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Sample records for preoperative risk assessment

  1. Preoperative anemia in colon cancer: assessment of risk factors.

    Science.gov (United States)

    Dunne, James R; Gannon, Christopher J; Osborn, Tiffany M; Taylor, Michelle D; Malone, Debra L; Napolitano, Lena M

    2002-06-01

    Anemia is common in cancer patients and is associated with reduced survival. Recent studies document that treatment of anemia with blood transfusion in cancer patients is associated with increased infection risk, tumor recurrence, and mortality. We therefore investigated the incidence of preoperative anemia in colorectal cancer and assessed risk factors for anemia. Prospective data were collected on 311 patients diagnosed with colorectal cancer over a 6-year period from 1994 through 1999. Patients were stratified by age, gender, presenting complaint, preoperative hematocrit, American Joint Committee on Cancer (AJCC) stage, and TNM classification. Discrete variables were compared using Pearson's Chi-square analysis. Continuous variables were compared using Student's t test. Differences were considered significant when P colon cancer with an incidence of 57.6 per cent followed by left colon cancer (42.2%) and rectal cancer (29.8%). Patients with right colon cancer had significantly lower preoperative hematocrits compared with left colon cancer (33 +/- 8.5 vs 36 +/- 7.4; P rectal cancer (33 +/- 8.5 vs 38 +/- 6.0; P colon cancer also had significantly increased stage at presentation compared with left colon cancer (2.3 +/- 1.3 vs 2.1 +/- 1.2; P cancer. We conclude that there is a high incidence of anemia in patients with colon cancer. Patients with right colon cancer had significantly lower preoperative hematocrits and higher stage of cancer at diagnosis. Complete colon evaluation with colonoscopy is warranted in patients with anemia to improve earlier diagnosis of right colon cancer. A clinical trial of preoperative treatment of anemic colorectal cancer patients with recombinant human erythropoietin is warranted.

  2. Preoperative testing and risk assessment: perspectives on patient selection in ambulatory anesthetic procedures

    Directory of Open Access Journals (Sweden)

    Stierer TL

    2015-08-01

    Full Text Available Tracey L Stierer,1,2 Nancy A Collop3,41Department of Anesthesiology, 2Department of Critical Care Medicine, Otolaryngology Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD, USA; 3Department of Medicine, 4Department of Neurology, Emory University, Emory Sleep Center, Wesley Woods Center, Atlanta, GA, USAAbstract: With recent advances in surgical and anesthetic technique, there has been a growing emphasis on the delivery of care to patients undergoing ambulatory procedures of increasing complexity. Appropriate patient selection and meticulous preparation are vital to the provision of a safe, quality perioperative experience. It is not unusual for patients with complex medical histories and substantial systemic disease to be scheduled for discharge on the same day as their surgical procedure. The trend to “push the envelope” by triaging progressively sicker patients to ambulatory surgical facilities has resulted in a number of challenges for the anesthesia provider who will assume their care. It is well known that certain patient diseases are associated with increased perioperative risk. It is therefore important to define clinical factors that warrant more extensive testing of the patient and medical conditions that present a prohibitive risk for an adverse outcome. The preoperative assessment is an opportunity for the anesthesia provider to determine the status and stability of the patient’s health, provide preoperative education and instructions, and offer support and reassurance to the patient and the patient’s family members. Communication between the surgeon/proceduralist and the anesthesia provider is critical in achieving optimal outcome. A multifaceted approach is required when considering whether a specific patient will be best served having their procedure on an outpatient basis. Not only should the patient's comorbidities be stable and optimized, but details regarding the planned procedure and the resources available

  3. A new clinically applicable age-specific comorbidity index for preoperative risk assessment of ovarian cancer patients

    DEFF Research Database (Denmark)

    Noer, Mette Calundann; Sperling, Cecilie Dyg; Antonsen, Sofie Leisby

    2016-01-01

    OBJECTIVE: To develop and validate a new feasible comorbidity index based on self-reported information suited for preoperative risk assessment of ovarian cancer patients. METHODS: The study was based on patient self-reported data from ovarian cancer patients registered in the Danish Gynecological...

  4. A Novel Technique for the Assessment of Preoperative Cardiovascular Risk: Reactive Hyperemic Response to Short-Term Exercise

    Directory of Open Access Journals (Sweden)

    Robert Schier

    2013-01-01

    Full Text Available Background. Perioperative vascular function has been widely studied using noninvasive techniques that measure reactive hyperemia as a surrogate marker of vascular function. However, studies are limited to a static setting with patients tested at rest. We hypothesized that exercise would increase reactive hyperemia as measured by digital thermal monitoring (DTM in association to patients' cardiometabolic risk. Methods. Thirty patients (58 ± 9 years scheduled for noncardiac surgery were studied prospectively. Preoperatively, temperature rebound (TR following upper arm cuff occlusion was measured before and 10 minutes after exercise. Data are presented as means ± SD. Statistical analysis utilized ANOVA and Fisher’s exact test, with P values <0.05 regarded as significant. Results. Following exercise, TR-derived parameters increased significantly (absolute: 0.53 ± 0.95 versus 0.04 ± 0.42∘C, P=0.04, and % change: 1.78 ± 3.29 versus 0.14 ± 1.27 %, P=0.03. All patients with preoperative cardiac risk factors had a change in TR (after/before exercise, ΔTR with values falling in the lower two tertiles of the study population (ΔTR <1.1%. Conclusion. Exercise increased the reactive hyperemic response to ischemia. This dynamic response was blunted in patients with cardiac risk factors. The usability of this short-term effect for the preoperative assessment of endothelial function warrants further study.

  5. PRA in Design: Increasing Confidence in Pre-Operational Assessments of Risks (Results of a Joint NASA/NRC Workshop)

    Science.gov (United States)

    Youngblood, Robert; Dezfuli, Homayoon; Siu, Nathan

    2010-01-01

    In late 2009, the National Aeronautics and Space Administration (NASA) and the U.S. Nuclear Regulatory Commission (NRC) jointly organized a workshop to discuss technical issues associated with application of risk assessments to early phases of system design. The workshop, which was coordinated by the Idaho National Laboratory, involved invited presentations from a number of PRA experts in the aerospace and nuclear fields and subsequent discussion to address the following questions: (a) What technical issues limit decision-makers' confidence in PRA results, especially at a pre-operational phase of the system life cycle? (b) What is being done to address these issues'? (c) What more can be done ? The workshop resulted in participant observations and suggestions on several technical issues, including the pursuit of non-traditional approaches to risk assessment and the verification and validation of risk models. The workshop participants also identified several important non-technical issues, including risk communication with decision makers, and the integration of PRA into the overall design process.

  6. Preoperative evaluation and comprehensive risk assessment for children with Down syndrome.

    Science.gov (United States)

    Lewanda, Amy Feldman; Matisoff, Andrew; Revenis, Mary; Harahsheh, Ashraf; Futterman, Craig; Nino, Gustavo; Greenberg, Jay; Myseros, John S; Rosenbaum, Kenneth N; Summar, Marshall

    2016-04-01

    Down syndrome is a common chromosome disorder affecting all body systems. This creates unique physiologic concerns that can affect safety during anesthesia and surgery. Little consensus exists, however, on the best way to evaluate children with Down syndrome in preparation for surgery. We review a number of salient topics affecting these children in the perioperative period, including cervical spine instability, cardiovascular abnormalities, pulmonary hypertension, upper airway obstruction, hematologic disturbances, prematurity, low birth weight, and the use of supplements and alternative therapies. Recommendations include obtaining a complete blood count to detect an increased risk for bleeding or stroke, and cardiology evaluation to identify patients with pulmonary hypertension, as well as undiagnosed or residual heart disease. Pediatric cardiac anesthesiologists and intensivists should be involved as needed. The potential for cervical spine instability should be considered, and the anesthesiologist may wish to have several options available both for the medications and equipment used. The child's family should always be asked if he or she is on any nutritional supplements, as some products marketed to families may have secondary effects such as inhibition of platelet function. Using this evaluation in presurgical planning will allow physicians to better consider the individual circumstances for their patients with Down syndrome. Our goal was to optimize patient safety by choosing the most appropriate setting and perioperative personnel, and to mitigate those risk factors amenable to intervention.

  7. Preoperatively Assessable Clinical and Pathological Risk Factors for Parametrial Involvement in Surgically Treated FIGO Stage IB-IIA Cervical Cancer.

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    Canaz, Emel; Ozyurek, Eser Sefik; Erdem, Baki; Aldikactioglu Talmac, Merve; Yildiz Ozaydin, Ipek; Akbayir, Ozgur; Numanoglu, Ceyhun; Ulker, Volkan

    2017-06-14

    Determining the risk factors associated with parametrial involvement (PMI) is of paramount importance to decrease the multimodality treatment in early-stage cervical cancer. We investigated the preoperatively assessable clinical and pathological risk factors associated with PMI in surgically treated stage IB1-IIA2 cervical cancer. A retrospective cohort study of women underwent Querleu-Morrow type C hysterectomy for cervical cancer stage IB1-IIA2 from 2001 to 2015. All patients underwent clinical staging examination under anesthesia by the same gynecological oncologists during the study period. Evaluated variables were age, menopausal status, body mass index, smoking status, FIGO (International Federation of Obstetrics and Gynecology) stage, clinically measured maximal tumor diameter, clinical presentation (exophytic or endophytic tumor), histological type, tumor grade, lymphovascular space invasion, clinical and pathological vaginal invasion, and uterine body involvement. Endophytic clinical presentation was defined for ulcerative tumors and barrel-shaped morphology. Two-dimensional transvaginal ultrasonography was used to measure tumor dimensions. Of 127 eligible women, 37 (29.1%) had PMI. On univariate analysis, endophytic clinical presentation (P = 0.01), larger tumor size (P PMI. In multivariate analysis endophytic clinical presentation (odds ratio, 11.34; 95% confidence interval, 1.34-95.85; P = 0.02) and larger tumor size (odds ratio, 32.31; 95% confidence interval, 2.46-423.83; P = 0.008) were the independent risk factors for PMI. Threshold of 31 mm in tumor size predicted PMI with 71% sensitivity and 75% specificity. We identified 18 patients with tumor size of more than 30 mm and endophytic presentation; 14 (77.7%) of these had PMI. Endophytic clinical presentation and larger clinical tumor size (>3 cm) are independent risk factors for PMI in stage IB-IIA cervical cancer. Approximately 78% of the patients with a tumor size of more than 3 cm and endophytic

  8. Stroke risk after abrupt internal carotid artery sacrifice: Accuracy of preoperative assessment with balloon test occlusion and stable xenon-enhanced CT

    Energy Technology Data Exchange (ETDEWEB)

    Linskey, M.E.; Jungreis, C.A.; Yonas, H.; Hirsch, W.L. Jr.; Sekhar, L.N.; Horton, J.A.; Janosky, J.E. [Univ. of Pittsburgh School of Medicine, PA (United States)

    1994-05-01

    To evaluate stable xenon-enhanced CT cerebral blood flow with balloon test occlusion as a predictor of stroke risk in internal carotid artery sacrifice. Abrupt internal carotid artery occlusion was performed by surgical or endovascular means below the origin of the ophthalmic artery in 31 normotensive patients who were assessed preoperatively by a 15-minute clinical balloon test occlusion followed by an internal carotid artery-occluded xenon CT cerebral blood flow study. One patient, who passed the clinical test occlusion but exhibited regions of cerebral blood flow less than 30 mL/100 g per minute on the occlusion xenon CT cerebral blood flow study went on to have a fatal stroke corresponding exactly to the region of assessment. Neuroimaging demonstrated possible flow-related infarctions, which subsequently developed in three patients. Two patients were asymptomatic, and one patient was left with a mild residual hemiparesis. Our protocol provided a statistically significant reduction in subsequent infarction rate and infarction-related death rate when compared with a control group of normotensive abrupt internal carotid artery occlusion patients who did not undergo any preoperative stroke-risk assessment (reported in the literature). The estimated false-negative rate for our preoperative assessment protocol ranged from 3.3% to 10% depending on the assessment of the cause of the three potentially flow-related infarctions. Although life-threatening major vascular territory infarctions have been avoided, our protocol is less sensitive to changes predicting smaller, often minimally symptomatic, vascular border zone infarctions and does not predict postoperative thromboembolic strokes. 94 refs., 5 figs., 4 tabs.

  9. Preoperative evaluation : risk management and implementation aspects

    NARCIS (Netherlands)

    Klei, W.A. van

    2002-01-01

    In preoperative risk management the anesthesiologist uses diagnostic information to estimate the probability of outcomes and to decide on the anesthetic strategy in a particular patient. The aim of this thesis was explore to what extent simple patient characteristics, particularly obtained from

  10. Preoperative evaluation : risk management and implementation aspects

    NARCIS (Netherlands)

    Klei, W.A. van

    2002-01-01

    In preoperative risk management the anesthesiologist uses diagnostic information to estimate the probability of outcomes and to decide on the anesthetic strategy in a particular patient. The aim of this thesis was explore to what extent simple patient characteristics, particularly obtained from preo

  11. [Preoperative assessment of lung disease patients.].

    Science.gov (United States)

    Ramos, Gilson; Ramos Filho, José; Pereira, Edísio; Junqueira, Marcos; Assis, Carlos Henrique C

    2003-02-01

    Lung complications are the most frequent causes of postoperative morbidity-mortality, especially in lung disease patients. So, those patients should be preoperatively carefully evaluated and prepared, both clinically and laboratorially. This review aimed at determining surgical risk and at establishing preoperative procedures to minimize peri and postoperative morbidity-mortality in lung disease patients. Major anesthetic-surgical repercussions in lung function have already been described. Similarly, we tried to select higher-risk patients, submitted or not to lung resection. To that end, clinical and laboratorial propedeutics were used. Finally, a proposal of a preoperative algorithm was presented for procedures with lung resection. Lung disease patients, especially those with chronic evolution, need to be preoperatively thoroughly evaluated. ASA physical status and Goldmans cardiac index are important risk forecasting factors for lung disease patients not candidates for lung resection. Adding to these criteria, estimated postoperative max VO2, FEV1 and diffusion capacity are mandatory for some patients submitted to lung resection. beta2-agonists and steroids should be considered in the preoperative period of these patients.

  12. Preoperative Evaluation: Estimation of Pulmonary Risk.

    Science.gov (United States)

    Lakshminarasimhachar, Anand; Smetana, Gerald W

    2016-03-01

    Postoperative pulmonary complications (PPCs) are common after major non-thoracic surgery and associated with significant morbidity and high cost of care. A number of risk factors are strong predictors of PPCs. The overall goal of the preoperative pulmonary evaluation is to identify these potential, patient and procedure-related risks and optimize the health of the patients before surgery. A thorough clinical examination supported by appropriate laboratory tests will help guide the clinician to provide optimal perioperative care. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Recognition and management of preoperative risk.

    Science.gov (United States)

    Nierman, E; Zakrzewski, K

    1999-08-01

    Internists are frequently asked to do preoperative consultations and to manage perioperative complications. Realistic goals are to identify patient factors that increase the risk of surgery, to quantify this risk in order to make decisions about the appropriateness of and timing of the surgery, to provide recommendations on how to minimize the risk, to identify and manage coexisting medical conditions and their associated medication requirements, to monitor the patient for perioperative problems, and to make recommendations to deal with these problems when they occur. With few exceptions, nonselective imaging and laboratory screening tests have repeatedly been shown to be of little value when the history and physical do not suggest a problem. The risk associated with the planned surgery can be estimated, with the most common serious complications being cardiac events. Updated versions of Goldman's risk indices are particularly helpful for this. Clinical variables are optimally combined with selective stress testing to discern which patients will benefit from preoperative revascularization. This has been studied best in the setting of vascular surgery. A critical guiding principle is that the value of revascularization must be judged in terms of long term gains rather than just immediate perioperative benefit. Other interventions include the selective use of beta blockers, adequate analgesia for all, control of hypertension, and appropriate volume management, especially in the settings of preexisting CHF or valvular disease. It must also be recognized that perioperative ischemia and CHF often present atypically. An approach that combines aspects of both the ACC/AHA and the ACP guidelines seems optimal. A variety of noncardiac issues must also be addressed. Postoperative pulmonary complications are common, especially with preexisting pulmonary disease, thoracic and upper abdominal surgery, and obesity. PFTs and ABGs are indicated in selected patients. Stopping

  14. Preoperative Ultrasonographic Assessment of the Number and Size of Gallbladder Stones: Is It a Useful Predictor of Asymptomatic Choledochal Lithiasis?

    National Research Council Canada - National Science Library

    Costi, Renato; Sarli, Leopoldo; Caruso, Giuseppe; Iusco, Domenico; Gobbi, Sara; Violi, Vincenzo; Roncoroni, Luigi

    2002-01-01

    .... To evaluate whether preoperative ultrasonographic assessment of the number and size of gallbladder stones can identify patients at increased risk of having asymptomatic common bile duct stones. Methods...

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

    Directory of Open Access Journals (Sweden)

    Sanne E. Hoeks

    2010-07-01

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

  16. Preoperative Ultrasonographic Assessment of the Number and Size of Gallbladder Stones

    National Research Council Canada - National Science Library

    Costi, Renato; Sarli, Leopoldo; Caruso, Giuseppe; Iusco, Domenico; Gobbi, Sara; Violi, Vincenzo; Roncoroni, Luigi

    2002-01-01

    Objective. To evaluate whether preoperative ultrasonographic assessment of the number and size of gallbladder stones can identify patients at increased risk of having asymptomatic common bile duct stones. Methods...

  17. Risk factors and the preoperative assessment of right para-oesophageal lymph node metastasis in right lobe papillary thyroid carcinoma: A case series.

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    Qu, You; Zhang, Hao; Zhang, Ping; Dong, Wenwu; He, Liang; Sun, Wei; Liu, Jinhao

    2017-06-01

    Right para-oesophageal lymph nodes (RPELN) are included among the right central compartment lymph nodes (rCLN) and located behind right recurrent laryngeal nerve (rRLN). However, due to the likelihood of increasing postoperative complications, and the extremely difficulties of RPELN dissection, the decision to perform RPELN dissection remains controversial. The aim of this study was to explore the risk factors of RPELN metastasis and evaluate RPELN metastasis by preoperative examination. We reviewed the medical records of 163 consecutive papillary thyroid carcinoma (PTC) patients (125 females and 38 males) who underwent right lobe plus isthmic resection (91 patients) or total thyroidectomy (72 patients) with right or bilateral central compartment lymph node dissection. The RPELN dissections were performed in all patients and were individually dissected and recorded intraoperatively. All patients underwent thyroid ultrasound and enhanced neck computed tomography (CT) routinely during preoperative examination. RPELN metastasis was detected in 20 patients (12.3%), among whom 6 (3.7%) had RPELN metastasis without rCLN metastasis. Total rCLN metastasis and lateral compartment lymph node metastasis were confirmed in 57 (35.0%) and 24 (14.7%) patients, respectively. The tumour diameter, number of metastatic rCLN and lateral compartment lymph nodes, RPELN visible on CT, and enhanced CT value of RPELN were confirmed significantly associated with RPELN metastasis by univariate analysis (P 1 cm) in the right lobe or suspected rCLN metastasis were recommended to undergo prophylactic RPELN dissection, particularly in those with a high enhanced CT value (>132) of RPELN or those with the copresence of lateral compartment lymph node metastasis. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  18. [Preoperative assessment of patients with diabetes mellitus].

    Science.gov (United States)

    Takeda, Kiyoshi

    2010-07-01

    The perioperative morbidity of diabetic patients is related to preoperative end-organ damage. Due to the microvascular pathology, autonomic neuropathy is common and cardiovascular abnormalities such as hypertension, painless myocardial ischemia, and orthostatic hypotension may predispose patients to perioperative cardiovascular instability. Autonomic dysfunction also contributes to delayed gastric emptying, and preoperative administration of a histamine antagonist and a gastric emptying agent is needed. Chronic hyperglycemia leads to glycosylation of tissue proteins and the accumulation of abnormal collagen can cause stiff joint syndrome resulting in difficult tracheal intubation. The primary goal of pre and intraoperative blood glucose control is to avoid hypoglycemia and ketosis. Moreover, the tight glycemic control has been reported to improve survival in critically ill patients who were treated in the intensive care unit.

  19. Quantitative risk analysis preoperational of gas pipeline

    Energy Technology Data Exchange (ETDEWEB)

    Manfredi, Carlos; Bispo, Gustavo G.; Esteves, Alvaro [Gie S.A., Buenos Aires (Argentina)

    2009-07-01

    The purpose of this analysis is to predict how it can be affected the individual risk and the public's general security due to the operation of a gas pipeline. In case that the single or social risks are considered intolerable, compared with the international standards, to be recommended measures of mitigation of the risk associated to the operation until levels that can be considered compatible with the best practices in the industry. The quantitative risk analysis calculates the probability of occurrence of an event based on the frequency of occurrence of the same one and it requires a complex mathematical treatment. The present work has as objective to develop a calculation methodology based on the previously mentioned publication. This calculation methodology is centered in defining the frequencies of occurrence of events, according to representative database of each case in study. Besides, it settles down the consequences particularly according to the considerations of each area and the different possibilities of interferences with the gas pipeline in study. For each one of the interferences a typical curve of ignition probabilities is developed in function from the distance to the pipe. (author)

  20. Systematic review of obesity surgery mortality risk score--preoperative risk stratification in bariatric surgery.

    Science.gov (United States)

    Thomas, Harun; Agrawal, Sanjay

    2012-07-01

    Bariatric surgery is the best long term treatment for morbid obesity. However, it carries risks of considerable morbidity and potential mortality. There is no published review on pre-operative identification of high-risk patients in bariatric surgery. This systematic review analyses obesity surgery mortality risk score (OS-MRS) as a tool for pre-operative prediction of mortality risk in bariatric surgery. Medline and Embase was systematically searched using the medical subjects headings (MeSH) terms 'bariatric surgery' and 'mortality' with further free text search and cross references. Studies that described OS-MRS to predict mortality risk after bariatric surgery were included in this review. Six studies evaluated 9,382 patients to assess the validity of OS-MRS to predict the mortality risk after bariatric surgery. Patient's age ranged from 19 to 67 years, and the body mass index ranged from 30 to 84. There were 83 deaths among the 9,382 patients (0.88 %) with individual studies reporting a mortality range from 0 % to 1.49 %. There were 13 deaths among 4,912 (0.26 %) class A patients, 55 deaths among 4,124 (1.33 %) class B patients and 15 deaths among 346 (4.34 %) class C patients. Mortality in classes A, B and C was significantly different from each of the other two classes (P < 0.05, χ(2)). This systematic review confirms that OS-MRS stratifies the mortality risk in the three-risk classification subgroups of patients. The OS-MRS can be used for pre-operative identification of high-risk patients undergoing primary Roux-en-Y gastric bypass surgery.

  1. Preoperative risk factor analysis in orthotopic liver transplantation with pretransplant artificial liver support therapy

    Institute of Scientific and Technical Information of China (English)

    Jin-Zhong Yuan; Qi-Fa Ye; Ling-Ling Zhao; Ying-Zi Ming; Hong Sun; Shai-Hong Zhu; Zu-Fa Huang; Min-Min Wang

    2006-01-01

    AIM: To assess the value of pre-transplant artificial liver support in reducing the pre-operative risk factors relating to early mortality after orthotopic liver transplantation (OLT).METHODS: Fifty adult patients with various stages and various etiologies undergoing OLT procedures were treated with molecular adsorbent recycling system (MARS) as preoperative liver support therapy. The study included two parts, the first one is to evaluate the medical effectiveness of single MARS treatment with some clinical and laboratory parameters, which were supposed to be the therapeutical pre-transplant risk factors, the second part is to study the patients undergoing OLT using the regression analysis on preoperative risk factors relating to early mortality (30 d)after OLT.RESULTS: In the 50 patients, the statistically significant improvement in the biochemical parameters was observed (pre-treatment and post-treatment). Eight patients avoided the scheduled Ltx due to significant relief of clinical condition or recovery of failing liver function, 8 patients died, 34 patients were successfully bridged to Ltx, the immediate outcome of this 34patients within 30d observation was: 28 kept alive and 6patients died.CONCLUSION: Pre-operative SOFA, level of creatinine,INR, TNF-α, IL-10 are the main preoperative risk factors that cause early death after operation, MARS treatment before transplantion can relieve these factors significantly.

  2. Risk assessment

    DEFF Research Database (Denmark)

    Pedersen, Liselotte; Rasmussen, Kirsten; Elsass, Peter

    2010-01-01

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

  3. Risk assessment

    Energy Technology Data Exchange (ETDEWEB)

    Gittus, J.H.

    1986-03-01

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

  4. Preoperative risk factors for anastomotic leakage after resection for colorectal cancer

    DEFF Research Database (Denmark)

    Pommergaard, Hans-Christian; Gessler, B; Burcharth, Jakob

    2014-01-01

    for cancer. The meta-analyses found that a low rectal anastomosis [OR = 3.26 (95% CI: 2.31-4.62)], male gender [OR = 1.48 (95% CI: 1.37-1.60)] and preoperative radiotherapy [OR = 1.65 (95% CI: 1.06-2.56)] may be risk factors for anastomotic leakage. Primarily as a result of observational design, the quality...... was used for bias assessment within studies, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used for quality assessment of evidence on outcome levels. RESULTS: This review included 23 studies evaluating 110,272 patients undergoing colorectal resection......AIM: Colorectal anastomotic leakage is a serious complication. Despite extensive research, no consensus on the most important preoperative risk factors exists. The aim of this systematic review and meta-analysis was to evaluate risk factors for anastomotic leakage in patients operated...

  5. 营养风险筛查表2002对胰腺癌患者术前营养的评估%Nutritional Risk Screening 2002 used for preoperative nutritional assessment of patients with pancreatic cancer

    Institute of Scientific and Technical Information of China (English)

    韩冰; 徐庆祥; 丁义涛; 卞晓洁; 仇毓东; 周铁; 毛谅; 谢敏; 包善华

    2016-01-01

    Objective To investigate the value of the Nutritional Risk Screening 2002 (NRS2002) for preoperative nutritional assessment of patients with pancreatic cancer.Methods Ninety-one patients who had undergone surgery in the Department of General Surgery,the Affiliated Drum Tower Hospital of Nanjing University Medical School from March 2012 to December 2014 were included into this study.These patients had all underwent preoperative nutritional assessment using NRS2002.According to the results of the NRS2002 evaluation,all these patients were divided into two groups,the nutritional risk group (51 patients) with a score of NRS2002 ≥ 3 and the non-nutritional risk group (40 patients) with a score of NRS2002 <3.The preoperative and postoperative nutritional indicators,postoperative complications,physical state and quality of life,length of postoperative hospital stay,and medical costs were compared between the two groups.Results The anthropometric measurements in the risk group were significantly lower than that of the no risk group.These included the body mass index (22.4 ± 1.8 vs 24.5 ± 1.6),triceps skinfold thickness (14.6±3.7 vs 16.5 ±4.0)mm,mid-arm circumference (26.1 ±3.7 vs 28.2±4.l)cm,and midarm muscle circumference (21.5 ± 2.5 vs 23.0 ± 2.9) (P < 0.05).Similarly,in the risk group,the preoperative and postoperative prealbumin,albumin on postoperative day 1,and transferrin on postoperative day 4 and day 7 were significantly lower than that of the no risk group.In addition,there were significant differences between the two groups in postoperative complication rates (25/51 vs 8/40),surgical site complications (22/51 vs 7/40),non-surgical site complications (11/51 vs 2/40),Karnofsky Performance Status,Zubrod-ECOG-WHO,Quality of Life,dosage of albumin,length of postoperative hospital stay,medical cost and Glasgow prognostic score.Conclusions The nutritional status of patients with pancreatic cancer would influence rehabilitation after surgery.NRS2002

  6. Preoperative statin is associated with decreased operative mortality in high risk coronary artery bypass patients

    Directory of Open Access Journals (Sweden)

    Maher Thomas D

    2010-02-01

    Full Text Available Abstract Background Statins are widely prescribed to patients with atherosclerosis. A retrospective database analysis was used to examine the role of preoperative statin use in hospital mortality, for patients undergoing isolated coronary artery bypass grafting (CABG. Methods The study population comprised 2377 patients who had isolated CABG at Allegheny General Hospital between 2000 and 2004. Mean age of the patients was 65 ± 11 years (range 27 to 92 years. 1594 (67% were male, 5% had previous open heart procedures, and 4% had emergency surgery. 1004 patients (42% were being treated with a statin at the time of admission. Univariate, bivariate (Chi2, Fisher's Exact and Student's t-tests and multivariate (stepwise linear regression analyses were used to evaluate the association of statin use with mortality following CABG. Results Annual prevalence of preoperative statin use was similar over the study period and averaged 40%. Preoperative clinical risk assessment demonstrated a 2% risk of mortality in both the statin and non-statin groups. Operative mortality was 2.4% for all patients, 1.7% for statin users and 2.8% for non-statin users (p Conclusions Between 2000 and 2004 less than 50% of patients at this institution were receiving statins before admission for isolated CABG. A retrospective analysis of this cohort provides evidence that preoperative statin use is associated with lower operative mortality in high-risk patients.

  7. Assessment of spiral CT pneumocolon in preoperative colorectal carcinoma

    Institute of Scientific and Technical Information of China (English)

    Can-Hui Sun; Zi-Ping Li; Quan-Fei Meng; Shen-Ping Yu; Da-Sheng Xu

    2005-01-01

    AIM: To investigate the value of spiral CT pneumocolon in preoperative colorectal carcinoma.METHODS: Spiral CT pneumocolon was performed prior to surgery in 64 patients with colorectal carcinoma. Spiral CT images were compared to specimens from the resected tumor.RESULTS: Spiral CT depicted the tumor in all patients.Comparison of spiral CT and histologic results showed that the sensitivity and specificity were 95.2%, 40.9% in detection of local invasion, and 75.0%, 90.9% in detection of lymph node metastasis. Compared to the Dukes classification,the disease was correctly staged as A in 6 of 18 patients,as B in 18 of 23, as C in 10 of 15, and as D in 7 of 8. Overall,spiral CT correctly staged 64.1% of patients.CONCLUSION: Spiral CT pneumocolon may be useful in the preoperative assessment of patients with colorectal carcinoma as a means for assisting surgical planning.

  8. Identifying and assessing anxiety in pre-operative patients.

    Science.gov (United States)

    Pritchard, Michael John

    Increasing demands for hospitals to be more efficient mean that patients attending for an operation are generally admitted on the day of surgery. As a result, healthcare professionals have little time to talk to the patient to ascertain his or her wellbeing, to check for any signs of anxiety and ask whether the patient requires further information about the forthcoming procedure. Healthcare professionals should be encouraged to use appropriate interventions to identify and assess anxious patients. There are several instruments available to measure the patient's level of pre-operative anxiety. This article reviews the Amsterdam Preoperative Anxiety and Information Scale, which is easy for patients to complete and may help to identify which individuals need extra support.

  9. [Valvular heart disease: preoperative assessment and postoperative care].

    Science.gov (United States)

    Nägele, Reto; Kaufmann, Beat A

    2013-10-30

    Patients with valvular heart disease or with a prosthetic heart valve replacement are seen with increasing frequency in clinical practice. The medical care and evaluation of patients with valvular heart disease before valve surgery, but also the post-operative treatment is complex and managed by general practitioners, cardiologists and cardiac surgeons. In this mini-review we will first discuss the preoperative assessment of the two most common valvulopathies, aortic stenosis and mitral regurgitation. Then we will discuss the post-operative care, which includes the management of anticoagulation, serial follow up and as well as the diagnostic assessment of complications such as thromboembolism, hemolysis, endocarditis and valve dysfunction.

  10. An anaesthetic pre-operative assessment clinic reduces pre-operative inpatient stay in patients requiring major vascular surgery.

    LENUS (Irish Health Repository)

    O'Connor, D B

    2012-02-01

    BACKGROUND: Patients undergoing major vascular surgery (MVS) require extensive anaesthetic assessment. This can require extended pre-operative stays. AIMS: We investigated whether a newly established anaesthetic pre-operative assessment clinic (PAC) would reduce the pre-operative inpatient stay, avoid unnecessary investigations and facilitate day before surgery (DBS) admissions for patients undergoing MVS. PATIENT AND METHODS: One year following and preceding the establishment of the PAC the records of patients undergoing open or endovascular aortic aneurysm repair, carotid endarterectomy and infra-inguinal bypass were reviewed to measure pre-operative length of stay (LoS). RESULTS: Pre-operative LoS was significantly reduced in the study period (1.85 vs. 4.2 days, respectively, P < 0.0001). Only 12 out of 61 patients in 2007 were admitted on the DBS and this increased to 33 out of 63 patients (P = 0.0002). No procedure was cancelled for medical reasons. CONCLUSION: The PAC has facilitated accurate outpatient anaesthetic assessment for patients requiring MVS. The pre-operative in-patient stay has been significantly reduced.

  11. Preoperative Assessment of Different Treatment Modalities in Bronchial Asthma Patients

    Directory of Open Access Journals (Sweden)

    Kawther A. Azzam M.D. and **Sahar S. Khattab MD

    2003-06-01

    Full Text Available This study was performed to assess the effectiveness of acupuncture and medical therapies of bronchial asthma preoperatively. Sixty patients suffered from mild to moderate bronchial asthma and coming for elective operations were chozen from the outpatient clinic of Al-Zahraa University Hospital. Patients were randomly divided into three equal groups (n=20 each. Group I patients (drug group received oral theophylline and Salbutamol (ventolin inhaler according to the needs. Group II patients (drug +ear acupuncture group received same medical treatment as in group I and added ear acupuncture. Group III patients (drug + ear and body acupuncture group received same medical treatment as in group I and II and added ear and body acupuncture. Ventilatory function tests through spirometer and interleukin-13 estimation were performed before treatment and after two weeks of treatment. Improvement of subjective and objective parameters had occurred with significant decrease in the mean serum level of interleukin-13 and decrease in the mean number of using b-agonist puffs after two weeks of treatment in the three groups, with the best results being in group III than in group II and then in group I. Conclusion: Interleukin-13 estimation togheter with ventilatory function tests is a useful parameter for pre-operative assessment and evaluation of asthmatic patients. Also medication was significantly reduced when combined with acupuncture.

  12. Preoperative prealbumin level as a risk factor for surgical site infection following elective spine surgery

    Directory of Open Access Journals (Sweden)

    David J Salvetti

    2015-01-01

    Conclusions: Our results reinforce the relationship between preoperative nutritional status and outcomes in elective spine surgery. The data indicate that preoperative prealbumin levels may be useful in risk stratification. Further study is needed to determine whether nutritional supplementation may reduce the risk of infection.

  13. Preoperative assessment of the older surgical patient: honing in on geriatric syndromes

    Directory of Open Access Journals (Sweden)

    Kim S

    2014-12-01

    Full Text Available Sunghye Kim,1 Amber K Brooks,2 Leanne Groban21Department of Hospital Medicine, 2Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USAAbstract: Nearly 50% of Americans will have an operation after the age of 65 years. Traditional preoperative anesthesia consultations capture only some of the information needed to identify older patients (defined as ≥65 years of age undergoing elective surgery who are at increased risk for postoperative complications, prolonged hospital stays, and delayed or hampered functional recovery. As a catalyst to this review, we compared traditional risk scores (eg, cardiac-focused to geriatric-specific risk measures from two older female patients seen in our preoperative clinic who were scheduled for elective, robotic-assisted hysterectomies. Despite having a lower cardiac risk index and Charlson comorbidity score, the younger of the two patients presented with more subtle negative geriatric-specific risk predictors – including intermediate or pre-frail status, borderline malnutrition, and reduced functional/mobility – which may have contributed to her 1-day-longer length of stay and need for readmission. Adequate screening of physiologic and cognitive reserves in older patients scheduled for surgery could identify at-risk, vulnerable elders and enable proactive perioperative management strategies (eg, strength, balance, and mobility prehabilitation to reduce adverse postoperative outcomes and readmissions. Here, we describe our initial two cases and review the stress response to surgery and the impact of advanced age on this response as well as preoperative geriatric assessments, including frailty, nutrition, physical function, cognition, and mood state tests that may better predict postoperative outcomes in older adults. A brief overview of the literature on anesthetic techniques that may influence geriatric-related syndromes is also presented. Keywords: frailty, mobility

  14. Predicting complications after pulmonary resection. Preoperative exercise testing vs a multifactorial cardiopulmonary risk index.

    Science.gov (United States)

    Epstein, S K; Faling, L J; Daly, B D; Celli, B R

    1993-09-01

    Recent studies have used preoperative cardiopulmonary exercise testing to improve risk assessment of pulmonary resection for lung cancer. These studies have demonstrated inconsistent correlation between peak oxygen uptake (VO2) and postoperative complications but have not systematically examined other methods of risk stratification. We analyzed the findings in 42 patients who had cardiopulmonary exercise testing prior to lung cancer resection. Preoperative clinical data combining pulmonary factors (obesity, productive cough, wheezing, tobacco use, ratio of the forced expiratory volume in 1 s over the forced vital capacity [FEV1/FVC] 45 mm Hg), and an established cardiac risk index were used to generate a cardiopulmonary risk index (CPRI). When analyzed using the risk index, the incidence of postoperative complications increased with higher CPRI scores. Those with a CPRI of 4 or greater were 22 times more likely to develop a complication, compared to a CPRI of less than 4 (p CPRI of 4 or greater was associated with significant reductions in peak VO2. We conclude that both the peak VO2 during cardiopulmonary exercise testing and a multifactorial CPRI are highly predictive of complications after lung resection. Adding the peak VO2 did not enhance the risk estimation generated by the CPRI. The association between postoperative complications and peak VO2 may be explained by the correlation between identifiable cardiopulmonary disease (CPRI) and reduced oxygen uptake with exercise.

  15. Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk

    DEFF Research Database (Denmark)

    Jie, Bin; Jiang, Zhu-Ming; Nolan, Marie T

    2012-01-01

    This multicenter, prospective cohort study evaluated the effect of preoperative nutritional support in abdominal surgical patients at nutritional risk as defined by the Nutritional Risk Screening Tool 2002 (NRS-2002)....

  16. Assessment of Preoperative Anxiety in Cardiac Surgery Patients Lacking a History of Anxiety: Contributing Factors and Postoperative Morbidity.

    Science.gov (United States)

    Hernández-Palazón, Joaquín; Fuentes-García, Diego; Falcón-Araña, Luis; Roca-Calvo, María José; Burguillos-López, Sebastián; Doménech-Asensi, Paloma; Jara-Rubio, Rubén

    2017-04-26

    The aim of this study was to measure the level of preoperative anxiety in patients scheduled for cardiac surgery, identify any influencing clinical factors, and assess the relationship between anxiety and postoperative morbidity. A prospective and consecutive study. A single university hospital. The study comprised 200 patients scheduled for cardiac surgery. Each patient was asked to grade his or her preoperative anxiety level using the Visual Analogue Scale for Anxiety, Amsterdam Preoperative Anxiety and Information Scale, and set of specific anxiety-related questions. Demographic data (age, sex, body mass index) and anesthetic and surgical data (American Society of Anesthesiologists physical status, EuroSCORE surgical risk, preoperative length of stay, and previous anesthetic experience) were registered. Also, postoperative morbidity was assessed. Twenty-eight percent of the patients developed high preoperative anxiety. The mean Amsterdam Preoperative Anxiety and Information Scale score was 11.4 ± 4.3, and the mean Visual Analogue Scale for Anxiety score was 48 ± 21. Patients scheduled for coronary artery bypass surgery, who had no previous anesthetic experience, and who were hospitalized before surgery, had higher anxiety scores. Coronary bypass surgery (odds ratio 3.026; 1.509-6.067; p = 0.002) was associated independently with preoperative high-level anxiety. Anxiety most commonly was caused by waiting for surgery, not knowing what is happening, fearing not being able to awaken from anesthesia, and being at the mercy of staff. Anxiety did not modify the postoperative course. In patients waiting to undergo cardiac surgery, both fear of the unknown and lack of information, especially related to the surgery, are crucial factors in high levels of preoperative anxiety in cardiac surgery. Coronary bypass surgery is a determining factor for preoperative anxiety. The anxiety level did not modify the postoperative course in these patients. Copyright © 2017 Elsevier

  17. Preoperative assessment of the older surgical patient: honing in on geriatric syndromes.

    Science.gov (United States)

    Kim, Sunghye; Brooks, Amber K; Groban, Leanne

    2015-01-01

    Nearly 50% of Americans will have an operation after the age of 65 years. Traditional preoperative anesthesia consultations capture only some of the information needed to identify older patients (defined as ≥65 years of age) undergoing elective surgery who are at increased risk for postoperative complications, prolonged hospital stays, and delayed or hampered functional recovery. As a catalyst to this review, we compared traditional risk scores (eg, cardiac-focused) to geriatric-specific risk measures from two older female patients seen in our preoperative clinic who were scheduled for elective, robotic-assisted hysterectomies. Despite having a lower cardiac risk index and Charlson comorbidity score, the younger of the two patients presented with more subtle negative geriatric-specific risk predictors - including intermediate or pre-frail status, borderline malnutrition, and reduced functional/mobility - which may have contributed to her 1-day-longer length of stay and need for readmission. Adequate screening of physiologic and cognitive reserves in older patients scheduled for surgery could identify at-risk, vulnerable elders and enable proactive perioperative management strategies (eg, strength, balance, and mobility prehabilitation) to reduce adverse postoperative outcomes and readmissions. Here, we describe our initial two cases and review the stress response to surgery and the impact of advanced age on this response as well as preoperative geriatric assessments, including frailty, nutrition, physical function, cognition, and mood state tests that may better predict postoperative outcomes in older adults. A brief overview of the literature on anesthetic techniques that may influence geriatric-related syndromes is also presented.

  18. Length of preoperative hospital stay: a risk factor for reducing surgical infection in femoral fracture cases

    Directory of Open Access Journals (Sweden)

    Hoberdan Oliveira Pereira

    2015-12-01

    Full Text Available ABSTRACT OBJECTIVE: To analyze infections of the surgical site among patients undergoing clean-wound surgery for correction of femoral fractures. METHODS: This was a historical cohort study developed in a large-sized hospital in Belo Horizonte. Data covering the period from July 2007 to July 2009 were gathered from the records in electronic medical files, relating to the characteristics of the patients, surgical procedures and surgical infections. The risk factors for infection were identified by means of statistical tests on bilateral hypotheses, taking the significance level to be 5%. Continuous variables were evaluated using Student'sttest. Categorical variables were evaluated using the chi-square test, or Fisher's exact test, when necessary. For each factor under analysis, a point estimate and the 95% confidence interval for the relative risk were obtained. In the final stage of the study, multivariate logistic regression analysis was performed. RESULTS: 432 patients who underwent clean-wound surgery for correcting femoral fractures were included in this study. The rate of incidence of surgical site infections was 4.9% and the risk factors identified were the presence of stroke (odds ratio, OR = 5.0 and length of preoperative hospital stay greater than four days (OR = 3.3. CONCLUSION: To prevent surgical site infections in operations for treating femoral fractures, measures involving assessment of patients' clinical conditions by a multiprofessional team, reduction of the length of preoperative hospital stay and prevention of complications resulting from infections will be necessary.

  19. Preoperative assessment and optimization in periampullary and pancreatic cancer

    Directory of Open Access Journals (Sweden)

    S Myatra

    2011-01-01

    Full Text Available Perioperative management of pancreatic and periampullary cancer poses a considerable challenge to the pancreatic surgeon, anesthesiologist, and the intensive care team. The preoperative surgical evaluation of a pancreatic lesion aims to define the nature of the lesion (malignant or benign, stage the tumor, and to determine resectability or other non-surgical treatment options. Patients are often elderly and may have significant comorbidities and malnutrition. Obstructive jaundice may lead to coagulopathy, infection, renal dysfunction, and adverse outcomes. Routine preoperative biliary drainage can result in higher complication rates, and metal stents may be preferred over plastic stents in selected patients with resectable disease. Judicious use of antibiotics and maintaining fluid volume preoperatively can reduce the incidence of infection and renal dysfunction, respectively. Perioperative fluid therapy with hemodynamic optimization using minimally invasive monitoring may help improve outcomes. Careful patient selection, appropriate preoperative evaluation and optimization can greatly contribute to a favorable outcome after major pancreatic resections.

  20. A novel visual facial anxiety scale for assessing preoperative anxiety

    Science.gov (United States)

    Cao, Xuezhao; Yumul, Roya; Elvir Lazo, Ofelia Loani; Friedman, Jeremy; Durra, Omar; Zhang, Xiao; White, Paul F.

    2017-01-01

    Background There is currently no widely accepted instrument for measuring preoperative anxiety. The objective of this study was to develop a simple visual facial anxiety scale (VFAS) for assessing acute preoperative anxiety. Methods The initial VFAS was comprised of 11 similarly styled stick-figure reflecting different types of facial expressions (Fig 1). After obtaining IRB approval, a total of 265 participant-healthcare providers (e.g., anesthesiologists, anesthesiology residents, and perioperative nurses) were recruited to participate in this study. The participants were asked to: (1) rank the 11 faces from 0–10 (0 = no anxiety, while 10 = highest anxiety) and then to (2) match one of the 11 facial expression with a numeric verbal rating scale (NVRS) (0 = no anxiety and 10 = highest level of anxiety) and a specific categorical level of anxiety, namely no anxiety, mild, mild-moderate, moderate, moderate-high or highest anxiety. Based on these data, the Spearman correlation and frequencies of the 11 faces in relation to the 11-point numerical anxiety scale and 6 categorical anxiety levels were calculated. The highest frequency of a face assigned to a level of the numerical anxiety scale resulted in a finalized order of faces corresponding to the 11-point numeric rating scale. Results The highest frequency for each of the NVRS anxiety scores were as follow: A0, A1, A2, A3, A4, A5, A7, A6, A8, A9 and A10 (Fig 2). For the six categorical anxiety levels, a total of 260 (98.1%) participants chose the face A0 as representing ‘no’ anxiety, 250 (94.3%) participants chose the face A10 as representing ‘highest’ anxiety and 147 (55.5%) participants chose the face A8 as representing ‘moderate-high’ anxiety. Spearman analysis showed a significant correlation between the faces A3 and A5 assigned to the mild-moderate anxiety category (r = 0.58), but A5 was ultimately chosen due to its higher frequency compared to the frequency of A3 (30.6% vs 24.9%)(Fig 3

  1. Assessment of patient satisfaction with the preoperative anesthetic evaluation

    Directory of Open Access Journals (Sweden)

    Gebremedhn EG

    2014-09-01

    Full Text Available Endale Gebreegziabher Gebremedhn, Vidhya Nagaratnam Department of Anesthesia, School of Medicine, Gondar College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia Background: The evaluation of patient satisfaction is a core aspect of the continuous quality improvement in anesthesia service that can be affected by the preoperative anesthetist visit. This visit enables the anesthetist to know about the patient's general health status and the nature of surgery, to choose the type of anesthesia, and to discuss perioperative complications and their management with the patient. Patients have sometimes complained about the information given during the preoperative anesthetic evaluation in the University of Gondar teaching and referral hospital. The aim of this study was to determine the level of patient satisfaction with the preoperative anesthetist visit. Methods: A cross-sectional study was conducted from February 15 to April 15, 2013. All consecutive elective patients who were operated upon under anesthesia during the study period were interviewed 24 hours after operation. A pretested questionnaire and checklists, which were developed based on the hospital's anesthetic evaluation sheet, were used for data collection. Results: A total of 116 elective patients were operated upon under anesthesia during the study period. Of these, 102 patients were included in our study, with a response rate of 87.9%. Anesthetists introduced themselves to ~24% patients; provided information about anesthesia to ~32%, postoperative complications to ~21%, postoperative analgesia to ~18, and postoperative nausea and vomiting to ~21%; and spent adequate time with ~74%. Patients' questions were answered by the anesthetist in ~65% of cases, and ~65% of patients had reduced anxiety after the anesthetist visit. The patients' overall satisfaction with the preoperative anesthetist visit was ~65%. Conclusion and recommendation: Patient satisfaction with the

  2. Preoperative, high IL-6 blood level is a risk factor of postoperative delirium onset in old patients

    Directory of Open Access Journals (Sweden)

    Miriam eCapri

    2014-10-01

    Full Text Available Background: Postoperative delirium (POD is a common complication in elderly patients undergoing surgery, but the underpinning causes are not clear. We hypothesized that inflammaging, the subclinical low and chronic grade inflammation characteristic of old people, can contribute to POD onset. Accordingly, we investigated the association of preoperative and circulating cytokines in elderly patients (>65 yrs, admitted for elective and emergence surgery.Methods: This is secondary analysis of a sub-cohort of patients belonging to a previous large case-control study, where 351 patients were clinically and cognitively thoroughly characterized, together with the assessment of POD (47 patients by Confusion Assessment Method (CAM and Delirium Rating Scale (DRS. 74 preoperative plasma samples were selected from a larger bio-bank and they included 37 subjects with POD and 37 without POD. Inflammaging related cytokines, i.e. IL-1 β, IL-2, IL-6, IL-8, IL-10 and TNF-α were assayed by ELISA in pre-operative blood samples; univariate and multivariable analyses have been applied to identify cytokines independently associated to POD. Associations of cytokine levels with functional status, cognitive decline, intra-hospital mortality and comorbidity were also analyzed independently of POD onset.Results:. High IL-6 and low IL-2 levels were significantly associated with POD. After adjustment for potential confounders in multivariate analysis, high level of preoperative IL-6 was confirmed to be significantly associated with risk of POD onset.. High level of IL-6 was also associated with several baseline features (including poor functional status, cognitive impairment, emergency admission and higher comorbidity burden and intra-hospital mortality.Conclusions: Preoperative, high plasma level of IL-6 ( ≥ 9 pg/mL was significantly associated with POD onset. We propose IL-6 as an additional risk factor of POD onset together with the previously identified factors

  3. [Use of preoperative glucocorticoid to risk reduction of complications after esophagectomy by esophagus carcinoma: meta-analysis].

    Science.gov (United States)

    Raimondi, Antônio Marcos

    2006-12-01

    Preoperative glucocorticoid administration has been proposed for reducing postoperative morbidity. This is not widely used before esophageal resection because of incomplete knowledge regarding its effectiveness. The aim here was to assess the effects of preoperative glucocorticoid administration in adults undergoing esophageal resection for esophageal carcinoma. Studies were identified by searching the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CancerLit, SCIELO and Cochrane Library, and by manual searching from relevant articles. The last search for clinical trials for this systematic review was performed in December 2005. This review included randomized studies of patients with potentially resectable carcinomas of the esophagus that compared preoperative glucocorticoid administration with placebo. Data were extracted by the reviewer, and the trial quality was assessed using Jadad scoring. Odds ratio with 95% confidence limits and bayesian relative risk were used to assess the significance of the difference between the treatment arms. Four randomized trials involving 169 patients were found. There were no differences in postoperative mortality, anastomotic leakage, hepatic and renal failure between the glucocorticoid and placebo groups. There were fewer postoperative respiratory complications (95% CI = 0.09-0.46), sepsis (95% CI = 0.10-0.81), and total postoperative complications (95% CI = 0.06-0.23) with preoperative glucocorticoid administration. Prophylactic administration of glucocorticoids is associated with decreased postoperative complications.

  4. Preoperative calculation of risk for prolonged intensive care unit stay following coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Dihmis Walid C

    2006-05-01

    Full Text Available Abstract Objective Patients who have prolonged stay in intensive care unit (ICU are associated with adverse outcomes. Such patients have cost implications and can lead to shortage of ICU beds. We aimed to develop a preoperative risk prediction tool for prolonged ICU stay following coronary artery surgery (CABG. Methods 5,186 patients who underwent CABG between 1st April 1997 and 31st March 2002 were analysed in a development dataset. Logistic regression was used with forward stepwise technique to identify preoperative risk factors for prolonged ICU stay; defined as patients staying longer than 3 days on ICU. Variables examined included presentation history, co-morbidities, catheter and demographic details. The use of cardiopulmonary bypass (CPB was also recorded. The prediction tool was tested on validation dataset (1197 CABG patients between 1st April 2003 and 31st March 2004. The area under the receiver operating characteristic (ROC curve was calculated to assess the performance of the prediction tool. Results 475(9.2% patients had a prolonged ICU stay in the development dataset. Variables identified as risk factors for a prolonged ICU stay included renal dysfunction, unstable angina, poor ejection fraction, peripheral vascular disease, obesity, increasing age, smoking, diabetes, priority, hypercholesterolaemia, hypertension, and use of CPB. In the validation dataset, 8.1% patients had a prolonged ICU stay compared to 8.7% expected. The ROC curve for the development and validation datasets was 0.72 and 0.74 respectively. Conclusion A prediction tool has been developed which is reliable and valid. The tool is being piloted at our institution to aid resource management.

  5. Preoperative assessment and classification of benign laryngotracheal stenosis : a consensus paper of the European Laryngological Society

    NARCIS (Netherlands)

    Monnier, Ph.; Dikkers, F. G.; Eckel, H.; Sittel, C.; Piazza, C.; Campos, G.; Remacle, M.; Peretti, G.

    2015-01-01

    Adult and pediatric laryngotracheal stenoses (LTS) comprise a wide array of various conditions that require precise preoperative assessment and classification to improve comparison of different therapeutic modalities in a matched series of patients. This consensus paper of the European Laryngologica

  6. Preoperative High-Resolution Ultrasound for the Assessment of Malignant Central Compartment Lymph Nodes in Papillary Thyroid Cancer.

    Science.gov (United States)

    Khokhar, Mamoona T; Day, Kristopher M; Sangal, Rohit B; Ahmedli, Nigar N; Pisharodi, Latha R; Beland, Michael D; Monchik, Jack M

    2015-12-01

    The identification and removal of malignant central compartment lymph nodes (MCLN) is important to minimize the risk of persistent or recurrent local disease in patients with papillary thyroid cancer (PTC). While the diagnostic accuracy of preoperative ultrasound for the assessment of lateral compartment node metastases is well recognized, its role in the identification of central compartment node metastases in patients with PTC is less established. This study delineates the utility of high-resolution ultrasound (HUS) for the assessment of MCLN in patients with PTC. A retrospective chart review was performed of 227 consecutive patients who underwent total thyroidectomy for biopsy-proven PTC by a single endocrine surgeon in an academic tertiary care center between 2004 and 2014. Preoperative sonographic results were compared to postoperative pathology reports to determine the accuracy of HUS for the assessment of MCLN. Statistical analysis also included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). HUS identified abnormal central compartment nodes in 51 (22.5%) patients. All 227 patients underwent a careful central compartment node exploration. One hundred and four (45.8%) patients had MCLN identified by surgery, of whom 65 (62.5%) had a negative preoperative central compartment HUS. The sensitivity and specificity of preoperative HUS for the assessment of MCLN were 0.38 and 0.90, respectively. The PPV and NPV were 0.76 and 0.63, with an accuracy of 0.66. Preoperative HUS is quite specific for the identification of MCLN in patients with PTC. The present findings emphasize, however, that a negative HUS does not obviate the need for careful exploration of the central compartment to minimize the risk of persistent or recurrent local disease.

  7. Comparing the organisational structure of the preoperative assessment clinic at eight university hospitals.

    Science.gov (United States)

    Edward, G M; Biervliet, J D; Hollmann, M W; Schlack, W S; Preckel, B

    2008-01-01

    The preoperative assessment clinic (PAC) has been implemented in most major hospitals. However, there is no uniformity in the way PACs are organised. We compared the organisational structure of the PACs from all eight university hospitals in The Netherlands, looking at the following variables: number of patients visiting the PAC, staffing of the PAC, opening hours, scheduling, and additional preoperative diagnostic testing. The number of patients seen yearly varies from 7.000 to 13.500. In all clinics, the preoperative assessment was performed by anaesthetists and residents. In five PACs, preoperative assessment was also performed by physician assistants or nurse practitioners. Opening hours varied. Consultations are by appointment, 'walk-in', or a combination of these two. In four clinics additional testing is performed at the PAC itself. This study shows that the organisational structure of the PAC at similar university hospitals varies greatly; this can have important implications when designing a benchmarking process.

  8. Preoperative assessment of the cancellous bone mineral density of the proximal humerus using CT data

    Energy Technology Data Exchange (ETDEWEB)

    Krappinger, Dietmar; Roth, Tobias; Gschwentner, Martin; Suckert, Armin; Blauth, Michael; Hengg, Clemens; Kralinger, Franz [Innsbruck Medical University, Department of Trauma Surgery and Sports Medicine, Innsbruck (Austria)

    2012-03-15

    Osteoporotic fractures of the proximal humerus show an increasing incidence. Osteoporosis not only influences the fracture risk after low-energy trauma, but also affects the mechanical stability of internal fixation. Preoperative assessment of the local bone quality may be useful in the surgical treatment of patients sustaining these injuries. The aim of the present study was to present a method for the preoperative assessment of the local cancellous bone mineral density (BMD) of the proximal humerus using CT data. In the first part of the study, CT scans of 30 patients with unilateral fractures of the proximal humerus after low-energy trauma were used. The local BMD was assessed on the contralateral uninjured side. All 30 patients additionally underwent dual-emission X-ray absorptiometry (DXA) of the lumbar spine, proximal femur, and forearm of the side of the uninjured proximal humerus within 6 weeks after trauma. Three independent trauma surgeons performed measurements on the uninjured proximal humerus twice with a time interval of 4 weeks in order to assess the inter- and intraobserver reliability of the method. In the second part of the study, the local BMD of 507 patients with either proximal humerus fractures or chronic shoulder instability was assessed by a single trauma surgeon. In both parts, the average HU values in standardized ROIs of the humeral head were automatically calculated after correcting for HU values below the water equivalent. A linear calibration equation was computed for the calculation from HU to BMD using a calibration device (EFP). The intra- and interobserver reliability was high (ICC > 0.95). Correlation coefficients between the local BMD of the proximal humerus and other anatomical sites were between 0.35 (lumbar spine) and 0.64 (forearm). We found a high correlation between the local BMD and age. The BMD in the fracture group was significantly lower than in the instability group. These patients were significantly older and more

  9. Focus assessed transthoracic echocardiography for preoperative assessment in patients scheduled for acute surgery

    DEFF Research Database (Denmark)

    Bøtker, Morten Thingemann; Frederiksen, C.A.; Lauridsen Vang, M.K.

    2013-01-01

    Introduction: Unexpected cardiopulmonary complications are a well-known and feared entity during surgery and anaesthesia, acknowledged in previous reports. Focus Assessed Transthoracic Echocardiography (FATE) has proven to be feasible in intensive care units and perioperatively for evaluation...... were recorded. After the routine preoperative assessment these were reported to the anaesthetist responsible for the anaesthesia.Whether or not this led to changes in the perioperative management was registered. Results: 112 patients scheduled for acute surgery were included. Mean age was 62 years (57...

  10. Relationship between preschool children and the caregiver's preoperative anxiety. A cross study assessing modified Yale preoperative anxiety Scale (m-YPAS)

    OpenAIRE

    Emiliana Gomes de Mello; Vivian Brancalione Gonçalves; Neil Ferreira Novo; Eduardo Toshiyuki Moro

    2015-01-01

    Anxiety is a common event in children before surgery. Several ways have been proposed to assess the level of anxiety in pediatric patients. The modified Yale Preoperative Anxiety Scale (m-Ypas) was developed recently and allows the assessment of anxiety level from the observation of children's attitudes. The aim of the study was to evaluate the influence of variables such as anxiety of caregivers (parents or relatives), preoperative fasting and previous surgical experiences on children's anxi...

  11. Preoperative serum tetranectin, CA125 and menopausal status used as single markers in screening and in a risk assessment index (RAI) in discriminating between benign and malignant ovarian tumors

    DEFF Research Database (Denmark)

    Begum, F D; Høgdall, E; Kjaer, S K;

    2009-01-01

    risk for OC for quick referral to highly specialized centers in gynecologic oncology. These aims were addressed in the present study by evaluating serum tetranectin (TN) and serum CA125 on a large number of pre- and postmenopausal women with ovarian tumors and controls. METHODS: The potential ability...... of the markers to discriminate between the four groups (208 benign ovarian tumor, 153 borderline ovarian tumor (BOT), 445 OC and 1333 age matched controls) in OC screening was examined. We also constructed a risk assessment index (RAI) for discrimination between tumor groups based on these variables...

  12. Pre-Operative Patient Education is Associated With Decreased Risk of Arthrofibrosis After Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Livbjerg, Anna Emilie; Frøkjær, Sara; Simonsen, Ole

    2013-01-01

    -control studies. Data on potential risk factors were extracted from the Danish Knee arthroplasty Register and from a postal questionnaire including long-term outcome measures regarding pain, function and quality of life (Oxford Knee Score and EQ-5D). Previous knee surgery and a high preoperative Knee Society...

  13. Pipeline risk assessment

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-07-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1999-02-01

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

  15. High-resolution CT: pre-operative assessment of chronic and recurrent rhinosinusitis

    Energy Technology Data Exchange (ETDEWEB)

    Ferrie, J.C. [Dept. of Radiology A, University Hospital, 86 Poitiers (France); Vandermarcq, P. [Dept. of Radiology A, University Hospital, 86 Poitiers (France); Azais, O. [Dept. of Radiology A, University Hospital, 86 Poitiers (France); Klossek, J.M. [Dept. of Oto-Rhino-Laryngology, University Hospital, 86 Poitiers (France); Drouineau, J. [Dept. of Radiology A, University Hospital, 86 Poitiers (France)

    1993-04-01

    The better understanding of chronic and recurrent rhinosinusitis and the advance in endoscopic endonasal surgery have modified the radiological pre-operative investigation of this condition. The ethmoid labyrinth, not accessible to the endoscope, may be explored by axial and coronal high-resolution thin section (2 mm) CT. We have reviewed 100 CT scans with endoscopic correlation in order to assess the accuracy of this pre-operative method. This anatomical study reveals the presence and extent of parasinus diseases which are usually concentrated in the area of the ostiomeatal unit. The anatomic variations of the lateral nasal wall that have been reporded as predisposing to sinusitis and the morphologic variations altering the relationships of the ethmoid with the orbits and the brain were also studied. This pre-operative radiological assessment is currently necessary for functional and safe surgery. (orig.)

  16. Risk reduction before surgery. The role of the primary care provider in preoperative smoking and alcohol cessation

    DEFF Research Database (Denmark)

    Tønnesen, Hanne; Faurschou, Pernille; Ralov, Helge

    2010-01-01

    Daily smokers and hazardous drinkers are high-risk patients, developing 2-4 times more complications after surgery. Preoperative smoking and alcohol cessation for four to eight weeks prior to surgery halves this complication rate. The patients' preoperative contact with the surgical departments m...

  17. Assessment of cardiovascular risk.

    LENUS (Irish Health Repository)

    Cooney, Marie Therese

    2010-10-01

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

  18. Preoperative airway assessment - experience gained from a multicentre cluster randomised trial and the Danish Anaesthesia Database.

    Science.gov (United States)

    Nørskov, Anders Kehlet

    2016-05-01

    Difficulties with airway management in relation to general anaesthesia have been a challenge for the anaesthesiologist since the birth of anaesthesia. Massive landmark improvements have been made and general anaesthesia is now regarded as a safe procedure. However, rare, difficult airway management still occurs and it prompts increased risk of morbidity and mortality - especially when not anticipated. Several preoperative risk factors for airway difficulties have been identified, yet none have convincing diagnostic accuracy as stand alone tests. Combining several risk factors increase the predictive value of the test and multivariable risk models have been developed. The Simplified Airway Risk Index (SARI) is a predictive model developed for anticipation of a difficult direct laryngoscopy. However, neither the diagnostic accuracy of the SARI nor of any other model has been tested prospectively and compared with existing practice for airway assessment in a randomised trial setting. The first objective of this thesis was to quantify the proportion of unanticipated difficult intubation and difficult mask ventilation in Denmark. The second objective was to design a cluster randomised trial, using state of the art methodology, in order to test the clinical impact of using the SARI for preoperative airway assessment compared with a clinical judgement based on usual practice for airway assessment. Finally, to test if implementation of the SARI would reduce the proportion of unanticipated difficult intubation compared with usual care for airway assessment. This thesis is based on data from the Danish Anaesthesia Database (DAD). Paper 1 presents an observational cohort study on 188,064 patients who underwent tracheal intubation from 2008 to 2011. Data on the anaesthesiologists' preoperative anticipations of airway difficulties was compared with actual airway management conditions, thus enabling an estimation of the proportion of unanticipated difficulties with intubation

  19. Assessing preoperative anxiety using a questionnaire and clinical rating: a prospective observational study.

    Science.gov (United States)

    Laufenberg-Feldmann, Rita; Kappis, Bernd

    2013-12-01

    Preoperative anxiety and need for information can be detected during preoperative consultation via structured and standardised screening by the Amsterdam Preoperative Anxiety and Information Scale (APAIS) questionnaire. To identify the prevalence of preoperative anxiety and need for information, with regard to influencing factors such as age, sex, previous operation and grade of surgery, and to examine the level of agreement between patients' self-rating and physicians' ratings. Prospective observational study. Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Germany. Two hundred seventeen patients scheduled for elective surgery. The patients completed questionnaires prior to the interaction with the anaesthesiologist. Physicians were blinded to the patients' ratings and provided their subjective ratings about patients' anxiety and need for information immediately after seeing the patient. Degree of anxiety and need for information, agreement of patients' self-reports and physician's rating. 18.9% of patients were classified as 'anxiety cases' (31.8% in women and 10.6% in men). The grade of the intended surgery but no other investigated factor was related to patients' anxiety. Age (older patients) was correlated with information requirement (r = 0.21, P = 0.002). Analysis of agreement showed only weak correlations between patients' self-reports and physicians' ratings, demonstrated in low weighted Kappa-coefficients (0.12 to 0.32). The APAIS is a useful instrument to assess the level of patients' preoperative anxiety and the need for information. Given the relationship between preoperative anxiety and postoperative outcome, it seems justified to incorporate this approach into the preoperative consultation. German Clinical Trials Register DRKS00003084.

  20. GM Risk Assessment

    Science.gov (United States)

    Sparrow, Penny A. C.

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

  1. The obesity paradox in surgical patients : From preoperative assessment to long term outcome

    NARCIS (Netherlands)

    W. Galal (Wael)

    2016-01-01

    markdownabstractIn the Netherlands, 16 million inhabitants undergo about 1 million surgical procedures annually. The percentage of serious adverse advents is a burden to society and stresses the need for adequate preoperative assessment in order to select and optimize surgical patients. The clinical

  2. An evaluation of factors influencing the assessment time in a nurse practitioner-led anaesthetic pre-operative assessment clinic.

    Science.gov (United States)

    Hawes, R H; Andrzejowski, J C; Goodhart, I M; Berthoud, M C; Wiles, M D

    2016-03-01

    Elective patients undergoing anaesthetic pre-operative assessment are usually allocated the same period of time with a nurse practitioner, leading to potential inefficiencies in patient flow through the clinic. We prospectively collected data on 8519 patients attending a pre-operative assessment clinic. The data set were split into derivation and validation cohorts. Standard multiple regressions were used to construct a model in the derivation cohort, which was then tested in the validation cohort. Due to missing data, 2457 patients were not studied, leaving 5892 for analysis (3870 in the derivation cohort and 2022 in the validation cohort). The mean (SD) pre-operative assessment time was 46 (12) min. Age, ASA physical status, nurse practitioner and surgical specialty all influenced the time spent in pre-operative assessment. The predictive equations calculated using the derivation cohort, based on age and ASA physical status, correctly estimated duration of consultation to within 20% of the maximum predicted time in 74.2% of the validation cohort. We conclude that if age and ASA physical status are known before the pre-operative assessment consultation, it could allow appointment times to be allocated more accurately.

  3. Role of Pre-Operative Blood Transfusion and Subcutaneous Fat Thickness as Risk Factors for Surgical Site Infection after Posterior Thoracic Spine Stabilization.

    Science.gov (United States)

    Osterhoff, Georg; Burla, Laurin; Werner, Clément M L; Jentzsch, Thorsten; Wanner, Guido A; Simmen, Hans-Peter; Sprengel, Kai

    2015-06-01

    Surgical site infections (SSIs) increase morbidity and mortality rates and generate additional cost for the healthcare system. Pre-operative blood transfusion and the subcutaneous fat thickness (SFT) have been described as risk factors for SSI in other surgical areas. The purpose of this study was to assess the impact of pre-operative blood transfusion and the SFT on the occurrence of SSI in posterior thoracic spine surgery. In total, 244 patients (median age 55 y; 97 female) who underwent posterior thoracic spine fusions from 2008 to 2012 were reviewed retrospectively. Patient-specific characteristics, pre-operative hemoglobin concentration/hematocrit values, the amount of blood transfused, and the occurrence of a post-operative SSI were documented. The SFT was measured on pre-operative computed tomography scans. Surgical site infection was observed in 26 patients (11%). The SFT was 13 mm in patients without SSI and 14 mm in those with infection (p=0.195). The odds ratio for patients with pre-operative blood transfusion to present with SSI was 3.1 (confidence interval [CI] 1.4-7.2) and 2.7 (CI 1.1-6.4) when adjusted for age. There was no difference between the groups with regard to pre-operative hemoglobin concentration (p=0.519) or hematocrit (p=0.908). The SFT did not differ in the two groups. Allogeneic red blood cell transfusion within 48 h prior to surgery was an independent risk factor for SSI after posterior fusion for the fixation of thoracic spine instabilities. Pre-operative blood transfusion tripled the risk, whereas SFT had no influence on the occurrence of SSI.

  4. Risk of endometrial cancer in patients with a preoperative diagnosis of atypical endometrial hyperplasia treated with total laparoscopic hysterectomy

    Directory of Open Access Journals (Sweden)

    Katsutoshi Oda

    2016-05-01

    Conclusion: Careful preoperative examinations, including hysteroscopy, might be useful to evaluate the risk of EC. Accordingly, we should be still careful about the possibility of overdiagnosis in patients with AEH.

  5. Quantitative microbiological risk assessment.

    Science.gov (United States)

    Hoornstra, E; Notermans, S

    2001-05-21

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

  6. Risk Assessment Overview

    Science.gov (United States)

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

    2011-01-01

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

  7. Biosafety Risk Assessment Methodology

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-10-01

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

  8. Offshore risk assessment

    CERN Document Server

    Vinnem, Jan-Erik

    2014-01-01

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

  9. Morphologic assessment of thoracic deformities for the preoperative evaluation of pectus excavatum by magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Lollert, A.; Funk, J.; Tietze, N.; Laudemann, K.; Dueber, C.; Staatz, G. [Medical Center of the Johannes Gutenberg University, Department of Diagnostic and Interventional Radiology, Section Pediatric Radiology, Mainz (Germany); Turial, S. [Medical Center of the Johannes Gutenberg University, Department of Pediatric Surgery, Mainz (Germany)

    2014-10-15

    To assess whether MRI is a suitable modality for the preoperative assessment and quantification of pectus excavatum. A total of 69 patients (57 male, 12 female; median age 15 years, range 5-35 years) with pectus excavatum were evaluated preoperatively using standardized MRI sequences on 1.5- and 3-Tesla systems (T2-HASTE/inspiration and expiration, T1-VIBE, T2-TRUFI free-breathing, T2-BLADE). The MR sequences were analysed for quality semiquantitatively. The Haller index, correction index, sternal rotation angle and asymmetry index were assessed; correlations between these indices and changes in inspiration and expiration were evaluated. T2-HASTE was the best sequence to assess pectus excavatum morphology, with a higher quality at 3 T than at 1.5 T. All indices could be assessed in every patient. A total of 37 patients had a symmetric deformity, 32 patients an asymmetric deformity. The Haller index correlated significantly (p < 0.001) with the correction index, both becoming higher in expiration. The asymmetry index correlated with the sternal rotation angle (p < 0.001) and did not change significantly in expiration (p = 0.28). Thoracic MRI is suitable for the preoperative evaluation of patients with pectus excavatum. An exact morphologic assessment is possible without radiation exposure as well as the determination of several indices to quantify the deformities. (orig.)

  10. Evaluating Compliance with Institutional Preoperative Testing Guidelines for Minimal-Risk Patients Undergoing Elective Surgery

    Directory of Open Access Journals (Sweden)

    Arunotai Siriussawakul

    2013-01-01

    Full Text Available Background. Few investigations preoperatively are important for low-risk patients. This study was designed to determine the level of compliance with preoperative investigation guidelines for ASA I patients undergoing elective surgery. Secondary objectives included the following: to identify common inappropriate investigations, to evaluate the impact of abnormal testing on patient management, to determine factors affecting noncompliant tests, and to estimate unnecessary expenditure. Methods. This retrospective study was conducted on adult patients over a one-year period. The institute’s guidelines recommend tests according to the patients’ age groups: a complete blood count (CBC for those patients aged 18–45; CBC, chest radiograph (CXR and electrocardiography (ECG for those aged 46–60; and CBC, CXR, ECG, electrolytes, blood glucose, blood urea nitrogen (BUN, and creatinine (Cr for patients aged 61–65. Results. The medical records of 1,496 patients were reviewed. Compliant testing was found in only 12.1% (95% CI, 10.5–13.9. BUN and Cr testings were the most frequently overprescribed tests. Overinvestigations tended to be performed on major surgery and younger patients. Overall, overinvestigation incurred an estimated cost of US 200,000 dollars during the study period. Conclusions. The need to utilize the institution’s preoperative guidelines should be emphasized in order to decrease unnecessary testing and the consequential financial burden.

  11. Preoperative vaginal preparation with povidone-iodine and the risk of postcesarean endometritis.

    Science.gov (United States)

    Starr, Rosally V; Zurawski, Jill; Ismail, Mahmoud

    2005-05-01

    Postcesarean endometritis and wound infection remain significant morbidities, despite use of strategies to prevent these complications. We investigated the effect of preoperative vaginal preparation with povidone-iodine as a preventive intervention against postcesarean endometritis and wound infection. A randomized controlled study was performed in 308 women undergoing nonemergent cesarean delivery. Subjects received either standard abdominal scrub alone or abdominal scrub with an additional vaginal preparation with povidone-iodine solution. All subjects received prophylactic antibiotic at the time of umbilical cord clamping. Each subject's postoperative course was reviewed for development of febrile morbidity (temperature > 38.0 degrees C), endometritis (temperature > 38.4 degrees C accompanied by fundal tenderness occurring beyond the first postoperative day, in the absence of evidence of other infection), and wound infection. Postcesarean endometritis occurred in 7.0% of subjects who received a preoperative vaginal preparation and 14.5% of controls (P history of antenatal genitourinary infection (adjusted OR 2.9, 95% CI 1.265-6.596). Preoperative vaginal scrub with povidone-iodine decreases the incidence of postcesarean endometritis. This intervention does not seem to decrease the overall risk of postoperative fever or wound infection.

  12. Preoperative airway assessment - experience gained from a multicentre cluster randomised trial and the Danish Anaesthesia Database

    DEFF Research Database (Denmark)

    Nørskov, Anders Kehlet

    2016-01-01

    , using state of the art methodology, in order to test the clinical impact of using the SARI for preoperative airway assessment compared with a clinical judgement based on usual practice for airway assessment. Finally, to test if implementation of the SARI would reduce the proportion of unanticipated...... to the DIFFICAIR trial described in Paper 4. The trial was designed to randomise anaesthesia department to either thorough education in, and subsequent use of the SARI for preoperative airway assessment or to continue usual care. Registration of the SARI in DAD was made mandatory in SARI departments and impossible...... baseline values of the primary outcome used in the DIFFICAIR trial. Paper 1 revealed that 1.86% of all patients who were intubated, but not planned for advanced intubation techniques (e.g. video laryngoscopy), were unanticipated difficult to intubate. However, 75 to 93% of all difficult intubations were...

  13. Role of preoperative anemia for risk of transfusion and postoperative morbidity in fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Jans, Øivind; Jørgensen, Christoffer; Kehlet, Henrik

    2014-01-01

    BACKGROUND: Preoperative anemia has been associated with increased risk of allogeneic blood transfusion and postoperative morbidity and mortality. The prevalence of preoperative anemia and its association with postoperative outcomes has not previously been reported in relation to fast......-track elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). We aimed to evaluate the prevalence of preoperative anemia in elective fast-track THA and TKA and its association with risk of perioperative transfusion, prolonged length of hospital stay (LOS), and postoperative readmission. STUDY...... national databases and patient charts. Adjusted risk estimates for transfusion, prolonged LOS, and all-cause readmission according to preoperative anemia status were obtained by multivariate logistic regression. RESULTS: A total of 5.165 THA or TKA procedures were included with a mean patient age of 67...

  14. Development and Validation of a Preoperative Surgical Site Infection Risk Score for Primary or Revision Knee and Hip Arthroplasty.

    Science.gov (United States)

    Everhart, Joshua S; Andridge, Rebecca R; Scharschmidt, Thomas J; Mayerson, Joel L; Glassman, Andrew H; Lemeshow, Stanley

    2016-09-21

    Surgical site infection (SSI) is a major complication following total joint arthroplasty. Host susceptibility to infection has emerged as an important predictor of SSI. The purpose of this study was to develop and validate a preoperative SSI risk-assessment tool for primary or revision knee and hip arthroplasty. Data for 6,789 patients who underwent total joint arthroplasty (from the years 2000 to 2011) were obtained from a single hospital system. SSI was defined as a superficial infection within 30 days or deep infection within 1 year. Logistic regression modeling was utilized to create a risk scoring system for a derivation sample (n = 5,789; 199 SSIs), with validation performed on a hold-out sample (a subset of observations chosen randomly from the initial sample to form a testing set; n = 1,000; 41 SSIs). On the basis of logistic regression modeling, we created a scoring system to assess SSI risk (range, 0 to 35 points) that is the point sum of the following: primary hip arthroplasty (0 points); primary knee (1); revision hip (3); revision knee (3); non-insulin-dependent diabetes (1); insulin-dependent diabetes (1.5); chronic obstructive pulmonary disease (COPD) (1); inflammatory arthropathy (1.5); tobacco use (1.5); lower-extremity osteomyelitis or pyogenic arthritis (2); pelvis, thigh, or leg traumatic fracture (2); lower-extremity pathologic fracture (2.5); morbid obesity (2.5); primary bone cancer (4); reaction to prosthesis in the last 3 years (4); and history of staphylococcal septicemia (4.5). The risk score had good discriminatory capability (area under the ROC [receiver operating characteristic] curve = 0.77) and calibration (Hosmer-Lemeshow chi-square test, p = 0.34) and was validated using the independent sample (area under the ROC curve = 0.72). A small subset of patients (5.9%) had a >10% estimated infection risk. The patient comorbidities composing the risk score heavily influenced SSI risk for primary or revision knee and hip arthroplasty. We

  15. Preoperative airway assessment - experience gained from a multicentre cluster randomised trial and the Danish Anaesthesia Database

    DEFF Research Database (Denmark)

    Nørskov, Anders Kehlet

    2016-01-01

    difficult intubation compared with usual care for airway assessment. This thesis is based on data from the Danish Anaesthesia Database (DAD). Paper 1 presents an observational cohort study on 188,064 patients who underwent tracheal intubation from 2008 to 2011. Data on the anaesthesiologists' preoperative...... to the DIFFICAIR trial described in Paper 4. The trial was designed to randomise anaesthesia department to either thorough education in, and subsequent use of the SARI for preoperative airway assessment or to continue usual care. Registration of the SARI in DAD was made mandatory in SARI departments and impossible...... in usual care departments. Conditions regarding anticipation of difficulties and actual airway managements were recorded as for Paper 1. DAD data made it possible to estimate an appropriate sample size, considering the between cluster variation, and to construct a stratification variable based on 2011...

  16. Preoperative delay of more than 1 hour increases the risk of surgical site infection.

    Science.gov (United States)

    Radcliff, Kris E; Rasouli, Mohammad R; Neusner, Alex; Kepler, Christopher K; Albert, Todd J; Rihn, Jeffrey A; Hilibrand, Alan S; Vaccaro, Alexander R

    2013-07-01

    Retrospective institutional database review. To determine whether preoperative in-room time is a risk factor for surgical site infection (SSI). Prior to spine surgery, while the patient is in the operating room, several procedures may be performed that may delay surgery. During this time, the sterile field may be exposed and may become contaminated. The hypothesis of this study was that the length of time in the operative room prior to surgical incision (anesthesia ready time [ART]) was related to the risk of SSI. From 2005 to 2009, we identified 276 patients who developed SSI out of 7991 cases that underwent spine surgery from 2005 to 2009. Patient demographic factors, American Society of Anesthesiologists score, wound classification, number of levels, anatomic region, type of surgical approach, and length of surgery were extrapolated. ART was calculated as the time after the patient was brought into the operating room prior to surgical incision. Multivariate analysis was performed to identify risk factors for SSI. Mean ART was significantly (P = 0.001) higher in patients with infection (68 min) compared with those without infection (60 min). The infection rate was higher in cases with ART more than 1 hour compared with those with less than 1 hour (4.9% vs. 2.3%, P = 0.001). In multivariate analysis, ART more than 1 hour was an independent risk factor for SSI, along with number of levels, American Society of Anesthesiologists score and posterior approach. The highest percentage of cases with ART more than 1 hour occurred in August and September. Preoperative in-room time prior to the start of surgical incision is an independent risk factor for SSI. All possible steps should be taken prior to entry into the operating theater to reduce in-room time and opening of surgical sterile instrumentation be delayed until the surgery is ready to proceed.

  17. Landslide risk assessment

    Science.gov (United States)

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

    1983-01-01

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

  18. Patient caries risk assessment

    DEFF Research Database (Denmark)

    Twetman, Svante; Fontana, Margherita

    2009-01-01

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

  19. Implementation of a preoperative briefing protocol improves accuracy of teamwork assessment in the operating room.

    Science.gov (United States)

    Paige, John T; Aaron, Deborah L; Yang, Tong; Howell, D Shannon; Hilton, Charles W; Cohn, Isidore; Chauvin, Sheila W

    2008-09-01

    This study examined the effect of implementing a new preoperative briefing protocol on self- and peer-assessments of individual operating room (OR) teamwork behaviors. From July 2006 to February 2007, OR teamwork performance at a rural community hospital was evaluated before and after training and implementation of the protocol. After each case, every member on the team completed a 360-degree type teamwork behavior evaluation containing both self- and peer-assessments using a six-point Likert type scale (1 = definitely no to 6 = definitely yes). Individual behavior change was measured using the mean scale score of pre and postprotocol assessments. Statistical analysis included t test for both pre/post and self/peer differences. Data were available for one general surgeon and nine OR staff (pre = 20 cases, post = 16 cases). The preprotocol self-assessment mean score was significantly higher than peer-assessment (5.63 vs 5.29, P teamwork behaviors. No difference was observed in postassessment mean scores for self- and peer-assessments. Individuals overestimated their teamwork behaviors before protocol implementation. Using a preoperative protocol seems to improve OR staff teamwork behaviors and self-assessment accuracy. The use of a 360-degree assessment method targeting specific, observable behaviors may be useful in evaluating team-based interventions and enhancing teamwork effectiveness.

  20. Preoperative risk stratification using metabolic parameters of {sup 18}F-FDG PET/CT in patients with endometrial cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kitajima, Kazuhiro [Kobe University School of Medicine, Department of Radiology, Kobe (Japan); Kobe University Graduate School of Medicine, Department of Radiology, Kobe (Japan); Suenaga, Yuko; Ueno, Yoshiko; Maeda, Tetsuo; Sofue, Keitarou; Sugimura, Kazuro [Kobe University School of Medicine, Department of Radiology, Kobe (Japan); Ebina, Yasuhiko; Yamada, Hideto [Kobe University School of Medicine, Department of Obstetrics and Gynecology, Kobe (Japan); Okunaga, Takashi; Kubo, Kazuhiro [Kobe University Hospital, Department of Radiology Division, Kobe (Japan); Kanda, Tomonori [Teikyo University School of Medicine, Department of Radiology, Tokyo (Japan); Tamaki, Yukihisa [Shimane University School of Medicine, Department of Radiation Oncology, Shimane (Japan)

    2015-07-15

    To evaluate the usefulness of metabolic parameters obtained by {sup 18}F-FDG PET/CT for preoperative stratification of high-risk and low-risk endometrial carcinomas. Preoperative {sup 18}F-FDG PET/CT was performed in 56 women with endometrial cancer. Maximum standardized uptake values (SUVmax), metabolic tumour volume (MTV) and total lesion glycolysis (TLG) of primary tumours were compared with clinicopathological features of surgical specimens. Diagnostic performance in terms of differentiation of low-risk disease (endometrioid histology, histological grade 1 or 2, invasion of less than half of the myometrium, and FIGO stage I) from high-risk disease was assessed. MTV and TLG were significantly higher in patients with higher histological grade (p = 0.0026 and p = 0.034), larger tumour size (p = 0.002 and p = 0.0017), lymphovascular space involvement (LVSI; p = 0.012 and p = 0.0051), myometrial invasion (p = 0.027 and p = 0.031), cervical stromal invasion (p = 0.023 and p = 0.014), ovarian metastasis (p = 0.00022 and p = 0.00034), lymph node metastasis (p < 0.0001 and p < 0.0001), and higher FIGO stage (p = 0.0011 and p = 0.00048). SUVmax was significantly higher in patients with larger tumour size (p = 0.0025), LVSI (p = 0.00023) and myometrial invasion (p < 0.0001). The areas under the ROC curves (AUCs) for distinguishing high-risk from low-risk carcinoma were 0.625, 0.829 and 0.797 for SUVmax, MTV and TLG, respectively. AUCs for both MTV and TLG were significantly larger than that for SUVmax (p = 0.0049 and p = 0.021). The optimal TLG cut-off value of 70.2, determined by ROC analysis, was found to have 72.0 % sensitivity and 74.2 % specificity for risk stratification. MTV and TLG of primary endometrial cancer show better correlations with clinicopathological features and are more useful for differentiating high-risk from low-risk carcinoma than SUVmax. (orig.)

  1. Cardiac Risk Assessment

    Science.gov (United States)

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

  2. Preoperative TSH level and risk of thyroid cancer in patients with nodular thyroid disease: nodule size contribution.

    Science.gov (United States)

    Zafón, Carles; Obiols, Gabriel; Mesa, Jordi

    2015-01-01

    Many reports have supported the relationship between high preoperative TSH levels and risk of thyroid cancer in nodular thyroid disease (NTD). We investigated whether TSH levels are related to the risk of differentiated thyroid carcinoma (DTC) in patients who have undergone total thyroidectomy for NTD. The relationship between TSH and size of malignant nodule was investigated. Finally, we assessed whether TSH levels are related to DTC and presence of additional benign nodules. A retrospective study of 980 patients was conducted. Variables included age at diagnosis, TSH level, nodule size, gender, final histology (benign versus DTC), and type of malignancy. Malignancy was present in 261 (26.6%) patients. These patients had higher median TSH levels as compared to those with no malignancy (1.61 mU/L (0.9-2.5) versus 0.9 mU/L (0.3-1.6); p-value<0.001). TSH was higher in patients with DTC in whom the largest nodule was malignant than in patients in whom the largest nodule was benign (1.80 mU/L (1.1-2.6) versus 1.38 mU/L (0.7-2.1) respectively; p-value=0.025). A significant correlation was seen between malignant nodule size and TSH level, but not between TSH levels and size of the largest benign nodule. Our study supported an association between preoperative TSH levels and risk of DTC in patients with NTD. There was also a direct relationship between malignant nodule size and TSH levels. By contrast, no relationship was found between the size of benign nodules and TSH levels. Copyright © 2014 SEEN. Published by Elsevier Espana. All rights reserved.

  3. Relationship between preschool children and the caregiver's preoperative anxiety. A cross study assessing modified Yale preoperative anxiety Scale (m-YPAS

    Directory of Open Access Journals (Sweden)

    Emiliana Gomes de Mello

    2015-09-01

    Full Text Available Anxiety is a common event in children before surgery. Several ways have been proposed to assess the level of anxiety in pediatric patients. The modified Yale Preoperative Anxiety Scale (m-Ypas was developed recently and allows the assessment of anxiety level from the observation of children's attitudes. The aim of the study was to evaluate the influence of variables such as anxiety of caregivers (parents or relatives, preoperative fasting and previous surgical experiences on children's anxiety assessing m-YPAS. METHODS: We evaluated 39 preschool children submitted to elective surgery at a tertiary hospital in Sorocaba-Brazil. After preanesthetic evaluation, performed immediately after admission, children were referred to the pediatric ward where they were observed by the evaluator who applied the scale m-Ypas. Scores above 30 points were considered as anxiety. The level of caregivers's anxiety was evaluated assessing a linear visual scale of 0 to 10 points. Values a bove 3 were considered positive for anxiety. All children were premedicated with oral midazolam. Fasting time and the presence, or absence, of prior surgery were recorded. RESULTS: Thirty nine children were evaluated. The anxiety was observed in 36% of children and in 92% of caregivers. Children's anxiety was not related to caregiver's anxiety (p = 0.70. Fasting time (p = 0.28 or the presence, or absence, of previous surgery (p = 0:09 were not related to children's anxiety as well. CONCLUSION: The caregiver's anxiety, preoperative fasting time and previous surgery were not considered predictive factors for higher or lower level of preoperative anxiety in children.

  4. Value of flexible bronchoscopy for the preoperative assessment of NSCLC diagnosed using percutaneous core needle biopsy.

    Science.gov (United States)

    Jo, Kyung-Wook; Kim, Hyeong Ryul; Kim, Dong Kwan; Kim, Yong-Hee; Park, Seung-Il; Choi, Se Hoon; Choi, Chang-Min

    2014-10-01

    We aimed to investigate the value of routine flexible bronchoscopy (FB) for the preoperative assessment of early-stage non-small cell lung cancer (NSCLC) diagnosed using percutaneous core needle biopsy (PCNB). We enrolled 688 NSCLC patients who were treated at our hospital between January 2003 and December 2012 and who met the following criteria: (1) early-stage lung cancer (stage I or II); (2) lung cancer had been diagnosed using PCNB; and (3) no evidence of endobronchial disease in the airways other than the primary cancer site on both chest computed tomography (CT) and positron emission tomography-CT (PET-CT). All NSCLC patients were from the same tertiary referral center, where FB is routinely performed preoperatively for this disease, and their medical records were reviewed retrospectively. Of the 688 patients included in the study, 451 (65.6%) were male and the median age was 65 years. Pathology analysis revealed that adenocarcinoma was the most frequently observed cell type (516/688, 75.0%). The distribution of preoperative clinical staging for the 688 patients was (1) IA (54.5%, 375/688); (2) IB (22.1%, 152/688); (3) IIA (18.2%, 125/688); and (4) IIB (5.2%, 36/688). The majority of these patients (95.2%, 655/688) underwent surgical resection. Unsuspected malignant endobronchial lesion on FB was found in only two cases (0.3%), and the surgical strategy had to be modified for both of these patients. Preoperative FB is not beneficial for screening the airways of almost any patient with early-stage NSCLC, provided that neither PET-CT nor CT reveal any evidence of endobronchial malignant involvement other than at the primary cancer site. Georg Thieme Verlag KG Stuttgart · New York.

  5. Microbiological Quantitative Risk Assessment

    Science.gov (United States)

    Dominguez, Silvia; Schaffner, Donald W.

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

  6. Preoperative alcoholism and postoperative morbidity

    DEFF Research Database (Denmark)

    Tonnesen, H; Kehlet, H

    1999-01-01

    BACKGROUND: Preoperative risk assessment has become part of daily clinical practice, but preoperative alcohol abuse has not received much attention. METHODS: A Medline search was carried out to identify original papers published from 1967 to 1998. Relevant articles on postoperative morbidity...... in alcohol abusers were used to evaluate the evidence. RESULTS: Prospective and retrospective studies demonstrate a twofold to threefold increase in postoperative morbidity in alcohol abusers, the most frequent complications being infections, bleeding and cardiopulmonary insufficiency. Wound complications...... to postoperative morbidity. CONCLUSION: Alcohol consumption should be included in the preoperative assessment of likely postoperative outcome. Reduction of postoperative morbidity in alcohol abusers may include preoperative alcohol abstinence to improve organ function, or perioperative alcohol administration...

  7. Northwest Climate Risk Assessment

    Science.gov (United States)

    Mote, P.; Dalton, M. M.; Snover, A. K.

    2012-12-01

    As part of the US National Climate Assessment, the Northwest region undertook a process of climate risk assessment. This process included an expert evaluation of previously identified impacts, their likelihoods, and consequences, and engaged experts from both academia and natural resource management practice (federal, tribal, state, local, private, and non-profit) in a workshop setting. An important input was a list of 11 risks compiled by state agencies in Oregon and similar adaptation efforts in Washington. By considering jointly the likelihoods, consequences, and adaptive capacity, participants arrived at an approximately ranked list of risks which was further assessed and prioritized through a series of risk scoring exercises to arrive at the top three climate risks facing the Northwest: 1) changes in amount and timing of streamflow related to snowmelt, causing far-reaching ecological and socioeconomic consequences; 2) coastal erosion and inundation, and changing ocean acidity, combined with low adaptive capacity in the coastal zone to create large risks; and 3) the combined effects of wildfire, insect outbreaks, and diseases will cause large areas of forest mortality and long-term transformation of forest landscapes.

  8. Assessment of fracture risk

    Energy Technology Data Exchange (ETDEWEB)

    Kanis, John A. [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom)], E-mail: w.j.pontefract@sheffield.ac.uk; Johansson, Helena; Oden, Anders [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom); McCloskey, Eugene V. [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom); Osteoporosis Centre, Northern General Hospital, Sheffield (United Kingdom)

    2009-09-15

    Fractures are a common complication of osteoporosis. Although osteoporosis is defined by bone mineral density at the femoral neck, other sites and validated techniques can be used for fracture prediction. Several clinical risk factors contribute to fracture risk independently of BMD. These include age, prior fragility fracture, smoking, excess alcohol, family history of hip fracture, rheumatoid arthritis and the use of oral glucocorticoids. These risk factors in conjunction with BMD can be integrated to provide estimates of fracture probability using the FRAX tool. Fracture probability rather than BMD alone can be used to fashion strategies for the assessment and treatment of osteoporosis.

  9. Microbial Risk Assessment

    Science.gov (United States)

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

    2009-01-01

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

  10. Preoperative magnetic resonance imaging assessment of circumferential resection margin predicts disease-free survival and local recurrence: 5-year follow-up results of the MERCURY study.

    Science.gov (United States)

    Taylor, Fiona G M; Quirke, Philip; Heald, Richard J; Moran, Brendan J; Blomqvist, Lennart; Swift, Ian R; Sebag-Montefiore, David; Tekkis, Paris; Brown, Gina

    2014-01-01

    The prognostic relevance of preoperative high-resolution magnetic resonance imaging (MRI) assessment of circumferential resection margin (CRM) involvement is unknown. This follow-up study of 374 patients with rectal cancer reports the relationship between preoperative MRI assessment of CRM staging, American Joint Committee on Cancer (AJCC) TNM stage, and clinical variables with overall survival (OS), disease-free survival (DFS), and time to local recurrence (LR). Patients underwent protocol high-resolution pelvic MRI. Tumor distance to the mesorectal fascia of ≤ 1 mm was recorded as an MRI-involved CRM. A Cox proportional hazards model was used in multivariate analysis to determine the relationship of MRI assessment of CRM to survivorship after adjusting for preoperative covariates. Surviving patients were followed for a median of 62 months. The 5-year OS was 62.2% in patients with MRI-clear CRM compared with 42.2% in patients with MRI-involved CRM with a hazard ratio (HR) of 1.97 (95% CI, 1.27 to 3.04; P < .01). The 5-year DFS was 67.2% (95% CI, 61.4% to 73%) for MRI-clear CRM compared with 47.3% (95% CI, 33.7% to 60.9%) for MRI-involved CRM with an HR of 1.65 (95% CI, 1.01 to 2.69; P < .05). Local recurrence HR for MRI-involved CRM was 3.50 (95% CI, 1.53 to 8.00; P < .05). MRI-involved CRM was the only preoperative staging parameter that remained significant for OS, DFS, and LR on multivariate analysis. High-resolution MRI preoperative assessment of CRM status is superior to AJCC TNM-based criteria for assessing risk of LR, DFS, and OS. Furthermore, MRI CRM involvement is significantly associated with distant metastatic disease; therefore, colorectal cancer teams could intensify treatment and follow-up accordingly to improve survival outcomes.

  11. PIpelle Prospective ENDOmetrial carcinoma (PIPENDO) study, pre-operative recognition of high risk endometrial carcinoma: a multicentre prospective cohort study

    NARCIS (Netherlands)

    Visser, N.C.M.; Bulten, J.; Wurff, A.A. van der; Boss, E.A.; Bronkhorst, C.M.; Feijen, H.W.; Haartsen, J.E.; Herk, H.A. van; Kievit, I.M. de; Klinkhamer, P.J.; Pijlman, B.M.; Snijders, M.P.M.L.; Vandenput, I.; Vos, M.C.; Wit, P.E.J. de; Poll-Franse, L.V. van de; Massuger, L.F.A.G.; Pijnenborg, J.M.A.

    2015-01-01

    BACKGROUND: Endometrial carcinoma is the most common gynaecologic malignancy in industrialised countries and the incidence is still rising. Primary treatment is based on preoperative risk classification and consists in most cases of hysterectomy with bilateral salpingo-oophorectomy. In patients with

  12. PIpelle Prospective ENDOmetrial carcinoma (PIPENDO) study, pre-operative recognition of high risk endometrial carcinoma : A multicentre prospective cohort study

    NARCIS (Netherlands)

    Visser, N.C.M.; Bulten, J.; van de Wurff, A.A.; Boss, E.A.; Bronkhorst, C.M.; Feijen, H.W.F.; Haartsen, J.E.; van Herk, H.A.D.M.; de Kievit, I.M.; Klinkhamer, P.J.J.M.; Pijlman, B.M.; Snijders, M.P.; Vandenput, I.; Vos, M.C.; de Wit, P.E.J.; van de Poll-Franse, L.V.; Massuger, L.F.A.G.; Pijnenborg, J.M.A.

    2015-01-01

    Background Endometrial carcinoma is the most common gynaecologic malignancy in industrialised countries and the incidence is still rising. Primary treatment is based on preoperative risk classification and consists in most cases of hysterectomy with bilateral salpingo-oophorectomy. In patients with

  13. PIpelle Prospective ENDOmetrial carcinoma (PIPENDO) study, pre-operative recognition of high risk endometrial carcinoma: a multicentre prospective cohort study

    NARCIS (Netherlands)

    Visser, N.C.M.; Bulten, J.; Wurff, A.A. van der; Boss, E.A.; Bronkhorst, C.M.; Feijen, H.W.; Haartsen, J.E.; Herk, H.A. van; Kievit, I.M. de; Klinkhamer, P.J.; Pijlman, B.M.; Snijders, M.P.M.L.; Vandenput, I.; Vos, M.C.; Wit, P.E.J. de; Poll-Franse, L.V. van de; Massuger, L.F.A.G.; Pijnenborg, J.M.A.

    2015-01-01

    BACKGROUND: Endometrial carcinoma is the most common gynaecologic malignancy in industrialised countries and the incidence is still rising. Primary treatment is based on preoperative risk classification and consists in most cases of hysterectomy with bilateral salpingo-oophorectomy. In patients with

  14. PIpelle Prospective ENDOmetrial carcinoma (PIPENDO) study, pre-operative recognition of high risk endometrial carcinoma : A multicentre prospective cohort study

    NARCIS (Netherlands)

    Visser, N.C.M.; Bulten, J.; van de Wurff, A.A.; Boss, E.A.; Bronkhorst, C.M.; Feijen, H.W.F.; Haartsen, J.E.; van Herk, H.A.D.M.; de Kievit, I.M.; Klinkhamer, P.J.J.M.; Pijlman, B.M.; Snijders, M.P.; Vandenput, I.; Vos, M.C.; de Wit, P.E.J.; van de Poll-Franse, L.; Massuger, L.F.A.G.; Pijnenborg, J.M.A.

    2015-01-01

    Background Endometrial carcinoma is the most common gynaecologic malignancy in industrialised countries and the incidence is still rising. Primary treatment is based on preoperative risk classification and consists in most cases of hysterectomy with bilateral salpingo-oophorectomy. In patients with

  15. Evaluation of static and dynamic MRI for assessing response of bone sarcomas to preoperative chemotherapy: Correlation with histological necrosis

    Directory of Open Access Journals (Sweden)

    Priyadarshi Amit

    2015-01-01

    Full Text Available Objectives: Preoperative chemotherapy plays a key role in management of bone sarcomas. Postoperative evaluation of histological necrosis has been the gold standard method of assessing response to preoperative chemotherapy. This study was done to evaluate the efficacy of static and dynamic magnetic resonance imaging (MRI for assessing response preoperatively. Materials and Methods: Our study included 14 patients (12 osteosarcomas and 2 malignant fibrous histiocytomas with mean age of 21.8 years, treated with preoperative chemotherapy followed by surgery. They were evaluated with static and dynamic MRI twice, before starting chemotherapy and again prior to surgery. Change in tumor volume and slope of signal intensity - time curve were calculated and correlated with percentage of histological necrosis using Pearson correlation test. Results: The change in dynamic MRI slope was significant (P = 0.001. Also, ≥60% reduction in slope of the curve proved to be an indicator of good histological response [positive predictive value (PPV =80%]. Change in tumor volume failed to show significant correlation (P = 0.071. Although it showed high negative predictive value (NPV = 85.7%, PPV was too low (PPV = 57.14%. Conclusions: Dynamic MRI correctly predicts histological necrosis after administration of preoperative chemotherapy to bone sarcomas. Hence, it can be used as a preoperative indicator of response to neoadjuvant chemotherapy. On the other hand, volumetric assessment by static MRI is not an effective predictor of histological necrosis. This study proves the superiority of dynamic contrast-enhanced study over volumetric study by MRI.

  16. Risk reduction before surgery. The role of the primary care provider in preoperative smoking and alcohol cessation

    DEFF Research Database (Denmark)

    Tønnesen, Hanne; Faurschou, Pernille; Ralov, Helge;

    2010-01-01

    Daily smokers and hazardous drinkers are high-risk patients, developing 2-4 times more complications after surgery. Preoperative smoking and alcohol cessation for four to eight weeks prior to surgery halves this complication rate. The patients' preoperative contact with the surgical departments...... might be too brief for the hospital to initiate these programmes. Therefore, it was relevant to evaluate a new clinical practice which combined the general practitioner's (GP) referral to surgery with a referral to a smoking and alcohol intervention in the surgical pathway....

  17. Pre-operative patient education is associated with decreased risk of arthrofibrosis after total knee arthroplasty: a case control study.

    Science.gov (United States)

    Livbjerg, Anna Emilie; Froekjaer, Sara; Simonsen, Ole; Rathleff, Michael S

    2013-09-01

    The purpose was to investigate risk factors for postoperative stiffness and long-term outcome following manipulation under anaesthesia (MUA). In one of the five Danish regions, all patients in a 4-year period who received MUA following total knee arthroplasty (N=36) were included in two case-control studies. Data on potential risk factors were extracted from the Danish Knee arthroplasty Register and from a postal questionnaire including long-term outcome measures regarding pain, function and quality of life (Oxford Knee Score and EQ-5D). Previous knee surgery and a high preoperative Knee Society Function Score were significant risk factors, whereas attending a preoperative information meeting was associated with a significantly decreased risk of postoperative stiffness requiring MUA (P<0.001). The long-term results following MUA (1-5 years) were equivalent to patients without postoperative stiffness. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. Risk Factors for Preoperative Seizures and Loss of Seizure Control in Patients Undergoing Surgery for Metastatic Brain Tumors.

    Science.gov (United States)

    Wu, Adela; Weingart, Jon D; Gallia, Gary L; Lim, Michael; Brem, Henry; Bettegowda, Chetan; Chaichana, Kaisorn L

    2017-08-01

    Metastatic brain tumors are the most common brain tumors in adults. Patients with metastatic brain tumors have poor prognoses with median survival of 6-12 months. Seizures are a major presenting symptom and cause of morbidity and mortality. In this article, risk factors for the onset of preoperative seizures and postoperative seizure control are examined. Adult patients who underwent resection of one or more brain metastases at a single institution between 1998 and 2011 were reviewed retrospectively. Of 565 patients, 114 (20.2%) patients presented with seizures. Factors independently associated with preoperative seizures were preoperative headaches (P = 0.044), cognitive deficits (P = 0.031), more than 2 intracranial metastatic tumors (P = 0.013), temporal lobe location (P = 0.031), occipital lobe location (P = 0.010), and bone involvement by tumor (P = 0.029). Factors independently associated with loss of seizure control after surgical resection were preoperative seizures (P = 0.001), temporal lobe location (P = 0.037), lack of postoperative chemotherapy (P = 0.010), subtotal resection of tumor (P = 0.022), and local recurrence (P = 0.027). At last follow-up, the majority of patients (93.8%) were seizure-free. Thirty patients (5.30%) in total had loss of seizure control, and only 8 patients (1.41%) who did not have preoperative seizures presented with new-onset seizures after surgical resection of their metastases. The brain is a common site for metastases from numerous primary cancers, such as breast and lung. The identification of factors associated with onset of preoperative seizures as well as seizure control postoperatively could aid management strategies for patients with metastatic brain tumors. Patients with preoperative seizures who underwent resection tended to have good seizure control after surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Preoperative scallop-by-scallop assessment of mitral prolapse using 2D-transthoracic echocardiography

    Directory of Open Access Journals (Sweden)

    Leonetti Stefania

    2010-01-01

    Full Text Available Abstract Background This study was conducted to assess the accuracy of harmonic imaging 2D-transthoracic echocardiography (2D-TTE segmental analysis compared to surgical findings, in degenerative mitral regurgitation (MR. Methods Seventy-seven consecutive patients with severe degenerative MR were prospectively enrolled. Preoperative 2D-TTE with precise localization of prolapsing or flailing scallops/segments was performed. All patients underwent mitral valve surgical repair. Surgical reports (SR, including valve description, were used as references for comparisons. A postoperative control 2D-TTE was performed. Results Out of 462 scallops/segments studied, surgical inspection identified 102 prolapses or flails (22%, 92 of which had previously been detected by 2D-TTE (90.2% sensitivity, 100% specificity. Agreement between preoperative 2D-TTE segmental analysis and SR was 97.8% (k = 0.93; p Conclusions 2D-TTE, performed by an experienced echo-lab, has very good diagnostic accuracy in localizing the scallops/segments involved in degenerative MR, particularly for the middle ones (P2-A2, which represent almost the totality of prolapses. More invasive, time consuming and expensive exams should be reserved to selected cases.

  20. Methylmercury risk assessment issues

    Energy Technology Data Exchange (ETDEWEB)

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

    1996-07-01

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

  1. Usefulness of an accelerated transoesophageal stress echocardiography in the preoperative evaluation of high risk severely obese subjects awaiting bariatric surgery

    Directory of Open Access Journals (Sweden)

    Tessier Michel

    2010-07-01

    Full Text Available Abstract Background Severe obesity is associated with an increased risk of coronary artery disease (CAD. Bariatric surgery is an effective procedure for long term weight management as well as reduction of comorbidities. Preoperative evaluation of cardiac operative risk may often be necessary but unfortunately standard imaging techniques are often suboptimal in these subjects. The purpose of this study was to demonstrate the feasibility, safety and utility of transesophageal dobutamine stress echocardiography (TE-DSE using an adapted accelerated dobutamine infusion protocol in severely obese subjects with comorbidities being evaluated for bariatric surgery for assessing the presence of myocardial ischemia. Methods Subjects with severe obesity [body mass index (BMI >40 kg/m2] with known or suspected CAD and being evaluated for bariatric surgery were recruited. Results Twenty subjects (9M/11F, aged 50 ± 8 years (mean ± SD, weighing 141 ± 21 kg and with a BMI of 50 ± 5 kg/m2 were enrolled in the study and underwent a TE-DSE. The accelerated dobutamine infusion protocol used was well tolerated. Eighteen (90% subjects reached their target heart rate with a mean intubation time of 13 ± 4 minutes. Mean dobutamine dose was 31.5 ± 9.9 ug/kg/min while mean atropine dose was 0.5 ± 0.3 mg. TE-DSE was well tolerated by all subjects without complications including no significant arrhythmia, hypotension or reduction in blood arterial saturation. Two subjects had abnormal TE-DSE suggestive of myocardial ischemia. All patients underwent bariatric surgery with no documented cardiovascular complications. Conclusions TE-DSE using an accelerated infusion protocol is a safe and well tolerated imaging technique for the evaluation of suspected myocardial ischemia and cardiac operative risk in severely obese patients awaiting bariatric surgery. Moreover, the absence of myocardial ischemia on TE-DSE correlates well with a low operative risk of cardiac event.

  2. Computed tomography and magnetic resonance fusion imaging in cholesteatoma preoperative assessment.

    Science.gov (United States)

    Campos, Agustín; Mata, Federico; Reboll, Rosa; Peris, María Luisa; Basterra, Jorge

    2017-03-01

    The purpose of this study is to describe a method for developing fusion imaging for the preoperative evaluation of cholesteatoma. In 33 patients diagnosed with cholesteatoma, a high-resolution temporal bone computed tomography (CT) scan without intravenous contrast and propeller diffusion-weighted magnetic resonance imaging (MRI) were performed. Both studies were then sent to the BrainLAB work station, where the images were fused to obtain a morphological and color map. Intraoperative findings coincided with fusion CT-MRI imaging in all but two patients. In addition, one false positive and one false negative case were observed. CT and diffusion-weighted MRI are complementary techniques that should be employed to assess a cholesteatoma prior to surgery in many cases. Hence, to combine the advantages of each technique, we developed a fusion image technique similar to those that are routinely employed for radiotherapy planning and positron emission tomography-CT imaging. Fusion images can prove useful in selected cases.

  3. Preoperative Anxiety in Patients With Myasthenia Gravis and Risk for Myasthenic Crisis After Extended Transsternal Thymectomy: A CONSORT Study.

    Science.gov (United States)

    Zou, Jianyong; Su, Chunhua; Lun, Xueping; Liu, Weibing; Yang, Weiling; Zhong, Beilong; Zhu, Haoshuai; Lei, Yiyan; Luo, Honghe; Chen, Zhenguang

    2016-03-01

    A thymectomy can ameliorate the symptoms of myasthenia gravis (MG) and prevent the progression of ocular MG (OMG) to generalized MG (GMG). However, postoperative myasthenic crisis (POMC) is a serious post-thymectomy complication. Preoperative anxiety (POA) is common but typically neglected in MG patients. The association of POA with POMC has not yet been examined.From June 2007 to December 2013, 541 cases of MG were admitted to the First Affiliated Hospital of Sun Yat-sen University (Guangzhou, China). All cases underwent extended transsternal thymectomy (ETT). The clinical and pathological characteristics of these patients, including POA and POMC, were analyzed.A total of 179 patients experienced POA and 67 patients experienced POMC. Patients with POA were more likely to have POMC, a thymoma, and an ectopic thymus. Univariate analysis showed that POMC correlated with POA, presence of an ectopic thymus, dose of pyridostigmine bromide (PYR), presence of a thymoma, MGFA stage, preoperative myasthenic crisis, and postoperative pneumonia. Multivariate logistic regression analysis showed that the independent risk factors for POMC were POA, preoperative myasthenic crisis, higher dose of PYR, and postoperative pneumonia.Our results suggest that clinicians should consider the risk factors for POMC-especially preoperative anxiety-before performing a thymectomy in patients with MG.

  4. Anticipation of the difficult airway: preoperative airway assessment, an educational and quality improvement tool.

    Science.gov (United States)

    Cattano, D; Killoran, P V; Iannucci, D; Maddukuri, V; Altamirano, A V; Sridhar, S; Seitan, C; Chen, Z; Hagberg, C A

    2013-08-01

    Assessment of the potentially difficult airway (DA) is a critical aspect of resident education. We investigated the impact of a new assessment form on airway prediction and management by anaesthesia residents. We hypothesized that residents would demonstrate improvement in evaluation of DAs over the study duration. After IRB approval, anaesthesia residents were randomized into two groups: control (existing form) and experimental (new form). Data were collected prospectively from August 2008 to May 2010 on all non-obstetric adult patients undergoing non-emergent surgery. Eight thousand three hundred and sixty-four independent preoperative assessments were collected and 8075 were analysed. The experimental group had the higher completion rate than the control group (94.3% vs 84.3%, P=0.001). DA prediction was higher for the control group (71.2%) compared with the experimental group (69.1%; P=0.032). A significant improvement in prediction rates was found over time for the experimental group (likelihood estimate=0.00068, P=0.031). The use of a comprehensive airway assessment did not improve resident ability to predict a DA in an academic, tertiary-based hospital, anaesthesiology residency training programme.

  5. Surgery Risk Assessment (SRA) Database

    Data.gov (United States)

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

  6. Framework for Metals Risk Assessment

    Science.gov (United States)

    The Framework for Metals Risk Assessment is a science-based document that addresses the special attributes and behaviors of metals and metal compounds to be considered when assessing their human health and ecological risks.

  7. Framework for Ecological Risk Assessment

    Science.gov (United States)

    This is the first step in a long-term effort to develop risk assessment guidelines for ecological effects. Its primary purpose is to offer a simple, flexible structure for conducting and evaluating ecological risk assessment within EPA.

  8. Preoperative ultrasonographic assessment of the number and size of gallbladder stones: is it a useful predictor of asymptomatic choledochal lithiasis?

    Science.gov (United States)

    Costi, Renato; Sarli, Leopoldo; Caruso, Giuseppe; Iusco, Domenico; Gobbi, Sara; Violi, Vincenzo; Roncoroni, Luigi

    2002-09-01

    To evaluate whether preoperative ultrasonographic assessment of the number and size of gallbladder stones can identify patients at increased risk of having asymptomatic common bile duct stones. Ultrasonographic data for 300 consecutive patients undergoing laparoscopic cholecystectomy were analyzed. Patients were divided into a group in which multiple small ( 5 mm) gallbladder stones were present ("positive" stones) and a group with multiple large (> 5 mm) or single gallbladder stones, considered "negative." The ultrasonographic description was compared with surgical findings; finally, the prevalence of asymptomatic common bile duct stones in the 2 groups was compared. Ultrasonographic classification of gallbladder stones was confirmed at surgery in 285 cases (95%). Asymptomatic common bile duct stones were diagnosed in 9.5% of patients with an ultrasonographic diagnosis of positive gallbladder stones and in only 2.3% of patients with a diagnosis of negative gallbladder stones (P stones; the appearance of multiple small and variably sized gallbladder stones represent a risk factor for synchronous asymptomatic common bile duct stones.

  9. Risk assessment for carnitine.

    Science.gov (United States)

    Hathcock, John N; Shao, Andrew

    2006-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Jeremiah R. Brown

    2013-01-01

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

  11. Coronary computer tomographic angiography for preoperative risk stratification in patients undergoing liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Jodocy, Daniel, E-mail: daniel.jodocy@klinikum-minden.de [Department of Internal Medicine III (Cardiology), Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck (Austria); Abbrederis, Susanne, E-mail: susanne.abbrederis@uki.at [Department of Internal Medicine II (Gastroenterology and Hepatology), Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck (Austria); Graziadei, Ivo W., E-mail: ivo.graziadei@i-med.ac.at [Department of Internal Medicine II (Gastroenterology and Hepatology), Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck (Austria); Vogel, Wolfgang, E-mail: wolfgang.vogel@uki.at [Department of Internal Medicine II (Gastroenterology and Hepatology), Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck (Austria); Pachinger, Otmar, E-mail: otmar.pachinger@uki.at [Department of Internal Medicine III (Cardiology), Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck (Austria); Feuchtner, Gudrun M., E-mail: gudrun.feuchtner@i-med.ac.at [Department of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck (Austria); Jaschke, Werner, E-mail: werner.jaschke@i-med.ac.at [Department of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck (Austria); Friedrich, Guy, E-mail: guy.friedrich@uki.at [Department of Internal Medicine III (Cardiology), Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck (Austria)

    2012-09-15

    The assessment of the cardiovascular risk profile in patients with end-stage liver disease is essential prior to liver transplantation (LT) as cardiovascular diseases are major causes of morbidity and mortality in the posttransplant course. The aim of this study was to evaluate the accuracy of a 64-slice coronary computed tomographic angiography (CTA) and coronary calcium scoring (CCS) to predict the postoperative cardiovascular risk of patients assessed for LT. In this single center, observational study we included 54 consecutive patients who were assessed for LT and consequently transplanted. Twenty-four patients (44%) presented with a high CCS above 300 and/or a significant stenosis (>50% percent narrowing due to stenotic plaques) and were further referred to coronary angiography. Three of these patients had a more than 70% LAD stenosis with subsequent angioplasty (n = 1) or conservative therapy (n = 2). The other patients showed only diffuse CAD without significant stenosis. The remaining 30 patients with normal CTA findings were listed for LT without further tests. None of the 54 patients developed cardiovascular events peri- and postoperatively. This study indicated that CTA combined with CCS is a useful non-invasive imaging technique for pre-LT assessment of coronary artery disease and safe tool in the risk assessment of peri- and postoperative cardiovascular events in patients undergoing LT.

  12. Risk assessment in travel medicine.

    Science.gov (United States)

    Leggat, Peter A

    2006-01-01

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

  13. Risco nutricional no período pré-operatório Nutritional risk in the preoperative period

    Directory of Open Access Journals (Sweden)

    Vânia Aparecida Leandro-Merhi

    2009-09-01

    Full Text Available RACIONAL: Prognóstico nutricional ruim no período pré-operatório -, principalmente nos pacientes que apresentam perda de peso -, pode levar à complicações pós-operatórias em maior frequência. OBJETIVO: Investigar indicadores de risco nutricional em pacientes internados em enfermaria de cirurgia, no período pré-operatório, estratificados por grupos de doenças mais frequentes no serviço. MÉTODO: Foram avaliados 512 pacientes portadores de abdome agudo, doenças do trato digestório, doenças de vias biliares, doenças ginecológicas, doenças vasculares, hérnias e traumas, sendo analisados o índice de massa corporal, a perda de peso recente, o consumo energético habitual, a contagem de linfócitos e o tempo de internação. Os dados foram comparados entre os grupos de doenças, sendo utilizado o teste qui-quadrado para a comparação de proporções ou teste exato de Fisher, quando necessário, com nível de significância de 5%. RESULTADOS: Os pacientes com trauma, seguidos daqueles portadores de doenças do trato digestório e abdome agudo, apresentaram índice de massa corporal mais baixos, com diferença significativa entre os grupos (P=0,0222, e entre os que mais apresentaram perda de peso recente na internação, estavam os pacientes com abdome agudo, (P=0,0048. Verificou-se maior percentual de depleção imunológica grave e moderada nos portadores de abdome agudo (PBACKGROUND: Bad nutricional status in preoperative period - mainly associated to weight loss -, may lead to grater number of postoperative complications. AIM: To investigate the nutritional risk indicators in preoperative period, stratified by disease groups treated at the site. METHODS: A total of 512 patients with the following conditions were assessed: acute abdomen, digestive tract diseases, biliary diseases, gynecological diseases, vascular diseases, hernias and traumas. The following data were analyzed: body mass index, recent weight loss, habitual

  14. Preoperative Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Surgery - A Systematic Review and Meta-Analysis of Observational Studies

    DEFF Research Database (Denmark)

    Philip Rothman, Josephine; Burcharth, Jakob; Pommergaard, Hans-Christian;

    2016-01-01

    BACKGROUND: Preoperative risk factors for the conversion of laparoscopic cholecystectomy to open surgery have been identified, but never been explored systematically. Our objective was to systematically present the evidence of preoperative risk factors for conversion of laparoscopic cholecystecto...... cholecystitis were risk factors for the conversion of laparoscopic cholecystectomy to open surgery. Furthermore, there was no association between diabetes mellitus or white blood cell count and conversion to open surgery....

  15. Risk assessment and risk management of mycotoxins.

    Science.gov (United States)

    2012-01-01

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

  16. Preoperative physiologic assessment for patients with respiratory insufficiency%呼吸功能不全病人术前相关功能评价

    Institute of Scientific and Technical Information of China (English)

    沈策

    2011-01-01

    对合并肺功能不全病人的术前评估,应对个人的具体情况作出判断,以降低手术的风险.包括:6min步行试验、胸部CT检查、肺通气功能、肺弥散功能、放射性核素肺通气、肺血流灌注显像及运动性心肺功能检查等有助于做出正确的判断.最稳妥的办法是术前心脏、呼吸及麻醉专业的医生共同评价手术风险及预后.%The physiologic assessment of patients with respiratory insufficiency should be considered for surgery in order to reduce the postoperative pulmonary complications.The examinations help preoperative risk assessment of the patient. They are the 6min walk, chest CT, pulmonary function test, ventilation and perfusion lung scanning, Doppler venous flow detection and cardiopuimonary exercise testing. The best method for preoperative risk assessment is that pulmonologist,cardiologist, anaesthetist and surgeon discuss the surgery risk and prognosis together.

  17. Usefulness assessment of preoperative MRI fistulography in patients with perianal fistulas.

    Science.gov (United States)

    Waniczek, Dariusz; Adamczyk, Tomasz; Arendt, Jerzy; Kluczewska, Ewa; Kozińska-Marek, Ewa

    2011-10-01

    Accurate preoperative assessment of the perianal fistulous tract is the main purpose of the diagnostics and to a large extend determines surgery effectiveness. One of the useful diagnostic methods in perianal fistulas is magnetic resonance imaging. The authors presented experiences in the application of MRI fistulography for evaluation of cases of perianal fistulas difficult to diagnose and treat. Own examination method was described; MRI fistulography findings were analyzed and compared with intraoperative conditions in 14 patients (11 men and 3 women) diagnosed in the years 2005- 2009. Eight patients had recurrent fistulas and 6 had primary fistulas. Imaging was performed with a GE SIGNA LX HS scanner with a 1.5-Tesla field strength and a dedicated surface coil placed at the level of hip joints. Contrast agent was a gadolinium-based solution. Intraoperative findings were consistent with radiological descriptions of 13 MRI fistulographies. Only in one case, according to surgery findings, it was a transsphincteric fistula with an abscess in the ischioanal fossa, with an orifice in the posterior crypt; the radiologist described it as a transsphincteric, internal blind fistula. Due to its accuracy in the assessment of the perianal fistulous tracts in soft tissues, MRI fistulography becomes a useful and recommended diagnostic method in this pathology. It shows the location of the fistula regarding the system of anal sphincters, and identifies the internal orifice and branching of the fistula. It enables precise planning of surgical treatment. Authors suggest that this diagnostic method should be improved and applied more commonly.

  18. Caries risk assessment

    DEFF Research Database (Denmark)

    Mejàre, I; Axelsson, S; Dahlén, G

    2014-01-01

    OBJECTIVE: To assess the ability of multivariate models and single factors to correctly identify future caries development in pre-school children and schoolchildren/adolescents. STUDY DESIGN: A systematic literature search for relevant papers was conducted with pre-determined inclusion criteria....... Seven studies had high quality, 35 moderate and the rest poor quality. The accuracy of multivariate models was higher for pre-school children than for schoolchildren/adolescents. However, the models had seldom been validated in independent populations, making their accuracy uncertain. Of the single...... predictors, baseline caries experience had moderate/good accuracy in pre-school children and limited accuracy in schoolchildren/adolescents. The period of highest risk for caries incidence in permanent teeth was the first few years after tooth eruption. In general, the quality of evidence was limited...

  19. Tools for microbiological risk assessment

    OpenAIRE

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

    2012-01-01

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

  20. Practical Approaches to Risk Assessment

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

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

  1. Practical Approaches to Risk Assessment

    Institute of Scientific and Technical Information of China (English)

    SIMONBROOKE-TAYLOR

    2001-01-01

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

  2. Stage II/III rectal cancer with intermediate response to preoperative radiochemotherapy: Do we have indications for individual risk stratification?

    Directory of Open Access Journals (Sweden)

    Becker Heinz

    2010-04-01

    Full Text Available Abstract Background Response to preoperative radiochemotherapy (RCT in patients with locally advanced rectal cancer is very heterogeneous. Pathologic complete response (pCR is accompanied by a favorable outcome. However, most patients show incomplete response. The aim of this investigation was to find indications for risk stratification in the group of intermediate responders to RCT. Methods From a prospective database of 496 patients with rectal adenocarcinoma, 107 patients with stage II/III cancers and intermediate response to preoperative 5-FU based RCT (ypT2/3 and TRG 2/3, treated within the German Rectal Cancer Trials were studied. Surgical treatment comprised curative (R0 total mesorectal excision (TME in all cases. In 95 patients available for statistical analyses, residual transmural infiltration of the mesorectal compartment, nodal involvement and histolologic tumor grading were investigated for their prognostic impact on disease-free (DFS and overall survival (OS. Results Residual tumor transgression into the mesorectal compartment (ypT3 did not influence DFS and OS rates (p = 0.619, p = 0.602, respectively. Nodal involvement after preoperative RCT (ypN1/2 turned out to be a valid prognostic factor with decreased DFS and OS (p = 0.0463, p = 0.0236, respectively. Persistent tumor infiltration of the mesorectum (ypT3 and histologic tumor grading of residual tumor cell clusters were strongly correlated with lymph node metastases after neoadjuvant treatment (p Conclusions Advanced transmural tumor invasion after RCT does not affect prognosis when curative (R0 resection is achievable. Residual nodal status is the most important predictor of individual outcome in intermediate responders to preoperative RCT. Furthermore, ypT stage and tumor grading turn out to be additional auxiliary factors. Future clinical trials for risk-adapted adjuvant therapy should be based on a synopsis of clinicopathologic parameters.

  3. Preoperative assessment of hilar cholangiocarcinoma:combination of cholangiographyandCTangiography

    Institute of Scientific and Technical Information of China (English)

    Shi-An Yu; Cheng Zhang; Jia-Min Zhang; Gen-Jun Mao; Long-Tang Xu; Xiao-Kang Wu; Jin-Er Shu; Guang-Hong Lv; Zhang-Dong Zheng

    2010-01-01

    BACKGROUND: Hilar cholangiocarcinoma is one of the most dififcult carcinomas to manage because of the location of the main tumor at the hepatic hilus and the complex anatomy of the biliary, arterial, and portal systems. To plan an operation, it is important to acquire accurate information about the relationship between hilar cholangiocarcinoma and adjacent vessels. This study aimed to evaluate the clinical value of cholangiography combined with spiral CT three-dimensional (3D) angiography for a preoperative assessment of hilar cholangiocarcinoma. METHODS: From March 2007 to August 2009, cholangiography was performed in 13 patients with hilar cholangiocarcinoma. Meanwhile, contrast-enhanced abdominal scanning was performed using 16-slice spiral CT, and the 3D images of the hepatic artery and portal vein were acquired. The level and range of invasion of the hepatic artery, the portal vein, and the bile duct, the preoperative Bismuth classiifcation, and T-staging were recorded and compared with those after surgical exploration. RESULTS: The hepatic artery and portal vein were recon-structed successfully in all these patients. Percutaneous transhepatic cholangiography was performed in 9 patients, endoscopic retrograde cholangiopancreatography in 1, and magnetic resonance cholangiopancreatography in 3. The CT angiography records of invasion of the hepatic artery were consistent with the results of explorations in these patients. The data from 5 of the 13 patients were consistent with those on invasion of the portal vein. The results of the Bismuth classiifcation and the T-staging system were consistent with those of surgical exploration in 12 of the 13 patients. Seven of 8 patients who were estimated to be suitable for operation based on images were curatively treated and 5 who were judged to be unsuitable for curative operation by cholangiography and CT angiography were conifrmed intraoperatively and underwent palliative procedures. CONCLUSIONS

  4. Comparative Assessment of Preoperative versus Postoperative Dexamethasone on Postoperative Complications following Lower Third Molar Surgical Extraction

    Directory of Open Access Journals (Sweden)

    Hashem M. Al-Shamiri

    2017-01-01

    Full Text Available Aim. To evaluate the effect of preoperative versus postoperative administration of oral Dexamethasone on postoperative complications including pain, edema, and trismus following lower third molar surgery. Methods. 24 patients were divided into two equal groups receiving 8 mg Dexamethasone orally, one group one hour preoperatively and the other group immediately after surgery. Pain was measured using VAS, edema was measured using a graduated tape between 4 fixed points in the face, and the mouth opening was measured using a graduated sliding caliper. Results. In this study pain and trismus records were similar and statistically nonsignificant in both groups. The results had proven that preoperative administration was superior when compared to postoperative administration regarding edema (0.002. Conclusions. Preoperative oral administration of 8 mg Dexamethasone was superior to the postoperative administration of the same dose concerning edema after lower third molar surgery.

  5. Interventions for preoperative smoking cessation

    DEFF Research Database (Denmark)

    Møller, A; Villebro, N

    2005-01-01

    Smokers have a substantially increased risk of intra- and postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence. The preoperative period may be a well chosen time to offer smoking cessation interventions due to increased patient motivation....

  6. Information needs for risk assessment

    Energy Technology Data Exchange (ETDEWEB)

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

    1990-12-31

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

  7. Interventions for preoperative smoking cessation

    DEFF Research Database (Denmark)

    Thomsen, Thordis; Villebro, Nete; Møller, Ann Merete

    2014-01-01

    : Randomized controlled trials that recruited people who smoked prior to surgery, offered a smoking cessation intervention, and measured preoperative and long-term abstinence from smoking or the incidence of postoperative complications or both outcomes. DATA COLLECTION AND ANALYSIS: The review authors......BACKGROUND: Smokers have a substantially increased risk of postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence, and surgery may constitute a unique opportunity for smoking cessation interventions. OBJECTIVES: The objectives of this review...... are to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively, and on the incidence of postoperative complications. SEARCH METHODS: We searched the Cochrane Tobacco Addiction Group Specialized Register in January 2014. SELECTION CRITERIA...

  8. Cardiac Surgery Costs According to the Preoperative Risk in the Brazilian Public Health System

    Directory of Open Access Journals (Sweden)

    David Provenzale Titinger

    2015-01-01

    Full Text Available Abstract Background: Heart surgery has developed with increasing patient complexity. Objective: To assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the values reimbursed by the Brazilian Unified Health System (SUS. Method: All cardiac surgery procedures performed between January and July 2013 in a tertiary referral center were analyzed. Demographic and clinical data allowed the calculation of the value reimbursed by the Brazilian SUS. Patients were stratified as low, intermediate and high-risk categories according to the EuroSCORE. Clinical outcomes, use of resources and costs (real costs versus SUS were compared between established risk groups. Results: Postoperative mortality rates of low, intermediate and high-risk EuroSCORE risk strata showed a significant linear positive correlation (EuroSCORE: 3.8%, 10%, and 25%; p < 0.0001, as well as occurrence of any postoperative complication EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively; p = 0.006. Accordingly, length-of-stay increased from 20.9 days to 24.8 and 29.2 days (p < 0.001. The real cost was parallel to increased resource use according to EuroSCORE risk strata (R$ 27.116,00 ± R$ 13.928,00 versus R$ 34.854,00 ± R$ 27.814,00 versus R$ 43.234,00 ± R$ 26.009,00, respectively; p < 0.001. SUS reimbursement also increased (R$ 14.306,00 ± R$ 4.571,00 versus R$ 16.217,00 ± R$ 7.298,00 versus R$ 19.548,00 ± R$935,00; p < 0.001. However, as the EuroSCORE increased, there was significant difference (p < 0.0001 between the real cost increasing slope and the SUS reimbursement elevation per EuroSCORE risk strata. Conclusion: Higher EuroSCORE was related to higher postoperative mortality, complications, length of stay, and costs. Although SUS reimbursement increased according to risk, it was not proportional to real costs.

  9. Exploration Health Risks: Probabilistic Risk Assessment

    Science.gov (United States)

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

    2006-01-01

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

  10. [Forensic assessment of violence risk].

    Science.gov (United States)

    Pujol Robinat, Amadeo; Mohíno Justes, Susana; Gómez-Durán, Esperanza L

    2014-03-01

    Over the last 20 years there have been steps forward in the field of scientific research on prediction and handling different violent behaviors. In this work we go over the classic concept of "criminal dangerousness" and the more current of "violence risk assessment". We analyze the evolution of such assessment from the practice of non-structured clinical expert opinion to current actuarial methods and structured clinical expert opinion. Next we approach the problem of assessing physical violence risk analyzing the HCR-20 (Assessing Risk for Violence) and we also review the classic and complex subject of the relation between mental disease and violence. One of the most problematic types of violence, difficult to assess and predict, is sexual violence. We study the different actuarial and sexual violence risk prediction instruments and in the end we advise an integral approach to the problem. We also go through partner violence risk assessment, describing the most frequently used scales, especially SARA (Spouse Assault Risk Assessment) and EPV-R. Finally we give practical advice on risk assessment, emphasizing the importance of having maximum information about the case, carrying out a clinical examination, psychopathologic exploration and the application of one of the described risk assessment scales. We'll have to express an opinion about the dangerousness/risk of future violence from the subject and some recommendations on the conduct to follow and the most advisable treatment. Copyright © 2014 Elsevier España, S.L. All rights reserved.

  11. Using risk assessment in periodontics.

    Science.gov (United States)

    Woodman, Alan J

    2014-08-01

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

  12. Pre-operative assessment of cancer in the elderly (PACE) : A comprehensive assessment of underlying characteristics of elderly cancer patients prior to elective surgery

    NARCIS (Netherlands)

    Pope, D.; Ramesh, H.; Gennari, R.; Corsini, G.; Maffezzini, M.; Hoekstra, H. J.; Mobarak, D.; Sunouchi, K.; Stotter, A.; West, C.; Audisio, R. A.

    2006-01-01

    Background: Cancer is a disease that particularly affects the elderly and, although surgery is the first treatment choice, many elderly cancer patients do not receive standard surgery because they are considered unfit for treatment due to an inaccurate estimation of operative risk. Pre-operative Ass

  13. Preoperative Assessment of TERT Promoter Mutation on Thyroid Core Needle Biopsies Supports Diagnosis of Malignancy and Addresses Surgical Strategy.

    Science.gov (United States)

    Crescenzi, A; Trimboli, P; Modica, D C; Taffon, C; Guidobaldi, L; Taccogna, S; Rainer, A; Trombetta, M; Papini, E; Zelano, G

    2016-03-01

    In the last decade, several molecular markers have been proposed to improve the diagnosis of thyroid nodules. Among these, mutations in the telomerase reverse transcriptase (TERT) promoter have been correlated to malignant tumors, characterized by highest recurrence and decreased patients' survival. This suggests an important role of TERT mutational analysis in the clinical diagnosis and management of thyroid cancer patients. The aim of the study was to demonstrate the adequacy of core needle biopsy (CNB) for the preoperative assessment of TERT mutational status, to reach a more accurate definition of malignancy and a more appropriate surgical planning. Indeed, CNB is gaining momentum for improving diagnosis of thyroid nodules deemed inconclusive by fine needle aspirate (FNA). The study included 50 patients submitted to CNB due to inconclusive FNA report. TERT mutational status was correlated with BRAF mutation, definitive histology, and post-operative TNM staging of the neoplasia. C228T mutation of the TERT promoter was reported in 10% of the papillary carcinomas (PTC) series. When compared with final histology, all cases harboring TERT mutation resulted as locally invasive PTCs. The prevalence of TERT mutated cases was 17.6% among locally advanced PTCs. TERT analysis on CNB allows the assessment of the pathological population on paraffin sections before DNA isolation, minimizing the risk of false negatives due to poor sampling that affects FNA, and gathering aggregate information about morphology and TERT mutational status. Data indicating a worse outcome of the tumor might be used to individualize treatment decision, surgical option, and follow-up design. © Georg Thieme Verlag KG Stuttgart · New York.

  14. RESIDUAL RISK ASSESSMENT: ETHYLENE OXIDE ...

    Science.gov (United States)

    This document describes the residual risk assessment for the Ethylene Oxide Commercial Sterilization source category. For stationary sources, section 112 (f) of the Clean Air Act requires EPA to assess risks to human health and the environment following implementation of technology-based control standards. If these technology-based control standards do not provide an ample margin of safety, then EPA is required to promulgate addtional standards. This document describes the methodology and results of the residual risk assessment performed for the Ethylene Oxide Commercial Sterilization source category. The results of this analyiss will assist EPA in determining whether a residual risk rule for this source category is appropriate.

  15. Preoperative hemostatic testing and the risk of postoperative bleeding in coronary artery bypass surgery patients

    DEFF Research Database (Denmark)

    Rafiq, Sulman; Johansson, Pär I; Kofoed, Klaus F

    2016-01-01

    BACKGROUND: We sought to assess predictability of excessive bleeding using thrombelastography (TEG), multiplate impedance aggregometry, and conventional coagulation tests including fibrinogen in patients undergoing coronary artery bypass graft (CABG) surgery. METHODS: A total of 170 patients were...... enrolled in this prospective observational study. TEG, Multiplate aggregometry, and coagulation tests were sampled on the day before surgery. Excessive bleeding was defined as >1000 mL over 18 hours. RESULTS: Multiplate-adenosine diphosphate (ADP) measurements were significantly lower in patients...... impedance aggregometry identified patients at risk for excessive bleeding after CABG. Low fibrinogen levels were associated with increased bleeding. Neither routine TEG parameters nor conventional coagulation tests were correlated with bleeding....

  16. Nanomaterials: Regulation and Risk Assessment

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  17. Applicability of preoperative nuclear morphometry to evaluating risk for cervical lymph node metastasis in oral squamous cell carcinoma.

    Directory of Open Access Journals (Sweden)

    Masaaki Karino

    Full Text Available BACKGROUND: We previously reported the utility of preoperative nuclear morphometry for evaluating risk for cervical lymph node metastases in tongue squamous cell carcinoma. The risk for lymph node metastasis in oral squamous cell carcinoma, however, is known to differ depending on the anatomical site of the primary tumor, such as the tongue, gingiva, mouth floor, and buccal mucosa. In this study, we evaluated the applicability of this morphometric technique to evaluating the risk for cervical lymph node metastasis in oral squamous cell carcinoma. METHODS: A digital image system was used to measure the mean nuclear area, mean nuclear perimeter, nuclear circular rate, ratio of nuclear length to width (aspect ratio, and nuclear area coefficient of variation (NACV. Relationships between these parameters and nodal status were evaluated by t-test and logistic regression analysis. RESULTS: Eighty-eight cases of squamous cell carcinoma (52 of the tongue, 25 of the gingiva, 4 of the buccal mucosa, and 7 of the mouth floor were included: 46 with positive node classification and 42 with negative node classification. Nuclear area and perimeter were significantly larger in node-positive cases than in node-negative cases; however, there were no significant differences in circular rate, aspect ratio, or NACV. We derived two risk models based on the results of multivariate analysis: Model 1, which identified age and mean nuclear area and Model 2, which identified age and mean nuclear perimeter. It should be noted that primary tumor site was not associated the pN-positive status. There were no significant differences in pathological nodal status by aspect ratio, NACV, or primary tumor site. CONCLUSION: Our method of preoperative nuclear morphometry may contribute valuable information to evaluations of the risk for lymph node metastasis in oral squamous cell carcinoma.

  18. Implications of probabilistic risk assessment

    Energy Technology Data Exchange (ETDEWEB)

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

    1987-01-01

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

  19. FRAMEWORK FOR ASSESSING RISKS OF ...

    Science.gov (United States)

    The Framework for Children's Health Risk Assessment report can serve as a resource on children's health risk assessment and it addresses the need to provide a comprehensive and consistent framework for considering children in risk assessments at EPA. This framework lays out the process, points to existing published sources for more detailed information on life stage-specific considerations, and includes web links to specific online publications and relevant Agency science policy papers, guidelines and guidance. The document emphasizes the need to take into account the potential exposures to environmental agents during preconception and all stages of development and focuses on the relevant adverse health outcomes that may occur as a result of such exposures. This framework is not an Agency guideline, but rather describes the overall structure and the components considered important for children's health risk assessment. The document describes an approach that includes problem formulation, analysis, and risk characterization, and also builds on Agency experience assessing risk to susceptible populations. The problem formulation step focuses on the life stage-specific nature of the analysis to include scoping and screening level questions for hazard characterization, dose response and exposure assessment. The risk characterization step recognizes the need to consider life stage-specific risks and explicitly describes the uncertainties and variability in the d

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

    Science.gov (United States)

    Edwards, Michelle

    2010-01-01

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

  1. Quantitative risk assessment of CO

    NARCIS (Netherlands)

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

    2010-01-01

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

  2. Tools for Microbiological risk assessment

    DEFF Research Database (Denmark)

    Bassett, john; Nauta, Maarten; Lindqvist, Roland

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

  3. [Risk assessment of chemical agents].

    Science.gov (United States)

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

    2011-01-01

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

  4. Life Cycle Assessment and Risk Assessment

    DEFF Research Database (Denmark)

    Olsen, Stig Irving

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

  5. Building better environmental risk assessments

    Directory of Open Access Journals (Sweden)

    Raymond eLayton

    2015-08-01

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

  6. Hazard classification or risk assessment

    DEFF Research Database (Denmark)

    Hass, Ulla

    2013-01-01

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

  7. Deterministic quantitative risk assessment development

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-07-01

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

  8. The preoperative measurement of template and postoperative assessment in artificial total hip replacement

    Institute of Scientific and Technical Information of China (English)

    Jin Jin; Chen Bin; Xu Hongguang; Li Qiyi; Li Yijia; Qiu Guixing

    2005-01-01

    Objective: To study the accuracy and importance of preoperative template measurement in total hip replacement (THR). Methods: Between Oct. 2003 and Sep. 2004, 19 patients (19 hips), including 11 male and 8female, ranged from 40 to 74 years old (mean 58.7 years old), underwent unilateral primary total hip replacement.Limb length and offset was measured, radiographic template was done preoperatively to anticipate optimal implantation component position and determine level of expected femoral neck cut, and plan to restore equality of limbs.After surgery, all factors above were reevaluated. Results: Fifteen patients with limb length difference obtained a significant improvement, it is decreased from 8.4mm to 4.4mm, 73.7% of them the limb length discrepancies was controlled within 5mm. Bilateral offset difference decreased from 6.3mm to 3.0mm. Coincidence rate between planned and actually used components was 52.6% on the acetabular side and 63.2% on the femoral side. Conclusion: Accurate and careful preoperative template measurement has significant value in balanced hip reconstruction by correcting leg length differences and restoring offset.

  9. Preoperative glucocorticoid use and risk of postoperative bleeding and infection after gastric bypass surgery for the treatment of obesity.

    Science.gov (United States)

    Gribsholt, Sigrid Bjerge; Svensson, Elisabeth; Thomsen, Reimar Wernich; Richelsen, Bjørn; Sørensen, Henrik Toft

    2015-01-01

    Previous research suggests that patients using glucocorticoids may be at increased risk of postoperative bleeding and infection after major surgery. The objective was to investigate the association between preoperative glucocorticoid use and risk of bleeding and infection after Roux-en-Y gastric bypass surgery (RYGB). Nationwide cohort study of 13,195 patients, who underwent RYGB 2006-2012 using Danish population-based medical databases. Information was obtained on current (redeemed prescriptionsurgery), recent (prescription 60-180 d before surgery), or no glucocorticoid use, and postoperative bleeding or infection within 30 days of surgery. We computed risk differences and odds ratios (ORs) as a measure of relative risk with 95% confidence intervals (95% CIs) for the association between glucocorticoid use and bleeding or infection, adjusting for gender, age, and co-morbidities by logistic regression. Among RYGB patients, 325 (2.5%) were current glucocorticoid users, and 365 (2.8%) were recent users. The risk of bleeding was increased in current users: 2.8% versus 1.6% among nonusers (risk difference: 1.2%, 95% CI: -.6, 3.0) corresponding to an adjusted OR of 1.5 (95% CI: .8, 3.0). For recent users, the adjusted OR for bleeding was 1.2 (95% CI: .5, 2.5). The risk of infection did not differ materially between current (1.8%), recent (1.0%) and nonusers (1.7%), corresponding to an adjusted OR of .9 (95% CI: .4, 2.1) among current versus nonusers. Current use of glucocorticoids is associated with a slightly increased risk of postoperative bleeding, but not infection, after RYGB. No increased risks were found for recent users. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  10. Modern biogeochemistry environmental risk assessment

    CERN Document Server

    Bashkin, Vladimir N

    2006-01-01

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

  11. Cloud computing assessing the risks

    CERN Document Server

    Carstensen, Jared; Golden, Bernard

    2012-01-01

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

  12. Test reactor risk assessment methodology

    Energy Technology Data Exchange (ETDEWEB)

    Jennings, R.H.; Rawlins, J.K.; Stewart, M.E.

    1976-04-01

    A methodology has been developed for the identification of accident initiating events and the fault modeling of systems, including common mode identification, as these methods are applied in overall test reactor risk assessment. The methods are exemplified by a determination of risks to a loss of primary coolant flow in the Engineering Test Reactor.

  13. Risk assessment future cash flows

    OpenAIRE

    Chachina H. G.

    2012-01-01

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

  14. Risk assessment future cash flows

    OpenAIRE

    Chachina H. G.

    2012-01-01

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

  15. Measuring the value of process improvement initiatives in a preoperative assessment center using time-driven activity-based costing.

    Science.gov (United States)

    French, Katy E; Albright, Heidi W; Frenzel, John C; Incalcaterra, James R; Rubio, Augustin C; Jones, Jessica F; Feeley, Thomas W

    2013-12-01

    The value and impact of process improvement initiatives are difficult to quantify. We describe the use of time-driven activity-based costing (TDABC) in a clinical setting to quantify the value of process improvements in terms of cost, time and personnel resources. Difficulty in identifying and measuring the cost savings of process improvement initiatives in a Preoperative Assessment Center (PAC). Use TDABC to measure the value of process improvement initiatives that reduce the costs of performing a preoperative assessment while maintaining the quality of the assessment. Apply the principles of TDABC in a PAC to measure the value, from baseline, of two phases of performance improvement initiatives and determine the impact of each implementation in terms of cost, time and efficiency. Through two rounds of performance improvements, we quantified an overall reduction in time spent by patient and personnel of 33% that resulted in a 46% reduction in the costs of providing care in the center. The performance improvements resulted in a 17% decrease in the total number of full time equivalents (FTE's) needed to staff the center and a 19% increase in the numbers of patients assessed in the center. Quality of care, as assessed by the rate of cancellations on the day of surgery, was not adversely impacted by the process improvements. © 2013 Published by Elsevier Inc.

  16. SEISMIC RISK ASSESSMENT OF LEVEES

    Directory of Open Access Journals (Sweden)

    Dario Rosidi

    2007-01-01

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

  17. Tailored keyhole surgery for basal ganglia cavernous malformation with preoperative three-dimensional pyramidal tracts assessment and intraoperative electrophysiological monitoring

    Institute of Scientific and Technical Information of China (English)

    Kai Quan; Geng Xu; Fan Zhao; Wei Zhu

    2016-01-01

    Background:Accurately mapping the pyramidal tracts preoperatively and intraoperatively is the primary concern when operating on cavernous malformations (CMS) in the basal ganglia.We have conducted new methods for preoperative planning and have tailored lesion resection to prevent the damage of pyramidal tracts.Patients and methods:Eleven patients harboring cavernous malformations in basal ganglia were treated surgically from April 2008 to January 2015.Surgical planning was based on three-dimensional diffusion tensor pyramidal tractography and Virtual Reality system.Intraoperative detecting of pyramidal tracts with subcortical stimulation mapping and motor evoked potential monitoring were performed.The extent of resection and postoperative neurological function were assessed in each case.Results:Total removal of the cavernous malformations were achieved in each case.Four of the total eleven cases presented temporary neurological deficits,including one occurrence of hemiparesis and three occurrences of hemianesthesia.No permanent neurological deficit was developed in this series of cases.Conclusion:Three-dimensional diffusion tensor pyramidal tractography is quite helpful for preoperative planning of basal ganglia cavernous malformations,especially in choosing a suitable surgical approach.Intraoperative detection of pyramidal tracts with subcortical stimulation mapping and motor evoked potential monitoring play important roles in preventing damage to pyramidal tracts during lesion resection.

  18. Integrated climate change risk assessment:

    DEFF Research Database (Denmark)

    Kaspersen, Per Skougaard; Halsnæs, Kirsten

    2017-01-01

    Risk assessments of flooding in urban areas during extreme precipitation for use in, for example, decision-making regarding climate adaptation, are surrounded by great uncertainties stemming from climate model projections, methods of downscaling and the assumptions of socioeconomic impact models....... enables the relative importance of the different factors (i.e. degree of climate change, assets value, discount rate etc.) to be determined, thus influencing the overall output of the assessment.......Risk assessments of flooding in urban areas during extreme precipitation for use in, for example, decision-making regarding climate adaptation, are surrounded by great uncertainties stemming from climate model projections, methods of downscaling and the assumptions of socioeconomic impact models...... to address the complex linkages between the different kinds of data required in assessing climate adaptation. It emphasizes that the availability of spatially explicit data can reduce the overall uncertainty of the risk assessment and assist in identifying key vulnerable assets. The usefulness...

  19. Surgical treatment of patients with lung cancer and limited lung function: Preoperative assessment, operative mortality and morbidity

    Directory of Open Access Journals (Sweden)

    Subotić Dragan

    2007-01-01

    Full Text Available Introduction: Lung resection in patients with limited lung function is one of the greatest challenges in general thoracic surgery. Objective. The aim of the study was to analyze the pattern of lung function changes after operation, operative morbidity and mortality and to compare them with control group of patients. Method. The study included 34 patients with limited lung function, operated for primary lung cancer in one-year period. All patients underwent preoperative desobstructive treatment. The type of ventilatory disorder was analyzed depending on preoperative radiographic and bronchoscopic aspect. Statistics: chisquare test, t-test. Results. In patients with lobectomy, the mean difference in forced expiratory volume in the first second (FEV1 between preoperative and postoperative values was 16.81%, whilst in the pneumonectomy group this difference was 39.51%. The mean change in forced vital capacity (FVC in the lobectomy and pneumonectomy group was 15.83% and 42.73% respectively. In the control group of 28 patients with lobectomy, the decrease in FVC and FEV1 was 19.9% and 24.18% respectively. In the control group of 28 patients with pneumonectomy, the decrease in FVC and FEV1 was 43.52% and 41.36% respectively. In patients with limited lung function and lobectomy, changes in FEV1 and VC after resection were significantly lower compared to the control group of patients with lobectomy and normal lung function. None of 34 operated patients with borderline lung function died inside 30 postoperative days. In the same period, of a total number of 344 patients without respiratory function impairment, operative mortality was 3.1%. In the analyzed group, operative morbidity was 32.35%. Cardiovascular and respiratory complications in the analyzed and control groups occurred in 14.7% and 6.1% of patients respectively (p>0.05. Conclusion. Surgery should not be excluded in patients with borderline lung function prior to preoperative treatment and

  20. Influence of the Alveolar Cleft Type on Preoperative Estimation Using 3D CT Assessment for Alveolar Cleft

    Directory of Open Access Journals (Sweden)

    Hang Suk Choi

    2012-09-01

    Full Text Available BackgroundThe bone graft for the alveolar cleft has been accepted as one of the essential treatments for cleft lip patients. Precise preoperative measurement of the architecture and size of the bone defect in alveolar cleft has been considered helpful for increasing the success rate of bone grafting because those features may vary with the cleft type. Recently, some studies have reported on the usefulness of three-dimensional (3D computed tomography (CT assessment of alveolar bone defect; however, no study on the possible implication of the cleft type on the difference between the presumed and actual value has been conducted yet. We aimed to evaluate the clinical predictability of such measurement using 3D CT assessment according to the cleft type.MethodsThe study consisted of 47 pediatric patients. The subjects were divided according to the cleft type. CT was performed before the graft operation and assessed using image analysis software. The statistical significance of the difference between the preoperative estimation and intraoperative measurement was analyzed.ResultsThe difference between the preoperative and intraoperative values were -0.1±0.3 cm3 (P=0.084. There was no significant intergroup difference, but the groups with a cleft palate showed a significant difference of -0.2±0.3 cm3 (P<0.05.ConclusionsAssessment of the alveolar cleft volume using 3D CT scan data and image analysis software can help in selecting the optimal graft procedure and extracting the correct volume of cancellous bone for grafting. Considering the cleft type, it would be helpful to extract an additional volume of 0.2 cm3 in the presence of a cleft palate.

  1. Avalanche risk assessment in Russia

    Science.gov (United States)

    Komarov, Anton; Seliverstov, Yury; Sokratov, Sergey; Glazovskaya, Tatiana; Turchaniniva, Alla

    2017-04-01

    The avalanche prone area covers about 3 million square kilometers or 18% of total area of Russia and pose a significant problem in most mountain regions of the country. The constant growth of economic activity, especially in the North Caucasus region and therefore the increased avalanche hazard lead to the demand of the large-scale avalanche risk assessment methods development. Such methods are needed for the determination of appropriate avalanche protection measures as well as for economic assessments during all stages of spatial planning of the territory. The requirement of natural hazard risk assessments is determined by the Federal Law of Russian Federation. However, Russian Guidelines (SP 11-103-97; SP 47.13330.2012) are not clearly presented concerning avalanche risk assessment calculations. A great size of Russia territory, vast diversity of natural conditions and large variations in type and level of economic development of different regions cause significant variations in avalanche risk values. At the first stage of research the small scale avalanche risk assessment was performed in order to identify the most common patterns of risk situations and to calculate full social risk and individual risk. The full social avalanche risk for the territory of country was estimated at 91 victims. The area of territory with individual risk values lesser then 1×10(-6) covers more than 92 % of mountain areas of the country. Within these territories the safety of population can be achieved mainly by organizational activities. Approximately 7% of mountain areas have 1×10(-6) - 1×10(-4) individual risk values and require specific mitigation measures to protect people and infrastructure. Territories with individual risk values 1×10(-4) and above covers about 0,1 % of the territory and include the most severe and hazardous mountain areas. The whole specter of mitigation measures is required in order to minimize risk. The future development of such areas is not recommended

  2. Pre-operative urinary tract infection: is it a risk factor for early surgical site infection with hip fracture surgery? A retrospective analysis.

    Science.gov (United States)

    Yassa, Rafik Rd; Khalfaoui, Mahdi Y; Veravalli, Karunakar; Evans, D Alun

    2017-03-01

    The aims of the current study were to determine whether pre-operative urinary tract infections in patients presenting acutely with neck of femur fractures resulted in a delay to surgery and whether such patients were at increased risk of developing post-operative surgical site infections. A retrospective review of all patients presenting with a neck of femur fracture, at a single centre over a one-year period. The hospital hip fracture database was used as the main source of data. UK University Teaching Hospital. All patients (n = 460) presenting across a single year study period with a confirmed hip fracture. The presence of pre-operative urinary tract infection, the timing of surgical intervention, the occurrence of post-operative surgical site infection and the pathogens identified. A total of 367 patients were operated upon within 24 hours of admission. Urinary infections were the least common cause of delay. A total of 99 patients (21.5%) had pre-operative urinary tract infection. Post-operatively, a total of 57 (12.4%) patients developed a surgical site infection. Among the latter, 31 (54.4%) did not have a pre-operative urinary infection, 23 (40.4%) patients had a pre-operative urinary tract infection, 2 had chronic leg ulcers and one patient had a pre-operative chest infection. Statistically, there was a strong relationship between pre-operative urinary tract infection and the development of post-operative surgical site infection (p-value: 0.0005). The results of our study indicate that pre-operative urinary tract infection has a high prevalence amongst those presenting with neck of femur fractures, and this is a risk factor for the later development of post-operative surgical site infection.

  3. Cancer risk assessment of toxaphene.

    Science.gov (United States)

    Buranatrevedh, Surasak

    2004-07-01

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

  4. Qualitative methods for assessing risk

    Energy Technology Data Exchange (ETDEWEB)

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

    1995-04-01

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

  5. Qualitative methods for assessing risk

    Energy Technology Data Exchange (ETDEWEB)

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

    1995-04-01

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

  6. Pre-operative risk scores for the prediction of outcome in elderly people who require emergency surgery

    Directory of Open Access Journals (Sweden)

    Bates Tom

    2007-06-01

    Full Text Available Abstract Background The decision on whether to operate on a sick elderly person with an intra-abdominal emergency is one of the most difficult in general surgery. A predictive risk-score would be of great value in this situation. Methods A Medline search was performed to identify those predictive risk-scores relevant to sick elderly patients in whom emergency surgery might be life-saving. Results Many of the risk scores for surgical patients include the operative findings or require tests which are not available in the acute situation. Most of the relevant studies include younger patients and elective surgery. The Glasgow Aneurysm Score and Hardman Index are specific to ruptured aortic aneurysm while the Boey Score and the Hacetteppe Score are specific to perforated peptic ulcer. The Reiss Index and Fitness Score can be used pre-operatively if the elements of the score can be completed in time. The ASA score, which includes a significant element of subjective clinical judgement, can be augmented with factors such as age and urgency of surgery but no test has a negative predictive value sufficient to recommend against surgical intervention without clinical input. Conclusion Risk scores may be helpful in sick elderly patients needing emergency abdominal surgery but an experienced clinical opinion is still essential.

  7. Influence of the Alveolar Cleft Type on Preoperative Estimation Using 3D CT Assessment for Alveolar Cleft

    Directory of Open Access Journals (Sweden)

    Hang Suk Choi

    2012-09-01

    Full Text Available Background The bone graft for the alveolar cleft has been accepted as one of the essentialtreatments for cleft lip patients. Precise preoperative measurement of the architecture andsize of the bone defect in alveolar cleft has been considered helpful for increasing the successrate of bone grafting because those features may vary with the cleft type. Recently, somestudies have reported on the usefulness of three-dimensional (3D computed tomography(CT assessment of alveolar bone defect; however, no study on the possible implication of thecleft type on the difference between the presumed and actual value has been conducted yet.We aimed to evaluate the clinical predictability of such measurement using 3D CT assessmentaccording to the cleft type.Methods The study consisted of 47 pediatric patients. The subjects were divided according tothe cleft type. CT was performed before the graft operation and assessed using image analysissoftware. The statistical significance of the difference between the preoperative estimationand intraoperative measurement was analyzed.Results The difference between the preoperative and intraoperative values were -0.1±0.3cm3 (P=0.084. There was no significant intergroup difference, but the groups with a cleftpalate showed a significant difference of -0.2±0.3 cm3 (P<0.05.Conclusions Assessment of the alveolar cleft volume using 3D CT scan data and image analysissoftware can help in selecting the optimal graft procedure and extracting the correct volumeof cancellous bone for grafting. Considering the cleft type, it would be helpful to extract anadditional volume of 0.2 cm3 in the presence of a cleft palate.

  8. Are preoperative experimental pain assessments correlated with clinical pain outcomes after surgery? A systematic review

    DEFF Research Database (Denmark)

    Sangesland, Anders; Støren, Carl; Vaegter, Henrik B.

    2017-01-01

    Background Pain after surgery is not uncommon with 30% of patients reporting moderate to severe postoperative pain. Early identification of patients prone to postoperative pain may be a step forward towards individualized pain medicine providing a basis for improved clinical management through...... treatment strategies targeting relevant pain mechanisms in each patient. Assessment of pain processing by quantitative sensory testing (QST) prior to surgery has been proposed as a method to identify patients at risk for postoperative pain, although results have been conflicting. Since the last systematic...... review, several studies investigating the association between postoperative pain and more dynamic measures of pain processing like temporal summation of pain and conditioned pain modulation have been conducted. Objectives According to the PRISMA guidelines, the aim of this systematic review...

  9. Cardio-pulmonary exercise testing: An objective approach to pre-operative assessment to define level of perioperative care.

    Science.gov (United States)

    Bhagwat, Milind; Paramesh, Kaggere

    2010-07-01

    Cardiopulmonary exercise testing is a non-invasive, objective method of assessing integrated response of heart, lungs and musculoskeletal system to incremental exercise. Though it has been in use for a few decades, the recent rise in its use as a preoperative test modality is reviewed. A brief account of cardiopulmonary exercise test, as it is carried out in practice and its applications, is given. The physiological basis is explained and relationship of pathophysiology of poor exercise capacity with various test variables is discussed. Its use for prediction of postoperative morbidity in various noncardiopulmonary surgical procedures is reviewed.

  10. Role of heart-rate variability in preoperative assessment of physiological reserves in patients undergoing major abdominal surgery

    Directory of Open Access Journals (Sweden)

    Reimer P

    2017-09-01

    III n=6 vs n=0; p<0.05 and a greater number of complications than the CAR group (n=57 vs n=5; p<0.001. Significant differences were found for two specific subgroups of complications: hypotension requiring vasoactive drugs (NCAR: n=10 vs CAR: n=0; p<0.01 and ileus (NCAR: n=11 vs CAR: n=2; p<0.05. Moreover, significant differences were found in the ICU-LOS (NCAR: 5.7±3.5 days vs CAR: 2.6±0.7 days; p<0.0001 and H-LOS (NCAR: 12.2±5.6 days vs CAR: 7.2±1.7 days; p<0.0001. Conclusion: Preoperative HRV assessment during orthostatic load is objective and useful for identifying patients with low autonomic physiological reserves and high risk of poor post­operative course. Keywords: heart-rate variability, spectral analysis, orthostatic load, autonomic dysfunction, major abdominal surgery, postoperative complications

  11. An approach to risk assessment

    DEFF Research Database (Denmark)

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

    1998-01-01

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

  12. Army Independent Risk Assessment Guidebook

    Science.gov (United States)

    2014-04-01

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

  13. ANTHROPIC RISK ASSESSMENT ON BIODIVERSITY

    OpenAIRE

    2014-01-01

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

  14. Tsunami risk assessment in Indonesia

    Directory of Open Access Journals (Sweden)

    G. Strunz

    2011-01-01

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

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

  15. Effect of Pre-Operative Use of Medications on the Risk of Surgical Site Infections in Patients Undergoing Cardiac Surgery.

    Science.gov (United States)

    Eton, Vic; Sinyavskaya, Liliya; Langlois, Yves; Morin, Jean François; Suissa, Samy; Brassard, Paul

    2016-10-01

    Median sternotomy, the most common means of accessing the heart for cardiac procedures, is associated with higher risk of surgical site infections (SSIs). A limited number of studies reporting the impact of medication use prior to cardiac surgery on the subsequent risk of SSIs usually focused on antibacterial prophylaxis. The objective of the current study was to evaluate the effect of medications prescribed commonly to cardiac patients on the risk of incident SSIs. The study analyzed data on consecutive cardiac surgery patients undergoing median sternotomy at a McGill University teaching hospital between April 1, 2011 and October 31, 2013. Exposure of interest was use of medications for heart disease and cardiovascular conditions in the seven days prior to surgery and those for comorbid conditions. The main outcome was SSIs occurring within 90 d after surgery. Univariate and multivariate logistic regression (adjusted odds ratio [AOR]) was used to evaluate the effect. The cohort included 1,077 cardiac surgery patients, 79 of whom experienced SSIs within 90 d of surgery. The rates for sternal site infections and harvest site infections were 5.8 (95% confidence interval [CI]: 4.4-7.3) and 2.5 (95% CI: 1.4-3.7) per 100 procedures, respectively. The risk of SSI was increased with the pre-operative use of immunosuppressors/steroids (AOR 3.47, 95% CI: 1.27-9.52) and α-blockers (AOR 3.74, 95% CI: 1.21-1.47). Our findings support the effect of immunosuppressors/steroids on the risk of SSIs and add evidence to the previously reported association between the use of anti-hypertensive medications and subsequent development of infection/sepsis.

  16. [Efficiency assessment of preoperative preparatory programs in pediatric patients in dentistry].

    Science.gov (United States)

    Milenin, V V; Tolasov, K R; Ostreikov, I F

    2013-01-01

    Research objective was to compare the efficiency of different preoperative preparatory programs which had been used for anxiety decrease in Pediatric patients before oral cavity sanation with general anaesthesia. Two preparatory programs were used. In the first program patients were informed about the treatment they were undergoing. Patients visited the operating unit and watched the videos about forthcoming procedure (group of Information Technologies (IT), n = 82). The second program included the tutorials (face mask use, acquaintance with equipment alarms etc.) in addition to Information Technologies (group of lnformation Technologies and tutorials (ITT) n = 83). Information Technologies and tutorials were not used in the control group (n = 86). Both used programs were effective. ITT program was the most effective.

  17. Interventions for preoperative smoking cessation

    DEFF Research Database (Denmark)

    Thomsen, Thordis; Villebro, Nete; Møller, Ann Merete

    2010-01-01

    and keywords (surgery) or (operation) or (anaesthesia) or (anesthesia). MEDLINE, EMBASE and CINAHL were also searched, combining tobacco- and surgery-related terms. Most recent search April 2010. Selection criteria Randomized controlled trials that recruited people who smoked prior to surgery, offered......Background Smokers have a substantially increased risk of postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence, and surgery may constitute a unique opportunity for smoking cessation interventions. Objectives The objective of this review...... was to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively and on the incidence of postoperative complications. Search strategy The specialized register of the Cochrane Tobacco Addiction Group was searched using the free text...

  18. Interventions for preoperative smoking cessation

    DEFF Research Database (Denmark)

    Thomsen, Thordis; Villebro, N.; Møller, Ann Merete;

    2010-01-01

    Background Smokers have a substantially increased risk of postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence, and surgery may constitute a unique opportunity for smoking cessation interventions. Objectives The objective of this review...... was to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively and on the incidence of postoperative complications. Search strategy The specialized register of the Cochrane Tobacco Addiction Group was searched using the free text......; pooled RR 10.76 (95% confidence interval (CI) 4.55 to 25.46, two trials) and RR 1.41 (95% CI 1.22 to 1.63, five trials) respectively. Four trials evaluating the effect on long-term smoking cessation found a significant effect; pooled RR 1.61 (95% CI 1.12 to 2.33). However, when pooling intensive...

  19. Preoperative systemic etoposide/ifosfamide/doxorubicin chemotherapy combined with regional hyperthermia in high-risk sarcoma: a pilot study.

    Science.gov (United States)

    Issels, R D; Bosse, D; Abdel-Rahman, S; Starck, M; Panzer, M; Jauch, K W; Stiegler, H; Berger, H; Sauer, H; Peter, K

    1993-01-01

    From November 1990 to September 1991, 23 adults with high-risk, nonmetastatic sarcomas (20 soft-tissue sarcomas and 3 chondrosarcomas) were entered in a pilot protocol (RHT-91) involving regional hyperthermia combined with systemic chemotherapy followed by surgery. Of these patients, 12 had undergone previous surgery and/or radiation, 5 had received previous multidrug chemotherapy, and 6 were previously untreated. A tumor size of > 8 cm and/or an extracompartmental tumor location (11 patients) or local recurrence (12 patients) were defined as high-risk factors in addition to tumor grading (21 patients had grade 2 or 3 sarcomas). Regional hyperthermia was produced by an electromagnetic deep-regional-heating device. For systemic chemotherapy, all patients received etoposide/ifosfamide/doxorubicin (EIA) and mesna, with regional hyperthermia being given only on days 1 and 4 in repeated EIA/regional hyperthermia cycles every 3 weeks. Tumor temperatures (range, 40 degrees-44 degrees C) were measured by invasive thermometry in all patients during each regional hyperthermia treatment. A total of 181 regional hyperthermia treatments were applied within the pelvic region (11 patients) or extremities (12 patients) bearing relatively large tumors (mean volume, 848 cm3). By the cutoff date for this analysis (October 15, 1991), 13 patients had undergone surgery after receiving 2-6 (mean, 3.8) cycles of EIA chemotherapy combined with regional hyperthermia; all tumors except one were resected without disfiguration. In 22 evaluable patients (minimum, 2 EIA plus regional hyperthermia cycles), the clinical response rate was 27%, with 6 patients showing partial responses (PRs). In addition, a pathologic response to preoperative thermochemotherapy was evaluable in 13 patients, with 4 responders (31%) having > 50% histologic necrosis. In all, 3 of the responders (1 PR and 2 patients with > 50% histologic necrosis) relapsed within 3 months of surgical resection. The other 7 responding

  20. Dynamical systems probabilistic risk assessment.

    Energy Technology Data Exchange (ETDEWEB)

    Denman, Matthew R.; Ames, Arlo Leroy

    2014-03-01

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

  1. Dynamical systems probabilistic risk assessment

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-03-01

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

  2. Recurrence risk is associated with preoperatively advanced prolapse stage: Is there a difference between women with stage 2 and those with stage 3 or 4 cystocele?

    NARCIS (Netherlands)

    Vergeldt, T.F.M.; Notten, K.J.; Kluivers, K.B.; Weemhoff, M.

    2017-01-01

    INTRODUCTION AND HYPOTHESIS: Pelvic organ prolapse (POP) recurrence after surgery is a major problem. POP that is more advanced preoperatively is associated with a higher risk of recurrence postoperatively. We hypothesized that women with a stage 2 cystocele differ from those with a stage 3 or 4

  3. Analysis of the abdominal musculo-aponeurotic anatomy in rectus diastasis: comparison of CT scanning and preoperative clinical assessment with direct measurement intraoperatively.

    Science.gov (United States)

    Emanuelsson, P; Dahlstrand, U; Strömsten, U; Gunnarsson, U; Strigård, K; Stark, B

    2014-08-01

    To evaluate and compare the consistency of agreement of two methods for measuring abdominal rectus diastasis (ARD), preoperative computed tomography (CT) scanning and preoperative clinical assessment were compared with direct measurement intraoperatively. Fifty-five consecutive patients were retrieved from an ongoing prospective randomised trial comparing two operative techniques for the repair of ARD. All patients underwent a preoperative clinical assessment and CT scan, and the results were compared with intraoperative measurement of the ARD width. Agreement between methods was described with Bland-Altman plots (BA plots) and calculated using Lin's Concordance Correlation Coefficient (CCC). The median width of the diastasis was 4.0 cm in the upper midline and 3.0 cm in the lower midline for the intraoperative measurement. BA plots showed that measurements on CT and intraoperatively are not in agreement in the lower midline, whereas the agreement was stronger between the clinical and the intraoperative method. The CCC was higher for clinical vs. intraoperative measurement (0.479) than for CT vs. intraoperative measurement (-0.002) in the lower midline, although the agreement was over all low. CT scanning underestimated the width of the ARD when compared to 87 % of preoperative clinical assessments, and 83 % of intraoperative measurements. Preoperative clinical assessment overestimated ARD in 35 % when compared with intraoperative measurements. Clinical assessment prior to surgery provides more accurate information than CT scanning in the assessment of ARD width. CT scanning underestimates ARD width when compared with intraoperative measurement.

  4. Integrated Disposal Facility Risk Assessment

    Energy Technology Data Exchange (ETDEWEB)

    MANN, F. M.

    2003-06-03

    An environmental risk assessment associated with the disposal of projected Immobilized Low-Activity Waste, solid wastes and failed or decommissioned melters in an Integrated Disposal Facility was performed. Based on the analyses all performance objectives associated with the groundwater, air, and intruder pathways were met.

  5. Preoperative administration of 0.2% chlorhexidine mouthrinse reduces the risk of bacteraemia associated with intra-alveolar tooth extraction.

    Science.gov (United States)

    Ugwumba, Chinedu U; Adeyemo, Wasiu L; Odeniyi, Olalekan M; Arotiba, Godwin T; Ogunsola, Folasade T

    2014-12-01

    The aim of the study was to investigate the effect of preoperative 0.2% chlorhexidine mouthwash on the risk of bacteraemia following routine intra-alveolar tooth extraction. The study was a randomized controlled clinical study of 101 subjects who underwent intra-alveolar dental extractions under local anaesthesia. Subjects were randomly assigned to either chlorhexidine or a control group. The chlorhexidine group had 0.2% chlorhexidine mouthwash administered for 1 min before any dental manipulation, and the control group had a mouthrinse of sterile water. Blood samples were collected at baseline, 1 min and 15 min after the dental extractions. Subculture and further identification of the isolated bacteria were performed by conventional microbiological techniques. There was a statistically significant difference in the incidence of bacteraemia between the control group (52.4%) and chlorhexidine group (27.1%) (P = 0.012). Bacteraemia was most frequently detected at 1 min after extraction (33.3%). Of the 30 subjects who had positive blood culture at 1 min, bacteraemia persisted in 8 (26.7%) of the subjects after 15 min. Bacteria isolated included Staphylococcus aureus, Actinomycetes naesulendi, Prevotella species, Streptococcus spp., and Acinetobacter iwoffii. Routine use of 0.20% chlorhexidine mouthwash before dental extraction is recommended to reduce the risk of bacteraemia following tooth extraction.

  6. Caries risk assessment in children

    DEFF Research Database (Denmark)

    Twetman, S

    2016-01-01

    (recommendation levels A-D). RESULTS: Three SR, three guidelines, and five papers, not considered in previous SR, were identified and formed the base for the present summary and recommendations. One of the systematic reviews and three of the primary publications were of moderate risk of bias, while the rest......PURPOSE: To summarise the findings of recent systematic reviews (SR) covering caries risk assessment in children, updated with recent primary studies. METHODS: A search for relevant papers published 2012-2014 was conducted in electronic databases. The systematic reviews were quality assessed...... with the AMSTAR tool and the primary publications according to the Cochrane handbook. The quality was rated as low, moderate, or high risk of bias. The findings were descriptively synthesised and the quality of evidence was graded according to GRADE. For the recommendations of practice, the SIGN scores were used...

  7. Analysis of Preoperative Metabolic Risk Factors Affecting the Prognosis of Patients with Esophageal Squamous Cell Carcinoma: The Fujian Prospective Investigation of Cancer (FIESTA Study

    Directory of Open Access Journals (Sweden)

    Feng Peng

    2017-02-01

    Full Text Available Some metabolic factors have been shown to be associated with an increased risk of esophageal cancer; however the association with its prognosis is rarely reported. Here, we assessed the prediction of preoperative metabolic syndrome and its single components for esophageal cancer mortality by analyzing a subset of data from the ongoing Fujian prospective investigation of cancer (FIESTA study. Between 2000 and 2010, patients who underwent three-field lymphadenectomy were eligible for inclusion. Blood/tissue specimens, demographic and clinicopathologic data were collected at baseline. Metabolic syndrome is defined by the criteria proposed by Chinese Diabetes Society. In this study, analysis was restricted to esophageal squamous cell carcinoma (ESCC due to the limited number of other histological types. The median follow-up in 2396 ESCC patients (males/females: 1822/574 was 38.2 months (range, 0.5–180 months. The multivariate-adjusted hazard ratio (HR of metabolic syndrome for ESCC mortality was statistically significant in males (HR, 95% confidence interval, P: 1.45, 1.14–1.83, 0.002, but not in females (1.46, 0.92–2.31, 0.107. For single metabolic components, the multivariate-adjusted HRs were significant for hyperglycemia (1.98, 1.68–2.33, <0.001 and dyslipidemia (1.41, 1.20–1.65, <0.001 in males and for hyperglycemia (1.76, 1.23–2.51, <0.001 in females, independent of clinicopathologic characteristics and obesity. In tree-structured survival analysis, the top splitting factor in both genders was tumor-node-metastasis stage, followed by regional lymph node metastasis. Taken together, our findings demonstrate that preoperative metabolic syndrome was a significant independent predictor of ESCC mortality in males, and this effect was largely mediated by glyeolipid metabolism disorder.

  8. Analysis of Preoperative Metabolic Risk Factors Affecting the Prognosis of Patients with Esophageal Squamous Cell Carcinoma: The Fujian Prospective Investigation of Cancer (FIESTA) Study.

    Science.gov (United States)

    Peng, Feng; Hu, Dan; Lin, Xiandong; Chen, Gang; Liang, Binying; Zhang, Hejun; Dong, Xiaoqun; Lin, Jinxiu; Zheng, Xiongwei; Niu, Wenquan

    2017-02-01

    Some metabolic factors have been shown to be associated with an increased risk of esophageal cancer; however the association with its prognosis is rarely reported. Here, we assessed the prediction of preoperative metabolic syndrome and its single components for esophageal cancer mortality by analyzing a subset of data from the ongoing Fujian prospective investigation of cancer (FIESTA) study. Between 2000 and 2010, patients who underwent three-field lymphadenectomy were eligible for inclusion. Blood/tissue specimens, demographic and clinicopathologic data were collected at baseline. Metabolic syndrome is defined by the criteria proposed by Chinese Diabetes Society. In this study, analysis was restricted to esophageal squamous cell carcinoma (ESCC) due to the limited number of other histological types. The median follow-up in 2396 ESCC patients (males/females: 1822/574) was 38.2months (range, 0.5-180months). The multivariate-adjusted hazard ratio (HR) of metabolic syndrome for ESCC mortality was statistically significant in males (HR, 95% confidence interval, P: 1.45, 1.14-1.83, 0.002), but not in females (1.46, 0.92-2.31, 0.107). For single metabolic components, the multivariate-adjusted HRs were significant for hyperglycemia (1.98, 1.68-2.33, <0.001) and dyslipidemia (1.41, 1.20-1.65, <0.001) in males and for hyperglycemia (1.76, 1.23-2.51, <0.001) in females, independent of clinicopathologic characteristics and obesity. In tree-structured survival analysis, the top splitting factor in both genders was tumor-node-metastasis stage, followed by regional lymph node metastasis. Taken together, our findings demonstrate that preoperative metabolic syndrome was a significant independent predictor of ESCC mortality in males, and this effect was largely mediated by glyeolipid metabolism disorder. Copyright © 2017 3-V Biosciences. Published by Elsevier B.V. All rights reserved.

  9. 24 CFR 35.315 - Risk assessment.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Risk assessment. 35.315 Section 35... Provided by a Federal Agency Other Than HUD § 35.315 Risk assessment. Each owner shall complete a risk assessment in accordance with 40 CFR 745.227(d). Each risk assessment shall be completed in accordance with...

  10. Remote Digital Preoperative Assessments for Cleft Lip and Palate May Improve Clinical and Economic Impact in Global Plastic Surgery.

    Science.gov (United States)

    Hughes, Christopher; Campbell, Jacob; Mukhopadhyay, Swagoto; McCormack, Susan; Silverman, Richard; Lalikos, Janice; Babigian, Alan; Castiglione, Charles

    2017-09-01

    Reconstructive surgical care can play a vital role in the resource-poor settings of low- and middle-income countries. Telemedicine platforms can improve the efficiency and effectiveness of surgical care. The purpose of this study is to determine whether remote digital video evaluations are reliable in the context of a short-term plastic surgical intervention. The setting for this study was a district hospital located in Latacunga, Ecuador. Participants were 27 consecutive patients who presented for operative repair of cleft lip and palate. We calculated kappa coefficients for reliability between in-person and remote digital video assessments for the classification of cleft lip and palate between two separate craniofacial surgeons. We hypothesized that the technology would be a reliable method of preoperative assessment for cleft disease. Of the 27 (81.4%) participants, 22 received operative treatment for their cleft disorder. Mean age was 11.1 ± 8.3 years. Patients presented with a spectrum of disorders, including cleft lip (24 of 27, 88.9%), cleft palate (19 of 27, 70.4%), and alveolar cleft (19 of 27, 70.4%). We found a 95.7% agreement between observers for cleft lip with substantial reliability (κ = .78, P cleft palate, with a moderate interrater reliability (κ = .55, P = .01). We found only a 47.8% agreement between observers for alveolar cleft with a nonsignificant, weak kappa agreement (κ = .06, P = .74). Remote digital assessments are a reliable way to preoperatively diagnose cleft lip and palate in the context of short-term plastic surgical interventions in low- and middle-income countries. Future work will evaluate the potential for real-time, telemedicine assessments to reduce cost and improve clinical effectiveness in global plastic surgery.

  11. CT fluoroscopy-guided preoperative short hook wire placement for small pulmonary lesions: evaluation of safety and identification of risk factors for pneumothorax

    Energy Technology Data Exchange (ETDEWEB)

    Iguchi, Toshihiro; Hiraki, Takao; Gobara, Hideo; Fujiwara, Hiroyasu; Matsui, Yusuke; Kanazawa, Susumu [Okayama University Medical School, Departments of Radiology, Okayama (Japan); Miyoshi, Shinichiro [Okayama University Medical School, General Thoracic Surgery, Okayama (Japan)

    2016-01-15

    To retrospectively evaluate the safety of computed tomography (CT) fluoroscopy-guided short hook wire placement for video-assisted thoracoscopic surgery and the risk factors for pneumothorax associated with this procedure. We analyzed 267 short hook wire placements for 267 pulmonary lesions (mean diameter, 9.9 mm). Multiple variables related to the patients, lesions, and procedures were assessed to determine the risk factors for pneumothorax. Complications (219 grade 1 and 4 grade 2 adverse events) occurred in 196 procedures. No grade 3 or above adverse events were observed. Univariate analysis revealed increased vital capacity (odds ratio [OR], 1.518; P = 0.021), lower lobe lesion (OR, 2.343; P = 0.001), solid lesion (OR, 1.845; P = 0.014), prone positioning (OR, 1.793; P = 0.021), transfissural approach (OR, 11.941; P = 0.017), and longer procedure time (OR, 1.036; P = 0.038) were significant predictors of pneumothorax. Multivariate analysis revealed only the transfissural approach (OR, 12.171; P = 0.018) and a longer procedure time (OR, 1.048; P = 0.012) as significant independent predictors. Complications related to CT fluoroscopy-guided preoperative short hook wire placement often occurred, but all complications were minor. A transfissural approach and longer procedure time were significant independent predictors of pneumothorax. (orig.)

  12. An approach to risk assessment

    DEFF Research Database (Denmark)

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

    1998-01-01

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

  13. Clinical importance of color doppler ultrasonography in preoperative assessment of hemodialysis vascular access creation

    Directory of Open Access Journals (Sweden)

    Petrović Dejan

    2012-03-01

    Full Text Available Chronic kidney failure is characterized with progressive and ireversible diminishing of glomerular filtration rate. Arterio-venous fistula (AVF for hemodialysis should be created in patients with endogenous creatinine clearance ≤ 20 mL/min/1,73m2. Inner diameter of a. radialis ≥ 2.0 mm, inner diameter of v.cephalica ≥ 2.5 mm, flow velocity through the a.radialis - VmaxS ≥ 50 cm/s and flow through the a. radialis - Qa.radialis ≥ 40 mL/m intenable adequate maturing of distal radio-cephalic AVF. Diameter of v.cephalica ≥ 4.0 mmand blood flow Q AV ≥ 500 mL/min, four weeks after the AVF creation, indicate adequately matured AVF and possibility of puncturing it. Maximal blood flow velocity through AVF of 100-350 cm/s and blood flow of 500-1000 mL/min, are signs of good function of AVF and adequate hemodialysis. Color Doppler ultrasonography enables preoperative planning of AVF, early complication detection, choice of appropriate therapeutical procedure for complication treatment, estimation of maturation, prime time for puncture and AVF function, which all contribute to a significant morbidity decrease and better life quality in hemodialysis patients.

  14. Preoperative assessment and treatment of appendiceal mucocele complicated by acute torsion: a case report.

    Science.gov (United States)

    Stark, Christoffer; Jousi, Mikko; Enholm, Berndt

    2014-01-02

    Mucus-producing tumours of the appendix or mucoceles can, if left untreated, lead to dissemination of its contents into the peritoneal cavity causing substantial morbidity to the patient. Symptoms for complicated mucoceles can mimic those of acute appendicitis and the final diagnosis is most likely made intraoperatively. We here present a case that is, to our knowledge, one of only ten described in the literature and the first to characterize torsion of an appendiceal mucocele with abdominal magnetic resonance imaging. The patient, a 34-year-old Caucasian female presented at the emergency department with acute abdominal pain in the right lower quadrant. Initial diagnostic work-up including ultrasonography and abdominal magnetic resonance imaging showed a large tubular mass at the base of the appendix with indirect signs of torsion. A laparoscopic appendectomy was performed the following day where the finding was confirmed. The patient went on to have an uneventful recovery and was discharged from the hospital on the first postoperative day. Magnetic resonance imaging is a useful tool in identifying unknown lesions of the appendix and should be considered the primary imaging modality in especially younger patients requiring diagnostic imaging. In this case the preoperative imaging findings aided in choosing the correct timing and treatment option for the patient.

  15. Thymic pathologies in myasthenia gravis: a preoperative assessment of CAT scan and nuclear based imaging.

    Science.gov (United States)

    Jordan, Berit; Kellner, Juliane; Jordan, Karin; Bähre, Manfred; Behrmann, Curd; Zierz, Stephan

    2016-04-01

    Precise diagnostic work up of a suspected thymic pathology in patients with myasthenia gravis (MG) is very important for potential surgical implications and further disease course. In this study the diagnostic value of combined preoperative radiological (CAT scan) and nuclear based imaging (octreotide and thallium scintigraphy) in patients with MG was evaluated. Twenty four patients were included. Histopathology revealed thymoma in nine patients, thymic carcinoma (TC) in one patient, lymphofollicular hyperplasia in seven patients, and involuted thymus in another seven patients. Diagnostic sensitivity for detecting thymoma/TC was 80 % in CAT scan as well as in somatostatin scintigraphy; the combination of both procedures reached 90 %. However, the diagnostic specifity to exclude thymoma in CAT scan was 100 % and in octreotide scintigraphy 85.7 %. Semiquantitative octreotide uptake significantly correlated with histological grading of thymoma/TC (r = 0.764) and histological proliferation rate Ki67 (r = 0.894). Thallium scintigraphy was positive only in one out of four thymoma cases. In this study, somatostatin scintigraphy has been shown to be a useful additional diagnostic technique in detecting thymic malignancies in patients with MG. These results might be especially helpful in patients with late onset MG as these patients are in general no candidates for thymectomy.

  16. Uncertainties in risk assessment at USDOE facilities

    Energy Technology Data Exchange (ETDEWEB)

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

    1994-01-01

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

  17. Uncertainties in risk assessment at USDOE facilities

    Energy Technology Data Exchange (ETDEWEB)

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

    1994-01-01

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

  18. Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests

    Science.gov (United States)

    2012-01-01

    Background Routine pre-operative tests for anesthesia management are often ordered by both anesthesiologists and surgeons for healthy patients undergoing low-risk surgery. The Theoretical Domains Framework (TDF) was developed to investigate determinants of behaviour and identify potential behaviour change interventions. In this study, the TDF is used to explore anaesthesiologists’ and surgeons’ perceptions of ordering routine tests for healthy patients undergoing low-risk surgery. Methods Sixteen clinicians (eleven anesthesiologists and five surgeons) throughout Ontario were recruited. An interview guide based on the TDF was developed to identify beliefs about pre-operative testing practices. Content analysis of physicians’ statements into the relevant theoretical domains was performed. Specific beliefs were identified by grouping similar utterances of the interview participants. Relevant domains were identified by noting the frequencies of the beliefs reported, presence of conflicting beliefs, and perceived influence on the performance of the behaviour under investigation. Results Seven of the twelve domains were identified as likely relevant to changing clinicians’ behaviour about pre-operative test ordering for anesthesia management. Key beliefs were identified within these domains including: conflicting comments about who was responsible for the test-ordering (Social/professional role and identity); inability to cancel tests ordered by fellow physicians (Beliefs about capabilities and social influences); and the problem with tests being completed before the anesthesiologists see the patient (Beliefs about capabilities and Environmental context and resources). Often, tests were ordered by an anesthesiologist based on who may be the attending anesthesiologist on the day of surgery while surgeons ordered tests they thought anesthesiologists may need (Social influences). There were also conflicting comments about the potential consequences associated with

  19. Anesthesiologists' and surgeons' perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians' decisions to order pre-operative tests.

    Science.gov (United States)

    Patey, Andrea M; Islam, Rafat; Francis, Jill J; Bryson, Gregory L; Grimshaw, Jeremy M

    2012-06-09

    Routine pre-operative tests for anesthesia management are often ordered by both anesthesiologists and surgeons for healthy patients undergoing low-risk surgery. The Theoretical Domains Framework (TDF) was developed to investigate determinants of behaviour and identify potential behaviour change interventions. In this study, the TDF is used to explore anaesthesiologists' and surgeons' perceptions of ordering routine tests for healthy patients undergoing low-risk surgery. Sixteen clinicians (eleven anesthesiologists and five surgeons) throughout Ontario were recruited. An interview guide based on the TDF was developed to identify beliefs about pre-operative testing practices. Content analysis of physicians' statements into the relevant theoretical domains was performed. Specific beliefs were identified by grouping similar utterances of the interview participants. Relevant domains were identified by noting the frequencies of the beliefs reported, presence of conflicting beliefs, and perceived influence on the performance of the behaviour under investigation. Seven of the twelve domains were identified as likely relevant to changing clinicians' behaviour about pre-operative test ordering for anesthesia management. Key beliefs were identified within these domains including: conflicting comments about who was responsible for the test-ordering (Social/professional role and identity); inability to cancel tests ordered by fellow physicians (Beliefs about capabilities and social influences); and the problem with tests being completed before the anesthesiologists see the patient (Beliefs about capabilities and Environmental context and resources). Often, tests were ordered by an anesthesiologist based on who may be the attending anesthesiologist on the day of surgery while surgeons ordered tests they thought anesthesiologists may need (Social influences). There were also conflicting comments about the potential consequences associated with reducing testing, from negative

  20. Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF to identify factors that influence physicians’ decisions to order pre-operative tests

    Directory of Open Access Journals (Sweden)

    Patey Andrea M

    2012-06-01

    Full Text Available Abstract Background Routine pre-operative tests for anesthesia management are often ordered by both anesthesiologists and surgeons for healthy patients undergoing low-risk surgery. The Theoretical Domains Framework (TDF was developed to investigate determinants of behaviour and identify potential behaviour change interventions. In this study, the TDF is used to explore anaesthesiologists’ and surgeons’ perceptions of ordering routine tests for healthy patients undergoing low-risk surgery. Methods Sixteen clinicians (eleven anesthesiologists and five surgeons throughout Ontario were recruited. An interview guide based on the TDF was developed to identify beliefs about pre-operative testing practices. Content analysis of physicians’ statements into the relevant theoretical domains was performed. Specific beliefs were identified by grouping similar utterances of the interview participants. Relevant domains were identified by noting the frequencies of the beliefs reported, presence of conflicting beliefs, and perceived influence on the performance of the behaviour under investigation. Results Seven of the twelve domains were identified as likely relevant to changing clinicians’ behaviour about pre-operative test ordering for anesthesia management. Key beliefs were identified within these domains including: conflicting comments about who was responsible for the test-ordering (Social/professional role and identity; inability to cancel tests ordered by fellow physicians (Beliefs about capabilities and social influences; and the problem with tests being completed before the anesthesiologists see the patient (Beliefs about capabilities and Environmental context and resources. Often, tests were ordered by an anesthesiologist based on who may be the attending anesthesiologist on the day of surgery while surgeons ordered tests they thought anesthesiologists may need (Social influences. There were also conflicting comments about the potential

  1. A risk of malignancy index in preoperative diagnosis of ovarian cancer

    Institute of Scientific and Technical Information of China (English)

    马水清; 沈铿; 郎景和

    2003-01-01

    Objective To evaluate the ability of a risk of malignancy index (RMI), based on serum CA125 level, ultrasound findings and menopausal status, to discriminate benign from malignant pelvic mass. Methods One hundred and forty women with pelvic masses, at age 30 of years or more were admitted to the Peking Union Medical College Hospital between January 1998 and June 1999. The sensitivity, specificity and positive predictive value of serum CA125 level, ultrasound findings and the menopausal status in diagnosis of ovarian cancer were evaluated separately or combined into the RMI. Results RMI was more accurate than any individual criterion in diagnosing cancer. Using an RMI cutoff level of 200 to indicate malignancy, the RMI derived from this data set gave a sensitivity of 87.3%, a specificity of 84.4%, and a positive predictive value of 82.1%. Conclusions RMI is able to correctly discriminate malignant from benign pelvic mass. It can be introduced easily into clinical practice to facilitate the selection of patients for primary surgery.

  2. Benefits and risks of preoperative bowel cleansing in the pediatric population

    Directory of Open Access Journals (Sweden)

    Silvia Cordero Castro

    2013-10-01

    Full Text Available This article has as aim to announce the results of a clinical question referred about the intestinal cleanliness method most adapted for the pediatric population before a colorectal surgery, in order to diminish the electrolytic alterations for the utilization of the same ones and hereby to provide a better intestinal preparation with the minor risks. Is true the method of intestinal cleanliness it is a medical indication, the infirmary professionals must think about his work and wonder it brings over of his own practice and to work in a surest way (Young, 2003. There was realized a search, review and analysis of the scientific literature for that there were use different databases, as for example seeker academic GOOGLE, administrators of articles PUBMED, MEDLINE, EMBASE, SCIELO and Cochrane in Spanish and English language. Found 31 investigations that refer to the interest topic in indirect form. The conclusion were that the fosfosoda oral is effective and better tolerated in the intestinal cleanlinesses with the exception of the magnesium citrate who overcomes in flavor, for this could be an option for the use in pediatric populations. Nevertheless to use cautiously it's recommended to take renal function test and electrolytic pre, trans and post administration, added to the use of intravenous solutions mixed or electrolytic balanced intravenous as reinstatement to the losses. Nevertheless, there is no forceful evidence to determine which method of intestinal cleanliness is better and less risky for the children.

  3. Automating Spreadsheet Discovery & Risk Assessment

    CERN Document Server

    Perry, Eric

    2008-01-01

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

  4. Risk Assessment Terminology: Risk Communication Part 2.

    Science.gov (United States)

    Liuzzo, Gaetano; Bentley, Stefano; Giacometti, Federica; Piva, Silvia; Serraino, Andrea

    2016-04-19

    The paper describes the terminology of risk communication in the view of food safety: different aspects of risk perception (perceived risk, media triggers, the psychometric paradigm, fright factors and cultural determinants of risk perception) are described. The risk profile elements are illustrated in the manuscript: hazard-food commodity combination(s) of concern; description of the public health problem; food production, processing, distribution and consumption; needs and questions for the risk assessors; available information and major knowledge gaps and other risk profile elements.

  5. Risk assessment terminology: risk communication part 2

    Directory of Open Access Journals (Sweden)

    Gaetano Liuzzo

    2016-04-01

    Full Text Available The paper describes the terminology of risk communication in the view of food safety: different aspects of risk perception (perceived risk, media triggers, the psychometric paradigm, fright factors and cultural determinants of risk perception are described. The risk profile elements are illustrated in the manuscript: hazard-food commodity combination(s of concern; description of the public health problem; food production, processing, distribution and consumption; needs and questions for the risk assessors; available information and major knowledge gaps and other risk profile elements.

  6. Preoperative Evaluation for Noncardiac Surgery.

    Science.gov (United States)

    Cohn, Steven L

    2016-12-06

    This issue provides a clinical overview of preoperative evaluation for noncardiac surgery, focusing on risk factors, elements of evaluation, medication management, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

  7. Survey of mental health nurses' attitudes towards risk assessment, risk assessment tools and positive risk.

    Science.gov (United States)

    Downes, C; Gill, A; Doyle, L; Morrissey, J; Higgins, A

    2016-04-01

    WHAT IS KNOWN ON THE SUBJECT?: Risk assessment and safety planning are a core aspect of the role of the mental health nurse. Conflicting views exist on the value of risk assessment tools. Few studies have examined mental health nurses' attitudes towards risk, including use of tools and the role of positive risk in recovery. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Mental health nurses view risk assessment as a core dimension of their role and not merely an exercise to fulfil organizational clinical safety and governance obligations. The majority of nurses hold positive attitudes towards therapeutic or positive risk, and consider creative risk taking as vital to people's recovery. The majority of nurses believe that risk assessment tools facilitate professional decision making, however, some are concerned that tools may negatively impact upon therapeutic relationships. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Ongoing education on the use of risk assessment tools is required to minimize views that their use is incompatible with therapeutic engagement, and to enable nurses to develop confidence to engage with positive risk and to allow service users make decisions and take responsibility. Introduction Risk assessment and safety planning are considered core components of the role of the mental health nurse; however, little is known about nurses' attitudes towards risk assessment, use of tools to assess risk or therapeutic risk taking. Aim This study aimed to explore mental health nurses' attitudes towards completing risk assessments, use of tools as an aid, and therapeutic or positive risk. Method An anonymous survey which included 13 attitudinal statements, rated on a five-point Likert scale, was completed by 381 mental health nurses working in adult services in Ireland. Findings Findings indicate strong support for the practice of risk assessment in mental health practice. The vast majority of nurses believe that risk assessment tools facilitate professional

  8. Risk Assessment of Shellfish Toxins

    Directory of Open Access Journals (Sweden)

    Rex Munday

    2013-11-01

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

  9. Rate of ectasia and incidence of irregular topography in patients with unidentified preoperative risk factors undergoing femtosecond laser-assisted LASIK

    Directory of Open Access Journals (Sweden)

    Moshirfar M

    2013-12-01

    Full Text Available Majid Moshirfar,1 Jared G Smedley,2 Valliammai Muthappan,1 Allison Jarsted,3 Erik M Ostler1 1John A Moran Eye Center, University of Utah, Salt Lake City, UT, USA; 2College of Human Medicine, Michigan State University, Lansing, MI, USA; 3Department of Ophthalmology, State University of New York Upstate Medical University, Syracuse, NY, USA Purpose: To report the rate of postoperative ectasia after laser-assisted in situ keratomileusis (LASIK with femtosecond laser-assisted flap creation, in a population of patients with no identified preoperative risk factors. Methods: A retrospective case review of 1,992 eyes (1,364 patients treated between March 2007 and January 2009 was conducted, with a follow up of over 4 years. After identifying cases of ectasia, all the patient charts were examined retrospectively for preoperative findings suggestive of forme fruste keratoconus (FFKC. Results: Five eyes of four patients with post-LASIK ectasia were identified. All eyes passed preoperative screening and received bilateral LASIK. One of the five patients developed ectasia in both eyes. Three patients retrospectively revealed preoperative topography suggestive of FFKC, while one patient had no identifiable preoperative risk factors. Upon review of all the charts, a total 69 eyes, including four of the five eyes with ectasia, were retrospectively found to have topographies suggestive of FFKC. Conclusion: We identified four cases of post-LASIK ectasia that had risk factors for FFKC on reexamination of the chart and one case of post-LASIK ectasia with no identifiable preoperative risk factors. The most conservative screening recommendations would not have precluded this patient from LASIK. The rate of purely iatrogenic post-LASIK ectasia at our center was 0.05% (1/1,992, and the total rate of post-LASIK ectasia for our entire study was 0.25% (1/398. The rate of eyes with unrecognized preoperative FFKC that developed post-LASIK ectasia was 5.8% (1/17. Keywords

  10. Total cardiovascular disease risk assessment: a review.

    LENUS (Irish Health Repository)

    Cooney, Marie Therese

    2011-09-01

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

  11. [Risk assessment in pain therapy].

    Science.gov (United States)

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

    2008-10-01

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

  12. THE IMPORTANCE OF PREOPERATIVE RISK FACTORS IN THE RECOVERY OF PATIENTS WITH DEFORMITIES FOLLOWING TOTAL KNEE ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    Savin L.

    2015-08-01

    Full Text Available A retrospective observational study has been conducted on 457 patients diagnosed with advanced knee osteoarthritis and that underwent knee arthroplasty. Two groups of patients have been observed: the first group presented deformities (varus, valgus while the second group did not. There have been evaluated the prevalence of general risk factors (age, sex and local ones (obesity, muscle tone, deformities in the occurrence of advanced gonarthrosis requiring radical surgery and the influence of these factors on the evolution of patients¬ that underwent total knee arthroplasty. 53.6 % of patients had their knees correctly aligned while 39.8% presented a varus misalignment and only 6.1% a valgus misalignment. Within the group of patients included in the study, the average age of patients was 66 years and the highest frequency was found in patients aged over 70 years, both in genu varum and genu valgum. The female patients represent 74.4% of the total number of patients and more frequently affected by the occurrence of deformities. Obesity has been observed in 32 – 38% of the patients with deformities. Postoperative pain has been evaluated using the Visual Analogue Scale (VAS. In 50% of the cases, patients with varus and valgus accused early intense and severe postoperative pain (VAS 7-10. 32. 64% of the female patients accused level of pain marked as 7 – 10 VAS, while only 30.84% of the male patients accused the same levels of pain. Intense and severe pain is more frequently found in elderly patients. The deformities did not cause any important changes on early postoperative pain, obesity and muscular hypotrophy being the risk factors in increasing the level of pain. Postoperative recovery in patents with knee arthroplasty largely depends on preoperative planning, the surgical technique and, not lastly, the correct management of bleeding and pain.

  13. Patients’ perception of diagnostic tests in the preoperative assessment of esophageal cancer

    Science.gov (United States)

    Westerterp, Marinke; van Westreenen, Henderik L; Deutekom, Marije; Stoker, Jaap; Fockens, Paul; Comans, Emile FI; Plukker, John TM; Bossuyt, Patrick MM; van Lanschot, J Jan B; Sloof, Gerrit W

    2008-01-01

    Objective Defining an optimal staging strategy requires an evaluation of the effectiveness and costs of diagnostic tests and may include the burden of these tests for patients. This study evaluated the burden of cervical ultrasonography (US), endoscopic ultrasonography (EUS), computed tomography (CT) and positron emission tomography (PET) in patients with esophageal carcinoma (EC). Methods Consenting consecutive patients underwent a standard preoperative work-up. Burden of testing was evaluated with a self-report questionnaire addressing anxiety, embarrassment, and discomfort, each measured on a 1(none) to 5 (extreme) point-scale. An overall burden score was calculated by summing the three item scores. In addition, patients were asked to rank the four tests from least to most inconvenient. Statistical analysis was performed with nonparametric tests. Results 82 patients (67 , 15 ; mean age 64.3 yrs) participated. For most tests and most dimensions of burden, the large majority of subjects was in categories 1 and 2.With respect to anxiety, the rank order (from highest burden to lowest burden) was EUS, US, PET, and CT (average scores 1.7, 1.5, 1.4, and 1.2, respectively). For embarrassment, the rank order was EUS, PET, US, and CT (1.9, 1.5, 1.4, and 1.3 respectively). For discomfort, the rank order was EUS, PET, US and CT (2.0, 1.6, 1.4, and 1.2, respectively). And for total burden, the rank order was EUS, PET, US and CT (5.6, 4.6, 4.2, and 3.7). PET was ranked as least inconvenient by 35% of patients and as most inconvenient by 16% compared with the other tests. Conclusion Significant but small differences were observed in patient burden for imaging tests to evaluate EC. The perceived burden of PET was lower than that of EUS, but higher than the burden of CT. However absolute values were low for all tests and therefore patient burden will not be a key feature for the construction of an optimal staging algorithm for EC. PMID:19920957

  14. Can Public Health Risk Assessment Using Risk Matrices Be Misleading?

    Science.gov (United States)

    Vatanpour, Shabnam; Hrudey, Steve E; Dinu, Irina

    2015-08-14

    The risk assessment matrix is a widely accepted, semi-quantitative tool for assessing risks, and setting priorities in risk management. Although the method can be useful to promote discussion to distinguish high risks from low risks, a published critique described a problem when the frequency and severity of risks are negatively correlated. A theoretical analysis showed that risk predictions could be misleading. We evaluated a practical public health example because it provided experiential risk data that allowed us to assess the practical implications of the published concern that risk matrices would make predictions that are worse than random. We explored this predicted problem by constructing a risk assessment matrix using a public health risk scenario-Tainted blood transfusion infection risk-That provides negative correlation between harm frequency and severity. We estimated the risk from the experiential data and compared these estimates with those provided by the risk assessment matrix. Although we validated the theoretical concern, for these authentic experiential data, the practical scope of the problem was limited. The risk matrix has been widely used in risk assessment. This method should not be abandoned wholesale, but users must address the source of the problem, apply the risk matrix with a full understanding of this problem and use matrix predictions to inform, but not drive decision-making.

  15. Concordance between preoperative and postoperative assessments of primary caries lesion depth: results from the Dental PBRN

    DEFF Research Database (Denmark)

    Nascimento, Marcelle M; Bader, James D; Qvist, Vibeke

    2010-01-01

    This study investigated the concordance between pre- and postoperative assessments of primary caries lesion depths by dentists from The Dental Practice-Based Research Network (DPBRN; www.DentalPBRN.org). A total of 229 DPBRN dentists collected data on 8,351 consecutive restorations inserted due...... was at an advanced stage: 88% concordance at the D3 depth, compared to 54% concordance at the E1 depth. DPBRN dentists can discriminate caries lesions at different depths, but the accuracy of their depth assessments was higher for dentin than for enamel lesions. In general, DPBRN dentists were more likely...

  16. Assessment of preoperative ultrasonography of the neck and elective neck dissection in patients with oral squamous cell carcinoma.

    NARCIS (Netherlands)

    Wensing, B.M.; Merkx, M.A.W.; Wilde, P.C.M. de; Marres, H.A.M.; Hoogen, F.J.A. van den

    2010-01-01

    Estimating the value of our preoperative workup in the treatment of patients with clinically N0 (cN0) squamous cell carcinoma of the oral cavity. Retrospective analysis. Results of preoperative palpation, ultrasound (US) and ultrasound-guided fine needle aspiration cytology (FNAC) were compared to t

  17. RISK MANAGEMENT: AN INTEGRATED APPROACH TO RISK MANAGEMENT AND ASSESSMENT

    Directory of Open Access Journals (Sweden)

    Szabo Alina

    2012-12-01

    Full Text Available Purpose: The objective of this paper is to offer an overview over risk management cycle by focusing on prioritization and treatment, in order to ensure an integrated approach to risk management and assessment, and establish the ‘top 8-12’ risks report within the organization. The interface with Internal Audit is ensured by the implementation of the scoring method to prioritize risks collected from previous generated risk report. Methodology/approach: Using evidence from other research in the area and the professional expertise, this article outlines an integrated approach to risk assessment and risk management reporting processes, by separating the risk in two main categories: strategic and operational risks. The focus is on risk prioritization and scoring; the final output will comprise a mix of strategic and operational (‘top 8-12’ risks, which should be used to establish the annual Internal Audit plan. Originality/value: By using an integrated approach to risk assessment and risk management will eliminate the need for a separate Internal Audit risk assessment over prevailing risks. It will reduce the level of risk assessment overlap by different functions (Tax, Treasury, Information System over the same risk categories as a single methodology, is used and will align timings of risk assessment exercises. The risk prioritization by usage of risk and control scoring criteria highlights the combination between financial and non-financial impact criteria allowing risks that do not naturally lend themselves to a financial amount to be also assessed consistently. It is emphasized the usage of score method to prioritize the risks included in the annual audit plan in order to increase accuracy and timelines.

  18. Anatomic and Quantitative Temporal Bone CT for Preoperative Assessment of Branchio-Oto-Renal Syndrome.

    Science.gov (United States)

    Ginat, D T; Ferro, L; Gluth, M B

    2016-12-01

    We describe the temporal bone computed tomography (CT) findings of an unusual case of branchio-oto-renal syndrome with ectopic ossicles that are partially located in the middle cranial fossa. We also describe quantitative temporal bone CT assessment pertaining to cochlear implantation in the setting of anomalous cochlear anatomy associated with this syndrome.

  19. The relation of risk assessment and health impact assessment

    DEFF Research Database (Denmark)

    Ádám, Balázs; Gulis, Gabriel

    2013-01-01

    their relationship. The experiences accumulated during the preparation of several case studies in a large scale international project (RAPID) are used for argumentation and formulation of recommendations on how risk assessment can be systematically integrated into the HIA process. Risk assessment uses well...... than assessing a present situation. As part of this process, however, methods applied in risk assessment are used. Risk assessment typically characterises relation of a well-defined risk factor to a well-defined health outcome. Within HIA usually several individual risk assessments are needed...... in the risk appraisal phase to describe effects of various factors on different health outcomes. Consequently, HIA is typically led by a large, preferably intersectoral steering group with representatives of communities at risk. Risk assessment, in contrary, is mainly a licensed scientific process completed...

  20. Colonic resection with early discharge after combined subarachnoid-epidural analgesia, preoperative glucocorticoids, and early postoperative mobilization and feeding in a pulmonary high-risk patient

    DEFF Research Database (Denmark)

    Møiniche, S; Dahl, J B; Rosenberg, J

    1994-01-01

    BACKGROUND AND OBJECTIVES. A pulmonary high-risk patient undergoing right hemicolectomy for cancer was treated with a combination of intense afferent neural block with subarachnoid-epidural local anesthetics followed by continuous epidural analgesia, preoperative high-dose glucocorticoids......) with unchanged pulmonary function. Nocturnal episodic oxygen desaturation, hyperthermia, and postoperative fatigue were prevented. Defecation occurred on the first postoperative day and oral caloric intake was normal after 24 hours with no postoperative weight loss. Self care was normalized on the third...

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

    NARCIS (Netherlands)

    Mahmoudi, Hossein; Renn, Ortwin; Vanclay, Frank; Hoffmann, Volker; Karami, Ezatollah

    2013-01-01

    An increasing focus on integrative approaches is one of the current trends in impact assessment. There is potential to combine impact assessment with various other forms of assessment, such as risk assessment, to make impact assessment and the management of social risks more effective. We identify

  2. Risk assessment terminology: risk communication part 1

    Directory of Open Access Journals (Sweden)

    Gaetano Liuzzo

    2016-03-01

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

  3. 3D-echo in preoperative assessment of aortic cusps effective height

    Institute of Scientific and Technical Information of China (English)

    Jan; Nijs; Sandro; Gelsomino; Bastian; BLJH; Kietselaer; Orlando; Parise; Fabiana; Lucà; Jos; G; Maessen; Mark; La; Meir

    2014-01-01

    Effective height,which represents the height difference between the central free margins and the aortic insertion lines can be easily determined by 2-D echocardiography and allows for identification of prolapse in the native cusps and assessment of prolapse correction after valve repair.Nonetheless,it allows to see only two of three aortic valve(AV)coaptation planes and this may lead to misunderstanding of the underlying pathophysiological mechanism for aortic regurgitation and hence in unsuccessful repair.In contrast,3D transoesophageal echocardiography and multiple plane reconstruction lets visualize all the three coaptation planes between the AV cusps and it represents an invaluable tool in the assessment of aortic valve geometry.It is highly recommendable before AV repair to accurately study the complex three dimensional cusps anatomy and their geometric interrelation with aortic root.

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

    Science.gov (United States)

    Stahlmann, Ralf; Horvath, Aniko

    2015-01-01

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

  5. Risks, risk assessment and risk competence in toxicology

    Directory of Open Access Journals (Sweden)

    Stahlmann, Ralf

    2015-07-01

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

  6. Role of multimodality cardiac imaging in preoperative cardiovascular evaluation before noncardiac surgery

    Directory of Open Access Journals (Sweden)

    Fathala Ahmed

    2011-01-01

    Full Text Available The preoperative cardiac assessment of patients undergoing noncardiac surgery is common in the daily practice of medical consultants, anesthesiologists, and surgeons. The number of patients undergoing noncardiac surgery worldwide is increasing. Currently, there are several noninvasive diagnostic tests available for preoperative evaluation. Both nuclear cardiology with myocardial perfusion single photon emission computed tomography (SPECT and stress echocardiography are well-established techniques for preoperative cardiac evaluation. Recently, some studies demonstrated that both coronary angiography by gated multidetector computed tomography and stress cardiac magnetic resonance might potentially play a role in preoperative evaluation as well, but more studies are needed to assess the role of these new modalities in preoperative risk stratification. A common question that arises in preoperative evaluation is if further preoperative testing is needed, which preoperative test should be used. The preferred stress test is the exercise electrocardiogram (ECG. Stress imaging with exercise or pharmacologic stress agents is to be considered in patients with abnormal rest ECG or patients who are unable to exercise. After reviewing this article, the reader should develop an understanding of the following: (1 the magnitude of the cardiac preoperative morbidity and mortality, (2 how to select a patient for further preoperative testing, (3 currently available noninvasive cardiac testing for the detection of coronary artery disease and assessment of left ventricular function, and (4 an approach to select the most appropriate noninvasive cardiac test, if needed.

  7. Does preoperative heparin increase the postoperative bleeding risk in women undergoing prosthetic breast implant surgery? A review of the data from a single institution.

    Science.gov (United States)

    Monsivais, Sharon E; Roehl, Kendall R; Mahabir, Raman C

    2015-01-01

    In 2008, the authors' institution adopted a policy requiring that all patients, regardless of preoperative risk, receive both sequential compression devices and a single preoperative subcutaneous 5000 unit injection of heparin. A previously published 12-year review at this same institution before this policy demonstrated a 1.5% 30-day postoperative incidence of hematoma in primary augmentation or delayed tissue expander based breast reconstructions. To determine the incidence of postoperative bleeding complications associated with preoperative administration of 5000 units of subcutaneous heparin and compare that incidence with previously published data. Patient data were collected prospectively and maintained in a secure database at a single institution with institutional review board approval. Current procedural terminology and International Classification of Diseases, Ninth Revision, coding was then used to identify all patients who received either primary breast augmentation or delayed tissue expander based breast reconstruction during a five-year period. The primary outcome was the incidence of postoperative bleeding complication. A bleeding complication was defined as any hemorrhagic event that required a return to the operating room. The overall incidence of significant postoperative bleeding was 1.47% (five of 340 [1.16% augmentation, 2.50% expander]). Comparing the current results with the previously published data, demonstrated an OR of 0.98 (95% CI 0.38 to 2.55). In women undergoing primary breast augmentation or delayed tissue expander breast reconstruction, heparin prophylaxis did not increase the risk for significant postoperative bleeding compared with historical controls.

  8. Risk assessment and risk management in managed aquifer recharge

    CSIR Research Space (South Africa)

    Page, D

    2012-06-01

    Full Text Available This chapter presents the methodologies used for risk assessment and risk management in MAR in Australia and the European Union, qualitative and quantitative approaches adopted within the RECLAIM Water project and case studies where the outcomes...

  9. Image analysis of the inner ear with CT and MR imaging; Pre-operative assessment for cochlear implant surgery

    Energy Technology Data Exchange (ETDEWEB)

    Kumakawa, Kohzoh; Takeda, Hidehiko; Mutoh, Naoko; Miyakawa, Kohichi (Toranomon Hospital, Tokyo (Japan)); Yukawa, Kumiko; Funasaka, Sohtaro

    1992-06-01

    Recent progress in magnetic resonance imaging (MRI) has made it possible to obtain detailed images of the inner ear by delineating the lymphatic fluid within the labyrinth. We analyzed CT scans and MR imaging in 70 ears manifesting profound deafness owing to inner ear lesions and compared their detective ability for inner ear lesions. The following results were obtained. CT scan examination showed slight to extensive ossification of the labyrinth in six ears (9%), whereas MRI examination revealed low to absent signal intensity of the inner ear in nine ears (13%). Therefore, it was concluded that MRI is more sensitive in detecting abnormalities of the inner ear than CT scan. MRI provided useful information as to whether the cochlear turn is filled with lymphatic fluid or obstructed. This point was one of the greatest advantages of MRI over CT scan. Abnormal findings in either or both the CT scan and the MRI were detected in suppurative labyrinthitis occurring secondary to chronic otitis media, bacterial meningitis and in inner ear trauma. However, such abnormal findings were not detected in patients with idiopathic progressive sensorineural hearing loss, ototoxity or sudden deafness. These findings should be taken into consideration in pre-operative assessment of cochlear implant candidates. (author).

  10. Colorectal Cancer Risk Assessment Tool

    Science.gov (United States)

    ... 11/12/2014 Risk Calculator About the Tool Colorectal Cancer Risk Factors Download SAS and Gauss Code Page ... Rectal Cancer: Prevention, Genetics, Causes Tests to Detect Colorectal Cancer and Polyps Cancer Risk Prediction Resources Update November ...

  11. From Hazard to Risk - Assessing the Risk

    NARCIS (Netherlands)

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

    2013-01-01

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

  12. Fuzzy based risk register for construction project risk assessment

    Science.gov (United States)

    Kuchta, Dorota; Ptaszyńska, Ewa

    2017-07-01

    The paper contains fuzzy based risk register used to identify risks which appear in construction projects and to assess their attributes. Risk is considered here as a possible event with negative consequences for the project [4]. We use different risk attributes in the proposed risk register. Values of risk attributes are generated by using fuzzy numbers. Specific risk attributes have different importance for project managers of construction projects. To compare specific risk attributes we use methods of fuzzy numbers ranking. The main strengths of the proposed concept in managing construction projects are also presented in the paper.

  13. Advances in the assessment of suicide risk.

    Science.gov (United States)

    Bryan, Craig J; Rudd, M David

    2006-02-01

    This article reviews and integrates empirically grounded advances in the assessment of suicidality. The practices discussed are consistent with existing standards of care, practice guidelines, and applicable research. The authors differentiate between risk assessment and prediction and then emphasize the important role of time in risk assessment. We present and illustrate a continuum of suicidality for risk assessment and offer practical recommendations for clinical decision making and treatment. (c) 2005 Wiley Periodicals, Inc.

  14. Gender differences in risk assessment

    Directory of Open Access Journals (Sweden)

    Christine R. Harris

    2006-07-01

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

  15. Preoperative assessment of trigeminal neuralgia and hemifacial spasm using constructive interference in steady state-three-dimensional fourier transformation magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Yamakami, Iwao; Kobayashi, Eiichi; Hirai, Shinji; Yamaura, Akira [Chiba Univ. (Japan). School of Medicine

    2000-11-01

    Results of microvascular decompression (MVD) for trigeminal neuralgia (TN) and hemifacial spasm (HFS) may be improved by accurate preoperative assessment of neurovascular relationships at the root entry/exit zone (REZ). Constructive interference in steady state (CISS)-three-dimensional Fourier transformation (3DFT) magnetic resonance (MR) imaging was evaluated for visualizing the neurovascular relationships at the REZ. Fourteen patients with TN and eight patients with HFS underwent MR imaging using CISS-3DFT and 3D fast inflow with steady-state precession (FISP) sequences. Axial images of the cerebellopontine angle (CPA) obtained by the two sequences were reviewed to assess the neurovascular relationships at the REZ of the trigeminal and facial nerves. Eleven patients subsequently underwent MVD. Preoperative MR imaging findings were related to surgical observations and results. CISS MR imaging provided excellent contrast between the cranial nerves, small vessels, and cerebrospinal fluid (CSF) in the CPA. CISS was significantly better than FISP for delineating anatomic detail in the CPA (trigeminal and facial nerves, petrosal vein) and abnormal neurovascular relationships responsible for TN and HFS (vascular contact and deformity at the REZ). Preoperative CISS MR imaging demonstrated precisely the neurovascular relationships at the REZ and identified the offending artery in all seven patients with TN undergoing MVD. CISS MR imaging has high resolution and excellent contrast between cranial nerves, small vessels, and CSF, so can precisely and accurately delineate normal and abnormal neurovascular relationships at the REZ in the CPA, and is a valuable preoperative examination for MVD. (author)

  16. ASSESSMENT OF BODY FAT IN OBESE PATIENTS PREOPERATIVELY FOR BARIATRIC SURGERY.

    Science.gov (United States)

    Fernandez, Mônica; Toimil, Rosana Farah; Rasslan, Zied; Ilias, Elias Jirjoss; Gradinar, Ana Lúcia Torloni; Malheiros, Carlos Alberto

    The study of body composition in patient candidates for bariatric surgery is directly related to the increase and distribution of body fat in the development of cardiovascular disease. To correlate anthropometric indicators and bioelectrical impedance in the assessment of body fat in female candidates for bariatric surgery. Cross-sectional, observational study of 88 women. The weight, height, body mass index and waist circumference data were evaluated in the anthropometric analysis. The body fat was determinate by bioelectrical impedance conducted according to the manufacturer´s recommended technique with a specific severe obesity formula. The patients were divided into two subgroups according to the average waist circumference and body mass index for better analysis of the results. The group had a mean age of 39.7 years (±7.2), average weight of 125.6 kg (±16.2), mean body mass index of 48.7 kg/m2 (±6.4) and the mean waist circumference 137.6 cm (±12.4). Negative and significant relationship between BMI values waist circumference and resistance obtained by bioelectrical impedance ​​were found. By analyzing the two groups the mean BMI and waist circumference, a significant relationship was observed, ie, the higher the degree of obesity less resistance was obtained by bioelectrical impedance. The higher is the obesity the lower is value found for resistance. The increase of anthropometric indicators (BMI and waist circumference) determined reduction in resistance and reactance obtained by bioelectrical impedance analysis in obese women candidates to bariatric surgery. O estudo da composição corporal em pacientes candidatas à cirurgia bariátrica tem relação direta com o aumento e distribuição da gordura corporal e no desenvolvimento de doenças cardiovasculares. Estudar a correlação entre indicadores antropométricos e da bioimpedância elétrica na avaliação da gordura corporal em mulheres candidatas à cirurgia bariátrica. Estudo transversal

  17. Delivering tailored surgery to older cancer patients : Preoperative geriatric assessment domains and screening tools - A systematic review of systematic reviews

    NARCIS (Netherlands)

    Huisman, M. G.; Kok, M.; de Bock, G. H.; van Leeuwen, B. L.

    The onco-geriatric population is increasing and thus more and more elderly will require surgery; an important treatment modality for many cancer types. This population's heterogeneity demands preopeiative risk stratification, which has led to the introduction of Geriatric Assessment (GA) and

  18. Methodology of environmental risk assessment management

    Directory of Open Access Journals (Sweden)

    Saša T. Bakrač

    2012-04-01

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

  19. Natural risk assessment and decision planning for disaster mitigation

    Directory of Open Access Journals (Sweden)

    P. Fiorucci

    2005-01-01

    Full Text Available In this paper, decisional models are introduced aiming at defining a general framework for natural disaster mitigation. More specifically, an integrated approach based on system modelling and optimal resource assignment is presented in order to support the decision makers in pre-operational and real-time management of forest fire emergencies. Some strategies for pre-operative and real time risk management will be described and formalized as optimal resource assignment problems. To this end, some models capable to describe the resources dynamics will be introduced, both in pre-operative phase and in real-time phase.

  20. Borderline Ovarian Tumors and Diagnostic Dilemma of Intraoperative Diagnosis: Could Preoperative He4 Assay and ROMA Score Assessment Increase the Frozen Section Accuracy? A Multicenter Case-Control Study

    Directory of Open Access Journals (Sweden)

    Salvatore Gizzo

    2014-01-01

    Full Text Available The aim of our study was to assess the value of a preoperative He4-serum-assay and ROMA-score assessment in improving the accuracy of frozen section histology in the diagnosis of borderline ovarian tumors (BOT. 113 women presenting with a unilateral ovarian mass diagnosed as serous/mucinous BOT at frozen-section-histology (FS and/or confirmed on final pathology were recruited. Pathologists were informed of the results of preoperative clinical/instrumental assessment of all patients. For Group_A patients, additional information regarding He4, CA125, and ROMA score was available (in Group_B only CA125 was known. The comparison between Group A and Group B in terms of FS accuracy, demonstrated a consensual diagnosis in 62.8% versus 58.6% (P: n.s., underdiagnosis in 25.6% versus 41.4% (P<0.05, and overdiagnosis in 11.6% versus 0% (P<0.01. Low FS diagnostic accuracy was associated with menopausal status (OR: 2.13, laparoscopic approach (OR: 2.18, mucinous histotype (OR: 2.23, low grading (OR: 1.30, and FIGO stage I (OR: 2.53. Ultrasound detection of papillae (OR: 0.29, septa (OR: 0.39, atypical vascularization (OR: 0.34, serum He4 assay (OR: 0.39, and ROMA score assessment (OR: 0.44 decreased the probability of underdiagnosis. A combined preoperative assessment through serum markers and ultrasonographic features may potentially reduce the risk of underdiagnosis of BOTs on FS while likely increasing the concomitant incidence of false-positive events.

  1. Pressure sore risk assessment in palliative care.

    Science.gov (United States)

    Chaplin, J

    2000-01-01

    Pressure sore prevention in palliative care is recognized as being an essential element of holistic care, with the primary goal of promoting quality of life for patient and family. Little is known about the incidence of pressure sore development and the use of pressure sore risk assessment tools in palliative care settings. The development of a risk assessment tool specifically for palliative care patients in a 41-bedded specialist palliative care unit is described. The risk assessment tool was developed as part of a tissue viability practice development initiative. The approach adopted in the validation of the Hunters Hill Marie Curie Centre pressure sore risk assessment tool was the comparative analysis of professional judgment of experienced palliative care nurses with the numerical scores achieved during the assessment of risk on 291 patients (529 risk assessment events). This comparative analysis identified the threshold for different degrees of risk for the patient group involved: low risk, medium risk, high risk and very high risk. Further work is being undertaken to evaluate the inter-rater reliability of the new tool. A number of issues are explored in this paper in relation to pressure sore prevention in palliative care: the role of risk assessment tools, the sometimes conflicting aims of trying to ensure comfort and prevent pressure sore damage, and the uncertainties faced by palliative care nurses when they are trying to maintain quality of life for the dying.

  2. [Application of three risk assessment models in occupational health risk assessment of dimethylformamide].

    Science.gov (United States)

    Wu, Z J; Xu, B; Jiang, H; Zheng, M; Zhang, M; Zhao, W J; Cheng, J

    2016-08-20

    Objective: To investigate the application of United States Environmental Protection Agency (EPA) inhalation risk assessment model, Singapore semi-quantitative risk assessment model, and occupational hazards risk assessment index method in occupational health risk in enterprises using dimethylformamide (DMF) in a certain area in Jiangsu, China, and to put forward related risk control measures. Methods: The industries involving DMF exposure in Jiangsu province were chosen as the evaluation objects in 2013 and three risk assessment models were used in the evaluation. EPA inhalation risk assessment model: HQ=EC/RfC; Singapore semi-quantitative risk assessment model: Risk= (HR×ER) (1/2); Occupational hazards risk assessment index=2(Health effect level)×2(exposure ratio)×Operation condition level. Results: The results of hazard quotient (HQ>1) from EPA inhalation risk assessment model suggested that all the workshops (dry method, wet method and printing) and work positions (pasting, burdening, unreeling, rolling, assisting) were high risk. The results of Singapore semi-quantitative risk assessment model indicated that the workshop risk level of dry method, wet method and printing were 3.5 (high) , 3.5 (high) and 2.8 (general) , and position risk level of pasting, burdening, unreeling, rolling, assisting were 4 (high) , 4 (high) , 2.8 (general) , 2.8 (general) and 2.8 (general) . The results of occupational hazards risk assessment index method demonstrated that the position risk index of pasting, burdening, unreeling, rolling, assisting were 42 (high) , 33 (high) , 23 (middle) , 21 (middle) and 22 (middle) . The results of Singapore semi-quantitative risk assessment model and occupational hazards risk assessment index method were similar, while EPA inhalation risk assessment model indicated all the workshops and positions were high risk. Conclusion: The occupational hazards risk assessment index method fully considers health effects, exposure, and operating conditions

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

    Science.gov (United States)

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

    2014-03-01

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

  4. Assessing Human Health Risk from Pesticides

    Science.gov (United States)

    EPA protects human health and the environment by evaluating the risk associated with pesticides before allowing them to be used in the United States. Learn about the tools and processes used in risk assessment for pesticides.

  5. Colon Cancer Risk Assessment - Gauss Program

    Science.gov (United States)

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

  6. Risk assessment theory, methods, and applications

    CERN Document Server

    Rausand, Marvin

    2011-01-01

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

  7. Approaches to risk assessment in food allergy

    DEFF Research Database (Denmark)

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

    2009-01-01

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

  8. RISK ASSESSMENT PROCEDURE FOR CIVIL AIRPORT

    Directory of Open Access Journals (Sweden)

    Natalia Distefano

    2014-03-01

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

  9. Patients with Fever of Unknown Origin and Splenomegaly: Diagnostic Value of Splenectomy and Preoperative Risk Factors Suggestive of Underlying Lymphomas.

    Science.gov (United States)

    Zhang, Lu; Zhang, Wei; Cai, Huacong; Cao, Xinxin; Chen, Miao; Li, Jian; Zhu, Tienan; Duan, Minghui; Wang, Shujie; Han, Bing; Zhou, Daobin

    2017-01-01

    We reviewed patients with fever of unknown origin (FUO) and splenomegaly and assessed the diagnostic value of splenectomy and measured risk factors suggestive of an underlying lymphoma. FUO patients (n = 83) who had splenomegaly and underwent splenectomy were enrolled into this retrospective single-center study. Clinical presentations were documented and risk factors suggestive of an underlying lymphoma were tested. Seventy-four patients (89.2%) had a diagnosis of lymphoma or not after splenectomy and follow-up. Of those (55.4%) diagnosed with lymphoma, 29 had B-cell non-Hodgkin lymphoma and 12 had T-cell non-Hodgkin lymphoma. The remaining 33 (44.6%) had diseases other than lymphoma. Using multivariate logistic analysis, the following 3 independent risk factors were found to be related to a final diagnosis of lymphoma: age (continuous) (HR 1.086; 95% CI 1.033-1.141; p = 0.001), massively enlarged spleen (HR 7.797; 95% CI 1.267-47.959; p = 0.027), and enlarged intra-abdominal lymph nodes (HR 63.925; 95% CI 7.962-513.219; p < 0.001). The calibration of the model was satisfactory (p = 0.248 using the Hosmer-Lemeshow test), and the discrimination power was good (area under the receiver operating characteristic curve 0.925; 95% CI 0.863-0.987). Splenectomy is an effective diagnostic procedure for patients with FUO and splenomegaly and lymphoma is a common cause. Older age, a massively enlarged spleen, and enlarged intra-abdominal lymph nodes are risk factors suggesting an underlying lymphoma, and surgery for high-risk patients should be considered. © 2017 S. Karger AG, Basel.

  10. Risk communication in environmental assessment

    Energy Technology Data Exchange (ETDEWEB)

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

    1996-08-26

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

  11. Preoperative assessment of motor cortex and pyramidal tracts in central cavernoma employing functional and diffusion-weighted magnetic resonance imaging.

    Science.gov (United States)

    Möller-Hartmann, Walter; Krings, Timo; Coenen, Volker A; Mayfrank, Lothar; Weidemann, Jürgen; Kränzlein, Heidi; Thron, Armin

    2002-11-01

    Functional MRI (fMRI) combines anatomic with functional information and has therefore been widely used for preoperative planning of patients with mass lesions affecting functionally important brain regions. However, the courses of functionally important fiber tracts are not visualized. We therefore propose to combine fMRI with diffusion-weighted MRI (DWI) that allows visualization of large fiber tracts and to implement this data in a neuronavigation system. DWI was successfully performed at a field strength of 1.5 Tesla, employing a spin-echo sequence with gradient sensitivity in six noncollinear directions to visualize the course of the pyramidal tracts, and was combined with echo-planar T2* fMRI during a hand motor task in a patient with central cavernoma. Fusion of both data sets allowed visualization of the displacement of both the primary sensorimotor area (M1) and its large descending fiber tracts. Intraoperatively, these data were used to aid in neuronavigation. Confirmation was obtained by intraoperative electrical stimulation. Postoperative MRI revealed an undisrupted pyramidal tract in the neurologically intact patient. The combination of fMRI with DWI allows for assessment of functionally important cortical areas and additional visualization of large fiber tracts. Information about the orientation of fiber tracts in normal appearing white matter in patients with tumors within the cortical motor system cannot be obtained by other functional or conventional imaging methods and is vital for reducing operative morbidity as the information about functional cortex. This technique might, therefore, have the prospect of guiding neurosurgical interventions, especially when linked to a neuronavigation system.

  12. Society of Anesthesia and Sleep Medicine Guideline on Preoperative Screening and Assessment of Patients With Obstructive Sleep Apnea.

    Science.gov (United States)

    Chung, Frances; Memtsoudis, Stavros; Krishna Ramachandran, Satya; Nagappa, Mahesh; Opperer, Mathias; Cozowicz, Crispiana; Patrawala, Sara; Lam, David; Kumar, Anjana; Joshi, Girish P; Fleetham, John; Ayas, Najib; Collop, Nancy; Doufas, Anthony; Eikermann, Matthias; Englesakis, Marina; Gali, Bhargavi; Gay, Peter; Hernandes, Adrian; Kaw, Roop; Kezirian, Eric; Malhotra, Atul; Mokhlesi, Babak; Parthasarathy, Sairam; Stierer, Tracey; Wappler, Frank; Hillman, David R; Auckley, Dennis

    2016-06-01

    The purpose of the Society of Anesthesia and Sleep Medicine guideline on preoperative screening and assessment of patients with obstructive sleep apnea (OSA) is to present recommendations based on the available clinical evidence on the topic where possible. As very few well-performed randomized studies in this field of perioperative care are available, most of the recommendations were developed by experts in the field through consensus processes involving utilization of evidence grading to indicate the level of evidence upon which recommendations were based. This guideline may not be appropriate for all clinical situations and all patients. The decision whether to follow these recommendations must be made by a responsible physician on an individual basis. Protocols should be developed by individual institutions taking into account the patients' conditions, extent of interventions and available resources. This practice guideline is not intended to define standards of care or represent absolute requirements for patient care. The adherence to these guidelines cannot in any way guarantee successful outcomes and is rather meant to help individuals and institutions formulate plans to better deal with the challenges posed by perioperative patients with OSA. These recommendations reflect the current state of knowledge and its interpretation by a group of experts in the field at the time of publication. While these guidelines will be periodically updated, new information that becomes available between updates should be taken into account. Deviations in practice from guidelines may be justifiable and such deviations should not be interpreted as a basis for claims of negligence.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

  13. Comprehensive preoperative evaluation and repair of inguinal hernias at the time of open radical retropubic prostatectomy decreases risk of developing post-prostatectomy hernia.

    Science.gov (United States)

    Marien, Tracy; Taouli, Bachir; Telegrafi, Shpetim; Babb, James S; Lepor, Herbert

    2012-12-01

    What's known on the subject? and What does the study add? Some studies have evaluated preoperative and intraoperative examination for inguinal hernias and their repair, noting a decrease in the rate of post-prostatectomy hernias. However, this did not eradicate post-prostatectomy hernias, indicating that this method probably missed subclinical hernias. Other studies looked at prophylactic procedures to prevent the formation of inguinal hernias at the time of prostatectomy and showed a decrease in the rate of postoperative hernias. To our knowledge this is the only series evaluating a multi-modal approach with magnetic resonance imaging, ultrasonography and examination to identify all clinical and subclinical hernias and repair them at the time of prostatectomy. This approach only subjects those patients at risk for symptomatic hernias to an additional procedure and decreases the post-prostatectomy hernia rate to hernias and repair of these hernias at the time of open radical retropubic prostatectomy (ORRP) decreases the incidence of clinical inguinal hernias (IHs) after ORRP. • Between 1 July 2007 and 31 July 2010, 281 consecutive men underwent ORRP by a single surgeon. • Of these men, 207 (74%) underwent comprehensive preoperative screening for IH, which included physical examination, upstanding ultrasonography and magnetic resonance imaging. • Between 12 and 24 months after ORRP, 178 (86%) of these men completed a questionnaire designed to capture development of clinical IHs. • Of the 178 evaluable patients, 92 (52%) were diagnosed preoperatively with IH by at least one diagnostic modality. • Forty-one and 51 of the men had bilateral or unilateral IHs, respectively for a total of 133 IHs. • No preoperative factor was significantly associated with the presence of an IH before prostatectomy. • No groin subjected to IH repair (IHR) at the time of ORRP developed a clinical IH compared with four of the 21 patients with postoperative IHs who did not

  14. Effects of using the simplified airway risk index vs usual airway assessment on unanticipated difficult tracheal intubation - a cluster randomized trial with 64,273 participants

    DEFF Research Database (Denmark)

    Nørskov, A K; Wetterslev, J; Rosenstock, C V

    2016-01-01

    ' heterogeneous individual airway assessments. Preoperative prediction of difficult intubation and actual intubation difficulties were registered in the Danish Anaesthesia Database for both groups. Patients who were preoperatively scheduled for intubation by advanced techniques (e.g. video laryngoscopy; flexible......BACKGROUND: Unanticipated difficult intubation remains a challenge in anaesthesia. The Simplified Airway Risk Index (SARI) is a multivariable risk model consisting of seven independent risk factors for difficult intubation. Our aim was to compare preoperative airway assessment based on the SARI...... with usual airway assessment. METHODS: From 01.10.2012 to 31.12.2013, 28 departments were cluster-randomized to apply the SARI model or usual airway assessment. The SARI group implemented the SARI model. The Non-SARI group continued usual airway assessment, thus reflecting a group of anaesthetists...

  15. Quantitative Microbial Risk Assessment Tutorial - Primer

    Science.gov (United States)

    This document provides a Quantitative Microbial Risk Assessment (QMRA) primer that organizes QMRA tutorials. The tutorials describe functionality of a QMRA infrastructure, guide the user through software use and assessment options, provide step-by-step instructions for implementi...

  16. Revised Human Health Risk Assessment on Chlorpyrifos

    Science.gov (United States)

    We have revised our human health risk assessment and drinking water exposure assessment for chlorpyrifos that supported our October 2015 proposal to revoke all food residue tolerances for chlorpyrifos. Learn about the revised analysis.

  17. Preoperative anxiety in neurosurgical patients.

    Science.gov (United States)

    Perks, Anna; Chakravarti, Sucharita; Manninen, Pirjo

    2009-04-01

    Anxiety is common in surgical patients, with an incidence of 60% to 92%. There is little information on the incidence and severity of preoperative anxiety in patients scheduled for neurosurgery. The aim of this study was to measure the level of preoperative anxiety in neurosurgical patients and to assess any influencing factors. After the Institutional Review Board approval and informed written consent, 100 patients booked for neurosurgery were interviewed preoperatively. Each patient was asked to grade their preoperative anxiety level on a verbal analog scale, Amsterdam Preoperative Anxiety and Information Scale, and a set of specific anxiety-related questions. The anxiety scores and the responses to the questions were compared between the sex, age, weight, diagnosis, and history of previous surgery. The mean age (+/-SD) was 50+/-13 years. The preoperative diagnosis was tumor (n=64), aneurysm (n=14), and other (n=22). Overall verbal analog scale was 5.2+/-2.7; the score was higher for female (5.8+/-2.8) than male patients (4.6+/-2.5) (PAmsterdam Preoperative Anxiety and Information Scale anxiety and knowledge scores were greater for surgery than for anesthesia. Questionnaire results showed that the most common anxieties were waiting for surgery, physical/mental harm, and results of the operation. In conclusion, our study showed that neurosurgical patients have high levels of anxiety, with a higher incidence in females. There was a moderately high need for information, particularly in patients with a high level of preoperative anxiety.

  18. Association of Preoperative Anemia With Postoperative Mortality in Neonates.

    Science.gov (United States)

    Goobie, Susan M; Faraoni, David; Zurakowski, David; DiNardo, James A

    2016-09-01

    Neonates undergoing noncardiac surgery are at risk for adverse outcomes. Preoperative anemia is a strong independent risk factor for postoperative mortality in adults. To our knowledge, this association has not been investigated in the neonatal population. To assess the association between preoperative anemia and postoperative mortality in neonates undergoing noncardiac surgery in a large sample of US hospitals. Using data from the 2012 and 2013 pediatric databases of the American College of Surgeons National Surgical Quality Improvement Program, we conducted a retrospective study of neonates undergoing noncardiac surgery. Analysis of the data took place between June 2015 and December 2015. All neonates (0-30 days old) with a recorded preoperative hematocrit value were included. Anemia defined as hematocrit level of less than 40%. Receiver operating characteristics analysis was used to assess the association between preoperative hematocrit and mortality, and the Youden J Index was used to determine the specific hematocrit cutoff point to define anemia in the neonatal population. Demographic and postoperative outcomes variables were compared between anemic and nonanemic neonates. Univariate and multivariable logistic regression analyses were used to determine factors associated with postoperative neonatal mortality. An external validation was performed using the 2014 American College of Surgeons National Surgical Quality Improvement Program database. Neonates accounted for 2764 children (6%) in the 2012-2013 American College of Surgeons National Surgical Quality Improvement Program databases. Neonates inlcuded in the study were predominately male (64.5%), white (66.3%), and term (69.9% greater than 36 weeks' gestation) and weighed more than 2 kg (85.0%). Postoperative in-hospital mortality was 3.4% in neonates and 0.6% in all age groups (0-18 years). A preoperative hematocrit level of less than 40% was the optimal cutoff (Youden) to predict in-hospital mortality

  19. Life Cycle Assessment and Risk Assessment

    DEFF Research Database (Denmark)

    Olsen, Stig Irving

    Life Cycle Assessment (LCA) is a tool for environmental assessment of product and systems – over the whole life cycle from acquisition of raw materials to the end-of-life of the product – and encompassing all environmental impacts of emissions and resource usage, e.g. global warming, acidification...... the emissions, how should they be defined and classified and what should be measured? LCA have many of these issues in common with RA. There is a need to understand which properties of nanomaterials are crucial for the assessment of their potential transformation and fate as well as their ability to cause...... adverse effects on target organisms or systems. If we want to be able to assess toxic impacts both in LCA and in RA these issues need to be addressed by the RA community and the LCA community must follow closely the progress made....

  20. Preoperative statin therapy and infectious complications in cardiac surgery

    NARCIS (Netherlands)

    Hartholt, N L; Rettig, T C D; Schijffelen, M; Morshuis, W J; van de Garde, E M W; Noordzij, P G

    AIM: To assess whether preoperative statin therapy is associated with the risk of postoperative infection in patients undergoing cardiac surgery. METHODS: 520 patients undergoing cardiac surgery in 2010 were retrospectively examined. Data regarding statin and antibiotic use prior to and after

  1. Assessing reservoir operations risk under climate change

    Science.gov (United States)

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

    2009-01-01

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

  2. Risk assessment methodology in oil shale mining

    Energy Technology Data Exchange (ETDEWEB)

    Sabanov, S. [Tallinn Univ. of Technology, Tallinn (Estonia)

    2009-07-01

    The safety challenges posed by different mining processes were discussed in terms of geotechnical risk factors. Various mining processes can result in work hazards, a production shut-down, economic damage to the enterprise, and environmental impacts. In Estonia, risk assessment methods are utilized in different branches of industry. However, the literature on solving mining problems is limited. Various methods are applicable for solving complicated mining problems. This paper elaborated on a modified risk assessment methodology for oil shale mining in Estonia. The paper specifically discussed problems associated with oil shale mining as well as risk assessment methods such as risk analysis and risk evaluation. Topics that were introduced included risk analysis; risk identification; risk estimation; risk evaluation; risk mitigation; and risk acceptance. The modified risk assessment methodology was successfully applied to the extraction of mineral resources, stability of a mining block, and their influence on the environment. It was concluded that the methodology provides opportunity to find improved methods for new mine planning in accordance with environmental performances and the economical profit for companies. 8 refs., 2 figs.

  3. Cardiovascular Risk Assessment and Management in Prerenal Transplantation Candidates.

    Science.gov (United States)

    Lindley, Eric M; Hall, Amanda K; Hess, Jordan; Abraham, Jo; Smith, Brigham; Hopkins, Paul N; Shihab, Fuad; Welt, Frederick; Owan, Theophilus; Fang, James C

    2016-01-01

    Cardiovascular (CV) assessment in prerenal transplant patients varies by center. Current guidelines recommend stress testing for candidates if ≥ 3 CV risk factors exist. We evaluated the CV assessment and management in 685 patients referred for kidney transplant over a 7-year period. All patients had CV risk factors, and the most common cause of end-stage renal disease was diabetes. Thirty-three percent (n = 229) underwent coronary angiography. The sensitivity of stress testing to detect obstructive coronary artery disease (CAD) was poor (0.26). Patients who had no CAD, nonobstructive CAD, or CAD with intervention had significantly higher event-free survival compared with patients with obstructive CAD without intervention. There were no adverse clinical events (death, myocardial infarction, stroke, revascularization, and graft failure) within 30 days post-transplant in patients who had preoperative angiography (n = 77). Of the transplanted patients who did not have an angiogram (n = 289), there were 8 clinical events (6 myocardial infarctions) in the first 30 days. In conclusion, our results indicate that stress testing and usual risk factors were poor predictors of obstructive CAD and that revascularization may prove beneficial in these patients.

  4. Risk assessment of plant protection products

    Directory of Open Access Journals (Sweden)

    Hardy T

    2012-10-01

    Full Text Available

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

  5. Production Risk Assessing Methodology (PRAM).

    Science.gov (United States)

    1982-05-01

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

  6. Aquatic Macrophyte Risk Assessment for Pesticides

    NARCIS (Netherlands)

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

    2009-01-01

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

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

    NARCIS (Netherlands)

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

    2013-01-01

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

  8. Recovery in environmental risk assessment at EFSA

    NARCIS (Netherlands)

    Brock, T.C.M.

    2016-01-01

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

  9. Aquatic Macrophyte Risk Assessment for Pesticides

    NARCIS (Netherlands)

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

    2009-01-01

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

  10. Recovery in environmental risk assessment at EFSA

    NARCIS (Netherlands)

    Brock, T.C.M.

    2016-01-01

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

  11. Fuzzy sets applications for cancer risk assessment.

    Science.gov (United States)

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

    2002-09-01

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

  12. Risk Assessment for an Unmanned Merchant Ship

    Directory of Open Access Journals (Sweden)

    Ø.J. Rødseth

    2015-09-01

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

  13. Caries risk assessment models in caries prediction

    Directory of Open Access Journals (Sweden)

    Amila Zukanović

    2013-11-01

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

  14. Cheese Microbial Risk Assessments — A Review

    Directory of Open Access Journals (Sweden)

    Kyoung-Hee Choi

    2016-03-01

    Full Text Available Cheese is generally considered a safe and nutritious food, but foodborne illnesses linked to cheese consumption have occurred in many countries. Several microbial risk assessments related to Listeria monocytogenes, Staphylococcus aureus, and Escherichia coli infections, causing cheese-related foodborne illnesses, have been conducted. Although the assessments of microbial risk in soft and low moisture cheeses such as semi-hard and hard cheeses have been accomplished, it has been more focused on the correlations between pathogenic bacteria and soft cheese, because cheese-associated foodborne illnesses have been attributed to the consumption of soft cheeses. As a part of this microbial risk assessment, predictive models have been developed to describe the relationship between several factors (pH, Aw, starter culture, and time and the fates of foodborne pathogens in cheese. Predictions from these studies have been used for microbial risk assessment as a part of exposure assessment. These microbial risk assessments have identified that risk increased in cheese with high moisture content, especially for raw milk cheese, but the risk can be reduced by preharvest and postharvest preventions. For accurate quantitative microbial risk assessment, more data including interventions such as curd cooking conditions (temperature and time and ripening period should be available for predictive models developed with cheese, cheese consumption amounts and cheese intake frequency data as well as more dose-response models.

  15. Comparison of cone-beam computed tomography and osteometric examination in preoperative assessment of the proximity of the mandibular canal to the apices of the teeth.

    Science.gov (United States)

    Adibi, Sadaf; Paknahad, Maryam

    2016-11-11

    The risk of postoperative neurosensory impairment after extraction of a third molar will be greater if the inferior alveolar nerve is in close proximity to the apices of the root. Precise preoperative evaluation of the relative positions of the nerve and the mandibular apices is important to protect the nerve from mechanical irritation. The aim of this study was to assess the accuracy of cone-beam computed tomography (CT) in the identification of the positional relations of the mandibular third molar and the inferior alveolar canal using Rood's criteria. Panoramic images of 10 dry hemimandibles were obtained, and 20 teeth each with one of Rood's criteria indicating close relations to the mandibular canal were selected. Cone-beam CT images of the selected points were obtained. The closest distance between the apex of the root and the inferior alveolar canal was measured on cross-sectional cone-beam CT images. The same measurements were made on the corresponding osteometric sections with digital callipers. The intra-class correlation coefficient (ICC) was used to measure the consistency between the two measurements as the reference method, and showed that there was a high level of inter-rater agreement (r>0.90). The mean (SD) deviation of cone-beam CT measurements from the gold standard osteometric measurements was small at 0.30 (0.24). There were lmost perfect matches between cone-beam CT and gold standard measurements. Cone-beam CT is an accurate technique to measure the proximity of the mandibular apices to the alveolar nerve.

  16. Pre-operative anaemia.

    Science.gov (United States)

    Clevenger, B; Richards, T

    2015-01-01

    Pre-operative anaemia is a relatively common finding, affecting a third of patients undergoing elective surgery. Traditionally associated with chronic disease, management has historically focused on the use of blood transfusion as a solution for anaemia in the peri-operative period. Data from large series now suggest that anaemia is an independent risk associated with poor outcome in both cardiac and non-cardiac surgery. Furthermore, blood transfusion does not appear to ameliorate this risk, and in fact may increase the risk of postoperative complications and hospital length of stay. Consequently, there is a need to identify, diagnose and manage pre-operative anaemia to reduce surgical risk. Discoveries in the pathways of iron metabolism have found that chronic disease can cause a state of functional iron deficiency leading to anaemia. The key iron regulatory protein hepcidin, activated in response to inflammation, inhibits absorption of iron from the gastrointestinal tract and further reduces bioavailability of iron stores for red cell production. Consequently, although iron stores (predominantly ferritin) may be normal, the transport of iron either from the gastrointestinal tract or iron stores to the bone marrow is inhibited, leading to a state of 'functional' iron deficiency and subsequent anaemia. Since absorption from the gastrointestinal tract is blocked, increasing oral iron intake is ineffective, and studies are now looking at the role of intravenous iron to treat anaemia in the surgical setting. In this article, we review the incidence and impact of anaemia on the pre-operative patient. We explain how anaemia may be caused by functional iron deficiency, and how iron deficiency anaemia may be diagnosed and treated.

  17. Preoperative mapping of the sensorimotor cortex: comparative assessment of task-based and resting-state FMRI.

    Directory of Open Access Journals (Sweden)

    Cristina Rosazza

    Full Text Available Resting state fMRI (rs-fMRI has recently been considered as a possible complement or alternative to task-based fMRI (tb-fMRI for presurgical mapping. However, evidence of its usefulness remains scant, because existing studies have investigated relatively small samples and focused primarily on qualitative evaluation. The aim of this study is to investigate the clinical usefulness of rs-fMRI in the context of presurgical mapping of motor functions, and in particular to determine the degree of correspondence with tb-fMRI which, while not a gold-standard, is commonly used in preoperative setting. A group of 13 patients with lesions close to the sensorimotor cortex underwent rs-fMRI and tb-fMRI to localize the hand, foot and mouth motor areas. We assessed quantitatively the degree of correspondence between multiple rs-fMRI analyses (independent-component and seed-based analyses and tb-fMRI, with reference to sensitivity and specificity of rs-fMRI with respect to tb-fMRI, and centre-of-mass distances. Agreement with electro-cortical stimulation (ECS was also investigated, and a traditional map thresholding approach based on agreement between two experienced operators was compared to an automatic threshold determination method. Rs-fMRI can localize the sensorimotor cortex successfully, providing anatomical specificity for hand, foot and mouth motor subregions, in particular with seed-based analyses. Agreement with tb-fMRI was only partial and rs-fMRI tended to provide larger patterns of correlated activity. With respect to the ECS data available, rs-fMRI and tb-fMRI performed comparably, even though the shortest distance to stimulation points was observed for the latter. Notably, the results of both were on the whole robust to thresholding procedure. Localization performed by rs-fMRI is not equivalent to tb-fMRI, hence rs-fMRI cannot be considered as an outright replacement for tb-fMRI. Nevertheless, since there is significant agreement between the two

  18. Preoperative information management system using wireless PDAs.

    Science.gov (United States)

    Sawa, Tomohiro; Okahara, Masaharu; Santo, Masayuki; Schmidt, Ulrich; Nakata, Yoshinori; Morita, Shigeho; Ohno-Machado, Lucila

    2003-01-01

    Personal Digital Assistant (PDA) and wireless communication are currently available in clinical settings. We developed wireless PDA software that assists anesthesiologists in pre-operative patient assessment. The device communicates with the hospital information system through a wireless LAN and is equipped with pre-programmed data entry templates for pre-operative assessment. As a preliminary test of the device, we randomly assigned residents in preoperative assessment to an intervention and a control arm and compared the results.

  19. Engaging Patients, Health Care Professionals, and Community Members to Improve Preoperative Decision Making for Older Adults Facing High-Risk Surgery.

    Science.gov (United States)

    Steffens, Nicole M; Tucholka, Jennifer L; Nabozny, Michael J; Schmick, Andrea E; Brasel, Karen J; Schwarze, Margaret L

    2016-10-01

    Older patients are at greater risk for postoperative complications, yet they are less likely than younger patients to ask questions about surgery. To design an intervention to improve preoperative decision making and manage postoperative expectations. A Patient and Family Advisory Council (PFAC) was created to help identify preoperative decisional needs. The PFAC included 4 men and women who had previous experience with high-risk surgery as older patients or their family members; the PFAC met monthly at a local library from May 2014 to April 2015 to examine findings from a prior qualitative study and to integrate themes with PFAC members' experiences. Patient observations included 91 recorded conversations between patients and surgeons and 61 patient interviews before and after surgery. The PFAC members and other stakeholders evaluated 118 publicly available questions and selected 12 corresponding to identified needs to generate a question prompt list (QPL). Three focus groups, including 31 community members from diverse backgrounds, were conducted at community centers in Madison and Milwaukee, Wisconsin, to refine the QPL. A clinical pilot with 42 patients considering surgery was conducted in one outpatient surgical clinic in Madison. Generation of a QPL to address patients' preoperative informational and decisional needs. Through exploration of qualitative data, the PFAC noted 3 critical problems. Patients and family members believed surgery had to be done, were surprised that postoperative recovery was difficult, and lacked knowledge about the perioperative use of advance directives. The PFAC identified a need for more information and decisional support during preoperative conversations that included clarification of treatment options, setting postoperative expectations, and advance care planning. The following 3 question prompt categories arose: "Should I have surgery?" "What should I expect if everything goes well?" and "What happens if things go wrong?" The

  20. Risk Assessment: Perchloroethylene Dry Cleaners Refined Human Health Risk Characterization

    Science.gov (United States)

    This November 2005 memo and appendices describe the methods by which EPA conducted its refined risk assessment of the Major Source and Area Source facilities within the perchloroethylene (perc) dry cleaners source category.

  1. Visual Analogue Scale for Anxiety and Amsterdam Preoperative Anxiety Scale Provide a Simple and Reliable Measurement of Preoperative Anxiety in Patients Undergoing Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Joaquín Hernández-Palazón

    2015-03-01

    Full Text Available Background: Anxiety is an emotional state characterized by apprehension and fear resulting from anticipation of a threatening event. Objectives: The present study aimed to analyze the incidence and level of preoperative anxiety in the patients scheduled for cardiac surgery by using a Visual Analogue Scale for Anxiety (VAS-A and Amsterdam Preoperative Anxiety and Information Scale (APAIS and to identify the influencing clinical factors. Patients and Methods: This prospective, longitudinal study was performed on 300 cardiac surgery patients in a single university hospital. The patients were assessed regarding their preoperative anxiety level using VAS-A, APAIS, and a set of specific anxiety-related questions. Their demographic features as well as their anesthetic and surgical characteristics (ASA physical status, EuroSCORE, preoperative Length of Stay (LoS, and surgical history were recorded, as well. Then, one-way ANOVA and t-test were applied along with odds ratio for risk assessment. Results: According to the results, 94% of the patients presented preoperative anxiety, with 37% developing high anxiety (VAS-A ≥ 7. Preoperative LoS > 2 days was the only significant risk factor for preoperative anxiety (odds ratio = 2.5, CI 95%, 1.3 - 5.1, P = 0.009. Besides, a positive correlation was found between anxiety level (APAISa and requirement of knowledge (APAISk. APAISa and APAISk scores were greater for surgery than for anesthesia. Moreover, the results showed that the most common anxieties resulted from the operation, waiting for surgery, not knowing what is happening, postoperative pain, awareness during anesthesia, and not awakening from anesthesia. Conclusions: APAIS and VAS-A provided a quantitative assessment of anxiety and a specific qualitative questionnaire for preoperative anxiety in cardiac surgery. According to the results, preoperative LoS > 2 days and lack of information related to surgery were the risk factors for high anxiety levels.

  2. An IOT Security Risk Autonomic Assessment Algorithm

    Directory of Open Access Journals (Sweden)

    Zhengchao Ma

    2013-02-01

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

  3. Systems Toxicology: The Future of Risk Assessment.

    Science.gov (United States)

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

    2015-01-01

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

  4. Survey: Risk Assessment for Cloud Computing

    Directory of Open Access Journals (Sweden)

    Drissi S.

    2013-01-01

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

  5. NASA Human System Risk Assessment Process

    Science.gov (United States)

    Francisco, D.; Romero, E.

    2016-01-01

    NASA utilizes an evidence based system to perform risk assessments for the human system for spaceflight missions. The center of this process is the multi-disciplinary Human System Risk Board (HSRB). The HSRB is chartered from the Chief Health and Medical Officer (OCHMO) at NASA Headquarters. The HSRB reviews all human system risks via an established comprehensive risk and configuration management plan based on a project management approach. The HSRB facilitates the integration of human research (terrestrial and spaceflight), medical operations, occupational surveillance, systems engineering and many other disciplines in a comprehensive review of human system risks. The HSRB considers all factors that influence human risk. These factors include pre-mission considerations such as screening criteria, training, age, sex, and physiological condition. In mission factors such as available countermeasures, mission duration and location and post mission factors such as time to return to baseline (reconditioning), post mission health screening, and available treatments. All of the factors influence the total risk assessment for each human risk. The HSRB performed a comprehensive review of all potential inflight medical conditions and events and over the course of several reviews consolidated the number of human system risks to 30, where the greatest emphasis is placed for investing program dollars for risk mitigation. The HSRB considers all available evidence from human research and, medical operations and occupational surveillance in assessing the risks for appropriate mitigation and future work. All applicable DRMs (low earth orbit for 6 and 12 months, deep space for 30 days and 1 year, a lunar mission for 1 year, and a planetary mission for 3 years) are considered as human system risks are modified by the hazards associated with space flight such as microgravity, exposure to radiation, distance from the earth, isolation and a closed environment. Each risk has a summary

  6. Preoperative Chemotherapy in Patients With Intermediate-Risk Rectal Adenocarcinoma Selected by High-Resolution Magnetic Resonance Imaging: The GEMCAD 0801 Phase II Multicenter Trial

    Science.gov (United States)

    Brown, Gina; Estevan, Rafael; Salud, Antonieta; Montagut, Clara; Maurel, Joan; Safont, Maria Jose; Aparicio, Jorge; Feliu, Jaime; Vera, Ruth; Alonso, Vicente; Gallego, Javier; Martin, Marta; Pera, Miguel; Sierra, Enrique; Serra, Javier; Delgado, Salvadora; Roig, Jose V.; Santos, Jesus; Pericay, Carles

    2014-01-01

    Background. The need for preoperative chemoradiation or short-course radiation in all T3 rectal tumors is a controversial issue. A multicenter phase II trial was undertaken to evaluate the efficacy and safety of neoadjuvant capecitabine and oxaliplatin combined with bevacizumab in patients with intermediate-risk rectal adenocarcinoma. Methods. We recruited 46 patients with T3 rectal adenocarcinoma selected by magnetic resonance imaging (MRI) who were candidates for (R0) resection located in the middle third with clear mesorectal fascia and who were selected by pelvic MRI. Patients received four cycles of neoadjuvant capecitabine and oxaliplatin combined with bevacizumab (final cycle without bevacizumab) before total mesorectal excision (TME). In case of progression, preoperative chemoradiation was planned. The primary endpoint was overall response rate (ORR). Results. On an intent-to-treat analysis, the ORR was 78% (n = 36; 95% confidence interval [CI]: 63%–89%) and no progression was detected. Pathologic complete response was observed in nine patients (20%; 95% CI: 9–33), and T downstaging was observed in 48%. Forty-four patients proceeded to TME, and all had R0 resection. During preoperative therapy, two deaths occurred as a result of pulmonary embolism and diarrhea, respectively, and one patient died after surgery as a result of peritonitis secondary to an anastomotic leak (AL). A 13% rate of AL was higher than expected. The 24-month disease-free survival rate was 75% (95% CI: 60%–85%), and the 2-year local relapse rate was 2% (95% CI: 0%–11%). Conclusion. In this selected population, initial chemotherapy results in promising activity, but the observed toxicity does not support further investigation of this specific regimen. Nevertheless, these early results warrant further testing of this strategy in an enriched population and in randomized trials. PMID:25209376

  7. Preoperative chemotherapy in patients with intermediate-risk rectal adenocarcinoma selected by high-resolution magnetic resonance imaging: the GEMCAD 0801 Phase II Multicenter Trial.

    Science.gov (United States)

    Fernandez-Martos, Carlos; Brown, Gina; Estevan, Rafael; Salud, Antonieta; Montagut, Clara; Maurel, Joan; Safont, Maria Jose; Aparicio, Jorge; Feliu, Jaime; Vera, Ruth; Alonso, Vicente; Gallego, Javier; Martin, Marta; Pera, Miguel; Sierra, Enrique; Serra, Javier; Delgado, Salvadora; Roig, Jose V; Santos, Jesus; Pericay, Carles

    2014-10-01

    The need for preoperative chemoradiation or short-course radiation in all T3 rectal tumors is a controversial issue. A multicenter phase II trial was undertaken to evaluate the efficacy and safety of neoadjuvant capecitabine and oxaliplatin combined with bevacizumab in patients with intermediate-risk rectal adenocarcinoma. We recruited 46 patients with T3 rectal adenocarcinoma selected by magnetic resonance imaging (MRI) who were candidates for (R0) resection located in the middle third with clear mesorectal fascia and who were selected by pelvic MRI. Patients received four cycles of neoadjuvant capecitabine and oxaliplatin combined with bevacizumab (final cycle without bevacizumab) before total mesorectal excision (TME). In case of progression, preoperative chemoradiation was planned. The primary endpoint was overall response rate (ORR). On an intent-to-treat analysis, the ORR was 78% (n = 36; 95% confidence interval [CI]: 63%-89%) and no progression was detected. Pathologic complete response was observed in nine patients (20%; 95% CI: 9-33), and T downstaging was observed in 48%. Forty-four patients proceeded to TME, and all had R0 resection. During preoperative therapy, two deaths occurred as a result of pulmonary embolism and diarrhea, respectively, and one patient died after surgery as a result of peritonitis secondary to an anastomotic leak (AL). A 13% rate of AL was higher than expected. The 24-month disease-free survival rate was 75% (95% CI: 60%-85%), and the 2-year local relapse rate was 2% (95% CI: 0%-11%). In this selected population, initial chemotherapy results in promising activity, but the observed toxicity does not support further investigation of this specific regimen. Nevertheless, these early results warrant further testing of this strategy in an enriched population and in randomized trials. ©AlphaMed Press; the data published online to support this summary is the property of the authors.

  8. Cardiovascular risk assessment in diabetes

    NARCIS (Netherlands)

    Djaberi, Roxana

    2014-01-01

    Research described in this thesis is based on clinical data obtained through diabetes cardiovascular risk management (DIACARM) project. A clinical protocol founded on the co-operation of the departments of endocrinology, cardiology, nephrology, radiology and nuclear medicine at the Leiden University

  9. Risk assessment in support of plant health

    DEFF Research Database (Denmark)

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

    2012-01-01

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

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

    NARCIS (Netherlands)

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

    1999-01-01

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

  11. [Study on application of two risk assessment methods in coal dust occupational health risk assessment].

    Science.gov (United States)

    Wu, B; Zhang, Y L; Chen, Y Q

    2017-04-20

    Objective: To evaluate the applicability of quantitative grading method (GBZ/T 229.1-2010) and occupational hazard risk index method in coal dust occupational health risk assessment. Methods: Taking 4 coal mines as the research object of risk assessment and making occupational health field testing and investigation. Based on two risk assessment methods, we analysed the health risk levels of 20 occupations which were exposed to coal dust in workplaces. Results: Coal dust working post had different risk levels in 4 coal mines, the post of higher risk level were mainly concentrated in the underground workplace of coal mine, especially the post of coal mining and tunneling system. The two risk assessment results showed that the risk levels of coal-mining machine drivers and tunneling machine drivers were the highest. The risk levels of coal dust working post used by two risk assessment methods had no significant difference (P>0.05) and were highly correlated (r=0.821, Prisk assessment methods were supported by the field investigation and literatures. Conclusion: The two risk assessment methods can be used in coal dust occupational health risk assessment.

  12. Subjective risk assessment for planning conservation projects

    Science.gov (United States)

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

    2013-12-01

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

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

    Science.gov (United States)

    Brown, Gerald G; Cox, Louis Anthony Tony

    2011-02-01

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

  14. Operationalization Of The Professional Risks Assessment Activity

    Science.gov (United States)

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

    2015-07-01

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

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

    DEFF Research Database (Denmark)

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

    2001-01-01

    Life Cycle Assessment and Risk Assessment are two different tools in environmental management. The paper identifies harmonies, discrepancies and relations between the two tools exemplified by the risk assessment principles of the European Commission (EC) and the LCA method ‘EDIP’ (En-vironmental...... conditions. It is concluded that the conceptual background and the purpose of the tools are different but that there are overlaps where they may benefit from each other and they do complement each other in an overall environmental effort....... Design of Industrial Products) developed in Denmark, respectively. A very important feature of LCA is the relative assessment due to the use of a functional unit. Risk assessment on the other hand is an absolute assessment, which may require very specific and detailed information on e.g. the exposure...

  16. Assessing Risk with GASB Statement No. 3.

    Science.gov (United States)

    Wood, Venita M.; Scott, Bob

    1987-01-01

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

  17. Framework for Shared Drinking Water Risk Assessment.

    Energy Technology Data Exchange (ETDEWEB)

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

    2017-01-01

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

  18. Center for Advancing Microbial Risk Assessment

    Data.gov (United States)

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

  19. Safety Factors in Pesticide Risk Assessment

    DEFF Research Database (Denmark)

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

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

  20. Procedures for health risk assessment in Europe

    NARCIS (Netherlands)

    Seeley, M.R.; Tonner-Navarro, L.E.; Beck, B.D.; Deskin, R.; Feron, V.J.; Johanson, G.; Bolt, H.M.

    2001-01-01

    This report compares cancer classification systems, health risk assessment approaches, and procedures used for establishing occupational exposure limits (OELs), in various European countries and scientific organizations. The objectives were to highlight and compare key aspects of these processes and

  1. Risk assessment in support of plant health

    DEFF Research Database (Denmark)

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

    2012-01-01

    With the establishment of the Plant Health Panel in 2006, EFSA became the body responsible for risk assessment in the plant health area for the European Union (EU). Since then more than 70 outputs have been produced dealing with the full range of organisms harmful to plant health across all crop...... of guidance documents. These deal with the peer review of existing pest risk assessments, a framework for conducting risk assessments which harmonise standards set by the International Plant Protection Convention and the legislative requirements of the EU, and extension of this framework to include......-evaluation of quantitative pathway analyses, and in statistical modelling of experimental data. A Plant Health Network has been established to facilitate interaction with EU Member States, especially in relation to data collection and co-ordination of risk assessment activities. At the current time a revision of the EU...

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

    Science.gov (United States)

    2012-03-01

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

  3. Latest developments in foodborne pathogen risk assessment

    OpenAIRE

    Membré, Jeanne Marie; Guillou, Sandrine

    2016-01-01

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

  4. UAV Swarm Operational Risk Assessment system

    OpenAIRE

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

    2015-01-01

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

  5. Environmental risk assessment of pesticides in Ethiopia

    NARCIS (Netherlands)

    Teklu, B.M.

    2016-01-01

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

  6. Gender and risk assessment in contraceptive technologies

    NARCIS (Netherlands)

    Kammen, van Jessika; Oudshoorn, Nelly

    2002-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-11-15

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

  8. Biodiversity Risk Assessment of Protected Ecosystems

    Directory of Open Access Journals (Sweden)

    Vitalija Rudzkienė

    2013-10-01

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

  9. Do psychological interventions reduce preoperative anxiety?

    Science.gov (United States)

    Renouf, Tessa; Leary, Alison; Wiseman, Theresa

    The systematic review investigates whether, during preoperative assessments, nurse-delivered psychological interventions reduce anxiety levels preoperatively for patients undergoing elective surgery. Seventeen studies met the inclusion criteria for data extraction and in-depth critiquing. Of these, two were discarded due to lack of validity, while the remaining studies were organised thematically in a narrative synthesis, generating two principal results: patients' preoperative anxieties were lowered by nurse-delivered general preoperative psychological interventions; and patients valued individualised preoperative interventions delivered by nurses. However, the single oncology study in the review showed an elevation in preoperative anxiety, regardless of intervention, and highlights the need for more research in this under-reviewed area. In the meantime, the authors believe that service improvements should be implemented to ensure that, where possible, psychological preoperative interventions are individualised.

  10. New Methodology for Rapid Seismic Risk Assessment

    Science.gov (United States)

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

    2002-05-01

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

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

    Science.gov (United States)

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

    2016-07-01

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

  12. Can preoperative electrical nociceptive stimulation predict acute pain after groin herniotomy?

    DEFF Research Database (Denmark)

    Aasvang, Eske Kvanner; Hansen, J.B.; Kehlet, H.

    2008-01-01

    pain (rho = -0.13, P = .09, and rho = -1.2, P = .4, respectively. PERSPECTIVE: Although preoperative electrical nociceptive stimulation may predict patients at risk of high-intensity acute pain after other surgical procedures, this was not the case in groin hernia repair patients receiving concomitant......Preoperative identification of patients at risk for high-intensity postoperative pain may be used to predict patients at risk for development of a persistent pain state and allocate patients to more intensive specific pain therapy. Preoperative pain threshold to electrocutaneus stimulation has...... recently been shown to correlate to acute postoperative pain after cesarean section, but the findings have not been confirmed in larger studies or other procedures. Preoperative electrical pain detection threshold and pain tolerance were assessed in patients undergoing a primary unilateral groin hernia...

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

    Science.gov (United States)

    Dezfuli, Homayoon

    2010-01-01

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

  14. Preoperative Nutritional Assessment by Controlling Nutritional Status (CONUT) is Useful to estimate Postoperative Morbidity After Esophagectomy for Esophageal Cancer.

    Science.gov (United States)

    Yoshida, Naoya; Baba, Yoshifumi; Shigaki, Hironobu; Harada, Kazuto; Iwatsuki, Masaaki; Kurashige, Junji; Sakamoto, Yasuo; Miyamoto, Yuji; Ishimoto, Takatsugu; Kosumi, Keisuke; Tokunaga, Ryuma; Imamura, Yu; Ida, Satoshi; Hiyoshi, Yukiharu; Watanabe, Masayuki; Baba, Hideo

    2016-08-01

    A nutritional indicator suitable for predicting complications after esophagectomy has not been confirmed. The nutritional screening tool CONUT is a potential candidate. We retrospectively analyzed 352 patients who underwent elective esophagectomy with lymphadenectomy for esophageal cancer between April 2005 and December 2014. Patients were divided into three groups according to the malnutrition degree in controlling nutritional status (CONUT): normal, light malnutrition, moderate or severe malnutrition. The numbers of patients assigned to the normal, light malnutrition, and moderate or severe malnutrition groups were 205, 126, and 21, respectively. One hundred forty-seven (41.8 %) patients were considered malnourished. Patients with moderate or severe malnutrition had a significantly high incidence of any morbidity, severe morbidities, and surgical site infection. Hospital stay in patients with moderate or severe malnutrition was significantly longer. Logistic regression analysis suggested that moderate or severe malnutrition was an independent risk factor for any morbidity [hazard ratio (HR) 2.75, 95 % confidence interval (CI) 1.081-7.020; p = 0.034] and severe morbidities (HR 3.07, 95 % CI 1.002-9.432; p = 0.049). CONUT was a convenient and useful tool to assess nutritional status before esophagectomy. Patients with moderate or severe malnutrition according to CONUT are at high risk for postoperative complications.

  15. Biological Based Risk Assessment for Space Exploration

    Science.gov (United States)

    Cucinotta, Francis A.

    2011-01-01

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

  16. Trichloroethylene risk assessment: relevance of interindividual differences

    NARCIS (Netherlands)

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

    2001-01-01

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

  17. Trichloroethylene risk assessment: relevance of interindividual differences

    NARCIS (Netherlands)

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

    2001-01-01

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

  18. Risk Assessment Study for Storage Explosive

    Directory of Open Access Journals (Sweden)

    S. S. Azhar

    2006-01-01

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

  19. Earthquake risk assessment for Istanbul metropolitan area

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

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

  20. High risk process control system assessment methodology

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-07-01

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

  1. TSCA Work Plan Chemical Risk Assessment: 1 ...

    Science.gov (United States)

    1-Bromopropane (CASRN 106-94-5): or 1-BP is a volatile organic chemical that is considered moderately persistent in the environment but does not have the potential to bioaccumulate in fish or other animals. The majority of the 1-BP production volume (~ 47%) is used as a vapor degreaser for optics electronics, plastics, and metals. 1-BP also is used as an aerosol solvent in cleaning products, as a spray fixative in arts and crafts, and as a spot cleaner in various industrial/commercial/consumer sectors. Focus of the Risk Assessment: The assessment will focus on uses of 1-BP in commercial (i.e., vapor degreasing, spray adhesives, and dry cleaning) and consumer applications (i.e., aerosol solvent cleaners and spray adhesives). Given the range of endpoints (i.e., cancer, non-cancer; the latter includes potential effects on the developing fetus), susceptible populations are expected to include adults (including pregnant women) in commercial uses and children (as bystanders) and adults of all ages (including pregnant women) for consumer uses. Thus, the assessment will focus on all humans/lifestages. EPA anticipates issuing draft risk assessments for public review and comment as they are completed. At the conclusion of the review process, if an assessment of specific uses indicates significant risk, EPA will evaluate and pursue appropriate risk reduction actions, as warranted. If an assessment indicates no significant risk, EPA will conclude its work on the a

  2. Postural risk assessment of mechanised firewood processing.

    Science.gov (United States)

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

    2017-03-01

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

  3. Quantitative Risk Assessment of Contact Sensitization

    DEFF Research Database (Denmark)

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

    2010-01-01

    Background: Contact hypersensitivity quantitative risk assessment (QRA) for fragrance ingredients is being used to establish new international standards for all fragrance ingredients that are potential skin sensitizers. Objective: The objective was to evaluate the retrospective clinical data...... as potential sensitizers. Methods: This article reviews clinical data for three fragrance ingredients cinnamic aldehyde, citral, and isoeugenol to assess the utility of the QRA approach for fragrance ingredients. Results: This assessment suggests that had the QRA approach been available at the time standards...

  4. Risk propensity assessment in military special operations.

    Science.gov (United States)

    Sicard, B; Jouve, E; Blin, O

    2001-10-01

    Risk taking, decision making, and stress factors are strongly associated in military operations. The authors used the Bond and Lader mood and alertness scale and a new scale, Evaluation of Risks (EVAR), to assess risk proneness in a maritime counter-terrorism exercise. EVAR items are distributed among five factors: self-control, danger seeking, energy, impulsiveness, and invincibility. In the study, 10 pilots were submitted to strenuous night flights with limited sleep deprivation. Compared with baseline data, pilots reported an increase in impulsiveness, whereas EVAR factors were consistent in a control group composed of 9 navy crew member. Correlations were observed between mood and alertness and risk factors. These results illustrate how EVAR can be used to evaluate change in risk proneness in individuals submitted to various stressors. But further studies are required to weigh stress factors and environmental conditions in risk propensity with a larger population of various age and personality traits.

  5. Risk scores to facilitate preoperative prediction of transfusion and large volume blood transfusion associated with adult cardiac surgery.

    Science.gov (United States)

    Goudie, R; Sterne, J A C; Verheyden, V; Bhabra, M; Ranucci, M; Murphy, G J

    2015-05-01

    The aim of this study was to develop two novel risk prediction scores for transfusion and bleeding that would be used to inform treatment decisions, quality assurance, and clinical trial design in cardiac surgery. Clinical data prospectively collected from 26 UK cardiac surgical centres and a single European centre were used to develop two risk prediction models: one for any red blood cell (RBC) transfusion, and the other for large volume blood transfusion (≥4 RBC units; LVBT), an index of severe blood loss. 'Complete case' data were available for 24 749 patients. Multiple imputation was used for missing covariate data (typically data set containing 39 970 patients. Risk models were developed in the complete case data set, with internal validation using leave-one-centre-out cross-validation. The final selected models were fitted to the imputed data set. Final risk scores were then compared with the performance of three existing scores: the Transfusion Risk and Clinical Knowledge score (TRACK), the Transfusion Risk Understanding Scoring Tool (TRUST), and the Papworth Bleeding Risk Score (BRiSc). The area under the receiver operating characteristic curve (AUC) was 0.77 (95% confidence interval 0.77-0.77) for the any RBC transfusion score and AUC 0.80 (0.79-0.80) for the LVBT score in the imputed data set. The LVBT model also showed excellent discrimination (Hosmer-Lemeshow P=0.32). In the imputed data set, the AUCs for the TRACK and TRUST scores for any RBC transfusion were 0.71 and 0.71, respectively, and for LVBT the AUC for the BRiSc score was 0.69. Two new risk scores for any RBC transfusion or LVBT among cardiac surgery patients have excellent discrimination, and could inform clinical decision making. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  6. The relation of risk assessment and health impact assessment

    DEFF Research Database (Denmark)

    Ádám, Balázs; Gulis, Gabriel

    2013-01-01

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

  7. Risk assessment of Genetically Modified Organisms (GMOs

    Directory of Open Access Journals (Sweden)

    Waigmann E

    2012-10-01

    Full Text Available

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

  8. The value of high-resolution MRI technique in patients with rectal carcinoma: pre-operative assessment of mesorectal fascia involvement, circumferential resection margin and local staging.

    Science.gov (United States)

    Algebally, Ahmed Mohamed; Mohey, Nesreen; Szmigielski, Wojciech; Yousef, Reda Ramadan Hussein; Kohla, Samah

    2015-01-01

    The purpose of the study was to identify the accuracy of high-resolution MRI in the pre-operative assessment of mesorectal fascia involvement, circumfrential resection margin (CRM) and local staging in patients with rectal carcinoma. The study included 56 patients: 32 male and 24 female. All patients underwent high-resolution MRI and had confirmed histopathological diagnosis of rectal cancer located within 15 cm from the anal verge, followed by surgery. MRI findings were compared with pathological and surgical results. The overall accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI-based T-staging were 92.8, 88.8%, 96.5%, 96%, and 90.3%, respectively. The accuracy, sensitivity, specificity, PPV, and NPV of MRI-based assessment of CRM were 94.6%, 84.6%, 97.6%, 91.4, and 94.6%, respectively. The accuracy, sensitivity, specificity, PPV, and NPV of MRI-based N-staging were 82.1%, 75%, 67.3%, 60%, and 86.1%, respectively. Preoperative high-resolution rectal MRI is accurate in predicting tumor stage and CRM involvement. MRI is a precise diagnostic tool to select patients who may benefit from neo-adjuvant therapy and to avoid overtreatment in those patients who can proceed directly to surgery.

  9. Update earthquake risk assessment in Cairo, Egypt

    Science.gov (United States)

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

    2016-12-01

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

  10. Update earthquake risk assessment in Cairo, Egypt

    Science.gov (United States)

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

    2017-07-01

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

  11. Risks in hospitals. Assessment and Management

    Directory of Open Access Journals (Sweden)

    Bradea Ioana-Alexandra

    2014-12-01

    Full Text Available In a complex world, characterized by a multitude of risks, managers need to manage the risks they encounter, in an efficient way and in the shortest time possible. In the current economic crisis, the concept of hospital risk management, as the process in which is identified, analyzed, reduced, or avoided a risk that may affect the hospital, gained great importance. The Romanian health system, distinguished by: lack of transparency, poor funding, the loss of the valuable medical staff, lack of hospitals in villages and small towns, inability to engage patients due to the old and poor equipment, lack of research and problems in information privacy and cyber-security, requires an appropriate management, enabling risk managers to take decisions in order to avoid the occurrence of risks. Important for the functioning of every hospital is the perception of patients and their degree of satisfaction, regarding the quality of services, which depend largely on the quality of human resources. But what are the human resources weaknesses and risks from the patient point of view? What are the risk indicators which must be monitored to avoid risks? And also, which is the most useful method for measurement and assessment of risk?

  12. Integrating public risk perception into formal natural hazard risk assessment

    Directory of Open Access Journals (Sweden)

    Th. Plattner

    2006-01-01

    Full Text Available An urgent need to take perception into account for risk assessment has been pointed out by relevant literature, its impact in terms of risk-related behaviour by individuals is obvious. This study represents an effort to overcome the broadly discussed question of whether risk perception is quantifiable or not by proposing a still simple but applicable methodology. A novel approach is elaborated to obtain a more accurate and comprehensive quantification of risk in comparison to present formal risk evaluation practice. A consideration of relevant factors enables a explicit quantification of individual risk perception and evaluation. The model approach integrates the effective individual risk reff and a weighted mean of relevant perception affecting factors PAF. The relevant PAF cover voluntariness of risk-taking, individual reducibility of risk, knowledge and experience, endangerment, subjective damage rating and subjective recurrence frequency perception. The approach assigns an individual weight to each PAF to represent its impact magnitude. The quantification of these weights is target-group-dependent (e.g. experts, laypersons and may be effected by psychometric methods. The novel approach is subject to a plausibility check using data from an expert-workshop. A first model application is conducted by means of data of an empirical risk perception study in Western Germany to deduce PAF and weight quantification as well as to confirm and evaluate model applicbility and flexibility. Main fields of application will be a quantification of risk perception by individual persons in a formal and technical way e.g. for the purpose of risk communication issues in illustrating differing perspectives of experts and non-experts. For decision making processes this model will have to be applied with caution, since it is by definition not designed to quantify risk acceptance or risk evaluation. The approach may well explain how risk perception differs, but not

  13. Accuracy of 3 T versus 1.5 T breast MRI for pre-operative assessment of extent of disease in newly diagnosed DCIS

    Energy Technology Data Exchange (ETDEWEB)

    Rahbar, Habib, E-mail: hrahbar@uw.edu; DeMartini, Wendy B.; Lee, Amie Y.; Partridge, Savannah C.; Peacock, Sue; Lehman, Constance D.

    2015-04-15

    Highlights: •We compared sizes of known ductal carcinoma in situ (DCIS) on pre-operative breast MRI at 3 T and 1.5 T with final pathology sizes. •DCIS sizes on 3 T MRI correlated better with pathologic sizes than 1.5 T MRI. •Imaging features of DCIS, including morphology and kinetics, were similar at 3 T and 1.5 T MRI. -- Abstract: Objectives: While 3 T breast magnetic resonance imaging has increased in use over the past decade, there is little data comparing its use for assessing ductal carcinoma in situ (DCIS) versus 1.5 T. We sought to compare the accuracies of DCIS extent of disease measures on pre-operative 3 T versus 1.5 T MRI. Methods: This institutional review board-approved prospective study included 20 patients with ductal carcinoma in situ diagnosed by core needle biopsy (CNB) who underwent pre-operative breast MRI at both 3 T (resolution = 0.5 mm × 0.5 mm × 1.3 mm) and 1.5 T (0.85 mm × 0.85 mm × 1.6 mm). All patients provided informed consent, and the study was HIPPA compliant. Lesion sizes and imaging characteristics (morphologic and kinetic enhancement) were recorded for the 3 T and 1.5 T examinations. Lesion size measures at both field strengths were correlated to final pathology, and imaging characteristics also were compared. Results: Of the initial cohort of 20 patients with CNB-diagnosed DCIS, 19 underwent definitive surgery. Median DCIS sizes of these 19 patients were 6 mm (range: 0–67 mm) on 3 T, 13 mm (0–60 mm) on 1.5 T, and 6 mm (0–55 mm) on surgical pathology. Size correlation between MRI and pathology was higher for 3 T (Spearman's ρ = 0.66, p = 0.002) than 1.5 T (ρ = 0.36, p = 0.13). In 10 women in which a residual area of suspicious enhancement was identified on both field strengths, there was agreement of morphologic description (NME vs. mass) in nine, and no significant difference in dynamic contrast enhanced kinetics at 3 T compared to 1.5 T. Conclusions: Pre-operative breast MRI at 3 T provided higher

  14. Medical Recapitulate%Application of High Resolution Computed Tomography in Patients with Chronic Suppurative Otitis Media in Preoperative Assessment

    Institute of Scientific and Technical Information of China (English)

    张建鹏

    2016-01-01

    Objective To discuss the value of high resolution computed tomography(HRCT) in preop-erative evaluation of in patients with chronic suppurative otitis media ( CSOM) .Methods Total of 210 patients with CSOM in Shangluo Central Hospital from May 2012 to May 2015 were included in the study,including 105 cases of bone ulcer otitis and 105 cases of cholesteatoma otitis.HRCT was used to check the extent of damage of bone ulcer otitis media and cholesteatoma otitis media in incus body ,crus longum incudis,crus breve incudis,lenticular process, stirrup,malleus head and malleus handle,and compare the results with intraoperative observation.Results The extent of damage in patients with bone ulcer otitis media in the pre-operative HRCT examination compared with intraoperative results showed no statistically significant difference (P>0.05).The extent of damage in patients with cholesteatoma otitis media in the preoperative HRCT examination compared with intraoperative results showed:there were statistically significant differences in the extent of damage in crus breve incudis, lenticular process and stirrup(P 0.05 ) .Conclusion HRCT plays an important role not only in the diagnosis of CSOM,but also in the preoperative evaluation and the choice of surgical methods.%目的:探讨高分辨率 CT( HRCT)在慢性化脓性中耳炎( CSOM)患者术前评估中的作用。方法选泽2012年5月至2015年5月商洛市中心医院就诊且诊断为CSOM的骨疡型患者105例,胆脂瘤型患者105例,术前通过HRCT来评估两型中耳炎在砧骨体、砧骨长脚、砧骨短脚、豆状突、镫骨、锤骨头和锤骨柄这7个部位的破坏情况,并与术中所观察到的两型中耳炎7个部位的破坏程度进行比较。结果骨疡型中耳炎患者在术前进行的 HRCT检查显示的破坏程度与术中观察到的结果进行比较发现,7个部位部位的听骨破坏程度差异无统计学意义( P >0.05)。胆脂瘤型中耳炎患者

  15. Assessing the Environmental Risks of Nanomaterials

    DEFF Research Database (Denmark)

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

    decisionmakers better decide on which risk assessment/analysis framework may be best suited for the specific risk decision at hand. Among other results, we find that while many of the assessed frameworks have their advantages along with limitations, most may require potentially lengthy decision-making processes...... of uncertainty, degree of precaution, inclusion of quantitative or qualitative data, inclusion of life-cycle perspective, iterative and/or adaptive, ensuring timely decision making, and degree of transparency. This analysis can ultimately assist scientists, government agencies, organizations, and other......Assessing the environmental risks of engineered nanomaterials (NM) is currently an intensely contested subject among scientists, organizations, governments, and policymakers. The shear number, variety, and market penetration of NM in consumer goods and other applications, including environmental...

  16. Safety Factors in Pesticide Risk Assessment

    DEFF Research Database (Denmark)

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

    Foreword It has become common practice to protect the environment from hazardous chemicals by use of risk assessment to establish environmental concentration at which only limited damage to the ecosystem can be expected. The methods and tools applied in the risk assessment need constant evaluation...... to many species in real ecosystems · extrapolating from acute to chronic or long term effects. The project was co-funded by the Environmental Protection Agency and The National Environmental Research Institute Summary In this report two factors are studied which have implications for the size of safety...... factors used in pesticide risk assessment: the variability in species sensitivities, and the relationship between acute LC50's and chronic NOEC's....

  17. Risk factors for and assessment of constipation.

    Science.gov (United States)

    Chapman, Sherree; Hungerford, Catherine

    2015-04-01

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

  18. Concepts of modern risk assessment and management.

    Science.gov (United States)

    Corbin, S B

    1994-01-01

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

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

    Science.gov (United States)

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

    2015-08-01

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

  20. Prediction of nodal involvement in primary rectal carcinoma without invasion to pelvic structures: accuracy of preoperative CT, MR, and DWIBS assessments relative to histopathologic findings.

    Directory of Open Access Journals (Sweden)

    Jun Zhou

    Full Text Available OBJECTIVE: To investigate the accuracy of preoperative computed tomography (CT, magnetic resonance (MR imaging and diffusion-weighted imaging with background body signal suppression (DWIBS in the prediction of nodal involvement in primary rectal carcinoma patients in the absence of tumor invasion into pelvic structures. METHODS AND MATERIALS: Fifty-two subjects with primary rectal cancer were preoperatively assessed by CT and MRI at 1.5 T with a phased-array coil. Preoperative lymph node staging with imaging modalities (CT, MRI, and DWIBS were compared with the final histological findings. RESULTS: The accuracy of CT, MRI, and DWIBS were 57.7%, 63.5%, and 40.4%. The accuracy of DWIBS with higher sensitivity and negative predictive value for evaluating primary rectal cancer patients was lower than that of CT and MRI. Nodal staging agreement between imaging and pathology was fairly strong for CT and MRI (Kappa value = 0.331 and 0.348, P<0.01 but was relatively weaker for DWIBS (Kappa value = 0.174, P<0.05. The accuracy was 57.7% and 59.6%, respectively, for CT and MRI when the lymph node border information was used as the criteria, and was 57.7% and 61.5%, respectively, for enhanced CT and MRI when the lymph node enhancement pattern was used as the criteria. CONCLUSION: MRI is more accurate than CT in predicting nodal involvement in primary rectal carcinoma patients in the absence of tumor invasion into pelvic structures. DWIBS has a great diagnostic value in differentiating small malignant from benign lymph nodes.

  1. [Patient safety in antibiotics administration: Risk assessment].

    Science.gov (United States)

    Maqueda Palau, M; Pérez Juan, E

    To determine the level of risk in the preparation and administration of antibiotics frequently used in the Intensive Care Unit using a risk matrix. A study was conducted using situation analysis and literature review of databases, protocols and good practice guidelines on intravenous therapy, drugs, and their administration routes. The most used antibiotics in the ICU registered in the ENVIN-HELICS program from 1 April to 30 June 2015 were selected. In this period, 257 patients received antimicrobial treatment and 26 antibiotics were evaluated. Variables studied: A risk assessment of each antibiotic using the scale Risk Assessment Tool, of the National Patient Safety Agency, as well as pH, osmolarity, type of catheter recommended for administration, and compatibility and incompatibility with other antibiotics studied. Almost two-thirds (65.3%) of antibiotics had more than 3 risk factors (represented by a yellow stripe), with the remaining 34.7% of antibiotics having between 0 and 2 risk factors (represented by a green stripe). There were no antibiotics with 6 or more risk factors (represented by a red stripe). Most drugs needed reconstitution, additional dilution, and the use of part of the vial to administer the prescribed dose. More than half of the antibiotics studied had a moderate risk level; thus measures should be adopted in order to reduce it. The risk matrix is a useful tool for the assessment and detection of weaknesses associated with the preparation and administration of intravenous antibiotics. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

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

    Science.gov (United States)

    Hanslik, Thomas; Boëlle, Pierre Yves

    2007-04-01

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

  3. Preoperative staging of rectal cancer.

    Science.gov (United States)

    Smith, Neil; Brown, Gina

    2008-01-01

    Detailed preoperative staging using high resolution magnetic resonance imaging (MRI) enables the selection of patients that require preoperative therapy for tumour regression. This information can be used to instigate neoadjuvant therapy in those patients with poor prognostic features prior to disturbing the tumour bed and potentially disseminating disease. The design of trials incorporating MR assessment of prognostic factors prior to therapy has been found to be of value in assessing treatment modalities and outcomes that are targeted to these preoperative prognostic subgroups and in providing a quantifiable assessment of the efficacy of particular chemoradiation treatment protocols by comparing pre-treatment MR staging with post therapy histology assessment. At present, we are focused on achieving clear surgical margins of excision (CRM) to avoid local recurrence. We recommend that all patients with rectal cancer should undergo pre-operative MRI staging. Of these, about half will have good prognosis features (T1-T3b, N0, EMVI negative, CRM clear) and may safely undergo primary total mesorectal excision. Of the remainder, those with threatened or involved margins will certainly benefit from pre-operative chemoradiotherapy with the aim of downstaging to permit safe surgical excision. In the future, our ability to recognise features predicting distant failure, such as extramural vascular invasion (EMVI) may be used to stratify patients for neo-adjuvant systemic chemotherapy in an effort to prevent distant relapse. The optimal pre-operative treatment regimes for these patients (radiotherapy alone, systemic chemotherapy alone or combination chemo-radiotherapy) is the subject of current and future trials.

  4. Assessment of health risks of policies

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-09-15

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

  5. Caries risk assessment in young adults

    DEFF Research Database (Denmark)

    Petersson, Gunnel Hänsel; Twetman, Svante

    2015-01-01

    BACKGROUND: To validate baseline caries risk classifications according to the Cariogram model with the actual caries development over a 3-year period in a group of young adults living in Sweden. METHODS: The study group consisted of 1,295 19-year-old patients that completed a comprehensive clinical...... baseline examination, including radiographs and salivary tests. An individual caries risk profile was computed and the patient was placed in one of five risk categories. After 3 years, 982 patients (75.8%) were re-examined and caries increment for each patient was calculated. The outcome was expressed...... as sensitivity, specificity and predictive values and compared with a risk assessment scheme used in Public Dental Service. RESULTS: The drop-outs displayed more risk factors and a significantly higher caries burden at baseline compared with those that remained in the project (p 

  6. Risk Assessment of Genetically Modified Microorganisms

    DEFF Research Database (Denmark)

    Jacobsen, B. L.; Wilcks, Andrea

    2001-01-01

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

  7. Concepts in ecological risk assessment. Professional paper

    Energy Technology Data Exchange (ETDEWEB)

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

    1991-05-01

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

  8. Recording pressure ulcer risk assessment and incidence.

    Science.gov (United States)

    Plaskitt, Anne; Heywood, Nicola; Arrowsmith, Michaela

    2015-07-15

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

  9. Application of geostatistics to risk assessment.

    Science.gov (United States)

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

    2003-10-01

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

  10. Risk Assessment in Cholelithiasis: Is Cholecystectomy Always to be Preferred?

    Science.gov (United States)

    Mertens, Marlies C.; Roukema, Jan A.; Scholtes, Vincent P. W.

    2010-01-01

    Background As many patients with gallstone disease do not benefit from cholecystectomy, preoperative recognition of such high-risk patients is important. The aim of the study is to identify predictors of persisting symptoms at 6 months after cholecystectomy for patients with different preoperative symptomatology. Method Participants in this prospective study were consecutive patients (n = 172), age 18–65 years, with symptomatic cholelithiasis, undergoing a laparoscopic cholecystectomy. Predictors were identified using uni- and multivariate regression analyses. Results At 6 months postcholecystectomy, patients with only preoperative biliary symptoms were most often free of symptoms (62.5%). Patients with only dyspeptic symptoms most often reported persistence of preexisting symptoms (63.2%). Preoperative non-specific symptoms predicted the report of postoperative biliary and/or dyspeptic symptoms (OR = 4.5–6.1). Persistence of preexisting pattern of symptoms was predicted by the use of psychotropic medication (OR = 5.3) and dyspeptic symptoms (OR = 4.5). Postoperative biliary symptoms were predicted by High Trait Anxiety (HTA) (OR = 10.6). Conclusion Surgeons should take account of individual risks of patients in the management of cholelithiasis. Instead of cholecystectomy, expectative management should be the first choice in patients with non-specific symptoms, with dyspeptic symptoms only, with HTA and in patients using psychotropic medication. PMID:20502977

  11. Clinical practice of risk assessment of sexual violence

    OpenAIRE

    Judge, Joseph Gerard

    2012-01-01

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

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

    CERN Document Server

    Heimsch, Laura

    2016-01-01

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

  13. Nutritional risk screening for preoperative patients with different parts of colorectal cancer%不同部位的大肠癌患者术前营养风险筛查

    Institute of Scientific and Technical Information of China (English)

    李卡; 何凌霄; 习鹭; 黄明君; 汪晓东

    2010-01-01

    Objective To investigate the impact of nutritional risk of preoperative patients with different parts of colorectal cancer. Methods 385 cases of surgical patients diagnosed with colorectal cancer were selected in the retrospective study in April 2008 to March 2009, Gastrointestinal Surgery Center of West China Hospital in Sichuan University. Patients were divided into the right colon cancer group, the left colon cancer group, the rectal cancer group, using internationally recognized NRS- 2002 Scale and serum nutrition indicators to assess their preoperative nutrition. Results NRS-2002 score in the right colon cancer group showed higher than the left colon and rectal cancer group, but no statistical difference between the latter two rates; serum concentrations of HGB, TP, ALB, A/G were lower in the right colon cancer group than the other two groups, but the concentrations of ALT, AST, Ca2+, PO43-showed no statistical difference among three groups. Conclusions The proximal colon (right colon cancer) were more susceptible to the risk of preoperative malnutrition, the patients with different parts of colorectal cancer should be given to the corresponding preoperative nutritional assessment and nutritional support.%目的 探讨大肠癌患者不同患病部位对其术前营养风险评分的影响.方法 回顾研究了2008年4月至2009年3月四川大学华西医院胃肠外科中心确诊并施行手术的385例大肠癌患者,分为右半结肠癌组、左半结肠癌组、直肠癌组,采用国际认可的NRS-2002营养风险筛查量表和血清学营养指标进行术前营养评估.结果 右半结肠癌组NRS-2002评分分布与左半结肠癌和直肠癌组比较差异显著,但后两者评分分布比较无显著差异;右半结肠癌HGB、TP、ALB血清浓度及A/G显著低于另2组,但ALT、AST、Ca2+、PO43-浓度比较3组均无显著差异.结论 近端结肠癌(右半结肠癌)患者更易发生术前营养不良风险,应针对不同部位的患者

  14. Microbiological risk assessment for personal care products.

    Science.gov (United States)

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

    2016-12-01

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

  15. Health effects of risk-assessment categories

    Energy Technology Data Exchange (ETDEWEB)

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

    1983-10-01

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

  16. Flood risk assessment and associated uncertainty

    Directory of Open Access Journals (Sweden)

    H. Apel

    2004-01-01

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

  17. Accuracy and precision of perfusion lung scintigraphy versus {sup 133}Xe-radiospirometry for preoperative pulmonary functional assessment of patients with lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Mariano-Goulart, Denis [Montpellier University Hospital, Department of Nuclear Medicine, Montpellier (France); Service Central de Medecine Nucleaire, CHU Lapeyronie, Montpellier Cedex 5 (France); Barbotte, Eric; Basurko, Celia [Montpellier University Hospital, Department of Statistics and Epidemiology, Montpellier (France); Comte, F.; Rossi, Michel [Montpellier University Hospital, Department of Nuclear Medicine, Montpellier (France)

    2006-09-15

    Purpose: This study sought to determine whether {sup 133}Xe-radiospirometry (XRS) successfully selects patients able to undergo lung resection without postoperative respiratory complications and whether perfusion lung scintigraphy (PLS) is likely to provide a similar selection of patients for certain tumour stages. Methods: Two hundred and eighty-four patients with resectable lung cancer underwent preoperative assessment of postoperative forced expiratory volume in 1 s (FEV{sub 1}) by XRS and PLS. Correlations, Bland and Altman analysis and contingency tables were used to analyse the difference between the two predictive techniques. One hundred and sixty patients underwent lung resection on the basis of XRS preoperative testing only. None of them developed respiratory insufficiency. Despite a close correlation, the limits of agreement between predicted FEV{sub 1} by XRS and PLS exceeded {+-}0.3 l/s. For tumour stages T1Nx and T2N0, PLS underestimated postoperative FEV{sub 1} whereas it overestimated this parameter for stage III. XRS accurately selects patients able to undergo lung resection without postoperative pulmonary insufficiency. The agreement between XRS and PLS is unacceptable. When only PLS is available, higher thresholds for patients with stage III cancers and lower thresholds for those with stage I cancers should be used to decide on operability. (orig.)

  18. Predictive Role of Functional Visceral Fat Activity Assessed by Preoperative F-18 FDG PET/CT for Regional Lymph Node or Distant Metastasis in Patients with Colorectal Cancer.

    Directory of Open Access Journals (Sweden)

    Kisoo Pahk

    Full Text Available To investigate the role of functional visceral fat activity assessed by preoperative F-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT in colorectal cancer (CRC for predicting regional lymph node (LN or distant metastasis.We evaluated 131 patients with newly diagnosed CRC. They all underwent pre-operative 18F-FDG PET/CT and surgery. Functional fat activity was measured by maximum standardized uptake value (SUVmax using 18F-FDG PET/CT. Functional visceral fat activity was measured by SUVmax of visceral fat/SUVmax of subcutaneous fat (V/S ratio. Mann-Whitney U test, χ2 test, Fisher's exact test, receiver-operating characteristic (ROC analysis, Spearrman's correlation coefficient, and uni- and multivariate logistic regression statistical analyses were done.Patients with higher V/S ratio displayed a significantly higher rate of regional LN (p = 0.004 and distant metastasis (p<0.001. In addition, V/S ratio was the only factor that was significantly associated with distant metastasis. An optimal cut-off V/S ratio of 1.88 was proposed for predicting distant metastasis with a sensitivity of 84.6% and specificity of 78.8% (area under the curve: 0.86; p<0.0001.Functional visceral fat activity is significantly associated with distant metastasis in CRC patients. Furthermore, V/S ratio can be useful as a complementary factor in predicting distant metastasis.

  19. Preoperative psychological testing--another form of prejudice.

    Science.gov (United States)

    Ashton, David; Favretti, Franco; Segato, Gianni

    2008-10-01

    Preoperative psychological screening of bariatric surgery candidates has become routine, and a significant proportion of patients have their surgery deferred as a consequence. If psychological testing is being used as a form of preoperative triage, both patients and surgeons are entitled to know whether there is sufficient evidence to justify its use in this way. We define the argument for psychological screening as consisting of four premises (p1-p4) and a conclusion (C) as follows: (p1) A significant minority of obese patients will not be successful in losing weight following bariatric surgery-the "failure" group; (p2) A significant minority of patients will exhibit abnormal psychological profiles during preoperative testing; (p3) The majority of individuals referred to in (p2) will be found in group (p1) i.e., abnormal psychological profiles identified preoperatively predict less favorable weight loss outcomes postoperatively; (p4) Identifying patients with adverse psychological profiles preoperatively would allow either exclusion of those at high risk of failure or provide a more secure rationale for targeted pre- and postoperative support; (C) Psychological screening should be part of the routine preoperative assessment for patients undergoing obesity surgery. We reviewed the literature to find evidence to support the premises and show that (p1) can be justified but that (p2) is problematic and can only be accepted in a heavily qualified version. We find no evidence for (p3) and since (p4) and (C) are predicated on (p3), the argument clearly fails. There is no evidence to suggest that preoperative psychological screening can predict postoperative outcomes and no justification for using such testing as a means of discriminating between candidates presenting themselves for bariatric surgery.

  20. Risk assessment and management logistics chains

    Directory of Open Access Journals (Sweden)

    Vladimir Vikulov

    2014-03-01

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

  1. Handling Interdependencies in Climate Change Risk Assessment

    Directory of Open Access Journals (Sweden)

    Richard J. Dawson

    2015-12-01

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

  2. Ecosystem services in risk assessment and management. ...

    Science.gov (United States)

    The ecosystem services (ES) concept holds much promise for environmental decision making. Even so, the concept has yet to gain full traction in the decisions and policies of environmental agencies in the United States, Europe, and elsewhere. Here we examine the opportunities for and implications of including ES in risk assessments and the risk management decisions that they inform. We assert that use of ES will: 1) lead to more comprehensive environmental protection; 2) help to articulate the benefits of environmental decisions, policies, and actions; 3) better inform the derivation of environmental quality standards; 4) enable integration of human health and ecological risk assessment; and 5) facilitate horizontal integration of policies, regulations, and programs. We provide the technical basis and supporting rationale for each assertion, relying on examples taken from experiences in the United States and European Union. Specific recommendations are offered for use of ES in risk assessment and risk management, and issues and challenges to advancing use of ES are described along with some of the science needed to improve the value of the ES concept to environmental protection. This paper is one of 4 papers generated from the 2014 Pellston Workshop “Ecosystem Services, Environmental Stressors and Decision Making,” organized jointly by the Society of Environmental Toxicology and Chemistry and the Ecological Society of America. The main workshop objective was

  3. Risk assessment for SAGD well blowouts

    Energy Technology Data Exchange (ETDEWEB)

    Worth, D.; Alhanati, F.; Lastiwka, M. [C-FER Technologies, Edmonton, AB (Canada); Crepin, S. [Petrocedeno, Caracas (Venezuela)

    2008-10-15

    This paper discussed a steam assisted gravity drainage (SAGD) pilot project currently being conducted in Venezuela's Orinoco Belt. A risk assessment was conducted as part of the pilot program in order to evaluate the use of single barrier completions in conjunction with a blowout response plan. The study considered 3 options: (1) an isolated double barrier completion with a downhole safety valve (DHSV) in the production tubing string and a packer in the production casing annulus; (2) a partially isolated completion with no DHSV and a packer in the production casing annulus; and (3) an open single barrier completion with no additional downhole barriers. A reservoir model was used to assess the blowout flowing potential of SAGD well pairs. The probability of a blowout was estimated using fault tree analysis techniques. Risk was determined for various blowout scenarios, including blowouts during normal and workover operations, as well as blowouts through various flow paths. Total risk for each completion scenario was also determined at 3 different time periods within the production life of the well pair. The possible consequences of a blowout were assessed using quantitative consequence models. Results of the study showed that environmental and economic risks were much higher for the open completion technique. Higher risks were also associated with the earlier life of the completion strings. 20 refs., 3 tabs., 19 figs.

  4. Automating defence generation for risk assessment

    NARCIS (Netherlands)

    Gadyatskaya, Olga

    2016-01-01

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

  5. Soil Erosion Risk Assessment and Modelling

    Science.gov (United States)

    Fister, Wolfgang; Kuhn, Nikolaus J.; Heckrath, Goswin

    2013-04-01

    Soil erosion is a phenomenon with relevance for many research topics in the geosciences. Consequently, PhD students with many different backgrounds are exposed to soil erosion related questions during their research. These students require a compact, but detailed introduction to erosion processes, the risks associated with erosion, but also tools to assess and study erosion related questions ranging from a simple risk assessment to effects of climate change on erosion-related effects on geochemistry on various scales. The PhD course on Soil Erosion Risk Assessment and Modelling offered by the University of Aarhus and conducted jointly with the University of Basel is aimed at graduate students with degrees in the geosciences and a PhD research topic with a link to soil erosion. The course offers a unique introduction to erosion processes, conventional risk assessment and field-truthing of results. This is achieved by combing lectures, mapping, erosion experiments, and GIS-based erosion modelling. A particular mark of the course design is the direct link between the results of each part of the course activities. This ensures the achievement of a holistic understanding of erosion in the environment as a key learning outcome.

  6. Dermal absorption and toxicological risk assessment

    NARCIS (Netherlands)

    Buist, H.

    2016-01-01

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

  7. Risk assessment as an argumentation game

    NARCIS (Netherlands)

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

    2013-01-01

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

  8. Methodology for qualitative urban flooding risk assessment.

    Science.gov (United States)

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

    2013-01-01

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

  9. Dermal absorption and toxicological risk assessment

    NARCIS (Netherlands)

    Buist, H.

    2016-01-01

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

  10. Incorporating Agency Into Climate Change Risk Assessments

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-11-01

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

  11. Health Risk Assessment for Organotins in Textiles

    NARCIS (Netherlands)

    Janssen PJCM; Veen MP van; Speijers GJA; CSR; LBM

    2000-01-01

    In January 1998 RIVM was asked to carry out a preliminary risk assessment on organic tin compounds (organotins) in textiles. Measurements carried out by the Dutch Health Protection Inspectorate had shown these potentially toxic compounds to be present in several consumer products, including items of

  12. New risk assessment tools in the Netherlands

    NARCIS (Netherlands)

    Kraker, H. de; Douwes, M.

    2012-01-01

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

  13. Economic impact assessment in pest risk analysis

    NARCIS (Netherlands)

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

    2010-01-01

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

  14. Simulation modeling for microbial risk assessment.

    Science.gov (United States)

    Cassin, M H; Paoli, G M; Lammerding, A M

    1998-11-01

    Quantitative microbial risk assessment implies an estimation of the probability and impact of adverse health outcomes due to microbial hazards. In the case of food safety, the probability of human illness is a complex function of the variability of many parameters that influence the microbial environment, from the production to the consumption of a food. The analytical integration required to estimate the probability of foodborne illness is intractable in all but the simplest of models. Monte Carlo simulation is an alternative to computing analytical solutions. In some cases, a risk assessment may be commissioned to serve a larger purpose than simply the estimation of risk. A Monte Carlo simulation can provide insights into complex processes that are invaluable, and otherwise unavailable, to those charged with the task of risk management. Using examples from a farm-to-fork model of the fate of Escherichia coli O157:H7 in ground beef hamburgers, this paper describes specifically how such goals as research prioritization, risk-based characterization of control points, and risk-based comparison of intervention strategies can be objectively achieved using Monte Carlo simulation.

  15. Preoperative CA125 and fibrinogen in patients with endometrial cancer: a risk model for predicting lymphovascular space invasion

    Science.gov (United States)

    2017-01-01

    Objective The aim of this study was to build a model to predict the risk of lymphovascular space invasion (LVSI) in women with endometrial cancer (EC). Methods From December 2010 to June 2013, 211 patients with EC undergoing surgery at Shanghai First Maternity and Infant Hospital were enrolled in this retrospective study. Those patients were divided into a positive LVSI group and a negative LVSI group. The clinical and pathological characteristics were compared between the two groups; logistic regression was used to explore risk factors associated with LVSI occurrence. The threshold values of significant factors were calculated to build a risk model and predict LVSI. Results There were 190 patients who were negative for LVSI and 21 patients were positive for LVSI out of 211 patients with EC. It was found that tumor grade, depth of myometrial invasion, number of pelvic lymph nodes, and International Federation of Gynecology and Obstetrics (FIGO) stage (p0.05) were not associated with LVSI. Receiver operating characteristic (ROC) curves revealed that the threshold values of the following factors were correlated with positive LVSI: 28.1 U/mL of CA19-9, 21.2 U/mL of CA125, 2.58 mg/dL of fibrinogen (Fn), 1.84 U/mL of carcinoembryonic antigen (CEA) and (6.35×109)/L of white blood cell (WBC). Logistic regression analysis indicated that CA125 ≥21.2 (p=0.032) and Fn ≥2.58 mg/dL (p=0.014) were significantly associated with LVSI. Conclusion Positive LVSI could be predicted by CA125 ≥21.2 U/mL and Fn ≥2.58 mg/dL in women with EC. It could help gynecologists better adapt surgical staging and adjuvant therapies. PMID:27894164

  16. Housing conditions in calves welfare risk assessment

    Directory of Open Access Journals (Sweden)

    Relić Renata R.

    2010-01-01

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

  17. Terminal valve of sapheno-femoral junction: a comparative assessment between pre-operative color-duplex ultrasound and intra-operative evaluation

    Directory of Open Access Journals (Sweden)

    Attilio Cavezzi

    2013-01-01

    Full Text Available According to literature data, up to 59% of incompetent great saphenous veins (GSV have no reflux at the terminal valve (TV of the saphenofemoral junction (SFJ. The aim was to compare color duplex ultrasound (CDU investigation and direct intra-operative assessment of competence of the TV at SFJ. A prospective comparative study was performed on 28 patients, who consecutively presented for surgical intervention for their primary varicose veins of the lower limbs with GSV incompetence. CDU assessment was performed pre-operatively to define GSV and SFJ terminal valve morphology and hemodynamics. Under local anesthesia these patients underwent SFJ disconnection (crossectomy and segmental inverted saphenous stripping of the incompetent GSV tract + phlebectomy of the varicose tributaries. SFJ disconnection was performed in four stages in an ascending fashion: I division of GSV below the lower SFJ tributaries, II disconnection of lower SFJ tributaries, III disconnection of upper tributaries, IV flush to CFV ligature of GSV stump. After the completion of stage I, the SFJ stump was opened and kept open when needed throughout the subsequent stages, in order to highlight any possible blood leak through the SFJ stump. To highlight intraoperative blood leak from SFJ stump visual observation was carried out both during respiration and when performing Valsalva maneuver and manual compression of homolateral iliac fossa. As to pre-operative CDU all limbs showed GSV reflux and they were divided in two groups according to TV competence (group A or incompetence (group B. Group A comprised 18 patients (6 M and 12 F, mean age 50.6 years. Group B included 10 patients (4 M and 6 F, mean age 54.8 years. Mean calibre of GSV at proximal/mid thigh was 6.4 mm in group A and 7.8 in group B. Concerning the intra-operative findings: in the group A, 5 patients had blood leak in the SFJ stump after stage I, 4 patients showed blood leak after stage II. After completion of stage III

  18. Pulmonary dysfunction and surgical risk. How to assess and minimize the hazards.

    Science.gov (United States)

    Okeson, G C

    1983-11-01

    Postoperative deterioration of pulmonary function can be considerable, resulting in hypoxemia and atelectasis, if such effects are not anticipated and efforts made to prevent or minimize them. The risk of postoperative pulmonary complications depends on the patient's age, degree of obesity, and cigarette consumption; the type of surgery to be performed; and the anesthetic agent used. Assessment of risk is based primarily on clinical and laboratory evaluations. The tests performed may vary from patient to patient, and specialized studies of regional pulmonary function are frequently required. Even though a patient may be identified as having a high risk of postoperative pulmonary complications, risk can often be decreased through a number of preoperative and intraoperative measures as well as a postoperative therapeutic program.

  19. Fragility fracture: recent developments in risk assessment.

    Science.gov (United States)

    Aspray, Terry J

    2015-02-01

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

  20. Pre-operative use of anti-TNF-alpha agents and the risk of post-operative complications in patients with Crohn's disease--a nationwide cohort study

    DEFF Research Database (Denmark)

    Nørgård, Bente Mertz; Nielsen, J.; Qvist, N.

    2013-01-01

    BACKGROUND: A possible negative role of pre-operative use of antitumour necrosis factor-alpha (anti-TNF-alpha) agents on post-operative outcomes in Crohn's disease (CD) patients is still debated. AIM: To examine the impact of pre-operative anti-TNF-alpha agents on post-operative outcomes 30 and 6...

  1. Pre-operative use of anti-TNF-α agents and the risk of post-operative complications in patients with ulcerative colitis - a nationwide cohort study

    DEFF Research Database (Denmark)

    Nørgård, B M; Nielsen, J; Qvist, N;

    2012-01-01

    It is still controversial whether pre-operative anti-tumour necrosis factor-alpha (anti-TNF-α) agents increase post-operative complications in patients with ulcerative colitis (UC).......It is still controversial whether pre-operative anti-tumour necrosis factor-alpha (anti-TNF-α) agents increase post-operative complications in patients with ulcerative colitis (UC)....

  2. Model based risk assessment - the CORAS framework

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-04-15

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

  3. Benefit-Risk Assessment in Drug Development

    DEFF Research Database (Denmark)

    Sarac, Sinan

    This thesis covers the development, testing and use of an eight-step structured method for data-driven benefit-risk assessment. The aim of this thesis was to create a tailored method for the assessment of clinical data. The focus has been on three major aspects: (i) A simple preliminary method....... In total, four pilot studies and internal workshops were conducted. The method was therefore developed in an iterative fashion. The method involves eight successive steps: 1) establishment of the decision context, 2) identification of benefit and risk criteria, 3) weighting, 4) scoring, 5) evaluation...... and supported by a qualitative framework with built-in quantitative measures. However, at the same time the method is transparent in the sense that all assumptions made in the various steps of the assessment are clearly expressed all the way to the final decision. This is important both to avoid that unreported...

  4. Behavioral toxicology, risk assessment, and chlorinated hydrocarbons

    Energy Technology Data Exchange (ETDEWEB)

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

    1996-04-01

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

  5. Levels and occupational health risk assessment of trace metals in ...

    African Journals Online (AJOL)

    Levels and occupational health risk assessment of trace metals in soils from ... African Journal of Environmental Science and Technology ... The trace metal levels were subjected to risk assessment model to estimate toxic risks due to ...

  6. Risk assessment and risk scores in the management of aortic aneurysms.

    Science.gov (United States)

    Von Meijenfeldt, Gerdine C I; Van Der Laan, Maarten J; Zeebregts, Clark J; Balm, Ron; Verhagen, Hence J M

    2016-04-01

    The decision whether to operate a patient or not can be challenging for a clinician for both ruptured abdominal aortic aneurysms (AAAs) as well as elective AAAs. Prior to surgical intervention it would be preferable that the clinician exactly knows which clinical variables lower or increase the chances of morbidity and mortality postintervention. To help in the preoperative counselling and shared decision making several clinical variables can be identified as risk factors and with these, risk models can be developed. An ideal risk score for aneurysm repair includes routinely obtained physiological and anatomical variables, has excellent discrimination and calibration, and is validated in different geographical areas. For elective AAA repair, several risk scores are available, for ruptured AAA treatment, these scores are far less well developed. In this manuscript, we describe the designs and results of published risk scores for elective and open repair. Also, suggestions for uniformly reporting of risk factors and their statistical analyses are described. Furthermore, the preliminary results of a new risk model for ruptured aortic aneurysm will be discussed. This score identifies age, hemoglobin, cardiopulmonary resuscitation and preoperative systolic blood pressure as risk factors after multivariate regression analysis. This new risk score can help to identify patients that would not benefit from repair, but it can also potentially identify patients who would benefit and therefore lower turndown rates. The challenge for further research is to expand on validation of already existing promising risk scores in order to come to a risk model with optimal discrimination and calibration.

  7. Seismic Risk Assessment for the Kyrgyz Republic

    Science.gov (United States)

    Pittore, Massimiliano; Sousa, Luis; Grant, Damian; Fleming, Kevin; Parolai, Stefano; Fourniadis, Yannis; Free, Matthew; Moldobekov, Bolot; Takeuchi, Ko

    2017-04-01

    The Kyrgyz Republic is one of the most socially and economically dynamic countries in Central Asia, and one of the most endangered by earthquake hazard in the region. In order to support the government of the Kyrgyz Republic in the development of a country-level Disaster Risk Reduction strategy, a comprehensive seismic risk study has been developed with the support of the World Bank. As part of this project, state-of-the-art hazard, exposure and vulnerability models have been developed and combined into the assessment of direct physical and economic risk on residential, educational and transportation infrastructure. The seismic hazard has been modelled with three different approaches, in order to provide a comprehensive overview of the possible consequences. A probabilistic seismic hazard assessment (PSHA) approach has been used to quantitatively evaluate the distribution of expected ground shaking intensity, as constrained by the compiled earthquake catalogue and associated seismic source model. A set of specific seismic scenarios based on events generated from known fault systems have been also considered, in order to provide insight on the expected consequences in case of strong events in proximity of densely inhabited areas. Furthermore, long-span catalogues of events have been generated stochastically and employed in the probabilistic analysis of expected losses over the territory of the Kyrgyz Republic. Damage and risk estimates have been computed by using an exposure model recently developed for the country, combined with the assignment of suitable fragility/vulnerability models. The risk estimation has been carried out with spatial aggregation at the district (rayon) level. The obtained results confirm the high level of seismic risk throughout the country, also pinpointing the location of several risk hotspots, particularly in the southern districts, in correspondence with the Ferghana valley. The outcome of this project will further support the local

  8. Risk factors for cervical carotid and intracranial cerebrovascular lesions in patients undergoing coronary artery bypass grafting. Preoperative evaluation using magnetic resonance imaging and angiography

    Energy Technology Data Exchange (ETDEWEB)

    Makino, Masahiro [Kyoto Prefectural Univ. of Medicine (Japan). Research Inst. for Neurological Diseases and Geriatrics

    2001-12-01

    Recently neurologic complications after coronary artery bypass grafting (CABG) have received increasing attention. There is no detailed report about the risk factors for these complications, although stenosis in the cervical and intracranial arteries, especially in Japanese patients, latent ischemic brain lesions and preoperative neurological conditions are related to these events. In this prospective study, we evaluated occlusive lesions in the cervical carotid and intracranial arteries, silent brain infarction and cerebral deep white matter lesion with MRA and MRI in patients scheduled to undergo CABG to determine the prevalence of occlusive diseases in cervical carotid and intracranial arteries, latent ischemic change in the brain in this population and to identify preoperative risk factors for these patients. The subjects were 144 consecutive patients (103 men and 41 women, mean age 65.9{+-}9.2 years old) who were scheduled for CABG under elective conditions and who were examined by the same MRI apparatus using the same protocol between November 1998 and March 2001. After routine neurological examination and Mini-Mental State Examination (MMSE) were completed, MRI and MRA were obtained, then the prevalence of abnormalities on MRI and MRA studies and risk factors were evaluated. Cervical carotid artery stenosis with {>=}50% luminal narrowing was detected in 29.2% of the subjects, and that with {>=}75% luminal narrowing was detected in 16.0% of the subjects. Intracranial arterial stenosis showing {>=}50% luminal narrowing was detected in 38.2% of subjects, and that showing {>=}75% luminal narrowing was detected in 19.4% of subjects. Brain infarction was observed in 74.3% of subjects, cerebral deep white matter lesion showing grade 2 or higher on Fazekas classification was observed in 17.4% of the subjects. The characteristics, including possible risk factors of subjects with and without these abnormal findings, were compared. Patients with cervical carotid

  9. Asteroid Risk Assessment: A Probabilistic Approach.

    Science.gov (United States)

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

    2016-02-01

    Following the 2013 Chelyabinsk event, the risks posed by asteroids attracted renewed interest, from both the scientific and policy-making communities. It reminded the world that impacts from near-Earth objects (NEOs), while rare, have the potential to cause great damage to cities and populations. Point estimates of the risk (such as mean numbers of casualties) have been proposed, but because of the low-probability, high-consequence nature of asteroid impacts, these averages provide limited actionable information. While more work is needed to further refine its input distributions (e.g., NEO diameters), the probabilistic model presented in this article allows a more complete evaluation of the risk of NEO impacts because the results are distributions that cover the range of potential casualties. This model is based on a modularized simulation that uses probabilistic inputs to estimate probabilistic risk metrics, including those of rare asteroid impacts. Illustrative results of this analysis are presented for a period of 100 years. As part of this demonstration, we assess the effectiveness of civil defense measures in mitigating the risk of human casualties. We find that they are likely to be beneficial but not a panacea. We also compute the probability-but not the consequences-of an impact with global effects ("cataclysm"). We conclude that there is a continued need for NEO observation, and for analyses of the feasibility and risk-reduction effectiveness of space missions designed to deflect or destroy asteroids that threaten the Earth. © 2015 Society for Risk Analysis.

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

    Science.gov (United States)

    Calabrese, Edward J

    2015-04-01

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

  11. Quantitative Risk Assessment of Contact Sensitization

    DEFF Research Database (Denmark)

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

    2010-01-01

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

  12. Preoperative staging of perforated diverticulitis by computed tomography scanning

    NARCIS (Netherlands)

    M.P.M. Gielens; I.M. Mulder (Irene); E. van der Harst (Erwin); M.P. Gosselink (Martijn Pieter); K.J. Kraal; H.T. Teng; J.F. Lange (Johan); J. Vermeulen (Jefrey)

    2012-01-01

    textabstractBackground: Treatment of perforated diverticulitis depends on disease severity classified according to Hinchey's preoperative classification. This study assessed the accuracy of preoperative staging of perforated diverticulitis by computerized tomography (CT) scanning. Methods: All patie

  13. The Amsterdam Preoperative Anxiety and Information Scale (APAIS)

    National Research Council Canada - National Science Library

    Moerman, N; Dam, van, F.S.A.M; Muller, M.J; Oosting, H

    1996-01-01

    ... phase.During routine preoperative screening, 320 patients were asked to assess their anxiety and information requirement on a six-item questionnaire, the Amsterdam Preoperative Anxiety and Information Scale (APAIS...

  14. A toolbox for rockfall Quantitative Risk Assessment

    Science.gov (United States)

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

    2012-04-01

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

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

    Science.gov (United States)

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

    2008-11-15

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

  16. Flood risk assessment of land pollution hotspots

    Science.gov (United States)

    Masi, Matteo; Arrighi, Chiara; Iannelli, Renato

    2017-04-01

    Among the risks caused by extreme events, the potential spread of pollutants stored in land hotspots due to floods is an aspect that has been rarely examined with a risk-based approach. In this contribution, an attempt to estimate pollution risks related to flood events of land pollution hotspots was carried out. Flood risk has been defined as the combination of river flood hazard, hotspots exposure and vulnerability to contamination of the area, i.e. the expected severity of the environmental impacts. The assessment was performed on a geographical basis, using geo-referenced open data, available from databases of land management institutions, authorities and agencies. The list of land pollution hotspots included landfills and other waste handling facilities (e.g., temporary storage, treatment and recycling sites), municipal wastewater treatment plants, liquid waste treatment facilities and contaminated sites. The assessment was carried out by combining geo-referenced data of pollution hotspots with flood hazard maps. We derived maps of land pollution risk based on geographical and geological properties and source characteristics available from environmental authorities. These included information about soil particle size, soil hydraulic conductivity, terrain slope, type of stored pollutants, the type of facility, capacity, size of the area, land use, etc. The analysis was carried out at catchment scale. The case study of the Arno river basin in Tuscany (central Italy) is presented.

  17. Clinical risk assessment in intensive care unit

    Directory of Open Access Journals (Sweden)

    Saeed Asefzadeh

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Nara Somaratne

    2013-09-01

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

  19. Preoperative preparation of high-risk, specifically hyperimmunized canine renal allograft recipients with total-lymphoid irradiation and cyclosporine

    Energy Technology Data Exchange (ETDEWEB)

    Rapaport, F.T.; Meek, A.G.; Arnold, A.N.; Miura, S.; Hayashi, R.; Strober, S.

    1987-08-01

    Hyperimmunized subjects are a particularly high-risk and rapidly growing group in the patient population awaiting renal transplantation. In a search for methods designed to ameliorate the prognosis in such cases, dogs of defined DLA genotype were sensitized with DLA incompatible skin allografts and injections of buffy coat. Each recipient was challenged with a renal allograft bearing the same DLA incompatibilities. Five dogs received kidney transplants, without any other treatment, and rejected their transplants at 2.5, 4, 5, 6, and 6.5 days, respectively. Another four dogs were given a 9-11-week course (1760 +/- 35 cGy) of total-lymphoid irradiation (TLI), followed by rabbit antithymocyte globulin (ATG); these animals rejected their renal allografts at 7, 8, 14, and 17 days, respectively. Five other dogs were treated with TLI and received cyclosporine (CsA) and methylprednisolone (MPd) daily until graft rejection. Their renal allografts survived for 7.5, 8.5, 20, 62, and 227 days, respectively. Renal allografts placed in normal recipients under the same conditions of donor-recipient DLA incompatibility had a mean survival time of 12.4 days (range: 10-18 days). At the time of transplantation, the specific anti-DLA antibody titers in the recipients were 81 to 243 in the untreated dogs; 27 to 81 in the TLI-ATG-treated group, and 3 to 243 in the TLI-CsA/MPd-treated group. The titers fell within 24-48 hr after renal transplantation, to 3 to 81 in the untreated sensitized dogs; they were 3 to 9 in the TLI-ATG-treated group, and were 9 to 243 in the TLI-CsA/MPd treated group. The cytotoxic antibody titers reached postoperative peaks of 6500 to 200,000 in the untreated dogs; 729 to 6500 in the TLI-ATG-treated dogs, and 243 to 6500 in the TLI-CsA/MPd-treated recipients.

  20. Risk assessment of lymph node metastasis before surgery in endometrial cancer: do we need a clinical trial for low-risk patients?

    Science.gov (United States)

    Kang, Sokbom; Todo, Yukiharu; Watari, Hidemichi

    2014-02-01

    Due to advances of radiological imaging and tumor biomarkers, the extent of information provided by preoperative assessment is rapidly growing. The Korean Gynecologic Oncology Group (KGOG) recently proposed new preoperative criteria to identify patients at low risk for lymph node metastasis in endometrial cancer. In the multicenter study, serum carbohydrate antigen 125 levels and three magnetic resonance imaging parameters were found to be independent risk factors for nodal metastasis, and classified 53% of patients as part of a low-risk group. The false-negative predictive value (NPV) was 1.7%, and was 1.4% in the validation set. Furthermore, the KGOG low-risk criteria were validated in 319 Japanese patients with endometrial cancer. The criteria identified 181 of 319 patients as a low-risk group (51%), and three false-negative cases were found (1.9%). These results indicate that we are able to identify low-risk patients with a negligible NPV before surgery. In addition, the low false NPV implies that there is great difficulty in performing a randomized trial to determine the efficacy of routine lymphadenectomy in patients at low risk of lymph node metastasis. Based on these data, the challenges and possible solutions for developing a consensus on the optimized management of low-risk endometrial cancer will be discussed in this review. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Christian eKohl

    2015-08-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  4. [Risk assessment of genetically modified organisms].

    Science.gov (United States)

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

    2011-01-01

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

  5. Supplemental Hazard Analysis and Risk Assessment - Hydrotreater

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-04-01

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

  6. Probabilistic risk assessment of disassembly procedures

    Energy Technology Data Exchange (ETDEWEB)

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

    1993-11-01

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

  7. Risk assessment of topically applied products

    DEFF Research Database (Denmark)

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

    2007-01-01

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

  8. The Chornobyl accident: A comprehensive risk assessment

    Energy Technology Data Exchange (ETDEWEB)

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

    1999-10-01

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

  9. Risk assessment meta tool LDRD final report.

    Energy Technology Data Exchange (ETDEWEB)

    Bouchard, Ann Marie; Osbourn, Gordon Cecil

    2006-12-01

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

  10. Depression in primary care: assessing suicide risk

    Science.gov (United States)

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

    2017-01-01

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

  11. Risk assessment of tailings facility dam failure

    OpenAIRE

    Hadzi-Nikolova, Marija; Mirakovski, Dejan; Stefanova, Violeta

    2011-01-01

    This paper presents the consequences of tailings facility dam failure and therefore the needs for its risk assessment. Tailings are fine-grained wastes of the mining industry, output as slurries, due to mixing with water during mineral processing. Tailings dams vary a lot as it is affected by: tailings characteristics and mill output, site characteristics as: topography, hydrology, geology, groundwater, seismicity and available material and disposal methods. The talings which accumulat...

  12. Moving Forward in Human Cancer Risk Assessment

    OpenAIRE

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

    2010-01-01

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

  13. Gender, risk assessment, and political ambition.

    Science.gov (United States)

    Sweet-Cushman, Jennie

    2016-01-01

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

  14. Natural-technological risk assessment and management

    Science.gov (United States)

    Burova, Valentina; Frolova, Nina

    2016-04-01

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

  15. Selection of Dispersivity in Groundwater Risk Assessment

    Institute of Scientific and Technical Information of China (English)

    武晓峰; 唐杰

    2004-01-01

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

  16. Standardizing preoperative preparation to reduce surgical site infections among pediatric neurosurgical patients.

    Science.gov (United States)

    Schaffzin, Joshua K; Simon, Katherine; Connelly, Beverly L; Mangano, Francesco T

    2017-04-01

    OBJECTIVE Surgical site infections (SSIs) are costly to patients and the health care system. Pediatric neurosurgery SSI risk factors are not well defined. Intraoperative protocols have reduced, but have not eliminated, SSIs. The effect of preoperative intervention is unknown. Using quality improvement methods, a preoperative SSI prevention protocol for pediatric neurosurgical patients was implemented to assess its effect on SSI rate. METHODS Patients who underwent a scheduled neurosurgical procedure between January 2014 and December 2015 were included. Published evidence and provider consensus were used to guide preoperative protocol development. The Model for Improvement was used to test interventions. Intraoperative and postoperative management was not standardized or modified systematically. Staff, family, and overall adherence was measured as all-or-nothing. In addition, SSI rates among eligible procedures were measured before and after protocol implementation. RESULTS Within 4 months, overall protocol adherence increased from 51.3% to a sustained 85.7%. SSI rates decreased from 2.9 per 100 procedures preintervention to 0.62 infections postintervention (p = 0.003). An approximate 79% reduction in SSI risk was identified (risk ratio 0.21, 95% CI 0.08-0.56; p = 0.001). CONCLUSIONS Clinical staff and families successfully collaborated on a standardized preoperative protocol for pediatric neurosurgical patients. Standardization of the preoperative phase of care alone reduced SSI rates. Attention to the preoperative in addition to the intraoperative and postoperative phases of care may lead to further reduction in SSI rates.

  17. Weighted normalized risk factor for floods risk assessment

    Directory of Open Access Journals (Sweden)

    Ashraf Mohamed Elmoustafa

    2012-12-01

    Full Text Available Multi Criteria Analysis (MCA describes any structured approach used to determine overall preferences among alternative options, where options accomplish certain or several objectives. The flood protection of properties is a highly important issue due to the damage, danger and other hazards associated to it to human life, properties, and environment. To determine the priority of execution of protection works for any project, many aspects should be considered in order to decide the areas to start the data collection and analysis with. Multi criteria analysis techniques were tested and evaluated for the purpose of flood risk assessment, hydro-morphological parameters were used in this analysis. Finally a suitable technique was chosen and tested to be adopted as a mark of flood risk level and results were presented.

  18. Endocrine disrupting pesticides: implications for risk assessment.

    Science.gov (United States)

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

    2008-02-01

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

  19. ECOLOGICAL RISK ASSESSMENT IN THE REGULATED WATERCOURSES

    Directory of Open Access Journals (Sweden)

    Elżbieta Bondar-Nowakowska

    2015-11-01

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

  20. Assessment of a Standardized Pre-Operative Telephone Checklist Designed to Avoid Late Cancellation of Ambulatory Surgery: The AMBUPROG Multicenter Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Sonia Gaucher

    Full Text Available To assess the impact of a standardized pre-operative telephone checklist on the rate of late cancellations of ambulatory surgery (AMBUPROG trial.Multicenter, two-arm, parallel-group, open-label randomized controlled trial.11 university hospital ambulatory surgery units in Paris, France.Patients scheduled for ambulatory surgery and able to be reached by telephone.A 7-item checklist designed to prevent late cancellation, available in five languages and two versions (for children and adults, was administered between 7 and 3 days before the planned date of surgery, by an automated phone system or a research assistant. The control group received standard management alone.Rate of cancellation on the day of surgery or the day before.The study population comprised 3900 patients enrolled between November 2012 and September 2013: 1950 patients were randomized to the checklist arm and 1950 patients to the control arm. The checklist was administered to 68.8% of patients in the intervention arm, 1002 by the automated phone system and 340 by a research assistant. The rate of late cancellation did not differ significantly between the checklist and control arms (109 (5.6% vs. 113 (5.8%, adjusted odds ratio [95% confidence interval] = 0.91 [0.65-1.29], (p = 0.57. Checklist administration revealed that 355 patients (28.0% had not undergone tests ordered by the surgeon or anesthetist, and that 254 patients (20.0% still had questions concerning the fasting state.A standardized pre-operative telephone checklist did not avoid late cancellations of ambulatory surgery but enabled us to identify several frequent causes.ClinicalTrials.gov NCT01732159.

  1. Assessment of a Standardized Pre-Operative Telephone Checklist Designed to Avoid Late Cancellation of Ambulatory Surgery: The AMBUPROG Multicenter Randomized Controlled Trial

    Science.gov (United States)

    Marchand-Maillet, Florence; Baron, Gabriel; Douard, Richard; Béthoux, Jean-Pierre

    2016-01-01

    Objectives To assess the impact of a standardized pre-operative telephone checklist on the rate of late cancellations of ambulatory surgery (AMBUPROG trial). Design Multicenter, two-arm, parallel-group, open-label randomized controlled trial. Setting 11 university hospital ambulatory surgery units in Paris, France. Participants Patients scheduled for ambulatory surgery and able to be reached by telephone. Intervention A 7-item checklist designed to prevent late cancellation, available in five languages and two versions (for children and adults), was administered between 7 and 3 days before the planned date of surgery, by an automated phone system or a research assistant. The control group received standard management alone. Main Outcome Measures Rate of cancellation on the day of surgery or the day before. Results The study population comprised 3900 patients enrolled between November 2012 and September 2013: 1950 patients were randomized to the checklist arm and 1950 patients to the control arm. The checklist was administered to 68.8% of patients in the intervention arm, 1002 by the automated phone system and 340 by a research assistant. The rate of late cancellation did not differ significantly between the checklist and control arms (109 (5.6%) vs. 113 (5.8%), adjusted odds ratio [95% confidence interval] = 0.91 [0.65–1.29], (p = 0.57)). Checklist administration revealed that 355 patients (28.0%) had not undergone tests ordered by the surgeon or anesthetist, and that 254 patients (20.0%) still had questions concerning the fasting state. Conclusions A standardized pre-operative telephone checklist did not avoid late cancellations of ambulatory surgery but enabled us to identify several frequent causes. Trial Registration ClinicalTrials.gov NCT01732159 PMID:26829478

  2. 77 FR 26292 - Risk Evaluation and Mitigation Strategy Assessments: Social Science Methodologies to Assess Goals...

    Science.gov (United States)

    2012-05-03

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

  3. Screening Models for Cardiac Risk Evaluation in Emergency Abdominal Surgery. I. Evaluation of the Intraoperative Period Risk based on Data from the Preoperative Period

    Directory of Open Access Journals (Sweden)

    Mikhail Matveev

    2008-04-01

    Full Text Available A classification of intraoperative cardio-vascular complications (CVC was performed, based on data from 466 patients subjected to emergency surgery, due to severe abdominal surgical diseases or traumas, in accordance with the severe criteria of ACC/AHA for CVC in noncardiac surgery. There were 370 intraoperative CVC registered, distributed as follows: groups with low risk (148, moderate risk (200, and high risk (22. Patient groups were formed, according to the CVC risk level, during the intraoperative period, for which the determinant factor for the group distribution of patients was the complication with the highest risk. Individual data was collected for each patient, based on 65 indices: age, physical status, diseases, surgical interventions, anaesthesiological information, intra and postoperative cardio-vascular complications, disease outcome, causes of death, cardiovascular disease anamnesis, anamnesis of all other nonsurgical diseases present, laboratory results, results from all imaging and instrumental examinations, etc. On the basis of these indices, a new distribution of the risk factors was implemented, into groups with different levels of risk of CVC during intraoperative period. This result is a solid argument, substantiating the proposal to introduce these adjustments for determining the severity of CVC in the specific conditions of emergency abdominal surgery.

  4. Relationship Between Preoperative Anemia and In-Hospital Mortality in Children Undergoing Noncardiac Surgery.

    Science.gov (United States)

    Faraoni, David; DiNardo, James A; Goobie, Susan M

    2016-12-01

    The relationship between preoperative anemia and in-hospital mortality has not been investigated in the pediatric surgical population. We hypothesized that children with preoperative anemia undergoing noncardiac surgery may have an increased risk of in-hospital mortality. We identified all children between 1 and 18 years of age with a recorded preoperative hematocrit (HCT) in the 2012, 2013, and 2014 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) pediatric databases. The endpoint was defined as the incidence of in-hospital mortality. Children with preoperative anemia were identified based on their preoperative HCT. Demographic and surgical characteristics, as well as comorbidities, were considered potential confounding variables in a multivariable logistic regression analysis. A sensitivity analysis was performed using propensity-matched analysis. Among the 183,833 children included in the 2012, 2013, and 2014 ACS NSQIP database, 74,508 had a preoperative HCT recorded (41%). After exclusion of all children children were anemic, and 39,071 (76%) were nonanemic. The median preoperative HCT was 33% (interquartile range, 31-35) in anemic children, and 39% (interquartile range, 37-42) in nonanemic children (P anemia was associated with higher odds for in-hospital mortality (OR, 2.17; 95% CI, 1.48-3.19; P anemia was also associated with higher odds of in-hospital mortality (OR, 1.75; 95% CI, 1.15-2.65; P = .004). Our study demonstrates that children with preoperative anemia are at increased risk for in-hospital mortality. Further studies are needed to assess whether the correction of preoperative HCT, through the development of a patient blood management program, improves patient outcomes or simply reduces the need for transfusions.

  5. Risk assessment methodology for the forniture industrial sector

    OpenAIRE

    Rodrigues, Matilde A.

    2014-01-01

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

  6. Visual Impairment/Intracranial Pressure Risk Assessment

    Science.gov (United States)

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

    2010-01-01

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

  7. Influence of Preoperative Peripheral Parenteral Nutrition with Micronutrients after Colorectal Cancer Patients

    Science.gov (United States)

    Tang, Hsiu-Chih; Hu, Shu-Hui; Yang, Hui-Lan

    2015-01-01

    Background. The inflammatory reactions are stronger after surgery of malnourished preoperative patients. Many studies have shown vitamin and trace element deficiencies appear to affect the functioning of immune cells. Enteral nutrition is often inadequate for malnourished patients. Therefore, total parenteral nutrition (TPN) is considered an effective method for providing preoperative nutritional support. TPN needs a central vein catheter, and there are more risks associated with TPN. However, peripheral parenteral nutrition (PPN) often does not provide enough energy or nutrients. Purpose. This study investigated the inflammatory response and prognosis for patients receiving a modified form of PPN with added fat emulsion infusion, multiple vitamins (MTV), and trace elements (TE) to assess the feasibility of preoperative nutritional support. Methods. A cross-sectional design was used to compare the influence of PPN with or without adding MTV and TE on malnourished abdominal surgery patients. Results. Both preoperative groups received equal calories and protein, but due to the lack of micronutrients, patients in preoperative Group B exhibited higher inflammation, lower serum albumin levels, and higher anastomotic leak rates and also required prolonged hospital stays. Conclusion. Malnourished patients who receive micronutrient supplementation preoperatively have lower postoperative inflammatory responses and better prognoses. PPN with added fat emulsion, MTV, and TE provides valid and effective preoperative nutritional support. PMID:26000296

  8. Risk-Based Assessment of Structural Robustness

    Directory of Open Access Journals (Sweden)

    Oana-Mihaela Ioniţă

    2010-01-01

    Full Text Available Providing safety of structures is one of the main aims of design. In traditional design it is achieved by designing structural components against specified limit states. However, as showed the Ronan Point collapse in UK in 1968, when a gas explosion in one of flats on the 18-th floor of the residential building caused the failure of an entire section of the building, this approach is not sufficient. The approach does not exclude the risk of local damage to a structure due to accidental events that can occur during service life of the structure. While probability of occurrence of such events for ordinary structures is low, and, therefore, they are not considered explicitly in design, their effect on structural safety becomes significant if the structure is not robust, that is when some local damage can trigger a chain reaction of failures causing collapse of the whole structure or of a major part of it, the so called progressive collapse. The purpose of this paper is to outline the basic premises for the utilization of risk assessment in evaluating the robustness of structures. In the following the robustness assessment is understood as a process of decision making based on risks.

  9. Risk assessment of poultry sloughterhouses in Albania

    Directory of Open Access Journals (Sweden)

    ROVENA JAHELEZI

    2014-06-01

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

  10. Spent Nuclear Fuel Alternative Technology Risk Assessment

    Energy Technology Data Exchange (ETDEWEB)

    Perella, V.F.

    1999-11-29

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

  11. Environmental risk assessment in GMO analysis.

    Science.gov (United States)

    Pirondini, Andrea; Marmiroli, Nelson

    2010-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Salman MD

    2001-03-01

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

  13. Anxiety in preoperative anesthetic procedures.

    Science.gov (United States)

    Valenzuela Millán, Jaquelyn; Barrera Serrano, José René; Ornelas Aguirre, José Manuel

    2010-01-01

    Preoperative anxiety is a common and poorly evaluated condition in patients who will undergo an anesthetic and surgical intervention. The objective of this study was to determine the prevalence of anxiety in a group of patients undergoing elective surgery, as assessed by the Amsterdam Anxiety Preoperative and Information (AAPI) scale. We studied 135 patients scheduled for elective surgery applying the AAPI scale 24 h before the surgical procedure to evaluate the presence of anxiety and patient characteristics. A descriptive analysis with mean +/- standard deviation for categorical variables was done. For intragroup differences, chi(2) test was used. Pearson correlation for the association between anxiety and postoperative complications was carried out. A value of p =0.05 was considered significant. One hundred six patients were surgically treated, 88% were female (average age 44 +/- 12 years). Some degree of preoperative anxiety was present in 72 patients (76%; p = 0.001) with a grade point average on the AAPI scale equal to 17 +/- 7 points, of which 95 (70%, OR = 5.08; p = 0.002) were females. Results of this study suggest the presence of high levels of preoperative anxiety in patients scheduled for elective surgery. The origin of the anxiety appears to be related to many factors that can be evaluated in pre-anesthetic consultation. Further study is needed to prevent the presence of this disorder.

  14. Harmonization of international risk assessment protocol

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-07-01

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

  15. Risk Assessment in Advanced Engineering Design

    Directory of Open Access Journals (Sweden)

    M. Holický

    2003-01-01

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

  16. Flood risk assessment: concepts, modelling, applications

    Directory of Open Access Journals (Sweden)

    G. Tsakiris

    2014-01-01

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

  17. Risk assessment of soybean-based phytoestrogens.

    Science.gov (United States)

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

    2009-01-01

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

  18. Technical Overview of Ecological Risk Assessment - Analysis Phase: Exposure Characterization

    Science.gov (United States)

    Exposure Characterization is the second major component of the analysis phase of a risk assessment. For a pesticide risk assessment, the exposure characterization describes the potential or actual contact of a pesticide with a plant, animal, or media.

  19. 77 FR 28406 - Spent Fuel Transportation Risk Assessment

    Science.gov (United States)

    2012-05-14

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

  20. Reduction in pulmonary complications in high risk patients undergoing surgery for total hip replacement under general anesthesia by preoperative intensive inspiratory muscle training:A randomized controlled clinical trial

    Institute of Scientific and Technical Information of China (English)

    Bingqiang Ma; Hongguang Bao

    2009-01-01

    Objective: To evaluate the effects of preoperative inspiratory muscle training (IMT) on the incidence of atelectasis in patients at high risk of postoperative pulmonary complications scheduled for elective total hip replacement surgery under general anesthesia. Methods: Thirty two high-risk paticnts undergoing elective total hip replacement surgery under general anesthesia were chosen from Nanjing Medical University, Affiliated Nanjing First Hospital. In this single-blind randomized controlled clinical trial, patients were randomly assigned to receive preoperative inspiratory muscle training or conventional treatment (CT). The major effectiveness outcome variables were atelectasis and duration of postoperative hospitalization. Results: Both groups were comparable prior to surgery. Seven patients in the CT group and 3 in the IMT group developed atelectasis (P = 0.25). Median duration of postoperative hospitalization was 13 days (range, 10~17 days) in the IMT group versus 16 days (range, 11~23 days) in the CT group (Mann-Whitney U statistics, Z =-2.22, P = 0.03). Mean postoperative inspiratory pressure was 5% higher in the IMT group. Conclusion: Preoperative intensive inspiratory muscle training appears to reduce the incidence of atelectasis and duration of postoperative hospitalization in patients at high risk of developing postoperative pulmonary complications who were scheduled for elective total hip replacement surgery under general anesthesia.

  1. Lipid and Some Other Cardiovascular Risk Factors Assessment in a ...

    African Journals Online (AJOL)

    Lipid and Some Other Cardiovascular Risk Factors Assessment in a Rural ... of modifiable cardiovascular risk factors (cardiovascular diseases [CVDs]) in ... and risk predictive index were higher in females while triglyceride (TG), high density ...

  2. Preliminary report on hepatic and cardiovascular risk assessment of ...

    African Journals Online (AJOL)

    Preliminary report on hepatic and cardiovascular risk assessment of ... The triglyceride level, artherogenic and coronary risk index of the mechanics was higher ... risk, mechanics, lipid profile, cardiovascular disease, liver dysfunction, benzene.

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

    CERN Document Server

    Li, Wenyuan

    2014-01-01

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

  4. Risk Assessment tailored to cryogenics - LINDE approach

    CERN Document Server

    CERN. Geneva

    2016-01-01

    The following Risk Assessment Tools will be presented: **HAZID – Hazard Identification Study** Application: if the process contains new applications or provides new challenges (e.g. plant location) Purpose: Identify hazards such as fire/explosion, toxic impact, occupational hazards etc. and assess adequate preventive / mitigation measures **HAZOP – Hazard and Operability Study** Application: for all Projects Purpose: Detailed review of design reflected in the PID to ensure that adequate safeguards are available for all possible process upsets or maloperations. **HAZAN – Hazard Analysis** Application: for all PFHE (plate-fin heat exchangers), CWHE (coil wound heat exchangers) and straight tube sheet heat exchangers Purpose: detailed analysis of the impact of process upset conditions and start-up / shut down scenarios on the lifetime of the heat exchangers – including definition of additional safeguards, if required. **TQR – Technology Qualification Review** Application: for applications...

  5. Diffusion-Weighted Magnetic Resonance Imaging of Endometrial Cancer: Differentiation from Benign Endometrial Lesions and Preoperative Assessment of Myometrial Invasion

    Energy Technology Data Exchange (ETDEWEB)

    Takeuchi, M.; Matsuzaki, K.; Nishitani, H. (Dept. of Radiology, Univ. of Tokushima, Tokushima (Japan))

    2009-10-15

    Background: Uterine endometrial cancer is the most common gynecologic malignancy, and benign endometrial hyperplasia or polyps should be differentiated from endometrial cancer. In evaluating endometrial cancer on magnetic resonance imaging (MRI), the assessment of the depth of myometrial invasion is important because it closely correlates with the patient's prognosis. Purpose: To verify the feasibility of diffusion-weighted magnetic resonance imaging (DWI) to distinguish benign and malignant endometrial lesions, and to evaluate myometrial invasion of endometrial cancer. Material and Methods: Sixty-seven endometrial lesions including 45 cancers and 22 benign lesions (hyperplasia and polyps) were evaluated by DWI with apparent diffusion coefficient (ADC) measurement. The staging accuracies of DWI and gadolinium-enhanced T1-weighted images in the assessment of myometrial invasion were evaluated in 33 patients with endometrial cancer. Results: The ADC values (x10-3 mm2/s) in cancer and benign lesions were 0.84+-0.19 and 1.58+-0.36, respectively (P<0.01). The staging accuracy (superficial or deep myometrial invasion) was 94% for DWI and 88% for gadolinium-enhanced T1-weighted images. Coexisting adenomyosis and infiltrative myometrial invasion caused staging errors on gadolinium-enhanced T1-weighted images, whereas DWI could demonstrate the tumor extent correctly. Conclusion: DWI provides helpful information in evaluating benign and malignant endometrial lesions.

  6. 78 FR 23901 - Interagency Risk Assessment-Listeria monocytogenes

    Science.gov (United States)

    2013-04-23

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

  7. Laboratory Biosafety and Biosecurity Risk Assessment Technical Guidance Document

    Energy Technology Data Exchange (ETDEWEB)

    Astuto-Gribble, Lisa M; Caskey, Susan Adele

    2014-07-01

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

  8. 75 FR 70009 - Development of Health Risk Assessment Guidance

    Science.gov (United States)

    2010-11-16

    ... HUMAN SERVICES Centers for Disease Control and Prevention Development of Health Risk Assessment Guidance... guidance concerning Health Risk Assessment (HRAs). Section 4103 of the Affordable Care Act (ACA) (Pub. L. 111-148) requires that a health risk assessment be included in the annual wellness visit benefit...

  9. Assessing risk factors for periodontitis using regression

    Science.gov (United States)

    Lobo Pereira, J. A.; Ferreira, Maria Cristina; Oliveira, Teresa

    2013-10-01

    Multivariate statistical analysis is indispensable to assess the associations and interactions between different factors and the risk of periodontitis. Among others, regression analysis is a statistical technique widely used in healthcare to investigate and model the relationship between variables. In our work we study the impact of socio-demographic, medical and behavioral factors on periodontal health. Using regression, linear and logistic models, we can assess the relevance, as risk factors for periodontitis disease, of the following independent variables (IVs): Age, Gender, Diabetic Status, Education, Smoking status and Plaque Index. The multiple linear regression analysis model was built to evaluate the influence of IVs on mean Attachment Loss (AL). Thus, the regression coefficients along with respective p-values will be obtained as well as the respective p-values from the significance tests. The classification of a case (individual) adopted in the logistic model was the extent of the destruction of periodontal tissues defined by an Attachment Loss greater than or equal to 4 mm in 25% (AL≥4mm/≥25%) of sites surveyed. The association measures include the Odds Ratios together with the correspondent 95% confidence intervals.

  10. Risk Assessment Model for Mobile Malware

    Directory of Open Access Journals (Sweden)

    George Stanescu

    2015-03-01

    Full Text Available The mobile technology is considered to be the fastest-developing IT security area. Only in the last year security threats around mobile devices have reached new heights in terms of both quality and quantity. The speed of this development has made possible several types of security attacks that, until recently, were only possible on computers. In terms of the most targeted mobile operating systems, Android continues to be the most vulnerable, although new ways of strengthening its security model were introduced by Google. The aim of this article is to provide a model for assessing the risk of mobile infection with malware, starting from a statistical analysis of the permissions required by each application installed into the mobile system. The software implementation of this model will use the Android operating system and in order to do so, we will start by analyzing its permission-based security architecture. Furthermore, based on statistical data regarding the most dangerous permissions, we build the risk assessment model and, to prove its efficiency, we scan some of the most popular apps and interpret the results. To this end, we offer an overview of the strengths and weaknesses of this permission-based model and we also state a short conclusion regarding model’s efficiency.

  11. Contrast-enhanced Reformatted MR Images for Preoperative Assessment of the Bridging Veins of the Skull Base.

    Science.gov (United States)

    Wangaryattawanich, Pattana; Chavali, Lakshmi S; Shah, Komal B; Gogia, Bhanu; Valenzuela, Raul F; DeMonte, Franco; Kumar, Ashok J; Hayman, L Anne

    2016-01-01

    Magnetic resonance (MR) venography and computed tomographic (CT) venography are suited for displaying the convexity veins that drain the medial and lateral surfaces of the brain hemispheres. However, such is not the case for the bridging veins of the skull base. Technical factors prevent contrast material-enhanced MR or CT images obtained in standard axial, coronal, and sagittal planes from fully displaying the curved pathways of these clinically important venous structures. This limitation can be overcome by using a reconstruction technique that depicts these venous structures and their interconnections. Curved and multiplanar reformatted images that distill the important venous features often require knowledgeable manipulation of source images by an operator who is familiar with numerous venous variants and their surgical implications. The normal anatomy of the draining veins is detailed-anatomy that radiologists must master before they can show the surgeon the important venous anatomy that is often missing at standard imaging; this information will foster better communication between radiologists and their surgical colleagues. As a practical matter, the skull base veins are arbitrarily subdivided into those that are at greatest risk with the pterional approach and the subtemporal approach, respectively. These approaches can be expanded to define connections between the superficial venous system and the other valveless venous networks that drain the deep portions of the cerebral hemisphere, the scalp, face, muscles of the neck, diploë of the skull, and meninges. As radiologists gain experience, their image interpretations should mature beyond simple analysis of the primary hemodynamic changes induced by intraoperative sacrifice or injury.

  12. Physical characterization of MMVF for risk assessment.

    Science.gov (United States)

    Schneider, T

    1995-10-01

    Size and other physical properties of MMVF play a central role in risk assessment. They can be affected by, for example, conditions during manufacturing, and preparation prior to administration to experimental animals or cells. It is suggested that a necessary requirement for stating that an experiment has been repeated should be documented evidence that: (i) the administered fibres are alike when analysed with not less than a minimum number of well-established methods on single fibre and on bulk sample level; and (ii) doses must be equal, and the fibre concentrations and sizes at the primary target tissue must be documented. Assessment of fibre toxicity and assessment of potential for exposure are equally important in the risk assessment process. The physics of fibrous dust release is described and methods for a priori assessment of exposure are classified into three levels depending on the analytical effort involved: (1) direct analysis of the fibrous bulk material; (2) bench-scale test; and (3) full-scale tests of prefabricated insulation material in a test room during standardized insulation work. For the first method, two approaches are investigated. One relates the size-dependent measures (the mass of fibres with D fractions (the fraction of total fibre length with D fraction of WHO fibre number, and the fraction of fibre number with D fractions only range up to 2 orders of magnitude and are almost independent on GSD(D) for nominal diameters ranging 2-4 microns. The combined effect on exposure of bulk fibre size, and of addition of oil and binder, should be assessed by the rotating drum dustiness test. The gold standard test of prefabricated MMVF products should be a full-scale simulation. The slope of the curve relating overall average product nominal diameter and airborne fibre concentrations on a log-log scale [Esmen et al., Am. ind. Hyg. Ass.J. 40, 108-117 (1979)] has been confirmed on a qualitative basis using model calculations, so that this relation

  13. Applying a weed risk assessment approach to GM crops.

    Science.gov (United States)

    Keese, Paul K; Robold, Andrea V; Myers, Ruth C; Weisman, Sarah; Smith, Joe

    2014-12-01

    Current approaches to environmental risk assessment of genetically modified (GM) plants are modelled on chemical risk assessment methods, which have a strong focus on toxicity. There are additional types of harms posed by plants that have been extensively studied by weed scientists and incorporated into weed risk assessment methods. Weed risk assessment uses robust, validated methods that are widely applied to regulatory decision-making about potentially problematic plants. They are designed to encompass a broad variety of plant forms and traits in different environments, and can provide reliable conclusions even with limited data. The knowledge and experience that underpin weed risk assessment can be harnessed for environmental risk assessment of GM plants. A case study illustrates the application of the Australian post-border weed risk assessment approach to a representative GM plant. This approach is a valuable tool to identify potential risks from GM plants.

  14. Maximum standardized uptake value on PET/CT in preoperative assessment of lymph node metastasis from thoracic esophageal squamous cell carcinoma

    Institute of Scientific and Technical Information of China (English)

    Amos JM Ela Bella; Ya-Rui Zhang; Wei Fan; Kong-Jia Luo; Tie-Hua Rong; Peng Lin; Hong Yang; Jian-Hua Fu

    2014-01-01

    The presence of lymph node metastasis is an important prognostic factor for patients with esophageal cancer. Accurate assessment of lymph nodes in thoracic esophageal carcinoma is essential for selecting appropriate treatment and forecasting disease progression. Positron emission tomography combined with computed tomography (PET/CT) is becoming an important tool in the workup of esophageal carcinoma. Here, we evaluated the effectiveness of the maximum standardized uptake value (SUVmax) in assessing lymph node metastasis in esophageal squamous cell carcinoma (ESCC) prior to surgery. Fifty-nine surgical patients with pathologically confirmed thoracic ESCC were retrospectively studied. These patients underwent radical esophagectomy with pathologic evaluation of lymph nodes. They al had 18F-FDG PET/CT scans in their preoperative staging procedures. None had a prior history of cancer. The pathologic status and PET/CT SUVmax of lymph nodes were col ected to calculate the receiver operating characteristic (ROC) curve and to determine the best cutoff value of the PET/CT SUVmax to distinguish benign from malignant lymph nodes. Lymph node data from 27 others were used for the validation. A total of 323 lymph nodes including 39 metastatic lymph nodes were evaluated in the training cohort, and 117 lymph nodes including 32 metastatic lymph nodes were evaluated in the validation cohort. The cutoff point of the SUVmax for lymph nodes was 4.1, as calculated by ROC curve (sensitivity, 80%; specificity, 92%;accuracy, 90%). When this cutoff value was applied to the validation cohort, a sensitivity, a specificity, and an accuracy of 81%, 88%, and 86%, respectively, were obtained. These results suggest that the SUVmax of lymph nodes predicts malignancy. Indeed, when an SUVmax of 4.1 was used instead of 2.5, FDG-PET/CT was more accurate in assessing nodal metastasis.

  15. Endometrial cancer--current state of the art therapies and unmet clinical needs: the role of surgery and preoperative radiographic assessment.

    Science.gov (United States)

    Hunn, Jessica; Dodson, Mark K; Webb, Joel; Soisson, Andrew P

    2009-08-10

    Endometrial carcinoma is the fourth most common cancer among women in the United States. Surgical pathologic staging has been the standard of care since 1988, which consists of analysis of collected peritoneal fluid, hysterectomy/oophorectomy, and pelvic and para-aortic lymphadenectomy. In 2005, it was further recommended that essentially all women with endometrial cancer who choose to undergo surgery have pelvic and para-aortic lymph node analysis. Despite this recommendation, there still remains controversy as to whether all patients with endometrial cancer should undergo full lymph node dissection. In this review, we assess the evidence surrounding this controversy and conclude that women with endometrial cancer should undergo complete lymphadenectomy at the time of surgery. Furthermore, we evaluate the evidence regarding laparoscopic surgical staging as a safe and effective alternative to the more invasive traditional laparotomy. Finally, for those patients who a gynecologic oncologist is not readily available to perform a complete lymph node dissection, we evaluate the various imaging studies and their utility as preoperative triage modalities.

  16. A classification scheme for risk assessment methods.

    Energy Technology Data Exchange (ETDEWEB)

    Stamp, Jason Edwin; Campbell, Philip LaRoche

    2004-08-01

    This report presents a classification scheme for risk assessment methods. This scheme, like all classification schemes, provides meaning by imposing a structure that identifies relationships. Our scheme is based on two orthogonal aspects--level of detail, and approach. The resulting structure is shown in Table 1 and is explained in the body of the report. Each cell in the Table represent a different arrangement of strengths and weaknesses. Those arrangements shift gradually as one moves through the table, each cell optimal for a particular situation. The intention of this report is to enable informed use of the methods so that a method chosen is optimal for a situation given. This report imposes structure on the set of risk assessment methods in order to reveal their relationships and thus optimize their usage.We present a two-dimensional structure in the form of a matrix, using three abstraction levels for the rows and three approaches for the columns. For each of the nine cells in the matrix we identify the method type by name and example. The matrix helps the user understand: (1) what to expect from a given method, (2) how it relates to other methods, and (3) how best to use it. Each cell in the matrix represent a different arrangement of strengths and weaknesses. Those arrangements shift gradually as one moves through the table, each cell optimal for a particular situation. The intention of this report is to enable informed use of the methods so that a method chosen is optimal for a situation given. The matrix, with type names in the cells, is introduced in Table 2 on page 13 below. Unless otherwise stated we use the word 'method' in this report to refer to a 'risk assessment method', though often times we use the full phrase. The use of the terms 'risk assessment' and 'risk management' are close enough that we do not attempt to distinguish them in this report. The remainder of this report is organized as follows. In

  17. Assessing the Invasion Risk of Eucalyptus in the United States Using the Australian Weed Risk Assessment

    Directory of Open Access Journals (Sweden)

    Doria R. Gordon

    2012-01-01

    Full Text Available Many agricultural species have undergone selection for traits that are consistent with those that increase the probability that a species will become invasive. However, the risk of invasion may be accurately predicted for the majority of plant species tested using the Australian Weed Risk Assessment (WRA. This system has been tested in multiple climates and geographies and, on average, correctly identifies 90% of the major plant invaders as having high invasion risk, and 70% of the noninvaders as having low risk. We used this tool to evaluate the invasion risk of 38 Eucalyptus taxa currently being tested and cultivated in the USA for pulp, biofuel, and other purposes. We predict 15 taxa to have low risk of invasion, 14 taxa to have high risk, and 9 taxa to require further information. In addition to a history of naturalization and invasiveness elsewhere, the traits that significantly contribute to a high invasion risk conclusion include having prolific seed production and a short generation time. Selection against these traits should reduce the probability that eucalypts cultivated in the USA will become invasive threats to natural areas and agricultural systems.

  18. Assessment and insurance risk of foreign economic activity: accounting aspect

    Directory of Open Access Journals (Sweden)

    S.V. Susyuk

    2015-06-01

    Full Text Available Based on research approaches to risk positioning grounded classification of risks arising in foreign trade activity. Deals with issues of assessment and insurance risks expediency display your losses from them. To reduce the negative impact of risks the theoretical foundations of security and practical advice with his reflection in the system of accounts. Grounded algorithm to select the most suitable method of risk assessment and constructed flowchart automation choice method for assessing the risk of foreign trade. The expediency of development of self-insurance risks of foreign economic activity.

  19. Food allergy and risk assessment: Current status and future directions

    Science.gov (United States)

    Remington, Benjamin C.

    2017-09-01

    Risk analysis is a three part, interactive process that consists of a scientific risk assessment, a risk management strategy and an exchange of information through risk communication. Quantitative risk assessment methodologies are now available and widely used for assessing risks regarding the unintentional consumption of major, regulated allergens but new or modified proteins can also pose a risk of de-novo sensitization. The risks due to de-novo sensitization to new food allergies are harder to quantify. There is a need for a systematic, comprehensive battery of tests and assessment strategy to identify and characterise de-novo sensitization to new proteins and the risks associated with them. A risk assessment must be attuned to answer the risk management questions and needs. Consequently, the hazard and risk assessment methods applied and the desired information are determined by the requested outcome for risk management purposes and decisions to be made. The COST Action network (ImpARAS, www.imparas.eu) has recently started to discuss these risk management criteria from first principles and will continue with the broader subject of improving strategies for allergen risk assessment throughout 2016-2018/9.

  20. Risk factors and prognosis for 894 cases of esophageal neoplasm patients with preoperative nutritional risk%894例食管癌术前营养风险危险因素分析与预后

    Institute of Scientific and Technical Information of China (English)

    汤敏; 潘琪; 吴俊伟; 田希贵; 刘德森

    2015-01-01

    Objective To provide the reference basis for reducing the occurrence of nutritional risk by analyzing possible risk factors for nutritional risk status and investigating the relationship between preoperative nutritional risk status and prognosis.Methods We retrospectively analyzed the clinical data of 894 patients(nutritional risk group of 491 cases,non-nutritional risk group of 403 cases) with esophageal cancer resection.The univariate analysis was used to analyze the relationships between nutritional risk status with postoperative complications and length of hospitalization.And the multiple Logistic regression model analysis was applied to analyze the risk factors of nutritional risk status.Results The nutritional risk group had a higher rate of postoperative complications (33.60 % vs.19.60 %,U =-3.429,P =0.001),higher incidence of serious complications (23.01% vs.8.68%,U =-3.611,P =0.000) and longer hospital stays [(37.20 ± 13.89) days vs.(31.69 ± 13.49) days,t =4.124,P =0.000] than that of non-nutritional risk group.The results of the multiple logistic regression analysis showed that the preoperative nutritional risk factors were associated with the patients' age (OR =1.58,95% CI:1.101-2.268),number of symptoms entries(OR =7.97,95 % CI:6.071-10.463),symptom severity (OR =0.26,95% CI:0.186 -0.385),and dietary intake (OR =0.62,95 % CI:0.482-0.813),P < 0.05 for all.Conclusion The older patients with more severe symptoms and poor diet are more likely to suffer from nutritional risk.Prolonged hospital stay and postoperative complications easily happen in patients with nutritional risk.So patients with preoperative nutritional risk should be given timely and effective nutrition intervention measures,in order to reduce postoperative complications and length of hospitalization.%目的 探讨食管癌患者术前营养风险状况与预后的关系,分析营养风险的危险因素.方法 回顾性分析894例食管癌切除患者的临床资料.根

  1. Fine Needle Aspiration and Medullary Thyroid Carcinoma: The Risk of Inadequate Preoperative Evaluation and Initial Surgery When Relying Upon FNAB Cytology Alone

    NARCIS (Netherlands)

    Essig, G.F.; Porter, K.; Schneider, D.; Debora, A.; Lindsey, S.C.; Busonero, G.; Fineberg, D.; Fruci, B.; Boelaert, K.; Smit, J.W.A.; Meijer, J.A.M.; Duntas, L.; Sharma, N.; Costante, G.; Filetti, S.; Sippel, R.S.; Biondi, B.; Topliss, D.J.; Pacini, F.; Maciel, R.M.; Walz, P.C.; Kloos, R.T.

    2013-01-01

    Objectives: To evaluate the diagnostic accuracy of fine-needle aspiration biopsy (FNAB) to preoperatively diagnose medullary thyroid cancer (MTC) among multiple international centers and evaluate how the cytological diagnosis alone could impact patient management.Methods: We performed a retrospectiv

  2. [Regional atmospheric environment risk source identification and assessment].

    Science.gov (United States)

    Zhang, Xiao-Chun; Chen, Wei-Ping; Ma, Chun; Zhan, Shui-Fen; Jiao, Wen-Tao

    2012-12-01

    Identification and assessment for atmospheric environment risk source plays an important role in regional atmospheric risk assessment and regional atmospheric pollution prevention and control. The likelihood exposure and consequence assessment method (LEC method) and the Delphi method were employed to build a fast and effective method for identification and assessment of regional atmospheric environment risk sources. This method was applied to the case study of a large coal transportation port in North China. The assessment results showed that the risk characteristics and the harm degree of regional atmospheric environment risk source were in line with the actual situation. Fast and effective identification and assessment of risk source has laid an important foundation for the regional atmospheric environmental risk assessment and regional atmospheric pollution prevention and control.

  3. Ecological risk assessment conceptual model formulation for nonindigenous species.

    Science.gov (United States)

    Landis, Wayne G

    2004-08-01

    This article addresses the application of ecological risk assessment at the regional scale to the prediction of impacts due to invasive or nonindigenous species (NIS). The first section describes risk assessment, the decision-making process, and introduces regional risk assessment. A general conceptual model for the risk assessment of NIS is then presented based upon the regional risk assessment approach. Two diverse examples of the application of this approach are presented. The first example is based upon the dynamics of introduced plasmids into bacteria populations. The second example is the application risk assessment approach to the invasion of a coastal marine site of Cherry Point, Washington, USA by the European green crab. The lessons learned from the two examples demonstrate that assessment of the risks of invasion of NIS will have to incorporate not only the characteristics of the invasive species, but also the other stresses and impacts affecting the region of interest.

  4. Ecological Risk Assessment of Genetically Modified Higher Plants (GMHP)

    DEFF Research Database (Denmark)

    Kjær, C.; Damgaard, C.; Kjellsson, G.

    of the project Biotechnology: elements in environmental risk assessment of genetically modified plants. December 1999 Christian Kjær Introduction In ecological risk assessment of transgenic plants, information on a wide range of subjects is needed for an effective and reliable assessment procedure...... the actual risk assessment procedures and the risk evaluation, which must proceed the data collection. The report use the terminology ecological risk assessment rather than environmental risk assessment because at present this work does not include bio-geochemical effects and environmental impacts from...... for uncertainties in the extrapolation from limited laboratory studies to the species rich field environment. The relationship between the size of the safety factor and the number of species is therefore an issue of the risk assessment. Some of the issues raised in this report overlap with data needs...

  5. Radiological risk assessment of environmental radon

    Science.gov (United States)

    Khalid, Norafatin; Majid, Amran Ab; Yahaya, Redzuwan; Yasir, Muhammad Samudi

    2013-11-01

    Measurements of radon gas (222Rn) in the environmental are important to assess indoor air quality and to study the potential risk to human health. Generally known that exposure to radon is considered the second leading cause of lung cancer after smoking. The environmental radon concentration depends on the 226Ra concentration, indoor atmosphere, cracking on rocks and building materials. This study was carried out to determine the indoor radon concentration from selected samples of tin tailings (amang) and building materials in an airtight sealed homemade radon chamber. The radiological risk assessment for radon gas was also calculated based on the annual exposure dose, effective dose equivalent, radon exhalation rates and fatal cancer risk. The continuous radon monitor Sun Nuclear model 1029 was used to measure the radon concentration emanates from selected samples for 96 hours. Five types of tin tailings collected from Kampar, Perak and four samples of building materials commonly used in Malaysia dwellings or building constructions were analysed for radon concentration. The indoor radon concentration determined in ilmenite, monazite, struverite, xenotime and zircon samples varies from 219.6 ± 76.8 Bq m-3 to 571.1 ± 251.4 Bq m-3, 101.0 ± 41.0 Bq m-3 to 245.3 ± 100.2 Bq m-3, 53.1 ± 7.5 Bq m-3 to 181.8 ± 9.7 Bq m-3, 256.1 ± 59.3 Bq m-3 to 652.2 ± 222.2 Bq m-3 and 164.5 ± 75.9 Bq m-3 to 653.3 ± 240.0 Bq m-3, respectively. Whereas, in the building materials, the radon concentration from cement brick, red-clay brick, gravel aggregate and cement showed 396.3 ± 194.3 Bq m-3, 192.1 ± 75.4 Bq m-3, 176.1 ± 85.9 Bq m-3 and 28.4 ± 5.7 Bq m-3, respectively. The radon concentration in tin tailings and building materials were found to be much higher in xenotime and cement brick samples than others. All samples in tin tailings were exceeded the action level for radon gas of 148 Bq m-3 proposed by EPA except monazite 0.15 kg, struverite 0.15 kg and 0.25 kg. Whereas

  6. Way forward: Geriatric frailty assessment as risk predictor in gastric cancer surgery

    Institute of Scientific and Technical Information of China (English)

    Juul; JW; Tegels; Jan; HMB; Stoot

    2015-01-01

    In gastric cancer patients chronological and biological age might vary greatly between patients. Age as well as American Society of Anaesthesiologists-physical status classifications are very non-specific and do not adequately predict adverse outcome. Improvements have been made such as the introduction of Charlson Comorbidity Index. Geriatric frailty is probably a better measure for patients resistance to stressors and physiological reserves. An increasing amount of evidence shows that geriatric frailty is a better predictor for adverse outcome after surgery, including gastric cancer surgery. Geriatric frailty can be assessed in a number of ways. Questionnaires such as the Groningen Frailty Indicator provide an ease and low cost method for gauging the presence of frailty in gastric cancer patients. This can then be used to provide a better preoperative risk assessment in these patients and improve decision making.

  7. DETERMINANTS OF RISK ASSESSMENT PROCESS IN CRITICAL ENERGY INFRASTRUCTURE

    OpenAIRE

    Przemysław Borkowski

    2016-01-01

    Article deals with the problem of risk assessment in critical energy infrastructure. Firstly the critical infrastructure in energy sector is discussed than risk identification methodology for application to critical infrastructure is proposed. Specific conditions resulting from features of critical infrastructure are addressed in the context of risk assessment procedure. The limits of such a procedure are outlined and critical factors influencing different stages of risk assessment process a...

  8. DETERMINANTS OF RISK ASSESSMENT PROCESS IN CRITICAL ENERGY INFRASTRUCTURE

    Directory of Open Access Journals (Sweden)

    Przemysław Borkowski

    2016-06-01

    Full Text Available Article deals with the problem of risk assessment in critical energy infrastructure. Firstly the critical infrastructure in energy sector is discussed than risk identification methodology for application to critical infrastructure is proposed. Specific conditions resulting from features of critical infrastructure are addressed in the context of risk assessment procedure. The limits of such a procedure are outlined and critical factors influencing different stages of risk assessment process are researched in view of specificity of the sector.

  9. Comparative Assessment Of Natural Gas Accident Risks

    Energy Technology Data Exchange (ETDEWEB)

    Burgherr, P.; Hirschberg, S

    2005-01-01

    The study utilizes a hierarchical approach including (1) comparative analyses of different energy chains, (2) specific evaluations for the natural gas chain, and (3) a detailed overview of the German situation, based on an extensive data set provided by Deutsche Vereinigung des Gas- und Wasserfaches (DVGW). According to SVGW-expertise DVGW-data can be regarded as fully representative for Swiss conditions due to very similar technologies, management, regulations and safety culture, but has a substantially stronger statistical basis because the German gas grid is about 30 times larger compared to Switzerland. Specifically, the following tasks were carried out by PSI to accomplish the objectives of this project: (1) Consolidation of existing ENSAD data, (2) identification and evaluation of additional sources, (3) comparative assessment of accident risks, and (4) detailed evaluations of specific issues and technical aspects for severe and smaller accidents in the natural gas chain that are relevant under Swiss conditions. (author)

  10. Assessing the Environmental Risks of Nanomaterials

    DEFF Research Database (Denmark)

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

    Assessing the environmental risks of engineered nanomaterials (NM) is currently an intensely contested subject among scientists, organizations, governments, and policymakers. The shear number, variety, and market penetration of NM in consumer goods and other applications, including environmental...... to a wide range of technical limitations. For instance, serious knowledge gaps remain within e.g. the detection of NM in the environment, developing adequate testing equipment and protocols, and toxicity endpoints (Grieger et al., 2009). In the past few years, many scientists and organizations have...... of uncertainty, degree of precaution, inclusion of quantitative or qualitative data, inclusion of life-cycle perspective, iterative and/or adaptive, ensuring timely decision making, and degree of transparency. This analysis can ultimately assist scientists, government agencies, organizations, and other...

  11. Performing Probabilistic Risk Assessment Through RAVEN

    Energy Technology Data Exchange (ETDEWEB)

    A. Alfonsi; C. Rabiti; D. Mandelli; J. Cogliati; R. Kinoshita

    2013-06-01

    The Reactor Analysis and Virtual control ENviroment (RAVEN) code is a software tool that acts as the control logic driver and post-processing engine for the newly developed Thermal-Hydraulic code RELAP-7. RAVEN is now a multi-purpose Probabilistic Risk Assessment (PRA) software framework that allows dispatching different functionalities: Derive and actuate the control logic required to simulate the plant control system and operator actions (guided procedures), allowing on-line monitoring/controlling in the Phase Space Perform both Monte-Carlo sampling of random distributed events and Dynamic Event Tree based analysis Facilitate the input/output handling through a Graphical User Interface (GUI) and a post-processing data mining module

  12. Miniature Biosensor with Health Risk Assessment Feedback

    Science.gov (United States)

    Hanson, Andrea; Downs, Meghan; Kalogera, Kent; Buxton, Roxanne; Cooper, Tommy; Cooper, Alan; Cooper, Ross

    2016-01-01

    Heart rate (HR) monitoring is a medical requirement during exercise on the International Space Station (ISS), fitness tests, and extravehicular activity (EVA); however, NASA does not currently have the technology to consistently and accurately monitor HR and other physiological data during these activities. Performance of currently available HR monitor technologies is dependent on uninterrupted contact with the torso and are prone to data drop-out and motion artifact. Here, we seek an alternative to the chest strap and electrode based sensors currently in use on ISS today. This project aims to develop a high performance, robust earbud based biosensor with focused efforts on improved HR data quality during exercise or EVA. A health risk assessment algorithm will further advance the goals of autonomous crew health care for exploration missions.

  13. Risk-Assessment for Equipment Operating on the Lunar Surface

    Science.gov (United States)

    Richmond, R. C.; Kusiak, A.; Ramachandran, N.

    2008-01-01

    Particle-size distribution of lunar dust simulant is evaluated using scanning electron spectroscopy in order to consider approaches to evaluating risk to individual mechanical components operating on the lunar surface. Assessing component risk and risk-mitigation during actual operations will require noninvasive continuous data gathering on numerous parameters. Those data sets would best be evaluated using data-mining algorithms to assess risk, and recovery from risk, of individual mechanical components in real-time.

  14. Inhalation cancer risk assessment of cobalt metal.

    Science.gov (United States)

    Suh, Mina; Thompson, Chad M; Brorby, Gregory P; Mittal, Liz; Proctor, Deborah M

    2016-08-01

    Cobalt compounds (metal, salts, hard metals, oxides, and alloys) are used widely in various industrial, medical and military applications. Chronic inhalation exposure to cobalt metal and cobalt sulfate has caused lung cancer in rats and mice, as well as systemic tumors in rats. Cobalt compounds are listed as probable or possible human carcinogens by some agencies, and there is a need for quantitative cancer toxicity criteria. The U.S. Environmental Protection Agency has derived a provisional inhalation unit risk (IUR) of 0.009 per μg/m(3) based on a chronic inhalation study of soluble cobalt sulfate heptahydrate; however, a recent 2-year cancer bioassay affords the opportunity to derive IURs specifically for cobalt metal. The mechanistic data support that the carcinogenic mode of action (MOA) is likely to involve oxidative stress, and thus, non-linear/threshold mechanisms. However, the lack of a detailed MOA and use of high, toxic exposure concentrations in the bioassay (≥1.25 mg/m(3)) preclude derivation of a reference concentration (RfC) protective of cancer. Several analyses resulted in an IUR of 0.003 per μg/m(3) for cobalt metal, which is ∼3-fold less potent than the provisional IUR. Future research should focus on establishing the exposure-response for key precursor events to improve cobalt metal risk assessment.

  15. Coenoses risk assessment in industry (resource specificity

    Directory of Open Access Journals (Sweden)

    Tyaglov Sergey, G.

    2015-09-01

    Full Text Available The modernization of the economic infrastructure of modern Russia is now essential, taking a natural limiter necessary momentum, which is especially important in the current conditions of global trends and taking into account the efforts taken by the State, aimed at large-scale growth of production of Russian companies. This paper discusses the direction of overcoming the problem of lack of access to financial services to business entities, due to the lack of a universal tool to identify risks in the provision of credit resources to the understanding that, despite the differences in interpretation of Russian and foreign sources, is a complex of ontological perception of researchers, proposed expanded by generally accepted phenomenon of self-organization. It is proposed to assess the risks of the enterprises on the basis of the provisions of coenoses theory, which allows using a few key parameters to determine the degree of efficiency of use of available resources, to identify the stability of the enterprise as a system and predict its dynamic changes.

  16. [Preoperative preparation, antibiotic prophylaxis and surgical wound infection in breast surgery].

    Science.gov (United States)

    Rodríguez-Caravaca, Gil; de las Casas-Cámara, Gonzalo; Pita-López, María José; Robustillo-Rodela, Ana; Díaz-Agero, Cristina; Monge-Jodrá, Vicente; Fereres, José

    2011-01-01

    The impact of surgical wound infection on public health justifies its surveillance and prevention. Our objectives were to estimate the incidence of surgical wound infection in breast procedures and assess its protocol of antibiotic prophylaxis and preoperative preparation. Observational multicentre prospective cohort study of incidence of surgical wound infection. Incidence was evaluated, stratified by National Nosocomial Infection Surveillance (NNIS) risk index and we calculated the standardized incidence ratio (SIR). The SIR was compared with Spanish rates and U.S. rates. The compliance and performance of the antibiotic prophylaxis and preoperative preparation protocol were assessed and their influence in the incidence of infection with the relative risk. Ten hospitals from the Comunidad de Madrid were included, providing 592 procedures. The cumulative incidence of surgical wound infection was 3.89% (95% CI: 2.3-5.5). The SIR was 1.82 on the Spanish rate and 2.16 on the American. Antibiotic prophylaxis was applied in 97.81% of cases, when indicated. The overall performance of antibiotic prophylaxis was 75%, and 53% for preoperative preparation. No association was found between infection and performance of prophylaxis or preoperative preparation (P>.05). Our incidence is within those seen in the literature although it is somewhat higher than the national surveillance programs. The performance of prophylaxis antibiotic must be improved, as well as the recording of preoperative preparation data. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  17. Preoperative optimization of the vascular surgery patient

    Directory of Open Access Journals (Sweden)

    Zhan HT

    2015-07-01

    Full Text Available Henry T Zhan,1 Seth T Purcell,1,2 Ruth L Bush1 1Texas A&M Health Science Center College of Medicine, Bryan, 2Baylor Scott and White, Temple, TX, USA Abstract: It is well known that patients who suffer from peripheral (noncardiac vascular disease often have coexisting atherosclerotic diseases of the heart. This may leave the patients susceptible to major adverse cardiac events, including death, myocardial infarction, unstable angina, and pulmonary edema, during the perioperative time period, in addition to the many other complications they may sustain as they undergo vascular surgery procedures, regardless of whether the procedure is performed as an open or endovascular modality. As these patients are at particularly high risk, up to 16% in published studies, for postoperative cardiac complications, many proposals and algorithms for perioperative optimization have been suggested and studied in the literature. Moreover, in patients with recent coronary stents, the risk of noncardiac surgery on adverse cardiac events is incremental in the first 6 months following stent implantation. Just as postoperative management of patients is vital to the outcome of a patient, preoperative assessment and optimization may reduce, and possibly completely alleviate, the risks of major postoperative complications, as well as assist in the decision-making process regarding the appropriate surgical and anesthetic management. This review article addresses several tools and therapies that treating physicians may employ to medically optimize a patient before they undergo noncardiac vascular surgery. Keywords: perioperative care, intraoperative care, medical management, risk evaluation/stratification, medical treatment

  18. A Successful ED Fall Risk Program Using the KINDER 1 Fall RiskAssessment Tool.

    Science.gov (United States)

    Townsend, Ann B; Valle-Ortiz, Marisol; Sansweet, Tracy

    2016-11-01

    Emergency nurses did not perform falls risk assessments routinely on our ED patients; the instrument used was aimed at inpatients. We identified a need to revise fall assessment practices specific to our emergency department. The purpose of the performance improvement project was to reduce ED falls and evaluate the use of an ED-specific fall risk tool, the KINDER 1 Fall Risk Assessment. The plan was to establish fall risk assessment practices at point of ED entry and to decrease total falls.

  19. Risk, surprises and black swans fundamental ideas and concepts in risk assessment and risk management

    CERN Document Server

    Aven, Terje

    2014-01-01

    Risk, Surprises and Black Swans provides an in depth analysis of the risk concept with a focus on the critical link to knowledge; and the lack of knowledge, that risk and probability judgements are based on.Based on technical scientific research, this book presents a new perspective to help you understand how to assess and manage surprising, extreme events, known as 'Black Swans'. This approach looks beyond the traditional probability-based principles to offer a broader insight into the important aspects of uncertain events and in doing so explores the ways to manage them.

  20. Conceptual risk assessment framework for global change risk analysis SRP

    CSIR Research Space (South Africa)

    Elphinstone, CD

    2007-12-01

    Full Text Available This report is submitted as a deliverable of the SRP project Global Change Risk Analysis which aims at applying risk analysis as a unifying notion for quantifying and communicating threats to ecosystem services originating from global change...

  1. Periodontal risk assessment, diagnosis and treatment planning.

    Science.gov (United States)

    Pihlstrom, B L

    2001-01-01

    The prevention and treatment of the periodontal diseases is based on accurate diagnosis, reduction or elimination of causative agents, risk management and correction of the harmful effects of disease. Prominent and confirmed risk factors or risk predictors for periodontitis in adults include smoking, diabetes, race, P. gingivalis, P. intermedia, low education, infrequent dental attendance and genetic influences. Several other specific periodontal bacteria, herpesviruses, increased age, male, sex, depression, race, traumatic occlusion and female osteoporosis in the presence of heavy dental calculus have been shown to be associated with loss of periodontal support and can be considered to be risk indicators of periodontitis. The presence of furcation involvement, tooth mobility, and a parafunctional habit without the use of a biteguard are associated with a poorer periodontal prognosis following periodontal therapy. An accurate diagnosis can only be made by a thorough evaluation of data that have been systematically collected by: 1) patient interview, 2) medical consultation as indicated, 3) clinical periodontal examination, 4) radiographic examination, and 5) laboratory tests as needed. Clinical signs of periodontal disease such as pocket depth, loss of clinical attachment and bone loss are cumulative measures of past disease. They do not provide the dentist with a current assessment of disease activity. In an attempt to improve the ability to predict future disease progression, several types of diagnostic tests have been studied, including host inflammatory products and mediators, enzymes, tissue breakdown products and subgingival temperature. In general, the usefulness of these tests for predicting future disease activity remains to be established in terms of sensitivity, specificity and predictive value. Although microbiological analysis of subgingival plaque is not necessary to diagnose and treat most patients with periodontitis, it is helpful when treating

  2. Gasbuggy Site Assessment and Risk Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    None

    2011-03-01

    contaminant exposure scenario, drilling of natural gas wells near the site. The results of this risk evaluation will guide DOE's future surveillance and monitoring activities in the area to ensure that site conditions are adequately protective of human health. This evaluation is not a comprehensive risk assessment for the site; it is intended to provide assurance that DOE's monitoring approach can detect the presence of site-related contamination at levels well below those that would pose an unacceptable risk to human health.

  3. [Management of coronary artery disease in diabetic patients with lower limb critical ischaemia: assessment of operational risk, drug therapy and indications for interventions].

    Science.gov (United States)

    Dedov, I I; Kalashnikov, V Iu; Terekhin, S A; Melkozerov, K V

    2012-01-01

    Despite obvious progress in management of diabetes mellitus, the DM-related complications rate remains inadmissibly high. Macroangiopathy is known to rank first amongst complications of diabetes mellitus, and coronary artery disease remains to be the major cause of death. Analysed herein are peculiarities of the clinical course in diabetic patients presenting with coronary artery disease and lower limb critical ischaemia, followed by discussing the issues concerning drug therapy, preoperative examination, and methods of diagnosis in this cohort of patients prior to vascular operations, assessment of the preoperative risk, indications for coronarography and myocardial revascularization. Also presented are the results of the main clinical trials dedicated to preoperative myocardial revascularization, including those in diabetic patients with limb critical ischaemia, and finally highlighting current importance of optimizing approaches to managing and working out algorithms of treatment policy for diabetic patients with a combination of coronary artery disease, diabetes mellitus, and critical limb ischaemia.

  4. Comparative Risk Assessment to Inform Adaptation Priorities for the Natural Environment: Observations from the First UK Climate Change Risk Assessment

    OpenAIRE

    Iain Brown

    2015-01-01

    Risk assessment can potentially provide an objective framework to synthesise and prioritise climate change risks to inform adaptation policy. However, there are significant challenges in the application of comparative risk assessment procedures to climate change, particularly for the natural environment. These challenges are evaluated with particular reference to the first statutory Climate Change Risk Assessment (CCRA) and evidence review procedures used to guide policy for the UK government...

  5. Assessing and managing multiple risks in a changing world ...

    Science.gov (United States)

    Roskilde University (Denmark) hosted a November 2015 workshop, Environmental Risk—Assessing and Managing Multiple Risks in a Changing World. This Focus article presents the consensus recommendations of 30 attendees from 9 countries regarding implementation of a common currency (ecosystem services) for holistic environmental risk assessment and management; improvements to risk assessment and management in a complex, human-modified, and changing world; appropriate development of protection goals in a 2-stage process; dealing with societal issues; risk-management information needs; conducting risk assessment of risk management; and development of adaptive and flexible regulatory systems. The authors encourage both cross-disciplinary and interdisciplinary approaches to address their 10 recommendations: 1) adopt ecosystem services as a common currency for risk assessment and management; 2) consider cumulative stressors (chemical and nonchemical) and determine which dominate to best manage and restore ecosystem services; 3) fully integrate risk managers and communities of interest into the risk-assessment process; 4) fully integrate risk assessors and communities of interest into the risk-management process; 5) consider socioeconomics and increased transparency in both risk assessment and risk management; 6) recognize the ethical rights of humans and ecosystems to an adequate level of protection; 7) determine relevant reference conditions and the proper ecological c

  6. Development and evolution of risk assessment for food allergens

    NARCIS (Netherlands)

    Crevel, R.W.R.; Baumert, J.L.; Baka, A.; Houben, G.F.; Knulst, A.C.; Kruizinga, A.G.; Luccioli, S.; Taylor, S.L.; Madsen, C.B.

    2014-01-01

    The need to assess the risk from food allergens derives directly from the need to manage effectively this food safety hazard. Work spanning the last two decades dispelled the initial thinking that food allergens were so unique that the risk they posed was not amenable to established risk assessment

  7. Critical notes on microbiological risk assessment of food

    NARCIS (Netherlands)

    Reij, M.W.; Schothorst, van M.

    2000-01-01

    Although numerous papers on Microbiological Risk Assessment (MRA) of food products have been published, a number of issues related to it remain unresolved. This paper explains the role of Microbiological Risk Assessment in the context of Risk Analysis as outlined by Codex Alimentarius. It reviews so

  8. 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.

  9. Guidance on the environmental risk assessment of plant pests

    DEFF Research Database (Denmark)

    Baker, R.; Candresse, T.; Dormannsne Simon, E.

    2011-01-01

    the environmental risks of plant pests that have previously been used in pest risk assessment. The limitations identified by the review led the Panel to define the new methodology for environmental risk assessment which is described in this guidance document. The guidance is primarily addressed to the EFSA PLH...

  10. Risk assessment and toxicology databases for health effects assessment

    Energy Technology Data Exchange (ETDEWEB)

    Lu, P.Y.; Wassom, J.S. [Oak Ridge National Laboratory, TN (United States)

    1990-12-31

    Scientific and technological developments bring unprecedented stress to our environment. Society has to predict the results of potential health risks from technologically based actions that may have serious, far-reaching consequences. The potential for error in making such predictions or assessment is great and multiplies with the increasing size and complexity of the problem being studied. Because of this, the availability and use of reliable data is the key to any successful forecasting effort. Scientific research and development generate new data and information. Much of the scientific data being produced daily is stored in computers for subsequent analysis. This situation provides both an invaluable resource and an enormous challenge. With large amounts of government funds being devoted to health and environmental research programs and with maintenance of our living environment at stake, we must make maximum use of the resulting data to forecast and avert catastrophic effects. Along with the readily available. The most efficient means of obtaining the data necessary for assessing the health effects of chemicals is to utilize applications include the toxicology databases and information files developed at ORNL. To make most efficient use of the data/information that has already been prepared, attention and resources should be directed toward projects that meticulously evaluate the available data/information and create specialized peer-reviewed value-added databases. Such projects include the National Library of Medicine`s Hazardous Substances Data Bank, and the U.S. Air Force Installation Restoration Toxicology Guide. These and similar value-added toxicology databases were developed at ORNL and are being maintained and updated. These databases and supporting information files, as well as some data evaluation techniques are discussed in this paper with special focus on how they are used to assess potential health effects of environmental agents. 19 refs., 5 tabs.

  11. Risk assessment in winter backcountry travel.

    Science.gov (United States)

    Silverton, Natalie A; McIntosh, Scott E; Kim, Han S

    2009-01-01

    Risk assessment is an important part of safe backcountry travel in avalanche terrain. The purpose of this study was to determine and compare the ability of backcountry travelers to accurately estimate the avalanche danger for their destination and time of travel. We surveyed 353 winter backcountry users, asking them to rate the avalanche danger for their destination that day. We then compared this estimation to the Utah Avalanche Center daily advisory for that specific location, aspect, and elevation. Tendency to underestimate the avalanche danger was then compared across 6 different sports (backcountry skiing, backco