients who were assessed with a low physiological risk by PRS would be safe to undergo laparoscopic surgery. On the contrary, surgeons should make decisions prudently on the operation method for patient with a high physiological risk. PMID:28816959

Lung cancer risk by polycyclic aromatic hydrocarbons in a Mediterranean industrialized area.

PubMed

Cuadras, Anna; Rovira, Enric; Marcé, Rosa Maria; Borrull, Francesc

2016-11-01

This study focuses on characterizing the chronic risk assessment from inhalation of polycyclic aromatic hydrocarbons (PAHs) for people living near the largest chemical complex in the Mediterranean area. Eighteen PAHs were determined in the atmospheric gas and particle phases, counting PM 10 and total suspended particles. The lifetime lung cancer risk from PAH exposure was estimated, and the contribution was assessed by phases. The results obtained with the continuous lifetime scenario were compared with those obtained with different chronic scenarios. The estimated chronic risk was also compared with those reported in previous studies. PAHs were present at higher concentration in the gas phase (>84 %) with a major contribution of the most volatile PAHs, and an equitable distribution of heavy PAHs between gas and particle phases was observed. Petroleum combustion and traffic emissions were suggested as the main sources, but the influence of petrogenic sources cannot be ruled out. The estimated average lifetime lung cancer risk in this study ranged between 3.2 × 10 -5 and 4.3 × 10 -5 . The gas phase accounted for the most significant contribution to the total risk (>60 %). Fluoranthene (FluT), dibenzo(a,h)anthracene (DahA) and benzo(a)pyrene (BaP), as a whole, made the greatest contribution to the total risk (>80 %). BaP-bound PM 10 accounted for a small contribution of the total risk (10 %). Chronic exposures lower than total lifetime hours could even pose a risk >10 -5 . The results also showed that BaP-bound PM 10 , according to current legislation, may not be a good indicator of the real risk by PAH exposure. Concerning previous studies, the economic situation may have an impact on reducing the cancer risk by PAH inhalation.

Pilot-scale demonstration of phytofiltration for treatment of arsenic in New Mexico drinking water.

PubMed

Elless, Mark P; Poynton, Charissa Y; Willms, Cari A; Doyle, Mike P; Lopez, Alisa C; Sokkary, Dale A; Ferguson, Bruce W; Blaylock, Michael J

2005-10-01

Arsenic contamination of drinking water poses serious health risks to millions of people worldwide. To reduce such risks, the United States Environmental Protection Agency recently lowered the Maximum Contaminant Level for arsenic in drinking water from 50 to 10 microgL(-1). The majority of water systems requiring compliance are small systems that serve less than 10,000 people. Current technologies used to clean arsenic-contaminated water have significant drawbacks, particularly for small treatment systems. In this pilot-scale demonstration, we investigated the use of arsenic-hyperaccumulating ferns to remove arsenic from drinking water using a continuous flow phytofiltration system. Over the course of a 3-month demonstration period, the system consistently produced water having an arsenic concentration less than the detection limit of 2 microgL(-1), at flow rates as high as 1900 L day(-1) for a total treated water volume of approximately 60,000 L. Our results demonstrate that phytofiltration provides the basis for a solar-powered hydroponic technique to enable small-scale cleanup of arsenic-contaminated drinking water.

A Methodology for Assessing the Seismic Vulnerability of Highway Systems

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

Cirianni, Francis; Leonardi, Giovanni; Scopelliti, Francesco

2008-07-08

Modern society is totally dependent on a complex and articulated infrastructure network of vital importance for the existence of the urban settlements scattered on the territory. On these infrastructure systems, usually indicated with the term lifelines, are entrusted numerous services and indispensable functions of the normal urban and human activity.The systems of the lifelines represent an essential element in all the urbanised areas which are subject to seismic risk. It is important that, in these zones, they are planned according to opportune criteria based on two fundamental assumptions: a) determination of the best territorial localization, avoiding, within limits, the placesmore » of higher dangerousness; b) application of constructive technologies finalized to the reduction of the vulnerability.Therefore it is indispensable that in any modern process of seismic risk assessment the study of the networks is taken in the rightful consideration, to be integrated with the traditional analyses of the buildings.The present paper moves in this direction, dedicating particular attention to one kind of lifeline: the highway system, proposing a methodology of analysis finalized to the assessment of the seismic vulnerability of the system.« less

Characterization and biotoxicity assessment of dissolved organic matter in RO concentrate from a municipal wastewater reclamation reverse osmosis system.

PubMed

Sun, Ying-Xue; Gao, Yue; Hu, Hong-Ying; Tang, Fang; Yang, Zhe

2014-12-01

Reverse osmosis (RO) concentrate from municipal wastewater reclamation reverse osmosis (mWRRO) system containing organic compounds may associate with toxic risk, and its discharge might pose an environmental risk. To identify a basis for the selection of feasible technology in treating RO concentrates, the characteristics and biotoxicity of different fractions of dissolved organic matter (DOM) in RO concentrates from an mWRRO system were investigated. The results indicated that the hydrophilic neutrals (HIN), hydrophobic acids (HOA) and hydrophobic bases (HOB) accounted for 96% of the dissolved organic carbon (DOC) of the total DOM in the RO concentrate. According to the SEC chromatograph detected at 254 nm wavelength of UV, the DOM with molecular weight (MW) 1-3 kDa accounted for the majority of the basic and neutral fractions. The fluorescence spectra of the excitation emission matrix (EEM) indicated that most aromatic proteins, humic/fulvic acid-like and soluble microbial by-product-like substances existed in the fractions HOA and hydrophobic neutrals (HON). The genotoxicity and anti-estrogenic activity of the RO concentrate were 1795.6 ± 57.2 μg 4-NQOL(-1) and 2.19 ± 0.05 mg TAM L(-1), respectively. The HIN, HOA, and HOB contributed to the genotoxicity of the RO concentrate, and the HIN was with the highest genotoxic level of 1007.9 ± 94.8 μg 4-NQOL(-1). The HOA, HON, and HIN lead to the total anti-estrogenic activity of the RO concentrate, and HOA occupied approximately 60% of the total, which was 1.3 ± 0.17 mg TAM L(-1). Copyright © 2014 Elsevier Ltd. All rights reserved.

Impact of a Specific Amino Acid Composition with Micronutrients on Well-Being in Subjects with Chronic Psychological Stress and Exhaustion Conditions: A Pilot Study

PubMed Central

Armborst, Deborah; Metzner, Christine; Alteheld, Birgit; Bitterlich, Norman; Rösler, Daniela; Siener, Roswitha

2018-01-01

Chronic work-life stress leads to dysfunction of the hypothalamus–pituitary–adrenal axis, the autonomic nervous system, and the serotonergic system, with resultant impairment of overall well-being. Aim of the study was to improve perceived stress by a specific amino acid composition with micronutrients in the verum versus placebo group. A total of 59 participants (18–65 years) with self-reported perceived chronic stress and exhaustion conditions participated in this randomized, double-blind, placebo-controlled study. The Perceived Stress Questionnaire (PSQ30), amino acid profile, anthropometric, clinical, blood, urine parameters, and dietary intake were assessed. After 12 weeks, the verum group achieved significantly greater improvements in the total PSQ30 score compared with the placebo group. In the verum group, serum taurine concentration, folic acid concentration, urinary magnesium excretion, and the ratio of l-tryptophan to the sum of competing amino acids rose significantly. In the placebo group, serum concentrations of serotonin, protein, and magnesium decreased significantly, whereas the cardiometabolic risk parameters body weight, body mass index, waist circumference, and waist-to-height ratio increased significantly. Compared with placebo, the verum supplementation resulted in a higher improvement in perceived stress. Beneficial effects on the serotonergic system and preventive effects on magnesium homeostasis and some cardiometabolic risk factors were supposed. Additional effects might be caused by the optimized food intake. PMID:29710825

Usefulness of Myeloperoxidase Levels in Healthy Elderly Subjects to Predict Risk of Developing Heart Failure

PubMed Central

Tang, W.H. Wilson; Katz, Ronit; Brennan, Marie-Luise; Aviles, Ronnier J.; Tracy, Russell P.; Psaty, Bruce M.; Hazen, Stanley L.

2009-01-01

Increased systemic myeloperoxidase (MPO) has been associated with both the presence and severity of heart failure (HF). This study tested the hypothesis that increased systemic MPO in apparently healthy elderly subjects may predict increased risk of developing HF. Systemic MPO was measured in all available samples from the 1992 to 1993 visit of the Cardiovascular Health Study (CHS). After excluding subjects without available blood samples or with a history of prevalent HF, myocardial infarction (MI), or stroke, 3,733 subjects were included. A total of 569 subjects developed incident HF during 7.2 ± 2.3 years of follow-up. Patients in the highest MPO quartile (>432 pmol/L) showed higher risk of developing incident HF after adjusting for MI, age, gender, systolic blood pressure, smoking, low-density lipoprotein cholesterol, diabetes mellitus, and any subclinical cardiovascular disease (hazard ratio 1.34, 95% confidence interval 1.06 to 1.72, p = 0.013). However, the relation was more apparent after censoring subjects with incident MI before incident HF, even when adjusted for C-reactive protein and cystatin C (hazard ratio 1.46, 95% confidence interval 1.08 to 1.97, p = 0.02). Interestingly, stratified analyses showed that the relation between increased MPO and HF risk was stronger in subjects without traditional cardiovascular risk factors (≤75 years old, systolic blood pressure ≤136 mm Hg, no subclinical cardiovascular disease, and no diabetes mellitus). In conclusion, an independent association between increased MPO and the development of HF in apparently healthy elderly subjects was observed, particularly beyond MI and traditional cardiac risk factors. PMID:19406270

Breeding objectives for pigs in Kenya. II: economic values incorporating risks in different smallholder production systems.

PubMed

Mbuthia, Jackson Mwenda; Rewe, Thomas Odiwuor; Kahi, Alexander Kigunzu

2015-02-01

This study estimated economic values for production traits (dressing percentage (DP), %; live weight for growers (LWg), kg; live weight for sows (LWs), kg) and functional traits (feed intake for growers (FEEDg), feed intake for sow (FEEDs), preweaning survival rate (PrSR), %; postweaning survival (PoSR), %; sow survival rate (SoSR), %, total number of piglets born (TNB) and farrowing interval (FI), days) under different smallholder pig production systems in Kenya. Economic values were estimated considering two production circumstances: fixed-herd and fixed-feed. Under the fixed-herd scenario, economic values were estimated assuming a situation where the herd cannot be increased due to other constraints apart from feed resources. The fixed-feed input scenario assumed that the herd size is restricted by limitation of feed resources available. In addition to the tradition profit model, a risk-rated bio-economic model was used to derive risk-rated economic values. This model accounted for imperfect knowledge concerning risk attitude of farmers and variance of input and output prices. Positive economic values obtained for traits DP, LWg, LWs, PoSR, PrSR, SoSR and TNB indicate that targeting them in improvement would positively impact profitability in pig breeding programmes. Under the fixed-feed basis, the risk-rated economic values for DP, LWg, LWs and SoSR were similar to those obtained under the fixed-herd situation. Accounting for risks in the EVs did not yield errors greater than ±50 % in all the production systems and basis of evaluation meaning there would be relatively little effect on the real genetic gain of a selection index. Therefore, both traditional and risk-rated models can be satisfactorily used to predict profitability in pig breeding programmes.

Real-world effectiveness of valsartan on hypertension and total cardiovascular risk: review and implications of a translational research program

PubMed Central

Abraham, Ivo; MacDonald, Karen; Hermans, Christine; Aerts, Ann; Lee, Christopher; Brié, Heidi; Vancayzeele, Stefaan

2011-01-01

The pharmacological efficacy of various monotherapy, single pill, and combination therapies of the angiotensin II receptor blocker valsartan have been established, mainly through randomized controlled trials that used similar methodological and statistical platforms and thus enabled synthesis of evidence. The real world effectiveness of valsartan has been studied extensively, but the relative lack of scientific and technical congruence of these studies render synthesis virtually impossible. To date, all have focused on blood pressure outcomes, despite evidence-based calls to grade antihypertensive treatment to patients’ total cardiovascular risk. We review a T3 translational research program of seven studies involving valsartan monotherapy as well as single and separate pill combinations, and the determinants and effect on blood pressure and total cardiovascular risk outcomes. All seven studies examined not only the impact of valsartan-based regimens on blood pressure values and control, but also, within a statistical hierarchical approach, the physician- and patient-related determinants of these blood pressure outcomes. Two studies also investigated the determinants and outcomes of valsartan-based treatment on total cardiovascular risk – among the first studies to use this risk coefficient as an outcome rather than only a determinant. These seven studies included a total of 19,533 patients, contributed by 3434 physician-investigators in Belgium – a country particularly well-suited for observational effectiveness studies because of demographics and epidemiology. Each study used the same methodological and statistical platform. We summarize the impact of various valsartan regimens on such outcomes as blood pressure values and control, change in total cardiovascular risk, and reduction in risk by at least one category. We also review the results of statistical multilevel and logistic modeling of physician- and patient-related determinants on these outcomes, including the proportion of variance attributable to a physician class effect before patients enter the equation. In its different formulations, valsartan has major real-world benefits in lowering blood pressure and total cardiovascular risk within a 90-day period. It is essential to understand the physician- and patient-related determinants of blood pressure and total cardiovascular risk outcomes associated with valsartan treatment. Antihypertensive research should expand its historical focus on lowering blood pressure with an emphasis on lowering total cardiovascular research. PMID:21490947

Dairy product consumption and risk of colorectal cancer in an older mediterranean population at high cardiovascular risk.

PubMed

Barrubés, Laura; Babio, Nancy; Mena-Sánchez, Guillermo; Toledo, Estefania; Ramírez-Sabio, Judith B; Estruch, Ramón; Ros, Emilio; Fitó, Montserrat; Arós, Fernando; Fiol, Miquel; Santos-Lozano, José Manuel; Serra-Majem, Lluís; Pintó, Xavier; Martínez-González, Miguel Ángel; Sorlí, José Vicente; Basora, Josep; Salas-Salvadó, Jordi

2018-04-16

Prospective studies have reported an inverse association between the consumption of total dairy products and milk and the risk of colorectal cancer (CRC). Nonetheless, there is little and inconsistent evidence regarding subtypes of dairy product and CRC risk. We assessed the associations between the consumption of total dairy products, their different subtypes and CRC risk in older Mediterranean individuals at high cardiovascular risk. We analyzed data from 7,216 men and women (55-80 years) without CRC at baseline from the PREvención con DIeta MEDiterránea study. Individuals were recruited between 2003 and 2009 and followed up until December 2012. At baseline and yearly thereafter, consumption of total and specific dairy products was assessed using a validated 137-item food-frequency questionnaire. Cox proportional hazards ratios (HRs) of CRC incidence were estimated for tertiles of mean consumption of dairy products during the follow-up. During a median [interquartile range] follow-up of 6.0 [4.4-7.3] years, we documented 101 incident CRC cases. In the multivariable-adjusted models, HRs and 95% confidence intervals (CIs) of CRC for the comparison of extreme tertiles of total dairy product and low-fat milk consumption were 0.55 (95% CI: 0.31-0.99; p-trend = 0.037) and 0.54 (95% CI: 0.32-0.92; p-trend = 0.022), respectively. No significant associations with other dairy products (whole-fat and low-fat dairy products; total, low-fat and whole-fat yogurt; cheese; total, low-fat and whole-fat milk; concentrated full-fat dairy products, sugar-enriched dairy products and fermented dairy products) were found. A high consumption of total dairy products and low-fat milk was significantly associated with a reduced CRC risk. © 2018 UICC.

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

PubMed

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

2015-07-14

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

Governance of innovation and appropriateness of hospitalization for high-risk pregnancy: the TOCOMAT system.

PubMed

Tagliaferri, Salvatore; Ippolito, Adelaide; Cuccaro, Patrizia; Annunziata, Maria Laura; Campanile, Marta; Di Lieto, Andrea

2013-07-01

Over the last 30 years, a great increase in the application of technologies in public health, with an undisputed impact on both the effectiveness of performance and the investment and management costs, has occurred. This evidence has induced the development of assessment tools to clarify the relationships among resources, outputs, and outcomes of technological innovations. This analysis was developed in order to examine the use of a telematic system for reporting remotely transmitted cardiotocographic traces, specifically (1) its impact on the health organization and on the appropriateness of the care setting used and (2) the efficiency of its adoption in a regional network. We adopted a case-control study on patients' medical records during the first 4 months of 2009, 2010, and 2011 and a cost analysis of resources used for the creation of a computerized telecardiotocography network connecting eight peripheral areas to the operations center. The case-control study showed a reduction in the average hospital stay days for high-risk patients (1.32) and for low-risk patient (1.7) with a total of cost savings of €89,628 for high-risk patients and €170,170 for low-risk patients. The cost savings of the regional network was €20,769.04. The adoption of a remote transmission system of cardiotocography provided a managerial and economic advantage in the reduction of inappropriate admissions for prepartum symptoms and an improvement in the admission indicators (hospital stay days).

The incidences and risk factors related to early dysphagia after anterior cervical spine surgery: A prospective study.

PubMed

Liu, Jia-Ming; Tong, Wei-Lai; Chen, Xuan-Yin; Zhou, Yang; Chen, Wen-Zhao; Huang, Shan-Hu; Liu, Zhi-Li

2017-01-01

Dysphagia is a common complication following anterior cervical spine surgery (ACSS). The incidences of dysphagia were variable and controversial. The purpose of this study was to determine the incidence of early dysphagia after ACSS with a new scoring system, and to identify the risk factors of it. A prospective study was carried out and patients who underwent ACSS from March 2014 to August 2014 in our hospital were included in this study. A self-designed dysphagia questionnaire was delivered to all of the patients from the first day to the fifth day after ACSS. Perioperative characteristics of patients were recorded, and incidences and risk factors of dysphagia were analyzed. A total of 104 patients who underwent ACSS were included and incidences of dysphagia from the first to the fifth day after ACSS was 87.5%, 79.81%, 62.14%, 50% and 44.23%, respectively. There was a good correlation between the new dysphagia scoring system and Bazaz scoring system (P < 0.001). Operative time and body mass index (BMI) were the risk factors for dysphagia during the first to the second day postoperatively. However, the dC2-C7angle was the main risk factor for dysphagia from the third to the fifth day after surgery. There were comparatively high incidences of early dysphagia after ACSS, which may be ascribed to operative time, BMI and the dC2-C7 angle.

The incidences and risk factors related to early dysphagia after anterior cervical spine surgery: A prospective study

PubMed Central

Chen, Xuan-Yin; Zhou, Yang; Chen, Wen-Zhao; Huang, Shan-Hu; Liu, Zhi-Li

2017-01-01

Dysphagia is a common complication following anterior cervical spine surgery (ACSS). The incidences of dysphagia were variable and controversial. The purpose of this study was to determine the incidence of early dysphagia after ACSS with a new scoring system, and to identify the risk factors of it. A prospective study was carried out and patients who underwent ACSS from March 2014 to August 2014 in our hospital were included in this study. A self-designed dysphagia questionnaire was delivered to all of the patients from the first day to the fifth day after ACSS. Perioperative characteristics of patients were recorded, and incidences and risk factors of dysphagia were analyzed. A total of 104 patients who underwent ACSS were included and incidences of dysphagia from the first to the fifth day after ACSS was 87.5%, 79.81%, 62.14%, 50% and 44.23%, respectively. There was a good correlation between the new dysphagia scoring system and Bazaz scoring system (P < 0.001). Operative time and body mass index (BMI) were the risk factors for dysphagia during the first to the second day postoperatively. However, the dC2-C7angle was the main risk factor for dysphagia from the third to the fifth day after surgery. There were comparatively high incidences of early dysphagia after ACSS, which may be ascribed to operative time, BMI and the dC2-C7 angle. PMID:28267777

Sharing risk between payer and provider by leasing health technologies: an affordable and effective reimbursement strategy for innovative technologies?

PubMed

Edlin, Richard; Hall, Peter; Wallner, Klemens; McCabe, Christopher

2014-06-01

The challenge of implementing high-cost innovative technologies in health care systems operating under significant budgetary pressure has led to a radical shift in the health technology reimbursement landscape. New reimbursement strategies attempt to reduce the risk of making the wrong decision, that is, paying for a technology that is not good value for the health care system, while promoting the adoption of innovative technologies into clinical practice. The remaining risk, however, is not shared between the manufacturer and the health care payer at the individual purchase level; it continues to be passed from the manufacturer to the payer at the time of purchase. In this article, we propose a health technology payment strategy-technology leasing reimbursement scheme-that allows the sharing of risk between the manufacturer and the payer: the replacing of up-front payments with a stream of payments spread over the expected duration of benefit from the technology, subject to the technology delivering the claimed health benefit. Using trastuzumab (Herceptin) in early breast cancer as an exemplar technology, we show how a technology leasing reimbursement scheme not only reduces the total budgetary impact of the innovative technology but also truly shares risk between the manufacturer and the health care system, while reducing the value of further research and thus promoting the rapid adoption of innovative technologies into clinical practice. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Risk of leukaemia or cancer in the central nervous system among children living in an area with high indoor radon concentrations: results from a cohort study in Norway.

PubMed

Del Risco Kollerud, R; Blaasaas, K G; Claussen, B

2014-09-23

Over the past few years, there has been growing interest in assessing the relationship between exposure to radon at home and the risk of childhood cancer. Previous studies have produced conflicting results, probably because of limitations assessing radon exposure, too few cancer cases and poorly documented health statistics. We used a cohort approach of 0-15-year-old children to examine whether residential radon exposure was associated with childhood leukaemia and cancer in the central nervous system in the Oslo region. The study was based on Norwegian population registers and identified cancer cases from The Cancer Registry of Norway. The residence of every child was geo-coded and assigned a radon exposure. In all, 712 674 children were followed from 1967 to 2009 from birth to date of cancer diagnosis, death, emigration or 15 years of age. A total of 864 cancer cases were identified, 437 children got leukaemia and 427 got cancer in the central nervous system.Conclusions or interpretation:No association was found for childhood leukaemia. An elevated nonsignificant risk for cancer in the central nervous system was observed. This association should be interpreted with caution owing to the crude exposure assessment and possibilities of confounding.

Fibreglass Total Contact Casting, Removable Cast Walkers, and Irremovable Cast Walkers to Treat Diabetic Neuropathic Foot Ulcers: A Health Technology Assessment

PubMed Central

Costa, Vania; Tu, Hong Anh; Wells, David; Weir, Mark; Holubowich, Corinne; Walter, Melissa

2017-01-01

Background Diabetic neuropathic foot ulcers are a risk factor for lower leg amputation. Many experts recommend offloading with fibreglass total contact casting, removable cast walkers, and irremovable cast walkers as a way to treat these ulcers. Methods We completed a health technology assessment, which included an evaluation of clinical benefits and harms, value for money, and patient preferences for offloading devices. We performed a systematic literature search on August 17, 2016, to identify randomized controlled trials that compared fibreglass total contact casting, removable cast walkers, and irremovable cast walkers with other treatments (offloading or non-offloading) in patients with diabetic neuropathic foot ulcers. We developed a decision-analytic model to assess the cost-effectiveness of fibreglass total contact casting, removable cast walkers, and irremovable cast walkers, and we conducted a 5-year budget impact analysis. Finally, we interviewed people with diabetes who had lived experience with foot ulcers, asking them about the different offloading devices and the factors that influenced their treatment choices. Results We identified 13 randomized controlled trials. The evidence suggests that total contact casting, removable cast walkers, and irremovable cast walkers are beneficial in the treatment of neuropathic, noninfected foot ulcers in patients with diabetes but without severe peripheral arterial disease. Compared to removable cast walkers, ulcer healing was improved with total contact casting (moderate quality evidence; risk difference 0.17 [95% confidence interval 0.00–0.33]) and irremovable cast walkers (low quality evidence; risk difference 0.21 [95% confidence interval 0.01–0.40]). We found no difference in ulcer healing between total contact casting and irremovable cast walkers (low quality evidence; risk difference 0.02 [95% confidence interval −0.11–0.14]). The economic analysis showed that total contact casting and irremovable cast walkers were less expensive and led to more health outcome gains (e.g., ulcers healed and quality-adjusted life-years) than removable cast walkers. Irremovable cast walkers were as effective as total contact casting and were associated with lower costs. The 5-year budget impact of funding total contact casting, removable cast walkers, and irremovable cast walkers (device costs only at 100% access) would be $17 to $20 million per year. The patients we interviewed felt that wound healing was improved with total contact casting than with removable cast walkers, but that removable cast walkers were more convenient and came with a lower cost burden. They reported no experience or familiarity with irremovable cast walkers. Conclusions Ulcer healing improved with total contact casting, irremovable cast walkers, and removable cast walkers, but total contact casting and irremovable cast walkers had higher rates of ulcer healing than removable cast walkers. Increased access to offloading devices could result in cost savings for the health system because of fewer amputations. Patients with diabetic foot ulcers reported a preference for total contact casting over removable cast walkers, largely because they perceived wound healing to be improved with total contact casting. However, cost, comfort, and convenience are concerns for patients. PMID:28989556

Fibreglass Total Contact Casting, Removable Cast Walkers, and Irremovable Cast Walkers to Treat Diabetic Neuropathic Foot Ulcers: A Health Technology Assessment.

PubMed

2017-01-01

Diabetic neuropathic foot ulcers are a risk factor for lower leg amputation. Many experts recommend offloading with fibreglass total contact casting, removable cast walkers, and irremovable cast walkers as a way to treat these ulcers. We completed a health technology assessment, which included an evaluation of clinical benefits and harms, value for money, and patient preferences for offloading devices. We performed a systematic literature search on August 17, 2016, to identify randomized controlled trials that compared fibreglass total contact casting, removable cast walkers, and irremovable cast walkers with other treatments (offloading or non-offloading) in patients with diabetic neuropathic foot ulcers. We developed a decision-analytic model to assess the cost-effectiveness of fibreglass total contact casting, removable cast walkers, and irremovable cast walkers, and we conducted a 5-year budget impact analysis. Finally, we interviewed people with diabetes who had lived experience with foot ulcers, asking them about the different offloading devices and the factors that influenced their treatment choices. We identified 13 randomized controlled trials. The evidence suggests that total contact casting, removable cast walkers, and irremovable cast walkers are beneficial in the treatment of neuropathic, noninfected foot ulcers in patients with diabetes but without severe peripheral arterial disease. Compared to removable cast walkers, ulcer healing was improved with total contact casting (moderate quality evidence; risk difference 0.17 [95% confidence interval 0.00-0.33]) and irremovable cast walkers (low quality evidence; risk difference 0.21 [95% confidence interval 0.01-0.40]). We found no difference in ulcer healing between total contact casting and irremovable cast walkers (low quality evidence; risk difference 0.02 [95% confidence interval -0.11-0.14]). The economic analysis showed that total contact casting and irremovable cast walkers were less expensive and led to more health outcome gains (e.g., ulcers healed and quality-adjusted life-years) than removable cast walkers. Irremovable cast walkers were as effective as total contact casting and were associated with lower costs. The 5-year budget impact of funding total contact casting, removable cast walkers, and irremovable cast walkers (device costs only at 100% access) would be $17 to $20 million per year. The patients we interviewed felt that wound healing was improved with total contact casting than with removable cast walkers, but that removable cast walkers were more convenient and came with a lower cost burden. They reported no experience or familiarity with irremovable cast walkers. Ulcer healing improved with total contact casting, irremovable cast walkers, and removable cast walkers, but total contact casting and irremovable cast walkers had higher rates of ulcer healing than removable cast walkers. Increased access to offloading devices could result in cost savings for the health system because of fewer amputations. Patients with diabetic foot ulcers reported a preference for total contact casting over removable cast walkers, largely because they perceived wound healing to be improved with total contact casting. However, cost, comfort, and convenience are concerns for patients.

The -765G>C polymorphism in the cyclooxygenase-2 gene and digestive system cancer: a meta-analysis.

PubMed

Zhao, Fen; Cao, Yue; Zhu, Hong; Huang, Min; Yi, Cheng; Huang, Ying

2014-01-01

Published data regarding associations between the -765G>C polymorphism in cyclooxygenase-2 (COX-2) gene and digestive system cancer risk have been inconclusive. The aim of this study was to comprehensively evaluate the genetic risk of the -765G>C polymorphism in the COX-2 gene for digestive system cancer. A search was performed in Pubmed, Medline (Ovid), Embase, CNKI, Weipu, Wanfang and CBM databases, covering all studies until Feb 10, 2014. Statistical analysis was performed using Revman5.2. A total of 10,814 cases and 16,174 controls in 38 case-control studies were included in this meta-analysis. The results indicated that C allele carriers (GC+CC) had a 20% increased risk of digestive system cancer when compared with the homozygote GG (odds ratio (OR)=1.20, 95% confidence interval (CI), 1.00-1.44 for GC+CC vs GG). In the subgroup analysis by ethnicity, significant elevated risks were associated with C allele carriers (GC+CC) in Asians (OR = 1.46, 95% CI=1.07-2.01, and p=0.02) and Africans (OR=2.12, 95% CI=1.57-2.87, and p< 0.00001), but not among Caucasians, Americans and mixed groups. For subgroup analysis by cancer type (GC+CC vs GG), significant associations were found between the -765G>C polymorphism and higher risk for gastric cancer (OR=1.64, 95% CI=1.03-2.61, and p=0.04), but not for colorectal cancer, oral cancer, esophageal cancer, and others. Regarding study design (GC+CC vs GG), no significant associations were found in then population-based case-control (PCC), hospital-based case-control (HCC) and family-based case-control (FCC) studies. This meta-analysis suggested that the -765G>C polymorphism of the COX-2 gene is a potential risk factor for digestive system cancer in Asians and Africans and gastric cancer overall.

Use of the Dynamic Visual Acuity Test as a screener for community-dwelling older adults who fall.

PubMed

Honaker, Julie A; Shepard, Neil T

2011-01-01

Adequate function of the peripheral vestibular system, specifically the vestibulo-ocular reflex (VOR; a network of neural connections between the peripheral vestibular system and the extraocular muscles) is essential for maintaining stable vision during head movements. Decreased visual acuity resulting from an impaired peripheral vestibular system may impede balance and postural control and place an individual at risk of falling. Therefore, sensitive measures of the vestibular system are warranted to screen for the tendency to fall, alerting clinicians to recommend further risk of falling assessment and referral to a falling risk reduction program. Dynamic Visual Acuity (DVA) testing is a computerized VOR assessment method to evaluate the peripheral vestibular system during head movements; reduced visual acuity as documented with DVA testing may be sensitive to screen for falling risk. This study examined the sensitivity and specificity of the computerized DVA test with yaw plane head movements for identifying community-dwelling adults (58-78 years) who are prone to falling. A total of 16 older adults with a history of two or more unexplained falls in the previous twelve months and 16 age and gender matched controls without a history of falls in the previous twelve months participated. Computerized DVA with horizontal head movements at a fixed velocity of 120 deg/sec was measured and compared with the Dynamic Gait Index (DGI) a gold standard gait assessment measurement for identifying falling risk. Receiver operating characteristics (ROC) curve analysis and area under the ROC curve (AUC) were used to assess the sensitivity and specificity of the computerized DVA as a screening measure for falling risk as determined by the DGI. Results suggested a link between computerized DVA and the propensity to fall; DVA in the yaw plane was found to be a sensitive (92%) and accurate screening measure when using a cutoff logMAR value of >0.25.

Risk assessment for arsenic-contaminated groundwater along River Indus in Pakistan.

PubMed

Rabbani, Unaib; Mahar, Gohar; Siddique, Azhar; Fatmi, Zafar

2017-02-01

The study determined the risk zone and estimated the population at risk of adverse health effects for arsenic exposure along the bank of River Indus in Pakistan. A cross-sectional survey was conducted in 216 randomly selected villages of one of the districts along River Indus. Wells of ten households from each village were selected to measure arsenic levels. The location of wells was identified using global positioning system device, and spatial variations of the groundwater contamination were assessed using geographical information system tools. Using layers of contaminated drinking water wells according to arsenic levels and population with major landmarks, a risk zone and estimated population at risk were determined, which were exposed to arsenic level ≥10 µg/L. Drinking wells with arsenic levels of ≥10 µg/L were concentrated within 18 km near the river bank. Based on these estimates, a total of 13 million people were exposed to ≥10 µg/L arsenic concentration along the course of River Indus traversing through 27 districts in Pakistan. This information would help the researchers in designing health effect studies on arsenic and policy makers in allocating resources for designing focused interventions for arsenic mitigation in Pakistan. The study methods have implication on similar populations which are affected along rivers due to arsenic contamination.

Ultrasound-Based Risk Stratification for Malignancy in Thyroid Nodules: A Four-Tier Categorization System.

PubMed

Seo, Hyobin; Na, Dong Gyu; Kim, Ji-Hoon; Kim, Kyung Won; Yoon, Ji Won

2015-07-01

The purpose of this study was to stratify the malignancy risk of US features, with an emphasis on nodule echogenicity. A total of 1,058 nodules of 824 consecutive patients (236 malignant and 822 benign) were included in this study. Malignancy risk of each nodule was analyzed according to US features, with an emphasis on nodule echogenecity, and was stratified into 4-tier categories. In multivariate analysis, isoechogenicity, indistinct margin, non-solid internal content, and parallel orientation were predictive of benign nodules (P < 0.002), while hypoechogenicity, marked hypoechogenicity, spiculated/microlobulated margin, solid content, nonparallel orientation (taller than wide), microcalcification, and macrocalcification were predictive of malignancy (P ≤ 0.037). Although the presence of US features associated with malignancy was significantly predictive of malignancy in hypoechoic and markedly hypoechoic nodules (P ≤ 0.004), it was not associated with malignancy in isoechoic or hyperechoic nodules. Thyroid nodules could be stratified into four categories according to the malignancy risk: benign (risk 0%), probably benign (risk ≤ 5%), indeterminate (risk > 5 and < 50%), and suspicion of malignancy (risk > 50%). The US-based four-tier categorization system will be useful for predicting the risk of malignancy and decisions regarding FNA for thyroid nodules. • No US feature was predictive of malignancy in isoechoic nodules. • Isoechoic nodules without calcification can be included in the probably benign category. • We suggest a four-tier categorization stratified primarily by nodule echogenecity. • The four-tier categorization of thyroid nodules will be useful for FNA decisions.

A Systematic Review of Risk Factors for Intimate Partner Violence

PubMed Central

Capaldi, Deborah M.; Knoble, Naomi B.; Shortt, Joann Wu; Kim, Hyoun K.

2012-01-01

A systematic review of risk factors for intimate partner violence was conducted. Inclusion criteria included publication in a peer-reviewed journal, a representative community sample or a clinical sample with a control-group comparison, a response rate of at least 50%, use of a physical or sexual violence outcome measure, and control of confounding factors in the analyses. A total of 228 articles were included (170 articles with adult and 58 with adolescent samples). Organized by levels of a dynamic developmental systems perspective, risk factors included: (a) contextual characteristics of partners (demographic, neighborhood, community and school factors), (b) developmental characteristics and behaviors of the partners (e.g., family, peer, psychological/behavioral, and cognitive factors), and (c) relationship influences and interactional patterns. Comparisons to a prior review highlight developments in the field in the past 10 years. Recommendations for intervention and policy along with future directions for intimate partner violence (IPV) risk factor research are presented. PMID:22754606

[Telematics in the public health sector. Where is the protection of health data?].

PubMed

Voßhoff, Andrea; Raum, Bertram; Ernestus, Walter

2015-10-01

There is a long history of telematics in the German health system. Apart from the growing technical possibilities in the field, it is important to concentrate on the protection of health data in telematics applications. Health data in the hands of service providers or other third parties entails certain risks for the patient's personality rights, because these institutions may not be bound by the practice of medical confidentiality. In addition, big data processing risks make the individual lives of patients and insured persons totally transparent. Measures to reduce these risks have to be taken by the providers as well as by the users of telematics infrastructure; they are the ones who should explicitly address the relevant risks and dangers in a data protection and IT-security concept and develop adequate strategies to cope with these dangers. Additionally, the German legislator remains obliged to create a regulatory framework for the protection of patients' rights.

A web-based personalized risk communication and decision-making tool for women with dense breasts: Design and methods of a randomized controlled trial within an integrated health care system.

PubMed

Knerr, Sarah; Wernli, Karen J; Leppig, Kathleen; Ehrlich, Kelly; Graham, Amanda L; Farrell, David; Evans, Chalanda; Luta, George; Schwartz, Marc D; O'Neill, Suzanne C

2017-05-01

Mammographic breast density is one of the strongest risk factors for breast cancer after age and family history. Mandatory breast density disclosure policies are increasing nationally without clear guidance on how to communicate density status to women. Coupling density disclosure with personalized risk counseling and decision support through a web-based tool may be an effective way to allow women to make informed, values-consistent risk management decisions without increasing distress. This paper describes the design and methods of Engaged, a prospective, randomized controlled trial examining the effect of online personalized risk counseling and decision support on risk management decisions in women with dense breasts and increased breast cancer risk. The trial is embedded in a large integrated health care system in the Pacific Northwest. A total of 1250 female health plan members aged 40-69 with a recent negative screening mammogram who are at increased risk for interval cancer based on their 5-year breast cancer risk and BI-RADS® breast density will be randomly assigned to access either a personalized web-based counseling and decision support tool or standard educational content. Primary outcomes will be assessed using electronic health record data (i.e., chemoprevention and breast MRI utilization) and telephone surveys (i.e., distress) at baseline, six weeks, and twelve months. Engaged will provide evidence about whether a web-based personalized risk counseling and decision support tool is an effective method for communicating with women about breast density and risk management. An effective intervention could be disseminated with minimal clinical burden to align with density disclosure mandates. Clinical Trials Registration Number:NCT03029286. Copyright © 2017 Elsevier Inc. All rights reserved.

Patient and health system delay among patients with pulmonary tuberculosis in Beira city, Mozambique.

PubMed

Saifodine, Abuchahama; Gudo, Paula Samo; Sidat, Mohsin; Black, James

2013-06-07

TB control is based on the rapid identification of cases and their effective treatment. However, many studies have shown that there are important delays in diagnosis and treatment of patients with TB. The purpose of this study was to assess the prevalence of and identify risk factors associated with patient delay and health system delay among newly diagnosed patients with pulmonary TB. A cross sectional study was carried out in Beira city, Mozambique between September 2009 and February 2010. Patients in the first month of treatment were consecutively selected to this study if they had a diagnosis of pulmonary TB, had no history of previous TB treatment, and were 18 years or older and provided informed consent. Data was obtained through a questionnaire administered to the patients and from patients' files. Among the 622 patients included in the study the median age was 32 years (interquartile range, 26-40) and 272 (43.7%) were females. The median total delay, patient delay and health system delay was 150 days (interquartile range, 91-240), 61 days (28-113) and 62 days (37-120), respectively. The contribution of patient delay and health system delay to total delay was similar. Farming, visiting first a traditional healer, low TB knowledge and coexistence of a chronic disease were associated with increased patient delay. More than two visits to a health facility, farming and coexistence of a chronic disease were associated with increased health system delay. This study revealed a long total delay with a similar contribution of patient delay and health system delay. To reduce the total delay in this setting we need a combination of interventions to encourage patients to seek appropriate health care earlier and to expedite TB diagnosis within the health care system.

Development of a Korean Fracture Risk Score (KFRS) for Predicting Osteoporotic Fracture Risk: Analysis of Data from the Korean National Health Insurance Service

PubMed Central

Jang, Eun Jin; Park, ByeongJu; Kim, Tae-Young; Shin, Soon-Ae

2016-01-01

Background Asian-specific prediction models for estimating individual risk of osteoporotic fractures are rare. We developed a Korean fracture risk prediction model using clinical risk factors and assessed validity of the final model. Methods A total of 718,306 Korean men and women aged 50–90 years were followed for 7 years in a national system-based cohort study. In total, 50% of the subjects were assigned randomly to the development dataset and 50% were assigned to the validation dataset. Clinical risk factors for osteoporotic fracture were assessed at the biennial health check. Data on osteoporotic fractures during the follow-up period were identified by ICD-10 codes and the nationwide database of the National Health Insurance Service (NHIS). Results During the follow-up period, 19,840 osteoporotic fractures were reported (4,889 in men and 14,951 in women) in the development dataset. The assessment tool called the Korean Fracture Risk Score (KFRS) is comprised of a set of nine variables, including age, body mass index, recent fragility fracture, current smoking, high alcohol intake, lack of regular exercise, recent use of oral glucocorticoid, rheumatoid arthritis, and other causes of secondary osteoporosis. The KFRS predicted osteoporotic fractures over the 7 years. This score was validated using an independent dataset. A close relationship with overall fracture rate was observed when we compared the mean predicted scores after applying the KFRS with the observed risks after 7 years within each 10th of predicted risk. Conclusion We developed a Korean specific prediction model for osteoporotic fractures. The KFRS was able to predict risk of fracture in the primary population without bone mineral density testing and is therefore suitable for use in both clinical setting and self-assessment. The website is available at http://www.nhis.or.kr. PMID:27399597

Medical comorbidities and perioperative allogeneic red blood cell transfusion are risk factors for surgical site infection after shoulder arthroplasty.

PubMed

Everhart, Joshua S; Bishop, Julie Y; Barlow, Jonathan D

2017-11-01

Multiple perioperative factors have been implicated in infection risk after shoulder arthroplasty. The purpose of this study was to determine surgical site infection (SSI) risk due to medical comorbidities or blood transfusion after primary or revision shoulder arthroplasty. Comprehensive data on medical comorbidities, surgical indication, perioperative transfusion, and SSI were obtained for 707 patients who underwent primary or revision hemiarthroplasty or total shoulder arthroplasty in a single hospital system. Multivariate Poisson regression was used to determine the independent association between allogeneic red blood cell transfusion, medical comorbidities, and SSI after controlling for procedure. The SSI rate was 1.9% for primary hemiarthroplasties and 1.3% for primary total shoulder arthroplasties. Among patients without prior shoulder infection, revision arthroplasty or prior open reduction and internal fixation had higher SSI risk than primary arthroplasties (incidence risk ratio [IRR], 11.4; 95% confidence interval [CI], 3.84-34.0; P < .001); among primary arthroplasties, SSI risk factors included male gender (IRR, 60.0; CI, 4.39-819; P = .002), rheumatoid arthritis (IRR, 8.63; CI, 1.84-40.4; P = .006), and long-term corticosteroid use (IRR, 37.4; CI, 5.79-242; P < .001). Perioperative allogeneic red blood cell transfusion significantly increased SSI risk and was dose dependent (IRR, 1.68 per unit packed red blood cell; CI, 1.21-2.35; P = .002). Gender, rheumatoid arthritis, and long-term (>1 year) corticosteroid use affect SSI risk after shoulder arthroplasty. Revision surgery, particularly in the setting of prior infection, increased risk of future infection. Finally, allogeneic red blood cell transfusion increases SSI risk after shoulder arthroplasty in a dose-dependent manner. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Development of a Korean Fracture Risk Score (KFRS) for Predicting Osteoporotic Fracture Risk: Analysis of Data from the Korean National Health Insurance Service.

PubMed

Kim, Ha Young; Jang, Eun Jin; Park, ByeongJu; Kim, Tae-Young; Shin, Soon-Ae; Ha, Yong-Chan; Jang, Sunmee

2016-01-01

Asian-specific prediction models for estimating individual risk of osteoporotic fractures are rare. We developed a Korean fracture risk prediction model using clinical risk factors and assessed validity of the final model. A total of 718,306 Korean men and women aged 50-90 years were followed for 7 years in a national system-based cohort study. In total, 50% of the subjects were assigned randomly to the development dataset and 50% were assigned to the validation dataset. Clinical risk factors for osteoporotic fracture were assessed at the biennial health check. Data on osteoporotic fractures during the follow-up period were identified by ICD-10 codes and the nationwide database of the National Health Insurance Service (NHIS). During the follow-up period, 19,840 osteoporotic fractures were reported (4,889 in men and 14,951 in women) in the development dataset. The assessment tool called the Korean Fracture Risk Score (KFRS) is comprised of a set of nine variables, including age, body mass index, recent fragility fracture, current smoking, high alcohol intake, lack of regular exercise, recent use of oral glucocorticoid, rheumatoid arthritis, and other causes of secondary osteoporosis. The KFRS predicted osteoporotic fractures over the 7 years. This score was validated using an independent dataset. A close relationship with overall fracture rate was observed when we compared the mean predicted scores after applying the KFRS with the observed risks after 7 years within each 10th of predicted risk. We developed a Korean specific prediction model for osteoporotic fractures. The KFRS was able to predict risk of fracture in the primary population without bone mineral density testing and is therefore suitable for use in both clinical setting and self-assessment. The website is available at http://www.nhis.or.kr.

Risk of cancer in children, adolescents, and young adults with autistic disorder.

PubMed

Chiang, Huey-Ling; Liu, Chia-Jen; Hu, Yu-Wen; Chen, San-Chi; Hu, Li-Yu; Shen, Cheng-Che; Yeh, Chiu-Mei; Chen, Tzeng-Ji; Gau, Susan Shur-Fen

2015-02-01

To investigate whether individuals with autism have an increased risk for cancer relative to the general population. We enrolled patients with autistic disorder from the Taiwan National Health Insurance database in years 1997-2011. A total of 8438 patients diagnosed with autism were retrieved from the Registry for Catastrophic Illness Patients database. The diagnosis of cancers was also based on the certificate of catastrophic illness, which requires histological confirmation. The risk of cancer among the autism cohort was determined with a standardized incidence ratio (SIR). During the observation period, cancer occurred in 20 individuals with autism, which was significantly higher than a total number of expected cancers with a SIR estimate of 1.94 (95% CI 1.18-2.99). The number of cancer in males was greater than the expected number with a SIR of 1.95 (1.11-3.16), but no excess risk was found for females with a SIR of 1.91 (0.52-4.88). Cancer developed more than expected in individuals age 15-19 years with the SIR of 3.58 (1.44-7.38), but did not differ in other age range groups. The number of cancers of genitourinary system was significantly in excess of the expected number (SIR 4.15; 95% CI 1.13-10.65), and increased risk was found in ovarian cancer with SIR of 9.21 (1.12-33.29). Our study demonstrated that patients with autistic disorder have an increased risk of cancer. Copyright © 2015 Elsevier Inc. All rights reserved.

Functional polymorphisms in the CYP2C19 gene contribute to digestive system cancer risk: evidence from 11,042 subjects.

PubMed

Zhou, Bo; Song, Zhenshun; Qian, Mingping; Li, Liang; Gong, Jian; Zou, Shaowu

2013-01-01

CYP2C19 belongs to the cytochrome P450 superfamily of enzymes involved in activating and detoxifying many carcinogens and endogenous compounds, which has attracted considerable attention as a candidate gene for digestive system cancer. CYP2C19 has two main point mutation sites (CYP2C19*2, CYP2C19*3) leading to poor metabolizer (PM) phenotype. In the past decade, the relationship between CYP2C19 polymorphism and digestive system cancer has been reported in various ethnic groups; however, these studies have yielded contradictory results. To clarify this inconsistency, we performed this meta-analysis. Databases including Pubmed, EMBASE, Web of Science and China National Knowledge Infrastructure (CNKI) were searched to find relevant studies. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of association. In total, 18 studies with 4,414 cases and 6,628 controls were included. Overall, significantly elevated digestive system cancer risk was associated CYP2C19 PM with OR of 1.66 (95%CI: 1.31-2.10, P<10(-5)) when all studies were pooled into the meta-analysis. There was strong evidence of heterogeneity (P = 0.006), which largely disappeared after stratification by cancer type. In the stratified analyses according to cancer type, ethnicity, control source and sample size, significantly increased risks were found. In summary, our meta-analysis suggested that the PM phenotype caused by the variation on CYP2C19 gene is associated with increased risk of digestive system cancer, especially in East Asians.

Delivery System Integration and Health Care Spending and Quality for Medicare Beneficiaries

PubMed Central

McWilliams, J. Michael; Chernew, Michael E.; Zaslavsky, Alan M.; Hamed, Pasha; Landon, Bruce E.

2013-01-01

Background The Medicare accountable care organization (ACO) programs rely on delivery system integration and provider risk sharing to lower spending while improving quality of care. Methods Using 2009 Medicare claims and linked American Medical Association Group Practice data, we assigned 4.29 million beneficiaries to provider groups based on primary care use. We categorized group size according to eligibility thresholds for the Shared Savings (≥5,000 assigned beneficiaries) and Pioneer (≥15,000) ACO programs and distinguished hospital-based from independent groups. We compared spending and quality of care between larger and smaller provider groups and examined how size-related differences varied by 2 factors considered central to ACO performance: group primary care orientation (measured by the primary care share of large groups’ specialty mix) and provider risk sharing (measured by county health maintenance organization penetration and its relationship to financial risk accepted by different group types for managed care patients). Spending and quality of care measures included total medical spending, spending by type of service, 5 process measures of quality, and 30-day readmissions, all adjusted for sociodemographic and clinical characteristics. Results Compared with smaller groups, larger hospital-based groups had higher total per-beneficiary spending in 2009 (mean difference: +$849), higher 30-day readmission rates (+1.3% percentage points), and similar performance on 4 of 5 process measures of quality. In contrast, larger independent physician groups performed better than smaller groups on all process measures and exhibited significantly lower per-beneficiary spending in counties where risk sharing by these groups was more common (−$426). Among all groups sufficiently large to participate in ACO programs, a strong primary care orientation was associated with lower spending, fewer readmissions, and better quality of diabetes care. Conclusions Spending was lower and quality of care better for Medicare beneficiaries served by larger independent physician groups with strong primary care orientations in environments where providers accepted greater risk. PMID:23780467

Complication-related removal of totally implantable venous access port systems: Does the interval between placement and first use and the neutropenia-inducing potential of chemotherapy regimens influence their incidence? A four-year prospective study of 4045 patients.

PubMed

Kakkos, A; Bresson, L; Hudry, D; Cousin, S; Lervat, C; Bogart, E; Meurant, J P; El Bedoui, S; Decanter, G; Hannebicque, K; Regis, C; Hamdani, A; Penel, N; Tresch-Bruneel, E; Narducci, F

2017-04-01

Totally implantable venous access port systems are widely used in oncology, with frequent complications that sometimes necessitate device removal. The aim of this study is to investigate the impact of the time interval between port placement and initiation of chemotherapy and the neutropenia-inducing potential of the chemotherapy administered upon complication-related port removal. Between January 2010 and December 2013, 4045 consecutive patients were included in this observational, single-center prospective study. The chemotherapy regimens were classified as having a low (<10%), intermediate (10-20%), or high (>20%) risk for inducing neutropenia. The overall removal rate due to complications was 7.2%. Among them, port-related infection (2.5%) and port expulsion (1%) were the most frequent. The interval between port insertion and its first use was shown to be a predictive factor for complication-related removal rates. A cut-off of 6 days was statistically significant (p = 0.008), as the removal rate for complications was 9.4% when this interval was 0-5 days and 5.7% when it was ≥6 days. Another factor associated with port complication rate was the neutropenia-inducing potential of the chemotherapy regimens used, with removal for complications involved in 5.5% of low-risk regimens versus 9.4% for the intermediate- and high-risk regimens (p = 0.003). An interval of 6 days between placement and first use of the port reduces the removal rate from complications. The intermediate- and high-risk for neutropenia chemotherapy regimens are related to higher port removal rates from complications than low-risk regimens. Copyright © 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

[Determinants of patient and health system delays for women with breast cancer in Morocco, 2013].

PubMed

Benbakhta, B; Tazi, M; Benjaafar, N; Khattabi, A; Maaroufi, A

2015-06-01

In Morocco, breast cancer is the first most common cancer in women. It is diagnosed in most cases at an advanced stage. Delay in diagnosis and access to treatment for breast cancer increases morbidity and mortality. The objective of this study was to determine the consultation delay (patient delay), diagnosis delay and access to treatment delay (health system delays) of women with breast cancer admitted at the National Institute of Oncology in Rabat. Factors associated with these delays were analyzed. We conducted a cross-sectional study from December 2012 to May 2013 at the National Institute of Oncology in Rabat. Two hundred eligible and consenting women were interviewed using a structured and pre-tested questionnaire. Stages I and II were identified as "early stages" and III and IV as "advanced stages". In our population, 54% were diagnosed at an early stage of breast cancer and 46% at an advanced stage. The median total delay was 120 days (interquartile interval [IIQ]=81-202 days). The patient delay (median=65 days, IIQ=31-121) was longer than the health system delay (median=50 days, IIQ=29-77). High risk for a long total delay (more than 4 months) was observed for women who were aged over 65 years (OR=1.30, 95% CI 1.10-4.20), illiterate (OR=4.50, 95% CI 2.10-6.20), rural residents (OR=3.40, 95% CI 1.23-8.13), in a lower socioeconomic category (OR=4.75, 95% CI 1.45-15.60), without knowledge about breast self-examination (OR=5.67, 95% CI 2.65-12.15) and seen more than 2 times before diagnosis (OR=7.70, 95% CI 2.88-20.50). A long total delay increased the risk of being diagnosed at an advanced stage (OR=5.62, 95% CI 3.03-10.45). Efforts should be directed to providing good information to the population at risk, better access to screening and continuing medical training to enable diagnosis and early treatment. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Relationship between fruit and vegetable intake and the risk of metabolic syndrome and its disorders in Korean women according to menopausal status.

PubMed

Hong, Seo Ah; Kim, Mi Kyung

2017-05-01

The association between fruit and vegetable (FV) intake and risk of the metabolic syndrome (MetS) has not been elucidated fully, particularly by menopausal status. Method and Study Design: The study population was 2,999 women aged 40-64 years participating in the 4th Korea National Health and Nutrition Examination Survey. The definition of MetS and its components was based on the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) for Koreans. Dietary data were assessed by a 24-hour recall. Fruit intake was inversely related only to the risk of high blood pressure (BP), but not MetS. Total vegetable consumption was inversely associated with the MetS risk, and when combined with fruits, the inverse association was observed even in its features of high triglycerides (TG) and low HDLcholesterol as well as MetS. Assessing women by menopausal status revealed that the inverse association with the MetS risk was found only in postmenopausal women having greater total vegetables and total FV intake (aOR=0.47, 95% CI=0.29-0.75, p-trend=0.003 and aOR=0.54, 95% CI=0.35-0.85, p-trend=0.007, respectively). Analysis regarding MetS features showed that while the inverse association of total vegetables or total FV intake was observed with high TG risk in postmenopausal women, fruits intake was inversely associated with high BP risk in premenopausal women (aOR=0.54, 95% CI=0.37-0.79, p-trend=0.004). Results suggest that while fruit intake was inversely associated with high BP in premenopausal women, greater dietary intake of vegetables and total FV may protect against the risk of MetS, particularly in postmenopausal women.

Health risk assessment of emissions of dioxins and furans from a municipal waste incinerator: comparison with other emission sources.

PubMed

Meneses, Montse; Schuhmacher, Marta; Domingo, José L

2004-06-01

The aim of this study was to calculate the incremental lifetime-risk to dioxins and furans (PCDD/Fs) for the population living in the surroundings of a municipal solid waste incinerator (MSWI), as well as to establish the potential reduction on human health risks as a consequence of the adaptation to the EU legislation on pollutant emissions from the MSWI stack. Analytical and modelled results were obtained. PCDD/F concentrations in environmental media were determined by means of a simple-compartment-multimedia model (air-soil-vegetation model). Predicted and measured PCDD/F concentrations in soils and vegetation were compared, and the effects of MSWI emissions in the environmental media were determined. Human health risks due to PCDD/F emissions from the MSWI were also estimated based on I-TEQ measured and modelled in various environmental media. Cancer risks due to PCDD/F emissions of the plant were 1.07E-07 and 3.08E-09, before and after installation of the clean air system, respectively. On the other hand, cancer risks due to other PCDD/F emission sources in the area were 5.54E-06 and 1.86E-06. Total PCDD/F cancer risks (including those from diet) for the population living in the vicinity of the MSWI were 1.3E-04 and 4.25E-05, respectively (67.6% of reduction). Hazard ratio for total PCDD/F exposure (including diet) decreased during the last 5 years from 1.16 to 0.38. The above data show that other emission sources of PCDD/Fs also have a notable environmental impact on the area under direct influence of the MSWI.

Cortico-Striatal GABAergic and Glutamatergic Dysregulations in Subjects at Ultra-High Risk for Psychosis Investigated with Proton Magnetic Resonance Spectroscopy

PubMed Central

Reyes-Madrigal, Francisco; Mao, Xiangling; León-Ortiz, Pablo; Rodríguez-Mayoral, Oscar; Solís-Vivanco, Rodolfo; Favila, Rafael; Graff-Guerrero, Ariel; Shungu, Dikoma C.

2016-01-01

Background: Dysregulations of the major inhibitory and excitatory amino neurotransmitter systems of γ-aminobutyric acid and glutamate, respectively, have been described in patients with schizophrenia. However, it is unclear whether these abnormalities are present in subjects at ultra-high risk for psychosis. Methods: Twenty-three antipsychotic naïve subjects at ultra-high risk and 24 healthy control subjects, matched for age, sex, handedness, cigarette smoking, and parental education, underwent proton magnetic resonance spectroscopy scans in the dorsal caudate bilaterally and the medial prefrontal cortex at 3T. Levels of γ-aminobutyric acid and of the combined resonance of glutamate and glutamine (Glx) were obtained using the standard J-editing technique and expressed as peak area ratios relative to the synchronously acquired unsuppressed voxel water signal. Results: Higher levels of γ-aminobutyric acid (P<.001) and Glx (P=.007) were found in the dorsal caudate of the subjects at ultra-high risk than in the healthy controls. In the medial prefrontal cortex, likewise, both γ-aminobutyric acid (P=.03) and Glx (P=.006) levels were higher in the ultra-high risk group than in the healthy controls. No group differences were found for any of the other metabolites (N-acetylaspartate, total choline, or total creatine) in the 2 regions of interest. Conclusions: This study presents the first evidence of abnormal elevations, in subjects at ultra-high risk, of γ-aminobutyric acid and Glx in 2 brain regions that have been implicated in the pathophysiology of psychosis, warranting longitudinal studies to assess whether these neurotransmitter abnormalities can serve as noninvasive biomarkers of conversion risk to psychosis as well as of illness progression and treatment response. PMID:26364273

Coffee, tea and caffeine consumption and risk of primary infertility in women: a Danish cohort study.

PubMed

Í Soylu, Lív; Jensen, Allan; Juul, Kirsten E; Kesmodel, Ulrik S; Frederiksen, Kirsten; Kjaer, Susanne K; Hargreave, Marie

2018-05-01

The aim of this study was to investigate whether consumption of coffee, tea and caffeine affects the risk of primary infertility in women. We selected nulliparous Danish women aged 20-29 years from a prospective cohort and retrieved information on coffee and tea consumption from a questionnaire and an interview at enrollment. We assessed the women's fertility by linkage to the Danish Infertility Cohort and retrieved information on children and vital status from the Civil Registration System. All 7574 women included for analysis were followed for primary infertility from the date of enrollment (1991-1993) until 31 December 2010. Analyses were performed with Cox proportional hazard models. During follow up, primary infertility was diagnosed in 822 women. Compared with never consumers, the risk of primary infertility among women who drank coffee or tea was not affected. The risk of primary infertility was neither associated with an increasing number of daily servings of coffee (hazard ratio 1.00; 95% confidence interval (CI), 0.97-1.03) or tea (hazard ratio 1.01; 95% CI, 0.99-1.03) in consumers only. Concerning total caffeine consumption (from coffee and tea), the risk of infertility was similar among consumers compared with never consumers. Finally, none of the additional daily 100 mg of caffeine affected the risk among consumers only (hazard ratio 1.00; 95% CI 0.98-1.02). In this population-based cohort study, not restricted to women seeking pregnancy, we found no association between coffee, tea or total caffeine consumption and the risk of primary infertility in women. © 2018 Nordic Federation of Societies of Obstetrics and Gynecology.

(131)I therapy in patients with benign thyroid disease does not conclusively lead to a higher risk of subsequent malignancies.

PubMed

Verburg, F A; Luster, M; Lassmann, M; Reiners, C

2011-01-01

Due to its excellent tolerability and low incidence of side effects, 131I therapy has been the treatment of choice for benign thyroid diseases for over 60 years. A potentially increased risk of malignancies due to this therapy is however still subject of debate. To review the literature pertaining to 131I therapy of benign thyroid diseases in order to establish whether there is an increased incidence of, or increased mortality due to malignancies of the thyroid or other organs. In order to allow for sufficient long-term follow-up time after 131I therapy, only literature after 1990 was reviewed. Two criteria were applied to consider an increased incidence of malignancies linked to 131I therapy: a) there should be a latency period of at least 5 years between 131I therapy and the observation of an increased risk b) an elevated risk should increase with increasing radiation exposure. A total of 7 studies reporting cancer incidence and / or mortality in 4 different patient collectives spanning a total of 54510 patients over an observation period varying from 2-49 years were found. Although some studies detected a slightly increased risk for malignancies of the thyroid or the digestive system, others did not find these effects - while other studies even reported a slightly lower risk of malignant (thyroid) disease after 131I therapy for benign thyroid diseases. As over 60 years of experience has thus far failed to produce conclusive evidence to the contrary, it can be concluded that there is no increased risk of malignancies after 131I therapy for benign thyroid disease.

Reproductive Steroid Hormones and Recurrence-Free Survival in Women with a History of Breast Cancer

PubMed Central

Rock, Cheryl L.; Flatt, Shirley W.; Laughlin, Gail A.; Gold, Ellen B.; Thomson, Cynthia A.; Natarajan, Loki; Jones, Lovell A.; Caan, Bette J.; Stefanick, Marcia L.; Hajek, Richard A.; Al-Delaimy, Wael K.; Stanczyk, Frank Z.; Pierce, John P.

2008-01-01

Epidemiologic studies fairly consistently show in postmenopausal women that reproductive steroid hormones contribute to primary breast cancer risk, and this association is strongly supported by experimental studies using laboratory animals and model systems. Evidence linking sex hormone concentrations with risk for recurrence in women diagnosed with breast cancer is limited; however, beneficial effects of antiestrogenic therapy on recurrence-free survival suggest that these hormones affect progression and risk for recurrence. This study examined whether baseline serum concentrations of estradiol, testosterone, and sex hormone binding globulin were associated with recurrence-free survival in a nested case-control cohort of women from a randomized diet trial (Women's Healthy Eating and Living Study) who were followed for >7 years after diagnosis. In 153 case-control pairs of perimenopausal and postmenopausal women in this analysis, total estradiol [hazard ratio (HR), 1.41 per unit increase in log concentration; 95% confidence interval (95% CI), 1.01−1.97], bioavailable estradiol (HR, 1.26; 95% CI, 1.03−1.53), and free estradiol (HR, 1.31; 95% CI, 1.03−1.65) concentrations were significantly associated with risk for recurrence. Recurred women had an average total estradiol concentration that was double that of nonrecurred women (22.7 versus 10.8 pg/mL; P = 0.05). Testosterone and sex hormone binding globulin concentrations did not differ between cases and controls and were not associated with risk for recurrence. Although genetic and metabolic factors likely modulate the relationship between circulating sex hormones and risk, results from this study provide evidence that higher serum estrogen concentration contributes to risk for recurrence in women diagnosed with early stage breast cancer. PMID:18323413

Different Choices of Drinking Water Source and Different Health Risks in a Rural Population Living Near a Lead/Zinc Mine in Chenzhou City, Southern China

PubMed Central

Huang, Xiao; He, Liping; Li, Jun; Yang, Fei; Tan, Hongzhuan

2015-01-01

This study aimed to describe the households’ choices of drinking water sources, and evaluate the risk of human exposure to heavy metals via different drinking water sources in Chenzhou City of Hunan Province, Southern China. A cross-sectional face-to-face survey of 192 householders in MaTian and ZhuDui village was conducted. The concentrations of heavy metals in their drinking water sources were analyzed. Carcinogenic and non-carcinogenic risk assessment was performed according to the method recommended by the United States Environmental Protection Agency. In total, 52.60% of the households used hand-pressed well water, and 34.89% used barreled water for drinking. In total, 6.67% of the water samples exceeded the Chinese drinking water standards. The total health risk of five metals is 5.20 × 10−9~3.62 × 10−5. The total health risk of five metals was at acceptable levels for drinking water sources. However, the total risk of using hand-pressed well water’s highest value is 6961 times higher than the risk of using tap water. Household income level was significantly associated with drinking water choices. Arsenic (As) and lead (Pb) are priority controlled pollutants in this region. Using safe drinking water (tap water, barreled water and so on) can remarkably reduce the risk of ingesting heavy metals. PMID:26569281

Assessment of cardiovascular risk profile based on measurement of tophus volume in patients with gout.

PubMed

Lee, Kyung-Ann; Ryu, Se-Ri; Park, Seong-Jun; Kim, Hae-Rim; Lee, Sang-Heon

2018-05-01

Hyperuricemia and gout are associated with increased risk of cardiovascular disease and metabolic syndrome. The aim of this study was to evaluate the correlation of total tophus volumes, measured using dual-energy computed tomography, with cardiovascular risk and the presence of metabolic syndrome. Dual-energy computed tomography datasets from 91 patients with a diagnosis of gout were analyzed retrospectively. Patients who received urate lowering therapy were excluded to avoid the effect on tophus volume. The total volumes of tophaceous deposition were quantified using automated volume assessment software. The 10-year cardiovascular risk using the Framingham Risk Score and metabolic syndrome based on the Third Adult Treatment Panel criteria were estimated. Fifty-five and 36 patients with positive and negative dual-energy computed tomography results, respectively, were assessed. Patients with positive dual-energy computed tomography results showed significantly higher systolic blood pressure, diastolic blood pressure, fasting glucose, and higher prevalence of chronic kidney disease, compared with those with negative dual-energy computed tomography results. The total tophus volumes were significantly correlated with the Framingham Risk Score, and the number of metabolic syndrome components (r = 0.22 and p = 0.036 and r = 0.373 and p < 0.001, respectively). The total tophus volume was one of the independent prognostic factors for the Framingham Risk Score in a multivariate analysis. This study showed the correlation of total tophus volumes with cardiovascular risk and metabolic syndrome-related comorbidities. A high urate burden could affect unfavorable cardiovascular profiles.

Maryland veterans' knowledge of risk factors for and signs of oral cancers and their use of dental services.

PubMed

Canto, M T; Horowitz, A M; Goodman, H S; Watson, M R; Cohen, L A; Fedele, D J

1998-01-01

The purpose of this study was to evaluate outpatient veteran'í knowledge about risk factors for and signs of oral cancers, and their utilization of dental services. Patients receiving primary health care services were surveyed during August 1997. Primary health care services at three medical centres within the VA Maryland Health Care System (VAMHCS). A total of 135 outpatient veterans were interviewed. Questionnaire administered by trained interviewers. Fifteen percent of the sample were eligible for dental care at the VA, while over 40% of those veterans participating in the study were unaware of their VA eligibility for dental services. Fifty six percent of the total sample received dental services from a private dentist, while 13% reported they had no provider of dental care. Of those not eligible for dental care at the VA (n = 115), the majority (67%) received dental care from a private dentist. Current use of tobacco and alcohol was reported by 27% of the sample. Nonsmokers were more likely to visit the dentist in the previous year than smokers (OR = 2.39, 95% C.I. 1.11,5.12). Although 84% correctly identified tobacco use as a risk factor, only 39% correctly identified regular alcohol use as a risk factor. Veterans at higher risk for oral cancers were less likely to have visited the dentist in the previous year, and, overall, were ill informed and misinformed about these cancers.

Redesigning a risk-management process for tracking injuries.

PubMed

Wenzel, G R

1998-01-01

The changing responsibilities of registered nurses are challenging even the most dedicated professionals. To survive within her newly-defined roles, one nurse used a total quality improvement model to understand, analyze, and improve a medical center's system for tracking inpatient injuries. This process led to the drafting of an original software design that implemented a nursing informatics tracking system. It has resulted in significant savings of time and money and has far surpassed the accuracy, efficiency, and scope of the previous method. This article presents an overview of the design process.

One-carbon metabolite ratios as functional B-vitamin markers and in relation to colorectal cancer risk.

PubMed

Gylling, Björn; Myte, Robin; Ulvik, Arve; Ueland, Per M; Midttun, Øivind; Schneede, Jörn; Hallmans, Göran; Häggström, Jenny; Johansson, Ingegerd; Van Guelpen, Bethany; Palmqvist, Richard

2018-05-22

One-carbon metabolism biomarkers are easily measured in plasma, but analyzing them one at a time in relation to disease does not take into account the interdependence of the many factors involved. The relative dynamics of major one-carbon metabolism branches can be assessed by relating the functional B-vitamin marker total homocysteine (tHcy) to transsulfuration (total cysteine) and methylation (creatinine) outputs. We validated the ratios of tHcy to total cysteine (Hcy:Cys), tHcy to creatinine (Hcy:Cre), and tHcy to cysteine to creatinine (Hcy:Cys:Cre) as functional markers of B-vitamin status. We also calculated the associations of these ratios to colorectal cancer (CRC) risk. Furthermore, the relative contribution of potential confounders to the variance of the ratio-based B-vitamin markers was calculated by linear regression in a nested case-control study of 613 CRC cases and 1190 matched controls. Total B-vitamin status was represented by a summary score comprising Z-standardized plasma concentrations of folate, cobalamin, betaine, pyridoxal 5'-phosphate, and riboflavin. Associations with CRC risk were estimated using conditional logistic regression. We found that the ratio-based B-vitamin markers all outperformed tHcy as markers of total B-vitamin status, in both CRC cases and controls. Additionally, associations with CRC risk were similar for the ratio-based B-vitamin markers and total B-vitamin status (approximately 25% lower risk for high versus low B-vitamin status). In conclusion, ratio-based B-vitamin markers were good predictors of total B-vitamin status and displayed similar associations as total B-vitamin status with CRC risk. Since tHcy and creatinine are routinely clinically analyzed, Hcy:Cre could be easily implemented in clinical practice. This article is protected by copyright. All rights reserved. © 2018 UICC.

Mortality from Circulatory System Diseases among French Uranium Miners: A Nested Case-Control Study.

PubMed

Drubay, Damien; Caër-Lorho, Sylvaine; Laroche, Pierre; Laurier, Dominique; Rage, Estelle

2015-05-01

A significant association has been observed between radon exposure and cerebrovascular disease (CeVD) mortality among French uranium miners, but risk factors for circulatory system diseases (CSD) have not been previously considered. We conducted new analyses in the recently updated (through 2007) French cohort of uranium miners (n = 5,086), which included 442 deaths from CSD, 167 of them from ischemic heart disease (IHD) and 105 from CeVD. A nested case-control study was then set up to collect and investigate the influence of these risk factors on the relationships between mortality from CSD and occupational external gamma ray and internal ionizing radiation exposure (radon and long-lived radionuclides) in this updated cohort. The nested case-control study included miners first employed after 1955, still employed in 1976 and followed up through 2007. Individual information about CSD risk factors was collected from medical files for the 76 deaths from CSD (including 26 from IHD and 16 from CeVD) and 237 miners who had not died of CSD by the end of follow-up. The exposure-risk relationships were assessed with a Cox proportional hazard model weighted by the inverse sampling probability. A significant increase in all CSD and CeVD mortality risks associated with radon exposure was observed in the total cohort [hazard ratios: HRCSD/100 working level months (WLM) = 1.11, 95% confidence interval (1.01; 1.22) and HRCeVD/100 WLM = 1.25 (1.09; 1.43), respectively]. A nonsignificant exposure-risk relationship was observed for every type of cumulative ionizing radiation exposure and every end point [e.g., HRCSD/100WLM = 1.43 (0.71; 2.87)]. The adjustment for each CSD risk factor did not substantially change the exposure-risk relationships. When the model was adjusted for overweight, hypertension, diabetes, hypercholesterolemia and smoking status, the HR/100WLM for CSD, for example, was equal to 1.21 (0.54; 2.75); and when it was adjusted for risk factors selected with the Akaike information criterion, it was equal to 1.44 (0.66; 3.14). To our knowledge, this is the first study to use a uranium miner cohort to consider the major standard CSD risk factors in assessing the relationships between ionizing radiation exposure and the risk of death from these diseases. These results suggest that the significant relationship between CeVD risk and radon exposure observed in the total French cohort is probably not affected by the CSD risk factors. Extending the collection of information about CSD risk factors to a larger subsample would be useful to confirm this result.

Optical identification of subjects at high risk for developing breast cancer

NASA Astrophysics Data System (ADS)

Taroni, Paola; Quarto, Giovanna; Pifferi, Antonio; Ieva, Francesca; Paganoni, Anna Maria; Abbate, Francesca; Balestreri, Nicola; Menna, Simona; Cassano, Enrico; Cubeddu, Rinaldo

2013-06-01

A time-domain multiwavelength (635 to 1060 nm) optical mammography was performed on 147 subjects with recent x-ray mammograms available, and average breast tissue composition (water, lipid, collagen, oxy- and deoxyhemoglobin) and scattering parameters (amplitude a and slope b) were estimated. Correlation was observed between optically derived parameters and mammographic density [Breast Imaging and Reporting Data System (BI-RADS) categories], which is a strong risk factor for breast cancer. A regression logistic model was obtained to best identify high-risk (BI-RADS 4) subjects, based on collagen content and scattering parameters. The model presents a total misclassification error of 12.3%, sensitivity of 69%, specificity of 94%, and simple kappa of 0.84, which compares favorably even with intraradiologist assignments of BI-RADS categories.

Microbiological performance of a food safety management system in a food service operation.

PubMed

Lahou, E; Jacxsens, L; Daelman, J; Van Landeghem, F; Uyttendaele, M

2012-04-01

The microbiological performance of a food safety management system in a food service operation was measured using a microbiological assessment scheme as a vertical sampling plan throughout the production process, from raw materials to final product. The assessment scheme can give insight into the microbiological contamination and the variability of a production process and pinpoint bottlenecks in the food safety management system. Three production processes were evaluated: a high-risk sandwich production process (involving raw meat preparation), a medium-risk hot meal production process (starting from undercooked raw materials), and a low-risk hot meal production process (reheating in a bag). Microbial quality parameters, hygiene indicators, and relevant pathogens (Listeria monocytogenes, Salmonella, Bacillus cereus, and Escherichia coli O157) were in accordance with legal criteria and/or microbiological guidelines, suggesting that the food safety management system was effective. High levels of total aerobic bacteria (>3.9 log CFU/50 cm(2)) were noted occasionally on gloves of food handlers and on food contact surfaces, especially in high contamination areas (e.g., during handling of raw material, preparation room). Core control activities such as hand hygiene of personnel and cleaning and disinfection (especially in highly contaminated areas) were considered points of attention. The present sampling plan was used to produce an overall microbiological profile (snapshot) to validate the food safety management system in place.

Cost-Effectiveness of Staphylococcus aureus Decolonization Strategies in High-Risk Total Joint Arthroplasty Patients.

PubMed

Williams, Devin M; Miller, Andy O; Henry, Michael W; Westrich, Geoffrey H; Ghomrawi, Hassan M K

2017-09-01

The risk of prosthetic joint infection increases with Staphylococcus aureus colonization. The cost-effectiveness of decolonization is controversial. We evaluated cost-effectiveness decolonization protocols in high-risk arthroplasty patients. An analytical model evaluated risk under 3 protocols: 4 swabs, 2 swabs, and nasal swab alone. These were compared to no-screening and universal decolonization strategies. Cost-effectiveness was evaluated from the hospital, patient, and societal perspective. Under base case conditions, universal decolonization and 4-swab strategies were most effective. The 2-swab and universal decolonization strategy were most cost-effective from patient and societal perspectives. From the hospital perspective, universal decolonization was the dominant strategy (much less costly and more effective). S aureus decolonization may be cost-effective for reducing prosthetic joint infections in high-risk patients. These results may have important implications for treatment of patients and for cost containment in a bundled payment system. Copyright © 2017 Elsevier Inc. All rights reserved.

Risk and Vulnerability Assessment Using Cybernomic Computational Models: Tailored for Industrial Control Systems

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

Abercrombie, Robert K; Sheldon, Federick T.; Schlicher, Bob G

2015-01-01

There are many influencing economic factors to weigh from the defender-practitioner stakeholder point-of-view that involve cost combined with development/deployment models. Some examples include the cost of countermeasures themselves, the cost of training and the cost of maintenance. Meanwhile, we must better anticipate the total cost from a compromise. The return on investment in countermeasures is essentially impact costs (i.e., the costs from violating availability, integrity and confidentiality / privacy requirements). The natural question arises about choosing the main risks that must be mitigated/controlled and monitored in deciding where to focus security investments. To answer this question, we have investigated themore » cost/benefits to the attacker/defender to better estimate risk exposure. In doing so, it s important to develop a sound basis for estimating the factors that derive risk exposure, such as likelihood that a threat will emerge and whether it will be thwarted. This impact assessment framework can provide key information for ranking cybersecurity threats and managing risk.« less

Role of Hot Water System Design on Factors Influential to Pathogen Regrowth: Temperature, Chlorine Residual, Hydrogen Evolution, and Sediment

PubMed Central

Brazeau, Randi H.; Edwards, Marc A.

2013-01-01

Abstract Residential water heating is linked to growth of pathogens in premise plumbing, which is the primary source of waterborne disease in the United States. Temperature and disinfectant residual are critical factors controlling increased concentration of pathogens, but understanding of how each factor varies in different water heater configurations is lacking. A direct comparative study of electric water heater systems was conducted to evaluate temporal variations in temperature and water quality parameters including dissolved oxygen levels, hydrogen evolution, total and soluble metal concentrations, and disinfectant decay. Recirculation tanks had much greater volumes of water at temperature ranges with potential for increased pathogen growth when set at 49°C compared with standard tank systems without recirculation. In contrast, when set at the higher end of acceptable ranges (i.e., 60°C), this relationship was reversed and recirculation systems had less volume of water at risk for pathogen growth compared with conventional systems. Recirculation tanks also tended to have much lower levels of disinfectant residual (standard systems had 40–600% higher residual), 4–6 times as much hydrogen, and 3–20 times more sediment compared with standard tanks without recirculation. On demand tankless systems had very small volumes of water at risk and relatively high levels of disinfectant residual. Recirculation systems may have distinct advantages in controlling pathogens via thermal disinfection if set at 60°C, but these systems have lower levels of disinfectant residual and greater volumes at risk if set at lower temperatures. PMID:24170969

Similar associations of total adiponectin and high molecular weight adiponectin with cardio-metabolic risk factors in a population of overweight and obese postmenopausal women: a MONET study.

PubMed

Elisha, B; Ziai, S; Karelis, A D; Rakel, A; Coderre, L; Imbeault, P; Rabasa-Lhoret, R

2010-07-01

The aim of the study was to examine the association between total adiponectin and high molecular weight (HMW) adiponectin levels with cardio-metabolic risk factors in a population of sedentary, overweight, and obese postmenopausal women. Cross-sectional study was carried out on 55 nondiabetic sedentary overweight and obese postmenopausal women aged between 50 and 70 years. Insulin sensitivity was assessed by euglycemic-hyperinsulinemic clamp technique. Body composition and visceral fat were measured using dual X-ray absorptiometry and computed tomography, respectively. Other cardio-metabolic risk factors included: plasma lipids, hsC-reactive protein, energy expenditure (doubly labeled water), peak oxygen consumption, muscle strength (using weight training equipment) as well as total and HMW adiponectin. Correlations of total and HMW adiponectin with various cardio-metabolic risk factors were comparable. In addition, regression analysis results showed similar independent predictors of total and HMW adiponectin. Finally, the receiver operator characteristic (ROC) curves for total and HMW adiponectin to predict insulin sensitivity showed no difference between the areas under curve (AUC) (AUC total adiponectin=0.80 [95% CI: 0.66-0.95] versus AUC HMW adiponectin=0.76 [95% CI: 0.60-0.91], p=0.36). The present study indicates that HMW adiponectin does not seem to provide additional information than total adiponectin in relation to cardio-metabolic risk factors in overweight/obese postmenopausal women. (c) Georg Thieme Verlag KG Stuttgart . New York.

A cost-effectiveness modelling study of strategies to reduce risk of infection following primary hip replacement based on a systematic review.

PubMed

Graves, Nicholas; Wloch, Catherine; Wilson, Jennie; Barnett, Adrian; Sutton, Alex; Cooper, Nicola; Merollini, Katharina; McCreanor, Victoria; Cheng, Qinglu; Burn, Edward; Lamagni, Theresa; Charlett, Andre

2016-07-01

A deep infection of the surgical site is reported in 0.7% of all cases of total hip arthroplasty (THA). This often leads to revision surgery that is invasive, painful and costly. A range of strategies is employed in NHS hospitals to reduce risk, yet no economic analysis has been undertaken to compare the value for money of competing prevention strategies. To compare the costs and health benefits of strategies that reduce the risk of deep infection following THA in NHS hospitals. To make recommendations to decision-makers about the cost-effectiveness of the alternatives. The study comprised a systematic review and cost-effectiveness decision analysis. 77,321 patients who had a primary hip arthroplasty in NHS hospitals in 2012. Nine different treatment strategies including antibiotic prophylaxis, antibiotic-impregnated cement and ventilation systems used in the operating theatre. Change in the number of deep infections, change in the total costs and change in the total health benefits in quality-adjusted life-years (QALYs). Literature searches using MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trials were undertaken to cover the period 1966-2012 to identify infection prevention strategies. Relevant journals, conference proceedings and bibliographies of retrieved papers were hand-searched. Orthopaedic surgeons and infection prevention experts were also consulted. English-language papers only. The selection of evidence was by two independent reviewers. Studies were included if they were interventions that reported THA-related deep surgical site infection (SSI) as an outcome. Mixed-treatment comparisons were made to produce estimates of the relative effects of competing infection control strategies. Twelve studies, six randomised controlled trials and six observational studies, involving 123,788 total hip replacements (THRs) and nine infection control strategies, were identified. The quality of the evidence was judged against four categories developed by the National Institute for Health and Care Excellence Methods for Development of NICE Public Health Guidance ( http://publications.nice.org.uk/methods-for-the-development-of-nice-public-health-guidance-third-edition-pmg4 ), accessed March 2012. All evidence was found to fit the two highest categories of 1 and 2. Nine competing infection control interventions [treatments (Ts) 1-9] were used in a cohort simulation model of 77,321 patients who had a primary THR in 2012. Predictions were made for cases of deep infection and total costs, and QALY outcomes. Compared with a baseline of T1 (no systemic antibiotics, plain cement and conventional ventilation) all other treatment strategies reduced risk. T6 was the most effective (systemic antibiotics, antibiotic-impregnated cement and conventional ventilation) and prevented a further 1481 cases of deep infection, and led to the largest annual cost savings and the greatest gains to QALYs. The additional uses of laminar airflow and body exhaust suits indicate higher costs and worse health outcomes. T6 is an optimal strategy for reducing the risk of SSI following THA. The other strategies that are commonly used among NHS hospitals lead to higher cost and worse QALY outcomes. Policy-makers, therefore, have an opportunity to save resources and improve health outcomes. The effects of laminar air flow and body exhaust suits might be further studied if policy-makers are to consider disinvesting in these technologies. A wide range of evidence sources was synthesised and there is large uncertainty in the conclusions. The National Institute for Health Research Health Technology Assessment programme and the Queensland Health Quality Improvement and Enhancement Programme (grant number 2008001769).

Cirrhosis is a risk factor for total hip arthroplasty for avascular necrosis.

PubMed

Deleuran, Thomas; Overgaard, Søren; Vilstrup, Hendrik; Jepsen, Peter

2016-06-01

Background and purpose - There are limited data on risk factors for avascular necrosis of the hip, but cirrhosis has been proposed as a risk factor. We examined the association between cirrhosis and incidence of total hip arthroplasty for avascular necrosis. Methods - We used nationwide healthcare data to identify all Danish residents diagnosed with cirrhosis in 1994-2011, and matched them 1:5 by age and sex to non-cirrhotic reference individuals from the general population. We excluded people with a previous total hip arthroplasty, a previous hip fracture, or a previous diagnosis of avascular necrosis. We used stratified Cox regression to estimate the hazard ratio (HR) for cirrhosis patients relative to reference individuals, adjusting for potential confounders. We used the cumulative incidence function to compute 5-year risks. Results - We included 25,421 cirrhosis patients and 114,052 reference individuals. Their median age was 57 years, and 65% were men. 45 cirrhosis patients and 44 reference individuals underwent total hip arthroplasty for avascular necrosis. Cirrhosis patients' HR for a total hip arthroplasty for avascular necrosis was 10 (95% CI: 6-17), yet their 5-year risk of avascular necrosis was only 0.2%. For the reference individuals, the 5-year risk was 0.02%. Interpretation - Cirrhosis is a strong risk factor for avascular necrosis of the hip, but it is rare even in cirrhosis patients.

Cirrhosis is a risk factor for total hip arthroplasty for avascular necrosis

PubMed Central

Deleuran, Thomas; Overgaard, Søren; Vilstrup, Hendrik; Jepsen, Peter

2016-01-01

Background and purpose There are limited data on risk factors for avascular necrosis of the hip, but cirrhosis has been proposed as a risk factor. We examined the association between cirrhosis and incidence of total hip arthroplasty for avascular necrosis. Methods We used nationwide healthcare data to identify all Danish residents diagnosed with cirrhosis in 1994–2011, and matched them 1:5 by age and sex to non-cirrhotic reference individuals from the general population. We excluded people with a previous total hip arthroplasty, a previous hip fracture, or a previous diagnosis of avascular necrosis. We used stratified Cox regression to estimate the hazard ratio (HR) for cirrhosis patients relative to reference individuals, adjusting for potential confounders. We used the cumulative incidence function to compute 5-year risks. Results We included 25,421 cirrhosis patients and 114,052 reference individuals. Their median age was 57 years, and 65% were men. 45 cirrhosis patients and 44 reference individuals underwent total hip arthroplasty for avascular necrosis. Cirrhosis patients’ HR for a total hip arthroplasty for avascular necrosis was 10 (95% CI: 6–17), yet their 5-year risk of avascular necrosis was only 0.2%. For the reference individuals, the 5-year risk was 0.02%. Interpretation Cirrhosis is a strong risk factor for avascular necrosis of the hip, but it is rare even in cirrhosis patients. PMID:26900635

Brain Volume as an Integrated Marker for the Risk of Death in a Community-Based Sample: Age Gene/Environment Susceptibility--Reykjavik Study.

PubMed

Van Elderen, Saskia S G C; Zhang, Qian; Sigurdsson, Sigudur; Haight, Thaddeus J; Lopez, Oscar; Eiriksdottir, Gudny; Jonsson, Palmi; de Jong, Laura; Harris, Tamara B; Garcia, Melissa; Gudnason, Vilmundar; van Buchem, Mark A; Launer, Lenore J

2016-01-01

Total brain volume is an integrated measure of health and may be an independent indicator of mortality risk independent of any one clinical or subclinical disease state. We investigate the association of brain volume to total and cause-specific mortality in a large nondemented stroke-free community-based cohort. The analysis includes 3,543 men and women (born 1907-1935) participating in the Age, Gene, Environment Susceptibility-Reykjavik Study. Participants with a known brain-related high risk for mortality (cognitive impairment or stroke) were excluded from these analyses. Quantitative estimates of total brain volume, white matter, white matter lesions, total gray matter (GM; cortical GM and subcortical GM separately), and focal cerebral vascular disease were generated from brain magnetic resonance imaging. Brain atrophy was expressed as brain tissue volume divided by total intracranial volume, yielding a percentage. Mean follow-up duration was 7.2 (0-10) years, with 647 deaths. Cox regression was used to analyze the association of mortality to brain atrophy, adjusting for demographics, cardiovascular risk factors, and cerebral vascular disease. Reduced risk of mortality was significantly associated with higher total brain volume (hazard ratio, 95% confidence interval = 0.71, 0.65-0.78), white matter (0.85, 0.78-0.93), total GM (0.74, 0.68-0.81), and cortical GM (0.78, 0.70-0.87). Overall, the associations were similar for cardiovascular and noncardiovascular-related deaths. Independent of multiple risk factors and cerebral vascular damage, global brain volume predicts mortality in a large nondemented stroke-free community-dwelling older cohort. Total brain volume may be an integrated measure reflecting a range of health and with further investigation could be a useful clinical tool when assessing risk for mortality. Published by Oxford University Press on behalf of the Gerontological Society of America 2014.

Serum cholesterol levels, HMG-CoA reductase inhibitors and the risk of intracerebral haemorrhage. The Multicenter Study on Cerebral Haemorrhage in Italy (MUCH-Italy).

PubMed

Pezzini, Alessandro; Grassi, Mario; Iacoviello, Licia; Zedde, Marialuisa; Marcheselli, Simona; Silvestrelli, Giorgio; DeLodovici, Maria Luisa; Sessa, Maria; Zini, Andrea; Paciaroni, Maurizio; Azzini, Cristiano; Gamba, Massimo; Del Sette, Massimo; Toriello, Antonella; Gandolfo, Carlo; Bonifati, Domenico Marco; Tassi, Rossana; Cavallini, Anna; Chiti, Alberto; Calabrò, Rocco Salvatore; Musolino, Rossella; Bovi, Paolo; Tomelleri, Giampaolo; Di Castelnuovo, Augusto; Vandelli, Laura; Ritelli, Marco; Agnelli, Giancarlo; De Vito, Alessandro; Pugliese, Nicola; Martini, Giuseppe; Lanari, Alessia; Ciccone, Alfonso; Lodigiani, Corrado; Malferrari, Giovanni; Del Zotto, Elisabetta; Morotti, Andrea; Costa, Paolo; Poli, Loris; De Giuli, Valeria; Bonaiti, Silvia; La Spina, Paolo; Marcello, Norina; Micieli, Giuseppe; de Gaetano, Giovanni; Colombi, Marina; Padovani, Alessandro

2016-09-01

Although a concern exists that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) might increase the risk of intracerebral haemorrhage (ICH), the contribution of these agents to the relationship between serum cholesterol and disease occurrence has been poorly investigated. We compared consecutive patients having ICH with age and sex-matched stroke-free control subjects in a case-control analysis, as part of the Multicenter Study on Cerebral Haemorrhage in Italy (MUCH-Italy), and tested the presence of interaction effects between total serum cholesterol levels and statins on the risk of ICH. A total of 3492 cases (mean age, 73.0±12.7 years; males, 56.6%) and 3492 control subjects were enrolled. Increasing total serum cholesterol levels were confirmed to be inversely associated with ICH. We observed a statistical interaction between total serum cholesterol levels and statin use for the risk of haemorrhage (Interaction OR (IOR), 1.09; 95% CI 1.05 to 1.12). Increasing levels of total serum cholesterol were associated with a decreased risk of ICH within statin strata (average OR, 0.87; 95% CI 0.86 to 0.88 for every increase of 0.26 mmol/l of total serum cholesterol concentrations), while statin use was associated with an increased risk (OR, 1.54; 95% CI 1.31 to 1.81 of the average level of total serum cholesterol). The protective effect of serum cholesterol against ICH was reduced by statins in strictly lobar brain regions more than in non-lobar ones. Statin therapy and total serum cholesterol levels exhibit interaction effects towards the risk of ICH. The magnitude of such effects appears higher in lobar brain regions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Provider risk factors for medication administration error alerts: analyses of a large-scale closed-loop medication administration system using RFID and barcode.

PubMed

Hwang, Yeonsoo; Yoon, Dukyong; Ahn, Eun Kyoung; Hwang, Hee; Park, Rae Woong

2016-12-01

To determine the risk factors and rate of medication administration error (MAE) alerts by analyzing large-scale medication administration data and related error logs automatically recorded in a closed-loop medication administration system using radio-frequency identification and barcodes. The subject hospital adopted a closed-loop medication administration system. All medication administrations in the general wards were automatically recorded in real-time using radio-frequency identification, barcodes, and hand-held point-of-care devices. MAE alert logs recorded during a full 1 year of 2012. We evaluated risk factors for MAE alerts including administration time, order type, medication route, the number of medication doses administered, and factors associated with nurse practices by logistic regression analysis. A total of 2 874 539 medication dose records from 30 232 patients (882.6 patient-years) were included in 2012. We identified 35 082 MAE alerts (1.22% of total medication doses). The MAE alerts were significantly related to administration at non-standard time [odds ratio (OR) 1.559, 95% confidence interval (CI) 1.515-1.604], emergency order (OR 1.527, 95%CI 1.464-1.594), and the number of medication doses administered (OR 0.993, 95%CI 0.992-0.993). Medication route, nurse's employment duration, and working schedule were also significantly related. The MAE alert rate was 1.22% over the 1-year observation period in the hospital examined in this study. The MAE alerts were significantly related to administration time, order type, medication route, the number of medication doses administered, nurse's employment duration, and working schedule. The real-time closed-loop medication administration system contributed to improving patient safety by preventing potential MAEs. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Risk factors for implant failure: a retrospective study in an educational institution using GEE analyses.

PubMed

Borba, Marcelo; Deluiz, Daniel; Lourenço, Eduardo José Veras; Oliveira, Luciano; Tannure, Patrícia Nivoloni

2017-08-21

This study aimed to evaluate dental implant outcomes and to identify risk factors associated with implant failure over 12 years via dental records of patients attending an educational institution. Dental records of 202 patients receiving 774 dental implants from 2002 to 2014 were analyzed by adopting a more reliable statistical method to evaluate risk factors with patients as the unit [generalized estimating equation (GEE)]. Information regarding patient age at implantation, sex, use of tobacco, and history of systemic diseases was collected. Information about implant location in the arch region and implant length, diameter, and placement in a grafted area was evaluated after 2 years under load. Systemic and local risk factors for early and late implant failure were studied. A total of 18 patients experienced 25 implant failures, resulting in an overall survival rate of 96.8% (2.84% and 0.38% early and late implant failures, respectively). The patient-based survival rate was 91.8%. GEE univariate and multivariate analyses revealed that a significant risk factor for implant failure was the maxillary implant (p = 0.006 and p = 0.014, respectively). Bone grafting appeared to be a risk factor for implant failure (p = 0.054). According to GEE analyses, maxillary implants had significantly worse outcomes in this population and were considered to be a risk factor for implant failure. Our results suggested that implants placed in a bone augmentation area had a tendency to fail.

Contract Design: Risk Management and Evaluation

PubMed Central

Amelung, Volker E.; Juhnke, Christin

2018-01-01

Introduction: Effective risk adjustment is an aspect that is more and more given weight on the background of competitive health insurance systems and vital healthcare systems. The risk structure of the providers plays a vital role in Pay for Performance. A prerequisite for optimal incentive-based service models is a (partial) dependence of the agent’s returns on the provider’s gain level. Integrated care systems as well as accountable care organisations (ACOs) in the US and similar concepts in other countries are advocated as an effective method of improving the performance of healthcare systems. These systems outline a payment and care delivery model that intends to tie provider reimbursements to predefined quality metrics. By this the total costs of care shall be reduced. Methods: Little is known about the contractual design and the main challenges of delegating “accountability” to these new kinds of organisations and/or contracts. The costs of market utilisation are highly relevant for the conception of healthcare contracts; furthermore information asymmetries and contract-specific investments are an obstacle to the efficient operation of ACOs. A comprehensive literature review on methods of designing contracts in Integrated Care was conducted. The research question in this article focuses on how reimbursement strategies, evaluation of measures and methods of risk adjustment can best be integrated in healthcare contracting. Results: Each integrated care contract includes challenges for both payers and providers without having sufficient empirical data on both sides. These challenges are clinical, administrative or financial nature. Risk adjusted contracts ensure that the reimbursement roughly matches the true costs resulting from the morbidity of a population. If reimbursement of care provider corresponds to the actual expenses for an individual/population the problem of risk selection is greatly reduced. The currently used methods of risk adjustment have widely differing model and forecast accuracy. For this reason, it is necessary to clearly regulate the method of risk adjustment in the integrated care contract. Conclusions and discussion: The series of three articles on contract design has shown that coordination and motivation problems in designing healthcare contracts cannot be solved at no-costs. Moreover, it became clear, that complete contracts in healthcare are unrealistic and that contracts do always include certain uncertainties. These are based on the risk of random, and no contracting party can control these risks completely. It is also not possible to fully integrate these risks in the contract or to eliminate these risks by the parties. PMID:29632454

Differentiating Community Dwellers at Risk for Pathological Narcissism From Community Dwellers at Risk for Psychopathy Using Measures of Emotion Recognition and Subjective Emotional Activation.

PubMed

Fossati, Andrea; Somma, Antonella; Pincus, Aaron; Borroni, Serena; Dowgwillo, Emily A

2017-06-01

The Italian translations of the Pathological Narcissism Inventory (PNI) and Triarchic Psychopathy Measure (TriPM) were administered to 609 community dwelling adults. Participants who scored in the upper 10% of the distribution of the PNI total score were assigned to the group of participants at risk for pathological narcissism, whereas participants who scored in the upper 10% of the distribution of the TriPM total score were assigned to the group of participants at risk for psychopathy. The final sample included 126 participants who were administered the Reading the Mind in the Eyes Test (RMET) and emotion-eliciting movie clips. Participants at risk for pathological narcissism scored significantly lower on the RMET total score than participants who were not at risk for pathological narcissism. Participants at risk for psychopathy showed a significant reduction in the subjective experience of disgust, fear, sadness, and tenderness compared to participants who were not at risk for psychopathy.

Value of Progression of Coronary Artery Calcification for Risk Prediction of Coronary and Cardiovascular Events: Result of the HNR Study (Heinz Nixdorf Recall).

PubMed

Lehmann, Nils; Erbel, Raimund; Mahabadi, Amir A; Rauwolf, Michael; Möhlenkamp, Stefan; Moebus, Susanne; Kälsch, Hagen; Budde, Thomas; Schmermund, Axel; Stang, Andreas; Führer-Sakel, Dagmar; Weimar, Christian; Roggenbuck, Ulla; Dragano, Nico; Jöckel, Karl-Heinz

2018-02-13

Computed tomography (CT) allows estimation of coronary artery calcium (CAC) progression. We evaluated several progression algorithms in our unselected, population-based cohort for risk prediction of coronary and cardiovascular events. In 3281 participants (45-74 years of age), free from cardiovascular disease until the second visit, risk factors, and CTs at baseline (b) and after a mean of 5.1 years (5y) were measured. Hard coronary and cardiovascular events, and total cardiovascular events including revascularization, as well, were recorded during a follow-up time of 7.8±2.2 years after the second CT. The added predictive value of 10 CAC progression algorithms on top of risk factors including baseline CAC was evaluated by using survival analysis, C-statistics, net reclassification improvement, and integrated discrimination index. A subgroup analysis of risk in CAC categories was performed. We observed 85 (2.6%) hard coronary, 161 (4.9%) hard cardiovascular, and 241 (7.3%) total cardiovascular events. Absolute CAC progression was higher with versus without subsequent coronary events (median, 115 [Q1-Q3, 23-360] versus 8 [0-83], P <0.0001; similar for hard/total cardiovascular events). Some progression algorithms added to the predictive value of baseline CT and risk assessment in terms of C-statistic or integrated discrimination index, especially for total cardiovascular events. However, CAC progression did not improve models including CAC 5y and 5-year risk factors. An excellent prognosis was found for 921 participants with double-zero CAC b =CAC 5y =0 (10-year coronary and hard/total cardiovascular risk: 1.4%, 2.0%, and 2.8%), which was for participants with incident CAC 1.8%, 3.8%, and 6.6%, respectively. When CAC b progressed from 1 to 399 to CAC 5y ≥400, coronary and total cardiovascular risk were nearly 2-fold in comparison with subjects who remained below CAC 5y =400. Participants with CAC b ≥400 had high rates of hard coronary and hard/total cardiovascular events (10-year risk: 12.0%, 13.5%, and 30.9%, respectively). CAC progression is associated with coronary and cardiovascular event rates, but adds only weakly to risk prediction. What counts is the most recent CAC value and risk factor assessment. Therefore, a repeat scan >5 years after the first scan may be of additional value, except when a double-zero CT scan is present or when the subjects are already at high risk. © 2017 The Authors.

Intensive nursing care by an electronic followup system to promote secondary prevention after percutaneous coronary intervention: a randomized trial.

PubMed

Hu, Xin; Zhu, Xiuqin; Gao, Lei

2014-01-01

To investigate the effectiveness of an intensive nursing care electronic followup system for cardiovascular risk management after percutaneous coronary intervention (PCI). In total, 840 subjects who underwent PCI in a single hospital in Beijing between January 2010 and January 2012 were enrolled. All subjects were randomized into the control and intensive nursing care groups (n = 420 each group). Both groups received standard secondary prevention according to guidelines. The control group received regular followup while the intensive nursing care group was closely monitored and followed by specific nursing staff with the electronic followup system. In total, 807 subjects were followed up for 1 year. Compared with subjects in the control group, those in the intensive group had decreased levels of total cholesterol (3.99 ± 1.08 vs 3.76 ± 0.98; P < .05), systolic blood pressure (142.41 ± 11.53 vs 135.71 ± 14.57 mm Hg; P < .05), low-density lipoprotein cholesterol (LDL-C) (2.72 ± 1.01 vs 2.42 ± 0.81; P < .05), and body mass index (25.13 ± 5.12 vs 24.23 ± 6.22; P < .05); a higher percentage with target LDL-C < 2.6 mmol/L (66.99% vs 47.88%; P < .05); increased use of medication including aspirin (96.51% vs 99.26%; P < .05), clopidogrel (87.53% vs 98.77%; P < .05), statins (52.62% vs 93.10%; P < .05), β-blockers (48.63% vs 61.33%; P < .05), and angiotensin-converting enzyme inhibitors (32.92% vs 61.82%; P < .05); and better dietary control and physical exercise (55.66% vs 26.18%, P < .05; 62.56% vs 38.65%, P < .05). Intensive nursing care by the electronic followup system may lead to an improvement in quality of secondary prevention after PCI, including risk factor control, the use of medication, and self-management abilities.

Associations between Perceptions of Drinking Water Service Delivery and Measured Drinking Water Quality in Rural Alabama

PubMed Central

Wedgworth, Jessica C.; Brown, Joe; Johnson, Pauline; Olson, Julie B.; Elliott, Mark; Forehand, Rick; Stauber, Christine E.

2014-01-01

Although small, rural water supplies may present elevated microbial risks to consumers in some settings, characterizing exposures through representative point-of-consumption sampling is logistically challenging. In order to evaluate the usefulness of consumer self-reported data in predicting measured water quality and risk factors for contamination, we compared matched consumer interview data with point-of-survey, household water quality and pressure data for 910 households served by 14 small water systems in rural Alabama. Participating households completed one survey that included detailed feedback on two key areas of water service conditions: delivery conditions (intermittent service and low water pressure) and general aesthetic characteristics (taste, odor and color), providing five condition values. Microbial water samples were taken at the point-of-use (from kitchen faucets) and as-delivered from the distribution network (from outside flame-sterilized taps, if available), where pressure was also measured. Water samples were analyzed for free and total chlorine, pH, turbidity, and presence of total coliforms and Escherichia coli. Of the 910 households surveyed, 35% of participants reported experiencing low water pressure, 15% reported intermittent service, and almost 20% reported aesthetic problems (taste, odor or color). Consumer-reported low pressure was associated with lower gauge-measured pressure at taps. While total coliforms (TC) were detected in 17% of outside tap samples and 12% of samples from kitchen faucets, no reported water service conditions or aesthetic characteristics were associated with presence of TC. We conclude that consumer-reported data were of limited utility in predicting potential microbial risks associated with small water supplies in this setting, although consumer feedback on low pressure—a risk factor for contamination—may be relatively reliable and therefore useful in future monitoring efforts. PMID:25046635

Associations between perceptions of drinking water service delivery and measured drinking water quality in rural Alabama.

PubMed

Wedgworth, Jessica C; Brown, Joe; Johnson, Pauline; Olson, Julie B; Elliott, Mark; Forehand, Rick; Stauber, Christine E

2014-07-18

Although small, rural water supplies may present elevated microbial risks to consumers in some settings, characterizing exposures through representative point-of-consumption sampling is logistically challenging. In order to evaluate the usefulness of consumer self-reported data in predicting measured water quality and risk factors for contamination, we compared matched consumer interview data with point-of-survey, household water quality and pressure data for 910 households served by 14 small water systems in rural Alabama. Participating households completed one survey that included detailed feedback on two key areas of water service conditions: delivery conditions (intermittent service and low water pressure) and general aesthetic characteristics (taste, odor and color), providing five condition values. Microbial water samples were taken at the point-of-use (from kitchen faucets) and as-delivered from the distribution network (from outside flame-sterilized taps, if available), where pressure was also measured. Water samples were analyzed for free and total chlorine, pH, turbidity, and presence of total coliforms and Escherichia coli. Of the 910 households surveyed, 35% of participants reported experiencing low water pressure, 15% reported intermittent service, and almost 20% reported aesthetic problems (taste, odor or color). Consumer-reported low pressure was associated with lower gauge-measured pressure at taps. While total coliforms (TC) were detected in 17% of outside tap samples and 12% of samples from kitchen faucets, no reported water service conditions or aesthetic characteristics were associated with presence of TC. We conclude that consumer-reported data were of limited utility in predicting potential microbial risks associated with small water supplies in this setting, although consumer feedback on low pressure-a risk factor for contamination-may be relatively reliable and therefore useful in future monitoring efforts.

Nationwide multicenter follow-up cohort study of hip arthroplasties performed for osteonecrosis of the femoral head.

PubMed

Kobayashi, Seneki; Kubo, Toshikazu; Iwamoto, Yukihide; Fukushima, Wakaba; Sugano, Nobuhiko

2018-05-12

To identify modifiable factors related to post-operative dislocation and reoperation in patients with osteonecrosis of the femoral head (ONFH) in a large cohort. We studied 4995 hip arthroplasties: total hip arthroplasty (THA) was performed in 79% of patients; bipolar hemiarthroplasty (BP), 17%; total resurfacing arthroplasty (tRS), 3%; and hemi-resurfacing arthroplasty (hRS), 1%. A new type of BP (accounting for 49% of BPs) comprised a femoral component with a polished or smooth, small-diameter (approximately 10 mm) neck with a round or oval axial cut surface and no sharp corners. The infection rate was relatively low (0.56%) even though 58% of cases of ONFH were associated with systemic steroid use, a known risk factor for infection. Post-operative dislocation occurred in 4.3% of cases, with re-operation needed in 3.9%. The dislocation rate was related to surgery type: 5.2% in THA, 0.9% in BP, and 0% in tRS and hRS. Among total arthroplasties with six month or longer follow-up (3670 THAs and 159 tRSs), the risk factors for post-operative dislocation were younger (≤ 40 years) or older (≥ 62 years) age, higher body weight, posterolateral approach, and smaller prosthetic head diameter. Regarding the need for re-operation, higher body weight and surgery type were identified as risk factors. The relatively high dislocation rate of 5.2% in THA is a cause for concern. The identified risk factors for dislocation should be considered when selecting THA for treatment. Prosthesis survivorship in hRSs was inferior to that in BPs or THAs. Body weight also affected the survivorship of hip arthroplasties.

Asellus aquaticus as a Potential Carrier of Escherichia coli and Other Coliform Bacteria into Drinking Water Distribution Systems

PubMed Central

Christensen, Sarah C. B.; Arvin, Erik; Nissen, Erling; Albrechtsen, Hans-Jørgen

2013-01-01

Individuals of the water louse, Asellus aquaticus, enter drinking water distribution systems in temperate parts of the world, where they establish breeding populations. We analysed populations of surface water A. aquaticus from two ponds for associated faecal indicator bacteria and assessed the risk of A. aquaticus transporting bacteria into distribution systems. Concentrations of up to two E. coli and five total coliforms·mL−1 were measured in the water and 200 E. coli and >240 total coliforms·mL−1 in the sediments of the investigated ponds. Concentrations of A. aquaticus associated bacteria never exceeded three E. coli and six total coliforms·A. aquaticus−1. During exposure to high concentrations of coliforms, concentrations reached 350 coliforms·A. aquaticus−1. A. aquaticus associated E. coli were only detected as long as E. coli were present in the water and sediment. The calculated probability of exceeding drinking water guideline values in non-disinfected systems by intrusion of A. aquaticus was low. Only in scenarios with narrow pipes and low flows, did total coliforms exceed guideline values, implying that the probability of detection by routine monitoring is also low. The study expands the knowledge base for evaluating incidents with presence of coliform indicators in drinking water by showing that intruding A. aquaticus were not important carriers of E. coli or other coliform bacteria even when emerging from faecally contaminated waters. PMID:23455399

Asellus aquaticus as a potential carrier of Escherichia coli and other coliform bacteria into drinking water distribution systems.

PubMed

Christensen, Sarah C B; Arvin, Erik; Nissen, Erling; Albrechtsen, Hans-Jørgen

2013-03-01

Individuals of the water louse, Asellus aquaticus, enter drinking water distribution systems in temperate parts of the world, where they establish breeding populations. We analysed populations of surface water A. aquaticus from two ponds for associated faecal indicator bacteria and assessed the risk of A. aquaticus transporting bacteria into distribution systems. Concentrations of up to two E. coli and five total coliforms·mL-1 were measured in the water and 200 E. coli and >240 total coliforms·mL-1 in the sediments of the investigated ponds. Concentrations of A. aquaticus associated bacteria never exceeded three E. coli and six total coliforms·A. aquaticus-1. During exposure to high concentrations of coliforms, concentrations reached 350 coliforms·A. aquaticus-1. A. aquaticus associated E. coli were only detected as long as E. coli were present in the water and sediment. The calculated probability of exceeding drinking water guideline values in non-disinfected systems by intrusion of A. aquaticus was low. Only in scenarios with narrow pipes and low flows, did total coliforms exceed guideline values, implying that the probability of detection by routine monitoring is also low. The study expands the knowledge base for evaluating incidents with presence of coliform indicators in drinking water by showing that intruding A. aquaticus were not important carriers of E. coli or other coliform bacteria even when emerging from faecally contaminated waters.

Can therapy dogs improve pain and satisfaction after total joint arthroplasty? A randomized controlled trial.

PubMed

Harper, Carl M; Dong, Yan; Thornhill, Thomas S; Wright, John; Ready, John; Brick, Gregory W; Dyer, George

2015-01-01

The use of animals to augment traditional medical therapies was reported as early as the 9th century but to our knowledge has not been studied in an orthopaedic patient population. The purpose of this study was to evaluate the role of animal-assisted therapy using therapy dogs in the postoperative recovery of patients after THA and TKA. We asked: (1) Do therapy dogs have an effect on patients' perception of pain after total joint arthroplasty as measured by the VAS? (3) Do therapy dogs have an effect on patients' satisfaction with their hospital stay after total joint arthroplasty as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)? A randomized controlled trial of 72 patients undergoing primary unilateral THA or TKA was conducted. Patients were randomized to a 15-minute visitation with a therapy dog before physical therapy or standard postoperative physical therapy regimens. Both groups had similar demographic characteristics. Reduction in pain was assessed using the VAS after each physical therapy session, beginning on postoperative Day 1 and continuing for three consecutive sessions. To ascertain patient satisfaction, the proportion of patients selecting top-category ratings in each subsection of the HCAHPS was compared. Patients in the treatment group had lower VAS scores after each physical therapy session with a final VAS score difference of 2.4 units (animal-assisted therapy VAS, 1.7; SD, 0.97 [95% CI, 1.4-2.0] versus control VAS, 4.1; SD, 0.97 [95% CI, 3.8-4.4], p<0.001) after the third physical therapy session. Patients in the treatment group had a higher proportion of top-box HCAHPS scores in the following fields: nursing communication (33 of 36, 92% [95% CI, 78%-98%] versus 69%, 25 of 36 [95% CI, 52%-84%], p=0.035; risk ratio, 1.3 [95% CI of risk ratio, 1.0-1.7]; risk difference, 23% [95% CI of risk difference, 5%-40%]), pain management (34 of 36, 94% [95% CI, 81%-99%], versus 26 of 36, 72% [95% CI, 55%-86%], p=0.024; risk ratio, 1.3 [95% CI of risk ratio, 1.1-1.6]; risk difference, 18% [95% CI of risk difference, 5%-39%]). The overall hospital rating also was greater in the treatment group (0-10 scale) (9.6; SD, 0.7 [95% CI, 9.3-9.8] versus 8.6, SD, 0.9 [95% CI, 8.3-8.9], p<0.001). The use of therapy dogs has a positive effect on patients' pain level and satisfaction with hospital stay after total joint replacement. Surgeons are encouraged to inquire about the status of volunteer-based animal-assisted therapy programs in their hospital as this may provide a means to improve the immediate postoperative recovery for a select group of patients having total joint arthroplasty. Level II, randomized controlled study. See Instructions for Authors for a complete description of levels of evidence.

Outcome and prognostic factors in critically ill patients with systemic lupus erythematosus: a retrospective study.

PubMed

Hsu, Chia-Lin; Chen, Kuan-Yu; Yeh, Pu-Sheng; Hsu, Yeong-Long; Chang, Hou-Tai; Shau, Wen-Yi; Yu, Chia-Li; Yang, Pan-Chyr

2005-06-01

Systemic lupus erythematosus (SLE) is an archetypal autoimmune disease, involving multiple organ systems with varying course and prognosis. However, there is a paucity of clinical data regarding prognostic factors in SLE patients admitted to the intensive care unit (ICU). From January 1992 to December 2000, all patients admitted to the ICU with a diagnosis of SLE were included. Patients were excluded if the diagnosis of SLE was established at or after ICU admission. A multivariate logistic regression model was applied using Acute Physiology and Chronic Health Evaluation II scores and variables that were at least moderately associated (P < 0.2) with survival in the univariate analysis. A total of 51 patients meeting the criteria were included. The mortality rate was 47%. The most common cause of admission was pneumonia with acute respiratory distress syndrome. Multivariate logistic regression analysis showed that intracranial haemorrhage occurring while the patient was in the ICU (relative risk = 18.68), complicating gastrointestinal bleeding (relative risk = 6.97) and concurrent septic shock (relative risk = 77.06) were associated with greater risk of dying, whereas causes of ICU admission and Acute Physiology and Chronic Health Evaluation II score were not significantly associated with death. The mortality rate in critically ill SLE patients was high. Gastrointestinal bleeding, intracranial haemorrhage and septic shock were significant prognostic factors in SLE patients admitted to the ICU.

12 CFR 208.43 - Capital measures and capital category definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... categories of asset quality, management, earnings, liquidity, or sensitivity to market risk. .... For purposes of section 38 and this subpart, the relevant capital measures are: (1) The total risk...” if the bank: (i) Has a total risk-based capital ratio of 10.0 percent or greater; and (ii) Has a Tier...

12 CFR 208.43 - Capital measures and capital category definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... categories of asset quality, management, earnings, liquidity, or sensitivity to market risk. .... For purposes of section 38 and this subpart, the relevant capital measures are: (1) The total risk...” if the bank: (i) Has a total risk-based capital ratio of 10.0 percent or greater; and (ii) Has a Tier...

Dietary fat intake and endometrial cancer risk

PubMed Central

Zhao, Jing; Lyu, Chen; Gao, Jian; Du, Li; Shan, Boer; Zhang, Hong; Wang, Hua-Ying; Gao, Ying

2016-01-01

Abstract Since body fatness is a convincing risk factor for endometrial cancer, dietary fat intake was speculated to be associated with endometrial cancer risk. However, epidemiological studies are inconclusive. We aimed to conduct a meta-analysis to assess the associations between dietary fat intake and endometrial cancer risk. We searched the PubMed, Embase, and Web of science databases updated to September 2015. In total, 7 cohort and 14 case–control studies were included. Pooled analysis of case–control studies suggested that endometrial cancer risk was significantly increased by 5% per 10% kilocalories from total fat intake (P=0.02) and by 17% per 10 g/1000 kcal of saturated fat intake (P < 0.001). Summary of 3 cohort studies showed significant inverse association between monounsaturated fatty acids and endometrial cancer risk (odds ratio = 0.84, 95% confidence interval = 0.73–0.98) with a total of 524583 participants and 3503 incident cases. No significant associations were found for polyunsaturated fatty acids and linoleic acid. In conclusion, positive associations with endometrial cancer risk were observed for total fat and saturated fat intake in the case–control studies. Results from the cohort studies suggested higher monounsaturated fatty acids intake was significantly associated with lower endometrial cancer risk. PMID:27399120

Haloacetic acids in drinking water and risk for stillbirth.

PubMed

King, W D; Dodds, L; Allen, A C; Armson, B A; Fell, D; Nimrod, C

2005-02-01

Trihalomethanes (THMs) occurring in public drinking water sources have been investigated in several epidemiological studies of fetal death and results support a modest association. Other classes of disinfection by-products found in drinking water have not been investigated. To investigate the effects of haloacetic acid (HAA) compounds in drinking water on stillbirth risk. A population based case-control study was conducted in Nova Scotia and Eastern Ontario, Canada. Estimates of daily exposure to total and specific HAAs were based on household water samples and questionnaire information on water consumption at home and work. The analysis included 112 stillbirth cases and 398 live birth controls. In analysis without adjustment for total THM exposure, a relative risk greater than 2 was observed for an intermediate exposure category for total HAA and dichloroacetic acid measures. After adjustment for total THM exposure, the risk estimates for intermediate exposure categories were diminished, the relative risk associated with the highest category was in the direction of a protective effect, and all confidence intervals included the null value. No association was observed between HAA exposures and stillbirth risk after controlling for THM exposures.

How much energy is locked in the USA? Alternative metrics for characterising the magnitude of overweight and obesity derived from BRFSS 2010 data.

PubMed

Reidpath, Daniel D; Masood, Mohd; Allotey, Pascale

2014-06-01

Four metrics to characterise population overweight are described. Behavioural Risk Factors Surveillance System data were used to estimate the weight the US population needed to lose to achieve a BMI < 25. The metrics for population level overweight were total weight, total volume, total energy, and energy value. About 144 million people in the US need to lose 2.4 million metric tonnes. The volume of fat is 2.6 billion litres-1,038 Olympic size swimming pools. The energy in the fat would power 90,000 households for a year and is worth around 162 million dollars. Four confronting ways of talking about a national overweight and obesity are described. The value of the metrics remains to be tested.

[Effect of Earth magnetic field on circadian rhythm of total antioxidant capacity of human saliva in the North].

PubMed

Borisenkov, M F

2007-01-01

In the inhabitants of the North during increase of geomagnetic activity and during magnetic calm the decrease of amplitude of circadian rhythm of total antioxidant capacity of saliva is observed. The most favorable conditions to display the circadian rhythm are observed at Kp from 0,5 up to 2. The long residing in the North is connected to influence of irregularly varying geomagnetic activity causing disturbance of function of circadian and antioxidant systems that, probably, is one of the reasons of acceleration of process of aging at northerner and of higher risk of occurrence in them the age associated diseases.

Systemic connective tissue features in women with fibromuscular dysplasia.

PubMed

O'Connor, Sarah; Kim, Esther Sh; Brinza, Ellen; Moran, Rocio; Fendrikova-Mahlay, Natalia; Wolski, Kathy; Gornik, Heather L

2015-10-01

Fibromuscular dysplasia (FMD) is a non-atherosclerotic disease associated with hypertension, headache, dissection, stroke, and aneurysm. The etiology is unknown but hypothesized to involve genetic and environmental components. Previous studies suggest a possible overlap of FMD with other connective tissue diseases that present with dissections and aneurysms. The aim of this study was to investigate the prevalence of connective tissue physical features in FMD. A total of 142 FMD patients were consecutively enrolled at a single referral center (97.9% female, 92.1% of whom had multifocal FMD). Data are reported for 139 female patients. Moderately severe myopia (29.1%), high palate (33.1%), dental crowding (29.7%), and early-onset arthritis (15.6%) were prevalent features. Classic connective features such as hypertelorism, cleft palate, and hypermobility were uncommon. The frequency of systemic connective tissue features was compared between FMD patients with a high vascular risk profile (having had ⩾1 dissection and/or ⩾2 aneurysms) and those with a standard vascular risk profile. A history of spontaneous pneumothorax (5.9% high risk vs 0% standard risk) and atrophic scarring (17.6% high risk vs 6.8% standard risk) were significantly more prevalent in the high risk group, p<0.05. High palate was observed in 43.1% of the high risk group versus 27.3% in the standard risk group, p=0.055. In conclusion, in a cohort of women with FMD, there was a prevalence of moderately severe myopia, high palate, dental crowding, and early-onset osteoarthritis. However, a characteristic phenotype was not discovered. Several connective tissue features such as high palate and pneumothorax were more prominent among FMD patients with a high vascular risk profile. © The Author(s) 2015.

New scoring system for intra-abdominal injury diagnosis after blunt trauma.

PubMed

Shojaee, Majid; Faridaalaee, Gholamreza; Yousefifard, Mahmoud; Yaseri, Mehdi; Arhami Dolatabadi, Ali; Sabzghabaei, Anita; Malekirastekenari, Ali

2014-01-01

An accurate scoring system for intra-abdominal injury (IAI) based on clinical manifestation and examination may decrease unnecessary CT scans, save time, and reduce healthcare cost. This study is designed to provide a new scoring system for a better diagnosis of IAI after blunt trauma. This prospective observational study was performed from April 2011 to October 2012 on patients aged above 18 years and suspected with blunt abdominal trauma (BAT) admitted to the emergency department (ED) of Imam Hussein Hospital and Shohadaye Hafte Tir Hospital. All patients were assessed and treated based on Advanced Trauma Life Support and ED protocol. Diagnosis was done according to CT scan findings, which was considered as the gold standard. Data were gathered based on patient's history, physical exam, ultrasound and CT scan findings by a general practitioner who was not blind to this study. Chi-square test and logistic regression were done. Factors with significant relationship with CT scan were imported in multivariate regression models, where a coefficient (β) was given based on the contribution of each of them. Scoring system was developed based on the obtained total β of each factor. Altogether 261 patients (80.1% male) were enrolled (48 cases of IAI). A 24-point blunt abdominal trauma scoring system (BATSS) was developed. Patients were divided into three groups including low (score<8), moderate (8≤score<12) and high risk (score≥12). In high risk group immediate laparotomy should be done, moderate group needs further assessments, and low risk group should be kept under observation. Low risk patients did not show positive CT-scans (specificity 100%). Conversely, all high risk patients had positive CT-scan findings (sensitivity 100%). The receiver operating characteristic curve indicated a close relationship between the results of CT scan and BATSS (sensitivity=99.3%). The present scoring system furnishes a high precision and reproducible diagnostic tool for BAT detection and has the potential to reduce unnecessary CT scan and cut unnecessary costs.

Predictive value of different prostate-specific antigen-based markers in men with baseline total prostate-specific antigen <2.0 ng/mL.

PubMed

Fujizuka, Yuji; Ito, Kazuto; Oki, Ryo; Suzuki, Rie; Sekine, Yoshitaka; Koike, Hidekazu; Matsui, Hiroshi; Shibata, Yasuhiro; Suzuki, Kazuhiro

2017-08-01

To investigate the predictive value of various molecular forms of prostate-specific antigen in men with baseline prostate-specific antigen <2.0 ng/mL. The case cohort comprised 150 men with a baseline prostate-specific antigen level <2.0 ng/mL, and who developed prostate cancer within 10 years. The control cohort was 300 baseline prostate-specific antigen- and age-adjusted men who did not develop prostate cancer. Serum prostate-specific antigen, free prostate-specific antigen, and [-2] proenzyme prostate-specific antigen were measured at baseline and last screening visit. The predictive impact of baseline prostate-specific antigen- and [-2] proenzyme prostate-specific antigen-related indices on developing prostate cancer was investigated. The predictive impact of those indices at last screening visit and velocities from baseline to final screening on tumor aggressiveness were also investigated. The baseline free to total prostate-specific antigen ratio was a significant predictor of prostate cancer development. The odds ratio was 6.08 in the lowest quintile baseline free to total prostate-specific antigen ratio subgroup. No serum indices at diagnosis were associated with tumor aggressiveness. The Prostate Health Index velocity and [-2] proenzyme prostate-specific antigen/free prostate-specific antigen velocity significantly increased in patients with higher risk D'Amico risk groups and higher Gleason scores. Free to total prostate-specific antigen ratio in men with low baseline prostate-specific antigen levels seems to predict the risk of developing prostate cancer, and it could be useful for a more effective individualized screening system. Longitudinal changes in [-2] proenzyme prostate-specific antigen-related indices seem to correlate with tumor aggressiveness, and they could be used as prognostic tool before treatment and during active surveillance. © 2017 The Japanese Urological Association.

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

PubMed

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

2017-06-29

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

[Pregnancy and congenital heart disease].

PubMed

Manso, Begoña; Gran, Ferrán; Pijuán, Antonia; Giralt, Gemma; Ferrer, Queralt; Betrián, Pedro; Albert, Dimpna; Rosés, Ferrán; Rivas, Nuria; Parra, Montserrat; Girona, Josep; Farrán, Inmaculada; Casaldáliga, Jaume

2008-03-01

Since the creation of the Adult Congenital Heart Disease Units and of the High Obstetric Risk Units, there has been increasing interest in hemodynamic and obstetric outcomes in pregnant woman with congenital heart disease. Retrospective descriptive study of 56 women with congenital heart disease aged (mean [range]) 25 (18-40) years, who experienced a total of 84 pregnancies between January 1992 and August 2006. The women were divided into three pregnancy risk groups: A, low-risk; B, moderate-risk, and C, high-risk. The incidence of complications during pregnancy was 1.6%, 15%, and 20% in groups A, B, and C, respectively; the incidence during the puerperium was 2%, 23%, and 50%, respectively; and maternal mortality was 0%, 7.6%, and 25%, respectively. Overall, 69 children were born, and the prematurity rates in the three groups were 11%, 15%, and 100%, respectively. The following risk factors were studied: pulmonary hypertension, cyanosis, arrhythmia, left ventricular outflow tract obstruction, right ventricular dilatation, systemic right ventricle, and anticoagulation therapy. The risk factor most significantly associated with maternal or fetal morbidity or mortality was found to be pulmonary hypertension. Risk stratification in pregnant women with congenital heart disease provides prognostic information that can help multidisciplinary teams to target care to achieve the best results.

Risk stratification in patients with advanced heart failure requiring biventricular assist device support as a bridge to cardiac transplantation.

PubMed

Cheng, Richard K; Deng, Mario C; Tseng, Chi-hong; Shemin, Richard J; Kubak, Bernard M; MacLellan, W Robb

2012-08-01

Prior studies have identified risk factors for survival in patients with end-stage heart failure (HF) requiring left ventricular assist device (LVAD) support. However, patients with biventricular HF may represent a unique cohort. We retrospectively evaluated a consecutive cohort of 113 adult, end-stage HF patients at University of California Los Angeles Medical Center who required BIVAD support between 2000 and 2009. Survival to transplant was 66.4%, with 1-year actuarial survival of 62.8%. All patients were Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Level 1 or 2 and received Thoratec (Pleasanton, CA) paracorporeal BIVAD as a bridge to transplant. Univariate analyses showed dialysis use, ventilator use, extracorporal membrane oxygenation use, low cardiac output, preserved LV ejection fraction (restrictive physiology), normal-to-high sodium, low platelet count, low total cholesterol, low high-density and high-density lipoprotein, low albumin, and elevated aspartate aminotransferase were associated with increased risk of death. We generated a scoring system for survival to transplant. Our final model, with age, sex, dialysis, cholesterol, ventilator, and albumin, gave a C-statistic of 0.870. A simplified system preserved a C-statistic of 0.844. Patients were divided into high-risk or highest-risk groups (median respective survival, 367 and 17 days), with strong discrimination between groups for death. We have generated a scoring system that offers high prognostic ability for patients requiring BIVAD support and hope that it may assist in clinical decision making. Further studies are needed to prospectively validate our scoring system. Copyright © 2012 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

A genetic variant in MiR-146a modifies digestive system cancer risk: a meta-analysis.

PubMed

Li, Ying-Jun; Zhang, Zhen-Yu; Mao, Ying-Ying; Jin, Ming-Juan; Jing, Fang-Yuan; Ye, Zhen-Hua; Chen, Kun

2014-01-01

MicroRNAs (miRNAs) negatively regulate gene expression and act as tumor suppressors or oncogenes in oncogenesis. The association between a single nucleotide polymorphism (SNP) in miR-146a rs2910164 and susceptibility to digestive system cancers was inconsistent in previous studies. In this study, we conducted a literature search of PubMed to identify all relevant studies published before August 31, 2013. A total of 21 independent case-control studies were included in this updated meta-analysis with 9,558 cases and 10,614 controls. We found that the miR-146a rs2910164 polymorphism was significantly associated with decreased risk of digestive system cancers in an allele model (OR=0.90, 95%CI 0.87-0.94), homozygote model (OR=0.84, 95%CI 0.77-0.91), dominant model (OR=0.90, 95%CI 0.84-0.96), and recessive model (OR=0.85, 95%CI 0.79-0.91), while in a heterozygous model (OR = 0.99, 95% CI 0.89-1.11) the association showed marginal significance. Subgroup analysis by cancer site revealed decreased risk in colorectal cancer above allele model (OR=0.90, 95%CI 0.83- 0.97) and homozygote model (OR=0.85, 95%CI 0.72-1.00). Similarly, decreased cancer risk was observed when compared with allele model (OR=0.87, 95%CI 0.81-0.93) and recessive model (OR=0.81, 95%CI 0.72-0.90) in gastric cancer. When stratified by ethnicity, genotyping methods and quality score, decreased cancer risks were also observed. This current meta-analysis indicated that miR-146a rs2910164 polymorphism may decrease the susceptibility to digestive system cancers, especially in Asian populations.

Impact of the revised International Prognostic Scoring System, cytogenetics and monosomal karyotype on outcome after allogeneic stem cell transplantation for myelodysplastic syndromes and secondary acute myeloid leukemia evolving from myelodysplastic syndromes: a retrospective multicenter study of the European Society of Blood and Marrow Transplantation

PubMed Central

Koenecke, Christian; Göhring, Gudrun; de Wreede, Liesbeth C.; van Biezen, Anja; Scheid, Christof; Volin, Liisa; Maertens, Johan; Finke, Jürgen; Schaap, Nicolaas; Robin, Marie; Passweg, Jakob; Cornelissen, Jan; Beelen, Dietrich; Heuser, Michael; de Witte, Theo; Kröger, Nicolaus

2015-01-01

The aim of this study was to determine the impact of the revised 5-group International Prognostic Scoring System cytogenetic classification on outcome after allogeneic stem cell transplantation in patients with myelodysplastic syndromes or secondary acute myeloid leukemia who were reported to the European Society for Blood and Marrow Transplantation database. A total of 903 patients had sufficient cytogenetic information available at stem cell transplantation to be classified according to the 5-group classification. Poor and very poor risk according to this classification was an independent predictor of shorter relapse-free survival (hazard ratio 1.40 and 2.14), overall survival (hazard ratio 1.38 and 2.14), and significantly higher cumulative incidence of relapse (hazard ratio 1.64 and 2.76), compared to patients with very good, good or intermediate risk. When comparing the predictive performance of a series of Cox models both for relapse-free survival and for overall survival, a model with simplified 5-group cytogenetics (merging very good, good and intermediate cytogenetics) performed best. Furthermore, monosomal karyotype is an additional negative predictor for outcome within patients of the poor, but not the very poor risk group of the 5-group classification. The revised International Prognostic Scoring System cytogenetic classification allows patients with myelodysplastic syndromes to be separated into three groups with clearly different outcomes after stem cell transplantation. Poor and very poor risk cytogenetics were strong predictors of poor patient outcome. The new cytogenetic classification added value to prediction of patient outcome compared to prediction models using only traditional risk factors or the 3-group International Prognostic Scoring System cytogenetic classification. PMID:25552702

Analysis of space systems for the space disposal of nuclear waste follow-on study. Volume 2: Technical report

NASA Technical Reports Server (NTRS)

1982-01-01

The space option for disposal of certain high-level nuclear wastes in space as a complement to mined geological repositories is studied. A brief overview of the study background, scope, objective, guidelines and assumptions, and contents is presented. The determination of the effects of variations in the waste mix on the space systems concept to allow determination of the space systems effect on total system risk benefits when used as a complement to the DOE reference mined geological repository is studied. The waste payload system, launch site, launch system, and orbit transfer system are all addressed. Rescue mission requirements are studied. The characteristics of waste forms suitable for space disposal are identified. Trajectories and performance requirements are discussed.

Epidemiologic and economic evaluation of risk-based meat inspection for bovine cysticercosis in Danish cattle.

PubMed

Calvo-Artavia, F F; Nielsen, L R; Alban, L

2013-03-01

Under the current EU meat inspection regulation, every single carcase from all bovines above 6 weeks of age has to be examined for bovine cysticercosis (BC). This is time-consuming, costly, and is of limited value in countries with low prevalence. The aim of this study was to develop a stochastic simulation model for analysis of tentative risk-based meat inspection systems for BC in Danish cattle with regard to system sensitivity (SSSe), specificity and potential monetary benefits compared to the current system, which has an estimated SSSe of 15%. The relevant risk factors used to construct three alternative scenario trees were identified from previous Danish risk factor studies (1) gender, (2) grazing and (3) access to risky water sources. Thus, females, animals that had been grazing or animals with access to risky water sources were considered high-risk and would be subjected to invasive inspection at meat inspection. All animals in the low-risk groups (i.e. males, non-grazing or no access to risky water sources, respectively) would be subjected to visual inspection only. It was assumed that half of the cattle were slaughtered in abattoirs that would be able to reorganise the work at the slaughterline, allowing them to do with one meat inspector less. All abattoirs would gain on the price of sold uncut beef from the masseter muscles from visually inspected cattle. Under these assumptions, using gender and grazing were preferable due to them having SSSe only slightly lower than the current system, and highest effectiveness ratios, but they had a lower net economic effect (NEE) than the scenario using risky water sources. Using gender to differentiate high and low-risk groups was judged preferable over grazing due to feasibility, because the information is readily available at the slaughter line. The exact total NEE for the cattle sector depends on how many and which of the abattoirs that would be able to reorganise the work at the slaughter line to save money on inspection of the head of carcases. Overall, the SSSe was low in all scenarios leading to undetected BC-positive cattle both in the current meat inspection and under the investigated risk-based meat inspection systems. Therefore, improving the sensitivity of the methods used for inspection of high-risk cattle would be beneficial. Copyright © 2012 Elsevier B.V. All rights reserved.

Drinking carrot juice increases total antioxidant status and decreases lipid peroxidation in adults.

PubMed

Potter, Andrew S; Foroudi, Shahrzad; Stamatikos, Alexis; Patil, Bhimanagouda S; Deyhim, Farzad

2011-09-24

High prevalence of obesity and cardiovascular disease is attributable to sedentary lifestyle and eating diets high in fat and refined carbohydrate while eating diets low in fruit and vegetables. Epidemiological studies have confirmed a strong association between eating diets rich in fruits and vegetables and cardiovascular health. The aim of this pilot study was to determine whether drinking fresh carrot juice influences antioxidant status and cardiovascular risk markers in subjects not modifying their eating habits. An experiment was conducted to evaluate the effects of consuming 16 fl oz of daily freshly squeezed carrot juice for three months on cardiovascular risk markers, C-reactive protein, insulin, leptin, interleukin-1α, body fat percentage, body mass index (BMI), blood pressure, antioxidant status, and malondialdehyde production. Fasting blood samples were collected pre-test and 90 days afterward to conclude the study. Drinking carrot juice did not affect (P > 0.1) the plasma cholesterol, triglycerides, Apo A, Apo B, LDL, HDL, body fat percentage, insulin, leptin, interleukin-1α, or C-reactive protein. Drinking carrot juice decreased (P = 0.06) systolic pressure, but did not influence diastolic pressure. Drinking carrot juice significantly (P < 0.05) increased the plasma total antioxidant capacity and decreased (P < 0.05) the plasma malondialdehyde production. Drinking carrot juice may protect the cardiovascular system by increasing total antioxidant status and by decreasing lipid peroxidation independent of any of the cardiovascular risk markers measured in the study.

A stochastic conflict resolution model for trading pollutant discharge permits in river systems.

PubMed

Niksokhan, Mohammad Hossein; Kerachian, Reza; Amin, Pedram

2009-07-01

This paper presents an efficient methodology for developing pollutant discharge permit trading in river systems considering the conflict of interests of involving decision-makers and the stakeholders. In this methodology, a trade-off curve between objectives is developed using a powerful and recently developed multi-objective genetic algorithm technique known as the Nondominated Sorting Genetic Algorithm-II (NSGA-II). The best non-dominated solution on the trade-off curve is defined using the Young conflict resolution theory, which considers the utility functions of decision makers and stakeholders of the system. These utility functions are related to the total treatment cost and a fuzzy risk of violating the water quality standards. The fuzzy risk is evaluated using the Monte Carlo analysis. Finally, an optimization model provides the trading discharge permit policies. The practical utility of the proposed methodology in decision-making is illustrated through a realistic example of the Zarjub River in the northern part of Iran.

Cancer incidence among union carpenters in New Jersey.

PubMed

Dement, John; Pompeii, Lisa; Lipkus, Isaac M; Samsa, Gregory P

2003-10-01

A cohort of 13,354 male union carpenters in New Jersey was linked to cancer registry data to investigate cancer incidence during 1979 through 2000. Surveillance, Epidemiology and End Results data were used to calculate standardized incidence ratios (SIRs). A total of 592 incident cancers were observed among this cohort (SIR=1.07), which was not statistically in excess. However, significant excesses were observed for cancers of the digestive system and peritoneum (SIR=1.24) and the respiratory system (SIR=1.52). Workers in the union more than 30 years were at significant risk for cancers of the digestive organs and peritoneum (SIR=3.98), rectum (SIR=4.85), trachea, bronchus, and lung (SIR=4.56), and other parts of the respiratory system (SIR=11.00). Testicular cancer was significantly in excess (SIR=2.48) in analyses that lagged results 15 years from initial union membership. Additional etiologic research is needed to evaluate possible occupational and nonoccupational risk factors for testicular cancer.

Quality Management Framework for Total Diet Study centres in Europe.

PubMed

Pité, Marina; Pinchen, Hannah; Castanheira, Isabel; Oliveira, Luisa; Roe, Mark; Ruprich, Jiri; Rehurkova, Irena; Sirot, Veronique; Papadopoulos, Alexandra; Gunnlaugsdóttir, Helga; Reykdal, Ólafur; Lindtner, Oliver; Ritvanen, Tiina; Finglas, Paul

2018-02-01

A Quality Management Framework to improve quality and harmonization of Total Diet Study practices in Europe was developed within the TDS-Exposure Project. Seventeen processes were identified and hazards, Critical Control Points and associated preventive and corrective measures described. The Total Diet Study process was summarized in a flowchart divided into planning and practical (sample collection, preparation and analysis; risk assessment analysis and publication) phases. Standard Operating Procedures were developed and implemented in pilot studies in five organizations. The flowchart was used to develop a quality framework for Total Diet Studies that could be included in formal quality management systems. Pilot studies operated by four project partners were visited by project assessors who reviewed implementation of the proposed framework and identified areas that could be improved. The quality framework developed can be the starting point for any Total Diet Study centre and can be used within existing formal quality management approaches. Copyright © 2017 Elsevier Ltd. All rights reserved.

Application of receptor-specific risk distribution in the arsenic contaminated land management.

PubMed

Chen, I-chun; Ng, Shane; Wang, Gen-shuh; Ma, Hwong-wen

2013-11-15

Concerns over health risks and financial costs have caused difficulties in the management of arsenic contaminated land in Taiwan. Inflexible risk criteria and lack of economic support often result in failure of a brownfields regeneration project. To address the issue of flexible risk criteria, this study is aimed to develop maps with receptor-specific risk distribution to facilitate scenario analysis of contaminated land management. A contaminated site risk map model (ArcGIS for risk assessment and management, abbreviated as Arc-RAM) was constructed by combining the four major steps of risk assessment with Geographic Information Systems. Sampling of contaminated media, survey of exposure attributes, and modeling of multimedia transport were integrated to produce receptor group-specific maps that depicted the probabilistic spatial distribution of risks of various receptor groups. Flexible risk management schemes can then be developed and assessed. In this study, a risk management program that took into account the ratios of various land use types at specified risk levels was explored. A case study of arsenic contaminated land of 6.387 km(2) has found that for a risk value between 1.00E-05 and 1.00E-06, the proposed flexible risk management of agricultural land achieves improved utilization of land. Using this method, the investigated case can reduce costs related to compensation for farmland totaling approximately NTD 5.94 million annually. Copyright © 2012 Elsevier B.V. All rights reserved.

Association of Physical Activity by Type and Intensity With Digestive System Cancer Risk.

PubMed

Keum, NaNa; Bao, Ying; Smith-Warner, Stephanie A; Orav, John; Wu, Kana; Fuchs, Charles S; Giovannucci, Edward L

2016-09-01

Accumulating evidence indicates that common carcinogenic pathways may underlie digestive system cancers. Physical activity may influence these pathways. Yet, to our knowledge, no previous study has evaluated the role of physical activity in overall digestive system cancer risk. To examine the association between physical activity and digestive system cancer risk, accounting for amount, type (aerobic vs resistance), and intensity of physical activity. A prospective cohort study followed 43 479 men from the Health Professionals Follow-up Study from 1986 to 2012. At enrollment, the eligible participants were 40 years or older, were free of cancer, and reported physical activity. Follow-up rates exceeded 90% in each 2-year cycle. The amount of total physical activity expressed in metabolic equivalent of task (MET)-hours/week. Incident cancer of the digestive system encompassing the digestive tract (mouth, throat, esophagus, stomach, small intestine, and colorectum) and digestive accessory organs (pancreas, gallbladder, and liver). Over 686 924 person-years, we documented 1370 incident digestive system cancers. Higher levels of physical activity were associated with lower digestive system cancer risk (hazard ratio [HR], 0.74 for ≥63.0 vs ≤8.9 MET-hours/week; 95% CI, 0.59-0.93; P value for trend = .003). The inverse association was more evident with digestive tract cancers (HR, 0.66 for ≥63.0 vs ≤8.9 MET-hours/week; 95% CI, 0.51-0.87) than with digestive accessary organ cancers. Aerobic exercise was particularly beneficial against digestive system cancers, with the optimal benefit observed at approximately 30 MET-hours/week (HR, 0.68; 95% CI, 0.56-0.83; P value for nonlinearity = .02). Moreover, as long as the same level of MET-hour score was achieved from aerobic exercise, the magnitude of risk reduction was similar regardless of intensity of aerobic exercise. Physical activity, as indicated by MET-hours/week, was inversely associated with the risk of digestive system cancers, particularly digestive tract cancers, in men. The optimal benefit was observed through aerobic exercise of any intensity at the equivalent of energy expenditure of approximately 10 hours/week of walking at average pace. Future studies are warranted to confirm our findings and to translate them into clinical and public health recommendation.

Association of physical activity by type and intensity with digestive system cancer risk

PubMed Central

Keum, NaNa; Bao, Ying; Smith-Warner, Stephanie A.; Orav, John; Wu, Kana; Fuchs, Charles S.; Giovannucci, Edward L.

2018-01-01

Importance Accumulating evidence indicates that common carcinogenic pathways may underlie digestive system cancers. Physical activity may influence these pathways, yet no previous study has evaluated the role of physical activity in overall digestive system cancer risk. Objective To examine the association between physical activity and digestive system cancer risk, accounting for amount, type (aerobic versus resistance), and intensity of physical activity. Design A prospective cohort study followed from 1986 to 2012. Setting Male health professionals living in the general community in the US Participants Eligible participants were 40 years or older, were free of cancer, and reported physical activity. Out of 51,529 individuals, 43,479 were followed-up, with follow-up rates exceeding 90% in each 2-year cycle. Exposures The amount of total physical activity expressed in metabolic equivalent of task [MET]-hours/week Main Outcomes and Measures Incident cancer of the digestive system encompassing the digestive tract (mouth, throat, esophagus, stomach, small intestine, and colorectum) and digestive accessory organs (pancreas, gallbladder, and liver). Results Over 686,924 person-years, we documented 1,370 incident digestive system cancers. Higher levels of physical activity were associated with lower digestive system cancer risk (hazard ratio [HR], 0.74 for 63+ versus ≤8.9 MET-hours/week; 95% confidence interval [CI], 0.59-0.93; P for trend, .003). The inverse association was more evident with digestive tract cancers (HR, 0.66 for 63+ versus ≤8.9 MET-hours/week; 95% CI, 0.51-0.87) than with digestive accessary organ cancers. Aerobic exercise was particularly beneficial against digestive system cancers, with the optimal benefit observed at approximately 30 MET-hours/week (HR, 0.68; 95% CI, 0.56-0.83; Pnon-linearity, 0.02). Moreover, as long as the same level of MET-hour score was achieved from aerobic exercise, the magnitude of risk reduction was similar regardless of intensity of aerobic exercise. Conclusion and Relevance Physical activity, as indicated by MET-hours/week, was inversely associated with the risk of digestive system cancers, particularly digestive tract cancers, in men. The optimal benefit was observed through aerobic exercise of any intensity at the equivalent of energy expenditure of approximately 10 hours/week of walking at average pace. Future studies are warranted to confirm our findings and to translate them into clinical and public health recommendation. PMID:27196375

Proposal for a sub-classification of hepato-biliary-pancreatic operations for surgical site infection surveillance following assessment of results of prospective multicenter data.

PubMed

Nakahira, Shin; Shimizu, Junzo; Miyamoto, Atsushi; Kobayashi, Shogo; Umeshita, Koji; Ito, Toshinori; Monden, Morito; Doki, Yuichiro; Mori, Masaki

2013-06-01

Surgical site infection (SSI) surveillance in Japan is based on the National Nosocomial Infection Surveillance system, which categorizes all hepato-biliary-pancreatic surgeries, except for cholecystectomy, into "BILI." We evaluated differences among BILI procedures to determine the optimal subdivision for SSI surveillance. We conducted multicenter SSI surveillance at 20 hospitals. BILI was subdivided into choledochectomy, pancreatoduodenectomy, hepatectomy, hepatectomy with biliary reconstruction, pancreatoduodenectomy with hepatectomy, distal pancreatectomy and total pancreatectomy to determine the optimal subdivision. The outcome of interest was SSI. Univariate and multivariate analyses were performed to determine the predictive significance of variables in each type of surgery. 1,926 BILI cases were included in this study. SSI rates were 23.2 % for all BILI; for choledochectomy 23.6 %, pancreatoduodenectomy 39.3 %, hepatectomy 12.8 %, hepatectomy with biliary reconstruction 41.9 %, pancreatoduodenectomy with hepatectomy 27.3 %, distal pancreatectomy 31.8 %, and total pancreatectomy 20.0 %. SSI rates for hepatectomy were significantly lower than those for non-hepatectomy BILI. Risk factors for developing SSI with hepatectomy were drain placement and long operative duration, while for non-hepatectomy BILI, risk factors were use of intra-abdominal silk sutures, SSI risk index and long operative duration. Hepatectomy and non-hepatectomy BILI differ with regard to the incidence of and risk factors for developing SSI. These surgeries should be assessed separately when conducting SSI surveillance.

Management of cardiovascular risk in systemic lupus erythematosus: a systematic review.

PubMed

Andrades, C; Fuego, C; Manrique-Arija, S; Fernández-Nebro, A

2017-11-01

Systemic lupus erythematosus is associated with accelerated atherosclerosis and increased risk of cardiovascular complications. The aim of this study was to review the effectiveness of interventions for primary and secondary prevention of cardiovascular events and mortality and to review the effectiveness of interventions for cardiovascular risk factor reduction in systemic lupus erythematosus patients. A systematic review was conducted. Electronic databases Medline and Embase (1961-2015) were searched. Nineteen articles met the inclusion criteria and were selected. Low-calorie and/or low glycaemic index calories may be a useful option for secondary prevention in obese patients with systemic lupus erythematosus, and exercise would be useful in improving the endothelial function measured by flow-mediated dilation in this group of patients. The use of lipid-lowering drugs may improve the lipid profile in patients with systemic lupus erythematosus and hyperlipidaemia, but the effect of this treatment on overall cardiovascular mortality remains unknown. Antiplatelets, anticoagulants, antimalarials and lipid-lowering drugs may be effective in the primary and secondary prevention of major cardiovascular events, such as acute myocardial infarction or stroke. Similarly, lipid-lowering drugs and antimalarial drugs appear to reduce the serum levels of total cholesterol, low-density lipoprotein, glucose, diastolic blood pressure and calcium deposition at the coronary arteries. They may also improve insulin resistance and the level of high-density lipoproteins. It appears that treatment with antihypertensive drugs reduces blood pressure in patients with systemic lupus erythematosus, but the available studies are of low quality.

Risk of cancer after primary total hip replacement: The influence of bearings, cementation and the material of the stem

PubMed Central

Levašič, Vesna; Milošev, Ingrid; Zadnik, Vesna

2018-01-01

Background and purpose Despite the increasing number of total hip replacements (THRs), their systemic influence is still not known. We have studied the influence of specific features of THRs—the bearing surface, the use of bone cement and the material of the stem—on the cancer incidence. Patients and methods In a retrospective cohort study we identified 8,343 patients with THRs performed at Valdoltra Hospital from September 1, 1997 to December 31, 2009. Patient data were linked to national cancer and population registries. The standardized incidence ratios (SIR) and Poisson regression relative risks (RR) were calculated for all and specific cancers. Results General cancer risk in our cohort was comparable to the population risk. Comparing with population, the risk of prostate cancer was statistically significantly higher in patients with metal-on-metal bearings (SIR =1.35); with metal-on-polyethylene bearings (SIR =1.30), with non-cemented THRs (SIR =1.40), and with titanium alloy THRs (SIR =1.41). In these last 3 groups there was a lower risk of hematopoietic tumors (SIR =0.69; 0.66 and 0.66 respectively). Risk of kidney cancer was significantly higher in the non-metal-on-metal, non-cemented, and titanium alloy groups (SIR =1.30; 1.46 and 1.41 respectively). Risk of colorectal and lung cancer was significantly lower in the investigated cohort (SIR =0.82 and 0.83, respectively). Risk for all cancers combined as well as for prostate and skin cancer, shown by Poisson analysis, was higher in the metal-on-metal group compared with non-metal-on-metal group (RR =1.56; 2.02 and 1.92, respectively). Interpretation Some associations were found between the THRs’ features, especially a positive association between metal-on-metal bearings, and specific cancers. PMID:29388497

[Hospital risk management from the viewpoint of insurers].

PubMed

Gausmann, Peter; Petry, Franz Michael

2004-10-01

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

Families at financial risk due to high ratio of out-of-pocket health care expenditures to total income.

PubMed

Bennett, Kevin J; Dismuke, Clara E

2010-05-01

High out-of-pocket expenditures for health care can put individuals and families at financial risk. Several groups, including racial/ethnic minority groups, the uninsured, rural residents, and those in poorer health are at risk for this increased burden. The analysis utilized 2004-2005 MEPS data. The dependent variables were the out-of-pocket health care spending to total income ratios for total spending, office-based visits, and prescription drugs. Multivariate analyses with instrumental variables controlled for respondent characteristics. Gender, age, rurality, insurance coverage, health status, and health care utilization were all associated with higher out-of-pocket to income ratios. Certain groups, such as women, the elderly, those in poor health, and rural residents, are at a greater financial risk due to their higher out-of-pocket to total income spending ratios. Policymakers must be aware of these increased risks in order to provide adequate resources and targeted interventions to alleviate some of this burden.

Evaluation of energy in heated water vapor for the application of lung volume reduction in patients with severe emphysema.

PubMed

Henne, Erik; Kesten, Steven; Herth, Felix J F

2013-01-01

A method of achieving endoscopic lung volume reduction for emphysema has been developed that utilizes precise amounts of thermal energy in the form of water vapor to ablate lung tissue. This study evaluates the energy output and implications of the commercial InterVapor system and compares it to the clinical trial system. Two methods of evaluating the energy output of the vapor systems were used, a direct energy measurement and a quantification of resultant thermal profile in a lung model. Direct measurement of total energy and the component attributable to gas (vapor energy) was performed by condensing vapor in a water bath and measuring the temperature and mass changes. Infrared images of a lung model were taken after vapor delivery. The images were quantified to characterize the thermal profile. The total energy and vapor energy of the InterVapor system was measured at various dose levels and compared to the clinical trial system at a dose of 10.0 cal/g. An InterVapor dose of 8.5 cal/g was found to have the most similar vapor energy output with the smallest associated reduction in total energy. This was supported by characterization of the thermal profile in the lung model that demonstrated the profile of InterVapor at 8.5 cal/g to not exceed the profile of the clinical trial system. Considering both total energy and vapor energy is important during the development of clinical vapor applications. For InterVapor, a closer study of both energy types justified a reduced target vapor-dosing range for lung volume reduction. The clinical implication is a potential improvement for benefiting the risk profile. Copyright © 2013 S. Karger AG, Basel.

Revision total hip arthoplasty: factors associated with re-revision surgery.

PubMed

Khatod, Monti; Cafri, Guy; Inacio, Maria C S; Schepps, Alan L; Paxton, Elizabeth W; Bini, Stefano A

2015-03-04

The survivorship of implants after revision total hip arthroplasty and risk factors associated with re-revision are not well defined. We evaluated the re-revision rate with use of the institutional total joint replacement registry. The purpose of this study was to determine patient, implant, and surgeon factors associated with re-revision total hip arthroplasty. A retrospective cohort study was conducted. The total joint replacement registry was used to identify patients who had undergone revision total hip arthroplasty for aseptic reasons from April 1, 2001, to December 31, 2010. The end point of interest was re-revision total hip arthroplasty. Risk factors evaluated for re-revision total hip arthroplasty included: patient risk factors (age, sex, body mass index, race, and general health status), implant risk factors (fixation type, bearing surface, femoral head size, and component replacement), and surgeon risk factors (volume and experience). A multivariable Cox proportional hazards model was used. Six hundred and twenty-nine revision total hip arthroplasties with sixty-three (10%) re-revisions were evaluated. The mean cohort age (and standard deviation) was 57.0 ± 12.4 years, the mean body mass index (and standard deviation) was 29.5 ± 6.1 kg/m(2), and most of the patients were women (64.5%) and white (81.9%) and had an American Society of Anesthesiologists score of <3 (52.9%). The five-year implant survival after revision total hip arthroplasty was 86.8% (95% confidence interval, 83.57% to 90.25%). In adjusted models, age, total number of revision surgical procedures performed by the surgeon, fixation, and bearing surface were associated with the risk of re-revision. For every ten-year increase in patient age, the hazard ratio for re-revision decreases by a factor of 0.72 (95% confidence interval, 0.58 to 0.90). For every five revision surgical procedures performed by a surgeon, the risk of revision decreases by a factor of 0.93 (95% confidence interval, 0.86 to 0.99). At the time of revision, a new or retained cemented femoral implant or all-cemented hip implant increases the risk of revision by a factor of 3.19 (95% confidence interval, 1.22 to 8.38) relative to a retained or new uncemented hip implant. A ceramic on a highly cross-linked polyethylene bearing articulation decreases the hazard relative to metal on highly cross-linked polyethylene by a factor of 0.32 (95% confidence interval, 0.11 to 0.95). Metal on constrained bearing increases the hazard relative to metal on highly cross-linked polyethylene by a factor of 3.32 (95% confidence interval, 1.16 to 9.48). When evaluating patient, implant, and surgical factors at the time of revision total hip arthroplasty, age, surgeon experience, implant fixation, and bearing surfaces had significant impacts on the risk of re-revision. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Chlorination Disinfection By-Products and Risk of Congenital Anomalies in England and Wales

PubMed Central

Nieuwenhuijsen, Mark J.; Toledano, Mireille B.; Bennett, James; Best, Nicky; Hambly, Peter; de Hoogh, Cornelis; Wellesley, Diana; Boyd, Patricia A.; Abramsky, Lenore; Dattani, Nirupa; Fawell, John; Briggs, David; Jarup, Lars; Elliott, Paul

2008-01-01

Background Increased risk of various congenital anomalies has been reported to be associated with trihalomethane (THM) exposure in the water supply. Objectives We conducted a registry-based study to determine the relationship between THM concentrations and the risk of congenital anomalies in England and Wales. Methods We obtained congenital anomaly data from the National Congenital Anomalies System, regional registries, and the national terminations registry; THM data were obtained from water companies. Total THM (< 30, 30 to < 60, ≥60 μg/L), total brominated exposure (< 10, 10 to < 20, ≥20 μg/L), and bromoform exposure (< 2, 2 to < 4, ≥4 μg/L) were modeled at the place of residence for the first trimester of pregnancy. We included 2,605,226 live births, stillbirths, and terminations with 22,828 cases of congenital anomalies. Analyses using fixed- and random-effects models were performed for broadly defined groups of anomalies (cleft palate/lip, abdominal wall, major cardiac, neural tube, urinary and respiratory defects), a more restricted set of anomalies with better ascertainment, and for isolated and multiple anomalies. Data were adjusted for sex, maternal age, and socioeconomic status. Results We found no statistically significant trends across exposure categories for either the broadly defined or more restricted sets of anomalies. For the restricted set of anomalies with isolated defects, there were significant (p < 0.05) excess risks in the high-exposure categories of total THMs for ventricular septal defects [odds ratio (OR) = 1.43; 95% confidence interval (CI), 1.00–2.04] and of bromoform for major cardiovascular defects and gastroschisis (OR = 1.18; 95% CI, 1.00–1.39; and OR = 1.38; 95% CI, 1.00–1.92, respectively). Conclusion In this large national study we found little evidence for a relationship between THM concentrations in drinking water and risk of congenital anomalies. PMID:18288321

Delivery system integration and health care spending and quality for Medicare beneficiaries.

PubMed

McWilliams, J Michael; Chernew, Michael E; Zaslavsky, Alan M; Hamed, Pasha; Landon, Bruce E

2013-08-12

The Medicare accountable care organization (ACO) programs rely on delivery system integration and health care provider risk sharing to lower spending while improving quality of care. To compare spending and quality between larger and smaller provider groups and examine how size-related differences vary by 2 factors considered central to ACO performance: group primary care orientation and financial risk sharing by health care providers. Using 2009 Medicare claims and linked American Medical Association Group Practice data, we assigned 4.29 million beneficiaries to health care provider groups based on primary care use. We categorized group size according to eligibility thresholds for the Shared Savings (≥5000 assigned beneficiaries) and Pioneer (≥15,000) ACO programs and distinguished hospital-based from independent groups. We assessed the primary care orientation of larger groups' specialty mix and used health maintenance organization market penetration and data from the Community Tracking Study to measure the extent of financial risk accepted by different types of provider groups in different areas for managed care patients. We estimated linear regression models comparing spending and quality between larger and smaller health care provider groups, allowing size-related differences to vary by measures of group primary care orientation and risk sharing. Spending and quality measures included total medical spending, spending by type of service, 5 process measures of quality, and 30-day readmissions, all adjusted for sociodemographic and clinical characteristics. Compared with smaller groups, larger hospital-based groups had higher total per-beneficiary spending in 2009 (mean difference, +$849), higher 30-day readmission rates (+1.3 percentage points), and similar performance on 4 of 5 process measures of quality. In contrast, larger independent physician groups performed better than smaller groups on all process measures and exhibited significantly lower per-beneficiary spending in counties where risk sharing by these groups was more common (-$426). Among all groups sufficiently large to participate in ACO programs, a strong primary care orientation was associated with lower spending, fewer readmissions, and better quality of diabetes care. Spending was lower and quality of care better for Medicare beneficiaries served by larger independent physician groups with strong primary care orientations in environments where health care providers accepted greater risk.

Audit of a new model of birth care for women with low risk pregnancies in South Africa: the primary care onsite midwife-led birth unit (OMBU).

PubMed

Hofmeyr, George Justus; Mancotywa, Thozeka; Silwana-Kwadjo, Nomvula; Mgudlwa, Batembu; Lawrie, Theresa A; Gülmezoglu, Ahmet Metin

2014-12-20

South Africa's health system is based on the primary care model in which low-risk maternity care is provided at community health centres and clinics, and 'high-risk' care is provided at secondary/tertiary hospitals. This model has the disadvantage of delays in the management of unexpected intrapartum complications in otherwise low-risk pregnancies, therefore, there is a need to re-evaluate the models of birth care in South Africa. To date, two primary care onsite midwife-led birth units (OMBUs) have been established in the Eastern Cape. OMBUs are similar to alongside midwifery units but have been adapted to the South African health system in that they are staffed, administered and funded by the primary care service. They allow women considered to be at 'low risk' to choose between birth in a community health centre and birth in the OMBU. The purpose of this audit was to evaluate the impact of establishing an OMBU at Frere Maternity Hospital in East London, South Africa, on maternity services. We conducted an audit of routinely collected data from Frere Maternity Hospital over two 12 month periods, before and after the OMBU opened. Retrospectively retrieved data included the number of births, maternal and perinatal deaths, and mode of delivery. After the OMBU opened at Frere Maternity Hospital, the total number of births on the hospital premises increased by 16%. The total number of births in the hospital obstetric unit (OU) dropped by 9.3%, with 1611 births out of 7375 (22%) occurring in the new OMBU. The number of maternal and perinatal deaths was lower in the post-OMBU period compared with the pre-OMBU period. These improvements cannot be assumed to be the result of the intervention as observational studies are prone to bias. The mortality data should be interpreted with caution as other factors such as change in risk profile may have contributed to the death reductions. There are many additional advantages for women, hospital staff and primary care staff with this model, which may also be more cost-effective than the standard (freestanding) primary care model.

Fecal microbial determinants of fecal and systemic estrogens and estrogen metabolites: a cross-sectional study.

PubMed

Flores, Roberto; Shi, Jianxin; Fuhrman, Barbara; Xu, Xia; Veenstra, Timothy D; Gail, Mitchell H; Gajer, Pawel; Ravel, Jacques; Goedert, James J

2012-12-21

High systemic estrogen levels contribute to breast cancer risk for postmenopausal women, whereas low levels contribute to osteoporosis risk. Except for obesity, determinants of non-ovarian systemic estrogen levels are undefined. We sought to identify members and functions of the intestinal microbial community associated with estrogen levels via enterohepatic recirculation. Fifty-one epidemiologists at the National Institutes of Health, including 25 men, 7 postmenopausal women, and 19 premenopausal women, provided urine and aliquots of feces, using methods proven to yield accurate and reproducible results. Estradiol, estrone, 13 estrogen metabolites (EM), and their sum (total estrogens) were quantified in urine and feces by liquid chromatography/tandem mass spectrometry. In feces, β-glucuronidase and β-glucosidase activities were determined by realtime kinetics, and microbiome diversity and taxonomy were estimated by pyrosequencing 16S rRNA amplicons. Pearson correlations were computed for each loge estrogen level, loge enzymatic activity level, and microbiome alpha diversity estimate. For the 55 taxa with mean relative abundance of at least 0.1%, ordinal levels were created [zero, low (below median of detected sequences), high] and compared to loge estrogens, β-glucuronidase and β-glucosidase enzymatic activity levels by linear regression. Significance was based on two-sided tests with α=0.05. In men and postmenopausal women, levels of total urinary estrogens (as well as most individual EM) were very strongly and directly associated with all measures of fecal microbiome richness and alpha diversity (R≥0.50, P≤0.003). These non-ovarian systemic estrogens also were strongly and significantly associated with fecal Clostridia taxa, including non-Clostridiales and three genera in the Ruminococcaceae family (R=0.57-0.70, P=0.03-0.002). Estrone, but not other EM, in urine correlated significantly with functional activity of fecal β-glucuronidase (R=0.36, P=0.04). In contrast, fecal β-glucuronidase correlated inversely with fecal total estrogens, both conjugated and deconjugated (R≤-0.47, P≤0.01). Premenopausal female estrogen levels, which were collected across menstrual cycles and thus highly variable, were completely unrelated to fecal microbiome and enzyme parameters (P≥0.6). Intestinal microbial richness and functions, including but not limited to β-glucuronidase, influence levels of non-ovarian estrogens via enterohepatic circulation. Thus, the gut microbial community likely affects the risk for estrogen-related conditions in older adults. Understanding how Clostridia taxa relate to systemic estrogens may identify targets for interventions.

Flavonoids intake and risk of type 2 diabetes mellitus: A meta-analysis of prospective cohort studies.

PubMed

Xu, Hui; Luo, Jia; Huang, Jia; Wen, Qian

2018-05-01

Epidemiological studies exploring the role of flavonoids intake in preventing type 2 diabetes mellitus (T2DM) showed inconsistent results. Therefore, we performed a meta-analysis of relevant studies to examine the relationship between flavonoids intake and risk of T2DM. We hypothesized that flavonoids intake may decrease the risk of developing T2DM.A systematical search in PubMed and Embase until September 2017 was performed to identify eligible prospective cohort studies. The summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random-effect models. Dose-response pattern between total flavonoids intake and T2DM risk was also estimated.Eight prospective studies were included with 312,015 participants, of whom 19,953 developed T2DM during the follow-up periods of 4 to 28 years. Compared with lower consumption, high intake of total flavonoids was associated with a decreased risk of T2DM (RR: 0.89, 95% CI: 0.82-0.96). Among flavonoid subclasses, inverse correlations with T2DM were achieved for intakes of anthocyanidins, flavan-3-ols, flavonols, and isoflavones. Dose-response meta-analysis indicated a curvilinear relationship between total flavonoids intake and incident T2DM (P for nonlinearity = .042), with a significant risk reduction at an intake of ≥550 mg/day. When assuming a linear pattern, the risk of T2DM was decreased by 5% for each 300-mg/day increment in total flavonoids intake (RR: 0.95, 95% CI: 0.93-0.97).Our study suggests that higher intakes of total flavonoids and subclasses (anthocyanidins, flavan-3-ols, flavonols, and isoflavones) are associated with lower risk of T2DM.

Carbohydrate, dietary glycaemic index and glycaemic load, and colorectal cancer risk: a case-control study in China.

PubMed

Huang, Jing; Fang, Yu-Jing; Xu, Ming; Luo, Hong; Zhang, Nai-Qi; Huang, Wu-Qing; Pan, Zhi-Zhong; Chen, Yu-Ming; Zhang, Cai-Xia

2018-04-01

A carbohydrate-rich diet results in hyperglycaemia and hyperinsulinaemia; it may further induce the carcinogenesis of colorectal cancer. However, epidemiological evidence among Chinese population is quite limited. The aim of this study was to investigate total carbohydrate, non-fibre carbohydrate, total fibre, starch, dietary glycaemic index (GI) and glycaemic load (GL) in relation to colorectal cancer risk in Chinese population. A case-control study was conducted from July 2010 to April 2017, recruiting 1944 eligible colorectal cancer cases and 2027 age (5-year interval) and sex frequency-matched controls. Dietary information was collected by using a validated FFQ. The OR and 95 % CI of colorectal cancer risk were assessed by multivariable logistic regression models. There was no clear association between total carbohydrate intake and colorectal cancer risk. The adjusted OR was 0·85 (95 % CI 0·70, 1·03, P trend=0·08) comparing the highest with the lowest quartile. Total fibre was related to a 53 % reduction in colorectal cancer risk (adjusted ORquartile 4 v. 1 0·47; 95 % CI 0·39, 0·58). However, dietary GI was positively associated with colorectal cancer risk, with an adjusted ORquartile 4 v. 1 of 3·10 (95 % CI 2·51, 3·85). No significant association was found between the intakes of non-fibre carbohydrate, starch and dietary GL and colorectal cancer risk. This study indicated that dietary GI was positively associated with colorectal cancer risk, but no evidence supported that total carbohydrate, non-fibre carbohydrate, starch or high dietary GL intake were related to an increased risk of colorectal cancer in a Chinese population.

Non-steroidal Anti-inflammatory Drugs and Cancer Risk in Women: Results from the Women’s Health Initiative

PubMed Central

Brasky, Theodore M.; Liu, Jingmin; White, Emily; Peters, Ulrike; Potter, John D.; Walter, Roland B.; Baik, Christina S.; Lane, Dorothy S.; Manson, JoAnn E.; Vitolins, Mara Z.; Allison, Matthew A.; Tang, Jean Y.; Wactawski-Wende, Jean

2017-01-01

The use of non-steroidal anti-inflammatory drugs (NSAIDs) has been associated with reduced risks of cancers at several sites in some studies; however, we recently reported no association between their use and total cancer risk in women in a prospective study. Here we examine the association between NSAIDs and total and site-specific cancer incidence in the large, prospective Women’s Health Initiative (WHI). 129,013 women were recruited to participate in the WHI at 40 US clinical centers from 1993 to 1998 and followed prospectively. After 9.7 years of follow-up, 12,998 incident, first primary, invasive cancers were diagnosed. NSAID use was systematically collected at study visits. We used Cox proportional hazards regression models to estimate multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) for associations between NSAIDs use and total and site-specific cancer risk. Relative to non-use, consistent use (i.e., use at baseline and year 3 of follow-up) of any NSAID was not associated with total cancer risk (HR 1.00, 95% CI: 0.94–1.06). Results for individual NSAIDs were similar to the aggregate measure. In site-specific analyses, NSAIDs were associated with reduced risks of colorectal cancer, ovarian cancer, and melanoma. Our study confirms a chemopreventive benefit for colorectal cancer in women and gives preliminary evidence for a reduction of the risk of some rarer cancers. NSAIDs’ benefit on cancer risk was limited to specific sites and not evident when total cancer risk was examined. This information may be of importance when NSAIDs are considered as chemopreventive agents. PMID:24599876

The preferred magnetic resonance imaging planes in quantifying visceral adipose tissue and evaluating cardiovascular risk.

PubMed

Liu, K H; Chan, Y L; Chan, J C N; Chan, W B; Kong, M O; Poon, M Y

2005-09-01

Magnetic Resonance Imaging (MRI) is a well-accepted non-invasive method in the quantification of visceral adipose tissue. However, a standard method of measurement has not yet been universally agreed. The objectives of the present study were 2-fold, firstly, to identify the imaging plane in the Chinese population which gives the best correlation with total visceral adipose tissue volume and cardiovascular risk factors; and secondly to compare the correlations between single-slice and multiple-slice approach with cardiovascular risk factors. Thirty-seven Chinese subjects with no known medical history underwent MRI examination for quantifying total visceral adipose tissue volume. The visceral adipose tissue area at five axial imaging levels within abdomen and pelvis were determined. All subjects had blood pressure measured and fasting blood taken for analysis of cardiovascular risk factors. Framingham risk score for each subject was calculated. The imaging plane at the level of 'lower costal margin' (LCM) in both men and women had the highest correlation with total visceral adipose tissue volume (r = 0.97 and 0.99 respectively). The visceral adipose tissue area at specific imaging levels showed higher correlations with various cardiovascular risk factors and Framingham risk score than total visceral adipose tissue volume. The visceral adipose tissue area at 'umbilicus' (UMB) level in men (r = 0.88) and LCM level in women (r = 0.70) showed the best correlation with Framingham risk score. The imaging plane at the level of LCM is preferred for reflecting total visceral adipose tissue volume in Chinese subjects. For investigating the association of cardiovascular risk with visceral adipose tissue in MRI-obesity research, the single-slice approach is superior to the multiple-slice approach, with the level of UMB in men and LCM in women as the preferred imaging planes.

Usual Cruciferous Vegetable Consumption and Ovarian Cancer: A Case-Control Study.

PubMed

McManus, Hallie; Moysich, Kirsten B; Tang, Li; Joseph, Janine; McCann, Susan E

2018-01-01

Ovarian cancer is the fifth leading cause of cancer-related deaths among women, primarily due to diagnosis at late stages. Therefore, identification of modifiable risk factors for this disease is warranted. Using the Patient Epidemiology Data System (PEDS), collected from 1981 to 1998 at Roswell Park Cancer Institute, Buffalo, NY, we conducted a hospital-based, case-control analysis of self-reported cruciferous vegetable intake and ovarian cancer among 675 women with primary, incident ovarian cancer, and 1275 without cancer. Cruciferous vegetable intake was queried using a 44-item food frequency questionnaire (FFQ). Odds ratios (OR) and 95% confidence intervals (CI) were estimated with logistic regression, adjusting for age, body mass index (BMI), education, smoking status, parity, family history of ovarian cancer, total fruit consumption, total meat consumption, and total noncruciferous vegetable consumption. We observed a significant inverse association for women with highest vs. lowest intakes of total vegetables (OR = 0.65, 95% CI = 0.46-0.92), cooked cauliflower (OR = 0.82, 95% CI = 0.67-0.99), and cooked greens (OR = 0.63, 95% CI = 0.46-0.86) and an inverse, dose-dependent association between cooked cruciferous vegetables intake and ovarian cancer (for each additional ten servings per month, OR = 0.85, 95% CI = 0.76-0.96). These findings suggest that a diet that includes cruciferous vegetables could be an important modifiable risk factor for ovarian cancer.

Bulk metal concentrations versus total suspended solids in rivers: Time-invariant & catchment-specific relationships.

PubMed

Nasrabadi, Touraj; Ruegner, Hermann; Schwientek, Marc; Bennett, Jeremy; Fazel Valipour, Shahin; Grathwohl, Peter

2018-01-01

Suspended particles in rivers can act as carriers of potentially bioavailable metal species and are thus an emerging area of interest in river system monitoring. The delineation of bulk metals concentrations in river water into dissolved and particulate components is also important for risk assessment. Linear relationships between bulk metal concentrations in water (CW,tot) and total suspended solids (TSS) in water can be used to easily evaluate dissolved (CW, intercept) and particle-bound metal fluxes (CSUS, slope) in streams (CW,tot = CW + CSUS TSS). In this study, we apply this principle to catchments in Iran (Haraz) and Germany (Ammer, Goldersbach, and Steinlach) that show differences in geology, geochemistry, land use and hydrological characteristics. For each catchment, particle-bound and dissolved concentrations for a suite of metals in water were calculated based on linear regressions of total suspended solids and total metal concentrations. Results were replicable across sampling campaigns in different years and seasons (between 2013 and 2016) and could be reproduced in a laboratory sedimentation experiment. CSUS values generally showed little variability in different catchments and agree well with soil background values for some metals (e.g. lead and nickel) while other metals (e.g. copper) indicate anthropogenic influences. CW was elevated in the Haraz (Iran) catchment, indicating higher bioavailability and potential human and ecological health concerns (where higher values of CSUS/CW are considered as a risk indicator).

Bulk metal concentrations versus total suspended solids in rivers: Time-invariant & catchment-specific relationships

PubMed Central

Ruegner, Hermann; Schwientek, Marc; Bennett, Jeremy; Fazel Valipour, Shahin; Grathwohl, Peter

2018-01-01

Suspended particles in rivers can act as carriers of potentially bioavailable metal species and are thus an emerging area of interest in river system monitoring. The delineation of bulk metals concentrations in river water into dissolved and particulate components is also important for risk assessment. Linear relationships between bulk metal concentrations in water (CW,tot) and total suspended solids (TSS) in water can be used to easily evaluate dissolved (CW, intercept) and particle-bound metal fluxes (CSUS, slope) in streams (CW,tot = CW + CSUS TSS). In this study, we apply this principle to catchments in Iran (Haraz) and Germany (Ammer, Goldersbach, and Steinlach) that show differences in geology, geochemistry, land use and hydrological characteristics. For each catchment, particle-bound and dissolved concentrations for a suite of metals in water were calculated based on linear regressions of total suspended solids and total metal concentrations. Results were replicable across sampling campaigns in different years and seasons (between 2013 and 2016) and could be reproduced in a laboratory sedimentation experiment. CSUS values generally showed little variability in different catchments and agree well with soil background values for some metals (e.g. lead and nickel) while other metals (e.g. copper) indicate anthropogenic influences. CW was elevated in the Haraz (Iran) catchment, indicating higher bioavailability and potential human and ecological health concerns (where higher values of CSUS/CW are considered as a risk indicator). PMID:29342204

Determination and evaluation of heavy metals in soils under two different greenhouse vegetable production systems in eastern China.

PubMed

Tian, Kang; Hu, Wenyou; Xing, Zhe; Huang, Biao; Jia, Mengmeng; Wan, Mengxue

2016-12-01

The evaluation of heavy metals (HMs) in greenhouse soils is crucial for both environmental monitoring and human health; thus, it is imperative to determine their concentrations, identify their sources and assess their potential risks. In this study, eight metals (As, Cd, Cr, Cu, Hg, Ni, Pb, and Zn) in 167 surface soils were investigated in two representative greenhouse vegetable systems of China: perennial solar greenhouse (SG) and seasonal plastic greenhouse (PG). The results indicated accumulations of Cd, Cu, Hg and Zn in the SG soils and Cd, Pb, Hg and Zn in the PG soils, with higher concentrations than the background values. In particular, Cd and Hg exhibited high levels of pollution under both GVP systems due to their positive Igeo values. Principle component analysis (PCA) and correlation analysis suggested that Cd, Cu, Hg and Zn in the SG soils and Cd, Hg and Zn in the PG soils were mainly related to intensive farming practices; Pb in the PG soils was significantly affected by atmospheric deposition. The results showed that soil characteristics, in particular soil organic matter, total nitrogen and total phosphorus, exerted significant influence on Hg, Cu, Cd, and Zn under the SG system. However, the HMs in the PG soils were weakly affected by soil properties. Overall, this study provides comparative research on the accumulation, potential risks and sources of HMs in two typical greenhouse soils in China, and our findings suggest that, Cd and Hg in both greenhouse soils could potentially represent environmental problems. Copyright © 2016 Elsevier Ltd. All rights reserved.

A novel scoring system for predicting adherent placenta in women with placenta previa.

PubMed

Tanimura, Kenji; Morizane, Mayumi; Deguchi, Masashi; Ebina, Yasuhiko; Tanaka, Utaru; Ueno, Yoshiko; Kitajima, Kazuhiro; Maeda, Tetsuo; Sugimura, Kazuro; Yamada, Hideto

2018-04-01

Placenta previa (PP) is one of the most significant risk factors for adherent placenta (AP). The aim of this study was to evaluate the diagnostic efficacy of a novel scoring system for predicting AP in pregnant women with PP. This prospective cohort study enrolled 175 women with PP. The placenta previa with adherent placenta score (PPAP score) is composed of 2 categories: (1) past history of cesarean section (CS), surgical abortion, and/or uterine surgery; and (2) ultrasonography and magnetic resonance imaging findings. Each category is graded as 0, 1, 2, or 4 points, yielding a total score between 0 and 24. When women with PP had PPAP score ≥8, they were considered to be at a high risk for AP and received placement of preoperative internal iliac artery occlusion balloon catheters. If they were found to have AP during CS, they underwent hysterectomy or placenta removal using advanced bipolar with balloon catheter occlusion. The predictive accuracy of PPAP score was evaluated. In total, 23 of the 175 women with PP were diagnosed as having AP, histopathologically or clinically. Twenty-one of 24 women with PPAP score ≥8 had AP, whereas two of 151 women with PPAP score <8 had AP. The scoring system yielded 91.3% sensitivity, 98.0% specificity, 87.5% positive predictive value, and 98.7% negative predictive value for predicting AP in women with PP. This prospective study demonstrated that PPAP scoring system may be useful for predicting AP in women with PP. Copyright © 2018 Elsevier Ltd. All rights reserved.

Dosimetric evaluation of total marrow irradiation using 2 different planning systems

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

Nalichowski, Adrian, E-mail: nalichoa@karmanos.org; Eagle, Don G.; Burmeister, Jay

This study compared 2 different treatment planning systems (TPSs) for quality and efficiency of total marrow irradiation (TMI) plans. The TPSs used in this study were VOxel-Less Optimization (VoLO) (Accuray Inc, Sunnyvale, CA) using helical dose delivery on a Tomotherapy Hi-Art treatment unit and Eclipse (Varian Medical Systems Inc, Palo Alto, CA) using volumetric modulated arc therapy (VMAT) dose delivery on a Varian iX treatment unit. A total dose of 1200 cGy was prescribed to cover 95% of the planning target volume (PTV). The plans were optimized and calculated based on a single CT data and structure set using themore » Alderson Rando phantom (The Phantom Laboratory, Salem, NY) and physician contoured target and organ at risk (OAR) volumes. The OARs were lungs, heart, liver, kidneys, brain, and small bowel. The plans were evaluated based on plan quality, time to optimize the plan and calculate the dose, and beam on time. The resulting mean and maximum doses to the PTV were 1268 and 1465 cGy for VoLO and 1284 and 1541 cGy for Eclipse, respectively. For 5 of 6 OAR structures the VoLO system achieved lower mean and D10 doses ranging from 22% to 52% and 3% to 44%, respectively. Total computational time including only optimization and dose calculation were 0.9 hours for VoLO and 3.8 hours for Eclipse. These times do not include user-dependent target delineation and field setup. Both planning systems are capable of creating high-quality plans for total marrow irradiation. The VoLO planning system was able to achieve more uniform dose distribution throughout the target volume and steeper dose fall off, resulting in superior OAR sparing. VoLO's graphics processing unit (GPU)–based optimization and dose calculation algorithm also allowed much faster creation of TMI plans.« less

Medicare overpayments to private plans, 1985-2012: shifting seniors to private plans has already cost Medicare US$282.6 billion.

PubMed

Hellander, Ida; Himmelstein, David U; Woolhandler, Steffie

2013-01-01

Previous research has documented Medicare overpayments to the private Medicare Advantage (MA) plans that compete with traditional fee-for-service Medicare. This research has assessed individual categories of overpayment for, at most, a few years. However, no study has calculated the total overpayments to private plans since the program's inception. Prior to 2004, selective enrollment of healthier seniors was the major source of excess payments. We estimate this has added US$41 billion to Medicare's costs since 1985. Medicare adopted a risk-adjustment scheme in 2004, but this has not curbed private plans' ability to game the payment system. This has added US$122.5 billion to Medicare's costs since 2004. Congress mandated increased payment to private plans in the 2003 Medicare Modernization Act, which was mitigated, to a degree, by the subsequent Affordable Care Act. In total, we find that Medicare has overpaid private insurers by US$282.6 billion since 1985. Risk adjustment does not work in for-profit MA plans, which have a financial incentive, the data, and the ingenuity to game whatever system Medicare devises. It is time to end Medicare's costly experiment with privatization. The U.S. needs to adopt a single-payer national health insurance program with effective methods for controlling costs.

Incorporating location, routing, and inventory decisions in a bi-objective supply chain design problem with risk-pooling

NASA Astrophysics Data System (ADS)

Tavakkoli-Moghaddam, Reza; Forouzanfar, Fateme; Ebrahimnejad, Sadoullah

2013-07-01

This paper considers a single-sourcing network design problem for a three-level supply chain. For the first time, a novel mathematical model is presented considering risk-pooling, the inventory existence at distribution centers (DCs) under demand uncertainty, the existence of several alternatives to transport the product between facilities, and routing of vehicles from distribution centers to customer in a stochastic supply chain system, simultaneously. This problem is formulated as a bi-objective stochastic mixed-integer nonlinear programming model. The aim of this model is to determine the number of located distribution centers, their locations, and capacity levels, and allocating customers to distribution centers and distribution centers to suppliers. It also determines the inventory control decisions on the amount of ordered products and the amount of safety stocks at each opened DC, selecting a type of vehicle for transportation. Moreover, it determines routing decisions, such as determination of vehicles' routes starting from an opened distribution center to serve its allocated customers and returning to that distribution center. All are done in a way that the total system cost and the total transportation time are minimized. The Lingo software is used to solve the presented model. The computational results are illustrated in this paper.

European Surveillance System on Contact Allergies (ESSCA): polysensitization, 2009-2014.

PubMed

Dittmar, Daan; Uter, Wolfgang; Bauer, Andrea; Fortina, Ana B; Bircher, Andreas J; Czarnecka-Operacz, Magdalena; Dugonik, Aleksandra; Elsner, Peter; Gallo, Rosella; Ghaffar, Sharizan A; Giménez-Arnau, Anna; Johnston, Graham A; Kręcisz, Beata; Filon, Francesca L; Rustemeyer, Thomas; Sadowska-Przytocka, Anna; Sánchez-Pérez, Javier; Schnuch, Axel; Simon, Dagmar; Spiewak, Radoslaw; Spring, Philipp; Corradin, Maria T; Valiukevičienė, Skaidra; Vok, Marko; Weisshaar, Elke; Wilkinson, Mark; Schuttelaar, Marie L

2018-06-01

Polysensitization, defined as being allergic to three or more haptens from the European baseline series, is considered to reflect increased susceptibility to developing a contact allergy, and is likely to be associated with an impaired quality of life. To evaluate the prevalences of polysensitization across Europe and to analyse factors associated with polysensitization. Patch test data collected by the European Surveillance System on Contact Allergies (ESSCA; www.essca-dc.org) in consecutively patch tested patients from January 2009 to December 2014, comprising 11 countries and 57 departments, were retrospectively analysed. A total of 86 416 patients were available for analysis, showing a standardized prevalence of polysensitization of 7.02%, ranging from 12.7% (Austria) to 4.6% (Italy). Allergen pairs with the strongest association are reported for the total population, for South Europe, and for North/Central Europe. Overall, polysensitized patients showed a higher percentage of extreme (+++) positive patch test reactions than oligosensitized patients. Female sex, occupational dermatitis and age > 40 years were risk factors for polysensitization. The varying prevalences of polysensitization across Europe most likely reflect differences in patient characteristics and referral patterns between departments. Known risk factors for polysensitization are confirmed in a European dermatitis population. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Direct healthcare cost of obesity in brazil: an application of the cost-of-illness method from the perspective of the public health system in 2011.

PubMed

de Oliveira, Michele Lessa; Santos, Leonor Maria Pacheco; da Silva, Everton Nunes

2015-01-01

Obesity is a global public health problem and a risk factor for several diseases that financially impact healthcare systems. To estimate the direct costs attributable to obesity (body mass index {BMI} ≥ 30 kg/m2) and morbid obesity (BMI ≥ 40 kg/m2) in adults aged ≥ 20 incurred by the Brazilian public health system in 2011. Public hospitals and outpatient care. A cost-of-illness method was adopted using a top-down approach based on prevalence. The proportion of the cost of each obesity-associated comorbidity was calculated and obesity prevalence was used to calculate attributable risk. Direct healthcare cost data (inpatient care, bariatric surgery, outpatient care, medications and diagnostic procedures) were extracted from the Ministry of Health information systems, available on the web. Direct costs attributable to obesity totaled US$ 269.6 million (1.86% of all expenditures on medium- and high-complexity health care). The cost of morbid obesity accounted for 23.8% (US$ 64.2 million) of all obesity-related costs despite being 18 times less prevalent than obesity. Bariatric surgery costs in Brazil totaled US$ 17.4 million in 2011. The cost of morbid obesity in women was five times higher than it was in men. The cost of morbid obesity was found to be proportionally higher than the cost of obesity. If the current epidemic were not reversed, the prevalence of obesity in Brazil will increase gradually in the coming years, as well as its costs, having serious implications for the financial sustainability of the Brazilian public health system.

Heavy metal accumulation and health risk assessment in soil-wheat system under different nitrogen levels.

PubMed

Zhang, Yang; Yin, Changbin; Cao, Suzhen; Cheng, Leilei; Wu, Guosheng; Guo, Jianbiao

2018-05-01

Heavy metal(loid)s (HMs) in organic fertilizer have become a primary source of HMs pollution of farmlands, which could cause deleterious health effects in people exposed through soil-plant systems via multi-pathways. This study investigated China's main grain production area (Henan Province) to evaluate the accumulation and transport characteristics of HMs (Cr, Mn, Ni, Cu, Zn, As, Cd and Pb) in a soil-wheat system and conduct a health risk assessment for wheat (Triticum aestivum) grain under different nitrogenous fertilizer treatments. The results indicated that the Cr, Cu, As and Cd contents in soil were 56.21-113.66, 13.97-58.72, 5.79-22.62 and 0.04-0.23mg·kg -1 , and the mean contents of Cr and As contents in wheat grains were 0.78±0.31 and 0.49±0.18mg·kg -1 , respectively, which exceeded the corresponding standards. The bio-concentration factor and transfer factor were lowest in response to N-fertilization with N8-N15. Health risk assessment showed that the local population who ingested grain from culture condition of N15 experienced the lowest non-cancer and cancer risks. Among different population groups, HMs posed relatively higher non-cancer and cancer risks to children aged 0-5years. Furthermore, Cr and As exposure was the greatest contributor to Hazard Index (HI), accounting for 74.72-83.11%, while Cr exposure accounted for >90% of the total potential cancer risk. Concluding, this study indicated that, to protect human health, the current application of nitrogenous fertilizer should be controlled to an appropriate level. Copyright © 2017 Elsevier B.V. All rights reserved.

The influence of prehospital systemic corticosteroid use on development of acute respiratory distress syndrome and hospital outcomes.

PubMed

Karnatovskaia, Lioudmila V; Lee, Augustine S; Gajic, Ognjen; Festic, Emir

2013-07-01

The role of systemic corticosteroids in pathophysiology and treatment of acute respiratory distress syndrome is controversial. Use of prehospital systemic corticosteroid therapy may prevent the development of acute respiratory distress syndrome and improve hospital outcomes. This is a preplanned retrospective subgroup analysis of the prospectively identified cohort from a trial by the U.S. Critical Illness and Injury Trials Group designed to validate the Lung Injury Prediction Score. Twenty-two acute care hospitals. : Five thousand eighty-nine patients with at least one risk factor for acute respiratory distress syndrome at the time of hospitalization. Propensity-based analysis of previously recorded data. Three hundred sixty-four patients were on systemic corticosteroids. Prevalence of acute respiratory distress syndrome was 7.7% and 6.9% (odds ratio, 1.1 [95% CI, 0.8-1.7]; p = 0.54) for patients on systemic corticosteroid and not on systemic corticosteroids, respectively. A propensity for being on systemic corticosteroids was derived through logistic regression by using all available covariates. Subsequently, 354 patients (97%) on systemic corticosteroids were matched to 1,093 not on systemic corticosteroids by their propensity score for a total of 1,447 patients in the matched set. Adjusted risk for acute respiratory distress syndrome (odds ratio, 0.96 [95% CI, 0.54-1.38]), invasive ventilation (odds ratio, 0.84 [95% CI, 0.62-1.12]), and in-hospital mortality (odds ratio, 0.97 [95% CI, 0.63-1.49]) was then calculated from the propensity-matched sample using conditional logistic regression model. No significant associations were present. Prehospital use of systemic corticosteroids neither decreased the development of acute respiratory distress syndrome among patients hospitalized with at one least risk factor, nor affected the need for mechanical ventilation or hospital mortality.

Prevention of MSD by means of ergonomic risk assessment (tools) in all phases of the vehicle development process.

PubMed

Karlheinz, Schaub; Michaela, Kugler; Max, Bierwirth; Andrea, Sinn-Behrendt; Ralph, Bruder

2012-01-01

In industrialized countries musculoskeletal disorders (MSD) play an import role and are often responsible for almost one third of the total sick leave. The changes in the demographic profiles, i.e. aging work forces might even worsen this situation in the future. For a highly productive and sustainable use of human resources in production systems, ergonomics offers high potentials. In the recent years the authors have developed several ergonomic risk assessment tools, especially for the use in automotive industries. These methods may be used during the planning phases in the Tech Centers as well as during the production phase at shop floor level. The tools might also be used for a standardized communication in between the Tech Center and the plants to improve the effects of "lessons learned" for the design and layout of workstations and processes and the optimization of vehicle components. This paper describes suitable risk assessment tools as well as the integration of these tools into the vehicle development process. It introduces a comprehensive management approach for the integration of ergonomics into the management of production systems.

The Interaction Between Punishment Sensitivity and Effortful Control for Emerging Adults' Substance Use Behaviors.

PubMed

Kahn, Rachel E; Chiu, Pearl H; Deater-Deckard, Kirby; Hochgraf, Anna K; King-Casas, Brooks; Kim-Spoon, Jungmeen

2018-01-08

Within the dual systems perspective, high reward sensitivity and low punishment sensitivity in conjunction with deficits in cognitive control may contribute to high levels of risk taking, such as substance use. The current study examined whether the individual components of effortful control (inhibitory control, attentional control, and activation control) serve as regulators and moderate the association between reward or punishment sensitivity and substance use behaviors. A total of 1,808 emerging adults from a university setting (Mean age = 19.48; 72% female) completed self-report measures of reward and punishment sensitivity, effortful control, and substance use. Findings indicated significant two-way interactions for punishment sensitivity and inhibitory control for alcohol and marijuana use. The form of these interactions revealed a significant negative association between punishment sensitivity and alcohol and marijuana use at low levels of inhibitory control. No significant interactions emerged for reward sensitivity or other components of effortful control. The current findings provide preliminary evidence suggesting the dual systems theorized to influence risk taking behavior interact to make joint contributions to health risk behaviors such as substance use in emerging adults.

Future trends in dental benefits.

PubMed

Anderson, Maxwell H

2005-05-01

Dentistry and dental payment systems as we know them today will continue to evolve. Dentistry as practiced today and the prepayment systems of dentistry are substantially different than they were fifty years ago when dental insurance as we know it was first developed. Dentistry has always changed with the development of our science and the expression of dentistry's diseases in the populations we serve. The changes that are likely to occur in the future will be focused on improving health outcomes across risk-analyzed populations with the goals of providing optimal health outcomes at reasonable costs. Dentists will increasingly become engaged in the whole health of their patients. Where sufficient correlations can be leveraged between dentistry and overall health, medical plans will play an increasing role in dentistry's future for two reasons. Given favorably altered therapeutic outcomes for medical systems that preserve scarce resources, it will be an economic imperative to engage the dental system. It will also be the right thing to do from a total health perspective. In the final analysis, this elevates the role of dentistry and empowers the dentist to participate in the total health of their patients.

Major Physical Health Conditions and Risk of Suicide.

PubMed

Ahmedani, Brian K; Peterson, Edward L; Hu, Yong; Rossom, Rebecca C; Lynch, Frances; Lu, Christine Y; Waitzfelder, Beth E; Owen-Smith, Ashli A; Hubley, Samuel; Prabhakar, Deepak; Williams, L Keoki; Zeld, Nicole; Mutter, Elizabeth; Beck, Arne; Tolsma, Dennis; Simon, Gregory E

2017-09-01

Most individuals make healthcare visits before suicide, but many do not have a diagnosed mental health condition. This study seeks to investigate suicide risk among patients with a range of physical health conditions in a U.S. general population sample and whether risk persists after adjustment for mental health and substance use diagnoses. This study included 2,674 individuals who died by suicide between 2000 and 2013 along with 267,400 controls matched on year and location in a case-control study conducted in 2016 across eight Mental Health Research Network healthcare systems. A total of 19 physical health conditions were identified using diagnostic codes within the healthcare systems' Virtual Data Warehouse, including electronic health record and insurance claims data, during the year before index date. Seventeen physical health conditions were associated with increased suicide risk after adjustment for age and sex (p<0.001); nine associations persisted after additional adjustment for mental health and substance use diagnoses. Three conditions had a more than twofold increased suicide risk: traumatic brain injury (AOR=8.80, p<0.001); sleep disorders; and HIV/AIDS. Multimorbidity was present in 38% of cases versus 15.5% of controls, and represented nearly a twofold increased risk for suicide. Although several individual conditions, for example, traumatic brain injury, were associated with high risk of suicide, nearly all physical health conditions increased suicide risk, even after adjustment for potential confounders. In addition, having multiple physical health conditions increased suicide risk substantially. These data support suicide prevention based on the overall burden of physical health. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Fetal Growth and Childhood Cancer: A Population-Based Study

PubMed Central

Sørensen, Henrik Toft; Grotmol, Tom; Engeland, Anders; Stephansson, Olof; Gissler, Mika; Tretli, Steinar; Troisi, Rebecca

2013-01-01

OBJECTIVE: The etiology of childhood cancers is largely unknown. Studies have suggested that birth characteristics may be associated with risk. Our goal was to evaluate the risk of childhood cancers in relation to fetal growth. METHODS: We conducted a case-control study nested within Nordic birth registries. The study included cancer cases diagnosed in Denmark, Finland, Norway, and Sweden among children born from 1967 to 2010 and up to 10 matched controls per case, totaling 17 698 cases and 172 422 controls. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were derived from conditional logistic regression. RESULTS: Risks of all childhood cancers increased with increasing birth weight (Ptrend ≤ .001). Risks of acute lymphoid leukemia and Wilms tumor were elevated when birth weight was >4000 g and of central nervous system tumors when birth weight was >4500 g. Newborns large for gestational age were at increased risk of Wilms tumor (OR: 2.1 [95% CI: 1.2–3.6]) and connective/soft tissue tumors (OR: 2.1 [95% CI: 1.1–4.4]). In contrast, the risk of acute myeloid leukemia was increased among children born small for gestational age (OR: 1.8 [95% CI: 1.1–3.1]). Children diagnosed with central nervous system tumors at <1 year of age had elevated risk with increasing head circumference (Ptrend < .001). Those with head circumference >39 cm had the highest risk (OR: 4.7 [95% CI: 2.5–8.7]). CONCLUSIONS: In this large, Nordic population-based study, increased risks for several childhood tumors were associated with measures of fetal growth, supporting the hypothesis that tumorigenesis manifesting in childhood is initiated in utero. PMID:24167169

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

PubMed

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

2015-04-29

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

Quantify landslide exposure in areas with limited hazard information

NASA Astrophysics Data System (ADS)

Pellicani, R.; Spilotro, G.; Van Westen, C. J.

2012-04-01

In Daunia region, located in the North-western part of Apulia (Southern Italy), landslides are the main source of damage to properties in the urban centers of the area, involving especially transportation system and the foundation stability of buildings. In the last 50 years, the growing demand for physical development of these unstable minor hillside and mountain centers has produced a very rapid expansion of built-up areas, often with poor planning of urban and territorial infrastructures, and invasion of the agricultural soil. Because of the expansion of the built-up towards not safe areas, human activities such as deforestation or excavation of slopes for road cuts and building sites, etc., have become important triggers for landslide occurrence. In the study area, the probability of occurrence of landslides is very difficult to predict, as well as the expected magnitude of events, due to the limited data availability on past landslide activity. Because the main limitations concern the availability of temporal data on landslides and triggering events (frequency), run-out distance and landslide magnitude, it was not possible to produce a reliable landslide hazard map and, consequently, a risk map. Given these limitations in data availability and details, a qualitative exposure map has been produced and combined with a landslide susceptibility map, both generated using a spatial multi-criteria evaluation (SMCE) procedure in a GIS system, for obtaining the qualitative landslide risk map. The qualitative analysis has been provided the spatial distribution of the exposure level in the study area; this information could be used in a preliminary stage of regional planning. In order to have a better definition of the risk level in the Daunia territory, the quantification of the economic losses at municipal level was carried out. For transforming these information on economic consequences into landslide risk quantification, it was necessary to assume the temporal probability of landslides, on the basis of the expert knowledge on the landslide phenomena. For each of twenty-five municipalities included in the study area, the expected losses (or consequences), in monetary terms, due to different hazard scenarios have been evaluated. After calculating the economic losses, the total risk at municipal level was evaluated, by generating the risk curves and calculating the area under the curves. The analysis of the risk curves related to the 25 municipalities has showed that the total risk values, expressed in monetary terms, is higher for the bigger municipal areas located in the southern part of the study area where the elevation is lower, as are more numerous the elements at risk distributed on the municipal territory. Finally, this quantitative risk assessment procedure, which calculates the exposure in monetary terms of elements at risk, allows to establish the changes in risk in future with urban development and monetary inflation.

Microbiological and chemical properties of litter from different chicken types and production systems.

PubMed

Omeira, N; Barbour, E K; Nehme, P A; Hamadeh, S K; Zurayk, R; Bashour, I

2006-08-15

Chicken litter is produced in large quantities from all types of poultry raising activities. It is primarily used for land application, thus it is essential to analyze its properties before it is released to the environment. The objective of this study is to compare the microbiological and chemical properties of litter generated from layer and broiler chickens reared under intensive and free-range production systems. The microbiological analysis consisted of the enumeration of total bacteria, total coliforms, Staphylococcus species, Salmonella species and Clostridium perfringens. Chicken litter from layers reared under intensive and free range systems showed lower mean total bacterial count than the litter collected from chicken broilers reared under either of the two systems (P=0.0291). The litter from intensive layers had the lowest mean total coliform counts (P=0.0222) while the lowest Staphylococcus species count was observed in the litter from free-range layers (P=0.0077). The C. perfringens count was the lowest in chicken litter from intensively raised broilers and layers (P=0.0001). The chemical properties of litter from the different chicken types and production systems were compared based on determination of pH, electrical conductivity, carbon, nitrogen, phosphorus, potassium, cadmium and zinc. Litter from free-range broilers showed the highest pH value (P=0.0005); however, the electrical conductivity was higher in the litter from both intensive and free-range layers compared to the litter from both broiler production systems (P=0.0117). Chicken litter from intensive systems had higher nitrogen content than litter from free-range systems (P=0.0000). The total phosphorus was the lowest in free-range broiler litter (P=0.0001), while the total potassium was the lowest in litter from intensively managed broilers (P=0.0000). Zinc appeared higher in litter from layers compared to that from broilers (P=0.0101). The cadmium content was higher in the litter from free-range broilers and layers compared to that in the litter from intensively managed systems (P=0.0439). Staphylococcus species in the litter as well as cadmium concentrations seem to be the most critical parameters presenting risks on the environment and on human health. Based on the lowest coliform counts (an indication of water pollution), the high nutrient levels and the low cadmium values, litter from intensively managed layers appears as the most suitable for application on agricultural soils.

Inadequate exercise as a risk factor for sepsis mortality.

PubMed

Williams, Paul T

2013-01-01

Test whether inadequate exercise is related to sepsis mortality. Mortality surveillance of an epidemiological cohort of 155,484 National Walkers' and Runners' Health Study participants residing in the United States. Deaths were monitored for an average of 11.6-years using the National Death index through December 31, 2008. Cox proportional hazard analyses were used to compare sepsis mortality (ICD-10 A40-41) to inadequate exercise (<1.07 METh/d run or walked) as measured on their baseline questionnaires. Deaths occurring within one year of the baseline survey were excluded. Sepsis was the underlying cause in 54 deaths (sepsis(underlying)) and a contributing cause in 184 deaths (sepsis(contributing)), or 238 total sepsis-related deaths (sepsis(total)). Inadequate exercise was associated with 2.24-fold increased risk for sepsis(underlying) (95%CI: 1.21 to 4.07-fold, P = 0.01), 2.11-fold increased risk for sepsis(contributing) (95%CI: 1.51- to 2.92-fold, P<10(-4)), and 2.13-fold increased risk for sepsis(total) (95%CI: 1.59- to 2.84-fold, P<10(-6)) when adjusted for age, sex, race, and cohort. The risk increase did not differ significantly between runners and walkers, by sex, or by age. Sepsis(total) risk was greater in diabetics (P = 10(-5)), cancer survivors (P = 0.0001), and heart attack survivors (P = 0.003) and increased with waist circumference (P = 0.0004). The sepsis(total) risk associated with inadequate exercise persisted when further adjusted for diabetes, prior cancer, prior heart attack and waist circumference, and when excluding deaths with cancer, or cardiovascular, respiratory, or genitourinary disease as the underlying cause. Inadequate exercise also increased sepsis(total) risk in 2163 baseline diabetics (4.78-fold, 95%CI: 2.1- to 13.8-fold, P = 0.0001) when adjusted, which was significantly greater (P = 0.03) than the adjusted risk increase in non-diabetics (1.80-fold, 95%CI: 1.30- to 2.46-fold, P = 0.0006). Inadequate exercise is a risk factor for sepsis mortality, particular in diabetics.

An Increase in the Omega-6/Omega-3 Fatty Acid Ratio Increases the Risk for Obesity.

PubMed

Simopoulos, Artemis P

2016-03-02

In the past three decades, total fat and saturated fat intake as a percentage of total calories has continuously decreased in Western diets, while the intake of omega-6 fatty acid increased and the omega-3 fatty acid decreased, resulting in a large increase in the omega-6/omega-3 ratio from 1:1 during evolution to 20:1 today or even higher. This change in the composition of fatty acids parallels a significant increase in the prevalence of overweight and obesity. Experimental studies have suggested that omega-6 and omega-3 fatty acids elicit divergent effects on body fat gain through mechanisms of adipogenesis, browning of adipose tissue, lipid homeostasis, brain-gut-adipose tissue axis, and most importantly systemic inflammation. Prospective studies clearly show an increase in the risk of obesity as the level of omega-6 fatty acids and the omega-6/omega-3 ratio increase in red blood cell (RBC) membrane phospholipids, whereas high omega-3 RBC membrane phospholipids decrease the risk of obesity. Recent studies in humans show that in addition to absolute amounts of omega-6 and omega-3 fatty acid intake, the omega-6/omega-3 ratio plays an important role in increasing the development of obesity via both AA eicosanoid metabolites and hyperactivity of the cannabinoid system, which can be reversed with increased intake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). A balanced omega-6/omega-3 ratio is important for health and in the prevention and management of obesity.

An Increase in the Omega-6/Omega-3 Fatty Acid Ratio Increases the Risk for Obesity

PubMed Central

Simopoulos, Artemis P.

2016-01-01

In the past three decades, total fat and saturated fat intake as a percentage of total calories has continuously decreased in Western diets, while the intake of omega-6 fatty acid increased and the omega-3 fatty acid decreased, resulting in a large increase in the omega-6/omega-3 ratio from 1:1 during evolution to 20:1 today or even higher. This change in the composition of fatty acids parallels a significant increase in the prevalence of overweight and obesity. Experimental studies have suggested that omega-6 and omega-3 fatty acids elicit divergent effects on body fat gain through mechanisms of adipogenesis, browning of adipose tissue, lipid homeostasis, brain-gut-adipose tissue axis, and most importantly systemic inflammation. Prospective studies clearly show an increase in the risk of obesity as the level of omega-6 fatty acids and the omega-6/omega-3 ratio increase in red blood cell (RBC) membrane phospholipids, whereas high omega-3 RBC membrane phospholipids decrease the risk of obesity. Recent studies in humans show that in addition to absolute amounts of omega-6 and omega-3 fatty acid intake, the omega-6/omega-3 ratio plays an important role in increasing the development of obesity via both AA eicosanoid metabolites and hyperactivity of the cannabinoid system, which can be reversed with increased intake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). A balanced omega-6/omega-3 ratio is important for health and in the prevention and management of obesity. PMID:26950145

A Methodological Approach to Small Area Estimation for the Behavioral Risk Factor Surveillance System

PubMed Central

Xu, Fang; Wallace, Robyn C.; Garvin, William; Greenlund, Kurt J.; Bartoli, William; Ford, Derek; Eke, Paul; Town, G. Machell

2016-01-01

Public health researchers have used a class of statistical methods to calculate prevalence estimates for small geographic areas with few direct observations. Many researchers have used Behavioral Risk Factor Surveillance System (BRFSS) data as a basis for their models. The aims of this study were to 1) describe a new BRFSS small area estimation (SAE) method and 2) investigate the internal and external validity of the BRFSS SAEs it produced. The BRFSS SAE method uses 4 data sets (the BRFSS, the American Community Survey Public Use Microdata Sample, Nielsen Claritas population totals, and the Missouri Census Geographic Equivalency File) to build a single weighted data set. Our findings indicate that internal and external validity tests were successful across many estimates. The BRFSS SAE method is one of several methods that can be used to produce reliable prevalence estimates in small geographic areas. PMID:27418213

A prospective study of water intake and subsequent risk of all-cause mortality in a national cohort1234

PubMed Central

Kant, Ashima K; Graubard, Barry I

2017-01-01

Background: Water, an essential nutrient, is believed to be related to a variety of health outcomes. Published studies have examined the association of fluid or beverage intake with risk of mortality from coronary diseases, diabetes, or cancer, but few studies have examined the association of total water intake with all-cause mortality. Objective: We examined prospective risk of mortality from all causes in relation to intakes of total water and each of the 3 water sources. Design: We used public-domain, mortality-linked water intake data from the NHANES conducted in 1988–1994 and 1999–2004 for this prospective cohort study (n = 12,660 women and 12,050 men; aged ≥25 y). Mortality follow-up was completed through 31 December 2011. We used sex-specific Cox proportional hazards regression methods that were appropriate for complex surveys to examine the independent associations of plain water, beverage water, water in foods, and total water with multiple covariate–adjusted risk of mortality from all causes. Results: Over a median of 11.4 y of follow-up, 3504 men and 3032 women died of any cause in this cohort. In men, neither total water intake nor each of the individual water source variables (plain water, water in beverages, and water in foods) was independently related with risk of all-cause mortality. In women, risk of mortality increased slightly in the highest quartile of total or plain water intake but did not approach the Bonferroni-corrected level of significance of P < 0.002. Conclusions: There was no survival advantage in association with higher total or plain water intake in men or women in this national cohort. The slight increase in risk of mortality noted in women with higher total and plain water intakes may be spurious and requires further investigation. PMID:27903521

Periodontal disease severity and cancer risk in postmenopausal women: The Buffalo OsteoPerio Study

PubMed Central

Mai, Xiaodan; LaMonte, Michael J.; Hovey, Kathleen M.; Freudenheim, Jo L.; Andrews, Christopher A.; Genco, Robert J.; Wactawski-Wende, Jean

2015-01-01

Purpose Few prospective studies have reported on relationships between objective periodontal disease (PD) measures and cancer risk. This association was examined in 1,337 postmenopausal women participating in the Buffalo OsteoPerio Study. Methods Oral alveolar crestal bone height (ACH) was measured using oral radiographs. Incident cancers were adjudicated with medical records. Hazard ratios (HR) and 95% confidence intervals (CI) for associations between ACH and incident cancer outcomes were estimated using Cox proportional hazards models. Results There were 203 confirmed total incident cancer cases during follow-up (12.2±4.2 years). After adjusting for age and smoking, there were no statistically significant associations between ACH-defined PD categories and total cancer risk (mild/moderate vs. none: HR=1.33, 95%CI: 0.91–1.94; severe vs. none: HR=1.20, 95%CI: 0.77–1.86). ACH-defined PD categories were not associated with common site-specific cancers. Whole mouth mean and worst site ACH (per 1mm loss) were significantly associated with increased risk of lung (adjusted HR=1.81, 95% CI: 1.30–2.54; adjusted HR=1.34, 95% CI: 1.08–1.66, respectively), but not total or other site-specific cancer. Smoking status modified the associations between continuous ACH variables and total cancer risk; measures of PD were associated with total cancer among smokers but not never-smokers (interaction p=0.02 and p<0.01 for whole mouth mean and worst site ACH, respectively). Conclusions ACH-defined PD was associated with total cancer risk in ever but not never-smoking postmenopausal women. Whole mouth mean and worst site ACH were associated with increased lung cancer risk. However, these results need to be interpreted cautiously given the small number of lung cancer cases (n=18). Further research utilizing a larger sample is warranted to confirm the relationships among oral bone loss, site-specific cancers, and total cancer. PMID:26661782

A prospective study of water intake and subsequent risk of all-cause mortality in a national cohort.

PubMed

Kant, Ashima K; Graubard, Barry I

2017-01-01

Water, an essential nutrient, is believed to be related to a variety of health outcomes. Published studies have examined the association of fluid or beverage intake with risk of mortality from coronary diseases, diabetes, or cancer, but few studies have examined the association of total water intake with all-cause mortality. We examined prospective risk of mortality from all causes in relation to intakes of total water and each of the 3 water sources. We used public-domain, mortality-linked water intake data from the NHANES conducted in 1988-1994 and 1999-2004 for this prospective cohort study (n = 12,660 women and 12,050 men; aged ≥25 y). Mortality follow-up was completed through 31 December 2011. We used sex-specific Cox proportional hazards regression methods that were appropriate for complex surveys to examine the independent associations of plain water, beverage water, water in foods, and total water with multiple covariate-adjusted risk of mortality from all causes. Over a median of 11.4 y of follow-up, 3504 men and 3032 women died of any cause in this cohort. In men, neither total water intake nor each of the individual water source variables (plain water, water in beverages, and water in foods) was independently related with risk of all-cause mortality. In women, risk of mortality increased slightly in the highest quartile of total or plain water intake but did not approach the Bonferroni-corrected level of significance of P < 0.002. There was no survival advantage in association with higher total or plain water intake in men or women in this national cohort. The slight increase in risk of mortality noted in women with higher total and plain water intakes may be spurious and requires further investigation. © 2017 American Society for Nutrition.

Necessity and Effect of Combating Legionella pneumophila in Municipal Shower Systems

PubMed Central

Wiik, Ragnhild; Krøvel, Anne Vatland

2014-01-01

The objective was to obtain research-based, holistic knowledge about necessity and effect of practiced measures against L. pneumophila in municipal shower systems in Stavanger, Norway. The effects of hot water treatment and membrane-filtering were investigated and compared to no intervention at all. The studies were done under real-world conditions. Additionally, a surveillance pilot study of municipal showers in Stavanger was performed. The validity of high total plate count (TPC) as an indication of L. pneumophila was evaluated. A simplified method, named “dripping method”, for detection and quantification of L. pneumophila was developed. The sensitivity of the dripping method is 5 colony-forming units of L. pneumophila/ml. The transference of L. pneumophila from shower water to aerosols was studied. Interviews and observational studies among the stakeholders were done in order to identify patterns of communication and behavior in a Legionella risk perspective. No substantial effects of the measures against L. pneumophila were demonstrated, except for a distally placed membrane filter. No significant positive correlation between TPC and L. pneumophila concentrations were found. L. pneumophila serogroup 2–14 was demonstrated in 21% of the 29 buildings tested in the surveillance pilot. Relatively few cells of L. pneumophila were transferred from shower water to aerosols. Anxiety appeared as the major driving force in the risk governance of Legionella. In conclusion, the risk of acquiring Legionnaires' disease from municipal shower systems is evaluated as low and uncertain. By eliminating ineffective approaches, targeted Legionella risk governance can be practiced. Risk management by surveillance is evaluated as appropriate. PMID:25490721

Impact of graft composition on the systemic inflammatory response after an elective repair of an abdominal aortic aneurysm

PubMed Central

Baek, Jong Kwan; Kwon, Hyunwook; Ko, Gi-Young; Kim, Min Joo; Han, Youngjin; Chung, Young Soo; Park, Hojong; Kwon, Tae-Won

2015-01-01

Purpose The present study aimed to evaluate the risk factors and the role of graft material in the development of an acute phase systemic inflammatory response, and the clinical outcome in patients who undergo endovascular aneurysm repair (EVAR) or open surgical repair (OSR) of an abdominal aortic aneurysm (AAA). Methods We retrospectively evaluated the risk factors and the role of graft material in an increased risk of developing systemic inflammatory response syndrome (SIRS), and the clinical outcome in patients who underwent EVAR or OSR of an AAA. Results A total of 308 consecutive patients who underwent AAA repair were included; 178 received EVAR and 130 received OSR. There was no significant difference in the incidence of SIRS between EVAR patients and OSR patients. Regardless of treatment modality, SIRS was observed more frequently in patients treated with woven polyester grafts. Postoperative hospitalization was significantly prolonged in patients that experienced SIRS. In multivariate analyses, the initial white blood cell count (P = 0.001) and the use of woven polyester grafts (P = 0.005) were significantly associated with an increased risk of developing SIRS in patients who underwent EVAR. By contrast, the use of woven polyester grafts was the only factor associated with an increased risk of developing SIRS in patients who underwent OSR, although this was not statistically significant (P = 0.052). Conclusion The current study shows that the graft composition plays a primordial role in the development of SIRS, and it leads to prolonged hospitalization in both EVAR and OSR patients. PMID:25553321

Efficacy of a proactive health and safety risk management system in the fire service.

PubMed

Poplin, Gerald S; Griffin, Stephanie; Pollack Porter, Keshia; Mallett, Joshua; Hu, Chengcheng; Day-Nash, Virginia; Burgess, Jefferey L

2018-04-16

This study evaluated the efficacy of a fire department proactive risk management program aimed at reducing firefighter injuries and their associated costs. Injury data were collected for the intervention fire department and a contemporary control department. Workers' compensation claim frequency and costs were analyzed for the intervention fire department only. Total, exercise, patient transport, and fireground operations injury rates were calculated for both fire departments. There was a post-intervention average annual reduction in injuries (13%), workers' compensation injury claims (30%) and claims costs (21%). Median monthly injury rates comparing the post-intervention to the pre-intervention period did not show statistically significant changes in either the intervention or control fire department. Reduced workers' compensation claims and costs were observed following the risk management intervention, but changes in injury rates were not statistically significant.

Occurrence, distribution and sources of organochlorine pesticides (OCPs) in surface sediments from the Lijiang River, a typical karst river of southwestern China.

PubMed

Zhang, Dan; Wang, Yinghui; Yu, Kefu; Li, Pingyang; Zhang, Ruijie; Xu, Yiyin

2014-11-01

The Lijiang River is a typical karst river of southwestern China. Karst-aquifer systems are more vulnerable to contamination compared to other types of aquifers. The occurrence and distribution of organochlorine pesticides (OCPs) in surface sediments from the Lijiang River were investigated to evaluate their potential ecological risks. The total concentrations of them in sediments ranged from 0.80 to 18.73 ng/g dry weight (dw) (mean 6.83 ng/g dw). The residue levels of OCPs varied in the order of HCB > HCHs > DDTs. Compositional analyses of OCPs showed that HCHs and DDTs were mainly from historical usage. The ecological risk assessment suggested that HCHs and DDTs in Lijiang River sediments may cause adverse ecological risks, particularly at sites near agricultural areas.

Risk management in spatio-temporally varying field by true slime mold

NASA Astrophysics Data System (ADS)

Ito, Kentaro; Sumpter, David; Nakagaki, Toshiyuki

Revealing how lower organisms solve complicated problems is a challenging research area, which could reveal the evolutionary origin of biological information processing. Here we report on the ability of a single-celled organism, true slime mold, to find a smart solution of risk management under spatio-temporally varying conditions. We designed test conditions under which there were three food-locations at vertices of equilateral triangle and a toxic light illuminated the organism on alternating halves of the triangle. We found that the organism behavior depended on the period of the repeated illumination, even though the total exposure time was kept the same . A simple mathematical model for the experimental results is proposed from a dynamical system point of view. We discuss our results in the context of a strategy of risk management by Physarum.

Circulating vitamin D binding protein, total, free and bioavailable 25-hydroxyvitamin D and risk of colorectal cancer

PubMed Central

Ying, Hou-Qun; Sun, Hui-Ling; He, Bang-Shun; Pan, Yu-Qin; Wang, Feng; Deng, Qi-Wen; Chen, Jie; Liu, Xian; Wang, Shu-Kui

2015-01-01

Epidemiological investigation have suggested that there is a significantly inverse association between circulating 25-hydroxyvitamin D (25(OH)D) and the risk for developing colorectal cancer (CRC) in humans. However, little is known about the role of vitamin D binding protein (VDBP) in colorectal carcinogenesis. Blood samples were collected from 212 CRC patients and 212 controls matched with age, gender and blood collection time. We used logistic regression to calculate the odds ratios and 95% confidence intervals for further estimation of the association of the quartiles of VDBP, total, free and bioavailable 25(OH)D with CRC risk. The results revealed that there was no significant association between circulating VDBP concentrations and CRC in the present study, and that a negative association existed between total 25(OH)D and the risk of CRC, which was unchanged after adjustment for VDBP. Higher levels of free and bioavailable 25(OH)D were significantly associated with decreased risk of CRC. After stratifying by VDBP, high levels of total, free and bioavailable 25(OH)D were associated significantly with decreased CRC risk among participants with circulating VDBP below the median. These findings indicate that VDBP is not directly associated with the risk of CRC, but it modulates circulating free and bioavailable 25(OH)D concentration. PMID:25609140

Possible risk factors associated with greater damage in systemic lupus erythematosus patients: an Egyptian multicenter study.

PubMed

Hammad, M; Eissa, M; Fathi, S

2016-08-01

Systemic lupus erythematosus (SLE) is a prototypic multisystem autoimmune disorder. The total damage in a patient with SLE may result from SLE itself or from any other pathologic process. The aim of this study was to assess risk factors of greater damage in a sample of Egyptian SLE patients. This Egyptian multicenter retrospective study included 100 SLE patients: 64 patients from Cairo University Hospitals and 36 patients from Zagazig University Hospitals. The Systemic Lupus International Collaborative Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (ACR-DI) was used to document the damage in each patient. The total SLICC/ACR-DI score ranged from 0 to 8. A higher DI score was found in hypertensive patients, compared to normotensive patients; and among those with positive anti-phospholipid antibodies, compared to those with negative anti-phospholipid antibodies. This difference was statistically significant (p < 0.01). Also, a higher DI score was found in cyclophosphamide users, compared to non-users; and in those with proteinuria and seizures, compared to those without; and the difference was statistically significant (p < 0.05). There was a significant positive correlation between the DI and patient age (p < 0.05). Damage in SLE cannot be prevented completely, as SLE disease is considered an aggressive disease treated by aggressive medications, but rheumatologists should try to minimize damage as much as possible to maintain the patients' health, functioning and general wellbeing. © The Author(s) 2016.

Total Hip Intraoperative Femur Fracture: Do the Design Enhancements of a Second-Generation Tapered-Wedge Stem Reduce the Incidence?

PubMed

Colacchio, Nicholas D; Robbins, Claire E; Aghazadeh, Mehran S; Talmo, Carl T; Bono, James V

2017-10-01

Intraoperative femur fracture (IFF) is a well-known complication in primary uncemented total hip arthroplasty (THA). Variations in implant instrumentation design and operative technique may influence the risk of IFF. This study investigates IFF between a standard uncemented tapered-wedge femoral stem and its second-generation successor with the following design changes: size-specific medial curvature, proportional incremental stem growth, modest reduction in stem length, and distal lateral relief. A single experienced surgeon's patient database was retrospectively queried for IFF occurring during primary uncemented THA using a standard tapered-wedge femoral stem system or a second-generation stem. All procedures were performed using soft tissue preserving anatomic capsule repair and posterior approach. The primary outcome measure was IFF. A z-test of proportions was performed to determine significant difference between the 2 stems with respect to IFF. Patient demographics, Dorr classification, and implant characteristics were also examined. Forty-one of 1510 patients (2.72%) who received a standard tapered-wedge femoral stem sustained an IFF, whereas 5 of 800 patients (0.63%) using the second-generation stem incurred an IFF. No other significant associations were found. A standard tapered-wedge femoral stem instrumentation system resulted in greater than 4 times higher incidence of IFF than its second-generation successor used for primary uncemented THA. Identifying risk factors for IFF is necessary to facilitate implant system improvements and thus maximize patient outcomes. Copyright © 2017. Published by Elsevier Inc.

A prospective analysis of the association between dietary fiber intake and prostate cancer risk in EPIC.

PubMed

Suzuki, Reiko; Allen, Naomi E; Key, Timothy J; Appleby, Paul N; Tjønneland, Anne; Johnsen, Nina Føns; Jensen, Majken K; Overvad, Kim; Boeing, Heiner; Pischon, Tobias; Kaaks, Rudolf; Rohrmann, Sabine; Trichopoulou, Antonia; Misirli, Gesthimani; Trichopoulos, Dimitrios; Bueno-de-Mesquita, H Bas; van Duijnhoven, Fränzel; Sacerdote, Carlotta; Pala, Valeria; Palli, Domenico; Tumino, Rosario; Ardanaz, Eva; Quirós, José Ramón; Larrañaga, Nerea; Sánchez, Maria-José; Tormo, María-José; Jakszyn, Paula; Johansson, Ingegerd; Stattin, Pär; Berglund, Göran; Manjer, Jonas; Bingham, Sheila; Khaw, Kay-Tee; Egevad, Lars; Ferrari, Pietro; Jenab, Mazda; Riboli, Elio

2009-01-01

Few studies have examined the association between dietary fiber intake and prostate cancer risk. We evaluated the association between dietary fiber intake and the risk of prostate cancer among 142,590 men in the European Prospective Investigation into Cancer and Nutrition (EPIC). Consumption of dietary fiber (total, cereal, fruit and vegetable fiber) was estimated by validated dietary questionnaires and calibrated using 24-hr dietary recalls. Incidence rate ratios were estimated using Cox regression and adjusted for potential confounding factors. During an average of 8.7 years follow-up, prostate cancer was diagnosed in 2,747 men. Overall, there was no association between dietary fiber intake (total, cereal, fruit or vegetable fiber) and prostate cancer risk, although calibrated intakes of total fiber and fruit fiber were associated with nonstatistically significant reductions in risk. There was no association between fiber derived from cereals or vegetables and risk and no evidence for heterogeneity in any of the risk estimates by stage or grade of disease. Our results suggest that dietary fiber intake is not associated with prostate cancer risk.

Effects of the body mass index on menopausal symptoms among Asian American midlife women using two different classification systems.

PubMed

Chang, Sun Ju; Chee, Wonshik; Im, Eun-Ok

2014-01-01

To explore the effects of the body mass index (BMI) on menopausal symptoms among Asian American midlife women using two different classification systems: the international classification and the BMI classification for public health action among Asian populations. Secondary analysis using data from two large Internet survey studies. Communities and groups of midlife women on the Internet. A total of 223 Asian American midlife women who were recruited over the Internet. The Midlife Women's Symptom Index and self-reports of height and weight were used to collect data. The data were analyzed using multiple analyses of covariance. No significant differences in the prevalence and severity scores among three subscales and total menopausal symptoms according to the international classification were found. When the BMI classification for public health action among Asian populations was used as an independent variable, significant differences were found in the severity scores of three subscales and total menopausal symptoms. Results of the post-hoc analyses showed that Asian American midlife women who were in the BMI classification for high risk had significantly more severe menopausal symptoms than those who were in the BMI classification for increased risk. For Asian American women, BMI categorized using the BMI classification for Asian populations is more closely related to the severity of menopausal symptoms than BMI categorized using the international classification. Nurses need to consider the BMI classification for Asian populations when they develop interventions to prevent and alleviate menopausal symptoms among Asian American midlife women. © 2013 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

Health-Related Financial Catastrophe, Inequality and Chronic Illness in Bangladesh

PubMed Central

Rahman, Md. Mizanur; Gilmour, Stuart; Saito, Eiko; Sultana, Papia; Shibuya, Kenji

2013-01-01

Background Bangladesh has a high proportion of households incurring catastrophic health expenditure, and very limited risk sharing mechanisms. Identifying determinants of out-of-pocket (OOP) payments and catastrophic health expenditure may reveal opportunities to reduce costs and protect households from financial risk. Objective This study investigates the determinants of high healthcare expenditure and healthcare- related financial catastrophe. Methods A cross-sectional household survey was conducted in Rajshahi city, Bangladesh, in 2011. Catastrophic health expenditure was estimated separately based on capacity to pay and proportion of non-food expenditure. Determinants of OOP payments and financial catastrophe were estimated using double hurdle and Poisson regression models respectively. Results On average households spent 11% of their total budgets on health, half the residents spent 7% of the monthly per capita consumption expenditure for one illness, and nearly 9% of households faced financial catastrophe. The poorest households spent less on health but had a four times higher risk of catastrophe than the richest households. The risk of financial catastrophe and the level of OOP payments were higher for users of inpatient, outpatient public and private facilities respectively compared to using self-medication or traditional healers. Other determinants of OOP payments and catastrophic expenses were economic status, presence of chronic illness in the household, and illness among children and adults. Conclusion Households that received inpatient or outpatient private care experienced the highest burden of health expenditure. The poorest members of the community also face large, often catastrophic expenses. Chronic illness management is crucial to reducing the total burden of disease in a household and its associated increased risk of level of OOP payments and catastrophic expenses. Households can only be protected from these situations by reducing the health system's dependency on OOP payments and providing more financial risk protection. PMID:23451102

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

PubMed

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

2010-03-01

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

Occurrence and risk assessment of phthalate esters (PAEs) in vegetables and soils of suburban plastic film greenhouses.

PubMed

Wang, Jun; Chen, Gangcai; Christie, Peter; Zhang, Manyun; Luo, Yongming; Teng, Ying

2015-08-01

Phthalate esters (PAEs) are suspected of having adverse effects on human health and have been frequently detected in soils and vegetables. The present study investigated their occurrence and composition in plastic film greenhouse soil-vegetable systems and assessed their potential health risks to farmers exposed to these widespread pollutants. Six priority control phthalates, namely dimethyl phthalate (DMP), diethyl phthalate (DEP), di-n-butyl phthalate (DnBP), butyl benzyl phthalate (BBP), di-(2-ethylhexyl) phthalate (DEHP) and di-n-octyl phthalate (DnOP), were determined in 44 plastic film greenhouse vegetables and corresponding soils. Total PAEs ranged from 0.51 to 7.16mgkg(-1) in vegetables and 0.40 to 6.20mgkg(-1) in soils with average concentrations of 2.56 and 2.23mgkg(-1), respectively. DnBP, DEHP and DnOP contributed more than 90% of the total PAEs in both vegetables and soils but the proportions of DnBP and DnOP in vegetables were significantly (p<0.05) higher than in soils. The average concentrations of PAEs in pot herb mustard, celery and lettuce were >3.00mgkg(-1) but were <2.50mgkg(-1) in the corresponding soils. Stem and leaf vegetables accumulated more PAEs. There were no clear relationships between vegetable and soil PAEs. Risk assessment indicates that DnBP, DEHP and DnOP exhibited elevated non-cancer risk with values of 0.039, 0.338 and 0.038, respectively. The carcinogenic risk of DEHP was about 3.94×10(-5) to farmers working in plastic film greenhouses. Health risks were mainly by exposure through vegetable consumption and soil ingestion. Copyright © 2015 Elsevier B.V. All rights reserved.

Risk of Retinal Artery Occlusion in Patients With End-Stage Renal Disease

PubMed Central

Chang, Yuh-Shin; Weng, Shih-Feng; Chang, Chun; Wang, Jhi-Joung; Tseng, Sung-Huei; Ko, Shun-Yao; Su, Shih-Bin; Huang, Chien-Cheng; Wang, Jiu-Yao; Jan, Ren-Long

2016-01-01

Abstract There is globally increasing prevalence and incidence in end-stage renal disease (ESRD). These patients are frequently reported to have retinal abnormalities and both diseases share some systemic risk factors. Hence, it is clinically relevant to determine whether ESRD is a predictor of retinal artery occlusion (RAO). To investigate the risk of RAO in ESRD patients. A retrospective, nationwide, matched cohort study. The study included 93,766 ESRD patients recruited between 2000 and 2009 from the Taiwan National Health Insurance Research Database. The same number control group included age- and sex-matched patients without ESRD selected from the Taiwan Longitudinal Health Insurance Database, 2000. Data for each patient were collected from the index date until December 2011. The incidence and risk of RAO were compared between the 2 groups. The hazard ratio (HR) for RAO after adjustment for potential confounders was calculated using Cox proportional hazards regression. Kaplan–Meier analysis was used to calculate the cumulative RAO incidence rate. In total, 237 ESRD patients and 73 controls exhibited RAO during follow-up; thus, the RAO incidence rate in ESRD patients was 4.49 times (95% confidence interval (CI), 3.45–5.83) that in the control patients. After adjustment for potential confounders, including diabetes mellitus, hypertension, hyperlipidemia, congestive heart failure, and coronary artery disease, ESRD patients were 2.78 times (95% CI, 2.02–3.84) more likely to develop RAO in cohort for the total sample. Among patients with hypertension, the RAO incidence rate was significantly higher in the ESRD group, and hypertension significantly increased RAO risk even after adjustment for other confounders in the cohort. ESRD increases the risk of RAO, particularly in ESRD patients with hypertension. Therefore, clinicians should educate ESRD patients about RAO and ensure appropriate blood pressure control. PMID:27057891