WorldWideScience

Sample records for nordrisk practical risk

  1. NKS NordRisk. Atlas of long-range atmospheric dispersion and deposition of radionuclides from selected risk sites in the Northern Hemisphere

    International Nuclear Information System (INIS)

    Havskov Soerensen, J.; Baklanov, A.; Mahura, A.; Lauritzen, Bent; Mikkelsen, Torben

    2008-07-01

    Within the NKS NordRisk project, 'Nuclear risk from atmospheric dispersion in Northern Europe', the NKS NordRisk Atlas has been developed. The atlas describes risks from hypothetical long-range atmospheric dispersion and deposition of radionuclides from selected nuclear risk sites in the Northern Hemisphere. A number of case studies of long-term long-range atmospheric transport and deposition of radionuclides has been developed, based on two years of meteorological data. Radionuclide concentrations in air and radionuclide depositions have been evaluated and examples of long-term averages of the dispersion and deposition and of the variability around these mean values are provided. (au)

  2. NKS NordRisk. Atlas of long-range atmospheric dispersion and deposition of radionuclides from selected risk sites in the Northern Hemisphere

    Energy Technology Data Exchange (ETDEWEB)

    Havskov Soerensen, J.; Baklanov, A.; Mahura, A. (Danish Meteorological Institute, Copenhagen (Denmark)); Lauritzen, Bent; Mikkelsen, Torben (Technical Univ. of Denmark, Risoe National Lab. for Sustainable Energy, Roskilde (Denmark))

    2008-07-15

    Within the NKS NordRisk project, 'Nuclear risk from atmospheric dispersion in Northern Europe', the NKS NordRisk Atlas has been developed. The atlas describes risks from hypothetical long-range atmospheric dispersion and deposition of radionuclides from selected nuclear risk sites in the Northern Hemisphere. A number of case studies of long-term long-range atmospheric transport and deposition of radionuclides has been developed, based on two years of meteorological data. Radionuclide concentrations in air and radionuclide depositions have been evaluated and examples of long-term averages of the dispersion and deposition and of the variability around these mean values are provided. (au)

  3. NKS-B NordRisk II: Nuclear risk from atmospheric dispersion in Northern Europe - Summary report

    International Nuclear Information System (INIS)

    Lauritzen, B.

    2011-05-01

    The objective of the NordRisk II project has been to derive practical means for assessing the risks from long-range atmospheric dispersion of radioactive materials. An atlas over different atmospheric dispersion and deposition scenarios has been developed using historical numerical weather prediction (NWP) model data. The NWP model data covers three years spanning the climate variability associated with the North Atlantic Oscillation, and the atlas considers radioactive releases from 16 release sites in and near the Nordic countries. A statistical analysis of the long-range dispersion and deposition patterns is undertaken to quantify the mean dispersion and deposition as well as the variability. Preliminary analyses show that the large-scale atmospheric dispersion and deposition is near-isotropic, irrespective of the release site and detailed climatology, and allows for a simple parameterization of the global dispersion and deposition patterns. The atlas and the underlying data are made available in a format compatible with the ARGOS decision support system, and have been implemented in ARGOS. (Author)

  4. NKS-B NordRisk II: Nuclear risk from atmospheric dispersion in Northern Europe - Summary report

    Energy Technology Data Exchange (ETDEWEB)

    Lauritzen, B. (Technical Univ. of Denmark, Risoe National Lab. for Sustainable Energy. Radiation Research Div., Roskilde (Denmark))

    2011-05-15

    The objective of the NordRisk II project has been to derive practical means for assessing the risks from long-range atmospheric dispersion of radioactive materials. An atlas over different atmospheric dispersion and deposition scenarios has been developed using historical numerical weather prediction (NWP) model data. The NWP model data covers three years spanning the climate variability associated with the North Atlantic Oscillation, and the atlas considers radioactive releases from 16 release sites in and near the Nordic countries. A statistical analysis of the long-range dispersion and deposition patterns is undertaken to quantify the mean dispersion and deposition as well as the variability. Preliminary analyses show that the large-scale atmospheric dispersion and deposition is near-isotropic, irrespective of the release site and detailed climatology, and allows for a simple parameterization of the global dispersion and deposition patterns. The atlas and the underlying data are made available in a format compatible with the ARGOS decision support system, and have been implemented in ARGOS. (Author)

  5. NKS NordRisk II: Atlas of long-range atmospheric dispersion and deposition of radionuclides from selected risk sites in the Northern Hemisphere

    DEFF Research Database (Denmark)

    Smith Korsholm, Ulrik; Astrup, Poul; Lauritzen, Bent

    The present atlas has been developed within the NKS/NordRisk-II project "Nuclear risk from atmospheric dispersion in Northern Europe". The atlas describes risks from hypothetical long-range dispersion and deposition of radionuclides from 16 nuclear risk sites on the Northern Hemisphere...... spanning the climate variability associated with the North Atlantic Oscillation, and corresponding time evolution of the ensemble mean atmospheric dispersion....

  6. NKS NordRisk II: Atlas of long-range atmospheric dispersion and deposition of radionuclides from selected risk sites in the Northern Hemisphere

    International Nuclear Information System (INIS)

    Smith Korsholm, U.; Havskov Soerensen, J.; Astrup, P.; Lauritzen, B.

    2011-04-01

    The present atlas has been developed within the NKS/NordRisk-II project 'Nuclear risk from atmospheric dispersion in Northern Europe'. The atlas describes risks from hypothetical long-range dispersion and deposition of radionuclides from 16 nuclear risk sites on the Northern Hemisphere. The atmospheric dispersion model calculations cover a period of 30 days following each release to ensure almost complete deposition of the dispersed material. The atlas contains maps showing the total deposition and time-integrated air concentration of Cs-137 and I-131 based on three years of meteorological data spanning the climate variability associated with the North Atlantic Oscillation, and corresponding time evolution of the ensemble mean atmospheric dispersion. (Author)

  7. NKS NordRisk II: Atlas of long-range atmospheric dispersion and deposition of radionuclides from selected risk sites in the Northern Hemisphere

    Energy Technology Data Exchange (ETDEWEB)

    Smith Korsholm, U.; Havskov Soerensen, J. (Danish Meteorological Institute (DMI), Copenhagen (Denmark)); Astrup, P.; Lauritzen, B. (Technical Univ. of Denmark, Risoe National Lab. for Sustainable Energy. Radiation Research Div., Roskilde (Denmark))

    2011-04-15

    The present atlas has been developed within the NKS/NordRisk-II project 'Nuclear risk from atmospheric dispersion in Northern Europe'. The atlas describes risks from hypothetical long-range dispersion and deposition of radionuclides from 16 nuclear risk sites on the Northern Hemisphere. The atmospheric dispersion model calculations cover a period of 30 days following each release to ensure almost complete deposition of the dispersed material. The atlas contains maps showing the total deposition and time-integrated air concentration of Cs-137 and I-131 based on three years of meteorological data spanning the climate variability associated with the North Atlantic Oscillation, and corresponding time evolution of the ensemble mean atmospheric dispersion. (Author)

  8. Nuclear risk from atmospheric dispersion in Northern Europe

    International Nuclear Information System (INIS)

    Lauritzen, B.

    2007-04-01

    The aim of the 2005-06 NKS-B NordRisk project has been to present practical methods for probabilistic risk assessment from long-range atmospheric transport and deposition of radioactive material. In this project an atlas of long-range atmospheric dispersion and deposition patterns derived from archived numerical weather prediction (NWP) model data coupled to an atmospheric dispersion model has been produced, and a PC-based software tool has been developed, based on a simplified description of the long-term, long-range atmospheric dispersion and deposition. The atlas and the software tool may allow for a rapid, first assessment of the risks following a nuclear emergency, when detailed information on the long-range atmospheric dispersion and deposition is not available. (au)

  9. Nuclear risk from atmospheric dispersion in Northern Europe - Summary Report

    DEFF Research Database (Denmark)

    Lauritzen, Bent

    The objective of the NordRisk II project has been to derive practical means for assessing the risks from long-range atmospheric dispersion of radioac-tive materials. An atlas over different atmospheric dispersion and deposi-tion scenarios has been developed using historical numerical weather pre......-diction (NWP) model data. The NWP model data covers three years span-ning the climate variability associated with the North Atlantic Oscillation, and the atlas considers radioactive releases from 16 release sites in and near the Nordic countries. A statistical analysis of the long-range disper......-sion and deposition patterns is undertaken to quantify the mean dispersion and deposition as well as the variability. Preliminary analyses show that the large-scale atmospheric dispersion and deposition is near-isotropic, irrespective of the release site and detailed climatology, and allows for a simple...

  10. Report from risk communication practice

    International Nuclear Information System (INIS)

    Kanda, Reiko

    2011-01-01

    National Institute of Radiological Sciences (NIRS) set up a phone consulting service early after Fukushima Nuclear Power Plant Accident and inquiries to the service attained over 14,000 at August end, 2011. This paper describes the process, present state and future view of the risk communication based on experiences through the service. The communication is classified in 3 stages of consensus/care in peacetime, crisis, and consensus/care post disaster. The first one contains the consensus of atomic power policy and provision of its information; the second, of evacuation/indoor evacuation and indication of restricted water and food intake; and the third, communication for changes and standard of radiation related matters. Initial inquiries to the NIRS service were many concerning examinations of radiation screening, decontamination and internal exposure, from inside and outside of Fukushima Prefecture, suggesting the concern had been spread to remote area from the Prefecture. Then, the time needed per inquiry/consultation prolonged, implying the wish for solving the concern. The risk communication and consideration for realizing radiation risk at peacetime might have rather unrealistic, which was thought to be the major cause of problems at crisis. In addition, interpretation of various values relating to radiation had been apparently different from expert to expert, and findings by radiation effects and rules of radiation protection had been confusedly understood, which probably influenced on people's correct understanding. However, it is conceivably a fruit of taken risk communication that the past understanding ''radiation, unseeable, is terrible'' has changed to the current understanding ''protection can be done through risk assessment of radiation, measurable''. Hereafter, important are the practical use of various numerical values officially informed and realization of dose through exposure routes, and dispatch of their integrated information to lessen the

  11. Risk Management Practices by Barbadian Banks

    Directory of Open Access Journals (Sweden)

    Anthony Wood

    2013-07-01

    The main findings of the paper are: risk managers perceive risk management as critical to their banks’ performance; the types of risks causing the greatest exposures are credit risk, operational risk, country/sovereign risk, interest rate risk and market risk; there was a high level of success with current risk management practices and these practices have evolved over time in line with the changing economic environment and regulatory updates. Overall, the findings suggest strongly that in light of the current depressed economic climate, banks operating in Barbados are indeed risk-focused or might we say “risk intelligent”.

  12. Risk Management Practices: The Ghanaian Firms' Perspective ...

    African Journals Online (AJOL)

    Using a quantitative approach the findings of the study are that Ghanaian firms understand risk and risk management. Additionally, operational, liquidity and credit risk are the most dominant risks experienced while risk identification and selection jointly determine risk management practices in Ghana. Based on the findings ...

  13. Implications of Risk Management Practices on Financial ...

    African Journals Online (AJOL)

    Implications of Risk Management Practices on Financial Performance of Sugar ... The respondents were functional heads of the companies under the survey. ... of downside losses in order to minimize the negative impact of risk on returns.

  14. Risk Management Practices of Multinational and indigenous ...

    African Journals Online (AJOL)

    Construction projects' high uncertainty rates make them unattractive to non-risk takers. Construction companies are therefore necessarily risk takers, albeit, to varying degrees. This study made an inquiry into the risk management (RM) practices of multinational and indigenous construction companies (MCCs and ICCs, ...

  15. Industry challenge to best practice risk communication.

    Science.gov (United States)

    McEntire, J; Boateng, A

    2012-04-01

    Effective food safety and food defense risk communication helps to inform consumers without causing panic and alarm. The Risk Communication Team of the Natl. Center for Food Protection and Defense has developed a list of 11 best practices recommended for effective risk communication. These practices, designed for a food defense crisis, are currently applied to food safety issues, since fortunately a food defense crisis has yet to occur. IFT examined the utility of these best practices and the limitations on their use during food safety and food defense crises by academics, trade associations, and the government. It was hypothesized that legal and business considerations as well as the nature of the event would determine the implementation of the best practices. Through the use of focus group meetings, it was discovered that there was a low level of awareness of the best practices. However, stakeholders practiced some aspects of the recommended practices. Participants felt some of the practices were related and could be consolidated. They also agreed that a food defense event will increase the urgency of the communication and include players not typically involved in food safety issues. The challenges reported by the stakeholders varied, but legal liability, as well as the impact their communications could have on an industry, were often cited. From the government perspective, their need to act within their authorities drove some of their actions with respect to communication. Determining the differences in communication limitations during food safety against food defense events can provide key information to further developing and refining risk communications and specific messages targeted for a food defense incident. Effective food safety and food defense risk communication helps to inform consumers without causing panic and alarm. Determining the differences in communication limitations during food safety against food defense events can provide key information to

  16. METHODOLOGICAL PROBLEMS OF PRACTICAL RADIOGENIC RISK ESTIMATIONS

    Directory of Open Access Journals (Sweden)

    A. Т. Gubin

    2014-01-01

    Full Text Available Mathematical ratios were established according to the description of the calculation procedure for the values of the nominal risk coefficient given in the ICRP Recommendations 2007. It is shown that the lifetime radiogenic risk is a linear functional from the distribution of the dose in time with a multiplier descending with age. As a consequence, application of the nominal risk coefficient in the risk calculations is justified in the case when prolonged exposure is practically evenly distributed in time, and gives a significant deviation at a single exposure. When using the additive model of radiogenic risk proposed in the UNSCEAR Report 2006 for solid cancers, this factor is almost linearly decreasing with the age, which is convenient for its practical application.

  17. Practical Risk Management for the CIO

    CERN Document Server

    Scherling, Mark

    2007-01-01

    The growing complexity of today's interconnected systems has not only increased the need for improved information security, but also helped to move information from the IT backroom to the executive boardroom as a strategic asset. And, just like the tip of an iceberg is all you see until you run into it, the risks to your information are mostly invisible until disaster strikes. Detailing procedures that will help your team perform better risk assessments and aggregate results into more meaningful metrics, Practical Risk Management for the CIO approaches information risk management through impro

  18. Practical Methods for Information Security Risk Management

    Directory of Open Access Journals (Sweden)

    Cristian AMANCEI

    2011-01-01

    Full Text Available The purpose of this paper is to present some directions to perform the risk man-agement for information security. The article follows to practical methods through question-naire that asses the internal control, and through evaluation based on existing controls as part of vulnerability assessment. The methods presented contains all the key elements that concurs in risk management, through the elements proposed for evaluation questionnaire, list of threats, resource classification and evaluation, correlation between risks and controls and residual risk computation.

  19. Risk Assessment in Finland: Theory and Practice

    Directory of Open Access Journals (Sweden)

    Hannu Anttonen

    2010-09-01

    Full Text Available The Finnish risk assessment practice is based on the Occupational Safety and Health Act aiming to improve working conditions in order maintain the employees' work ability, and to prevent occupational accidents and diseases. In practice there are hundreds of risk assessment methods in use. A simple method is used in SME's and more complex risk evaluation methods in larger work places. Does the risk management function in the work places in Finland? According to our experience something more is needed. That is, understanding of common and company related benefits of risk management. The wider conclusion is that commitment for risk assessment in Finland is high enough. However, in those enterprises where OSH management was at an acceptable level or above it, there were also more varied and more successfully accomplished actions to remove or reduce the risks than in enterprises, where OSH management was in lower level. In risk assessment it is important to process active technical prevention and exact communication, increase work place attraction and increase job satisfaction and motivation. Investments in occupational safety and health are also good business. Low absenteeism due to illness or accidents increases directly the production results by improved quality and quantity of the product. In general Finnish studies have consistently shown that the return of an invested euro is three to seven-old. In national level, according to our calculations the savings could be even 20% of our gross national product.

  20. Current Risk Management Practices in Psychotherapy Supervision.

    Science.gov (United States)

    Mehrtens, Ilayna K; Crapanzano, Kathleen; Tynes, L Lee

    2017-12-01

    Psychotherapy competence is a core skill for psychiatry residents, and psychotherapy supervision is a time-honored approach to teaching this skill. To explore the current supervision practices of psychiatry training programs, a 24-item questionnaire was sent to all program directors of Accreditation Council for Graduate Medical Education (ACGME)-approved adult psychiatry programs. The questionnaire included items regarding adherence to recently proposed therapy supervision practices aimed at reducing potential liability risk. The results suggested that current therapy supervision practices do not include sufficient management of the potential liability involved in therapy supervision. Better protections for patients, residents, supervisors and the institutions would be possible with improved credentialing practices and better documentation of informed consent and supervision policies and procedures. © 2017 American Academy of Psychiatry and the Law.

  1. Implications of radiation risk for practical dosimetry

    International Nuclear Information System (INIS)

    Dennis, J.A.

    1984-01-01

    Radiobiological experiments with animals and cells have led to an expectation that the risks of cancer and hereditary effects are reduced at low doses and low dose rates of low LET radiation. Risk estimates derived from human exposures at high doses and dose rates usually contain an allowance for low dose effects in comparison with high dose effects, but no allowance may have been made for low dose rate effects. Although there are reasons for thinking that leukaemia risks may possibly have been underestimated, the total cancer risk assumed by ICRP for occupational exposures is reasonably realistic. For practical dosimetry the primary dose concepts and limits have to be translated into secondary quantities that are capable of practical realisation and measurement, and which will provide a stable and robust system of metrology. If the ICRP risk assumptions are approximately correct, it is extremely unlikely that epidemiological studies of occupational exposures will detect the influence of radiation. Elaboration of dosimetry and dose recording for epidemiological purposes is therefore unjustified except possibly in relation to differences between high and low LET radiations. (author)

  2. Risk assessment instruments in clinical practice.

    Science.gov (United States)

    Côté, Gilles; Crocker, Anne G; Nicholls, Tonia L; Seto, Michael C

    2012-04-01

    To determine whether the items in one of the most widely validated instruments of violence risk assessment, the Historical-Clinical-Risk Management-20 (HCR-20), are used in review board hearings to assess the risk of violence by people found Not Criminally Responsible on account of Mental Disorder (NCRMD). This study was conducted from October 2004 to August 2006 in Quebec's sole forensic psychiatric hospital and 2 large civil psychiatric hospitals designated for the care of people declared NCRMD in the Montreal metropolitan area. The risk assessments presented by clinicians at annual review board hearings and the boards' rationale for the release or detention of people found NCRMD were contrasted with the risk assessments conducted by the research team using the HCR-20. The final sample was comprised of 96 men. Very few of the risk factors identified by prior research (HCR-20 items) were mentioned in the hearing process, whether in clinical reports, discussions during the hearing, or in the disposition justification. The findings confirm that there remains a significant gap between research evidence and risk assessment practice.

  3. Practical implications of the new risk perspectives

    International Nuclear Information System (INIS)

    Aven, Terje

    2013-01-01

    In recent years several authors have argued for the adoption of certain new types of risk perspectives which highlight uncertainties rather than probabilities in the way risk is understood and measured. The theoretical rationale for these new perspectives is well established, but the practical implications have not been so clearly demonstrated. There is a need to show how the new perspectives change the way risk is described and communicated in real-life situations and in its turn the effects on risk management and decision making. The present paper aims at contributing to this end by considering two cases, related to a national risk level, and a specific analysis concerning an LNG plant. The paper concludes that the new risk perspectives influence the current regime in many ways, in particular the manner in which the knowledge dimension is described and dealt with. Two methods for characterising the strength of knowledge are presented, one of them based on a new concept, the “assumption deviation risk”, reflecting risks related to the deviations from the conditions/states defined by the assumption made

  4. Depression and HIV risk behavior practices among at risk women.

    Science.gov (United States)

    Klein, Hugh; Elifson, Kirk W; Sterk, Claire E

    2008-01-01

    In this study, we examined the relationship between depression and HIV-related risk behavior practices in a sample of 250 at risk, predominantly African American women living in the Atlanta, Georgia metropolitan area. Interviews were conducted between August 1997 and August 2000. Street outreach efforts were used to identify potential study participants, with further expansion of the sample via targeted sampling and ethnographic mapping procedures. Our conceptual model hypothesized a relationship between depression and HIV risk in which depression and condom-related attitudes were construed as intervening (or mediating) variables. A multivariate analysis was used to determine the relationship between depression and women's risk behaviors. The results showed that depression was a key-mediating variable, having its primary influence on women's risky practices through its impact upon their attitudes toward using condoms. Factors associated with depression, included religiosity, closeness of family relationships, financial problems, childhood maltreatment experiences, and drug-related problems. The implications of these findings for prevention and intervention efforts are: (1) heightening faith community involvement and religious participation to decrease depression; (2) working with women whose familial bonds are in need of strengthening to combat depression; (3) providing mental health and counseling services to women who were emotionally and/or sexually abused during their formative years seems to help these women to recover from unresolved issues that may be fueling depression; (4) assisting at risk women who need training in money management issues to minimize their risk for depression; and (5) helping women drug abusers to receive treatment for their drug problems to combat their depression and lower their HIV risk.

  5. Obsolescence Risk Assessment Process Best Practice

    Science.gov (United States)

    Romero Rojo, F. J.; Roy, R.; Kelly, S.

    2012-05-01

    A component becomes obsolete when it is no longer available from the original manufacturer to the original specification. In long-lifecycle projects, obsolescence has become a major problem as it prevents the maintenance of the system. This is the reason why obsolescence management is now an essential part of the product support activities in sectors such as defence, aerospace, nuclear and railway; where systems need to be supported for several decades. The obsolescence risk assessment for the bill of materials (BoM) is a paramount activity in order to manage obsolescence proactively and cost-effectively. This is the reason why it was necessary to undertake a benchmarking study to develop best practice in this process. A total of 22 obsolescence experts from 13 different organisations/projects from across UK and USA have participated in this study. Their current processes and experience have been taken into account in the development of the best practice process for obsolescence risk assessment. The key factors that have to be analysed in the risk assessment process for each component in the BoM are: number of manufacturers, years to end of life, stock available, consumption rate and operational impact criticality. For the very high risk components, a more detailed analysis is required to inform the decisions regarding the most suitable mitigation strategies. On the contrary, for the low risk components, a fully proactive approach is neither appropriate nor cost effective. Therefore, it is advised for these components that obsolescence issues are dealt with reactively. This process has been validated using case studies with several experts from industry and is currently being implemented by the UK Ministry of Defence as technical guidance within the JSP 886 Volume 7 Part 8.13 standards.

  6. Obsolescence Risk Assessment Process Best Practice

    International Nuclear Information System (INIS)

    Rojo, F J Romero; Roy, R; Kelly, S

    2012-01-01

    A component becomes obsolete when it is no longer available from the original manufacturer to the original specification. In long-lifecycle projects, obsolescence has become a major problem as it prevents the maintenance of the system. This is the reason why obsolescence management is now an essential part of the product support activities in sectors such as defence, aerospace, nuclear and railway; where systems need to be supported for several decades. The obsolescence risk assessment for the bill of materials (BoM) is a paramount activity in order to manage obsolescence proactively and cost-effectively. This is the reason why it was necessary to undertake a benchmarking study to develop best practice in this process. A total of 22 obsolescence experts from 13 different organisations/projects from across UK and USA have participated in this study. Their current processes and experience have been taken into account in the development of the best practice process for obsolescence risk assessment. The key factors that have to be analysed in the risk assessment process for each component in the BoM are: number of manufacturers, years to end of life, stock available, consumption rate and operational impact criticality. For the very high risk components, a more detailed analysis is required to inform the decisions regarding the most suitable mitigation strategies. On the contrary, for the low risk components, a fully proactive approach is neither appropriate nor cost effective. Therefore, it is advised for these components that obsolescence issues are dealt with reactively. This process has been validated using case studies with several experts from industry and is currently being implemented by the UK Ministry of Defence as technical guidance within the JSP 886 Volume 7 Part 8.13 standards.

  7. Genetic cancer risk assessment in practice

    International Nuclear Information System (INIS)

    Gruber, S.

    2004-01-01

    The advent of genetic testing has made a dramatic impact on the management of individuals with inherited susceptibility to cancer and their relatives. Genetic counsel ing, with or without testing, is warranted when clues to familial cancer are recognized. Today, genetic testing for classic cancer genetic syndromes is now the standard of care, and has been complemented by genetic testing for other situations commonly encountered in clinical practice. Genetic testing for colorectal cancer, breast cancer, kidney cancer, thyroid cancer, melanoma, and pancreatic cancer raise important issues about the parameters for testing. Genetic cancer risk assessment can lead to measurable reductions in morbidity and mortality through strategies that rely on surveillance, chemo prevention, and risk-reducing surgery

  8. Mitigating tin whisker risks theory and practice

    CERN Document Server

    Handwerker, Carol A; Bath, Jasbir

    2016-01-01

    Discusses the growth mechanisms of tin whiskers and the effective mitigation strategies necessary to reduce whisker growth risks. This book covers key tin whisker topics, ranging from fundamental science to practical mitigation strategies. The text begins with a review of the characteristic properties of local microstructures around whisker and hillock grains to identify why these particular grains and locations become predisposed to forming whiskers and hillocks. The book discusses the basic properties of tin-based alloy finishes and the effects of various alloying elements on whisker formation, with a focus on potential mechanisms for whisker suppression or enhancement for each element. Tin whisker risk mitigation strategies for each tier of the supply chain for high reliability electronic systems are also described.

  9. From Risk factors to health resources in medical practice

    DEFF Research Database (Denmark)

    Hollnagel, Hanne; Malterud, Kirsti

    2000-01-01

    autonomy, communication, empowerment, epidemiology, general practice, healing, health resources, informed consent, preventive medicine, risk factors, salutogenesis......autonomy, communication, empowerment, epidemiology, general practice, healing, health resources, informed consent, preventive medicine, risk factors, salutogenesis...

  10. Top Ten Embezzlement Risks in Your Medical Practice.

    Science.gov (United States)

    Shorr, Jay A

    2015-01-01

    Medical practices are often faced with employee embezzlement and theft. To protect themselves and their practices, physicians and practice executives should have in place policies and procedures for identifying and handling unethical behaviors by employees. This article deals with the common risks in healthcare practices and provides suggestions to help mitigate the risk of embezzlement.

  11. Cardiovascular risk age: concepts and practicalities.

    LENUS (Irish Health Repository)

    Cooney, Marie Therese

    2012-06-01

    A young person with many risk factors may have the same level of risk as an older person with no risk factors. Thus a high-risk 40-year-old may have a risk age of 60 years or more. The aim of the study was to derive a generic equation for risk age, construct risk age charts, and explore the hypothesis that risk age is similar regardless of the cardiovascular disease (CVD) end point used.

  12. 78 FR 36784 - Survey of Nanomaterial Risk Management Practices

    Science.gov (United States)

    2013-06-19

    ...-0010, Docket Number NIOSH-265] Survey of Nanomaterial Risk Management Practices AGENCY: National...), Department of Health and Human Services (HHS). ACTION: Proposed NIOSH Survey of Nanomaterial Risk Management... questions addressing risk management practices for ENMs? (5) What should be the maximum amount of time...

  13. Controlling operational risk: Concepts and practices

    NARCIS (Netherlands)

    van den Tillaart, A.H.A.J.

    2003-01-01

    The subject of this thesis is controlling 'operational risk' in banks. Operational risk is defined as the risk of losses resulting from inadequate or failed internal processes, people, systems, or from external events. Within this very broad subject, we focus on the place of operational risk

  14. Sexual and menstrual practices: risks for cervix cancer | Maree ...

    African Journals Online (AJOL)

    Cervix cancer is the cancer that causes most female deaths in South Africa. Little is known about the sexual and menstrual practices in high-risk communities in South Africa. Knowledge of the risks inherent in these practices might lead to changed behaviour. The purpose of this study was to investigate if there are inherent ...

  15. Management Risk Reporting Practices and their determinants

    OpenAIRE

    VANDEMAELE, Sigrid; VERGAUWEN, Philip; MICHIELS, Anneleen

    2009-01-01

    In recent years, the need for effective risk management, internal control and transparent risk reporting has become an important corporate governance principle and a predominant issue in business. Already in 1987, the AICPA[ ] report stated that shareholders are increasingly demanding that financial statements include more information concerning the risks and uncertainties companies are facing (Schrand and Elliott, 1998). Abraham and Cox (2007) claim that this information can help investors t...

  16. Knowledge, risk perception and practice regarding tuberculosis ...

    African Journals Online (AJOL)

    Background: Window opening during bus transportation is recommended as a tuberculosis prevention strategy.Yet, drivers are affected by lack knowledge and risk perception of passengers and assistants. Boosting knowledge of and notifying the high risk of tuberculosis transmission for every passenger could be too costly.

  17. The Evolving Forms of Risk Reporting Practices

    DEFF Research Database (Denmark)

    Christiansen, Ulrik; Thrane, Sof; Andersen, Torben Juul

    reporting system. The risk management frameworks generally assume that information is communicated in exact codified form, but little research has analyzed the construction of risk when the reporting trespasses organizational levels. The managers in the middle however are often depicted as mediators between...

  18. Violence Risk Assessment Practices in Denmark: A Multidisciplinary National Survey

    Directory of Open Access Journals (Sweden)

    Nielsen Louise Hjort

    2015-12-01

    Full Text Available With a quadrupling of forensic psychiatric patients in Denmark over the past 20 years, focus on violence risk assessment practices across the country has increased. However, information is lacking regarding Danish risk assessment practice across professional disciplines and clinical settings; little is known about how violence risk assessments are conducted, which instruments are used for what purposes, and how mental health professionals rate their utility and costs. As part of a global survey exploring the application of violence risk assessment across 44 countries, the current study investigated Danish practice across several professional disciplines and settings in which forensic and high-risk mental health patients are assessed and treated. In total, 125 mental health professionals across the country completed the survey. The five instruments that respondents reported most commonly using for risk assessment, risk management planning and risk monitoring were Broset, HCR-20, the START, the PCL-R, and the PCL:SV. Whereas the HCR-20 was rated highest in usefulness for risk assessment, the START was rated most useful for risk management and risk monitoring. No significant differences in utility were observed across professional groups. Unstructured clinical judgments were reported to be faster but more expensive to conduct than using a risk assessment instrument. Implications for clinical practice are discussed.

  19. Audit Practices: Summary of Risk Assessment Methodologies

    National Research Council Canada - National Science Library

    2002-01-01

    .... The primary objective of an audit risk assessment is to provide its users with the assurance that audit resources are focused on those areas needing greatest attention and will provide the best value...

  20. Radon risk communication research: Practical lessons

    International Nuclear Information System (INIS)

    Fisher, A.; Johnson, F.R.

    1990-01-01

    Those responsible for state and local radon programs often express frustration about the small share of homes that have been tested for radon, and the small share of those with high readings that have been mitigated. There are now a number of completed studies that have examined how well alternative ways of communicating about radon risk have accomplished the goals of motivating appropriate testing and mitigation. This paper summarizes the research results that are most crucial for planning and implementing effective radon risk communication programs. We identify six reasons why people do not respond to radon as a serious threat and provide some remedies suggested by radon studies

  1. RISK MANAGEMENT APPROACHES AND PRACTICES IN IT PROJECTS

    Directory of Open Access Journals (Sweden)

    BRANDAS Claudiu

    2012-07-01

    Full Text Available Risk is identified in project management literature as an important factor influencing IT projects success, and it is relevant for both academic and practitionersn#8217; communities. The paper presents the past and current approaches to risk management in IT projects. The objective of this paper is to compare the different approaches and relate them to existing practices. Project management literature and practice have brought different approaches to risk management, and as a result, many projects ended in failure. We present how risk management is considered in the literature, and we compare the main two approaches: the evaluation approach and the management approach. The contingency approach does not consider risk management to be a specific process as it is an embedded process in the other project management processes. Then, we present the main practices in risk management. The methodology applied is based on documentary study review and analysis of the concepts used by the literature. We analyzed the literature published between 1978 and 2011 from the main journals for IT project management and found out that the essence of project management is risk management. The risk management practices have a considerable influence on stakeholdersn#8217; perception of project success. But, regardless of the chosen approach, a standard method for identifying, assessing, and responding to risks should be included in any project as this influences the outcome of the project.

  2. Effects of Risk Management Practices on IT Project Success

    Directory of Open Access Journals (Sweden)

    Pimchangthong Daranee

    2017-03-01

    Full Text Available Successful management of an information technology (IT project is the most desirable for all organisations and stakeholders. Many researchers elaborated that risk management is a key part of project management for any project size. Risk management is so critical because it provides project managers with a forward-looking view of both threats and opportunities to improve the project success. The objectives of this research are to explore organisational factors affecting IT project success and risk management practices influencing IT project success. Risk management practices include risk identification, risk analysis, risk response planning, and risk monitoring and control. The IT project success is measured by process performance and product performance. Data are collected from 200 project managers, IT managers, and IT analysts in IT firms through questionnaires and analysed using Independent Sample t-test, One-way ANOVA, and Multiple Linear Regression at the statistical significance level of 0.05. The results show that the differences in organisational types affect IT project success in all aspects, while the differences on organisational sizes affect IT project success in the aspect of product performance and total aspects. Risk identification and risk response planning influence the process performance and the total aspects of IT project success. Risk identification has the highest positive influence on product performance, followed closely by risk response, while risk analysis negatively influences product performance.

  3. Obsolescence Risk Assessment Process Best Practice

    OpenAIRE

    Romero Rojo, Francisco Javier; Roy, Rajkumar; Kelly, S.

    2013-01-01

    A component becomes obsolete when it is no longer available from the original manufacturer to the original specification. In long-lifecycle projects, obsolescence has become a major problem as it prevents the maintenance of the system. This is the reason why obsolescence management is now an essential part of the product support activities in sectors such as defence, aerospace, nuclear and railway; where systems need to be supported for several decades. The obsolescence risk assessment for th...

  4. Prevalence and risk factors of obesity among practicing nurses at ...

    African Journals Online (AJOL)

    The need to foster healthy lifestyle is essential in health profession and pertinent to prevent obesity and future morbidity and mortality associated with cardiovascular metabolic risk factors. Journal of Medical and Biomedical Sciences (2016) 5(3), 45-55. Keywords: Obesity, overweight, risk, practicing Nurses, Kumasi ...

  5. Oral hygiene practices and risk of oral leukoplakia | Macigo | East ...

    African Journals Online (AJOL)

    Objective: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. Design: Case control study. Setting: Githongo sublocation in Meru District. Subjects: Eighty five cases and 141 controls identified in a house-to-house screening. Results: The relative risk (RR) of oral ...

  6. Risk pricing practices in finance, insurance and construction

    OpenAIRE

    Laryea, Samuel

    2008-01-01

    A review of current risk pricing practices in the financial, insurance and construction sectors is conducted through a comprehensive literature review. The purpose was to inform a study on risk and price in the tendering processes of contractors: specifically, how contractors take account of risk when they are calculating their bids for construction work. The reference to mainstream literature was in view of construction management research as a field of application rather than a fundamental ...

  7. Mental Health Professionals' Suicide Risk Assessment and Management Practices.

    Science.gov (United States)

    Roush, Jared F; Brown, Sarah L; Jahn, Danielle R; Mitchell, Sean M; Taylor, Nathanael J; Quinnett, Paul; Ries, Richard

    2018-01-01

    Approximately 20% of suicide decedents have had contact with a mental health professional within 1 month prior to their death, and the majority of mental health professionals have treated suicidal individuals. Despite limited evidence-based training, mental health professionals make important clinical decisions related to suicide risk assessment and management. The current study aimed to determine the frequency of suicide risk assessment and management practices and the association between fear of suicide-related outcomes or comfort working with suicidal individuals and adequacy of suicide risk management decisions among mental health professionals. Mental health professionals completed self-report assessments of fear, comfort, and suicide risk assessment and management practices. Approximately one third of mental health professionals did not ask every patient about current or previous suicidal thoughts or behaviors. Further, comfort, but not fear, was positively associated with greater odds of conducting evidence-based suicide risk assessments at first appointments and adequacy of suicide risk management practices with patients reporting suicide ideation and a recent suicide attempt. The study utilized a cross-sectional design and self-report questionnaires. Although the majority of mental health professionals report using evidenced-based practices, there appears to be variability in utilization of evidence-based practices.

  8. Workplace road safety risk management: An investigation into Australian practices.

    Science.gov (United States)

    Warmerdam, Amanda; Newnam, Sharon; Sheppard, Dianne; Griffin, Mark; Stevenson, Mark

    2017-01-01

    In Australia, more than 30% of the traffic volume can be attributed to work-related vehicles. Although work-related driver safety has been given increasing attention in the scientific literature, it is uncertain how well this knowledge has been translated into practice in industry. It is also unclear how current practice in industry can inform scientific knowledge. The aim of the research was to use a benchmarking tool developed by the National Road Safety Partnership Program to assess industry maturity in relation to risk management practices. A total of 83 managers from a range of small, medium and large organisations were recruited through the Victorian Work Authority. Semi-structured interviews aimed at eliciting information on current organisational practices, as well as policy and procedures around work-related driving were conducted and the data mapped onto the benchmarking tool. Overall, the results demonstrated varying levels of maturity of risk management practices across organisations, highlighting the need to build accountability within organisations, improve communication practices, improve journey management, reduce vehicle-related risk, improve driver competency through an effective workplace road safety management program and review organisational incident and infringement management. The findings of the study have important implications for industry and highlight the need to review current risk management practices. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. [Parental practices and pedestrian risk behaviors in Chilean adolescents].

    Science.gov (United States)

    Herrera, Andrea C; Repetto, Paula B

    2014-08-01

    Traffic accidents are the second leading cause of death among adolescents and young adults in Chile. However, few studies have examined this behavior among this age group. Parental practices have a great influence on risk behaviors in adolescents, such as substance use, sexuality and violence, among others. Specifically, we propose that these practices will influence pedestrian risk behaviors among adolescents. To study the role of parental practices such as mother and father support, and behavioral control (monitoring and presence of rules) in pedestrian risk behaviors of teenagers. A sample of 470 adolescents attending schools in the Metropolitan Region of Santiago, Chile were studied. They answered a self-administered questionnaire in which they were asked about parental practices and pedestrian risk behaviors. Analyses were performed using descriptive and inferential statistics, using multiple regression. Paternal support and the presence of rules were protective factors for pedestrian risky behaviors. However, maternal support or monitoring did not influence these behaviors. Parental practices influence pedestrian behaviors of teenagers. The study provides further evidence for the importance of these practices in the development of behavioral self-regulation.

  10. Risk Management Techniques and Practice Workshop Workshop Report

    Energy Technology Data Exchange (ETDEWEB)

    Quinn, T; Zosel, M

    2008-12-02

    At the request of the Department of Energy (DOE) Office of Science (SC), Lawrence Livermore National Laboratory (LLNL) hosted a two-day Risk Management Techniques and Practice (RMTAP) workshop held September 18-19 at the Hotel Nikko in San Francisco. The purpose of the workshop, which was sponsored by the SC/Advanced Scientific Computing Research (ASCR) program and the National Nuclear Security Administration (NNSA)/Advanced Simulation and Computing (ASC) program, was to assess current and emerging techniques, practices, and lessons learned for effectively identifying, understanding, managing, and mitigating the risks associated with acquiring leading-edge computing systems at high-performance computing centers (HPCCs). Representatives from fifteen high-performance computing (HPC) organizations, four HPC vendor partners, and three government agencies attended the workshop. The overall workshop findings were: (1) Standard risk management techniques and tools are in the aggregate applicable to projects at HPCCs and are commonly employed by the HPC community; (2) HPC projects have characteristics that necessitate a tailoring of the standard risk management practices; (3) All HPCC acquisition projects can benefit by employing risk management, but the specific choice of risk management processes and tools is less important to the success of the project; (4) The special relationship between the HPCCs and HPC vendors must be reflected in the risk management strategy; (5) Best practices findings include developing a prioritized risk register with special attention to the top risks, establishing a practice of regular meetings and status updates with the platform partner, supporting regular and open reviews that engage the interests and expertise of a wide range of staff and stakeholders, and documenting and sharing the acquisition/build/deployment experience; and (6) Top risk categories include system scaling issues, request for proposal/contract and acceptance testing, and

  11. An Assessment of risk response strategies practiced in software projects

    Directory of Open Access Journals (Sweden)

    Vanita Bhoola

    2014-11-01

    Full Text Available Risk management and success in projects are highly intertwined – better approaches to project risk management tend to increase chances of project success in terms of achieving scope & quality, schedule and cost targets. The process of responding to risk factors during a project’s life cycle is a crucial aspect of risk management referred to as risk response strategies, in this paper. The current research explores the status of risk response strategies applied in the software development projects in India. India provides a young IT-savvy English-speaking population, which is also cost effective. Other than the workforce, the environment for implementation of software projects in India is different from the matured economies. Risk management process is a commonly discussed theme, though its implementation in practice has a huge scope for improvement in India. The paper talks about four fundamental treatments to risk response – Avoidance, Transference, Mitigation and Acceptance (ATMA. From a primary data of 302 project managers, the paper attempts to address the risk response factors that lead to successful achievement of project scope & quality, schedule and cost targets, by using a series of regressions followed with Seemingly Unrelated Regression Equations (SURE modelling. Mitigation emerged as the most significant risk response strategy to achieve project targets. Acceptance, transference, and avoidance of risk were mostly manifested in the forms of transparency in communication across stakeholders, careful study of the nature of risks and close coordination between project team, customers/end-users and top management.

  12. A Look at the Practice of Risk Classification: Integrative Review

    Directory of Open Access Journals (Sweden)

    Luiz Alves Morais Filho

    2017-03-01

    Full Text Available Introduction: the increase in the number of patients in emergency services / emergency brought the need for screening / risk classification as a way to organize the urgency and emergency care in the health institutions. Objectives: know how to develop the risk classification practice in the Brazilian reality using the scientific production, the insertion of nurses in risk classification using the Brazilian scientific production. Methods: an integrative review was carried out, the data occurred during September 2015 in the following databases: Scientific Electronic Library Online (SciELO, Medical Literature Analysis and Retrieval System Online (Medline, and the Latin American and Caribbean System of Information on Health Sciences (LILACS "GOOGLE SCHOLAR." Results: it found 9,874 articles and selected 33 for analysis. The results were organized in 04 categories: Risk classification as assistance qualifier; risk classification’s organization; operation weaknesses of the risk classification and nurse's role in risk classification. Conclusion: We conclude that the risk classification qualifies the assistance in emergency services; there are many difficulties for the risk classification’s operation and the nurse has been established as a professional with technical and legal competence to perform the risk classification.

  13. Developing risk management dashboards using risk and quality measures: A visual best practices approach.

    Science.gov (United States)

    Bunting, Robert F; Siegal, Dana

    2017-10-01

    Because quality measures are ubiquitous, health care risk management leaders often use them as a proxy for risk management measures. While certain quality measures adequately reflect some aspects of risk management, they are neither a perfect nor complete substitute for well-developed and comprehensive risk management measures. Using a comprehensive approach consisting of quality measures, risk measures, and measures that are less amenable to classification would be the best approach. Identifying the most powerful and informative measures, designing the most appropriate dashboards, and incorporating visual best practices are crucial steps required for evaluating the effectiveness and value of an enterprise risk management program. The authors explain the terms and concepts, review the measures available in the literature, propose new measures, discuss visual best practices, and provide sample dashboard components. © 2017 American Society for Healthcare Risk Management of the American Hospital Association.

  14. The South African Stroke Risk in General Practice Study | Connor ...

    African Journals Online (AJOL)

    Two hundred general practices were randomly selected from lists provided by pharmaceutical .representatives. Each GP approached 50 consecutive patients aged 30 years and older. Patients completed an information sheet and the GP documented the patient's risk factors. The resulting sample is relevant.if not necessarily ...

  15. Knowledge of risk factors, beliefs and practices of female healthcare ...

    African Journals Online (AJOL)

    This study aims to investigate knowledge of breast cancer risk factors, beliefs about treatment and practice of screening methods among a cohort of female healthcare professionals in Morocco. Methods: A cross-sectional study was conducted using a self-administered questionnaire to assess the knowledge of breast cancer ...

  16. Managing Communities – Mining MNEs’ Community Risk Management Practices

    DEFF Research Database (Denmark)

    Taarup Esbensen, Jacob

    This PhD reflects the effort to close a gap in the multinational enterprise (MNE) risk management literature on the identification and mitigation of risk arising from local communities. Small villages and towns that are situated geographically close to the MNEs’ place of operation have increasingly......-to-date information about mining MNE operations. This improved outreach has meant that mines have been closed due to conflicts with local communities and therefor a need had arisen for MNEs to implement management practices that can effectively mitigate these types of risks....... been identified as a source of risk (BSR, 2003; ICMM, 2015). The mining industry is one of the most exposed to risks from local communities, where there historically have been many conflicts between mine owners on one side and the people living close to the mine on the other (Godoy, 1985; Hoskin, 1912...

  17. On Best Practices for Risk Management in Complex Projects

    Directory of Open Access Journals (Sweden)

    Dan BENTA

    2011-01-01

    Full Text Available Risk management shall be proactive. This is one of the key preliminaries to cope with the challenges of complex projects. An overarching and consistent view on project risks and uncertainties is necessary to follow a holistic approach in project risk management. Uncertainty is inevitable since projects are unique and temporary undertakings based on assumptions and constraints, delivering project results to multiple stakeholders with different requirements. Project management can be seen as an attempt to control this uncertain environment, through the use of structured and disciplined techniques such as estimating, planning, cost control, task allocation, earned value analysis, monitoring, and review meetings. Each of these elements of project management has a role in defining or controlling inherent variability in projects. Project risk management provides approaches by which uncertainty can be understood, assessed, and managed within projects. A number of associations (e.g., Project Management Institute – PMI®, International Project Management Association – IPMA,or Network of Nordic Project Management Associations - NORDNET work constantly in acquiring, improving, and standardizing best practices in project management.Based on the industrial practice, this paper outlines strategies to identify, prioritize, and mitigate risks for achievement of project’ or organizational objectives.

  18. Do pressure ulcer risk assessment scales improve clinical practice?

    Directory of Open Access Journals (Sweden)

    Jan Kottner

    2010-07-01

    Full Text Available Jan Kottner1, Katrin Balzer21Department of Nursing Science, Charité-Universitätsmedizin Berlin, Germany; 2Nursing Research Group, Institute for Social Medicine, Universitätsklinikum Schleswig-Holstein, Lübeck, GermanyAbstract: Standardized assessment instruments are deemed important for estimating pressure ulcer risk. Today, more than 40 so-called pressure ulcer risk assessment scales are available but still there is an ongoing debate about their usefulness. From a measurement point of view pressure ulcer (PU risk assessment scales have serious limitations. Empirical evidence supporting the validity of PU risk assessment scale scores is weak and obtained scores contain varying amounts of measurement error. The concept of pressure ulcer risk is strongly related to the general health status and severity of illness. A clinical impact due do the application of these scales could also not be demonstrated. It is questionable whether completion of standardized pressure ulcer risk scales in clinical practice is really needed.Keywords: Braden pressure ulcer, prevention, risk assessment, nursing assessment, predictive value, clinical effectiveness, review

  19. Crises communication practices and their consequences for risk communication

    DEFF Research Database (Denmark)

    Andersen, Nina Blom

    Title of paper: Crisis communication practices and their consequences for risk communication   There is a close coverage of disasters in modern western societies in the media. And there is a growing expectation that authorities handle the tasks of crisis communication in certain ways.   The first...... aim of this paper is to show, that the communication practices about the consequences of a disaster tend to focus on the individual citizen’s situation, and include the psychological consequences and suffering to a large degree. At least for a while. Then the debates and discussions about the event...... change from concern and care about the people affected towards discussions about e.g. cause, responsibility or even guilt.   The second aim of the paper is to discuss other ways for a society to come to terms with risks that leads to disastrous situations than through the topics mentioned above...

  20. Crises communication practices and their consequences for risk communication

    DEFF Research Database (Denmark)

    Andersen, Nina Blom

    2016-01-01

    Title of paper: Crisis communication practices and their consequences for risk communication There is a close coverage of disasters in modern western societies in the media. And there is a growing expectation that authorities handle the tasks of crisis communication in certain ways. The first aim...... of this paper is to show, that the communication practices about the consequences of a disaster tend to focus on the individual citizen?s situation, and include the psychological consequences and suffering to a large degree. At least for a while. Then the debates and discussions about the event change from...... concern and care about the people affected towards discussions about e.g. cause, responsibility or even guilt. The second aim of the paper is to discuss other ways for a society to come to terms with risks that leads to disastrous situations than through the topics mentioned above, and as well how...

  1. Supply Chain Disruptions Theory and Practice of Managing Risk

    CERN Document Server

    Mehrotra, Anuj; Ray, Saibal

    2012-01-01

    One of the most critical issues facing supply chain managers in today’s globalized and highly uncertain business environments is how to deal proactively with disruptions that might affect the complicated supply networks characterizing modern enterprises. Supply Chain Disruptions: Theory and Practice of Managing Risk presents a state-of the-art perspective on this particular issue. Supply Chain Disruptions: Theory and Practice of Managing Risk demonstrates that effective management of supply disruptions necessitates both strategic and tactical measures – the former involving optimal design of supply networks; the latter involving inventory, finance and demand management. It shows that managers ought to use all available levers at their disposal throughout the supply network – like sourcing and pricing strategies, providing financial subsidies, encouraging information sharing and incentive alignment between supply chain partners – in order to tackle supply disruptions. The editors combine up-to-date aca...

  2. Contemporary cosmetic surgery: the potential risks and relevance for practice.

    Science.gov (United States)

    Gilmartin, Jo

    2011-07-01

    To examine and critique the risks of cosmetic surgery and consider implications for practice. Cosmetic surgery is a growing industry with a significant global phenomenon. Feminists have been critical of aesthetic surgery practice, offering a range of representations in regard to 'identity', 'normality', 'cultural and social pressures', 'agency' and 'self-enhancement'. Discourses around minimising risk information acknowledge deficits in not supplying patients with full risk information. The results are usually devastating and lead to serious health complications that incisively diminish well-being for patients and increase health costs. Critical review. This paper represents a critical review of risks associated with cosmetic surgery. A Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System online (Medline) and British Nursing Index (BNI) search with relevant key words were undertaken and selected exemplary articles and research describing and/or evaluating cosmetic surgery risk. Only papers in the English language from 1982-2009 were reviewed. The papers examined were mainly empirical studies; some opinion papers, policy documents, textbooks and websites were examined too. The literature revealed that several factors influence consumer risks including regulation vagaries, medicalisation processes, fear of ageing discrimination, wanting to avoid ethnic prejudice and media pressure. Government strategies in the United Kingdom (UK) have attempted to improve clinical standards; however, little attempt has been made globally to raise institutional and professional awareness of the huge impact of cultural and social pressures on consumers. Avoiding shattering complications by improving the provision of risk information for patients is a worthwhile goal. Therefore, health professionals need to consider consumer rights and autonomy more carefully, facilitate rigorous screening and develop knowledge in regard to

  3. The clinical practice guideline for falls and fall risk

    OpenAIRE

    Vance, Jacqueline

    2011-01-01

    Falling is a significant cause of injury and death in frail older adults. Residents in long-term care (LTC) facilities fall for a variety of reasons and are more likely to endure injuries after a fall than those in the community The American Medical Directors Association (AMDA) Clinical Practice Guideline is written to give LTC staff an understanding of risk factors for falls and provide guidance for a systematic approach to patient assessment and selection of appropriate interventions. It is...

  4. Workplace injuries and risk reduction practices in Malaysia.

    Science.gov (United States)

    Ali, Roslinah; Shaharudin, Rafiza; Omar, Azahadi; Yusoff, Fadhli

    2012-01-01

    This study on workplace injuries and risk reduction practices was part of the Malaysia National Health Morbidity Survey III (NHMS III) conducted in 2006. This cross-sectional population-based survey was conducted to determine the incidence of workplaces injuries and assess the magnitude of some important risk reduction practices among workers. Data were gathered through face-to-face household interviews using a pre-coded questionnaire. Of the 22 880 eligible respondents, 88·2% (20 180) responded. The incidence rate for injuries at the workplace was 4·9 per 100 (95% CI: 4·6-5·2). The overall proportion of workers who had received occupational safety and health (OSH) training before or within 1 month of starting work was 33·6%. Among respondents who perceived that personal protective equipment (PPE) was required at their workplace, only 38·9% (95% CI: 37·8-39·4) were provided with it by their employers. Further studies are urgently needed to identify reasons for and management of the low uptake of risk reduction practices. This issue needs to be addressed to ensure the safety and health of our working population.

  5. Comparison of landslide hazard and risk assessment practices in Europe

    Science.gov (United States)

    Corominas, J.; Mavrouli, O.

    2012-04-01

    An overview is made of the landslide hazard and risk assessment practices that are officially promoted or applied in Europe by administration offices, geological surveys, and decision makers (recommendations, regulations and codes). The reported countries are: Andorra, Austria, France, Italy (selected river basins), Romania, Spain (Catalonia), Switzerland and United Kingdom. The objective here was to compare the different practices for hazard and risk evaluation with respect to the official policies, the methodologies used (qualitative and quantitative), the provided outputs and their contents, and the terminology and map symbols used. The main observations made are illustrated with examples and the possibility of harmonization of the policies and the application of common practices to bridge the existing gaps is discussed. Some of the conclusions reached include the following: zoning maps are legally binding for public administrators and land owners only in some cases and generally when referring to site-specific or local scales rather than regional or national ones; so far, information is mainly provided on landslide susceptibility and hazard and risk assessment is performed only in a few countries; there is a variation in the use of scales between countries; the classification criteria for landslide types and mechanisms present large diversity even within the same country (in some cases no landslide mechanisms are specified while in others there is an exhaustive list); the techniques to obtain input data for the landslide inventory and susceptibility maps vary from basic to sophisticated, resulting in various levels of data quality and quantity; the procedures followed for hazard and risk assessment include analytical procedures supported by computer simulation, weighted-indicators, expert judgment and field survey-based, or a combination of all; there is an important variation between hazard and risk matrices with respect to the used parameters, the thresholds

  6. Risk factors for potential drug interactions in general practice

    DEFF Research Database (Denmark)

    Bjerrum, Lars; Gonzalez Lopez-Valcarcel, Beatriz; Petersen, Gert

    2008-01-01

    interactions during 1 year. Patient factors associated with increased risk of potential drug interactions were high age, a high number of concurrently used drugs, and a high number of prescribers. Practice factors associated with potential drug interactions were a high percentage of elderly patients and a low......Objective: To identify patient- and practice-related factors associated with potential drug interactions. Methods: A register analysis study in general practices in the county of Funen, Denmark. Prescription data were retrieved from a population-based prescription database (Odense University......, depending on the severity of outcome and the quality of documentation. A two-level random coefficient logistic regression model was used to investigate factors related to potential drug interactions. Results: One-third of the population was exposed to polypharmacy, and 6% were exposed to potential drug...

  7. Protection goals in environmental risk assessment: a practical approach.

    Science.gov (United States)

    Garcia-Alonso, Monica; Raybould, Alan

    2014-12-01

    Policy protection goals are set up in most countries to minimise harm to the environment, humans and animals caused by human activities. Decisions on whether to approve new agricultural products, like pesticides or genetically modified (GM) crops, take into account these policy protection goals. To support decision-making, applications for approval of commercial uses of GM crops usually comprise an environmental risk assessment (ERA). These risk assessments are analytical tools, based on science, that follow a conceptual model that includes a problem formulation step where policy protection goals are considered. However, in most countries, risk assessors face major problems in that policy protection goals set in the legislation are stated in very broad terms and are too ambiguous to be directly applicable in ERAs. This means that risk assessors often have to interpret policy protection goals without clear guidance on what effects would be considered harmful. In this paper we propose a practical approach that may help risk assessors to translate policy protection goals into unambiguous (i.e., operational) protection goals and to establish relevant assessment endpoints and risk hypotheses that can be used in ERAs. Examples are provided to show how this approach can be applied to two areas of environmental concern relevant to the ERAs of GM crops.

  8. Ecological models and pesticide risk assessment: current modeling practice.

    Science.gov (United States)

    Schmolke, Amelie; Thorbek, Pernille; Chapman, Peter; Grimm, Volker

    2010-04-01

    Ecological risk assessments of pesticides usually focus on risk at the level of individuals, and are carried out by comparing exposure and toxicological endpoints. However, in most cases the protection goal is populations rather than individuals. On the population level, effects of pesticides depend not only on exposure and toxicity, but also on factors such as life history characteristics, population structure, timing of application, presence of refuges in time and space, and landscape structure. Ecological models can integrate such factors and have the potential to become important tools for the prediction of population-level effects of exposure to pesticides, thus allowing extrapolations, for example, from laboratory to field. Indeed, a broad range of ecological models have been applied to chemical risk assessment in the scientific literature, but so far such models have only rarely been used to support regulatory risk assessments of pesticides. To better understand the reasons for this situation, the current modeling practice in this field was assessed in the present study. The scientific literature was searched for relevant models and assessed according to nine characteristics: model type, model complexity, toxicity measure, exposure pattern, other factors, taxonomic group, risk assessment endpoint, parameterization, and model evaluation. The present study found that, although most models were of a high scientific standard, many of them would need modification before they are suitable for regulatory risk assessments. The main shortcomings of currently available models in the context of regulatory pesticide risk assessments were identified. When ecological models are applied to regulatory risk assessments, we recommend reviewing these models according to the nine characteristics evaluated here. (c) 2010 SETAC.

  9. Health risk assessment and the practice of industrial hygiene.

    Science.gov (United States)

    Paustenbach, D J

    1990-07-01

    It has been claimed that there may be as many as 2000 airborne chemicals to which persons could be exposed in the workplace and in the community. Of these, occupational exposure limits have been set for approximately 700 chemicals, and only about 30 chemicals have limits for the ambient air. It is likely that some type of health risk assessment methodology will be used to establish limits for the remainder. Although these methods have been used for over 10 yr to set environmental limits, each step of the process (hazard identification, dose-response assessment, exposure assessment, and risk characterization) contains a number of traps into which scientists and risk managers can fall. For example, regulatory approaches to the hazard identification step have allowed little discrimination between the various animal carcinogens, even though these chemicals can vary greatly in their potency and mechanisms of action. In general, epidemiology data have been given little weight compared to the results of rodent bioassays. The dose-response extrapolation process, as generally practiced, often does not present the range of equally plausible values. Procedures which acknowledge and quantitatively account for some or all of the different classes of chemical carcinogens have not been widely adopted. For example, physiologically based pharmacokinetic (PB-PK) and biologically based models need to become a part of future risk assessments. The exposure evaluation portion of risk assessments can now be significantly more valid because of better dispersion models, validated exposure parameters, and the use of computers to account for complex environmental factors. Using these procedures, industrial hygienists are now able to quantitatively estimate the risks caused not only by the inhalation of chemicals but also those caused by dermal contact and incidental ingestion. The appropriate use of risk assessment methods should allow scientists and risk managers to set scientifically valid

  10. Biotechnology risks and benefits: Science instructor perspectives and practices

    Science.gov (United States)

    Gardner, Grant Ean

    Developing scientifically literate students who understand the socially contextualized nature of science and technology is a national focus of science education reform. Understanding teachers' views on this topic is of equal importance. This document focuses on the topic of risks and benefits posed by science and technology as an important topic for which the socially contextualized nature of science and technology readily emerges. Following introduction of a theoretical model and a review of the literature, two research studies are described that examined teachers' perceptions of the risks posed by biotechnology and the role of risk topics in an undergraduate science course. The first research study examines four groups of science educators; pre-service science teachers, in-service science teachers, science graduate teaching assistants, and science professors (n = 91). The participants completed a survey and card sort task to determine their perceptions of the risks of biotechnology. The results show that teacher perceptions were shaped by the risk severity, regulation processes, public acceptance, fear, reciprocal benefits, and whether the applications would impact humans or the environment. Factors determining risk perception included personal worldviews, trust in communicating institutions, and personal experiences with biotechnology. The different types of science teachers were compared and contrasted in light of these factors and the implications of instructor perceptions on science pedagogy are discussed. The second research manuscript describes a case study in which six biology graduate teaching assistants (GTAs) were observed teaching as lesson on the potential risks and benefits of biotechnology. The data sources included classroom observations and semi-structured interviews. Qualitative analysis reveals that GTAs framed the instruction of risk in one of three ways: analytical, focus on perspectives and biases, and promotion of individual reflection

  11. Imagining flood futures: risk assessment and management in practice.

    Science.gov (United States)

    Lane, Stuart N; Landström, Catharina; Whatmore, Sarah J

    2011-05-13

    The mantra that policy and management should be 'evidence-based' is well established. Less so are the implications that follow from 'evidence' being predictions of the future (forecasts, scenarios, horizons) even though such futures define the actions taken today to make the future sustainable. Here, we consider the tension between 'evidence', reliable because it is observed, and predictions of the future, unobservable in conventional terms. For flood risk management in England and Wales, we show that futures are actively constituted, and so imagined, through 'suites of practices' entwining policy, management and scientific analysis. Management has to constrain analysis because of the many ways in which flood futures can be constructed, but also because of commitment to an accounting calculus, which requires risk to be expressed in monetary terms. It is grounded in numerical simulation, undertaken by scientific consultants who follow policy/management guidelines that define the futures to be considered. Historical evidence is needed to deal with process and parameter uncertainties and the futures imagined are tied to pasts experienced. Reliance on past events is a challenge for prediction, given changing probability (e.g. climate change) and consequence (e.g. development on floodplains). So, risk management allows some elements of risk analysis to become unstable (notably in relation to climate change) but forces others to remain stable (e.g. invoking regulation to prevent inappropriate floodplain development). We conclude that the assumed separation of risk assessment and management is false because the risk calculation has to be defined by management. Making this process accountable requires openness about the procedures that make flood risk analysis more (or less) reliable to those we entrust to produce and act upon them such that, unlike the 'pseudosciences', they can be put to the test of public interrogation by those who have to live with their consequences

  12. Ten practical lessons for an effective radon risk communication program

    International Nuclear Information System (INIS)

    Fisher, A.; Johnson, F.R.

    1990-01-01

    Those responsible for state and local radon programs often express frustration about the small share of homes that have been tested for radon, and the small share of those with high readings that have been mitigated. Several recent studies have examined how well alternative ways of communicating about radon's risk have accomplished the goals of motivating appropriate testing and mitigation. Unfortunately, the results of these studies have not reached practitioners. This paper is for them. It summarizes the practical implications that are most crucial for planning and implementing an effective radon risk communication program--a program that will motivate people to test for radon and mitigate when radon levels are high, without unduly alarming those whose radon levels are low

  13. Study on practical application of risk informed inservice inspection

    International Nuclear Information System (INIS)

    Sato, Chikahiro; Machida, Hideo; Takeda, Shuhei; Miyata, Koichi; Nishino, Shoichiro

    2009-01-01

    This paper describes pilot study relevant to the application of risk informed inservice inspection (RI-ISI) to class 1 piping systems in a Japanese typical BWR5 plant. The benefits of making use of risk information are improvement in plant safety, quality of inspection and explanation of security activities in nuclear power plants. The current RI-ISI procedures and rules were developed to take advantage of lessons learned from PSA data and piping failure experiences, and are expected to rationalize of security activities for plant operation and maintenance. To introduce RI-ISI, it is necessary to collaborate with industry, academia and government. Development of the technical basis is one of the key issues to become practical of RI-ISI programs. (author)

  14. Evaluation of radiation risk and work practices during cerebral interventions

    Energy Technology Data Exchange (ETDEWEB)

    Livingstone, Roshan S; Raghuram, L; Korah, Ipeson P; Raj, D Victor [Department of Radiodiagnosis, Christian Medical College, Vellore 632004 (India)

    2003-09-01

    This study was intended to evaluate radiation risk to patients during cerebral interventions and the contribution to this risk from work practices. Thirty nine patients undergoing cerebral interventions in a digital subtraction angiography suite were included in this study. Patients who underwent cerebral interventions were categorised into two groups according to the number of cerebral interventions performed on them, and their effective doses were calculated. The effective dose for patients undergoing a single cerebral intervention (group A) varied from 1.55 to 15.9 mSv and for multiple cerebral interventions (group B) varied from 16.52 to 43.52 mSv. Two patients who underwent multiple cerebral interventions (group B) had alopecia of the irradiated scalp.

  15. Use of sanitizing products: safety practices and risk situations

    Directory of Open Access Journals (Sweden)

    Ana Aurélia Rocha da Silva

    2014-04-01

    Full Text Available OBJECTIVES: to evaluate the handling and risk factors for poisoning and/or digestive tract injuries associated with the use of sanitizing products at home. METHODS: interviews were conducted in 419 households from different regions, collecting epidemiological data from residents and risk habits related to the use and storage of cleaning products. RESULTS: sanitizing products considered to be a health risk were found in 98% of the households where the research was conducted, and in 54% of cases, they were stored in places easily accessible to children. Lye was found in 19%, followed by illicit products in 39% of homes. In 13% of households, people produced soap, and in 12% they stored products in non-original containers. The use of illicit products and the manufacture of handmade soap were associated with lower educational level of the household owners and with the regions and socioeconomic classes with lower purchasing power. CONCLUSIONS: risk practices such as inadequate storage, manufacturing, and use of sanitizing products by the population evidence the need for public health policies, including educational measures, as a means of preventing accidents.

  16. Criticality Risk Management: Why Analysis of Operating Practices Matters

    International Nuclear Information System (INIS)

    Menuet, L.; Tasset, D.; Hebraud, C.

    2016-01-01

    The criticality risk is an unwanted neutron chain reaction that could lead, if not under control, to a criticality accident resulting in a high release of energy accompanied by an intense emission of neutron and gamma radiation. Thus, the management of criticality risk in Fuel Cycle Facilities relies mainly on a set of prescriptions and requirements established by the licencees for achieving safety objectives. This paper intends to show that, beyond prescriptions and requirements, a socio-technical approach is essential to define a relevant set of criticality safety rules favouring efficient and safe human activities. Indeed, a thorough knowledge of staff operating practices, beyond contributing significantly to the definition of appropriate technical and organizational provisions, enhances safety management combining “rule-based safety” and “managed safety”. Rule-based safety (top down definition of the rules) can be achieved by anticipating undesirable situations and defining provisions to avoid and manage them in daily practices. On the other hand, managed safety (integration of local characteristics) develops the sociotechnical system capacity to anticipate, recognise and formulate appropriate responses to unexpected scenarios that were not foreseen by the organization, or to rules that are not applicable to the operational realities. Thus, an effective safety management relies on human expertise, on the skills of individuals, on the quality of initiatives, and on the way teams and organizations perform the operations on a daily basis, interact and coordinate to integrate and regulate both ruled-based safety and managed safety.

  17. Practical consequences of the assessment of different energy health risks

    International Nuclear Information System (INIS)

    Hamilton, L.D.

    1984-01-01

    Public authorities must make decisions about energy, and the risks of alternative strategies need to be calculated including health and environmental costs. Information from various sources must be organized into a logical framework for comparing impacts. This must include the widest practicable range of health and environmental damage - public health impact of pollution, role of accidents, disease and hazardous materials in the workplace, and odds for catastrophes. It must put each part of the energy cycle into perspective - giving particular attention to uncertainties in knowledge - to convey what is known, what is uncertain, and the importance of each factor in the overall picture. This paper gives examples of the use of health-impact assessment by decision-makers: (1) comparative risk assessment of the health effects of coal and nuclear fuel cycles used in nuclear power plant siting and licensing hearings, and (2) health risks of acid deposition and other air-transported pollutants, carried out as part of an assessment for the U.S. Congress Office of Technology Assessment. (author)

  18. International and Russian practice of banking risk-management. Mortgage risks

    Directory of Open Access Journals (Sweden)

    A. V. Nikolaeva

    2016-01-01

    Full Text Available The goal of the work is to compare Russian norms and standards of risk management of mortgage lending with international standards of risk management based on the documents of the Basel Committee. The article also aims to analyze new banking tools of risk management of mortgage lending, that arise in connection with the application of international norms and standards of risk management.Materials and Methods: The main documents considered in the article are the agreements on capital, issued by the Basel Committee on Banking Supervision: Basel-I (1988, Basel-II (2004 and Basel-III (2010, as well as instructions and standing orders issued by the Central Bank of Russia, including: Instruction № 139-I "Ob obiazatel'nykh normativakh bankov", instruction № 1 "O poriadke regulirovaniia deiatel'nosti kommercheskikh bankov", the standing order number 215-P "O metodike opredeleniia sobstvennykh sredstv (kapitala kreditnykh organizatsii", the standing order № 395-P "O metodike opredeleniia velichiny sobstvennykh sredstv (kapitala kreditnykh organizatsii («BAZEL III»" and others. On the basis of these documents the work examines and summarizes the main methods of risk management of mortgage lending, such as: comparison and analysis of risk management techniques, study of the basic documents regulating risk management in banks and generalization of risk management methods in the segment of mortgage lending.Results: The article analyzes the legal and methodological basis of risk management and provides practical methods that can be used in practice for managerial decisions in a constantly changing external economic environment. It also analyses international and native risk management. Russian standards of risk-management are compared with international. The work conducts a critical review of the effects of introduction of international standards in Russia. Special attention is paid to the practice of mortgage risk

  19. The utility of absolute risk prediction using FRAX® and Garvan Fracture Risk Calculator in daily practice.

    Science.gov (United States)

    van Geel, Tineke A C M; Eisman, John A; Geusens, Piet P; van den Bergh, Joop P W; Center, Jacqueline R; Dinant, Geert-Jan

    2014-02-01

    There are two commonly used fracture risk prediction tools FRAX(®) and Garvan Fracture Risk Calculator (GARVAN-FRC). The objective of this study was to investigate the utility of these tools in daily practice. A prospective population-based 5-year follow-up study was conducted in ten general practice centres in the Netherlands. For the analyses, the FRAX(®) and GARVAN-FRC 10-year absolute risks (FRAX(®) does not have 5-year risk prediction) for all fractures were used. Among 506 postmenopausal women aged ≥60 years (mean age: 67.8±5.8 years), 48 (9.5%) sustained a fracture during follow-up. Both tools, using BMD values, distinguish between women who did and did not fracture (10.2% vs. 6.8%, respectively for FRAX(®) and 32.4% vs. 39.1%, respectively for GARVAN-FRC, pbetter for women who sustained a fracture (higher sensitivity) and FRAX(®) for women who did not sustain a fracture (higher specificity). Similar results were obtained using age related cut off points. The discriminant value of both models is at least as good as models used in other medical conditions; hence they can be used to communicate the fracture risk to patients. However, given differences in the estimated risks between FRAX(®) and GARVAN-FRC, the significance of the absolute risk must be related to country-specific recommended intervention thresholds to inform the patient. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  20. Binge drinking among adolescents: prevalence, risk practices and related variables.

    Science.gov (United States)

    Golpe, Sandra; Isorna, Manuel; Barreiro, Carmen; Braña, Teresa; Rial, Antonio

    2017-09-29

    According to the last Survey on Drug Use among Secondary School Students (ESTUDES 2014-2015), consumption levels of alcohol and other substances have decreased in the last years in Spain. However, available data on binge drinking remain worrying, given the negative consequences related with this pattern. The aim of this paper is to analyse binge drinking among adolescents, providing updated data on prevalence in addition to information about the consequences and some predictive factors of binge drinking. A correlational method was used for this purpose, comprised of administering a survey to Compulsory Secondary School, High School and Vocational Training students. Based on a sample of 3,419 Galician adolescents aged between 12 and 18 years (M = 14.57; SD = 1.76), the results show that binge drinking is a common and global practice, with few socio-demographic differences but related with a wide range of risk practices. Furthermore, variables such as consumption expectancies, consumption by family and friends, as well as curfew time and allowance money have been identified as interesting predictive factors that should be taken into account at the preventive level.

  1. Risk factors for dementia diagnosis in German primary care practices.

    Science.gov (United States)

    Booker, Anke; Jacob, Louis Ec; Rapp, Michael; Bohlken, Jens; Kostev, Karel

    2016-07-01

    Dementia is a psychiatric condition the development of which is associated with numerous aspects of life. Our aim was to estimate dementia risk factors in German primary care patients. The case-control study included primary care patients (70-90 years) with first diagnosis of dementia (all-cause) during the index period (01/2010-12/2014) (Disease Analyzer, Germany), and controls without dementia matched (1:1) to cases on the basis of age, sex, type of health insurance, and physician. Practice visit records were used to verify that there had been 10 years of continuous follow-up prior to the index date. Multivariate logistic regression models were fitted with dementia as a dependent variable and the potential predictors. The mean age for the 11,956 cases and the 11,956 controls was 80.4 (SD: 5.3) years. 39.0% of them were male and 1.9% had private health insurance. In the multivariate regression model, the following variables were linked to a significant extent with an increased risk of dementia: diabetes (OR: 1.17; 95% CI: 1.10-1.24), lipid metabolism (1.07; 1.00-1.14), stroke incl. TIA (1.68; 1.57-1.80), Parkinson's disease (PD) (1.89; 1.64-2.19), intracranial injury (1.30; 1.00-1.70), coronary heart disease (1.06; 1.00-1.13), mild cognitive impairment (MCI) (2.12; 1.82-2.48), mental and behavioral disorders due to alcohol use (1.96; 1.50-2.57). The use of statins (OR: 0.94; 0.90-0.99), proton-pump inhibitors (PPI) (0.93; 0.90-0.97), and antihypertensive drugs (0.96, 0.94-0.99) were associated with a decreased risk of developing dementia. Risk factors for dementia found in this study are consistent with the literature. Nevertheless, the associations between statin, PPI and antihypertensive drug use, and decreased risk of dementia need further investigations.

  2. Managing the unmanageable: risk assessment and risk management in contemporary professional practice.

    Science.gov (United States)

    Raven, J; Rix, P

    1999-07-01

    This study sets out to investigate the theories and practices of risk assessment and management in the context of contemporary mental health practice. Although risk assessment and management policies are well established for those working in the field of community mental health care, there are noticeable anomalies and regional variations, in the criteria, procedures and decision-making strategies used. Focus group taped interviews were conducted with over 100 mental health professionals in one NHS Trust. These were compared with an extensive literature review on the topic. The main theme to emerge was lack of resources, which included time and staff in the context of a changing and increasing workload. Another important theme was the lack of access to centralized and accurate information about mental health service provision. It is essential that professionals, clients, their families and the public feel confident in professional judgements and practices to avoid a 'back to the asylum' lobby, for the care and treatment of seriously mentally ill individuals.

  3. A practical approach to assess depression risk and to guide risk reduction strategies in later life.

    Science.gov (United States)

    Almeida, Osvaldo P; Alfonso, Helman; Pirkis, Jane; Kerse, Ngaire; Sim, Moira; Flicker, Leon; Snowdon, John; Draper, Brian; Byrne, Gerard; Goldney, Robert; Lautenschlager, Nicola T; Stocks, Nigel; Scazufca, Marcia; Huisman, Martijn; Araya, Ricardo; Pfaff, Jon

    2011-03-01

    Many factors have been associated with the onset and maintenance of depressive symptoms in later life, although this knowledge is yet to be translated into significant health gains for the population. This study gathered information about common modifiable and non-modifiable risk factors for depression with the aim of developing a practical probabilistic model of depression that can be used to guide risk reduction strategies. A cross-sectional study was undertaken of 20,677 community-dwelling Australians aged 60 years or over in contact with their general practitioner during the preceding 12 months. Prevalent depression (minor or major) according to the Patient Health Questionnaire (PHQ-9) assessment was the main outcome of interest. Other measured exposures included self-reported age, gender, education, loss of mother or father before age 15 years, physical or sexual abuse before age 15 years, marital status, financial stress, social support, smoking and alcohol use, physical activity, obesity, diabetes, hypertension, and prevalent cardiovascular diseases, chronic respiratory diseases and cancer. The mean age of participants was 71.7 ± 7.6 years and 57.9% were women. Depression was present in 1665 (8.0%) of our subjects. Multivariate logistic regression showed depression was independently associated with age older than 75 years, childhood adverse experiences, adverse lifestyle practices (smoking, risk alcohol use, physical inactivity), intermediate health hazards (obesity, diabetes and hypertension), comorbid medical conditions (clinical history of coronary heart disease, stroke, asthma, chronic obstructive pulmonary disease, emphysema or cancers), and social or financial strain. We stratified the exposures to build a matrix that showed that the probability of depression increased progressively with the accumulation of risk factors, from less than 3% for those with no adverse factors to more than 80% for people reporting the maximum number of risk factors. Our

  4. Risk of Agricultural Practices and Habitat Change to Farmland Birds

    Directory of Open Access Journals (Sweden)

    David Anthony. Kirk

    2011-06-01

    Full Text Available Many common bird species have declined as a result of agricultural intensification and this could be mitigated by organic farming. We paired sites for habitat and geographical location on organic and nonorganic farms in Ontario, Canada to test a priori predictions of effects on birds overall, 9 guilds and 22 species in relation to candidate models for farming practices (13 variables, local habitat features (12 variables, or habitat features that influence susceptibility to predation. We found that: (1 Overall bird abundance, but not richness, was significantly (p < 0.05 higher on organic sites (mean 43.1 individuals per site than nonorganic sites (35.8 individuals per site. Significantly more species of birds were observed for five guilds, including primary grassland birds, on organic vs. nonorganic sites. No guild had higher richness or abundance on nonorganic farms; (2 Farming practice models were the best (Î"AIC < 4 for abundance of birds overall, primary grassland bird richness, sallier aerial insectivore richness and abundance, and abundance of ground nesters; (3 Habitat models were the best for overall richness, Neotropical migrant abundance, richness and abundance of Ontario-USA-Mexico (short-distance migrants and resident richness; (4 Predation models were the best for richness of secondary grassland birds and ground feeders; (5 A combination of variables from the model types were best for richness or abundance overall, 13 of 18 guilds (richness and abundance and 16 of 22 species analyzed. Five of 10 farming practice variables (including herbicide use, organic farm type and 9 of 13 habitat variables (including hedgerow length, proportion of hay were significant in best models. Risk modeling indicated that herbicide use could decrease primary grassland birds by one species (35% decline from 3.4 to 2.3 species per site. Organic farming could benefit species of conservation concern by 49% (an increase from 7.6 to 11.4 grassland birds. An

  5. Procurement risk management practices and supply chain performance among mobile phone service providers in Kenya

    OpenAIRE

    Emily Adhiambo Okonjo; Peterson Obara Magutu; Richard Bitange Nyaoga

    2016-01-01

    The aim of this study was to establish the relationship between procurement risk management practices and supply chain performance among mobile phone service providers in Kenya. The study specifically set out to establish the extent to which mobile phone service providers have implemented procurement risk management practices and to determine the relationship between procurement risk management practices and supply chain performance. The study adopted a descriptive study design by collecting ...

  6. THE EFFECTS OF STRATEGIC MANAGEMENT PRACTICES AND RISK PERCEPTION ON COMPETITIVE ADVANTAGE

    OpenAIRE

    Demir, Bülent

    2018-01-01

    Theaim of this research is to examine the impact of strategic management practicesand risk perception on the competitive advantage. In the research, strategicmanagement practices and risk perception were considered as independentvariables and competitive advantage as dependent variable.Theresearch is expected to contribute to the theoretical and practical aspects ofthe literature. The theoretical contribution of the research is that the effectof strategic management practices and the risk per...

  7. A Practical Risk Assessment Methodology for Safety-Critical Train Control Systems

    Science.gov (United States)

    2009-07-01

    This project proposes a Practical Risk Assessment Methodology (PRAM) for analyzing railroad accident data and assessing the risk and benefit of safety-critical train control systems. This report documents in simple steps the algorithms and data input...

  8. Is your practice at risk for medical identity theft?

    Science.gov (United States)

    Weinstock, Donna

    2014-01-01

    Medical identity theft has become increasingly prevalent. Medical practices need to take action and have policies and procedures in place to prevent data breaches. This will protect both the patient and the practice from medical identity theft.

  9. Improving risk management: from lame excuses to principled practice.

    Science.gov (United States)

    Paté-Cornell, Elisabeth; Cox, Louis Anthony

    2014-07-01

    The three classic pillars of risk analysis are risk assessment (how big is the risk and how sure can we be?), risk management (what shall we do about it?), and risk communication (what shall we say about it, to whom, when, and how?). We propose two complements as important parts of these three bases: risk attribution (who or what addressable conditions actually caused an accident or loss?) and learning from experience about risk reduction (what works, and how well?). Failures in complex systems usually evoke blame, often with insufficient attention to root causes of failure, including some aspects of the situation, design decisions, or social norms and culture. Focusing on blame, however, can inhibit effective learning, instead eliciting excuses to deflect attention and perceived culpability. Productive understanding of what went wrong, and how to do better, thus requires moving past recrimination and excuses. This article identifies common blame-shifting "lame excuses" for poor risk management. These generally contribute little to effective improvements and may leave real risks and preventable causes unaddressed. We propose principles from risk and decision sciences and organizational design to improve results. These start with organizational leadership. More specifically, they include: deliberate testing and learning-especially from near-misses and accident precursors; careful causal analysis of accidents; risk quantification; candid expression of uncertainties about costs and benefits of risk-reduction options; optimization of tradeoffs between gathering additional information and immediate action; promotion of safety culture; and mindful allocation of people, responsibilities, and resources to reduce risks. We propose that these principles provide sound foundations for improving successful risk management. © 2014 Society for Risk Analysis.

  10. RISK IDENTIFICATION TOOLS – POLISH MSMES COMPANIES PRACTICES

    Directory of Open Access Journals (Sweden)

    Iwona Gorzeń-Mitka

    2013-07-01

    Full Text Available The purpose of this study is to present risk identification tools in Polish micro, small and medium-sized enterprises (MSMEs. Risk identification is a key element of the risk management process in companies. Correctly fitting risk identification tools affect the accuracy of management decisions. The result of research is to identify the leading risk identification tools used by MSMEs. The study was conducted in 2010-2012 using a mixed survey-monographic method and questionnaires. The qualitative data were obtained during the study.

  11. Early formula feeding practices and their potential contribution to later obesity risk

    LENUS (Irish Health Repository)

    Tarrant, R C

    2013-01-02

    Background and Aims: Early feeding practices, including early introduction to solid foods and overfeeding, are known risk factors for childhood obesity. This study aimed to assess maternal formula feeding practices and infant formula feeding patterns, factors that are known to potentially contribute to later obesity risk. \\r\

  12. Analysis of the effect of risk management practices on the performance of new product development programs

    DEFF Research Database (Denmark)

    Oehmen, Josef; Olechowski, Alison; Kenley, C. Robert

    2014-01-01

    Risk management is receiving much attention, as it is seen as a method to improve cost, schedule, and technical performance of new product development programs. However, there is a lack of empirical research that investigates the effective integration of specific risk management practices proposed...... skills and resources; (2) Tailor risk management to and integrate it with new product development; (3) Quantify impacts of risks on your main objectives; (4) Support all critical decisions with risk management results; (5) Monitor and review your risks, risk mitigation actions, and risk management...... by various standards with new product development programs and their association with various dimensions of risk management success. Based on a survey of 291 product development programs, this paper investigates the association of risk management practices with five categories of product development program...

  13. Risk practices for HIV infection and other STDs amongst female prostitutes working in legalized brothels.

    Science.gov (United States)

    Pyett, P M; Haste, B R; Snow, J

    1996-02-01

    Most research investigating risk practices for HIV infection and other STDs amongst sex workers has focused on street prostitutes to the exclusion of those prostitutes who work in different sections of the industry. This is largely a consequence of methodological difficulties in accessing prostitutes other than those who work on the streets. HIV prevention research and interventions must address the fact that risk practices may vary according to the type of prostitution engaged in. This paper reports on risk practices for HIV infection and other STDs amongst prostitutes working in legalized brothels in Victoria, Australia. A self-administered questionnaire was distributed by representatives of a sex worker organization whose collaboration was an important factor in obtaining a large sample of prostitutes. The study found low levels of risk practices for prostitutes working in legal brothels in Victoria. The major risk practices indentified were injecting drug use and condom non-use with non-paying partners.

  14. Procurement risk management practices and supply chain performance among mobile phone service providers in Kenya

    Directory of Open Access Journals (Sweden)

    Emily Adhiambo Okonjo

    2016-02-01

    Full Text Available The aim of this study was to establish the relationship between procurement risk management practices and supply chain performance among mobile phone service providers in Kenya. The study specifically set out to establish the extent to which mobile phone service providers have implemented procurement risk management practices and to determine the relationship between procurement risk management practices and supply chain performance. The study adopted a descriptive study design by collecting data from the four (4 mobile telecommunication companies in Kenya using a self-administered questionnaire. Means, standard deviation, and regression analysis were used to analyze the data collected. The study established that most of the mobile phone service providers in Kenya had implemented procurement risk management practices. It was also clear that there was a very significant relationship between procurement risk management practices and supply chain performance.

  15. Best practice vendor risk management in today's interconnected world.

    Science.gov (United States)

    Beale, Ian

    2017-01-01

    This paper explains why vendor/third-party risk is so important to all organisations, as well as the principal risks that organisations must consider. It describes the responsibility of management to manage these risks with support from risk experts at the selection phase and through the ongoing relationship. Different sources of information about the management of the key risks and alternative ways of collecting the data are evaluated. The paper concludes by discussing how both customer and supplier organisations benefit from a balanced approach to risk management. The approach described in the paper applies to organisations of all types and sizes and can be applied to varied supply chains. The data and insights are based on research conducted by CEB.

  16. Operational Risk Management A Practical Approach to Intelligent Data Analysis

    CERN Document Server

    Kenett, Ron

    2010-01-01

    The book will introduce modern Operational Risk (OpR) Management and illustrates the various sources of OpR assessment and OpR mitigation. This book discusses how various data sources can be integrated and analyzed and how OpR is synergetic to other risk management activities such as Financial Risk Management and Internationalization. The topics will include state of the art technology such as semantic analysis, ontology engineering, data mining and statistical analysis.

  17. Managing Acquisition Risk by Applying Proven Best Practices

    National Research Council Canada - National Science Library

    Evans, Mike; Segura, Corinne; Doherty, Frank

    2005-01-01

    .... While risk management is ingrained within their culture, these organizations take active measures to sustain effective implementation across programs by routinely conducting assessments to maintain...

  18. Understanding producers’ motives to adopt sustainable practices: the role of expected rewards, risk perception, and risk tolerance

    NARCIS (Netherlands)

    Hofenk, D.J.B.; Pennings, J.M.E.; Trujillo Barrera, A.A.

    2014-01-01

    Abstract The purpose of this study is to examine producers’ motives underlying the adoption of sustainable practices. In particular, we focus on expected economic, social, and personal rewards, and examine the roles of producers’ risk perception and risk tolerance. Preliminary results from a survey

  19. Understanding Producers’ Motives for Adopting Sustainable Practices: The Role of Expected Rewards, Risk Perception, and Risk Tolerance

    NARCIS (Netherlands)

    Hofenk, D.J.B.; Pennings, J.M.E.; Trujillo Barrera, A.A.

    2014-01-01

    This paper examines producers’ motives underlying the adoption of sustainable practices. In particular, we focus on expected economic, social, and personal rewards, and examine the role of producers’ risk perception and risk tolerance. Results from personal computer-guided interviews with164 hog

  20. Toward an HRD Auditing Protocol: Assessing HRD Risk Management Practices

    Science.gov (United States)

    Clardy, Alan

    2004-01-01

    Even though HRD-related programs and activities carry risks that should be monitored and assessed, there is little literature on how auditing applies to the HRD function; the existing literature on the topic defines HRD auditing in widely different ways. The nature of risk for organizational process is discussed, followed by a review of the…

  1. Determinants of cardiovascular risk in current rheumatic practice

    NARCIS (Netherlands)

    Meek, I.L.

    2014-01-01

    The aim of this thesis was to study cardiovascular risk in arthritis: Firstly, how do different rheumatic diseases compare in the patients’ traditional cardiovascular (CV) risk factor profiles, and does this justify the general focus on rheumatoid arthritis regarding cardiovascular complications in

  2. Assessing Violence Risk and Psychopathy in Juvenile and Adult Offenders: A Survey of Clinical Practices

    Science.gov (United States)

    Viljoen, Jodi L.; McLachlan, Kaitlyn; Vincent, Gina M.

    2010-01-01

    This study surveyed 199 forensic clinicians about the practices that they use in assessing violence risk in juvenile and adult offenders. Results indicated that the use of risk assessment and psychopathy tools was common. Although clinicians reported more routine use of psychopathy measures in adult risk assessments compared with juvenile risks…

  3. Radiation protection standards: A practical exercise in risk assessment

    Energy Technology Data Exchange (ETDEWEB)

    Clarke, Roger H [National Radiological Protection Board (United Kingdom)

    1992-07-01

    Within 12 months of the discovery of x-rays in 1895, it was reported that large doses of radiation were harmful to living human tissues. The first radiation protection standards were set to avoid the early effects of acute irradiation. By the 1950s, evidence was mounting for late somatic effects - mainly a small excess of cancers - in irradiated populations. In the late 1980's, sufficient human epidemiological data had been accumulated to allow a comprehensive assessment of carcinogenic radiation risks following the delivery of moderately high doses. Workers and the public are exposed to lower doses and dose-rates than the groups from whom good data are available so that risks have had to be estimated for protection purposes. However, in the 1990s, some confirmation of these risk factors has been derived occupationally exposed populations. If an estimate is made of the risk per unit dose, then in order to set dose limits, an unacceptable level of risk must be established for both workers and the public. There has been and continues to be a debate about the definitions of 'acceptable' and 'tolerable' and the attributing of numerical values to these definitions. This paper discusses the issues involved in the quantification of these terms and their application to setting dose limits on risk grounds. Conclusions are drawn about the present protection standards and the application of the methods to other fields of risk assessment. (author)

  4. Radiation protection standards: A practical exercise in risk assessment

    International Nuclear Information System (INIS)

    Clarke, Roger H.

    1992-01-01

    Within 12 months of the discovery of x-rays in 1895, it was reported that large doses of radiation were harmful to living human tissues. The first radiation protection standards were set to avoid the early effects of acute irradiation. By the 1950s, evidence was mounting for late somatic effects - mainly a small excess of cancers - in irradiated populations. In the late 1980's, sufficient human epidemiological data had been accumulated to allow a comprehensive assessment of carcinogenic radiation risks following the delivery of moderately high doses. Workers and the public are exposed to lower doses and dose-rates than the groups from whom good data are available so that risks have had to be estimated for protection purposes. However, in the 1990s, some confirmation of these risk factors has been derived occupationally exposed populations. If an estimate is made of the risk per unit dose, then in order to set dose limits, an unacceptable level of risk must be established for both workers and the public. There has been and continues to be a debate about the definitions of 'acceptable' and 'tolerable' and the attributing of numerical values to these definitions. This paper discusses the issues involved in the quantification of these terms and their application to setting dose limits on risk grounds. Conclusions are drawn about the present protection standards and the application of the methods to other fields of risk assessment. (author)

  5. Risk assessment practice within primary mental health care: A logics perspective.

    Science.gov (United States)

    Flintoff, Adam; Speed, Ewen; McPherson, Susan

    2018-04-01

    From the 1980s onwards, discourses of risk have continued to grow, almost in ubiquity. Ideas and practices of risk and risk aversion have extended to UK mental health care where services are expected to assess and manage risks, and high-quality clinical assessment has been revised to incorporate risk assessment. This article problematises practices of risk assessment in mental health provision, focussing on the base-rate problem. It presents an analysis of audio recordings of risk assessments completed within a primary care mental health service. The analysis is informed by a critical logics approach which, using ideas from discourse theory as well as Lacanian psychoanalysis, involves developing a set of logics to describe, analyse and explain social phenomena. We characterise the assessments as functioning according to social logics of well-oiled administration and preservation, whereby bureaucratic processes are prioritised, contingency ironed out or ignored, and a need to manage potential risks to the service are the dominant operational frames. These logics are considered in terms of their beatific and horrific fantasmatic dimensions, whereby risk assessment is enacted as infallible (beatific) until clients become threats (horrific), creating a range of potential false negatives, false positives and so forth. These processes function to obscure or background problems with risk assessment, by generating practices that favour and offer protection to assessors, at the expense of those being assessed, thus presenting a challenge to the stated aim of risk assessment practice.

  6. Knowledge of risk factors, beliefs and practices of female healthcare ...

    African Journals Online (AJOL)

    Background: Breast cancer is the most common cancer affecting women in Morocco. Screening for early detection has led to reduction in mortality from the disease. It is known that female healthcare professionals have greater influence on women's positive perception of breast cancer and motivation to practice screening ...

  7. Health Risk Screening Practices of Pharmacy and Chemist Shops in ...

    African Journals Online (AJOL)

    Methodology: Fifty two pharmacy and chemist shops were selected using simple random number sampling technique from 120 registered pharmacy and chemist shops in Jos Metropolis. A semi-structured questionnaire, examining the screening practice of the sales persons was interviewer administered to all the sales ...

  8. Practical risk-based decision making: Good decisions made efficiently

    International Nuclear Information System (INIS)

    Haire, M.J.; Guthrie, V.; Walker, D.; Singer, R.

    1995-01-01

    The Robotics and Process Systems Division of the Oak Ridge National Laboratory and the Westinghouse Savannah River Company have teamed with JBF Associates, Inc. to address risk-based robotic planning. The objective of the project is to provide systematic, risk-based relative comparisons of competing alternatives for solving clean-up problems at DOE facilities. This paper presents the methodology developed, describes the software developed to efficiently apply the methodology, and discusses the results of initial applications for DOE. The paper also addresses current work in applying the approach to problems in other industries (including an example from the hydrocarbon processing industry)

  9. A theoretical and practical perspective on the equity risk premium

    NARCIS (Netherlands)

    Salomons, Roelof

    In historical perspective, equity returns have been higher than interest rates but have also varied a good deal more. However, the average excess return has been larger than what could be expected based on classical equilibrium theory: the equity risk premium (ERP) puzzle. This paper has two

  10. Cardiovascular risk calculation | Ker | South African Family Practice

    African Journals Online (AJOL)

    Cardiovascular disease remains a major cause of global mortality and morbidity. Atherosclerosis is the main underlying cause in the majority of cardiovascular disease events. Traditional independent risk factors for car diovascular disease include age, abnormal lipid levels, elevated blood pressure, smoking and elevated ...

  11. Knowledge, Attitude and Practices Towards Risk Factors for ...

    African Journals Online (AJOL)

    Vihar

    reported to be doing physical exercises were 52.35%, smoking 9.54% and drinking alcohol 29.56%. ... necessary to provide education to people so that they can avoid the risk factors hence reduce the .... blood and because parents do.

  12. Managing business model innovation risks - lessons for theory and practice

    DEFF Research Database (Denmark)

    Taran, Yariv; Chester Goduscheit, René; Boer, Harry

    2015-01-01

    approach, arguing from a “no risk no reward” aphorism, a sloppy implementation approach towards business model innovation may result in catastrophic, sometimes even fatal, consequences to a firm’s core business. Based on four unsuccessful business model innovation experiences, which took place in three...

  13. Osteoporosis in clinical practice – bone densitometry and fracture risk

    African Journals Online (AJOL)

    Osteoporosis is a condition of decreased bone mass and bone density associated with an increase in fracture risk. Bone mineral density (BMD) of the lumbar spine and femur can be reliably measured by double-beam X-ray absorptiometry (DEXA), which provides a measure of bone strength. Reduction in BMD is a ...

  14. Osteoporosis and the risk of fracture | | South African Family Practice

    African Journals Online (AJOL)

    Osteoporosis is a skeletal disease characterised by low bone mass and a deterioration of the microarchitecture of bone tissue, leading to an increase in bone fragility and a greater risk of fracture. It is a life-threatening disease, with mortality following hip fracture exceeding mortality after myocardial infarction.1 For women, ...

  15. Asthma in General practice: risk factors and asthma control.

    NARCIS (Netherlands)

    Nieuwenhof, L. van den

    2009-01-01

    Asthma is a chronic, inflammatory, pulmonary disease with a significant impact on patients, their families, and society. When symptomatic asthma is diagnosed, often irreversible changes in the airways have occurred. Therefore it is important to detect persons at high risk of asthma as early as

  16. Probabilistic Risk Assessment (PRA): A Practical and Cost Effective Approach

    Science.gov (United States)

    Lee, Lydia L.; Ingegneri, Antonino J.; Djam, Melody

    2006-01-01

    The Lunar Reconnaissance Orbiter (LRO) is the first mission of the Robotic Lunar Exploration Program (RLEP), a space exploration venture to the Moon, Mars and beyond. The LRO mission includes spacecraft developed by NASA Goddard Space Flight Center (GSFC) and seven instruments built by GSFC, Russia, and contractors across the nation. LRO is defined as a measurement mission, not a science mission. It emphasizes the overall objectives of obtaining data to facilitate returning mankind safely to the Moon in preparation for an eventual manned mission to Mars. As the first mission in response to the President's commitment of the journey of exploring the solar system and beyond: returning to the Moon in the next decade, then venturing further into the solar system, ultimately sending humans to Mars and beyond, LRO has high-visibility to the public but limited resources and a tight schedule. This paper demonstrates how NASA's Lunar Reconnaissance Orbiter Mission project office incorporated reliability analyses in assessing risks and performing design tradeoffs to ensure mission success. Risk assessment is performed using NASA Procedural Requirements (NPR) 8705.5 - Probabilistic Risk Assessment (PRA) Procedures for NASA Programs and Projects to formulate probabilistic risk assessment (PRA). As required, a limited scope PRA is being performed for the LRO project. The PRA is used to optimize the mission design within mandated budget, manpower, and schedule constraints. The technique that LRO project office uses to perform PRA relies on the application of a component failure database to quantify the potential mission success risks. To ensure mission success in an efficient manner, low cost and tight schedule, the traditional reliability analyses, such as reliability predictions, Failure Modes and Effects Analysis (FMEA), and Fault Tree Analysis (FTA), are used to perform PRA for the large system of LRO with more than 14,000 piece parts and over 120 purchased or contractor

  17. Double contingency: A practical example of a risk acceptance philosophy

    International Nuclear Information System (INIS)

    Bazley, J.J.

    1995-01-01

    The double-contingency principle as defined in ANSI/ANS-8.1 specifies that open-quotes Process designs should, in general, incorporate sufficient factors of safety to require at least two unlikely, independent, and concurrent changes in process conditions before a criticality accident is possible.close quotes The following practical example has been used to familiarize plant operators and managers and train criticality safety engineers in double contingency

  18. Privacy Threats and Practical Solutions for Genetic Risk Tests

    OpenAIRE

    Barman, Ludovic; El Graini, Mohammed-Taha; Raisaro, Jean Louis; Ayday, Erman; Hubaux, Jean-Pierre

    2015-01-01

    Recently, several solutions have been proposed to address the complex challenge of protecting individuals’ genetic data during personalized medicine tests. In this short paper, we analyze different privacy threats and propose simple countermeasures for the generic architecture mainly used in the literature. In particular, we present and evaluate a new practical solution against a critical attack of a malicious medical center trying to actively infer raw genetic information of patients.

  19. Linking Risk Management Practices and Strategies to Performance

    OpenAIRE

    Wieland, Andreas; Wallenburg, Carl Marcus

    2014-01-01

    Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG geförderten) Allianz- bzw. Nationallizenz frei zugänglich. This publication is with permission of the rights owner freely accessible due to an Alliance licence and a national licence (funded by the DFG, German Research Foundation) respectively. Purpose – The effects of supply chain risk management (SCRM) on the performance of a supply chain remain unexplored. It is assumed that SCRM helps supply chains to cope with...

  20. Knowledge, Attitude and Practice towards Screening and Risk ...

    African Journals Online (AJOL)

    In the past one week, 40(14.3%) said they were totally physically inactive for at least 30 minutes per day, while 69(24.6%) and 82(29.3%) of respondents took fast food confectionaries and sugar containing drinks respectively for at least more than once a day. Conclusion: The study group is at risk of developing DM. There is ...

  1. Governance implications of nanomaterials companies' inconsistent risk perceptions and safety practices

    Science.gov (United States)

    Engeman, Cassandra D.; Baumgartner, Lynn; Carr, Benjamin M.; Fish, Allison M.; Meyerhofer, John D.; Satterfield, Terre A.; Holden, Patricia A.; Harthorn, Barbara Herr

    2012-03-01

    Current research on the nanotechnology industry indicates its downstream expansion at a rapid pace, while toxicological research and best practices for environmental health and safety are still being developed. Companies that use and/or produce engineered nanomaterials (ENMs) have enormous potential to influence safe-handling practices for ENMs across the product life cycle. Knowledge of both industry practices and leaders' perceptions of risk is vital for understanding how companies will act to control potential environmental and health risks. This article reports results from a new international survey of nanomaterials companies in 14 countries. In this survey, company participants reported relatively high levels of uncertainty and/or perceived risk with regard to ENMs. However, these perspectives were not accompanied by expected risk-avoidant practices or preferences for regulatory oversight. A majority of companies indicated "lack of information" as a significant impediment to implementing nano-specific safety practices, but they also reported practices that were inconsistent with widely available guidance. Additionally, in the absence of safe-handling regulations, companies reported nano-specific health and safety programs that were narrow in scope. Taken together, these findings indicate that health and safety guidance is not reaching industry. While industry leaders' reluctance toward regulation might be expected, their own reported unsafe practices and recognition of possible risks suggest a more top-down approach from regulators is needed to protect workers and the environment.

  2. Governance implications of nanomaterials companies' inconsistent risk perceptions and safety practices

    Energy Technology Data Exchange (ETDEWEB)

    Engeman, Cassandra D. [University of California, Santa Barbara, Department of Sociology (United States); Baumgartner, Lynn; Carr, Benjamin M.; Fish, Allison M.; Meyerhofer, John D. [UC Center for the Environmental Implications of Nanotechnology (UC CEIN), University of California, Santa Barbara (United States); Satterfield, Terre A. [University of California, Santa Barbara, NSF Center for Nanotechnology and Society (United States); Holden, Patricia A. [UC Center for the Environmental Implications of Nanotechnology (UC CEIN), University of California, Santa Barbara (United States); Harthorn, Barbara Herr, E-mail: harthorn@cns.ucsb.edu [University of California, Santa Barbara, NSF Center for Nanotechnology and Society (United States)

    2012-03-15

    Current research on the nanotechnology industry indicates its downstream expansion at a rapid pace, while toxicological research and best practices for environmental health and safety are still being developed. Companies that use and/or produce engineered nanomaterials (ENMs) have enormous potential to influence safe-handling practices for ENMs across the product life cycle. Knowledge of both industry practices and leaders' perceptions of risk is vital for understanding how companies will act to control potential environmental and health risks. This article reports results from a new international survey of nanomaterials companies in 14 countries. In this survey, company participants reported relatively high levels of uncertainty and/or perceived risk with regard to ENMs. However, these perspectives were not accompanied by expected risk-avoidant practices or preferences for regulatory oversight. A majority of companies indicated 'lack of information' as a significant impediment to implementing nano-specific safety practices, but they also reported practices that were inconsistent with widely available guidance. Additionally, in the absence of safe-handling regulations, companies reported nano-specific health and safety programs that were narrow in scope. Taken together, these findings indicate that health and safety guidance is not reaching industry. While industry leaders' reluctance toward regulation might be expected, their own reported unsafe practices and recognition of possible risks suggest a more top-down approach from regulators is needed to protect workers and the environment.

  3. Governance implications of nanomaterials companies’ inconsistent risk perceptions and safety practices

    International Nuclear Information System (INIS)

    Engeman, Cassandra D.; Baumgartner, Lynn; Carr, Benjamin M.; Fish, Allison M.; Meyerhofer, John D.; Satterfield, Terre A.; Holden, Patricia A.; Harthorn, Barbara Herr

    2012-01-01

    Current research on the nanotechnology industry indicates its downstream expansion at a rapid pace, while toxicological research and best practices for environmental health and safety are still being developed. Companies that use and/or produce engineered nanomaterials (ENMs) have enormous potential to influence safe-handling practices for ENMs across the product life cycle. Knowledge of both industry practices and leaders’ perceptions of risk is vital for understanding how companies will act to control potential environmental and health risks. This article reports results from a new international survey of nanomaterials companies in 14 countries. In this survey, company participants reported relatively high levels of uncertainty and/or perceived risk with regard to ENMs. However, these perspectives were not accompanied by expected risk-avoidant practices or preferences for regulatory oversight. A majority of companies indicated “lack of information” as a significant impediment to implementing nano-specific safety practices, but they also reported practices that were inconsistent with widely available guidance. Additionally, in the absence of safe-handling regulations, companies reported nano-specific health and safety programs that were narrow in scope. Taken together, these findings indicate that health and safety guidance is not reaching industry. While industry leaders’ reluctance toward regulation might be expected, their own reported unsafe practices and recognition of possible risks suggest a more top-down approach from regulators is needed to protect workers and the environment.

  4. Risk measures in practical use: risk reduction has its price, but is it known?

    International Nuclear Information System (INIS)

    Reinertsen, Rune

    1995-01-01

    Different risk measures are discussed in order to decide which to use to best express the risk workers are exposed to. A new risk measure is introduced and advantages and disadvantages are presented. The need for a new risk measure (Expected Number of Fatalities Rate ENFR), is discussed and explained with the help of an example. The example also contains a comparison with the well-known FAR-value. Also some problems and benefits of introducing a measure of the kind: ΔRISK/Δ$ are discussed and conclusions made. The question of what amount of money should be used on risk reducing activities is also addressed

  5. Cost-effectiveness of cardiovascular risk management by practice nurses in primary care

    NARCIS (Netherlands)

    Tiessen, Ans H.; Vermeulen, Karin M.; Broer, Jan; Smit, Andries J.; van der Meer, Klaas

    2013-01-01

    Background: Cardiovascular disease (CVD) is largely preventable and prevention expenditures are relatively low. The randomised controlled SPRING-trial (SPRING-RCT) shows that cardiovascular risk management by practice nurses in general practice with and without self-monitoring both decreases

  6. Inappropriate complementary feeding practice increases risk of stunting in children aged 12-24 months

    Directory of Open Access Journals (Sweden)

    Hijra Hijra

    2016-12-01

    Inappropriate complementary feeding practice increased the risk of stunting in 12-24 months old children by 8.26. This study confirms the need to scale up interventions during the first 2 years of life, including appropriate infant feeding practices.

  7. Risk informed decisions and regulations - STUK's policy and current practice

    International Nuclear Information System (INIS)

    Julin, A.; Niemalae, I.; Virolainen, R.

    2001-01-01

    Consideration of severe accidents beyond the traditional design basis, including full core melt accidents, has become an important ingredient of regulatory process in Finland. Accordingly, plant-specific level-1 and level-2 PSA studies are a regulatory requirement. These studies are being used in a living fashion both at the utilities and STUK. Plant specific living PSAs have been completed for all operating Finnish plants, including internal initiators, fires, flooding, harsh weather conditions seismic events for operation mode and internal events for low power mode. Many specific applications of the Living PSA have already been introduced but some are still waiting for further development such as Risk Informed ISI, IST and Tech Specs. Examples of safety issues, for which the PSA insights give an improved basis for decisions, are approvals of plant modifications and resolution of testing, inspection and maintenance strategies. PSA insights are also of value in assessing meaningfulness of requirements which are based on traditional engineering judgement but do not form an essential part of defence-in-depth concept. Examples of such requirements are details of safety classification and many Technical Specification requirements. STUK has recently conducted a pilot study on risk-informed ISI. The aim of the study was to explore how the plant specific PSAs could best be used for assessment of the ISI programmes. This paper discusses the findings obtained during the pilot study on risk-informed ISI of pipings. The study produced essential insights of the applied method. Furthermore, the study gave guidance to extract items for further development. Based on these results and overall experience the general suitability of the method for further application is evaluated. (author)

  8. Analysis of the effect of corporate governance attributes on risk management practices

    Directory of Open Access Journals (Sweden)

    Raef Gouiaa

    2018-03-01

    Full Text Available Despite recent increased risk research attention being focussed on the Canadian and international scene, there are few research studies that specifically address the relation between corporate governance systems and risk management practices. This paper examines the relation between corporate governance systems and enterprise risk management. More specifically, we analyze how corporate governance attributes and particularly board characteristics can affect risk management practices in the context of Canadian listed companies. Using a content analysis approach, the level of exposure to risk in terms of likelihood, the consequences of such risk and the strategies for managing that risk were identified for each type of risk. The results reveal that corporate governance attributes related to board’s structure, directors’ characteristics and the board's operating process play a significant and important role in establishing an integrative risk management approach. The results show that directors’ characteristics and the board's process significantly determine the quality of risk management through the level of risk-taking in decisions, especially in terms of financial risks.

  9. The fear factor of risk - clinical governance and midwifery talk and practice in the UK.

    Science.gov (United States)

    Scamell, Mandie

    2016-07-01

    Through the critical application of social theory, this paper will scrutinise how the operations of risk management help to constitute midwives׳ understandings of childbirth in a particular way. Drawing from rich ethnographic data, collected in the southeast of England, the paper presents empirical evidence to critically explore how institutional concerns around risk and risk management impact upon the way midwives can legitimately imagine and manage labour and childbirth. Observational field notes, transcribed interviews with various midwives, along with material culture in the form of documentary evidence will be used to explore the unintended consequences of clinical governance and its risk management technologies. Through this analysis the fear factor of risk in midwifery talk and practice will be introduced to provide an insight into how risk management impacts midwifery practice in the UK. Copyright © 2016. Published by Elsevier Ltd.

  10. Assessing the risk of recurrent venous thromboembolism – a practical approach

    Science.gov (United States)

    Fahrni, Jennifer; Husmann, Marc; Gretener, Silvia B; Keo, Hong H

    2015-01-01

    Recurrent venous thromboembolism (VTE) is associated with increased morbidity and mortality. This risk is lowered by anticoagulation, with a large effect in the initial phase following the venous thromboembolic event, and with a smaller effect in terms of secondary prevention of recurrence when extended anticoagulation is performed. On the other hand, extended anticoagulation is associated with an increased risk of major bleeding and thus leads to morbidity and mortality. Therefore, it is necessary to assess the risk of recurrence for VTE on an individual basis, and a recommendation for secondary prophylaxis should be specifically based on risk calculation of recurrence of VTE and bleeding. In this review, we provide a comprehensive summary of relevant risk factors for recurrent VTE and a practical approach for assessing the risk of recurrence in daily practice. PMID:26316770

  11. Assessing the risk of recurrent venous thromboembolism--a practical approach.

    Science.gov (United States)

    Fahrni, Jennifer; Husmann, Marc; Gretener, Silvia B; Keo, Hong H

    2015-01-01

    Recurrent venous thromboembolism (VTE) is associated with increased morbidity and mortality. This risk is lowered by anticoagulation, with a large effect in the initial phase following the venous thromboembolic event, and with a smaller effect in terms of secondary prevention of recurrence when extended anticoagulation is performed. On the other hand, extended anticoagulation is associated with an increased risk of major bleeding and thus leads to morbidity and mortality. Therefore, it is necessary to assess the risk of recurrence for VTE on an individual basis, and a recommendation for secondary prophylaxis should be specifically based on risk calculation of recurrence of VTE and bleeding. In this review, we provide a comprehensive summary of relevant risk factors for recurrent VTE and a practical approach for assessing the risk of recurrence in daily practice.

  12. THE THEORETHICAL APPROACH AND PRACTICE OF CONTROLLING AND BUSSINESS RISK

    Directory of Open Access Journals (Sweden)

    István HÁGEN

    2015-07-01

    Full Text Available Achieving the controlling approach at the companies has the obvious advantage that it is getting easier to exactly define the strategic and operative objectives, the planning system encourages the increase of performance and the decrease of costs and it helps by comparing plan-fact data. By defining the indices and continuous monitoring it is easier to get the fact data closer to the plans, so in case of careful planning business risk can be reduced. With the application of the controlling approach enterprises can be made economical, efficient and effective, so the activity naturally involving several risks, namely weather conditions, biological hazards, can be made more predictable. To sum up, the application of the Balanced Scorecard at the enterprises on the one hand helps short-term profitability and on the other hand designates what to do to reach long-term financial profitability and competitiveness. The objective of the research was to conduct a survey via questionnaires suitable for analysis as well as relevant deep interviews among the small and medium sized enterprises from different branches in the Carpathian Basin.

  13. Current knowledge on radon risk. Implications for practical radiation protection?

    International Nuclear Information System (INIS)

    Mueller, Wolfgang-Ulrich; Giussani, Augusto; Kreuzer, Michaela; Sobotzki, Christina; Ruehm, Werner; Lecomte, Jean-Francois; Harrison, John; Breckow, Joachim

    2016-01-01

    ICRP suggested a strategy based on the distinction between a protection approach for dwellings and one for workplaces in the previous recommendations on radon. Now, the Commission recommends an integrated approach for the protection against radon exposure in all buildings irrespective of their purpose and the status of their occupants. The strategy of protection in buildings, implemented through a national action plan, is based on the application of the optimisation principle below a derived reference level in concentration (maximum 300 Bq m -3 ). A problem, however, arises that due to new epidemiological findings and application of dosimetric models, ICRP 115 (Ann ICRP 40, 2010) presents nominal probability coefficients for radon exposure that are approximately by a factor of 2 larger than in the former recommendations of ICRP 65 (Ann ICRP 23, 1993). On the basis of the so-called epidemiological approach and the dosimetric approach, the doubling of risk per unit exposure is represented by a doubling of the dose coefficients, while the risk coefficient of ICRP 103 (2007) remains unchanged. Thus, an identical given radon exposure situation with the new dose coefficients would result in a doubling of dose compared with the former values. This is of serious conceptual implications. A possible solution of this problem was presented during the workshop. (orig.)

  14. Current knowledge on radon risk. Implications for practical radiation protection?

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, Wolfgang-Ulrich [Universitaetsklinikum Essen, Institut fuer Medizinische Strahlenbiologie, Essen (Germany); Giussani, Augusto; Kreuzer, Michaela; Sobotzki, Christina [Federal Office for Radiation Protection, Oberschleissheim (Germany); Ruehm, Werner [German Research Center for Environmental Health, Institute of Radiation Protection, Helmholtz Zentrum Muenchen, Neuherberg (Germany); Lecomte, Jean-Francois [International Affaires Directorate, Institut de Radioprotection et de Surete Nucleaire, P.O. Box 17, Fontenay-aux-Roses (France); Harrison, John [Oxford Brookes University, Faculty of Health and Life Sciences, Oxford (United Kingdom); Breckow, Joachim [THM University of Applied Sciences, Institute of Medical Physics and Radiation Protection, Giessen (Germany)

    2016-08-15

    ICRP suggested a strategy based on the distinction between a protection approach for dwellings and one for workplaces in the previous recommendations on radon. Now, the Commission recommends an integrated approach for the protection against radon exposure in all buildings irrespective of their purpose and the status of their occupants. The strategy of protection in buildings, implemented through a national action plan, is based on the application of the optimisation principle below a derived reference level in concentration (maximum 300 Bq m{sup -3}). A problem, however, arises that due to new epidemiological findings and application of dosimetric models, ICRP 115 (Ann ICRP 40, 2010) presents nominal probability coefficients for radon exposure that are approximately by a factor of 2 larger than in the former recommendations of ICRP 65 (Ann ICRP 23, 1993). On the basis of the so-called epidemiological approach and the dosimetric approach, the doubling of risk per unit exposure is represented by a doubling of the dose coefficients, while the risk coefficient of ICRP 103 (2007) remains unchanged. Thus, an identical given radon exposure situation with the new dose coefficients would result in a doubling of dose compared with the former values. This is of serious conceptual implications. A possible solution of this problem was presented during the workshop. (orig.)

  15. On the Need for Rethinking Current Practice that Highlights Goal Achievement Risk in an Enterprise Context.

    Science.gov (United States)

    Aven, Eyvind; Aven, Terje

    2015-09-01

    This article addresses the issue of how performance and risk management can complement each other in order to enhance the management of an enterprise. Often, we see that risk management focuses on goal achievements and not the enterprise risk related to its activities in the value chain. The statement "no goal, no risk" is a common misconception. The main aim of the article is to present a normative model for describing the links between performance and risk, and to use this model to give recommendations on how to best structure and plan the management of an enterprise in situations involving risk and uncertainties. The model, which has several novel features, is based on the interaction between different types of risk management (enterprise risk management, task risk management, and personal risk management) and a structure where the enterprise risk management overrules both the task and personal risk management. To illustrate the model we use the metaphor of a ship, where the ship is loaded with cash-generating activities and has a direction over time determined by the overall strategic objectives. Compared to the current enterprise risk management practice, the model and related analysis are founded on a new perspective on risk, highlighting knowledge and uncertainties beyond probabilities. © 2015 Society for Risk Analysis.

  16. Managing health and safety risks: Implications for tailoring health and safety management system practices.

    Science.gov (United States)

    Willmer, D R; Haas, E J

    2016-01-01

    As national and international health and safety management system (HSMS) standards are voluntarily accepted or regulated into practice, organizations are making an effort to modify and integrate strategic elements of a connected management system into their daily risk management practices. In high-risk industries such as mining, that effort takes on added importance. The mining industry has long recognized the importance of a more integrated approach to recognizing and responding to site-specific risks, encouraging the adoption of a risk-based management framework. Recently, the U.S. National Mining Association led the development of an industry-specific HSMS built on the strategic frameworks of ANSI: Z10, OHSAS 18001, The American Chemistry Council's Responsible Care, and ILO-OSH 2001. All of these standards provide strategic guidance and focus on how to incorporate a plan-do-check-act cycle into the identification, management and evaluation of worksite risks. This paper details an exploratory study into whether practices associated with executing a risk-based management framework are visible through the actions of an organization's site-level management of health and safety risks. The results of this study show ways that site-level leaders manage day-to-day risk at their operations that can be characterized according to practices associated with a risk-based management framework. Having tangible operational examples of day-to-day risk management can serve as a starting point for evaluating field-level risk assessment efforts and their alignment to overall company efforts at effective risk mitigation through a HSMS or other processes.

  17. Risk Management Practices in Islamic Bank: A Case Study of Islami Bank Bangladesh Limited

    OpenAIRE

    Uddin, Md Akther

    2015-01-01

    Islamic banking industry has been growing rapidly for last three decades. As risk is inherent in banking business it is necessary to develop a comprehensive risk management framework and process. In this paper, a humble attempt has been made to study and analyze risk management practices of Islami Bank Bangladesh Limited (IBBL), one of the leading Islamic banks in Bangaladesh. Annual reports of IBBL and 7 other full-fledged Islamic banks, Bangladesh Bank, the central bank of Bangladesh, publi...

  18. COMPARISON OF TRENDS IN RISK MANAGEMENT THEORY AND PRACTICES WITHIN THE CONSTRUCTION INDUSTRY

    OpenAIRE

    Dena Crnković; Mladen Vukomanović

    2016-01-01

    This study considered the problem of understanding and use of risk management methods in construction projects and their representation in the literature and their practical application. Research of trends in risk management was conducted using studies from the EBSCO database that were published in the period from 1999 to 2015. The focus included the development of two terms, namely traditional and holistic approach to risk management as well as to uncertainty and opportunity management. The ...

  19. Perioperative pulmonary aspiration is infrequent and low risk in pediatric anesthetic practice.

    Science.gov (United States)

    Kelly, Christopher J; Walker, Robert W M

    2015-01-01

    Recent studies have reported perioperative pulmonary aspiration in pediatric practice to be an uncommon problem associated with low morbidity and mortality. This paper examines the recent publications in both the adult and pediatric literature and looks at some of the potential risk factors involved, both patient and anesthetic, in the development of aspiration of gastric contents. We also look at the risk of severe morbidity following pulmonary aspiration and speculate on possible reasons behind the assertion that pulmonary aspiration in pediatric anesthetic practice is rare and a low-risk event. © 2014 John Wiley & Sons Ltd.

  20. Risk-averse purchasing behavior of female dentists and innovation in dental practice

    Directory of Open Access Journals (Sweden)

    James J McGrath

    2015-01-01

    Full Text Available Introduction: The aim of this study was to see if there was any correlation between the variables of age, gender, practice location and longevity, and type of practice on the risk-taking behavior of dentists in Connecticut. Risk-taking behavior was defined as the willingness to adopt new technologies. A questionnaire was used to gather data, and a series of questions were then posed to estimate the degree to which the responding dentists would be willing to implement the technology into their practices. Materials and Methods: Three hundred Connecticut dentists were randomly selected from a list of dentists that was provided by Benco Dental Supply Company. A questionnaire was written and mailed to all 300 dentists with a return envelope inside. One hundred twenty-nine dentists responded. The questionnaire contained questions to gather demographic information about the respondents. It posed a hypothetical situation that described a new imaging technology that was recently brought into the market. The only differences between this technology and current imaging machines were that it did not emit any radiation, and it was twice as expensive as comparable imaging technologies. A risk score was calculated based on the responses to the three main questions. Those who would adopt the technology quickly or immediately received higher risk scores, and those who would wait or would not buy the technology at all received low risk scores. The data were then analyzed with SPSS software to detect if there were statistically significant differences between different groups of dentists. Results: Male dentists were found to have higher risk scores than their female counterparts. Men in the 30-39-years age range had the highest risk scores, while women in this age range had the lowest. As age increased, the difference between the sexes decreased. Specialists were found to have higher risk scores compared to general dentists of the same gender; however, male

  1. Omalizumab: Practical considerations regarding the risk of anaphylaxis

    Directory of Open Access Journals (Sweden)

    Kim Harold L

    2010-12-01

    Full Text Available Abstract Omalizumab has demonstrated efficacy among patients with moderate to severe persistent allergic asthma, whose symptoms are inadequately controlled with other controller agents. This therapy is generally well tolerated, but there are some safety considerations, the most important of which is the rare, but potentially life-threatening, occurrence of omalizumab-associated anaphylaxis. In Canada, data from the manufacturer of omalizumab indicate that the frequency of anaphylaxis attributed to Xolair in post-marketing use is approximately 0.2%. Other researchers, including the American Omalizumab Joint Task Force (OJTF, have suggested a lower overall frequency of 0.09%. This paper provides a summary of the epidemiologic research carried out to date and presents a concise, practical set of recommendations for the prevention, monitoring and management of omalizumab-associated anaphylaxis. Prevention tips include advice on patient education measures, concomitant medications and optimal administration. For the first three injections, the recommendation is to monitor in clinic for two hours after the omalizumab injection; for subsequent injections, the monitoring period should be 30 minutes or an appropriate time agreed upon by the individual patient and healthcare professional. In the event that a patient does experience omalizumab-associated anaphylaxis, the paper provides recommendations for handling the situation in-clinic and recommendations on how to counsel patients to recognize the potential signs and symptoms in the community and react appropriately.

  2. Risk of contamination of nasal sprays in otolaryngologic practice

    Directory of Open Access Journals (Sweden)

    Akkuzu Babur

    2007-03-01

    Full Text Available Abstract Background Reusable nasal-spray devices are frequently used in otolaryngologic examinations, and there is an increasing concern about the risk of cross-contamination from these devices. The aim of our study was to determine, by means of microbiologic analysis, the safety of a positive-displacement or pump-type atomizer after multiple uses. Methods A reusable nasal spray bottle, pump, and tips were used in the nasal physical examination of 282 patients admitted to a tertiary otolaryngology clinic. The effectiveness of 2 different methods of prophylaxis against microbiologic contamination (the use of protective punched caps or rinsing the bottle tip with alcohol was compared with that of a control procedure. Results Although there was no statistically significant difference in positive culture rates among the types of nasal spray bottles tested, methicillin-resistant coagulase-negative staphylococci were isolated in 4 of 198 cultures. Conclusion Given these findings, we concluded that additional precautions (such as the use of an autoclave between sprays, disposable tips, or disposable devices are warranted to avoid interpatient cross-contamination from a reusable nasal spray device.

  3. Risk Assessment in the UK Health and Safety System: Theory and Practice

    Directory of Open Access Journals (Sweden)

    Karen Russ

    2010-09-01

    Full Text Available In the UK, a person or organisation that creates risk is required to manage and control that risk so that it is reduced 'So Far As Is Reasonably Practicable' (SFAIRP. How the risk is managed is to be determined by those who create the risk. They have a duty to demonstrate that they have taken action to ensure all risk is reduced SFAIRP and must have documentary evidence, for example a risk assessment or safety case, to prove that they manage the risks their activities create. The UK Health and Safety Executive (HSE does not tell organisations how to manage the risks they create but does inspect the quality of risk identification and management. This paper gives a brief overview of where responsibility for occupational health and safety lies in the UK, and how risk should be managed through risk assessment. The focus of the paper is three recent major UK incidents, all involving fatalities, and all of which were wholly avoidable if risks had been properly assessed and managed. The paper concludes with an analysis of the common failings of risk assessments and key actions for improvement.

  4. Risk Assessment in the UK Health and Safety System: Theory and Practice.

    Science.gov (United States)

    Russ, Karen

    2010-09-01

    In the UK, a person or organisation that creates risk is required to manage and control that risk so that it is reduced 'So Far As Is Reasonably Practicable' (SFAIRP). How the risk is managed is to be determined by those who create the risk. They have a duty to demonstrate that they have taken action to ensure all risk is reduced SFAIRP and must have documentary evidence, for example a risk assessment or safety case, to prove that they manage the risks their activities create. The UK Health and Safety Executive (HSE) does not tell organisations how to manage the risks they create but does inspect the quality of risk identification and management. This paper gives a brief overview of where responsibility for occupational health and safety lies in the UK, and how risk should be managed through risk assessment. The focus of the paper is three recent major UK incidents, all involving fatalities, and all of which were wholly avoidable if risks had been properly assessed and managed. The paper concludes with an analysis of the common failings of risk assessments and key actions for improvement.

  5. Food parenting practices and their association with child nutrition risk status: comparing mothers and fathers.

    Science.gov (United States)

    Watterworth, Jessica C; Hutchinson, Joy M; Buchholz, Andrea C; Darlington, Gerarda; Randall Simpson, Janis A; Ma, David W L; Haines, Jess

    2017-06-01

    In Canada, little is known about how food parenting practices are associated with young children's dietary intakes and no studies have examined food parenting practices of Canadian fathers. This study aimed to examine associations between food parenting practices and preschool-age children's nutrition risk. We conducted a cross-sectional analysis of thirty-one 2-parent families; 31 mothers, 31 fathers, and 40 preschool-age children. Parents completed an adapted version of the Comprehensive Feeding Practices Questionnaire. We calculated children's nutrition risk using their NutriSTEP score. To account for sibling association, we used generalized estimating equations, adjusting for child age, sex, household income, and parental body mass index. Both mothers' and fathers' involvement of children in meal preparation were associated with lower child nutrition risk (mother [Formula: see text] = -3.45, p = 0.02; father [Formula: see text] = -1.74, p = 0.01), as were their healthy home environment scores (mother [Formula: see text] = -8.36, p food as a reward was associated with higher nutrition risk ([Formula: see text] = 4.67, p food parenting practices are associated with their children's nutrition status. Fathers should be included in food parenting practices interventions.

  6. Corporate risk tolerance and capital allocation: A practical approach to implementing an exploration risk policy

    International Nuclear Information System (INIS)

    Walls, M.R.

    1995-01-01

    Petroleum exploration companies are confronted regularly with the issue of allocating scarce capital among a set of available exploration projects, which are generally characterized by a high degree of financial risk and uncertainty. Commonly used methods for evaluating alternative investments consider the amount and timing of the monetary flows associated with a project and ignore the firm's ability or willingness to assume the business risk of the project. The preference-theory approach combines the traditional means of project valuation, net present value (NPV) analysis, with a decision-science-based approach to risk management. This integrated model provides a means for exploration firms to measure and to manage the financial risks associated with petroleum exploration, consistent with the firm's desired risk policy

  7. COMPARISON OF TRENDS IN RISK MANAGEMENT THEORY AND PRACTICES WITHIN THE CONSTRUCTION INDUSTRY

    Directory of Open Access Journals (Sweden)

    Dena Crnković

    2016-12-01

    Full Text Available This study considered the problem of understanding and use of risk management methods in construction projects and their representation in the literature and their practical application. Research of trends in risk management was conducted using studies from the EBSCO database that were published in the period from 1999 to 2015. The focus included the development of two terms, namely traditional and holistic approach to risk management as well as to uncertainty and opportunity management. The trend of leading standards in the field of project management, PMBoK and ISO 31000 indicated full support for the modernization of risk management that focused on the risks as well as potential opportunities in the project. The findings also revealed that the global practices continued to lack awareness of risk management and its benefits for project goals. A similar situation was found in Croatia by observing project management practices in two case studies, namely Project Zagrebačka obala in Rijeka and a Project of SEECEL Zagreb. Primarily, the lack of education and communication between experts are important issues requiring attention in practice and academics. It is necessary to gradually introduce standards over time to prepare for progress in managing uncertainties and adopting more holistic approaches.

  8. Management of occupational health risks in small-animal veterinary practices.

    Science.gov (United States)

    D'Souza, Eva; Barraclough, Richard; Fishwick, David; Curran, Andrew

    2009-08-01

    Small-animal work is a major element of veterinary practice in the UK and may be hazardous, with high levels of work-related injuries and ill-health reported in Australia and USA. There are no studies addressing the management of occupational health risks arising from small-animal work in the UK. To investigate the sources of health and safety information used and how health and safety and 12 specific occupational health risks are managed by practices. A cross-sectional postal survey of all small-animal veterinary practices in Hampshire. A response was mandatory as this was a Health & Safety Executive (HSE) inspection activity. A total of 118 (100%) practices responded of which 93 were eligible for inclusion. Of these, 99 and 86%, respectively, were aware of the Royal College of Veterinary Surgeons (RCVS) practice standards and had British Small Animal Veterinary Association (BSAVA) staff members, while only 51% had previous contact with HSE (publications, advice and visit). Ninety per cent had health and safety policies, but only 31% had trained responsible staff in health and safety. Specific health hazards such as occupational allergens and computer use were relatively overlooked both by practices and the RCVS/BSAVA guidance available in 2002. Failings in active health risk management systems could be due to a lack of training to ensure competence in those with responsibilities. Practices rely on guidance produced by their professional bodies. Current RCVS guidance, available since 2005, has remedied some previous omissions, but further improvements are recommended.

  9. Association Between Mind-Body Practice and Cardiometabolic Risk Factors: The Rotterdam Study.

    Science.gov (United States)

    Younge, John O; Leening, Maarten J G; Tiemeier, Henning; Franco, Oscar H; Kiefte-de Jong, Jessica; Hofman, Albert; Roos-Hesselink, Jolien W; Hunink, M G Myriam

    2015-09-01

    The increased popularity of mind-body practices highlights the need to explore their potential effects. We determined the cross-sectional association between mind-body practices and cardiometabolic risk factors. We used data from 2579 participants free of cardiovascular disease from the Rotterdam Study (2009-2013). A structured home-based interview was used to evaluate engagement in mind-body practices including meditation, yoga, self-prayer, breathing exercises, or other forms of mind-body practice. We regressed engagement in mind-body practices on cardiometabolic risk factors (body mass index, blood pressure, and fasting blood levels of cholesterol, triglycerides, and glucose) and presence of metabolic syndrome. All analyses were adjusted for age, sex, educational level, smoking, alcohol consumption, (in)activities in daily living, grief, and depressive symptoms. Fifteen percent of the participants engaged in a form of mind-body practice. Those who did mind-body practices had significantly lower body mass index (β = -0.84 kg/m, 95% confidence interval [CI] = -1.30 to -0.38, p triglyceride levels (β = -0.02, 95% CI = -0.04 to -0.001, p = .037), and log-transformed fasting glucose levels (β = -0.01, 95% CI = -0.02 to -0.004, p = .004). Metabolic syndrome was less common among individuals who engaged in mind-body practices (odds ratio = 0.71, 95% CI = 0.54-0.95, p = .019). Individuals who do mind-body practices have a favorable cardiometabolic risk profile compared with those who do not. However, the cross-sectional design of this study does not allow for causal inference and prospective, and intervention studies are needed to elucidate the association between mind-body practices and cardiometabolic processes.

  10. Underreporting of high-risk water and sanitation practices undermines progress on global targets.

    Science.gov (United States)

    Vedachalam, Sridhar; MacDonald, Luke H; Shiferaw, Solomon; Seme, Assefa; Schwab, Kellogg J

    2017-01-01

    Water and sanitation indicators under the Millennium Development Goals failed to capture high-risk practices undertaken on a regular basis. In conjunction with local partners, fourteen rounds of household surveys using mobile phones with a customized open-source application were conducted across nine study geographies in Asia and Africa. In addition to the main water and sanitation facilities, interviewees (n = 245,054) identified all water and sanitation options regularly used for at least one season of the year. Unimproved water consumption and open defecation were targeted as high-risk practices. We defined underreporting as the difference between the regular and main use of high-risk practices. Our estimates of high-risk practices as the main option matched the widely accepted Demographic and Health Surveys (DHS) estimates within the 95% confidence interval. However, estimates of these practices as a regular option was far higher than the DHS estimates. Across the nine geographies, median underreporting of unimproved water use was 5.5%, with a range of 0.5% to 13.9%. Median underreporting of open defecation was much higher at 9.9%, with a range of 2.7% to 11.5%. This resulted in an underreported population of 25 million regularly consuming unimproved water and 50 million regularly practicing open defecation. Further examination of data from Ethiopia suggested that location and socio-economic factors were significant drivers of underreporting. Current global monitoring relies on a framework that considers the availability and use of a single option to meet drinking water and sanitation needs. Our analysis demonstrates the use of multiple options and widespread underreporting of high-risk practices. Policies based on current monitoring data, therefore, fail to consider the range of challenges and solutions to meeting water and sanitation needs, and result in an inflated sense of progress. Mobile surveys offer a cost-effective and innovative platform to rapidly

  11. Climate Change Risk Management Consulting: The opportunity for an independent business practice

    Science.gov (United States)

    Ciccozzi, R.

    2009-04-01

    The Paper outlines the main questions to be addressed with reference to the actual demand of climate change risk management consulting, in the financial services. Moreover, the Project shall also try to investigate if the Catastrophe Modelling Industry can start and manage a business practice specialised on climate change risk exposures. In this context, the Paper aims at testing the possibility to build a sound business case, based upon typical MBA course analysis tools, such as PEST(LE), SWOT, etc. Specific references to the tools to be used and to other contribution from academic literature and general documentation are also discussed in the body of the Paper and listed at the end. The analysis shall also focus on the core competencies required for an independent climate change risk management consulting business practice, with the purpose to outline a valid definition of how to achieve competitive advantage in climate change risk management consulting.

  12. PDA survey of quality risk management practices in the pharmaceutical, devices, & biotechnology industries.

    Science.gov (United States)

    Ahmed, Ruhi; Baseman, Harold; Ferreira, Jorge; Genova, Thomas; Harclerode, William; Hartman, Jeffery; Kim, Samuel; Londeree, Nanette; Long, Michael; Miele, William; Ramjit, Timothy; Raschiatore, Marlene; Tomonto, Charles

    2008-01-01

    In July 2006 the Parenteral Drug Association's Risk Management Task Force for Aseptic Processes, conducted an electronic survey of PDA members to determine current industry practices regarding implementation of Quality Risk Management in their organizations. This electronic survey was open and publicly available via the PDA website and targeted professionals in our industry who are involved in initiating, implementing, or reviewing risk management programs or decisions in their organizations. One hundred twenty-nine members participated and their demographics are presented in the sidebar "Correspondents Profile". Among the major findings are: *The "Aseptic Processing/Filling" operation is the functional area identified as having the greatest need for risk assessment and quality risk management. *The most widely used methodology in industry to identify risk is Failure Mode and Effects Analysis (FMEA). This tool was most widely applied in assessing change control and for adverse event, complaint, or failure investigations. *Despite the fact that personnel training was identified as the strategy most used for controlling/minimizing risk, the largest contributors to sterility failure in operations are still "Personnel". *Most companies still rely on "Manufacturing Controls" to mitigate risk and deemed the utilization of Process Analytical Technology (PAT) least important in this aspect. *A majority of correspondents verified that they did not periodically assess their risk management programs. *A majority of the correspondents desired to see case studies or examples of risk analysis implementation (as applicable to aseptic processing) in future PDA technical reports on risk management.

  13. Feeding practices and potential risk factors for laminitis in dairy cows in Thailand

    OpenAIRE

    Pilachai, R.

    2013-01-01

    Laminitis is considered an important health problem facing the Thai dairy industry. Although the etiology of laminitis is multifactorial, nutrition is considered an important risk factor. Rumen acidosis, lipopolysaccharides (LPS) and histamine may play a role in the development of laminitis in dairy cattle. However, the relevancy of these risk factors in relation to the occurrence of laminitis under practical feeding conditions in Thailand is not clear. In Thailand, dairy rations are generall...

  14. Increasing Glencore's sustainable management performance: recommendation and risks, statements based on literature and best practices

    OpenAIRE

    Gottschall, Arnaud; Maeder, Eric

    2014-01-01

    The main purpose of this report is to provide Glencore with applicable recommendations so that it can improve its sustainable reputation. The second purpose of the work is to present all risks incurred by Glencore’s non-application of sustainable recommendations. Recommendations and risks have been developed based on literature, interviews and companies’ good practices. Sustainability reports of mining companies publicly quoted have been intensively used to grasp the different sustainability ...

  15. Low-cost risk reduction strategy for small workplaces: how can we spread good practices?

    Science.gov (United States)

    Kogi, K

    2006-01-01

    Recent advances in health risk reduction approaches are examined based on inter-country networking experiences. A noteworthy progress is the wider application of low-cost improvements to risk reduction particularly in small enterprises and agriculture in both industrially developing and developed countries. This is helped by the readiness of managers and workers to implement these improvements despite many constraints. Typical improvements include mobile racks, simple workstation changes, screening hazards, better welfare facilities and teamwork arrangements. In view of the complex circumstances of work-related health risks, it is important to know whether a low-cost strategy can advance risk reduction practices effectively and what support measures are necessary. It is confirmed that the strategy can overcome related constraints through its advantages. Main advantages lie in (a) the facilitation of improved practices in multiple technical areas, (b) the strengthening of realistic stepwise risk reduction, and (c) the enhanced multiplier effects through training of local trainers. Action-oriented risk assessment tools, such as action checklists and low-cost improvement guides, can encourage risk-reducing measures adjusted to each local situation. It is suggested to spread the low-cost risk reduction strategy for improving small workplaces in diversified settings with the support of these locally tailored tools.

  16. Survey of prenatal counselling practices regarding aneuploidy risk modification, invasive diagnostic procedure risks, and procedure eligibility criteria in Canadian centres.

    Science.gov (United States)

    Hull, Danna; Davies, Gregory; Armour, Christine M

    2012-07-01

    To explore prenatal practices related to aneuploidy screening, risk modification, and invasive diagnostic procedures across Canadian centres. We conducted a survey of members of the Canadian Association of Genetic Counsellors, the Canadian College of Medical Genetics, and the Canadian Society of Maternal Fetal Medicine, who provide direct counselling or management of prenatal patients in Canada. Eighty-two of 157 respondents indicated that their centre's definition of advanced maternal age was ≥ 35 years, with 33/157 respondents reporting an advanced maternal age definition of ≥ 40 years. The majority of respondents reported that prenatal serum screening for aneuploidy is provincially funded in their province or territory (121/147). The majority of respondents who reported that prenatal screening is not provincially funded (17/147) were from Quebec (14/17). Thirty-nine of 123 respondents reported that their centre defines increased nuchal translucency as ≥ 3.0 mm, whereas 49/123 reported a definition of ≥ 3.5 mm. Sixty-four of 150 respondents reported that the aneuploidy risk provided by serum screening is modified by a soft marker likelihood ratio, whereas 46/150 respondents reported that both age-related and serum screening risks are modified. Fifty-nine of 124 respondents reported that their centre will modify aneuploidy risk after a normal ultrasound; the most commonly cited negative likelihood ratio was 0.5. The most commonly reported procedure-related risk for chorionic villus sampling was 1/100 (123/147) and for amniocentesis was 1/200 (73/142). This study demonstrates inconsistencies in prenatal practices and access to screening programs across Canada. The information gained from this study will inform policy advisors developing prenatal practice guidelines at both the provincial and national levels.

  17. Traditional and Local Knowledge Practices for Disaster Risk Reduction in Northern Ghana

    Directory of Open Access Journals (Sweden)

    Nsioh Macnight Ngwese

    2018-03-01

    Full Text Available In order to deal with recurrent disasters, like floods and droughts coupled with the limited adaptive capacity, in the semiarid regions of Northern Ghana, local communities have no choice but to apply traditional and local knowledge practices. This study seeks to identify such practices employed in selected rural communities in Northern Ghana and to investigate their effectiveness. Data were collected through key informant interviews, household questionnaire surveys, focus group discussions, and participant observations. The findings indicated that although diverse practices were applied to predict and manage local disaster events, skepticism prevailed among locals toward these practices regarding their effectiveness. Due to the lack of science-based tools and systems for disaster prediction and management, local communities continually depended on these knowledge systems and practices. Integrating local and traditional disaster risk reduction (DRR efforts into modern scientific knowledge should be encouraged in order to reduce the vulnerability of local communities to disasters with thorough effectiveness evaluation protocols.

  18. A practical approach to assess depression risk and to guide risk reduction strategies in later life

    NARCIS (Netherlands)

    Almeida, O.P.; Alfonso, H.; Pirkis, J; Kerse, N.; Sim, M.; Flicker, L.; Snowdon, J.; Draper, B.; Byrne, G.; Goldney, R.; Lautenschlager, N.T.; Stocks, N.; Scazufca, M.; Huisman, M.; Araya, R.; Pfaff, J.

    2011-01-01

    Background: Many factors have been associated with the onset and maintenance of depressive symptoms in later life, although this knowledge is yet to be translated into significant health gains for the population. This study gathered information about common modifiable and non-modifiable risk factors

  19. A practical approach to risk-benefit estimation in pediatric drug research.

    Science.gov (United States)

    Koren, Gideon

    2015-02-01

    One of the most difficult challenges in pediatric drug research is in exposing children to risk, often without a balanced chance of benefits. While the concept of risk is similar in adult research, the adult patient can decide for himself/herself on an acceptable level of risk, whereas children have to accept the decisions of their guardians. This paper attempts to put the complexities of estimating risk in pediatric drug research into their practical perspective, and to familiarize the reader with the way such processes are conducted in different parts of the world. Although there are regional differences, all authorities typically quantify risks of pediatric research in general, and drug research in particular, in three levels: those experienced in day-to-day life; risks slightly above this 'baseline' risk; and risks substantially above 'baseline risk'. Proportionally, the diligence of the ethics process depends on these levels, as well as on the potential benefits (or lack of) to the child involved in the research. Importantly, risk is context dependent, and a particular intervention may be effective or safe in one setting but not in another, based on local experience, staffing levels, and similar variabilities.

  20. Healthcare waste management practices and risk perceptions: findings from hospitals in the Algarve region, Portugal.

    Science.gov (United States)

    Ferreira, Vera; Teixeira, Margarida Ribau

    2010-12-01

    The management of healthcare wastes is receiving greater attention because of the risks to both human health and the environment caused by inadequate waste management practices. In that context, the objective of this study was to analyse the healthcare waste management practices in hospitals of the Algarve region, Portugal, and in particular to assess the risk perceptions of, and actual risk to, healthcare staff. The study included three of the six hospitals in the region, covering 41% of the bed capacity. Data were collected via surveys, interviews, and on-site observations. The results indicate that waste separation is the main deficiency in healthcare waste practice, with correct separation being positively related to the degree of daily contact with the waste. Risk perceptions of healthcare staff show the highest levels for the environment (4.24) and waste workers (4.08), and the lowest for patients (3.29) and visitors (2.80), again being positively associated with the degree of daily contact. Risk perceptions of healthcare staff are related to the difficulties of the correct separation of wastes and the lack of knowledge concerning the importance of that separation. The risk of infection with needlesticks/sharps is higher during patient care than during waste handling, and the frequency of these injuries is related to the daily tasks of each healthcare group (doctors, nurses, and housekeepers). Furthermore, legislative definitions and classifications of healthcare wastes appear to have conditioned the management practices associated with, and the perceptions of risk concerning, healthcare wastes. Copyright © 2010 Elsevier Ltd. All rights reserved.

  1. Development of good modelling practice for phsiologically based pharmacokinetic models for use in risk assessment: The first steps

    Science.gov (United States)

    The increasing use of tissue dosimetry estimated using pharmacokinetic models in chemical risk assessments in multiple countries necessitates the need to develop internationally recognized good modelling practices. These practices would facilitate sharing of models and model eva...

  2. Environmental and personal hygiene practices: risk factors for diarrhoea among children of Nigerian market women.

    Science.gov (United States)

    Oyemade, A; Omokhodion, F O; Olawuyi, J F; Sridhar, M K; Olaseha, I O

    1998-12-01

    A Cross-sectional survey was carried out to determine the environmental and personal hygiene practices of mothers of children aged less than five years in two markets in Ibadan--one with poor sanitary conditions (Bodija) and the other one with better sanitation facilities (Gbagi). The study sought to identify the risk factors for diarrhoea among these children. Two hundred and sixty-six mothers in Bodija and 260 in Gbagi were interviewed. A questionnaire was used for collecting information on social and demographic characteristics, personal and environmental hygiene practices, including sources of food and water for their children, waste-disposal practices and occurrence of diarrhoea among their children aged less than five years. The educational status of the women in Bodija was lower than that of the women in Gbagi (p homes, and 45 (17%) bought it from vendors in the market. The corresponding figures for women of the Gbagi market were 41 (16%), 98 (38%) and 19 (7%). Two hundred and thirty-four (90%) women in Gbagi prepared breakfast at home for their children compared to 216 (81%) women in Bodija. This difference was statistically significant (p Waste disposal and personal hygiene practices were poorer among the women in Bodija. Yet the occurrence of diarrhoea was not significantly different in both the markets. Risk factors for diarrhoea identified in this study were water and food bought from vendors, child defaecation practices, mothers' cleaning up practices after child's defaecation, and refuse-disposal practices. The inherent risk of sale of unwholesome food and water by vendors is a great concern for public health authorities in Nigeria. Efforts to control diarrhoea must not only be focused on improving mothers' knowledge about food hygiene but also on environmental hygiene practices within the community.

  3. Approach Regarding a Framework for Risk Reporting in Order to Enhance the Related Good Practices

    Directory of Open Access Journals (Sweden)

    Mirela Nichita

    2015-08-01

    Full Text Available The nowadays accounting information user profile became more sophisticated and the financial reports face new challenges in accomplishing process to meet users’ needs. The purpose of financial reports is to provide useful information to users. According to International Accounting Standards Board, the utility of information is defined through the qualitative characteristics (fundamental and enhancing. The financial crisis emphasized the limits of financial reporting who has been unable to prevent investors about the risks they were facing. Some managers expressed reservations about the quality and relevance of corporate reporting, stating that the annual report is no longer a useful tool. Due to the current changes in business environment, managers have been highly motivated to rethink and improve the risk governance philosophy, processes and methodologies. The lack of quality, timely data and adequate systems to capture, report and measure the right information across the organization is a fundamental challenge to implementing and sustaining all aspects of effective risk management. Starting from 80s, the investors became more interested in narratives (Notes to financial statements, than in primary reports (financial position and performance. Our research suggests a framework for risk reporting with the main goal of improving the good practice in risk management field. Also, we will debate the relation between the qualitative characteristics of accounting information, transparency and risk, and explore the possibility of developing some good practices in risk reporting.

  4. Assessing the risk of recurrent venous thromboembolism – a practical approach

    Directory of Open Access Journals (Sweden)

    Fahrni J

    2015-08-01

    Full Text Available Jennifer Fahrni,1 Marc Husmann,2 Silvia B Gretener,3 Hong H Keo1 1Division of Angiology, Medical University Clinic, Kantonsspital Aarau AG, Aarau, Switzerland; 2Clinic for Angiology, University Hospital, University of Zurich, Zürich, Switzerland; 3Clinic for Angiology Oberaargau, Langenthal, Switzerland Abstract: Recurrent venous thromboembolism (VTE is associated with increased morbidity and mortality. This risk is lowered by anticoagulation, with a large effect in the initial phase following the venous thromboembolic event, and with a smaller effect in terms of secondary prevention of recurrence when extended anticoagulation is performed. On the other hand, extended anticoagulation is associated with an increased risk of major bleeding and thus leads to morbidity and mortality. Therefore, it is necessary to assess the risk of recurrence for VTE on an individual basis, and a recommendation for secondary prophylaxis should be specifically based on risk calculation of recurrence of VTE and bleeding. In this review, we provide a comprehensive summary of relevant risk factors for recurrent VTE and a practical approach for assessing the risk of recurrence in daily practice. Keywords: thrombosis, hemorrhage, risk assessment 

  5. Enterprise risk management today's leading research and best practices for tomorrow's executives

    CERN Document Server

    Simkins, Betty J

    2010-01-01

    Essential insights on the various aspects of enterprise risk management If you want to understand enterprise risk management from some of the leading academics and practitioners of this exciting new methodology, Enterprise Risk Management is the book for you. Through in–depth insights into what practitioners of this evolving business practice are actually doing as well as anticipating what needs to be taught on the topic, John Fraser and Betty Simkins have sought out the leading experts in this field to clearly explain what enterprise risk management is and how you can teach, learn, and implement these leading practices within the context of your business activities. In this book, the authors take a broad view of ERM, or what is called a holistic approach to ERM. Enterprise Risk Management introduces you to the wide range of concepts and techniques for managing risk in a holistic way that correctly identifies risks and prioritizes the appropriate responses. This invaluable guide offers a broad overview of...

  6. Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice.

    Science.gov (United States)

    Slemon, Allie; Jenkins, Emily; Bungay, Vicky

    2017-10-01

    The discourse of safety has informed the care of individuals with mental illness through institutionalization and into modern psychiatric nursing practices. Confinement arose from safety: out of both societal stigma and fear for public safety, as well as benevolently paternalistic aims to protect individuals from self-harm. In this paper, we argue that within current psychiatric inpatient environments, safety is maintained as the predominant value, and risk management is the cornerstone of nursing care. Practices that accord with this value are legitimized and perpetuated through the safety discourse, despite evidence refuting their efficacy, and patient perspectives demonstrating harm. To illustrate this growing concern in mental health nursing care, we provide four exemplars of risk management strategies utilized in psychiatric inpatient settings: close observations, seclusion, door locking and defensive nursing practice. The use of these strategies demonstrates the necessity to shift perspectives on safety and risk in nursing care. We suggest that to re-centre meaningful support and treatment of clients, nurses should provide individualized, flexible care that incorporates safety measures while also fundamentally re-evaluating the risk management culture that gives rise to and legitimizes harmful practices. © 2017 The Authors Nursing Inquiry published by John Wiley & Sons Ltd.

  7. An Exploratory Study of Suicide Risk Assessment Practices in the School Setting

    Science.gov (United States)

    Crepeau-Hobson, Franci

    2013-01-01

    Suicidal behavior in children and youth continues to be a major public health problem in the United States. School personnel have a legal and ethical obligation to recognize and respond to the mental health needs of their students and to take steps to ensure their safety. In this exploratory study, suicide risk assessment practices of three large…

  8. A Digital Curate's Egg: A Risk Management Approach to Enhancing Data Management Practices

    Science.gov (United States)

    Knight, Gareth

    2012-01-01

    This article provides a case study of work performed at King's College London to survey information management practices, policies, and procedures applied by data creators and managers within three research units and three business units, and to determine the risk factors that may limit access and use of their digital assets over time. The…

  9. Predictors of sexual-risk behaviour and HIV-preventive practices ...

    African Journals Online (AJOL)

    A cross-sectional study design was used to assess sexual-risk behaviour and HIV-preventive practices among students at Hawassa University, Ethiopia, in 2009. Among 1 220 students eligible for the study, approximately 29% reported experience of sex (36.3% of the males and 9.3% of the females). Of the total sexually ...

  10. 27 CFR 10.52 - Practice which puts trade buyer independence at risk.

    Science.gov (United States)

    2010-04-01

    ... place trade buyer independence at risk within the description of exclusion in § 10.51: Industry member...-employer in return for the employee agreeing to order distilled spirits, wine, or malt beverages from the industry member. The practice enumerated here is an example and does not constitute a complete list of...

  11. Risk factors in street food practices in developing countries: A review

    Directory of Open Access Journals (Sweden)

    Buliyaminu Adegbemiro Alimi

    2016-09-01

    Full Text Available Street food trading solves major social and economic problems in developing countries through the provision of ready-made meals at relatively inexpensive prices and employment for teeming rural and urban populace along its value chain. However, due to informal nature of the enterprise, the activities of the practitioners are not regulated. This gives ample room for unwholesome practices. The results are the risks such activities pose to the health and safety of practitioners along the value chain. This review paper, a summary of literature reports on risk factors in street food trade in developing countries and recommended safety intervention, is written with the hope of providing global baseline for intervention to ensure safe food practices. Adoption of safety approaches that permeates the entire chain of street food business from good agricultural practices through hazard analysis critical control points strategy to good hygiene practices by farmers, vendors and consumers would significantly reduce risks in street food consumption. Above all, active collaboration of all stakeholders toward the strengthening and proper enforcement of public health policies to ensure safe practices and engender safer and healthier society is recommended.

  12. Place of Risk Analysis in Tax Audit: Some Country Practices and an Evaluation for Turkey

    Directory of Open Access Journals (Sweden)

    Feride BAKAR

    2016-12-01

    Full Text Available The use of information technologies and risk analysis have become an important position in tax audit, as in all fields. Systems used in this area, are different in many ways and for this reason, making comparative study, evaluating best practices and its effects to results should be examined. In this study, development of risk analysis systems in Australia, United Kingdom, Austria, the USA and their place ensuring effectiveness of tax audit was investigated. Thus, some findings were made for Turkey with help of examining the current status of tax audits based on risk analysis. In the past, risk analysis was used for providing effectiveness of tax audit, but today the purpose has evolved to focus increasing tax compliance. For realization of this purpose in Turkey, disclosure of risk areas in general, informing taxpayers and establishment of cooperative compliance model with large business is needed.

  13. Fuzzy hierarchical model for risk assessment principles, concepts, and practical applications

    CERN Document Server

    Chan, Hing Kai

    2013-01-01

    Risk management is often complicated by situational uncertainties and the subjective preferences of decision makers. Fuzzy Hierarchical Model for Risk Assessment introduces a fuzzy-based hierarchical approach to solve risk management problems considering both qualitative and quantitative criteria to tackle imprecise information.   This approach is illustrated through number of case studies using examples from the food, fashion and electronics sectors to cover a range of applications including supply chain management, green product design and green initiatives. These practical examples explore how this method can be adapted and fine tuned to fit other industries as well.   Supported by an extensive literature review, Fuzzy Hierarchical Model for Risk Assessment  comprehensively introduces a new method for project managers across all industries as well as researchers in risk management.

  14. Risk assessment as rhetorical practice: The ironic mathematics behind terrorism, banking, and public policy.

    Science.gov (United States)

    Danisch, Robert

    2013-02-01

    The twin problems of possible terrorist attacks and a global economic recession have been, and continue to be, critical components of contemporary political culture. At the center of both problems is the assessment of future risk. To calculate the probability that a loan will default or to estimate the likelihood of an act of bioterrorism crippling an American city is to engage in the quantitative science of risk assessment. The process of risk assessment is an attempt to rationalize the uncertainty and contingency of the future. In this essay, I read risk assessments made by the Department of Homeland Security and by major banks during the recent financial collapse as examples of rhetorical practice. As such, I show the rhetorical form and function of risk assessments in order to determine the effect that they have on contemporary political culture.

  15. Accounts Receivable Risk Management Practices and Growth of SMEs in Kakamega County, Kenya

    Directory of Open Access Journals (Sweden)

    Mary Nelima LYANI (SINDANI

    2016-10-01

    Full Text Available Accounts receivable risk management is a structured approach to managing uncertainties through risk assessment, developing strategies to manage it, and mitigation of risk using managerial resources (Gakure et al., 2012 Although there has been a considerable interest by government to promote SMEs by encouraging owners to take up government tenders, in Kenya the number of SMEs capable of sustaining themselves is still low. Studies show credit risk as an important variable affecting firms. Nonetheless, these risks’ influence on SMEs has not received as much attention as it should. This study’s main objective was to examine the influence of credit risk assessment practices on growth of SMEs. The objective of the study was to evaluate the effect of credit risk assessment practices on growth of SMEs in Kakamega County, in Kenya. Causal research design was applied to show the influence of credit risk assessment practice on growth. Using the sampling technique of purposive stratified random, a sample size of 359 out of 5401 SMEs was used from Kakamega Central Sub-County that had been in operation between 2013 and 2015. Secondary data was acquired from the Kakamega County Revenue Department, for the period under study. The hypotheses that form the premises for a regression model using analysis techniques like homoscedasticity and autocorrelation. Ordinary Least Square method was utilized to establish the relationship of cause-effect between variables while hypothesis was tested at 5% significance level. The overall model was discovered to be significant considering the F=14.918 and p-value (0.00 < 0.05. The findings revealed that good credit risk assessment practices when adopted by SMEs lead to growth. The study recommended that owners and managers should be trained and made to understand the various techniques risk management to well manage them so as to increase growth. The findings would form a basis for government and policy makers to formulate

  16. Risk practices and immunization against hepatitis B among female sex workers

    Directory of Open Access Journals (Sweden)

    Rosilane de Lima Brito Magalhães

    2016-01-01

    Full Text Available Objective: to identify the use of hepatitis B vaccine and risk practices among female sex workers. Methods: cross-sectional research using the Respondent Driven Sampling methodology. One-hundred and fifty-three sex workers were studied.Results: risk practices were related to the early onset of sexual activity, multiple partners with up to 17 clients per week 34 (22.2%, lack of use of condom 9 (5.9%, 124 (81.0% shared sharps and 53 (34.6% reported no vaccine against hepatitis B. Conclusion: sex workers found themselves exposed to various risk situations to the hepatitis B virus, due to the lack of immunization schedule, sexual precocity, multiple sex partners lack of use of condom, habit of sharing sharp objects. It is urgent to invest in health promotion with guidance on the importance of the vaccine, the adoption of protective measures and increased access of sex workers to health facilities.

  17. [Security of hospital infusion practices: From an a priori risk analysis to an improvement action plan].

    Science.gov (United States)

    Pignard, J; Cosserant, S; Traore, O; Souweine, B; Sautou, V

    2016-03-01

    Infusion in care units, and all the more in intensive care units, is a complex process which can be the source of many risks for the patient. Under cover of an institutional approach for the improvement of the quality and safety of patient healthcare, a risk mapping infusion practices was performed. The analysis was focused on intravenous infusion situations in adults, the a priori risk assessment methodology was applied and a multidisciplinary work group established. Forty-three risks were identified for the infusion process (prescription, preparation and administration). The risks' assessment and the existing means of control showed that 48% of them would have a highly critical patient security impact. Recommendations were developed for 20 risks considered to be most critical, to limit their occurrence and severity, and improve their control level. An institutional action plan was developed and validated in the Drug and Sterile Medical Devices Commission. This mapping allowed the realization of an exhaustive inventory of potential risks associated with the infusion. At the end of this work, multidisciplinary groups were set up to work on different themes and regular quarterly meetings were established to follow the progress of various projects. Risk mapping will be performed in pediatric and oncology unit where the risks associated with the handling of toxic products is omnipresent. Copyright © 2015 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

  18. Parenting practices, parents' underestimation of daughters' risks, and alcohol and sexual behaviors of urban girls.

    Science.gov (United States)

    O'Donnell, Lydia; Stueve, Ann; Duran, Richard; Myint-U, Athi; Agronick, Gail; San Doval, Alexi; Wilson-Simmons, Renée

    2008-05-01

    In urban economically distressed communities, high rates of early sexual initiation combined with alcohol use place adolescent girls at risk for myriad negative health consequences. This article reports on the extent to which parents of young teens underestimate both the risks their daughters are exposed to and the considerable influence that they have over their children's decisions and behaviors. Surveys were conducted with more than 700 sixth-grade girls and their parents, recruited from seven New York City schools serving low-income families. Bivariate and multivariate analyses examined relationships among parents' practices and perceptions of daughters' risks, girls' reports of parenting, and outcomes of girls' alcohol use, media and peer conduct, and heterosexual romantic and social behaviors that typically precede sexual intercourse. Although only four parents thought that their daughters had used alcohol, 22% of the daughters reported drinking in the past year. Approximately 5% of parents thought that daughters had hugged and kissed a boy for a long time or had "hung out" with older boys, whereas 38% of girls reported these behaviors. Parents' underestimation of risk was correlated with lower reports of positive parenting practices by daughters. In multivariate analyses, girls' reports of parental oversight, rules, and disapproval of risk are associated with all three behavioral outcomes. Adult reports of parenting practices are associated with girls' conduct and heterosexual behaviors, but not with their alcohol use. Creating greater awareness of the early onset of risk behaviors among urban adolescent girls is important for fostering positive parenting practices, which in turn may help parents to support their daughters' healthier choices.

  19. Protection of people and environment from radiation risk through good regulatory practice

    Science.gov (United States)

    Jais, Azlina Mohammad; Hassan, Najwa

    2017-01-01

    The term "good regulatory practice" has seen growing frequency of usage worldwide, especially since the 2011 Fukushima nuclear incident. However, the term appears quite ambiguous as it may mean differently to different people. This leads us to the first important question: what does "good regulatory practice" actually mean? When used in conjunction with the Fukushima incident, do we imply that there is an absence of "good regulatory practice" in the Japanese' Nuclear and Industry Safety Agency (NISA)? This is quite troubling. It is clear that the term should be defined formally so that our understanding of "good regulatory practice" can be standardized. There is still another important question beyond agreeing on what "good regulatory practice" is: is "good regulatory practice" specific to a region, or is it global? And is it applicable only to nuclear regulators, or to all types of regulators per se? This paper aims to deliberate on the above mentioned questions. Specifically, we hope to discuss the "good regulatory practice" for atomic energy activities in order to protect the people and the environment from radiation risk of such activities. By understanding what "good regulatory practice" truly means, a newcomer country such as Malaysia can quickly learn and adopt these practices so as to assure a competent national nuclear regulatory authority who will be responsible in ensuring the safety, security and safeguards of peaceful atomic energy activities in the country including nuclear liability. In understanding this concept, a holistic approach will be taken by looking into example of advanced and newcomer countries of various nuclear regulatory authorities all around the world. Then the paper will focus on the challenges that the current nuclear regulatory authority in Malaysia which is Atomic Energy Licensing Board has, its challenges to follow the concept of "good regulatory practice" and its ways to overcome it. This study explore the initiatives could be

  20. Need of risk management practice amongst bumiputera contractors in Malaysia construction industries

    Science.gov (United States)

    Syuhada Fadzil, Nur; Noor, Nurazuwa Md; Rahman, Ismail Abdul

    2017-11-01

    Malaysia construction industry has been growing continuously with double-digit growth for the past two decades. There are many issues surrounded the industry such as delay in delivery, cost overrun, quality and safety. In bumiputera contractor’s context, the literature review found that 32 issues were encountered in the construction project. These issues can be handled properly with the application of risk management. According to previous researchers, application of risk management in Malaysia construction industry is at the low level where it is implemented in traditional ways that are brainstorming and checklist. These were due to lack of knowledge, the high cost of hiring experts and avoiding extra cost. Besides that, this study also intentions to analyse the risk categories in the construction industry as well as identify risk management process to resolve the construction issues. Hence, this paper presents issues engulfed by Bumiputera contractors which can partly be resolved by applying risk management practice in carrying out the construction activity. This may inspire the contractors to apply the risk management practice in ensuring the success of their construction project.

  1. The use of a basic safety investment model in a practical risk management context

    International Nuclear Information System (INIS)

    Aven, Terje; Hiriart, Yolande

    2011-01-01

    We consider a basic model in economic safety analysis: a firm is willing to invest an amount x in safety measures to avoid an accident A, which in the case of occurrence, leads to a loss of size L. The probability of an accident is a function of x. The optimal value of x is determined by minimizing the expected costs. In the paper, we re-examine this model by adopting a practical risk/safety management perspective. We question how this model can be used for guiding the firm and regulators in determining the proper level of investment in safety. Attention is given to issues like how to determine the probability of an accident and how to take into account uncertainties that extend beyond the expected value. It is concluded that the model, with suitable extensions and if properly implemented, provides a valuable decision support tool. By focusing on investment levels and stimulating thereby the generation of alternative risk-reducing measures, the model is considered particularly useful in risk reduction (ALARP) processes. - Highlights: → It is shown how to use a basic investment model in a practical risk management setting. → The model may be a valuable decision support tool if properly implemented. → It guides decision makers on risk reduction and how to determine what is ALARP. → The model stimulates the generation of alternative risk-reducing measures.

  2. Review of clinical practice guidelines for the management of LDL-related risk.

    Science.gov (United States)

    Morris, Pamela B; Ballantyne, Christie M; Birtcher, Kim K; Dunn, Steven P; Urbina, Elaine M

    2014-07-15

    Managing risk related to low-density lipoprotein (LDL) is vital in therapy for patients at risk for atherosclerotic cardiovascular disease (ASCVD) events given its important etiologic role in atherogenesis. Despite decades of research showing reduction of ASCVD risk with multiple approaches to lowering of LDL cholesterol, there continue to be significant gaps in care with inadequate numbers of patients receiving standard of care lipid-lowering therapy. Confusion regarding implementation of the multiple published clinical practice guidelines has been identified as one contributor to suboptimal management of LDL-related risk. This review summarizes the current guidelines for reduction of LDL-related cardiovascular risk provided by a number of major professional societies, which have broad applicability to diverse populations worldwide. Statements have varied in the process and methodology of development of recommendations, the grading system for level and strength of evidence, the inclusion or exclusion of expert opinion, the suggested ASCVD risk assessment tool, the lipoproteins recommended for risk assessment, and the lipoprotein targets of therapy. The similarities and differences among important guidelines in the United States and internationally are discussed, with recommendations for future strategies to improve consistency in approaches to LDL-related ASCVD risk and to reduce gaps in implementation of evidence-based therapies. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  3. A practical approach to communicating benefit-risk decisions of medicines to stakeholders

    Directory of Open Access Journals (Sweden)

    James eLeong

    2015-06-01

    Full Text Available AbstractPurposeThe importance of a framework for a systematic structured assessment of the benefits and risks has been established, but in addition, it is necessary that the benefit-risk decisions and the processes to derive those decisions are documented and communicated to various stakeholders for accountability. Hence there is now a need to find appropriate tools to enhance communication in a manner that would uphold transparency, consistency and standards. MethodsA retrospective, non-comparative study was conducted to determine the applicability and practicality of a summary template in documenting benefit-risk assessment and communicating benefit-risk balance and conclusions for reviewers to other stakeholders. The benefit-risk (BR Summary Template and its User Manual was evaluated by 12 reviewers within a regulatory agency in Singapore, the Health Sciences Authority (HSA. ResultsThe BR Summary Template was found to be adequate in documenting benefits, risks, relevant summaries and conclusions, while the User Manual was useful in guiding the reviewer in completing the template. The BR Summary Template was also considered a useful tool for communicating benefit-risk decisions to a variety of stakeholders.ConclusionsThe use of a template may be of value for the communicating benefit-risk assessment of medicines to stakeholders.

  4. A practical approach to communicating benefit-risk decisions of medicines to stakeholders.

    Science.gov (United States)

    Leong, James; Walker, Stuart; Salek, Sam

    2015-01-01

    The importance of a framework for a systematic structured assessment of the benefits and risks has been established, but in addition, it is necessary that the benefit-risk decisions and the processes to derive those decisions are documented and communicated to various stakeholders for accountability. Hence there is now a need to find appropriate tools to enhance communication between regulators and other stakeholders, in a manner that would uphold transparency, consistency and standards. A retrospective, non-comparative study was conducted to determine the applicability and practicality of a summary template in documenting benefit-risk assessment and communicating benefit-risk balance and conclusions for reviewers to other stakeholders. The benefit-risk (BR) Summary Template and its User Manual was evaluated by 12 reviewers within a regulatory agency in Singapore, the Health Sciences Authority (HSA). The BR Summary Template was found to be adequate in documenting benefits, risks, relevant summaries and conclusions, while the User Manual was useful in guiding the reviewer in completing the template. The BR Summary Template was also considered a useful tool for communicating benefit-risk decisions to a variety of stakeholders. The use of a template may be of value for the communicating benefit-risk assessment of medicines to stakeholders.

  5. Risk-informed Management of Water Infrastructure in the United States: History, Development, and Best Practices

    Science.gov (United States)

    Wolfhope, J.

    2017-12-01

    This presentation will focus on the history, development, and best practices for evaluating the risks associated with the portfolio of water infrastructure in the United States. These practices have evolved from the early development of the Federal Guidelines for Dam Safety and the establishment of the National Dam Safety Program, to the most recent update of the Best Practices for Dam and Levee Risk Analysis jointly published by the U.S. Department of Interior Bureau of Reclamation and the U.S. Army Corps of Engineers. Since President Obama signed the Water Infrastructure Improvements for the Nation Act (WIIN) Act, on December 16, 2016, adding a new grant program under FEMA's National Dam Safety Program, the focus has been on establishing a risk-based priority system for use in identifying eligible high hazard potential dams for which grants may be made. Finally, the presentation provides thoughts on the future direction and priorities for managing the risk of dams and levees in the United States.

  6. Safety assessment of nuclear medicine practice using the Risk Matrix Method

    International Nuclear Information System (INIS)

    Cruz, Dumenigo; Cruz, Yoanis; Soler, Karen; Guerrero, Mayka

    2013-01-01

    This paper presents the main results from the application of the methodology of Risk Matrices in a hypothetical service / department of the Nuclear medicine that realize metabolic radiotherapy treatment and diagnostic studies with 131 I and 99 m Tc and 18 F. We could identify major equipment failures and human errors that could potentially lead to a accident in practice. For each analyzed initiating events evaluated the frequency of occurrence, identified key existing defenses to avoid the accident and assessed the potential consequences of an accident if this comes to fruition. With this methodology we could identify which accident sequences increased risk and to propose means to reduce the risk in such cases. As a result of this work was developed the 'RMA Nuclear Medicine' computer tools that will apply this methodology in nuclear medicine services that need to do similar risk assessments

  7. ENVIRONMENTAL RISK ASSESSMENT OF SOME COPPER BASED FUNGICIDES ACCORDING TO THE REQUIREMENTS OF GOOD LABORATORY PRACTICE

    Directory of Open Access Journals (Sweden)

    Marga GRĂDILĂ

    2015-10-01

    Full Text Available The paper presents data demonstrating the functionality of biological systems reconstituted with aquatic organisms developed under Good Laboratory Practice testing facility within Research - Development Institute for Plant Protection Bucharest for environmental risk assessment of four fungicides based on copper, according to Good Laboratory Practice requirements. For risk assessment, according to GLP were made the following steps: Good Laboratory Practice test facility was established, we have ensured adequate space for growth, acclimatization and testing for each test species, it was installed a complex water production instalation needed to perform tests, it was achieved control system for checking environmental conditions and have developed specific operating procedures that have been accredited according to Good Laboratory Practice.The results showed that biological systems model of the Good Laboratory Practice test facility in Research - Development Institute for Plant Protection meet the requirements of Organisation for Economic Co-operation and Development Guidelines regarding GLP, and after testing copper-based fungicides in terms of acute toxicity Cyprinus carpio and to Daphnia magna revealed that three of them (copper oxychloride, copper hydroxide and copper sulphate showed ecological efficiency, ie low toxicity. Metallic copper based fungicides showed a higher toxicity, resulting in fish toxicity symptoms: sleep, sudden immersion, faded, weakness, swimming in spiral, lack of balance, breathing slow and cumbersome, spasms and mortality.

  8. The intergenerational transmission of at-risk/problem gambling: The moderating role of parenting practices.

    Science.gov (United States)

    Dowling, Nicki A; Shandley, Kerrie A; Oldenhof, Erin; Affleck, Julia M; Youssef, George J; Frydenberg, Erica; Thomas, Shane A; Jackson, Alun C

    2017-10-01

    Although parenting practices are articulated as underlying mechanisms or protective factors in several theoretical models, their role in the intergenerational transmission of gambling problems has received limited research attention. This study therefore examined the degree to which parenting practices (positive parenting, parental involvement, and inconsistent discipline) moderated the intergenerational transmission of paternal and maternal problem gambling. Students aged 12-18 years (N = 612) recruited from 17 Australian secondary schools completed a survey measuring parental problem gambling, problem gambling severity, and parenting practices. Participants endorsing paternal problem gambling (23.3%) were 4.3 times more likely to be classified as at-risk/problem gamblers than their peers (5.4%). Participants endorsing maternal problem gambling (6.9%) were no more likely than their peers (4.0%) to be classified as at-risk/problem gamblers. Paternal problem gambling was a significant predictor of offspring at-risk/problem gambling after controlling for maternal problem gambling and participant demographic characteristics. The relationship between maternal problem gambling and offspring at-risk/problem gambling was buffered by parental involvement. Paternal problem gambling may be important in the development of adolescent at-risk/problem gambling behaviours and higher levels of parental involvement buffers the influence of maternal problem gambling in the development of offspring gambling problems. Further research is therefore required to identify factors that attenuate the seemingly greater risk of transmission associated with paternal gambling problems. Parental involvement is a potential candidate for prevention and intervention efforts designed to reduce the intergenerational transmission of gambling problems. (Am J Addict 2017;26:707-712). © 2017 American Academy of Addiction Psychiatry.

  9. Tooth wear risk assessment and care-planning in general dental practice.

    Science.gov (United States)

    O'Toole, S; Khan, M; Patel, A; Patel, N J; Shah, N; Bartlett, D; Movahedi, S

    2018-03-09

    Objective To assess charting, risk assessment and treatment-planning of tooth wear between recently qualified and experienced dentists in general dental practice.Design Service evaluation.Setting Multi-setting evaluation of three mixed NHS/Private general dental practices in North-East London.Methods The clinical notes of new patient examinations on dentate adults presenting from the 1 October 2016 to 31 December 2016 were audited collecting data on tooth wear charting, risk assessment and treatment planning. Data were analysed using descriptives, chi square and logistic regressions in SPSS. Significance was inferred at p charted for 48% of those attending foundation dentists and 5% of those attending experienced dentists. Diet was assessed in 50.6% of patients examined by foundation dentists and 1.0% of patients examined by experienced dentists. Foundation dentists were more likely to chart tooth wear, risk assess and preventively manage tooth wear compared to experienced dentists (p <0.001).Conclusion This service evaluation highlights that improvements are required in recording, risk assessing and preventive treatment planning of erosive tooth wear. Experienced dentists were less likely to risk assess tooth wear and less likely to provide preventive treatment. Experienced GDPs may benefit from re-training in this area.

  10. Knowledge of risk factors, beliefs and practices of female healthcare professionals towards breast cancer, Morocco

    Directory of Open Access Journals (Sweden)

    Samia Ghanem

    2011-10-01

    Full Text Available le doctors were the only professional group that had satisfactory knowledge of risk factors while the nurses had an unsatisfactory knowledge with a mean score of 43%. A half of participants believed that that herbal therapy can cure breast cancer. 75% practice breast self-examination once a month and only 15% have ever had a mammogram. Age, profession and beliefs were not significantly associated with rate of BSE in this study; however this rate is influenced by knowledge of breast cancer risk factors. CONCLUSION: Results from this study suggest the need for continuing medical education programs aimed at improving knowledge of breast cancer among the nurses.

  11. Neural network-based survey analysis of risk management practices in new product development

    DEFF Research Database (Denmark)

    Kampianakis, Andreas N.; Oehmen, Josef

    2017-01-01

    The current study investigates the applicability of Artificial Neural Networks (ANNs) to analyse survey data on the effectiveness of risk management practices in product development (PD) projects, and its ability to forecast project outcomes. Moreover, this study presents the relations between risk...... Neural Networks. Dataset used is a filtered survey of 291 product development programs. Answers of this survey are used as training input and target output, in pattern recognition two-layer feed forward networks, using various transfer functions. Using this method, relations among 6 project practices...... and 13 outcome metrics were revealed. Results of this analysis are compared with existent results made through statistical analysis in prior work of one of the authors. Future investigation is needed in order to tackle the lack of data and create an easy to use platform for industrial use....

  12. Novel low-risk commercial sex practices in the parks of Vietnam.

    Science.gov (United States)

    Walters, I

    2003-06-01

    This is a paper about a novel form of commercial sex practice recorded in Vietnam, and its implications for HIV/AIDS prevention strategies. Female commercial sex workers occupy urban parks in the evenings, offering on-site masturbation services to clients at cheap prices even by local standards. All sex acts are performed in public by workers who sit on benches, path edges or stools,often behind bicycles or open umbrellas in the quest for some semblance of privacy. Clients are local men, with only an occasional foreigner involved Many sex workers were involved, some having 15 to 20 or more clients a night. Sex workers and clients in Vietnam, a s elsewhere, operate at high risk of HIV/AIDS infection. As a service which minimizes risks, this form of commercial sex practice should perhaps be given serious consideration by policy makers and authorities for formal deployment in the fight against AIDS.

  13. Medical Assistant-based care management for high risk patients in small primary care practices

    DEFF Research Database (Denmark)

    Freund, Tobias; Peters-Klimm, Frank; Boyd, Cynthia M.

    2016-01-01

    Background: Patients with multiple chronic conditions are at high risk of potentially avoidable hospital admissions, which may be reduced by care coordination and self-management support. Medical assistants are an increasingly available resource for patient care in primary care practices. Objective......: To determine whether protocol-based care management delivered by medical assistants improves patient care in patients at high risk of future hospitalization in primary care. Design: Two-year cluster randomized clinical trial. Setting: 115 primary care practices in Germany. Patients: 2,076 patients with type 2......, and monitoring delivered by medical assistants with usual care. Measurements: All-cause hospitalizations at 12 months (primary outcome) and quality of life scores (Short Form 12 Health Questionnaire [SF-12] and the Euroqol instrument [EQ-5D]). Results: Included patients had, on average, four co-occurring chronic...

  14. A Best Practices Notebook for Disaster Risk Reduction and Climate Change Adaptation: Guidance and Insights for Policy and Practice from the CATALYST Project

    NARCIS (Netherlands)

    Hare, M.; Bers, van C.; Mysiak, J.; Calliari, E.; Haque, A.; Warner, K.; Yuzva, K.; Zissener, M.; Jaspers, A.M.J.; Timmerman, J.G.

    2014-01-01

    This publication, A Best Practices Notebook for Disaster Risk Reduction and Climate Change Adaptation: Guidance and Insights for Policy and Practice from the CATALYST Project is one of two main CATALYST knowledge products that focus on the transformative approaches and measures that can support

  15. Is physical activity, practiced as recommended for health benefit, a risk factor for osteoarthritis?

    Science.gov (United States)

    Lefèvre-Colau, Marie-Martine; Nguyen, Christelle; Haddad, Rebecca; Delamarche, Paul; Paris, Guillaume; Palazzo, Clémence; Poiraudeau, Serge; Rannou, François; Roren, Alexandra

    2016-06-01

    In this critical narrative review, we examine the role of physical activity (PA), recreational and elite sports in the development of knee/hip osteoarthritis (OA), taking into account the role of injury in this relationship. The process of article selection was unsystematic. Articles were selected on the basis of the authors' expertise, self-knowledge, and reflective practice. In the general adult population, self-reported diagnosis of knee/hip OA was not associated with low, moderate or high levels of PA. For studies using radiographic knee/hip OA as a primary outcome, the incidence of asymptomatic radiographic OA was higher for subjects with the highest quartile of usual PA than the least active subjects. The risk of incident radiographic knee/hip OA features was increased for subjects with a history of regular sports participation (for osteophyte formation but not joint space narrowing). This risk depended on the type of sport (team and power sports but not endurance and running), and certain conditions (high level of practice) were closely related to the risk of injury. The prevalence of radiographic OA was significantly higher, especially the presence of osteophytes, in former elite athletes than controls. The risk of OA was higher with participation in mixed sports, especially soccer or power sports, than endurance sport. However, the prevalence of clinical OA between former elite athletes and controls was similar, with less hip/knee disability in former athletes. Moderate daily recreational or sport activities, whatever the type of sport, are not a consistent risk factor for clinical or radiographic knee/hip OA. Risk of injury in different sports may be the key factor to understanding the risk of OA related to sport. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  16. Knowledge of risk factors, beliefs and practices of female healthcare professionals towards breast cancer, Morocco.

    Science.gov (United States)

    Ghanem, Samia; Glaoui, Meriem; Elkhoyaali, Siham; Mesmoudi, Mohamed; Boutayeb, Saber; Errihani, Hassan

    2011-01-01

    Breast cancer is the most common cancer affecting women in Morocco. Screening for early detection has led to reduction in mortality from the disease. It is known that female healthcare professionals have greater influence on women's positive perception of breast cancer and motivation to practice screening methods for early detection of the disease. This study aims to investigate knowledge of breast cancer risk factors, beliefs about treatment and practice of screening methods among a cohort of female healthcare professionals in Morocco. A cross-sectional study was conducted using a self-administered questionnaire to assess the knowledge of breast cancer risk factors, beliefs about treatment and practice of screening methods among 136 female doctors and nurses working in the university hospital of Rabat, Morocco. Stratified random sampling method was employed. Chi square test, analysis of variance and Mantel-Haenszel test were performed in data analysis using SPSS v19.0. Female doctors were the only professional group that had satisfactory knowledge of risk factors while the nurses had an unsatisfactory knowledge with a mean score of 43%. A half of participants believed that that herbal therapy can cure breast cancer. 75% practice breast self-examination once a month and only 15% have ever had a mammogram. Age, profession and beliefs were not significantly associated with rate of BSE in this study; however this rate is influenced by knowledge of breast cancer risk factors. Results from this study suggest the need for continuing medical education programs aimed at improving knowledge of breast cancer among the nurses.

  17. 78 FR 11611 - Current Good Manufacturing Practice and Hazard Analysis and Risk-Based Preventive Controls for...

    Science.gov (United States)

    2013-02-19

    ... related to the proposed rule on ``Current Good Manufacturing Practice and Hazard Analysis and Risk-Based... . All comments should be identified with the title ``Current Good Manufacturing Practice and Hazard... rulemaking to modernize the regulation for ``Current Good Manufacturing Practice In Manufacturing, Packing...

  18. 78 FR 48636 - Current Good Manufacturing Practice and Hazard Analysis and Risk-Based Preventive Controls for...

    Science.gov (United States)

    2013-08-09

    ... collection related to the proposed rule, ``Current Good Manufacturing Practice and Hazard Analysis and Risk... period. These two proposals are related to the proposed rule ``Current Good Manufacturing Practice and... final extension of the comment period for the ``Current Good Manufacturing Practice and Hazard Analysis...

  19. Preventive dentistry: practitioners' recommendations for low-risk patients compared with scientific evidence and practice guidelines.

    Science.gov (United States)

    Frame, P S; Sawai, R; Bowen, W H; Meyerowitz, C

    2000-02-01

    The purpose of this article is to compare published evidence supporting procedures to prevent dental caries and periodontal disease, in low-risk patients, with the actual preventive recommendations of practicing dentists. Methods included (1) a survey questionnaire of general dentists practicing in western New York State concerning the preventive procedures they would recommend and at what intervals for low-risk children, young adults, and older adults; and (2) review of the published, English-language literature for evidence supporting preventive dental interventions. The majority of dentists surveyed recommended semiannual visits for visual examination and probing to detect caries (73% to 79%), and scaling and polishing to prevent periodontal disease (83% to 86%) for low-risk patients of all ages. Bite-wing radiographs were recommended for all age groups at annual or semiannual intervals. In-office fluoride applications were recommended for low-risk children at intervals of 6 to 12 months by 73% of dentists but were recommended for low-risk older persons by only 22% of dentists. Application of sealants to prevent pit and fissure caries was recommended for low-risk children by 22% of dentists. Literature review found no studies comparing different frequencies of dental examinations and bite-wing radiographs to determine the optimal screening interval in low-risk patients. Two studies of the effect of scaling and polishing on the prevention of periodontal disease found no benefit from more frequent than annual treatments. Although fluoride is clearly a major reason for the decline in the prevalence of dental caries, there are no studies of the incremental benefit of in-office fluoride treatments for low-risk patients exposed to fluoridated water and using fluoridated toothpaste. Comparative studies using outcome end points are needed to determine the optimal frequency of dental examinations and bite-wing radiographs for the early detection of caries, and of scaling

  20. Gasoline risk management: a compendium of regulations, standards, and industry practices.

    Science.gov (United States)

    Swick, Derek; Jaques, Andrew; Walker, J C; Estreicher, Herb

    2014-11-01

    This paper is part of a special series of publications regarding gasoline toxicology testing and gasoline risk management; this article covers regulations, standards, and industry practices concerning gasoline risk management. Gasoline is one of the highest volume liquid fuel products produced globally. In the U.S., gasoline production in 2013 was the highest on record (API, 2013). Regulations such as those pursuant to the Clean Air Act (CAA) (Clean Air Act, 2012: § 7401, et seq.) and many others provide the U.S. federal government with extensive authority to regulate gasoline composition, manufacture, storage, transportation and distribution practices, worker and consumer exposure, product labeling, and emissions from engines and other sources designed to operate on this fuel. The entire gasoline lifecycle-from manufacture, through distribution, to end-use-is subject to detailed, complex, and overlapping regulatory schemes intended to protect human health, welfare, and the environment. In addition to these legal requirements, industry has implemented a broad array of voluntary standards and best management practices to ensure that risks from gasoline manufacturing, distribution, and use are minimized. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

  1. [Approaching the "evidence-practice gap" in pharmaceutical risk management: analysis of healthcare claim data].

    Science.gov (United States)

    Nakayama, Takeo

    2012-01-01

    The concept of evidence-based medicine (EBM) has promulgated among healthcare professionals in recent years, on the other hand, the problem of underuse of useful clinical evidence is coming to be important. This is called as evidence-practice gap. The major concern about evidence-practice gap is insufficient implementation of evidence-based effective treatment, however, the perspective can be extended to measures to improve drug safety and prevention of drug related adverse events. First, this article reviews the characteristics of the database of receipt (healthcare claims) and the usefulness for research purpose of pharmacoepidemiology. Second, as the real example of the study on evidence-practice gap by using the receipt database, the case of ergot-derived anti-Parkinson drugs, of which risk of valvulopathy has been identified, is introduced. The receipt analysis showed that more than 70% of Parkinson's disease patients prescribed with cabergoline or pergolide did not undergo echocardiography despite the revision of the product label recommendation. Afterwards, the issues of pharmaceutical risk management and risk communication will be discussed.

  2. Emotions in Risk Assessment and Decision Making Processes During Craft Practice

    Directory of Open Access Journals (Sweden)

    Camilla Groth

    2015-12-01

    Full Text Available Traditionally subjective experiences and emotions have been overlooked in the practice of scientific research. In the field of design and craft research too, feelings and emotions have been considered as interfering with the rigour of research. However, as a result of findings in neuroscience, a new understanding has emerged, providing emotions a central role in risk assessment and decision making processes. This has implications also for how we understand craft practice. In this practice-led research, a craft practitioner analysed five video-recordings of herself while throwing clay blindfolded. The researcher-practitioner specifically studied critical incidents in the throwing process and made a detailed analysis of how sensory experiences and emotions guided her in risk assessment, decision making, and problem solving during the clay-throwing sessions. She found that her tactile experience gave her important clues on the condition of the material and its consequent possibilities at different stages. These experiences in turn affected her emotions in either positive or negative ways, affecting her risk assessment, decision making, and problem solving activities. This research has shown that sensory experiences and emotions influence the craft making process and are thus important elements in the expertise of the craftsperson. The role of such emotions remains to be studied further in the expertise of researchers in general.

  3. Characteristics, Risk Factors, and Treatment Practices of Known Adult Hypertensive Patients in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    N. Al-Hamdan

    2010-01-01

    Methods. Cross-sectional community-based study using the WHO stepwise approach. Saudi adults were randomly chosen from Primary Health Care Centers catchment areas. Data was collected using a questionnaire which included sociodemographic data, history of hypertension, risk factors, treatment practices, biochemical and anthropometric measurements. Collected data was cheeked, computer fed, and analysed using SPSS V17. Results. Out of 4719 subjects (99.2% response, 542 (11.5% subjects were known hypertensives or detected by health workers in the past 12 months. Hypertension was significantly associated with age, gender, geographical location, education, employment, diabetes, physical inactivity, excess body weight, and ever smoking. Multiple logistic analysis controlling for age showed that significant predictors of hypertension were diabetes mellitus, ever smoking, obesity, and hypercholesteremia. Several treatment modalities and practices were significantly associated with gender, age, education, and occupation. About 74% were under prescribed treatment by physicians, 62% on dietary modification, 37% attempted weight reduction, 27% performed physical exercise, and less than 7% used herbs, consulted traditional healers or quitted smoking. Income was not significantly associated with any treatment modality or patient practices. Conclusion. Hypertension (known and undetected is a major chronic health problem among adults in Saudi Arabia. Many patients' practices need changes. A comprehensive approach is needed to prevent, early detect, and control the disease targeting, the risk factors, and predictors identified.

  4. Risk Modeling of Interdependent Complex Systems of Systems: Theory and Practice.

    Science.gov (United States)

    Haimes, Yacov Y

    2018-01-01

    The emergence of the complexity characterizing our systems of systems (SoS) requires a reevaluation of the way we model, assess, manage, communicate, and analyze the risk thereto. Current models for risk analysis of emergent complex SoS are insufficient because too often they rely on the same risk functions and models used for single systems. These models commonly fail to incorporate the complexity derived from the networks of interdependencies and interconnectedness (I-I) characterizing SoS. There is a need to reevaluate currently practiced risk analysis to respond to this reality by examining, and thus comprehending, what makes emergent SoS complex. The key to evaluating the risk to SoS lies in understanding the genesis of characterizing I-I of systems manifested through shared states and other essential entities within and among the systems that constitute SoS. The term "essential entities" includes shared decisions, resources, functions, policies, decisionmakers, stakeholders, organizational setups, and others. This undertaking can be accomplished by building on state-space theory, which is fundamental to systems engineering and process control. This article presents a theoretical and analytical framework for modeling the risk to SoS with two case studies performed with the MITRE Corporation and demonstrates the pivotal contributions made by shared states and other essential entities to modeling and analysis of the risk to complex SoS. A third case study highlights the multifarious representations of SoS, which require harmonizing the risk analysis process currently applied to single systems when applied to complex SoS. © 2017 Society for Risk Analysis.

  5. NHS health checks through general practice: randomised trial of population cardiovascular risk reduction

    Directory of Open Access Journals (Sweden)

    Cochrane Thomas

    2012-11-01

    Full Text Available Abstract Background The global burden of the major vascular diseases is projected to rise and to remain the dominant non-communicable disease cluster well into the twenty first century. The Department of Health in England has developed the NHS Health Check service as a policy initiative to reduce population vascular disease risk. The aims of this study were to monitor population changes in cardiovascular disease (CVD risk factors over the first year of the new service and to assess the value of tailored lifestyle support, including motivational interview with ongoing support and referral to other services. Methods Randomised trial comparing NHS Health Check service only with NHS Health Check service plus additional lifestyle support in Stoke on Trent, England. Thirty eight general practices and 601 (365 usual care, 236 additional lifestyle support patients were recruited and randomised independently between September 2009 and February 2010. Changes in population CVD risk between baseline and one year follow-up were compared, using intention-to-treat analysis. The primary outcome was the Framingham 10 year CVD risk score. Secondary outcomes included individual modifiable risk measures and prevalence of individual risk categories. Additional lifestyle support included referral to a lifestyle coach and free sessions as needed for: weight management, physical activity, cook and eat and positive thinking. Results Average population CVD risk decreased from 32.9% to 29.4% (p Conclusions The NHS Health Check service in Stoke on Trent resulted in significant reduction in estimated population CVD risk. There was no evidence of further benefit of the additional lifestyle support services in terms of absolute CVD risk reduction.

  6. A review of multidisciplinary clinical practice guidelines in suicide prevention: toward an emerging standard in suicide risk assessment and management, training and practice.

    Science.gov (United States)

    Bernert, Rebecca A; Hom, Melanie A; Roberts, Laura Weiss

    2014-10-01

    The current paper aims to: (1) examine clinical practice guidelines in suicide prevention across fields, organizations, and clinical specialties and (2) inform emerging standards in clinical practice, research, and training. The authors conducted a systematic literature review to identify clinical practice guidelines and resource documents in suicide prevention and risk management. The authors used PubMed, Google Scholar, and Google Search, and keywords included: clinical practice guideline, practice guideline, practice parameters, suicide, suicidality, suicidal behaviors, assessment, and management. To assess for commonalities, the authors reviewed guidelines and resource documents across 13 key content categories and assessed whether each document suggested validated assessment measures. The search generated 101 source documents, which included N = 10 clinical practice guidelines and N = 12 additional resource documents (e.g., non-formalized guidelines, tool-kits). All guidelines (100 %) provided detailed recommendations for the use of evidence-based risk factors and protective factors, 80 % provided brief (but not detailed) recommendations for the assessment of suicidal intent, and 70 % recommended risk management strategies. By comparison, only 30 % discussed standardization of risk-level categorizations and other content areas considered central to best practices in suicide prevention (e.g., restricting access to means, ethical considerations, confidentiality/legal issues, training, and postvention practices). Resource documents were largely consistent with these findings. Current guidelines address similar aspects of suicide risk assessment and management, but significant discrepancies exist. A lack of consensus was evident in recommendations across core competencies, which may be improved by increased standardization in practice and training. Additional resources appear useful for supplemental use.

  7. Managing occupational risk in creative practice: a new perspective for occupational health and safety.

    Science.gov (United States)

    Oughton, Nicholas

    2013-01-01

    There has been little recognition of the fact that creative production operates in a somewhat different environment and timeframe to that associated with traditional industries. This has resulted in the application of an orthodox, generic or ``one size fits all'' framework of Occupational Health and Safety (OHS) systems across all industries. With the rapid growth of ``creative industry,'' certain challenges arise from the application of this "generic" strategy, mainly because the systems currently employed may not be entirely suitable for creative practice. Some OHS practitioners suggest that the current OHS paradigm is failing. This paper questions the appropriateness of applying a twentieth century OHS model in the present industrial context, and considers what framework will best provide for the well-being of creative workers and their enterprise in the twenty-first century. The paper questions the notion of "Risk" and the paradox associated with "Risk Management," particularly in the context of the creative process. Clearly, risk taking contributes to creative enterprise and effective risk management should accommodate both risk minimization and risk exploitation.

  8. Conservative sharp wound debridement: an overview of Canadian education, practice, risk, and policy.

    Science.gov (United States)

    Rodd-Nielsen, Elise; Harris, Connie L

    2013-01-01

    The purpose of this study was to describe the education, policy, practice, and risk management strategies of nurses performing conservative sharp wound debridement (CSWD) in Canada, prior to the release of the Canadian Association for Enterostomal Therapy Evidence-Based Recommendations for Conservative Sharp Wound Debridement. Data collection was based on a nonrandomized, nonexperimental study design and reported using descriptive statistics. Invitations for health care professionals to participate in a CSWD scan were sent to 4315 people via e-mail through the membership lists of 2 Canadian voluntary professional wound care associations. Skip logic screened out respondents who had no experience in CSWD (n = 57). The total number of professionals who participated was 487. A 26-question electronic scan addressed demographics, education, policy, practice, and risk/quality issues related to CSWD. A comment section was included for some questions. A selected subsample of 397 nurses was chosen from the original total of 487 respondents. Nonnurse respondents were excluded due to the low total number of participants in each of these other professional categories. Nurses perform CSWD in all types of care settings in Canada from outpost nursing stations to hospital wards, homes, and long-term care facilities. The wound education preparation reported varied. The most frequently reported formal wound care education was a 2-day course (59%; n = 220), followed by an enterostomal therapy course (42%; n = 155) and the International Interdisciplinary Wound Care Course (26%; n = 98), with overlapping preparation evident. Eleven percent of respondents (n = 47) reported having taken no formal wound course, and 7% (n = 27) taught themselves to perform CSWD. Twenty-eight percent of nurses (n = 112) were unclear about whether CSWD was within their scope of practice or replied that it was not, and 69% (n = 273) did not know if there was provincial legislation that restricted their

  9. Knowledge, attitudes and practices of business travelers regarding malaria risk and prevention.

    Science.gov (United States)

    Weber, Roger; Schlagenhauf, Patricia; Amsler, Lorenz; Steffen, Robert

    2003-01-01

    This study aimed to determine the knowledge, attitudes and practices of Swiss business travelers with regard to malaria. Questionnaires printed in three languages were distributed by employers, travel agencies and tropical medicine specialists to business travelers with destinations in malaria endemic countries. In total, 401 questionnaires were evaluated. Thirty-three percent visited high-risk areas, 27% visited low-risk areas, and 40% visited only malaria-free areas within endemic countries. Among the investigated business travelers, 6% had experienced malaria infection, and 29% had previously had blood smears tested for malaria at least once. Almost all business travelers, 95%, knew that mosquitoes are the main vectors of malaria. The infection risk between dusk and dawn was known to 71%, and the incubation time to 36%. Apart from fever (99%) and headache (63%), other malaria symptoms were known to only 13% to 36% of the travelers. If signs of illness such as fever and headache occurred, 63% would react adequately and seek medical advice within 24 h. Only 16% of the travelers to African high-risk areas followed the recommended behavior concerning anti-mosquito and antimalarial strategies; 31% of those on trips to low-risk areas used an adequate protective strategy. Of the business travelers using chemoprophylaxis during travel, just 50% continued intake post travel, as requested, after leaving the endemic area. Business travelers are well informed regarding the mode of transmission and the risk of malaria at specific destinations but tend to comply poorly with anti-mosquito and chemoprophylactic strategies. The knowledge, attitudes and practices of business travelers with regard to malaria prevention need to be improved.

  10. Firearm Ownership, Storage Practices, and Suicide Risk Factors in Washington State, 2013-2016.

    Science.gov (United States)

    Morgan, Erin Renee; Gomez, Anthony; Rowhani-Rahbar, Ali

    2018-05-17

    To characterize firearm ownership and storage practices in Washington State and assess their relationship with suicide risk factors. Using Washington State Behavioral Risk Factor Surveillance System data for 2013 to 2016, we conducted survey-weighted multivariable Poisson regression models to obtain prevalence ratios (PRs) and confidence intervals (CIs). Of 34 884 adult respondents, 34.3% (95% CI = 33.7%, 35.0%) reported a firearm in their household, among whom 36.6% (95% CI = 35.4%, 37.7%) stored their firearm locked and unloaded. There were no differences in mental health indicators by firearm ownership or storage practice status. Binge and chronic alcohol use were somewhat more prevalent among adults from firearm-owning households (PR = 1.2; 95% CI = 1.1, 1.3; PR = 1.2; 95% CI = 1.1, 1.4, respectively) and among those living in households not practicing safe storage (PR = 1.4; 95% CI = 1.2, 1.7; PR = 1.9; 1.5, 2.3, respectively). Variability in mental health does not explain the substantial increased suicide risk among individuals in firearm-owning households. Greater prevalence of alcohol misuse among adults in firearm-owning households not practicing safe storage highlights the need for suicide prevention interventions. (Am J Public Health. Published online ahead of print May 17, 2018: e1-e7. doi:10.2105/AJPH.2018.304403).

  11. Did our current initial treatment practice change after EAU/ESPU vesicoureteral reflux risk grouping?

    Science.gov (United States)

    Tokat, Eda; Gurocak, Serhat; Ure, Iyimser; Acar, Cenk; Sınık, Zafer; Tan, Mustafa Ozgur

    2018-06-02

    The "European Association of Urology (EAU) Guidelines on Vesicoureteral Reflux (VUR) in Children (September 2012)" established risk classification by analyzing and defining risk factors for each patient. In this study we aimed to investigate how our initial treatment procedures were affected by EAU/ESPU guideline vesicoureteral reflux risk grouping and to compare the early clinical results of treatments performed before and after the risk classification in our patients with VUR. 334 renal units with regular clinical follow-up who were treated owing to VUR (vesicoureteral reflux) between years 2009 and 2017 were retrospectively reviewed. Preoperative clinical parameters such as grade and laterality of reflux, presence of renal scar, initial and follow-up treatments, findings of medical treatment and surgical procedures were analyzed. The initial medical and surgical methods were compared by categorizing patients according to risk groups before and after 2013. Mean age and follow-up duration were 71.4(6-216) months and 47(4-141) months, respectively. Among the preoperative parameters, only high EAU risk group (p = 0.01) and treating lower urinary tract symptoms (p age, sex, and presence of renal scar at DMSA were not affecting the success of treatment significantly. While no significant difference in medical and surgical treatment rates is observed after risk grouping system in low risk group, the percentages of patients who are treated with surgical methods initially were significantly decreased in moderate and high risk groups (p = 0.002 and p = 0.012, respectively). We determined that VUR risk grouping did not change clinical success significantly in all risk groups. Despite the fact that EAU/ESPU VUR risk classification changed our current practice in terms of initial treatment method, this different approach did not seem to affect early clinical success positively. There is still an absolute need for studies with larger sample size and long

  12. The concept of antifragility and its implications for the practice of risk analysis.

    Science.gov (United States)

    Aven, Terje

    2015-03-01

    Nassim Taleb's antifragile concept has been shown considerable interest in the media and on the Internet recently. For Taleb, the antifragile concept is a blueprint for living in a black swan world (where surprising extreme events may occur), the key being to love variation and uncertainty to some degree, and thus also errors. The antonym of "fragile" is not robustness or resilience, but "please mishandle" or "please handle carelessly," using an example from Taleb when referring to sending a package full of glasses by post. In this article, we perform a detailed analysis of this concept, having a special focus on how the antifragile concept relates to common ideas and principles of risk management. The article argues that Taleb's antifragile concept adds an important contribution to the current practice of risk analysis by its focus on the dynamic aspects of risk and performance, and the necessity of some variation, uncertainties, and risk to achieve improvements and high performance at later stages. © 2014 Society for Risk Analysis.

  13. [Neonatal arterial ischemic stroke: Which thrombotic biological risk factors to investigate and which practical consequences?

    Science.gov (United States)

    Perez, T; Valentin, J B; Saliba, E; Gruel, Y

    2017-09-01

    All biological risk factors that have been previously identified to increase the risk of thrombosis in adults, have also been studied in neonates with arterial Ischemic Stroke (NAIS), but most studies were retrospective and included relatively low numbers of affected children. We therefore could not suggest recommendations with a strong level of evidence and only expert proposals potentially useful for clinical practice will be presented in this text. Despite these limitations, the extensive analysis of published data supported that factor V Leiden (FVL) and increased levels of Lp(a) could be significant risk factors for NAIS. Importantly, these 2 risk factors cannot be considered as having provoked NAIS, and moreover, they do not influence the prognosis and the immediate treatment. However, since the FVL may have an impact for the prescription of a thromboprophylaxis when the neonate will become adult, to look for its presence in affected patients may be justified. For clinical practice, the following propositions can be applied: 1. Routine testing for thrombophilia (AT, PC PS deficiency, FV Leiden or FII20210A) or for detecting other biological risk factors such as antiphospholipid antibodies, high FVIII, homocystein or Lp(a) levels, MTHFR thermolabile variant, should not be considered in neonates with NAIS. 2. Testing for FV Leiden can be performed in case of documented family history of venous thromboembolic disease. 3. Testing neonates for the presence of antiphospholipid antibodies (APA) is mandatory in case of clinical events suggesting antiphospholipid syndrome in the mother (vascular thrombosis, and/or pregnancy morbidity). 4. Routine testing for thrombophilia is not proposed in both parents in case of early death of the neonate, apart from APA in the mother. © 2017 Elsevier Masson SAS. Tous droits réservés.

  14. Implementation of a risk assessment tool based on a probabilistic safety assessment developed for radiotherapy practices

    International Nuclear Information System (INIS)

    Paz, A.; Godinez, V.; Lopez, R.

    2010-10-01

    The present work describes the implementation process and main results of the risk assessment to the radiotherapy practices with Linear Accelerators (Linac), with cobalt 60, and with brachytherapy. These evaluations were made throughout the risk assessment tool for radiotherapy practices SEVRRA (risk evaluation system for radiotherapy), developed at the Mexican National Commission in Nuclear Safety and Safeguards derived from the outcome obtained with the Probabilistic Safety Analysis developed at the Ibero-American Regulators Forum for these radiotherapy facilities. The methodology used is supported by risk matrices method, a mathematical tool that estimates the risk to the patient, radiation workers and public from mechanical failures, mis calibration of the devices, human mistakes, and so. The initiating events are defined as those undesirable events that, together with other failures, can produce a delivery of an over-dose or an under-dose of the medical prescribed dose, to the planned target volume, or a significant dose to non prescribed human organs. Initiating events frequency and reducer of its frequency (actions intended to avoid the accident) are estimated as well as robustness of barriers to those actions, such as mechanical switches, which detect and prevent the accident from occurring. The spectrum of the consequences is parameterized, and the actions performed to reduce the consequences are identified. Based on this analysis, a software tool was developed in order to simplify the evaluations to radiotherapy installations and it has been applied as a first step forward to some Mexican installations, as part of a national implementation process, the final goal is evaluation of all Mexican facilities in the near future. The main target and benefits of the SEVRRA implementation are presented in this paper. (Author)

  15. Implementation of a risk assessment tool based on a probabilistic safety assessment developed for radiotherapy practices

    Energy Technology Data Exchange (ETDEWEB)

    Paz, A.; Godinez, V.; Lopez, R., E-mail: abpaz@cnsns.gob.m [Comision Nacional de Seguridad Nuclear y Salvaguardias, Dr. Barragan No. 779, Col. Narvarte, 03020 Mexico D. F. (Mexico)

    2010-10-15

    The present work describes the implementation process and main results of the risk assessment to the radiotherapy practices with Linear Accelerators (Linac), with cobalt 60, and with brachytherapy. These evaluations were made throughout the risk assessment tool for radiotherapy practices SEVRRA (risk evaluation system for radiotherapy), developed at the Mexican National Commission in Nuclear Safety and Safeguards derived from the outcome obtained with the Probabilistic Safety Analysis developed at the Ibero-American Regulators Forum for these radiotherapy facilities. The methodology used is supported by risk matrices method, a mathematical tool that estimates the risk to the patient, radiation workers and public from mechanical failures, mis calibration of the devices, human mistakes, and so. The initiating events are defined as those undesirable events that, together with other failures, can produce a delivery of an over-dose or an under-dose of the medical prescribed dose, to the planned target volume, or a significant dose to non prescribed human organs. Initiating events frequency and reducer of its frequency (actions intended to avoid the accident) are estimated as well as robustness of barriers to those actions, such as mechanical switches, which detect and prevent the accident from occurring. The spectrum of the consequences is parameterized, and the actions performed to reduce the consequences are identified. Based on this analysis, a software tool was developed in order to simplify the evaluations to radiotherapy installations and it has been applied as a first step forward to some Mexican installations, as part of a national implementation process, the final goal is evaluation of all Mexican facilities in the near future. The main target and benefits of the SEVRRA implementation are presented in this paper. (Author)

  16. Prevalence of and risk factors for violent disciplinary practices at home in Viet Nam.

    Science.gov (United States)

    Cappa, Claudia; Dam, Hang

    2014-02-01

    Data on parenting practices and the use of violence in child rearing remain scarce worldwide, hindering prevention efforts. This study examines disciplinary methods used on children at home in Viet Nam. It is based on data collected from 2010 to 2011 through the fourth round of the Multiple Indicator Cluster Survey (MICS4)-a household survey program supported by the United Nations Children's Fund (UNICEF) that focuses on women and children in low- and middle-income countries. Respondents in the survey were asked 11 questions relating to disciplinary measures used in the preceding month on one randomly selected child (2-14 years old) in each household. A final question about attitudes probed adults' views on the need for physical punishment in child rearing. Univariate and multivariate analyses were conducted to estimate the prevalence of violent and nonviolent forms of discipline, and to identify risk factors associated with violent punishment. Results showed that three in four children in Viet Nam are disciplined through violent means. The exposure of Vietnamese children to violent forms of discipline was significantly associated with varied characteristics of both children and their caregivers. Moreover, the use of violent disciplinary practices on children was strongly associated with positive attitudes toward corporal punishment. Risk factors for violent child discipline identified in this study can inform future interventions to promote positive practices and to protect Vietnamese children against violence in the home.

  17. Simulation of changes on the psychosocial risk in the nursing personnel after implementing the policy of good practices on the risk treatment.

    Science.gov (United States)

    Bolívar Murcia, María Paula; Cruz González, Joan Paola; Rodríguez Bello, Luz Angélica

    2018-02-01

    Evaluate the change over time of psychosocial risk management for the nursing personnel of an intermediate complexity clinic of Bogota (Colombia). Descriptive and correlational research performed under the approach of risk management (identification, analysis, assessment and treatment). The psychosocial risk of the nursing personnel was studied through 10-year system dynamics models (with and without the implementation of the policy of good practices on the risk treatment) in two scenarios: when the nursing personnel works shifts of 6 hours (morning or afternoon) and when they work over 12 hours (double shift or night shift). When implementing a policy of good practices on the risk treatment, the double shift scenario shows an improvement among 25% to 88% in the variables of: health, labor motivation, burnout, service level and productivity; as well as in the variables of the organization associated to number of patients, nursing personnel and profit. Likewise, the single shift scenario with good practices improves in all the above-mentioned variables and generates stability on the variables of absenteeism and resignations. The best scenario is the single shift scenario with the application of good practices of risk treatment in comparison with the double shift scenario with good practices, which allows concluding that the good practices have a positive effect on the variables of nursing personnel and on those associated to the organization. Copyright© by the Universidad de Antioquia.

  18. Smartphone applications for communicating avalanche risk information - a review of existing practices

    Science.gov (United States)

    Charrière, M. K. M.; Bogaard, T. A.

    2015-11-01

    Every year, in all mountainous regions, people are victims of avalanches. One way to decrease those losses is believed to be informing about danger levels. The paper presents a study on current practices in the development of smartphones applications that are dedicated to avalanche risk communication. The analysis based on semi-structured interviews with developers of smartphone apps highlights the context of their development, how choices of content and visualization were made as well as how their effectiveness is evaluated. It appears that although the communicators agree on the message to disseminate, its representation triggers debate. Moreover, only simple evaluation processes are conducted but there is a clear awareness that further scientific efforts are needed to analyze the effectiveness of the smartphone apps. Finally, the current or planned possibility for non-experts users to report feedback on the snow and avalanches conditions open the doors to a transition of these apps from one-way communication tools to two-ways communication platforms. This paper also indicates the remaining challenges that avalanche risk communication is facing, although it is disputably the most advanced and standardized practice compared to other natural hazards. Therefore, this research is of interest for the entire field of natural hazards related risk communication.

  19. Associations of contextual risk and protective factors with fathers' parenting practices in the postdeployment environment.

    Science.gov (United States)

    Davis, Laurel; Hanson, Sheila K; Zamir, Osnat; Gewirtz, Abigail H; DeGarmo, David S

    2015-08-01

    Deployment separation and reunifications are salient contexts that directly impact effective family functioning and parenting for military fathers. Yet, we know very little about determinants of postdeployed father involvement and effective parenting. The present study examined hypothesized risk and protective factors of observed parenting for 282 postdeployed fathers who served in the National Guard/Reserves. Preintervention data were employed from fathers participating in the After Deployment, Adaptive Parenting Tools randomized control trial. Parenting practices were obtained from direct observation of father-child interaction and included measures of problem solving, harsh discipline, positive involvement, encouragement, and monitoring. Risk factors included combat exposure, negative life events, months deployed, and posttraumatic stress disorder symptoms. Protective factors included education, income, dyadic adjustment, and social support. Results of a structural equation model assessing risk and protective factors for an effective parenting construct indicated that months deployed, income, and father age were most related to observed parenting, explaining 16% of the variance. We are aware of no other study using direct parent-child observations of fathers' parenting skills following overseas deployment. Implications for practice and preventive intervention are discussed. (c) 2015 APA, all rights reserved).

  20. Evaluation of activities aimed at preventing microbiological risks in dental practice

    Directory of Open Access Journals (Sweden)

    Jolanta Szymańska

    2013-02-01

    Full Text Available Background: Microbiological contamination of water in dental unit waterlines (DUWL creates a risk of cross-infections, and is a source of biological risk factors in the work environment of a dentist. The aim of the study was to evaluate dentists' knowledge on DUWL microbiological contamination and the scope of activities/procedures they undertake to monitor it. Material and Methods: The questionnaire survey was conducted in 2010 among 107 Polish dentists using dental units in everyday clinical practice. Results: It has been found that in their daily practice, dentists do not follow procedures leading to reduction or elimination of microbiological contamination of dental unit reservoir water. They are not aware of microbiological contamination of DUWL that supply working handpieces with water. They are unaware of the principles of dealing with dental water and water supply systems or the health risk posed by microbiological contamination of unit water for a dental team and patients. Conclusions: It is necessary to provide dentists with information on microbiological contamination of water in dental units, on the correct procedures of handling water and waterlines that supply working handpieces with water. Med Pr 2013;64(1:11–17

  1. Risk and Rationality in Adolescent Decision Making: Implications for Theory, Practice, and Public Policy.

    Science.gov (United States)

    Reyna, Valerie F; Farley, Frank

    2006-09-01

    Crime, smoking, drug use, alcoholism, reckless driving, and many other unhealthy patterns of behavior that play out over a lifetime often debut during adolescence. Avoiding risks or buying time can set a different lifetime pattern. Changing unhealthy behaviors in adolescence would have a broad impact on society, reducing the burdens of disease, injury, human suffering, and associated economic costs. Any program designed to prevent or change such risky behaviors should be founded on a clear idea of what is normative (what behaviors, ideally, should the program foster?), descriptive (how are adolescents making decisions in the absence of the program?), and prescriptive (which practices can realistically move adolescent decisions closer to the normative ideal?). Normatively, decision processes should be evaluated for coherence (is the thinking process nonsensical, illogical, or self-contradictory?) and correspondence (are the outcomes of the decisions positive?). Behaviors that promote positive physical and mental health outcomes in modern society can be at odds with those selected for by evolution (e.g., early procreation). Healthy behaviors may also conflict with a decision maker's goals. Adolescents' goals are more likely to maximize immediate pleasure, and strict decision analysis implies that many kinds of unhealthy behavior, such as drinking and drug use, could be deemed rational. However, based on data showing developmental changes in goals, it is important for policy to promote positive long-term outcomes rather than adolescents' short-term goals. Developmental data also suggest that greater risk aversion is generally adaptive, and that decision processes that support this aversion are more advanced than those that support risk taking. A key question is whether adolescents are developmentally competent to make decisions about risks. In principle, barring temptations with high rewards and individual differences that reduce self-control (i.e., under ideal

  2. Risk analysis methods: their importance for safety assessment of practices using radiation

    International Nuclear Information System (INIS)

    Dumenigo, C; Vilaragut, J.J.; Ferro, R.; Guillen, A.; Ramirez, M.L.; Ortiz Lopez, P.; Rodriguez, M.; McDonnell, J.D.; Papadopulos, S.; Pereira, P.P.; Goncalvez, M.; Morales, J.; Larrinaga, E.; Lopez Morones, R.; Sanchez, R.; Delgado, J.M.; Sanchez, C.; Somoano, F.

    2008-01-01

    Radiation safety has been based for many years on verification of compliance with regulatory requirements, codes of practice and international standards, which can be considered prescriptive methods. Accident analyses have been published, lessons have been learned and safety assessments have incorporated the need to check whether a facility is ready to avoid accidents similar to the reported ones. These approaches can be also called 'reactive methods'. They have in common the fundamental limitation of being restricted to reported experience, but do not take into account other potential events, which were never published or never happened, i.e. latent risks. Moreover, they focus on accident sequences with major consequences and low probability but may not pay enough attention to other sequences leading to lower, but still significant consequences with higher probability. More proactive approaches are, therefore, needed, to assess risk in radiation facilities. They aim at identifying all potential equipment faults and human error, which can lead to predefined unwanted consequences and are based on the general risk equation: Risk = Probability of occurrence of an accidental sequence * magnitude of the consequences. In this work, a review is given of the experience obtained by the countries of the Ibero American Forum of Nuclear and Radiation Safety Regulatory Organizations, by applying proactive methods to radiotherapy practice. In particular, probabilistic safety assessment (PSA) used for external beam treatments with linear electron accelerators and two studies, on cobalt 60 therapy and brachytherapy using the risk-matrix approach are presented. The work has identified event sequences, their likelihood of occurrence, the consequences, the efficiency of interlocks and control checks and the global importance in terms of overall risk, to facilitate decision making and implementation of preventive measures. A comparison is presented of advantages and limitations of

  3. Constructions of masculinity and femininity and sexual risk negotiation practices among women in urban Ghana.

    Science.gov (United States)

    Fiaveh, Daniel Y; Izugbara, Chimaraoke O; Okyerefo, Michael P K; Reysoo, Fenneke; Fayorsey, Clara K

    2015-01-01

    Using qualitative data gathered through in-depth interviews with women in Accra, Ghana, this paper explores narratives of masculinity and femininity and sexual risk negotiation practices among women. While women framed 'proper' masculinity in terms of stereotypical reproductive norms, they also acknowledged the fluidity and multiplicity of masculinities. Femininity was more uniformly characterised in terms of physical attractiveness and beauty, responsibility and reproduction. These features, especially those related to adherence to morally and socially appropriate sexual norms (e.g., menstrual and bodily hygiene, unplanned pregnancy etc.), influenced women's approach to sexual negotiation. Work aiming to support women to negotiate sex safely needs to pay attention to their notions of gender and practices of sexual negotiation.

  4. Assessing gender stereotypes and sexual risk practices in men who have sex with men.

    Science.gov (United States)

    Gasch Gallén, Ángel; Tomás Aznar, Concepción; Rubio Aranda, Encarnación

    2017-06-22

    To analyze the construct validity and the internal consistency of the 12-item Bem Sex Role Inventory (BSRI-12) questionnaire and to study the association between gender stereotypes and sexual risk practices in men who have sex with men (MSM). Cross-sectional study of 601 MSM who voluntarily and anonymously responded to an online survey on risk practices and gender stereotypes. The BSRI-12 was used to obtain gender stereotypes (masculine, feminine, undifferentiated and androgynous). For data analysis, exploratory factor analysis (EFA) of the BSRI-12 and logistic regression were performed. Two main factors (Cronbach alpha 0.95 and 0.81) were obtained from the EFA. Using the androgynous roles as the reference category, we found lower odds of engaging in unprotected anal intercourse (UAI) among those who endorse feminine roles (OR: 0.53; 95%CI: 0.29-0.95). Endorsing masculine roles with alcohol consumption (OR: 1.92; 95%CI: 1.15-3.20) or the undifferentiated when not knowing the partner's serological status (OR: 1.55; 95%CI: 1.02-2.35) were associated with higher odds of UAI compared to those endorsing the androgynous roles. Undifferentiated participants also perform receptive UAI using poppers (OR: 2.19; 95%CI: 1.24-3.87), and insertive UAI not knowing the serological status of the sexual partner (OR: 1.69; 95%CI: 1.04-2.76) compared to androgynous participants. The BSRI is a valid and consistent instrument for identifying gender stereotypes in MSM. A greater proportion of participants within the undifferentiated and the masculine category engage in risk practices with the influence of substance consumption and unawareness of their sexual partner's serological status. The information obtained may be useful to define intervention and prevention programs. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Safety risks with investigational drugs: Pharmacy practices and perceptions in the veterans affairs health system.

    Science.gov (United States)

    Cruz, Jennifer L; Brown, Jamie N

    2015-06-01

    Rigorous practices for safe dispensing of investigational drugs are not standardized. This investigation sought to identify error-prevention processes utilized in the provision of investigational drug services (IDS) and to characterize pharmacists' perceptions about safety risks posed by investigational drugs. An electronic questionnaire was distributed to an audience of IDS pharmacists within the Veteran Affairs Health System. Multiple facets were examined including demographics, perceptions of medication safety, and standard processes used to support investigational drug protocols. Twenty-one respondents (32.8% response rate) from the Northeast, Midwest, South, West, and Non-contiguous United States participated. The mean number of pharmacist full-time equivalents (FTEs) dedicated to the IDS was 0.77 per site with 0.2 technician FTEs. The mean number of active protocols was 22. Seventeen respondents (81%) indicated some level of concern for safety risks. Concerns related to the packaging of medications were expressed, most notably lack of product differentiation, expiration dating, barcodes, and choice of font size or color. Regarding medication safety practices, the majority of sites had specific procedures in place for storing and securing drug supply, temperature monitoring, and prescription labeling. Repackaging bulk items and proactive error-identification strategies were less common. Sixty-seven percent of respondents reported that an independent double check was not routinely performed. Medication safety concerns exist among pharmacists in an investigational drug service; however, a variety of measures have been employed to improve medication safety practices. Best practices for the safe dispensing of investigational medications should be developed in order to standardize these error-prevention strategies.

  6. Metabolic syndrome in family practice in Jordan: a study of high-risk groups.

    Science.gov (United States)

    Yasein, N; Masa'd, D

    2011-12-01

    This study assessed the prevalence of the metabolic syndrome, and its components, as defined by Adult Treatment Panel III criteria in Jordanian patients attending a family practice clinic for management of cardiovascular risk factors. The sample was 730 randomly selected patients aged > or = 25 years. The prevalence of metabolic syndrome was 37.4% (31.7% in men; 41.0% in women). The prevalence increased with age in the total sample and in both sexes. High waist circumference showed the highest prevalence in the total sample (61.6%). Among females it ranked as the first criterion (73.5%). High serum triglyceride level showed the highest prevalence in males (50.2%). Differences between the sexes were significant. Family practitioners should be alerted to the importance of multiple risk factors in the metabolic syndrome.

  7. Chronic kidney disease in dogs in UK veterinary practices: prevalence, risk factors, and survival.

    Science.gov (United States)

    O'Neill, D G; Elliott, J; Church, D B; McGreevy, P D; Thomson, P C; Brodbelt, D C

    2013-01-01

    The prevalence for chronic kidney disease (CKD) in dogs varies widely (0.05-3.74%). Identified risk factors include advancing age, specific breeds, small body size, and periodontal disease. To estimate the prevalence and identify risk factors associated with CKD diagnosis and survival in dogs. Purebred dogs were hypothesized to have higher CKD risk and poorer survival characteristics than crossbred dogs. A merged clinical database of 107,214 dogs attending 89 UK veterinary practices over a 2-year period (January 2010-December 2011). A longitudinal study design estimated the apparent prevalence (AP) whereas the true prevalence (TP) was estimated using Bayesian analysis. A nested case-control study design evaluated risk factors. Survival analysis used the Kaplan-Meier survival curve method and multivariable Cox proportional hazards regression modeling. The CKD AP was 0.21% (95% CI: 0.19-0.24%) and TP was 0.37% (95% posterior credibility interval 0.02-1.44%). Significant risk factors included increasing age, being insured, and certain breeds (Cocker Spaniel, Cavalier King Charles Spaniel). Cardiac disease was a significant comorbid disorder. Significant clinical signs included halitosis, weight loss, polyuria/polydipsia, urinary incontinence, vomiting, decreased appetite, lethargy, and diarrhea. The median survival time from diagnosis was 226 days (95% CI 112-326 days). International Renal Interest Society stage and blood urea nitrogen concentration at diagnosis were significantly associated with hazard of death due to CKD. Chronic kidney disease compromises dog welfare. Increased awareness of CKD risk factors and association of blood biochemistry results with survival time should facilitate diagnosis and optimize case management to improve animal survival and welfare. Copyright © 2013 by the American College of Veterinary Internal Medicine.

  8. Attitudes, norms and controls influencing lifestyle risk factor management in general practice.

    Science.gov (United States)

    Ampt, Amanda J; Amoroso, Cheryl; Harris, Mark F; McKenzie, Suzanne H; Rose, Vanessa K; Taggart, Jane R

    2009-08-26

    With increasing rates of chronic disease associated with lifestyle behavioural risk factors, there is urgent need for intervention strategies in primary health care. Currently there is a gap in the knowledge of factors that influence the delivery of preventive strategies by General Practitioners (GPs) around interventions for smoking, nutrition, alcohol consumption and physical activity (SNAP). This qualitative study explores the delivery of lifestyle behavioural risk factor screening and management by GPs within a 45-49 year old health check consultation. The aims of this research are to identify the influences affecting GPs' choosing to screen and choosing to manage SNAP lifestyle risk factors, as well as identify influences on screening and management when multiple SNAP factors exist. A total of 29 audio-taped interviews were conducted with 15 GPs and one practice nurse over two stages. Transcripts from the interviews were thematically analysed, and a model of influencing factors on preventive care behaviour was developed using the Theory of Planned Behaviour as a structural framework. GPs felt that assessing smoking status was straightforward, however some found assessing alcohol intake only possible during a formal health check. Diet and physical activity were often inferred from appearance, only being assessed if the patient was overweight. The frequency and thoroughness of assessment were influenced by the GPs' personal interests and perceived congruence with their role, the level of risk to the patient, the capacity of the practice and availability of time. All GPs considered advising and educating patients part of their professional responsibility. However their attempts to motivate patients were influenced by perceptions of their own effectiveness, with smoking causing the most frustration. Active follow-up and referral of patients appeared to depend on the GPs' orientation to preventive care, the patient's motivation, and cost and accessibility of

  9. Attitudes, norms and controls influencing lifestyle risk factor management in general practice

    Directory of Open Access Journals (Sweden)

    McKenzie Suzanne H

    2009-08-01

    Full Text Available Abstract Background With increasing rates of chronic disease associated with lifestyle behavioural risk factors, there is urgent need for intervention strategies in primary health care. Currently there is a gap in the knowledge of factors that influence the delivery of preventive strategies by General Practitioners (GPs around interventions for smoking, nutrition, alcohol consumption and physical activity (SNAP. This qualitative study explores the delivery of lifestyle behavioural risk factor screening and management by GPs within a 45–49 year old health check consultation. The aims of this research are to identify the influences affecting GPs' choosing to screen and choosing to manage SNAP lifestyle risk factors, as well as identify influences on screening and management when multiple SNAP factors exist. Methods A total of 29 audio-taped interviews were conducted with 15 GPs and one practice nurse over two stages. Transcripts from the interviews were thematically analysed, and a model of influencing factors on preventive care behaviour was developed using the Theory of Planned Behaviour as a structural framework. Results GPs felt that assessing smoking status was straightforward, however some found assessing alcohol intake only possible during a formal health check. Diet and physical activity were often inferred from appearance, only being assessed if the patient was overweight. The frequency and thoroughness of assessment were influenced by the GPs' personal interests and perceived congruence with their role, the level of risk to the patient, the capacity of the practice and availability of time. All GPs considered advising and educating patients part of their professional responsibility. However their attempts to motivate patients were influenced by perceptions of their own effectiveness, with smoking causing the most frustration. Active follow-up and referral of patients appeared to depend on the GPs' orientation to preventive care, the

  10. A comparative analysis of occupational health and safety risk prevention practices in Sweden and Spain.

    Science.gov (United States)

    Morillas, Rosa María; Rubio-Romero, Juan Carlos; Fuertes, Alba

    2013-12-01

    Scandinavian countries such as Sweden implemented the occupational health and safety (OHS) measures in the European Directive 89/391/EEC earlier than other European counties, including Spain. In fact, statistics on workplace accident rates reveal that between 2004 and 2009, there were considerably fewer accidents in Sweden than in Spain. The objective of the research described in this paper was to reduce workplace accidents and to improve OHS management in Spain by exploring the OHS practices in Sweden. For this purpose, an exploratory comparative study was conducted, which focused on the effectiveness of the EU directive in both countries. The study included a cross-sectional analysis of workplace accident rates and other contextual indicators in both national contexts. A case study of 14 Swedish and Spanish companies identified 14 differences in the preventive practices implemented. These differences were then assessed with a Delphi study to evaluate their contribution to the reduction of workplace accidents and their potential for improving health and safety management in Spain. The results showed that there was agreement concerning 12 of the 14 practices. Finally, we discuss opportunities of improvement in Spanish companies so that they can make their risk management practices more effective. The findings of this comparative study on the implementation of the European Directive 89/391/EEC in both Sweden and Spain have revealed health and safety managerial practices which, if properly implemented, could contribute to improved work conditions and accident statistics of Spanish companies. In particular, the results suggest that Spanish employers, safety managers, external prevention services, safety deputies and Labour Inspectorates should consider implementing streamlined internal preventive management, promoting the integration of prevention responsibilities to the chain of command, and preventing health and safety management from becoming a mere exchange of

  11. Scientific practices and social behaviors in managing landslide risks: comparing experiences between developing and developed countries

    Science.gov (United States)

    Devoli, G.

    2012-04-01

    A successful landslide risk reduction program requires that the society is aware and understand the landslide problems within the geographic area involved. Central organizations that manage national landslide risks should: a) create and systematically applied natural hazard laws/national landslide strategies, where roles and limits of responsibilities of federal, state, provincial, municipal and private entities are well defined; c) establish fruitful multidisciplinary and interinstitutional collaboration among scientists; d) provide good risk assessments in which landslide experts report transparently what is really known and the limitations of methods and tools used; e) share and systematically communicate their knowledge more effectively with all private and public stakeholders involved, paying attention to providing balanced information about risks and addressing inevitable uncertainties; f) support the mass-media in spreading correct scientific information; g) perform serious risk and cost-benefit analyses before mitigation measures are realized; h) assist local authorities in the application of land-use planning policies and g) built trust and confidence by means of a continuous contact and communication with the public and local authorities. However, this is not yet achieved, not even in developed countries where, in theory, more economical resources are available and people are better educated then in developing countries. Herein I make some observations on how national landslide prevention efforts are being organized in two countries (Nicaragua and Norway), where I have been worked at governmental agencies as landslide expert in the last 10 years. I start describing similarities and differences between the countries and try to compare practices and experiences. The analysis was motivated by the following questions: Why after so many years of landslide mapping and investigations, landslide prevention is not good and effective as it should be? Is this

  12. Preparing disabled students for professional practice: managing risk through a principles-based approach.

    Science.gov (United States)

    Hargreaves, Janet; Walker, Lizzie

    2014-08-01

    A discussion exploring the ways disabled students are managed in practice settings. It proposes and argues for morally and legally viable principles to guide risk assessment and inclusive decision-making in practice. Equality law means that universities are bound not to discriminate against students on the basis, amongst other things, of disability. As a consequence in the UK, there is a perceived increase in numbers of disabled people applying for and succeeding as health professionals. Whilst placement providers are equally obliged by the law to have inclusive policies, competing needs including patient safety, public confidence and professional regulations mean that adjustments that can be made in an educational environment to appropriately support student learning may prove to be more difficult in placements that provide direct care to the public. This discussion is an outcome of recommendations from published research by the authors and their research partners. It is supported by related literature, critical debate amongst academics, disabled students and disabled and non-disabled practitioners. Ensuring a nursing workforce that mirrors the diversity of the population it serves is of universal importance. Effective management of disabled students can contribute to achieving this goal and to promoting a positive view of disabled practitioners. Legislation is necessary to protect disabled people from discrimination. To respect this legislation, when preparing nurses and other health professions, a clear understanding of the law and a principles-based approach to guiding risk is important. © 2014 John Wiley & Sons Ltd.

  13. Cross-Cultural Approach of Postpartum Depression: Manifestation, Practices Applied, Risk Factors and Therapeutic Interventions.

    Science.gov (United States)

    Evagorou, Olympia; Arvaniti, Aikaterini; Samakouri, Maria

    2016-03-01

    It is a well known fact that postpartum depression (PPD) is a global phenomenon that women may experience, regardless of cultural identity and beliefs. This literature review presents the cultural beliefs and postnatal practices around the world, in each continent and people's origins, looking through the extent to which they contribute positively or negatively to the onset of the disease. 106 articles were used in this research, through a systematic electronic search of Pubmed (Medline) and Scopus. Comparison is also made between the prevalence, the risk factors and the different ways of appearance of the disease around the world and among immigrants. Finally, the initiatives and interventions made so far by the governments and institutions with a view to prevent and address this global problem are presented. The results showed (a) that different cultures share the same risk factors towards the disease (b) significant differences in the prevalence of the disease among both Western and non Western cultures and between the cultures themselves (c) more tendencies for somatization of depressive symptoms in non-Western cultures, (d) different postnatal practices between cultures, which are not always effective (e) the more non-West a culture is, the less interventions concern on mental health; the same phenomenon is observed on populations burdened by immigration. The beliefs held by culture should be taken seriously in detecting of PPD, as well as the assessment of the needs of women who have recently given birth.

  14. Dentists' use of caries risk assessment in children: findings from the Dental Practice-Based Research Network

    DEFF Research Database (Denmark)

    Riley, Joseph L; Qvist, Vebeke; Fellows, Jeffrey L

    2010-01-01

    This study surveyed Dental Practice-Based Research Network (DPBRN) member dentists (from four regions in the U.S. and Scandinavia) who perform restorative dentistry in their practices. The survey asked a range of questions about caries risk assessment in patients aged 6 to 18. Among respondents, 73...

  15. 78 FR 64425 - Current Good Manufacturing Practice and Hazard Analysis and Risk-Based Preventive Controls for...

    Science.gov (United States)

    2013-10-29

    ..., 507, and 579 [Docket No. FDA-2011-N-0922] Current Good Manufacturing Practice and Hazard Analysis and... requirements for current good manufacturing practice and hazard analysis and risk-based preventive controls for..., packing, or holding of animal food in two ways. First, it would create new current good manufacturing...

  16. 78 FR 24691 - Current Good Manufacturing Practice and Hazard Analysis and Risk-Based Preventive Controls for...

    Science.gov (United States)

    2013-04-26

    ... comments should be identified with the title ``Current Good Manufacturing Practice and Hazard Analysis and..., 114, 117, 120, 123, 129, 179, and 211 [Docket No. FDA-2011-N-0920] RIN 0910-AG36 Current Good Manufacturing Practice and Hazard Analysis and Risk- Based Preventive Controls for Human Food; Extension of...

  17. 78 FR 69604 - Current Good Manufacturing Practice and Hazard Analysis and Risk-Based Preventive Controls for...

    Science.gov (United States)

    2013-11-20

    ... Federal Register of January 16, 2013 (78 FR 3646), entitled ``Current Good Manufacturing Practice and... a proposed rule entitled ``Current Good Manufacturing Practice and Hazard Analysis and Risk-Based..., 114, 117, 120, 123, 129, 179, and 211 [Docket No. FDA-2011-N-0920] RIN 0910-AG36 Current Good...

  18. Practice variation of vaginal birth after cesarean and the influence of risk factors at patient level: a retrospective cohort study

    NARCIS (Netherlands)

    Vankan, E.; Schoorel, E.N.; Kuijk, S.M. van; Mol, B.J.; Nijhuis, J.G.; Aardenburg, R.; Alink, M.; Boer, K. de; Delemarre, F.M.; Dirksen, C.D.; Dooren, I.M. van; Franssen, M.T.; Kaplan, M.; Kleiverda, G.; Kuppens, S.M.; Kwee, A.; Langenveld, J.; Lim, F.T.; Melman, S.; Sikkema, M.J.; Smits, L.J; Visser, H.; Woiski, M.D.; Scheepers, H.C.; Hermens, R.P.M.G.

    2017-01-01

    INTRODUCTION: Large practice variation exists in mode of delivery after cesarean section, suggesting variation in implementation of contemporary guidelines. We aim to evaluate this practice variation and to what extent this can be explained by risk factors at patient level. MATERIAL AND METHODS:

  19. Practice variation of vaginal birth after cesarean and the influence of risk factors at patient level : A retrospective cohort study

    NARCIS (Netherlands)

    Vankan, Emy; Schoorel, Ellen N. C.; van Kuijk, Sander M. J.; Mol, Ben-Willem J.; Nijhuis, Jan G.; Aardenburg, Robert; Alink, Marleen; de Boer, Karin; Delemarre, Friso M. C.; Dirksen, Carmen D.; Van Dooren, Ivo M. A.; Franssen, Maureen T. M.; Kaplan, Mesrure; Kleiverda, Gunilla; Kuppens, Simone M. I.; Kwee, Anneke; Langenveld, Josje; Lim, Frans T. H.; Melman, Sonja; Sikkema, Marko J.; Smits, Luc J.; Visser, Harry; Woiski, Mallory; Scheepers, Hubertina C.; Hermens, Rosella P. M. G.

    IntroductionLarge practice variation exists in mode of delivery after cesarean section, suggesting variation in implementation of contemporary guidelines. We aim to evaluate this practice variation and to what extent this can be explained by risk factors at patient level. Material and methodsThis

  20. Quantitative microbiological risk assessment in food industry: Theory and practical application.

    Science.gov (United States)

    Membré, Jeanne-Marie; Boué, Géraldine

    2018-04-01

    The objective of this article is to bring scientific background as well as practical hints and tips to guide risk assessors and modelers who want to develop a quantitative Microbiological Risk Assessment (MRA) in an industrial context. MRA aims at determining the public health risk associated with biological hazards in a food. Its implementation in industry enables to compare the efficiency of different risk reduction measures, and more precisely different operational settings, by predicting their effect on the final model output. The first stage in MRA is to clearly define the purpose and scope with stakeholders, risk assessors and modelers. Then, a probabilistic model is developed; this includes schematically three important phases. Firstly, the model structure has to be defined, i.e. the connections between different operational processing steps. An important step in food industry is the thermal processing leading to microbial inactivation. Growth of heat-treated surviving microorganisms and/or post-process contamination during storage phase is also important to take into account. Secondly, mathematical equations are determined to estimate the change of microbial load after each processing step. This phase includes the construction of model inputs by collecting data or eliciting experts. Finally, the model outputs are obtained by simulation procedures, they have to be interpreted and communicated to targeted stakeholders. In this latter phase, tools such as what-if scenarios provide an essential added value. These different MRA phases are illustrated through two examples covering important issues in industry. The first one covers process optimization in a food safety context, the second one covers shelf-life determination in a food quality context. Although both contexts required the same methodology, they do not have the same endpoint: up to the human health in the foie gras case-study illustrating here a safety application, up to the food portion in the

  1. Risk

    Science.gov (United States)

    Barshi, Immanuel

    2016-01-01

    Speaking up, i.e. expressing ones concerns, is a critical piece of effective communication. Yet, we see many situations in which crew members have concerns and still remain silent. Why would that be the case? And how can we assess the risks of speaking up vs. the risks of keeping silent? And once we do make up our minds to speak up, how should we go about it? Our workshop aims to answer these questions, and to provide us all with practical tools for effective risk assessment and effective speaking-up strategies..

  2. Education for Disaster Risk Reduction (DRR: Linking Theory with Practice in Ghana’s Basic Schools

    Directory of Open Access Journals (Sweden)

    Priscilla T. Apronti

    2015-07-01

    Full Text Available Current understanding of disaster risk reduction (DRR concurs that, when provided the right education, children have the potential to reduce their own vulnerability and the vulnerability of others in their community. What, then, comprises the right education for DRR? Research has established the need for disaster education to address the causes and effects, prevention and response, and management and recovery from disaster events. The educational process must include diverse and practical techniques that reinforce disaster knowledge and builds a culture of safety and resilience amongst students. Drawing on syllabus content analysis and field research in two rural communities in semi-arid Northern Ghana, this study explored the presence and nature of DRR within the syllabi of the basic school system. By comparing the result of the content analysis with results from interviews and questionnaires completed by teachers and students, significant gaps were identified between the disaster pedagogy outlined in the syllabi (theory and that which occurs in the classroom (practice. It was realized that while the theory outlines active and innovative techniques for teaching, learning, and evaluating DRR lessons, various challenges hinder the practical application of these techniques in the classroom. The study concludes that a lack of teacher training and professional development, and inadequate teaching and learning materials, generally account for these results. A new and consolidated effort is required from all stakeholders to train teachers and to provide the appropriate learning materials to improve on the current DRR education.

  3. Considering Vulnerability in Disaster Risk Reduction Plans: From Policy to Practice in Ladakh, India

    Directory of Open Access Journals (Sweden)

    Virginie Le Masson

    2015-05-01

    Full Text Available In Ladakh, India, a mountainous region prone to natural hazards, particularly floods, it is critical to adapt disaster risk reduction (DRR measures to the local environment. The floods that struck Ladakh in 2010 created momentum for local authorities and nongovernmental organizations (NGOs to engage in DRR initiatives in order to better prepare people to cope with and recover from emergencies. This paper analyzes the way DRR approaches in Ladakh, from the central government to the district level, take both vulnerability and capacity into account. National and state policies are integrated and reflect the vulnerability concept quite well. However, as the case of Ladakh shows, establishing policies does not guarantee that appropriate practices will follow. Although NGOs' relief efforts in 2010 were praised for building on local communities' context and capacities, most practitioners still view DRR through a hazard-focused lens. Likewise, the policy framework for DRR does not yet address the socioeconomic construction of disasters and is not translated into adequate interventions that build on lessons learned during the 2010 emergency. Development obstacles, such as corruption, may also compromise efforts to translate DRR policies into appropriate and sustainable practices. However, local development projects that enhance the resilience of local mountain communities exist and could be valued as effective DRR. Emphasis should be placed on the practical integration of DRR in sustainable development efforts in order to better tackle disasters.

  4. Quality of Disease Management and Risk of Mortality in English Primary Care Practices.

    Science.gov (United States)

    Dusheiko, Mark; Gravelle, Hugh; Martin, Stephen; Smith, Peter C

    2015-10-01

    To investigate whether better management of chronic conditions by family practices reduces mortality risk. Two random samples of 5 million patients registered with over 8,000 English family practices followed up for 4 years (2004/5-2007/8). Measures of the quality of disease management for 10 conditions were constructed for each family practice for each year. The outcome measure was an indicator taking the value 1 if the patient died during a specified year, 0 otherwise. Cross-section and multilevel panel data multiple logistic regressions were estimated. Covariates included age, gender, morbidity, hospitalizations, attributed socio-economic characteristics, and local health care supply measures. Although a composite measure of the quality of disease management for all 10 conditions was significantly associated with lower mortality, only the quality of stroke care was significant when all 10 quality measures were entered in the regression. The panel data results suggest that a 1 percent improvement in the quality of stroke care could reduce the annual number of deaths in England by 782 [95 percent CI: 423, 1140]. A longer study period may be necessary to detect any mortality impact of better management of other conditions. © Health Research and Educational Trust.

  5. Risk of stroke in people with type 2 diabetes in the UK: a study using the General Practice Research Database

    NARCIS (Netherlands)

    Mulnier, H.E.; Seaman, H.E.; Raleigh, V.S.; Soedamah-Muthu, S.S.; Colhoun, H.M.; Lawrenson, R.A.; Vries, de C.S.

    2006-01-01

    Aims/hypothesis Risk estimates for stroke in patients with diabetes vary. We sought to obtain reliable risk estimates for stroke and the association with diabetes, comorbidity and lifestyle in a large cohort of type 2 diabetic patients in the UK. Materials and methods Using the General Practice

  6. The relevance of the early history of probability theory to current risk assessment practices in mental health care.

    Science.gov (United States)

    Large, Matthew

    2013-12-01

    Probability theory is at the base of modern concepts of risk assessment in mental health. The aim of the current paper is to review the key developments in the early history of probability theory in order to enrich our understanding of current risk assessment practices.

  7. Identifying crime victims who are at high risk for post traumatic stress disorder: developing a practical referral instrument

    NARCIS (Netherlands)

    Wohlfarth, T.; Winkel, F. W.; van den Brink, W.

    2002-01-01

    Objective To construct a practical instrument for the identification and referral of crime victims who are at high risk for post traumatic stress disorder (PTSD). Method: Crime victims filing a complaint at a police station were asked to fill out a questionnaire probing risk factors for PTSD (n

  8. Exploring geographic distributions of high-risk water, sanitation, and hygiene practices and their association with child diarrhea in Uganda

    Directory of Open Access Journals (Sweden)

    Mitsuaki Hirai

    2016-10-01

    Full Text Available Background: High-risk water, sanitation, and hygiene (WASH practices are still prevalent in most low-income countries. Because of limited access to WASH, children may be put at an increased risk of diarrheal diseases. Objectives: This study aims to 1 develop a new measure of WASH-induced burden, the WASH Resource Index (WRI, and estimate its correlation with child diarrhea and an additive index of high-risk WASH practices; 2 explore the geographic distribution of high-risk WASH practices, child diarrhea, and summary indices at the cluster level; and 3 examine the association between the WRI and child diarrhea at the individual level. Design: A sample of 7,019 children from the Uganda Demographic and Health Survey 2011 were included in this study. Principal component analysis was used to develop a WRI, and households were classified as WASH poorest, poorer, middle, richer, and richest. A hot spot analysis was conducted to assess whether and how high-risk WASH practices and child diarrhea were geographically clustered. A potential association between the WRI and child diarrhea was examined through a nested regression analysis. Results: High-risk WASH practices were clustered at geographically distant regions from Kampala. The 2-week prevalence of child diarrhea, however, was concentrated in Eastern and East Central regions where high-risk WASH practices were not prevalent. At the individual level, none of the high-risk WASH practices were significantly associated with child diarrhea. Being in the highest WASH quintile was, however, significantly associated with 24.9% lower prevalence of child diarrhea compared to being in the lowest quintile (p<0.05. Conclusions: Only a weak association was found between the WRI and child diarrhea in this study. Future research should explore the potential utility of the WRI to examine WASH-induced burden.

  9. Medication Errors: New EU Good Practice Guide on Risk Minimisation and Error Prevention.

    Science.gov (United States)

    Goedecke, Thomas; Ord, Kathryn; Newbould, Victoria; Brosch, Sabine; Arlett, Peter

    2016-06-01

    A medication error is an unintended failure in the drug treatment process that leads to, or has the potential to lead to, harm to the patient. Reducing the risk of medication errors is a shared responsibility between patients, healthcare professionals, regulators and the pharmaceutical industry at all levels of healthcare delivery. In 2015, the EU regulatory network released a two-part good practice guide on medication errors to support both the pharmaceutical industry and regulators in the implementation of the changes introduced with the EU pharmacovigilance legislation. These changes included a modification of the 'adverse reaction' definition to include events associated with medication errors, and the requirement for national competent authorities responsible for pharmacovigilance in EU Member States to collaborate and exchange information on medication errors resulting in harm with national patient safety organisations. To facilitate reporting and learning from medication errors, a clear distinction has been made in the guidance between medication errors resulting in adverse reactions, medication errors without harm, intercepted medication errors and potential errors. This distinction is supported by an enhanced MedDRA(®) terminology that allows for coding all stages of the medication use process where the error occurred in addition to any clinical consequences. To better understand the causes and contributing factors, individual case safety reports involving an error should be followed-up with the primary reporter to gather information relevant for the conduct of root cause analysis where this may be appropriate. Such reports should also be summarised in periodic safety update reports and addressed in risk management plans. Any risk minimisation and prevention strategy for medication errors should consider all stages of a medicinal product's life-cycle, particularly the main sources and types of medication errors during product development. This article

  10. A practical approach for implementing risk-based inservice testing of pumps at nuclear power plants

    International Nuclear Information System (INIS)

    Hartley, R.S.; Maret, D.; Seniuk, P.; Smith, L.

    1996-01-01

    The American Society of Mechanical Engineers (ASME) Center for Research and Technology Development's (CRTD) Research Task Force on Risk-Based Inservice Testing has developed guidelines for risk-based inservice testing (IST) of pumps and valves. These guidelines are intended to help the ASME Operation and Maintenance (OM) Committee to enhance plant safety while focussing appropriate testing resources on critical components. This paper describes a practical approach for implementing those guidelines for pumps at nuclear power plants. The approach, as described in this paper, relies on input, direction, and assistance from several entities such as the ASME Code Committees, United States Nuclear Regulatory Commission (NRC), and the National Laboratories, as well as industry groups and personnel with applicable expertise. Key parts of the risk-based IST process that are addressed here include: identification of important failure modes, identification of significant failure causes, assessing the effectiveness of testing and maintenance activities, development of alternative testing and maintenance strategies, and assessing the effectiveness of alternative testing strategies with present ASME Code requirements. Finally, the paper suggests a method of implementing this process into the ASME OM Code for pump testing

  11. Risk factors for intracranial infection secondary to penetrating craniocerebral gunshot wounds in civilian practice.

    Science.gov (United States)

    Jimenez, Carlos Mario; Polo, Jonathan; España, Julian Andres

    2013-01-01

    To determine risk factors for intracranial infection secondary to penetrating craniocerebral gunshot wounds (PCGWs) in civilian practice, in patients who underwent surgery with removal of bullet fragments, wound debridement, and watertight dural closure. An observational, analytical, prospective, cohort-type study was conducted with follow-up in a group of patients with PCGWs caused by a low-velocity projectile admitted between January 2000 and November 2010. There were 160 patients, 59 of whom were administered prophylactic antibiotics based on the decision of the treating neurosurgeon. Average follow-up time was 39 months (range, 3-92 months). Infection occurred in 40 patients (25%); 20 patients received antibiotics (20 of 59 [33.9%]), and 20 patients did not receive antibiotics (20 of 101 [19.8%]). Three variables were independent risk factors for infection: (i) persistence of parenchymal osseous or metallic fragments after surgery (P projectile trajectory through a natural cavity with contaminating flora (P = 0.03, RR 2.84); and (iii) prolonged hospitalization time (P Projectile trajectory through potentially contaminating cavities, persistence of intraparenchymal osseous or metallic fragments after surgery, and prolonged hospital stay were independent risk factors for intracranial infection. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. A practical approach for implementing risk-based inservice testing of pumps at nuclear power plants

    Energy Technology Data Exchange (ETDEWEB)

    Hartley, R.S. [Idaho National Engineering Lab., Idaho Falls, ID (United States); Maret, D.; Seniuk, P.; Smith, L.

    1996-12-01

    The American Society of Mechanical Engineers (ASME) Center for Research and Technology Development`s (CRTD) Research Task Force on Risk-Based Inservice Testing has developed guidelines for risk-based inservice testing (IST) of pumps and valves. These guidelines are intended to help the ASME Operation and Maintenance (OM) Committee to enhance plant safety while focussing appropriate testing resources on critical components. This paper describes a practical approach for implementing those guidelines for pumps at nuclear power plants. The approach, as described in this paper, relies on input, direction, and assistance from several entities such as the ASME Code Committees, United States Nuclear Regulatory Commission (NRC), and the National Laboratories, as well as industry groups and personnel with applicable expertise. Key parts of the risk-based IST process that are addressed here include: identification of important failure modes, identification of significant failure causes, assessing the effectiveness of testing and maintenance activities, development of alternative testing and maintenance strategies, and assessing the effectiveness of alternative testing strategies with present ASME Code requirements. Finally, the paper suggests a method of implementing this process into the ASME OM Code for pump testing.

  13. Sun protection and sunbathing practices among at-risk family members of patients with melanoma

    Science.gov (United States)

    2011-01-01

    Background Despite the increased level of familial risk, research indicates that family members of patients with melanoma engage in relatively low levels of sun protection and high levels of sun exposure. The goal of this study was to evaluate a broad range of demographic, medical, psychological, knowledge, and social influence correlates of sun protection and sunbathing practices among first-degree relatives (FDRs) of melanoma patients and to determine if correlates of sun protection and sunbathing were unique. Methods We evaluated correlates of sun protection and sunbathing among FDRs of melanoma patients who were at increased disease risk due to low compliance with sun protection and skin surveillance behaviors. Participants (N = 545) completed a phone survey. Results FDRs who reported higher sun protection had a higher education level, lower benefits of sunbathing, greater sunscreen self-efficacy, greater concerns about photo-aging and greater sun protection norms. FDRs who reported higher sunbathing were younger, more likely to be female, endorsed fewer sunscreen barriers, perceived more benefits of sunbathing, had lower image norms for tanness, and endorsed higher sunbathing norms. Conclusion Interventions for family members at risk for melanoma might benefit from improving sun protection self-efficacy, reducing perceived sunbathing benefits, and targeting normative influences to sunbathe. PMID:21338483

  14. Risk factors for epistaxis in patients followed in general practices in Germany.

    Science.gov (United States)

    Seidel, D U; Jacob, L; Kostev, K; Sesterhenn, A M

    2017-12-01

    The goal of the present study was to analyze the risk factors for epistaxis in patients followed in general practices in Germany. The current study sample included patients aged 18 years or older who received a first epistaxis diagnosis between January 2012 and December 2016 (index date). Epistaxis patients and controls without epistaxis were matched (1:1) on the basis of age, gender, insurance status and physician. A total of 16,801 patients with epistaxis and 16,801 control subjects were included in this study. Of the subjects, 53.2% were men, and the mean age was 59.6 years (SD=21.2 years). Epistaxis was found to be positively associated with hypertension, obesity, chronic sinusitis, other disorders of the nose and nasal sinuses, anxiety disorder, and adjustment disorder (ORs ranging from 1.13 to 1.44). Epistaxis was also associated with the prescription of vitamin K antagonists, preparations from the heparin group, platelet aggregation inhibitors excluding heparin, direct thrombin inhibitors, direct factor Xa inhibitors, other antithrombotic agents, selective serotonin reuptake inhibitors and nasal steroids (ORs ranging from 1.15 to 3.55). Overall, epistaxis risk is increased by multiple medical and psychiatric disorders. Several antithrombotic and nasal steroid therapies are also associated with this risk.

  15. Evaluation of biologic occupational risk control practices: quality indicators development and validation.

    Science.gov (United States)

    Takahashi, Renata Ferreira; Gryschek, Anna Luíza F P L; Izumi Nichiata, Lúcia Yasuko; Lacerda, Rúbia Aparecida; Ciosak, Suely Itsuko; Gir, Elucir; Padoveze, Maria Clara

    2010-05-01

    There is growing demand for the adoption of qualification systems for health care practices. This study is aimed at describing the development and validation of indicators for evaluation of biologic occupational risk control programs. The study involved 3 stages: (1) setting up a research team, (2) development of indicators, and (3) validation of the indicators by a team of specialists recruited to validate each attribute of the developed indicators. The content validation method was used for the validation, and a psychometric scale was developed for the specialists' assessment. A consensus technique was used, and every attribute that obtained a Content Validity Index of at least 0.75 was approved. Eight indicators were developed for the evaluation of the biologic occupational risk prevention program, with emphasis on accidents caused by sharp instruments and occupational tuberculosis prevention. The indicators included evaluation of the structure, process, and results at the prevention and biologic risk control levels. The majority of indicators achieved a favorable consensus regarding all validated attributes. The developed indicators were considered validated, and the method used for construction and validation proved to be effective. Copyright (c) 2010 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  16. Management of climatic heat stress risk in construction: a review of practices, methodologies, and future research.

    Science.gov (United States)

    Rowlinson, Steve; Yunyanjia, Andrea; Li, Baizhan; Chuanjingju, Carrie

    2014-05-01

    Climatic heat stress leads to accidents on construction sites brought about by a range of human factors emanating from heat induced illness, and fatigue leading to impaired capability, physical and mental. It is an occupational characteristic of construction work in many climates and the authors take the approach of re-engineering the whole safety management system rather than focusing on incremental improvement, which is current management practice in the construction industry. From a scientific viewpoint, climatic heat stress is determined by six key factors: (1) air temperature, (2) humidity, (3) radiant heat, and (4) wind speed indicating the environment, (5) metabolic heat generated by physical activities, and (6) "clothing effect" that moderates the heat exchange between the body and the environment. By making use of existing heat stress indices and heat stress management processes, heat stress risk on construction sites can be managed in three ways: (1) control of environmental heat stress exposure through use of an action-triggering threshold system, (2) control of continuous work time (CWT, referred by maximum allowable exposure duration) with mandatory work-rest regimens, and (3) enabling self-paced working through empowerment of employees. Existing heat stress practices and methodologies are critically reviewed and the authors propose a three-level methodology for an action-triggering, localized, simplified threshold system to facilitate effective decisions by frontline supervisors. The authors point out the need for "regional based" heat stress management practices that reflect unique climatic conditions, working practices and acclimatization propensity by local workers indifferent geographic regions. The authors set out the case for regional, rather than international, standards that account for this uniqueness and which are derived from site-based rather than laboratory-based research. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. Climate Risk Informed Decision Analysis (CRIDA): A novel practical guidance for Climate Resilient Investments and Planning

    Science.gov (United States)

    Jeuken, Ad; Mendoza, Guillermo; Matthews, John; Ray, Patrick; Haasnoot, Marjolijn; Gilroy, Kristin; Olsen, Rolf; Kucharski, John; Stakhiv, Gene; Cushing, Janet; Brown, Casey

    2016-04-01

    Engineers and water managers have always incorporated uncertainty in water resources operations, design and planning. In recent years, concern has been growing concern that many of the fundamental principles to address uncertainty in planning and design are insufficient for coping with unprecedented shifts in climate, especially given the long lifetimes of water investments - spanning decades, even centuries. Can we design and operate new flood risk management, energy, water supply and sanitation, and agricultural projects that are robust to shifts over 20, 50, or more years? Since about 2009, better approaches to planning and designing under climate uncertainty have been gaining ground worldwide. The main challenge is to operationalize these approaches and bring them from science to practice, embed them within the existing decision-making processes of particular institutions, and shift from highly specialized "boutique" applications to methods that result in consistent, replicable outcomes accessible to water managers worldwide. With CRIDA a serious step is taken to achieve these goals. CRIDA is built on two innovative but complementary approaches that have developed in isolation across the Atlantic over the past seven years: diagnosing and assessing risk (decision scaling), and developing sequential decision steps to compensate for uncertainty within regulatory / performance standards (adaptation pathways). First, the decision scaling or "bottom up" framework to climate change adaptation was first conceptualized during the US/Canada Great Lakes regulation study and has recently been placed in a decision-making context for water-related investments published by the World Bank Second, the adaptation pathways approach was developed in the Netherlands to cope with the level of climate uncertainty we now face. Adaptation pathways is a tool for maintaining options and flexibility while meeting operational goals by envisioning how sequences of decisions can be navigated

  18. Sexual behavior and risk practices of HIV positive and HIV negative Rwandan women

    Science.gov (United States)

    ADEDIMEJI, Adebola A.; HOOVER, Donald R.; SHI, Qiuhu; GARD, Tracy; MUTIMURA, Eugene; SINAYOBYE, Jean d’Amour; COHEN, Mardge H.; ANASTOS, Kathryn

    2014-01-01

    It is not well understood how infection with HIV and prior experience of sexual violence affects sexual behavior in African women. We describe factors influencing current sexual practices of Rwandan women living with or without HIV/AIDS. By design, 75% of participants were HIV positive and ~50% reported having experienced genocidal rape. Univariate and multivariate logistic regression models were fit to describe demographic and clinical characteristics that influenced sexual behavior in the previous 6 months, condom use, history of transactional sex, and prior infection with a non-HIV sexually transmitted disease. Respondents’ age, where they lived, whether or not they lived with a husband or partner, experience of sexual trauma, CD4 count, CES-D and PTSD scores were strongly associated with risky sexual behavior and infection with non-HIV STI. HIV positive women with a history of sexual violence in the contexts of war and conflict may be susceptible to some high-risk sexual behaviors. PMID:25488169

  19. Risk management policies and practices regarding radio frequency electromagnetic fields: results from a WHO survey

    International Nuclear Information System (INIS)

    Dhungel, Amit; Zmirou-Navier, Denis; Van Deventer, Emilie

    2015-01-01

    This study aims to describe current risk management practices and policies across the world in relation to personal exposures from devices emitting radiofrequency fields, environmental exposures from fixed installations and exposures in the work environment. Data from 86 countries representing all WHO regions were collected through a survey. The majority of countries (76.8 %) had set exposure limits for mobile devices, almost all (90.7 %) had set public exposure limits for fixed installations and 76.5 % had specified exposure limits for personnel in occupational settings. A number of other policies had been implemented at the national level, ranging from information provisions on how to reduce personal exposures and restrictions of usage for certain populations, such as children or pregnant women to prevention of access around base stations. This study suggests that countries with higher mobile subscriptions tend to have set radiofrequency exposure limits for mobile devices and to have provisions on exposure measurements about fixed installations. (authors)

  20. Mobile phones in clinical practice: reducing the risk of bacterial contamination.

    Science.gov (United States)

    Mark, D; Leonard, C; Breen, H; Graydon, R; O'Gorman, C; Kirk, S

    2014-09-01

    Mobile smart phones have become increasingly integrated into the practice of doctors and allied medical professionals. Recent studies suggest them to represent reservoirs for pathogens with potential to cause nosocomial infections. This study aimed to investigate the level of contamination on phones used on surgical wards and identify strategies for their safe use within clinical areas. Fifty mobile phones were taken from members of the multidisciplinary team working in a surgical unit. Phones were swabbed by two trained investigators using a standardised technique and samples streaked out using an automated specimen inoculator onto two types of culture media (Columbia blood agar and MacConkey agar). Colonies were identified and counted by a single trained investigator in a blinded fashion. Simultaneously a questionnaire investigating usage levels of phones was given to 150 healthcare workers. Sixty per cent of phones sampled had some form of contaminant isolated from their phone. Thirty-one (62%) of phones had only three colonies or less isolated on medium. No pathogenic or drug resistant strains of bacteria were identified. A total of 88% of individuals sampled by questionnaire used their phone within the workplace of which 55% used it for clinical purposes. Sixty-three per cent expected there to be some form of contaminant on their phone with only 37% admitting to cleaning it regularly. Seventy-five per cent of people did not view a ban on phones as a practical solution was they found to be an infection risk. Touch screen smart phones may be used safely in a clinical environment, with a low risk of cross-contamination of nosocomial bacteria to patients, in the setting of effective adherence to hand hygiene policies. © 2014 John Wiley & Sons Ltd.

  1. Disease Risk Perception and Safety Practices: A Survey of Australian Flying Fox Rehabilitators.

    Directory of Open Access Journals (Sweden)

    Cecilia A Sánchez

    2016-02-01

    Full Text Available Interactions with flying foxes pose disease transmission risks to volunteer rehabilitators (carers who treat injured, ill, and orphaned bats. In particular, Australian bat lyssavirus (ABLV can be transmitted directly from flying foxes to humans in Australia. Personal protective equipment (PPE and rabies vaccination can be used to protect against lyssavirus infection. During May and June 2014, active Australian flying fox carers participated in an online survey (SOAR: Survey Of Australian flying fox Rehabilitators designed to gather demographic data, assess perceptions of disease risk, and explore safety practices. Responses to open-ended questions were analysed thematically. A logistic regression was performed to assess whether rehabilitators' gender, use of PPE, threat perception, and years of experience predicted variation in their odds of being bitten or scratched. Eligible responses were received from 122 rehabilitators located predominantly on the eastern coast of Australia. Eighty-four percent of respondents were female. Years of experience ranged from <1 to 30 years (median 5 years. Respondents were highly educated. All rehabilitators were vaccinated against rabies and 94% received a rabies titre check at least every two years. Sixty-three percent of carers did not perceive viruses in flying foxes as a potential threat to their health, yet 74% of carers reported using PPE when handling flying foxes. Eighty-three percent of rehabilitators had received a flying fox bite or scratch at some point during their career. Carers provide an important community service by rescuing and rehabilitating flying foxes. While rehabilitators in this study have many excellent safety practices, including a 100% vaccination rate against rabies, there is room for improvement in PPE use. We recommend 1 the establishment of an Australia-wide set of guidelines for safety when caring for bats and 2 that the responsible government agencies in Australia support

  2. Psoriasis risk in patients with type 2 diabetes in German primary care practices.

    Science.gov (United States)

    Jacob, Louis; Kostev, Karel

    2017-02-01

    To analyze psoriasis risk in type 2 diabetes mellitus (T2DM) patients treated in German primary care practices. The study included 87,964 T2DM patients aged 40 years or over who received their initial diabetes diagnosis between 2004 and 2013. Patients were excluded if they had been diagnosed with psoriasis prior to diabetes diagnosis or if the observation period prior to the index date was less than 365 days. After applying these exclusion criteria, 72,148 T2DM patients were included. A total of 72,148 non-diabetic controls were matched (1:1) to T2DM cases based on age, gender, type of health insurance (private or statutory), number of medical visits, and index date. The primary outcome was the diagnosis of psoriasis. Skin infections, dermatitis/eczema, hyperlipidemia, and medications associated with psoriasis (beta blockers, angiotensin-converting enzyme (ACE) inhibitors, lithium, antimalarials, nonsteroidal anti-inflammatory drugs, and benzodiazepines) were included as potential confounders. The mean age was 68.7 years (SD=12.7 years) and 48.6% of subjects were men. Hyperlipidemia, dermatitis/eczema, and skin infections were more frequent in T2DM patients than in controls. Beta blockers, ACE inhibitors, and nonsteroidal anti-inflammatory drugs were also more commonly used in people with T2DM than in controls. A total of 3.4% of T2DM patients and 2.8% of matched controls developed psoriasis within ten years of follow-up (p-value risk of developing psoriasis than controls (HR=1.18, 95% CI: 1.08-1.29). T2DM was positively associated with psoriasis in patients treated in German primary care practices. Copyright © 2016 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  3. Risk factors associated with the practice of child marriage among Roma girls in Serbia.

    Science.gov (United States)

    Hotchkiss, David R; Godha, Deepali; Gage, Anastasia J; Cappa, Claudia

    2016-02-01

    Relatively little research on the issue of child marriage has been conducted in European countries where the overall prevalence of child marriage is relatively low, but relatively high among marginalized ethnic sub-groups. The purpose of this study is to assess the risk factors associated with the practice of child marriage among females living in Roma settlements in Serbia and among the general population and to explore the inter-relationship between child marriage and school enrollment decisions. The study is based on data from a nationally representative household survey in Serbia conducted in 2010 - and a separate survey of households living in Roma settlements in the same year. For each survey, we estimated a bivariate probit model of risk factors associated with being currently married and currently enrolled in school based on girls 15 to 17 years of age in the nationally representative and Roma settlements samples. The practice of child marriage among the Roma was found to be most common among girls who lived in poorer households, who had less education, and who lived in rural locations. The results of the bivariate probit analysis suggest that, among girls in the general population, decisions about child marriage school attendance are inter-dependent in that common unobserved factors were found to influence both decisions. However, among girls living in Roma settlements, there is only weak evidence of simultaneous decision making. The study finds evidence of the interdependence between marriage and school enrollment decisions among the general population and, to a lesser extent, among the Roma. Further research is needed on child marriage among the Roma and other marginalized sub-groups in Europe, and should be based on panel data, combined with qualitative data, to assess the role of community-level factors and the characteristics of households where girls grow up on child marriage and education decisions.

  4. Mothers of children with externalizing behavior problems: cognitive risk factors for abuse potential and discipline style and practices.

    Science.gov (United States)

    McElroy, Erika M; Rodriguez, Christina M

    2008-08-01

    Utilizing the conceptual framework of the Social Information Processing (SIP) model (Milner, 1993, 2000), associations between cognitive risk factors and child physical abuse risk and maladaptive discipline style and practices were examined in an at-risk population. Seventy-three mothers of 5-12-year-old children, who were identified by their therapist as having an externalizing behavior problem, responded to self-report measures pertaining to cognitive risk factors (empathic perspective taking, frustration tolerance, developmental expectations, parenting locus of control), abuse risk, and discipline style and practices. The Child Behavior Checklist (CBCL) provided a confirmation of the child's externalizing behaviors independent of the therapist's assessment. The results of this study suggest several cognitive risk factors significantly predict risk of parental aggression toward children. A parent's ability to empathize and take the perspective of their child, parental locus of control, and parental level of frustration tolerance were significant predictors of abuse potential (accounting for 63% of the variance) and inappropriate discipline practices (accounting for 55% of the variance). Findings of the present study provide support for processes theorized in the SIP model. Specifically, results underscore the potential role of parents' frustration tolerance, developmental expectations, locus of control, and empathy as predictive of abuse potential and disciplinary style in an at-risk sample.

  5. [Drug advertising to the general public: conceptual parameters of a risk producer practice].

    Science.gov (United States)

    Nascimento, Alvaro César

    2010-11-01

    This article analyzes some concepts relating to marketing, advertising, medications, regulation and manipulation. It discusses ethical and health surveillance parameters of drugs advertising for the general public. The focus of this work is the analysis of contradictions from a conceptual point of view between the practice of pharmaceutical advertising as a tool for the increase of sales and the conquest of markets versus the policy of rational use of medicines. Academic studies and monitoring of drugs advertising conducted by the National Health Surveillance Agency show that the contents of the advertising pieces oriented towards the general public overestimate the - sometimes dubious - qualities of their medication, focusing almost exclusively on the benefits and put them in a central position in the therapeutic process. They also fail to mention the risks inherent in their use. Rather than focusing on regulatory proposals aimed at creating constraints to this practice, this article discusses the impossibility, considering the interests of public health, of the coexistence of marketing with the policies for the correct, rational and safe use of drugs.

  6. Evidence for Public Health Risks of Wastewater and Excreta Management Practices in Southeast Asia: A Scoping Review

    Directory of Open Access Journals (Sweden)

    Steven Lam

    2015-10-01

    Full Text Available The use of wastewater and excreta in agriculture is a common practice in Southeast Asia; however, concerns remain about the potential public health risks of this practice. We undertook a scoping review to examine the extent, range, and nature of literature, as well as synthesize the evidence for associations between wastewater and excreta management practices and public health risks in Southeast Asia. Three electronic databases (PubMed, CAB Direct, and Web of Science were searched and a total of 27 relevant studies were included and evaluated. The available evidence suggested that possible occupational health risks of wastewater and excreta management practices include diarrhea, skin infection, parasitic infection, bacterial infection, and epilepsy. Community members can be at risk for adverse health outcomes through consuming contaminated fish, vegetables, or fruits. Results suggested that practices including handling, treatment, and use of waste may be harmful to human health, particularly farmer’s health. Many studies in this review, however, had limitations including lack of gender analyses, exposure assessment, and longitudinal study designs. These findings suggest that more studies on identifying, quantitatively assessing, and mitigating health risks are needed if sustainable benefits are to be obtained from wastewater and excreta reuse in agriculture in Southeast Asia.

  7. Evidence for Public Health Risks of Wastewater and Excreta Management Practices in Southeast Asia: A Scoping Review.

    Science.gov (United States)

    Lam, Steven; Nguyen-Viet, Hung; Tuyet-Hanh, Tran Thi; Nguyen-Mai, Huong; Harper, Sherilee

    2015-10-15

    The use of wastewater and excreta in agriculture is a common practice in Southeast Asia; however, concerns remain about the potential public health risks of this practice. We undertook a scoping review to examine the extent, range, and nature of literature, as well as synthesize the evidence for associations between wastewater and excreta management practices and public health risks in Southeast Asia. Three electronic databases (PubMed, CAB Direct, and Web of Science) were searched and a total of 27 relevant studies were included and evaluated. The available evidence suggested that possible occupational health risks of wastewater and excreta management practices include diarrhea, skin infection, parasitic infection, bacterial infection, and epilepsy. Community members can be at risk for adverse health outcomes through consuming contaminated fish, vegetables, or fruits. Results suggested that practices including handling, treatment, and use of waste may be harmful to human health, particularly farmer's health. Many studies in this review, however, had limitations including lack of gender analyses, exposure assessment, and longitudinal study designs. These findings suggest that more studies on identifying, quantitatively assessing, and mitigating health risks are needed if sustainable benefits are to be obtained from wastewater and excreta reuse in agriculture in Southeast Asia.

  8. Student Judgments of the risks of HIV-Infection as a function of sexual practice, sex of target and partner, and age and sex of student

    OpenAIRE

    Spears, Russell; Abraham, Charles; Sheeran, Paschal; Abrams, Dominic

    1995-01-01

    Two age cohorts of male and female students (n = 311) were investigated concerning their perceptions of the HIV-related risks of various sex-related practices (unprotected vaginal, oral, and anal sex, and mutual masturbation and kissing). Participants judged the risk of these activities for either a male or a female acquiring either a new male sexual partner or a new female one. The greater risks of unprotected sex compared to other practices and the enhanced risks of these practices within g...

  9. Arsenic accumulation in rice: Consequences of rice genotypes and management practices to reduce human health risk.

    Science.gov (United States)

    Islam, Shofiqul; Rahman, Mohammad Mahmudur; Islam, M R; Naidu, Ravi

    2016-11-01

    Rice is an essential staple food and feeds over half of the world's population. Consumption of rice has increased from limited intake in Western countries some 50years ago to major dietary intake now. Rice consumption represents a major route for inorganic arsenic (As) exposure in many countries, especially for people with a large proportion of rice in their daily diet as much as 60%. Rice plants are more efficient in assimilating As into its grains than other cereal crops and the accumulation may also adversely affect the quality of rice and their nutrition. Rice is generally grown as a lowland crop in flooded soils under reducing conditions. Under these conditions the bioavailability of As is greatly enhanced leading to excessive As bioaccumulation compared to that under oxidizing upland conditions. Inorganic As species are carcinogenic to humans and even at low levels in the diet pose a considerable risk to humans. There is a substantial genetic variation among the rice genotypes in grain-As accumulation as well as speciation. Identifying the extent of genetic variation in grain-As concentration and speciation of As compounds are crucial to determining the rice varieties which accumulate low inorganic As. Varietal selection, irrigation water management, use of fertilizer and soil amendments, cooking practices etc. play a vital role in reducing As exposure from rice grains. In the meantime assessing the bioavailability of As from rice is crucial to understanding human health exposure and reducing the risk. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Quantifying risk of early relapse in patients with first demyelinating events: Prediction in clinical practice.

    Science.gov (United States)

    Spelman, Tim; Meyniel, Claire; Rojas, Juan Ignacio; Lugaresi, Alessandra; Izquierdo, Guillermo; Grand'Maison, Francois; Boz, Cavit; Alroughani, Raed; Havrdova, Eva; Horakova, Dana; Iuliano, Gerardo; Duquette, Pierre; Terzi, Murat; Grammond, Pierre; Hupperts, Raymond; Lechner-Scott, Jeannette; Oreja-Guevara, Celia; Pucci, Eugenio; Verheul, Freek; Fiol, Marcela; Van Pesch, Vincent; Cristiano, Edgardo; Petersen, Thor; Moore, Fraser; Kalincik, Tomas; Jokubaitis, Vilija; Trojano, Maria; Butzkueven, Helmut

    2017-09-01

    Characteristics at clinically isolated syndrome (CIS) examination assist in identification of patient at highest risk of early second attack and could benefit the most from early disease-modifying drugs (DMDs). To examine determinants of second attack and validate a prognostic nomogram for individualised risk assessment of clinical conversion. Patients with CIS were prospectively followed up in the MSBase Incident Study. Predictors of clinical conversion were analysed using Cox proportional hazards regression. Prognostic nomograms were derived to calculate conversion probability and validated using concordance indices. A total of 3296 patients from 50 clinics in 22 countries were followed up for a median (inter-quartile range (IQR)) of 1.92 years (0.90, 3.71). In all, 1953 (59.3%) patients recorded a second attack. Higher Expanded Disability Status Scale (EDSS) at baseline, first symptom location, oligoclonal bands and various brain and spinal magnetic resonance imaging (MRI) metrics were all predictors of conversion. Conversely, older age and DMD exposure post-CIS were associated with reduced rates. Prognostic nomograms demonstrated high concordance between estimated and observed conversion probabilities. This multinational study shows that age at CIS onset, DMD exposure, EDSS, multiple brain and spinal MRI criteria and oligoclonal bands are associated with shorter time to relapse. Nomogram assessment may be useful in clinical practice for estimating future clinical conversion.

  11. Benefits and Limitations of Real Options Analysis for the Practice of River Flood Risk Management

    Science.gov (United States)

    Kind, Jarl M.; Baayen, Jorn H.; Botzen, W. J. Wouter

    2018-04-01

    Decisions on long-lived flood risk management (FRM) investments are complex because the future is uncertain. Flexibility and robustness can be used to deal with future uncertainty. Real options analysis (ROA) provides a welfare-economics framework to design and evaluate robust and flexible FRM strategies under risk or uncertainty. Although its potential benefits are large, ROA is hardly used in todays' FRM practice. In this paper, we investigate benefits and limitations of a ROA, by applying it to a realistic FRM case study for an entire river branch. We illustrate how ROA identifies optimal short-term investments and values future options. We develop robust dike investment strategies and value the flexibility offered by additional room for the river measures. We benchmark the results of ROA against those of a standard cost-benefit analysis and show ROA's potential policy implications. The ROA for a realistic case requires a high level of geographical detail, a large ensemble of scenarios, and the inclusion of stakeholders' preferences. We found several limitations of applying the ROA. It is complex. In particular, relevant sources of uncertainty need to be recognized, quantified, integrated, and discretized in scenarios, requiring subjective choices and expert judgment. Decision trees have to be generated and stakeholders' preferences have to be translated into decision rules. On basis of this study, we give general recommendations to use high discharge scenarios for the design of measures with high fixed costs and few alternatives. Lower scenarios may be used when alternatives offer future flexibility.

  12. Program for Volcanic Risk Reduction in the Americas: Translation of Science into Policy and Practice

    Science.gov (United States)

    Mangan, Margaret; Pierson, Thomas; Wilkinson, Stuart; Westby, Elizabeth; Driedger, Carolyn; Ewert, John

    2016-04-01

    In 2013, the United States Geological Survey (USGS) and the U.S. Agency for International Development/Office of Foreign Disaster Assistance (USAID/OFDA) inaugurated Volcanic Risk Reduction in the Americas, a program that brings together binational delegations of scientists, civil authorities, and emergency response managers to discuss the challenges of integrating volcano science into crisis response and risk reduction practices. During reciprocal visits, delegations tour areas impacted by volcanic unrest and/or eruption, meet with affected communities, and exchange insights and best practices. The 2013 exchange focused on hazards at Mount Rainier (Washington, USA) and Nevado del Ruiz (Caldas/Tolima, Colombia). Both of these volcanoes are highly susceptible to large volcanic mudflows (lahars). The Colombia-USA exchange allowed participants to share insights on lahar warning systems, self-evacuation planning, and effective education programs for at-risk communities. [See Driedger and Ewert (2015) Abstract 76171 presented at 2015 Fall AGU, San Francisco, Calif., Dec 14-18]. The second exchange, in 2015, took place between the USA and Chile, focusing on the Long Valley volcanic region (California, USA) and Chaitén volcano (Lagos, Chile) - both are centers of rhyolite volcanism. The high viscosity of rhyolite magma can cause explosive eruptions with widespread destruction. The rare but catastrophic "super eruptions" of the world have largely been the result of rhyolite volcanism. Chaitén produced the world's first explosive rhyolite eruption in the age of modern volcano monitoring in 2008-2009. Rhyolite eruptions of similar scale and style have occurred frequently in the Long Valley volcanic region, most recently about 600 years ago. The explosivity and relative rarity of rhyolite eruptions create unique challenges to risk reduction efforts. The recent Chaitén eruption was unexpected - little was known of Chaitén's eruptive history, and because of this, monitoring

  13. [Rational nutrition as a prerequisite for eliminating the risk of overweight: public opinion and practice].

    Science.gov (United States)

    Ryngach, Natalia O; Scherbinina, Marina B; Shevchenko, Tatiana M; Gladun, Victoria M; Sarychev, Volodymyr I

    2018-01-01

    Introduction: The awareness of the working-age population regarding the principles of a healthy lifestyle and risk factors of diseases is analyzed. Aim: To identify and characterize the level of awareness of the working-age population regarding the essence of a healthy lifestyle and risk factors (with a focus on irrational nutrition and its consequences). Materials and methods: In the sociological study (2017), on request of Dnipropetrovsk regional state administration, methods of deep (N20) and personalized formal interviews (N2000) were used according to a specially developed methodology of qualitative and quantitative research stages and data collection tools. Results: In their understanding of a healthy lifestyle, 71% of the respondents shared the idea of a mandatory nutrition that meets the needs of a particular person. With a fairly complete awareness as a whole, there is a spread of unhealthy drinking practices with high sugar content (26.7% of respondents), street food (16%), and visiting fast food establishments (10.7%). It has been shown that the rationalization of nutrition at the primary level is underestimated: only 12.7% of the respondents received advice from their family / district doctor or nurse over the past 12 months about the change in nutrition. At the same time, less than a quarter of the recommendations were specified, the rest concerned only healthy eating at all. Therefore, on average, one in three respondents reported adherence to the advised advice. Significantly, more than 40% of respondents consider a significant obstacle to implementing the recommendations of the high cost of "healthy" products. Conclusions: Awareness of the population of Dnipropetrovsk region about the danger of inappropriate nutrition is estimated as insufficient. There is a clear need to increase the training of family medicine, medical staff and combine their activities with information and education work among the population to minimize this risk factor, develop

  14. From Thoughts To Action - Linking Practice, Science, Policy And Decision Making: Dissemination Activities Of The Global Risk Forum, GRF Davos

    Science.gov (United States)

    Stal, Marc; Sutter, Corina; Ammann, Walter

    2010-05-01

    The world's growing population in combination with expanding urbanisation, globalisation and climate change has greatly aggravated the risk potential to all communities and nations. These increasing risks imply the intensification of worldwide disasters, hence collaborations and worldwide knowledge exchange to mitigate these negative impacts is mandatory. How can these exchange and collaboration activities take place? The Global Risk Forum, GRF Davos addresses the variety of risks that face communities with a special focus on climate change, natural hazards, environmental degradation as well as technical, biological risks, pandemics and terrorism - all across different political institutions, national and international organisations, countries and business sectors. One of GRF's main goals is to bridge the gap between science and practice and to promote and accelerate the worldwide exchange of know-how and experience. GRF Davos aims at targeting solutions and promoting good practice in integral risk management and climate change adaptation.. The Forum also provides and manages a network for decision-makers, practitioners and experts from politics, government, IGOs, business, science, NGOs, media and the public and works on maintaining and expanding these networks constantly to enable the dissemination of disaster and risk reduction techniques. In order to link practice, science, policy and decision making, GRF Davos has three pillars, the Risk Academy, the International Disaster and Risk Conferences and Workshops (IDRC) as well as the online Platform for Networks. With its pillars, the GRFs aims at reducing vulnerability for all types of risks and disasters to protect life, property, environment, critical infrastructure and all means of business for the worldwide community on a sustainable basis.

  15. European Practice Assessment of Cardiovascular risk management (EPA Cardio: protocol of an international observational study in primary care

    Directory of Open Access Journals (Sweden)

    van Lieshout Jan

    2009-01-01

    Full Text Available Abstract Background Despite important improvements in available prevention and treatment, cardiovascular diseases (CVD remain an important cause of morbidity and mortality. Not all high-risk patients and patients with CVD have healthy lifestyles and receive the best possible healthcare. Internationally comparative data are needed to compare cardiovascular risk management in different countries, and to examine the impact of improvement programs and others factors. Objectives This study aims to provide internationally comparative data on cardiovascular risk management provided in primary care and on health-related lifestyles of patients in Europe. The study will also explore the views of doctors and patients on innovative preventive services for CVDs. Design and methods An observational cross-sectional study is planned. In 10 European countries, stratified samples of 36 practices per country will be recruited. In each practice, three samples of 15 patients each will be sampled: patients with coronary heart disease, patients at high risk for CVD, and healthy adult patients. The quality of cardiovascular risk management has been specified in terms of 44 performance indicators that resulted from an international Delphi-procedure with general practitioners. Most indicators are based on medical records, and some on a structured interview with a contact person of the practice. Lifestyle (smoking, physical exercise, diet will be measured with previously validated questionnaires that are completed by patients. Additional measures include practice characteristics and exposure to programs to improve cardiovascular care.

  16. Looking beyond borders: integrating best practices in benefit-risk analysis into the field of food and nutrition.

    Science.gov (United States)

    Tijhuis, M J; Pohjola, M V; Gunnlaugsdóttir, H; Kalogeras, N; Leino, O; Luteijn, J M; Magnússon, S H; Odekerken-Schröder, G; Poto, M; Tuomisto, J T; Ueland, O; White, B C; Holm, F; Verhagen, H

    2012-01-01

    An integrated benefit-risk analysis aims to give guidance in decision situations where benefits do not clearly prevail over risks, and explicit weighing of benefits and risks is thus indicated. The BEPRARIBEAN project aims to advance benefit-risk analysis in the area of food and nutrition by learning from other fields. This paper constitutes the final stage of the project, in which commonalities and differences in benefit-risk analysis are identified between the Food and Nutrition field and other fields, namely Medicines, Food Microbiology, Environmental Health, Economics and Marketing-Finance, and Consumer Perception. From this, ways forward are characterized for benefit-risk analysis in Food and Nutrition. Integrated benefit-risk analysis in Food and Nutrition may advance in the following ways: Increased engagement and communication between assessors, managers, and stakeholders; more pragmatic problem-oriented framing of assessment; accepting some risk; pre- and post-market analysis; explicit communication of the assessment purpose, input and output; more human (dose-response) data and more efficient use of human data; segmenting populations based on physiology; explicit consideration of value judgments in assessment; integration of multiple benefits and risks from multiple domains; explicit recognition of the impact of consumer beliefs, opinions, views, perceptions, and attitudes on behaviour; and segmenting populations based on behaviour; the opportunities proposed here do not provide ultimate solutions; rather, they define a collection of issues to be taken account of in developing methods, tools, practices and policies, as well as refining the regulatory context, for benefit-risk analysis in Food and Nutrition and other fields. Thus, these opportunities will now need to be explored further and incorporated into benefit-risk practice and policy. If accepted, incorporation of these opportunities will also involve a paradigm shift in Food and Nutrition benefit-risk

  17. Inhibitor Risk Stratification and Individualized Treatment in Patients With Nonsevere Hemophilia A: A Single-Institution Practice Audit.

    Science.gov (United States)

    Sun, Haowei Linda; Chan, Stella; Yenson, Paul; Jackson, Shannon

    2018-03-01

    Inhibitor risk in nonsevere hemophilia A increases with cumulative factor VIII (FVIII) exposure days and high-risk mutations. A standardized approach to minimize inhibitor risk is warranted. Following establishment of a systematic approach to reduce inhibitor risk in nonsevere hemophilia, we evaluated the uptake of these strategies into clinical practice. All adult males with nonsevere hemophilia A followed by British Columbia Adult Hemophilia Program from 2004 to 2016 were included in this retrospective audit. Quality-of-care indicators on inhibitor prevention were examined. Of 108 patients, 18 patients had high-risk FVIII mutations for inhibitor development. Rates of FVIII genotyping and 1-deamino-8-d-arginine-vasopressin (DDAVP) testing in mild patients without contraindications were both over 90%, although DDAVP was used for surgical prophylaxis in only 70% of procedures. Inhibitor testing and clinic visits occurred at a median interval of 22 months. Over 80% of patients with high-risk mutations had documentation and education on their inhibitor risk. Our practice audit demonstrated a high level of recognition and patient education of individual inhibitor risk. Impact of our standardized approach on the incidence of inhibitor development is yet to be determined.

  18. A qualitative phenomenological study: Enhanced, risk-based FAA oversight on part 145 maintenance practices

    Science.gov (United States)

    Sheehan, Bryan G.

    The purpose of this qualitative phenomenological study was to examine the phenomenon of enhanced, risk-based Federal Aviation Administration (FAA) oversight of Part 145 repair stations that performed aircraft maintenance for Part 121 air carriers between 2007 and 2014 in Oklahoma. Specifically, this research was utilized to explore what operational changes have occurred in the domestic Part 145 repair station industry such as variations in management or hiring practices, training, recordkeeping and technical data, inventory and aircraft parts supply-chain logistics, equipment, and facilities. After interviewing 12 managers from Part 145 repair stations in Oklahoma, six major theme codes emerged from the data: quality of oversight before 2007, quality of oversight after 2007, advantages of oversight, disadvantages of oversight, status quo of oversight, and process improvement . Of those six major theme codes, 17 subthemes appeared from the data that were used to explain the phenomenon of enhanced oversight in the Part 145 repair station industry. Forty-two percent of the participants indicated a weak FAA oversight system that has hindered the continuous process improvement program in their repair stations. Some of them were financially burdened after hiring additional full-time quality assurance inspectors to specifically manage enhanced FAA oversight. Notwithstanding, the participants of the study indicated that the FAA must apply its surveillance on a more standardized and consistent basis. They want to see this standardization in how FAA inspectors interpret regulations and practice the same quality of oversight for all repair stations, particularly those that are repeat violators and fail to comply with federal aviation regulations. They believed that when the FAA enforces standardization on a consistent basis, repair stations can become more efficient and safer in the performance of their scope of work for the U.S. commercial air transportation industry.

  19. Epidemiology of Trichinella infection in the horse: the risk from animal product feeding practices.

    Science.gov (United States)

    Murrell, K D; Djordjevic, M; Cuperlovic, K; Sofronic, Lj; Savic, M; Djordjevic, M; Damjanovic, S

    2004-09-02

    meat than realized and that the intentional feeding of animal products and kitchen waste is a common occurrence among horse owners in Serbia (and elsewhere?). This is a high risk practice which demands closer scrutiny by veterinary and food safety authorities, including the implementation of rules and procedures to ensure that such feeds are rendered safe for horses, as is now required for feeding to swine.

  20. Landslide risk assessment and landslide disaster risk management: on the missing link between scientific knowledge, decision making and practice (Sergey Soloviev Medal Lecture)

    Science.gov (United States)

    Alcántara-Ayala, Irasema

    2016-04-01

    Different investigations have been developed to address the uncertainty and quality evaluations leading to improve landslide hazard and risk assessment. With no doubt, and by using a wide range of scientific and technical approaches, they have contributed to a major extent to the understanding of the dynamics of landslide processes at different scales. Nonetheless, in a similar fashion than other hazards, it has been rather difficult to assess in a precise manner the multi-dimensions of their associated vulnerability and what is more, to effectively link risk assessments with disaster risk management. Owing to the double-character of landslide events, as natural and socio-natural hazards, mass movements turn out to be very complex processes, as their occurrence is also enhanced by population growth, socio-economic inequality, urbanization processes, land-degradation, unsustainable practices and mounting hazard exposure. Disaster Risk Management rope in the actions to attain Disaster Risk Reduction. The latter aims at decreasing existing hazard, vulnerability, and exposure, in addition to strengthening resilience, and very importantly, avoiding the construction of future disaster risk (UNISDR, 2015a). More specifically, and along the same line of ideas, the new-fangled Sendai Framework for Disaster Risk Reduction (SFDRR) 2015-2030 (UNISDR, 2015b) points towards reducing disaster risk and losses by engaging in a series of actions at local, national and global levels. Among them and of utterly significance are those initiatives related to the need of moving from risk assessment into disaster risk management. Consequently, and beyond championing scientific and technical capacity to strengthen landslide knowledge to assess vulnerability, hazard exposure and disaster risks, the challenge remains in the realm of promoting and improving permanent communication, dialogue and partnership among the science and technology communities, policymakers and other stakeholders

  1. Assessing plant protection practices using pressure indicator and toxicity risk indicators: analysis of therelationship between these indicators for improved risk management, application in viticulture.

    Science.gov (United States)

    Oussama, Mghirbi; Kamel, Ellefi; Philippe, Le Grusse; Elisabeth, Mandart; Jacques, Fabre; Habiba, Ayadi; Jean-Paul, Bord

    2015-06-01

    The excessive use of plant protection products (PPPs) has given rise to issues of public and environmental health because of their toxicity. Reducing the use of toxic PPPs and replacing them with products that are less toxic for human health and the environment have become socially, environmentally and economically indispensable. In this article, we assess the plant protection practices of a small group of winegrowers practicing "integrated agriculture" in the south of France, in order to measure the benefit of using toxicity risk indicators as a decision-support tool for different players in land management. An analysis of plant protection practices using indicators of the risk to operator health and the environment (IRSA, IRTE), together with a frequency-of-treatment indicator (TFI), enabled us to (i) show the variability of these indicators depending on the production system and farmers' pesticide use strategies and (ii) calculate correlations between these indicators. This analysis of plant protection practices at different scales (farm, field), carried out in collaboration with the growers, enabled us to perform an initial validation of decision-support tools for determining risk management strategies regarding the use of pesticides.

  2. Forward Commitment Procurement : A practical methodology that helps to manage risk in procuring innovative goods and services

    NARCIS (Netherlands)

    Whyles, G.; Meerveld, H. van; Nauta, N.J.

    2015-01-01

    The Forward Commitment Procurement (FCP) is a Public Procurement of Innovation (PPI) methodology. It was specifically designed to both provide a practical methodology for procurers to follow and to manage the perceived risk of the customer and supplier in innovation investments. The paper describes

  3. Detection of previously undiagnosed cases of COPD in a high-risk population identified in general practice

    DEFF Research Database (Denmark)

    Løkke, Anders; Ulrik, Charlotte Suppli; Dahl, Ronald

    2012-01-01

    Background and Aim: Under-diagnosis of COPD is a widespread problem. This study aimed to identify previously undiagnosed cases of COPD in a high-risk population identified through general practice. Methods: Participating GPs (n = 241) recruited subjects with no previous diagnosis of lung disease,...

  4. Randomized controlled trial on cardiovascular risk management by practice nurses supported by self-monitoring in primary care

    NARCIS (Netherlands)

    Tiessen, Ans H.; Smit, Andries J.; Broer, Jan; Groenier, Klaas H.; van der Meer, Klaas

    2012-01-01

    Background: Treatment goals for cardiovascular risk management are generally not achieved. Specialized practice nurses are increasingly facilitating the work of general practitioners and self-monitoring devices have been developed as counseling aid. The aim of this study was to compare standard

  5. Legionellosis prevention in building water and HVAC systems a practical guide for design, operation and maintenance to minimize the risk

    CERN Document Server

    Joppolo, Cesare Maria; Pitera, Luca Alberto; Angermann, Jean Pierre; Izard, Mark

    2013-01-01

    This Guidebook is a practical guide for design, operation and maintenance to minimize the risk of legionellosis in building water and HVAC systmes. It is devided into several themes such as: Air conditioning of the air (by water – humidification), Production of hot water for washing (fundamentally but not only hot water for washing) and Evaporative cooling tower.

  6. [Medical practice in support of hypertension as risk factor kidney in general medical practice, and primary prevention in children in schools, and the pregnant woman in Annaba (Algeria)].

    Science.gov (United States)

    Rayane, R

    2014-06-01

    To study medical practice in the management of hypertension as a factor in renal risk in general medical practice and primary prevention in children at school, and pregnant women under prenatal monitoring. The longitudinal study, observational over a year, focused on medical practice in schools, maternal health and medical practice among 100 physicians (general practitioner and specialist practitioner) in Annaba (Algeria). In children in schools, measurement of blood pressure is never done on the grounds because this gesture is considered unnecessary in 100% of cases. In pregnant women, the measurement of blood pressure is not performed in more than 26% of pregnant women because it is deemed unnecessary by the midwife in 89% of pregnant women and default material in 11% of they. In current medical practice, 69% of doctors routinely take blood pressure. For the rest, represented mainly by specialists, it is the patient who does not justify. Sixty-two percent of physicians, that is hypertension, above 140/90mmHg, and 15% of physicians that is hypertension, above 145/95mmHg. Among the physicians, 58.7% did not use urinary strip, either, because they think that this review should be done in a laboratory (64.8%), or because the urinary strip are not available at even consulting (35.2%). Inadequacies in the coverage (care) of the HTA are real. Their effects on the progress of prevalence of the renal insufficiency chronic terminal treated are possibly important. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  7. Serving high-risk foods in a high-risk setting: survey of hospital food service practices after an outbreak of listeriosis in a hospital.

    Science.gov (United States)

    Cokes, Carolyn; France, Anne Marie; Reddy, Vasudha; Hanson, Heather; Lee, Lillian; Kornstein, Laura; Stavinsky, Faina; Balter, Sharon

    2011-04-01

    Prepared ready-to-eat salads and ready-to-eat delicatessen-style meats present a high risk for Listeria contamination. Because no foodborne illness risk management guidelines exist specifically for US hospitals, a survey of New York City (NYC) hospitals was conducted to characterize policies and practices after a listeriosis outbreak occurred in a NYC hospital. From August through October 2008, a listeriosis outbreak in a NYC hospital was investigated. From February through April 2009, NYC's 61 acute-care hospitals were asked to participate in a telephone survey regarding food safety practices and policies, specifically service of high-risk foods to patients at increased risk for listeriosis. Five patients with medical conditions that put them at high risk for listeriosis had laboratory-confirmed Listeria monocytogenes infection. The Listeria outbreak strain was isolated from tuna salad prepared in the hospital. Fifty-four (89%) of 61 hospitals responded to the survey. Overall, 81% of respondents reported serving ready-to-eat deli meats to patients, and 100% reported serving prepared ready-to-eat salads. Pregnant women, patients receiving immunosuppressive drugs, and patients undergoing chemotherapy were served ready-to-eat deli meats at 77%, 59%, and 49% of hospitals, respectively, and were served prepared ready-to-eat salads at 94%, 89%, and 73% of hospitals, respectively. Only 4 (25%) of 16 respondents reported having a policy that ready-to-eat deli meats must be heated until steaming hot before serving. Despite the potential for severe outcomes of Listeria infection among hospitalized patients, the majority of NYC hospitals had no food preparation policies to minimize risk. Hospitals should implement policies to avoid serving high-risk foods to patients at risk for listeriosis.

  8. Using agricultural practices information for multiscale environmental assessment of phosphorus risk

    Science.gov (United States)

    Matos Moreira, Mariana; Lemercier, Blandine; Michot, Didier; Dupas, Rémi; Gascuel-Odoux, Chantal

    2015-04-01

    Phosphorus (P) is an essential nutrient for plant growth. In intensively farmed areas, excessive applications of animal manure and mineral P fertilizers to soils have raised both economic and ecological concerns. P accumulation in agricultural soils leads to increased P losses to surface waterbodies contributing to eutrophication. Increasing soil P content over time in agricultural soils is often correlated with agricultural practices; in Brittany (NW France), an intensive livestock farming region, soil P content is well correlated with animal density (Lemercier et al.,2008). Thus, a better understanding of the factors controlling P distribution is required to enable environmental assessment of P risk. The aim of this study was to understand spatial distribution of extractable (Olsen method) and total P contents and its controlling factors at the catchment scale in order to predict P contents at regional scale (Brittany). Data on soil morphology, soil tests (including P status, particles size, organic carbon…) for 198 punctual positions, crops succession since 20 years, agricultural systems, field and animal manure management were obtained on a well-characterized catchment (ORE Agrhys, 10 km²). A multivariate analysis with mixed quantitative variables and factors and a digital soil mapping approach were performed to identify variables playing a significant role in soil total and extractable P contents and distribution. Spatial analysis was performed by means of the Cubist model, a decision tree-based algorithm. Different scenarios were assessed, considering various panels of predictive variables: soil data, terrain attributes derived from digital elevation model, gamma-ray spectrometry (from airborne geophysical survey) and agricultural practices information. In the research catchment, mean extractable and total P content were 140.0 ± 63.4 mg/kg and 2862.7 ± 773.0 mg/kg, respectively. Organic and mineral P inputs, P balance, soil pH, and Al contents were

  9. Meanings of sex, concepts of risk and sexual practices among migrant coal miners in Quang Ninh, Vietnam.

    Science.gov (United States)

    Van Tuan, Ta

    2010-08-01

    The study explores the meanings of sex among migrant coal miners in Vietnam and identifies contextual factors influencing engagement in unsafe sexual practices. Findings reveal that sex carries a number of social meanings in the lives of migrant miners: sex is relaxation and reward for their risk and hard work; access to sex is an incentive for miners to continue working in the mine; sex strengthens identity and social networks; sex helps miners to affirm manhood, group membership and masculinity; and sex workers are confidants with whom they can share their problems. Facing accidents at work on a daily basis, miners are less inclined to worry about the long-term risks of HIV infection. In addition, being excluded from access to relevant information, miners feel distant from HIV infection. Findings suggest that interventions on sexual behaviour and practices should be sensitive to the concepts of risk and meanings of sex among migrant groups such as coal miners.

  10. The risk of female genital cutting in Europe: Comparing immigrant attitudes toward uncut girls with attitudes in a practicing country.

    Science.gov (United States)

    Vogt, Sonja; Efferson, Charles; Fehr, Ernst

    2017-12-01

    Worldwide, an estimated 200 million girls and women have been subjected to female genital cutting. Female genital cutting is defined as an intentional injury to the female genitalia without medical justification. The practice occurs in at least 29 countries in Africa, the Middle East, and Asia. In addition, globalization and migration have brought immigrants from countries where cutting is commonly practiced to countries where cutting is not traditionally practiced and may even be illegal. In countries receiving immigrants, governments and development agencies would like to know if girls with parents who immigrated from practicing countries are at risk of being cut. Risk assessments, for example, could help governments identify the need for programs promoting the abandonment of cutting among immigrants. Extrapolating from the prevalence and incidence rates in practicing countries, however, is generally not sufficient to guarantee a valid estimate of risk in immigrant populations. In particular, immigrants might differ from their counterparts in the country of origin in terms of attitudes toward female genital cutting. Attitudes can differ because migrants represent a special sample of people from the country of origin or because immigrants acculturate after arriving in a new country. To examine these possibilities, we used a fully anonymous, computerized task to elicit implicit attitudes toward female genital cutting among Sudanese immigrants living in Switzerland and Sudanese people in Sudan. Results show that Sudanese immigrants in Switzerland were significantly more positive about uncut girls than Sudanese in Sudan, and that selective migration out of Sudan likely contributed substantially to this difference. We conclude by suggesting how our method could potentially be coupled with recent efforts to refine extrapolation methods for estimating cutting risk among immigrant populations. More broadly, our results highlight the need to better understand how

  11. Nutrition care-related practices and factors affecting nutritional intakes in hospital patients at risk of pressure ulcers.

    Science.gov (United States)

    Roberts, S; Chaboyer, W; Desbrow, B

    2015-08-01

    Malnutrition is common in hospitals and is a risk factor for pressure ulcers. Nutrition care practices relating to the identification and treatment of malnutrition have not been assessed in patients at risk of pressure ulcers. The present study describes nutrition care practices and factors affecting nutritional intakes in this patient group. The study was conducted in four wards at two hospitals in Queensland, Australia. Adult patients at risk of pressure ulcers as a result of restricted mobility were observed for 24 h to determine their daily oral intake and practices such as nutrition screening, documentation and intervention. Independent samples t-tests and chi-squared tests were used to analyse dietary intake and nutrition care-related data. Predictors of receiving a dietitian referral were identified using logistic regression analyses. Two hundred and forty-one patients participated in the present study. The observed nutritional screening rate was 59% (142 patients). Weight and height were documented in 71% and 34% of cases. Sixty-nine patients (29%) received a dietitian referral. Predictors of receiving a dietitian referral included lower body mass index and longer length of stay. On average, patients consumed 73% and 72% of the energy and protein provided, respectively. Between 22% and 38% of patients consumed meals. Nutrition care practices including malnutrition risk screening and documentation of nutritional parameters appear to be inadequate in patients at risk of pressure ulcers. A significant proportion of these patients eat inadequately at main meals, further increasing their risk of malnutrition and pressure ulcers. © 2014 The British Dietetic Association Ltd.

  12. Risk regulation in Islamic banking: Does Saudi Arabia need to adopt the risk regulation practices of Basel?

    OpenAIRE

    Sharbatly, A.

    2016-01-01

    Proponents of Islamic finance often argue that the success of Islamic banks in the UK and Malaysia during the 2007-8 Financial Crisis is proof of the proposition that all Islamic banks (IBs) are immune from sub-prime-mortgage type shocks. The implementation of Basel practices in Saudi Arabia will be very difficult and is likely through various challenges. However, it is arguable that such practices may bring about change in a substantial way in the UAE market. Thus, this thesis will discuss f...

  13. Safe sleep practices and sudden infant death syndrome risk reduction: NICU and well-baby nursery graduates.

    Science.gov (United States)

    Fowler, Aja J; Evans, Patricia W; Etchegaray, Jason M; Ottenbacher, Allison; Arnold, Cody

    2013-11-01

    Our primary objective was to compare parents of infants cared for in newborn intensive care units (NICUs) and infants cared for in well-baby ("general") nurseries with regard to knowledge and practice of safe sleep practices/sudden infant death syndrome risk reduction measures and guidelines. Our secondary objective was to obtain qualitative data regarding reasons for noncompliance in both populations. Sixty participants (30 from each population) completed our survey measuring safe sleep knowledge and practice. Parents of NICU infants reported using 2 safe sleep practices-(a) always placing baby in crib to sleep and (b) always placing baby on back to sleep-significantly more frequently than parents of well infants. Additional findings and implications for future studies are discussed.

  14. Benefits, pitfalls and risks of phytotherapy in clinical practice in otorhinolaryngology.

    Science.gov (United States)

    Laccourreye, O; Werner, A; Laccourreye, L; Bonfils, P

    2017-04-01

    To elucidate the benefits, pitfalls and risks of phytotherapy in the clinical practice of otorhinolaryngology. The PubMed and Cochrane databases were searched using the following keywords: phytotherapy, phytomedicine, herbs, otology, rhinology, laryngology, otitis, rhinitis, laryngitis and otorhinolaryngology. Seventy-two articles (18 prospective randomized studies, 4 Cochrane analyses, 4 meta-analysis and 15 reviews of the literature) devoted to clinical studies were analyzed. Articles devoted to in vitro or animal studies, biochemical analyses or case reports (including fewer than 10 patients) and articles dealing with honey, aromatherapy or minerals were excluded. Per os ginkgo biloba has no indications in tinnitus, presbycusis or anosmia following viral rhinitis. Traditional Asian medicine has no proven benefit in sudden deafness or laryngeal papillomatosis. Per os mistletoe extracts associated to conventional treatment for head and neck squamous cell carcinoma does not increase 5-year survival. Extracts of various herbs, notably echinacea, eucalyptus, petasites hybridus, pelargonium sidoides, rosemary, spirulina and thyme, show superiority over placebo for rhinosinusitis and allergic rhinitis, as does gingko biloba for selected vertigo. There have been encouraging preliminary results for intratumoral injection of mistletoe in head and neck carcinoma and acupoint herbal patching for allergic rhinitis. Herb intake should be screened for in case of certain unexplained symptoms such as epistaxis, headache or dizziness, or signs suggesting allergy. Phytotherapy should be interrupted ahead of surgery and/or chemotherapy. Scientific proof of the benefit of phytotherapy in otorhinolaryngology remains to be established but, given its widespread use and the reported data, knowledge of this form of treatment needs to be developed. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  15. Fatigue risk management in aviation maintenance : current best practices and potential future countermeasures.

    Science.gov (United States)

    2011-06-01

    The unregulated hours and frequent night work characteristic of maintenance can produce significant levels of : employee fatigue, with a resultant risk of maintenance error. Fatigue Risk Management Systems (FRMS) are : widely used to manage fatigue a...

  16. Knowledge, attitude and practice for breast cancer risk factors and screening modalities in staff nurses of Ayub teaching hospital Abbottabad

    International Nuclear Information System (INIS)

    Ahmad, S.; Riaz, A.; Rizwan, M.; Qureshi, N.A.; Atta, S.

    2012-01-01

    Background: Breast cancer is the commonest cancer modality in female worldwide. Avoiding the risk factors can reduce its incidence and adhering to screening and early detection can reduce its mortality. A sufficient knowledge regarding the risk factors and screening modalities is therefore essential. We assessed the knowledge level about these parameters in our staff nurses. Methods: A self-administered questionnaire survey was performed. Knowledge regarding the risk factors and screening modalities were categorised into good, fair, poor and very poor categories. Results: Knowledge regarding most of the factors was found to be fair. A few things were termed as good knowledge like role of breast-feeding in protecting against breast cancer. Practice regarding the screening modalities was not satisfactory. Only a few nurses had good knowledge of the risk factors and screening modalities. Practice of the Screening modalities was also poor. Conclusion: There is a need to improve the nursing curriculum, training at the workplace and motivate them for screening practices. They should be encouraged to talk to their patients and their female attendants about prevention and early detection of breast cancer. (author)

  17. Rationale and methods of the European Study on Cardiovascular Risk Prevention and Management in Daily Practice (EURIKA

    Directory of Open Access Journals (Sweden)

    Jiménez Francisco

    2010-06-01

    Full Text Available Abstract Background The EURIKA study aims to assess the status of primary prevention of cardiovascular disease (CVD across Europe. Specifically, it will determine the degree of control of cardiovascular risk factors in current clinical practice in relation to the European guidelines on cardiovascular prevention. It will also assess physicians' knowledge and attitudes about CVD prevention as well as the barriers impeding effective risk factor management in clinical practice. Methods/Design Cross-sectional study conducted simultaneously in 12 countries across Europe. The study has two components: firstly at the physician level, assessing eight hundred and nine primary care and specialist physicians with a daily practice in CVD prevention. A physician specific questionnaire captures information regarding physician demographics, practice settings, cardiovascular prevention beliefs and management. Secondly at the patient level, including 7641 patients aged 50 years or older, free of clinical CVD and with at least one classical risk factor, enrolled by the participating physicians. A patient-specific questionnaire captures information from clinical records and patient interview regarding sociodemographic data, CVD risk factors, and current medications. Finally, each patient provides a fasting blood sample, which is sent to a central laboratory for measuring serum lipids, apolipoproteins, hemoglobin-A1c, and inflammatory biomarkers. Discussion Primary prevention of CVD is an extremely important clinical issue, with preventable circulatory diseases remaining the leading cause of major disease burden. The EURIKA study will provide key information to assess effectiveness of and attitudes toward primary prevention of CVD in Europe. A transnational study creates opportunities for benchmarking good clinical practice across countries and improving outcomes. (ClinicalTrials.gov number, NCT00882336.

  18. The adoption and design of Enterprise Risk Management practices : An empirical study

    NARCIS (Netherlands)

    Paape, L.; Speklé, R.F.

    2012-01-01

    We examine (1) the extent of enterprise risk management (ERM) implementation and the factors that are associated with cross-sectional differences in the level of ERM adoption, and (2) specific risk management design choices and their effect on perceived risk management effectiveness. Broadly

  19. Getting beyond 'grin and bear it' in the practice of risk management

    International Nuclear Information System (INIS)

    Belzer, R.B.

    2001-01-01

    Risk perception researchers frequently notice major discrepancies between expert judgment and lay opinion concerning the identity of 'large' risks. These discrepancies are particularly disconcerting because they lead to a significant misallocation of scarce resources devoted to public risk management. Yet, democratic decision-making also appeals to many risk perception researchers, and some see such little prospect for a solution thaty they seem close to surrendering to decision-making based on lay risk perception. This article argues that such a 'grin and bear it' strategy is also unsatisfactory; that risk perceptions are unstable grounds for decision-making; that expert risk assessment and lay risk perception differ by design rather than accident; that risk experts' search for 'virtuous lawmakers' who would make public decisions for the greatest public good is a vain one; that the dissonance risk perception researchers now observe will likely get worse in the new information age; and that risk perception researchers need to return to first principles to find solutions to these dilemmas. In particular, the gap between expert judgment and lay perception will close only when non-experts are permitted and expected to make their own risk management decisions, so far as that is possible, while bearing full responsibility for their choices

  20. Bridging Two Worlds: Reconciling Practical Risk Assessment Methodologies with Theory of Attack Trees

    NARCIS (Netherlands)

    Gadyatskaya, Olga; Harpes, Carlo; Mauw, Sjouke; Muller, Cedric; Muller, Steve

    2016-01-01

    Security risk treatment often requires a complex cost-benefit analysis to be carried out in order to select countermeasures that optimally reduce risks while having minimal costs. According to ISO/IEC 27001, risk treatment relies on catalogues of countermeasures, and the analysts are expected to

  1. Risk management: Core principles and practices, and their relevance to wildland fire

    Science.gov (United States)

    Matthew P. Thompson; Donald G. MacGregor; Dave Calkin

    2016-01-01

    The Forest Service, U.S. Department of Agriculture faces a future of increasing complexity and risk, pressing financial issues, and the inescapable possibility of loss of human life. These issues are perhaps most acute for wildland fire management, the highest risk activity in which the Forest Service engages. Risk management (RM) has long been put forth as an...

  2. A systematic checklist approach to immunosuppression risk management: An audit of practice at two clinical neuroimmunology centers.

    Science.gov (United States)

    Mori, Amelia M; Agarwal, Smriti; Lee, Monique W M; Rafferty, Martina; Hardy, Todd A; Coles, Alasdair; Reddel, Stephen W; Riminton, D Sean

    2017-11-15

    There is no consensus approach to safety screening for immune intervention in clinical neuroimmunology. An immunosuppression risk evaluation checklist was used as an audit tool to assess real-world immunosuppression risk management and formulate recommendations for quality improvements in patient safety. Ninety-nine patients from two centres with 27 non-MS diagnoses were included. An average of 1.9 comorbidities with the potential to adversely impact morbidity and mortality associated with immunosuppression were identified. Diabetes and smoking were the most common, however a range of rarer but potentially life-threatening co-morbid disorders in the context of immunosuppression were identified. Inadequate documentation of risk mitigation tasks was common at 40.1% of total tasks across both cohorts. A routine, systematic immunosuppression checklist approach should be considered to improve immunosuppression risk management in clinical neuroimmunology practice. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. A report on the climate change and investment risk workshop : best practices for Canadian pension funds and institutional investors

    International Nuclear Information System (INIS)

    Boshyk, A.

    2004-01-01

    Investors realize that the value of investment portfolios can be influenced by environmental risks such as climate change. This report is intended to raise awareness within the financial community of climate change risk, and to encourage greater corporate disclosure on climate change. It presents recommended best practices from the Social Investment Organization (SIO) regarding pension funds and other institutional investors for assessing and managing climate change risk. In 2003, 87 institutional investors handling $9 trillion, asked the 500 largest publicly traded companies in the world to disclose investment-relevant information concerning their greenhouse gas emissions. Nearly 800 organizations in all sectors of the Canadian economy have launched voluntary action plans to reduce greenhouse gas emissions. The SIO recommends that Canadian institutional investors should sign the Carbon Disclosure Project, a mechanism designed to obtain carbon risk data from the largest companies in the world. Mandatory disclosure programs have been a successful tool in promoting sustainable development. 37 refs

  4. A Practical Risk Stratification Approach for Implementing a Primary Care Chronic Disease Management Program in an Underserved Community.

    Science.gov (United States)

    Xu, Junjun; Williams-Livingston, Arletha; Gaglioti, Anne; McAllister, Calvin; Rust, George

    2018-01-01

    The use of value metrics is often dependent on payer-initiated health care management incentives. There is a need for practices to define and manage their own patient panels regardless of payer to participate effectively in population health management. A key step is to define a panel of primary care patients with high comorbidity profiles. Our sample included all patients seen in an urban academic family medicine clinic over a two-year period. The simplified risk stratification was built using internal electronic health record and billing system data based on ICD-9 codes. There were 347 patients classified as high-risk out of the 5,364 patient panel. Average age was 59 years (SD 15). Hypertension (90%), hyperlipidemia (62%), and depression (55%) were the most common conditions among high-risk patients. Simplified risk stratification provides a feasible option for our team to understand and respond to the nuances of population health in our underserved community.

  5. Cardiovascular prevention in a high risk sport, ice hockey: applications in wider sports physical therapy practice.

    Science.gov (United States)

    Hopkins-Rosseel, Diana H

    2006-11-01

    Although acute myocardial infarction and sudden cardiac death are relatively rare occurrences in athletics, cardiovascular accidents do occur. This manuscript presents information on the cardiovascular risks in athletics. In addition, information is provided on screening for cardiovascular risk - including history taking, chart review, physical examination - and the appropriate guidelines on the treatment of athletes found to be at risk. For the purpose of this article, the sport of ice hockey is used to illustrate the subject matter and highlight the behaviors in sport that carry cardiovascular risk. Physical therapists have ethical and legal responsibility to undertake the necessary screening procedures to recognize and respond to any signs of cardiovascular risk in their clients.

  6. Corporate governance practices and financial performance: The mediating effect of risk management committee at manufacturing firms

    Directory of Open Access Journals (Sweden)

    Edyanus Herman Halim

    2017-12-01

    Full Text Available This study attempts to examine the effect of the Risk Management Committee on firm performance, and the intervening effect of the Risk Management Committee on the relationship between Corporate Governance, Firm Size, Financial Reporting Risk, and Firm Performance. Using the purposive sampling method, 299 firms were selected as the sample. This study used secondary data obtained from the companies’ annual reports, and the data was then analyze using SPSS, version 20.0. The results of this study indicate that the entire research hypothesis is accepted. This study found that the Risk Management Committee affects firm performance, and that Risk Management Committee acts as the intervening variable in the relationship between corporate governance, firm size, and financial reporting risk on firm performance. The existence of RMC would facilitate the company to control better the quality of financial reporting risks.

  7. [Suicide Risk Assessment in the Clinical Practice Guidelines for the Diagnosis and Management of Depression in Colombia].

    Science.gov (United States)

    Gómez Restrepo, Carlos; Bohórquez Peñaranda, Adriana Patricia; Gil Lemus, Laura Marcela; Jaramillo, Luis Eduardo; García Valencia, Jenny; Bravo Narváez, Eliana; de la Hoz Bradford, Ana María; Palacio, Carlos

    2013-01-01

    Suicide is the most serious complications of depression. It has high associated health costs and causes millions of deaths worldwide per year. Given its implications, it is important to know the factors that increase the risk of its occurrence and the most useful tools for addressing it. To identify the signs and symptoms that indicate an increased risk of suicide, and factors that increase the risk in patients diagnosed with depression. To establish the tools best fitted to identify suicide risk in people with depression. Clinical practice guidelines were developed, following those of the methodmethodological guidelines of the Ministry of Social Protection, to collect evidence and to adjust recommendations. Recommendations from the NICE90 and CANMAT guidelines were adopted and updated for questions found in these guidelines, while new recommendations were developed for questions not found in them. Basic points and recommendations are presented from a chapter of the clinical practice guidelines on depressive episodes and recurrent depressive disorder related to suicide risk assessment. Their corresponding recommendation levels are included. Copyright © 2013 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  8. A practical discussion of risk management for manufacturing of pharmaceutical products.

    Science.gov (United States)

    Mollah, A Hamid; Baseman, Harold S; Long, Mike; Rathore, Anurag S

    2014-01-01

    Quality risk management (QRM) is now a regulatory expectation, and it makes good business sense. The goal of the risk assessment is to increase process understanding and deliver safe and effective product to the patients. Risk analysis and management is an acceptable and effective way to minimize patient risk and determine the appropriate level of controls in manufacturing. While understanding the elements of QRM is important, knowing how to apply them in the manufacturing environment is essential for effective process performance and control. This article will preview application of QRM in pharmaceutical and biopharmaceutical manufacturing to illustrate how QRM can help the reader achieve that objective. There are several areas of risk that a drug company may encounter in pharmaceutical manufacturing, specifically addressing oral solid and liquid formulations. QRM tools can be used effectively to identify the risks and develop strategy to minimize or control them. Risks are associated throughout the biopharmaceutical manufacturing process-from raw material supply through manufacturing and filling operations to final distribution via a controlled cold chain process. Assessing relevant attributes and risks for biotechnology-derived products is more complicated and challenging for complex pharmaceuticals. This paper discusses key risk factors in biopharmaceutical manufacturing. Successful development and commercialization of pharmaceutical products is all about managing risks. If a company was to take zero risk, most likely the path to commercialization would not be commercially viable. On the other hand, if the risk taken was too much, the product is likely to have a suboptimal safety and efficacy profile and thus is unlikely to be a successful product. This article addresses the topic of quality risk management with the key objective of minimizing patient risk while creating an optimal process and product. Various tools are presented to aid implementation of these

  9. Risk behavior score: a practical approach for assessing risk among men who have sex with men in Brazil

    Directory of Open Access Journals (Sweden)

    Gustavo Machado Rocha

    2018-03-01

    Full Text Available HIV/AIDS epidemic is not well controlled, and multiple sexual behavior factors help explain high rates of HIV infection among men who have sex with men (MSM. This article proposes to exam the use of a potential risk behavior score for HIV infection, based on the type and number of sexual partners, and condom use, and their associated factors in a sample of MSM in Brazil. A cross sectional RDS (Respondent Driven Sampling study was performed among 3738 MSM aged 18+ years old from ten Brazilian cities. The risk behavior score was composed by the number of male partners and anal condom use in the last year with steady, casual, and commercial partners. Most participants were 25+ years old (58.1%, non-white (83.1%, and single (84.9%. Final weighted ordinal logistic model showed that age ≤ 25 years old (p = 0.037, homosexual or bisexual identity (p < 0.001, sexual initiation before 15-year-old (p < 0.001, having sex with men only in the last 12 months (p < 0.001, frequent alcohol and illicit drug use (p < 0.001, and use of local sites to meet sexual partners in the last month were independently associated with higher scores of risky behavior. Specific strategies should be developed aimed at the MSM population. Additionally, pre-exposed prophylaxis (Prep should be considered for those at higher score as a strategy for reducing risk for HIV infection in this population. Keywords: Homosexuals, High-risk sex, Unsafe sex, HIV, AIDS

  10. Rabies-related knowledge and practices among persons at risk of bat exposures in Thailand.

    Directory of Open Access Journals (Sweden)

    Kis Robertson

    2011-06-01

    Full Text Available BACKGROUND: Rabies is a fatal encephalitis caused by lyssaviruses. Evidence of lyssavirus circulation has recently emerged in Southeast Asian bats. A cross-sectional study was conducted in Thailand to assess rabies-related knowledge and practices among persons regularly exposed to bats and bat habitats. The objectives were to identify deficiencies in rabies awareness, describe the occurrence of bat exposures, and explore factors associated with transdermal bat exposures. METHODS: A survey was administered to a convenience sample of adult guano miners, bat hunters, game wardens, and residents/personnel at Buddhist temples where mass bat roosting occurs. The questionnaire elicited information on demographics, experience with bat exposures, and rabies knowledge. Participants were also asked to describe actions they would take in response to a bat bite as well as actions for a bite from a potentially rabid animal. Bivariate analysis was used to compare responses between groups and multivariable logistic regression was used to explore factors independently associated with being bitten or scratched by a bat. FINDINGS: Of 106 people interviewed, 11 (10% identified bats as a potential source of rabies. A history of a bat bite or scratch was reported by 29 (27%, and 38 (36% stated either that they would do nothing or that they did not know what they would do in response to a bat bite. Guano miners were less likely than other groups to indicate animal bites as a mechanism of rabies transmission (68% vs. 90%, p=0.03 and were less likely to say they would respond appropriately to a bat bite or scratch (61% vs. 27%, p=0.003. Guano mining, bat hunting, and being in a bat cave or roost area more than 5 times a year were associated with history of a bat bite or scratch. CONCLUSIONS: These findings indicate the need for educational outreach to raise awareness of bat rabies, promote exposure prevention, and ensure appropriate health-seeking behaviors for bat

  11. Best Practices in Weathering Climate Risks: Advancing Corporate and Community Resilience

    Science.gov (United States)

    Klima, K.; Winkelman, S.

    2012-12-01

    As the annual costs of severe weather events in the US grow into the billions of dollars, companies and communities are examining how best to plan ahead to protect their assets and bolster their bottom line. The Center for Clean Air Policy's Weathering Climate Risks program aims to help cities and companies enhance resilience to the economic impacts of severe weather and a changing climate. This presentation will highlight three communication techniques aimed at different types of audiences such as businesses, policymakers, the media, and society. First, we find that although planning for natural hazards now saves money later, stakeholders must fi¬nd their own self-interest if they are going to engage in a solution. Thus we research best practices and hold informational, off-the-record interviews to better understand the different stakeholders' perspectives, key concerns, and issues surrounding adaptation, resilience, and/or hazard mitigation. Diverse stakeholders find it attractive when a solution has multiple co-benefits such as climate resilience, greenhouse gas reduction, reduced costs, and social benefits. Second, we use off-the-record dialogues emphasizing candid public-private discussion to promote collaborative problem solving. Our high-level workshops typically consist of 30-40 scientists, companies, communities, and policymakers. We begin with presenting background material, such as geographic information systems (GIS) maps. Then we move to informal conservation. Topics include ideas such as "Ask the Climate Question": How will infrastructure, land development, and investment decisions affect GHG emissions and resilience to climate change impacts? We find these dialogues help stakeholders share their perspectives and advance public-private collaboration on climate resilience to protect critical urban infrastructure, ensure business continuity, and increase extreme weather resilience. Third, we find that communication to the general public must capture

  12. Obstructive sleep apnea among commercial motor vehicle drivers: using evidence-based practice to identify risk factors.

    Science.gov (United States)

    Olszewski, Kimberly; Wolf, Debra

    2013-11-01

    Commercial motor vehicle driving is a hazardous occupation, having the third highest fatality rate among common U.S. jobs. Among the estimated 14 million U.S. commercial motor vehicle drivers, the prevalence of obstructive sleep apnea is reported to be 17% to 28%. Despite the identified increased prevalence of obstructive sleep apnea among commercial motor vehicle drivers, federal law does not require that they be screened for obstructive sleep apnea. This article presents an evidence-based practice change project; the authors developed, implemented, and evaluated a screening program to identify commercial motor vehicle drivers' risk for obstructive sleep apnea during commercial driver medical examinations. The results of this practice change indicated screening for obstructive sleep apnea during the commercial driver medical examination led to improved identification of obstructive sleep apnea risk among commercial motor vehicle drivers and should be a clinical standard in occupational health clinics. Copyright 2013, SLACK Incorporated.

  13. Gender Power Control, Sexual Experiences, Safer Sex Practices, and Potential HIV Risk Behaviors Among Young Asian-American Women

    Science.gov (United States)

    Lee, Jieha; Rough, Kathryn; Strathdee, Steffanie A.

    2012-01-01

    We examined the prevalence of three domains of sexual behaviors among young Asian-American women: sexual experiences, safer sex practices, and potential HIV risk behaviors. We also investigated the impact of gender power control on these domains. Among sexually experienced women, 51% reported using condoms during their most recent sex act, 63% reported inconsistent condom use, and 18% reported ever having forced sex. Multiple logistic regression analyses revealed that women’s perceived lower relationship power control was not associated with vaginal sex or safer sex practices, but it was powerfully associated with forced sex and all three potential HIV risk behaviors. This study demonstrates that control within young Asian-American women’s intimate relationships exerts different associations depending on the type of sexual behavior. The application of the Theory of Gender and Power should be employed with prudence when designing HIV interventions for this population. PMID:21259042

  14. Gender power control, sexual experiences, safer sex practices, and potential HIV risk behaviors among young Asian-American women.

    Science.gov (United States)

    Hahm, Hyeouk Chris; Lee, Jieha; Rough, Kathryn; Strathdee, Steffanie A

    2012-01-01

    We examined the prevalence of three domains of sexual behaviors among young Asian-American women: sexual experiences, safer sex practices, and potential HIV risk behaviors. We also investigated the impact of gender power control on these domains. Among sexually experienced women, 51% reported using condoms during their most recent sex act, 63% reported inconsistent condom use, and 18% reported ever having forced sex. Multiple logistic regression analyses revealed that women's perceived lower relationship power control was not associated with vaginal sex or safer sex practices, but it was powerfully associated with forced sex and all three potential HIV risk behaviors. This study demonstrates that control within young Asian-American women's intimate relationships exerts different associations depending on the type of sexual behavior. The application of the Theory of Gender and Power should be employed with prudence when designing HIV interventions for this population.

  15. Best practices in risk and crisis communication: Implications for natural hazards management

    Science.gov (United States)

    Toddi A. Steelman; Sarah McCaffrey

    2013-01-01

    As societies evolve, often the most appropriate response to the hazard must also evolve. However, such shifts in appropriate response to a hazard, whether at the individual or at the societal level, are rarely straightforward: Closing the gap between desired practice and current practice requires effective communication. Although there is a significant literature on...

  16. Risk and Strategic Decision-Making in Developing Evidence-Based Practice Guidelines

    Science.gov (United States)

    Wilczynski, Susan M.

    2012-01-01

    Evidence-based practice (EBP) represents an important approach to educating and treating individuals diagnosed with disabilities or disorders. Understanding research findings is the cornerstone of EBP. The methodology of systematic reviews, which involves carefully analyzing research findings, can result a practice guideline that recommends…

  17. Identification of at-risk students and strategies to improve academic success in first year health programs. A Practice Report

    Directory of Open Access Journals (Sweden)

    Andrew Gerard Pearson

    2013-04-01

    Full Text Available The transition to university is a difficult process for many students, having a negative impact on their academic performance, ultimately resulting in failure or withdrawal from one or more courses in their first semester. This practice report describes a profile analysis and readiness assessment designed to identify students at high academic risk. Students so identified were offered additional workshops to address assumed knowledge and academic skills. Attendance at the workshops correlated with improved academic outcomes.

  18. An Assessment of the Effectiveness of Air Force Risk Management Practices in Program Acquisition Using Survey Instrument Analysis

    Science.gov (United States)

    2015-06-18

    Engineering Effectiveness Survey. CMU/SEI-2012-SR-009. Carnegie Mellon University. November 2012. Field, Andy. Discovering Statistics Using SPSS , 3rd...enough into the survey to begin answering questions on risk practices. All of the data statistical analysis will be performed using SPSS . Prior to...probabilistically using distributions for likelihood and impact. Statistical methods like Monte Carlo can more comprehensively evaluate the cost and

  19. Implications of Fuzziness for the Practical Management of High-Stakes Risks

    Directory of Open Access Journals (Sweden)

    Mark Jablonowski

    2010-04-01

    Full Text Available High-stakes (dangerous, catastrophic risks take on a wider profile as progress unfolds. What are the impacts of technological and social change on the risk landscape? Due to the complexities and dynamics involved, we can only answer these questions approximately. By using the concept of fuzziness, we can formalize our imprecision about high-stakes risk, and therefore place their management on a stronger footing. We review here the impacts of fuzziness, i.e., knowledge imperfection, on high-stakes risk management, including its implementation via computationally intelligent decision aids.

  20. A population-based audit of ethnicity and breast cancer risk in one general practice catchment area in North London, UK: implications for practice

    Directory of Open Access Journals (Sweden)

    Ferris Michelle

    2007-09-01

    Full Text Available Abstract Objectives To conduct a pilot population-based study within a general practice catchment area to determine whether the incidence of breast cancer was increased in the Ashkenazi population. Design Population-based cohort study. Setting A single general practice catchment area in North London. Participants 1947 women over the age of 16 who responded to a questionnaire about ethnicity and breast cancer. Main outcome measures Incidence of breast cancer, ethnicity. Results This study showed a 1.5-fold (95% CI 0.93–2.39 increase in breast cancer risk in the Ashkenazim compared with the non-Ashkenazi white population. The increased incidence was for both premenopausal and postmenopausal breast cancer (expected incidence pre:post is 1:4 whereas in the Ashkenazim it was 1:1; 51 and 52% of cases respectively. This increase was not shown in the Sephardim. Asians had a reduction in incidence (OR = 0.44; 95% CI 0.10–1.89. Results were adjusted for other risk factors for breast cancer. Conclusion This study showed a 1.5-fold increase in breast cancer rates in Ashkenazim compared with the non-Jewish white population when adjusted for age (i.e. corrections were made to allow comparison of age groups and this is not observed in the Sephardic population. The proportion of premenopausal breast cancer was just over double that of the general population. This is the first general practice population-based study in the UK to address this issue and has implications for general practitioners who care for patients from the Ashkenazi community.

  1. Awareness of breast cancer risk factors and practice of breast self examination among high school students in Turkey

    Directory of Open Access Journals (Sweden)

    Çetinkaya Aynur

    2008-10-01

    Full Text Available Abstract Background Young breast cancer patients have a lower rate of survival than old breast cancer patients due to being diagnosed at advanced stages. Breast self-examination makes women more "breast aware", which in turn may lead to an earlier diagnosis of breast cancer. The purpose of this study was to investigate knowledge and practice of breast self-examination and to determine knowledge of risk factors for breast cancer among high school students. Methods This is a descriptive and cross-sectional study. It was conducted in a high school in Manisa, Turkey. The study sample included 718 female high school students. A socio-demographic characteristics data form, knowledge of breast self examination and risk factors for breast cancer form and breast self examination practice form were used to collect data. Results The female high school students had insufficient knowledge about breast self-examination and a low percentage of students reported that they had performed breast self examination monthly. The most common reason for not doing breast self- examination was "not knowing how to perform breast self-examination" (98.5%. Most of the students had little knowledge of the risk factors for breast cancer. The most widely known risk factor by the students was personal history of breast cancer (68.7%. There was a significant relation between breast self-examination practice and age, school grade, knowledge about breast cancer and knowledge about breast self- examination. Conclusion There is a need to increase knowledge of adolescent females about the risks of breast cancer and benefits of early detection. In fact, health care professionals can develop effective breast health care programs and help young women to acquire good health habits.

  2. Poultry slaughtering practices in rural communities of Bangladesh and risk of avian influenza transmission: a qualitative study.

    Science.gov (United States)

    Rimi, Nadia Ali; Sultana, Rebeca; Ishtiak-Ahmed, Kazi; Khan, Salah Uddin; Sharker, M A Yushuf; Uz Zaman, Rashid; Azziz-Baumgartner, Eduardo; Gurley, Emily S; Nahar, Nazmun; Luby, Stephen P

    2014-01-01

    Slaughtering sick poultry is a risk factor for human infection with highly pathogenic avian influenza and is a common practice in Bangladesh. This paper describes human exposures to poultry during slaughtering process and the customs and rituals influencing these practices in two Bangladeshi rural communities. In 2009, we conducted 30 observations to observe slaughtering practices and 110 in-depth and short interviews and 36 group discussions to explore reasons behind those practices. The villagers reported slaughtering 103 poultry, including 20 sick poultry during 2 months. During different stages of slaughtering, humans, the environment, healthy poultry, and other animals were exposed to poultry blood and body parts. Women performed most of the slaughtering tasks, including evisceration. Defeathering required the most time and involved several persons. During festivals, ceremonies, and rituals, many people gathered and participated in the slaughtering of poultry. Exposure to poultry slaughtering created numerous opportunities for potential avian influenza transmission. Strategies that can be further tested to determine if they reduce the risk of transmission include skinning the carcasses of sick poultry, using hot water for defeathering and cleaning, using a bucket to contain slaughtering blood and carcass, burying the offal and encouraging handwashing.

  3. Ethical implications for clinical practice and future research in "at risk" individuals.

    Science.gov (United States)

    Singh, Fiza; Mirzakhanian, Heline; Fusar-Poli, Paolo; de la Fuente-Sandoval, Camilo; Cadenhead, Kristin S

    2012-01-01

    The last 15 years have witnessed a shift in schizophrenia research with increasing interest in earlier stages of illness with the hope of early intervention and ultimately prevention of psychotic illness. Large-scale longitudinal studies have identified clinical and biological risk factors associated with increased risk of psychotic conversion, which together with symptomatic and demographic risk factors may improve the power of prediction algorithms for psychotic transition. Despite these advances, 45-70% of at risk subjects in most samples do not convert to frank psychosis, but continue to function well below their age matched counterparts. The issue is of utmost importance in light of the upcoming DSM-V and the possible inclusion of the attenuated psychotic symptoms syndrome (APSS) diagnosis, with clinical and ethical implications. Clinical considerations include feasibility of reliably diagnosing the at risk state in non-academic medical centers, variable psychotic conversion rates, a non-uniform definition of conversion and extensive debate about treatment for individuals with an ill-defined outcome. On the ethical side, diagnosing APSS could lead to unnecessary prescribing of antipsychotics with long-term deleterious consequences, slow research by providing a false sense of comfort in the diagnosis, and have psychosocial implications for those who receive a diagnosis. Thus it may be prudent to engage at risk populations early and to use broad-spectrum treatments with low risk benefit ratios to relieve functional impairments, while simultaneously studying all subsets of the at risk population.

  4. A Risk and Prevention Counselor Training Program Model: Theory and Practice

    Science.gov (United States)

    Mason, Michael J.; Nakkula, Michael J.

    2008-01-01

    The need for training mental health counselors in risk and prevention is presented, and justification of the development of an innovative and integrative prevention training program is offered. Theoretical underpinnings that connect the counseling discipline to the field of prevention are described. A risk and prevention training model from…

  5. Current industrial practice of managing risks in product development project portfolios

    DEFF Research Database (Denmark)

    Weng, R.; Oehmen, Josef; Ben-Daya, M.

    2013-01-01

    Managing portfolios of development and engineering projects currently presents significant challenges to companies. This is even more the case in the management of portfolio risks, where both industry and academia currently lack a clear conceptual understanding of what portfolio risks are and what...

  6. Environmental Health Risk Governance in Practice: Lessons Learned from a Flemish Case Study Approach

    NARCIS (Netherlands)

    Stassen, K.R.; Leroy, P.; Gislason, M.K.

    2013-01-01

    PURPOSE: Risk governance is being successfully inserted into scientific and political agendas as a way to understand and address complex problems, such as health problems that have both social and ecological dimensions. However, to date, the debate on risk governance has remained rather conceptual.

  7. Predicting the onset of psychosis in patients at clinical high risk: practical guide to probabilistic prognostic reasoning.

    Science.gov (United States)

    Fusar-Poli, P; Schultze-Lutter, F

    2016-02-01

    Prediction of psychosis in patients at clinical high risk (CHR) has become a mainstream focus of clinical and research interest worldwide. When using CHR instruments for clinical purposes, the predicted outcome is but only a probability; and, consequently, any therapeutic action following the assessment is based on probabilistic prognostic reasoning. Yet, probabilistic reasoning makes considerable demands on the clinicians. We provide here a scholarly practical guide summarising the key concepts to support clinicians with probabilistic prognostic reasoning in the CHR state. We review risk or cumulative incidence of psychosis in, person-time rate of psychosis, Kaplan-Meier estimates of psychosis risk, measures of prognostic accuracy, sensitivity and specificity in receiver operator characteristic curves, positive and negative predictive values, Bayes' theorem, likelihood ratios, potentials and limits of real-life applications of prognostic probabilistic reasoning in the CHR state. Understanding basic measures used for prognostic probabilistic reasoning is a prerequisite for successfully implementing the early detection and prevention of psychosis in clinical practice. Future refinement of these measures for CHR patients may actually influence risk management, especially as regards initiating or withholding treatment. 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/

  8. Practical use of registered veterinary medicinal products in Macedonia in identifying the risk of developing of antimicrobial resistance

    Directory of Open Access Journals (Sweden)

    Velev Romel

    2013-07-01

    Full Text Available The use of antimicrobial agents is the key risk factor for the development and spread of antimicrobial resistance. It is therefore generally recognized that data on the usage of antimicrobial agents in food-producing animals are essential for identifying and quantifying the risk of developing and spreading of antimicrobial resistance in the food-chain. According to the WHO guidelines, the Anatomical Therapeutic Chemical system for the classification of veterinary medicines (ATC-vet is widely recognized as a classification tool. The aim of this work is to analyze the list of registered veterinary medicinal products in R. Macedonia and to evaluate the quality and practical use of this list according to the ATC-vet classification in order to identify the risk of developing and spreading of antimicrobial resistance.

  9. Does the risk of reprisal prevent nurses blowing the whistle on bad practice?

    Science.gov (United States)

    Whitehead, Bill; Barker, Denise

    Despite the introduction of legislation to protect people who report poor or unsafe practice, whistleblowing can still have serious consequences for nurses. To review the literature on whistleblowing in healthcare, and explore the barriers to reporting poor practice. Studies focusing on whistleblowing in healthcare were used to assess the safety of incident reporting, and to determine what prevented nurses from reporting poor practice. Four major themes were identified as the main barriers to whistleblowing in healthcare: experience of the nurse; confidentiality and reporting processes; incident severity; and personal beliefs. Reprisal for whistleblowing remains a major concern for nurses. Patient safety could be improved by prioritising confidentiality and creating an environment where nurses feel safe to report poor practice.

  10. Cumulative Risk Assessment: Overview of Agency Guidance, Practice and Current Major Research Activities

    Science.gov (United States)

    Powerpoint presentation that includes the EPA's definition of CRA, relevant publications already in existence, the CRA Guidelines effort, science issues where research is still needed, program office practices related to CRA, and EPA research activities.

  11. Risk of venous thrombosis in users of hormonal contraceptives in German gynaecological practices: a patient database analysis.

    Science.gov (United States)

    Ziller, M; Ziller, V; Haas, G; Rex, J; Kostev, K

    2014-02-01

    Recent studies showed differences in the risk of venous thrombosis between different combined hormonal contraceptives. Database studies comprising large cohorts can add relevant aspects from daily clinical practice. The purpose of this study was to evaluate different progestogen in combination with ethinylestradiol on the risk of venous thrombosis in Germany. Computerized data from 68,168 contraceptive users in gynecological practices throughout Germany (Disease Analyzer Database) were analyzed. The adjusted odds ratios for risk of thrombosis were estimated in users of different oral contraceptive (OC) formulations relative to users of levonorgestrel-containing preparations. In total, 38 (0.06 %) of the 68,168 contraceptive users had a recorded diagnosis of thrombosis within 365 days after the initial prescription. The adjusted risk was 1.95 for desogestrel (95 % CI 0.52-7.29), 2.97 for dienogest (95 % CI 0.96-9.24), 1.57 for drospirenone (95 % CI 0.46-5.38), 2.54 for chlormadinone (95 % CI 0.72-9.04), and 3.24 for norgestimate (95 % CI 0.59-17.75) compared to levonorgestrel. None of those findings reached statistical significance. The maximum absolute increase versus levonorgestrel was 6 cases per 10,000 women (n.s.). The study shows the low incidence rates of thrombosis in OC users. Since there is no significant difference, this study does not confirm an increased risk but shows only a tendency for this risk of third- and fourth-generation OC versus levonorgestrel-containing products.

  12. Poultry slaughtering practices in rural communities of Bangladesh and risk of avian influenza transmission

    DEFF Research Database (Denmark)

    Rimi, Nadia Ali; Sultana, Rebeca; Ishtiak-Ahmed, Kazi

    2014-01-01

    communities. In 2009, we conducted 30 observations to observe slaughtering practices and 110 in-depth and short interviews and 36 group discussions to explore reasons behind those practices. The villagers reported slaughtering 103 poultry, including 20 sick poultry during 2 months. During different stages...... poultry, using hot water for defeathering and cleaning, using a bucket to contain slaughtering blood and carcass, burying the offal and encouraging handwashing....

  13. The risk of fracture in patients with multiple sclerosis: The UK general practice research database

    DEFF Research Database (Denmark)

    Bazelier, Marloes T; van Staa, Tjeerd; Uitdehaag, Bernard Mj

    2011-01-01

    Patients with multiple sclerosis (MS) may be at an increased risk of fracture owing to a greater risk of falling and decreased bone mineral density when compared with the general population. This study was designed to estimate the relative and absolute risk of fracture in patients with MS. We...... were used to derive adjusted hazard ratios (HRs) for fracture associated with MS. Time-dependent adjustments were made for age, comorbidity, and drug use. Absolute 5- and 10-year risks of fracture were estimated for MS patients as a function of age. Compared with controls, MS patients had an almost...... threefold increased risk of hip fracture [HR = 2.79,95% confidence interval (CI) 1.83-4.26] and a risk of osteoporotic fracture that was increased 1.4-fold (HR = 1.35,95% CI 1.13-1.62). Risk was greater in patients who had been prescribed oral/intravenous glucocorticoids (GCs; HR = 1.85, 95% CI 1...

  14. Association of Practice-Level Social and Medical Risk With Performance in the Medicare Physician Value-Based Payment Modifier Program.

    Science.gov (United States)

    Chen, Lena M; Epstein, Arnold M; Orav, E John; Filice, Clara E; Samson, Lok Wong; Joynt Maddox, Karen E

    2017-08-01

    Medicare recently launched the Physician Value-Based Payment Modifier (PVBM) Program, a mandatory pay-for-performance program for physician practices. Little is known about performance by practices that serve socially or medically high-risk patients. To compare performance in the PVBM Program by practice characteristics. Cross-sectional observational study using PVBM Program data for payments made in 2015 based on performance of large US physician practices caring for fee-for-service Medicare beneficiaries in 2013. High social risk (defined as practices in the top quartile of proportion of patients dually eligible for Medicare and Medicaid) and high medical risk (defined as practices in the top quartile of mean Hierarchical Condition Category risk score among fee-for-service beneficiaries). Quality and cost z scores based on a composite of individual measures. Higher z scores reflect better performance on quality; lower scores, better performance on costs. Among 899 physician practices with 5 189 880 beneficiaries, 547 practices were categorized as low risk (neither high social nor high medical risk) (mean, 7909 beneficiaries; mean, 320 clinicians), 128 were high medical risk only (mean, 3675 beneficiaries; mean, 370 clinicians), 102 were high social risk only (mean, 1635 beneficiaries; mean, 284 clinicians), and 122 were high medical and social risk (mean, 1858 beneficiaries; mean, 269 clinicians). Practices categorized as low risk performed the best on the composite quality score (z score, 0.18 [95% CI, 0.09 to 0.28]) compared with each of the practices categorized as high risk (high medical risk only: z score, -0.55 [95% CI, -0.77 to -0.32]; high social risk only: z score, -0.86 [95% CI, -1.17 to -0.54]; and high medical and social risk: -0.78 [95% CI, -1.04 to -0.51]) (P risk only performed the best on the composite cost score (z score, -0.52 [95% CI, -0.71 to -0.33]), low risk had the next best cost score (z score, -0.18 [95% CI, -0.25 to -0.10]), then

  15. The risk environment of anabolic-androgenic steroid users in the UK: Examining motivations, practices and accounts of use.

    Science.gov (United States)

    Hanley Santos, Gisella; Coomber, Ross

    2017-02-01

    The numbers using illicit anabolic-androgenic steroids are a cause of concern for those seeking to reduce health harms. Using the 'risk environment' as a conceptual framework to better comprehend how steroid users' practices and perspectives impact on health risks, this paper examines steroid user motivations, patterns of use, and the ways in which these practices are accounted for. As part of a wider mixed-method study into performance and image enhancing drug (PIED) use and supply in one mid-sized city in South West England, qualitative interviews were undertaken with 22 steroid users. Participants were recruited from a local safer injecting service, rather than bodybuilding gyms, in order to access a wider cross-section of steroid users. A limitation of this approach is potential sample bias towards those showing more health optimising behaviours. The research findings highlight that patterns of steroid use varied according to motivation for use, experience and knowledge gained. Most reported having had little or no knowledge on steroids prior to use, with first use being based on information gained from fellow users or suppliers-sometimes inaccurate or incomplete. In accounting for their practices, many users differentiated themselves from other groups of steroid users-for example, older users expressed concern over patterns of use of younger and (what they saw as) inexperienced steroid users. Implicit in these accounts were intimations that the 'other' group engaged in riskier behaviour than they did. Examining social contexts of use and user beliefs and motivations is vital to understanding how 'risk' behaviours are experienced so that this, in turn, informs harm reduction strategies. This paper examines the ways in which use of steroids is socially situated and the implications of this for policy and practice. Copyright © 2016 Elsevier B.V. All rights reserved.

  16. Fish intake, cooking practices, and risk of prostate cancer: results from a multi-ethnic case-control study.

    Science.gov (United States)

    Joshi, Amit D; John, Esther M; Koo, Jocelyn; Ingles, Sue A; Stern, Mariana C

    2012-03-01

    Studies conducted to assess the association between fish consumption and prostate cancer (PCA) risk are inconclusive. However, few studies have distinguished between fatty and lean fish, and no studies have considered the role of different cooking practices, which may lead to differential accumulation of chemical carcinogens. In this study, we investigated the association between fish intake and localized and advanced PCA taking into account fish types (lean vs. fatty) and cooking practices. We analyzed data for 1,096 controls, 717 localized and 1,140 advanced cases from the California Collaborative Prostate Cancer Study, a multiethnic, population-based case-control study. We used multivariate conditional logistic regression to estimate odds ratios using nutrient density converted variables of fried fish, tuna, dark fish and white fish consumption. We tested for effect modification by cooking methods (high- vs. low-temperature methods) and levels of doneness. We observed that high white fish intake was associated with increased risk of advanced PCA among men who cooked with high-temperature methods (pan-frying, oven-broiling and grilling) until fish was well done (p (trend) = 0.001). No associations were found among men who cooked fish at low temperature and/or just until done (white fish x cooking method p (interaction) = 0.040). Our results indicate that consideration of fish type (oily vs. lean), specific fish cooking practices and levels of doneness of cooked fish helps elucidate the association between fish intake and PCA risk and suggest that avoiding high-temperature cooking methods for white fish may lower PCA risk.

  17. Perceived determinants of cardiovascular risk management in primary care: disconnections between patient behaviours, practice organisation and healthcare system.

    Science.gov (United States)

    Huntink, E; Wensing, M; Klomp, M A; van Lieshout, J

    2015-12-15

    Although conditions for high quality cardiovascular risk management in primary care in the Netherlands are favourable, there still remains a gap between practice guideline recommendations and practice. The aim of the current study was to identify determinants of cardiovascular primary care in the Netherlands. We performed a qualitative study, using semi-structured interviews with healthcare professionals and patients with established cardiovascular diseases or at high cardiovascular risk. A framework analysis was used to cluster the determinants into seven domains: 1) guideline factors, 2) individual healthcare professional factors, 3) patient factors, 4) professional interaction, 5) incentives and recourses, 6) mandate, authority and accountability, and 7) social, political and legal factors. Twelve healthcare professionals and 16 patients were interviewed. Healthcare professionals and patients mentioned a variety of factors concerning all seven domains. Determinants of practice according to the health care professionals were related to communication between healthcare professionals, patients' lack of knowledge and self-management, time management, market mechanisms in the Dutch healthcare system and motivational interviewing skills of healthcare professionals. Patients mentioned determinants related to their knowledge of risk factors for cardiovascular diseases, medication adherence and self-management as key determinants. A key finding is the mismatch between healthcare professionals' and patients' views on patient's knowledge and self-management. Perceived determinants of cardiovascular risk management were mainly related to patient behaviors and (but only for health professionals) to the healthcare system. Though health care professionals and patients agree upon the importance of patients' knowledge and self-management, their judgment of the current state of knowledge and self-management is entirely different.

  18. What Hinders the Implementation of the Supply Chain Risk Management Process Into Practice Organizations?

    DEFF Research Database (Denmark)

    Gredal, Pauline; Panyi, Zsófia; Kinra, Aseem

    2017-01-01

    Supply chain risk management process (SCRMP) is being advanced as a systematic and structured approach for identifying, assessing, mitigating, and monitoring all risks arising from complex supply chains. However, while the literature deems it necessary to implement such a process as the solution ...... indicate that the unavailability of information and lack of proper data management hinders the implementation of SCRMP in the context global supply chains.......Supply chain risk management process (SCRMP) is being advanced as a systematic and structured approach for identifying, assessing, mitigating, and monitoring all risks arising from complex supply chains. However, while the literature deems it necessary to implement such a process as the solution...... to the increasing vulnerability companies face, there is a lack of empirical evidence on whether the process model can be implemented. This paper shows possible hindrances in the implementation of SCRMP for companies with global supply chains based on the findings of an in-depth case study. Our empirical findings...

  19. Social Media and Health Care Professionals: Benefits, Risks, and Best Practices

    OpenAIRE

    Ventola, C. Lee

    2014-01-01

    Health care professionals can use a variety of social media tools to improve or enhance networking, education, and other activities. However, these tools also present some potential risks, such as unreliable information and violations of patients’ privacy rights.

  20. Social media and health care professionals: benefits, risks, and best practices.

    Science.gov (United States)

    Ventola, C Lee

    2014-07-01

    Health care professionals can use a variety of social media tools to improve or enhance networking, education, and other activities. However, these tools also present some potential risks, such as unreliable information and violations of patients' privacy rights.

  1. Linking Risk Management Practices and Strategies to Performance. Case Study: Ceramic and Tiles Industry

    OpenAIRE

    Hamideh Khanzadeh Charkhab; Mohammad Reza Eslami; Hassan Dehghan Dehnavi

    2014-01-01

    The supply chain is a network of independent and linked organizations that cooperate in direction to controlling, managing and improving of material and information flow from suppliers to final consumers in order to meet satisfaction of client. Supply chain risk management (SCRM) is very important in industry especially that goes to long supply chains. SCRM process focus on recognition of existing risk and decrease of undesired effect in supply chains, it consists of recognition, assessment, ...

  2. Theoretical and practical aspects of risk management in contemporary global supply chains

    Directory of Open Access Journals (Sweden)

    2010-09-01

    Full Text Available Globalization, off-shoring, outsourcing and pressure on cost reduction influence on the increasing complexity of supply chains and lead to higher risk. This may concern supplies, deliveries, manufacturing and transportation. Companies which source from distant countries have to implement risk management system. Examples of companies which use such systems prove, that it is possible to reduce uncertainty. Results concern shorter lead times, better quality and accepted cost level.

  3. Atherogenic Dyslipidemia and Residual Vascular Risk in Practice of Family Doctor

    OpenAIRE

    Alibasic, Esad; Ramic, Enisa; Bajraktarevic, Amila; Ljuca, Farid; Batic-Mujanovic, Olivera; Zildzic, Muharem

    2015-01-01

    Objective: Timely recognition and optimal management of atherogenic dyslipidemia (AD) and residual vascular risk (RVR) in family medicine. Background: The global increase of the incidence of obesity is accompanied by an increase in the incidence of many metabolic and lipoprotein disorders, in particular AD, as an typical feature of obesity, metabolic syndrome, insulin resistance and diabetes type 2. AD is an important factor in cardio metabolic risk, and is characterized by a lipoprotein prof...

  4. THEORY AND PRACTICE OF INDIVIDUAL SNOW AVALANCHE RISK ASSESSMENT IN THE RUSSIAN ARCTIC

    Directory of Open Access Journals (Sweden)

    Aleksandr Shnyparkov

    2012-01-01

    Full Text Available In recent years, the Government of the Russian Federation considerably increased attention to the exploitation of the Russian Arctic territories. Simultaneously, the evaluation of snow avalanches danger was enhanced with the aim to decrease fatalities and reduce economic losses. However, it turned out that solely reporting the degree of avalanche danger is not sufficient. Instead, quantitative information on probabilistic parameters of natural hazards, the characteristics of their effects on the environment and possibly resulting losses is increasingly needed. Such information allows for the estimation of risk, including risk related to snow avalanches. Here, snow avalanche risk is quantified for the Khibiny Mountains, one of the most industrialized parts of the Russian Arctic: Major parts of the territory have an acceptable degree of individual snow avalanche risk (<1×10-6. The territories with an admissible (10-4–10-6 or unacceptable (>1×10-4 degree of individual snow avalanche risk (0.5 and 2% of the total area correspond to the Southeast of the Khibiny Mountains where settlements and mining industries are situated. Moreover, due to an increase in winter tourism, some traffic infrastructure is located in valleys with an admissible or unacceptable degree of individual snow avalanches risk.

  5. Hazard Identification and Risk Assessment in Water Treatment Plant considering Environmental Health and Safety Practice

    Science.gov (United States)

    Falakh, Fajrul; Setiani, Onny

    2018-02-01

    Water Treatment Plant (WTP) is an important infrastructure to ensure human health and the environment. In its development, aspects of environmental safety and health are of concern. This paper case study was conducted at the Water Treatment Plant Company in Semarang, Central Java, Indonesia. Hazard identification and risk assessment is one part of the occupational safety and health program at the risk management stage. The purpose of this study was to identify potential hazards using hazard identification methods and risk assessment methods. Risk assessment is done using criteria of severity and probability of accident. The results obtained from this risk assessment are 22 potential hazards present in the water purification process. Extreme categories that exist in the risk assessment are leakage of chlorine and industrial fires. Chlorine and fire leakage gets the highest value because its impact threatens many things, such as industrial disasters that could endanger human life and the environment. Control measures undertaken to avoid potential hazards are to apply the use of personal protective equipment, but management will also be better managed in accordance with hazard control hazards, occupational safety and health programs such as issuing work permits, emergency response training is required, Very useful in overcoming potential hazards that have been determined.

  6. Hazard Identification and Risk Assessment in Water Treatment Plant considering Environmental Health and Safety Practice

    Directory of Open Access Journals (Sweden)

    Falakh Fajrul

    2018-01-01

    Full Text Available Water Treatment Plant (WTP is an important infrastructure to ensure human health and the environment. In its development, aspects of environmental safety and health are of concern. This paper case study was conducted at the Water Treatment Plant Company in Semarang, Central Java, Indonesia. Hazard identification and risk assessment is one part of the occupational safety and health program at the risk management stage. The purpose of this study was to identify potential hazards using hazard identification methods and risk assessment methods. Risk assessment is done using criteria of severity and probability of accident. The results obtained from this risk assessment are 22 potential hazards present in the water purification process. Extreme categories that exist in the risk assessment are leakage of chlorine and industrial fires. Chlorine and fire leakage gets the highest value because its impact threatens many things, such as industrial disasters that could endanger human life and the environment. Control measures undertaken to avoid potential hazards are to apply the use of personal protective equipment, but management will also be better managed in accordance with hazard control hazards, occupational safety and health programs such as issuing work permits, emergency response training is required, Very useful in overcoming potential hazards that have been determined.

  7. Managers’ Practices Related to Work–Family Balance Predict Employee Cardiovascular Risk and Sleep Duration in Extended Care Settings

    Science.gov (United States)

    Berkman, Lisa F.; Buxton, Orfeu; Ertel, Karen; Okechukwu, Cassandra

    2012-01-01

    An increasing proportion of U.S. workers have family caregiving responsibilities. The purpose of this study was to determine whether employees in extended care settings whose managers are supportive, open, and creative about work–family needs, such as flexibility with work schedules, have lower cardiovascular disease (CVD) risk and longer sleep than their less supported counterparts. From semistructured interviews with managers, we constructed a work–family balance score of manager openness and creativity in dealing with employee work–family needs. Trained interviewers collected survey and physiologic outcome data from 393 employees whose managers had a work–family score. Employee outcomes are sleep duration (actigraphy) and CVD risk assessed by blood cholesterol, high glycosylated hemoglobin/diabetes, blood pressure/hypertension, body-mass index, and tobacco consumption. Employees whose managers were less supportive slept less (29 min/day) and were over twice as likely to have 2 or more CVD risk factors (ORs = 2.1 and 2.03 for low and middle manager work–family scores, respectively) than employees whose managers were most open and creative. Employees who provide direct patient care exhibited particularly elevated CVD risk associated with low manager work–family score. Managers’ attitudes and practices may affect employee health, including sleep duration and CVD risk. PMID:20604637

  8. Managers' practices related to work-family balance predict employee cardiovascular risk and sleep duration in extended care settings.

    Science.gov (United States)

    Berkman, Lisa F; Buxton, Orfeu; Ertel, Karen; Okechukwu, Cassandra

    2010-07-01

    An increasing proportion of U.S. workers have family caregiving responsibilities. The purpose of this study was to determine whether employees in extended care settings whose managers are supportive, open, and creative about work-family needs, such as flexibility with work schedules, have lower cardiovascular disease (CVD) risk and longer sleep than their less supported counterparts. From semistructured interviews with managers, we constructed a work-family balance score of manager openness and creativity in dealing with employee work-family needs. Trained interviewers collected survey and physiologic outcome data from 393 employees whose managers had a work-family score. Employee outcomes are sleep duration (actigraphy) and CVD risk assessed by blood cholesterol, high glycosylated hemoglobin/diabetes, blood pressure/hypertension, body-mass index, and tobacco consumption. Employees whose managers were less supportive slept less (29 min/day) and were over twice as likely to have 2 or more CVD risk factors (ORs = 2.1 and 2.03 for low and middle manager work-family scores, respectively) than employees whose managers were most open and creative. Employees who provide direct patient care exhibited particularly elevated CVD risk associated with low manager work-family score. Managers' attitudes and practices may affect employee health, including sleep duration and CVD risk.

  9. Multifactorial risk assessment for survival of abutments of removable partial dentures based on practice-based longitudinal study.

    Science.gov (United States)

    Tada, Sayaka; Ikebe, Kazunori; Matsuda, Ken-Ichi; Maeda, Yoshinobu

    2013-12-01

    Predicting the tooth survival is such a great challenge for evidence-based dentistry. To prevent further tooth loss of partially edentulous patients, estimation of individualized risk and benefit for each residual tooth is important to the clinical decision-making. While there are several reports indicating a risk of losing the abutment teeth of RPDs, there are no existing reports exploring the cause of abutment loss by multifactorial analysis. The aim of this practice-based longitudinal study was to determine the prognostic factors affecting the survival period of RPD abutments using a multifactorial risk assessment. One hundred and forty-seven patients had been previously provided with a total of 236 new RPDs at the Osaka University Dental Hospital; the 856 abutments for these RPDs were analyzed. Survival of abutment teeth was estimated using the Kaplan-Meier method. Multivariate analysis was conducted by Cox's proportional hazard modelling. The 5-year survival rates were 86.6% for direct abutments and 93.1% for indirect abutments, compared with 95.8% survival in non-abutment teeth. The multivariate analysis showed that abutment survival was significantly associated with crown-root ratio (hazard ratio (HR): 3.13), root canal treatment (HR: 2.93), pocket depth (HR: 2.51), type of abutments (HR: 2.19) and occlusal support (HR: 1.90). From this practice-based longitudinal study, we concluded that RPD abutment teeth are more likely to be lost than other residual teeth. From the multifactorial risk factor assessment, several prognostic factors, such as occlusal support, crown-root ratio, root canal treatment, and pocket depth were suggested. These results could be used to estimate the individualized risk for the residual teeth, to predict the prognosis of RPD abutments and to facilitate an evidence-based clinical decision making. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. Benefits, challenges, and best practices for involving audiences in the development of interactive coastal risk communication tools: Professional communicators' experiences

    Science.gov (United States)

    Stephens, S. H.; DeLorme, D.

    2017-12-01

    To make scientific information useful and usable to audiences, communicators must understand audience needs, expectations, and future applications. This presentation synthesizes benefits, challenges, and best practices resulting from a qualitative social science interview study of nine professionals on their experiences developing interactive visualization tools for communicating about coastal environmental risks. Online interactive risk visualization tools, such as flooding maps, are used to provide scientific information about the impacts of coastal hazards. These tools have a wide range of audiences and purposes, including time-sensitive emergency communication, infrastructure and natural resource planning, and simply starting a community conversation about risks. Thus, the science, purposes, and audiences of these tools require a multifaceted communication strategy. In order to make these tools useable and accepted by their audiences, many professional development teams solicit target end-user input or incorporate formal user-centered design into the development process. This presentation will share results of seven interviews with developers of U.S. interactive coastal risk communication tools, ranging from state-level to international in scope. Specific techniques and procedures for audience input that were used in these projects will be discussed, including ad-hoc conversations with users, iterative usability testing with project stakeholder groups, and other participatory mechanisms. The presentation will then focus on benefits, challenges, and recommendations for best practice that the interviewees disclosed about including audiences in their development projects. Presentation attendees will gain an understanding of different procedures and techniques that professionals employ to involve end-users in risk tool development projects, as well as important considerations and recommendations for effectively involving audiences in science communication design.

  11. Psychosocial Adaptation and Depressive Manifestations in High-Risk Pregnant Women: Implications for Clinical Practice.

    Science.gov (United States)

    Fiskin, Gamze; Kaydirak, Meltem Mecdi; Oskay, Umran Yesiltepe

    2017-02-01

    High-risk pregnancy research has focused primarily on psychological well-being. The aim is to determine psychosocial adaptation and depression levels of pregnant women who were admitted to hospital with diagnosis of high-risk pregnancy. This study was descriptive. Sampling was composed of 122 high-risk pregnant women who were hospitalized in the perinatology service of Istanbul University Medical School, Department of Obstetrics and Gynecology between January 1, 2014, and May 31, 2014, and met the study criteria. The Pregnant Introduction Form, Psychosocial Adjustment of Illness Scale-Self Report, and CES Depression Scale were used. Of high-risk pregnant women, 47% were found to have a poor level of psychosocial adaptation and 57% presented with depressive symptoms. There were statistically significant difference found between the levels of psychosocial adaptation and status of depressive manifestations. The difference between the average scores increased as the adaptation levels weaken and the pregnant women with a poor level of psychosocial adaptation showed more depressive manifestations. The results of this study indicate that, depending on the high-risk pregnancy status, pregnant women experience difficulty in adaptation to their current status and pregnant women with a poor level of psychosocial adaptation showed more depressive manifestations. Nurses should deliver care in high-risk pregnancies with the awareness of physiological needs as well the psychosocial needs of pregnant women, and information meetings should be held in order to increase the psychosocial support of their families and decrease their tendency toward depression. Nursing initiatives should be developed with further studies for the psychosocial adaptation of high-risk pregnancy and reduction of the depressive manifestations. © 2016 Sigma Theta Tau International.

  12. Actuarial Evaluation of Pension Risks of Russia: from Theory to Practice

    Directory of Open Access Journals (Sweden)

    Aleksandr Anatolyevich Kuklin

    2017-09-01

    Full Text Available The article discusses the origins of the development of pension systems in the world, shows the causes of the emergence of various models of public pension provision. We pay a particular attention to the history of the formation of the Russian pension system, and analyse the stages and causes of modern reform. From the position of modern legislation, we systemise the forms, types of pension provision and pension insurance in the Russian Federation from the point of view of the sources of financing and subjects of pension relations. The authors have defined the concept of “actuarial evaluation” from the point of view of the process and system approach. We have revealed the content of the pension risk category, as well as classified the pension risks by the spheres of origin. The authors have developed the methodology of actuarial estimation of the risks of the pension system classified by different criteria: demographic, economic, financial, labor risks. The proposed methodological approach to the evaluation of pension risks is based on the comprehensive assessment of socio-economic indicators and the identification of dependencies between socio-demographic and economic processes in the pension system and economy of the country. The authors have tested the developed tools on the actuarial estimation of the pension risks of the Russian Federation. The article presents the results of calculations and identifies critical risks for the Russian pension system. We have proved that stagnation processes in the economy and a high share of the shadow economy represent the greatest threat to the Russian pension system in the short term, whereas, the aging of the population and the increase in life expectancy — in the long term.

  13. Knowledge, attitudes, and practices toward malaria risk and prevention among frequent business travelers of a major oil and gas company.

    Science.gov (United States)

    Berg, Johannes; Breederveld, Daan; Roukens, Anna H; Hennink, Yvonne; Schouten, Marjolijn; Wendt, Judy K; Visser, Leo G

    2011-01-01

    Despite significant morbidity and mortality among business travelers due to malaria, very little has been published on knowledge, attitudes, and practices (KAP) toward malaria risk. The aim of this study was to assess KAP among frequent international business travelers (FBT) and to identify recommendations for improving malaria prevention that could be applied to the wider FBT community in occupational health. A retrospective web-based survey was conducted in 2005 among self-registered FBT of an oil and gas company based in the Netherlands. The survey was completed by 328 of the 608 self-registered FBT (54%). Fifty-four percent of respondents had visited a high-risk area for malaria. Most respondents (96%) were experienced travelers; the majority (71%) sought health advice before their trip and made use of a company health resource. Fever was recognized as a malaria symptom by all FBT; travel to high-risk malaria areas was correctly identified by 96%, and 99% of these travelers adhered to use of adequate personal protective measures. The proportion of travelers carrying appropriate anti-malaria drug regimen was positively associated with receiving company advice among FBT traveling to high-risk destinations (RR = 2.10, 95% CI: 1.21-3.67), but not for those traveling to low- or no-risk destinations. Only 8% (14) of those going to a high-risk area were not carrying malaria prophylaxis. One in five of FBT traveling to no-risk areas were unnecessarily carrying malaria prophylaxis. The majority of KAP results were excellent. We postulate that a company culture with a strong focus on health, safety, security, and environment can positively contribute to high KAP scores. Notwithstanding the excellent findings, this study also provides a cautionary tale for company health functions against overprescribing of malaria prophylaxis. It demonstrates the need for constant review and audit of adherence to quality criteria. © 2011 International Society of Travel Medicine.

  14. Risk activities and pre-travel health seeking practices of notified cases of imported infectious diseases in Australia.

    Science.gov (United States)

    Paudel, Prakash; Raina, C; Zwar, Nicholas; Seale, Holly; Worth, Heather; Sheikh, Mohamud; Heywood, Anita E

    2017-09-01

    Travellers are at risk of acquiring infectious diseases during travel, with risks differing by destination, travel and traveller characteristics. A pre-travel health consultation may minimize this risk. However, uptake of pre-travel health advice remains low. We investigated pre-travel health preparations and disease-specific risk behaviours among notified cases of selected travel-associated infectious diseases imported into Australia. Prospective enhanced surveillance of notified cases of typhoid, paratyphoid, measles, hepatitis A, hepatitis E, malaria and chikungunya was conducted in two Australian states between February 2013 and January 2014. Details of pre-travel health preparation and disease-specific risk behaviours were collected. Among 180 cases associated with international travel, 28% were travellers and 22% were frequent travellers, having travelled ≥5 times in the past 5 years. 25% had sought pre-travel advice from a healthcare provider, and 16% reported a pre-travel vaccine. Seeking pre-travel health advice did not differ by immigrant status ( P  = 0.22) or by reason for travel ( P  = 0.13) but was more commonly sought by first time travellers ( P  = 0.03). Travellers visiting friends and relatives were more likely to report at-risk activities of brushing teeth with tap water ( P  food ( P  = 0.03) during travel compared to other travellers. Pre-travel health advice seeking practices and vaccine uptake was suboptimal among cases of notified disease. The results of this study highlight the need for a better understanding of barriers to pre-travel health seeking, particularly among high risk travellers, to reduce the importation of infectious diseases into Australia. © International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

  15. Risk mitigation strategies for viral contamination of biotechnology products: consideration of best practices.

    Science.gov (United States)

    Rosenberg, Amy S; Cherney, Barry; Brorson, Kurt; Clouse, Kathleen; Kozlowski, Steven; Hughes, Patricia; Friedman, Rick

    2011-01-01

    CONFERENCE PROCEEDING Proceedings of the PDA/FDA Adventitious Viruses in Biologics: Detection and Mitigation Strategies Workshop in Bethesda, MD, USA; December 1-3, 2010 Guest Editors: Arifa Khan (Bethesda, MD), Patricia Hughes (Bethesda, MD) and Michael Wiebe (San Francisco, CA) Viral contamination of biotech product facilities is a potentially devastating manufacturing risk and, unfortunately, is more common than is generally reported or previously appreciated. Although viral contaminants of biotech products are thought to originate principally from biological raw materials, all potential process risks merit evaluation. Limitations to existing methods for virus detection are becoming evident as emerging viruses have contaminated facilities and disrupted supplies of critical products. New technologies, such as broad-based polymerase chain reaction screens for multiple virus types, are increasingly becoming available to detect adventitious viral contamination and thus, mitigate risks to biotech products and processes. Further, the industry embrace of quality risk management that promotes improvements in testing stratagems, enhanced viral inactivation methods for raw materials, implementation and standardization of robust viral clearance procedures, and efforts to learn from both epidemiologic screening of raw material sources and from the experience of other manufacturers with regard to this problem will serve to enhance the safety of biotech products available to patients. Based on this evolving landscape, we propose a set of principles for manufacturers of biotech products: Pillars of Risk Mitigation for Viral Contamination of Biotech Products.

  16. Teratogenic risk and contraceptive counselling in psychiatric practice: analysis of anticonvulsant therapy

    Science.gov (United States)

    2013-01-01

    Background Anticonvulsants have been used to manage psychiatric conditions for over 50 years. It is recognised that some, particularly valproate, carbamazepine and lamotrigine, are human teratogens, while others including topiramate require further investigation. We aimed to appraise the documentation of this risk by psychiatrists and review discussion around contraceptive issues. Methods A retrospective review of prescribing patterns of four anticonvulsants (valproate, carbamazepine, lamotrigine and topiramate) in women of child bearing age was undertaken. Documented evidence of discussion surrounding teratogenicity and contraceptive issues was sought. Results Valproate was most commonly prescribed (n=67). Evidence of teratogenic risk counselling at medication initiation was sub-optimal – 40% of individuals prescribed carbamazepine and 22% of valproate. Documentation surrounding contraceptive issues was also low- 17% of individuals prescribed carbamazepine and 13% of valproate. Conclusion We found both low rates of teratogenic risk counselling and low rates of contraception advice in our cohort. Given the high rates of unplanned pregnancies combined with the relatively high risk of major congenital malformations, it is essential that a detailed appraisal of the risks and benefits associated with anticonvulsant medication occurs and is documented within patients’ psychiatric notes. PMID:24066860

  17. Implications of black swans to the foundations and practice of risk assessment and management

    International Nuclear Information System (INIS)

    Aven, Terje

    2015-01-01

    In this article, we discuss how to deal with black swans in a risk context. A black swan is here understood as a surprising extreme event relative to one's knowledge/beliefs, and can be of different types: a) unknown unknowns, b) unknown knowns (we do not have the knowledge but others do) and c) events that are judged to have a negligible probability of occurrence and thus are not believed to occur. In the article, we review the current approaches for confronting black swans, the aim being to gain new insights by addressing the three types of black swans separately, motivated by the fact that they require different types of measures. The main conclusions of the article are that there is a need to i) extend the current risk conceptualisation and treatment frameworks to include the black swan risk, ii) develop a new generation of risk assessment and decision support methods that place more emphasis on the black swan risk and iii) better understand what analysis captures and what lies within the management domain. - Highlights: • The article provides further clarifications on the meaning of black swans. • It reviews and discusses current approaches for confronting black swans. • It provides new insights by addressing three types of black swans separately. • It points to the need for improvements on concepts, assessment and management

  18. Early indicators and risk factors for ethical issues in clinical practice.

    Science.gov (United States)

    Pavlish, Carol; Brown-Saltzman, Katherine; Hersh, Mary; Shirk, Marilyn; Nudelman, Olga

    2011-03-01

    Nurses in all clinical settings encounter ethical issues that frequently lead to moral distress. This critical incident study explored nurses' descriptions of ethically difficult situations to identify risk factors and early indicators of ethical conflicts. Employing the critical incident technique, researchers developed a questionnaire that collected information on ethically difficult situations, their risk factors and early indicators, nurse actions, and situational outcomes. Two nurse researchers independently analyzed and categorized data using a constant comparison technique. Most of the ethically difficult situations pertained to end-of-life care for children and adults. Conflicts in interpersonal relationships were prevalent. Nurses were especially moved by patient and family suffering and concerned about patient vulnerability, harm-benefit ratio, and patient autonomy. Researchers discovered risk factor categories for patients, families, healthcare providers, and health systems. Additionally, researchers found subcategories in six major categories of early indicators: signs of conflict, patient suffering, nurse distress, ethics violation, unrealistic expectations, and poor communication. Nurses are keenly aware of pertinent risk factors and early indicators of unfolding ethical conflicts. Many nurses reported feeling powerless in the face of ethical conflict. Research that develops interventions to strengthen nurses' voices in ethically difficult situation is warranted. Nurses are in a key position to identify patient situations with a high risk for ethical conflict. Initiating early ethics consultation and interventions can alter the course of pending conflicts and diminish the potential for patient and family suffering and nurses' moral distress. © 2011 Sigma Theta Tau International.

  19. Risk of contamination of different areas of dentist′s face during dental practices

    Directory of Open Access Journals (Sweden)

    Farahnaz Nejatidanesh

    2013-01-01

    Conclusions: During dental practice, central areas of the face such as inner part of the eyes and around the nose were most contaminated areas. These parts are the important areas for transmission of infection. It is recommended to use protective means like glasses, mask, and protective shield, which have more protection field in these areas.

  20. Biomedicine, psychology and the kindergarten: children at risk and emerging knowledge practices

    NARCIS (Netherlands)

    Kontopodis, M.

    2013-01-01

    This study moves in the space between two fields: science and technology studies (STS) and childhood studies; it thus belongs to the broader STS literature that investigates everyday practices outside the laboratory. The interpretation of ethnographic and bibliographic data on contemporary

  1. Reducing the Risks of Firearm Violence in High Schools: Principals' Perceptions and Practices.

    Science.gov (United States)

    Price, James H; Khubchandani, Jagdish; Payton, Erica; Thompson, Amy

    2016-04-01

    This study assessed the perceptions and practices of a national sample of secondary school principals regarding reducing firearm violence in high schools. Data were collected via three-wave postal mailings. A 59-item valid and reliable questionnaire was mailed to a national random sample of 800 secondary school principals. Of the 349 principals (46 %) that responded, 17 % reported a firearm incident at their school in the past 5 years. Principals perceived inadequate parental monitoring (70 %), inadequate mental health services (64 %), peer harassment/bullying (59 %), and easy access to firearms (50 %) as the main causes of firearm violence in schools. The three barriers to implementing firearm violence prevention practices were: lack of expertise as to which practices to implement (33 %), lack of time (30 %), and lack of research as to which practices are most effective (30 %). Less than half of schools trained school personnel regarding firearm violence issues. The findings indicate that firearm incidents at schools may be more common than previously thought. A significant portion of principals are at a loss as to what to implement because of a lack of empirical evidence on what is effective. More research is needed to find the most effective school interventions for reducing firearm violence.

  2. Biomedicine, Psychology and the Kindergarten: Children at Risk and Emerging Knowledge Practices

    Science.gov (United States)

    Kontopodis, Michalis

    2013-01-01

    This study moves in the space between two fields: science and technology studies (STS) and childhood studies; it thus belongs to the broader STS literature that investigates everyday practices outside the laboratory. The interpretation of ethnographic and bibliographic data on contemporary cardiovascular and obesity prevention in German…

  3. Exploring and Adapting a Conceptual Model of Sexual Positioning Practices and Sexual Risk Among HIV-Negative Black Men Who Have Sex With Men.

    Science.gov (United States)

    Dangerfield, Derek T; Ober, Allison J; Smith, Laramie R; Shoptaw, Steven; Bluthenthal, Ricky N

    2018-02-21

    Estimates show a 50% lifetime human immunodeficiency virus (HIV) risk among Black men who have sex with men (BMSM) in the United States(U.S.). Studying the dynamics of sexual positioning practices among BMSM could provide insights into the disparities observed among U.S. groups of men who have sex with men (MSM). This study explored sexual positioning dynamics among HIV-negative BMSM and how they aligned with a theoretical model of sexual positioning and HIV/sexually transmitted infection (STI) risk among MSM. In-depth qualitative interviews were conducted with 29 HIV-negative BMSM between ages 25 and 35 in Los Angeles. Comments related to sexual behaviors were reviewed for relevance regarding oral or anal sexual positioning practices. Data presented represent the range of themes related to decision making regarding sexual positioning. Personal preference, partner attraction, HIV avoidance, and feeling obligated to practice partner preferences influenced sexual positioning. Drug use also affected decision making and was sometimes preferred in order to practice receptive anal intercourse. These variables build on the conceptual model of sexual positioning practices and sexual risk, and add understanding to the relationship between preferences, practices, and risk management. Future research on risk among HIV-negative BMSM should quantify the relative impact of personal preferences, partner attraction, partner type, compromise, and substance use on sexual positioning practices and risk.

  4. Some considerations on the treatment of uncertainties in risk assessment for practical decision making

    International Nuclear Information System (INIS)

    Aven, Terje; Zio, Enrico

    2011-01-01

    This paper discusses the challenges involved in the representation and treatment of uncertainties in risk assessment, taking the point of view of its use in support to decision making. Two main issues are addressed: (1) how to faithfully represent and express the knowledge available to best support the decision making and (2) how to best inform the decision maker. A general risk-uncertainty framework is presented which provides definitions and interpretations of the key concepts introduced. The framework covers probability theory as well as alternative representations of uncertainty, including interval probability, possibility and evidence theory.

  5. Workplace Violence: Practical Considerations for Mental Health Professionals in Consultation, Assessment, and Management of Risk.

    Science.gov (United States)

    Saragoza, Philip; White, Stephen G

    2016-12-01

    Workplace predatory violence has been the focus of increased study over the past 30 years, leading to a more sophisticated understanding of the factors that contribute to it, and important considerations for its assessment and management. Risk assessment professionals involved in workplace violence consultations should be mindful of issues specific to the workplace context and the principles of threat assessment to provide a more precise opinion of risk, to inform and enhance critical decisions regarding the employment status of the individual of concern, security measures, possible treatment options, and other management responses, while being mindful of the employee's certain rights. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. The impact of risk management practice upon the implementation of recovery-oriented care in community mental health services: a qualitative investigation.

    Science.gov (United States)

    Holley, Jessica; Chambers, Mary; Gillard, Steven

    2016-08-01

    Recovery-oriented care has become guiding principle for mental health policies and practice in the UK and elsewhere. However, a pre-existing culture of risk management practice may impact upon the provision of recovery-oriented mental health services. To explore how risk management practice impacts upon the implementation of recovery-oriented care within community mental health services. Semi-structured interviews using vignettes were conducted with eight mental health worker and service user dyads. Grounded theory techniques were used to develop explanatory themes. Four themes arose: (1) recovery and positive risk taking; (2) competing frameworks of practice; (3) a hybrid of risk and recovery; (4) real-life recovery in the context of risk. In abstract responses to the vignettes, mental health workers described how they would use a positive-risk taking approach in support of recovery. In practice, this was restricted by a risk-averse culture embedded within services. Mental health workers set conditions with which service users complied to gain some responsibility for recovery. A lack of strategic guidance at policy level and lack of support and guidance at practice level may result in resistance to implementing ROC in the context of RMP. Recommendations are made for policy, training and future research.

  7. Health-damaging policing practices among persons who inject drugs in Mexico: Are deported migrants at greater risk?

    Science.gov (United States)

    Pinedo, Miguel; Beletsky, Leo; Alamillo, Nathan; Ojeda, Victoria D

    2017-08-01

    Evidence-based public health and criminal justice policies aimed at addressing the structurally vulnerable population of persons who inject drugs (PWID) and who are involved in the immigrant enforcement and deportation system are lacking. Policing practices are critical structural determinants of HIV among PWID. PWID in Mexico who have been deported from the US are at elevated risk of HIV. From 2011 to 2013, 733 PWID were recruited to complete structured questionnaires, including past 6-month experiences with police. Eligible PWID were 18 years or older, had injected in the past month, and resided in Tijuana, Mexico with no intentions of moving. To determine if deportation status was associated with experiences of arrests and problematic policing practices, we conducted separate multivariate logistic regression models for independent policing variables. In multivariate analyses, deportation status was independently associated with higher odds of being arrested (Adjusted Odds Ratio (AOR): 1.45; 95% Confidence Interval (CI): 1.02-2.05), being asked for a bribe (AOR: 1.39; 95% CI: 1.05-2.04), and being forced to leave a place of residence (AOR: 2.00; 95% CI: 1.08-3.70) in the past 6 months. Results highlight a previously poorly understood elements of the US-deportation experience: migrants' experiences with law enforcement post-deportation and the role of deportation policies and practices as structural drivers of public health risk in destination countries. We provide policy recommendations for Mexico and the US based on our findings, which have potential application in other countries seeking to improve enforcement and related policing practices from a public health perspective. Copyright © 2017. Published by Elsevier B.V.

  8. Menstrual Hygiene Practices, WASH Access and the Risk of Urogenital Infection in Women from Odisha, India

    Science.gov (United States)

    Das, Padma; Baker, Kelly K.; Dutta, Ambarish; Swain, Tapoja; Sahoo, Sunita; Das, Bhabani Sankar; Panda, Bijay; Nayak, Arati; Bara, Mary; Bilung, Bibiana; Mishra, Pravas Ranjan; Panigrahi, Pinaki; Cairncross, Sandy; Torondel, Belen

    2015-01-01

    Menstrual hygiene management (MHM) practices vary worldwide and depend on the individual’s socioeconomic status, personal preferences, local traditions and beliefs, and access to water and sanitation resources. MHM practices can be particularly unhygienic and inconvenient for girls and women in poorer settings. Little is known about whether unhygienic MHM practices increase a woman’s exposure to urogenital infections, such as bacterial vaginosis (BV) and urinary tract infection (UTI). This study aimed to determine the association of MHM practices with urogenital infections, controlling for environmental drivers. A hospital-based case-control study was conducted on 486 women at Odisha, India. Cases and controls were recruited using a syndromic approach. Vaginal swabs were collected from all the participants and tested for BV status using Amsel’s criteria. Urine samples were cultured to assess UTI status. Socioeconomic status, clinical symptoms and reproductive history, and MHM and water and sanitation practices were obtained by standardised questionnaire. A total of 486 women were recruited to the study, 228 symptomatic cases and 258 asymptomatic controls. Women who used reusable absorbent pads were more likely to have symptoms of urogenital infection (AdjOR=2.3, 95%CI1.5-3.4) or to be diagnosed with at least one urogenital infection (BV or UTI) (AdjOR=2.8, 95%CI1.7-4.5), than women using disposable pads. Increased wealth and space for personal hygiene in the household were protective for BV (AdjOR=0.5, 95%CI0.3-0.9 and AdjOR=0.6, 95%CI0.3-0.9 respectively). Lower education of the participants was the only factor associated with UTI after adjusting for all the confounders (AdjOR=3.1, 95%CI1.2-7.9). Interventions that ensure women have access to private facilities with water for MHM and that educate women about safer, low-cost MHM materials could reduce urogenital disease among women. Further studies of the effects of specific practices for managing

  9. Differences in Sexual Practices, Sexual Behavior and HIV Risk Profile between Adolescents and Young Persons in Rural and Urban Nigeria.

    Science.gov (United States)

    Folayan, Morenike Oluwatoyin; Adebajo, Sylvia; Adeyemi, Adedayo; Ogungbemi, Kayode Micheal

    2015-01-01

    We aimed to determine differences in sexual practices, HIV sexual risk behaviors, and HIV risk profile of adolescents and young persons' in rural and urban Nigeria. We recruited 772 participants 15 to 24 years old from urban and rural townships in Nigeria through a household survey. Information on participants' socio-demographic profile (age sex, residential area, number of meals taken per day), sexual practices (vagina, oral and anal sex; heterosexual and homosexual sex; sex with spouse, casual acquaintances, boy/girlfriend and commercial sex workers), sexual behavior (age of sexual debut, use of condom, multiple sex partners, transactional sex and age of sexual partner), and other HIV risk factors (use of alcohol and psychoactive substances, reason for sexual debut, knowledge of HIV prevention and HIV transmission, report of STI symptoms) were collected through an interviewer administered questionnaire. Differences in sexual behavior and sexual practices of adolescents and HIV risk profile of adolescents and young persons resident in urban and rural areas were determined. More than half (53.5%) of the respondents were sexually active, with more residing in the rural than urban areas (64.9% vs 44.1%; p<0.001) and more resident in the rural area reporting having more than one sexual partner (29.5% vs 20.4%; p = 0.04). Also, 97.3% of sexually active respondents reported having vaginal sex, 8.7% reported oral sex and 1.9% reported anal sex. More male than female respondents in the urban area used condoms during the last vaginal sexual intercourse (69.1% vs 51.9%; p = 0.02), and reported sex with casual partners (7.0% vs 15.3%; p = 0.007). More female than male respondents residing in the rural area engaged in transactional sex (1.0% vs 6.7%; p = 0.005). More females than males in both rural (3.6% vs 10.2%; p = 0.04) and urban (4.7% vs 26.6%; p<0.001) areas self-reported a history of discharge. More females than males in both rural (1.4% vs 17.0%; p = 0.04) and urban

  10. Anonymous sex and HIV risk practices among men using the Internet specifically to find male partners for unprotected sex.

    Science.gov (United States)

    Klein, H

    2012-06-01

    To examine the popularity of anonymous sex practices among men using the Internet to find male partners for unprotected sex, and how anonymous sex relates to involvement in other HIV-related risk behaviours, and to investigate the factors associated with engaging in anonymous sex. Structured telephone interviews were conducted with men who used the Internet specifically to find male partners for unprotected sex. Random sampling from 16 websites was used to obtain a national sample. The data reported in this paper were based on quantitative interviews collected with a cross-sectional study design. Between January 2008 and May 2009, confidential telephone interviews lasting approximately 1-2 h were completed with 332 men. Participants were paid $35 for their participation. Most of the men (67.4%) liked anonymous sex, and slightly more than half (51.2%) had engaged in the behaviour during the month prior to interview. Involvement in anonymous sex was associated with greater involvement in a variety of human immunodeficiency virus (HIV)-related risk practices, such as illegal drug use, number of sex partners, and amount of unprotected sex. Four factors were associated with having vs not having anonymous sex: (1) being HIV positive; (2) answering all of the HIV-related knowledge questions correctly; (3) deriving greater enjoyment from having sex in public places, such as parks, public toilets, or adult book shops; and (4) greater impulsivity. Seven factors were associated with greater vs lesser involvement in anonymous sex among those practising the behaviour: (1) being involved in a relationship with a long-term partner; (2) liking to have sex in public places; (3) using bareback-oriented websites to identify sex partners; (4) greater impulsivity; (5) low level of condom use self-efficacy; (6) greater knowledge about HIV/acquired immunodeficiency syndrome; and either (7a) severe childhood maltreatment or (7b) Caucasian race. Men in this population often sought

  11. Risk communications in nuclear energy as science and technology. Arrangement and analysis of academic findings and practical cases

    International Nuclear Information System (INIS)

    Toyoda, Satoshi

    2006-01-01

    Problems in communication among the government, enterprise, experts and so on and the society and people, now confront us in several areas of science and technology. In order to be accepted by the society, each area of science and technology has experienced common processes such as beginnings, business, society introduction, problem renovation and maturity. Each area can be positioned based on the degree of maturity, which helps to find solutions of the problems. Arrangement and analysis of academic findings and practical cases on risk communications in nuclear energy are described. (T. Tanaka)

  12. Differences in Sexual Practices, Sexual Behavior and HIV Risk Profile between Adolescents and Young Persons in Rural and Urban Nigeria.

    Directory of Open Access Journals (Sweden)

    Morenike Oluwatoyin Folayan

    Full Text Available We aimed to determine differences in sexual practices, HIV sexual risk behaviors, and HIV risk profile of adolescents and young persons' in rural and urban Nigeria.We recruited 772 participants 15 to 24 years old from urban and rural townships in Nigeria through a household survey. Information on participants' socio-demographic profile (age sex, residential area, number of meals taken per day, sexual practices (vagina, oral and anal sex; heterosexual and homosexual sex; sex with spouse, casual acquaintances, boy/girlfriend and commercial sex workers, sexual behavior (age of sexual debut, use of condom, multiple sex partners, transactional sex and age of sexual partner, and other HIV risk factors (use of alcohol and psychoactive substances, reason for sexual debut, knowledge of HIV prevention and HIV transmission, report of STI symptoms were collected through an interviewer administered questionnaire. Differences in sexual behavior and sexual practices of adolescents and HIV risk profile of adolescents and young persons resident in urban and rural areas were determined.More than half (53.5% of the respondents were sexually active, with more residing in the rural than urban areas (64.9% vs 44.1%; p<0.001 and more resident in the rural area reporting having more than one sexual partner (29.5% vs 20.4%; p = 0.04. Also, 97.3% of sexually active respondents reported having vaginal sex, 8.7% reported oral sex and 1.9% reported anal sex. More male than female respondents in the urban area used condoms during the last vaginal sexual intercourse (69.1% vs 51.9%; p = 0.02, and reported sex with casual partners (7.0% vs 15.3%; p = 0.007. More female than male respondents residing in the rural area engaged in transactional sex (1.0% vs 6.7%; p = 0.005. More females than males in both rural (3.6% vs 10.2%; p = 0.04 and urban (4.7% vs 26.6%; p<0.001 areas self-reported a history of discharge. More females than males in both rural (1.4% vs 17.0%; p = 0.04 and

  13. Feeding practices and potential risk factors for laminitis in dairy cows in Thailand

    NARCIS (Netherlands)

    Pilachai, R.

    2013-01-01

    Laminitis is considered an important health problem facing the Thai dairy industry. Although the etiology of laminitis is multifactorial, nutrition is considered an important risk factor. Rumen acidosis, lipopolysaccharides (LPS) and histamine may play a role in the development of laminitis in dairy

  14. Deterministic and probabilistic approach to determine seismic risk of nuclear power plants; a practical example

    International Nuclear Information System (INIS)

    Soriano Pena, A.; Lopez Arroyo, A.; Roesset, J.M.

    1976-01-01

    The probabilistic and deterministic approaches for calculating the seismic risk of nuclear power plants are both applied to a particular case in Southern Spain. The results obtained by both methods, when varying the input data, are presented and some conclusions drawn in relation to the applicability of the methods, their reliability and their sensitivity to change

  15. Classroom Practices and Academic Outcomes in Urban Afterschool Programs: Alleviating Social-Behavioral Risk

    Science.gov (United States)

    Cappella, Elise; Hwang, Sophia H. J.; Kieffer, Michael J.; Yates, Miranda

    2018-01-01

    Given the potential of afterschool programs to support youth in urban, low-income communities, we examined the role of afterschool classroom ecology in the academic outcomes of Latino and African American youth with and without social-behavioral risk. Using multireporter methods and multilevel analysis, we find that positive classroom ecology…

  16. Hedging Financial Risks in the Economic Practices of Small Business: Current Imperatives

    Directory of Open Access Journals (Sweden)

    Kolomiyets Ganna M.

    2017-04-01

    Full Text Available The article considers the need to update approaches to hedging the financial risks of small businesses. Reducing the probability of financial costs and losses is of continuing relevance. It appears to be especially critical for small businesses. Small business plays a significant role in the country’s economic system as creator of jobs and as a producer of goods and services that adapts quickly to changing consumer requirements. However, its access to credit resources has certain limitations. The instability of the economic environment by individual factors can affect small businesses not less, and sometimes even more than large and medium-sized businesses. Design of the risk-management in terms of small business needs to be updated. In the current context, there is a need in re-evaluating that the efficient financial risk management can only be carried out in a complex of all the enterprise’s risks, with an increase in the planning horizon and the identification of obstacles to achieving the objective set.

  17. Recent status of development and practical application of risk analysis in the nuclear field

    International Nuclear Information System (INIS)

    Birkhofer, A.

    1980-01-01

    The present status of reliability as well as of risk analysis in the field of nuclear safety in the Federal Republic of Germany, is described. An attempt is made to select typical examples rather than to give a complete survey. (E.G.) [pt

  18. Quantitative risk assessment for environmental and occupational health. The practical solution

    International Nuclear Information System (INIS)

    Hallenbeck, W.H.; Cunningham, K.M.

    1986-01-01

    These following topics are covered in this book: concepts, methods, and limitations; exposure characterization; qualitative evaluation of human and animal studies; quantitative evaluation of human and animal studies; risk analysis; acceptable concentrations; environmental and occupational exposure to a hypothetical toxicant; and environmental exposure to a natural toxicant radon-222 and its daughters

  19. Fall-Risk Evaluation and Management: Challenges in Adopting Geriatric Care Practices

    Science.gov (United States)

    Tinetti, Mary E.; Gordon, Catherine; Sogolow, Ellen; Lapin, Pauline; Bradley, Elizabeth H.

    2006-01-01

    One third of older adults fall each year, placing them at risk for serious injury, functional decline, and health care utilization. Despite the availability of effective preventive approaches, policy and clinical efforts at preventing falls among older adults have been limited. In this article we present the burden of falls, review evidence…

  20. SOCIAL ENVIRONMENTAL RISK AND PROTECTION: A TYPOLOGY WITH IMPLICATIONS FOR PRACTICE IN ELEMENTARY SCHOOLS.

    Science.gov (United States)

    Bowen, Natasha K; Lee, Jung-Sook; Weller, Bridget E

    2007-01-01

    Social environmental assessments can play a critical role in prevention planning in schools. The purpose of this study was to describe the importance of conducting social environmental assessments, demonstrate that complex social environmental data can be simplified into a useful and valid typology, and illustrate how the typology can guide prevention planning in schools. Data collected from 532 3(rd) through 5(th) graders using the Elementary School Success Profile were analyzed in the study. A latent profile analysis based on eight child-report social environmental dimensions identified five patterns of social environmental risk and protection. The classes were labeled High Protection, Moderate Protection, Moderate Protection/Peer Risk, Little Protection/Family Risk, and No Protection//School Risk. Class membership was significantly associated with measures of well-being, social behavior and academic performance. The article illustrates how the typology can be used to guide decisions about who to target in school-based preventions, which features of the social environment to target, and how much change to seek. Information is provided about online resources for selecting prevention strategies once these decisions are made.

  1. Teacher Behavioral Practices: Relations to Student Risk Behaviors, Learning Barriers, and School Climate

    Science.gov (United States)

    Martinez, Andrew; Mcmahon, Susan D.; Coker, Crystal; Keys, Christopher B.

    2016-01-01

    Student behavioral problems pose a myriad of challenges for schools. In this study, we examine the relations among teacher and school-level constructs (i.e., teacher collaboration, supervision/discipline, instructional management), and student-related outcomes (i.e., high-risk behaviors, barriers to learning, student social-behavioral climate).…

  2. Education for disaster risk reduction : linking theory with practice in Ghana´s basic schools

    NARCIS (Netherlands)

    Apronti, Priscilla; Saito, Osamu; Otsuki, K.|info:eu-repo/dai/nl/306279258; Kranjac-Berisavljevic, Gordana

    2015-01-01

    Current understanding of disaster risk reduction (DRR) concurs that, when provided the right education, children have the potential to reduce their own vulnerability and the vulnerability of others in their community. What, then, comprises the right education for DRR? Research has established the

  3. Pricing, hedging and risk management : practical tips for natural gas buyers and sellers

    International Nuclear Information System (INIS)

    Shields, D.

    1998-01-01

    Risk analysis and techniques to manage risk as it pertains to the natural gas industry were discussed. Portfolio allocations for long-term, short-term fixed price and variable price contracts were described. Options were defined as a market instrument offering the benefits of a fixed price purchase or sale without the obligation of incurring financial or opportunity losses if the market goes against the option buyer. Options should be used as a defence strategy to protect portfolios from price risk in times of uncertainty and to take advantage of current floating market conditions without making a full price commitment. Options can also be used as an offensive strategy to make a directional play on the market or on volatility. Options selling was regarded as a much higher risk than options buying. The variables that affect options premiums were: (1) volatility, (2) time to expiration, (3) underlying price versus strike price, and (4) flexibility. Williams Energy's new world class energy trading floor in Tulsa, Oklahoma was also described. Williams is the largest-volume transporter of natural gas in the U.S. with more than 27,000 miles of pipelines. Williams pipelines transport 16 per cent of all the natural gas used in the U.S. and the company is one of the nation's largest natural gas gatherers and processors. tabs., figs

  4. Practical examples of modeling choices and their consequences for risk assessment

    Science.gov (United States)

    Although benchmark dose (BMD) modeling has become the preferred approach to identifying a point of departure (POD) over the No Observed Adverse Effect Level, there remain challenges to its application in human health risk assessment. BMD modeling, as currently implemented by the...

  5. Long-term risks of inadequate management practices on the sustainability of agricultural soils

    NARCIS (Netherlands)

    Vries, de W.; Groenenberg, J.E.; Murányi, A.; Curlík, J.; Sefcík, P.; Römkens, P.F.A.M.; Reinds, G.J.; Bril, J.; Modin, A.K.; Sverdrup, H.U.; Alloway, B.J.

    2003-01-01

    This report describes the major result of a research project funded by the INCO-Copernicus programma of European Commission under Contract number ERB-IC15-CT98-0133. The study focused on the long-term environmental risk of soil acidification on: (i) mobilisation and leaching and (ii) plant uptake of

  6. Incorporating Gender Specific Approaches for Incarcerated Female Adolescents: Multilevel Risk Model for Practice

    Science.gov (United States)

    Welch, Chiquitia L.; Roberts-Lewis, Amelia C.; Parker, Sharon

    2009-01-01

    The rise in female delinquency has resulted in large numbers of girls being incarcerated in Youth Development Centers (YDC). However, there are few gender specific treatment programs for incarcerated female adolescent offenders, particularly for those with a history of substance dependency. In this article, we present a Multi-level Risk Model…

  7. Expressing best practices in (risk) analysis and testing of safety-critical systems using patterns

    DEFF Research Database (Denmark)

    Herzner, Wolfgang; Sieverding, Sven; Kacimi, Omar

    2014-01-01

    The continuing pervasion of our society with safety-critical cyber-physical systems not only demands for adequate (risk) analysis, testing and verification techniques, it also generates growing experience on their use, which can be considered as important as the tools themselves for their efficient...

  8. HIV knowledge, risk perception, and safer sex practices among female sex workers in Port Moresby, Papua New Guinea

    Science.gov (United States)

    Bruce, Eunice; Bauai, Ludwina; Sapuri, Mathias; Kaldor, John M; Fairley, Christopher K; Keogh, Louise A

    2011-01-01

    Sex workers are considered a high-risk group for sexually transmitted infections, including human immunodeficiency virus (HIV), and are often targeted by prevention interventions with safer sex messages. The purpose of this study was to explore the extent to which knowledge of HIV and perception of risk influence safer sex practices among female sex workers (FSWs) in Port Moresby, Papua New Guinea. FSWs (n = 174) were recruited from 19 sites to participate in the study. Qualitative data were collected using semistructured interviews with FSWs (n = 142) through focus group discussions and (n = 32) individual interviews. In addition, quantitative data were collected from all FSWs using a short structured, demographic questionnaire. Data were analyzed using recurring themes and calculations of confidence intervals. Despite some common misperceptions, overall, most FSWs were basically aware of the risks of HIV and informed about transmission and prevention modalities but used condoms inconsistently. Most reported using condoms ‘sometimes’, almost one-sixth ‘never’ used condoms, only a fraction used condoms ‘always’ with clients, and none used condoms ‘always’ with regular sexual partners (RSPs). Among these FSWs, being knowledgeable about the risks, transmission, and prevention of HIV did not translate into safe sex. The findings suggest that certain contextual barriers to safer sex practices exist. These barriers could heighten HIV vulnerability and possibly may be responsible for infection in FSWs. Specific interventions that focus on improving condom self-efficacy in FSWs and simultaneously target clients and RSPs with safer sex messages are recommended. PMID:21445375

  9. Beyond anal sex: sexual practices associated with HIV risk reduction among men who have sex with men in Boston, Massachusetts.

    Science.gov (United States)

    Reisner, Sari L; Mimiaga, Matthew J; Skeer, Margie; Mayer, Kenneth H

    2009-07-01

    Men who have sex with men (MSM) continue to bear a disproportionate HIV and sexually transmitted disease (STD) burden. The current study examined the frequency and associations of sexual risk reduction behaviors among a sample of MSM in the greater Boston, Massachusetts area. One hundred eighty-nine MSM completed a one-time behavioral and psychosocial assessment between March 2006 and May 2007. Logistic regression procedures examined the association of demographic, psychosocial, and behavioral factors with risk reduction practices. Twenty percent of the sample reported rimming, mutual masturbation, digital penetration, using sex toys, or 100% condom use as a means to reduce their risk of acquiring or transmitting HIV in the prior 12 months. In bivariate analyses, risk reducers were more likely to disclose their MSM status (i.e., be "out"; odds ratio [OR] = 3.64; p < 0.05), and report oral sex with a condom in the prior 12 months (OR = 4.85; p < 0.01). They were less likely to report: depression (Center for Epidemiologic Studies Depression Scale [CES-D] score 16+; OR = 0.48; p < 0.05), a history of one or more sexually transmitted diseases (STDs; OR = 0.40; p < 0.05), and meeting sexual partners at public cruising areas (OR = 0.32; p < 0.01). In a multivariable model, risk reducers were less likely to report: alcohol use during sex (adjusted odds ratio [AOR] = 0.33; p < 0.05), depression (CESD score 16+; AOR = 0.32; p < 0.05), or meeting sexual partners at public cruising areas (AOR = 0.30; p < 0.05), or via the Internet (AOR = 0.12; p < 0.05) in the previous 12 months. Identifying and understanding such factors associated with risk reduction behaviors may be important to consider in designing effective prevention interventions to promote sexual health for MSM.

  10. [Type of partner, socio-economic factors and risk practices in men who have sex with men].

    Science.gov (United States)

    Gasch Gallén, Àngel; Tomás Aznar, Concepción; Rubio Aranda, Encarnación

    2015-01-01

    Men who have sex with men (MSM) perform risk practices that pose a challenge to prevention strategies. The aim of this study was to analyse the association between receptive and insertive unprotected anal intercourse (RUAI and IUAI) according to the type of partner and the practice of barebacking with socioeconomic factors. A descriptive study was conducted through a self-administered questionnaire distributed by a software tool in social networks and non-governmental organizations from June-2014 to January-2015. Participants consisted of 601 people living in Spain. Pearson's χ(2) test and logistic regression models were applied with odds ratios (OR) and 95% confidence intervals (95% CI). In stable couples, the risk of RUAI increased in individuals with a medium income (OR: 1.79; 95%CI: 1.14-2.80) and in those who lived together (OR: 2.94; 95%CI: 1.74-4.98) and IUAI increased in individuals living with a partner (OR: 5.58; 95%IC: 3.24-9.59). When the partner was a friend, the risk of RUAI was higher among individuals with secondary education (OR: 2.20; 95%CI: 1.44-3.36) and those who were retired (OR: 3.6; 95%CI: 1.25-10.37), while living with a partner was a protective factor (OR: 0.56; 95%CI: 0.32-0.98). The risk of barebacking was greater in younger men (OR: 2.59; 95%CI: 1.27-5.28), in those with secondary education (OR: 1.51; 95%CI: 0.99-2.29) and in those living with a partner (OR: 3.64; 95%CI: 2.12-6.24). There is a need to reduce vulnerability due to socioeconomic factors that influence engagement in risk practices and to highlight the importance of barebacking, mainly in young MSM. Partner-based interventions and harm reduction strategies should be incorporated into preventive strategies. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

  11. Risk factors and trends in attempting or committing suicide in Dutch general practice in 1983–2009 and tools for early recognition.

    NARCIS (Netherlands)

    Donker, G.A.; Wolters, I.; Schellevis, F.

    2010-01-01

    Background: Many patients visit their general practitioner (GP) before attempting or committing suicide. This study analyses determinants and trends of suicidal behaviour to enhance early recognition of risk factors in general practice. Method: Analysis of trends, patient and treatment

  12. Trends in the knowledge, attitudes and practices of travel risk groups towards prevention of malaria: results from the Dutch Schiphol Airport Survey 2002 to 2009

    NARCIS (Netherlands)

    van Genderen, Perry J. J.; van Thiel, Pieter P. A. M.; Mulder, Paul G. H.; Overbosch, David; Hoebe, Christian; Felix, Sietse

    2012-01-01

    Background: Previous studies investigating the travellers' knowledge, attitudes and practices (KAP) profile indicated an important educational need among those travelling to risk destinations. Initiatives to improve such education should target all groups of travellers, including business

  13. Trends in Knowledge, Attitudes, and Practices of Travel Risk Groups Toward Prevention of Hepatitis A: Results From the Dutch Schiphol Airport Survey 2002 to 2009

    NARCIS (Netherlands)

    van Genderen, Perry J. J.; van Thiel, Pieter P. A. M.; Mulder, Paul G. H.; Overbosch, David

    2012-01-01

    Background. Previous studies investigating the travelers' knowledge, attitudes, and practices (KAP) profile indicated an important educational need among those traveling to risk destinations. Initiatives to improve such education should target all groups of travelers, including business travelers,

  14. Trends in the knowledge, attitudes and practices of travel risk groups towards prevention of malaria: Results from the Dutch Schiphol airport survey 2002 to 2009

    NARCIS (Netherlands)

    P.J.J. van Genderen (Perry); P.P.A.M. van Thiel (Pieter P. A.); P.G.H. Mulder (Paul); D. Overbosch (David)

    2012-01-01

    textabstractBackground: Previous studies investigating the travellers knowledge, attitudes and practices (KAP) profile indicated an important educational need among those travelling to risk destinations. Initiatives to improve such education should target all groups of travellers, including business

  15. Benefits and risks of adopting the global code of practice for recreational fisheries

    Science.gov (United States)

    Arlinghaus, Robert; Beard, T. Douglas; Cooke, Steven J.; Cowx, Ian G.

    2012-01-01

    Recreational fishing constitutes the dominant or sole use of many fish stocks, particularly in freshwater ecosystems in Western industrialized countries. However, despite their social and economic importance, recreational fisheries are generally guided by local or regional norms and standards, with few comprehensive policy and development frameworks existing across jurisdictions. We argue that adoption of a recently developed Global Code of Practice (CoP) for Recreational Fisheries can provide benefits for moving recreational fisheries toward sustainability on a global scale. The CoP is a voluntary document, specifically framed toward recreational fisheries practices and issues, thereby complementing and extending the United Nation's Code of Conduct for Responsible Fisheries by the Food and Agricultural Organization. The CoP for Recreational Fisheries describes the minimum standards of environmentally friendly, ethically appropriate, and—depending on local situations—socially acceptable recreational fishing and its management. Although many, if not all, of the provisions presented in the CoP are already addressed through national fisheries legislation and state-based fisheries management regulations in North America, adopting a common framework for best practices in recreational fisheries across multiple jurisdictions would further promote their long-term viability in the face of interjurisdictional angler movements and some expanding threats to the activity related to shifting sociopolitical norms.

  16. Zoonotic disease risk perceptions and infection control practices of Australian veterinarians: call for change in work culture.

    Science.gov (United States)

    Dowd, Karen; Taylor, Melanie; Toribio, Jenny-Ann L M L; Hooker, Claire; Dhand, Navneet K

    2013-08-01

    This study was conducted to determine the perceptions of zoonotic disease risk among Australian veterinarians, the infection control practices they use to protect themselves from zoonotic diseases, and the factors influencing their use of these protective practices. A questionnaire was designed and piloted prior to its administration to veterinarians at the annual Australian Veterinary Association Conference in May 2011. The questionnaire comprised 21 closed, semi-closed and open questions. Data from the questionnaire were analyzed using ordinal logistic regression analyses to determine significant factors for veterinarians' use of personal protective equipment (PPE). A total of 344 veterinarians completed the questionnaire of which 63.7% were women, 63.2% worked in small/companion animal practice, and 79.9% worked in private veterinary practice. Of the respondents, 44.9% reported contracting a zoonosis during their careers with 19.7% reporting a suspected case and 25.2% reporting a confirmed incidence. Around 40-60% of veterinarians perceived exposure to zoonosis likely or very likely in a variety of situations. With reference to current national industry guidelines, the reported use of PPE was less than "adequate" for most scenarios except for performing postmortems, surgery or dental procedures. No PPE was used by 60-70% of veterinarians for treating respiratory and neurological cases and by 40-50% when treating gastrointestinal and dermatological cases. Workplace conditions need improvement as 34.8% of workplaces did not have isolation units for infected animals, 21.1% did not have separate eating areas for staff, and 57.1% did not have complete PPE kits for use. Veterinarians were more likely to use PPE if they had undertaken postgraduate education, perceived that zoonosis exposure from animals and procedures was likely, consciously considered PPE use for every case they dealt with and believed that liability issues and risks encouraged use of PPE. In contrast

  17. The efficiency of training for doctors of general practice — family medicine concerning to features work of teenagers at risk

    Directory of Open Access Journals (Sweden)

    Bobkova O.V.

    2016-05-01

    Full Text Available Medical personnel provide assistance to teenagers and young people because of understanding their problems and a common search for ways to resolve them to change risky behavior and health. A major problem for doctors of general practice — family medicine is the condition of adolescent morbidity diseases that are transmitted mainly through sexual contact, HIV infection, which requires the formation of the teenagers responsible attitude to their own health. Doctor of general practice — family medicine should actively influence on health status, including reproductive health specified target group of patients. The aim of the study was analysis of the effectiveness of educational training on( monitoring and evaluation M & E within the scientific support project «HIV prevention among young women of sex business, people who inject drugs and young people who live or work on the street» and development of an effective system of improving professional qualification of doctors of general practice — family medicine relative characteristics of health care among risk adolescents. During 2015 there were trainings for doctors, psychologists, social workers and nurses. Investigation of the effectiveness of the activities performed on a specially designed questionnaire monitoring and evaluation (M & E. 53 respondents were interviewed — doctors of general practice — family medicine of the Zaporozhye region and the city. Zaporozhye. Questioning was conducted before and after training exercises investigated by experts of department of medical care teenagers and youth KU «Zaporozhye Regional Children Clinical Hospital.» The rating was given on a 5-point scale. The study made the following findings: therapeutic and preventive work with teenagers and young people, is one of the major problems of medical and social work in Ukraine and practice of general practitioner — family medicine; training on the basis of a single M & E system is an effective means

  18. [The precautionary principle applied to blood transfusion. What is its impact on practices and risk management?].

    Science.gov (United States)

    Hergon, E; Moutel, G; Duchange, N; Bellier, L; Hervé, C; Rouger, P

    2004-07-01

    The precautionary principle has boomed in the French public health sector through blood transfusion. There has been, however, no perambulatory reflection on the definition, objectives, methods of application or consequences of this principle. The question of the pertinence of its application remains unanswered. This study, based on interviews with blood transfusion practitioners, aims to establish their perceptions of the precautionary principle's application in this specific field and of its consequences in terms of risk management and patients' rights. The pros and cons of this application are analysed based on these perceptions. According to our analysis, the precautionary principle seems to be born of confusion. It is seen more as a way to protect decision makers than patients and, if taken to extremes, could prejudice medical logic. Nevertheless, it also brings measures which renew and encourage evolution in transfusion risk management.

  19. Does risk-adjusted payment influence primary care providers’ decision on where to set up practices?

    DEFF Research Database (Denmark)

    Anell, Anders; Dackehag, Margareta; Dietrichson, Jens

    2018-01-01

    Background: Providing equal access to healthcare is an important objective in most health care systems. It is especially pertinent in systems like the Swedish primary care market, where private providers are free to establish themselves in any part of the country. To improve equity in access...... to care, 15 out 21 county councils in Sweden have implemented risk-adjusted capitation based on the Care Need Index, which increases capitation to primary care centers with a large share of patients with unfavorable socioeconomic and demographic characteristics. Our aim is to estimate the effects of using...... Index values. Results: Risk-adjusted capitation significantly increases the number of private primary care centers in areas with relatively high Care Need Index values. The adjustment results in a changed distribution of private centers within county councils; the total number of private centers does...

  20. Project management best practices: forging win-win partnerships and mitigating power project risk

    International Nuclear Information System (INIS)

    Trowsdale, R.

    2006-01-01

    This paper discusses aspects of project management to mitigate power project risk. end-to-end project development involves development phase, permitting phase, implementation phase, and operational phase. Each phase involves a number of different elements. In renewable energy project good management requires maintaining project discipline and schedule throughout all phases. Project success requires commercial competitiveness, fuel availability, power sales contracts, stake holder support, permitting, effective execution, construction and good technical performance

  1. HIV Risk Assessment Practices of Primary Care Physicians: A National Study

    Science.gov (United States)

    2008-01-01

    Lesbian Medical Association and LGBT health experts. Healthy People 2010 Companion Document for Lesbian, Gay, Bisexual, and Transgender ( LGBT ) Health. 2001...stigmatization or discrimination might hinder their candor. For this reason, one might advise – as the CDC recommends – that all patients between 13...from the perspective of HIV risk). This is unclear; however, since patient concerns about stigmatization or discrimination might hinder their candor

  2. Does Risk-Adjusted Payment Influence Primary Care Providers' Decision on Where to Set Up Practices?

    DEFF Research Database (Denmark)

    Dietrichson, Jens; Anell, Anders; Dackehag, Margareta

    Providing equal access to health care is an important objective in most health care systems. It is especially pertinent in systems like the Swedish primary care market, where providers are free to establish themselves in any part of the country. To improve equity in access to care, 15 out 21 county...... of private primary care centers in areas with unfavorable socioeconomic and demographic characteristics. More generally, this result indicates that risk-adjusted capitation can significantly affect private providers’ establishment decisions....

  3. Young Risk Takers: Alcohol, Illicit Drugs, and Sexual Practices among a Sample of Music Festival Attendees

    Science.gov (United States)

    Jenkinson, Rebecca; Bowring, Anna; Dietze, Paul; Hellard, Margaret; Lim, Megan S. C.

    2014-01-01

    Background. Alcohol and other drug use and sexual risk behaviour are increasing among young Australians, with associated preventable health outcomes such as sexually transmissible infections (STIs) on the rise. Methods. A cross-sectional study of young people's health behaviours conducted at a music festival in Melbourne, Australia, in 2011. Results. 1365 young people aged 16–29 completed the survey; 62% were female with a mean age of 20 years. The majority (94%, n = 1287) reported drinking alcohol during the previous 12 months; among those, 32% reported “binge” drinking (6+ drinks) at least weekly. Half (52%) reported ever using illicit drugs and 25% reported past month use. One-quarter (27%) were identified as being at risk of STIs through unprotected sex with new or casual partners during the previous 12 months. Multivariable analyses found that risky sexual behaviour was associated with younger age (≤19 years), younger age of sexual debut (≤15 years), having discussed sexual health/contraception with a doctor, regular binge drinking, and recent illicit drug use. Conclusion. Substance use correlated strongly with risky sexual behaviour. Further research should explore young people's knowledge of alcohol/drug-related impairment and associated risk-taking behaviours, and campaigns should encourage appropriate STI testing among music festival attendees. PMID:26316974

  4. Practical aspects of the use of FMEA tool in clinical laboratory risk management

    Directory of Open Access Journals (Sweden)

    Maria Elizabete Mendes

    2013-06-01

    Full Text Available INTRODUCTION: This paper presents the failure modes and effects analysis (FMEA tool in a clinical laboratory through the introduction of new technology for blood gas and serum ionized calcium in multi-parameter analyzers such as Point of Care Testing (POCT. OBJECTIVE: To present FMEA as a tool for risk managing and improvement with the introduction of new technologies in a public laboratory. METHODS: The change of multiparameter gas analyzer type POCT was defined and described as a process. Subsequently, the criteria were presented to the risk assessment and its quantification. We studied the failure modes that might occur in this process. We established three action plans involving improvements to be made in the technological change. FMEA was applied in two stages: at the beginning of the project and after the implementation of the proposed measures. RESULTS: The first plan involved administrative measures related to the bidding process; the second preventive action involved the possibility of which supplier would win the bid by studying the efficiency of the analyzer and its impact on productivity; the third set of actions was directed to improvements in the relationship with the clinical staff in order to minimize occasional complaints. The last actions referred to employing new employees to meet the growing demand. CONCLUSION: FMEA proved to be a reliable tool for performance improvement, which proactively identifies, prioritizes and mitigates patient risks.

  5. [Practices and perception of risk in human immunodeficiency virus infected males who have sex with other males].

    Science.gov (United States)

    Fernández de Mosteyrín, Sol; del Val Acebrón, María; Fernández de Mosteyrín, Teresa; Fernández Guerrero, Manuel L

    2014-04-01

    The incidence of human immunodeficiency virus (HIV) and other sexually transmitted diseases increases in males who have sex with males (MSM), despite the knowledge on how to prevent them. To determine the mechanisms that are driving this lack of prevention is important to reverse the trend. An anonymous, voluntary and self-reporting questionnaire was completed by HIV+ MSM patients who were seen in a hospital clinic, with the aim of finding out the sexual risk practices and behaviour, as well as their perceptions and assessment as regards this risk. The questionnaire included 58questions, divided into 10sections, to explore the knowledge, attitudes, and behaviour as regards HIV. The questionnaires were also given to the physicians, with the aim of exploring their perceptions, attitudes and opinions as regards the situation of the epidemic, prevention, perception of the diseases and the patient, and values in clinical practice. A total of 495 questionnaires from the patients were analysed. Most of them (87%) said they knew how HIV was acquired, and 97% knew how to prevent it, but 69% knew they were in a risk situation, and 43% had little concern of contracting HIV. Almost two-thirds (65%) had sex with ≥2persons on the same day, 47% met on the Internet and 26% had group sex. The same percentage of those surveyed considered that they acted impulsively. They highlighted a lack of information (33%), bad luck (32%), assumed excessive risk (36%), and lake of concern (25%), as the main reasons for acquiring the infection. When confronted with diagnosis 41% of patients answered «I never thought that it would happen to me», and 32% said «I had bad luck». Of the 121 physicians who completed the questionnaire, 24% considered that infection due to HIV/AIDS was out of control in Spain, and 65% responded that there was an image that HIV/AIDS was a controlled disease and of little concern. A large majority (71%) of those surveyed, considered that the increase in new

  6. Strategies for enhancing the implementation of school-based policies or practices targeting risk factors for chronic disease.

    Science.gov (United States)

    Wolfenden, Luke; Nathan, Nicole K; Sutherland, Rachel; Yoong, Sze Lin; Hodder, Rebecca K; Wyse, Rebecca J; Delaney, Tessa; Grady, Alice; Fielding, Alison; Tzelepis, Flora; Clinton-McHarg, Tara; Parmenter, Benjamin; Butler, Peter; Wiggers, John; Bauman, Adrian; Milat, Andrew; Booth, Debbie; Williams, Christopher M

    2017-11-29

    consulted with experts in the field to identify other relevant research. 'Implementation' was defined as the use of strategies to adopt and integrate evidence-based health interventions and to change practice patterns within specific settings. We included any trial (randomised or non-randomised) conducted at any scale, with a parallel control group that compared a strategy to implement policies or practices to address diet, physical activity, overweight or obesity, tobacco or alcohol use by school staff to 'no intervention', 'usual' practice or a different implementation strategy. Citation screening, data extraction and assessment of risk of bias was performed by review authors in pairs. Disagreements between review authors were resolved via consensus, or if required, by a third author. Considerable trial heterogeneity precluded meta-analysis. We narratively synthesised trial findings by describing the effect size of the primary outcome measure for policy or practice implementation (or the median of such measures where a single primary outcome was not stated). We included 27 trials, 18 of which were conducted in the USA. Nineteen studies employed randomised controlled trial (RCT) designs. Fifteen trials tested strategies to implement healthy eating policies, practice or programs; six trials tested strategies targeting physical activity policies or practices; and three trials targeted tobacco policies or practices. Three trials targeted a combination of risk factors. None of the included trials sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials examined multi-strategic implementation strategies and no two trials examined the same combinations of implementation strategies. The most common implementation strategies included educational materials, educational outreach and educational meetings. For all outcomes, the overall quality of evidence was very low and the risk of bias was high for the majority of

  7. Effectiveness of risk minimization measures for cabergoline-induced cardiac valve fibrosis in clinical practice in Italy.

    Science.gov (United States)

    Italiano, Domenico; Bianchini, Elisa; Ilardi, Maura; Cilia, Roberto; Pezzoli, Gianni; Zanettini, Renzo; Vacca, Laura; Stocchi, Fabrizio; Bramanti, Placido; Ciurleo, Rosella; Di Lorenzo, Giuseppe; Polimeni, Giovanni; de Luise, Cynthia; Ross, Douglas; Rijnbeek, Peter; Sturkenboom, Miriam; Trifirò, Gianluca

    2015-06-01

    On June 2008, the European Medicines Agency (EMA) introduced changes to the Summary of Product Characteristics (SPC) for cabergoline and pergolide, to reduce the risk of cardiac valvulopathy in users of these drugs. To assess the effectiveness of EMA recommendations in Italian clinical practice, we retrospectively reviewed medical charts of patients with degenerative Parkinsonism treated with cabergoline in three large Italian clinics between January 2006 and June 2012. The prevalence and the severity of cardiac valve regurgitation were assessed in patients who stopped cabergoline therapy prior to June 2008 or continued therapy after that date. In addition, the proportion of patients undergoing echocardiographic examination in each cohort was evaluated. A total of 61 patients were available for evaluation. The proportion of patients who underwent a baseline echocardiographic examination increased from 64 % in the period before the 2008 SPC changes to 71 % among those who continued treatment after that date. However, only 18 and 29 % of patients underwent at least two echocardiographic examinations during the pre-SPC and cross-SPC change period, respectively. No severe cardiac valve regurgitation was documented in any of the study patients using cabergoline either prior or after 26th June 2008. Our findings show that the 2008 changes to the SPC resulted in an increase in physicians' awareness of cabergoline-induced valvulopathy risk in Italy. However, only a small percentage of patients underwent serial echocardiography. Further efforts are needed to achieve better compliance with the prescribing guidelines for cabergoline treated patients in clinical practice.

  8. Brief report: Young children's risk of unintentional injury: a comparison of mothers' and fathers' supervision beliefs and reported practices.

    Science.gov (United States)

    Morrongiello, Barbara A; Walpole, Beverly; McArthur, Brae Anne

    2009-01-01

    There is increasing interest in understanding how parent supervision influences young children's risk of injury, but nearly all of this research has been conducted with mothers. The present study compared first-time mothers' and fathers' supervisory beliefs and reported practices, and related these scores to parental reports of their child's history of injuries. Mothers and fathers of children 2-5 years each independently completed a telephone interview and previously validated questionnaires about their supervisory beliefs and practices and their child's history of injuries. Mothers and fathers provided similar reports of their child's injuries (minor, medically attended) and scored similarly on various supervision indices. Despite these similarities, the way mothers' and fathers' supervision indices related to children's injury history scores differed. Children's frequency of minor and medically attended injuries was predicted from maternal supervisory scores but not from paternal scores. Maternal supervision has more impact on children's risk of injury than paternal supervision, possibly because mothers spend more time with children than fathers.

  9. Associations of contextual risk and protective factors with fathers’ parenting practices in the post-deployment environment

    Science.gov (United States)

    Davis, Laurel; Hanson, Sheila K.; Zamir, Osnat; Gewirtz, Abigail H.; DeGarmo, David S.

    2015-01-01

    Deployment separation and reunifications are salient contexts that directly impact effective family functioning and parenting for military fathers. Yet, we know very little about determinants of post-deployed father involvement and effective parenting. The present study examined hypothesized risk and protective factors of observed parenting for 282 post-deployed fathers who served in the Army National Guard/Reserves. Pre-intervention data were employed from fathers participating in the After Deployment, Adaptive Parenting Tools (ADAPT) randomized control trial. Parenting practices were obtained from direct observation of father-child interaction and included measures of problem solving, harsh discipline, positive involvement, encouragement, and monitoring. Risk factors included combat exposure, negative life events, months deployed, and PTSD symptoms. Protective factors included education, income, dyadic adjustment, and social support. Results of a structural equation model predicting an effective parenting construct indicated that months deployed, income, and father age were most related to observed parenting, explaining 16% of the variance. We are aware of no other study utilizing direct parent-child observations of father’s parenting skills following overseas deployment. Implications for practice and preventive intervention are discussed. PMID:26213794

  10. Body piercing and tattoos: a survey on young adults' knowledge of the risks and practices in body art

    Directory of Open Access Journals (Sweden)

    Caggiano Giuseppina

    2011-10-01

    Full Text Available Abstract Background The practice of tattooing and piercing has expanded in western society. In order to verify young adults' knowledge of the risk and practices related to body art, an investigation was conducted among freshmen of the University of Bari in the region of Apulia, Italy. Methods The study was carried out in the Academic Year 2009-2010 through an anonymous self-administered written questionnaire distributed to 1.656 freshmen enrolled in 17 Degree Courses. Results Of the 1.598 students included in the analysis, 78.3% believe it is risky to undergo piercing/tattoo practices. AIDS was indicated as a possible infection by 60.3% of freshmen, hepatitis C by 38.2%, tetanus by 34.3% and hepatitis B by 33.7% of the sample. 28.1% of freshmen were not aware that there are also non-infectious complications. 29% of the sample had at least one piercing or tattoo (this percentage does not include earlobe piercing in women. Of those with body art, the decision to undergo body art was made autonomously in 57.9% of the participants. 56.3% of freshmen undergoing body art had taken less than a month to decide. With regard to the reasons that led the sample to undergo body art, 28.4% were unable to explain it, 23.8% answered to improve their aesthetic aspect, 18.4% to distinguish themselves from others, 12.3% for fashion; 17.1% for other reasons. 25.4% of the sample declared that they had a piercing (79.8% female vs 20.2% male; ratio M/F 1:4.0. The average age for a first piercing was 15.3 years (range 10-27; SD ± 2.9. 9.6% of the sample declared that they have a tattoo (69.9% female vs 30.1% male; ratio M/F 1:2.3. The average age for a first tattoo was 17.5 years (range 10-26, SD ± 2.4. Conclusions Most of the freshmen knew about AIDS-related risks but not other potential risks. Body art is fairly common among young adults (especially women. The decision is often not shared with the family and is undertaken mostly without a specific reason or for the

  11. How safe is GP obstetrics? An assessment of antenatal risk factors and perinatal outcomes in one rural practice.

    Science.gov (United States)

    Kirke, Andrew B

    2010-01-01

    Approximately one-fifth of Western Australian women deliver their babies in rural and remote regions of the state. The medical workforce caring for these women is predominantly non-specialist GP obstetricians. This article explores how safe is rural GP obstetrics. It reviews one rural obstetric practice in detail. In particular it asks these questions: What are the antenatal risk factors? What are the obstetric outcomes for the mother? What are the obstetric outcomes for the baby? This study is an audit of the author's obstetric practice over a two-year period from July 2007 to June 2009. The audit criteria included all obstetric patients managed by the author through to delivery and immediate post-partum care. Hospital and practice notes for 195 singleton pregnancies were reviewed. Antenatal risk factors, intrapartum events and immediate post-partum events for all patients cared for by the author through to delivery were recorded and compared with averages for Western Australia from published 2007 figures. The maternal population had mean age of 28.5 years, 2.1% were Aboriginal. Body mass index (BMI) at booking was a mean of 27.1 (range 18-40). Those with a BMI > 40 were referred elsewhere. Significant antenatal risks included smoking (14.9%), previous caesarean section (14.4%), hypertension (13.3%), pre-eclampsia (5.1%) and gestational diabetes (8.2%). Intrapartum there were high rates of induction (33.5%), epidural/spinal (34.7%) and shoulder dystocia (3.6%). Type of delivery was predominantly spontaneous vaginal (65.6%), vacuum (14.9%), forceps (2.6%), elective caesarean (9.7%) and non-elective caesarean (8.7%). Post-partum events included post-partum haemorrhage (10.3%), transfusion (1.5%), retained placenta (2.1%), neonatal jaundice (21.1%), neonatal seizures (1.5%) neonatal sepsis (1.5%) and neonatal special care or intensive care (SCU/NICU) admission (9.8%). The audit population was a group of relatively low risk pregnant women. Despite referral of more

  12. Social characteristics, HIV/AIDS knowledge, preventive practices and risk factors elicitation among prisoners in Lagos, Nigeria.

    Science.gov (United States)

    Odujinrin, M T; Adebajo, S B

    2001-01-01

    Although many behavioral research studies and public enlightenment campaigns have been undertaken by both government and non-governmental organizations in the general public, no such study has been documented on prison inmates in Nigeria. This study aimed at documenting the social characteristics, HIV/AIDS knowledge and preventive practices of selected prisoners in Nigeria. It also elicited risk factors HIV/AIDS transmission in Nigeria prisons. A cross-sectional study of prison inmates using an anonymous risk-factors identification questionnaire was undertaken in January 1997. The Kiri-kiri (maximum, medium and female) prisons were selected by balloting. Thereafter, two hundred and fifty two inmates were selected by systematic random sampling method using the full listing of all inmates as at the time of the survey. The study comprised of an interview session using a well structured questionnaire to seek information about their social data, their knowledge about HIV/AIDS including its transmission and preventive social data, and their indulgence in HIV/AIDS risky behaviour. The majority (53.6%) of the respondents were in the age group 20-29 years, 18 (7.1%) were less than 20 years old one of whom was in the maximum-security prison and three were females (table 1). The majority (52%) had secondary education while 9.9% had tertiary education and 7.1% had no formal education. About 97.2% of the study population had heard about AIDS although only 20.6% had known or seen someone with AIDS before and about 34.1% knew the causative agent of AIDS. 60.3% knew the correct mode of transmission of AIDS. 15.5% claimed fidelity and 12.7 % claimed use of condom for casual sexual contact, were measures that could help prevent AIDS but 7.9% did not know any preventive measure. Since hearing about AIDS, 59.5% claimed to have taken steps to protect themselves. 42.7% of the 89 who had not taken any protective steps against AIDS had no knowledge of how to protect themselves. About 56

  13. Risk management in clinical practice. Part 5. Ethical considerations for dental enhancement procedures.

    Science.gov (United States)

    Ahmad, I

    2010-09-11

    After the demise of the Industrial Age, we currently live in an 'Information Age' fuelled mainly by the Internet, with an ever-increasing medically and dentally literate population. The media has played its role by reporting scientific advances, as well as securitising medical and dental practices. Reality television such as 'Extreme makeovers' has also raised public awareness of body enhancements, with a greater number of people seeking such procedures. To satiate this growing demand, the dental industry has flourished by introducing novel cosmetic products such as bleaching kits, tooth coloured filling materials and a variety of dental ceramics. In addition, one only has to browse through a dental journal to notice innumerable courses and lectures on techniques for providing cosmetic dentistry. The incessant public interest, combined with unrelenting marketing by companies is gradually shifting the balance of dental care from a healing to an enhancement profession. The purpose of this article is to endeavour to answer questions such as, What is aesthetic or cosmetic dentistry? Why do patients seek cosmetic dentistry? Are enhancement procedures a part of dental practice? What, if any, ethical guidelines and constraints apply to elective enhancement procedures? What is the role of the dentist in providing or encouraging this type of 'therapy'? What treatment modalities are available for aesthetic dental treatment?

  14. Does regular practice of physical activity reduce the risk of dysphonia?

    Science.gov (United States)

    Assunção, Ada Avila; de Medeiros, Adriane Mesquita; Barreto, Sandhi Maria; Gama, Ana Cristina Cortes

    2009-12-01

    The purpose of this study was to investigate the association between regular physical activity and the prevalence of dysphonia. A cross-sectional study was conducted with 3142 teachers from 129 municipal public schools in the city of Belo Horizonte, Brazil. The dependent variable, dysphonia, was classified (absent or present) according to reported symptoms (fatigue when speaking and loss of voice quality), their frequency (occasionally and daily), and duration (past 15 days). The independent variable was regular physical activity. The degree of association was estimated based on the prevalence ratio and a 95% confidence interval obtained by the Poisson regression adapted for cross-sectional studies. In the study sample, the prevalence of dysphonia in teachers was 15.63%. Nearly half (47.52%) of the teachers reported no regular practice of physical exercises. The remaining teachers (52.48%) walked and did physical exercises, sports, and other activities; 31.25% undertook these activities once or twice a week, and 21.23% exercised three or more times a week. Teachers who did not practice physical activity were more likely to present dysphonia compared to those that exercised three or more times a week. Regular physical activity was associated positively with the prevalence of dysphonia.

  15. Meat consumption, Cooking Practices, Meat Mutagens and Risk of Prostate Cancer

    Science.gov (United States)

    John, Esther M.; Stern, Mariana C.; Sinha, Rashmi; Koo, Jocelyn

    2012-01-01

    Consumption of red meat, particularly well done meat, has been associated with increased prostate cancer risk. High temperature cooking methods such as grilling and barbequeing may produce heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs) which are known carcinogens. We assessed the association with meat consumption and estimated HCA and PAH exposure in a population-based case-control study of prostate cancer. Newly diagnosed cases aged 40–79 years (531 advanced cases, 195 localized cases) and 527 controls were asked about dietary intake, including usual meat cooking methods and doneness levels. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multivariate logistic regression. For advanced prostate cancer, but not localized disease, increased risks were associated with higher consumption of hamburgers (OR=1.79. CI=1.10–2.92), processed meat (OR=1.57, CI=1.04, 2.36), grilled red meat (OR=1.63, CI=0.99–2.68), and well done red meat (OR=1.52, CI=0.93–2.46), and intermediate intake of 2-amino-1-methyl1-6-phenylimidazo[4,5-b]pyridine (PhIP) (quartile 2 vs. 1: OR=1.41, CI=0.98–2.01; quartile 3 vs. 1: OR=1.42, CI=0.98–2.04), but not for higher intake. White meat consumption was not associated with prostate cancer. These findings provide further evidence that consumption of processed meat and red meat cooked at high temperature is associated with increased risk of advanced, but not localized prostate cancer. PMID:21526454

  16. Low-dose aspirin and risk of intracranial bleeds: An observational study in UK general practice.

    Science.gov (United States)

    Cea Soriano, Lucía; Gaist, David; Soriano-Gabarró, Montse; Bromley, Susan; García Rodríguez, Luis A

    2017-11-28

    To quantify the risk of intracranial bleeds (ICBs) associated with new use of prophylactic low-dose aspirin using a population-based primary care database in the United Kingdom. A cohort of new users of low-dose aspirin (75-300 mg; n = 199,079) aged 40-84 years and a 1:1 matched cohort of nonusers of low-dose aspirin at baseline were followed (maximum 14 years, median 5.4 years) to identify incident cases of ICB, with validation by manual review of patient records or linkage to hospitalization data. Using 10,000 frequency-matched controls, adjusted rate ratios (RRs) with 95% confidence intervals (CIs) were calculated for current low-dose aspirin use (0-7 days before the index date [ICB date for cases, random date for controls]); reference group was never used. There were 1,611 cases of ICB (n = 743 for intracerebral hemorrhage [ICH], n = 483 for subdural hematoma [SDH], and n = 385 for subarachnoid hemorrhage [SAH]). RRs (95% CI) were 0.98 (0.84-1.13) for all ICB, 0.98 (0.80-1.20) for ICH, 1.23 (0.95-1.59) for SDH, and 0.77 (0.58-1.01) for SAH. No duration of use or dose-response association was apparent. RRs (95% CI) for ≥1 year of low-dose aspirin use were 0.90 (0.72-1.13) for ICH, 1.20 (0.91-1.57) for SDH, and 0.69 (0.50-0.94) for SAH. Low-dose aspirin is not associated with an increased risk of any type of ICB and is associated with a significantly decreased risk of SAH when used for ≥1 year. © 2017 American Academy of Neurology.

  17. The construction of ethnic differences in work incapacity risks: Analysing ordering practices of physicians in the Netherlands.

    Science.gov (United States)

    Meershoek, Agnes; Krumeich, Anja; Vos, Rein

    2011-01-01

    Drawing from Science and Technology Studies we investigate the consequences for social differentiation of physicians' practices in Dutch illness certification. Using participant observation methods, we followed six 'Arbodienst' physicians for two weeks each. Our analysis explores whether and how the work of Dutch physicians contributes to the appearance of a category of 'problematic migrant patients'. We present how physicians, in using instruments to distinguish plausible from implausible claims for sick leave, impose order upon reality. In particular situations this ordering involves a distinction between Dutch and migrant clients. Here ethnicity appears in physicians' practice as a separate instrument to constitute order, which in the case of migrants overrules the productive instruments that are used for 'Dutch' clients. By interpreting clients' behaviour in cultural terms and making them into strangers, physicians lose their ability to fine-tune their coaching activities to the needs of these clients. As a result migrants remain work incapacitated for a longer period, which leads to a higher risk of their ending up in the disability pension program. As a consequence migrants become visible as a problematic group in the data on work incapacity and disability. The practice to categorise migrant clients with separate instruments thus results in a 'hard' category of problematic migrant clients and leads to social differentiation. Copyright © 2010 Elsevier Ltd. All rights reserved.

  18. A Practical and Time-Efficient High-Intensity Interval Training Program Modifies Cardio-Metabolic Risk Factors in Adults with Risk Factors for Type II Diabetes

    Directory of Open Access Journals (Sweden)

    Bethan E. Phillips

    2017-09-01

    Full Text Available IntroductionRegular physical activity (PA can reduce the risk of developing type 2 diabetes, but adherence to time-orientated (150 min week−1 or more PA guidelines is very poor. A practical and time-efficient PA regime that was equally efficacious at controlling risk factors for cardio-metabolic disease is one solution to this problem. Herein, we evaluate a new time-efficient and genuinely practical high-intensity interval training (HIT protocol in men and women with pre-existing risk factors for type 2 diabetes.Materials and methodsOne hundred eighty-nine sedentary women (n = 101 and men (n = 88 with impaired glucose tolerance and/or a body mass index >27 kg m−2 [mean (range age: 36 (18–53 years] participated in this multi-center study. Each completed a fully supervised 6-week HIT protocol at work-loads equivalent to ~100 or ~125% V˙O2 max. Change in V˙O2 max was used to monitor protocol efficacy, while Actiheart™ monitors were used to determine PA during four, weeklong, periods. Mean arterial (blood pressure (MAP and fasting insulin resistance [homeostatic model assessment (HOMA-IR] represent key health biomarker outcomes.ResultsThe higher intensity bouts (~125% V˙O2 max used during a 5-by-1 min HIT protocol resulted in a robust increase in V˙O2 max (136 participants, +10.0%, p < 0.001; large size effect. 5-by-1 HIT reduced MAP (~3%; p < 0.001 and HOMA-IR (~16%; p < 0.01. Physiological responses were similar in men and women while a sizeable proportion of the training-induced changes in V˙O2 max, MAP, and HOMA-IR was retained 3 weeks after cessation of training. The supervised HIT sessions accounted for the entire quantifiable increase in PA, and this equated to 400 metabolic equivalent (MET min week−1. Meta-analysis indicated that 5-by-1 HIT matched the efficacy and variability of a time-consuming 30-week PA program on V˙O2 max, MAP, and HOMA-IR.ConclusionWith a total time-commitment of

  19. Enteral feeding of intrauterine growth restriction preterm infants: theoretical risks and practical implications

    Directory of Open Access Journals (Sweden)

    Valentina Bozzetti

    2017-06-01

    Full Text Available Intrauterine growth restriction (IUGR infants are thought to have impaired gut function after birth secondary to intrauterine redistribution of the blood flow, due to placental insufficiency, with a consequent reduction of gut perfusion. For this reason, infants complicated by IUGR have been considered at higher risk of feeding intolerance. Postnatal evaluation of splanchnic perfusion, through Doppler of the superior mesenteric artery, and of splanchnic oxygenation, through near infrared spectroscopy measurements, may be useful in evaluating the persistence (or not of the redistribution of blood flow occurred in utero.

  20. Glacial Lake Outburst Flood Risk in Nepal and Their Mitigation Practices in Nepal

    Science.gov (United States)

    Gurung, S.

    2017-12-01

    Glacial lakes in Nepal face a huge risk of Glacial Lake Outburst Flood (GLOF) due to the ongoing effects of climate change leading to considerable amount of snow and glacier melt thus weakening the natural barriers holding these high altitude glacial lakes. Nepal is at an ever growing risk every year and always waiting for an inevitable natural disaster. Since GLOF can cause extreme huge loss of human lives and physical properties, it has now become very important to design a proper mechanism which helps in reducing hazards from such events. There is little we can do to stop natural disasters, but we can implement pro-active control measures to minimize the loss. Early Warning System is the provision of timely and effective information, which allows individuals exposed to hazards to take action, avoid or reduce risk to life and property and prepare for effective response. The basic idea behind Early Warning System is that, the earlier and more accurately we are able to predict potential risks associated with natural hazards especially flood, the more likely we will be able to manage and mitigate the disasters' impact on society, economies and environment. We are currently focused on the development of early warning system for Imja Glacial Lake. The objective of developing early warning system for Imja GLOF is to help reduce economic losses and mitigate the number of injuries or deaths by providing information that allows individuals and communities downstream of Imja Lake to protect their lives and properties by using the latest and most advanced technology available. We have installed one Automatic Weather Station near the left lateral moraine of Imja Lake to study the effects of different meteorological parameters so as to predict occurrence of any GLOF event. The sensor includes pluviometer, pyranometer, temperature and humidity sensor, wind sensor, Snowdepth sensor. Two radar level sensors are installed at the outlet of Imja Lake and downstream of Imja river

  1. Malaria in Hadhramout, a southeast province of Yemen: prevalence, risk factors, knowledge, attitude and practices (KAPs).

    Science.gov (United States)

    Bamaga, Omar A A; Mahdy, Mohammed A K; Mahmud, Rohela; Lim, Yvonne A L

    2014-07-29

    Yemen is a Mediterranean country where 65% of its population is at risk of malaria, with 43% at high risk. Yemen is still in the control phase without sustainable reduction in the proportion of malaria cases. A cross-sectional household survey was carried out in different districts in the southeast of the country to determine malaria prevalence and identify factors that impede progress of the elimination phase. Blood specimens were collected from 735 individuals aged 1-66 years. Plasmodium species were detected and identified by microscopic examination of Giemsa-stained thick and thin blood smears. A household-based questionnaire was used to collect demographic, socioeconomic and environmental data. The overall prevalence of malaria was 18.8% with Plasmodium falciparum as the predominant species (99.3%), with a low rate of Plasmodium vivax detected (0.7%). The infection rate was higher in Al-Raydah and Qusyer districts (21.8%) compared to Hajer district (11.8%). Fifty-two percent of the persons positive for Plasmodium were asymptomatic with low parasite density. The adults had a higher infection rate as compared to children. Univariate analysis identified those whose household's head are fishermen (OR = 11.3, 95% CI: 3.13-40.5) and farmers (OR = 4.84, 95% CI: 1.73-13.6) as high-risk groups. A higher number of positive smears were observed in people living in houses with uncemented brick walls (OR = 2.1, 95% CI: 1.32-3.30), without access to toilets (OR = 1.6, 95% CI: 1.05-2.32), without a fridge (OR = 1. 6, 95% CI: 1.05-2.30), or without TV (OR = 1. 6, (95% CI: 1.05-2.30). People living in houses with water collection points located less than 200 meters away were also at higher risk of acquiring malaria (OR = 1.6, 95% CI: 1.05-2.30). Knowledge about the importance of using insecticide-treated mosquito nets (ITNs) and indoor residual spraying (IRS) for prevention of malaria was 7% and 2%, respectively. Several environmental, socioeconomic

  2. A comparison of cardiovascular risk factors for ten antipsychotic drugs in clinical practice

    Directory of Open Access Journals (Sweden)

    Bodén R

    2013-03-01

    Full Text Available Robert Bodén,1,2 Gunnar Edman,3,4 Johan Reutfors,2 Claes-Göran Östenson,3 Urban Ösby3,4 1Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden; 2Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden; 3Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; 4Department of Psychiatry, Tiohundra AB, Norrtälje, Sweden Abstract: It is well known that abdominal obesity, dyslipidemia, and insulin resistance are highly prevalent in patients receiving maintenance treatment with antipsychotics, but there is limited knowledge about the association between cardiovascular risk factors and treatment with antipsychotic drugs. In this naturalistic study we investigated a sample of 809 antipsychotic-treated patients from Swedish psychosis outpatient teams. Cardiovascular risk factors (eg, metabolic syndrome, homeostasis model assessment of insulin resistance, and low-density lipoprotein values were measured, and their associations to current antipsychotic pharmacotherapy were studied. Ten antipsychotic drugs were compared in a stepwise logistic regression model. For the patients, the presence of the components of metabolic syndrome ranged from 35% for hyperglycemia to 64% for elevated waist circumference. Hypertriglyceridemia was associated with clozapine (odds ratio [OR] = 1.81, 95% confidence interval [CI] 1.08–3.04, reduced high-density lipoprotein with both clozapine and olanzapine (OR = 1.73, 95% CI 1.01–2.97; and OR = 2.03, 95% CI 1.32–3.13, hypertension with perphenazine (OR = 2.00, 95% CI 1.21–3.59, and hyperglycemia inversely with ziprasidone (OR = 0.21, 95% CI 0.05–0.89 and positively with haloperidol (OR = 2.02, 95% CI 1.18–3.48. There were no significant relationships between any of the antipsychotic drugs and increased waist circumference, homeostasis model assessment of insulin resistance, or low-density lipoprotein levels. In

  3. Risk mitigation of shared electronic records system in campus institutions: medical social work practice in singapore.

    Science.gov (United States)

    Ow Yong, Lai Meng; Tan, Amanda Wei Li; Loo, Cecilia Lay Keng; Lim, Esther Li Ping

    2014-10-01

    In 2013, the Singapore General Hospital (SGH) Campus initiated a shared electronic system where patient records and documentations were standardized and shared across institutions within the Campus. The project was initiated to enhance quality of health care, improve accessibility, and ensure integrated (as opposed to fragmented) care for best outcomes in our patients. In mitigating the risks of ICT, it was found that familiarity with guiding ethical principles, and ensuring adherence to regulatory and technical competencies in medical social work were important. The need to negotiate and maneuver in a large environment within the Campus to ensure proactive integrative process helped.

  4. The genetic basis of Lynch syndrome and its implications for clinical practice and risk management

    Science.gov (United States)

    Cohen, Stephanie A; Leininger, Anna

    2014-01-01

    Lynch syndrome is the most common cause of hereditary colon cancer, and accounts for as much as 3% of all colon and endometrial cancers. The identification and management of individuals with Lynch syndrome have evolved over the past 20 years, yet the syndrome remains vastly underdiagnosed. It is important for clinicians to recognize individuals and families who are at risk in order to be able to manage them appropriately and reduce their morbidity and mortality from this condition. This review will touch on the history of Lynch syndrome, the current knowledge of genotype–phenotype correlations, the cancers associated with Lynch syndrome, and management of individuals who are gene carriers. PMID:25161364

  5. Developing a good practice for the review of evidence relevant to GMO risk assessment

    DEFF Research Database (Denmark)

    Kohl, Christian; Craig, Wendy; Frampton, Geoff

    2013-01-01

    such research results in a transparent, reproducible and unbiased manner. The EU-funded project GRACE (GMO Risk Assessment and Communication of Evidence) aims to explore, adapt, apply, and promote these tools to enhance accountability in decision-making by providing policy makers with comprehensive, science......-based information on potential impacts (scenarios) of genetically modified plants and their derived products. Furthermore, GRACE will establish an open-access database in order to support the review process, to mirror the evidence synthesis, to assist the dissemination of results and conclusions, as well as to act......, in more general terms, as an information resource on biosafety of genetically modified plants....

  6. STUDENTS JUDGMENTS OF THE RISKS OF HIV-INFECTION AS A FUNCTION OF SEXUAL PRACTICE, SEX OF TARGET AND PARTNER, AND AGE AND SEX OF STUDENT

    NARCIS (Netherlands)

    SPEARS, R; ABRAHAM, C; SHEERAN, P; ABRAMS, D

    1995-01-01

    Two age cohorts of male and female students (n = 311) were investigated concerning their perceptions of the HIV-related risks of various sex-related practices (unprotected vaginal, oral, and anal sex, and mutual masturbation and kissing). Participants judged the risk of these activities for either a

  7. Effects of a general practice-based intervention on diet, body mass index and blood lipids in patients at cardiovascular risk

    NARCIS (Netherlands)

    Woollard, J.; Burke, V.; Beilin, L.J.; Verheijden, M.W.; Bulsara, M.K.

    2003-01-01

    Background General practice-based health-promotion programmes implemented by nurse-counsellors may reduce cardiovascular risk factors, particularly in patients at increased risk. Neither change in fat intake nor serum cholesterol differed significantly between groups. Body mass index increased in

  8. The prevention access and risk taking in young people (PARTY) project protocol: a cluster randomised controlled trial of health risk screening and motivational interviewing for young people presenting to general practice.

    Science.gov (United States)

    Sanci, Lena; Grabsch, Brenda; Chondros, Patty; Shiell, Alan; Pirkis, Jane; Sawyer, Susan; Hegarty, Kelsey; Patterson, Elizabeth; Cahill, Helen; Ozer, Elizabeth; Seymour, Janelle; Patton, George

    2012-06-06

    There are growing worldwide concerns about the ability of primary health care systems to manage the major burden of illness in young people. Over two thirds of premature adult deaths result from risks that manifest in adolescence, including injury, neuropsychiatric problems and consequences of risky behaviours. One policy response is to better reorientate primary health services towards prevention and early intervention. Currently, however, there is insufficient evidence to support this recommendation for young people. This paper describes the design and implementation of a trial testing an intervention to promote psychosocial risk screening of all young people attending general practice and to respond to identified risks using motivational interviewing. clinicians' detection of risk-taking and emotional distress, young people's intention to change and reduction of risk taking. pathways to care, trust in the clinician and likelihood of returning for future visits. The design of the economic and process evaluation are not detailed in this protocol. PARTY is a cluster randomised trial recruiting 42 general practices in Victoria, Australia. Baseline measures include: youth friendly practice characteristics; practice staff's self-perceived competency in young people's care and clinicians' detection and response to risk taking behaviours and emotional distress in 14-24 year olds, attending the practice. Practices are then stratified by a social disadvantage index and billing methods and randomised. Intervention practices receive: nine hours of training and tools; feedback of their baseline data and two practice visits over six weeks. Comparison practices receive a three hour seminar in youth friendly practice only. Six weeks post-intervention, 30 consecutive young people are interviewed post-consultation from each practice and followed-up for self-reported risk taking behaviour and emotional distress three and 12 months post consultation. The PARTY trial is the

  9. The prevention access and risk taking in young people (PARTY project protocol: A cluster randomised controlled trial of health risk screening and motivational interviewing for young people presenting to general practice

    Directory of Open Access Journals (Sweden)

    Sanci Lena

    2012-06-01

    Full Text Available Abstract Background There are growing worldwide concerns about the ability of primary health care systems to manage the major burden of illness in young people. Over two thirds of premature adult deaths result from risks that manifest in adolescence, including injury, neuropsychiatric problems and consequences of risky behaviours. One policy response is to better reorientate primary health services towards prevention and early intervention. Currently, however, there is insufficient evidence to support this recommendation for young people. This paper describes the design and implementation of a trial testing an intervention to promote psychosocial risk screening of all young people attending general practice and to respond to identified risks using motivational interviewing. Main outcomes: clinicians’ detection of risk-taking and emotional distress, young people’s intention to change and reduction of risk taking. Secondary outcomes: pathways to care, trust in the clinician and likelihood of returning for future visits. The design of the economic and process evaluation are not detailed in this protocol. Methods PARTY is a cluster randomised trial recruiting 42 general practices in Victoria, Australia. Baseline measures include: youth friendly practice characteristics; practice staff’s self-perceived competency in young people’s care and clinicians’ detection and response to risk taking behaviours and emotional distress in 14–24 year olds, attending the practice. Practices are then stratified by a social disadvantage index and billing methods and randomised. Intervention practices receive: nine hours of training and tools; feedback of their baseline data and two practice visits over six weeks. Comparison practices receive a three hour seminar in youth friendly practice only. Six weeks post-intervention, 30 consecutive young people are interviewed post-consultation from each practice and followed-up for self-reported risk taking

  10. Species sensitivity distributions in a context of practical applications for risk-based decisions

    Energy Technology Data Exchange (ETDEWEB)

    Posthuma, L.; Traas, T.P.; Roelofs, W.; Winterse, A.; Zwart, D. de; Meent, D. van de [RIVM, Bilthoven (Netherlands)

    2003-07-01

    Different biological species clearly show different sensitivities to toxic compounds present in their habitat. The absence of differences in sensitivity would entail an 'all nothing' response, with all species responding similarly to pollution. Given the sensitivity variation, however, some species show adverse effects, and others flourish. In this sense, variation is 'music for ecotoxicologists'. But it also is a nuisance: ecotoxicologists need to handle the vast diversity of sensitivities in Ecological Risk Assessment (ERA). This contribution addresses a pragmatic, versatile, statistics-based concept to address species sensitivity differences, and shows options for application. In the 1980s, ecotoxicologists have coined the term 'Species Sensitivity Distributions' (SSDs) for the statistical descriptions that can be applied to address sensitivity variation. An SSD is a Probability Density Function (usually bell-shaped) or Cumulative Distribution Function (sigmoid), that relates the environmental concentration (x) to 'risk' (y). Since their original description and use, the concept was further developed, criticised, and tailored to various policy or assessment problems. (orig.)

  11. Managing carbon regulatory risk in utility resource planning: Current practices in the Western United States

    International Nuclear Information System (INIS)

    Barbose, Galen; Wiser, Ryan; Phadke, Amol; Goldman, Charles

    2008-01-01

    Concerns about global climate change have substantially increased the likelihood that future policy will seek to minimize carbon dioxide emissions. As such, even today, electric utilities are making resource planning and investment decisions that consider the possible implications of these future carbon regulations. In this article, we examine the manner in which utilities assess the financial risks associated with future carbon regulations within their long-term resource plans. We base our analysis on a review of the most recent resource plans filed by 15 electric utilities in the Western United States. Virtually all of these utilities made some effort to quantitatively evaluate the potential cost of future carbon regulations when analyzing alternate supply- and demand-side resource options for meeting customer load. Even without federal climate regulation in the US, the prospect of that regulation is already having an impact on utility decision-making and resource choices. That said, the methods and assumptions used by utilities to analyze carbon regulatory risk, and the impact of that analysis on their choice of a particular resource strategy, vary considerably, revealing a number of opportunities for analytic improvement. Though our review focuses on a subset of US electric utilities, this work holds implications for all electric utilities and energy policymakers who are seeking to minimize the compliance costs associated with future carbon regulations

  12. Does market integration buffer risk, erode traditional sharing practices and increase inequality? A test among Bolivian forager-farmers.

    Science.gov (United States)

    Gurven, Michael; Jaeggi, Adrian V; von Rueden, Chris; Hooper, Paul L; Kaplan, Hillard

    2015-08-01

    Sharing and exchange are common practices for minimizing food insecurity in rural populations. The advent of markets and monetization in egalitarian indigenous populations presents an alternative means of managing risk, with the potential impact of eroding traditional networks. We test whether market involvement buffers several types of risk and reduces traditional sharing behavior among Tsimane Amerindians of the Bolivian Amazon. Results vary based on type of market integration and scale of analysis (household vs. village), consistent with the notion that local culture and ecology shape risk management strategies. Greater wealth and income were unassociated with the reliance on others for food, or on reciprocity, but wealth was associated with a greater proportion of food given to others (i.e., giving intensity) and a greater number of sharing partners (i.e., sharing breadth). Across villages, greater mean income was negatively associated with reciprocity, but economic inequality was positively associated with giving intensity and sharing breadth. Incipient market integration does not necessarily replace traditional buffering strategies but instead can often enhance social capital.

  13. Hypothesis of a nuclear accident to the nuclear power plant of Gravelines with important radioactive release out of the site: risks prevention, intervention strategies. Evaluation of the sensitization to the nuclear risk of the physician practicing near the site

    International Nuclear Information System (INIS)

    Mraovic, Th.

    1998-01-01

    This thesis has for hypothesis a nuclear accident at the nuclear power plant of Gravelines with radioactive release out of the site: the risks prevention and the strategies of intervention are studied. An evaluation of the sensitization to a nuclear risk is made for the general practitioner that practices near the site. (N.C.)

  14. Risk management in clinical practice. Part 2. Getting to 'yes'--the matter of consent.

    Science.gov (United States)

    D'Cruz, L

    2010-07-24

    Consent is an integral part of delivering the care patients want. In order to consent to treatment, patients must have the legal capacity to give valid consent. If this three stage test is satisfied, the patient can elect to have any treatment they wish even if it is not in their best interest. Before a patient is able to consent to treatment they must have adequate knowledge about the risks, benefits and alternatives to the treatment. The amount of information provided to the patient by the dentist is determined to some degree by the legal system prevailing. The patient must voluntarily agree to treatment without being coerced by the dentist or other parties and if things change during treatment the patient needs to be advised. Written consent is very useful in the defence of cases but simply signing the consent form does not mean that the patient knows or understands the treatment to which they have agreed.

  15. Threats and risks to information security: a practical analysis of free access wireless networks

    Science.gov (United States)

    Quirumbay, Daniel I.; Coronel, Iván. A.; Bayas, Marcia M.; Rovira, Ronald H.; Gromaszek, Konrad; Tleshova, Akmaral; Kozbekova, Ainur

    2017-08-01

    Nowadays, there is an ever-growing need to investigate, consult and communicate through the internet. This need leads to the intensification of free access to the web in strategic and functional points for the benefit of the community. However, this open access is also related to the increase of information insecurity. The existing works on computer security primarily focus on the development of techniques to reduce cyber-attacks. However, these approaches do not address the sector of inexperienced users who have difficulty understanding browser settings. Two methods can solve this problem: first the development of friendly browsers with intuitive setups for new users and on the other hand, by implementing awareness programs on essential security without deepening on technical information. This article addresses an analysis of the vulnerabilities of wireless equipment that provides internet service in the open access zones and the potential risks that could be found when using these means.

  16. Associations between breast cancer risk factors and religious practices in Utah.

    Science.gov (United States)

    Daniels, Melissa; Merrill, Ray M; Lyon, Joseph L; Stanford, Joseph B; White, George L

    2004-01-01

    Utah has the lowest female malignant breast cancer incidence rates in the United States, due in part to low rates among women who are members of the Church of Jesus Christ of Latter-day Saints (LDS or Mormon). Several established reproductive and non-reproductive breast cancer risk factors may be lower among LDS women because of their religious doctrine related to marriage, family, and health. This paper investigates the association between selected breast cancer risk factors and religious preference and religiosity in Utah. A 37-item anonymous cross-sectional telephone survey was developed and conducted during March and April 2002. Results are based on 848 non-Hispanic white female respondents. Number of births (parity), prevalence of breastfeeding, and lifetime total duration of breastfeeding were highest among LDS women who attended church weekly. Average months of breastfeeding per child were greatest among weekly church attendees, regardless of religious preference. Oral contraceptive use and total duration of hormone replacement therapy use were greatest for individuals of any religion attending church less than weekly and for individuals with no religious preference. Comparisons of divergent reproductive behaviors between LDS and non-LDS, and between weekly and less than weekly church goers, provide strong support for the relatively low breast cancer incidence rates previously identified among LDS and, therefore, in Utah. High parity and breastfeeding coincide with comparatively low breast cancer incidence rates among LDS and are consistent with recent findings of the Collaborative Group on Hormonal Factors in Breast Cancer, showing the primary role parity and breastfeeding play in reducing breast cancer.

  17. Targeting modifiable risk factors in age-related macular degeneration in optometric practice in Sweden

    Directory of Open Access Journals (Sweden)

    Martin L

    2017-04-01

    Full Text Available Lene Martin1,2 1School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden; 2School of Health Sciences, City, University of London, London, UK Purpose: The purpose of this study was to investigate the extent to which ophthalmologists and optometrists in Sweden recommend the use of nutritional supplements, changes in diet, or smoking cessation to patients who are at risk of or with signs of age-related macular degeneration (AMD. In addition, this study also examined how these practitioners rate the strength of evidence for nutritional supplements in AMD management and which sources of information they consult to determine supplement recommendations for the prevention or treatment of AMD. Methods: This study implemented a cross-sectional design using data from a questionnaire. All Swedish optometrists and ophthalmologists who were registered in the membership databases of their respective professional organizations were invited to participate. The questionnaire contained 18 forced choice questions and one free text question and was organized into the following four sections: use of nutritional supplements, dietary advice, smoking and eye diseases, and strength of evidence and the sources of information regarding nutritional supplement interventions. Results: The response rate was 40.3% for optometrists and 5% for ophthalmologists. Optometrists were more likely than ophthalmologists to recommend nutritional supplements in AMD and provided significantly more advice about diet than did the ophthalmologists for both patients at risk for AMD and those with established disease. The ophthalmologists were more likely than the optometrists to rely on the findings from the age-related eye disease studies of AMD regarding treatment with and selection of supplements and to recommend smoking cessation. Conclusion: Common evidence-based strategies for AMD management among eye care professionals would presumably be beneficial for AMD

  18. Retrospective analysis of Bluetongue farm risk profile definition, based on biology, farm management practices and climatic data.

    Science.gov (United States)

    Cappai, Stefano; Loi, Federica; Coccollone, Annamaria; Contu, Marino; Capece, Paolo; Fiori, Michele; Canu, Simona; Foxi, Cipriano; Rolesu, Sandro

    2018-07-01

    Bluetongue (BT) is a vector-borne disease transmitted by species of Culicoides midges (Diptera: Ceratopogonidae). Many studies have contributed to clarifying various aspects of its aetiology, epidemiology and vector dynamic; however, BT remains a disease of epidemiological and economic importance that affects ruminants worldwide. Since 2000, the Sardinia region has been the most affected area of the Mediterranean basin. The region is characterised by wide pastoral areas for sheep and represents the most likely candidate region for the study of Bluetongue virus (BTV) distribution and prevalence in Italy. Furthermore, specific information on the farm level and epidemiological studies needs to be provided to increase the knowledge on the disease's spread and to provide valid mitigation strategies in Sardinia. This study conducted a punctual investigation into the spatial patterns of BTV transmission to define a risk profile for all Sardinian farmsby using a logistic multilevel mixed model that take into account agro-meteorological aspects, as well as farm characteristics and management. Data about animal density (i.e. sheep, goats and cattle), vaccination, previous outbreaks, altitude, land use, rainfall, evapotranspiration, water surface, and farm management practices (i.e. use of repellents, treatment against insect vectors, storage of animals in shelter overnight, cleaning, presence of mud and manure) were collected for 12,277 farms for the years 2011-2015. The logistic multilevel mixed model showed the fundamental role of climatic factors in disease development and the protective role of good management, vaccination, outbreak in the previous year and altitude. Regional BTV risk maps were developed, based on the predictor values of logistic model results, and updated every 10 days. These maps were used to identify, 20 days in advance, the areas at highest risk. The risk farm profile, as defined by the model, would provide specific information about the role of each

  19. Knowledge, Attitude, and Practice Regarding the Risk of Cardiovascular Diseases in Patients Attending Outpatient Clinic in Kuantan, Malaysia.

    Science.gov (United States)

    Mohammad, Nursyafiza B; Rahman, Nor Azlina A; Haque, Mainul

    2018-01-01

    Cardiovascular disease (CVD) is a leading cause of death around the world including Malaysia. Ischemic heart disease (IHD) is the single largest cause of death in the developed countries and is one of the main contributors to the disease burden in developing countries. This was a cross-sectional study conducted to determine knowledge, attitude, and practice (KAP) regarding the risk of CVD in patients attending an outpatient clinic in Kuantan, Malaysia. A total of 100 patients comprising 52 male and 48 female subjects were selected through convenient sampling method. Of the total subjects, 86% were Malays. The mean scores (standard deviation) for KAP were 60.75±4.823, 54.36±8.711, and 33.43±4.046, respectively, whereas the maximum scores obtained by the subjects for KAP were 71, 65, and 43, respectively. Regarding questions related to knowledge, 88% subjects knew irregular eating pattern can cause disease and the benefits of vegetable intake. Most subjects recognized that smoking and obesity were CVD risk factors. Regarding questions related to attitude, 96% agreed that exercise can prevent CVD. More than half of the subjects followed healthy lifestyle. There were statistically significant differences observed in knowledge level between sexes ( P = 0.046) and races ( P = 0.001). Nevertheless, there was no statistically significant difference observed in KAP across different education levels of the subjects regarding the risk of CVD ( P -value = 0.332, 0.185, and 0.160, respectively). This study revealed that patients had good knowledge and attitude regarding CVD risk factors. Yet, the number of smokers is still quite high. Development of better public information system is essential for the well-being of the society.

  20. Risk of Adverse Pregnancy Outcomes among Women Practicing Poor Sanitation in Rural India: A Population-Based Prospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Bijaya K Padhi

    2015-07-01

    Full Text Available The importance of maternal sanitation behaviour during pregnancy for birth outcomes remains unclear. Poor sanitation practices can promote infection and induce stress during pregnancy and may contribute to adverse pregnancy outcomes (APOs. We aimed to assess whether poor sanitation practices were associated with increased risk of APOs such as preterm birth and low birth weight in a population-based study in rural India.A prospective cohort of pregnant women (n = 670 in their first trimester of pregnancy was enrolled and followed until birth. Socio-demographic, clinical, and anthropometric factors, along with access to toilets and sanitation practices, were recorded at enrolment (12th week of gestation. A trained community health volunteer conducted home visits to ensure retention in the study and learn about study outcomes during the course of pregnancy. Unadjusted odds ratios (ORs and adjusted odds ratios (AORs and 95% confidence intervals for APOs were estimated by logistic regression models. Of the 667 women who were retained at the end of the study, 58.2% practiced open defecation and 25.7% experienced APOs, including 130 (19.4% preterm births, 95 (14.2% births with low birth weight, 11 (1.7% spontaneous abortions, and six (0.9% stillbirths. Unadjusted ORs for APOs (OR: 2.53; 95% CI: 1.72-3.71, preterm birth (OR: 2.36; 95% CI: 1.54-3.62, and low birth weight (OR: 2.00; 95% CI: 1.24-3.23 were found to be significantly associated with open defecation practices. After adjustment for potential confounders such as maternal socio-demographic and clinical factors, open defecation was still significantly associated with increased odds of APOs (AOR: 2.38; 95% CI: 1.49-3.80 and preterm birth (AOR: 2.22; 95% CI: 1.29-3.79 but not low birth weight (AOR: 1.61; 95% CI: 0.94-2.73. The association between APOs and open defecation was independent of poverty and caste. Even though we accounted for several key confounding factors in our estimates, the

  1. Risk of Adverse Pregnancy Outcomes among Women Practicing Poor Sanitation in Rural India: A Population-Based Prospective Cohort Study.

    Science.gov (United States)

    Padhi, Bijaya K; Baker, Kelly K; Dutta, Ambarish; Cumming, Oliver; Freeman, Matthew C; Satpathy, Radhanatha; Das, Bhabani S; Panigrahi, Pinaki

    2015-07-01

    The importance of maternal sanitation behaviour during pregnancy for birth outcomes remains unclear. Poor sanitation practices can promote infection and induce stress during pregnancy and may contribute to adverse pregnancy outcomes (APOs). We aimed to assess whether poor sanitation practices were associated with increased risk of APOs such as preterm birth and low birth weight in a population-based study in rural India. A prospective cohort of pregnant women (n = 670) in their first trimester of pregnancy was enrolled and followed until birth. Socio-demographic, clinical, and anthropometric factors, along with access to toilets and sanitation practices, were recorded at enrolment (12th week of gestation). A trained community health volunteer conducted home visits to ensure retention in the study and learn about study outcomes during the course of pregnancy. Unadjusted odds ratios (ORs) and adjusted odds ratios (AORs) and 95% confidence intervals for APOs were estimated by logistic regression models. Of the 667 women who were retained at the end of the study, 58.2% practiced open defecation and 25.7% experienced APOs, including 130 (19.4%) preterm births, 95 (14.2%) births with low birth weight, 11 (1.7%) spontaneous abortions, and six (0.9%) stillbirths. Unadjusted ORs for APOs (OR: 2.53; 95% CI: 1.72-3.71), preterm birth (OR: 2.36; 95% CI: 1.54-3.62), and low birth weight (OR: 2.00; 95% CI: 1.24-3.23) were found to be significantly associated with open defecation practices. After adjustment for potential confounders such as maternal socio-demographic and clinical factors, open defecation was still significantly associated with increased odds of APOs (AOR: 2.38; 95% CI: 1.49-3.80) and preterm birth (AOR: 2.22; 95% CI: 1.29-3.79) but not low birth weight (AOR: 1.61; 95% CI: 0.94-2.73). The association between APOs and open defecation was independent of poverty and caste. Even though we accounted for several key confounding factors in our estimates, the possibility

  2. Contact lenses purchased over the internet place individuals potentially at risk for harmful eye care practices.

    Science.gov (United States)

    Fogel, Joshua; Zidile, Chaya

    2008-01-01

    Individuals are increasingly purchasing contact lenses over the Internet. No studies exist regarding Internet purchase of contact lenses and eye care health practices. One hundred fifty-one college students were surveyed regarding contact lenses purchase category (doctor's office, store, Internet). Pearson chi-square analyses compared purchase category with responses regarding U.S. Food and Drug Administration (FDA) recommendations for purchasing contact lenses online. Analysis of variance compared contact lenses purchase category with the Time Pressure Scale (TPS). Also, correlation analyses compared the TPS with Internet eye-health statements. Contact lens purchase categories included doctor's office (43.0%), store (55.0%), and Internet (22.5%), with individuals purchasing at multiple venues. With regard to the FDA recommendations, those who purchased contact lenses at a doctor's office more often adhered to the recommendations, whereas those who purchased contact lenses at a store or the Internet did so less often. Those who purchased contact lenses over the Internet had significantly higher TPS scores. In addition, higher TPS scores were significantly correlated with various statements regarding the Internet. Those who purchase contact lenses via the Internet or store do not follow a number of FDA contact lenses recommendations. Also, those with higher TPS scores trust possible non-evidence-based contact lenses Internet information. Implications with regard to the Fairness to Contact Lens Consumers Act are discussed.

  3. Deployment of Wind Turbines in the Built Environment: Risks, Lessons, and Recommended Practices

    Energy Technology Data Exchange (ETDEWEB)

    Fields, Jason [National Renewable Energy Lab. (NREL), Golden, CO (United States); Oteri, Frank [National Renewable Energy Lab. (NREL), Golden, CO (United States); Preus, Robert [National Renewable Energy Lab. (NREL), Golden, CO (United States); Baring-Gould, Ian [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2016-06-01

    Built-environment wind turbine (BEWT) projects are wind energy projects that are constructed on, in, or near buildings. These projects present an opportunity for distributed, low-carbon generation combined with highly visible statements on sustainability, but the BEWT niche of the wind industry is still developing and is relatively less mature than the utility-scale wind or traditional distributed wind sectors. The findings from this report cannot be extended to wind energy deployments in general because of the large difference in application and technology maturity. This paper investigates the current state of the BEWT industry by reviewing available literature on BEWT projects as well as interviewing project owners on their experiences deploying and operating the technology. The authors generated a series of case studies that outline the pertinent project details, project outcomes, and lessons learned. This paper integrates those information sources into recommended practices that can be utilized by future stakeholders to evaluate the feasibility of BEWTs for their unique applications and sites.

  4. Risk factors and most common traumatic injuries in people who practice long-distance running

    Directory of Open Access Journals (Sweden)

    Anna Lewandowska

    2017-08-01

    Full Text Available Undoubtedly, the fashion of running comes. Initially people used to run for fun, pleasure, to forget about worries or problems. With time, however, was no longer just about the idea itself, people more and more fascinated with jogging went one step further. At the same time, not realizing how important changes may occur in their body. These are usually overload or inflammatory changes. The aim of this paper is to present the most frequent injuries of long distance runners and the main predisposing factors for their trauma. The work will also cover the possibility of prevention of these injuries. The most important factors predisposing to injury include: the awareness of running people, the overweight and obesity, the incorrect running pattern and the inappropriate training plan. The consequences of these factors may be: runner's knee, leg overload syndrome, Achilles tendonitis, plantar fasciitis, fatigue fractures, and iliotibial-band syndrome. The injuries are, unfortunately, inscribed into the life of every runner, regardless of the level of advancement. However, it is worth remembering that they can be effectively prevented, and at the moment of their appearance, effectively heal. The injuries of runners depend primarily on their approach to practicing this form of physical activity, to a lesser extent from genetic or mechanical factors.

  5. A quantitative measure of diabetes risk in community practice impacts clinical decisions: the PREVAIL initiative.

    Science.gov (United States)

    Shah, B R; Cox, M; Inzucchi, S E; Foody, J M; Zimmer, L O; Jorge, C B; Ratner, R E; Barringer, T A; McGuire, D K; Peterson, E D

    2014-04-01

    While predictive tools are being developed to identify those at highest risk for developing diabetes, little is known whether these assays affect clinical care. Thirty sites who used the PreDx(®) (Tethys BioScience, Emeryville, CA) abstracted clinical information from baseline clinic visits prior to a PreDx test and from the most recent visit at time of abstraction. All visits occurred between May 2008-April 2011 (median follow-up 198 days, IQR 124-334). The primary analysis was the influence of the PreDx test (5-year diabetes prediction) on subsequent care; descriptive statistics were used to summarize baseline and follow-up variables. Overall 913 patients with 2 abstracted visits were included. Relative to baseline, median SBP decreased 1.5 mmHg (p = 0.039), DBP decreased 2 mmHg (p < 0.001), LDL-C decreased 4 mg/dL (p = 0.009), and HDL-C increased 2 mg/dL (p < 0.001) at follow-up. Behavioral or lifestyle counseling was not significantly different from baseline to follow-up (71.2% vs. 68.1% (p = 0.077), but BMI was lower by 0.2 kg/m(2) at follow up (p = 0.013). At follow-up, more patients were prescribed metformin (13.7% vs. 9.7%, p < 0.001). A higher PreDx score was significantly associated with metformin prescription (p = 0.0003), lifestyle counseling (p = 0.0099), and a lower BMI at follow-up (p = 0.007). The use of a prognostic test in patients perceived to be high risk for diabetes was associated with a modest but significant increase in the prescription of metformin and lifestyle interventions and a reduction in BMI. Copyright © 2013 Elsevier B.V. All rights reserved.

  6. Bone strength and management of postmenopausal fracture risk with antiresorptive therapies: considerations for women’s health practice

    Directory of Open Access Journals (Sweden)

    Cheung AM

    2016-09-01

    Full Text Available Angela M Cheung,1–3 Heather Frame,4 Michael Ho,5 Erin S Mackinnon,6 Jacques P Brown7 1Department of Medicine, University of Toronto, 2Centre of Excellence in Skeletal Health Assessment, Joint Department of Medical Imaging, University Health Network (UHN, 3Mount Sinai Hospital, University of Toronto, Toronto, ON, 4Assiniboine Clinic, Winnipeg, MB, 5University Health Network, Toronto, 6Amgen Canada, Inc, Mississauga, ON, 7Rheumatology Division, CHU de Québec Research Centre, Laval University, Quebec City, QC, Canada Abstract: Bone strength – and, hence, fracture risk – reflects the structural and material properties of the skeleton, which changes with bone turnover during aging and following effective pharmacotherapy. A variety of powerful new techniques (quantitative computed tomography, as well as peripheral quantitative computed tomography and high-resolution peripheral quantitative computed tomography provide precise images of bone structure and can be used to model the response of specific bones to different types of mechanical load. This review explores the various components of bone strength and the clinical significance of measures, such as bone mineral density, bone turnover markers, and modern imaging data, with regard to fracture risk in women with postmenopausal osteoporosis, before and after initiating antiresorptive therapy. These imaging and related techniques offer an ever-clearer picture of the changes in bone structure and bone mineral metabolism during normal aging and in osteoporosis, as well as in response to treatment. However, because the newer techniques are not yet available in routine practice, validated tools for absolute fracture risk assessment remain essential for clinical decision making. These tools, which are tailored to patient risk data in individual countries, are based on bone mineral density and other readily available clinical data. In addition, bone turnover marker measurements can be useful in

  7. Use of global coronary heart disease risk assessment in practice: a cross-sectional survey of a sample of U.S. physicians

    Directory of Open Access Journals (Sweden)

    Shillinglaw Benjamin

    2012-01-01

    Full Text Available Abstract Background Global coronary heart disease (CHD risk assessment is recommended to guide primary preventive pharmacotherapy. However, little is known about physicians' understanding and use of global CHD risk assessment. Our objective was to examine US physicians' awareness, use, and attitudes regarding global CHD risk assessment in clinical practice, and how these vary by provider specialty. Methods Using a web-based survey of US family physicians, general internists, and cardiologists, we examined awareness of tools available to calculate CHD risk, method and use of CHD risk assessment, attitudes towards CHD risk assessment, and frequency of using CHD risk assessment to guide recommendations of aspirin, lipid-lowering and blood pressure (BP lowering therapies for primary prevention. Characteristics of physicians indicating they use CHD risk assessments were compared in unadjusted and adjusted analyses. Results A total of 952 physicians completed the questionnaire, with 92% reporting awareness of tools available to calculate CHD global risk. Among those aware of such tools, over 80% agreed that CHD risk calculation is useful, improves patient care, and leads to better decisions about recommending preventive therapies. However, only 41% use CHD risk assessment in practice. The most commonly reported barrier to CHD risk assessment is that it is too time consuming. Among respondents who calculate global CHD risk, 69% indicated they use it to guide lipid lowering therapy recommendations; 54% use it to guide aspirin therapy recommendations; and 48% use it to guide BP lowering therapy. Only 40% of respondents who use global CHD risk routinely tell patients their risk. Use of a personal digital assistant or smart phone was associated with reported use of CHD risk assessment (adjusted OR 1.58; 95% CI 1.17-2.12. Conclusions Reported awareness of tools to calculate global CHD risk appears high, but the majority of physicians in this sample do not

  8. Practical application of decision support metrics for power plant risk-informed asset management

    International Nuclear Information System (INIS)

    Liming, James K.; Johnson, David H.; Kee, Ernest J.; Sun, Alice Y.; Young, Garry G.

    2003-01-01

    The objective of this paper is to provide electric utilities with a concept for developing and applying effective decision support metrics via integrated risk-informed asset management (RIAM) programs for power stations and generating companies. RIAM is a process by which analysts review historical performance and develop predictive logic models and data analyses to predict critical decision support figures-of-merit (or metrics) for generating station managers and electric utility company executives. These metrics include, but are not limited to, the following; profitability, net benefit, benefit-to-cost ratio, projected return on investment, projected revenue, projected costs, asset value, safety (catastrophic facility damage frequency and consequences, etc.), power production availability (capacity factor, etc.), efficiency (heat rate), and others. RIAM applies probabilistic safety assessment (PSA) techniques and generates predictions probabilistically so that metrics information can be supplied to managers in terms of probability distributions as well as point estimates. This enables the managers to apply the concept of 'confidence levels' in their critical decision-making processes. (author)

  9. Prevalence and risk factors for canine obesity surveyed in veterinary practices in Beijing, China.

    Science.gov (United States)

    Mao, Junfu; Xia, Zhaofei; Chen, Jiangnan; Yu, Jinhai

    2013-11-01

    An epidemiological survey of canine obesity was carried out in Beijing, China. Cases (n=2391, 7 districts) were collected at 14 animal hospitals between April 2008 and April 2011. The body condition score (scales of 1-5) was used to assess obesity of the dogs (Burkholder and Toll, 2000; Laflamme, 1997). Obesity rates were analyzed with respect to breed, age, sex, neutering, food control, feeding frequency, reproduction status, food type, nutritional supplements, living environment, feeding time, number of pets per household, feeding purpose, activity control, exercise duration, exercise status and exercise type. The overall canine obesity rate was 44.4% in this survey. The risk factors for dog obesity were food type (non-commercial food, OR=1.377, pobesity was high in pugs (70.7%), Cocker Spaniel (69.4%), Pekingese (51.9%), Pomeranian (54.6%) and Golden Retriever (51.9%). This is the first report of the epidemiology of canine obesity in China. Copyright © 2013 Elsevier B.V. All rights reserved.

  10. Rate of Corneal Collagen Crosslinking Redo in Private Practice: Risk Factors and Safety

    Directory of Open Access Journals (Sweden)

    Joelle Antoun

    2015-01-01

    Full Text Available Objective. To report the rate of progression of keratectasia after primary crosslinking (CXL and evaluate the safety and efficiency of CXL redo. Materials and Methods. We conducted a retrospective analysis of the patients who underwent CXL between 2010 and 2013 at the Beirut Eye Specialist Hospital, Lebanon. Progression of keratectasia was based on the presence of an increase in maximum keratometry of 1.00 D, a change in the map difference between two consecutive topographies of 1.00 D, a deterioration of visual acuity, or any change in the refraction. Primary and redo CXL were done using the same protocol. Results. Among the 221 eyes of 130 patients who underwent CXL, 7 eyes (3.17% of five patients met the criteria of progression. All patients reported a history of allergic conjunctivitis and eye rubbing and progressed within 9 to 48 months. No complications were noted and all patients were stable 1 year after CXL redo. Conclusion. Allergic conjunctivitis and eye rubbing were the only risk factors associated with keratoconus progression after CXL. A close followup is thus mandatory, even years after the procedure. CXL redo seems to be a safe and efficient technique to halt the progression after a primary CXL.

  11. Corrosion Assessment by Using Risk-Based Inspection Method for Petrochemical Plant - Practical Experience

    International Nuclear Information System (INIS)

    Choi, Song Chun; Song, Ki Hun

    2009-01-01

    Corrosion assessment has a number of uses but the use considered here is as a precursor to Risk-Based Inspection (RBI) planning. Systematic methods consisting of technical modules of RBI program were used to assess the effect of specific corrosion mechanism on the probability of failure in equipment of petrochemical plants. Especially in part of the damage and corrosion assessment, screening step involved evaluating the combinations of process conditions and construction materials for each equipment item in order to determine which damage mechanisms are potentially active. For general internal corrosion, either API 510 or API 570 was applied as the damage rate in the calculation to determine the remaining life and inspection frequency. In some cases, a measured rate of corrosion may not be available. The technical modules of RBI program employ default values for corrosion, typically derived from published data or from experience with similar processes, for use until inspection results are available. This paper describes the case study of corrosion and damage assessment by using RBI methodology in petrochemical plant. Specifically, this paper reports the methodology and the results of its application to the petrochemical units using the KGS-RBI TM program, developed by the Korea Gas Safety Corporation to suit Korean situation in conformity with API 581 Codes

  12. [Prescribed and dispensed in the third trimester of pregnancy drugs: What practices and risks?].

    Science.gov (United States)

    Parent, G; Mottet, N; Mairot, P; Baudier, F; Carel, D; Goguey, M; Riethmuller, D; Limat, S

    2016-09-01

    The aim of the study was to describe the prescribing of drugs to pregnant women during the third trimester of pregnancy. The retrospective analysis is interested by pregnant women from August 2009 to April 2011, living in Franche-Comté. The used data are recorded in the database of the French Health Insurance Service. Drugs prescribing were analyzed and classified according to three categories: drugs that are contraindicated, not recommended drugs and drugs that are used. This classification is based on two databases: the Summaries of Product Characteristics of Vidal 2010 and data from the National Security Agency of Medicines. The potential exposure of patients was pointed out. On 15,027 patients, 80% had a prescription. Six percent of prescriptions containing drugs not recommended and 1% drugs that contraindicated. Therapeutic classes identified are analgesics, anti-infective drugs and medicines supplementing with vitamins and minerals. Contraindicated drugs (10%) are NSAIDs, rubella vaccine, cyclins and ACE inhibitors and ARBs. Approximately 2.7% of women were potentially exposed to these drugs. Despite the recommendations of the ANSM, some drugs that are contraindicated are prescribed for pregnant women in their third trimester of pregnancy. In the absence of studies, the decision must be made on a case by case basis by assessing the risk-benefit ratio. Particular care is to bring about the drugs taken in self-medication. Information and advice are key steps to avoid incidents. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  13. Pooling raw shell eggs: Salmonella contamination and high risk practices in the United Kingdom food service sector.

    Science.gov (United States)

    Gormley, F J; Little, C L; Murphy, N; de Pinna, E; McLauchlin, J

    2010-03-01

    Salmonella contamination of pooled raw shelled egg mix (RSEM) used as an ingredient in lightly cooked or uncooked foods and high-risk kitchen hygiene practices in United Kingdom food service establishments using RSEM were investigated. Samples were collected from 934 premises. Salmonella was found in 1 (0.13%) of 764 RSEM samples, 2 (0.3%) of 726 samples from surfaces where ready-to-eat foods were prepared, and 7 (1.3%) of 550 cleaning cloths. Poor RSEM storage and handling practices were highlighted. Workers in 40% of the premises sampled failed to use designated utensils when RSEM was added to other ingredients, workers in 17% of the premises did not clean surfaces and utensils thoroughly after use with RSEM and before preparing other foods, only 42% of workers washed and dried their hands after handling eggs or RSEM, workers in 41% of the premises did not store RSEM at refrigeration temperature before use, and workers in 8% of the premises added RSEM to cooked rice at the end of cooking when preparing egg fried rice. Take-away premises, especially those serving Chinese cuisine, were least likely to have a documented food safety management system and awareness of the key food safety points concerning the use of RSEM compared with other food service premises (P < 0.0001). Food service businesses using RSEM must be aware of the continuing hazard from Salmonella, must adopt appropriate control measures, and must follow advice provided by national food agencies to reduce the risk of Salmonella infection.

  14. Malaria transmission risk variations derived from different agricultural practices in an irrigated area of northern Tanzania.

    Science.gov (United States)

    Ijumba, J N; Mosha, F W; Lindsay, S W

    2002-03-01

    Malaria vector Anopheles and other mosquitoes (Diptera: Culicidae) were monitored for 12 months during 1994-95 in villages of Lower Moshi irrigation area (37 degrees 20' E, 3 degrees 21' S; approximately 700 m a.s.l.) south of Mount Kilimanjaro in northern Tanzania. Adult mosquito populations were sampled fortnightly by five methods: human bait collection indoors (18.00-06.00 hours) and outdoors (18.00-24.00 hours); from daytime resting-sites indoors and outdoors; by CDC light-traps over sleepers. Anopheles densities and rates of survival, anthropophily and malaria infection were compared between three villages representing different agro-ecosystems: irrigated sugarcane plantation; smallholder rice irrigation scheme, and savannah with subsistence crops. Respective study villages were Mvuleni (population 2200), Chekereni (population 3200) and Kisangasangeni (population approximately/= 1000), at least 7 km apart. Anopheles arabiensis Patton was found to be the principal malaria vector throughout the study area, with An. funestus Giles sensu lato of secondary importance in the sugarcane and savannah villages. Irrigated sugarcane cultivation resulted in water pooling, but this did not produce more vectors. Anopheles arabiensis densities averaged four-fold higher in the ricefield village, although their human blood-index was significantly less (48%) than in the sugarcane (68%) or savannah (66%) villages, despite similar proportions of humans and cows (ratio 1:1.1-1.4) as the main hosts at all sites. Parous rates, duration of the gonotrophic cycle and survival rates of An. arabiensis were similar in villages of all three agro-ecosystems. The potential risk of malaria, based on measurements of vectorial capacity of An. arabiensis and An.funestus combined, was four-fold higher in the ricefield village than in the sugarcane or savannah villages nearby. However, the more realistic estimate of malaria risk, based on entomological inoculation rates, indicated that exposure to

  15. Radiographers' and radiology practitioners' opinion, experience and practice of benefit-risk communication and consent in paediatric imaging

    International Nuclear Information System (INIS)

    Portelli, J.L.; McNulty, J.P.; Bezzina, P.; Rainford, L.

    2016-01-01

    Objectives: To investigate radiographers' and radiology practitioners' opinion, experience and practice of radiation benefit-risk communication and consent for paediatric imaging examinations. Methods: A cross-sectional survey was conducted amongst radiographers and radiology practitioners working at a primary paediatric referral centre in Malta, so as to acquire information about their interactions with paediatric patients and/or their parents, particularly their opinion and practice of communicating benefit-risk information and seeking consent for imaging examinations. Results: The return of 112 questionnaires provided a response rate of 66.7%. Findings revealed varied practice relating to the provision of benefit-risk information, whereby details concerning examination benefits and potential risks are not always conveyed. For 89% of participants, parental consent was sought for paediatric imaging examinations in their current practice. Only 36.7% of participants indicated that they were highly confident in their ability to communicate benefit-risk information. The study findings also revealed that parents can truly be worried about the associated radiation exposure, with some even refusing an imaging examination as a result of such concerns. Conclusions: The practice of communicating benefit-risk information to paediatric patients and/or their parents is varied. A possible gap in benefit-risk communication education and/or training was identified, which may impact radiographers' and radiology practitioners' confidence in conveying such information. Education/training activities for radiographers and radiology practitioners are therefore necessary to foster improved benefit-risk dialogues and help provide reassurance to parents/guardians about the benefits of appropriately indicated paediatric imaging examinations. - Highlights: • The practice of communicating radiation benefit-risk information to parents of paediatric patients is varied.

  16. Intellectual Capital at Risk: Data Management Practices and Data Loss by Faculty Members at Five American Universities

    Directory of Open Access Journals (Sweden)

    Jaime Schumacher

    2015-06-01

    Full Text Available A study of 56 professors at five American universities found that a majority had little understanding of principles, well-known in the field of data curation, informing the ongoing administration of digital materials and chose to manage and store work-related data by relying on the use of their own storage devices and cloud accounts. It also found that a majority of them had experienced the loss of at least one work-related digital object that they considered to be important in the course of their professional career. Despite such a rate of loss, a majority of respondents expressed at least a moderate level of confidence that they would be able to make use of their digital objects in 25 years. The data suggest that many faculty members are unaware that their data is at risk. They also indicate a strong correlation between faculty members’ digital object loss and their data management practices. University professors producing digital objects can help themselves by becoming aware that these materials are subject to loss. They can also benefit from awareness and use of better personal data management practices, as well as participation in university-level programmatic digital curation efforts and the availability of more readily accessible, robust infrastructure for the storage of digital materials.

  17. Diabetes in the Cape Coast metropolis of Ghana: an assessment of risk factors, nutritional practices and lifestyle changes.

    Science.gov (United States)

    Gato, Worlanyo E; Acquah, Samuel; Apenteng, Bettye A; Opoku, Samuel T; Boakye, Blessed K

    2017-09-01

    Despite the significant increase in the incidence of diabetes in Ghana, research in this area has been lagging. The purpose of the study was to assess the risk factors associated with diabetes in the Cape Coast metropolis of Ghana, and to describe nutritional practices and efforts toward lifestyle change. A convenient sample of 482 adults from the Cape Coast metropolis was surveyed using a self-reported questionnaire. The survey collected information on the demographic, socioeconomic characteristics, health status and routine nutritional practices of respondents. The aims of the study were addressed using multivariable regression analyses. A total of 8% of respondents reported that they had been diagnosed with diabetes. Older age and body weight were found to be independently associated with diabetes. Individuals living with diabetes were no more likely than those without diabetes to have taken active steps at reducing their weight. The percentage of self-reported diabetes in this population was consistent with what has been reported in previous studies in Ghana. The findings from this study highlight the need for more patient education on physical activity and weight management. © The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. Participation in Risk Management Decisions: Theoretical, Practical, and Strategic Difficulties in the Evaluation of Public Participation Initiatives

    International Nuclear Information System (INIS)

    Rowe, Gene; Frewer, Lynn

    2003-01-01

    A current trend in risk management, and policy setting more generally, is the involvement of members of the public, or other significant stakeholders, in the decision-making process. Such involvement has been argued to have the advantage of increasing the democratic legitimacy of decisions, and allowing the incorporation of lay insight into problems that have a degree of scientific uncertainty (and hence that are based to some extent on value judgments). One significant issue is the quality or validity of such processes, namely, the issue of evaluation. Evaluation is important, not only from a quality control perspective, but because it may indicate potential improvements for the conduct of further exercises, and importantly, may help to assure participants (and the public more widely) that the exercise is more than just a public relations exercise. However, evaluation of public involvement initiatives is relatively rare, and little discussed in the academic literature. It is also beset with a large number of potential problems and uncertainties. In this paper, we will discuss a variety of problems with conducting evaluations of participation initiatives. These problems range from the theoretical (how one defines effectiveness, how one measures this, how one confirms the validity, reliability and utility of one's measures), to the practical (how one conducts evaluations given limitations in time, space, resources, and possible sources of data), to the strategic/political (how one deals with sponsor/organiser resistance to evaluation). These problems will be discussed from a theoretical point of view, and with reference to practical evaluations that we have conducted with a large variety of governmental and non-governmental organisations, predominantly in the UK. The paper will conclude with a number of recommendations regarding best practice in conducting evaluations

  19. Assessment of food safety practices of food service food handlers (risk assessment data): testing a communication intervention (evaluation of tools).

    Science.gov (United States)

    Chapman, Benjamin; Eversley, Tiffany; Fillion, Katie; Maclaurin, Tanya; Powell, Douglas

    2010-06-01

    Globally, foodborne illness affects an estimated 30% of individuals annually. Meals prepared outside of the home are a risk factor for acquiring foodborne illness and have been implicated in up to 70% of traced outbreaks. The Centers for Disease Control and Prevention has called on food safety communicators to design new methods and messages aimed at increasing food safety risk-reduction practices from farm to fork. Food safety infosheets, a novel communication tool designed to appeal to food handlers and compel behavior change, were evaluated. Food safety infosheets were provided weekly to food handlers in working food service operations for 7 weeks. It was hypothesized that through the posting of food safety infosheets in highly visible locations, such as kitchen work areas and hand washing stations, that safe food handling behaviors of food service staff could be positively influenced. Using video observation, food handlers (n = 47) in eight food service operations were observed for a total of 348 h (pre- and postintervention combined). After the food safety infosheets were introduced, food handlers demonstrated a significant increase (6.7%, P < 0.05, 95% confidence interval) in mean hand washing attempts, and a significant reduction in indirect cross-contamination events (19.6%, P < 0.05, 95% confidence interval). Results of the research demonstrate that posting food safety infosheets is an effective intervention tool that positively influences the food safety behaviors of food handlers.

  20. Reducing the risk of heart disease among Indian Australians: knowledge, attitudes, and beliefs regarding food practices - a focus group study.

    Science.gov (United States)

    Fernandez, Ritin; Rolley, John X; Rajaratnam, Rohan; Everett, Bronwyn; Davidson, Patricia M

    2015-01-01

    Australia has a growing number of Asian Indian immigrants. Unfortunately, this population has an increased risk for coronary heart disease (CHD). Dietary adherence is an important strategy in reducing risk for CHD. This study aimed to gain greater understanding of the knowledge, attitudes and beliefs relating to food practices in Asian Indian Australians. Two focus groups with six participants in each were recruited using a convenience sampling technique. Verbatim transcriptions were made and thematic content analysis undertaken. Four main themes that emerged from the data included: migration as a pervasive factor for diet and health; importance of food in maintaining the social fabric; knowledge and understanding of health and diet; and elements of effective interventions. Diet is a complex constructed factor in how people express themselves individually, in families and communities. There are many interconnected factors influencing diet choice that goes beyond culture and religion to include migration and acculturation. Food and associated behaviors are an important aspect of the social fabric. Entrenched and inherent knowledge, attitudes, beliefs and traditions frame individuals' point of reference around food and recommendations for an optimal diet.

  1. Transport Risk Index of Physiologic Stability, version II (TRIPS-II): a simple and practical neonatal illness severity score.

    Science.gov (United States)

    Lee, Shoo K; Aziz, Khalid; Dunn, Michael; Clarke, Maxine; Kovacs, Lajos; Ojah, Cecil; Ye, Xiang Y

    2013-05-01

    Derive and validate a practical assessment of infant illness severity at admission to neonatal intensive care units (NICUs). Prospective study involving 17,075 infants admitted to 15 NICUs in 2006 to 2008. Logistic regression was used to derive a prediction model for mortality comprising four empirically weighted items (temperature, blood pressure, respiratory status, response to noxious stimuli). This Transport Risk Index of Physiologic Stability, version II (TRIPS-II) was then validated for prediction of 7-day and total NICU mortality. TRIPS-II discriminated 7-day (receiver operating curve [ROC] area, 0.90) and total NICU mortality (ROC area, 0.87) from survival. Furthermore, there was a direct association between changes in TRIPS-II at 12 and 24 hours and mortality. There was good calibration across the full range of TRIPS-II scores and the gestational age at birth, and addition of TRIPS-II improved performance of prediction models that use gestational age and baseline population risk variables. TRIPS-II is a validated benchmarking tool for assessing infant illness severity at admission and for up to 24 hours after. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  2. Perception and Practicing of the Health Risk Factors Related to Tobacco in Workers Working in a Tobacco Factory

    Directory of Open Access Journals (Sweden)

    Nefize Gokmen

    2007-12-01

    Full Text Available This study was planned to investigate tobacco smoking status, perception and practicing of the health risk factors related to tobacco in workers working in a tobacco factory. The study was performed with 270 workers in a cigarette factory in Istanbul. A questionnaire was developed by the investigater using current literature. Spirometry device was used to obtain data in this study. The analysis of the data was performed by using, percent distrubition, chi-square and ANOVA tests.The study group consisted of 177 males, 93 females. It was determined that 57.4% of the workers were smoking every day and 81.9% of the smokers were thinking to quit smoking. It was found that 85.2% of the workers did not have health problems related to working in the factory, 59.3% of the workers perceived risk of getting working related diseases in the factory, 71.1% of the workers were disturbed by phsyical conditions of working place and 83.8% of the workers interpreted their health as good. It was found that 75.2% of the workers did not use masks, 63% took a bath regularly, 90% did not take medical reports during last year and 61.5 % applied to doctor immediately after their health problems. [TAF Prev Med Bull. 2007; 6(6: 465-474

  3. Perception and Practicing of the Health Risk Factors Related to Tobacco in Workers Working in a Tobacco Factory

    Directory of Open Access Journals (Sweden)

    Nefize Gokmen

    2007-12-01

    Full Text Available This study was planned to investigate tobacco smoking status, perception and practicing of the health risk factors related to tobacco in workers working in a tobacco factory. The study was performed with 270 workers in a cigarette factory in Istanbul. A questionnaire was developed by the investigater using current literature. Spirometry device was used to obtain data in this study. The analysis of the data was performed by using, percent distrubition, chi-square and ANOVA tests.The study group consisted of 177 males, 93 females. It was determined that 57.4% of the workers were smoking every day and 81.9% of the smokers were thinking to quit smoking. It was found that 85.2% of the workers did not have health problems related to working in the factory, 59.3% of the workers perceived risk of getting working related diseases in the factory, 71.1% of the workers were disturbed by phsyical conditions of working place and 83.8% of the workers interpreted their health as good. It was found that 75.2% of the workers did not use masks, 63% took a bath regularly, 90% did not take medical reports during last year and 61.5 % applied to doctor immediately after their health problems. [TAF Prev Med Bull 2007; 6(6.000: 465-474

  4. Exposure to dust-bound PAHs and associated carcinogenic risk in primitive and traditional cooking practices in Pakistan.

    Science.gov (United States)

    Kamal, Atif; Malik, Riffat Naseem; Martellini, Tania; Cincinelli, Alessandra

    2015-08-01

    The aim of this study was to determine the abundance and distribution of polycyclic aromatic hydrocarbons (PAHs) in dust samples collected from the selected professional cooking workplaces (WCs) and residential household cooking areas (WRs), where traditional and primitive cooking practices are still prevelent. Another aim of this study was to investigate the carcinogenic risk for Pakistani human exposure to dust-bound PAHs via the routes of inhalation, ingestion, and dermal contact. Generally, the concentration of individual congeners of PAHs in surface dust samples of WC sites was higher than those measured in WR sites (p < 0.05). The benzo(a)pyrene (B(a)P), a very high carcinogenic compound, was present in the dust samples from WC sites in the highest mean concentration (630 ng g(-1) dry weight (d.w.)). The BaP mean concentration in WC workplaces was almost eight times higher than the mean value found in WR exposure sites. Moreover, the average concentration of ∑PAHs, combustion origin PAHs (∑COMB) and sum total of 7-carcinogenic PAHs (∑7-carcinogens) were also significantly higher in WC dusts samples than that in WR workplaces. Principal component analysis (PCA) and diagnostic ratios suggested coal/wood combustion as major PAH emission sources in both exposure sites. The average incremental lifetime cancer risk (ILCR) suggested a moderate to potential high cancer risk for adults and children exposed to dust-bound PAHs in both exposure sites, in particular via both dermal and ingestion contact pathways.

  5. Quantitative risk assessment of WSSV transmission through partial harvesting and transport practices for shrimp aquaculture in Mexico.

    Science.gov (United States)

    Sanchez-Zazueta, Edgar; Martínez-Cordero, Francisco Javier; Chávez-Sánchez, María Cristina; Montoya-Rodríguez, Leobardo

    2017-10-01

    spilled in the culture pond (VCWSCP, 4 or 20L). In the sensitivity analysis, for a SD of 30 PL/m 2 , it was shown that starting with a VL of 1×10 5 mL -1 and a VCWSCP of 12L, the P N was moderate (1.05×10 -3 ). This was the threshold for greater risks, given the increase in either the VCWSCP or VL. These findings supported recommendations to prevent WSSV spread through more controlled transportation and partial harvesting practices. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Safe sleep practices in a New Zealand community and development of a Sudden Unexpected Death in Infancy (SUDI) risk assessment instrument.

    Science.gov (United States)

    Galland, Barbara C; Gray, Andrew; Sayers, Rachel M; Heath, Anne-Louise M; Lawrence, Julie; Taylor, Rachael; Taylor, Barry J

    2014-10-13

    Interventions to prevent sudden unexpected death in infancy (SUDI) have generally been population wide interventions instituted after case-control studies identified specific childcare practices associated with sudden death. While successful overall, in New Zealand (NZ), the rates are still relatively high by international comparison. This study aims to describe childcare practices related to SUDI prevention messages in a New Zealand community, and to develop and explore the utility of a risk assessment instrument based on international guidelines and evidence. Prospective longitudinal study of 209 infants recruited antenatally. Participant characteristics and infant care data were collected by questionnaire at: baseline (third trimester), and monthly from infant age 3 weeks through 23 weeks. Published meta-analyses data were used to estimate individual risk ratios for 6 important SUDI risk factors which, when combined, yielded a "SUDI risk score". Most infants were at low risk for SUDI with 72% at the lowest or slightly elevated risk (combined risk ratio ≤1.5). There was a high prevalence of the safe practices: supine sleeping (86-89% over 3-19 weeks), mother not smoking (90-92% over 3-19 weeks), and not bed sharing at a young age (87% at 3 weeks). Five independent predictors of a high SUDI risk score were: higher parity (P =0.028), younger age (P =0.030), not working or caring for other children antenatally (P =0.031), higher depression scores antenatally (P =0.036), and lower education (P =0.042). Groups within the community identified as priorities for education about safe sleep practices beyond standard care are mothers who are young, have high parity, low educational levels, and have symptoms of depression antenatally. These findings emphasize the importance of addressing maternal depression as a modifiable risk factor in pregnancy.

  7. Regional variations in home canning practices and the risk of foodborne botulism in the Republic of Georgia, 2003.

    Science.gov (United States)

    Tarkhashvili, N; Chokheli, M; Chubinidze, M; Abazashvili, N; Chakvetadze, N; Imnadze, P; Kretsinger, K; Varma, J; Sobel, J

    2015-04-01

    Foodborne botulism is a severe, paralytic illness caused by ingestion of preformed neurotoxins produced by Clostridium botulinum. In 2003, we conducted a population-based household survey of home canning practices to explore marked regional variations in botulism incidence in the Republic of Georgia (ROG). We designed a cluster sampling scheme and subdivided each of the 10 regions of the ROG into a variable number of strata. Households were selected from each stratum using a two-step cluster sampling methodology. We administered a questionnaire about home canning practices to household members responsible for food preparation. Using multivariate logistic regression analysis, we modeled high (eastern ROG) against low (western ROG) incidence areas. Overall, we surveyed 2,742 households nationwide. Home canning with a capping device hermetically sealing the lid covering the jar was practiced by 1,909 households (65.9%; 95% confidence interval [CI]: 59.8 to 72.1%). Canning was more prevalent in regions of low botulism incidence (34 versus 32%; P canning vegetables and consuming them (adjusted odds ratio [aOR] = 2.1; 95% CI: 1.3 to 3.5) and adding any of the following ingredients to the jar at time of preparation: >1 tablespoon of salt per liter (aOR = 5.1; 95% CI: 1.2 to 22.6); vinegar (aOR = 2.2; 95% CI: 1.3 to 3.7), and greens (aOR = 5.6; 95% CI: 1.7 to 18.2). The following practices were associated with a decreased risk in high-botulism areas: >57 jars canned per household annually (aOR = 0.5; 95% CI: 0.3 to 0.9), covering or immersing vegetables in boiling water before placing them into the jar (aOR = 0.3 95% CI: 0.2 to 0.6), covering or immersing vegetables in boiling water after placing them into the jar (aOR = 0.4; 95% CI: 0.2 to 0.9), or adding garlic (aOR = 0.2; 95% CI: 0.1 to 0.5) or aspirin (aOR = 0.1; 95% CI: 0.1 to 0.2) to the jar at the time of preparation.

  8. Risk management

    OpenAIRE

    Mcmanus, John

    2009-01-01

    Few projects are completed on time, on budget, and to their original requirement or specifications. Focusing on what project managers need to know about risk in the pursuit of delivering projects, Risk Management covers key components of the risk management process and the software development process, as well as best practices for risk identification, risk planning, and risk analysis. The book examines risk planning, risk analysis responses to risk, the tracking and modelling of risks, intel...

  9. Risk

    Science.gov (United States)

    Cole, Stephen R.; Hudgens, Michael G.; Brookhart, M. Alan; Westreich, Daniel

    2015-01-01

    The epidemiologist primarily studies transitions between states of health and disease. The purpose of the present article is to define a foundational parameter for such studies, namely risk. We begin simply and build to the setting in which there is more than 1 event type (i.e., competing risks or competing events), as well as more than 1 treatment or exposure level of interest. In the presence of competing events, the risks are a set of counterfactual cumulative incidence functions for each treatment. These risks can be depicted visually and summarized numerically. We use an example from the study of human immunodeficiency virus to illustrate concepts. PMID:25660080

  10. Cultural practices and sexual risk behaviour among adolescent orphans and non-orphans: a qualitative study on perceptions from a community in western Kenya

    OpenAIRE

    Juma, Milka; Askew, Ian; Alaii, Jane; Bartholomew, L Kay; van den Borne, Bart

    2014-01-01

    Background This study explored community perceptions of cultural beliefs and practices that may increase sexual risk behaviour of adolescents, to understand more about meaning they hold within the culture and how they expose adolescent orphans and non-orphans to higher risks in a high HIV and teenage pregnancy prevalence context. Methods Using a qualitative descriptive cross-sectional design 14 focus group discussions were conducted with 78 adolescents and 68 parents/guardians purposively sel...

  11. Terraced landscape: from an old best practice to a rising land abandoned-related soil erosion risk

    Science.gov (United States)

    Tarolli, Paolo; Preti, Federico; Romano, Nunzio

    2013-04-01

    Among the most evident landscape signatures of human fingerprint during the Holocene, the terraces related to agricultural activities deserve a great importance. Landscape terracing probably represents one of the oldest best practice primarily for crop production, but also for mitigating soil erosion and stabilizing hillslopes in landforms dominated by steep slopes. This technique is widely used in various parts of the world even under different environmental conditions. In some zones, terraced landscapes, because of their history and locations, can also be considered a historical heritage and a sort of "cultural landscape" to preserve, an absolutely value for tourism. To preserve their original role of soil erosion prevention, terraces should be properly designed built according to specific and sustainable engineering rules. Then, their maintenance is the most critical issue to deal with. It is well known from literature that terraced landscapes subject to abandonment would result in an increasing of terrace failure and related land degradation. If not maintained, a progressively increasing of gully erosion affects the structure of the walls. The results of this process is the increasing of connectivity and runoff. During the last few years and partly because of changing in the society perspective and migration toward metropolitan areas, some Countries have been affected by a serious and wider land abandonment with an increasing of soil erosion and derived landslide risk. Italy is one example. In this work, we consider three typical case studies of a terraced landscape where the lack of maintenance characterizing the last few years, increased the landslide risk with several problems to the population. The first case study is located along the renowed "Amalfi Coast" (a portion of land located near Salerno, southern Italy), the second is placed in the north of Toscana (a region located in Central Italy), and the third one along the so-called "Cinque Terre" (a region

  12. Performance-based risk-sharing arrangements-good practices for design, implementation, and evaluation: report of the ISPOR good practices for performance-based risk-sharing arrangements task force.

    Science.gov (United States)

    Garrison, Louis P; Towse, Adrian; Briggs, Andrew; de Pouvourville, Gerard; Grueger, Jens; Mohr, Penny E; Severens, J L Hans; Siviero, Paolo; Sleeper, Miguel

    2013-01-01

    There is a significant and growing interest among both payers and producers of medical products for agreements that involve a "pay-for-performance" or "risk-sharing" element. These payment schemes-called "performance-based risk-sharing arrangements" (PBRSAs)-involve a plan by which the performance of the product is tracked in a defined patient population over a specified period of time and the amount or level of reimbursement is based on the health and cost outcomes achieved. There has always been considerable uncertainty at product launch about the ultimate real-world clinical and economic performance of new products, but this appears to have increased in recent years. PBRSAs represent one mechanism for reducing this uncertainty through greater investment in evidence collection while a technology is used within a health care system. The objective of this Task Force report was to set out the standards that should be applied to "good practices"-both research and operational-in the use of a PBRSA, encompassing questions around the desirability, design, implementation, and evaluation of such an arrangement. This report provides practical recommendations for the development and application of state-of-the-art methods to be used when considering, using, or reviewing PBRSAs. Key findings and recommendations include the following. Additional evidence collection is costly, and there are numerous barriers to establishing viable and cost-effective PBRSAs: negotiation, monitoring, and evaluation costs can be substantial. For good research practice in PBRSAs, it is critical to match the appropriate study and research design to the uncertainties being addressed. Good governance processes are also essential. The information generated as part of PBRSAs has public good aspects, bringing ethical and professional obligations, which need to be considered from a policy perspective. The societal desirability of a particular PBRSA is fundamentally an issue as to whether the cost of

  13. Protocol for the 'e-Nudge trial': a randomised controlled trial of electronic feedback to reduce the cardiovascular risk of individuals in general practice [ISRCTN64828380

    Science.gov (United States)

    Holt, Tim A; Thorogood, Margaret; Griffiths, Frances; Munday, Stephen

    2006-01-01

    Background Cardiovascular disease (including coronary heart disease and stroke) is a major cause of death and disability in the United Kingdom, and is to a large extent preventable, by lifestyle modification and drug therapy. The recent standardisation of electronic codes for cardiovascular risk variables through the United Kingdom's new General Practice contract provides an opportunity for the application of risk algorithms to identify high risk individuals. This randomised controlled trial will test the benefits of an automated system of alert messages and practice searches to identify those at highest risk of cardiovascular disease in primary care databases. Design Patients over 50 years old in practice databases will be randomised to the intervention group that will receive the alert messages and searches, and a control group who will continue to receive usual care. In addition to those at high estimated risk, potentially high risk patients will be identified who have insufficient data to allow a risk estimate to be made. Further groups identified will be those with possible undiagnosed diabetes, based either on elevated past recorded blood glucose measurements, or an absence of recent blood glucose measurement in those with established cardiovascular disease. Outcome measures The intervention will be applied for two years, and outcome data will be collected for a further year. The primary outcome measure will be the annual rate of cardiovascular events in the intervention and control arms of the study. Secondary measures include the proportion of patients at high estimated cardiovascular risk, the proportion of patients with missing data for a risk estimate, and the proportion with undefined diabetes status at the end of the trial. PMID:16646967

  14. Protocol for the 'e-Nudge trial': a randomised controlled trial of electronic feedback to reduce the cardiovascular risk of individuals in general practice [ISRCTN64828380

    Directory of Open Access Journals (Sweden)

    Griffiths Frances

    2006-04-01

    Full Text Available Abstract Background Cardiovascular disease (including coronary heart disease and stroke is a major cause of death and disability in the United Kingdom, and is to a large extent preventable, by lifestyle modification and drug therapy. The recent standardisation of electronic codes for cardiovascular risk variables through the United Kingdom's new General Practice contract provides an opportunity for the application of risk algorithms to identify high risk individuals. This randomised controlled trial will test the benefits of an automated system of alert messages and practice searches to identify those at highest risk of cardiovascular disease in primary care databases. Design Patients over 50 years old in practice databases will be randomised to the intervention group that will receive the alert messages and searches, and a control group who will continue to receive usual care. In addition to those at high estimated risk, potentially high risk patients will be identified who have insufficient data to allow a risk estimate to be made. Further groups identified will be those with possible undiagnosed diabetes, based either on elevated past recorded blood glucose measurements, or an absence of recent blood glucose measurement in those with established cardiovascular disease. Outcome measures The intervention will be applied for two years, and outcome data will be collected for a further year. The primary outcome measure will be the annual rate of cardiovascular events in the intervention and control arms of the study. Secondary measures include the proportion of patients at high estimated cardiovascular risk, the proportion of patients with missing data for a risk estimate, and the proportion with undefined diabetes status at the end of the trial.

  15. Older Adult Consumer Knowledge, Attitudes, and Self-Reported Storage Practices of Ready-to-Eat Food Products and Risks Associated with Listeriosis.

    Science.gov (United States)

    Evans, Ellen W; Redmond, Elizabeth C

    2016-02-01

    Consumer implementation of recommended food safety practices, specifically relating to time and temperature control of ready-to-eat (RTE) food products associated with listeriosis are crucial. This is particularly the case for at-risk consumers such as older adults, given the increased listeriosis incidence reported internationally among adults aged ≥60 years. However, data detailing older adults' cognitive risk factors associated with listeriosis are lacking. Combining data about knowledge, self-reported practices, and attitudes can achieve a cumulative multilayered in-depth understanding of consumer food safety behavior and cognition. This study aims to ascertain older adults' cognition and behavior in relation to domestic food handling and storage practices that may increase the risks associated with L. monocytogenes. Older adults (≥60 years) (n = 100) participated in an interview and questionnaire to determine knowledge, self-reported practices, and attitudes toward recommended practices. Although the majority (79%) had positive attitudes toward refrigeration, 84% were unaware of recommended temperatures (5°C) and 65% self-reported "never" checking their refrigerator temperature. Although most (72%) knew that "use-by" dates indicate food safety and 62% reported "always" taking note, neutral attitudes were held, with 67% believing it was safe to eat food beyond use-by dates and 57% reporting doing so. Attitudes toward consuming foods within the recommended 2 days of opening were neutral, with 55% aware of recommendations and , 84% reporting that they consume RTE foods beyond recommendations. Although knowledgeable of some key practices, older adults self-reported potentially unsafe practices when storing RTE foods at home, which may increase risks associated with L. monocytogenes. This study has determined that older adults' food safety cognition may affect their behaviors; understanding consumer food safety cognition is essential for developing targeted

  16. Lymphedema Risk Reduction Practices

    Science.gov (United States)

    ... Question Corner (68) Research (38) Insurance (46) Inspirational Patients (8) LymphLink Articles (174) FAQ's (6) Position Papers (9) LSAP Perspective (9) FOLLOW US! Sign up for our mailing list. twitter Facebook LinkedIn Copyright ©2018 National Lymphedema Network ...

  17. Bovine cysticercosis in slaughtered cattle as an indicator of Good Agricultural Practices (GAP) and epidemiological risk factors.

    Science.gov (United States)

    Rossi, Gabriel Augusto Marques; Hoppe, Estevam Guilherme Lux; Mathias, Luis Antonio; Martins, Ana Maria Centola Vidal; Mussi, Leila Aparecida; Prata, Luiz Francisco

    2015-03-01

    This study focused on estimating the economic losses resulting from cysticercosis at beef cattle farms that supply an export slaughterhouse located in the state of São Paulo, Brazil, and to identify the epidemiological risks factors involved in the disease to ascertain if these farms adopt Good Agricultural Practices (GAP). To this, we used data recorded in 2012 by Brazil's Federal Inspection Service (SIF) on the daily occurrence of the disease, according to the farm from which the animals originated. In addition, the associated risk factors were determined based on a case-control study at 48 farms. Cysticercosis was detected in 2.26% (95% CI 2.2-2.33) of the 190,903 bovines supplied by 556 farms in the following four states: 2.92% (95% CI 2.83-3.03) in São Paulo, 1.81% (95% CI 1.71-1.93) in Minas Gerais, 0.71% (95% CI 0.6-0.82) in Goiás and 1.11% (95% CI 0.79-1.57) in Mato Grosso do Sul, with significant differences in the epidemiological indices of these states. Cysticercosis was detected at 58.45% (95% CI 54.36-62.55) of the farms of this study, representing estimated economic losses of US$312,194.52 for the farmers. Lower prevalence of this disease were found at the farms qualified for exports to the European Union, indicating a statistically significant difference from those not qualified to export to Europe. The access of cattle to non-controlled water sources, as well as sport fishing activities near the farms, was identified as risk factors. Cysticercosis causes considerable losses in Brazil's beef supply chain, with lower prevalence appearing only at farms qualified to export to the European Union. As for the access of cattle to non-controlled water sources, this is an indication that GAP are not implemented by some farms, demonstrating the violation of international agreements by the industry and the farms. Copyright © 2015 Elsevier B.V. All rights reserved.

  18. Practicalities of developing a breast magnetic resonance imaging screening service for women at high risk for breast cancer.

    Science.gov (United States)

    Kiely, Belinda E; Hossack, Lucinda K; Shadbolt, Clair L; Davis, Anna; Cassumbhoy, Robin; Moodie, Kate; Antill, Yoland; Mitchell, Gillian

    2011-10-01

    Demand for screening breast magnetic resonance imaging (MRI) for women with a hereditary predisposition to breast cancer has increased since the introduction of a medicare item number. To aid future service planning, we examined the practicalities of establishing and running a breast MRI screening programme for high risk women and to describe the early outcomes of our screening programme. We undertook a retrospective audit of prospectively collected data. Women detection rate; and patient satisfaction via questionnaire. From 2006 to 2009, 82 women completed a round one screening MRI and 45, 21 and one women completed second, third and fourth round annual MRI studies, respectively. Median MRI process times were: booking 20 min; attendance in radiology department 90 min; imaging duration 45 min; reporting by one radiologist 30 min. Of the 82 round one studies, 23 (28%) were reported as ≥Breast Imaging Reporting and Data System three requiring further investigation. Of the round two and three studies completed, 13/45 (28%) and 2/21 (9%) have been recalled, respectively. Seven malignancies were detected. Questionnaires revealed women were satisfied with the service. Significant time, staff and equipment is required to run an effective breast MRI screening programme and this must be considered by future service providers.

  19. The Prevalence and Marketing of Electronic Cigarettes in Proximity to At-Risk Youths: An Investigation of Point-of-Sale Practices near Alternative High Schools

    Science.gov (United States)

    Miller, Stephen; Pike, James; Chapman, Jared; Xie, Bin; Hilton, Brian N.; Ames, Susan L.; Stacy, Alan W.

    2017-01-01

    This study examines the point-of-sale marketing practices used to promote electronic cigarettes at stores near schools that serve at-risk youths. One hundred stores selling tobacco products within a half-mile of alternative high schools in Southern California were assessed for this study. Seventy percent of stores in the sample sold electronic…

  20. A comparative study of voice complaints and risk factors for voice complaints in female student teachers and practicing teachers early in their career.

    NARCIS (Netherlands)

    Thomas, G.; Kooijman, P.G.C.; Cremers, C.W.R.J.; Jong, F.I.C.R.S. de

    2006-01-01

    A cross-sectional questionnaire survey was performed to compare female student teachers (454 subjects; 1st to 4th year of training) and practicing teachers (82 female teachers; 1st to 4th year of teaching career) of primary education early in their career, with regard to risk factors perceived to be

  1. Safer Prescribing and Care for the Elderly (SPACE): feasibility of audit and feedback plus practice mail-out to patients with high-risk prescribing.

    Science.gov (United States)

    Wallis, Katharine; Tuckey, Rebecca

    2017-06-01

    INTRODUCTION High-risk prescribing in general practice is common and places patients at increased risk of adverse events. AIM The Safer Prescribing and Care for the Elderly (SPACE) intervention, comprising audit and feedback plus practice mail-out to patients with high-risk prescribing, was designed to promote medicines review and support safer prescribing. This study aims to test the SPACE intervention feasibility in general practice. METHODS This feasibility study involved an Auckland Primary Health Organisation (PHO), a clinical advisory pharmacist, two purposively sampled urban general practices, and seven GPs. The acceptability and utility of the SPACE intervention were assessed by semi- structured interviews involving study participants, including 11 patients with high-risk prescribing. Interviews were audio-recorded, transcribed verbatim and analysed using a general inductive approach to identify emergent themes. RESULTS The pharmacist said the SPACE intervention facilitated communication with GPs, and provided a platform for their clinical advisory role at no extra cost to the PHO. GPs said the feedback session with the pharmacist was educational but added to time pressures. GPs selected 29 patients for the mail-out. Some GPs were concerned the mail-out might upset patients, but patients said they felt cared for. Some patients intended to take the letter to their next appointment and discuss their medicines with their GP; others said there were already many things to discuss and not enough time. Some patients were confused by the medicines information brochure. DISCUSSION The SPACE intervention is feasible in general practice. The medicines information brochure needs simplification. Further research is needed to test the effect of SPACE on high-risk prescribing.

  2. The contribution of ineffective urban planning practices to disaster and disaster risks accumulation in urban areas: the case of former Kunduchi quarry site in Dar es Salaam, Tanzania

    Directory of Open Access Journals (Sweden)

    Benedict F. Malele

    2009-04-01

    Full Text Available This study examined the link between urban planning practices and disaster risks. The study used the former Kunduchi Quarry Site within the City of Dar es Salaam to demonstrate how laxity in enforcing the laid down planning rules, regulations and procedures facilitates the accumulation and occurrence of disaster risks and disasters in urban areas. This undermines one of the central roles of urban planning, which is to protect the lives of people from disaster risks and disasters. In exploring this, the study specifically focused on understanding the rules, regulations and procedures of planning in Tanzania; the extent to which they are followed and, where they are not followed, their implications for disaster risks and disasters; the coping initiatives adopted by local communities to reduce risks and their level of success or failure; and finally the drawing of lessons and recommendations for disaster risk reduction in urban areas. Strongly emerging from this study is the finding that although planning rules and regulations do exist, they are not enforced. As a result urban communities suffer from disaster risks and disasters caused by unregulated activities. The study analyzed the coping initiatives that urban communities apply to reduce disaster risks in their areas. It noted that, while a range of “coping” responses could be observed, these are not lasting solutions to the disaster risks being faced. Sustainable solutions seem to be known by the local community but they are not adopted for fear of compromising or undermining their existing livelihood strategies.

  3. Usual care and management of fall risk increasing drugs in older dizzy patients in Dutch general practice

    Science.gov (United States)

    Stam, Hanneke; Harting, Thomas; van der Sluijs, Marjolijn; van Marum, Rob; van der Horst, Henriëtte; van der Wouden, Johannes C.; Maarsingh, Otto R.

    2016-01-01

    Objective For general practitioners (GPs) dizziness is a challenging condition to deal with. Data on the management of dizziness in older patients are mostly lacking. Furthermore, it is unknown whether GPs attempt to decrease Fall Risk Increasing Drugs (FRIDs) use in the management of dizziness in older patients. The aim of this study is to gain more insight into GP’s management of dizziness in older patients, including FRID evaluation and adjustment. Design Data were derived from electronic medical records, obtained over a 12-month period in 2013. Setting Forty-six Dutch general practices. Patients The study sample comprised of 2812 older dizzy patients of 65 years and over. Patients were identified using International Classification of Primary Care codes and free text. Main outcome measures Usual care was categorized into wait-and-see strategy (no treatment initiated); education and advice; additional testing; medication adjustment; and referral. Results Frequently applied treatments included a wait-and-see strategy (28.4%) and education and advice (28.0%). Additional testing was performed in 26.8%; 19.0% of the patients were referred. Of the patients 87.2% had at least one FRID prescription. During the observation period, GPs adjusted the use of one or more FRIDs for 11.7% of the patients. Conclusion This study revealed a wide variety in management strategies for dizziness in older adults. The referral rate for dizziness was high compared to prior research. Although many older dizzy patients use at least one FRID, FRID evaluation and adjustment is scarce. We expect that more FRID adjustments may reduce dizziness and dizziness-related impairment. Key PointsIt is important to know how general practitioners manage dizziness in older patients in order to assess potential cues for improvement.This study revealed a wide variety in management strategies for dizziness in older patients.There was a scarcity in Fall Risk Increasing Drug (FRID) evaluation and adjustment

  4. Do not fear the Framingham: Practical application to properly evaluate and modify cardiovascular risk in commercial divers.

    Science.gov (United States)

    Suresh, Rahul; Pavela, James; Kus, Marcus S; Alleman, Tony; Sanders, Robert

    2018-01-01

    In April 2016 the Association of Diving Contractors International (ADCI) consensus guidelines began recommending annual cardiovascular risk stratification of commercial divers using the Framingham Risk Score (FRS). For those at elevated risk, further testing is recommended. This approach has raised concerns about potential operational and financial impacts. However, the prevalence of elevated cardiovascular risk and need for additional testing among commercial divers is not known. Clinical data required to calculate the FRS was abstracted for 190 commercial divers in two cohorts. Population demographics, FRS distribution, contributions of risk factors and effect of interventions on reducing risk-factor burden were assessed. Mean FRS score was 1.68 ± 6.35 points, with 13 divers (6.8%) at intermediate risk and none at high 10-year risk. In these 13 divers, the mean contributions to the FRS were from age (6.5 points), cholesterol (3.1 pts.), smoking (1.3 pts.), highdensity lipoprotein (1 pt.), and systolic blood pressure (0.8 pts). The youngest age group had a significantly higher modifiable risk core than the oldest age group (5.87 vs. 1.2 points, P ⟨ 0.001). All 13 intermediate risk divers could have been reclassified as low-risk with successful treatment of modifiable risk factors. The prevalence of elevated cardiovascular risk among commercial divers is low, and treatment of modifiable risk factors could reclassify those at intermediate risk to low risk. Therefore, FRS implementation coupled with intensive risk-reduction strategies for at risk-divers may help improve diver health and prolong the careers of divers while limiting the need for additional testing and adverse operational impact. Copyright© Undersea and Hyperbaric Medical Society.

  5. Mapping for the management of diffuse pollution risks related to agricultural plant protection practices: case of the Etang de l'Or catchment area in France.

    Science.gov (United States)

    Mghirbi, Oussama; Bord, Jean-Paul; Le Grusse, Philippe; Mandart, Elisabeth; Fabre, Jacques

    2018-03-08

    Faced with health, environmental, and socio-economic issues related to the heavy use of pesticides, diffuse phytosanitary pollution becomes a major concern shared by all the field actors. These actors, namely the farmers and territorial managers, have expressed the need to implement decision support tools for the territorial management of diffuse pollution resulting from the plant protection practices and their impacts. To meet these steadily increasing requests, a cartographic analysis approach was implemented based on GIS which allows the spatialization of the diffuse pollution impacts related to plant protection practices on the Etang de l'Or catchment area in the South of France. Risk mapping represents a support-decision tool that enables the different field actors to identify and locate vulnerable areas, so as to determine action plans and agri-environmental measures depending on the context of the natural environment. This work shows that mapping is helpful for managing risks related to the use of pesticides in agriculture by employing indicators of pressure (TFI) and risk on the applicator's health (IRSA) and on the environment (IRTE). These indicators were designed to assess the impact of plant protection practices at various spatial scales (field, farm, etc.). The cartographic analysis of risks related to plant protection practices shows that diffuse pollution is unequally located in the North (known for its abundant garrigues and vineyards) and in the South of the Etang de l'Or catchment area (the Mauguio-Lunel agricultural plain known for its diversified cropping systems). This spatial inequity is essentially related to land use and agricultural production system. Indeed, the agricultural lands cover about 60% of the total catchment area. Consequently, this cartographic analysis helps the territorial actors with the implementation of strategies for managing risks of diffuse pollution related to pesticides use in agriculture, based on environmental and

  6. Alcohol consumption and sport: a cross-sectional study of alcohol management practices associated with at-risk alcohol consumption at community football clubs.

    Science.gov (United States)

    Kingsland, Melanie; Wolfenden, Luke; Rowland, Bosco C; Gillham, Karen E; Kennedy, Vanessa J; Ramsden, Robyn L; Colbran, Richard W; Weir, Sarah; Wiggers, John H

    2013-08-16

    Excessive alcohol consumption is responsible for considerable harm from chronic disease and injury. Within most developed countries, members of sporting clubs participate in at-risk alcohol consumption at levels above that of communities generally. There has been limited research investigating the predictors of at-risk alcohol consumption in sporting settings, particularly at the non-elite level. The purpose of this study was to examine the association between the alcohol management practices and characteristics of community football clubs and at-risk alcohol consumption by club members. A cross sectional survey of community football club management representatives and members was conducted. Logistic regression analysis (adjusting for clustering by club) was used to determine the association between the alcohol management practices (including alcohol management policy, alcohol-related sponsorship, availability of low- and non-alcoholic drinks, and alcohol-related promotions, awards and prizes) and characteristics (football code, size and location) of sporting clubs and at-risk alcohol consumption by club members. Members of clubs that served alcohol to intoxicated people [OR: 2.23 (95% CI: 1.26-3.93)], conducted 'happy hour' promotions [OR: 2.84 (95% CI: 1.84-4.38)] or provided alcohol-only awards and prizes [OR: 1.80 (95% CI: 1.16-2.80)] were at significantly greater odds of consuming alcohol at risky levels than members of clubs that did not have such alcohol management practices. At-risk alcohol consumption was also more likely among members of clubs with less than 150 players compared with larger clubs [OR:1.45 (95% CI: 1.02-2.05)] and amongst members of particular football codes. The findings of this study suggest a need and opportunity for the implementation of alcohol harm reduction strategies targeting specific alcohol management practices at community football clubs.

  7. Safety assessment of nuclear medicine practice using the Risk Matrix Method; Evaluaciones de seguridad de la practica de medicina nuclear utilizando el metodo de Matrices de Riesgo

    Energy Technology Data Exchange (ETDEWEB)

    Cruz, Dumenigo; Cruz, Yoanis; Soler, Karen, E-mail: cruz@orasen.co.cu [Centro Nacional de Seguridad Nuclear (CNSN), La Habana (Cuba); Guerrero, Mayka, E-mail: mayka@infomed.sld.cu [Centro de investigaciones Medico Quirurgicas (CIMEQ), La Habana (Cuba)

    2013-10-01

    This paper presents the main results from the application of the methodology of Risk Matrices in a hypothetical service / department of the Nuclear medicine that realize metabolic radiotherapy treatment and diagnostic studies with {sup 131}I and {sup 99} m Tc and {sup 18}F. We could identify major equipment failures and human errors that could potentially lead to a accident in practice. For each analyzed initiating events evaluated the frequency of occurrence, identified key existing defenses to avoid the accident and assessed the potential consequences of an accident if this comes to fruition. With this methodology we could identify which accident sequences increased risk and to propose means to reduce the risk in such cases. As a result of this work was developed the 'RMA Nuclear Medicine' computer tools that will apply this methodology in nuclear medicine services that need to do similar risk assessments.

  8. Gaming under pre-trial detention: At-risk youth and their digital leisure practices during remand

    OpenAIRE

    Nielsen, Rune Kristian; Witkowski, Emma

    2013-01-01

    This paper looks at the practices of young men engaging with digital leisure activities within the physical, social, and psychological setting of a Danish Juvenile Detention Center. The study of young men's digital play prevails in game studies, yet the experiences and lifestyles captured in over a decade of research on youth gaming practices are far from representative of the diversity of gamer lives. In view of this disparity, this exploration renders visible gaming practices from other kin...

  9. Reducing risk of overdose with midazolam injection in adults: an evaluation of change in clinical practice to improve patient safety in England.

    Science.gov (United States)

    Flood, Chris; Matthew, Linda; Marsh, Rachel; Patel, Bhavesh; Mansaray, Mariama; Lamont, Tara

    2015-02-01

    This study sought to evaluate potential reductions in risk associated with midazolam injection, a sedating medication, following a UK National Patient Safety Alert. This alert, 'Reducing risk of overdose with midazolam injection in adults', was sent to all National Health Service organizations as a Rapid Response Report detailing actions services should take to minimize risks. To evaluate any potential changes arising from this alert, a number of data sources were explored including reported incidents to a national reporting system for health care error, clinician survey and audit data, pharmaceutical purchasing patterns and feedback from National Health Service managers. Prior to the Rapid Response Report, 498 incidents were received by the National Patient Safety Agency including three deaths. Post-implementation of the Rapid Response Report (June 2009), no incidents resulting in death or severe harm had been received. All organizations reported having completed the Rapid Response Report actions. Purchase and use of risk-prone, high-strength sedating midazolam by health care organizations decreased significantly as did the increased use of safer, lower strength doses (as recommended in the Rapid Response Report). Organizations can achieve safer medication practices, better knowledge, awareness and implementation of national safer practice recommendations. Risks from inadvertent overdose of midazolam injection were reduced post-implementation of national recommendations. Ongoing monitoring of this particular adverse event will be required with a sustained patient safety message to health services to maintain awareness of the issue and reduction in the number of midazolam-related errors. © 2014 John Wiley & Sons, Ltd.

  10. Quantification and site-specification of the support practice factor when mapping soil erosion risk associated with olive plantations in the Mediterranean island of Crete.

    Science.gov (United States)

    Karydas, Christos G; Sekuloska, Tijana; Silleos, Georgios N

    2009-02-01

    Due to inappropriate agricultural management practices, soil erosion is becoming one of the most dangerous forms of soil degradation in many olive farming areas in the Mediterranean region, leading to significant decrease of soil fertility and yield. In order to prevent further soil degradation, proper measures are necessary to be locally implemented. In this perspective, an increase in the spatial accuracy of remote sensing datasets and advanced image analysis are significant tools necessary and efficient for mapping soil erosion risk on a fine scale. In this study, the Revised Universal Soil Loss Equation (RUSLE) was implemented in the spatial domain using GIS, while a very high resolution satellite image, namely a QuickBird image, was used for deriving cover management (C) and support practice (P) factors, in order to map the risk of soil erosion in Kolymvari, a typical olive farming area in the island of Crete, Greece. The results comprised a risk map of soil erosion when P factor was taken uniform (conventional approach) and a risk map when P factor was quantified site-specifically using object-oriented image analysis. The results showed that the QuickBird image was necessary in order to achieve site-specificity of the P factor and therefore to support fine scale mapping of soil erosion risk in an olive cultivation area, such as the one of Kolymvari in Crete. Increasing the accuracy of the QB image classification will further improve the resulted soil erosion mapping.

  11. Risks with older adults in acute care settings: UK occupational therapists' and physiotherapists' perceptions of risks associated with discharge and professional practice.

    Science.gov (United States)

    Atwal, Anita; McIntyre, Anne; Wiggett, Claire

    2012-06-01

    Internationally, there is evidence that hospital discharge to home for older adults is a complex and challenging process that is dependent upon multidisciplinary team working. At the centre of the discharge process is the management of risk, which involves occupational therapists and other healthcare professionals managing perceived dangers and determining why some dangers are seen as presenting risks while others are not. This study did not aim to explore interprofessional differences but to ascertain a greater understanding of professionals' perceptions of risk in acute care settings. This qualitative study utilised 12 semi-structured interviews with seven occupational therapists and five physiotherapists in the United Kingdom (UK). During the interview, therapists were asked to read and answer questions on a validated vignette. The interview data were subjected to thematic content analysis and the vignettes to template analysis. Our research is one of the first studies to explore therapists' perceptions of risk with older adults in acute care settings. Our study has highlighted that perception of risk does have an impact on discharge decision-making and location. Therapists used negative terminology to refer to patients who wanted to take risks, which could be a reflection of the therapists' anxiety. Mental capacity, and patients' functioning and safety were key factors in risk decision-making with older adults. Our research has highlighted the potential value of multidisciplinary working to manage risk situations and the need for reflection and discussion regarding how persons who do not have capacity wishes ar