WorldWideScience

Sample records for emerging arboviruses risk

  1. Emerging arboviruses in Quebec, Canada: assessing public health risk by serology in humans, horses and pet dogs.

    Science.gov (United States)

    Rocheleau, J P; Michel, P; Lindsay, L R; Drebot, M; Dibernardo, A; Ogden, N H; Fortin, A; Arsenault, J

    2017-10-01

    Periodic outbreaks of West Nile virus (WNV), Eastern equine encephalitis virus (EEEV) and to a lesser extent, California serogroup viruses (CSGV), have been reported in parts of Canada in the last decade. This study was designed to provide a broad assessment of arboviral activity in Quebec, Canada, by conducting serological surveys for these arboviruses in 196 horses, 1442 dogs and 485 humans. Sera were screened by a competitive enzyme linked immunosorbent assay and positive samples confirmed by plaque reduction neutralisation tests. The percentage of seropositive samples was 83·7%, 16·5%, 7·1% in horses, 18·8%, 0·6%, 0% in humans, 11·7%, 3·1%, 0% in adult dogs and 2·9%, 0·3%, 0% in juvenile dogs for CSGV, WNV and EEEV, respectively. Serological results in horses and dogs appeared to provide a meaningful assessment of risk to public health posed by multiple arboviruses.

  2. Factors contributing to and strategies to combat emerging arboviruses.

    Science.gov (United States)

    Callender, David Michael

    2018-04-17

    Less than half a century ago infectious diseases appeared to be destined to be extinguished via as a culmination of medical triumphs. As focus turned towards combating non-communicable diseases, emerging and re-emerging diseases (EIDs) have bloomed from those ashes. Five epidemic mosquito-borne arboviruses (Yellow Fever virus (YFV), Dengue virus, West Nile virus, Chikungunya virus, and Zika virus) have emerged in the recent past. Arboviruses are of the utmost importance with respect to EIDs due to intensive growth of globalisation, arthropod urban fitness/adaption, and environmental changes. We focus on recent outbreaks of the arthropod borne viruses (arboviruses) Zika virus and YFV. Factors contributing to the blossoming of EIDs (environmental, globalisation, and urbanisation) and combating strategies (surveillance, containment, and prevention) will be discussed. Specifically, Zika virus and YFV will be used in the context of these factors and strategies. YFV is discussed in detail as it pertains to these factors and strategies in the United States (US), 2017 Brazil Outbreak, 2016 Africa Outbreak, and global risk. Vigilance is needed to focus on, prevent, and control the current and next arbovirus EIDs.

  3. Emerging souvenirs-clinical presentation of the returning traveller with imported arbovirus infections in Europe.

    Science.gov (United States)

    Eckerle, I; Briciu, V T; Ergönül, Ö; Lupşe, M; Papa, A; Radulescu, A; Tsiodras, S; Tsitou, C; Drosten, C; Nussenblatt, V R; Reusken, C B; Sigfrid, L A; Beeching, N J

    2018-03-01

    Arboviruses are an emerging group of viruses that are causing increasing health concerns globally, including in Europe. Clinical presentation usually consists of a nonspecific febrile illness that may be accompanied by rash, arthralgia and arthritis, with or without neurological or haemorrhagic syndromes. The range of differential diagnoses of other infectious and noninfectious aetiologies is broad, presenting a challenge for physicians. While knowledge of the geographical distribution of pathogens and the current epidemiological situation, incubation periods, exposure risk factors and vaccination history can help guide the diagnostic approach, the nonspecific and variable clinical presentation can delay final diagnosis. This narrative review aims to summarize the main clinical and laboratory-based findings of the three most common imported arboviruses in Europe. Evidence is extracted from published literature and clinical expertise of European arbovirus experts. We present three cases that highlight similarities and differences between some of the most common travel-related arboviruses imported to Europe. These include a patient with chikungunya virus infection presenting in Greece, a case of dengue fever in Turkey and a travel-related case of Zika virus infection in Romania. Early diagnosis of travel-imported cases is important to reduce the risk of localized outbreaks of tropical arboviruses such as dengue and chikungunya and the risk of local transmission from body fluids or vertical transmission. Given the global relevance of arboviruses and the continuous risk of (re)emerging arbovirus events, clinicians should be aware of the clinical syndromes of arbovirus fevers and the potential pitfalls in diagnosis. Copyright © 2018. Published by Elsevier Ltd.

  4. Dengue, Zika and Chikungunya: Emerging Arboviruses in the New World.

    Science.gov (United States)

    Patterson, Jessica; Sammon, Maura; Garg, Manish

    2016-11-01

    The arboviruses that cause dengue, chikungunya, and Zika illnesses have rapidly expanded across the globe in recent years, with large-scale outbreaks occurring in Western Hemisphere territories in close proximity to the United States (U.S.). In March 2016, the Centers for Disease Control and Protection (CDC) expanded its vector surveillance maps for A. aegypti and A. albopictus , the mosquito vectors for these arboviruses. They have now been shown to inhabit a larger portion of the U.S., including the heavily populated northeast corridor. Emergency physicians need to further familiarize themselves with these diseases, which have classically been considered only in returning travelers but may soon be encountered in the U.S. even in the absence of travel. In this paper, we discuss the presentation and treatment of dengue, Zika, and chikungunya, as well as special challenges presented to the emergency physician in evaluating a patient with a suspected arbovirus infection.

  5. [Zika virus: Another emerging arbovirus in Venezuela?].

    Science.gov (United States)

    Valero Nereida

    2015-09-01

    Current health conditions of Venezuela, together with the tropical proliferation of different types of Aedes (aegypti and albopictus), suggest the arrival to this country of ZIKA virus (ZIKV). The Pan American Health Organization urges Latin American countries to take measures to prevent the ZIKV entry and advises that these measures must be designed to detect the introduction of ZIKV in an area, track its spread and actively monitor the disease. In Venezuela and other Latin-American countries, where endemicity is high for other arboviruses such as dengue arid chikungunya, health authorities should strengthen their surveillance systems to detect early and timely introduction of ZIKV ap.d refine diagnostic methods to confirm the infection rate; however, the high incidence of cases due those viral agents reflects weakened and poorly timed insensitive monitoring systems, as well as, poor vector control measures, arising the questions: will this arbovirus pop in our country, will it set as the other as edemicepidemic and lead to alter their clinical behavior and severity of the disease?

  6. Emerging arboviruses and public health challenges in Brazil

    Directory of Open Access Journals (Sweden)

    Tamara Nunes Lima-Camara

    2016-01-01

    Full Text Available ABSTRACT Environmental modification by anthropogenic actions, disordered urban growth, globalization of international exchange and climate change are some factors that help the emergence and dissemination of human infectious diseases transmitted by vectors. This review discusses the recent entry of three arboviruses in Brazil: Chikungunya, West Nile, and Zika virus, focusing on the challenges for the Country’s public health. The Brazilian population is exposed to infections caused by these three arboviruses widely distributed on the national territory and associated with humans. Without effective vaccine and specific treatment, the maintainance and integration of a continuos entomological and epidemiological surveillance are important so we can set methods to control and prevent these arboviruses in the Country.

  7. Emerging and reemerging arboviruses: A new threat in Eastern Peru.

    Science.gov (United States)

    Alva-Urcia, Carlos; Aguilar-Luis, Miguel Angel; Palomares-Reyes, Carlos; Silva-Caso, Wilmer; Suarez-Ognio, Luis; Weilg, Pablo; Manrique, Carlos; Vasquez-Achaya, Fernando; Del Valle, Luis J; Del Valle-Mendoza, Juana

    2017-01-01

    Arboviral diseases are one of the most common causes of acute febrile illness (AFI) and a significant health problem in South America. In Peru, laboratory etiologic identification of these infections occurs in less than 50% of cases, leading to underdiagnoses of important emerging arboviruses. To assess the prevalence of the Dengue (DENV), Oropouche (OROV), Chikungunya (CHIKV), Mayaro (MAYV) and Zika (ZIKV) viruses in patients with acute febrile illness from Puerto Maldonado (Peru). Serum samples were obtained from patients with AFI during January 2016 to March 2016. A total of 139 specimens were analyzed for the presence of DENV, OROV, CHIKV, MAYV, and ZIKV using polymerase chain reaction (PCR). CHIKV in 9.4% and OROV in 8.6% were the most prevalent arboviruses, followed by DENV and ZIKV, with a prevalence of 6.5% and 5%, respectively. Among all patients, the most common symptoms accompanying fever were headaches 79.9%, muscle pain 65.5% and joint pain 63.3%. During this short 3-month period, 4 arboviruses were detected by PCR, CHIKV and OROV being the most common arboviruses in Puerto Maldonado (Peru). Thus, it is crucial to include OROV detection in the national health surveillance. Furthermore, the etiologic clinical diagnosis of arboviral infections is not possible due to the low specificity of symptoms; therefore an increase of cases confirmed by molecular diagnostic methods will enhance arboviral surveillance in Peru.

  8. Emerging arboviruses and public health challenges in Brazil

    OpenAIRE

    Lima-Camara,Tamara Nunes

    2016-01-01

    ABSTRACT Environmental modification by anthropogenic actions, disordered urban growth, globalization of international exchange and climate change are some factors that help the emergence and dissemination of human infectious diseases transmitted by vectors. This review discusses the recent entry of three arboviruses in Brazil: Chikungunya, West Nile, and Zika virus, focusing on the challenges for the Country’s public health. The Brazilian population is exposed to infections caused by th...

  9. Emerging arboviruses and public health challenges in Brazil.

    Science.gov (United States)

    Lima-Camara, Tamara Nunes

    2016-06-27

    Environmental modification by anthropogenic actions, disordered urban growth, globalization of international exchange and climate change are some factors that help the emergence and dissemination of human infectious diseases transmitted by vectors. This review discusses the recent entry of three arboviruses in Brazil: Chikungunya, West Nile, and Zika virus, focusing on the challenges for the Country's public health. The Brazilian population is exposed to infections caused by these three arboviruses widely distributed on the national territory and associated with humans. Without effective vaccine and specific treatment, the maintainance and integration of a continuos entomological and epidemiological surveillance are important so we can set methods to control and prevent these arboviruses in the Country. RESUMO A modificação do ambiente por ações antrópicas, o crescimento urbano desordenado, o processo de globalização do intercâmbio internacional e as mudanças climáticas são alguns fatores que vêm facilitando a emergência e disseminação de doenças infecciosas humanas transmitidas por vetores. Este comentário aborda a recente entrada de três arbovírus no Brasil, Chikungunya (CHIKV), West Nile (WNV) e Zika (ZIKV), com enfoque nos desafios para a Saúde Pública do País. Transmitidos por mosquitos vetores amplamente distribuídos no território nacional e associados ao homem, a população brasileira encontra-se exposta à infecção por esses três arbovírus. Na ausência de vacina eficaz e tratamento específico, são importantes a manutenção e integração de uma vigilância entomológica e epidemiológica contínua, a fim de direcionarmos métodos de controle e prevenção contra essas arboviroses no País.

  10. Factors responsible for the emergence of arboviruses; strategies, challenges and limitations for their control.

    Science.gov (United States)

    Liang, Guodong; Gao, Xiaoyan; Gould, Ernest A

    2015-03-01

    Slave trading of Africans to the Americas, during the 16th to the 19th century was responsible for the first recorded emergence in the New World of two arthropod-borne viruses (arboviruses), yellow fever virus and dengue virus. Many other arboviruses have since emerged from their sylvatic reservoirs and dispersed globally due to evolving factors that include anthropological behaviour, commercial transportation and land-remediation. Here, we outline some characteristics of these highly divergent arboviruses, including the variety of life cycles they have developed and the mechanisms by which they have adapted to evolving changes in habitat and host availability. We cite recent examples of virus emergence that exemplify how arboviruses have exploited the consequences of the modern human lifestyle. Using our current understanding of these viruses, we also attempt to demonstrate some of the limitations encountered in developing control strategies to reduce the impact of future emerging arbovirus diseases. Finally, we present recommendations for development by an international panel of experts reporting directly to World Health Organization, with the intention of providing internationally acceptable guidelines for improving emerging arbovirus disease control strategies. Success in these aims should alleviate the suffering and costs encountered during recent decades when arboviruses have emerged from their sylvatic environment.

  11. The Role of Interferon Antagonist, Non-Structural Proteins in the Pathogenesis and Emergence of Arboviruses

    Directory of Open Access Journals (Sweden)

    Samantha S. Soldan

    2011-06-01

    Full Text Available A myriad of factors favor the emergence and re-emergence of arthropod-borne viruses (arboviruses, including migration, climate change, intensified livestock production, an increasing volume of international trade and transportation, and changes to ecosystems (e.g., deforestation and loss of biodiversity. Consequently, arboviruses are distributed worldwide and represent over 30% of all emerging infectious diseases identified in the past decade. Although some arboviral infections go undetected or are associated with mild, flu-like symptoms, many are important human and veterinary pathogens causing serious illnesses such as arthritis, gastroenteritis, encephalitis and hemorrhagic fever and devastating economic loss as a consequence of lost productivity and high mortality rates among livestock. One of the most consistent molecular features of emerging arboviruses, in addition to their near exclusive use of RNA genomes, is the inclusion of viral, non-structural proteins that act as interferon antagonists. In this review, we describe these interferon antagonists and common strategies that arboviruses use to counter the host innate immune response. In addition, we discuss the complex interplay between host factors and viral determinants that are associated with virus emergence and re-emergence, and identify potential targets for vaccine and anti-viral therapies.

  12. Emerging arboviruses in Rio Grande do Sul, Brazil: Chikungunya and Zika outbreaks, 2014-2016.

    Science.gov (United States)

    Gregianini, Tatiana Schäffer; Ranieri, Tani; Favreto, Cátia; Nunes, Zenaida Marion Alves; Tumioto Giannini, Gabriela Luchiari; Sanberg, Nara Druck; da Rosa, Marilda Tereza Mar; da Veiga, Ana Beatriz Gorini

    2017-11-01

    The recent emergence of arboviruses such as Chikungunya virus (CHIKV) and Zika virus (ZIKV) in Brazil has posed a threat to human health and to the country's economy. Outbreaks occur mainly in tropical areas; however, increasing number of cases have been observed in Rio Grande do Sul (RS), the Southernmost state; therefore, surveillance of these arboviruses is essential for public health measures. In this study, we analyzed 1276 samples from patients with clinically suspected arboviral diseases between 2014 and 2016. Demographic and clinical data were collected and described; cases of microcephaly associated with congenital infection were analyzed. Results show that CHIKV and ZIKV entered RS in 2014 and 2015, respectively, with imported cases confirmed. Autochthonous infections occurred in 2016 for both viruses, with a total of 5 autochthonous cases for CHIKV and 44 for ZIKV. Most patients were older than 21 years; the main symptoms were fever, arthralgia, myalgia, and headache; rash, conjunctivitis, and pruritus were also reported in ZIKV cases. Three cases of congenital Zika syndrome were confirmed in our study, while another 20 cases of microcephaly associated with congenital infection were confirmed (10 positive for syphilis, 6 for toxoplasmosis and 4 for cytomegalovirus). Considering co-circulation of different arbovirus in RS, including Dengue virus, CHIKV, and ZIKV, and the presence of Aedes aegypti and Aedes albopictus in the area, surveillance of patients infected by these viruses contributes to the control and prevention of such diseases. Practical difficulties in diagnosing these infections are discussed. Copyright © 2017 John Wiley & Sons, Ltd.

  13. A review on Zika virus, a re-emerging arbovirus: review article

    Directory of Open Access Journals (Sweden)

    Farshad Khodakhah

    2018-02-01

    Full Text Available Before the recent outbreaks of Zika virus, few people have ever heard of its name. Even virologists had paid little attention to this member of the Flaviviridae family. Hence, up to January 2016, only 269 articles about Zika virus had been indexed in PubMed compared to the 9187 articles related to dengue virus. However, declaration of the World health organization (WHO about the global Zika virus spreading, which has been associated with birth defects and some neurological problems, diverted more attention to this forgotten virus. Afterwards, the virus hit the headlines and became a research interest. Since then, up to 9 August 2017, the number of Zika related articles indexed in PubMed reached to 3214. Zika virus is a re-emerging arbovirus. The First detection of Zika virus was in Uganda in 1947. It belongs to the Flavivirus genus in the Flaviviridae family. Zika can typically cause a mild and self-limiting disease in a healthy person. However, in pregnant women, it might cause birth defects and occasionally it can be associated with peripheral neuropathy such as Guillain-Barre syndrome. Although many research have been conducted to find out the casual link between this virus and these disorders but this relationship is still dim and controversial. Considering its recent epidemics in 2015 and 2016 the geographical distribution of Zika virus seems to expand all over the world progressively. Interaction between virus and vector is dynamic. Variety of competent vectors and adaptability of virus to new arthropod vectors are the two major factors for this process. According to the last report published by WHO, 84 countries/territories in five continents have reported the circulation of Zika virus in their area. In the recent outbreak, WHO regional office in our region (EMRO have reported no case of Zika virus transmission from this region. Nonetheless, because specific and competent vectors exist in some countries, this region has a potential of

  14. Arboviruses emerging in Brazil: challenges for clinic and implications for public health.

    Science.gov (United States)

    Donalisio, Maria Rita; Freitas, André Ricardo Ribas; Zuben, Andrea Paula Bruno Von

    2017-04-10

    Arboviruses have been emerging in different parts of the world due to genetic changes in the virus, alteration of the host and vector population dynamics, or because of anthropogenic environmental factors. These viruses' capacity for adaptation is notable, as well as the likelihood of their emergence and establishment in new geographic areas. In Brazilian epidemiologic scenario, the most common arboviruses are DENV, CHIKV, and ZIKV, although others may spread in the country. Little is yet known of the impact of viral co-circulation, which would theoretically result in more intense viremia or other immunological alterations that could trigger autoimmune diseases, such as Guillain-Barré syndrome. The impact on morbidity and mortality intensifies as extensive epidemics lead to a high number of affected individuals, severe cases, and implications for health services, mainly due to the absence of treatment, vaccines, and effective prevention and control measures. RESUMO Notifica-se a emergência de arboviroses em diferentes regiões do planeta em decorrência de mudanças genéticas no vírus, alteração da dinâmica populacional de hospedeiros e vetores ou por fatores ambientais de origem antropogênica. É notável a capacidade de adaptação desses vírus e a possibilidade de emergirem e se estabelecerem em novas áreas geográficas. No contexto epidemiológico brasileiro, os arbovírus de maior circulação são DENV, CHIKV e ZIKV, embora existam outros com potencial de disseminação no País. O impacto da cocirculação viral ainda é pouco conhecido, a qual teoricamente resultaria em viremias mais intensas ou outras alterações imunológicas que poderiam ser o gatilho para doenças autoimunes, como a síndrome de Guillain-Barré. O impacto na morbidade e mortalidade se intensifica à medida que extensas epidemias pressupõem grande número de indivíduos acometidos, casos graves e implicações sobre os serviços de saúde, principalmente diante da aus

  15. Risk factors for arbovirus infections in a low-income community of Rio de Janeiro, Brazil, 2015-2016.

    Directory of Open Access Journals (Sweden)

    Nádia Cristina Pinheiro Rodrigues

    Full Text Available Dengue epidemics have occurred in the city of Rio de Janeiro (Brazil since 1986. In the year 2015, Zika and chikungunya viruses were introduced in the city, causing sequential and simultaneous epidemics. Poor socioeconomic conditions have been suggested as contributing factors of arboviral infection.To describe the spatial distribution of human cases of symptomatic arboviral infections and to identify risk factors for infection in a poor community of Rio de Janeiro in the years 2015 and 2016.We built thematic maps of incidence rates for 78 micro-areas in the Manguinhos neighborhood. The micro-areas congregate about 600 inhabitants. Simple and multiple multilevel logistic regression models were used to evaluate the association between the incidence of arboviral diseases and socio-demographic factors at both the individual and micro-area levels.From 2015 to 2016, 370 human cases of arbovirus infection were reported in the Manguinhos community: 123 in 2015 and 247 in 2016. There was a significant difference in the risk of arbovirus diseases among different micro-areas, but this was not explained by water and sanitation indicators. The cumulative incidence rate was 849/100,000 in two years. The incidence was greater in those individuals with familiar vulnerability (1,156/100,000 vs. 794/100,000. The multilevel adjusted model showed that the odds of acquiring an arbovirus infection was 55% greater in those with familiar vulnerability.Arbovirus infections cause a high burden of disease in Brazilian urban centers. Our results suggest that even in poor neighborhoods, there is a high spatial variability in the risk of acquiring an arbovirus infection. The conditions that favor vector proliferation and infection by arboviruses are complex and involve both individual and environmental characteristics that vary from place to place. To reduce the burden of arboviral diseases, continued public health policies and basic services should be provided to the

  16. Emergent and Reemergent Arboviruses in South America and the Caribbean: Why So Many and Why Now?

    Science.gov (United States)

    Marcondes, Carlos Brisola; Contigiani, Marta; Gleiser, Raquel Miranda

    2017-05-01

    Varios arbovirus han emergido y/o reemergido en el Nuevo Mundo en las últimas décadas. Los virus Zika y chikungunya, anteriormente restringidos a África y quizás Asia, invadieron el continente, causando gran preocupación; además siguen ocurriendo brotes causados por el virus dengue en casi todos los países, con millones de casos por año. El virus West Nile invadió rápidamente América del Norte, y ya se han encontrado casos en América Central y del Sur. Otros arbovirus, como Mayaro y el virus de la encefalitis equina del este han aumentado su actividad y se han encontrado en nuevas regiones. Se han documentado cambios en la patogenicidad de algunos virus que conducen a enfermedades inesperadas. Una fauna diversa de mosquitos, cambios climáticos y en la vegetación, aumento de los viajes, y urbanizaciones no planificadas que generan condiciones adecuadas para la proliferación de Aedes aegypti (L.), Culex quinquefasciatus Say y otros mosquitos vectores, se han combinado para influir fuertemente en los cambios en la distribución y la incidencia de varios arbovirus. Se enfatiza la necesidad de realizar estudios exhaustivos de la fauna de mosquitos y modificaciones de las condiciones ambientales, sobre todo en las zonas urbanas fuertemente influenciadas por factores sociales, políticos y económicos. © The Authors 2017. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  17. Knowledge, Attitude and Practices of Vector-Borne Disease Prevention during the Emergence of a New Arbovirus: Implications for the Control of Chikungunya Virus in French Guiana.

    Directory of Open Access Journals (Sweden)

    Camille Fritzell

    2016-11-01

    Full Text Available During the last decade, French Guiana has been affected by major dengue fever outbreaks. Although this arbovirus has been a focus of many awareness campaigns, very little information is available about beliefs, attitudes and behaviors regarding vector-borne diseases among the population of French Guiana. During the first outbreak of the chikungunya virus, a quantitative survey was conducted among high school students to study experiences, practices and perceptions related to mosquito-borne diseases and to identify socio-demographic, cognitive and environmental factors that could be associated with the engagement in protective behaviors.A cross-sectional survey was administered in May 2014, with a total of 1462 students interviewed. Classrooms were randomly selected using a two-stage selection procedure with cluster samples. A multiple correspondence analysis (MCA associated with a hierarchical cluster analysis and with an ordinal logistic regression was performed. Chikungunya was less understood and perceived as a more dreadful disease than dengue fever. The analysis identified three groups of individual protection levels against mosquito-borne diseases: "low" (30%, "moderate" (42% and "high" (28%". Protective health behaviors were found to be performed more frequently among students who were female, had a parent with a higher educational status, lived in an individual house, and had a better understanding of the disease.This study allowed us to estimate the level of protective practices against vector-borne diseases among students after the emergence of a new arbovirus. These results revealed that the adoption of protective behaviors is a multi-factorial process that depends on both sociocultural and cognitive factors. These findings may help public health authorities to strengthen communication and outreach strategies, thereby increasing the adoption of protective health behaviors, particularly in high-risk populations.

  18. Chikungunya fever: CNS infection and pathologies of a re-emerging arbovirus.

    Science.gov (United States)

    Das, Trina; Jaffar-Bandjee, Marie Christine; Hoarau, Jean Jacques; Krejbich Trotot, Pascale; Denizot, Melanie; Lee-Pat-Yuen, Ghislaine; Sahoo, Renubala; Guiraud, Pascale; Ramful, Duksha; Robin, Stephanie; Alessandri, Jean Luc; Gauzere, Bernard Alex; Gasque, Philippe

    2010-06-01

    Chikungunya virus (CHIKV) is transmitted by Aedes mosquitoes and causes an acute symptomatic illness with fever, skin rash, and incapacitating arthralgia, which can evolve into chronic rheumatoid arthritis in elderly patients. This is a tropical disease originally described in central/east Africa in the 1960s, but its 2004 re-emergence in Africa and rapid spread in lands in and around the Indian Ocean (Reunion island, India, Malaysia) as well as Europe (Italy) led to almost 6 million cases worldwide. The risk of importation and spreading diseases with long-term sequelae is even greater today given the global distribution of the vectors (including in the Americas), increased tourism and the apparent capacity of CHIKV to produce high levels of viremia (10(9)-10(12) virus/ml of blood) and new mutants. CHIKV-associated neuropathology was described early in the 1960s, but it is the unprecedented incidence rate in Indian Ocean areas with efficient clinical facilities that allowed a better description of cases with severe encephalitis, meningoencephalitis, peripheral neuropathies and deaths among newborns (mother-to-child infection), infants and elderly patients. Death rates following CHIKV infection were estimated at 1:1000 cases in la Reunion's outbreak. These clinical observations have been corroborated by experimental infection in several mouse models, leading to CNS pathologies. We further describe in this review the capacity of CHIKV to infect neurons and glial cells, delineate the fundamental innate (intrinsic) immune defence mechanisms to protect from infection and argue about the possible mechanisms involved in the encephalopathy. (c) 2010 Elsevier Ltd. All rights reserved.

  19. A geographical information system-based web model of arbovirus transmission risk in the continental United States of America

    Directory of Open Access Journals (Sweden)

    Sarah K. Konrad

    2012-11-01

    Full Text Available A degree-day (DD model of West Nile virus capable of forecasting real-time transmission risk in the continental United States of America up to one week in advance using a 50-km grid is available online at https://sites. google.com/site/arbovirusmap/. Daily averages of historical risk based on temperatures for 1994-2003 are available at 10- km resolution. Transmission risk maps can be downloaded from 2010 to the present. The model can be adapted to work with any arbovirus for which the temperature-related parameters are known, e.g. Rift Valley fever virus. To more effectively assess virus establishment and transmission, the model incorporates “compound risk” maps and forecasts, which includes livestock density as a parameter.

  20. Reconstruction of the Evolutionary History and Dispersal of Usutu Virus, a Neglected Emerging Arbovirus in Europe and Africa.

    Science.gov (United States)

    Engel, Dimitri; Jöst, Hanna; Wink, Michael; Börstler, Jessica; Bosch, Stefan; Garigliany, Mutien-Marie; Jöst, Artur; Czajka, Christina; Lühken, Renke; Ziegler, Ute; Groschup, Martin H; Pfeffer, Martin; Becker, Norbert; Cadar, Daniel; Schmidt-Chanasit, Jonas

    2016-02-02

    Usutu virus (USUV), one of the most neglected Old World encephalitic flaviviruses, causes epizootics among wild and captive birds and sporadic infection in humans. The dynamics of USUV spread and evolution in its natural hosts are unknown. Here, we present the phylogeny and evolutionary history of all available USUV strains, including 77 newly sequenced complete genomes from a variety of host species at a temporal and spatial scaled resolution. The results showed that USUV can be classified into six distinct lineages and that the most recent common ancestor of the recent European epizootics emerged in Africa at least 500 years ago. We demonstrated that USUV was introduced regularly from Africa into Europe in the last 50 years, and the genetic diversity of European lineages is shaped primarily by in situ evolution, while the African lineages have been driven by extensive gene flow. Most of the amino acid changes are deleterious polymorphisms removed by purifying selection, with adaptive evolution restricted to the NS5 gene and several others evolving under episodic directional selection, indicating that the ecological or immunological factors were mostly the key determinants of USUV dispersal and outbreaks. Host-specific mutations have been detected, while the host transition analysis identified mosquitoes as the most likely origin of the common ancestor and birds as the source of the recent European USUV lineages. Our results suggest that the major migratory bird flyways could predict the continental and intercontinental dispersal patterns of USUV and that migratory birds might act as potential long-distance dispersal vehicles. Usutu virus (USUV), a mosquito-borne flavivirus of the Japanese encephalitis virus antigenic group, caused massive bird die-offs, mostly in Europe. There is increasing evidence that USUV appears to be pathogenic for humans, becoming a potential public health problem. The emergence of USUV in Europe allows us to understand how an arbovirus

  1. The molecular biology of nairoviruses, an emerging group of tick-borne arboviruses.

    Science.gov (United States)

    Lasecka, Lidia; Baron, Michael D

    2014-06-01

    The nairoviruses are a rapidly emerging group of tick-borne bunyaviruses that includes pathogens of humans (Crimean-Congo hemorrhagic fever virus [CCHFV]) and livestock (Nairobi sheep disease virus [NSDV], also known as Ganjam virus), as well as a large number of viruses for which the normal vertebrate host has not been established. Studies on this group of viruses have been fairly limited, not least because CCHFV is a BSL4 human pathogen, restricting the number of labs able to study the live virus, while NSDV, although highly pathogenic in naive animals, is not seen as a threat in developed countries, making it a low priority. Nevertheless, recent years have seen significant progress in our understanding of the biology of these viruses, particularly that of CCHFV, and this article seeks to draw together our existing knowledge to generate an overall picture of their molecular biology, underlining areas of particular ignorance for future studies.

  2. Bibliometric analysis of Oropouche research: impact on the surveillance of emerging arboviruses in Latin America [version 2; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Carlos Culquichicón

    2017-03-01

    Full Text Available Given the emergence and reemergence of viral diseases, particularly in Latin America, we would like to provide an analysis of the patterns of research and publication on Oropouche virus (OROV. We also discuss the implications of recent epidemics in certain areas of South America, and how more clinical and epidemiological information regarding OROV is urgently needed.

  3. Bibliometric analysis of Oropouche research: impact on the surveillance of emerging arboviruses in Latin America [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Carlos Culquichicón

    2017-02-01

    Full Text Available Given the emergence and reemergence of viral diseases, particularly in Latin America, we would like to provide an analysis of the patterns of research and publication on Oropouche virus (OROV. We also discuss the implications of recent epidemics in certain areas of South America, and how more clinical and epidemiological information regarding OROV is urgently needed.

  4. (Arbo)viruses in high European Arctic

    OpenAIRE

    ELSTEROVÁ, Jana

    2016-01-01

    Since an ongoing climate change covers strongly the polar areas. Higher temperatures and related climate parameters bring the emergence of new parasites and their pathogens to higher latitudes. This may influence zoonotic diseases including arthropod-transmitted diseases. The tick species Ixodes uriae, parasitizing seabirds in the Arctic, may transmit many pathogens including various arboviruses, Borrelia spirochetes and Babesia apicomplexans. In the study we diagnosed 89 individuals of seabi...

  5. Nature, Nurture and Evolution of Intra-Species Variation in Mosquito Arbovirus Transmission Competence

    Directory of Open Access Journals (Sweden)

    Walter J. Tabachnick

    2013-01-01

    Full Text Available Mosquitoes vary in their competence or ability to transmit arthropod-borne viruses (arboviruses. Many arboviruses cause disease in humans and animals. Identifying the environmental and genetic causes of variation in mosquito competence for arboviruses is one of the great challenges in public health. Progress identifying genetic (nature and environmental (nurture factors influencing mosquito competence for arboviruses is reviewed. There is great complexity in the various traits that comprise mosquito competence. The complex interactions between environmental and genetic factors controlling these traits and the factors shaping variation in Nature are largely unknown. The norms of reaction of specific genes influencing competence, their distributions in natural populations and the effects of genetic polymorphism on phenotypic variation need to be determined. Mechanisms influencing competence are not likely due to natural selection because of the direct effects of the arbovirus on mosquito fitness. More likely the traits for mosquito competence for arboviruses are the effects of adaptations for other functions of these competence mechanisms. Determining these other functions is essential to understand the evolution and distributions of competence for arboviruses. This information is needed to assess risk from mosquito-borne disease, predict new mosquito-arbovirus systems, and provide novel strategies to mitigate mosquito-borne arbovirus transmission.

  6. Nature, Nurture and Evolution of Intra-Species Variation in Mosquito Arbovirus Transmission Competence

    Science.gov (United States)

    Tabachnick, Walter J.

    2013-01-01

    Mosquitoes vary in their competence or ability to transmit arthropod-borne viruses (arboviruses). Many arboviruses cause disease in humans and animals. Identifying the environmental and genetic causes of variation in mosquito competence for arboviruses is one of the great challenges in public health. Progress identifying genetic (nature) and environmental (nurture) factors influencing mosquito competence for arboviruses is reviewed. There is great complexity in the various traits that comprise mosquito competence. The complex interactions between environmental and genetic factors controlling these traits and the factors shaping variation in Nature are largely unknown. The norms of reaction of specific genes influencing competence, their distributions in natural populations and the effects of genetic polymorphism on phenotypic variation need to be determined. Mechanisms influencing competence are not likely due to natural selection because of the direct effects of the arbovirus on mosquito fitness. More likely the traits for mosquito competence for arboviruses are the effects of adaptations for other functions of these competence mechanisms. Determining these other functions is essential to understand the evolution and distributions of competence for arboviruses. This information is needed to assess risk from mosquito-borne disease, predict new mosquito-arbovirus systems, and provide novel strategies to mitigate mosquito-borne arbovirus transmission. PMID:23343982

  7. Nature, nurture and evolution of intra-species variation in mosquito arbovirus transmission competence.

    Science.gov (United States)

    Tabachnick, Walter J

    2013-01-11

    Mosquitoes vary in their competence or ability to transmit arthropod-borne viruses (arboviruses). Many arboviruses cause disease in humans and animals. Identifying the environmental and genetic causes of variation in mosquito competence for arboviruses is one of the great challenges in public health. Progress identifying genetic (nature) and environmental (nurture) factors influencing mosquito competence for arboviruses is reviewed. There is great complexity in the various traits that comprise mosquito competence. The complex interactions between environmental and genetic factors controlling these traits and the factors shaping variation in Nature are largely unknown. The norms of reaction of specific genes influencing competence, their distributions in natural populations and the effects of genetic polymorphism on phenotypic variation need to be determined. Mechanisms influencing competence are not likely due to natural selection because of the direct effects of the arbovirus on mosquito fitness. More likely the traits for mosquito competence for arboviruses are the effects of adaptations for other functions of these competence mechanisms. Determining these other functions is essential to understand the evolution and distributions of competence for arboviruses. This information is needed to assess risk from mosquito-borne disease, predict new mosquito-arbovirus systems, and provide novel strategies to mitigate mosquito-borne arbovirus transmission.

  8. Local environmental and meteorological conditions influencing the invasive mosquito Ae. albopictus and arbovirus transmission risk in New York City.

    Science.gov (United States)

    Little, Eliza; Bajwa, Waheed; Shaman, Jeffrey

    2017-08-01

    Ae. albopictus, an invasive mosquito vector now endemic to much of the northeastern US, is a significant public health threat both as a nuisance biter and vector of disease (e.g. chikungunya virus). Here, we aim to quantify the relationships between local environmental and meteorological conditions and the abundance of Ae. albopictus mosquitoes in New York City. Using statistical modeling, we create a fine-scale spatially explicit risk map of Ae. albopictus abundance and validate the accuracy of spatiotemporal model predictions using observational data from 2016. We find that the spatial variability of annual Ae. albopictus abundance is greater than its temporal variability in New York City but that both local environmental and meteorological conditions are associated with Ae. albopictus numbers. Specifically, key land use characteristics, including open spaces, residential areas, and vacant lots, and spring and early summer meteorological conditions are associated with annual Ae. albopictus abundance. In addition, we investigate the distribution of imported chikungunya cases during 2014 and use these data to delineate areas with the highest rates of arboviral importation. We show that the spatial distribution of imported arboviral cases has been mostly discordant with mosquito production and thus, to date, has provided a check on local arboviral transmission in New York City. We do, however, find concordant areas where high Ae. albopictus abundance and chikungunya importation co-occur. Public health and vector control officials should prioritize control efforts to these areas and thus more cost effectively reduce the risk of local arboviral transmission. The methods applied here can be used to monitor and identify areas of risk for other imported vector-borne diseases.

  9. [Arboviruses also have an American dream].

    Science.gov (United States)

    Rodhain, F

    2017-08-01

    Some arboviruses that originated in the Old World have been introduced by humans into the American continent. The first of them was the yellow fever virus, coming from the West African coast with slaves in the 17th-19th centuries, followed by dengue viruses, which were always prevalent within the Americas. Next was theWest Nile virus, introduced in New York in 1999, that spread in only a few years over the whole continent. Then, Chikungunya virus arrived on Saint Martin Island in 2013 after its outbreak in Polynesia; it is now widespread in the Caribbean Islands and on the American continent from the United States to Brazil. Finally, Zika virus, already active in Asia and in the South Pacific region, was introduced in Brazil and spread between the southern part of United States and south Brazil. These unexpected emergences are the consequence of the generalization of transoceanic trading; so, it is humans who are truly responsible for such transportation of viruses from the African and Asian continents. The mechanisms of virus establishment in unusual ecosystems have to be analyzed in order to understand the conditions for the circulation of the viruses, which supposes an adaptation to new hosts and vectors that are sometimes local species (like Culex vectors of West Nile virus) but mainly previously introduced mosquitoes (like Aedes aegypti and/or Aedes albopictus). Over time, all these vectors developed a strong anthropophily and, most of them, a remarkable adaptation to urban environment; hence, these arboviruses can disseminate both in rural and urban context. This type of arboviral emergences will certainly continue in the following years and we must imperatively develop preventive strategies by detecting virus mutations with capacity for emergence, enhancing the sensibility and rapidity of epidemiological surveillance, and becoming ready to face such events that cause a truly international health crisis.

  10. On the entry of an emerging arbovirus into host cells: Mayaro virus takes the highway to the cytoplasm through fusion with early endosomes and caveolae-derived vesicles

    Directory of Open Access Journals (Sweden)

    Carlos A.M. Carvalho

    2017-04-01

    Full Text Available Mayaro virus (MAYV is an emergent sylvatic alphavirus in South America, related to sporadic outbreaks of a chikungunya-like human febrile illness accompanied by severe arthralgia. Despite its high potential for urban emergence, MAYV is still an obscure virus with scarce information about its infection cycle, including the corresponding early events. Even for prototypical alphaviruses, the cell entry mechanism still has some rough edges to trim: although clathrin-mediated endocytosis is quoted as the putative route, alternative paths as distinct as direct virus genome injection through the cell plasma membrane seems to be possible. Our aim was to clarify crucial details on the entry route exploited by MAYV to gain access into the host cell. Tracking the virus since its first contact with the surface of Vero cells by fluorescence microscopy, we show that its entry occurs by a fast endocytic process and relies on fusion with acidic endosomal compartments. Moreover, blocking clathrin-mediated endocytosis or depleting cholesterol from the cell membrane leads to a strong inhibition of viral infection, as assessed by plaque assays. Following this clue, we found that early endosomes and caveolae-derived vesicles are both implicated as target membranes for MAYV fusion. Our findings unravel the very first events that culminate in a productive infection by MAYV and shed light on potential targets for a rational antiviral therapy, besides providing a better comprehension of the entry routes exploited by alphaviruses to get into the cell.

  11. Inadequate management of natural ecosystem in the Brazilian Amazon region results in the emergence and reemergence of arboviruses Gestão imprópria do ecossistema natural na Amazônia brasileira resulta na emergência e reemergência de arbovírus

    Directory of Open Access Journals (Sweden)

    Pedro F. C. Vasconcelos

    2001-01-01

    Full Text Available A total of 187 different species of arboviruses and other viruses in vertebrates were identified at the Evandro Chagas Institute (IEC from 1954 to 1998, among more than 10,000 arbovirus strains isolated from humans, hematophagous insects, and wild and sentinel vertebrates. Despite intensive studies in the Brazilian Amazon region, especially in Pará State, very little is known about most of these viruses, except for information on date, time, source, and method of isolation, as well as their capacity to infect laboratory animals. This paper reviews ecological and epidemiological data and analyzes the impact of vector and host population changes on various viruses as a result of profound changes in the natural environment. Deforestation, mining, dam and highway construction, human colonization, and urbanization were the main manmade environmental changes associated with the emergence and/or reemergence of relevant arboviruses, including some known pathogens for humans.Um total de 187 diferentes espécies de arbovírus, além de outros vírus de vertebrados, foram identificados pelo Instituto Evandro Chagas (IEC no período de 1954 a 1998, entre as mais de 10.000 cepas de vírus isoladas de seres humanos, insetos hematófagos e vertebrados-sentinela e silvestres. Apesar dos estudos intensivos realizados na Amazônia brasileira, sobretudo no Estado do Pará, pouco se sabe a respeito da maioria desses vírus, com exceção de dados a respeito de data, hora, fonte e método de isolamento, assim como a capacidade de infectar animais laboratoriais. Os autores fazem uma revisão dos dados ecológicos e epidemiológicos e procuram associar o impacto, sobre os diversos vírus, das mudanças populacionais dos vetores e hospedeiros induzidas por profundas alterações no meio ambiente. O desmatamento, o uso do subsolo, a construção de represas e de rodovias, a colonização humana e a urbanização foram as principais modificações ambientais

  12. Arboviruses in North Dakota, 2003–2006

    Science.gov (United States)

    Anderson, John F.; Main, Andy J.; Armstrong, Philip M.; Andreadis, Theodore G.; Ferrandino, Francis J.

    2015-01-01

    To investigate arbovirus transmission in North Dakota, we collected and screened mosquitoes for viral infection by Vero cell culture assay. Seven viruses were isolated from 13 mosquito species. Spatial and temporal distributions of the important vectors of West Nile virus (WNV), Cache Valley virus, Jamestown Canyon virus (JCV), and trivittatus virus are reported. Snowshoe hare virus, Potosi virus, and western equine encephalomyelitis virus were also isolated. The risks of Culex tarsalis and Aedes vexans transmitting WNV to humans were 61.4% and 34.0% in 2003–2006, respectively, but in 2003 when the largest epidemic was reported, risks for Ae. vexans and Cx. tarsalis in Cass County were 73.6% and 23.9%, respectively. Risk of humans acquiring an infectious bite was greatest from about the second week of July through most of August. West Nile virus sequences were of the WN02 genotype. Most JCV strains belonged to a single clade of genetically related strains. Cache Valley virus and JCV were prevalent during August and early September and during July and August, respectively. PMID:25487728

  13. The Role of RNA Interference (RNAi in Arbovirus-Vector Interactions

    Directory of Open Access Journals (Sweden)

    Carol D. Blair

    2015-02-01

    Full Text Available RNA interference (RNAi was shown over 18 years ago to be a mechanism by which arbovirus replication and transmission could be controlled in arthropod vectors. During the intervening period, research on RNAi has defined many of the components and mechanisms of this antiviral pathway in arthropods, yet a number of unexplored questions remain. RNAi refers to RNA-mediated regulation of gene expression. Originally, the term described silencing of endogenous genes by introduction of exogenous double-stranded (dsRNA with the same sequence as the gene to be silenced. Further research has shown that RNAi comprises three gene regulation pathways that are mediated by small RNAs: the small interfering (siRNA, micro (miRNA, and Piwi-interacting (piRNA pathways. The exogenous (exo-siRNA pathway is now recognized as a major antiviral innate immune response of arthropods. More recent studies suggest that the piRNA and miRNA pathways might also have important roles in arbovirus-vector interactions. This review will focus on current knowledge of the role of the exo-siRNA pathway as an arthropod vector antiviral response and on emerging research into vector piRNA and miRNA pathway modulation of arbovirus-vector interactions. Although it is assumed that arboviruses must evade the vector’s antiviral RNAi response in order to maintain their natural transmission cycles, the strategies by which this is accomplished are not well defined. RNAi is also an important tool for arthropod gene knock-down in functional genomics studies and in development of arbovirus-resistant mosquito populations. Possible arbovirus strategies for evasion of RNAi and applications of RNAi in functional genomics analysis and arbovirus transmission control will also be reviewed.

  14. Idiosyncratic Risk in Emerging Market

    Directory of Open Access Journals (Sweden)

    Marselinus Asri

    2017-10-01

    Using the SEM AMOS Ver.24 and Sobel Test Path Analysis, the results show that Current Operating Accrual has a negative and significant relationship to the idiosyncratic risk and stock price. For non-Current Operating Accrual variables have positive and significant relation. By using Sobel Test, the test result shows that idiosyncratic risk has mediation effect in Persistence Current Operating Accrual, Non-Current Operating Accrual relationship to stock price.

  15. Nanotechnology risk perceptions and communication: emerging technologies, emerging challenges.

    Science.gov (United States)

    Pidgeon, Nick; Harthorn, Barbara; Satterfield, Terre

    2011-11-01

    Nanotechnology involves the fabrication, manipulation, and control of materials at the atomic level and may also bring novel uncertainties and risks. Potential parallels with other controversial technologies mean there is a need to develop a comprehensive understanding of processes of public perception of nanotechnology uncertainties, risks, and benefits, alongside related communication issues. Study of perceptions, at so early a stage in the development trajectory of a technology, is probably unique in the risk perception and communication field. As such it also brings new methodological and conceptual challenges. These include: dealing with the inherent diversity of the nanotechnology field itself; the unfamiliar and intangible nature of the concept, with few analogies to anchor mental models or risk perceptions; and the ethical and value questions underlying many nanotechnology debates. Utilizing the lens of social amplification of risk, and drawing upon the various contributions to this special issue of Risk Analysis on Nanotechnology Risk Perceptions and Communication, nanotechnology may at present be an attenuated hazard. The generic idea of "upstream public engagement" for emerging technologies such as nanotechnology is also discussed, alongside its importance for future work with emerging technologies in the risk communication field. © 2011 Society for Risk Analysis.

  16. Highly Enhanced Risk Management Emergency Satellite

    DEFF Research Database (Denmark)

    Dalmeir, Michael; Gataullin, Yunir; Indrajit, Agung

    HERMES (Highly Enhanced Risk Management Emergency Satellite) is potential European satellite mission for global flood management, being implemented by Technical University Munich and European Space Agency. With its main instrument - a reliable and precise Synthetic Aperture Radar (SAR) antenna...

  17. 2017 Emerging Technology Domains Risk Survey

    Science.gov (United States)

    2017-10-01

    REV-03.18.2016.0 2017 Emerging Technology Domains Risk Survey Daniel Klinedinst Joel Land Kyle O’Meara October 2017 TECHNICAL REPORT CMU/SEI...Distribution Statement A: Approved for Public Release. Distribution is Unlimited. List of Tables Table 1: New and Emerging Technologies 2 Table 2: Security...Impact of New and Emerging Technologies 4 Table 3: Severity Classifications and Impact Scores 5 CMU/SEI-2017-TR-008 | SOFTWARE ENGINEERING

  18. Determinants of Arbovirus Vertical Transmission in Mosquitoes.

    Directory of Open Access Journals (Sweden)

    Sebastian Lequime

    2016-05-01

    Full Text Available Vertical transmission (VT and horizontal transmission (HT of pathogens refer to parental and non-parental chains of host-to-host transmission. Combining HT with VT enlarges considerably the range of ecological conditions in which a pathogen can persist, but the factors governing the relative frequency of each transmission mode are poorly understood for pathogens with mixed-mode transmission. Elucidating these factors is particularly important for understanding the epidemiology of arthropod-borne viruses (arboviruses of public health significance. Arboviruses are primarily maintained by HT between arthropod vectors and vertebrate hosts in nature, but are occasionally transmitted vertically in the vector population from an infected female to her offspring, which is a proposed maintenance mechanism during adverse conditions for HT. Here, we review over a century of published primary literature on natural and experimental VT, which we previously assembled into large databases, to identify biological factors associated with the efficiency of arbovirus VT in mosquito vectors. Using a robust statistical framework, we highlight a suite of environmental, taxonomic, and physiological predictors of arbovirus VT. These novel insights contribute to refine our understanding of strategies employed by arboviruses to persist in the environment and cause substantial public health concern. They also provide hypotheses on the biological processes underlying the relative VT frequency for pathogens with mixed-mode transmission that can be tested empirically.

  19. Evolution of Mosquito-Based Arbovirus Surveillance Systems in Australia

    Directory of Open Access Journals (Sweden)

    Andrew F. van den Hurk

    2012-01-01

    Full Text Available Control of arboviral disease is dependent on the sensitive and timely detection of elevated virus activity or the identification of emergent or exotic viruses. The emergence of Japanese encephalitis virus (JEV in northern Australia revealed numerous problems with performing arbovirus surveillance in remote locations. A sentinel pig programme detected JEV activity, although there were a number of financial, logistical, diagnostic and ethical limitations. A system was developed which detected viral RNA in mosquitoes collected by solar or propane powered CO2-baited traps. However, this method was hampered by trap-component malfunction, microbial contamination and large mosquito numbers which overwhelmed diagnostic capabilities. A novel approach involves allowing mosquitoes within a box trap to probe a sugar-baited nucleic-acid preservation card that is processed for expectorated arboviruses. In a longitudinal field trial, both Ross River and Barmah Forest viruses were detected numerous times from multiple traps over different weeks. Further refinements, including the development of unpowered traps and use of yeast-generated CO2, could enhance the applicability of this system to remote locations. New diagnostic technology, such as next generation sequencing and biosensors, will increase the capacity for recognizing emergent or exotic viruses, while cloud computing platforms will facilitate rapid dissemination of data.

  20. Zoonotic encephalitides caused by arboviruses: transmission and epidemiology of alphaviruses and flaviviruses.

    Science.gov (United States)

    Go, Yun Young; Balasuriya, Udeni B R; Lee, Chong-Kyo

    2014-01-01

    In this review, we mainly focus on zoonotic encephalitides caused by arthropod-borne viruses (arboviruses) of the families Flaviviridae (genus Flavivirus) and Togaviridae (genus Alphavirus) that are important in both humans and domestic animals. Specifically, we will focus on alphaviruses (Eastern equine encephalitis virus, Western equine encephalitis virus, Venezuelan equine encephalitis virus) and flaviviruses (Japanese encephalitis virus and West Nile virus). Most of these viruses were originally found in tropical regions such as Africa and South America or in some regions in Asia. However, they have dispersed widely and currently cause diseases around the world. Global warming, increasing urbanization and population size in tropical regions, faster transportation and rapid spread of arthropod vectors contribute in continuous spreading of arboviruses into new geographic areas causing reemerging or resurging diseases. Most of the reemerging arboviruses also have emerged as zoonotic disease agents and created major public health issues and disease epidemics.

  1. Arbovirus vaccines: opportunities for the baculovirus-insect cell expression system

    NARCIS (Netherlands)

    Metz, S.W.H.; Pijlman, G.P.

    2011-01-01

    The baculovirus-insect cell expression system is a well-established technology for the production of heterologous viral (glyco)proteins in cultured cells, applicable for basic scientific research as well as for the development and production of vaccines and diagnostics. Arboviruses form an emerging

  2. Emergent Risks In Critical Infrastructures

    Science.gov (United States)

    Dynes, Scott

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

  3. Emerging Technological Risk Underpinning the Risk of Technology Innovation

    CERN Document Server

    Anderson, Stuart

    2012-01-01

    Classes of socio-technical hazards allow a characterization of the risk in technology innovation and clarify the mechanisms underpinning emergent technological risk. Emerging Technological Risk provides an interdisciplinary account of risk in socio-technical systems including hazards which highlight: ·         How technological risk crosses organizational boundaries, ·         How technological trajectories and evolution develop from resolving tensions emerging between social aspects of organisations and technologies and ·         How social behaviour shapes, and is shaped by, technology. Addressing an audience from a range of academic and professional backgrounds, Emerging Technological Risk is a key source for those who wish to benefit from a detail and methodical exposure to multiple perspectives on technological risk. By providing a synthesis of recent work on risk that captures the complex mechanisms that characterize the emergence of risk in technology innovation, Emerging Tec...

  4. Risk stratification in emergency patients by copeptin

    DEFF Research Database (Denmark)

    Iversen, Kasper; Gøtze, Jens P; Dalsgaard, Morten

    2014-01-01

    BACKGROUND: Rapid risk stratification is a core task in emergency medicine. Identifying patients at high and low risk shortly after admission could help clinical decision-making regarding treatment, level of observation, allocation of resources and post discharge follow-up. The purpose of the pre...

  5. Aedes aegypti (Diptera: Culicidae) in Mauritania: First Report on the Presence of the Arbovirus Mosquito Vector in Nouakchott.

    Science.gov (United States)

    Mint Lekweiry, Khadijetou; Ould Ahmedou Salem, Mohamed Salem; Ould Brahim, Khyarhoum; Ould Lemrabott, Mohamed Aly; Brengues, Cécile; Faye, Ousmane; Simard, Frédéric; Ould Mohamed Salem Boukhary, Ali

    2015-07-01

    Aedes aegypti L. (Diptera: Culicidae) is a major vector of yellow fever, dengue, and chikungunya viruses throughout tropical and subtropical areas of the world. Although the southernmost part of Mauritania along the Senegal river has long been recognized at risk of yellow fever transmission, Aedes spp. mosquitoes had never been reported northwards in Mauritania. Here, we report the first observation of Aedes aegypti aegypti (L.) and Aedes (Ochlerotatus) caspius (Pallas, 1771) in the capital city, Nouakchott. We describe the development sites in which larvae of the two species were found, drawing attention to the risk for emergence of arbovirus transmission in the city. © The Authors 2015. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  6. A Probabilistic Risk Assessment For Emergency Preparedness

    International Nuclear Information System (INIS)

    Lee, Joomyung; Jae, Moosung; Ahn, Kwangil

    2013-01-01

    The importance of nuclear power plant PSA has grown up all over the world due to this incident. The main concern of this study is to develop a methodology to carry on an emergency preparedness evaluation and to set an exclusive area, or the emergency response area boundary in order to apply it to domestic reference plants. This study also focuses on evaluating the risk parameter of major nuclides through a sensitivity analysis and a safety assessment by calculating the population dose, early fatality, and cancer fatality rates. A methodology for an emergency preparedness, which can be applied to evaluate the damage of the radioactive release as well as to assess the safety of the accident scenario of a nuclear power plant, has been developed and applied for the reference plants in Korea. By applying a source term analysis, an exclusive zone based on the radioactive dose is obtained. And the results of the health effect assessment based on the release fraction of specific nuclides to public with an effective emergency response activity have been simulated. A methodology utilizing the Level 3 PSA with the actual emergency response activities has been developed and applied to typical nuclear accident situations. The plausible standard for performing an emergency plan is suggested and the valuable information regarding emergency preparedness has been produced in this study. For further works, the sensitivity study on important parameters will be performed to simulate the actual severe accident situations such as sheltering, evacuation, and emergency response activities

  7. Using risk based tools in emergency response

    International Nuclear Information System (INIS)

    Dixon, B.W.; Ferns, K.G.

    1987-01-01

    Probabilistic Risk Assessment (PRA) techniques are used by the nuclear industry to model the potential response of a reactor subjected to unusual conditions. The knowledge contained in these models can aid in emergency response decision making. This paper presents requirements for a PRA based emergency response support system to date. A brief discussion of published work provides background for a detailed description of recent developments. A rapid deep assessment capability for specific portions of full plant models is presented. The program uses a screening rule base to control search space expansion in a combinational algorithm

  8. Mosquito-borne arbovirus surveillance at selected sites in diverse ecological zones of Kenya; 2007 – 2012

    Science.gov (United States)

    2013-01-01

    Background Increased frequency of arbovirus outbreaks in East Africa necessitated the determination of distribution of risk by entomologic arbovirus surveillance. A systematic vector surveillance programme spanning 5 years and covering 11 sites representing seven of the eight provinces in Kenya and located in diverse ecological zones was carried out. Methods Mosquitoes were sampled bi-annually during the wet seasons and screened for arboviruses. Mosquitoes were identified to species, pooled by species, collection date and site and screened for arboviruses by isolation in cell culture and/or RT-PCR screening and sequencing. Results Over 450,000 mosquitoes in 15,890 pools were screened with 83 viruses being detected/isolated that include members of the alphavirus, flavivirus and orthobunyavirus genera many of which are known to be of significant public health importance in the East African region. These include West Nile, Ndumu, Sindbis, Bunyamwera, Pongola and Usutu viruses detected from diverse sites. Ngari virus, which was associated with hemorrhagic fever in northern Kenya in 1997/98 was isolated from a pool of Anopheles funestus sampled from Tana-delta and from Aedes mcintoshi from Garissa. Insect only flaviviruses previously undescribed in Kenya were also isolated in the coastal site of Rabai. A flavivirus most closely related to the Chaoyang virus, a new virus recently identified in China and two isolates closely related to Quang Binh virus previously unreported in Kenya were also detected. Conclusion Active transmission of arboviruses of public health significance continues in various parts of the country with possible undetermined human impact. Arbovirus activity was highest in the pastoralist dominated semi-arid to arid zones sites of the country where 49% of the viruses were isolated suggesting a role of animals as amplifiers and indicating the need for improved arbovirus disease diagnosis among pastoral communities. PMID:23663381

  9. Emerging carbon constraints for corporate risk management

    International Nuclear Information System (INIS)

    Busch, Timo; Hoffmann, Volker H.

    2007-01-01

    While discussions about global sustainability challenges abound, the financial risks that they incur, albeit important, have received less attention. We suggest that corporate risk assessments should include sustainability-related aspects, especially with relation to the natural environment, and encompass the flux of critical materials within a company's value chain. Such a comprehensive risk assessment takes into account input- as well as output-related factors. With this paper, we focus on the flux of carbon and define carbon constraints that emerge due to the disposition of fossil fuels in the input dimension and due to direct and indirect climate change effects in the output dimension. We review the literature regarding the financial consequences of carbon constraints on the macroeconomic, sector, and company level. We conclude that: a) financial consequences seem to be asymmetrically distributed between and within sectors, b) the individual risk exposure of companies depends on the intensity of and dependency on carbon-based materials and energy, and c) financial markets have only started to incorporate these aspects in their valuations. This paper ends with recommendations on how to incorporate our results in an integrated carbon risk management framework. (author)

  10. Emergency thoracic ultrasound and clinical risk management

    Directory of Open Access Journals (Sweden)

    Interrigi MC

    2017-02-01

    Full Text Available Maria Concetta Interrigi,1 Francesca M Trovato,2,3 Daniela Catalano,3,4 Guglielmo M Trovato3,5 1Accident and Emergency Department, Ospedale Cannizzaro, Catania, 2Accident and Emergency Department, Ospedale Civile, Ragusa, 3Department of Clinical and Experimental Medicine, The School of Medicine, University of Catania, 4Postgraduate School of Clinical Ultrasound, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Policlinico, University of Catania, 5Postgraduate School of e-Learning and ICT in Health Sciences, The School of Medicine, University of Catania, Catania, Italy Purpose: Thoracic ultrasound (TUS has been proposed as an easy-option replacement for chest X-ray (CXR in emergency diagnosis of pneumonia, pleural effusion, and pneumothorax. We investigated CXR unforeseen diagnosis, subsequently investigated by TUS, considering its usefulness in clinical risk assessment and management and also assessing the sustainability of telementoring. Patients and methods: This observational report includes a period of 6 months with proactive concurrent adjunctive TUS diagnosis telementoring, which was done using freely available smartphone applications for transfer of images and movies. Results: Three hundred and seventy emergency TUS scans (excluding trauma patients were performed and telementored. In 310 cases, no significant chest pathology was detected either by CXR, TUS, or the subsequent work-up; in 24 patients, there was full concordance between TUS and CXR (ten isolated pleural effusion; eleven pleural effusion with lung consolidations; and three lung consolidation without pleural effusion; in ten patients with lung consolidations, abnormalities identified by CXR were not detected by TUS. In 26 patients, only TUS diagnosis criteria of disease were present: in 19 patients, CXR was not diagnostic, ie, substantially negative, but TUS detected these conditions correctly, and these were later confirmed by computed

  11. Risk-based emergency decision support

    International Nuclear Information System (INIS)

    Koerte, Jens

    2003-01-01

    In the present paper we discuss how to assist critical decisions taken under complex, contingent circumstances, with a high degree of uncertainty and short time frames. In such sharp-end decision regimes, standard rule-based decision support systems do not capture the complexity of the situation. At the same time, traditional risk analysis is of little use due to variability in the specific circumstances. How then, can an organisation provide assistance to, e.g. pilots in dealing with such emergencies? A method called 'contingent risk and decision analysis' is presented, to provide decision support for decisions under variable circumstances and short available time scales. The method consists of nine steps of definition, modelling, analysis and criteria definition to be performed 'off-line' by analysts, and procedure generation to transform the analysis result into an operational decision aid. Examples of pilots' decisions in response to sudden vibration in offshore helicopter transport method are used to illustrate the approach

  12. Vertebrate reservoirs of arboviruses: myth, synonym of amplifier, or reality?

    Czech Academy of Sciences Publication Activity Database

    Kuno, G.; Mackenzie, J. S.; Junglen, S.; Hubálek, Zdeněk; Plyusnin, A.; Gubler, D. J.

    2017-01-01

    Roč. 9, č. 7 (2017), č. článku 185. ISSN 1999-4915 Institutional support: RVO:68081766 Keywords : insect-specific virus * arbovirus * transmission mechanism * vertebrate reservoir * origin of arbovirus * virus maintenance * zoonosis * host range Subject RIV: EE - Microbiology, Virology OBOR OECD: Virology Impact factor: 3.465, year: 2016

  13. Insect-Specific Virus Discovery: Significance for the Arbovirus Community

    Directory of Open Access Journals (Sweden)

    Bethany G. Bolling

    2015-09-01

    Full Text Available Arthropod-borne viruses (arboviruses, especially those transmitted by mosquitoes, are a significant cause of morbidity and mortality in humans and animals worldwide. Recent discoveries indicate that mosquitoes are naturally infected with a wide range of other viruses, many within taxa occupied by arboviruses that are considered insect-specific. Over the past ten years there has been a dramatic increase in the literature describing novel insect-specific virus detection in mosquitoes, which has provided new insights about viral diversity and evolution, including that of arboviruses. It has also raised questions about what effects the mosquito virome has on arbovirus transmission. Additionally, the discovery of these new viruses has generated interest in their potential use as biological control agents as well as novel vaccine platforms. The arbovirus community will benefit from the growing database of knowledge concerning these newly described viral endosymbionts, as their impacts will likely be far reaching.

  14. Vertebrate Reservoirs of Arboviruses: Myth, Synonym of Amplifier, or Reality?

    Directory of Open Access Journals (Sweden)

    Goro Kuno

    2017-07-01

    Full Text Available The rapid succession of the pandemic of arbovirus diseases, such as dengue, West Nile fever, chikungunya, and Zika fever, has intensified research on these and other arbovirus diseases worldwide. Investigating the unique mode of vector-borne transmission requires a clear understanding of the roles of vertebrates. One major obstacle to this understanding is the ambiguity of the arbovirus definition originally established by the World Health Organization. The paucity of pertinent information on arbovirus transmission at the time contributed to the notion that vertebrates played the role of reservoir in the arbovirus transmission cycle. Because this notion is a salient feature of the arbovirus definition, it is important to reexamine its validity. This review addresses controversial issues concerning vertebrate reservoirs and their role in arbovirus persistence in nature, examines the genesis of the problem from a historical perspective, discusses various unresolved issues from multiple points of view, assesses the present status of the notion in light of current knowledge, and provides options for a solution to resolve the issue.

  15. Vertebrate Reservoirs of Arboviruses: Myth, Synonym of Amplifier, or Reality?

    Science.gov (United States)

    Kuno, Goro; Mackenzie, John S; Junglen, Sandra; Hubálek, Zdeněk; Plyusnin, Alexander; Gubler, Duane J

    2017-07-13

    The rapid succession of the pandemic of arbovirus diseases, such as dengue, West Nile fever, chikungunya, and Zika fever, has intensified research on these and other arbovirus diseases worldwide. Investigating the unique mode of vector-borne transmission requires a clear understanding of the roles of vertebrates. One major obstacle to this understanding is the ambiguity of the arbovirus definition originally established by the World Health Organization. The paucity of pertinent information on arbovirus transmission at the time contributed to the notion that vertebrates played the role of reservoir in the arbovirus transmission cycle. Because this notion is a salient feature of the arbovirus definition, it is important to reexamine its validity. This review addresses controversial issues concerning vertebrate reservoirs and their role in arbovirus persistence in nature, examines the genesis of the problem from a historical perspective, discusses various unresolved issues from multiple points of view, assesses the present status of the notion in light of current knowledge, and provides options for a solution to resolve the issue.

  16. Quantitative risk assessment: an emerging tool for emerging foodborne pathogens.

    OpenAIRE

    Lammerding, A. M.; Paoli, G. M.

    1997-01-01

    New challenges to the safety of the food supply require new strategies for evaluating and managing food safety risks. Changes in pathogens, food preparation, distribution, and consumption, and population immunity have the potential to adversely affect human health. Risk assessment offers a framework for predicting the impact of changes and trends on the provision of safe food. Risk assessment models facilitate the evaluation of active or passive changes in how foods are produced, processed, d...

  17. [Arbovirus circulation in the Republic of Guinea].

    Science.gov (United States)

    Butenko, A M

    1996-01-01

    In 1978-1991 the USSR-Guinea Virological and Microbiological Laboratory functioned in Kindia, the Republic of Guinea. Arbovirus activity in this country was studied by a number of virologists and other specialists. Their personal contribution and achievements in this collaboration are reflected in the present paper. About 74,000 mosquitoes, 100,000 Ixodidae ticks, 1,500 wild birds, 2,700 bats, 106 monkeys, and 308 other mammals, 927 blood samples collected from febrile patients were examined in 1978-1989, using inoculation of new-born white mice. As a result of this work 127 strains of the following arboviruses were isolated: Chikungunia (1 strain), Dengue 2 (4), Saboya (7), Wesselsbron (1), Bunyamwera (4), M'Poko (5), Rift Valley Fever (6), CHF-Congo (9), Dugbe (22), Bhanja (6), Forecariah (2), Jos (26), Abadina (15), Kindia (2), Ark 6956 (1), Fomede (2), Bluetongue (9), Mossuril (2), AnK 6009 (1), and Kolente (2). Dengue 2, Wesselsbron, Bunyamwera, M'Poko, Kindia, Mossuril viruses were isolated from mosquitoes. Ixodidae ticks were sources for isolation of Chikungunia, Saboya, CCHF, Dugbe, Bhanja, Forecaciah, Jos, Abadina, Kindia, Ark 6956, Fomede, Bluetongue, and Kolente viruses. Saboya, RVF, Fomede, Kolente, AnK 6909 were isolated from bats (Chiroptera); Saboya, Abadina, and Bluetongue viruses from birds. One strain of Dugbe virus was originated from the brain of Cercopithecus patas. Bunyamwera and Abadina viruses were isolated from the blood of two febrile patients. Serological identification of many strains was kindly conducted at the Pasteur Institute, Dakar (J. P.Digoutte) and some at the YARU, USA (R. Shope). Kindia and Ark 6956 (Reovirus, gr. Palyam), Fomede (gr. Chobar Gorge), Forecariah (Bunyavirus, gr. Bhanja), Kolente (Rhabdovirus) were identified as an original type of Lagos bat virus. The results of seroepidemiological surveys are also presented.

  18. Liquidity and credit risk in the emerging financial markets

    OpenAIRE

    Amir Saadaoui, Younes Boujelbene

    2014-01-01

    In this paper, we examine the relationship between liquidity, liquidity risk and credit risk in emerging sovereign bonds after the subprime crisis period. In our study, we concentrate in the effect of liquidity and credit risk in the problem of liquidity and in the emerging bond market. The presence of control variables, asymmetric information, amount outstanding, coupon, age and interest rate, assist to more explain this relationship. To explain the role of liquidity and credit risk in the p...

  19. Evaluating emergency risk communications: a dialogue with the experts.

    Science.gov (United States)

    Thomas, Craig W; Vanderford, Marsha L; Crouse Quinn, Sandra

    2008-10-01

    Evaluating emergency risk communications is fraught with challenges since communication can be approached from both a systemic and programmatic level. Therefore, one must consider stakeholders' perspectives, effectiveness issues, standards of evidence and utility, and channels of influence (e.g., mass media and law enforcement). Evaluation issues related to timing, evaluation questions, methods, measures, and accountability are raised in this dialogue with emergency risk communication specialists. Besides the usual evaluation competencies, evaluators in this area need to understand and work collaboratively with stakeholders and be attuned to the dynamic contextual nature of emergency risk communications. Sample resources and measures are provided here to aid in this emerging and exciting field of evaluation.

  20. A Risk Management Architecture for Emergency Integrated Aircraft Control

    Science.gov (United States)

    McGlynn, Gregory E.; Litt, Jonathan S.; Lemon, Kimberly A.; Csank, Jeffrey T.

    2011-01-01

    Enhanced engine operation--operation that is beyond normal limits--has the potential to improve the adaptability and safety of aircraft in emergency situations. Intelligent use of enhanced engine operation to improve the handling qualities of the aircraft requires sophisticated risk estimation techniques and a risk management system that spans the flight and propulsion controllers. In this paper, an architecture that weighs the risks of the emergency and of possible engine performance enhancements to reduce overall risk to the aircraft is described. Two examples of emergency situations are presented to demonstrate the interaction between the flight and propulsion controllers to facilitate the enhanced operation.

  1. RNA interference targets arbovirus replication in Culicoides cells.

    Science.gov (United States)

    Schnettler, Esther; Ratinier, Maxime; Watson, Mick; Shaw, Andrew E; McFarlane, Melanie; Varela, Mariana; Elliott, Richard M; Palmarini, Massimo; Kohl, Alain

    2013-03-01

    Arboviruses are transmitted to vertebrate hosts by biting arthropod vectors such as mosquitoes, ticks, and midges. These viruses replicate in both arthropods and vertebrates and are thus exposed to different antiviral responses in these organisms. RNA interference (RNAi) is a sequence-specific RNA degradation mechanism that has been shown to play a major role in the antiviral response against arboviruses in mosquitoes. Culicoides midges are important vectors of arboviruses, known to transmit pathogens of humans and livestock such as bluetongue virus (BTV) (Reoviridae), Oropouche virus (Bunyaviridae), and likely the recently discovered Schmallenberg virus (Bunyaviridae). In this study, we investigated whether Culicoides cells possess an antiviral RNAi response and whether this is effective against arboviruses, including those with double-stranded RNA (dsRNA) genomes, such as BTV. Using reporter gene-based assays, we established the presence of a functional RNAi response in Culicoides sonorensis-derived KC cells which is effective in inhibiting BTV infection. Sequencing of small RNAs from KC and Aedes aegypti-derived Aag2 cells infected with BTV or the unrelated Schmallenberg virus resulted in the production of virus-derived small interfering RNAs (viRNAs) of 21 nucleotides, similar to the viRNAs produced during arbovirus infections of mosquitoes. In addition, viRNA profiles strongly suggest that the BTV dsRNA genome is accessible to a Dicer-type nuclease. Thus, we show for the first time that midge cells target arbovirus replication by mounting an antiviral RNAi response mainly resembling that of other insect vectors of arboviruses.

  2. Neglected Australian Arboviruses and Undifferentiated Febrile Illness: Addressing Public Health Challenges Arising From the 'Developing Northern Australia' Government Policy.

    Science.gov (United States)

    Gyawali, Narayan; Bradbury, Richard S; Aaskov, John G; Taylor-Robinson, Andrew W

    2017-01-01

    The Australian Government is currently promoting the development of Northern Australia, with an associated increase in the local population. Consequent to this is the public health threat posed by heightened human exposure to many previously neglected arboviruses that are indigenous to the region. This initiative to support economic activity in the tropical north of the continent is leading to the accelerated expansion of an infection-naïve human population into hitherto un-encountered ecosystems inhabited by reservoir animals and vectors for these arboviruses. Combined with an apparent rise in the number and impact of dramatic climate events, such as tropical cyclones and floods caused by torrential monsoonal rainfall, this heightens the potential for viral transmission to humans. More than 75 arboviruses have been identified in Australia, some of which are associated with human disease but for which routine tests are not available to diagnose infection. Here, we describe briefly the neglected Australian arboviruses that are most likely to emerge as significant agents of human disease in the coming decades. We also advocate the establishment of a thorough surveillance and diagnostic protocol, including developing new pan-viral rapid tests for primary care use to assist in the early diagnosis and correct treatment of affected patients. We propose that the implementation of these activities will enhance our understanding of the geographical range, prevalence, identification and control of neglected Australian arboviruses. This would minimise and limit the possibility of large-scale outbreaks with these agents as population and economic growth expands further into Australia's tropical north.

  3. Risk communications and the Chemical Stockpile Emergency-Planning Program

    Energy Technology Data Exchange (ETDEWEB)

    Vogt, B.M.; Sorensen, J.H.

    1994-09-01

    The CSEPP (Chemical Stockpile Emergency Preparedness Program) was created to improve emergency planning and response capabilities at the eight sites around the country that store chemical weapons. These weapons are scheduled to be destroyed in the near future. In preparation of the Draft Programmatic Environmental Impact Statement (DPEIS) for the Chemical Stockpile Disposal Program (CSDP), it was proposed that the Army mitigate accidents through an enhanced community emergency preparedness program at the eight storage sites. In 1986, the Army initiated the development of an Emergency Response Concept Plan (ERCP) for the CSDP, one of 12 technical support studies conducted during preparation of the Final Programmatic Environmental Impact Statement (FPEIS). The purpose of this document is to provide a fairly comprehensive source book on risk, risk management, risk communication research and recommended risk communication practices. It does not merely summarize each publication in the risk communication literature, but attempts to synthesize them along the lines of a set of organizing principles. Furthermore, it is not intended to duplicate other guidance manuals (such as Covello et al.`s manual on risk comparison). The source book was developed for the CSEPP in support of the training module on risk communications. Although the examples provided are specific to CSEPP, its use goes beyond that of CSEPP as the findings apply to a broad spectrum of risk communication topics. While the emphasis is on communication in emergency preparedness and response specific to the CSEPP, the materials cover other non-emergency communication settings. 329 refs.

  4. Emerging Radiation Health-Risk Mitigation Technologies

    International Nuclear Information System (INIS)

    Wilson, J.W.; Cucinotta, F.A.; Schimmerling, W.

    2004-01-01

    Past space missions beyond the confines of the Earth's protective magnetic field have been of short duration and protection from the effects of solar particle events was of primary concern. The extension of operational infrastructure beyond low-Earth orbit to enable routine access to more interesting regions of space will require protection from the hazards of the accumulated exposures of Galactic Cosmic Rays (GCR). There are significant challenges in providing protection from the long-duration exposure to GCR: the human risks to the exposures are highly uncertain and safety requirements places unreasonable demands in supplying sufficient shielding materials in the design. A vigorous approach to future radiation health-risk mitigation requires a triage of techniques (using biological and technical factors) and reduction of the uncertainty in radiation risk models. The present paper discusses the triage of factors for risk mitigation with associated materials issues and engineering design methods

  5. Nature, Nurture and Evolution of Intra-Species Variation in Mosquito Arbovirus Transmission Competence

    OpenAIRE

    Tabachnick, Walter J.

    2013-01-01

    Mosquitoes vary in their competence or ability to transmit arthropod-borne viruses (arboviruses). Many arboviruses cause disease in humans and animals. Identifying the environmental and genetic causes of variation in mosquito competence for arboviruses is one of the great challenges in public health. Progress identifying genetic (nature) and environmental (nurture) factors influencing mosquito competence for arboviruses is reviewed. There is great complexity in the various traits that compris...

  6. Biological Control Strategies for Mosquito Vectors of Arboviruses.

    Science.gov (United States)

    Huang, Yan-Jang S; Higgs, Stephen; Vanlandingham, Dana L

    2017-02-10

    Historically, biological control utilizes predatory species and pathogenic microorganisms to reduce the population of mosquitoes as disease vectors. This is particularly important for the control of mosquito-borne arboviruses, which normally do not have specific antiviral therapies available. Although development of resistance is likely, the advantages of biological control are that the resources used are typically biodegradable and ecologically friendly. Over the past decade, the advancement of molecular biology has enabled optimization by the manipulation of genetic materials associated with biological control agents. Two significant advancements are the discovery of cytoplasmic incompatibility induced by Wolbachia bacteria, which has enhanced replacement programs, and the introduction of dominant lethal genes into local mosquito populations through the release of genetically modified mosquitoes. As various arboviruses continue to be significant public health threats, biological control strategies have evolved to be more diverse and become critical tools to reduce the disease burden of arboviruses.

  7. Biological Control Strategies for Mosquito Vectors of Arboviruses

    Directory of Open Access Journals (Sweden)

    Yan-Jang S. Huang

    2017-02-01

    Full Text Available Historically, biological control utilizes predatory species and pathogenic microorganisms to reduce the population of mosquitoes as disease vectors. This is particularly important for the control of mosquito-borne arboviruses, which normally do not have specific antiviral therapies available. Although development of resistance is likely, the advantages of biological control are that the resources used are typically biodegradable and ecologically friendly. Over the past decade, the advancement of molecular biology has enabled optimization by the manipulation of genetic materials associated with biological control agents. Two significant advancements are the discovery of cytoplasmic incompatibility induced by Wolbachia bacteria, which has enhanced replacement programs, and the introduction of dominant lethal genes into local mosquito populations through the release of genetically modified mosquitoes. As various arboviruses continue to be significant public health threats, biological control strategies have evolved to be more diverse and become critical tools to reduce the disease burden of arboviruses.

  8. Ecological effects on arbovirus-mosquito cycles of transmission.

    Science.gov (United States)

    Tabachnick, Walter J

    2016-12-01

    Mosquitoes transmit many viruses to a variety of hosts. Cycles of mosquito borne arbovirus transmission are the result of complex interactions between the mosquito, the arbovirus and the host that are influenced by genetic variations in a variety of traits in each that are all influenced by many environmental factors. R 0 , the basic reproduction number or mean number of individuals infected from a single infected individual, is a measure of mosquito borne arbovirus transmission. Understanding the causes for the distribution of R 0 in any transmission cycle is a daunting challenge due to the lack of information on the genetic and environmental variances that influence R 0 . Information about the major factors influencing R 0 for specific transmission cycles is essential to develop efficient and effective strategies to reduce transmission in different cycles and locations. Copyright © 2016 Elsevier B.V. All rights reserved.

  9. The Insect Microbiome Modulates Vector Competence for Arboviruses

    Directory of Open Access Journals (Sweden)

    Natapong Jupatanakul

    2014-11-01

    Full Text Available Diseases caused by arthropod-borne viruses (arboviruses, such as Dengue, West Nile, and Chikungunya, constitute a major global health burden and are increasing in incidence and geographic range. The natural microbiota of insect vectors influences various aspects of host biology, such as nutrition, reproduction, metabolism, and immunity, and recent studies have highlighted the ability of insect-associated bacteria to reduce vector competence for arboviruses and other pathogens. This reduction can occur through mechanisms, such as immune response activation, resource competition, or the production of anti-viral molecules. Studying the interactions between insect vectors and their microbiota is an important step toward developing alternative strategies for arbovirus transmission control.

  10. Privatization, political risk and stock market development in emerging economies

    NARCIS (Netherlands)

    Perotti, E.C.; van Oijen, P.H.

    1999-01-01

    This paper investigates whether privatisation in emerging economies has a significant indirect effect on local stock market development through the resolution of political risk. We argue that a sustained privatisation programme represents a major political test which gradually resolves uncertainty

  11. Predicting risk and the emergence of schizophrenia.

    LENUS (Irish Health Repository)

    Clarke, Mary C

    2012-09-01

    This article gives an overview of genetic and environmental risk factors for schizophrenia. The presence of certain molecular, biological, and psychosocial factors at certain points in the life span, has been linked to later development of schizophrenia. All need to be considered in the context of schizophrenia as a lifelong brain disorder. Research interest in schizophrenia is shifting to late childhood\\/early adolescence for screening and preventative measures. This article discusses those environmental risk factors for schizophrenia for which there is the largest evidence base.

  12. Zika virus: history of a newly emerging arbovirus.

    Science.gov (United States)

    Wikan, Nitwara; Smith, Duncan R

    2016-07-01

    Zika virus was originally identified in a sentinel rhesus monkey in the Zika Forest of Uganda in 1947. The virus is a member of the family Flaviviridae, genus Flavivirus, and is transmitted to humans by Aedes species mosquitoes. The first report of Zika virus outside Africa and Asia was in 2007 when the virus was associated with a small outbreak in Yap State, part of the Federated States of Micronesia. Since then, Zika virus infections have been reported around the world, including in southeast Asia; French Polynesia and other islands in the Pacific Ocean; and parts of South, Central, and North America. Symptomatic infection in human beings normally results in a mild and self-limiting febrile disease, although recent reports have suggested a possible association with more serious sequelae such as Guillain-Barré syndrome, and microcephaly in newborn infants of mothers infected with Zika virus during pregnancy. In this Review, we summarise the history of Zika virus from its first detection to its current worldwide distribution. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Cardiovascular Disease Risk Factors among Emerging Adults in College

    Science.gov (United States)

    Abshire, Demetrius Alexander

    2014-01-01

    The purpose of this dissertation was to examine factors associated with cardiovascular disease (CVD) risk among emerging adults in college aged 18-25 years. CVD risks that develop during this period often persist into adulthood making it an ideal time to target CVD prevention. The specific aims of this dissertation were to 1) explore perceptions…

  14. [Health alert management and emerging risk].

    Science.gov (United States)

    Pillonel, J

    2010-12-01

    Following health crisis that have occurred in the nineties (contaminated blood, mad cow, asbestos, etc.) and more recently those generated by the heat wave in 2003 or by emerging infectious pathogens (SARS, West Nile, Chikungunya, H5N1, H1N1…), a real health vigilance system has been progressively developed in France. After a brief historical overview of the health alert system, this article will give the guiding principles of its current organization in France and will present two examples of recent health alerts (Chikungunya in the Reunion Island in 2005-2006 and hepatitis A outbreak in the Côtes-d'Armor in August 2007), that have needed the implementation of preventive measures regarding the blood donor selection. These two examples have shown that the position of the alert in the French health vigilance system needs to be very close to the event. In that case, health alert is a very useful tool for decision making especially when measures have to be taken to prevent transfusion-transmitted pathogens. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  15. Quantitative risk analysis as a basis for emergency planning

    Energy Technology Data Exchange (ETDEWEB)

    Yogui, Regiane Tiemi Teruya [Bureau Veritas do Brasil, Rio de Janeiro, RJ (Brazil); Macedo, Eduardo Soares de [Instituto de Pesquisas Tecnologicas (IPT), Sao Paulo, SP (Brazil)

    2009-07-01

    Several environmental accidents happened in Brazil and in the world during the 70's and 80's. This strongly motivated the preparation for emergencies in the chemical and petrochemical industries. Environmental accidents affect the environment and the communities that are neighbor to the industrial facilities. The present study aims at subsidizing and providing orientation to develop Emergency Planning from the data obtained on Quantitative Risk Analysis, elaborated according to the Technical Standard P4.261/03 from CETESB (Sao Paulo Environmental Agency). It was observed, during the development of the research, that the data generated on these studies need a complementation and a deeper analysis, so that it is possible to use them on the Emergency Plans. The main issues that were analyzed and discussed on this study were the reevaluation of hazard identification for the emergency plans, the consequences and vulnerability analysis for the response planning, the risk communication, and the preparation to respond to the emergencies of the communities exposed to manageable risks. As a result, the study intends to improve the interpretation and use of the data deriving from the Quantitative Risk Analysis to develop the emergency plans. (author)

  16. Enveloped virus-like particles as vaccines against pathogenic arboviruses

    NARCIS (Netherlands)

    Pijlman, G.P.

    2015-01-01

    Arthropod-borne arboviruses form a continuous threat to human and animal health, but few arboviral vaccines are currently available. Advances in expression technology for complex, enveloped virus-like particles (eVLPs) create new opportunities to develop potent vaccines against pathogenic

  17. [Entomologic situation regarding arbovirus circulation in the Guajaibon area].

    Science.gov (United States)

    Fuentes González, O; Fernández Martínez, A; Castex Rodríguez, M; Pelegrino Martínez, J L

    1989-01-01

    The collections of culicidae made in the Guajaibón area, North coast of Havana province, are analyzed with arbovirologic purposes. The predominance of Aedes scapularis in the human bait collections is confirmed. The possibility of arbovirus circulation in the area is suggested.

  18. Collection & Processing of Medically Important Arthropods for Arbovirus Isolation.

    Science.gov (United States)

    Sudia, W. Daniel; Chamberlain, Roy W.

    The methods given for collecting, preserving, and processing mosquitoes and other archropods for isolation of arboviruses are those used by the National Communicable Disease Center. Techniques of collecting mosquitoes as they bite, using light or bait traps, and from their daytime resting sites are described and illustrated. Details of subsequent…

  19. US and Cuban Scientists Forge Collaboration on Arbovirus Research.

    Science.gov (United States)

    Pérez-Ávila, Jorge; Guzmán-Tirado, Maria G; Fraga-Nodarse, Jorge; Handley, Gray; Meegan, James; Pelegrino-Martínez de la Cotera, Jose L; Fauci, Anthony S

    2018-04-01

    After December 17, 2014, when the US and Cuban governments announced their intent to restore relations, the two countries participated in various exchange activities in an effort to encourage cooperation in public health, health research and biomedical sciences. The conference entitled Exploring Opportunities for Arbovirus Research Collaboration, hosted at Havana's Hotel Nacional, was part of these efforts and was the first major US-Cuban scientific conference in over 50 years. Its purpose was to share information about current arbovirus research and recent findings, and to explore opportunities for future joint research. The nearly 100 participants included leading arbovirus and vector transmission experts from ten US academic institutions, NIH, CDC, FDA and the US Department of Defense. Cuban participants included researchers, clinicians and students from Cuba's Ministry of Public Health, Pedro Kourí Tropical Medicine Institute, Center for Genetic Engineering and Biotechnology, Center for State Control of Medicines and Medical Devices and other health research and regulatory organizations. Topics highlighted at the three-day meeting included surveillance, research and epidemiology; pathogenesis, immunology and virology; treatment and diagnosis; vector biology and control; vaccine development and clinical trials; and regulatory matters. Concurrent breakout discussions focused on novel vector control, nonvector transmission, community engagement, Zika in pregnancy, and workforce development. Following the conference, the Pedro Kourí Tropical Medicine Institute and the US National Institute of Allergic and Infectious Diseases have continued to explore ways to encourage and support scientists in Cuba and the USA who wish to pursue arbovirus research cooperation to advance scientific discovery to improve disease prevention and control. KEYWORDS Arboviruses, flavivirus, Zika virus, chikungunya virus, dengue virus, research, disease vectors, Cuba, USA.

  20. Arctic shipping and risks: Emergency categories and response capacities

    DEFF Research Database (Denmark)

    Marchenko, Nataly A.; Andreassen, Natalia; Borch, Odd Jarl

    2018-01-01

    The sea ice in the Arctic has shrunk significantly in the last decades. The transport pattern has as a result partly changed with more traffic in remote areas. This change may influence the risk pattern. The critical factors are harsh weather, ice conditions, remoteness and vulnerability of natur...... are rare, there are limited statistics available for Arctic maritime accidents. Hence, this study offers a qualitative analysis and an expert-based risk assessment. Implications for the emergency preparedness system of the Arctic region are discussed........ In this paper, we look into the risk of accidents in Atlantic Arctic based on previous ship accidents and the changes in maritime activity. The risk has to be assessed to ensure a proper level of emergency response. The consequences of incidents depend on the incident type, scale and location. As accidents...

  1. Comparative, collaborative, and integrative risk governance for emerging technologies

    OpenAIRE

    LINKOV IGOR; TRUMP BENJAMIN D.; ANKLAM ELKE; BERBUBE DAVID; BOISSEAU PATRICK; CUMMINGS CHRISTOPHER; FERSON SCOTT; FLORIN MARIE-VALENTINE; GOLDSTEIN BERNARD; HRISTOZOV DANAIL; JENSEN KELD ASTRUP; KATALAGARIANAKIS GEORGIOS; KUZMA JENNIFER; LAMBERT JAMES H.; MALLOY TIMOTHY

    2018-01-01

    Various emerging technologies challenge existing governance processes to identify, assess, and manage risk. Though the existing risk-based paradigm has been essential for assessment of many chemical, biological, radiological, and nuclear technologies, a complementary approach may be warranted for the early-stage assessment and management challenges of high uncertainty technologies ranging from nanotechnology to synthetic biology to artificial intelligence, among many others. This ...

  2. Nurses' perception about risk classification in an emergency service

    Directory of Open Access Journals (Sweden)

    Cristiane Chaves de Souza

    2014-04-01

    Full Text Available Objective. Get to know how nurses perceive the accomplishment of risk classification in an emergency service. Methodology. In this qualitative study, 11 nurses were included with at least two months of experience in the risk classification of patients who visited the emergency service. Semistructured interviews were used to collect the information. The data were collected between August and December 2011. For data analysis, Bardin's theoretical framework was used. Results. The nurses in the study consider the risk classification as a work organization instruments that permits closer contact between nurses and patients. The nursing skills needed for risk classification were identified: knowledge about the scale used, clinical perspective, patience and agility. The availability of risk classification scales was the main facilitator of this work. The main difficulties were the disorganization of the care network and the health team's lack of knowledge of the protocol. Conclusion. Risk classification offers an opportunity for professional autonomy to the extent that it is the main responsible for regulating care at the entry door of the emergency services.

  3. Computer technologies for industrial risk prevention and emergency management

    International Nuclear Information System (INIS)

    Balduccelli, C.; Bologna, S.; Di Costanzo, G.; Vicoli, G.

    1996-07-01

    This document provides an overview about problems related to the engineering of computer based systems for industrial risk prevention and emergency management. Such systems are rather complex and subject to precise reliability and safety requirements. With the evolution of informatic technologies, such systems are becoming to be the means for building protective barriers for reduction of risk associated with plant operations. For giving more generality to this document, and for not concentrating on only a specific plant, the emergency management systems will be dealt with more details than ones for accident prevention. The document is organized in six chapters. Chapter one is an introduction to the problem and to its state of art, with particular emphasis to the aspects of safety requirements definition. Chapter two is an introduction to the problems related to the emergency management and to the training of operators in charge of this task. Chapter three deals in details the topic of the Training Support Systems, in particular about MUSTER (multi-user system for training and evaluation of environmental emergency response) system. Chapter four deals in details the topic of decision support systems, in particular about ISEM (information technology support for emergency management) system. Chapter five illustrates an application of support to the operators of Civil Protection Department for the management of emergencies in the fields of industrial chemical. Chapter six is about a synthesis of the state of art and the future possibilities, identifying some research and development activities more promising for the future

  4. Privatization, political risk and stock market development in emerging economies

    NARCIS (Netherlands)

    Perotti, E.C.; van Oijen, P. H.

    2001-01-01

    This paper investigates whether privatization in emerging economies has a significant indirect effect on local stock market development through the resolution of political risk. We argue that a sustained privatization program represents a major political test that gradually resolves uncertainty over

  5. Sovereign Risk and Natural Disasters in Emerging Markets

    NARCIS (Netherlands)

    Klomp, Jeroen

    2015-01-01

    In this article, we explore the effect of large-scale natural disasters on sovereign default risk. We use a heterogeneous dynamic panel model including a set of more than 380 large-scale natural disasters for about forty emerging market countries in the period 1999-2010. After testing for the

  6. Privatization, political risk and stock market development in emerging economies

    NARCIS (Netherlands)

    Perotti, E.C.; van Oijen, P.H.

    1999-01-01

    This paper investigates whether privatization in emerging economies has a significant indirect effect on local stock market development through the resolution of political risk. We argue that a sustained privatization program represents a major political test that gradually resolves uncertainty over

  7. Value investing in emerging markets : local macroeconomic risk and extrapolation

    NARCIS (Netherlands)

    Kouwenberg, R.; Salomons, R.M.

    2003-01-01

    Our results confirm the profitability of value investing at the country level in emerging markets. A portfolio of countries with low price-to-book ratios significantly outperforms a portfolio of high price-to-book countries. Global risk factors cannot explain this outperformance. Next we measure a

  8. Hydrocomplexity: Addressing water security and emergent environmental risks

    Science.gov (United States)

    Kumar, Praveen

    2015-07-01

    Water security and emergent environmental risks are among the most significant societal concerns. They are highly interlinked to other global risks such as those related to climate, human health, food, human migration, biodiversity loss, urban sustainability, etc. Emergent risks result from the confluence of unanticipated interactions from evolving interdependencies between complex systems, such as those embedded in the water cycle. They are associated with the novelty of dynamical possibilities that have significant potential consequences to human and ecological systems, and not with probabilities based on historical precedence. To ensure water security we need to be able to anticipate the likelihood of risk possibilities as they present the prospect of the most impact through cascade of vulnerabilities. They arise due to a confluence of nonstationary drivers that include growing population, climate change, demographic shifts, urban growth, and economic expansion, among others, which create novel interdependencies leading to a potential of cascading network effects. Hydrocomplexity aims to address water security and emergent risks through the development of science, methods, and practices with the potential to foster a "Blue Revolution" akin to the Green revolution for food security. It blends both hard infrastructure based solution with soft knowledge driven solutions to increase the range of planning and design, management, mitigation and adaptation strategies. It provides a conceptual and synthetic framework to enable us to integrate discovery science and engineering, observational and information science, computational and communication systems, and social and institutional approaches to address consequential water and environmental challenges.

  9. Severe accidents risk assessment as a basis for emergency preparedness

    International Nuclear Information System (INIS)

    Sinka, D.; Mikulicic, V.

    2000-01-01

    The paper demonstrates, by example of the Republic of Croatia, the possibilities of implementing risk assessment as basis for nuclear accident emergency preparedness development. Individual risks of severe accidents for citizens of the biggest Croatian population centers, as well as collective risk for entire population have been assessed using the PRONEL method. The assessment covered 90 power reactors located at a distance up to 1.000 km. The conducted assessment shows the risks for various regions of the Republic of Croatia, and comparison between them. If risk would be taken as basic criterion in nuclear emergency planning, the results of assessment would directly indicate the necessary preparation level for each region. Furthermore, the assessment of risks from individual power plants and power plant types indicates to which facilities the greatest attention should be paid in nuclear accidents preparedness development. Risks from groups of power plants formed in accordance with their respective distance from exposure location shows what kind of tools for determining consequences and protective actions during a nuclear accident should be made available. (author)

  10. Taking a bite out of nutrition and arbovirus infection.

    Directory of Open Access Journals (Sweden)

    James Weger-Lucarelli

    2018-03-01

    Full Text Available Nutrition is a key factor in host-pathogen defense. Malnutrition can increase both host susceptibility and severity of infection through a number of pathways, and infection itself can promote nutritional deterioration and further susceptibility. Nutritional status can also strongly influence response to vaccination or therapeutic pharmaceuticals. Arthropod-borne viruses (arboviruses have a long history of infecting humans, resulting in regular pandemics as well as an increasing frequency of autochthonous transmission. Interestingly, aside from host-related factors, nutrition could also play a role in the competence of vectors required for transmission of these viruses. Nutritional status of the host and vector could even influence viral evolution itself. Therefore, it is vital to understand the role of nutrition in the arbovirus lifecycle. This Review will focus on nutritional factors that could influence susceptibility and severity of infection in the host, response to prophylactic and therapeutic strategies, vector competence, and viral evolution.

  11. Development and field evaluation of the sentinel mosquito arbovirus capture kit (SMACK)

    OpenAIRE

    Johnson, Brian J.; Kerlin, Tim; Hall-Mendelin, Sonja; van den Hurk, Andrew F.; Cortis, Giles; Doggett, Stephen L.; Toi, Cheryl; Fall, Ken; McMahon, Jamie L.; Townsend, Michael; Ritchie, Scott A.

    2015-01-01

    Background Although sentinel animals are used successfully throughout the world to monitor arbovirus activity, ethical considerations and cross-reactions in serological assays highlight the importance of developing viable alternatives. Here we outline the development of a passive sentinel mosquito arbovirus capture kit (SMACK) that allows for the detection of arboviruses on honey-baited nucleic acid preservation cards (Flinders Technology Associates; FTA®) and has a similar trap efficacy as s...

  12. Identification of Blood Meals from Potential Arbovirus Mosquito Vectors in the Peruvian Amazon Basin

    OpenAIRE

    Palermo, Pedro M.; Aguilar, Patricia V.; Sanchez, Juan F.; Zorrilla, Víctor; Flores-Mendoza, Carmen; Huayanay, Anibal; Guevara, Carolina; Lescano, Andrés G.; Halsey, Eric S.

    2016-01-01

    The transmission dynamics of many arboviruses in the Amazon Basin region have not been fully elucidated, including the vectors and natural reservoir hosts. Identification of blood meal sources in field-caught mosquitoes could yield information for identifying potential arbovirus vertebrate hosts. We identified blood meal sources in 131 mosquitoes collected from areas endemic for arboviruses in the Peruvian Department of Loreto by sequencing polymerase chain reaction amplicons of the cytochrom...

  13. Managing climate change risk : emerging financial sector expectations

    International Nuclear Information System (INIS)

    Williams, R.

    2004-01-01

    Engagement of the financial sector in the climate change debate is apparent, with social investors and advocacy groups launching 32 climate change related shareholder resolutions with American and Canadian energy companies in 2003. Eos Research and Consulting Ltd. recently conducted a study to examine emerging standards for how energy companies manage climate change related risks. A survey was conducted in the first part of the study to determine the environmental awareness of energy companies. Financial firms were asked whether they sought information concerning GHG inventories; projections of future emissions; action plans for addressing climate change and energy efficiency; evaluation of relative risk; estimation of cost of carbon; assessment of financial impact; evaluation of future regulations; and emissions trading activity. The second part of the study compared the response of 11 leading energy companies. The result was 2 opposing views on how climate change risks should be managed. The survey revealed that while most mainstream financial institutions are not paying much attention to climate change issues, socially responsible investment (SRI) investors are aware and working to factor climate change risk management information into their activities. In addition, SRI is growing at a faster pace than other investment segments, which may lead to greater future expectations for energy companies' climate change risk management efforts. It was concluded that the financial sector may emerge as an important source of direction that will guide energy companies in their future efforts to manage climate change risks. The five trends that contribute to the sector's emerging role are the continuing influence of advocacy groups; evolution of socially responsible approaches to investment; growing concerns for reputation; development of financial risk assessment approaches in terms of climate change; and, increase focus on corporate governance issues. 15 refs., 2 tabs., 1

  14. Mosquito fauna and arbovirus surveillance in a coastal Mississippi community after Hurricane Katrina.

    Science.gov (United States)

    Foppa, Ivo M; Evans, Christopher L; Wozniak, Arthur; Wills, William

    2007-06-01

    Hurricane Katrina caused massive destruction and flooding along the Gulf Coast in August 2005. We collected mosquitoes and tested them for arboviral infection in a severely hurricane-damaged community to determine species composition and to assess the risk of a mosquito-borne epidemic disease in that community about 6 wk after the landfall of Hurricane Katrina. Light-trap collections yielded 8,215 mosquitoes representing 19 species, while limited gravid-trap collections were not productive. The most abundant mosquito species was Culex nigripalpus, which constituted 73.6% of all specimens. No arboviruses were detected in any of the mosquitoes collected in this survey, which did not support the assertion that human risk for arboviral infection was increased in the coastal community 6 wk after the hurricane.

  15. Peridomestic Aedes malayensis and Aedes albopictus are capable vectors of arboviruses in cities.

    Science.gov (United States)

    Mendenhall, Ian H; Manuel, Menchie; Moorthy, Mahesh; Lee, Theodore T M; Low, Dolyce H W; Missé, Dorothée; Gubler, Duane J; Ellis, Brett R; Ooi, Eng Eong; Pompon, Julien

    2017-06-01

    Dengue and chikungunya are global re-emerging mosquito-borne diseases. In Singapore, sustained vector control coupled with household improvements reduced domestic mosquito populations for the past 45 years, particularly the primary vector Aedes aegypti. However, while disease incidence was low for the first 30 years following vector control implementation, outbreaks have re-emerged in the past 15 years. Epidemiological observations point to the importance of peridomestic infection in areas not targeted by control programs. We investigated the role of vectors in peri-domestic areas. We carried out entomological surveys to identify the Aedes species present in vegetated sites in highly populated areas and determine whether mosquitoes were present in open-air areas frequented by people. We compared vector competence of Aedes albopictus and Aedes malayensis with Ae. aegypti after oral infection with sympatric dengue serotype 2 and chikungunya viruses. Mosquito saliva was tested for the presence of infectious virus particles as a surrogate for transmission following oral infection. We identified Aedes albopictus and Aedes malayensis throughout Singapore and quantified their presence in forested and opened grassy areas. Both Ae. albopictus and Ae. malayensis can occupy sylvatic niches and were highly susceptible to both arboviruses. A majority of saliva of infected Ae. malayensis contained infectious particles for both viruses. Our study reveals the prevalence of competent vectors in peri-domestic areas, including Ae. malayensis for which we established the vector status. Epidemics can be driven by infection foci, which are epidemiologically enhanced in the context of low herd immunity, selective pressure on arbovirus transmission and the presence of infectious asymptomatic persons, all these conditions being present in Singapore. Learning from Singapore's vector control success that reduced domestic vector populations, but has not sustainably reduced arboviral incidence

  16. Distribution and abundance of key vectors of Rift Valley fever and other arboviruses in two ecologically distinct counties in Kenya.

    Directory of Open Access Journals (Sweden)

    Rosemary Sang

    2017-02-01

    Full Text Available Rift Valley fever (RVF is a mosquito-borne viral zoonosis of ruminants and humans that causes outbreaks in Africa and the Arabian Peninsula with significant public health and economic consequences. Humans become infected through mosquito bites and contact with infected livestock. The virus is maintained between outbreaks through vertically infected eggs of the primary vectors of Aedes species which emerge following rains with extensive flooding. Infected female mosquitoes initiate transmission among nearby animals, which amplifies virus, thereby infecting more mosquitoes and moving the virus beyond the initial point of emergence. With each successive outbreak, RVF has been found to expand its geographic distribution to new areas, possibly driven by available vectors. The aim of the present study was to determine if RVF virus (RVFV transmission risk in two different ecological zones in Kenya could be assessed by looking at the species composition, abundance and distribution of key primary and secondary vector species and the level of virus activity.Mosquitoes were trapped during short and long rainy seasons in 2014 and 2015 using CO2 baited CDC light traps in two counties which differ in RVF epidemic risk levels(high risk Tana-River and low risk Isiolo,cryo-preserved in liquid nitrogen, transported to the laboratory, and identified to species. Mosquito pools were analyzed for virus infection using cell culture screening and molecular analysis.Over 69,000 mosquitoes were sampled and identified as 40 different species belonging to 6 genera (Aedes, Anopheles, Mansonia, Culex, Aedeomyia, Coquillettidia. The presence and abundance of Aedes mcintoshi and Aedes ochraceus, the primary mosquito vectors associated with RVFV transmission in outbreaks, varied significantly between Tana-River and Isiolo. Ae. mcintoshi was abundant in Tana-River and Isiolo but notably, Aedes ochraceus found in relatively high numbers in Tana-River (n = 1,290, was totally

  17. Crisis and emergency risk communication as an integrative model.

    Science.gov (United States)

    Reynolds, Barbara; W Seeger, Matthew

    2005-01-01

    This article describes a model of communication known as crisis and emergency risk communication (CERC). The model is outlined as a merger of many traditional notions of health and risk communication with work in crisis and disaster communication. The specific kinds of communication activities that should be called for at various stages of disaster or crisis development are outlined. Although crises are by definition uncertain, equivocal, and often chaotic situations, the CERC model is presented as a tool health communicators can use to help manage these complex events.

  18. Emerging risks: The wave of black swan events

    Directory of Open Access Journals (Sweden)

    Matić Vesna

    2016-01-01

    Full Text Available The rising trend of new business opportunities, triggered by the emerging technologies, has substantially contributed to the recovery of the global economy in recent years. The global growth supported by modern technology, however, has also generated a new wave of complex, mutually intertwined and rather changeable risks, which are unambiguously warning against the uncertainties arising in the economic environment. A thorough and continuous monitoring of these risks has become an imperative for business entities in the function of protecting the operations of enterprises and banks.

  19. Privatization, political risk and stock market development in emerging economies

    OpenAIRE

    Perotti, E.C.; van Oijen, P.H.

    1999-01-01

    This paper investigates whether privatization in emerging economies has a significant indirect effect on local stock market development through the resolution of political risk. We argue that a sustained privatization program represents a major political test that gradually resolves uncertainty over political commitment to a market-oriented policy as well as to regulatory and private property rights. We present evidence suggesting that progress in privatization is indeed correlated with impro...

  20. Risk perception, experience, and objective risk: a cross-national study with European emergency survivors.

    Science.gov (United States)

    Knuth, Daniela; Kehl, Doris; Hulse, Lynn; Schmidt, Silke

    2014-07-01

    Understanding public risk perceptions and their underlying processes is important in order to learn more about the way people interpret and respond to hazardous emergency events. Direct experience with an involuntary hazard has been found to heighten the perceived risk of experiencing the same hazard and its consequences in the future, but it remains unclear if cross-over effects are possible (i.e., experience with one hazard influencing perceived risk for other hazards also). Furthermore, the impact of objective risk and country of residence on perceived risk is not well understood. As part of the BeSeCu (Behavior, Security, and Culture) Project, a sample of 1,045 survivors of emergencies from seven European countries (i.e., Germany, the Czech Republic, Poland, Sweden, Spain, Turkey, and Italy) was drawn. Results revealed heightened perceived risk for emergency events (i.e., domestic and public fires, earthquakes, floods, and terrorist attacks) when the event had been experienced previously plus some evidence of cross-over effects, although these effects were not so strong. The largest country differences in perceived risk were observed for earthquakes, but this effect was significantly reduced by taking into account the objective earthquake risk. For fires, floods, terrorist attacks, and traffic accidents, only small country differences in perceived risk were found. Further studies including a larger number of countries are welcomed. © 2013 Society for Risk Analysis.

  1. Emerging Risk Factors and Prevention of Perioperative Pulmonary Complications

    Directory of Open Access Journals (Sweden)

    Priyanka Bhateja

    2014-01-01

    Full Text Available Modern surgery is faced with the emergence of newer “risk factors” and the challenges associated with identifying and managing these risks in the perioperative period. Obstructive sleep apnea and obesity hypoventilation syndrome pose unique challenges in the perioperative setting. Recent studies have identified some of the specific risks arising from caring for such patients in the surgical setting. While all possible postoperative complications are not yet fully established or understood, the prevention and management of these complications pose even greater challenges. Pulmonary hypertension with its changing epidemiology and novel management strategies is another new disease for the surgeon and the anesthesiologist in the noncardiac surgical setting. Traditionally most such patients were not considered surgical candidates for any required elective surgery. Our review discusses these disease entities which are often undiagnosed before elective noncardiac surgery.

  2. Global health risks and cosmopolitisation: from emergence to interference.

    Science.gov (United States)

    Figuié, Muriel

    2013-02-01

    According to Beck's 'World at Risk' theory, global risks push nations towards a cosmopolitisation of their health policy and open opportunities for a democratic turn. This article provides an empirical analysis of Beck's theory, based on the experience of Vietnamese authorities from 2003 to 2007 in managing the emerging avian flu virus. It shows how Vietnam's framing of avian flu has shifted, under the pressure from international organisations and the US administration, from an epizootic and zoonotic risk (or a classic risk) to a pandemic threat (or a late modern risk). Vietnam's response was part of its overall strategy to join the World Trade Organization and it was limited by Vietnam's defence of its sovereignty. This strategy has been successful for Vietnam but has limited the possibility of cosmopolitan and democratic transformations. The case study highlights the constructed dimension of risks of late modernity and their possible instrumentalisation: it minimises the role of a community of fear relative to a community of trade. © 2013 The Author. Sociology of Health & Illness © 2013 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

  3. Emerging technologies in healthcare: navigating risks, evaluating rewards.

    Science.gov (United States)

    McGrady, Elizabeth; Conger, Sue; Blanke, Sandra; Landry, Brett J L

    2010-01-01

    The purpose of this prescriptive research is to help decision makers become better informed about three technologies emerging in the healthcare arena by providing a basic description of the technology and describing their current applications, future healthcare deployment, potential risks, and related managerial issues. Two of the technologies, radio frequency identification (RFID) and global positioning systems (GPS), are currently available to healthcare organizations and appear capable of decreasing cost but may require significant initial investment and have disruptive potential. The third technology, nanotechnology, has limited current use but may revolutionize both the delivery of medicine and hospital infrastructure management. With cautious attention to managerial issues and meticulous attention to implementation details, healthcare organizations that can successfully navigate the coming technologically driven paradigm shifts will emerge more resilient organizations.

  4. Experimental Infections of Oryzomys couesi with Sympatric Arboviruses from Mexico

    Science.gov (United States)

    Deardorff, Eleanor R.; Forrester, Naomi L.; Travassos da Rosa, Amelia P.; Estrada-Franco, Jose G.; Navarro-Lopez, Roberto; Tesh, Robert B.; Weaver, Scott C.

    2010-01-01

    Coues rice rat (Oryzomys couesi), a species abundant throughout Central America, was evaluated experimentally for the ability to serve as an amplifying host for three arboviruses: Patois (Bunyaviridae, Orthobunyavirus), Nepuyo (Orthobunyavirus), and Venezuelan equine encephalitis virus subtype ID (Togaviridae, Alphavirus). These three viruses have similar ecologies and are known to co-circulate in nature. Animals from all three cohorts survived infection and developed viremia with no apparent signs of illness and long-lasting antibodies. Thus, O. couesi may play a role in the general maintenance of these viruses in nature. PMID:20134016

  5. Emergency Status Management in Energetic Field . Risk Transfer

    Directory of Open Access Journals (Sweden)

    Gherasim Solovestru DOMIDE

    2016-12-01

    Full Text Available The state of emergency in the energy sector generates technical problems such as: disruption in the operation of machinery and equipment, replacement of equipment or others needs. Besides the technical problems which appear, also intervene economic and financial issues that generate costs for the replacement of machines, equipment and installations and expenses of compensation to third parties who have suffered losses by disconnecting the power supply or lack of electricity over a longer or shorter period. Modern methods of risk management include also economic solutions. Some of these solutions will be treated in this paper.

  6. Identification of the high risk emergency surgical patient: Which risk prediction model should be used?

    Science.gov (United States)

    Stonelake, Stephen; Thomson, Peter; Suggett, Nigel

    2015-09-01

    National guidance states that all patients having emergency surgery should have a mortality risk assessment calculated on admission so that the 'high risk' patient can receive the appropriate seniority and level of care. We aimed to assess if peri-operative risk scoring tools could accurately calculate mortality and morbidity risk. Mortality risk scores for 86 consecutive emergency laparotomies, were calculated using pre-operative (ASA, Lee index) and post-operative (POSSUM, P-POSSUM and CR-POSSUM) risk calculation tools. Morbidity risk scores were calculated using the POSSUM predicted morbidity and compared against actual morbidity according to the Clavien-Dindo classification. The actual mortality was 10.5%. The average predicted risk scores for all laparotomies were: ASA 26.5%, Lee Index 2.5%, POSSUM 29.5%, P-POSSUM 18.5%, CR-POSSUM 10.5%. Complications occurred following 67 laparotomies (78%). The majority (51%) of complications were classified as Clavien-Dindo grade 2-3 (non-life-threatening). Patients having a POSSUM morbidity risk of greater than 50% developed significantly more life-threatening complications (CD 4-5) compared with those who predicted less than or equal to 50% morbidity risk (P = 0.01). Pre-operative risk stratification remains a challenge because the Lee Index under-predicts and ASA over-predicts mortality risk. Post-operative risk scoring using the CR-POSSUM is more accurate and we suggest can be used to identify patients who require intensive care post-operatively. In the absence of accurate risk scoring tools that can be used on admission to hospital it is not possible to reliably audit the achievement of national standards of care for the 'high-risk' patient.

  7. Asymmetric impacts of global risk appetite on the risk premium for an emerging market

    Science.gov (United States)

    Kanlı, İbrahim Burak

    2008-05-01

    This paper analyzes the impact of global risk appetite on the risk premium utilizing high-frequency data. Taking the Turkish economy as our laboratory, we find that the risk premium volatility responds only to a worsening in the risk appetite for the Turkish economy, which is a result that we do not observe for the other emerging markets. Then, we investigate the role of current account dynamics on this asymmetric effect, by focusing also on an economy with similar current account performance. The empirical results find supporting evidence for the role of current account dynamics on the estimated asymmetry.

  8. Genetic evidence for a worldwide chaotic dispersion pattern of the arbovirus vector, Aedes albopictus.

    Directory of Open Access Journals (Sweden)

    Mosè Manni

    2017-01-01

    Full Text Available Invasive species represent a global concern for their rapid spread and the possibility of infectious disease transmission. This is the case of the global invader Aedes albopictus, the Asian tiger mosquito. This species is a vector of medically important arboviruses, notably chikungunya (CHIKV, dengue (DENV and Zika (ZIKV. The reconstruction of the complex colonization pattern of this mosquito has great potential for mitigating its spread and, consequently, disease risks.Classical population genetics analyses and Approximate Bayesian Computation (ABC approaches were combined to disentangle the demographic history of Aedes albopictus populations from representative countries in the Southeast Asian native range and in the recent and more recently colonized areas. In Southeast Asia, the low differentiation and the high co-ancestry values identified among China, Thailand and Japan indicate that, in the native range, these populations maintain high genetic connectivity, revealing their ancestral common origin. China appears to be the oldest population. Outside Southeast Asia, the invasion process in La Réunion, America and the Mediterranean Basin is primarily supported by a chaotic propagule distribution, which cooperates in maintaining a relatively high genetic diversity within the adventive populations.From our data, it appears that independent and also trans-continental introductions of Ae. albopictus may have facilitated the rapid establishment of adventive populations through admixture of unrelated genomes. As a consequence, a great amount of intra-population variability has been detected, and it is likely that this variability may extend to the genetic mechanisms controlling vector competence. Thus, in the context of the invasion process of this mosquito, it is possible that both population ancestry and admixture contribute to create the conditions for the efficient transmission of arboviruses and for outbreak establishment.

  9. Industrial Accidents Triggered by Natural Hazards: an Emerging Risk Issue

    Science.gov (United States)

    Renni, Elisabetta; Krausmann, Elisabeth; Basco, Anna; Salzano, Ernesto; Cozzani, Valerio

    2010-05-01

    Natural disasters such as earthquakes, tsunamis, flooding or hurricanes have recently and dramatically hit several countries worldwide. Both direct and indirect consequences involved the population, causing on the one hand a high number of fatalities and on the other hand so relevant economical losses that the national gross product may be affected for many years. Loss of critical industrial infrastructures (electricity generation and distribution, gas pipelines, oil refineries, etc.) also occurred, causing further indirect damage to the population. In several cases, accident scenarios with large releases of hazardous materials were triggered by these natural events, causing so-called "Natech events", in which the overall damage resulted from the simultaneous consequences of the natural event and of the release of hazardous substances. Toxic releases, large fires and explosions, as well as possible long-term environmental pollution, economical losses, and overloading of emergency systems were recognised by post-event studies as the main issues of these Natech scenarios. In recent years the increasing frequency and severity of some natural hazards due to climate change has slowly increased the awareness of Natech risk as an emerging risk among the stakeholders. Indeed, the iNTeg-Risk project, co-funded by the European Commission within the 7th Framework Program specifically addresses these scenarios among new technological issues on public safety. The present study, in part carried out within the iNTeg-Risk project, was aimed at the analysis and further development of methods and tools for the assessment and mitigation of Natech accidents. Available tools and knowledge gaps in the assessment of Natech scenarios were highlighted. The analysis mainly addressed the potential impact of flood, lightning and earthquake events on industrial installations where hazardous substances are present. Preliminary screening methodologies and more detailed methods based on

  10. Visual Impairment and Intracranial Hypertension: An Emerging Spaceflight Risk

    Science.gov (United States)

    Fogarty, Jennifer A.; Polk, J. D.; Tarver, W.; Gibson, C. R.; Sargsyan, A.; Taddeo, T.; Alexander, D.; Otto, C.

    2010-01-01

    What is the risk? Given that astronauts exposed to microgravity experience a cephalad fluid shift, and that both symptomatic and asymptomatic astronauts have exhibited optic nerve sheath edema on MRI, there is a high probability that all astronauts have some degree of increased intracranial pressure (ICP; intracranial hypertension), and that those susceptible (via eye architecture, anatomy, narrow optic disc) have a high likelihood of developing papilledema (optic disc edema, globe flattening), choroidal folds, and/or hyperopic shifts and that the degree of edema may determine long-term or permanent vision impairment or loss. Back to back panels on this topic have been developed to address this emerging risk. The first panel will focus on the 6 clinical cases with emphasis on ophthalmic findings and imaging techniques used pre-, in-, and post-flight. The second panel will discuss the operational mitigation and medical requirements, the potential role of CO2 on ISS, and the research approach being developed. In total these back to back panels will explore what is known about this risk, what has been done immediately to address it, and how an integrated research model is being developed.

  11. Occupational emerging risks affecting international virtual project Team Results

    Directory of Open Access Journals (Sweden)

    Dumitraşcu-Băldău Iulia

    2017-01-01

    Full Text Available The expansion of internet access, high-speed connection services, collaborative work platforms and tools, allowed employees to interact virtually offering companies the possibility to develop projects around the world, reducing operational costs and gain competitive advantage. Realizing the advantages and disadvantages of developing a project team in an international virtual work environment, requires adopting specific strategies to construct an effective team and ensure the project success. One of the most important disadvantages that we identified is that the new work environment brings new risks for both team members and managers. So, it becomes mandatory to identify and analyze the occupational emerging risks and their impact on the productivity of virtual team members, in order to prevent them efficiently and to ensure the safety and health of employees in a virtual working environment. This paper aims to highlight the necessity for project managers and organizations, to include in their specific project strategies, an efficient occupational risks management in the virtual workplace, to obtain a continuously improved virtual working environment, so to achieve a high performance from virtual employees.

  12. Preliminary investigation of Culicidae species in South Pantanal, Brazil and their potential importance in arbovirus transmission.

    Science.gov (United States)

    Pauvolid-Corrêa, Alex; Tavares, Fernando Neto; Alencar, Jeronimo; Silva, Julia dos Santos; Murta, Michele; Serra-Freire, Nicolau Maués; Pellegrin, Aiesca Oliveira; Gil-Santana, Hélcio; Guimarães, Anthony Erico; Silva, Edson Elias da

    2010-01-01

    In view of the high circulation of migratory birds and the environmental and climatic conditions which favor the proliferation of arthropods, the Brazilian Pantanal is susceptible to circulation of arboviruses. However, the amount of data concerning arbovirus vectors in this area is scarce; therefore the aim of this study was to conduct a preliminary investigation of Culicidae species in the Nhecolândia Sub-region of South Pantanal, Brazil and their potential importance in the arbovirus transmission. A total of 3684 specimens of mosquitoes were captured, 1689 of which caught in the rainy season of 2007, were divided into 78 pools and submitted to viral isolation, Semi-Nested RT-PCR and Nested RT-PCR, with a view to identifying the most important arboviruses in Brazil. Simultaneously, 70 specimens of ticks found blood-feeding on horses were also submitted to the same virological assays. No virus was isolated and viral nucleic-acid detection by RT-PCR was also negative. Nevertheless, a total of 22 Culicidae species were identified, ten of which had previously been reported as vectors of important arboviruses. The diversity of species found blood-feeding on human and horse hosts together with the arboviruses circulation previously reported suggest that the Nhecolândia Sub-region of South Pantanal is an important area for arbovirus surveillance in Brazil.

  13. Enhanced risk management by an emerging multi-agent architecture

    Science.gov (United States)

    Lin, Sin-Jin; Hsu, Ming-Fu

    2014-07-01

    Classification in imbalanced datasets has attracted much attention from researchers in the field of machine learning. Most existing techniques tend not to perform well on minority class instances when the dataset is highly skewed because they focus on minimising the forecasting error without considering the relative distribution of each class. This investigation proposes an emerging multi-agent architecture, grounded on cooperative learning, to solve the class-imbalanced classification problem. Additionally, this study deals further with the obscure nature of the multi-agent architecture and expresses comprehensive rules for auditors. The results from this study indicate that the presented model performs satisfactorily in risk management and is able to tackle a highly class-imbalanced dataset comparatively well. Furthermore, the knowledge visualised process, supported by real examples, can assist both internal and external auditors who must allocate limited detecting resources; they can take the rules as roadmaps to modify the auditing programme.

  14. A Conceptual Framework for the Evaluation of Emergency Risk Communications

    Science.gov (United States)

    Lin, Leesa; Gamhewage, Gaya M.

    2017-01-01

    Objectives. To articulate a conceptual framework in support of evaluation activities in emergency risk communications (ERC). Methods. The framework proposed is based on a systematic review of the scientific literature (2001–2016) combined with data derived from a series of semistructured interviews with experts and practitioners in ERC, and it is designed to support local, national, and international public health organizations in implementing evaluation studies in ERC. Results. We identified a list of ERC outcomes from the full-text review of 152 articles and categorized these into 3 groups, depending upon the level at which the outcome was measured: (1) information environment, (2) population, and (3) public health system. We analyzed interviewees’ data from 18 interviews to identify practices and processes related to the effectiveness of ERC and included these as key structural components and processes in the developed evaluation framework. Conclusions. Researchers and public health practitioners interested in the evaluation of ERC can use the conceptual framework described in this article to guide the development of evaluation studies and methods for assessing communication outcomes related to public health emergencies. PMID:28892436

  15. Risk Informed Optimization of Nuclear Instrumentation for Emergency Conditions

    International Nuclear Information System (INIS)

    Knoll, Alexander

    2013-06-01

    Emergency conditions after a nuclear accident are different in each case and cannot be predicted accurately. The accident at TMI did not contaminate the environment. The accident at Chernobyl had a large, early release of nuclear contamination, widely dispersed over many countries. Although there was no large, early release of contamination at Fukushima Daiichi, the timeline of the accident included days of later contamination of various degrees of severity. A large amount of the contamination has been released to the ocean and an exclusion zone still exists around the station. In all of these accidents there were no adequate radiation monitoring systems distant from the origin point that could provide accurate status to the authorities and the local population. In the recent years a number of new nuclear monitoring systems have been implemented or are under development to be installed in areas that might be exposed to nuclear contamination in emergencies. Based on the risk informed optimization methodology, this paper provides recommendations for selecting the quantity and type of instrumentation, the location and sampling of data, and the real-time processing of information. (authors)

  16. A Conceptual Framework for the Evaluation of Emergency Risk Communications.

    Science.gov (United States)

    Savoia, Elena; Lin, Leesa; Gamhewage, Gaya M

    2017-09-01

    To articulate a conceptual framework in support of evaluation activities in emergency risk communications (ERC). The framework proposed is based on a systematic review of the scientific literature (2001-2016) combined with data derived from a series of semistructured interviews with experts and practitioners in ERC, and it is designed to support local, national, and international public health organizations in implementing evaluation studies in ERC. We identified a list of ERC outcomes from the full-text review of 152 articles and categorized these into 3 groups, depending upon the level at which the outcome was measured: (1) information environment, (2) population, and (3) public health system. We analyzed interviewees' data from 18 interviews to identify practices and processes related to the effectiveness of ERC and included these as key structural components and processes in the developed evaluation framework. Researchers and public health practitioners interested in the evaluation of ERC can use the conceptual framework described in this article to guide the development of evaluation studies and methods for assessing communication outcomes related to public health emergencies.

  17. Emerging risk issues in underground storage of bituminous coal

    Energy Technology Data Exchange (ETDEWEB)

    Sipila, J.

    2013-11-01

    This thesis aims to address the root causes and means of prevention, mitigation and other improvements to the challenges from smouldering fires, coal freezing and occupational risk in an underground storage silo built into granite bedrock. In addition, appropriate performance indicators are suggested, and the benefits of the recommended or adopted actions are estimated. The issues and observed incidents demonstrate hazards that are largely classified to represent issues of emerging risk. To reduce the fire risk, successful measures included bottom maintenance door sealing and modified design of silo filling and discharge. The assessed benefits of these actions suggest a payback period of only about 10 days, assuming that, without these measures, a fire like the one in 2008 could occur once in four years. Additional recommendations are made to reduce air flow through the coal bed and near the silo ceiling, and to improve nitrogen purging at the hoppers. Filling with subzero coal can freeze silo drains, resulting in water inflow and further freezing to hamper discharge. As the heat flow is unlike any previously known cases of coal freezing, conventional mitigation e.g. by freeze conditioning agents, would not help. After implementing modified filling procedures for cold coal, no severe freezing cases have occurred. Safety advantages from the automated and remotely controlled operation do not necessarily apply under exceptional circumstances requiring human involvement. As preventive measures, protection has been sought from additional technical barriers and training effort. The rarity of serious incidents is a challenge in demonstrating success, but also emphasizes the importance of using leading (not only lagging) safety performance indicators for measurable safety promotion. In contrast, suitable leading performance indicators of the fire risk have been suggested for deliveries as an index of coal properties and for storage (gas emissions and temperature

  18. Threshold Evaluation of Emergency Risk Communication for Health Risks Related to Hazardous Ambient Temperature.

    Science.gov (United States)

    Liu, Yang; Hoppe, Brenda O; Convertino, Matteo

    2018-04-10

    Emergency risk communication (ERC) programs that activate when the ambient temperature is expected to cross certain extreme thresholds are widely used to manage relevant public health risks. In practice, however, the effectiveness of these thresholds has rarely been examined. The goal of this study is to test if the activation criteria based on extreme temperature thresholds, both cold and heat, capture elevated health risks for all-cause and cause-specific mortality and morbidity in the Minneapolis-St. Paul Metropolitan Area. A distributed lag nonlinear model (DLNM) combined with a quasi-Poisson generalized linear model is used to derive the exposure-response functions between daily maximum heat index and mortality (1998-2014) and morbidity (emergency department visits; 2007-2014). Specific causes considered include cardiovascular, respiratory, renal diseases, and diabetes. Six extreme temperature thresholds, corresponding to 1st-3rd and 97th-99th percentiles of local exposure history, are examined. All six extreme temperature thresholds capture significantly increased relative risks for all-cause mortality and morbidity. However, the cause-specific analyses reveal heterogeneity. Extreme cold thresholds capture increased mortality and morbidity risks for cardiovascular and respiratory diseases and extreme heat thresholds for renal disease. Percentile-based extreme temperature thresholds are appropriate for initiating ERC targeting the general population. Tailoring ERC by specific causes may protect some but not all individuals with health conditions exacerbated by hazardous ambient temperature exposure. © 2018 Society for Risk Analysis.

  19. Imported Arbovirus Infections in Canada 1974-89

    Directory of Open Access Journals (Sweden)

    Harvey Artsob

    1991-01-01

    Full Text Available From 1974 to 1989, sera from symptomatic patients with histories of recent travel outside Canada were tested for antibodies to several arboviruses, principally of the alphavirus and flavivirus families. Diagnostic seroconversions were documented in 84 individuals from six provinces, including one alphavirus (Chikungunya and 83 flavivirus seroconvertors. Dengue 1 virus was isolated from the blood of one patient. Most flavivirus seroconvertors were likely infected with dengue virus, but infections with tick-borne encephalitis, St Louis encephalitis and Powassan viruses were also recognized. Patients had histories of recent travel to the Caribbean, South America, Asia, Africa, North America (outside Canada, Tahiti, Fiji and Europe. Possible imported infections due to Japanese encephalitis, Ross River, western equine encephalitis and Colorado tick fever viruses were also encountered.

  20. Microculture Plaque Neutralization Test for California Group Arboviruses

    Science.gov (United States)

    Seawright, Gary L.; Harding, Gherry; Thomas, Frederick C.; Hanson, Robert P.

    1974-01-01

    A microculture plaque neutralization test is described for California-group arboviruses that is as precise and quantitative as the standard test conducted in 60-mm petri dishes. It was shown that there was no significant between-panel or between-day variation in determinations and that a single pipette could be used for all serum-dilution levels within a titration without inoculum carry-over effect. The experimental protocol and statistical methods used produce 50% neutralization end points that meet the assumptions of parametric statistics. This permits the power and versatility of the analysis of variance to be exploited in testing for treatment effects in serological and immunological studies with viruses. Images PMID:4216288

  1. High-risk facilities. Emergency management in nuclear, chemical and hazardous waste facilities

    International Nuclear Information System (INIS)

    Kloepfer, Michael

    2012-01-01

    The book on emergency management in high-risk facilities covers the following topics: Change in the nuclear policy, risk management of high-risk facilities as a constitutional problem - emergency management in nuclear facilities, operational mechanisms of risk control in nuclear facilities, regulatory surveillance responsibilities for nuclear facilities, operational mechanism of the risk control in chemical plants, regulatory surveillance responsibilities for chemical facilities, operational mechanisms of the risk control in hazardous waste facilities, regulatory surveillance responsibilities for hazardous waste facilities, civil law consequences in case of accidents in high-risk facilities, criminal prosecution in case of accidents in high-risk facilities, safety margins as site risk for emission protection facilities, national emergency management - strategic emergency management structures, warning and self-protection of the public in case of CBRN hazards including aspects of the psych-social emergency management.

  2. Emerging risks and outcomes of blood transfusion in surgery.

    Science.gov (United States)

    Shander, Aryeh

    2004-01-01

    Prior to 1900, blood transfusions were fraught with danger and often caused more complications than the underlying disease. Discovery of the ABO compatibility system in the early twentieth century opened the modern era of blood transfusion, yet ABO incompatibility-as a result of clerical error-remains a significant threat to the recipient today. The risk of disease transmission now includes new and emerging agents, such as Trepanosoma cruzii and West Nile Virus (WNV), as well as other existing pathogens. Transfusion-related immunomodulation (TRIM) presents a further risk to recipient patients. Confounding these problems are shortages of safe blood and the accelerated rise in the cost of blood due to increased testing. Outcome data on transfusion therapy have not always been favorable, particularly in the areas of postoperative infection, systemic inflammatory response syndrome (SIRS), multiple organ failure (MOF), and mortality. Such data have generated extensive efforts to determine association versus underlying cause of post-transfusion complications. In addition, unprecedented global initiatives to minimize the use of allogeneic blood are on the way. Options may include, but are not limited to, the use of "blood substitutes," although validation of such products is still required. In the meantime, blood product conservation techniques should become part of routine transfusion medicine.

  3. Review of risk from potential emerging contaminants in UK groundwater.

    Science.gov (United States)

    Stuart, Marianne; Lapworth, Dan; Crane, Emily; Hart, Alwyn

    2012-02-01

    This paper provides a review of the types of emerging organic groundwater contaminants (EGCs) which are beginning to be found in the UK. EGCs are compounds being found in groundwater that were previously not detectable or known to be significant and can come from agricultural, urban and rural point sources. EGCs include nanomaterials, pesticides, pharmaceuticals, industrial compounds, personal care products, fragrances, water treatment by-products, flame retardants and surfactants, as well as caffeine and nicotine. Many are relatively small polar molecules which may not be effectively removed by drinking water treatment. Data from the UK Environment Agency's groundwater screening programme for organic pollutants found within the 30 most frequently detected compounds a number of EGCs such as pesticide metabolites, caffeine and DEET. Specific determinands frequently detected include pesticides metabolites, pharmaceuticals including carbamazepine and triclosan, nicotine, food additives and alkyl phosphates. This paper discusses the routes by which these compounds enter groundwater, their toxicity and potential risks to drinking water and the environment. It identifies challenges that need to be met to minimise risk to drinking water and ecosystems. Copyright © 2012. Published by Elsevier B.V.

  4. Regulatory uncertainty and the associated business risk for emerging technologies

    International Nuclear Information System (INIS)

    Hoerr, Robert A.

    2011-01-01

    An oversight system specifically concerned with nanomaterials should be flexible enough to take into account the unique aspects of individual novel materials and the settings in which they might be used, while recognizing that heretofore unrecognized safety issues may require future modifications. This article considers a question not explicitly considered by the project team: what is the risk that uncertainty over how regulatory oversight will be applied to nanomaterials will delay or block the development of this emerging technology, thereby depriving human health of potential and substantial benefits? An ambiguous regulatory environment could delay the availability of valuable new technology and therapeutics for human health by reducing access to investment capital. Venture capitalists list regulatory uncertainty as a major reason not to invest at all in certain areas. Uncertainty is far more difficult to evaluate than risk, which lends itself to quantitative models and can be factored into projections of return on possible investments. Loss of time has a large impact on investment return. An examination of regulatory case histories suggests that an increase in regulatory resting requirement, where the path is well-defined, is far less costly than a delay of a year or more in achieving product approval and market launch.

  5. Regulatory uncertainty and the associated business risk for emerging technologies

    Science.gov (United States)

    Hoerr, Robert A.

    2011-04-01

    An oversight system specifically concerned with nanomaterials should be flexible enough to take into account the unique aspects of individual novel materials and the settings in which they might be used, while recognizing that heretofore unrecognized safety issues may require future modifications. This article considers a question not explicitly considered by the project team: what is the risk that uncertainty over how regulatory oversight will be applied to nanomaterials will delay or block the development of this emerging technology, thereby depriving human health of potential and substantial benefits? An ambiguous regulatory environment could delay the availability of valuable new technology and therapeutics for human health by reducing access to investment capital. Venture capitalists list regulatory uncertainty as a major reason not to invest at all in certain areas. Uncertainty is far more difficult to evaluate than risk, which lends itself to quantitative models and can be factored into projections of return on possible investments. Loss of time has a large impact on investment return. An examination of regulatory case histories suggests that an increase in regulatory resting requirement, where the path is well-defined, is far less costly than a delay of a year or more in achieving product approval and market launch.

  6. Identification of Blood Meals from Potential Arbovirus Mosquito Vectors in the Peruvian Amazon Basin.

    Science.gov (United States)

    Palermo, Pedro M; Aguilar, Patricia V; Sanchez, Juan F; Zorrilla, Víctor; Flores-Mendoza, Carmen; Huayanay, Anibal; Guevara, Carolina; Lescano, Andrés G; Halsey, Eric S

    2016-11-02

    The transmission dynamics of many arboviruses in the Amazon Basin region have not been fully elucidated, including the vectors and natural reservoir hosts. Identification of blood meal sources in field-caught mosquitoes could yield information for identifying potential arbovirus vertebrate hosts. We identified blood meal sources in 131 mosquitoes collected from areas endemic for arboviruses in the Peruvian Department of Loreto by sequencing polymerase chain reaction amplicons of the cytochrome b gene. Psorophora (Janthinosoma) albigenu, Psorophora (Grabhamia) cingulata, Mansonia humeralis, Anopheles oswaldoi s.l., and Anopheles benarrochi s.l. had mainly anthropophilic feeding preferences; Aedes (Ochlerotatus) serratus, and Aedes (Ochlerotatus) fulvus had feeding preferences for peridomestic animals; and Culex (Melanoconion) spp. fed on a variety of vertebrates, mainly rodents (spiny rats), birds, and amphibians. On the basis of these feeding preferences, many mosquitoes could be considered as potential enzootic and bridge arbovirus vectors in the Amazon Basin of Peru. © The American Society of Tropical Medicine and Hygiene.

  7. The Success Of Stock Selection Strategies In Emerging Markets: Is It Risk Or Behavioral Bias?

    NARCIS (Netherlands)

    J. van der Hart; G.J. de Zwart (Gerben); D.J.C. van Dijk (Dick)

    2005-01-01

    textabstractWe examine competing explanations, based on risk and behavioral models, for the profitability of stock selection strategies in emerging markets. We document that both emerging market risk and global risk factors cannot account for the significant excess returns of selection strategies

  8. Evaluation of Cases with Rabies Risk Presenting to Emergency Department

    Directory of Open Access Journals (Sweden)

    Fevzi Yilmaz

    2013-10-01

    Full Text Available Aim: All around the world 10-12 million people/year receive rabies prophylaxis. Rabies is an acute fatal central nervous system viral enfection. The virus can infect all warm-blooded animals and almost in all cases the enfection results with fatal encephalitis. The aim of this study is to determine the demographic characteristics of cases with rabies risk exposures and behind this to emphasise the significance of cooperation between the institutions to perform effective and accurate treatment. Material and Method: This study was performed with retrospective analysis of 1429 cases who attended to Emergency Department of Diyarbakir Goverment Hospital between January 2007-2010 for animal bites and exposures with the risk of rabies. Statistical analysis of data was performed SPSS V16 pocket programme. Data were defined as frequency and %. For statistical analysis Chi-Square and Fischer exact test was used. A value of P<0.05 was accepted statistically significant. Results: A total of 1055 (73.8% were male, 374 (26.2% were female and the mean age was 21.75 ± 16.9 (6 months-87 years. The major group in children was 6-11 years old and 651 (% 45.5 of the cases attended to hospital were under 18 years old. The vast majority (39.3% in adults were between 19-49 years. In our study 808 (56.5% of the cases  were bitten, 597 (41.8% of the cases  were scrabbled by the animal and 24 (1.7%of them  had indirect contact with the animal Both of them were taken into prophylactic vaccination programme (p<0.05. The vast majority of animal bites were dog (67%  and cat (28%. 3 doses of Human diploid cell vaccine-HDCV were administered to 1001 (70% of the patients and 5 doses to 428 (30% of patients. Human rabies immune globulin-HRIG were administered to 475 (33,3% of the patients in addition to vaccine. Discussion:  In our region rabies risk exposure is an important public health problem. Public oriented education should be given about attending to health care

  9. Clinical and serological tests for arboviruses in free-living domestic pigeons (Columba livia).

    Science.gov (United States)

    Ramos, Bruna Alves; Chiang, Jannifer Oliveira; Martins, Lívia Carício; Chagas, Liliane Leal das; Silva, Franko de Arruda E; Ferreira, Milene Silveira; Freitas, Maria Nazaré Oliveira; Alcantara, Bianca Nascimento de; Silva, Sandro Patroca da; Miranda, Stefânia Araújo; Sepulvreda, Barbara Alves; Corrêa, Layna Thayssa Guimarães; Negrão, Andréa Maria Góes; Vasconcelos, Pedro Fernando da Costa; Casseb, Alexandre do Rosário

    2017-08-01

    In this study, we evaluated the role of free-living domestic pigeons (Columba livia) as a reservoir of arboviruses in the city of Belém, state of Pará, Brazil. We investigated the presence of antibodies against the most prevalent arboviruses. This study was aimed at evaluating some clinical and physical parameters of domestic pigeons, including the presence of antibodies to Amazon-endemic arboviruses. Eighty-five healthy pigeons were captured in Mangal das Garças Park, in Belém, and were bled. Upon capture, the birds were subjected to a clinical examination in search of alterations that could indicate the presence of arboviruses. Blood samples were converted to serum and tested using the haemagglutination inhibition (HI) technique with a panel of 19 antigens of arboviruses circulating in the Amazon. The confirmation assay for the positive reactions to the viral species tested by HI was a neutralisation test in new-born Swiss albino mice (Mus musculus) [mouse neutralisation test (MNT)]. A total of 10 (11.8%) serum samples tested positive for antiflavivirus antibodies by HI. All the samples positive for the HI test were subjected to MNT for detection of viruses and yielded negative results (logarithmic neutralisation index < 1.7). The results represent the first serological detection of antiarbovirus antibodies in domestic pigeons as potential hosts of arboviruses in Brazil. The detection of haemagglutination-inhibiting antibodies against genus Flavivirus indicated that there was recent contact between the analysed domestic pigeons and these arboviruses. Further studies are needed to evaluate the role of free-living pigeons in the maintenance cycle and spread of arboviruses in the Amazon.

  10. A Risk Metric Assessment of Scenario-Based Market Risk Measures for Volatility and Risk Estimation: Evidence from Emerging Markets

    Directory of Open Access Journals (Sweden)

    Sitima Innocent

    2015-03-01

    Full Text Available The study evaluated the sensitivity of the Value- at- Risk (VaR and Expected Shortfalls (ES with respect to portfolio allocation in emerging markets with an index portfolio of a developed market. This study utilised different models for VaR and ES techniques using various scenario-based models such as Covariance Methods, Historical Simulation and the GARCH (1, 1 for the predictive ability of these models in both relatively stable market conditions and extreme market conditions. The results showed that Expected Shortfall has less risk tolerance than VaR based on the same scenario-based market risk measures

  11. Nanopesticides and nanofertilizers: emerging contaminants or opportunities for risk mitigation?

    Directory of Open Access Journals (Sweden)

    Melanie eKah

    2015-11-01

    Full Text Available Research into nanotechnology applications for use in agriculture has become increasingly popular over the past decade, with a particular interest in developing novel nanoagrochemicals in the form of so-called nanopesticides and nanofertilizers. In view of the extensive body of scientific literature available on the topic, many authors have foreseen a revolution in current agricultural practices.This perspective integrates scientific, regulatory, public and commercial viewpoints, and aims at critically evaluating progress made over the last decade. A number of key (and sometimes controversial questions are addressed with the aim of identifying the products that will soon emerge on the market and analyzing how they can fit into current regulatory and commercial frameworks. Issues related to the differences in definitions and perceptions within different sectors are discussed, as well as our current ability to assess new risks and benefits relative to conventional products. Many nanoagrochemicals resemble products used currently, which raises the question whether the effect of formulation has been sufficiently taken into account when evaluating agrochemicals. This analysis identifies directions for future research and regulatory needs in order to encourage intelligent design and promote the development of more sustainable agrochemicals.

  12. Risk Factors for Depression in the Emerging Adulthood

    Directory of Open Access Journals (Sweden)

    Sándor Lisznyai

    2014-03-01

    Full Text Available Emerging adulthood is a period from the late teens through the twenties, when individuals are faced with more transitions and life-decisions than at any other stage of life. For the majority, psychological well-being is improved in this period, but for a significant number of individuals these challenges and contingencies entail many controversies, which in turn can lead to depression or anxiety. This paper focuses on the background of, and risk factors behind, high level depression among university students, who are typically in this life stage, in order to identify the typical client characteristics of a university counselling centre. 773 university students completed an online survey measuring depression symptoms, socioeconomic status, distal and proximal social capital, bullying, substance abuse and indirect aspects of mental health as mediate variables. 13.6% of the participants reported moderate or major depression symptoms. Using hierarchical multiple regression, male gender and poor financial situation were found to predict higher depression. After controlling for the effects of background variables, social capital factors, identity status and life skills made a significant contribution to the prediction of lower depression. This supports the idea of the importance of social skills in enabling the individual to create their own social circle and joining the community of young people at the university.

  13. Risk identification in food safety: Strategy and outcomes of the EFSA emerging risks exchange network (EREN), 2010-2014

    DEFF Research Database (Denmark)

    Costa, M. C.; Goumperis, T.; Andersson, W.

    2017-01-01

    should be considered emerging or not, and if it merited further consideration, such as generating data on the issue, starting a full risk assessment and/or consultation of other bodies. According to the emerging risks identification process set in place at EFSA, the issues discussed and found...

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

    Science.gov (United States)

    Huang, Chongfu; Wu, Tong; Renn, Ortwin

    2016-07-01

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

  15. Contemporary status of insecticide resistance in the major Aedes vectors of arboviruses infecting humans.

    Science.gov (United States)

    Moyes, Catherine L; Vontas, John; Martins, Ademir J; Ng, Lee Ching; Koou, Sin Ying; Dusfour, Isabelle; Raghavendra, Kamaraju; Pinto, João; Corbel, Vincent; David, Jean-Philippe; Weetman, David

    2017-07-01

    Both Aedes aegytpi and Ae. albopictus are major vectors of 5 important arboviruses (namely chikungunya virus, dengue virus, Rift Valley fever virus, yellow fever virus, and Zika virus), making these mosquitoes an important factor in the worldwide burden of infectious disease. Vector control using insecticides coupled with larval source reduction is critical to control the transmission of these viruses to humans but is threatened by the emergence of insecticide resistance. Here, we review the available evidence for the geographical distribution of insecticide resistance in these 2 major vectors worldwide and map the data collated for the 4 main classes of neurotoxic insecticide (carbamates, organochlorines, organophosphates, and pyrethroids). Emerging resistance to all 4 of these insecticide classes has been detected in the Americas, Africa, and Asia. Target-site mutations and increased insecticide detoxification have both been linked to resistance in Ae. aegypti and Ae. albopictus but more work is required to further elucidate metabolic mechanisms and develop robust diagnostic assays. Geographical distributions are provided for the mechanisms that have been shown to be important to date. Estimating insecticide resistance in unsampled locations is hampered by a lack of standardisation in the diagnostic tools used and by a lack of data in a number of regions for both resistance phenotypes and genotypes. The need for increased sampling using standard methods is critical to tackle the issue of emerging insecticide resistance threatening human health. Specifically, diagnostic doses and well-characterised susceptible strains are needed for the full range of insecticides used to control Ae. aegypti and Ae. albopictus to standardise measurement of the resistant phenotype, and calibrated diagnostic assays are needed for the major mechanisms of resistance.

  16. Contemporary status of insecticide resistance in the major Aedes vectors of arboviruses infecting humans

    Science.gov (United States)

    Vontas, John; Martins, Ademir J.; Ng, Lee Ching; Koou, Sin Ying; Dusfour, Isabelle; Raghavendra, Kamaraju; Pinto, João; Corbel, Vincent; David, Jean-Philippe; Weetman, David

    2017-01-01

    Both Aedes aegytpi and Ae. albopictus are major vectors of 5 important arboviruses (namely chikungunya virus, dengue virus, Rift Valley fever virus, yellow fever virus, and Zika virus), making these mosquitoes an important factor in the worldwide burden of infectious disease. Vector control using insecticides coupled with larval source reduction is critical to control the transmission of these viruses to humans but is threatened by the emergence of insecticide resistance. Here, we review the available evidence for the geographical distribution of insecticide resistance in these 2 major vectors worldwide and map the data collated for the 4 main classes of neurotoxic insecticide (carbamates, organochlorines, organophosphates, and pyrethroids). Emerging resistance to all 4 of these insecticide classes has been detected in the Americas, Africa, and Asia. Target-site mutations and increased insecticide detoxification have both been linked to resistance in Ae. aegypti and Ae. albopictus but more work is required to further elucidate metabolic mechanisms and develop robust diagnostic assays. Geographical distributions are provided for the mechanisms that have been shown to be important to date. Estimating insecticide resistance in unsampled locations is hampered by a lack of standardisation in the diagnostic tools used and by a lack of data in a number of regions for both resistance phenotypes and genotypes. The need for increased sampling using standard methods is critical to tackle the issue of emerging insecticide resistance threatening human health. Specifically, diagnostic doses and well-characterised susceptible strains are needed for the full range of insecticides used to control Ae. aegypti and Ae. albopictus to standardise measurement of the resistant phenotype, and calibrated diagnostic assays are needed for the major mechanisms of resistance. PMID:28727779

  17. Contemporary status of insecticide resistance in the major Aedes vectors of arboviruses infecting humans.

    Directory of Open Access Journals (Sweden)

    Catherine L Moyes

    2017-07-01

    Full Text Available Both Aedes aegytpi and Ae. albopictus are major vectors of 5 important arboviruses (namely chikungunya virus, dengue virus, Rift Valley fever virus, yellow fever virus, and Zika virus, making these mosquitoes an important factor in the worldwide burden of infectious disease. Vector control using insecticides coupled with larval source reduction is critical to control the transmission of these viruses to humans but is threatened by the emergence of insecticide resistance. Here, we review the available evidence for the geographical distribution of insecticide resistance in these 2 major vectors worldwide and map the data collated for the 4 main classes of neurotoxic insecticide (carbamates, organochlorines, organophosphates, and pyrethroids. Emerging resistance to all 4 of these insecticide classes has been detected in the Americas, Africa, and Asia. Target-site mutations and increased insecticide detoxification have both been linked to resistance in Ae. aegypti and Ae. albopictus but more work is required to further elucidate metabolic mechanisms and develop robust diagnostic assays. Geographical distributions are provided for the mechanisms that have been shown to be important to date. Estimating insecticide resistance in unsampled locations is hampered by a lack of standardisation in the diagnostic tools used and by a lack of data in a number of regions for both resistance phenotypes and genotypes. The need for increased sampling using standard methods is critical to tackle the issue of emerging insecticide resistance threatening human health. Specifically, diagnostic doses and well-characterised susceptible strains are needed for the full range of insecticides used to control Ae. aegypti and Ae. albopictus to standardise measurement of the resistant phenotype, and calibrated diagnostic assays are needed for the major mechanisms of resistance.

  18. Hospital all-risk emergency preparedness in Ghana | Norman ...

    African Journals Online (AJOL)

    (2) The hospitals' respective abilities to handle large scale RTA's were ... The biggest challenge facing the hospitals in their emergency intervention is the lack of preemergency and emergency preparedness plans as well as the coordination of the hospitals response mechanisms. Conclusion: The paper ended with ...

  19. Cyber risk: a big challenge in developed and emerging markets

    OpenAIRE

    Arcuri, Maria Cristina; Brogi, Marina; Gandolfi, Gino

    2016-01-01

    The dependence on cyberspace has considerably increased over time, as such, people look at risk associated with cyber technology. This chapter focuses on the cyber risk issue. The authors aim to describe the global state of the art and point out the potential negative consequences of this type of systemic risk. Cyber risk increasingly affects both public and private institutions. Some of the risks that entities face are the following: computer security breaches, cyber theft, cyber terrorism, ...

  20. Expert forecast on emerging psychosocial risks related to occupational safety and health

    NARCIS (Netherlands)

    Milczarek, M.; Brun, E.; Houtman, I.; Goudswaard, A.; Evers, M.; Bovenkamp, M. van de; Roskams, N.; Op de Beeck, R.; Pahkin, K.; Berthet, M.; Morvan, E.; Kuhn, K.; Kaluza, K.; Hupke, M.; Hauke, A.; Reinert, D.; Widerszal-Bazyl, M.; Perez, J.; Oncins de Frutos, M.

    2007-01-01

    This report is in cooperation with TNO Work and Employment and the European Agency for Safety and Health at Work. The expert forecast on emerging psychosocial risks was carried out by means of the Delphi method. The main emerging psychosocial risks revealed were related to new forms of employment

  1. Aedes Mosquitoes and Aedes-Borne Arboviruses in Africa: Current and Future Threats

    Science.gov (United States)

    Weetman, David; Shearer, Freya M.; Coulibaly, Mamadou

    2018-01-01

    The Zika crisis drew attention to the long-overlooked problem of arboviruses transmitted by Aedes mosquitoes in Africa. Yellow fever, dengue, chikungunya and Zika are poorly controlled in Africa and often go unrecognized. However, to combat these diseases, both in Africa and worldwide, it is crucial that this situation changes. Here, we review available data on the distribution of each disease in Africa, their Aedes vectors, transmission potential, and challenges and opportunities for Aedes control. Data on disease and vector ranges are sparse, and consequently maps of risk are uncertain. Issues such as genetic and ecological diversity, and opportunities for integration with malaria control, are primarily African; others such as ever-increasing urbanization, insecticide resistance and lack of evidence for most control-interventions reflect problems throughout the tropics. We identify key knowledge gaps and future research areas, and in particular, highlight the need to improve knowledge of the distributions of disease and major vectors, insecticide resistance, and to develop specific plans and capacity for arboviral disease surveillance, prevention and outbreak responses. PMID:29382107

  2. A FTA-based method for risk decision-making in emergency response

    DEFF Research Database (Denmark)

    Liu, Yang; Li, Hongyan

    2014-01-01

    Decision-making problems in emergency response are usually risky and uncertain due to the limited decision data and possible evolvement of emergency scenarios. This paper focuses on a risk decisionmaking problem in emergency response with several distinct characteristics including dynamic...... evolvement process of emergency, multiple scenarios, and impact of response actions on the emergency scenarios. A method based on Fault Tree Analysis (FTA) is proposed to solve the problem. By analyzing the evolvement process of emergency, the Fault Tree (FT) is constructed to describe the logical relations...

  3. Emergency caesarean section in low risk nulliparous women

    DEFF Research Database (Denmark)

    Haerskjold, Ann; Hegaard, H K; Kjaergaard, H

    2012-01-01

    and identifies maternal and fetal risk factors associated with ECS. We included 2,748 low-risk women and 8.7% had ECS. Failure-to-progress (FTP) accounted for 68.3% of the ECS and 30.4% were performed due to suspected fetal distress (SFD). Multivariate logistic regression analyses were done to estimate.......26-3.20) were associated with increased risk of ECS due to FTP....

  4. Application of modified shell vial culture procedure for arbovirus detection.

    Directory of Open Access Journals (Sweden)

    Edna R Caceda

    Full Text Available The isolation of arboviruses from patient's low titer sera can be difficult. Here we compared the detection efficiency of Dengue (DEN, Yellow Fever (YF, Saint Louis Encephalitis (SLE, West Nile (WN, Ilheus (ILH, Group C (GC, Oropouche (ORO, Mayaro (MAY and Venezuela Encephalitis Equine (VEE viruses using a Modified Shell Vial Culture (MSVC protocol to a Standard Cell Culture (SCC protocol. First the MSVC and SCC protocols were compared using five dilutions for each of the following stock viruses: DEN-1, DEN-2, DEN-3, DEN-4, YF, SLE, WN, ILH, GC, ORO, MAY and VEE. Next, patients' original sera from which viruses (DEN-1, DEN-2, DEN-3, YF, GC, ORO, MAY and VEE had been previously isolated were compare by the two methods using five sera dilutions. In addition, seven sera that were positive for DEN-3 by RT-PCR and negative by SCC were processed by MSVC. The MSVC protocol was consistently 1-2 logs higher virus dilution more sensitive for virus detection than the SCC protocol for all stock Flaviviruses tested (DEN-1, DEN-2, DEN-3, DEN-4, YF, SLE, WN and ILH. MSVC was equal to or one log more sensitive for virus detection than SCC for the stock Bunyaviruses (GC and ORO. For the stock Alphavirus MAY, MSVC was equally or one log more sensitive for virus detection than SCC, while for VEE SCC was equally or one log more sensitive for virus detection than MSVC. MSVC was consistently one to two sera dilutions more sensitive than SCC for the detection of Flaviviruses from patients' sera. Both methods were approximately equally sensitive for the detection of Bunyaviruses from patients' sera and equal or one dilution less sensitive for the detection of Alphaviruses from patients' sera. Additionally, MSVC detected DEN virus in five of seven DEN-3 RT-PCR positive, SCC negative patients' sera.

  5. Protective response to technological emergency: risk perception and behavioral intention

    International Nuclear Information System (INIS)

    Lindell, M.K.; Barnes, V.E.

    1986-01-01

    This article examines why, as suggested by the Three Mile Island Nuclear Station (TMI) event, the public is more inclined to evacuate in response to a radiation release than to a natural hazard. During the TMI incident, for example, did authorities present confusing or conflicting information or did the public have an exaggerated perception of radiation risk. Behavioral intention studies are combined with risk perception analyses to ascertain (1) the extent to which intentions to evacuate can be generalized from one sample to another and from one hazard to another, (2) the degree to which behavioral intentions are related to specific dimensions of risk perception, and (3) how public perceptions of risk compare with estimates of risk produced by reactor accident consequence analyses

  6. Engineering risk assessment for emergency disposal projects of sudden water pollution incidents.

    Science.gov (United States)

    Shi, Bin; Jiang, Jiping; Liu, Rentao; Khan, Afed Ullah; Wang, Peng

    2017-06-01

    Without an engineering risk assessment for emergency disposal in response to sudden water pollution incidents, responders are prone to be challenged during emergency decision making. To address this gap, the concept and framework of emergency disposal engineering risks are reported in this paper. The proposed risk index system covers three stages consistent with the progress of an emergency disposal project. Fuzzy fault tree analysis (FFTA), a logical and diagrammatic method, was developed to evaluate the potential failure during the process of emergency disposal. The probability of basic events and their combination, which caused the failure of an emergency disposal project, were calculated based on the case of an emergency disposal project of an aniline pollution incident in the Zhuozhang River, Changzhi, China, in 2014. The critical events that can cause the occurrence of a top event (TE) were identified according to their contribution. Finally, advices on how to take measures using limited resources to prevent the failure of a TE are given according to the quantified results of risk magnitude. The proposed approach could be a potential useful safeguard for the implementation of an emergency disposal project during the process of emergency response.

  7. Development and field evaluation of the sentinel mosquito arbovirus capture kit (SMACK).

    Science.gov (United States)

    Johnson, Brian J; Kerlin, Tim; Hall-Mendelin, Sonja; van den Hurk, Andrew F; Cortis, Giles; Doggett, Stephen L; Toi, Cheryl; Fall, Ken; McMahon, Jamie L; Townsend, Michael; Ritchie, Scott A

    2015-10-06

    Although sentinel animals are used successfully throughout the world to monitor arbovirus activity, ethical considerations and cross-reactions in serological assays highlight the importance of developing viable alternatives. Here we outline the development of a passive sentinel mosquito arbovirus capture kit (SMACK) that allows for the detection of arboviruses on honey-baited nucleic acid preservation cards (Flinders Technology Associates; FTA®) and has a similar trap efficacy as standard light traps in our trials. The trap efficacy of the SMACK was assessed against Centers for Disease Control and Prevention (CDC) miniature light traps (standard and ultraviolet) and the Encephalitis Vector Survey (EVS) trap in a series of Latin square field trials conducted in North Queensland, Australia. The ability of the SMACK to serve as a sentinel arbovirus surveillance tool was assessed in comparison to Passive Box Traps (PBT) during the 2014 wet season in the Cairns, Australia region and individually in the remote Northern Peninsula Area (NPA) of Australia during the 2015 wet season. The SMACK caught comparable numbers of mosquitoes to both CDC light traps (mean capture ratio 0.86: 1) and consistently outperformed the EVS trap (mean capture ratio 2.28: 1) when CO2 was supplied by either a gas cylinder (500 ml/min) or dry ice (1 kg). During the 2014 arbovirus survey, the SMACK captured significantly (t 6 = 2.1, P = 0.04) more mosquitoes than the PBT, and 2 and 1 FTA® cards were positive for Ross River virus and Barmah Forest virus, respectively, while no arboviruses were detected from PBTs. Arbovirus activity was detected at all three surveillance sites during the NPA survey in 2015 and ca. 27 % of FTA® cards tested positive for either Murray Valley encephalitis virus (2 detections), West Nile virus (Kunjin subtype; 13 detections), or both viruses on two occasions. These results demonstrate that the SMACK is a versatile, simple, and effective passive arbovirus

  8. Emerging risk – Conceptual definition and a relation to black swan type of events

    International Nuclear Information System (INIS)

    Flage, R.; Aven, T.

    2015-01-01

    The concept of emerging risk has gained increasing attention in recent years. The term has an intuitive appeal and meaning but a consistent and agreed definition is missing. We perform an in-depth analysis of this concept, in particular its relation to black swan type of events, and show that these can be considered meaningful and complementary concepts by relating emerging risk to known unknowns and black swans to unknown knowns, unknown unknowns and a subset of known knowns. The former is consistent with saying that we face emerging risk related to an activity when the background knowledge is weak but contains indications/justified beliefs that a new type of event (new in the context of that activity) could occur in the future and potentially have severe consequences to something humans value. The weak background knowledge among other things results in difficulty specifying consequences and possibly also in fully specifying the event itself; i.e. in difficulty specifying scenarios. Here knowledge becomes the key concept for both emerging risk and black swan type of events, allowing for taking into consideration time dynamics since knowledge develops over time. Some implications of our findings in terms of risk assessment and risk management are pointed out. - Highlights: • We perform an in-depth analysis of the concept of emerging risk. • Emerging risk and black swan type of events are shown to be complementary concepts. • We propose a definition of emerging risk where knowledge becomes the key term. • Some implications for risk assessment and risk management are pointed out.

  9. Oviposition ecology and species composition of Aedes spp. and Aedes aegypti dynamics in variously urbanized settings in arbovirus foci in southeastern Côte d'Ivoire.

    Science.gov (United States)

    Zahouli, Julien B Z; Utzinger, Jürg; Adja, Maurice A; Müller, Pie; Malone, David; Tano, Yao; Koudou, Benjamin G

    2016-09-29

    Aedes mosquito-transmitted outbreaks of dengue and yellow fever have been reported from rural and urban parts of Côte d'Ivoire. The present study aimed at assessing Aedes spp. oviposition ecology in variously urbanized settings within arbovirus foci in southeastern Côte d'Ivoire. Aedes spp. eggs were sampled using a standard ovitrap method from January 2013 to April 2014 in different ecosystems of rural, suburban and urban areas. Emerged larvae were reared until the adult stage for species identification. Aedes spp. oviposition ecology significantly varied from rural-to-urban areas and according to the ecozones and the seasons. Species richness of Aedes spp. gradually decreased from rural (eight species) to suburban (three species) and urban (one species) areas. Conversely, emerged adult Aedes spp. mean numbers were higher in the urban (1.97 Aedes/ovitrap/week), followed by the suburban (1.44 Aedes/ovitrap/week) and rural (0.89 Aedes/ovitrap/week) areas. Aedes aegypti was the only species in the urban setting (100 %), and was also the predominant species in suburban (85.5 %) and rural (63.3 %) areas. The highest Ae. aegypti mean number was observed in the urban (1.97 Ae. aegypti/ovitrap/week), followed by the suburban (1.20 Ae. aegypti/ovitrap/week) and rural (0.57 Ae. aegypti/ovitrap/week) areas. Aedes africanus (9.4 %), Ae. dendrophilus (8.0 %), Ae. metallicus (1.3 %) in the rural, and Ae. vittatus (6.5 %) and Ae. metallicus (1.2 %) in the suburban areas each represented more than 1 % of the total Aedes fauna. In all areas, Aedes species richness and abundance were higher in the peridomestic zones and during the rainy season, with stronger variations in species richness in the rural and in abundance in the urban areas. Besides, the highest Culex quinquefasciatus abundance was found in the urban areas, while Eretmapodites chrysogaster was restricted to the rural areas. Urbanization correlates with a substantially higher abundance in Aedes mosquitoes and

  10. Survey of UK horse owners' knowledge of equine arboviruses and disease vectors.

    Science.gov (United States)

    Chapman, Gail Elaine; Baylis, Matthew; Archer, Debra C

    2018-05-15

    Increased globalisation and climate change have led to concern about the increasing risk of arthropod-borne virus (arbovirus) outbreaks globally. An outbreak of equine arboviral disease in northern Europe could impact significantly on equine welfare, and result in economic losses. Early identification of arboviral disease by horse owners may help limit disease spread. In order to determine what horse owners understand about arboviral diseases of horses and their vectors, the authors undertook an open, cross-sectional online survey of UK horse owners. The questionnaire was distributed using social media and a press release and was active between May and July 2016. There were 466 respondents, of whom 327 completed the survey in full. High proportions of respondents correctly identified photographic images of biting midges (71.2 per cent) and mosquitoes (65.4 per cent), yet few were aware that they transmit equine infectious diseases (31.4 per cent and 35.9 per cent, respectively). Of the total number of respondents, only 7.4 per cent and 16.2 per cent correctly named a disease transmitted by biting midges and mosquitoes, respectively. Only 13.1 per cent and 12.5 per cent of participants identified specific clinical signs of African horse sickness (AHS) and West Nile virus (WNV), respectively. This study demonstrates that in the event of heightened disease risk educational campaigns directed towards horse owners need to be implemented, focussing on disease awareness, clinical signs and effective disease prevention strategies. © British Veterinary Association (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  11. Risk of influenza transmission in a hospital emergency department during the week of highest incidence.

    Science.gov (United States)

    Esteve-Esteve, Miguel; Bautista-Rentero, Daniel; Zanón-Viguer, Vicente

    2018-02-01

    To estimate the risk of influenza transmission in patients coming to a hospital emergency department during the week of highest incidence and to analyze factors associated with transmission. Retrospective observational analysis of a cohort of patients treated in the emergency room during the 2014-2015 flu season. The following variables were collected from records: recorded influenza diagnosis, results of a rapid influenza confirmation test, point of exposure (emergency department, outpatient clinic, or the community), age, sex, flu vaccination or not, number of emergency visits, time spent in the waiting room, and total time in the hospital. We compiled descriptive statistics and performed bivariate and multivariate analyses by means of a Poisson regression to estimate relative risk (RR) and 95% CIs. The emergency department patients had a RR of contracting influenza 3.29 times that of the communityexposed population (95% CI, 1.53-7.08, P=.002); their risk was 2.05 times greater than that of outpatient clinic visitors (95% CI, 1.04-4.02, P=.036). Emergency patients under the age of 15 years had a 5.27 greater risk than older patients (95% CI, 1.59-17.51; P=.007). The RR of patients visiting more than once was 11.43 times greater (95% CI, 3.58-36.44; P<.001). The risk attributable to visiting the emergency department risk was 70.5%, whereas risk attributable to community exposure was 2%. The risk of contracting influenza is greater for emergency department patients than for the general population or for patients coming to the hospital for outpatient clinic visits. Patients under the age of 15 years incur greater risk.

  12. Sectoral networks and macroeconomic tail risks in an emerging economy.

    Science.gov (United States)

    Romero, Pedro P; López, Ricardo; Jiménez, Carlos

    2018-01-01

    This paper aims to explain the macroeconomic volatility due to microeconomic shocks to one or several sectors, recognizing the non-symmetrical relation in the interaction among the Ecuadorian economic sectors. To grasp the economic structure of this emerging economy, a statistical analysis of network data is applied to the respective input-output matrix of Ecuador from 1975 until 2012. We find periods wherein the production of domestic inputs is concentrated in a few suppliers; for example, in 2010, the concentration significantly affects sectors and their downstream providers, thus influencing aggregate volatility. Compared to the US productive structure, this emerging economy presents fewer sectors and degree distributions with less extreme fat-tail behavior. In this simpler economy, we continue to find a link between microeconomic shocks and aggregate volatility. Two new theoretical propositions are introduced to formalize our results.

  13. Sectoral networks and macroeconomic tail risks in an emerging economy

    Science.gov (United States)

    López, Ricardo; Jiménez, Carlos

    2018-01-01

    This paper aims to explain the macroeconomic volatility due to microeconomic shocks to one or several sectors, recognizing the non-symmetrical relation in the interaction among the Ecuadorian economic sectors. To grasp the economic structure of this emerging economy, a statistical analysis of network data is applied to the respective input-output matrix of Ecuador from 1975 until 2012. We find periods wherein the production of domestic inputs is concentrated in a few suppliers; for example, in 2010, the concentration significantly affects sectors and their downstream providers, thus influencing aggregate volatility. Compared to the US productive structure, this emerging economy presents fewer sectors and degree distributions with less extreme fat-tail behavior. In this simpler economy, we continue to find a link between microeconomic shocks and aggregate volatility. Two new theoretical propositions are introduced to formalize our results. PMID:29293567

  14. Credit risk in emerging markets Peruvian listed company

    Directory of Open Access Journals (Sweden)

    Kurt Burneo Farfan

    2017-07-01

    Full Text Available The aim of this paper is to introduce the importance of the banking credit risk, the main elements that conform it and the main alternatives that are offered to access to a loan as well as a description of its measurement and management in the sector. There will be a general explanation of credit risk and the main parties involved in it. As the topic is developed it is going to be analyzed the lending process carried out by the banks as well as the quantitative and qualitative elements taken into account when taking a credit decision (The 5C’s of credit, credit scoring and models for quantification of losses for instance. Another thing to considerate is that Credit risk arises whenever a borrower is expecting to use future cash flows to pay a current debt. Also, the investors have the access for the information of a client and they are compensated for assuming credit risk by way of interest payments from the borrower or issuer of a debt obligation and the credit risk is a useful tool for the finance management. The Enterprise risk management in Peru changed in 2015 because the local regulator is in process to review the norm, including some aspects of corporate governance; these changes are not included in this research.

  15. Comparable risk of childhood asthma after vaginal delivery and emergency caesarean section

    DEFF Research Database (Denmark)

    Brix, Nis; Stokholm, Lonny; Jonsdottir, Fjola

    2017-01-01

    INTRODUCTION: Caesarean section is thought to be a risk factor for childhood asthma, but this association may be caused by confounding from, for instance, familial factors. To address this problem, we used twin pairs to assess the risk of childhood asthma after emergency caesarean section. METHODS...... respiratory morbidity, the risk of childhood asthma following emergency caesarean section remained unchanged. CONCLUSION: Emergency caesarean section was not associated with childhood asthma. FUNDING: none. TRIAL REGISTRATION: not relevant.......: In total, 464 twin pairs (928 twins) were included. In 30 pairs, the first twin (vaginal delivery) was diagnosed with asthma, but the second twin (emergency caesarean section) was not. In 20 pairs, the second twin (emergency caesarean section) was diagnosed with asthma, but the first twin (vaginal delivery...

  16. Review of risk from potential emerging contaminants in UK groundwater

    OpenAIRE

    Stuart, Marianne; Lapworth, Dan; Crane, Emily; Hart, Alwyn

    2012-01-01

    This paper provides a review of the types of emerging organic groundwater contaminants (EGCs) which are beginning to be found in the UK. EGCs are compounds being found in groundwater that were previously not detectable or known to be significant and can come from agricultural, urban and rural point sources. EGCs include nanomaterials, pesticides, pharmaceuticals, industrial compounds, personal care products, fragrances, water treatment by-products, flame retardants and surfactants, as well a...

  17. [Assessment of a transfusion emergent risk: the case of HEV].

    Science.gov (United States)

    Pillonel, J; Gallian, P; Sommen, C; Couturier, E; Piquet, Y; Djoudi, R; Laperche, S

    2014-11-01

    The risk assessment for blood transfusion is an essential step that must precede any screening strategy of a pathogen transmitted by transfusion. After several cases of HEV transmission by transfusion in France, a risk assessment for this virus was performed. We used a method based on the prevalence of HEV-RNA in plasmas collected for the preparation of SD-plasma. To estimate the rate of HEV-RNA positive among all blood donations, data on SD-plasma were adjusted on the following HEV risk factors: gender, age group and region of residence. We assumed that HEV risk factors were the same in plasma donors and whole blood donors. Among 57,101 plasma donations tested for HEV-RNA in 2013, 24 were positive (crude rate of 4.2 per 10,000 donations). After adjustment, the total number of HEV-RNA positive blood donations was estimated at 788, accounting for a rate of 2.65 per 10,000 donations (95% CI: 1.6-3.7) or 1 in 3800 donations (1 in 6,200-1 in 2,700). This rate was 12 times higher in men than in women, increased with age, and varied according to region of residence. The risk of blood donation contamination by HEV has been estimated to be 1 in 3800 donations in 2013. An essential input is still missing to assess now the risk in recipients: the minimum infectious dose. Furthermore, the risk in recipients has to be analyzed according to characteristics of transfused patients: presence of anti-HEV immunity, existence of chronic liver disease or immunodeficiency. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  18. Teen options for change: an intervention for young emergency patients who screen positive for suicide risk.

    Science.gov (United States)

    King, Cheryl A; Gipson, Polly Y; Horwitz, Adam G; Opperman, Kiel J

    2015-01-01

    Previous research has documented the feasibility of screening in emergency departments for adolescent suicide risk. This randomized trial examined the effectiveness of Teen Options for Change (TOC), an intervention for adolescents seeking general medical emergency services who screen positive for suicide risk. Participants were 49 youths, ages 14 to 19, seeking services for nonpsychiatric emergencies. They screened positive for suicide risk because of recent suicidal ideation, suicide attempt, or depression plus substance abuse. Youths were randomly assigned to the TOC intervention or to enhanced treatment as usual. Depression, hopelessness, and suicidal ideation were assessed at baseline and two months later. Adolescents assigned to TOC showed greater reductions in depression than adolescents assigned to the comparison group (Cohen's d=1.07, a large effect size). Hopelessness, suicidal ideation, and substance abuse outcomes trended positively (nonsignificantly), with small to moderate effect sizes. TOC may be a promising, brief intervention for adolescents seeking emergency services and at risk of suicide.

  19. Survey on methodologies in the risk assessment of chemical exposures in emergency response situations in Europe

    DEFF Research Database (Denmark)

    Heinälä, Milla; Gundert-Remy, Ursula; Wood, Maureen Heraty

    2013-01-01

    A scientifically sound assessment of the risk to human health resulting from acute chemical releases is the cornerstone for chemical incident prevention, preparedness and response. Although the general methodology to identify acute toxicity of chemicals has not substantially changed in the last....../corrosive chemicals will remain serious risks also in future the development of plausible scenarios for potential emerging risks is also needed. This includes risks from new mixtures and chemicals (e.g. nanoparticles)....

  20. Profiles of Emergent Literacy Skills among Preschool Children Who Are at Risk for Academic Difficulties

    Science.gov (United States)

    Cabell, Sonia Q.; Justice, Laura M.; Konold, Timothy R.; McGinty, Anita S.

    2011-01-01

    The purpose of this study was to explore patterns of within-group variability in the emergent literacy skills of preschoolers who are at risk for academic difficulties. We used the person-centered approach of cluster analysis to identify profiles of emergent literacy skills, taking into account both oral language and code-related skills.…

  1. International legal framework for geoengineering: Managing the risks of an emerging technology

    NARCIS (Netherlands)

    Du, Haomiao

    2016-01-01

    The present book “International Legal Framework for Geoengineering – Managing the Risks of an Emerging Technology” is about international law and an emerging technology called geoengineering, which refers to the large-scale manipulation of the planetary environment for counteracting anthropogenic

  2. 12 CFR 370.8 - Systemic risk emergency special assessment to recover loss.

    Science.gov (United States)

    2010-01-01

    ... recover loss. 370.8 Section 370.8 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION REGULATIONS AND STATEMENTS OF GENERAL POLICY TEMPORARY LIQUIDITY GUARANTEE PROGRAM § 370.8 Systemic risk emergency special... temporary liquidity guarantee program, the Corporation shall impose an emergency special assessment on...

  3. Emerging contaminants: Presentations at the 2009 Toxicology and Risk Assessment Conference

    International Nuclear Information System (INIS)

    Murnyak, George; Vandenberg, John; Yaroschak, Paul J.; Williams, Larry; Prabhakaran, Krishnan; Hinz, John

    2011-01-01

    A session entitled 'Emerging Contaminants' was held in April 2009 in Cincinnati, OH at the 2009 Toxicology and Risk Assessment Conference. The purpose of the session was to share information on both programmatic and technical aspects associated with emerging contaminants. Emerging contaminants are chemicals or materials that are characterized by a perceived or real threat to human health or environment, a lack of published health standards or an evolving standard. A contaminant may also be 'emerging' because of the discovery of a new source, a new pathway to humans, or a new detection method or technology. The session included five speakers representing the Department of Defense (DoD), the Environmental Protection Agency (EPA), and each of the military services. The DoD created the Emerging Contaminant Directorate to proactively address environmental, health, and safety concerns associated with emerging contaminants. This session described the scan-watch-action list process, impact assessment methodology, and integrated risk management concept that DoD has implemented to manage emerging contaminants. EPA presented emerging trends in health risk assessment. Researchers made technical presentations on the status of some emerging contaminates in the assessment process (i.e. manganese, RDX, and naphthalene).

  4. 76 FR 63308 - Data and Data Needs To Advance Risk Assessment for Emerging Infectious Diseases Relevant to Blood...

    Science.gov (United States)

    2011-10-12

    ...] Data and Data Needs To Advance Risk Assessment for Emerging Infectious Diseases Relevant to Blood and... Needs to Advance Risk Assessment for Emerging Infectious Diseases Relevant to Blood and Blood Products... an important tool for evaluating the risks associated with new emerging infectious diseases (EIDs...

  5. Theory-based approaches to understanding public emergency preparedness: implications for effective health and risk communication.

    Science.gov (United States)

    Paek, Hye-Jin; Hilyard, Karen; Freimuth, Vicki; Barge, J Kevin; Mindlin, Michele

    2010-06-01

    Recent natural and human-caused disasters have awakened public health officials to the importance of emergency preparedness. Guided by health behavior and media effects theories, the analysis of a statewide survey in Georgia reveals that self-efficacy, subjective norm, and emergency news exposure are positively associated with the respondents' possession of emergency items and their stages of emergency preparedness. Practical implications suggest less focus on demographics as the sole predictor of emergency preparedness and more comprehensive measures of preparedness, including both a person's cognitive stage of preparedness and checklists of emergency items on hand. We highlight the utility of theory-based approaches for understanding and predicting public emergency preparedness as a way to enable more effective health and risk communication.

  6. The cyanobacteria toxins, microcystins – emerging risks to human health

    Science.gov (United States)

    Dialysis patients appear to be at increased risk for exposure to cyanobacteria toxins; episodes of microcystin (MCYST) exposure via dialysate during 1996 and 2001 have been previously reported. During 2001, as many as 44 renal insufficiency patients were exposed to contaminated d...

  7. Sovereign risk and macroeconomic fluctuations in an emerging market economy

    NARCIS (Netherlands)

    Kirchner, M.; Rieth, M.

    2010-01-01

    This paper assesses the role of sovereign risk in explaining macroeconomic fluctuations in Turkey. We estimate two versions of a simple New Keynesian small open economy model on quarterly data for the period 1994Q3-2008Q2: a basic version and a version augmented by a default premium on government

  8. Opium; an emerging risk factor for gastric adenocarcinoma

    Science.gov (United States)

    Shakeri, Ramin; Malekzadeh, Reza; Etemadi, Arash; Nasrollahzadeh, Dariush; Aghcheli, Karim; Sotoudeh, Masoud; Islami, Farhad; Pourshams, Akram; Pawlita, Michael; Boffetta, Paolo; Dawsey, Sanford M.; Abnet, Christian C.; Kamangar, Farin

    2013-01-01

    Opium use has been associated with higher risk of cancers of the esophagus, bladder, larynx, and lung; however, no previous study has examined its association with gastric cancer. There is also little information on the associations between hookah (water pipe) smoking or the chewing of tobacco products and the risk of gastric cancer. In a case-control study in Golestan Province of Iran, we enrolled 309 cases of gastric adenocarcinoma (118 noncardia, 161 cardia, and 30 mixed-location adenocarcinomas) and 613 matched controls. Detailed information on long-term use of opium, tobacco products, and other covariates were collected using structured and validated lifestyle and food frequency questionnaires. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were obtained using conditional logistic regression models. Opium use was associated with an increased risk of gastric adenocarcinoma, with an adjusted OR (95% CI) of 3.1 (1.9 – 5.1), and this increased risk was apparent for both anatomic subsites (cardia and noncardia). There was a dose-response effect, and individuals with the highest cumulative opium use had the strongest association (OR: 4.5; 95%CI: 2.3-8.5). We did not find a statistically significant association between the use of any of the tobacco products and risk of gastric adenocarcinoma, overall or by anatomic subsite. We showed, for the first time, an association between opium use and gastric adenocarcinoma. Given that opium use is a traditional practice in many parts of the world, these results are of public health significance. PMID:23319416

  9. Opium: an emerging risk factor for gastric adenocarcinoma.

    Science.gov (United States)

    Shakeri, Ramin; Malekzadeh, Reza; Etemadi, Arash; Nasrollahzadeh, Dariush; Aghcheli, Karim; Sotoudeh, Masoud; Islami, Farhad; Pourshams, Akram; Pawlita, Michael; Boffetta, Paolo; Dawsey, Sanford M; Abnet, Christian C; Kamangar, Farin

    2013-07-15

    Opium use has been associated with higher risk of cancers of the esophagus, bladder, larynx, and lung; however, no previous study has examined its association with gastric cancer. There is also little information on the associations between hookah (water pipe) smoking or the chewing of tobacco products and the risk of gastric cancer. In a case-control study in Golestan Province of Iran, we enrolled 309 cases of gastric adenocarcinoma (118 noncardia, 161 cardia and 30 mixed-location adenocarcinomas) and 613 matched controls. Detailed information on long-term use of opium, tobacco products and other covariates were collected using structured and validated lifestyle and food frequency questionnaires. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were obtained using conditional logistic regression models. Opium use was associated with an increased risk of gastric adenocarcinoma, with an adjusted OR (95% CI) of 3.1 (1.9-5.1), and this increased risk was apparent for both anatomic subsites (cardia and noncardia). There was a dose-response effect, and individuals with the highest cumulative opium use had the strongest association (OR: 4.5; 95% CI: 2.3-8.5). We did not find a statistically significant association between the use of any of the tobacco products and risk of gastric adenocarcinoma, overall or by anatomic subsite. We showed, for the first time, an association between opium use and gastric adenocarcinoma. Given that opium use is a traditional practice in many parts of the world, these results are of public health significance. Copyright © 2013 UICC.

  10. Physicians' and nurses' perceptions of patient safety risks in the emergency department.

    Science.gov (United States)

    Källberg, Ann-Sofie; Ehrenberg, Anna; Florin, Jan; Östergren, Jan; Göransson, Katarina E

    2017-07-01

    The emergency department has been described as a high-risk area for errors. It is also known that working conditions such as a high workload and shortage off staff in the healthcare field are common factors that negatively affect patient safety. A limited amount of research has been conducted with regard to patient safety in Swedish emergency departments. Additionally, there is a lack of knowledge about clinicians' perceptions of patient safety risks. Therefore, the purpose of this study was to describe emergency department clinicians' experiences with regard to patient safety risks. Semi-structured interviews were conducted with 10 physicians and 10 registered nurses from two emergency departments. Interviews were analysed by inductive content analysis. The experiences reflect the complexities involved in the daily operation of a professional practice, and the perception of risks due to a high workload, lack of control, communication and organizational failures. The results reflect a complex system in which high workload was perceived as a risk for patient safety and that, in a combination with other risks, was thought to further jeopardize patient safety. Emergency department staff should be involved in the development of patient safety procedures in order to increase knowledge regarding risk factors as well as identify strategies which can facilitate the maintenance of patient safety during periods in which the workload is high. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Seroprevalence of arboviruses among blood donors in French Polynesia, 2011–2013

    Directory of Open Access Journals (Sweden)

    Maite Aubry

    2015-12-01

    Conclusions: These results corroborate the expected high transmission of DENV and conversely suggest that no active circulation of ZIKV, JEV, and WNV occurred in French Polynesia before 2011. Information provided by this study may be useful for public health authorities to improve surveillance and implement strategies to prevent the transmission of arboviruses.

  12. Mosquito-borne Arbovirus Surveillance at Selected Sites in Diverse Ecological Zones of Kenya 2007 -- 2012

    Science.gov (United States)

    2013-05-10

    and pooled (1 to 25 mosquitoes per pool) by species, sex and collection sites using mosquito identification keys by [23-26] and preserved in 1.5 ml...reference and research on arboviruses and haemorrhagic fever viruses. Dakar, Senegal: Institut Pasteur de Dakar; 2000. 8. Kalunda M, Lwanga-Ssozi C

  13. Modelling the effects of past and future climate on the risk of bluetongue emergence in Europe

    Science.gov (United States)

    Guis, Helene; Caminade, Cyril; Calvete, Carlos; Morse, Andrew P.; Tran, Annelise; Baylis, Matthew

    2012-01-01

    Vector-borne diseases are among those most sensitive to climate because the ecology of vectors and the development rate of pathogens within them are highly dependent on environmental conditions. Bluetongue (BT), a recently emerged arboviral disease of ruminants in Europe, is often cited as an illustration of climate's impact on disease emergence, although no study has yet tested this association. Here, we develop a framework to quantitatively evaluate the effects of climate on BT's emergence in Europe by integrating high-resolution climate observations and model simulations within a mechanistic model of BT transmission risk. We demonstrate that a climate-driven model explains, in both space and time, many aspects of BT's recent emergence and spread, including the 2006 BT outbreak in northwest Europe which occurred in the year of highest projected risk since at least 1960. Furthermore, the model provides mechanistic insight into BT's emergence, suggesting that the drivers of emergence across Europe differ between the South and the North. Driven by simulated future climate from an ensemble of 11 regional climate models, the model projects increase in the future risk of BT emergence across most of Europe with uncertainty in rate but not in trend. The framework described here is adaptable and applicable to other diseases, where the link between climate and disease transmission risk can be quantified, permitting the evaluation of scale and uncertainty in climate change's impact on the future of such diseases. PMID:21697167

  14. Comparable risk of childhood asthma after vaginal delivery and emergency caesarean section.

    Science.gov (United States)

    Brix, Nis; Stokholm, Lonny; Jonsdottir, Fjola; Kristensen, Kim; Secher, Niels Jørgen

    2017-01-01

    Caesarean section is thought to be a risk factor for childhood asthma, but this association may be caused by confounding from, for instance, familial factors. To address this problem, we used twin pairs to assess the risk of childhood asthma after emergency caesarean section. The study was a register-based nation-wide matched cohort study using twin pairs to minimise residual confounding. Included were twin pairs in which the first twin was delivered vaginally and the second by emergency caesarean section during the study period from January 1997 through December 2012. In total, 464 twin pairs (928 twins) were included. In 30 pairs, the first twin (vaginal delivery) was diagnosed with asthma, but the second twin (emergency caesarean section) was not. In 20 pairs, the second twin (emergency caesarean section) was diagnosed with asthma, but the first twin (vaginal delivery) was not. In 11 pairs, both twins developed asthma. In the unadjusted analysis, emergency caesarean section did not affect the risk of asthma (odds ratio = 0.67 (95% confidence interval: 0.38-1.17); p = 0.16). After adjusting for birth weight, gender, umbilical cord pH, Apgar score at 5 min. and neonatal respiratory morbidity, the risk of childhood asthma following emergency caesarean section remained unchanged. Emergency caesarean section was not associated with childhood asthma. none. not relevant.

  15. Microbiological Zoonotic Emerging Risks, Transmitted Between Livestock Animals and Humans (2007-2015).

    Science.gov (United States)

    Filippitzi, M E; Goumperis, T; Robinson, T; Saegerman, C

    2017-08-01

    As part of the Emerging Risk Identification (ERI) activities of the European Food Safety Authority (EFSA), a literature search was conducted to identify the microbiological agents transmitted between livestock animals and humans that have been suggested as having emerged between 2007 and 2015 in peer-reviewed scientific literature published during the same period (2007-2015). According to the criteria set, the search identified seven such zoonotic agents, namely West Nile Fever virus, Rift Valley Fever virus, Crimean-Congo Haemorrhagic Fever virus, Influenza A H1N1 virus, Coxiella burnetii, Streptococcus suis and livestock-associated methicillin-resistant Staphylococcus aureus clonal complex 398. An explanation of the agents' consideration as emerging risks is provided. The experience gained from these emergences has shown that the detection of and response to such risks can be achieved faster and more successfully within a multidisciplinary, collaborative context at the field, local, national and international levels. © 2016 Blackwell Verlag GmbH.

  16. Worker, workplace, and community/environmental risk factors for workplace violence in emergency departments.

    Science.gov (United States)

    Gillespie, Gordon Lee; Pekar, Bunnany; Byczkowski, Terri L; Fisher, Bonnie S

    2017-03-04

    Workplace violence committed by patients and visitors has high propensity to occur against emergency department employees. This article reports the association of worker, workplace, and community/environmental factors with violence risks. A cross-sectional research design was used with 280 employees from six emergency departments in the Midwest United States. Respondents completed the Survey of Violence Experienced by Staff and a 10-item demographic questionnaire. Data were analyzed using frequencies, percentages, Chi-square tests, and adjusted relative risks with 95% confidence intervals. Over 80% of respondents experienced at least one type of workplace violence with their current employer and approximately 40% experienced all three types. Risks for workplace violence were significantly higher for registered nurses and hospital-based emergency departments. Workplace violence can impact all employees in the emergency department regardless of worker, workplace, and community/environmental factors.

  17. Safety vs. reputation: risk controversies in emerging policy networks regarding school safety in the Netherlands

    NARCIS (Netherlands)

    Binkhorst, J.; Kingma, S.F.

    2012-01-01

    This article deals with risk controversies in emerging policy networks regarding school safety in the Netherlands. It offers a grounded account of the interpretations of school risks and safety measures by the various stakeholders of the policy network, in particular, schools, local government and

  18. L-061: EPR--First responders: Risk and Protection radiological emergency

    International Nuclear Information System (INIS)

    2011-01-01

    This conference is about the basic risks, protection and the consequences in a radiological emergency. The first responders have to know the deterministic and stochastic effects in the health as well as the cancer risk due of the high radioactive doses exposure

  19. Risk factors associated with visiting or not visiting the accident & emergency department after a fall

    NARCIS (Netherlands)

    Scheffer, Alice C.; van Hensbroek, Pieter Boele; van Dijk, Nynke; Luitse, Jan S. K.; Goslings, Johannes C.; Luigies, René H.; de Rooij, Sophia E.

    2013-01-01

    Little is known about the prevalence of modifiable risk factors of falling in elderly persons with a fall-history who do not visit the Accident and Emergency (A&E) Department after one or more falls. The objective of this study was to determine the prevalence of modifiable risk factors in a

  20. Risk perception of different emergencies in a sample of European firefighters.

    Science.gov (United States)

    Prati, Gabriele; Pietrantoni, Luca; Saccinto, Elisa; Kehl, Doris; Knuth, Daniela; Schmidt, Silke

    2013-01-01

    Firefighters frequently incur injuries while providing emergency services. Risk perception has been found to be associated with injury and safety behavior. This study examined risk perception of different emergency situations among firefighters. Along with risk perceptions, we investigated the role of practical experience, perceived training, tenure, and acute stress related to different emergency situations. Participants were a sample of 1324 firefighters from Germany and Italy. A questionnaire was administered to participants on risk perceptions, practical experience, perceived training, tenure, and acute stress. The results showed that different levels of risk perception are related to different practical experience, acute stress reactions, and training. Higher risk perception was associated with higher perceived training, practical experience, and acute stress reactions. A significant difference was found between the German and the Italian sample in risk perceptions. More specifically the Italian sample perceived disasters (e.g., earthquakes) as more risky. Moreover, there were some differences in perceived training and practical experience about the different emergency situations, in the two samples. The results underline the importance of considering organizational factors in the prediction of risk perception among firefighters.

  1. Opium use: an emerging risk factor for cancer?

    Science.gov (United States)

    Kamangar, Farin; Shakeri, Ramin; Malekzadeh, Reza; Islami, Farhad

    2014-02-01

    An estimated 16·5 million people worldwide illicitly use opiates, of whom 4 million use raw opium. We did a systematic review to investigate the association between opium use and cancer incidence and mortality. Opium use was associated with an increased risk of cancers of the oesophagus, stomach, larynx, lung, and urinary bladder. Although the present evidence suggests that these associations are possibly causal, further epidemiological studies (particularly prospective studies that collect detailed data about lifetime opium use and control for a broad range of potential confounders) are needed. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Rates of Delirium Diagnosis Do Not Improve with Emergency Risk Screening: Results of the Emergency Department Delirium Initiative Trial.

    Science.gov (United States)

    Arendts, Glenn; Love, Jennefer; Nagree, Yusuf; Bruce, David; Hare, Malcolm; Dey, Ian

    2017-08-01

    To determine whether a bundled risk screening and warning or action card system improves formal delirium diagnosis and person-centered outcomes in hospitalized older adults. Prospective trial with sequential introduction of screening and interventional processes. Two tertiary referral hospitals in Australia. Individuals aged 65 and older presenting to the emergency department (ED) and not requiring immediate resuscitation (N = 3,905). Formal ED delirium screening algorithm and use of a risk warning card with a recommended series of actions for the prevention and management of delirium during the subsequent admission MEASUREMENTS: Delirium diagnosis at hospital discharge, proportion discharged to new assisted living arrangements, in-hospital complications (use of sedation, falls, aspiration pneumonia, death), hospital length of stay. Participants with a positive risk screen were significantly more likely (relative risk = 6.0, 95% confidence interval = 4.9-7.3) to develop delirium, and the proportion of at-risk participants with a positive screen was constant across three study phases. Delirium detection rate in participants undergoing the final intervention (Phase 3) was 12.1% (a 2% absolute and 17% relative increase from the baseline rate) but this was not statistically significant (P = .29), and a similar relative increase was seen over time in participants not receiving the intervention CONCLUSION: A risk screening and warning or action card intervention in the ED did not significantly improve rates of delirium detection or other important outcomes. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  3. Exploring risk profiles and emergency frequency of purchasers and non-purchasers of personal emergency alarms: a prospective cohort study.

    Science.gov (United States)

    De San Miguel, Kristen; Lewin, Gill; Burton, Elissa; Toye, Christine; Boldy, Duncan; Howat, Peter

    2015-10-27

    Personal alarms support independent living and have the potential to reduce serious consequences after a fall or during a medical emergency. While some Australian states have government funded personal alarm programs, others do not; but user-pays services are available. Although several studies have examined the profiles of alarm users, little is known about the risk profile of non-users. Specifically, whether there are "at risk" individuals who are unable, or choose not to purchase a service, who experience a home-based emergency in which an alarm could have mitigated an adverse outcome. This study aimed to describe the 'risk profile' of purchasers and non-purchasers of alarms; explore the reasons behind the decision to purchase or not to purchase and identify how often emergency assistance was needed and why. Purchasers and non-purchasers were followed for one year in this prospective cohort study. Demographic, decision-making and risk factor data were collected at an initial face-to-face interview, while information about emergencies was collected by monthly calls. One hundred and fifty-seven purchasers and sixty-five non-purchasers completed the study. The risk profiles between the groups were similar in terms of gender, living arrangements, fall history and medical conditions. Purchasers (Mean = 82.6 years) were significantly older than non-purchasers (Mean = 79.3 years), (t(220) = -3.38, p = 0.000) and more functionally dependent on the IADL (z = -2.57, p = 0.010) and ADL (z = -2.45 p = 0.014) function scores. Non-purchasers (Mean = 8.04, SD = 3.57) were more socially isolated with significantly fewer family networks than purchasers (Mean = 9.46, SD = 3.25) (t(220) = -2.86, p = 0.005). Both groups experienced similarly high numbers of emergencies, 38.2 % of purchasers and 41.5 % of non-purchasers had at least one emergency where an alarm could have assisted. Main reasons for non-purchase were: cost (77 %), limited alarm range (51 %), no need (39 %) and lack

  4. Emerging Politics of Authorship: Recovering Collectivity, Negotiating the Risk

    Directory of Open Access Journals (Sweden)

    Andrea Pisac

    2011-12-01

    Full Text Available This article examines authorship as a socially embedded process by challenging Western notions of the autonomous creative genius. It considers social interactions between various agents in the field of literary production which in turn recovers the collective nature of modern authorship. Far from leaving it unexamined, it further contextualises authorial collectivity and its role in the emerging model of authorship. Questions and arguments raised in this article are informed by the ethnographic data collected during my doctoral research focusing on the reception of post-1990s ex-Yugoslav literature on the UK book market. Such ethnographic approach to literary translations – i.e. the micro-level analysis of social interactions that ‘create’ literature – demonstrated how the author is ‘created’ in the communication of two literary systems through linguistic translation as well as re-translations of symbolic and social capitals. My research was concerned with analysing the ‘backstage’ of the publishing industry – informal networks and international literary geopolitics – which all contributed to debunking the myth of the autonomous creative genius. However, instead of retracing my steps, this article outlines new avenues and questions that such analysis has opened up. One such question is how new technologies are (reconstructing and (repositioning the role of the author.

  5. Management of acute paracetamol (acetaminophen) toxicity: a standardised proforma improves risk assessment and overall risk stratification by emergency medicine doctors.

    Science.gov (United States)

    McQuade, David J; Aknuri, Srikanth; Dargan, Paul I; Wood, David M

    2012-12-01

    Paracetamol (acetaminophen) poisoning is the most common toxicological presentation in the UK. Doctors managing patients with paracetamol poisoning need to assess the risk of their patient developing hepatotoxicity before determining appropriate treatment. Patients deemed to be at 'high risk' of hepatotoxicity have lower treatment thresholds than those deemed to be at 'normal risk'. Errors in this process can lead to harmful or potentially fatal under or over treatment. To determine how well treating doctors assess risk factor status and whether a standardised proforma is useful in the risk stratification process. Retrospective 12-month case note review of all patients presenting with paracetamol poisoning to our large inner-city emergency department. Data were collected on the documentation of risk factors, the presence of a local hospital proforma and treatment outcomes. 249 presentations were analysed and only 59 (23.7%) had full documentation of all the risk factors required to make a complete risk assessment. 56 of the 59 (94.9%) had the local hospital proforma included in the notes; the remaining 3 (5.1%) had full documentation of risk factors despite the absence of a proforma. A local hospital proforma was more likely to be included in the emergency department notes in those with 'adequate documentation' (78 out of 120 (65%)) than for those with 'inadequate documentation' (16 out of 129 (12.4%)); X(2), pparacetamol poisoning.

  6. A Comparative Analysis of Value at Risk Measurement on Emerging Stock Markets: Case of Montenegro

    Directory of Open Access Journals (Sweden)

    Cerović Julija

    2015-03-01

    Full Text Available Background: The concept of value at risk gives estimation of the maximum loss of financial position at a given time for a given probability. The motivation for this analysis lies in the desire to devote necessary attention to risks in Montenegro, and to approach to quantifying and managing risk more thoroughly. Objectives: This paper considers adequacy of the most recent approaches for quantifying market risk, especially of methods that are in the basis of extreme value theory, in Montenegrin emerging market before and during the global financial crisis. In particular, the purpose of the paper is to investigate whether extreme value theory outperforms econometric and quantile evaluation of VaR in emerging stock markets such as Montenegrin market. Methods/Approach: Daily return of Montenegrin stock market index MONEX20 is analyzed for the period January, 2004 - February, 2014. Value at Risk results based on GARCH models, quantile estimation and extreme value theory are compared. Results: Results of the empirical analysis show that the assessments of Value at Risk based on extreme value theory outperform econometric and quantile evaluations. Conclusions: It is obvious that econometric evaluations (ARMA(2,0- GARCH(1,1 and RiskMetrics proved to be on the lower bound of possible Value at Risk movements. Risk estimation on emerging markets can be focused on methodology using extreme value theory that is more sophisticated as it has been proven to be the most cautious model when dealing with turbulent times and financial turmoil.

  7. Risk analysis of emergent water pollution accidents based on a Bayesian Network.

    Science.gov (United States)

    Tang, Caihong; Yi, Yujun; Yang, Zhifeng; Sun, Jie

    2016-01-01

    To guarantee the security of water quality in water transfer channels, especially in open channels, analysis of potential emergent pollution sources in the water transfer process is critical. It is also indispensable for forewarnings and protection from emergent pollution accidents. Bridges above open channels with large amounts of truck traffic are the main locations where emergent accidents could occur. A Bayesian Network model, which consists of six root nodes and three middle layer nodes, was developed in this paper, and was employed to identify the possibility of potential pollution risk. Dianbei Bridge is reviewed as a typical bridge on an open channel of the Middle Route of the South to North Water Transfer Project where emergent traffic accidents could occur. Risk of water pollutions caused by leakage of pollutants into water is focused in this study. The risk for potential traffic accidents at the Dianbei Bridge implies a risk for water pollution in the canal. Based on survey data, statistical analysis, and domain specialist knowledge, a Bayesian Network model was established. The human factor of emergent accidents has been considered in this model. Additionally, this model has been employed to describe the probability of accidents and the risk level. The sensitive reasons for pollution accidents have been deduced. The case has also been simulated that sensitive factors are in a state of most likely to lead to accidents. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Emerging technologies in educational institutions: assets and potential risks

    Directory of Open Access Journals (Sweden)

    François Victor Tochon

    2012-12-01

    Full Text Available This article is a review of some aspects of research on electronic portfolios with a critical analysis of the pros and cons of the invasive use of new technologies for education. Besides the creation and conceptual composition of educative portfolios that help teachers grow professionnally, this instrument implies a formatting around artifacts posited as proofs of competence, which support an uncritical realist ontology that has its limitations. Thus networked learning and personal learning environments stimulate reflective teacher learning, but possibly lead portfolio users to confuse the indicator of performance with the actual competence. Portfolio creation takes much time on other activities that could be most beneficial (and could be complementary, such as shared reflection on personal belief systems. Universalist stands and standardisation seem to take the fore while educative humane value go back stage. The new wave of distance learning creates new risks in terms of depth and quality as well as health, related to the daily use of pulsed microwaves and radio frequencies. It is suggested that a mode of control independent from the financial milieux that capitalize on these innovations should be created.

  9. Identifying Factors Associated with Risk Assessment Competencies of Public Health Emergency Responders.

    Science.gov (United States)

    Hao, Jiejing; Ren, Jiaojiao; Wu, Qunhong; Hao, Yanhua; Sun, Hong; Ning, Ning; Ding, Ding

    2017-06-04

    This study aimed to better understand the current situation of risk assessment and identify the factors associated with competence of emergency responders in public health risk assessment. The participants were selected by a multi-stage, stratified cluster sampling method in Heilongjiang Centers for Disease Control and Prevention (CDC). The questionnaires that measured their perceptions on risk assessment competences were administered through the face-to-face survey. A final sample of 1889 staff was obtained. Of this sample, 78.6% of respondents rated their own risk assessment competences as "relatively low", contrasting with 21.4% rated as "relatively high". Most of the respondents (62.7%) did not participate in any risk assessment work. Only 13.7% and 42.7% of respondents reported participating in risk assessment training and were familiar with risk assessment tools. There existed statistical significance between risk assessment-related characteristics of respondents and their self-rated competences scores. Financial support from the government and administrative attention were regarded as the important factors contributing to risk assessment competences of CDC responders. Higher attention should be given to risk assessment training and enhancing the availability of surveillance data. Continuous efforts should be made to remove the financial and technical obstacles to improve the competences of risk assessment for public health emergency responders.

  10. An emergency department intervention to protect an overlooked group of children at risk of significant harm.

    LENUS (Irish Health Repository)

    Kaye, P

    2012-02-01

    BACKGROUND: Parental psychiatric disorder, especially depression, personality disorder and deliberate self-harm, is known to put children at greater risk of mental illness, neglect or physical, emotional and sexual abuse. Without a reliable procedure to identify children of parents presenting with these mental health problems, children at high risk of significant harm can be easily overlooked. Although deliberate self-harm constitutes a significant proportion of emergency presentations, there are no guidelines which address the emergency physician\\'s role in identifying and assessing risk to children of these patients. METHODS: A robust system was jointly developed with the local social services child protection team to identify and risk-stratify children of parents with mental illness. This allows us to intervene when we identify children at immediate risk of harm and to ensure that social services are aware of potential risk to all children in this group. The referral process was audited repeatedly to refine the agreed protocol. RESULTS: The proportion of patients asked by the emergency department personnel about dependent children increased and the quality of information received by the social services child protection team improved. CONCLUSIONS: All emergency departments should acknowledge the inadequacy of information available to them regarding patients\\' children and consider a policy of referral to social services for all children of parents with mental health presentations. This process can only be developed through close liaison within the multidisciplinary child protection team.

  11. Incorporating emergency evacuation planning, through human reliability analysis, in the risk management of industrial installation

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Isaac J.A. Luquetti; Carvalho, Paulo V.R.; Grecco, Claudio H.S. [Instituto de Engenharia Nuclear (IEN/CNEN-RJ), Rio de Janeiro, RJ (Brazil)], Email: luquetti@ien.gov.br

    2009-07-01

    An industrial installation presents many risks in the form of the process hazards, such as fire, explosion, gas and radiation release. In these situations, workers may need to evacuate from the work environment as soon as possible. In this case, the emergency evacuation planning is a key element that involves an iterative process to identify the best evacuation routes and to estimate the time required to evacuate the area at risk. The mean aspects for a successful emergency evacuation are influenced by the type of human error and the severity of the initiator event. The aim of this paper is to present a methodological framework for the identification of the performance shaping factors and prediction of human error probabilities of the responsible by the emergency evacuation of the workers in an industrial installation, providing a proactive approach for the allocation of the human factors in the risk assessment of the industrial installation. (author)

  12. Emergency-Dependent Supply Decisions with Risk Perception and Price Control

    Directory of Open Access Journals (Sweden)

    Shaofu Du

    2014-01-01

    Full Text Available This paper studies the impact of emergencies on the supplier’s decision-making behaviors including production and information sharing in consideration of consumer risk perception, consumer loss aversion phenomenon, and government price control. The intensity of emergencies is sequential and emergencies can be divided into two types (positive or negative according to their effect on demand. When emergencies have negative effect on demand, the supplier’s sales will reduce and he would share information to the market. When emergencies have positive effect on demand, we find that when the price is under price cap the supplier will not share information to the market; when the price reaches price cap, the supplier will share a certain amount of information to the market. We were surprised to find that increasing demand is not always good for the supplier when there exist government price control and lost sales penalty, and information helps the supplier to effectively manipulate demand.

  13. Vulnerability and social justice as factors in emergent U.S. nanotechnology risk perceptions.

    Science.gov (United States)

    Conti, Joseph; Satterfield, Terre; Harthorn, Barbara Herr

    2011-11-01

    As an emerging domain of risk research, nanotechnologies engender novel research questions, including how new technologies are encountered given different framing and contextual detail. Using data from a recent U.S. national survey of perceived risks (N= 1,100), risk versus benefit framings and the specific social positions from which people encounter or perceive new technologies are explored. Results indicate that vulnerability and attitudes toward environmental justice significantly influenced risk perceptions of nanotechnology as a broad class, while controlling for demographic and affective factors. Comparative analyses of different examples of nanotechnology applications demonstrated heightened ambivalence across acceptability when risk versus benefit information was provided with application descriptions (described in short vignettes as compared to the general category "nanotechnology," absent of risk or benefit information). The acceptability of these nano-specific vignettes varied significantly in only some cases given indexes of vulnerability and attitudes toward environmental justice. However, experimental narrative analyses, using longer, more comprehensive descriptive passages, show how assessments of risks and benefits are tied to the systematically manipulated psychometric qualities of the application (its invasiveness and controllability), risk messaging from scientists, and the social implications of the technology with regard to justice. The article concludes with discussion of these findings for risk perception research and public policy related to nanotechnology and possibly other emerging technologies. © 2011 Society for Risk Analysis.

  14. Agricultural production - Phase 2. Indonesia. Isolation of arboviruses, their identification and the identification of their culicoides vectors in Indonesia

    International Nuclear Information System (INIS)

    Mellor, P.S.

    1991-01-01

    The aims of the two-week mission were to provide assistance in studies to determine the incidence and importance of arbovirus infection in ruminants in Indonesia, specifically to help with identification of the vectors tat transmit bluetongue and related arbovirus infections, and to develop work plans for future studies under the project. The report contains detailed information on handling systems for Culicoides species, on identification of Culicoides to be used for viral isolation and on the isolation of virus from Culicoides

  15. Trade Openness and Bank Risk-Taking Behavior: Evidence from Emerging Economies

    Directory of Open Access Journals (Sweden)

    Badar Nadeem Ashraf

    2017-07-01

    Full Text Available In this paper, we examine the impact of trade openness on bank risk-taking behavior. Using a panel dataset of 291 banks from 37 emerging countries over the period from 1998 to 2012, we find that higher trade openness decreases bank risk-taking. The results are robust when we use alternative bank risk-taking proxies and alternative estimation methods. We argue that trade openness provides diversification opportunities to banks in lending activities, which decrease overall bank risk. Further to this end, we observe that higher trade openness helps domestic banks to smooth out income volatility and decreases the impact of a financial crisis on banks.

  16. Risk assessment model for nuclear accident emergency protection countermeasure based on fuzzy matter-element analysis

    International Nuclear Information System (INIS)

    Xin Jing; Tang Huaqing; Zhang Yinghua; Zhang Limin

    2009-01-01

    A risk assessment model of nuclear accident emergency protection countermeasure based on fuzzy matter-element analysis and Euclid approach degree is proposed in the paper. The weight of assessed index is determined by information entropy and the scoring by experts, which could not only make full use of the inherent information of the indexes adequately, but reduce subjective assumption in the course of assessment effectively. The applied result shows that it is reasonable that the model is adopted to make risk assessment for nuclear accident emergency protective countermeasure,and it could be a kind of effective analytical method and decision making basis to choose the optimum protection countermeasure. (authors)

  17. Risk-Averse Evolutionary Game Model of Aviation Joint Emergency Response

    Directory of Open Access Journals (Sweden)

    Wei Pan

    2016-01-01

    Full Text Available We study effects of risk-averse attitude of both participators in aviation joint emergency response on the coevolution of cooperation mechanisms and individual preferences between airport and nonprofit organization. First, based on the current aviation joint emergency mechanism in China, we put forward two mechanisms to select the joint nonprofit organization, including reputation cooperation and bidding competition. Meanwhile, we consider two preferences including altruism and selfishness. Then we build replicator dynamics equations using the theory of conditional value-at-risk (CVaR taking risk aversion attitude into account. Finally, we introduce the factor of government and give all participators some suggestions. We show that the risk-averse attitude of the other game participator affects the one participator’s decision and the effects subject to some parameters.

  18. Strong compound-risk factors: efficient discovery through emerging patterns and contrast sets.

    Science.gov (United States)

    Li, Jinyan; Yang, Qiang

    2007-09-01

    Odds ratio (OR), relative risk (RR) (risk ratio), and absolute risk reduction (ARR) (risk difference) are biostatistics measurements that are widely used for identifying significant risk factors in dichotomous groups of subjects. In the past, they have often been used to assess simple risk factors. In this paper, we introduce the concept of compound-risk factors to broaden the applicability of these statistical tests for assessing factor interplays. We observe that compound-risk factors with a high risk ratio or a big risk difference have an one-to-one correspondence to strong emerging patterns or strong contrast sets-two types of patterns that have been extensively studied in the data mining field. Such a relationship has been unknown to researchers in the past, and efficient algorithms for discovering strong compound-risk factors have been lacking. In this paper, we propose a theoretical framework and a new algorithm that unify the discovery of compound-risk factors that have a strong OR, risk ratio, or a risk difference. Our method guarantees that all patterns meeting a certain test threshold can be efficiently discovered. Our contribution thus represents the first of its kind in linking the risk ratios and ORs to pattern mining algorithms, making it possible to find compound-risk factors in large-scale data sets. In addition, we show that using compound-risk factors can improve classification accuracy in probabilistic learning algorithms on several disease data sets, because these compound-risk factors capture the interdependency between important data attributes.

  19. Screening for Fall Risks in the Emergency Department: A Novel Nursing-Driven Program

    OpenAIRE

    Huded, Jill M.; Dresden, Scott M.; Gravenor, Stephanie J.; Rowe, Theresa; Lindquist, Lee A.

    2015-01-01

    Introduction: Seniors represent the fasting growing population in the U.S., accounting for 20.3 million visits to emergency departments (EDs) annually. The ED visit can provide an opportunity for identifying seniors at high risk of falls. We sought to incorporate the Timed Up & Go Test (TUGT), a commonly used falls screening tool, into the ED encounter to identify seniors at high fall risk and prompt interventions through a geriatric nurse liaison (GNL) model. Methods: P...

  20. Enhanced arbovirus surveillance with deep sequencing: Identification of novel rhabdoviruses and bunyaviruses in Australian mosquitoes.

    Science.gov (United States)

    Coffey, Lark L; Page, Brady L; Greninger, Alexander L; Herring, Belinda L; Russell, Richard C; Doggett, Stephen L; Haniotis, John; Wang, Chunlin; Deng, Xutao; Delwart, Eric L

    2014-01-05

    Viral metagenomics characterizes known and identifies unknown viruses based on sequence similarities to any previously sequenced viral genomes. A metagenomics approach was used to identify virus sequences in Australian mosquitoes causing cytopathic effects in inoculated mammalian cell cultures. Sequence comparisons revealed strains of Liao Ning virus (Reovirus, Seadornavirus), previously detected only in China, livestock-infecting Stretch Lagoon virus (Reovirus, Orbivirus), two novel dimarhabdoviruses, named Beaumont and North Creek viruses, and two novel orthobunyaviruses, named Murrumbidgee and Salt Ash viruses. The novel virus proteomes diverged by ≥ 50% relative to their closest previously genetically characterized viral relatives. Deep sequencing also generated genomes of Warrego and Wallal viruses, orbiviruses linked to kangaroo blindness, whose genomes had not been fully characterized. This study highlights viral metagenomics in concert with traditional arbovirus surveillance to characterize known and new arboviruses in field-collected mosquitoes. Follow-up epidemiological studies are required to determine whether the novel viruses infect humans. © 2013 Elsevier Inc. All rights reserved.

  1. Volcanic risk and tourism in southern Iceland: Implications for hazard, risk and emergency response education and training

    Science.gov (United States)

    Bird, Deanne K.; Gisladottir, Gudrun; Dominey-Howes, Dale

    2010-01-01

    This paper examines the relationship between volcanic risk and the tourism sector in southern Iceland and the complex challenge emergency management officials face in developing effective volcanic risk mitigation strategies. An early warning system and emergency response procedures were developed for communities surrounding Katla, the volcano underlying the Mýrdalsjökull ice cap. However, prior to and during the 2007 tourist season these mitigation efforts were not effectively communicated to stakeholders located in the tourist destination of Þórsmörk despite its location within the hazard zone of Katla. The hazard zone represents the potential extent of a catastrophic jökulhlaup (glacial outburst flood). Furthermore, volcanic risk mitigation efforts in Þórsmörk were based solely on information derived from physical investigations of volcanic hazards. They did not consider the human dimension of risk. In order to address this gap and provide support to current risk mitigation efforts, questionnaire surveys were used to investigate tourists' and tourism employees' hazard knowledge, risk perception, adoption of personal preparedness measures, predicted behaviour if faced with a Katla eruption and views on education. Results indicate that tourists lack hazard knowledge and they do not adopt preparedness measures to deal with the consequences of an eruption. Despite a high level of risk perception, tourism employees lack knowledge about the early warning system and emergency response procedures. Results show that tourists are positive about receiving information concerning Katla and its hazards and therefore, the reticence of tourism employees with respect to disseminating hazard information is unjustified. In order to improve the tourism sector's collective capacity to positively respond during a future eruption, recommendations are made to ensure adequate dissemination of hazard, risk and emergency response information. Most importantly education campaigns

  2. Incommensurate Environmental Risks and the Regulator’s Dilemma in the Governance of Emergency Situation

    Directory of Open Access Journals (Sweden)

    Vesela Radovic

    2016-12-01

    Full Text Available In the 21st century humans face with the great risk how to protect themselves from disasters of different kinds. Emergencies happened in many countries and caused a great suffering of humans. The main question of stakeholders is: ‘’how to protect human health and environment in an adequate way’’. Emergency management is an issue which is included in numerous education institutions all over the globe and the action of various national and international organizations. Therefore it is interesting that in the process of fostering emergency management many countries neglect the need of creating more effective tools for response, preparedness and recovery in environmental emergencies. The paper is based on analyzes of Serbian approach in the governance of emergency situation followed by incommensurate environmental risks. Serbia had to accept International environmental emergency help after the floods in 2014. The Joint United Nations Environment Programme (UNEP / Office for the Coordination of Humanitarian Affairs (OCHA Environment Unit (JEU helped Serbia to mitigate consequences of horrified environmental emergency in “Stolice” mine near city Krupanj. This assistance was needed because Serbia did not have enough capacity to struggle with the consequences of breaking the dam and contamination of soil and rivers. This study shows that a similar disaster in the future could be solved only by strengthening multilateral response of different actors at local and national level. After all, Serbia is at the beginning of the path, and need to highlight strategic challenges in the governance of emergency situation followed by environmental emergencies. Only with full implementation of positive practice of the international community Serbia could avoid long term impact on life support functions, nature and humans.

  3. Risk Perception of an Emergent Technology: The Case of Hydrogen Energy

    Directory of Open Access Journals (Sweden)

    Rob Flynn

    2006-01-01

    Full Text Available Although hydrogen has been used in industry for many years as a chemical commodity, its use as a fuel or energy carrier is relatively new and expert knowledge about its associated risks is neither complete nor consensual. Public awareness of hydrogen energy and attitudes towards a future hydrogen economy are yet to be systematically investigated. This paper opens by discussing alternative conceptualisations of risk, then focuses on issues surrounding the use of emerging technologies based on hydrogen energy. It summarises expert assessments of risks associated with hydrogen. It goes on to review debates about public perceptions of risk, and in doing so makes comparisons with public perceptions of other emergent technologies—Carbon Capture and Storage (CCS, Genetically Modified Organisms and Food (GM and Nanotechnology (NT—for which there is considerable scientific uncertainty and relatively little public awareness. The paper finally examines arguments about public engagement and "upstream" consultation in the development of new technologies. It is argued that scientific and technological uncertainties are perceived in varying ways and different stakeholders and different publics focus on different aspects or types of risk. Attempting to move public consultation further "upstream" may not avoid this, because the framing of risks and benefits is necessarily embedded in a cultural and ideological context, and is subject to change as experience of the emergent technology unfolds. URN: urn:nbn:de:0114-fqs0601194

  4. Risk-communication capability for public health emergencies varies by community diversity

    Directory of Open Access Journals (Sweden)

    Viswanath Kasisomayajula

    2008-03-01

    Full Text Available Abstract Background Public health emergencies heighten several challenges in risk-communication: providing trustworthy sources of information, reaching marginalized populations, and minimizing fear and public confusion. In emergencies, however, information may not diffuse equally among all social groups, and gaps in knowledge may increase. Such knowledge gaps vary by social structure and the size, socioeconomic status, and diversity of the population. This study explores the relationship between risk-communication capabilities, as perceived by public officials participating in emergency tabletop exercises, and community size and diversity. Findings For each of the three communication functions tested, risk-communication capabilities are perceived to be greater in communities with fewer then 10% of the population speaking a language other than English at home, decreasing as the percentage grows to 20% (ANOVA P ≤ 0.02. With respect to community size, however, we found an N-shaped relationship between perceived risk communication capabilities and population size. Capabilities are perceived highest in the largest communities and lowest in the smallest, but lower in communities with 20,000–49,999 inhabitants compared to those with 2,500–19,999. Conclusion The results of this study suggest the need to factor population diversity into risk communication plans and the need for improved state or regional risk-communication capabilities, especially for communities with limited local capacity.

  5. Converting Mosquito Surveillance to Arbovirus Surveillance with Honey-Baited Nucleic Acid Preservation Cards.

    Science.gov (United States)

    Flies, Emily J; Toi, Cheryl; Weinstein, Philip; Doggett, Stephen L; Williams, Craig R

    2015-07-01

    Spatially and temporally accurate information about infectious mosquito distribution allows for pre-emptive public health interventions that can reduce the burden of mosquito-borne infections on human populations. However, the labile nature of arboviruses, the low prevalence of infection in mosquitoes, the expensive labor costs for mosquito identification and sorting, and the specialized equipment required for arbovirus testing can obstruct arbovirus surveillance efforts. The recently developed techniques of testing mosquito expectorate using honey-baited nucleic acid preservation cards or sugar bait stations allows a sensitive method of testing for infectious, rather than infected, mosquito vectors. Here we report the results from the first large-scale incorporation of honey-baited cards into an existing mosquito surveillance program. During 4 months of the peak virus season (January-April, 2014) for a total of 577 trap nights, we set CO2-baited encephalitis vector survey (EVS) light traps at 88 locations in South Australia. The collection container for the EVS trap was modified to allow for the placement of a honey-baited nucleic acid preservation card (FTA™ card) inside. After collection, mosquitoes were maintained in a humid environment and allowed access to the cards for 1 week. Cards were then analyzed for common endemic Australian arboviruses using a nested RT-PCR. Eighteen virus detections, including 11 Ross River virus, four Barmah Forest virus, and three Stratford virus (not previously reported from South Australia) were obtained. Our findings suggest that adding FTA cards to an existing mosquito surveillance program is a rapid and efficient way of detecting infectious mosquitoes with high spatial resolution.

  6. Arbovirus circulation, temporal distribution, and abundance of mosquito species in two Carolina bay habitats.

    Science.gov (United States)

    Ortiz, D I; Wozniak, A; Tolson, M W; Turner, P E

    2005-01-01

    Carolina bays, a type of geomorphic feature, may be important in the ecology of mosquito vectors in South Carolina. Their hydrology varies from wetland habitats with marked flooding/drying regimes to permanently flooded spring-fed lakes. Moreover, they possess characteristics that contribute to the support of a particularly abundant and diverse invertebrate fauna. Although it has been estimated that 2,700+ bays exist in South Carolina, approximately 97% have been altered; Heritage Preserve (SBHP) and Woods Bay State Park (WBSP), from June 1997 to July 1998 to determine mosquito temporal distribution, species composition, and the occurrence of arbovirus activity. The largest mosquito collection was obtained at WBSP (n = 31,172) representing 25 species followed by SBHP (n = 3,940) with 24 species. Anopheles crucians complex were the most common species encountered in both bays. Two virus isolates were obtained from SBHP in 1997: Keystone (KEY) virus from Ochlerotatus atlanticus-tormentor and Cache Valley (CV) virus from Oc. canadensis canadensis. Twenty-nine (29) arbovirus-positive pools were obtained from WBSP: 28 in 1997 and one in 1998. KEY virus was isolated from three pools of Oc. atlanticus-tormentor and Tensaw (TEN) virus was isolated from two pools of An. crucians complex; 10 isolates could not be identified with the sera available. Additionally, 14 pools of An. crucians complex tested positive for Eastern equine encephalitis (EEE) virus antigen. These represent the first record of KEY and CV viruses in South Carolina. Our data indicate the presence of high mosquito density and diversity in both Carolina bay habitats, which may be influenced, in part, by seasonal changes in their hydroperiods. The study of mosquito and arbovirus ecology in Carolina Bay habitats could provide more information on the transmission dynamics of arboviruses and its impact on human and animal arboviral disease occurrence in South Carolina.

  7. Prediction of Outcome After Emergency High-Risk Intra-abdominal Surgery Using the Surgical Apgar Score

    DEFF Research Database (Denmark)

    Cihoric, Mirjana; Toft Tengberg, Line; Bay-Nielsen, Morten

    2016-01-01

    BACKGROUND: With current literature quoting mortality rates up to 45%, emergency high-risk abdominal surgery has, compared with elective surgery, a significantly greater risk of death and major complications. The Surgical Apgar Score (SAS) is predictive of outcome in elective surgery, but has nev...... emergency high-risk abdominal surgery. Despite its predictive value, the SAS cannot in its current version be recommended as a standalone prognostic tool in an emergency setting....

  8. Emerging contaminants in Belgian marine waters: single toxicant and mixture risks of pharmaceuticals.

    Science.gov (United States)

    Claessens, Michiel; Vanhaecke, Lynn; Wille, Klaas; Janssen, Colin R

    2013-06-15

    Knowledge on the effects of pharmaceuticals on aquatic marine ecosystems is limited. The aim of this study was therefore to establish the effect thresholds of pharmaceutical compounds occurring in the Belgian marine environment for the marine diatom Phaeodactylum tricornutum, and subsequently perform an environmental risk assessment for these substances. Additionally, a screening-level risk assessment was performed for the pharmaceutical mixtures. No immediate risk for acute toxic effects of these compounds on P. tricornutum were apparent at the concentrations observed in the Belgian marine environment. In two Belgian coastal harbours however, a potential chronic risk was observed for the β-blocker propranolol. No additional risks arising from the exposure to mixtures of pharmaceuticals present in the sampling area could be detected. However, as risk characterization ratios for mixtures of up to 0.5 were observed, mixture effects could emerge should more compounds be taken into account. Copyright © 2013 Elsevier Ltd. All rights reserved.

  9. [Arbovirus infections on the island of Nosy-Be; serologic and entomologic findings].

    Science.gov (United States)

    Fontenille, D; Mathiot, C; Rodhain, F; Coulanges, P

    1988-01-01

    Since 1977, the Pasteur Institute of madagascar has been studying, during six surveys, the arboviruses of Nosy-Be area, in the north-west of Madagascar. 47.2 p. 100 out of 271 human sera and 11.3 p. 100 out of 150 animal sera (mostly from Lemurs), tested for antibodies to 16 arboviruses by the haemagglutination inhibition test, are positive. The results show an important prevalence of Flaviviruses. West-Nile and Dengue 1 viruses were probably circulating some years before the surveys. Antibodies against Sindbis and Rift Valley Fever viruses, were found only in few subjects. Bunyamwera and Tahyna viruses are absent. The rate of positive Lemurs is weak, particularly in Lemur macaco species. Flaviviruses are the most frequent. 12262 haematophagous diptera (11965 Culicidae belonging to 40 species) were caught . Aedes aegypti and Aedes albopictus are both present. Arbovirus isolation attempts from 394 mosquito pools failed; only Mengo virus was isolated from four pools of Erethmapodites quinquevittatus and one pool of Aedes (Skusea) sp.

  10. Genome Investigations of Vector Competence in Aedes aegypti to Inform Novel Arbovirus Disease Control Approaches

    Directory of Open Access Journals (Sweden)

    David W. Severson

    2016-10-01

    Full Text Available Dengue (DENV, yellow fever, chikungunya, and Zika virus transmission to humans by a mosquito host is confounded by both intrinsic and extrinsic variables. Besides virulence factors of the individual arboviruses, likelihood of virus transmission is subject to variability in the genome of the primary mosquito vector, Aedes aegypti. The “vectorial capacity” of A. aegypti varies depending upon its density, biting rate, and survival rate, as well as its intrinsic ability to acquire, host and transmit a given arbovirus. This intrinsic ability is known as “vector competence”. Based on whole transcriptome analysis, several genes and pathways have been predicated to have an association with a susceptible or refractory response in A. aegypti to DENV infection. However, the functional genomics of vector competence of A. aegypti is not well understood, primarily due to lack of integrative approaches in genomic or transcriptomic studies. In this review, we focus on the present status of genomics studies of DENV vector competence in A. aegypti as limited information is available relative to the other arboviruses. We propose future areas of research needed to facilitate the integration of vector and virus genomics and environmental factors to work towards better understanding of vector competence and vectorial capacity in natural conditions.

  11. Prevalence of Arbovirus Infections among Pregnant Women at a Maternity Hospital School

    Directory of Open Access Journals (Sweden)

    Maria das Neves Figueiroa

    2017-04-01

    Full Text Available Objective: Survey the prevalence of arbovirus infections among pregnant women provided with care at a maternity hospital school in Recife, Pernambuco, Brazil. Method: Descriptive, cross-sectional, retrospective, and quantitative study, carried out with data collected from the notification forms filled in during obstetric screening between August 2015 and July 2016. Results: Positive serology was found for arboviruses in 40.2% of the 103 suspected cases. Serology was not performed or it showed inconclusive results in 59.8% of the cases. Dengue fever occurred in 44% of the cases, chikungunya in 34%, and zika fever in 22%. Infections were more frequent among pregnant women over 20 years old, with low income and low schooling levels, living in Recife (48.5% and Olinda, Pernambuco, Brazil (24.3%. The most frequently mentioned symptoms were arthralgia (94%, exanthema (82%, and fever (78%. Infections occurred within the first trimester of pregnancy (54.5%, 63.3% of the pregnant women had to be hospitalized, and 45.4% of them did not undergo morphological ultrasonography. Most babies were born full-term and they had adequate weight. The prevalence of microcephaly was 9.7% when considering cases of arbovirose and 62.5% when considering specific cases of zika fever. Conclusion: The prevalence and repercussions of arboviruses justify the consolidation of actions to fight Aedes aegypti, as well as the effective deployment of clinical protocols and recommendations aimed at the mother and child care.

  12. Perceived Parental Relationships and Health-Risk Behaviors in College-Attending Emerging Adults

    Science.gov (United States)

    Schwartz, Seth J.; Zamboanga, Byron L.; Ravert, Russell D.; Kim, Su Yeong; Weisskirch, Robert S.; Williams, Michelle K.; Bersamin, Melina; Finley, Gordon E.

    2009-01-01

    The present study investigated the association of perceived parenting with health-risk behaviors in an ethnically diverse sample of 1,728 college-attending emerging adults. Participants completed retrospective measures of perceived maternal and paternal nurturance, connection, psychological control, and disrespect and reported their frequency of…

  13. Food safety ontology and text mining strategies as a tool in (re)emerging risk identification

    NARCIS (Netherlands)

    Brug, F. van de

    2009-01-01

    Industry and government are held responsible for the safety of food and feed products. Therefore actual and relevant information concerning emerging safety risks is crucial. But how is it possible to filter relevant information from the fast growing volumes of information produced by science and the

  14. A Minimax Regret Analysis of Flood Risk Management Strategies Under Climate Change Uncertainty and Emerging Information

    NARCIS (Netherlands)

    Pol, van der T.D.; Gabbert, S.; Weikard, H.P.; Ierland, van E.C.; Hendrix, E.M.T.

    2017-01-01

    This paper studies the dynamic application of the minimax regret (MR) decision criterion to identify robust flood risk management strategies under climate change uncertainty and emerging information. An MR method is developed that uses multiple learning scenarios, for example about sea level rise

  15. Outbreaks of emerging infectious diseases: Risk perception and behaviour of the general public

    NARCIS (Netherlands)

    M. Bults (Marloes)

    2014-01-01

    markdownabstract__Abstract__ This thesis focuses on risk perception and behaviour of the public during the outbreaks of emerging infectious diseases. It consists of studies on Influenza A (H1N1), Q fever and Lyme disease. These studies were conducted among both the general public and specific

  16. Emergence behaviour of the serotine bat (Eptesicus serotinus) under predation risk

    Czech Academy of Sciences Publication Activity Database

    Petrželková, Klára Judita; Zukal, Jan

    Roc. 51, č. 4 (2001), s. 395-414 ISSN 0028-2960 R&D Projects: GA AV ČR IAC6087502; GA AV ČR KSK6005114 Institutional research plan: CEZ:AV0Z6093917 Keywords : Eptesicus serotinus * emergence * predation risk Subject RIV: EG - Zoology Impact factor: 0.509, year: 2001

  17. Design of emergency plans due to the failure risk of hydraulic works - Theory and case study

    International Nuclear Information System (INIS)

    Ochoa Rivera, Juan Camilo

    2006-01-01

    Dams are built to be highly safe hydraulic works. Nevertheless, they are not exempt from a certain failure risk, which turns in a variable value along the time service of the dam. As the mentioned dam-failure risk can be a significant hazard, analysis on dam-break is becoming important, as same as the assessment of its consequences. This type of studies are intended to reduce the costs linked to dam-failure, which are mainly due to the losses of human beings and material goods. A suitable way to minimize such losses consists of designing emergency plans, which permit to prepare and implant appropriate protection measures. A methodological framework to carry out this kind of emergency plans is introduced in this paper, accompanied by a case study corresponding to an emergency plan of a Spanish dam

  18. Media coverage of Fukushima accident in the Russian press. Lessons for radiation emergency risk communication

    International Nuclear Information System (INIS)

    Melikhova, E.; Arutyunyan, R.

    2014-01-01

    The paper reviews recent results of content analysis of the Russian press and data of all-Russia public opinion polls on the subject of the Fukushima accident and discusses them in the wider context of challenges in communication of 'no risk' messages to the public in the case of a nuclear accident. Radiation risk regulation base in the low dose range is proposed to be one of the main obstacles for the communication and a new approach to emergency risk communication is proposed. (author)

  19. Increased risk environment for emergency general surgery in the context of regionalization and specialization.

    Science.gov (United States)

    Beecher, S; O'Leary, D P; McLaughlin, R

    2015-09-01

    The pressures on tertiary hospitals with increased volume and complexity related to regionalization and specialization has impacted upon availability of operating theatres with consequent displacement of emergencies to high risk out of hours settings. A retrospective review of an electronic emergency theatre list prospectively maintained database was performed over a two year period. Data gathered included type of operation performed, Time to Theatre (TTT), operation start time and length of stay (LOS). Of 7041 emergency operations 25% were performed out of hours. 2949 patient had general surgical emergency procedures with 910 (30%) performed out of hours. 53% of all emergency laparotomies and 54% of appendicectomies were out of hours. 57% of cases operated on out of hours had been awaiting surgery during the day. Mean TTT was shorter for those admitted at the weekend compared to those admitted during the week (15.6 vs 24.9 h) (p emergency surgery is performed out of hours in a way unfavorable to good clinical outcomes. It is of concern that more than half of the most life threating procedures involving laparotomy, take place out of hours. Regionalization needs to be accompanied by infrastructure planning to accommodate emergency surgery. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  20. Cross-cultural differences and sexual risk behavior of emerging adults.

    Science.gov (United States)

    Thomas, Tami L; Yarandi, Hossein N; Dalmida, Safiya George; Frados, Andrew; Klienert, Kathleen

    2015-01-01

    The authors examined population-specific risk factors that increase emerging adults' risk of acquiring sexually transmitted infections (STIs), including the human papillomavirus (HPV). A cross-sectional sample of 335 diverse, emerging adults ages 18 to 24 years was recruited from a health center at a large university in the Southeastern United States. The mean age was 20.6 ± 1.9 years, majority were females (74.0%), and 61.0% were Hispanic. Findings revealed inconsistent condom use, reasons for not using condoms, and a need for more culturally specific intervention strategies. Healthcare providers should identify culturally specific reasons for inconsistent condom use, examine cultural and geographic differences in sexual risk behaviors among groups and communities, and modify communication, educational programs, and interventions accordingly. By adopting a multicultural approach to the control of STIs, nurses can address specific cultural attitudes and behaviors that may influence exposure to STIs, including HPV. © The Author(s) 2014.

  1. From Dyad to Triad: Mediatization and Emerging Risks for Professional Autonomy

    Directory of Open Access Journals (Sweden)

    Michaela Pfadenhauer

    2017-02-01

    Full Text Available With the emergence and spread of digital media, more business models foster and empower client participation in medical professions. With services and products ranging from rating platforms to apps targeting self-diagnosis, these businesses transform the client–practitioner relationship yet risk undermining a central pillar of professions—autonomy. Practitioners have to take legal actions against these business models, making visible the frictional interplay among the involved actors. This development calls for an analytical understanding of how this technology-induced cultural change affects professions and discourses on professionalism. We argue that a perspective on how practitioners deal with these challenges in various situations can be beneficial. Hence, we conceptualize professionals as engaged in identifying, assessing and managing risks for themselves and their clients. The emerging risk-management practices lead to an understanding of how this apparent cultural change plays an increasingly meaningful role for research on how professionalism regarding legitimation of authority is negotiated.

  2. Climate Influence on Emerging Risk Areas for Rift Valley Fever Epidemics in Tanzania.

    Science.gov (United States)

    Mweya, Clement N; Mboera, Leonard E G; Kimera, Sharadhuli I

    2017-07-01

    Rift Valley Fever (RVF) is a climate-related arboviral infection of animals and humans. Climate is thought to represent a threat toward emerging risk areas for RVF epidemics globally. The objective of this study was to evaluate influence of climate on distribution of suitable breeding habitats for Culex pipiens complex, potential mosquito vector responsible for transmission and distribution of disease epidemics risk areas in Tanzania. We used ecological niche models to estimate potential distribution of disease risk areas based on vectors and disease co-occurrence data approach. Climatic variables for the current and future scenarios were used as model inputs. Changes in mosquito vectors' habitat suitability in relation to disease risk areas were estimated. We used partial receiver operating characteristic and the area under the curves approach to evaluate model predictive performance and significance. Habitat suitability for Cx. pipiens complex indicated broad-scale potential for change and shift in the distribution of the vectors and disease for both 2020 and 2050 climatic scenarios. Risk areas indicated more intensification in the areas surrounding Lake Victoria and northeastern part of the country through 2050 climate scenario. Models show higher probability of emerging risk areas spreading toward the western parts of Tanzania from northeastern areas and decrease in the southern part of the country. Results presented here identified sites for consideration to guide surveillance and control interventions to reduce risk of RVF disease epidemics in Tanzania. A collaborative approach is recommended to develop and adapt climate-related disease control and prevention strategies.

  3. Farmers risk perception and risk management strategies in an emerging mussel aquaculture industry in Denmark

    DEFF Research Database (Denmark)

    Ahsan, Dewan; Roth, Eva

    2010-01-01

    The aim of this exploratory study is to provide empirical insight into how the mussel farmers perceive and manage risks. The results show that future price and demand of mussel are the high ranked perceived risk. Bad weather, oxygen depletion, harmful algal blooms, E-coli, change in governmental...... regulation and public view towards mussel culture are also considered important risk factors in mussel farming. On the other hand, produced at lowest possible cost, cooperative marketing, good relation with government, prioritize liquidity, adopt new technology and experience sharing are perceived most...

  4. Identification of the high risk emergency surgical patient: Which risk prediction model should be used?

    Directory of Open Access Journals (Sweden)

    Stephen Stonelake

    2015-09-01

    Conclusions: In the absence of accurate risk scoring tools that can be used on admission to hospital it is not possible to reliably audit the achievement of national standards of care for the ‘high-risk’ patient.

  5. Risk-based systems analysis for emerging technologies: Applications of a technology risk assessment model to public decision making

    International Nuclear Information System (INIS)

    Quadrel, M.J.; Fowler, K.M.; Cameron, R.; Treat, R.J.; McCormack, W.D.; Cruse, J.

    1995-01-01

    The risk-based systems analysis model was designed to establish funding priorities among competing technologies for tank waste remediation. The model addresses a gap in the Department of Energy's (DOE's) ''toolkit'' for establishing funding priorities among emerging technologies by providing disciplined risk and cost assessments of candidate technologies within the context of a complete remediation system. The model is comprised of a risk and cost assessment and a decision interface. The former assesses the potential reductions in risk and cost offered by new technology relative to the baseline risk and cost of an entire system. The latter places this critical information in context of other values articulated by decision makers and stakeholders in the DOE system. The risk assessment portion of the model is demonstrated for two candidate technologies for tank waste retrieval (arm-based mechanical retrieval -- the ''long reach arm'') and subsurface barriers (close-coupled chemical barriers). Relative changes from the base case in cost and risk are presented for these two technologies to illustrate how the model works. The model and associated software build on previous work performed for DOE's Office of Technology Development and the former Underground Storage Tank Integrated Demonstration, and complement a decision making tool presented at Waste Management 1994 for integrating technical judgements and non-technical (stakeholder) values when making technology funding decisions

  6. Poverty and Arbovirus Outbreaks: When Chikungunya Virus Hits More Precarious Populations Than Dengue Virus in French Guiana.

    Science.gov (United States)

    Bonifay, Timothée; Douine, Maylis; Bonnefoy, Clémence; Hurpeau, Benoit; Nacher, Mathieu; Djossou, Félix; Epelboin, Loïc

    2017-01-01

    Since 2013, 3 successive arbovirus outbreaks, dengue (DENV), chikungunya (CHIKV), and Zika virus, have occurred in French Guiana (FG). The primary objective of this study was to describe the socioeconomic indicators of the first patients infected with CHIKV during the outbreak of 2014. The secondary objective was to compare those patients with patient infected by DENV and with the local population. A monocentric, retrospective, case-control study was conducted in Cayenne hospital in FG comparing a group of patients infected with CHIKV in 2014 with a group infected with DENV in 2013. Children aged less than 15 years and pregnant women were excluded. A total of 168 CHIKV patients were compared with 168 DENV patients. Factors associated with CHIKV were living in poor neighborhoods (82% vs 44%; odds ratio [OR], 5.81; 95% confidence interval [CI], 3.35-10.2), having a precarious status (54% vs 33%; OR, 2.37; 95% CI, 1.49-3.78), and being born abroad (70% vs 35%; OR, 4.35; 95% CI, 2.69-7.06). The present results suggest that early in the epidemic, the populations most at risk for CHIKV infection were the most socially vulnerable populations in the poorest neighborhoods, whereas DENV appeared to have affected a richer population and richer areas.

  7. Eye Emergencies

    Science.gov (United States)

    ... The Marfan Foundation Marfan & Related Disorders What is Marfan Syndrome? What are Related Disorders? What are the Signs? ... Emergencies Eye Emergencies Lung Emergencies Surgeries Eye Emergencies Marfan syndrome significantly increases your risk of retinal detachment, a ...

  8. The forgotten realm of the new and emerging psychosocial risk factors.

    Science.gov (United States)

    Chirico, Francesco

    2017-09-28

    In Europe, employers of all private and public enterprises have a legal obligation to protect their employers by all the different types of workplace hazards to the safety and health of workers. The most important methods developed for the work-related stress risk assessment are based on the Cox's research commissioned by European Agency for Safety and Health at Work (EU-OSHA) and are the Management Standard HSE for work-related stress in United Kingdom, the START method in Germany, the Screening, Observation, Analysis, Expertise (SOBANE) in Belgium, and the National Institute for Prevention and Safety at Work (INAIL-ISPESL) model in Italy, the latter based on the British Management Standard. Unfortunately, the definition of "work-related stress" elaborated by EU-OSHA was criticized, because it is not completely equal to the broader "psychosocial risk," which includes new and emerging psychosocial risk factors, such as the combined exposure to physical and psychosocial risks, job insecurity, work intensification and high demands at work, high emotional load related to burnout, work-life balance problems, and violence and harassment at work. All these new emerging psychosocial hazards could require different and additional methodologies to save workers' health and safety. For this reason, the concept that stakeholders and policy makers should keep in mind in order to develop better national regulations and strategies is that work-related stress risk and psychosocial risk factors are not the same.

  9. Rethinking risk assessment for emerging technology first-in-human trials.

    Science.gov (United States)

    Genske, Anna; Engel-Glatter, Sabrina

    2016-03-01

    Recent progress in synthetic biology (SynBio) has enabled the development of novel therapeutic opportunities for the treatment of human disease. In the near future, first-in-human trials (FIH) will be indicated. FIH trials mark a key milestone in the translation of medical SynBio applications into clinical practice. Fostered by uncertainty of possible adverse events for trial participants, a variety of ethical concerns emerge with regards to SynBio FIH trials, including 'risk' minimization. These concerns are associated with any FIH trial, however, due to the novelty of the approach, they become more pronounced for medical applications of emerging technologies (emTech) like SynBio. To minimize potential harm for trial participants, scholars, guidelines, regulations and policy makers alike suggest using 'risk assessment' as evaluation tool for such trials. Conversely, in the context of emTech FIH trials, we believe it to be at least questionable to contextualize uncertainty of potential adverse events as 'risk' and apply traditional risk assessment methods. Hence, this issue needs to be discussed to enable alterations of the evaluation process before the translational phase of SynBio applications begins. In this paper, we will take the opportunity to start the debate and highlight how a misunderstanding of the concept of risk, and the possibilities and limitations of risk assessment, respectively, might impair decision-making by the relevant regulatory authorities and research ethics committees, and discuss possible solutions to tackle the issue.

  10. Integrating emerging earth science technologies into disaster risk management: an enterprise architecture approach

    Science.gov (United States)

    Evans, J. D.; Hao, W.; Chettri, S. R.

    2014-12-01

    Disaster risk management has grown to rely on earth observations, multi-source data analysis, numerical modeling, and interagency information sharing. The practice and outcomes of disaster risk management will likely undergo further change as several emerging earth science technologies come of age: mobile devices; location-based services; ubiquitous sensors; drones; small satellites; satellite direct readout; Big Data analytics; cloud computing; Web services for predictive modeling, semantic reconciliation, and collaboration; and many others. Integrating these new technologies well requires developing and adapting them to meet current needs; but also rethinking current practice to draw on new capabilities to reach additional objectives. This requires a holistic view of the disaster risk management enterprise and of the analytical or operational capabilities afforded by these technologies. One helpful tool for this assessment, the GEOSS Architecture for the Use of Remote Sensing Products in Disaster Management and Risk Assessment (Evans & Moe, 2013), considers all phases of the disaster risk management lifecycle for a comprehensive set of natural hazard types, and outlines common clusters of activities and their use of information and computation resources. We are using these architectural views, together with insights from current practice, to highlight effective, interrelated roles for emerging earth science technologies in disaster risk management. These roles may be helpful in creating roadmaps for research and development investment at national and international levels.

  11. Development of a novel scoring system for identifying emerging chemical risks in the food chain.

    Science.gov (United States)

    Oltmanns, J; Licht, O; Bitsch, A; Bohlen, M-L; Escher, S E; Silano, V; MacLeod, M; Serafimova, R; Kass, G E N; Merten, C

    2018-02-21

    The European Food Safety Authority (EFSA) is responsible for risk assessment of all aspects of food safety, including the establishment of procedures aimed at the identification of emerging risks to food safety. Here, a scoring system was developed for identifying chemicals registered under the European REACH Regulation that could be of potential concern in the food chain using the following parameters: (i) environmental release based on maximum aggregated tonnages and environmental release categories; (ii) biodegradation in the environment; (iii) bioaccumulation and in vivo and in vitro toxicity. The screening approach was tested on 100 data-rich chemicals registered under the REACH Regulation at aggregated volumes of at least 1000 tonnes per annum. The results show that substance-specific data generated under the REACH Regulation can be used to identify potential emerging risks in the food chain. After application of the screening procedure, priority chemicals can be identified as potentially emerging risk chemicals through the integration of exposure, environmental fate and toxicity. The default approach is to generate a single total score for each substance using a predefined weighting scenario. However, it is also possible to use a pivot table approach to combine the individual scores in different ways that reflect user-defined priorities, which enables a very flexible, iterative definition of screening criteria. Possible applications of the approaches are discussed using illustrative examples. Either approach can then be followed by in-depth evaluation of priority substances to ensure the identification of substances that present a real emerging chemical risk in the food chain.

  12. Workshop "Emerging risks and early warning systems" : deelproject 1.2 : miniconferentie over roegtijdig signalering en waarschuwingssystemen

    NARCIS (Netherlands)

    Koenderink, N.J.J.P.; Kreft, F.

    2007-01-01

    This report is the result of the workshop “Emerging risks and early warning system” held in Wageningen, the Netherlands on October the 19th 2006. The workshop is part of the project “Emerging risks in Dutch food chains”. The purpose of this project is to develop a procedure to identify potential

  13. Occupational Risks of Health Professionals in Turkey as an Emerging Economy.

    Science.gov (United States)

    Ulutasdemir, Nilgun; Cirpan, Metin; Copur, Ebru Ozturk; Tanir, Ferdi

    2015-01-01

    Health services are one of the work areas that contain important risks in terms of the occupational health and safety of the laborer. Professionals in various areas of health services encounter biological, chemical, physical, ergonomic, and psychosocial risks, particularly in hospitals. This study has been performed to evaluate the impacts of the occupational risks on health of health professionals in Turkey. In Turkey, as an emerging economy, the history of studies on health professionals is not longstanding. There have been various regulations intended for the occupational health and safety of health professionals in line with the Regulation of the Provision on Patient and Staff Safety prepared in 2012. However, applications can differ from region to region, institution to institution, and person to person. We believe that this review will lead health professionals to be aware of occupational risks and contribute to planning health services for health professionals. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  14. Fear of childbirth and emergency caesarean section in low-risk nulliparous women

    DEFF Research Database (Denmark)

    Jespersen, Cecilie; Hegaard, Hanne Kristine; Schroll, Anne-Mette

    2014-01-01

    OBJECTIVE: To assess the association between fear of childbirth (FOC) and emergency caesarean section. DESIGN: A prospective cohort study of low-risk nulliparous women at term. SETTING: Nine obstetric departments in Denmark, May 2004-July 2005. POPULATION: A total of 2598 nulliparous women...... in spontaneous labor with a single fetus in cephalic presentation at term. METHODS: Self-reported FOC was assessed at 37 weeks of gestation by the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) version A and at admission to the labor ward by the Delivery Fear Scale (DFS). Mode of delivery...... was recorded by the attending staff. Logistic regression analyses were used to estimate unadjusted and adjusted odds ratios (OR). MAIN OUTCOME MEASURES: Risk of emergency caesarean section in women who feared childbirth. RESULTS: FOC (W-DEQ sum score ≥ 85 and DFS sum score ≥ 70) was not associated...

  15. Emerging Infectious Diseases and Blood Safety: Modeling the Transfusion-Transmission Risk.

    Science.gov (United States)

    Kiely, Philip; Gambhir, Manoj; Cheng, Allen C; McQuilten, Zoe K; Seed, Clive R; Wood, Erica M

    2017-07-01

    While the transfusion-transmission (TT) risk associated with the major transfusion-relevant viruses such as HIV is now very low, during the last 20 years there has been a growing awareness of the threat to blood safety from emerging infectious diseases, a number of which are known to be, or are potentially, transfusion transmissible. Two published models for estimating the transfusion-transmission risk from EIDs, referred to as the Biggerstaff-Petersen model and the European Upfront Risk Assessment Tool (EUFRAT), respectively, have been applied to several EIDs in outbreak situations. We describe and compare the methodological principles of both models, highlighting their similarities and differences. We also discuss the appropriateness of comparing results from the two models. Quantitating the TT risk of EIDs can inform decisions about risk mitigation strategies and their cost-effectiveness. Finally, we present a qualitative risk assessment for Zika virus (ZIKV), an EID agent that has caused several outbreaks since 2007. In the latest and largest ever outbreak, several probable cases of transfusion-transmission ZIKV have been reported, indicating that it is transfusion-transmissible and therefore a risk to blood safety. We discuss why quantitative modeling the TT risk of ZIKV is currently problematic. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  16. Results of the Working Group 'Risk Communications for Emergencies and Disasters'

    International Nuclear Information System (INIS)

    Sorensen, J.H.; Dombrowsky, W.R.

    1988-01-01

    Enhancing crisis communication is important to industry, government and the public. The public is becoming increasingly concerned about technological failures as our reliance on technology increases. Better preparedness and more public awareness can increase public acceptance of and confidence in ability to manage high consequence technologies including ability to manage its failures. Failed communications in emergencies has increased the loss of life and property and public scepticism. Effective communication can a) engender confidence and trust in authorities; b) give rise of acceptance of risks and risk management and c) reduce the consequences of disasters. (orig./HSCH)

  17. A neuroscience perspective on sexual risk behavior in adolescence and emerging adulthood

    Science.gov (United States)

    VICTOR, ELIZABETH C.; HARIRI, AHMAD R.

    2016-01-01

    Late adolescence and emerging adulthood (specifically ages 15–24) represent a period of heightened sexual risk taking resulting in the greatest annual rates of sexually transmitted infections and unplanned pregnancies in the US population. Ongoing efforts to prevent such negative consequences are likely to benefit from a deepening of our understanding of biological mechanisms through which sexual risk taking emerges and biases decision making during this critical window. Here we present a neuroscience framework from which a mechanistic examination of sexual risk taking can be advanced. Specifically, we adapt the neurodevelopmental triadic model, which outlines how motivated behavior is governed by three systems: approach, avoidance, and regulation, to sexual decision making and subsequent risk behavior. We further propose a testable hypothesis of the triadic model, wherein relatively decreased threat-related amygdala reactivity and increased reward-related ventral striatum reactivity leads to sexual risk taking, which is particularly exaggerated during adolescence and young adulthood when there is an overexpression of dopaminergic neurons coupled with immature top-down prefrontal cortex regulation. We conclude by discussing how future research based on our adapted triadic model can inform ongoing efforts to improve intervention and prevention efforts. PMID:26611719

  18. Emerging Issues for our Nation's Health: The Intersection of Marijuana Use and Cardiometabolic Disease Risk

    OpenAIRE

    Vidot, Denise C.; Prado, Guillermo; Hlaing, WayWay M.; Arheart, Kristopher L.; Messiah, Sarah E.

    2014-01-01

    Current marijuana use rates are the highest in the past decade and not likely to decrease given the legalization of marijuana for medicinal and/or recreational use. Concurrently, the nation is facing epidemic levels of obesity, cardiovascular disease and diabetes but little is known about the intersecting relationships of marijuana use and cardiometabolic health. The objective of this study was to explore emerging issues in context to the intersection of cardiometabolic risk and marijuana use...

  19. Strengthening Preparedness for Arbovirus Infections in Mediterranean and Black Sea Countries: A Conceptual Framework to Assess Integrated Surveillance in the Context of the One Health Strategy.

    Science.gov (United States)

    Dente, Maria Grazia; Riccardo, Flavia; Nacca, Gloria; Ranghiasci, Alessia; Escadafal, Camille; Gaayeb, Lobna; Jiménez-Clavero, Miguel Angel; Manuguerra, Jean-Claude; Picard, Marie; Fernández-Pinero, Jovita; Pérez-Ramírez, Elisa; Robert, Vincent; Victoir, Kathleen; Declich, Silvia

    2018-03-10

    In the context of One Health, there is presently an effort to integrate surveillance of human, animal, entomological, and environmental sectors. This aims to strengthen the prevention of, and preparedness against, arbovirus infections, also in the light of environmental and climate changes that could increase the risk of transmission. However, criteria to define integrated surveillance, and to compare different systems, still need to be identified and tested. We conducted a scoping review to identify and examine surveillance systems for West Nile virus (WNV), chikungunya virus (CHKV), dengue virus (DENV), and Rift Valley fever virus (RVFV), which involve human, animal, entomological, and environmental sectors. We analyzed findings using a conceptual framework we developed for this purpose. The review highlights that the criteria proposed in the conceptual framework to describe integrated surveillance are consistently reported in the context of studies and programs related to integrated surveillance of the selected arboviral diseases. These criteria can facilitate the identification and description of operationalized One Health surveillance.

  20. Economic growth, urbanization, globalization, and the risks of emerging infectious diseases in China: A review.

    Science.gov (United States)

    Wu, Tong; Perrings, Charles; Kinzig, Ann; Collins, James P; Minteer, Ben A; Daszak, Peter

    2017-02-01

    Three interrelated world trends may be exacerbating emerging zoonotic risks: income growth, urbanization, and globalization. Income growth is associated with rising animal protein consumption in developing countries, which increases the conversion of wild lands to livestock production, and hence the probability of zoonotic emergence. Urbanization implies the greater concentration and connectedness of people, which increases the speed at which new infections are spread. Globalization-the closer integration of the world economy-has facilitated pathogen spread among countries through the growth of trade and travel. High-risk areas for the emergence and spread of infectious disease are where these three trends intersect with predisposing socioecological conditions including the presence of wild disease reservoirs, agricultural practices that increase contact between wildlife and livestock, and cultural practices that increase contact between humans, wildlife, and livestock. Such an intersection occurs in China, which has been a "cradle" of zoonoses from the Black Death to avian influenza and SARS. Disease management in China is thus critical to the mitigation of global zoonotic risks.

  1. Risk classification priorities in an emergency unit and outcomes of the service provided

    Directory of Open Access Journals (Sweden)

    Rafael Silva Marconato

    2017-12-01

    Full Text Available ABSTRACT Objective: to check the association of the proposed priorities of the institutional protocol of risk classification with the outcomes and evaluate the profile of the care provided in an emergency unit. Method: observational epidemiological study based on data from the computerized files of a Reference Emergency Unit. Care provided to adults was evaluated regarding risk classification and outcomes (death, hospitalization and hospital discharge based on the information recorded in the emergency bulletin. Results: the mean age of the 97,099 registered patients was 43.4 years; 81.5% cases were spontaneous demand; 41.2% had been classified as green, 15.3% yellow, 3.7% blue, 3% red and 36.and 9% had not received a classification; 90.2% of the patients had been discharged, 9.4% hospitalized and 0.4% had died. Among patients who were discharged, 14.7% had been classified as yellow or red, 13.6% green or blue, and 1.8% as blue or green. Conclusion: the protocol of risk classification showed good sensitivity to predict serious situations that can progress to death or hospitalization.

  2. Risk model for suspected acute coronary syndrome is of limited value in an emergency department.

    Science.gov (United States)

    Mogensen, Christian Backer; Christiansen, Maja; Jørgensen, Jess Bjerre; Staehr, Peter Bisgaard

    2015-10-01

    Among patients with acute chest pain, acute coronary syndrome (ACS) is seen only in a minority of the patients, which raises the question, whether it is possible to separate a group with a high risk of ACS for admission to a cardiac care unit (CCU) from those with a low risk who would be treated at an emergency department (ED). The aim of this study was to describe a risk stratification model for a Danish context. This was a historic prospective cohort study of patients with suspicion of ACS. The patient was defined as a low-risk patient and admitted to the ED if: 1) electrocardiogram (ECG) was normal, 2) the patient did not have persisting chest pain and 3) there was no history of ischaemic heart disease, heart failure or cardioverter defibrillator. Otherwise, patients were admitted to the CCU. The primary outcome was whether the ACS diagnosis was confirmed or rejected. We included a total of 488 patients with suspicion of ACS, 50% of whom were low-risk patients. 17% had a verified ACS; 10% of those in the low-risk group and 24% of those in the high-risk group (p = 0.0001). Among the verified ACS cases, 71% went primarily to the CCU. The odds ratio for an ACS if assigned to the high-risk group was 3.0. Allocation to the high-risk group, male gender and age above 60 years was associated with a higher risk of ACS. For patients fulfilling the high-risk definition, sensitivity was 71%, specificity 55%, negative predictive value 90% and positive predictive value 24% for an ACS. The model for stratification separated patients into two equal groups, allocated 71% of all ACS directly to the CCU and could not be improved by any of the additional factors examined. Further development of referral strategies for chest pain patients is required. none. not relevant.

  3. Emergency Peripartum Hysterectomy as Postpartum Hemorrhage Treatment: Incidence, Risk factors, and Complications

    Directory of Open Access Journals (Sweden)

    Meena Pradhan

    2014-03-01

    Full Text Available Introduction: The aim of the research was to investigate incidence, risk factors, and complications associated with emergency peripartum hysterectomy, the ultimate treatment method for intractable postpartum hemorrhage. Methods: This is a single center case-control study conducted in Chongqing city in central China from 1st January 2007 to 31st December 2012 for emergency peripartum hysterectomy performed as a treatment of postpartum hemorrhage both in caesarean and vaginal delivery cases. While the study group included emergency peripartum hysterectomy (n=61 due to intractable postpartum hemorrhage, the control group included no hysterectomy (n=333 during the same study period. Results: We found 61 cases recorded for emergency peripartum hysterectomy for intractable postpartum hemorrhage. Incidence of peripartum hysterectomy was 2.2 per 1000 deliveries. Emergency peripartum hysterectomy as treatment of intractable postpartum hemorrhage include the followings: (i blood loss 1000-2000 ml, crude odd ratio (OR =18.48 (95% CI 5.1-65.7, adjusted odd ratio (AOR = 9.1 (95% CI 2.2-37.7; (ii blood loss >2000 ml, OR = 152 (95% CI 43.7-528.4, AOR = 45.3 (95% CI 11.6-176.9; (iii previous caesarean section, OR = 5.5 (95% CI 2.9-9.7, AOR = 3.7(95% CI 1.4-9.9; (iv uterine atony, OR = 11.9 (95% CI 5.8-24.6, AOR = 7.5 (95% CI 1.8-30.2; (v placenta previa, OR = 2.04 (95% CI 1.1-3.5, AOR = none. Conclusions: Emergency peripartum hysterectomy is the last resort as treatment of intractable severe postpartum hemorrhage. Our study depicts that severe post partum hemorrhage, further dreaded complex events for emergency peripartum hysterectomy, has significant association with placental factors, previous caesarean section, and uterine atony. Pathologically, placenta accreta remained the most leading cause of hysterectomy. Keywords: caesarean section; hemorrhage; peripartum hysterectomy; placenta previa.

  4. Thromboprophylaxis for Patients with High-risk Atrial Fibrillation and Flutter Discharged from the Emergency Department

    Directory of Open Access Journals (Sweden)

    E. Margaret Warton

    2018-02-01

    Full Text Available Introduction: Many patients with atrial fibrillation or atrial flutter (AF/FL who are high risk for ischemic stroke are not receiving evidence-based thromboprophylaxis. We examined anticoagulant prescribing within 30 days of receiving dysrhythmia care for non-valvular AF/FL in the emergency department (ED. Methods: This prospective study included non-anticoagulated adults at high risk for ischemic stroke (ATRIA score ≥7 who received emergency AF/FL care and were discharged home from seven community EDs between May 2011 and August 2012. We characterized oral anticoagulant prescribing patterns and identified predictors of receiving anticoagulants within 30 days of the index ED visit. We also describe documented reasons for withholding anticoagulation. Results: Of 312 eligible patients, 128 (41.0% were prescribed anticoagulation at ED discharge or within 30 days. Independent predictors of anticoagulation included age (adjusted odds ratio [aOR] 0.89 per year, 95% confidence interval [CI] 0.82–0.96; ED cardiology consultation (aOR 1.89, 95% CI [1.10–3.23]; and failure of sinus restoration by time of ED discharge (aOR 2.65, 95% CI [1.35–5.21]. Reasons for withholding anticoagulation at ED discharge were documented in 139 of 227 cases (61.2%, the most common of which were deferring the shared decision-making process to the patient’s outpatient provider, perceived bleeding risk, patient refusal, and restoration of sinus rhythm. Conclusion: Approximately 40% of non-anticoagulated AF/FL patients at high risk for stroke who presented for emergency dysrhythmia care were prescribed anticoagulation within 30 days. Physicians were less likely to anticoagulate older patients and those with ED sinus restoration. Opportunities exist to improve rates of thromboprophylaxis in this high-risk population.

  5. Risk model for suspected acute coronary syndrome is of limited value in an emergency department

    DEFF Research Database (Denmark)

    Mogensen, Christian Backer; Christiansen, Maja; Jørgensen, Jess Bjerre

    2015-01-01

    INTRODUCTION: Among patients with acute chest pain, acute coronary syndrome (ACS) is seen only in a minority of the patients, which raises the question, whether it is possible to separate a group with a high risk of ACS for admission to a cardiac care unit (CCU) from those with a low risk who would...... be treated at an emergency department (ED). The aim of this study was to describe a risk stratification model for a Danish context. METHODS: This was a historic prospective cohort study of patients with suspicion of ACS. The patient was defined as a low-risk patient and admitted to the ED if: 1....... RESULTS: We included a total of 488 patients with suspicion of ACS, 50% of whom were low-risk patients. 17% had a verified ACS; 10% of those in the low-risk group and 24% of those in the high-risk group (p = 0.0001). Among the verified ACS cases, 71% went primarily to the CCU. The odds ratio for an ACS...

  6. Emerging infectious disease outbreaks: estimating disease risk in Australian blood donors travelling overseas.

    Science.gov (United States)

    Coghlan, A; Hoad, V C; Seed, C R; Flower, R Lp; Harley, R J; Herbert, D; Faddy, H M

    2018-01-01

    International travel assists spread of infectious pathogens. Australians regularly travel to South-eastern Asia and the isles of the South Pacific, where they may become infected with infectious agents, such as dengue (DENV), chikungunya (CHIKV) and Zika (ZIKV) viruses that pose a potential risk to transfusion safety. In Australia, donors are temporarily restricted from donating for fresh component manufacture following travel to many countries, including those in this study. We aimed to estimate the unmitigated transfusion-transmission (TT) risk from donors travelling internationally to areas affected by emerging infectious diseases. We used the European Up-Front Risk Assessment Tool, with travel and notification data, to estimate the TT risk from donors travelling to areas affected by disease outbreaks: Fiji (DENV), Bali (DENV), Phuket (DENV), Indonesia (CHIKV) and French Polynesia (ZIKV). We predict minimal risk from travel, with the annual unmitigated risk of an infected component being released varying from 1 in 1·43 million to disease outbreak areas to source plasma collection provides a simple and effective risk management approach. © 2017 International Society of Blood Transfusion.

  7. Detection of arboviruses and other micro-organisms in experimentally infected mosquitoes using massively parallel sequencing.

    Directory of Open Access Journals (Sweden)

    Sonja Hall-Mendelin

    Full Text Available Human disease incidence attributed to arbovirus infection is increasing throughout the world, with effective control interventions limited by issues of sustainability, insecticide resistance and the lack of effective vaccines. Several promising control strategies are currently under development, such as the release of mosquitoes trans-infected with virus-blocking Wolbachia bacteria. Implementation of any control program is dependent on effective virus surveillance and a thorough understanding of virus-vector interactions. Massively parallel sequencing has enormous potential for providing comprehensive genomic information that can be used to assess many aspects of arbovirus ecology, as well as to evaluate novel control strategies. To demonstrate proof-of-principle, we analyzed Aedes aegypti or Aedes albopictus experimentally infected with dengue, yellow fever or chikungunya viruses. Random amplification was used to prepare sufficient template for sequencing on the Personal Genome Machine. Viral sequences were present in all infected mosquitoes. In addition, in most cases, we were also able to identify the mosquito species and mosquito micro-organisms, including the bacterial endosymbiont Wolbachia. Importantly, naturally occurring Wolbachia strains could be differentiated from strains that had been trans-infected into the mosquito. The method allowed us to assemble near full-length viral genomes and detect other micro-organisms without prior sequence knowledge, in a single reaction. This is a step toward the application of massively parallel sequencing as an arbovirus surveillance tool. It has the potential to provide insight into virus transmission dynamics, and has applicability to the post-release monitoring of Wolbachia in mosquito populations.

  8. The relationship of reported HIV risk and history of HIV testing among emergency department patients.

    Science.gov (United States)

    Merchant, Roland C; Freelove, Sarah M; Langan, Thomas J; Clark, Melissa A; Mayer, Kenneth H; Seage, George R; DeGruttola, Victor G

    2010-01-01

    Among a random sample of emergency department (ED) patients, we sought to determine the extent to which reported risk for human immunodeficiency virus (HIV) is related to ever having been tested for HIV. A random sample of patients (aged 18-64 years) from an adult, urban, northeastern United States, academic ED were surveyed about their history of ever having been tested for HIV and their reported HIV risk behaviors. A reported HIV risk score was calculated from the survey responses and divided into 4 levels, based on quartiles of the risk scores. Pearson's X(2) testing was used to compare HIV testing history and level of reported HIV risk. Logistic regression models were created to investigate the association between level of reported HIV risk and the outcome of ever having been tested for HIV. Of the 557 participants, 62.1% were female. A larger proportion of females than males (71.4% vs 60.6%; P history of injection-drug use, were associated with prior HIV testing for both genders. In the logistic regression analyses, there was no relationship between increasing level of reported HIV risk and a history of ever having been tested for HIV for males. For females, a history of ever having been tested was related to increasing level of reported risk, but not in a linear fashion. The relationship between reported HIV risk and history of testing among these ED patients was complex and differed by gender. Among these patients, having greater risk did not necessarily mean a higher likelihood of ever having been tested for HIV.

  9. Emerging Cardiovascular Risk Research: Impact of Pets on Cardiovascular Risk Prevention.

    Science.gov (United States)

    Schreiner, Pamela J

    2016-02-01

    Animals interact with humans in multiple ways, including as therapy and service animals, commercially as livestock, as wildlife, and in zoos. But the most common interaction is as companion animals in our homes, with an estimated 180 million cats and dogs living in US households. While pet ownership has been reported to have many health benefits, the findings are inconsistent. Cardiovascular risk factors such as lipids, glucose, obesity, and heart rate variability have improved, worsened, or remained the same in the limited number of studies considering companion animals. Physical activity increases have more consistently been linked with dog ownership, although whether this reflects antecedent motivation or direct benefit from the dog is unclear. Allergies and asthma also are variably linked to pet ownership and are confounded by family history of atopy and timing of exposure to pet dander. The benefits of companion animals are most likely to be through reduction in depression, anxiety, and social isolation, but these studies have been largely cross-sectional and may depend on degree of bonding of the owner with the animal. Positive relationships show measurably higher oxytocin with lower cortisol and alpha-amylase levels. Finally, pet ownership is also a marker of better socioeconomic status and family stability, and if companion animals are to provide cardiovascular risk benefit, the route should perhaps be through improved education and opportunity for ownership.

  10. Changing trends of cardiovascular risk factors among Indians: a review of emerging risks

    Directory of Open Access Journals (Sweden)

    Arun Kumar

    2014-12-01

    Full Text Available The global burden of disease due to cardiovascular diseases (CVDs is escalating, and the changing trends of CVD risk factors are identified among Indians experiencing rapid health transition. Contributory causes include: growing population with demographic shifts and altered age profile, socio-economic factors, lifestyle changes due to urbanization. Indians are also having genetic predisposition to cardiovascular diseases and adult are susceptible to vascular disease linking possible gene-environment interactions influencing ethnic diversity. Altered diets with more of junk foods along with diminished physical activity are additive factors contributing to the acceleration of CVD epidemics, along with all form of tobacco use. The pace of health transition, however, varies across geographical regions from urban to rural population with consequent variations in the relative burdens of the dominant CVDs. A comprehensive public health response must be looked to plan over all strategies to integrate policies and programs that effectively impact on the multiple determinants of CVDs to provide protection over the life span through primordial, primary and secondary prevention. Populations as well as individuals at risk must be protected through initiatives, enable nutrition-based preventive strategies to protect and promote cardiovascular health.

  11. Emergent risk factors associated with eyeball loss and ambulatory vision loss after globe injuries.

    Science.gov (United States)

    Hyun Lee, Seung; Ahn, Jae Kyoun

    2010-07-01

    The objective of this study was to evaluate risk factors associated with eyeball loss and ambulatory vision loss on emergent examination of patients with ocular trauma. We reviewed the medical records of 1,875 patients hospitalized in a single tertiary referral center between January 2003 and December 2007. Emergent examinations included a history of trauma, elapsed time between injury and hospital arrival, visible intraocular tissues, and initial visual acuity (VA) using a penlight. The main outcome measures were ocular survival and ambulatory vision survival (>20/200) at 1 year after trauma using univariate and multivariate regression analysis. The ocular trauma scores were significantly higher in open globe injuries than in closed globe injuries (p eyeball loss. Elapsed time more than 12 hours and visible intraocular tissues were the significant risk factors associated with ambulatory vision loss. The most powerful predictor of eyeball loss and ambulatory vision loss was eyeball rupture. In closed globe injuries, there were no significant risk factors of eyeball loss, whereas initial vision less than LP and the presence of relative afferent pupillary defect were the significant risk factors associated with ambulatory vision loss. An initial VA less than LP using a penlight, a history of golf ball injury, and elapsed time more than 12 hours between ocular trauma and hospital arrival were associated with eyeball loss and ambulatory vision loss. Physicians should bear these factors in mind so that they can more effectively counsel patients with such injuries.

  12. Emerging pollutants in the environment: present and future challenges in biomonitoring, ecological risks and bioremediation.

    Science.gov (United States)

    Gavrilescu, Maria; Demnerová, Kateřina; Aamand, Jens; Agathos, Spiros; Fava, Fabio

    2015-01-25

    Emerging pollutants reach the environment from various anthropogenic sources and are distributed throughout environmental matrices. Although great advances have been made in the detection and analysis of trace pollutants during recent decades, due to the continued development and refinement of specific techniques, a wide array of undetected contaminants of emerging environmental concern need to be identified and quantified in various environmental components and biological tissues. These pollutants may be mobile and persistent in air, water, soil, sediments and ecological receptors even at low concentrations. Robust data on their fate and behaviour in the environment, as well as on threats to ecological and human health, are still lacking. Moreover, the ecotoxicological significance of some emerging micropollutants remains largely unknown, because satisfactory data to determine their risk often do not exist. This paper discusses the fate, behaviour, (bio)monitoring, environmental and health risks associated with emerging chemical (pharmaceuticals, endocrine disruptors, hormones, toxins, among others) and biological (bacteria, viruses) micropollutants in soils, sediments, groundwater, industrial and municipal wastewaters, aquaculture effluents, and freshwater and marine ecosystems, and highlights new horizons for their (bio)removal. Our study aims to demonstrate the imperative need to boost research and innovation for new and cost-effective treatment technologies, in line with the uptake, mode of action and consequences of each emerging contaminant. We also address the topic of innovative tools for the evaluation of the effects of toxicity on human health and for the prediction of microbial availability and degradation in the environment. Additionally, we consider the development of (bio)sensors to perform environmental monitoring in real-time mode. This needs to address multiple species, along with a more effective exploitation of specialised microbes or enzymes

  13. A scenario-based modeling approach for emergency evacuation management and risk analysis under multiple uncertainties

    Energy Technology Data Exchange (ETDEWEB)

    Lv, Y., E-mail: lvyying@hotmail.com [School of Traffic and Transportation, Beijing Jiaotong University, Beijing 100044 (China); Faculty of Engineering and Applied Science, University of Regina, Regina, Saskatchewan S4S 0A2 (Canada); Huang, G.H., E-mail: huang@iseis.org [Faculty of Engineering and Applied Science, University of Regina, Regina, Saskatchewan S4S 0A2 (Canada); Guo, L., E-mail: guoli8658@hotmail.com [Faculty of Engineering and Applied Science, University of Regina, Regina, Saskatchewan S4S 0A2 (Canada); Li, Y.P., E-mail: yongping.li@iseis.org [MOE Key Laboratory of Regional Energy and Environmental Systems Optimization, Resources and Environmental Research Academy, North China Electric Power University, Beijing 102206 (China); Dai, C., E-mail: daichao321@gmail.com [College of Environmental Sciences and Engineering, Peking University, Beijing 100871 (China); Wang, X.W., E-mail: wangxingwei0812@gamil.com [State Key Laboratory of Water Environment Simulation, School of Environment, Beijing Normal University, Beijing 100875 (China); Sun, W., E-mail: sunwei@iseis.org [Faculty of Engineering and Applied Science, University of Regina, Regina, Saskatchewan S4S 0A2 (Canada)

    2013-02-15

    Highlights: ► An interval-parameter joint-probabilistic integer programming method is developed. ► It is useful for nuclear emergency management practices under uncertainties. ► It can schedule optimal routes with maximizing evacuees during a finite time. ► Scenario-based analysis enhances robustness in controlling system risk. ► The method will help to improve the capability of disaster responses. -- Abstract: Nuclear emergency evacuation is important to prevent radioactive harms by hazardous materials and to limit the accidents’ consequences; however, uncertainties are involved in the components and processes of such a management system. In the study, an interval-parameter joint-probabilistic integer programming (IJIP) method is developed for emergency evacuation management under uncertainties. Optimization techniques of interval-parameter programming (IPP) and joint-probabilistic constrained (JPC) programming are incorporated into an integer linear programming framework, so that the approach can deal with uncertainties expressed as joint probability and interval values. The IJIP method can schedule the optimal routes to guarantee the maximum population evacuated away from the effected zone during a finite time. Furthermore, it can also facilitate post optimization analysis to enhance robustness in controlling system violation risk imposed on the joint-probabilistic constraints. The developed method has been applied to a case study of nuclear emergency management; meanwhile, a number of scenarios under different system conditions have been analyzed. It is indicated that the solutions are useful for evacuation management practices. The result of the IJIP method can not only help to raise the capability of disaster responses in a systematic manner, but also provide an insight into complex relationships among evacuation planning, resources utilizations, policy requirements and system risks.

  14. Emergency response and nuclear risk governance. Nuclear safety at nuclear power plant accidents

    International Nuclear Information System (INIS)

    Kuhlen, Johannes

    2014-01-01

    The present study entitled ''Emergency Response and Nuclear Risk Governance: nuclear safety at nuclear power plant accidents'' deals with issues of the protection of the population and the environment against hazardous radiation (the hazards of nuclear energy) and the harmful effects of radioactivity during nuclear power plant accidents. The aim of this study is to contribute to both the identification and remediation of shortcomings and deficits in the management of severe nuclear accidents like those that occurred at Chernobyl in 1986 and at Fukushima in 2011 as well as to the improvement and harmonization of plans and measures taken on an international level in nuclear emergency management. This thesis is divided into a theoretical part and an empirical part. The theoretical part focuses on embedding the subject in a specifically global governance concept, which includes, as far as Nuclear Risk Governance is concerned, the global governance of nuclear risks. Due to their characteristic features the following governance concepts can be assigned to these risks: Nuclear Safety Governance is related to safety, Nuclear Security Governance to security and NonProliferation Governance to safeguards. The subject of investigation of the present study is as a special case of the Nuclear Safety Governance, the Nuclear Emergency governance, which refers to off-site emergency response. The global impact of nuclear accidents and the concepts of security, safety culture and residual risk are contemplated in this context. The findings (accident sequences, their consequences and implications) from the analyses of two reactor accidents prior to Fukushima (Three Mile Iceland in 1979, Chernobyl in 1986) are examined from a historical analytical perspective and the state of the Nuclear Emergency governance and international cooperation aimed at improving nuclear safety after Chernobyl is portrayed by discussing, among other topics, examples of &apos

  15. Risk assessment of the emergency processes: Healthcare failure mode and effect analysis.

    Science.gov (United States)

    Taleghani, Yasamin Molavi; Rezaei, Fatemeh; Sheikhbardsiri, Hojat

    2016-01-01

    Ensuring about the patient's safety is the first vital step in improving the quality of care and the emergency ward is known as a high-risk area in treatment health care. The present study was conducted to evaluate the selected risk processes of emergency surgery department of a treatment-educational Qaem center in Mashhad by using analysis method of the conditions and failure effects in health care. In this study, in combination (qualitative action research and quantitative cross-sectional), failure modes and effects of 5 high-risk procedures of the emergency surgery department were identified and analyzed according to Healthcare Failure Mode and Effects Analysis (HFMEA). To classify the failure modes from the "nursing errors in clinical management model (NECM)", the classification of the effective causes of error from "Eindhoven model" and determination of the strategies to improve from the "theory of solving problem by an inventive method" were used. To analyze the quantitative data of descriptive statistics (total points) and to analyze the qualitative data, content analysis and agreement of comments of the members were used. In 5 selected processes by "voting method using rating", 23 steps, 61 sub-processes and 217 potential failure modes were identified by HFMEA. 25 (11.5%) failure modes as the high risk errors were detected and transferred to the decision tree. The most and the least failure modes were placed in the categories of care errors (54.7%) and knowledge and skill (9.5%), respectively. Also, 29.4% of preventive measures were in the category of human resource management strategy. "Revision and re-engineering of processes", "continuous monitoring of the works", "preparation and revision of operating procedures and policies", "developing the criteria for evaluating the performance of the personnel", "designing a suitable educational content for needs of employee", "training patients", "reducing the workload and power shortage", "improving team

  16. Emergency Physician Attitudes, Preferences, and Risk Tolerance for Stroke as a Potential Cause of Dizziness Symptoms

    Directory of Open Access Journals (Sweden)

    Mamata V. Kene

    2015-10-01

    Full Text Available Introduction: We evaluated emergency physicians’ (EP current perceptions, practice, and attitudes towards evaluating stroke as a cause of dizziness among emergency department patients. Methods: We administered a survey to all EPs in a large integrated healthcare delivery system. The survey included clinical vignettes, perceived utility of historical and exam elements, attitudes about the value of and requisite post-test probability of a clinical prediction rule for dizziness. We calculated descriptive statistics and post-test probabilities for such a clinical prediction rule. Results: The response rate was 68% (366/535. Respondents’ median practice tenure was eight years (37% female, 92% emergency medicine board certified. Symptom quality and typical vascular risk factors increased suspicion for stroke as a cause of dizziness. Most respondents reported obtaining head computed tomography (CT (74%. Nearly all respondents used and felt confident using cranial nerve and limb strength testing. A substantial minority of EPs used the Epley maneuver (49% and HINTS (head-thrust test, gaze-evoked nystagmus, and skew deviation testing (30%; however, few EPs reported confidence in these tests’ bedside application (35% and 16%, respectively. Respondents favorably viewed applying a properly validated clinical prediction rule for assessment of immediate and 30-day stroke risk, but indicated it would have to reduce stroke risk to <0.5% to be clinically useful. Conclusion: EPs report relying on symptom quality, vascular risk factors, simple physical exam elements, and head CT to diagnose stroke as the cause of dizziness, but would find a validated clinical prediction rule for dizziness helpful. A clinical prediction rule would have to achieve a 0.5% post-test stroke probability for acceptability.

  17. All-Cause and Cause-Specific Risk of Emergency Transport Attributable to Temperature

    Science.gov (United States)

    Onozuka, Daisuke; Hagihara, Akihito

    2015-01-01

    Abstract Although several studies have estimated the associations between mortality or morbidity and extreme temperatures in terms of relative risk, few studies have investigated the risk of emergency transport attributable to the whole temperature range nationwide. We acquired data on daily emergency ambulance dispatches in all 47 prefectures of Japan from 2007 to 2010. We examined the relationship between emergency transport and temperature for each prefecture using a Poisson regression model in a distributed lag nonlinear model with adjustment for time trends. A random-effect multivariate meta-analysis was then applied to pool the estimates at the national level. Attributable morbidity was calculated for high and low temperatures, which were defined as those above or below the optimum temperature (ie, the minimum morbidity temperature) and for moderate and also extreme temperatures, which were defined using cutoffs at the 2.5th and 97.5th temperature percentiles. A total of 15,868,086 cases of emergency transport met the inclusion criteria. The emergency transport was attributable to nonoptimal temperature. The median minimum morbidity percentile was in the 79th percentile for all causes, the 96th percentile for cardiovascular disease, and the 92th percentile for respiratory disease. The fraction attributable to low temperature was 6.94% (95% eCI: 5.93–7.70) for all causes, 17.93% (95% eCI: 16.10–19.25) for cardiovascular disease, and 12.19% (95% eCI: 9.90–13.66) for respiratory disease, whereas the fraction attributable to high temperature was small (all causes = 1.01%, 95% eCI: 0.90–1.11; cardiovascular disease = 0.10%, 95% eCI: 0.04–0.14; respiratory disease = 0.29%, 95% eCI: 0.07–0.50). The all-cause morbidity risk that was attributable to temperature was related to moderate cold, with an overall estimate of 6.41% (95% eCI: 5.47–7.20). Extreme temperatures were responsible for a small fraction, which corresponded to 0.57% (95% e

  18. Zika, chikungunya and dengue: the causes and threats of new and re-emerging arboviral diseases.

    Science.gov (United States)

    Paixão, Enny S; Teixeira, Maria Gloria; Rodrigues, Laura C

    2018-01-01

    The recent emergence and re-emergence of viral infections transmitted by vectors-Zika, chikungunya, dengue, Japanese encephalitis, West Nile, yellow fever and others-is a cause for international concern. Using as examples Zika, chikungunya and dengue, we summarise current knowledge on characteristics of the viruses and their transmission, clinical features, laboratory diagnosis, burden, history, possible causes of the spread and the expectation for future epidemics. Arboviruses are transmitted by mosquitoes, are of difficult diagnosis, can have surprising clinical complications and cause severe burden. The current situation is complex, because there is no vaccine for Zika and chikungunya and no specific treatment for the three arboviruses. Vector control is the only comprehensive solution available now and this remains a challenge because up to now this has not been very effective. Until we develop new technologies of control mosquito populations, the globalised and urbanised world we live in will remain vulnerable to the threat of successive arbovirus epidemics.

  19. Emergence of Stenotrophomonas maltophilia nosocomial isolates in a Saudi children's hospital. Risk factors and clinical characteristics.

    Science.gov (United States)

    Alqahtani, Jobran M

    2017-05-01

      To describe the clinical characteristics of pediatric patients colonized or infected by Stenotrophomonas maltophilia (S. maltophilia) at a Saudi children's hospital, to identify risk factors associated with infection, and to investigate the antimicrobial resistance patterns of this emerging pathogen.  Methods: In this cross-sectional observational study, 64 non-duplicating S. maltophilia strains were isolated  in Najran Maternity and Children's Hospital, Najran,  Saudi Arabia between January 2015 to February 2016. Antimicrobial susceptibility testing was performed using the reference broth microdilution method.  Results: In this study, 48 (75%) isolates were identified in true infections and 16 (25%) isolates were considered colonization. The main types of S. maltophilia infection were pneumonia in 22 (45.8%) patients and bloodstream infection in 14 (29.2%) patients. The significant risk factors included exposure to invasive procedure (p=0.02), and presence of acute leukemia as an underlying disease (p=0.02). The most active antimicrobials were trimethoprim/sulfamethoxazole (100% sensitivity) and tigecycline (93.7% sensitivity). Conclusions: Stenotrophomonas maltophilia is an emerging nosocomial pathogen among pediatric patients. Accurate identification and susceptibility testing of this emerging pathogen are crucial for the management of infected patients and prevention of spread of this nosocomial pathogen.

  20. I Want Your Sext: Sexting and Sexual Risk in Emerging Adult Minority Men.

    Science.gov (United States)

    Davis, Mikaela Jessica; Powell, Adeya; Gordon, Derrick; Kershaw, Trace

    2016-04-01

    Sexting, sending, or receiving sexually suggestive or explicit messages/photos/videos, have not been studied extensively. The aims of this study is to understand factors associated with sexting among minority (e.g., African- American, Hispanic) emerging adult males and the association between sexting and sexual risk. We recruited 119 emerging adult heterosexual males and assessed sexting and sexual risk behaviors. Fifty-four percent of participants sent a sext, and 70% received a sext. Participants were more likely to sext with casual partners than with steady partners. Multiple regression analyses showed that participants who sent sexts to steady partners had significantly more unprotected vaginal intercourse and oral sex. Participants who sent sexts to casual partners had significantly more partners, and participants who received sexts from casual partners had significantly more unprotected oral sex and sex while on substances. We found that sexting is a frequent and reciprocal behavior among emerging adults, and there were different patterns of significance for sexts with casual and steady partners.

  1. Psychosocial risks and stress as predictors of burnout in junior doctors performing emergency guards

    Science.gov (United States)

    Fernández-Prada, María; González-Cabrera, Joaquín; Iribar-Ibabe, Concepción; Peinado, José María

    2017-01-01

    To study the stress, the psychosocial risks associated to the job and the burnout, in a group of junior doctors working at the emergency ward; and to analyze what of those variables could predict and are better related with burnout. Cross-sectional study, with a sample of 42 junior doctors which are on duty in the emergency ward of the University Hospital San Cecilio, Granada (Spain). The Spanish adapted version of the Perceived Stress Scale was used to evaluate stress, the Maslach Burnout Inventory (MBI) to evaluate the professional burnout and the adapted and scaled questionnaire for the self-evaluation of psychosocial risks at work (CopSoQ-ISTAS21). 78% of the junior doctors are in the unfavorable or intermediate range for all CopSoQ-ISTAS21 dimensions, being particularly relevant that 90% of them display unfavorable score in psychological demands. In addition, MBI results show that 45% of our population presents high emotional exhaustion simultaneously to high depersonalization. ISTAS21 psychological demands dimensions (ß = 0.393; p stress scores (ß = 0.451; p burnout. These results indicate the need of psychological and structural interventions in order to improve the professional performance of junior doctors at the emergency ward. Copyright: © 2017 SecretarÍa de Salud

  2. Probabilistic risk assessment support of emergency preparedness at the Savannah River Site

    International Nuclear Information System (INIS)

    O'Kula, K.R.; Baker, W.H.; Simpkins, A.A.; Taylor, R.P.; Wagner, K.C.; Amos, C.N.

    1992-01-01

    Integration of the Probabilistic Risk Assessment (PRA) for K Reactor operation into related technical areas at the Savannah River Site (SRS) includes coordination with several onsite organizations responsible for maintaining and upgrading emergency preparedness capabilities. Major functional categories of the PRA application are scenario development and source term algorithm enhancement. Insights and technologies from the SRS PRA have facilitated development of: (1) credible timelines for scenarios; (2) algorithms tied to plant instrumentation to provide best-estimate source terms for dose projection; and (3) expert-system logic models to implement informed counter-measures to assure onsite and offsite safety following accidental releases. The latter methodology, in particular, is readily transferable to other reactor and non-reactor facilities at SRS and represents a distinct advance relative to emergency preparedness capabilities elsewhere in the DOE complex

  3. Prognosis and risk factors for deterioration in patients admitted to a medical emergency department

    DEFF Research Database (Denmark)

    Henriksen, Daniel Pilsgaard; Brabrand, Mikkel; Lassen, Annmarie Touborg

    2014-01-01

    vital signs at arrival to a medical emergency department (MED). DESIGN AND SETTING: Single-centre, retrospective cohort study of all patients admitted to the MED from September 2010-August 2011. SUBJECTS: Patients were included when their vital signs (systolic blood pressure, pulse rate, respiratory.......2-3.0%) among the non-deteriorating, hazard ratio 4.11 (95% CI: 2.38-7.10). CONCLUSIONS: Among acutely admitted medical patients who arrive with normal vital signs, 31.0% showed signs of deterioration within 24 hours. Risk factors included old age, Do-not-attempt-to-resuscitate order, admission from the open...... general ED. Thirty-day mortality among patients with deterioration was four times higher than among non-deteriorating patients. Further research is needed to determine whether intensified monitoring of vital signs can help to prevent deterioration or mortality among medical emergency patients....

  4. Nutritional Risk in Emergency-2017: A New Simplified Proposal for a Nutrition Screening Tool.

    Science.gov (United States)

    Marcadenti, Aline; Mendes, Larissa Loures; Rabito, Estela Iraci; Fink, Jaqueline da Silva; Silva, Flávia Moraes

    2018-03-13

    There are many nutrition screening tools currently being applied in hospitals to identify risk of malnutrition. However, multivariate statistical models are not usually employed to take into account the importance of each variable included in the instrument's development. To develop and evaluate the concurrent and predictive validities of a new screening tool of nutrition risk. A prospective cohort study was developed, in which 4 nutrition screening tools were applied to all patients. Length of stay in hospital and mortality were considered to test the predictive validity, and the concurrent validity was tested by comparing the Nuritional Risk in Emergency (NRE)-2017 to the other tools. A total of 748 patients were included. The final NRE-2017 score was composed of 6 questions (advanced age, metabolic stress of the disease, decreased appetite, changing of food consistency, unintentional weight loss, and muscle mass loss) with answers yes or no. The prevalence of nutrition risk was 50.7% and 38.8% considering the cutoff points 1.0 and 1.5, respectively. The NRE-2017 showed a satisfactory power to indentify risk of malnutrition (area under the curve >0.790 for all analyses). According to the NRE-2017, patients at risk of malnutrition have twice as high relative risk of a very long hospital stay. The hazard ratio for mortality was 2.78 (1.03-7.49) when the cutoff adopted by the NRE-2017 was 1.5 points. NRE-2017 is a new, easy-to-apply nutrition screening tool which uses 6 bi-categoric features to detect the risk of malnutrition, and it presented a good concurrent and predictive validity. © 2018 American Society for Parenteral and Enteral Nutrition.

  5. Identifying Adolescents at Highly Elevated Risk for Suicidal Behavior in the Emergency Department

    Science.gov (United States)

    Berona, Johnny; Czyz, Ewa; Horwitz, Adam G.; Gipson, Polly Y.

    2015-01-01

    Abstract Objective: The feasibility and concurrent validity of adolescent suicide risk screening in medical emergency departments (EDs) has been documented. The objectives of this short-term prospective study of adolescents who screened positive for suicide risk in the ED were: 1) to examine adolescents' rate of suicidal behavior during the 2 months following their ED visits and compare it with reported rates for psychiatric samples; and 2) to identify possible predictors of acute risk for suicidal behavior in this at-risk sample. Method: Participants were 81 adolescents, ages 14–19 years, seeking services for psychiatric and nonpsychiatric chief complaints, who screened positive for suicide risk because of recent suicidal ideation, a suicide attempt, and/or depression plus alcohol or substance misuse. A comprehensive assessment of suicidal behavior, using the Columbia-Suicide Severity Rating Scale, was conducted at baseline and 2 month follow-up. Results: Six adolescents (7.4%) reported a suicide attempt and 15 (18.5%) engaged in some type of suicidal behavior (actual, aborted, or interrupted suicide attempt; preparatory behavior) during the 2 months following their ED visit. These rates suggest that this screen identified a high-risk sample. Furthermore, adolescents who screened positive for suicidal ideation and/or attempt plus depression and alcohol/substance misuse were most likely to engage in future suicidal behavior (38.9%). Conclusions: In this study, use of a higher screen threshold (multiple suicide risk factors) showed promise for identifying highly elevated acute risk for suicidal behavior. PMID:25746114

  6. International workshop on insecticide resistance in vectors of arboviruses, December 2016, Rio de Janeiro, Brazil.

    Science.gov (United States)

    Corbel, Vincent; Fonseca, Dina M; Weetman, David; Pinto, João; Achee, Nicole L; Chandre, Fabrice; Coulibaly, Mamadou B; Dusfour, Isabelle; Grieco, John; Juntarajumnong, Waraporn; Lenhart, Audrey; Martins, Ademir J; Moyes, Catherine; Ng, Lee Ching; Raghavendra, Kamaraju; Vatandoost, Hassan; Vontas, John; Muller, Pie; Kasai, Shinji; Fouque, Florence; Velayudhan, Raman; Durot, Claire; David, Jean-Philippe

    2017-06-02

    Vector-borne diseases transmitted by insect vectors such as mosquitoes occur in over 100 countries and affect almost half of the world's population. Dengue is currently the most prevalent arboviral disease but chikungunya, Zika and yellow fever show increasing prevalence and severity. Vector control, mainly by the use of insecticides, play a key role in disease prevention but the use of the same chemicals for more than 40 years, together with the dissemination of mosquitoes by trade and environmental changes, resulted in the global spread of insecticide resistance. In this context, innovative tools and strategies for vector control, including the management of resistance, are urgently needed. This report summarizes the main outputs of the first international workshop on Insecticide resistance in vectors of arboviruses held in Rio de Janeiro, Brazil, 5-8 December 2016. The primary aims of this workshop were to identify strategies for the development and implementation of standardized insecticide resistance management, also to allow comparisons across nations and across time, and to define research priorities for control of vectors of arboviruses. The workshop brought together 163 participants from 28 nationalities and was accessible, live, through the web (> 70,000 web-accesses over 3 days).

  7. Ticks associated with macquarie island penguins carry arboviruses from four genera.

    Directory of Open Access Journals (Sweden)

    Lee Major

    Full Text Available Macquarie Island, a small subantarctic island, is home to rockhopper, royal and king penguins, which are often infested with the globally distributed seabird tick, Ixodes uriae. A flavivirus, an orbivirus, a phlebovirus, and a nairovirus were isolated from these ticks and partial sequences obtained. The flavivirus was nearly identical to Gadgets Gully virus, isolated some 30 year previously, illustrating the remarkable genetic stability of this virus. The nearest relative to the orbivirus (for which we propose the name Sandy Bay virus was the Scottish Broadhaven virus, and provided only the second available sequences from the Great Island orbivirus serogroup. The phlebovirus (for which we propose the name Catch-me-cave virus and the previously isolated Precarious Point virus were distinct but related, with both showing homology with the Finnish Uukuniemi virus. These penguin viruses provided the second and third available sequences for the Uukuniemi group of phleboviruses. The nairovirus (for which we propose the name Finch Creek virus was shown to be related to the North American Tillamook virus, the Asian Hazara virus and Nairobi sheep disease virus. Macquarie Island penguins thus harbour arboviruses from at least four of the seven arbovirus-containing genera, with related viruses often found in the northern hemisphere.

  8. Investigations into yellow fever virus and other arboviruses in the northern regions of Kenya.

    Science.gov (United States)

    Henderson, B E; Metselaar, D; Kirya, G B; Timms, G L

    1970-01-01

    Previous studies having shown an appreciable level of yellow fever immunity to exist in northern Kenya, further epidemiological and serological surveys were carried out there in 1968 in an attempt to define more clearly the distribution of yellow fever and to locate possible vector and reservoir hosts of the disease; these surveys also provided information on a number of other arboviruses.Altogether 436 sera from 5 areas in northern Kenya were screened by haemagglutination-inhibition tests with 8 antigens, and 107 of these sera by neutralization tests for Group-B arboviruses. Small numbers of yellow-fever-immune adults were found in Ileret, Garissa, Loglogo and Mikona. At Marsabit high proportions of immune adults and children were found among the Burgi tribe. As the Burgi are permanent agricultural workers on Marsabit Mountain, an entomological investigation was made, over 15 000 mosquitos being collected. From these, 13 strains of Pongola virus, 1 strain of Semliki Forest virus and an unidentified virus were isolated, but no yellow fever strains. Aedes africanus and Aedes simpsoni were not found at Marsabit; small numbers of Aedes aegypti were collected biting man. The vector potential of other mosquitos collected (particularly Mansonia africana, which is present throughout the year) is discussed.

  9. Monitoring emerging contaminants in the drinking water of Milan and assessment of the human risk.

    Science.gov (United States)

    Riva, Francesco; Castiglioni, Sara; Fattore, Elena; Manenti, Angela; Davoli, Enrico; Zuccato, Ettore

    2018-04-01

    Emerging Contaminants (ECs) are ubiquitous in waters, arousing concern because of their potential risks for human health and the environment. This study investigated the presence of multiple classes of ECs in 21 wells over the drinking water network of Milan, in the most inhabited and industrialized area of Italy, and assessed the risks for consumers. Samples were analyzed using liquid chromatography coupled to mass spectrometry. Human risk assessment (HRA) was conducted by comparing the measured concentrations with drinking water thresholds from guidelines or calculated in this study; first considering the exposure to each single EC and then the entire mixture. Thirteen ECs were measured in the low ng/L range, and were generally detected in less than half of the wells. Pharmaceuticals, perfluorinated substances, personal care products, and anthropogenic markers were the most frequently detected. The results of the HRA excluded any risks for consumers in each scenario considered. This is one of the most comprehensive studies assessing the presence of a large number of ECs in the whole drinking water network of a city, and the risks for human health. Results improve the limited information on ECs sources and occurrence in drinking water and help establishing guidelines for regulatory purposes. Copyright © 2018 Elsevier GmbH. All rights reserved.

  10. Risk Communication Emergency Response Preparedness: Contextual Assessment of the Protective Action Decision Model.

    Science.gov (United States)

    Heath, Robert L; Lee, Jaesub; Palenchar, Michael J; Lemon, Laura L

    2018-02-01

    Studies are continuously performed to improve risk communication campaign designs to better prepare residents to act in the safest manner during an emergency. To that end, this article investigates the predictive ability of the protective action decision model (PADM), which links environmental and social cues, predecision processes (attention, exposure, and comprehension), and risk decision perceptions (threat, alternative protective actions, and stakeholder norms) with protective action decision making. This current quasi-longitudinal study of residents (N = 400 for each year) in a high-risk (chemical release) petrochemical manufacturing community investigated whether PADM core risk perceptions predict protective action decision making. Telephone survey data collected at four intervals (1995, 1998, 2002, 2012) reveal that perceptions of protective actions and stakeholder norms, but not of threat, currently predict protective action decision making (intention to shelter in place). Of significance, rather than threat perceptions, perception of Wally Wise Guy (a spokes-character who advocates shelter in place) correlates with perceptions of protective action, stakeholder norms, and protective action decision making. Wally's response-efficacy advice predicts residents' behavioral intentions to shelter in place, thereby offering contextually sensitive support and refinement for PADM. © 2017 Society for Risk Analysis.

  11. What are we missing? Risk behaviors among Arab-American adolescents and emerging adults.

    Science.gov (United States)

    Munro-Kramer, Michelle L; Fava, Nicole M; Saftner, Melissa A; Darling-Fisher, Cynthia S; Tate, Nutrena H; Stoddard, Sarah A; Martyn, Kristy K

    2016-09-01

    Research on Arab-Americans as a distinct ethnic group is limited, especially when considering the health of Arab-American youth. This study describes health risk (substance use, violence); health promotive behaviors (hope, spirituality); and sexual activity (oral, vaginal, anal sex) of Arab-American adolescents and emerging adults (aged 15-23) within their life context, as well as the association between these behaviors. A secondary analysis of data on a subset of Arab-American participants obtained from a randomized-control trial was utilized to conduct mixed methods analyses. Qualitative analyses completed on the open-ended questions used the constant comparative method for a subsample (n = 24) of participants. Descriptive quantitative analyses of survey data utilized bivariate analyses and stepwise logistic regression to explore the relation between risk behaviors and sexual activity among the full sample (n = 57). Qualitative analyses revealed two groups of participants: (a) multiple risk behaviors and negative life-events, and (b) minimal risk behaviors and positive life-events. Quantitative analyses indicated older youth, smokers, and those with higher hope pathways were more likely to report vaginal sex. The unique cultural and social contexts of Arab-American youth provide a framework for recommendations for the prevention of risk behaviors. ©2016 American Association of Nurse Practitioners.

  12. Autonomic nervous system activity as risk predictor in the medical emergency department: a prospective cohort study.

    Science.gov (United States)

    Eick, Christian; Rizas, Konstantinos D; Meyer-Zürn, Christine S; Groga-Bada, Patrick; Hamm, Wolfgang; Kreth, Florian; Overkamp, Dietrich; Weyrich, Peter; Gawaz, Meinrad; Bauer, Axel

    2015-05-01

    To evaluate heart rate deceleration capacity, an electrocardiogram-based marker of autonomic nervous system activity, as risk predictor in a medical emergency department and to test its incremental predictive value to the modified early warning score. Prospective cohort study. Medical emergency department of a large university hospital. Five thousand seven hundred thirty consecutive patients of either sex in sinus rhythm, who were admitted to the medical emergency department of the University of Tübingen, Germany, between November 2010 and March 2012. None. Deceleration capacity of heart rate was calculated within the first minutes after emergency department admission. The modified early warning score was assessed from respiratory rate, heart rate, systolic blood pressure, body temperature, and level of consciousness as previously described. Primary endpoint was intrahospital mortality; secondary endpoints included transfer to the ICU as well as 30-day and 180-day mortality. One hundred forty-two patients (2.5%) reached the primary endpoint. Deceleration capacity was highly significantly lower in nonsurvivors than survivors (2.9 ± 2.1 ms vs 5.6 ± 2.9 ms; p model yielded an area under the receiver-operator characteristic curve of 0.706 (0.667-0.750). Implementing deceleration capacity into the modified early warning score model led to a highly significant increase of the area under the receiver-operator characteristic curve to 0.804 (0.770-0.835; p capacity was also a highly significant predictor of 30-day and 180-day mortality as well as transfer to the ICU. Deceleration capacity is a strong and independent predictor of short-term mortality among patients admitted to a medical emergency department.

  13. Staggering the dose of sugammadex lowers risks for severe emergence cough: a randomized control trial.

    Science.gov (United States)

    P S, Loh; Miskan, M M; Y Z, Chin; Zaki, R A

    2017-10-11

    Cough on emergence has been reported as a common adverse reaction with sugammadex reversal. We investigated if staggering the dose of sugammadex will reduce emergence cough in a single-center, randomized, double-blinded study. A hundred and twenty ASA 1-3 adults were randomly reversed with 1 mg/kg sugammadex prior to extubation followed by another 1 mg/kg immediately after extubation (staggered group), single dose of 2 mg/kg sugammadex (single bolus group) or neostigmine 0.02 mg/kg with glycopyrrolate (neostigmine group). We found 70% of patients (n = 28) reversed with single boluses of sugammadex had Grade 3 emergence cough compared to 12.5% (n = 5) in the staggered sugammadex group and 17.5% (n = 7) in the neostigmine group (p sugammadex group (n = 14, 35%, p = 0.005). On the other hand, staggering sugammadex lowered risks of developing severe cough (RR 0.2, p sugammadex group and control given neostigmine. In terms of timing, there was no delay in time taken from discontinuing anesthetic agents to reversal and extubation if sugammadex was staggered (emergence time 6.0 ± 3.2 s, p = 0.625 and reversal time 6.5 ± 3.5, p = 0.809). Staggering the dose of sugammadex for reversal will effectively decrease common emergence and early postoperative complications. ANZCTR Number ACTRN12616000116426 . Retrospectively registered on 2nd February 2016.

  14. [Intra-anesthetic arterial hypotension in elderly patients during emergency surgery: what are the risk factors?

    Science.gov (United States)

    Boubacar Ba, El Hadji; Leye, Papa Alassane; Traoré, Mamadou Mour; Ndiaye, Pape Ibrahima; Gaye, Ibrahima; Bah, Mamadou Diawo; Fall, Mamadou Lamine; Diouf, Elisabeth

    2017-01-01

    Emergency anesthesia in elderly patients aged 65 years and older is complex. The occurrence of intraoperative incidents and arterial hypotension is conditioned by patients' initial health status and by the quality of intraoperative management. This study aimed to determine the incidence of intra-anesthetic arterial hypotension in elderly patients during emergency surgery and to assess the involvement of certain factors in its occurrence: age, sex, patient's history, ASA class, anesthetic technique. We conducted a retrospective descriptive and analytical study in the Emergency Surgery Department at the Aristide Le Dantec University Hospital from 1 March 2014 to 28 February 2015. We collected data from 210 patients out of 224 elderly patients aged 65 years and older undergoing emergency anesthesias (10.93%). Data of 101 men and 109 women were included in the analysis, of whom 64.3% had at least one defect. Patients' preoperative status was assessed using American Society of Anesthesiology (ASA) classification: 71% of patients were ASA class 1 and 2 and 29% were ASA class 3 and 4. Locoregional anesthesia was the most practiced anesthetic technique (56.7%). 28 patients (13.33%) had intra-anesthetic arterial hypotension, of whom 16 under general anesthesia and 12 under locoregional anesthesia. It was more frequent in patients with high ASA class and a little less frequent in patients with PAH and underlying heart disease. Arterial hypotension in elderly patients during emergency surgery exposes the subject to the risk of not negligible intraoperative hypotension, especially in patients with high ASA class. Prevention is based on adequate preoperative assessment and anesthetic management.

  15. 27 September 1991-Royal Order establishing an emergency plan for nuclear risks on Belgian territory

    International Nuclear Information System (INIS)

    1992-01-01

    This emergency plan is to serve as guidance for the protection measures to be taken whenever necessary. It establishes the duties of the different services and bodies, in accordance with their responsibilities under the national laws and regulations. The plan, which describes the general organisation, must be supplemented by intervention plans at the different action levels: by the provincial authorities, the communal authorities and the various services and institutions concerned. This plan mainly concerns large nuclear installations and transport of nuclear fuels and radioactive materials; however, lower risks from other activities are also covered. (NEA)

  16. Transversus abdominis plane block for an emergency laparotomy in a high-risk, elderly patient

    Directory of Open Access Journals (Sweden)

    Surekha S Patil

    2010-01-01

    Full Text Available A 72-year-old male patient with gall bladder perforation and small intestinal obstruction from impacted gall stone was posted for emergency laparotomy. He had congestive heart failure, severe hypertension at admission and history of multiple other coexisting diseases. On admission, he developed pulmonary oedema from systolic hypertension which was controlled by ventilatory support, nitroglycerine and furosemide. Preoperative international normalized ratio was 2.34 and left ventricular ejection fraction was only 20%. Because of risk of exaggerated fall in blood pressure during induction of anaesthesia (general or neuraxial, a transversus abdominis plane block via combined Petit triangle and subcostal technique was administered and supplemented with Propofol sedation.

  17. Differential Dynamic Evolutionary Model of Emergency Financial Service Supply Chain in Natural Disaster Risk Management

    Directory of Open Access Journals (Sweden)

    Shujian Ma

    2016-01-01

    Full Text Available A government-market-public partnership (GMPP could be a feasible arrangement for providing insurance coverage for natural disaster. Firstly, we put forward GMPP management mode. Secondly, the emergency financial service supply chain for natural disaster risk is built from the view of supply chain. Finally, the objective of this paper is to obtain insights into the cooperative and competitive relationship in GMPP system. We establish the cooperative and competitive differential dynamic evolutionary models and prove the existence of equilibrium solutions in order to solve the coordination problems. In conclusion, the equilibrium solutions can be achieved among the insurers, the operating governments, and the public.

  18. Does Implementation of Biomathematical Models Mitigate Fatigue and Fatigue-related Risks in Emergency Medical Services Operations? A Systematic Review

    Science.gov (United States)

    2018-01-11

    Background: Work schedules like those of Emergency Medical Services (EMS) personnel have been associated with increased risk of fatigue-related impairment. Biomathematical modeling is a means of objectively estimating the potential impacts of fatigue...

  19. Alcohol Use as Risk Factors for Older Adults’ Emergency Department Visits: A Latent Class Analysis

    Directory of Open Access Journals (Sweden)

    Namkee G. Choi, PhD

    2015-12-01

    Full Text Available Introduction: Late middle-aged and older adults’ share of emergency department (ED visits is increasing more than other age groups. ED visits by individuals with substance-related problems are also increasing. This paper was intended to identify subgroups of individuals aged 50+ by their risk for ED visits by examining their health/mental health status and alcohol use patterns. Methods: Data came from the 2013 National Health Interview Survey’s Sample Adult file (n=15,713. Following descriptive analysis of sample characteristics by alcohol use patterns, latent class analysis (LCA modeling was fit using alcohol use pattern (lifetime abstainers, ex-drinkers, current infrequent/light/ moderate drinkers, and current heavy drinkers, chronic health and mental health status, and past-year ED visits as indicators. Results: LCA identified a four-class model. All members of Class 1 (35% of the sample; lowest-risk group were infrequent/light/moderate drinkers and exhibited the lowest probabilities of chronic health/ mental health problems; Class 2 (21%; low-risk group consisted entirely of lifetime abstainers and, despite being the oldest group, exhibited low probabilities of health/mental health problems; Class 3 (37%; moderate-risk group was evenly divided between ex-drinkers and heavy drinkers; and Class 4 (7%; high-risk group included all four groups of drinkers but more ex-drinkers. In addition, Class 4 had the highest probabilities of chronic health/mental problems, unhealthy behaviors, and repeat ED visits, with the highest proportion of Blacks and the lowest proportions of college graduates and employed persons, indicating significant roles of these risk factors. Conclusion: Alcohol nonuse/use (and quantity of use and chronic health conditions are significant contributors to varying levels of ED visit risk. Clinicians need to help heavy-drinking older adults reduce unhealthy alcohol consumption and help both heavy drinkers and ex

  20. L-035: EPR-First Responders: Basic Risk and Protection for First Responders to a Radiological Emergency

    International Nuclear Information System (INIS)

    2011-01-01

    There are some basic actions and self-protective actions to take in an radiological emergency. Radiation is detected with appropriate instrumentation and measuring the rate of exposure (Sv per hour) in contact with radioactive materials involved. Is important to note: Responsive to a radiological emergency, tool to identify radiological risks, radiation protection, radioactive symbol and instrumentation

  1. Feelings of nurses in the reception and risk classification evaluation in the emergency room

    Directory of Open Access Journals (Sweden)

    Andressa Midori Sakai

    2016-05-01

    Full Text Available Objective: to reveal feelings of nurses who host with risk assessment and classification in an emergency room of a pubic hospital. Methods: it is a qualitative research approach with 12 nurses interviewed. The data were analyzed, categorized and discussed according to the theoretical framework of work psychodynamics. Results: the nurses expressed feelings of satisfaction in meeting the user needs assistance. They reported feeling as fear, stress and fatigue due to the sharp pace of work, gaps in health care network and situations of violence. They highlighted coping strategies to reduce the burden of this assignment, how to share the completion of the screening with the nursing staff. Conclusion: the host with risk assessment and classification favors the autonomy of nurses and provide greater accountability to this professional users, but the limitations of available resources to solve the complaint of patients generate physical and psychological burden to this worker.

  2. Feelings of nurses in the reception and risk classification evaluation in the emergency room

    Directory of Open Access Journals (Sweden)

    Andressa Midori Sakai

    2016-01-01

    Full Text Available Objective: to reveal feelings of nurses who host with risk assessment and classification in an emergency room of a pubic hospital. Methods: it is a qualitative research approach with 12 nurses interviewed. The data were analyzed, categorized and discussed according to the theoretical framework of work psychodynamics. Results: the nurses expressed feelings of satisfaction in meeting the user needs assistance. They reported feeling as fear, stress and fatigue due to the sharp pace of work, gaps in health care network and situations of violence. They highlighted coping strategies to reduce the burden of this assignment, how to share the completion of the screening with the nursing staff. Conclusion: the host with risk assessment and classification favors the autonomy of nurses and provide greater accountability to this professional users, but the limitations of available resources to solve the complaint of patients generate physical and psychological burden to this worker.

  3. On the benefits of multi-attribute risk analysis in nuclear emergency management

    International Nuclear Information System (INIS)

    Haemaelaeinen, R.P.; Lindstedt, M.

    1999-01-01

    The radiation protection authorities have seen a need to apply multi-attribute risk analysis in the nuclear emergency management and planning processes to deal with the conflicting objectives, different parties involved and uncertainties. This type of an approach is expected to help in at least the following three areas; to ensure that all the relevant attributes are considered in the decision making, to enhance communication between concerned parties including the population, and to provide a method for including risk analysis explicitly in the process. A MAUT analysis was used to select a strategy for protecting the population after a simulated nuclear accident. A value-focused approach and the use of a neutral facilitator were seen as very useful

  4. On the benefits of multi-attribute risk analysis in nuclear emergency management

    Energy Technology Data Exchange (ETDEWEB)

    Haemaelaeinen, R.P.; Lindstedt, M. [Helsinki Univ. of Technology (Finland). Systems Analysis Lab.; Sinkko, K. [The Radiation and Nuclear Safety Authority, Helsinki (Finland)

    1999-12-01

    The radiation protection authorities have seen a need to apply multi-attribute risk analysis in the nuclear emergency management and planning processes to deal with the conflicting objectives, different parties involved and uncertainties. This type of an approach is expected to help in at least the following three areas; to ensure that all the relevant attributes are considered in the decision making, to enhance communication between concerned parties including the population, and to provide a method for including risk analysis explicitly in the process. A MAUT analysis was used to select a strategy for protecting the population after a simulated nuclear accident. A value-focused approach and the use of a neutral facilitator were seen as very useful.

  5. Lung Emergencies

    Science.gov (United States)

    ... The Marfan Foundation Marfan & Related Disorders What is Marfan Syndrome? What are Related Disorders? What are the Signs? ... Emergencies Lung Emergencies Surgeries Lung Emergencies People with Marfan syndrome can be at increased risk of sudden lung ...

  6. Collaborative Audit of Risk Evaluation in Medical Emergency Treatment (CARE-MET I) - an international pilot.

    Science.gov (United States)

    Subbe, C P; Gauntlett, W; Kellett, J G

    2010-06-01

    The absence of an accepted model for risk-adjustment of acute medical admissions leads to suboptimal clinical triage and serves as a disincentive to compare outcomes in different hospitals. The Simple Clinical Score (SCS) is a model based on 16 clinical parameters affecting hospital mortality. We undertook a feasibility pilot in 21 hospitals in Europe and New Zealand each collecting data for 12 or more consecutive medical emergency admissions. Data from 281 patients was analysed. Severity of illness as estimated by SCS was related to risk of admission to the Intensive Care Unit (pRisk group to 22% in the Very High Risk Group (p<0.0001). Very low scores were associated with earlier discharge as opposed to very high scores (mean length of stay of 2.4 days vs 5.6 days, p<0.001). There were differences in the pattern of discharges in different hospitals with comparable SCS data. Clinicians reported no significant problems with the collection of data for the score in a number of different health care settings. The SCS appears to be a feasible tool to assist clinical triage of medical emergency admissions. The ability to view the profile of the SCS for different clinical centres opens up the possibility of accurate comparison of outcomes across clinical centres without distortion by different regional standards of health care. This pilot study demonstrates that the adoption of the SCS is practical across an international range of hospitals. Copyright 2010 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  7. Screening for violence risk factors identifies young adults at risk for return emergency department visit for injury.

    Science.gov (United States)

    Hankin, Abigail; Wei, Stanley; Foreman, Juron; Houry, Debra

    2014-08-01

    Homicide is the second leading cause of death among youth aged 15-24. Prior cross-sectional studies, in non-healthcare settings, have reported exposure to community violence, peer behavior, and delinquency as risk factors for violent injury. However, longitudinal cohort studies have not been performed to evaluate the temporal or predictive relationship between these risk factors and emergency department (ED) visits for injuries among at-risk youth. The objective was to assess whether self-reported exposure to violence risk factors in young adults can be used to predict future ED visits for injuries over a 1-year period. This prospective cohort study was performed in the ED of a Southeastern US Level I trauma center. Eligible participants were patients aged 18-24, presenting for any chief complaint. We excluded patients if they were critically ill, incarcerated, or could not read English. Initial recruitment occurred over a 6-month period, by a research assistant in the ED for 3-5 days per week, with shifts scheduled such that they included weekends and weekdays, over the hours from 8AM-8PM. At the time of initial contact in the ED, patients were asked to complete a written questionnaire, consisting of previously validated instruments measuring the following risk factors: a) aggression, b) perceived likelihood of violence, c) recent violent behavior, d) peer behavior, e) community exposure to violence, and f) positive future outlook. At 12 months following the initial ED visit, the participants' medical records were reviewed to identify any subsequent ED visits for injury-related complaints. We analyzed data with chi-square and logistic regression analyses. Three hundred thirty-two patients were approached, of whom 300 patients consented. Participants' average age was 21.1 years, with 60.1% female, 86.0% African American. After controlling for participant gender, ethnicity, or injury complaint at time of first visit, return visits for injuries were significantly

  8. First report in italy of the exotic mosquito species Aedes (Finlaya koreicus, a potential vector of arboviruses and filariae

    Directory of Open Access Journals (Sweden)

    Capelli Gioia

    2011-09-01

    Full Text Available Abstract Background In the Veneto region (north-eastern Italy an entomological surveillance system has been implemented since the introduction of the Asian tiger mosquito (Aedes albopictus in 1991. During the routine monitoring activity in a tiger mosquito-free area, an unexpected mosquito was noticed, which clearly did not belong to the recorded Italian fauna. Findings At the end of May 2011, twelve larvae and pupae were collected in a small village in Belluno province (Veneto region from a single manhole. Ten adults reared in the laboratory were morphologically and genetically identified as Aedes (Finlaya koreicus (Edwards, 1917, a species native to Southeast Asia. The subsequent investigations carried out in the following months in the same village provided evidence that this species had become established locally. Entomological and epidemiological investigations are currently ongoing in the surrounding area, to verify the eventual extension of the species outside the village and to trace back the route of entry into Italy. Conclusions This is the first report in Italy of the introduction of the exotic mosquito Ae. koreicus. This species has been shown experimentally to be competent in the transmission of the Japanese encephalitis virus and of the dog heartworm Dirofilaria immitis and is considered a potential vector of other arboviruses. Thus, the establishment of this species may increase the current risk or pose new potential threats, for human and animal health. This finding considerably complicates the entomological monitoring of the Asian tiger mosquito Ae. albopictus in Italy and stresses the importance of implementing the entomological surveillance for the early detection of and the rapid response against invasive mosquito species.

  9. Detection and phylogenetic characterization of arbovirus dual-infections among persons during a chikungunya fever outbreak, Haiti 2014.

    Directory of Open Access Journals (Sweden)

    Sarah K White

    2018-05-01

    Full Text Available In the context of recent arbovirus epidemics, questions about the frequency of simultaneous infection of patients with different arbovirus species have been raised. In 2014, a major Chikungunya virus (CHIKV epidemic impacted the Caribbean and South America. As part of ongoing screening of schoolchildren presenting with acute undifferentiated febrile illness in rural Haiti, we used RT-PCR to identify CHIKV infections in 82 of 100 children with this diagnosis during May-August 2014. Among these, eight were infected with a second arbovirus: six with Zika virus (ZIKV, one with Dengue virus serotype 2, and one with Mayaro virus (MAYV. These dual infections were only detected following culture of the specimen, suggesting low viral loads of the co-infecting species. Phylogenetic analyses indicated that the ZIKV and MAYV strains differ from those detected later in 2014 and 2015, respectively. Moreover, CHIKV and ZIKV strains from co-infected patients clustered monophyletically in their respective phylogeny, and clock calibration traced back the common ancestor of each clade to an overlapping timeframe of introduction of these arboviruses onto the island.

  10. Emergency Department Crowding and Loss of Medical Licensure: A New Risk of Patient Care in Hallways

    Directory of Open Access Journals (Sweden)

    Robert W. Derlet

    2014-03-01

    Full Text Available We report the case of a 32-year-old male recently diagnosed with type 2 diabetes treated at an urban university emergency department (ED crowded to 250% over capacity. His initial symptoms of shortness of breath and feeling ill for several days were evaluated with chest radiograph, electrocardiogram (EKG, and laboratory studies, which suggested mild diabetic ketoacidosis. His medical care in the ED was conducted in a crowded hallway. After correction of his metabolic abnormalities he felt improved and was discharged with arrangements made for outpatient follow-up. Two days later he returned in cardiac arrest, and resuscitation efforts failed. The autopsy was significant for multiple acute and chronic pulmonary emboli but no coronary artery disease. The hospital settled the case for $1 million and allocated major responsibility to the treating emergency physician (EP. As a result the state medical board named the EP in a disciplinary action, claiming negligence because the EKG had not been personally interpreted by that physician. A formal hearing was conducted with the EP’s medical license placed in jeopardy. This case illustrates the risk to EPs who treat patients in crowded hallways, where it is difficult to provide the highest level of care. This case also demonstrates the failure of hospital administration to accept responsibility and provide resources to the ED to ensure patient safety. [West J Emerg Med. 2014;15(2:137–141.

  11. Sarcopenia increases risk of long-term mortality in elderly patients undergoing emergency abdominal surgery.

    Science.gov (United States)

    Rangel, Erika L; Rios-Diaz, Arturo J; Uyeda, Jennifer W; Castillo-Angeles, Manuel; Cooper, Zara; Olufajo, Olubode A; Salim, Ali; Sodickson, Aaron D

    2017-12-01

    Frailty is associated with poor surgical outcomes in elderly patients but is difficult to measure in the emergency setting. Sarcopenia, or the loss of lean muscle mass, is a surrogate for frailty and can be measured using cross-sectional imaging. We sought to determine the impact of sarcopenia on 1-year mortality after emergency abdominal surgery in elderly patients. Sarcopenia was assessed in patients 70 years or older who underwent emergency abdominal surgery at a single hospital from 2006 to 2011. Average bilateral psoas muscle cross-sectional area at L3, normalized for height (Total Psoas Index [TPI]), was calculated using computed tomography. Sarcopenia was defined as TPI in the lowest sex-specific quartile. Primary outcome was mortality at 1 year. Secondary outcomes were in-hospital mortality and mortality at 30, 90, and 180 days. The association of sarcopenia with mortality was assessed using Cox proportional hazards regression and model performance judged using Harrell's C-statistic. Two hundred ninety-seven of 390 emergency abdominal surgery patients had preoperative imaging and height. The median age was 79 years, and 1-year mortality was 32%. Sarcopenic and nonsarcopenic patients were comparable in age, sex, race, comorbidities, American Society of Anesthesiologists classification, procedure urgency and type, operative severity, and need for discharge to a nursing facility. Sarcopenic patients had lower body mass index, greater need for intensive care, and longer hospital length of stay (p Sarcopenia was independently associated with increased in-hospital mortality (risk ratio, 2.6; 95% confidence interval [CI], 1.6-3.7) and mortality at 30 days (hazard ratio [HR], 3.7; 95% CI, 1.9-7.4), 90 days (HR, 3.3; 95% CI, 1.8-6.0), 180 days (HR, 2.5; 95% CI, 1.4-4.4), and 1 year (HR, 2.4; 95% CI, 1.4-3.9). Sarcopenia is associated with increased risk of mortality over 1 year in elderly patients undergoing emergency abdominal surgery. Sarcopenia defined by TPI is

  12. Identification of At-Risk Youth by Suicide Screening in a Pediatric Emergency Department.

    Science.gov (United States)

    Ballard, Elizabeth D; Cwik, Mary; Van Eck, Kathryn; Goldstein, Mitchell; Alfes, Clarissa; Wilson, Mary Ellen; Virden, Jane M; Horowitz, Lisa M; Wilcox, Holly C

    2017-02-01

    The pediatric emergency department (ED) is a critical location for the identification of children and adolescents at risk for suicide. Screening instruments that can be easily incorporated into clinical practice in EDs to identify and intervene with patients at increased suicide risk is a promising suicide prevention strategy and patient safety objective. This study is a retrospective review of the implementation of a brief suicide screen for pediatric psychiatric ED patients as standard of care. The Ask Suicide Screening Questions (ASQ) was implemented in an urban pediatric ED for patients with psychiatric presenting complaints. Nursing compliance rates, identification of at-risk patients, and sensitivity for repeated ED visits were evaluated using medical records from 970 patients. The ASQ was implemented with a compliance rate of 79 %. Fifty-three percent of the patients who screened positive (237/448) did not present to the ED with suicide-related complaints. These identified patients were more likely to be male, African American, and have externalizing behavior diagnoses. The ASQ demonstrated a sensitivity of 93 % and specificity of 43 % to predict return ED visits with suicide-related presenting complaints within 6 months of the index visit. Brief suicide screening instruments can be incorporated into standard of care in pediatric ED settings. Such screens can identify patients who do not directly report suicide-related presenting complaints at triage and who may be at particular risk for future suicidal behavior. Results have the potential to inform suicide prevention strategies in pediatric EDs.

  13. Dealing with at-risk populations in radiological/nuclear emergencies

    International Nuclear Information System (INIS)

    Wilkinson, D.

    2009-01-01

    In a mass casualty event, there will be at-risk populations that will require unique triage, treatment and consequence management to minimise immediate and long-term health effects. This statement is particularly true for radiological/nuclear (R/N) disasters where individuals exhibit a broad range of physiological responses to radiation exposure. For example, immunocompromised individuals will experience more detrimental radiation health effects; however, it is not always possible to definitively identify these individuals at the time of triage. Immediate and long-term consequence management for these individuals may require unique and potentially limited resources. Thus, at the time of an R/N event, it is crucial to assist community planners by: (a) rapidly identifying at-risk individuals who may have been exposed; (b) determining the dose and individual-specific health risks associated with radiation exposure; (c) identifying additional resources needed to deal with unique, population-specific requirements; and (d) developing treatment strategies in keeping with the rules of 'supply and demand'. A comprehensive approach to identifying issues relevant to the R/N emergency preparedness for dealing with at-risk populations will be discussed with the aim of defining future research objectives. (authors)

  14. [Pediatric anesthesia emergence delirium after elective ambulatory surgery: etiology, risk factors and prevalence].

    Science.gov (United States)

    Gololobov, Alik; Todris, Liat; Berman, Yakov; Rosenberg-Gilad, Zipi; Schlaeffer, Pnina; Kenett, Ron; Ben-Jacob, Ron; Segal, Eran

    2015-04-01

    Emergence delirium (ED) is a common problem among children and adults recovering from general anesthesia after surgery. Its symptoms include psychomotor agitation, hallucinations, and aggressive behavior. The phenomenon, which is most probably an adverse effect of general anesthesia agents, harms the recovery process and endangers the physical safety of patients and their health. Ranging between 10% and 80%, the exact prevalence of ED is unknown, and the risk factors of the phenomenon are unclear. The aim of the current retrospective study was to determine the prevalence rate of ED in 3947 children recovering from general anesthesia after short elective ambulatory surgery, and to map the influence of various risk factors on this phenomenon. Data were collected using electronic medical records. ED severity was assessed using the Pediatric Anesthesia Emergence Delirium Scale. Results showed the prevalence of ED among children. ED was significantly correlated with patients' age, type of surgery and premedication. ED was not correlated with severity of pain, type of anesthesia or with patients' sex.

  15. A qualitative study of health problems, risk factors, and prevention among Emergency Medical Service workers.

    Science.gov (United States)

    Dropkin, Jonathan; Moline, Jacqueline; Power, Paul M; Kim, Hyun

    2015-01-01

    Risk factors among Emergency Medical Service (EMS) workers are difficult to characterize and inconsistencies remain about their main health problems. To identify main work-related health problems among EMS workers in the United States; identify risk factors at the organizational, task, and exposure level; identify prevention strategies; examine these issues between participants (EMS workers and supervisors). Two types of qualitative research methods based on grounded theory were used: in-depth interviews with emergency medical technicians/paramedics (EMS workers) and focus groups (EMS workers and supervisors). Most participants reported similar health problems (musculoskeletal injuries) and the task related to these injuries, patient handling. Participants also reported similar physical exposures (ascending stairs with patients and patient weight). For organization/psychosocial factors, participants agreed that fitness, wages, breaks, and shift scheduling were linked with injuries, but overall, perceptions about these issues differed more than physical exposures. Lack of trust between EMS workers and supervisors were recurrent concerns among workers. However, not all organizational/psychosocial factors differed. EMS workers and supervisors agreed pre-employment screening could reduce injuries. Participants identified micro- and macro-level prevention opportunities. The grounded theory approach identified workers' main health problems, and the organizational factors and exposures linked with them. Perceptions about work organization/psychosocial exposures appeared more diverse than physical exposures. Prevention among all participants focused on mechanized equipment, but EMS workers also wanted more organizational support.

  16. The incidence of and risk factors for emergence delirium in U.S. military combat veterans.

    Science.gov (United States)

    McGuire, Jason M

    2012-08-01

    The purpose of this research was to identify the incidence and potential risk factors for emergence delirium (ED) in a U.S. military combat veteran surgical population at Naval Hospital Camp Pendleton. ED is a postanesthetic phenomenon that occurs immediately after emergence from general anesthesia and is characterized by agitation, confusion, and violent behavior. Clinical evidence suggests that ED is increasingly seen among military personnel returning from the wars in Iraq and Afghanistan, and that the incidence of anxiety, depression, and post-traumatic stress disorder (PTSD) are higher in this population than in noncombat troops or nonmilitary populations. The incidence of ED in this sample of 130 postoperative military personnel with combat exposure was 20% (n=26). Those previously diagnosed with a psychological disorder had a higher rate of ED (50%) than those who did not (17.5%), χ(2)=5.53, PPTSD symptoms, and depression [state anxiety: r(128)=0.40, PPTSD: r(128)=0.35, PPTSD, and depression as risk factors. Regression modeling suggested that state-anxiety served as the best predictor. These findings increase clinicians' understanding of ED among combat veterans and give direction to future studies that should focus on preventive treatment. Published by Elsevier Inc.

  17. [Challenges in the assessment and managment of health risks associated with emerging water micropollutants].

    Science.gov (United States)

    Levi, Yves

    2009-06-01

    Analytical laboratories can now identify and quantify an impressive number of "new" pollutants present at very low concentrations in water. Nanotechnology products are a new cause for concern. " Emerging " pollutants are defined as substances that were not previously sought or detected (plasticizers, drugs, chlorination byproducts, persistant organic pollutants, ...) and that are now being identified in many continental water resources. The biological actions of these substances, alone and in combination with other more " classical "pollutants, include such effects as endocrine disruption. Contaminants may be present in surface and groundwater resources, may be generated during treatment, and are found in drinking water distribution networks. In industrialized countries, the main source of emerging pollutants for humans is not water, but rather food, cosmetics and air. Urgent measures are needed to protect biodiversity and human health, including quantitative risk assessment, toxicologic studies of xenobiotic mixtures and chronic effects, strategies to protect water resources, technological advances in wastewater treatment, reliable potable water production, and new inert materials for transport and storage. Good sanitation and safe tap water are major contributors to human health and well-being Major efforts and investments are needed, based on rigorous, objective assessments of risks for the environment and public health.

  18. [Miscommunication as a risk focus in patient safety : Work process analysis in prehospital emergency care].

    Science.gov (United States)

    Wilk, S; Siegl, L; Siegl, K; Hohenstein, C

    2018-04-01

    In an analysis of a critical incident reporting system (CIRS) in out-of-hospital emergency medicine, it was demonstrated that in 30% of cases deficient communication led to a threat to patients; however, the analysis did not show what exactly the most dangerous work processes are. Current research shows the impact of poor communication on patient safety. An out-of-hospital workflow analysis collects data about key work processes and risk areas. The analysis points out confounding factors for a sufficient communication. Almost 70% of critical incidents are based on human factors. Factors, such as communication and teamwork have an impact but fatigue, noise levels and illness also have a major influence. (I) CIRS database analysis The workflow analysis was based on 247 CIRS cases. This was completed by participant observation and interviews with emergency doctors and paramedics. The 247 CIRS cases displayed 282 communication incidents, which are categorized into 6 subcategories of miscommunication. One CIRS case can be classified into different categories if more communication incidents were validated by the reviewers and four experienced emergency physicians sorted these cases into six subcategories. (II) Workflow analysis The workflow analysis was carried out between 2015 and 2016 in Jena and Berlin, Germany. The focal point of research was to find accumulation of communication risks in different parts of prehospital patient care. During 30 h driving with emergency ambulances, the author interviewed 12 members of the emergency medical service of which 5 were emergency physicians and 7 paramedics. A total of 11 internal medicine cases and one automobile accident were monitored. After patient care the author asked in a 15-min interview if miscommunication or communication incidents occurred. (I) CIRS analysis Between 2005 and 2015, 845 reports were reported to the database. The experts identified 247 incident reports with communication failure. All

  19. Toxicological risk assessment and prioritization of drinking water relevant contaminants of emerging concern.

    Science.gov (United States)

    Baken, Kirsten A; Sjerps, Rosa M A; Schriks, Merijn; van Wezel, Annemarie P

    2018-06-13

    Toxicological risk assessment of contaminants of emerging concern (CEC) in (sources of) drinking water is required to identify potential health risks and prioritize chemicals for abatement or monitoring. In such assessments, concentrations of chemicals in drinking water or sources are compared to either (i) health-based (statutory) drinking water guideline values, (ii) provisional guideline values based on recent toxicity data in absence of drinking water guidelines, or (iii) generic drinking water target values in absence of toxicity data. Here, we performed a toxicological risk assessment for 163 CEC that were selected as relevant for drinking water. This relevance was based on their presence in drinking water and/or groundwater and surface water sources in downstream parts of the Rhine and Meuse, in combination with concentration levels and physicochemical properties. Statutory and provisional drinking water guideline values could be derived from publically available toxicological information for 142 of the CEC. Based on measured concentrations it was concluded that the majority of substances do not occur in concentrations which individually pose an appreciable human health risk. A health concern could however not be excluded for vinylchloride, trichloroethene, bromodichloromethane, aniline, phenol, 2-chlorobenzenamine, mevinphos, 1,4-dioxane, and nitrolotriacetic acid. For part of the selected substances, toxicological risk assessment for drinking water could not be performed since either toxicity data (hazard) or drinking water concentrations (exposure) were lacking. In absence of toxicity data, the Threshold of Toxicological Concern (TTC) approach can be applied for screening level risk assessment. The toxicological information on the selected substances was used to evaluate whether drinking water target values based on existing TTC levels are sufficiently protective for drinking water relevant CEC. Generic drinking water target levels of 37 μg/L for

  20. Risk for Repeat Emergency Department Visits for Violent Injuries in Youth Firearm Victims

    Directory of Open Access Journals (Sweden)

    Hyun Ja Lim

    2009-01-01

    Full Text Available Objective To identify significant risk factors associated with repeat emergency department (ED. Visits for violent injuries in youth firearm victims. Methods The study subjects of this retrospective cohort study were firearm victims aged 18 and younger presenting to a Pediatric Emergency Department/Trauma Center at Children's Hospital of Wisconsin between 1990 and 1995. The primary outcome was subsequent Emergency Department visits (REDV at any emergency department in Milwaukee for a violent injury. Results A total of 495 subjects were eligible for the present study in the pediatric firearm victim's ED visit database. Eighty-five percent (n = 420 were males and 82% were African-Americans. Mean age was 15 years old (s.d = ±3.6. A majority of them had a single-parent family. Eighty-eight subjects (17.8% had a prior history of ED visit due to violence. During the study time, 201 subjects had at least one REDV. In the multivariable model, a subject without a social worker consulting at the hospital were more likely to have REDV compared to subjects with a social worker consulting (O.R = 1.749; p-value = 0.047, controlling for guardian and disposition. Subjects disposed to detention center or police custody were more likely to have REDV compared to subjects disposed to home or a hospital (O.R = 5.351; p-value = 0.003. Conclusion Our analysis indicates that individuals with guardians, those who did not receive social worker intervention on their initial visit, and those discharged in police custody were associated with increased repeat ED visits due to a violent injury.

  1. Evaluating the Laboratory Risk Indicator to Differentiate Cellulitis from Necrotizing Fasciitis in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Michael M. Neeki

    2017-05-01

    Full Text Available Introduction: Necrotizing fasciitis (NF is an uncommon but rapidly progressive infection that results in gross morbidity and mortality if not treated in its early stages. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC score is used to distinguish NF from other soft tissue infections such as cellulitis or abscess. This study analyzed the ability of the LRINEC score to accurately rule out NF in patients who were confirmed to have cellulitis, as well as the capability to differentiate cellulitis from NF. Methods: This was a 10-year retrospective chart-review study that included emergency department (ED patients ≥18 years old with a diagnosis of cellulitis or NF. We calculated a LRINEC score ranging from 0–13 for each patient with all pertinent laboratory values. Three categories were developed per the original LRINEC score guidelines denoting NF risk stratification: high risk (LRINEC score ≥8, moderate risk (LRINEC score 6–7, and low risk (LRINEC score ≤5. All cases missing laboratory values were due to the absence of a C-reactive protein (CRP value. Since the score for a negative or positive CRP value for the LRINEC score was 0 or 4 respectively, a LRINEC score of 0 or 1 without a CRP value would have placed the patient in the “low risk” group and a LRINEC score of 8 or greater without CRP value would have placed the patient in the “high risk” group. These patients missing CRP values were added to these respective groups. Results: Among the 948 ED patients with cellulitis, more than one-tenth (10.7%, n=102 of 948 were moderate or high risk for NF based on LRINEC score. Of the 135 ED patients with a diagnosis of NF, 22 patients had valid CRP laboratory values and LRINEC scores were calculated. Among the other 113 patients without CRP values, six patients had a LRINEC score ≥ 8, and 19 patients had a LRINEC score ≤ 1. Thus, a total of 47 patients were further classified based on LRINEC score without a CRP value

  2. Application of a Proactive Risk Analysis to Emergency Department Sickle Cell Care

    Directory of Open Access Journals (Sweden)

    Victoria L. Thornton

    2014-07-01

    Full Text Available Introduction: Patients with sickle cell disease (SCD often seek care in emergency departments (EDs for severe pain. However, there is evidence that they experience inaccurate assessment, suboptimal care, and inadequate follow-up referrals. The aim of this project was to 1 explore the feasibility of applying a failure modes, effects and criticality analysis (FMECA in two EDs examining four processes of care (triage, analgesic management, high risk/high users, and referrals made for patients with SCD, and 2 report the failures of these care processes in each ED. Methods: A FMECA was conducted of ED SCD patient care at two hospitals. A multidisciplinary group examined each step of four processes. Providers identified failures in each step, and then characterized the frequency, impact, and safeguards, resulting in risk categorization. Results: Many “high risk” failures existed in both institutions, including a lack of recognition of high-risk or high-user patients and a lack of emphasis on psychosocial referrals. Specific to SCD analgesic management, one setting inconsistently used existing analgesic policies, while the other setting did not have such policies. Conclusion: FMECA facilitated the identification of failures of ED SCD care and has guided quality improvement activities. Interventions can focus on improvements in these specific areas targeting improvements in the delivery and organization of ED SCD care. Improvements should correspond with the forthcoming National Heart, Lung and Blood-sponsored guidelines for treatment of patients with sickle cell disease. [West J Emerg Med. 2014;15(4:446–458.

  3. Risks and factors contributing towards rural entrepreneurial orientation growth of business in an emerging economy

    Directory of Open Access Journals (Sweden)

    Lawrence Mpele Lekhanya

    2016-10-01

    Full Text Available This paper examines risks and critical factors contributing to the rural entrepreneurial orientation growth of businesses. The concept of entrepreneurial orientation and various factors influencing the rural entrepreneurial orientation growth are still not well known. The study aimed to assess risks and critical factors affecting rural entrepreneurial orientation growth of businesses. Questionnaire was developed and used to collect primary data from 127 rural entrepreneurs. The sample was made with small and medium entrepreneurs operating in rural places. They were selected using quota sampling, with respondents completing a questionnaire with the assistance of an interviewer. The study used quantitative technique for data collection. SPSS (23.0 version was used for data analysis and scientific statistical significance level found to be (.000* at the Cronbach’s alpha (.791* reliability. Results of the survey reveal that majority indicates competition as a big challenge for them. Findings further indicate that competitor is due to the small market and lack of products differentiation. This study introduces an additional literature in the field of entrepreneurship with specific reference to rural entrepreneurship. The paper will benefit rural entrepreneurs, entrepreneurial marketing managers, potential young entrepreneurs, business consultants, policymakers, financial institutions, government agencies and all affiliated stakeholders by introducing a new understanding of risks and various critical factors causative into rural entrepreneurial orientation growth of business in an emerging economy. Most work on the entrepreneurship development has concentrated in the urban areas with little emphasis on the rural places. The findings of this study limited by study’s exploratory, small sample and quantitative nature. Therefore, generalisation of results should be done with care and further research is encouraged and should aim at the development of

  4. National survey of emergency physicians for transient ischemic attack (TIA) risk stratification consensus and appropriate treatment for a given level of risk.

    Science.gov (United States)

    Perry, Jeffrey J; Losier, Justin H; Stiell, Ian G; Sharma, Mukul; Abdulaziz, Kasim

    2016-01-01

    Five percent of transient ischemic attack (TIA) patients have a subsequent stroke within 7 days. The Canadian TIA Score uses clinical findings to calculate the subsequent stroke risk within 7 days. Our objectives were to assess 1) anticipated use; 2) component face validity; 3) risk strata for stroke within 7 days; and 4) actions required, for a given risk for subsequent stroke. After a rigorous development process, a survey questionnaire was administered to a random sample of 300 emergency physicians selected from those registered in a national medical directory. The surveys were distributed using a modified Dillman technique. From a total of 271 eligible surveys, we received 131 (48.3%) completed surveys; 96.2% of emergency physicians would use a validated Canadian TIA Score; 8 of 13 components comprising the Canadian TIA Score were rated as Very Important or Important by survey respondents. Risk categories for subsequent stroke were defined as minimal-risk: 10% risk of subsequent stroke within 7 days. A validated Canadian TIA Score will likely be used by emergency physicians. Most components of the TIA Score have high face validity. Risk strata are definable, which may allow physicians to determine immediate actions, based on subsequent stroke risk, in the emergency department.

  5. Evaluation of three physiologically based pharmacokinetic (PBPK) modeling tools for emergency risk assessment after acute dichloromethane exposure

    NARCIS (Netherlands)

    Boerleider, R. Z.; Olie, J. D N; van Eijkeren, J. C H; Bos, P. M J; Hof, B. G H; de Vries, I.; Bessems, J. G M; Meulenbelt, J.; Hunault, C. C.

    2015-01-01

    Introduction: Physiologically based pharmacokinetic (PBPK) models may be useful in emergency risk assessment, after acute exposure to chemicals, such as dichloromethane (DCM). We evaluated the applicability of three PBPK models for human risk assessment following a single exposure to DCM: one model

  6. Screening for Fall Risks in the Emergency Department: A Novel Nursing-Driven Program.

    Science.gov (United States)

    Huded, Jill M; Dresden, Scott M; Gravenor, Stephanie J; Rowe, Theresa; Lindquist, Lee A

    2015-12-01

    Seniors represent the fasting growing population in the U.S., accounting for 20.3 million visits to emergency departments (EDs) annually. The ED visit can provide an opportunity for identifying seniors at high risk of falls. We sought to incorporate the Timed Up & Go Test (TUGT), a commonly used falls screening tool, into the ED encounter to identify seniors at high fall risk and prompt interventions through a geriatric nurse liaison (GNL) model. Patients aged 65 and older presenting to an urban ED were evaluated by a team of ED nurses trained in care coordination and geriatric assessment skills. They performed fall risk screening with the TUGT. Patients with abnormal TUGT results could then be referred to physical therapy (PT), social work or home health as determined by the GNL. Gait assessment with the TUGT was performed on 443 elderly patients between 4/1/13 and 5/31/14. A prior fall was reported in 37% of patients in the previous six months. Of those screened with the TUGT, 368 patients experienced a positive result. Interventions for positive results included ED-based PT (n=63, 17.1%), outpatient PT referrals (n=56, 12.2%) and social work consultation (n=162, 44%). The ED visit may provide an opportunity for older adults to be screened for fall risk. Our results show ED nurses can conduct the TUGT, a validated and time efficient screen, and place appropriate referrals based on assessment results. Identifying and intervening on high fall risk patients who visit the ED has the potential to improve the trajectory of functional decline in our elderly population.

  7. Homelessness: patterns of emergency department use and risk factors for re-presentation.

    Science.gov (United States)

    Moore, G; Gerdtz, M F; Hepworth, G; Manias, E

    2011-05-01

    To describe patterns of service use and to predict risk factors for re-presentation to a metropolitan emergency department (ED) among people who are homeless. A retrospective cohort analysis was undertaken over a 24-month period from a principal referral hospital in Melbourne, Australia. All ED visits relating to people classified as homeless were included. A predictive model for risk of re-presentation was developed using logistic regression with random effects. Rates of re-presentation, defined as the total number of visits to the same ED within 28 days of discharge, were measured. The study period was 1 January 2003 to 31 December 2004. The re-presentation rate for homeless people was 47.8% (3199/6689) of ED visits and 45.5% (725/1595) of the patients. The final predictive model included risk factors, which incorporated both hospital and community service use. Those characteristics that resulted in significantly increased odds of re-presentation were leaving hospital at own risk (OR 1.31; 95% CI 1.10 to 1.56), treatment in another hospital (OR 1.45, 95% CI 1.23 to 1.72) and being in receipt of community-based case management (OR 1.31, 95% CI 1.11 to 1.54) or pension (OR 1.34, 95% CI 1.12 to 1.62). The predictive model identified nine risk factors of re-presentation to the ED for people who are homeless. Early identification of these factors among homeless people may alert clinicians to the complexity of issues influencing an individual ED visit. This information can be used at admission and discharge by ensuring that homeless people have access to services commensurate with their health needs. Improved linkage between community and hospital services must be underscored by the capacity to provide safe and secure housing.

  8. Screening for Fall Risks in the Emergency Department: A Novel Nursing-Driven Program

    Directory of Open Access Journals (Sweden)

    Jill M. Huded

    2015-12-01

    Full Text Available Introduction: Seniors represent the fasting growing population in the U.S., accounting for 20.3 million visits to emergency departments (EDs annually. The ED visit can provide an opportunity for identifying seniors at high risk of falls. We sought to incorporate the Timed Up & Go Test (TUGT, a commonly used falls screening tool, into the ED encounter to identify seniors at high fall risk and prompt interventions through a geriatric nurse liaison (GNL model. Methods: Patients aged 65 and older presenting to an urban ED were evaluated by a team of ED nurses trained in care coordination and geriatric assessment skills. They performed fall risk screening with the TUGT. Patients with abnormal TUGT results could then be referred to physical therapy (PT, social work or home health as determined by the GNL. Results: Gait assessment with the TUGT was performed on 443 elderly patients between 4/1/13 and 5/31/14. A prior fall was reported in 37% of patients in the previous six months. Of those screened with the TUGT, 368 patients experienced a positive result. Interventions for positive results included ED-based PT (n=63, 17.1%, outpatient PT referrals (n=56, 12.2% and social work consultation (n=162, 44%. Conclusion: The ED visit may provide an opportunity for older adults to be screened for fall risk. Our results show ED nurses can conduct the TUGT, a validated and time efficient screen, and place appropriate referrals based on assessment results. Identifying and intervening on high fall risk patients who visit the ED has the potential to improve the trajectory of functional decline in our elderly population.

  9. Firearm Violence Among High-Risk Emergency Department Youth After an Assault Injury

    Science.gov (United States)

    Walton, Maureen A.; Roehler, Douglas R.; Goldstick, Jason; Zimmerman, Marc A.; Blow, Frederic C.; Cunningham, Rebecca M.

    2015-01-01

    BACKGROUND: The risk for firearm violence among high-risk youth after treatment for an assault is unknown. METHODS: In this 2-year prospective cohort study, data were analyzed from a consecutive sample of 14- to 24-year-olds with drug use in the past 6 months seeking assault-injury care (AIG) at an urban level 1 emergency department (ED) compared with a proportionally sampled comparison group (CG) of drug-using nonassaulted youth. Validated measures were administered at baseline and follow-up (6, 12, 18, 24 months). RESULTS: A total of 349 AIG and 250 CG youth were followed for 24 months. During the follow-up period, 59% of the AIG reported firearm violence, a 40% higher risk than was observed among the CG (59.0% vs. 42.5%; relative risk [RR] = 1.39). Among those reporting firearm violence, 31.7% reported aggression, and 96.4% reported victimization, including 19 firearm injuries requiring medical care and 2 homicides. The majority with firearm violence (63.5%) reported at least 1 event within the first 6 months. Poisson regression identified baseline predictors of firearm violence, including male gender (RR = 1.51), African American race (RR = 1.26), assault-injury (RR = 1.35), firearm possession (RR = 1.23), attitudes favoring retaliation (RR = 1.03), posttraumatic stress disorder (RR = 1.39), and a drug use disorder (RR = 1.22). CONCLUSIONS: High-risk youth presenting to urban EDs for assault have elevated rates of subsequent firearm violence. Interventions at an index visit addressing substance use, mental health needs, retaliatory attitudes, and firearm possession may help decrease firearm violence among urban youth. PMID:25847808

  10. Risk factors associated with visiting or not visiting the accident & emergency department after a fall.

    Science.gov (United States)

    Scheffer, Alice C; van Hensbroek, Pieter Boele; van Dijk, Nynke; Luitse, Jan S K; Goslings, Johannes C; Luigies, René H; de Rooij, Sophia E

    2013-07-26

    Little is known about the prevalence of modifiable risk factors of falling in elderly persons with a fall-history who do not visit the Accident and Emergency (A&E) Department after one or more falls. The objective of this study was to determine the prevalence of modifiable risk factors in a population that visited the A&E Department after a fall (A&E group) and in a community-dwelling population of elderly individuals with a fall history who did not visit the A&E Department after a fall (non-A&E group). Two cohorts were included in this study. The first cohort included 547 individuals 65 years and older who were visited at home by a mobile fall prevention team. The participants in this cohort had fall histories but did not visit the A&E Department after a previous fall. These participants were age- and gender-matched to persons who visited the A&E Department for care after a fall. All participants were asked to complete the CAREFALL Triage Instrument. The mean number of modifiable risk factors in patients who did not visit the A&E Department was 2.9, compared to 3.8 in the group that visited the A&E Department (pfalling, impaired vision, mood and high risk of osteoporosis were all independently associated with visiting the A&E Department. All modifiable risk factors for falling were found to be shared between community-dwelling elderly individuals with a fall history who visited the A&E Department and those who did not visit the Department, although the prevalence of these factors was somewhat lower in the A&E group. Preventive strategies aimed both at patients presenting to the A&E Department after a fall and those not presenting after a fall could perhaps reduce the number of recurrent falls, the occurrence of injury and the frequency of visits to the A&E Department.

  11. Estimating the risk of re-emergence after stopping polio vaccination

    Directory of Open Access Journals (Sweden)

    Akira eSasaki

    2012-05-01

    Full Text Available Live vaccination against polio has effectively prevented outbreaks in most developed countries for more than 40 years, and there remain only a few countries where outbreaks of poliomyelitis by the wild strain still threaten the community. It is expected that worldwide eradication will be eventually achieved through careful surveillance and a well-managed immunization program. The present paper argues, however, that based on a simple stochastic model the risk of outbreak by a vaccine-derived strain after the cessation of vaccination is quite high, even if many years have passed since the last confirmed case. As vaccinated hosts are natural reservoirs for virulent poliovirus, the source of the risk is the vaccination itself, employed to prevent the outbreaks. The crisis after stopping vaccination will emerge when the following two conditions are met: the susceptible host density exceeds the threshold for epidemics and the vaccinated host density remains large enough to ensure the occurrence of virulent mutants in the population. Our estimates for transmission, recovery, and mutation rates, show that the probability of an outbreak of vaccine-derived virulent viruses easily exceeds 90%. Moreover, if a small fraction of hosts have a longer infectious period, as observed in individuals with innate immunodeficiency, the risk of an outbreak rises significantly. Under such conditions, successful global eradication of polio is restricted to a certain range of parameters even if inactive polio vaccine (IPV is extensively used after the termination of live vaccination.

  12. Emerging organic contaminants in coastal waters: anthropogenic impact, environmental release and ecological risk.

    Science.gov (United States)

    Jiang, Jheng-Jie; Lee, Chon-Lin; Fang, Meng-Der

    2014-08-30

    This study provides a first estimate of the sources, distribution, and risk presented by emerging organic contaminants (EOCs) in coastal waters off southwestern Taiwan. Ten illicit drugs, seven nonsteroidal anti-inflammatory drugs (NSAIDs), five antibiotics, two blood lipid regulators, two antiepileptic drugs, two UV filters, caffeine, atenolol, and omeprazole were analyzed by solid-phase extraction and liquid chromatography coupled to tandem mass spectrometry (SPE-LC-MS/MS). Thirteen EOCs were detected in coastal waters, including four NSAIDs (acetaminophen, ibuprofen, ketoprofen, and codeine), three antibiotics (ampicillin, erythromycin, and cefalexin), three illicit drugs (ketamine, pseudoephedrine, and MDMA), caffeine, carbamazepine, and gemfibrozil. The median concentrations for the 13 EOCs ranged from 1.47 ng/L to 156 ng/L. Spatial variation in concentration of the 13 EOCs suggests discharge into coastal waters via ocean outfall pipes and rivers. Codeine and ampicillin have significant pollution risk quotients (RQ>1), indicating potentially high risk to aquatic organisms in coastal waters. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. A comparison between integrated risk assessment and classical health/environmental assessment: Emerging beneficial properties

    International Nuclear Information System (INIS)

    Sekizawa, Jun; Tanabe, Shinsuke

    2005-01-01

    Both humans and wildlife are exposed to various types of halogenated organic compounds such as polychlorinated biphenyls (PCBs) and dichlorodiphenyltrichloroethane (DDT), typically old chemicals, and tris(4-chlorophenyl) methane (TCPM) and brominated flame retardants, some new chemicals, simultaneously. Classical risk assessment has evaluated health and ecological risks independently by experts from different disciplines. Taking into considerations the recent concerns about endocrine disrupting chemicals and the progress of research in related areas, we integrated and assessed data on exposure and potential effects in humans and wildlife. Comparisons were made for organ concentrations, body burdens of several organochlorine compounds (OCs), metabolic capacities between humans and various wildlife. When we integrate the knowledge on effects and exposure in humans and in wildlife, new insights were suggested about similarities and/or differences in potential effects among various human populations living on different foods and having different body burdens. Combining existing information with emerging knowledge of mechanisms of actions on endocrine disrupting chemicals after exposure to above chemicals during early developmental stages will further elucidate potential risks from exposure to those chemicals

  14. Four emerging arboviral diseases in North America: Jamestown Canyon, Powassan, chikungunya, and Zika virus diseases.

    Science.gov (United States)

    Pastula, Daniel M; Smith, Daniel E; Beckham, J David; Tyler, Kenneth L

    2016-06-01

    Arthropod-borne viruses, or arboviruses, are viruses that are transmitted through the bites of mosquitoes, ticks, or sandflies. There are numerous arboviruses throughout the world capable of causing human disease spanning different viral families and genera. Recently, Jamestown Canyon, Powassan, chikungunya, and Zika viruses have emerged as increasingly important arboviruses that can cause human disease in North America. Unfortunately, there are currently no proven disease-modifying therapies for these arboviral diseases, so treatment is largely supportive. Given there are also no commercially available vaccines for these four arboviral infections, prevention is the key. To prevent mosquito or tick bites that might result in one of these arboviral diseases, people should wear long-sleeved shirts and pants while outside if feasible, apply insect repellant when going outdoors, using window screens or air conditioning to keep mosquitoes outside, and perform tick checks after being in wooded or brushy outdoor areas.

  15. PIWIs Go Viral: Arbovirus-Derived piRNAs in Vector Mosquitoes.

    Directory of Open Access Journals (Sweden)

    Pascal Miesen

    2016-12-01

    Full Text Available Vector mosquitoes are responsible for transmission of the majority of arthropod-borne (arbo- viruses. Virus replication in these vectors needs to be sufficiently high to permit efficient virus transfer to vertebrate hosts. The mosquito immune response therefore is a key determinant for arbovirus transmission. Mosquito antiviral immunity is primarily mediated by the small interfering RNA pathway. Besides this well-established antiviral machinery, the PIWI-interacting RNA (piRNA pathway processes viral RNA into piRNAs. In recent years, significant progress has been made in characterizing the biogenesis and function of these viral piRNAs. In this review, we discuss these developments, identify knowledge gaps, and suggest directions for future research.

  16. Role of India's wildlife in the emergence and re-emergence of zoonotic pathogens, risk factors and public health implications.

    Science.gov (United States)

    Singh, B B; Gajadhar, A A

    2014-10-01

    Evolving land use practices have led to an increase in interactions at the human/wildlife interface. The presence and poor knowledge of zoonotic pathogens in India's wildlife and the occurrence of enormous human populations interfacing with, and critically linked to, forest ecosystems warrant attention. Factors such as diverse migratory bird populations, climate change, expanding human population and shrinking wildlife habitats play a significant role in the emergence and re-emergence of zoonotic pathogens from India's wildlife. The introduction of a novel Kyasanur forest disease virus (family flaviviridae) into human populations in 1957 and subsequent occurrence of seasonal outbreaks illustrate the key role that India's wild animals play in the emergence and reemergence of zoonotic pathogens. Other high priority zoonotic diseases of wildlife origin which could affect both livestock and humans include influenza, Nipah, Japanese encephalitis, rabies, plague, leptospirosis, anthrax and leishmaniasis. Continuous monitoring of India's extensively diverse and dispersed wildlife is challenging, but their use as indicators should facilitate efficient and rapid disease-outbreak response across the region and occasionally the globe. Defining and prioritizing research on zoonotic pathogens in wildlife are essential, particularly in a multidisciplinary one-world one-health approach which includes human and veterinary medical studies at the wildlife-livestock-human interfaces. This review indicates that wild animals play an important role in the emergence and re-emergence of zoonotic pathogens and provides brief summaries of the zoonotic diseases that have occurred in wild animals in India. Copyright © 2014 Elsevier B.V. All rights reserved.

  17. Comprehensive proteome profiling in Aedes albopictus to decipher Wolbachia-arbovirus interference phenomenon.

    Science.gov (United States)

    Saucereau, Yoann; Valiente Moro, Claire; Dieryckx, Cindy; Dupuy, Jean-William; Tran, Florence-Hélène; Girard, Vincent; Potier, Patrick; Mavingui, Patrick

    2017-08-18

    Aedes albopictus is a vector of arboviruses that cause severe diseases in humans such as Chikungunya, Dengue and Zika fevers. The vector competence of Ae. albopictus varies depending on the mosquito population involved and the virus transmitted. Wolbachia infection status in believed to be among key elements that determine viral transmission efficiency. Little is known about the cellular functions mobilized in Ae. albopictus during co-infection by Wolbachia and a given arbovirus. To decipher this tripartite interaction at the molecular level, we performed a proteome analysis in Ae. albopictus C6/36 cells mono-infected by Wolbachia wAlbB strain or Chikungunya virus (CHIKV), and bi-infected. We first confirmed significant inhibition of CHIKV by Wolbachia. Using two-dimensional gel electrophoresis followed by nano liquid chromatography coupled with tandem mass spectrometry, we identified 600 unique differentially expressed proteins mostly related to glycolysis, translation and protein metabolism. Wolbachia infection had greater impact on cellular functions than CHIKV infection, inducing either up or down-regulation of proteins associated with metabolic processes such as glycolysis and ATP metabolism, or structural glycoproteins and capsid proteins in the case of bi-infection with CHIKV. CHIKV infection inhibited expression of proteins linked with the processes of transcription, translation, lipid storage and miRNA pathways. The results of our proteome profiling have provided new insights into the molecular pathways involved in tripartite Ae. albopictus-Wolbachia-CHIKV interaction and may help defining targets for the better implementation of Wolbachia-based strategies for disease transmission control.

  18. Entrepreneurship, Emerging Technologies, Emerging Markets

    NARCIS (Netherlands)

    Thukral, Inderpreet S.; Von Ehr, James; Walsh, Steven Thomas; Groen, Arend J.; van der Sijde, Peter; Adham, Khairul Akmaliah

    2008-01-01

    Academics and practitioners alike have long understood the benefits, if not the risks, of both emerging markets and emerging technologies.Yet it is only recently that foresighted firms have embraced emerging technologies and emerging markets through entrepreneurial activity. Emerging technologies

  19. [Relationship between the risk of emergency cesarean section for nullipara with the prepregnancy body mass index or gestational weight gain].

    Science.gov (United States)

    Zhao, R F; Zhang, W Y; Zhou, L

    2017-11-25

    Objective: To investigate the risk of emergency cesarean section during labor with the pre-pregnancy body mass index or gestational weight gain. Methods: A total of 6 908 healthy nullipara with singleton pregnancy and cephalic presentation who was in term labor in Beijing Obstetrics and Gynecology Hospital from August 1(st), 2014 to September 30(th), 2015 were recruited. They were divided into two groups, the vaginal delivery group (92.88%, 6 416/6 908) and the emergency cesarean section group (7.12%, 492/6 908). According to WHO body mass index (BMI) classification criteria and the pre-pregnancy BMI, the 6 908 women were divided into three groups, the underweight group(BMIgain (GWG) group (16.72%, 1 155/6 908), the appropriate GWG group (43.11%, 2 978/6 908), the excessive GWG group (40.17%, 2 775/6 908). Unadjusted and adjusted odds ratio ( OR ) and confidence interval ( CI ) of the risk of emergency cesarean section were calculated by bivariate logistic regression. Results: (1) Comparing to the vaginal delivery group, women in the emergency cesarean section group were older, with a lower education level. Their prepregnancy BMI was higer and had more gestational weight gain. They had higher morbidity of pregnancy induced hypertension and gestational diabetes mellitus. Comparing to the vaginal delivery group, the neonates in the emergency cesarean section group were elder in gestational week, with higher birth weight. More male infants and large for gestation age infants were seen in the emergency cesarean section group (all P gain was associated with the increased risk of emergency cesarean section, (a OR= 1.03, 95% CI : 1.01-1.05). GWG above IOM giudelines did not independently affect the risk of emergency cesarean section ( OR= 1.30, 95% CI : 1.07-1.58; a OR= 1.01, 95% CI : 0.82-1.24). In the underweight group, the normal weight group and the overweight or obese group, the excessive GWG women and the appropriate GWG women had no significant difference in the

  20. Emerging mosquito-borne viruses: transmission and modulation of host defence

    NARCIS (Netherlands)

    Fros, J.J.

    2015-01-01

    Summary

    Two highly pathogenic arthropod-borne (arbo)viruses, West Nile virus (WNV) and chikungunya virus (CHIKV), recently (re-)emerged in both Europe and the Americas. This resulted in large-scale epidemics of severe encephalitic and arthritogenic human disease,

  1. Advanced Nuclear Measurements - Sensitivity Analysis Emerging Safeguards, Problems and Proliferation Risk

    International Nuclear Information System (INIS)

    Dreicer, J.S.

    1999-01-01

    During the past year this component of the Advanced Nuclear Measurements LDRD-DR has focused on emerging safeguards problems and proliferation risk by investigating problems in two domains. The first is related to the analysis, quantification, and characterization of existing inventories of fissile materials, in particular, the minor actinides (MA) formed in the commercial fuel cycle. Understanding material forms and quantities helps identify and define future measurement problems, instrument requirements, and assists in prioritizing safeguards technology development. The second problem (dissertation research) has focused on the development of a theoretical foundation for sensor array anomaly detection. Remote and unattended monitoring or verification of safeguards activities is becoming a necessity due to domestic and international budgetary constraints. However, the ability to assess the trustworthiness of a sensor array has not been investigated. This research is developing an anomaly detection methodology to assess the sensor array

  2. Hotspot health physics codes used as a tool for managing excess risk on radiological emergencies

    International Nuclear Information System (INIS)

    Andrade, Edson Ramos de; Alves, Nelson Mendes; Rocha, Joao B.T.; Cruz, Ivana B. Manica da; Santos, Greice F. Fey dos; Machado, Michel Mansur; Rossato, Veronica Venturini; Bauermann, Liliane Freitas

    2008-01-01

    This work is aimed to use the Hotspot Health Physics codes in acute mode in order to estimate the immediate radiological impact associated with high acute radiation doses, which is applied to special target organs such as lung, small intestine wall, and red bone marrow. Organic compounds such as Diphenyl Diselenide (C 6 H 5 Se 2 C 6 H 5 ) and Ebselen (C 13 H 9 NOSe), an antioxidants selenium containing compounds, were used over irradiated phospholipids extracted from chicken yolk eggs, in vitro in order to reduce lipo-peroxidation. Experimental data were measured by Thiobarbituric Acid Reactive Substance (TBARS) assay which is able to measure the production of oxidative stress in the sample. Experimental data were extrapolated and applied as a reduction factors over equations for cancer excess risk calculation from BEIR V, for helping the decisonmaking process on Radiological Emergency Scenarios. (author)

  3. Risk stratification and rapid geriatric screening in an emergency department - a quasi-randomised controlled trial.

    Science.gov (United States)

    Foo, Chik Loon; Siu, Vivan Wing Yin; Ang, Hou; Phuah, Madeline Wei Ling; Ooi, Chee Kheong

    2014-08-30

    To determine if risk stratification followed by rapid geriatric screening in an emergency department (ED) reduced functional decline, ED reattendance and hospitalisation. This was a quasi-randomised controlled trial. Patients were randomised by the last digit of their national registration identity card (NRIC). Odd number controls received standard ED care; even number patients received geriatric screening, followed by intervention and/or onward referrals. Patients were followed up for 12 months. There were 500 and 280 patients in the control and intervention groups. The intervention group had higher Triage Risk Screening Tool (TRST) scores (34.3% vs 25.4% TRST ≥3, p = 0.01) and lower baseline Instrumental Activity of Daily Living (IADL) scores (22.84 vs 24.18, p fall risk (65.0%), vision (61.4%), and footwear (58.2%). 28.2% were referred to a geriatric clinic and 11.8% were admitted. 425 (85.0%) controls and 234 (83.6%) in the intervention group completed their follow-up. After adjusting for TRST and baseline IADL, the intervention group had significant preservation in function (Basic ADL -0.99 vs -0.24, p geriatric screening at the request of the ED doctor. A major limitation was that a large proportion of patients who were randomized to the intervention group either refused (18.8%) or left the ED before being approached (32.0%). These two groups were not followed up, and hence were excluded in our analysis. Risk stratification and focused geriatric screening in ED resulted in significant preservation of patients' function at 12 months. National Healthcare Group (NHG) Domain Specific Review Board (DSRB) C/09/023. Registered 5th March 2009.

  4. Risk prediction of emergency department revisit 30 days post discharge: a prospective study.

    Directory of Open Access Journals (Sweden)

    Shiying Hao

    Full Text Available Among patients who are discharged from the Emergency Department (ED, about 3% return within 30 days. Revisits can be related to the nature of the disease, medical errors, and/or inadequate diagnoses and treatment during their initial ED visit. Identification of high-risk patient population can help device new strategies for improved ED care with reduced ED utilization.A decision tree based model with discriminant Electronic Medical Record (EMR features was developed and validated, estimating patient ED 30 day revisit risk. A retrospective cohort of 293,461 ED encounters from HealthInfoNet (HIN, Maine's Health Information Exchange (HIE, between January 1, 2012 and December 31, 2012, was assembled with the associated patients' demographic information and one-year clinical histories before the discharge date as the inputs. To validate, a prospective cohort of 193,886 encounters between January 1, 2013 and June 30, 2013 was constructed. The c-statistics for the retrospective and prospective predictions were 0.710 and 0.704 respectively. Clinical resource utilization, including ED use, was analyzed as a function of the ED risk score. Cluster analysis of high-risk patients identified discrete sub-populations with distinctive demographic, clinical and resource utilization patterns.Our ED 30-day revisit model was prospectively validated on the Maine State HIN secure statewide data system. Future integration of our ED predictive analytics into the ED care work flow may lead to increased opportunities for targeted care intervention to reduce ED resource burden and overall healthcare expense, and improve outcomes.

  5. [A prospective cohort study of the risk factors of emergence agitation in pediatric after general anesthesia].

    Science.gov (United States)

    Fan, Hao; Tao, Fan; Wan, Hai-fang; Luo, Hong

    2012-05-08

    To evaluate risk factors associated with emergence agitation (EA) in pediatrics after general anesthesia. A prospective cohort study was conducted in 268 pediatric patients aged 2-9 years, who received general anesthesia for various operative procedures in our hospital between January 2008 and October 2011. The incidence of EA was assessed. Difficult parental-separation behavior, pharmacologic and non-pharmacologic interventions, and adverse events were also recorded. Univariate and multivariate analysis were used to determine the factors associated with EA. A p-value of less than 0.05 was considered significant. One hundred and sixteen children (43.3%) had EA, with an average duration of 9.1 ± 6.6 minutes. EA associated with adverse events occurred in 35 agitated children (30.2%). From univariate analysis, factors associated with EA were difficult parental-separation behavior, preschool age (2 - 5 years), and general anesthesia with sevoflurane. However, difficult parental-separation behavior, and preschool age were the only factors significantly associated with EA in the multiple Logistic regression analysis with OR = 3.091 (95%CI: 1.688, 5.465, P < 0.01) and OR = 1.965 (95%CI: 1.112, 3.318, P = 0.024), respectively. The present study indicated that the incidence of EA was high in PACU. Preschool children and difficult parental-separation behavior were the predictive factors of emergence agitation.

  6. Risks and benefits from using mobile banking in an emerging country

    Directory of Open Access Journals (Sweden)

    Onneile Juliet Ntseme

    2016-11-01

    Full Text Available An emerging countries banking service providers are eager to implement new technologies and services in order to grasp, penetrate the market and gain competitive advantage. The banks made use of technology by introducing new products such as mobile banking, but customers are not really adopting this new banking model provided as a result some challenges. Then, the overall objective of this study is to explore the risks and benefits on acceptance and usage of mobile banking by users in emerging countries. Also, to identify whether the independent variables are statistically significant factors in the adoption of mobile banking. The research established the effect of independent variables, which include perceived usefulness, and perceived ease use on dependent variables, i.e. the adoption of mobile banking. In the findings it was found that participants would use mobile banking if it is easy to use because then it will be useful to them. Conclusions were made that perceived ease of use of mobile banking positively affect perceived usefulness of mobile banking, perceived ease of use of mobile banking positively affect the behavioral intention to use mobile banking while perceived usefulness of mobile banking has a positive impact on the behavioral intention to use mobile banking

  7. POST Traumatic Stress Disorder in Emergency Workers: Risk Factors and Treatment

    Science.gov (United States)

    Argentero, Piergiorgio; Dell'Olivo, Bianca; Setti, Ilaria

    Post traumatic stress disorder (PTSD) are emergent phenomena resulting from exposure to a traumatic event that causes actual or threatened death or injury and produces intense fear, helplessness, or horror. In order to assess the role of different factors contributing to this kind of emergent phenomenon prevalence rates across gender, cultures, and samples exposed to different traumas are examined. Risk factors for PTSD, including pre-existing individual-based factors, features of the traumatic event, and post-trauma interventions are examined as well. Several characteristics of the trauma, related to cognitions, post-trauma social support and therapeutic interventions for PTSD are also considered. Further work is needed in order to analyze the inter-relationships among these factors and underlying mechanisms. The chaotic nature of traumatic processes, the multiple and interactive impacts on traumatic events require a comprehensive perspective aimed at planning effective interventions. Treatment outcome studies recommended the combined use of training and therapies as first-line treatment for PTSD.

  8. Emergency Department Patient Perspectives on the Risk of Addiction to Prescription Opioids.

    Science.gov (United States)

    Conrardy, Michael; Lank, Patrick; Cameron, Kenzie A; McConnell, Ryan; Chevrier, Alison; Sears, Jill; Ahlstrom, Eric; Wolf, Michael S; Courtney, D Mark; McCarthy, Danielle M

    2016-01-01

    To characterize emergency department (ED) patients' knowledge and beliefs about the addictive potential of opioids. Mixed methods analysis of data from a randomized controlled trial. Urban academic ED (>88,000 visits). One hundred and seventy four discharged ED patients prescribed hydrocodone-acetaminophen for acute pain. The study analyzed data collected from a randomized controlled trial investigating patients' knowledge of opioids. ED patients discharged with hydrocodone-acetaminophen completed an audio-recorded phone interview 4–7 days later. This analysis focuses on responses about addiction. Responses were categorized using content analysis; thematic analysis identified broad themes common across different categories. Participants' mean age was 45.5 years (SD, 14.8), 58.6% female, 50.6% white, and the majority had an orthopedic diagnosis (24.1% back pain, 52.3% other injuries). Responses were categorized first based on whether the patient believed that opioids could be addictive (categorized as: yes, 58.7%; no, 19.5%; depends, 17.2%; or do not know, 4.6%), and second based on whether or not the patient discussed his/her own experience with the medication (categorized as: personalized, 35.6%; or not personalized, 64.4%). Cohen's Kappa was 0.84 for all categories. Three themes emerged in the thematic analysis: theme 1) patients expect to “feel” addicted if they are addicted, theme 2) patients fear addiction, and theme 3) side effects affected patient views of addiction. In this sample, patients had misconceptions about opioid addiction. Some patients did not know opioids could be addictive, others underestimated their personal risk of addiction, and others overtly feared addiction and, therefore, risked inadequate pain management. Despite limited data, we recommend providers discuss opioid addiction with their patients. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. 2016. This work is written by US Government

  9. The Risk of Treatment-Emergent Mania With Methylphenidate in Bipolar Disorder.

    Science.gov (United States)

    Viktorin, Alexander; Rydén, Eleonore; Thase, Michael E; Chang, Zheng; Lundholm, Cecilia; D'Onofrio, Brian M; Almqvist, Catarina; Magnusson, Patrik K E; Lichtenstein, Paul; Larsson, Henrik; Landén, Mikael

    2017-04-01

    The authors sought to determine the risk of treatment-emergent mania associated with methylphenidate, used in monotherapy or with a concomitant mood-stabilizing medication, in patients with bipolar disorder. Using linked Swedish national registries, the authors identified 2,307 adults with bipolar disorder who initiated therapy with methylphenidate between 2006 and 2014. The cohort was divided into two groups: those with and those without concomitant mood-stabilizing treatment. To adjust for individual-specific confounders, including disorder severity, genetic makeup, and early environmental factors, Cox regression analyses were used, conditioning on individual to compare the rate of mania (defined as hospitalization for mania or a new dispensation of stabilizing medication) 0-3 months and 3-6 months after medication start following nontreated periods. Patients on methylphenidate monotherapy displayed an increased rate of manic episodes within 3 months of medication initiation (hazard ratio=6.7, 95% CI=2.0-22.4), with similar results for the subsequent 3 months. By contrast, for patients taking mood stabilizers, the risk of mania was lower after starting methylphenidate (hazard ratio=0.6, 95% CI=0.4-0.9). Comparable results were observed when only hospitalizations for mania were counted. No evidence was found for a positive association between methylphenidate and treatment-emergent mania among patients with bipolar disorder who were concomitantly receiving a mood-stabilizing medication. This is clinically important given that up to 20% of people with bipolar disorder suffer from comorbid ADHD. Given the markedly increased hazard ratio of mania following methylphenidate initiation in bipolar patients not taking mood stabilizers, careful assessment to rule out bipolar disorder is indicated before initiating monotherapy with psychostimulants.

  10. Trimming the fat: identification of risk factors associated with obesity in a pediatric emergency department.

    Science.gov (United States)

    Thundiyil, Josef G; Christiano-Smith, Danielle; Greenberger, Sarah; Cramm, Kelly; Latimer-Pierson, Janese; Modica, Renee F

    2010-10-01

    The purpose of this study was to assess which knowledge deficits and dietary habits in an urban pediatric emergency department (ED) population are risk factors for obesity. This cross-sectional study in an urban pediatric ED used a modified version of the Diet and Health Knowledge Survey, an in-person interview questionnaire, to collect data on demographics, dietary knowledge, and practices. All patients aged 2 to 17 years were enrolled in the study over a 4-month period. Subjects were excluded if they were in extremis, pregnant, incarcerated, institutionalized, considered an emancipated minor, or consumed only a modified consistency diet. One hundred seventy-nine subjects were enrolled in this study. Based on body mass index, the prevalence of obesity in our study population was 24%. Parents with obese children answered a mean of 62.9% (95% confidence interval, 60.4%-65.5%) of knowledge questions correctly, whereas all others scored 60.3% (95% confidence interval, 58.3%-62.3%) correctly. Based on the univariate analysis, 10 predictors met inclusion criteria into logistic regression analysis: screen time (P = 0.03), race (P = 0.08), sex (P = 0.04), parental education (P = 0.08), parental estimation that child is overweight (P obesity were independently associated with obesity. Knowledge deficiencies regarding healthy nutrition among parents in an urban pediatric ED population were not significantly associated with having obese children; however, specific habits were. Emergency physicians may provide a valuable role in identification and brief behavioral intervention in high-risk populations during the current epidemic of childhood obesity.

  11. Identifying emergency department patients with chest pain who are at low risk for acute coronary syndromes [digest].

    Science.gov (United States)

    Markel, David; Kim, Jeremy

    2017-07-21

    Though a minority of patients presenting to the emergency department with chest pain have acute coronary syndromes,identifying the patients who may be safely discharged and determining whether further testing is needed remains challenging. From the prehospital care setting to disposition and follow-up, this systematic review addresses the fundamentals of the emergency department evaluation of patients determined to be at low risk for acute coronary syndromes or adverse outcomes. Clinical risk scores are discussed, as well as the evidence and indications for confirmatory testing. The emerging role of new technologies, such as high-sensitivity troponin assays and advanced imaging techniques, are also presented. [Points & Pearls is a digest of Emergency Medicine Practice].

  12. ["Hormone bomb": risks of emergency contraception from the perspective of pharmacy attendants in Rio de Janeiro, Brazil].

    Science.gov (United States)

    Brandão, Elaine Reis; Cabral, Cristiane da Silva; Ventura, Miriam; Paiva, Sabrina Pereira; Bastos, Luiza Lena; Oliveira, Naira Villas Boas Vidal de; Szabo, Iolanda

    2016-09-19

    This study focused on views towards emergency contraception among pharmacy attendants in Greater Metropolitan Rio de Janeiro, Brazil. The empirical material came from a socio-anthropological study with 20 semi-structured interviews of pharmacy attendants of both sexes (8 females and 12 males). The interviews showed negative views of emergency contraception, emphasizing its potential health risks. Interviews considered emergency contraception a "hormone bomb" that can harm the female reproductive organs and other organ systems. The pharmacy attendants highlighted the risks of "uncontrolled" or "indiscriminate" use, especially by adolescents and young women. Since they considered it "dangerous" to women's bodies, they assigned the responsibility for orientation and counseling on use of the method to gynecologists rather than to pharmacists. The article discusses the need to expand the public debate on emergency contraception in Brazil to include pharmacists and pharmacy attendants, in addition to health professionals in general and teachers.

  13. Addressing Emerging Risks: Scientific and Regulatory Challenges Associated with Environmentally Persistent Free Radicals

    Directory of Open Access Journals (Sweden)

    Tammy R. Dugas

    2016-06-01

    Full Text Available Airborne fine and ultrafine particulate matter (PM are often generated through widely-used thermal processes such as the combustion of fuels or the thermal decomposition of waste. Residents near Superfund sites are exposed to PM through the inhalation of windblown dust, ingestion of soil and sediments, and inhalation of emissions from the on-site thermal treatment of contaminated soils. Epidemiological evidence supports a link between exposure to airborne PM and an increased risk of cardiovascular and pulmonary diseases. It is well-known that during combustion processes, incomplete combustion can lead to the production of organic pollutants that can adsorb to the surface of PM. Recent studies have demonstrated that their interaction with metal centers can lead to the generation of a surface stabilized metal-radical complex capable of redox cycling to produce ROS. Moreover, these free radicals can persist in the environment, hence their designation as Environmentally Persistent Free Radicals (EPFR. EPFR has been demonstrated in both ambient air PM2.5 (diameter < 2.5 µm and in PM from a variety of combustion sources. Thus, low-temperature, thermal treatment of soils can potentially increase the concentration of EPFR in areas in and around Superfund sites. In this review, we will outline the evidence to date supporting EPFR formation and its environmental significance. Furthermore, we will address the lack of methodologies for specifically addressing its risk assessment and challenges associated with regulating this new, emerging contaminant.

  14. Emerging contaminants in the environment: Risk-based analysis for better management.

    Science.gov (United States)

    Naidu, Ravi; Arias Espana, Victor Andres; Liu, Yanju; Jit, Joytishna

    2016-07-01

    Emerging contaminants (ECs) are chemicals of a synthetic origin or deriving from a natural source that has recently been discovered and for which environmental or public health risks are yet to be established. This is due to limited available information on their interaction and toxicological impacts on receptors. Several types of ECs exist such as antibiotics, pesticides, pharmaceuticals, personal care products, effluents, certain naturally occurring contaminants and more recently nanomaterials. ECs may derive from a known source, for example released directly to the aquatic environment from direct discharges such as those from wastewater treatment plants. Although in most instances the direct source cannot be identified, ECs have been detected in virtually every country's natural environment and as a consequence they represent a global problem. There is very limited information on the fate and transport of ECs in the environment and their toxicological impact. This lack of information can be attributed to limited financial resources and the lack of analytical techniques for detecting their effects on ecosystems and human health on their own or as mixture. We do not know how ECs interact with each other or various contaminants. This paper presents an overview of existing knowledge on ECs, their fate and transport and a risk-based analysis for ECs management and complementary strategies. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. High initial tidal volumes in emergency department patients at risk for acute respiratory distress syndrome.

    Science.gov (United States)

    Allison, Michael G; Scott, Michael C; Hu, Kami M; Witting, Michael D; Winters, Michael E

    2015-04-01

    Emergency department (ED) patients are at high risk for the acute respiratory distress syndrome (ARDS). Settings only 1 mL/kg above recommended tidal volumes confers harm for these patients. The purpose of this study was to determine whether ED physicians routinely initiate mechanical ventilation with low tidal volumes in patients at risk for ARDS. We retrospectively reviewed the charts of all adult patients who were intubated in an urban, academic ED. The charts were analyzed to identify patients in whom ARDS developed within 48 hours after ED admission. Patients were eligible for inclusion if they had bilateral infiltrates on imaging, had a Pao2/Fio2 ratio less than 300 mm Hg and did not have heart failure contributing to their presentation. The tidal volumes set in the ED were then compared with the recommended tidal volume of 6 mL/kg of predicted body weight. The initial tidal volumes set in the ED were higher than recommended by an average of 80 mL (95% confidence interval, 60-110, P tidal volume ventilation setting. In an academic, tertiary hospital, newly intubated ED patients in whom ARDS developed within 48 hours after intubation were ventilated with tidal volumes that exceeded recommendations by an average of 1.5 mL/kg. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. The hookworm Ancylostoma ceylanicum: An emerging public health risk in Australian tropical rainforests and Indigenous communities.

    Science.gov (United States)

    Smout, Felicity A; Skerratt, Lee F; Butler, James R A; Johnson, Christopher N; Congdon, Bradley C; Thompson, R C Andrew

    2017-06-01

    Ancylostoma ceylanicum is the common hookworm of domestic dogs and cats throughout Asia, and is an emerging but little understood public health risk in tropical northern Australia. We investigated the prevalence of A. ceylanicum in soil and free-ranging domestic dogs at six rainforest locations in Far North Queensland that are Indigenous Australian communities and popular tourist attractions within the Wet Tropics World Heritage Area. By combining PCR-based techniques with traditional methods of hookworm species identification, we found the prevalence of hookworm in Indigenous community dogs was high (96.3% and 91.9% from necropsy and faecal samples, respectively). The majority of these infections were A. caninum. We also observed, for the first time, the presence of A. ceylanicum infection in domestic dogs (21.7%) and soil (55.6%) in an Indigenous community. A. ceylanicum was present in soil samples from two out of the three popular tourist locations sampled. Our results contribute to the understanding of dogs as a public health risk to Indigenous communities and tourists in the Wet Tropics. Dog health needs to be more fully addressed as part of the Australian Government's commitments to "closing the gap" in chronic disease between Indigenous and other Australians, and encouraging tourism in similar locations.

  17. An Online Tool for Nurse Triage to Evaluate Risk for Acute Coronary Syndrome at Emergency Department

    Directory of Open Access Journals (Sweden)

    Yuwares Sittichanbuncha

    2015-01-01

    Full Text Available Background. To differentiate acute coronary syndrome (ACS from other causes in patients presenting with chest pain at the emergency department (ED is crucial and can be performed by the nurse triage. We evaluated the effectiveness of the ED nurse triage for ACS of the tertiary care hospital. Methods. We retrospectively enrolled consecutive patients who were identified as ACS at risk patients by the ED nurse triage. Patients were categorized as ACS and non-ACS group by the final diagnosis. Multivariate logistic analysis was used to predict factors associated with ACS. An online model predictive of ACS for the ED nurse triage was constructed. Results. There were 175 patients who met the study criteria. Of those, 28 patients (16.0% were diagnosed with ACS. Patients with diabetes, patients with previous history of CAD, and those who had at least one character of ACS chest pain were independently associated with having ACS by multivariate logistic regression. The adjusted odds ratios (95% confidence interval were 4.220 (1.445, 12.327, 3.333 (1.040, 10.684, and 12.539 (3.876, 40.567, respectively. Conclusions. The effectiveness of the ED nurse triage for ACS was 16%. The online tool is available for the ED triage nurse to evaluate risk of ACS in individuals.

  18. The hookworm Ancylostoma ceylanicum: An emerging public health risk in Australian tropical rainforests and Indigenous communities

    Directory of Open Access Journals (Sweden)

    Felicity A. Smout

    2017-06-01

    Full Text Available Ancylostoma ceylanicum is the common hookworm of domestic dogs and cats throughout Asia, and is an emerging but little understood public health risk in tropical northern Australia. We investigated the prevalence of A. ceylanicum in soil and free-ranging domestic dogs at six rainforest locations in Far North Queensland that are Indigenous Australian communities and popular tourist attractions within the Wet Tropics World Heritage Area. By combining PCR-based techniques with traditional methods of hookworm species identification, we found the prevalence of hookworm in Indigenous community dogs was high (96.3% and 91.9% from necropsy and faecal samples, respectively. The majority of these infections were A. caninum. We also observed, for the first time, the presence of A. ceylanicum infection in domestic dogs (21.7% and soil (55.6% in an Indigenous community. A. ceylanicum was present in soil samples from two out of the three popular tourist locations sampled. Our results contribute to the understanding of dogs as a public health risk to Indigenous communities and tourists in the Wet Tropics. Dog health needs to be more fully addressed as part of the Australian Government's commitments to “closing the gap” in chronic disease between Indigenous and other Australians, and encouraging tourism in similar locations.

  19. Re-emergence of cholera in the Americas: Risks, susceptibility, and ecology

    Directory of Open Access Journals (Sweden)

    Mathieu JP Poirier

    2012-01-01

    Full Text Available Background: The re-emergence of cholera in Haiti has established a new reservoir for the seventh cholera pandemic which threatens to spread to other countries in the Americas. Materials and Methods: Statistics from this new epidemic are compared to the 1991 Peru epidemic, which demonstrated the speed and complexity with which this disease can spread from country to country. Environmental factors implicated in the spread of Vibrio cholerae such as ocean currents and temperatures, as well as biotic factors from zooplankton to waterfowl pose a risk for many countries in the Americas. Results: The movement of people and goods from Hispaniola are mostly destined for North America, but occur to some degree throughout the Americas. These modes of transmission, and the probability of uncontrolled community spread beyond Hispaniola, however, are completely dependent upon risk factors within these countries such as water quality and availability of sanitation. Although North America has excellent coverage of these deterrents to the spread of infectious gastrointestinal diseases, many countries throughout Latin America and the Caribbean lack these basic services and infrastructures. Conclusions : In order to curb the immediate spread of cholera in Hispaniola, treatment availability should be expanded to all parts of the island and phase II epidemic management initiatives must be developed.

  20. Is warfarin usage a risk factor for osteoporotic fractures? A cohort study in the emergency department

    Directory of Open Access Journals (Sweden)

    Genady Drozdinsky

    2017-04-01

    Full Text Available Background Several studies have examined the association between warfarin sodium use and risk of osteoporotic fractures with conflicting results. Our study addresses this question, for the first time regarding patients attending emergency department (ED. Aims The aim of this study was to retrospectively detect whether there is higher rate of usage of warfarin sodium in patients with osteoporotic fractures attending an ED. Methods This is a retrospective study from patients' computerized charts. All individuals >65 years old who had an osteoporotic fracture and attended an ED in a tertiary hospital were compared with a similar group of elderly individuals >65 years old without an osteoporotic fracture who attended the ED for a cause other than an osteoporotic fracture. Results This study included 328 patients who were evaluated in the years 2005–2016. Overall, 164 individuals with a typical osteoporotic fracture (hip -66 patients (40 per cent, spine- 92 patients (56 per cent, humerus -4 patients (2 per cent, radius -13 patients (8 per cent were identified and compared with a matched group of elderly individuals who were evaluated in the ED for other complaints. Warfarin sodium was used in 61 individuals (19 per cent in the entire cohort, 34 in the fracture group and 27 in the non-fracture group (p=0.324. Conclusion In elderly patients, attending an ED, warfarin sodium use does not seem to be a risk factor for an osteoporotic fracture

  1. Metabolic risk factors in pediatric stone formers: a report from an emerging economy.

    Science.gov (United States)

    Imran, Kiran; Zafar, Mirza Naqi; Ozair, Uzma; Khan, Sadia; Rizvi, Syed Adibul Hasan

    2017-08-01

    The goal of this study was to investigate metabolic risk factors in pediatric stone formers in an emerging economy. A prospective, data collection enrolled 250 children age ammonia and oxalate in urine. All reported values were two sided and statistical significance was considered at p value ≤0.05. The mean age at diagnosis was 7.50 ± 3.56 years with a male to female ratio of 1.84:1. A family history of urolithiasis was found in 41 (16.4 %), urinary tract infection in 18 (7 %) and chronic diarrhea in 75 (30 %). Hypercalcemia was seen in 37 (14.8 %), hyperuricemia in 23 (9.2 %) and hyperphosphatemia in 6 (2.4 %). Urinary metabolic abnormalities were identified in 248 (98 %) of the cases. Hypocitraturia was found in 207 (82.8 %), hyperoxaluria in 62 (26.4 %), hyperuricosuria in 82 (32.8 %), hypercalciuria in 51 (20.4 %), hyperphosphaturia in 46 (18.4 %), hyperammonuria in 10 (4 %), hypocalciuria in 82 (32.8 %), and hypovolemia in 73 (29.2 %). Risk factors were similar between genders except higher rates of hyponatriuria, hypophosphaturia, and hypocalciuria in females. Hyperuricosuria, hyponatriuria, and hypovolemia were highest in 1-5 years (52, 49, 49 %) as compared to (18, 21, 12 %) those in 11-15 years (p < 0.001), respectively. This study shows that careful metabolic analysis can identify risk factors in 98 % of the children where appropriate metaphylaxis can be undertaken both for treatment and prevention of recurrence.

  2. Disparities in Treatment of Older Adults with Suicide Risk in the Emergency Department.

    Science.gov (United States)

    Arias, Sarah A; Boudreaux, Edwin D; Segal, Daniel L; Miller, Ivan; Camargo, Carlos A; Betz, Marian E

    2017-10-01

    We described characteristics and treatment received for older (≥60 years) vs younger (adult emergency department (ED) patients with suicide risk. Retrospective chart review. An ED with universal screening for suicide risk. Eligible charts included a random sample of adults (≥18 years) who screened positive for suicidal ideation (SI) in past 2 weeks and/or a suicide attempt (SA) within the past 6 months. Visit dates were from May 2014 to September 2016. A total of 800 charts were reviewed, with oversampling of older adults. Of the 200 older adults sampled, fewer older adults compared to younger adults (n = 600) had a chief complaint involving psychiatric behavior (53% vs 70%) or self-harm behavior (26% vs 36%). Although a higher number of older adults (93%) had documentation of current SI compared to younger adults (79%), fewer older adults (17%) reported SA in the past 2 weeks compared to younger adults (23%). Of those with a positive suicide screen who were discharged home, less than half of older adults received a mental health evaluation during their visit (42%, 95% CI 34-52) compared to 66% (95% CI 61-70) of younger adults who met the same criteria. Similarly, fewer older, than younger, adult patients with current SI/SA received referral resources (34%; 95% CI 26-43; vs 60%; 95% CI 55-65). Significantly fewer suicidal older adult patients who were discharged home received a mental health evaluation when compared to similar younger adults. These findings highlight an important area for improvement in the treatment of older adults at risk for suicide. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  3. Living donor risk model for predicting kidney allograft and patient survival in an emerging economy.

    Science.gov (United States)

    Zafar, Mirza Naqi; Wong, Germaine; Aziz, Tahir; Abbas, Khawar; Adibul Hasan Rizvi, S

    2018-03-01

    Living donor kidney is the main source of donor organs in low to middle income countries. We aimed to develop a living donor risk model that predicts graft and patient survival in an emerging economy. We used data from the Sindh Institute of Urology and Transplantation (SIUT) database (n = 2283 recipients and n = 2283 living kidney donors, transplanted between 1993 and 2009) and conducted Cox proportional hazard analyses to develop a composite score that predicts graft and patient survivals. Donor factors age, creatinine clearance, nephron dose (estimated by donor/recipient body weight ratio) and human leukocyte antigen (HLA) match were included in the living donor risk model. The adjusted hazard ratios (HRs) for graft failures among those who received a kidney with living donor scores (reference to donor score of zero) of 1, 2, 3 and 4 were 1.14 (95%CI: 0.94-1.39), 1.24 (95%CI:1.03-1.49), 1.25 (95%CI:1.03-1.51) and 1.36 (95%CI:1.08-1.72) (P-value for trend =0.05). Similar findings were observed for patient survival. Similar to findings in high income countries, our study suggests that donor characteristics such as age, nephron dose, creatinine clearance and HLA match are important factors that determine the long-term patient and graft survival in low income countries. However, other crucial but undefined factors may play a role in determining the overall risk of graft failure and mortality in living kidney donor transplant recipients. © 2016 Asian Pacific Society of Nephrology.

  4. Costs, effects and implementation of routine data emergency admission risk prediction models in primary care for patients with, or at risk of, chronic conditions: a systematic review protocol.

    Science.gov (United States)

    Kingston, Mark Rhys; Evans, Bridie Angela; Nelson, Kayleigh; Hutchings, Hayley; Russell, Ian; Snooks, Helen

    2016-03-01

    Emergency admission risk prediction models are increasingly used to identify patients, typically with one or more chronic conditions, for proactive management in primary care to avoid admissions, save costs and improve patient experience. To identify and review the published evidence on the costs, effects and implementation of emergency admission risk prediction models in primary care for patients with, or at risk of, chronic conditions. We shall search for studies of healthcare interventions using routine data-generated emergency admission risk models. We shall report: the effects on emergency admissions and health costs; clinician and patient views; and implementation findings. We shall search ASSIA, CINAHL, the Cochrane Library, HMIC, ISI Web of Science, MEDLINE and Scopus from 2005, review references in and citations of included articles, search key journals and contact experts. Study selection, data extraction and quality assessment will be performed by two independent reviewers. No ethical permissions are required for this study using published data. Findings will be disseminated widely, including publication in a peer-reviewed journal and through conferences in primary and emergency care and chronic conditions. We judge our results will help a wide audience including primary care practitioners and commissioners, and policymakers. CRD42015016874; Pre-results. 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/

  5. Identification of fall risk factors in older adult emergency department patients.

    Science.gov (United States)

    Carpenter, Christopher R; Scheatzle, Mark D; D'Antonio, Joyce A; Ricci, Paul T; Coben, Jeffrey H

    2009-03-01

    Falls represent an increasingly frequent source of injury among older adults. Identification of fall risk factors in geriatric patients may permit the effective utilization of scarce preventative resources. The objective of this study was to identify independent risk factors associated with an increased 6-month fall risk in community-dwelling older adults discharged from the emergency department (ED). This was a prospective observational study with a convenience sampling of noninstitutionalized elders presenting to an urban teaching hospital ED who did not require hospital admission. Interviews were conducted to determine the presence of fall risk factors previously described in non-ED populations. Subjects were followed monthly for 6 months through postcard or telephone contact to identify subsequent falls. Univariate and Cox regression analysis were used to determine the association of risk factors with 6-month fall incidence. A total of 263 patients completed the survey, and 161 (61%) completed the entire 6 months of follow-up. Among the 263 enrolled, 39% reported a fall in the preceding year, including 15% with more than one fall and 22% with injurious falls. Among those completing the 6 months of follow-up, 14% reported at least one fall. Cox regression analysis identified four factors associated with falls during the 6-month follow-up: nonhealing foot sores (hazard ratio [HR] = 3.71, 95% confidence interval [CI] = 1.73 to 7.95), a prior fall history (HR = 2.62, 95% CI = 1.32 to 5.18), inability to cut one's own toenails (HR = 2.04, 95% CI = 1.04 to 4.01), and self-reported depression (HR = 1.72, 95% CI = 0.83 to 3.55). Falls, recurrent falls, and injurious falls in community-dwelling elder ED patients being evaluated for non-fall-related complaints occur at least as frequently as in previously described outpatient cohorts. Nonhealing foot sores, self-reported depression, not clipping one's own toenails, and previous falls are all associated with falls after

  6. Risk factors for deliberate self-harm in patients presenting to the emergency departments of karachi

    International Nuclear Information System (INIS)

    Shahid, M.; Iqbal, R.

    2015-01-01

    To determine the risk factors for Deliberate Self-Harm (DSH) in patients presenting to the Emergency Departments (EDs) of three tertiary care hospitals of Karachi, Pakistan. Study Design: Multicentre matched case control study. Place and Duration of Study: EDs of the Aga Khan University Hospital, Karachi, Civil Hospital, Karachi and Jinnah Postgraduate Medical Centre, Karachi, from March 2011 to February 2012. Methodology: A total of 201 cases and 201 matched controls were taken from three hospitals situated in Karachi. All patients of 16 years and above presenting to the EDs of the hospitals with DSH attempt were invited to participate in the study. Controls were ED patients with complaints other than DSH. A control was matched with case for hospital, gender and age. Two questionnaires were used to collect information on the risk factors of DSH. Conditional Logistic Regression (CLR) was used to assess the association of various risk factors with DSH. Results: Risk factors of DSH in Karachi included current history of mental disorder (OR = 4.53, 95% CI = 1.59 - 12.92), not sharing problems with someone (OR = 4.67, 95% CI = 2.4 - 9.0), living in rented houses (OR = 2.58, 95% CI = 1.37 - 4.84), Pathan ethnicity (OR = 5.05, 95% CI = 1.01-25.38) followed by others (OR = 3.88, 95% CI = 0.77 - 19.69) and Urdu speaking (OR = 2.71, 95% CI = 0.59 - 12.45). Absence of physical illness in the past month had an inverse association with DSH (OR = 0.17, 95% CI = 0.07 - 0.37). Conclusion: Mental illnesses, low socio-economic status and loneliness were the risk factors of DSH patients presenting to the three EDs of Karachi. Physical illness in the last month was protective against DSH in these patients. Psychiatric evaluation of DSH patients in the ED is important for early diagnosis and management of mental disorders. (author)

  7. Risk perception and perceived self-efficacy of deaf and hard-of-hearing seniors and young adults in emergencies.

    Science.gov (United States)

    Engelman, Alina; Ivey, Susan L; Tseng, Winston; Neuhauser, Linda

    The authors explored the factors influencing risk perception and perceived self-efficacy before and during an emergency for deaf and hard-of-hearing (Deaf/HH) seniors and young adults. The authors collected demographic survey data and conducted four focus groups with 38 Deaf/HH residents of the San Francisco Bay Area; two groups were with young adults (ages 18-35), including one group of college students and one group of young professionals, and two were with older adults (ages 50-90). Significant differences were found between Deaf/HH young adults and seniors in both the sources of self-efficacy and risk perception and their attitudes toward preparedness. All groups demonstrated high resilience. Deaf/HH young professionals expressed more concern about their risk in an emergency than Deaf/HH college students. Alternately, the risk perception of Deaf/HH older adults was often rooted in their past experiences (survival of past emergencies, inaccessibility of communications during drills). Policy implications include the need to dedicate more resources to increasing accessibility and relevance of emergency communications technology for Deaf/HH populations. This could help increase adaptability before, during, and after emergencies among all groups of Deaf/HH people, particularly among young Deaf/HH professionals.

  8. The incidence of emergence delirium and risk factors following sevoflurane use in pediatric patients for day case surgery, Kingston, Jamaica

    Directory of Open Access Journals (Sweden)

    Rachel Gooden

    2014-12-01

    Full Text Available Background and objectives: Emergence delirium is a distressing complication of the use of sevoflurane for general anesthesia. This study sought to determine the incidence of emergence delirium and risk factors in patients at a specialist pediatric hospital in Kingston, Jamaica. Methods: This was a cross-sectional, observational study including pediatric patients aged 3-10 years, ASA I and II, undergoing general anesthesia with sevoflurane for elective day-case procedures. Data collected included patients' level of anxiety pre-operatively using the modified Yale Preoperative Anxiety Scale, surgery performed, anesthetic duration and analgesics administered. Postoperatively, patients were assessed for emergence delirium, defined as agitation with non-purposeful movement, restlessness or thrashing; inconsolability and unresponsiveness to nursing and/or parental presence. The need for pharmacological treatment and post-operative complications related to emergence delirium episodes were also noted. Results: One hundred and forty-five (145 children were included, with emergence delirium occurring in 28 (19.3%. Emergence delirium episodes had a mean duration of 6.9±7.8 min, required pharmacologic intervention in 19 (67.8% children and were associated with a prolonged recovery time (49.4±11.9 versus 29.7± 10.8 min for non-agitated children; p<0.001. Factors positively associated with emergence delirium included younger age (p = 0.01, OR 3.3, 95% CI 1.2-8.6 and moderate and severe anxiety prior to induction (p <0.001, OR 5.6, 95% CI 2.3-13.0. Complications of emergence delirium included intravenous line removal (n = 1, and surgical site bleeding (n = 3. Conclusion: Children of younger age with greater preoperative anxiety are at increased risk of developing emergence delirium following general anesthesia with sevoflurane. The overall incidence of emergence delirium was 19%.

  9. Transient ischemic attack: reviewing the evolution of the definition, diagnosis, risk stratification, and management for the emergency physician.

    Science.gov (United States)

    Siket, Matthew S; Edlow, Jonathan A

    2012-08-01

    A transient ischemic attack (TIA) is an episode of reversible neurologic deficit caused by temporary focal central nervous system hypoperfusion. TIA is a medical emergency. Because patients with TIA in the emergency department (ED) have a high risk for stroke within the next 48 hours, it is imperative for the clinician to recognize this golden opportunity to prevent a disabling stroke. This article reviews our conceptual understanding of TIA, its definition, diagnosis, ways to stratify stroke risk, the acute management and disposition in the ED, and the potential future role of diagnostic biomarkers. Copyright © 2012 Elsevier Inc. All rights reserved.

  10. [Yellow fever virus, dengue 2 and other arboviruses isolated from mosquitos, in Burkina Faso, from 1983 to 1986. Entomological and epidemiological considerations].

    Science.gov (United States)

    Robert, V; Lhuillier, M; Meunier, D; Sarthou, J L; Monteny, N; Digoutte, J P; Cornet, M; Germain, M; Cordellier, R

    1993-01-01

    An arbovirus surveillance was carried out in Burkina Faso from 1983 to 1986. It was based on crepuscular catches of mosquitoes on human bait in some wooded areas and in one town. The total collection was 228 catches with an average of 8 men per catch. The total number of mosquitoes caught was 44,956 among which 32,010 potential vector of yellow fever; all these mosquitoes were analysed for arbovirology. In the south-western part of the country (region of Bobo-Dioulasso), surveillance was conducted each year from August to November, whilst the circulation of Aedes-borne arboviruses is well known to be favoured. In 1983, 1984 and 1986, seven strains of yellow fever virus were isolated in circumstances remarkably similar. They came from selvatic areas and never from the town. They concerned only Aedes (Stegomyia) luteocephalus which is the very predominant potential vector of yellow fever in the region. They were obtained in low figure, between 1 and 4 per year. They occurred from 27th of October to 21th of November. These observations confirm that the southern portion of the Sudan savanna zone of West Africa is the setting of a customary circulation of yellow fever virus and therefore belongs to the endemic emergence zone. In 1986, two strains of dengue 2 virus were isolated. One concerned Ae. luteocephalus from the selvatic area, the other Ae. (St.) aegypti from the heart of town. These data suggest two distinct cycles for dengue 2 virus, one urban and one selvatic, which could coexist simultaneously in the same region. In the south-eastern part of the country (region of Fada-N'Gourma) a yellow fever epidemic occurred between September and December 1983; its study has enable to precise their entomological aspects. The entomological inoculation rate of yellow fever virus has been evaluated to 22 infected bites per man during the month of october, for a man living close to forest gallery. 25 strains of yellow fever virus strains was isolated from Ae. (Diceromyia

  11. Zika Virus: Critical Information for Emergency Providers.

    Science.gov (United States)

    Shastry, Siri; Koenig, Kristi L; Hirshon, Jon Mark

    2016-08-01

    Zika virus is an arbovirus of the Flaviviridae family. It is primarily a minimally symptomatic mosquito-borne infection. However, with Zika's 2015 to 2016 introduction into the Western Hemisphere and its dramatic and rapid spread, it has become a public health concern, in large part due to congenital abnormalities associated with infection in pregnant women. In early 2016, the World Health Organization declared the microcephaly and other neurologic conditions associated with Zika virus infection a public health emergency of international concern. This article discusses the current epidemiologic and clinical understanding of Zika virus, focusing on critical information needed by emergency providers. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. A perspective on the benefit-risk assessment for new and emerging pharmaceuticals in Japan

    Directory of Open Access Journals (Sweden)

    Tanimoto T

    2015-03-01

    Full Text Available Tetsuya Tanimoto Division of Social Communication System for Advanced Clinical Research, Institute of Medical Science, University of Tokyo, Tokyo, Japan Abstract: The universal health care system in Japan is facing a historical turning point as a result of the increasing fiscal burden, rapidly aging society, and a decreasing population. To understand the challenges and opportunities in the Japanese pharmaceutical market, which occupies one tenth of the global share, this review highlights several issues related to the benefit-risk assessment that is unique to the modern Japanese society: 1 regulatory system for new drug development; 2 health hazards related to pharmaceuticals (“Yakugai” in Japanese; 3 drug lag; 4 problems and controversies in the vaccination policy; and 5 clinical study misconduct. The regulatory process places a significant importance on Japanese data collection regardless of data accumulation from other countries. Because Yakugai has repeatedly caused tragedies and social disputes historically, the regulatory judgments generally tend to be more prudential when safety concerns are raised for new and emerging pharmaceuticals. Such a regulatory system has caused more than several years of approval delays compared to delays in other countries. The problem of drug lag still lingers on despite several regulatory system revisions, while the solution is incompatible with the elimination of Yakugai because the lag potentially reduces the risk of unpredictable adverse events. The Japanese vaccination policy has also received a lot of criticism, and needs improvements so that the decision-making process can be more transparent and scientifically based. Additionally, repeated clinical study misconduct damaged the reputation of Japanese clinical studies with unnecessary defrayment in health insurance; therefore, the medical community must change its inappropriate relationship with the industry. The problems surrounding pharmaceuticals

  13. Communicating risk and promoting disease mitigation measures in epidemics and emerging disease settings.

    Science.gov (United States)

    Schiavo, Renata; May Leung, May; Brown, Mason

    2014-03-01

    This review aims to identify and assess evidence on interventions to communicate risk and promote disease mitigation measures in epidemics and emerging disease outbreak settings. The study focuses on data that are relevant to low and middle-income country (LMIC) settings. We conducted a comprehensive literature search using five major electronic databases (Pubmed Medline, Biomed Central, EMBASE, Science of Citation Index, and Cochrane Library) and other sources to identify relevant studies published from January 2002 to July 2013. The review was guided by the socio-ecological model/perspective of public health and the ideation theory and focused on interventions at the community, healthcare, and multi-sectoral settings, which also reflect key intervention levels of the Ottawa Charter for Health Promotion. Eligible quantitative studies were selected according to specific study criteria and assessed using the Critical Appraisal Skills Program (CASP) framework. Conversely, qualitative studies, reviews, case studies, and editorials were not included. Studies were selected by two independent reviewers. Twenty-nine relevant studies from 16 countries were included. Most studies focused on a single intervention or intervention level, rather than multi-sectoral interventions. The majority of the evidence relates to programs aimed at behavioral and social results (or relevant intermediate steps) within a specific population group. Two studies included implications for improvements in health service delivery, two studies examined the intervention's impact on health systems-related outcomes, and three had also implications for environmental health outcomes. Cost- and health equity-related implications for select evidence were also discussed. The paucity of well-designed quantitative evaluations of interventions to communicate health risk and promote disease control measures in LMICs does not allow for any definitive conclusions. Yet, the review identified several promising

  14. Delayed neuropsychological sequelae after carbon monoxide poisoning: predictive risk factors in the Emergency Department. A retrospective study

    Directory of Open Access Journals (Sweden)

    Botti Primo

    2011-03-01

    Full Text Available Abstract Background Delayed neuropsychological sequelae (DNS commonly occur after recovery from acute carbon monoxide (CO poisoning. The preventive role and the indications for hyperbaric oxygen therapy in the acute setting are still controversial. Early identification of patients at risk in the Emergency Department might permit an improvement in quality of care. We conducted a retrospective study to identify predictive risk factors for DNS development in the Emergency Department. Methods We retrospectively considered all CO-poisoned patients admitted to the Emergency Department of Careggi University General Hospital (Florence, Italy from 1992 to 2007. Patients were invited to participate in three follow-up visits at one, six and twelve months from hospital discharge. Clinical and biohumoral data were collected; univariate and multivariate analysis were performed to identify predictive risk factors for DNS. Results Three hundred forty seven patients were admitted to the Emergency Department for acute CO poisoning from 1992 to 2007; 141/347 patients participated in the follow-up visit at one month from hospital discharge. Thirty four/141 patients were diagnosed with DNS (24.1%. Five/34 patients previously diagnosed as having DNS presented to the follow-up visit at six months, reporting a complete recovery. The following variables (collected before or upon Emergency Department admission were associated to DNS development at one month from hospital discharge in the univariate analysis: CO exposure duration >6 hours, a Glasgow Coma Scale (GCS score Conclusions Our study identified several potential predictive risk factors for DNS. Treatment algorithms based on an appropriate risk-stratification of patients in the Emergency Department might reduce DNS incidence; however, more studies are needed. Adequate follow-up after hospital discharge, aimed at correct recognition of DNS, is also important.

  15. Distribution of mosquitoes and mosquito-borne arboviruses in Yunnan Province near the China-Myanmar-Laos border.

    Science.gov (United States)

    Wang, Jinglin; Zhang, Hailin; Sun, Xiaohong; Fu, Shihong; Wang, Huanqin; Feng, Yun; Wang, Huanyu; Tang, Qing; Liang, Guo-Dong

    2011-05-01

    Economic development and increased tourism in the southern region of Yunnan Province in China, adjacent to several countries in Southeast Asia, has increased the likelihood of import and export of vectors and vector-borne diseases. We report the results of surveillance of mosquitoes and mosquito-borne arboviruses along the border of China-Myanmar-Laos in 2005 and 2006, and information associating several arboviruses with infections and possibly disease in local human populations. Seventeen mosquito species representing four genera were obtained, and 14 strains of mosquito-borne viruses representing six viruses in five genera were isolated from Culex tritaeniorhynchus. In addition, IgM against Japanese encephalitis virus, Sindbis virus, Yunnan orbivirus and novel Banna virus was detected in acute-phase serum samples obtained from hospitalized patients with fever and encephalitis near the areas where the viruses were isolated. This investigation suggests that Japanese encephalitis virus, Sindbis virus, and lesser-known arboviruses circulate and may be infecting humans in the China-Myanmar-Laos border region.

  16. Managing flood risks in the Mekong Delta: How to address emerging challenges under climate change and socioeconomic developments

    OpenAIRE

    Hoang, L.P.; Biesbroek, R.; Tri, V.P.D.; Kummu, M.; van Vliet, M.T.H.; Leemans, R.; Kabat, P.; Ludwig, F.

    2018-01-01

    Climate change and accelerating socioeconomic developments increasingly challenge flood-risk management in the Vietnamese Mekong River Delta—a typical large, economically dynamic and highly vulnerable delta. This study identifies and addresses the emerging challenges for flood-risk management. Furthermore, we identify and analyse response solutions, focusing on meaningful configurations of the individual solutions and how they can be tailored to specific challenges using expert surveys, conte...

  17. Risk factors for maxillofacial injuries in a Brazilian emergency hospital sample

    Directory of Open Access Journals (Sweden)

    José Luiz Rodrigues Leles

    2010-02-01

    Full Text Available BACKGROUND: Maxillofacial injuries occur in a significant number of trauma patients. Epidemiological assessments are essential to reaffirm patterns, identify new trends and develop clinical and research priorities for effective treatment and prevention of these injuries. OBJECTIVE: The aim of this study was to identify the epidemiological profile and risk factors associated with maxillofacial trauma treated at a referral emergency hospital for the Public Health System in the State Capital of Goiás, Brazil. MATERIAL AND METHODS: A cross-sectional study was designed including 530 patients with maxillofacial trauma, 76% male, with a mean age of 25.5±15.0 years. Data were collected between May 2003 and August 2004 over weekly shift-working periods. RESULTS: The main causes of trauma were traffic accidents (45.7% and physical assaults (24.3%, and differences in etiological factors were identified according to gender (p<0.001. The distribution of patients according to age and etiology showed significant differences for traffic accidents (p<0.01, physical assaults (p<0.001, falls (p<0.001 and sport injuries (p<0.01. In the multinomial logistic regression analysis (R² = 0.233; p<0.05, age was associated with injury in traffic accidents and falls (p<0.01, sports-related accidents were associated with males (p<0.05, and alcohol consumption with assaults and traffic accidents (p<0.001. Facial soft tissue lesions were found in 98% of patients and facial fractures in 51%. CONCLUSIONS: The significant association of maxillofacial trauma with young males and alcohol consumption reinforces the need for educational strategies and the development of policies for the prevention and reduction of associated damage in this specific risk group.

  18. Risk factors for early return visits to the emergency department in patients with urinary tract infection.

    Science.gov (United States)

    Jorgensen, Sarah; Zurayk, Mira; Yeung, Samantha; Terry, Jill; Dunn, Maureen; Nieberg, Paul; Wong-Beringer, Annie

    2018-01-01

    Optimal management of urinary tract infections (UTIs) in the emergency department (ED) is challenging due to high patient turnover, decreased continuity of care, and treatment decisions made in the absence of microbiologic data. We sought to identify risk factors for return visits in ED patients treated for UTI. A random sample of 350 adult ED patients with UTI by ICD 9/10 codes was selected for review. Relevant data was extracted from medical charts and compared between patients with and without ED return visits within 30days (ERVs). We identified 51 patients (15%) with 59 ERVs, of whom 6% returned within 72h. Nearly half of ERVs (47%) were UTI-related and 33% of ERV patients required hospitalization. ERVs were significantly more likely (Ppregnancy; skilled nursing facility residence; dementia; psychiatric disorder; obstructive uropathy; healthcare exposure; temperature≥38 °C heart rate>100; and bacteremia. Escherichia coli was the most common uropathogen (70%) and susceptibility rates to most oral antibiotics were below 80% in both groups except nitrofurantoin (99% susceptible). Cephalexin was the most frequently prescribed antibiotic (51% vs. 44%; P=0.32). Cephalexin bug-drug mismatches were more common in ERV patients (41% vs. 15%; P=0.02). Culture follow-up occurred less frequently in ERV patients (75% vs. 100%; PUTI patients may be minimized by using ED-source specific antibiogram data to guide empiric treatment decisions and by targeting at-risk patients for post-discharge follow-up. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Keep Them Engaged: Romanian County Inspectorates for Emergency Situations’ Facebook Usage for Disaster Risk Communication and Beyond

    Directory of Open Access Journals (Sweden)

    Monika Meltzer

    2018-05-01

    Full Text Available Nowadays, the use of social media by public institutions involved in disaster management is starting to become common practice. However, despite scientific interest in the effect of social media on disaster risk and crisis communication, data exploring emergency management agencies’ round-the-clock Facebook usage and the impact of their content and media choices on stakeholder engagement is limited. This study set out to investigate Romanian local emergency agencies’ Facebook usage patterns and stakeholders’ engagement with their content. The data is comprised of 7810 messages posted between the 1st January and 25th October 2017 by 32 County Inspectorates for Emergency Situations. First, using content analysis techniques, the topics of the posts were summarized to illustrate how these agencies use Facebook. Second, stakeholder engagement was investigated using social media marketing techniques. Third, messages related to natural hazards were analyzed in greater depth to reveal disaster risk communication patterns. The results suggest that Romanian emergency agencies mainly promote transparency and their institutional image on Facebook. Stakeholders were most likely to engage with brand-oriented posts, especially if these also offered rich multimedia feature. Meanwhile, stakeholders were less likely to interact with messages about natural hazards, particularly if they incorporated educational content. These observations suggest that, while at the moment Romanian local emergency management agencies take advantage of Facebook to create and maintain relationships with their stakeholders, they bypass opportunities to implement communication strategies for effective disaster risk reduction.

  20. Late language emergence in 24-month-old twins: heritable and increased risk for late language emergence in twins.

    Science.gov (United States)

    Rice, Mabel L; Zubrick, Stephen R; Taylor, Catherine L; Gayán, Javier; Bontempo, Daniel E

    2014-06-01

    This study investigated the etiology of late language emergence (LLE) in 24-month-old twins, considering possible twinning, zygosity, gender, and heritability effects for vocabulary and grammar phenotypes. A population-based sample of 473 twin pairs participated. Multilevel modeling estimated means and variances of vocabulary and grammar phenotypes, controlling for familiality. Heritability was estimated with DeFries-Fulker regression and variance components models to determine effects of heritability, shared environment, and nonshared environment. Twins had lower average language scores than norms for single-born children, with lower average performance for monozygotic than dizygotic twins and for boys than girls, although gender and zygosity did not interact. Gender did not predict LLE. Significant heritability was detected for vocabulary (0.26) and grammar phenotypes (0.52 and 0.43 for boys and girls, respectively) in the full sample and in the sample selected for LLE (0.42 and 0.44). LLE and the appearance of Word Combinations were also significantly heritable (0.22-0.23). The findings revealed an increased likelihood of LLE in twin toddlers compared with single-born children that is modulated by zygosity and gender differences. Heritability estimates are consistent with previous research for vocabulary and add further suggestion of heritable differences in early grammar acquisition.

  1. Drivers and barriers for psychosocial risk management: an analysis of the findings of the European Survey of Enterprises on New and Emerging Risks (ESENER)

    NARCIS (Netherlands)

    Milczarek, M.; Irastorza, X.; Leka, S.; Jain, A.; Iavicoli, S.; Mirabile, M.; Buresti, G.; Gagliardi, D.; Houtman, I.; Bakhuys Roozeboom, M.M.C.; Vartia, M.; Pahkin, K.

    2012-01-01

    In 2009, EU-OSHA carried out the first Europe-wide establishment survey on health and safety at the workplace, the European Survey of Enterprises on New and Emerging Risks (ESENER). Following on from the initial analysis presented in the descriptive overview report in 2010, four secondary analysis

  2. PRA for emergency planning: assessing the risk profile of a 3-loop PWR on the basis of US and German risk studies

    International Nuclear Information System (INIS)

    Chakraborty, S.; Fuchs, H.; Gubler, R.; Landolt, J.; Miteff, L.

    1985-01-01

    Emergency planning around nuclear power plants should be based on a realistic assessment of their risk profile. Since the results of the Rasmussen study (WASH-1400) and later of the German risk study (Phase A) were not judged to be fully representative for NPP's in Switzerland, an investigation was started to transfer applicable US and German results to a Swiss 3-loop PWR (Goesgen) and to assess the impact of differences in plant design compared to Surry-1 and Biblis-B. The core melt probability for Goesgen was calculated to be more than a factor of ten smaller than for the US and German studies. This is mainly due to more redundancy/better separation (especially in the emergency feedwater) and to partial automation of cooldown after a small break. The results were instrumental in limiting the release categories to be used as reference cases for emergency planning. Further reduction of postulated accidental releases is expected from the current source term research

  3. Passing crisis and emergency risk communications: the effects of communication channel, information type, and repetition.

    Science.gov (United States)

    Edworthy, Judy; Hellier, Elizabeth; Newbold, Lex; Titchener, Kirsteen

    2015-05-01

    Three experiments explore several factors which influence information transmission when warning messages are passed from person to person. In Experiment 1, messages were passed down chains of participants using five different modes of communication. Written communication channels resulted in more accurate message transmission than verbal. In addition, some elements of the message endured further down the chain than others. Experiment 2 largely replicated these effects and also demonstrated that simple repetition of a message eliminated differences between written and spoken communication. In a final field experiment, chains of participants passed information however they wanted to, with the proviso that half of the chains could not use telephones. Here, the lack of ability to use a telephone did not affect accuracy, but did slow down the speed of transmission from the recipient of the message to the last person in the chain. Implications of the findings for crisis and emergency risk communication are discussed. Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.

  4. Assessing the risk of an emerging zoonosis of worldwide concern: anisakiasis

    Science.gov (United States)

    Bao, Miguel; Pierce, Graham J.; Pascual, Santiago; González-Muñoz, Miguel; Mattiucci, Simonetta; Mladineo, Ivona; Cipriani, Paolo; Bušelić, Ivana; Strachan, Norval J. C.

    2017-03-01

    Anisakiasis is an emerging zoonosis caused by the fish parasitic nematode Anisakis. Spain appears to have the highest reported incidence in Europe and marinated anchovies are recognised as the main food vehicle. Using data on fishery landings, fish infection rates and consumption habits of the Spanish population from questionnaires, we developed a quantitative risk assessment (QRA) model for the anchovy value chain. Spaniards were estimated to consume on average 0.66 Anisakis per untreated (non-frozen) raw or marinated anchovy meal. A dose-response relationship was generated and the probability of anisakiasis was calculated to be 9.56 × 10-5 per meal, and the number of annual anisakiasis cases requiring medical attention was predicted between 7,700 and 8,320. Monte Carlo simulations estimated post-mortem migration of Anisakis from viscera to flesh increases the disease burden by >1000% whilst an education campaign to freeze anchovy before consumption may reduce cases by 80%. However, most of the questionnaire respondents who ate untreated meals knew how to prevent Anisakis infection. The QRA suggests that previously reported figures of 500 anisakiasis per year in Europe is a considerable underestimate. The QRA tool can be used by policy makers and informs industry, health professionals and consumers about this underdiagnosed zoonosis.

  5. Addressing Emerging Risks: Scientific and Regulatory Challenges Associated with Environmentally Persistent Free Radicals.

    Science.gov (United States)

    Dugas, Tammy R; Lomnicki, Slawomir; Cormier, Stephania A; Dellinger, Barry; Reams, Margaret

    2016-06-08

    Airborne fine and ultrafine particulate matter (PM) are often generated through widely-used thermal processes such as the combustion of fuels or the thermal decomposition of waste. Residents near Superfund sites are exposed to PM through the inhalation of windblown dust, ingestion of soil and sediments, and inhalation of emissions from the on-site thermal treatment of contaminated soils. Epidemiological evidence supports a link between exposure to airborne PM and an increased risk of cardiovascular and pulmonary diseases. It is well-known that during combustion processes, incomplete combustion can lead to the production of organic pollutants that can adsorb to the surface of PM. Recent studies have demonstrated that their interaction with metal centers can lead to the generation of a surface stabilized metal-radical complex capable of redox cycling to produce ROS. Moreover, these free radicals can persist in the environment, hence their designation as Environmentally Persistent Free Radicals (EPFR). EPFR has been demonstrated in both ambient air PM2.5 (diameter challenges associated with regulating this new, emerging contaminant.

  6. Identifying Emergency Department Patients at Low Risk for a Variceal Source of Upper Gastrointestinal Hemorrhage.

    Science.gov (United States)

    Klein, Lauren R; Money, Joel; Maharaj, Kaveesh; Robinson, Aaron; Lai, Tarissa; Driver, Brian E

    2017-11-01

    Assessing the likelihood of a variceal versus nonvariceal source of upper gastrointestinal bleeding (UGIB) guides therapy, but can be difficult to determine on clinical grounds. The objective of this study was to determine if there are easily ascertainable clinical and laboratory findings that can identify a patient as low risk for a variceal source of hemorrhage. This was a retrospective cohort study of adult ED patients with UGIB between January 2008 and December 2014 who had upper endoscopy performed during hospitalization. Clinical and laboratory data were abstracted from the medical record. The source of the UGIB was defined as variceal or nonvariceal based on endoscopic reports. Binary recursive partitioning was utilized to create a clinical decision rule. The rule was internally validated and test characteristics were calculated with 1,000 bootstrap replications. A total of 719 patients were identified; mean age was 55 years and 61% were male. There were 71 (10%) patients with a variceal UGIB identified on endoscopy. Binary recursive partitioning yielded a two-step decision rule (platelet count > 200 × 10 9 /L and an international normalized ratio [INR] study must be externally validated before widespread use, patients presenting to the ED with an acute UGIB with platelet count of >200 × 10 9 /L and an INR of upper gastrointestinal hemorrhage. © 2017 by the Society for Academic Emergency Medicine.

  7. Value-at-risk estimation with wavelet-based extreme value theory: Evidence from emerging markets

    Science.gov (United States)

    Cifter, Atilla

    2011-06-01

    This paper introduces wavelet-based extreme value theory (EVT) for univariate value-at-risk estimation. Wavelets and EVT are combined for volatility forecasting to estimate a hybrid model. In the first stage, wavelets are used as a threshold in generalized Pareto distribution, and in the second stage, EVT is applied with a wavelet-based threshold. This new model is applied to two major emerging stock markets: the Istanbul Stock Exchange (ISE) and the Budapest Stock Exchange (BUX). The relative performance of wavelet-based EVT is benchmarked against the Riskmetrics-EWMA, ARMA-GARCH, generalized Pareto distribution, and conditional generalized Pareto distribution models. The empirical results show that the wavelet-based extreme value theory increases predictive performance of financial forecasting according to number of violations and tail-loss tests. The superior forecasting performance of the wavelet-based EVT model is also consistent with Basel II requirements, and this new model can be used by financial institutions as well.

  8. Pro-active approaches to the identification of emerging risks in the food chain: Retrospective case studies.

    NARCIS (Netherlands)

    Hagenaars, T.H.J.; Elbers, A.R.W.; Kleter, G.A.; Kreft, F.; Leeuwen, van P.; Waalwijk, C.; Hoogenboom, L.A.P.; Marvin, H.J.P.

    2006-01-01

    In this report six case studies are carried out on food-safety and animal-health crises that have occurred in the recent past. The aim is to learn from these cases if and how the identification of emerging food-safety (and animal-health) risks can be improved by adopting a (more) pro-active approach

  9. Evaluation of semi-generic PBTK modeling for emergency risk assessment after acute inhalation exposure to volatile hazardous chemicals

    NARCIS (Netherlands)

    Olie, J Daniël N; Bessems, Jos G; Clewell, Harvey J; Meulenbelt, Jan; Hunault, Claudine C

    BACKGROUND: Physiologically Based Toxicokinetic Models (PBTK) may facilitate emergency risk assessment after chemical incidents with inhalation exposure, but they are rarely used due to their relative complexity and skill requirements. We aimed to tackle this problem by evaluating a semi-generic

  10. Evaluation of semi-generic PBTK modeling for emergency risk assessment after acute inhalation exposure to volatile hazardous chemicals

    NARCIS (Netherlands)

    Olie, J. Daniël N; Bessems, Jos G.; Clewell, Harvey J.; Meulenbelt, Jan; Hunault, Claudine C.

    2015-01-01

    BACKGROUND: Physiologically Based Toxicokinetic Models (PBTK) may facilitate emergency risk assessment after chemical incidents with inhalation exposure, but they are rarely used due to their relative complexity and skill requirements. We aimed to tackle this problem by evaluating a semi-generic

  11. Pressure ulcer development in trauma patients with suspected spinal injury; the influence of risk factors present in the Emergency Department

    NARCIS (Netherlands)

    Ham, H. W (Wietske); Schoonhoven, Lisette; Schuurmans, M. (Marieke) J; Leenen, L. (Luke) P H

    2017-01-01

    Objectives To explore the influence of risk factors present at Emergency Department admission on pressure ulcer development in trauma patients with suspected spinal injury, admitted to the hospital for evaluation and treatment of acute traumatic injuries. Design Prospective cohort study setting

  12. Risk factors for emergence and progression of scoliosis in children with severe cerebral palsy : a systematic review

    NARCIS (Netherlands)

    Loeters, Marianne J. B.; Maathuis, Carel G. B.; Hadders-Algra, Mijna

    Aim Scoliosis is a frequently occurring and serious complication of severe cerebral palsy (CP). This systematic review aims to the assess the risk factors associated with the emergence and progression of scoliosis in children with CP functioning at level IV or V of the Gross Motor Function

  13. Environment, arbovirus transmission and control of epidemics Ambiente, transmissão de arbovírus e controle de epidemias

    Directory of Open Access Journals (Sweden)

    Roger Cordellier

    1992-09-01

    Full Text Available In order to illustrate the relationships between the biotopes (or phytogeographical zones, arbovirus vectors and vertebrate hosts (including man, and epidemiology, current knowledge on the transmission of Yellow Fever virus in West Africa is reported. A dynamic scheme has been devised to integrate the observed geographical distribution of cases and the timing of their occurrence. Two principal areas, endemicity and epidetnicity, were defined according to the presence or absence of sylvatic monkey-mosquito transmission. The intensity and potential of contacts between humans and vectors depends on the degree of man-made changes in the environment, often increasing the extension of ecotone areas where the mosquitoes are easily biting at the ground level. Prevention and/or control of arbovirus diseases require detailed eco-epidemiological studies to determine: (1 the effective role of each potential vector in each phytogeographical region; (2 the risk factors for the people living in or near areas with a sylvatic transmission cycle; (3 the priorities - vaccination and/or control - for preventing the expansion of natural foci.Para ilustrar as relações existentes entre os biótopos (ou zonas fitogeográficas, os vetores e hospedeiros vertebrados (incluindo o homem de arbovírus e a epidemiologia, o conhecimento atual sobre a transmissão do vírus de febre amarela na África Ocidental é apresentado e discutido. Um modelo dinâmico foi desenvolvido para integrar a distribuição geográfica dos casos observados e o momento de sua ocorrência. Duas áreas principais, endemicidade e epidemicidade, foram definidas de acordo com a presença ou ausência de transmissão silvática macaco-mosquito. A intensidade e o potencial dos contatos entre homem e vetores depende do grau das alterações ambientais produzidas pelas atividades humanas, geralmente aumentando a extensão das áreas de ecótono onde os mosquitos estão ativos ao nível do solo. A preven

  14. Climate Change and the Arboviruses: Lessons from the Evolution of the Dengue and Yellow Fever Viruses.

    Science.gov (United States)

    Tabachnick, Walter J

    2016-09-29

    The impact of anticipated changes in global climate on the arboviruses and the diseases they cause poses a significant challenge for public health. The past evolution of the dengue and yellow fever viruses provides clues about the influence of changes in climate on their future evolution. The evolution of both viruses has been influenced by virus interactions involving the mosquito species and the primate hosts involved in virus transmission, and by their domestic and sylvatic cycles. Information is needed on how viral genes in general influence phenotypic variance for important viral functions. Changes in global climate will alter the interactions of mosquito species with their primate hosts and with the viruses in domestic cycles, and greater attention should be paid to the sylvatic cycles. There is great danger for the evolution of novel viruses, such as new serotypes, that could compromise vaccination programs and jeopardize public health. It is essential to understand (a) both sylvatic and domestic cycles and (b) the role of virus genetic and environmental variances in shaping virus phenotypic variance to more fully assess the impact of global climate change.

  15. Serologic survey for selected arboviruses and other potential pathogens in wildlife from Mexico.

    Science.gov (United States)

    Aguirre, A A; McLean, R G; Cook, R S; Quan, T J

    1992-07-01

    During 1988 and 1989, a serologic survey of wildlife was conducted in northeastern Mexico to determine the presence, prevalence, and distribution of arboviruses and other selected disease agents. Eighty mammal specimens were tested. Antibodies to vesicular stomatitis-Indiana, Venezuelan equine encephalitis-Mena II, Rio Grande virus, and vesicular stomatitis-New Jersey were detected predominantly in small mammals. Deer and mouflon (Ovis musimon) had antibodies to bluetongue and epizootic hemorrhagic disease. Two species had serologic evidence of recent exposure to Francisella tularensis. A white-tailed deer (Odocoileus virginianus) had antibodies to Anaplasma marginale. All specimens tested for antibodies against Yersinia pestis and Brucella abortus were negative. Sera from 315 birds were tested for antibody against five equine encephalitis viruses and six avian pathogens. During 1988, antibodies to Venezuelan equine encephalitis-Mena II, Venezuelan equine encephalitis-TC83, St. Louis encephalitis, eastern equine encephalitis, and western equine encephalitis were detected in birds of several species. Antibodies to Pasteurella multocida and Newcastle disease virus were also detected. Birds from five species presented antibodies to Mycoplasma meleagridis. Specimens tested for M. gallisepticum, M. synoviae, and Chlamydia psittaci were negative. To the best of our knowledge, this survey represents the first serologic evidence of bluetongue, Cache Valley virus, epizootic hemorrhagic disease, Jamestown Canyon virus, vesicular stomatitis-Indiana, vesicular stomatitis-New Jersey, Rio Grande virus, and tularemia reported among wildlife in Mexico.

  16. Dengue and Zika viruses: lessons learned from the similarities between these Aedes mosquito-vectored arboviruses.

    Science.gov (United States)

    Suwanmanee, San; Luplertlop, Natthanej

    2017-02-01

    The currently spreading arbovirus epidemic is having a severe impact on human health worldwide. The two most common flaviviruses, dengue virus (DENV) and Zika virus (ZIKV), are transmitted through the same viral vector, Aedes spp. mosquitoes. Since the discovery of DENV in 1943, this virus has been reported to cause around 390 million human infections per year, approximately 500,000 of which require hospitalization and over 20,000 of which are lethal. The present DENV epidemic is primarily concentrated in Southeast Asia. ZIKV, which was discovered in 1952, is another important arthropod-borne flavivirus. The neurotropic role of ZIKV has been reported in infected newborns with microcephaly and in adults with Guillain-Barre syndrome. Despite DENV and ZIKV sharing the same viral vector, their complex pathogenic natures are poorly understood, and the infections they cause do not have specific treatments or effective vaccines. Therefore, this review will describe what is currently known about the clinical characteristics, pathogenesis mechanisms, and transmission of these two viruses. Better understanding of the interrelationships between DENV and ZIKV will provide a useful perspective for developing an effective strategy for controlling both viruses in the future.

  17. Mosquitoes used to draw blood for arbovirus viremia determinations in small vertebrates.

    Directory of Open Access Journals (Sweden)

    Rebekah C Kading

    Full Text Available Serial samples from the same individuals may be required for certain virological studies, however, some small animals cannot easily be blood-sampled. Therefore, we evaluated the use of Culex quinquefasciatus Say and Aedes albopictus Skuse mosquitoes as "biological syringes" to draw blood for virus titer determinations in small vertebrates. Groups of chicks (Gallus gallus, hamsters (Mesocricetus auratus, and house sparrows (Passer domesticus were experimentally infected with West Nile virus (WNV or Highlands J virus (HJV. In general, good correlation was seen between mosquito- and syringe-derived blood samples at titers ≥5.0 log10 pfu/mL serum as compared with titers 105 pfu/mL serum had mosquito- and syringe-derived titers within one log of each other. Sparrow viremia profiles generated from single mosquito blood meals and syringe were not significantly different (p>0.05. This technique is valuable for assessing the roles of small vertebrates in the ecologies of arboviruses, and could be used in applications beyond virology and infectious diseases, when <10 µL of whole blood is required.

  18. Screening Models for Cardiac Risk Evaluation in Emergency Abdominal Surgery. I. Evaluation of the Intraoperative Period Risk based on Data from the Preoperative Period

    Directory of Open Access Journals (Sweden)

    Mikhail Matveev

    2008-04-01

    Full Text Available A classification of intraoperative cardio-vascular complications (CVC was performed, based on data from 466 patients subjected to emergency surgery, due to severe abdominal surgical diseases or traumas, in accordance with the severe criteria of ACC/AHA for CVC in noncardiac surgery. There were 370 intraoperative CVC registered, distributed as follows: groups with low risk (148, moderate risk (200, and high risk (22. Patient groups were formed, according to the CVC risk level, during the intraoperative period, for which the determinant factor for the group distribution of patients was the complication with the highest risk. Individual data was collected for each patient, based on 65 indices: age, physical status, diseases, surgical interventions, anaesthesiological information, intra and postoperative cardio-vascular complications, disease outcome, causes of death, cardiovascular disease anamnesis, anamnesis of all other nonsurgical diseases present, laboratory results, results from all imaging and instrumental examinations, etc. On the basis of these indices, a new distribution of the risk factors was implemented, into groups with different levels of risk of CVC during intraoperative period. This result is a solid argument, substantiating the proposal to introduce these adjustments for determining the severity of CVC in the specific conditions of emergency abdominal surgery.

  19. Crisis and emergency risk communication in a pandemic: a model for building capacity and resilience of minority communities.

    Science.gov (United States)

    Crouse Quinn, Sandra

    2008-10-01

    As public health agencies prepare for pandemic influenza, it is evident from our experience with Hurricane Katrina that these events will occur in the same social, historical, and cultural milieu in which marked distrust of government and health disparities already exist. This article grapples with the challenges of crisis and emergency risk communication with special populations during a pandemic. Recognizing that targeting messages to specific groups poses significant difficulties at that time, this article proposes a model of community engagement, disaster risk education, and crisis and emergency risk communication to prepare minority communities and government agencies to work effectively in a pandemic, build the capacity of each to respond, and strengthen the trust that is critical at such moments. Examples of such engagement and potential strategies to enhance trust include tools familiar to many health educators.

  20. Strengthening Preparedness for Arbovirus Infections in Mediterranean and Black Sea Countries: A Conceptual Framework to Assess Integrated Surveillance in the Context of the One Health Strategy

    Directory of Open Access Journals (Sweden)

    Maria Grazia Dente

    2018-03-01

    Full Text Available In the context of One Health, there is presently an effort to integrate surveillance of human, animal, entomological, and environmental sectors. This aims to strengthen the prevention of, and preparedness against, arbovirus infections, also in the light of environmental and climate changes that could increase the risk of transmission. However, criteria to define integrated surveillance, and to compare different systems, still need to be identified and tested. We conducted a scoping review to identify and examine surveillance systems for West Nile virus (WNV, chikungunya virus (CHKV, dengue virus (DENV, and Rift Valley fever virus (RVFV, which involve human, animal, entomological, and environmental sectors. We analyzed findings using a conceptual framework we developed for this purpose. The review highlights that the criteria proposed in the conceptual framework to describe integrated surveillance are consistently reported in the context of studies and programs related to integrated surveillance of the selected arboviral diseases. These criteria can facilitate the identification and description of operationalized One Health surveillance.

  1. The emerging molecular architecture of schizophrenia, polygenic risk scores and the clinical implications for GxE research.

    Science.gov (United States)

    Iyegbe, Conrad; Campbell, Desmond; Butler, Amy; Ajnakina, Olesya; Sham, Pak

    2014-02-01

    Schizophrenia is a devastating mental disorder. The level of risk in the general population is sustained by the persistence of social, environmental and biological factors, as well as their interactions. Socio-environmental risk factors for schizophrenia are well established and robust. The same can belatedly be said of genetic risk factors for the disorder. Recent progress in schizophrenia genetics is primarily fuelled by genome-wide association, which is able to leverage substantial proportions of additional explained variance previously classified as 'missing'. Here, we provide an outline of the emerging genetic landscape of schizophrenia and demonstrate how this knowledge can be turned into a simple empirical measure of genetic risk, known as a polygenic risk score. We highlight the statistical framework used to assess the clinical potential of the new score and finally, draw relevance to and discuss the clinical implications for the study of gene-environment interaction.

  2. Assessment of disaster preparedness among emergency departments in Italian hospitals: a cautious warning for disaster risk reduction and management capacity.

    Science.gov (United States)

    Paganini, Matteo; Borrelli, Francesco; Cattani, Jonathan; Ragazzoni, Luca; Djalali, Ahmadreza; Carenzo, Luca; Della Corte, Francesco; Burkle, Frederick M Jr; Ingrassia, Pier Luigi

    2016-08-15

    Since the 1990s, Italian hospitals are required to comply with emergency disaster plans known as Emergency Plan for Massive Influx of Casualties. While various studies reveal that hospitals overall suffer from an insufficient preparedness level, the aim of this study was to better determine the preparedness level of Emergency Departments of Italian hospitals by assessing the knowledge-base of emergency physicians regarding basic disaster planning and procedures. A prospective observational study utilized a convenience sample of Italian Emergency Departments identified from the Italian Ministry of Health website. Anonymous telephone interviews were conducted of medical consultants in charge at the time in the respective Emergency Departments, and were structured in 3 parts: (1) general data and demographics, (2) the current disaster plan and (3) protocols and actions of the disaster plan. Eighty-five Emergency Departments met inclusion criteria, and 69 (81 %) agreed to undergo the interview. Only 45 % of participants declared to know what an Emergency Plan for Massive Influx of Casualties is, 41 % believed to know who has the authority to activate the plan, 38 % knew who is in charge of intra-hospital operations. In Part 3 physicians revealed a worrisome inconsistency in critical content knowledge of their answers. Results demonstrate a poor knowledge-base of basic hospital disaster planning concepts by Italian Emergency Department physicians-on-duty. These findings should alert authorities to enhance staff disaster preparedness education, training and follow-up to ensure that these plans are known to all who have responsibility for disaster risk reduction and management capacity.

  3. Screening for iron deficiency anemia in at risk children in the pediatric emergency department: a survey of Canadian pediatric emergency department physicians.

    Science.gov (United States)

    Berard, Roberta; Matsui, Doreen; Lynch, Tim

    2007-05-01

    To determine the attitudes and reported practices of physicians regarding screening for iron deficiency anemia in at-risk children in pediatric emergency departments (PEDs) across Canada. A standardized survey was mailed to 183 PED physicians at 10 tertiary care PED across Canada. The practices and attitudes regarding screening for iron deficiency anemia were collected via a questionnaire consisting of single select closed-ended items and items which required ranking in order of importance. Sixty-one percent (111/183) of physicians responded to the survey. Ninety-six percent of respondents do not routinely screen for iron deficiency anemia. One third of respondents believed that screening for iron deficiency anemia in the PED is possible. The remaining stated lack of time, difficulty with follow-up, it not being an emergent issue and cost as prohibitive factors. One third of participants stated that 21% to 40% of the pediatric patients seen in their PED did not have a primary care physician. The main considerations in deciding on whom to perform venipuncture were based on dietary history and physical examination with a history of consumption of milk greater than 24 ounces per day (94%) and conjunctival or skin pallor (97%, 94%, respectively) selected as the most important items. The results of this study indicate that Canadian PED physicians are not routinely screening for iron deficiency anemia, although they demonstrate knowledge of the risk factors for iron deficiency anemia and recognize the importance of diagnosis and treatment to prevent long-term morbidity.

  4. Follow Up for Emergency Department Patients After Intravenous Contrast and Risk of Nephropathy

    Directory of Open Access Journals (Sweden)

    Getaw Worku Hassen

    2014-05-01

    Full Text Available Introduction: Contrast-induced nephropathy (CIN, defined as an increase in serum creatinine (SCr greater than 25% or ≥0.5 mg/dL within 3 days of intravenous (IV contrast administration in the absence of an alternative cause, is the third most common cause of new acute renal failure in hospitalized patients. It is known to increase in-hospital mortality up to 27%. The purpose of this study was to investigate the rate of outpatient follow up and the occurrence of CIN in patients who presented to the emergency department (ED and were discharged home after computed tomography (CT of the abdomen and pelvis (AP with IV contrast. Methods: We conducted a single center retrospective review of charts for patients who required CT of AP with IV contrast and who were discharged home. Patients’ clinical data included the presence of diabetes mellitus, hypertension, chronic kidney disease (CKD and congestive heart failure (CHF. Results: Five hundred and thirty six patients underwent CT of AP with IV contrast in 2011 and were discharged home. Diabetes mellitus was documented in 96 patients (18%. Hypertension was present in 141 patients (26.3%, and 82 patients (15.3% were on angiotensin-converting-enzyme inhibitors (ACEI. Five patients (0.9% had documented CHF and all of them were taking furosemide. Seventy patients (13% had a baseline SCr >1.2 mg/dL. One hundred fifty patients (28% followed up in one of the clinics or the ED within one week after discharge, but only 40 patients (7.5% had laboratory workup. Out of 40 patients who followed up within 1 week after discharge, 9 patients (22.5% developed CIN. One hundred ninety patients (35.4% followed up in one of the clinics or the ED after 7 days and within 1 month after discharge, but only 71 patients (13.2% had laboratory workup completed. Out of 71 patients who followed up within 1 month, 11 patients (15% developed CIN. The overall incidence of CIN was 15.3% (17 out of 111 patients. Conclusion: There was a

  5. Toys in the upper aerodigestive tract: evidence on their risk as emerging from the ESFBI study.

    Science.gov (United States)

    Foltran, Francesca; Gregori, Dario; Passàli, Desiderio; Bellussi, Luisa; Caruso, Giuseppe; Passàli, Francesco Maria; Passàli, Giulio Cesare

    2011-10-01

    Foreign body inhalation/aspiration or ingestion is a relatively common event in young children and, despite many efforts made in several Countries to reach acceptable safety levels for products devoted to children, small toys or toy parts are frequently mentioned among risky foreign bodies. The aim of the present study is to characterize the risk of complications and prolonged hospitalization due to toys inhalation/aspiration or ingestion according to age and gender of patients, FB characteristics and FB location, circumstances of the accident, as emerging from the ESFBI study. A retrospective study in major hospitals of 19 European Countries was realized on children aged 0-14 having inhaled/aspired or ingested a toy, with regard to the characteristics of the child and the FB (shape, volume, consistency), the FB location, the hospitalization's details and the occurrence of complications. In the years 2000-2003 a total of 2094 FB injuries occurred in children aged 0-14 years. Among them 121 (5.8%) were due to toys (mainly parts of toys) and 95 (4.5%) occurred in the lower/upper aero-digestive tract. 58 children needed hospitalization. The first determinant of a damage requiring hospitalization is the rigid consistence of the object. Almost 27% of toys related injuries happened under adults' supervision. Despite the adoption of preventive strategies, including products modification by manufacturers, has resulted in a decrease of children's mortality rate for choking in the last decades, our results seem to testify that preventive strategies imposing a regulation of industrial production, even if fundamental, are not sufficient and need to be integrated with other preventive intervention addressed to improve parents ability to be conscious of FB injuries and attentive toward a proper surveillance of children. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  6. Calcium polysulphide, its applications and emerging risk of environmental pollution-a review article.

    Science.gov (United States)

    Dahlawi, Saad Mohammed; Siddiqui, Samreen

    2017-01-01

    Easy availability, preparation technique, and economic value make calcium polysulphide (CaS x ) a very useful inorganic chemical for various field and industrial applications. In this article, disparate applications of CaS x solution have been reviewed to suggest potential and future consolidation. This article also encompasses the physiochemical properties and production of CaS x solution, with critical appraisal on research focusing on CaS x application in agriculture industries and removal of potentially toxic elements (PTEs) from the environment. The kinetics of CaS x , technical issues associated with optimization of its dosage and environmental fate is also discussed in detail. This study covers almost all of the peer-reviewed research that has been performed since 1914. Some of the critiques in this article include the lack of integration between the exposure effect and the efficiency of treatment method, effects of oxidizing environments on the long-term performance of CaS x solution, and kinetics of CaS x solution with the PTEs. The working model of CaS x with PTEs is still system dependent, and therefore cannot be used with other applications. The kinetics of CaS x is described in detail with various phase stoichiometric reactions. Environmental fate is discussed based on applications, government reports, peer-reviewed articles and kinetics of CaS x , which provides a clear picture of emerging contaminants in the environment in relation to the insect resistance and ecotoxicology. Real time, lab based research articles are needed to identify toxicity limits of CaS x in environment in order to describe its effective permissible limit in environmental system. This review article provides a risk assessment of environmental pollution by CaS x based on its physicochemical characteristic, stoichiometry, kinetics, field, and industrial applications.

  7. Frequency and risk factors associated with emergency medical readmissions in Galway University Hospitals.

    LENUS (Irish Health Repository)

    Gorman, J

    2010-06-01

    Unplanned readmissions of medical hospital patients have been increasing in recent years. We examined the frequency and associates of emergency medical readmissions to Galway University Hospitals (GUH).

  8. Prospective validation of a predictive model that identifies homeless people at risk of re-presentation to the emergency department.

    Science.gov (United States)

    Moore, Gaye; Hepworth, Graham; Weiland, Tracey; Manias, Elizabeth; Gerdtz, Marie Frances; Kelaher, Margaret; Dunt, David

    2012-02-01

    To prospectively evaluate the accuracy of a predictive model to identify homeless people at risk of representation to an emergency department. A prospective cohort analysis utilised one month of data from a Principal Referral Hospital in Melbourne, Australia. All visits involving people classified as homeless were included, excluding those who died. Homelessness was defined as living on the streets, in crisis accommodation, in boarding houses or residing in unstable housing. Rates of re-presentation, defined as the total number of visits to the same emergency department within 28 days of discharge from hospital, were measured. Performance of the risk screening tool was assessed by calculating sensitivity, specificity, positive and negative predictive values and likelihood ratios. Over the study period (April 1, 2009 to April 30, 2009), 3298 presentations from 2888 individuals were recorded. The homeless population accounted for 10% (n=327) of all visits and 7% (n=211) of all patients. A total of 90 (43%) homeless people re-presented to the emergency department. The predictive model included nine variables and achieved 98% (CI, 0.92-0.99) sensitivity and 66% (CI, 0.57-0.74) specificity. The positive predictive value was 68% and the negative predictive value was 98%. The positive likelihood ratio 2.9 (CI, 2.2-3.7) and the negative likelihood ratio was 0.03 (CI, 0.01-0.13). The high emergency department re-presentation rate for people who were homeless identifies unresolved psychosocial health needs. The emergency department remains a vital access point for homeless people, particularly after hours. The risk screening tool is key to identify medical and social aspects of a homeless patient's presentation to assist early identification and referral. Copyright © 2012 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

  9. Pressure ulcer development in trauma patients with suspected spinal injury; the influence of risk factors present in the Emergency Department.

    Science.gov (United States)

    Ham, H W Wietske; Schoonhoven, L Lisette; Schuurmans, M Marieke J; Leenen, L Luke P H

    2017-01-01

    To explore the influence of risk factors present at Emergency Department admission on pressure ulcer development in trauma patients with suspected spinal injury, admitted to the hospital for evaluation and treatment of acute traumatic injuries. Prospective cohort study setting level one trauma center in the Netherlands participants adult trauma patients transported to the Emergency Department on a backboard, with extrication collar and headblocks and admitted to the hospital for treatment or evaluation of their injuries. Between January and December 2013, 254 trauma patients were included. The following dependent variables were collected: Age, Skin color and Body Mass Index, and Time in Emergency Department, Injury Severity Score, Mean Arterial Pressure, hemoglobin level, Glasgow Coma Score, and admission ward after Emergency Department. Pressure ulcer development during admission was associated with a higher age (p 0.00, OR 1.05) and a lower Glasgow Coma Scale score (p 0.00, OR 1.21) and higher Injury Severity Scores (p 0.03, OR 1.05). Extra nutrition decreases the probability of PU development during admission (p 0.04, OR 0.20). Pressure ulcer development within the first 48h of admission was positively associated with a higher age (p 0.01, OR 1.03) and a lower Glasgow Coma Scale score (p 0.01, OR 1.16). The proportion of patients admitted to the Intensive Care Unit and Medium Care Unit was higher in patients with pressure ulcers. The pressure ulcer risk during admission is high in patients with an increased age, lower Glasgow Coma Scale and higher Injury Severity Score in the Emergency Department. Pressure ulcer risk should be assessed in the Emergency Department to apply preventive interventions in time. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Emergency Risk Communication: Lessons Learned from a Rapid Review of Recent Gray Literature on Ebola, Zika, and Yellow Fever.

    Science.gov (United States)

    Toppenberg-Pejcic, Deborah; Noyes, Jane; Allen, Tomas; Alexander, Nyka; Vanderford, Marsha; Gamhewage, Gaya

    2018-03-20

    A rapid review of gray literature from 2015 to 2016 was conducted to identify the lessons learned for emergency risk communication from recent outbreaks of Ebola, Zika, and yellow fever. Gray literature databases and key websites were searched and requests for documents were posted to expert networks. A total of 83 documents met inclusion criteria, 68 of which are cited in this report. This article focuses on the 3 questions, out of 12 posed by World Health Organization as part of a Guideline development process, dealing most directly with communicating risk during health emergencies: community engagement, trust building, and social media. Documents were evaluated for credibility using an Authority, Accuracy, Coverage, Objectivity, Date, Significance (AACODS) checklist? and if the document contained a study, a method-specific tool was applied. A rapid content analysis of included sources was undertaken with relevant text either extracted verbatim or summarized and mapped against the questions. A database subset was created for each question and citations were assigned to the subset(s) for which they contained relevant information. Multiple designations per document were common. Database subsets were used to synthesize the results into a coherent narrative. The gray literature strongly underlines the central importance of local communities. A one-size-fits-all approach does not work. For maximum effectiveness, local communities need to be involved with and own emergency risk communication processes, preferably well before an emergency occurs. Social media can open new avenues for communication, but is not a general panacea and should not be viewed as a replacement for traditional modes of communication. In general, the gray literature indicates movement toward greater recognition of emergency risk communication as a vitally important element of public health.

  11. Wuchereria bancrofti infection in Haitian immigrants and the risk of re-emergence of lymphatic filariasis in the Brazilian Amazon

    Directory of Open Access Journals (Sweden)

    Edson Fidelis da Silva Junior

    Full Text Available Abstract INTRODUCTION: Lymphatic filariasis (LF is a public health problem in Haiti. Thus, the emigration of Haitians to Brazil is worrisome because of the risk for LF re-emergence. METHODS: Blood samples of Haitian immigrants, aged ≥18 years, who emigrated to Manaus (Brazilian Amazon, were examined using thick blood smears, membrane blood filtration, and immunochromatography. RESULTS: Of the 244 immigrants evaluated, 1 (0.4% tested positive for W. bancrofti; 11.5% reported as having received LF treatment in Haiti. CONCLUSIONS: The re-emergence of LF in Manaus is unlikely, due to its low prevalence and low density of microfilaremia among the assessed Haitian immigrants.

  12. Emerging and established global life-style risk factors for cancer of the upper aero-digestive tract.

    Science.gov (United States)

    Gupta, Bhawna; Johnson, Newell W

    2014-01-01

    Upper aero-digestive tract cancer is a multidimensional problem, international trends showing complex rises and falls in incidence and mortality across the globe, with variation across different cultural and socio-economic groups. This paper seeks some explanations and identifies some research and policy needs. The literature illustrates the multifactorial nature of carcinogenesis. At the cellular level, it is viewed as a multistep process involving multiple mutations and selection for cells with progressively increasing capacity for proliferation, survival, invasion, and metastasis. Established and emerging risk factors, in addition to changes in incidence and prevalence of cancers of the upper aero-digestive tract, were identified. Exposure to tobacco and alcohol, as well as diets inadequate in fresh fruits and vegetables, remain the major risk factors, with persistent infection by particular so-called "high risk" genotypes of human papillomavirus increasingly recognised as also playing an important role in a subset of cases, particularly for the oropharynx. Chronic trauma to oral mucosa from poor restorations and prostheses, in addition to poor oral hygiene with a consequent heavy microbial load in the mouth, are also emerging as significant risk factors. Understanding and quantifying the impact of individual risk factors for these cancers is vital for health decision-making, planning and prevention. National policies and programmes should be designed and implemented to control exposure to environmental risks, by legislation if necessary, and to raise awareness so that people are provided with the information and support they need to adopt healthy lifestyles.

  13. Failure mode effects and criticality analysis: innovative risk assessment to identify critical areas for improvement in emergency department sepsis resuscitation.

    Science.gov (United States)

    Powell, Emilie S; O'Connor, Lanty M; Nannicelli, Anna P; Barker, Lisa T; Khare, Rahul K; Seivert, Nicholas P; Holl, Jane L; Vozenilek, John A

    2014-06-01

    Sepsis is an increasing problem in the practice of emergency medicine as the prevalence is increasing and optimal care to reduce mortality requires significant resources and time. Evidence-based septic shock resuscitation strategies exist, and rely on appropriate recognition and diagnosis, but variation in adherence to the recommendations and therefore outcomes remains. Our objective was to perform a multi-institutional prospective risk-assessment, using failure mode effects and criticality analysis (FMECA), to identify high-risk failures in ED sepsis resuscitation. We conducted a FMECA, which prospectively identifies critical areas for improvement in systems and processes of care, across three diverse hospitals. A multidisciplinary group of participants described the process of emergency department (ED) sepsis resuscitation to then create a comprehensive map and table listing all process steps and identified process failures. High-risk failures in sepsis resuscitation from each of the institutions were compiled to identify common high-risk failures. Common high-risk failures included limited availability of equipment to place the central venous catheter and conduct invasive monitoring, and cognitive overload leading to errors in decision-making. Additionally, we identified great variability in care processes across institutions. Several common high-risk failures in sepsis care exist: a disparity in resources available across hospitals, a lack of adherence to the invasive components of care, and cognitive barriers that affect expert clinicians' decision-making capabilities. Future work may concentrate on dissemination of non-invasive alternatives and overcoming cognitive barriers in diagnosis and knowledge translation.

  14. Occurrence and ecological risk assessment of emerging organic chemicals in urban rivers

    DEFF Research Database (Denmark)

    Peng, Fengjiao; Pan, Chang Gui; Zhang, Min

    2017-01-01

    at the suburb area. A screening-level risk assessment showed that 4-nonylphenol and triclosan (TCS) pose potential risks to aquatic organisms in most sampling sites. For individual taxa, 4-NP may pose risks to various groups of aquatic organisms, while TCS only might pose high risks to algae....

  15. Risk Prevention of Spreading Emerging Infectious Diseases Using a HybridCrowdsensing Paradigm, Optical Sensors, and Smartphone.

    Science.gov (United States)

    Edoh, Thierry

    2018-04-10

    The risk of spreading diseases within (ad-hoc)crowds and the need to pervasively screen asymptomatic individuals to protect the population against emerging infectious diseases, request permanentcrowd surveillance., particularly in high-risk regions. Thecase of Ebola epidemic in West Africa in recent years has shown the need for pervasive screening. The trend today in diseases surveillance is consisting of epidemiological data collection about emerging infectious diseases using social media, wearable sensors systems, or mobile applications and data analysis. This approach presents various limitations. This paper proposes a novel approach for diseases monitoring and risk prevention of spreading infectious diseases. The proposed approach, aiming at overcoming the limitation of existing disease surveillance approaches, combines the hybrid crowdsensing paradigm with sensing individuals' bio-signals using optical sensors for monitoring any risks of spreading emerging infectious diseases in any (ad-hoc) crowds. A proof-of-concept has been performed using a drone armed with a cat s60 smartphone featuring a Forward Looking Infra-Red (FLIR) camera. According to the results of the conducted experiment, the concept has the potential to improve the conventional epidemiological data collection. The measurement is reliable, and the recorded data are valid. The measurement error rates are about 8%.

  16. Pre-operative risk scores for the prediction of outcome in elderly people who require emergency surgery

    Directory of Open Access Journals (Sweden)

    Bates Tom

    2007-06-01

    Full Text Available Abstract Background The decision on whether to operate on a sick elderly person with an intra-abdominal emergency is one of the most difficult in general surgery. A predictive risk-score would be of great value in this situation. Methods A Medline search was performed to identify those predictive risk-scores relevant to sick elderly patients in whom emergency surgery might be life-saving. Results Many of the risk scores for surgical patients include the operative findings or require tests which are not available in the acute situation. Most of the relevant studies include younger patients and elective surgery. The Glasgow Aneurysm Score and Hardman Index are specific to ruptured aortic aneurysm while the Boey Score and the Hacetteppe Score are specific to perforated peptic ulcer. The Reiss Index and Fitness Score can be used pre-operatively if the elements of the score can be completed in time. The ASA score, which includes a significant element of subjective clinical judgement, can be augmented with factors such as age and urgency of surgery but no test has a negative predictive value sufficient to recommend against surgical intervention without clinical input. Conclusion Risk scores may be helpful in sick elderly patients needing emergency abdominal surgery but an experienced clinical opinion is still essential.

  17. Design and Development of Virtual Reality Simulation for Teaching High-Risk Low-Volume Problem-Prone Office-Based Medical Emergencies

    Science.gov (United States)

    Lemheney, Alexander J.

    2014-01-01

    Physicians' offices are not the usual place where emergencies occur; thus how staff remains prepared and current regarding medical emergencies presents an ongoing challenge for private practitioners. The very nature of low-volume, high-risk, and problem-prone medical emergencies is that they occur with such infrequency it is difficult for staff to…

  18. Psychosocial risk and protective factors for the health and well-being of professionals working in emergency and non-emergency medical transport services, identified via questionnaires.

    Science.gov (United States)

    Navarro Moya, P; González Carrasco, M; Villar Hoz, E

    2017-09-06

    Medical transport (MT) professionals are subject to considerable emotional demands due to their involvement in life-or-death situations and their exposure to the serious health problems of their clients. An increase in the demand for MT services has, in turn, increased interest in the study of the psychosocial risk factors affecting the health of workers in this sector. However, research thus far has not distinguished between emergency (EMT) and non-emergency (non-EMT) services, nor between the sexes. Furthermore, little emphasis has been placed on the protective factors involved. The main objective of the present study is to identify any existing differential exposure - for reasons of work setting (EMT and non-EMT) or of gender - to the various psychosocial risk and protective factors affecting the health of MT workers. Descriptive and transversal research with responses from 201 professionals. The scores obtained on the various psychosocial scales in our study - as indicators of future health problems - were more unfavourable for non-EMT workers than they were for EMT workers. Work setting, but not gender, was able to account for these differences. The scores obtained for the different psychosocial factors are generally more favourable for the professionals we surveyed than those obtained in previous samples. The significant differences observed between EMT and non-EMT personnel raise important questions regarding the organization of work in companies that carry out both services at the same time in the same territory. The relationships among the set of risk/protective factors suggests a need for further investigation into working conditions as well as a consideration of the workers' sense of coherence and subjective well-being as protective factors against occupational burnout syndrome.

  19. Above, Beyond, and Over the Side rails: Evaluating the New Memorial Emergency Department Fall-Risk-Assessment Tool.

    Science.gov (United States)

    Scott, Robin A; Oman, Kathleen S; Flarity, Kathleen; Comer, Jennifer L

    2018-03-06

    Patient falls are a significant issue in hospitalized patients and financially costly to hospitals. The Joint Commission requires that patients be assessed for fall risk and interventions in place to mitigate the risk of falls. It is imperative to have a patient population/setting specific fall risk assessment tool to identify patients at risk for falling. The purpose of this study was to evaluate the reliability and validity of the 2013 Memorial ED Fall Risk Assessment tool (MEDFRAT) specifically designed for the ED population. A two-phase prospective design was used for this study. Phase one determined the interrater reliability of the MEDFRAT. Phase two assessed the validity of the MEDFRAT in an emergency department (ED) within a 600-bed academic/teaching institution; Level II Trauma Center with >100,000 annual patient visits. The Memorial ED Fall Risk Assessment Tool was validated in this ED setting. The tool demonstrated positive interrater reliability (k=0.701) and when implemented with a falls prevention strategy and staff education demonstrated a 48% decrease in ED fall rate (0.57 falls/1000 patient visits) post implementation during the study period. The MEDFRAT, an evidenced based ED-specific fall risk tool was implemented on the basis of the risk factors consistently identified in the literature: prior fall history, impaired mobility, altered mental status, altered elimination, and the use of sedative medication. The Memorial ED Fall Risk Assessment Tool demonstrated to be a valid tool for this hospital system. Copyright © 2018 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  20. Interactive web visualization tools to the results interpretation of a seismic risk study aimed at the emergency levels definition

    Science.gov (United States)

    Rivas-Medina, A.; Gutierrez, V.; Gaspar-Escribano, J. M.; Benito, B.

    2009-04-01

    Results of a seismic risk assessment study are often applied and interpreted by users unspecialised on the topic or lacking a scientific background. In this context, the availability of tools that help translating essentially scientific contents to broader audiences (such as decision makers or civil defence officials) as well as representing and managing results in a user-friendly fashion, are on indubitable value. On of such tools is the visualization tool VISOR-RISNA, a web tool developed within the RISNA project (financed by the Emergency Agency of Navarre, Spain) for regional seismic risk assessment of Navarre and the subsequent development of emergency plans. The RISNA study included seismic hazard evaluation, geotechnical characterization of soils, incorporation of site effects to expected ground motions, vulnerability distribution assessment and estimation of expected damage distributions for a 10% probability of exceedance in 50 years. The main goal of RISNA was the identification of higher risk area where focusing detailed, local-scale risk studies in the future and the corresponding urban emergency plans. A geographic information system was used to combine different information layers, generate tables of results and represent maps with partial and final results. The visualization tool VISOR-RISNA is intended to facilitate the interpretation and representation of the collection of results, with the ultimate purpose of defining actuation plans. A number of criteria for defining actuation priorities are proposed in this work. They are based on combinations of risk parameters resulting from the risk study (such as expected ground motion and damage and exposed population), as determined by risk assessment specialists. Although the values that these parameters take are a result of the risk study, their distribution in several classes depends on the intervals defined by decision takers or civil defense officials. These criteria provide a ranking of

  1. Insight into "Calculated Risk": An Application to the Prioritization of Emerging Infectious Diseases for Blood Transfusion Safety.

    Science.gov (United States)

    Neslo, R E J; Oei, W; Janssen, M P

    2017-09-01

    Increasing identification of transmissions of emerging infectious diseases (EIDs) by blood transfusion raised the question which of these EIDs poses the highest risk to blood safety. For a number of the EIDs that are perceived to be a threat to blood safety, evidence on actual disease or transmission characteristics is lacking, which might render measures against such EIDs disputable. On the other hand, the fact that we call them "emerging" implies almost by definition that we are uncertain about at least some of their characteristics. So what is the relative importance of various disease and transmission characteristics, and how are these influenced by the degree of uncertainty associated with their actual values? We identified the likelihood of transmission by blood transfusion, the presence of an asymptomatic phase of infection, prevalence of infection, and the disease impact as the main characteristics of the perceived risk of disease transmission by blood transfusion. A group of experts in the field of infectious diseases and blood transfusion ranked sets of (hypothetical) diseases with varying degrees of uncertainty associated with their disease characteristics, and used probabilistic inversion to obtain probability distributions for the weight of each of these risk characteristics. These distribution weights can be used to rank both existing and newly emerging infectious diseases with (partially) known characteristics. Analyses show that in case there is a lack of data concerning disease characteristics, it is the uncertainty concerning the asymptomatic phase and the disease impact that are the most important drivers of the perceived risk. On the other hand, if disease characteristics are well established, it is the prevalence of infection and the transmissibility of the disease by blood transfusion that will drive the perceived risk. The risk prioritization model derived provides an easy to obtain and rational expert assessment of the relative importance of

  2. THE ISSUES OF MANAGEMENT OF ENVIRONMENTAL-TECHNOGENIC SAFETY AND THE RISKS OF EMERGENCY SITUATIONS BY GEORGIA'S PROVINCES

    International Nuclear Information System (INIS)

    Tsikhelashvili, Z.; Zakutashvili, G.; Akhvlediani, T.; Verulava, G.

    2008-01-01

    The issues of management of environmentasl-technogenic safety and the risks of emergency situations by Georgia's provinces are discussed. It is justified that the development of the program of decreasing the risk of emergency situations and mitigating the consequences of such situations according to Georgia's provinces is essential nowadays. The program should involve the following tasks: 1. Working-out and development of scientific-methodological bases for management of risks of emergency situations; 2. Working-out of standard-legal and methodological bases for providing the state and international control and standardization of risks of emergency situations and for mitigation of the consequences of such situations. 3. Development of economic tools for controlling the activities associated with decreasing the risks and mitigating the consequences of emergency situations. 4. Designing of forecast and monitoring systems. 5. Designing of automated control systems, improvement of communication and warning systems etc. (author)

  3. Stressful Life Events and Predictors of Post-traumatic Growth among High-Risk Early Emerging Adults.

    Science.gov (United States)

    Arpawong, Thalida E; Rohrbach, Louise A; Milam, Joel E; Unger, Jennifer B; Land, Helen; Sun, Ping; Spruijt-Metz, Donna; Sussman, Steve

    2016-01-01

    Stressful life events (SLEs) may elicit positive psychosocial change among youth, referred to as Post-traumatic Growth (PTG). We assessed types of SLEs experienced, degree to which participants reported PTG, and variables predicting PTG across 24 months among a sample of high risk, ethnically diverse early emerging adults. Participants were recruited from alternative high schools ( n = 564; mean age=16.8; 65% Hispanic). Multi-level regression models were constructed to examine the impact of environmental (SLE quantity, severity) and personal factors (hedonic ability, perceived stress, developmental stage, future time orientation) on a composite score of PTG. The majority of participants reported positive changes resulted from their most life-altering SLE of the past two years. Predictors of PTG included fewer SLEs, less general stress, having a future time perspective, and greater identification with the developmental stage of Emerging Adulthood. Findings suggest intervention targets to foster positive adaptation among early emerging adults who experience frequent SLEs.

  4. Autonomic reactivity and romantic relational aggression among female emerging adults: moderating roles of social and cognitive risk.

    Science.gov (United States)

    Murray-Close, Dianna

    2011-04-01

    This study investigates the association between autonomic arousal in response to a relational stressor and the perpetration of relational aggression against romantic partners. In addition, the moderating role of social risk (relational victimization by a romantic partner) and cognitive risk (hostile attribution biases) was explored. Skin conductance, heart rate, and respiratory sinus arrhythmia during an experience of exclusion were assessed in a sample of female emerging adults (N=131). Participants provided self-reports of romantic relational aggression, romantic relational victimization, and hostile attribution biases. Results indicated that both heightened and blunted reactivity served as risk factors for the perpetration of romantic relational aggression depending on women's social and contextual risks. Implications for understanding the development of intimate aggression are discussed. Copyright © 2011 Elsevier B.V. All rights reserved.

  5. Risks of cardiovascular adverse events and death in patients with previous stroke undergoing emergency noncardiac, nonintracranial surgery

    DEFF Research Database (Denmark)

    Christiansen, Mia N.; Andersson, Charlotte; Gislason, Gunnar H.

    2017-01-01

    Background: The outcomes of emergent noncardiac, nonintracranial surgery in patients with previous stroke remain unknown. Methods: All emergency surgeries performed in Denmark (2005 to 2011) were analyzed according to time elapsed between previous ischemic stroke and surgery. The risks of 30-day...... mortality and major adverse cardiovascular events were estimated as odds ratios (ORs) and 95% CIs using adjusted logistic regression models in a priori defined groups (reference was no previous stroke). In patients undergoing surgery immediately (within 1 to 3 days) or early after stroke (within 4 to 14...... and general anesthesia less frequent in patients with previous stroke (all P Risks of major adverse cardiovascular events and mortality were high for patients with stroke less than 3 months (20.7 and 16.4% events; OR = 4.71 [95% CI, 4.18 to 5.32] and 1.65 [95% CI, 1.45 to 1.88]), and remained...

  6. Identifying Patients at Risk of Deterioration in the Joint Emergency Department

    DEFF Research Database (Denmark)

    Schmidt, Thomas; Wiil, Uffe Kock

    2015-01-01

    at the case through the lenses of common information spaces. In particular, we apply Bossen’s seven-parameter framework to discover new dimensions of how Emergency Departments and individual clinicians identify and respond to unforeseen events, and how they handle the associated cognitive challenges. We......In recent years, Danish hospitals have merged their emergency facilities into Joint Emergency Departments. This poses new collaborative challenges across traditionally separated specialized departments, which now have to collaborate in a shared environment. Despite established protocols and patient...

  7. Relationship Between the Urine Flow Rate and Risk of Contrast-Induced Nephropathy After Emergent Percutaneous Coronary Intervention.

    Science.gov (United States)

    Liu, Yong; Lin, Lixia; Li, Yun; Li, Hualong; Wu, Deng-Xuan; Zhao, Jian-bin; Lian, Dan; Zhou, Yingling; Liu, Yuanhui; Ye, Piao; Ran, Peng; Duan, Chongyang; Chen, Shiqun; Chen, Pingyan; Xian, Ying; Chen, Jiyan; Tan, Ning

    2015-12-01

    A low urine flow rate is a marker of acute kidney injury. However, it is unclear whether a high urine flow rate is associated with a reduced risk of contrast-induced nephropathy (CIN) in high-risk patients. We conducted this study to evaluate the predictive value of the urine flow rate for the risk of CIN following emergent percutaneous coronary intervention (PCI). We prospectively examined 308 patients undergoing emergent PCI who provided consent. The predictive value of the 24-hour postprocedural urine flow rate, adjusted by weight (UR/W, mL/kg/h) and divided into quartiles, for the risk of CIN was assessed using multivariate logistic regression analysis. The cumulative incidence of CIN was 24.4%. In particular, CIN was observed in 29.5%, 19.5%, 16.7%, and 32.0% of cases in the UR/W quartile (Q)-1 (≤0.94  mL/kg/h), Q2 (0.94-1.30  mL/kg/h), Q3 (1.30-1.71  mL/kg/h), and Q4 (≥1.71  mL/kg/h), respectively. Moreover, in-hospital death was noted in 7.7%, 3.9%, 5.1%, and 5.3% of patients in Q1, Q2, Q3, and Q4, respectively. After adjusting for potential confounding predictors, multivariate analysis indicated that compared with the moderate urine flow rate quartiles (Q2 + Q3), a high urine flow rate (Q4) (odds ratio [OR], 2.69; 95% confidence interval [CI], 1.27-5.68; P = 0.010) and low urine flow rate (Q1) (OR, 2.23; 95% CI, 1.03-4.82; P = 0.041) were significantly associated with an increased risk of CIN. Moreover, a moderate urine flow rate (0.94-1.71  mL/kg/h) was significantly associated with a decreased risk of mortality. Our data suggest that higher and lower urine flow rates were significantly associated with an increased risk of CIN after emergent PCI, and a moderate urine flow rate (0.94-1.71  mL/kg/h) may be associated with a decreased risk of CIN with a good long-term prognosis after emergent PCI.

  8. Prevalence and risk factors of workplace violence against health care workers in emergency department in Ismailia, Egypt.

    Science.gov (United States)

    Abdellah, Rasha Farouk; Salama, Khaled Morsy

    2017-01-01

    Emergency department is one of the high-risk areas, where violence against health care workers (HCWs) is a prevalent and serious problem. Violence has negative effects on HCWs, and therefore on the quality of care provided in emergency department. This study aimed to determine the prevalence, types, sources and risk factors of violence reported by HCWs in emergency department. A cross-sectional study was conducted using a standardized questionnaire developed by the WHO. One hundred thirty four questionnaires were included in this study (94.4% response rate). WPV was reported by 59.7% of HCWs. Verbal violence was the most reported (58.2%), compared to physical violence (15.7%). The most reported reasons for violence were waiting time and that patient and family expectations not being met. Only 29.5% of HCWs who experienced verbal violence and 23.8% of who experienced physical violence reported it to hospital authority. About 75% of HCW thought that work place violence could be prevented, and about 60% said that no action was taken against the attacker by hospital authority. Violence against HCWs in emergency department is a significant issue that cannot be ignored. There are multiple reasons. The key point in dealing with the problem is to treat its specific causes.

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

    Science.gov (United States)

    Qi, Yuan; Zhao, Hongtao

    2017-04-01

    China is one of few several natural disaster prone countries, which has complex geological and geographical environment and abnormal climate. On August 8, 2010, a large debris flow disaster happened in Zhouqu Country, Gansu province, resulting in more than 1700 casualties and more than 200 buildings damaged. In order to percept landslide and debris flow, an early warning system was established in the county. Spatial information technologies, such as remote sensing, GIS, and GPS, play core role in the early warning system, due to their functions in observing, analyzing, and locating geological disasters. However, all of these spatial information technologies could play an important role only guided by the emergency response mechanism. This article takes the establishment of Zhouqu Country's Disaster Emergency Response Interaction Mechanism (DERIM) as an example to discuss the risk management of country-level administrative units. The country-level risk management aims to information sharing, resources integration, integrated prevention and unified command. Then, nine subsystems support DERIM, which included disaster prevention and emergency data collection and sharing system, joint duty system, disaster verification and evaluation system, disaster consultation system, emergency warning and information release system, emergency response system, disaster reporting system, plan management system, mass prediction and prevention management system. At last, an emergency command platform in Zhouqu Country built up to realize DERIM. The core mission of the platform consists of daily management of disaster, monitoring and warning, comprehensive analysis, information release, consultation and decision-making, emergency response, etc. Five functional modules, including module of disaster information management, comprehensive monitoring module (geological monitoring, meteorological monitoring, water conservancy and hydrological monitoring), alarm management module, emergency

  10. Field evaluation of picaridin repellents reveals differences in repellent sensitivity between Southeast Asian vectors of malaria and arboviruses.

    Directory of Open Access Journals (Sweden)

    Karel Van Roey

    2014-12-01

    Full Text Available Scaling up of insecticide treated nets has contributed to a substantial malaria decline. However, some malaria vectors, and most arbovirus vectors, bite outdoors and in the early evening. Therefore, topically applied insect repellents may provide crucial additional protection against mosquito-borne pathogens. Among topical repellents, DEET is the most commonly used, followed by others such as picaridin. The protective efficacy of two formulated picaridin repellents against mosquito bites, including arbovirus and malaria vectors, was evaluated in a field study in Cambodia. Over a period of two years, human landing collections were performed on repellent treated persons, with rotation to account for the effect of collection place, time and individual collector. Based on a total of 4996 mosquitoes collected on negative control persons, the overall five hour protection rate was 97.4% [95%CI: 97.1-97.8%], not decreasing over time. Picaridin 20% performed equally well as DEET 20% and better than picaridin 10%. Repellents performed better against Mansonia and Culex spp. as compared to aedines and anophelines. A lower performance was observed against Aedes albopictus as compared to Aedes aegypti, and against Anopheles barbirostris as compared to several vector species. Parity rates were higher in vectors collected on repellent treated person as compared to control persons. As such, field evaluation shows that repellents can provide additional personal protection against early and outdoor biting malaria and arbovirus vectors, with excellent protection up to five hours after application. The heterogeneity in repellent sensitivity between mosquito genera and vector species could however impact the efficacy of repellents in public health programs. Considering its excellent performance and potential to protect against early and outdoor biting vectors, as well as its higher acceptability as compared to DEET, picaridin is an appropriate product to evaluate the

  11. Field evaluation of picaridin repellents reveals differences in repellent sensitivity between Southeast Asian vectors of malaria and arboviruses.

    Science.gov (United States)

    Van Roey, Karel; Sokny, Mao; Denis, Leen; Van den Broeck, Nick; Heng, Somony; Siv, Sovannaroth; Sluydts, Vincent; Sochantha, Tho; Coosemans, Marc; Durnez, Lies

    2014-12-01

    Scaling up of insecticide treated nets has contributed to a substantial malaria decline. However, some malaria vectors, and most arbovirus vectors, bite outdoors and in the early evening. Therefore, topically applied insect repellents may provide crucial additional protection against mosquito-borne pathogens. Among topical repellents, DEET is the most commonly used, followed by others such as picaridin. The protective efficacy of two formulated picaridin repellents against mosquito bites, including arbovirus and malaria vectors, was evaluated in a field study in Cambodia. Over a period of two years, human landing collections were performed on repellent treated persons, with rotation to account for the effect of collection place, time and individual collector. Based on a total of 4996 mosquitoes collected on negative control persons, the overall five hour protection rate was 97.4% [95%CI: 97.1-97.8%], not decreasing over time. Picaridin 20% performed equally well as DEET 20% and better than picaridin 10%. Repellents performed better against Mansonia and Culex spp. as compared to aedines and anophelines. A lower performance was observed against Aedes albopictus as compared to Aedes aegypti, and against Anopheles barbirostris as compared to several vector species. Parity rates were higher in vectors collected on repellent treated person as compared to control persons. As such, field evaluation shows that repellents can provide additional personal protection against early and outdoor biting malaria and arbovirus vectors, with excellent protection up to five hours after application. The heterogeneity in repellent sensitivity between mosquito genera and vector species could however impact the efficacy of repellents in public health programs. Considering its excellent performance and potential to protect against early and outdoor biting vectors, as well as its higher acceptability as compared to DEET, picaridin is an appropriate product to evaluate the epidemiological

  12. Relationship between the prevalence of antibodies to arbovirus and hepatitis B virus in the Vale do Ribeira region, Brazil

    Directory of Open Access Journals (Sweden)

    Cláudio Sérgio Pannuti

    1989-04-01

    Full Text Available 280 students, between 6 and 14 years old, residents in the Iguape county, southern coast of the State of São Paulo, were studied in order to identify the existence of a possible association between the prevalence of specific antibodies to the hepatitis B virus and the exposure to haematophagous mosquitoes, evaluated indirectly through the prevalence of antibodies to 17 arboviruses isolated in Brazil. The children were from 4 areas with different topographical characteristics: 89 of the children were from the urban zone of the town of Iguape, 89 were from the periurban zone, 30 were from the rural area with extensive banana plantations, and 72 were from the jungle zone. Previous studies had shown significantly higher prevalence of antibodies to different arboviruses in the cultivated zone and the jungle zone, when compared to the urban and periurban zones of Iguape. The detection of antibodies to the HBV surface antigen (HBs Ag was done through the radioimmunoassay (Ausab, Abbott Laboratory. The cases considered positive were confirmed through the presence of anti-core HBV antibodies (anti-HBc-EIA Roche. A significantly higher prevalence of anti-HBV antibodies was observed in children from the jungle zone (26/72 = 36,1% when compared to those from the urban zone (5/89 = 5,6%, peri-urban (6/89 = 6,7% or from the cultivated zone (0/30 = 0%. The result suggest the existence of a common factor in the dissemination of the arboviruses and the hepatitis B virus, supporting the hypothesis that mosquitoes may play an important role in the HBV transmission in tropical forested region.

  13. Relationship between the prevalence of antibodies to arbovirus and hepatitis B virus in the Vale do Ribeira region, Brazil.

    Science.gov (United States)

    Pannuti, C S; Iversson, L B; de Mendonça, J S; Travassos da Rosa, A P; Granato, C F

    1989-01-01

    280 students, between 6 and 14 years old, residents in the Iguape county, southern coast of the State of São Paulo, were studied in order to identify the existence of a possible association between the prevalence of specific antibodies to the hepatitis B virus and the exposure to haematophagous mosquitoes, evaluated indirectly through the prevalence of antibodies to 17 arboviruses isolated in Brazil. The children were from 4 areas with different topographical characteristics: 89 of the children were from the urban zone of the town of Iguape, 89 were from the peri-urban zone, 30 were from the rural area with extensive banana plantations, and 72 were from the jungle zone. Previous studies had shown significantly higher prevalence of antibodies to different arboviruses in the cultivated zone and the jungle zone, when compared to the urban and peri-urban zones of Iguape. The detection of antibodies to the HBV surface antigen (HBs Ag) was done through the radioimmunoassay (Ausab, Abbott Laboratory). The cases considered positive were confirmed through the presence of anti-core HBV antibodies (anti-HBc-EIA Roche). A significantly higher prevalence of anti-HBV antibodies was observed in children from the jungle zone (26/72 = 36.1%) when compared to those from the urban zone (5/89 = 5.6%), peri-urban (6/89 = 6.7%) or from the cultivated zone (0/30 = 0%). The result suggest the existence of a common factor in the dissemination of the arboviruses and the hepatitis B virus, supporting the hypothesis that mosquitoes may play an important role in the HBV transmission in tropical forested region.

  14. The nuclear medicine department in the emergency management plan: a referent structure for the nuclear and radiological risks

    International Nuclear Information System (INIS)

    Barat, J.L.; Ducassou, D.; Lesgourgues, P.; Zamaron, S.; Boulard, G.

    2006-01-01

    Each french public or private hospital has to establish guidelines for an immediate response to mass casualties (Emergency Management Plan or 'White' Plan). For a nuclear accident or terrorist attack, the staff of the Nuclear Medicine Department may be adequately prepared and equipped. This paper presents the nuclear and radiological risks section of the final draft of the White Plan developed at Bordeaux University Hospital. (author)

  15. The persistence of risk levels of general equity funds in an emerging market economy

    Directory of Open Access Journals (Sweden)

    Rousseau Lötter

    2013-10-01

    Full Text Available The persistence of risk levels of local General Equity unit trusts is evaluated. Variations in absolute and market-adjusted returns are measured to determine whether investors can use historical risk as a proxy for future risk levels. The General Equity funds are fairly homogenous, and different funds should exhibit stable risk levels if the fund managers’ investment mandates and investment styles remain stable over time. The results indicate a degree of absolute and market-adjusted risk stability over time. The market-adjusted risk and return relationship remained stable through the 2008 global crises, indicating that, on average, the fund managers maintained their benchmark-related risk exposures. Both the absolute and market-adjusted results indicate no statistically significant relationship between risk and return for the 2000 to 2012 period.

  16. The persistence of risk levels of general equity funds in an emerging market economy

    Directory of Open Access Journals (Sweden)

    Rousseau Lötter

    2013-12-01

    Full Text Available The persistence of risk levels of local General Equity unit trusts is evaluated. Variations in absolute and market-adjusted returns are measured to determine whether investors can use historical risk as a proxy for future risk levels. The General Equity funds are fairly homogenous, and different funds should exhibit stable risk levels if the fund managers’ investment mandates and investment styles remain stable over time. The results indicate a degree of absolute and market-adjusted risk stability over time. The market-adjusted risk and return relationship remained stable through the 2008 global crises, indicating that, on average, the fund managers maintained their benchmark-related risk exposures. Both the absolute and market-adjusted results indicate no statistically significant relationship between risk and return for the 2000 to 2012 period.

  17. RISK PERCEPTION IN E-COMMERCE: A HOLISTIC REVIEW OF EMERGING ONLINE SHOPPING IN INDIA

    OpenAIRE

    Muhammad Shafeeque A.P.; Thomachan K.T.

    2017-01-01

    This paper examines the perceived risks associated with online shopping. Perceived risk defined as a consumer’s belief about the potential losses or other negative outcomes from transacting on the internet. Fifty-eight percent of internet users describe online shopping as a frustrating, confusing, and overwhelming activity. Even though majority of the online shoppers have perceive risk, religion, income and occupation are not found to be significant factors in risk perception.

  18. Emerging Earth Science Technologies in Disaster Risk Management: Prototype and Assessment

    Data.gov (United States)

    National Aeronautics and Space Administration — Examine emerging technologies and assess their potential to dramatically change the utility and impact of satellite data for GEOSS societal benefits • Investigate...

  19. Absence and Need for Fatigue Risk Management in Emergency Medical Services

    Science.gov (United States)

    2018-01-11

    Fatigue in the Emergency Medical Services (EMS) workplace is widespread. Reports of fatigue-related events that involve ambulance crashes, personnel injury, patient death, and other negative outcomes are on the rise (1-7). There is growing evidence t...

  20. Evidence-Based Guidelines for Fatigue Risk Management in Emergency Medical Services

    Science.gov (United States)

    2018-01-11

    Background: Administrators of Emergency Medical Services (EMS) operations lack guidance on how to mitigate workplace fatigue, which affects greater than half of all EMS personnel. The primary objective of the Fatigue in EMS Project was to create an e...

  1. Emerging pollutants in the environment: present and future challenges in biomonitoring, ecological risks and bioremediation

    OpenAIRE

    Gavrilescu, M.; Demnerová, K.; Aamand, J.; Agathos, S.; Fava, F.

    2015-01-01

    Emerging pollutants reach the environment from various anthropogenic sources and are distributed throughout environmental matrices. Although great advances have been made in the detection and analysis of trace pollutants during recent decades, due to the continued development and refinement of specific techniques, a wide array of undetected contaminants of emerging environmental concern need to be identified and quantified in various environmental components and biological tissues. These poll...

  2. The Usefulness of the MEESSI Score for Risk Stratification of Patients With Acute Heart Failure at the Emergency Department.

    Science.gov (United States)

    Miró, Òscar; Rosselló, Xavier; Gil, Víctor; Martín-Sánchez, Francisco Javier; Llorens, Pere; Herrero, Pablo; Jacob, Javier; López-Grima, María Luisa; Gil, Cristina; Lucas Imbernón, Francisco Javier; Garrido, José Manuel; Pérez-Durá, María José; López-Díez, María Pilar; Richard, Fernando; Bueno, Héctor; Pocock, Stuart J

    2018-06-11

    The MEESSI scale stratifies acute heart failure (AHF) patients at the emergency department (ED) according to the 30-day mortality risk. We validated the MEESSI risk score in a new cohort of Spanish patients to assess its accuracy in stratifying patients by risk and to compare its performance in different settings. We included consecutive patients diagnosed with AHF in 30 EDs during January and February 2016. The MEESSI score was calculated for each patient. The c-statistic measured the discriminatory capacity to predict 30-day mortality of the full MEESSI model and secondary models. Further comparisons were made among subgroups of patients from university and community hospitals, EDs with high-, medium- or low-activity and EDs that recruited or not patients in the original MEESSI derivation cohort. We analyzed 4711 patients (university/community hospitals: 3811/900; high-/medium-/low-activity EDs: 2695/1479/537; EDs participating/not participating in the previous MEESSI derivation study: 3892/819). The distribution of patients according to the MEESSI risk categories was: 1673 (35.5%) low risk, 2023 (42.9%) intermediate risk, 530 (11.3%) high risk and 485 (10.3%) very high risk, with 30-day mortality of 2.0%, 7.8%, 17.9%, and 41.4%, respectively. The c-statistic for the full model was 0.810 (95%CI, 0.790-0.830), ranging from 0.731 to 0.785 for the subsequent secondary models. The discriminatory capacity of the MEESSI risk score was similar among subgroups of hospital type, ED activity, and original recruiter EDs. The MEESSI risk score successfully stratifies AHF patients at the ED according to the 30-day mortality risk, potentially helping clinicians in the decision-making process for hospitalizing patients. Copyright © 2018. Published by Elsevier España, S.L.U.

  3. Radiological emergency response for community agencies with cognitive task analysis, risk analysis, and decision support framework.

    Science.gov (United States)

    Meyer, Travis S; Muething, Joseph Z; Lima, Gustavo Amoras Souza; Torres, Breno Raemy Rangel; del Rosario, Trystyn Keia; Gomes, José Orlando; Lambert, James H

    2012-01-01

    Radiological nuclear emergency responders must be able to coordinate evacuation and relief efforts following the release of radioactive material into populated areas. In order to respond quickly and effectively to a nuclear emergency, high-level coordination is needed between a number of large, independent organizations, including police, military, hazmat, and transportation authorities. Given the complexity, scale, time-pressure, and potential negative consequences inherent in radiological emergency responses, tracking and communicating information that will assist decision makers during a crisis is crucial. The emergency response team at the Angra dos Reis nuclear power facility, located outside of Rio de Janeiro, Brazil, presently conducts emergency response simulations once every two years to prepare organizational leaders for real-life emergency situations. However, current exercises are conducted without the aid of electronic or software tools, resulting in possible cognitive overload and delays in decision-making. This paper describes the development of a decision support system employing systems methodologies, including cognitive task analysis and human-machine interface design. The decision support system can aid the coordination team by automating cognitive functions and improving information sharing. A prototype of the design will be evaluated by plant officials in Brazil and incorporated to a future trial run of a response simulation.

  4. Association between knowledge about levonorgestrel emergency contraception and the risk of ectopic pregnancy following levonorgestrel emergency contraception failure: a comparative survey.

    Science.gov (United States)

    Zhang, Duo; Yan, Ming-Xing; Ma, Jue; Xia, Wei; Xue, Rui-Hong; Sun, Jing; Zhang, Jian

    2016-08-01

    To study the association between knowledge about levonorgestrel emergency contraception (LNG-EC) and the risk of ectopic pregnancy (EP) following LNG-EC failure. This study included 600 women who had visited the hospital with LNG-EC failure. Of these, 300 with EP and 300 with intrauterine pregnancy (IUP) were recruited to the EP group and IUP group respectively. The participants were interviewed face-to-face using a standardized questionnaire. Pearson's chi-square tests and t-test were used to compare the sociodemographic characteristics, reproductive and gynecological history, surgical history, previous contraceptive experience, and answers to 10 questions concerning the knowledge about LNG-EC. Those who gave incorrect answers to the question regarding the basic mechanism and specific method of levonorgestrel emergency contraceptive pills (LNG-ECPs) were at a higher risk of EP after LNG-EC failure. Women who did not strictly follow instructions or advice from healthcare professionals were more likely to subsequently experience EP (p < 10(-4) ). Women with LNG-EC failure reported friends/peers, TV, and Internet as the main sources of information. No difference was observed with regard to the sources of knowledge on LNG-EC (p = 0.07). The results illustrate the importance of strictly following the doctor's guidance or drug instructions when using LNG-ECPs. The media should be used to disseminate information about responsible EC, and pharmacy staff should receive regular educational training sessions in this regard. © 2016 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd. © 2016 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.

  5. Household Chemical Emergencies

    Science.gov (United States)

    ... Content Home Be Informed Household Chemical Emergencies Household Chemical Emergencies Although the risk of a chemical accident ... reduce the risk of injury. Before a Household Chemical Emergency It is critical to store household chemicals ...

  6. Empiric antibiotic therapy in urinary tract infection in patients with risk factors for antibiotic resistance in a German emergency department.

    Science.gov (United States)

    Bischoff, Sebastian; Walter, Thomas; Gerigk, Marlis; Ebert, Matthias; Vogelmann, Roger

    2018-01-26

    The aim of this study was to identify clinical risk factors for antimicrobial resistances and multidrug resistance (MDR) in urinary tract infections (UTI) in an emergency department in order to improve empirical therapy. UTI cases from an emergency department (ED) during January 2013 and June 2015 were analyzed. Differences between patients with and without resistances towards Ciprofloxacin, Piperacillin with Tazobactam (Pip/taz), Gentamicin, Cefuroxime, Cefpodoxime and Ceftazidime were analyzed with Fisher's exact tests. Results were used to identify risk factors with logistic regression modelling. Susceptibility rates were analyzed in relation to risk factors. One hundred thirty-seven of four hundred sixty-nine patients who met the criteria of UTI had a positive urine culture. An MDR pathogen was found in 36.5% of these. Overall susceptibility was less than 85% for standard antimicrobial agents. Logistic regression identified residence in nursing homes, male gender, hospitalization within the last 30 days, renal transplantation, antibiotic treatment within the last 30 days, indwelling urinary catheter and recurrent UTI as risk factors for MDR or any of these resistances. For patients with no risk factors Ciprofloxacin had 90%, Pip/taz 88%, Gentamicin 95%, Cefuroxime 98%, Cefpodoxime 98% and Ceftazidime 100% susceptibility. For patients with 1 risk factor Ciprofloxacin had 80%, Pip/taz 80%, Gentamicin 88%, Cefuroxime 78%, Cefpodoxime 78% and Ceftazidime 83% susceptibility. For 2 or more risk factors Ciprofloxacin drops its susceptibility to 52%, Cefuroxime to 54% and Cefpodoxime to 61%. Pip/taz, Gentamicin and Ceftazidime remain at 75% and 77%, respectively. We identified several risk factors for resistances and MDR in UTI. Susceptibility towards antimicrobials depends on these risk factors. With no risk factor cephalosporins seem to be the best choice for empiric therapy, but in patients with risk factors the beta-lactam penicillin Piperacillin with Tazobactam

  7. Private Sector Investments from Small States in Emerging Markets: Can International Financial Institutions Help Handle the Risks?

    Directory of Open Access Journals (Sweden)

    Hilmar Þór Hilmarsson

    2008-12-01

    Full Text Available The private sector plays an important role in the economic reconstruction of emerging market economies, and international financial institutions (IFIs increasingly work in partnership with the private sector to increase economic growth and reduce poverty in those economies. IFIs, for example, offer: (i equity financing and/or loans for private sector projects, (ii investment guarantees against political risks (or non-commercial risks, (iii technical assistance, and (iv advisory services, etc. This article will briefly discuss the services that IFIs offer the private sector in emerging markets and cases in which these services could be useful for Icelandic companies. The institutions discussed are (i the World Bank Group, (ii the European Bank for Reconstruction and Development (EBRD, (iii the Asian Development Bank (AsDB, (iv the Inter-American Development Bank (IDB, and (v the African Development Bank (AfDB. A few Icelandic firms already have plans for relatively large projects in emerging market economies, especially in the energy sector, some of them in countries that could be classified as being risky. The ongoing economic crisis in Iceland will make project financing in emerging markets more problematic than before and therefore investments in partnership with international financial institutions could be an option that Icelandic firms will increasingly need to consider if they intend to invest abroad. However, increased private sector and IFI partnerships will not happen without government action. Iceland is a member of only two of the above-mentioned IFIs: the World Bank Group and the EBRD. The decision for Iceland to become member of the AsDB, IDB and AfDB rests solely with the government. Further government inaction in this area could become an impediment for foreign direct investment from Iceland to emerging markets and increase risks when the Icelandic private sector invests in those economies. Unnecessary risks might not only hurt

  8. Risk Mitigation of Emerging Zoonoses: Hendra Virus and Non-Vaccinating Horse Owners.

    Science.gov (United States)

    Manyweathers, J; Field, H; Jordan, D; Longnecker, N; Agho, K; Smith, C; Taylor, M

    2017-12-01

    Hendra virus was identified in horses and humans in 1994, in Queensland, Australia. Flying foxes are the natural host. Horses are thought to acquire infection by direct or indirect contact with infected flying fox urine. Humans are infected from close contact with infected horses. To reduce risk of infection in horses and humans, Australian horse owners are encouraged to vaccinate horses against the virus and adopt property risk mitigation practices that focus on reducing flying fox horse contact and contamination of horses' environment with flying fox bodily fluids. This study investigates uptake of four Hendra virus risk mitigation practices in a sample of non- and partially vaccinating horse owners living close to previous Hendra virus cases. Protection motivation theory was used to develop a conceptual model to investigate risk perception and coping factors associated with uptake of risk mitigation practices. An online survey was administered via Facebook pages of veterinary clinics close to previous Hendra virus cases. Factors associated with uptake of risk mitigation practices were investigated using univariate and multivariate binary logistic regression. Belief that a risk mitigation practice would be effective in reducing Hendra virus risk was significantly associated with the uptake of that practice. Issues around the practicality of implementing risk mitigation practices were found to be the greatest barrier to uptake. Factors that relate to risk immediacy, such as nearby infection, were identified as more likely to trigger uptake of risk mitigation practices. The role of veterinarians in supporting Hendra risk mitigation was identified as more influential than that of respected others or friends. Findings from this study are being used to assist stakeholders in Australia responsible for promotion of risk mitigation practice in identifying additional pathways and reliable influencing factors that could be utilized for engaging and communicating with horse

  9. Syncope: Assessment of risk and an approach to evaluation in the emergency department and urgent care clinic

    Directory of Open Access Journals (Sweden)

    Baris Akdemir

    2015-03-01

    Full Text Available Syncope is among the most frequent forms of transient loss of consciousness (TLOC, and is characterized by a relatively brief and self-limited loss of consciousness that by definition is triggered by transient cerebral hypoperfusion. Most often, syncope is caused by a temporary drop of systemic arterial pressure below that required to maintain cerebral function, but brief enough not to cause permanent structural brain injury. Currently, approximately one-third of syncope/collapse patients seen in the emergency department (ED or urgent care clinic are admitted to hospital for evaluation. The primary objective of developing syncope/TLOC risk stratification schemes is to provide guidance regarding the immediate prognostic risk of syncope patients presenting to the ED or clinic; thereafter, based on that risk assessment physicians may be better equipped to determine which patients can be safely evaluated as outpatients, and which require hospital care. In general, the need for hospitalization is determined by several key issues: i the patient's immediate (usually considered 1 week to 1 month mortality risk and risk for physical injury (e.g., falls risk, ii the patient's ability to care for him/herself, and iii whether certain treatments inherently require in-hospital initiation (e.g., pacemaker implantation. However, at present no single risk assessment protocol appears to be satisfactory for universal application, and development of a consensus recommendation is an essential next step.

  10. A quantitative risk assessment approach for mosquito-borne diseases: malaria re-emergence in southern France

    Directory of Open Access Journals (Sweden)

    Luty Adrian JF

    2008-08-01

    Full Text Available Abstract Background The Camargue region is a former malaria endemic area, where potential Anopheles vectors are still abundant. Considering the importation of Plasmodium due to the high number of imported malaria cases in France, the aim of this article was to make some predictions regarding the risk of malaria re-emergence in the Camargue. Methods Receptivity (vectorial capacity and infectivity (vector susceptibility were inferred using an innovative probabilistic approach and considering both Plasmodium falciparum and Plasmodium vivax. Each parameter of receptivity (human biting rate, anthropophily, length of trophogonic cycle, survival rate, length of sporogonic cycle and infectivity were estimated based on field survey, bibliographic data and expert knowledge and fitted with probability distributions taking into account the variability and the uncertainty of the estimation. Spatial and temporal variations of the parameters were determined using environmental factors derived from satellite imagery, meteorological data and entomological field data. The entomological risk (receptivity/infectivity was calculated using 10,000 different randomly selected sets of values extracted from the probability distributions. The result was mapped in the Camargue area. Finally, vulnerability (number of malaria imported cases was inferred using data collected in regional hospitals. Results The entomological risk presented large spatial, temporal and Plasmodium species-dependent variations. The sensitivity analysis showed that susceptibility, survival rate and human biting rate were the three most influential parameters for entomological risk. Assessment of vulnerability showed that among the imported cases in the region, only very few were imported in at-risk areas. Conclusion The current risk of malaria re-emergence seems negligible due to the very low number of imported Plasmodium. This model demonstrated its efficiency for mosquito-borne diseases risk

  11. Risk, Benefit, and Cost Thresholds for Emergency Department Testing: A Cross-sectional, Scenario-based Study.

    Science.gov (United States)

    Meka, Arjun Prasad; Porath, Jonathan Douglas; Iyengar, Rahul; Morrow, Chelsea; Fagerlin, Angela; Meurer, William J

    2017-06-01

    While diagnostic testing is common in the emergency department, the value of some testing is questionable. The purpose of this study was to assess how varying levels of benefit, risk, and costs influenced an individual's desire to have diagnostic testing. A survey through Amazon Mechanical Turk presented hypothetical clinical situations: low-risk chest pain and minor traumatic brain injury. Each scenario included three given variables (benefit, risk, and cost), that was independently randomly varied over four possible values (0.1, 1, 5, and 10% for benefit and risk and $0, $100, $500, and $1,000 for the individual's personal cost for receiving the test). Benefit was defined as the probability of finding the target disease (traumatic intracranial hemorrhage or acute coronary syndrome). One-thousand unique respondents completed the survey. With an increased benefit from 0.1% to 10%, the percentage of respondents who accepted a diagnostic test went from 28.4% to 53.1%. (odds ratio [OR] = 3.42; 95% confidence interval [CI] = 2.57-4.54). As risk increased from 0.1% to 10%, this number decreased from 52.5% to 28.5%. (OR = 0.33; 95% CI = 0.25-0.44). Increasing cost from $0 to $1,000 had the greatest change of those accepting the test from 61.1% to 21.4%, respectively (OR = 0.15; 95% CI = 0.11-0.2). The desire for testing was strongly sensitive to the benefits, risks, and costs. Many participants wanted a test when there was no added cost, regardless of benefit or risk levels, but far fewer elected to receive the test as cost increased incrementally. This suggests that out-of-pocket costs may deter patients from undergoing diagnostic testing with low potential benefit. © 2016 by the Society for Academic Emergency Medicine.

  12. Molecular profiling--a tool for addressing emerging gaps in the comparative risk assessment of GMOs.

    Science.gov (United States)

    Heinemann, Jack A; Kurenbach, Brigitta; Quist, David

    2011-10-01

    Assessing the risks of genetically modified organisms (GMOs) is required by both international agreement and domestic legislation. Many view the use of the "omics" tools for profiling classes of molecules as useful in risk assessment, but no consensus has formed on the need or value of these techniques for assessing the risks of all GMOs. In this and many other cases, experts support case-by-case use of molecular profiling techniques for risk assessment. We review the latest research on the applicability and usefulness of molecular profiling techniques for GMO risk assessment. As more and more kinds of GMOs and traits are developed, broader use of molecular profiling in a risk assessment may be required to supplement the comparative approach to risk assessment. The literature-based discussions on the use of profiling appear to have settled on two findings: 1. profiling techniques are reliable and relevant, at least no less so than other techniques used in risk assessment; and 2. although not required routinely, regulators should be aware of when they are needed. The dismissal of routine molecular profiling may be confusing to regulators who then lack guidance on when molecular profiling might be worthwhile. Molecular profiling is an important way to increase confidence in risk assessments if the profiles are properly designed to address relevant risks and are applied at the correct stage of the assessment. Copyright © 2011 Elsevier Ltd. All rights reserved.

  13. Head multidetector computed tomography: emergency medicine physicians overestimate the pretest probability and legal risk of significant findings.

    Science.gov (United States)

    Baskerville, Jerry Ray; Herrick, John

    2012-02-01

    This study focuses on clinically assigned prospective estimated pretest probability and pretest perception of legal risk as independent variables in the ordering of multidetector computed tomographic (MDCT) head scans. Our primary aim is to measure the association between pretest probability of a significant finding and pretest perception of legal risk. Secondarily, we measure the percentage of MDCT scans that physicians would not order if there was no legal risk. This study is a prospective, cross-sectional, descriptive analysis of patients 18 years and older for whom emergency medicine physicians ordered a head MDCT. We collected a sample of 138 patients subjected to head MDCT scans. The prevalence of a significant finding in our population was 6%, yet the pretest probability expectation of a significant finding was 33%. The legal risk presumed was even more dramatic at 54%. These data support the hypothesis that physicians presume the legal risk to be significantly higher than the risk of a significant finding. A total of 21% or 15% patients (95% confidence interval, ±5.9%) would not have been subjected to MDCT if there was no legal risk. Physicians overestimated the probability that the computed tomographic scan would yield a significant result and indicated an even greater perceived medicolegal risk if the scan was not obtained. Physician test-ordering behavior is complex, and our study queries pertinent aspects of MDCT testing. The magnification of legal risk vs the pretest probability of a significant finding is demonstrated. Physicians significantly overestimated pretest probability of a significant finding on head MDCT scans and presumed legal risk. Copyright © 2012 Elsevier Inc. All rights reserved.

  14. Risk estimation and annual fluxes of emerging contaminants from a Scottish priority catchment to the estuary and North Sea.

    Science.gov (United States)

    Zhang, Zulin; Lebleu, Melanie; Osprey, Mark; Kerr, Christine; Courtot, Estelle

    2017-06-28

    Emerging contaminants (ECs) such as endocrine-disrupting chemicals (EDCs) and pharmaceuticals and personal care products (PPCPs) attracted global concern during the last decades due to their potential adverse effects on humans and ecosystems. This work is the first study to assess the spatiotemporal changes, annual fluxes and ecological risk of ECs (4 EDCs and 6 PPCPs) by different monitoring strategies (spot and passive sampling) over 12 months in a Scottish priority catchment (River Ugie, Scotland, 335 km 2 ). Overall, the total concentration in water ranged from contaminants in the River Ugie. The total annual fluxes of 4 EDCs transported to the Ugie estuary and North Sea were estimated to be 409 and 294 g based on the spot and passive sampling data, respectively, while they were 4636 and 4517 g for 6 PPCPs by spot and passive sampling, respectively. The spatiotemporal trend suggested that human activities and medication usages were the primary source of the contaminants. The overall comparison of the two sampling strategies supported the hypothesis that passive sampling tends to integrate the contaminants over a period of exposure and allows quantification of contamination at low concentration. The ecological risk assessment showed that bisphenol A posed the highest risks with 21.5% of the spot samples, resulting in a risk quotient >1. This suggests that mitigation measures might need to be taken to reduce the input of emerging contaminants into the river and its adjacent estuary and sea.

  15. Migrants and emerging public health issues in a globalized world: threats, risks and challenges, an evidence-based framework.

    Science.gov (United States)

    Gushulak, Bd; Weekers, J; Macpherson, Dw

    2009-01-01

    International population mobility is an underlying factor in the emergence of public health threats and risks that must be managed globally. These risks are often related, but not limited, to transmissible pathogens. Mobile populations can link zones of disease emergence to lowprevalence or nonendemic areas through rapid or high-volume international movements, or both. Against this background of human movement, other global processes such as economics, trade, transportation, environment and climate change, as well as civil security influence the health impacts of disease emergence. Concurrently, global information systems, together with regulatory frameworks for disease surveillance and reporting, affect organizational and public awareness of events of potential public health significance. International regulations directed at disease mitigation and control have not kept pace with the growing challenges associated with the volume, speed, diversity, and disparity of modern patterns of human movement. The thesis that human population mobility is itself a major determinant of global public health is supported in this article by review of the published literature from the perspective of determinants of health (such as genetics/biology, behavior, environment, and socioeconomics), population-based disease prevalence differences, existing national and international health policies and regulations, as well as inter-regional shifts in population demographics and health outcomes. This paper highlights some of the emerging threats and risks to public health, identifies gaps in existing frameworks to manage health issues associated with migration, and suggests changes in approach to population mobility, globalization, and public health. The proposed integrated approach includes a broad spectrum of stakeholders ranging from individual health-care providers to policy makers and international organizations that are primarily involved in global health management, or are influenced

  16. Risk-Return Trade-off in Emerging Markets:Evidence from Dhaka Stock Exchange Bangladesh

    Directory of Open Access Journals (Sweden)

    Abu T. Mollik

    2015-03-01

    Full Text Available This paper attempts to measure the risk and return relationship in Dhaka Stock Exchange (DSE. The study reports a statistically significant positive relationship between risk and return both at the individual security level and at the portfolio level, confirming the theoretical predictions and empirical findings on this issue in developed markets. Although portfolio risk and returns are found to be significantly positively related in general, some inconsistencies were revealed in the context of relative risk for high risk portfolios, suggesting the existence of some anomalies or mispricing in high risk assets. These findings have important implications for investment decisions at the DSE in that the investors may be able to create profitable investment strategies using the mispricing information.

  17. Governance and Risk Management of Network and Information Security: The Role of Public Private Partnerships in Managing the Existing and Emerging Risks

    Science.gov (United States)

    Navare, Jyoti; Gemikonakli, Orhan

    Globalisation and new technology has opened the gates to more security risks. As the strategic importance of communication networks and information increased, threats to the security and safety of communication infrastructures, as well as information stored in and/or transmitted increased significantly. The development of the self replicating programmes has become a nightmare for Internet users. Leading companies, strategic organisations were not immune to attacks; they were also "hacked" and overtaken by intruders. Incidents of recent years have also shown that national/regional crisis may also trigger cyber attacks at large scale. Experts forecast that cyber wars are likely to take the stage as tension mounts between developed societies. New risks such as cyber-attacks, network terrorism and disintegration of traditional infrastructures has somewhat blurred the boundaries of operation and control. This paper seeks to consider the risk management and governance and looking more specifically at implications for emerging economies.

  18. Emergency response and nuclear risk governance. Nuclear safety at nuclear power plant accidents; Notfallschutz und Risk Governance. Zur nuklearen Sicherheit bei Kernkraftwerksunfaellen

    Energy Technology Data Exchange (ETDEWEB)

    Kuhlen, Johannes

    2014-07-01

    The present study entitled ''Emergency Response and Nuclear Risk Governance: nuclear safety at nuclear power plant accidents'' deals with issues of the protection of the population and the environment against hazardous radiation (the hazards of nuclear energy) and the harmful effects of radioactivity during nuclear power plant accidents. The aim of this study is to contribute to both the identification and remediation of shortcomings and deficits in the management of severe nuclear accidents like those that occurred at Chernobyl in 1986 and at Fukushima in 2011 as well as to the improvement and harmonization of plans and measures taken on an international level in nuclear emergency management. This thesis is divided into a theoretical part and an empirical part. The theoretical part focuses on embedding the subject in a specifically global governance concept, which includes, as far as Nuclear Risk Governance is concerned, the global governance of nuclear risks. Due to their characteristic features the following governance concepts can be assigned to these risks: Nuclear Safety Governance is related to safety, Nuclear Security Governance to security and NonProliferation Governance to safeguards. The subject of investigation of the present study is as a special case of the Nuclear Safety Governance, the Nuclear Emergency governance, which refers to off-site emergency response. The global impact of nuclear accidents and the concepts of security, safety culture and residual risk are contemplated in this context. The findings (accident sequences, their consequences and implications) from the analyses of two reactor accidents prior to Fukushima (Three Mile Iceland in 1979, Chernobyl in 1986) are examined from a historical analytical perspective and the state of the Nuclear Emergency governance and international cooperation aimed at improving nuclear safety after Chernobyl is portrayed by discussing, among other topics, examples of &apos

  19. Risk Factors for Emergence of Resistance to Broad-Spectrum Cephalosporins among Enterobacter spp.

    Science.gov (United States)

    Kaye, Keith S.; Cosgrove, Sara; Harris, Anthony; Eliopoulos, George M.; Carmeli, Yehuda

    2001-01-01

    Among 477 patients with susceptible Enterobacter spp., 49 subsequently harbored third-generation cephalosporin-resistant Enterobacter spp. Broad-spectrum cephalosporins were independent risk factors for resistance (relative risk [OR] = 2.3, P = 0.01); quinolone therapy was protective (OR = 0.4, P = 0.03). There were trends toward decreased risk for resistance among patients receiving broad-spectrum cephalosporins and either aminoglycosides or imipenem. Of the patients receiving broad-spectrum cephalosporins, 19% developed resistance. PMID:11502540

  20. Risk management of emergency service vehicle crashes in the United States fire service: process, outputs, and recommendations.

    Science.gov (United States)

    Bui, David P; Pollack Porter, Keshia; Griffin, Stephanie; French, Dustin D; Jung, Alesia M; Crothers, Stephen; Burgess, Jefferey L

    2017-11-17

    Emergency service vehicle crashes (ESVCs) are a leading cause of death in the United States fire service. Risk management (RM) is a proactive process for identifying occupational risks and reducing hazards and unwanted events through an iterative process of scoping hazards, risk assessment, and implementing controls. We describe the process, outputs, and lessons learned from the application of a proactive RM process to reduce ESVCs in US fire departments. Three fire departments representative of urban, suburban, and rural geographies, participated in a facilitated RM process delivered through focus groups and stakeholder discussion. Crash reports from department databases were reviewed to characterize the context, circumstances, hazards and risks of ESVCs. Identified risks were ranked using a risk matrix that considered risk likelihood and severity. Department-specific control measures were selected based on group consensus. Interviews, and focus groups were used to assess acceptability and utility of the RM process and perceived facilitators and barriers of implementation. Three to six RM meetings were conducted at each fire department. There were 7.4 crashes per 100 personnel in the urban department and 10.5 per 100 personnel in the suburban department; the rural department experienced zero crashes. All departments identified emergency response, backing, on scene struck by, driver distraction, vehicle/road visibility, and driver training as high or medium concerns. Additional high priority risks varied by department; the urban department prioritized turning and rear ending crashes; the suburban firefighters prioritized inclement weather/road environment and low visibility related crashes; and the rural volunteer fire department prioritized exiting station, vehicle failure, and inclement weather/road environment related incidents. Selected controls included new policies and standard operating procedures to reduce emergency response, cameras to enhance driver

  1. The study on development of emergency operating procedures based on symptom and risk for accident management

    International Nuclear Information System (INIS)

    Kang, K. S.; Jeong, H. J.

    1998-01-01

    The Advanced EOP(AEOP) has been developed by focusing on the importance of the operators role in emergency conditions. In the AEOP, to overcome the complexity of current EOPs and maintain the consistency of operators action according to plant emergency conditions, operator's task were allocated according to their duties. As an alternative, the Computerized Operator Aid System (COAS) has been developed to reduce operator's burden and provide detailed instructions of procedure. Probabilistic Safety Assessment (PSA) results were synthesized in the AEOP using the event tree to give the awareness and the prediction of accident progression in advance. In conclusion, the existing EOP with its inherent complexity should be simplified and consolidated using computerized operator support system and task allocation to prevent more severe accidents and to reduce operator cognitive overload in emergency conditions

  2. The study on development of emergency operating procedures based on symptom and risk for accident management

    Energy Technology Data Exchange (ETDEWEB)

    Kang, K. S.; Jeong, H. J. [KOPEC, Taejon (Korea, Republic of)

    1998-10-01

    The Advanced EOP(AEOP) has been developed by focusing on the importance of the operators role in emergency conditions. In the AEOP, to overcome the complexity of current EOPs and maintain the consistency of operators action according to plant emergency conditions, operator's task were allocated according to their duties. As an alternative, the Computerized Operator Aid System (COAS) has been developed to reduce operator's burden and provide detailed instructions of procedure. Probabilistic Safety Assessment (PSA) results were synthesized in the AEOP using the event tree to give the awareness and the prediction of accident progression in advance. In conclusion, the existing EOP with its inherent complexity should be simplified and consolidated using computerized operator support system and task allocation to prevent more severe accidents and to reduce operator cognitive overload in emergency conditions.

  3. Risk of Zika virus transmission in the Euro-Mediterranean area and the added value of building preparedness to arboviral threats from a One Health perspective.

    Science.gov (United States)

    Escadafal, Camille; Gaayeb, Lobna; Riccardo, Flavia; Pérez-Ramírez, Elisa; Picard, Marie; Dente, Maria Grazia; Fernández-Pinero, Jovita; Manuguerra, Jean-Claude; Jiménez-Clavero, Miguel-Ángel; Declich, Silvia; Victoir, Kathleen; Robert, Vincent

    2016-12-03

    In the alarming context of risk of Zika virus (ZIKV) transmission in the Euro-Mediterranean area, there is a need to examine whether capacities to detect, diagnose and notify ZIKV infections in the region are in place and whether ongoing capacity-building initiatives are filling existing gaps.The MediLabSecure network, created in 2014, comprises 55 laboratories of virology and medical entomology and 19 public health institutions in 19 countries in the Balkans, North-Africa, the Middle-East and the Black Sea regions. It aims to set up awareness, risk assessment, monitoring and control of emerging and re-emerging vector-borne viruses. We here examine the actions and strategies that MediLabSecure has been implementing and how they will contribute to the prevention and control of the ZIKV threat in the Euro-Mediterranean area.Capacity-building for arbovirus diagnostics is a major objective of the project and follows a methodological rather than disease-driven approach. This enables the implementation of laboratory trainings on techniques that are common to several arboviruses, including ZIKV, and putting into action appropriate diagnostic tools in the target region.Moreover, by its One Health approach and the interaction of its four sub-networks in human virology, animal virology, medical entomology and public health, MediLabSecure is fostering intersectoral collaboration, expertise and sharing of information. The resulting exchanges (methodological, communication and operational) across disciplines and across countries, dedicated research on intersectoral collaboration and increasing diagnostic capacities are providing new paths and tools to public health professionals to face emerging viral threats such as a ZIKV epidemic in the Euro-Mediterranean region.

  4. Risk of Zika virus transmission in the Euro-Mediterranean area and the added value of building preparedness to arboviral threats from a One Health perspective

    Directory of Open Access Journals (Sweden)

    Camille Escadafal

    2016-12-01

    Full Text Available Abstract In the alarming context of risk of Zika virus (ZIKV transmission in the Euro-Mediterranean area, there is a need to examine whether capacities to detect, diagnose and notify ZIKV infections in the region are in place and whether ongoing capacity-building initiatives are filling existing gaps. The MediLabSecure network, created in 2014, comprises 55 laboratories of virology and medical entomology and 19 public health institutions in 19 countries in the Balkans, North-Africa, the Middle-East and the Black Sea regions. It aims to set up awareness, risk assessment, monitoring and control of emerging and re-emerging vector-borne viruses. We here examine the actions and strategies that MediLabSecure has been implementing and how they will contribute to the prevention and control of the ZIKV threat in the Euro-Mediterranean area. Capacity-building for arbovirus diagnostics is a major objective of the project and follows a methodological rather than disease-driven approach. This enables the implementation of laboratory trainings on techniques that are common to several arboviruses, including ZIKV, and putting into action appropriate diagnostic tools in the target region. Moreover, by its One Health approach and the interaction of its four sub-networks in human virology, animal virology, medical entomology and public health, MediLabSecure is fostering intersectoral collaboration, expertise and sharing of information. The resulting exchanges (methodological, communication and operational across disciplines and across countries, dedicated research on intersectoral collaboration and increasing diagnostic capacities are providing new paths and tools to public health professionals to face emerging viral threats such as a ZIKV epidemic in the Euro-Mediterranean region.

  5. Environmental risk assessment of effluents as a whole emerging contaminant: Efficiency of alternative tertiary treatments for wastewater depuration.

    Science.gov (United States)

    Díaz-Garduño, B; Pintado-Herrera, M G; Biel-Maeso, M; Rueda-Márquez, J J; Lara-Martín, P A; Perales, J A; Manzano, M A; Garrido-Pérez, C; Martín-Díaz, M L

    2017-08-01

    Emerging contaminants (ECs) and regulated compounds (RCs) from three different WWTP effluents were measured in the current study. The efficiency of two tertiary treatments, Photobiotreatment (PhtBio) and Multi-Barrier Treatment (MBT), for removing contaminants was determined. Results indicated different percentages of removal depending on the treatment and the origin of the effluent. Risk Quotients (RQs) were determined for different species of algae, Daphnia, and fish. RQ results revealed diverse risk values depending on the bioindicator species. Tonalide, galaxolide (fragrances), and ofloxacin (antibiotic) were the most persistent and harmful substances in tested effluents. "Negligible risk" category was reached since a wide diversity of ECs were removed by MBT with high removal percentages. Contrarily, PhtBio was effective only in the depuration of certain chemical compounds, and its efficiency depended on the composition of the raw effluent. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. All-Cause and Cause-Specific Risk of Emergency Transport Attributable to Temperature: A Nationwide Study.

    Science.gov (United States)

    Onozuka, Daisuke; Hagihara, Akihito

    2015-12-01

    Although several studies have estimated the associations between mortality or morbidity and extreme temperatures in terms of relative risk, few studies have investigated the risk of emergency transport attributable to the whole temperature range nationwide.We acquired data on daily emergency ambulance dispatches in all 47 prefectures of Japan from 2007 to 2010. We examined the relationship between emergency transport and temperature for each prefecture using a Poisson regression model in a distributed lag nonlinear model with adjustment for time trends. A random-effect multivariate meta-analysis was then applied to pool the estimates at the national level. Attributable morbidity was calculated for high and low temperatures, which were defined as those above or below the optimum temperature (ie, the minimum morbidity temperature) and for moderate and also extreme temperatures, which were defined using cutoffs at the 2.5th and 97.5th temperature percentiles.A total of 15,868,086 cases of emergency transport met the inclusion criteria. The emergency transport was attributable to nonoptimal temperature. The median minimum morbidity percentile was in the 79th percentile for all causes, the 96th percentile for cardiovascular disease, and the 92th percentile for respiratory disease. The fraction attributable to low temperature was 6.94% (95% eCI: 5.93-7.70) for all causes, 17.93% (95% eCI: 16.10-19.25) for cardiovascular disease, and 12.19% (95% eCI: 9.90-13.66) for respiratory disease, whereas the fraction attributable to high temperature was small (all causes = 1.01%, 95% eCI: 0.90-1.11; cardiovascular disease = 0.10%, 95% eCI: 0.04-0.14; respiratory disease = 0.29%, 95% eCI: 0.07-0.50). The all-cause morbidity risk that was attributable to temperature was related to moderate cold, with an overall estimate of 6.41% (95% eCI: 5.47-7.20). Extreme temperatures were responsible for a small fraction, which corresponded to 0.57% (95% eCI: 0.50-0.62) for extreme

  7. Enhanced risk prediction model for emergency department use and hospitalizations in patients in a primary care medical home.

    Science.gov (United States)

    Takahashi, Paul Y; Heien, Herbert C; Sangaralingham, Lindsey R; Shah, Nilay D; Naessens, James M

    2016-07-01

    With the advent of healthcare payment reform, identifying high-risk populations has become more important to providers. Existing risk-prediction models often focus on chronic conditions. This study sought to better understand other factors to improve identification of the highest risk population. A retrospective cohort study of a paneled primary care population utilizing 2010 data to calibrate a risk prediction model of hospital and emergency department (ED) use in 2011. Data were randomly split into development and validation data sets. We compared the enhanced model containing the additional risk predictors with the Minnesota medical tiering model. The study was conducted in the primary care practice of an integrated delivery system at an academic medical center in Rochester, Minnesota. The study focus was primary care medical home patients in 2010 and 2011 (n = 84,752), with the primary outcome of subsequent hospitalization or ED visit. A total of 42,384 individuals derived the enhanced risk-prediction model and 42,368 individuals validated the model. Predictors included Adjusted Clinical Groups-based Minnesota medical tiering, patient demographics, insurance status, and prior year healthcare utilization. Additional variables included specific mental and medical conditions, use of high-risk medications, and body mass index. The area under the curve in the enhanced model was 0.705 (95% CI, 0.698-0.712) compared with 0.662 (95% CI, 0.656-0.669) in the Minnesota medical tiering-only model. New high-risk patients in the enhanced model were more likely to have lack of health insurance, presence of Medicaid, diagnosed depression, and prior ED utilization. An enhanced model including additional healthcare-related factors improved the prediction of risk of hospitalization or ED visit.

  8. Emergence of Commodity Derivatives as Defensive Instrument in Portfolio Risk Hedging: A Case of Indian Commodity Markets

    Directory of Open Access Journals (Sweden)

    Singhal Shelly

    2017-04-01

    Full Text Available This paper empirically examines whether commodity derivatives can be used as an alternative investment asset in India where commodity markets are at emerging state and provides the same diversification benefit as they provide in developed commodity markets. In India only commodity futures are prevalent so various commodity indices representing various sectors has been used in the study. Diversification aspect of commodity derivatives has been tested initially by using correlation analysis. Compounded Daily Growth rate and Relative Standard deviation has been used as a measure of calculating risk and return of daily data of SENSEX, BOND and four Commodity Indices (MCX Comdex, MCX AGRI, MCX Metal, MCX Energy. Markowitz Efficient Frontier theory has been used to calculate portfolio risk return and Sharpe risk adjusted ratio has been used to evaluate the various portfolios. Optimal portfolio has been obtained for the combination of equity, bond and commodity and overall results of the study indicate that an investor who is risk averse will prefer to invest in combination of SENSEX, BOND & MCX Energy whereas an investor who gets utility by taking more risk for more returns will prefer to invest in combination of SENSEX, BOND & MCX Metal. Investor having inclination towards moderate risk return would tend to invest in MCX AGRI along with SENSEX and BOND.

  9. Identification of risk factors affecting construction of projects: The case of emerging economy

    Directory of Open Access Journals (Sweden)

    Chipo Mellania Maseko

    2017-12-01

    Full Text Available Controlling project risks has become a daunting task in construction and this can be attributed to issues such as the nature of modern projects. The challenge is that risk appears unannounced at any project phase for various reasons and thereby affecting the performance and the success of unprepared projects. The current studies that explored risk matters include Pehlivan and Öztemir (2015, Katre, and Ghaitidak (2016 amongst others. However, there is absence of unanimity from these studies on risk factors in construction. Thus, this article was instigated in order to identify and classify risk factors that affect the chances of project success. The research methodology selected for this article comprised of peer-reviewed articles between the periods of 2007 to 2017. This approach involved a comprehensive scrutiny into scholarly articles to comprehend risks in construction projects. Following a conceptual analysis, eighty factors were identified and classified under the following; technical, construction, financial, socio-political, physical, organisational, and environmental and other risks. From these categories, political instability was, found to be the most influential risk factor in construction projects and this factor was classified within the socio-political category and this category has total of 11 factors. Finding suggests the need for further empirical study.

  10. Emergence of Stenotrophomonas maltophilia nosocomial isolates in a Saudi children’s hospital. Risk factors and clinical characteristics

    Directory of Open Access Journals (Sweden)

    Jobran M. Alqahtani

    2017-05-01

    Full Text Available Objectives: To describe the clinical characteristics of pediatric patients colonized or infected by Stenotrophomonas maltophilia (S. maltophilia at a Saudi children’s hospital, to identify risk factors associated with infection, and to investigate the antimicrobial resistance patterns of this emerging pathogen. Methods: In this cross-sectional observational study, 64 non-duplicating S. maltophilia strains were isolated in Najran Maternity and Children’s Hospital, Najran, Saudi Arabia between January 2015 to February 2016. Antimicrobial susceptibility testing was performed using the reference broth microdilution method. Results: In this study, 48 (75% isolates were identified in true infections and 16 (25% isolates were considered colonization. The main types of S. maltophilia infection were pneumonia in 22 (45.8% patients and bloodstream infection in 14 (29.2% patients. The significant risk factors included exposure to invasive procedure (p=0.02, and presence of acute leukemia as an underlying disease (p=0.02. The most active antimicrobials were trimethoprim/sulfamethoxazole (100% sensitivity and tigecycline (93.7% sensitivity. Conclusions: Stenotrophomonas maltophilia is an emerging nosocomial pathogen among pediatric patients. Accurate identification and susceptibility testing of this emerging pathogen are crucial for the management of infected patients and prevention of spread of this nosocomial pathogen.

  11. Occurrence and ecological risk assessment of emerging organic chemicals in urban rivers

    NARCIS (Netherlands)

    Peng, Feng Jiao; Pan, Chang Gui; Zhang, Min; Zhang, Nai Sheng; Windfeld, Ronja; Salvito, Daniel; Selck, Henriette; Brink, Van den Paul J.; Ying, Guang Guo

    2017-01-01

    Urban rivers may receive contamination from various sources including point sources like domestic sewage and nonpoint sources (e.g., runoff), resulting in contamination with various chemicals. This study investigated the occurrence of emerging organic contaminants (3 endocrine disrupting

  12. Risk factors associated with short term mortality changes over time, after arrival to the emergency department

    DEFF Research Database (Denmark)

    Bech, Camilla Nørgaard; Brabrand, Mikkel; Mikkelsen, Søren

    2018-01-01

    , 0-2 day, 3-7 day and 8-30 day mortality. The degree of acuteness at arrival defined by urgency-level, physician-assisted transfer to the Emergency Department and abnormal vital parameters are associated with 0-2 day mortality. High temperature at arrival shows no association in either mortality...

  13. Characteristics of revisits of children at risk for serious infections in pediatric emergency care

    NARCIS (Netherlands)

    E. De Vos-Kerkhof (Evelien); D.H.F. Geurts (Dorien); E.W. Steyerberg (Ewout); M. Lakhanpaul (Monica); H.A. Moll (Henriëtte); R. Oostenbrink (Rianne)

    2018-01-01

    textabstractIn this study, we aimed to identify characteristics of (unscheduled) revisits and its optimal time frame after Emergency Department (ED) discharge. Children with fever, dyspnea, or vomiting/diarrhea (1 month–16 years) who attended the ED of Erasmus MC-Sophia, Rotterdam (2010–2013), the

  14. Emerging information technologies in accounting and related security risks – what is the impact on the Romanian accounting profession

    Directory of Open Access Journals (Sweden)

    Sînziana-Maria Rîndașu

    2017-12-01

    Full Text Available This study investigates whether aspiring and professional accountants understand the benefits and security challenges brought by emerging technologies such as: Big Data, data analytics, cloud computing and mobile technologies. 115 participants took part in a survey during January and February 2017, all having at least one year of practical experience in accounting or audit and 80% of them being affiliated with national or international accounting professional bodies. The research has three key findings: (1 Professional accountants and auditors are having in average a theoretical knowledge of the emerging technologies in the accounting field, but they still need to enhance their skills to exploit them efficiently, (2 Mobile technologies started to be adopted by the Romanian practitioners and (3 The profession has become aware of the security risks brought by emerging technologies in the digital accounting. The accounting profession is on the verge of change and the practitioners do not yet possess sufficient skills regarding the analyzed emerging technologies. As per this, the professional bodies and academic environment should reassess their curricula to enforce the necessary changes for preparing practitioners to successfully face the future challenges and avoid their replacement by other professions more qualified.

  15. Emerging and Reemerging Neglected Tropical Diseases: a Review of Key Characteristics, Risk Factors, and the Policy and Innovation Environment

    Science.gov (United States)

    Liang, Bryan A.; Cuomo, Raphael; Hafen, Ryan; Brouwer, Kimberly C.; Lee, Daniel E.

    2014-01-01

    SUMMARY In global health, critical challenges have arisen from infectious diseases, including the emergence and reemergence of old and new infectious diseases. Emergence and reemergence are accelerated by rapid human development, including numerous changes in demographics, populations, and the environment. This has also led to zoonoses in the changing human-animal ecosystem, which are impacted by a growing globalized society where pathogens do not recognize geopolitical borders. Within this context, neglected tropical infectious diseases have historically lacked adequate attention in international public health efforts, leading to insufficient prevention and treatment options. This subset of 17 infectious tropical diseases disproportionately impacts the world's poorest, represents a significant and underappreciated global disease burden, and is a major barrier to development efforts to alleviate poverty and improve human health. Neglected tropical diseases that are also categorized as emerging or reemerging infectious diseases are an even more serious threat and have not been adequately examined or discussed in terms of their unique risk characteristics. This review sets out to identify emerging and reemerging neglected tropical diseases and explore the policy and innovation environment that could hamper or enable control efforts. Through this examination, we hope to raise awareness and guide potential approaches to addressing this global health concern. PMID:25278579

  16. Use of ABCD2 risk scoring system to determine the short-term stroke risk in patients presenting to emergency department with transient ischaemic attack

    International Nuclear Information System (INIS)

    Ozpolat, C.; Denizbasi, A.; Onur, O.; Eroglu, S.E.

    2013-01-01

    Objective: To determine the 3-day stroke risk of patients presenting to emergency department with transient ischaemic attack, and to evaluate the predictive value of ABCD2 (Age, Blood pressure, Clinical features, Duration of symptoms and Diabetes) score for these patients. Methods: The prospective study was conducted on patients with diagnosis of transient ischaemic attack who were divided into low (0-3 points), medium (4-5 points) and high (6-7 points) risk groups according to their ABCD2 scores. The sensitivity of the scoring system on estimation of the risk of stroke in 3 days was evaluated through receiver operating characteristic curve. SPSS 15 was used for data analysis. Results: Of the 64 patients in the study, none of the low-risk group had stroke. Stroke was present in 4 of 33 (12.12%) medium-risk patients, while there were 4 in 18 (22.22%) in the high-risk group. Sensitivity and specificity of each ABCD2 score for 3rd day stroke risk was calculated. In the receiver operating curve generated by these calculations, the c statistics was determined as 0.76 (95% CI: 0.64, 0.86; p<0.01) and the most appropriate cut-off score to dichotomise the study group was determined as 4. Conclusions: In transient ischaemic attack patients with an ABCD2 score of four or higher had a markedly increased short-term stroke risk, while those with a lower score were quite safe. It is appropriate to hospitalise patients with a score of four or more and investigate for underlying cause and initiate treatment. (author)

  17. Information risk in emerging utility markets: The role of commission- sponsored audits

    Energy Technology Data Exchange (ETDEWEB)

    Wirick, D.W.; Lawton, R.W.; Burns, R.E.; Lee, S.

    1996-03-01

    As public utilities and regulators begin to define their new relationship under various forms of regulations, some have questioned the continuing need for commission-sponsored audits. This study evaluates the role of such audits by examining their core purpose: the reduction of information risk (risk that a commission might make a wrong decision because of reliance on faulty information). It identifies five generic types of information that will be needed by commissions in the future and describes a cost-benefit analysis for identifying the appropriate method for mitigating information risk for state regulatory commissions.

  18. Measuring risk/benefit perceptions of emerging technologies and their potential impact on communication of public opinion toward science.

    Science.gov (United States)

    Binder, Andrew R; Cacciatore, Michael A; Scheufele, Dietram A; Shaw, Bret R; Corley, Elizabeth A

    2012-10-01

    This study presents a systematic comparison of two alternative measures of citizens' perceptions of risks and benefits of emerging technologies. By focusing on two specific issues (nanotechnology and biofuels), we derive several insights for the measurement of public views of science. Most importantly, our analyses reveal that relying on global, single-item measures may lead to invalid inferences regarding external influences on public perceptions, particularly those related to cognitive schema and media use. Beyond these methodological implications, this analysis suggests several reasons why researchers in the area of public attitudes toward science must revisit notions of measurement in order to accurately inform the general public, policymakers, scientists, and journalists about trends in public opinion toward emerging technologies.

  19. A Strategy of Dialogue for Communicating Hazard and Risk Information Between the Science and Emergency Management Sectors

    Science.gov (United States)

    Eisner, R. K.

    2015-12-01

    This presentation will describe a collaborative dialogue process between earth scientists and emergency management officials that focused on translation of science into policy, building long term trust based relationships between sectors and unified presentation of hazards, risks and consequence management to public officials and the general public. The author will describe the structure and process of the California Earthquake Prediction Evaluation Council (CEPEC) in assessing the credibility of long and short term earthquake predictions, assessment of risk, and the formulation of public communication strategies and preparatory actions by government agencies. For nearly 4 decades, earth scientists, politically appointed state officials and emergency managers have engaged in ongoing discussions of the policy implications of research on potential seismic risk. Some discussions were scheduled and occurred over months, and others were ad hoc and occurred in the minutes between potential precursory incidents and possible large events. The effectiveness of this process was dependent on building respect for ones counterparts expertise, bias and responsibilities, clear communication of data, uncertainty and knowledge of the physical models assumed, history and probabilities; and the physical and political consequences of possible events; and the costs and economic and social disruption of alternative preparedness actions. But, the dialogue included political and social scientists, representatives of the print and broadcast media, political and management officials from federal, state and local governments. The presentation will provide an assessment of the effectiveness of the collaborative dialogue process and lessons on sustaining a long term partnership among the participating federal, state and local officials.

  20. Value-at-Risk Performances during the 2007-2008 Global Financial Crisis: a comparison of three Value-at-Risk models in the emerging markets of China, India and Philippines.

    OpenAIRE

    Li, Mi

    2012-01-01

    Ever since the world economic outlook was fundamentally changed by the 2007-2008 financial crisis, risk management and reliable risk measurements have been drew much attentions. This thesis selects three Asian emerging markets, that is, China, India, Philippine, as the research targets and evaluates the performances of three different Value-at-Risk (VaR) models (the Historical Simulation, the Monte Carlo Simulation, and the Extreme Value Theory) in these three emerging markets’ stock markets ...

  1. Credit Booms and Busts in Emerging Markets: The Role of Bank Governance and Risk Management

    OpenAIRE

    Brown, Martin; Andries, Alin Marius

    2014-01-01

    This paper investigates to what extent risk management and corporate governance mitigate the involvement of banks in credit boom and bust cycles. Using a unique, hand-collected dataset on 156 banks from Central and Eastern Europe during 2005-2012, we assess whether banks with stronger risk management and corporate governance display more moderate credit growth in the pre-crisis credit boom as well as a smaller credit contraction and fewer credit losses in the crisis period. With respect to ba...

  2. Postprandial Metabolism of Macronutrients and Cardiometabolic Risk: Recent Developments, Emerging Concepts, and Future Directions12

    OpenAIRE

    Jacome-Sosa, Miriam; Parks, Elizabeth J; Bruno, Richard S; Tasali, Esra; Lewis, Gary F; Schneeman, Barbara O; Rains, Tia M

    2016-01-01

    Cardiovascular disease (CVD) is the leading cause of death in the United States. Although the role of habitual lifestyle factors such as physical activity and dietary patterns in increasing CVD risk has long been appreciated, less is known about how acute daily activities may cumulatively contribute to long-term disease risk. Here, the term acute refers to metabolic responses occurring in a short period of time after eating, and the goal of this article is to review recently identified stress...

  3. Environmental risk prediction and emergency plan for liquid ammonia leakage fault

    International Nuclear Information System (INIS)

    He Zhanfei; Lian Guoxi; Zhang Yuntao; Sun Juan; Du Juan

    2014-01-01

    Taking liquid ammonia storage in a uranium production process as an example, a multi-puff Gassian model was used to predict and analyze the environmental risk under the scenario of the maximum credible accident as well as the most unfavorable weather conditions. According to the results of prediction, the suggestions for safety evacuation and evacuation way were made, thus providing theoretical basis and technical guideline for uranium mine making risk management and contingency plan. (authors)

  4. Risk Factors for Malnutrition among Older Adults in the Emergency Department: A Multicenter Study.

    Science.gov (United States)

    Burks, Collin E; Jones, Christopher W; Braz, Valerie A; Swor, Robert A; Richmond, Natalie L; Hwang, Kay S; Hollowell, Allison G; Weaver, Mark A; Platts-Mills, Timothy F

    2017-08-01

    Among older adults, malnutrition is common, often missed by healthcare providers, and influences recovery from illness or injury. To identify modifiable risk factors associated with malnutrition in older patients. Prospective cross-sectional multicenter study. 3 EDs in the South, Northeast, and Midwest. Non-critically ill, English-speaking adults aged ≥65 years. Random time block sampling was used to enroll patients. The ED interview assessed malnutrition using the Mini Nutritional Assessment Short-Form. Food insecurity and poor oral health were assessed using validated measures. Other risk factors examined included depressive symptoms, limited mobility, lack of transportation, loneliness, and medication side effects, qualified by whether the patient reported the risk factor affected their diet. The population attributable risk proportion (PARP) for malnutrition was estimated for each risk factor. In our sample (n = 252), the prevalence of malnutrition was 12%. Patient characteristics associated with malnutrition included not having a college degree, being admitted to the hospital, and residence in an assisted living facility. Of the risk factors examined, the PARPs for malnutrition were highest for poor oral health (54%; 95% CI 16%, 78%), food insecurity (14%; 95% CI 3%, 31%), and lack of transportation affecting diet (12%; 95% CI 3%, 28%). Results of this observational study identify multiple modifiable factors associated with the problem of malnutrition in older adults. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  5. Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study

    Science.gov (United States)

    Nijman, Ruud G; Vergouwe, Yvonne; Thompson, Matthew; van Veen, Mirjam; van Meurs, Alfred H J; van der Lei, Johan; Steyerberg, Ewout W; Moll, Henriette A

    2013-01-01

    Objective To derive, cross validate, and externally validate a clinical prediction model that assesses the risks of different serious bacterial infections in children with fever at the emergency department. Design Prospective observational diagnostic study. Setting Three paediatric emergency care units: two in the Netherlands and one in the United Kingdom. Participants Children with fever, aged 1 month to 15 years, at three paediatric emergency care units: Rotterdam (n=1750) and the Hague (n=967), the Netherlands, and Coventry (n=487), United Kingdom. A prediction model was constructed using multivariable polytomous logistic regression analysis and included the predefined predictor variables age, duration of fever, tachycardia, temperature, tachypnoea, ill appearance, chest wall retractions, prolonged capillary refill time (>3 seconds), oxygen saturation rule out the presence of other SBIs. Discriminative ability (C statistic) to predict pneumonia was 0.81 (95% confidence interval 0.73 to 0.88); for other SBIs this was even better: 0.86 (0.79 to 0.92). Risk thresholds of 10% or more were useful to identify children with serious bacterial infections; risk thresholds less than 2.5% were useful to rule out the presence of serious bacterial infections. External validation showed good discrimination for the prediction of pneumonia (0.81, 0.69 to 0.93); discriminative ability for the prediction of other SBIs was lower (0.69, 0.53 to 0.86). Conclusion A validated prediction model, including clinical signs, symptoms, and C reactive protein level, was useful for estimating the likelihood of pneumonia and other SBIs in children with fever, such as septicaemia/meningitis and urinary tract infections. PMID:23550046

  6. Non-nuclear radiological emergencies. Special plan for radiological risk of the Valencian Community

    International Nuclear Information System (INIS)

    Rodríguez Rodrigo, I.; Piles Alepuz, I.; Peiró Juan, J.; Calvet Rodríguez, D.

    2015-01-01

    After the publication of the Radiological Hazard Basic Directive, Generalitat (the regional government in Valencian Community) initiated the edition of the pertinent Special Plan, with the objective to assemble the response of all the Security and Emergency Agencies, including the Armed Forces, in a radiological emergency affecting the territory of the Valencian Community, under a single hierarchy command. Being approved and homologated the Radiological Hazard Special Plan, Generalitat has undertaken the implementation process planned to finish in June 2015. Following the same process as other Plans, implementation is organized in a first informative stage, followed of a formative and training stage, and finishing with an activation exercise of the Plan. At the end of the process, is expected that every Agency will know their functions, the structure and organization in which the intervention takes place, the resources needed, and adapt their protocols to the Plan requirements. From the beginning, it has been essential working together with the Nuclear Safety Council, as is established in the agreement signed in order to collaborate in Planning, Preparedness and Response in Radiological Emergencies. [es

  7. Unplanned pregnancy-risks and use of emergency contraception: a survey of two Nigerian Universities.

    Science.gov (United States)

    Ajayi, Anthony Idowu; Nwokocha, Ezebunwa Ethelbert; Adeniyi, Oladele Vincent; Ter Goon, Daniel; Akpan, Wilson

    2017-06-02

    The vulnerabilities of young women of low socio-economic status and those with little or no formal education tend to dominate the discourse on unplanned pregnancy, unsafe abortion and emergency contraception (EC) in sub-Saharan Africa. This article draws on a survey conducted among female undergraduate students to shed light on sexual behaviour and the dynamics of emergency contraceptive use among this cohort. The survey involved 420 female undergraduate students drawn using a multistage sampling technique, while a self-administered questionnaire was used for data collection. Univariate and bivariate analyses were applied to examine the factors associated with the use of emergency contraception. Of the 176 female students who reported being sexually active in the year preceding the survey, only 38.6% reported the use of condom during the entire year. Of those who reported unplanned pregnancy anxiety n = 94, about 30.1% used EC, 20.4% used non-EC pills as EC, while others reported having used no EC. A few respondents (n = 3) had terminated a pregnancy under unsafe conditions. Awareness of EC (p contraceptive methods. Poor knowledge of EC methods and timing of use, as well as wrong perception about EC side effects, are barriers to the utilisation of EC for the prevention of unplanned pregnancy among the study participants.

  8. Contemporary challenges in applying of the modified model CAPM with country risk premium in emerging economies

    Directory of Open Access Journals (Sweden)

    Petrović Dragana

    2017-01-01

    Full Text Available Modern approach in determining the expected return of foreign investors' investments is based on the evaluation investment in capital asset-CAPM (Capital Asset Pricing Model. In order to use the CAPM model for calculating the expected return of foreign investors in growing economies, it is developed the extended model CAPM with the risk premium in the country. This variant of the CAPM model has been used for estimating the cost of capital. This is the expected return on a portfolio of the company's stocks in less developed countries. Those countries have certain problems and factors of risk investment. This research examines the limitations and shortcomings in the application of the extended model with country risk premium, during the calculation of the cost of capital in the less developed economies. We present possible models to overcome those problems and also a need for upgrading of modified CAPM model with a risk premium of the country which, beside risk of the country (CR must have a discount for the 'advantage of the country'.

  9. Clinical Risk Assessment in the Antiphospholipid Syndrome: Current Landscape and Emerging Biomarkers.

    Science.gov (United States)

    Chaturvedi, Shruti; McCrae, Keith R

    2017-07-01

    Laboratory criteria for the classification of antiphospholipid syndrome include the detection of a lupus anticoagulant and/or anticardiolipin and anti-β2-glycoprotein I antibodies. However, the majority of patients who test positive in these assays do not have thrombosis. Current risk-stratification tools are largely limited to the antiphospholipid antibody profile and traditional thrombotic risk factors. Novel biomarkers that correlate with disease activity and potentially provide insight into future clinical events include domain 1 specific anti-β 2 GPI antibodies, antibodies to other phospholipids or phospholipid/protein antigens (such as anti-PS/PT), and functional/biological assays such as thrombin generation, complement activation, levels of circulating microparticles, and annexin A5 resistance. Clinical risk scores may also have value in predicting clinical events. Biomarkers that predict thrombosis risk in patients with antiphospholipid antibodies have been long sought, and several biomarkers have been proposed. Ultimately, integration of biomarkers with established assays and clinical characteristics may offer the best chance of identifying patients at highest risk of APS-related complications.

  10. Early awareness of emerging risks associated with food and feed production: Synopsis of pertinent work carried out within the SAFE FOODS project

    NARCIS (Netherlands)

    Marvin, H.J.P.; Kleter, G.A.

    2009-01-01

    This introduction to the journal¿s supplement on emerging food and feed safety issues summarizes the objectives and activities of the EU-funded SAFE FOODS project in general and its work package focusing on the early identification of emerging food safety risks, in particular. Within this work

  11. Obesity and contraception: metabolic changes, risk of thromboembolism, use of emergency contraceptives, and role of bariatric surgery.

    Science.gov (United States)

    Gurney, E P; Murthy, A S

    2013-06-01

    Rates of obesity are increasing worldwide. Due to the medical consequences of obesity, routine health care like family planning becomes complicated. Conflicting data exists regarding efficacy of hormonal contraceptives in obese women, while little data on efficacy of emergency contraception in obese women exists. Much of what is available suggests lower serum hormonal levels in obese women with little effect on ovulation inhibition. Contraceptive steroids can cause a number of deteriorating metabolic changes, particularly in obese women; whether these changes are clinically significant is unknown. Venous thromboembolic risk is increased with both obesity and use of hormonal contraceptives; however the question remains if the risk is additive or multiplicative. Bariatric surgery can lead to digestive changes which may affect absorption of contraceptive hormones. While long acting reversible contraceptives may be the best option in the post operative obese patient, little data, beyond a simple recommendation to avoid pregnancy for at least one year, exists to help guide appropriate contraceptive choice.

  12. Glyburide increases risk in patients with diabetes mellitus after emergent percutaneous intervention for myocardial infarction - A nationwide study

    DEFF Research Database (Denmark)

    Jørgensen, C H; Gislason, G H; Bretler, D

    2011-01-01

    Danish patients receiving glucose-lowering drugs admitted with myocardial infarction between 1997 and 2006 who underwent emergent percutaneous coronary intervention were identified from national registers. Multivariable Cox proportional hazards models were used to analyze the risk of cardiovascular.......9%) received metformin. Cox proportional hazard regression analyses adjusted for age, sex, calendar year, comorbidity and concomitant pharmacotherapy showed an increased risk of cardiovascular mortality (hazard ratio [HR] 2.91, 95% confidence interval [CI] 1.26-6.72 ; p=0.012), cardiovascular mortality...... and nonfatal myocardial infarction (HR 2.69 , 95% CI 1.21-6.00; p=0.016), and all-cause mortality (HR 2.46, 95% CI 1.11-5.47; p=0.027), respectively, with glyburide compared to metformin. CONCLUSIONS: Glyburide is associated with increased cardiovascular mortality and morbidity in patients with diabetes...

  13. Floods and climate: emerging perspectives for flood risk assessment and management

    DEFF Research Database (Denmark)

    Merz, B.; Aerts, J.; Arnbjerg-Nielsen, Karsten

    2014-01-01

    context of floods. We come to the following conclusions: (1) extending the traditional system boundaries (local catchment, recent decades, hydrological/hydraulic processes) opens up exciting possibilities for better understanding and improved tools for flood risk assessment and management. (2) Statistical......, and this variation may be partially quantifiable and predictable, with the perspective of dynamic, climate-informed flood risk management. (4) Efforts are needed to fully account for factors that contribute to changes in all three risk components (hazard, exposure, vulnerability) and to better understand......Flood estimation and flood management have traditionally been the domain of hydrologists, water resources engineers and statisticians, and disciplinary approaches abound. Dominant views have been shaped; one example is the catchment perspective: floods are formed and influenced by the interaction...

  14. Osteoporosis among Fallers without Concomitant Fracture Identified in an Emergency Department: Frequencies and Risk Factors

    DEFF Research Database (Denmark)

    Glintborg, Bente; Hesse, Ulrik; Houe, Thomas

    2011-01-01

    aged 50-80 years sustaining a low-energy fall without fracture were identified from an ED (n = 199). Patients answered a questionnaire on risk factors and underwent osteodensitometry. Data was compared to a group of patients routinely referred to osteodensitometry from general practice (n = 201......). Results. Among the 199 included fallers, 41 (21%) had osteoporosis. Among these, 35 (85%) reported either previous fracture or reduced body height (>3¿cm). These two risk factors were more frequent among fallers with osteoporosis compared to fallers with normal bone mineral density or osteopenia (previous...... if the patient has a prior fracture or declined body height. Since fallers generally have higher fracture risk, the ED might serve as an additional entrance to osteodensitometry compared to referral from primary care....

  15. Multihazard risk analysis and disaster planning for emergency services as a basis for efficient provision in the case of natural hazards - case study municipality of Au, Austria

    Science.gov (United States)

    Maltzkait, Anika; Pfurtscheller, Clemens

    2014-05-01

    Multihazard risk analysis and disaster planning for emergency services as a basis for efficient provision in the case of natural hazards - case study municipality of Au, Austria A. Maltzkait (1) & C. Pfurtscheller (1) (1) Institute for Interdisciplinary Mountain Research (IGF), Austrian Academy of Sciences, Innsbruck, Austria The extreme flood events of 2002, 2005 and 2013 in Austria underlined the importance of local emergency services being able to withstand and reduce the adverse impacts of natural hazards. Although for legal reasons municipal emergency and crisis management plans exist in Austria, they mostly do not cover risk analyses of natural hazards - a sound, comparable assessment to identify and evaluate risks. Moreover, total losses and operational emergencies triggered by natural hazards have increased in recent decades. Given sparse public funds, objective budget decisions are needed to ensure the efficient provision of operating resources, like personnel, vehicles and equipment in the case of natural hazards. We present a case study of the municipality of Au, Austria, which was hardly affected during the 2005 floods. Our approach is primarily based on a qualitative risk analysis, combining existing hazard plans, GIS data, field mapping and data on operational efforts of the fire departments. The risk analysis includes a map of phenomena discussed in a workshop with local experts and a list of risks as well as a risk matrix prepared at that workshop. On the basis for the exact requirements for technical and non-technical mitigation measures for each natural hazard risk were analysed in close collaboration with members of the municipal operation control and members of the local emergency services (fire brigade, Red Cross). The measures includes warning, evacuation and, technical interventions with heavy equipment and personnel. These results are used, first, to improve the municipal emergency and crisis management plan by providing a risk map, and a

  16. Landscape epidemiology: An emerging perspective in the mapping and modelling of disease and disease risk factors

    Directory of Open Access Journals (Sweden)

    Nnadi Nnaemeka Emmanuel

    2011-09-01

    Full Text Available Landscape epidemiology describes how the temporal dynamics of host, vector, and pathogen populations interact spatially within a permissive environment to enable transmission. It also aims at understanding the vegetation and geologic conditions that are necessary for the maintenance and transmission of a particular pathogen. The current review describes the evolution of landscape epidemiology. As a science, it also highlights the various methods of mapping and modeling diseases and disease risk factors. The key tool to characterize landscape is satellite remote sensing and these data are used as inputs to drive spatial models of transmission risk.

  17. Extrapolating understanding of food risk perceptions to emerging food safety cases

    NARCIS (Netherlands)

    Kaptan, Gülbanu; Fischer, Arnout R.H.; Frewer, Lynn J.

    2017-01-01

    Important determinants of risk perceptions associated with foods are the extent to which the potential hazards are perceived to have technological or naturally occurring origins, together with the acute vs. chronic dimension in which the potential hazard is presented (acute or chronic). This

  18. Overeating and Binge Eating in Emerging Adulthood: 10-Year Stability and Risk Factors

    Science.gov (United States)

    Goldschmidt, Andrea B.; Wall, Melanie M.; Zhang, Jun; Loth, Katie A.; Neumark-Sztainer, Dianne

    2016-01-01

    Overeating (eating an unusually large amount of food) and binge eating (overeating with loss of control [LOC]) predict adverse health consequences in adolescence. We aimed to characterize the stability of and risk factors for these distinct but interrelated constructs during critical developmental transitions. We used a population-based sample (n…

  19. Sex differences in the use of social information emerge under conditions of risk

    Directory of Open Access Journals (Sweden)

    Charlotte O. Brand

    2018-01-01

    Full Text Available Social learning provides an effective route to gaining up-to-date information, particularly when information is costly to obtain asocially. Theoretical work predicts that the willingness to switch between using asocial and social sources of information will vary between individuals according to their risk tolerance. We tested the prediction that, where there are sex differences in risk tolerance, altering the variance of the payoffs of using asocial and social information differentially influences the probability of social information use by sex. In a computer-based task that involved building a virtual spaceship, men and women (N = 88 were given the option of using either asocial or social sources of information to improve their performance. When the asocial option was risky (i.e., the participant’s score could markedly increase or decrease and the social option was safe (i.e., their score could slightly increase or remain the same, women, but not men, were more likely to use the social option than the asocial option. In all other conditions, both women and men preferentially used the asocial option to a similar degree. We therefore found both a sex difference in risk aversion and a sex difference in the preference for social information when relying on asocial information was risky, consistent with the hypothesis that levels of risk-aversion influence the use of social information.

  20. Risk Pricing in Emerging Economies: Credit Scoring and Private Banking in Iran

    Directory of Open Access Journals (Sweden)

    Yiannis Anagnostopoulos

    2016-01-01

    Full Text Available Iran’s banking industry as a developing country is comparatively very new to risk management practices. An inevitable predictive implication of this rapid growth is the growing concerns with regard to credit risk management which is the motivation of conducting this research. The paper focuses on the credit scoring aspect of credit risk management using both logit and probit regression approaches. Real data on corporate customers are available for conducting this research which is also a contribution to this area for all other developing countries. Our questions focus on how future customers can be classified in terms of credibility, which models and methods are more effective in better capturing risks. Findings suggest that probit approaches are more effective in capturing the significance of variables and goodness-of-fitness tests. Seven variables of the Ohlson O-Score model are used: CL_CA, INTWO, OENEG, TA_TL, SIZE, WCAP_TA, and ROA; two were found to be statistically significant in logit (ROA, TL_TA and three were statistically significant in probit (ROA, TL_TA, SIZE. Also, CL_CA, ROA, and WCAP_TA were the three variables with an unexpected correlation to the probability of default. The prediction power with the cut-off point is set equal to 26% and 56.91% for defaulted customers in both logit and probit models. However, logit achieved 54.85% correct estimation of defaulted assets, 0.37% more than what probit estimated.

  1. Emerging Demands for Public Policies in Rio De Janeiro: Educational Prevention of Social Risks

    Science.gov (United States)

    Gomes Da Silva, Magda Maria Ventura; Garcia, Maria del Pilar Quicios

    2016-01-01

    This paper disseminates some results of an international research on the social risk manifestations published in eight periodicals in Rio de Janeiro from July 2013 to December 2014. A sample of the research coincides with the population: 541 news, which constitutes 1255 analytical units. The methodology consisted of a content analysis of the news,…

  2. Population displacements as a risk factor for the emergence of epidemics

    Directory of Open Access Journals (Sweden)

    Darem Tabbaa

    2013-03-01

    Full Text Available Wars and civil conflicts have been terrible experiences since ancient times but, regretfully, they are always present even in the 21st century. Their catastrophic effects are still lived by many populations displaced from their native areas. Conflicts, particularly the civil ones, create disruption in most aspects of national structures and populations, which are forced to move to more or less safer or even distant areas, survive under downgraded conditions. They are usually housed in temporary shelters in overcrowded camps and contaminated environment. Water and food are neither safe nor sufficient. Malnutrition, lack or weak sanitary care and long-term stress lead these populations to being vulnerable to severe infections. Under such conditions there are high rates of morbidity and mortality, with elders and children being the main victims. Public health, animal health, municipalities and other inter-related sectors should work on preparedness plans well in advance in order to provide ways and means to face emergencies. Zoonotic and other communicable disease outbreaks should not be left uncontrolled, as their impact would be an additional burden for the country under unrest. Guidance should be provided on how to best articulate an emergency management plan from the early detection of outbreaks up to their control. These aspects are briefly exposed together with the imperative request for alleviation of suffering and of the multitude of hazards conflict-affected populations have to face.

  3. Leukaemia and thyroid cancer in emergency workers of the Chernobyl accident:. Estimation of radiation risks (1986-1995)

    International Nuclear Information System (INIS)

    Ivanov, V.K.; Tsyb, A.F.; Gorsky, A.I.; Maksyutov, M.A.; Rastopchin, E.M.; Konogorov, A.P.; Korelo, A.M.; Biryukov, A.P.; Matyash, V.A.

    1997-01-01

    This work focuses on the direct epidemiological assessment of the risks of radiation-induced leukaemia and thyroid cancer in emergency workers (EW) after the Chernobyl accident. The Russian National Medical Dosimetric Registry (RNMDR) contains data for 168 000 EW as of January 1, 1996. The analysis relates to 48 leukaemias and 47 thyroid cancers, diagnosed and verified. Radiation risks are estimated by comparing the EW data with national data for a male population of the same age distribution. For leukaemia, an excess relative risk per Gy (ERR/Gy) of 4.30 (95% CI: 0.83, 7.75) is obtained, while the excess absolute risk per 10 4 person-years (PY) Gy (EAR/10 4 PY Gy) is found to be 1.31 (95% CI: 0.23, 2.39); for thyroid cancer an ERR/Gy of 5.31 (95% CI: 0.04, 10.58) is obtained, and an EAR/10 4 PY Gy of 1.15 (95% CI: 0.08, 2.22). (orig.). With 9 figs., 10 tabs

  4. Occurrence and ecological risk assessment of emerging organic chemicals in urban rivers: Guangzhou as a case study in China.

    Science.gov (United States)

    Peng, Feng-Jiao; Pan, Chang-Gui; Zhang, Min; Zhang, Nai-Sheng; Windfeld, Ronja; Salvito, Daniel; Selck, Henriette; Van den Brink, Paul J; Ying, Guang-Guo

    2017-07-01

    Urban rivers may receive contamination from various sources including point sources like domestic sewage and nonpoint sources (e.g., runoff), resulting in contamination with various chemicals. This study investigated the occurrence of emerging organic contaminants (3 endocrine disrupting compounds (EDCs), and 17 pharmaceuticals and personal care products (PPCPs)) in six urban rivers of a representative subtropical city, Guangzhou (southern China). Our results showed that EDCs and personal care products were frequently detected in the water phase and sediment phase. 4-nonylphenol (4-NP) was the most predominant compound with the highest concentration of 5050ng/L in the water phase and 14,400ng/g dry weight (dw) in the sediment. Generally, higher total concentrations of EDCs and PPCPs were detected in the four urban streams compared to the main stream Zhujiang River and the Liuxi River at the suburb area. A screening-level risk assessment showed that 4-nonylphenol and triclosan (TCS) pose potential risks to aquatic organisms in most sampling sites. For individual taxa, 4-NP may pose risks to various groups of aquatic organisms, while TCS only might pose high risks to algae. Higher contamination of EDCs and PPCPs was observed in rivers in urban area; 4-nonylphenol and triclosan showed RQs>1 in >70% of the reported area. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Risk of emergency medical treatment following consumption of cannabis or synthetic cannabinoids in a large global sample.

    Science.gov (United States)

    Winstock, Adam; Lynskey, Michael; Borschmann, Rohan; Waldron, Jon

    2015-06-01

    Synthetic cannabinoids (SCs) have become increasingly popular in recent years. Diverse in chemical structure, many have been subjected to legislative regulation, but their availability and use persists. Often marketed to reflect their similar effects to cannabis, their use has been associated with a range of negative health effects. We sought to determine the relative risk of seeking emergency medical treatment (EMT) following use of SCs and natural cannabis. We utilized an anonymous online survey of drug use, obtaining data from 22,289 respondents. We calculated the relative risk of seeking EMT between the two substances using an estimate for days used in the past year. Thirty-seven cannabis users (0.2%) and 21 SC users (1.0%) had sought EMT during the past year following use. The relative risk associated with the use of SCs was 30 (95% CI 17.5-51.2) times higher than that associated with cannabis. Significantly more symptoms (p=0.03) were reported by respondents seeking treatment for SCs than for cannabis. Whilst these findings must be treated with caution, SCs potentially pose a greater risk to users' health than natural forms of cannabis. Regulation is unlikely to remove SCs from the market, so well-informed user-focused health promotion messages need to be crafted to discourage their use. © The Author(s) 2015.

  6. Reabilitação psicológica de pacientes com seqüelas da encefalite por arbovirus Psychological rehabilitation of patients with sequelae due to encephalitis caused by arbovirus

    Directory of Open Access Journals (Sweden)

    Anency Giannotti Hallage

    1981-10-01

    Full Text Available Foi investigado o possível comprometimento psíquico de pacientes com seqüelas da encefalite por arbovirus, do litoral sul do Estado de São Paulo (Brasil, com a finalidade de definir o papel do psicólogo, em um programa de reabilitação física e psicossocial. A presença das seqüelas era encarada de forma depreciativa e observou-se que essa percepção comprometeu fundamentalmente a identidade do paciente como ser humano, trazendo uma série de respostas emocionais desadaptadas e impossibibilitando a convivência satisfatória consigo e com o próximo. Os resultados analisados, em seu aspecto psicossociológico, revelaram que as dificuldades psíquicas observadas eram originárias da maneira como a deficiência física é encarada no meio social.The possibility of psychological damage in patients with sequelae from encephalitis caused by arbovirus in the southern section of the coastal area of the State of S. Paulo (Brazil was investigated for the purpose of defining the role of the psychologist in a programme of physical and psychosocial rehabilitation. The presence of the sequelae was regarded depreciatively by the patients and this attitude affected their self-regard as human beings. The result was a series of emotional maladjustments which made it impossible for the patients to live with themselves or maintain a satisfactory relationship with others. The results analyzed from a psychosocial standpoint revealed that the psychological problems observed arose from the way in which the physical deficiency is regarded within the social context.

  7. Mean platelet volume as a risk stratification tool in the Emergency Department for evaluating patients with ischaemic stroke and TIA

    International Nuclear Information System (INIS)

    Dogan, N.O.; Karakurt, K.

    2013-01-01

    Objective: To investigate the variations of mean platelet volume in patients with ischaemic cerebrovascular complaints, and to find out its diagnostic utility in an acute setting to help risk stratification in patients with ischaemic stroke and transient ischaemic attacks. Methods: The prospective cross-sectional study was conducted at the Gazi University Hospital, Ankara, Turkey, from November 2009 to June 2010. It comprised 143 consecutive patients of acute ischaemic stroke, 39 patients of transient ischaemic attacks and 60 healthy volunteers. SPSS 13 was used for statistical analysis, and so were t-test, one-way analysis of variance test and correlation analysis. Statistical significance was accepted at p <0.05. Results: Mean platelet volume results were significantly higher in patients with cortical infarction and transient ischaemic attack compared to the control group (p <0.001 and p <0.002). A statistically significant increase was also noted in hospitalised patients when com