Conceptual models for cumulative risk assessment.

Science.gov (United States)

Linder, Stephen H; Sexton, Ken

2011-12-01

In the absence of scientific consensus on an appropriate theoretical framework, cumulative risk assessment and related research have relied on speculative conceptual models. We argue for the importance of theoretical backing for such models and discuss 3 relevant theoretical frameworks, each supporting a distinctive "family" of models. Social determinant models postulate that unequal health outcomes are caused by structural inequalities; health disparity models envision social and contextual factors acting through individual behaviors and biological mechanisms; and multiple stressor models incorporate environmental agents, emphasizing the intermediary role of these and other stressors. The conclusion is that more careful reliance on established frameworks will lead directly to improvements in characterizing cumulative risk burdens and accounting for disproportionate adverse health effects.

Correlation Between Monthly Cumulative Auroral Electrojet Indices, DST Index and Interplanetary Electric Field During Magnetic Storms

Directory of Open Access Journals (Sweden)

Yoon-Kyung Park

2005-12-01

Full Text Available Magnetospheric substorms occur frequently during magnetic storms, suggesting that the two phenomena are closely associated. We can investigate the relation between magnetospheric substorms and magnetic storms by examining the correlation between AE and Dst indices. For this purpose, we calculated the monthly cumulative AU, |AL| and |Dst| indices. The correlation coefficient between the monthly cumulative |AL| and |Dst| index is found to be 0.60, while that between monthly cumulative AU and |Dst| index is 0.28. This result indicates that substorms seem to contribute to the development of magnetic storms. On the other hand, it has been reported that the interplanetary electric field associated with southward IMF intensifies the magnetospheric convection, which injects charged particles into the inner magnetosphere, thus developing the ring current. To evaluate the contribution of the interplanetary electric field to the development of the storm time ring current belt, we compared the monthly cumulative interplanetary electric field and the monthly cumulative Dst index. The correlation coefficient between the two cumulative indices is 0.83 for southward IMF and 0.39 for northward IMF. It indicates that magnetospheric convection induced by southward IMF is also important in developing magnetic storms. Therefore, both magnetospheric substorm and enhanced magnetospheric convection seem to contribute to the buildup of magnetic storm.

Implications of applying cumulative risk assessment to the workplace.

Science.gov (United States)

Fox, Mary A; Spicer, Kristen; Chosewood, L Casey; Susi, Pam; Johns, Douglas O; Dotson, G Scott

2018-06-01

Multiple changes are influencing work, workplaces and workers in the US including shifts in the main types of work and the rise of the 'gig' economy. Work and workplace changes have coincided with a decline in unions and associated advocacy for improved safety and health conditions. Risk assessment has been the primary method to inform occupational and environmental health policy and management for many types of hazards. Although often focused on one hazard at a time, risk assessment frameworks and methods have advanced toward cumulative risk assessment recognizing that exposure to a single chemical or non-chemical stressor rarely occurs in isolation. We explore how applying cumulative risk approaches may change the roles of workers and employers as they pursue improved health and safety and elucidate some of the challenges and opportunities that might arise. Application of cumulative risk assessment should result in better understanding of complex exposures and health risks with the potential to inform more effective controls and improved safety and health risk management overall. Roles and responsibilities of both employers and workers are anticipated to change with potential for a greater burden of responsibility on workers to address risk factors both inside and outside the workplace that affect health at work. A range of policies, guidance and training have helped develop cumulative risk assessment for the environmental health field and similar approaches are available to foster the practice in occupational safety and health. Copyright © 2018 Elsevier Ltd. All rights reserved.

Cumulative childhood risk is associated with a new measure of chronic inflammation in adulthood.

Science.gov (United States)

Rasmussen, Line Jee Hartmann; Moffitt, Terrie E; Eugen-Olsen, Jesper; Belsky, Daniel W; Danese, Andrea; Harrington, HonaLee; Houts, Renate M; Poulton, Richie; Sugden, Karen; Williams, Benjamin; Caspi, Avshalom

2018-05-09

Childhood risk factors are associated with elevated inflammatory biomarkers in adulthood, but it is unknown whether these risk factors are associated with increased adult levels of the chronic inflammation marker soluble urokinase plasminogen activator receptor (suPAR). We aimed to test the hypothesis that childhood exposure to risk factors for adult disease is associated with elevated suPAR in adulthood and to compare suPAR with the oft-reported inflammatory biomarker C-reactive protein (CRP). Prospective study of a population-representative 1972-1973 birth cohort; the Dunedin Multidisciplinary Health and Development Study observed participants to age 38 years. Main childhood predictors were poor health, socioeconomic disadvantage, adverse childhood experiences (ACEs), low IQ, and poor self-control. Main adult outcomes were adulthood inflammation measured as suPAR and high-sensitivity CRP (hsCRP). Participants with available plasma samples at age 38 were included (N = 837, 50.5% male). suPAR (mean 2.40 ng/ml; SD 0.91) was positively correlated with hsCRP (r 0.15, p childhood risks were aggregated into a Cumulative Childhood Risk index, and controlling for sex, BMI, and smoking, Cumulative Childhood Risk was associated with higher suPAR (b 0.10; SE 0.03; p = .002). Cumulative Childhood Risk predicted elevated suPAR, after controlling for hsCRP (b 0.18; SE 0.03; p childhood risk factors was associated with higher suPAR levels, independent of CRP. suPAR is a useful addition to studies connecting childhood risk to adult inflammatory burden. © 2018 Association for Child and Adolescent Mental Health.

Chemical evolution and the origin of life: cumulative keyword subject index 1970-1986

Science.gov (United States)

Roy, A. C.; Powers, J. V.; Rummel, J. D. (Principal Investigator)

1990-01-01

This cumulative subject index encompasses the subject indexes of the bibliographies on Chemical Evolution and the Origin of Life that were first published in 1970 and have continued through publication of the 1986 bibliography supplement. Early bibliographies focused on experimental and theoretical material dealing directly with the concepts of chemical evolution and the origin of life, excluding the broader areas of exobiology, biological evolution, and geochemistry. In recent years, these broader subject areas have also been incorporated as they appear in literature searches relating to chemical evolution and the origin of life, although direct attempts have not been made to compile all of the citations in these broad areas. The keyword subject indexes have also undergone an analogous change in scope. Compilers of earlier bibliographies used the most specific term available in producing the subject index. Compilers of recent bibliographies have used a number of broad terms relating to the overall subject content of each citation and specific terms where appropriate. The subject indexes of these 17 bibliographies have, in general, been cumulatively compiled exactly as they originally appeared. However, some changes have been made in an attempt to correct errors, combine terms, and provide more meaningful terms.

Predicting the cumulative risk of death during hospitalization by modeling weekend, weekday and diurnal mortality risks.

Science.gov (United States)

Coiera, Enrico; Wang, Ying; Magrabi, Farah; Concha, Oscar Perez; Gallego, Blanca; Runciman, William

2014-05-21

Current prognostic models factor in patient and disease specific variables but do not consider cumulative risks of hospitalization over time. We developed risk models of the likelihood of death associated with cumulative exposure to hospitalization, based on time-varying risks of hospitalization over any given day, as well as day of the week. Model performance was evaluated alone, and in combination with simple disease-specific models. Patients admitted between 2000 and 2006 from 501 public and private hospitals in NSW, Australia were used for training and 2007 data for evaluation. The impact of hospital care delivered over different days of the week and or times of the day was modeled by separating hospitalization risk into 21 separate time periods (morning, day, night across the days of the week). Three models were developed to predict death up to 7-days post-discharge: 1/a simple background risk model using age, gender; 2/a time-varying risk model for exposure to hospitalization (admission time, days in hospital); 3/disease specific models (Charlson co-morbidity index, DRG). Combining these three generated a full model. Models were evaluated by accuracy, AUC, Akaike and Bayesian information criteria. There was a clear diurnal rhythm to hospital mortality in the data set, peaking in the evening, as well as the well-known 'weekend-effect' where mortality peaks with weekend admissions. Individual models had modest performance on the test data set (AUC 0.71, 0.79 and 0.79 respectively). The combined model which included time-varying risk however yielded an average AUC of 0.92. This model performed best for stays up to 7-days (93% of admissions), peaking at days 3 to 5 (AUC 0.94). Risks of hospitalization vary not just with the day of the week but also time of the day, and can be used to make predictions about the cumulative risk of death associated with an individual's hospitalization. Combining disease specific models with such time varying- estimates appears to

EPA Workshop on Epigenetics and Cumulative Risk ...

Science.gov (United States)

Agenda Download the Workshop Agenda (PDF) The workshop included presentations and discussions by scientific experts pertaining to three topics (i.e., epigenetic changes associated with diverse stressors, key science considerations in understanding epigenetic changes, and practical application of epigenetic tools to address cumulative risks from environmental stressors), to address several questions under each topic, and included an opportunity for attendees to participate in break-out groups, provide comments and ask questions. Workshop Goals The workshop seeks to examine the opportunity for use of aggregate epigenetic change as an indicator in cumulative risk assessment for populations exposed to multiple stressors that affect epigenetic status. Epigenetic changes are specific molecular changes around DNA that alter expression of genes. Epigenetic changes include DNA methylation, formation of histone adducts, and changes in micro RNAs. Research today indicates that epigenetic changes are involved in many chronic diseases (cancer, cardiovascular disease, obesity, diabetes, mental health disorders, and asthma). Research has also linked a wide range of stressors including pollution and social factors with occurrence of epigenetic alterations. Epigenetic changes have the potential to reflect impacts of risk factors across multiple stages of life. Only recently receiving attention is the nexus between the factors of cumulative exposure to environmental

An analysis of cumulative risks based on biomonitoring data for six phthalates using the Maximum Cumulative Ratio

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The Maximum Cumulative Ratio (MCR) quantifies the degree to which a single chemical drives the cumulative risk of an individual exposed to multiple chemicals. Phthalates are a class of chemicals with ubiquitous exposures in the general population that have the potential to cause ...

Mapping cumulative environmental risks: examples from the EU NoMiracle project

NARCIS (Netherlands)

Pistocchi, A.; Groenwold, J.; Lahr, J.; Loos, M.; Mujica, M.; Ragas, A.M.J.; Rallo, R.; Sala, S.; Schlink, U.; Strebel, K.; Vighi, M.; Vizcaino, P.

2011-01-01

We present examples of cumulative chemical risk mapping methods developed within the NoMiracle project. The different examples illustrate the application of the concentration addition (CA) approach to pesticides at different scale, the integration in space of cumulative risks to individual organisms

Single and Cumulative Relations of Social Risk Factors with Children's Dental Health and Care-Utilization Within Regions of the United States.

Science.gov (United States)

Yang, Alyssa J; Gromoske, Andrea N; Olson, Melissa A; Chaffin, Jeffrey G

2016-03-01

The purpose is to examine the relation of social risk factors, and the cumulative burden of social risk factors, on parent-reported dental health and dental care-seeking behavior. National Survey of Children's Health data (2011-2012) were analyzed for US children by Title V Block Grant regions. Multivariate logistic regressions were estimated for ten social risk factors, as well as a cumulative risk index, to find any associations with poor condition of teeth, presence of dental caries, and no dental care visits. Almost all of the risk factors were significantly associated with poor condition of teeth and presence of dental caries for the US. Models associating no dental care visits suggested that low family income (OR 1.58), poor maternal mental health (OR 1.54), high school education or less (OR 1.34), and multi-racial/other race (OR 1.18) were significant factors for the US. Regional variation existed for those risk factors and their association with the outcomes, but income, education, and poor maternal mental health consistently played a significant role in adverse outcomes. The cumulative risk index was strongly related to poor oral health outcomes, with a weaker relationship to dental care utilization. US children experiencing certain social risk factors, such as low family income, high school education or less, and poor maternal mental health, are likely to be at greater risk for poor dental health and low levels of dental-care seeking behavior. Children experiencing multiple social risks are at greater risk for poor oral outcomes than children who experience fewer social risks. An approach that involves the social determinants of health is needed to address these issues.

Repeated exposure to high-frequency spanking and child externalizing behavior across the first decade: a moderating role for cumulative risk.

Science.gov (United States)

MacKenzie, Michael J; Nicklas, Eric; Brooks-Gunn, Jeanne; Waldfogel, Jane

2014-12-01

This study used the Fragile Families and Child Well-Being Study to examine the effects of repeated exposure to harsh parenting on child externalizing behavior across the first decade of life, and a moderating role for cumulative ecological risk. Maternal report of harsh parenting, defined as high frequency spanking, was assessed at age 1, 3, 5, and 9, along with child externalizing at age 9 (N=2,768). Controlling for gender, race, maternal nativity, and city of residence, we found a cumulative risk index to significantly moderate the effects of repeated harsh parenting on child behavior, with the effects of repeated high-frequency spanking being amplified for those experiencing greater levels of cumulative risk. Harsh parenting, in the form of high frequency spanking, remains a too common experience for children, and results demonstrate that the effects of repeated exposure to harsh parenting across the first decade are amplified for those children already facing the most burden. Copyright © 2014. Published by Elsevier Ltd.

The EPA's human exposure research program for assessing cumulative risk in communities.

Science.gov (United States)

Zartarian, Valerie G; Schultz, Bradley D

2010-06-01

Communities are faced with challenges in identifying and prioritizing environmental issues, taking actions to reduce their exposures, and determining their effectiveness for reducing human health risks. Additional challenges include determining what scientific tools are available and most relevant, and understanding how to use those tools; given these barriers, community groups tend to rely more on risk perception than science. The U.S. Environmental Protection Agency's Office of Research and Development, National Exposure Research Laboratory (NERL) and collaborators are developing and applying tools (models, data, methods) for enhancing cumulative risk assessments. The NERL's "Cumulative Communities Research Program" focuses on key science questions: (1) How to systematically identify and prioritize key chemical stressors within a given community?; (2) How to develop estimates of exposure to multiple stressors for individuals in epidemiologic studies?; and (3) What tools can be used to assess community-level distributions of exposures for the development and evaluation of the effectiveness of risk reduction strategies? This paper provides community partners and scientific researchers with an understanding of the NERL research program and other efforts to address cumulative community risks; and key research needs and opportunities. Some initial findings include the following: (1) Many useful tools exist for components of risk assessment, but need to be developed collaboratively with end users and made more comprehensive and user-friendly for practical application; (2) Tools for quantifying cumulative risks and impact of community risk reduction activities are also needed; (3) More data are needed to assess community- and individual-level exposures, and to link exposure-related information with health effects; and (4) Additional research is needed to incorporate risk-modifying factors ("non-chemical stressors") into cumulative risk assessments. The products of this

Considering Environmental and Occupational Stressors in Cumulative Risk Assessments

Science.gov (United States)

While definitions vary across the global scientific community, cumulative risk assessments (CRAs) typically are described as exhibiting a population focus and analyzing the combined risks posed by multiple stressors. CRAs also may consider risk management alternatives as an anal...

Cumulative Index of ERIC Resources in Counseling and Personnel Services. 1967-1976.

Science.gov (United States)

Walz, Garry R.; And Others

This cumulative index contains over 5500 titles from the ERIC collection, and represents all the document input from the Clearinghouse on Counseling and Personnel Services between 1967-1976. Topics cover theoretical and practical information in all areas of counseling and guidance as well as in drug abuse, aging, sexuality and death. Directions…

Performance of a risk index for advanced proximal colorectal neoplasia among a racially/ethnically diverse patient population (risk index for advanced proximal neoplasia).

Science.gov (United States)

Levitzky, Benjamin E; Brown, Colin C; Heeren, Timothy C; Schroy, Paul C

2011-06-01

Tailoring the use of screening colonoscopy based on the risk of advanced proximal neoplasia (APN) has been advocated as a strategy for reducing demand and optimizing effectiveness. A 7-point index based on age, sex, and distal findings at sigmoidoscopy has been proposed that stratifies individuals into low, intermediate, and high-risk categories. The aim of this cross-sectional analysis was to determine the validity of this index, which was originally derived and validated among mostly whites, for black and Hispanic patients. Data, including age, sex, colonoscopic findings, and pathology, were collected retrospectively from 1,481 white, 1,329 black, and 689 Hispanic asymptomatic, average-risk patients undergoing screening colonoscopy between 2000 and 2005. Cumulative scores ranging from 0 to 7 were derived for each subject and categorized as low, intermediate, or high risk. Rates of APN were assessed for each risk category after stratification by race/ethnicity. Index performance was assessed using the C-statistic and compared across the three racial groups. Rates of APN among patients categorized as low, intermediate, or high risk increased from 1.0 to 2.8 to 3.7% for whites, 1.0 to 2.2 to 4.2% for blacks, and 0.6 to 1.9 to 3.7% for Hispanics. The index performed similarly for all three groups, but showed limited ability to discriminate low from intermediate-risk patients, with C-statistic values of 0.62 for whites, 0.63 for blacks, and 0.68 for Hispanics. A risk index based on age, sex, and distal endoscopic findings has limited ability to discriminate low from intermediate-risk white, black, and Hispanic patients for APN.

Aggregate Exposure and Cumulative Risk Assessment--Integrating Occupational and Non-occupational Risk Factors.

Science.gov (United States)

Lentz, T J; Dotson, G S; Williams, P R D; Maier, A; Gadagbui, B; Pandalai, S P; Lamba, A; Hearl, F; Mumtaz, M

2015-01-01

Occupational exposure limits have traditionally focused on preventing morbidity and mortality arising from inhalation exposures to individual chemical stressors in the workplace. While central to occupational risk assessment, occupational exposure limits have limited application as a refined disease prevention tool because they do not account for all of the complexities of the work and non-occupational environments and are based on varying health endpoints. To be of greater utility, occupational exposure limits and other risk management tools could integrate broader consideration of risks from multiple exposure pathways and routes (aggregate risk) as well as the combined risk from exposure to both chemical and non-chemical stressors, within and beyond the workplace, including the possibility that such exposures may cause interactions or modify the toxic effects observed (cumulative risk). Although still at a rudimentary stage in many cases, a variety of methods and tools have been developed or are being used in allied risk assessment fields to incorporate such considerations in the risk assessment process. These approaches, which are collectively referred to as cumulative risk assessment, have potential to be adapted or modified for occupational scenarios and provide a tangible path forward for occupational risk assessment. Accounting for complex exposures in the workplace and the broader risks faced by the individual also requires a more complete consideration of the composite effects of occupational and non-occupational risk factors to fully assess and manage worker health problems. Barriers to integrating these different factors remain, but new and ongoing community-based and worker health-related initiatives may provide mechanisms for identifying and integrating risk from aggregate exposures and cumulative risks from all relevant sources, be they occupational or non-occupational.

Cumulative risk hypothesis: Predicting and preventing child maltreatment recidivism.

Science.gov (United States)

Solomon, David; Åsberg, Kia; Peer, Samuel; Prince, Gwendolyn

2016-08-01

Although Child Protective Services (CPS) and other child welfare agencies aim to prevent further maltreatment in cases of child abuse and neglect, recidivism is common. Having a better understanding of recidivism predictors could aid in preventing additional instances of maltreatment. A previous study identified two CPS interventions that predicted recidivism: psychotherapy for the parent, which was related to a reduced risk of recidivism, and temporary removal of the child from the parent's custody, which was related to an increased recidivism risk. However, counter to expectations, this previous study did not identify any other specific risk factors related to maltreatment recidivism. For the current study, it was hypothesized that (a) cumulative risk (i.e., the total number of risk factors) would significantly predict maltreatment recidivism above and beyond intervention variables in a sample of CPS case files and that (b) therapy for the parent would be related to a reduced likelihood of recidivism. Because it was believed that the relation between temporary removal of a child from the parent's custody and maltreatment recidivism is explained by cumulative risk, the study also hypothesized that that the relation between temporary removal of the child from the parent's custody and recidivism would be mediated by cumulative risk. After performing a hierarchical logistic regression analysis, the first two hypotheses were supported, and an additional predictor, psychotherapy for the child, also was related to reduced chances of recidivism. However, Hypothesis 3 was not supported, as risk did not significantly mediate the relation between temporary removal and recidivism. Copyright © 2016 Elsevier Ltd. All rights reserved.

Cumulative Risk Assessment Toolbox: Methods and Approaches for the Practitioner

Directory of Open Access Journals (Sweden)

Margaret M. MacDonell

2013-01-01

Full Text Available The historical approach to assessing health risks of environmental chemicals has been to evaluate them one at a time. In fact, we are exposed every day to a wide variety of chemicals and are increasingly aware of potential health implications. Although considerable progress has been made in the science underlying risk assessments for real-world exposures, implementation has lagged because many practitioners are unaware of methods and tools available to support these analyses. To address this issue, the US Environmental Protection Agency developed a toolbox of cumulative risk resources for contaminated sites, as part of a resource document that was published in 2007. This paper highlights information for nearly 80 resources from the toolbox and provides selected updates, with practical notes for cumulative risk applications. Resources are organized according to the main elements of the assessment process: (1 planning, scoping, and problem formulation; (2 environmental fate and transport; (3 exposure analysis extending to human factors; (4 toxicity analysis; and (5 risk and uncertainty characterization, including presentation of results. In addition to providing online access, plans for the toolbox include addressing nonchemical stressors and applications beyond contaminated sites and further strengthening resource accessibility to support evolving analyses for cumulative risk and sustainable communities.

Cumulative Risk of Bovine Mastitis Treatments in Denmark, Finland, Norway and Sweden

OpenAIRE

Valde, JP; Lawson, LG; Lindberg, A; Agger, JF; Saloniemi, H; Østerås, O

2004-01-01

Data from the national dairy cow recording systems during 1997 were used to calculate lactation-specific cumulative risk of mastitis treatments and cumulative risk of removal from the herds in Denmark, Finland Norway and Sweden. Sweden had the lowest risk of recorded mastitis treatments during 305 days of lactation and Norway had the highest risk. The incidence risk of recorded mastitis treatments during 305 days of lactation in Denmark, Finland, Norway and Sweden was 0.177, 0.139, 0.215 and...

Childhood Psychosocial Cumulative Risks and Carotid Intima-Media Thickness in Adulthood: The Cardiovascular Risk in Young Finns Study

Science.gov (United States)

Hakulinen, Christian; Pulkki-Råback, Laura; Elovainio, Marko; Kubzansky, Laura D.; Jokela, Markus; Hintsanen, Mirka; Juonala, Markus; Kivimäki, Mika; Josefsson, Kim; Hutri-Kähönen, Nina; Kähönen, Mika; Viikari, Jorma; Keltikangas-Järvinen, Liisa; Raitakari, Olli T

2015-01-01

Objective Adverse experiences in childhood may influence cardiovascular risk in adulthood. We examined the prospective associations between types of psychosocial adversity as well as having multiple adversities (e.g., cumulative risk) with carotid intima-media thickness (IMT) and its progression among young adults. Higher cumulative risk score in childhood was expected to be associated with higher IMT and its progression. Methods Participants were 2265 men and women (age range: 24-39 years in 2001) from the on-going Cardiovascular Risk in Young Finns study whose carotid IMT were measured in 2001 and 2007. A cumulative psychosocial risk score, assessed at the study baseline in 1980, was derived from four separate aspects of the childhood environment that may impose risk (childhood stressful life-events, parental health behavior family, socioeconomic status, and childhood emotional environment). Results The cumulative risk score was associated with higher IMT in 2007 (b=.004; se=.001; padulthood, including adulthood health behavior, adulthood socioeconomic status and depressive symptoms. Among the individual childhood psychosocial risk categories, having more stressful life-events was associated with higher IMT in 2001 (b=.007; se=.003; p=.016) and poorer parental health behavior predicted higher IMT in 2007 (b=.004; se=.002; p=.031) after adjustment for age, sex and childhood cardiovascular risk factors. Conclusions Early life psychosocial environment influences cardiovascular risk later in life and considering cumulative childhood risk factors may be more informative than individual factors in predicting progression of preclinical atherosclerosis in adulthood. PMID:26809108

The Role of Cumulative Risk Assessment in Decisions about Environmental Justice

Directory of Open Access Journals (Sweden)

Ken Sexton

2010-11-01

Full Text Available There is strong presumptive evidence that people living in poverty and certain racial and ethnic groups bear a disproportionate burden of environmental health risk. Many have argued that conducting formal assessments of the health risk experienced by affected communities is both unnecessary and counterproductive—that instead of analyzing the situation our efforts should be devoted to fixing obvious problems and rectifying observable wrongs. We contend that formal assessment of cumulative health risks from combined effects of chemical and nonchemical stressors is a valuable tool to aid decision makers in choosing risk management options that are effective, efficient, and equitable. If used properly, cumulative risk assessment need not impair decision makers’ discretion, nor should it be used as an excuse for doing nothing in the face of evident harm. Good policy decisions require more than good intentions; they necessitate analysis of risk-related information along with careful consideration of economic issues, ethical and moral principles, legal precedents, political realities, cultural beliefs, societal values, and bureaucratic impediments. Cumulative risk assessment can provide a systematic and impartial means for informing policy decisions about environmental justice.

Cumulative Risk Assessment (CRA): transforming the way we assess health risks.

Science.gov (United States)

Williams, Pamela R D; Dotson, G Scott; Maier, Andrew

2012-10-16

Human health risk assessments continue to evolve and now focus on the need for cumulative risk assessment (CRA). CRA involves assessing the combined risk from coexposure to multiple chemical and nonchemical stressors for varying health effects. CRAs are broader in scope than traditional chemical risk assessments because they allow for a more comprehensive evaluation of the interaction between different stressors and their combined impact on human health. Future directions of CRA include greater emphasis on local-level community-based assessments; integrating environmental, occupational, community, and individual risk factors; and identifying and implementing common frameworks and risk metrics for incorporating multiple stressors.

A Review of Non-Chemical Stressors and Their Importance in Cumulative Risk Assessment

Science.gov (United States)

Cumulative exposure/risk assessments need to include non-chemical stressors as well as human activities and chemical data. Multiple stressor research can offer information on the interactions between chemical and non-chemical stressors needed for cumulative risk assessment resea...

Cumulative Risks of Foster Care Placement for Danish Children

DEFF Research Database (Denmark)

Fallesen, Peter; Emanuel, Natalia; Wildeman, Christopher

2014-01-01

children. Our results also show some variations by parental ethnicity and sex, but these differences are small. Indeed, they appear quite muted relative to racial/ethnic differences in these risks in the United States. Last, though cumulative risks are similar between Danish and American children...

Pesticide Cumulative Risk Assessment: Framework for Screening Analysis

Science.gov (United States)

This document provides guidance on how to screen groups of pesticides for cumulative evaluation using a two-step approach: begin with evaluation of available toxicological information and, if necessary, follow up with a risk-based screening approach.

Estimation of lifetime cumulative incidence and mortality risk of gastric cancer.

Science.gov (United States)

Taniyama, Yukari; Katanoda, Kota; Charvat, Hadrien; Hori, Megumi; Ohno, Yuko; Sasazuki, Shizuka; Tsugane, Shoichiro

2017-11-01

To estimate cumulative incidence and mortality risk for gastric cancer by risk category. Risk was classified into four types according to the presence/absence of Helicobacter pylori infection and chronic atrophic gastritis: in order of lowest to highest risk, Group A: H. pylori(-) and atrophic gastritis(-); Group B: H. pylori(+) and atrophic gastritis(-); Group C:H. pylori(+) and atrophic gastritis(+); and, Group D: H. pylori(-) and atrophic gastritis(+). We used vital statistics for the crude all-cause and crude gastric cancer mortality rates in 2011 and data from population-based cancer registries (the Monitoring of Cancer Incidence in Japan) for gastric cancer incidence in 2011. For relative risk and prevalence, we used the results of a meta-analysis integrating previous studies and data from the Japan Public Health Center-based Prospective Study for the Next Generation, respectively (baseline survey 2011-16). We calculated the crude incidence and mortality rates and estimated the cumulative risk using a life-table method. The estimated lifetime cumulative incidence risk was 11.4% for men and 5.7% for women. The estimated risk for Groups A, B, C and D was 2.4%, 10.8%, 26.7% and 35.5% for men, and 1.2%, 5.5%, 13.5% and 18.0% for women, respectively. Similarly, the estimated lifetime cumulative mortality risk was 3.9% for men and 1.8% for women. The estimated risk of mortality for Groups A, B, C and D was 0.8%, 3.6%, 9.0% and 12.0% for men, and 0.4%, 1.7%, 4.2% and 5.7% for women, respectively. Our results may be useful for designing individually tailored prevention programs. © The Author 2017. Published by Oxford University Press.

78 FR 25440 - Request for Information and Citations on Methods for Cumulative Risk Assessment

Science.gov (United States)

2013-05-01

... Citations on Methods for Cumulative Risk Assessment AGENCY: Office of the Science Advisor, Environmental... influence exposures, dose-response or risk/hazard posed by environmental contaminant exposures, and methods... who wish to receive further information about submitting information on methods for cumulative risk...

Family cumulative risk and at-risk kindergarteners' social competence: the mediating role of parent representations of the attachment relationship.

Science.gov (United States)

Sparks, Lauren A; Trentacosta, Christopher J; Owusu, Erika; McLear, Caitlin; Smith-Darden, Joanne

2018-08-01

Secure attachment relationships have been linked to social competence in at-risk children. In the current study, we examined the role of parent secure base scripts in predicting at-risk kindergarteners' social competence. Parent representations of secure attachment were hypothesized to mediate the relationship between lower family cumulative risk and children's social competence. Participants included 106 kindergarteners and their primary caregivers recruited from three urban charter schools serving low-income families as a part of a longitudinal study. Lower levels of cumulative risk predicted greater secure attachment representations in parents, and scores on the secure base script assessment predicted children's social competence. An indirect relationship between lower cumulative risk and kindergarteners' social competence via parent secure base script scores was also supported. Parent script-based representations of the attachment relationship appear to be an important link between lower levels of cumulative risk and low-income kindergarteners' social competence. Implications of these findings for future interventions are discussed.

Probabilistic cumulative risk assessment of anti-androgenic pesticides in food

DEFF Research Database (Denmark)

Müller, Anne Kirstine; Nielsen, Elsa

2008-01-01

A cumulative risk assessment of three anti-androgenic pesticides vinclozolin, procymidone and prochloraz in combination has been carried out using an Integrated Probabilistic Risk Assessment (IPRA) model. In the model, variability in both exposure and sensitivity between individuals were combined...

Probabilistic cumulative risk assessment of anti-androgenic pesticides in food.

NARCIS (Netherlands)

Müller, A.K.; Bosgra, S.; Boon, P.E.; van der Voet, H.; Nielsen, E.; Ladefoged, O.

2009-01-01

In this paper, we present a cumulative risk assessment of three anti-androgenic pesticides (vinclozolin, procymidone and prochloraz) using the relative potency factor (RPF) approach and an integrated probabilistic risk assessment (IPRA) model. RPFs for each substance were estimated for three

Probabilistic cumulative risk assessment of anti-androgenic pesticides in food

NARCIS (Netherlands)

Muller, A.K.; Bosgra, S.; Boon, P.E.; Voet, van der H.; Nielsen, E.; Ladefoged, O.

2009-01-01

In this paper, we present a cumulative risk assessment of three anti-androgenic pesticides (vinclozolin, procymidone and prochloraz) using the relative potency factor (RPF) approach and an integrated probabilistic risk assessment (IPRA) model. RPFs for each substance were estimated for three

The Composite Strain Index (COSI) and Cumulative Strain Index (CUSI): methodologies for quantifying biomechanical stressors for complex tasks and job rotation using the Revised Strain Index.

Science.gov (United States)

Garg, Arun; Moore, J Steven; Kapellusch, Jay M

2017-08-01

The Composite Strain Index (COSI) quantifies biomechanical stressors for complex tasks consisting of exertions at different force levels and/or with different exertion times. The Cumulative Strain Index (CUSI) further integrates biomechanical stressors from different tasks to quantify exposure for the entire work shift. The paper provides methodologies to compute COSI and CUSI along with examples. Complex task simulation produced 169,214 distinct tasks. Use of average, time-weighted average (TWA) and peak force and COSI classified 66.9, 28.2, 100 and 38.9% of tasks as hazardous, respectively. For job rotation the simulation produced 10,920 distinct jobs. TWA COSI, peak task COSI and CUSI classified 36.5, 78.1 and 66.6% jobs as hazardous, respectively. The results suggest that the TWA approach systematically underestimates the biomechanical stressors and peak approach overestimates biomechanical stressors, both at the task and job level. It is believed that the COSI and CUSI partially address these underestimations and overestimations of biomechanical stressors. Practitioner Summary: COSI quantifies exposure when applied hand force and/or duration of that force changes during a task cycle. CUSI integrates physical exposures from job rotation. These should be valuable tools for designing and analysing tasks and job rotation to determine risk of musculoskeletal injuries.

Cumulative keyboard strokes: a possible risk factor for carpal tunnel syndrome

Directory of Open Access Journals (Sweden)

Eleftheriou Andreas

2012-08-01

Full Text Available Abstract Background Contradictory reports have been published regarding the association of Carpal Tunnel Syndrome (CTS and the use of computer keyboard. Previous studies did not take into account the cumulative exposure to keyboard strokes among computer workers. The aim of the present study was to investigate the association between cumulative keyboard use (keyboard strokes and CTS. Methods Employees (461 from a Governmental data entry & processing unit agreed to participate (response rate: 84.1 % in a cross-sectional study. Α questionnaire was distributed to the participants to obtain information on socio-demographics and risk factors for CTS. The participants were examined for signs and symptoms related to CTS and were asked if they had previous history or surgery for CTS. The cumulative amount of the keyboard strokes per worker per year was calculated by the use of payroll’s registry. Two case definitions for CTS were used. The first included subjects with personal history/surgery for CTS while the second included subjects that belonged to the first case definition plus those participants were identified through clinical examination. Results Multivariate analysis used for both case definitions, indicated that those employees with high cumulative exposure to keyboard strokes were at increased risk of CTS (case definition A: OR = 2.23;95 % CI = 1.09-4.52 and case definition B: OR = 2.41; 95%CI = 1.36-4.25. A dose response pattern between cumulative exposure to keyboard strokes and CTS has been revealed (p  Conclusions The present study indicated a possible association between cumulative exposure to keyboard strokes and development of CTS. Cumulative exposure to key-board strokes would be taken into account as an exposure indicator regarding exposure assessment of computer workers. Further research is needed in order to test the results of the current study and assess causality between cumulative keyboard strokes and

Cumulative childhood risk and adult functioning in abused and neglected children grown up.

Science.gov (United States)

Horan, Jacqueline M; Widom, Cathy Spatz

2015-08-01

This paper examines the relationship between childhood exposure to cumulative risk and three indicators of psychosocial adjustment in adulthood (educational attainment, mental health, and criminal behavior) and tests three different models (linear, quadratic, and interaction). Data were collected over several time points from individuals who were part of a prospective cohort design study that matched children with documented cases of abuse and/or neglect with children without such histories and followed them into adulthood. Hierarchical multiple regressions compared linear and quadratic models and then examined potential moderating effects of child abuse/neglect and gender. Exposure to a greater number of childhood risk factors was significantly related to fewer years of education, more anxiety and depression symptomatology, and more criminal arrests in adulthood. The relationship between cumulative risk and years of education demonstrated a curvilinear pattern, whereas the relationship between cumulative risk and both mental health and criminal arrests was linear. Child abuse/neglect did not moderate these relationships, although there were direct effects for both child abuse/neglect and gender on criminal arrests, with more arrests for abused/neglected individuals than controls and more for males than females. Gender interacted with cumulative risk to impact educational attainment and criminal behavior, suggesting that interventions may be more effective if tailored differently for males and females. Interventions may need to be multifaceted and designed to address these different domains of functioning.

A novel structural risk index for primary spontaneous pneumothorax: Ankara Numune Risk Index.

Science.gov (United States)

Akkas, Yucel; Peri, Neslihan Gulay; Kocer, Bulent; Kaplan, Tevfik; Alhan, Aslihan

2017-07-01

In this study, we aimed to reveal a novel risk index as a structural risk marker for primary spontanoeus pneumothorax using body mass index and chest height, structural risk factors for pneumothorax development. Records of 86 cases admitted between February 2014 and January 2015 with or without primary spontaneous pneumothorax were analysed retrospectively. The patients were allocated to two groups as Group I and Group II. The patients were evaluated with regard to age, gender, pneumothorax side, duration of hospital stay, treatment type, recurrence, chest height and transverse diameter on posteroanterior chest graphy and body mass index. Body mass index ratio per cm of chest height was calculated by dividing body mass index with chest height. We named this risk index ratio which is defined first as 'Ankara Numune Risk Index'. Diagnostic value of Ankara Numune Risk Index value for prediction of primary spontaneous pneumothorax development was analysed with Receiver Operating Characteristics curver. Of 86 patients, 69 (80.2%) were male and 17 (19.8%) were female. Each group was composed of 43 (50%) patients. When Receiver Operating Characteristics curve analysis was done for optimal limit value 0.74 of Ankara Numune Risk Index determined for prediction of pneumothorax development risk, area under the curve was 0.925 (95% Cl, 0.872-0.977, p pneumothorax development however it is insufficient for determining recurrence. Copyright © 2015. Published by Elsevier Taiwan.

Gender disparities among the association between cumulative family-level stress & adolescent weight status.

Science.gov (United States)

Hernandez, Daphne C; Pressler, Emily

2015-04-01

To investigate precursors to gender-related obesity disparities by examining multiple family-level stress indices. Analyses was based on adolescents born between 1975 and 1991 to women from the 1979 National Longitudinal Study of Youth data set (N=4762). Three types of family-level stressors were captured from birth to age 15: family disruption and conflict, financial strain, and maternal risky health behaviors, along with a total cumulative risk index. Body mass index was constructed on reference criteria for children outlined by the Centers for Disease Control. Multivariate logistic regressions were conducted for the three types of family stressors and for the total cumulative index. The accumulation of family disruption and conflict and financial stress was positively related to female adolescents being overweight/obese. Childhood exposure to maternal risky health behaviors was positively associated with higher weight status for male adolescents. Total cumulative stress was related to overweight/obesity for females, but not males. Different family-level stress indices are associated with the weight status of female and male adolescents. Combining types of family-level stress into one cumulative index appears to mask these differences. Copyright © 2015 Elsevier Inc. All rights reserved.

Reducing Production Basis Risk through Rainfall Intensity Frequency (RIF) Indexes: Global Sensitivity Analysis' Implication on Policy Design

Science.gov (United States)

Muneepeerakul, Chitsomanus; Huffaker, Ray; Munoz-Carpena, Rafael

2016-04-01

The weather index insurance promises financial resilience to farmers struck by harsh weather conditions with swift compensation at affordable premium thanks to its minimal adverse selection and moral hazard. Despite these advantages, the very nature of indexing causes the presence of "production basis risk" that the selected weather indexes and their thresholds do not correspond to actual damages. To reduce basis risk without additional data collection cost, we propose the use of rain intensity and frequency as indexes as it could offer better protection at the lower premium by avoiding basis risk-strike trade-off inherent in the total rainfall index. We present empirical evidences and modeling results that even under the similar cumulative rainfall and temperature environment, yield can significantly differ especially for drought sensitive crops. We further show that deriving the trigger level and payoff function from regression between historical yield and total rainfall data may pose significant basis risk owing to their non-unique relationship in the insured range of rainfall. Lastly, we discuss the design of index insurance in terms of contract specifications based on the results from global sensitivity analysis.

Cumulative Index to the First Fifteen Semiannual Reports of the Commission to the Congress. January 1947 - 1953

Energy Technology Data Exchange (ETDEWEB)

Dean, Gordon

1954-01-31

The first fifteen semiannual reports of the United States Atomic Energy Commission to Congress cover the major unclassified activities of the Commission from January 1947 through December 1953. This cumulative name and subject index provides a guide to the information published in these reports.

Effects of cumulative risk on behavioral and psychological well-being in first grade: moderation by neighborhood context.

Science.gov (United States)

Lima, Julie; Caughy, Margaret; Nettles, Saundra M; O'Campo, Patricia J

2010-10-01

This study builds upon existing research by examining whether risk indices for child psychological well-being behave in the same way in different types of neighborhoods. Specifically, we sought to determine if neighborhood characteristics acted to exacerbate or, alternatively, to buffer risk factors at the family and/or child level. Families with a child entering first grade in Fall 2002 were recruited from Baltimore City neighborhoods, defined as census block groups. This study included 405 children, and data came from an interview with the primary caregiver and an assessment of the first grader. The dependent variables were externalizing behavior and internalizing problems. A family risk index consisting of 13 measures, and a child risk index consisting of three measures were the main independent variables of interest. We examined the effects of these indices on child psychological well-being and behavior across two neighborhood characteristics: neighborhood potential for community involvement with children and neighborhood negative social climate. Results of multivariate analyses indicated that cumulative family risk was associated with an increase in both internalizing and externalizing behavior problems. Perceived negative social climate moderated the effect of family risks on behavior problems such that more risk was associated with a larger increment in both externalizing behavior problems and psychological problems for children living in high versus low risk neighborhoods. These findings further emphasize the importance of considering neighborhood context in the study of child psychological well-being. Copyright © 2010 Elsevier Ltd. All rights reserved.

Oral contraceptive use and impact of cumulative intake of estrogen and progestin on risk of ovarian cancer

DEFF Research Database (Denmark)

Faber, M T; Jensen, A; Frederiksen, K

2013-01-01

Oral contraceptive use decreases the risk of ovarian cancer, but no previous studies have assessed the impact of cumulative intake of estrogen and progestin on ovarian cancer risk.......Oral contraceptive use decreases the risk of ovarian cancer, but no previous studies have assessed the impact of cumulative intake of estrogen and progestin on ovarian cancer risk....

Comparison of cumulative false-positive risk of screening mammography in the United States and Denmark

DEFF Research Database (Denmark)

Jacobsen, Katja Kemp

2015-01-01

INTRODUCTION: In the United States (US), about one-half of women screened with annual mammography have at least one false-positive test after ten screens. The estimate for European women screened ten times biennially is much lower. We evaluate to what extent screening interval, mammogram type......=400,204), between 1991-2012 and 1993-2013, respectively. Model-based cumulative false-positive risks were computed for the entire sample, using two statistical methods (Hubbard Njor) previously used to estimate false-positive risks in the US and Europe. RESULTS: Empirical cumulative risk of at least...... one false-positive test after eight (annual or biennial) screens was 41.9% in BCSC, 16.1% in Copenhagen, and 7.4% in Funen. Variation in screening interval and mammogram type did not explain the differences by country. Using the Hubbard method, the model-based cumulative risks after eight screens...

Probabilistic cumulative risk assessment of anti-androgenic pesticides in food

DEFF Research Database (Denmark)

Müller, Anne Kirstine; Bosgra, Sieto; Boon, Polly E.

2009-01-01

In this paper, we present a cumulative risk assessment of three anti-androgenic pesticides (vinclozolin, procymidone and prochloraz) using the relative potency factor (RPF) approach and an integrated probabilistic risk assessment (IPRA) model. RPFs for each substance were estimated for three......) and the fraction of individuals with IMoEs vinclozolin, procymidone and prochloraz is not likely to be of concern for the reproductive development of their male foetuses. However...

The collected papers of Albert Einstein. - Vol. 11: Cumulative index, bibliography, list of correspondence, chronology, and errata to volumes 1-10

NARCIS (Netherlands)

Kox, A.J.; Sauer, T.; Kormos Buchwald, D.; Hirschmann, R.; Moses, O.; Aronin, B.; Stolper, J.

2009-01-01

This index volume provides quick access to the most authoritative compilation of documents and information concerning Einstein's work and correspondence for the first half of his life. It offers readers a Cumulative Index to the first ten volumes of the collected papers, the first complete

Low Fruit/Vegetable Consumption in the Home: Cumulative Risk Factors in Early Childhood

Science.gov (United States)

Ward, Wendy L.; Swindle, Taren M.; Kyzer, Angela L.; Whiteside-Mansell, Leanne

2015-01-01

Cumulative risk theory suggests that a variety of social risk factors would have an additive effect on obesity risk. Multiple studies have suggested that obesity is related to basic resources such as transportation and financial resources. Additional research points to parental engagement and parental monitoring as additional sources of risk. This…

Cumulative Index to Twenty Five Semiannual Reports of the Commission to the Congress. January 1947 - January 1959

Energy Technology Data Exchange (ETDEWEB)

McCone, John A.

1960-01-31

The first twenty five semiannual reports of the United States Atomic Energy Commission to Congress cover the major unclassified activities of the Commission from January 1947 through January 1959. In addition to the semiannual summaries, a series of special reports on important atomic energy programs were included in many of the semiannual reports. This cumulative name and subject index provides a guide to the information published in these reports. Beginning in 1960, the Commission will be issuing annual reports, each separately indexed, ceasing the semiannual reporting.

The impact of physical activity on cumulative cardiovascular disease risk factors among Malaysian adults.

Science.gov (United States)

Rasiah, Rajah; Thangiah, Govindamal; Yusoff, Khalid; Manikam, Rishya; Chandrasekaran, Sankara Kumar; Mustafa, Rujhan; Bakar, Najmin Binti Abu

2015-12-16

Numerous studies have shown the importance of physical activity in reducing the morbidity and mortality rates caused by cardiovascular disease (CVD). However, most of these studies emphasise little on the cumulative effect of CVD risk factors. Hence, this study investigates the association between physical exercise and cumulative CVD risk factors among adults in three different age groups. Using a sample of 7276 respondents drawn from community centers, the REDISCOVER team gathered information on physical activity, CVD risk factors (obesity, diabetes, hypertension, hypercholesterolemia, tobacco use) and socioeconomic and demographic variables in Malaysia. Because the study required medical examination, a convenience sampling frame was preferred in which all volunteers were included in the study. Fasting blood samples and anthropometric (height, weight and more) measurements were collected by trained staffs. Socio-demographic and physical activity variables were recorded through questionnaires. A Chi-square test was performed to identify the bivariate association between the covariates (socioeconomic variables, demographic variables and physical activity) and outcome variable. The association between the main exposure, physical activity, and the outcome variable, cumulative CVD risk factors, was assessed using an ordinal logistic regression model, controlling for socioeconomic status and demographic influences in three different age groups, 35-49, 50-64 and 65 and above. The mean age of participants is 51.8 (SD = 9.4). Respondents in the age groups of 35-49 (aORmoderate = 0.12; 95 % CI: 0.02 - 0.53 ) and 65 and above (aORhigh = 0.58; 95 % CI: 0.24, 0.78) showed a statistically significant inverse relationship between physical activity and cumulative CVD risk factors. However, this relationship was not significant among respondents in the 50-64 age group suggesting the possible influence of other variables, such as stress and environment. The

Cumulative Index to the Sixteenth through the Twentieth Semiannual Reports of the Commission to the Congress. January 1954 - June 1956

Energy Technology Data Exchange (ETDEWEB)

Strauss, Lewis L.

1956-07-30

The sixteenth through the twentieth semiannual reports of the United States Atomic Energy Commission to Congress are covered in this cumulative index, which included both a name and subject index as aids to finding information in the full reports.. The full semiannual reports themselves cover the major unclassified activities of the Commission from January 1954 through June 1956.

Cumulative Risk of Bovine Mastitis Treatments in Denmark, Finland, Norway and Sweden

Directory of Open Access Journals (Sweden)

Saloniemi H

2004-12-01

Full Text Available Data from the national dairy cow recording systems during 1997 were used to calculate lactation-specific cumulative risk of mastitis treatments and cumulative risk of removal from the herds in Denmark, Finland Norway and Sweden. Sweden had the lowest risk of recorded mastitis treatments during 305 days of lactation and Norway had the highest risk. The incidence risk of recorded mastitis treatments during 305 days of lactation in Denmark, Finland, Norway and Sweden was 0.177, 0.139, 0.215 and 0.127 for first parity cows and 0.228, 0.215, 0.358 and 0.204 for parities higher than three, respectively. The risk of a first parity cow being treated for mastitis was almost 3 times higher at calving in Norway than in Sweden. The period with the highest risk for mastitis treatments was from 2 days before calving until 14 days after calving and the highest risk for removal was from calving to 10 days after calving in all countries. The study clearly demonstrated differences in bovine mastitis treatment patterns among the Nordic countries. The most important findings were the differences in treatment risks during different lactations within each country, as well as differences in strategies with respect to the time during lactation mastitis was treated.

Cumulative risk of bovine mastitis treatments in Denmark, Finland, Norway and Sweden.

Science.gov (United States)

Valde, J P; Lawson, L G; Lindberg, A; Agger, J F; Saloniemi, H; Osterås, O

2004-01-01

Data from the national dairy cow recording systems during 1997 were used to calculate lactation-specific cumulative risk of mastitis treatments and cumulative risk of removal from the herds in Denmark, Finland Norway and Sweden. Sweden had the lowest risk of recorded mastitis treatments during 305 days of lactation and Norway had the highest risk. The incidence risk of recorded mastitis treatments during 305 days of lactation in Denmark, Finland, Norway and Sweden was 0.177, 0.139, 0.215 and 0.127 for first parity cows and 0.228, 0.215, 0.358 and 0.204 for parities higher than three, respectively. The risk of a first parity cow being treated for mastitis was almost 3 times higher at calving in Norway than in Sweden. The period with the highest risk for mastitis treatments was from 2 days before calving until 14 days after calving and the highest risk for removal was from calving to 10 days after calving in all countries. The study clearly demonstrated differences in bovine mastitis treatment patterns among the Nordic countries. The most important findings were the differences in treatment risks during different lactations within each country, as well as differences in strategies with respect to the time during lactation mastitis was treated.

76 FR 69726 - Pyrethrins/Pyrethroid Cumulative Risk Assessment; Notice of Availability

Science.gov (United States)

2011-11-09

... exposure to multiple chemicals that have a common mechanism of toxicity when making regulatory decisions... stakeholders including environmental, human health, farm worker, and agricultural advocates; the chemical... Cumulative Risk Assessment; Notice of Availability AGENCY: Environmental Protection Agency (EPA). ACTION...

Wealth index and risk of childhood overweight and obesity: evidence from four prospective cohorts in Peru and Vietnam.

Science.gov (United States)

Carrillo-Larco, Rodrigo M; Miranda, J Jaime; Bernabé-Ortiz, Antonio

2016-05-01

To estimate the incidence and risk of childhood overweight and obesity according to socioeconomic status in Peruvian and Vietnamese school-aged children. Longitudinal data from the Young Lives study were analyzed. Exposure was wealth index in tertiles. Outcome was overweight and obesity. Cumulative incidence per 100 children-years, relative risks (RR), and 95 % confidence intervals (95 % CI) were calculated. A hierarchical approach, including child- and family-related variables, was followed to construct multivariable models. The cumulative incidence of overweight and obesity was 4.8 (95 % CI 4.1-5.5) and 1.7 (95 % CI 1.3-2.2) in the younger and older Peruvian cohort, respectively; and in Vietnam 1.5 (95 % CI 1.2-1.8) and 0.3 (95 % CI 0.2-0.5), respectively. The incidence of overweight and obesity was higher at the top wealth index tertile in all samples. In the older cohorts, comparing highest versus bottom wealth index tertile, RR of overweight and obesity was four to nine times higher: 4.25 in Peru (95 % CI 2.21-8.18) and 9.11 in Vietnam (95 % CI 1.07-77.42). The results provide important information for childhood obesity prevention in countries moving ahead with economic, epidemiological and nutritional transitions.

Parenting intervention and the caregiving environment : cumulative risk and process evaluation

NARCIS (Netherlands)

Stolk, Mirjam Neeltje

2007-01-01

The objective of the research described in this thesis was to study single and cumulative family risk in relation to early childhood externalizing problems and the effectiveness of a parenting intervention program. The Video-feedback Intervention to promote Positive Parenting and Sensitive

The MCRA model for probabilistic single-compound and cumulative risk assessment of pesticides.

Science.gov (United States)

van der Voet, Hilko; de Boer, Waldo J; Kruisselbrink, Johannes W; Goedhart, Paul W; van der Heijden, Gerie W A M; Kennedy, Marc C; Boon, Polly E; van Klaveren, Jacob D

2015-05-01

Pesticide risk assessment is hampered by worst-case assumptions leading to overly pessimistic assessments. On the other hand, cumulative health effects of similar pesticides are often not taken into account. This paper describes models and a web-based software system developed in the European research project ACROPOLIS. The models are appropriate for both acute and chronic exposure assessments of single compounds and of multiple compounds in cumulative assessment groups. The software system MCRA (Monte Carlo Risk Assessment) is available for stakeholders in pesticide risk assessment at mcra.rivm.nl. We describe the MCRA implementation of the methods as advised in the 2012 EFSA Guidance on probabilistic modelling, as well as more refined methods developed in the ACROPOLIS project. The emphasis is on cumulative assessments. Two approaches, sample-based and compound-based, are contrasted. It is shown that additional data on agricultural use of pesticides may give more realistic risk assessments. Examples are given of model and software validation of acute and chronic assessments, using both simulated data and comparisons against the previous release of MCRA and against the standard software DEEM-FCID used by the Environmental Protection Agency in the USA. It is shown that the EFSA Guidance pessimistic model may not always give an appropriate modelling of exposure. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Cumulative health risk assessment: integrated approaches for multiple contaminants, exposures, and effects

International Nuclear Information System (INIS)

Rice, Glenn; Teuschler, Linda; MacDonel, Margaret; Butler, Jim; Finster, Molly; Hertzberg, Rick; Harou, Lynne

2007-01-01

Available in abstract form only. Full text of publication follows: As information about environmental contamination has increased in recent years, so has public interest in the combined effects of multiple contaminants. This interest has been highlighted by recent tragedies such as the World Trade Center disaster and hurricane Katrina. In fact, assessing multiple contaminants, exposures, and effects has long been an issue for contaminated sites, including U.S. Department of Energy (DOE) legacy waste sites. Local citizens have explicitly asked the federal government to account for cumulative risks, with contaminants moving offsite via groundwater flow, surface runoff, and air dispersal being a common emphasis. Multiple exposures range from ingestion and inhalation to dermal absorption and external gamma irradiation. Three types of concerns can lead to cumulative assessments: (1) specific sources or releases - e.g., industrial facilities or accidental discharges; (2) contaminant levels - in environmental media or human tissues; and (3) elevated rates of disease - e.g., asthma or cancer. The specific initiator frames the assessment strategy, including a determination of appropriate models to be used. Approaches are being developed to better integrate a variety of data, extending from environmental to internal co-location of contaminants and combined effects, to support more practical assessments of cumulative health risks. (authors)

Effects of Cumulative Family Risk Factors on American Students' Academic Performance

Science.gov (United States)

Dunst, Carl J.; Hamby, Deborah W.

2016-01-01

The relationships between cumulative family risk factors and American students' academic performance were examined in all 50 States and the District of Columbia. Data from the 2007 "American Community Survey" were used to ascertain the percent of birth to 18 year old children in the United States who experienced three or more risk…

Language Delay in Severely Neglected Children: A Cumulative or Specific Effect of Risk Factors?

Science.gov (United States)

Sylvestre, Audette; Merette, Chantal

2010-01-01

Objectives: This research sought to determine if the language delay (LD) of severely neglected children under 3 years old was better explained by a cumulative risk model or by the specificity of risk factors. The objective was also to identify the risk factors with the strongest impact on LD among various biological, psychological, and…

Associations between parenting, media use, cumulative risk, and children’s executive functioning

NARCIS (Netherlands)

Linebarger, D.L.; Barr, R.; Lapierre, M.A.; Piotrowski, J.

2014-01-01

Objective: This study was designed to examine how parenting style, media exposure, and cumulative risk were associated with executive functioning (EF) during early childhood. Methods: A nationally representative group of US parents/caregivers (N = 1156) with 1 child between 2 and 8 years

A novel index for quantifying the risk of early complications for patients undergoing cervical spine surgeries.

Science.gov (United States)

Passias, Peter G; Diebo, Bassel G; Marascalchi, Bryan J; Jalai, Cyrus M; Horn, Samantha R; Zhou, Peter L; Paltoo, Karen; Bono, Olivia J; Worley, Nancy; Poorman, Gregory W; Challier, Vincent; Dixit, Anant; Paulino, Carl; Lafage, Virginie

2017-11-01

OBJECTIVE It is becoming increasingly necessary for surgeons to provide evidence supporting cost-effectiveness of surgical treatment for cervical spine pathology. Anticipating surgical risk is critical in accurately evaluating the risk/benefit balance of such treatment. Determining the risk and cost-effectiveness of surgery, complications, revision procedures, and mortality rates are the most significant limitations. The purpose of this study was to determine independent risk factors for medical complications (MCs), surgical complications (SCs), revisions, and mortality rates following surgery for patients with cervical spine pathology. The most relevant risk factors were used to structure an index that will help quantify risk and anticipate failure for such procedures. METHODS The authors of this study performed a retrospective review of the National Inpatient Sample (NIS) database for patients treated surgically for cervical spine pathology between 2001 and 2010. Multivariate models were performed to calculate the odds ratio (OR) of the independent risk factors that led to MCs and repeated for SCs, revisions, and mortality. The models controlled for age ( 65 years old), sex, race, revision status (except for revision analysis), surgical approach, number of levels fused/re-fused (2-3, 4-8, ≥ 9), and osteotomy utilization. ORs were weighted based on their predictive category: 2 times for revision surgery predictors and 4 times for mortality predictors. Fifty points were distributed among the predictors based on their cumulative OR to establish a risk index. RESULTS Discharges for 362,989 patients with cervical spine pathology were identified. The mean age was 52.65 years, and 49.47% of patients were women. Independent risk factors included medical comorbidities, surgical parameters, and demographic factors. Medical comorbidities included the following: pulmonary circulation disorder, coagulopathy, metastatic cancer, renal failure, congestive heart failure

Non-Chemical Stressors and Cumulative Risk Assessment: An Overview of Current Initiatives and Potential Air Pollutant Interactions

Science.gov (United States)

Lewis, Ari S.; Sax, Sonja N.; Wason, Susan C.; Campleman, Sharan L.

2011-01-01

Regulatory agencies are under increased pressure to consider broader public health concerns that extend to multiple pollutant exposures, multiple exposure pathways, and vulnerable populations. Specifically, cumulative risk assessment initiatives have stressed the importance of considering both chemical and non-chemical stressors, such as socioeconomic status (SES) and related psychosocial stress, in evaluating health risks. The integration of non-chemical stressors into a cumulative risk assessment framework has been largely driven by evidence of health disparities across different segments of society that may also bear a disproportionate risk from chemical exposures. This review will discuss current efforts to advance the field of cumulative risk assessment, highlighting some of the major challenges, discussed within the construct of the traditional risk assessment paradigm. Additionally, we present a summary of studies of potential interactions between social stressors and air pollutants on health as an example of current research that supports the incorporation of non-chemical stressors into risk assessment. The results from these studies, while suggestive of possible interactions, are mixed and hindered by inconsistent application of social stress indicators. Overall, while there have been significant advances, further developments across all of the risk assessment stages (i.e., hazard identification, exposure assessment, dose-response, and risk characterization) are necessary to provide a scientific basis for regulatory actions and effective community interventions, particularly when considering non-chemical stressors. A better understanding of the biological underpinnings of social stress on disease and implications for chemical-based dose-response relationships is needed. Furthermore, when considering non-chemical stressors, an appropriate metric, or series of metrics, for risk characterization is also needed. Cumulative risk assessment research will benefit

Cumulative Risk Disparities in Children's Neurocognitive Functioning: A Developmental Cascade Model

Science.gov (United States)

Wade, Mark; Browne, Dillon T.; Plamondon, Andre; Daniel, Ella; Jenkins, Jennifer M.

2016-01-01

The current longitudinal study examined the role of cumulative social risk on children's theory of mind (ToM) and executive functioning (EF) across early development. Further, we also tested a cascade model of development in which children's social cognition at 18 months was hypothesized to predict ToM and EF at age 4.5 through intermediary…

Risk management of stock index futures

Institute of Scientific and Technical Information of China (English)

无

2008-01-01

The Hong Kong Hang Seng index futures is taken as a study object and a method of empirical analysis is adopted in order to verify the validity of the application of the value-at-risk (VaR) method in the risk measurement of the stock index futures market. The results suggest that under normal market conditions it is feasible to apply the VaR method in the measurement of the market risks of stock index futures. The daily VaR value of the stock index futures provides a foreseeable profit and loss of the stock ...

Community Engaged Cumulative Risk Assessment of Exposure to Inorganic Well Water Contaminants, Crow Reservation, Montana

Science.gov (United States)

Doyle, John T.; Lefthand, Myra J.; Young, Sara L.; Kindness, Larry; Other Medicine, Roberta; Ford, Timothy E.; Dietrich, Eric; Parker, Albert E.; Hoover, Joseph H.; Camper, Anne K.

2018-01-01

An estimated 11 million people in the US have home wells with unsafe levels of hazardous metals and nitrate. The national scope of the health risk from consuming this water has not been assessed as home wells are largely unregulated and data on well water treatment and consumption are lacking. Here, we assessed health risks from consumption of contaminated well water on the Crow Reservation by conducting a community-engaged, cumulative risk assessment. Well water testing, surveys and interviews were used to collect data on contaminant concentrations, water treatment methods, well water consumption, and well and septic system protection and maintenance practices. Additive Hazard Index calculations show that the water in more than 39% of wells is unsafe due to uranium, manganese, nitrate, zinc and/or arsenic. Most families’ financial resources are limited, and 95% of participants do not employ water treatment technologies. Despite widespread high total dissolved solids, poor taste and odor, 80% of families consume their well water. Lack of environmental health literacy about well water safety, pre-existing health conditions and limited environmental enforcement also contribute to vulnerability. Ensuring access to safe drinking water and providing accompanying education are urgent public health priorities for Crow and other rural US families with low environmental health literacy and limited financial resources. PMID:29304032

The proportional odds cumulative incidence model for competing risks

DEFF Research Database (Denmark)

Eriksson, Frank; Li, Jianing; Scheike, Thomas

2015-01-01

We suggest an estimator for the proportional odds cumulative incidence model for competing risks data. The key advantage of this model is that the regression parameters have the simple and useful odds ratio interpretation. The model has been considered by many authors, but it is rarely used...... in practice due to the lack of reliable estimation procedures. We suggest such procedures and show that their performance improve considerably on existing methods. We also suggest a goodness-of-fit test for the proportional odds assumption. We derive the large sample properties and provide estimators...

Cumulative Risk Exposure and Mental Health Symptoms among Maltreated Youth Placed in Out-of-Home Care

Science.gov (United States)

Raviv, Tali; Taussig, Heather N.; Culhane, Sara E.; Garrido, Edward F.

2010-01-01

Objective: Maltreated children placed in out-of-home care are at high risk for exhibiting symptoms of psychopathology by virtue of their exposure to numerous risk factors. Research examining cumulative risk has consistently found that the accumulation of risk factors increases the likelihood of mental health problems. The goal of the current study…

Do risk factors for problem behaviour act in a cumulative manner? An examination of ethnic minority and majority children through an ecological perspective.

Science.gov (United States)

Atzaba-Poria, Naama; Pike, Alison; Deater-Deckard, Kirby

2004-05-01

Extensive research has identified risk factors for problem behaviour in childhood. However, most of this research has focused on isolated variables, ignoring possible additive influences. The purpose of this study was to examine whether risk factors for problem behaviour act in a cumulative manner, and to investigate whether cumulative risk stemming from distinct ecological levels (Bronfenbrenner, 1979) differentially influences the manifestation of problem behaviours in middle childhood. In addition, ethnic differences between minority (i.e., Indian) and majority (i.e., English) families were examined. The sample consisted of 125 children (59 English and 66 of Indian origin) between the ages of 7 and 9.6 (M = 8.51, SD = 0.62) and their parents. Both mothers and fathers completed questionnaires regarding the children's problem behaviour and provided reports of the children's characteristics and environment. Children were also assessed and provided reports about themselves and their relationships. Finally, parent-child mutuality and parenting behaviour were coded from a videotaped parent-child interaction task. Risk factors acted in a cumulative manner - the more risk children experienced, the more problem behaviour they exhibited. Total problem behaviour was predicted by all three levels: individual, microsystem and exosystem. However, externalising problems were mainly predicted by microsystem-level cumulative risk, whereas internalising problems were predicted by both individual-level cumulative risk and exosystem-level cumulative risk. These results were similar for both ethnic groups. The support for the cumulative hypothesis highlights the importance of having a broad picture of children's characteristics and environmental components when analysing children's adjustment. The distinct influence of risk stemming from the different ecological levels suggests that the trajectories of internalising, externalising and total problem behaviour may be different.

A general index of inherent risk

OpenAIRE

Schnytzer, Adi; Westreich, Sara

2009-01-01

We extend the pioneering work of Aumann and Serrano by presenting an index of inherent riskiness of a gamble having the desirable properties of their index, while being applicable to gambles with either positive or negative expectations. As such, our index provides a measure of riskiness which is of use for both risk lovers and risk aversive gamblers, and is defined for all discrete and a large class of continuous gambles. We analyze abstract properties of our index, and present in addition t...

Biweekly list of papers on radiation chemistry and photochemistry. Annual cumulation with keyword and author indexes. Volume 16. 1983

International Nuclear Information System (INIS)

Carmichael, I.C.; Helman, W.P.; Hug, G.L.; Ross, A.B.

1983-01-01

The Biweekly List of Papers on Radiation Chemistry and Photochemistry is a current-awareness service published by the Radiation Chemistry Data Center (RCDC), with special emphasis on the kinetics and other properties of transient ions, radicals, and excited species. Papers are included on the radiation chemistry and photochemistry of organic and inorganic systems, biological molecules and polymers, with references to ESR and luminescence studies. Complete coverage is attempted only for those studies which are initiated by light or ionizing radiation, and which provide quantitative physical chemical data such as quantum yields, specific rates, G values, etc. No attempt is made to cover topics such as mechanistic and preparative photochemistry, photosynthesis, photography, and irradiation of metals. The references listed herein are obtained from scanning about 60 current journals as well as Chemical Abstracts, INIS Atomindex and several other publications listing current references. The reference lists, which are issued biweekly, are cumulated annually with the addition of keyword and author indexes. Indexed cumulations were published semiannually for Vol. 4-6 (1971-73) and are published annually for Vol. 7+ (1974+); back copies are available from the National Technical Information Service (NTIS)

Social Determinants of Health in Environmental Justice Communities: Examining Cumulative Risk in Terms of Environmental Exposures and Social Determinants of Health

OpenAIRE

Prochaska, John D.; Nolen, Alexandra B.; Kelley, Hilton; Sexton, Ken; Linder, Stephen H.; Sullivan, John

2014-01-01

Residents of environmental justice (EJ) communities may bear a disproportionate burden of environmental health risk, and often face additional burdens from social determinants of health. Accounting for cumulative risk should include measures of risk from both environmental sources and social determinants. This study sought to better understand cumulative health risk from both social and environmental sources in a disadvantaged community in Texas. Key outcomes were determining what data are cu...

Cumulative Risk and Continuity in Nonparental Care from Infancy to Early Adolescence.

Science.gov (United States)

Colwell, Malinda J; Pettit, Gregory S; Meece, Darrell; Bates, John E; Dodge, Kenneth A

2001-04-01

Variations in amounts of nonparental care across infancy, preschool, early elementary school, and early adolescence were examined in a longitudinal sample (N = 438). Of interest was (a) continuity in use of the different arrangements, (b) whether the arrangements were additively and cumulatively associated with children's externalizing behavior problems, and (c) whether predictive relations were accounted for by social-ecological (socioeconomic status, mothers' employment status, marital status) and social-experiential (parenting quality, exposure to aggressive peers) factors. Correlations among overall amounts of care provided little evidence of cross-time continuity. Consistent with the cumulative risk perspective, Grade 1 self-care and Grade 6 unsupervised peer contact incrementally predicted Grade 6 externalizing problems. Most of the predictive associations were accounted for by family background and social relationship factors.

Cumulative risk effects for the development of behaviour difficulties in children and adolescents with special educational needs and disabilities.

Science.gov (United States)

Oldfield, Jeremy; Humphrey, Neil; Hebron, Judith

2015-01-01

Research has identified multiple risk factors for the development of behaviour difficulties. What have been less explored are the cumulative effects of exposure to multiple risks on behavioural outcomes, with no study specifically investigating these effects within a population of young people with special educational needs and disabilities (SEND). Furthermore, it is unclear whether a threshold or linear risk model better fits the data for this population. The sample included 2660 children and 1628 adolescents with SEND. Risk factors associated with increases in behaviour difficulties over an 18-month period were summed to create a cumulative risk score, with this explanatory variable being added into a multi-level model. A quadratic term was then added to test the threshold model. There was evidence of a cumulative risk effect, suggesting that exposure to higher numbers of risk factors, regardless of their exact nature, resulted in increased behaviour difficulties. The relationship between risk and behaviour difficulties was non-linear, with exposure to increasing risk having a disproportionate and detrimental impact on behaviour difficulties in child and adolescent models. Interventions aimed at reducing behaviour difficulties need to consider the impact of multiple risk variables. Tailoring interventions towards those exposed to large numbers of risks would be advantageous. Copyright © 2015 Elsevier Ltd. All rights reserved.

Cumulative Small Effect Genetic Markers and the Risk of Colorectal Cancer in Poland, Estonia, Lithuania, and Latvia

Directory of Open Access Journals (Sweden)

Pablo Serrano-Fernandez

2015-01-01

Full Text Available The continued identification of new low-penetrance genetic variants for colorectal cancer (CRC raises the question of their potential cumulative effect among compound carriers. We focused on 6 SNPs (rs380284, rs4464148, rs4779584, rs4939827, rs6983267, and rs10795668, already described as risk markers, and tested their possible independent and combined contribution to CRC predisposition. Material and Methods. DNA was collected and genotyped from 2330 unselected consecutive CRC cases and controls from Estonia (166 cases and controls, Latvia (81 cases and controls, Lithuania (123 cases and controls, and Poland (795 cases and controls. Results. Beyond individual effects, the analysis revealed statistically significant linear cumulative effects for these 6 markers for all samples except of the Latvian one (corrected P value = 0.018 for the Estonian, corrected P value = 0.0034 for the Lithuanian, and corrected P value = 0.0076 for the Polish sample. Conclusions. The significant linear cumulative effects demonstrated here support the idea of using sets of low-risk markers for delimiting new groups with high-risk of CRC in clinical practice that are not carriers of the usual CRC high-risk markers.

Education, income and ethnic differences in cumulative biological risk profiles in a national sample of US adults: NHANES III (1988-1994).

Science.gov (United States)

Seeman, Teresa; Merkin, Sharon S; Crimmins, Eileen; Koretz, Brandon; Charette, Susan; Karlamangla, Arun

2008-01-01

Data from the nationally representative US National Health and Nutrition Examination Survey (NHANES) III cohort were used to examine the hypothesis that socio-economic status is consistently and negatively associated with levels of biological risk, as measured by nine biological parameters known to predict health risks (diastolic and systolic blood pressure, pulse, HDL and total cholesterol, glycosylated hemoglobin, c-reactive protein, albumin and waist-hip ratio), resulting in greater cumulative burdens of biological risk among those of lower education and/or income. As hypothesized, consistent education and income gradients were seen for biological parameters reflecting cardiovascular, metabolic and inflammatory risk: those with lower education and income exhibiting greater prevalence of high-risk values for each of nine individual biological risk factors. Significant education and income gradients were also seen for summary indices reflecting cumulative burdens of cardiovascular, metabolic and inflammatory risks as well as overall total biological risks. Multivariable cumulative logistic regression models revealed that the education and income effects were each independently and negatively associated with cumulative biological risks, and that these effects remained significant independent of age, gender, ethnicity and lifestyle factors such as smoking and physical activity. There were no significant ethnic differences in the patterns of association between socio-economic status and biological risks, but older age was associated with significantly weaker education and income gradients.

Ecological correlates of multiple sexual partnerships among adolescents and young adults in urban Cape Town: a cumulative risk factor approach.

Science.gov (United States)

Muchiri, Evans; Odimegwu, Clifford; Banda, Pamela; Ntoimo, Lorreta; Adedini, Sunday

2017-07-01

Studies in South Africa have reported unsafe levels of risky sexual behvaiours among adolescents and young adults, with the country reporting the highest burden of HIV/AIDS globally, as well as a high rate of teenage pregnancy. While determinants of risky sexual behaviours have been investigated for factors occurring at the individual and household levels, not fully explored in the literature is the effect of community level factors. Furthermore, it is unclear whether risk factors occurring within the ecology of adolescents and young adults act cumulatively to influence their sexual practices. This article aims to address this knowledge gap using a case study of the Cape Area Panel Study of adolescents and young adults in urban Cape Town, South Africa. The ecological framework was adopted to guide the selection of risk factors at the individual, household, and community levels. Multivariate linear discriminant function analyses were used to select significant risk factors for multiple sexual partnerships and used to produce risk indices for the respondents. The cumulative risk approach was applied to test whether significant risk factors acted cumulatively. Findings point to the importance of ecological factors in influencing outcomes of multiple sexual partnerships among respondents and further demonstrate that ecological risk factors may act cumulatively. These findings are important for South Africa that is grappling with teenage pregnancy and disproportionate HIV epidemic among the youth.

Cumulative occupational mechanical exposures during working life and risk of sickness absence and disability pension

DEFF Research Database (Denmark)

Sundstrup, Emil; Hansen, Åse Marie; Mortensen, Erik Lykke

2017-01-01

and Midlife Biobank with a job exposure matrix and a national register containing information on social transfer payment. By coding individual job histories from the Danish version of ISCO-codes (International Standard Classification of Occupations), we calculated cumulative occupational mechanical exposures......-regression analyses estimated the relative risk of register-based long-term sickness absence (LTSA) and disability pension with cumulative occupational mechanical exposures throughout working life. Analyses were censored for competing events and adjusted for multiple confounders. Results: During the follow-up period......, 970 persons (19.3%) had ≥1 episode of LTSA and 85 persons (1.7%) were granted a disability pension. Number of ton-, lifting- and kneeling-years showed an exposure-response association with increased risk of LTSA (P

CUMEX: a cumulative hazard index for assessing limiting exposures to environmental pollutants

International Nuclear Information System (INIS)

Walsh, P.J.; Killough, G.G.; Parzyck, D.C.; Rohwer, P.S.; Rupp, e.M.; Whitfield, B.L.; Booth, R.S.; Raridon, R.J.

1977-04-01

A hazard index methodology called CUMEX has been developed for limiting human exposure to environmental pollutants. Hazard index is defined as Q/Q/sub L/ where Q is exposure or dose to total-body, organ or tissue from all environmental pathways and Q/sub L/ is a limit which should not be exceeded because of health risk to humans. Mathematical formulations for hazard indices are developed for each sampling medium corresponding to each effluent type. These hazard indices are accumulated into composite indices such that total human intake or dose would not exceed the health risk limit. Mathematical formulation for composite hazard indices or CUMEX indices for multiple pollutants are presented. An example CUMEX application to cadmium release from a smelter complex in East Helena, Montana demonstrates details of the methodology for a single pollutant where human intake occurs through inhalation and ingestion

Cumulative risk and developmental health: an argument for the importance of a family-wide science.

Science.gov (United States)

Browne, Dillon T; Plamondon, Andre; Prime, Heather; Puente-Duran, Sofia; Wade, Mark

2015-01-01

A substantial body of research links social disadvantage and developmental health via a cascade running from poverty, to cumulative psychosocial risk, to disrupted family dynamics, to child biological regulatory systems and neurocognitive processing, and finally to morbidity across the lifespan. Most research in this area employs single-dyad or between-family methodology. While informative, there are limitations to this approach. Specifically, it is impossible to determine how risk alters psychosocial environments that are similar for all persons within a household, versus processes that are unique to particular children. This is important in light of literature citing the primacy of child-specific environments in driving developmental health. Methodologically speaking, there are both benefits and challenges to family-wide approaches that differentiate between- and within-family environments. This review describes literature linking cumulative risk and developmental health via family process, while articulating the importance of family-wide approaches. Areas of shortcoming and recommendations for a family-wide science are provided. © 2015 John Wiley & Sons, Ltd.

Risk of therapy-related leukaemia and preleukaemia after Hodgkin's disease. Relation to age, cumulative dose of alkylating agents, and time from chemotherapy

DEFF Research Database (Denmark)

Pedersen-Bjergaard, J.; Specht, L.; Larsen, S.O.

1987-01-01

391 patients treated intensively for Hodgkin's disease were followed for up to 15 years to evaluate the risk of therapy-related acute non-lymphocytic leukaemia (t-ANLL) and preleukaemia. Only two independent factors, patient age and cumulative dose of alkylating agents, were related to the risk...... of t-ANLL. The hazard rate of t-ANLL was roughly proportional to the square of patient age and to the total cumulative dose of alkylating agents. In 320 patients treated with alkylating agents the cumulative risk of t-ANLL increased steadily from 1 year after the start of treatment and reached 13.......0% (SE 3.0) at 10 years after which time there were no further cases. Calculated from cessation of therapy with alkylating agents, however, the cumulative risk curve increased steeply during the first 1-2 years then gradually levelled out and no new cases were observed beyond 7 years. With a 15-year...

Children neglected: Where cumulative risk theory fails.

Science.gov (United States)

O'Hara, Mandy; Legano, Lori; Homel, Peter; Walker-Descartes, Ingrid; Rojas, Mary; Laraque, Danielle

2015-07-01

Neglected children, by far the majority of children maltreated, experience an environment most deficient in cognitive stimulation and language exchange. When physical abuse co-occurs with neglect, there is more stimulation through negative parent-child interaction, which may lead to better cognitive outcomes, contrary to Cumulative Risk Theory. The purpose of the current study was to assess whether children only neglected perform worse on cognitive tasks than children neglected and physically abused. Utilizing LONGSCAN archived data, 271 children only neglected and 101 children neglected and physically abused in the first four years of life were compared. The two groups were assessed at age 6 on the WPPSI-R vocabulary and block design subtests, correlates of cognitive intelligence. Regression analyses were performed, controlling for additional predictors of poor cognitive outcome, including socioeconomic variables and caregiver depression. Children only neglected scored significantly worse than children neglected and abused on the WPPSI-R vocabulary subtest (p=0.03). The groups did not differ on the block design subtest (p=0.4). This study shows that for neglected children, additional abuse may not additively accumulate risk when considering intelligence outcomes. Children experiencing only neglect may need to be referred for services that address cognitive development, with emphasis on the linguistic environment, in order to best support the developmental challenges of neglected children. Copyright © 2015 Elsevier Ltd. All rights reserved.

Cumulative occupational mechanical exposures during working life and risk of sickness absence and disability pension: prospective cohort study.

Science.gov (United States)

Sundstrup, Emil; Hansen, Åse Marie; Mortensen, Erik Lykke; Poulsen, Otto Melchior; Clausen, Thomas; Rugulies, Reiner; Møller, Anne; Andersen, Lars L

2017-09-01

Objectives The aim of this study was to determine the prospective association of cumulative mechanical exposure during working life with health-related labor market outcomes. Methods This prospective cohort study combines data from 5076 older workers (age 49-63 years) from the Copenhagen Aging and Midlife Biobank with a job exposure matrix and a national register containing information on social transfer payment. By coding individual job histories from the Danish version of ISCO-codes (International Standard Classification of Occupations), we calculated cumulative occupational mechanical exposures from a JEM for ton-years (lifting 1000 kg each day in one year), lifting-years (lifting loads weighing ≥20 kg >10 times each day in one year), kneeling-years (kneeling for one hour each day in one year) and vibration-years (whole-body vibration for one hour each day in one year). Cox-regression analyses estimated the relative risk of register-based long-term sickness absence (LTSA) and disability pension with cumulative occupational mechanical exposures throughout working life. Analyses were censored for competing events and adjusted for multiple confounders. Results During the follow-up period, 970 persons (19.3%) had ≥1 episode of LTSA and 85 persons (1.7%) were granted a disability pension. Number of ton-, lifting- and kneeling-years showed an exposure-response association with increased risk of LTSA (Ppension (HR 1.75 95% CI 1.01-3.04). Conclusions Cumulative occupational mechanical exposures during working life - such as lifting and kneeling work - increased the risk of LTSA. Importantly, being exposed to lifting increased the risk of disability pension.

Development and implementation of a business continuity management risk index.

Science.gov (United States)

Kadar, Michael

This paper will present the building blocks for developing and implementing the BCM risk index; whether it is used as a comprehensive metric for risk or preparedness. This paper introduces the concept of a business continuity management (BCM) risk index--a comprehensive metric that measures and reports the status of the primary 'intended outcome' of the BCM programme to top management. In addition to measuring the primary programme output,;the BCM risk index can be used to demonstrate the overall value of the BCM programme to executive management. This is accomplished because the BCM risk index allows quantitative measurement of current risk levels and their comparison with established risk tolerances. The BCM Risk Index can provide executive management with reports on the risk level of individual business units, departments, subsidiaries or the enterprise in a way that drives both risk management and BCM initiatives. The name 'risk index' can be misleading, however. The BCM risk index concept can also be used to measure preparedness levels. In fact, implementation at DTE Energy has resulted in calling it the 'preparedness index', which is used to measure and report preparedness levels rather than risk levels.

Entomologic index for human risk of Lyme disease.

Science.gov (United States)

Mather, T N; Nicholson, M C; Donnelly, E F; Matyas, B T

1996-12-01

An entomologic index based on density estimates of Lyme disease spirochete-infected nymphal deer ticks (lxodes scapularis) was developed to assess human risk of Lyme disease. The authors used a standardized protocol to determine tick density and infection in numerous forested sites in six Rhode Island towns. An entomologic risk index calculated for each town was compared with the number of human Lyme disease cases reported to the Rhode Island State Health Department for the same year. A strong positive relation between entomologic risk index and the Lyme disease case rate for each town suggested that the entomologic index was predictive of Lyme disease risk.

Early Educational Intervention, Early Cumulative Risk, and the Early Home Environment as Predictors of Young Adult Outcomes within a High-Risk Sample

Science.gov (United States)

Pungello, Elizabeth P.; Kainz, Kirsten; Burchinal, Margaret; Wasik, Barbara H.; Sparling, Joseph J.; Ramey, Craig T.; Campbell, Frances A.

2010-01-01

The extent to which early educational intervention, early cumulative risk, and the early home environment were associated with young adult outcomes was investigated in a sample of 139 young adults (age 21) from high-risk families enrolled in randomized trials of early intervention. Positive effects of treatment were found for education attainment,…

Dietary cumulative acute risk assessment of organophosphorus, carbamates and pyrethroids insecticides for the Brazilian population.

NARCIS (Netherlands)

Jardim, Andreia Nunes Oliveira; Brito, Alessandra Page; van Donkersgoed, Gerda; Boon, Polly E; Caldas, Eloisa Dutra

Cumulative acute dietary risk assessments of organophosphorus (OPs), carbamates (CBs) and pyrethroids (PYs) were conducted for the Brazilian population. Residue data for 30786 samples of 30 foods were obtained from two national monitoring programs and one University laboratory, and consumption data

The cumulative risk of false-positive screening results across screening centres in the Norwegian Breast Cancer Screening Program

Energy Technology Data Exchange (ETDEWEB)

Roman, M., E-mail: Marta.Roman@kreftregisteret.no [Cancer Registry of Norway, Oslo (Norway); Department of Women and Children’s Health, Oslo University Hospital, Oslo (Norway); Skaane, P., E-mail: PERSK@ous-hf.no [Department of Radiology, Oslo University Hospital Ullevaal, University of Oslo, Oslo (Norway); Hofvind, S., E-mail: Solveig.Hofvind@kreftregisteret.no [Cancer Registry of Norway, Oslo (Norway); Oslo and Akershus University College of Applied Sciences, Faculty of Health Science, Oslo (Norway)

2014-09-15

Highlights: • We found variation in early performance measures across screening centres. • Radiologists’ performance may play a key role in the variability. • Potential to improve the effectiveness of breast cancer screening programs. • Continuous surveillance of screening centres and radiologists is essential. - Abstract: Background: Recall for assessment in mammographic screening entails an inevitable number of false-positive screening results. This study aimed to investigate the variation in the cumulative risk of a false positive screening result and the positive predictive value across the screening centres in the Norwegian Breast Cancer Screening Program. Methods: We studied 618,636 women aged 50–69 years who underwent 2,090,575 screening exams (1996–2010. Recall rate, positive predictive value, rate of screen-detected cancer, and the cumulative risk of a false positive screening result, without and with invasive procedures across the screening centres were calculated. Generalized linear models were used to estimate the probability of a false positive screening result and to compute the cumulative false-positive risk for up to ten biennial screening examinations. Results: The cumulative risk of a false-positive screening exam varied from 10.7% (95% CI: 9.4–12.0%) to 41.5% (95% CI: 34.1–48.9%) across screening centres, with a highest to lowest ratio of 3.9 (95% CI: 3.7–4.0). The highest to lowest ratio for the cumulative risk of undergoing an invasive procedure with a benign outcome was 4.3 (95% CI: 4.0–4.6). The positive predictive value of recall varied between 12.0% (95% CI: 11.0–12.9%) and 19.9% (95% CI: 18.3–21.5%), with a highest to lowest ratio of 1.7 (95% CI: 1.5–1.9). Conclusions: A substantial variation in the performance measures across the screening centres in the Norwegian Breast Cancer Screening Program was identified, despite of similar administration, procedures, and quality assurance requirements. Differences in the

The cumulative risk of false-positive screening results across screening centres in the Norwegian Breast Cancer Screening Program

International Nuclear Information System (INIS)

Roman, M.; Skaane, P.; Hofvind, S.

2014-01-01

Highlights: • We found variation in early performance measures across screening centres. • Radiologists’ performance may play a key role in the variability. • Potential to improve the effectiveness of breast cancer screening programs. • Continuous surveillance of screening centres and radiologists is essential. - Abstract: Background: Recall for assessment in mammographic screening entails an inevitable number of false-positive screening results. This study aimed to investigate the variation in the cumulative risk of a false positive screening result and the positive predictive value across the screening centres in the Norwegian Breast Cancer Screening Program. Methods: We studied 618,636 women aged 50–69 years who underwent 2,090,575 screening exams (1996–2010. Recall rate, positive predictive value, rate of screen-detected cancer, and the cumulative risk of a false positive screening result, without and with invasive procedures across the screening centres were calculated. Generalized linear models were used to estimate the probability of a false positive screening result and to compute the cumulative false-positive risk for up to ten biennial screening examinations. Results: The cumulative risk of a false-positive screening exam varied from 10.7% (95% CI: 9.4–12.0%) to 41.5% (95% CI: 34.1–48.9%) across screening centres, with a highest to lowest ratio of 3.9 (95% CI: 3.7–4.0). The highest to lowest ratio for the cumulative risk of undergoing an invasive procedure with a benign outcome was 4.3 (95% CI: 4.0–4.6). The positive predictive value of recall varied between 12.0% (95% CI: 11.0–12.9%) and 19.9% (95% CI: 18.3–21.5%), with a highest to lowest ratio of 1.7 (95% CI: 1.5–1.9). Conclusions: A substantial variation in the performance measures across the screening centres in the Norwegian Breast Cancer Screening Program was identified, despite of similar administration, procedures, and quality assurance requirements. Differences in the

Optimization of the cumulative risk assessment of pesticides and biocides using computational techniques: Pilot project

DEFF Research Database (Denmark)

Jonsdottir, Svava Osk; Reffstrup, Trine Klein; Petersen, Annette

This pilot project is intended as the first step in developing a computational strategy to assist in refining methods for higher tier cumulative and aggregate risk assessment of exposure to mixture of pesticides and biocides. For this purpose, physiologically based toxicokinetic (PBTK) models were...

Nonparametric Estimation of Cumulative Incidence Functions for Competing Risks Data with Missing Cause of Failure

DEFF Research Database (Denmark)

Effraimidis, Georgios; Dahl, Christian Møller

In this paper, we develop a fully nonparametric approach for the estimation of the cumulative incidence function with Missing At Random right-censored competing risks data. We obtain results on the pointwise asymptotic normality as well as the uniform convergence rate of the proposed nonparametric...

Cumulative trauma disorders in the upper extremities: reliability of the postural and repetitive risk-factors index.

Science.gov (United States)

James, C P; Harburn, K L; Kramer, J F

1997-08-01

This study addresses test-retest reliability of the Postural and Repetitive Risk-Factors Index (PRRI) for work-related upper body injuries. This assessment was developed by the present authors. A repeated measures design was used to assess the test-retest reliability of a videotaped work-site assessment of subjects' movements. Ten heavy users of video display terminals (VDTs) from a local banking industry participated in the study. The 10 subjects' movements were videotaped for 2 hours on each of 2 separate days, while working on-site at their VDTs. The videotaped assessment, which utilized known postural risk factors for developing musculoskeletal disorder, pain, and discomfort in heavy VDT users (ie, repetitiveness, awkward and static postures, and contraction time), was called the PRRI. The videotaped movement assessments were subsequently analyzed in 15-minute sessions (five sessions per 2-hour videotape, which produced a total of 10 sessions over the 2 testing days), and each session was chosen randomly from the videotape. The subjects' movements were given a postural risk score according to the criteria in the PRRI. Each subject was therefore tested a total of 10 times (ie, 10 sessions), over two days. The maximum PRRI score for both sides of the body was 216 points. Reliability coefficients (RCs) for the PRRI scores were calculated, and the reliability of any one session met the minimum criterion for excellent reliability, which was .75. A two-way analysis of variance (ANOVA) confirmed that there was no statistically significant difference between sessions (p < .05). Calculations using the standard error of measurement (SEM) indicated that an individual tested once, on one day and with a PRRI score of 25, required a change of at least 8 points in order to be confident that a true change in score had occurred. The significant results from the reliability tests indicated that the PRRI was a reliable measurement tool that could be used by occupational health

Social Determinants of Health in Environmental Justice Communities: Examining Cumulative Risk in Terms of Environmental Exposures and Social Determinants of Health.

Science.gov (United States)

Prochaska, John D; Nolen, Alexandra B; Kelley, Hilton; Sexton, Ken; Linder, Stephen H; Sullivan, John

2014-01-01

Residents of environmental justice (EJ) communities may bear a disproportionate burden of environmental health risk, and often face additional burdens from social determinants of health. Accounting for cumulative risk should include measures of risk from both environmental sources and social determinants. This study sought to better understand cumulative health risk from both social and environmental sources in a disadvantaged community in Texas. Key outcomes were determining what data are currently available for this assessment, clarifying data needs, identifying data gaps, and considering how those gaps could be filled. Analyses suggested that the traditionally defined EJ community in Port Arthur may have a lower environmental risk from air toxics than the rest of the City of Port Arthur (although the entire city has a higher risk than the average for the state), but may have a larger burden from social determinants of health. However, the results should be interpreted in light of the availability of data, the definitions of community boundaries, and the areal unit utilized. Continued focus on environmental justice communities and the cumulative risks faced by their residents is critical to protecting these residents and, ultimately, moving towards a more equitable distribution and acceptable level of risk throughout society.

Radiation effects and risks: overview and a new risk perception index

International Nuclear Information System (INIS)

Rehani, M.M.

2015-01-01

Uncertainty provides opportunities for differences in perception, and radiation risks at low level of exposures involved in few computed tomography scans fall in this category. While there is good agreement among national and international organisations on risk probability of cancer, risk perception has barely been dealt with by these organisations. Risk perception is commonly defined as the subjective judgment that people make about the characteristics and severity of a risk. Severity and latency are important factors in perception. There is a need to connect all these. Leaving risk perception purely as a subjective judgement provides opportunities for people to amplifying risk. The author postulates a risk perception index as severity divided by latency that becomes determining factor for risk perception. It is hoped that this index will bring rationality in risk perception. (authors)

Assessing stress-related treatment needs among girls at risk for poor functional outcomes: The impact of cumulative adversity, criterion traumas, and non-criterion events.

Science.gov (United States)

Lansing, Amy E; Plante, Wendy Y; Beck, Audrey N

2017-05-01

Despite growing recognition that cumulative adversity (total stressor exposure, including complex trauma), increases the risk for psychopathology and impacts development, assessment strategies lag behind: Adversity-related mental health needs (symptoms, functional impairment, maladaptive coping) are typically assessed in response to only one qualifying Criterion-A traumatic event. This is especially problematic for youth at-risk for health and academic disparities who experience cumulative adversity, including non-qualifying events (separation from caregivers) which may produce more impairing symptomatology. Data from 118 delinquent girls demonstrate: (1) an average of 14 adverse Criterion-A and non-Criterion event exposures; (2) serious maladaptive coping strategies (self-injury) directly in response to cumulative adversity; (3) more cumulative adversity-related than worst-event related symptomatology and functional impairment; and (4) comparable symptomatology, but greater functional impairment, in response to non-Criterion events. These data support the evaluation of mental health needs in response to cumulative adversity for optimal identification and tailoring of services in high-risk populations to reduce disparities. Copyright © 2016 Elsevier Ltd. All rights reserved.

Observed Sensitivity during Family Interactions and Cumulative Risk: A Study of Multiple Dyads per Family

Science.gov (United States)

Browne, Dillon T.; Leckie, George; Prime, Heather; Perlman, Michal; Jenkins, Jennifer M.

2016-01-01

The present study sought to investigate the family, individual, and dyad-specific contributions to observed cognitive sensitivity during family interactions. Moreover, the influence of cumulative risk on sensitivity at the aforementioned levels of the family was examined. Mothers and 2 children per family were observed interacting in a round robin…

The effects of cumulative risks and promotive factors on urban adolescent alcohol and other drug use: a longitudinal study of resiliency.

Science.gov (United States)

Ostaszewski, Krzysztof; Zimmerman, Marc A

2006-12-01

Resiliency theory provides a conceptual framework for studying why some youth exposed to risk factors do not develop the negative behaviors they predict. The purpose of this study was to test compensatory and protective models of resiliency in a longitudinal sample of urban adolescents (80% African American). The data were from Years 1 (9th grade) and 4 (12th grade). The study examined effects of cumulative risk and promotive factors on adolescent polydrug use including alcohol, tobacco and marijuana. Cumulative measures of risk/promotive factors represented individual characteristics, peer influence, and parental/familial influences. After controlling for demographics, results of multiple regression of polydrug use support the compensatory model of resiliency both cross-sectionally and longitudinally. Promotive factors were also found to have compensatory effects on change in adolescent polydrug use. The protective model of resiliency evidenced cross-sectionally was not supported in longitudinal analysis. The findings support resiliency theory and the use of cumulative risk/promotive measures in resiliency research. Implications focused on utilizing multiple assets and resources in prevention programming are discussed.

Is the cluster risk model of parental adversities better than the cumulative risk model as an indicator of childhood physical abuse?: findings from two representative community surveys.

Science.gov (United States)

Fuller-Thomson, E; Sawyer, J-L

2014-01-01

Screening strategies for childhood physical abuse (CPA) need to be improved in order to identify those most at risk. This study uses two regionally representative community samples to examine whether a cluster or cumulative model of risk indicators (i.e. parental divorce, parental unemployment, and parental addictions) explains a larger proportion of the variation in CPA. Data were drawn from Statistics Canada's National Population Health Survey (1994-1995) and Canadian Community Health Survey 3.1 (2005). Response rates were greater than 80% in both samples. Each survey had approximately 13,000 respondents aged 18 and over who answered questions about the above adverse childhood experiences. A gradient was shown with similar outcomes in each data set. Only 3.4% of adults who experienced none of the three risk indicators reported they had been physically abused during childhood or adolescence. The prevalence of CPA was greater among those who experienced parental divorce alone (8.3%-10.7%), parental unemployment alone (8.9%-9.7%) or parental addictions alone (18.0%-19.5%). When all three risk indicators were present, the prevalence of CPA ranged from 36.0%-41.0% and the age-sex-race adjusted odds were greater than 15 times that of individuals with none of the three risk indicators. The cluster model explained a statistically significantly larger proportion of the variation than the cumulative model although the difference between the two models was modest. For the purposes of parsimony, the cumulative model may be the better alternative. Adults who were exposed to two or more childhood risk indicators were much more likely to report that they were physically abused during their childhood than those with only one or no risk factors. Medical professionals may use this information on cumulative risk factors to more effectively target screening for potential CPA. Future research should include prospective studies. © 2012 John Wiley & Sons Ltd.

Serious, Minor, and Non-Delinquents in Early Adolescence : The Impact of Cumulative Risk and Promotive Factors. The TRAILS Study

NARCIS (Netherlands)

van der Laan, A.M.; Veenstra, R.; Bogaerts, S.; Verhulst, F.C.; Ormel, J.

This study uses a social-ecological approach to the development of delinquency. The authors emphasize that a balance between eliminating risk and enhancing protection across domains is essential in reducing problems and promoting competence. The cumulative risk and promotive effects of temperament,

Serious, minor, and non-delinquents in early adolescence: The impact of cumulative risk and promotive factors. The TRAILS study

NARCIS (Netherlands)

A.M. van der Laan (André); R. Veenstra (René); S. Bogaerts (Stefan); F.C. Verhulst (Frank); J. Ormel (Johan Hans)

2010-01-01

textabstractThis study uses a social-ecological approach to the development of delinquency. The authors emphasize that a balance between eliminating risk and enhancing protection across domains is essential in reducing problems and promoting competence. The cumulative risk and promotive effects of

Synergistic effect of cumulative corticosteroid dose and immunosuppressants on avascular necrosis in patients with systemic lupus erythematosus.

Science.gov (United States)

Kwon, H H; Bang, S Y; Won, S; Park, Y; Yi, J H; Joo, Y B; Lee, H S; Bae, S C

2018-01-01

Objectives Avascular necrosis (AVN) is one of the most common causes of organ damage in patients with systemic lupus erythematosus (SLE) and often causes serious physical disability. The aims of this study were to investigate clinical risk factors associated with symptomatic AVN and to analyze their synergistic effects in a large SLE cohort in Korea. Methods Patients with SLE were enrolled and followed from 1998 to 2014 in the Hanyang BAE Lupus cohort, and damage was measured annually according to the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). AVN was confirmed by imaging study if patients had symptoms. To determine risk factors for AVN, clinical, laboratory and therapeutic variables were analyzed by logistic regression. Relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S) were calculated to measure interactions between significant variables. Results Among 1219 SLE patients, symptomatic AVN was the most common type of musculoskeletal damage (10.8%, n = 132). SLE patients with AVN showed an earlier onset age, demonstrated AVN more commonly in conjunction with certain other clinical manifestations such as renal and neuropsychiatric disorders, and received significantly higher total cumulative corticosteroid dose and immunosuppressive agents than did patients without AVN. However, in multivariable analysis, only two variables including use of a cumulative corticosteroid dose greater than 20 g (odds ratio (OR) 3.62, p = 0.015) and use of immunosuppressants including cyclophosphamide or mycophenolate mofetil (OR 4.51, p AVN. Patients with cumulative corticosteroid dose > 20 g and immunosuppressant use had a 15.44-fold increased risk for AVN, compared with patients without these risk factors ( p AVN in our Korean lupus cohort. Conclusions An individual risk assessment for AVN development should be made prior to and during treatment for SLE

Can the Air Pollution Index be used to communicate the health risks of air pollution?

International Nuclear Information System (INIS)

Li, Li; Lin, Guo-Zhen; Liu, Hua-Zhang; Guo, Yuming; Ou, Chun-Quan; Chen, Ping-Yan

2015-01-01

The validity of using the Air Pollution Index (API) to assess health impacts of air pollution and potential modification by individual characteristics on air pollution effects remain uncertain. We applied distributed lag non-linear models (DLNMs) to assess associations of daily API, specific pollution indices for PM 10 , SO 2 , NO 2 and the weighted combined API (APIw) with mortality during 2003–2011 in Guangzhou, China. An increase of 10 in API was associated with a 0.88% (95% confidence interval (CI): 0.50, 1.27%) increase of non-accidental mortality at lag 0–2 days. Harvesting effects appeared after 2 days’ exposure. The effect estimate of API over lag 0–15 days was statistically significant and similar with those of pollutant-specific indices and APIw. Stronger associations between API and mortality were observed in the elderly, females and residents with low educational attainment. In conclusion, the API can be used to communicate health risks of air pollution. - Highlights: • The cumulative effects of API on mortality over lag 0–15 days remained significant. • The indices for three specific pollutants had similar associations with mortality. • The effects of API were modified by age, gender and educational attainment. • Our findings can help to communicate health risks of air pollution to the public. - The Air Pollution Index communicates health risks of air pollution

Validity of the Medication-based Disease Burden Index compared with the Charlson Comorbidity Index and the Cumulative Illness Rating Scale for geriatrics: a cohort study.

Science.gov (United States)

Beloosesky, Yichayaou; Weiss, Avraham; Mansur, Nariman

2011-12-01

Co-morbidity is common in older people. A co-morbidity index reduces coexisting illnesses and their severity to a single numerical score, allowing comparison with scores from other patients. Recently, the Medication-Based Disease Burden Index (MDBI) was developed. The aim of the study was to assess the MDBI's validity in hospitalized elderly patients. Clinical and demographic data and data on patients' medications on admission were obtained prospectively. Retrospectively, we applied the MDBI to the patients' medication regimens, determining their co-morbidity using the Charlson Comorbidity Index and Cumulative Illness Rating Scale for Geriatrics (CIRS-G). The MDBI's criterion validity was assessed against the Charlson and CIRS-G indices. Convergent and discriminant validities were also assessed. The MDBI's predictive validity was assessed by its ability to predict 3-month post-discharge readmissions or mortality compared with the Charlson and CIRS-G indices. MDBI scores were correlated with the Charlson and CIRS-G indices' scores (r = 0.44 and r = 0.37, respectively [p indices had good predictive ability for mortality (OR 1.50 [95% CI 1.22, 1.84; p failed to differentiate between cognitive and functional patient groups. The MDBI should be investigated in larger studies to determine its validity in settings where medication data rather than diagnostic data are more readily available. In clinical practice with elderly patients, we recommend employing co-morbidity indices that are based on medical records, such as the Charlson Comorbidity Index and CIRS-G.

Potential Health Risks Posed by Plant-Derived Cumulative Neurotoxic Bufadienolides in South Africa

Directory of Open Access Journals (Sweden)

Christo Botha

2016-03-01

Full Text Available Bufadienolide-type cardiac glycosides have a worldwide distribution and are mainly synthesized by plants, but there are also animal sources. In South Africa, members of three genera of the Crassulaceae (Cotyledon, Tylecodon and Kalanchoe cause a unique chronic form of cardiac glycoside poisoning, predominantly in small stock. This paretic/paralytic condition is referred to as “krimpsiekte”, cotyledonosis or “nenta”. “Krimpsiekte” is a plant poisoning only reported from South Africa and is regarded as the most important plant poisoning of small stock in the semi-arid Little Karoo and southern fringes of the Great Karoo. The toxicosis is caused by cumulative bufadienolides which have neurotoxic properties. Four types of cumulative neurotoxic bufadienolides, namely cotyledoside, and the tyledosides, orbicusides and lanceotoxins, have been isolated. Based on the structure activity relationships and certain toxicokinetic parameters possible reasons for their accumulation are presented. Consumption of edible tissues from animals that have ingested these plants poses a potential risk to humans.

An Investigation into the Decision Makers's Risk Attitude Index ...

African Journals Online (AJOL)

An Investigation into the Decision Makers's Risk Attitude Index Ranking Technique for Fuzzy Critical Path Analysis. ... Nigerian Journal of Technology ... for a benchmark problem, the decision maker's risk attitude index ranking method produces unrealistic results when the decision maker's attitude towards risk was neutral.

Earthquake Disaster Risk Index for Cities: Baku, Yerevan, Tbilisi

International Nuclear Information System (INIS)

Varazanashvili, O.; Mammadli, T.; Nazaretyan, S.

2005-01-01

For comparative analysis of seismic risk in the capitals of the South Caucasian States - Baku, Yerevan and Tbilisi - the methodology of determination of earthquake disaster risk index (EDRI) has been used. Earthquake disaster risk indexes have been determined for considered cities. EDRI-analysis is performed, some peculiarities of main risk factors are revealed and risk portraits are made in each city of the given sample. (author)

Novel Threat-risk Index Using Probabilistic Risk Assessment and Human Reliability Analysis - Final Report

Energy Technology Data Exchange (ETDEWEB)

George A. Beitel

2004-02-01

In support of a national need to improve the current state-of-the-art in alerting decision makers to the risk of terrorist attack, a quantitative approach employing scientific and engineering concepts to develop a threat-risk index was undertaken at the Idaho National Engineering and Environmental Laboratory (INEEL). As a result of this effort, a set of models has been successfully integrated into a single comprehensive model known as Quantitative Threat-Risk Index Model (QTRIM), with the capability of computing a quantitative threat-risk index on a system level, as well as for the major components of the system. Such a threat-risk index could provide a quantitative variant or basis for either prioritizing security upgrades or updating the current qualitative national color-coded terrorist threat alert.

Serious, Minor, and Non-Delinquents in Early Adolescence: The Impact of Cumulative Risk and Promotive Factors. The TRAILS Study

Science.gov (United States)

van der Laan, Andre M.; Veenstra, Rene; Bogaerts, Stefan; Verhulst, Frank C.; Ormel, Johan

2010-01-01

This study uses a social-ecological approach to the development of delinquency. The authors emphasize that a balance between eliminating risk and enhancing protection across domains is essential in reducing problems and promoting competence. The cumulative risk and promotive effects of temperament, family and school factors in preadolescence were…

Kaplan-Meier survival analysis overestimates cumulative incidence of health-related events in competing risk settings: a meta-analysis.

Science.gov (United States)

Lacny, Sarah; Wilson, Todd; Clement, Fiona; Roberts, Derek J; Faris, Peter; Ghali, William A; Marshall, Deborah A

2018-01-01

Kaplan-Meier survival analysis overestimates cumulative incidence in competing risks (CRs) settings. The extent of overestimation (or its clinical significance) has been questioned, and CRs methods are infrequently used. This meta-analysis compares the Kaplan-Meier method to the cumulative incidence function (CIF), a CRs method. We searched MEDLINE, EMBASE, BIOSIS Previews, Web of Science (1992-2016), and article bibliographies for studies estimating cumulative incidence using the Kaplan-Meier method and CIF. For studies with sufficient data, we calculated pooled risk ratios (RRs) comparing Kaplan-Meier and CIF estimates using DerSimonian and Laird random effects models. We performed stratified meta-analyses by clinical area, rate of CRs (CRs/events of interest), and follow-up time. Of 2,192 identified abstracts, we included 77 studies in the systematic review and meta-analyzed 55. The pooled RR demonstrated the Kaplan-Meier estimate was 1.41 [95% confidence interval (CI): 1.36, 1.47] times higher than the CIF. Overestimation was highest among studies with high rates of CRs [RR = 2.36 (95% CI: 1.79, 3.12)], studies related to hepatology [RR = 2.60 (95% CI: 2.12, 3.19)], and obstetrics and gynecology [RR = 1.84 (95% CI: 1.52, 2.23)]. The Kaplan-Meier method overestimated the cumulative incidence across 10 clinical areas. Using CRs methods will ensure accurate results inform clinical and policy decisions. Copyright © 2017 Elsevier Inc. All rights reserved.

Climate risk index for Italy

Science.gov (United States)

Mysiak, Jaroslav; Torresan, Silvia; Bosello, Francesco; Mistry, Malcolm; Amadio, Mattia; Marzi, Sepehr; Furlan, Elisa; Sperotto, Anna

2018-06-01

We describe a climate risk index that has been developed to inform national climate adaptation planning in Italy and that is further elaborated in this paper. The index supports national authorities in designing adaptation policies and plans, guides the initial problem formulation phase, and identifies administrative areas with higher propensity to being adversely affected by climate change. The index combines (i) climate change-amplified hazards; (ii) high-resolution indicators of exposure of chosen economic, social, natural and built- or manufactured capital (MC) assets and (iii) vulnerability, which comprises both present sensitivity to climate-induced hazards and adaptive capacity. We use standardized anomalies of selected extreme climate indices derived from high-resolution regional climate model simulations of the EURO-CORDEX initiative as proxies of climate change-altered weather and climate-related hazards. The exposure and sensitivity assessment is based on indicators of manufactured, natural, social and economic capital assets exposed to and adversely affected by climate-related hazards. The MC refers to material goods or fixed assets which support the production process (e.g. industrial machines and buildings); Natural Capital comprises natural resources and processes (renewable and non-renewable) producing goods and services for well-being; Social Capital (SC) addressed factors at the individual (people's health, knowledge, skills) and collective (institutional) level (e.g. families, communities, organizations and schools); and Economic Capital (EC) includes owned and traded goods and services. The results of the climate risk analysis are used to rank the subnational administrative and statistical units according to the climate risk challenges, and possibly for financial resource allocation for climate adaptation. This article is part of the theme issue `Advances in risk assessment for climate change adaptation policy'.

Flood Risk Index Assessment in Johor River Basin

International Nuclear Information System (INIS)

Ahmad Shakir Mohd Saudi; Hafizan Juahir; Azman Azid; Fazureen Azaman; Ahmad Shakir Mohd Saudi

2015-01-01

This study is focusing on constructing the flood risk index in the Johor river basin. The application of statistical methods such as factor analysis (FA), statistical process control (SPC) and artificial neural network (ANN) had revealed the most efficient flood risk index. The result in FA was water level has correlation coefficient of 0.738 and the most practicable variable to be used for the warning alert system. The upper control limits (UCL) for the water level in the river basin Johor is 4.423 m and the risk index for the water level has been set by this method consisting of 0-100.The accuracy of prediction has been evaluated by using ANN and the accuracy of the test result was R"2 = 0.96408 with RMSE= 2.5736. The future prediction for UCL in Johor river basin has been predicted and the value was 3.75 m. This model can shows the current and future prediction for flood risk index in the Johor river basin and can help local authorities for flood control and prevention of the state of Johor. (author)

Comparative Coastal Risk Index (CCRI: A multidisciplinary risk index for Latin America and the Caribbean.

Directory of Open Access Journals (Sweden)

Juliano Calil

Full Text Available As the world's population grows to a projected 11.2 billion by 2100, the number of people living in low-lying areas exposed to coastal hazards is projected to increase. Critical infrastructure and valuable assets continue to be placed in vulnerable areas, and in recent years, millions of people have been displaced by natural hazards. Impacts from coastal hazards depend on the number of people, value of assets, and presence of critical resources in harm's way. Risks related to natural hazards are determined by a complex interaction between physical hazards, the vulnerability of a society or social-ecological system and its exposure to such hazards. Moreover, these risks are amplified by challenging socioeconomic dynamics, including poorly planned urban development, income inequality, and poverty. This study employs a combination of machine learning clustering techniques (Self Organizing Maps and K-Means and a spatial index, to assess coastal risks in Latin America and the Caribbean (LAC on a comparative scale. The proposed method meets multiple objectives, including the identification of hotspots and key drivers of coastal risk, and the ability to process large-volume multidimensional and multivariate datasets, effectively reducing sixteen variables related to coastal hazards, geographic exposure, and socioeconomic vulnerability, into a single index. Our results demonstrate that in LAC, more than 500,000 people live in areas where coastal hazards, exposure (of people, assets and ecosystems and poverty converge, creating the ideal conditions for a perfect storm. Hotspot locations of coastal risk, identified by the proposed Comparative Coastal Risk Index (CCRI, contain more than 300,00 people and include: El Oro, Ecuador; Sinaloa, Mexico; Usulutan, El Salvador; and Chiapas, Mexico. Our results provide important insights into potential adaptation alternatives that could reduce the impacts of future hazards. Effective adaptation options must not only

Estimating a population cumulative incidence under calendar time trends

DEFF Research Database (Denmark)

Hansen, Stefan N; Overgaard, Morten; Andersen, Per K

2017-01-01

BACKGROUND: The risk of a disease or psychiatric disorder is frequently measured by the age-specific cumulative incidence. Cumulative incidence estimates are often derived in cohort studies with individuals recruited over calendar time and with the end of follow-up governed by a specific date....... It is common practice to apply the Kaplan-Meier or Aalen-Johansen estimator to the total sample and report either the estimated cumulative incidence curve or just a single point on the curve as a description of the disease risk. METHODS: We argue that, whenever the disease or disorder of interest is influenced...

Cumulative Trauma Among Mayas Living in Southeast Florida.

Science.gov (United States)

Millender, Eugenia I; Lowe, John

2017-06-01

Mayas, having experienced genocide, exile, and severe poverty, are at high risk for the consequences of cumulative trauma that continually resurfaces through current fear of an uncertain future. Little is known about the mental health and alcohol use status of this population. This correlational study explored t/he relationship of cumulative trauma as it relates to social determinants of health (years in the United States, education, health insurance status, marital status, and employment), psychological health (depression symptoms), and health behaviors (alcohol use) of 102 Guatemalan Mayas living in Southeast Florida. The results of this study indicated that, as specific social determinants of health and cumulative trauma increased, depression symptoms (particularly among women) and the risk for harmful alcohol use (particularly among men) increased. Identifying risk factors at an early stage before serious disease or problems are manifest provides room for early screening leading to early identification, early treatment, and better outcomes.

A Risk Severity Index for industrial plants and sites

International Nuclear Information System (INIS)

Planas, E.; Arnaldos, J.; Silvetti, B.; Vallee, Agnes; Casal, J.

2006-01-01

A risk index (Risk Severity Index, S) has been devised to allow the assessment of the risk level originated by a given installation or site over the affected zone. A set of threshold levels for thermal radiation, toxic concentration and overpressure, together with the probabilities and frequencies associated to critical events and their effects have been the basis for calculating the values of S. A computer tool has been designed to perform a quick calculation of the diverse Risk Severity Indexes (for a critical event, for a dangerous phenomenon, for a type of effect and for the whole installation) and to plot a map of the risk severity levels around the site. The methodology has been applied to diverse test cases and it has proved to be useful for risk assessment, for comparative studies and for land use planning

Estimating a population cumulative incidence under calendar time trends

DEFF Research Database (Denmark)

Hansen, Stefan N; Overgaard, Morten; Andersen, Per K

2017-01-01

BACKGROUND: The risk of a disease or psychiatric disorder is frequently measured by the age-specific cumulative incidence. Cumulative incidence estimates are often derived in cohort studies with individuals recruited over calendar time and with the end of follow-up governed by a specific date...... by calendar time trends, the total sample Kaplan-Meier and Aalen-Johansen estimators do not provide useful estimates of the general risk in the target population. We present some alternatives to this type of analysis. RESULTS: We show how a proportional hazards model may be used to extrapolate disease risk...... estimates if proportionality is a reasonable assumption. If not reasonable, we instead advocate that a more useful description of the disease risk lies in the age-specific cumulative incidence curves across strata given by time of entry or perhaps just the end of follow-up estimates across all strata...

Toward the breast screening balance sheet: cumulative risk of false positives for annual versus biennial mammograms commencing at age 40 or 50.

Science.gov (United States)

Winch, Caleb J; Sherman, Kerry A; Boyages, John

2015-01-01

This study aimed to: (1) Estimate cumulative risk of recall from breast screening where no cancer is detected (a harm) in Australia; (2) Compare women screened annually versus biennially, commencing age 40 versus 50; and (3) Compare with international findings. At the no-cost metropolitan program studied, women attended biennial screening, but were offered annual screening if regarded at elevated risk for breast cancer. The cumulative risk of at least one recall was estimated using discrete-time survival analysis. Cancer detection statistics were computed. In total, 801,636 mammograms were undertaken in 231,824 women. Over 10 years, cumulative risk of recall was 13.3 % (95 % CI 12.7-13.8) for those screened biennially, and 19.9 % (CI 16.6-23.2) for those screened annually from age 50-51. Cumulative risk of complex false positive involving a biopsy was 3.1 % (CI 2.9-3.4) and 5.0 % (CI 3.4-6.6), respectively. From age 40-41, the risk of recall was 15.1 % (CI 14.3-16.0) and 22.5 % (CI 17.9-27.1) for biennial and annual screening, respectively. Corresponding rates of complex false positive were 3.3 % (CI 2.9-3.8) and 6.3 % (CI 3.4-9.1). Over 10 mammograms, invasive cancer was detected in 3.4 % (CI 3.3-3.5) and ductal carcinoma in situ in 0.7 % (CI 0.6-0.7) of women, with a non-significant trend toward a larger proportion of Tis and T1N0 cancers in women screened annually (74.5 %) versus biennially (70.1 %), χ (2) = 2.77, p = 0.10. Cancer detection was comparable to international findings. Recall risk was equal to European estimates for women screening from 50 and lower for screening from 40. Recall risk was half of United States' rates across start age and rescreening interval categories. Future benefit/harm balance sheets may be useful for communicating these findings to women.

Cumulative occupational mechanical exposures during working life and risk of sickness absence and disability pension

DEFF Research Database (Denmark)

Sundstrup, Emil; Hansen, Åse Marie; Mortensen, Erik Lykke

2017-01-01

-regression analyses estimated the relative risk of register-based long-term sickness absence (LTSA) and disability pension with cumulative occupational mechanical exposures throughout working life. Analyses were censored for competing events and adjusted for multiple confounders. Results: During the follow-up period......Objectives: The aim of this study was to determine the prospective association of cumulative mechanical exposure during working life with health-related labor market outcomes. Methods: This prospective cohort study combines data from 5076 older workers (age 49-63 years) from the Copenhagen Aging...... from a JEM for ton-years (lifting 1000 kg each day in one year), lifting-years (lifting loads weighing ≥20 kg >10 times each day in one year), kneeling-years (kneeling for one hour each day in one year) and vibration-years (whole-body vibration for one hour each day in one year). Cox...

Cumulative Risk and Adolescent's Internalizing and Externalizing Problems: The Mediating Roles of Maternal Responsiveness and Self-Regulation

Science.gov (United States)

Doan, Stacey N.; Fuller-Rowell, Thomas E.; Evans, Gary W.

2012-01-01

The purpose of the present study was to examine longitudinal associations among maternal responsiveness, self-regulation, and behavioral adjustment in adolescents. The authors used structural equation modeling to test a model that demonstrates that the effects of early cumulative risk on behavioral problems is mediated by maternal responsiveness…

Cumulative organic anion transporter-mediated drug-drug interaction potential of multiple components in salvia miltiorrhiza (danshen) preparations.

Science.gov (United States)

Wang, Li; Venitz, Jürgen; Sweet, Douglas H

2014-12-01

To evaluate organic anion transporter-mediated drug-drug interaction (DDI) potential for individual active components of Danshen (Salvia miltiorrhiza) vs. combinations using in vitro and in silico approaches. Inhibition profiles for single Danshen components and combinations were generated in stably-expressing human (h)OAT1 and hOAT3 cells. Plasma concentration-time profiles for compounds were estimated from in vivo human data using an i.v. two-compartment model (with first-order elimination). The cumulative DDI index was proposed as an indicator of DDI potential for combination products. This index was used to evaluate the DDI potential for Danshen injectables from 16 different manufacturers and 14 different lots from a single manufacturer. The cumulative DDI index predicted in vivo inhibition potentials, 82% (hOAT1) and 74% (hOAT3), comparable with those observed in vitro, 72 ± 7% (hOAT1) and 81 ± 10% (hOAT3), for Danshen component combinations. Using simulated unbound Cmax values, a wide range in cumulative DDI index between manufacturers, and between lots, was predicted. Many products exhibited a cumulative DDI index > 1 (50% inhibition). Danshen injectables will likely exhibit strong potential to inhibit hOAT1 and hOAT3 function in vivo. The proposed cumulative DDI index might improve prediction of DDI potential of herbal medicines or pharmaceutical preparations containing multiple components.

Consumption of fruits and vegetables and probabilistic assessment of the cumulative acute exposure to organophosphorus and carbamate pesticides of schoolchildren in Slovenia.

Science.gov (United States)

Blaznik, Urška; Yngve, Agneta; Eržen, Ivan; Hlastan Ribič, Cirila

2016-02-01

Adequate consumption of fruits and vegetables is a part of recommendations for a healthy diet. The aim of the present study was to assess acute cumulative dietary exposure to organophosphorus and carbamate pesticides via fruit and vegetable consumption by the population of schoolchildren aged 11-12 years and the level of risk for their health. Cumulative probabilistic risk assessment methodology with the index compound approach was applied. Slovenia, primary schools. Schoolchildren (n 1145) from thirty-one primary schools in Slovenia. Children were part of the PRO GREENS study 2009/10 which assessed 11-year-olds' consumption of fruit and vegetables in ten European countries. The cumulative acute exposure amounted to 8.3 (95% CI 7.7, 10.6) % of the acute reference dose (ARfD) for acephate as index compound (100 µg/kg body weight per d) at the 99.9th percentile for daily intake and to 4.5 (95% CI 3.5, 4.7) % of the ARfD at the 99.9th percentile for intakes during school time and at lunch. Apples, bananas, oranges and lettuce contributed most to the total acute pesticides intake. The estimations showed that acute dietary exposure to organophosphorus and carbamate pesticides is not a health concern for schoolchildren with the assessed dietary patterns of fruit and vegetable consumption.

Aumann and Serrano’s economic index of risk for sums of gambles

Directory of Open Access Journals (Sweden)

Minqiang Li

2014-12-01

Full Text Available We study Aumann and Serrano’s (2008 risk index for sums of gambles that are not dependent. If the dependent parts are similarly ordered, then the risk index of the sum is always larger than the minimum of the risk indices of the two gambles. For negative dependence, the risk index of the sum is always smaller than the maximum. The above results agree with our intuitions of risk diversification well. These result points out another attractive property of Aumann and Serrano’s risk index. These properties are potentially useful for risk assessment purposes of financial securities.

Low Birth Weight, Cumulative Obesity Dose, and the Risk of Incident Type 2 Diabetes

OpenAIRE

Feng, Cindy; Osgood, Nathaniel D.; Dyck, Roland F.

2018-01-01

Background. Obesity history may provide a better understanding of the contribution of obesity to T2DM risk. Methods. 17,634 participants from the 1958 National Child Development Study were followed from birth to 50 years. Cumulative obesity dose, a measure of obesity history, was calculated by subtracting the upper cut-off of the normal BMI from the actual BMI at each follow-up and summing the areas under the obesity dose curve. Hazard ratios (HRs) for diabetes were calculated using Cox regre...

A framework for cumulative risk assessment in the 21st century.

Science.gov (United States)

Moretto, Angelo; Bachman, Ammie; Boobis, Alan; Solomon, Keith R; Pastoor, Timothy P; Wilks, Martin F; Embry, Michelle R

2017-02-01

The ILSI Health and Environmental Sciences Institute (HESI) has developed a framework to support a transition in the way in which information for chemical risk assessment is obtained and used (RISK21). The approach is based on detailed problem formulation, where exposure drives the data acquisition process in order to enable informed decision-making on human health safety as soon as sufficient evidence is available. Information is evaluated in a transparent and consistent way with the aim of optimizing available resources. In the context of risk assessment, cumulative risk assessment (CRA) poses additional problems and questions that can be addressed using the RISK21 approach. The focus in CRA to date has generally been on chemicals that have common mechanisms of action. Recently, concern has also been expressed about chemicals acting on multiple pathways that lead to a common health outcome, and non-chemical other conditions (non-chemical stressors) that can lead to or modify a common outcome. Acknowledging that CRAs, as described above, are more conceptually, methodologically and computationally complex than traditional single-stressor risk assessments, RISK21 further developed the framework for implementation of workable processes and procedures for conducting assessments of combined effects from exposure to multiple chemicals and non-chemical stressors. As part of the problem formulation process, this evidence-based framework allows the identification of the circumstances in which it is appropriate to conduct a CRA for a group of compounds. A tiered approach is then proposed, where additional chemical stressors and/or non-chemical modulating factors (ModFs) are considered sequentially. Criteria are provided to facilitate the decision on whether or not to include ModFs in the formal quantitative assessment, with the intention to help focus the use of available resources to have the greatest potential to protect public health.

Cumulative Environmental Impacts: Science and Policy to Protect Communities.

Science.gov (United States)

Solomon, Gina M; Morello-Frosch, Rachel; Zeise, Lauren; Faust, John B

2016-01-01

Many communities are located near multiple sources of pollution, including current and former industrial sites, major roadways, and agricultural operations. Populations in such locations are predominantly low-income, with a large percentage of minorities and non-English speakers. These communities face challenges that can affect the health of their residents, including limited access to health care, a shortage of grocery stores, poor housing quality, and a lack of parks and open spaces. Environmental exposures may interact with social stressors, thereby worsening health outcomes. Age, genetic characteristics, and preexisting health conditions increase the risk of adverse health effects from exposure to pollutants. There are existing approaches for characterizing cumulative exposures, cumulative risks, and cumulative health impacts. Although such approaches have merit, they also have significant constraints. New developments in exposure monitoring, mapping, toxicology, and epidemiology, especially when informed by community participation, have the potential to advance the science on cumulative impacts and to improve decision making.

Sleep duration and cancer risk: time to use a "sleep-years" index?

Science.gov (United States)

Erren, Thomas C

2012-09-01

With a focus on melatonin, a recent paper in the Journal investigated the hypothesis that endometrial cancer might be associated with the duration, and ultimately, amount of sleep. The authors found that "[s]elf-reported sleep duration may not adequately represent melatonin levels." The authors also concluded that there was "weak evidence of an association between sleep duration and endometrial cancer risk." Overall, these are interesting observations because primarily experimental and mechanistic research from many angles supports the study's notion that inappropriate sleep may be a determinant of cancer risk. To find out whether this is so in man, rather than assigning study individuals to fixed or average "baseline sleep categories" i.e., ≤5, 6, 7, 8, ≥9 h of habitual sleep in the present study, the accumulated amount of sleep over decades should be reconstructed in retrospective or constructed in prospective studies. To achieve this end, future epidemiological studies may want to use a sleep-years index [SYI]. This simple exposure parameter promises to be a sensible, feasible, and affordable way to approximate cumulative time spent at sleep in critical time windows over many years which we should expect to be relevant for the development of cancer. The SYI could be tested and used in observational studies which promise to be comparable and can be merged. This commentary provides roots of the index and explains why and how it should be used and how it could be interpreted in rigorous studies of biologically plausible links between sleep, on the one hand, and the development of internal cancers, on the other. This commentary also points out limitations of interpreting the SYI. It is emphasized that, where possible, the SYI should be assessed independently of (a) other sleep facets--such as quality--and of (b) known or suspected cancer risk factors. The respective contribution of (a) and (b) to risk must then be assessed during the analyses. Overall, the

The Risk Premia Embedded in Index Options

DEFF Research Database (Denmark)

Andersen, Torben Gustav; Fusari, Nicola; Todorov, Viktor

We study the dynamic relation between market risks and risk premia using time series of index option surfaces. We find that priced left tail risk cannot be spanned by market volatility (and its components) and introduce a new tail factor. This tail factor has no incremental predictive power...... for future volatility and jump risks, beyond current and past volatility, but it critical in predicting future market equity and variance risk premia. Our findings suggest a wide wedge between the dynamics of market risks and their compensation, with the latter typically displaying a far more persistent...

The Risk Premia Embedded in Index Options

DEFF Research Database (Denmark)

Andersen, Torben Gustav; Fusari, Nicola; Todorov, Viktor

We study the dynamic relation between market risks and risk premia using time series of index option surfaces. We find that priced left tail risk cannot be spanned by market volatility (and its components) and introduce a new tail factor. This tail factor has no incremental predictive power...... for future volatility and jump risks, beyond current and past volatility, but is critical in predicting future market equity and variance risk premia. Our findings suggest a wide wedge between the dynamics of market risks and their compensation, with the latter typically displaying a far more persistent...

A cumulative risk factor model for early identification of academic difficulties in premature and low birth weight infants.

Science.gov (United States)

Roberts, G; Bellinger, D; McCormick, M C

2007-03-01

Premature and low birth weight children have a high prevalence of academic difficulties. This study examines a model comprised of cumulative risk factors that allows early identification of these difficulties. This is a secondary analysis of data from a large cohort of premature (mathematics. Potential predictor variables were categorized into 4 domains: sociodemographic, neonatal, maternal mental health and early childhood (ages 3 and 5). Regression analysis was used to create a model to predict reading and mathematics scores. Variables from all domains were significant in the model, predicting low achievement scores in reading (R (2) of 0.49, model p-value mathematics (R (2) of 0.44, model p-value intelligence, visual-motor skill and higher behavioral disturbance scores (early childhood). Lower mathematics scores were predicted by lower maternal education, income and age and Black or Hispanic race (sociodemographic); lower birth weight and higher head circumference (neonatal); lower maternal responsivity (maternal mental health); lower intelligence, visual-motor skill and higher behavioral disturbance scores (early childhood). Sequential early childhood risk factors in premature and LBW children lead to a cumulative risk for academic difficulties and can be used for early identification.

Body mass index influences prostate cancer risk at biopsy in Japanese men.

Science.gov (United States)

Masuda, Hitoshi; Kagawa, Makoto; Kawakami, Satoru; Numao, Noboru; Matsuoka, Yoh; Yokoyama, Minato; Yamamoto, Shinya; Yonese, Junji; Fukui, Iwao; Kihara, Kazunori

2013-07-01

To determine the relationship between body mass index and prostate cancer risk at biopsy in Japanese men, and to compared the risk with that of Caucasian men. We retrospectively evaluated 3966 men with prostate-specific antigen levels from 2.5 to 19.9 ng/mL who underwent an initial extended prostate biopsy. Using logistic regression, odds ratios of each body mass index category for risk of prostate cancer and high-grade disease (Gleason score ≥4 + 3) were estimated after controlling for age, prostate-specific antigen, %free prostate-specific antigen, prostate volume, digital rectal examination findings, family history of prostate cancer and the number of biopsy cores. Patients were divided into six categories according to their body mass index (kg/m(2) ) as follows: body mass index and prostate cancer risk at biopsy, with an increased risk observed in men whose body mass index was ≥27.0 compared with the reference group. A significantly increased risk starting at body mass index ≥25.0 was found in high-grade disease. In contrast to our results, there has been no reported increase in the risk of prostate cancer at biopsy in Caucasians within the overweight range (body mass index of 25.0-29.9 based on World Health Organization classification). Japanese men within the overweight body mass index range who have an elevated prostate-specific antigen level also have a significant risk of harboring prostate cancer, especially high-grade disease. Overweight Japanese might be at greater prostate cancer risk at biopsy than overweight Caucasians. © 2012 The Japanese Urological Association.

Cumulative Effect of Depression on Dementia Risk

OpenAIRE

Olazarán, J.; Trincado, R.; Bermejo-Pareja, F.

2013-01-01

Objective. To analyze a potential cumulative effect of life-time depression on dementia and Alzheimer's disease (AD), with control of vascular factors (VFs). Methods. This study was a subanalysis of the Neurological Disorders in Central Spain (NEDICES) study. Past and present depression, VFs, dementia status, and dementia due to AD were documented at study inception. Dementia status was also documented after three years. Four groups were created according to baseline data: never depression (n...

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

Science.gov (United States)

Ruco, Arlinda; Stock, David; Hilsden, Robert J; McGregor, S Elizabeth; Paszat, Lawrence F; Saskin, Refik; Rabeneck, Linda

2015-01-01

A clinical risk index that uses distal colorectal findings at flexible sigmoidoscopy (FS) in conjunction with easily determined risk factors for advanced proximal neoplasia (APN) may be useful for tailoring or prioritizing screening with colonoscopy. To conduct an external evaluation of a previously published risk index in a large, well-characterized cohort. Cross-sectional. Teaching hospital and colorectal cancer screening center. A total of 5139 asymptomatic persons aged 50 to 74 (54.9% women) with a mean age (±SD) of 58.3 (±6.2) years. Between 2003 and 2011, all participants underwent a complete screening colonoscopy and removal of all polyps. Participants were classified as low, intermediate, or high risk for APN, based on their composite risk index scores. The concordance or c-statistic was used to measure discriminating ability of the risk index. A total of 167 persons (3.2%) had APN. The prevalence of those with APN among low-, intermediate-, and high-risk categories was 2.1%, 2.9%, and 6.5%, respectively. High-risk individuals were 3.2 times more likely to have APN compared with those in the low-risk category. The index did not discriminate well between those in the low- and intermediate-risk categories. The c-statistic for the overall index was 0.62 (95% confidence interval, 0.58-0.66). Distal colorectal findings were derived from colonoscopies and not FS itself. The risk index discriminated between those at low risk and those at high risk, but it had limited ability to discriminate between low- and intermediate-risk categories for prevalent APN. Information on other risk factors may be needed to tailor, or prioritize, access to screening colonoscopy. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

An index of harm for comparing occupational risks

International Nuclear Information System (INIS)

Schaaf, E.; Hennig, J.; Schnadt, H.; Becker, G.

1986-03-01

An index of harm is presented describing the health hazards of persons occupationally exposed to ionizing radiation, for comparison with occupational risks in conventional working areas. The criterion for evaluating injuries is the remaining lifetime affected by chronic damage. The affected years of life themselves are evaluated in a scheme considering the degree of reduced ability to work. The index of harm is based on an evaluation of a data pool collected by all F.R.G. associations for social insurance against occupational accidents, which recorded all data of first compensation for accidents. The index can be taken into consideration for assessment of risks emanating from ionizing radiation, and for evaluating the radiation protection currently provided by maximum permissible limits, etc. (DG) [de

The Cumulative Effect of Gene-Gene and Gene-Environment Interactions on the Risk of Prostate Cancer in Chinese Men

Directory of Open Access Journals (Sweden)

Ming Liu

2016-01-01

Full Text Available Prostate cancer (PCa is a multifactorial disease involving complex genetic and environmental factors interactions. Gene-gene and gene-environment interactions associated with PCa in Chinese men are less studied. We explored the association between 36 SNPs and PCa in 574 subjects from northern China. Body mass index (BMI, smoking, and alcohol consumption were determined through self-administered questionnaires in 134 PCa patients. Then gene-gene and gene-environment interactions among the PCa-associated SNPs were analyzed using the generalized multifactor dimensionality reduction (GMDR and logistic regression methods. Allelic and genotypic association analyses showed that six variants were associated with PCa and the cumulative effect suggested men who carried any combination of 1, 2, or ≥3 risk genotypes had a gradually increased PCa risk (odds ratios (ORs = 1.79–4.41. GMDR analysis identified the best gene-gene interaction model with scores of 10 for both the cross-validation consistency and sign tests. For gene-environment interactions, rs6983561 CC and rs16901966 GG in individuals with a BMI ≥ 28 had ORs of 7.66 (p = 0.032 and 5.33 (p = 0.046, respectively. rs7679673 CC + CA and rs12653946 TT in individuals that smoked had ORs of 2.77 (p = 0.007 and 3.11 (p = 0.024, respectively. rs7679673 CC in individuals that consumed alcohol had an OR of 4.37 (p = 0.041. These results suggest that polymorphisms, either individually or by interacting with other genes or environmental factors, contribute to an increased risk of PCa.

Vector-borne disease risk indexes in spatially structured populations.

Directory of Open Access Journals (Sweden)

Jorge Velázquez-Castro

2018-02-01

Full Text Available There are economic and physical limitations when applying prevention and control strategies for urban vector borne diseases. Consequently, there are increasing concerns and interest in designing efficient strategies and regulations that health agencies can follow in order to reduce the imminent impact of viruses like Dengue, Zika and Chikungunya. That includes fumigation, abatization, reducing the hatcheries, picking up trash, information campaigns. A basic question that arise when designing control strategies is about which and where these ones should focus. In other words, one would like to know whether preventing the contagion or decrease vector population, and in which area of the city, is more efficient. In this work, we propose risk indexes based on the idea of secondary cases from patch to patch. Thus, they take into account human mobility and indicate which patch has more chance to be a corridor for the spread of the disease and which is more vulnerable, i.e. more likely to have cases?. They can also indicate the neighborhood where hatchery control will reduce more the number of potential cases. In order to illustrate the usefulness of these indexes, we run a set of numerical simulations in a mathematical model that takes into account the urban mobility and the differences in population density among the areas of a city. If we label by i a particular neighborhood, the transmission risk index (TRi measures the potential secondary cases caused by a host in that neighborhood. The vector transmission risk index (VTRi measures the potential secondary cases caused by a vector. Finally, the vulnerability risk index (VRi measures the potential secondary cases in the neighborhood. Transmission indexes can be used to give geographical priority to some neighborhoods when applying prevention and control measures. On the other hand, the vulnerability index can be useful to implement monitoring campaigns or public health investment.

Cumulative risk on the oxytocin receptor gene (OXTR) underpins empathic communication difficulties at the first stages of romantic love.

Science.gov (United States)

Schneiderman, Inna; Kanat-Maymon, Yaniv; Ebstein, Richard P; Feldman, Ruth

2014-10-01

Empathic communication between couples plays an important role in relationship quality and individual well-being and research has pointed to the role of oxytocin in providing the neurobiological substrate for pair-bonding and empathy. Here, we examined links between genetic variability on the oxytocin receptor gene (OXTR) and empathic behaviour at the initiation of romantic love. Allelic variations on five OXTR single nucleotide polymorphisms (SNPs) previously associated with susceptibility to disorders of social functioning were genotyped in 120 new lovers: OXTRrs13316193, rs2254298, rs1042778, rs2268494 and rs2268490. Cumulative genetic risk was computed by summing risk alleles on each SNP. Couples were observed in support-giving interaction and behaviour was coded for empathic communication, including affective congruence, maintaining focus on partner, acknowledging partner's distress, reciprocal exchange and non-verbal empathy. Hierarchical linear modelling indicated that individuals with high OXTR risk exhibited difficulties in empathic communication. OXTR risk predicted empathic difficulties above and beyond the couple level, relationship duration, and anxiety and depressive symptoms. Findings underscore the involvement of oxytocin in empathic behaviour during the early stages of social affiliation, and suggest the utility of cumulative risk and plasticity indices on the OXTR as potential biomarkers for research on disorders of social dysfunction and the neurobiology of empathy. © The Author (2013). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

Vulnerability Risk Index Profile for Elder Abuse in Community-Dwelling Population

Science.gov (United States)

Dong, XinQi; Simon, Melissa A.

2013-01-01

Objectives Elder abuse is associated with increased morbidity and mortality. This study aims to develop a vulnerability index for elder abuse in a community-dwelling population. Design Population-based study Setting Geographically defined community in Chicago. Participants A population-based study was conducted in Chicago of community-dwelling older adults who participated in the Chicago Health and Aging Project (CHAP). Of the 8,157 participants in the CHAP study, 213 participants were reported to social services agency for suspected elder abuse. Measurements A vulnerability index for elder abuse was constructed from sociodemographic, health-related, and psychosocial factors. The outcomes of interest were reported and confirmed elder abuse. Logistic regression models were used to determine the accuracy of the index with respect to elder abuse outcomes. Results Out of the selected risk index for elder abuse, every one point increase in the 9 item vulnerability index items, there was a two fold increase in the risk for reported elder abuse (OR, 2.19 (2.00–2.40) and confirmed elder abuse (OR, 2.19 (1.94–2.47). Compared to the reference group, older adults with 3–4 vulnerability index items had increased risk for reported elder abuse (OR, 2.98 (1.98–4.49) and confirmed elder abuse (OR, 3.90, (2.07–7.36); and older adults with 5 or more risk index items, there was an 18 fold increase in risk for reported elder abuse (OR, 18.46 (12.15–28.04) and confirmed elder abuse (OR, 26.79 (14.18–50.61). Receiver Operating Characteristic (ROC) statistically derived curves for identifying reported elder abuse ranged between 0.77–0.84 and for predicting confirmed elder abuse ranged between 0.79–0.86. Conclusion The vulnerability risk index demonstrates value for identifying individuals at risk for elder abuse. Additional studies are needed to validate this index in other community dwelling populations. PMID:25180376

Maintenance hemodialysis patients have high cumulative radiation exposure.

LENUS (Irish Health Repository)

Kinsella, Sinead M

2010-10-01

Hemodialysis is associated with an increased risk of neoplasms which may result, at least in part, from exposure to ionizing radiation associated with frequent radiographic procedures. In order to estimate the average radiation exposure of those on hemodialysis, we conducted a retrospective study of 100 patients in a university-based dialysis unit followed for a median of 3.4 years. The number and type of radiological procedures were obtained from a central radiology database, and the cumulative effective radiation dose was calculated using standardized, procedure-specific radiation levels. The median annual radiation dose was 6.9 millisieverts (mSv) per patient-year. However, 14 patients had an annual cumulative effective radiation dose over 20 mSv, the upper averaged annual limit for occupational exposure. The median total cumulative effective radiation dose per patient over the study period was 21.7 mSv, in which 13 patients had a total cumulative effective radiation dose over 75 mSv, a value reported to be associated with a 7% increased risk of cancer-related mortality. Two-thirds of the total cumulative effective radiation dose was due to CT scanning. The average radiation exposure was significantly associated with the cause of end-stage renal disease, history of ischemic heart disease, transplant waitlist status, number of in-patient hospital days over follow-up, and death during the study period. These results highlight the substantial exposure to ionizing radiation in hemodialysis patients.

Identification of cardiometabolic risk: visceral adiposity index versus triglyceride/HDL cholesterol ratio.

Science.gov (United States)

Salazar, Martin R; Carbajal, Horacio A; Espeche, Walter G; Aizpurúa, Marcelo; Maciel, Pablo M; Reaven, Gerald M

2014-02-01

The plasma concentration ratio of triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) can identify cardiometabolic risk and cardiovascular disease. The visceral adiposity index is a sex-specific index, in which measurements of body mass index and waist circumference are combined with TG and HDL-C concentrations. The current analysis was initiated to see if the visceral adiposity index would improve the ability of the TG/HDL-C to identify increased cardiometabolic risk and outcome. Cardiometabolic data were obtained in 2003 from 926 apparently healthy individuals, 796 of whom were evaluated in 2012 for evidence of incident cardiovascular disease. The relationship between TG/HDL-C and values for visceral adiposity index was evaluated by Pearson's correlation coefficient. The relative risks for first cardiovascular event between individuals above and below the TG/HDL-C sex-specific cut points, and in the top quartile of visceral adiposity index versus the remaining 3 quartiles, were estimated using Cox proportional hazard models. TG/HDL-C concentration and visceral adiposity index were highly correlated (r = 0.99) in both men and women. Although more men (133 vs121) and women (73 vs 59) were identified as being at "high risk" by an elevated TG/HDL-C ratio, the individual cardiometabolic risk factors were essentially identical with either index used. However, the hazard ratio of developing cardiovascular disease was significantly increased in individuals with an elevated TG/HDL-C, whereas it was not the case when the visceral adiposity index was used to define "high risk." The visceral adiposity index does not identify individuals with an adverse cardiometabolic profile any better than the TG/HDL-C. Copyright © 2014 Elsevier Inc. All rights reserved.

Evaluating Pharmacokinetic and Pharmacodynamic Interactions with Computational Models in Supporting Cumulative Risk Assessment

Science.gov (United States)

Tan, Yu-Mei; Clewell, Harvey; Campbell, Jerry; Andersen, Melvin

2011-01-01

Simultaneous or sequential exposure to multiple chemicals may cause interactions in the pharmacokinetics (PK) and/or pharmacodynamics (PD) of the individual chemicals. Such interactions can cause modification of the internal or target dose/response of one chemical in the mixture by other chemical(s), resulting in a change in the toxicity from that predicted from the summation of the effects of the single chemicals using dose additivity. In such cases, conducting quantitative cumulative risk assessment for chemicals present as a mixture is difficult. The uncertainties that arise from PK interactions can be addressed by developing physiologically based pharmacokinetic (PBPK) models to describe the disposition of chemical mixtures. Further, PK models can be developed to describe mechanisms of action and tissue responses. In this article, PBPK/PD modeling efforts conducted to investigate chemical interactions at the PK and PD levels are reviewed to demonstrate the use of this predictive modeling framework in assessing health risks associated with exposures to complex chemical mixtures. PMID:21655141

Cumulative Prospect Theory, Option Returns, and the Variance Premium

NARCIS (Netherlands)

Baele, Lieven; Driessen, Joost; Ebert, Sebastian; Londono Yarce, J.M.; Spalt, Oliver

The variance premium and the pricing of out-of-the-money (OTM) equity index options are major challenges to standard asset pricing models. We develop a tractable equilibrium model with Cumulative Prospect Theory (CPT) preferences that can overcome both challenges. The key insight is that the

Re-conceptualising prenatal life stressors in predicting post-partum depression: cumulative-, specific-, and domain-specific approaches to calculating risk.

Science.gov (United States)

Liu, Cindy H; Tronick, Ed

2013-09-01

Prenatal life stress predicts post-partum depression (PPD); however, studies generally examine individual stressors (a specific approach) or the summation of such exposure (a cumulative approach) and their associations with PPD. Such approaches may oversimplify prenatal life stress as a risk factor for PPD. We evaluated approaches in assessing prenatal life stress as a predictor of PPD diagnosis, including a domain-specific approach that captures cumulative life stress while accounting for stress across different life stress domains: financial, relational, and physical health. The Pregnancy Risk Assessment Monitoring System, a population-based survey, was used to analyse the association of prenatal life stressors with PPD diagnoses among 3566 New York City post-partum women. Specific stressors were not associated with PPD diagnosis after controlling for sociodemographic variables. Exposure to a greater number of stressors was associated with PPD diagnosis, even after adjusting for both sociodemographic variables and specific stressors [odds ratio (OR) = 3.1, 95% confidence interval (CI) = 1.5, 6.7]. Individuals reporting a moderate-to-high number of financial problems along with a moderate-to-high number of physical problems were at greater odds of PPD (OR = 4.2, 95% CI = 1.2, 15.3); those with a moderate-to-high number of problems in all three domains were at over fivefold increased odds of PPD (OR = 5.5, CI = 1.1, 28.5). In assessing prenatal stress, clinicians should consider the extent to which stressors occur across different life domains; this association appears stronger with PPD diagnosis than simple assessments of individual stressors, which typically overestimate risk or cumulative exposures. © 2013 John Wiley & Sons Ltd.

The effect of financial ratios on systematic risk index

Directory of Open Access Journals (Sweden)

Ali Faez

2013-11-01

Full Text Available This paper investigates the relationship between financial ratios and indicator of systemic risk in the Tehran Stock Exchange. The study selects 73 manufacturing companies of the Tehran Stock Exchange market over the period 2003-2010. The study first calculates the independent variables in the form of financial ratios and then the ratios affecting the systematic risk index are extracted using entropy method. The output of this stage is the introduction of five influential financial indicators as the independent variables of the study. Using t-test and Pearson correlation coefficient the rate of independent variables effect on the systematic risk index is evaluated and finally, using stepwise regression method, the effect of independent variables on the dependent variable is examined. According to results of our survey, the correlation coefficient of such indices as “the ratio of stock price to the profit of each share”, “Current ratio”, “each share profit ratio” and “the stockholders rights return ratio” have respectively the highest correlation with the systematic risk index.

Changes in geriatric nutritional risk index and risk of major adverse cardiac and cerebrovascular events in incident peritoneal dialysis patients

Directory of Open Access Journals (Sweden)

Mi Jung Lee

2017-12-01

Full Text Available Background: Geriatric nutritional risk index (GNRI is a validated nutritional assessment method, and lower GNRI values are closely associated with adverse clinical outcomes in dialysis patients. This study investigated the impact of changes in GNRI during the first year of dialysis on cardiovascular outcomes in incident peritoneal dialysis (PD patients. Methods: We reviewed medical records in 133 incident PD patients to determine GNRI at the start of PD and after 12 months. Patients were categorized into improved (delta GNRI > 0 and worsening/stationary (delta GNRI ≤ 0 groups. The primary outcome was major adverse cardiac and cerebrovascular events (MACCEs. Results: During a mean follow-up of 51.1 months, the primary outcome was observed in 42 patients (31.6%. The baseline GNRI at PD initiation was not significantly associated with MACCEs (log-rank test, P = 0.40. However, the cumulative event-free rate was significantly lower in the worsening or stationary GNRI group than in the improved group (log-rank test, P = 0.004. Multivariate Cox analysis revealed that a worsening or stationary GNRI was independently associated with higher risk for MACCEs (hazard ratio, 2.47; 95% confidence interval, 1.15–5.29; P = 0.02. In subgroup analysis, patients with worsening or stationary GNRI were at significantly greater risk for MACCEs in both the lower (P = 0.04 and higher (P = 0.01 baseline GNRI groups. Conclusion: Baseline GNRI was not associated with MACCEs, but patients with deteriorating or stationary nutritional status were at significantly greater risk for MACCEs, suggesting that serial monitoring of nutritional status is important to stratify cardiovascular risk in incident PD patients.

Development of a preliminary risk index to identify trauma patients at risk for an unplanned intubation.

Science.gov (United States)

Kim, Dennis; Kobayashi, Leslie; Chang, David; Fortlage, Dale; Coimbra, Raul

2014-01-01

The development of respiratory failure requiring an emergent unplanned intubation (UI) is a potentially preventable complication associated with increased morbidity and mortality. The objective of this study was to develop a clinical risk index for UI based on readily available clinical data to assist in the identification of trauma patients at risk for this complication. We also sought to determine the impact of UI on patient outcomes. This is a 3-year retrospective analysis of our Level 1 trauma center registry to identify all patients requiring a UI. Patients who required a UI were compared with patients who were never intubated. An additive risk index consisting of 10 clinical variables was created using the final significant variables from a stepwise logistic regression model. The sensitivity and specificity of every possible index score were calculated and added together to calculate the "gain in certainty" values. During the 3-year period, 7,552 patients were admitted, of whom 967 (12.8%) required intubation. Of these, 55 (5.7%) underwent a UI. The final risk index consisted of 10 variables as follows: age 55 years to 64 years, age 65 years or older, male sex, Glasgow Coma Scale (GCS) score of 9 to 13, seizures, chronic obstructive pulmonary disease, traumatic brain injury, four or more rib fractures, spine fractures, and long-bone fractures. Gain in certainty was maximized at an index score of 4, with the highest combined sensitivity and specificity of 86.0% and 74.9%, respectively. The probability of UI increased from 0.9% at a score of 1 to 2.9% at 4 and 43% at 9. UI was associated with increased overall complications, length of stay, and mortality (p the development of an additive risk index. Prospective validation of the risk index is potentially warranted. Diagnostic study, level III.

Cumulative Socioeconomic Status Risk, Allostatic Load, and Adjustment: A Prospective Latent Profile Analysis with Contextual and Genetic Protective Factors

Science.gov (United States)

Brody, Gene H.; Yu, Tianyi; Chen, Yi-Fu; Kogan, Steven M.; Evans, Gary W.; Beach, Steven R. H.; Windle, Michael; Simons, Ronald L.; Gerrard, Meg; Gibbons, Frederick X.; Philibert, Robert A.

2013-01-01

The health disparities literature has identified a common pattern among middle-aged African Americans that includes high rates of chronic disease along with low rates of psychiatric disorders despite exposure to high levels of cumulative socioeconomic status (SES) risk. The current study was designed to test hypotheses about the developmental…

Long-term cumulative depressive symptom burden and risk of cognitive decline and dementia among very old women.

Science.gov (United States)

Zeki Al Hazzouri, Adina; Vittinghoff, Eric; Byers, Amy; Covinsky, Ken; Blazer, Dan; Diem, Susan; Ensrud, Kristine E; Yaffe, Kristine

2014-05-01

Depressive symptoms and cognitive outcomes are strongly interrelated. Despite that rates of depressive symptoms fluctuate during late life, little is known about the impact of long-term cumulative depressive symptom burden on cognitive decline and dementia in older adults. This study examines the association of nearly 20 years of cumulative depressive symptoms with cognitive outcomes in a cohort of older women. We assessed depressive symptoms in 7,240 women using the Geriatric Depression scale (GDS) at serial visits. We used a Poisson model with random slopes to estimate GDS trajectories for each participant from baseline to death or end of follow-up, and then characterized depressive symptom burden by quartile of the area under the curve. We assessed cognitive outcomes using repeated measures of the Mini-Mental State Examination (MMSE) and Trails B score over 20 years, Year-20 neuropsychological test battery, and adjudicated dementia and mild cognitive impairment (MCI). Adjusting for potential confounders, compared with women in the lowest quartile of cumulative depressive symptoms burden, women in the highest quartile had 21% more MMSE errors over time (95% CI = 17%, 26%), 20% worse Trails B score over time (95% CI = 17%, 23%), worse scores on most of the Year-20 cognitive tests, and a twofold greater likelihood of developing dementia or MCI (95% CI = 1.48, 3.11). Long-term cumulative depressive symptom burden was associated with cognitive decline and risk of dementia or MCI. Older adults with a history of depression should be closely monitored for recurrent episodes or unresolved depressive symptoms as well as any cognitive deficits.

Waist-to-height ratio as index of cardiometabolic risk among the doctors

Directory of Open Access Journals (Sweden)

Miliva Mozaffor

2017-12-01

Full Text Available The aim of this study was to see the cardiometabolic risk among doctors using waist-to-height ratio index as tool. Cardiometabolic risk is an umbrella term that includes all the risk factors of diabetes and cardiovascular disease. The study was conducted among 195 doctors. According to waist-to-height ratio index 167 (85.6% doctors had cardiometabolic risk. Waist-to-height ratio index was found good (area under the curve >0.5, sensitivity 88.1%, specificity 23.2%, positive predictive value 53.9%, and negative predictive value 66.7% for their predictive value of cardiometabolic risk. Age grouping was done and found that no age group was free from cardiometabolic risk.

Cumulative effective dose and cancer risk for pediatric population in repetitive full spine follow-up imaging: How micro dose is the EOS microdose protocol?

Science.gov (United States)

Law, Martin; Ma, Wang-Kei; Lau, Damian; Cheung, Kenneth; Ip, Janice; Yip, Lawrance; Lam, Wendy

2018-04-01

To evaluate and to obtain analytic formulation for the calculation of the effective dose and associated cancer risk using the EOS microdose protocol for scoliotic pediatric patients undergoing full spine imaging at different age of exposure; to demonstrate the microdose protocol capable of delivering lesser radiation dose and hence of further reducing cancer risk induction when compared with the EOS low dose protocol; to obtain cumulative effective dose and cancer risk for both genders scoliotic pediatrics of US and Hong Kong population using the microdose protocol. Organ absorbed doses of full spine exposed scoliotic pediatric patients have been simulated with the use of EOS microdose protocol imaging parameters input to the Monte Carlo software PCXMC. Gender and age specific effective dose has been calculated with the simulated organ absorbed dose using the ICRP-103 approach. The associated radiation induced cancer risk, expressed as lifetime attributable risk (LAR), has been estimated according to the method introduced in the Biological Effects of Ionizing Radiation VII report. Values of LAR have been estimated for scoliotic patients exposed repetitively during their follow up period at different age for US and Hong Kong population. The effective doses of full spine imaging with simultaneous posteroanterior and lateral projection for patients exposed at the age between 5 and 18 years using the EOS microdose protocol have been calculated within the range of 2.54-14.75 μSv. The corresponding LAR for US and Hong Kong population was ranged between 0.04 × 10 -6 and 0.84 × 10 -6 . Cumulative effective dose and cancer risk during follow-up period can be estimated using the results and are of information to patients and their parents. With the use of computer simulation and analytic formulation, we obtained the cumulative effective dose and cancer risk at any age of exposure for pediatric patients of US and Hong Kong population undergoing repetitive

Childhood body mass index and multiple sclerosis risk

DEFF Research Database (Denmark)

Munger, Kassandra L; Bentzen, Joan; Laursen, Bjarne

2013-01-01

BACKGROUND: Obesity in late adolescence has been associated with an increased risk of multiple sclerosis (MS); however, it is not known if body size in childhood is associated with MS risk. METHODS: Using a prospective design we examined whether body mass index (BMI) at ages 7-13 years...

Consideration of the FQPA Safety Factor and Other Uncertainty Factors in Cumulative Risk Assessment of Chemicals Sharing a Common Mechanism of Toxicity

Science.gov (United States)

This guidance document provides OPP's current thinking on application of the provision in FFDCA about an additional safety factor for the protection of infants and children in the context of cumulative risk assessments.

Applicability of the tissue stem cell turnover concept on the validity of cumulative dose based radiation risk evaluation

International Nuclear Information System (INIS)

Otsuka, Kensuke; Hamada, Nobuyuki; Iwasaki, Toshiyasu; Yoshida, Kazuo

2011-01-01

The radiation protection system adopts the linear no-threshold model to achieve proper radiation protection for considering cancer risks resulting from radiation exposure. This model uses cumulative dose to a tissue for risk evaluation in which cumulative dose is related to the amount of DNA damage and consequential induction of gene mutation. In this concept, gene mutation accumulates in tissue stem cells, the putative target of carcinogenesis, with total dose given to the tissue. Unlike high-dose-rate exposure, epidemiological studies in high radiation background areas, such as Kerala in India, revealed that cancer risks is not elevated by the dose to the inhabitants, suggesting that there exists some mechanisms to eliminate the damage/mutation in the exposed tissue under extremely low-dose-rate exposure situations. In this report, the dynamics of tissue stem cell turnover is evaluated as a possible mechanism under extremely low-dose-rate exposure situations. To this end, we reviewed recent literatures studying tissue stem cell turnover, and found that great advances in stem cell research have made it possible to trace a fate of stem cells in tissues. Furthermore, turnover of tissue stem cells is found to occur after irradiation, due to competition of stem cells within tissues. This raises a possibility that radiation effects may not accumulate in a tissue depending on the dose-rate and duration of exposure period. (author)

Cumulative radiation exposure in children with cystic fibrosis.

LENUS (Irish Health Repository)

O'Reilly, R

2010-02-01

This retrospective study calculated the cumulative radiation dose for children with cystic fibrosis (CF) attending a tertiary CF centre. Information on 77 children with a mean age of 9.5 years, a follow up time of 658 person years and 1757 studies including 1485 chest radiographs, 215 abdominal radiographs and 57 computed tomography (CT) scans, of which 51 were thoracic CT scans, were analysed. The average cumulative radiation dose was 6.2 (0.04-25) mSv per CF patient. Cumulative radiation dose increased with increasing age and number of CT scans and was greater in children who presented with meconium ileus. No correlation was identified between cumulative radiation dose and either lung function or patient microbiology cultures. Radiation carries a risk of malignancy and children are particularly susceptible. Every effort must be made to avoid unnecessary radiation exposure in these patients whose life expectancy is increasing.

A multi-attribute Systemic Risk Index for comparing and prioritizing chemical industrial areas

International Nuclear Information System (INIS)

Reniers, G.L.L.; Sörensen, K.; Dullaert, W.

2012-01-01

Measures taken to decrease interdependent risks within chemical industrial areas should be based on quantitative data from a holistic (cluster-based) point of view. Therefore, this paper examines the typology of networks representing industrial areas to formulate recommendations to more effectively protect a chemical cluster against existing systemic risks. Chemical industrial areas are modeled as two distinct complex networks and are prioritized by computing two sub-indices with respect to existing systemic safety and security risks (using Domino Danger Units) and supply chain risks (using units from an ordinal expert scale). Subsequently, a Systemic Risk Index for the industrial area is determined employing the Borda algorithm, whereby the systemic risk index considers both a safety and security network risk index and a supply chain network risk index. The developed method allows decreasing systemic risks within chemical industrial areas from a holistic (inter-organizational and/or inter-cluster) perspective. An illustrative example is given.

Failure-To-Thrive, Maltreatment and the Behavior and Development of 6-Year-Old Children from Low-Income, Urban Families: A Cumulative Risk Model.

Science.gov (United States)

Kerr, Mia A.; Black, Maureen M.; Krishnakumar, Ambika

2000-01-01

A cumulative risk model was used to examine the relationship among failure-to-thrive (FIT), maltreatment, and four aspects of children's development (cognitive performance, adaptive functioning at school, classroom behavior, and behavior at home) in 193 6-year-olds. Risk status was negatively associated with the four developmental outcomes.…

[Association between fat mass index and fat-free mass index values and cardiovascular risk in adolescents].

Science.gov (United States)

de Oliveira, Patrícia Morais; da Silva, Fabiana Almeida; Souza Oliveira, Renata Maria; Mendes, Larissa Loures; Netto, Michele Pereira; Cândido, Ana Paula Carlos

2016-01-01

To describe the association between fat mass index and fat-free mass index values and factors associated with cardiovascular risk in adolescents in the city of Juiz de Fora, Minas Gerais. Cross-sectional study with 403 adolescents aged 10-14 years, from public and private schools. Anthropometric, clinical, biochemical measurements were obtained, as well as self-reported time spent performing physical exercises, sedentary activities and sexual maturation stage. Regarding the nutritional status; 66.5% of the adolescents had normal weight; 19.9% were overweight and 10.2% were obese. For both genders, the fat mass index was higher in adolescents that had high serum triglycerides, body mass index and waist circumference. Adolescents that had anthropometric, clinical and biochemical characteristics considered to be of risk for the development of cardiovascular disease had higher values of fat mass index. Different methodologies for the assessment of body composition make health promotion and disease prevention more effective. Copyright © 2015 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

Added sugars and sugar-sweetened beverage consumption, dietary carbohydrate index and depression risk in the Seguimiento Universidad de Navarra (SUN) Project.

Science.gov (United States)

Sanchez-Villegas, Almudena; Zazpe, Itziar; Santiago, Susana; Perez-Cornago, Aurora; Martinez-Gonzalez, Miguel A; Lahortiga-Ramos, Francisca

2018-01-01

The association between added sugars or sugar-sweetened beverage consumption and the risk of depression, as well as the role of carbohydrate quality in depression risk, remains unclear. Among 15 546 Spanish university graduates from the Seguimiento Universidad de Navarra (SUN) prospective cohort study, diet was assessed with a validated 136-item semi-quantitative FFQ at baseline and at 10-year follow-up. Cumulative average consumption of added sugars, sweetened drinks and an overall carbohydrate quality index (CQI) were calculated. A better CQI was associated with higher whole-grain consumption and fibre intake and lower glycaemic index and consumption of solid (instead of liquid) carbohydrates. Clinical diagnoses of depression during follow-up were classified as incident cases. Multivariable time-dependent Cox regression models were used to estimate hazard ratios (HR) of depression according to consumption of added sugars, sweetened drinks and CQI. We observed 769 incident cases of depression. Participants in the highest quartile of added sugars consumption showed a significant increment in the risk of depression (HR=1·35; 95 % CI 1·09, 1·67, P=0·034), whereas those in the highest quartile of CQI (upper quartile of the CQI) showed a relative risk reduction of 30 % compared with those in the lowest quartile of the CQI (HR=0·70; 95 % CI 0·56, 0·88). No significant association between sugar-sweetened beverage consumption and depression risk was found. Higher added sugars and lower quality of carbohydrate consumption were associated with depression risk in the SUN Cohort. Further studies are necessary to confirm the reported results.

Changes in corneal endothelial cell density and the cumulative risk of corneal decompensation after Ahmed glaucoma valve implantation.

Science.gov (United States)

Kim, Kyoung Nam; Lee, Sung Bok; Lee, Yeon Hee; Lee, Jong Joo; Lim, Hyung Bin; Kim, Chang-Sik

2016-07-01

To evaluate changes in the corneal endothelial cell density (ECD) and corneal decompensation following Ahmed glaucoma valve (AGV) implantation. This study was retrospective and observational case series. Patients with refractory glaucoma who underwent AGV implantation and were followed >5 years were consecutively enrolled. We reviewed the medical records, including the results of central corneal specular microscopy. Of the 127 enrolled patients, the annual change in ECD (%) was determined using linear regression for 72 eyes evaluated at least four times using serial specular microscopic examination and compared with 31 control eyes (fellow glaucomatous eyes under medical treatment). The main outcome measures were cumulative risk of corneal decompensation and differences in the ECD loss rates between subjects and controls. The mean follow-up after AGV implantation was 43.1 months. There were no cases of postoperative tube-corneal touch. The cumulative risk of corneal decompensation was 3.3%, 5 years after AGV implantation. There was a more rapid loss of ECD in the 72 subject eyes compared with the 31 controls (-7.0% and -0.1%/year, respectively; p<0.001). However, the rate of loss decreased over time and statistical significance compared with control eyes disappeared after 2 years postoperatively: -10.7% from baseline to 1 year (p<0.01), -7.0% from 1 year to 2 years (p=0.037), -4.2% from 2 years to 3 years (p=0.230) and -2.7% from 3 years to the final follow-up (p=0.111). In case of uncomplicated AGV implantation, the cumulative risk of corneal decompensation was 3.3%, 5 years after the operation. The ECD loss was statistically greater in eyes with AGV than in control eyes without AGV, but the difference was significant only up to 2 years post surgery. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Modeling of Ship Collision Risk Index Based on Complex Plane and Its Realization

OpenAIRE

Xiaoqin Xu; Xiaoqiao Geng; Yuanqiao Wen

2016-01-01

Ship collision risk index is the basic and important concept in the domain of ship collision avoidance. In this paper, the advantages and deficiencies of the various calculation methods of ship collision risk index are pointed out. Then the ship collision risk model based on complex plane, which can well make up for the deficiencies of the widely-used evaluation model proposed by Kearon.J and Liu ruru is proposed. On this basis, the calculation method of collision risk index under the encount...

Cumulative socioeconomic status risk, allostatic load, and adjustment: a prospective latent profile analysis with contextual and genetic protective factors.

Science.gov (United States)

Brody, Gene H; Yu, Tianyi; Chen, Yi-fu; Kogan, Steven M; Evans, Gary W; Beach, Steven R H; Windle, Michael; Simons, Ronald L; Gerrard, Meg; Gibbons, Frederick X; Philibert, Robert A

2013-05-01

The health disparities literature has identified a common pattern among middle-aged African Americans that includes high rates of chronic disease along with low rates of psychiatric disorders despite exposure to high levels of cumulative socioeconomic status (SES) risk. The current study was designed to test hypotheses about the developmental precursors to this pattern. Hypotheses were tested with a representative sample of 443 African American youths living in the rural South. Cumulative SES risk and protective processes were assessed at ages 11-13 years; psychological adjustment was assessed at ages 14-18 years; genotyping at the 5-HTTLPR was conducted at age 16 years; and allostatic load (AL) was assessed at age 19 years. A latent profile analysis identified 5 profiles that evinced distinct patterns of SES risk, AL, and psychological adjustment, with 2 relatively large profiles designated as focal profiles: a physical health vulnerability profile characterized by high SES risk/high AL/low adjustment problems, and a resilient profile characterized by high SES risk/low AL/low adjustment problems. The physical health vulnerability profile mirrored the pattern found in the adult health disparities literature. Multinomial logistic regression analyses indicated that carrying an s allele at the 5-HTTLPR and receiving less peer support distinguished the physical health vulnerability profile from the resilient profile. Protective parenting and planful self-regulation distinguished both focal profiles from the other 3 profiles. The results suggest the public health importance of preventive interventions that enhance coping and reduce the effects of stress across childhood and adolescence.

Body mass index, waist circumference, body adiposity index, and risk for type 2 diabetes in two populations in Brazil: general and Amerindian.

Directory of Open Access Journals (Sweden)

Rafael de Oliveira Alvim

Full Text Available The use of the anthropometric indices of adiposity, especially body mass index and waist circumference in the prediction of diabetes mellitus has been widely explored. Recently, a new body composition index, the body adiposity index was proposed. The aim of this study was to compare the effectiveness of body mass index, waist circumference, and body adiposity index in the risk assessment for type 2 diabetes mellitus.A total of 1,572 individuals from the general population of Vitoria City, Brazil and 620 Amerindians from the Aracruz Indian Reserve, Brazil were randomly selected. BMI, waist circumference, and BAI were determined according to a standard protocol. Type 2 diabetes mellitus was diagnosed by the presence of fasting glucose ≥126 mg/dL or by the use of antidiabetic drugs.The area under the curve was similar for all anthropometric indices tested in the Amerindian population, but with very different sensitivities or specificities. In women from the general population, the area under the curve of waist circumference was significantly higher than that of the body adiposity index. Regarding risk assessment for type 2 diabetes mellitus, the body adiposity index was a better risk predictor than body mass index and waist circumference in the Amerindian population and was the index with highest odds ratio for type 2 diabetes mellitus in men from the general population, while in women from the general population waist circumference was the best risk predictor.Body adiposity index was the best risk predictor for type 2 diabetes mellitus in the Amerindian population and men from the general population. Our data suggest that the body adiposity index is a useful tool for the risk assessment of type 2 diabetes mellitus in admixture populations.

Advanced Atherogenic Index for the Assessment of Consolidated Lipid Risk in Premature Coronary Artery Disease Patients in India.

Science.gov (United States)

Bansal, Sanjiv Kumar; Agarwal, Sarita; Daga, Mridul Kumar

2016-01-01

The high prevalence, severity, and prematurity of coronary artery disease (CAD) in the Indian population cannot be completely explained by the conventional lipid parameters and the existing lipid indices. To calculate newly defined advanced atherogenic index (AAI) in premature CAD patients and compare it between cases and controls and Correlate its values with the existing indices. One hundred and twenty premature CAD patients and an equal number of age and sex matched healthy individuals were included in this study. Lipid profile and nonconventional lipid parameters like oxidized Low density lipoprotein (OX LDL), small dense LDL (SD LDL), lipoprotein (a) apolipoprotein B (Apo B), and apolipoprotein A1 (Apo A1) were estimated and their values were used to define AAI and existing lipid indices like AI, lipid tetrad index (LTI) and lipid pentad index (LPI). The mean age of cases and controls was 37.29 + 4.50 and 36.13 + 3.53 years, respectively. The value of AAI was highly significant in cases (3461.22 ± 45.20) as compared to controls (305.84 ± 21.80). AAI has shown better statistical significance and correlation (P statistic and cumulative distribution function plot has shown that AAI can discriminate cases and controls more accurately as compared to the earlier indices. Statistically AAI appears to be a better marker of consolidated lipid risk in premature CAD patients as compared to the earlier indices.

Modeling of Ship Collision Risk Index Based on Complex Plane and Its Realization

Directory of Open Access Journals (Sweden)

Xiaoqin Xu

2016-07-01

Full Text Available Ship collision risk index is the basic and important concept in the domain of ship collision avoidance. In this paper, the advantages and deficiencies of the various calculation methods of ship collision risk index are pointed out. Then the ship collision risk model based on complex plane, which can well make up for the deficiencies of the widely-used evaluation model proposed by Kearon.J and Liu ruru is proposed. On this basis, the calculation method of collision risk index under the encountering situation of multi-ships is constructed, then the three-dimensional image and spatial curve of the risk index are figured out. Finally, single chip microcomputer is used to realize the model. And attaching this single chip microcomputer to ARPA is helpful to the decision-making of the marine navigators.

A new index of risks for lethal diseases by ionizing radiation

International Nuclear Information System (INIS)

Sato, Fumiaki; Higuti, Isao.

1979-01-01

Estimates of the somatic risk of radiation exposure have mainly been based on the incidence of fatal cancers. An improvement on the estimates of the risk will be made by taking mean ages at deaths into consideration in addition to the incidence of cancer. The authors report on an index of contribution of each cause of death to life shortening. The index is the sum of three terms. The first term indicates a contribution of change in incidence and the second term indicates that of changes in mean age at death from the cause of death in question. The last term is an interaction term of the two factors mentioned above. If a radiation exposure increases incidence of a cause of death and shortens the mean age at death from the cause of death, the index gives a large positive value. On the other hand, an increase in incidence of a late occurring cause of death will bring about a small positive or sometimes negative value for the index. The index proposed here will be promising in estimating risks by ionizing radiation. (author)

A partner-related risk behavior index to identify people at elevated risk for sexually transmitted infections.

Science.gov (United States)

Crosby, Richard; Shrier, Lydia A

2013-04-01

The purpose of this study was to develop and test a sexual-partner-related risk behavior index to identify high-risk individuals most likely to have a sexually transmitted infection (STI). Patients from five STI and adolescent medical clinics in three US cities were recruited (N = 928; M age = 29.2 years). Data were collected using audio-computer-assisted self-interviewing. Of seven sexual-partner-related variables, those that were significantly associated with the outcomes were combined into a partner-related risk behavior index. The dependent variables were laboratory-confirmed infection with Chlamydia trachomatis, Neisseria gonorrhoeae, and/or Trichomonas vaginalis. Nearly one-fifth of the sample (169/928; 18.4%) tested positive for an STI. Three of the seven items were significantly associated with having one or more STIs: sex with a newly released prisoner, sex with a person known or suspected of having an STI, and sexual concurrency. In combined form, this three-item index was significantly associated with STI prevalence (p one or more of three STIs. This index could be used to prioritize and guide intensified clinic-based counseling for high-risk patients of STI and other clinics.

Genetically Predicted Body Mass Index and Breast Cancer Risk

DEFF Research Database (Denmark)

Guo, Yan; Warren Andersen, Shaneda; Shu, Xiao-Ou

2016-01-01

BACKGROUND: Observational epidemiological studies have shown that high body mass index (BMI) is associated with a reduced risk of breast cancer in premenopausal women but an increased risk in postmenopausal women. It is unclear whether this association is mediated through shared genetic or enviro...

Radiation risk index for pediatric CT. A patient-derived metric

International Nuclear Information System (INIS)

Samei, Ehsan; Tian, Xiaoyu; Paul Segars, W.; Frush, Donald P.

2017-01-01

There is a benefit in characterizing radiation-induced cancer risk in pediatric chest and abdominopelvic CT: a singular metric that represents the whole-body radiation burden while also accounting for age, gender and organ sensitivity. To compute an index of radiation risk for pediatric chest and abdominopelvic CT. Using a protocol approved by our institutional review board, 42 pediatric patients (age: 0-16 years, weight: 2-80 kg) were modeled into virtual whole-body anatomical models. Organ doses were estimated for clinical chest and abdominopelvic CT examinations of the patients using validated Monte Carlo simulations of two major scanner models. Using age-, size- and gender-specific organ risk coefficients, the values were converted to normalized effective dose (by dose length product) (denoted as the k factor) and a normalized risk index (denoted as the q factor). An analysis was performed to determine how these factors are correlated with patient age and size for both males and females to provide a strategy to better characterize individualized risk. The k factor was found to be exponentially correlated with the average patient diameter. For both genders, the q factor also exhibited an exponential relationship with both the average patient diameter and with patient age. For both factors, the differences between the scanner models were less than 8%. The study defines a whole-body radiation risk index for chest and abdominopelvic CT imaging, that incorporates individual estimated organ dose values, organ radiation sensitivity, patient size, exposure age and patient gender. This indexing metrology enables the assessment and potential improvement of chest and abdominopelvic CT performance through surveillance of practice dose profiles across patients and may afford improved informed communication. (orig.)

Radiation risk index for pediatric CT. A patient-derived metric

Energy Technology Data Exchange (ETDEWEB)

Samei, Ehsan [Duke University Medical Center, Department of Radiology, Carl E. Ravin Advanced Imaging Laboratories, Durham, NC (United States); Duke University Medical Center, Department of Biomedical Engineering, Electrical and Computer Engineering, Durham, NC (United States); Duke University Medical Center, Medical Physics Graduate Program, Durham, NC (United States); Tian, Xiaoyu [Duke University Medical Center, Department of Radiology, Carl E. Ravin Advanced Imaging Laboratories, Durham, NC (United States); Paul Segars, W. [Duke University Medical Center, Department of Radiology, Carl E. Ravin Advanced Imaging Laboratories, Durham, NC (United States); Duke University Medical Center, Medical Physics Graduate Program, Durham, NC (United States); Frush, Donald P. [Duke University Medical Center, Medical Physics Graduate Program, Durham, NC (United States); Duke University Medical Center, Division of Pediatric Radiology, Department of Radiology, Durham, NC (United States)

2017-12-15

There is a benefit in characterizing radiation-induced cancer risk in pediatric chest and abdominopelvic CT: a singular metric that represents the whole-body radiation burden while also accounting for age, gender and organ sensitivity. To compute an index of radiation risk for pediatric chest and abdominopelvic CT. Using a protocol approved by our institutional review board, 42 pediatric patients (age: 0-16 years, weight: 2-80 kg) were modeled into virtual whole-body anatomical models. Organ doses were estimated for clinical chest and abdominopelvic CT examinations of the patients using validated Monte Carlo simulations of two major scanner models. Using age-, size- and gender-specific organ risk coefficients, the values were converted to normalized effective dose (by dose length product) (denoted as the k factor) and a normalized risk index (denoted as the q factor). An analysis was performed to determine how these factors are correlated with patient age and size for both males and females to provide a strategy to better characterize individualized risk. The k factor was found to be exponentially correlated with the average patient diameter. For both genders, the q factor also exhibited an exponential relationship with both the average patient diameter and with patient age. For both factors, the differences between the scanner models were less than 8%. The study defines a whole-body radiation risk index for chest and abdominopelvic CT imaging, that incorporates individual estimated organ dose values, organ radiation sensitivity, patient size, exposure age and patient gender. This indexing metrology enables the assessment and potential improvement of chest and abdominopelvic CT performance through surveillance of practice dose profiles across patients and may afford improved informed communication. (orig.)

An inflammation-based cumulative prognostic score system in patients with diffuse large B cell lymphoma in rituximab era.

Science.gov (United States)

Sun, Feifei; Zhu, Jia; Lu, Suying; Zhen, Zijun; Wang, Juan; Huang, Junting; Ding, Zonghui; Zeng, Musheng; Sun, Xiaofei

2018-01-02

Systemic inflammatory parameters are associated with poor outcomes in malignant patients. Several inflammation-based cumulative prognostic score systems were established for various solid tumors. However, there is few inflammation based cumulative prognostic score system for patients with diffuse large B cell lymphoma (DLBCL). We retrospectively reviewed 564 adult DLBCL patients who had received rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP) therapy between Nov 1 2006 and Dec 30 2013 and assessed the prognostic significance of six systemic inflammatory parameters evaluated in previous studies by univariate and multivariate analysis:C-reactive protein(CRP), albumin levels, the lymphocyte-monocyte ratio (LMR), the neutrophil-lymphocyte ratio(NLR), the platelet-lymphocyte ratio(PLR)and fibrinogen levels. Multivariate analysis identified CRP, albumin levels and the LMR are three independent prognostic parameters for overall survival (OS). Based on these three factors, we constructed a novel inflammation-based cumulative prognostic score (ICPS) system. Four risk groups were formed: group ICPS = 0, ICPS = 1, ICPS = 2 and ICPS = 3. Advanced multivariate analysis indicated that the ICPS model is a prognostic score system independent of International Prognostic Index (IPI) for both progression-free survival (PFS) (p systemic inflammatory status was associated with clinical outcomes of patients with DLBCL in rituximab era. The ICPS model was shown to classify risk groups more accurately than any single inflammatory prognostic parameters. These findings may be useful for identifying candidates for further inflammation-related mechanism research or novel anti-inflammation target therapies.

An Axiomatization of Cumulative Prospect Theory for Decision under Risk

NARCIS (Netherlands)

Wakker, P.P.; Chateauneuf, A.

1999-01-01

Cumulative prospect theory was introduced by Tversky and Kahneman so as to combine the empirical realism of their original prospect theory with the theoretical advantages of Quiggin's rank-dependent utility. Preference axiomatizations were provided in several papers. All those axiomatizations,

Development of a brief parent-report risk index for children following parental divorce.

Science.gov (United States)

Tein, Jenn-Yun; Sandler, Irwin N; Braver, Sanford L; Wolchik, Sharlene A

2013-12-01

This article reports on the development of a brief 15-item parent-report risk index (Child Risk Index for Divorced or Separated Families; CRI-DS) to predict problem outcomes of children who have experienced parental divorce. A series of analyses using 3 data sets were conducted that identified and cross-validated a parsimonious set of items representing parent report of child behavior problems and family level risk and protective factors, each of which contributed to the predictive accuracy of the index. The index predicted child behavior outcomes and substance abuse problems up to 6 years later. The index has acceptable levels of sensitivity and specificity as a screening measure to predict problem outcomes up to 1 year later. The use of the index to identify the need for preventive services is discussed, along with limitations of the study.

Dysglycemia and Index60 as Prediagnostic End Points for Type 1 Diabetes Prevention Trials.

Science.gov (United States)

Nathan, Brandon M; Boulware, David; Geyer, Susan; Atkinson, Mark A; Colman, Peter; Goland, Robin; Russell, William; Wentworth, John M; Wilson, Darrell M; Evans-Molina, Carmella; Wherrett, Diane; Skyler, Jay S; Moran, Antoinette; Sosenko, Jay M

2017-11-01

We assessed dysglycemia and a T1D Diagnostic Index60 (Index60) ≥1.00 (on the basis of fasting C-peptide, 60-min glucose, and 60-min C-peptide levels) as prediagnostic end points for type 1 diabetes among Type 1 Diabetes TrialNet Pathway to Prevention Study participants. Two cohorts were analyzed: 1 ) baseline normoglycemic oral glucose tolerance tests (OGTTs) with an incident dysglycemic OGTT and 2 ) baseline Index60 <1.00 OGTTs with an incident Index60 ≥1.00 OGTT. Incident dysglycemic OGTTs were divided into those with (DYS/IND+) and without (DYS/IND-) concomitant Index60 ≥1.00. Incident Index60 ≥1.00 OGTTs were divided into those with (IND/DYS+) and without (IND/DYS-) concomitant dysglycemia. The cumulative incidence for type 1 diabetes was greater after IND/DYS- than after DYS/IND- ( P < 0.01). Within the normoglycemic cohort, the cumulative incidence of type 1 diabetes was higher after DYS/IND+ than after DYS/IND- ( P < 0.001), whereas within the Index60 <1.00 cohort, the cumulative incidence after IND/DYS+ and after IND/DYS- did not differ significantly. Among nonprogressors, type 1 diabetes risk at the last OGTT was greater for IND/DYS- than for DYS/IND- ( P < 0.001). Hazard ratios (HRs) of DYS/IND- with age and 30- to 0-min C-peptide were positive ( P < 0.001 for both), whereas HRs of type 1 diabetes with these variables were inverse ( P < 0.001 for both). In contrast, HRs of IND/DYS- and type 1 diabetes with age and 30- to 0-min C-peptide were consistent (all inverse [ P < 0.01 for all]). The findings suggest that incident dysglycemia without Index60 ≥1.00 is a suboptimal prediagnostic end point for type 1 diabetes. Measures that include both glucose and C-peptide levels, such as Index60 ≥1.00, appear better suited as prediagnostic end points. © 2017 by the American Diabetes Association.

Visceral adiposity index as an indicator of cardiometabolic risk in patients treated for craniopharyngioma.

Science.gov (United States)

Ferraù, Francesco; Spagnolo, Federica; Cotta, Oana Ruxandra; Cannavò, Laura; Alibrandi, Angela; Russo, Giuseppina Tiziana; Aversa, Tommaso; Trimarchi, Francesco; Cannavò, Salvatore

2017-11-01

Craniopharyngioma is associated with metabolic alterations leading to increased cardiovascular mortality. Recently, the visceral adiposity index has been proposed as a marker of visceral adipose tissue dysfunction and of the related cardiometabolic risk. The role of the visceral adiposity index has never been explored in craniopharyngioma patients. We assessed the cardiometabolic risk on the basis of the visceral adiposity index in craniopharyngioma patients. We evaluated data of 24 patients treated for craniopharyngioma in a single-centre. We investigated the relationship among patients' clinical and biochemical features, cardiovascular risk -assessed by the Framingham and the atherosclerotic cardiovascular disease risk scores-, visceral adiposity index and adipose tissue dysfunction severity. Increased visceral adiposity index was found in 8 patients (33%). Adipose tissue dysfunction resulted to be severe, moderate or mild in 5, 2 and 1 cases. Increased visceral adiposity index significantly correlated with the occurrence of metabolic syndrome (p 0.027), IRI (p 0.001), triglycerides (p < 0.001), HOMA-IR (p < 0.001) and with lower ISI-Matsuda (p 0.005) and HDL-cholesterol (p < 0.001). Higher degree of adipose tissue dysfunction associated with increased insulin resistance. No gender difference was found for visceral adiposity index, adipose tissue dysfunction severity, and cardiovascular risk scores. Patients with adulthood onset craniopharyngioma showed higher Framingham risk score (p 0.004), atherosclerotic cardiovascular disease 10-year (p < 0.001) and lifetime (p 0.018) risk scores than those with childhood onset disease. Visceral adiposity index is increased in one third of our patients with craniopharyngioma, even if metabolic syndrome does not occur. Increased visceral adiposity index and adipose tissue dysfunction severity correlate with insulin sensitivity parameters, do not correlate with Framingham or atherosclerotic cardiovascular

Dynamic prediction of cumulative incidence functions by direct binomial regression.

Science.gov (United States)

Grand, Mia K; de Witte, Theo J M; Putter, Hein

2018-03-25

In recent years there have been a series of advances in the field of dynamic prediction. Among those is the development of methods for dynamic prediction of the cumulative incidence function in a competing risk setting. These models enable the predictions to be updated as time progresses and more information becomes available, for example when a patient comes back for a follow-up visit after completing a year of treatment, the risk of death, and adverse events may have changed since treatment initiation. One approach to model the cumulative incidence function in competing risks is by direct binomial regression, where right censoring of the event times is handled by inverse probability of censoring weights. We extend the approach by combining it with landmarking to enable dynamic prediction of the cumulative incidence function. The proposed models are very flexible, as they allow the covariates to have complex time-varying effects, and we illustrate how to investigate possible time-varying structures using Wald tests. The models are fitted using generalized estimating equations. The method is applied to bone marrow transplant data and the performance is investigated in a simulation study. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Pollution potential leaching index as a tool to assess water leaching risk of arsenic in excavated urban soils.

Science.gov (United States)

Li, Jining; Kosugi, Tomoya; Riya, Shohei; Hashimoto, Yohey; Hou, Hong; Terada, Akihiko; Hosomi, Masaaki

2018-01-01

Leaching of hazardous trace elements from excavated urban soils during construction of cities has received considerable attention in recent years in Japan. A new concept, the pollution potential leaching index (PPLI), was applied to assess the risk of arsenic (As) leaching from excavated soils. Sequential leaching tests (SLT) with two liquid-to-solid (L/S) ratios (10 and 20Lkg -1 ) were conducted to determine the PPLI values, which represent the critical cumulative L/S ratios at which the average As concentrations in the cumulative leachates are reduced to critical values (10 or 5µgL -1 ). Two models (a logarithmic function model and an empirical two-site first-order leaching model) were compared to estimate the PPLI values. The fractionations of As before and after SLT were extracted according to a five-step sequential extraction procedure. Ten alkaline excavated soils were obtained from different construction projects in Japan. Although their total As contents were low (from 6.75 to 79.4mgkg -1 ), the As leaching was not negligible. Different L/S ratios at each step of the SLT had little influence on the cumulative As release or PPLI values. Experimentally determined PPLI values were in agreement with those from model estimations. A five-step SLT with an L/S of 10Lkg -1 at each step, combined with a logarithmic function fitting was suggested for the easy estimation of PPLI. Results of the sequential extraction procedure showed that large portions of more labile As fractions (non-specifically and specifically sorbed fractions) were removed during long-term leaching and so were small, but non-negligible, portions of strongly bound As fractions. Copyright © 2017 Elsevier Inc. All rights reserved.

A case study to illustrate the utility of the Aggregate Exposure Pathway and Adverse Outcome Pathway frameworks for integrating human health and ecological data into cumulative risk assessment

Science.gov (United States)

Cumulative risk assessment (CRA) methods, which evaluate the risk of multiple adverse outcomes (AOs) from multiple chemicals, promote the use of a conceptual site model (CSM) to integrate risk from relevant stressors. The Adverse Outcome Pathway (AOP) framework can inform these r...

An Integrated Cumulative Transformation and Feature Fusion Approach for Bearing Degradation Prognostics

Directory of Open Access Journals (Sweden)

Lixiang Duan

2018-01-01

Full Text Available Aimed at degradation prognostics of a rolling bearing, this paper proposed a novel cumulative transformation algorithm for data processing and a feature fusion technique for bearing degradation assessment. First, a cumulative transformation is presented to map the original features extracted from a vibration signal to their respective cumulative forms. The technique not only makes the extracted features show a monotonic trend but also reduces the fluctuation; such properties are more propitious to reflect the bearing degradation trend. Then, a new degradation index system is constructed, which fuses multidimensional cumulative features by kernel principal component analysis (KPCA. Finally, an extreme learning machine model based on phase space reconstruction is proposed to predict the degradation trend. The model performance is experimentally validated with a whole-life experiment of a rolling bearing. The results prove that the proposed method reflects the bearing degradation process clearly and achieves a good balance between model accuracy and complexity.

University building safety index measurement using risk and implementation matrix

Science.gov (United States)

Rahman, A.; Arumsari, F.; Maryani, A.

2018-04-01

Many high rise building constructed in several universities in Indonesia. The high-rise building management must provide the safety planning and proper safety equipment in each part of the building. Unfortunately, most of the university in Indonesia have not been applying safety policy yet and less awareness on treating safety facilities. Several fire accidents in university showed that some significant risk should be managed by the building management. This research developed a framework for measuring the high rise building safety index in university The framework is not only assessed the risk magnitude but also designed modular building safety checklist for measuring the safety implementation level. The safety checklist has been developed for 8 types of the university rooms, i.e.: office, classroom, 4 type of laboratories, canteen, and library. University building safety index determined using risk-implementation matrix by measuring the risk magnitude and assessing the safety implementation level. Building Safety Index measurement has been applied in 4 high rise buildings in ITS Campus. The building assessment showed that the rectorate building in secure condition and chemical department building in beware condition. While the library and administration center building was in less secure condition.

Contextual Risk, Maternal Negative Emotionality, and the Negative Emotion Dysregulation of Preschool Children from Economically Disadvantaged Families

Science.gov (United States)

Brown, Eleanor D.; Ackerman, Brian P.

2011-01-01

Research Findings: This study examined relations between contextual risk, maternal negative emotionality, and preschool teacher reports of the negative emotion dysregulation of children from economically disadvantaged families. Contextual risk was represented by cumulative indexes of family and neighborhood adversity. The results showed a direct…

Potential Risk Estimation Drowning Index for Children (PREDIC): a pilot study from Matlab, Bangladesh.

Science.gov (United States)

Borse, N N; Hyder, A A; Bishai, D; Baker, T; Arifeen, S E

2011-11-01

Childhood drowning is a major public health problem that has been neglected in many low- and middle-income countries. In Matlab, rural Bangladesh, more than 40% of child deaths aged 1-4 years are due to drowning. The main objective of this paper was to develop and evaluate a childhood drowning risk prediction index. A literature review was carried out to document risk factors identified for childhood drowning in Bangladesh. The Newacheck model for special health care needs for children was adapted and applied to construct a childhood drowning risk index called "Potential Risk Estimation Drowning Index for Children" (PREDIC). Finally, the proposed PREDIC Index was applied to childhood drowning deaths and compared with the comparison group from children living in Matlab, Bangladesh. This pilot study used t-tests and Receiver Operating Characteristic (ROC) curve to analyze the results. The PREDIC index was applied to 302 drowning deaths and 624 children 0-4 years old living in Matlab. The results of t-test indicate that the drowned children had a statistically (t=-8.58, p=0.0001) significant higher mean PREDIC score (6.01) than those in comparison group (5.26). Drowning cases had a PREDIC score of 6 or more for 68% of the children however, the comparison group had 43% of the children with score of 6 or more which was statistically significant (t=-7.36, p<0.001). The area under the curve for the Receiver Operating Characteristic curve was 0.662. Index score construction was scientifically plausible; and the index is relatively complete, fairly accurate, and practical. The risk index can help identify and target high risk children with drowning prevention programs. PREDIC index needs to be further tested for its accuracy, feasibility and effectiveness in drowning risk reduction in Bangladesh and other countries. Copyright © 2011 Elsevier Ltd. All rights reserved.

Examining cumulative victimization, community violence exposure, and stigma as contributors to PTSD symptoms among high-risk young women.

Science.gov (United States)

Kennedy, Angie C; Bybee, Deborah; Greeson, Megan R

2014-05-01

This study examines patterns of lifetime victimization within the family, community violence exposure, and stigma as contributors to posttraumatic stress disorder (PTSD) symptoms within a sample of 198 high-risk young women who are pregnant or parenting. We used cluster analysis to identify 5 profiles of cumulative victimization, based on participants' levels of witnessing intimate partner violence (IPV), physical abuse by an adult caregiver, and sexual victimization, all beginning by age 12. Hierarchical regression was used to examine these 5 clusters (ranging from a High All Victimization cluster characterized by high levels of all 3 forms of violence, to a Low All Victimization cluster characterized by low levels of all 3 forms), along with community violence exposure and stigma, as predictors of PTSD symptoms. We found that 3 of the cumulative victimization clusters, in comparison with Low All Victimization, were significant predictors of PTSD symptoms, as was stigma, while community violence exposure was not a significant predictor. PsycINFO Database Record (c) 2014 APA, all rights reserved

Trends in one-year cumulative incidence of death between 2005 and 2013 among patients initiating antiretroviral therapy in Uganda.

Science.gov (United States)

Bebell, Lisa M; Siedner, Mark J; Musinguzi, Nicholas; Boum, Yap; Bwana, Bosco M; Muyindike, Winnie; Hunt, Peter W; Martin, Jeffrey N; Bangsberg, David R

2017-07-01

Recent ecological data demonstrate improving outcomes for HIV-infected people in sub-Saharan Africa. Recently, Uganda has experienced a resurgence in HIV incidence and prevalence, but trends in HIV-related deaths have not been well described. Data were collected through the Uganda AIDS Rural Treatment Outcomes (UARTO) Study, an observational longitudinal cohort of Ugandan adults initiating antiretroviral therapy (ART) between 2005 and 2013. We calculated cumulative incidence of death within one year of ART initiation, and fit Poisson models with robust variance estimators to estimate the effect enrollment period on one-year risk of death and loss to follow-up. Of 760 persons in UARTO who started ART, 30 deaths occurred within one year of ART initiation (cumulative incidence 3.9%, 95% confidence interval [CI] 2.7-5.6%). Risk of death was highest for those starting ART in 2005 (13.0%, 95% CI 6.0-24.0%), decreased in 2006-2007 to 4% (95% CI 2.0-6.0%), and did not change thereafter ( P = 0.61). These results were robust to adjustment for age, sex, CD4 cell count, viral load, asset wealth, baseline depression, and body mass index. Here, we demonstrate that one-year cumulative incidence of death was high just after free ART rollout, decreased the following year, and remained low thereafter. Once established, ART programs in President's Emergency Fund for AIDS Relief-supported countries can maintain high quality care.

Strategy for an assessment of cumulative ecological impacts

International Nuclear Information System (INIS)

Boucher, P.; Collins, J.; Nelsen, J.

1995-01-01

The US Department of Energy (DOE) has developed a strategy to conduct an assessment of the cumulative ecological impact of operations at the 300-square-mile Savannah River Site. This facility has over 400 identified waste units and contains several large watersheds. In addition to individual waste units, residual contamination must be evaluated in terms of its contribution to ecological risks at zonal and site-wide levels. DOE must be able to generate sufficient information to facilitate cleanup in the immediate future within the context of a site-wide ecological risk assessment that may not be completed for many years. The strategy superimposes a more global perspective on ecological assessments of individual waste units and provides strategic underpinnings for conducting individual screening-level and baseline risk assessments at the operable unit and zonal or watershed levels. It identifies ecological endpoints and risk assessment tools appropriate for each level of the risk assessment. In addition, it provides a clear mechanism for identifying clean sites through screening-level risk assessments and for elevating sites with residual contamination to the next level of assessment. Whereas screening-level and operable unit-level risk assessments relate directly to cleanup, zonal and site-wide assessments verity or confirm the overall effectiveness of remediation. The latter assessments must show, for example, whether multiple small areas with residual pesticide contamination that have minimal individual impact would pose a cumulative risk from bioaccumulation because they are within the habitat range of an ecological receptor

Turbulent times: effects of turbulence and violence exposure in adolescence on high school completion, health risk behavior, and mental health in young adulthood.

Science.gov (United States)

Boynton-Jarrett, Renée; Hair, Elizabeth; Zuckerman, Barry

2013-10-01

Turbulent social environments are associated with health and developmental risk, yet mechanisms have been understudied. Guided by a life course framework and stress theory, this study examined the association between turbulent life transitions (including frequent residential mobility, school transitions, family structure disruptions, and homelessness) and exposure to violence during adolescence and high school completion, mental health, and health risk behaviors in young adulthood. Participants (n = 4834) from the U.S. National Longitudinal Survey of Youth, 1997 cohort were followed prospectively from age 12-14 years for 10 years. We used structural equation models to investigate pathways between turbulence and cumulative exposure to violence (CEV), and high school completion, mental health, and health risk behaviors, while accounting for early life socio-demographics, family processes, and individual characteristics. Results indicated that turbulence index was associated with cumulative exposure to violence in adolescence. Both turbulence index and cumulative exposure to violence were positively associated with higher health risk behavior, poorer mental health, and inversely associated with high school completion. These findings highlight the importance of considering the cumulative impact of turbulent and adverse social environments when developing interventions to optimize health and developmental trajectory for adolescents transitioning into adulthood. Copyright © 2012 Elsevier Ltd. All rights reserved.

Probabilistic acute risk assessment of cumulative exposure to organophosphorus and carbamate pesticides from dietary vegetables and fruits in Shanghai populations.

Science.gov (United States)

Li, Fan; Yuan, Yaqun; Meng, Pai; Wu, Min; Li, Shuguang; Chen, Bo

2017-05-01

Organophosphorus pesticides (OPs) and carbamate pesticides (CPs) are among the most widely used pesticides in China, playing a major role in protecting agricultural commodities. In this study, we determined the cumulative acute exposure to OPs and CPs of Shanghai residents from vegetables and fruits (VFs). The food consumption data were obtained from the Shanghai Food Consumption Survey (SHFCS) of 2012-14 including a total of 1973 participants aged 2-90 years. The pesticide residue data were obtained from the Shanghai monitoring programme during 2008-11 with 34 organophosphates and 11 carbamates analysed in a total of 5335 samples of VFs. A probabilistic approach was performed as recommended by the EFSA, using the optimistic model with non-detects set as zero and with processing factors (PFs) being used and the pessimistic model with non-detects replaced by limit of detection (LOD) and without PFs. We used the relative potency factor (RPF) method to normalise the various pesticides to the index compound (IC) of methamidophos and chlorpyrifos separately. Only in the pessimistic model using methamidophos as the IC was there was small risk of exposure exceeding the ARfD (3 µg kg - 1 bw day - 1 ) in the populations of preschool children (0.029%), school-age children (0.022%) and adults (0.002%). There were no risk of exposure exceeding the ARfD of methamidophos in the optimistic model and of chlorpyrifos (100 µg kg - 1 bw day - 1 ) in both optimistic and pessimistic models in all three populations. Considering the Chinese habits of overwhelmingly eating processed food (vegetables being cooked, and fruits being washed or peeled), we conclude that little acute risk was found for the exposure to VF-sourced OPs and CPs in Shanghai.

Fuzzy set theory for cumulative trauma prediction

OpenAIRE

Fonseca, Daniel J.; Merritt, Thomas W.; Moynihan, Gary P.

2001-01-01

A widely used fuzzy reasoning algorithm was modified and implemented via an expert system to assess the potential risk of employee repetitive strain injury in the workplace. This fuzzy relational model, known as the Priority First Cover Algorithm (PFC), was adapted to describe the relationship between 12 cumulative trauma disorders (CTDs) of the upper extremity, and 29 identified risk factors. The algorithm, which finds a suboptimal subset from a group of variables based on the criterion of...

Cumulative effective and individual organ dose levels in paediatric patients undergoing multiple catheterizations for congenital heart disease

International Nuclear Information System (INIS)

Jones, T.P.; Brennan, P.C.; Ryan, E.

2017-01-01

This study examines the cumulative radiation dose levels received by a group of children who underwent multiple cardiac catheterisation procedures during the investigation and management of congenital heart disease (CHD). The purpose is to calculate cumulative doses, identify higher dose individuals, outline the inconsistencies with risk assessment and encourage the establishment of dose databases in order to facilitate the longitudinal research necessary to better understand health risks. A retrospective review of patient records for 117 paediatric patients who have undergone two or more cardiac catheterizations for the investigation of CHD was undertaken. This cohort consisted of patients who were catheterised over a period from September 2002 to August 2014. The age distribution was from newborn to 17 y. Archived kerma-area product (P KA ) and fluoroscopy time (T) readings were retrieved and analysed. Cumulative effective and individual organ doses were determined. The cumulative P KA levels ranged from 1.8 to 651.2 Gycm 2 , whilst cumulative effective dose levels varied from 2 to 259 mSv. The cumulative fluoroscopy time was shown to vary from 8.1 to 193.5 min. Median cumulative organ doses ranged from 3 to 94 mGy. Cumulative effective dose levels are highly variable but may exceed 250 mSv. Individual organ and effective dose measurements remain useful for comparison purposes between institutions although current methodologies used for determining lifetime risks are inadequate. (authors)

[Application of occupational hazard risk index model in occupational health risk assessment in a decorative coating manufacturing enterprises].

Science.gov (United States)

He, P L; Zhao, C X; Dong, Q Y; Hao, S B; Xu, P; Zhang, J; Li, J G

2018-01-20

Objective: To evaluate the occupational health risk of decorative coating manufacturing enterprises and to explore the applicability of occupational hazard risk index model in the health risk assessment, so as to provide basis for the health management of enterprises. Methods: A decorative coating manufacturing enterprise in Hebei Province was chosen as research object, following the types of occupational hazards and contact patterns, the occupational hazard risk index model was used to evaluate occupational health risk factors of occupational hazards in the key positions of the decorative coating manufacturing enterprise, and measured with workplace test results and occupational health examination. Results: The positions of oily painters, water-borne painters, filling workers and packers who contacted noise were moderate harm. And positions of color workers who contacted chromic acid salts, oily painters who contacted butyl acetate were mild harm. Other positions were harmless. The abnormal rate of contacting noise in physical examination results was 6.25%, and the abnormality was not checked by other risk factors. Conclusion: The occupational hazard risk index model can be used in the occupational health risk assessment of decorative coating manufacturing enterprises, and noise was the key harzard among occupational harzards in this enterprise.

Body adiposity index versus body mass index and other anthropometric traits as correlates of cardiometabolic risk factors.

Directory of Open Access Journals (Sweden)

Charlene T Lichtash

Full Text Available The worldwide prevalence of obesity mandates a widely accessible tool to categorize adiposity that can best predict associated health risks. The body adiposity index (BAI was designed as a single equation to predict body adiposity in pooled analysis of both genders. We compared body adiposity index (BAI, body mass index (BMI, and other anthropometric measures, including percent body fat (PBF, in their correlations with cardiometabolic risk factors. We also compared BAI with BMI to determine which index is a better predictor of PBF.The cohort consisted of 698 Mexican Americans. We calculated correlations of BAI, BMI, and other anthropometric measurements (PBF measured by dual energy X-ray absorptiometry, waist and hip circumference, height, weight with glucose homeostasis indices (including insulin sensitivity and insulin clearance from euglycemic clamp, lipid parameters, cardiovascular traits (including carotid intima-media thickness, and biomarkers (C-reactive protein, plasminogen activator inhibitor-1 and adiponectin. Correlations between each anthropometric measure and cardiometabolic trait were compared in both sex-pooled and sex-stratified groups.BMI was associated with all but two measured traits (carotid intima-media thickness and fasting glucose in men, while BAI lacked association with several variables. BAI did not outperform BMI in its associations with any cardiometabolic trait. BAI was correlated more strongly than BMI with PBF in sex-pooled analyses (r = 0.78 versus r = 0.51, but not in sex-stratified analyses (men, r = 0.63 versus r = 0.79; women, r = 0.69 versus r = 0.77. Additionally, PBF showed fewer correlations with cardiometabolic risk factors than BMI. Weight was more strongly correlated than hip with many of the cardiometabolic risk factors examined.BAI is inferior to the widely used BMI as a correlate of the cardiometabolic risk factors studied. Additionally, BMI's relationship with total adiposity

Cumulative Risk and Impact Modeling on Environmental Chemical and Social Stressors.

Science.gov (United States)

Huang, Hongtai; Wang, Aolin; Morello-Frosch, Rachel; Lam, Juleen; Sirota, Marina; Padula, Amy; Woodruff, Tracey J

2018-03-01

The goal of this review is to identify cumulative modeling methods used to evaluate combined effects of exposures to environmental chemicals and social stressors. The specific review question is: What are the existing quantitative methods used to examine the cumulative impacts of exposures to environmental chemical and social stressors on health? There has been an increase in literature that evaluates combined effects of exposures to environmental chemicals and social stressors on health using regression models; very few studies applied other data mining and machine learning techniques to this problem. The majority of studies we identified used regression models to evaluate combined effects of multiple environmental and social stressors. With proper study design and appropriate modeling assumptions, additional data mining methods may be useful to examine combined effects of environmental and social stressors.

An Integrated Risk Index Model Based on Hierarchical Fuzzy Logic for Underground Risk Assessment

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Muhammad Fayaz

2017-10-01

Full Text Available Available space in congested cities is getting scarce due to growing urbanization in the recent past. The utilization of underground space is considered as a solution to the limited space in smart cities. The numbers of underground facilities are growing day by day in the developing world. Typical underground facilities include the transit subway, parking lots, electric lines, water supply and sewer lines. The likelihood of the occurrence of accidents due to underground facilities is a random phenomenon. To avoid any accidental loss, a risk assessment method is required to conduct the continuous risk assessment and report any abnormality before it happens. In this paper, we have proposed a hierarchical fuzzy inference based model for under-ground risk assessment. The proposed hierarchical fuzzy inference architecture reduces the total number of rules from the rule base. Rule reduction is important because the curse of dimensionality damages the transparency and interpretation as it is very tough to understand and justify hundreds or thousands of fuzzy rules. The computation time also increases as rules increase. The proposed model takes 175 rules having eight input parameters to compute the risk index, and the conventional fuzzy logic requires 390,625 rules, having the same number of input parameters to compute risk index. Hence, the proposed model significantly reduces the curse of dimensionality. Rule design for fuzzy logic is also a tedious task. In this paper, we have also introduced new rule schemes, namely maximum rule-based and average rule-based; both schemes can be used interchangeably according to the logic needed for rule design. The experimental results show that the proposed method is a virtuous choice for risk index calculation where the numbers of variables are greater.

Hierarchical Bayesian parameter estimation for cumulative prospect theory

NARCIS (Netherlands)

Nilsson, H.; Rieskamp, J.; Wagenmakers, E.-J.

2011-01-01

Cumulative prospect theory (CPT Tversky & Kahneman, 1992) has provided one of the most influential accounts of how people make decisions under risk. CPT is a formal model with parameters that quantify psychological processes such as loss aversion, subjective values of gains and losses, and

A Risk-Free Protection Index Model for Portfolio Selection with Entropy Constraint under an Uncertainty Framework

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Jianwei Gao

2017-02-01

Full Text Available This paper aims to develop a risk-free protection index model for portfolio selection based on the uncertain theory. First, the returns of risk assets are assumed as uncertain variables and subject to reputable experts’ evaluations. Second, under this assumption, combining with the risk-free interest rate we define a risk-free protection index (RFPI, which can measure the protection degree when the loss of risk assets happens. Third, note that the proportion entropy serves as a complementary means to reduce the risk by the preset diversification requirement. We put forward a risk-free protection index model with an entropy constraint under an uncertainty framework by applying the RFPI, Huang’s risk index model (RIM, and mean-variance-entropy model (MVEM. Furthermore, to solve our portfolio model, an algorithm is given to estimate the uncertain expected return and standard deviation of different risk assets by applying the Delphi method. Finally, an example is provided to show that the risk-free protection index model performs better than the traditional MVEM and RIM.

Body mass index predicts risk for complications from transtemporal cerebellopontine angle surgery.

Science.gov (United States)

Mantravadi, Avinash V; Leonetti, John P; Burgette, Ryan; Pontikis, George; Marzo, Sam J; Anderson, Douglas

2013-03-01

To determine the relationship between body mass index (BMI) and risk for specific complications from transtemporal cerebellopontine angle (CPA) surgery for nonmalignant disease. Case series with chart review. Tertiary-care academic hospital. Retrospective review of 134 consecutive patients undergoing transtemporal cerebellopontine angle surgery for nonmalignant disease from 2009 to 2011. Data were collected regarding demographics, body mass index, intraoperative details, hospital stay, and complications including cerebrospinal fluid leak, wound complications, and brachial plexopathy. One hundred thirty-four patients were analyzed with a mean preoperative body mass index of 28.58. Statistical analysis demonstrated a significant difference in body mass index between patients with a postoperative cerebrospinal fluid leak and those without (P = .04), as well as a similar significant difference between those experiencing postoperative brachial plexopathy and those with no such complication (P = .03). Logistical regression analysis confirmed that body mass index is significant in predicting both postoperative cerebrospinal fluid leak (P = .004; odds ratio, 1.10) and brachial plexopathy (P = .04; odds ratio, 1.07). Elevated body mass index was not significant in predicting wound complications or increased hospital stay beyond postoperative day 3. Risk of cerebrospinal fluid leak and brachial plexopathy is increased in patients with elevated body mass index undergoing surgery of the cerebellopontine angle. Consideration should be given to preoperative optimization via dietary and lifestyle modifications as well as intraoperative somatosensory evoked potential monitoring of the brachial plexus to decrease these risks.

Innovation in drought risk management: exploring the potential of weather index insurance

Science.gov (United States)

Iglesias, E.; Baez, K.

2012-04-01

Many family farming and indigenous communities depend on grazing livestock activities and are particularly prone to drought risks. Vulnerability to drought limits the ability of these households to exit poverty and in many cases leads to environmental degradation. It is well known that uninsured exposure exacerbates income inequality in farming systems and eventually results in welfare losses for rural families. The advantages of farmers who have access to financial tools have been widely acknowledged. However, high administrative costs of traditional insurance hinder small farmers' access to risk management tools. One of the main problems in insurance design relates to the lack of quality data to estimate the risk premium. In rural areas where there are no historical records of farm production data on adverse events such as drought. New technologies such as remote sensing help to overcome this problem and generate information from these areas that otherwise would be impossible or too expensive to obtain. In this paper, we use a satellite based vegetation index (NDVI) and develop a stochastic model to analyse the potential of index insurance to address the risk of drought in Chilean grazing lands. Our results suggest that contract design is a key issue to improve the correlation of the index with individual farm losses, thus reducing basis risk. In particular, we find that the definition of homogeneous areas and the selection of the triggering index threshold are critical issues and show the incidence of different contract designs on (i) the probability that the farmer experience losses but does not receive compensation (false negative) and (ii) the probability that the index triggers compensation but the farmer does not experience drought losses (false negative). Both aspects are key issues to offer the farmer an adequate protection against droughts and guarantee the affordability of the risk premium.

Occupational coke oven emissions exposure and risk of abnormal liver function: modifications of body mass index and hepatitis virus infection

Energy Technology Data Exchange (ETDEWEB)

Y. Hu; B. Chen; J. Qian; L. Jin; T. Jin; D. Lu [Fudan University, Shanghai (China). Department of Occupational and Environmental Health

2010-03-15

Occupational coke oven emissions (COEs) have been considered an important health issue. However, there are no conclusive data on human hepatic injury due to COE exposure. The association of COE exposure with liver function was explored and the effects of modification of potential non-occupational factors were assessed. 705 coke oven workers and 247 referents were investigated. Individual cumulative COE exposure was quantitatively estimated. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), {gamma}-glutamyl transferase, alkaline phosphatase, hepatitis B surface antigen and anti-hepatitis C antibody were measured. Among those with high COE exposure, the adjusted ORs of abnormal ALT and AST were 5.23 (95% CI 2.66 to 10.27) and 1.95 (95% CI 1.18 to 3.52), respectively. Overweight individuals (body mass index (BMI) {>=}25 kg/m{sup 2}) with high COE exposure had elevated risks of abnormal ALT (adjusted OR 23.93, 95% CI 8.73 to 65.62) and AST (adjusted OR 5.18, 95% CI 2.32 to 11.58). Risk of liver damage in hepatitis B virus- or hepatitis C virus-positive individuals with COE exposure was also elevated. Long-term exposure to COE increases the risk of liver dysfunction, which is more prominent among those with higher BMI and hepatitis virus infection. The risk assessment of liver damage associated with COE exposure should take BMI and hepatitis virus infection into consideration.

A Risk Prediction Index for Advanced Colorectal Neoplasia at Screening Colonoscopy.

Science.gov (United States)

Schroy, Paul C; Wong, John B; O'Brien, Michael J; Chen, Clara A; Griffith, John L

2015-07-01

Eliciting patient preferences within the context of shared decision making has been advocated for colorectal cancer screening. Risk stratification for advanced colorectal neoplasia (ACN) might facilitate more effective shared decision making when selecting an appropriate screening option. Our objective was to develop and validate a clinical index for estimating the probability of ACN at screening colonoscopy. We conducted a cross-sectional analysis of 3,543 asymptomatic, mostly average-risk patients 50-79 years of age undergoing screening colonoscopy at two urban safety net hospitals. Predictors of ACN were identified using multiple logistic regression. Model performance was internally validated using bootstrapping methods. The final index consisted of five independent predictors of risk (age, smoking, alcohol intake, height, and a combined sex/race/ethnicity variable). Smoking was the strongest predictor (net reclassification improvement (NRI), 8.4%) and height the weakest (NRI, 1.5%). Using a simplified weighted scoring system based on 0.5 increments of the adjusted odds ratio, the risk of ACN ranged from 3.2% (95% confidence interval (CI), 2.6-3.9) for the low-risk group (score ≤2) to 8.6% (95% CI, 7.4-9.7) for the intermediate/high-risk group (score 3-11). The model had moderate to good overall discrimination (C-statistic, 0.69; 95% CI, 0.66-0.72) and good calibration (P=0.73-0.93). A simple 5-item risk index based on readily available clinical data accurately stratifies average-risk patients into low- and intermediate/high-risk categories for ACN at screening colonoscopy. Uptake into clinical practice could facilitate more effective shared decision-making for CRC screening, particularly in situations where patient and provider test preferences differ.

Predictive value of body mass index to metabolic syndrome risk factors in Syrian adolescents.

Science.gov (United States)

Al-Bachir, Mahfouz; Bakir, Mohamad Adel

2017-06-25

Obesity has become a serious epidemic health problem in both developing and developed countries. There is much evidence that obesity among adolescents contributed significantly to the development of type 2 diabetes and coronary heart disease in adulthood. Very limited information exists on the prevalence of overweight, obesity, and associated metabolic risk factors among Syrian adolescents. Therefore, the purpose of this study was to determine the relationship between obesity determined by body mass index and the major metabolic risk factors among Syrian adolescents. A cross-sectional study of a randomly selected sample of 2064 apparently healthy Syrian adolescents aged 18 to 19 years from Damascus city, in Syria, was performed. Body mass index and blood pressure were measured. Serum concentrations of glucose, triglycerides, total cholesterol, high-density lipoprotein-cholesterol, and low-density lipoprotein-cholesterol were determined. Metabolic syndrome was defined using the national criteria for each determined metabolic risk factor. Individuals with a body mass index 25 to 29.9 were classified as overweight, whereas individuals with a body mass index ≥30 were classified as obese. A receiver operating characteristics curve was drawn to determine appropriate cut-off points of the body mass index for defining overweight and obesity, and to indicate the performance of body mass index as a predictor of risk factors. The obtained data showed that blood pressure and the overall mean concentrations of fasting blood sugar, triglycerides, cholesterol, low-density lipoprotein-cholesterol, and triglycerides/high-density lipoprotein-cholesterol were significantly higher in overweight and obese adolescent groups (p index and some metabolic risks, the data suggest the best body mass index cut-offs ranged between 23.25 and 24.35 kg/m 2 . A strong association between overweight and obesity as determined by body mass index and high concentrations of metabolic syndrome

Triglyceride and glucose (TyG) index as a predictor of incident hypertension: a 9-year longitudinal population-based study.

Science.gov (United States)

Zheng, Rongjiong; Mao, Yushan

2017-09-13

Hypertension and the triglyceride and glucose index both have been associated with insulin resistance; however, the longitudinal association remains unclear. This study was designed to investigate the longitudinal association between the triglyceride and glucose index and incident hypertension among the Chinese population. We studied 4686 subjects (3177 males and 1509 females) and followed up for 9 years. The subjects were divided into four groups based on the triglyceride and glucose index. Univariate and multivariate Cox regression models were used to analyse the risk factors of hypertension. After 9 years of follow-up, 2047 subjects developed hypertension. The overall 9-year cumulative incidence of hypertension was 43.7%, ranging from 28.5% in quartile 1 to 36.9% in quartile 2, 49.2% in quartile 3 and 59.8% in quartile 4 (p for trend triglyceride and glucose index was associated with an increased risk of subsequent incident hypertension. The triglyceride and glucose index can predict the incident hypertension among the Chinese population.

Cumulative Poisson Distribution Program

Science.gov (United States)

Bowerman, Paul N.; Scheuer, Ernest M.; Nolty, Robert

1990-01-01

Overflow and underflow in sums prevented. Cumulative Poisson Distribution Program, CUMPOIS, one of two computer programs that make calculations involving cumulative Poisson distributions. Both programs, CUMPOIS (NPO-17714) and NEWTPOIS (NPO-17715), used independently of one another. CUMPOIS determines cumulative Poisson distribution, used to evaluate cumulative distribution function (cdf) for gamma distributions with integer shape parameters and cdf for X (sup2) distributions with even degrees of freedom. Used by statisticians and others concerned with probabilities of independent events occurring over specific units of time, area, or volume. Written in C.

Genetic moderation of multiple pathways linking early cumulative socioeconomic adversity and young adults' cardiometabolic disease risk.

Science.gov (United States)

Wickrama, Kandauda A S; Lee, Tae Kyoung; O'Neal, Catherine Walker

2018-02-01

Recent research suggests that psychosocial resources and life stressors are mediating pathways explaining socioeconomic variation in young adults' health risks. However, less research has examined both these pathways simultaneously and their genetic moderation. A nationally representative sample of 11,030 respondents with prospective data collected over 13 years from the National Study of Adolescent to Adult Health was examined. First, the association between early cumulative socioeconomic adversity and young adults' (ages 25-34) cardiometabolic disease risk, as measured by 10 biomarkers, through psychosocial resources (educational attainment) and life stressors (accelerated transition to adulthood) was examined. Second, moderation of these pathways by the serotonin transporter linked polymorphic region gene (5-HTTLPR) was examined. There was evidence for the association between early socioeconomic adversity and young adults' cardiometabolic disease risk directly and indirectly through educational attainment and accelerated transitions. These direct and mediating pathways were amplified by the 5-HTTLPR polymorphism. These findings elucidate how early adversity can have an enduring influence on young adults' cardiometabolic disease risk directly and indirectly through psychosocial resources and life stressors and their genetic moderation. This information suggests that effective intervention and prevention programs should focus on early adversity, youth educational attainment, and their transition to young adulthood.

Towards personalized screening: Cumulative risk of breast cancer screening outcomes in women with and without a first-degree relative with a history of breast cancer.

Science.gov (United States)

Ripping, Theodora Maria; Hubbard, Rebecca A; Otten, Johannes D M; den Heeten, Gerard J; Verbeek, André L M; Broeders, Mireille J M

2016-04-01

Several reviews have estimated the balance of benefits and harms of mammographic screening in the general population. The balance may, however, differ between individuals with and without family history. Therefore, our aim is to assess the cumulative risk of screening outcomes; screen-detected breast cancer, interval cancer, and false-positive results, in women screenees aged 50-75 and 40-75, with and without a first-degree relative with a history of breast cancer at the start of screening. Data on screening attendance, recall and breast cancer detection were collected for each woman living in Nijmegen (The Netherlands) since 1975. We used a discrete time survival model to calculate the cumulative probability of each major screening outcome over 19 screening rounds. Women with a family history of breast cancer had a higher risk of all screening outcomes. For women screened from age 50-75, the cumulative risk of screen-detected breast cancer, interval cancer and false-positive results were 9.0, 4.4 and 11.1% for women with a family history and 6.3, 2.7 and 7.3% for women without a family history, respectively. The results for women 40-75 followed the same pattern for women screened 50-75 for cancer outcomes, but were almost doubled for false-positive results. To conclude, women with a first-degree relative with a history of breast cancer are more likely to experience benefits and harms of screening than women without a family history. To complete the balance and provide risk-based screening recommendations, the breast cancer mortality reduction and overdiagnosis should be estimated for family history subgroups. © 2015 UICC.

Healthy lifestyle index and risk of gastric adenocarcinoma in the EPIC cohort study.

Science.gov (United States)

Buckland, G; Travier, N; Huerta, J M; Bueno-de-Mesquita, H B As; Siersema, P D; Skeie, G; Weiderpass, E; Engeset, D; Ericson, U; Ohlsson, B; Agudo, A; Romieu, I; Ferrari, P; Freisling, H; Colorado-Yohar, S; Li, K; Kaaks, R; Pala, V; Cross, A J; Riboli, E; Trichopoulou, A; Lagiou, P; Bamia, C; Boutron-Ruault, M C; Fagherazzi, G; Dartois, L; May, A M; Peeters, P H; Panico, S; Johansson, M; Wallner, B; Palli, D; Key, T J; Khaw, K T; Ardanaz, E; Overvad, K; Tjønneland, A; Dorronsoro, M; Sánchez, M J; Quirós, J R; Naccarati, A; Tumino, R; Boeing, H; Gonzalez, C A

2015-08-01

Several modifiable lifestyle factors, including smoking, alcohol, certain dietary factors and weight are independently associated with gastric cancer (GC); however, their combined impact on GC risk is unknown. We constructed a healthy lifestyle index to investigate the joint influence of these behaviors on GC risk within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The analysis included 461,550 participants (662 first incident GC cases) with a mean follow-up of 11.4 years. A healthy lifestyle index was constructed, assigning 1 point for each healthy behavior related to smoking status, alcohol consumption and diet quality (represented by the Mediterranean diet) for assessing overall GC and also body mass index for cardia GC and 0 points otherwise. Risk of GC was calculated using Cox proportional hazards regression models while adjusting for relevant confounders. The highest versus lowest score in the healthy lifestyle index was associated with a significant lower risk of GC, by 51% overall (HR 0.49 95% CI 0.35, 0.70), by 77% for cardia GC (HR 0.23 95% CI 0.08, 0.68) and by 47% for noncardia GC (HR 0.53 (95% CI 0.32, 0.87), p-trendshealthy lifestyle behaviors of this index. Adopting several healthy lifestyle behaviors including not smoking, limiting alcohol consumption, eating a healthy diet and maintaining a normal weight is associated with a large decreased risk of GC. © 2014 UICC.

Value at Risk on Composite Price Share Index Stock Data

Science.gov (United States)

Oktaviarina, A.

2018-01-01

The financial servicest authority was declared Let’s Save Campaign on n commemoration of the World Savings Day that falls on this day, October 31, 2016. The activity was greeted enthusiastically by Indonesia Stock Exchange by taking out the slogan Let’s Save The Stocks. Stock is a form of investment that is expected to benefit in the future despite has risks. Value at Risk (VaR) is a method that can measure how much the risk of a financial investment. Composite Stock Price Indeks is the stock price index used by Indonesia Stock Exchange as stock volatility benchmarks in Indonesia. This study aimed to estimate Value at Risk (VaR) on closing price Composite Price Share Index Stock data on the period 20 September 2016 until 20 September 2017. Box-Pierce test results p value=0.9528 which is greater than a, that shows homoskedasticity. Value at Risk (VaR) with Variance Covariance Method is Rp.3.054.916,07 which means with 99% confindence interval someone who invests Rp.100.000.000,00 will get Rp.3.054.916,07 as a maximum loss.

Hazard Assessment on Chlorine Distribution Use of Chemical Transportation Risk Index

International Nuclear Information System (INIS)

Kim, Jeong Gon; Byun, Hun Soo

2014-01-01

Chlorine is one of the most produced and most used non-flammable chemical substances in the world even though its toxicity and high reactivity cause the ozone layer depletion. However, in modern life, it is impossible to live a good life without using Chlorine and its derivatives since they are being used as an typical ingredient in more than 40 percent of the manufactured goods including medicines, detergents, deodorant, fungicides, herbicides, insecticides, and plastic, etc. Even if Chlorine has been handled and distributed in various business (small and medium-sized businesses, water purification plants, distribution company, etc.), there have been few researches about its possible health hazard and transportation risks. Accordingly, the purpose of this paper is to make a detailed assessment of Chlorinerelated risks and to model an index of chemicals transportation risks that is adequate for domestic circumstances. The assessment of possible health hazard and transportation risks was made on 13 kinds of hazardous chemicals, including liquid chlorine. This research may be contributed to standardizing the risk assessment of Chlorine and other hazardous chemicals by using an index of transportation risks

Hazard Assessment on Chlorine Distribution Use of Chemical Transportation Risk Index

Energy Technology Data Exchange (ETDEWEB)

Kim, Jeong Gon [Hanwha Chemical Ulsan Site, Ulsan (Korea, Republic of); Byun, Hun Soo [Chonnam National University, Yeosu (Korea, Republic of)

2014-12-15

Chlorine is one of the most produced and most used non-flammable chemical substances in the world even though its toxicity and high reactivity cause the ozone layer depletion. However, in modern life, it is impossible to live a good life without using Chlorine and its derivatives since they are being used as an typical ingredient in more than 40 percent of the manufactured goods including medicines, detergents, deodorant, fungicides, herbicides, insecticides, and plastic, etc. Even if Chlorine has been handled and distributed in various business (small and medium-sized businesses, water purification plants, distribution company, etc.), there have been few researches about its possible health hazard and transportation risks. Accordingly, the purpose of this paper is to make a detailed assessment of Chlorinerelated risks and to model an index of chemicals transportation risks that is adequate for domestic circumstances. The assessment of possible health hazard and transportation risks was made on 13 kinds of hazardous chemicals, including liquid chlorine. This research may be contributed to standardizing the risk assessment of Chlorine and other hazardous chemicals by using an index of transportation risks.

The effect of elevated body mass index on ischemic heart disease risk

DEFF Research Database (Denmark)

Nordestgaard, Børge G; Palmer, Tom M; Benn, Marianne

2012-01-01

Adiposity, assessed as elevated body mass index (BMI), is associated with increased risk of ischemic heart disease (IHD); however, whether this is causal is unknown. We tested the hypothesis that positive observational associations between BMI and IHD are causal.......Adiposity, assessed as elevated body mass index (BMI), is associated with increased risk of ischemic heart disease (IHD); however, whether this is causal is unknown. We tested the hypothesis that positive observational associations between BMI and IHD are causal....

Risk preference or financial literacy? Behavioural experiment on index insurance demand

NARCIS (Netherlands)

Awel, Y.; Azomahou, T.T.

2015-01-01

We use unique cross-sectional household data from Ethiopia to investigate the effect of risk preference, financial literacy and other socio-economic characteristics on demand for index insurance. We measure risk preference based on survey experiments using lottery choice game with real monetary

Towards personalized screening: Cumulative risk of breast cancer screening outcomes in women with and without a first-degree relative with a history of breast cancer

NARCIS (Netherlands)

Ripping, Theodora Maria; Hubbard, Rebecca A.; Otten, Johannes D. M.; den Heeten, Gerard J.; Verbeek, André L. M.; Broeders, Mireille J. M.

2016-01-01

Several reviews have estimated the balance of benefits and harms of mammographic screening in the general population. The balance may, however, differ between individuals with and without family history. Therefore, our aim is to assess the cumulative risk of screening outcomes; screen-detected

Cumulative effects of planned industrial development and climate change on marine ecosystems

Directory of Open Access Journals (Sweden)

Cathryn Clarke Murray

2015-07-01

Full Text Available With increasing human population, large scale climate changes, and the interaction of multiple stressors, understanding cumulative effects on marine ecosystems is increasingly important. Two major drivers of change in coastal and marine ecosystems are industrial developments with acute impacts on local ecosystems, and global climate change stressors with widespread impacts. We conducted a cumulative effects mapping analysis of the marine waters of British Columbia, Canada, under different scenarios: climate change and planned developments. At the coast-wide scale, climate change drove the largest change in cumulative effects with both widespread impacts and high vulnerability scores. Where the impacts of planned developments occur, planned industrial and pipeline activities had high cumulative effects, but the footprint of these effects was comparatively localized. Nearshore habitats were at greatest risk from planned industrial and pipeline activities; in particular, the impacts of planned pipelines on rocky intertidal habitats were predicted to cause the highest change in cumulative effects. This method of incorporating planned industrial development in cumulative effects mapping allows explicit comparison of different scenarios with the potential to be used in environmental impact assessments at various scales. Its use allows resource managers to consider cumulative effect hotspots when making decisions regarding industrial developments and avoid unacceptable cumulative effects. Management needs to consider both global and local stressors in managing marine ecosystems for the protection of biodiversity and the provisioning of ecosystem services.

High body mass index and cancer risk

DEFF Research Database (Denmark)

Benn, Marianne; Tybjærg-Hansen, Anne; Smith, George Davey

2016-01-01

of follow-up (range 0-37), 8002 developed non-skin cancer, 3347 non-melanoma skin cancer, 1396 lung cancer, 637 other smoking related cancers, 1203 colon cancer, 159 kidney cancer, 1402 breast cancer, 1062 prostate cancer, and 2804 other cancers. Participants were genotyped for five genetic variants...... with a BMI ≥ 30 versus 18.5-24.9 kg/m(2). Corresponding risk of breast cancer was 20 % (0-44 %) higher in postmenopausal women. BMI was not associated with risk of colon, kidney, other smoking related cancers, prostate cancer, or other cancers. In genetic analyses, carrying 7-10 versus 0-4 BMI increasing......High body mass index (BMI) has been associated with increased risk of some cancer. Whether these reflect causal associations is unknown. We examined this issue. Using a Mendelian randomisation approach, we studied 108,812 individuals from the general population. During a median of 4.7 years...

[Development of a portable fall risk index for elderly people living in the community].

Science.gov (United States)

Toba, Kenji; Okochi, Jiro; Takahashi, Tai; Matsubayashi, Kozo; Nishinaga, Masanori; Yamada, Shizuru; Takahashi, Ryutaro; Nishijima, Reiko; Kobayashi, Yoshio; Machida, Ayako; Akishita, Masahiro; Sasaki, Hidetada

2005-05-01

To develop a portable risk index for falls. Risk factors were chosen from previously established factors then we added several environmental factors to the risk index; previous falls in the last 12 month, trippig or stumbling, inability to ascend or descend stairs without help, decreased walking speed, inability to cross a road within the green signal interval, inability to walk 1km without a break, inability to stand on one leg for 5 seconds (eyes open), using a cane, inability to wring out a towel, dizziness or faintness, stooped or rounded back, knee joint pain, visual disturbance, hearing disturbance, cognitive decline, fear of falling, receiving 5 or more prescribed drugs, sensation of darkness at home, obstacles inside, barrier on the carpet or floor, using steps daily at home, steep slopes around home. The questionnaire sheet was completed by 2,439 community-dwelling elderly subjects (76.3 +/- 7.4 years old). The frequency of each items of fall risk index was compared between fallers (history of fall within one year) and non-fallers. Multiple regression analysis was performed to identify independent risk factors for previous falls. Except barrier, step use and steep slope around home, all items in the fall risk index were more frequent in fallers. Multivariate analysis revealed that tripping or stumbling, inability to cross a road within the green signal interval, dizziness or faintness, obstacles inside, inability to wring out a towel, cane use and knee joint pain were independent risk factors for previous falls. These 7 selected items were further analyzed as predictors. The maximum sum of sensitivity and specificity was reached at the cut-off point of 2/3 (sensitivity 0.65, specificity 0.72) by receiver operating curve. Portable fall risk index is useful for clinical settings to identify high-risk subjects.

[Diagnostic accuracy of malignancy risk index II in post-menopausal women with adnexal tumours].

Science.gov (United States)

Treviño-Báez, Joaquín Darío; Cantú-Cruz, Javier Alejandro; Medina-Mercado, Javier; Abundis, Alberto

2016-01-01

The purpose of the diagnostic evaluation of adnexal tumours is to exclude the possibility of malignancy. The malignancy risk index II identifies patients at high risk for ovarian cancer. The cut-off value is greater than 200. To evaluate the diagnostic accuracy of malignancy risk index II in post-menopausal women with adnexal tumours in relation to the histopathological results. A total of 138 women with an adnexal mass were studied. The malignancy risk index II was determined in all of them. They were divided into two groups according to the histopathology results; 69 patients with benign tumours and 69 patients with malignant tumours. A diagnostic test type analysis was performed with respect to the results of malignancy risk index II ≤ 200 or greater than this. The percentages and 95% confidence intervals were calculated. The accuracy was 81.8% (75.5-88.3), sensitivity 76.8% (66.9-86.7), specificity 87% (79.1-94.9), with a positive predictive value of 85.5% (76.7-94.3), and a negative predictive value of 78.9% (69.7-88.1). The positive likelihood ratio was 590, and the negative likelihood ratio was 0.266. The malignancy risk index II has good performance in the proper classification of post-menopausal women with adnexal masses, both benign and malignant, with an accuracy of 81.8%. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

Mechanisms and risk of cumulative impacts to coastal ecosystem services: An expert elicitation approach.

Science.gov (United States)

Singh, Gerald G; Sinner, Jim; Ellis, Joanne; Kandlikar, Milind; Halpern, Benjamin S; Satterfield, Terre; Chan, Kai M A

2017-09-01

Coastal environments are some of the most populated on Earth, with greater pressures projected in the future. Managing coastal systems requires the consideration of multiple uses, which both benefit from and threaten multiple ecosystem services. Thus understanding the cumulative impacts of human activities on coastal ecosystem services would seem fundamental to management, yet there is no widely accepted approach for assessing these. This study trials an approach for understanding the cumulative impacts of anthropogenic change, focusing on Tasman and Golden Bays, New Zealand. Using an expert elicitation procedure, we collected information on three aspects of cumulative impacts: the importance and magnitude of impacts by various activities and stressors on ecosystem services, and the causal processes of impact on ecosystem services. We assessed impacts to four ecosystem service benefits - fisheries, shellfish aquaculture, marine recreation and existence value of biodiversity-addressing three main research questions: (1) how severe are cumulative impacts on ecosystem services (correspondingly, what potential is there for restoration)?; (2) are threats evenly distributed across activities and stressors, or do a few threats dominate?; (3) do prominent activities mainly operate through direct stressors, or do they often exacerbate other impacts? We found (1) that despite high uncertainty in the threat posed by individual stressors and impacts, total cumulative impact is consistently severe for all four ecosystem services. (2) A subset of drivers and stressors pose important threats across the ecosystem services explored, including climate change, commercial fishing, sedimentation and pollution. (3) Climate change and commercial fishing contribute to prominent indirect impacts across ecosystem services by exacerbating regional impacts, namely sedimentation and pollution. The prevalence and magnitude of these indirect, networked impacts highlights the need for approaches

Mechanisms and risk of cumulative impacts to coastal ecosystem services: An expert elicitation approach

KAUST Repository

Singh, Gerald G.

2017-05-23

Coastal environments are some of the most populated on Earth, with greater pressures projected in the future. Managing coastal systems requires the consideration of multiple uses, which both benefit from and threaten multiple ecosystem services. Thus understanding the cumulative impacts of human activities on coastal ecosystem services would seem fundamental to management, yet there is no widely accepted approach for assessing these. This study trials an approach for understanding the cumulative impacts of anthropogenic change, focusing on Tasman and Golden Bays, New Zealand. Using an expert elicitation procedure, we collected information on three aspects of cumulative impacts: the importance and magnitude of impacts by various activities and stressors on ecosystem services, and the causal processes of impact on ecosystem services. We assessed impacts to four ecosystem service benefits — fisheries, shellfish aquaculture, marine recreation and existence value of biodiversity—addressing three main research questions: (1) how severe are cumulative impacts on ecosystem services (correspondingly, what potential is there for restoration)?; (2) are threats evenly distributed across activities and stressors, or do a few threats dominate?; (3) do prominent activities mainly operate through direct stressors, or do they often exacerbate other impacts? We found (1) that despite high uncertainty in the threat posed by individual stressors and impacts, total cumulative impact is consistently severe for all four ecosystem services. (2) A subset of drivers and stressors pose important threats across the ecosystem services explored, including climate change, commercial fishing, sedimentation and pollution. (3) Climate change and commercial fishing contribute to prominent indirect impacts across ecosystem services by exacerbating regional impacts, namely sedimentation and pollution. The prevalence and magnitude of these indirect, networked impacts highlights the need for

Improving index mutual fund risk perception : Increase financial literacy or communicate better?

NARCIS (Netherlands)

de Goeij, Peter; Van Campenhout, Geert; Subotic, Marjana

2017-01-01

We investigate the effect of financial literacy and index mutual fund risk disclosure format on investors’ risk perception by examining the risk disclosure part in the Key Investor Information Document (KIID) for UCITS funds in Europe. Using an experimental survey administered to 244 university

Contextual risk and child psychopathology.

Science.gov (United States)

Flouri, Eirini

2008-10-01

In developmental psychopathology it almost goes without saying that contextual risk factors do not occur in isolation and that it is the combination of various risk factors that portends numerous negative child outcomes. Despite this, the body of literature that examines the relation between multiple risk exposure and child psychopathology using a cumulative risk approach is still relatively small. Even when studies use a cumulative risk approach they rarely test properly whether the relation between cumulative risk and child psychopathology is linear or nonlinear, with consequences for both theory development and intervention design: if cumulative risk impacts problem behavior in a positively accelerated exponential manner, for instance, it means that exposure to multiple risk is especially difficult to manage as problem behavior accelerates at a critical level of risk. Furthermore, few studies have actually examined factors that protect from negative outcomes in those exposed to cumulative risk and even fewer have explored cumulative protection in relation to cumulative risk. On the other hand, there is the view that a cumulative risk approach at least implicitly assumes that risk factors are, in essence, interchangeable. According to this view, the importance of testing for specificity should not be underestimated. Finally, the renewed interest in the role of neighborhood risk in child development has initiated a lively debate as to whether contextual risk should be operationalized at the family or the area level. In this letter I discuss these issues, and offer some suggestions as to how future research can address them.

Increasing Risk Awareness: The Coastal Community Resilience Index

Science.gov (United States)

Thompson, Jody A.; Sempier, Tracie; Swann, LaDon

2012-01-01

As the number of people moving to the Gulf Coast increases, so does the risk of exposure to floods, hurricanes, and other storm-related events. In an effort to assist communities in preparing for future storm events, the Coastal Community Resilience Index was created. The end result is for communities to take actions to address the weaknesses they…

Adaptive strategies for cumulative cultural learning.

Science.gov (United States)

Ehn, Micael; Laland, Kevin

2012-05-21

The demographic and ecological success of our species is frequently attributed to our capacity for cumulative culture. However, it is not yet known how humans combine social and asocial learning to generate effective strategies for learning in a cumulative cultural context. Here we explore how cumulative culture influences the relative merits of various pure and conditional learning strategies, including pure asocial and social learning, critical social learning, conditional social learning and individual refiner strategies. We replicate the Rogers' paradox in the cumulative setting. However, our analysis suggests that strategies that resolved Rogers' paradox in a non-cumulative setting may not necessarily evolve in a cumulative setting, thus different strategies will optimize cumulative and non-cumulative cultural learning. Copyright © 2012 Elsevier Ltd. All rights reserved.

The influence of freezer storage of urine samples on the BONN-Risk-Index for calcium oxalate crystallization.

Science.gov (United States)

Laube, Norbert; Zimmermann, Diana J

2004-01-01

This study was performed to quantify the effect of a 1-week freezer storage of urine on its calcium oxalate crystallization risk. Calcium oxalate is the most common urinary stone material observed in urolithiasis patients in western and affluent countries. The BONN-Risk-Index of calcium oxalate crystallization risk in human urine is determined from a crystallization experiment performed on untreated native urine samples. We tested the influence of a 1-week freezing on the BONN-Risk-Index value as well as the effect of the sample freezing on the urinary osmolality. In vitro crystallization experiments in 49 native urine samples from stone-forming and non-stone forming individuals were performed in order to determine their calcium oxalate crystallization risk according to the BONN-Risk-Index approach. Comparison of the results derived from original sample investigations with those obtained from the thawed aliquots by statistical evaluation shows that i) no significant deviation from linearity between both results exists and ii) both results are identical by statistical means. This is valid for both, the BONN-Risk-Index and the osmolality data. The differences in the BONN-Risk-Index results of both procedures of BONN-Risk-Index determination, however, exceed the clinically acceptable difference. Thus, determination of the urinary calcium oxalate crystallization risk from thawed urine samples cannot be recommended.

Creating a Flood Risk Index to Improve Community Resilience

Science.gov (United States)

Klima, K.; El Gammal, L.

2017-12-01

While flood risk reduction is an existent discourse and agenda in policy and insurance, vulnerabilities vary between communities; some communities may have aging infrastructure, or an older/poorer population less able to absorb a flood, putting them at increased risk from the hazards. As a result, some are considering environmental justice aspects of flood risk reduction. To date, catastrophe models have focused on creating floodmaps (e.g., NOAA's Sea Level Rise Viewer, Climate Central's Surging Seas), or on linking hydrological models to economic loss models (e.g., HEC-RAS + HAZUS). However, this approach may be highly inequitable between areas of different income (as well as other demographics). Some have begun work on combining hydrology with vulnerability information (e.g., USACE's North Atlantic Comprehensive Coastal Study). To our knowledge, no one has tried to adapt the more advanced known heat risk theory to water risk by combining hydrology information (e.g., HEC-RAS, floodplain maps) with the social vulnerability (e.g., Cutter et al.) of the residents. This project will create a method to combine water hazard data with a derived water vulnerability index to help a community understand their current and future water risk. We will use the case study area of Pittsburgh, PA, which faces severe precipitation and riverine flooding hazards. Building on present literature of factors influencing water vulnerability contextualized to the Pittsburgh region, we will identify, quantify, and map the top factors impacting water vulnerability. We will combine these with flood maps to identify the geospatial distribution of water risk. This work will allow policy makers to identify location-specific aspects of water vulnerability and risk in any community, thus promoting environmental justice. It is possible that this type of original research would create maps of relative water risk that may prove as understandable to the general public as other flood maps, and may also

ENSO-Based Index Insurance: Approach and Peru Flood Risk Management Application

Science.gov (United States)

Khalil, A. F.; Kwon, H.; Lall, U.; Miranda, M. J.; Skees, J. R.

2006-12-01

Index insurance has recently been advocated as a useful risk transfer tool for disaster management situations where rapid fiscal relief is desirable, and where estimating insured losses may be difficult, time consuming, or subject to manipulation and falsification. For climate related hazards, a rainfall or temperature index may be proposed. However, rainfall may be highly spatially variable relative to the gauge network, and in many locations data are inadequate to develop an index due to short time-series and the spatial dispersion of stations. In such cases, it may be helpful to consider a climate proxy index as a regional rainfall index. This is particularly useful if a long record is available for the climate index through an independent source and it is well correlated with the regional rainfall hazard. Here, ENSO related climate indices are explored for use as a proxy to extreme rainfall in one of the departments of Peru -- Piura. The ENSO index insurance product may be purchased by banks or microfinance institutions (MFIs) to aid agricultural damage relief in Peru. Crop losses in the region are highly correlated with floods, but are difficult to assess directly. Beyond agriculture, many other sectors suffer as well. Basic infrastructure is destroyed during the most severe events. This disrupts trade for many micro-enterprises. The reliability and quality of the local rainfall data is variable. Averaging the financial risk across the region is desirable. Some issues with the implementation of the proxy ENSO index are identified and discussed. Specifically, we explore (a) the reliability of the index at different levels of probability of exceedance of maximum seasonal rainfall; (b) the potential for clustering of payoffs; (c) the potential that the index could be predicted with some lead time prior to the flood season; and (d) evidence for climate change or non-stationarity in the flood exceedance probability from the long ENSO record. Finally, prospects for

Development of environmental risk assessment framework using index method

International Nuclear Information System (INIS)

Ali, M.W.; Wu, Y.

2000-01-01

This paper presents a newly developed framework for assessing the risk from events which are considered to be major accidents to the environment according to the classifications by the United Kingdom Department of Environment (DoE). The application of an environmental risk assessment framework using the newly developed index method is demonstrated by means of a case study. The framework makes use of Environmental Hazard Index (EHI) method by the United Kingdom AEA Technology for releases to river, but improves it by taking account to toxic dose rather than concentration; taking account of long-term effects including persistence and bio accumulation, not just short term effects; extending the method to all aspects of environment, not just rivers; and allowing account to be taken of design changes to mitigate the risk. The development of the framework has also led to a revision of the tolerability criteria to be used with the framework proposed earlier by weakness and recommend further work to improve this newly proposed environmental risk assessment framework. From the study, it is recommended that the environmental risk assessment framework be applied to a wide range of other case studies in order to further improve it. The framework should be modified to maintain consistency when the DoE revises its definitions of major accidents to the environment. Ease-of-use of the framework (and any other environmental framework) would be aided by the compilation of databases for environmental toxicity, river data and available consequence models. Further work could also be done to suggest methods of mitigating the risk and including them as numerical factors within method. (author)

Latino children’s autonomic nervous system reactivity moderates the relations between cumulative socioeconomic adversity in the first five years and externalizing behavior problems at seven years

Directory of Open Access Journals (Sweden)

Abbey Alkon

2016-05-01

Full Text Available Background: Thirty-seven percent of Hispanic and Latino children under 5 years of age are living in poverty in the United States. Children growing up under conditions of cumulative adversity are at much greater risk for compromised psychosocial adjustment with long-lasting ramifications for mental and physical health. This study assessed whether the relations between adversity early in life and later externalizing behaviors was moderated by children’s autonomic nervous system (ANS reactivity for immigrant, poor, MexicanAmerican children. Methods: A cumulative socioeconomic adversity index of children’s exposure to poverty, father’s absence, household crowding, mothers speaking Spanish, and poor housing condition at 6 months and 1, 3.5, and 5 years of age was calculated. At 5 years, ANS profiles during resting and social- and emotion-evoking challenges were calculated as combined parasympathetic and sympathetic difference scores. At 7 years, parents assessed children’s externalizing behavior problems. Results: Multiple regression models (n=220 showed that the relations between cumulative socioeconomic adversity and externalizing behaviors were moderated by children’s ANS profiles of coactivation during a social, not emotion-evoking, challenge, controlling for relevant covariates. Conclusions: Children living in adverse conditions early in life with specific psychobiologic responses to social challenges may be at risk for developing externalizing behavior problems later in life.

Cumulative Human Impacts on Coral Reefs: Assessing Risk and Management Implications for Brazilian Coral Reefs

OpenAIRE

Rafael A. Magris; Alana Grech; Robert L. Pressey

2018-01-01

Effective management of coral reefs requires strategies tailored to cope with cumulative disturbances from human activities. In Brazil, where coral reefs are a priority for conservation, intensifying threats from local and global stressors are of paramount concern to management agencies. Using a cumulative impact assessment approach, our goal was to inform management actions for coral reefs in Brazil by assessing their exposure to multiple stressors (fishing, land-based activities, coastal de...

Prognostic value of exercise echocardiography: validation of a new risk index combining echocardiographic, treadmill, and exercise electrocardiographic parameters.

Science.gov (United States)

Mazur, Wojciech; Rivera, Jose M; Khoury, Alexander F; Basu, Abhijeet G; Perez-Verdia, Alejandro; Marks, Gary F; Chang, Su Min; Olmos, Leopoldo; Quiñones, Miguel A; Zoghbi, William A

2003-04-01

Exercise (Ex) echocardiography has been shown to have significant prognostic power, independent of other known predictors of risk from an Ex stress test. The purpose of this study was to evaluate a risk index, incorporating echocardiographic and conventional Ex variables, for a more comprehensive risk stratification and identification of a very low-risk group. Two consecutive, mutually exclusive populations referred for treadmill Ex echocardiography with the Bruce protocol were investigated: hypothesis-generating (388 patients; 268 males; age 55 +/- 13 years) and hypothesis-testing (105 patients; 61 males age: 54 +/- 14 years).Cardiac events included cardiac death, myocardial infarction, late revascularization (>90 days), hospital admission for unstable angina, and admission for heart failure. Mean follow-up in the hypothesis-generating population was 3.1 years. There were 38 cardiac events. Independent predictors of events by multivariate analysis were: Ex wall motion score index (odds ratio [OR] = 2.77/Unit; P or = 1 mm (OR = 2.84; P =.002); and treadmill time (OR = 0.87/min; P =.037). A risk index was generated on the basis of the multivariate Cox regression model as: risk index = 1.02 (Ex wall motion score index) + 1.04 (S-T change) - 0.14 (treadmill time). The validity of this index was tested in the hypothesis-testing population. Event rates at 3 years were lowest (0%) in the lower quartile of risk index (-1.22 to -0.47), highest (29.6%) in the upper quartile (+0.66 to +2.02), and intermediate (19.2% to 15.3%) in the intermediate quartiles. The OR of the risk index for predicting cardiac events was 2.94/Unit ([95% confidence interval: 1.4 to 6.2]; P =.0043). Echocardiographic and Ex parameters are independent powerful predictors of cardiac events after treadmill stress testing. A risk index can be derived with these parameters for a more comprehensive risk stratification with Ex echocardiography.

Understanding the Relation of Low Income to HPA-Axis Functioning in Preschool Children: Cumulative Family Risk and Parenting as Pathways to Disruptions in Cortisol

Science.gov (United States)

Zalewski, Maureen; Lengua, Liliana J.; Kiff, Cara J.; Fisher, Philip A.

2012-01-01

This study examined the relation of low income and poverty to cortisol levels, and tested potential pathways from low income to disruptions in cortisol through cumulative family risk and parenting. The sample of 306 mothers and their preschool children included 29 % families at or near poverty, 27 % families below the median income, and the…

Validation of the What Matters Index: A brief, patient-reported index that guides care for chronic conditions and can substitute for computer-generated risk models.

Science.gov (United States)

Wasson, John H; Ho, Lynn; Soloway, Laura; Moore, L Gordon

2018-01-01

Current health care delivery relies on complex, computer-generated risk models constructed from insurance claims and medical record data. However, these models produce inaccurate predictions of risk levels for individual patients, do not explicitly guide care, and undermine health management investments in many patients at lesser risk. Therefore, this study prospectively validates a concise patient-reported risk assessment that addresses these inadequacies of computer-generated risk models. Five measures with well-documented impacts on the use of health services are summed to create a "What Matters Index." These measures are: 1) insufficient confidence to self-manage health problems, 2) pain, 3) bothersome emotions, 4) polypharmacy, and 5) adverse medication effects. We compare the sensitivity and predictive values of this index with two representative risk models in a population of 8619 Medicaid recipients. The patient-reported "What Matters Index" and the conventional risk models are found to exhibit similar sensitivities and predictive values for subsequent hospital or emergency room use. The "What Matters Index" is also reliable: akin to its performance during development, for patients with index scores of 1, 2, and ≥3, the odds ratios (with 95% confidence intervals) for subsequent hospitalization within 1 year, relative to patients with a score of 0, are 1.3 (1.1-1.6), 2.0 (1.6-2.4), and 3.4 (2.9-4.0), respectively; for emergency room use, the corresponding odds ratios are 1.3 (1.1-1.4), 1.9 (1.6-2.1), and 2.9 (2.6-3.3). Similar findings were replicated among smaller populations of 1061 mostly older patients from nine private practices and 4428 Medicaid patients without chronic conditions. In contrast to complex computer-generated risk models, the brief patient-reported "What Matters Index" immediately and unambiguously identifies fundamental, remediable needs for each patient and more sensibly directs the delivery of services to patient categories based on

Psychotic-spectrum symptoms, cumulative adversity exposure and substance use among high-risk girls.

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Lansing, Amy E; Plante, Wendy Y; Fennema-Notestine, Christine; Golshan, Shahrokh; Beck, Audrey N

2018-02-01

Psychotic-spectrum symptoms are linked to trauma, substance/alcohol use (SAU), criminality/violence and poor functional outcomes, supporting the need for early detection in vulnerable populations. To better understand high-risk girls' mental health, we assessed: (1) psychotic-spectrum symptoms; (2) cumulative trauma, adversity and loss exposures (C-TALE) and adversity-indicators (symptoms, maladaptive coping, stressor-reactivity); and SAU risk-factors; and (3) relationships among psychotic-spectrum symptoms, adversity-indicators and SAU risk-factors. We administered the Structured Clinical Interviews for Psychotic Spectrum, and Trauma and Loss Spectrum to 158 adolescent delinquent girls. Girls' psychotic-spectrum profiles were similar to previously reported adult psychotic patients and characterized by typical symptoms (hallucinations/delusions, reported largely SAU-independent), interpersonal sensitivity, schizoid traits and paranoia (over-interpretation, anger over-reactivity, hypervigilance). Auditory/visual hallucinations (55.7%), delusions (92.4%), ideas of reference (96.8%) and adversity (90.0% ≥10/24 C-TALE-types) were common. Mean loss (4) and trauma (8) onset-age occurred before SAU-onset (12). Significant positive correlations were found among psychotic-spectrum symptoms, stressor-reactivity, C-TALE, adversity-indicators; and number of SAU-types; and a negative correlation occurred between psychotic-spectrum symptoms and earlier alcohol use onset. After controlling for number of SAU-types, stressor-reactivity and adversity-related numbing individually had the largest associations with total psychotic-spectrum symptoms (b = 2.6-4.3). Girls averaged more than 4 maladaptive coping strategies (e.g., 24.8% attempted suicide) in response to adversity, amplifying potential health-disparities. No racial/ethnic differences emerged on psychotic-spectrum symptoms. This symptom constellation during adolescence likely interferes with social and academic

Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment with Ankle Brachial Index in Adults

Science.gov (United States)

... Force Recommendations Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment with Ankle Brachial Index in Adults ... on Screening for Peripheral Artery Disease (PAD) and Cardiovascular Disease (CVD) Risk Assessment with Ankle Brachial Index (ABI) ...

Biomechanical rupture risk assessment of abdominal aortic aneurysms based on a novel probabilistic rupture risk index.

Science.gov (United States)

Polzer, Stanislav; Gasser, T Christian

2015-12-06

A rupture risk assessment is critical to the clinical treatment of abdominal aortic aneurysm (AAA) patients. The biomechanical AAA rupture risk assessment quantitatively integrates many known AAA rupture risk factors but the variability of risk predictions due to model input uncertainties remains a challenging limitation. This study derives a probabilistic rupture risk index (PRRI). Specifically, the uncertainties in AAA wall thickness and wall strength were considered, and wall stress was predicted with a state-of-the-art deterministic biomechanical model. The discriminative power of PRRI was tested in a diameter-matched cohort of ruptured (n = 7) and intact (n = 7) AAAs and compared to alternative risk assessment methods. Computed PRRI at 1.5 mean arterial pressure was significantly (p = 0.041) higher in ruptured AAAs (20.21(s.d. 14.15%)) than in intact AAAs (3.71(s.d. 5.77)%). PRRI showed a high sensitivity and specificity (discriminative power of 0.837) to discriminate between ruptured and intact AAA cases. The underlying statistical representation of stochastic data of wall thickness, wall strength and peak wall stress had only negligible effects on PRRI computations. Uncertainties in AAA wall stress predictions, the wide range of reported wall strength and the stochastic nature of failure motivate a probabilistic rupture risk assessment. Advanced AAA biomechanical modelling paired with a probabilistic rupture index definition as known from engineering risk assessment seems to be superior to a purely deterministic approach. © 2015 The Author(s).

Are all risks equal? Early experiences of poverty-related risk and children's functioning.

Science.gov (United States)

Roy, Amanda L; Raver, C Cybele

2014-06-01

Using cumulative risk and latent class analysis (LCA) models, we examined how exposure to deep poverty (income-to-needs ratio risks (i.e., single-parent household, residential crowding, caregiver depression, and multiple life stressors) in preschool is related to children's future difficulty in school in a longitudinal sample of 602 Head Start-enrolled, low-income families. Results from the LCA revealed 4 risk profiles: low risk, deep poverty and single, single and stressed, and deep poverty and crowded household. Tests of measurement invariance across racial/ethnic groups established that, although patterns of risk are similar across groups (i.e., risks covary in the same way), the prevalence of risk profiles differs. African American families were overrepresented in the "deep poverty and single" profile while Latino and White families were overrepresented in the "deep poverty and crowded" profile. Finally, children's third grade functioning in 3 domains (i.e., academic performance, behavior problems, and self-regulatory skills) was predicted using a cumulative risk index and LCA-identified risk profiles. Both approaches demonstrated that children who experienced higher levels of risk in preschool had worse school performance than children with low levels of risk. However, LCA also revealed that children who experienced "single and stressed" family settings had more behavior problems than low-risk children while children who experienced "deep poverty and crowded" family settings had worse academic performance. The results indicate that all risks are not equal for children's development and highlight the utility of LCA for tailoring intervention efforts to best meet the needs of target populations. PsycINFO Database Record (c) 2014 APA, all rights reserved

Poverty Risk Index as A New Methodology for Social Inequality Distribution Assessment

Science.gov (United States)

Swiader, Małgorzata; Szewrański, Szymon; Kazak, Jan

2017-10-01

The paper presents new concept of poverty risk index measurement due to dynamics of urban development among years. The rapid urbanization could seriously surpass the capacity of the most cities, which may lead to insufficient services of their inhabitants. Consequence of this situation could be polarized, social differentiated cities with high rates of urban poverty. The measurement and analysis of urban poverty phenomenon requires the dedicated tools and techniques. The data based assessment could allow planners and public policy makers to develop more socially integrated cities. This paper presents analysis of urban poverty phenomenon in Wrocław city (Poland) during period 2010-2012. This analysis was conducted for ten Social Assistance Terrain Units (SATU) delineated at the city area. Our primary study objective concerns the proposal and calculation of poverty risk index based on diagnostic features, which represent the most common causes of social benefits granting, as: number of single households granted permanent benefits, number of people in families granted permanent benefits, number of people in families granted temporary benefits due to unemployment, number of people in families granted temporary benefits due to disability, number of people in families granted meals for children. The calculation was conducted by using the theory of development pattern - Hellwig’s economic development measure. The analysis of poverty risk index showed that commonly the central and south-eastern part of the city is characterized by the highest poverty risk index. The obtained results of the inequalities spatial distribution relate to European and American patterns of poverty concentration in urban structures.

Cumulative Head Impact Exposure Predicts Later-Life Depression, Apathy, Executive Dysfunction, and Cognitive Impairment in Former High School and College Football Players.

Science.gov (United States)

Montenigro, Philip H; Alosco, Michael L; Martin, Brett M; Daneshvar, Daniel H; Mez, Jesse; Chaisson, Christine E; Nowinski, Christopher J; Au, Rhoda; McKee, Ann C; Cantu, Robert C; McClean, Michael D; Stern, Robert A; Tripodis, Yorghos

2017-01-15

The term "repetitive head impacts" (RHI) refers to the cumulative exposure to concussive and subconcussive events. Although RHI are believed to increase risk for later-life neurological consequences (including chronic traumatic encephalopathy), quantitative analysis of this relationship has not yet been examined because of the lack of validated tools to quantify lifetime RHI exposure. The objectives of this study were: 1) to develop a metric to quantify cumulative RHI exposure from football, which we term the "cumulative head impact index" (CHII); 2) to use the CHII to examine the association between RHI exposure and long-term clinical outcomes; and 3) to evaluate its predictive properties relative to other exposure metrics (i.e., duration of play, age of first exposure, concussion history). Participants included 93 former high school and collegiate football players who completed objective cognitive and self-reported behavioral/mood tests as part of a larger ongoing longitudinal study. Using established cutoff scores, we transformed continuous outcomes into dichotomous variables (normal vs. impaired). The CHII was computed for each participant and derived from a combination of self-reported athletic history (i.e., number of seasons, position[s], levels played), and impact frequencies reported in helmet accelerometer studies. A bivariate probit, instrumental variable model revealed a threshold dose-response relationship between the CHII and risk for later-life cognitive impairment (p < 0.0001), self-reported executive dysfunction (p < 0.0001), depression (p < 0.0001), apathy (p = 0.0161), and behavioral dysregulation (p < 0.0001). Ultimately, the CHII demonstrated greater predictive validity than other individual exposure metrics.

An index for drought induced financial risk in the mining industry

Science.gov (United States)

Bonnafous, L.; Lall, U.; Siegel, J.

2017-02-01

Water scarcity has emerged as a potential risk for mining operations. High capital spending for desalination and water conflicts leading to asset stranding have recently occurred. Investors in mining companies are interested in the exposure to such risks across portfolios of mining assets (whether the practical at-site consequences are foregone production, higher OPEX and CAPEX and ensuing lost revenues, or asset-stranding). In this paper, an index of the potential financial exposure of a portfolio is developed and its application is illustrated. Since the likely loss at each mine is hard to estimate a priori, one needs a proxy for potential loss. The index considers drought duration, severity and frequency (defined by a return-level in years) at each mining asset, and provides a measure of financial exposure through weighing of production or Net Asset Value. Changes in human needs are not considered, but are relevant, and could be incorporated if global data on mine and other water use were available at the appropriate resolution. Potential for contemporaneous drought incidence across sites in a portfolio is considered specifically. Through an appropriate choice of drought thresholds, an analyst can customize a scenario to assess potential losses in production value or profits, or whether conflicts could emerge that would lead to stranded assets or capital expenditure to secure alternate water supplies. Global climate data sets that allow a customized development of such an index are identified, and selected mining company portfolios are scored as to the risk associated with one publicly available drought index.

Family Income, Cumulative Risk Exposure, and White Matter Structure in Middle Childhood

Directory of Open Access Journals (Sweden)

Alexander J. Dufford

2017-11-01

Full Text Available Family income is associated with gray matter morphometry in children, but little is known about the relationship between family income and white matter structure. In this paper, using Tract-Based Spatial Statistics, a whole brain, voxel-wise approach, we examined the relationship between family income (assessed by income-to-needs ratio and white matter organization in middle childhood (N = 27, M = 8.66 years. Results from a non-parametric, voxel-wise, multiple regression (threshold-free cluster enhancement, p < 0.05 FWE corrected indicated that lower family income was associated with lower white matter organization [assessed by fractional anisotropy (FA] for several clusters in white matter tracts involved in cognitive and emotional functions including fronto-limbic circuitry (uncinate fasciculus and cingulum bundle, association fibers (inferior longitudinal fasciculus, superior longitudinal fasciculus, and corticospinal tracts. Further, we examined the possibility that cumulative risk (CR exposure might function as one of the potential pathways by which family income influences neural outcomes. Using multiple regressions, we found lower FA in portions of these tracts, including those found in the left cingulum bundle and left superior longitudinal fasciculus, was significantly related to greater exposure to CR (β = -0.47, p < 0.05 and β = -0.45, p < 0.05.

An exposure-based framework for grouping pollutants for a cumulative risk assessment approach: case study of indoor semi-volatile organic compounds.

Science.gov (United States)

Fournier, Kevin; Glorennec, Philippe; Bonvallot, Nathalie

2014-04-01

Humans are exposed to a large number of contaminants, many of which may have similar health effects. This paper presents a framework for identifying pollutants to be included in a cumulative risk assessment approach. To account for the possibility of simultaneous exposure to chemicals with common toxic modes of action, the first step of the traditional risk assessment process, i.e. hazard identification, is structured in three sub-steps: (1a) Identification of pollutants people are exposed to, (1b) identification of effects and mechanisms of action of these pollutants, (1c) grouping of pollutants according to similarity of their mechanism of action and health effects. Based on this exposure-based grouping we can derive "multi-pollutant" toxicity reference values, in the "dose-response assessment" step. The approach proposed in this work is original in that it is based on real exposures instead of a limited number of pollutants from a unique chemical family, as traditionally performed. This framework is illustrated by the case study of semi-volatile organic compounds in French dwellings, providing insights into practical considerations regarding the accuracy of the available toxicological information. This case study illustrates the value of the exposure-based approach as opposed to the traditional cumulative framework, in which chemicals with similar health effects were not always included in the same chemical class. Copyright © 2014 Elsevier Inc. All rights reserved.

Development of a risk index for the prediction of chronic post-surgical pain.

Science.gov (United States)

Althaus, A; Hinrichs-Rocker, A; Chapman, R; Arránz Becker, O; Lefering, R; Simanski, C; Weber, F; Moser, K-H; Joppich, R; Trojan, S; Gutzeit, N; Neugebauer, E

2012-07-01

The incidence of chronic post-surgical pain (CPSP) after various common operations is 10% to 50%. Identification of patients at risk of developing chronic pain, and the management and prevention of CPSP remains inadequate. The aim of this study was to develop an easily applicable risk index for the detection of high-risk patients that takes into account the multifactorial aetiology of CPSP. A comprehensive item pool was derived from a systematic literature search. Items that turned out significant in bivariate analyses were then analysed multivariately, using logistic regression analyses. The items that yielded significant predictors in the multivariate analyses were compiled into an index. The cut-off score for a high risk of developing CPSP with an optimal trade-off between sensitivity and specificity was identified. The data of 150 patients who underwent different types of surgery were included in the analyses. Six months after surgery, 43.3% of the patients reported CPSP. Five predictors multivariately contributed to the prediction of CPSP: capacity overload, preoperative pain in the operating field, other chronic preoperative pain, post-surgical acute pain and co-morbid stress symptoms. These results suggest that several easily assessable preoperative and perioperative patient characteristics can predict a patient's risk of developing CPSP. The risk index may help caregivers to tailor individual pain management and to assist high-risk patients with pain coping. © 2011 European Federation of International Association for the Study of Pain Chapters.

Association Between Cumulative Psychosocial Risk and Cervical Human Papillomavirus Infection Among Female Adolescents in a Free Vaccination Program.

Science.gov (United States)

Linares, Lourdes Oriana; Shankar, Viswanathan; Diaz, Angela; Nucci-Sack, Anne; Strickler, Howard D; Peake, Ken; Weiss, Jocelyn; Burk, Robert D; Schlecht, Nicolas F

2015-10-01

This study investigated the association of cervical human papillomavirus (HPV) infection with cumulative psychosocial risk reflecting family disadvantage, psychological distress, and unhealthy lifestyle. The sample (N = 745) comprised sexually active female adolescent patients (12-19 yr), primarily ethnic minorities, enrolled in a free HPV vaccination program. Subjects completed questionnaires and provided cervical swabs for HPV DNA testing. Unweighted and weighted principal component analyses for categorical data were used to derive multisystemic psychosocial risk indices using 9 indicators: low socioeconomic status, lack of adult involvement, not attending high school/college, history of treatment for depression/anxiety, antisocial/delinquent behavior, number of recent sexual partners, use of alcohol, use of drugs, and dependency risk for alcohol/drugs. The association between cervical HPV (any type, high-risk types, vaccine types) assayed by polymerase chain reaction and self-reported number of psychosocial risk indicators was estimated using multivariable logistic regression. Subjects had a median of 3 psychosocial risk indicators. Multiple logistic regression analyses showed associations with unweighted and weighted number of psychosocial indicators for HPV any type (adjusted odds ratio [aOR] = 1.1; 95% confidence interval [CI], 1.0-1.2), with the strongest associations between weighted drug/alcohol use, drug/alcohol dependency risk, and antisocial/delinquent behavior and detection of HPV vaccine types (aOR = 1.5; 95% CI, 1.1-2.0) independent of number of recent sexual partners and vaccine dose (0-3). Increased HPV infections including HPV vaccine types were associated with greater number of psychosocial risk indicators even after controlling for demographics, sexual behavior, history of chlamydia, and vaccine dose.

Advanced atherogenic index for the assessment of consolidated lipid risk in premature coronary artery disease patients in India

Directory of Open Access Journals (Sweden)

Sanjiv Kumar Bansal

2016-01-01

Full Text Available Introduction: The high prevalence, severity, and prematurity of coronary artery disease (CAD in the Indian population cannot be completely explained by the conventional lipid parameters and the existing lipid indices. Aims and Objectives: To calculate newly defined advanced atherogenic index (AAI in premature CAD patients and compare it between cases and controls and Correlate its values with the existing indices. Material and Methods: One hundred and twenty premature CAD patients and an equal number of age and sex matched healthy individuals were included in this study. Lipid profile and nonconventional lipid parameters like oxidized Low density lipoprotein (OX LDL, small dense LDL (SD LDL, lipoprotein (a apolipoprotein B (Apo B, and apolipoprotein A1 (Apo A1 were estimated and their values were used to define AAI and existing lipid indices like AI, lipid tetrad index (LTI and lipid pentad index (LPI. Results: The mean age of cases and controls was 37.29 + 4.50 and 36.13 + 3.53 years, respectively. The value of AAI was highly significant in cases (3461.22 ± 45.20 as compared to controls (305.84 ± 21.80. AAI has shown better statistical significance and correlation (P < 0.0001, r = 0.737 as compared to the earlier indices such as AI (P < 0.01, r = 0.52, LTI (P < 0.001, r = 0.677 and LPI (P < 0.001, r = 0.622 in premature CAD. Kolmogorov D statistic and cumulative distribution function plot has shown that AAI can discriminate cases and controls more accurately as compared to the earlier indices. Conclusion: Statistically AAI appears to be a better marker of consolidated lipid risk in premature CAD patients as compared to the earlier indices.

A Case Study Application of the Aggregate Exposure Pathway (AEP) and Adverse Outcome Pathway (AOP) Frameworks to Facilitate the Integration of Human Health and Ecological End Points for Cumulative Risk Assessment (CRA)

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Cumulative risk assessment (CRA) methods promote the use of a conceptual site model (CSM) to apportion exposures and integrate risk from multiple stressors. While CSMs may encompass multiple species, evaluating end points across taxa can be challenging due to data availability an...

Human Health Risk from Metals in Fish from Saudi Arabia: Consumption Patterns for Some Species Exceed Allowable Limits

KAUST Repository

Burger, Joanna

2014-10-06

ABSTRACT: Fish are a healthful source of protein, but contaminants in some fish pose a risk. While there are multiple risk assessments from Europe and North America, there are far fewer for other parts of the world. We examined the risks from mercury, arsenic, lead, and other metals in fish consumed by people in Jeddah area, Saudi Arabia, using site-specific data on consumption patterns and metal levels in fish. The U.S. Environmental Protection Agency\\'s Hazard Quotient (HQ) and cumulative Hazard Index (HI) for non-cancer endpoints and Carcinogenic Index for cancer were used to determine the health risk based on fish consumption rates. Of the 13 fish species examined, HQ was greater than 1 (indicating elevated risk) in two species for arsenic, and seven species for methylmercury. The cumulative HI for all metals was above 1 for all but three species of fish at the mean consumption rates. Generally, fish species with HI above 1 for one sampling location, had HI above 1 for all sampling locations. The implications of these findings are discussed in the light of strategies for reducing risk from fish consumption while encouraging dietary intakes of fish with low mercury and arsenic levels.

Cumulative absolute breast cancer risk for young women treated for Hodgkin lymphoma

NARCIS (Netherlands)

Travis, L.B.; Hill, D.A.; Dores, G.M.; Gospodarowicz, M.; Leeuwen, van F.E.; Holowaty, E.; Glimelius, B.; Andersson, M.; Pukkala, E.; Lynch, C.F.; Pee, D.; Smith, S.A.; Veer, van 't M.B.; Joensuu, T.; Storm, H.; Stovall, M.; Boice, J.D.,Jr.; Gilbert, E.; Gail, M.H.

2005-01-01

or = 40 Gy) and use of alkylating agents (yes or no) were estimated from a case-control study conducted within an international population-based cohort of 3817 female 1-year survivors of HL diagnosed at age 30 years or younger from January 1, 1965, through December 31, 1994. To compute cumulative

Definition and GIS-based characterization of an integral risk index applied to a chemical/petrochemical area.

Science.gov (United States)

Nadal, Martí; Kumar, Vikas; Schuhmacher, Marta; Domingo, José L

2006-08-01

A risk map of the chemical/petrochemical industrial area of Tarragona (Catalonia, Spain) was designed following a two-stage procedure. The first step was the creation of a ranking system (Hazard Index) for a number of different inorganic and organic pollutants: heavy metals, polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), polychlorinated biphenyls (PCBs) and polychlorinated aromatic hydrocarbons (PAHs) by applying self-organizing maps (SOM) to persistence, bioaccumulation and toxicity properties of the chemicals. PCBs seemed to be the most hazardous compounds, while the light PAHs showed the minimum values. Subsequently, an Integral Risk Index was developed taking into account the Hazard Index and the concentrations of all pollutants in soil samples collected in the assessed area of Tarragona. Finally, a risk map was elaborated by representing the spatial distribution of the Integral Risk Index with a geographic information system (GIS). The results of the present study seem to indicate that the development of an integral risk map might be useful to help in making-decision processes concerning environmental pollutants.

Hedging with stock index futures: downside risk versus the variance

NARCIS (Netherlands)

Brouwer, F.; Nat, van der M.

1995-01-01

In this paper we investigate hedging a stock portfolio with stock index futures.Instead of defining the hedge ratio as the minimum variance hedge ratio, we considerseveral measures of downside risk: the semivariance according to Markowitz [ 19591 andthe various lower partial moments according to

Development of a risk prediction model for lung cancer: The Japan Public Health Center-based Prospective Study.

Science.gov (United States)

Charvat, Hadrien; Sasazuki, Shizuka; Shimazu, Taichi; Budhathoki, Sanjeev; Inoue, Manami; Iwasaki, Motoki; Sawada, Norie; Yamaji, Taiki; Tsugane, Shoichiro

2018-03-01

Although the impact of tobacco consumption on the occurrence of lung cancer is well-established, risk estimation could be improved by risk prediction models that consider various smoking habits, such as quantity, duration, and time since quitting. We constructed a risk prediction model using a population of 59 161 individuals from the Japan Public Health Center (JPHC) Study Cohort II. A parametric survival model was used to assess the impact of age, gender, and smoking-related factors (cumulative smoking intensity measured in pack-years, age at initiation, and time since cessation). Ten-year cumulative probability of lung cancer occurrence estimates were calculated with consideration of the competing risk of death from other causes. Finally, the model was externally validated using 47 501 individuals from JPHC Study Cohort I. A total of 1210 cases of lung cancer occurred during 986 408 person-years of follow-up. We found a dose-dependent effect of tobacco consumption with hazard ratios for current smokers ranging from 3.78 (2.00-7.16) for cumulative consumption ≤15 pack-years to 15.80 (9.67-25.79) for >75 pack-years. Risk decreased with time since cessation. Ten-year cumulative probability of lung cancer occurrence estimates ranged from 0.04% to 11.14% in men and 0.07% to 6.55% in women. The model showed good predictive performance regarding discrimination (cross-validated c-index = 0.793) and calibration (cross-validated χ 2 = 6.60; P-value = .58). The model still showed good discrimination in the external validation population (c-index = 0.772). In conclusion, we developed a prediction model to estimate the probability of developing lung cancer based on age, gender, and tobacco consumption. This model appears useful in encouraging high-risk individuals to quit smoking and undergo increased surveillance. © 2018 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association.

Body mass index and risk of autoimmune diseases

DEFF Research Database (Denmark)

Harpsøe, Maria C; Basit, Saima; Andersson, Mikael

2014-01-01

.57) and type 1 diabetes mellitus (HR 2.67; 95% CI, 1.71 to 4.17). Risk of dermatitis herpetiformis increased by 14% (95% CI, 1% to 30%) per BMI unit. Conversely, risk of celiac disease and Raynaud's phenomenon decreased by 7% (95% CI, 1% to 13%) and 12% (95% CI, 4% to 19%) per BMI unit, respectively. Further......BACKGROUND: A possible aetiological link between obesity and certain autoimmune diseases (ADs) has been suggested. We investigated the associations between body mass index (BMI, kg/m2) and 43 ADs. METHODS: 75,008 women participating in the Danish National Birth Cohort were followed during a median......-up, 2430 women (3.2%) developed a total of 2607 new-onset ADs. Risk of any autoimmune disease was increased in obese women (HR, 1.27; 95% CI, 1.11 to 1.46) compared with normal weight women (18.5-≤25 kg/m2). Obese women (BMI≥30 kg/m2) were at increased risk of sarcoidosis (HR 3.59; 95% CI, 2.31 to 5...

Climate Risk and Production Shocks: Using Index Insurance to Link Climate Science to Policy for Sustainable Development

Science.gov (United States)

McCarney, G. R.; Osgood, D. E.

2011-12-01

Smallholder farmers in developing countries are often severely impacted by droughts and other climate related events. However, agricultural insurance programs are largely unavailable in lower-income countries because of limitations in traditional loss-based indemnity insurance. As a result, it is often the case that farmers who are the most vulnerable to climate shocks lack access to the insurance tools that could help to reduce their production risk. Index insurance, a recent financial innovation, has the potential to increase access to insurance for smallholder farmers (Barrett et al. 2007). Index insurance allows farmers to insure their production risk based on a weather index (such as total seasonal rainfall) rather than on crop yields. The use of a weather index addresses many of the perverse incentive problems found in traditional crop insurance, and greatly reduces the costs of insuring smallholder farmers. The trade-off in index insurance, however, is limited accuracy in calibrating payouts to actual losses, a phenomenon commonly known as basis risk. While index insurance has promise as a risk-smoothing instrument, many argue it has greater promise as a mechanism for improving access to credit for smallholder farmers in developing countries (e.g. Barnett, Barrett & Skees 2008). In these areas, farmers are often fully exposed to climate shocks, which greatly affect their willingness to borrow. By smoothing the uncertainty in climate shocks, insurance may allow farmers to take credit for productive risks. There has been much discussion as to the optimal strategy for combining index insurance with credit, specifically if the financial institutions or the individual farmers themselves should hold the insurance policy. Many existing insurance implementations insure the farmer directly. However, since a weather index is a proxy for yield loss based on regional data, there is basis risk due to uninsured idiosyncratic differences between farmers. As a response to

Using the Steel Vessel Material-Cost Index to Mitigate Shipbuilder Risk

National Research Council Canada - National Science Library

Keating, Edward G; Murphy, Robert; Schank, John F; Birkler, John

2008-01-01

This paper describes how the US Navy structures fixed-price and fixed-price, incentive-fee shipbuilding contracts and how labor- and material-cost indexes can mitigate shipbuilder risk in either type of contract...

Cumulative effects of wind turbines. A guide to assessing the cumulative effects of wind energy development

Energy Technology Data Exchange (ETDEWEB)

NONE

2000-07-01

This guidance provides advice on how to assess the cumulative effects of wind energy developments in an area and is aimed at developers, planners, and stakeholders interested in the development of wind energy in the UK. The principles of cumulative assessment, wind energy development in the UK, cumulative assessment of wind energy development, and best practice conclusions are discussed. The identification and assessment of the cumulative effects is examined in terms of global environmental sustainability, local environmental quality and socio-economic activity. Supplementary guidance for assessing the principle cumulative effects on the landscape, on birds, and on the visual effect is provided. The consensus building approach behind the preparation of this guidance is outlined in the annexes of the report.

The challenge of cumulative impacts

Energy Technology Data Exchange (ETDEWEB)

Masden, Elisabeth

2011-07-01

Full text: As governments pledge to combat climate change, wind turbines are becoming a common feature of terrestrial and marine environments. Although wind power is a renewable energy source and a means of reducing carbon emissions, there is a need to ensure that the wind farms themselves do not damage the environment. There is particular concern over the impacts of wind farms on bird populations, and with increasing numbers of wind farm proposals, the concern focuses on cumulative impacts. Individually, a wind farm, or indeed any activity/action, may have minor effects on the environment, but collectively these may be significant, potentially greater than the sum of the individual parts acting alone. Cumulative impact assessment is a legislative requirement of environmental impact assessment but such assessments are rarely adequate restricting the acquisition of basic knowledge about the cumulative impacts of wind farms on bird populations. Reasons for this are numerous but a recurring theme is the lack of clear definitions and guidance on how to perform cumulative assessments. Here we present a conceptual framework and include illustrative examples to demonstrate how the framework can be used to improve the planning and execution of cumulative impact assessments. The core concept is that explicit definitions of impacts, actions and scales of assessment are required to reduce uncertainty in the process of assessment and improve communication between stake holders. Only when it is clear what has been included within a cumulative assessment, is it possible to make comparisons between developments. Our framework requires improved legislative guidance on the actions to include in assessments, and advice on the appropriate baselines against which to assess impacts. Cumulative impacts are currently considered on restricted scales (spatial and temporal) relating to individual development assessments. We propose that benefits would be gained from elevating cumulative

Quantitative Relationship Between Cumulative Risk Alleles Based on Genome-Wide Association Studies and Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis

Directory of Open Access Journals (Sweden)

Satoru Kodama

2018-01-01

Full Text Available Many epidemiological studies have assessed the genetic risk of having undiagnosed or of developing type 2 diabetes mellitus (T2DM using several single nucleotide polymorphisms (SNPs based on findings of genome-wide association studies (GWAS. However, the quantitative association of cumulative risk alleles (RAs of such SNPs with T2DM risk has been unclear. The aim of this meta-analysis is to review the strength of the association between cumulative RAs and T2DM risk. Systematic literature searches were conducted for cross-sectional or longitudinal studies that examined odds ratios (ORs for T2DM in relation to genetic profiles. Logarithm of the estimated OR (log OR of T2DM for 1 increment in RAs carried (1-ΔRA in each study was pooled using a random-effects model. There were 46 eligible studies that included 74,880 cases among 249,365 participants. In 32 studies with a cross-sectional design, the pooled OR for T2DM morbidity for 1-ΔRA was 1.16 (95% confidence interval [CI], 1.13–1.19. In 15 studies that had a longitudinal design, the OR for incident T2DM was 1.10 (95% CI, 1.08–1.13. There was large heterogeneity in the magnitude of log OR (P < 0.001 for both cross-sectional studies and longitudinal studies. The top 10 commonly used genes significantly explained the variance in the log OR (P = 0.04 for cross-sectional studies; P = 0.006 for longitudinal studies. The current meta-analysis indicated that carrying 1-ΔRA in T2DM-associated SNPs was associated with a modest risk of prevalent or incident T2DM, although the heterogeneity in the used genes among studies requires us to interpret the results with caution.

The Role of Age and Excess Body Mass Index in Progression to Type 1 Diabetes in At-Risk Adults.

Science.gov (United States)

Ferrara, Christine T; Geyer, Susan M; Evans-Molina, Carmella; Libman, Ingrid M; Becker, Dorothy J; Wentworth, John M; Moran, Antoinette; Gitelman, Stephen E; Redondo, Maria J

2017-12-01

Given the global rise in both type 1 diabetes incidence and obesity, the role of body mass index (BMI) on type 1 diabetes pathophysiology has gained great interest. Sustained excess BMI in pediatric participants of the TrialNet Pathway to Prevention (PTP) cohort increased risk for progression to type 1 diabetes, but the effects of age and obesity in adults remain largely unknown. To determine the effect of age and sustained obesity on the risk for type 1 diabetes in adult participants in the TrialNet PTP cohort (i.e., nondiabetic autoantibody-positive relatives of patients with type 1 diabetes). Longitudinally accumulated BMI >25 kg/m2 was calculated to generate a cumulative excess BMI (ceBMI) for each participant, with ceBMI values ≥0 kg/m2 and ≥5 kg/m2 representing sustained overweight or obese status, respectively. Recursive partitioning analysis yielded sex- and age-specific thresholds for ceBMI that confer the greatest risk for type 1 diabetes progression. In this cohort of 665 adults (age 20 to 50 years; median follow-up, 3.9 years), 49 participants developed type 1 diabetes. Age was an independent protective factor for type 1 diabetes progression (hazard ratio, 0.95; P = 0.008), with a threshold of >35 years that reduced risk for type 1 diabetes. In men age >35 years and women age <35 years, sustained obesity (ceBMI ≥5 kg/m2) increased the risk for type 1 diabetes. Age is an important factor for type 1 diabetes progression in adults and influences the impact of elevated BMI, indicating an interplay of excess weight, age, and sex in adult type 1 diabetes pathophysiology. Copyright © 2017 Endocrine Society

Cumulative reproductive effects of in utero administration of mixtures of antiandrogens in male SD rats: synergy or additivity?

Science.gov (United States)

In 1996 the USEPA was charged under the FQPA to consider the cumulative effects of chemicals in their risk assessments. Our studies were conducted to provide a framework for assessing the cumulative effects of antiandrogens. Toxicants were administered individually or as mixtures...

Pre-prepregnancy body mass index and the risk of gestational diabetes mellitus

Directory of Open Access Journals (Sweden)

Rudić-Grujić Vesna

2017-01-01

Full Text Available Introduction/Objective. Not only do pre-pregnancy overweight or obesity increase the risk of adverse maternal and perinatal outcomes but they also lead to the development of gestational diabetes mellitus. The objective of this study was to estimate the prevalence of pre-pregnancy overweight and obesity in the Republic of Srpska and to investigate its association with hyperglycemia and risk of gestational diabetes mellitus. Methods. A cross-sectional study was carried out during the period from February to October 2012 among 555 pregnant women in gestational period from 24 to 28 weeks. The criterion for exclusion from the sample was previously diagnosed type 1 or type 2 diabetes. Results. Before pregnancy, 20.39% of participants had increased body mass index, while 4.04 % [95% confidence interval (CI; 2.62–6.13] were obese. Gestational diabetes mellitus was diagnosed in 10.91% (95% CI, 8.44–13.98 of them. The increase in body mass index by 1 increased the risk of gestational diabetes mellitus by 1.09 times [odds ratio (OR = 1.09; 95% CI; 1.02–1.16]. Pregnant women who were overweight had a 4.88 times greater risk (OR = 4.88; 95% CI, 1.23–29.41 of developing gestational diabetes. Conclusion. Every fifth pregnant woman in this study was overweight or obese before pregnancy. The increase in body mass index by 1 increased the risk of gestational diabetes by 1.09 times (OR = 1.09; 95% CI; 1.02–1.16. Counselling is necessary for overweight and obese women planning pregnancy.

Safety criteria: Intercomparison and aggregation of risks

International Nuclear Information System (INIS)

Yadigaroglu, G.

1987-08-01

Review of the assumptions underlying the use of limit lines in nuclear regulation and risk comparisons led to an alternative approach, where frequency-consequence curves are divided into two components: number of accidents during a specified time period and consequences conditional upon the occurrence of an unwanted event. This approach leads to a neat separation between natural and technological disasters. To compare probability distributions when stochastic dominance principles are not applicable, risk indices based on a linearized moments model (LMM) were established. The LMM permits explicit introduction of individual, societal or group opinions, thus incorporating the various perceptions of risks by society directly into the evaluation process. A questionnaire was applied to elicit empirical data which were then compared with the predictions of the linearized moments model. Furthermore the LMM also allows the comparison of events in those cases where the cumulative probability distributions cross each other. For the evaluation of a probability distribution that crosses the limit line, the risk index of the limit line (calculated by using the LMM) should be compared to the index of the accident under consideration

Predictive Value of Triglyceride Glucose Index for the Risk of Incident Diabetes: A 4-Year Retrospective Longitudinal Study.

Science.gov (United States)

Lee, Da Young; Lee, Eun Seo; Kim, Ji Hyun; Park, Se Eun; Park, Cheol-Young; Oh, Ki-Won; Park, Sung-Woo; Rhee, Eun-Jung; Lee, Won-Young

The Triglyceride Glucose Index (TyG index) is considered a surrogate marker of insulin resistance. The aim of this study is to investigate whether the TyG index has a predictive role in identifying individuals with a high risk of incident diabetes and to compare it with other indicators of metabolic health. A total 2900 non-diabetic adults who attended five consecutive annual health check-ups at Kangbuk Samsung Hospital was divided into four subgroups using three methods: (1) baseline TyG index; (2) obesity status (body mass index ≥25 kg/m2) and cutoff value of TyG index; (3) obesity status and metabolic health, defined as having fewer than two of the five components of high blood pressure, fasting blood glucose, triglyceride, low high-density lipoprotein cholesterol, and highest decile of homeostasis model assessment-insulin resistance. The development of diabetes was assessed annually using self-questionnaire, fasting glucose, and glycated hemoglobin. We compared the risk of incident diabetes using multivariate Cox analysis. During 11623 person-years there were 101 case of incident diabetes. Subjects with high TyG index had a high risk of diabetes. For TyG index quartiles, hazard ratios (HRs) of quartiles 3 and 4 were 4.06 (p = 0.033) and 5.65 (p = 0.006) respectively. When the subjects were divided by obesity status and cutoff value of TyG index of 8.8, the subgroups with TyG index ≥ 8.8 regardless of obesity had a significantly high risk for diabetes (HR 2.40 [p = 0.024] and 2.25 [p = 0.048]). For obesity status and metabolic health, the two metabolically unhealthy subgroups regardless of obesity had a significantly high risk for diabetes (HRs 2.54 [p = 0.024] and 2.73 [p = 0.021]). In conclusion, the TyG index measured at a single time point may be an indicator of the risk for incident diabetes. The predictive value of the TyG index was comparable to that of metabolic health.

The construction of power grid operation index system considering the risk of maintenance

Science.gov (United States)

Tang, Jihong; Wang, Canlin; Jiang, Xinfan; Ye, Jianhui; Pan, Feilai

2018-02-01

In recent years, large-scale blackout occurred at home and abroad caused widespread concern about the operation of the grid in the world, and the maintenance risk is an important indicator of grid safety. The barrier operation of the circuit breaker exists in the process of overhaul of the power grid. The operation of the different barrier is of great significance to the change of the power flow, thus affecting the safe operation of the system. Most of the grid operating status evaluation index system did not consider the risk of maintenance, to this end, this paper from the security, economy, quality and cleanliness of the four angles, build the power grid operation index system considering the risk of maintenance.

The Association between Cumulative Psychosocial Risk and Cervical HPV Infection Among Female Adolescents in a Free Vaccination Program

Science.gov (United States)

Linares, Lourdes Oriana; Shankar, Viswanathan; Diaz, Angela; Nucci-Sack, Anne; Strickler, Howard D.; Peake, Ken; Weiss, Jocelyn; Burk, Robert D.; Schlecht, Nicolas F.

2016-01-01

Objective This study investigated the association of cervical Human Papillomavirus (HPV) infection with cumulative psychosocial risk reflecting family disadvantage, psychological distress, and unhealthy life style. Methods The sample (N=745) was comprised of sexually-active female adolescent patients (12-19 years), primarily ethnic minorities, enrolled in a free HPV vaccination program. Subjects completed questionnaires and provided cervical swabs for HPV DNA testing. Unweighted and weighted Principal Component Analyses (PCA) for categorical data were used to derive multi-systemic psychosocial risk indices using nine indicators: low socioeconomic status, lack of adult involvement, not attending high-school/college, history of treatment for depression/anxiety, antisocial/delinquent behavior, number of recent sexual partners, use of alcohol, use of drugs, and dependency risk for alcohol/drugs. The association between cervical HPV (any-type, high risk-types, vaccine-types) assayed by polymerase chain reaction and self-reported number of psychosocial risk indicators was estimated using multivariable logistic regression. Results Subjects had a median of three psychosocial risk indicators. Multiple logistic regression analyses showed associations with unweighted and weighted number of psychosocial indicators for HPV any-type (adjusted odds ratio [aOR]=1.1; 95% confidence interval [CI]: 1.0-1.2 ); with the strongest associations between weighted drug/alcohol use, drug/alcohol dependency risk, and antisocial/delinquent behavior and detection of HPV vaccine-types (aOR=1.5; 95%CI: 1.1-2.0) independent of number of recent sexual partners and vaccine dose (0-3). Conclusion Increased HPV infections including HPV vaccine-types were associated with greater number of psychosocial risk indicators even after controlling for demographics, sexual behavior, history of chlamydia, and vaccine dose. PMID:25985216

Study of cumulative fatigue damage detection for used parts with nonlinear output frequency response functions based on NARMAX modelling

Science.gov (United States)

Huang, Honglan; Mao, Hanying; Mao, Hanling; Zheng, Weixue; Huang, Zhenfeng; Li, Xinxin; Wang, Xianghong

2017-12-01

Cumulative fatigue damage detection for used parts plays a key role in the process of remanufacturing engineering and is related to the service safety of the remanufactured parts. In light of the nonlinear properties of used parts caused by cumulative fatigue damage, the based nonlinear output frequency response functions detection approach offers a breakthrough to solve this key problem. First, a modified PSO-adaptive lasso algorithm is introduced to improve the accuracy of the NARMAX model under impulse hammer excitation, and then, an effective new algorithm is derived to estimate the nonlinear output frequency response functions under rectangular pulse excitation, and a based nonlinear output frequency response functions index is introduced to detect the cumulative fatigue damage in used parts. Then, a novel damage detection approach that integrates the NARMAX model and the rectangular pulse is proposed for nonlinear output frequency response functions identification and cumulative fatigue damage detection of used parts. Finally, experimental studies of fatigued plate specimens and used connecting rod parts are conducted to verify the validity of the novel approach. The obtained results reveal that the new approach can detect cumulative fatigue damages of used parts effectively and efficiently and that the various values of the based nonlinear output frequency response functions index can be used to detect the different fatigue damages or working time. Since the proposed new approach can extract nonlinear properties of systems by only a single excitation of the inspected system, it shows great promise for use in remanufacturing engineering applications.

An internationally generalizable risk index for mortality after one year of antiretroviral therapy

NARCIS (Netherlands)

Tate, Janet P.; Justice, Amy C.; Hughes, Michael D.; Bonnet, Fabrice; Reiss, Peter; Mocroft, Amanda; Nattermann, Jacob; Lampe, Fiona C.; Bucher, Heiner C.; Sterling, Timothy R.; Crane, Heidi M.; Kitahata, Mari M.; May, Margaret; Sterne, Jonathan A. C.

2013-01-01

Despite the success of antiretroviral therapy (ART), excess mortality continues for those with HIV infection. A comprehensive approach to risk assessment, addressing multiorgan system injury on ART, is needed. We sought to develop and validate a practical and generalizable mortality risk index for

Associations of adversity in childhood and risk factors for cardiovascular disease in mid-adulthood.

Science.gov (United States)

Anderson, Emma L; Fraser, Abigail; Caleyachetty, Rishi; Hardy, Rebecca; Lawlor, Debbie A; Howe, Laura D

2018-02-01

Studies assessing associations of childhood psychosocial adversity (e.g. sexual abuse, physical neglect, parental death), as opposed to socioeconomic adversity, with cardiovascular disease (CVD) risk factors in adulthood are scarce. The aim of this study is to assess associations of various types of psychosocial adversity and cumulative adversity in childhood, with multiple CVD risk factors in mid-life. At study enrolment, women from the Avon Longitudinal Study of Parents and Children (N=3612) retrospectively reported: lack of maternal care, maternal overprotection, parental mental illness, household dysfunction, sexual abuse, physical and emotional abuse, and neglect in childhood. Approximately 23 years later, body mass index (BMI), waist circumference, systolic and diastolic blood pressure, plasma glucose, insulin, triglycerides, low and high density lipoprotein cholesterol, C-reactive protein, carotid intima-media thickness (cIMT) and arterial distensibility were assessed (mean age 51 years). We examined associations of each specific type of psychosocial adversity and cumulative adversity with CVD risk factors. No specific type of psychosocial adversity was consistently associated with the CVD risk factors. There was evidence that a one standard deviation greater cumulative psychosocial adversity was associated with 0.51cm greater waist circumference (95% confidence interval [CI]: 0.02cm, 1.00cm, p=0.04) and a lower arterial distensibility, even after adjustment for age, ethnicity and childhood and adult socioeconomic position. We found no consistent evidence that any specific type of psychosocial adversity, or cumulative psychosocial adversity in childhood, is associated with CVD risk factors in adult women. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

32 CFR 651.16 - Cumulative impacts.

Science.gov (United States)

2010-07-01

... 32 National Defense 4 2010-07-01 2010-07-01 true Cumulative impacts. 651.16 Section 651.16... § 651.16 Cumulative impacts. (a) NEPA analyses must assess cumulative effects, which are the impact on the environment resulting from the incremental impact of the action when added to other past, present...

Business risk assessment of the companies on the Mexican Stock Exchange’s sustainable index

Directory of Open Access Journals (Sweden)

José Antonio Morales Castro

2014-12-01

Full Text Available (Received: 2014/10/27 - Accepted: 2014/12/15This work evaluated the business risk change of 20 companies included on the sustainable index of the Mexican Stock Exchange (BMV. The unlevered beta coefficient was used for this analysis. Two periods were compared: the one before, and the one after including the companies on the index. For each of the 20 companies it was used financial information, stocks closing prices and the stock market index value, over a period of 234 weeks. Then, considering the two periods, the statistical difference between the unlevered beta coefficient averages was calculated. Finally, a hypothesis proof was made to evaluate the business risk change. It was found that for 12 out of the 20 companies, the unlevered beta coefficient suffered a reduction. The findings suggest that it is not enough for the companies to certify as sustainable in order to reduce its business risk.

Spatial modelling of population at risk and PM 2.5 exposure index: A ...

African Journals Online (AJOL)

However, monitoring, spatial representation and development of associated risk indicators have been major problems undermining formulation of relevant policy on air quality. This study used ... to environmental health. Key Words: Population at risk, PM2.5; Spatial modeling, GIS, Exposure index, environmental health ...

Risk of metachronous colon cancer following surgery for rectal cancer in mismatch repair gene mutation carriers.

Science.gov (United States)

Win, Aung Ko; Parry, Susan; Parry, Bryan; Kalady, Matthew F; Macrae, Finlay A; Ahnen, Dennis J; Young, Graeme P; Lipton, Lara; Winship, Ingrid; Boussioutas, Alex; Young, Joanne P; Buchanan, Daniel D; Arnold, Julie; Le Marchand, Loïc; Newcomb, Polly A; Haile, Robert W; Lindor, Noralane M; Gallinger, Steven; Hopper, John L; Jenkins, Mark A

2013-06-01

Despite regular surveillance colonoscopy, the metachronous colorectal cancer risk for mismatch repair (MMR) gene mutation carriers after segmental resection for colon cancer is high and total or subtotal colectomy is the preferred option. However, if the index cancer is in the rectum, management decisions are complicated by considerations of impaired bowel function. We aimed to estimate the risk of metachronous colon cancer for MMR gene mutation carriers who underwent a proctectomy for index rectal cancer. This retrospective cohort study comprised 79 carriers of germline mutation in a MMR gene (18 MLH1, 55 MSH2, 4 MSH6, and 2 PMS2) from the Colon Cancer Family Registry who had had a proctectomy for index rectal cancer. Cumulative risks of metachronous colon cancer were calculated using the Kaplan-Meier method. During median 9 years (range 1-32 years) of observation since the first diagnosis of rectal cancer, 21 carriers (27 %) were diagnosed with metachronous colon cancer (incidence 24.25, 95 % confidence interval [CI] 15.81-37.19 per 1,000 person-years). Cumulative risk of metachronous colon cancer was 19 % (95 % CI 9-31 %) at 10 years, 47 (95 % CI 31-68 %) at 20 years, and 69 % (95 % CI 45-89 %) at 30 years after surgical resection. The frequency of surveillance colonoscopy was 1 colonoscopy per 1.16 years (95 % CI 1.01-1.31 years). The AJCC stages of the metachronous cancers, where available, were 72 % stage I, 22 % stage II, and 6 % stage III. Given the high metachronous colon cancer risk for MMR gene mutation carriers diagnosed with an index rectal cancer, proctocolectomy may need to be considered.

Italian Mediterranean Index and risk of colorectal cancer in the Italian section of the EPIC cohort.

Science.gov (United States)

Agnoli, Claudia; Grioni, Sara; Sieri, Sabina; Palli, Domenico; Masala, Giovanna; Sacerdote, Carlotta; Vineis, Paolo; Tumino, Rosario; Giurdanella, Maria Concetta; Pala, Valeria; Berrino, Franco; Mattiello, Amalia; Panico, Salvatore; Krogh, Vittorio

2013-03-15

Colorectal cancer is among the commonest cancers worldwide. Dietary factors have been linked to colorectal cancer risk, however, few studies have evaluated the relationship between a priori dietary patterns and colorectal cancer risk. We evaluated the effect of adherence to a Mediterranean dietary pattern, as measured by the Italian Mediterranean Index, on the risk of colorectal cancer in the 45,275 participants of the Italian section of the EPIC study who completed a dietary questionnaire. Hazard ratios (HRs) with 95% confidence intervals (CIs) for colorectal cancer in relation to categories of Italian Mediterranean Index score were estimated by multivariate Cox models adjusted for known risk factors, on the whole cohort, on men and women and according to cancer subsite. During a mean follow-up of 11.28 years, 435 colorectal cancer cases were identified. The Italian Mediterranean Index was inversely associated with colorectal cancer risk (HR: 0.50; 95% CI: 0.35-0.71 for the highest category compared to the lowest, P-trend: 0.043). Results did not differ by sex. Highest Italian Mediterranean Index score was also significantly associated with reduced risks of any colon cancer (HR: 0.54, 95% CI: 0.36-0.81), distal colon cancer (HR: 0.44, 95% CI: 0.26-0.75) and rectal cancer (HR: 0.41, 95% CI: 0.20-0.81), but not of proximal colon cancer. These findings suggest that adherence to a Mediterranean diet (as measured by the Italian Mediterranean Index) protects against colorectal cancer in general but not against cancer developing in the proximal colon. Copyright © 2012 UICC.

Single-compound and cumulative risk assessment of mycotoxins present in breakfast cereals consumed by children from Lisbon region, Portugal.

Science.gov (United States)

Assunção, Ricardo; Vasco, Elsa; Nunes, Baltazar; Loureiro, Susana; Martins, Carla; Alvito, Paula

2015-12-01

Humans can be exposed to multiple chemicals, but current risk assessment is usually carried out on one chemical at a time. Mycotoxins are commonly found in a variety of foods including those intended to consumption by children namely breakfast cereals. The present study aims to perform, the risk assessment of single and multiple mycotoxins present in breakfast cereals consumed by children (1-3 years old) from Lisbon region, Portugal. Daily exposure of children to ochratoxin A, fumonisins and trichothecenes showed no health risks to the children population considering individual mycotoxins, while exposure to aflatoxin B1 (AFB1) suggested a potential health concern for the high percentiles of intake (P90, P95 and P99). The combined exposure to fumonisins and trichothecenes are not expected to be of health concern. The combined margin of exposure (MoET) for the aflatoxins group could constitute a potential health concern and AFB1 was the main contributor for MoET. Legal limits and control strategies regarding the presence of multiple mycotoxins in foodstuffs is an urgent need. To the best of our knowledge, this is the first time a cumulative risk assessment was performed on multiple mycotoxins present in breakfast cereals consumed by children. Copyright © 2015 Elsevier Ltd. All rights reserved.

High cumulative insulin exposure : a risk factor of atherosclerosis in type 1 diabetes?

NARCIS (Netherlands)

Muis, MJ; Bots, ML; Bilo, HJG; Hoogma, RPLM; Hoekstra, JBL; Grobbee, DE; Stolk, RP

Background: Since insulin therapy might have an atherogenic effect, we studied the relationship between cumulative insulin dose and atherosclerosis in type 1 diabetes. We have focused on patients with type 1 diabetes instead of type 2 diabetes to minimise the effect of insulin resistance as a

High cumulative insulin exposure: a risk factor of atherosclerosis in type 1 diabetes?

NARCIS (Netherlands)

Muis, Marian J.; Bots, Michiel L.; Bilo, Henk J. G.; Hoogma, Roel P. L. M.; Hoekstra, Joost B. L.; Grobbee, Diederick E.; Stolk, Ronald P.

2005-01-01

Background: Since insulin therapy might have an atherogenic effect, we studied the relationship between cumulative insulin dose and atherosclerosis in type 1 diabetes. We have focused on patients with type 1 diabetes instead of type 2 diabetes to minimise the effect of insulin resistance as a

Mendelian Randomization Study of Body Mass Index and Colorectal Cancer Risk

DEFF Research Database (Denmark)

Thrift, Aaron P.; Gong, Jian; Peters, Ulrike

2015-01-01

Background: High body mass index (BMI) is consistently linked to increased risk of colorectal cancer for men, whereas the association is less clear for women. As risk estimates from observational studies may be biased and/or confounded, we conducted a Mendelian randomization study to estimate...... the causal association between BMI and colorectal cancer. Methods: We used data from 10,226 colorectal cancer cases and 10,286 controls of European ancestry. The Mendelian randomization analysis used a weighted genetic risk score, derived from 77 genome-wide association study–identified variants associated......, rather than overall obesity, is a more important risk factor for men requires further investigation. Impact: Overall, conventional epidemiologic and Mendelian randomization studies suggest a strong association between obesity and the risk of colorectal cancer....

Modified Creatinine Index and the Risk of Bone Fracture in Patients Undergoing Hemodialysis: The Q-Cohort Study.

Science.gov (United States)

Yamada, Shunsuke; Taniguchi, Masatomo; Tokumoto, Masanori; Yoshitomi, Ryota; Yoshida, Hisako; Tatsumoto, Narihito; Hirakata, Hideki; Fujimi, Satoru; Kitazono, Takanari; Tsuruya, Kazuhiko

2017-08-01

Hemodialysis patients are at increased risk for bone fracture and sarcopenia. There is close interplay between skeletal muscle and bone. However, it is still unclear whether lower skeletal muscle mass increases the risk for bone fracture. Cross-sectional study and prospective longitudinal cohort study. An independent cohort of 78 hemodialysis patients in the cross-sectional study and 3,030 prevalent patients undergoing maintenance hemodialysis prospectively followed up for 4 years. Skeletal muscle mass measured by bioelectrical impedance analysis (BIA) and modified creatinine index, an estimate of skeletal muscle mass based on age, sex, Kt/V for urea, and serum creatinine level. Bone fracture at any site. In the cross-sectional study, modified creatinine index was significantly correlated with skeletal muscle mass measured by BIA. During a median follow-up of 3.9 years, 140 patients had bone fracture. When patients were divided into sex-specific quartiles based on modified creatinine index, risk for bone fracture estimated by a Fine-Gray proportional subdistribution hazards model with all-cause death as a competing risk was significantly higher in the lower modified creatinine index quartiles (Q1 and Q2) compared to the highest modified creatinine index quartile (Q4) as the reference value in both sexes (multivariable-adjusted HRs for men were 7.81 [95% CI, 2.63-23.26], 5.48 [95% CI, 2.08-14.40], 2.24 [95% CI, 0.72-7.00], and 1.00 [P for trend creatinine index; no data for residual kidney function and fracture sites and causes. Modified creatinine index was correlated with skeletal muscle mass measured by BIA. Lower modified creatinine index was associated with increased risk for bone fracture in male and female hemodialysis patients. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Cumulative Risk and Continuity in Nonparental Care from Infancy to Early Adolescence

OpenAIRE

Colwell, Malinda J.; Pettit, Gregory S.; Meece, Darrell; Bates, John E.; Dodge, Kenneth A.

2001-01-01

Variations in amounts of nonparental care across infancy, preschool, early elementary school, and early adolescence were examined in a longitudinal sample (N = 438). Of interest was (a) continuity in use of the different arrangements, (b) whether the arrangements were additively and cumulatively associated with children’s externalizing behavior problems, and (c) whether predictive relations were accounted for by social-ecological (socioeconomic status, mothers’ employment status, marital stat...

Quantifying Cardiometabolic Risk Using Modifiable Non–Self-Reported Risk Factors

Science.gov (United States)

Marino, Miguel; Li, Yi; Pencina, Michael J.; D’Agostino, Ralph B.; Berkman, Lisa F.; Buxton, Orfeu M.

2014-01-01

Background Sensitive general cardiometabolic risk assessment tools of modifiable risk factors would be helpful and practical in a range of primary prevention interventions or for preventive health maintenance. Purpose To develop and validate a cumulative general cardiometabolic risk score that focuses on non–self-reported modifiable risk factors such as glycosylated hemoglobin (HbA1c) and BMI so as to be sensitive to small changes across a span of major modifiable risk factors, which may not individually cross clinical cut off points for risk categories. Methods We prospectively followed 2,359 cardiovascular disease (CVD)-free subjects from the Framingham offspring cohort over a 14–year follow-up. Baseline (fifth offspring examination cycle) included HbA1c and cholesterol measurements. Gender–specific Cox proportional hazards models were considered to evaluate the effects of non–self-reported modifiable risk factors (blood pressure, total cholesterol, high–density lipoprotein cholesterol, smoking, BMI, and HbA1c) on general CVD risk. We constructed 10–year general cardiometabolic risk score functions and evaluated its predictive performance in 2012–2013. Results HbA1c was significantly related to general CVD risk. The proposed cardiometabolic general CVD risk model showed good predictive performance as determined by cross-validated discrimination (male C-index=0.703, 95% CI=0.668, 0.734; female C-index=0.762, 95% CI=0.726, 0.801) and calibration (lack-of-fit χ2=9.05 [p=0.338] and 12.54 [p=0.128] for men and women, respectively). Conclusions This study presents a risk factor algorithm that provides a convenient and informative way to quantify cardiometabolic risk based on modifiable risk factors that can motivate an individual’s commitment to prevention and intervention. PMID:24951039

Quantifying cardiometabolic risk using modifiable non-self-reported risk factors.

Science.gov (United States)

Marino, Miguel; Li, Yi; Pencina, Michael J; D'Agostino, Ralph B; Berkman, Lisa F; Buxton, Orfeu M

2014-08-01

Sensitive general cardiometabolic risk assessment tools of modifiable risk factors would be helpful and practical in a range of primary prevention interventions or for preventive health maintenance. To develop and validate a cumulative general cardiometabolic risk score that focuses on non-self-reported modifiable risk factors such as glycosylated hemoglobin (HbA1c) and BMI so as to be sensitive to small changes across a span of major modifiable risk factors, which may not individually cross clinical cut-off points for risk categories. We prospectively followed 2,359 cardiovascular disease (CVD)-free subjects from the Framingham offspring cohort over a 14-year follow-up. Baseline (fifth offspring examination cycle) included HbA1c and cholesterol measurements. Gender-specific Cox proportional hazards models were considered to evaluate the effects of non-self-reported modifiable risk factors (blood pressure, total cholesterol, high-density lipoprotein cholesterol, smoking, BMI, and HbA1c) on general CVD risk. We constructed 10-year general cardiometabolic risk score functions and evaluated its predictive performance in 2012-2013. HbA1c was significantly related to general CVD risk. The proposed cardiometabolic general CVD risk model showed good predictive performance as determined by cross-validated discrimination (male C-index=0.703, 95% CI=0.668, 0.734; female C-index=0.762, 95% CI=0.726, 0.801) and calibration (lack-of-fit chi-square=9.05 [p=0.338] and 12.54 [p=0.128] for men and women, respectively). This study presents a risk factor algorithm that provides a convenient and informative way to quantify cardiometabolic risk on the basis of modifiable risk factors that can motivate an individual's commitment to prevention and intervention. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Cumulative incidence of youth obesity is associated with low cardiorespiratory fitness levels and with maternal overweight

Directory of Open Access Journals (Sweden)

Anelise Reis Gaya

2015-12-01

Full Text Available Abstract This longitudinal study evaluated the association between the incidence of youth overweight/obesity (Ow/Ob and low levels of cardiorespiratory fitness (CRF over 4 years and youths' and their parents' demographic and nutritional characteristics. The randomized sample comprised 398 youth, aged 7-17 years at baseline, from a city in southern Brazil. Subjects were classified as being Ow/Ob according to international body mass index (BMI parameters. Parental weight and height were determined by direct questioning. Youth CRF was measured by a 9-minute walk-and-run test. The cumulative incidences of Ow/Ob and of low CRF levels were 25.1% and 20.5%, respectively. Relative to other youth, youth who were classified as "unhealthy" at baseline (with respect to CRF and by the fourth year were more likely to be classified as Ow/Ob (relative risks: 1.12 and 1.10, respectively. Youth whose mothers were categorized as Ow/Ob were at higher risk of being classified as Ow/Ob than youth whose mothers had normal BMIs (relative risks: 1.19 at baseline and 1.20 in the fourth year. The incidence of Ow/Ob among the former youth was associated with low CRF levels and with maternal Ob.

Duration of Adulthood Overweight, Obesity, and Cancer Risk in the Women's Health Initiative: A Longitudinal Study from the United States

OpenAIRE

Arnold, M; Jiang, L; Stefanick, ML; Johnson, KC; Lane, DS; LeBlanc, ES; Prentice, R; Rohan, TE; Snively, BM; Vitolins, M; Zaslavsky, O; Soerjomataram, I; Anton-Culver, H

2016-01-01

Background High body mass index (BMI) has become the leading risk factor of disease burden in high-income countries. While recent studies have suggested that the risk of cancer related to obesity is mediated by time, insights into the dose-response relationship and the cumulative impact of overweight and obesity during the life course on cancer risk remain scarce. To our knowledge, this study is the first to assess the impact of adulthood overweight and obesity duration on the risk of cancer ...

Divergent Cumulative Cultural Evolution

OpenAIRE

Marriott, Chris; Chebib, Jobran

2016-01-01

Divergent cumulative cultural evolution occurs when the cultural evolutionary trajectory diverges from the biological evolutionary trajectory. We consider the conditions under which divergent cumulative cultural evolution can occur. We hypothesize that two conditions are necessary. First that genetic and cultural information are stored separately in the agent. Second cultural information must be transferred horizontally between agents of different generations. We implement a model with these ...

Human Development Inequality Index and Cancer Pattern: a Global Distributive Study.

Science.gov (United States)

Rezaeian, Shahab; Khazaei, Salman; Khazaei, Somayeh; Mansori, Kamyar; Sanjari Moghaddam, Ali; Ayubi, Erfan

2016-01-01

This study aimed to quantify associations of the human development inequality (HDI) index with incidence, mortality, and mortality to incidence ratios for eight common cancers among different countries. In this ecological study, data about incidence and mortality rates of cancers was obtained from the Global Cancer Project for 169 countries. HDI indices for the same countries was obtained from the United Nations Development Program (UNDP) database. The concentration index was defined as the covariance between cumulative percentage of cancer indicators (incidence, mortality and mortality to incidence ratio) and the cumulative percentage of economic indicators (country economic rank). Results indicated that incidences of cancers of liver, cervix and esophagus were mainly concentrated in countries with a low HDI index while cancers of lung, breast, colorectum, prostate and stomach were concentrated mainly in countries with a high HDI index. The same pattern was observed for mortality from cancer except for prostate cancer that was more concentrated in countries with a low HDI index. Higher MIRs for all cancers were more concentrated in countries with a low HDI index. It was concluded that patterns of cancer occurrence correlate with care disparities at the country level.

Direct comparison of risk-adjusted and non-risk-adjusted CUSUM analyses of coronary artery bypass surgery outcomes.

Science.gov (United States)

Novick, Richard J; Fox, Stephanie A; Stitt, Larry W; Forbes, Thomas L; Steiner, Stefan

2006-08-01

We previously applied non-risk-adjusted cumulative sum methods to analyze coronary bypass outcomes. The objective of this study was to assess the incremental advantage of risk-adjusted cumulative sum methods in this setting. Prospective data were collected in 793 consecutive patients who underwent coronary bypass grafting performed by a single surgeon during a period of 5 years. The composite occurrence of an "adverse outcome" included mortality or any of 10 major complications. An institutional logistic regression model for adverse outcome was developed by using 2608 contemporaneous patients undergoing coronary bypass. The predicted risk of adverse outcome in each of the surgeon's 793 patients was then calculated. A risk-adjusted cumulative sum curve was then generated after specifying control limits and odds ratio. This risk-adjusted curve was compared with the non-risk-adjusted cumulative sum curve, and the clinical significance of this difference was assessed. The surgeon's adverse outcome rate was 96 of 793 (12.1%) versus 270 of 1815 (14.9%) for all the other institution's surgeons combined (P = .06). The non-risk-adjusted curve reached below the lower control limit, signifying excellent outcomes between cases 164 and 313, 323 and 407, and 667 and 793, but transgressed the upper limit between cases 461 and 478. The risk-adjusted cumulative sum curve never transgressed the upper control limit, signifying that cases preceding and including 461 to 478 were at an increased predicted risk. Furthermore, if the risk-adjusted cumulative sum curve was reset to zero whenever a control limit was reached, it still signaled a decrease in adverse outcome at 166, 653, and 782 cases. Risk-adjusted cumulative sum techniques provide incremental advantages over non-risk-adjusted methods by not signaling a decrement in performance when preoperative patient risk is high.

Nutrition-related risk indexes and long-term mortality in noncritically ill inpatients who receive total parenteral nutrition (prospective multicenter study).

Science.gov (United States)

Tapia, María José; Ocón, Julia; Cabrejas-Gómez, Carmen; Ballesteros-Pomar, María D; Vidal-Casariego, Alfonso; Arraiza-Irigoyen, Carmen; Olivares, Josefina; Conde-García, Ma Carmen; García-Manzanares, Álvaro; Botella-Romero, Francisco; Quílez-Toboso, Rosa P; Cabrerizo, Lucio; Rubio, Miguel A; Chicharro, Luisa; Burgos, Rosa; Pujante, Pedro; Ferrer, Mercedes; Zugasti, Ana; Petrina, Estrella; Manjón, Laura; Diéguez, Marta; Carrera, Ma José; Vila-Bundo, Anna; Urgelés, Juan Ramón; Aragón-Valera, Carmen; Sánchez-Vilar, Olga; Bretón, Irene; García-Peris, Pilar; Muñoz-Garach, Araceli; Márquez, Efren; del Olmo, Dolores; Pereira, José Luis; Tous, María C; Olveira, Gabriel

2015-10-01

Malnutrition in hospitalized patients is associated with an increased risk of death, in both the short and the long term. The purpose of this study was to determine which nutrition-related risk index predicts long-term mortality better (three years) in patients who receive total parenteral nutrition (TPN). This prospective, multicenter study involved noncritically ill patients who were prescribed TPN during hospitalization. Data were collected on Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Geriatric Nutritional Risk Index (GNRI), body mass index, albumin and prealbumin, as well as long-term mortality. Over the 1- and 3-year follow-up periods, 174 and 244 study subjects (28.8% and 40.3%) respectively, died. Based on the Cox proportional hazards survival model, the nutrition-related risk indexes most strongly associated with mortality were SGA and albumin (Nutrition and Metabolism. All rights reserved.

Severe occupational hand eczema, job stress and cumulative sickness absence.

Science.gov (United States)

Böhm, D; Stock Gissendanner, S; Finkeldey, F; John, S M; Werfel, T; Diepgen, T L; Breuer, K

2014-10-01

Stress is known to activate or exacerbate dermatoses, but the relationships between chronic stress, job-related stress and sickness absence among occupational hand eczema (OHE) patients are inadequately understood. To see whether chronic stress or burnout symptoms were associated with cumulative sickness absence in patients with OHE and to determine which factors predicted sickness absence in a model including measures of job-related and chronic stress. We investigated correlations of these factors in employed adult inpatients with a history of sickness absence due to OHE in a retrospective cross-sectional explorative study, which assessed chronic stress (Trier Inventory for the Assessment of Chronic Stress), burnout (Shirom Melamed Burnout Measure), clinical symptom severity (Osnabrück Hand Eczema Severity Index), perceived symptom severity, demographic characteristics and cumulative days of sickness absence. The study group consisted of 122 patients. OHE symptoms were not more severe among patients experiencing greater stress and burnout. Women reported higher levels of chronic stress on some measures. Cumulative days of sickness absence correlated with individual dimensions of job-related stress and, in multiple regression analysis, with an overall measure of chronic stress. Chronic stress is an additional factor predicting cumulative sickness absence among severely affected OHE patients. Other relevant factors for this study sample included the 'cognitive weariness' subscale of the Shirom Melamed Burnout Measure and the physical component summary score of the SF-36, a measure of health-related life quality. Prevention and rehabilitation should take job stress into consideration in multidisciplinary treatment strategies for severely affected OHE patients. © The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Association and interaction between triglyceride-glucose index and obesity on risk of hypertension in middle-aged and elderly adults.

Science.gov (United States)

Jian, Song; Su-Mei, Nie; Xue, Chen; Jie, Zhang; Xue-Sen, Wu

2017-01-01

To investigate the association between triglyceride-glucose(TyG) index and the risk of hypertension. A cross-sectional study was conducted in Bengbu, China. The participants received relevant questionnaire survey, anthropometric tests, and laboratory examination. Multivariate logistic regression analysis was performed to estimate the possible association between TyG index and hypertension risk. The additive interaction evaluated by the relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index(SI) was calculated. A total of 1777 participants (748 men and 1029 women) were investigated. There was a significant increase in the risk of hypertension and isolated systolic hypertension (ISH) when comparing the highest TyG index (the fourth quartile) to the lowest TyG index (the first quartile) and corresponding ORs were 2.446 (95% CI: 1.746-3.426) and 2.621(95%CI: 1.627-4.224), respectively. However, no significant relationship was observed between TyG index and isolated diastolic hypertension (IDH). In males, significant interactions between TyG index and WHtR (RERI:1.978, 95%CI: 0.162-3.792; AP: 0.359, 0.113-0.605; SI:1.782, 1.017-3.122), smoking (AP: 0.437, 95%CI: 0.048-0.825), family history of hypertension (AP:0.433, 95%CI: 0.203-0.662; SI:2.248, 95%CI: 1.333-3.791) were observed. As for females, there were also significant interactions between TyG index and WHtR (RERI:1.415, 95%CI: 0.693-2.136; AP: 0.198, 95%CI: 0.104-0.291; SI:1.298, 95%CI:1.101-1.530), family history of hypertension (RERI:1.744, 95%CI: 0.221-3.267; AP:0.405, 95%CI: 0.113-0.697) on risk of hypertension. Increased TyG index was significantly associated with higher risk of hypertension and ISH, but not for IDH in middle-aged and elderly adults. Our results also demonstrated interactions of TyG index and abdominal obesity and family history of hypertension on hypertension risk.

Cumulative environmental risk in substance abusing women: early intervention, parenting stress, child abuse potential and child development.

Science.gov (United States)

Nair, Prasanna; Schuler, Maureen E; Black, Maureen M; Kettinger, Laurie; Harrington, Donna

2003-09-01

To assess the relationship between cumulative environmental risks and early intervention, parenting attitudes, potential for child abuse and child development in substance abusing mothers. We studied 161 substance-abusing women, from a randomized longitudinal study of a home based early intervention, who had custody of their children through 18 months. The intervention group received weekly home visits in the first 6 months and biweekly visits from 6 to 18 months. Parenting stress and child abuse potential were assessed at 6 and 18 months postpartum. Children's mental and motor development (Bayley MDI and PDI) and language development (REEL) were assessed at 6, 12, and 18 months postpartum. Ten maternal risk factors were assessed: maternal depression, domestic violence, nondomestic violence, family size, incarceration, no significant other in home, negative life events, psychiatric problems, homelessness, and severity of drug use. Level of risk was recoded into four categories (2 or less, 3, 4, and 5 or more), which had adequate cell sizes for repeated measures analysis. Repeated measures analyses were run to examine how level of risk and group (intervention or control) were related to parenting stress, child abuse potential, and children's mental, motor and language development over time. Parenting stress and child abuse potential were higher for women with five risks or more compared with women who had four or fewer risks; children's mental, motor, and language development were not related to level of risk. Children in the intervention group had significantly higher scores on the PDI at 6 and 18 months (107.4 vs. 103.6 and 101.1 vs. 97.2) and had marginally better scores on the MDI at 6 and 12 months (107.7 vs. 104.2 and 103.6 vs. 100.1), compared to the control group. Compared to drug-abusing women with fewer than five risks, women with five or more risks found parenting more stressful and indicated greater inclination towards abusive and neglectful behavior

NON-EXPECTED UTILITY THEORIES: WEIGHTED EXPECTED, RANK DEPENDENT, AND CUMULATIVE PROSPECT THEORY UTILITY

OpenAIRE

Tuthill, Jonathan W.; Frechette, Darren L.

2002-01-01

This paper discusses some of the failings of expected utility including the Allais paradox and expected utility's inadequate one dimensional characterization of risk. Three alternatives to expected utility are discussed at length; weighted expected utility, rank dependent utility, and cumulative prospect theory. Each alternative is capable of explaining Allais paradox type problems and permits more sophisticated multi dimensional risk preferences.

Development of an Integrated Moisture Index for predicting species composition

Science.gov (United States)

Louis R. Iverson; Charles T. Scott; Martin E. Dale; Anantha Prasad

1996-01-01

A geographic information system (GIS) approach was used to develop an Integrated Moisture Index (IMI), which was used to predict species composition for Ohio forests. Several landscape features (a slope-aspect shading index, cumulative flow of water downslope, curvature of the landscape, and the water-holding capacity of the soil) were derived from elevation and soils...

The Aggregate Risk Index: An intuitive tool providing the health risks of air pollution to health care community and public

Science.gov (United States)

Sicard, Pierre; Talbot, Charles; Lesne, Olivia; Mangin, Antoine; Alexandre, Nicolas; Collomp, Rémy

2012-01-01

In the framework of the European project PASODOBLE (FP7), we set up downstream information services by combining environmental and health data with a view to support the health care community and to improve vulnerable people welfare. Indeed there is a profound relationship between human health, well-being and air pollution levels. The main objectives are to establish correlations between air quality, exposure of populations and their reactivity, to develop and validate air quality indexes and to construct a prediction model of this sanitary index. This index will be implemented on 3 European sites: Greece (Athens and Thessaloniki), the Netherlands and "Provence Alpes Côte d'Azur" (South East of France). The selected region and cities are among the most affected by the atmospheric pollution in Europe and leads to serious sanitary concerns. The service aims to provide up-to-date, detailed information on air quality discomfort. The Aggregate Risk Index is based on the Cairncross's concept, obtained from the Relative Risk associated with short-term exposure to common air pollutants and takes into account the possible effects of a mixture of pollutants. This communication tool, easy to use and intuitive, about the levels of air pollution and the associated health risks, will be used to communicate information to the general population, authorities and to the health care community and will provide advanced warning of potentially health-damaging air pollution events.

Cumulative Effect of Depression on Dementia Risk

Directory of Open Access Journals (Sweden)

J. Olazarán

2013-01-01

Full Text Available Objective. To analyze a potential cumulative effect of life-time depression on dementia and Alzheimer’s disease (AD, with control of vascular factors (VFs. Methods. This study was a subanalysis of the Neurological Disorders in Central Spain (NEDICES study. Past and present depression, VFs, dementia status, and dementia due to AD were documented at study inception. Dementia status was also documented after three years. Four groups were created according to baseline data: never depression (nD, past depression (pD, present depression (prD, and present and past depression (prpD. Logistic regression was used. Results. Data of 1,807 subjects were investigated at baseline (mean age 74.3, 59.3% women, and 1,376 (81.6% subjects were evaluated after three years. The prevalence of dementia at baseline was 6.7%, and dementia incidence was 6.3%. An effect of depression was observed on dementia prevalence (OR [CI 95%] 1.84 [1.01–3.35] for prD and 2.73 [1.08–6.87] for prpD, and on dementia due to AD (OR 1.98 [0.98–3.99] for prD and OR 3.98 [1.48–10.71] for prpD (fully adjusted models, nD as reference. Depression did not influence dementia incidence. Conclusions. Present depression and, particularly, present and past depression are associated with dementia at old age. Multiple mechanisms, including toxic effect of depression on hippocampal neurons, plausibly explain these associations.

Evaluation of a clinical risk index for advanced colorectal neoplasia among a North American population of screening age.

Science.gov (United States)

Ruco, Arlinda; Stock, David; Hilsden, Robert J; McGregor, S Elizabeth; Paszat, Lawrence F; Saskin, Refik; Rabeneck, Linda

2015-11-19

A clinical risk index employing age, sex, family history of colorectal cancer (CRC), smoking history and body mass index (BMI) may be useful for prioritizing screening with colonoscopy. The aim of this study was to conduct an external evaluation of a previously published risk index for advanced neoplasia (AN) in a large, well-characterized cohort. Five thousand one hundred thirty-seven asymptomatic persons aged 50 to 74 (54.9 % women) with a mean age (SD) of 58.3 (6.2) years were recruited for the study from a teaching hospital and colorectal cancer screening centre between 2003 and 2011. All participants underwent a complete screening colonoscopy and removal of all polyps. AN was defined as cancer or a tubular adenoma, traditional serrated adenoma (TSA), or sessile serrated adenoma (SSA) with villous characteristics (≥25% villous component), and/or high-grade dysplasia and/or diameter ≥10 mm. Risk scores for each participant were summed to derive an overall score (0-8). The c-statistic was used to measure discriminating ability of the risk index. The prevalence of AN in the study cohort was 6.8 %. The likelihood of detecting AN increased from 3.6 to 13.1 % for those with a risk score of 1 to 6 respectively. The c-statistic for the multivariable logistic model in our cohort was 0.64 (95 % CI = 0.61-067) indicating modest overlap between risk scores. The risk index for AN using age, sex, family history, smoking history and BMI was found to be of limited discriminating ability upon external validation. The index requires further refinement to better predict AN in average risk persons of screening age.

Cumulative emission budgets and their implications: the case for SAFE carbon

Science.gov (United States)

Allen, Myles; Bowerman, Niel; Frame, David; Mason, Charles

2010-05-01

The risk of dangerous long-term climate change due to anthropogenic carbon dioxide emissions is predominantly determined by cumulative emissions over all time, not the rate of emission in any given year or commitment period. This has profound implications for climate mitigation policy: emission targets for specific years such as 2020 or 2050 provide no guarantee of meeting any overall cumulative emission budget. By focusing attention on short-term measures to reduce the flow of emissions, they may even exacerbate the overall long-term stock. Here we consider how climate policies might be designed explicitly to limit cumulative emissions to, for example, one trillion tonnes of carbon, a figure that has been estimated to give a most likely warming of two degrees above pre-industrial, with a likely range of 1.6-2.6 degrees. Three approaches are considered: tradable emission permits with the possibility of indefinite emission banking, carbon taxes explicitly linked to cumulative emissions and mandatory carbon sequestration. Framing mitigation policy around cumulative targets alleviates the apparent tension between climate protection and short-term consumption that bedevils any attempt to forge global agreement. We argue that the simplest and hence potentially the most effective approach might be a mandatory requirement on the fossil fuel industry to ensure that a steadily increasing fraction of fossil carbon extracted from the ground is artificially removed from the active carbon cycle through some form of sequestration. We define Sequestered Adequate Fraction of Extracted (SAFE) carbon as a source in which this sequestered fraction is anchored to cumulative emissions, increasing smoothly to reach 100% before we release the trillionth tonne. While adopting the use of SAFE carbon would increase the cost of fossil energy much as a system of emission permits or carbon taxes would, it could do so with much less explicit government intervention. We contrast this proposal

Cumulative effects of cascade hydropower stations on total dissolved gas supersaturation.

Science.gov (United States)

Ma, Qian; Li, Ran; Feng, Jingjie; Lu, Jingying; Zhou, Qin

2018-03-01

Elevated levels of total dissolved gas (TDG) may occur downstream of dams during the spill process. These high levels would increase the incidence of gas bubble disease in fish and cause severe environmental impacts. With increasing numbers of cascade hydropower stations being built or planned, the cumulative effects of TDG supersaturation are becoming increasingly prominent. The TDG saturation distribution in the downstream reaches of the Jinsha River was studied to investigate the cumulative effects of TDG supersaturation resulting from the cascade hydropower stations. A comparison of the effects of the joint operation and the single operation of two hydropower stations (XLD and XJB) was performed to analyze the risk degree to fish posed by TDG supersaturation. The results showed that water with supersaturated TDG generated at the upstream cascade can be transported to the downstream power station, leading to cumulative TDG supersaturation effects. Compared with the single operation of XJB, the joint operation of both stations produced a much higher TDG saturation downstream of XJB, especially during the non-flood discharge period. Moreover, the duration of high TDG saturation and the lengths of the lethal and sub-lethal areas were much higher in the joint operation scenario, posing a greater threat to fish and severely damaging the environment. This work provides a scientific basis for strategies to reduce TDG supersaturation to the permissible level and minimize the potential risk of supersaturated TDG.

Arsenic methylation capability and hypertension risk in subjects living in arseniasis-hyperendemic areas in southwestern Taiwan

International Nuclear Information System (INIS)

Huang, Y.-K.; Tseng, C.-H.; Huang, Y.-L.; Yang, M.-H.; Chen, C.-J.; Hsueh, Y.-M.

2007-01-01

Background: Cumulative arsenic exposure (CAE) from drinking water has been shown to be associated with hypertension in a dose-response pattern. This study further explored the association between arsenic methylation capability and hypertension risk among residents of arseniasis-hyperendemic areas in Taiwan considering the effect of CAE and other potential confounders. Method: There were 871 subjects (488 women and 383 men) and among them 372 were diagnosed as having hypertension based on a positive history or measured systolic blood pressure ≥ 140 mm Hg and/or diastolic blood pressure ≥ 90 mm Hg. Urinary arsenic species were determined by high-performance liquid chromatography-hydride generator and atomic absorption spectrometry. Primary arsenic methylation index [PMI, defined as monomethylarsonic acid (MMA V ) divided by (As III + As V )] and secondary arsenic methylation index (SMI, defined as dimethylarsinic acid divided by MMA V ) were used as indicators for arsenic methylation capability. Results: The level of urinary arsenic was still significantly correlated with cumulative arsenic exposure (CAE) calculated from a questionnaire interview (p = 0.02) even after the residents stopped drinking the artesian well water for 2-3 decades. Hypertensive subjects had higher percentages of MMA V and lower SMI than subjects without hypertension. However, subjects having CAE > 0 mg/L-year had higher hypertension risk than those who had CAE = 0 mg/L-year disregard a high or low methylation index. Conclusion: Inefficient arsenic methylation ability may be related with hypertension risk

Somatic involvement assessed through a cumulative score of clinical severity in patients with eating disorders.

Science.gov (United States)

Scanelli, Giovanni; Gualandi, Malvina; Simoni, Marzia; Manzato, Emilia

2014-03-01

To evaluate the overall somatic involvement in patients with eating disorders (EDs). The medical records of 206 patients (age 15-56 years, 96.1% females) with diagnosis of anorexia nervosa (AN, n = 63, 30.6%), bulimia nervosa (BN, n = 78, 37.9%), or eating disorder not otherwise specified (EDNOS, n = 65, 31.6 %) were analyzed. A cumulative score of clinical severity (SCS) was computed according to the presence of physical, instrumental, and laboratory abnormalities, as well as to their prognostic impact. Based on the tertile distribution of SCS, three levels of severity were defined: low, medium, and high. A medium/high level of severity was found in 63% of the whole sample, 89% of AN, 49% of BN, and 55% of EDNOS. In the whole sample, the risk of medium/high SCS was significantly and inversely related to the body mass index (BMI) and to the lifetime minimum BMI. The severity level was significantly and positively associated with diagnosis of AN, duration of amenorrhea C1 year, and presence of ED-related symptoms. EDNOS patients showed a higher risk for increased SCS than BN patients, although not significantly. The non-negligible frequency of a relevant somatic involvement in patients with EDNOS suggests that a transdiagnostic scoring system might be helpful to identify ED cases at risk of medical complications.

Environmental risk index: A tool to assess the safety of dams for leachate

International Nuclear Information System (INIS)

Colomer Mendoza, Francisco J.; Gallardo Izquierdo, Antonio

2009-01-01

Dams for leachate store very toxic substances that contain a large amount of organic material and, probably, heavy metals; they therefore constitute an important threat to the environment. Existing models of environmental risk assessment for landfills do not take into consideration the specific risk that leachate dams may represent for the environment. In this paper a methodology to improve the environmental safety is presented according to the parameters used in their construction and management. In order to do that, the following characteristics of the dam must be known: (1) geotechnical stability, (2) erosion of downstream slope, (3) type of sealing of the dam, (4) overtopping probability, (5) volume of leachate stored inside the dam and (6) pollution load of leachate. Once these parameters have been calculated, they are transformed by means of rating curves into homogeneous units, so as to make it possible to operate between them. From the study and analysis of these parameters an environmental risk index for a dam for leachate can be calculated. If the environmental risk index exceeds an established value then it involves a dam for leachate with high environmental risk, therefore preventive measures in its design, construction and management would be necessary

A simplified donor risk index for predicting outcome after deceased donor kidney transplantation.

Science.gov (United States)

Watson, Christopher J E; Johnson, Rachel J; Birch, Rhiannon; Collett, Dave; Bradley, J Andrew

2012-02-15

We sought to determine the deceased donor factors associated with outcome after kidney transplantation and to develop a clinically applicable Kidney Donor Risk Index. Data from the UK Transplant Registry on 7620 adult recipients of adult deceased donor kidney transplants between 2000 and 2007 inclusive were analyzed. Donor factors potentially influencing transplant outcome were investigated using Cox regression, adjusting for significant recipient and transplant factors. A United Kingdom Kidney Donor Risk Index was derived from the model and validated. Donor age was the most significant factor predicting poor transplant outcome (hazard ratio for 18-39 and 60+ years relative to 40-59 years was 0.78 and 1.49, respectively, Pinformed consent.

Comparison between frailty index of deficit accumulation and fracture risk assessment tool (FRAX) in prediction of risk of fractures.

Science.gov (United States)

Li, Guowei; Thabane, Lehana; Papaioannou, Alexandra; Adachi, Jonathan D

2015-08-01

A frailty index (FI) of deficit accumulation could quantify and predict the risk of fractures based on the degree of frailty in the elderly. We aimed to compare the predictive powers between the FI and the fracture risk assessment tool (FRAX) in predicting risk of major osteoporotic fracture (hip, upper arm or shoulder, spine, or wrist) and hip fracture, using the data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) 3-year Hamilton cohort. There were 3985 women included in the study, with the mean age of 69.4 years (standard deviation [SD] = 8.89). During the follow-up, there were 149 (3.98%) incident major osteoporotic fractures and 18 (0.48%) hip fractures reported. The FRAX and FI were significantly related to each other. Both FRAX and FI significantly predicted risk of major osteoporotic fracture, with a hazard ratio (HR) of 1.03 (95% confidence interval [CI]: 1.02-1.05) and 1.02 (95% CI: 1.01-1.04) for per-0.01 increment for the FRAX and FI respectively. The HRs were 1.37 (95% CI: 1.19-1.58) and 1.26 (95% CI: 1.12-1.42) for an increase of per-0.10 (approximately one SD) in the FRAX and FI respectively. Similar discriminative ability of the models was found: c-index = 0.62 for the FRAX and c-index = 0.61 for the FI. When cut-points were chosen to trichotomize participants into low-risk, medium-risk and high-risk groups, a significant increase in fracture risk was found in the high-risk group (HR = 2.04, 95% CI: 1.36-3.07) but not in the medium-risk group (HR = 1.23, 95% CI: 0.82-1.84) compared with the low-risk women for the FI, while for FRAX the medium-risk (HR = 2.00, 95% CI: 1.09-3.68) and high-risk groups (HR = 2.61, 95% CI: 1.48-4.58) predicted risk of major osteoporotic fracture significantly only when survival time exceeded 18months (550 days). Similar findings were observed for hip fracture and in sensitivity analyses. In conclusion, the FI is comparable with FRAX in the prediction of risk of future fractures, indicating that

Association of body mass index with amnestic and non-amnestic mild cognitive impairment risk in elderly.

Science.gov (United States)

Wang, Feng; Zhao, Minghui; Han, Zhaoli; Li, Dai; Zhang, Shishuang; Zhang, Yongqiang; Kong, Xiaodong; Sun, Ning; Zhang, Qiang; Lei, Ping

2017-09-15

Previous studies focused on the relationship between body mass index and cognitive disorder and obtained many conflicting results. This study explored the potential effects of body mass index on the risk of mild cognitive impairment (amnestic and non-amnestic) in the elderly. The study enrolled 240 amnestic mild cognitive impairment patients, 240 non-amnestic mild cognitive impairment patients and 480 normal cognitive function controls. Data on admission and retrospective data at baseline (6 years ago) were collected from their medical records. Cognitive function was evaluated using Mini-Mental State Examination and Montreal Cognitive Assessment. Being underweight, overweight or obese at baseline was associated with an increased risk of amnestic mild cognitive impairment (OR: 2.30, 95%CI: 1.50 ~ 3.52; OR: 1.74, 95%CI: 1.36 ~ 2.20; OR: 1.71, 95%CI: 1.32 ~ 2.22, respectively). Being overweight or obese at baseline was also associated with an increased risk of non-amnestic mild cognitive impairment (OR: 1.51, 95%CI: 1.20 ~ 1.92; OR: 1.52, 95%CI: 1.21 ~ 1.97, respectively). In subjects with normal weights at baseline, an increased or decreased body mass index at follow-up was associated with an elevated risk of amnestic mild cognitive impairment (OR: 1.80, 95%CI: 1.10 ~ 3.05; OR: 3.96, 95%CI: 2.88 ~ 5.49, respectively), but only an increased body mass index was associated with an elevated risk of non-amnestic mild cognitive impairment (OR: 1.71, 95%CI: 1.16 ~ 2.59). Unhealthy body mass index levels at baseline and follow-up might impact the risk of both types of mild cognitive impairment (amnestic and non-amnestic).

Secant cumulants and toric geometry

NARCIS (Netherlands)

Michalek, M.; Oeding, L.; Zwiernik, P.W.

2012-01-01

We study the secant line variety of the Segre product of projective spaces using special cumulant coordinates adapted for secant varieties. We show that the secant variety is covered by open normal toric varieties. We prove that in cumulant coordinates its ideal is generated by binomial quadrics. We

Index-Based Dietary Patterns and Colorectal Cancer Risk: A Systematic Review123

Science.gov (United States)

Steck, Susan E; Guinter, Mark; Zheng, Jiali; Thomson, Cynthia A

2015-01-01

Colorectal cancer (CRC) is the third most common cancer in both men and women in the United States. Various a priori dietary patterns that take into account diet complexity have been associated with CRC risk. This systematic review augments the evidence for an association between CRC risk and the Mediterranean Diet Score (MDS) and the Healthy Eating Index (HEI), and provides new evidence for a novel Dietary Inflammatory Index (DII). Human studies published in English after 31 December 2008 were reviewed. Five case-control studies and 7 prospective cohort studies conducted in the United States and Europe were identified. Five of the studies examined the MDS, 4 examined the HEI, and 4 examined the DII. Comparing highest to lowest score groups, higher MDSs were associated with an 8–54% lower CRC risk, and higher HEI scores were associated with a 20–56% lower CRC risk. More proinflammatory diet scores were associated with a 12–65% higher CRC risk compared with more anti-inflammatory diets in studies that used the DII. The results reported by sex suggested similar associations for men and women. This review builds upon the evidence supporting the association between higher overall diet quality and lower risk of CRC. Increasing scores of MDS and HEI and anti-inflammatory DII scores are characterized by high intake of plant-based foods and low intake of animal products. Future studies in more diverse populations and with consistent scoring calculations are recommended. PMID:26567200

Hyperbaric index in the primary prevention of hypertensive complications in high-risk pregnancy.

Science.gov (United States)

Otero González, Alfonso; Uribe Moya, Silvia; Arenas Moncaleano, Ivan Gilberto; Borrajo Prol, María Paz; García García, María Jesús; López Sánchez, Luis

2015-01-01

Preeclampsia (PE) is a major cause of fetal morbidity and mortality. In the Western World, PE affects 2-7% of pregnancies and is responsible for 50,000 deaths annually. Early detection is a priority as it can change the clinical course, but there are no biomarkers or instrumental methods with high sensitivity and specificity. Only the hyperbaric index has a sensitivity and specificity of 99% for early identification of pregnant women at risk of developing PE, but its use is not widespread. To assess the usefulness of the hyperbaric index in the primary prevention of hypertensive pregnancy complications in a public healthcare area. This is a retrospective study of pregnancies that occurred in our area during the period 2007-2012 (N=11,784). The diagnosis was established by the hyperbaric index and pregnant women at risk were treated with ASA at night. In pregnant patients referred to the nephrology clinic (38.2%), diagnosed as high-risk for PE, and treated with 100mg ASA/night (from week 17), the incidence of PE episodes was reduced by 96.94. Copyright © 2015 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

GLOBALISATION AND THE UNPREDICTABILITY OF CRISIS EPISODES: AN EMPIRICAL ANALYSIS OF COUNTRY RISK INDEXES

Directory of Open Access Journals (Sweden)

San-Martín-Albizuri, Nerea

2012-05-01

Full Text Available The ongoing globalisation process has not put an end to international financial crises. On the contrary, it seems to have contributed to their appearance and to accentuating their degrees of unpredictability. In this context, the main objective of the present study is to establish whether the values of the best-known and most widely used country risk indexes, namely, the Euromoney index and the International Country Risk Group (ICRG, and the values of their representative variables could have forecasted well in advance the crises that took place between 1994 and 2002, a period which is herein termed the ‘globalisation era’. The results show that, although the selected indexes and their representative variables were able to identify certain vulnerabilities, they could not accurately identify the political, economic, and/or financial factors that developed prior to these crisis episodes.

Cumulative Culture and Future Thinking: Is Mental Time Travel a Prerequisite to Cumulative Cultural Evolution?

Science.gov (United States)

Vale, G. L.; Flynn, E. G.; Kendal, R. L.

2012-01-01

Cumulative culture denotes the, arguably, human capacity to build on the cultural behaviors of one's predecessors, allowing increases in cultural complexity to occur such that many of our cultural artifacts, products and technologies have progressed beyond what a single individual could invent alone. This process of cumulative cultural evolution…

Prospects of renewable energy sources in India: Prioritization of alternative sources in terms of Energy Index

International Nuclear Information System (INIS)

Jha, Shibani K.; Puppala, Harish

2017-01-01

The growing energy demand in progressing civilization governs the exploitation of various renewable sources over the conventional sources. Wind, Solar, Hydro, Biomass, and waste & Bagasse are the various available renewable sources in India. A reliable nonconventional geothermal source is also available in India but it is restricted to direct heat applications. This study archives the status of renewable alternatives in India. The techno economic factors and environmental aspects associated with each of these alternatives are discussed. This study focusses on prioritizing the renewable sources based on a parameter introduced as Energy Index. This index is evaluated using cumulative scores obtained for each of the alternatives. The cumulative score is obtained by evaluating each alternative over a range of eleven environmental and techno economic criteria following Fuzzy Analytical Hierarchy Process. The eleven criteria's considered in the study are Carbon dioxide emissions (CO 2 ), Sulphur dioxide emissions (SO 2 ), Nitrogen oxide emissions (NO x ), Land requirement, Current energy cost, Potential future energy cost, Turnkey investment, Capacity factor, Energy efficiency, Design period and Water consumption. It is concluded from the study that the geothermal source is the most preferable alternative with highest Energy Index. Hydro, Wind, Biomass and Solar sources are subsequently preferred alternatives. - Highlights: • FAH process is used to obtain cumulative score for each renewable alternative. • Cumulative score is normalized by highest score of ideal source. • Energy Index shows how best a renewable alternative is. • Priority order is obtained for alternatives based on Energy Index. • Geothermal is most preferable source followed by Hydro, Wind, Biomass and Solar.

Assessing systematic risk in the S&P500 index between 2000 and 2011: A Bayesian nonparametric approach

OpenAIRE

Rodríguez, Abel; Wang, Ziwei; Kottas, Athanasios

2017-01-01

We develop a Bayesian nonparametric model to assess the effect of systematic risks on multiple financial markets, and apply it to understand the behavior of the S&P500 sector indexes between January 1, 2000 and December 31, 2011. More than prediction, our main goal is to understand the evolution of systematic and idiosyncratic risks in the U.S. economy over this particular time period, leading to novel sector-specific risk indexes. To accomplish this goal, we model the appearance of extreme l...

Implementation of a module for risk of ozone impacts assessment to vegetation in the Integrated Assessment Modelling system for the Iberian Peninsula. Evaluation for wheat and Holm oak

International Nuclear Information System (INIS)

Andrés, Juan Manuel de; Borge, Rafael; Paz, David de la; Lumbreras, Julio; Rodríguez, Encarnación

2012-01-01

A module to estimate risks of ozone damage to vegetation has been implemented in the Integrated Assessment Modelling system for the Iberian Peninsula. It was applied to compute three different indexes for wheat and Holm oak; daylight AOT40 (cumulative ozone concentration over 40 ppb), cumulative ozone exposure index according to the Directive 2008/50/EC (AOT40-D) and POD Y (Phytotoxic Ozone Dose over a given threshold of Y nmol m −2 s −1 ). The use of these indexes led to remarkable differences in spatial patterns of relative ozone risks on vegetation. Ozone critical levels were exceeded in most of the modelling domain and soil moisture content was found to have a significant impact on the results. According to the outputs of the model, daylight AOT40 constitutes a more conservative index than the AOT40-D. Additionally, flux-based estimations indicate high risk areas in Portugal for both wheat and Holm oak that are not identified by AOT-based methods. - Highlights: ► A modelling system to estimate the risk of ozone in the Iberian Peninsula is presented. ► Ozone exposure- and flux-based approaches lead to rather different conclusions. ► Available ozone critical levels were exceeded in most locations where wheat is present. ► Soil moisture content has a significant impact on the flux-based results in some areas. - Flux-based indexes are needed to provide an effective protection of the vegetation in the Iberian Peninsula; currently, available critical levels for wheat are widely exceeded.

Air quality trends and potential health effects - Development of an aggregate risk index

Science.gov (United States)

Sicard, Pierre; Lesne, Olivia; Alexandre, Nicolas; Mangin, Antoine; Collomp, Rémy

2011-02-01

The "Provence Alpes Côte d'Azur" (PACA) region, in the South East of France, is one of Europe's regions most influenced by the atmospheric pollution. During the last 15 years, the industrial emissions decrease caused an evolution of the atmospheric pollution nature. Nowadays, atmospheric pollution is more and more influenced by the road traffic, the dominating pollution source in urban zones for the PACA region. Combined with this intense road traffic, the strong hot season of the Mediterranean climate contributes to the region bad air quality; it is known to be one of the worse in Europe. The recognized air pollution effects over public health include increased risk of hospital admissions and mortality by respiratory or cardiovascular diseases. The combination of these serious pollution related health hazards with senior and children vulnerabilities leads to serious sanitary concerns. Over the 1990-2005 period, we obtained, using the non-parametric Mann-Kendall test from annual mortality dataset (CépiDC), decreasing trends for Asthma (-5.00% year -1), Cardiovascular (-0.73% year -1), Ischemic (-0.69% year -1) and cerebrovascular diseases (-3.10% year -1). However, for "Other heart diseases" (+0.10% year -1) and "Respiratory" (+0.10% year -1) an increase was observed. The development of an adequate tool to understand impacts of pollution levels is of utmost importance. Different pollutants have different health endpoints, information may be lost through the use of a single index consequently, in this study we present the modified formula of air quality index, based on Cairncross's concept the Aggregate Risk Index (ARI). ARI is based on the relative risk of the well-established increased daily mortality, or morbidity, enabling an assessment of additive effects of short-term exposure to the main air pollutants: PM 2.5, PM 10, SO 2, O 3 and NO 2 in order to account for the reality of the multiple exposures impacts of chemical agents. The ARI, developed per pathology

Body mass index and the risk of Parkinson disease.

Science.gov (United States)

Hu, G; Jousilahti, P; Nissinen, A; Antikainen, R; Kivipelto, M; Tuomilehto, J

2006-12-12

To examine the association between body mass index (BMI) and the risk of Parkinson disease (PD). Study cohorts included 22,367 Finnish men and 23,439 women 25 to 59 years of age without a history of PD at baseline. Hazards ratios (HRs) of incident PD were estimated for different levels of BMI. During a mean follow-up period of 18.8 years, 272 men and 254 women developed incident PD. After adjustment for confounding factors (age, study years, systolic blood pressure, total cholesterol, education, leisure-time physical activity, smoking, and alcohol, coffee, and tea consumption), the HRs of PD at different levels of BMI ( or =30 kg/m(2)) were 1.00, 1.97 (95% CI: 1.21 to 3.22), 1.83 (95% CI: 1.12 to 2.99), 2.34 (95% CI: 1.45 to 3.78), and 2.44 (95% CI: 1.44 to 4.15) in men, and 1.00, 1.50 (95% CI: 0.95 to 2.37), 1.65 (95% CI: 1.05 to 2.59), 1.79 (95% CI: 1.15 to 2.80), and 1.77 (95% CI: 1.12 to 2.78) in women, and 1.00, 1.70 (95% CI: 1.23 to 2.37), 1.70 (95% CI: 1.23 to 2.37), 2.02 (95% CI: 1.46 to 2.79), and 2.03 (95% CI: 1.44 to 2.85) in men and women combined (adjusted also for sex). In both sexes combined, the multivariate-adjusted direct association between BMI and the risk of PD was present both in subjects aged 25 to 49 years and 50 to 59 years, in never smokers and smokers and in participants diagnosed PD before and after 65 years of age. Body mass index is associated with a risk of Parkinson disease. The effect is graded and independent of other risk factors.

Integrated Monitoring and Modeling of Carbon Dioxide Leakage Risk Using Remote Sensing, Ground-Based Monitoring, Atmospheric Models and Risk-Indexing Tools

Science.gov (United States)

Burton, E. A.; Pickles, W. L.; Gouveia, F. J.; Bogen, K. T.; Rau, G. H.; Friedmann, J.

2006-12-01

Correct assessment of the potential for CO2 leakage to the atmosphere or near surface is key to managing the risk associated with CO2 storage. Catastrophic, point-source leaks, diffuse seepage, and low leakage rates all merit assessment. Smaller leaks may be early warnings of catastrophic failures, and may be sufficient to damage natural vegetation or crops. Small leaks also may lead to cumulative build-up of lethal levels of CO2 in enclosed spaces, such as basements, groundwater-well head spaces, and caverns. Working with our ZERT partners, we are integrating a variety of monitoring and modeling approaches to understand how to assess potential health, property and environmental risks across this spectrum of leakage types. Remote sensing offers a rapid technique to monitor large areas for adverse environmental effects. If it can be deployed prior to the onset of storage operations, remote sensing also can document baseline conditions against which future claims of environmental damage can be compared. LLNL has been using hyperspectral imaging to detect plant stress associated with CO2 gas leakage, and has begun investigating use of NASA's new satellite or airborne instrumentation that directly measures gas compositions in the atmosphere. While remote sensing techniques have been criticized as lacking the necessary resolution to address environmental problems, new instruments and data processing techniques are demonstrated to resolve environmental changes at the scale associated with gas-leakage scenarios. During the shallow low-flow- CO2 release field experiments planned by ZERT, for the first time, we will have the opportunity to ground- truth hyperspectral data by simultaneous measurement of changes in hyperspectral readings, soil and root zone microbiology, ambient air, soil and aquifer CO2 concentrations. When monitoring data appear to indicate a CO2 leakage event, risk assessment and mitigation of that event requires a robust and nearly real-time method for

System-Reliability Cumulative-Binomial Program

Science.gov (United States)

Scheuer, Ernest M.; Bowerman, Paul N.

1989-01-01

Cumulative-binomial computer program, NEWTONP, one of set of three programs, calculates cumulative binomial probability distributions for arbitrary inputs. NEWTONP, CUMBIN (NPO-17555), and CROSSER (NPO-17557), used independently of one another. Program finds probability required to yield given system reliability. Used by statisticians and users of statistical procedures, test planners, designers, and numerical analysts. Program written in C.

Cumulative human impacts on marine predators.

Science.gov (United States)

Maxwell, Sara M; Hazen, Elliott L; Bograd, Steven J; Halpern, Benjamin S; Breed, Greg A; Nickel, Barry; Teutschel, Nicole M; Crowder, Larry B; Benson, Scott; Dutton, Peter H; Bailey, Helen; Kappes, Michelle A; Kuhn, Carey E; Weise, Michael J; Mate, Bruce; Shaffer, Scott A; Hassrick, Jason L; Henry, Robert W; Irvine, Ladd; McDonald, Birgitte I; Robinson, Patrick W; Block, Barbara A; Costa, Daniel P

2013-01-01

Stressors associated with human activities interact in complex ways to affect marine ecosystems, yet we lack spatially explicit assessments of cumulative impacts on ecologically and economically key components such as marine predators. Here we develop a metric of cumulative utilization and impact (CUI) on marine predators by combining electronic tracking data of eight protected predator species (n=685 individuals) in the California Current Ecosystem with data on 24 anthropogenic stressors. We show significant variation in CUI with some of the highest impacts within US National Marine Sanctuaries. High variation in underlying species and cumulative impact distributions means that neither alone is sufficient for effective spatial management. Instead, comprehensive management approaches accounting for both cumulative human impacts and trade-offs among multiple stressors must be applied in planning the use of marine resources.

Redefining high-risk patients with stage II colon cancer by risk index and microRNA-21: results from a population-based cohort

DEFF Research Database (Denmark)

Hansen, T F; Kjær-Frifeldt, S; Christensen, R D

2014-01-01

Background:The aim of the present study was to analyse the prognostic value of microRNA-21 (miRNA-21) in patients with stage II colon cancer aiming at a risk index for this group of patients.Methods:A population-based cohort of 554 patients was included. MicroRNA-21 was analysed by qPCR based...... on tumour tissue. An index was created using the coefficients obtained from a collective multiple Cox regression. The entire procedure was cross-validated (10-fold). The performance of the index was quantified by time-dependent receiver operating characteristics curves.Results:High miRNA-21 expression...... was associated with an unfavourable recurrence-free cancer-specific survival (RF-CSS), hazard ratio 1.35 (95% confidence interval, 1.03-1.76) (P=0.028). The generated RF-CSS index divided the traditional high-risk patients into subgroups with 5-year RF-CSS rates of 87% and 73%, respectively (P...

CUMULATIVE REPRODUCTIVE EFFECTS OF IN UTERO ADMINISTRATION OF A MIXTURE OF TEN “ANTIANDROGENS” IN MALE SD RATS: SYNERGY OR ADDITIVITY?

Science.gov (United States)

In 1996, the USEPA was charged under FQPA to consider the cumulative effects of chemicals in their risk assessments. We are conducting studies to provide a framework for assessing the cumulative effects of antiandrogens. In the current study, ten “antiandrogenic” chemicals were a...

[Risk factors of venous thromboembolism recurrence and the predictive value of simplified pulmonary embolism severity index in medical inpatients].

Science.gov (United States)

Shi, C L; Zhou, H X; Tang, Y J; Wang, L; Yi, Q; Liang, Z A

2016-04-12

To explore the risk factors of venous thromboembolism (VTE) recurrence and the predictive value of simplified pulmonary embolism severity index (sPESI) in medical inpatients. A total of 149 consecutive patients with first diagnosed VTE from the medical departments of West China Hospital of Sichuan University from January 2011 and December 2012 were enrolled and followed-up for 24 months. The VTE recurrence rate was calculated and univariate and multivariate cox proportional hazards regression analysis were performed to identify the risk factors associated with VTE recurrence. All the patients were evaluated by sPESI, and survival analysis was used to explore its value in predicting VTE recurrence in these medical patients. Out of the included 149 patients, 23(15.4%) patients had VTE recurrence during the 2 years' follow-up and median recurrence time was 167 days. The univariate analysis showed bed rest, severe lung disease, nephrotic syndrome, inappropriate anticoagulant therapy, smoking, diabetes, and malignant neoplasm might be associated with VTE recurrence (P=0.043, 0.006, 0.009, 0.032, 0.098, 0.048, 0.021). Among these risk factors, the multivariate analysis revealed severe lung disease, nephrotic syndrome, and malignant neoplasm were the independent risk factors (HR=3.45, 5.67, 3.60; P=0.020, 0.020, 0.047); while for inappropriate anticoagulant therapy, the P value was marginal (HR=3.94, 95% CI: 0.99-15.63, P=0.051). The median sPESI scores of the patients with VTE recurrence was higher than that of the patients without VTE recurrence[1(1, 2) vs 0(0, 1), P=0.001], and patients with sPESI≥1 were associated with 5.57-fold increased risk of VTE recurrence compared with patients with sPESI=0 (95%CI: 1.79-17.30, P=0.001). Survival analysis also showed that the 2-year cumulative VTE recurrence rate of patients with sPESI≥1 was significant higher than that of patients with sPESI=0 (38.4% vs 5.7%, P=0.001). The medical VTE patients have high VTE recurrence risk

A probabilistic method for computing quantitative risk indexes from medical injuries compensation claims.

Science.gov (United States)

Dalle Carbonare, S; Folli, F; Patrini, E; Giudici, P; Bellazzi, R

2013-01-01

The increasing demand of health care services and the complexity of health care delivery require Health Care Organizations (HCOs) to approach clinical risk management through proper methods and tools. An important aspect of risk management is to exploit the analysis of medical injuries compensation claims in order to reduce adverse events and, at the same time, to optimize the costs of health insurance policies. This work provides a probabilistic method to estimate the risk level of a HCO by computing quantitative risk indexes from medical injury compensation claims. Our method is based on the estimate of a loss probability distribution from compensation claims data through parametric and non-parametric modeling and Monte Carlo simulations. The loss distribution can be estimated both on the whole dataset and, thanks to the application of a Bayesian hierarchical model, on stratified data. The approach allows to quantitatively assessing the risk structure of the HCO by analyzing the loss distribution and deriving its expected value and percentiles. We applied the proposed method to 206 cases of injuries with compensation requests collected from 1999 to the first semester of 2007 by the HCO of Lodi, in the Northern part of Italy. We computed the risk indexes taking into account the different clinical departments and the different hospitals involved. The approach proved to be useful to understand the HCO risk structure in terms of frequency, severity, expected and unexpected loss related to adverse events.

Common-Reliability Cumulative-Binomial Program

Science.gov (United States)

Scheuer, Ernest, M.; Bowerman, Paul N.

1989-01-01

Cumulative-binomial computer program, CROSSER, one of set of three programs, calculates cumulative binomial probability distributions for arbitrary inputs. CROSSER, CUMBIN (NPO-17555), and NEWTONP (NPO-17556), used independently of one another. Point of equality between reliability of system and common reliability of components found. Used by statisticians and users of statistical procedures, test planners, designers, and numerical analysts. Program written in C.

Cumulative effects assessment: Does scale matter?

International Nuclear Information System (INIS)

Therivel, Riki; Ross, Bill

2007-01-01

Cumulative effects assessment (CEA) is (or should be) an integral part of environmental assessment at both the project and the more strategic level. CEA helps to link the different scales of environmental assessment in that it focuses on how a given receptor is affected by the totality of plans, projects and activities, rather than on the effects of a particular plan or project. This article reviews how CEAs consider, and could consider, scale issues: spatial extent, level of detail, and temporal issues. It is based on an analysis of Canadian project-level CEAs and UK strategic-level CEAs. Based on a review of literature and, especially, case studies with which the authors are familiar, it concludes that scale issues are poorly considered at both levels, with particular problems being unclear or non-existing cumulative effects scoping methodologies; poor consideration of past or likely future human activities beyond the plan or project in question; attempts to apportion 'blame' for cumulative effects; and, at the plan level, limited management of cumulative effects caused particularly by the absence of consent regimes. Scale issues are important in most of these problems. However both strategic-level and project-level CEA have much potential for managing cumulative effects through better siting and phasing of development, demand reduction and other behavioural changes, and particularly through setting development consent rules for projects. The lack of strategic resource-based thresholds constrains the robust management of strategic-level cumulative effects

Cumulative cultural learning: Development and diversity

Science.gov (United States)

2017-01-01

The complexity and variability of human culture is unmatched by any other species. Humans live in culturally constructed niches filled with artifacts, skills, beliefs, and practices that have been inherited, accumulated, and modified over generations. A causal account of the complexity of human culture must explain its distinguishing characteristics: It is cumulative and highly variable within and across populations. I propose that the psychological adaptations supporting cumulative cultural transmission are universal but are sufficiently flexible to support the acquisition of highly variable behavioral repertoires. This paper describes variation in the transmission practices (teaching) and acquisition strategies (imitation) that support cumulative cultural learning in childhood. Examining flexibility and variation in caregiver socialization and children’s learning extends our understanding of evolution in living systems by providing insight into the psychological foundations of cumulative cultural transmission—the cornerstone of human cultural diversity. PMID:28739945

Cumulative cultural learning: Development and diversity.

Science.gov (United States)

Legare, Cristine H

2017-07-24

The complexity and variability of human culture is unmatched by any other species. Humans live in culturally constructed niches filled with artifacts, skills, beliefs, and practices that have been inherited, accumulated, and modified over generations. A causal account of the complexity of human culture must explain its distinguishing characteristics: It is cumulative and highly variable within and across populations. I propose that the psychological adaptations supporting cumulative cultural transmission are universal but are sufficiently flexible to support the acquisition of highly variable behavioral repertoires. This paper describes variation in the transmission practices (teaching) and acquisition strategies (imitation) that support cumulative cultural learning in childhood. Examining flexibility and variation in caregiver socialization and children's learning extends our understanding of evolution in living systems by providing insight into the psychological foundations of cumulative cultural transmission-the cornerstone of human cultural diversity.

Suicide Risk Screening Tools and the Youth Population.

Science.gov (United States)

Patterson, Sharon

2016-08-01

The use of suicide risk screening tools is a critical component of a comprehensive approach to suicide risk assessment. Since nurses frequently spend more time with patients than any other healthcare professional, they are in key positions to detect and prevent suicidal behavior in youth. To inform nurses about suicide risk screening tools for the youth population. Suicide risk screening tools are research-based standardized instruments that are used to identify people who may be at risk for suicide. A literature search was performed using the Athabasca University Library Resource, the databases of the Cumulative Index to Nursing and Allied Health Literature, ScienceDirect, and Google Scholar. Nurses are cautioned to utilize suicide risk screening tools as only part of the suicide risk assessment in youth populations and avoid the danger of relying on tools that may result in a blind application of evidence to the detriment of clinical experience and judgement. © 2016 Wiley Periodicals, Inc.

A Land-Use Perspective for Birdstrike Risk Assessment: The Attraction Risk Index.

Directory of Open Access Journals (Sweden)

Francesca Coccon

Full Text Available Collisions between aircraft and birds, birdstrikes, pose a serious threat to aviation safety. The occurrence of these events is influenced by land-uses in the surroundings of airports. Airports located in the same region might have different trends for birdstrike risk, due to differences in the surrounding habitats. Here we developed a quantitative tool that assesses the risk of birdstrike based on the habitats within a 13-km buffer from the airport. For this purpose, we developed Generalized Linear Models (GLMs with binomial distribution to estimate the contribution of habitats to wildlife use of the study area, depending on season. These GLMs predictions were combined to the flight altitude of birds within the 13-km buffer, the airport traffic pattern and the severity indices associated with impacts. Our approach was developed at Venice Marco Polo International airport (VCE, located in northeast Italy and then tested at Treviso Antonio Canova International airport (TSF, which is 20 km inland. Results from the two airports revealed that both the surrounding habitats and the season had a significant influence to the pattern of risk. With regard to VCE, agricultural fields, wetlands and urban areas contributed most to the presence of birds in the study area. Furthermore, the key role of distance of land-uses from the airport on the probability of presence of birds was highlighted. The reliability of developed risk index was demonstrated since at VCE it was significantly correlated with bird strike rate. This study emphasizes the importance of the territory near airports and the wildlife use of its habitats, as factors in need of consideration for birdstrike risk assessment procedures. Information on the contribution of habitats in attracting birds, depending on season, can be used by airport managers and local authorities to plan specific interventions in the study area in order to lower the risk.

Unraveling the Link between Trauma and Male Delinquency: The Cumulative Versus Differential Risk Perspectives

Science.gov (United States)

Maschi, Tina

2006-01-01

This study examined how the cumulative (additive) versus differential (individual) effects of trauma influenced male delinquency. Using a comprehensive measure of trauma, a secondary data analysis was conducted on a nationally representative sample of male youths between the ages of 12 and 17. Logistic regression analyses revealed that all three…

Adult body mass index and risk of ovarian cancer by subtype

DEFF Research Database (Denmark)

Dixon, Suzanne C; Nagle, Christina M; Thrift, Aaron P

2016-01-01

BACKGROUND: Observational studies have reported a positive association between body mass index (BMI) and ovarian cancer risk. However, questions remain as to whether this represents a causal effect, or holds for all histological subtypes. The lack of association observed for serous cancers may......, for instance, be due to disease-associated weight loss. Mendelian randomization (MR) uses genetic markers as proxies for risk factors to overcome limitations of observational studies. We used MR to elucidate the relationship between BMI and ovarian cancer, hypothesizing that genetically predicted BMI would...... be associated with increased risk of non-high grade serous ovarian cancers (non-HGSC) but not HGSC. METHODS: We pooled data from 39 studies (14 047 cases, 23 003 controls) in the Ovarian Cancer Association Consortium. We constructed a weighted genetic risk score (GRS, partial F-statistic = 172), summing alleles...

Creating a spatially-explicit index: a method for assessing the global wildfire-water risk

Science.gov (United States)

Robinne, François-Nicolas; Parisien, Marc-André; Flannigan, Mike; Miller, Carol; Bladon, Kevin D.

2017-04-01

The wildfire-water risk (WWR) has been defined as the potential for wildfires to adversely affect water resources that are important for downstream ecosystems and human water needs for adequate water quantity and quality, therefore compromising the security of their water supply. While tools and methods are numerous for watershed-scale risk analysis, the development of a toolbox for the large-scale evaluation of the wildfire risk to water security has only started recently. In order to provide managers and policy-makers with an adequate tool, we implemented a method for the spatial analysis of the global WWR based on the Driving forces-Pressures-States-Impacts-Responses (DPSIR) framework. This framework relies on the cause-and-effect relationships existing between the five categories of the DPSIR chain. As this approach heavily relies on data, we gathered an extensive set of spatial indicators relevant to fire-induced hydrological hazards and water consumption patterns by human and natural communities. When appropriate, we applied a hydrological routing function to our indicators in order to simulate downstream accumulation of potentially harmful material. Each indicator was then assigned a DPSIR category. We collapsed the information in each category using a principal component analysis in order to extract the most relevant pixel-based information provided by each spatial indicator. Finally, we compiled our five categories using an additive indexation process to produce a spatially-explicit index of the WWR. A thorough sensitivity analysis has been performed in order to understand the relationship between the final risk values and the spatial pattern of each category used during the indexation. For comparison purposes, we aggregated index scores by global hydrological regions, or hydrobelts, to get a sense of regional DPSIR specificities. This rather simple method does not necessitate the use of complex physical models and provides a scalable and efficient tool

Cumulative occupational shoulder exposures and surgery for subacromial impingement syndrome: a nationwide Danish cohort study.

Science.gov (United States)

Dalbøge, Annett; Frost, Poul; Andersen, Johan Hviid; Svendsen, Susanne Wulff

2014-11-01

The primary aim was to examine exposure-response relationships between cumulative occupational shoulder exposures and surgery for subacromial impingement syndrome (SIS), and to compare sex-specific exposure-response relationships. The secondary aim was to examine the time window of relevant exposures. We conducted a nationwide register study of all persons born in Denmark (1933-1977), who had at least 5 years of full-time employment. In the follow-up period (2003-2008), we identified first-time events of surgery for SIS. Cumulative exposure estimates for a 10-year exposure time window with a 1-year lag time were obtained by linking occupational codes with a job exposure matrix. The exposure estimates were expressed as, for example, arm-elevation-years in accordance with the pack-year concept of tobacco consumption. We used a multivariable logistic regression technique equivalent to discrete survival analysis. The adjusted OR (ORadj) increased to a maximum of 2.1 for arm-elevation-years, repetition-years and force-years, and to 1.5 for hand-arm-vibration-years. Sex-specific exposure-response relationships were similar for men and women, when assessed using a relative risk scale. The ORadj increased gradually with the number of years contributing to the cumulative exposure estimates. The excess fraction was 24%. Cumulative occupational shoulder exposures carried an increase in risk of surgery for SIS with similar exposure-response curves for men and women. The risk of surgery for SIS increased gradually, when the period of exposure assessment was extended. In the general working population, a substantial fraction of all first-time operations for SIS could be related to occupational exposures. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Calculating Cumulative Binomial-Distribution Probabilities

Science.gov (United States)

Scheuer, Ernest M.; Bowerman, Paul N.

1989-01-01

Cumulative-binomial computer program, CUMBIN, one of set of three programs, calculates cumulative binomial probability distributions for arbitrary inputs. CUMBIN, NEWTONP (NPO-17556), and CROSSER (NPO-17557), used independently of one another. Reliabilities and availabilities of k-out-of-n systems analyzed. Used by statisticians and users of statistical procedures, test planners, designers, and numerical analysts. Used for calculations of reliability and availability. Program written in C.

Adherence to a healthy Nordic food index and risk of myocardial infarction in middle-aged Danes

DEFF Research Database (Denmark)

Gunge, V B; Andersen, I; Kyrø, C

2017-01-01

BACKGROUND/OBJECTIVES: For decades, the Mediterranean diet has been in focus regarding healthy eating as it has been associated with reduced risk of non-communicable diseases. Less interest has been given to health benefits of other regional diets. The aim of the present study was to assess whether...... adherence to a healthy Nordic food index was associated with lower risk of myocardial infarction (MI) among middle-aged Danes. SUBJECTS/METHODS: Data were obtained from the Danish Diet, Cancer and Health cohort study of 57 053 men and women aged 50 − 64 years recruited between 1993 and 1997. The healthy.......55, 95% CI = 0.37, 0.82) relative to those scoring 0 points in the index (lowest score). A significantly lower MI risk was found per 1-point increment in the index in both men (HR = 0.95, 95% CI = 0.92, 0.99) and women (HR = 0.93, 95% CI = 0.88, 0.98). CONCLUSIONS: A healthy Nordic diet is associated...

Cumulative human impacts on marine predators

DEFF Research Database (Denmark)

Maxwell, Sara M; Hazen, Elliott L; Bograd, Steven J

2013-01-01

Stressors associated with human activities interact in complex ways to affect marine ecosystems, yet we lack spatially explicit assessments of cumulative impacts on ecologically and economically key components such as marine predators. Here we develop a metric of cumulative utilization and impact...

Predicting nosocomial lower respiratory tract infections by a risk index based system

NARCIS (Netherlands)

Chen, Yong; Shan, Xue; Zhao, Jingya; Han, Xuelin; Tian, Shuguang; Chen, Fangyan; Su, Xueting; Sun, Yansong; Huang, Liuyu; Grundmann, Hajo; Wang, Hongyuan; Han, Li

2017-01-01

Although belonging to one of the most common type of nosocomial infection, there was currently no simple prediction model for lower respiratory tract infections (LRTIs). This study aims to develop a risk index based system for predicting nosocomial LRTIs based on data from a large point-prevalence

Enviromentally sensitive patch index of desertification risk applied to the main habitats of Sicily

Science.gov (United States)

Duro, A.; Piccione, V.; Ragusa, M. A.; Rapicavoli, V.; Veneziano, V.

2017-07-01

The authors applied the MEDALUS - Mediterranean Desertification and Land Use - procedure to the most representative sicilian habitat by extension, socio-economic and environmental importance, in order to assess the risk of desertification. Thanks to the ESPI, Environmentally Sensitive Patch Index, in this paper the authors estimate the current and future regional levels of desertification risk.

STORMTOOLS: Coastal Environmental Risk Index (CERI

Directory of Open Access Journals (Sweden)

Malcolm L. Spaulding

2016-08-01

Full Text Available One of the challenges facing coastal zone managers and municipal planners is the development of an objective, quantitative assessment of the risk to structures, infrastructure, and public safety that coastal communities face from storm surge in the presence of changing climatic conditions, particularly sea level rise and coastal erosion. Here we use state of the art modeling tool (ADCIRC and STWAVE to predict storm surge and wave, combined with shoreline change maps (erosion, and damage functions to construct a Coastal Environmental Risk Index (CERI. Access to the state emergency data base (E-911 provides information on structure characteristics and the ability to perform analyses for individual structures. CERI has been designed as an on line Geographic Information System (GIS based tool, and hence is fully compatible with current flooding maps, including those from FEMA. The basic framework and associated GIS methods can be readily applied to any coastal area. The approach can be used by local and state planners to objectively evaluate different policy options for effectiveness and cost/benefit. In this study, CERI is applied to RI two communities; Charlestown representing a typical coastal barrier system directly exposed to ocean waves and high erosion rates, with predominantly low density single family residences and Warwick located within Narragansett Bay, with more limited wave exposure, lower erosion rates, and higher residential housing density. Results of these applications are highlighted herein.

The EVIDENT diet quality index is associated with cardiovascular risk and arterial stiffness in adults

Directory of Open Access Journals (Sweden)

Carmela Rodríguez-Martin

2017-04-01

Full Text Available Abstract Background We aimed to simplify information from food frequency questionnaires (FFQs in a single parameter that allows for rapid identification of quality of patient diet and its relationship to cardiovascular risk and pulse wave velocity (PWV. Methods The sample from the EVIDENT study, consisting of 1553 subjects (aged 20–80 years with no cardiovascular disease selected by random sampling among those attending primary care clinics, was used. The EVIDENT diet index (range 0–100 was calculated based on the results of a FFQ. Evaluation of dietary habits also included adherence to the Mediterranean diet (MD. Cardiovascular risk was estimated, and carotid-femoral pulse wave velocity was measured. Results Mean subject age was 54.9 ± 13.8 years, and 60.3% of subjects were female. The mean value of the EVIDENT diet index was 52.1 ± 3.2 points. Subjects in the third tertile (the highest score had the greatest adherence to MD and the highest energy intake, with greater amounts of carbohydrates, protein, and fiber. The best cut-off point of the EVIDENT diet index for predicting good adherence to the MD is 52.3 (0.71 sensitivity, 0.61 specificity. In a multiple regression analysis, after a complete adjustment, it was estimated that for each one-point increase in the EVIDENT diet index, cardiovascular risk (CVR, blood-pressure, waist circumference, and PWV decreased by 0.14, 0.43, 0.24, and 0.09 respectively (p < 0.05, all. Conclusions The diet quality index developed is associated to CVR and its components, and also with arterial stiffness, as measured with PWV. This index is also a good predictor of adherence to MD.

Risk Quantitative Determination of Fire and Explosion in a Process Unit By Dow’s Fire and Explosion Index

Directory of Open Access Journals (Sweden)

S. Varmazyar

2008-04-01

Full Text Available Background and aims   Fire and explosion hazards are the first and second of major hazards in process industries, respectively. This study has been done to determine fire and explosion risk severity,radius of exposure and estimating of most probable loss.   Methods   In this quantitative study process unit has been selected with affecting parameters on  fire and explosion risk. Then, it was analyzed by DOW's fire and explosion index (F&EI. Technical data were obtained from process documents and reports, fire and explosion guideline.After calculating of DOW's index, radius of exposure determined and finally most  probable loss was estimated.   Results   The results showed an F&EI value of 226 for this process unit.The F&EI was extremely  high and unacceptable.Risk severity was categorized in sever class.Radius of exposure and damage factor were calculated 57 meters and 83%,respectively. As well as most probable loss was  estimated about 6.7 million dollars.   Conclusion   F&EI is a proper technique for risk assessment and loss estimation of fire and  explosion in process industries.Also,It is an important index for detecting high risk and low risk   areas in an industry. At this technique, all of factors affecting on fire and explosion risk was  showed as index that is a base for judgement risk class. Finally, estimated losses could be used as  a base of fire and explosion insurance.

Minor Cytological Abnormalities and up to 7-Year Risk for Subsequent High-Grade Lesions by HPV Type.

Directory of Open Access Journals (Sweden)

Maria Persson

Full Text Available Diagnoses of atypical squamous cells of undetermined significance (ASCUS and low-grade squamous intraepithelial lesions (LSIL are common, but the corresponding risk of disease varies by human papillomavirus (HPV status, complicating management strategies. Our aim was to estimate the longer-term risk of cervical intraepithelial neoplasia grade 2 or worse (CIN2+ among women with ASCUS/LSIL by age, HPV status, and genotype(s.A total of 314 women with ASCUS/ LSIL were followed for a median of 3.8 years. Baseline HPV status was determined by reflex testing and women with histologically confirmed CIN2+ were identified through linkage to the Swedish National Quality Register for Cervical Cancer Prevention. Cumulative incidence and hazard ratios were estimated to explore differences between index data and associations with CIN2+.In total, 89 women (28.3% developed CIN2+. High-risk (HR HPV-positive women developed significantly more CIN2+ than HR-HPV-negative women (cumulative incidence 3.5 years after the index test: 42.2%, 95% CI: 32.5-53.5 for HPV16/18; 36.2%, 95% CI: 28.3-45.4 for other HR-HPV types; and 2.0%, 95% CI: 0.5-7.8 for HR-HPV-negative women; p<0.0001.HPV status was of greatest importance in determining the risk of CIN2+. The risk was low among HPV-negative women during the first years of follow-up, suggesting these women could be followed less intensively. HPV16/18-positive women may need intensified follow-up as they showed the highest risk of CIN2+.

Minor Cytological Abnormalities and up to 7-Year Risk for Subsequent High-Grade Lesions by HPV Type.

Science.gov (United States)

Persson, Maria; Elfström, K Miriam; Olsson, Sven-Erik; Dillner, Joakim; Andersson, Sonia

2015-01-01

Diagnoses of atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesions (LSIL) are common, but the corresponding risk of disease varies by human papillomavirus (HPV) status, complicating management strategies. Our aim was to estimate the longer-term risk of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) among women with ASCUS/LSIL by age, HPV status, and genotype(s). A total of 314 women with ASCUS/ LSIL were followed for a median of 3.8 years. Baseline HPV status was determined by reflex testing and women with histologically confirmed CIN2+ were identified through linkage to the Swedish National Quality Register for Cervical Cancer Prevention. Cumulative incidence and hazard ratios were estimated to explore differences between index data and associations with CIN2+. In total, 89 women (28.3%) developed CIN2+. High-risk (HR) HPV-positive women developed significantly more CIN2+ than HR-HPV-negative women (cumulative incidence 3.5 years after the index test: 42.2%, 95% CI: 32.5-53.5 for HPV16/18; 36.2%, 95% CI: 28.3-45.4 for other HR-HPV types; and 2.0%, 95% CI: 0.5-7.8 for HR-HPV-negative women; p<0.0001). HPV status was of greatest importance in determining the risk of CIN2+. The risk was low among HPV-negative women during the first years of follow-up, suggesting these women could be followed less intensively. HPV16/18-positive women may need intensified follow-up as they showed the highest risk of CIN2+.

Use of Segregation Indices, Townsend Index, and Air Toxics Data to Assess Lifetime Cancer Risk Disparities in Metropolitan Charleston, South Carolina, USA

Directory of Open Access Journals (Sweden)

LaShanta J. Rice

2014-05-01

Full Text Available Background: Studies have demonstrated a relationship between segregation and level of education, occupational opportunities, and risk behaviors, yet a paucity of research has elucidated the association between racial residential segregation, socioeconomic deprivation, and lifetime cancer risk. Objectives: We examined estimated lifetime cancer risk from air toxics by racial composition, segregation, and deprivation in census tracts in Metropolitan Charleston. Methods: Segregation indices were used to measure the distribution of groups of people from different races within neighborhoods. The Townsend Index was used to measure economic deprivation in the study area. Poisson multivariate regressions were applied to assess the association of lifetime cancer risk with segregation indices and Townsend Index along with several sociodemographic measures. Results: Lifetime cancer risk from all pollution sources was 28 persons/million for half of the census tracts in Metropolitan Charleston. Isolation Index and Townsend Index both showed significant correlation with lifetime cancer risk from different sources. This significance still holds after adjusting for other sociodemographic measures in a Poisson regression, and these two indices have stronger effect on lifetime cancer risk compared to the effects of sociodemographic measures. Conclusions: We found that material deprivation, measured by the Townsend Index and segregation measured by the Isolation index, introduced high impact on lifetime cancer risk by air toxics at the census tract level.

Flood risk index pattern assessment: case study in Langat River Basin

African Journals Online (AJOL)

This study focus on the creation of flood risk index in the study area based on secondary data derived from the Department of Drainage and Irrigation (DID) since 1982-2012. Based on the result, it shows that the water level is the best variable to be taken for the purposed of flood warning alert system as the result for ...

The c-index is not proper for the evaluation of $t$-year predicted risks.

Science.gov (United States)

Blanche, Paul; Kattan, Michael W; Gerds, Thomas A

2018-02-16

We show that the widely used concordance index for time to event outcome is not proper when interest is in predicting a $t$-year risk of an event, for example 10-year mortality. In the situation with a fixed prediction horizon, the concordance index can be higher for a misspecified model than for a correctly specified model. Impropriety happens because the concordance index assesses the order of the event times and not the order of the event status at the prediction horizon. The time-dependent area under the receiver operating characteristic curve does not have this problem and is proper in this context.

Association of waist circumference, body mass index and conicity index with cardiovascular risk factors in postmenopausal women.

Science.gov (United States)

Shidfar, Farzad; Alborzi, Fatemeh; Salehi, Maryam; Nojomi, Marzieh

2012-09-01

In menopause, changes in body fat distribution lead to increasing risk of cardiovascular disease and metabolic disorders. The aim of this study was to assess the association of adiposity using the conicity index (CI), body mass index (BMI) and waist circumference (WC) with cardiovascular risk factors (hypertension, diabetes and dyslipidaemia). The sample of this cross-sectional study was collected from June to October 2010 and 165 consecutive menopausal women who had attended the Health and Treatment Centre and Endocrine Research Centre of Firoozgar Hospital in Tehran, Iran were assessed. Age, weight, height, WC, waist-hip ratio (WHR), CI and fat mass were measured. Systolic and diastolic blood pressure (SBP and DBP), fasting blood glucose, insulin, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and total cholesterol (TC) levels were also determined. All statistical analyses were performed by SPSS version 17 (SPSS Inc, Chicago, IL, USA). Results showed that BMI was positively and significantly associated with SBP (r = 0.21; p = 0.009). WC was positively and significantly correlated with SBP (r = 0.26; p = 0.02) and DBP (r = 0.16; p = 0.05). WHR was also significantly and positively associated with SBP (r = 0.29; p = 0.001). Age and WC were associated with CI quartiles at the 0.05 significance level. The correlation of CI quartiles with SBP and weight were at the 0.01 significance level. We showed a significant association of WC with SBP and DBP, and that BMI could be an important determining factor of SBP. For assessing the association between CI and cardiovascular risk factors, future studies with larger sample sizes are recommended.

[Study on building index system of risk assessment of post-marketing Chinese patent medicine based on AHP-fuzzy neural network].

Science.gov (United States)

Li, Yuanyuan; Xie, Yanming; Fu, Yingkun

2011-10-01

Currently massive researches have been launched about the safety, efficiency and economy of post-marketing Chinese patent medicine (CPM) proprietary Chinese medicine, but it was lack of a comprehensive interpretation. Establishing the risk evaluation index system and risk assessment model of CPM is the key to solve drug safety problems and protect people's health. The clinical risk factors of CPM exist similarities with the Western medicine, can draw lessons from foreign experience, but also have itself multi-factor multivariate multi-level complex features. Drug safety risk assessment for the uncertainty and complexity, using analytic hierarchy process (AHP) to empower the index weights, AHP-based fuzzy neural network to build post-marketing CPM risk evaluation index system and risk assessment model and constantly improving the application of traditional Chinese medicine characteristic is accord with the road and feasible beneficial exploration.

Chapter 19. Cumulative watershed effects and watershed analysis

Science.gov (United States)

Leslie M. Reid

1998-01-01

Cumulative watershed effects are environmental changes that are affected by more than.one land-use activity and that are influenced by.processes involving the generation or transport.of water. Almost all environmental changes are.cumulative effects, and almost all land-use.activities contribute to cumulative effects

Currency risk management of non-financial public limited companies listed on WIG30 index

Directory of Open Access Journals (Sweden)

Alicja Mikołajewicz-Woźniak

2013-12-01

Full Text Available The objects of the study are selected aspects of currency risk management of nonfinancial public limited companies listed on WIG30 index. The estimation of net profit sensitivity to currencies exchange rates was used to determine importance of currency risk management for functioning of analyzed entities. The indication of the methods and tools used in currency risk management process became the basis for evaluation of taken actions. The determination of the relationship between hedging accounting and risk management results enabled the verification to what extent Polish companies exploit existing opportunities.

Cumulative trauma and partner conflict predict post-traumatic stress disorder in postpartum African-American women.

Science.gov (United States)

Hauff, Nancy J; Fry-McComish, Judith; Chiodo, Lisa M

2017-08-01

To describe relationships between cumulative trauma, partner conflict and post-traumatic stress in African-American postpartum women. Cumulative trauma exposure estimates for women in the USA range from 51-69%. During pregnancy, most trauma research has focused on physical injury to the mother. Post-traumatic stress disorder (PTSD) is associated with trauma and more prevalent in African-American women than women of other groups. Knowledge about both the rate and impact of cumulative trauma on pregnancy may contribute to our understanding of women seeking prenatal care, and disparities in infant morbidity and mortality. This retrospective, correlational, cross-sectional study took place on postpartum units of two Detroit hospitals. Participants were 150 African-American women aged between 18-45 who had given birth. Mothers completed the Cumulative Trauma Scale, Conflict Tactics Scale, Clinician Administered Post-traumatic Stress Scale, Edinburgh Postnatal Depression Scale and a Demographic Data form. Descriptive statistics, correlations and multiple regressions were used for data analysis. All participants reported at least one traumatic event in their lifetime. Cumulative trauma and partner conflict predicted PTSD, with the trauma of a life-threatening event for a loved one reported by 60% of the sample. Nearly, one-fourth of the women screened were at risk for PTSD. Increased cumulative trauma, increased partner conflict and lower level of education were related to higher rates of PTSD symptoms. Both cumulative trauma and partner conflict in the past year predict PTSD. Reasoning was used most often for partner conflict resolution. The results of this study offer additional knowledge regarding relationships between cumulative trauma, partner conflict and PTSD in African-American women. Healthcare providers need to be sensitive to patient life-threatening events, personal failures, abuse and other types of trauma. Current evidence supports the need to assess for

Risk factors for competing noncancer mortality after definitive treatment for advanced-stage head and neck cancer.

Science.gov (United States)

Kim, Yong Han; Roh, Jong-Lyel; Kim, Sung-Bae; Choi, Seung-Ho; Nam, Soon Yuhl; Kim, Sang Yoon

2018-05-27

Patients with head and neck cancer (HNC) can die of index tumor progression and second tumor or noncancer causes. Here, we investigated the risk factors for competing noncancer mortality (NCM) in a prospective cohort of patients with advanced-stage HNC. A prospective observational study was conducted with 604 patients who underwent definitive treatment for advanced-stage HNC between 2010 and 2015. Main outcomes were NCM and cancer mortality (CM) defined as death from noncancer causes and HNC or second cancers, respectively. Cumulative incidence and cause-specific hazard functions were used to analyze the risk factors of NCM and CM. Age, smoking, Charlson comorbidity index (CCI), performance status, body mass index, rural residence, education and hemoglobin level at diagnosis, and chemotherapy were significantly associated with NCM (all Padvanced-stage HNC. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

THE ASSESSMENT OF LIFE STYLE AND THE VISCERAL ADIPOSITY INDEX AS CARDIOMETABOLIC RISK FACTORS

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Sigina R. GÂRGAVU

2018-06-01

Full Text Available Introduction. The patients with cardiometabolic/ cardiovascular risk are commonly found in clinics and ambulatory clinics. The cardiovascular (CV or cardiometabolic (CM risk factors and biomarkers are certain characteristics of the person without CV disease, which are independently correlated with the subsequent occurrence of CV disease, without necessarily having a causal relationship between factor and disease. The visceral adiposity index (VAI indicates the function of visceral adipose tissue and its growth is independently correlated with cardiovascular and cerebrovascular risk. The objective of the study was to evaluate the lifestyle and visceral adiposity index as possible cardiometabolic risk factors in patients with diabetes, prediabetes, and in the general population. Methods. The study was epidemiological, transversal, noninterventional, and was performed by analyzing 300 subjects, divided into three groups: group 1 (100 patients with type 2 diabetes, group 2 (100 pre-diabetic patients, and group 3 (control consisting of 100 individuals randomly recruited without diabetes. Results. The accumulation of cardiovascular risk factors results is an increased risk of cardiovascular disease. We found statistically significant differences between the three groups in terms of BMI, CT, VAI, CT, HDL-c and LDL-c values, which were higher in patients with diabetes mellitus (DM than in prediabetics or in the general population, which also coincided with higher cardiovascular risk in these patients. Conclusions. We emphasize the importance of both early cardiovascular risk assessment and the importance of controlling cardiovascular risk factors, both by non-pharmacological methods, and by associating early drug therapy when necessary.

Prospective weight change and colon cancer risk in male US health professionals

DEFF Research Database (Denmark)

Thygesen, Lau Caspar; Grønbaek, Morten; Johansen, Christoffer

2008-01-01

Epidemiological studies are remarkably consistent, especially among men, in showing that overweight and obesity [body mass index (BMI) >25] are associated with increased risk of colon cancer. However, no prospective studies address the influence of weight change in adulthood on subsequent colon...... cancer risk. In this study, we investigated whether weight change influences colon cancer risk utilizing prospectively collected weight data. We included 46,349 men aged 40-75 participating in the Health Professionals Follow-Up Study. Questionnaires including items on weight were completed every second......-year period, we documented 765 cases of colon cancer. Cumulative mean BMI >22.5 was associated with significantly increased risk of colon cancer. The short-term weight change in the prior 2 to 4 years was positively and significantly associated with risk [HR = 1.14 (95% confidence interval, 1...

Ecosystem assessment methods for cumulative effects at the regional scale

International Nuclear Information System (INIS)

Hunsaker, C.T.

1989-01-01

Environmental issues such as nonpoint-source pollution, acid rain, reduced biodiversity, land use change, and climate change have widespread ecological impacts and require an integrated assessment approach. Since 1978, the implementing regulations for the National Environmental Policy Act (NEPA) have required assessment of potential cumulative environmental impacts. Current environmental issues have encouraged ecologists to improve their understanding of ecosystem process and function at several spatial scales. However, management activities usually occur at the local scale, and there is little consideration of the potential impacts to the environmental quality of a region. This paper proposes that regional ecological risk assessment provides a useful approach for assisting scientists in accomplishing the task of assessing cumulative impacts. Critical issues such as spatial heterogeneity, boundary definition, and data aggregation are discussed. Examples from an assessment of acidic deposition effects on fish in Adirondack lakes illustrate the importance of integrated data bases, associated modeling efforts, and boundary definition at the regional scale

Managing cumulative impacts: A key to sustainability?

Energy Technology Data Exchange (ETDEWEB)

Hunsaker, C.T.

1994-12-31

This paper addresses how science can be more effectively used in creating policy to manage cumulative effects on ecosystems. The paper focuses on the scientific techniques that we have to identify and to assess cumulative impacts on ecosystems. The term ``sustainable development`` was brought into common use by the World Commission on Environment and Development (The Brundtland Commission) in 1987. The Brundtland Commission report highlighted the need to simultaneously address developmental and environmental imperatives simultaneously by calling for development that ``meets the needs of the present generation without compromising the needs of future generations.`` We cannot claim to be working toward sustainable development until we can quantitatively assess cumulative impacts on the environment: The two concepts are inextricibally linked in that the elusiveness of cumulative effects likely has the greatest potential of keeping us from achieving sustainability. In this paper, assessment and management frameworks relevant to cumulative impacts are discussed along with recent literature on how to improve such assessments. When possible, examples are given for marine ecosystems.

Stagewise pseudo-value regression for time-varying effects on the cumulative incidence

DEFF Research Database (Denmark)

Zöller, Daniela; Schmidtmann, Irene; Weinmann, Arndt

2016-01-01

In a competing risks setting, the cumulative incidence of an event of interest describes the absolute risk for this event as a function of time. For regression analysis, one can either choose to model all competing events by separate cause-specific hazard models or directly model the association...... for time-varying effects. This is implemented by coupling variable selection between the grid times, but determining estimates separately. The effect estimates are regularized to also allow for model fitting with a low to moderate number of observations. This technique is illustrated in an application...

Air University Library Index to Military Periodicals. Cumulative Issue January - December 1972. Volume 23, Number 4

National Research Council Canada - National Science Library

Rucks, Frances

1972-01-01

The Air University Library Index to Military Periodicals is a subject index to significant articles, news items and editorials appearing in 65 English language military and aeronautical periodicals...

Air University Library Index to Military Periodicals. Cumulative Issue January-December 1980. Volume 31, Number 4

National Research Council Canada - National Science Library

Rucks, Frances

1980-01-01

The Air University Library Index to Military Periodicals is a subject index to significant articles, news items and editorials appearing in 73 English language military and aeronautical periodicals...

Air University Library Index to Military Periodicals. Cumulative Issue January - December 1979. Volume 30, Number 4

National Research Council Canada - National Science Library

1979-01-01

The Air University Library Index to Military Periodicals is a subject index to significant articles, news items and editorials appearing in 68 English language military and aeronautical periodicals...

Air University Library Index to Military Periodicals. Cumulative Issue January - December 1985. Volume 36, Number 4

National Research Council Canada - National Science Library

Goodman, A

1985-01-01

The Air University Library Index to Military Periodicals is a subject index to significant articles, news items, and editorials appearing in 76 English language military and aeronautical periodicals...

Air University Library Index to Military Periodicals. Cumulative Issue January - December 1982. Volume 33, Number 4

National Research Council Canada - National Science Library

Hatton, Jackie

1982-01-01

The Air University Library Index to Military Periodicals is a subject index to significant articles, news items, and editorials appearing in 76 English language military and aeronautical periodicals...

Air University Library Index to Military Periodicals. Cumulative Issue January - December 1975. Volume 26, Number 4

National Research Council Canada - National Science Library

Rucks, Frances

1975-01-01

The Air University Library Index to Military Periodicals is a subject index to significant articles, news items and editorials appearing in 67 English language military and aeronautical periodicals...

Air University Library Index to Military Periodicals. Cumulative Issue January-December 1981. Volume 32, Number 4

National Research Council Canada - National Science Library

1981-01-01

The Air University Library Index to Military Periodicals is a subject index to significant articles, news items and editorials appearing in 72 English language military and aeronautical periodicals...

Air University Library Index to Military Periodicals. Cumulative Issue January - December 1974. Volume 25, Number 4

National Research Council Canada - National Science Library

Rucks, Frances

1974-01-01

The Air University Library Index to Military Periodicals is a subject index to significant articles, news items and editorials appearing in 65 English language military and aeronautical periodicals...

Air University Library Index to Military Periodicals. Cumulative Issue January-December 1978. Volume 29, Number 4

National Research Council Canada - National Science Library

Rucks, Frances

1978-01-01

The Air University Library Index to Military Periodicals is a subject index to significant articles, news items and editorials appearing in 68 English language military and aeronautical periodicals...

Air University Library Index to Military Periodicals. Cumulative Issue January - December 1988. Volume 39, Number 4

National Research Council Canada - National Science Library

Adams, Emily

1988-01-01

The Air University Library Index to Military Periodicals is a subject index to significant articles, news items, and editorials appearing in 77 English language military and aeronautical periodicals...

Geriatric nutritional risk index as a prognostic factor in patients with diffuse large B cell lymphoma.

Science.gov (United States)

Kanemasa, Yusuke; Shimoyama, Tatsu; Sasaki, Yuki; Hishima, Tsunekazu; Omuro, Yasushi

2018-06-01

The geriatric nutritional risk index (GNRI) is a simple and well-established nutritional assessment tool that is a significant prognostic factor for various cancers. However, the role of the GNRI in predicting clinical outcomes of diffuse large B cell lymphoma (DLBCL) patients has not been investigated. To address this issue, we retrospectively analyzed a total of 476 patients with newly diagnosed de novo DLBCL. We defined the best cutoff value of the GNRI as 96.8 using a receiver operating characteristic curve. Patients with a GNRI risk by National Comprehensive Cancer Network-International Prognostic Index (NCCN-IPI), the 5-year OS was significantly lower in patients with a GNRI risk, 59.5 vs. 75.2%, P = 0.006; high risk, 37.4 vs. 64.9%, P = 0.033). In the present study, we demonstrated that the GNRI was an independent prognostic factor in DLBCL patients. The GNRI could identify a population of poor-risk patients among those with high-intermediate and high-risk by NCCN-IPI.

Cumulative dosages of antipsychotic drugs are associated with increased mortality rate in patients with Alzheimer's dementia

DEFF Research Database (Denmark)

Nielsen, R E; Lolk, A; Valentin, J B

2016-01-01

OBJECTIVE: We wished to investigate the effects of cumulative dosages of antipsychotic drug in Alzheimer's dementia, when controlling for known risk factors, including current antipsychotic exposure, on all-cause mortality. METHOD: We utilized a nationwide, population-based, retrospective cohort...... study design with mortality as outcome in individual patients diagnosed with Alzheimer's dementia. RESULTS: We included a total of 45 894 patients and followed them for 3 803 996 person-years in total, presenting 27 894 deaths in the study population. Cumulative antipsychotic exposure increased...... or equal to 730 DDDs: HR 1.06, 95% CI (0.95-1.18), P = 0.322, when controlling for proxy markers of severity, somatic and mental comorbid disorders. CONCLUSION: In this nationwide cohort study of 45 894 patients diagnosed with Alzheimer's dementia, we found that cumulative dosages of antipsychotic drugs...

Lower cumulative stress is associated with better health for physically active adults in the community

Science.gov (United States)

Stults-Kolehmainen, Matthew A.; Tuit, Keri; Sinha, Rajita

2015-01-01

Both cumulative adversity, an individual's lifetime exposure to stressors, and insufficient exercise are associated with poor health outcomes. The purpose of this study was to ascertain whether exercise buffers the association of cumulative adverse life events (CALE) with health in a community-wide sample of healthy adults (ages 18–50 years; women: n 219, 29.5 ± 9.2 years; men: n = 176, 29.4 ± 8.7 years, mean ± standard deviation). Participants underwent the Cumulative Adversity Interview, which divides life events into three subsets: major life events (MLE), recent life events (RLE) and traumatic experiences (TLE). These individuals also completed the Cornell Medical Index and a short assessment for moderate or greater intensity exercise behavior, modified from the Nurses’ Health Study. Results indicated that higher CALE was associated with greater total health problems (r = 0.431, pstress and exercise were not apparent for RLE and TLE. However, at low levels of MLE, greater exercise was related to fewer total, physical, cardiovascular and psychological health problems (p valuestress. Increased levels of exercise were related to better physical health in men, at all levels of CALE. Only women who reported both low levels of CALE and high levels of exercise had more favorable physical health outcomes. A similar pattern of results emerged for RLE. Together, these data suggest that increased exercise is related to better health, but these effects may vary by cumulative stress exposure and sex. PMID:24392966

Body mass index and risk of BPH: a meta-analysis.

Science.gov (United States)

Wang, S; Mao, Q; Lin, Y; Wu, J; Wang, X; Zheng, X; Xie, L

2012-09-01

Epidemiological studies have reported conflicting results relating obesity to BPH. A meta-analysis of cohort and case-control studies was conducted to pool the risk estimates of the association between obesity and BPH. Eligible studies were retrieved by both computer searches and review of references. We analyzed abstracted data with random effects models to obtain the summary risk estimates. Dose-response meta-analysis was performed for studies reporting categorical risk estimates for a series of exposure levels. A total of 19 studies met the inclusion criteria of the meta-analysis. Positive association with body mass index (BMI) was observed in BPH and lower urinary tract symptoms (LUTS) combined group (odds ratio=1.27, 95% confidence intervals 1.05-1.53). In subgroup analysis, BMI exhibited a positive dose-response relationship with BPH/LUTS in population-based case-control studies and a marginal positive association was observed between risk of BPH and increased BMI. However, no association between BPH/LUTS and BMI was observed in other subgroups stratified by study design, geographical region or primary outcome. The overall current literatures suggested that BMI was associated with increased risk of BPH. Further efforts should be made to confirm these findings and clarify the underlying biological mechanisms.

Reliability testing across the Environmental Quality Index and national environmental indices.

Science.gov (United States)

One challenge in environmental epidemiology is the exploration of cumulative environmental exposure across multiple domains (e.g. air, water, land). The Environmental Quality Index (EQI), created by the U.S. EPA, uses principle component analyses combining environmental domains (...

Biweekly list of papers on radiation chemistry. Annual cumulation with keyword and author indexes. Volume 9

International Nuclear Information System (INIS)

1976-01-01

The reference lists and indexes are generated from a computer-searchable bibliographic data base; an indexing program collects and alphabetizes authors' names and keywords and correlates them with reference numbers

The association between a body shape index and cardiovascular risk in overweight and obese children and adolescents.

Science.gov (United States)

Mameli, Chiara; Krakauer, Nir Y; Krakauer, Jesse C; Bosetti, Alessandra; Ferrari, Chiara Matilde; Moiana, Norma; Schneider, Laura; Borsani, Barbara; Genoni, Teresa; Zuccotti, Gianvincenzo

2018-01-01

A Body Shape Index (ABSI) and normalized hip circumference (Hip Index, HI) have been recently shown to be strong risk factors for mortality and for cardiovascular disease in adults. We conducted an observational cross-sectional study to evaluate the relationship between ABSI, HI and cardiometabolic risk factors and obesity-related comorbidities in overweight and obese children and adolescents aged 2-18 years. We performed multivariate linear and logistic regression analyses with BMI, ABSI, and HI age and sex normalized z scores as predictors to examine the association with cardiometabolic risk markers (systolic and diastolic blood pressure, fasting glucose and insulin, total cholesterol and its components, transaminases, fat mass % detected by bioelectrical impedance analysis) and obesity-related conditions (including hepatic steatosis and metabolic syndrome). We recruited 217 patients (114 males), mean age 11.3 years. Multivariate linear regression showed a significant association of ABSI z score with 10 out of 15 risk markers expressed as continuous variables, while BMI z score showed a significant correlation with 9 and HI only with 1. In multivariate logistic regression to predict occurrence of obesity-related conditions and above-threshold values of risk factors, BMI z score was significantly correlated to 7 out of 12, ABSI to 5, and HI to 1. Overall, ABSI is an independent anthropometric index that was significantly associated with cardiometabolic risk markers in a pediatric population affected by overweight and obesity.

The triglycerides and glucose index is associated with cardiovascular risk factors in normal-weight children and adolescents.

Science.gov (United States)

Simental-Mendía, Luis E; Hernández-Ronquillo, Gabriela; Gómez-Díaz, Rita; Rodríguez-Morán, Martha; Guerrero-Romero, Fernando

2017-12-01

BackgroundGiven the usefulness of the product of triglycerides and glucose (TyG) to recognize individuals at high risk for developing cardiovascular events, the aim of this study was to determine whether the TyG index is associated with the presence of cardiovascular risk factors in apparently healthy normal-weight children and adolescents.MethodsApparently healthy children and adolescents with normal weight, aged 6-15 years, were enrolled in a population-based cross-sectional study. The children were allocated into groups with and without cardiovascular risk factors. Cardiovascular risk factors were considered as the occurrence of at least one of the following: elevated blood pressure, hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL-C), or hyperglycemia.ResultsA total of 2,117 children and adolescents were enrolled in the study; of them, 1,078 (50.9%) participants exhibited cardiovascular risk. The adjusted logistic regression analysis showed that elevated TyG index was significantly associated with hypertriglyceridemia (odds ratio (OR)=96.45, 95% confidence interval (CI): 48.44-192.04), low HDL-C (OR=2.07, 95% CI: 1.46-2.92), and hyperglycemia (OR=3.11, 95% CI: 2.05-4.72), but not with elevated blood pressure (OR=1.39, 95% CI: 0.89-2.16).ConclusionThe elevated TyG index is associated with the presence of cardiovascular risk factors in healthy normal-weight children and adolescents.

Evaluating the Welfare of Index Insurance

DEFF Research Database (Denmark)

Harrison, Glenn W.; Martínez-Correa, Jimmy; Ng, Jia Min

affects both the demand for the product and the welfare of individuals making take-up decisions. We study the impact of basis risk on insurance take-up and on expected welfare in a laboratory experiment with an insurance frame. We measure the expected welfare of index insurance to individuals while......Index insurance was conceived to be a product that would simplify the claim settlement process and make it more objective, reducing transaction costs and moral hazard. However, index insurance also exposes the insured to basis risk, which arises because there can be a mismatch between the index...... risks that are different from preferences exhibited for their actuarially-equivalent counterparts. We study the potential link between index insurance demand and attitudes towards compound risks. We test the hypothesis that the compound risk nature of index insurance induced by basis risk negatively...

El Carreto o Cumulá - Aspidosperma Dugandii Standl El Carreto o Cumulá - Aspidosperma Dugandii Standl

Directory of Open Access Journals (Sweden)

Dugand Armando

1944-03-01

Full Text Available Nombres vulgares: Carreto (Atlántico, Bolívar, Magdalena; Cumulá, Cumulá (Cundinamarca, ToIima. Según el Dr. Emilio Robledo (Lecciones de Bot. ed. 3, 2: 544. 1939 el nombre Carreto también es empleado en Puerto Berrío (Antioquia. El mismo autor (loc. cit. da el nombre Comulá para una especie indeterminada de Viburnum en Mariquita (Tolima y J. M. Duque, refiriendose a la misma planta y localidad (en Bot. Gen. Colomb. 340, 356. 1943 atribuye este nombre vulgar al Aspidosperma ellipticum Rusby.  Sin embargo, las muestras de madera de Cumulá o Comulá que yo he examinado, procedentes de la región de Mariquita -una de las cuales me fue recientemente enviada por el distinguido ictiólogo Sr. Cecil Miles- pertenecen sin duda alguna al A. Dugandii StandI. Por otra parte, Santiago Cortés (FI. Colomb. 206. 1898; ed, 2: 239. 1912 cita el Cumulá "de Anapoima y otros lugares del (rio Magdalena" diciendo que pertenece a las Leguminosas, pero la brevísima descripción que este autor hace de la madera "naranjada y notable por densidad, dureza y resistencia a la humedad", me induce a creer que se trata del mismo Cumula coleccionado recientemente en Tocaima, ya que esta población esta situada a pocos kilómetros de Anapoima. Nombres vulgares: Carreto (Atlántico, Bolívar, Magdalena; Cumulá, Cumulá (Cundinamarca, ToIima. Según el Dr. Emilio Robledo (Lecciones de Bot. ed. 3, 2: 544. 1939 el nombre Carreto también es empleado en Puerto Berrío (Antioquia. El mismo autor (loc. cit. da el nombre Comulá para una especie indeterminada de Viburnum en Mariquita (Tolima y J. M. Duque, refiriendose a la misma planta y localidad (en Bot. Gen. Colomb. 340, 356. 1943 atribuye este nombre vulgar al Aspidosperma ellipticum Rusby.  Sin embargo, las muestras de madera de Cumulá o Comulá que yo he examinado, procedentes de la región de Mariquita -una de las cuales me fue recientemente enviada por el distinguido ictiólogo Sr. Cecil Miles- pertenecen sin

Sunlight exposure during leisure activities and risk of prostate cancer in Montréal, Canada, 2005-2009.

Science.gov (United States)

Yu, Jennifer; Lavoué, Jérôme; Parent, Marie-Élise

2014-07-28

Prostate cancer (PCa) is the leading cause of cancer in men in many developed countries, but no modifiable risk factors have been identified. A handful of analytical studies have suggested a possible etiological role for sunlight exposure. We report here on the association between leisure-time sunlight exposure during adulthood and PCa risk in the context of a population-based case-control study. In all, 1,904 PCa cases were ascertained across Montreal French hospitals between 2005 and 2009. Concurrently, 1,962 population controls, frequency matched to cases by age (±5 years), were selected from the electoral list for French-speakers in Greater Montreal. Interviews elicited the frequency of engagement in any leisure activity during adulthood. This was used to derive cumulative sunlight exposure indices: a cumulative number of leisure activities events entailing sunlight exposure and a cumulative duration of sunlight exposure during leisure activities. Unconditional logistic regression was conducted to yield odds ratios (OR) and 95% confidence intervals (CI) for estimating the association between sunlight exposure indices and PCa risk, adjusting for age, ancestry, family history of PCa, PCa screening, education, solar protection, body mass index and physical activity. Compared with men in the upper quartile category for the number of sunlight exposure events, men never exposed during leisure time had an OR of 1.32 (95% CI: 0.82-2.14). ORs were 1.11, 0.91 and 1.00 for the first to the third quartiles of exposure, respectively. Similar results were observed for cumulative duration of exposure to sunlight, and by PCa aggressiveness. These findings provide little evidence of an association between sunlight exposure during leisure-time and PCa risk. Men with no sunlight exposure appeared at somewhat higher risks but none of the estimates achieved statistical significance.

Redefining high-risk patients with stage II colon cancer by risk index and microRNA-21: results from a population-based cohort

DEFF Research Database (Denmark)

Hansen, T F; Kjær-Frifeldt, S; Christensen, R D

2014-01-01

Background:The aim of the present study was to analyse the prognostic value of microRNA-21 (miRNA-21) in patients with stage II colon cancer aiming at a risk index for this group of patients.Methods:A population-based cohort of 554 patients was included. MicroRNA-21 was analysed by qPCR based.......001). The overall survival (OS) index identified three different subgroups (Pcolon cancer. Furthermore...... on tumour tissue. An index was created using the coefficients obtained from a collective multiple Cox regression. The entire procedure was cross-validated (10-fold). The performance of the index was quantified by time-dependent receiver operating characteristics curves.Results:High miRNA-21 expression...

Predicting Cumulative Incidence Probability by Direct Binomial Regression

DEFF Research Database (Denmark)

Scheike, Thomas H.; Zhang, Mei-Jie

Binomial modelling; cumulative incidence probability; cause-specific hazards; subdistribution hazard......Binomial modelling; cumulative incidence probability; cause-specific hazards; subdistribution hazard...

"RISK ASSESSMENT OF DEVELOPING DISTAL UPPER EXTREMITY DISORDERS BY STRAIN INDEX METHOD IN AN ASSEMBLING ELECTRONIC INDUSTRY"

OpenAIRE

M. Pourmahabadian; J.N. Saraji; M. Aghabeighi H. Saddeghi-Naeeni

2005-01-01

The strain index (SI) is a substantial advancement and has been devised to analyze ergonomic risks for distal upper extremity (DUE) disorders. This semi-quantitative tool allows for the measurement of hazards and does not require unduly lengthy training to begin to use it accurately. Uses of the strain index include analysis of a current job to assess whether it is safe or hazardous, quantification of the risks, and assistance in the initial design of a job or in the redesign of a job. The ai...

7 CFR 42.132 - Determining cumulative sum values.

Science.gov (United States)

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false Determining cumulative sum values. 42.132 Section 42... Determining cumulative sum values. (a) The parameters for the on-line cumulative sum sampling plans for AQL's... 3 1 2.5 3 1 2 1 (b) At the beginning of the basic inspection period, the CuSum value is set equal to...

The Algebra of the Cumulative Percent Operation.

Science.gov (United States)

Berry, Andrew J.

2002-01-01

Discusses how to help students avoid some pervasive reasoning errors in solving cumulative percent problems. Discusses the meaning of ."%+b%." the additive inverse of ."%." and other useful applications. Emphasizes the operational aspect of the cumulative percent concept. (KHR)

Regulatory and technical reports (abstract index journal): Annual compilation for 1994. Volume 19, Number 4

Energy Technology Data Exchange (ETDEWEB)

NONE

1995-03-01

This compilation consists of bibliographic data and abstracts for the formal regulatory and technical reports issued by the US Nuclear Regulatory Commission (NRC) Staff and its contractors. It is NRC`s intention to publish this compilation quarterly and to cumulate it annually. The main citations and abstracts in this compilation are listed in NUREG number order. These precede the following indexes: secondary report number index, personal author index, subject index, NRC originating organization index (staff reports), NRC originating organization index (international agreements), NRC contract sponsor index (contractor reports), contractor index, international organization index, and licensed facility index. A detailed explanation of the entries precedes each index.

1960-69 Cumulative Index of Articles Related to Oceanography and Limnology Education in The Science Teacher.

Science.gov (United States)

Cohen, Maxwell

Indexed are articles relating to oceanography and limnology published in "The Science Teacher" between 1960 and 1969. Articles are indexed under title, author, and topic. Topics include background information, course descriptions, and laboratory equipment and techniques. (EB)

Process monitoring in intensive care with the use of cumulative expected minus observed mortality and risk-adjusted P charts.

Science.gov (United States)

Cockings, Jerome G L; Cook, David A; Iqbal, Rehana K

2006-02-01

A health care system is a complex adaptive system. The effect of a single intervention, incorporated into a complex clinical environment, may be different from that expected. A national database such as the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme in the UK represents a centralised monitoring, surveillance and reporting system for retrospective quality and comparative audit. This can be supplemented with real-time process monitoring at a local level for continuous process improvement, allowing early detection of the impact of both unplanned and deliberately imposed changes in the clinical environment. Demographic and UK Acute Physiology and Chronic Health Evaluation II (APACHE II) data were prospectively collected on all patients admitted to a UK regional hospital between 1 January 2003 and 30 June 2004 in accordance with the ICNARC Case Mix Programme. We present a cumulative expected minus observed (E-O) plot and the risk-adjusted p chart as methods of continuous process monitoring. We describe the construction and interpretation of these charts and show how they can be used to detect planned or unplanned organisational process changes affecting mortality outcomes. Five hundred and eighty-nine adult patients were included. The overall death rate was 0.78 of predicted. Calibration showed excess survival in ranges above 30% risk of death. The E-O plot confirmed a survival above that predicted. Small transient variations were seen in the slope that could represent random effects, or real but transient changes in the quality of care. The risk-adjusted p chart showed several observations below the 2 SD control limits of the expected mortality rate. These plots provide rapid analysis of risk-adjusted performance suitable for local application and interpretation. The E-O chart provided rapid easily visible feedback of changes in risk-adjusted mortality, while the risk-adjusted p chart allowed statistical evaluation. Local analysis of

Probabilistic assessment of the cumulative dietary acute exposure of the population of Denmark to organophosphorus and carbamate pesticides

DEFF Research Database (Denmark)

Jensen, Bodil Hamborg; Petersen, Annette; Christensen, Tue

2009-01-01

and methamidophos. RPF values derived from the literature were used in the calculations. We calculated the cumulative acute exposure to 1.8% and 0.8% of the acute reference dose (ARfD) of 100 mu g kg(-1) body weight (bw) day(-1) of chlorpyrifos as an index compound at the 99.9th percentile (P99.5) for children...

The prediction of the incidence rate of upper limb musculoskeletal disorders, with CTD risk index method on potters of Meybod city

Directory of Open Access Journals (Sweden)

Reza Khani Jazani

2012-02-01

Full Text Available Background: The objective of this study was to predict the incidence of musculoskeletal disorders in potters of Meybod city by performing CTD risk index method.Materials and Method: This is a descriptive cross-sectional study. Target society was all workers in pottery workshops which were located in the Meybod. Information related to musculoskeletal disorders was obtained by the Nordic questionnaire and we used CTD risk index method to predict the incidence of musculoskeletal disorders.Results: We observed in this study that 59.3% of the potters had symptoms of musculoskeletal disorders in at least in one of their upper extremities. Also significant differences between mean CTD risk index on potters with and without symptoms of the upper limb musculoskeletal disorders, respectively (p=0.038.Conclusion: CTD risk index method can be as a suitable method for predicting the incidence of musculoskeletal disorders used in the potters

Ponderal index at birth associates with later risk of gestational diabetes mellitus

DEFF Research Database (Denmark)

Crusell, Mie; Damm, Peter; Hansen, Torben

2017-01-01

PURPOSE: Low birth weight (BW) and low ponderal index (PI) are associated with increased risk of type 2 diabetes mellitus. This study has two purposes: first to investigate the influence of PI on the risk of gestational diabetes mellitus (GDM); second, to study the association between glucose...... metabolism and BW in women with previous GDM. METHODS: GDM cohort: 185 women with GDM in 1978-1996, attending a follow-up study in 2000-2002. Control cohort: 1137 women from a population-based diabetes screening study (Inter99) in a neighbouring county in 1999-2001. BW and birth length were collected from...

Featured Article: Community Crime Exposure and Risk for Obesity in Preschool Children: Moderation by the Hypothalamic-Pituitary-Adrenal-Axis Response.

Science.gov (United States)

Gartstein, Maria A; Seamon, Erich; Thompson, Stephanie F; Lengua, Liliana J

2018-05-01

Identification of early risk factors related to obesity is critical to preventative public health efforts. In this study, we investigated links between the Hypothalamic-Pituitary-Adrenal (HPA)-axis activity (diurnal cortisol pattern), geospatially operationalized exposure to neighborhood crime, and body mass index (BMI) for a sample of 5-year-old children. Greater community crime exposure and lower HPA-axis activity were hypothesized to contribute to higher BMI, with child HPA-axis moderating the association between crime exposure and BMI. Families residing within the boundaries of the City of Seattle (N = 114) provided information concerning demographic/psychosocial risk factors, used to calculate a Cumulative Risk Index, indicating the number of contextual adversities present. Child BMI and diurnal cortisol pattern (derived from assays of saliva samples) were examined, along with neighborhood crime indices computed with publically available information, based on participants' locations. Hierarchical multiple regression analyses, adjusted for covariates (cumulative risk, age, and sex), indicated that crime proximity made a unique contribution to child BMI, in the direction signaling an increase in the risk for obesity. Consistent with our hypothesis, a significant interaction was observed, indicative of moderation by diurnal cortisol pattern. Follow-up simple slope analyses demonstrated that crime exposure was significantly related to higher BMI for children with low-flat (blunted) diurnal cortisol patterns, where community crime and BMI were not significantly associated at higher levels of cortisol. Community crime exposure contributes to higher BMI as early as the preschool period, and blunted diurnal cortisol patterns may place children experiencing neighborhood adversity at greater risk for obesity.

The impact of socially responsible investment index constituent announcements on firm price: evidence from the JSE

Directory of Open Access Journals (Sweden)

Chimwemwe Chipeta

2012-11-01

Full Text Available This paper examines whether Socially Responsible Investment (SRI Index constituent announcements have any impact on the returns of firms listing on the JSE SRI Index. The event study methodology is utilised to estimate abnormal returns for the firms included in the Index. The results indicate insignificant average abnormal returns (AARs for the years 2004, 2006, 2007, 2008 and 2009, suggesting no significant shareholder gains over the entire event window. However, the year 2005 is associated with positive and significant abnormal returns. Post announcement cumulative average abnormal returns (CAARs are positive for the years 2005 and 2007. However, the year 2008 exhibited extreme swings in CAARs with a general declining trend in the latter part of the event window. These swings are attributed to the global financial crisis of 2008. Furthermore, the cumulative returns for the total sample show no clear outperformance of the SRI over the JSE All Share Index.

EXAFS cumulants of CdSe

International Nuclear Information System (INIS)

Diop, D.

1997-04-01

EXAFS functions had been extracted from measurements on the K edge of Se at different temperatures between 20 and 300 K. The analysis of the EXAFS of the filtered first two shells has been done in the wavevector range laying between 2 and 15.5 A -1 in terms of the cumulants of the effective distribution of distances. The cumulants C 3 and C 4 obtained from the phase difference and the amplitude ratio methods have shown the anharmonicity in the vibrations of atoms around their equilibrium position. (author). 13 refs, 3 figs

The association between a body shape index and cardiovascular risk in overweight and obese children and adolescents.

Directory of Open Access Journals (Sweden)

Chiara Mameli

Full Text Available A Body Shape Index (ABSI and normalized hip circumference (Hip Index, HI have been recently shown to be strong risk factors for mortality and for cardiovascular disease in adults. We conducted an observational cross-sectional study to evaluate the relationship between ABSI, HI and cardiometabolic risk factors and obesity-related comorbidities in overweight and obese children and adolescents aged 2-18 years. We performed multivariate linear and logistic regression analyses with BMI, ABSI, and HI age and sex normalized z scores as predictors to examine the association with cardiometabolic risk markers (systolic and diastolic blood pressure, fasting glucose and insulin, total cholesterol and its components, transaminases, fat mass % detected by bioelectrical impedance analysis and obesity-related conditions (including hepatic steatosis and metabolic syndrome. We recruited 217 patients (114 males, mean age 11.3 years. Multivariate linear regression showed a significant association of ABSI z score with 10 out of 15 risk markers expressed as continuous variables, while BMI z score showed a significant correlation with 9 and HI only with 1. In multivariate logistic regression to predict occurrence of obesity-related conditions and above-threshold values of risk factors, BMI z score was significantly correlated to 7 out of 12, ABSI to 5, and HI to 1. Overall, ABSI is an independent anthropometric index that was significantly associated with cardiometabolic risk markers in a pediatric population affected by overweight and obesity.

The injury and cumulative effects on human skin by UV exposure from artificial fluorescence emission.