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Sample records for cardiac risk assessment

  1. Cardiac Risk Assessment

    Science.gov (United States)

    ... Risk Assessment Related tests: Lipid Profile , VLDL Cholesterol , hs-CRP , Lp(a) Overview | Common Questions | Related Pages What ... cardiac risk include: High-sensitivity C-reactive protein (hs-CRP) : Studies have shown that measuring CRP with a ...

  2. Epidural catheterization in cardiac surgery: The 2012 risk assessment

    Directory of Open Access Journals (Sweden)

    Thomas M Hemmerling

    2013-01-01

    Full Text Available Aims and Objectives: The risk assessment of epidural hematoma due to catheter placement in patients undergoing cardiac surgery is essential since its benefits have to be weighed against risks, such as the risk of paraplegia. We determined the risk of the catheter-related epidural hematoma in cardiac surgery based on the cases reported in the literature up to September 2012. Materials and Methods: We included all reported cases of epidural catheter placement for cardiac surgery in web and in literature from 1966 to September 2012. Risks of other medical and non-medical activities were retrieved from recent reviews or national statistical reports. Results: Based on our analysis the risk of catheter-related epidural hematoma is 1 in 5493 with a 95% confidence interval (CI of 1/970-1/31114. The risk of catheter-related epidural hematoma in cardiac surgery is similar to the risk in the general surgery population at 1 in 6,628 (95% CI 1/1,170-1/37,552. Conclusions: The present risk calculation does not justify not offering epidural analgesia as part of a multimodal analgesia protocol in cardiac surgery.

  3. QTc interval in the assessment of cardiac risk

    DEFF Research Database (Denmark)

    Elming, Hanne; Brendorp, Bente; Køber, Lars;

    2002-01-01

    with increased risk of arrhythmias. The paper gives a review of the possibilities to assess the risk of ventricular arrhythmia and/or cardiac death from QTc. Prolonged QTc may hold independent prognostic importance for mortality in common diseases as ischemic heart disease and diabetes mellitus where...... importance in hypertrophic cardiomyopathy or in the arrhythmogenic right ventricular disease. The degree of QTc prolonging during treatment with QTc prolonging drugs is prognostic for the risk of ventricular arrhythmia in form of torsade de pointes and QTc prolonging drugs should probably not be prescribed...

  4. Imminent Cardiac Risk Assessment via Optical Intravascular Biochemical Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Wetzel, D.; Wetzel, L; Wetzel, M; Lodder, R

    2009-01-01

    Heart disease is by far the biggest killer in the United States, and type II diabetes, which affects 8% of the U.S. population, is on the rise. In many cases, the acute coronary syndrome and/or sudden cardiac death occurs without warning. Atherosclerosis has known behavioral, genetic and dietary risk factors. However, our laboratory studies with animal models and human post-mortem tissue using FT-IR microspectroscopy reveal the chemical microstructure within arteries and in the arterial walls themselves. These include spectra obtained from the aortas of ApoE-/- knockout mice on sucrose and normal diets showing lipid deposition in the former case. Also pre-aneurysm chemical images of knockout mouse aorta walls, and spectra of plaque excised from a living human patient are shown for comparison. In keeping with the theme of the SPEC 2008 conference Spectroscopic Diagnosis of Disease this paper describes the background and potential value of a new catheter-based system to provide in vivo biochemical analysis of plaque in human coronary arteries. We report the following: (1) results of FT-IR microspectroscopy on animal models of vascular disease to illustrate the localized chemical distinctions between pathological and normal tissue, (2) current diagnostic techniques used for risk assessment of patients with potential unstable coronary syndromes, and (3) the advantages and limitations of each of these techniques illustrated with patent care histories, related in the first person, by the physician coauthors. Note that the physician comments clarify the contribution of each diagnostic technique to imminent cardiac risk assessment in a clinical setting, leading to the appreciation of what localized intravascular chemical analysis can contribute as an add-on diagnostic tool. The quality of medical imaging has improved dramatically since the turn of the century. Among clinical non-invasive diagnostic tools, laboratory tests of body fluids, EKG, and physical examination are

  5. Cardiac Risk Assessment, Morbidity Prediction, and Outcome in the Vascular Intensive Care Unit.

    LENUS (Irish Health Repository)

    Dover, Mary

    2013-09-17

    Objectives: The aim of this study is to examine the predictive value of the Lee revised cardiac risk index (RCRI) for a standard vascular intensive care unit (ICU) population as well as assessing the utility of transthoracic echocardiography and the impact of prior coronary artery disease (CAD) and coronary revascularization on patient outcome. Design: This is a retrospective review of prospectively maintained Vascubase and prospectively collected ICU data. Materials and Methods: Data from 363 consecutive vascular ICU admissions were collected. Findings were used to calculate the RCRI, which was then correlated with patient outcomes. All patients were on optimal medical therapy (OMT) in the form of cardioselective β-blocker, aspirin, statin, and folic acid. Results: There was no relationship found between a reduced ejection fraction and patient outcome. Mortality was significantly increased for patients with left ventricular hypertrophy (LVH) as identified on echo (14.9% vs 6.5%, P = .028). The overall complication rates were significantly elevated for patients with valvular dysfunction. Discrimination for the RCRI on receiver-operating characteristic analysis was poor, with an area under the receiver-operating characteristic curve of .621. Model calibration was reasonable with an Hosmer-Lemeshow Ĉ statistic of 2.726 (P = .256). Of those with known CAD, 41.22% of the patients receiving best medical treatment developed acute myocardial infarction (AMI) compared to 35.3% of those who previously underwent percutaneous cardiac intervention and 23.5% of those who had undergone coronary artery bypass grafting. There was 3-fold increase in major adverse clinical events in patients with troponin rise and LVH. Conclusions: The RCRI\\'s discriminatory capacity is low, and this raises difficulties in assessing cardiac risk in patients undergoing vascular intervention. The AMI is highest in the OMT group without prior cardiac intervention, which mandates protocols to

  6. Post-Traumatic Stress Disorder among Cardiac Patients: Prevalence, Risk Factors, and Considerations for Assessment and Treatment

    Directory of Open Access Journals (Sweden)

    Heather Tulloch

    2014-12-01

    Full Text Available There is increasing awareness of the impact of post-traumatic stress disorder (PTSD on physical health, particularly cardiovascular disease. We review the literature on the role of trauma in the development of cardiovascular risk factors and disease, aftermath of a cardiac event, and risk for recurrence in cardiac patients. We explore possible mechanisms to explain these relationships, as well as appropriate assessment and treatment strategies for this population. Our main conclusion is that screening and referral for appropriate treatments are important given the high prevalence rates of PTSD in cardiac populations and the associated impact on morbidity and mortality.

  7. Delirium in cardiac surgery : a study on risk-assessment and long-term consequenses

    NARCIS (Netherlands)

    Koster, Sandra

    2011-01-01

    BACKGROUND: Delirium or acute confusion is a temporary mental disorder, which occurs frequently among hospitalized elderly patients. Patients who undergo cardiac surgery have an increased risk of developing delirium. Delirium is associated with many negative consequences. Therefore, prevention or ea

  8. A multi-region assessment of population rates of cardiac catheterization and yield of high-risk coronary artery disease

    Directory of Open Access Journals (Sweden)

    Clement Fiona M

    2011-11-01

    Full Text Available Abstract Background There is variation in cardiac catheterization utilization across jurisdictions. Previous work from Alberta, Canada, showed no evidence of a plateau in the yield of high-risk disease at cardiac catheterization rates as high as 600 per 100,000 population suggesting that the optimal rate is higher. This work aims 1 To determine if a previously demonstrated linear relationship between the yield of high-risk coronary disease and cardiac catheterization rates persists with contemporary data and 2 to explore whether the linear relationship exists in other jurisdictions. Methods Detailed clinical information on all patients undergoing cardiac catheterization in 3 Canadian provinces was available through the Alberta Provincial Project for Outcomes Assessment in Coronary Heart (APPROACH disease and partner initiatives in British Columbia and Nova Scotia. Population rates of catheterization and high-risk coronary disease detection for each health region in these three provinces, and age-adjusted rates produced using direct standardization. A mixed effects regression analysis was performed to assess the relationship between catheterization rate and high-risk coronary disease detection. Results In the contemporary Alberta data, we found a linear relationship between the population catheterization rate and the high-risk yield. Although the yield was slightly less in time period 2 (2002-2006 than in time period 1(1995-2001, there was no statistical evidence of a plateau. The linear relationship between catheterization rate and high-risk yield was similarly demonstrated in British Columbia and Nova Scotia and appears to extend, without a plateau in yield, to rates over 800 procedures per 100,000 population. Conclusions Our study demonstrates a consistent finding, over time and across jurisdictions, of linearly increasing detection of high-risk CAD as population rates of cardiac catheterization increase. This internationally-relevant finding

  9. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery.

    Science.gov (United States)

    Duceppe, Emmanuelle; Parlow, Joel; MacDonald, Paul; Lyons, Kristin; McMullen, Michael; Srinathan, Sadeesh; Graham, Michelle; Tandon, Vikas; Styles, Kim; Bessissow, Amal; Sessler, Daniel I; Bryson, Gregory; Devereaux, P J

    2017-01-01

    The Canadian Cardiovascular Society Guidelines Committee and key Canadian opinion leaders believed there was a need for up to date guidelines that used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of evidence assessment for patients who undergo noncardiac surgery. Strong recommendations included: 1) measuring brain natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP) before surgery to enhance perioperative cardiac risk estimation in patients who are 65 years of age or older, are 45-64 years of age with significant cardiovascular disease, or have a Revised Cardiac Risk Index score ≥ 1; 2) against performing preoperative resting echocardiography, coronary computed tomography angiography, exercise or cardiopulmonary exercise testing, or pharmacological stress echocardiography or radionuclide imaging to enhance perioperative cardiac risk estimation; 3) against the initiation or continuation of acetylsalicylic acid for the prevention of perioperative cardiac events, except in patients with a recent coronary artery stent or who will undergo carotid endarterectomy; 4) against α2 agonist or β-blocker initiation within 24 hours before surgery; 5) withholding angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker starting 24 hours before surgery; 6) facilitating smoking cessation before surgery; 7) measuring daily troponin for 48 to 72 hours after surgery in patients with an elevated NT-proBNP/BNP measurement before surgery or if there is no NT-proBNP/BNP measurement before surgery, in those who have a Revised Cardiac Risk Index score ≥1, age 45-64 years with significant cardiovascular disease, or age 65 years or older; and 8) initiating of long-term acetylsalicylic acid and statin therapy in patients who suffer myocardial injury/infarction after surgery.

  10. Clinical features and risk assessment for cardiac surgery in adult congenital heart disease: Three years at a single Japanese center

    Directory of Open Access Journals (Sweden)

    Satoshi Kurokawa

    2014-04-01

    Conclusion: Cardiac surgery could be safely performed in most ACHD cases. Exercise tolerance testing can be useful in identifying patients at high risk of mortality or major complications. BNP can be valuable in predicting poor outcomes after cardiac surgery.

  11. Cardiac tumors: echo assessment.

    Science.gov (United States)

    Mankad, Rekha; Herrmann, Joerg

    2016-12-01

    Cardiac tumors are exceedingly rare (0.001-0.03% in most autopsy series). They can be present anywhere within the heart and can be attached to any surface or be embedded in the myocardium or pericardial space. Signs and symptoms are nonspecific and highly variable related to the localization, size and composition of the cardiac mass. Echocardiography, typically performed for another indication, may be the first imaging modality alerting the clinician to the presence of a cardiac mass. Although echocardiography cannot give the histopathology, certain imaging features and adjunctive tools such as contrast imaging may aid in the differential diagnosis as do the adjunctive clinical data and the following principles: (1) thrombus or vegetations are the most likely etiology, (2) cardiac tumors are mostly secondary and (3) primary cardiac tumors are mostly benign. Although the finding of a cardiac mass on echocardiography may generate confusion, a stepwise approach may serve well practically. Herein, we will review such an approach and the role of echocardiography in the assessment of cardiac masses.

  12. Pre-pregnancy risk assessment and counselling of the cardiac patient

    NARCIS (Netherlands)

    Pieper, P. G.

    2011-01-01

    Pregnant women with heart disease often have an increased risk of maternal cardiovascular and offspring complications. The magnitude of these risks varies depending on the type and severity of the underlying disease. Therefore risk assessment should be performed before pregnancy. This can be accompl

  13. Assessment of Cardiac Functional Alterations of Ankylosing Spondylitis Patients without Cardiovascular Risk Factors

    Directory of Open Access Journals (Sweden)

    Alper Kepez

    2013-08-01

    Full Text Available Introduction: The aim of this study is to evaluate cardiac functional alterations of ankylosing spondylitis patients without any cardiovascular risk factors.Patients and Methods: Thirty seven consecutive akylosing spondylitis patients without any cardiovascular risk factors constituted our study patient population (age: 41.4 ± 11.1 years, 28 male. Electrocardiographs (ECG of all patients were obtained and all patients underwent comprehensive transthoracic echocardiographic examination. QRS durations, p wave dispersion and corrected QT dispersion (QTcd values were calculated from 12-lead ECG’s. Data reflecting left ventricular systolic and diastolic functions were obtained from echocardiographic examinations. Data of patients were compared with the data of 28 age-and gender matched healthy control subjects (age: 40.1 ± 10.5 years, 19 male.Results: There were no significant differences between patients and controls regarding QRS durations, p wave dispersion and QTcd values. There were also no significant differences between patients and controls regarding parameters reflecting left ventricular systolic and diastolic functions. Annular velocities at mitral and tricuspid annulus levels evaluated with pulsed-wave tissue Doppler imaging were also similar as well. Two (7.2% subjects in the control group and 2 (5.4% patients in the akylosing spondylitis group had minimal aortic regurgitation (p= 0.51. Conclusion: We could not demonstrate any electrocardiographic or echocardiographic evidence of structural myocardial alterations in a small sample of akylosing spondylitis patients free of cardiovascular risk factors. Effects of frequently encountered co-existent cardiovascular risk factors of ankylosing spondylitis patients might have contributed to the conflicting literature data related with this topic.

  14. Sudden cardiac death risk stratification.

    Science.gov (United States)

    Deyell, Marc W; Krahn, Andrew D; Goldberger, Jeffrey J

    2015-06-01

    Arrhythmic sudden cardiac death (SCD) may be caused by ventricular tachycardia/fibrillation or pulseless electric activity/asystole. Effective risk stratification to identify patients at risk of arrhythmic SCD is essential for targeting our healthcare and research resources to tackle this important public health issue. Although our understanding of SCD because of pulseless electric activity/asystole is growing, the overwhelming majority of research in risk stratification has focused on SCD-ventricular tachycardia/ventricular fibrillation. This review focuses on existing and novel risk stratification tools for SCD-ventricular tachycardia/ventricular fibrillation. For patients with left ventricular dysfunction or myocardial infarction, advances in imaging, measures of cardiac autonomic function, and measures of repolarization have shown considerable promise in refining risk. Yet the majority of SCD-ventricular tachycardia/ventricular fibrillation occurs in patients without known cardiac disease. Biomarkers and novel imaging techniques may provide further risk stratification in the general population beyond traditional risk stratification for coronary artery disease alone. Despite these advances, significant challenges in risk stratification remain that must be overcome before a meaningful impact on SCD can be realized.

  15. ASSESSMENT OF CARDIAC RISK FACTORS IN MEDICAL STUDENTS OF TEHRAN UNIVERSITY

    Directory of Open Access Journals (Sweden)

    "M. J. Mahmoudi

    2004-11-01

    Full Text Available Prevention of coronary heart disease, mainly by reducing the levels of known risk factors in the population, remains a priority in public health. This cross-sectional study on randomly selected medical students during their internship was conducted from July 2001 to April 2002 in order to determine the prevalence of major coronary artery disease (CAD risk factors. This survey was done by filling the questionnaire, measuring physical parameters, and taking a fasting blood sample. Two hundred and sixty four medical students were evaluated in this study (48 female, 216 male with the mean age of 26.5 ± 2.8 years. The main risk factors in descending order of frequency were physical inactivity (43.5%, low high-density lipoprotein cholesterol (26.2%, family history of premature CAD (15.9%, smoking (10.3%, abdominal obesity (10.2%, high triglyceride level (5.3%, high blood pressure (3.4%, and high low-density lipoprotein cholesterol (1.5%. Also, 25% of married females were using oral contraceptives regularly. The number of risk factors per person was 2.2 on average (1.1 in females and 2.5 in males. Prevalence of CAD risk factors in this medical students’ population was unacceptably high. Additional studies should be done to gather more information and determine the need for preventive, educational or curative interventions.

  16. Non-cardiac QTc-prolonging drugs and the risk of sudden cardiac death

    NARCIS (Netherlands)

    Straus, SMJM; Sturkenboom, MCJM; Bleumink, GS; van der Lei, J; de Graeff, PA; Kingma, JH; Stricker, BHC

    2005-01-01

    Aims To assess the association between the use of non-cardiac QTc-prolonging drugs and the risk of sudden cardiac death. Methods and results A population-based case-control study was performed in the Integrated Primary Care Information (IPCI) project, a longitudinal observational database with compl

  17. Risk assessment

    DEFF Research Database (Denmark)

    Pedersen, Liselotte; Rasmussen, Kirsten; Elsass, Peter

    2010-01-01

    ). All patients were assessed for risk of future violence utilizing a structured professional judgment model: the Historical-Clinical-Risk Management-20 (HCR-20) violence risk assessment scheme. After a follow-up period of 5.6 years, recidivism outcome were obtained from the Danish National Crime...... predictive of violent recidivism compared to static items. In sum, the findings support the use of structured professional judgment models of risk assessment and in particular the HCR-20 violence risk assessment scheme. Findings regarding the importance of the (clinical) structured final risk judgment......International research suggests that using formalized risk assessment methods may improve the predictive validity of professionals' predictions of risk of future violence. This study presents data on forensic psychiatric patients discharged from a forensic unit in Denmark in year 2001-2002 (n=107...

  18. Cardiac fibrillation risk of Taser weapons.

    Science.gov (United States)

    Leitgeb, Norbert

    2014-06-01

    The debate on potential health hazards associated with delivering electric discharges to incapacitated subjects, in particular on whether electric discharge weapons are lethal, less lethal or non-lethal, is still controversial. The cardiac fibrillation risks of Taser weapons X26 and X3 have been investigated by measuring the delivered high-tension pulses in dependence on load impedance. Excitation thresholds and sinus-to-Taser conversion factors have been determined by numerical modeling of endocardial, myocardial, and epicardial cells. Detailed quantitative assessment of cardiac electric exposure has been performed by numerical simulation at the normal-weighted anatomical model NORMAN. The impact of anatomical variation has been quantified at an overweight model (Visible Man), both with a spatial resolution of 2 × 2 × 2 mm voxels. Spacing and location of dart electrodes were systematically varied and the worst-case position determined. Based on volume-weighted cardiac exposure assessment, the fibrillation probability of the worst-case hit was determined to 30% (Taser X26) and 9% (Taser X3). The overall risk assessment of Taser application accounting for realistic spatial hit distributions was derived from training sessions of police officers under realistic scenarios and by accounting for the influence of body (over-)weight as well as gender. The analysis of the results showed that the overall fibrillation risk of Taser use is not negligible. It is higher at Taser X26 than at Taser X3 and amounts to about 1% for Europeans with an about 20% higher risk for Asians. Results demonstrate that enhancement as well as further reduction of fibrillation risk depends on responsible use or abuse of Taser weapons.

  19. Risk assessment

    Energy Technology Data Exchange (ETDEWEB)

    Gittus, J.H.

    1986-03-01

    The article deals with the calculation of risks, as applied to living near to a) a nuclear reactor or b) an industrial complex. The application of risk assessment techniques to the pressurised water reactor (PWR) is discussed with respect to: containment, frequencies of degraded core accidents, release of radioisotopes, consequences and risk to society, and uncertainties. The risk assessment for an industrial complex concerns the work of the Safety and Reliability Directorate for the chemical complex on Canvey Island. (U.K.).

  20. THE ASSESSMENT AND REDUCTION OF CARDIAC EVENTS RISK IN NONCARDIAC OPERATIONS: IS THERE A NEED FOR REVIEW OF RECOMMENDATIONS?

    Directory of Open Access Journals (Sweden)

    A. N. Sumin

    2013-01-01

    Full Text Available One of the pressing problems of modern cardiology is the cardiac complications risk evaluation and correction in noncardiac surgery. Recent international guidelines on this issue have focused on the pharmacological prevention of complications while reducing the preoperative examination and preventive revascularization. The reason for this experts position has been a series of studies DECREASE, performed in the Erasmus Medical Center (The Netherlands under the supervision of Professor D. Poldermans. However, this summer the results of these studies have found no scientific value because of the significant irregularities in their conduct. It makes to have a new look at the problem of perioperative medicine, to rethink the available scientific evidence. In this review we discussed in detail the use of beta-blockers in noncardiac surgery in view of new circumstances.

  1. THE ASSESSMENT AND REDUCTION OF CARDIAC EVENTS RISK IN NONCARDIAC OPERATIONS: IS THERE A NEED FOR REVIEW OF RECOMMENDATIONS?

    Directory of Open Access Journals (Sweden)

    A. N. Sumin

    2015-09-01

    Full Text Available One of the pressing problems of modern cardiology is the cardiac complications risk evaluation and correction in noncardiac surgery. Recent international guidelines on this issue have focused on the pharmacological prevention of complications while reducing the preoperative examination and preventive revascularization. The reason for this experts position has been a series of studies DECREASE, performed in the Erasmus Medical Center (The Netherlands under the supervision of Professor D. Poldermans. However, this summer the results of these studies have found no scientific value because of the significant irregularities in their conduct. It makes to have a new look at the problem of perioperative medicine, to rethink the available scientific evidence. In this review we discussed in detail the use of beta-blockers in noncardiac surgery in view of new circumstances.

  2. Risk factors of cardiac allograft vasculopathy.

    Science.gov (United States)

    Szyguła-Jurkiewicz, Bożena; Szczurek, Wioletta; Gąsior, Mariusz; Zembala, Marian

    2015-12-01

    Despite advances in prevention and treatment of heart transplant rejection, development of cardiac allograft vasculopathy (CAV) remains the leading factor limiting long-term survival of the graft. Cardiac allograft vasculopathy etiopathogenesis is not fully understood, but a significant role is attributed to endothelial cell damage, caused by immunological and non-immunological mechanisms. Immunological factors include the differences between the recipient's and the donor's HLA systems, the presence of alloreactive antibodies and episodes of acute rejection. Among the non-immunological factors the most important are the age of the donor, ischemia-reperfusion injury and cytomegalovirus infection. The classical cardiovascular risk factors (diabetes, hypertension, obesity and hyperlipidemia) are also important. This study presents an up-to-date overview of current knowledge on the vasculopathy etiopathogenesis and the role played by endothelium and inflammatory processes in CAV, and it also investigates the factors which may serve as risk markers of cardiac allograft vasculopathy.

  3. European Society of Cardiology 2009 guidelines for preoperative cardiac risk assessment and perioperative cardiac management in noncardiac surgery. Key messages for clinical practice

    Directory of Open Access Journals (Sweden)

    Sanne E. Hoeks

    2010-07-01

    Full Text Available Patients undergoing noncardiac surgery are at risk of adverse perioperative and long-term outcome. When considering a patient for noncardiac surgery, a careful preoperative clinical risk evaluation and subsequent risk-reduction strategies are essential to reduce postoperative complications. To assist physicians with decision making, clinical guidelines are developed. The aim of clinical guidelines is to improve patient care by providing recommendations about appropriate healthcare in specific circumstances. Development of clinical guidelines is an important component in improving the quality of care. By translating the best available scientific evidence into specific recommendations, guidelines can serve as a useful tool to achieve effective and efficient patient care. In 2009, the first European Society of Cardiology guidelines on perioperative care were developed. This decisionmaking process integrates clinical markers, early coronary evaluation, functional capacity, and the type of surgery involved.

  4. The relationship between Elder Risk Assessment (ERA scores and cardiac revascularization: a cohort study in Olmsted County, Minnesota, USA

    Directory of Open Access Journals (Sweden)

    Sharma S

    2013-09-01

    Full Text Available Saurabh Sharma,1 Shruti Datta,1 Shahyar Gharacholou,1,2 Shahzad K Siddique,3 Stephen S Cha,4 Paul Y Takahashi1,5,6 1Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA; 2Division of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA; 3Shifa International Hospital, Islamabad, Pakistan; 4Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; 5Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA; 6Kogod Center of Aging, Mayo Clinic, Rochester, MN, USA Purpose: The aging population is predisposed to cardiovascular disease. Our goal was to determine the relationship between a higher Elder Risk Assessment (ERA score and coronary artery bypass graft (CABG or percutaneous coronary intervention (PCI, in adults over 60 years. Methods: This was a retrospective cohort study in a primary care internal medicine practice. Patients included community-dwelling individuals aged 60 years or older on January 1, 2005. The primary outcome was a combined outcome of CABG and PCI in 2 years. The secondary outcome was mortality 5 years after CABG or PCI. The primary predictor variable was the score on the ERA Index, an instrument that predicts emergency room visits and hospitalization. The outcomes were obtained using administrative data from electronic medical records. The analysis included logistic regression, with odds ratios for the primary outcome and time-to-event analysis for mortality. Results: The records of 12,650 patients were studied. A total of 902 patients (7.1% had either CABG or PCI, with an average age of 74.5 years (±8.3 years. There were 205 patients (23% who experienced CABG or PCI in the highest-score group (top 10% compared with 29 patients (3% in the lowest score group, for an odds ratio of 15.4; 95% confidence interval, 10.1–23.5. There was a greater association of revascularization events by increasing score group. We noted increased mortality by increasing ERA score, in patients

  5. Assessing Depression in Cardiac Patients: What Measures Should Be Considered?

    Directory of Open Access Journals (Sweden)

    M. Ceccarini

    2014-01-01

    Full Text Available It is highly recommended to promptly assess depression in heart disease patients as it represents a crucial risk factor which may result in premature deaths following acute cardiac events and a more severe psychopathology, even in cases of subsequent nonfatal cardiac events. Patients and professionals often underestimate or misjudge depressive symptomatology as cardiac symptoms; hence, quick, reliable, and early mood changes assessments are warranted. Failing to detect depressive signals may have detrimental effects on these patients’ wellbeing and full recovery. Choosing gold-standard depression investigations in cardiac patients that fit a hospitalised cardiac setting well is fundamental. This paper will examine eight well established tools following Italian and international guidelines on mood disorders diagnosis in cardiac patients: the Hospital Anxiety and Depression Scale (HADS, the Cognitive Behavioural Assessment Hospital Form (CBA-H, the Beck Depression Inventory (BDI, the two and nine-item Patient Health Questionnaire (PHQ-2, PHQ-9, the Depression Interview and Structured Hamilton (DISH, the Hamilton Rating Scale for Depression (HAM-D/HRSD, and the Composite International Diagnostic Interview (CIDI. Though their strengths and weaknesses may appear to be homogeneous, the BDI-II and the PHQ are more efficient towards an early depression assessment within cardiac hospitalised patients.

  6. Controlled exposures to air pollutants and risk of cardiac arrhythmia

    NARCIS (Netherlands)

    Langrish, Jeremy P; Watts, Simon J; Hunter, Amanda J; Shah, Anoop S V; Bosson, Jenny A; Unosson, Jon; Barath, Stefan; Lundbäck, Magnus; Cassee, Flemming R; Donaldson, Ken; Sandström, Thomas; Blomberg, Anders; Newby, David E; Mills, Nicholas L

    2014-01-01

    BACKGROUND: Epidemiological studies have reported associations between air pollution exposure and increases in cardiovascular morbidity and mortality. Exposure to air pollutants can influence cardiac autonomic tone and reduce heart rate variability, and may increase the risk of cardiac arrhythmias,

  7. Risk factors and risk index of cardiac events in pregnant women with heart disease

    Institute of Scientific and Technical Information of China (English)

    LIU Hua; HUANG Tao-tao; LIN Jian-hua

    2012-01-01

    Background Pregnant women with heart disease are at high risk.Studies of risk factors of these patients are of great significance to improve maternal and fetal outcomes.In this paper,we try to discuss the main risk factors of cardiac events in pregnant women with heart disease and to establish a risk assessment system.Methods A retrospective analysis was carried out for pregnancies in 1741 women with heart disease who delivered in Shanghai Obstetrical Cardiology Intensive Care Center between January 1993 and September 2010.A Logistic regression model was used to identify independent risk factors of cardiac events and calculate the risk index in pregnant women with heart disease.Results The composition of heart disease in pregnant women was arrhythmia (n=662,38.00%),congenital heart disease (CHD; n=529,30.40%),cardiomyopathy (n=327,18.80%),rheumatic heart disease (RHD; n=151,8.70%),and cardiopathy induced by pre-eclampsia (n=53,3.00%).Main cardiac events were heart failure (n=110,6.32%),symptomatic arrhythmia needing medication (n=43,2.47%),cardiac arrest (n=2,0.11%),syncope (n=3,0.17%),and maternal death (n=10,0.57%).Six independent risk factors to predict cardiac events in pregnant women with heart disease were cardiac events before pregnancy (heart failure,severe arrhythmia,cardiac shock,etc.,P=0.000),New York Heart Association (NYHA) class >ll (P=0.000),oxygen saturation <90% (P=0.018),pulmonary artery hypertention (PAH)>50 mmHg (P=0.025),cyanotic heart disease without surgical correction (P=0.015),and reduced left ventricular systolic function (ejection fraction <40%,P=0.003).Every risk factor was calculated as 1 score.The incidence of cardiac events in patients with scores 0,1,2,3,and ≥4 was 2.10%,31.61%,61.25%,68.97%,and 100.00% respectively.Conclusions Pregnancy with heart disease could lead to undesirable pregnancy outcomes.The risk of cardiac events in pregnant women with heart disease could be assessed by risk

  8. Risk factors and the effect of cardiac resynchronization therapy on cardiac and non-cardiac mortality in MADIT-CRT

    DEFF Research Database (Denmark)

    Perkiomaki, Juha S; Ruwald, Anne-Christine; Kutyifa, Valentina;

    2015-01-01

    causes, 108 (63.9%) deemed cardiac, and 61 (36.1%) non-cardiac. In multivariate analysis, increased baseline creatinine was significantly associated with both cardiac and non-cardiac deaths [hazard ratio (HR) 2.97, P ...AIMS: To understand modes of death and factors associated with the risk for cardiac and non-cardiac deaths in patients with cardiac resynchronization therapy with implantable cardioverter-defibrillator (CRT-D) vs. implantable cardioverter-defibrillator (ICD) therapy, which may help clarify...... the action and limitations of cardiac resynchronization therapy (CRT) in relieving myocardial dysfunction. METHODS AND RESULTS: In Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT), during 4 years of follow-up, 169 (9.3%) of 1820 patients died of known...

  9. Cardiac morbidity risk and depression and anxiety

    DEFF Research Database (Denmark)

    Tully, Phillip J; Pedersen, Susanne S.; Winefield, Helen R

    2011-01-01

    The aim of this study was to examine depression and anxiety disorders and their characteristic symptoms (anhedonia/low positive affect and anxious arousal, respectively), along with measures of state negative affect (NA) and Type D personality, in relation to cardiac surgery related morbidity....... Patients awaiting elective coronary artery bypass graft surgery (n=158; 20.9% female; 11.4% concomitant valve surgery; age M=64.7, SD=10.6) underwent the structured MINI International Neuropsychiatric Interview to determine current affective disorders. Patients also completed the Mood and Anxiety Symptom...... analysis of personality traits revealed the NA component of Type D personality was associated with cardiac morbidity (OR=1.07, 95% CI 1.01-1.14, p=0.03). The Mood and Anxiety Symptom Questionnaire subscales were not associated with increased morbidity risk. Affective disorders, affective phenotypes...

  10. Ultrasound assessment of fetal cardiac function

    Science.gov (United States)

    Crispi, Fàtima; Valenzuela‐Alcaraz, Brenda; Cruz‐Lemini, Monica

    2015-01-01

    Abstract Introduction: Fetal heart evaluation with US is feasible and reproducible, although challenging due to the smallness of the heart, the high heart rate and limited access to the fetus. However, some cardiac parameters have already shown a strong correlation with outcomes and may soon be incorporated into clinical practice. Materials and Methods: Cardiac function assessment has proven utility in the differential diagnosis of cardiomyopathies or prediction of perinatal mortality in congenital heart disease. In addition, some cardiac parameters with high sensitivity such as MPI or annular peak velocities have shown promising results in monitoring and predicting outcome in intrauterine growth restriction or congenital diaphragmatic hernia. Conclusion: Cardiac function can be adequately evaluated in most fetuses when appropriate expertise, equipment and time are available. Fetal cardiac function assessment is a promising tool that may soon be incorporated into clinical practice to diagnose, monitor or predict outcome in some fetal conditions. Thus, more research is warranted to further define specific protocols for each fetal condition that may affect cardiac function. PMID:28191192

  11. Assessment of cardiac sympathetic nerve integrity with positron emission tomography

    Energy Technology Data Exchange (ETDEWEB)

    Raffel, David M. E-mail: raffel@umich.edu; Wieland, Donald M

    2001-07-01

    The autonomic nervous system plays a critical role in the regulation of cardiac function. Abnormalities of cardiac innervation have been implicated in the pathophysiology of many heart diseases, including sudden cardiac death and congestive heart failure. In an effort to provide clinicians with the ability to regionally map cardiac innervation, several radiotracers for imaging cardiac sympathetic neurons have been developed. This paper reviews the development of neuronal imaging agents and discusses their emerging role in the noninvasive assessment of cardiac sympathetic innervation.

  12. I-123-mIBG myocardial imaging for assessment of risk for a major cardiac event in heart failure patients: insights from a retrospective European multicenter study

    Energy Technology Data Exchange (ETDEWEB)

    Agostini, Denis [CHU Cote de Nacre, Caen (France); Verberne, Hein J. [Academic Medical Centre, Amsterdam (Netherlands); Burchert, Wolfgang [Ruhr University Bochum, Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center NRW, Bad Oeyenhausen (Germany); Knuuti, Juhani [Turku University Central Hospital, Turku (Finland); Povinec, Pavol [Comenius University School of Medicine, Bratislava (Slovakia); Sambuceti, Gianmario [University of Genova, Genova (Italy); Unlu, Mustafa [Gazi University, Ankara (Turkey); Estorch, Montserrat [Hospital Sant Pau, Barcelona (Spain); Banerjee, Gopa; Jacobson, Arnold F. [GE Healthcare, Princeton, NJ (United States)

    2008-03-15

    Single-center experiences have shown that myocardial meta-iodobenzylguanidine (mIBG) uptake has prognostic value in heart failure (HF) patients. To verify these observations using a rigorous clinical trial methodology, a retrospective review and prospective quantitative reanalysis was performed on a series of cardiac {sup 123}I-mIBG scans acquired during a 10-year period at six centers in Europe. {sup 123}I-mIBG scans obtained on 290 HF patients [(262 with left ventricular ejection fraction (LVEF) < 50%)] from 1993 to 2002 were reanalyzed using a standardized methodology to determine the heart-to-mediastinum ratio (H/M) on delayed planar images. All image results were verified by three independent reviewers. Major cardiac events [MCEs; cardiac death, cardiac transplant, potentially fatal arrhythmia (including implantable cardioverter-defibrillator discharge)] during 24-month follow-up were confirmed by an adjudication committee. MCEs occurred in 67 patients (26%): mean H/M ratio was 1.51 {+-} 0.30 for the MCE group and 1.97 {+-} 0.54 for the non-MCE group (p < 0.001). Two-year event-free survival using an optimum H/M ratio threshold of 1.75 was 62% for H/M ratio less than 1.75, 95% for H/M ratio greater than or equal to 1.75 (p < 0.0001). Logistic regression showed H/M ratio and LVEF as the only significant predictors of MCE. Using the lower and upper H/M quartiles of 1.45 and 2.17 as high- and very low-risk thresholds, 2-year event-free survival rates were 52% and 98%, respectively. Among patients with LVEF {<=} 35% and H/M {>=} 1.75 (n = 73), there were nine MCEs because of progressive HF and only one because of an arrhythmia. Application of a clinical trial methodology via the retrospective reanalysis of {sup 123}I-mIBG images confirms the previously reported prognostic value of this method in HF patients, including potential identification of a quantitative threshold for low risk for cardiac mortality and potentially fatal ventricular arrhythmias. (orig.)

  13. Cardiac imaging for the assessment of patients being evaluated for kidney or liver transplantation.

    Science.gov (United States)

    Parikh, Kalindi; Appis, Andrew; Doukky, Rami

    2015-04-01

    Cardiac risk assessment prior to kidney and liver transplantation is controversial. Given the paucity of available organs, selecting appropriate recipients with favorable short- and long-term cardiovascular risk profile is crucial. Using noninvasive cardiac imaging tools to guide cardiovascular risk assessment and management can also be challenging and controversial. In this article, we address the burden of coronary artery disease among kidney and liver transplant candidates and review the literature pertaining to the diagnostic accuracy and the prognostic value of noninvasive cardiac imaging techniques in this population.

  14. Exploration Health Risks: Probabilistic Risk Assessment

    Science.gov (United States)

    Rhatigan, Jennifer; Charles, John; Hayes, Judith; Wren, Kiley

    2006-01-01

    Maintenance of human health on long-duration exploration missions is a primary challenge to mission designers. Indeed, human health risks are currently the largest risk contributors to the risks of evacuation or loss of the crew on long-duration International Space Station missions. We describe a quantitative assessment of the relative probabilities of occurrence of the individual risks to human safety and efficiency during space flight to augment qualitative assessments used in this field to date. Quantitative probabilistic risk assessments will allow program managers to focus resources on those human health risks most likely to occur with undesirable consequences. Truly quantitative assessments are common, even expected, in the engineering and actuarial spheres, but that capability is just emerging in some arenas of life sciences research, such as identifying and minimize the hazards to astronauts during future space exploration missions. Our expectation is that these results can be used to inform NASA mission design trade studies in the near future with the objective of preventing the higher among the human health risks. We identify and discuss statistical techniques to provide this risk quantification based on relevant sets of astronaut biomedical data from short and long duration space flights as well as relevant analog populations. We outline critical assumptions made in the calculations and discuss the rationale for these. Our efforts to date have focussed on quantifying the probabilities of medical risks that are qualitatively perceived as relatively high risks of radiation sickness, cardiac dysrhythmias, medically significant renal stone formation due to increased calcium mobilization, decompression sickness as a result of EVA (extravehicular activity), and bone fracture due to loss of bone mineral density. We present these quantitative probabilities in order-of-magnitude comparison format so that relative risk can be gauged. We address the effects of

  15. Increased risk of sudden cardiac arrest in obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Warnier, Miriam Jacoba; Blom, Marieke Tabo; Bardai, Abdennasser;

    2013-01-01

    BACKGROUND: We aimed to determine whether (1) patients with obstructive pulmonary disease (OPD) have an increased risk of sudden cardiac arrest (SCA) due to ventricular tachycardia or fibrillation (VT/VF), and (2) the SCA risk is mediated by cardiovascular risk-profile and/or respiratory drug use...... with electrocardiographic documentation of VT/VF were included. Conditional logistic regression analysis was used to assess the association between SCA and OPD. Pre-specified subgroup analyses were performed regarding age, sex, cardiovascular risk-profile, disease severity, and current use of respiratory drugs. RESULTS......: A higher risk of SCA was observed in patients with OPD (n = 190 cases [15%], 622 controls [11%]) than in those without OPD (OR adjusted for cardiovascular risk-profile 1.4 [1.2-1.6]). In OPD patients with a high cardiovascular risk-profile (OR 3.5 [2.7-4.4]) a higher risk of SCA was observed than in those...

  16. Pipeline risk assessment

    Energy Technology Data Exchange (ETDEWEB)

    Kariyawasam, S. [TransCanada PipeLines Ltd., Calgary, AB (Canada); Weir, D. [Enbridge Pipelines Inc., Calgary, AB (Canada)] (comps.)

    2009-07-01

    Risk assessments and risk analysis are system-wide activities that include site-specific risk and reliability-based decision-making, implementation, and monitoring. This working group discussed the risk management process in the pipeline industry, including reliability-based integrity management and risk control processes. Attendants at the group discussed reliability-based decision support and performance measurements designed to support corporate risk management policies. New developments and technologies designed to optimize risk management procedures were also presented. The group was divided into 3 sessions: (1) current practice, strengths and limitations of system-wide risk assessments for facility assets; (2) accounting for uncertainties to assure safety; and (3) reliability based excavation repair criteria and removing potentially unsafe corrosion defects. Presentations of risk assessment procedures used at various companies were given. The role of regulators, best practices, and effective networking environments in ensuring the success of risk assessment policies was discussed. Risk assessment models were also reviewed.

  17. Current Roles and Future Applications of Cardiac CT: Risk Stratification of Coronary Artery Disease

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Yeonyee Elizabeth [Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam 463-707 (Korea, Republic of); Lim, Tae-Hwan [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736 (Korea, Republic of)

    2014-07-01

    Cardiac computed tomography (CT) has emerged as a noninvasive modality for the assessment of coronary artery disease (CAD), and has been rapidly integrated into clinical cares. CT has changed the traditional risk stratification based on clinical risk to image-based identification of patient risk. Cardiac CT, including coronary artery calcium score and coronary CT angiography, can provide prognostic information and is expected to improve risk stratification of CAD. Currently used conventional cardiac CT, provides accurate anatomic information but not functional significance of CAD, and it may not be sufficient to guide treatments such as revascularization. Recently, myocardial CT perfusion imaging, intracoronary luminal attenuation gradient, and CT-derived computed fractional flow reserve were developed to combine anatomical and functional data. Although at present, the diagnostic and prognostic value of these novel technologies needs to be evaluated further, it is expected that all-in-one cardiac CT can guide treatment and improve patient outcomes in the near future.

  18. Athletes at Risk for Sudden Cardiac Death

    Science.gov (United States)

    Subasic, Kim

    2010-01-01

    High school athletes represent the largest group of individuals affected by sudden cardiac death, with an estimated incidence of once or twice per week. Structural cardiovascular abnormalities are the most frequent cause of sudden cardiac death. Athletes participating in basketball, football, track, soccer, baseball, and swimming were found to…

  19. Assessment of cardiovascular risk.

    LENUS (Irish Health Repository)

    Cooney, Marie Therese

    2010-10-01

    Atherosclerotic cardiovascular disease (CVD) is the most common cause of death worldwide. Usually atherosclerosis is caused by the combined effects of multiple risk factors. For this reason, most guidelines on the prevention of CVD stress the assessment of total CVD risk. The most intensive risk factor modification can then be directed towards the individuals who will derive the greatest benefit. To assist the clinician in calculating the effects of these multiple interacting risk factors, a number of risk estimation systems have been developed. This review address several issues regarding total CVD risk assessment: Why should total CVD risk be assessed? What risk estimation systems are available? How well do these systems estimate risk? What are the advantages and disadvantages of the current systems? What are the current limitations of risk estimation systems and how can they be resolved? What new developments have occurred in CVD risk estimation?

  20. GM Risk Assessment

    Science.gov (United States)

    Sparrow, Penny A. C.

    GM risk assessments play an important role in the decision-making process surrounding the regulation, notification and permission to handle Genetically Modified Organisms (GMOs). Ultimately the role of a GM risk assessment will be to ensure the safe handling and containment of the GMO; and to assess any potential impacts on the environment and human health. A risk assessment should answer all ‘what if’ scenarios, based on scientific evidence.

  1. Elite Athletes experiences with risk related to Cardiac Screening

    DEFF Research Database (Denmark)

    Christensen, Jonas Schmidt; Thing, Lone Friis

    Elite Athletes experiences with risks related to Cardiac Screening Jonas Schmidt Christensen1, Lone Friis Thing1 1University of Copenhagen - Department of Nutrition, Exercise and Sports (NEXS), Cardiac screening of elite athletes are recommended by both the American Heart Association & the European...... is dominated by studies with a clinical medical focus and studies of athlete’s perspectives on cardiac screening are consequently an absence. By using an interpretive sociological perspective (Denzin 2001) and qualitative research done with elite athletes of both gender this paper seeks to explore how elite...... athletes experience risks associated with cardiac screening. To make possible an analysis of how elite athletes come to an understanding of and position themselves in relation to the risk discourse (Lupton 2013) they are met by, the focus is on Foucault’s technologies of the self and a subjectivity...

  2. Effects of Lifestyle Modification Programs on Cardiac Risk Factors

    Science.gov (United States)

    Razavi, Moaven; Fournier, Stephen; Shepard, Donald S.; Ritter, Grant; Strickler, Gail K.; Stason, William B.

    2014-01-01

    Medicare conducted a payment demonstration to evaluate the effectiveness of two intensive lifestyle modification programs in patients with symptomatic coronary artery disease: the Dr. Dean Ornish Program for Reversing Heart Disease (Ornish) and Cardiac Wellness Program of the Benson-Henry Mind Body Institute. This report describes the changes in cardiac risk factors achieved by each program during the active intervention year and subsequent year of follow-up. The demonstration enrolled 580 participants who had had an acute myocardial infarction, had undergone coronary artery bypass graft surgery or percutaneous coronary intervention within 12 months, or had documented stable angina pectoris. Of these, 98% completed the intense 3-month intervention, 71% the 12-month intervention, and 56% an additional follow-up year. Most cardiac risk factors improved significantly during the intense intervention period in both programs. Favorable changes in cardiac risk factors and functional cardiac capacity were maintained or improved further at 12 and 24 months in participants with active follow-up. Multivariable regressions found that risk-factor improvements were positively associated with abnormal baseline values, Ornish program participation for body mass index and systolic blood pressure, and with coronary artery bypass graft surgery. Expressed levels of motivation to lose weight and maintain weight loss were significant independent predictors of sustained weight loss (p = 0.006). Both lifestyle modification programs achieved well-sustained reductions in cardiac risk factors. PMID:25490202

  3. Effects of lifestyle modification programs on cardiac risk factors.

    Directory of Open Access Journals (Sweden)

    Moaven Razavi

    Full Text Available Medicare conducted a payment demonstration to evaluate the effectiveness of two intensive lifestyle modification programs in patients with symptomatic coronary artery disease: the Dr. Dean Ornish Program for Reversing Heart Disease (Ornish and Cardiac Wellness Program of the Benson-Henry Mind Body Institute. This report describes the changes in cardiac risk factors achieved by each program during the active intervention year and subsequent year of follow-up. The demonstration enrolled 580 participants who had had an acute myocardial infarction, had undergone coronary artery bypass graft surgery or percutaneous coronary intervention within 12 months, or had documented stable angina pectoris. Of these, 98% completed the intense 3-month intervention, 71% the 12-month intervention, and 56% an additional follow-up year. Most cardiac risk factors improved significantly during the intense intervention period in both programs. Favorable changes in cardiac risk factors and functional cardiac capacity were maintained or improved further at 12 and 24 months in participants with active follow-up. Multivariable regressions found that risk-factor improvements were positively associated with abnormal baseline values, Ornish program participation for body mass index and systolic blood pressure, and with coronary artery bypass graft surgery. Expressed levels of motivation to lose weight and maintain weight loss were significant independent predictors of sustained weight loss (p = 0.006. Both lifestyle modification programs achieved well-sustained reductions in cardiac risk factors.

  4. Quantitative microbiological risk assessment.

    Science.gov (United States)

    Hoornstra, E; Notermans, S

    2001-05-21

    The production of safe food is being increasingly based on the use of risk analysis, and this process is now in use to establish national and international food safety objectives. It is also being used more frequently to guarantee that safety objectives are met and that such guarantees are achieved in a cost-effective manner. One part of the overall risk analysis procedure-risk assessment-is the scientific process in which the hazards and risk factors are identified, and the risk estimate or risk profile is determined. Risk assessment is an especially important tool for governments when food safety objectives have to be developed in the case of 'new' contaminants in known products or known contaminants causing trouble in 'new' products. Risk assessment is also an important approach for food companies (i) during product development, (ii) during (hygienic) process optimalization, and (iii) as an extension (validation) of the more qualitative HACCP-plan. This paper discusses these two different types of risk assessment, and uses probability distribution functions to assess the risks posed by Escherichia coli O157:H7 in each case. Such approaches are essential elements of risk management, as they draw on all available information to derive accurate and realistic estimations of the risk posed. The paper also discusses the potential of scenario-analysis in simulating the impact of different or modified risk factors during the consideration of new or improved control measures.

  5. Risk Assessment Overview

    Science.gov (United States)

    Prassinos, Peter G.; Lyver, John W., IV; Bui, Chinh T.

    2011-01-01

    Risk assessment is used in many industries to identify and manage risks. Initially developed for use on aeronautical and nuclear systems, risk assessment has been applied to transportation, chemical, computer, financial, and security systems among others. It is used to gain an understanding of the weaknesses or vulnerabilities in a system so modification can be made to increase operability, efficiency, and safety and to reduce failure and down-time. Risk assessment results are primary inputs to risk-informed decision making; where risk information including uncertainty is used along with other pertinent information to assist management in the decision-making process. Therefore, to be useful, a risk assessment must be directed at specific objectives. As the world embraces the globalization of trade and manufacturing, understanding the associated risk become important to decision making. Applying risk assessment techniques to a global system of development, manufacturing, and transportation can provide insight into how the system can fail, the likelihood of system failure and the consequences of system failure. The risk assessment can identify those elements that contribute most to risk and identify measures to prevent and mitigate failures, disruptions, and damaging outcomes. In addition, risk associated with public and environment impact can be identified. The risk insights gained can be applied to making decisions concerning suitable development and manufacturing locations, supply chains, and transportation strategies. While risk assessment has been mostly applied to mechanical and electrical systems, the concepts and techniques can be applied across other systems and activities. This paper provides a basic overview of the development of a risk assessment.

  6. Biosafety Risk Assessment Methodology

    Energy Technology Data Exchange (ETDEWEB)

    Caskey, Susan Adele [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). International Biological Threat Reduction Program; Gaudioso, Jennifer M. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). International Biological Threat Reduction Program; Salerno, Reynolds Mathewson [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). International Biological Threat Reduction Program; Wagner, Stefan M. [Public Health Agency of Canada, Winnipeg, MB (Canada). Canadian Science Centre for Human and Animal Health (CSCHAH); Shigematsu, Mika [National Inst. of Infectious Diseases (NIID), Tokyo (Japan); Risi, George [Infectious Disease Specialists, P.C, Missoula, MT (United States); Kozlovac, Joe [US Dept. of Agriculture (USDA)., Beltsville, MD (United States); Halkjaer-Knudsen, Vibeke [Statens Serum Inst., Copenhagen (Denmark); Prat, Esmeralda [Bayer CropScience, Monheim am Rhein (Germany)

    2010-10-01

    Laboratories that work with biological agents need to manage their safety risks to persons working the laboratories and the human and animal community in the surrounding areas. Biosafety guidance defines a wide variety of biosafety risk mitigation measures, which include measures which fall under the following categories: engineering controls, procedural and administrative controls, and the use of personal protective equipment; the determination of which mitigation measures should be used to address the specific laboratory risks are dependent upon a risk assessment. Ideally, a risk assessment should be conducted in a manner which is standardized and systematic which allows it to be repeatable and comparable. A risk assessment should clearly define the risk being assessed and avoid over complication.

  7. Offshore risk assessment

    CERN Document Server

    Vinnem, Jan-Erik

    2014-01-01

      Offshore Risk Assessment was the first book to deal with quantified risk assessment (QRA) as applied specifically to offshore installations and operations. Risk assessment techniques have been used for more than three decades in the offshore oil and gas industry, and their use is set to expand increasingly as the industry moves into new areas and faces new challenges in older regions.   This updated and expanded third edition has been informed by a major R&D program on offshore risk assessment in Norway and summarizes research from 2006 to the present day. Rooted with a thorough discussion of risk metrics and risk analysis methodology,  subsequent chapters are devoted to analytical approaches to escalation, escape, evacuation and rescue analysis of safety and emergency systems.   Separate chapters analyze the main hazards of offshore structures: fire, explosion, collision, and falling objects as well as structural and marine hazards. Risk mitigation and control are discussed, as well as an illustrat...

  8. Cardiac cell proliferation assessed by EdU, a novel analysis of cardiac regeneration.

    Science.gov (United States)

    Zeng, Bin; Tong, Suiyang; Ren, Xiaofeng; Xia, Hao

    2016-08-01

    Emerging evidence suggests that mammalian hearts maintain the capacity for cardiac regeneration. Rapid and sensitive identification of cardiac cellular proliferation is prerequisite for understanding the underlying mechanisms and strategies of cardiac regeneration. The following immunologically related markers of cardiac cells were analyzed: cardiac transcription factors Nkx2.5 and Gata 4; specific marker of cardiomyocytes TnT; endothelial cell marker CD31; vascular smooth muscle marker smooth muscle myosin IgG; cardiac resident stem cells markers IsL1, Tbx18, and Wt1. Markers were co-localized in cardiac tissues of embryonic, neonatal, adult, and pathological samples by 5-ethynyl-2'-deoxyuridine (EdU) staining. EdU was also used to label isolated neonatal cardiomyocytes in vitro. EdU robustly labeled proliferating cells in vitro and in vivo, co-immunostaining with different cardiac cells markers. EdU can rapidly and sensitively label proliferating cardiac cells in developmental and pathological states. Cardiac cell proliferation assessed by EdU is a novel analytical tool for investigating the mechanism and strategies of cardiac regeneration in response to injury.

  9. Age-specific performance of the revised cardiac risk index for predicting cardiovascular risk in elective noncardiac surgery

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Wissenberg, Mads; Jørgensen, Mads Emil;

    2015-01-01

    BACKGROUND: The revised cardiac risk index (RCRI) holds a central role in preoperative cardiac risk stratification in noncardiac surgery. Its performance in unselected populations, including different age groups, has, however, not been systematically investigated. We assessed the relationship......%, 71%, 64%, 66%, and 67% in patients aged ≤ 55, 56 to 65, 66 to 75, 76 to 85, and >85 years, respectively; the negative predictive values were >98% across all age groups. CONCLUSIONS: In a nationwide unselected cohort, the performance of the RCRI was similar to that of the original cohort. Having ≥ 1...

  10. Common variation in fatty acid metabolic genes and risk of incident sudden cardiac arrest

    NARCIS (Netherlands)

    R.N. Lemaitre (Rozenn ); C.O. Johnson (Catherine); S. Hesselson (Stephanie); N. Sotoodhenia (Nona); B. McKnight (Barbara); C.M. Sitlani (Colleen); D. Rea (Dan); I.B. King (Irena); P.-Y. Kwok (Pui-Yan); A. Mak (Angel); G. Li (Guo); J. Brody (Jennifer); E.B. Larson (Eric); D. Mozaffarian (Dariush); B.M. Psaty (Bruce); A. Huertas-Vazquez (Adriana); J.-C. Tardif (Jean-Claude); C.M. Albert (Christine); L.-P. Lyytikäinen (Leo-Pekka); D.E. Arking (Dan); S. Kääb (Stefan); H.V. Huikuri (Heikki); B.P. Krijthe (Bouwe); M. Eijgelsheim (Mark); Y.A. Wang (Ying); K. Reinier (Kyndaron); T. Lehtimäki (Terho); S.L. Pulit (Sara); R. Brugada (Ramon); M. Müller-Nurasyid (Martina); C. Newton-Cheh (Christopher); P.J. Karhunen (Pekka); B.H.Ch. Stricker (Bruno); P. Goyette (Philippe); J.I. Rotter (Jerome); S.S. Chugh (Sumeet); A. Chakravarti (Aravinda); X. Jouven (Xavier); D.S. Siscovick (David)

    2014-01-01

    textabstractBackground There is limited information on genetic factors associated with sudden cardiac arrest (SCA). Objective To assess the association of common variation in genes in fatty acid pathways with SCA risk. Methods We selected 85 candidate genes and 1155 single nucleotide polymorphisms (

  11. Determinants of Left Ventricular Mass and Hypertrophy in Hemodialysis Patients Assessed by Cardiac Magnetic Resonance Imaging

    OpenAIRE

    Patel, Rajan K.; Oliver, Scott; Mark, Patrick B.; Powell, Joanna R.; Emily P. McQuarrie; Traynor, James P.; Dargie, Henry J.; Jardine, Alan G.

    2009-01-01

    Background and objectives: Left ventricular hypertrophy (LVH) is an independent risk factor for premature cardiovascular death in hemodialysis (HD) patients and one of the three forms of uremic cardiomyopathy. Cardiovascular magnetic resonance (CMR) is a volume-independent technique to assess cardiac structure. We used CMR to assess the determinants of left ventricular mass (LVM) and LVH in HD patients.

  12. Landslide risk assessment

    Science.gov (United States)

    Lessing, P.; Messina, C.P.; Fonner, R.F.

    1983-01-01

    Landslide risk can be assessed by evaluating geological conditions associated with past events. A sample of 2,4 16 slides from urban areas in West Virginia, each with 12 associated geological factors, has been analyzed using SAS computer methods. In addition, selected data have been normalized to account for areal distribution of rock formations, soil series, and slope percents. Final calculations yield landslide risk assessments of 1.50=high risk. The simplicity of the method provides for a rapid, initial assessment prior to financial investment. However, it does not replace on-site investigations, nor excuse poor construction. ?? 1983 Springer-Verlag New York Inc.

  13. Patient caries risk assessment

    DEFF Research Database (Denmark)

    Twetman, Svante; Fontana, Margherita

    2009-01-01

    Risk assessment is an essential component in the decision-making process for the correct prevention and management of dental caries. Multiple risk factors and indicators have been proposed as targets in the assessment of risk of future disease, varying sometimes based on the age group at which...... for prediction purposes, as measured until now in the literature, is at best questionable in schoolchildren, adolescents and adults. That is not to say these additional factors should not be assessed to help understand the strength of their associations with the disease experience in a particular patient......, and aid in the development of an individualized and targeted preventive and management plan....

  14. Controlled Exposures to Air Pollutants and Risk of Cardiac Arrhythmia

    Science.gov (United States)

    Watts, Simon J.; Hunter, Amanda J.; Shah, Anoop S.V.; Bosson, Jenny A.; Unosson, Jon; Barath, Stefan; Lundbäck, Magnus; Cassee, Flemming R.; Donaldson, Ken; Sandström, Thomas; Blomberg, Anders; Newby, David E.; Mills, Nicholas L.

    2014-01-01

    Background: Epidemiological studies have reported associations between air pollution exposure and increases in cardiovascular morbidity and mortality. Exposure to air pollutants can influence cardiac autonomic tone and reduce heart rate variability, and may increase the risk of cardiac arrhythmias, particularly in susceptible patient groups. Objectives: We investigated the incidence of cardiac arrhythmias during and after controlled exposure to air pollutants in healthy volunteers and patients with coronary heart disease. Methods: We analyzed data from 13 double-blind randomized crossover studies including 282 participants (140 healthy volunteers and 142 patients with stable coronary heart disease) from whom continuous electrocardiograms were available. The incidence of cardiac arrhythmias was recorded for each exposure and study population. Results: There were no increases in any cardiac arrhythmia during or after exposure to dilute diesel exhaust, wood smoke, ozone, concentrated ambient particles, engineered carbon nanoparticles, or high ambient levels of air pollution in either healthy volunteers or patients with coronary heart disease. Conclusions: Acute controlled exposure to air pollutants did not increase the short-term risk of arrhythmia in participants. Research employing these techniques remains crucial in identifying the important pathophysiological pathways involved in the adverse effects of air pollution, and is vital to inform environmental and public health policy decisions. Citation: Langrish JP, Watts SJ, Hunter AJ, Shah AS, Bosson JA, Unosson J, Barath S, Lundbäck M, Cassee FR, Donaldson K, Sandström T, Blomberg A, Newby DE, Mills NL. 2014. Controlled exposures to air pollutants and risk of cardiac arrhythmia. Environ Health Perspect 122:747–753; http://dx.doi.org/10.1289/ehp.1307337 PMID:24667535

  15. Microbiological Quantitative Risk Assessment

    Science.gov (United States)

    Dominguez, Silvia; Schaffner, Donald W.

    The meat and poultry industry faces ongoing challenges due to the natural association of pathogens of concern (e.g., Salmonella, Campylobacter jejuni, Escherichia coli O157:H7) with a variety of domesticated food animals. In addition, pathogens such as Listeria monocytogenes pose a significant cross-contamination risk during further meat and poultry processing, distribution, and storage. Furthermore, the meat and poultry industries are constantly changing with the addition of new products, use of new raw materials, and targeting of new consumer populations, each of which may give rise to potential new risks. National and international regulations are increasingly using a “risk-based” approach to food safety (where the regulatory focus is driven by the magnitude of the risk), so risk assessment is becoming a valuable tool to systematically organize and evaluate the potential public health risk posed by food processing operations.

  16. Microbial Risk Assessment

    Science.gov (United States)

    Ott, C. M.; Mena, K. D.; Nickerson, C.A.; Pierson, D. L.

    2009-01-01

    Historically, microbiological spaceflight requirements have been established in a subjective manner based upon expert opinion of both environmental and clinical monitoring results and the incidence of disease. The limited amount of data, especially from long-duration missions, has created very conservative requirements based primarily on the concentration of microorganisms. Periodic reevaluations of new data from later missions have allowed some relaxation of these stringent requirements. However, the requirements remain very conservative and subjective in nature, and the risk of crew illness due to infectious microorganisms is not well defined. The use of modeling techniques for microbial risk has been applied in the food and potable water industries and has exceptional potential for spaceflight applications. From a productivity standpoint, this type of modeling can (1) decrease unnecessary costs and resource usage and (2) prevent inadequate or inappropriate data for health assessment. In addition, a quantitative model has several advantages for risk management and communication. By identifying the variable components of the model and the knowledge associated with each component, this type of modeling can: (1) Systematically identify and close knowledge gaps, (2) Systematically identify acceptable and unacceptable risks, (3) Improve communication with stakeholders as to the reasons for resource use, and (4) Facilitate external scientific approval of the NASA requirements. The modeling of microbial risk involves the evaluation of several key factors including hazard identification, crew exposure assessment, dose-response assessment, and risk characterization. Many of these factors are similar to conditions found on Earth; however, the spaceflight environment is very specialized as the inhabitants live in a small, semi-closed environment that is often dependent on regenerative life support systems. To further complicate modeling efforts, microbial dose

  17. Validity of Type D personality in Iceland: association with disease severity and risk markers in cardiac patients.

    Science.gov (United States)

    Svansdottir, Erla; Karlsson, Hrobjartur D; Gudnason, Thorarinn; Olason, Daniel T; Thorgilsson, Hordur; Sigtryggsdottir, Unnur; Sijbrands, Eric J; Pedersen, Susanne S; Denollet, Johan

    2012-04-01

    Type D personality has been associated with poor prognosis in cardiac patients. This study investigated the validity of the Type D construct in Iceland and its association with disease severity and health-related risk markers in cardiac patients. A sample of 1,452 cardiac patients completed the Type D scale (DS14), and a subgroup of 161 patients completed measurements for the five-factor model of personality, emotional control, anxiety, depression, stress and lifestyle factors. The Icelandic DS14 had good psychometric properties and its construct validity was confirmed. Prevalence of Type D was 26-29%, and assessment of Type D personality was not confounded by severity of underlying coronary artery disease. Regarding risk markers, Type D patients reported more psychopharmacological medication use and smoking, but frequency of previous mental problems was similar across groups. Type D is a valid personality construct in Iceland, and is associated with health-related risk markers, but not cardiac disease severity.

  18. Methylmercury risk assessment issues

    Energy Technology Data Exchange (ETDEWEB)

    Lipfert, F.W. [Brookhaven National Lab., Upton, NY (United States); Saroff, L. [USDOE, Washington, DC (United States)

    1996-07-01

    This paper reviews the general background of health risks associated with mercury (Hg), primarily methylmercury (MeHg), with a view towards application to advanced technologies that could reduce any contributions from coal combustion. The need for accurate assessment of such risks is discussed, since Hg is now widely dispersed in the environment and cannot easily be eliminated. The primary pathway of MeHg intake is through eating contaminated fish. The issues of concern include identification of critical health outcomes (various neurological indices) and their confounding factors, accurate assessment of MeHg intake rates, and appropriate use of dose-response functions. Ultimately, such information will be used to evaluate alternative coal combustion systems.

  19. Surgery Risk Assessment (SRA) Database

    Data.gov (United States)

    Department of Veterans Affairs — The Surgery Risk Assessment (SRA) database is part of the VA Surgical Quality Improvement Program (VASQIP). This database contains assessments of selected surgical...

  20. Risk assessment in travel medicine.

    Science.gov (United States)

    Leggat, Peter A

    2006-01-01

    Risk assessment is an integral part of pre-travel and post- assessment. Risk assessment largely determines what health and safety advice and interventions are given within the relevant prevailing travel health guidelines. Risk assessment needs time and depends on information, including that given by the traveller. Risk assessment also needs to be documented. Risk assessment of the traveller preferably starts before they enter the consulting room, where travellers may complete a pre-travel health questionnaire. Armed with this information, risk assessment may be assisted by access to computerised travel health databases and the published literature. Experience of travel to the destination may also assist in risk assessment and the tour operator, overseas employer or agency, the traveller or even the travel health advisers themselves may provide this information.

  1. Cardiac causes of pulmonary arterial hypertension: assessment with multidetector CT

    Energy Technology Data Exchange (ETDEWEB)

    Hoey, Edward T.D.; Gopalan, Deepa; Agrawal, S.K.B. [Papworth Hospital, Cambridge (United Kingdom); Screaton, Nicholas J. [Papworth Hospital, Cambridge (United Kingdom); Papworth Hospital NHS Trust, Diagnostic Centre, Department of Radiology, Papworth Everard, Cambridgeshire (United Kingdom)

    2009-11-15

    The causes of pulmonary arterial hypertension (PAH) are diverse and include multiple congenital and acquired cardiac diseases as well as diseases primarily affecting the pulmonary vasculature, lung, pleura and chest wall. The traditional role of CT in evaluating PAH includes assessment of pulmonary vasculature and lung parenchyma with limited assessment of the heart. Advances in multidetector CT technology with improved spatial and temporal resolution now permit accurate delineation of cardiac morphology. CT pulmonary angiography (CTPA) is widely utilised in the workup of patients with suspected pulmonary vascular disease and can identify both pulmonary and cardiac causes. As the initial presentation for CTPA is often precipitated by nonspecific, unexplained symptoms and therefore undertaken by a general radiologist, it is important that a systematic approach to the interpretation of these studies, including cardiac evaluation, is routinely adopted. This paper reviews the CT evaluation in pulmonary hypertension with a particular focus on the cardiac causes, their subclassification into congenital systemic to pulmonary shunts and secondary to left heart disease, and their imaging features. It emphasises the use of a systematic approach to interpretation of CTPA examinations both in patients with known PAH and those with previously unsuspected disease. (orig.)

  2. Risk assessment and risk management of mycotoxins.

    Science.gov (United States)

    2012-01-01

    Risk assessment is the process of quantifying the magnitude and exposure, or probability, of a harmful effect to individuals or populations from certain agents or activities. Here, we summarize the four steps of risk assessment: hazard identification, dose-response assessment, exposure assessment, and risk characterization. Risk assessments using these principles have been conducted on the major mycotoxins (aflatoxins, fumonisins, ochratoxin A, deoxynivalenol, and zearalenone) by various regulatory agencies for the purpose of setting food safety guidelines. We critically evaluate the impact of these risk assessment parameters on the estimated global burden of the associated diseases as well as the impact of regulatory measures on food supply and international trade. Apart from the well-established risk posed by aflatoxins, many uncertainties still exist about risk assessments for the other major mycotoxins, often reflecting a lack of epidemiological data. Differences exist in the risk management strategies and in the ways different governments impose regulations and technologies to reduce levels of mycotoxins in the food-chain. Regulatory measures have very little impact on remote rural and subsistence farming communities in developing countries, in contrast to developed countries, where regulations are strictly enforced to reduce and/or remove mycotoxin contamination. However, in the absence of the relevant technologies or the necessary infrastructure, we highlight simple intervention practices to reduce mycotoxin contamination in the field and/or prevent mycotoxin formation during storage.

  3. Risk assessment for carnitine.

    Science.gov (United States)

    Hathcock, John N; Shao, Andrew

    2006-10-01

    Carnitine is a conditionally essential amino acid-like compound involved in the transport of long-chain fatty acids into the mitochondria during the beta-oxidation process. Carnitine has become an increasingly popular ingredient in dietary supplements, especially weight loss and some sports nutrition products. A number of clinical trials have been conducted examining the effect of carnitine supplementation on weight loss and energy balance. Regarding safety, systematic evaluation of the research designs and data do not provide a basis for risk assessment and the usual safe upper level of intake (UL) derived from it unless the newer methods described as the observed safe level (OSL) or highest observed intake (HOI) are utilized. The OSL risk assessment method indicates that the evidence of safety is strong at intakes up to 2000mg/day l-carnitine equivalents for chronic supplementation, and this level is identified as the OSL. Although much higher levels have been tested without adverse effects and may be safe, the data for intakes above 2000mg/day are not sufficient for a confident conclusion of long-term safety.

  4. Does electrophysiological testing have any role in risk stratification for sudden cardiac death?

    Institute of Scientific and Technical Information of China (English)

    Fei Lü; Wei Hua

    2010-01-01

    @@ Introduction Implantation of implantable cardioverter defibrillators (ICD) has widely been accepted for secondary prevention of sudden cardiac death (SCD) in cardiac arrest survivors.1 Currently there are increasing interests in primary prevention of SCD in selected high risk patients who have not experienced cardiac arrest.1

  5. The application of European system for cardiac operative risk evaluation II (EuroSCORE II and Society of Thoracic Surgeons (STS risk-score for risk stratification in Indian patients undergoing cardiac surgery

    Directory of Open Access Journals (Sweden)

    Deepak Borde

    2013-01-01

    Full Text Available Aims and Objectives: To validate European system for cardiac operative risk evaluation II (EuroSCORE II and Society of Thoracic Surgeons (STS risk-score for predicting mortality and STS risk-score for predicting morbidity in Indian patients after cardiac surgery. Materials and Methods: EuroSCORE II and STS risk-scores were obtained pre-operatively for 498 consecutive patients. The patients were followed for mortality and various morbidities. The calibration of the scoring systems was assessed using Hosmer-Lemeshow test. The discriminative capacity was estimated by area under receiver operating characteristic (ROC curves. Results: The mortality was 1.6%. For EuroSCORE II and STS risk-score C-statics of 5.43 and 6.11 were obtained indicating satisfactory model fit for both the scores. Area under ROC was 0.69 and 0.65 for EuroSCORE II and STS risk-score with P values of 0.068 and 0.15, respectively, indicating poor discriminatory power. Good fit and discrimination was obtained for renal failure, long-stay in hospital, prolonged ventilator support and deep sternal wound infection but the scores failed in predicting risk of reoperation and stroke. Mortality risk was correctly estimated in low ( 5% patients by both scoring systems. Conclusions: EuroSCORE II and STS risk-scores have satisfactory calibration power in Indian patients but their discriminatory power is poor. Mortality risk was over-estimated by both the scoring systems in high-risk patients. The present study highlights the need for forming a national database and formulating risk stratification tools to provide better quality care to cardiac surgical patients in India.

  6. Risk Factors for Sudden Cardiac Death : Risk Factors for Sudden Cardiac Death

    NARCIS (Netherlands)

    M.N. Niemeijer (Maartje)

    2016-01-01

    markdownabstractSCD is a common cause of death, with around four to five million cases annually worldwide. Determining which persons are at high risk for SCD remains difficult, due to lack of knowledge on individual risk factors and because in the majority of cases, SCD is the first manifestation of

  7. Radionuclide assessment of left ventricular function following cardiac surgery

    Energy Technology Data Exchange (ETDEWEB)

    Howe, W.R.; Jones, R.H.; Sabiston, D.C. Jr.

    1976-01-01

    Use of a high count-rate gamma scintillation camera permits the noninvasive assessment of left ventricular function by nuclear angiocardiography. Counts recorded from the region of the left ventricle at 50- or 100-msec intervals during the first transit of an intravenously administered bolus of radioisotope produce a high-fidelity indicator-dilution curve. Count fluctuations reflect left ventricular volume changes during the cardiac cycle and permit measurement of dv/dt, ejection fraction, mean transit time, and wall motion of this chamber. The present study evaluates (1) the accuracy of this technique compared to standard biplane cineangiography and (2) its usefulness in evaluating patients after cardiac surgery.

  8. Tools for microbiological risk assessment

    OpenAIRE

    Bassett, J; Nauta, M; Lindqvist, R.; Zwietering, M. H.

    2012-01-01

    Microbiological Risk Assessment (MRA) has emerged as a comprehensive and systematic approach for addressing the risk of pathogens in specific foods and/or processes. At government level, MRA is increasingly recognised as a structured and objective approach to understand the level of risk in a given food/pathogen scenario. Tools developed so far support qualitative and quantitative assessments of the risk that a food pathogen poses to a particular population. Risk can be expressed as absolute ...

  9. Diagnostic Certified Assay: Neuromuscular and Cardiac Assessments

    Directory of Open Access Journals (Sweden)

    Rea Valaperta

    2013-01-01

    Full Text Available The expansion of the specific trinucleotide sequence, [CTG], is the molecular pathological mechanism responsible for the clinical manifestations of DM1. Many studies have described different molecular genetic techniques to detect DM1, but as yet there is no data on the analytical performances of techniques used so far in this disease. We therefore developed and validated a molecular method, “Myotonic Dystrophy SB kit,” to better characterize our DM1 population. 113 patients were examined: 20 DM1-positive, 11 DM1/DM2-negative, and13 DM1-negative/DM2-positive, who had a previous molecular diagnosis, while 69 were new cases. This assay correctly identified 113/113 patients, and all were confirmed by different homemade assays. Comparative analysis revealed that the sensitivity and the specificity of the new kit were very high (>99%. Same results were obtained using several extraction procedures and different concentrations of DNA. The distribution of pathologic alleles showed a prevalence of the “classical” form, while of the 96 nonexpanded alleles 19 different allelic types were observed. Cardiac and neuromuscular parameters were used to clinically characterize our patients and support the new genetic analysis. Our findings suggest that this assay appears to be a very robust and reliable molecular test, showing high reproducibility and giving an unambiguous interpretation of results.

  10. Prognostic value of cardiac biomarkers in the risk stratification of syncope: a systematic review.

    Science.gov (United States)

    Thiruganasambandamoorthy, Venkatesh; Ramaekers, Rosa; Rahman, Mohammed Omair; Stiell, Ian Gilmour; Sikora, Lindsey; Kelly, Sarah-Louise; Christ, Michael; Claret, Pierre-Geraud; Reed, Matthew James

    2015-12-01

    The role of cardiac biomarkers in risk stratification of syncope is unclear. We undertook a systematic review to assess their predictive value for short-term major adverse cardiovascular events (MACE). We conducted a systematic review using MEDLINE, EMBASE, DARE and Cochrane databases from inception to July 2014. We included studies involving adult syncope patients that evaluated cardiac biomarker levels for risk stratification during acute management and excluded case reports, reviews and studies involving children. Primary outcome (MACE) included death, cardiopulmonary resuscitation, myocardial infarction (MI), structural heart disease, pulmonary embolism, significant hemorrhage or cardiac procedural interventions. Secondary outcome analysis assessed for prediction of MI, cardiac syncope and death. Two reviewers extracted patient-level data based on the cut-off reported. Pooled sensitivities and specificities were calculated using patient-level data. A total of 1862 articles were identified, and 11 studies with 4246 patients were included. Studies evaluated 3 biomarkers: contemporary troponin (2693 patients), natriuretic peptides (1353 patients) and high-sensitive troponin (819 patients). The pooled sensitivities and specificities for MACE were: contemporary troponin 0.29 (95 % CI 0.24, 0.34) and 0.88 (95 % CI 0.86, 0.89); natriuretic peptides 0.77 (95 % CI 0.69, 0.85) and 0.73 (95 % CI 0.70, 0.76); high-sensitive troponin 0.74 (95 % CI 0.65, 0.83) and 0.65 (95 % CI 0.62, 0.69), respectively. Natriuretic peptides and high-sensitive troponin showed good diagnostic characteristics for both primary and secondary outcomes. Natriuretic peptides and high-sensitive troponin might be useful in risk stratification.

  11. Practical Approaches to Risk Assessment

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    The importance of using risk assessment in developing foodregulations is growing with the globalization of our food supply. The World Trade Organization has entrenched the principles of science-based risk assessment in the Agreement on Sanitary and Phytosanitary Measures. The relevant international organization for food standards, the Codex Alimentarius Commission, recognises risk analysis, and its component parts risk assessment, risk management and risk communication, as the basis for scientific decision-making. Risk assessment comprises two activities: hazard evaluation; and exposure estimation. A hazard may be chemical, microbiological or nutritional in origin. The practical application of risk assessment in Australia is illustrated in this presentation by four examples involving: (1) food additives, (2) microbiological safety of imported raw milk cheeses, (3) genetically modified foods and (4) imported food inspection.

  12. Practical Approaches to Risk Assessment

    Institute of Scientific and Technical Information of China (English)

    SIMONBROOKE-TAYLOR

    2001-01-01

    The importance of using risk assessment in developing food regulations is growing with the globalization of our food supple,The World Trade Oranization has entrenched the principles of science-based risk assessment in the Agreement on Sanitary and Phytosanitary Measures.The relevant international organization for food standards,the Codex Alimentarius Commission,recognises risk analysis,and its component parts risk assessment,risk management and risk communication as the basis for scientific decision-making,Risk assessment comprises two activities:hazard evaluation;and exposure estimation.A hazard may be chemical,microbiological or nutritional in origin,The practical application of risk assessment in Australia is illustrated in this presentation y four examples involving:(1) food additives,(2) microiological safety of imported raw milk cheeses,(3) genetically modified foods and (4) imported food inspection.

  13. Impact of worksite wellness intervention on cardiac risk factors and one-year health care costs.

    Science.gov (United States)

    Milani, Richard V; Lavie, Carl J

    2009-11-15

    Cardiac rehabilitation and exercise training (CRET) provides health risk intervention in cardiac patients over a relatively short time frame. Worksite health programs offer a unique opportunity for health intervention, but these programs remain underused due to concerns over recouping the costs. We evaluated the clinical efficacy and cost-effectiveness of a 6-month worksite health intervention using staff from CRET. Employees (n = 308) and spouses (n = 31) of a single employer were randomized to active intervention (n = 185) consisting of worksite health education, nutritional counseling, smoking cessation counseling, physical activity promotion, selected physician referral, and other health counseling versus usual care (n = 154). Health risk status was assessed at baseline and after the 6-month intervention program, and total medical claim costs were obtained in all participants during the year before and the year after intervention. Significant improvements were demonstrated in quality-of-life scores (+10%, p = 0.001), behavioral symptoms (depression -33%, anxiety -32%, somatization -33%, and hostility -47%, all p values health habits (-60%, p = 0.0001), and total health risk (-25%, p = 0.0001). Of employees categorized as high risk at baseline, 57% were converted to low-risk status. Average employee annual claim costs decreased 48% (p = 0.002) for the 12 months after the intervention, whereas control employees' costs remained unchanged (-16%, p = NS), thus creating a sixfold return on investment. In conclusion, worksite health intervention using CRET staff decreased total health risk and markedly decreased medical claim costs within 12 months.

  14. Risk stratification for sudden cardiac death in hypertrophic cardiomyopathy : Systematic review of clinical risk markers

    NARCIS (Netherlands)

    Christiaans, Imke; Van Engelen, Klaartje; Van Langen, Irene M.; Birnie, Erwin; Bonsel, Gouke J.; Elliott, Perry M.; Wilde, Arthur A.M.

    2010-01-01

    We performed a systematic literature review of recommended 'major' and 'possible' clinical risk markers for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). We searched the Medline, Embase and Cochrane databases for articles published between 1971 and 2007. We included English langua

  15. Risk stratification for sudden cardiac death in hypertrophic cardiomyopathy: systematic review of clinical risk markers

    NARCIS (Netherlands)

    I. Christiaans; K. van Engelen; I.M. van Langen; E. Birnie; G.J. Bonsel; P.M. Elliott; A.A.M. Wilde

    2010-01-01

    We performed a systematic literature review of recommended 'major' and 'possible' clinical risk markers for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). We searched the Medline, Embase and Cochrane databases for articles published between 1971 and 2007. We included English langua

  16. Short-term Exposure to Microgravity and the Associated Risk of Sudden Cardiac Arrest: Implications for Commercial Spaceflight

    Science.gov (United States)

    Laing, Kevin J. C.; Russamono, Thais

    2013-02-01

    The likelihood of trained astronauts developing a life threatening cardiac event during spaceflight is relatively rare, whilst the incidence in untrained individuals is unknown. Space tourists who live a sedentary lifestyle have reduced cardiovascular function, but the associated danger of sudden cardiac arrest (SCA) during a suborbital spaceflight (SOSF) is unclear. Risk during SOSF was examined by reviewing several microgravity studies and methods of determining poor cardiovascular condition. Accurately assessing cardiovascular function and improving baroreceptor sensitivity through exercise is suggested to reduce the incidence of SCA during future SOSFs. Future studies will benefit from past participants sharing medical history; allowing creation of risk profiles and suitable guidelines.

  17. Risk Factor Assessment Branch (RFAB)

    Science.gov (United States)

    The Risk Factor Assessment Branch (RFAB) focuses on the development, evaluation, and dissemination of high-quality risk factor metrics, methods, tools, technologies, and resources for use across the cancer research continuum, and the assessment of cancer-related risk factors in the population.

  18. Macrolide antibiotics and the risk of cardiac arrhythmias.

    Science.gov (United States)

    Albert, Richard K; Schuller, Joseph L

    2014-05-15

    Randomized, controlled trials have demonstrated that chronic therapy with macrolide antibiotics reduces the morbidity of patients with cystic fibrosis, non-cystic fibrosis bronchiectasis, chronic obstructive pulmonary disease, and nontuberculous mycobacterial infections. Lower levels of evidence indicate that chronic macrolides are also effective in treating patients with panbronchiolitis, bronchiolitis obliterans, and rejection after lung transplant. Macrolides are known to cause torsade des pointes and other ventricular arrhythmias, and a recent observational study prompted the FDA to strengthen the Warnings and Precautions section of azithromycin drug labels. This summary describes the electrophysiological effects of macrolides, reviews literature indicating that the large majority of subjects experiencing cardiac arrhythmias from macrolides have coexisting risk factors and that the incidence of arrhythmias in absence of coexisting risk factors is very low, examines recently published studies describing the relative risk of arrhythmias from macrolides, and concludes that this risk has been overestimated and suggests an approach to patient evaluation that should reduce the relative risk and the incidence of arrhythmias to the point that chronic macrolides can be used safely in the majority of subjects for whom they are recommended.

  19. Automatic assessment of cardiac perfusion MRI

    DEFF Research Database (Denmark)

    Ólafsdóttir, Hildur; Stegmann, Mikkel Bille; Larsson, Henrik B.W.

    2004-01-01

    In this paper, a method based on Active Appearance Models (AAM) is applied for automatic registration of myocardial perfusion MRI. A semi-quantitative perfusion assessment of the registered image sequences is presented. This includes the formation of perfusion maps for three parameters; maximum up...

  20. Information needs for risk assessment

    Energy Technology Data Exchange (ETDEWEB)

    DeRosa, C.T.; Choudhury, H.; Schoeny, R.S.

    1990-12-31

    Risk assessment can be thought of as a conceptual approach to bridge the gap between the available data and the ultimate goal of characterizing the risk or hazard associated with a particular environmental problem. To lend consistency to and to promote quality in the process, the US Environmental Protection Agency (EPA) published Guidelines for Risk Assessment of Carcinogenicity, Developmental Toxicity, Germ Cell Mutagenicity and Exposure Assessment, and Risk Assessment of Chemical Mixtures. The guidelines provide a framework for organizing the information, evaluating data, and for carrying out the risk assessment in a scientifically plausible manner. In the absence of sufficient scientific information or when abundant data are available, the guidelines provide alternative methodologies that can be employed in the risk assessment. 4 refs., 3 figs., 2 tabs.

  1. Risk Stratification with Serum Cardiac Troponin I in Acute Myocardial Infarction on Admission

    Institute of Scientific and Technical Information of China (English)

    张铸; 苏恩本; 张寄南; 杨志健; 曹克将; 马文珠

    2001-01-01

    Objective To assess the prognostic significance of serum cardiac troponin I (cTnI) concentration in patients with acute myocardial infarction on admission. Methods Serum samples of 108 patients with established AMI were collected on admission for measuring cTnI and were grouped according to the intervals between the onset of chest pain and admission. Results In each of these groups, the serum cTnI concentrations in patients died after admission were significantly higher than those who survived (all P<0.05). Conclusions A higher serum cTnI concentration on admission in patients with AMI was associated with an increased risk of subsequent cardiac death during hospitalization.

  2. Predischarge maximal exercise test identifies risk for cardiac death in patients with acute myocardial infarction

    DEFF Research Database (Denmark)

    Nielsen, J R; Mickley, H; Damsgaard, E M

    1990-01-01

    A maximal exercise test was performed in 54 patients with acute myocardial infarction (AMI) before discharge and in 49 age-matched control subjects. The long-term prognosis was assessed after an average follow-up of 7.6 years in AMI patients and 5.8 years in control subjects. The maximal work...... capacity and systolic blood pressure increase in AMI patients was 59% that of control subjects (p less than 0.001). Seventeen AMI patients had significant ST-segment shifts, 13 with ST depression and 4 with ST elevation. In AMI patients experiencing a cardiac death during follow-up the maximal work...... were of no significant value. In this study maximal work capacity turned out to be the best single exercise variable for identifying groups of AMI patients with very low and relative high risk of cardiac death. When all 3 exercise variables were combined, the predischarge maximal exercise test...

  3. Chlorination byproducts and nitrate in drinking water and risk for congenital cardiac defects.

    Science.gov (United States)

    Cedergren, Marie I; Selbing, Anders J; Löfman, Owe; Källen, Bengt A J

    2002-06-01

    Drinking water disinfection byproducts have been associated with an increased risk for congenital defects including cardiac defects. Using Swedish health registers linked to information on municipal drinking water composition, individual data on drinking water characteristics were obtained for 58,669 women. Among the infants born, 753 had a cardiac defect. The risk for a cardiac defect was determined for ground water versus surface water, for different chlorination procedures, and for trihalomethane and nitrate concentrations. Ground water was associated with an increased risk for cardiac defect when crude rates were analyzed but after suitable adjustments this excess rate was found to be determined by chlorination procedures including chlorine dioxide. Chlorine dioxide appears itself as an independent risk factor for cardiac defects (adjusted odds ratio 1.61 (95%CI 1.00-2.59)). The risk for cardiac defects increased with increasing trihalomethane concentrations (P=0.0005). There was an indicated but statistically nonsignificant excess risk associated with nitrate concentration. The individual risk for congenital cardiac defect caused by chlorine dioxide and trihalomethanes is small but as a large population is exposed to public drinking water, the attributable risk for cardiac defects may not be negligible.

  4. The usefulness of myocardial SPECT for the preoperative cardiac risk evaluation in noncardiac surgery

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Seok Tae; Lee, Dong Soo; Kang, Won Jon; Chung, June Key; Lee, Myung Chul [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)

    1999-02-01

    We investigated whether myocardial SPECT had additional usefulness to clinical, functional or surgical indices for the preoperative evaluation of cardiac risks in noncardiac surgery. 118 patients ( M: F=66: 52, 62.7{+-}10.5 years) were studied retrospectively. Eighteen underwent vascular surgeries and 100 nonvascular surgeries. Rest Tl-201/ stress Tc-99m-MIBI SPECT was performed before operation and cardiac events (hard event: cardiac death and myocardial infarction; soft event: ischemic ECG change, congestive heat failure and unstable angina) were surveyed through perioperative periods (14.6{+-}5.6 days). Clinical risk indices, functional capacity, surgery procedures and SPECT findings were tested for their predictive values of perioperative cardiac events. Peri-operative cardiac events occurred in 25 patients (3 hard events and 22 soft events). Clinical risk indices, surgical procedure risks and SPECT findings but functional capacity were predictive of cardiac events. Reversible perfusion decrease was a better predictor than persistent decrease. Multivariate analysis sorted out surgical procedure risk (p=0.0018) and SPECT findings (p=0.0001) as significant risk factors. SPECT could re-stratify perioperative cardiac risks in patients ranked with surgical procedures. We conclude that myocardial SPECT provides additional predictive value to surgical type risks as well as clinical indexes or functional capacity for the prediction of preoperative cardiac events in noncardiac surgery.

  5. Risk of cardiac arrhythmias during hypoglycemia in patients with type 2 diabetes and cardiovascular risk.

    Science.gov (United States)

    Chow, Elaine; Bernjak, Alan; Williams, Scott; Fawdry, Robert A; Hibbert, Steve; Freeman, Jenny; Sheridan, Paul J; Heller, Simon R

    2014-05-01

    Recent trials of intensive glycemic control suggest a possible link between hypoglycemia and excess cardiovascular mortality in patients with type 2 diabetes. Hypoglycemia might cause arrhythmias through effects on cardiac repolarization and changes in cardiac autonomic activity. Our aim was to study the risk of arrhythmias during spontaneous hypoglycemia in type 2 diabetic patients with cardiovascular risk. Twenty-five insulin-treated patients with type 2 diabetes and a history of cardiovascular disease or two or more risk factors underwent simultaneous continuous interstitial glucose and ambulatory electrocardiogram monitoring. Frequency of arrhythmias, heart rate variability, and markers of cardiac repolarization were compared between hypoglycemia and euglycemia and between hyperglycemia and euglycemia matched for time of day. There were 134 h of recording at hypoglycemia, 65 h at hyperglycemia, and 1,258 h at euglycemia. Bradycardia and atrial and ventricular ectopic counts were significantly higher during nocturnal hypoglycemia compared with euglycemia. Arrhythmias were more frequent during nocturnal versus daytime hypoglycemia. Excessive compensatory vagal activation after the counterregulatory phase may account for bradycardia and associated arrhythmias. QT intervals, corrected for heart rate, >500 ms and abnormal T-wave morphology were observed during hypoglycemia in some participants. Hypoglycemia, frequently asymptomatic and prolonged, may increase the risk of arrhythmias in patients with type 2 diabetes and high cardiovascular risk. This is a plausible mechanism that could contribute to increased cardiovascular mortality during intensive glycemic therapy.

  6. Using risk assessment in periodontics.

    Science.gov (United States)

    Woodman, Alan J

    2014-08-01

    Risk assessment has become a regular feature in both dental practice and society as a whole, and principles used to assess risk in society are similar to those used in a clinical setting. Although the concept of risk assessment as a prognostic indicator for periodontal disease incidence and activity is well established in the management of periodontitis, the use of risk assessment to manage the practical treatment of periodontitis and its sequelae appears to have less foundation. A simple system of initial risk assessment - building on the use of the Basic Periodontal Examination (BPE), clinical, medical and social factors - is described, linked to protocols for delivering care suited to general dental practice and stressing the role of long-term supportive care. The risks of not treating the patient are considered, together with the possible causes of failure, and the problems of successful treatment are illustrated by the practical management of post-treatment recession.

  7. Protocol for cardiac assessment of recreational athletes.

    Science.gov (United States)

    Chinea, Ana M; Lollett, Carlos; Herrera, Hector; Passariello, Gianfranco; Wong, Sara

    2012-01-01

    In this work, the development of a database on physical fitness is presented. As initial population to fill this database, people who practice recreational sports at the Universidad Simon Bolivar (USB) were chosen. The goal was studying individual physical fitness in order to structure exercise routines that gives certain benefits without risking the individual health, promoting a less sedentary way of life. Before the study, a low-cost noninvasive protocol was designed to determine the level of physical fitness. The methodology consisted of four steps: a) A review of existing protocols to propose a set of physical fitness (International Physical Activity Questionnaire (IPAQ)), cardiovascular (heart rate variability, heart rate recovery time and arterial blood pressure), anthropomorphic, aerobic (maximum oxygen consumption) and mood state (Profile of Mood State (POMS)) measurements, which allow sketching a complete profile on the sportsman physical fitness. b) Instrumental data collection. c) Electrocardiographic signal processing. d) Data post-processing using multivariate analysis. The database was composed of 26 subject from USB. Ten subjects were soccer players, ten were mountain climbers and six were sedentary people. Results showed that the heart rate recover time after 2-3 min, IPAQ and maximum oxygen consumption have higher weights for classifying individuals according to their habitual physical activity. Heart rate variability, as well as, POMS did not contribute greatly for discriminating recreational sport from sedentary persons.

  8. Update in cardiology: vascular risk and cardiac rehabilitation.

    Science.gov (United States)

    Galve, Enrique; Cordero, Alberto; Bertomeu-Martínez, Vicente; Fácila, Lorenzo; Mazón, Pilar; Alegría, Eduardo; Fernández de Bobadilla, Jaime; García-Porrero, Esteban; Martínez-Sellés, Manuel; González-Juanatey, José Ramón

    2015-02-01

    As in other fields, understanding of vascular risk and rehabilitation is constantly improving. The present review of recent epidemiological update shows how far we are from achieving good risk factor control: in diet and nutrition, where unhealthy and excessive societal consumption is clearly increasing the prevalence of obesity; in exercise, where it is difficult to find a balance between benefit and risk, despite systemization efforts; in smoking, where developments center on programs and policies, with the electronic cigarette seeming more like a problem than a solution; in lipids, where the transatlantic debate between guidelines is becoming a paradigm of the divergence of views in this extensively studied area; in hypertension, where a nonpharmacological alternative (renal denervation) has been undermined by the SYMPLICITY HTN-3 setback, forcing a deep reassessment; in diabetes mellitus, where the new dipeptidyl peptidase-4 and sodium-glucose cotransporter type 2 inhibitors and glucagon like peptide 1 analogues have contributed much new information and a glimpse of the future of diabetes treatment, and in cardiac rehabilitation, which continues to benefit from new information and communication technologies and where clinical benefit is not hindered by advanced diseases, such as heart failure. Our summary concludes with the update in elderly patients, whose treatment criteria are extrapolated from those of younger patients, with the present review clearly indicating that should not be the case.

  9. Perceived stress as a risk factor for changes in health behaviour and cardiac risk profile

    DEFF Research Database (Denmark)

    Rod, Naja Hulvej; Grønbaek, M; Schnohr, P;

    2009-01-01

    in health behaviour (smoking, physical activity, alcohol consumption, overweight) and cardiac risk profile (cholesterol, HDL cholesterol, blood pressure, diabetes). RESULTS: Individuals with high levels of stress compared to those with low levels of stress were less likely to quit smoking (OR = 0.58; 95% CI......OBJECTIVE: The aim of this study was to evaluate the long-term effects of stress on changes in health behaviour and cardiac risk profile in men and women. DESIGN: A prospective cohort study. SETTING: The Copenhagen City Heart Study, Denmark. SUBJECTS: The analyses were based on 7066 women and men...... to use antihypertensive medication (1.94; 1.63-2.30), and stressed men were more than two times as likely to develop diabetes during follow-up (2.36; 1.22-4.59). CONCLUSION: This longitudinal study supports a causal relation between stress and cardiovascular diseases mediated through unfavourable changes...

  10. Analysis of agreement between cardiac risk stratification protocols applied to participants of a center for cardiac rehabilitation

    Science.gov (United States)

    Santos, Ana A. S.; Silva, Anne K. F.; Vanderlei, Franciele M.; Christofaro, Diego G. D.; Gonçalves, Aline F. L.; Vanderlei, Luiz C. M.

    2016-01-01

    ABSTRACT Background Cardiac risk stratification is related to the risk of the occurrence of events induced by exercise. Despite the existence of several protocols to calculate risk stratification, studies indicating that there is similarity between these protocols are still unknown. Objective To evaluate the agreement between the existing protocols on cardiac risk rating in cardiac patients. Method The records of 50 patients from a cardiac rehabilitation program were analyzed, from which the following information was extracted: age, sex, weight, height, clinical diagnosis, medical history, risk factors, associated diseases, and the results from the most recent laboratory and complementary tests performed. This information was used for risk stratification of the patients in the protocols of the American College of Sports Medicine, the Brazilian Society of Cardiology, the American Heart Association, the protocol designed by Frederic J. Pashkow, the American Association of Cardiovascular and Pulmonary Rehabilitation, the Société Française de Cardiologie, and the Sociedad Española de Cardiología. Descriptive statistics were used to characterize the sample and the analysis of agreement between the protocols was calculated using the Kappa coefficient. Differences were considered with a significance level of 5%. Results Of the 21 analyses of agreement, 12 were considered significant between the protocols used for risk classification, with nine classified as moderate and three as low. No agreements were classified as excellent. Different proportions were observed in each risk category, with significant differences between the protocols for all risk categories. Conclusion The agreements between the protocols were considered low and moderate and the risk proportions differed between protocols. PMID:27556385

  11. Risk Assessment and Integration Team (RAIT) Portfolio Risk Analysis Strategy

    Science.gov (United States)

    Edwards, Michelle

    2010-01-01

    Impact at management level: Qualitative assessment of risk criticality in conjunction with risk consequence, likelihood, and severity enable development of an "investment policy" towards managing a portfolio of risks. Impact at research level: Quantitative risk assessments enable researchers to develop risk mitigation strategies with meaningful risk reduction results. Quantitative assessment approach provides useful risk mitigation information.

  12. Nanomaterials: Regulation and Risk Assessment

    DEFF Research Database (Denmark)

    Hansen, Steffen Foss; Grieger, Khara Deanne; Baun, Anders

    2013-01-01

    The topics of regulation and risk assessment of nanomaterials have never been more relevant and controversial in Europe than they are at this point in time. In this entry, we present and discuss a number of major pieces of legislation relevant for the regulation of nanomaterials, including REACH...... Regulation. Chemical risk assessment provides a fundamental element in support of existing legislation. Risk assessment is normally said to consist of four elements, i.e., hazard identification, dose–response assessment, exposure assessment, and risk characterization. Each of these four elements hold......, the Water Framework Directive, pharmaceuticals regulation, and the Novel Foods Regulation. Current regulation of nanomaterials entail three overall challenges: 1) limitations in regard to terminology and definitions of key terms such as a “substance,” “novel food,” etc.; 2) safety assessment requirements...

  13. Cardiac Atrophy and Diastolic Dysfunction During and After Long Duration Spaceflight: Functional Consequences for Orthostatic Intolerance, Exercise Capability and Risk for Cardiac Arrhythmias

    Science.gov (United States)

    Levine, Benjamin D.; Bungo, Michael W.; Platts, Steven H.; Hamilton, Douglas R.; Johnston, Smith L.

    2009-01-01

    Cardiac Atrophy and Diastolic Dysfunction During and After Long Duration Spaceflight: Functional Consequences for Orthostatic Intolerance, Exercise Capability and Risk for Cardiac Arrhythmias (Integrated Cardiovascular) will quantify the extent of long-duration space flightassociated cardiac atrophy (deterioration) on the International Space Station crewmembers.

  14. Implications of probabilistic risk assessment

    Energy Technology Data Exchange (ETDEWEB)

    Cullingford, M.C.; Shah, S.M.; Gittus, J.H. (eds.)

    1987-01-01

    Probabilistic risk assessment (PRA) is an analytical process that quantifies the likelihoods, consequences and associated uncertainties of the potential outcomes of postulated events. Starting with planned or normal operation, probabilistic risk assessment covers a wide range of potential accidents and considers the whole plant and the interactions of systems and human actions. Probabilistic risk assessment can be applied in safety decisions in design, licensing and operation of industrial facilities, particularly nuclear power plants. The proceedings include a review of PRA procedures, methods and technical issues in treating uncertainties, operating and licensing issues and future trends. Risk assessment for specific reactor types or components and specific risks (eg aircraft crashing onto a reactor) are used to illustrate the points raised. All 52 articles are indexed separately. (U.K.).

  15. Antidepressant Use and Risk of Out-of-Hospital Cardiac Arrest

    DEFF Research Database (Denmark)

    Weeke, P; Jensen, Aksel Karl Georg; Folke, F;

    2012-01-01

    Treatment with some types of antidepressants has been associated with sudden cardiac death. It is unknown whether the increased risk is due to a class effect or related to specific antidepressants within drug classes. All patients in Denmark with an out-of-hospital cardiac arrest (OHCA) were.......17-12.2). An association between cardiac arrest and antidepressant use could be documented in both the SSRI and TCA classes of drugs....

  16. Quantitative risk assessment of CO

    NARCIS (Netherlands)

    Koornneef, J.; Spruijt, M.; Molag, M.; Ramírez, A.; Turkenburg, W.; Faaij, A.

    2010-01-01

    A systematic assessment, based on an extensive literature review, of the impact of gaps and uncertainties on the results of quantitative risk assessments (QRAs) for CO2 pipelines is presented. Sources of uncertainties that have been assessed are: failure rates, pipeline pressure, temperat

  17. Simulation evaluation of quantitative myocardial perfusion assessment from cardiac CT

    Science.gov (United States)

    Bindschadler, Michael; Modgil, Dimple; Branch, Kelley R.; La Riviere, Patrick J.; Alessio, Adam M.

    2014-03-01

    Contrast enhancement on cardiac CT provides valuable information about myocardial perfusion and methods have been proposed to assess perfusion with static and dynamic acquisitions. There is a lack of knowledge and consensus on the appropriate approach to ensure 1) sufficient diagnostic accuracy for clinical decisions and 2) low radiation doses for patient safety. This work developed a thorough dynamic CT simulation and several accepted blood flow estimation techniques to evaluate the performance of perfusion assessment across a range of acquisition and estimation scenarios. Cardiac CT acquisitions were simulated for a range of flow states (Flow = 0.5, 1, 2, 3 ml/g/min, cardiac output = 3,5,8 L/min). CT acquisitions were simulated with a validated CT simulator incorporating polyenergetic data acquisition and realistic x-ray flux levels for dynamic acquisitions with a range of scenarios including 1, 2, 3 sec sampling for 30 sec with 25, 70, 140 mAs. Images were generated using conventional image reconstruction with additional image-based beam hardening correction to account for iodine content. Time attenuation curves were extracted for multiple regions around the myocardium and used to estimate flow. In total, 2,700 independent realizations of dynamic sequences were generated and multiple MBF estimation methods were applied to each of these. Evaluation of quantitative kinetic modeling yielded blood flow estimates with an root mean square error (RMSE) of ~0.6 ml/g/min averaged across multiple scenarios. Semi-quantitative modeling and qualitative static imaging resulted in significantly more error (RMSE = ~1.2 and ~1.2 ml/min/g respectively). For quantitative methods, dose reduction through reduced temporal sampling or reduced tube current had comparable impact on the MBF estimate fidelity. On average, half dose acquisitions increased the RMSE of estimates by only 18% suggesting that substantial dose reductions can be employed in the context of quantitative myocardial

  18. Tools for Microbiological risk assessment

    DEFF Research Database (Denmark)

    Bassett, john; Nauta, Maarten; Lindqvist, Roland

    Microbiological Risk Assessment (MRA) has emerged as a comprehensive and systematic approach for addressing the risk of pathogens in specific foods and/or processes. At government level, MRA is increasingly recognised as a structured and objective approach to understand the level of risk in a given...... food/pathogen scenario. Tools developed so far support qualitative and quantitative assessments of the risk that a food pathogen poses to a particular population. Risk can be expressed as absolute numbers or as relative (ranked) risks. The food industry is beginning to appreciate that the tools for MRA...... can increase the understanding of microbiological risks in foods. It is timely to inform food safety professionals about the availability and utility of MRA tools. Therefore, the focus of this report is to aid the food safety manager by providing a concise summary of the tools available for the MRA...

  19. Epileptic Patients are at Risk of Cardiac Arrhythmias: A Novel Approach using QT-nomogram, Tachogram, and Cardiac Restitution Plots

    Science.gov (United States)

    Al-Nimer, Marwan S.; Al-Mahdawi, Sura A.; Abdullah, Namir M.; Al-Mahdawi, Akram

    2017-01-01

    Background: Sudden death is reported in patients who had a history of epilepsy and some authors believed that is due to cardiac arrhythmias. Objectives: This study aimed to predict that the epileptic patients are at risk of serious cardiac arrhythmias by QT-nomogram, tachogram (Lorenz), and cardiac restitution plots. Methods: A total number of 71 healthy subjects (Group I) and 64 newly diagnosed epileptic patients (Group II) were recruited from Al-Yarmouk and Baghdad Teaching hospitals in Baghdad from March 2015 to July 2015 and included in this study. The diagnosis of epilepsy achieved clinically, electroencephalograph record and radio-images including computerized tomography and magnetic image resonance. At the time of entry into the study, an electrocardiography (ECG) was done, and the determinants of each ECG record were calculated. The QT-nomogram, tachogram, and cardiac restitution plots were used to identify the patients at risk of cardiac arrhythmias. Results: Significant prolonged corrected QT corrected (QTc) and JT corrected intervals were observed in female compared with male at age ≥50 years while the TQ interval was significantly prolonged in males of Group II. Eight patients of Group II had a significant pathological prolonged QTc interval compared with undetectable finding in Group I. QT nomogram did not disclose significant findings while the plots of Lorenz and restitution steepness disclose that the patients of Group II were vulnerable to cardiac arrhythmias. Abnormal ECG findings were observed in the age extremities (≤18 years and ≥50 years) in Group II compared with Group I. Conclusion: Utilization of QT-nomogram, restitution steepness, and tachogram plots is useful tools for detection subclinical vulnerable epileptic patient with cardiac arrhythmias. PMID:28149075

  20. Epileptic patients are at risk of cardiac arrhythmias: A novel approach using QT-nomogram, tachogram, and cardiac restitution plots

    Directory of Open Access Journals (Sweden)

    Marwan S Al-Nimer

    2017-01-01

    Full Text Available Background: Sudden death is reported in patients who had a history of epilepsy and some authors believed that is due to cardiac arrhythmias. Objectives: This study aimed to predict that the epileptic patients are at risk of serious cardiac arrhythmias by QT-nomogram, tachogram (Lorenz, and cardiac restitution plots. Methods: A total number of 71 healthy subjects (Group I and 64 newly diagnosed epileptic patients (Group II were recruited from Al-Yarmouk and Baghdad Teaching hospitals in Baghdad from March 2015 to July 2015 and included in this study. The diagnosis of epilepsy achieved clinically, electroencephalograph record and radio-images including computerized tomography and magnetic image resonance. At the time of entry into the study, an electrocardiography (ECG was done, and the determinants of each ECG record were calculated. The QT-nomogram, tachogram, and cardiac restitution plots were used to identify the patients at risk of cardiac arrhythmias. Results: Significant prolonged corrected QT corrected (QTc and JT corrected intervals were observed in female compared with male at age ≥50 years while the TQ interval was significantly prolonged in males of Group II. Eight patients of Group II had a significant pathological prolonged QTc interval compared with undetectable finding in Group I. QT nomogram did not disclose significant findings while the plots of Lorenz and restitution steepness disclose that the patients of Group II were vulnerable to cardiac arrhythmias. Abnormal ECG findings were observed in the age extremities (≤18 years and ≥50 years in Group II compared with Group I. Conclusion: Utilization of QT-nomogram, restitution steepness, and tachogram plots is useful tools for detection subclinical vulnerable epileptic patient with cardiac arrhythmias.

  1. [Risk assessment of chemical agents].

    Science.gov (United States)

    Cottica, Danilo; Grignani, Elena; Bartolucci, Giovanni Battista

    2011-01-01

    The risk assessment of chemical agents is a well known and applied process carried out by Industrial Hygienists and Occupational Physicians based on exposure evaluation. The application of REACH (CE 1907/2006), CLP (CE 1272/2008) and SDS (UE 453/2010) introduces some changes and instruments to carry out the occupational exposure assessment, like new classification of substances, Exposure Scenario, suggested control measures that the Industrial Hygienist and the Occupational Physician must evaluate. If there is not a similar Exposure Scenario to apply a new risk assessment must carried out also by recommended software (ECETOC Targeted Risk Assessment; Easy to use workplace EMKG; Stoffenmanager). Looking at the relevance of the control measures and evaluation of Exposure Scenario we report the flowchart of risk assessment and management by the Method of Organisational Congruencies carried out with the Prevention and Protection Service and Occupational Physician Office of the Health Service of the Azienda Provinciale of Trento.

  2. Update on pharmacological cardiac stress testing: efficacy, risk stratification and patient selection.

    Science.gov (United States)

    Blankstein, Ron; Cannon, Christopher; Udelson, James

    2014-11-01

    Despite greater control of risk factors and improved treatments, coronary heart disease (CHD) remains a significant cause of mortality with 1 in every 4 deaths in the United States due to this disorder.(1) Cardiac stress tests have long been one of the most often utilized testing modalities used to identify patients suspected of having CHD, specifically coronary artery disease (CAD). These tests allow for noninvasive assessment of the coronary circulation and its ability to augment flow in response to physiologic demand. As with any diagnostic testing however, potential health risks as well as the financial burden of cardiovascular stress testing, must be weighed against the benefits and utility of the data procured. Given the rapidly evolving field of cardiac stress testing with respect to new risk stratification guidelines, new agents, and new assessment methods, it is difficult for physicians to remain up to date on the latest research and the benefits and risks of different testing modalities. A recent survey of primary care physicians and cardiologists conducted by the Elsevier Office of Continuing Medical Education found that approximately one-quarter of the cardiologists and primary care physicians surveyed do not feel confident identifying the factors which should be considered before ordering a cardiac stress test as part of pre-operative screening for a patient. Additionally, this survey also reported that primary care physicians reported a high degree of confidence in ordering the appropriate cardiac screening tests for patients yet, cardiologists reported that they frequently/somewhat frequently felt the need to change the test ordered by the internist. This educational intervention focuses on patient selection, exercise vs. pharmacologic stress testing, pharmacologic agents, and the importance of patient and doctor communication in ensuring the right test is recommended for the right patient. This CME Multimedia Activity is also available through the

  3. Cardiac Complications after Non-cardiac Surgery: Perioperative Risk Prediction and Reduction Strategies

    NARCIS (Netherlands)

    E.J. Bakker (Erik Jan)

    2013-01-01

    markdownabstract__Abstract__ Introduction | 9 I More than 200 million people worldwide undergo non-cardiac surgery annually. It is estimated that 2-5 percent of these patients suffer a cardiac complication (i.e. myocardial infarction, congestive heart failure, arrhythmia), resulting in death in app

  4. Building better environmental risk assessments

    Directory of Open Access Journals (Sweden)

    Raymond eLayton

    2015-08-01

    Full Text Available Risk assessment is a reasoned, structured approach to address uncertainty based on scientific and technical evidence. It forms the foundation for regulatory decision making, which is bound by legislative and policy requirements, as well as the need for making timely decisions using available resources. In order to be most useful, environmental risk assessments (ERA for genetically modified (GM crops should provide consistent, reliable, and transparent results across all types of GM crops, traits, and environments. The assessments must also separate essential information from scientific or agronomic data of marginal relevance or value for evaluating risk and complete the assessment in a timely fashion. Challenges in conducting ERAs differ across regulatory systems – examples are presented from Canada, Malaysia, and Argentina. One challenge faced across the globe is the conduct of risk assessments with limited resources. This challenge can be overcome by clarifying risk concepts, placing greater emphasis on data critical to assess environmental risk (for example, phenotypic and plant performance data rather than molecular data, and adapting advances in risk analysis from other relevant disciplines.

  5. Hazard classification or risk assessment

    DEFF Research Database (Denmark)

    Hass, Ulla

    2013-01-01

    The EU classification of substances for e.g. reproductive toxicants is hazard based and does not to address the risk suchsubstances may pose through normal, or extreme, use. Such hazard classification complies with the consumer's right to know. It is also an incentive to careful use and storage...... and to substitute with less toxic compounds. Actually, if exposure is constant across product class, producersmay make substitution decisions based on hazard. Hazard classification is also useful during major accidents where there is no time for risk assessment and the exposure is likely to be substantial enough...... be a poor substitute for a proper risk assessment as low potency substances can constitute a risk if the exposure is high enough and vice versa. Examples illustrating the strength and limitations of hazard classification, risk assessment and toxicological potency will be presented with focus on reproductive...

  6. Life Cycle Assessment and Risk Assessment

    DEFF Research Database (Denmark)

    Olsen, Stig Irving

    Life Cycle Assessment (LCA) is a tool for environmental assessment of product and systems – over the whole life cycle from acquisition of raw materials to the end-of-life of the product – and encompassing all environmental impacts of emissions and resource usage, e.g. global warming, acidification...... and toxicity. Whereas Risk Assessment (RA) aims to identify absolute risks, LCA assess potential or relative impacts. LCA is readily applicable to nanotechnologies and several studies have been carried out, but LCA faces large problems when addressing toxic impacts of nanomaterials emitted during the life...... cycle. The models for assessing toxic impacts in LCA are to a large extent based on those developed for RA, e.g. EUSES, and require basic information about the inherent properties of the emissions like solubility, LogKow,ED50 etc. Additionally, it is a prerequisite to know how to characterize...

  7. Deterministic quantitative risk assessment development

    Energy Technology Data Exchange (ETDEWEB)

    Dawson, Jane; Colquhoun, Iain [PII Pipeline Solutions Business of GE Oil and Gas, Cramlington Northumberland (United Kingdom)

    2009-07-01

    Current risk assessment practice in pipeline integrity management is to use a semi-quantitative index-based or model based methodology. This approach has been found to be very flexible and provide useful results for identifying high risk areas and for prioritizing physical integrity assessments. However, as pipeline operators progressively adopt an operating strategy of continual risk reduction with a view to minimizing total expenditures within safety, environmental, and reliability constraints, the need for quantitative assessments of risk levels is becoming evident. Whereas reliability based quantitative risk assessments can be and are routinely carried out on a site-specific basis, they require significant amounts of quantitative data for the results to be meaningful. This need for detailed and reliable data tends to make these methods unwieldy for system-wide risk k assessment applications. This paper describes methods for estimating risk quantitatively through the calibration of semi-quantitative estimates to failure rates for peer pipeline systems. The methods involve the analysis of the failure rate distribution, and techniques for mapping the rate to the distribution of likelihoods available from currently available semi-quantitative programs. By applying point value probabilities to the failure rates, deterministic quantitative risk assessment (QRA) provides greater rigor and objectivity than can usually be achieved through the implementation of semi-quantitative risk assessment results. The method permits a fully quantitative approach or a mixture of QRA and semi-QRA to suit the operator's data availability and quality, and analysis needs. For example, consequence analysis can be quantitative or can address qualitative ranges for consequence categories. Likewise, failure likelihoods can be output as classical probabilities or as expected failure frequencies as required. (author)

  8. Risk assessment future cash flows

    OpenAIRE

    Chachina H. G.

    2012-01-01

    This article is about risk assessment in planning future cash flows. Discount rate in DCF-model must include four factors: risk cash flow, inflation, value of investments, turnover assets. This has an influence net present value cash flow and make his incomparable.

  9. Cloud computing assessing the risks

    CERN Document Server

    Carstensen, Jared; Golden, Bernard

    2012-01-01

    Cloud Computing: Assessing the risks answers these questions and many more. Using jargon-free language and relevant examples, analogies and diagrams, it is an up-to-date, clear and comprehensive guide the security, governance, risk, and compliance elements of Cloud Computing.

  10. Modern biogeochemistry environmental risk assessment

    CERN Document Server

    Bashkin, Vladimir N

    2006-01-01

    Most books deal mainly with various technical aspects of ERA description and calculationsAims at generalizing the modern ideas of both biogeochemical and environmental risk assessment during recent yearsAims at supplementing the existing books by providing a modern understanding of mechanisms that are responsible for the ecological risk for human beings and ecosystem

  11. SEISMIC RISK ASSESSMENT OF LEVEES

    Directory of Open Access Journals (Sweden)

    Dario Rosidi

    2007-01-01

    Full Text Available A seismic risk assessment procedure for earth embankments and levees is presented. The procedure consists of three major elements: (1 probability of ground motion at the site, (2 probability of levee failure given a level of ground motion has occurred and (3 expected loss resulting from the failure. This paper discusses the first two elements of the risk assessment. The third element, which includes economic losses and human casualty, will not be presented herein. The ground motions for risk assessment are developed using a probabilistic seismic hazard analysis. A two-dimensional finite element analysis is performed to estimate the dynamic responses of levee, and the probability of levee failure is calculated using the levee fragility curve. The overall objective of the assessment is to develop an analytical tool for assessing the failure risk and the effectiveness of various levee strengthening alternatives for risk reduction. An example of the procedure, as it applies to a levee built along the perimeter of an island for flood protection and water storage, is presented. Variations in earthquake ground motion and soil and water conditions at the site are incorporated in the risk assessment. The effects of liquefaction in the foundation soils are also considered.

  12. Risk factors for lead complications in cardiac pacing

    DEFF Research Database (Denmark)

    Kirkfeldt, Rikke Esberg; Johansen, Jens Brock; Nøhr, Ellen Aagaard;

    2011-01-01

    Lead complications are the main reason for reoperation after implantation of pacemakers (PM) or cardiac resynchronization therapy (CRT-P) devices.......Lead complications are the main reason for reoperation after implantation of pacemakers (PM) or cardiac resynchronization therapy (CRT-P) devices....

  13. Pharmacological and Biological Risk Factors for Cardiac Arrhythmias

    NARCIS (Netherlands)

    C. van Noord (Charlotte)

    2009-01-01

    textabstractSudden death is among the most common causes of death in developed countries. Sudden death from cardiac causes accounts for approximately 50% of all deaths from cardiovascular diseases and 20% of all deaths. The majority (80-85%) of sudden cardiac deaths are caused by acute ventricular a

  14. Inpatient and outpatient cardiac rehabilitation programmes improve cardiometabolic risk in revascularized coronary patients with type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Claudiu Avram

    2010-12-01

    Full Text Available The purpose of this paper is to evaluate cardiometabolic risk reduction of diabetic patients following coronary revascularizationprocedures after participation in outpatients or inpatients cardiac rehabilitation programmes. Materials and methods: weperformed a retrospective analytical study which included a group of 103 revascularized coronary patients with diabetesmellitus. Depending on participation in a cardiac rehabilitation program we have defined the following subgroups of patients:Group O (N=37 - attended the outpatient cardiac rehabilitation program; Group H (N=37 - attended the inpatient cardiacrehabilitation program; Group C (N=34 - did not participate in any cardiac rehabilitation program. Between those two momentsof assessment: T0 - revascularization / early post-revascularization and T1 - time of the interview (16±2.3 months afterrevascularization, patients in groups A and S participated in outpatient cardiac rehabilitation program (12 weeks, 3sessions/week of exercise training, with clinical and paraclinical evaluation scheduled at 1, 6, 12 months afterrevascularization, or inpatient cardiac rehabilitation program (3 weeks, intensive sessions, scheduled at 1, 3, 6 and 12months after revascularization. Results: at the end of the study, we found significant differences among the three groups forthe following parameters: body mass index (p=0.01, systolic blood pressure (p=0.002, total cholesterol (p<0.001, LDLcholesterol(p<0.001 and non-HDL cholesterol (p=0.004 in favor of groups A and S, that have participated in comprehensivecardiac rehabilitation programs. Conclusions: comprehensive cardiac rehabilitation programmes, performed outpatient orinpatient, are effective methods of reducing the high cardiometabolic risk, specific in revascularized coronary patients withdiabetes.

  15. Reducing cardiovascular risk in spouses of cardiac patients: a randomized controlled trial.

    Science.gov (United States)

    Yates, Bernice C; Rowland, Sheri; Mancuso, Kerry; Kupzyk, Kevin A; Norman, Joseph F; Shurmur, Scott; Tesina, Karen

    2015-01-01

    Few studies have examined risk-reducing interventions in spouses of coronary artery bypass patients. This study examined the effects of the Partners Together in Health (PaTH) intervention versus usual care on cardiovascular risk factors. Spouses in the experimental group (n = 17/group) attended cardiac rehabilitation with patients and made the same physical activity and healthy eating changes as patients. Spouses in the usual care group attended educational classes with patients. Spouses' 30-year cardiovascular risk was calculated using the Lifetime Risk Scale before and after cardiac rehabilitation (3 months), and at 6 months. Spouses in both groups significantly reduced 30-year risk scores at 3 and 6 months. Exercise was the key ingredient in lowering risk. There was a trend toward reduction in systolic blood pressure and an increase in high-density lipoprotein cholesterol in both groups. Although there were no group differences, having spouses participate in cardiac rehabilitation with the patient was effective for reducing spouses' cardiovascular risk.

  16. Caries risk assessment

    DEFF Research Database (Denmark)

    Mejàre, I; Axelsson, S; Dahlén, G

    2014-01-01

    OBJECTIVE: To assess the ability of multivariate models and single factors to correctly identify future caries development in pre-school children and schoolchildren/adolescents. STUDY DESIGN: A systematic literature search for relevant papers was conducted with pre-determined inclusion criteria. ...

  17. Comparative Cardiac Risks of Methylphenidate and Amphetamines in Treatment of ADHD

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2009-08-01

    Full Text Available The risk for adverse cardiac events in subjects between 3 and 20 years of age treated with methylphenidate or amphetamine salts for ADHD was determined in a retrospective study at University of Florida, Gainesville, FL.

  18. Cancer risk assessment of toxaphene.

    Science.gov (United States)

    Buranatrevedh, Surasak

    2004-07-01

    The primary purpose is to do cancer risk assessment of toxaphene by using four steps of risk assessment proposed by the United States National Academy of Sciences/National Research Council (NAS/NRC). Four steps of risk assessment including hazard identification, dose-response relationship, exposure assessment, and risk characterization were used to evaluate cancer risk of toxaphene. Toxaphene was the most heavily used insecticide in many parts of the world before it was banned in 1982. It increased incidence of neoplasms of liver and uterus in mice and increased incidence of neoplasms of endocrine organs, thyroid, pituitary, adrenal, mammary glands, and reproductive systems in rats. From mice's and rats' study, slope factor for toxaphene is 0.8557 (mg/ kg/day)(-1). Lifetime average daily dose (LADD) of toxaphene from ambient air, surface water, soil, and fish were 1.08 x 10(-6), 5.71 x 10(-6), 3.43 x 10(-7), and 7.96 x 10(-5) mg/kg/day, respectively. Cancer risk of toxaphene for average exposure is 7.42 x 10(-5). From this study, toxaphene might have carcinogenic risk among humans.

  19. Suicide Risk Assessment in Adolescents

    DEFF Research Database (Denmark)

    Jakobsen, Ida Skytte; Larsen, Kim Juul; Horwood, John

    2016-01-01

    Background: Assessment and screening are often the first step in planning interventions to help adolescents at risk of suicide. Causes of suicidal thoughts and behavior are multifaceted and it is important for clinical work that assessment reflects this complexity. Aim(s): To investigate whether ...

  20. Qualitative methods for assessing risk

    Energy Technology Data Exchange (ETDEWEB)

    Mahn, J.A. [Sandia National Labs., Albuquerque, NM (United States); Hannaman, G.W. [Science Applications International Corp., San Diego, CA (United States); Kryska, P. [Science Applications International Corp., Albuquerque, NM (United States)

    1995-04-01

    The Department of Energy`s (DOE) non-nuclear facilities generally require only a qualitative accident analysis to assess facility risks in accordance with DOE Order 5481.1B, Safety Analysis and Review System. Achieving a meaningful qualitative assessment of risk necessarily requires the use of suitable non-numerical assessment criteria. Typically, the methods and criteria for assigning facility-specific accident scenarios to the qualitative severity and likelihood classification system in the DOE order requires significant judgment in many applications. Systematic methods for more consistently assigning the total accident scenario frequency and associated consequences are required to substantiate and enhance future risk ranking between various activities at Sandia National Laboratories (SNL). SNL`s Risk Management and National Environmental Policy Act (NEPA) Department has developed an improved methodology for performing qualitative risk assessments in accordance wi the DOE order requirements. Products of this effort are an improved set of qualitative description that permit (1) definition of the severity for both technical and programmatic consequences that may result from a variety of accident scenarios, and (2) qualitative representation of the likelihood of occurrence. These sets of descriptions are intended to facilitate proper application of DOE criteria for assessing facility risks.

  1. Caries risk assessment in children

    DEFF Research Database (Denmark)

    Twetman, S

    2016-01-01

    displayed a high risk of bias. CONCLUSIONS: Based on the present summary of literature, it may be concluded: (1) a caries risk assessment should be carried out at the child's first dental visit and reassessments should be done during childhood (D); (2) multivariate models display a better accuracy than......PURPOSE: To summarise the findings of recent systematic reviews (SR) covering caries risk assessment in children, updated with recent primary studies. METHODS: A search for relevant papers published 2012-2014 was conducted in electronic databases. The systematic reviews were quality assessed...... the use of single predictors and this is especially true for preschool children (C); (3) there is no clearly superior method to predict future caries and no evidence to support the use of one model, program, or technology before the other (C); and (4) the risk category should be linked to appropriate...

  2. Cardiac pathologies in female carriers of Duchenne muscular dystrophy assessed by cardiovascular magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Schelhorn, Juliane; Schemuth, Haemi; Nensa, Felix; Nassenstein, Kai; Forsting, Michael; Schlosser, Thomas [University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Schoenecker, Anne; Neudorf, Ulrich [University Hospital Essen, Department of Pediatric Cardiology, Essen (Germany); Schara, Ulrike [University Hospital Essen, Department of Pediatric Neurology, Essen (Germany)

    2015-10-15

    Duchenne muscular dystrophy (DMD) is the most common and severe dystrophinopathy. DMD carriers rarely present with clinical symptoms, but may suffer from cardiac involvement. Because echocardiographic findings are inconsistent and cardiac magnetic resonance imaging (CMRI) data are limited, this study sought to investigate asymptomatic carriers for cardiac abnormalities using CMRI. Fifteen genetically confirmed DMD carriers (age, 32.3 ± 10.2 years) were prospectively examined on a 1.5T MR system. Cine, T2, and late-gadolinium-enhanced (LGE) images were acquired, and were evaluated in consensus by two experienced readers. Left ventricular (LV) parameters were analysed semiautomatically, normalized to BSA. Normalized LV end-diastolic volume was increased in 7 % (73.7 ± 16.8 ml/m{sup 2}; range, 48-116 ml/m{sup 2}) and normalized LV end-systolic volume in 20 % (31.5 ± 13.3 ml/m{sup 2}; range, 15-74 ml/m{sup 2}). EF was reduced in 33 % (58.4 ± 7.6 %; range, 37-69 %) and normalized LV myocardial mass in 80 % (40.5 ± 6.8 g/m{sup 2}; range, 31-55 g/m{sup 2}). In 80 %, regional myocardial thinning was detected in more than one segment. In 13 % and 40 %, apical-lateral accentuation of LV non-compaction was present. LGE was found in 60 % (midmyocardial inferolateral accentuation). Given the high frequency of cardiac pathologies detected by CMRI, regular cardiac risk assessment is advisable for DMD carriers. Besides clinical examination, CMRI is an excellent tool for this purpose. (orig.)

  3. Assessment of inflammatory factors and cardiac troponin T in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Falaknazi Kianoosh

    2009-01-01

    Full Text Available Hemodialysis (HD patients suffer from chronic inflammations which make them at increased risk of cardiovascular diseases. The purpose of this study was to see if there is a significant association between inflammatory factors such as ferritin and C-reactive protein (CRP as well as troponin T in patients on HD. We assessed these serum factors as well as other known cardiac risk factors in 53 patients on HD. The serum ferritin and CRP levels were measured by chemiluminescence′s immune assay while troponin T levels were measured by electrochemist luminescence immune assay. We found that serum concentrations of CRP and ferritin were not significantly higher in patients on HD with known cardiac risk factors (compared with the control group (p< 0.05. However, the serum troponin T levels in HD patients with cardiovascular risk factors were significantly higher than the control group. Our study suggests that elevated serum troponin T levels can play an important role as a predictor of cardiovascular disease in HD patients. Also, inflammatory factors such as CRP and ferritin may be influenced by chronic inflammation or nutritional status of these patients.

  4. Improving VTE risk assessment at point of admission to a tertiary centre cardiology ward

    Science.gov (United States)

    Wilson, Rachel

    2015-01-01

    Cardiology wards are generally high turnover units, which may receive primary PCI, high-risk NSTEMI patients, and other general cardiac admissions from a large geographical area. Many centres also provide national specialist services for rarer cardiac conditions for which admissions may be lengthy. Cardiac patients have significant risk factors for venous thromboembolism (VTE) as immobility may be due to systolic dysfunction, attachment to continuous monitoring and predisposition to chest pain, or cardiac syncope. It is recommended by NICE that an initial VTE risk assessment is undertaken at the time of patient admission, with reassessment within 24 hours. For this purpose a risk assessment tool is featured on the front of many Trust drug charts. It is noted that this risk assessment is electronic in other trusts. We undertook an audit into the drug chart documentation of VTE risk assessment on the cardiology ward and the Coronary Care Unit (CCU) at The Royal Free Hospital. It was evident that documentation of VTE risk assessment was poor. The audit interventions were; a teaching presentation to the cardiology department, an educational poster, several update emails to the department and the identification of a ‘VTE risk assessment champion’ to audit ongoing compliance. Following these measures the second audit round demonstrated that documentation of initial risk assessment was slightly improved, but significant improvement was seen in documentation of risk assessment at 24 hours post admission. Results from a third audit cycle indicated that the improvement in initial VTE risk assessment was sustained, and that there was a significant sustained improvement in risk assessment at 24 hours (p <0.05). Recommendations for sustained improvement included: redesigning the drug chart so that the VTE risk assessment tool was linked to the VTE prophylaxis prescription box, and designating the responsibility of the initial VTE risk assessment to the on call junior doctor

  5. Cardiac risk stratification with myocardial perfusion imaging in potential renal-pancreas transplant recipients

    Energy Technology Data Exchange (ETDEWEB)

    McCarthy, M.C.; Larcos, G.; Chapman, J. [Westmead Hospital, Westmead, Sydney, NSW (Australia). Departments of Nuclear Medicine and Ultrasound

    1998-06-01

    Full text: Combined renal/pancreas transplantation is used in patients with severe type-1 diabetes and renal failure. Many patients have asymptomatic coronary artery disease (CAD). Thus, myocardial perfusion imaging (MPI) is widely used for preoperative risk assessment, however, its value has recently been challenged. The purpose of this study was to determine the predictive value of MPI compared to coronary angiography and/or thirty day perioperative cardiac events (cardiac death, myocardial infarction and unstable angina). We reviewed the MPI in 132 patients that were referred for possible renal pancreas transplantation during the period between 1987 - June 1997. Fifty five patients were excluded because of: still awaiting transplantation (n=19) ongoing medical assessment (n=21), received kidney only transplant (n=6) or other factors (n=9). Thus, 77 patients form the basis of this report. Seventy one patients were transplanted, 5 had coronary angiography and one died before transplantation but with coronary anatomy defined at autopsy. All patients (39 male, 38 female; mean age 37 years) had Tl-201 or Tc-99m MIBI SPECT at Westmead (n=54) or elsewhere (n=23). Patients underwent MPI, a mean of 12.1 months before transplantation and a mean of 6 months before coronary angiography or autopsy. MPI was normal in 64 (83%) and abnormal in 13 (17%) patients. Of the abnormal MPI, 7 patients had CAD and one had unstable angina post-operatively (PPV = 8/13; 61%). One patient had a fixed defect post CABG but proceeded to transplant with-out event; the other 4 patients had normal coronary anatomy. Of the normal MPIs there were no transplant related cardiac events, but one patient required CABG >12 months post MPI and a further patient died >12 months post transplant and was shown to have CAD at autopsy (NPV=62/64;97%). In conclusion we have found an excellent NPV and an acceptable PPV for MPI in potential renal pancreas graft recipients

  6. Automatic Assessment of Socioeconomic Impact on Cardiac Rehabilitation

    Directory of Open Access Journals (Sweden)

    Mireia Calvo

    2013-10-01

    Full Text Available Disability-Adjusted Life Years (DALYs and Quality-Adjusted Life Years (QALYs, which capture life expectancy and quality of the remaining life-years, are applied in a new method to measure socioeconomic impacts related to health. A 7-step methodology estimating the impact of health interventions based on DALYs, QALYs and functioning changes is presented. It relates the latter (1 to the EQ-5D-5L questionnaire (2 to automatically calculate the health status before and after the intervention (3. This change of status is represented as a change in quality of life when calculating QALYs gained due to the intervention (4. In order to make an economic assessment, QALYs gained are converted to DALYs averted (5. Then, by inferring the cost/DALY from the cost associated to the disability in terms of DALYs lost (6 and taking into account the cost of the action, cost savings due to the intervention are calculated (7 as an objective measure of socioeconomic impact. The methodology is implemented in Java. Cases within the framework of cardiac rehabilitation processes are analyzed and the calculations are based on 200 patients who underwent different cardiac-rehabilitation processes. Results show that these interventions result, on average, in a gain in QALYs of 0.6 and a cost savings of 8,000 €.

  7. Automatic assessment of socioeconomic impact on cardiac rehabilitation.

    Science.gov (United States)

    Calvo, Mireia; Subirats, Laia; Ceccaroni, Luigi; Maroto, José María; de Pablo, Carmen; Miralles, Felip

    2013-10-25

    Disability-Adjusted Life Years (DALYs) and Quality-Adjusted Life Years (QALYs), which capture life expectancy and quality of the remaining life-years, are applied in a new method to measure socioeconomic impacts related to health. A 7-step methodology estimating the impact of health interventions based on DALYs, QALYs and functioning changes is presented. It relates the latter (1) to the EQ-5D-5L questionnaire (2) to automatically calculate the health status before and after the intervention (3). This change of status is represented as a change in quality of life when calculating QALYs gained due to the intervention (4). In order to make an economic assessment, QALYs gained are converted to DALYs averted (5). Then, by inferring the cost/DALY from the cost associated to the disability in terms of DALYs lost (6) and taking into account the cost of the action, cost savings due to the intervention are calculated (7) as an objective measure of socioeconomic impact. The methodology is implemented in Java. Cases within the framework of cardiac rehabilitation processes are analyzed and the calculations are based on 200 patients who underwent different cardiac-rehabilitation processes. Results show that these interventions result, on average, in a gain in QALYs of 0.6 and a cost savings of 8,000 €.

  8. An approach to risk assessment

    DEFF Research Database (Denmark)

    Simonsen, L.; Lund, S. P.; Hass, Ulla

    1998-01-01

    indicate that numerous persons are exposed in the working as well as in the general environment to several chemicals, for which almost no data on the effect on subtle neurophysiological functions are available. Development of an approach to risk assessment dealing with this problem is a major challenge...... in the nineties. Different approaches to risk assessment are discussed, the quality of the databases available for hazard assessment are evaluated, and the needs for further research are identified. (C) 1996 Intox Press, Inc.......A strategy for delineating risk factors from use of neurotoxic chemicals was applied to the Danish working environment. An analysis using this strategy disclosed the need for internationally adopted criteria for neurotoxicity, and consequently a working group was established by the Nordic Council...

  9. ANTHROPIC RISK ASSESSMENT ON BIODIVERSITY

    OpenAIRE

    2014-01-01

    This paper presents a methodology for risk assessment of anthropic activities on habitats and species. The method has been developed for Veneto Region, in order to simplify and improve the quality of EIA procedure (VINCA). Habitats and species, animals and plants, are protected by European Directive 92/43/EEC and 2009/147/EC but they are subject at hazard due to pollution produced by human activities. Biodiversity risks may conduct to deterioration and disturbance in ecological niche...

  10. Army Independent Risk Assessment Guidebook

    Science.gov (United States)

    2014-04-01

    AMSAA Kadry Rizk, TARDEC Lisa Graf, TARDEC Klaus Sanford, TRAC Elyse Krezmien, TRAC Jerry Scriven, ALU Igor Linkov, ERDC Alison Tichenor...Engineering ATEC - Army Test and Evaluation Command BCA - Business Case Analysis C - Consequence Level C- BA - Cost Benefit Analysis CDD...the AMSAA Risk Team has completed 12 technical and schedule risk assessments to support AoAs and Cost-Benefit Analyses (C- BAs ). AMSAA also developed

  11. Risk Factors for Postoperative Encephalopathies in Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    A. N. Shepelyuk

    2012-01-01

    Full Text Available Objective: to reveal risk factors for postoperative neurological complications (PONC during surgery under extracorporeal circulation (EC. Subjects and methods. Five hundred and forty-eight patients were operated on under EC. Multimodality monitoring was performed in all the patients. Pre-, intra-, and postoperative data were analyzed. Results. Two patient groups were identified. These were 1 59 patients with PONC and 2 489 patients without PONC. The patients with PONC were older than those without PONC (61.95±1.15 and 59±0.4 years and had a smaller body surface area (1.87±0.02 and 1.97±0.01 m2; in the PONC group, there were more women (37.3±6.4 and 22.1±1.9%. In Group 1, comorbidity was a significantly more common indication for surgery (33.9±6.22 and 9.2±1.29%. In this group, cerebral oxygenation (CO was significantly lower (64±1.41 and 69.9±0.38%. In the preoperative period, there were group differences in hemoglobin (Hb, total protein, creatinine, and urea (135±2.03; 142±0.71 g/l, 73±0.93; 74.9±0.3 mmol/l, 104.7±3.3; 96.3±1.06 mmol/l, 7.5±0.4; 6.5±0.1 mmol/l, respectively. The PONC group more frequently exhibited more than 50% internal carotid artery (ICA stenosis (28.8±5.95; 15.3± 1.63%; р<0.05, dyscirculatory encephalopathies (DEP (38.9±6.4 and 19.4±1.8%; р<0.05, CO, Hb, hematocrit, and oxygen delivery were lower in Group 1 at all stages. In the preperfusion period, cardiac index was lower in Group 1 (2.3±0.1 and 2.5±0.03 l/min/m2; р<0.01. In the postper-fusion period, blood pressure was lower in Group 1 (72.3±1.4 and 76.4±0.47 mm Hg; р=0.007 and higher rate was higher (92.65±1.5 and 88.16±0.49 min-1; р=0.007. Lower PCO2a was noted in Group 1. In this group, the patients were given epinephrine more frequently (33.9±6.2 and 20.5±1.8%; р<0.05 and in larger dosages (0.02±0.001 and 0.01±0.003 ^g/kg/min; р<0.05. Conclusion. The preoperative risk factors of CONC is female gender, lower body surface area

  12. Tsunami risk assessment in Indonesia

    Directory of Open Access Journals (Sweden)

    G. Strunz

    2011-01-01

    Full Text Available In the framework of the German Indonesian Tsunami Early Warning System (GITEWS the assessment of tsunami risk is an essential part of the overall activities. The scientific and technical approach for the tsunami risk assessment has been developed and the results are implemented in the national Indonesian Tsunami Warning Centre and are provided to the national and regional disaster management and spatial planning institutions in Indonesia.

    The paper explains the underlying concepts and applied methods and shows some of the results achieved in the GITEWS project (Rudloff et al., 2009. The tsunami risk assessment has been performed at an overview scale at sub-national level covering the coastal areas of southern Sumatra, Java and Bali and also on a detailed scale in three pilot areas. The results are provided as thematic maps and GIS information layers for the national and regional planning institutions. From the analyses key parameters of tsunami risk are derived, which are integrated and stored in the decision support system of the national Indonesian Early Warning Centre. Moreover, technical descriptions and guidelines were elaborated to explain the developed approach, to allow future updates of the results and the further development of the methodologies, and to enable the local authorities to conduct tsunami risk assessment by using their own resources.

  13. Growth hormone and risk for cardiac tumors in Carney complex.

    Science.gov (United States)

    Bandettini, W Patricia; Karageorgiadis, Alexander S; Sinaii, Ninet; Rosing, Douglas R; Sachdev, Vandana; Schernthaner-Reiter, Marie Helene; Gourgari, Evgenia; Papadakis, Georgios Z; Keil, Meg F; Lyssikatos, Charalampos; Carney, J Aidan; Arai, Andrew E; Lodish, Maya; Stratakis, Constantine A

    2016-09-01

    Carney complex (CNC) is a multiple neoplasia syndrome that is caused mostly by PRKAR1A mutations. Cardiac myxomas are the leading cause of mortality in CNC patients who, in addition, often develop growth hormone (GH) excess. We studied patients with CNC, who were observed for over a period of 20 years (1995-2015) for the development of both GH excess and cardiac myxomas. GH secretion was evaluated by standard testing; dedicated cardiovascular imaging was used to detect cardiac abnormalities. Four excised cardiac myxomas were tested for the expression of insulin-like growth factor-1 (IGF-1). A total of 99 CNC patients (97 with a PRKAR1A mutation) were included in the study with a mean age of 25.8 ± 16.6 years at presentation. Over an observed mean follow-up of 25.8 years, 60% of patients with GH excess (n = 46) developed a cardiac myxoma compared with only 36% of those without GH excess (n = 54) (P = 0.016). Overall, patients with GH excess were also more likely to have a tumor vs those with normal GH secretion (OR: 2.78, 95% CI: 1.23-6.29; P = 0.014). IGF-1 mRNA and protein were higher in CNC myxomas than in normal heart tissue. We conclude that the development of cardiac myxomas in CNC may be associated with increased GH secretion, in a manner analogous to the association between fibrous dysplasia and GH excess in McCune-Albright syndrome, a condition similar to CNC. We speculate that treatment of GH excess in patients with CNC may reduce the likelihood of cardiac myxoma formation and/or recurrence of this tumor.

  14. Scintigraphic assessment of cardiac sympathetic innervation with I-123-metaiodobenzylguanidine in cardiomyopathy. Special reference to cardiac arrhythmia

    Energy Technology Data Exchange (ETDEWEB)

    Asano, Takahisa; Otsuka, Nobuaki; Sone, Teruki; Mimura, Hiroaki; Yanagimoto, Shinichi; Tomomitsu, Tatsushi; Fukunaga, Masao [Kawasaki Medical School, Kurashiki, Okayama (Japan); Morita, Koichi

    1999-07-01

    Cardiac sympathetic imagings with I-123-metaiodobenzylguanidine (MIBG) were carried out in 5 cases with dilated cardiomyopathy (DCM), 26 cases with hypertrophic cardiomyopathy (HCM), and 4 cases without cardiac disease as a control to assess cardiac sympathetic innervation qualitatively and quantitatively, and to clarify the relation of MIBG accumulation to arrhythmia. MIBG scintigraphy was performed at 15 min. (early image) and 4 hr. (delayed image) after intravenous injection of MIBG 111 MBq. The MIBG uptake ratio of mediastinum (H/M) and the cardiac washout rate (WR) from early to delayed images were calculated. On both early and delayed SPECTs, MIBG uptake was assessed by defect scores (DSs). Regarding the cases with HCM, the MIBG uptake ratio, WR, and DS were also compared in cases with and without arrhythmia. In DCM, the MIBG uptake on delayed SPECT was markedly low, the H/M ratio was significantly lower, and the DS was significantly higher than in the control (all p<0.05). As for the WR, there was no significant difference between HCM, DCM and the control. In HCM, significantly reduced MIBG uptake was observed in cases with ventricular techycardia (VT) and in cases with atrial fibrillation (Af), as compared with cases without arrhythmia (all p<0.05). There results suggest that MIBG scintigraphy might be a useful tool in the assessment of cardiac sympathetic abnormalities in cardiomyopathy, especially in cases with arrhythmia. (author)

  15. Determination of the value of glycated hemoglobin HbA1c and fructosamine in assessing the risk of perioperative complications after cardiac surgery in patients with type 2 diabetes

    Science.gov (United States)

    Wróbel, Marta; Rokicka, Dominika; Szymborska-Kajanek, Aleksandra; Foremny, Jerzy; Nadziakiewicz, Paweł; Zembala, Marian; Strojek, Krzysztof

    2016-01-01

    Introduction Patients with diabetes have a worse postoperative course and longer length of hospital stay after surgery. A good indicator of proper long-term (3 months) glycemic control is glycated hemoglobin (HbA1c), and fructosamine in the short term (2–3 weeks). Aim To determine the degree of glycemic control evaluated preoperatively by HbA1c and/or fructosamine influence on the postoperative course of patients with diabetes undergoing coronary artery bypass grafting (CABG) in 2014–2015. Material and methods Before the operation HbA1c (N < 7.0) and fructosamine (N < 280 µmol/l) were measured and depending on the results the respondents were divided into 4 groups: group I (n = 46) – normal both parameters; group II (n = 22) – high both values; group III (n = 4) – normal fructosamine/HbA1c high; group IV (n = 33) – high HbA1c/fructosamine normal. Statistical analysis was performed using the t-test assuming p < 0.05 to be statistically significant. Results One hundred and five patients were treated by CABG/OPCAB (39 female, 66 males). The mean age was 65.7 ±7.3, HbA1c: 7.23 ±1.2%, fructosamine: 261.8 ±43.8. There was no difference in the incidence of other postoperative complications between the two groups. Conclusions Glycated hemoglobin and fructosamine levels to a similar extent define the risk of perioperative complications in patients undergoing cardiac surgery. In patients in whom there is a need to quickly compensate for elevated blood glucose consider enabling determination of fructosamine. PMID:28096825

  16. Prolonged QTc interval and risk of sudden cardiac death in a population of older adults

    DEFF Research Database (Denmark)

    Straus, Sabine M J M; Kors, Jan A; De Bruin, Marie L;

    2006-01-01

    OBJECTIVES: This study sought to investigate whether prolongation of the heart rate-corrected QT (QTc) interval is a risk factor for sudden cardiac death in the general population. BACKGROUND: In developed countries, sudden cardiac death is a major cause of cardiovascular mortality. Prolongation...... of the QTc interval has been associated with ventricular arrhythmias, but in most population-based studies no consistent association was found between QTc prolongation and total or cardiovascular mortality. Only very few of these studies specifically addressed sudden cardiac death. METHODS: This study......). The association between a prolonged QTc interval and sudden cardiac death was estimated using Cox proportional hazards analysis. RESULTS: During an average follow-up period of 6.7 years (standard deviation, 2.3 years) 125 patients died of sudden cardiac death. An abnormally prolonged QTc interval (>450 ms in men...

  17. hERG (KCNH2 or Kv11.1) K+ channels: screening for cardiac arrhythmia risk.

    Science.gov (United States)

    Bowlby, Mark R; Peri, Ravi; Zhang, Howard; Dunlop, John

    2008-11-01

    Testing new compounds for pro-arrhythmic potential has focused in recent years on avoiding activity at the hERG K+ channel, as hERG block is a common feature of many pro-arrhythmic compounds associated with Torsades de Pointes in humans. Blockers of hERG are well known to prolong cardiac action potentials and lead to long QT syndrome, and activators, although rarer, can lead to short QT syndrome. The most reliable assays of hERG utilize stable cell lines, and include ligand binding, Rb+ flux and electrophysiology (both automated and manual). These assays can be followed by measurement of activity at other ion channels contributing to cardiac contractility and detailed action potential/repolarization measurements in cardiac tissue. An integrated risk assessment for pro-arrhythmic potential is ultimately required, as the constellation of ion channel activities and potencies, along with the mechanism/kinetics of ion channel block, may ultimately be the best predictor of cardiac risk in vivo.

  18. Dynamical systems probabilistic risk assessment.

    Energy Technology Data Exchange (ETDEWEB)

    Denman, Matthew R.; Ames, Arlo Leroy

    2014-03-01

    Probabilistic Risk Assessment (PRA) is the primary tool used to risk-inform nuclear power regulatory and licensing activities. Risk-informed regulations are intended to reduce inherent conservatism in regulatory metrics (e.g., allowable operating conditions and technical specifications) which are built into the regulatory framework by quantifying both the total risk profile as well as the change in the risk profile caused by an event or action (e.g., in-service inspection procedures or power uprates). Dynamical Systems (DS) analysis has been used to understand unintended time-dependent feedbacks in both industrial and organizational settings. In dynamical systems analysis, feedback loops can be characterized and studied as a function of time to describe the changes to the reliability of plant Structures, Systems and Components (SSCs). While DS has been used in many subject areas, some even within the PRA community, it has not been applied toward creating long-time horizon, dynamic PRAs (with time scales ranging between days and decades depending upon the analysis). Understanding slowly developing dynamic effects, such as wear-out, on SSC reliabilities may be instrumental in ensuring a safely and reliably operating nuclear fleet. Improving the estimation of a plant's continuously changing risk profile will allow for more meaningful risk insights, greater stakeholder confidence in risk insights, and increased operational flexibility.

  19. Dynamical systems probabilistic risk assessment

    Energy Technology Data Exchange (ETDEWEB)

    Denman, Matthew R. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Ames, Arlo Leroy [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2014-03-01

    Probabilistic Risk Assessment (PRA) is the primary tool used to risk-inform nuclear power regulatory and licensing activities. Risk-informed regulations are intended to reduce inherent conservatism in regulatory metrics (e.g., allowable operating conditions and technical specifications) which are built into the regulatory framework by quantifying both the total risk profile as well as the change in the risk profile caused by an event or action (e.g., in-service inspection procedures or power uprates). Dynamical Systems (DS) analysis has been used to understand unintended time-dependent feedbacks in both industrial and organizational settings. In dynamical systems analysis, feedback loops can be characterized and studied as a function of time to describe the changes to the reliability of plant Structures, Systems and Components (SSCs). While DS has been used in many subject areas, some even within the PRA community, it has not been applied toward creating long-time horizon, dynamic PRAs (with time scales ranging between days and decades depending upon the analysis). Understanding slowly developing dynamic effects, such as wear-out, on SSC reliabilities may be instrumental in ensuring a safely and reliably operating nuclear fleet. Improving the estimation of a plant's continuously changing risk profile will allow for more meaningful risk insights, greater stakeholder confidence in risk insights, and increased operational flexibility.

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

    Science.gov (United States)

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

    2015-08-17

    BACKGROUND We hypothesized that the combination of a preoperative and a postoperative scoring system would improve the accuracy of mortality prediction and therefore combined the preoperative 'additive EuroSCORE' (European system for cardiac operative risk evaluation) with the postoperative 'additive CASUS' (Cardiac Surgery Score) to form the 'modified CASUS'. MATERIAL AND METHODS We included all consecutive adult patients after cardiac surgery during January 2007 and December 2010 in our prospective study. Our single-centre study was conducted in a German general referral university hospital. The original additive and the 'modified CASUS' were tested using calibration and discrimination statistics. We compared the area under the curve (AUC) of the receiver characteristic curves (ROC) by DeLong's method and calculated overall correct classification (OCC) values. RESULTS The mean age among the total of 5207 patients was 67.2 ± 10.9 years. Whilst the ICU mortality was 5.9% we observed a mean length of ICU stay of 4.6 ± 7.0 days. Both models demonstrated excellent discriminatory power (mean AUC of 'modified CASUS': ≥ 0.929; 'additive CASUS': ≥ 0.920), with no significant differences according to DeLong. Neither model showed a significant p-value (cardiac surgery by combining a preoperative and a postoperative scoring system. A separate calculation of the two individual elements is therefore recommended.

  1. Beating and insulting children as a risk for adult cancer, cardiac disease and asthma.

    Science.gov (United States)

    Hyland, Michael E; Alkhalaf, Ahmed M; Whalley, Ben

    2013-12-01

    The use of physical punishment for children is associated with poor psychological and behavioral outcomes, but the causal pathway is controversial, and the effects on later physical health unknown. We conducted a cross-sectional survey of asthma, cancer, and cardiac patients (150 in each category, 75 male) recruited from outpatient clinics and 250 healthy controls (125 male). All participants were 40-60 years old and citizens of Saudi Arabia, where the use of beating and insults is an acceptable parenting style. Demographic data and recalled frequency of beatings and insults as a child were assessed on an 8-point scale. Beating and insults were highly correlated (ρ = 0.846). Propensity score matching was used to control for demographic differences between the disease and healthy groups. After controlling for differences, more frequent beating (once or more per month) and insults were associated with a significantly increased risk for cancer (RR = 1.7), cardiac disease (RR = 1.3) and asthma (RR = 1.6), with evidence of increased risk for cancer and asthma with beating frequency of once every 6 months or more. Our results show that a threatening parenting style of beating and insults is associated with increased risk for somatic disease, possibly because this form of parenting induces stress. Our findings are consistent with previous research showing that child abuse and other early life stressors adversely affect adult somatic health, but provide evidence that the pathogenic effects occur also with chronic minor stress. A stress-inducing parenting style, even when normative, has long term adverse health consequences.

  2. Pancreatic cellular injury after cardiac surgery with cardiopulmonary bypass: frequency, time course and risk factors.

    Science.gov (United States)

    Nys, Monique; Venneman, Ingrid; Deby-Dupont, Ginette; Preiser, Jean-Charles; Vanbelle, Sophie; Albert, Adelin; Camus, Gérard; Damas, Pierre; Larbuisson, Robert; Lamy, Maurice

    2007-05-01

    Although often clinically silent, pancreatic cellular injury (PCI) is relatively frequent after cardiac surgery with cardiopulmonary bypass; and its etiology and time course are largely unknown. We defined PCI as the simultaneous presence of abnormal values of pancreatic isoamylase and immunoreactive trypsin (IRT). The frequency and time evolution of PCI were assessed in this condition using assays for specific exocrine pancreatic enzymes. Correlations with inflammatory markers were searched for preoperative risk factors. One hundred ninety-three patients submitted to cardiac surgery were enrolled prospectively. Blood IRT, amylase, pancreatic isoamylase, lipase, and markers of inflammation (alpha1-protease inhibitor, alpha2-macroglobulin, myeloperoxidase) were measured preoperatively and postoperatively until day 8. The postoperative increase in plasma levels of pancreatic enzymes and urinary IRT was biphasic in all patients: early after surgery and later (from day 4 to 8 after surgery). One hundred thirty-three patients (69%) experienced PCI, with mean IRT, isoamylase, and alpha1-protease inhibitor values higher for each sample than that in patients without PCI. By multiple regression analysis, we found preoperative values of plasma IRT >or=40 ng/mL, amylase >or=42 IU/mL, and pancreatic isoamylase >or=20 IU/L associated with a higher incidence of postsurgery PCI (P < 0.005). In the PCI patients, a significant correlation was found between the 4 pancreatic enzymes and urinary IRT, total calcium, myeloperoxidase, alpha1-protease inhibitor, and alpha2-macroglobulin. These data support a high prevalence of postoperative PCI after cardiac surgery with cardiopulmonary bypass, typically biphasic and clinically silent, especially when pancreatic enzymes were elevated preoperatively.

  3. Left atrial enlargement increases the risk of major adverse cardiac events independent of coronary vasodilator capacity

    Energy Technology Data Exchange (ETDEWEB)

    Koh, Angela S. [Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); National Heart Centre Singapore, Singapore (Singapore); Murthy, Venkatesh L.; Sitek, Arkadiusz; Gayed, Peter; Bruyere, John; Di Carli, Marcelo F. [Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); Wu, Justina [Brigham and Women' s Hospital, Division of Cardiology, Department of Medicine, and the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, Boston, MA (United States); Dorbala, Sharmila [Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); Brigham and Women' s Hospital, Department of Radiology and the Division of Cardiology, Noninvasive Cardiovascular Imaging Section, Boston, MA (United States)

    2015-09-15

    Longstanding uncontrolled atherogenic risk factors may contribute to left atrial (LA) hypertension, LA enlargement (LAE) and coronary vascular dysfunction. Together they may better identify risk of major adverse cardiac events (MACE). The aim of this study was to test the hypothesis that chronic LA hypertension as assessed by LAE modifies the relationship between coronary vascular function and MACE. In 508 unselected subjects with a normal clinical {sup 82}Rb PET/CT, ejection fraction ≥40 %, no prior coronary artery disease, valve disease or atrial fibrillation, LAE was determined based on LA volumes estimated from the hybrid perfusion and CT transmission scan images and indexed to body surface area. Absolute myocardial blood flow and global coronary flow reserve (CFR) were calculated. Subjects were systematically followed-up for the primary end-point - MACE - a composite of all-cause death, myocardial infarction, hospitalization for heart failure, stroke, coronary artery disease progression or revascularization. During a median follow-up of 862 days, 65 of the subjects experienced a composite event. Compared with subjects with normal LA size, subjects with LAE showed significantly lower CFR (2.25 ± 0.83 vs. 1.95 ± 0.80, p = 0.01). LAE independently and incrementally predicted MACE even after accounting for clinical risk factors, medication use, stress left ventricular ejection fraction, stress left ventricular end-diastolic volume index and CFR (chi-squared statistic increased from 30.9 to 48.3; p = 0.001). Among subjects with normal CFR, those with LAE had significantly worse event-free survival (risk adjusted HR 5.4, 95 % CI 2.3 - 12.8, p < 0.0001). LAE and reduced CFR are related but distinct cardiovascular adaptations to atherogenic risk factors. LAE is a risk marker for MACE independent of clinical factors and left ventricular volumes; individuals with LAE may be at risk of MACE despite normal coronary vascular function. (orig.)

  4. Non-sedating antihistamine drugs and cardiac arrhythmias : biased risk estimates from spontaneous reporting systems?

    NARCIS (Netherlands)

    De Bruin, M L; van Puijenbroek, E P; Egberts, A C G; Hoes, A W; Leufkens, H G M

    2002-01-01

    AIMS: This study used spontaneous reports of adverse events to estimate the risk for developing cardiac arrhythmias due to the systemic use of non-sedating antihistamine drugs and compared the risk estimate before and after the regulatory action to recall the over-the-counter status of some of these

  5. High-Risk Cardiac Disease in Pregnancy Part I

    NARCIS (Netherlands)

    Elkayam, Uri; Goland, Sorel; Pieper, Petronella G.; Silverside, Candice K.

    2016-01-01

    The incidence of pregnancy in women with cardiovascular disease is rising, primarily due to the increased number of women with congenital heart disease reaching childbearing age and the changing demographics associated with advancing maternal age. Although most cardiac conditions are well tolerated

  6. Risk of congenital heart disease in relatives of probands with conotruncal cardiac defects: an evaluation of 1,620 families.

    Science.gov (United States)

    Peyvandi, Shabnam; Ingall, Eitan; Woyciechowski, Stacy; Garbarini, Jennifer; Mitchell, Laura E; Goldmuntz, Elizabeth

    2014-06-01

    Current recurrence risk counseling for conotruncal cardiac defects (CTD) is based on empiric estimates from multiple studies. We examined the risk of congenital heart disease (CHD) in relatives of probands with CTDs to assist in counseling practices in the current era. One thousand six-twenty probands with CTDs and no reported chromosomal or genetic abnormalities were recruited sequentially. A three-generation pedigree was obtained for each proband by a genetic counselor detailing the presence and type of CHD in each family member. Risks and 95% confidence intervals (CI) were calculated for sub-groups of relatives based on degree of relationship for all probands and by individual lesion of the proband. For pairs of affected relatives, concordance rates were calculated. Severity of CHD in the affected relative was assessed. The risk of CHD was higher in siblings (4.4%, 95% CI 3.4-5.4) than in parents (1.5%, 95% CI 1.1-1.9). Risk varied by the cardiac lesion of the proband with the highest risk in first-degree relatives of probands with tetralogy of Fallot and the lowest in D-transposition of the great arteries. 39% of affected parents and 69% of affected siblings had a concordant lesion (i.e., CTD). Most affected siblings of probands with severe CTDs had complex defects (58%), whereas very few affected parents had complex defects (20%). These data suggest that recurrence risk varies by lesion and relationship, with substantial concordance observed by cardiac lesion and complexity of disease, particularly among siblings. These findings contribute to risk counseling in the current era.

  7. Uncertainties in risk assessment at USDOE facilities

    Energy Technology Data Exchange (ETDEWEB)

    Hamilton, L.D.; Holtzman, S.; Meinhold, A.F.; Morris, S.C.; Rowe, M.D.

    1994-01-01

    The United States Department of Energy (USDOE) has embarked on an ambitious program to remediate environmental contamination at its facilities. Decisions concerning cleanup goals, choices among cleanup technologies, and funding prioritization should be largely risk-based. Risk assessments will be used more extensively by the USDOE in the future. USDOE needs to develop and refine risk assessment methods and fund research to reduce major sources of uncertainty in risk assessments at USDOE facilities. The terms{open_quote} risk assessment{close_quote} and{open_quote} risk management{close_quote} are frequently confused. The National Research Council (1983) and the United States Environmental Protection Agency (USEPA, 1991a) described risk assessment as a scientific process that contributes to risk management. Risk assessment is the process of collecting, analyzing and integrating data and information to identify hazards, assess exposures and dose responses, and characterize risks. Risk characterization must include a clear presentation of {open_quotes}... the most significant data and uncertainties...{close_quotes} in an assessment. Significant data and uncertainties are {open_quotes}...those that define and explain the main risk conclusions{close_quotes}. Risk management integrates risk assessment information with other considerations, such as risk perceptions, socioeconomic and political factors, and statutes, to make and justify decisions. Risk assessments, as scientific processes, should be made independently of the other aspects of risk management (USEPA, 1991a), but current methods for assessing health risks are based on conservative regulatory principles, causing unnecessary public concern and misallocation of funds for remediation.

  8. Total cardiovascular disease risk assessment: a review.

    LENUS (Irish Health Repository)

    Cooney, Marie Therese

    2011-09-01

    The high risk strategy for the prevention of cardiovascular disease (CVD) requires an assessment of an individual\\'s total CVD risk so that the most intensive risk factor management can be directed towards those at highest risk. Here we review developments in the assessment and estimation of total CVD risk.

  9. Automating Spreadsheet Discovery & Risk Assessment

    CERN Document Server

    Perry, Eric

    2008-01-01

    There have been many articles and mishaps published about the risks of uncontrolled spreadsheets in today's business environment, including non-compliance, operational risk, errors, and fraud all leading to significant loss events. Spreadsheets fall into the realm of end user developed applications and are often absent the proper safeguards and controls an IT organization would enforce for enterprise applications. There is also an overall lack of software programming discipline enforced in how spreadsheets are developed. However, before an organization can apply proper controls and discipline to critical spreadsheets, an accurate and living inventory of spreadsheets across the enterprise must be created, and all critical spreadsheets must be identified. As such, this paper proposes an automated approach to the initial stages of the spreadsheet management lifecycle - discovery, inventory and risk assessment. Without the use of technology, these phases are often treated as a one-off project. By leveraging techn...

  10. Analytical and assay issues for use of cardiac troponin testing for risk stratification in primary care.

    Science.gov (United States)

    Wu, Alan H B; Christenson, Robert H

    2013-08-01

    Cardiac troponin is the standard marker for diagnosis of acute myocardial infarction and risk stratification of patients who present to an emergency department with signs and symptoms of acute cardiac ischemia. Over the past few years, the analytical sensitivity of assays for cardiac troponin has improved significantly to the point where a detectable amount of troponin can be measured in essentially all healthy subjects. Recent studies have shown that use of a highly sensitive troponin assays may provide value to traditional markers of primary disease risk for patients, i.e., for those who have no history of heart disease. There are barriers to the adoption of cardiac troponin for screening high risk cohorts such as the elderly, diabetics and perhaps even the asymptomatic population. Strategies used for the assignment of cutoff concentrations in acute care, i.e., the 99 th percentile, may not be appropriate for primary care as changes over baseline levels may provide more accurate information of risk than cross-sectional results. A review of biological variation has shown that cardiac troponin as a biomarker has low index of individuality, indicating that reference values are of little utility. Whether or not cardiac troponin can be released in reversible injury is a debate that could have significance for detecting minor myocardial injury. A major hurdle for use of troponin in primary care is the lack of assay standardization and nomenclature for the different generations of troponin assays. Standardization requires knowledge of what is released after cardiac injury and what the various cardiac troponin assays are measuring. Currently it is not clear if the cardiac troponin release after ischemic injury is identical to that in circulation of healthy individuals. This may affect the design of future assays and standardization approaches. There is potential that a marker of myocardial injury such as troponin can add to the value of existing indicators and biomarkers

  11. Sexual activity and cardiac risk: is depression a contributing factor?

    Science.gov (United States)

    Roose, S P; Seidman, S N

    2000-07-20

    There is a well-documented association between depression, ischemic heart disease, and cardiovascular mortality. This association has a number of dimensions including: (1) depressed patients have a higher than expected rate of sudden cardiovascular death; (2) over the course of a lifetime, patients with depression develop symptomatic and fatal ischemic heart disease at a higher rate compared with a nondepressed group; and (3) depression after myocardial infarction (MI) is associated with increased cardiac mortality. Depression is also associated with sexual dysfunction, particularly erectile dysfunction. If depression is the primary illness, then erectile dysfunction can be considered a symptom of the depressive illness. However, if the erectile dysfunction is primary, men may develop a depressive syndrome in reaction to the loss of sexual function. Regardless of whether erectile dysfunction is a symptom of depression or depression is a consequence of erectile dysfunction, these conditions are frequently comorbid. Thus, the patient with ischemic heart disease who is depressed is more likely to have erectile difficulties. An attempt by this patient to engage in sexual activity is therefore more likely to be unsuccessful and, given the increase in cardiac mortality associated with depression, it may result in a serious cardiac event.

  12. Risk Assessment of Shellfish Toxins

    Directory of Open Access Journals (Sweden)

    Rex Munday

    2013-11-01

    Full Text Available Complex secondary metabolites, some of which are highly toxic to mammals, are produced by many marine organisms. Some of these organisms are important food sources for marine animals and, when ingested, the toxins that they produce may be absorbed and stored in the tissues of the predators, which then become toxic to animals higher up the food chain. This is a particular problem with shellfish, and many cases of poisoning are reported in shellfish consumers each year. At present, there is no practicable means of preventing uptake of the toxins by shellfish or of removing them after harvesting. Assessment of the risk posed by such toxins is therefore required in order to determine levels that are unlikely to cause adverse effects in humans and to permit the establishment of regulatory limits in shellfish for human consumption. In the present review, the basic principles of risk assessment are described, and the progress made toward robust risk assessment of seafood toxins is discussed. While good progress has been made, it is clear that further toxicological studies are required before this goal is fully achieved.

  13. Probing cardiac repolarization reserve in drug safety assessment

    NARCIS (Netherlands)

    Nalos, L.

    2011-01-01

    Excessive prolongation of cardiac repolarization, manifested as QT prolongation on ECG, is common unwanted side effect of many drugs and drug candidates. Prolongation of QT interval may lead to life threatening cardiac arrhythmia – Torsade de Point (TdP). Number of drugs was withdrawn from the marke

  14. Risk factors for transient dysfunction of gas exchange after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Cristiane Delgado Alves Rodrigues

    2015-02-01

    Full Text Available Objective: A retrospective cohort study was preformed aiming to verify the presence of transient dysfunction of gas exchange in the postoperative period of cardiac surgery and determine if this disorder is linked to cardiorespiratory events. Methods: We included 942 consecutive patients undergoing cardiac surgery and cardiac procedures who were referred to the Intensive Care Unit between June 2007 and November 2011. Results: Fifteen patients had acute respiratory distress syndrome (2%, 199 (27.75% had mild transient dysfunction of gas exchange, 402 (56.1% had moderate transient dysfunction of gas exchange, and 39 (5.4% had severe transient dysfunction of gas exchange. Hypertension and cardiogenic shock were associated with the emergence of moderate transient dysfunction of gas exchange postoperatively (P=0.02 and P=0.019, respectively and were risk factors for this dysfunction (P=0.0023 and P=0.0017, respectively. Diabetes mellitus was also a risk factor for transient dysfunction of gas exchange (P=0.03. Pneumonia was present in 8.9% of cases and correlated with the presence of moderate transient dysfunction of gas exchange (P=0.001. Severe transient dysfunction of gas exchange was associated with patients who had renal replacement therapy (P=0.0005, hemotherapy (P=0.0001, enteral nutrition (P=0.0012, or cardiac arrhythmia (P=0.0451. Conclusion: Preoperative hypertension and cardiogenic shock were associated with the occurrence of postoperative transient dysfunction of gas exchange. The preoperative risk factors included hypertension, cardiogenic shock, and diabetes. Postoperatively, pneumonia, ventilator-associated pneumonia, renal replacement therapy, hemotherapy, and cardiac arrhythmia were associated with the appearance of some degree of transient dysfunction of gas exchange, which was a risk factor for reintubation, pneumonia, ventilator-associated pneumonia, and renal replacement therapy in the postoperative period of cardiac surgery and

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

    NARCIS (Netherlands)

    Siregar, S.; Groenwold, R.H.; Versteegh, M.I.; Noyez, L.; Burg, W.J.P.P. ter; Bots, M.L.; Graaf, Y. van der; Herwerden, L.A. van

    2013-01-01

    OBJECTIVE: Upcoding or undercoding of risk factors could affect the benchmarking of risk-adjusted mortality rates. The aim was to investigate the effect of misclassification of risk factors on the benchmarking of mortality rates after cardiac surgery. METHODS: A prospective cohort was used comprisin

  16. Cardiac abnormalities assessed by non-invasive techniques in patients with newly diagnosed idiopathic inflammatory myopathies

    DEFF Research Database (Denmark)

    Diederichsen, Louise Pyndt; Simonsen, Jane Angel; Diederichsen, Axel Cosmus Pyndt;

    2015-01-01

    , cardiac troponin-I (TnI), electrocardiogram (standard 12-lead and 48-h Holter monitoring), echocardiography with tissue Doppler measures, cardiac magnetic resonance (CMR) imaging with T2 mapping and semi-quantitative (99m)technetium pyrophosphate ((99m)Tc-PYP) scintigraphy. RESULTS: Dyspnoea was present....... The myocardial (99m)Tc-PYP uptake and CMR results differed between patients and controls, albeit not with statistical significance. Overall, cardiac abnormalities were demonstrated in 9 (64%) of the patients versus 2 (14%) of the controls (p=0.02). CONCLUSIONS: Cardiac abnormalities assessed by TnI, ECG...

  17. [Risk assessment in pain therapy].

    Science.gov (United States)

    Schoeffel, D; Casser, H R; Bach, M; Kress, H G; Likar, R; Locher, H; Steinleitner, W; Strohmeier, M; Brunner, H; Treede, R D; Zieglgänsberger, W; Sandkühler, J

    2008-10-01

    Analgesic therapy is not without risk. However, the risk of most analgesic interventions is minor compared to the risk of the inadequate treatment of pain and insufficient treatment may lead to chronic pain.A correct diagnosis should be the basis of any specific treatment of pain disorders. Only a diagnosis which implicates a multi-disciplinary assessment and which considers both the pathoanatomical, functional and biopsychosocial dysfunctions can lead to an adequate therapeutic intervention. Furthermore, therapeutic planning should include the personal needs of the patient and should have realistic aims.Pharmacological treatment is guided by the WHO pain ladder. The risks of the relevant substance groups must be considered. NSAIDs (non-steroidal anti-inflammatory drugs) which are included in all steps of the WHO pain ladder carry specific risks for the gastrointestinal, cardiovascular and renal systems and are contraindicated in many patients in need of analgesic therapy, e.g. in many elderly patients. Opioids which are recommended at steps 2 and 3 of the WHO pain ladder have less organ toxicity but they are still used reluctantly. Coanalgetics, especially antidepressants bear specific risks and the discussion on suicide rates under antidepressant medication is ongoing.Invasive methods such as the intrathecal application of analgesics are valuable procedures if the indication is correct and the treating physician has sufficient experience. Pain therapy is essential and the risks of the procedures are manageable. Considering the current knowledge on the mechanisms of pain sensitisation, the lack of adequate pain control can lead to chronic pain with severe consequences for the patient.

  18. Noninvasive cardiac assessment in children of women with systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    Maria de Fátima Monteitro Pereira Leite

    2003-11-01

    Full Text Available OBJECTIVE: Noninvasive cardiac assessment of newborns and infants of women with systemic lupus erythematosus. The children had no congenital total atrioventricular block and were compared with the children of healthy women. METHODS: We prospectively assessed 13 newborns and infants aged 1 to 60 days, children of women with systemic lupus erythematosus and without congenital total atrioventricular block. These children were compared with 30 children of women who had no lupus or anti-Ro/SSA antibodies, and no risk factors for congenital heart disease either. Their age groups matched. The following examinations were performed: cardiological physical examination, electrocardiography, echocardiography, and signal-averaged electrocardiography. RESULTS: The statistical analysis showed no significant difference in ventricular function or in the cardiac conduction system between the groups. CONCLUSION: In regard to the conduction system and ventricular function in the absence of total atrioventricular block, no statistically significant difference was observed between the children of women with systemic lupus erythematosus and children of healthy women.

  19. Incidence and risk factors of delirium in critically ill patients after non-cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    SHI Cheng-mei; WANG Dong-xin; CHEN Kai-sheng; GU Xiu-e

    2010-01-01

    Background Delirium is a common and deleterious complication in critically ill patients after surgery. The purpose of this study was to determine the incidence and risk factors of delirium in critically ill patients after non-cardiac surgery, and to investigate the relationship between the serum cortisol level and the occurrence of postoperative delirium. Methods In a prospective cohort study, 164 consecutive patients who were admitted to the surgical intensive care unit after non-cardiac surgery were enrolled. Baseline characteristics and perioperative variables were collected. Blood samples were obtained on the first postoperative day and serum cortisol concentrations were measured. Delirium was assessed using the Nursing Delirium Screening Scale until the seventh postoperative day or the disappearance of delirious symptoms.Results Postoperative delirium occurred in 44.5% of patients (73 of 164). The median time to first onset of delirium is 0 (range 0 to 5 days) and the median duration of delirium is 3 (1 to 13) days. Independent risk factors of postoperative delirium included increasing age (odds ratio (OR) 2.646, 95% confidence interval (CI) 1.431 to 4.890, P=0.002), a history of previous stroke (OR 4.499, 95%CI 1.228 to 16.481, P=0.023), high Acute Physiology and Chronic Health Evaluation Ⅱ score on surgical intensive care unite admission (OR 1.391, 95%CI 1.201 to 1.612, P<0.001), and high serum cortisol level on the 1 st postoperative day (OR 3.381, 95%CI 1.690 to 6.765, P=0.001). The development of delirium was linked to higher incidence of postoperative complications (28.8% vs. 7.7%, P<0.001), and longer duration of hospitalization (18 (7 to 74) days vs. 13 (3 to 48) days, P <0.001).Conclusions Delirium was a frequent complication in critically ill patients after non-cardiac surgery. High serum cortisol level was associated with increased incidence of postoperative delirium.

  20. QUALITY OF LIFE ASSESSMENT IN CARDIAC TRANSPLANT RECIPIENTS

    Directory of Open Access Journals (Sweden)

    A. O. Shevchenko

    2014-01-01

    Full Text Available Background. Quality of life (QoL is an important criterion for the treatment effi cacy that provides an important data regarding patient’s personal estimation of social adaptation and ability to perform daily duties.Methods. The study was aimed to evaluate QoL in cardiac transplant recipients. We have enrolled 42 stage D heart failure patients aged 29–61 (mean 39,23 ± 12,31 y/o, 38 males and 4 females, survived cardiac transplant surgery between Jan 2008 and Jan 2013. QoL was evaluated using the SF-36 survey prior to the heart surgery and during the follow-up period up to the 5 years.Results. Pre-operative assessment revealed low QoL indices of physical activity as well as general health status. Follow-up showed dramatic improvement in all QoL measures during 1 year after the surgery which was consistent through the whole observation period. There was an increase in physical functioning index by 2,8 times (p < 0,01, physical status dependent role functioning by 14 times (р < 0,0001, emotional status dependent role functioning by 3 times (р = 0,02, social functioning by 4,8 times (p = 0,002, pain threshold by 3 times (p = 0,02, psychic health by 3,6 times (p = 0,001, life activity by 2,6 times(p = 0,003, and total health by 1,6 times (p = 0,03. Physical activity was restored in 90% of patients during the fi rst year.Conclusion. The study shows signifi cant improvement in all QoL variables after heart transplantation in stage D heart failure patients. Main indices of physical, psychical, and social activities rise at the fi rst year and remain high during the 5-year period. These data support heart transplantation as a radical and effective method of terminal heart failure treatment.

  1. Reproducibility of area at risk assessment in acute myocardial infarction by T1- and T2-mapping sequences in cardiac magnetic resonance imaging in comparison to Tc99m-sestamibi SPECT.

    Science.gov (United States)

    Langhans, Birgit; Nadjiri, Jonathan; Jähnichen, Christin; Kastrati, Adnan; Martinoff, Stefan; Hadamitzky, Martin

    2014-10-01

    Area at risk (AAR) is an important parameter for the assessment of the salvage area after revascularization in acute myocardial infarction (AMI). By combining AAR assessment by T2-weighted imaging and scar quantification by late gadolinium enhancement imaging cardiovascular magnetic resonance (CMR) offers a promising alternative to the "classical" modality of Tc99m-sestamibi single photon emission tomography (SPECT). Current T2 weighted sequences for edema imaging in CMR are limited by low contrast to noise ratios and motion artifacts. During the last years novel CMR imaging techniques for quantification of acute myocardial injury, particularly the T1-mapping and T2-mapping, have attracted rising attention. But no direct comparison between the different sequences in the setting of AMI or a validation against SPECT has been reported so far. We analyzed 14 patients undergoing primary coronary revascularization in AMI in whom both a pre-intervention Tc99m-sestamibi-SPECT and CMR imaging at a median of 3.4 (interquartile range 3.3-3.6) days after the acute event were performed. Size of AAR was measured by three different non-contrast CMR techniques on corresponding short axis slices: T2-weighted, fat-suppressed turbospin echo sequence (TSE), T2-mapping from T2-prepared balanced steady state free precession sequences (T2-MAP) and T1-mapping from modified look locker inversion recovery (MOLLI) sequences. For each CMR sequence, the AAR was quantified by appropriate methods (absolute values for mapping sequences, comparison with remote myocardium for other sequences) and correlated with Tc99m-sestamibi-SPECT. All measurements were performed on a 1.5 Tesla scanner. The size of the AAR assessed by CMR was 28.7 ± 20.9 % of left ventricular myocardial volume (%LV) for TSE, 45.8 ± 16.6 %LV for T2-MAP, and 40.1 ± 14.4 %LV for MOLLI. AAR assessed by SPECT measured 41.6 ± 20.7 %LV. Correlation analysis revealed best correlation with SPECT for T2-MAP at a T2-threshold of 60 ms

  2. Cardiac risk of coronary patients after reintegration into occupations with heavy physical exertion.

    Science.gov (United States)

    Wolf, R; Habel, F; Heiermann, M; Jäkel, R; Sinn, R

    2005-04-01

    The job related reintegration of patients with coronary artery disease (CAD) is a central part of cardiac rehabilitation. However, specific occupational demands like jobs with heavy physical exertion (> 6 METs) could increase the cardiovascular risk because the relative risk for acute myocardial infarction (MI) and cardiac death is temporarily elevated after vigorous exertion ("hazard period"). Thus, in 2001 any male patient with proven CAD who performed a job with heavy exertion until the occurrence of an index event (MI/ACS, any interventional or surgical revascularization measure) received a questionnaire after an average of 20 months. Complete data were available in 108 from 119 included patients (90.8%), aged 51.8+/-7.8 years. Ejection fraction was 61.5+/-13.1% and the functional capacity at the time of hospital discharge averaged 130.1+/-31.2 W. 75% of the patients had a previous MI and 59.3% underwent bypass surgery. During follow-up the previous job with heavy exertion was performed over a cumulated time of 74 years. The aim of the study was to compare the observed and the expected incidence of MI and cardiac death with and without job performance. The expected ("basal") risk for MI and cardiac death without heavy physical exertion was determined from pooled study results and assumed to be 5.2% per year. The combined risk due to performing an occupation with strenuous exertion can be calculated from time periods with and without working hours and amounts to 11.9%. There could be expected 0.119 . 74=8.8 cardiac events related to the job. In contrast, 5 MIs (4 NSTEMI, 1 STEMI) were observed (6.8%). The relative risk for an expected event compared to the basal risk without heavy exertion was 2.3 (95% CI: 0.7-7.4). The relative risk for the observed cardiac events amounts to 1.3 (95% CI: 0.4-4.8). The lower observed risk is probably due to the high grade of physical fitness in this patient group. In spite of several limitations, our study showed no convincing

  3. Preventing tomorrow's sudden cardiac death today: part I: Current data on risk stratification for sudden cardiac death.

    Science.gov (United States)

    Al-Khatib, Sana M; Sanders, Gillian D; Bigger, J Thomas; Buxton, Alfred E; Califf, Robert M; Carlson, Mark; Curtis, Anne; Curtis, Jeptha; Fain, Eric; Gersh, Bernard J; Gold, Michael R; Haghighi-Mood, Ali; Hammill, Stephen C; Healey, Jeff; Hlatky, Mark; Hohnloser, Stefan; Kim, Raymond J; Lee, Kerry; Mark, Daniel; Mianulli, Marcus; Mitchell, Brent; Prystowsky, Eric N; Smith, Joseph; Steinhaus, David; Zareba, Wojciech

    2007-06-01

    Accurate and timely prediction of sudden cardiac death (SCD) is a necessary prerequisite for effective prevention and therapy. Although the largest number of SCD events occurs in patients without overt heart disease, there are currently no tests that are of proven predictive value in this population. Efforts in risk stratification for SCD have focused primarily on predicting SCD in patients with known structural heart disease. Despite the ubiquity of tests that have been purported to predict SCD vulnerability in such patients, there is little consensus on which test, in addition to the left ventricular ejection fraction, should be used to determine which patients will benefit from an implantable cardioverter defibrillator. On July 20 and 21, 2006, a group of experts representing clinical cardiology, cardiac electrophysiology, biostatistics, economics, and health policy were joined by representatives of the US Food and Drug administration, Centers for Medicare Services, Agency for Health Research and Quality, the Heart Rhythm Society, and the device and pharmaceutical industry for a round table meeting to review current data on strategies of risk stratification for SCD, to explore methods to translate these strategies into practice and policy, and to identify areas that need to be addressed by future research studies. The meeting was organized by the Duke Center for the Prevention of SCD at the Duke Clinical Research Institute and was funded by industry participants. This article summarizes the presentations and discussions that occurred at that meeting.

  4. Digital Health Intervention as an Adjunct to Cardiac Rehabilitation Reduces Cardiovascular Risk Factors and Rehospitalizations.

    Science.gov (United States)

    Widmer, R Jay; Allison, Thomas G; Lerman, Lilach O; Lerman, Amir

    2015-07-01

    Cardiac rehabilitation (CR) following myocardial infarction is vastly underused. As such, the aim of this study was to test a digital health intervention (DHI) as an adjunct to CR. Patients undergoing standard Mayo Clinic CR were recruited prior to CR (n = 25) or after 3 months CR (n = 17). Changes in risk factors and rehospitalizations plus emergency department (ED) visits were assessed after 3 months. Patients assigned to DHI during CR had significant reductions in weight (-4.0 ± 5.2 kg, P = .001), blood pressure (-10.8 ± 13.5 mmHg, P = .0009), and the group using DHI after 3 months of CR had significant reductions in weight (-2.5 ± 3.8 kg, P = .04) and systolic BP (-12.6 ± 12.4 mmHg, P = .001) compared to the control groups. Both DHI groups also displayed significant reductions in rehospitalizations/ED visits (-37.9 %, P = 0.01 and -28 %, P = .04, respectively). This study suggests that a guideline-driven DHI CR program can augment secondary prevention strategies during usual CR by improving risk factors for repeat events.

  5. Risks, risk assessment and risk competence in toxicology.

    Science.gov (United States)

    Stahlmann, Ralf; Horvath, Aniko

    2015-01-01

    Understanding the toxic effects of xenobiotics requires sound knowledge of physiology and biochemistry. The often described lack of understanding pharmacology/toxicology is therefore primarily caused by the general absence of the necessary fundamental knowledge. Since toxic effects depend on exposure (or dosage) assessing the risks arising from toxic substances also requires quantitative reasoning. Typically public discussions nearly always neglect quantitative aspects and laypersons tend to disregard dose-effect-relationships. One of the main reasons for such disregard is the fact that exposures often occur at extremely low concentrations that can only be perceived intellectually but not by the human senses. However, thresholds in the low exposure range are often scientifically disputed. At the same time, ignorance towards known dangers is wide-spread. Thus, enhancing the risk competence of laypersons will have to be initially restricted to increasing the awareness of existing problems.

  6. Risks, risk assessment and risk competence in toxicology

    Directory of Open Access Journals (Sweden)

    Stahlmann, Ralf

    2015-07-01

    Full Text Available Understanding the toxic effects of xenobiotics requires sound knowledge of physiology and biochemistry. The often described lack of understanding pharmacology/toxicology is therefore primarily caused by the general absence of the necessary fundamental knowledge. Since toxic effects depend on exposure (or dosage assessing the risks arising from toxic substances also requires quantitative reasoning. Typically public discussions nearly always neglect quantitative aspects and laypersons tend to disregard dose-effect-relationships. One of the main reasons for such disregard is the fact that exposures often occur at extremely low concentrations that can only be perceived intellectually but not by the human senses. However, thresholds in the low exposure range are often scientifically disputed. At the same time, ignorance towards known dangers is wide-spread. Thus, enhancing the risk competence of laypersons will have to be initially restricted to increasing the awareness of existing problems.

  7. Cardiac CT for the assessment of chest pain: Imaging techniques and clinical results

    Energy Technology Data Exchange (ETDEWEB)

    Becker, Hans-Christoph, E-mail: christoph.becker@med.uni-muenchen.de [Ludwig-Maximilians-University, Grosshadern Clinic, Department of Clinical Radiology, Marchioninistr. 15, 81377 Munich (Germany); Johnson, Thorsten [Ludwig-Maximilians-University, Grosshadern Clinic, Department of Clinical Radiology, Marchioninistr. 15, 81377 Munich (Germany)

    2012-12-15

    Immediate and efficient risk stratification and management of patients with acute chest pain in the emergency department is challenging. Traditional management of these patients includes serial ECG, laboratory tests and further on radionuclide perfusion imaging or ECG treadmill testing. Due to the advances of multi-detector CT technology, dedicated coronary CT angiography provides the potential to rapidly and reliably diagnose or exclude acute coronary artery disease. Life-threatening causes of chest pain, such as aortic dissection and pulmonary embolism can simultaneously be assessed with a single scan, sometimes referred to as “triple rule out” scan. With appropriate patient selection, cardiac CT can accurately diagnose heart disease or other sources of chest pain, markedly decrease health care costs, and reliably predict clinical outcomes. This article reviews imaging techniques and clinical results for CT been used to evaluate patients with chest pain entering the emergency department.

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

    Science.gov (United States)

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

    2015-10-01

    The study aims to verify quality of life of elderly patients submitted to cardiac surgery, and correlating surgical risk to health-related quality of life instrument domains. Prospective cohort study, performed at a cardiology hospital. It included elderly patients who had undergone elective cardiac surgery. Pre- and postoperative quality of life was evaluated by applying the World Health Organization Quality of Life-Old (WHOQOL-OLD) scale and the Short-Form Health Survey (SF-36) questionnaire. Surgical risk was stratified using the European System for Cardiac Operative Risk Evaluation (EuroSCORE). Fifty-four patients, mostly men (64.8%), were included, with a mean age of 69.3 ± 5.7 years. The eight domains of the SF-36 questionnaire, and the four facets presented for the WHOQOL-OLD scale showed improved quality of life 6 months after surgery (P quality of life instruments. The data showed improved quality of life of elderly people submitted to cardiac surgery, unrelated to surgical risk.

  9. Risk assessment terminology: risk communication part 1

    Directory of Open Access Journals (Sweden)

    Gaetano Liuzzo

    2016-03-01

    Full Text Available The paper describes the terminology of risk communication in the view of food safety: the theory of stakeholders, the citizens’ involvement and the community interest and consultation are reported. Different aspects of risk communication (public communication, scientific uncertainty, trust, care, consensus and crisis communication are discussed.

  10. Inflammation reduces HDL protection against primary cardiac risk

    NARCIS (Netherlands)

    Corsetti, James P.; Gansevoort, Ron T.; Sparks, Charles E.; Dullaart, Robin P. F.

    2010-01-01

    P>Background We recently reported high high-density lipoprotein (HDL) cholesterol as a predictor of recurrent risk in a subgroup of postinfarction patients defined by hypercholesterolemia and high C-reactive protein (CRP) levels. We investigated whether a similar high-risk subgroup might exist for i

  11. Risk of cardiac rupture after acute myocardial infarction is related to a risk of hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Geng QIAN; Hong-bin LIU; Jin-wen WANG; Chen WU; Yun-dai CHEN

    2013-01-01

    Although cardiac rupture (CR) is a fatal mechanical complication of acute myocardial infarction (AMI),to date no predictive model for CR has been described.CR has common pathological characteristics with major bleeding.We aimed to investigate the relationship between the risk factors of major bleeding and CR.A total of 10202 consecutive AMI patients were recruited,and mechanical complications occurred in 72 patients.AMI patients without CR were chosen as control group.Clinical characteristics including bleeding-related factors were compared between the groups.The incidences of free wall rupture (FWR),ventricular septal rupture (VSR),and papillary muscle rupture (PMR) were 0.39%,0.21%,and 0.09%,respectively,and the hospital mortalities were 92.5%,45.5%,and 10.0%,respectively.Female proportion and average age were significantly higher in the groups of FWR and VSR than in the control group (P<0.01); higher white blood cell count and lower hemoglobin were found in all CR groups (P<0.01).Compared to the control group,patients with CR were more likely to receive an administration of thrombolysis [26.39%vs.13.19%,P<0.05],and were less likely to be treated with primary percutaneous coronary intervention (PCI) [41.67%vs.81.60%,P<0.05].The major bleeding scores (integer scores) of FWR,VSR,and PMR were (17.70±7.24),(21.91±8.33),and (18.60±7.88),respectively,and were significantly higher than that of the control group (11.72±7.71)(P<0.05).A regression analysis identified age,increased heart rate,anemia,higher white blood cell count,and thrombolysis as independent risk factors of CR,most of which were major bleeding-related factors.The patients with CR have a significantly higher risk of hemorrhage compared to the group without CR.Risk of CR after AMI is related to the risk of hemorrhage.

  12. Electrophysiologic testing guided risk stratification approach for sudden cardiac death beyond the left ventricular ejection fraction

    Institute of Scientific and Technical Information of China (English)

    Konstantinos A Gatzoulis; Dimitris Tsiachris; Petros Arsenos; Dimitris Tousoulis

    2016-01-01

    Sudden cardiac death threats ischaemic and dilated cardiomyopathy patients. Anti- arrhythmic protection may be provided to these patients with implanted cardiac defibrillators(ICD), after an efficient risk stratification approach. The proposed risk stratifier of an impaired left ventricular ejection fraction has limited sensitivity meaning that a significant number of victims will remain undetectable by this risk stratification approach because they have a preserved left ventricular systolic function. Current risk stratification strategies focus on combinations of non invasive methods like T wave alternans, late potentials, heart rate turbulence, deceleration capacity and others, with invasive methods like the electrophysiologic study. In the presence of an electrically impaired substrate with formed post myocardial infarction fibrotic zones, programmed ventricular stimulation provides important prognostic information for the selection of the patients expected to benefit from an ICD implantation, while due to its high negative predictive value, patients at low risk level may also be detected. Clustering evidence from different research groups and electrophysiologic labs support an electrophysiologic testing guided risk stratification approach for sudden cardiac death.

  13. Electrophysiologic testing guided risk stratification approach for sudden cardiac death beyond the left ventricular ejection fraction.

    Science.gov (United States)

    Gatzoulis, Konstantinos A; Tsiachris, Dimitris; Arsenos, Petros; Tousoulis, Dimitris

    2016-01-26

    Sudden cardiac death threats ischaemic and dilated cardiomyopathy patients. Anti- arrhythmic protection may be provided to these patients with implanted cardiac defibrillators (ICD), after an efficient risk stratification approach. The proposed risk stratifier of an impaired left ventricular ejection fraction has limited sensitivity meaning that a significant number of victims will remain undetectable by this risk stratification approach because they have a preserved left ventricular systolic function. Current risk stratification strategies focus on combinations of non invasive methods like T wave alternans, late potentials, heart rate turbulence, deceleration capacity and others, with invasive methods like the electrophysiologic study. In the presence of an electrically impaired substrate with formed post myocardial infarction fibrotic zones, programmed ventricular stimulation provides important prognostic information for the selection of the patients expected to benefit from an ICD implantation, while due to its high negative predictive value, patients at low risk level may also be detected. Clustering evidence from different research groups and electrophysiologic labs support an electrophysiologic testing guided risk stratification approach for sudden cardiac death.

  14. Supporting Risk Assessment: Accounting for Indirect Risk to Ecosystem Components

    Science.gov (United States)

    Mach, Megan E.; Martone, Rebecca G.; Singh, Gerald G.; O, Miriam; Chan, Kai M. A.

    2016-01-01

    The multi-scalar complexity of social-ecological systems makes it challenging to quantify impacts from human activities on ecosystems, inspiring risk-based approaches to assessments of potential effects of human activities on valued ecosystem components. Risk assessments do not commonly include the risk from indirect effects as mediated via habitat and prey. In this case study from British Columbia, Canada, we illustrate how such “indirect risks” can be incorporated into risk assessments for seventeen ecosystem components. We ask whether (i) the addition of indirect risk changes the at-risk ranking of the seventeen ecosystem components and if (ii) risk scores correlate with trophic prey and habitat linkages in the food web. Even with conservative assumptions about the transfer of impacts or risks from prey species and habitats, the addition of indirect risks in the cumulative risk score changes the ranking of priorities for management. In particular, resident orca, Steller sea lion, and Pacific herring all increase in relative risk, more closely aligning these species with their “at-risk status” designations. Risk assessments are not a replacement for impact assessments, but—by considering the potential for indirect risks as we demonstrate here—they offer a crucial complementary perspective for the management of ecosystems and the organisms within. PMID:27632287

  15. Use of nitric oxide in thoracic surgery for a high risk cardiac patient

    Directory of Open Access Journals (Sweden)

    Vishal Garg

    2014-01-01

    Full Text Available Nitric oxide (NO is a selective pulmonary vasodilator especially in the presence of pulmonary artery hypertension. With right ventricle (RV dysfunction, inhaled NO may increase RV ejection fraction and cardiac output. The main advantage of NO over intravenous therapy is its inability to decrease systemic pressure thereby maintaining the coronary perfusion pressure and the myocardial perfusion. In this case report, we discuss the use of NO in a routine thoracic surgery patient suffering with severe left ventricular dysfunction and a potential candidate for a very high cardiac risk.

  16. Heart rate complexity: A novel approach to assessing cardiac stress reactivity.

    Science.gov (United States)

    Brindle, Ryan C; Ginty, Annie T; Phillips, Anna C; Fisher, James P; McIntyre, David; Carroll, Douglas

    2016-04-01

    Correlation dimension (D2), a measure of heart rate (HR) complexity, has been shown to decrease in response to acute mental stress and relate to adverse cardiovascular health. However, the relationship between stress-induced changes in D2 and HR has yet to be established. The present studies aimed to assess this relationship systematically while controlling for changes in respiration and autonomic activity. In Study 1 (N = 25) D2 decreased during stress and predicted HR reactivity even after adjusting for changes in respiration rate, and cardiac vagal tone. This result was replicated in Study 2 (N = 162) and extended by including a measure of cardiac sympathetic activity; correlation dimension remained an independent predictor of HR reactivity in a hierarchical linear model containing measures of cardiac parasympathetic and sympathetic activity and their interaction. These results suggest that correlation dimension may provide additional information regarding cardiac stress reactivity above that provided by traditional measures of cardiac autonomic function.

  17. Current state of cardiac rehabilitation in Germany: patient characteristics, risk factor management and control status, by education level

    Directory of Open Access Journals (Sweden)

    Bestehorn K

    2011-10-01

    Full Text Available Kurt Bestehorn1, Christina Jannowitz2, Martin Horack3, Barbara Karmann2, Martin Halle4, Heinz Völler5 1Institute for Clinical Pharmacology, Technical University, Dresden; 2Medical Department, MSD Sharp and Dohme GmbH, Haar; 3Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen; 4Center for Prevention and Sports Medicine, Technical University, Munich; 5Klinik am See, Rehabilitation Center for Cardiovascular Diseases, Rüdersdorf, Germany Background: After the acute hospital stay, most cardiac patients in Germany are transferred for a 3–4-week period of inpatient cardiac rehabilitation. We aim to describe patient characteristics and risk factor management of cardiac rehabilitation patients with a focus on drug treatment and control status, differentiated by education level (low level, elementary school; intermediate level, secondary modern school; high level, grammar school/university. Methods: Data covering a time period between 2003 and 2008 from 68,191 hospitalized patients in cardiac rehabilitation from a large-scale registry (Transparency Registry to Objectify Guideline-Oriented Risk Factor Management were analyzed descriptively. Further, a multivariate model was applied to assess factors associated with good control of risk factors. Results: In the total cohort, patients with a manifestation of coronary artery disease (mean age 63.7 years, males 71.7% were referred to cardiac rehabilitation after having received percutaneous coronary intervention (51.6% or coronary bypass surgery (39.5%. Statin therapy increased from 76.3% at entry to 88.9% at discharge, and low density lipoprotein cholesterol <100 mg/dL rates increased from 31.1% to 69.6%. Mean fasting blood glucose decreased from 108 mg/dL to 104 mg/dL, and mean exercise capacity increased from 78 W to 95 W. Age and gender did not differ by education. In contrast with patients having high education, those with low education had more diabetes

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

    Energy Technology Data Exchange (ETDEWEB)

    Garofallo, Silvia Bueno; Machado, Daniel Pinheiro; Rodrigues, Clarissa Garcia; Bordim, Odemir Jr.; Kalil, Renato A. K.; Portal, Vera Lúcia, E-mail: veraportal.pesquisa@gmail.com [Post-Graduation Program in Health Sciences: Cardiology, Instituto de Cardiologia/Fundação Universitária de Cardiologia, Porto Alegre, RS (Brazil)

    2014-06-15

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

  19. Cardiac MRI in addition to MR angiography: a longitudinal study in vascular risk patients; Kardiale MRT als Ergaenzung zur MR-Angiografie: Eine longitudinale Studie bei vaskulaeren Risikopatienten

    Energy Technology Data Exchange (ETDEWEB)

    Seeger, A.; Grimm, F.; Fenchel, M.; Kramer, U.; Doering, J.S.; Klumpp, B.; Claussen, C.D.; Miller, S. [Abt. fuer Radiologische Diagnostik, Eberhard-Karls-Univ. Tuebingen (Germany); Scheule, A. [Abt. fuer Herz-, Thorax- und Gefaesschirurgie, Eberhard-Karls-Univ. Tuebingen (Germany); May, A.E. [Abt. fuer Kardiologie, Eberhard-Karls-Univ. Tuebingen (Germany)

    2008-05-15

    Purpose: the aim of the study was to assess the feasibility and additional diagnostic information of cardiac MRI as a supplement to state-of-the-art MR angiography (MRA) in the case of vascular risk patients. Therefore, the prevalence of delayed myocardial enhancement (DE) was determined in patients suffering from peripheral artery disease (PAD) and a clinical follow-up was evaluated after 2 years. Materials and method: 87 consecutive patients (ages 66 {+-} 10 years, 67 males) with symptomatic peripheral arterial occlusive disease (n = 68) or abdominal aortic aneurysm (n = 19) were examined using delayed cardiac enhancement (DE) within the clinical indication of MRA at a 1.5T system. A follow-up examination was carried out two years later (24 months {+-} 4 months) with regards to cardiac events (cardiac death, myocardial infarction or acute coronary syndrome, heart insufficiency, coronary revascularization). Results: in total, 40/87 patients had myocardial infarctions shown in MRI (46%). In 25 patients (29%), the myocardial infarction was already known, while in 15 patients (17%) an occult progressing infarction was diagnosed (38% of the myocardial infarcts). Follow-up data was able to be obtained after 2 years for 82 patients. 15 patients had a major cardiac event during the follow-up period, and 10 (67%) of them already showed DE in the MRI. In the group with occult progressing infarctions, cardiac events occurred in 40% (6/15 patients, cardiac death n = 1, ischemia n = 4, heart insufficiency n = 1, bypass n = 1), in patients with known infarction in 17% (4/23 patients, cardiac death n = 1, ischemia n = 3, bypass n = 2) and in 11% of patients without myocardial scars (5/44 patients, cardiac death n = 1, ischemia n = 2, heart insufficiency n = 2). (orig.)

  20. Sudden cardiac death in hemodialysis patients: a comprehensive care approach to reduce risk.

    Science.gov (United States)

    Pun, Patrick H; Middleton, John P

    2012-01-01

    Sudden cardiac death is a major problem in hemodialysis patients, and our understanding of this disease is underdeveloped. The lack of a precise definition tailored for use in the hemodialysis population limits the reliability of epidemiologic reports. Efforts should be directed toward an accurate classification of all deaths that occur in this vulnerable population. The traditional paradigm of disease pathophysiology based on known cardiac risk factors appears to be inadequate to explain the magnitude of sudden cardiac death risk in chronic kidney disease, and numerous unique cofactors and exposures appear to determine risk in this population. Well-designed cohort studies will be needed for a basic understanding of disease pathophysiology and risk factors, and randomized intervention trials will be needed before best management practices can be implemented. This review examines available data to describe the characteristics of the high-risk patient and suggests a comprehensive common sense approach to prevention using existing cardiovascular medications and reducing and monitoring potential dialysis-related arrhythmic triggers. Other unproven cardiovascular therapies such as implantable cardioverter defibrillators should be used on a case-by-case basis, with recognition of the associated hazards that these devices carry among hemodialysis patients.

  1. Risk Prediction of One-Year Mortality in Patients with Cardiac Arrhythmias Using Random Survival Forest.

    Science.gov (United States)

    Miao, Fen; Cai, Yun-Peng; Zhang, Yu-Xiao; Li, Ye; Zhang, Yuan-Ting

    2015-01-01

    Existing models for predicting mortality based on traditional Cox proportional hazard approach (CPH) often have low prediction accuracy. This paper aims to develop a clinical risk model with good accuracy for predicting 1-year mortality in cardiac arrhythmias patients using random survival forest (RSF), a robust approach for survival analysis. 10,488 cardiac arrhythmias patients available in the public MIMIC II clinical database were investigated, with 3,452 deaths occurring within 1-year followups. Forty risk factors including demographics and clinical and laboratory information and antiarrhythmic agents were analyzed as potential predictors of all-cause mortality. RSF was adopted to build a comprehensive survival model and a simplified risk model composed of 14 top risk factors. The built comprehensive model achieved a prediction accuracy of 0.81 measured by c-statistic with 10-fold cross validation. The simplified risk model also achieved a good accuracy of 0.799. Both results outperformed traditional CPH (which achieved a c-statistic of 0.733 for the comprehensive model and 0.718 for the simplified model). Moreover, various factors are observed to have nonlinear impact on cardiac arrhythmias prognosis. As a result, RSF based model which took nonlinearity into account significantly outperformed traditional Cox proportional hazard model and has great potential to be a more effective approach for survival analysis.

  2. From Hazard to Risk - Assessing the Risk

    NARCIS (Netherlands)

    Madsen, C.B.; Houben, G.; Hattersley, S.; Crevel, R.W.R.; Remington, B.C.; Baumert, J.L.

    2013-01-01

    Regulatory thresholds for allergenic foods have not yet been developed. This means that public and industrial risk managers do not have regulatory thresholds to decide if a content or level of contamination is acceptable or not. For a long time, data have been inadequate to define safe thresholds fo

  3. Risk of Mortality (Including Sudden Cardiac Death and Major Cardiovascular Events in Atypical and Typical Antipsychotic Users: A Study with the General Practice Research Database

    Directory of Open Access Journals (Sweden)

    Tarita Murray-Thomas

    2013-01-01

    Full Text Available Objective. Antipsychotics have been associated with increased cardiac events including mortality. This study assessed cardiac events including mortality among antipsychotic users relative to nonusers. Methods. The General Practice Research Database (GPRD was used to identify antipsychotic users, matched general population controls, and psychiatric diseased nonusers. Outcomes included cardiac mortality, sudden cardiac death (SCD, all-cause mortality (excluding suicide, coronary heart disease (CHD, and ventricular arrhythmias (VA. Sensitivity analyses were conducted for age, dose, duration, antipsychotic type, and psychiatric disease. Results. 183,392 antipsychotic users (115,491 typical and 67,901 atypical, 544,726 general population controls, and 193,920 psychiatric nonusers were identified. Nonusers with schizophrenia, dementia, or bipolar disorder had increased risks of all-cause mortality compared to general population controls, while nonusers with major depression had comparable risks. Relative to psychiatric nonusers, the adjusted relative ratios (aRR of all-cause mortality in antipsychotic users was 1.75 (95% CI: 1.64–1.87; cardiac mortality 1.72 (95% CI: 1.42–2.07; SCD primary definition 5.76 (95% CI: 2.90–11.45; SCD secondary definition 2.15 (95% CI: 1.64–2.81; CHD 1.16 (95% CI: 0.94–1.44; and VA 1.16 (95% CI: 1.02–1.31. aRRs of the various outcomes were lower for atypical versus typical antipsychotics (all-cause mortality 0.83 (95% CI: 0.80–0.85; cardiac mortality 0.89 (95% CI: 0.82–0.97; and SCD secondary definition 0.76 (95% CI: 0.55–1.04. Conclusions. Antipsychotic users had an increased risk of cardiac mortality, all-cause mortality, and SCD compared to a psychiatric nonuser cohort.

  4. Saint Francis adapts women's cardiac risk campaign for Missouri.

    Science.gov (United States)

    Botvin, Judith D

    2003-01-01

    Saint Francis Medical Center, Cape Girardeau, Mo., became the first hospital in Missouri to promote the VHA national initiative, Women's HeartAdvantage. Marketers incorporated Women's HeartAdvantage materials into the broader marketing plan for the Saint Francis Heart Institute. Using both traditional and innovative media, they're spreading the word that heart disease is woman's greatest health risk.

  5. Methodology of environmental risk assessment management

    Directory of Open Access Journals (Sweden)

    Saša T. Bakrač

    2012-04-01

    Full Text Available Successful protection of environment is mostly based on high-quality assessment of potential and present risks. Environmental risk management is a complex process which includes: identification, assessment and control of risk, namely taking measures in order to minimize the risk to an acceptable level. Environmental risk management methodology: In addition to these phases in the management of environmental risk, appropriate measures that affect the reduction of risk occurrence should be implemented: - normative and legal regulations (laws and regulations, - appropriate organizational structures in society, and - establishing quality monitoring of environment. The emphasis is placed on the application of assessment methodologies (three-model concept, as the most important aspect of successful management of environmental risk. Risk assessment methodology - European concept: The first concept of ecological risk assessment methodology is based on the so-called European model-concept. In order to better understand this ecological risk assessment methodology, two concepts - hazard and risk - are introduced. The European concept of environmental risk assessment has the following phases in its implementation: identification of hazard (danger, identification of consequences (if there is hazard, estimate of the scale of consequences, estimate of consequence probability and risk assessment (also called risk characterization. The European concept is often used to assess risk in the environment as a model for addressing the distribution of stressors along the source - path - receptor line. Risk assessment methodology - Canadian concept: The second concept of the methodology of environmental risk assessment is based on the so-called Canadian model-concept. The assessment of ecological risk includes risk arising from natural events (floods, extreme weather conditions, etc., technological processes and products, agents (chemical, biological, radiological, etc

  6. Persistent Maternal Cardiac Dysfunction After Preeclampsia Identifies Patients at Risk for Recurrent Preeclampsia.

    Science.gov (United States)

    Valensise, Herbert; Lo Presti, Damiano; Gagliardi, Giulia; Tiralongo, Grazia Maria; Pisani, Ilaria; Novelli, Gian Paolo; Vasapollo, Barbara

    2016-04-01

    The purpose of our study was to assess cardiac function in nonpregnant women with previous early preeclampsia before a second pregnancy to highlight the cardiovascular pattern, which may take a risk for recurrent preeclampsia. Seventy-five normotensive patients with previous preeclampsia and 147 controls with a previous uneventful pregnancy were enrolled in a case-control study and submitted to echocardiographic examination in the nonpregnant state 12 to 18 months after the first delivery. All patients included in the study had pregnancy within 24 months from the echocardiographic examination and were followed until term. Twenty-two (29%) of the 75 patients developed recurrent preeclampsia. In the nonpregnant state, patients with recurrent preeclampsia compared with controls and nonrecurrent preeclampsia had lower stroke volume (63 ± 14 mL versus 73 ± 12 mL and 70 ± 11 mL, Ppreeclampsia compared with controls (30.0 ± 6.3 g/m(2.7) and 30.4 ± 6.8 g/m(2.7) versus 24.8 ± 5.0 g/m(2.7), Ppreeclampsia. Previous preeclamptic patients with nonrecurrent preeclampsia show left ventricular structural and functional features intermediate with respect to controls and recurrent preeclampsia.

  7. Gender differences in risk assessment

    Directory of Open Access Journals (Sweden)

    Christine R. Harris

    2006-07-01

    Full Text Available Across many real-world domains, men engage in more risky behaviors than do women. To examine some of the beliefs and preferences that underlie this difference, 657 participants assessed their likelihood of engaging in various risky activities relating to four different domains (gambling, health, recreation, and social, and reported their perceptions of (1 probability of negative outcomes, (2 severity of potential negative outcomes, and (3 enjoyment expected from the risky activities. Women's greater perceived likelihood of negative outcomes and lesser expectation of enjoyment partially mediated their lower propensity toward risky choices in gambling, recreation, and health domains. Perceptions of severity of potential outcomes was a partial mediator in the gambling and health domains. The genders did not differ in their propensity towards taking social risks. A fifth domain of activities associated with high potential payoffs and fixed minor costs was also assessed. In contrast to other domains, women reported being more likely to engage in behaviors in this domain. This gender difference was partially mediated by women's more optimistic judgments of the probability of good outcomes and of

  8. [Urban ecological risk assessment: a review].

    Science.gov (United States)

    Wang, Mei-E; Chen, Wei-Ping; Peng, Chi

    2014-03-01

    With the development of urbanization and the degradation of urban living environment, urban ecological risks caused by urbanization have attracted more and more attentions. Based on urban ecology principles and ecological risk assessment frameworks, contents of urban ecological risk assessment were reviewed in terms of driven forces, risk resources, risk receptors, endpoints and integrated approaches for risk assessment. It was suggested that types and degrees of urban economical and social activities were the driven forces for urban ecological risks. Ecological functional components at different levels in urban ecosystems as well as the urban system as a whole were the risk receptors. Assessment endpoints involved in changes of urban ecological structures, processes, functional components and the integrity of characteristic and function. Social-ecological models should be the major approaches for urban ecological risk assessment. Trends for urban ecological risk assessment study should focus on setting a definite protection target and criteria corresponding to assessment endpoints, establishing a multiple-parameter assessment system and integrative assessment approaches.

  9. Risk assessment theory, methods, and applications

    CERN Document Server

    Rausand, Marvin

    2011-01-01

    With its balanced coverage of theory and applications along with standards and regulations, Risk Assessment: Theory, Methods, and Applications serves as a comprehensive introduction to the topic. The book serves as a practical guide to current risk analysis and risk assessment, emphasizing the possibility of sudden, major accidents across various areas of practice from machinery and manufacturing processes to nuclear power plants and transportation systems. The author applies a uniform framework to the discussion of each method, setting forth clear objectives and descriptions, while also shedding light on applications, essential resources, and advantages and disadvantages. Following an introduction that provides an overview of risk assessment, the book is organized into two sections that outline key theory, methods, and applications. * Introduction to Risk Assessment defines key concepts and details the steps of a thorough risk assessment along with the necessary quantitative risk measures. Chapters outline...

  10. Colon Cancer Risk Assessment - Gauss Program

    Science.gov (United States)

    An executable file (in GAUSS) that projects absolute colon cancer risk (with confidence intervals) according to NCI’s Colorectal Cancer Risk Assessment Tool (CCRAT) algorithm. GAUSS is not needed to run the program.

  11. Approaches to risk assessment in food allergy

    DEFF Research Database (Denmark)

    Madsen, Charlotte Bernhard; Hattersley, S.; Buck, J.;

    2009-01-01

    the area forward. Three possible approaches to safety assessment and risk assessment for allergenic foods were presented and discussed: safety assessment using NOAEL/LOAEL and uncertainty factors, safety assessment using Benchmark Dose and Margin of Exposure (MoE), and risk assessment using probabilistic...... models. The workshop concluded that all the three approaches to safety and risk assessment of allergenic foods should continue to be considered. A particular strength of the MoE and probabilistic approaches is that they do not rely on low-dose extrapolations with its inherent issues. Probabilistic...

  12. RISK ASSESSMENT PROCEDURE FOR CIVIL AIRPORT

    Directory of Open Access Journals (Sweden)

    Natalia Distefano

    2014-03-01

    Full Text Available A practical problem in air transport is how to manage risk and safety. In recent years have been developed special technical and managerial skills to the systematic, forward looking identification and control of hazards throughout the life cycle of a project, program, or activity. Safety Management System (SMS involves identifying, evaluating, and addressing of hazards or risk. Its sole purpose is to prevent accidents. Safety risk assessment is defined as the systematic identification and evaluation of the risk posed by the complete spectrum of possible accident scenarios. Risk assessment is a tool that supports decision making and as such supports risk management. Risk management comprises the safety optimization of the system, the verification process and risk acceptance, which support airport operations. This paper proposed a quantitative methodology for the risk assessment for a civil airport, which is based on historical data of aircraft accidents, contained in the Aviation Safety Network database, from 1 January 1980 to 31 December 2010.

  13. Inpatient and outpatient cardiac rehabilitation programmes improve cardiometabolic risk in revascularized coronary patients with type 2 diabetes

    OpenAIRE

    Claudiu Avram; Adina Avram; L.aura Crăciun; Stela Iurciuc; Lucian Hoble; Alexandra Rusu; Bogdan Almăjan-Guţă; Silvia Mancaş

    2010-01-01

    The purpose of this paper is to evaluate cardiometabolic risk reduction of diabetic patients following coronary revascularizationprocedures after participation in outpatients or inpatients cardiac rehabilitation programmes. Materials and methods: weperformed a retrospective analytical study which included a group of 103 revascularized coronary patients with diabetesmellitus. Depending on participation in a cardiac rehabilitation program we have defined the following subgroups of patients:Grou...

  14. Life Cycle Assessment and Risk Assessment: A Methodological Comparison

    DEFF Research Database (Denmark)

    Olsen, Stig Irving; Christensen, Frans Møller; Hauschild, Michael Zwicky

    2001-01-01

    Life Cycle Assessment and Risk Assessment are two different tools in environmental management. The paper identifies harmonies, discrepancies and relations between the two tools exemplified by the risk assessment principles of the European Commission (EC) and the LCA method ‘EDIP’ (En...

  15. A Kindergarten Cardiovascular Risk Surveillance Study: CARDIAC-Kinder

    Science.gov (United States)

    Cottrell, Lesley; Spangler-Murphy, Emily; Minor, Valerie; Downes, Amia; Nicholson, Paula; Neal, William A.

    2005-01-01

    Objective: To evaluate an intervention aimed at increasing family physical activity and parent education about diet and activity for kindergarten students and issues related to their children's BMI. Methods: A randomized, controlled trial design was used to assess intervention impact in parental report of child diet and physical activity, and step…

  16. Risk factor paradox in the occurrence of cardiac arrest in acute coronary syndrome patients

    Science.gov (United States)

    Rosa, Silvia Aguiar; Timóteo, Ana Teresa; Nogueira, Marta Afonso; Belo, Adriana; Ferreira, Rui Cruz

    2016-01-01

    Objective To compare patients without previously diagnosed cardiovascular risk factors) and patients with one or more risk factors admitted with acute coronary syndrome. Methods This was a retrospective analysis of patients admitted with first episode of acute coronary syndrome without previous heart disease, who were included in a national acute coronary syndrome registry. The patients were divided according to the number of risk factors, as follows: 0 risk factor (G0), 1 or 2 risk factors (G1 - 2) and 3 or more risk factors (G ≥ 3). Comparative analysis was performed between the three groups, and independent predictors of cardiac arrest and death were studied. Results A total of 5,518 patients were studied, of which 72.2% were male and the mean age was 64 ± 14 years. G0 had a greater incidence of ST-segment elevation myocardial infarction, with the left anterior descending artery being the most frequently involved vessel, and a lower prevalence of multivessel disease. Even though G0 had a lower Killip class (96% in Killip I; p < 0.001) and higher ejection fraction (G0 56 ± 10% versus G1 - 2 and G ≥ 3 53 ± 12%; p = 0.024) on admission, there was a significant higher incidence of cardiac arrest. Multivariate analysis identified the absence of risk factors as an independent predictor of cardiac arrest (OR 2.78; p = 0.019). Hospital mortality was slightly higher in G0, although this difference was not significant. By Cox regression analysis, the number of risk factors was found not to be associated with mortality. Predictors of death at 1 year follow up included age (OR 1.05; p < 0.001), ST-segment elevation myocardial infarction (OR 1.94; p = 0.003) and ejection fraction < 50% (OR 2.34; p < 0.001). Conclusion Even though the group without risk factors was composed of younger patients with fewer comorbidities, better left ventricular function and less extensive coronary disease, the absence of risk factors was an independent predictor of cardiac arrest. PMID

  17. Risk communication in environmental assessment

    Energy Technology Data Exchange (ETDEWEB)

    Rahm-Crites, L. [Lawrence Livermore National Lab., Germantown, MD (United States). Washington Operations Office

    1996-08-26

    Since the enactment of NEPA and other environmental legislation, the concept of `risk communication` has expanded from simply providing citizens with scientific information about risk to exploring ways of making risk information genuinely meaningful to the public and facilitating public involvement in the very processes whereby risk is analyzed and managed. Contemporary risk communication efforts attempt to find more effective ways of conveying increasingly complex risk information and to develop more democratic and proactive approaches to community involvement, in particular to ensuring the participation of diverse populations in risk decisions. Although considerable progress has been made in a relatively short time, risk communication researchers and practitioners currently face a number of challenges in a time of high expectations, low trust, and low budgets.

  18. 59. Urinary tract infection in children after cardiac surgery: Incidence, risk factors and outcome

    Directory of Open Access Journals (Sweden)

    Rehana Shafi

    2015-10-01

    Conclusions: Foley catheter duration, presence of syndrome and prolonged PCICU and hospital stay were the main risk factors for CAUTI in postoperative pediatric cardiac patients. Resistant Gram-negative were the main cause for BSI with one third of CAUTI cases caused by MDRO or ESBL organisms. The cases with CAUTI were generally sicker and with more morbidity. The study will establish a baseline clinical indicator for monitoring quality improvement and the future measures to minimize CAUTI incidence, and its co-morbidity.

  19. Assessment of cardiac output with transpulmonary thermodilution during exercise in humans

    DEFF Research Database (Denmark)

    Calbet, José A L; Boushel, Robert

    2015-01-01

    The accuracy and reproducibility of transpulmonary thermodilution (TPTd) to assess cardiac output (Q̇) in exercising men was determined using indocyanine green (ICG) dilution as a reference method. TPTd has been utilized for the assessment of Q̇ and preload indexes of global end-diastolic volume...

  20. Assessing reservoir operations risk under climate change

    Science.gov (United States)

    Brekke, L.D.; Maurer, E.P.; Anderson, J.D.; Dettinger, M.D.; Townsley, E.S.; Harrison, A.; Pruitt, T.

    2009-01-01

    Risk-based planning offers a robust way to identify strategies that permit adaptive water resources management under climate change. This paper presents a flexible methodology for conducting climate change risk assessments involving reservoir operations. Decision makers can apply this methodology to their systems by selecting future periods and risk metrics relevant to their planning questions and by collectively evaluating system impacts relative to an ensemble of climate projection scenarios (weighted or not). This paper shows multiple applications of this methodology in a case study involving California's Central Valley Project and State Water Project systems. Multiple applications were conducted to show how choices made in conducting the risk assessment, choices known as analytical design decisions, can affect assessed risk. Specifically, risk was reanalyzed for every choice combination of two design decisions: (1) whether to assume climate change will influence flood-control constraints on water supply operations (and how), and (2) whether to weight climate change scenarios (and how). Results show that assessed risk would motivate different planning pathways depending on decision-maker attitudes toward risk (e.g., risk neutral versus risk averse). Results also show that assessed risk at a given risk attitude is sensitive to the analytical design choices listed above, with the choice of whether to adjust flood-control rules under climate change having considerably more influence than the choice on whether to weight climate scenarios. Copyright 2009 by the American Geophysical Union.

  1. Patient-reported health status prior to cardiac resynchronisation therapy identifies patients at risk for poor survival and prolonged hospital stays

    DEFF Research Database (Denmark)

    Versteeg, H.; Denollet, J.; Meine, M.;

    2016-01-01

    BACKGROUND: Patient-reported factors have largely been neglected in search of predictors of response to cardiac resynchronisation therapy (CRT). The current study aimed to examine the independent value of pre-implantation patient-reported health status in predicting four-year survival and cardiac......-related hospitalisation of CRT patients. METHODS: Consecutive patients (N = 139) indicated to receive a first-time CRT-defibrillator at the University Medical Center Utrecht were asked to complete a set of questionnaires prior to implantation. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was used to assess heart...... % CI 1.88-5.44). CONCLUSIONS: Patient-reported health status assessed prior to CRT identifies patients at risk for poor survival and prolonged hospital stays, independent of traditional risk factors. These results emphasise the importance of incorporating health status measures in cardiovascular...

  2. Aconitine Challenge Test Reveals a Single Exposure to Air Pollution Causes Increased Cardiac Arrhythmia Risk in Hypertensive Rats - Abstract

    Science.gov (United States)

    Epidemiological studies demonstrate a significant association between arrhythmias and air pollution exposure. Sensitivity to aconitine-induced arrhythmia has been used repeatedly to examine the factors that increase the risk of such cardiac electrical dysfunction. In this study, ...

  3. Non-sedating antihistamine drugs and cardiac arrhythmias -- biased risk estimates from spontaneous reporting systems?

    DEFF Research Database (Denmark)

    De Bruin, M L; van Puijenbroek, E P; Egberts, A C G

    2002-01-01

    AIMS: This study used spontaneous reports of adverse events to estimate the risk for developing cardiac arrhythmias due to the systemic use of non-sedating antihistamine drugs and compared the risk estimate before and after the regulatory action to recall the over-the-counter status of some...... was not significantly higher than 1 (OR 1.37 [95% CI: 0.85, 2.23]), whereas the risk estimate calculated after the governmental decision did significantly differ from 1 (OR 4.19 [95% CI: 2.49, 7.05]). CONCLUSIONS: Our data suggest that non-sedating antihistamines might have an increased risk for inducing arrhythmias....... Our findings, however, strongly suggest that the increased risk identified can at least partly be explained by reporting bias as a result of publications about and mass media attention for antihistamine induced arrhythmias....

  4. Irradiation of left breast and cardiac risk: fundamentals for a prospective study; Irradiation du sein gauche et risque cardiaque: bases pour une etude prospective

    Energy Technology Data Exchange (ETDEWEB)

    Untereiner, M.; Frederick, B.; Burie, D.; Philippi, S.; Joseph, S.; Harzee, L.; Hoziel, D.; Eschenbrenner, A.; Meyer, P. [Centre Francois-Baclesse, Esch-sur-Alzette (Luxembourg); Gibeau, L.; Laurent-Daniel, F.; Libert, S.; Fressancourt, C. [Centre Gray, 59 - Maubeuge (France)

    2010-10-15

    As the delineation of the anterior interventricular artery and of the heart is to be taken into account during irradiations of the left beast, in order to limit cardiotoxicity, the authors discuss the results of previous studies which highlighted this risk, and notably in a retrospective assessment of dose-volume histograms of the anterior interventricular artery and of the heart which concerned 162 left breast irradiations. This last study allowed cardiac tolerance thresholds to be defined. Short communication

  5. Risk assessment of plant protection products

    Directory of Open Access Journals (Sweden)

    Hardy T

    2012-10-01

    Full Text Available

    EFSA’s Panel on Plant Protection Products and their Residues (PPR Panel provides independent scientific advice in the field of risk assessment of plant protection products (PPPs, pesticides. Since its establishment in 2003 under Regulation (EC No 178/2002, it has delivered a series of scientific outputs in support of evaluation of pesticide active substances, establishing scientific principles and guidance documents in the field of pesticide risk assessment and in support of decision making of European Union (EU law makers. Next to a series of scientific opinions evaluating specific adverse effects of PPPs for human health (like for instance carcinogenicity the Panel also delivered scientific opinions on general principles in the field of human health risk assessment (like reference value setting and is, in particular over the last years, very much engaged in development of methodologies to meet new challenges in regulatory risk assessments such as assessment of toxicity of pesticide metabolites and potential cumulative effects of pesticides to human health. Fate, behaviour and transformation of pesticides after their application and consequent release to the environment are a major aspect of pesticide risk assessment. The PPR Panel has achieved major accomplishments by delivering guidance and scientific opinions on degradation in soil, exposure of soil organisms and assessment of environmental risks by use of pesticides in greenhouses or grown under cover. A series of scientific opinions have been delivered also in the field of environmental risk assessment of pesticides. Scientific output covered specific issues arising in the peer review of specific active substances, revision of data requirements, development of risk assessment methodologies and the development of guidance documents. A major milestone of the PPR Panel was the development of the methodological framework for deriving specific protection goals for environmental risk

  6. GHGT-11 - Integrated Carbon Risk Assessment (ICARAS)

    NARCIS (Netherlands)

    Wollenweber, J.; Busby, D.; Wessel-Berg, D.; Nepveu, M.; Bossie Codreanu, D.; Grimstad, A-A.; Sijacic, D.; Maurand, N.; Lothe, A.; Wahl, F.; Polak, S.; Boot, H.; Grøver, A.; Wildenborg, T.

    2013-01-01

    In this paper an integrated workflow is described for risk assessment within CCS. IFPEN, SINTEF and TNO joined forces to define a comprehensive and transparent risk assessment methodology. The tools developed in these institutes are thereby integrated. The workflow can be applied to proposed carbon

  7. Aquatic Macrophyte Risk Assessment for Pesticides

    NARCIS (Netherlands)

    Maltby, L.; Arnold, D.; Arts, G.H.P.; Davies, J.; Heimbach, F.; Pickl, C.; Poulsen, V.

    2009-01-01

    Given the essential role that primary producers play in aquatic ecosystems, it is imperative that the potential risk of pesticides to the structure and functioning of aquatic plants is adequately assessed. This book discusses the assessment of the risk of pesticides with herbicidal activity to aquat

  8. Recovery in environmental risk assessment at EFSA

    NARCIS (Netherlands)

    Brock, T.C.M.

    2016-01-01

    EFSA performs environmental risk assessments (ERAs) for single potential stressors such as plant protection products, genetically modified organisms and feed additives and for invasive alien species that are harmful for plant health. In this risk assessment domain, the EFSA Scientific Committee reco

  9. Fuzzy sets applications for cancer risk assessment.

    Science.gov (United States)

    Molchanov, P A; Dudatiev, A V; Podobna, Y Y; Molchanova, O P

    2002-09-01

    The method of cancer risk assessment on the basis of the Fuzzy Set Theory is presented. The method is based on a multifactor risk assessment of cancer diseases. The individual risk of cancer disease is evaluated as the probability of disease multiplied by the value of an individual dose. An acupuncture method of cancer risk assessments was developed. The method is based on the analysis of changes of an electromagnetic field (biofield) of a person. The method allows to determine both cancer probability and probable location of the process.

  10. Risk Assessment for an Unmanned Merchant Ship

    Directory of Open Access Journals (Sweden)

    Ø.J. Rødseth

    2015-09-01

    Full Text Available The MUNIN project is doing a feasibility study on an unmanned bulk carrier on an intercontinental voyage. To develop the technical and operational concepts, MUNIN has used a risk-based design method, based on the Formal Safety Analysis method which is also recommended by the International Mari-time Organization. Scenario analysis has been used to identify risks and to simplify operational scope. Systematic hazard identification has been used to find critical safety and security risks and how to address these. Technology and operational concept testing is using a hypothesis-based test method, where the hypotheses have been created as a result of the risk assessment. Finally, the cost-benefit assessment will also use results from the risk assessment. This paper describes the risk assessment method, some of the most important results and also describes how the results have been or will be used in the different parts of the project.

  11. A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Gislason, Gunnar H; Hlatky, Mark A;

    2014-01-01

    BACKGROUND: Heart failure is an established risk factor for poor outcomes in patients undergoing non-cardiac surgery, yet risk stratification remains a clinical challenge. We developed an index for 30-day mortality risk prediction in this particular group. METHODS AND RESULTS: All individuals...... with heart failure undergoing non-cardiac surgery between October 23 2004 and October 31 2011 were included from Danish administrative registers (n = 16 827). In total, 1787 (10.6%) died within 30 days. In a simple risk score based on the variables from the revised cardiac risk index, plus age, gender, acute...... by bootstrapping (1000 re-samples) provided c-statistic of 0.79. A more complex risk score based on stepwise logistic regression including 24 variables at P failure, this simple...

  12. Caries risk assessment models in caries prediction

    Directory of Open Access Journals (Sweden)

    Amila Zukanović

    2013-11-01

    Full Text Available Objective. The aim of this research was to assess the efficiency of different multifactor models in caries prediction. Material and methods. Data from the questionnaire and objective examination of 109 examinees was entered into the Cariogram, Previser and Caries-Risk Assessment Tool (CAT multifactor risk assessment models. Caries risk was assessed with the help of all three models for each patient, classifying them as low, medium or high-risk patients. The development of new caries lesions over a period of three years [Decay Missing Filled Tooth (DMFT increment = difference between Decay Missing Filled Tooth Surface (DMFTS index at baseline and follow up], provided for examination of the predictive capacity concerning different multifactor models. Results. The data gathered showed that different multifactor risk assessment models give significantly different results (Friedman test: Chi square = 100.073, p=0.000. Cariogram is the model which identified the majority of examinees as medium risk patients (70%. The other two models were more radical in risk assessment, giving more unfavorable risk –profiles for patients. In only 12% of the patients did the three multifactor models assess the risk in the same way. Previser and CAT gave the same results in 63% of cases – the Wilcoxon test showed that there is no statistically significant difference in caries risk assessment between these two models (Z = -1.805, p=0.071. Conclusions. Evaluation of three different multifactor caries risk assessment models (Cariogram, PreViser and CAT showed that only the Cariogram can successfully predict new caries development in 12-year-old Bosnian children.

  13. Production Risk Assessing Methodology (PRAM).

    Science.gov (United States)

    1982-05-01

    the price up five-fold which translates to $30.M. On the optimistic side,this same commodity market could bring the price down to one half of the price...57 PWMIW- A recognitinn that past product ion probl ems represent f ut ri , producto ; risk areas suggested an empirically developed risk structure

  14. Non-invasive cardiac imaging techniques and vascular tools for the assessment of cardiovascular disease in type 2 diabetes mellitus.

    Science.gov (United States)

    Djaberi, R; Beishuizen, E D; Pereira, A M; Rabelink, T J; Smit, J W; Tamsma, J T; Huisman, M V; Jukema, J W

    2008-09-01

    Cardiovascular disease is the major cause of mortality in type 2 diabetes mellitus. The criteria for the selection of those asymptomatic patients with type 2 diabetes who should undergo cardiac screening and the therapeutic consequences of screening remain controversial. Non-invasive techniques as markers of atherosclerosis and myocardial ischaemia may aid risk stratification and the implementation of tailored therapy for the patient with type 2 diabetes. In the present article we review the literature on the implementation of non-invasive vascular tools and cardiac imaging techniques in this patient group. The value of these techniques as endpoints in clinical trials and as risk estimators in asymptomatic diabetic patients is discussed. Carotid intima-media thickness, arterial stiffness and flow-mediated dilation are abnormal long before the onset of type 2 diabetes. These vascular tools are therefore most likely to be useful for the identification of 'at risk' patients during the early stages of atherosclerotic disease. The additional value of these tools in risk stratification and tailored therapy in type 2 diabetes remains to be proven. Cardiac imaging techniques are more justified in individuals with a strong clinical suspicion of advanced coronary heart disease (CHD). Asymptomatic myocardial ischaemia can be detected by stress echocardiography and myocardial perfusion imaging. The more recently developed non-invasive multi-slice computed tomography angiography is recommended for exclusion of CHD, and can therefore be used to screen asymptomatic patients with type 2 diabetes, but has the associated disadvantages of high radiation exposure and costs. Therefore, we propose an algorithm for the screening of asymptomatic diabetic patients, the first step of which consists of coronary artery calcium score assessment and exercise ECG.

  15. An IOT Security Risk Autonomic Assessment Algorithm

    Directory of Open Access Journals (Sweden)

    Zhengchao Ma

    2013-02-01

    Full Text Available In terms of Internet of Things (IOT system with the possibility criterion of fuzziness and randomness security risk, we qualitatively analyze the security risk level of IOT security scene by describing generalization metrics the potential impact and likelihood of occurrence of every major threat scenarios. On this basis, we proposed self-assessment algorithm of IOT security risk, adopting three-dimensional normal cloud model integrated consideration of risk indicators, researching the multi-rule mapping relationship between the qualitative input of safety indicators and the quantitative reasoning of self-assessment. Finally, we build security risk assessment simulation platform, and verify the validity and accuracy of the algorithm in the premise of substantiating the risk level and the safety criterion domain.

  16. Performance of automated software in the assessment of segmental left ventricular function in cardiac CT: Comparison with cardiac magnetic resonance

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Rui [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Capital Medical University, Department of Radiology, Beijing Anzhen Hospital, Beijing (China); Meinel, Felix G. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Ludwig-Maximilians-University Hospital, Institute for Clinical Radiology, Munich (Germany); Schoepf, U.J. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Medical University of South Carolina, Division of Cardiology, Department of Medicine, Charleston, SC (United States); Canstein, Christian [Siemens Medical Solutions USA, Malvern, PA (United States); Spearman, James V. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); De Cecco, Carlo N. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); University of Rome ' ' Sapienza' ' , Departments of Radiological Sciences, Oncology and Pathology, Latina (Italy)

    2015-12-15

    To evaluate the accuracy, reliability and time saving potential of a novel cardiac CT (CCT)-based, automated software for the assessment of segmental left ventricular function compared to visual and manual quantitative assessment of CCT and cardiac magnetic resonance (CMR). Forty-seven patients with suspected or known coronary artery disease (CAD) were enrolled in the study. Wall thickening was calculated. Segmental LV wall motion was automatically calculated and shown as a colour-coded polar map. Processing time for each method was recorded. Mean wall thickness in both systolic and diastolic phases on polar map, CCT, and CMR was 9.2 ± 0.1 mm and 14.9 ± 0.2 mm, 8.9 ± 0.1 mm and 14.5 ± 0.1 mm, 8.3 ± 0.1 mm and 13.6 ± 0.1 mm, respectively. Mean wall thickening was 68.4 ± 1.5 %, 64.8 ± 1.4 % and 67.1 ± 1.4 %, respectively. Agreement for the assessment of LV wall motion between CCT, CMR and polar maps was good. Bland-Altman plots and ICC indicated good agreement between CCT, CMR and automated polar maps of the diastolic and systolic segmental wall thickness and thickening. The processing time using polar map was significantly decreased compared with CCT and CMR. Automated evaluation of segmental LV function with polar maps provides similar measurements to manual CCT and CMR evaluation, albeit with substantially reduced analysis time. (orig.)

  17. Survey: Risk Assessment for Cloud Computing

    Directory of Open Access Journals (Sweden)

    Drissi S.

    2013-01-01

    Full Text Available with the increase in the growth of cloud computing and the changes in technology that have resulted a new ways for cloud providers to deliver their services to cloud consumers, the cloud consumers should be aware of the risks and vulnerabilities present in the current cloud computing environment. An information security risk assessment is designed specifically for that task. However, there is lack of structured risk assessment approach to do it. This paper aims to survey existing knowledge regarding risk assessment for cloud computing and analyze existing use cases from cloud computing to identify the level of risk assessment realization in state of art systems and emerging challenges for future research.

  18. Systems Toxicology: The Future of Risk Assessment.

    Science.gov (United States)

    Sauer, John Michael; Hartung, Thomas; Leist, Marcel; Knudsen, Thomas B; Hoeng, Julia; Hayes, A Wallace

    2015-01-01

    Risk assessment, in the context of public health, is the process of quantifying the probability of a harmful effect to individuals or populations from human activities. With increasing public health concern regarding the potential risks associated with chemical exposure, there is a need for more predictive and accurate approaches to risk assessment. Developing such an approach requires a mechanistic understanding of the process by which xenobiotic substances perturb biological systems and lead to toxicity. Supplementing the shortfalls of traditional risk assessment with mechanistic biological data has been widely discussed but not routinely implemented in the evaluation of chemical exposure. These mechanistic approaches to risk assessment have been generally referred to as systems toxicology. This Symposium Overview article summarizes 4 talks presented at the 35th Annual Meeting of the American College of Toxicology.

  19. NASA Human System Risk Assessment Process

    Science.gov (United States)

    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

  20. Security risk assessment handbook a complete guide for performing security risk assessments

    CERN Document Server

    Landoll, Douglas J

    2005-01-01

    The Security Risk Assessment Handbook: A Complete Guide for Performing Security Risk Assessments provides detailed insight into precisely how to conduct an information security risk assessment. Designed for security professionals and their customers who want a more in-depth understanding of the risk assessment process, this volume contains real-world advice that promotes professional development. It also enables security consumers to better negotiate the scope and rigor of a security assessment, effectively interface with a security assessment team, deliver insightful comments on a draft repor

  1. Risk assessment in support of plant health

    DEFF Research Database (Denmark)

    Jeger, Michael; Schans, Jan; Lövei, Gabor L.

    2012-01-01

    types and plants in the environment. There has been an increasing trend towards producing scientific opinions which are full pest risk assessments for the whole EU territory. In its work, and as a contribution to the wider development of risk assessment methodology, the Panel has developed a series......-evaluation of quantitative pathway analyses, and in statistical modelling of experimental data. A Plant Health Network has been established to facilitate interaction with EU Member States, especially in relation to data collection and co-ordination of risk assessment activities. At the current time a revision of the EU...

  2. Cardiac abnormalities assessed by non-invasive techniques in patients with newly diagnosed idiopathic inflammatory myopathies

    DEFF Research Database (Denmark)

    Diederichsen, Louise Pyndt; Simonsen, Jane Angel; Diederichsen, Axel Cosmus Pyndt

    2015-01-01

    inflammatory myopathies (IIM) by means of non-invasive techniques. METHODS: Fourteen patients with IIM (8 polymyositis, 4 dermatomyositis, 2 cancer-associated dermatomyositis) and 14 gender- and age- matched healthy control subjects were investigated. Participant assessments included a cardiac questionnaire...

  3. How probabilistic risk assessment can mislead terrorism risk analysts.

    Science.gov (United States)

    Brown, Gerald G; Cox, Louis Anthony Tony

    2011-02-01

    Traditional probabilistic risk assessment (PRA), of the type originally developed for engineered systems, is still proposed for terrorism risk analysis. We show that such PRA applications are unjustified in general. The capacity of terrorists to seek and use information and to actively research different attack options before deciding what to do raises unique features of terrorism risk assessment that are not adequately addressed by conventional PRA for natural and engineered systems-in part because decisions based on such PRA estimates do not adequately hedge against the different probabilities that attackers may eventually act upon. These probabilities may differ from the defender's (even if the defender's experts are thoroughly trained, well calibrated, unbiased probability assessors) because they may be conditioned on different information. We illustrate the fundamental differences between PRA and terrorism risk analysis, and suggest use of robust decision analysis for risk management when attackers may know more about some attack options than we do.

  4. Subjective risk assessment for planning conservation projects

    Science.gov (United States)

    Game, Edward T.; Fitzsimons, James A.; Lipsett-Moore, Geoff; McDonald-Madden, Eve

    2013-12-01

    Conservation projects occur under many types of uncertainty. Where this uncertainty can affect achievement of a project’s objectives, there is risk. Understanding risks to project success should influence a range of strategic and tactical decisions in conservation, and yet, formal risk assessment rarely features in the guidance or practice of conservation planning. We describe how subjective risk analysis tools can be framed to facilitate the rapid identification and assessment of risks to conservation projects, and how this information should influence conservation planning. Our approach is illustrated with an assessment of risks to conservation success as part of a conservation plan for the work of The Nature Conservancy in northern Australia. Risks can be both internal and external to a project, and occur across environmental, social, economic and political systems. Based on the relative importance of a risk and the level of certainty in its assessment we propose a series of appropriate, project level responses including research, monitoring, and active amelioration. Explicit identification, prioritization, and where possible, management of risks are important elements of using conservation resources in an informed and accountable manner.

  5. Assessment factors for human health risk assessment: A discussion paper

    NARCIS (Netherlands)

    Vermeire, T.; Stevenson, H.; Pieters, M.N.; Rennen, M.; Slob, W.; Hakkert, B.C.

    1999-01-01

    The general goal of this discussion paper is to contribute toward the further harmonization of human health risk assessment. It first discusses the development of a formal, harmonized set of assessment factors. The status quo with regard to assessment factors is reviewed, that is, the type of factor

  6. Risk Factors for Acute Kidney Injury after Congenital Cardiac Surgery in Infants and Children: A Retrospective Observational Study

    Science.gov (United States)

    Kim, Eunhee; Park, Jung Bo; Kim, Youngwon; Yang, Ji-Hyuk; Jun, Tae-Gook; Kim, Chung Su

    2016-01-01

    Acute kidney injury (AKI) after pediatric cardiac surgery is associated with high morbidity and mortality. Modifiable risk factors for postoperative AKI including perioperative anesthesia-related parameters were assessed. The authors conducted a single-center, retrospective cohort study of 220 patients (aged 10 days to 19 years) who underwent congenital cardiac surgery between January and December 2012. The incidence of AKI within 7 days postoperatively was determined using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Ninety-two patients (41.8%) developed AKI and 18 (8.2%) required renal replacement therapy within the first postoperative week. Among patients who developed AKI, 57 patients (25.9%) were KDIGO stage 1, 27 patients (12.3%) were KDIGO stage 2, and eight patients (3.6%) were KDIGO stage 3. RACHS-1 (Risk-Adjusted classification for Congenital Heart Surgery) category, perioperative transfusion and fluid administration as well as fluid overload were compared between patients with and without AKI. Multivariable logistic regression analyses determined the risk factors for AKI. AKI was associated with longer hospital stay or ICU stay, and frequent sternal wound infections. Younger age (CPB) time (OR, 2.45; 95% CI, 1.24–4.84), and low preoperative hemoglobin (OR, 2.40; 95% CI, 1.07–5.40) were independent risk factors for AKI. Fluid overload was not a significant predictor for AKI. When a variable of hemoglobin concentration increase (>3 g/dl) from preoperative level on POD1 was entered into the multivariable analysis, it was independently associated with postoperative AKI (OR, 6.51; 95% CI, 2.23–19.03 compared with no increase). This association was significant after adjustment with patient demographics, medication history and RACHS-1 category (hemoglobin increase >3g/dl vs. no increase: adjusted OR, 6.94; 95% CI, 2.33–20.69), regardless of different age groups and cyanotic or non-cyanotic heart disease. Prospective trials are

  7. Screening and risk evaluation for sudden cardiac death in ischaemic and non-ischaemic cardiomyopathy

    DEFF Research Database (Denmark)

    Proclemer, Alessandro; Lewalter, Thorsten; Bongiorni, Maria Grazia;

    2013-01-01

    The purpose of this EHRA survey was to examine the current clinical practice of screening and risk evaluation for sudden cardiac death in ischaemic and non-ischaemic cardiomyopathy with a focus on selection of candidates for implantable cardioverter-defibrillator (ICD) therapy, timing of ICD...... centres (32.2%), and in patients with permanent dialysis in 8 centres (33.3%). Signal-averaged electrocardiography and heart rate variability were never considered as risk stratification tools in 23 centres (74.2%). Implantation of a loop recorder was performed in patients with borderline indications...... on the clinical risk stratification and not on non-invasive and invasive diagnostic tests or implantable loop recorder use....

  8. The utility of cardiac CT beyond the assessment of suspected coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Kakouros, N. [Johns Hopkins Hospital, Baltimore, MD (United States); Giles, J.; Crundwell, N.B. [Conquest Hospital, St Leonards-on-Sea, East Sussex (United Kingdom); McWilliams, E.T.M., E-mail: eric.mcwilliams@esht.nhs.uk [Conquest Hospital, St Leonards-on-Sea, East Sussex (United Kingdom)

    2012-07-15

    Extensive work has been done over recent years to improve the spatial and temporal resolution of electrocardiogram (ECG)-gated cardiac computed tomography (CT). Advances in both hardware and software analysis have enabled the development of non-invasive coronary angiography. However, these high-quality examinations lend themselves to multiple additional applications beyond coronary angiography. In this review, we illustrate and discuss some established and some emerging applications of ECG-gated cardiac CT beyond the assessment of suspected coronary disease, particularly in light of recent recommendations on the appropriate use of this technology.

  9. Operationalization Of The Professional Risks Assessment Activity

    Science.gov (United States)

    Ivascu, Victoria Larisa; Cirjaliu, Bianca; Draghici, Anca

    2015-07-01

    Professional risks assessment approach (integration of analysis and evaluation processes) is linked with the general concerns of nowadays companies for their employees' health and safety assurances, in the context of organizations sustainable development. The paper presents an approach for the operationalization of the professional risk assessment activity in companies through the implementation and use of the OnRisk platform (this have been tested in some industrial companies). The short presentation of the relevant technical reports and statistics on OSH management at the European Union level underlines the need for the development of a professional risks assessment. Finally, there have been described the designed and developed OnRisk platform as a web platform together with some case studies that have validate the created tool.

  10. ASSESSMENT OF SELECTED CARDIAC FUNCTIONS OF SPORTSPERSON OF VADODARA CITY

    Directory of Open Access Journals (Sweden)

    Rachit Joshi

    2012-02-01

    Full Text Available Aims and objective: Sports activity had always been an epitome of physical fitness activities. Multiple studies have shown that people, who maintain appropriate body fitness, using judicious regimens of exercise and weight control, have the additional benefit of prolonged life. The aim of this study was to find out and confirm the fact that regular exercise or sports activity have a beneficial effect on the various system of our body especially the cardiovascular system. Methodology: A comparative study was carried out at IPCL sports complex of Vadodara city in between the sportsperson and control persons using unpaired ‘t’ test for resting heart rate and blood pressure. They were subjected to hopping test: following which the maximum heart rate achieved and time taken for recovery to resting heart rate was measured. Results: As a result of our study we came to know that sportsperson have a significantly lower resting heart rate; lower maximum heart rate achieved and a reduced recovery time after hopping test than sedentary individuals. Conclusion: Our study reaffirms the fact that regular physical activity in any form slows the rate of decline with age of most of the physiological parameters that we associate with health and fitness especially by decline in basal heart rate and increased cardiac reserves. [National J of Med Res 2012; 2(1.000: 47-50

  11. A Tutorial on Probablilistic Risk Assessement and its Role in Risk-Informed Decision Making

    Science.gov (United States)

    Dezfuli, Homayoon

    2010-01-01

    This slide presentation reviews risk assessment and its role in risk-informed decision making. It includes information on probabilistic risk assessment, typical risk management process, origins of risk matrix, performance measures, performance objectives and Bayes theorem.

  12. Framework for Shared Drinking Water Risk Assessment.

    Energy Technology Data Exchange (ETDEWEB)

    Lowry, Thomas Stephen [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Tidwell, Vincent C. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Peplinski, William John [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Mitchell, Roger [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Binning, David [AEM Corp., Herndon, VA (United States); Meszaros, Jenny [AEM Corp., Herndon, VA (United States)

    2017-01-01

    Central to protecting our nation's critical infrastructure is the development of methodologies for prioritizing action and supporting resource allocation decisions associated with risk-reduction initiatives. Toward this need a web-based risk assessment framework that promotes the anonymous sharing of results among water utilities is demonstrated. Anonymous sharing of results offers a number of potential advantages such as assistance in recognizing and correcting bias, identification of 'unknown, unknowns', self-assessment and benchmarking for the local utility, treatment of shared assets and/or threats across multiple utilities, and prioritization of actions beyond the scale of a single utility. The constructed framework was demonstrated for three water utilities. Demonstration results were then compared to risk assessment results developed using a different risk assessment application by a different set of analysts.

  13. Assessing Risk with GASB Statement No. 3.

    Science.gov (United States)

    Wood, Venita M.; Scott, Bob

    1987-01-01

    Discusses a Government Accounting Standards Board (GASB) publication designed to provide financial statement users with information to assess a government's actual and future deposit and investment market and credit risk. (MLF)

  14. Safety Factors in Pesticide Risk Assessment

    DEFF Research Database (Denmark)

    Elmegaard, N.; Jagers op Akkerhuis, G. A. J. M.

    Foreword It has become common practice to protect the environment from hazardous chemicals by use of risk assessment to establish environmental concentration at which only limited damage to the ecosystem can be expected. The methods and tools applied in the risk assessment need constant evaluation...... to secure that the methodology is adequate. As new knowledge surfaces the risk assessment procedures develops. The present report is a contribution to the development of safety factors used to account for the uncertainty when · extrapolating from the results of test with a single species in the laboratory...... factors used in pesticide risk assessment: the variability in species sensitivities, and the relationship between acute LC50's and chronic NOEC's....

  15. Center for Advancing Microbial Risk Assessment

    Data.gov (United States)

    Federal Laboratory Consortium — The Center for Advancing Microbial Risk Assessment (CAMRA), based at Michigan State University and jointly funded by the U.S. Department of Homeland Security and the...

  16. Infective endocarditis and risk of death after cardiac implantable electronic device implantation

    DEFF Research Database (Denmark)

    Özcan, Cengiz; Raunsø, Jakob; Lamberts, Morten;

    2017-01-01

    AIMS: To determine the incidence, risk factors, and mortality of infective endocarditis (IE) following implantation of a first-time, permanent, cardiac implantable electronic device (CIED). METHODS AND RESULTS: From Danish nationwide administrative registers (beginning in 1996), we identified all...... de-novo permanent pacemakers (PMs) and implantable cardioverter defibrillators (ICDs) together with the occurrence of post-implantation IE-events in the period from 2000-2012. Included were 43 048 first-time PM/ICD recipients. Total follow-up time was 168 343 person-years (PYs). The incidence rate...

  17. Assessment of cardiac function in mice lacking the mitochondrial calcium uniporter.

    Science.gov (United States)

    Holmström, Kira M; Pan, Xin; Liu, Julia C; Menazza, Sara; Liu, Jie; Nguyen, Tiffany T; Pan, Haihui; Parks, Randi J; Anderson, Stasia; Noguchi, Audrey; Springer, Danielle; Murphy, Elizabeth; Finkel, Toren

    2015-08-01

    Mitochondrial calcium is thought to play an important role in the regulation of cardiac bioenergetics and function. The entry of calcium into the mitochondrial matrix requires that the divalent cation pass through the inner mitochondrial membrane via a specialized pore known as the mitochondrial calcium uniporter (MCU). Here, we use mice deficient of MCU expression to rigorously assess the role of mitochondrial calcium in cardiac function. Mitochondria isolated from MCU(-/-) mice have reduced matrix calcium levels, impaired calcium uptake and a defect in calcium-stimulated respiration. Nonetheless, we find that the absence of MCU expression does not affect basal cardiac function at either 12 or 20months of age. Moreover, the physiological response of MCU(-/-) mice to isoproterenol challenge or transverse aortic constriction appears similar to control mice. Thus, while mitochondria derived from MCU(-/-) mice have markedly impaired mitochondrial calcium handling, the hearts of these animals surprisingly appear to function relatively normally under basal conditions and during stress.

  18. Asbestos Workshop: Sampling, Analysis, and Risk Assessment

    Science.gov (United States)

    2012-03-01

    coatings Vinyl/asbestos floor tile Automatic transmission components Clutch facings Disc brake pads Drum brake linings Brake blocks Commercial and...1EMDQ March 2012 ASBESTOS WORKSHOP: SAMPLING, ANALYSIS , AND RISK ASSESSMENT Paul Black, PhD, Neptune and Company Ralph Perona, DABT, Neptune and...Sampling, Analysis , and Risk Assessment 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK

  19. UAV Swarm Operational Risk Assessment system

    OpenAIRE

    Marfo, Sariyu; Ehler, Shane; Fields, Ryan; Negron, Jamaries Benitez; Skopak, Shane; Junek, John; Zarzaca, Justin; Perrotta, Robert; Team CQ Alpha; Cohort 311-141A

    2015-01-01

    Approved for public release; distribution is unlimited This paper examines the need for a UAV Swarm Risk Assessment Tool and how it can assist the Navy’s decision makers in assessing risk of UAV swarm threats in littoral environments, near potentially hostile countries, based on the latest intelligence. Human-centered design principles help determine the needs of experienced battle commanders. These needs form the basis of requirements and functional analysis. The system design concept con...

  20. Latest developments in foodborne pathogen risk assessment

    OpenAIRE

    Membré, Jeanne Marie; Guillou, Sandrine

    2016-01-01

    Microbiological Risk Assessment (MRA) is a structured process for determining the public health risk associated with foodborne pathogens. In recent years, there has been a strong tendency in providing food safety decisions based upon quantitative assessment. Especially, variability and uncertainty inherent to biological processes have been integrated in food safety management through the use of powerful statistical and probabilistic techniques. Besides, recent developments in omic technologie...

  1. Gender and risk assessment in contraceptive technologies

    NARCIS (Netherlands)

    Kammen, van Jessika; Oudshoorn, Nelly

    2002-01-01

    This paper concerns a comparison of risk assessment practices of contraceptives for women and men. Our analysis shows how the evaluation of health risks of contraceptives does not simply reflect the specific effects of chemical compounds in the human body. Rather, we show how side-effects were rated

  2. Environmental risk assessment of pesticides in Ethiopia

    NARCIS (Netherlands)

    Teklu, B.M.

    2016-01-01

    The current increase in application rate and usage frequency of application of pesticides in Ethiopia pose direct risks to surface water aquatic organisms and humans and cattle using surface water as a source of drinking water in rural parts of the country. A model based risk assessment as currently

  3. Serum lipidomics meets cardiac magnetic resonance imaging: profiling of subjects at risk of dilated cardiomyopathy.

    Science.gov (United States)

    Sysi-Aho, Marko; Koikkalainen, Juha; Seppänen-Laakso, Tuulikki; Kaartinen, Maija; Kuusisto, Johanna; Peuhkurinen, Keijo; Kärkkäinen, Satu; Antila, Margareta; Lauerma, Kirsi; Reissell, Eeva; Jurkko, Raija; Lötjönen, Jyrki; Heliö, Tiina; Orešič, Matej

    2011-01-20

    Dilated cardiomyopathy (DCM), characterized by left ventricular dilatation and systolic dysfunction, constitutes a significant cause for heart failure, sudden cardiac death or need for heart transplantation. Lamin A/C gene (LMNA) on chromosome 1p12 is the most significant disease gene causing DCM and has been reported to cause 7-9% of DCM leading to cardiac transplantation. We have previously performed cardiac magnetic resonance imaging (MRI) to LMNA carriers to describe the early phenotype. Clinically, early recognition of subjects at risk of developing DCM would be important but is often difficult. Thus we have earlier used the MRI findings of these LMNA carriers for creating a model by which LMNA carriers could be identified from the controls at an asymptomatic stage. Some LMNA mutations may cause lipodystrophy. To characterize possible effects of LMNA mutations on lipid profile, we set out to apply global serum lipidomics using Ultra Performance Liquid Chromatography coupled to mass spectrometry in the same LMNA carriers, DCM patients without LMNA mutation and controls. All DCM patients, with or without LMNA mutation, differed from controls in regard to distinct serum lipidomic profile dominated by diminished odd-chain triglycerides and lipid ratios related to desaturation. Furthermore, we introduce a novel approach to identify associations between the molecular lipids from serum and the MR images from the LMNA carriers. The association analysis using dependency network and regression approaches also helped us to obtain novel insights into how the affected lipids might relate to cardiac shape and volume changes. Our study provides a framework for linking serum derived molecular markers not only with clinical endpoints, but also with the more subtle intermediate phenotypes, as derived from medical imaging, of potential pathophysiological relevance.

  4. Serum lipidomics meets cardiac magnetic resonance imaging: profiling of subjects at risk of dilated cardiomyopathy.

    Directory of Open Access Journals (Sweden)

    Marko Sysi-Aho

    Full Text Available Dilated cardiomyopathy (DCM, characterized by left ventricular dilatation and systolic dysfunction, constitutes a significant cause for heart failure, sudden cardiac death or need for heart transplantation. Lamin A/C gene (LMNA on chromosome 1p12 is the most significant disease gene causing DCM and has been reported to cause 7-9% of DCM leading to cardiac transplantation. We have previously performed cardiac magnetic resonance imaging (MRI to LMNA carriers to describe the early phenotype. Clinically, early recognition of subjects at risk of developing DCM would be important but is often difficult. Thus we have earlier used the MRI findings of these LMNA carriers for creating a model by which LMNA carriers could be identified from the controls at an asymptomatic stage. Some LMNA mutations may cause lipodystrophy. To characterize possible effects of LMNA mutations on lipid profile, we set out to apply global serum lipidomics using Ultra Performance Liquid Chromatography coupled to mass spectrometry in the same LMNA carriers, DCM patients without LMNA mutation and controls. All DCM patients, with or without LMNA mutation, differed from controls in regard to distinct serum lipidomic profile dominated by diminished odd-chain triglycerides and lipid ratios related to desaturation. Furthermore, we introduce a novel approach to identify associations between the molecular lipids from serum and the MR images from the LMNA carriers. The association analysis using dependency network and regression approaches also helped us to obtain novel insights into how the affected lipids might relate to cardiac shape and volume changes. Our study provides a framework for linking serum derived molecular markers not only with clinical endpoints, but also with the more subtle intermediate phenotypes, as derived from medical imaging, of potential pathophysiological relevance.

  5. Risk Factors for post-Cardiac Surgery Diaphragmatic Paralysis in Children with Congenital Heart Disease

    Directory of Open Access Journals (Sweden)

    Parvin Akbariasbagh

    2015-12-01

    Full Text Available Background: Injured phrenic nerve secondary to cardiac surgeries is the most common cause of diaphragmatic paralysis (DP in infants. The aim of this study was to determine the risk factors for DP caused by congenital heart defect corrective surgeries in pediatrics.Methods: This cross-sectional study, conducted in a 2-year period (2006–2008, included 451 children with congenital heart diseases admitted to the Pediatric Cardiac Surgery Ward of Imam Khomeini Hospital. The diaphragmatic function was examined via fluoroscopy, and the frequency of DP and its relevant parameters were evaluated.Results: Of the 451 patients, comprising 268 males and 183 females at an age range of 3 days to 204 months (28.2 ± 33.4 months, 25 (5.5% infants (60% male and 40% female, age range = 15 days to 132 months, 41.2 ± 28.1 months had DP as follows: 48% unilateral right-sided and 36% unilateral left-sided. Additionally, 68% had cyanotic congenital heart disease and 84% had DP following total correction surgery.  The highest prevalence rates of DP resulting in phrenic hemiparesis were observed after arterial switch operation, Fontan procedure, and Blalock–Taussig shunt surgery, respectively. Thirteen (52% of the 25 DP patients underwent surgical diaphragmatic plication because of severe respiratory distress and dependency on mechanical ventilation, and most of the cases of plication underwent arterial switch operation. The rate of mortality was 24% (6 patients.Conclusion: DP with a prevalence of 5.5% was one of the most common complications secondary to cardiac surgeries in the infants included in the present study. Effective factors were age, weight, cyanotic congenital heart defects, and previous cardiac surgery. Diaphragmatic plication improved prognosis in severe cases.

  6. Preoperative White Blood Cell Count and Risk of 30-Day Readmission after Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Jeremiah R. Brown

    2013-01-01

    Full Text Available Approximately 1 in 5 patients undergoing cardiac surgery are readmitted within 30 days of discharge. Among the primary causes of readmission are infection and disease states susceptible to the inflammatory cascade, such as diabetes, chronic obstructive pulmonary disease, and gastrointestinal complications. Currently, it is not known if a patient’s baseline inflammatory state measured by crude white blood cell (WBC counts could predict 30-day readmission. We collected data from 2,176 consecutive patients who underwent cardiac surgery at seven hospitals. Patient readmission data was abstracted from each hospital. The independent association with preoperative WBC count was determined using logistic regression. There were 259 patients readmitted within 30 days, with a median time of readmission of 9 days (IQR 4–16. Patients with elevated WBC count at baseline (10,000–12,000 and >12,000 mm3 had higher 30-day readmission than those with lower levels of WBC count prior to surgery (15% and 18% compared to 10%–12%, P=0.037. Adjusted odds ratios were 1.42 (0.86, 2.34 for WBC counts 10,000–12,000 and 1.81 (1.03, 3.17 for WBC count > 12,000. We conclude that WBC count measured prior to cardiac surgery as a measure of the patient’s inflammatory state could aid clinicians and continuity of care management teams in identifying patients at heightened risk of 30-day readmission after discharge from cardiac surgery.

  7. Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Emília Nozawa

    2003-03-01

    Full Text Available OBJECTIVE: To analyze parameters of respiratory system mechanics and oxygenation and cardiovascular alterations involved in weaning tracheostomized patients from long-term mechanical ventilation after cardiac surgery. METHODS: We studied 45 patients in their postoperative period of cardiac surgery, who required long-term mechanical ventilation for more than 10 days and had to undergo tracheostomy due to unsuccessful weaning from mechanical ventilation. The parameters of respiratory system mechanics, oxigenation and the following factors were analyzed: type of surgical procedure, presence of cardiac dysfunction, time of extracorporeal circulation, and presence of neurologic lesions. RESULTS: Of the 45 patients studied, successful weaning from mechanical ventilation was achieved in 22 patients, while the procedure was unsuccessful in 23 patients. No statistically significant difference was observed between the groups in regard to static pulmonary compliance (p=0.23, airway resistance (p=0.21, and the dead space/tidal volume ratio (p=0.54. No difference was also observed in regard to the variables PaO2/FiO2 ratio (p=0.86, rapid and superficial respiration index (p=0.48, and carbon dioxide arterial pressure (p=0.86. Cardiac dysfunction and time of extracorporeal circulation showed a significant difference. CONCLUSION: Data on respiratory system mechanics and oxygenation were not parameters for assessing the success or failure. Cardiac dysfunction and time of cardiopulmonary bypass, however, significantly interfered with the success in weaning patients from mechanical ventilation.

  8. Early cardiology assessment and intervention reduces mortality following myocardial injury after non-cardiac surgery (MINS)

    Science.gov (United States)

    Hua, Alina; Pattenden, Holly; Leung, Maria; Davies, Simon; George, David A.; Raubenheimer, Hilgardt; Niwaz, Zakiyah

    2016-01-01

    Background Myocardial injury after non-cardiac surgery (MINS) is defined as troponin elevation of ≥0.03 ng/mL associated with 3.87-fold increase in early mortality. We sought to determine the impact of cardiology intervention on mortality in patients who developed MINS after general thoracic surgery. Methods A retrospective review was performed in patients over 5 years. Troponin was routinely measured and levels ≥0.04 ng/mL classified as positive. Data acquisition and mortality status was obtained via medical records and NHS tracing systems. Thirty-day mortality was compared on MINS cohort using Fisher’s exact square testing and logistic regression analysis. Results Troponin levels were measured in 491 (96%) of 511 patients. Eighty (16%) patients fulfilled the MINS criteria. Sixty-one (76%) received early cardiology consult and “myocardial infarction” stated in four (5%) patients. Risk assessment (for AMI) was undertaken; 20 (25%) patients were commenced on aspirin, four (5%) on β-blockers and one (1%) underwent percutaneous coronary intervention. Forty-nine (61%) patients received primary risk factor modifications and 26 (33%) had outpatient follow-up. There were no significant differences in the proportion of patients who died within 30 days post-operatively in the MINS group of 2.6% compared to the non-MINS group of 1.6% (P=0.625). The odds ratio for 30-day mortality in the MINS group was 1.69 (95% CI: 0.34 to 8.57, P=0.522). Conclusions MINS is common after general thoracic surgery. Early cardiology intervention reduced the expected hazard ratio of early death from 3.87 to an odds ratio of 1.69 with no significant difference in 30-day mortality for patients who developed MINS. PMID:27162667

  9. Biodiversity Risk Assessment of Protected Ecosystems

    Directory of Open Access Journals (Sweden)

    Vitalija Rudzkienė

    2013-10-01

    Full Text Available Forest ecosystems are characterised by the most abundant biodiversity because there are the best conditions for existence of various species of plants, animals and various other organisms there. Generally, in the last decades a lot of attention is given to biodiversity, and scientific research draws attention to an increasing loss of biodiversity. Biodiversity measurements are needed in order to understand biodiversity changes and to control them. Measurements and assessments of biodiversity of ecosystems reveal the condition of an ecosystem of a certain territory as well as create the basis for a strategy of preserving separate species. A lot of indices for assessing biodiversity risk have been created in the last decades. Integrated indices are composed when joining indices, and one of them is the integrated biodiversity risk assessment index NABRAI (National Biodiversity Risk Assessment Index. This article analyses the principles of creating biodiversity risk indices, possible alternatives of components (variables of biodiversity resources, impact and response indices, and their suitability at the national level. Assessment and ranking methodology, adapted for assessment of biodiversity risk of local protected territories and for ranking of territories, is presented. Report data of directorates of Lithuanian national and regional parks are used for the analysis, as well as the data served as a basis to calculate integrated biodiversity risk indices of several protected territories of Lithuania.DOI: http://dx.doi.org/10.5755/j01.erem.65.3.4478

  10. The role of out-of-hospital cardiac arrest in predicting hospital mortality for percutaneous coronary interventions in the Clinical Outcomes Assessment Program.

    Science.gov (United States)

    Maynard, Charles; Rao, Sunil V; Gregg, Mary; Phillips, Richard C; Reisman, Mark; Tucker, Eben; Goss, J Richard

    2009-01-01

    Published mortality models for percutaneous coronary intervention (PCI), including the Clinical Outcomes Assessment Program (COAP) model, have not considered the effect of out-ofhospital cardiac arrest. The primary objective of this study was to determine if the inclusion of out-of-hospital cardiac arrest altered the COAP mortality model for PCI. The COAP PCI database contains extensive demographic, clinical, procedural and outcome information, including out-of-hospital cardiac arrest, which was added to the data collection form in 2006. This study included 15,586 consecutive PCIs performed in 31 Washington State hospitals in 2006. Using development and test sets, the existing COAP PCI logistic regression mortality model was examined to assess the effect of out-of-hospital arrest on in-hospital mortality. Overall, 2% of individuals undergoing PCI had cardiac arrest prior to hospital arrival. Among 8 hospitals with PCI volumes 120 cases per year did. In-hospital mortality was 19% in the arrest group and was 1.0% in remaining procedures (p < 0.0001). In the new multivariate model, out-of-hospital cardiac arrest was highly associated with mortality (odds ratio = 5.50; 95% confidence interval [CI] = 3.28-9.25). When evaluated in the test set, the new model had excellent discrimination (c-statistic = 0.89; 95% CI = 0.85-0.93). Out-of-hospital cardiac arrest is an important determinant of risk-adjusted in-hospital mortality for PCI, particularly for hospitals with low volumes and relatively high volumes of cardiac arrest cases.

  11. A framework for combining social impact assessment and risk assessment

    Energy Technology Data Exchange (ETDEWEB)

    Mahmoudi, Hossein, E-mail: mahmoudi@uni-hohenheim.de [Department of Social Sciences in Agriculture, University of Hohenheim (Germany); Environmental Sciences Research Institute, Shahid Beheshti University, G.C. (Iran, Islamic Republic of); Renn, Ortwin [Department of Technology and Environmental Sociology (and DIALOGIK), University of Stuttgart (Germany); Vanclay, Frank [Department of Cultural Geography, Faculty of Spatial Sciences, University of Groningen, Groningen (Netherlands); Hoffmann, Volker [Department of Social Sciences in Agriculture, University of Hohenheim (Germany); Karami, Ezatollah [College of Agriculture, Shiraz University, Shiraz (Iran, Islamic Republic of)

    2013-11-15

    An increasing focus on integrative approaches is one of the current trends in impact assessment. There is potential to combine impact assessment with various other forms of assessment, such as risk assessment, to make impact assessment and the management of social risks more effective. We identify the common features of social impact assessment (SIA) and social risk assessment (SRA), and discuss the merits of a combined approach. A hybrid model combining SIA and SRA to form a new approach called, ‘risk and social impact assessment’ (RSIA) is introduced. RSIA expands the capacity of SIA to evaluate and manage the social impacts of risky projects such as nuclear energy as well as natural hazards and disasters such as droughts and floods. We outline the three stages of RSIA, namely: impact identification, impact assessment, and impact management. -- Highlights: • A hybrid model to combine SIA and SRA namely RSIA is proposed. • RSIA can provide the proper mechanism to assess social impacts of natural hazards. • RSIA can play the role of ex-post as well as ex-ante assessment. • For some complicated and sensitive cases like nuclear energy, conducting a RSIA is necessary.

  12. Assessing quality in cardiac surgery: why this is necessary in the twenty-first century

    Science.gov (United States)

    Swain, J. A.; Hartz, R. S.

    2000-01-01

    The cost and high-profile nature of coronary surgery means that this is an area of close public scrutiny. As much pioneering work in data collection and risk analyses has been carried out by cardiac surgeons, substantial information exists and the correct interpretation of that data is identified as an important issue. This paper considers the background and history of risk-adjustment in cardiac surgery, the uses of quality data, examines the observed/expected mortality ratio and looks at issues such as cost and reactions to outliers. The conclusion of the study is that the continuation of accurate data collection by the whole operative team and a strong commitment to constantly improving quality is crucial to its meaningful application.

  13. New Methodology for Rapid Seismic Risk Assessment

    Science.gov (United States)

    Melikyan, A. E.; Balassanian, S. Y.

    2002-05-01

    Seismic risk is growing worldwide and is, increasingly, a problem of developing countries. Along with growing urbanization future earthquakes will have more disastrous social and economic consequences. Seismic risk assessment and reduction are important goals for each country located in seismically active zone. For Armenia these goals are of primary importance because the results of studies carried out by Armenian NSSP for assessment of the losses caused by various types of disasters in Armenia had shown that earthquakes are the most disastrous hazard for Armenia. The strategy for seismic risk reduction in 1999 was adopted by the Government of Armenia as a high priority state program. The world experience demonstrates that for efficient response the rapid assessment of seismic losses is necessary. There are several state-of-the-art approaches for seismic risk assessment (Radius, Hazus, etc.). All of them required large amount of various input data, which is impossible to collect in many developing countries, in particular in Armenia. Taking into account this very serious problem existing for developing countries, as well as rapid seismic risk assessment need immediately after strong earthquake the author undertake the attempt to contribute into a new approach for rapid seismic risk assessment under the supervision of Prof. S. Balassanian. The analysis of numerous factors influencing seismic risk in Armenia shows that the following elements contribute most significantly to the possible losses: seismic hazard; density of population; vulnerability of structures. Proposed approach for rapid seismic risk assessment based on these three factors has been tested for several seismic events. These tests have shown that such approach might represent from 80 to 90 percent of real losses.

  14. Ecosystem services as assessment endpoints for ecological risk assessment.

    Science.gov (United States)

    Munns, Wayne R; Rea, Anne W; Suter, Glenn W; Martin, Lawrence; Blake-Hedges, Lynne; Crk, Tanja; Davis, Christine; Ferreira, Gina; Jordan, Steve; Mahoney, Michele; Barron, Mace G

    2016-07-01

    Ecosystem services are defined as the outputs of ecological processes that contribute to human welfare or have the potential to do so in the future. Those outputs include food and drinking water, clean air and water, and pollinated crops. The need to protect the services provided by natural systems has been recognized previously, but ecosystem services have not been formally incorporated into ecological risk assessment practice in a general way in the United States. Endpoints used conventionally in ecological risk assessment, derived directly from the state of the ecosystem (e.g., biophysical structure and processes), and endpoints based on ecosystem services serve different purposes. Conventional endpoints are ecologically important and susceptible entities and attributes that are protected under US laws and regulations. Ecosystem service endpoints are a conceptual and analytical step beyond conventional endpoints and are intended to complement conventional endpoints by linking and extending endpoints to goods and services with more obvious benefit to humans. Conventional endpoints can be related to ecosystem services even when the latter are not considered explicitly during problem formulation. To advance the use of ecosystem service endpoints in ecological risk assessment, the US Environmental Protection Agency's Risk Assessment Forum has added generic endpoints based on ecosystem services (ES-GEAE) to the original 2003 set of generic ecological assessment endpoints (GEAEs). Like conventional GEAEs, ES-GEAEs are defined by an entity and an attribute. Also like conventional GEAEs, ES-GEAEs are broadly described and will need to be made specific when applied to individual assessments. Adoption of ecosystem services as a type of assessment endpoint is intended to improve the value of risk assessment to environmental decision making, linking ecological risk to human well-being, and providing an improved means of communicating those risks. Integr Environ Assess Manag

  15. Biological Based Risk Assessment for Space Exploration

    Science.gov (United States)

    Cucinotta, Francis A.

    2011-01-01

    Exposures from galactic cosmic rays (GCR) - made up of high-energy protons and high-energy and charge (HZE) nuclei, and solar particle events (SPEs) - comprised largely of low- to medium-energy protons are the primary health concern for astronauts for long-term space missions. Experimental studies have shown that HZE nuclei produce both qualitative and quantitative differences in biological effects compared to terrestrial radiation, making risk assessments for cancer and degenerative risks, such as central nervous system effects and heart disease, highly uncertain. The goal for space radiation protection at NASA is to be able to reduce the uncertainties in risk assessments for Mars exploration to be small enough to ensure acceptable levels of risks are not exceeded and to adequately assess the efficacy of mitigation measures such as shielding or biological countermeasures. We review the recent BEIR VII and UNSCEAR-2006 models of cancer risks and their uncertainties. These models are shown to have an inherent 2-fold uncertainty as defined by ratio of the 95% percent confidence level to the mean projection, even before radiation quality is considered. In order to overcome the uncertainties in these models, new approaches to risk assessment are warranted. We consider new computational biology approaches to modeling cancer risks. A basic program of research that includes stochastic descriptions of the physics and chemistry of radiation tracks and biochemistry of metabolic pathways, to emerging biological understanding of cellular and tissue modifications leading to cancer is described.

  16. Trichloroethylene risk assessment: relevance of interindividual differences

    NARCIS (Netherlands)

    Vermeulen, N.P.E.; Bladeren, P.J. van

    2001-01-01

    Interindividual variability in the disposition and effects of xenobiotics in humans and related inter-species differences should play a major role in human risk assessment. In particular for low-dose exposures to potentially carcinogenic compounds, novel tools and concepts are necessary to assess ri

  17. Assessment of Myocardial Infarction by Cardiac Magnetic Resonance Imaging and Long-Term Mortality

    Energy Technology Data Exchange (ETDEWEB)

    Petriz, João Luiz Fernandes, E-mail: jlpetriz@cardiol.br [Universidade Federal do Rio de Janeiro (UFRJ) / Instituto do Coração Edson Saad - Programa de Pós Graduação em Medicina (Cardiologia), Rio de Janeiro, RJ (Brazil); Hospital Barra D’Or, Rio de Janeiro, RJ (Brazil); Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, RJ (Brazil); Gomes, Bruno Ferraz de Oliveira; Rua, Braulio Santos [Hospital Barra D’Or, Rio de Janeiro, RJ (Brazil); Azevedo, Clério Francisco [Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, RJ (Brazil); Hadlich, Marcelo Souza [Universidade Federal do Rio de Janeiro (UFRJ) / Instituto do Coração Edson Saad - Programa de Pós Graduação em Medicina (Cardiologia), Rio de Janeiro, RJ (Brazil); Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, RJ (Brazil); Mussi, Henrique Thadeu Periard [Universidade Federal do Rio de Janeiro (UFRJ) / Instituto do Coração Edson Saad - Programa de Pós Graduação em Medicina (Cardiologia), Rio de Janeiro, RJ (Brazil); Hospital Barra D’Or, Rio de Janeiro, RJ (Brazil); Taets, Gunnar de Cunto [Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, RJ (Brazil); Nascimento, Emília Matos do; Pereira, Basílio de Bragança; Silva, Nelson Albuquerque de Souza e [Universidade Federal do Rio de Janeiro (UFRJ) / Instituto do Coração Edson Saad - Programa de Pós Graduação em Medicina (Cardiologia), Rio de Janeiro, RJ (Brazil)

    2015-02-15

    Cardiac magnetic resonance imaging provides detailed anatomical information on infarction. However, few studies have investigated the association of these data with mortality after acute myocardial infarction. To study the association between data regarding infarct size and anatomy, as obtained from cardiac magnetic resonance imaging after acute myocardial infarction, and long-term mortality. A total of 1959 reports of “infarct size” were identified in 7119 cardiac magnetic resonance imaging studies, of which 420 had clinical and laboratory confirmation of previous myocardial infarction. The variables studied were the classic risk factors – left ventricular ejection fraction, categorized ventricular function, and location of acute myocardial infarction. Infarct size and acute myocardial infarction extent and transmurality were analyzed alone and together, using the variable named “MET-AMI”. The statistical analysis was carried out using the elastic net regularization, with the Cox model and survival trees. The mean age was 62.3 ± 12 years, and 77.3% were males. During the mean follow-up of 6.4 ± 2.9 years, there were 76 deaths (18.1%). Serum creatinine, diabetes mellitus and previous myocardial infarction were independently associated with mortality. Age was the main explanatory factor. The cardiac magnetic resonance imaging variables independently associated with mortality were transmurality of acute myocardial infarction (p = 0.047), ventricular dysfunction (p = 0.0005) and infarcted size (p = 0.0005); the latter was the main explanatory variable for ischemic heart disease death. The MET-AMI variable was the most strongly associated with risk of ischemic heart disease death (HR: 16.04; 95%CI: 2.64-97.5; p = 0.003). The anatomical data of infarction, obtained from cardiac magnetic resonance imaging after acute myocardial infarction, were independently associated with long-term mortality, especially for ischemic heart disease death.

  18. Assessment of Myocardial Infarction by Cardiac Magnetic Resonance Imaging and Long-Term Mortality

    Directory of Open Access Journals (Sweden)

    João Luiz Fernandes Petriz

    2015-02-01

    Full Text Available Background: Cardiac magnetic resonance imaging provides detailed anatomical information on infarction. However, few studies have investigated the association of these data with mortality after acute myocardial infarction. Objective: To study the association between data regarding infarct size and anatomy, as obtained from cardiac magnetic resonance imaging after acute myocardial infarction, and long-term mortality. Methods: A total of 1959 reports of “infarct size” were identified in 7119 cardiac magnetic resonance imaging studies, of which 420 had clinical and laboratory confirmation of previous myocardial infarction. The variables studied were the classic risk factors – left ventricular ejection fraction, categorized ventricular function, and location of acute myocardial infarction. Infarct size and acute myocardial infarction extent and transmurality were analyzed alone and together, using the variable named “MET-AMI”. The statistical analysis was carried out using the elastic net regularization, with the Cox model and survival trees. Results: The mean age was 62.3 ± 12 years, and 77.3% were males. During the mean follow-up of 6.4 ± 2.9 years, there were 76 deaths (18.1%. Serum creatinine, diabetes mellitus and previous myocardial infarction were independently associated with mortality. Age was the main explanatory factor. The cardiac magnetic resonance imaging variables independently associated with mortality were transmurality of acute myocardial infarction (p = 0.047, ventricular dysfunction (p = 0.0005 and infarcted size (p = 0.0005; the latter was the main explanatory variable for ischemic heart disease death. The MET-AMI variable was the most strongly associated with risk of ischemic heart disease death (HR: 16.04; 95%CI: 2.64-97.5; p = 0.003. Conclusion: The anatomical data of infarction, obtained from cardiac magnetic resonance imaging after acute myocardial infarction, were independently associated with long

  19. Risk Assessment Study for Storage Explosive

    Directory of Open Access Journals (Sweden)

    S. S. Azhar

    2006-01-01

    Full Text Available In Malaysia, there has been rapidly increasing usage in amount of explosives due to widely expansion in quarrying and mining industries. The explosives are usually stored in the storage where the safety precaution had given high attention. As the storage of large quantity of explosive can be hazardous to workers and nearby residents in the events of accidental denotation of explosives, a risk assessment study for storage explosive (magazine had been carried out. Risk assessment study had been conducted in Kimanis Quarry Sdn. Bhd, located in Sabah. Risk assessment study had been carried out with the identification of hazards and failure scenarios and estimation of the failure frequency of occurrence. Analysis of possible consequences of failure and the effects of blast waves due to the explosion was evaluated. The risk had been estimated in term of fatalities and eardrum rupture to the workers and public. The average individual voluntary risk for fatality to the workers at the quarry is calculated to be 5.75 x 10-6 per person per year, which is much lower than the acceptable level. Eardrum rupture risk calculated to be 3.15 x 10-6 per person per year for voluntary risk. There is no involuntary risk found for fatality but for eardrum rupture it was calculated to be 6.98 x 10-8 per person per year, as given by Asian Development Bank.

  20. Earthquake risk assessment for Istanbul metropolitan area

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    The impact of earthquakes in urban centers prone to disastrous earthquakes necessitates the analysis of associated risk for rational formulation of contingency plans and mitigation strategies. In urban centers, the seismic risk is best quantified and portrayed through the preparation of "Earthquake Damage and Loss Scenarios." The components of such scenarios are the assessment of the hazard, inventories and the vulnerabilities of elements at risk. For the development of the earthquake risk scenario in Istanbul, two independent approaches, one based on intensities and the second on spectral displacements, are utilized. This paper will present the important features of a comprehensive study, highlight the methodology, discuss the results and provide insights to future developments.

  1. Out-of-hospital cardiac arrest risk attributable to temperature in Japan

    Science.gov (United States)

    Onozuka, Daisuke; Hagihara, Akihito

    2017-01-01

    Several studies have estimated the associations between extreme temperatures and mortality and morbidity; however, few have investigated the attributable fraction for a wide range of temperatures on the risk of out-of-hospital cardiac arrest (OHCA). We obtained daily records of OHCA cases in the 47 Japanese prefectures between 2005 and 2014. We examined the relationship between OHCA and temperature for each prefecture using a Poisson regression model combined with a distributed lag non-linear model. The estimated prefecture-specific associations were pooled at the nationwide level using a multivariate random-effect meta-analysis. A total of 659,752 cases of OHCA of presumed-cardiac origin met the inclusion criteria. Overall, 23.93% (95% empirical confidence interval [eCI]: 20.15–26.19) of OHCA was attributable to temperature. The attributable fraction to low temperatures was 23.64% (95% eCI: 19.76–25.87), whereas that of high temperatures was 0.29% (95% eCI: 0.21–0.35). The attributable fraction for OHCA was related to moderate low temperature with an overall estimate of 21.86% (95% eCI: 18.10–24.21). Extreme temperatures were responsible for a small fraction. The majority of temperature-related OHCAs were attributable to lower temperatures. The attributable risk of extremely low and high temperatures was markedly lower than that of moderate temperatures.

  2. Minimizing cardiac surgery risks in a Hepatitis C patient: Changing surgical strategy after evaluation by modern imaging technologies

    Directory of Open Access Journals (Sweden)

    Felix Kur

    2009-05-01

    Full Text Available Felix Kur1, Andres Beiras-Fernandez1, Martin Oberhoffer1, Konstantin Nikolaou2, Calin Vicol1, Bruno Reichart11Department of Cardiac Surgery, 2Department of Radiology, University Hospital Grosshadern, Munich, GermanyAbstract: Minimizing operative risks for the surgical team in infectious patients is crucial. We report on a patient suffering from Hepatitis C undergoing re-operative aortic valve and ascending aorta replacement for aortic aneurysm and paravalvular leakage due to recurrent endocarditis of a Smeloff–Cutter aortic ball prosthesis. Preoperative multi-slice computed tomography and real-time three-dimensional echocardiography proved helpful in changing operative strategy by detecting a previously unknown aortic aneurysm, assessing its extent, and demonstrating the close proximity of the right coronary artery, right ventricle, and the aortic aneurysm to the sternum. Thus, cardiopulmonary bypass was instituted via the femoral vessels, instead of conventionally. Location, morphology, and extent of the paravalvular defect could also be assessed.Keywords: aortic valve replacement, aorta, surgery, risk analysis

  3. High risk process control system assessment methodology

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Venetia [Pontificia Universidade Catolica do Rio de Janeiro (PUC-Rio), RJ (Brazil); Zamberlan, Maria Cristina [National Institute of Tehnology (INT), Rio de Janeiro, RJ (Brazil). Human Reliability and Ergonomics Research Group for the Oil, Gas and Energy Sector

    2009-07-01

    The evolution of ergonomics methodology has become necessary due to the dynamics imposed by the work environment, by the increase of the need of human cooperation and by the high interaction between various sections within a company. In the last 25 years, as of studies made in the high risk process control, we have developed a methodology to evaluate these situations that focus on the assessment of activities and human cooperation, the assessment of context, the assessment of the impact of work of other sectors in the final activity of the operator, as well as the modeling of existing risks. (author)

  4. Detecting drug-induced prolongation of the QRS complex: New insights for cardiac safety assessment

    Energy Technology Data Exchange (ETDEWEB)

    Cros, C., E-mail: caroline.cros@hotmail.co.uk [Safety Pharmacology, Global Safety Assessment, Safety Assessment UK, AstraZeneca R and D, Alderley Park, Macclesfield, SK10 4TG (United Kingdom); Skinner, M., E-mail: Matthew.Skinner@astrazeneca.com [Safety Pharmacology, Global Safety Assessment, Safety Assessment UK, AstraZeneca R and D, Alderley Park, Macclesfield, SK10 4TG (United Kingdom); Moors, J. [Safety Pharmacology, Global Safety Assessment, Safety Assessment UK, AstraZeneca R and D, Alderley Park, Macclesfield, SK10 4TG (United Kingdom); Lainee, P. [Sanofi-Aventis R and D, 371, rue du Pr Joseph Blayac, 34184 Montpellier Cedex 04 (France); Valentin, J.P. [Safety Pharmacology, Global Safety Assessment, Safety Assessment UK, AstraZeneca R and D, Alderley Park, Macclesfield, SK10 4TG (United Kingdom)

    2012-12-01

    Background: Drugs slowing the conduction of the cardiac action potential and prolonging QRS complex duration by blocking the sodium current (I{sub Na}) may carry pro-arrhythmic risks. Due to the frequency-dependent block of I{sub Na}, this study assesses whether activity-related spontaneous increases in heart rate (HR) occurring during standard dog telemetry studies can be used to optimise the detection of class I antiarrhythmic-induced QRS prolongation. Methods: Telemetered dogs were orally dosed with quinidine (class Ia), mexiletine (class Ib) or flecainide (class Ic). QRS duration was determined standardly (5 beats averaged at rest) but also prior to and at the plateau of each acute increase in HR (3 beats averaged at steady state), and averaged over 1 h period from 1 h pre-dose to 5 h post-dose. Results: Compared to time-matched vehicle, at rest, only quinidine and flecainide induced increases in QRS duration (E{sub max} 13% and 20% respectively, P < 0.01–0.001) whereas mexiletine had no effect. Importantly, the increase in QRS duration was enhanced at peak HR with an additional effect of + 0.7 ± 0.5 ms (quinidine, NS), + 1.8 ± 0.8 ms (mexiletine, P < 0.05) and + 2.8 ± 0.8 ms (flecainide, P < 0.01) (calculated as QRS at basal HR-QRS at high HR). Conclusion: Electrocardiogram recordings during elevated HR, not considered during routine analysis optimised for detecting QT prolongation, can be used to sensitise the detection of QRS prolongation. This could prove useful when borderline QRS effects are detected. Analysing during acute increases in HR could also be useful for detecting drug-induced effects on other aspects of cardiac function. -- Highlights: ► We aimed to improve detection of drug-induced QRS prolongation in safety screening. ► We used telemetered dogs to test class I antiarrhythmics at low and high heart rate. ► At low heart rate only quinidine and flecainide induced an increase in QRS duration. ► At high heart rate the effects of two

  5. Assessment of potential drug–drug interactions and its associated factors in the hospitalized cardiac patients

    Directory of Open Access Journals (Sweden)

    Ghulam Murtaza

    2016-03-01

    Full Text Available Drug–drug interactions (DDIs may result in the alteration of therapeutic response. Sometimes they may increase the untoward effects of many drugs. Hospitalized cardiac patients need more attention regarding drug–drug interactions due to complexity of their disease and therapeutic regimen. This research was performed to find out types, prevalence and association between various predictors of potential drug–drug interactions (pDDIs in the Department of Cardiology and to report common interactions. This study was performed in the hospitalized cardiac patients at Ayub Teaching Hospital, Abbottabad, Pakistan. Patient charts of 2342 patients were assessed for pDDIs using Micromedex® Drug Information. Logistic regression was applied to find predictors of pDDIs. The main outcome measure in the study was the association of the potential drug–drug interactions with various factors such as age, gender, polypharmacy, and hospital stay of the patients. We identified 53 interacting-combinations that were present in total 5109 pDDIs with median number of 02 pDDIs per patient. Overall, 91.6% patients had at least one pDDI; 86.3% were having at least one major pDDI, and 84.5% patients had at least one moderate pDDI. Among 5109 identified pDDIs, most were of moderate (55% or major severity (45%; established (24.2%, theoretical (18.8% or probable (57% type of scientific evidence. Top 10 common pDDIs included 3 major and 7 moderate interactions. Results obtained by multivariate logistic regression revealed a significant association of the occurrence of pDDIs in patient with age of 60 years or more (p < 0.001, hospital stay of 7 days or longer (p < 0.001 and taking 7 or more drugs (p < 0.001. We found a high prevalence for pDDIs in the Department of Cardiology, most of which were of moderate severity. Older patients, patients with longer hospital stay and with elevated number of prescribed drugs were at higher risk of pDDIs.

  6. Assessment of potential drug-drug interactions and its associated factors in the hospitalized cardiac patients.

    Science.gov (United States)

    Murtaza, Ghulam; Khan, Muhammad Yasir Ghani; Azhar, Saira; Khan, Shujaat Ali; Khan, Tahir M

    2016-03-01

    Drug-drug interactions (DDIs) may result in the alteration of therapeutic response. Sometimes they may increase the untoward effects of many drugs. Hospitalized cardiac patients need more attention regarding drug-drug interactions due to complexity of their disease and therapeutic regimen. This research was performed to find out types, prevalence and association between various predictors of potential drug-drug interactions (pDDIs) in the Department of Cardiology and to report common interactions. This study was performed in the hospitalized cardiac patients at Ayub Teaching Hospital, Abbottabad, Pakistan. Patient charts of 2342 patients were assessed for pDDIs using Micromedex® Drug Information. Logistic regression was applied to find predictors of pDDIs. The main outcome measure in the study was the association of the potential drug-drug interactions with various factors such as age, gender, polypharmacy, and hospital stay of the patients. We identified 53 interacting-combinations that were present in total 5109 pDDIs with median number of 02 pDDIs per patient. Overall, 91.6% patients had at least one pDDI; 86.3% were having at least one major pDDI, and 84.5% patients had at least one moderate pDDI. Among 5109 identified pDDIs, most were of moderate (55%) or major severity (45%); established (24.2%), theoretical (18.8%) or probable (57%) type of scientific evidence. Top 10 common pDDIs included 3 major and 7 moderate interactions. Results obtained by multivariate logistic regression revealed a significant association of the occurrence of pDDIs in patient with age of 60 years or more (p < 0.001), hospital stay of 7 days or longer (p < 0.001) and taking 7 or more drugs (p < 0.001). We found a high prevalence for pDDIs in the Department of Cardiology, most of which were of moderate severity. Older patients, patients with longer hospital stay and with elevated number of prescribed drugs were at higher risk of pDDIs.

  7. Postural risk assessment of mechanised firewood processing.

    Science.gov (United States)

    Spinelli, Raffaele; Aminti, Giovanni; De Francesco, Fabio

    2017-03-01

    The study assessed the postural risk of mechanised firewood processing with eight machines, representing the main technology solutions available on the market. Assessment was conducted with the Ovako Working posture Analysis System (OWAS) on 1000 still frames randomly extracted from videotaped work samples. The postural risk associated with firewood processing was variable and associated with technology type. Simple, manually operated new machines incurred a higher postural risk compared with semi- or fully automatic machines. In contrast, new semi-automatic and automatic machines were generally free from postural risk. In all cases, attention should be paid to postural risk that may occur during blockage resolution. The study did not cover the postural risk of firewood processing sites as a whole. The study provided useful information for selecting firewood processing machinery and for improving firewood machinery design, as part of a more articulate strategy aimed at enhancing the safety of firewood processing work sites. Practitioner Summary: The postural risk associated with mechanised firewood processing (eg cutting and splitting) depends on the type of equipment. Postural risk is highest (OWAS Action Category 2) with new in-line machines, designed for operation by a single worker. Fully automatic machines present minimum postural risk, except during blockage resolution.

  8. Limitations of early serum creatinine variations for the assessment of kidney injury in neonates and infants with cardiac surgery.

    Directory of Open Access Journals (Sweden)

    Mirela Bojan

    Full Text Available BACKGROUND: Changes in kidney function, as assessed by early and even small variations in serum creatinine (ΔsCr, affect survival in adults following cardiac surgery but such associations have not been reported in infants. This raises the question of the adequate assessment of kidney function by early ΔsCr in infants undergoing cardiac surgery. METHODOLOGY: The ability of ΔsCr within 2 days of surgery to assess the severity of kidney injury, accounted for by the risk of 30-day mortality, was explored retrospectively in 1019 consecutive neonates and infants. Patients aged ≤ 10 days were analyzed separately because of the physiological improvement in glomerular filtration early after birth. The Kml algorithm, an implementation of k-means for longitudinal data, was used to describe creatinine kinetics, and the receiver operating characteristic and the reclassification methodology to assess discrimination and the predictive ability of the risk of death. RESULTS: Three clusters of ΔsCr were identified: in 50% of all patients creatinine decreased, in 41.4% it increased slightly, and in 8.6% it rose abruptly. Mortality rates were not significantly different between the first and second clusters, 1.6% [0.0-4.1] vs 5.9% [1.9-10.9], respectively, in patients aged ≤ 10 days, and 1.6% [0.5-3.0] vs 3.8% [1.9-6.0] in older ones. Mortality rates were significantly higher when creatinine rose abruptly, 30.3% [15.1-46.2] in patients aged ≤ 10 days, and 15.1% [5.9-25.5] in older ones. However, only 41.3% of all patients who died had an abrupt increase in creatinine. ΔsCr improved prediction in survivors, but not in patients who died, and did not improve discrimination over a clinical mortality model. CONCLUSIONS: The present results suggest that a postoperative decrease in creatinine represents the normal course in neonates and infants with cardiac surgery, and that early creatinine variations lack sensitivity for the assessment of the severity of

  9. Noninvasive Physiologic Assessment of Coronary Stenoses Using Cardiac CT

    Directory of Open Access Journals (Sweden)

    Lei Xu

    2015-01-01

    Full Text Available Coronary CT angiography (CCTA has become an important noninvasive imaging modality in the diagnosis of coronary artery disease (CAD. CCTA enables accurate evaluation of coronary artery stenosis. However, CCTA provides limited information on the physiological significance of stenotic lesions. A noninvasive “one-stop-shop” diagnostic test that can provide both anatomical significance and functional significance of stenotic lesions would be beneficial in the diagnosis and management of CAD. Recently, with the introduction of novel techniques, such as myocardial CT perfusion, CT-derived fractional flow reserve (FFRCT, and transluminal attenuation gradient (TAG, CCTA has emerged as a noninvasive method for the assessment of both anatomy of coronary lesions and its physiological consequences during a single study. This review provides an overview of the current status of new CT techniques for the physiologic assessments of CAD.

  10. Cardiac arrest upon induction of anesthesia in children with cardiomyopathy: an analysis of incidence and risk factors.

    LENUS (Irish Health Repository)

    Lynch, Johanne

    2012-02-01

    INTRODUCTION: It is thought that patients with cardiomyopathy have an increased risk of cardiac arrest on induction of anesthesia, but there is little available data. The purpose of this study was to identify the incidence and potential risk factors for cardiac arrest upon induction of anesthesia in children with cardiomyopathy in our institution. METHODS: A retrospective chart review was performed. Eligible patients included patients admitted between 1998 and 2008 with the International Statistical Classification of Disease code for cardiomyopathy (ICD-9 code 425) who underwent airway intervention for sedation or general anesthesia in the operating room, cardiac diagnostic and interventional unit (CDIU) or intensive care unit. Patients undergoing emergency airway intervention following cardiovascular collapse were excluded. For each patient, we recorded patient demographics, disease severity, anesthesia location, and anesthetic technique. RESULTS: One hundred and twenty-nine patients with cardiomyopathy underwent a total of 236 anesthetic events, and four cardiac arrests were identified. One was related to bradycardia (HR<60), two were attributed to bradycardia in association with severe hypotension (systolic blood pressure<45), and the fourth arrest was related to isolated severe hypotension. Two occurred in the operating suite and two in the CDIU. There was no resulting mortality. One patient progressed to heart transplantation. Multiple combinations of anesthetic drugs were used for induction of anesthesia. CONCLUSION: We performed a review of the last 10 years of anesthesia events in children with cardiomyopathy. We report four cardiac arrests in two patients and 236 anesthetic events (1.7%). To the best of our knowledge, this is the largest review of these patients to date but is limited by its retrospective nature. The low cardiac arrest incidence prevents the identification of risk factors and the development of a cardiac arrest risk predictive clinical

  11. Risk assessment of Genetically Modified Organisms (GMOs

    Directory of Open Access Journals (Sweden)

    Waigmann E

    2012-10-01

    Full Text Available

    EFSA’s remit in the risk assessment of GMOs is very broad encompassing genetically modified plants, microorganisms and animals and assessing their safety for humans, animals and the environment. The legal frame for GMOs is set by Directive 2001/18/EC on their release into the environment, and Regulation (EC No 1829/2003 on GM food and feed. The main focus of EFSA’s GMO Panel and GMO Unit lies in the evaluation of the scientific risk assessment of new applications for market authorisation of GMOs, and in the development of corresponding guidelines for the applicants. The EFSA GMO Panel has elaborated comprehensive guidance documents on GM plants, GM microorganisms and GM animals, as well as on specific aspects of risk assessment such as the selection of comparators. EFSA also provides special scientific advice upon request of the European Commission; examples are post-market environmental monitoring of GMOs, and consideration of potential risks of new plant breeding techniques. The GMO Panel regularly reviews its guidance documents in the light of experience gained with the evaluation of applications, technological progress in breeding technologies and scientific developments in the diverse areas of risk assessment.

  12. Hyperglycemia at admission and during hospital stay are independent risk factors for mortality in high risk cardiac patients admitted to an intensive cardiac care unit

    NARCIS (Netherlands)

    J.A. Lipton (Jonathan); R. Barendse (Rj); R.T. van Domburg (Ron); A.F.L. Schinkel (Arend); H. Boersma (Eric); M.L. Simoons (Maarten); K.M. Akkerhuis (Martijn)

    2013-01-01

    textabstractAims: Hyperglycemia is associated with increased mortality in cardiac patients. However, the predictive value of admission- and average glucose levels in patients admitted to an intensive cardiac care unit (ICCU) has not been described. Methods: Observational study of patients admitted t

  13. The relation of risk assessment and health impact assessment

    DEFF Research Database (Denmark)

    Ádám, Balázs; Gulis, Gabriel

    2013-01-01

    as a powerful tool for the evaluation of potential health consequences of planned measures. It is often discussed whether HIA is not just another term or form of risk assessment and what is their relation. Our aim is to discuss similarities and differences between the two methods so as to clarify......The level and distribution of health risks in a society is substantially influenced by measures of various policies, programmes or projects. Risk assessment can evaluate the nature, likelihood and severity of an adverse effect. Health impact assessment (HIA) provides similar function when used...... standardised scientific methods to characterise the probability and magnitude of harm caused by a hazard, preferably in a quantitative manner. In turn, HIA is a process to assess future impacts of recent proposals and is dominated by qualitative evaluation. It makes a projection for a future scenario rather...

  14. Identifying potential functional impact of mutations and polymorphisms: Linking heart failure, increased risk of arrhythmias and sudden cardiac death.

    Directory of Open Access Journals (Sweden)

    BENOIT eJAGU

    2013-09-01

    Full Text Available Researchers and clinicians have discovered several important concepts regarding the mechanisms responsible for increased risk of arrhythmias, heart failure and sudden cardiac death. One major step in defining the molecular basis of normal and abnormal cardiac electrical behaviour has been the identification of single mutations that greatly increase the risk for arrhythmias and sudden cardiac death by changing channel-gating characteristics. Indeed, mutations in several genes encoding ion channels, such as SCN5A, which encodes the major cardiac Na+ channel, have emerged as the basis for a variety of inherited cardiac arrhythmias such as long QT syndrome, Brugada syndrome, progressive cardiac conduction disorder, sinus node dysfunction or sudden infant death syndrome. In addition, genes encoding ion channel accessory proteins, like anchoring or chaperone proteins, which modify the expression, the regulation of endocytosis and the degradation of ion channel α-subunits have also been reported as susceptibility genes for arrhythmic syndromes. The regulation of ion channel protein expression also depends on a fine-tuned balance among different other mechanisms, such as gene transcription, RNA processing, post-transcriptional control of gene expression by miRNA, protein synthesis, assembly and post-translational modification and trafficking.

  15. Update earthquake risk assessment in Cairo, Egypt

    Science.gov (United States)

    Badawy, Ahmed; Korrat, Ibrahim; El-Hadidy, Mahmoud; Gaber, Hanan

    2016-12-01

    The Cairo earthquake (12 October 1992; m b = 5.8) is still and after 25 years one of the most painful events and is dug into the Egyptians memory. This is not due to the strength of the earthquake but due to the accompanied losses and damages (561 dead; 10,000 injured and 3000 families lost their homes). Nowadays, the most frequent and important question that should rise is "what if this earthquake is repeated today." In this study, we simulate the same size earthquake (12 October 1992) ground motion shaking and the consequent social-economic impacts in terms of losses and damages. Seismic hazard, earthquake catalogs, soil types, demographics, and building inventories were integrated into HAZUS-MH to produce a sound earthquake risk assessment for Cairo including economic and social losses. Generally, the earthquake risk assessment clearly indicates that "the losses and damages may be increased twice or three times" in Cairo compared to the 1992 earthquake. The earthquake risk profile reveals that five districts (Al-Sahel, El Basateen, Dar El-Salam, Gharb, and Madinat Nasr sharq) lie in high seismic risks, and three districts (Manshiyat Naser, El-Waily, and Wassat (center)) are in low seismic risk level. Moreover, the building damage estimations reflect that Gharb is the highest vulnerable district. The analysis shows that the Cairo urban area faces high risk. Deteriorating buildings and infrastructure make the city particularly vulnerable to earthquake risks. For instance, more than 90 % of the estimated buildings damages are concentrated within the most densely populated (El Basateen, Dar El-Salam, Gharb, and Madinat Nasr Gharb) districts. Moreover, about 75 % of casualties are in the same districts. Actually, an earthquake risk assessment for Cairo represents a crucial application of the HAZUS earthquake loss estimation model for risk management. Finally, for mitigation, risk reduction, and to improve the seismic performance of structures and assure life safety

  16. Assessing patients' risk of febrile neutropenia: is there a correlation between physician-assessed risk and model-predicted risk?

    Science.gov (United States)

    Lyman, Gary H; Dale, David C; Legg, Jason C; Abella, Esteban; Morrow, Phuong Khanh; Whittaker, Sadie; Crawford, Jeffrey

    2015-08-01

    This study evaluated the correlation between the risk of febrile neutropenia (FN) estimated by physicians and the risk of severe neutropenia or FN predicted by a validated multivariate model in patients with nonmyeloid malignancies receiving chemotherapy. Before patient enrollment, physician and site characteristics were recorded, and physicians self-reported the FN risk at which they would typically consider granulocyte colony-stimulating factor (G-CSF) primary prophylaxis (FN risk intervention threshold). For each patient, physicians electronically recorded their estimated FN risk, orders for G-CSF primary prophylaxis (yes/no), and patient characteristics for model predictions. Correlations between physician-assessed FN risk and model-predicted risk (primary endpoints) and between physician-assessed FN risk and G-CSF orders were calculated. Overall, 124 community-based oncologists registered; 944 patients initiating chemotherapy with intermediate FN risk enrolled. Median physician-assessed FN risk over all chemotherapy cycles was 20.0%, and median model-predicted risk was 17.9%; the correlation was 0.249 (95% CI, 0.179-0.316). The correlation between physician-assessed FN risk and subsequent orders for G-CSF primary prophylaxis (n = 634) was 0.313 (95% CI, 0.135-0.472). Among patients with a physician-assessed FN risk ≥ 20%, 14% did not receive G-CSF orders. G-CSF was not ordered for 16% of patients at or above their physician's self-reported FN risk intervention threshold (median, 20.0%) and was ordered for 21% below the threshold. Physician-assessed FN risk and model-predicted risk correlated weakly; however, there was moderate correlation between physician-assessed FN risk and orders for G-CSF primary prophylaxis. Further research and education on FN risk factors and appropriate G-CSF use are needed.

  17. Suggested cut-off values for vitamin D as a risk marker for total and cardiac death in patients with suspected acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Patrycja Anna Naesgaard

    2016-02-01

    Full Text Available Background: Several studies have demonstrated an association between low vitamin D levels and cardiovascular risk. Vitamin D cut off levels are still under debate. Objectives: To assess two cut-off levels, 40 nmol/L and 70 nmol/L, respectively, for vitamin D measured as 25-hydroxyvitamin D [25(OHD] in chest pain patients with suspected acute coronary syndrome.Methods: We investigated 1853 patients from coastal-Norway and inland Northern-Argentina. A similar database was used for pooling of data. 2-year follow-up data including all-cause mortality, cardiac death and sudden cardiac death in the total patient population were analyzed, applying univariate and multivariable analysis. Results: 255 patients with known vitamin D concentrations died. In the multivariable analysis, there was a decrease in total mortality above a cut-off level of 40 nmol/L and a decrease in cardiac death above a cut-off level of 70 nmol/L, [HRs of 0.66 (95% CI, 0.50 – 0.88, p = 0.004 and 0.46 (95% CI, 0.22 – 0.94, p = 0.034, respectively].Conclusion: Vitamin D cut-off levels of 40 nmol/L and 70 nmol/L, were related to total mortality and cardiac death, respectively.

  18. Analysis of existing risk assessments, and list of suggestions

    CERN Document Server

    Heimsch, Laura

    2016-01-01

    The scope of this project was to analyse risk assessments made at CERN and extracting some crucial information about the different methodologies used, profiles of people who make the risk assessments, and gathering information of whether the risk matrix was used and if the acceptable level of risk was defined. Second step of the project was to trigger discussion inside HSE about risk assessment by suggesting a risk matrix and a risk assessment template.

  19. Clinical practice of risk assessment of sexual violence

    OpenAIRE

    Judge, Joseph Gerard

    2012-01-01

    Background: Risk assessment of sexual violence involves evidence based evaluation of the risks posed by sexual offenders. It informs risk management; the provision of treatment that reduces the risk of future sexual violence. Previous research has focused on assessment of the predictive accuracy of different risk assessment tools, as well as the identification of risk factors that are associated with recidivism. In contrast, the clinical practice of risk assessment is a research a...

  20. Risk factors for and assessment of constipation.

    Science.gov (United States)

    Chapman, Sherree; Hungerford, Catherine

    2015-04-01

    Constipation commonly occurs in older people, particularly in hospital or residential care settings, and leads to decreased quality of life and increased healthcare costs. Despite its frequency, however, nurses often overlook the condition. One possible reason for this may be the lack of appropriate tools or scales for nurses to assess risk factors for developing constipation. This article identifies, from the academic literature, 14 risk factors for developing constipation in older people. These factors are then considered in light of four common constipation assessment charts. The article concludes by arguing the need for more comprehensive assessment tools to, firstly, identify risk factors; and, secondly, support the implementation of appropriate preventative strategies that will enable better health outcomes for older people.

  1. Cardiac rehabilitation with a nurse case manager (GoHeart) across local and regional health authorities improves risk factors, self-care and psychosocial outcomes. A one-year follow-up study

    DEFF Research Database (Denmark)

    Hansen, Vibeke Brogaard; Maindal, Helle Terkildsen

    2014-01-01

    OBJECTIVES: In Denmark, the local and regional health authorities share responsibility for cardiac rehabilitation (CR). The objective was to assess effectiveness of CR across sectors coordinated by a nurse case manager (NCM). DESIGN: A one-year follow-up study. SETTING: A CR programme (Go......%). MAIN OUTCOME MEASURES: Cardiac risk factors, stratified self-care and self-reported psychosocial factors (SF12 and Hospital Anxiety and Depression Scale (HADS)) were assessed at admission (phase IIa), at three months at discharge (phase IIb) and at one-year follow-up (phase III). Intention.......01), self-care management (p 

  2. The effectiveness of cardiac rehabilitation in the sedentary cases with cardiovascular disease risk

    Directory of Open Access Journals (Sweden)

    Emrullah Hayta

    2016-10-01

    Full Text Available SUMMARY Objective: The aim of the present study is to apply cardiac rehabilitation (CR to the sedentary cases with cardiovascular disease (CVD risk, and to investigate the effect of CR on the various blood parameters and aerobic capacity of the cases. Method: The study included 106 individuals with sedentary life. Age, smoking history, presence of anxiety, CVD and DM history, pulmonary disease history, alcohol use, dietary habits, lipid profile, ECHO test of the patients were determined before the cardiac rehabilitation application. Furthermore, body mass index (BMI values, weight, waist-hip-thigh circumference, lipid profile, Metabolic Equivalent of Task (MET, and VO2 Max of all patients were measured. The patients who had a sedentary lifestyle were then put to respiratory function test, submaximal exercise test, and ECG-CB monitoring and treadmill-ergometric stress tests. The patients who responded well to the tests were included in an aerobic program for 12 weeks (30-50 min of aerobic exercise, 5 days/3 weeks based on the exercise tolerance test according to their clinical condition. Besides, the parametric measurements, which had been conducted prior to the aerobic program, and the results of the pre and post tests were evaluated and compared at the end of the 12th week. Results: There were meaningful improvements in body weights, BMI, waist and hip and EKO measurements of the individuals included in the study (p<0.005. The difference between triglyceride, HDL, LDL, MET, AT, VO2 max and body fat rate of the study participants before and after CR were found statistically significant (p<0.005. Conclusions: In the present study, CR applied to individuals having sedentary lifestyle has positive impacts on BMI decrease, body fat rate and lipids. Besides, CR achieves a significant increase in aerobic capacity in individuals having sedentary lifestyle Keywords: Sedentary life, Cardiac rehabilitation, Aerobic capacity

  3. Early Diagnosis of Penetrating Cardiac and Pleural Injury by Extended Focused Assessment with Sonography for Trauma

    Science.gov (United States)

    Singaravelu, K. P.; Saya, Rama Prakasha; Pandit, Vinay R.

    2016-01-01

    In India, stab injury is not uncommon, but identifying potential life threatening conditions in the emergency room (ER) and initiating prompt treatment are challenging. This is a case report of a young patient who presented to the ER with assault injury to the chest and shock; timely extended focused assessment with sonography for trauma helped to fast-track the patient to the operating room. A brief review of diagnosis and management of penetrating cardiac injury is presented herewith.

  4. Evaluation of optical imaging and spectroscopy approaches for cardiac tissue depth assessment

    Energy Technology Data Exchange (ETDEWEB)

    Lin, B; Matthews, D; Chernomordik, V; Gandjbakhche, A; Lane, S; Demos, S G

    2008-02-13

    NIR light scattering from ex vivo porcine cardiac tissue was investigated to understand how imaging or point measurement approaches may assist development of methods for tissue depth assessment. Our results indicate an increase of average image intensity as thickness increases up to approximately 2 mm. In a dual fiber spectroscopy configuration, sensitivity up to approximately 3 mm with an increase to 6 mm when spectral ratio between selected wavelengths was obtained. Preliminary Monte Carlo results provided reasonable fit to the experimental data.

  5. Concepts of modern risk assessment and management.

    Science.gov (United States)

    Corbin, S B

    1994-01-01

    An emerging and increasingly complex array of environmental health concerns face dental practitioners in both the private and public sectors. These concerns are challenging and possibly threatening the traditionally inviolable dentist-patient relationship. Regulatory bodies, health risk experts, attorneys, and enthusiastic media are inserting themselves into the process. Essential assets for "successful" dental practitioners include enhanced expertise in basic science and technology, including the area of risk assessment, and development of broadened perspectives and skills for communicating with patients and the public.

  6. Magnetic resonance imaging assessment of cardiac dysfunction in δ-sarcoglycan null mice.

    Science.gov (United States)

    Wansapura, Janaka P; Millay, Douglas P; Dunn, R Scott; Molkentin, Jeffery D; Benson, D Woodrow

    2011-01-01

    Delta-sarcoglycan (δ-sarcoglycan) null, Scgd(-/-), mice develop cardiac and skeletal muscle histopathological alterations similar to those in humans with limb-girdle muscular dystrophy. The objective of this study was to assess the feasibility of using MRI to investigate cardiac dysfunction in Scgd(-/-) mice. Cardiac MRI of 8 month old Scgd(-/-) and wild type (WT) mice was performed. Compared to WT, Scgd(-/-) mice had significantly lower LV ejection fraction (44±5% vs. 66±4%, p=0.014), lower RV ejection fraction (25±2% vs. 51±3%, p<0.001) lower myocardial circumferential strain, (15.0±0.3% vs. 16.9±0.3%, p=0.007) and RV dilatation (54±3 μL vs. 40±3 μL, p=0.007). The regional circumferential strain also demonstrated significant temporal dyssynchrony between opposing regions of the Scgd(-/-) LV. Our results demonstrate severe cardiac dysfunction in Scgd(-/-) mice at 8 months. The study identifies a set of non-invasive markers that could be used to study efficacy of novel therapeutic agents in dystrophic mice.

  7. [Benefit-risk assessment of vaccination strategies].

    Science.gov (United States)

    Hanslik, Thomas; Boëlle, Pierre Yves

    2007-04-01

    This article summarises the various stages of the risk/benefit assessment of vaccination strategies. Establishing the awaited effectiveness of a vaccination strategy supposes to have an epidemiologic description of the disease to be prevented. The effectiveness of the vaccine strategy will be thus expressed in numbers of cases, hospitalizations or deaths avoided. The effectiveness can be direct, expressed as the reduction of the incidence of the infectious disease in the vaccinated subjects compared to unvaccinated subjects. It can also be indirect, the unvaccinated persons being protected by the suspension in circulation of the pathogenic agent, consecutive to the implementation of the vaccination campaign. The risks of vaccination related to the adverse effects detected during the clinical trials preceding marketing are well quantified, but other risks can occur after marketing: e.g., serious and unexpected adverse effects detected by vaccinovigilance systems, or risk of increase in the age of cases if the vaccination coverage is insufficient. The medico-economic evaluation forms a part of the risks/benefit assessment, by positioning the vaccine strategy comparatively with other interventions for health. Epidemiologic and vaccinovigilance informations must be updated very regularly, which underlines the need for having an operational and reliable real time monitoring system to accompany the vaccination strategies. Lastly, in the context of uncertainty which often accompanies the risks/benefit assessments, it is important that an adapted communication towards the public and the doctors is planned.

  8. Assessment of health risks of policies

    Energy Technology Data Exchange (ETDEWEB)

    Ádám, Balázs, E-mail: badam@cmss.sdu.dk [Unit for Health Promotion Research, Faculty of Health Sciences, University of Southern Denmark, Niels Bohrs Vej 9, DK-6700 Esbjerg (Denmark); Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, P.O. Box 9, H-4012 Debrecen (Hungary); Molnár, Ágnes, E-mail: MolnarAg@smh.ca [Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, P.O. Box 9, H-4012 Debrecen (Hungary); Centre for Research on Inner City Health, Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael' s Hospital, Victoria 209, Rm. 3-26.22, M5B 1C6 Toronto, Ontario (Canada); Ádány, Róza, E-mail: adany.roza@sph.unideb.hu [Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, P.O. Box 9, H-4012 Debrecen (Hungary); Bianchi, Fabrizio, E-mail: Fabriepi@ifc.cnr.it [Unit of Environmental Epidemiology, Institute of Clinical Physiology, National Council of Research, Moruzzi 1, 56124 Pisa (Italy); Bitenc, Katarina, E-mail: katarina.bitenc@ivz-rs.si [National Institute of Public Health, Trubarjeva 2, SI-1000 Ljubljana (Slovenia); Chereches, Razvan, E-mail: razvan.m.chereches@gmail.com [Faculty of Political, Administrative and Communication Sciences, Babes-Bolyai University, Strada Mihail Kogalniceanu 1, 3400 Cluj (Romania); Cori, Liliana, E-mail: liliana.cori@ifc.cnr.it [Unit of Environmental Epidemiology, Institute of Clinical Physiology, National Council of Research, Moruzzi 1, 56124 Pisa (Italy); Fehr, Rainer, E-mail: rainer.fehr@uni-bielefeld.de [NRW Centre for Health, Westerfeldstr. 35-37, 33611 Bielefeld (Germany); Kobza, Joanna, E-mail: koga1@poczta.onet.pl [Public Health Department, Silesian Medical University, 18 Medykow Street, 40-752 Katowice (Poland); Kollarova, Jana, E-mail: janakollarova@yahoo.com [Department of Health Promotion, Regional Public Health Authority, Ipelska 1, 04011 Kosice (Slovakia); and others

    2014-09-15

    The assessment of health risks of policies is an inevitable, although challenging prerequisite for the inclusion of health considerations in political decision making. The aim of our project was to develop a so far missing methodological guide for the assessment of the complex impact structure of policies. The guide was developed in a consensual way based on experiences gathered during the assessment of specific national policies selected by the partners of an EU project. Methodological considerations were discussed and summarized in workshops and pilot tested on the EU Health Strategy for finalization. The combined tool, which includes a textual guidance and a checklist, follows the top-down approach, that is, it guides the analysis of causal chains from the policy through related health determinants and risk factors to health outcomes. The tool discusses the most important practical issues of assessment by impact level. It emphasises the transparent identification and prioritisation of factors, the consideration of the feasibility of exposure and outcome assessment with special focus on quantification. The developed guide provides useful methodological instructions for the comprehensive assessment of health risks of policies that can be effectively used in the health impact assessment of policy proposals. - Highlights: • Methodological guide for the assessment of health risks of policies is introduced. • The tool is developed based on the experiences from several case studies. • The combined tool consists of a textual guidance and a checklist. • The top-down approach is followed through the levels of the full impact chain. • The guide provides assistance for the health impact assessment of policy proposals.

  9. Sudden cardiac arrest risk stratification based on 24-hour Holter ECG statistics.

    Science.gov (United States)

    Kasahara, Keisuke; Shiobara, Masahito; Nakamura, Saya; Yamashiro, Koichiro; Yana, Kazuo; Ono, Takuya

    2015-08-01

    This study examined the feasibility of using indices obtained from a long term Holter ECG record for sudden cardiac arrest (SCA) risk stratification. The ndices tested were the QT-RR interval co-variability and the alternans ratio percentile (ARP(θ)) which is defined as the θ(th) percentile of alternans ratios over a 24 hour period. The QT-RR interval co-variabilities are evaluated by the serial correlation coefficient between QT and RR trend sequences (QTRC). Previously reported Kalman filter technique and a simple smoothing spline method for the trend estimation are compared. Parameter θ in the alternans ratio percentile index was optimized to achieve the best classification accuracy. These indices were estimated from 26 cardiovascular outpatients for Holter ECG record. Patients were classified into high and low risk groups according to their clinical diagnosis, and the obtained indices were compared with those of 25 control subjects. A risk stratification using the two indices QTRC and ARP(θ) yielded an average sensitivity of 0.812 and a specificity of 0.925. The sensitivities and specificities of all three categories exceeded 0.8 except for the sensitivity to detect the high-risk patient group. Other short-term ECG parameters may need to be incorporated in order to improve the sensitivity.

  10. Risk Assessment of Genetically Modified Microorganisms

    DEFF Research Database (Denmark)

    Jacobsen, B. L.; Wilcks, Andrea

    2001-01-01

    The rapid development of recombinant DNA techniques for food organisms urges for an ongoing discussion on the risk assessment of both new as traditional use of microorganisms in food production. This report, supported by the Nordic Council of Ministers, is the result of a workshop where people from...... the industry, national administration and research institutions were gathered to discuss which elements should be considered in a risk assessment of genetically modified microorganisms used as food or food ingredients. The existing EU and national regulations were presented, together with the experiences...

  11. Concepts in ecological risk assessment. Professional paper

    Energy Technology Data Exchange (ETDEWEB)

    Johnston, R.K.; Seligman, P.F.

    1991-05-01

    Assessing the risk of impact to natural ecosystems from xenobiotic compounds requires an accurate characterization of the threatened ecosystem, direct measures or estimates of environmental exposure, and a comprehensive evaluation of the biological effects from actual and potential contamination. Field and laboratory methods have been developed to obtain direct measures of environmental health. These methods have been implemented in monitoring programs to assess and verify the ecological risks of contamination from past events, such as hazardous waste disposal sites, as well as future scenarios, such as the environmental consequences from the use of biocides in antifouling bottom paints for ships.

  12. The incidence and risk factors of postoperative delirium in elderly patients in critical condition after non-cardiac surgery

    Directory of Open Access Journals (Sweden)

    Wei WANG

    2011-06-01

    Full Text Available Objective To identify the incidence and risk factors of postoperative delirium in elderly patients in critical condition after non-cardiac surgery.Methods One hundred and twenty-five elderly patients who were admitted to the surgical intensive care unit(SICU after non-cardiac surgery were involved in the present study.Baseline and the perioperative variables of patients were collected.Postoperative delirium was diagnosed using the Confusion Assessment Method for Intensive Care Unit(CAM-ICU.Delirium assessment was performed once daily during the first five days after surgery.Results Postoperative evaluations of delirium were completed in 124 patients.Postoperative delirium occurred in 42 patients(33.87%,among them delirium occurred within the first 2 postoperative days in 92.86%(39/42(4.76% in the operative day,50.00% in the first postoperative day,and 38.10% in the second postoperative day,respectively.When compared with the non-delirious patients,the delirious patients had longer duration of ICU stay [39.75(21.00-65.63h vs 19.63(17.77-22.31h,P=0.000],higher incidence of postoperative complications [(38.1%(16/42 vs 13.4%(11/82,P=0.000],and higher mortality [11.9%(5/42 vs 1.2%(1/82,P=0.000].Multivariate logistic regression analysis demonstrated that the following risk factors predicted the occurrence of postoperative delirium: preoperative history of cerebral accident(OR=3.051,95%CI 1.032-8.370,high APACHE Ⅱ score at admission to the SICU(OR=1.664,95%CI 1.268-2.184,and high pain score at 24 hours after operation(OR=1.043,95%CI 1.021-1.086.Conclusions Delirium is a common complication after surgery.The prognosis is significantly worse in the delirious patients than in the non-delirious patients.Risk factors of postoperative delirium include history of preoperative cerebral accident,high APACHE Ⅱ score at admission to the SICU,and high pain score at 24 hours after operation.

  13. Recording pressure ulcer risk assessment and incidence.

    Science.gov (United States)

    Plaskitt, Anne; Heywood, Nicola; Arrowsmith, Michaela

    2015-07-15

    This article reports on the introduction of an innovative computer-based system developed to record and report pressure ulcer risk and incidence at an acute NHS trust. The system was introduced to ensure that all patients have an early pressure ulcer risk assessment, which prompts staff to initiate appropriate management if a pressure ulcer is detected, thereby preventing further patient harm. Initial findings suggest that this electronic process has helped to improve the timeliness and accuracy of data on pressure ulcer risk and incidence. In addition, it has resulted in a reduced number of reported hospital-acquired pressure ulcers.

  14. [Left-ventricular hypertrophy as a cardiac risk factor: role of the renin-angiotensin-aldosterone system].

    Science.gov (United States)

    Erne, P

    1996-02-20

    Left-ventricular hypertrophy is the result of cardiac adaptation to global or regional overstress and represents an important cardiovascular risk factor, increasing the risk for development of congestive heart failure and incidence of sudden death. This review describes the pathophysiological and biochemical mechanisms involved in the development of left-ventricular hypertrophy and cardiac fibrosis with particular emphasis on the role of angiotensin II and aldosterone. Central to the cascade of cardiac fibrosis is the increased production or reduced degradation of collagen proteins in fibroblasts. Collagen proteins are proteins needed for the alignment of cellular compartments and the development of forces, contraction and relaxation of the heart. If overexpressed, an important rise of wall stiffness is observed in addition to a reduced capacity to provide oxygen to the cardiac tissue. This latter explains why in areas of histologically hypertrophied heart muscle atrophied muscle cells are observed. The characterization of the second-messenger systems involved in the regulation of cardiac cells as well as the identification of angiotensin-II receptor subtype and angiotensin IV is described. Both of these receptors are present on cardiac fibroblasts and stimulate these to collagen production, which can be inhibited by antagonists or the generation of angiotensin II by ACE inhibitors. In some forms of left-ventricular hypertrophy and in patients with congestive heart failure in addition to elevated angiotensin-II levels, increased aldosterone levels are observed. Aldosterone raises upon stimulation by angiotensin II and upon reduction of angiotensin-II generation subsequent to ACE inhibition through an escape mechanism. The contribution of aldosterone to left-ventricular hypertrophy and cardiac fibrosis can be prevented and reduced by the administration of its antagonist, spironolactone. Further and larger clinical trials are needed and in progress to evaluate if the

  15. Application of geostatistics to risk assessment.

    Science.gov (United States)

    Thayer, William C; Griffith, Daniel A; Goodrum, Philip E; Diamond, Gary L; Hassett, James M

    2003-10-01

    Geostatistics offers two fundamental contributions to environmental contaminant exposure assessment: (1) a group of methods to quantitatively describe the spatial distribution of a pollutant and (2) the ability to improve estimates of the exposure point concentration by exploiting the geospatial information present in the data. The second contribution is particularly valuable when exposure estimates must be derived from small data sets, which is often the case in environmental risk assessment. This article addresses two topics related to the use of geostatistics in human and ecological risk assessments performed at hazardous waste sites: (1) the importance of assessing model assumptions when using geostatistics and (2) the use of geostatistics to improve estimates of the exposure point concentration (EPC) in the limited data scenario. The latter topic is approached here by comparing design-based estimators that are familiar to environmental risk assessors (e.g., Land's method) with geostatistics, a model-based estimator. In this report, we summarize the basics of spatial weighting of sample data, kriging, and geostatistical simulation. We then explore the two topics identified above in a case study, using soil lead concentration data from a Superfund site (a skeet and trap range). We also describe several areas where research is needed to advance the use of geostatistics in environmental risk assessment.

  16. Cardiac troponin T: from diagnosis of myocardial infarction to cardiovascular risk prediction.

    Science.gov (United States)

    Mueller, Matthias; Vafaie, Mehrshad; Biener, Moritz; Giannitsis, Evangelos; Katus, Hugo A

    2013-01-01

    Cardiac troponins (cTns) T and I are exclusively expressed at high concentrations in cardiac muscle and have emerged as the preferred biomarker in the universal definition of myocardial infarction (MI). With the recent introduction of high-sensitivity (hs) assays, diagnostic sensitivity for earlier detection of MI has substantially improved. However, lowering the diagnostic cut-off has increased the detection of myocardial injuries in various non-acute coronary syndrome (ACS) conditions, which are not related to myocardial ischemia, leading to rising difficulties in diagnosing MI in clinical situations. Several approaches, such as serial sampling and incorporation of relative or absolute δ-changes, have been proposed to overcome the limitation of decreased sensitivity for MI diagnosis with hs-cTn assays. Current consensus for rapid rule-in proposes a 20% increase within 3 or 6h when baseline cTn levels are elevated. In the case of negative baseline values, relative increases ≥50% above the 99(th) percentile were found to be adequate to improve accuracy of MI diagnosis. Besides improved diagnostic accuracy for myocardial injury, even minor cTn elevations provide important prognostic information, and increased levels of cTn are associated with adverse outcomes in both the ACS and non-ACS condition, irrespective of whether the underlying cause is an acute or chronic illness. Thus, it is highly likely that lowering the diagnostic cut-off with even more sensitive assays might improve risk stratification in both conditions.

  17. High-resolution computed tomography in patients with atypical 'cardiac' chest pain: a study investigating patients at 10-year cardiovascular risks defined by the Framingham and PROCAM scores

    Institute of Scientific and Technical Information of China (English)

    Choon Kiat ANG; Kui Hian SIM; Alan Yean Yip FONG; Sze Piaw CHIN; Tiong Kiam ONG; Seyfarth M Tobias; Wei Ling CHAN; Chee Khoon LIEW; Rapaee ANNUAR; Houng Bang LIEW

    2006-01-01

    Background and objective Atypical 'cardiac' chest pain (ACCP) is not usually caused by myocardial ischaemia. Current noninvasive investigations for these symptoms are not yet as accurate as invasive coronary angiography. The latest 64-row multi-detector computed tomography (MDCT) technology is non-invasive, has high specificity and negative predictive values for the detection of significant coronary disease. Our aim was to investigate if this modality can provide more information in the assessment of outpatients with ACCP in addition to established cardiovascular risk scores. Methods Seventy consecutive patients presenting to the outpatient clinic with ACCP underwent 64-row MDCT scan of the coronary arteries. They were categorized into low, medium or high risk groups based upon the Framingham and PROCAM scores. We defined a clinically abnormal MDCT scan as coronary stenosis =50% or calcium score >400 Agatston. Results Fifty-three (75.7%) patients did not have clinically abnormal scans. Framingham score classified 43 patients as low-risk while PROCAM classified 59 patients as low-risk. MDCT scans were abnormal for 18.6% and 22.0% of the respective low-risk group of patients. For patients with medium-to-high risk, 33.3% and 36.4% of Framingham and PROCAM patient groups respectively had abnormal MDCT scans. Conclusion MDCT adds valuable information in the assessment of patients with ACCP by identifying a significant proportion of patients categorized as low-risk to have underlying significant coronary stenosis and coronary calcification by established cardiovascular risk scores.

  18. A Simplified and Rapid Screening Assay using Zebrafish to Assess Cardiac Effects of Air Pollution-derived Particulate Matter

    Science.gov (United States)

    Comparative toxicity assessment of particulate matter (PM) from different sources will potentially inform the understanding of regional differences in PM-induced cardiac health effects by identifying PM sources linked to highest potency components. Conventional low-throughput in...

  19. Benefit-Risk Assessment in Drug Development

    DEFF Research Database (Denmark)

    Sarac, Sinan

    This thesis covers the development, testing and use of an eight-step structured method for data-driven benefit-risk assessment. The aim of this thesis was to create a tailored method for the assessment of clinical data. The focus has been on three major aspects: (i) A simple preliminary method....... In total, four pilot studies and internal workshops were conducted. The method was therefore developed in an iterative fashion. The method involves eight successive steps: 1) establishment of the decision context, 2) identification of benefit and risk criteria, 3) weighting, 4) scoring, 5) evaluation...... biases and feedback distort the assessment, and to make it possible for the industrial partner and the regulatory agency to compare the results of their evaluation on a point-by-point basis. The qualitative framework ensures a structured approach to the assessment and a transparent communication...

  20. Microbiological risk assessment for personal care products.

    Science.gov (United States)

    Stewart, S E; Parker, M D; Amézquita, A; Pitt, T L

    2016-12-01

    Regulatory decisions regarding microbiological safety of cosmetics and personal care products are primarily hazard-based, where the presence of a potential pathogen determines decision-making. This contrasts with the Food industry where it is a commonplace to use a risk-based approach for ensuring microbiological safety. A risk-based approach allows consideration of the degree of exposure to assess unacceptable health risks. As there can be a number of advantages in using a risk-based approach to safety, this study explores the Codex Alimentarius (Codex) four-step Microbiological Risk Assessment (MRA) framework frequently used in the Food industry and examines how it can be applied to the safety assessment of personal care products. The hazard identification and hazard characterization steps (one and two) of the Codex MRA framework consider the main microorganisms of concern. These are addressed by reviewing the current industry guidelines for objectionable organisms and analysing reports of contaminated products notified by government agencies over a recent 5-year period, together with examples of reported outbreaks. Data related to estimation of exposure (step three) are discussed, and examples of possible calculations and references are included. The fourth step, performed by the risk assessor (risk characterization), is specific to each assessment and brings together the information from the first three steps to assess the risk. Although there are very few documented uses of the MRA approach for personal care products, this study illustrates that it is a practicable and sound approach for producing products that are safe by design. It can be helpful in the context of designing products and processes going to market and with setting of microbiological specifications. Additionally, it can be applied reactively to facilitate decision-making when contaminated products are released on to the marketplace. Currently, the knowledge available may only allow a

  1. Relation of Prolonged P-Wave Duration to Risk of Sudden Cardiac Death in the General Population (from the Atherosclerosis Risk in Communities Study).

    Science.gov (United States)

    Maheshwari, Ankit; Norby, Faye L; Soliman, Elsayed Z; Alraies, M Chadi; Adabag, Selcuk; O'Neal, Wesley T; Alonso, Alvaro; Chen, Lin Y

    2017-02-09

    Prolonged P-wave duration, a marker of left atrial abnormality, is associated with myocardial fibrosis, atrial fibrillation, and all-cause death. It is not known if prolonged P-wave duration is associated with sudden cardiac death (SCD) in the general population. We aimed to evaluate whether prolonged P-wave duration is independently associated with SCD risk in the Atherosclerosis Risk in Communities Study, a community-based prospective cohort study. We included 15,321 participants in our analysis (age 54.2 ± 5.7 years, 55.2% women, 26.4% black). Prolonged P-wave duration was defined as maximum P-wave duration >120 ms and was determined from 12-lead electrocardiograms obtained during 4 exams (1987 to 1999). SCD was physician adjudicated and defined as a sudden, pulseless condition in a previously stable patient without evidence for noncardiac cause of death. We used Cox proportional hazard models to assess the association between prolonged P-wave duration and SCD, adjusting for cardiovascular risk factors and conditions including atrial fibrillation. During a mean follow-up of 12.5 years (1987 to 2001), 268 SCDs were identified. The multivariable hazard ratio (95% confidence interval) of prolonged P-wave duration for SCD was 1.70 (1.31 to 2.20). This association was attenuated but remained significant after updating covariates to the end of follow-up with a hazard ratio of 1.35 (1.04 to 1.76). In conclusion, prolonged P-wave duration is independently associated with an increased risk of SCD in the general population. This association is independent of atrial fibrillation and is only partially mediated by shared cardiovascular risk factors.

  2. Health effects of risk-assessment categories

    Energy Technology Data Exchange (ETDEWEB)

    Kramer, C.F.; Rybicka, K.; Knutson, A.; Morris, S.C.

    1983-10-01

    Environmental and occupational health effects associated with exposures to various chemicals are a subject of increasing concern. One recently developed methodology for assessing the health impacts of various chemical compounds involves the classification of similar chemicals into risk-assessment categories (RACs). This report reviews documented human health effects for a broad range of pollutants, classified by RACs. It complements other studies that have estimated human health effects by RAC based on analysis and extrapolation of data from animal research.

  3. Flood risk assessment and associated uncertainty

    Directory of Open Access Journals (Sweden)

    H. Apel

    2004-01-01

    Full Text Available Flood disaster mitigation strategies should be based on a comprehensive assessment of the flood risk combined with a thorough investigation of the uncertainties associated with the risk assessment procedure. Within the 'German Research Network of Natural Disasters' (DFNK the working group 'Flood Risk Analysis' investigated the flood process chain from precipitation, runoff generation and concentration in the catchment, flood routing in the river network, possible failure of flood protection measures, inundation to economic damage. The working group represented each of these processes by deterministic, spatially distributed models at different scales. While these models provide the necessary understanding of the flood process chain, they are not suitable for risk and uncertainty analyses due to their complex nature and high CPU-time demand. We have therefore developed a stochastic flood risk model consisting of simplified model components associated with the components of the process chain. We parameterised these model components based on the results of the complex deterministic models and used them for the risk and uncertainty analysis in a Monte Carlo framework. The Monte Carlo framework is hierarchically structured in two layers representing two different sources of uncertainty, aleatory uncertainty (due to natural and anthropogenic variability and epistemic uncertainty (due to incomplete knowledge of the system. The model allows us to calculate probabilities of occurrence for events of different magnitudes along with the expected economic damage in a target area in the first layer of the Monte Carlo framework, i.e. to assess the economic risks, and to derive uncertainty bounds associated with these risks in the second layer. It is also possible to identify the contributions of individual sources of uncertainty to the overall uncertainty. It could be shown that the uncertainty caused by epistemic sources significantly alters the results

  4. Risk prediction models for major adverse cardiac event (MACE) following percutaneous coronary intervention (PCI): A review

    Science.gov (United States)

    Manan, Norhafizah A.; Abidin, Basir

    2015-02-01

    Five percent of patients who went through Percutaneous Coronary Intervention (PCI) experienced Major Adverse Cardiac Events (MACE) after PCI procedure. Risk prediction of MACE following a PCI procedure therefore is helpful. This work describes a review of such prediction models currently in use. Literature search was done on PubMed and SCOPUS database. Thirty literatures were found but only 4 studies were chosen based on the data used, design, and outcome of the study. Particular emphasis was given and commented on the study design, population, sample size, modeling method, predictors, outcomes, discrimination and calibration of the model. All the models had acceptable discrimination ability (C-statistics >0.7) and good calibration (Hosmer-Lameshow P-value >0.05). Most common model used was multivariate logistic regression and most popular predictor was age.

  5. Agile text mining for the 2014 i2b2/UTHealth Cardiac risk factors challenge.

    Science.gov (United States)

    Cormack, James; Nath, Chinmoy; Milward, David; Raja, Kalpana; Jonnalagadda, Siddhartha R

    2015-12-01

    This paper describes the use of an agile text mining platform (Linguamatics' Interactive Information Extraction Platform, I2E) to extract document-level cardiac risk factors in patient records as defined in the i2b2/UTHealth 2014 challenge. The approach uses a data-driven rule-based methodology with the addition of a simple supervised classifier. We demonstrate that agile text mining allows for rapid optimization of extraction strategies, while post-processing can leverage annotation guidelines, corpus statistics and logic inferred from the gold standard data. We also show how data imbalance in a training set affects performance. Evaluation of this approach on the test data gave an F-Score of 91.7%, one percent behind the top performing system.

  6. Evaluation of the Prevalence and Risk Factors of Delirium in Cardiac Surgery ICU

    Directory of Open Access Journals (Sweden)

    Kamran Shadvar

    2013-12-01

    Results: The prevalence of delirium in these patients was 23.5% (47 patients. The mean age of patients with delirium was more than other patients (P=0.001. The Incidence of delirium in the patients with cardiopulmonary bypass surgery (CPB was higher than the patients without CPB (P=0.01. The Incidence of delirium in the patients with Atrial fibrillation was higher than patients without it (P=0.002. The Incidence of delirium in the patients with CVA history was higher than the patients without CVA history (P=0.032. The mean time of mechanical ventilation in the delirious patients was more than other patients (P=0.01. Conclusion: Older Age, CPB, history of CVA, Atrial Fibrillation, and prolonged mechanical ventilation are considered as the risk factors of delirium in cardiac surgery patients.

  7. Comprehensive Cardiovascular Risk Reduction and Cardiac Rehabilitation in Diabetes and the Metabolic Syndrome

    Science.gov (United States)

    Heinl, Robert E.; Dhindsa, Devinder S.; Mahlof, Elliot N.; Schultz, William M.; Ricketts, Johnathan C.; Varghese, Tina; Esmaeeli, Amirhossein; Allard-Ratick, Marc P.; Millard, Anthony J.; Kelli, Heval M.; Sandesara, Pratik B.; Eapen, Danny J.; Sperling, Laurence

    2017-01-01

    The epidemic of obesity has contributed to a growing burden of metabolic syndrome (MetS) and diabetes mellitus (DM) worldwide. MetS is defined as central obesity along with associated factors such as hypertriglyceridemia, low high-density lipoprotein cholesterol, hyperglycemia, and hypertension. MetS and DM are associated with significant cardiovascular morbidity and mortality. Healthy behavioural modification is the cornerstone for reducing the atherosclerotic cardiovascular disease burden in this population. Comprehensive, multi-disciplinary cardiac rehabilitation (CR) programs reduce mortality and hospitalizations in patients with MetS and DM. Despite this benefit, patients with MetS and DM are less likely to attend and complete CR because of numerous barriers. Implementation of innovative CR delivery models might improve utilization of CR and cardiovascular outcomes in this high-risk population. PMID:27692115

  8. Risk assessment and management logistics chains

    Directory of Open Access Journals (Sweden)

    Vladimir Vikulov

    2014-03-01

    Full Text Available Background: In the context of economic globalization and increasing complexity of economic relations enterprises need methods and techniques to improve and sustain their position on the global market. Integration processes offer business new opportunities, but at the same time present new challenges for the management, including the key objectives of the risk management. Method: On the basis of analysis tools known from the pertinent literature (Supply Chain Management and Supply Chain Risk Management methods, methods of probability theory, methods of risk management, methods of statistics the authors of this paper proposed their own risk assessment method and the method of management of logistics chains. The proposed tool is a specific hybrid of solutions known from the literature. Results: The presented method has been successfully used within the frames of economic-mathematical model of industrial enterprises. Indicators of supply chain risks, including risks caused by supplier are considered in this paper. Authors formed a method of optimizing the level of supply chain risk in the integration with suppliers and customers. Conclusion: Every organization, which starting the process of integration with supplier and customers, needs to use tools, methodologies and techniques for identification of "weak links" in the supply chain. The proposed method allows to fix risk origin places in various links of the supply chain and to identify "weak links" of a logistic chain that may occur in the future. The method is a useful tool for managing not only risks and risk situations, but also to improve the efficiency of current assets management by providing the ability to optimize the level of risk in the current assets management of the industrial enterprise.

  9. Handling Interdependencies in Climate Change Risk Assessment

    Directory of Open Access Journals (Sweden)

    Richard J. Dawson

    2015-12-01

    Full Text Available Typically, a climate change risk assessment focuses on individual sectors or hazards. However, interdependencies between climate risks manifest themselves via functional, physical, geographical, economic, policy and social mechanisms. These can occur over a range of spatial or temporal scales and with different strengths of coupling. Three case studies are used to demonstrate how interdependencies can significantly alter the nature and magnitude of risk, and, consequently, investment priorities for adaptation. The three examples explore interdependencies that arise from (1 climate loading dependence; (2 mediation of two climate impacts by physical processes operating over large spatial extents; and, (3 multiple risks that are influenced by shared climatic and socio-economic drivers. Drawing upon learning from these case studies, and other work, a framework for the analysis and consideration of interdependencies in climate change risk assessment has been developed. This is an iterative learning loop that involves defining the system, scoping interaction mechanisms, applying appropriate modelling tools, identifying vulnerabilities and opportunities, and assessing the performance of adaptation interventions.

  10. The risk factors and prognostic implication of acute pulmonary edema in resuscitated cardiac arrest patients

    Science.gov (United States)

    Kang, Dae-hyun; Kim, Joonghee; Rhee, Joong Eui; Kim, Taeyun; Kim, Kyuseok; Jo, You Hwan; Lee, Jin Hee; Lee, Jae Hyuk; Kim, Yu Jin; Hwang, Seung Sik

    2015-01-01

    Objective Pulmonary edema is frequently observed after a successful resuscitation in out-of-hospital cardiac arrest (OHCA) patients. Currently, its risk factors and prognostic implications are mostly unknown. Methods Adult OHCA patients with a presumed cardiac etiology who achieved sustained return of spontaneous circulation (ROSC) in emergency department were retrospectively analyzed. The patients were grouped according to the severity of consolidation on their initial chest X-ray (group I, no consolidation; group II, patchy consolidations; group III, consolidation involving an entire lobe; group IV, total white-out of any lung). The primary objective was to identify the risk factors of developing severe pulmonary edema (group III or IV). The secondary objective was to evaluate the association between long-term prognosis and the severity of pulmonary edema. Results One hundred and seven patients were included. Total duration of cardiopulmonary resuscitation (CPR) and initial pCO2 level were both independent predictors of developing severe pulmonary edema with their odds ratio (OR) being 1.02 (95% confidence interval [CI], 1.00 to 1.04; per 1 minute) and 1.04 (95% CI, 1.01 to 1.07; per 1 mmHg), respectively. The long term prognosis was significantly poor in patients with severe pulmonary edema with a OR for good outcome (6-month cerebral performance category 1 or 2) being 0.22 (95% CI, 0.06 to 0.79) in group III and 0.16 (95% CI, 0.04 to 0.63) in group IV compared to group I. Conclusion The duration of CPR and initial pCO2 level were both independent predictors for the development of severe pulmonary edema after resuscitation in emergency department. The severity of the pulmonary edema was significantly associated with long-term outcome. PMID:27752581

  11. New risk assessment tools in the Netherlands

    NARCIS (Netherlands)

    Kraker, H. de; Douwes, M.

    2012-01-01

    In this paper an introduction to and description of the risk assessment tools that are freely available for companies in The Netherlands is given. It is explained in what way the tools can and should be used and how the level I checklist for physical load and the level II instruments are related. Th

  12. Incorporating Agency Into Climate Change Risk Assessments

    Energy Technology Data Exchange (ETDEWEB)

    Jones, R.N. [CSIRO Atmospheric Research, Aspendale, Victoria, 3195 (Australia)

    2004-11-01

    Human agency has been viewed as a problem for climate change assessments because of its contribution to uncertainty. In this editorial, I outline the advantages of agency in managing climate change risks, describing how those advantages can be placed within a probabilistic framework.

  13. Risk assessment as an argumentation game

    NARCIS (Netherlands)

    Prakken, Henry; Ionita, Dan; Wieringa, Roel; Leite, J.; Son, T.C.; Torrini, P.; Van Der Torre, L.; Woltran, S.

    2013-01-01

    This paper explores the idea that IT security risk assessment can be formalized as an argumentation game in which assessors argue about how the system can be attacked by a threat agent and defended by the assessors. A system architecture plus assumptions about the environment is specified as an ASPI

  14. Economic impact assessment in pest risk analysis

    NARCIS (Netherlands)

    Soliman, T.A.A.; Mourits, M.C.M.; Oude Lansink, A.G.J.M.; Werf, van der W.

    2010-01-01

    According to international treaties, phytosanitary measures against introduction and spread of invasive plant pests must be justified by a science-based pest risk analysis (PRA). Part of the PRA consists of an assessment of potential economic consequences. This paper evaluates the main available tec

  15. Dermal absorption and toxicological risk assessment

    NARCIS (Netherlands)

    Buist, H.

    2016-01-01

    Absorption of toxic substances via the skin is an important phenomenon in the assessment of the risk of exposure to these substances. People are exposed to a variety of substances and products via the skin, either directly or indirectly, while at work, at home or in public space. Pesticides, organic

  16. Methodology for qualitative urban flooding risk assessment.

    Science.gov (United States)

    Leitão, João P; Almeida, Maria do Céu; Simões, Nuno E; Martins, André

    2013-01-01

    Pluvial or surface flooding can cause significant damage and disruption as it often affects highly urbanised areas. Therefore it is essential to accurately identify consequences and assess the risks associated with such phenomena. The aim of this study is to present the results and investigate the applicability of a qualitative flood risk assessment methodology in urban areas. This methodology benefits from recent developments in urban flood modelling, such as the dual-drainage modelling concept, namely one-dimensional automatic overland flow network delineation tools (e.g. AOFD) and 1D/1D models incorporating both surface and sewer drainage systems. To assess flood risk, the consequences can be estimated using hydraulic model results, such as water velocities and water depth results; the likelihood was estimated based on the return period of historical rainfall events. To test the methodology two rainfall events with return periods of 350 and 2 years observed in Alcântara (Lisbon, Portugal) were used and three consequence dimensions were considered: affected public transportation services, affected properties and pedestrian safety. The most affected areas in terms of flooding were easily identified; the presented methodology was shown to be easy to implement and effective to assess flooding risk in urban areas, despite the common difficulties in obtaining data.

  17. Automating defence generation for risk assessment

    NARCIS (Netherlands)

    Gadyatskaya, Olga

    2016-01-01

    Efficient risk assessment requires automation of its most tedious tasks: identification of vulnerabilities, attacks that can exploit these vulnerabilities, and countermeasures that can mitigate the attacks. E.g., the attack tree generation by policy invalidation approach looks at systematic automati

  18. Resources for global risk assessment: the International Toxicity Estimates for Risk (ITER) and Risk Information Exchange (RiskIE) databases.

    Science.gov (United States)

    Wullenweber, Andrea; Kroner, Oliver; Kohrman, Melissa; Maier, Andrew; Dourson, Michael; Rak, Andrew; Wexler, Philip; Tomljanovic, Chuck

    2008-11-15

    The rate of chemical synthesis and use has outpaced the development of risk values and the resolution of risk assessment methodology questions. In addition, available risk values derived by different organizations may vary due to scientific judgments, mission of the organization, or use of more recently published data. Further, each organization derives values for a unique chemical list so it can be challenging to locate data on a given chemical. Two Internet resources are available to address these issues. First, the International Toxicity Estimates for Risk (ITER) database (www.tera.org/iter) provides chronic human health risk assessment data from a variety of organizations worldwide in a side-by-side format, explains differences in risk values derived by different organizations, and links directly to each organization's website for more detailed information. It is also the only database that includes risk information from independent parties whose risk values have undergone independent peer review. Second, the Risk Information Exchange (RiskIE) is a database of in progress chemical risk assessment work, and includes non-chemical information related to human health risk assessment, such as training modules, white papers and risk documents. RiskIE is available at http://www.allianceforrisk.org/RiskIE.htm, and will join ITER on National Library of Medicine's TOXNET (http://toxnet.nlm.nih.gov/). Together, ITER and RiskIE provide risk assessors essential tools for easily identifying and comparing available risk data, for sharing in progress assessments, and for enhancing interaction among risk assessment groups to decrease duplication of effort and to harmonize risk assessment procedures across organizations.

  19. Intraoperative High-Dose Dexamethasone in Cardiac Surgery and the Risk of Rethoracotomy

    NARCIS (Netherlands)

    van Osch, Dirk; Dieleman, Jan M.; Nathoe, Hendrik M.; Boasson, Marc P.; Kluin, Jolanda; Bunge, Jeroen J. H.; Nierich, Arno P.; Rosseel, Peter M.; Maaten, van der Joost; Hofland, Jan; Diephuis, Jan C.; de Lange, Fellery; Boer, Christa; van Dijk, Diederik

    2015-01-01

    Background. Cardiac surgery with the use of cardiopulmonary bypass is associated with a systemic inflammatory response. Intraoperative corticosteroids are administered to attenuate this inflammatory response. The recent Dexamethasone for Cardiac Surgery (DECS) trial could not demonstrate a beneficia

  20. Intraoperative High-Dose Dexamethasone in Cardiac Surgery and the Risk of Rethoracotomy

    NARCIS (Netherlands)

    van Osch, Dirk; Dieleman, Stefan; Nathoe, HM; Boasson, Marc P; Kluin, Jolanda; Bunge, Jeroen J H; Nierich, Arno P; Rosseel, Peter M; van der Maaten, Joost M; Hofland, Jan; Diephuis, Jan C; de Lange, Fellery; Boer, Christa; van Dijk, Diederik

    2015-01-01

    BACKGROUND: Cardiac surgery with the use of cardiopulmonary bypass is associated with a systemic inflammatory response. Intraoperative corticosteroids are administered to attenuate this inflammatory response. The recent Dexamethasone for Cardiac Surgery (DECS) trial could not demonstrate a beneficia

  1. Housing conditions in calves welfare risk assessment

    Directory of Open Access Journals (Sweden)

    Relić Renata R.

    2010-01-01

    Full Text Available This paper shows results of calf welfare risk assessment at intensive breeding farms. Assessment has been conducted on the basis of housing conditions which can have negative influence on welfare of cattle, especially in calf category considering their needs. According to analysis results very good housing conditions were confirmed in open shed rearing stall (C and closed type rearing stall without feeding yard (A, whilst in closed rearing stall with feeding yard (B housing conditions were estimated as acceptable. Based on collected data about housing conditions, we have estimated that the least risk for calf welfare is at C farm, slightly higher at A farm and the highest at B farm. Data about housing conditions and analysis of potential welfare risk factors show possible causes for already present health and other problems with animals, which also can reappear in future. However for that reason, applying described methods can increase rearing conditions and increase production at cattle farms.

  2. Risk of cardiac valvulopathy with use of bisphosphonates: a population-based, multi-country case-control study

    NARCIS (Netherlands)

    P.M. Coloma (Preciosa); M.A.J. de Ridder (Maria); I. Bezemer (Irene); R.M.C. Herings (Ron); R. Gini (Rosa); S. Pecchioli (Serena); L. Scotti (Lorenza); P.R. Rijnbeek (Peter); M. Mosseveld (Mees); J. van der Lei; G. Trifirò (Gianluca); M.C.J.M. Sturkenboom (Miriam)

    2016-01-01

    textabstractSummary: Analyses of healthcare data from 30 million individuals in three countries showed that current use of bisphosphonates may be associated with a small increased risk of cardiac valvulopathy (vs. those not exposed within the previous year), although confounding cannot be entirely r

  3. The association between cardiac rehabilitation and mortality risk for myocardial infarction patients with and without depressive symptoms

    NARCIS (Netherlands)

    Meurs, Maaike; Burger, Huibert; van Riezen, Jerry; Slaets, Joris P.; Rosmalen, Judith G. M.; van Melle, Joost P.; Roest, Annelieke M.; de Jonge, Peter

    2015-01-01

    Background: Post myocardial infarction (MI) depression is associated with reduced adherence to cardiac rehabilitation (CR) and increased mortality risk. The present study investigated whether all cause mortality reduction associated with CR is different for MI patients with and without depressive sy

  4. An operational research approach to identify cardiac surgery patients at risk of severe post-operative bleeding.

    Science.gov (United States)

    Reddy, Brian; Pagel, Christina; Vuylsteke, Alain; Gerrard, Caroline; Nashef, Sam; Utley, Martin

    2011-09-01

    Severe post-operative bleeding can lead to adverse outcomes for cardiac surgery patients and is a relatively common complication of cardiac surgery. One of the most effective drugs to prevent such bleeding, aprotinin, has been withdrawn from the market due to concerns over its safety. Alternative prophylactic drugs which can be given to patients to prevent bleeding can result in significant side effects and are expensive. For this reason it is difficult to make a clinical or economic case for administering these drugs to all cardiac surgery patients, and the prevailing view is that their use should be targeted at patients considered to be at relatively high risk of post-operative bleeding. However, there is currently no objective method for identifying such patients. Over the past 7 years, a team of clinicians and researchers at Papworth Hospital has collected data concerning post-operative blood loss for each cardiac surgery patient, totalling 11,592 consecutive records. They approached a team of operational researchers (MU, ACP, BR) with extensive experience of developing clinical risk models with the aim of devising a risk stratification scheme that could potentially be used to identify a cohort of higher risk patients. Such patients could be treated with the available prophylactic drugs or recruited to studies to evaluate new interventions. This paper is intended to describe the Operational Research process adopted in the development of this scheme. A concise description of the scheme and its clinical interpretation is published elsewhere.

  5. Treatment patterns and risk factor control in patients with and without metabolic syndrome in cardiac rehabilitation

    Directory of Open Access Journals (Sweden)

    Gitt A

    2012-04-01

    Full Text Available Anselm Gitt1, Christina Jannowitz2, Marthin Karoff3, Barbara Karmann2, Martin Horack1, Heinz Völler4,51Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen,2Medical Affairs, MSD Sharp and Dohme GmbH, Haar, 3Klinik Königsfeld der Deutschen Rentenversicherung Westfalen in Ennepetal (NRW, Klinik der Universität Witten-Herdecke, 4Kardiologie, Klinik am See, Rüdersdorf, 5Center of Rehabilitation Research, University Potsdam, GermanyAim: Metabolic syndrome (MetS is a clustering of factors that are associated with increased cardiovascular risk. We aimed to investigate the proportion of patients with MetS in patients undergoing cardiac rehabilitation (CR, and to describe differences between patients with MetS compared to those without MetS with regard to (1 patient characteristics including demographics, risk factors, and comorbidities, (2 risk factor management including drug treatment, and (3 control status of risk factors at entry to CR and discharge from CR.Methods: Post-hoc analysis of data from 27,904 inpatients (Transparency Registry to Objectify Guideline-Oriented Risk Factor Management registry that underwent a CR period of about 3 weeks were analyzed descriptively in total and compared by their MetS status.Results: In the total cohort, mean age was 64.3 years, (71.7% male, with no major differences between groups. Patients had been referred after a ST elevation of myocardial infarction event in 41.1% of cases, non-ST elevation of myocardial infarction in 21.8%, or angina pectoris in 16.7%. They had received a percutaneous coronary intervention in 55.1% and bypass surgery (coronary artery bypass graft in 39.5%. Patients with MetS (n = 15,819 compared to those without MetS (n = 12,085 were less frequently males, and in terms of cardiac interventions, more often received coronary artery bypass surgery. Overall, statin use increased from 79.9% at entry to 95.0% at discharge (MetS: 79.7% to 95.2%. Patients with Met

  6. Standardized echocardiographic assessment of cardiac function in normal adult zebrafish and heart disease models

    Science.gov (United States)

    Wang, Louis W.; Huttner, Inken G.; Santiago, Celine F.; Kesteven, Scott H.; Yu, Ze-Yan; Feneley, Michael P.

    2017-01-01

    ABSTRACT The zebrafish (Danio rerio) is an increasingly popular model organism in cardiovascular research. Major insights into cardiac developmental processes have been gained by studies of embryonic zebrafish. However, the utility of zebrafish for modeling adult-onset heart disease has been limited by a lack of robust methods for in vivo evaluation of cardiac function. We established a physiological protocol for underwater zebrafish echocardiography using high frequency ultrasound, and evaluated its reliability in detecting altered cardiac function in two disease models. Serial assessment of cardiac function was performed in wild-type zebrafish aged 3 to 12 months and the effects of anesthetic agents, age, sex and background strain were evaluated. There was a varying extent of bradycardia and ventricular contractile impairment with different anesthetic drugs and doses, with tricaine 0.75 mmol l−1 having a relatively more favorable profile. When compared with males, female fish were larger and had more measurement variability. Although age-related increments in ventricular chamber size were greater in females than males, there were no sex differences when data were normalized to body size. Systolic ventricular function was similar in both sexes at all time points, but differences in diastolic function were evident from 6 months onwards. Wild-type fish of both sexes showed a reliance on atrial contraction for ventricular diastolic filling. Echocardiographic evaluation of adult zebrafish with diphtheria toxin-induced myocarditis or anemia-induced volume overload accurately identified ventricular dilation and altered contraction, with suites of B-mode, ventricular strain, pulsed-wave Doppler and tissue Doppler indices showing concordant changes indicative of myocardial hypocontractility or hypercontractility, respectively. Repeatability, intra-observer and inter-observer correlations for echocardiographic measurements were high. We demonstrate that high

  7. Fragility fracture: recent developments in risk assessment.

    Science.gov (United States)

    Aspray, Terry J

    2015-02-01

    More than half of older women who sustain a fragility fracture do not have osteoporosis by World Health Organization (WHO) bone mineral density (BMD) criteria; and, while BMD has been used to assess fracture risk for over 30 years, a range of other skeletal and nonskeletal clinical risk factors (CRFs) for fracture have been recognized. More than 30 assessment tools using CRFs have been developed, some predicting fracture risk and others low BMD alone. Recent systematic reviews have reported that many tools have not been validated against fracture incidence, and that the complexity of tools and the number of CRFs included do not ensure best performance with poor assessment of (internal or comparative) validity. Internationally, FRAX® is the most commonly recommended tool, in addition to QFracture in the UK, The Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tool in Canada and Garvan in Australia. All tools estimate standard 10-year risk of major osteoporotic and 10-year risk of hip fracture: FRAX® is able to estimate fracture risk either with or without BMD, but CAROC and Garvan both require BMD and QFracture does not. The best evidence for the utility of these tools is in case finding but there may be future prospects for the use of 10-year fracture risk as a common currency with reference to the benefits of treatment, whether pharmacological or lifestyle. The use of this metric is important in supporting health economic analyses. However, further calibration studies will be needed to prove that the tools are robust and that their estimates can be used in supporting treatment decisions, independent of BMD.

  8. Model based risk assessment - the CORAS framework

    Energy Technology Data Exchange (ETDEWEB)

    Gran, Bjoern Axel; Fredriksen, Rune; Thunem, Atoosa P-J.

    2004-04-15

    Traditional risk analysis and assessment is based on failure-oriented models of the system. In contrast to this, model-based risk assessment (MBRA) utilizes success-oriented models describing all intended system aspects, including functional, operational and organizational aspects of the target. The target models are then used as input sources for complementary risk analysis and assessment techniques, as well as a basis for the documentation of the assessment results. The EU-funded CORAS project developed a tool-supported methodology for the application of MBRA in security-critical systems. The methodology has been tested with successful outcome through a series of seven trial within the telemedicine and ecommerce areas. The CORAS project in general and the CORAS application of MBRA in particular have contributed positively to the visibility of model-based risk assessment and thus to the disclosure of several potentials for further exploitation of various aspects within this important research field. In that connection, the CORAS methodology's possibilities for further improvement towards utilization in more complex architectures and also in other application domains such as the nuclear field can be addressed. The latter calls for adapting the framework to address nuclear standards such as IEC 60880 and IEC 61513. For this development we recommend applying a trial driven approach within the nuclear field. The tool supported approach for combining risk analysis and system development also fits well with the HRP proposal for developing an Integrated Design Environment (IDE) providing efficient methods and tools to support control room systems design. (Author)

  9. An abuse of risk assessment: how regulatory agencies improperly adopted LNT for cancer risk assessment.

    Science.gov (United States)

    Calabrese, Edward J

    2015-04-01

    The Genetics Panel of the National Academy of Sciences' Committee on Biological Effects of Atomic Radiation (BEAR) recommended the adoption of the linear dose-response model in 1956, abandoning the threshold dose-response for genetic risk assessments. This recommendation was quickly generalized to include somatic cells for cancer risk assessment and later was instrumental in the adoption of linearity for carcinogen risk assessment by the Environmental Protection Agency. The Genetics Panel failed to provide any scientific assessment to support this recommendation and refused to do so when later challenged by other leading scientists. Thus, the linearity model used in cancer risk assessment was based on ideology rather than science and originated with the recommendation of the NAS BEAR Committee Genetics Panel. Historical documentation in support of these conclusions is provided in the transcripts of the Panel meetings and in previously unexamined correspondence among Panel members.

  10. Behavioral toxicology, risk assessment, and chlorinated hydrocarbons

    Energy Technology Data Exchange (ETDEWEB)

    Evangelista de Duffard, A.M.; Duffard, R. [Laboratorio de Toxicologia Experimental, Santa Fe (Argentina)

    1996-04-01

    Behavioral end points are being used with greater frequency in neurotoxicology to detect and characterize the adverse effects of chemicals on the nervous system. Behavioral measures are particularly important for neurotoxicity risk assessment since many known neurotoxicants do not result in neuropathology. The chlorinated hydrocarbon class consists of a wide variety of chemicals including polychlorinated biphenyls, clioquinol, trichloroethylene, hexachlorophene, organochlorine insecticides (DDT, dicofol, chlordecone, dieldrin, and lindane), and phenoxyherbicides. Each of these chemicals has effects on motor, sensory, or cognitive function that are detectable using functional measures such as behavior. Furthermore, there is evidence that if exposure occurs during critical periods of development, many of the chlorinated hydrocarbons are developmental neurotoxicants. Developmental neurotoxicity is frequently expressed as alterations in motor function or cognitive abilities or charges in the ontogeny of sensorimotor reflexes. Neurotoxicity risk assessment should include assessments of the full range of possible neurotoxicological effects, including both structural and functional indicators of neurotoxicity. 121 refs., 1 tab.

  11. Pain after Cardiac Surgery: A Review of the Assessment and Management

    Directory of Open Access Journals (Sweden)

    Parizad Razieh

    2014-10-01

    Full Text Available Objective: Surgery is among the causes of acute pain. One of the major problems of patients after surgical procedures is postoperative pain. Annually, millions of people throughout the world undergo surgery and experience different intensities of postoperative pain. Due to physiological changes and given the stability of the heart and lung, the management and control of pain is rarely considered as a priority in the care of patients after cardiac surgery. Cardiac surgical patients experience pain due to the surgical incision and between the ribs nerve injury created during the course of the surgery, and irritation and inflammation of the pleura by catheters. Control and management of pain in intensive care units (ICU are the main tasks in nursing care. The purpose of this review study was the investigation, assessment, and management of pain in patients after cardiac surgery. Materials and Methods: In this study, the literature available on Magiran, Google Scholar, ScienceDirect, and PubMed were collected, and after reviewing, the relevant literature was studied. Results: Although pain is one of the major stressors in patients undergoing surgery, the measures taken for the treatment and care of these patients are associated with experiencing pain. In this regard, all the resources have emphasized the using of guidelines and tools to assess patients' pain. However, in cardiac surgery patients, sufficient attention is not paid to pain control. Patients reported poorly controlled pain and experiences of moderate to severe pain after surgery. Conclusion: Pain is a subjective experience, and in patients who cannot report their pain, it should be considered important. According to numerous studies, pain control is not performed in ICUs. Thus, efforts should be made for appropriate control and reduction of pain, use of valid methods to determine and control pain, and improvement of the quality of the programs.

  12. Application of bioreactance for cardiac output assessment during exercise in healthy individuals.

    Science.gov (United States)

    Elliott, Adrian; Hull, James H; Nunan, David; Jakovljevic, Djordje G; Brodie, David; Ansley, Lesley

    2010-07-01

    In patients with cardiac failure, bioreactance-based cardiac output (CO) monitoring provides a valid non-invasive method for assessing cardiac performance during exercise. The purpose of this study was to evaluate the efficacy of this technique during strenuous exercise in healthy, trained individuals. Fourteen recreational cyclists, mean (SD) age of 34 (8) years and relative peak oxygen uptake of (VO(2)) 56 (6) ml kg(-1) min(-1), underwent incremental maximal exercise testing, whilst CO was recorded continuously using a novel bioreactance-based device (CO(bio)). The CO(bio) was evaluated against relationship with VO(2), theoretical calculation of arterial-venous oxygen difference (C(a - v) O(2)) and level of agreement with an inert gas rebreathing method (CO(rb)) using a Bland-Altman plot. Bioreactance-based CO measurement was practical and straightforward in application, although there was intermittent loss of electrocardiograph signal at high-intensity exercise. At rest and during exercise, CO(bio) was strongly correlated with VO(2) (r = 0.84; P < 0.001), however, there was evidence of systematic bias with CO(bio) providing lower values than CO(rb); mean bias (limits of agreement) -19% (14.6 to -53%). Likewise, calculated (C(a - v) O(2)) was greater when determined using CO(bio) than CO(rb) (P < 0.001), although both devices provided values in excess of those reported in invasive studies. Bioreactance-based determination of CO provides a pragmatic approach to the continuous assessment of cardiac performance during strenuous exercise in trained individuals. Our findings, however, suggest that further work is needed to refine the key measurement determinants of CO using this device to improve measurement accuracy in this setting.

  13. Quantitative Risk Assessment of Contact Sensitization

    DEFF Research Database (Denmark)

    Api, Anne Marie; Belsito, Donald; Bickers, David;

    2010-01-01

    Background: Contact hypersensitivity quantitative risk assessment (QRA) for fragrance ingredients is being used to establish new international standards for all fragrance ingredients that are potential skin sensitizers. Objective: The objective was to evaluate the retrospective clinical data...... on three fragrance ingredients in order to provide a practical assessment of the predictive value of the QRA approach. It is important to have data to assess that the methodology provides a robust approach for primary prevention of contact sensitization induction for fragrance ingredients identified...... as potential sensitizers. Methods: This article reviews clinical data for three fragrance ingredients cinnamic aldehyde, citral, and isoeugenol to assess the utility of the QRA approach for fragrance ingredients. Results: This assessment suggests that had the QRA approach been available at the time standards...

  14. 78 FR 27939 - Draft Interagency Risk Assessment-Listeria monocytogenes

    Science.gov (United States)

    2013-05-13

    ... Draft Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens: Notice of... Assessment--Listeria monocytogenes in Retail Delicatessens.'' This draft quantitative risk assessment (QRA... conditions, such as Listeria (L.) monocytogenes contamination of certain ready-to-eat (RTE) foods,...

  15. A toolbox for rockfall Quantitative Risk Assessment

    Science.gov (United States)

    Agliardi, F.; Mavrouli, O.; Schubert, M.; Corominas, J.; Crosta, G. B.; Faber, M. H.; Frattini, P.; Narasimhan, H.

    2012-04-01

    Rockfall Quantitative Risk Analysis for mitigation design and implementation requires evaluating the probability of rockfall events, the probability and intensity of impacts on structures (elements at risk and countermeasures), their vulnerability, and the related expected costs for different scenarios. A sound theoretical framework has been developed during the last years both for spatially-distributed and local (i.e. single element at risk) analyses. Nevertheless, the practical application of existing methodologies remains challenging, due to difficulties in the collection of required data and to the lack of simple, dedicated analysis tools. In order to fill this gap, specific tools have been developed in the form of Excel spreadsheets, in the framework of Safeland EU project. These tools can be used by stakeholders, practitioners and other interested parties for the quantitative calculation of rock fall risk through its key components (probabilities, vulnerability, loss), using combinations of deterministic and probabilistic approaches. Three tools have been developed, namely: QuRAR (by UNIMIB), VulBlock (by UPC), and RiskNow-Falling Rocks (by ETH Zurich). QuRAR implements a spatially distributed, quantitative assessment methodology of rockfall risk for individual buildings or structures in a multi-building context (urban area). Risk is calculated in terms of expected annual cost, through the evaluation of rockfall event probability, propagation and impact probability (by 3D numerical modelling of rockfall trajectories), and empirical vulnerability for different risk protection scenarios. Vulblock allows a detailed, analytical calculation of the vulnerability of reinforced concrete frame buildings to rockfalls and related fragility curves, both as functions of block velocity and the size. The calculated vulnerability can be integrated in other methodologies/procedures based on the risk equation, by incorporating the uncertainty of the impact location of the rock

  16. Clinical risk assessment in intensive care unit

    Directory of Open Access Journals (Sweden)

    Saeed Asefzadeh

    2013-01-01

    Full Text Available Background: Clinical risk management focuses on improving the quality and safety of health care services by identifying the circumstances and opportunities that put patients at risk of harm and acting to prevent or control those risks. The goal of this study is to identify and assess the failure modes in the ICU of Qazvin′s Social Security Hospital (Razi Hospital through Failure Mode and Effect Analysis (FMEA. Methods: This was a qualitative-quantitative research by Focus Discussion Group (FDG performed in Qazvin Province, Iran during 2011. The study population included all individuals and owners who are familiar with the process in ICU. Sampling method was purposeful and the FDG group members were selected by the researcher. The research instrument was standard worksheet that has been used by several researchers. Data was analyzed by FMEA technique. Results: Forty eight clinical errors and failure modes identified, results showed that the highest risk probability number (RPN was in respiratory care "Ventilator′s alarm malfunction (no alarm" with the score 288, and the lowest was in gastrointestinal "not washing the NG-Tube" with the score 8. Conclusions: Many of the identified errors can be prevented by group members. Clinical risk assessment and management is the key to delivery of effective health care.

  17. Evolving regulatory paradigm for proarrhythmic risk assessment for new drugs.

    Science.gov (United States)

    Vicente, Jose; Stockbridge, Norman; Strauss, David G

    Fourteen drugs were removed from the market worldwide because their potential to cause torsade de pointes (torsade), a potentially fatal ventricular arrhythmia. The observation that most drugs that cause torsade block the potassium channel encoded by the human ether-à-go-go related gene (hERG) and prolong the heart rate corrected QT interval (QTc) on the ECG, led to a focus on screening new drugs for their potential to block the hERG potassium channel and prolong QTc. This has been a successful strategy keeping torsadogenic drugs off the market, but has resulted in drugs being dropped from development, sometimes inappropriately. This is because not all drugs that block the hERG potassium channel and prolong QTc cause torsade, sometimes because they block other channels. The regulatory paradigm is evolving to improve proarrhythmic risk prediction. ECG studies can now use exposure-response modeling for assessing the effect of a drug on the QTc in small sample size first-in-human studies. Furthermore, the Comprehensive in vitro Proarrhythmia Assay (CiPA) initiative is developing and validating a new in vitro paradigm for cardiac safety evaluation of new drugs that provides a more accurate and comprehensive mechanistic-based assessment of proarrhythmic potential. Under CiPA, the prediction of proarrhythmic potential will come from in vitro ion channel assessments coupled with an in silico model of the human ventricular myocyte. The preclinical assessment will be checked with an assessment of human phase 1 ECG data to determine if there are unexpected ion channel effects in humans compared to preclinical ion channel data. While there is ongoing validation work, the heart rate corrected J-Tpeak interval is likely to be assessed under CiPA to detect inward current block in presence of hERG potassium channel block.

  18. Prognostic factors for mortality among patients above the 6th decade undergoing non-cardiac surgery: cares - clinical assessment and research in elderly surgical patients

    Directory of Open Access Journals (Sweden)

    Adriana Nunes Machado

    2008-01-01

    Full Text Available PURPOSE: To ascertain perioperative morbimortality and identify prognostic factors for mortality among patients >55 years who undergo non-cardiac surgery. METHODS: A retrospective cohort of 403 patients relating to perioperative morbidity-mortality. Data were collected from a standardized protocol on gender, age, comorbidities, medications used, smoking, alcohol abuse, chronic use of benzodiazepine, nutritional status, presence of anemia, activities of daily living, American Society of Anesthesiology classification, Detsky's modified cardiac risk index - American College of Physicians, renal function evaluation, pulmonary risk according to the Torrington scale, risk of thromboembolic events, presence of malignant disease and complementary examinations. RESULTS: The mean age of the subjects was 70.8 ± 8.1 years. The "very old" (>80 years represented 14%. The mortality rate was 8.2%, and the complication rate was 15.8%. Multiple logistic regression showed that a history of coronary heart disease (OR: 3.75; p=0.02 and/or valvular heart disease (OR: 31.79; p=0.006 were predictors of mortality. The American Society of Anesthesiology classification was shown to be the best scale to mark risk (OR: 3.01; p=0.016. Nutritional status was a protective factor, in which serum albumin increases of 1 mg/dl decreased risk by 63%. DISCUSSION: The results indicate that serum albumin, coronary heart disease, valvular heart disease and the American Society of Anesthesiology classification could be prognostic predictors for aged patients in a perioperative setting. In this sample, provided that pulmonary, cardiac and thromboembolic risks were properly controlled, they did not constitute risk factors for mortality. Furthermore, continuous effort to learn more about the preoperative assessment of elderly patients could yield intervention possibilities and minimize morbimortality.

  19. Groundwater Risk Assessment Model (GRAM: Groundwater Risk Assessment Model for Wellfield Protection

    Directory of Open Access Journals (Sweden)

    Nara Somaratne

    2013-09-01

    Full Text Available A groundwater risk assessment was carried out for 30 potable water supply systems under a framework of protecting drinking water quality across South Australia. A semi-quantitative Groundwater Risk Assessment Model (GRAM was developed based on a “multi-barrier” approach using likelihood of release, contaminant pathway and consequence equation. Groundwater vulnerability and well integrity have been incorporated to the pathway component of the risk equation. The land use of the study basins varies from protected water reserves to heavily stocked grazing lands. Based on the risk assessment, 15 systems were considered as low risk, four as medium and 11 systems as at high risk. The GRAM risk levels were comparable with indicator bacteria—total coliform—detection. Most high risk systems were the result of poor well construction and casing corrosion rather than the land use. We carried out risk management actions, including changes to well designs and well operational practices, design to increase time of residence and setting the production zone below identified low permeable zones to provide additional barriers to contaminants. The highlight of the risk management element is the well integrity testing using down hole geophysical methods and camera views of the casing condition.

  20. Allometric scaling of decompression sickness risk in terrestrial mammals; cardiac output explains risk of decompression sickness

    Science.gov (United States)

    Fahlman, Andreas

    2017-02-01

    A probabilistic model was used to predict decompression sickness (DCS) outcome in pig (70 and 20 kg), hamster (100 g), rat (220 g) and mouse (20 g) following air saturation dives. The data set included 179 pig, 200 hamster, 360 rat, and 224 mouse exposures to saturation pressures ranging from 1.9–15.2 ATA and with varying decompression rates (0.9–156 ATA • min‑1). Single exponential kinetics described the tissue partial pressures (Ptiss) of N2: Ptiss =  ∫(Pamb – Ptiss) • τ‑1 dt, where Pamb is ambient N2 pressure and τ is a time constant. The probability of DCS [P(DCS)] was predicted from the risk function: P(DCS) = 1‑e‑r, where r = ∫(PtissN2 ‑ Thr ‑ Pamb) • Pamb–1 dt, and Thr is a threshold parameter. An equation that scaled τ with body mass included a constant (c) and an allometric scaling parameter (n), and the best model included n, Thr, and two c. The final model provided accurate predictions for 58 out of 61 dive profiles for pig, hamster, rat, and mouse. Thus, body mass helped improve the prediction of DCS risk in four mammalian species over a body mass range covering 3 orders of magnitude.

  1. The predictive value of CHADS₂ risk score in post myocardial infarction arrhythmias - a Cardiac Arrhythmias and RIsk Stratification after Myocardial infArction (CARISMA) substudy

    DEFF Research Database (Denmark)

    Ruwald, Anne-Christine Huth; Gang, Uffe; Thomsen, Poul Erik Bloch;

    2014-01-01

    of this study was to investigate if CHADS₂ score (congestive heart failure, hypertension, age ≥75 years, diabetes and previous stroke/TCI [doubled]) can be used as a risk tool for predicting cardiac arrhythmias after MI. METHODS: The study included 297 post-MI patients from the CARISMA study with left...

  2. Assessment of the quality of existing patient educational tools focused on sudden cardiac arrest: a systematic evaluation by the Sudden Cardiac Arrest Thought Leadership Alliance

    Directory of Open Access Journals (Sweden)

    Hazelton G

    2013-04-01

    Full Text Available Garrett Hazelton,1 Sana M Al-Khatib,2,3 Gregg C Fonarow,4 Kevin L Thomas,3 David Hayes,5 Gillian D Sanders,2,3 Susan M Campbell,6 Clyde Yancy,7 Eric D Peterson,2,3 Samuel Sears8 1Department of Psychiatric Medicine, East Carolina University, Greenville, NC, 2Duke Clinical Research Institute, 3Department of Medicine, Duke University School of Medicine, Durham, NC, 4Division of Cardiology, Geffen School of Medicine at UCLA, Los Angeles, CA, 5Mayo Clinic, Rochester, MN, 6WomenHeart, The National Coalition for Women with Heart Disease, Washington, DC, 7Division of Cardiology, Feinburg School of Medicine, Northwestern University, Chicago, IL, 8Departments of Psychology and Cardiology, East Carolina University, Greenville, NC, USA Background: Conveying contemporary treatment options for those at risk of sudden cardiac arrest (SCA is challenging. The purpose of the present research was to evaluate the quality and usability of available patient educational tools relevant to SCA and its treatment options, such as implantable cardioverter defibrillators (ICDs. We hypothesized that this review would identify gaps in areas of information for the enhancement of patient education and decision-making materials. Methods: We used a formal instrument to assess specific domains of content, development, and effectiveness of 18 available SCA and ICD educational tools. The multidisciplinary review panel included two electrophysiologists, two general cardiologists, a cardiac psychologist, a health services researcher, and a patient advocate. Results: Of the 18 education tools, four were rated as “good, may need revisions, but sufficient for use”, 12 were rated as “marginal, needs revision prior to use”, and two were rated as “poor, inadequate for use”. None of the tools were rated as being of “very good” or “excellent” quality. Conclusion: There appear to be opportunities to improve the quality and completeness of existing educational tools for

  3. Asteroid Risk Assessment: A Probabilistic Approach.

    Science.gov (United States)

    Reinhardt, Jason C; Chen, Xi; Liu, Wenhao; Manchev, Petar; Paté-Cornell, M Elisabeth

    2016-02-01

    Following the 2013 Chelyabinsk event, the risks posed by asteroids attracted renewed interest, from both the scientific and policy-making communities. It reminded the world that impacts from near-Earth objects (NEOs), while rare, have the potential to cause great damage to cities and populations. Point estimates of the risk (such as mean numbers of casualties) have been proposed, but because of the low-probability, high-consequence nature of asteroid impacts, these averages provide limited actionable information. While more work is needed to further refine its input distributions (e.g., NEO diameters), the probabilistic model presented in this article allows a more complete evaluation of the risk of NEO impacts because the results are distributions that cover the range of potential casualties. This model is based on a modularized simulation that uses probabilistic inputs to estimate probabilistic risk metrics, including those of rare asteroid impacts. Illustrative results of this analysis are presented for a period of 100 years. As part of this demonstration, we assess the effectiveness of civil defense measures in mitigating the risk of human casualties. We find that they are likely to be beneficial but not a panacea. We also compute the probability-but not the consequences-of an impact with global effects ("cataclysm"). We conclude that there is a continued need for NEO observation, and for analyses of the feasibility and risk-reduction effectiveness of space missions designed to deflect or destroy asteroids that threaten the Earth.

  4. Can Systematic Reviews Inform GMO Risk Assessment and Risk Management?

    Science.gov (United States)

    Kohl, Christian; Frampton, Geoff; Sweet, Jeremy; Spök, Armin; Haddaway, Neal Robert; Wilhelm, Ralf; Unger, Stefan; Schiemann, Joachim

    2015-01-01

    Systematic reviews represent powerful tools to identify, collect, synthesize, and evaluate primary research data on specific research questions in a highly standardized and reproducible manner. They enable the defensible synthesis of outcomes by increasing precision and minimizing bias whilst ensuring transparency of the methods used. This makes them especially valuable to inform evidence-based risk analysis and decision making in various topics and research disciplines. Although seen as a “gold standard” for synthesizing primary research data, systematic reviews are not without limitations as they are often cost, labor and time intensive and the utility of synthesis outcomes depends upon the availability of sufficient and robust primary research data. In this paper, we (1) consider the added value systematic reviews could provide when synthesizing primary research data on genetically modified organisms (GMO) and (2) critically assess the adequacy and feasibility of systematic review for collating and analyzing data on potential impacts of GMOs in order to better inform specific steps within GMO risk assessment and risk management. The regulatory framework of the EU is used as an example, although the issues we discuss are likely to be more widely applicable. PMID:26322307

  5. Can Systematic Reviews Inform GMO Risk Assessment and Risk Management?

    Science.gov (United States)

    Kohl, Christian; Frampton, Geoff; Sweet, Jeremy; Spök, Armin; Haddaway, Neal Robert; Wilhelm, Ralf; Unger, Stefan; Schiemann, Joachim

    2015-01-01

    Systematic reviews represent powerful tools to identify, collect, synthesize, and evaluate primary research data on specific research questions in a highly standardized and reproducible manner. They enable the defensible synthesis of outcomes by increasing precision and minimizing bias whilst ensuring transparency of the methods used. This makes them especially valuable to inform evidence-based risk analysis and decision making in various topics and research disciplines. Although seen as a "gold standard" for synthesizing primary research data, systematic reviews are not without limitations as they are often cost, labor and time intensive and the utility of synthesis outcomes depends upon the availability of sufficient and robust primary research data. In this paper, we (1) consider the added value systematic reviews could provide when synthesizing primary research data on genetically modified organisms (GMO) and (2) critically assess the adequacy and feasibility of systematic review for collating and analyzing data on potential impacts of GMOs in order to better inform specific steps within GMO risk assessment and risk management. The regulatory framework of the EU is used as an example, although the issues we discuss are likely to be more widely applicable.

  6. Can systematic reviews inform GMO risk assessment and risk management?

    Directory of Open Access Journals (Sweden)

    Christian eKohl

    2015-08-01

    Full Text Available Systematic reviews represent powerful tools to identify, collect, synthesize and evaluate primary research data on specific research questions in a highly standardized and reproducible manner. They enable the defensible synthesis of outcomes by increasing precision and minimizing bias whilst ensuring transparency of the methods used. This makes them especially valuable to inform evidence-based risk analysis and decision making in various topics and research disciplines. Although seen as a gold standard for synthesizing primary research data, systematic reviews are not without limitations as they are often cost, labor and time intensive and the utility of synthesis outcomes depends upon the availability of sufficient and robust primary research data. In this paper we 1 consider the added value systematic reviews could provide when synthesizing primary research data on genetically modified organisms (GMO and 2 critically assess the adequacy and feasibility of systematic review for collating and analyzing data on potential impacts of GMOs in order to better inform specific steps within GMO risk assessment and risk management. The regulatory framework of the EU is used as an example, although the issues we discuss are likely to be more widely applicable.

  7. Method of assessing a lipid-related health risk based on ion mobility analysis of lipoproteins

    Science.gov (United States)

    Benner, W. Henry; Krauss, Ronald M.; Blanche, Patricia J.

    2010-12-14

    A medical diagnostic method and instrumentation system for analyzing noncovalently bonded agglomerated biological particles is described. The method and system comprises: a method of preparation for the biological particles; an electrospray generator; an alpha particle radiation source; a differential mobility analyzer; a particle counter; and data acquisition and analysis means. The medical device is useful for the assessment of human diseases, such as cardiac disease risk and hyperlipidemia, by rapid quantitative analysis of lipoprotein fraction densities. Initially, purification procedures are described to reduce an initial blood sample to an analytical input to the instrument. The measured sizes from the analytical sample are correlated with densities, resulting in a spectrum of lipoprotein densities. The lipoprotein density distribution can then be used to characterize cardiac and other lipid-related health risks.

  8. Low dialysate potassium concentration: an overrated risk factor for cardiac arrhythmia?

    Science.gov (United States)

    Abuelo, J Gary

    2015-01-01

    Serum potassium concentrations rise with dietary potassium intake between dialysis sessions and are often at hyperkalemic levels by the next session. Conversely, potassium concentrations fall during each hemodialysis, and sometimes reach hypokalemic levels by the end. Low potassium dialysate, which rapidly decreases serum potassium and often brings it to hypokalemic levels, is almost universally considered a risk factor for life-threatening arrhythmias. While there is little doubt about the threat of lethal arrhythmias due to hyperkalemia, convincing evidence for the danger of low potassium dialysate and rapid or excess potassium removal has not been forthcoming. The original report of more frequent ventricular ectopy in early dialysis that was improved by reducing potassium removal has received very little confirmation from subsequent studies. Furthermore, the occurrence of ventricular ectopy during dialysis does not appear to predict mortality. Studies relating sudden deaths to low potassium dialysate are countered by studies with more thorough adjustment for markers of poor health. Dialysate potassium concentrations affect the excursions of serum potassium levels above or below the normal range, and have the potential to influence dialysis safety. Controlled studies of different dialysate potassium concentration and their effect on mortality and cardiac arrests have not been done. Until these results become available, I propose interim guidelines for the setting of dialysate potassium levels that may better balance risks and benefits.

  9. [Cardiac and metabolic risk factors in severe mental disorders. Task of a prevention manager].

    Science.gov (United States)

    Lederbogen, F; Schwarz, P; Häfner, S; Schweiger, U; Bohus, M; Deuschle, M

    2015-07-01

    People with severe mental disorders have a reduction in life expectancy of 13-30 % compared with the general population. This severe disadvantage is primarily due to an increased prevalence of cardiac and metabolic disorders, especially coronary heart disease (CHD) and type 2 diabetes mellitus and are the result of untoward health behavior characterized by smoking, low levels of physical activity and unhealthy dietary habits. Obesity, arterial hypertension and lipid disorders are also associated with this behavior and further increase the risk of CHD and type 2 diabetes. Thus, people with mental disorders constitute a population with a high risk of cardiovascular events. Appropriate measures for prevention and therapy are urgently indicated but rarely applied. This article presents new organizational structures to overcome this deficit with a prevention manager playing a central role in organizing and applying preventive and therapeutic care. Results from cardiology and diabetic medicine have shown the effectiveness of pooling this responsibility. The measure has the potential to reduce the increased mortality of people with severe mental disorders.

  10. Influence of age on perioperative major adverse cardiovascular events and mortality risks in elective non-cardiac surgery

    DEFF Research Database (Denmark)

    Hansen, Peter Wæde; Gislason, Gunnar H.; Jørgensen, Mads Emil;

    2016-01-01

    -cause mortality were analyzed by multivariable logistic regression models (adjusted for comorbidities, revised cardiac risk index, cardiovascular pharmacotherapy, body mass index, and surgery type). RESULTS: A total of 386,818 procedures on 302,459 patients were included; mean age was 54.8years (min-max 20......BACKGROUND AND AIMS: Advanced age increases the risk of perioperative cardiovascular complications and may pose reluctance to subject elderly patients to surgery. We examined the impact of high age on perioperative major adverse cardiovascular events (MACE) and mortality in a nationwide cohort...... of patients undergoing elective surgery. METHODS: All Danish patients aged ≥20years undergoing non-cardiac, elective surgery in 2005-2011 were identified from nationwide administrative registers. Risks of 30-day MACE (non-fatal ischemic stroke, non-fatal myocardial infarction, or cardiovascular death) and all...

  11. [Risk assessment of genetically modified organisms].

    Science.gov (United States)

    Costa, Thadeu Estevam Moreira Maramaldo; Dias, Aline Peçanha Muzy; Scheidegger, Erica Miranda Damasio; Marin, Victor Augustus

    2011-01-01

    Since the commercial approve in 1996, the global area of transgenic crops has raised more than 50 times. In the last two decades, governments have been planning strategies and protocols for safety assessment of food and feed genetically modified (GM). Evaluation of food safety should be taken on a case-by-case analysis depending on the specific traits of the modified crops and the changes introduced by the genetic modification, using for this the concept of substantial equivalence. This work presents approaches for the risk assessment of GM food, as well as some problems related with the genetic construction or even with the expression of the inserted gene.

  12. Supplemental Hazard Analysis and Risk Assessment - Hydrotreater

    Energy Technology Data Exchange (ETDEWEB)

    Lowry, Peter P. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Wagner, Katie A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2015-04-01

    A supplemental hazard analysis was conducted and quantitative risk assessment performed in response to an independent review comment received by the Pacific Northwest National Laboratory (PNNL) from the U.S. Department of Energy Pacific Northwest Field Office (PNSO) against the Hydrotreater/Distillation Column Hazard Analysis Report issued in April 2013. The supplemental analysis used the hazardous conditions documented by the previous April 2013 report as a basis. The conditions were screened and grouped for the purpose of identifying whether additional prudent, practical hazard controls could be identified, using a quantitative risk evaluation to assess the adequacy of the controls and establish a lower level of concern for the likelihood of potential serious accidents. Calculations were performed to support conclusions where necessary.

  13. Risk assessment of topically applied products

    DEFF Research Database (Denmark)

    Søborg, Tue; Basse, Line Hollesen; Halling-Sørensen, Bent

    2007-01-01

    The human risk of harmful substances in semisolid topical dosage forms applied topically to normal skin and broken skin, respectively, was assessed. Bisphenol A diglycidyl ether (BADGE) and three derivatives of BADGE previously quantified in aqueous cream and the UV filters 3-BC and 4-MBC were used...... as model compounds. Tolerable daily intake (TDI) values have been established for BADGE and derivatives. Endocrine disruption was chosen as endpoint for 3-BC and 4-MBC. Skin permeation of the model compounds was investigated in vitro using pig skin membranes. Tape stripping was applied to simulate broken...... parameters for estimating the risk. The immediate human risk of BADGE and derivatives in topical dosage forms was found to be low. However, local treatment of broken skin may lead to higher exposure of BADGE and derivatives compared to application to normal skin. 3-BC permeated skin at higher flux than 4-MBC...

  14. Probabilistic risk assessment of disassembly procedures

    Energy Technology Data Exchange (ETDEWEB)

    O`Brien, D.A.; Bement, T.R.; Letellier, B.C.

    1993-11-01

    The purpose of this report is to describe the use of Probabilistic Risk (Safety) Assessment (PRA or PSA) at a Department of Energy (DOE) facility. PRA is a methodology for (i) identifying combinations of events that, if they occur, lead to accidents (ii) estimating the frequency of occurrence of each combination of events and (iii) estimating the consequences of each accident. Specifically the study focused on evaluating the risks associated with dissembling a hazardous assembly. The PRA for the operation included a detailed evaluation only for those potential accident sequences which could lead to significant off-site consequences and affect public health. The overall purpose of this study was to investigate the feasibility of establishing a risk-consequence goal for DOE operations.

  15. The Chornobyl accident: A comprehensive risk assessment

    Energy Technology Data Exchange (ETDEWEB)

    Vargo, G.J. [ed.; Poyarkov, V.; Bar`yakhtar, V.; Kukhar, V.; Los, I.; Kholosha, V.; Shestopalov, V.

    1999-10-01

    The authors, all of whom are Ukrainian and Russian scientists involved with Chornobyl nuclear power plant since the April 1986 accident, present a comprehensive review of the accident. In addition, they present a risk assessment of the remains of the destroyed reactor and its surrounding shelter, Chornobyl radioactive waste storage and disposal sites, and environmental contamination in the region. The authors explore such questions as the risks posed by a collapse of the shelter, radionuclide migration from storage and disposal facilities in the exclusion zone, and transfer from soil to vegetation and its potential regional impact. The answers to these questions provide a scientific basis for the development of countermeasures against the Chornobyl accident in particular and the mitigation of environmental radioactive contamination in general. They also provide an important basis for understanding the human health and ecological risks posed by the accident.

  16. Risk assessment meta tool LDRD final report.

    Energy Technology Data Exchange (ETDEWEB)

    Bouchard, Ann Marie; Osbourn, Gordon Cecil

    2006-12-01

    The goal of this project was to develop a risk analysis meta tool--a tool that enables security analysts both to combine and analyze data from multiple other risk assessment tools on demand. Our approach was based on the innovative self-assembling software technology under development by the project team. This technology provides a mechanism for the user to specify his intentions at a very high level (e.g., equations or English-like text), and then the code self-assembles itself, taking care of the implementation details. The first version of the meta tool focused specifically in importing and analyzing data from Joint Conflict and Tactical Simulation (JCATS) force-on-force simulation. We discuss the problem, our approach, technical risk, and accomplishments on this project, and outline next steps to be addressed with follow-on funding.

  17. 77 FR 26292 - Risk Evaluation and Mitigation Strategy Assessments: Social Science Methodologies to Assess Goals...

    Science.gov (United States)

    2012-05-03

    ... Mitigation Strategy Assessments: Social Science Methodologies to Assess Goals Related to Knowledge.'' The... an issue paper entitled ``Risk Evaluation and Mitigation Strategy Assessments: Social Science...' knowledge about drugs' risks; (2) share current FDA experience regarding social science assessments...

  18. Wavelet transform analysis to assess oscillations in pial artery pulsation at the human cardiac frequency.

    Science.gov (United States)

    Winklewski, P J; Gruszecki, M; Wolf, J; Swierblewska, E; Kunicka, K; Wszedybyl-Winklewska, M; Guminski, W; Zabulewicz, J; Frydrychowski, A F; Bieniaszewski, L; Narkiewicz, K

    2015-05-01

    Pial artery adjustments to changes in blood pressure (BP) may last only seconds in humans. Using a novel method called near-infrared transillumination backscattering sounding (NIR-T/BSS) that allows for the non-invasive measurement of pial artery pulsation (cc-TQ) in humans, we aimed to assess the relationship between spontaneous oscillations in BP and cc-TQ at frequencies between 0.5 Hz and 5 Hz. We hypothesized that analysis of very short data segments would enable the estimation of changes in the cardiac contribution to the BP vs. cc-TQ relationship during very rapid pial artery adjustments to external stimuli. BP and pial artery oscillations during baseline (70s and 10s signals) and the response to maximal breath-hold apnea were studied in eighteen healthy subjects. The cc-TQ was measured using NIR-T/BSS; cerebral blood flow velocity, the pulsatility index and the resistive index were measured using Doppler ultrasound of the left internal carotid artery; heart rate and beat-to-beat systolic and diastolic blood pressure were recorded using a Finometer; end-tidal CO2 was measured using a medical gas analyzer. Wavelet transform analysis was used to assess the relationship between BP and cc-TQ oscillations. The recordings lasting 10s and representing 10 cycles with a frequency of ~1 Hz provided sufficient accuracy with respect to wavelet coherence and wavelet phase coherence values and yielded similar results to those obtained from approximately 70cycles (70s). A slight but significant decrease in wavelet coherence between augmented BP and cc-TQ oscillations was observed by the end of apnea. Wavelet transform analysis can be used to assess the relationship between BP and cc-TQ oscillations at cardiac frequency using signals intervals as short as 10s. Apnea slightly decreases the contribution of cardiac activity to BP and cc-TQ oscillations.

  19. Depression in primary care: assessing suicide risk

    Science.gov (United States)

    Ng, Chung Wai Mark; How, Choon How; Ng, Yin Ping

    2017-01-01

    Major depression is a common condition seen in the primary care setting. This article describes the suicide risk assessment of a depressed patient, including practical aspects of history-taking, consideration of factors in deciding if a patient requires immediate transfer for inpatient care and measures to be taken if the patient is not hospitalised. It follows on our earlier article about the approach to management of depression in primary care. PMID:28210741

  20. Moving Forward in Human Cancer Risk Assessment

    OpenAIRE

    Paules, Richard S.; Aubrecht, Jiri; Corvi, Raffaella; Garthoff, Bernward; Kleinjans, Jos C.

    2010-01-01

    Background The current safety paradigm for assessing carcinogenic properties of drugs, cosmetics, industrial chemicals, and environmental exposures relies mainly on in vitro genotoxicity testing followed by 2-year rodent bioassays. This testing battery is extremely sensitive but has low specificity. Furthermore, rodent bioassays are associated with high costs, high animal burden, and limited predictive value for human risks. Objectives We provide a response to a growing appeal for a paradigm ...

  1. The Oviduct and Serous Cancer Risk Assessment

    Science.gov (United States)

    2015-10-01

    all the pathological and immunological hallmarks of human high-grade serous cancer , such as gain of p53, EZH2 and MUC4 expression (Figure 2a) 15 26...59 60 For Peer Review Figure 3. . Molecular correlates of progression from STIC to invasive cancer . a. Left, Histology of the sections used...1 AWARD NUMBER: W81XWH-14-1-0504 TITLE: The Oviduct and Serous Cancer Risk Assessment PRINCIPAL INVESTIGATOR: Christopher P. Crum, MD

  2. Selection of Dispersivity in Groundwater Risk Assessment

    Institute of Scientific and Technical Information of China (English)

    武晓峰; 唐杰

    2004-01-01

    The Domenico model is used in combination with ASTM E 1739 in a Tier 2 risk assessment of chlorinated organic solvents contaminated groundwater sites to predict potential contaminant concentration in groundwater down-gradient from the point of exposure (POE). A knowledge of the dispersivity parameters is necessary for carrying out this calculation. A constant longitudinal dispersivity of 10 m is often used in analytical and numerical calculation. However, because of the scale effect of dispersion, two other main approaches are currently often used. From the viewpoint of conservative principle in risk assessment, it is necessary to determine which dispersivity data will give a higher predicted concentration, corresponding to a more conservative risk calculation. Generally, it is considered that a smaller dispersivity leads to a higher predicted concentration. This assumption is correct when dispersion is the only natural attenuation factor. However, degradation of commonly encountered chlorinated organic solvents in environment under natural condition has been widely reported. Calculations given in this paper of several representative cases show that a general consideration of the influence of dispersivity on concentration prediction is not always correct when a degradation term is included in the calculation. To give a conservative risk calculation, the scale effect of dispersion is considered. Calculations also show that the dispersivity parameters need to be determined by considering the POE distance from the source, the groundwater velocity, and the degradation rate of the contaminant.

  3. Gender, risk assessment, and political ambition.

    Science.gov (United States)

    Sweet-Cushman, Jennie

    2016-01-01

    In the United States, women have long held the right to vote and can participate fully in the political process, and yet they are underrepresented at all levels of elected office. Worldwide, men's dominance in the realm of politics has also been the norm. To date, scholars have focused on supply-side and demand-side explanations of women's underrepresentation but differences in how men and women assess electoral risk (the risk involved in seeking political office) are not fully explained. To fill this gap, I explore how evolutionary theory offers insights into gendered differences in political ambition and the evaluation of electoral risk. Using the framework of life-history theory, I hypothesize that both cognitive and environmental factors in human evolution, particularly as they relate to sexual selection and social roles, have shaped the psychology of ambition in gendered ways affecting contemporary politics. Cognitive risk-assessment mechanisms evolving in the hominid line came to be expressed differently in females and males, in women and men. These gendered expressions plausibly reflect differentiable environmental pressures in the past and may help explain behaviors in and barriers to women's electoral political activity in the present. If so, then the success of efforts to increase such activity - or, regressively, to suppress it - may be better understood.

  4. Natural-technological risk assessment and management

    Science.gov (United States)

    Burova, Valentina; Frolova, Nina

    2016-04-01

    EM-DAT statistical data on human impact and economic damages in the 1st semester 2015 are the highest since 2011: 41% of disasters were floods, responsible for 39% of economic damage and 7% of events were earthquakes responsible for 59% of total death toll. This suggests that disaster risk assessment and management still need to be improved and stay the principle issue in national and international related programs. The paper investigates the risk assessment and management practice in the Russian Federation at different levels. The method is proposed to identify the territories characterized by integrated natural-technological hazard. The maps of the Russian Federation zoning according to the integrated natural-technological hazard level are presented, as well as the procedure of updating the integrated hazard level taking into account the activity of separate processes. Special attention is paid to data bases on past natural and technological processes consequences, which are used for verification of current hazard estimation. The examples of natural-technological risk zoning for the country and some regions territory are presented. Different output risk indexes: both social and economic, are estimated taking into account requirements of end-users. In order to increase the safety of population of the Russian Federation the trans-boundaries hazards are also taken into account.

  5. Use of a Three Dimensional Printed Cardiac Model to Assess Suitability for Biventricular Repair.

    Science.gov (United States)

    Farooqi, Kanwal M; Gonzalez-Lengua, Carlos; Shenoy, Rajesh; Sanz, Javier; Nguyen, Khanh

    2016-05-01

    Three dimensional (3D) printing is rapidly gaining interest in the medical field for use in presurgical planning. We present the case of a seven-year-old boy with double outlet right ventricle who underwent a bidirectional Glenn anastomosis. We used a 3D cardiac model to assess his suitability for a biventricular repair. He underwent a left ventricle-to-aorta baffle with a right ventricle-to-pulmonary artery conduit placement. He did well postoperatively and was discharged home with no evidence of baffle obstruction and good biventricular function. A 3D printed model can provide invaluable intracardiac spatial information in these complex patients.

  6. Risk assessment methodology for the forniture industrial sector

    OpenAIRE

    Rodrigues, Matilde A.

    2014-01-01

    Companies need to constantly make decisions about risk. They need to decide if a certain risk level is low enough or if some measures for its reduction are still needed. In this regard, risk assessment appears as a basis for the decision-making about risks. However, risk acceptance is an important issue related to the risk assessment process, which may put into question its appropriateness. Despite the importance of risk acceptance, this subject is insufficiently discussed in the literature r...

  7. Endocrine disrupting pesticides: implications for risk assessment.

    Science.gov (United States)

    McKinlay, R; Plant, J A; Bell, J N B; Voulvoulis, N

    2008-02-01

    Endocrine disrupting (ED) chemicals are compounds that alter the normal functioning of the endocrine system, potentially causing disease or deformity in organisms and their offspring. Pesticides are used widely to kill unwanted organisms in crops, public areas, homes and gardens and medicinally to kill parasites. Many are proven or suspected to be EDs. Ancient physiological similarities between different vertebrate groups suggest that disorders observed in wildlife may indicate risks to humans. This makes accurate risk assessment and effective legislation difficult. In this paper, the hazardous properties of pesticides which are known to have ED properties are reviewed in order to assess the implications for risk assessment. As well as data on sources of exposure in the United Kingdom (UK) an assessment of the evidence on the health effects of ED pesticides is also included. In total, 127 have been identified from the literature and their effects and modes of action are listed in this paper. Using the UK as a case study, the types and quantities of pesticides used, and their methods of application are assessed, along with their potential pathways to humans. In the UK reliable data are available only for agricultural use, so non-agricultural routes of pesticide exposure have been poorly quantified. The exposure of people resident in or visiting rural areas could also have been grossly under-estimated. Material links between ED pesticide use and specific illnesses or deformities are complicated by the multifactorial nature of disease, which can be affected by factors such as diet. Despite these difficulties, a large body of evidence has accumulated linking specific conditions to ED pesticides in wildlife and humans. A more precautionary approach to the use of ED pesticides, especially for non-essential purposes is proposed.

  8. ECOLOGICAL RISK ASSESSMENT IN THE REGULATED WATERCOURSES

    Directory of Open Access Journals (Sweden)

    Elżbieta Bondar-Nowakowska

    2015-11-01

    Full Text Available Ecological risk has not been identified well enough for the designers and contractors to take any actions for its limitation. It results from the lack of the basis formed to assess its level objectively. The aim of this study was to determine the standards useful in the evaluation of the ecological risk for aquatic plants in rivers, where it is planned to conduct regulatory works. The basis for the analysis were the results of the study performed in 2008–2014 in unmodified and transformed lowland watercourses in Lower Silesia. 41 study sections were analysed in 11 watercourses. 30 sections were located in regulated watercourses, while 11 were in unmodified streams. The research included vascular aquatic plants identification and the degree of the bottom coverage by these plants. As a result of regulatory works qualitative and quantitative changes in aquatic plants communities were observed. The analysis of these changes concerning the range and conditions of works conduction enabled assigning measures to the factors of the considered risk. It served as a basis for describing the risk register and the matrix of risk. The study demonstrated that the most important threats resulting from the river regulation from the point of view of environmental protection are complete shading of watercourse bed, and in some cases, bed widening and deepening, embankments slope of 1: 1, 1: 0, embankments protection with stone material or their concreting.

  9. Risk Factor Analyses for the Return of Spontaneous Circulation in the Asphyxiation Cardiac Arrest Porcine Model

    Directory of Open Access Journals (Sweden)

    Cai-Jun Wu

    2015-01-01

    Full Text Available Background: Animal models of asphyxiation cardiac arrest (ACA are frequently used in basic research to mirror the clinical course of cardiac arrest (CA. The rates of the return of spontaneous circulation (ROSC in ACA animal models are lower than those from studies that have utilized ventricular fibrillation (VF animal models. The purpose of this study was to characterize the factors associated with the ROSC in the ACA porcine model. Methods: Forty-eight healthy miniature pigs underwent endotracheal tube clamping to induce CA. Once induced, CA was maintained untreated for a period of 8 min. Two minutes following the initiation of cardiopulmonary resuscitation (CPR, defibrillation was attempted until ROSC was achieved or the animal died. To assess the factors associated with ROSC in this CA model, logistic regression analyses were performed to analyze gender, the time of preparation, the amplitude spectrum area (AMSA from the beginning of CPR and the pH at the beginning of CPR. A receiver-operating characteristic (ROC curve was used to evaluate the predictive value of AMSA for ROSC. Results: ROSC was only 52.1% successful in this ACA porcine model. The multivariate logistic regression analyses revealed that ROSC significantly depended on the time of preparation, AMSA at the beginning of CPR and pH at the beginning of CPR. The area under the ROC curve in for AMSA at the beginning of CPR was 0.878 successful in predicting ROSC (95% confidence intervals: 0.773∼0.983, and the optimum cut-off value was 15.62 (specificity 95.7% and sensitivity 80.0%. Conclusions: The time of preparation, AMSA and the pH at the beginning of CPR were associated with ROSC in this ACA porcine model. AMSA also predicted the likelihood of ROSC in this ACA animal model.

  10. Relationships Between Animal Health Monitoring and the Risk Assessment Process

    Directory of Open Access Journals (Sweden)

    Salman MD

    2001-03-01

    Full Text Available Risk assessment is part of the risk analysis process as it is used in veterinary medicine to estimate risks related to international trade and food safety. Data from monitoring and surveillance systems (MO&SS are used throughout the risk assessment process for hazard identification, release assessment, exposure assessment and consequence assessment. As the quality of risk assessments depends to a large extent on the availability and quality of input data, there is a close relationship between MO&SS and risk assessment. In order to improve the quality of risk assessments, MO&SS should be designed according to minimum quality standards. Second, recent scientific developments on state-of-the-art design and analysis of surveys need to be translated into field applications and legislation. Finally, knowledge about the risk assessment process among MO&SS planners and managers should be promoted in order to assure high-quality data.

  11. Incidence and risk factors of nosocomial infections after cardiac surgery in Georgian population with congenital heart diseases.

    Science.gov (United States)

    Lomtadze, M; Chkhaidze, M; Mgeladze, E; Metreveli, I; Tsintsadze, A

    2010-01-01

    Nosocomial infections still remain a serious problem in patients undergoing open heart surgery. The aim of the study was to determine the incidence, etiology and main risk factors of nosocomial infections (NI) following cardiac surgery in congenital heart diseases population. Retrospective case study was conducted. 387 patients with congenital heart disease (CHD), who underwent cardiac surgery from January 2007 to December 2008 were studied. The age of the most patients varied between 1 day to 15 years, 73 patients (18,8%) were older than 15 years. All 387 patients underwent cardiac surgery. The rate of NI was 16%. The most common infections were bloodstream infections (BSI) (7,75%) and respiratory tract infections (7%) respectively. The rate of NI was higher in patients under 1 year of age, after urgent surgery and urgent reoperation, long cardiopulmonary bypass (CPB) and aortic cross-clamp time, also in patients with prolonged mechanical ventilation, massive haemotransfusion, with open heart bone after surgery, reintubation, hospitalization in another hospital during last three month. It was concluded that the most common nosocomial infection after cardiac surgery congenital heart diseases in Georgian population was blood stream infection. The main risk factors of NI in the same setting were age under 1 year, urgent surgery, urgent reoperation, long CPB and aortic cross-clamp time, long duration of mechanical ventilation, massive haemotransfusion, open heart bone after surgery, reintubation, hospitalization in another hospital during last three month.

  12. Quantitative assessment of myocardial blush grade in patients with coronary artery disease and in cardiac transplant recipients

    Institute of Scientific and Technical Information of China (English)

    Nina; Patricia; Hofmann; Hartmut; Dickhaus; Hugo; A; Katus; Grigorios; Korosoglou

    2014-01-01

    Quantitative assessment of myocardial perfusion by myocardial blush grade(MBG) is an angiographic computer-assisted method to assess myocardial tissue-level reperfusion in patients with acute coronary syndromes and microvascular integrity in heart transplant recipients with suspected cardiac allograft vasculopathy. This review describes the ability of quantitative MBG as a simple, fast and cost effective modality for the prompt diagnosis of impaired microvascular integrity during routine cardiac catheterization. Herein, we summarize the existing evidence, its usefulness in the clinical routine, and compare this method to other techniques which can be used for the assessment of myocardial perfusion.

  13. Visual Impairment/Intracranial Pressure Risk Assessment

    Science.gov (United States)

    Fogarty, Jennifer A.; Durham, T.; Otto, C.; Grounds, D.; Davis, J. R.

    2010-01-01

    Since 2006 there have been 6 reported cases of altered visual acuity and intracranial pressure (ICP) in long duration astronauts. In order to document this risk and develop an integrated approach to its mitigation, the NASA Space Life Sciences Directorate (SLSD) and Human Research Program (HRP) have chosen to use the Human System Risk Board (HSRB) and the risk management analysis tool (RMAT). The HSRB is the venue in which the stakeholders and customers discuss and vet the evidence and the RMAT is the tool that facilitates documentation and comparison of the evidence across mission profiles as well as identification of risk factors, and documentation of mitigation strategies. This process allows for information to be brought forward and dispositioned so that it may be properly incorporated into the RMAT and contribute to the design of the research and mitigation plans. The evidence thus far has resulted in the identification of a visual impairment/intracranial pressure (VIIP) project team, updating of both short and long duration medical requirements designed to assess visual acuity, and a research plan to characterize this issue further. In order to understand this issue more completely, a plan to develop an Accelerated Research Collaboration (ARC) has been approved by the HSRB. The ARC is a novel research model pioneered by the Myelin Repair Foundation. It is a patient centered research model that brings together researchers and clinicians, under the guidance of a scientific advisory panel, to collaborate and produce results much quickly than accomplished through traditional research models. The data and evidence from the updated medical requirements and the VIIP ARC will be reviewed at the HSRB on a regular basis. Each review package presented to the HSRB will include an assessment and recommendation with respect to continuation of research, countermeasure development, occupational surveillance modalities, selection criteria, etc. This process will determine the

  14. Radiographic assessment of the cardiac silhouette in clinically normal large- and small-breed dogs.

    Science.gov (United States)

    Mostafa, Ayman A; Berry, Clifford R

    2017-02-01

    OBJECTIVE To determine manubrium heart scores (MHSs) from measurements of cardiac short-axis length (cSAL) and long-axis length (cLAL) relative to the corresponding manubrium length (ML) on thoracic radiographic views of dogs and assess correlation of MHSs with vertebral heart scores (VHSs). ANIMALS 120 clinically normal large-breed dogs (LBDs) and small-breed dogs (SBDs). PROCEDURES On right lateral views (RLVs) and ventrodorsal views (VDVs) for each dog, cSAL and cLAL were measured and expressed as a ratio; the cSAL:ML ratio (short-MHS), cLAL:ML ratio (long-MHS), and cSAL-and-cLAL:ML ratio (overall-MHS) were also calculated. The VHS was determined from the RLV. Correlation of VHS with MHS was assessed. RESULTS On RLVs and VDVs, mean cSAL:cLAL ratios were 0.77 (SD, 0.05) and 0.72 (SD, 0.05), respectively, in 60 LBDs and 0.81 (SD, 0.06) and 0.78 (SD, 0.06), respectively, in 60 SBDs. In LBDs, mean short-MHS, long-MHS, and overall-MHS were 2.1 (SD, 0.22), 2.7 (SD, 0.24), and 4.8 (SD, 0.5), respectively, on RLVs and 2.3 (SD, 0.26), 3.2 (SD, 0.34), and 5.4 (SD, 0.6), respectively, on VDVs. In SBDs, mean short-MHS, long-MHS, and overall-MHS were 2.4 (SD, 0.39), 2.9 (SD, 0.50), and 5.3 (SD, 0.83), respectively, on RLVs and 2.5 (SD, 0.44), 3.2 (SD, 0.51), and 5.8 (SD, 0.92), respectively, on VDVs. Mean VHSs were 10.73 (SD, 0.52) and 10.27 (SD, 0.81) in LBDs and SBDs, respectively. A significant correlation was identified between VHS and each MHS in LBDs. CONCLUSIONS AND CLINICAL RELEVANCE In the dogs evaluated, radiographic cardiac dimensions and MHSs were correlated. Validity of the MHS for cardiac dimension assessment in other healthy dogs and dogs with cardiac disease warrants investigation.

  15. 斑点追踪技术预测急性心肌梗死患者再发心血管事件及死亡风险的随访研究%Risk prediction of cardiac events and cardiac death after acute myocardial infarction by speckle tracking ;imaging:a long-term follow-up study

    Institute of Scientific and Technical Information of China (English)

    胡波; 周青; 宋宏宁; 谭团团; 曹省; 郭瑞强

    2015-01-01

    AMI patients with and without cardiac events and cardiac death during long-term follow-up.Compared to patients without cardiac events during follow-up,LPSS and CPSS (P <0.001)of patients with cardiac events were relatively lower and the prognostic value of CPSS (HR=1 .4096)for the recurrence risk of cardiac events was better.For the risk prediction of cardiac death,LPSS ( P <0.001,HR=1.5735)was relatively better.Conclusions Left ventricular functional reservation and damage after AMI were accurately assessed by STI,which helped predicted the recurrence risk of cardiac events and cardiac death of AMI patients.CPSS and LPSS were optimal indicators for the prediction of cardiac events and cardiac death,respectively.

  16. Spent Nuclear Fuel Alternative Technology Risk Assessment

    Energy Technology Data Exchange (ETDEWEB)

    Perella, V.F.

    1999-11-29

    A Research Reactor Spent Nuclear Fuel Task Team (RRTT) was chartered by the Department of Energy (DOE) Office of Spent Fuel Management with the responsibility to recommend a course of action leading to a final technology selection for the interim management and ultimate disposition of the foreign and domestic aluminum-based research reactor spent nuclear fuel (SNF) under DOE''s jurisdiction. The RRTT evaluated eleven potential SNF management technologies and recommended that two technologies, direct co-disposal and an isotopic dilution alternative, either press and dilute or melt and dilute, be developed in parallel. Based upon that recommendation, the Westinghouse Savannah River Company (WSRC) organized the SNF Alternative Technology Program to further develop the direct co-disposal and melt and dilute technologies and provide a WSRC recommendation to DOE for a preferred SNF alternative management technology. A technology risk assessment was conducted as a first step in this recommendation process to determine if either, or both, of the technologies posed significant risks that would make them unsuitable for further development. This report provides the results of that technology risk assessment.

  17. Environmental risk assessment in GMO analysis.

    Science.gov (United States)

    Pirondini, Andrea; Marmiroli, Nelson

    2010-01-01

    Genetically modified or engineered organisms (GMOs, GEOs) are utilised in agriculture, expressing traits of interest, such as insect or herbicide resistance. Soybean, maize, cotton and oilseed rape are the GM crops with the largest acreage in the world. The distribution of GM acreage in the different countries is related with the different positions concerning labelling of GMO products: based on the principle of substantial equivalence, or rather based on the precautionary principle. The paper provides an overview on how the risks associated with release of GMO in the environments can be analysed and predicted, in view of a possible coexistence of GM and non-GM organisms in agriculture.Risk assessment procedures, both qualitative and quantitative, are compared in the context of application to GMOs considering also legislation requirements (Directive 2001/18/EC). Criteria and measurable properties to assess harm for human health and environmental safety are listed, and the possible consequences are evaluated in terms of significance.Finally, a mapping of the possible risks deriving from GMO release is reported, focusing on gene transfer to related species, horizontal gene transfer, direct and indirect effects on non target organisms, development of resistance in target organisms, and effects on biodiversity.

  18. Risk assessment of poultry sloughterhouses in Albania

    Directory of Open Access Journals (Sweden)

    ROVENA JAHELEZI

    2014-06-01

    Full Text Available The aim of this study is to assess the risk of poultry slaughterhouses in order to achieve a better official inspection. Study is taking place in 5 poultry slaughterhouses in Albania. The study was conducted through two tasks: poultry slaughterhouses classification related to the risk assessment based on the characteristics of the plant, product characteristics, production, hygiene processes, HACCP, and on the identification of presence of Salmonella spp in the slaughterhouse environment and in the final product. In every slaughterhouse, inspections are performed every 3 months, by completing the appropriate checklist using point’s evaluation. The results show that 5 slaughterhouses resulted in high risk (over 42 points. The detection of Salmonella spp in poultry carcasses is based on ISO 6579: 2002 method. 25 meat samples were analyzed in total where, out of which only one sample resulted with the presence of Salmonella spp in 25 gr. These results are due to an inappropriate Hygienic Practice, Manufacturing Practice and show that HACCP isnotimplementedrigorously.

  19. 77 FR 28406 - Spent Fuel Transportation Risk Assessment

    Science.gov (United States)

    2012-05-14

    ... COMMISSION Spent Fuel Transportation Risk Assessment AGENCY: Nuclear Regulatory Commission. ACTION: Draft... issuing for public comment a draft NUREG, NUREG-2125, ``Spent Fuel Transportation Risk Assessment (SFTRA...): You may access publicly-available documents online in the NRC Library at...

  20. Risk assessment of power systems models, methods, and applications

    CERN Document Server

    Li, Wenyuan

    2014-01-01

    Risk Assessment of Power Systems addresses the regulations and functions of risk assessment with regard to its relevance in system planning, maintenance, and asset management. Brimming with practical examples, this edition introduces the latest risk information on renewable resources, the smart grid, voltage stability assessment, and fuzzy risk evaluation. It is a comprehensive reference of a highly pertinent topic for engineers, managers, and upper-level students who seek examples of risk theory applications in the workplace.

  1. Harmonization of international risk assessment protocol

    Energy Technology Data Exchange (ETDEWEB)

    Toyofuku, Hajime [Food Safety Department, WHO, Geneva (Switzerland)]. E-mail toyofuku@nihs.go.jp

    2006-07-01

    For over centuries developments in food production and new food safety management systems in most developed countries have been perceived by many to be efficient in the prevention of food-borne disease. Nevertheless a number of problems remain dominant, one of these being the high level of food-borne microbiological disease which seems, for some pathogens, to have increased over the last decades. The development of an interdisciplinary approach with direct interaction between surveillance and risk analysis systems is described as a potential basis for improved prevention of food-borne disease. Quantitative microbiological risk assessment is a relatively new scientific approach, able to link data from food within the entire food chain and the various data on human disease to provide a clear estimation of risk. Today food safety is one of the WHOs top eleven priorities; the Organization calls for more systematic and aggressive steps to be taken to reduce significantly the risk of microbiological food-borne diseases. Dealing with this challenge is one of the major challenges for the 21st century in regard to food safety, implying a significant re-direction of food microbiology efforts in many parts of the world.

  2. China Patient-centered Evaluative Assessment of Cardiac Events Prospective Study of Acute Myocardial Infarction:Study Design

    Institute of Scientific and Technical Information of China (English)

    Jing Li; Rachel P Dreyer; Xi Li; Xue Du; Nicholas S Downing; Li Li; Hai-Bo Zhang

    2016-01-01

    Background: Despite the rapid growth in the incidence of acute myocardial infarction (AMI) in China, there is limited information about patients' experiences after AMI hospitalization, especially on long-term adverse events and patient-reported outcomes (PROs).Methods: The China Patient-centered Evaluative Assessment of Cardiac Events (PEACE)-Prospective AMI Study will enroll 4000 consecutive AMI patients from 53 diverse hospitals across China and follow them longitudinally for 12 months to document their treatment, recovery, and outcomes.Details of patients' medical history, treatment, and in-hospital outcomes are abstracted from medical charts.Comprehensive baseline interviews are being conducted to characterize patient demographics, risk factors, presentation, and healthcare utilization.As part of these interviews, validated instruments are administered to measure PROs, including quality of life, symptoms, mood, cognition, and sexual activity.Follow-up interviews, measuring PROs, medication adherence, risk factor control, and collecting hospitalization events are conducted at 1, 6, and 12 months after discharge.Supporting documents for potential outcomes are collected for adjudication by clinicians at the National Coordinating Center.Blood and urine samples are also obtained at baseline, 1-and 12-month follow-up.In addition, we are conducting a survey of participating hospitals to characterize their organizational characteristics.Conclusion: The China PEACE-Prospective AMI study will be uniquely positioned to generate new information regarding patient's experiences and outcomes after AMI in China and serve as a foundation for quality improvement activities.

  3. Flood risk assessment: concepts, modelling, applications

    Directory of Open Access Journals (Sweden)

    G. Tsakiris

    2014-01-01

    Full Text Available Natural hazards have caused severe consequences to the natural, modified and human systems, in the past. These consequences seem to increase with time due to both higher intensity of the natural phenomena and higher value of elements at risk. Among the water related hazards flood hazards have the most destructive impacts. The paper presents a new systemic paradigm for the assessment of flood hazard and flood risk in the riverine flood prone areas. Special emphasis is given to the urban areas with mild terrain and complicated topography, in which 2-D fully dynamic flood modelling is proposed. Further the EU flood directive is critically reviewed and examples of its implementation are presented. Some critical points in the flood directive implementation are also highlighted.

  4. Risk Assessment in Advanced Engineering Design

    Directory of Open Access Journals (Sweden)

    M. Holický

    2003-01-01

    Full Text Available Traditional methods for designing of civil engineering structures and other engineering systems are frequently based on the concept of target probability of failure. However, this fundamental quantity is usually specified on the basis of comparative studies and past experience only. Moreover, probabilistic design methods suffer from several deficiencies, including lack of consideration for accidental and other hazard situations and their consequences. Both of these extreme conditions are more and more frequently becoming causes of serious failures and other adverse events. Available experience clearly indicates that probabilistic design procedures may be efficiently supplemented by a risk analysis and assessment, which can take into account various consequences of unfavourable events. It is therefore anticipated that in addition to traditional probabilistic concepts the methods of advanced engineering design will also commonly include criteria for acceptable risks.

  5. Risk assessment of soybean-based phytoestrogens.

    Science.gov (United States)

    Kwack, Seung Jun; Kim, Kyu-Bong; Kim, Hyung Sik; Yoon, Kyung Sil; Lee, Byung Mu

    2009-01-01

    Koreans generally consume high quantities of soybean-based foods that contain a variety of phytoestrogens, such as, daidzein, zenistein, and biochalin A. However, phytoestrogens are considered to be potential endocrine-disrupting chemicals (EDC), which interfere with the normal function of the hormonal and reproductive systems. Therefore, dietary exposure to soybean-based phytoestrogens is of concern for Koreans, and comparative dietary risk assessments are required between Japanese (high consumers) versus Americans (low consumers). In this study, a relative risk assessment was conducted based upon daily intake levels of soybean-based foods and phytoestrogens in a Korean cohort, and the risks of photoestrogens were compared with those posed by estradiol and other EDC. Koreans approximately 30-49 yr of age consume on average a total of 135.2 g/d of soy-based foods including soybean, soybean sauce, soybean paste, and soybean oil, and 0.51 mg/kg body weight (bw)/d of phytoestrogens such as daidzein and genistein. Using estimated daily intakes (EDI) and estrogenic potencies (EP), margins of safety (MOS) were calculated where 0.05 is for estradiol (MOS value estrogenic effect); thus, MOS values of 1.89 for Japanese, 1.96 for Koreans, and 5.55 for Americans indicate that consumption of soybean-based foods exerted no apparent estrogenic effects, as all MOS values were all higher than 1. For other synthetic EDC used as reference values, MOS values were dieldrin 27, nonylphenol 250, butyl benzyl phthalate 321, bisphenol A 1000, biochanin A 2203, and coumesterol 2898. These results suggest that dietary exposure to phytoestrogens, such as daidzein and genistein, poses a relatively higher health risk for humans than synthetic EDC, although MOS values were all greater than 1.

  6. Laboratory Biosafety and Biosecurity Risk Assessment Technical Guidance Document

    Energy Technology Data Exchange (ETDEWEB)

    Astuto-Gribble, Lisa M; Caskey, Susan Adele

    2014-07-01

    The purpose of this document is threefold: 1) to describe the laboratory bio safety and biosecurity risk assessment process and its conceptual framework; 2) provide detailed guidance and suggested methodologies on how to conduct a risk assessment; and 3) present some practical risk assessment process strategies using realistic laboratory scenarios.

  7. 78 FR 23901 - Interagency Risk Assessment-Listeria monocytogenes

    Science.gov (United States)

    2013-04-23

    ... Food Safety and Inspection Service Interagency Risk Assessment--Listeria monocytogenes in Retail... risk assessment (QRA), ``Interagency Risk Assessment--Listeria monocytogenes in Retail Delicatessens... and on the FSIS Web site at http://www.fsis.usda.gov/PDF/Listeria-Transcript_062309.pdf ). II....

  8. Cardiac remodeling following percutaneous mitral valve repair. Initial results assessed by cardiovascular magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Radunski, U.K [University Heart Center, Hamburg (Germany). Cardiology; Franzen, O. [Rigshospitalet, Copenhagen (Denmark). Cardiology; Barmeyer, A. [Klinikum Dortmund (Germany). Kardiologie; and others

    2014-10-15

    Percutaneous mitral valve repair with the MitraClip device (Abbott Vascular, Redwood City, California, USA) is a novel therapeutic option in patients with mitral regurgitation. This study evaluated the feasibility of cardiac volume measurements by cardiovascular magnetic resonance imaging (CMR) to assess reverse myocardial remodeling in patients after MitraClip implantation. 12 patients underwent CMR at baseline (BL) before and at 6 months follow-up (FU) after MitraClip implantation. Cine-CMR was performed in short- and long-axes for the assessment of left ventricular (LV), right ventricular (RV) and left atrial (LA) volumes. Assessment of endocardial contours was not compromised by the device-related artifact. No significant differences in observer variances were observed for LV, RV and LA volume measurements between BL and FU. LV end-diastolic (median 127 [IQR 96-150] vs. 112 [86-150] ml/m{sup 2}; p=0.03) and LV end-systolic (82 [54-91] vs. 69 [48-99] ml/m{sup 2}; p=0.03) volume indices decreased significantly from BL to FU. No significant differences were found for RV end-diastolic (94 [75-103] vs. 99 [77-123] ml/m{sup 2}; p=0.91), RV end-systolic (48 [42-80] vs. 51 [40-81] ml/m{sup 2}; p=0.48), and LA (87 [55-124] vs. 92 [48-137]R ml/m{sup 2}; p=0.20) volume indices between BL and FU. CMR enables the assessment of cardiac volumes in patients after MitraClip implantation. Our CMR findings indicate that percutaneous mitral valve repair results in reverse LV but not in RV or LA remodeling.

  9. Tissue-Doppler assessment of cardiac left ventricular function during short-term adjuvant epirubicin therapy for breast cancer

    DEFF Research Database (Denmark)

    Appel, Jon M; Sogaard, Peter; Mortensen, Christiane E;

    2011-01-01

    It has been hypothesized that the extent of acute anthracycline-induced cardiotoxicity reflects the risk for late development of heart failure. The aim of this study was to examine if short-term changes in cardiac function can be detected even after low-dose adjuvant epirubicin therapy for breast...... cancer when using Doppler tissue imaging of longitudinal left ventricular function....

  10. Risk Assessment tailored to cryogenics - LINDE approach

    CERN Document Server

    CERN. Geneva

    2016-01-01

    The following Risk Assessment Tools will be presented: **HAZID – Hazard Identification Study** Application: if the process contains new applications or provides new challenges (e.g. plant location) Purpose: Identify hazards such as fire/explosion, toxic impact, occupational hazards etc. and assess adequate preventive / mitigation measures **HAZOP – Hazard and Operability Study** Application: for all Projects Purpose: Detailed review of design reflected in the PID to ensure that adequate safeguards are available for all possible process upsets or maloperations. **HAZAN – Hazard Analysis** Application: for all PFHE (plate-fin heat exchangers), CWHE (coil wound heat exchangers) and straight tube sheet heat exchangers Purpose: detailed analysis of the impact of process upset conditions and start-up / shut down scenarios on the lifetime of the heat exchangers – including definition of additional safeguards, if required. **TQR – Technology Qualification Review** Application: for applications...

  11. Applying a weed risk assessment approach to GM crops.

    Science.gov (United States)

    Keese, Paul K; Robold, Andrea V; Myers, Ruth C; Weisman, Sarah; Smith, Joe

    2014-12-01

    Current approaches to environmental risk assessment of genetically modified (GM) plants are modelled on chemical risk assessment methods, which have a strong focus on toxicity. There are additional types of harms posed by plants that have been extensively studied by weed scientists and incorporated into weed risk assessment methods. Weed risk assessment uses robust, validated methods that are widely applied to regulatory decision-making about potentially problematic plants. They are designed to encompass a broad variety of plant forms and traits in different environments, and can provide reliable conclusions even with limited data. The knowledge and experience that underpin weed risk assessment can be harnessed for environmental risk assessment of GM plants. A case study illustrates the application of the Australian post-border weed risk assessment approach to a representative GM plant. This approach is a valuable tool to identify potential risks from GM plants.

  12. A meta-analysis comparing the prognostic accuracy of six diagnostic tests for predicting perioperative cardiac risk in patients undergoing major vascular surgery

    NARCIS (Netherlands)

    M.D. Kertai (Miklos); J.J. Bax (Jeroen); M.H. Heijenbrok-Kal (Majanka); M.G.M. Hunink (Myriam); G.J. L' Italien; H. van Urk (Hero); D. Poldermans (Don); J.R.T.C. Roelandt (Jos); H. Boersma (Eric)

    2003-01-01

    textabstractOBJECTIVE: To evaluate the discriminatory value and compare the predictive performance of six non-invasive tests used for perioperative cardiac risk stratification in patients undergoing major vascular surgery. DESIGN: Meta-analysis of published reports. METHODS: Eight

  13. A predictive model to identify patients with suspected acute coronary syndromes at high risk of cardiac arrest or in-hospital mortality: An IMMEDIATE Trial sub-study

    Directory of Open Access Journals (Sweden)

    Madhab Ray

    2015-12-01

    Conclusions: The multivariable predictive model developed identified patients with very early ACS at high risk of cardiac arrest or death. Using this model could assist treating those with greatest potential benefit from GIK.

  14. CMR Imaging With Rapid Visual T1 Assessment Predicts Mortality in Patients Suspected of Cardiac Amyloidosis

    Science.gov (United States)

    White, James A.; Kim, Han W.; Shah, Dipan; Fine, Nowell; Kim, Ki-Young; Wendell, David C.; Al-Jaroudi, Wael; Parker, Michele; Patel, Manesh; Gwadry-Sridhar, Femida; Judd, Robert M.; Kim, Raymond J.

    2014-01-01

    OBJECTIVES This study tested the diagnostic and prognostic utility of a rapid, visual T1 assessment method for identification of cardiac amyloidosis (CA) in a “real-life” referral population undergoing cardiac magnetic resonance for suspected CA. BACKGROUND In patients with confirmed CA, delayed-enhancement cardiac magnetic resonance (DE-CMR) frequently shows a diffuse, global hyperenhancement (HE) pattern. However, imaging is often technically challenging, and the prognostic significance of diffuse HE is unclear. METHODS Ninety consecutive patients referred for suspected CA and 64 hypertensive patients with left ventricular hypertrophy (LVH) were prospectively enrolled and underwent a modified DE-CMR protocol. After gadolinium administration a method for rapid, visual T1 assessment was used to identify the presence of diffuse HE during the scan, allowing immediate optimization of settings for the conventional DE-CMR that followed. The primary endpoint was all-cause mortality. RESULTS Among patients with suspected CA, 66% (59 of 90) demonstrated HE, with 81% (48 of 59) of these meeting pre-specified visual T1 assessment criteria for diffuse HE. Among hypertensive LVH patients, 6% (4 of 64) had HE, with none having diffuse HE. During 29 months of follow-up (interquartile range: 12 to 44 months), there were 50 (56%) deaths in patients with suspected CA and 4 (6%) in patients with hypertensive LVH. Multivariable analysis demonstrated that the presence of diffuse HE was the most important predictor of death in the group with suspected CA (hazard ratio: 5.5, 95% confidence interval: 2.7 to 11.0; p < 0.0001) and in the population as a whole (hazard ratio: 6.0, 95% confidence interval 3.0 to 12.1; p < 0.0001). Among 25 patients with myocardial histology obtained during follow-up, the sensitivity, specificity, and accuracy of diffuse HE in the diagnosis of CA were 93%, 70%, and 84%, respectively. CONCLUSIONS Among patients suspected of CA, the presence of diffuse HE by

  15. Cardiac Magnetic Resonance-Verified Myocardial Fibrosis in Chagas Disease: Clinical Correlates and Risk Stratification

    Science.gov (United States)

    Uellendahl, Marly; de Siqueira, Maria Eduarda Menezes; Calado, Eveline Barros; Kalil-Filho, Roberto; Sobral, Dário; Ribeiro, Clébia; Oliveira, Wilson; Martins, Silvia; Narula, Jagat; Rochitte, Carlos Eduardo

    2016-01-01

    Background Chagas disease (CD) is an important cause of heart failure and mortality, mainly in Latin America. This study evaluated the morphological and functional characteristics of the heart as well the extent of myocardial fibrosis (MF) in patients with CD by cardiac magnetic resonance (CMR). The prognostic value of MF evaluated by myocardial-delayed enhancement (MDE) was compared with that via Rassi score. Methods This study assessed 39 patients divided into 2 groups: 28 asymptomatic patients as indeterminate form group (IND); and symptomatic patients as Chagas Heart Disease (CHD) group. All patients underwent CMR using the techniques of cine-MRI and MDE, and the amount of MF was compared with the Rassi score. Results Regarding the morphological and functional analysis, significant differences were observed between both groups (p < 0.001). Furthermore, there was a strong correlation between the extent of MF and the Rassi score (r = 0.76). Conclusions CMR is an important technique for evaluating patients with CD, stressing morphological and functional differences in all clinical presentations. The strong correlation with the Rassi score and the extent of MF detected by CMR emphasizes its role in the prognostic stratification of patients with CD. PMID:27982271

  16. Risk assessment by myocardial perfusion imaging for coronary revascularization, medical therapy, and noncardiac surgery.

    Science.gov (United States)

    Papaioannou, Georgios I; Heller, Gary V

    2003-01-01

    Stress myocardial perfusion imaging (MPI) has become an important tool in risk stratification of patients with known coronary artery disease. A normal myocardial perfusion scan has a high negative predictive value and is associated with low annual mortality rate ( 20% of the left ventricle), defects in more than 1 coronary vascular territory, transient or persistent left ventricular cavity dilation, and ejection fraction less than 45% have a high annual mortality rate (> 3%). Those patients should undergo coronary revascularization whenever feasible, as the cardiac event rate increases in proportion to the magnitude of the jeopardized myocardium. Stress MPI can be used to demonstrate ischemia in patients with symptoms early after coronary artery bypass surgery (/= 5 years) after coronary artery bypass surgery. With respect to patients who underwent percutaneous interventions, stress MPI can help detect in-stent restenosis early after the intervention (3-6 months) or assess the progression of native coronary disease afterward. Since preliminary data suggest that a reduction in the perfusion defect size may translate to a reduction of coronary events, stress MPI can help assess the efficacy of medical management of coronary disease. Finally, stress MPI is indicated for perioperative cardiac risk stratification for noncardiac surgery in patients with intermediate risk predictors (mild angina, prior myocardial infarction or heart failure symptoms, diabetes mellitus, renal insufficiency) and poor functional capacity or in those who undergo high-risk surgery with significant implications in further preoperative management.

  17. Risk Assessment Model for Mobile Malware

    Directory of Open Access Journals (Sweden)

    George Stanescu

    2015-03-01

    Full Text Available The mobile technology is considered to be the fastest-developing IT security area. Only in the last year security threats around mobile devices have reached new heights in terms of both quality and quantity. The speed of this development has made possible several types of security attacks that, until recently, were only possible on computers. In terms of the most targeted mobile operating systems, Android continues to be the most vulnerable, although new ways of strengthening its security model were introduced by Google. The aim of this article is to provide a model for assessing the risk of mobile infection with malware, starting from a statistical analysis of the permissions required by each application installed into the mobile system. The software implementation of this model will use the Android operating system and in order to do so, we will start by analyzing its permission-based security architecture. Furthermore, based on statistical data regarding the most dangerous permissions, we build the risk assessment model and, to prove its efficiency, we scan some of the most popular apps and interpret the results. To this end, we offer an overview of the strengths and weaknesses of this permission-based model and we also state a short conclusion regarding model’s efficiency.

  18. Assessing risk factors for periodontitis using regression

    Science.gov (United States)

    Lobo Pereira, J. A.; Ferreira, Maria Cristina; Oliveira, Teresa

    2013-10-01

    Multivariate statistical analysis is indispensable to assess the associations and interactions between different factors and the risk of periodontitis. Among others, regression analysis is a statistical technique widely used in healthcare to investigate and model the relationship between variables. In our work we study the impact of socio-demographic, medical and behavioral factors on periodontal health. Using regression, linear and logistic models, we can assess the relevance, as risk factors for periodontitis disease, of the following independent variables (IVs): Age, Gender, Diabetic Status, Education, Smoking status and Plaque Index. The multiple linear regression analysis model was built to evaluate the influence of IVs on mean Attachment Loss (AL). Thus, the regression coefficients along with respective p-values will be obtained as well as the respective p-values from the significance tests. The classification of a case (individual) adopted in the logistic model was the extent of the destruction of periodontal tissues defined by an Attachment Loss greater than or equal to 4 mm in 25% (AL≥4mm/≥25%) of sites surveyed. The association measures include the Odds Ratios together with the correspondent 95% confidence intervals.

  19. Predictive value of assessing diastolic strain rate on survival in cardiac amyloidosis patients with preserved ejection fraction.

    Directory of Open Access Journals (Sweden)

    Dan Liu

    Full Text Available Since diastolic abnormalities are typical findings of cardiac amyloidosis (CA, we hypothesized that speckle-tracking-imaging (STI derived longitudinal early diastolic strain rate (LSRdias could predict outcome in CA patients with preserved left ventricular ejection fraction (LVEF >50%.Diastolic abnormalities including altered early filling are typical findings and are related to outcome in CA patients. Reduced longitudinal systolic strain (LSsys assessed by STI predicts increased mortality in CA patients. It remains unknown if LSRdias also related to outcome in these patients.Conventional echocardiography and STI were performed in 41 CA patients with preserved LVEF (25 male; mean age 65±9 years. Global and segmental LSsys and LSRdias were obtained in six LV segments from apical 4-chamber views.Nineteen (46% out of 41 CA patients died during a median of 16 months (quartiles 5-35 months follow-up. Baseline mitral annular plane systolic excursion (MAPSE, 6 ± 2 vs. 8 ± 3 mm, global LSRdias and basal-septal LSRdias were significantly lower in non-survivors than in survivors (all p < 0.05. NYHA class, number of non-cardiac organs involved, MAPSE, mid-septal LSsys, global LSRdias, basal-septal LSRdias and E/LSRdias were the univariable predictors of all-cause death. Multivariable analysis showed that number of non-cardiac organs involved (hazard ratio [HR] = 1.96, 95% confidence interval [CI] 1.17-3.26, P = 0.010, global LSRdias (HR = 7.30, 95% CI 2.08-25.65, P = 0.002, and E/LSRdias (HR = 2.98, 95% CI 1.54-5.79, P = 0.001 remained independently predictive of increased mortality risk. The prognostic performance of global LSRdias was optimal at a cutoff value of 0.85 S-1 (sensitivity 68%, specificity 67%. Global LSRdias < 0.85 S-1 predicted a 4-fold increased mortality in CA patients with preserved LVEF.STI-derived early diastolic strain rate is a powerful independent predictor of survival in CA patients with preserved LVEF.

  20. Assessment and insurance risk of foreign economic activity: accounting aspect

    Directory of Open Access Journals (Sweden)

    S.V. Susyuk

    2015-06-01

    Full Text Available Based on research approaches to risk positioning grounded classification of risks arising in foreign trade activity. Deals with issues of assessment and insurance risks expediency display your losses from them. To reduce the negative impact of risks the theoretical foundations of security and practical advice with his reflection in the system of accounts. Grounded algorithm to select the most suitable method of risk assessment and constructed flowchart automation choice method for assessing the risk of foreign trade. The expediency of development of self-insurance risks of foreign economic activity.

  1. Physical characterization of MMVF for risk assessment.

    Science.gov (United States)

    Schneider, T

    1995-10-01

    Size and other physical properties of MMVF play a central role in risk assessment. They can be affected by, for example, conditions during manufacturing, and preparation prior to administration to experimental animals or cells. It is suggested that a necessary requirement for stating that an experiment has been repeated should be documented evidence that: (i) the administered fibres are alike when analysed with not less than a minimum number of well-established methods on single fibre and on bulk sample level; and (ii) doses must be equal, and the fibre concentrations and sizes at the primary target tissue must be documented. Assessment of fibre toxicity and assessment of potential for exposure are equally important in the risk assessment process. The physics of fibrous dust release is described and methods for a priori assessment of exposure are classified into three levels depending on the analytical effort involved: (1) direct analysis of the fibrous bulk material; (2) bench-scale test; and (3) full-scale tests of prefabricated insulation material in a test room during standardized insulation work. For the first method, two approaches are investigated. One relates the size-dependent measures (the mass of fibres with D fractions (the fraction of total fibre length with D fraction of WHO fibre number, and the fraction of fibre number with D fractions only range up to 2 orders of magnitude and are almost independent on GSD(D) for nominal diameters ranging 2-4 microns. The combined effect on exposure of bulk fibre size, and of addition of oil and binder, should be assessed by the rotating drum dustiness test. The gold standard test of prefabricated MMVF products should be a full-scale simulation. The slope of the curve relating overall average product nominal diameter and airborne fibre concentrations on a log-log scale [Esmen et al., Am. ind. Hyg. Ass.J. 40, 108-117 (1979)] has been confirmed on a qualitative basis using model calculations, so that this relation

  2. Echocardiographic and phonocardiographic assessment of the St. Jude cardiac valve prosthesis.

    Science.gov (United States)

    DePace, N L; Kotler, M N; Mintz, G S; Lichtenberg, R; Goel, I P; Segal, B L

    1981-09-01

    Forty-three consecutive patients with a St. Jude mitral, aortic, or combined prosthesis were studied by simultaneous phonocardiography and echocardiography. Twenty-eight patients had a mitral prosthesis, 20 an aortic prosthesis, and five had both. No opening click was recorded in any patient; however, a loud aortic or mitral closing click was recorded in all 43 patients. In patients with St. Jude mitral valve prosthesis, an echo-free space separated the two leaflets during diastole; seven of these also had a mid-diastolic closing and late diastolic reopening motion; two of the seven had an associated closing mid-diastolic click. A mid-diastolic rumble was recorded in six of 28 patients with St. Jude mitral valve prosthesis. In patients with a St. Jude aortic valve prosthesis, left atrium leaflet motion was recorded in 17 of 20 patients and was indistinguishable in appearance from echocardiograms obtained with various eccentric monocusp valves. In addition, we report one case of malfunction of a St. Jude mitral valve and one case of a paravalvular leak diagnosed by echophonocardiography. We concluded that the St. Jude cardiac prosthesis has variable normal phonocardiographic-echocardiographic patterns. Knowledge of these variable patterns is important in assessing patients with suspected malfunction of a St. Jude cardiac prosthesis.

  3. Assessing cardiac preload by the Initial Systolic Time Interval obtained from impedance cardiography

    Directory of Open Access Journals (Sweden)

    Jan H Meijer

    2010-01-01

    Full Text Available The Initial Systolic Time Interval (ISTI, obtained from the electrocardiogram (ECG and impedance cardiogram (ICG, is considered to be a measure for the time delay between the electrical and mechanical activity of the heart and reflects an early active period of the cardiac cycle. The clinical relevance of this time interval is subject of study. This paper presents preliminary results of a pilot study investigating the use of ISTI in evaluating and predicting the circulatory response to fluid administration in patients after coronary artery bypass graft surgery, by comparing ISTI with cardiac output (CO responsiveness. Also the use of the pulse transit time (PTT, earlier recommended for this purpose, is investigated. The results show an inverse relationship between ISTI and CO at all moments of fluid administration and also an inverse relationship between the changes ΔISTI and ΔCO before and after full fluid administration. No relationships between PTT and CO or ΔPTT and ΔCO were found. It is concluded that ISTI is dependent upon preload, and that ISTI has the potential to be used as a clinical parameter assessing preload.

  4. Infection and rejection risk after cardiac transplantation with induction vs. no induction: a multi-institutional study.

    Science.gov (United States)

    Mazimba, Sula; Tallaj, Jose A; George, James F; Kirklin, James K; Brown, Robert N; Pamboukian, Salpy V

    2014-09-01

    Data from Cardiac Transplant Research Database (CTRD) were analyzed from 1999 to 2006 to examine the effects of different induction strategies at the time of cardiac transplantation. A total of 2090 primary heart transplants were categorized by induction with interleukin-2 receptor blocker (IL-2RB), antithymocyte globulin (ATG), or no induction (NI). Probabilities for rejection and infection were estimated with parametric time-related models. Using these models, hazard was calculated for two theoretical patient profiles, one at lower risk for rejection and higher risk of infection (Profile 1) and higher risk for rejection and lower risk of infection (Profile 2). Of the 2090 transplants, 49.8% (1095) did not receive induction, 27.3% (599) received IL-2RB, and 18.0% (396) received ATG. Profile 1 patients had lower hazard for rejection with IL-2RB compared to ATG and NI (p infection (5.0 vs. 1.8 vs. 1.6, respectively, at four wk, p infection, IL-2RB reduced risk of rejection but at the expense of increased hazard for infection.

  5. Assessing the Invasion Risk of Eucalyptus in the United States Using the Australian Weed Risk Assessment

    Directory of Open Access Journals (Sweden)

    Doria R. Gordon

    2012-01-01

    Full Text Available Many agricultural species have undergone selection for traits that are consistent with those that increase the probability that a species will become invasive. However, the risk of invasion may be accurately predicted for the majority of plant species tested using the Australian Weed Risk Assessment (WRA. This system has been tested in multiple climates and geographies and, on average, correctly identifies 90% of the major plant invaders as having high invasion risk, and 70% of the noninvaders as having low risk. We used this tool to evaluate the invasion risk of 38 Eucalyptus taxa currently being tested and cultivated in the USA for pulp, biofuel, and other purposes. We predict 15 taxa to have low risk of invasion, 14 taxa to have high risk, and 9 taxa to require further information. In addition to a history of naturalization and invasiveness elsewhere, the traits that significantly contribute to a high invasion risk conclusion include having prolific seed production and a short generation time. Selection against these traits should reduce the probability that eucalypts cultivated in the USA will become invasive threats to natural areas and agricultural systems.

  6. [Regional atmospheric environment risk source identification and assessment].

    Science.gov (United States)

    Zhang, Xiao-Chun; Chen, Wei-Ping; Ma, Chun; Zhan, Shui-Fen; Jiao, Wen-Tao

    2012-12-01

    Identification and assessment for atmospheric environment risk source plays an important role in regional atmospheric risk assessment and regional atmospheric pollution prevention and control. The likelihood exposure and consequence assessment method (LEC method) and the Delphi method were employed to build a fast and effective method for identification and assessment of regional atmospheric environment risk sources. This method was applied to the case study of a large coal transportation port in North China. The assessment results showed that the risk characteristics and the harm degree of regional atmospheric environment risk source were in line with the actual situation. Fast and effective identification and assessment of risk source has laid an important foundation for the regional atmospheric environmental risk assessment and regional atmospheric pollution prevention and control.

  7. Ecological Risk Assessment of Genetically Modified Higher Plants (GMHP)

    DEFF Research Database (Denmark)

    Kjær, C.; Damgaard, C.; Kjellsson, G.

    of the project Biotechnology: elements in environmental risk assessment of genetically modified plants. December 1999 Christian Kjær Introduction In ecological risk assessment of transgenic plants, information on a wide range of subjects is needed for an effective and reliable assessment procedure...... the actual risk assessment procedures and the risk evaluation, which must proceed the data collection. The report use the terminology ecological risk assessment rather than environmental risk assessment because at present this work does not include bio-geochemical effects and environmental impacts from...... for uncertainties in the extrapolation from limited laboratory studies to the species rich field environment. The relationship between the size of the safety factor and the number of species is therefore an issue of the risk assessment. Some of the issues raised in this report overlap with data needs...

  8. Ecological risk assessment conceptual model formulation for nonindigenous species.

    Science.gov (United States)

    Landis, Wayne G

    2004-08-01

    This article addresses the application of ecological risk assessment at the regional scale to the prediction of impacts due to invasive or nonindigenous species (NIS). The first section describes risk assessment, the decision-making process, and introduces regional risk assessment. A general conceptual model for the risk assessment of NIS is then presented based upon the regional risk assessment approach. Two diverse examples of the application of this approach are presented. The first example is based upon the dynamics of introduced plasmids into bacteria populations. The second example is the application risk assessment approach to the invasion of a coastal marine site of Cherry Point, Washington, USA by the European green crab. The lessons learned from the two examples demonstrate that assessment of the risks of invasion of NIS will have to incorporate not only the characteristics of the invasive species, but also the other stresses and impacts affecting the region of interest.

  9. Cardiac surgery-associated acute kidney injury in a developing country: Prevalence, risk factors and outcome.

    Science.gov (United States)

    Ekure, Ekanem Nsikak; Esezobor, Christopher Imokhuede; Sridhar, Anuradha; Vasudevan, Jyothi; Subramanyan, Rajhavan; Cherian, Kotturathu Mammen

    2015-01-01

    Little is known about cardiac surgery-associated acute kidney injury (CS-AKI) in children in developing regions of the world. The study aimed to determine the prevalence of CSAKI, associated factors and its impact on mortality and utilization of hospital services. The hospital records of children aged 0-17 years who underwent CS at an Indian hospital were reviewed. CS-AKI was defined as a rise in serum creatinine of ≥0.3 mg/dL in any 48 h and or by urine output CS. The study included 323 children with a median age of one year (0.04-17), of whom 22 (6.8%) were neonates and 18.3% had a single ventricle. About 60% of the children had Risk Adjusted Congenital Heart Surgery-I category 1 or 2 interventions. CS-AKI occurred in 39 children (12.1%). Factors associated with CS-AKI were sepsis and intraand post-operative hypotension. In-hospital mortality was six-fold higher in children who developed CS-AKI. CS-AKI was associated with two to three days more of mechanical ventilation and Intensive care unit stay. CS-AKI occurs in children in developing countries, but at a lower frequency mainly due to the predominance of post-neonatal children undergoing less-complex CSs. CS-AKI was associated with higher in-hospital mortality and increased utilization of hospital services. Factors associated with CS-AKI included intraand post-operative hypotension and sepsis.

  10. A classification scheme for risk assessment methods.

    Energy Technology Data Exchange (ETDEWEB)

    Stamp, Jason Edwin; Campbell, Philip LaRoche

    2004-08-01

    This report presents a classification scheme for risk assessment methods. This scheme, like all classification schemes, provides meaning by imposing a structure that identifies relationships. Our scheme is based on two orthogonal aspects--level of detail, and approach. The resulting structure is shown in Table 1 and is explained in the body of the report. Each cell in the Table represent a different arrangement of strengths and weaknesses. Those arrangements shift gradually as one moves through the table, each cell optimal for a particular situation. The intention of this report is to enable informed use of the methods so that a method chosen is optimal for a situation given. This report imposes structure on the set of risk assessment methods in order to reveal their relationships and thus optimize their usage.We present a two-dimensional structure in the form of a matrix, using three abstraction levels for the rows and three approaches for the columns. For each of the nine cells in the matrix we identify the method type by name and example. The matrix helps the user understand: (1) what to expect from a given method, (2) how it relates to other methods, and (3) how best to use it. Each cell in the matrix represent a different arrangement of strengths and weaknesses. Those arrangements shift gradually as one moves through the table, each cell optimal for a particular situation. The intention of this report is to enable informed use of the methods so that a method chosen is optimal for a situation given. The matrix, with type names in the cells, is introduced in Table 2 on page 13 below. Unless otherwise stated we use the word 'method' in this report to refer to a 'risk assessment method', though often times we use the full phrase. The use of the terms 'risk assessment' and 'risk management' are close enough that we do not attempt to distinguish them in this report. The remainder of this report is organized as follows. In

  11. DETERMINANTS OF RISK ASSESSMENT PROCESS IN CRITICAL ENERGY INFRASTRUCTURE

    OpenAIRE

    Przemysław Borkowski

    2016-01-01

    Article deals with the problem of risk assessment in critical energy infrastructure. Firstly the critical infrastructure in energy sector is discussed than risk identification methodology for application to critical infrastructure is proposed. Specific conditions resulting from features of critical infrastructure are addressed in the context of risk assessment procedure. The limits of such a procedure are outlined and critical factors influencing different stages of risk assessment process a...

  12. DETERMINANTS OF RISK ASSESSMENT PROCESS IN CRITICAL ENERGY INFRASTRUCTURE

    Directory of Open Access Journals (Sweden)

    Przemysław Borkowski

    2016-06-01

    Full Text Available Article deals with the problem of risk assessment in critical energy infrastructure. Firstly the critical infrastructure in energy sector is discussed than risk identification methodology for application to critical infrastructure is proposed. Specific conditions resulting from features of critical infrastructure are addressed in the context of risk assessment procedure. The limits of such a procedure are outlined and critical factors influencing different stages of risk assessment process are researched in view of specificity of the sector.

  13. Risk-Assessment for Equipment Operating on the Lunar Surface

    Science.gov (United States)

    Richmond, R. C.; Kusiak, A.; Ramachandran, N.

    2008-01-01

    Particle-size distribution of lunar dust simulant is evaluated using scanning electron spectroscopy in order to consider approaches to evaluating risk to individual mechanical components operating on the lunar surface. Assessing component risk and risk-mitigation during actual operations will require noninvasive continuous data gathering on numerous parameters. Those data sets would best be evaluated using data-mining algorithms to assess risk, and recovery from risk, of individual mechanical components in real-time.

  14. A Successful ED Fall Risk Program Using the KINDER 1 Fall RiskAssessment Tool.

    Science.gov (United States)

    Townsend, Ann B; Valle-Ortiz, Marisol; Sansweet, Tracy

    2016-11-01

    Emergency nurses did not perform falls risk assessments routinely on our ED patients; the instrument used was aimed at inpatients. We identified a need to revise fall assessment practices specific to our emergency department. The purpose of the performance improvement project was to reduce ED falls and evaluate the use of an ED-specific fall risk tool, the KINDER 1 Fall Risk Assessment. The plan was to establish fall risk assessment practices at point of ED entry and to decrease total falls.

  15. Sudden Cardiac Risk Stratification with Electrocardiographic Indices - A Review on Computational Processing, Technology Transfer, and Scientific Evidence.

    Science.gov (United States)

    Gimeno-Blanes, Francisco J; Blanco-Velasco, Manuel; Barquero-Pérez, Óscar; García-Alberola, Arcadi; Rojo-Álvarez, José L

    2016-01-01

    Great effort has been devoted in recent years to the development of sudden cardiac risk predictors as a function of electric cardiac signals, mainly obtained from the electrocardiogram (ECG) analysis. But these prediction techniques are still seldom used in clinical practice, partly due to its limited diagnostic accuracy and to the lack of consensus about the appropriate computational signal processing implementation. This paper addresses a three-fold approach, based on ECG indices, to structure this review on sudden cardiac risk stratification. First, throughout the computational techniques that had been widely proposed for obtaining these indices in technical literature. Second, over the scientific evidence, that although is supported by observational clinical studies, they are not always representative enough. And third, via the limited technology transfer of academy-accepted algorithms, requiring further meditation for future systems. We focus on three families of ECG derived indices which are tackled from the aforementioned viewpoints, namely, heart rate turbulence (HRT), heart rate variability (HRV), and T-wave alternans. In terms of computational algorithms, we still need clearer scientific evidence, standardizing, and benchmarking, siting on advanced algorithms applied over large and representative datasets. New scenarios like electronic health recordings, big data, long-term monitoring, and cloud databases, will eventually open new frameworks to foresee suitable new paradigms in the near future.

  16. Sudden Cardiac Risk Stratification with Electrocardiographic Indices - A Review on Computational Processing, Technology Transfer, and Scientific Evidence

    Directory of Open Access Journals (Sweden)

    Francisco Javier eGimeno-Blanes

    2016-03-01

    Full Text Available Great effort has been devoted in recent years to the development of sudden cardiac risk predictors as a function of electric cardiac signals, mainly obtained from the electrocardiogram (ECG analysis. But these prediction techniques are still seldom used in clinical practice, partly due to its limited diagnostic accuracy and to the lack of consensus about the appropriate computational signal processing implementation. This paper addresses a three-fold approach, based on ECG indexes, to structure this review on sudden cardiac risk stratification. First, throughout the computational techniques that had been widely proposed for obtaining these indexes in technical literature. Second, over the scientific evidence, that although is supported by observational clinical studies, they are not always representative enough. And third, via the limited technology transfer of academy-accepted algorithms, requiring further meditation for future systems. We focus on three families of ECG derived indexes which are tackled from the aforementioned viewpoints, namely, heart rate turbulence, heart rate variability, and T-wave alternans. In terms of computational algorithms, we still need clearer scientific evidence, standardizing, and benchmarking, siting on advanced algorithms applied over large and representative datasets. New scenarios like electronic health recordings, big data, long-term monitoring, and cloud databases, will eventually open new frameworks to foresee suitable new paradigms in the near future.

  17. Risk, surprises and black swans fundamental ideas and concepts in risk assessment and risk management

    CERN Document Server

    Aven, Terje

    2014-01-01

    Risk, Surprises and Black Swans provides an in depth analysis of the risk concept with a focus on the critical link to knowledge; and the lack of knowledge, that risk and probability judgements are based on.Based on technical scientific research, this book presents a new perspective to help you understand how to assess and manage surprising, extreme events, known as 'Black Swans'. This approach looks beyond the traditional probability-based principles to offer a broader insight into the important aspects of uncertain events and in doing so explores the ways to manage them.

  18. Radiological risk assessment of environmental radon

    Science.gov (United States)

    Khalid, Norafatin; Majid, Amran Ab; Yahaya, Redzuwan; Yasir, Muhammad Samudi

    2013-11-01

    Measurements of radon gas (222Rn) in the environmental are important to assess indoor air quality and to study the potential risk to human health. Generally known that exposure to radon is considered the second leading cause of lung cancer after smoking. The environmental radon concentration depends on the 226Ra concentration, indoor atmosphere, cracking on rocks and building materials. This study was carried out to determine the indoor radon concentration from selected samples of tin tailings (amang) and building materials in an airtight sealed homemade radon chamber. The radiological risk assessment for radon gas was also calculated based on the annual exposure dose, effective dose equivalent, radon exhalation rates and fatal cancer risk. The continuous radon monitor Sun Nuclear model 1029 was used to measure the radon concentration emanates from selected samples for 96 hours. Five types of tin tailings collected from Kampar, Perak and four samples of building materials commonly used in Malaysia dwellings or building constructions were analysed for radon concentration. The indoor radon concentration determined in ilmenite, monazite, struverite, xenotime and zircon samples varies from 219.6 ± 76.8 Bq m-3 to 571.1 ± 251.4 Bq m-3, 101.0 ± 41.0 Bq m-3 to 245.3 ± 100.2 Bq m-3, 53.1 ± 7.5 Bq m-3 to 181.8 ± 9.7 Bq m-3, 256.1 ± 59.3 Bq m-3 to 652.2 ± 222.2 Bq m-3 and 164.5 ± 75.9 Bq m-3 to 653.3 ± 240.0 Bq m-3, respectively. Whereas, in the building materials, the radon concentration from cement brick, red-clay brick, gravel aggregate and cement showed 396.3 ± 194.3 Bq m-3, 192.1 ± 75.4 Bq m-3, 176.1 ± 85.9 Bq m-3 and 28.4 ± 5.7 Bq m-3, respectively. The radon concentration in tin tailings and building materials were found to be much higher in xenotime and cement brick samples than others. All samples in tin tailings were exceeded the action level for radon gas of 148 Bq m-3 proposed by EPA except monazite 0.15 kg, struverite 0.15 kg and 0.25 kg. Whereas

  19. Use of an Implantable Loop Recorder in a Chimpanzee (Pan troglodytes) to Monitor Cardiac Arrhythmias and Assess the Effects of Acupuncture and Laser Therapy.

    Science.gov (United States)

    Magden, Elizabeth R; Sleeper, Meg M; Buchl, Stephanie J; Jones, Rebekah A; Thiele, Erica J; Wilkerson, Gregory K

    2016-02-01

    Cardiovascular disease is a leading cause of death in captive chimpanzees and is often associated with myocardial fibrosis, which increases the risk of cardiac arrhythmias. In this case report, we present a 36-y-old male chimpanzee (Pan troglodytes) diagnosed with frequent ventricular premature complexes (VPC). We placed a subcutaneous implantable loop recorder for continual ECG monitoring to assess his arrhythmias without the confounding effects of anesthetics. During his initial treatment with the antiarrhythmia medication amiodarone, he developed thrombocytopenia, and the drug was discontinued. After reviewing other potential therapies for the treatment of cardiac arrhythmias, we elected to try acupuncture and laser therapy in view of the positive results and the lack of adverse side effects reported in humans. We used 2 well-known cardiac acupuncture sites on the wrist, PC6 (pericardium 6) and HT7 (heart 7), and evaluated the results of the therapy by using the ECG recordings from the implantable loop recorder. Although periodic increases in the animal's excitement level introduced confounding variables that caused some variation in the data, acupuncture and laser therapy appeared to decrease the mean number of VPC/min in this chimpanzee.

  20. Assessing the Environmental Risks of Nanomaterials

    DEFF Research Database (Denmark)

    Grieger, Khara Deanne; Hansen, Steffen Foss; Baun, Anders

    Assessing the environmental risks of engineered nanomaterials (NM) is currently an intensely contested subject among scientists, organizations, governments, and policymakers. The shear number, variety, and market penetration of NM in consumer goods and other applications, including environmental...... to a wide range of technical limitations. For instance, serious knowledge gaps remain within e.g. the detection of NM in the environment, developing adequate testing equipment and protocols, and toxicity endpoints (Grieger et al., 2009). In the past few years, many scientists and organizations have...... of uncertainty, degree of precaution, inclusion of quantitative or qualitative data, inclusion of life-cycle perspective, iterative and/or adaptive, ensuring timely decision making, and degree of transparency. This analysis can ultimately assist scientists, government agencies, organizations, and other...

  1. Performing Probabilistic Risk Assessment Through RAVEN

    Energy Technology Data Exchange (ETDEWEB)

    A. Alfonsi; C. Rabiti; D. Mandelli; J. Cogliati; R. Kinoshita

    2013-06-01

    The Reactor Analysis and Virtual control ENviroment (RAVEN) code is a software tool that acts as the control logic driver and post-processing engine for the newly developed Thermal-Hydraulic code RELAP-7. RAVEN is now a multi-purpose Probabilistic Risk Assessment (PRA) software framework that allows dispatching different functionalities: Derive and actuate the control logic required to simulate the plant control system and operator actions (guided procedures), allowing on-line monitoring/controlling in the Phase Space Perform both Monte-Carlo sampling of random distributed events and Dynamic Event Tree based analysis Facilitate the input/output handling through a Graphical User Interface (GUI) and a post-processing data mining module

  2. Comparative Assessment Of Natural Gas Accident Risks

    Energy Technology Data Exchange (ETDEWEB)

    Burgherr, P.; Hirschberg, S

    2005-01-01

    The study utilizes a hierarchical approach including (1) comparative analyses of different energy chains, (2) specific evaluations for the natural gas chain, and (3) a detailed overview of the German situation, based on an extensive data set provided by Deutsche Vereinigung des Gas- und Wasserfaches (DVGW). According to SVGW-expertise DVGW-data can be regarded as fully representative for Swiss conditions due to very similar technologies, management, regulations and safety culture, but has a substantially stronger statistical basis because the German gas grid is about 30 times larger compared to Switzerland. Specifically, the following tasks were carried out by PSI to accomplish the objectives of this project: (1) Consolidation of existing ENSAD data, (2) identification and evaluation of additional sources, (3) comparative assessment of accident risks, and (4) detailed evaluations of specific issues and technical aspects for severe and smaller accidents in the natural gas chain that are relevant under Swiss conditions. (author)

  3. Inhalation cancer risk assessment of cobalt metal.

    Science.gov (United States)

    Suh, Mina; Thompson, Chad M; Brorby, Gregory P; Mittal, Liz; Proctor, Deborah M

    2016-08-01

    Cobalt compounds (metal, salts, hard metals, oxides, and alloys) are used widely in various industrial, medical and military applications. Chronic inhalation exposure to cobalt metal and cobalt sulfate has caused lung cancer in rats and mice, as well as systemic tumors in rats. Cobalt compounds are listed as probable or possible human carcinogens by some agencies, and there is a need for quantitative cancer toxicity criteria. The U.S. Environmental Protection Agency has derived a provisional inhalation unit risk (IUR) of 0.009 per μg/m(3) based on a chronic inhalation study of soluble cobalt sulfate heptahydrate; however, a recent 2-year cancer bioassay affords the opportunity to derive IURs specifically for cobalt metal. The mechanistic data support that the carcinogenic mode of action (MOA) is likely to involve oxidative stress, and thus, non-linear/threshold mechanisms. However, the lack of a detailed MOA and use of high, toxic exposure concentrations in the bioassay (≥1.25 mg/m(3)) preclude derivation of a reference concentration (RfC) protective of cancer. Several analyses resulted in an IUR of 0.003 per μg/m(3) for cobalt metal, which is ∼3-fold less potent than the provisional IUR. Future research should focus on establishing the exposure-response for key precursor events to improve cobalt metal risk assessment.

  4. Comparative Risk Assessment to Inform Adaptation Priorities for the Natural Environment: Observations from the First UK Climate Change Risk Assessment

    OpenAIRE

    Iain Brown

    2015-01-01

    Risk assessment can potentially provide an objective framework to synthesise and prioritise climate change risks to inform adaptation policy. However, there are significant challenges in the application of comparative risk assessment procedures to climate change, particularly for the natural environment. These challenges are evaluated with particular reference to the first statutory Climate Change Risk Assessment (CCRA) and evidence review procedures used to guide policy for the UK government...

  5. Guidance on the environmental risk assessment of plant pests

    DEFF Research Database (Denmark)

    Baker, R.; Candresse, T.; Dormannsne Simon, E.

    2011-01-01

    the environmental risks of plant pests that have previously been used in pest risk assessment. The limitations identified by the review led the Panel to define the new methodology for environmental risk assessment which is described in this guidance document. The guidance is primarily addressed to the EFSA PLH...

  6. Violence Risk Assessment Practices in Denmark: A Multidisciplinary National Survey

    Directory of Open Access Journals (Sweden)

    Nielsen Louise Hjort

    2015-12-01

    Full Text Available With a quadrupling of forensic psychiatric patients in Denmark over the past 20 years, focus on violence risk assessment practices across the country has increased. However, information is lacking regarding Danish risk assessment practice across professional disciplines and clinical settings; little is known about how violence risk assessments are conducted, which instruments are used for what purposes, and how mental health professionals rate their utility and costs. As part of a global survey exploring the application of violence risk assessment across 44 countries, the current study investigated Danish practice across several professional disciplines and settings in which forensic and high-risk mental health patients are assessed and treated. In total, 125 mental health professionals across the country completed the survey. The five instruments that respondents reported most commonly using for risk assessment, risk management planning and risk monitoring were Broset, HCR-20, the START, the PCL-R, and the PCL:SV. Whereas the HCR-20 was rated highest in usefulness for risk assessment, the START was rated most useful for risk management and risk monitoring. No significant differences in utility were observed across professional groups. Unstructured clinical judgments were reported to be faster but more expensive to conduct than using a risk assessment instrument. Implications for clinical practice are discussed.

  7. Critical notes on microbiological risk assessment of food

    NARCIS (Netherlands)

    Reij, M.W.; Schothorst, van M.

    2000-01-01

    Although numerous papers on Microbiological Risk Assessment (MRA) of food products have been published, a number of issues related to it remain unresolved. This paper explains the role of Microbiological Risk Assessment in the context of Risk Analysis as outlined by Codex Alimentarius. It reviews so

  8. Development and evolution of risk assessment for food allergens

    NARCIS (Netherlands)

    Crevel, R.W.R.; Baumert, J.L.; Baka, A.; Houben, G.F.; Knulst, A.C.; Kruizinga, A.G.; Luccioli, S.; Taylor, S.L.; Madsen, C.B.

    2014-01-01

    The need to assess the risk from food allergens derives directly from the need to manage effectively this food safety hazard. Work spanning the last two decades dispelled the initial thinking that food allergens were so unique that the risk they posed was not amenable to established risk assessment

  9. Gasbuggy Site Assessment and Risk Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    None

    2011-03-01

    contaminant exposure scenario, drilling of natural gas wells near the site. The results of this risk evaluation will guide DOE's future surveillance and monitoring activities in the area to ensure that site conditions are adequately protective of human health. This evaluation is not a comprehensive risk assessment for the site; it is intended to provide assurance that DOE's monitoring approach can detect the presence of site-related contamination at levels well below those that would pose an unacceptable risk to human health.

  10. Periodontal risk assessment, diagnosis and treatment planning.

    Science.gov (United States)

    Pihlstrom, B L

    2001-01-01

    The prevention and treatment of the periodontal diseases is based on accurate diagnosis, reduction or elimination of causative agents, risk management and correction of the harmful effects of disease. Prominent and confirmed risk factors or risk predictors for periodontitis in adults include smoking, diabetes, race, P. gingivalis, P. intermedia, low education, infrequent dental attendance and genetic influences. Several other specific periodontal bacteria, herpesviruses, increased age, male, sex, depression, race, traumatic occlusion and female osteoporosis in the presence of heavy dental calculus have been shown to be associated with loss of periodontal support and can be considered to be risk indicators of periodontitis. The presence of furcation involvement, tooth mobility, and a parafunctional habit without the use of a biteguard are associated with a poorer periodontal prognosis following periodontal therapy. An accurate diagnosis can only be made by a thorough evaluation of data that have been systematically collected by: 1) patient interview, 2) medical consultation as indicated, 3) clinical periodontal examination, 4) radiographic examination, and 5) laboratory tests as needed. Clinical signs of periodontal disease such as pocket depth, loss of clinical attachment and bone loss are cumulative measures of past disease. They do not provide the dentist with a current assessment of disease activity. In an attempt to improve the ability to predict future disease progression, several types of diagnostic tests have been studied, including host inflammatory products and mediators, enzymes, tissue breakdown products and subgingival temperature. In general, the usefulness of these tests for predicting future disease activity remains to be established in terms of sensitivity, specificity and predictive value. Although microbiological analysis of subgingival plaque is not necessary to diagnose and treat most patients with periodontitis, it is helpful when treating

  11. Novel phase-based noise reduction strategy for quantification of left ventricular function and mass assessment by cardiac CT: Comparison with cardiac magnetic resonance

    Energy Technology Data Exchange (ETDEWEB)

    Wai, Bryan, E-mail: bwai@partners.org [Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Thai, Wai-ee [Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Brown, Heather [Qi Imaging, Redwood City, California (United States); Truong, Quynh A. [Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States)

    2013-08-15

    Background: Tube current modulation in retrospective ECG gated cardiac computed tomography (CT) results in increased image noise and may reduce the accuracy of left ventricular (LV) ejection fraction (EF) and mass assessment. Objective: To examine the effects of a novel CT phase-based noise reduction (NR) algorithm on LV EF and mass quantification as compared to cardiac magnetic resonance (CMR). Methods: In 40 subjects, we compared the LV EF and mass between CT and CMR. In a subset of 24 subjects with tube current modulated CT, the effect of phase-based noise reduction strategies on contrast-to-noise ratio (CNR) and the assessment of LV EF and mass was compared to CMR. Results: There was excellent correlation between CT and CMR for EF (r = 0.94) and mass (r = 0.97). As compared to CMR, the limits of agreement improved with increasing strength of NR strategy. There was a systematic underestimation of LV mass by CT compared to CMR with no NR (−10.3 ± 10.1 g) and low NR (−10.3 ± 12.5 g), but was attenuated with high NR (−0.5 ± 8.3 g). Studies without NR had lower CNR compared to low and high NR at both the ES phase and ED phase (all p < 0.01). Conclusions: A high NR strategy on tube current modulated functional cardiac CT improves correlation of EF compared to CMR and reduces variability of EF and mass evaluation by increasing the CNR. In an effort to reduce radiation dose with tube current modulation, this strategy provides better image quality when LV function and mass quantification is needed.

  12. The use of quantitative risk assessment in HACCP

    NARCIS (Netherlands)

    Hoornstra, E.; Northolt, M.D.; Notermans, S.; Barendsz, A.W.

    2001-01-01

    During the hazard analysis as part of the development of a HACCP-system, first the hazards (contaminants) have to be identified and then the risks have to be assessed. Often, this assessment is restricted to a qualitative analysis. By using elements of quantitative risk assessment (QRA) the hazard a

  13. In vivo validation of cardiac output assessment in non-standard 3D echocardiographic images

    Science.gov (United States)

    Nillesen, M. M.; Lopata, R. G. P.; de Boode, W. P.; Gerrits, I. H.; Huisman, H. J.; Thijssen, J. M.; Kapusta, L.; de Korte, C. L.

    2009-04-01

    Automatic segmentation of the endocardial surface in three-dimensional (3D) echocardiographic images is an important tool to assess left ventricular (LV) geometry and cardiac output (CO). The presence of speckle noise as well as the nonisotropic characteristics of the myocardium impose strong demands on the segmentation algorithm. In the analysis of normal heart geometries of standardized (apical) views, it is advantageous to incorporate a priori knowledge about the shape and appearance of the heart. In contrast, when analyzing abnormal heart geometries, for example in children with congenital malformations, this a priori knowledge about the shape and anatomy of the LV might induce erroneous segmentation results. This study describes a fully automated segmentation method for the analysis of non-standard echocardiographic images, without making strong assumptions on the shape and appearance of the heart. The method was validated in vivo in a piglet model. Real-time 3D echocardiographic image sequences of five piglets were acquired in radiofrequency (rf) format. These ECG-gated full volume images were acquired intra-operatively in a non-standard view. Cardiac blood flow was measured simultaneously by an ultrasound transit time flow probe positioned around the common pulmonary artery. Three-dimensional adaptive filtering using the characteristics of speckle was performed on the demodulated rf data to reduce the influence of speckle noise and to optimize the distinction between blood and myocardium. A gradient-based 3D deformable simplex mesh was then used to segment the endocardial surface. A gradient and a speed force were included as external forces of the model. To balance data fitting and mesh regularity, one fixed set of weighting parameters of internal, gradient and speed forces was used for all data sets. End-diastolic and end-systolic volumes were computed from the segmented endocardial surface. The cardiac output derived from this automatic segmentation was

  14. In vivo validation of cardiac output assessment in non-standard 3D echocardiographic images

    Energy Technology Data Exchange (ETDEWEB)

    Nillesen, M M; Lopata, R G P; Gerrits, I H; Thijssen, J M; De Korte, C L [Clinical Physics Laboratory-833, Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); De Boode, W P [Neonatology, Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Huisman, H J [Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Kapusta, L [Pediatric Cardiology, Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)], E-mail: m.m.nillesen@cukz.umcn.nl

    2009-04-07

    Automatic segmentation of the endocardial surface in three-dimensional (3D) echocardiographic images is an important tool to assess left ventricular (LV) geometry and cardiac output (CO). The presence of speckle noise as well as the nonisotropic characteristics of the myocardium impose strong demands on the segmentation algorithm. In the analysis of normal heart geometries of standardized (apical) views, it is advantageous to incorporate a priori knowledge about the shape and appearance of the heart. In contrast, when analyzing abnormal heart geometries, for example in children with congenital malformations, this a priori knowledge about the shape and anatomy of the LV might induce erroneous segmentation results. This study describes a fully automated segmentation method for the analysis of non-standard echocardiographic images, without making strong assumptions on the shape and appearance of the heart. The method was validated in vivo in a piglet model. Real-time 3D echocardiographic image sequences of five piglets were acquired in radiofrequency (rf) format. These ECG-gated full volume images were acquired intra-operatively in a non-standard view. Cardiac blood flow was measured simultaneously by an ultrasound transit time flow probe positioned around the common pulmonary artery. Three-dimensional adaptive filtering using the characteristics of speckle was performed on the demodulated rf data to reduce the influence of speckle noise and to optimize the distinction between blood and myocardium. A gradient-based 3D deformable simplex mesh was then used to segment the endocardial surface. A gradient and a speed force were included as external forces of the model. To balance data fitting and mesh regularity, one fixed set of weighting parameters of internal, gradient and speed forces was used for all data sets. End-diastolic and end-systolic volumes were computed from the segmented endocardial surface. The cardiac output derived from this automatic segmentation was

  15. Frameworks and tools for risk assessment of manufactured nanomaterials

    DEFF Research Database (Denmark)

    Hristozov, Danail; Gottardo, Stefania; Semenzin, Elena;

    2016-01-01

    Commercialization of nanotechnologies entails a regulatory requirement for understanding their environmental, health and safety (EHS) risks. Today we face challenges to assess these risks, which emerge from uncertainties around the interactions of manufactured nanomaterials (MNs) with humans...

  16. Breast Cancer Risk Assessment SAS Macro (Gail Model)

    Science.gov (United States)

    A SAS macro (commonly referred to as the Gail Model) that projects absolute risk of invasive breast cancer according to NCI’s Breast Cancer Risk Assessment Tool (BCRAT) algorithm for specified race/ethnic groups and age intervals.

  17. A new non-invasive statistical method to assess the spontaneous cardiac baroreflex in humans.

    Science.gov (United States)

    Ducher, M; Fauvel, J P; Gustin, M P; Cerutti, C; Najem, R; Cuisinaud, G; Laville, M; Pozet, N; Paultre, C Z

    1995-06-01

    1. A new method was developed to evaluate cardiac baroreflex sensitivity. The association of a high systolic blood pressure with a low heart rate or the converse is considered to be under the influence of cardiac baroreflex activity. This method is based on the determination of the statistical dependence between systolic blood pressure and heart rate values obtained non-invasively by a Finapres device. Our computerized analysis selects the associations with the highest statistical dependence. A 'Z-coefficient' quantifies the strength of the statistical dependence. The slope of the linear regression, computed on these selected associations, is used to estimate baroreflex sensitivity. 2. The present study was carried out in 11 healthy resting male subjects. The results obtained by the 'Z-coefficient' method were compared with those obtained by cross-spectrum analysis, which has already been validated in humans. Furthermore, the reproducibility of both methods was checked after 1 week. 3. The results obtained by the two methods were significantly correlated (r = 0.78 for the first and r = 0.76 for the second experiment, P < 0.01). When repeated after 1 week, the average results were not significantly different. Considering individual results, test-retest correlation coefficients were higher with the Z-analysis (r = 0.79, P < 0.01) than with the cross-spectrum analysis (r = 0.61, P < 0.05). 4. In conclusion, as the Z-method gives results similar to but more reproducible than the cross-spectrum method, it might be a powerful and reliable tool to assess baroreflex sensitivity in humans.

  18. Noninvasive cardiac risk stratification of diabetic and nondiabetic uremic renal allograft candidates using dipyridamole-thallium-201 imaging and radionuclide ventriculography

    Energy Technology Data Exchange (ETDEWEB)

    Brown, K.A.; Rimmer, J.; Haisch, C. (Univ. of Vermont College of Medicine, Burlington (USA))

    1989-11-01

    The ability of noninvasive risk stratification using dipyridamole-thallium-201 (Tl-201) imaging and radionuclide ventriculography to predict perioperative and long-term cardiac events (myocardial infarction or cardiac death) was evaluated in 36 uremic diabetic and 29 nondiabetic candidates for renal allograft surgery. Of the 35 patients who underwent renal allograft surgery 8 +/- 7 months after the study, none had transient Tl-201 defects (although 13 had depressed left ventricular ejection fraction) and none developed perioperative cardiac events. During a mean follow-up of 23 +/- 11 months, 6 (9%) patients developed cardiac events. Logistic regression analysis was used to compare the predictive value of clinical data (including age, sex, diabetes, chest pain history, allograft recipient) and radionuclide data. Presence of transient Tl-201 defect and left ventricular ejection fraction were the only significant predictors of future cardiac events (p less than 0.01). No other patient variables, including diabetes or receiving a renal allograft, had either univariate or multivariate predictive value. All 3 patients with transient Tl-201 defects had cardiac events compared with only 3 of 62 (5%) patients without transient Tl-201 defect (p less than 0.0001). Mean left ventricular ejection fraction was lower in patients with cardiac events (44 +/- 13%) compared with patients without cardiac events (57 +/- 9%, p less than 0.005). Overall, 5 of 6 patients with cardiac events had either transient Tl-201 defects or depressed left ventricular ejection fraction. Dipyridamole-Tl-201 imaging and radionuclide ventriculography may be helpful in identifying uremic candidates for renal allograft surgery who are at low risk for perioperative and long-term cardiac events.

  19. Reference manual for toxicity and exposure assessment and risk characterization. CERCLA Baseline Risk Assessment

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-03-01

    The Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA, 1980) (CERCLA or Superfund) was enacted to provide a program for identifying and responding to releases of hazardous substances into the environment. The Superfund Amendments and Reauthorization Act (SARA, 1986) was enacted to strengthen CERCLA by requiring that site clean-ups be permanent, and that they use treatments that significantly reduce the volume, toxicity, or mobility of hazardous pollutants. The National Oil and Hazardous Substances Pollution Contingency Plan (NCP) (USEPA, 1985; USEPA, 1990) implements the CERCLA statute, presenting a process for (1) identifying and prioritizing sites requiring remediation and (2) assessing the extent of remedial action required at each site. The process includes performing two studies: a Remedial Investigation (RI) to evaluate the nature, extent, and expected consequences of site contamination, and a Feasibility Study (FS) to select an appropriate remedial alternative adequate to reduce such risks to acceptable levels. An integral part of the RI is the evaluation of human health risks posed by hazardous substance releases. This risk evaluation serves a number of purposes within the overall context of the RI/FS process, the most essential of which is to provide an understanding of ``baseline`` risks posed by a given site. Baseline risks are those risks that would exist if no remediation or institutional controls are applied at a site. This document was written to (1) guide risk assessors through the process of interpreting EPA BRA policy and (2) help risk assessors to discuss EPA policy with regulators, decision makers, and stakeholders as it relates to conditions at a particular DOE site.

  20. Erythrocyte very long-chain saturated fatty acids associated with lower risk of incident sudden cardiac arrest.

    Science.gov (United States)

    Lemaitre, Rozenn N; King, Irena B; Rice, Kenneth; McKnight, Barbara; Sotoodehnia, Nona; Rea, Thomas D; Johnson, Catherine O; Raghunathan, Trivellore E; Cobb, Leonard A; Mozaffarian, Dariush; Siscovick, David S

    2014-10-01

    Prior studies suggest that circulating n-3 and trans-fatty acids influence the risk of sudden cardiac arrest (SCA). Yet, while other fatty acids also differ in their membrane properties and biological activities which may influence SCA, little is known about the associations of other circulating fatty acids with SCA. The aim of this study was to investigate the associations of 17 erythrocyte membrane fatty acids with SCA risk. We used data from a population-based case-control study of SCA in the greater Seattle, Washington, area. Cases, aged 25-74 years, were out-of-hospital SCA patients, attended by paramedics (n=265). Controls, matched to cases by age, sex and calendar year, were randomly identified from the community (n=415). All participants were free of prior clinically-diagnosed heart disease. Blood was obtained at the time of cardiac arrest by attending paramedics (cases) or at the time of an interview (controls). Higher levels of erythrocyte very long-chain saturated fatty acids (VLSFA) were associated with lower risk of SCA. After adjustment for risk factors and levels of n-3 and trans-fatty acids, higher levels of 20:0 corresponding to 1 SD were associated with 30% lower SCA risk (13-43%, p=0.001). Higher levels of 22:0 and 24:0 were associated with similar lower SCA risk (ORs for 1 SD-difference: 0.71 [95% CI: 0.57-0.88, p=0.002] for 22:0; and 0.79 [95% CI: 0.63-0.98, p=0.04] for 24:0). These novel findings support the need for investigation of biologic effects of circulating VLSFA and their determinants.

  1. Prehospital randomised assessment of a mechanical compression device in cardiac arrest (PaRAMeDIC trial protocol

    Directory of Open Access Journals (Sweden)

    McCabe Chris

    2010-11-01

    Full Text Available Abstract Background Survival after out-of-hospital cardiac arrest is closely linked to the quality of CPR, but in real life, resuscitation during prehospital care and ambulance transport is often suboptimal. Mechanical chest compression devices deliver consistent chest compressions, are not prone to fatigue and could potentially overcome some of the limitations of manual chest compression. However, there is no high-quality evidence that they improve clinical outcomes, or that they are cost effective. The Prehospital Randomised Assessment of a Mechanical Compression Device In Cardiac Arrest (PARAMEDIC trial is a pragmatic cluster randomised study of the LUCAS-2 device in adult patients with non-traumatic out-of-hospital cardiac arrest. Methods/design The primary objective of this trial is to evaluate the effect of chest compression using LUCAS-2 on mortality at 30 days post out-of-hospital cardiac arrest, compared with manual chest compression. Secondary objectives of the study are to evaluate the effects of LUCAS-2 on survival to 12 months, cognitive and quality of life outcomes and cost-effectiveness. Methods: Ambulance service vehicles will be randomised to either manual compression (control or LUCAS arms. Adult patients in out-of-hospital cardiac arrest, attended by a trial vehicle will be eligible for inclusion. Patients with traumatic cardiac arrest or who are pregnant will be excluded. The trial will recruit approximately 4000 patients from England, Wales and Scotland. A waiver of initial consent has been approved by the Research Ethics Committees. Consent will be sought from survivors for participation in the follow-up phase. Conclusion The trial will assess the clinical and cost effectiveness of the LUCAS-2 mechanical chest compression device. Trial Registration: The trial is registered on the International Standard Randomised Controlled Trial Number Registry (ISRCTN08233942.

  2. Cardiac sympathetic denervation in familial amyloid polyneuropathy assessed by iodine-123 metaiodobenzylguanidine scintigraphy and heart rate variability

    Energy Technology Data Exchange (ETDEWEB)

    Delahaye, N.; Le Guludec, D. [Department of Nuclear Medicine, Bichat Hospital, Paris (France); Dinanian, S.; Slama, M.S. [Department of Cardiology, A. Beclere Hospital, Paris (France); Mzabi, H.; Samuel, D. [Department of Hepatic Surgery, P. Brousse Hospital, Paris (France); Adams, D. [Department of Neurology, Bicetre Hospital, Paris (France); Merlet, P. [SHFJ, DSV-CEA, Orsay (France)

    1999-04-29

    Familial amyloid polyneuropathy (FAP) is a rare and severe hereditary form of amyloidosis, due to nervous deposits of a genetic variant transthyretin produced by the liver and characterized by both sensorimotor and autonomic neuropathy. Left ventricular systolic dysfunction is rare, but conduction disturbances and sudden deaths can occur. The neurological status of the heart has not been elucidated, and an alteration of the sympathetic nerves may be involved. We studied 17 patients (42{+-}12 years) before liver transplantation by iodine-123 metaiodobenzylguanidine (MIBG) scintigraphy, heart rate variability analysis, coronary angiography, radionuclide ventriculography, rest thallium single-photon emission tomography (SPET) and echocardiography. Coronary arteries, left ventricular systolic function and rest thallium SPET were normal in all patients. Only mild evidence of amyloid infiltration was found at echocardiographic examination. Cardiac MIBG uptake was dramatically decreased in patients compared with age-matched control subjects (heart-to-mediastinum activity ratio at 4 h: 1.36{+-}0.26 versus 1.98{+-}0.35, P<0.001), while there was no difference in MIBG washout rate. Heart rate variability analysis showed a considerable scatter of values, with high values in four patients despite cardiac sympathetic denervation as assessed by MIBG imaging. The clinical severity of the polyneuropathy correlated with MIBG uptake at 4 h but not with the heart rate variability indices. Cardiac MIBG uptake and the heart rate variability indices did not differ according to the presence or absence of conduction disturbances. Patients with FAP have sympathetic cardiac denervation as assessed by MIBG imaging despite a preserved left ventricular systolic function and cardiac perfusion, without correlation with conduction disturbances. Results of the heart rate variability analysis were more variable and this technique does not seem to be the best way to evaluate the extent of cardiac

  3. Gender Differences in Patients' Beliefs About Biological, Environmental, Behavioral, and Psychological Risk Factors in a Cardiac Rehabilitation Program

    Directory of Open Access Journals (Sweden)

    Mozhgan Saeidi

    2014-11-01

    Full Text Available Introduction: There are significant gender differences in the epidemiology and presentation of cardiovascular diseases (CVDs, physiological aspects of CVDs, response to diagnostic tests or interventions, and prevalence or incidence of the associated risk factors. Considering the independent influence of gender on early dire consequences of such diseases, this study was conducted to investigate gender differences in patients' beliefs about biological, environmental, behavioral, and psychological risk factors in a cardiac rehabilitation program. Materials and Methods: This study has cross sectional design. The sample was composed of 775 patients referred to cardiac rehabilitation unit in Imam Ali Hospital in Kermanshah, Iran. The data were collected using clinical interview and patients’ medical records. The data were analyzed using descriptive statistics such as mean, standard deviation, and chi-square test​​. To do the statistical analysis, SPSS version 20 was utilized. Results: As the results indicated, there was a significant difference between the beliefs of men and women about risk factors of heart disease (X2= 48.36; P

  4. Risk assessment and toxicology databases for health effects assessment

    Energy Technology Data Exchange (ETDEWEB)

    Lu, P.Y.; Wassom, J.S. [Oak Ridge National Laboratory, TN (United States)

    1990-12-31

    Scientific and technological developments bring unprecedented stress to our environment. Society has to predict the results of potential health risks from technologically based actions that may have serious, far-reaching consequences. The potential for error in making such predictions or assessment is great and multiplies with the increasing size and complexity of the problem being studied. Because of this, the availability and use of reliable data is the key to any successful forecasting effort. Scientific research and development generate new data and information. Much of the scientific data being produced daily is stored in computers for subsequent analysis. This situation provides both an invaluable resource and an enormous challenge. With large amounts of government funds being devoted to health and environmental research programs and with maintenance of our living environment at stake, we must make maximum use of the resulting data to forecast and avert catastrophic effects. Along with the readily available. The most efficient means of obtaining the data necessary for assessing the health effects of chemicals is to utilize applications include the toxicology databases and information files developed at ORNL. To make most efficient use of the data/information that has already been prepared, attention and resources should be directed toward projects that meticulously evaluate the available data/information and create specialized peer-reviewed value-added databases. Such projects include the National Library of Medicine`s Hazardous Substances Data Bank, and the U.S. Air Force Installation Restoration Toxicology Guide. These and similar value-added toxicology databases were developed at ORNL and are being maintained and updated. These databases and supporting information files, as well as some data evaluation techniques are discussed in this paper with special focus on how they are used to assess potential health effects of environmental agents. 19 refs., 5 tabs.

  5. Cardiac injuries caused by blunt trauma: an autopsy based assessment of the injury pattern.

    Science.gov (United States)

    Turan, Arzu Akcay; Karayel, Ferah Anik; Akyildiz, Elif; Pakis, Isil; Uzun, Ibrahim; Gurpinar, Kagan; Atilmis, Umit; Kir, Ziya

    2010-01-01

    Nonpenetrating chest trauma with injury to the heart and aorta has become increasingly common, particularly as a result of rapid deceleration in high-speed vehicular accidents, over the past 2-3 decades. The high mortality rate of cardiac injuries and possible late onset complications make blunt cardiac injuries an important challenging point for legal medicine. One hundred and ninety cases with blunt cardiac injuries in a period of 3 years were analyzed retrospectively in terms of patterns of cardiac injury, survival times, and demographic profiles of the cases in this study.

  6. Assessing human health risk in the USDA forest service

    Energy Technology Data Exchange (ETDEWEB)

    Hamel, D.R. [Department of Agriculture-Forest Service, Washington, DC (United States)

    1990-12-31

    This paper identifies the kinds of risk assessments being done by or for the US Department of Agriculture (USDA) Forest Service. Summaries of data sources currently in use and the pesticide risk assessments completed by the agency or its contractors are discussed. An overview is provided of the agency`s standard operating procedures for the conduct of toxicological, ecological, environmental fate, and human health risk assessments.

  7. Risk assessment of Pseudomonas aeruginosa in water.

    Science.gov (United States)

    Mena, Kristina D; Gerba, Charles P

    2009-01-01

    . 1986). Outbreaks have also been reported from exposure to P. aeruginosa in swimming pools and water slides. Although P. aeruginosa has a reputation for being resistant to disinfection, most studies show that it does not exhibit any marked resistance to the disinfectants used to treat drinking water such as chlorine, chloramines, ozone, or iodine. One author, however, did find it to be slightly more resistant to UV disinfection than most other bacteria (Wolfe 1990). Although much has been written about biofilms in the drinking water industry, very little has been reported regarding the role of P. aeruginosa in biofilms. Tap water appears to be a significant route of transmission in hospitals, from colonization of plumbing fixtures. It is still not clear if the colonization results from the water in the distribution system, or personnel use within the hospital. Infections and colonization can be significantly reduced by placement of filters on the water taps. The oral dose of P. aeruginosa required to establish colonization in a healthy subject is high (George et al. 1989a). During dose-response studies, even when subjects (mice or humans) were colonized via ingestion, there was no evidence of disease. P. aeruginosa administered by the aerosol route at levels of 10(7) cells did cause disease symptoms in mice, and was lethal in aerosolized doses of 10(9) cells. Aerosol dose-response studies have not been undertaken with human subjects. Human health risks associated with exposure to P. aeruginosa via drinking water ingestion were estimated using a four-step risk assessment approach. The risk of colonization from ingesting P. aeruginosa in drinking water is low. The risk is slightly higher if the subject is taking an antibiotic resisted by P. aeruginosa. The fact that individuals on ampicillin are more susceptible to Pseudomonas gastrointestinal infection probably results from suppression of normal intestinal flora, which would allow Pseudomonas to colonize. The process of

  8. Regional assessment of LV wall in infarcted heart using tagged MRI and cardiac modelling

    Science.gov (United States)

    Jahanzad, Zeinab; Miin Liew, Yih; Bilgen, Mehmet; McLaughlin, Robert A.; Onn Leong, Chen; Chee, Kok Han; Aziz, Yang Faridah Abdul; Ung, Ngie Min; Lai, Khin Wee; Ng, Siew-Cheok; Lim, Einly

    2015-05-01

    A segmental two-parameter empirical deformable model is proposed for evaluating regional motion abnormality of the left ventricle. Short-axis tagged MRI scans were acquired from 10 healthy subjects and 10 postinfarct patients. Two motion parameters, contraction and rotation, were quantified for each cardiac segment by fitting the proposed model using a non-rigid registration algorithm. The accuracy in motion estimation was compared to a global model approach. Motion parameters extracted from patients were correlated to infarct transmurality assessed with delayed-contrast-enhanced MRI. The proposed segmental model allows markedly improved accuracy in regional motion analysis as compared to the global model for both subject groups (1.22-1.40 mm versus 2.31-2.55 mm error). By end-systole, all healthy segments experienced radial displacement by ~25-35% of the epicardial radius, whereas the 3 short-axis planes rotated differently (basal: 3.3° mid:  -1° and apical:  -4.6°) to create a twisting motion. While systolic contraction showed clear correspondence to infarct transmurality, rotation was nonspecific to either infarct location or transmurality but could indicate the presence of functional abnormality. Regional contraction and rotation derived using this model could potentially aid in the assessment of severity of regional dysfunction of infarcted myocardium.

  9. Seismic risk assessment of Navarre (Northern Spain)

    Science.gov (United States)

    Gaspar-Escribano, J. M.; Rivas-Medina, A.; García Rodríguez, M. J.; Benito, B.; Tsige, M.; Martínez-Díaz, J. J.; Murphy, P.

    2009-04-01

    The RISNA project, financed by the Emergency Agency of Navarre (Northern Spain), aims at assessing the seismic risk of the entire region. The final goal of the project is the definition of emergency plans for future earthquakes. With this purpose, four main topics are covered: seismic hazard characterization, geotechnical classification, vulnerability assessment and damage estimation to structures and exposed population. A geographic information system is used to integrate, analyze and represent all information colleted in the different phases of the study. Expected ground motions on rock conditions with a 90% probability of non-exceedance in an exposure time of 50 years are determined following a Probabilistic Seismic Hazard Assessment (PSHA) methodology that includes a logic tree with different ground motion and source zoning models. As the region under study is located in the boundary between Spain and France, an effort is required to collect and homogenise seismological data from different national and regional agencies. A new homogenised seismic catalogue, merging data from Spanish, French, Catalonian and international agencies and establishing correlations between different magnitude scales, is developed. In addition, a new seismic zoning model focused on the study area is proposed. Results show that the highest ground motions on rock conditions are expected in the northeastern part of the region, decreasing southwards. Seismic hazard can be expressed as low-to-moderate. A geotechnical classification of the entire region is developed based on surface geology, available borehole data and morphotectonic constraints. Frequency-dependent amplification factors, consistent with code values, are proposed. The northern and southern parts of the region are characterized by stiff and soft soils respectively, being the softest soils located along river valleys. Seismic hazard maps including soil effects are obtained by applying these factors to the seismic hazard maps

  10. Cardiac Rehabilitation

    Science.gov (United States)

    ... your risk of future heart problems, and to improve your health and quality of life. Cardiac rehabilitation programs increase ... exercise routine at home or at a local gym. You may also continue to ... health concerns. Education about nutrition, lifestyle and weight loss ...

  11. 77 FR 58590 - Determining Technical Adequacy of Probabilistic Risk Assessment for Risk-Informed License...

    Science.gov (United States)

    2012-09-21

    ... COMMISSION Determining Technical Adequacy of Probabilistic Risk Assessment for Risk-Informed License... NUREG-0800, ``Standard Review Plan for the Review of Safety Analysis Reports for Nuclear Power Plants: LWR Edition,'' Section 19.1, ``Determining the Technical Adequacy of Probabilistic Risk Assessment...

  12. Extracting additional risk managers information from a risk assessment of Listeria monocytogenes in deli meats

    NARCIS (Netherlands)

    Pérez-Rodríguez, F.; Asselt, van E.D.; García-Gimeno, R.M.; Zurera, G.; Zwietering, M.H.

    2007-01-01

    The risk assessment study of Listeria monocytogenes in ready-to-eat foods conducted by the U.S. Food and Drug Administration is an example of an extensive quantitative microbiological risk assessment that could be used by risk analysts and other scientists to obtain information and by managers and s

  13. THE ASSESSMENT PROCEDURE OF THE OPERATIONAL RISK EVENTS

    OpenAIRE

    2009-01-01

    A credit institution must establish a management framework of the operational risk.This framework must cover the appetite and tolerance to the operational risk of a credit institution,in accordance with the management policies of this risk, including the measure and method inwhich the operational risk is transferred outside the credit institution.The management framework of the operational risk should include policies and processes for theidentification, assessment, monitoring and control/dim...

  14. Effect of Long-Term Physical Activity Practice after Cardiac Rehabilitation on Some Risk Factors

    Science.gov (United States)

    Freyssin, Celine, Jr.; Blanc, Philippe; Verkindt, Chantal; Maunier, Sebastien; Prieur, Fabrice

    2011-01-01

    The objective of this study was to evaluate the effects of long-term physical activity practice after a cardiac rehabilitation program on weight, physical capacity and arterial compliance. The Dijon Physical Activity Score was used to identify two groups: sedentary and active. Weight, distance at the 6-min walk test and the small artery elasticity…

  15. The Debate in Cuba's Scientific Community on Sudden Cardiac Death.

    Science.gov (United States)

    Vilches, Ernesto; Ochoa, Luis A; Ramos, Lianne

    2015-10-01

    Sudden cardiac death poses a challenge to modern medicine because of its high incidence, the unexpected and dramatic nature of the event, and years of potential life lost. What's more, despite modest decreases in global mortality attributed to cardiovascular diseases, incidence of sudden cardiac death has not declined. Cuba, like most of the Americas, suffers from knowledge gaps that hamper adequate strategies to address sudden cardiac death as a population health problem. We suggest that a generally accepted operational definition of sudden cardiac death be agreed upon, and a national registry developed that recognizes this cause of death on death certificates. These two actions will enable Cuba's public health authorities to assess the extent of the problem and to design intervention strategies for the population with intermediate and lower cardiovascular risk, the group in which most cases occur. KEYWORDS Sudden cardiac death, cardiovascular disease, sudden death, sudden cardiac arrest, risk reduction, prevention and control, Cuba.

  16. Photogrammetry in Experiments for Hydrogeological Risk Assessment

    Science.gov (United States)

    Barazzetti, L.; Scaioni, M.; Feng, T.; Qiao, G.; Lu, P.; Tong, X.; Li, R.

    2013-01-01

    The construction of scaled-down simulation platforms is largely used to support investigations for the assessment of hydrological risk. Achieved outcomes can be integrated and assimilated to numerical analyses for the study of unstable slope collapse, debris transport, and hydrological modeling in general. During design of such simulation platforms, a relevant role has to be given to the spatial sensor network (SSN) to deploy, which is in charge of collecting geo-referenced, quantitative information during experiments. Photogrammetry (including 3D imaging sensors) can play an important role in SSN owing to its capability of collecting 2D images and 3D point clouds data covering wide surfaces without any contact. Different kinds of metric measurements can be then extracted from datasets. The aim of this paper is to give an overview and some examples on the potential of photogrammetry in hydrogeological experiments. After a general introduction on a few preliminary issues (sensors, calibration, ground reference, usage of imaging or ranging sensors), potential applications are classified into 2D and 3D categories. Examples are focused on a scaled-down landslide simulation platform developed at Tongji University (Shanghai, P. R. China).

  17. Risk assessment of tuberculosis in immunocompromised patients

    DEFF Research Database (Denmark)

    Sester, Martina; van Leth, Frank; Bruchfeld, Judith

    2014-01-01

    of TST and IGRAs in five different groups of immunocompromised patients, and evaluated their ability to identify those at risk for development of tuberculosis. METHODS: Immunocompromised patients with HIV infection, chronic renal failure, rheumatoid arthritis, solid-organ or stem-cell transplantation......, and healthy control subjects were evaluated head-to-head by the TST, QuantiFERON-TB-Gold in-tube test (ELISA), and T-SPOT.TB test (enzyme-linked immunospot) at 17 centers in 11 European countries. Development of tuberculosis was assessed during follow-up. MEASUREMENTS AND MAIN RESULTS: Frequencies of positive...... test results varied from 8.7 to 15.9% in HIV infection (n = 768), 25.3 to 30.6% in chronic renal failure (n = 270), 25.0% to 37.2% in rheumatoid arthritis (n = 199), 9.0 to 20.0% in solid-organ transplant recipients (n = 197), 0% to 5.8% in stem-cell transplant recipients (n = 103), and 11.2 to 15...

  18. PHOTOGRAMMETRY IN EXPERIMENTS FOR HYDROGEOLOGICAL RISK ASSESSMENT

    Directory of Open Access Journals (Sweden)

    L. Barazzetti

    2014-01-01

    Full Text Available The construction of scaled-down simulation platforms is largely used to support investigations for the assessment of hydrological risk. Achieved outcomes can be integrated and assimilated to numerical analyses for the study of unstable slope collapse, debris transport, and hydrological modeling in general. During design of such simulation platforms, a relevant role has to be given to the spatial sensor network (SSN to deploy, which is in charge of collecting geo-referenced, quantitative information during experiments. Photogrammetry (including 3D imaging sensors can play an important role in SSN owing to its capability of collecting 2D images and 3D point clouds data covering wide surfaces without any contact. Different kinds of metric measurements can be then extracted from datasets. The aim of this paper is to give an overview and some examples on the potential of photogrammetry in hydrogeological experiments. After a general introduction on a few preliminary issues (sensors, calibration, ground reference, usage of imaging or ranging sensors, potential applications are classified into 2D and 3D categories. Examples are focused on a scaled-down landslide simulation platform developed at Tongji University (Shanghai, P. R. China.

  19. A dynamic human health risk assessment system.

    Science.gov (United States)

    Prasad, Umesh; Singh, Gurmit; Pant, A B

    2012-05-01

    An online human health risk assessment system (OHHRAS) has been designed and developed in the form of a prototype database-driven system and made available for the population of India through a website - www.healthriskindia.in. OHHRAS provide the three utilities, that is, health survey, health status, and bio-calculators. The first utility health survey is functional on the basis of database being developed dynamically and gives the desired output to the user on the basis of input criteria entered into the system; the second utility health status is providing the output on the basis of dynamic questionnaire and ticked (selected) answers and generates the health status reports based on multiple matches set as per advise of medical experts and the third utility bio-calculators are very useful for the scientists/researchers as online statistical analysis tool that gives more accuracy and save the time of user. The whole system and database-driven website has been designed and developed by using the software (mainly are PHP, My-SQL, Deamweaver, C++ etc.) and made available publically through a database-driven website (www.healthriskindia.in), which are very useful for researchers, academia, students, and general masses of all sectors.

  20. Advancing environmental risk assessment for transgenic biofeedstock crops

    Directory of Open Access Journals (Sweden)

    Wolt Jeffrey D

    2009-11-01

    Full Text Available Abstract Transgenic modification of plants is a key enabling technology for developing sustainable biofeedstocks for biofuels production. Regulatory decisions and the wider acceptance and development of transgenic biofeedstock crops are considered from the context of science-based risk assessment. The risk assessment paradigm for transgenic biofeedstock crops is fundamentally no different from that of current generation transgenic crops, except that the focus of the assessment must consider the unique attributes of a given biofeedstock crop and its environmental release. For currently envisioned biofeedstock crops, particular emphasis in risk assessment will be given to characterization of altered metabolic profiles and their implications relative to non-target environmental effects and food safety; weediness and invasiveness when plants are modified for abiotic stress tolerance or are domesticated; and aggregate risk when plants are platforms for multi-product production. Robust risk assessments for transgenic biofeedstock crops are case-specific, initiated through problem formulation, and use tiered approaches for risk characterization.

  1. Analysis of Alternatives for Risk Assessment Methodologies and Tools

    Energy Technology Data Exchange (ETDEWEB)

    Nachtigal, Noel M. [Sandia National Lab. (SNL-CA), Livermore, CA (United States). System Analytics; Fruetel, Julia A. [Sandia National Lab. (SNL-CA), Livermore, CA (United States). Systems Research and Analysis; Gleason, Nathaniel J. [Sandia National Lab. (SNL-CA), Livermore, CA (United States). Systems Research and Analysis; Helms, Jovana [Sandia National Lab. (SNL-CA), Livermore, CA (United States). Systems Research and Analysis; Imbro, Dennis Raymond [Sandia National Lab. (SNL-CA), Livermore, CA (United States). Systems Research and Analysis; Sumner, Matthew C. [Sandia National Lab. (SNL-CA), Livermore, CA (United States). Systems Research and Analysis

    2013-10-01

    The purpose of this document is to provide a basic overview and understanding of risk assessment methodologies and tools from the literature and to assess the suitability of these methodologies and tools for cyber risk assessment. Sandia National Laboratories (SNL) performed this review in support of risk modeling activities performed for the Stakeholder Engagement and Cyber Infrastructure Resilience (SECIR) division of the Department of Homeland Security (DHS) Office of Cybersecurity and Communications (CS&C). The set of methodologies and tools covered in this document is not intended to be exhaustive; instead, it focuses on those that are commonly used in the risk assessment community. The classification of methodologies and tools was performed by a group of analysts with experience in risk analysis and cybersecurity, and the resulting analysis of alternatives has been tailored to address the needs of a cyber risk assessment.

  2. Exposure Data for Travel Risk Assessment

    DEFF Research Database (Denmark)

    Jørgensen, N O; Koornstra, Matthijs; Broughton, Jeremy;

    1999-01-01

    This report illustrates why risk and exposure data are critical for policymaking at local, national and EU levels.Conclusions are drawn about the evaluation and use of risk information for different modes and estimates are presented for the fatality risk of various travel modes in the EU....

  3. Assessment of cardiac function by magnetic resonance imaging: segmented versus real time steady-state free precession sequences

    Energy Technology Data Exchange (ETDEWEB)

    Bezerra, Leonardo Bernardo [Rio Grande do Norte Univ., Natal, RN (Brazil)]. E-mail: warrenhellwind@yahoo.com.br; Marchiori, Edson; Pontes, Paulo V. [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Radiologia

    2006-09-15

    Objective: to compare ventricular systolic parameters on segmented and real-time steady-state free precession cine-MRI sequences and ECG-gated MRI in patients presenting or not with cardiac arrhythmias. Materials and methods: ejection fraction and end-diastolic/end-systolic volumes have been compared in 31 patients, 11 presenting with cardiac arrhythmias, and 20 with regular sinus rhythm, using ECG-gated segmented and real-time sequences. The statistical analysis was performed using Pearson's correlation and Bland-Altman agreement plot, with p < 0.01. Results: real-time acquisitions demonstrated endocardial borders blurring effects, but both sequences presented a clear, positive correlation: ejection fraction r = 0.94; end-diastolic volume r = 0.93 and end-systolic volume r 0.98. The assessment of 11 patients with arrhythmias has not demonstrated a statistically significant difference, despite the lower blood pool-myocardial contrast ratio. Conclusion: real-time sequences may be utilized for cardiac function assessment, regardless the patient's cardiac rhythm. (author)

  4. Assessment of cardiac function using myocardial perfusion imaging technique on SPECT with 99mTc sestamibi

    Science.gov (United States)

    Gani, M. R. A.; Nazir, F.; Pawiro, S. A.; Soejoko, D. S.

    2016-03-01

    Suspicion on coronary heart disease can be confirmed by observing the function of left ventricle cardiac muscle with Myocardial Perfusion Imaging techniques. The function perfusion itself is indicated by the uptake of radiopharmaceutical tracer. The 31 patients were studied undergoing the MPI examination on Gatot Soebroto Hospital using 99mTc-sestamibi radiopharmaceutical with stress and rest conditions. Stress was stimulated by physical exercise or pharmacological agent. After two hours, the patient did rest condition on the same day. The difference of uptake percentage between stress and rest conditions will be used to determine the malfunction of perfusion due to ischemic or infarct. Degradation of cardiac function was determined based on the image-based assessment of five segments of left ventricle cardiac. As a result, 8 (25.8%) patients had normal myocardial perfusion and 11 (35.5%) patients suspected for having partial ischemia. Total ischemia occurred to 8 (25.8%) patients with reversible and irreversible ischemia and the remaining 4 (12.9%) patients for partial infarct with characteristic the percentage of perfusion ≤50%. It is concluded that MPI technique of image-based assessment on uptake percentage difference between stress and rest conditions can be employed to predict abnormal perfusion as complementary information to diagnose the cardiac function.

  5. Cardiac Abnormalities in Adult Patients With Polymyositis or Dermatomyositis as Assessed by Noninvasive Modalities

    DEFF Research Database (Denmark)

    Diederichsen, L P; Simonsen, J A; Diederichsen, A C

    2016-01-01

    OBJECTIVE: Cardiac events are a major cause of death in patients with idiopathic inflammatory myopathies. The study objective was in a controlled setting to describe cardiac abnormalities by noninvasive methods in a cohort of patients with polymyositis (PM) or dermatomyositis (DM) and to identify...

  6. Defining food sampling strategy for chemical risk assessment

    OpenAIRE

    Wesolek, Nathalie; Roudot, Alain-Claude

    2012-01-01

    International audience; Collection of accurate and reliable data is a prerequisite for informed risk assessment and risk management. For chemical contaminants in food, contamination assessments enable consumer protection and exposure assessments. And yet, the accuracy of a contamination assessment depends on both chemical analysis and sampling plan performance. A sampling plan is always used when the contamination level of a food lot is evaluated, due to the fact that the whole lot can not be...

  7. Embedding climate change risk assessment within a governance context

    Energy Technology Data Exchange (ETDEWEB)

    Preston, Benjamin L [ORNL

    2011-01-01

    Climate change adaptation is increasingly being framed in the context of climate risk management. This has contributed to the proliferation of climate change vulnerability and/or risk assessments as means of supporting institutional decision-making regarding adaptation policies and measures. To date, however, little consideration has been given to how such assessment projects and programs interact with governance systems to facilitate or hinder the implementation of adaptive responses. An examination of recent case studies involving Australian local governments reveals two key linkages between risk assessment and the governance of adaptation. First, governance systems influence how risk assessment processes are conducted, by whom they are conducted, and whom they are meant to inform. Australia s governance system emphasizes evidence-based decision-making that reinforces a knowledge deficit model of decision support. Assessments are often carried out by external experts on behalf of local government, with limited participation by relevant stakeholders and/or civil society. Second, governance systems influence the extent to which the outputs from risk assessment activities are translated into adaptive responses and outcomes. Technical information regarding risk is often stranded by institutional barriers to adaptation including poor uptake of information, competition on the policy agenda, and lack of sufficient entitlements. Yet, risk assessments can assist in bringing such barriers to the surface, where they can be debated and resolved. In fact, well-designed risk assessments can contribute to multi-loop learning by institutions, and that reflexive problem orientation may be one of the more valuable benefits of assessment.

  8. Seismic vulnerability assessments in risk analysis

    Science.gov (United States)

    Frolova, Nina; Larionov, Valery; Bonnin, Jean; Ugarov, Alexander

    2013-04-01

    The assessment of seismic vulnerability is a critical issue within natural and technological risk analysis. In general, there are three common types of methods used for development of vulnerability functions of different elements at risk: empirical, analytical and expert estimations. The paper addresses the empirical methods for seismic vulnerability estimation for residential buildings and industrial facilities. The results of engineering analysis of past earthquake consequences, as well as the statistical data on buildings behavior during strong earthquakes presented in the different seismic intensity scales, are used to verify the regional parameters of mathematical models in order to simulate physical and economic vulnerability for different building types classified according to seismic scale MMSK-86. Verified procedure has been used to estimate the physical and economic vulnerability of buildings and constructions against earthquakes for the Northern Caucasus Federal region of the Russian Federation and Krasnodar area, which are characterized by rather high level of seismic activity and high population density. In order to estimate expected damage states to buildings and constructions in the case of the earthquakes according to the OSR-97B (return period T=1,000 years) within big cities and towns, they were divided into unit sites and their coordinates were presented as dots located in the centers of unit sites. Then the indexes obtained for each unit site were summed up. The maps of physical vulnerability zoning for Northern Caucasus Federal region of the Russian Federation and Krasnodar area includes two elements: percent of different damage states for settlements with number of inhabitants less than 1,000 and vulnerability for cities and towns with number of inhabitants more than 1,000. The hypsometric scale is used to represent both elements on the maps. Taking into account the size of oil pipe line systems located in the highly active seismic zones in

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

    Science.gov (United States)

    Chan, Ko Ling

    2012-01-01

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

  10. Assessment of cardiac sympathetic nerve activity in children with chronic heart failure using quantitative iodine-123 metaiodobenzylguanidine imaging

    Energy Technology Data Exchange (ETDEWEB)

    Karasawa, Kensuke; Ayusawa, Mamoru; Noto, Nobutaka; Sumitomo, Naokata; Okada, Tomoo; Harada, Kensuke [Nihon Univ., Tokyo (Japan). School of Medicine

    2000-12-01

    Cardiac sympathetic nerve activity in children with chronic heart failure was examined by quantitative iodine-123 metaiodobenzylguanidine (MIBG) myocardial imaging in 33 patients aged 7.5{+-}6.1 years (range 0-18 years), including 8 with cardiomyopathy, 15 with congenital heart disease, 3 with anthracycrine cardiotoxicity, 3 with myocarditis, 3 with primary pulmonary hypertension and 1 with Pompe's disease. Anterior planar images were obtained 15 min and 3 hr after the injection of iodine-123 MIBG. The cardiac iodine-123 MIBG uptake was assessed as the heart to upper mediastinum uptake activity ratio of the delayed image (H/M) and the cardiac percentage washout rate (%WR). The severity of chronic heart failure was class I (no medication) in 8 patients, class II (no symptom with medication) in 9, class III (symptom even with medication) in 10 and class IV (late cardiac death) in 6. H/M was 2.33{+-}0.22 in chronic heart failure class I, 2.50{+-}0.34 in class II, 1.95{+-}0.61 in class III, and 1.39{+-}0.29 in class IV (p<0.05). %WR was 24.8{+-}12.8% in chronic heart failure class I, 23.3{+-}10.2% in class II, 49.2{+-}24.5% in class III, and 66.3{+-}26.5% in class IV (p<0.05). The low H/M and high %WR were proportionate to the severity of chronic heart failure. Cardiac iodine-123 MIBG showed cardiac adrenergic neuronal dysfunction in children with severe chronic heart failure. Quantitative iodine-123 MIBG myocardial imaging is clinically useful as a predictor of therapeutic outcome and mortality in children with chronic heart failure. (author)

  11. Assessment of Cardiovascular Disease Risk in South Asian Populations

    Directory of Open Access Journals (Sweden)

    S. Monira Hussain

    2013-01-01

    Full Text Available Although South Asian populations have high cardiovascular disease (CVD burden in the world, their patterns of individual CVD risk factors have not been fully studied. None of the available algorithms/scores to assess CVD risk have originated from these populations. To explore the relevance of CVD risk scores for these populations, literature search and qualitative synthesis of available evidence were performed. South Asians usually have higher levels of both “classical” and nontraditional CVD risk factors and experience these at a younger age. There are marked variations in risk profiles between South Asian populations. More than 100 risk algorithms are currently available, with varying risk factors. However, no available algorithm has included all important risk factors that underlie CVD in these populations. The future challenge is either to appropriately calibrate current risk algorithms or ideally to develop new risk algorithms that include variables that provide an accurate estimate of CVD risk.

  12. Population-scale assessment endpoints in ecological risk assessment part II: selection of assessment endpoint attributes.

    Science.gov (United States)

    Landis, Wayne G; Kaminski, Laurel A

    2007-07-01

    Because ecological services often are tied to specific species, the risk to populations is a critical endpoint and important feature of ecological risk assessments. In Part 1 of this series it was demonstrated that population scale assessment endpoints are important expressions of the valued components of ecological structures. This commentary reviews several of the characteristics of populations that can be evaluated and used in population scale risk assessments. Two attributes are evaluated as promising. The 1st attribute is the change in potential productivity of the population over a specified time period. The 2nd attribute is the change in the age structure of a population, expressed graphically or as a normalized effects vector (NEV). The NEV is a description of the change in age structure due to a toxicant or other stressor and appears to be characteristic of specific stressor effects.

  13. Use of risk quotient and probabilistic approaches to assess risks of pesticides to birds

    Science.gov (United States)

    When conducting ecological risk assessments for pesticides, the United States Environmental Protection Agency typically relies upon the risk quotient (RQ). This approach is intended to be conservative in nature, making assumptions related to exposure and effects that are intended...

  14. 2011 FEMA Risk Mapping, Assessment, and Planning (Risk MAP) Lidar: Nashua River Watershed (Massachusetts, New Hampshire)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — These data are the lidar points collected for FEMA Risk Mapping, Assessment, and Planning (Risk MAP) for the Nashua River Watershed. This area falls in portions of...

  15. Assessment of the risk of transporting liquid chlorine by rail

    Energy Technology Data Exchange (ETDEWEB)

    Andrews, W.B.

    1980-03-01

    This report presents the risk of shipping liquid chlorine by rail. While chlorine is not an energy material, there are several benefits to studying chlorine transportation risks. First, chlorine, like energy materials, is widely used as a feedstock to industry. Second, it is the major purification agent in municipal water treatment systems and therefore, provides direct benefits to the public. Finally, other risk assessments have been completed for liquid chlorine shipments in the US and Europe, which provide a basis for comparison with this study. None of the previous PNL energy material risk assessments have had other studies for comparison. For these reasons, it was felt that a risk assessment of chlorine transportation by rail could provide information on chlorine risk levels, identify ways to reduce these risks and use previous studies on chlorine risks to assess the strengths and weaknesses of the PNL risk assessment methodology. The risk assessment methodology used in this study is summarized. The methodology is presented in the form of a risk assessment model which is constructed for ease of periodic updating of the data base so that the risk may be reevaluated as additional data become available. The report is sectioned to correspond to specific analysis steps identified in the model. The transport system and accident environment are described. The response of the transport system to accident environments is described. Release sequences are postulated and evaluated to determine both the likelihood and possible consequences of a release. Supportive data and analyses are given in the appendices. The risk assessment results are related to the year 1985 to allow a direct comparison with other reports in this series.

  16. Prediction of coronary risk by SYNTAX and derived scores: synergy between percutaneous coronary intervention with taxus and cardiac surgery.

    Science.gov (United States)

    Yadav, Mayank; Palmerini, Tullio; Caixeta, Adriano; Madhavan, Mahesh V; Sanidas, Elias; Kirtane, Ajay J; Stone, Gregg W; Généreux, Philippe

    2013-10-01

    The introduction of the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score has prompted a renewed interest for angiographic risk stratification in patients undergoing percutaneous coronary intervention. Syntax score is based on qualitative and quantitative characterization of coronary artery disease by including 11 angiographic variables that take into consideration lesion location and characteristics. Thus far, this score has been shown to be an effective tool to risk-stratify patients with complex coronary artery disease undergoing percutaneous coronary intervention in the landmark SYNTAX trial, as well as in other clinical settings. This review provides an overview of its current applications, including its integration with other nonangiographic clinical scores, and explores future applications of the SYNTAX and derived scores.

  17. High-sensitivity cardiac troponin T is associated with cognitive decline in older adults at high cardiovascular risk

    DEFF Research Database (Denmark)

    Wijsman, Liselotte W; de Craen, Anton JM; Trompet, Stella

    2016-01-01

    diseases risk factors or Apolipoprotein E genotype. Further adjusting for NT-proBNP levels revealed the same results. CONCLUSIONS: Higher levels of hs-cTnT associate with worse cognitive function and steeper cognitive decline in older adults independent of cardiovascular diseases, risk factors and NT-proBNP.......AIMS: Cardiac troponin T (cTnT), measured with a high-sensitivity (hs) assay, is associated with cognitive decline, but the underlying mechanism is unknown. We investigated the association of hs-cTnT with cognitive function and decline, and studied whether this association was independent....... Participants with pre-existent advanced clinical heart failure were excluded. Hs-cTnT and NT-proBNP obtained after 6 months of follow-up were related with cognitive function, tested repeatedly during a mean follow-up of 3.2 years. Participants with higher hs-cTnT performed worse at baseline on Stroop test...

  18. 78 FR 36787 - Rechanneling the Current Cardiac Risk Paradigm: Arrhythmia Risk Assessment During Drug...

    Science.gov (United States)

    2013-06-19

    ... the current guidelines, and the importance of a uniform assay schema. Date and Time: The public... look like, the benefits and limitations of the current guidelines, and the importance of a uniform... proarrthymia screening method as an alternative to clinical Thorough QT studies. The workshop, which will...

  19. Assessing risk: the role of probabilistic risk assessment (PRA) in patient safety improvement.

    Science.gov (United States)

    Wreathall, J; Nemeth, C

    2004-06-01

    Morbidity and mortality due to "medical errors" compel better understanding of health care as a system. Probabilistic risk assessment (PRA) has been used to assess the designs of high hazard, low risk systems such as commercial nuclear power plants and chemical manufacturing plants and is now being studied for its potential in the improvement of patient safety. PRA examines events that contribute to adverse outcomes through the use of event tree analysis and determines the likelihood of event occurrence through fault tree analysis. It complements tools already in use in patient safety such as failure modes and effects analyses (FMEAs) and root cause analyses (RCAs). PRA improves on RCA by taking account of the more complex causal interrelationships that are typical in health care. It also enables the analyst to examine potential solution effectiveness by direct graphical representations. However, PRA simplifies real world complexity by forcing binary conditions on events, and it lacks adequate probability data (although recent developments help to overcome these limitations). Its reliance on expert assessment calls for deep domain knowledge which has to come from research performed at the "sharp end" of acute care.

  20. Fracture risk assessed by Fracture Risk Assessment Tool (FRAX) compared with fracture risk derived from population fracture rates

    DEFF Research Database (Denmark)

    Rubin, Katrine Hass; Abrahamsen, Bo; Hermann, Anne Pernille

    2011-01-01

    Purpose: To evaluate the performance of the Swedish version of Fracture Risk Assessment Tool (FRAX)) without bone mass density (BMD) in a Danish population to examine the possibility of applying this version to Danish women. METHODS: From the Danish National Register of social security numbers, we...... randomly selected 5000 women living in the region of Southern Denmark aged 40-90 years to receive a mailed questionnaire concerning risk factors for osteoporosis based on FRAX. The predicted 10-year probability of hip fractures was calculated for each woman returning a complete questionnaire using...... the Swedish version of FRAX. The observed 10-year hip fracture risk was also calculated for each woman using age-specific hip fracture rates from the National Hospital Discharge Register and National survival tables. RESULTS: A total of 4194 (84%) women responded to the questionnaire and 3636 (73%) gave...

  1. HANFORD SAFETY ANALYSIS & RISK ASSESSMENT HANDBOOK (SARAH)

    Energy Technology Data Exchange (ETDEWEB)

    EVANS, C B

    2004-12-21

    The purpose of the Hanford Safety Analysis and Risk Assessment Handbook (SARAH) is to support the development of safety basis documentation for Hazard Category 2 and 3 (HC-2 and 3) U.S. Department of Energy (DOE) nuclear facilities to meet the requirements of 10 CFR 830, ''Nuclear Safety Management''. Subpart B, ''Safety Basis Requirements.'' Consistent with DOE-STD-3009-94, Change Notice 2, ''Preparation Guide for U.S. Department of Energy Nonreactor Nuclear Facility Documented Safety Analyses'' (STD-3009), and DOE-STD-3011-2002, ''Guidance for Preparation of Basis for Interim Operation (BIO) Documents'' (STD-3011), the Hanford SARAH describes methodology for performing a safety analysis leading to development of a Documented Safety Analysis (DSA) and derivation of Technical Safety Requirements (TSR), and provides the information necessary to ensure a consistently rigorous approach that meets DOE expectations. The DSA and TSR documents, together with the DOE-issued Safety Evaluation Report (SER), are the basic components of facility safety basis documentation. For HC-2 or 3 nuclear facilities in long-term surveillance and maintenance (S&M), for decommissioning activities, where source term has been eliminated to the point that only low-level, residual fixed contamination is present, or for environmental remediation activities outside of a facility structure, DOE-STD-1120-98, ''Integration of Environment, Safety, and Health into Facility Disposition Activities'' (STD-1120), may serve as the basis for the DSA. HC-2 and 3 environmental remediation sites also are subject to the hazard analysis methodologies of this standard.

  2. Can exercise capacity assessed by the 6 minute walk test predict the development of major adverse cardiac events in patients with STEMI after fibrinolysis?

    Directory of Open Access Journals (Sweden)

    Ayman K M Hassan

    Full Text Available BACKGROUND: To assess the added value of the 6 minute walk test distance (6MWTD in the risk-stratification methods for patients with ST -segment elevation myocardial infarction (STEMI treated with fibrinolysis. METHODOLOGY/PRINCIPAL FINDINGS: This is a prospective cohort study of one hundred consecutive patients with STEMI, who had received fibrinolysis, at Assuit University Hospital. All patients underwent 6MWT pre- discharge and were followed up for 3 months to monitor the incidence of major adverse cardiac events (MACE. Patients were divided into 3 groups according to the level of 6MWTD (level I>450 m, level II = 300-450 m and level III450 m, patients in level III (<300 m were more likely to have clinical risk factors as hypertension, diabetes and impaired renal function. The patient's mean TIMI score was 3.4±2.2, the mean GRACE score was 150.5±27.7. There was a significant negative correlation between the 6 MWTD and GRACE risk score (r = -0.80, p<0.001. At 3 months of follow-up, 51% had MACE including 16% were dead. Multivariate logistic regression analysis identified that the GRACE risk score and 6MWT distance levels were the best predictors of the MACE at 3 month of follow up. The incidence of MACE was 4 times higher in patients with high GRACE risk score who couldn't walk more than 300 meters (OR = 4.66, 95% CI = 1.1-14.5, p = 0.006. CONCLUSIONS/SIGNIFICANCE: In patients with STEMI treated with fibrinolysis, the addition of 6MWTD assessment pre-discharge to the traditional GRACE risk score improved the risk prediction of cardiovascular events at 3 month follow up.

  3. Comparative Risk Assessment to Inform Adaptation Priorities for the Natural Environment: Observations from the First UK Climate Change Risk Assessment

    Directory of Open Access Journals (Sweden)

    Iain Brown

    2015-11-01

    Full Text Available Risk assessment can potentially provide an objective framework to synthesise and prioritise climate change risks to inform adaptation policy. However, there are significant challenges in the application of comparative risk assessment procedures to climate change, particularly for the natural environment. These challenges are evaluated with particular reference to the first statutory Climate Change Risk Assessment (CCRA and evidence review procedures used to guide policy for the UK government. More progress was achieved on risk identification, screening and prioritisation compared to risk quantification. This was due to the inherent complexity and interdependence of ecological risks and their interaction with socio-economic drivers as well as a climate change. Robust strategies to manage risk were identified as those that coordinate organisational resources to enhance ecosystem resilience, and to accommodate inevitable change, rather than to meet specific species or habitats targets. The assessment also highlighted subjective and contextual components of risk appraisal including ethical issues regarding the level of human intervention in the natural environment and the proposed outcomes of any intervention. This suggests that goals for risk assessment need to be more clearly explicated and assumptions on tolerable risk declared as a primer for further dialogue on expectations for managed outcomes. Ecosystem-based adaptation may mean that traditional habitats and species conservation goals and existing regulatory frameworks no longer provide the best guide for long-term risk management thereby challenging the viability of some existing practices.

  4. Clinical Assessment of Intraventricular Blood Transport in Patients Undergoing Cardiac Resynchronization Therapy

    Science.gov (United States)

    Rossini, Lorenzo; Martinez-Legazpi, P.; Benito, Y.; Perez Del Villar, C.; Gonzalez-Mansilla, A.; Barrio, A.; Yotti, R.; Kahn, A. M.; Shadden, S. C.; Fernandez-Aviles, F.; Bermejo, J.; Del Alamo, J. C.

    2015-11-01

    In the healthy heart, left ventricular (LV) filling generates flow patterns which have been proposed to optimize blood transport by coupling diastole and systole phases. We present a novel image-based method to assess how flow patterns influence LV blood transport in patients undergoing cardiac resynchronization therapy (CRT). Solving the advection equation with time-varying inflow boundary conditions allows to track the transport of blood entering the LV in the different filling waves, as well as the transport barriers which couple filling and ejection. The velocity fields were obtained using echocardiographic color Doppler velocimetry, which provides two-dimensional time-resolved flow maps in the apical long axis three-chamber view of the LV. We analyze flow transport in a group of patients with CRT devices as well as in healthy volunteers. In the patients under CRT, the device programming was varied to analyze flow transport under different values of the atrioventricular (AV) conduction delay and to model tachycardia. This analysis illustrates how CRT influences the transit of blood inside the LV, contributes to conserving kinetic energy and favors the generation of hemodynamic forces that accelerate blood in the direction of the LV outflow tract.

  5. Echocardiographic Assessment of Degenerative Mitral Stenosis: A Diagnostic Challenge of an Emerging Cardiac Disease.

    Science.gov (United States)

    Oktay, Ahmet Afşşin; Gilliland, Yvonne E; Lavie, Carl J; Ramee, Stephen J; Parrino, Patrick E; Bates, Michael; Shah, Sangeeta; Cash, Michael E; Dinshaw, Homeyar; Qamruddin, Salima

    2017-03-01

    Degenerative mitral stenosis (DMS) is characterized by decreased mitral valve (MV) orifice area and increased transmitral pressure gradient due to chronic noninflammatory degeneration and subsequent calcification of the fibrous mitral annulus and the MV leaflets. The "true" prevalence of DMS in the general population is unknown. DMS predominantly affects elderly individuals, many of whom have multiple other comorbidities. Transcatheter MV replacement techniques, although their long-term outcomes are yet to be tested, have been gaining popularity and may emerge as more effective and relatively safer treatment option for patients with DMS. Echocardiography is the primary imaging modality for evaluation of DMS and related hemodynamic abnormalities such as increased transmitral pressure gradient and pulmonary arterial pressure. Classic echocardiographic techniques used for evaluation of mitral stenosis (pressure half time, proximal isovelocity surface area, continuity equation, and MV area planimetry) lack validation for DMS. Direct planimetry with 3-dimensional echocardiography and color flow Doppler is a reasonable technique for determining MV area in DMS. Cardiac computed tomography is an essential tool for planning potential interventions or surgeries for DMS. This article reviews the current concepts on mitral annular calcification and its role in DMS. We then discuss the epidemiology, natural history, differential diagnosis, mechanisms, and echocardiographic assessment of DMS.

  6. Environmental Risk Assessment of Genetically Modified Organisms (GMOs)

    DEFF Research Database (Denmark)

    Strandberg, B.; Kjær, C.; Hindar, K.

    It was the aim of this NordTest project to propose improvements that prepare us to assess ecological risks to the environment associated with releases of existing and coming GMO cases. The report is separated into three sections. The first describes the frames of ecological risk assessment...

  7. Recognizing Success: Assessing Arts Residencies for "At Risk" Populations

    Science.gov (United States)

    Davidoff, Paula

    2007-01-01

    Assessing the success of a residency with an at-risk population requires an expanded set of standards. While ultimate goals may be the same, one needs a longer time to achieve them. In this article, the author, a teaching artist with long experience working in at-risk settings, argues for a deeper and broader understanding of assessment and…

  8. MINI REVIEW - EPIGENETIC PROCESSES AND CANCER RISK ASSESSMENT

    Science.gov (United States)

    Abstract: The U.S. Environmental Protection Agency's Guidelines for Carcinogen Risk Assessment encourages the use of mechanistic data in the assessment of human cancer risk at low (environmental) exposure levels. The key events that define a particular mode of action for tumor fo...

  9. Study of occupation health risk assessment on Chinese coal mine

    Institute of Scientific and Technical Information of China (English)

    XIAO Guo-qing; YAN Xiang-nong

    2007-01-01

    Factors of occupation health hazard were identified and analyzed, and indexes system of occupation health risk assessment were established by applying fuzzy theory and system safety technique, the weights of index system were obtained by AHP, finally a reasonable mathematics model of occupation health risk assessment was accomplished by an example.

  10. Predictive validity of the Hand Arm Risk assessment Method (HARM)

    NARCIS (Netherlands)

    Douwes, M.; Boocock, M.; Coenen, P.; Heuvel, S. van den; Bosch, T.

    2014-01-01

    The Hand Arm Risk assessment Method (HARM) is a simplified risk assessment method for determining musculoskeletal symptoms to the arm, neck and/or shoulder posed by hand-arm tasks of the upper body. The purpose of this study was to evaluate the predictive validity of HARM using data collected from a

  11. Regulating by the Numbers: Probabilistic Risk Assessment and Nuclear Power.

    Science.gov (United States)

    Nichols, Elizabeth; Wildavsky, Aaron

    1988-01-01

    Probabilistic risk assessment has been promoted within the Nuclear Regulatory Commission as a means of judging risk to the public and of determining regulatory measures. Interviews with engineers and other technically trained personnel reveal the difficulties created by expectations that this form of assessment should be applied. (TJH)

  12. Effect of Different Styles of Coronary Heart Disease and Its Risk Factors on Cardiac Remodeling and Dysfunction

    Institute of Scientific and Technical Information of China (English)

    Wang Xuelihong; Guo Xuewei; Ma Yushan; Su Shuangshan; Guo Xiangyu

    2006-01-01

    Objectives To evaluate the effect of different styles of coronary heart disease (CHD),different regions of acute myocardial infarction (AMI),its risk factors and branches of coronary stenosis on left ventricular remodeling and dysfunction by applying echocardiography. Methods 251 patients with CHD and 96 patients without CHD (NoCHD) were verified by selective coronary angiography. CHD patients were divided into stable angina pectoris(SAP) 26, unstable angina pectoris(UAP) 53, acute myocardial infarction (AMI) 140 and old myocardial infarction (OMI) 30 based on clinical situation, cTnT, cardiac enzyme and ECG. AMI patients were further divided into subgroups including acute anterior myocardial infarct (Aa,n =53), acute inferior myocardial infarction(Ai, n=54)and Aa+Ai(n=33) based on ECG. Cardiac parameters:end-diastolic interventricular septum thickness (IVSd),end-diastolic left ventricular internal diameter(LVd ),left ventricular mass (LM), end-diastolic left ventricular volume (EDV), end-systolic left ventricular volume (ESV) and left ventricular ejection fraction(LVEF) were measured by ACUSON 128XP/10 echocardiography.Multiples linear regression analyses were performed to test statistical associations between LVEF and the involved branches of coronary stenosis, blood pressure, lipids, glucose and etc after onset of myocardial infarction. Results EDV and ESV were increased and LVEF decreased on patients with AMI,OMI and UAP (P<0.05-0.0001). LM was mainly increased in patients with OMI (P<0.01) and LVd was mainly enlarged in patients with AMI. EF was significantly decreased and EDV, ESV, LM and LVd were remarkably increased in AMI patients with Aa and Aa+Ai. With the multiple linear regression analyses by SPSS software, we found that LVEF was negatively correlated to the involved branches of coronary stenosis as well as to systolic blood pressure after onset of myocardial infarction while there was no significant correlation between LVEF and other factors. LVEF

  13. Scientific Opinion on Risk Assessment of Synthetic Biology.

    Science.gov (United States)

    Epstein, Michelle M; Vermeire, Theo

    2016-08-01

    In 2013, three Scientific Committees of the European Commission (EC) drafted Scientific Opinions on synthetic biology that provide an operational definition and address risk assessment methodology, safety aspects, environmental risks, knowledge gaps, and research priorities. These Opinions contribute to the international discussions on the risk governance for synthetic biology developments.

  14. Risk assessment: the importance of genetic polymorphisms in man

    DEFF Research Database (Denmark)

    Knudsen, Lisbeth E.; Loft, S H; Autrup, H

    2001-01-01

    and increased cancer risk, such results indicate effect modification regarding cancer risk. In risk assessment the safety 'factor' of 10 is generally accepted to allow for variation in individual susceptibility. Reviewing the literature justifies the factor of 10 when considering single polymorphisms. However...... the application in insurance situations is criticised....

  15. Risk assessment: the importance of genetic polymorphisms in man

    DEFF Research Database (Denmark)

    E. Knudsen, Lisbeth; Loft, Steffen; Autrup, Herman

    2001-01-01

    and increased cancer risk, such results indicate effect modification regarding cancer risk. In risk assessment the safety ‘factor’ of 10 is generally accepted to allow for variation in individual susceptibility. Reviewing the literature justifies the factor of 10 when considering single polymorphisms. However...... the application in insurance situations is criticised....

  16. Microbiological risk assessment of foods in international trade

    NARCIS (Netherlands)

    Schothorst, van M.

    2002-01-01

    The international workshop on "Promotion of Technical Harmonisation on Risk-Based Decision Making" reviewed the use of risk-based decision making across a range of industry sectors and countries. This paper presents the contribution to the workshop covering microbiological risk assessment of foods i

  17. Advancing the Contribution of Occupational Epidemiology to Risk Assessment

    NARCIS (Netherlands)

    Vlaanderen, J.J.

    2011-01-01

    The identification and quantification of risk factors that are characterized by low exposure levels, moderately increased risks, and unspecific exposure-disease relations is a major challenge facing risk assessment today. Occupational epidemiological studies can play a role in addressing this challe

  18. ArgueSecure: Out-of-the-box Risk Assessment

    NARCIS (Netherlands)

    Ionita, Dan; Kegel, Roeland; Wieringa, Roel; Baltuta, Andrei

    2016-01-01

    Most established security risk assessment methodologies aim to produce ranked lists of risks. But ranking requires quantification of risks, which in turn relies on data which may not be available or estimations which might not be accurate. As an alternative, we have previously proposed argumentation

  19. Status and future of Quantitative Microbiological Risk Assessment in China.

    Science.gov (United States)

    Dong, Q L; Barker, G C; Gorris, L G M; Tian, M S; Song, X Y; Malakar, P K

    2015-03-01

    Since the implementation of the Food Safety Law of the People's Republic of China in 2009 use of Quantitative Microbiological Risk Assessment (QMRA) has increased. QMRA is used to assess the risk posed to consumers by pathogenic bacteria which cause the majority of foodborne outbreaks in China. This review analyses the progress of QMRA research in China from 2000 to 2013 and discusses 3 possible improvements for the future. These improvements include planning and scoping to initiate QMRA, effectiveness of microbial risk assessment utility for risk management decision making, and application of QMRA to establish appropriate Food Safety Objectives.

  20. Cavity degradation risk insurance assessment. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Hampson, C.; Neill, P.; de Bivort, L.

    1980-01-01

    This study examined the risks and risk management issues involved with the implementation by electric power utilities of compressed air energy storage and underground pumped hydro storage systems. The results are listed in terms of relative risks for the construction and operation of these systems in different geologic deposits, with varying amounts of pressurization, with natural or man-made disasters in the vicinity of the storage equipment, and with different modes of operating the facilities. (LCL)