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Sample records for prognostic risk assessment

  1. Assessing calibration of prognostic risk scores.

    Science.gov (United States)

    Crowson, Cynthia S; Atkinson, Elizabeth J; Therneau, Terry M

    2016-08-01

    Current methods used to assess calibration are limited, particularly in the assessment of prognostic models. Methods for testing and visualizing calibration (e.g. the Hosmer-Lemeshow test and calibration slope) have been well thought out in the binary regression setting. However, extension of these methods to Cox models is less well known and could be improved. We describe a model-based framework for the assessment of calibration in the binary setting that provides natural extensions to the survival data setting. We show that Poisson regression models can be used to easily assess calibration in prognostic models. In addition, we show that a calibration test suggested for use in survival data has poor performance. Finally, we apply these methods to the problem of external validation of a risk score developed for the general population when assessed in a special patient population (i.e. patients with particular comorbidities, such as rheumatoid arthritis). © The Author(s) 2013.

  2. Improving online risk assessment with equipment prognostics and health monitoring

    Energy Technology Data Exchange (ETDEWEB)

    Coble, Jamie B.; Liu, Xiaotong; Briere, Chris; Ramuhalli, Pradeep

    2016-03-26

    The current approach to evaluating the risk of nuclear power plant (NPP) operation relies on static probabilities of component failure, which are based on industry experience with the existing fleet of nominally similar light water reactors (LWRs). As the nuclear industry looks to advanced reactor designs that feature non-light water coolants (e.g., liquid metal, high temperature gas, molten salt), this operating history is not available. Many advanced reactor designs use advanced components, such as electromagnetic pumps, that have not been used in the US commercial nuclear fleet. Given the lack of rich operating experience, we cannot accurately estimate the evolving probability of failure for basic components to populate the fault trees and event trees that typically comprise probabilistic risk assessment (PRA) models. Online equipment prognostics and health management (PHM) technologies can bridge this gap to estimate the failure probabilities for components under operation. The enhanced risk monitor (ERM) incorporates equipment condition assessment into the existing PRA and risk monitor framework to provide accurate and timely estimates of operational risk.

  3. Molecular Classification Substitutes for the Prognostic Variables Stage, Age, and MYCN Status in Neuroblastoma Risk Assessment

    Directory of Open Access Journals (Sweden)

    Carolina Rosswog

    2017-12-01

    Full Text Available BACKGROUND: Current risk stratification systems for neuroblastoma patients consider clinical, histopathological, and genetic variables, and additional prognostic markers have been proposed in recent years. We here sought to select highly informative covariates in a multistep strategy based on consecutive Cox regression models, resulting in a risk score that integrates hazard ratios of prognostic variables. METHODS: A cohort of 695 neuroblastoma patients was divided into a discovery set (n = 75 for multigene predictor generation, a training set (n = 411 for risk score development, and a validation set (n = 209. Relevant prognostic variables were identified by stepwise multivariable L1-penalized least absolute shrinkage and selection operator (LASSO Cox regression, followed by backward selection in multivariable Cox regression, and then integrated into a novel risk score. RESULTS: The variables stage, age, MYCN status, and two multigene predictors, NB-th24 and NB-th44, were selected as independent prognostic markers by LASSO Cox regression analysis. Following backward selection, only the multigene predictors were retained in the final model. Integration of these classifiers in a risk scoring system distinguished three patient subgroups that differed substantially in their outcome. The scoring system discriminated patients with diverging outcome in the validation cohort (5-year event-free survival, 84.9 ± 3.4 vs 63.6 ± 14.5 vs 31.0 ± 5.4; P < .001, and its prognostic value was validated by multivariable analysis. CONCLUSION: We here propose a translational strategy for developing risk assessment systems based on hazard ratios of relevant prognostic variables. Our final neuroblastoma risk score comprised two multigene predictors only, supporting the notion that molecular properties of the tumor cells strongly impact clinical courses of neuroblastoma patients.

  4. Prognostic impact of nutritional risk assessment in patients with chronic schizophrenia.

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    Tsai, Ming-Tsun; Chang, Tien-Hao; Wu, Bo-Jian

    2017-04-22

    Protein-energy wasting is associated with poor outcome in various clinical settings. However, the prevalence of malnutrition and the prognostic impact of nutritional status are poorly understood in institutionalized patients with chronic schizophrenia. This study aimed to assess the predictive ability of the Geriatric Nutritional Risk Index and Onodera's Prognostic Nutritional Index for long-term outcomes in patients with chronic schizophrenia. All measurements, including nutritional scores, were performed at baseline after the enrollment of 542 (64.6% men, mean age 53.8±9.7years) patients with chronic schizophrenia. The median follow-up period was 408days. The endpoints were falls and infection-related hospitalizations. At study completion, 34 patients suffered falls and 40 patients were admitted to hospitals due to infection. Both indices showed significant association with infectious complications, whereas only the Onodera's Prognostic Nutritional Index was significantly associated with falls. The adjusted hazard ratios (95% confidence intervals) of low Onodera's Prognostic Nutritional Index were 2.38 (1.16-4.86) for falls and 1.99 (1.05-3.76) for infectious complications. The Onodera's Prognostic Nutritional Index is more appropriate than the Geriatric Nutritional Risk Index in identifying patients with chronic schizophrenia who are at risk for malnutrition and nutrition-related morbidity. Further studies are needed to explore whether early detection of patients with schizophrenia who are at risk for malnutrition could lead to the reduction of morbidity and mortality with the aid of appropriate interventions. Copyright © 2016 Elsevier B.V. All rights reserved.

  5. Metabolic Acidosis Assessment in High-Risk Surgeries: Prognostic Importance.

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    Silva, João Manoel; Ribas Rosa de Oliveira, Amanda Maria; Mendes Nogueira, Fernando Augusto; Vianna, Pedro M M; Amendola, Cristina Prata; Carvalho Carmona, Maria José; Sá Malbouisson, Luiz M

    2016-11-01

    Metabolic acidosis frequently is present in surgical patients; however, different types of metabolic acidosis (hyperlactatemia, hyperchloremia, and others) may have different relationships to perioperative outcomes. We hypothesized that in postoperative surgical patients, distinctive types of metabolic acidosis would correlate differently with the outcomes of high-risk surgeries. A prospective, multicenter observational study was performed in 3 different tertiary care hospitals. Patients who required postoperative admission to the intensive care unit (ICU) were included in this study. Patients with a short life expectancy (those with untreated cancer and limited treatment), hepatic failure, renal failure, or a diagnosis of diabetes were excluded. Patients were classified at ICU admission according to the presence and type of metabolic acidosis into 4 groups: those without acidosis, those with a base excess 12 mmol/L, and those with a base excess 2 mmol/L. Furthermore, patients were reclassified 12 hours after admission to the ICU to verify the metabolic acidosis behavior and outcome differences among the groups. The study included 618 patients. The incidence of acidosis at ICU admission was 59.1%; 23.9% presented with hyperchloremia, 21.3% with hyperlactatemia, 13.9% with increased anion gap, and 40.9% of the patients presented without metabolic acidosis. Patients whose metabolic acidosis persisted for 12 hours had an incidence of ICU complications rates in hyperlactatemia group of 68.8%, increased anion gap of 68.6%, hyperchloremic of 65.8%, and those without acidosis over 12 hours of 59.3%. A Cox regression model for postoperative 30-day mortality showed: in hyperlactatemic acidosis, hazard ratio (HR) = 1.74, 95% confidence interval (CI) = 1.02-2.96; increased anion gap acidosis, HR = 1.68, 95% CI = 0.85-3.81; hyperchloremic acidosis, HR = 1.47, 95% CI = 0.75-2.89, and 10.3% of 30-day mortality rate in patients without acidosis. An adjusted survival curve by Cox

  6. Concordance for prognostic models with competing risks

    DEFF Research Database (Denmark)

    Wolbers, Marcel; Blanche, Paul; Koller, Michael T

    2014-01-01

    The concordance probability is a widely used measure to assess discrimination of prognostic models with binary and survival endpoints. We formally define the concordance probability for a prognostic model of the absolute risk of an event of interest in the presence of competing risks and relate i...... of the working model. We further illustrate the methods by computing the concordance probability for a prognostic model of coronary heart disease (CHD) events in the presence of the competing risk of non-CHD death.......The concordance probability is a widely used measure to assess discrimination of prognostic models with binary and survival endpoints. We formally define the concordance probability for a prognostic model of the absolute risk of an event of interest in the presence of competing risks and relate...

  7. Risk assessment in sepsis: a new prognostication rule by APACHE II score and serum soluble urokinase plasminogen activator receptor.

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    Giamarellos-Bourboulis, Evangelos J; Norrby-Teglund, Anna; Mylona, Vassiliki; Savva, Athina; Tsangaris, Iraklis; Dimopoulou, Ioanna; Mouktaroudi, Maria; Raftogiannis, Maria; Georgitsi, Marianna; Linnér, Anna; Adamis, George; Antonopoulou, Anastasia; Apostolidou, Efterpi; Chrisofos, Michael; Katsenos, Chrisostomos; Koutelidakis, Ioannis; Kotzampassi, Katerina; Koratzanis, George; Koupetori, Marina; Kritselis, Ioannis; Lymberopoulou, Korina; Mandragos, Konstantinos; Marioli, Androniki; Sundén-Cullberg, Jonas; Mega, Anna; Prekates, Athanassios; Routsi, Christina; Gogos, Charalambos; Treutiger, Carl-Johan; Armaganidis, Apostolos; Dimopoulos, George

    2012-08-08

    Early risk assessment is the mainstay of management of patients with sepsis. APACHE II is the gold standard prognostic stratification system. A prediction rule that aimed to improve prognostication by APACHE II with the application of serum suPAR (soluble urokinase plasminogen activator receptor) is developed. A prospective study cohort enrolled 1914 patients with sepsis including 62.2% with sepsis and 37.8% with severe sepsis/septic shock. Serum suPAR was measured in samples drawn after diagnosis by an enzyme-immunoabsorbent assay; in 367 patients sequential measurements were performed. After ROC analysis and multivariate logistic regression analysis a prediction rule for risk was developed. The rule was validated in a double-blind fashion by an independent confirmation cohort of 196 sepsis patients, predominantly severe sepsis/septic shock patients, from Sweden. Serum suPAR remained stable within survivors and non-survivors for 10 days. Regression analysis showed that APACHE II ≥ 17 and suPAR ≥ 12 ng/ml were independently associated with unfavorable outcome. Four strata of risk were identified: i) APACHE II APACHE II APACHE II ≥ 17 and suPAR APACHE II ≥ 17 and suPAR ≥ 12 ng/ml with mortality 51.7%. This prediction rule was confirmed by the Swedish cohort. A novel prediction rule with four levels of risk in sepsis based on APACHE II score and serum suPAR is proposed. Prognostication by this rule is confirmed by an independent cohort.

  8. Additional prognostic value of physical examination, exercise testing, and arterial ultrasonography for coronary risk assessment in primary prevention.

    Science.gov (United States)

    Cournot, Maxime; Taraszkiewicz, Dorota; Cambou, Jean-Pierre; Galinier, Michel; Boccalon, Henri; Hanaire-Broutin, Hélène; Chamontin, Bernard; Carrié, Didier; Ferrières, Jean

    2009-11-01

    The choice of noninvasive tests used in primary prevention of cardiovascular diseases must be based on medical evidence. The aim of this study was to assess the additional prognostic value, over conventional risk factors, of physical examination, exercise testing, and arterial ultrasonography, in predicting a first coronary event. A prospective cohort study was conducted between 1996 and 2004 (n = 2,709), with follow-up in 2006 (response rate 96.6%). Participants had no history or symptoms of cardiovascular disease and had a standardized physical examination, a cardiac exercise testing, and carotid and femoral ultrasonography at baseline. Incident cases of definite coronary events were recorded during follow-up. Over the Framingham risk score, femoral bruit, positive exercise test, intima-media thickness >0.63 mm, and a femoral plaque provided significant additional information to the prediction model. The addition of the exercise test to the traditional risk factors, then the intima-media thickness and lastly the presence of femoral plaques, produces incremental increases in the area under the receiver operating characteristic curve (0.73-0.78, P = .02) and about a 50% increase in the positive predictive value (15.8%-31.4%), with no effect on the negative predictive value (96.4%-96.9%). Physical examination, exercise testing, and arterial ultrasonography provide incremental information on the risk of coronary event in asymptomatic adults. Exercise testing and femoral ultrasonography also improve the accuracy of the risk stratification.

  9. Medical History for Prognostic Risk Assessment and Diagnosis of Stable Patients with Suspected Coronary Artery Disease

    Science.gov (United States)

    Min, James K.; Dunning, Allison; Gransar, Heidi; Achenbach, Stephan; Lin, Fay Y.; Al-Mallah, Mouaz; Budoff, Matthew J.; Callister, Tracy Q.; Chang, Hyuk-Jae; Cademartiri, Filippo; Chinnaiyan, Kavitha; Chow, Benjamin J. W.; D’Agostino, Ralph; DeLago, Augustin; Friedman, John; Hadamitzky, Martin; Hausleiter, Joerg; Hayes, Sean; Kaufmann, Philipp; Raff, Gilbert L.; Shaw, Leslee J.; Thomson, Louise; Villines, Todd; Cury, Ricardo C.; Feuchtner, Gudrun; Kim, Yong-Jin; Leipsic, Jonathon; Berman, Daniel S.; Pencina, Michael

    2014-01-01

    Aims To develop a clinical cardiac risk algorithm for stable patients with suspected CAD based upon angina typicality and CAD risk factors. Methods and Results Between 2004 and 2011, 14,004 adults with suspected CAD referred for cardiac imaging were followed: 1) 9,093 patients for CCTA (CCTA-1) followed for 2.0 years; 2) 2,132 patients for CCTA (CCTA-2) followed for 1·6 years, and 3) 2,779 patients for exercise myocardial perfusion scintigraphy followed for 5.0 years. A best-fit model from CCTA-1 for prediction of death or myocardial infarction (MI) was developed, with integer values proportional to regression coefficients. Discrimination was assessed using C-statistic. The validated model was also tested for estimation of the likelihood of obstructive CAD, defined as ≥50% stenosis, as compared to method of Diamond and Forrester (D-F). Primary outcomes included all-cause mortality and non-fatal MI. Secondary outcomes included prevalence of angiographically obstructive CAD. In CCTA-1, best-fit model discriminated individuals at risk of death or MI (C-statistic 0·76). The integer model ranged from 3-13, and corresponded to 3-year death risk or MI of 0·25% to 53·8%. When applied to the CCTA-2 and MPS, the model demonstrated C-statistics of 0·71 and 0·77. Both best-fit (C=0·76, 95% CI 0·746-0·771) and integer model (C=0·71, 95% CI 0·693-0·719) performed better than D-F (C=0·64; 95% CI, 0·628-0·659) for estimating obstructive CAD. Conclusions For stable symptomatic patients with suspected CAD, we developed a history-based method for prediction of death and obstructive CAD. PMID:25865923

  10. New Prospective for the Management of Low-Risk Pulmonary Embolism: Prognostic Assessment, Early Discharge, and Single-Drug Therapy with New Oral Anticoagulants

    Science.gov (United States)

    2012-01-01

    Patients with pulmonary embolism (PE) can be stratified into two different prognostic categories, based on the presence or absence of shock or sustained arterial hypotension. Some patients with normotensive PE have a low risk of early mortality, defined as <1% at 30 days or during hospital stay. In this paper, we will discuss the new prospective for the optimal management of low-risk PE: prognostic assessment, early discharge, and single-drug therapy with new oral anticoagulants. Several parameters have been proposed and investigated to identify low-risk PE: clinical prediction rules, imaging tests, and laboratory markers of right ventricular dysfunction or injury. Moreover, outpatient management has been suggested for low-risk PE: it may lead to a decrease in unnecessary hospitalizations, acquired infections, death, and costs and to an improvement in health-related quality of life. Finally, the main characteristics of new oral anticoagulant drugs and the most recent published data on phase III trials on PE suggest that the single-drug therapy is a possible suitable option. Oral administration, predictable anticoagulant responses, and few drug-drug interactions of direct thrombin and factor Xa inhibitors may further simplify PE home therapy avoiding administration of low-molecular-weight heparin. PMID:24278706

  11. Bridging the etiologic and prognostic outlooks in individualized assessment of absolute risk of an illness: application in lung cancer.

    Science.gov (United States)

    Karp, Igor; Sylvestre, Marie-Pierre; Abrahamowicz, Michal; Leffondré, Karen; Siemiatycki, Jack

    2016-11-01

    Assessment of individual risk of illness is an important activity in preventive medicine. Development of risk-assessment models has heretofore relied predominantly on studies involving follow-up of cohort-type populations, while case-control studies have generally been considered unfit for this purpose. To present a method for individualized assessment of absolute risk of an illness (as illustrated by lung cancer) based on data from a 'non-nested' case-control study. We used data from a case-control study conducted in Montreal, Canada in 1996-2001. Individuals diagnosed with lung cancer (n = 920) and age- and sex-matched lung-cancer-free subjects (n = 1288) completed questionnaires documenting life-time cigarette-smoking history and occupational, medical, and family history. Unweighted and weighted logistic models were fitted. Model overfitting was assessed using bootstrap-based cross-validation and 'shrinkage.' The discriminating ability was assessed by the c-statistic, and the risk-stratifying performance was assessed by examination of the variability in risk estimates over hypothetical risk-profiles. In the logistic models, the logarithm of incidence-density of lung cancer was expressed as a function of age, sex, cigarette-smoking history, history of respiratory conditions and exposure to occupational carcinogens, and family history of lung cancer. The models entailed a minimal degree of overfitting ('shrinkage' factor: 0.97 for both unweighted and weighted models) and moderately high discriminating ability (c-statistic: 0.82 for the unweighted model and 0.66 for the weighted model). The method's risk-stratifying performance was quite high. The presented method allows for individualized assessment of risk of lung cancer and can be used for development of risk-assessment models for other illnesses.

  12. Prognostic Indicators: Predicting Degree of Change from Interventions for Adolescents at Risk for Language Weakness

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    Poll, Gerard H.; Burke, Lisa; Miller, Carol A.; Fiene, Judy

    2017-01-01

    Prognostic statements are a standard component of assessments for adolescents at risk for language-learning disabilities, but there is limited evidence on the validity of prognostic indicators. In two studies, we collected measures of language ability and candidate prognostic indicators from adolescents age 12 to 13. We conducted an expository…

  13. A multi-factorial genetic model for prognostic assessment of high risk melanoma patients receiving adjuvant interferon.

    Directory of Open Access Journals (Sweden)

    Ena Wang

    Full Text Available PURPOSE: IFNa was the first cytokine to demonstrate anti-tumor activity in advanced melanoma. Despite the ability of high-dose IFNa reducing relapse and mortality by up to 33%, large majority of patients experience side effects and toxicity which outweigh the benefits. The current study attempts to identify genetic markers likely to be associated with benefit from IFN-a2b treatment and predictive for survival. EXPERIMENTAL DESIGN: We tested the association of variants in FOXP3 microsatellites, CTLA4 SNPs and HLA genotype in 284 melanoma patients and their association with prognosis and survival of melanoma patients who received IFNa adjuvant therapy. RESULTS: Univariate survival analysis suggested that patients bearing either the DRB1*15 or HLA-Cw7 allele suffered worse OS while patients bearing either HLA-Cw6 or HLA-B44 enjoyed better OS. DRB1*15 positive patients suffered also worse RFS and conversely HLA-Cw6 positive patients had better RFS. Multivariate analysis revealed that a five-marker genotyping signature was prognostic of OS independent of disease stage. In the multivariate Cox regression model, HLA-B38 (p = 0.021, HLA-C15 (p = 0.025, HLA-C3 (p = 0.014, DRB1*15 (p = 0.005 and CT60*G/G (0.081 were significantly associated with OS with risk ratio of 0.097 (95% CI, 0.013-0.709, 0.387 (95% CI, 0.169-0.889, 0.449 (95% CI, 0.237-0.851, 1.948 (95% CI, 1.221-3.109 and 1.484 (95% IC, 0.953-2.312 respectively. CONCLUSION: These results suggest that gene polymorphisms relevant to a biological occurrence are more likely to be informative when studied in concert to address potential redundant or conflicting functions that may limit each gene individual contribution. The five markers identified here exemplify this concept though prospective validation in independent cohorts is needed.

  14. Prognostic value of heart rate turbulence for risk assessment in patients with unstable angina and non-ST elevation myocardial infarction

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    Harris, Patricia RE; Stein, Phyllis K; Fung, Gordon L; Drew, Barbara J

    2013-01-01

    Background We sought to examine the prognostic value of heart rate turbulence derived from electrocardiographic recordings initiated in the emergency department for patients with non-ST elevation myocardial infarction (NSTEMI) or unstable angina. Methods Twenty-four-hour Holter recordings were started in patients with cardiac symptoms approximately 45 minutes after arrival in the emergency department. Patients subsequently diagnosed with NSTEMI or unstable angina who had recordings with ≥18 hours of sinus rhythm and sufficient data to compute Thrombolysis In Myocardial Infarction (TIMI) risk scores were chosen for analysis (n = 166). Endpoints were emergent re-entry to the cardiac emergency department and/or death at 30 days and one year. Results In Cox regression models, heart rate turbulence and TIMI risk scores together were significant predictors of 30-day (model chi square 13.200, P = 0.001, C-statistic 0.725) and one-year (model chi square 31.160, P turbulence, initiated upon arrival at the emergency department, may provide additional incremental value in the risk assessment for patients with NSTEMI or unstable angina. PMID:23976860

  15. Physicians' perceptions of the value of prognostic models: the benefits and risks of prognostic confidence.

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    Hallen, Sarah A M; Hootsmans, Norbert A M; Blaisdell, Laura; Gutheil, Caitlin M; Han, Paul K J

    2015-12-01

    The communication of prognosis in end-of-life (EOL) care is a challenging task that is limited by prognostic uncertainty and physicians' lack of confidence in their prognostic estimates. Clinical prediction models (CPMs) are increasingly common evidence-based tools that may mitigate these problems and facilitate the communication and use of prognostic information in EOL care; however, little is known about physicians' perceptions of the value of these tools. To explore physicians' perceptions of the value of CPMs in EOL care. Qualitative study using semi-structured individual interviews which were analysed using a constant comparative method. Convenience sample of 17 attending physicians representing five different medical specialties at a single large tertiary care medical centre. Physicians perceived CPMs as having three main benefits in EOL care: (i) enhancing their prognostic confidence; (ii) increasing their prognostic authority; and (iii) enabling patient persuasion in circumstances of low prognostic and therapeutic uncertainty. However, physicians also perceived CPMs as having potential risks, which include producing emotional distress in patients and promoting prognostic overconfidence in EOL care. Physicians perceive CPMs as a potentially valuable means of increasing their prognostic confidence, communication and explicit use of prognostic information in EOL care. However, physicians' perceptions of CPMs also indicate a need to establish broad and consistent implementation processes to engage patients in shared decision making in EOL care, to effectively communicate uncertainty in prognostic information and to help both patients and physicians manage uncertainty in EOL care decisions. © 2014 John Wiley & Sons Ltd.

  16. Risk Assessment

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    How the EPA conducts risk assessment to protect human health and the environment. Several assessments are included with the guidelines, models, databases, state-based RSL Tables, local contacts and framework documents used to perform these assessments.

  17. The study of the prognostic value scales of assessing the risk of adverse coronary events in patients with acute coronary syndrome without ST-segment elevation in combination with comorbid conditions

    Directory of Open Access Journals (Sweden)

    Dorokhova O.V.

    2014-12-01

    Full Text Available Objective: to identify the most prognostically significant scale risk assessment of patients with acute coronary syndrome without ST-segment elevation in combination with diabetes mellitus type 2, chronic renal failure, multifo-cal coronarocardiosclerosis, dyscirculatory encephalopathy. Material and methods. 260 patients with acute coronary syndrome without ST-segment elevation were divided into 4 groups according to the presence of severe concomitant diseases: patients with diabetes mellitus type 2 (71 people, chronic renal failure (49, multifocal lesions of the coronary arteries (76 and patients with dyscirculatory encephalopathy of grade 2-3, including ischemic stroke (64. All patients were stratified by major scales risk: TIMI, GRACE, PURSUIT. The development of negative coronary events was assessed in hospital and during the year after discharge. On the basis of the results, all scales were studied using the criterion of Mann-Whitney and identified the most predictably significant groups of patients with specific comorbid conditions. Results. It is revealed that the significance of the scales TIMI and GRACE in the study of distant forecast (up to 6 months is the most reliable with acute coronary syndrome without ST-segment elevation in combination with diabetes mellitus type 2. For the patients with combination with chronic renal insufficiency the best prognostic significance was obtained by the GRACE scale in the study of hospital risk and forecast up to 6 months. TIMI and GRACE scales in the study of hospital risk and forecast up to 6 months had the greatest prognostic significance for the patients with acute coronary syndrome without ST-segment elevation on the background of multifocal lesions of the coronary arteries. For the patients with dyscirculatory encephalopathy of the 2nd and 3rd grades, the greatest prognostic significance was obtained by stratification of risk on PURSUIT and GRACE scales in the study of hospital risk and

  18. Risk factors and prognostic indicators for medial tibial stress syndrome

    NARCIS (Netherlands)

    Moen, M. H.; Bongers, T.; Bakker, E. W.; Zimmermann, W. O.; Weir, A.; Tol, J. L.; Backx, F. J. G.

    2012-01-01

    The objective of the study was to examine the risk factors and prognostic indicators for medial tibial stress syndrome (MTSS). In total, 35 subjects were included in the study. For the risk factor analysis, the following parameters were investigated: hip internal and external ranges of motion, knee

  19. Prognostic implications of serial risk score assessments in patients with pulmonary arterial hypertension: a Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) analysis.

    Science.gov (United States)

    Benza, Raymond L; Miller, Dave P; Foreman, Aimee J; Frost, Adaani E; Badesch, David B; Benton, Wade W; McGoon, Michael D

    2015-03-01

    Data from the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) were used previously to develop a risk score calculator to predict 1-year survival. We evaluated prognostic implications of changes in the risk score and individual risk-score parameters over 12 months. Patients were grouped by decreased, unchanged, or increased risk score from enrollment to 12 months. Kaplan-Meier estimates of subsequent 1-year survival were made based on change in the risk score during the initial 12 months of follow-up. Cox regression was used for multivariable analysis. Of 2,529 patients in the analysis cohort, the risk score was decreased in 800, unchanged in 959, and increased in 770 at 12 months post-enrollment. Six parameters (functional class, systolic blood pressure, heart rate, 6-minute walk distance, brain natriuretic peptide levels, and pericardial effusion) each changed sufficiently over time to improve or worsen risk scores in ≥5% of patients. One-year survival estimates in the subsequent year were 93.7%, 90.3%, and 84.6% in patients with a decreased, unchanged, and increased risk score at 12 months, respectively. Change in risk score significantly predicted future survival, adjusting for risk at enrollment. Considering follow-up risk concurrently with risk at enrollment, follow-up risk was a much stronger predictor, although risk at enrollment maintained a significant effect on future survival. Changes in REVEAL risk scores occur in most patients with pulmonary arterial hypertension over a 12-month period and are predictive of survival. Thus, serial risk score assessments can identify changes in disease trajectory that may warrant treatment modifications. Copyright © 2015 International Society for Heart and Lung Transplantation. All rights reserved.

  20. 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...... and the individual dynamic items strengthen the use of this scheme in clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)...

  1. Joint System Prognostics For Increased Efficiency And Risk Mitigation In Advanced Nuclear Reactor Instrumentation and Control

    Energy Technology Data Exchange (ETDEWEB)

    Donald D. Dudenhoeffer; Tuan Q. Tran; Ronald L. Boring; Bruce P. Hallbert

    2006-08-01

    The science of prognostics is analogous to a doctor who, based on a set of symptoms and patient tests, assesses a probable cause, the risk to the patient, and a course of action for recovery. While traditional prognostics research has focused on the aspect of hydraulic and mechanical systems and associated failures, this project will take a joint view in focusing not only on the digital I&C aspect of reliability and risk, but also on the risks associated with the human element. Model development will not only include an approximation of the control system physical degradation but also on human performance degradation. Thus the goal of the prognostic system is to evaluate control room operation; to identify and potentially take action when performance degradation reduces plant efficiency, reliability or safety.

  2. Risk factors and prognostic models for perinatal asphyxia at term

    NARCIS (Netherlands)

    Ensing, S.

    2015-01-01

    This thesis will focus on the risk factors and prognostic models for adverse perinatal outcome at term, with a special focus on perinatal asphyxia and obstetric interventions during labor to reduce adverse pregnancy outcomes. For the majority of the studies in this thesis we were allowed to use data

  3. Prognostics

    Data.gov (United States)

    National Aeronautics and Space Administration — Prognostics has received considerable attention recently as an emerging sub-discipline within SHM. Prognosis is here strictly defined as “predicting the time at...

  4. Prognostic factors in Chinese patients with prostate cancer receiving primary androgen deprivation therapy: validation of Japan Cancer of the Prostate Risk Assessment (J-CAPRA) score and impacts of pre-existing obesity and diabetes mellitus.

    Science.gov (United States)

    Hu, Meng-Bo; Yang, Tian; Hu, Ji-Meng; Zhu, Wen-Hui; Jiang, Hao-Wen; Ding, Qiang

    2018-01-06

    Our aim was to determine the prognostic factors in Chinese patients with prostate cancer receiving primary androgen deprivation therapy (PADT), validate the Japan Cancer of the Prostate Risk Assessment (J-CAPRA) score, and investigate the impacts of pre-existing obesity and diabetes mellitus (DM). The study enrolled Chinese patients diagnosed with prostatic adenocarcinoma and treated with bilateral orchiectomy as PADT at Huashan Hospital, Fudan University (Shanghai, China), from January 2003 to December 2015. The overall survival (OS) and prognostic value of J-CAPRA score, pre-existing obesity, DM, and various clinicopathological variables were analyzed. Of the 435 patients enrolled, 174 (40.0%) deaths occurred during follow-up; 3- and 5-year OS were 74.0 and 58.9%, respectively. Multivariate analysis identified that higher Gleason score and metastasis were both correlated with worse OS and that higher J-CAPRA score was correlated with worse OS [hazard ratio (HR) 1.110, 95% confidence interval (CI) 1.035-1.190, P = 0.003). Different risk categories based on J-CAPRA score showed good stratification in OS (log-rank P = 0.015). In subgroup analysis, pre-existing obesity as a protective factor in younger patients (age ≤ 65, HR 0.271, 95% CI 0.075-0.980, P = 0.046) and pre-existing DM as a risk factor in older patients (> 75, HR 1.854, 95% CI 1.026-3.351, P = 0.041) for OS were recognized, and the prediction accuracy of J-CAPRA was elevated after incorporating pre-existing obesity and DM. The J-CAPRA score presented with good OS differentiation among Chinese patients under PADT. Younger patients (age ≤ 65) had better OS with pre-existing obesity, while older patients (age > 75) had worse OS with pre-existing DM.

  5. Risk factors and prognostic indicators for medial tibial stress syndrome.

    Science.gov (United States)

    Moen, M H; Bongers, T; Bakker, E W; Zimmermann, W O; Weir, A; Tol, J L; Backx, F J G

    2012-02-01

    The objective of the study was to examine the risk factors and prognostic indicators for medial tibial stress syndrome (MTSS). In total, 35 subjects were included in the study. For the risk factor analysis, the following parameters were investigated: hip internal and external ranges of motion, knee flexion and extension, dorsal and plantar ankle flexion, hallux flexion and extension, subtalar eversion and inversion, maximal calf girth, lean calf girth, standing foot angle and navicular drop test. After multivariate regression decreased hip internal range of motion, increased ankle plantar flexion and positive navicular drop were associated with MTSS. A higher body mass index was associated with a longer duration to full recovery. For other prognostic indicators, no relationship was found. © 2010 John Wiley & Sons A/S.

  6. Usefulness of Geriatric Nutritional Risk Index for Assessing Nutritional Status and Its Prognostic Impact in Patients Aged ≥65 Years With Acute Heart Failure.

    Science.gov (United States)

    Honda, Yasuyuki; Nagai, Toshiyuki; Iwakami, Naotsugu; Sugano, Yasuo; Honda, Satoshi; Okada, Atsushi; Asaumi, Yasuhide; Aiba, Takeshi; Noguchi, Teruo; Kusano, Kengo; Ogawa, Hisao; Yasuda, Satoshi; Anzai, Toshihisa

    2016-08-15

    Malnutrition is becoming one of the most important determinants of worse clinical outcomes in patients with acute heart failure (AHF). However, appropriate tools for evaluating the nutritional status in patients aged ≥65 years with AHF remain unclear. We examined 490 consecutive patients aged ≥65 years with AHF. They were divided into 2 groups according to Geriatric Nutritional Risk Index (GNRI; cut-off value = 92). During a median period of 189 days, the mortality rate was significantly higher in the lower GNRI group than the higher GNRI group (p nutritional indexes. Adding GNRI to an existing outcome prediction model for mortality in AHF significantly increased the C-statistic from 0.68 to 0.74 (p = 0.017). The net reclassification improvement afforded by GNRI was 60% overall, 27% for events, and 33% for nonevents (p nutritional parameters. Furthermore, the assessment of nutritional status using GNRI is very helpful for risk stratification. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Prognostication of traumatic brain injury outcomes in older trauma patients: A novel risk assessment tool based on initial cranial CT findings.

    Science.gov (United States)

    Stawicki, Stanislaw P; Wojda, Thomas R; Nuschke, John D; Mubang, Ronnie N; Cipolla, James; Hoff, William S; Hoey, Brian A; Thomas, Peter G; Sweeney, Joan; Ackerman, Daniel; Hosey, Jonathan; Falowski, Steven

    2017-01-01

    using matched NSI (n = 310) and non-NSI (n = 310) groups. All other analyses examined the combined patient sample (n = 620). Variables achieving a significance level of P functional outcome scores on discharge. Increasing CCTST was associated with greater mortality, morbidity, HLOS, SDLOS, ICULOS, and ventilator days. On multivariate analysis, factors independently associated with mortality included AISh (AOR 2.70, 95% CI 1.21-6.00), initial GCS (AOR 1.14, 1.07-1.22), and CCTST (AOR 1.31, 1.09-1.58). Variables independently associated with in-hospital morbidity included CCTST (AOR 1.16, 1.02-1.34), GCS (AOR 1.05, 1.01-1.09), and NSI (AOR 2.62, 1.69-4.06). Multivariate models incorporating factors independently associated with each respective outcome displayed good overall predictive characteristics for mortality (AUC 0.787) and in-hospital morbidity (AUC 0.651). Finally, modified CCTST demonstrated good overall predictive ability for NSI (AUC 0.755). This study found that the number of discrete findings on CCT is independently associated with major TBI outcome measures, including 30-day mortality, in-hospital morbidity, and NSI. Of note, multivariate models with best predictive characteristics incorporate both CCTST and GCS. CCTST is easy to calculate, and this preliminary investigation of its predictive utility in older patients with TBI warrants further validation, focusing on exploring prognostic synergies between CCTST, GCS, and AISh. If independently confirmed to be predictive of clinical outcomes and the need for NSI, the approach described herein could lead to a shift in both operative and nonoperative management of patients with TBI.

  8. Expansion of the prognostic assessment of patients with chronic obstructive pulmonary disease : the updated BODE index and the ADO index

    NARCIS (Netherlands)

    Puhan, Milo A.; Garcia-Aymerich, Judith; Frey, Martin; ter Riet, Gerben; Anto, Josep M.; Agusti, Alvar G.; Gomez, Federico P.; Rodriguez-Roisin, Roberto; Moons, Karel G. M.; Kessels, Alphons G.; Held, Ulrike

    2009-01-01

    Background The BODE index (including body-mass index, airflow obstruction, dyspnoea, and exercise capacity) was an important contribution to the prognostic assessment of patients with chronic obstructive pulmonary disease (COPD). However, no study has assessed whether the risk of mortality predicted

  9. Expansion of the prognostic assessment of patients with chronic obstructive pulmonary disease: the updated BODE index and the ADO index

    NARCIS (Netherlands)

    Puhan, Milo A.; Garcia-Aymerich, Judith; Frey, Martin; ter Riet, Gerben; Antó, Josep M.; Agustí, Alvar G.; Gómez, Federico P.; Rodríguez-Roisín, Roberto; Moons, Karel G. M.; Kessels, Alphons G.; Held, Ulrike

    2009-01-01

    Background The BODE index (including body-mass index, airflow obstruction, dyspnoea, and exercise capacity) was an important contribution to the prognostic assessment of patients with chronic obstructive pulmonary disease (COPD). However, no study has assessed whether the risk of mortality predicted

  10. Hypoproteinemia as a prognostic risk factor for arteriovenous fistula failure.

    Science.gov (United States)

    Premuzic, Vedran; Hudolin, Tvrtko; Pasini, Josip; Zimak, Zoran; Hauptman, Dinko; Jelakovic, Bojan; Kastelan, Zeljko

    2017-01-29

    Any vascular access is of limited duration with many factors which influence survival in patients on chronic hemodialysis (HD). Hypoproteinemia as a marker of chronic illness is common among chronic HD patients. Our aim was to analyze the survival of the primary arteriovenous fistula (AVFs) and the risk factors which influence their patency and to test the hypothesis that patients with normal values of serum proteins have lower risk of AVF failure compared to patients with hypoproteinemia. Seven hundred thirty-four consecutive patients were included who underwent creation of an AVF. The patients were prospectively followed-up for 2 years. Only patients with AVF function after a month from its creation were analyzed. The patients were divided into two subgroups, with normal and low serum protein levels (functional while 237 (32.3%) AVFs failed due to thrombosis or stenosis. Serum proteins and AVFs created on the forearm were positive predictors while diabetes was a negative predictor of longer AVF survival (P < 0.001; P = 0.003; P = 0.043). When comparing patients with normal and low serum protein levels (<65 g/L), mean survival time was significantly longer in patients with normal serum levels (P < 0.001). In this study, hypoproteinemia was an independent prognostic marker for AVF failure at 2 years. Hypoproteinemia, based on our results, is an independent, more sensitive and prognostic marker of possible vascular access failure than the presence of other common factors which influence shorter AVF survival. © 2017 International Society for Hemodialysis.

  11. Improved risk stratification by the integration of the revised international prognostic scoring system with the myelodysplastic syndromes comorbidity index.

    Science.gov (United States)

    van Spronsen, M F; Ossenkoppele, G J; Holman, R; van de Loosdrecht, A A

    2014-12-01

    Myelodysplastic syndromes (MDS) comprise bone marrow failure diseases with a diverse clinical outcome. For improved risk stratification, the International Prognostic Scoring System (IPSS) has recently been revised (IPSS-R). This single-centre study aimed to validate the IPSS-R and to evaluate prior prognostic scoring systems for MDS. We retrospectively analysed 363 patients diagnosed with MDS according to the FAB criteria between 2000 and 2012. The IPSS, MD Anderson Risk Model Score (MDAS), World Health Organisation (WHO)-classification based Prognostic Scoring System (WPSS), refined WPSS (WPSS-R), IPSS-R and MDS-Comorbidity Index (MDS-CI) were applied to 222 patients considered with primary MDS following the WHO criteria and their prognostic power was investigated. According to the IPSS-R, 18 (8%), 81 (37%), 50 (23%), 43 (19%) and 30 (13%) patients were classified as very low, low, intermediate, high and very high risk with, respectively, a median overall survival of 96 (95% Confidence interval (CI) not reached), 49 (95% CI 34-64), 22 (95% CI 0-49), 19 (95% CI 11-27) and 10 (95% CI 6-13) months (pMDS-CI refined the risk stratification of MDS patients stratified according to the IPSS-R. In conclusion, accounting for the disease status by means of the IPSS-R and comorbidity through the MDS-CI considerably improves the prognostic assessment in MDS patients. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. There’s Risk, and Then There’s RISK: The Latest Clinical Prognostic Risk Stratification Models in Myelodysplastic Syndromes

    OpenAIRE

    Zeidan, Amer M.; Komrokji, Rami S.

    2013-01-01

    Myelodysplastic syndromes (MDS) include a diverse group of clonal hematopoietic disorders characterized by progressive cytopenias and propensity for leukemic progression. The biologic heterogeneity that underlies MDS translates clinically in wide variations of clinical outcomes. Several prognostic schemes were developed to predict the natural course of MDS, counsel patients, and allow evidence-based, risk-adaptive implementation of therapeutic strategies. The prognostic schemes divide patient...

  13. The prognostic value of MRI in determining reinjury risk following acute hamstring injury: a systematic review.

    Science.gov (United States)

    van Heumen, Moniek; Tol, Johannes L; de Vos, Robert-Jan; Moen, Maarten H; Weir, Adam; Orchard, John; Reurink, Gustaaf

    2017-09-01

    A challenge for sports physicians is to estimate the risk of a hamstring re-injury, but the current evidence for MRI variables as a risk factor is unknown. To systematically review the literature on the prognostic value of MRI findings at index injury and/or return to play for acute hamstring re-injuries. Databases of PubMed, Embase, MEDLINE, Scopus, CINAHL, Google Scholar, Web of Science, LILACS, SciELO, ScienceDirect, ProQuest, SPORTDiscus and Cochrane Library were searched until 20 June 2016. Studies evaluating MRI as a prognostic tool for determining the risk of re-injury for athletes with acute hamstring injuries were eligible for inclusion. Two authors independently screened the search results and assessed risk of bias using standardised criteria from a consensus statement. A best-evidence synthesis was used to identify the level of evidence. Post hoc analysis included correction for insufficient sample size. Of the 11 studies included, 7 had a low and 4 had a high risk of bias. No strong evidence for any MRI finding as a risk factor for hamstring re-injury was found. There was moderate evidence that intratendinous injuries were associated with increased re-injury risk. Post hoc analysis showed moderate evidence that injury to the biceps femoris was a moderate to strong risk factor for re-injury. There is currently no strong evidence for any MRI finding in predicting hamstring re-injury risk. Intratendinous injuries and biceps femoris injuries showed moderate evidence for association with a higher re-injury risk. Registration in the PROSPERO International prospective register of systematic reviews was performed prior to study initiation (registration number CRD42015024620). © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  14. Hepatitis Risk Assessment

    Science.gov (United States)

    ... visit this page: About CDC.gov . Hepatitis Risk Assessment Recommend on Facebook Tweet Share Compartir Viral Hepatitis. ... at risk? Take this 5 minute Hepatitis Risk Assessment developed by the CDC and get a personalized ...

  15. Diagnostic and Prognostic Significance of DSM-5 Attenuated Psychosis Syndrome in Services for Individuals at Ultra High Risk for Psychosis.

    Science.gov (United States)

    Fusar-Poli, Paolo; De Micheli, Andrea; Cappucciati, Marco; Rutigliano, Grazia; Davies, Cathy; Ramella-Cravaro, Valentina; Oliver, Dominic; Bonoldi, Ilaria; Rocchetti, Matteo; Gavaghan, Lauren; Patel, Rashmi; McGuire, Philip

    2017-05-17

    The diagnostic and prognostic significance of the DSM-5-defined Attenuated Psychosis Syndrome (DSM-5-APS) in individuals undergoing an ultra high risk (UHR) clinical assessment for suspicion of psychosis risk is unknown. Prospective cohort study including all consecutive help-seeking individuals undergoing both a DSM-5-APS and a Comprehensive Assessment of At Risk Mental States (CAARMS 12/2006) assessment for psychosis risk at the Outreach and Support in South London (OASIS) UHR service (March 2013-April 2014). The diagnostic significance of DSM-5-APS was assessed with percent overall agreement, prevalence bias adjusted kappa, Bowker's test, Stuart-Maxwell test, residual analysis; the prognostic significance with Cox regression, Kaplan-Meier failure function, time-dependent area under the curve (AUC) and net benefits analysis. The impact of specific revisions of the DSM-5-APS was further tested. In 203 help-seeking individuals undergoing UHR assessment, the agreement between the DSM-5-APS and the CAARMS 12/2006 was only moderate (kappa 0.59). Among 142 nonpsychotic cases, those meeting DSM-5-APS criteria had a 5-fold probability (HR = 5.379) of developing psychosis compared to those not meeting DSM-5-APS criteria, with a 21-month cumulative risk of psychosis of 28.17% vs 6.49%, respectively. The DSM-5-APS prognostic accuracy was acceptable (AUC 0.76 at 24 months) and similar to the CAARMS 12/2006. The DSM-5-APS designation may be clinically useful to guide the provision of indicated interventions within a 7%-35% (2-year) range of psychosis risk. The removal of the criterion E or C of the DSM-5-APS may improve its prognostic performance and transdiagnostic value. The DSM-5-APS designation may be clinically useful in individuals accessing clinical services for psychosis prevention.

  16. Geriatric Nutritional Risk Index as a Prognostic Factor in Peritoneal Dialysis Patients

    OpenAIRE

    Kang, Seok Hui; Cho, Kyu Hyang; Park, Jong Won; Yoon, Kyung Woo; Do, Jun Young

    2013-01-01

    ♦ Background: The Geriatric Nutritional Risk Index (GNRI) might be a useful screening tool for malnutrition in dialysis patients. However, data concerning the GNRI as a prognostic factor in peritoneal dialysis (PD) patients are scarce.

  17. Geoinformational prognostic model of mudflows hazard and mudflows risk for the territory of Ukrainian Carpathians

    Science.gov (United States)

    Chepurna, Tetiana B.; Kuzmenko, Eduard D.; Chepurnyj, Igor V.

    2017-06-01

    The article is devoted to the geological issue of the space-time regional prognostication of mudflow hazard. The methodology of space-time prediction of mudflows hazard by creating GIS predictive model has been developed. Using GIS technologies the relevant and representative complex of significant influence of spatial and temporal factors, adjusted to use in the regional prediction of mudflows hazard, were selected. Geological, geomorphological, technological, climatic, and landscape factors have been selected as spatial mudflow factors. Spatial analysis is based on detection of a regular connection of spatial factor characteristics with spatial distribution of the mudflow sites. The function of a standard complex spatial index (SCSI) of the probability of the mudflow sites distribution has been calculated. The temporal, long-term prediction of the mudflows activity was based on the hypothesis of the regular reiteration of natural processes. Heliophysical, seismic, meteorological, and hydrogeological factors have been selected as time mudflow factors. The function of a complex index of long standing mudflow activity (CIMA) has been calculated. The prognostic geoinformational model of mudflow hazard up to 2020 year, a year of the next peak of the mudflows activity, has been created. Mudflow risks have been counted and carogram of mudflow risk assessment within the limits of administrative-territorial units has been built for 2020 year.

  18. Prognostic Value of the Nutritional Risk Index in Heart Transplant Recipients.

    Science.gov (United States)

    Barge-Caballero, Eduardo; García-López, Fernando; Marzoa-Rivas, Raquel; Barge-Caballero, Gonzalo; Couto-Mallón, David; Paniagua-Martín, María J; Solla-Buceta, Miguel; Velasco-Sierra, Carlos; Pita-Gutiérrez, Francisco; Herrera-Noreña, José M; Cuenca-Castillo, José J; Vázquez-Rodríguez, José Manuel; Crespo-Leiro, María G

    2017-08-01

    To study the prognostic impact of preoperative nutritional status, as assessed through the nutritional risk index (NRI), on postoperative outcomes after heart transplantation (HT). We conducted a retrospective, single-center study of 574 patients who underwent HT from 1991 to 2014. Preoperative NRI was calculated as 1.519 × serum albumin (g/L) + 41.7 × (body weight [kg] / ideal body weight [kg]). The association between preoperative NRI and postoperative outcomes was analyzed by means of multivariable logistic regression and multivariable Cox regression. Mean NRI before HT was 100.9 ± 9.9. According to this parameter, the prevalence of severe nutritional risk (NRI nutritional risk (83.5 ≤ NRI nutritional risk (97.5 ≤ NRI risk of postoperative infection (adjusted OR, 0.97; 95%CI, 0.95-1.00; P = .027) and prolonged postoperative ventilator support (adjusted OR, 0.96; 95%CI, 0.94-0.98; P = .001). Patients at moderate or severe nutritional risk had significantly higher 1-year post-HT mortality (adjusted HR, 1.55; 95%CI, 1.22-1.97; P risk of postoperative complications and mortality after HT. Preoperative NRI determination may help to identify HT candidates who might benefit from nutritional intervention. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  19. Prognostic ability of 18F-FDG PET/CT in the assessment of colorectal liver metastases.

    Science.gov (United States)

    Muralidharan, Vijayaragavan; Kwok, Marco; Lee, Sze Ting; Lau, Lawrence; Scott, Andrew M; Christophi, Christopher

    2012-09-01

    Modern multidisciplinary therapy for colorectal liver metastases (CRLM) is associated with significant morbidity and must be adapted to the patient's relative risk. The tools currently available to risk-stratify patients are limited. This study assessed the prognostic utility of metabolic measurements derived from(18)F-FDG PET compared with previously proposed prognostic scoring systems. Preoperative (18)F-FDG PET/CT studies from a series of 30 patients who underwent liver resection for CRLM after neoadjuvant chemotherapy were evaluated. Quantitative (18)F-FDG PET analysis calculated the maximum and mean standardized uptake value, metabolic tumor volume (MTV), and tumor glycolytic volume (TGV) as measures of the metabolic activity of tumors. The predictive value of these parameters was compared with that of 4 prognostic scores developed by Fong, Iwatsuki, Nordlinger, and Rees. High MTV and TGV in patients before metastasectomy were significantly associated with poorer overall survival (MTV: P = 0.001; TGV: P = 0.004) and recurrence-free survival (MTV: P = 0.001, TGV; P = 0.002). Maximum and mean standardized uptake value did not show any significant predictive ability. Of the prognostic scores, prediction of outcome was most accurate using the Basingstoke index (area under the curve, 0.898). Assessment of metabolic tumor burden with volumetric (18)F-FDG PET parameters appears to be a valuable adjunct in determining the biology of CRLM before surgical resection and may enable better risk stratification of patients.

  20. 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?

  1. External validation of prognostic models to predict risk of gestational diabetes mellitus in one Dutch cohort: prospective multicentre cohort study.

    Science.gov (United States)

    Lamain-de Ruiter, Marije; Kwee, Anneke; Naaktgeboren, Christiana A; de Groot, Inge; Evers, Inge M; Groenendaal, Floris; Hering, Yolanda R; Huisjes, Anjoke J M; Kirpestein, Cornel; Monincx, Wilma M; Siljee, Jacqueline E; Van 't Zelfde, Annewil; van Oirschot, Charlotte M; Vankan-Buitelaar, Simone A; Vonk, Mariska A A W; Wiegers, Therese A; Zwart, Joost J; Franx, Arie; Moons, Karel G M; Koster, Maria P H

    2016-08-30

     To perform an external validation and direct comparison of published prognostic models for early prediction of the risk of gestational diabetes mellitus, including predictors applicable in the first trimester of pregnancy.  External validation of all published prognostic models in large scale, prospective, multicentre cohort study.  31 independent midwifery practices and six hospitals in the Netherlands.  Women recruited in their first trimester (diabetes mellitus of any type were excluded.  Discrimination of the prognostic models was assessed by the C statistic, and calibration assessed by calibration plots.  3723 women were included for analysis, of whom 181 (4.9%) developed gestational diabetes mellitus in pregnancy. 12 prognostic models for the disorder could be validated in the cohort. C statistics ranged from 0.67 to 0.78. Calibration plots showed that eight of the 12 models were well calibrated. The four models with the highest C statistics included almost all of the following predictors: maternal age, maternal body mass index, history of gestational diabetes mellitus, ethnicity, and family history of diabetes. Prognostic models had a similar performance in a subgroup of nulliparous women only. Decision curve analysis showed that the use of these four models always had a positive net benefit.  In this external validation study, most of the published prognostic models for gestational diabetes mellitus show acceptable discrimination and calibration. The four models with the highest discriminative abilities in this study cohort, which also perform well in a subgroup of nulliparous women, are easy models to apply in clinical practice and therefore deserve further evaluation regarding their clinical impact. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  2. 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.

  3. ASSESSMENT OF PROGNOSTIC FACTORS CONSIDERING THE VOLUME OF SKELETAL METASTASIS IN PATIENTS WITH DISSEMINATED PROSTATE CANCER

    Directory of Open Access Journals (Sweden)

    N. E. Kosyh

    2017-01-01

    Full Text Available Purpose. To determine the correlation between prognostic factors (age, differentiation grade assessed using the Gleason scoring system, serum prostate specific antigen, prostate volume, and serum testosterone and the volume of skeletal metastasis expressed as bone metastasis index (BMI in patients with disseminated prostate cancer (DPC. Material and methods. We conducted a retrospective analysis of 157 patients with initially diagnosed DPC treated at the Khabarovsk Regional Cancer Center from 2003 to 2013. Bone metastases were revealed in all patients. The volume of skeletal metastasis was measured using a novel automated computeraided diagnosis system devised by the specialists of Computer Center of the Russian Academy of Sciences. Results. The patients were divided into four groups. Group1: BMI≤1 % and Gleason score≤5; group 2: BMI ≤1 % and Gleason Score≥3; group 3: BMI>1 % and Gleason score≤5; group 4: BMI>1 % and Gleason score>5. The median survival time was 48 months in group 1 patients, 36.5 months in group 2, 33 months in group 3 and 20 months in group 4 patients. Both log-rank and Wilcoxon tests demonstrated a statistically significant difference in survival curves between the groups 1 and 3, and between the groups 2 and 4. There was also a difference in differentiation grade assessed by the Gleason score system between these two pairs of groups. Correlation of other prognostic factors, such as age, serum prostate specific antigen, prostate volume, and serum testosterone with the volume of skeletal metastasis demonstrated that BMI predominantly influenced the survival of prostate cancer patients. Conclusion. The assessment of prognostic factors allowed the patients’ groups with the worst prognosis to be identified. The bone metastasis index and differentiation grade of the tumor appeared to be independent predictors of high death risk in patients with disseminated prostate cancer.

  4. Pollinator Risk Assessment Guidance

    Science.gov (United States)

    This Guidance is part of a long-term strategy to advance the science of assessing the risks posed by pesticides to honey bees, giving risk managers the means to further improve pollinator protection in our regulatory decisions.

  5. Ecological risk assessment

    National Research Council Canada - National Science Library

    Suter, Glenn W; Barnthouse, L. W. (Lawrence W)

    2007-01-01

    Ecological risk assessment is commonly applied to the regulation of chemicals, the remediation of contaminated sites, the monitoring of importation of exotic organisms, the management of watersheds...

  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. Fatigue as Prognostic Risk Marker of Mental Sickness Absence in White Collar Employees

    NARCIS (Netherlands)

    Roelen, C.A.M.; Heymans, M.W.; van Rhenen, W.; Groothoff, J.W.; Twisk, J.W.R.; Bultmann, U.

    2014-01-01

    Purpose: To investigate fatigue as prognostic risk marker for identifying working employees at risk of long-term sickness absence (SA). Methods: At baseline, fatigue was measured in 633 white collar employees with the checklist individual strength (CIS) including scales for fatigue severity, reduced

  8. Fatigue as prognostic risk marker of mental sickness absence in white collar employees

    NARCIS (Netherlands)

    Roelen, C. A. M.; Heymans, M. W.; van Rhenen, W.; Groothoff, J. W.; Twisk, J. W. R.; Bültmann, U.

    2014-01-01

    To investigate fatigue as prognostic risk marker for identifying working employees at risk of long-term sickness absence (SA). At baseline, fatigue was measured in 633 white collar employees with the checklist individual strength (CIS) including scales for fatigue severity, reduced concentration,

  9. Fatigue as Prognostic Risk Marker of Mental Sickness Absence in White Collar Employees

    NARCIS (Netherlands)

    Roelen, C. A. M.; Heymans, M. W.; van Rhenen, W.; Groothoff, J. W.; Twisk, J. W. R.; Bultmann, U.

    Purpose To investigate fatigue as prognostic risk marker for identifying working employees at risk of long-term sickness absence (SA). Methods At baseline, fatigue was measured in 633 white collar employees with the checklist individual strength (CIS) including scales for fatigue severity, reduced

  10. The prognostic value of MRI in determining reinjury risk following acute hamstring injury: a systematic review

    NARCIS (Netherlands)

    van Heumen, Moniek; Tol, Johannes L.; de Vos, Robert-Jan; Moen, Maarten H.; Weir, Adam; Orchard, John; Reurink, Gustaaf

    2017-01-01

    A challenge for sports physicians is to estimate the risk of a hamstring re-injury, but the current evidence for MRI variables as a risk factor is unknown. To systematically review the literature on the prognostic value of MRI findings at index injury and/or return to play for acute hamstring

  11. 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.

  12. 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...

  13. Performance of the Multidimensional Geriatric Assessment and Multidimensional Prognostic Index in predicting negative outcomes in older adults with cancer.

    Science.gov (United States)

    Giantin, V; Falci, C; De Luca, E; Valentini, E; Iasevoli, M; Siviero, P; Maggi, S; Martella, B; Crepaldi, G; Monfardini, S; Manzato, E

    2018-01-01

    The Multidimensional Geriatric Assessment (MGA) is currently used for assessing geriatric oncological patients, but a new prognostic index - the Multidimensional Prognostic Index (MPI) - has a demonstrated prognostic value in cancer patients too. The present work was designed to compare the MPI and MGA as predictors of 12-month mortality. 160 patients ≥70 years old with locally-advanced or metastatic solid cancers consecutively joining our Geriatric Oncology Program were administered a Comprehensive Geriatric Assessment to calculate their MGA and MPI scores. Geriatric Clinic, Geriatric Surgery Clinic, Medical Oncology Unit, Padova Hospital, Italy. Using Cohen's Kappa coefficient, there was a poor concordance between the MPI and MGA. Severe MPI being associated with a higher mortality risk than Frail in the MGA. The ROC curves indicated that the MPI had a greater discriminatory power for 12-month mortality than the MGA. In our population of elderly cancer patients, the MPI performed better than the MGA in predicting mortality. Further evidence from larger prospective trials is needed to establish whether other geriatric scales, such as the GDS and CIRS-SI, could enhance the value of prognostic indexes applied to elderly cancer patients. © 2016 John Wiley & Sons Ltd.

  14. Operational risk assessment.

    Science.gov (United States)

    McKim, Vicky L

    2017-06-01

    In the world of risk management, which encompasses the business continuity disciplines, many types of risk require evaluation. Financial risk is most often the primary focus, followed by product and market risks. Another critical area, which typically lacks a thorough review or may be overlooked, is operational risk. This category encompasses many risk exposure types including those around building structures and systems, environmental issues, nature, neighbours, clients, regulatory compliance, network, data security and so on. At times, insurance carriers will assess internal hazards, but seldom do these assessments include more than a cursory look at other types of operational risk. In heavily regulated environments, risk assessments are required but may not always include thorough assessments of operational exposures. Vulnerabilities may linger or go unnoticed, only to become the catalyst for a business disruption at a later time, some of which are so severe that business recovery becomes nearly impossible. Businesses may suffer loss of clients as the result of a prolonged disruption of services. Comprehensive operational risk assessments can assist in identifying such vulnerabilities, exposures and threats so that the risk can be minimised or removed. This paper lays out how an assessment of this type can be successfully conducted.

  15. Risk assessment [Chapter 9

    Science.gov (United States)

    Dennis S. Ojima; Louis R. Iverson; Brent L. Sohngen; James M. Vose; Christopher W. Woodall; Grant M. Domke; David L. Peterson; Jeremy S. Littell; Stephen N. Matthews; Anantha M. Prasad; Matthew P. Peters; Gary W. Yohe; Megan M. Friggens

    2014-01-01

    What is "risk" in the context of climate change? How can a "risk-based framework" help assess the effects of climate change and develop adaptation priorities? Risk can be described by the likelihood of an impact occurring and the magnitude of the consequences of the impact (Yohe 2010) (Fig. 9.1). High-magnitude impacts are always...

  16. Fatigue as prognostic risk marker of mental sickness absence in white collar employees.

    Science.gov (United States)

    Roelen, C A M; Heymans, M W; van Rhenen, W; Groothoff, J W; Twisk, J W R; Bültmann, U

    2014-06-01

    To investigate fatigue as prognostic risk marker for identifying working employees at risk of long-term sickness absence (SA). At baseline, fatigue was measured in 633 white collar employees with the checklist individual strength (CIS) including scales for fatigue severity, reduced concentration, reduced motivation, and reduced physical activity. SA was medically certified by an occupational physician in the 3rd or 4th SA week with diagnostic codes according to the 10th version of the International Classification of Diseases. Medically certified SA was retrieved at the individual level from an occupational health register after 1-year follow-up. CIS scores were investigated as prognostic risk markers predicting medically certified SA and particularly SA certified as mental SA. 614 employees (N = 378 men and N = 236 women) had complete data and were eligible for analysis; 63 (10 %) had medically certified SA of whom 39 (6 %) had mental SA. Fatigue severity and total CIS scores were associated with medically certified SA in men, but poorly discriminated between men with and without medically certified SA. Fatigue severity, reduced concentration, reduced motivation, and total CIS scores were also associated with mental SA in men. CIS and its reduced concentration scale were valid prognostic risk markers of mental SA. CONCLUSION Fatigue was a prognostic risk marker of mental SA in white collar men. The CIS should be further validated as a screening tool for the risk of mental SA in white collar working populations.

  17. Critical Assessment of Clinical Prognostic Tools in Melanoma.

    Science.gov (United States)

    Mahar, Alyson L; Compton, Carolyn; Halabi, Susan; Hess, Kenneth R; Gershenwald, Jeffrey E; Scolyer, Richard A; Groome, Patti A

    2016-09-01

    The 7th edition American Joint Committee on Cancer (AJCC) melanoma staging system classifies patients according to prognosis. Significant within-stage heterogeneity remains and the inclusion of additional clinicopathologic and other host- and tumor-based prognostic factors have been proposed. Clinical prognostic tools have been developed for use in clinical practice to refine survival estimates. Little is known about the comparative features of tools in melanoma. We performed a systematic search of the scientific published literature for clinical prognostic tools in melanoma and web-based resources. A priori criteria were used to evaluate their quality and clinical relevance, and included intended clinical use, model development approaches, validation strategies, and performance metrics. We identified 17 clinical prognostic tools for primary cutaneous melanoma. Patients with stages I-III and T1 or thin melanoma were the most frequently considered populations. Seventy-five percent of tools were developed using data collected from patients diagnosed in 2006 or earlier, and the well-established factors of tumor thickness, ulceration, and age were included in 70 % of tools. Internal validity using cross-validation or bootstrapping techniques was performed for two tools only. Fewer than half were evaluated for external validity; however, when done, the appropriate statistical methodology was applied and results indicated good generalizability. Several clinical prognostic tools have the potential to refine survival estimates for individual melanoma patients; however, there is a great opportunity to improve these tools and to foster the development of new, validated tools by the inclusion of contemporary clinicopathological covariates and by using improved statistical and methodological approaches.

  18. Introduction of a prognostic biomarker to strengthen risk stratification of acutely admitted patients

    DEFF Research Database (Denmark)

    Sandø, Andreas; Schultz, Martin; Eugen-Olsen, Jesper

    2016-01-01

    BACKGROUND: Several biomarkers have shown to carry prognostic value beyond current triage algorithms and may aid in initial risk stratification of patients in the emergency department (ED). It has yet to be established if information provided by biomarkers can be used to prevent serious complicat......BACKGROUND: Several biomarkers have shown to carry prognostic value beyond current triage algorithms and may aid in initial risk stratification of patients in the emergency department (ED). It has yet to be established if information provided by biomarkers can be used to prevent serious...... of prognostic information can improve outcome in acutely admitted patients. This might have an impact on health care organization and decision-making. TRIAL REGISTRATION: The trial is registered at clinicaltrials.gov (ID NCT02643459 , November 13, 2015) and at the Danish Data Protection agency (ID HGH-2015...

  19. 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...... they are targeted. Multiple reviews and systematic reviews are available in the literature on this topic. This chapter focusses primarily on results of reviews based on longitudinal studies required to establish the accuracy of caries risk assessment. These findings demonstrate that there is a strong body...... of evidence to support that caries experience is still, unfortunately, the single best predictor for future caries development. In young children, prediction models which include a variety of risk factors seem to increase the accuracy of the prediction, while the usefulness of additional risk factors...

  20. Public Risk Assessment Program

    Science.gov (United States)

    Mendeck, Gavin

    2010-01-01

    The Public Entry Risk Assessment (PERA) program addresses risk to the public from shuttle or other spacecraft re-entry trajectories. Managing public risk to acceptable levels is a major component of safe spacecraft operation. PERA is given scenario inputs of vehicle trajectory, probability of failure along that trajectory, the resulting debris characteristics, and field size and distribution, and returns risk metrics that quantify the individual and collective risk posed by that scenario. Due to the large volume of data required to perform such a risk analysis, PERA was designed to streamline the analysis process by using innovative mathematical analysis of the risk assessment equations. Real-time analysis in the event of a shuttle contingency operation, such as damage to the Orbiter, is possible because PERA allows for a change to the probability of failure models, therefore providing a much quicker estimation of public risk. PERA also provides the ability to generate movie files showing how the entry risk changes as the entry develops. PERA was designed to streamline the computation of the enormous amounts of data needed for this type of risk assessment by using an average distribution of debris on the ground, rather than pinpointing the impact point of every piece of debris. This has reduced the amount of computational time significantly without reducing the accuracy of the results. PERA was written in MATLAB; a compiled version can run from a DOS or UNIX prompt.

  1. Incremental prognostic value of coronary computed tomographic angiography high-risk plaque characteristics in newly symptomatic patients.

    Science.gov (United States)

    Fujimoto, Shinichiro; Kondo, Takeshi; Takamura, Kazuhisa; Baber, Usman; Shinozaki, Tomohiro; Nishizaki, Yuji; Kawaguchi, Yuko; Matsumori, Rie; Hiki, Makoto; Miyauchi, Katsumi; Daida, Hiroyuki; Hecht, Harvey; Stone, Gregg W; Narula, Jagat

    2016-06-01

    The incremental prognostic value of the plaque features in coronary computed tomographic angiography (CTA) has not been well assessed. This study was designed to determine whether CTA high-risk plaques have prognostic value incremental to the Framingham risk score (FRS) and the severity of luminal obstruction. A total of 628 newly symptomatic patients without known coronary artery disease underwent CTA. They were followed for a median of 677 days during which there were 26 cardiac events, including cardiac death, acute myocardial infarction, and hospitalization for unstable angina. Incremental prognostic value of adding plaque characteristics to the number of diseased vessels and the FRS was evaluated using 3 Cox models and net reclassification indexes. The discrimination index was significantly increased by adding the number of diseased vessels to the FRS (change in c-statistic from 65.8% to 78.6%, p=0.028) but not significantly by further adding plaque characteristics (change in c-statistic from 78.6% to 80.0%, p=0.812). However, improved model-fitting by adding plaque characteristics into the linear combination with risk score and the number of diseased vessels (p=0.007 from likelihood ratio test) and the lowest value of Akaike's information criteria of that model indicated that plaque characteristics improved both predictive accuracy and discrimination perspective. More subjects reclassified by plaque characteristics were moved to directions consistent with their subsequent cardiac event status than in an inconsistent direction. Evaluation of CTA plaque characteristics may provide incremental prognostic value to the number of diseased vessels and the FRS. Copyright © 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  2. Risk stratification using Bmi-1 and Snail expression is a useful prognostic tool for patients with upper tract urothelial carcinoma.

    Science.gov (United States)

    Matsumoto, Hiroaki; Munemori, Masaru; Shimizu, Kosuke; Fujii, Nakanori; Kobayashi, Keita; Inoue, Ryo; Yamamoto, Yoshiaki; Nagao, Kazuhiro; Matsuyama, Hideyasu

    2016-12-01

    To investigate the expression levels of E-cadherin, Snail, Twist and Bmi-1 in the human upper tract urothelial carcinoma, and to assess whether these factors could be prognostic markers. Immunohistochemistry was carried out to determine the expression of E-cadherin, Snail, Twist and Bmi-1 in upper tract urothelial carcinoma samples from 144 patients that underwent total nephroureterectomy between January 1995 and December 2010. The patient population had a median age of 71 years, and comprised 104 men and 40 women, with a median follow-up period of 40 months. The prognostic value of these markers was assessed by univariate and multivariate analysis. A risk stratification analysis was carried out. Snail and Bmi-1 expression predicted worse overall survival (P = 0.0075 and 0.0035), cancer-specific survival (P = 0.0919 and 0.0085) and recurrence-free survival (P = 0.0360 and 0.0817, respectively) compared with tumors that lacked Snail and Bmi-1 expression. Additionally, clinical parameters, grade, stage and lymphovascular invasion correlated with overall survival, cancer-specific survival and recurrence-free survival. Multivariate analysis showed that Bmi-1 expression was among the most significant factors in predicting cancer-specific survival (P = 0.0333). The combination of Snail, Bmi-1 and pathological stage was the most useful prognostic biomarker for upper tract urothelial carcinoma. Risk stratification by epithelial-mesenchymal transition and cancer stem cell-regulated genes, such as Snail and Bmi-1, might be useful prognostic markers for upper tract urothelial carcinoma. © 2016 The Japanese Urological Association.

  3. The Strauss and Carpenter Prognostic Scale in subjects clinically at high risk of psychosis

    NARCIS (Netherlands)

    Nieman, D. H.; Velthorst, E.; Becker, H. E.; de Haan, L.; Dingemans, P. M.; Linszen, D. H.; Birchwood, M.; Patterson, P.; Salokangas, R. K. R.; Heinimaa, M.; Heinz, A.; Juckel, G.; von Reventlow, H. G.; Morrison, A.; Schultze-Lutter, F.; Klosterkötter, J.; Ruhrmann, S.; McGorry, Patrick D.; McGlashan, Thomas H.; Knapp, Martin; van de Fliert, Reinaud; Klaassen, Rianne; Picker, Heinz; Neumann, Meike; Brockhaus-Dumke, Anke; Pukrop, Ralf; Svirskis, Tanja; Huttunen, Jukka; Laine, Tiina; Ilonen, Tuula; Ristkari, Terja; Hietala, Jarmo; Skeate, Amanda; Gudlowski, Yehonala; Ozgürdal, Seza; French, Paul; Stevens, Helen

    2013-01-01

    To investigate the predictive value of the Strauss and Carpenter Prognostic Scale (SCPS) for transition to a first psychotic episode in subjects clinically at high risk (CHR) of psychosis. Two hundred and forty-four CHR subjects participating in the European Prediction of Psychosis Study were

  4. Risk factors for necrotizing enterocolitis in neonates: A systematic review of prognostic studies

    NARCIS (Netherlands)

    Samuels, N. (Noor); R.A. van de Graaf (Rob); R.C.J. de Jonge (Rogier); I.K.M. Reiss (Irwin); M.J. Vermeulen (Marijn)

    2017-01-01

    textabstractBackground: Necrotizing enterocolitis (NEC) is a severe multifactorial disease in preterm neonates associated with high morbidity and mortality. Better insight into prognostic values of the many reported factors associated with NEC is needed to enable identification of neonates at risk

  5. Integrative prognostic risk score in acute myeloid leukemia with normal karyotype

    National Research Council Canada - National Science Library

    Damm, Frederik; Heuser, Michael; Morgan, Helen; Wagner, Katharina; Görlich, Kerstin; Großhennig, Anika; Hamwi, Iyas; Thol, Felicitas; Surdziel, Ewa; Fiedler, Walter; Lübbert, Michael; Kanz, Lothar; Reuter, Christoph; Heil, Gerhard; Delwel, Ruud; Löwenberg, Bob; Valk, Peter; Krauter, J; Ganser, Arnold

    2011-01-01

    .... Integrative prognostic risk score (IPRS) was modeled in 181 patients based on age, white blood cell count, mutation status of NPM1, FLT3-ITD, CEBPA, single nucleotide polymorphism rs16754, and expression levels of BAALC, ERG, MN1, and WT1...

  6. Maximum tumor diameter is not an independent prognostic factor in high-risk localized prostate cancer

    NARCIS (Netherlands)

    Oort, van I.M.; Witjes, J.A.; Kok, D.E.G.; Kiemeney, L.A.; Hulsbergen-van de Kaa, C.A.

    2008-01-01

    Previous studies suggest that maximum tumor diameter (MTD) is a predictor of recurrence in prostate cancer (PC). This study investigates the prognostic value of MTD for biochemical recurrence (BCR) in patients with PC, after radical prostatectomy (RP), with emphasis on high-risk localized prostate

  7. Maximum tumor diameter is not an independent prognostic factor in high-risk localized prostate cancer.

    NARCIS (Netherlands)

    Oort, I.M. van; Witjes, J.A.M.; Kok, D.E.; Kiemeney, L.A.L.M.; Hulsbergen- van de Kaa, C.A.

    2008-01-01

    OBJECTIVES: Previous studies suggest that maximum tumor diameter (MTD) is a predictor of recurrence in prostate cancer (PC). This study investigates the prognostic value of MTD for biochemical recurrence (BCR) in patients with PC, after radical prostatectomy (RP), with emphasis on high-risk

  8. Prognostic model to identify patients with myelofibrosis at the highest risk of transformation to acute myeloid leukemia.

    Science.gov (United States)

    Quintás-Cardama, Alfonso; Kantarjian, Hagop; Pierce, Sherry; Cortes, Jorge; Verstovsek, Srdan

    2013-06-01

    Some patients with myelofibrosis (MF) progress to acute myeloid leukemia (AML). Current prognostic tools were not devised to assess risk of AML transformation. Multivariate analysis in 649 patients followed for a median of 19 months (range, 1-180 months). We identified age > 60 (P = .004; hazard ratio [HR], 1.63), platelets HR, 1.62), bone marrow blast > 10% (P = .002; HR, 2.18), high-risk karyotype (P HR, 2.44), transfusion dependency (P HR, 2.64), performance status > 1 (P = .003; HR, 1.47), lactate dehydrogenase > 2000 U/L (P HR, 1.62), previous hydroxyurea (P HR, 1.69), and male sex (P = .005; HR, 1.41) as independent poor prognostic factors for survival. Using the same baseline variables we identified bone marrow blasts >10% and worst karyotype as independent risk factors for AML transformation. Patients with 1 or both of these risk factors (n = 80; 12%) had a median survival of 10 months and a 1-year AML transformation rate of 13% (2% if none of those factors, P = .001). We have identified risk factors that predict high risk of transformation from MF to AML. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. Sovereign default risk assessment

    NARCIS (Netherlands)

    Rijken, H.A.; Altman, E.I.

    2013-01-01

    We propose a new approach toward assessing sovereign risk by examining rigorously the health and aggregate default risk of a nation's private corporate sector. Models can be utilised to measure the probability of default of the non-financial sector cumulatively for five years, both as an absolute

  10. PROGNOSTIC RISK OF OBSTETRIC AND PERINATAL COMPLICATIONS IN PREGNANT WOMEN WITH THYROID DYSFUNCTION.

    Science.gov (United States)

    Morchiladze, N; Tkeshelashvili, B; Gagua, T; Gagua, D

    2017-03-01

    Maternal thyroid pathology takes important role in obstetric and peri-neonatal morbidity structure. Despite of the number of studies conducted in the field of thyroid disorders of pregnant females, the definition of influence of thyroid gland dysfunction on maternal and neonatal health still remains actual. The mentioned topics draw specific interest in the aspect of prognosticaiton of complications and unfavorable outcome. Aim of the study - to define the specificities of gestation period and determine the prognostic risk of obstetric and perinatal complications in pregnant females with thyroid pathology. The study was performed at the base of "David Gagua Clinic" Ltd. Prospective, open controlled study design was applied. Based upon the referral to the clinic, 292 pregnant females with thyroid pathology were involved in the main group. The control group involved 58 conditionally healthy pregnant females of reproductive age. Thyroid status had been monitored accoding to trimesters during the whole period of prgnancy and 1 month following the delivery. The health state of neonates was assessed by international protocols. To define the confidence interval for relative ratio between quantitative data of compared groups, c2 , P and RR indices were calculated, and its critical level was considered to be 0.05. The risks ratio with defining of the data was determined for obstetric and perinatal complications. 120 (41.4%) of pregnant subjects demonstrated hypothyroidism, 104 (35.6%) - isolated hypothyroxinmia, and 13 (4.5%) - hyperthyroidism. High levels of anti-thyroid peroxidase antibodies were observed in 54 (18.5%) of cases, nodular gout was found in 38 (13%) patients, 5 (12.3%) of which was associated with hypothyroidism and 9 (23%) - with isolated hypothyroxinemia. Correcting treatment was administered to all pregnant subjects during the pregnancy period. Based on the analysis of acquired data, the high probability of prengancy-related nausea/vomiting and iron

  11. Prognostic value of serum biomarkers in association with TIMI risk score for acute coronary syndromes.

    Science.gov (United States)

    Manenti, Euler R E; Bodanese, Luiz Carlos; Camey, Suzi Alves; Polanczyk, Carisi A

    2006-09-01

    Markers of neurohormonal activation and inflammation play a pivotal role in non-ST-elevation acute coronary syndromes (NSTE-ACS). We hypothesized that other biochemical markers could add prognostic value on Thrombolysis In Myocardial Infarction (TIMI) risk score to predict major cardiovascular events in patients with NSTE-ACS. In a cohort of 172 consecutive patients with NSTE-ACS, TIMI score was assessed in the first 24 h, and blood samples were collected for measurement of N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein, CD40 ligand, and creatinine. Major clinical outcomes (death and cardiovascular hospitalization) were accessed at 30 days and 6 months. Multivariate logistic regression was applied to identify markers significantly associated with outcomes and, based on individual coefficients, an expanded score was developed. Of 172 patients, 42% had acute myocardial infarction. The unadjusted 30-day event rate increased with age (odds ratio [OR] = 1.03; 95% confidence interval [CI] 1.00-1.06), creatinine (OR = 2.4; 1.4-4.1), TIMI score (OR = 1.6; 1.2-2.2), troponin I (OR = 3.4; 1.5-7.7), total CK (OR = 2.7; 1.2-6.1), and NT-proBNP (OR = 2.9; 1.3-6.3) levels. In multivariate analysis, TIMI risk score, creatinine, and NT-proBNP remained associated with worse prognosis. Multimarker Expanded TIMI Risk Score [TIMI score + (2 X creatinine [in mg/dl]) + (3, if NT-proBNP > 400 pg/ml)] showed good accuracy for 30-day (c statistic 0.77; p score were 7, 26, and 75%, respectively (p TIMI risk score provide a better risk stratification than either test alone.

  12. [Granulosa cell tumor--the assessment of some clinical and therapeutic parameters as prognostic factors].

    Science.gov (United States)

    Bidziński, M; Krynicki, R; Lindner, B; Sobiczewski, P; Panek, G; Wierzba, W; Lewandowski, Z

    2001-12-01

    The results of the clinical and therapeutic factors in prognostic mean was presented. 48 cases of granulosa cell tumours treated from 1984 to 1994 in Oncology Centre in Warsaw were analysed. In investigated group 13 patients died, but only 8 because of relapse of the tumour. Among all analysed patients, 79% have reached 5 years free survival period. Tumour rupture, FIGO stage and incidence of irregular bleeding before recognition of the tumour had significant prognostic value. There were surprising that relative risk of relapse between patients stage I and II were similar (1.0 vs 1.01). The relative risk between I and III stage had strong prognostic difference. Additional operation after no radical surgery did not influence on better prognosis, but followed radiotherapy increase treatment results.

  13. Genomics-based Approach and Prognostic Stratification Significance of Gene Mutations in Intermediate-risk Acute Myeloid Leukemia

    Directory of Open Access Journals (Sweden)

    Bian-Hong Wang

    2015-01-01

    Conclusions: NGS represents a pioneering and helpful approach to prognostic risk stratification of IR-AML patients. Further large-scale studies for comprehensive molecular analysis are needed to provide guidance and a theoretical basis for IR-AML prognostic stratification and clinical management.

  14. External validation of prognostic models to predict risk of gestational diabetes mellitus in one Dutch cohort : prospective multicentre cohort study

    NARCIS (Netherlands)

    Lamain-de Ruiter, Marije; Kwee, Anneke; Naaktgeboren, Christiana A; de Groot, Inge; Evers, Inge M; Groenendaal, Floris; Hering, Yolanda R; Huisjes, Anjoke J M; Kirpestein, Cornel; Monincx, Wilma M; Siljee, Jacqueline E; Van 't Zelfde, Annewil; van Oirschot, Charlotte M; Vankan-Buitelaar, Simone A; Vonk, Mariska A A W; Wiegers, Therese A; Zwart, Joost J; Franx, Arie; Moons, Karel G M; Koster, Maria P H

    2016-01-01

    OBJECTIVE: To perform an external validation and direct comparison of published prognostic models for early prediction of the risk of gestational diabetes mellitus, including predictors applicable in the first trimester of pregnancy. DESIGN: External validation of all published prognostic models in

  15. 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.

  16. Microbial Risk Assessment

    Science.gov (United States)

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

    2009-01-01

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

  17. Age-related and prognostic risk factors in dialysis patients

    NARCIS (Netherlands)

    G.L. Tripepi (Giovanni)

    2012-01-01

    textabstractThe replacement of renal function by dialysis is one of the major achievements of modern medicine. However, given the fact that renal failure shares common causes with cardiovascular diseases, dialysis patients are a population with a risk profile of almost unique severity. In fact, it

  18. Prognostic risk factors for early diagnosing of Preeclampsia in ...

    African Journals Online (AJOL)

    Background: Preeclampsia is of major complications of pregnancy that is associated with maternal morbidity and mortality. Therefore, prediction and early diagnosis of preeclampsia would be helpful for better controlling of related complications. Our study aimed to investigate risk factors helping to predict and early diagnose ...

  19. Application of a Prognostic Gleason Grade Grouping System to Assess Distant Prostate Cancer Outcomes.

    Science.gov (United States)

    Leapman, Michael S; Cowan, Janet E; Simko, Jeffry; Roberge, Gray; Stohr, Bradley A; Carroll, Peter R; Cooperberg, Matthew R

    2017-05-01

    There is growing enthusiasm for the adoption of a novel grade grouping system to better represent Gleason scores. To evaluate the ability of prognostic Gleason grade groups to predict prostate cancer (PCa)-specific mortality (PCSM) and bone metastatic progression. We identified patients with PCa enrolled in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry across treatment strategies, including conservative and nondefinitive therapy. We examined the prognostic ability of Gleason grade groups to predict risk of PCSM and bone metastasis using the Kaplan-Meier method and unadjusted and adjusted Cox proportional hazards models. We identified 10529 men with PCa followed for a median of 81 mo (interquartile range 40-127), including 64% in group I (bone metastasis were significantly associated with prognostic grade groupings for both biopsy and prostatectomy samples (all pGleason sums collapsed within grade group V were not significant; however, this analysis was limited by a small representation of men with Gleason pattern ≥ 4 + 5. The prognostic grade grouping system is associated with risk of PCSM and metastasis across management strategies, including definitive therapy, conservative management, and primary androgen deprivation. A five-level reporting system for prostate cancer pathology is associated with the risk of late prostate cancer endpoints. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  20. Reliability data update using condition monitoring and prognostics in probabilistic safety assessment

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyeon Min; Lee, Sang Hwan; Park, Jun Seok; Kim, Hyung Dae; Chang, Yoon Suk; Heo, Gyun Young [Dept. of Nuclear Engineering, Kyung Hee University, Yongin (Korea, Republic of)

    2015-03-15

    Probabilistic safety assessment (PSA) has had a significant role in quantitative decision making by finding design and operational vulnerabilities and evaluating cost-benefit in improving such weak points. In particular, it has been widely used as the core methodology for risk-informed applications (RIAs). Even though the nature of PSA seeks realistic results, there are still 'conservative' aspects. One of the sources for the conservatism is the assumptions of safety analysis and the estimation of failure frequency. Surveillance, diagnosis, and prognosis (SDP), utilizing massive databases and information technology, is worth highlighting in terms of its capability for alleviating the conservatism in conventional PSA. This article provides enabling techniques to solidify a method to provide time and condition-dependent risks by integrating a conventional PSA model with condition monitoring and prognostics techniques. We will discuss how to integrate the results with frequency of initiating events (IEs) and probability of basic events (BEs). Two illustrative examples will be introduced: (1) how the failure probability of a passive system can be evaluated under different plant conditions and (2) how the IE frequency for a steam generator tube rupture (SGTR) can be updated in terms of operating time. We expect that the proposed model can take a role of annunciator to show the variation of core damage frequency (CDF) depending on operational conditions.

  1. Using risk factors for detection and prognostication of uveal melanoma

    Directory of Open Access Journals (Sweden)

    Pukhraj Rishi

    2015-01-01

    Full Text Available The early detection of malignancy, particularly uveal melanoma, is crucial in protecting visual acuity, salvaging the eye, and preventing metastasis. Risk factors for early detection of uveal melanoma have been clearly delineated in the literature and allow identification of melanoma when it is tiny and simulates a nevus. These factors include thickness >2 mm, presence of subretinal fluid (SRF, symptoms, the orange pigment, margin near optic disc, acoustic hollowness, surrounding halo, and absence of drusen. The importance of early detection is realized when one considers melanoma thickness, as each millimeter increase in melanoma thickness imparts 5% increased risk for metastatic disease. Newer imaging modalities like enhanced depth imaging optical coherence tomography and fundus autoflouroscence facilitate in detection of SRF and orange pigment. Additional molecular biomarkers and cytological features have been identified which can predict the clinical behavior of a small melanocytic lesion. Features that suggest a poor prognosis include higher blood levels of tyrosinase m-RNA, vascular endothelial growth factor, insulin-like growth factor; monosomy 3 and gains in chromosome 8. Management of uveal melanoma includes enucleation (for large, local eye wall resection, brachytherapy, charged particle irradiation, and thermotherapy (for small to medium tumors. Although the role of a good clinical evaluation cannot be underestimated, it is advisable to evaluate the various radiological, molecular, and cytological features, to enhance the accuracy of early diagnosis and improved prognosis.

  2. The clinical and prognostic value of motor abnormalities in psychosis, and the importance of instrumental assessment.

    Science.gov (United States)

    van Harten, Peter N; Walther, Sebastian; Kent, Jerillyn S; Sponheim, Scott R; Mittal, Vijay A

    2017-07-13

    Motor abnormalities comprise several clinical signs intrinsic to psychosis. Critically, these features are of prognostic value in individuals at-risk for psychosis, and for those in early stages of psychotic disorders. Motor abnormalities such as tremor, rigidity, and neurological soft signs often go unrecognized. Currently, advances in this area are limited by a paucity of theoretical conceptions categorizing or linking these behaviours to underlying neurobiology affected in psychosis. However, emerging technological advances have significantly improved the ability to detect and assess motor abnormalities with objective instruments in a timely and reliable manner. Further, converging evidence has laid the groundwork for theoretically and empirically derived categorization and conceptualization. This review summarizes these advances, stressing the importance of motor abnormalities for understanding vulnerability across different stages of psychosis and introducing these innovative instrumental approaches. Patients, researchers and clinicians will benefit from these new developments, as better assessment aids the development of targeted interventions to ultimately improve the care for individuals experiencing psychosis. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Risk Assessment in Criminal Sentencing.

    Science.gov (United States)

    Monahan, John; Skeem, Jennifer L

    2016-01-01

    The past several years have seen a surge of interest in using risk assessment in criminal sentencing, both to reduce recidivism by incapacitating or treating high-risk offenders and to reduce prison populations by diverting low-risk offenders from prison. We begin by sketching jurisprudential theories of sentencing, distinguishing those that rely on risk assessment from those that preclude it. We then characterize and illustrate the varying roles that risk assessment may play in the sentencing process. We clarify questions regarding the various meanings of "risk" in sentencing and the appropriate time to assess the risk of convicted offenders. We conclude by addressing four principal problems confronting risk assessment in sentencing: conflating risk and blame, barring individual inferences based on group data, failing adequately to distinguish risk assessment from risk reduction, and ignoring whether, and if so, how, the use of risk assessment in sentencing affects racial and economic disparities in imprisonment.

  4. Prognostic Significance of Remote Myocardium Alterations Assessed by Quantitative Noncontrast T1 Mapping in ST-Segment Elevation Myocardial Infarction.

    Science.gov (United States)

    Reinstadler, Sebastian J; Stiermaier, Thomas; Liebetrau, Johanna; Fuernau, Georg; Eitel, Charlotte; de Waha, Suzanne; Desch, Steffen; Reil, Jan-Christian; Pöss, Janine; Metzler, Bernhard; Lücke, Christian; Gutberlet, Matthias; Schuler, Gerhard; Thiele, Holger; Eitel, Ingo

    2017-06-09

    This study assessed the prognostic significance of remote zone native T1 alterations for the prediction of clinical events in a population with ST-segment elevation myocardial infarction (STEMI) who were treated by primary percutaneous coronary intervention (PPCI) and compared it with conventional markers of infarct severity. The exact role and incremental prognostic relevance of remote myocardium native T1 mapping alterations assessed by cardiac magnetic resonance (CMR) after STEMI remains unclear. We included 255 consecutive patients with STEMI who were reperfused within 12 h after symptom onset. CMR core laboratory analysis was performed to assess left ventricular (LV) function, standard infarct characteristics, and native T1 values of the remote, noninfarcted myocardium. The primary endpoint was a composite of death, reinfarction, and new congestive heart failure within 6 months (major adverse cardiac events [MACE]). Patients with increased remote zone native T1 values (>1,129 ms) had significantly larger infarcts (p = 0.012), less myocardial salvage (p = 0.002), and more pronounced LV dysfunction (p = 0.011). In multivariable analysis, remote zone native T1 was independently associated with MACE after adjusting for clinical risk factors (p = 0.001) or other CMR variables (p = 0.007). In C-statistics, native T1 of remote myocardium provided incremental prognostic information beyond clinical risk factors, LV ejection fraction, and other markers of infarct severity (all p infarct size, and myocardial salvage index) led to net reclassification improvement of 0.82 (95% confidence interval: 0.46 to 1.17; p Myocardial Damage in STEMI [LIPSIA-COND]; NCT02158468). Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  5. Validation of cytogenetic risk groups according to International Prognostic Scoring Systems by peripheral blood CD34+FISH: results from a German diagnostic study in comparison with an international control group.

    Science.gov (United States)

    Braulke, Friederike; Platzbecker, Uwe; Müller-Thomas, Catharina; Götze, Katharina; Germing, Ulrich; Brümmendorf, Tim H; Nolte, Florian; Hofmann, Wolf-Karsten; Giagounidis, Aristoteles A N; Lübbert, Michael; Greenberg, Peter L; Bennett, John M; Solé, Francesc; Mallo, Mar; Slovak, Marilyn L; Ohyashiki, Kazuma; Le Beau, Michelle M; Tüchler, Heinz; Pfeilstöcker, Michael; Nösslinger, Thomas; Hildebrandt, Barbara; Shirneshan, Katayoon; Aul, Carlo; Stauder, Reinhard; Sperr, Wolfgang R; Valent, Peter; Fonatsch, Christa; Trümper, Lorenz; Haase, Detlef; Schanz, Julie

    2015-02-01

    International Prognostic Scoring Systems are used to determine the individual risk profile of myelodysplastic syndrome patients. For the assessment of International Prognostic Scoring Systems, an adequate chromosome banding analysis of the bone marrow is essential. Cytogenetic information is not available for a substantial number of patients (5%-20%) with dry marrow or an insufficient number of metaphase cells. For these patients, a valid risk classification is impossible. In the study presented here, the International Prognostic Scoring Systems were validated based on fluorescence in situ hybridization analyses using extended probe panels applied to cluster of differentiation 34 positive (CD34(+)) peripheral blood cells of 328 MDS patients of our prospective multicenter German diagnostic study and compared to chromosome banding results of 2902 previously published patients with myelodysplastic syndromes. For cytogenetic risk classification by fluorescence in situ hybridization analyses of CD34(+) peripheral blood cells, the groups differed significantly for overall and leukemia-free survival by uni- and multivariate analyses without discrepancies between treated and untreated patients. Including cytogenetic data of fluorescence in situ hybridization analyses of peripheral CD34(+) blood cells (instead of bone marrow banding analysis) into the complete International Prognostic Scoring System assessment, the prognostic risk groups separated significantly for overall and leukemia-free survival. Our data show that a reliable stratification to the risk groups of the International Prognostic Scoring Systems is possible from peripheral blood in patients with missing chromosome banding analysis by using a comprehensive probe panel (clinicaltrials.gov identifier:01355913). Copyright© Ferrata Storti Foundation.

  6. Validation of cytogenetic risk groups according to International Prognostic Scoring Systems by peripheral blood CD34+FISH: results from a German diagnostic study in comparison with an international control group

    Science.gov (United States)

    Braulke, Friederike; Platzbecker, Uwe; Müller-Thomas, Catharina; Götze, Katharina; Germing, Ulrich; Brümmendorf, Tim H.; Nolte, Florian; Hofmann, Wolf-Karsten; Giagounidis, Aristoteles A. N.; Lübbert, Michael; Greenberg, Peter L.; Bennett, John M.; Solé, Francesc; Mallo, Mar; Slovak, Marilyn L.; Ohyashiki, Kazuma; Le Beau, Michelle M.; Tüchler, Heinz; Pfeilstöcker, Michael; Nösslinger, Thomas; Hildebrandt, Barbara; Shirneshan, Katayoon; Aul, Carlo; Stauder, Reinhard; Sperr, Wolfgang R.; Valent, Peter; Fonatsch, Christa; Trümper, Lorenz; Haase, Detlef; Schanz, Julie

    2015-01-01

    International Prognostic Scoring Systems are used to determine the individual risk profile of myelodysplastic syndrome patients. For the assessment of International Prognostic Scoring Systems, an adequate chromosome banding analysis of the bone marrow is essential. Cytogenetic information is not available for a substantial number of patients (5%–20%) with dry marrow or an insufficient number of metaphase cells. For these patients, a valid risk classification is impossible. In the study presented here, the International Prognostic Scoring Systems were validated based on fluorescence in situ hybridization analyses using extended probe panels applied to cluster of differentiation 34 positive (CD34+) peripheral blood cells of 328 MDS patients of our prospective multicenter German diagnostic study and compared to chromosome banding results of 2902 previously published patients with myelodysplastic syndromes. For cytogenetic risk classification by fluorescence in situ hybridization analyses of CD34+ peripheral blood cells, the groups differed significantly for overall and leukemia-free survival by uni- and multivariate analyses without discrepancies between treated and untreated patients. Including cytogenetic data of fluorescence in situ hybridization analyses of peripheral CD34+ blood cells (instead of bone marrow banding analysis) into the complete International Prognostic Scoring System assessment, the prognostic risk groups separated significantly for overall and leukemia-free survival. Our data show that a reliable stratification to the risk groups of the International Prognostic Scoring Systems is possible from peripheral blood in patients with missing chromosome banding analysis by using a comprehensive probe panel (clinicaltrials.gov identifier:01355913). PMID:25344522

  7. Additive prognostic value of subjective assessment with respect to clinical cardiological data in patients with chronic heart failure.

    Science.gov (United States)

    Majani, Giuseppina; Pierobon, Antonia; Pinna, Gian Domenico; Giardini, Anna; Maestri, Roberto; La Rovere, Maria Teresa

    2011-12-01

    Health-related quality of life tools that better reflect the unique subjective perception of heart failure (HF) are needed for patients with this disorder. The aim of this study was to explore whether subjective satisfaction of HF patients about daily life may provide additional prognostic information with respect to clinical cardiological data. One hundred and seventy-eight patients (age 51 ± 9 years) with moderate to severe HF [New York Heart Association (NYHA) class 2.0 ± 0.7; left ventricular ejection fraction (LVEF) 29 ± 8%] in stable clinical condition underwent a standard clinical evaluation and compiled the Satisfaction Profile (SAT-P) questionnaire focusing on subjective satisfaction with daily life. Cox regression analysis was used to assess whether SAT-P factors (psychological functioning, physical functioning, work, sleep/eating/leisure, social functioning) had any prognostic value. Forty-six cardiac deaths occurred during a median of 30 months. Patients who died had higher NYHA class, more depressed left ventricular function, reduced systolic blood pressure (SBP), increased heart rate (HR), and worse biochemistry (all p patients who died (p = 0.003). Using the best subset selection procedure, resistance to physical fatigue (RPF) was selected from among the items of the PF factor. RPF showed independent predictive value when entered into a prognostic model including NYHA class, LVEF, SBP, and HR with an adjusted hazard ratio of 0.86 per 10 units increase (95% CI 0.75-0.98, p = 0.02). Patients' dissatisfaction with physical functioning is associated with reduced long-term survival, after adjustment for known risk factors in HF. Given its user-friendly structure, simplicity, and significant prognostic value, the RPF score may represent a useful instrument in clinical practice.

  8. Validation of the new graded prognostic assessment scale for brain metastases: a multicenter prospective study

    Directory of Open Access Journals (Sweden)

    Cuadras Patricia

    2011-03-01

    Full Text Available Abstract Background Prognostic indexes are useful to guide tailored treatment strategies for cancer patients with brain metastasis (BM. We evaluated the new Graded Prognostic Assessment (GPA scale in a prospective validation study to compare it with two published prognostic indexes. Methods A total of 285 newly diagnosed BM (n = 85 with synchronous BM patients, accrued prospectively between 2000 and 2009, were included in this analysis. Mean age was 62 ± 12.0 years. The median KPS and number of BM was 70 (range, 20-100 and 3 (range, 1-50, respectively. The majority of primary tumours were lung (53%, or breast (17% cancers. Treatment was administered to 255 (89.5% patients. Only a minority of patients could be classified prospectively in a favourable prognostic class: GPA 3.5-4: 3.9%; recursive partitioning analysis (RPA 1, 8.4% and Basic Score for BM (BSBM 3, 9.1%. Mean follow-up (FU time was 5.2 ± 4.7 months. Results During the period of FU, 225 (78.9% patients died. The 6 months- and 1 year-OS was 36.9% and 17.6%, respectively. On multivariate analysis, performance status (P P P = 0.007, RPA (P = 0.02 and GPA (P = 0.03 were statistically significant for OS. The survival prediction performances' of all indexes were identical. Noteworthy, the significant OS difference observed within 3 months of diagnosis between the BSBM, RPA and GPA classes/groups was not observed after this cut-off time point. Harrell's concordance indexes C were 0.58, 0.61 and 0.58 for the GPA, BSBM and RPA, respectively. Conclusions Our data suggest that the new GPA index is a valid prognostic index. In this prospective study, the prediction performance was as good as the BSBM or RPA systems. These published indexes may however have limited long term prognostication capability.

  9. Next-generation prognostic assessment for diffuse large B-cell lymphoma

    Science.gov (United States)

    Staton, Ashley D; Kof, Jean L; Chen, Qiushi; Ayer, Turgay; Flowers, Christopher R

    2015-01-01

    Current standard of care therapy for diffuse large B-cell lymphoma (DLBCL) cures a majority of patients with additional benefit in salvage therapy and autologous stem cell transplant for patients who relapse. The next generation of prognostic models for DLBCL aims to more accurately stratify patients for novel therapies and risk-adapted treatment strategies. This review discusses the significance of host genetic and tumor genomic alterations seen in DLBCL, clinical and epidemiologic factors, and how each can be integrated into risk stratification algorithms. In the future, treatment prediction and prognostic model development and subsequent validation will require data from a large number of DLBCL patients to establish sufficient statistical power to correctly predict outcome. Novel modeling approaches can augment these efforts. PMID:26289217

  10. Prognostic Impact of the Geriatric Nutritional Risk Index on Long-Term Outcomes in Patients Who Underwent Percutaneous Coronary Intervention.

    Science.gov (United States)

    Wada, Hideki; Dohi, Tomotaka; Miyauchi, Katsumi; Doi, Shinichiro; Naito, Ryo; Konishi, Hirokazu; Tsuboi, Shuta; Ogita, Manabu; Kasai, Takatoshi; Hassan, Ahmed; Okazaki, Shinya; Isoda, Kikuo; Suwa, Satoru; Daida, Hiroyuki

    2017-06-01

    Malnutrition has been identified as an important predictor of poor clinical outcomes in patients with heart failure. The aim of this study is to examine the prognostic impact of nutritional status in patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI). The impact of nutrition, assessed using the geriatric nutritional risk index (GNRI) calculated by serum albumin and body mass index, was evaluated in 2,853 patients with CAD who underwent their first PCI between 2000 and 2011. Patients were assigned to tertiles based on their GNRI levels. The incidences of all-cause death and cardiac death were assessed. The median GNRI values were 101 (interquartile range 95 to 106). Lower GNRI levels were associated with older age and higher prevalence of acute coronary syndrome and chronic kidney disease. During the median follow-up period of 7.4 years, Kaplan-Meier curves showed ongoing divergence in rates of mortality among tertiles (GNRI nutritional status was associated with long-term clinical outcomes in CAD patients after PCI. Evaluation of GNRI carries important prognostic information and may guide the therapeutic approach to such patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. 2007 TOXICOLOGY AND RISK ASSESSMENT ...

    Science.gov (United States)

    EPA has announced The 2007 Toxicology and Risk Assessment Conference Cincinnati Marriott North, West Chester (Cincinnati), OHApril 23- 26, 2007 - Click to register!The Annual Toxicology and Risk Assessment Conference is a unique meeting where several Government Agencies come together to discuss toxicology and risk assessment issues that are not only of concern to the government, but also to a broader audience including academia and industry. The theme of this year's conference is Emerging Issues and Challenges in Risk Assessment and the preliminary agenda includes: Plenary Sessions and prominent speakers (tentative) include: Issues of Emerging Chemical ContaminantsUncertainty and Variability in Risk Assessment Use of Mechanistic data in IARC evaluationsParallel Sessions:Uncertainty and Variability in Dose-Response Assessment Recent Advances in Toxicity and Risk Assessment of RDX The Use of Epidemiologic Data for Risk Assessment Applications Cumulative Health Risk Assessment:

  12. Report on outcomes of hypomethylating therapy for analyzing prognostic value of Revised International Prognostic Scoring System for patients with lower-risk myelodysplastic syndromes.

    Science.gov (United States)

    Lee, Yoo Jin; Park, Sung Woo; Lee, In Hee; Ahn, Jae Sook; Kim, Hyeoung Joon; Chung, Joo Seop; Shin, Ho Jin; Lee, Won Sik; Lee, Sang Min; Joo, Young Don; Kim, Hawk; Lee, Ho Sup; Kim, Yang Soo; Cho, Yoon Young; Moon, Joon Ho; Sohn, Sang Kyun

    2016-10-01

    The outcomes for patients with lower-risk myelodysplastic syndromes (LR-MDS) by the International Prognostic Scoring System (IPSS) vary widely. For more precise prognostication, this study evaluates the prognostic value of revised IPSS with the response to hypomethylating therapy (HMT). Using the Korean MDS Working Party database, treatment outcomes for 236 patients with HMT were retrospectively evaluated. The patients were then reclassified into very low/low (VL/L), intermediate (INT), and high (H) risk groups according to IPSS-R. According to the HMT response, the 3-year overall survival (OS) did not differ between the response group (37.9 ± 9.1 %) and the stable group (52.9 ± 6.6 %, p = 0. 782). When reclassifying according to IPSS-R, 42 patients (20.8 %) were reclassified into the H risk group. Most of them did not have benefit from continued HMT and progressed to secondary failure. The median OS was 59.0 months (range, 40.0-77.9 months) for the VL/L risk group, 31 months (range, 22.7-439.3 months) for the INT risk group, and 20.0 months (range, 15.9-24.1 months) for the H risk group (p risk group according to IPSS-R (HR = 3.054, p risk according to IPSS-R (HR = 4.912, p = 0.003), and transformation to AML (HR = 2.158, p = 0.002). If IPSS-R reclassifies LR-MDS patients as H risk, these patients should be considered for early allo-HCT, regardless of the current benefits from HMT.

  13. Gene expression risk signatures maintain prognostic power in multiple myeloma despite microarray probe set translation

    DEFF Research Database (Denmark)

    Hermansen, N E U; Borup, R; Andersen, M K

    2016-01-01

    INTRODUCTION: Gene expression profiling (GEP) risk models in multiple myeloma are based on 3'-end microarrays. We hypothesized that GEP risk signatures could retain prognostic power despite being translated and applied to whole-transcript microarray data. METHODS: We studied CD138-positive bone...... marrow plasma cells in a prospective cohort of 59 samples from newly diagnosed patients eligible for high-dose therapy (HDT) and 67 samples from previous HDT patients with progressive disease. We used Affymetrix Human Gene 1.1 ST microarrays for GEP. Nine GEP risk signatures were translated by probe set...... match and applied to our data in multivariate Cox regression analysis for progression-free survival and overall survival in combination with clinical, cytogenetic and biochemical risk markers, including the International Staging System (ISS). RESULTS: Median follow-up was 66 months (range 42...

  14. 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...

  15. 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.

  16. 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.

  17. Antibiotic-resistant Pseudomonas aeruginosa infection in patients with bronchiectasis: prevalence, risk factors and prognostic implications

    Directory of Open Access Journals (Sweden)

    Gao YH

    2018-01-01

    Full Text Available Yong-hua Gao,1,* Wei-jie Guan,2,* Ya-nan Zhu,3 Rong-chang Chen,2 Guo-jun Zhang1 1Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 2State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 3Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China *These authors contributed equally to this work Background and aims: Pseudomonas aeruginosa (PA is the most common pathogen in bronchiectasis and frequently develops resistance to multiple classes of antibiotics, but little is known about the clinical impacts of PA-resistant (PA-R isolates on bronchiectasis. We, therefore, investigated the prevalence, risk factors and prognostic implications of PA-R isolates in hospitalized bronchiectasis patients.Patients and methods: Between June 2011 and July 2016, data from adult bronchiectasis patients isolated with PA at the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. PA was classified as PA-R in case antibiogram demonstrated resistance on at least one occasion.Results: Seven hundred forty-seven bronchiectasis patients were assessed. Of these, 147 (19.7% had PA isolate in the sputum or bronchoscopic culture. PA-R and PA-sensitive accounted for 88 (59.9% and 59 (31.1% patients, respectively. In multivariate model, factors associated with PA-R isolate in bronchiectasis included prior exposure to antibiotics (odds ratio [OR] =6.18, three or more exacerbations in the previous year (OR =2.81, higher modified Medical Research Council dyspnea scores (OR =1.93 and greater radiologic severity (OR =1.15. During follow-up (median: 26 months; interquartile range: 6–59 months, 36 patients died, of whom 24 (66

  18. Prognostic significance of complex karyotype and monosomal karyotype in adult patients with acute lymphoblastic leukemia treated with risk-adapted protocols.

    Science.gov (United States)

    Motlló, Cristina; Ribera, Josep-María; Morgades, Mireia; Granada, Isabel; Montesinos, Pau; González-Campos, José; Fernández-Abellán, Pascual; Tormo, Mar; Bethencourt, Concepción; Brunet, Salut; Hernández-Rivas, Jesús-María; Moreno, María-José; Sarrà, Josep; Del Potro, Eloy; Barba, Pere; Bernal, Teresa; Grande, Carlos; Grau, Javier; Cervera, José; Feliu, Evarist

    2014-12-15

    The karyotype is a predictor of outcomes in adults with acute lymphoblastic leukemia (ALL). The unfavorable prognostic significance of complex karyotype (CK) has been reported, whereas the prognostic relevance of monosomal karyotype (MK) has not been consistently evaluated. We aimed to assess the prognostic value of CK and MK in adults with ALL treated with risk-adapted protocols of the Spanish PETHEMA Group. The karyotypes of 881 adult ALL patients treated according to the protocols of the PETHEMA Group between 1993 and 2012 were centrally reviewed. CK and MK were assessed according to Moorman's criteria, and Breem's criteria, respectively. Specific analyses according to the risk groups and to the presence of t(9:22) were performed. Of 364 evaluable patients 33 (9.2%) had CK, and 68 of 535 evaluable patients (12.8%) had MK. Complete remission rate, remission duration, and overall survival were not significantly different according to the presence of CK or MK in the whole series, according to the B or T lineage, in the high-risk group, or in patients with t(9;22), regardless of imatinib treatment, and in patients who received chemotherapy alone or chemotherapy followed by stem cell transplantation Our study shows that CK and MK were not associated with a worse prognosis in adult patients with ALL treated with risk-adapted or subtype-oriented protocols. In patients with Ph+ ALL, MK did not have an impact on prognosis irrespective of imatinib treatment. © 2014 American Cancer Society.

  19. Outcome of individuals "not at risk of psychosis" and prognostic accuracy of the Basel Screening Instrument for Psychosis (BSIP).

    Science.gov (United States)

    Papmeyer, Martina; Aston, Jacqueline; Everts-Graber, Judith; Heitz, Ulrike; Studerus, Erich; Borgwardt, Stefan J; Stieglitz, Rolf-Dieter; Riecher-Rössler, Anita

    2017-04-21

    We aimed to determine the prognostic accuracy of the Basel Screening Instrument for Psychosis (BSIP) in terms of specificity, sensitivity, positive and negative predictive value by following up individuals that were initially not considered to be at increased risk of psychosis based on the BSIP. Moreover, clinical characteristics of these individuals were examined given the relative lack of such information in the literature. As part of the "Früherkennung von Psychosen" (FePsy) study, 87 individuals were screened with the BSIP. Of these, 64 were classified at baseline as being in an at-risk mental state (ARMS+) for psychosis using the BSIP and followed up at regular time intervals for at least 2 years to determine a putative transition to psychosis. Twenty-three individuals were classified at baseline as not being in an at-risk mental state (ARMS-) using the BSIP and re-assessed after 4 years. Sensitivity, specificity, positive and negative predictive value of the BSIP were computed. Clinical characteristics of the ARMS- group were analysed descriptively. During the follow-up period, none of the ARMS- individuals, but 21 of ARMS+ had developed psychosis. Sensitivity of the BSIP was 1.0, specificity was 0.35. The majority of ARMS- individuals showed depressive disorders or anxiety disorders and varying levels of functioning. The BSIP has good prognostic accuracy for detecting the prodromal phase of psychosis with an excellent sensitivity and a specificity similar to other risk instruments and the advantage of a relatively short duration. Depressive and anxiety symptoms commonly develop in ARMS- individuals. © 2017 John Wiley & Sons Australia, Ltd.

  20. Prognostic factors in presurgical assessment of frontal lobe epilepsy

    OpenAIRE

    Ferrier, C.; Engelsman, J; Alarcon, G; Binnie, C.; Polkey, C

    1999-01-01

    OBJECTIVES—To determine predictors for surgical outcome in the presurgical assessment of frontal lobe epilepsy.
METHODS—Thirty seven patients were operated on for frontal lobe epilepsy between 1975 and 1996. Their medical records were reviewed for ictal semiology, age at onset, duration of the epilepsy, age at operation, preoperative interictal and ictal encephalographic findings, and abnormalities on neuroimaging and neuropsychological testing. In addition, type of re...

  1. [Risk factors and prognostic factors in nosocomial pneumonia outside the intensive care units setting].

    Science.gov (United States)

    Barreiro-López, Bienvenido; Tricas, Josep Maria; Mauri, Elisabeth; Quintana, Salvador; Garau, Javier

    2005-11-01

    Nosocomial pneumonia (NP) is the second most frequent cause of hospital-acquired infection and is associated with elevated morbidity and mortality rates, particularly in intensive care units (ICU). The objectives of this study were to determine the incidence, risk factors and prognostic factors of NP acquired outside the ICU. A prospective case-control study was performed. All NP cases were acquired outside the ICU, and each case was paired with a control subject matched for gender, age, date of admission and hospitalization area. Epidemiological, clinical and microbiological data were obtained from cases and controls, and the risk factors and prognostic factors for NP were established. During the study period a total of 67 cases of NP outside the ICU were diagnosed. Estimated incidence was 3.35 cases/1,000 admissions. Mean age of the patients was 70 +/- 13 years and 48 of them were men. On multivariate analysis adjusted for confounding factors, bronchoaspiration, previous surgery and steroids were significantly associated with the development of NP. Mortality attributable to NP was 27%. The existence of an ultimately or rapidly fatal underlying condition and the presence of leukocytosis or leukopenia were associated with poor prognosis. The incidence of NP outside the ICU setting is low. Measures to reduce bronchoaspiration and judicial steroid use are necessary to decrease the risk of acquiring NP and to improve the prognosis.

  2. 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...... 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....... CONCLUSIONS: Multivariate models and baseline caries prevalence performed better in pre-school children than in schoolchildren/adolescents. Baseline caries prevalence was the most accurate single predictor in all age groups. The heterogeneity of populations, models, outcome criteria, measures and reporting...

  3. Advances in stalking risk assessment.

    Science.gov (United States)

    McEwan, Troy E; Pathé, Michele; Ogloff, James R P

    2011-01-01

    Over the past 15 years, forensic mental health has become more concerned with the concepts of violence prevention, management, and treatment. The development of specialist tools to aid in the assessment of a range of risks reflects this concern. This article explores contemporary thinking on violence risk assessment and how this knowledge can be applied to the relatively newer field of stalking risk assessment. The role of risk state and risk status are discussed, in addition to the way that standard structured professional judgment procedures need to be adapted to reflect the variety of risks present in stalking situations. The authors go on to describe the development and format of the Stalking Risk Profile, a set of structured professional judgment guidelines for assessing risk in stalkers. Suggestions are made for future research to enhance knowledge and improve practice in the field of stalking risk assessment. Copyright © 2011 John Wiley & Sons, Ltd.

  4. Expansion of the prognostic assessment of patients with chronic obstructive pulmonary disease: the updated BODE index and the ADO index.

    Science.gov (United States)

    Puhan, Milo A; Garcia-Aymerich, Judith; Frey, Martin; ter Riet, Gerben; Antó, Josep M; Agustí, Alvar G; Gómez, Federico P; Rodríguez-Roisín, Roberto; Moons, Karel G M; Kessels, Alphons G; Held, Ulrike

    2009-08-29

    The BODE index (including body-mass index, airflow obstruction, dyspnoea, and exercise capacity) was an important contribution to the prognostic assessment of patients with chronic obstructive pulmonary disease (COPD). However, no study has assessed whether the risk of mortality predicted by the BODE index matches the observed mortality in different populations. We assessed the calibration of the BODE index, updated it to improve its calibration, and developed and validated a simplified index for use in primary-care settings. We included 232 patients from the Swiss Barmelweid cohort with longstanding and severe COPD and 342 patients from the Spanish Phenotype and Course of COPD cohort study who had had their first hospital admission due to moderate-to-severe COPD. In both cohorts we compared the observed 3-year risk of all-cause mortality with the risk predicted by the BODE index. We then updated the BODE index and developed a simplified ADO index (including age, dyspnoea, and airflow obstruction) from the Swiss cohort, and validated both in the Spanish cohort. Calibration of the BODE index was poor, with relative underprediction of 3-year risk of mortality by 36% in the Swiss cohort (median predicted risk 21.7% [IQR 12.7-31.7] vs 34.1% observed risk; p=0.013) and relative overprediction by 39% in the Spanish cohort (16.7% [12.7-31.7] vs 12.0%; p=0.035). The 3-year risk of mortality predicted by both the updated BODE (median 10.7% [8.1-13.8]) and ADO indices (11.8% [9.1-14.3]) matched the observed mortality in the Spanish cohort well (p=0.99 and p=0.98, respectively). Both the updated BODE and ADO indices could lend support to the prognostic assessment of patients with COPD in specialised and primary-care settings. Such assessment enhances the targeting of treatments to individual patients. Swiss National Science Foundation; Klinik Barmelweid; Fondo de Investigación Sanitaria Ministry of Health, Spain; Agència d'Avaluació de Tecnologia i Recerca M

  5. Improving Clinical Risk Stratification at Diagnosis in Primary Prostate Cancer: A Prognostic Modelling Study.

    Directory of Open Access Journals (Sweden)

    Vincent J Gnanapragasam

    2016-08-01

    Full Text Available Over 80% of the nearly 1 million men diagnosed with prostate cancer annually worldwide present with localised or locally advanced non-metastatic disease. Risk stratification is the cornerstone for clinical decision making and treatment selection for these men. The most widely applied stratification systems use presenting prostate-specific antigen (PSA concentration, biopsy Gleason grade, and clinical stage to classify patients as low, intermediate, or high risk. There is, however, significant heterogeneity in outcomes within these standard groupings. The International Society of Urological Pathology (ISUP has recently adopted a prognosis-based pathological classification that has yet to be included within a risk stratification system. Here we developed and tested a new stratification system based on the number of individual risk factors and incorporating the new ISUP prognostic score.Diagnostic clinicopathological data from 10,139 men with non-metastatic prostate cancer were available for this study from the Public Health England National Cancer Registration Service Eastern Office. This cohort was divided into a training set (n = 6,026; 1,557 total deaths, with 462 from prostate cancer and a testing set (n = 4,113; 1,053 total deaths, with 327 from prostate cancer. The median follow-up was 6.9 y, and the primary outcome measure was prostate-cancer-specific mortality (PCSM. An external validation cohort (n = 1,706 was also used. Patients were first categorised as low, intermediate, or high risk using the current three-stratum stratification system endorsed by the National Institute for Health and Care Excellence (NICE guidelines. The variables used to define the groups (PSA concentration, Gleason grading, and clinical stage were then used to sub-stratify within each risk category by testing the individual and then combined number of risk factors. In addition, we incorporated the new ISUP prognostic score as a discriminator. Using this approach, a

  6. Prognostic factors in presurgical assessment of frontal lobe epilepsy.

    Science.gov (United States)

    Ferrier, C H; Engelsman, J; Alarcón, G; Binnie, C D; Polkey, C E

    1999-03-01

    To determine predictors for surgical outcome in the presurgical assessment of frontal lobe epilepsy. Thirty seven patients were operated on for frontal lobe epilepsy between 1975 and 1996. Their medical records were reviewed for ictal semiology, age at onset, duration of the epilepsy, age at operation, preoperative interictal and ictal encephalographic findings, and abnormalities on neuroimaging and neuropsychological testing. In addition, type of resection and pathology were compared with surgical outcome. Univariate statistical analysis showed that the presence of a focal abnormality on neuroimaging was associated with favourable outcome. The presence of the following ictal findings was associated with poor outcome: autonomic manifestations, eye deviation, head version contralateral to the operated side, and bilateral or multifocal ictal onset. Fifteen patients had secondarily generalised interictal discharges and, interestingly, their presence was not associated with poor outcome. Multivariate logistic regression showed that the presence of a focal abnormality on neuroimaging was significantly associated with a favourable outcome while contralateral head version was the only variable significantly associated with poor surgical outcome. A focal abnormality on neuroimaging was the only variable which was significantly associated with a favourable surgical outcome, whereas contralateral head version was the most significant predictor for a poor outcome. The presence of generalised discharges before surgery was not associated with poor outcome.

  7. Risk factors for longer term psychological distress in well-functioning fibromyalgia patients: a prospective study into prognostic factors.

    NARCIS (Netherlands)

    Koulil, S. van; Lankveld, W.G.J.M. van; Kraaimaat, F.W.; Riel, P.L.C.M. van; Evers, A.W.M.

    2010-01-01

    OBJECTIVE: Psychological distress is a key risk factor for long-term complaints in fibromyalgia (FM). Prognostic factors for psychological distress might facilitate an early identification of patients at risk to help prevent long-term dysfunction, especially for the relatively well-functioning

  8. Onodera's prognostic nutritional index as a risk factor for mortality in peritoneal dialysis patients.

    Science.gov (United States)

    Kang, Seok Hui; Cho, Kyu Hyang; Park, Jong Won; Yoon, Kyung Woo; Do, Jun Young

    2012-11-01

    The aim of this study was to evaluate the clinical relevance and usefulness of the Onodera's prognostic nutritional index (OPNI) as a prognostic and nutritional indicator in peritoneal dialysis (PD) patients. Patients were divided into 3 groups based on the initial OPNI score: group A (n = 186, 45). Group A was associated with a higher grade according to the Davies risk index than the other groups. Serum creatinine and albumin levels, total lymphocyte count, and fat mass increased with an increase in OPNI. According to the edema index, the correlation coefficient for OPNI was -0.284 and for serum albumin was -0.322. Similarly, according to the C-reactive protein (CRP), the correlation coefficient for OPNI was -0.117 and for serum albumin was -0.169. Multivariate analysis adjusted for age, Davies risk index, CRP, and edema index revealed that the hazard ratios for low OPNI, serum albumin, and CRP were 1.672 (P = 0.003), 1.308 (P = 0.130), and 1.349 (P = 0.083), respectively. Our results demonstrate that the OPNI is a simple method that can be used for predicting the nutritional status and clinical outcome in PD patients.

  9. Preeclampsia in kidney transplanted women; Outcomes and a simple prognostic risk score system

    Science.gov (United States)

    Reisæter, Anna Varberg; Zucknick, Manuela; Lorentzen, Bjørg; Vangen, Siri; Henriksen, Tore; Michelsen, Trond Melbye

    2017-01-01

    Women pregnant following kidney transplantation are at high risk of preeclampsia. Identifying the effects of preeclampsia on pregnancy outcome and allograft function in kidney transplanted women, and predicting which women will require more targeted follow-up and possible therapeutic intervention, could improve both maternal and neonatal outcome. In this retrospective cohort study of all pregnancies following kidney transplantation in Norway between 1969 and 2013, we used medical records to identify clinical characteristics predictive of preeclampsia. 175 pregnancies were included, in which preeclampsia was diagnosed in 65. Pregnancies with preeclampsia had significantly higher postpartum serum creatinine levels, higher risks of preterm delivery, caesarean delivery, and small for gestational age infants. In the final multivariate model chronic hypertension (aOR = 5.02 [95% CI, 2.47–10.18]), previous preeclampsia (aOR = 3.26 [95% CI, 1.43–7.43]), and elevated serum creatinine (≥125 μmol/L) at the start of pregnancy (aOR = 5.79 [95% CI, 1.91–17.59]) were prognostic factors for preeclampsia. Based on this model the risk was 19% when none of these factors were present, 45–59% risk when one was present, 80–87% risk when two were present, and 96% risk when all three were present. We suggest that the risk of preeclampsia in pregnancies in kidney transplanted women can be predicted with these variables, which are easily available at the start of pregnancy. PMID:28319175

  10. Risk Factor Assessment Branch (RFAB)

    Science.gov (United States)

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

  11. Met expression is an independent prognostic risk factor in patients with oesophageal adenocarcinoma

    NARCIS (Netherlands)

    J.B. Tuynman; S.M. Lagarde (Sjoerd); F.J.W. ten Kate (Fiebo); D.J. Richel (Dirk); J.J.B. van Lanschot (Jan)

    2008-01-01

    textabstractOesophageal adenocarcinoma is an aggressive malignancy with propensity for early lymphatic and haematogenous dissemination. Since conventional TNM staging does not provide accurate prognostic information, novel molecular prognostic markers and potential therapeutic targets are subject of

  12. Met expression is an independent prognostic risk factor in patients with oesophageal adenocarcinoma

    NARCIS (Netherlands)

    Tuynman, J. B.; Lagarde, S. M.; ten Kate, F. J. W.; Richel, D. J.; van Lanschot, J. J. B.

    2008-01-01

    Oesophageal adenocarcinoma is an aggressive malignancy with propensity for early lymphatic and haematogenous dissemination. Since conventional TNM staging does not provide accurate prognostic information, novel molecular prognostic markers and potential therapeutic targets are subject of intense

  13. Fact Sheet: Assessing Risks from Flame Retardants

    Science.gov (United States)

    EPA's assessing and managing risk programs address pollution prevention, risk assessment, hazard and exposure assessment and/or characterization, and risk management for chemicals substances in commercial use.

  14. 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.

  15. Advancing Measurement Science to Assess Monitoring, Diagnostics, and Prognostics for Manufacturing Robotics.

    Science.gov (United States)

    Qiao, Guixiu; Weiss, Brian A

    2016-01-01

    Unexpected equipment downtime is a 'pain point' for manufacturers, especially in that this event usually translates to financial losses. To minimize this pain point, manufacturers are developing new health monitoring, diagnostic, prognostic, and maintenance (collectively known as prognostics and health management (PHM)) techniques to advance the state-of-the-art in their maintenance strategies. The manufacturing community has a wide-range of needs with respect to the advancement and integration of PHM technologies to enhance manufacturing robotic system capabilities. Numerous researchers, including personnel from the National Institute of Standards and Technology (NIST), have identified a broad landscape of barriers and challenges to advancing PHM technologies. One such challenge is the verification and validation of PHM technology through the development of performance metrics, test methods, reference datasets, and supporting tools. Besides documenting and presenting the research landscape, NIST personnel are actively researching PHM for robotics to promote the development of innovative sensing technology and prognostic decision algorithms and to produce a positional accuracy test method that emphasizes the identification of static and dynamic positional accuracy. The test method development will provide manufacturers with a methodology that will allow them to quickly assess the positional health of their robot systems along with supporting the verification and validation of PHM techniques for the robot system.

  16. 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

  17. Usefulness and prognostic impact on survival of WHO reclassification in FAB low risk myelodyplastic syndromes.

    Science.gov (United States)

    Breccia, Massimo; Carmosino, Ida; Biondo, Francesca; Mancini, Marco; Russo, Eleonora; Latagliata, Roberto; Alimena, Giuliana

    2006-02-01

    In 1999, WHO proposed a revised classification for myelodysplastic syndromes (MDS). According to this system, FAB low risk MDS (RA and RARS) were defined as such when the presence of dysplastic features was only restricted to the erythroid lineage, and new categories, refractory cytopenia with multilineage dysplasia (RCMD) and refractory cytopenia with multilineage dysplasia and ringed sideroblasts (RCMD-RS), were added. In a retrospective analysis of 240 consecutive patients diagnosed at our institution as having FAB RA and RARS, we reclassified the disease following the WHO criteria and we found that 179/214 patients (84%) still remained in the RA category, while 35/214 (16%) moved to RCMD. Moreover, 17/26 patients (65%) maintained the RARS diagnosis, whereas 9/26 (35%) were re-classified as RCMD-RS. We detected differences among the WHO subgroups as to age and sex distribution as well as to median survival observed by stratifying patients according to different prognostic scoring systems. Furthermore we confirmed the usefulness of WHO segregation with regard to its predictive value for evolution into acute leukaemia. Our study provides evidence that WHO classification may have prognostic impact on MDS subgroups which are usually categorized by FAB as having a favourable outcome.

  18. Risk factors for postoperative complications in oral cancer and their prognostic implications.

    Science.gov (United States)

    de Melo, G M; Ribeiro, K C; Kowalski, L P; Deheinzelin, D

    2001-07-01

    The surgical treatment of head and neck cancer can be limited by the risk of postoperative complications. Early identification of risk factors based on clinical characteristics may assist therapeutic planning. To identify risk factors for these complications and to evaluate their prognostic significance. The medical records of 110 patients with oral squamous cell carcinoma admitted from January 1, 1990, to December 31, 1994, who underwent radical surgery were reviewed. Data collected included demographic information, comorbidities, extended clinical severity stage, treatment, complications, and survival. The chi(2) test was used to verify the association between the variables. Survival analysis was performed with the Kaplan-Meier method. Logistic and Cox proportional hazards regression were used to build models with independent predictive factors for the risk of complications and death, respectively. The overall complication rate was 50%. Dehiscence and infection rates were 20.9% and 22.7%, respectively. The death rate was 3.6%. Forty-seven patients (42.7%) were electively referred to the intensive care unit (ICU). The occurrence of postoperative complications was associated with extended clinical severity stage (P =.02), type of surgery (P =.03), ICU (P =.03), type of reconstruction (P =.02), Functional Severity Index (P =.03), neck dissection (P =.002), and APACHE II (Acute Physiology and Chronic Health Evaluation II) (P =.008). The number of complications was significantly correlated with the length of hospital stay (r = 0.24, P =.01) and with the Functional Severity Index (r = 0.19, P =.04). Five-year overall survival was affected by the type of complications (none, 41.7%; local, 34.1%; and local plus systemic, 0% [Prisk = 3.57, P =.01) and an APACHE II score greater than 10 (relative risk = 3.86, P =.02) were independent risk factors for complications. The predictive prognostic model consisted of the following: staying in the ICU (hazard ratio = 1.83), local

  19. [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.

  20. Models for Pesticide Risk Assessment

    Science.gov (United States)

    EPA considers the toxicity of the pesticide as well as the amount of pesticide to which a person or the environments may be exposed in risk assessment. Scientists use mathematical models to predict pesticide concentrations in exposure assessment.

  1. Environmental Risk Communication through Qualitative Risk Assessment

    Directory of Open Access Journals (Sweden)

    Sabre J. Coleman

    2014-06-01

    Full Text Available Environmental analysts are often hampered in communicating the risks of environmental contaminants due to the myriad of regulatory requirements that are applicable. The use of a qualitative, risk-based control banding strategy for assessment and control of potential environmental contaminants provides a standardized approach to improve risk communication. Presented is a model that provides an effective means for determining standardized responses and controls for common environmental issues based on the level of risk. The model is designed for integration within an occupational health and safety management system to provide a multidisciplinary environmental and occupational risk management approach. This environmental model, which utilizes multidisciplinary control banding strategies for delineating risk, complements the existing Risk Level Based Management System, a proven method in a highly regulated facility for occupational health and safety. A simplified environmental risk matrix is presented that is stratified over four risk levels. Examples of qualitative environmental control banding strategies are presented as they apply to United States regulations for construction, research activities, facility maintenance, and spill remediation that affect air, water, soil, and waste disposal. This approach offers a standardized risk communication language for multidisciplinary issues that will improve communications within and between environmental health and safety professionals, workers, and management.

  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......, and also assist industry in their ambition to design innovative yet safe foods for consumers....

  3. Cancer Risk Prediction and Assessment

    Science.gov (United States)

    Cancer prediction models provide an important approach to assessing risk and prognosis by identifying individuals at high risk, facilitating the design and planning of clinical cancer trials, fostering the development of benefit-risk indices, and enabling estimates of the population burden and cost of cancer.

  4. Hazard classification or risk assessment

    DEFF Research Database (Denmark)

    Hass, Ulla

    2013-01-01

    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...... to be a risk. A hazard does not necessarily constitute a risk, as efforts can be done to minimize risk by reducing the exposure. Thus, the relationship between hazard and risk must be treated cautiously. Fora robust risk assessment good data on exposure to the substance is needed and exposure data for other...... similarly acting substances are needed for assessing the risk for mixture effects. Such data may, however, often be absent. Toxicological potency, i.e. the lowest dose found to cause adverse effects, has been proposed as one of the key characteristics when evaluating safety of a substance. However, this may...

  5. Risk-Assessment Computer Program

    Science.gov (United States)

    Dias, William C.; Mittman, David S.

    1993-01-01

    RISK D/C is prototype computer program assisting in attempts to do program risk modeling for Space Exploration Initiative (SEI) architectures proposed in Synthesis Group Report. Risk assessment performed with respect to risk events, probabilities, and severities of potential results. Enables ranking, with respect to effectiveness, of risk-mitigation strategies proposed for exploration program architecture. Allows for fact that risk assessment in early phases of planning subjective. Although specific to SEI in present form, also used as software framework for development of risk-assessment programs for other specific uses. Developed for Macintosh(TM) series computer. Requires HyperCard(TM) 2.0 or later, as well as 2 Mb of random-access memory and System 6.0.8 or later.

  6. Mental health symptoms as prognostic risk markers of all-cause and psychiatric sickness absence in office workers

    NARCIS (Netherlands)

    Roelen, C.A.M.; Rhenen, van W.; Hoedeman, R.; Groothoff, J.W.; Klink, van der J.J.L.; Bültmann, U.

    2013-01-01

    To investigate mental health symptoms as prognostic risk markers of all-cause and psychiatric sickness absence (SA). Methods: Mental health symptoms were measured in 1137 office workers with the Four-Dimensional Symptom Questionnaire (4DSQ), including scales for distress, depression, anxiety and

  7. Mental health symptoms as prognostic risk markers of all-cause and psychiatric sickness absence in office workers

    NARCIS (Netherlands)

    Roelen, Corne A. M.; Hoedeman, Rob; van Rhenen, Willem; Groothoff, Johan W.; van der Klink, Jac J. L.; Bultmann, Ute

    Background: To investigate mental health symptoms as prognostic risk markers of all-cause and psychiatric sickness absence (SA). Methods: Mental health symptoms were measured in 1137 office workers with the Four-Dimensional Symptom Questionnaire (4DSQ), including scales for distress, depression,

  8. Which patients benefit most from adjuvant aromatase inhibitors? Results using a composite measure of prognostic risk in the BIG 1-98 randomized trial

    Science.gov (United States)

    Viale, G.; Regan, M. M.; Dell'Orto, P.; Mastropasqua, M. G.; Maiorano, E.; Rasmussen, B. B.; MacGrogan, G.; Forbes, J. F.; Paridaens, R. J.; Colleoni, M.; Láng, I.; Thürlimann, B.; Mouridsen, H.; Mauriac, L.; Gelber, R. D.; Price, K. N.; Goldhirsch, A.; Gusterson, B. A.; Coates, A. S.

    2011-01-01

    Background: On average, aromatase inhibitors are better than tamoxifen when used as initial or sequential therapy for postmenopausal women with endocrine-responsive early breast cancer. Because there may be contraindications to their use based on side-effects or cost, we investigated subgroups in which aromatase inhibitors may be more or less important. Patients and methods: Breast International Group 1-98 trial randomized 6182 women among four groups comparing letrozole and tamoxifen with sequences of each agent; 5177 (84%) had centrally confirmed estrogen receptor (ER) positivity. We assessed whether centrally determined ER, progesterone receptor (PgR), human epidermal growth factor receptor 2, and Ki-67 labeling index, alone or in combination with other prognostic features, predicted the magnitude of letrozole effectiveness compared with either sequence or tamoxifen monotherapy. Results: Individually, none of the markers significantly predicted differential treatment effects. Subpopulation treatment effect pattern plot analysis of a composite measure of prognostic risk revealed three patterns. Estimated 5-year disease-free survival for letrozole monotherapy, letrozole→tamoxifen, tamoxifen→letrozole, and tamoxifen monotherapy were 96%, 94%, 93%, and 94%, respectively, for patients at lowest risk; 90%, 91%, 93%, and 86%, respectively, for patients at intermediate risk; and 80%, 76%, 74%, and 69%, respectively, for patients at highest risk. Conclusion: A composite measure of risk informs treatment selection better than individual biomarkers and supports the choice of 5 years of letrozole for patients at highest risk for recurrence. PMID:21335417

  9. ECOLOGICAL RISK ASSESSMENT

    Science.gov (United States)

    The Ecological Soil Screening Level (Eco-SSL) Work Group, composed of scientists and risk assessors from EPA, Environment Canada, DOE, Army, Navy, Air Force, states, industry, academia, and consulting companies, has been working on the development of scientifically sound, ecologi...

  10. Balancing risk: Ethical issues in risk assessment

    Energy Technology Data Exchange (ETDEWEB)

    Longstreth, J.D.

    1992-06-01

    The last five decades have seen an explosive growth of information, accompanied by the development of a strong environmental movement. These two factors have been critical contributors to the development of the scientific discipline that has come to be called risk analysis or risk assessment. In this context, risk assessment can be described as an analytic approach used to organize large amounts of information from diverse disciplines so as to evaluate the possible impacts of pollution on human health and the environment. Early efforts in this field focused on the protection of human health. More recently, however, it has been realized that humans and their environment are intimately linked and that environmental impacts must also be evaluated. At some point, it seems likely that the joint goals of protecting human health and the environment may come into conflict. This essay reviews current developments in the assessment of risks both to humans and the environment in order to expose similarities and differences with the ultimate aim of opening a dialogue between scientists in the different disciplines so that evaluation strategies can be designed which will enable decision makers to make trade-offs between human health and environmental risk is an informed and egalitarian way.

  11. Noninvasive in vivo detection of prognostic indicators for high-risk uveal melanoma: ultrasound parameter imaging.

    Science.gov (United States)

    Coleman, D Jackson; Silverman, Ronald H; Rondeau, Mark J; Boldt, H Culver; Lloyd, Harriet O; Lizzi, Frederic L; Weingeist, Thomas A; Chen, Xue; Vangveeravong, Sumalee; Folberg, Robert

    2004-03-01

    -validation procedure, 80.10% of cases were correctly classified. Ultrasound can be used noninvasively to classify tumors into high-risk and low-risk groups by detecting the presence of EMP patterns. By the use of previous studies that compared the histologic presence of EMP patterns with patient survival, estimates of hazard rates associated with ultrasound risk groups can be made. The noninvasive ultrasound classification is potentially useful as a prognostic variable and as a tool for stratification of patient populations for tumor treatment evaluation.

  12. Options for operational risk assessments

    Energy Technology Data Exchange (ETDEWEB)

    Dover, S.A.

    1985-01-01

    Risk assessment is a set of analytical tools that can be used to clarify possible outcomes of decisions where two different courses of action are indicated or different values are in conflict. These conflicts often arise in the management of any production or support facility. This paper outlines the options for performing risk assessments of any scope and the parameters that determine their effectiveness. It highlights the relative costs of each option, useful information developed, and limitations of the information. The paper concludes with the types of decisions that are routinely made in an operating facility and could benefit from the information generated in a risk assessment.

  13. 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...

  14. A Survey of Canadian Nephrologists Assessing Prognostication in End-Stage Renal Disease

    Directory of Open Access Journals (Sweden)

    Brian Forzley

    2017-08-01

    Full Text Available Background: Patients with end-stage renal disease (ESRD frequently have a relatively poor prognosis with complex care needs that depend on prognosis. While many means of assessing prognosis are available, little is known about how Canadian nephrologists predict prognosis, whether they routinely share prognostic information with their patients, and how this information guides management. Objective: To guide improvements in the management of patients with ESRD, we aimed to better understand how Canadian nephrologists consider prognosis during routine care. Design and methods: A web-based multiple choice survey was designed, and administered to adult nephrologists in Canada through the e-mail list of the Canadian Society of Nephrology. The survey asked the respondents about their routine practice of estimating survival and the perceived importance of prognostic practices and tools in patients with ESRD. Descriptive statistics were used in analyzing the responses. Results: Less than half of the respondents indicated they always or often make an explicit attempt to estimate and/or discuss survival with ESRD patients not on dialysis, and 25% reported they do so always or often with patients on dialysis. Survival estimation is most frequently based on clinical gestalt. Respondents endorse a wide range of issues that may be influenced by prognosis, including advance care planning, transplant referral, choice of dialysis access, medication management, and consideration of conservative care. Limitations: This is a Canadian sample of self-reported behavior, which was not validated, and may be less generalizable to non-Canadian health care jurisdictions. Conclusions: In conclusion, prognostication of patients with ESRD is an important issue for nephrologists and impacts management in fairly sophisticated ways. Information sharing on prognosis may be suboptimal.

  15. A Survey of Canadian Nephrologists Assessing Prognostication in End-Stage Renal Disease.

    Science.gov (United States)

    Forzley, Brian; Chiu, Helen H L; Djurdjev, Ognjenka; Carson, Rachel C; Hargrove, Gaylene; Martinusen, Dan; Karim, Mohamud

    2017-01-01

    Patients with end-stage renal disease (ESRD) frequently have a relatively poor prognosis with complex care needs that depend on prognosis. While many means of assessing prognosis are available, little is known about how Canadian nephrologists predict prognosis, whether they routinely share prognostic information with their patients, and how this information guides management. To guide improvements in the management of patients with ESRD, we aimed to better understand how Canadian nephrologists consider prognosis during routine care. A web-based multiple choice survey was designed, and administered to adult nephrologists in Canada through the e-mail list of the Canadian Society of Nephrology. The survey asked the respondents about their routine practice of estimating survival and the perceived importance of prognostic practices and tools in patients with ESRD. Descriptive statistics were used in analyzing the responses. Less than half of the respondents indicated they always or often make an explicit attempt to estimate and/or discuss survival with ESRD patients not on dialysis, and 25% reported they do so always or often with patients on dialysis. Survival estimation is most frequently based on clinical gestalt. Respondents endorse a wide range of issues that may be influenced by prognosis, including advance care planning, transplant referral, choice of dialysis access, medication management, and consideration of conservative care. This is a Canadian sample of self-reported behavior, which was not validated, and may be less generalizable to non-Canadian health care jurisdictions. In conclusion, prognostication of patients with ESRD is an important issue for nephrologists and impacts management in fairly sophisticated ways. Information sharing on prognosis may be suboptimal.

  16. Utility of 5-Methylcytosine Immunohistochemical Staining to Assess Global DNA Methylation and Its Prognostic Impact in MDS Patients

    Science.gov (United States)

    Chandra, Dinesh; Tyagi, Seema; Singh, Jasdeep; Deka, Roopam; Manivannan, Prabhu; Mishra, Pravas; Pati, Hara Prasad; Saxena, Renu

    2017-12-29

    Background: DNA methylation plays a vital role in the pathogenesis of the myelodysplastic syndrome (MDS), a heterogeneous group of clonal hematopoietic stem cell (HSC) disorders. It is reported to be an independent prognostic factor affecting overall survival (OS). Our aim was to analyze the role of global DNA methylation using an anti-5-methylcytosine (5-MC) antibody by immunohistochemistry (IHC) of bone marrow biopsy (BM Bx) specimens in MDS patients, assessing correlations with various clinical and biological prognostic factors. Material and methods: A total of 59 MDS cases, classified as per the World Health Organization (WHO) 2008 guidelines, were evaluated over a period of 4 years. Clinical data were retrieved from departmental case records and anti-5-MC expression was analyzed with formalin fixed paraffin embedded sections of BM Bx specimens of MDS patients and controls. Results: The median age at diagnosis was 52 years (15-85years). Patients were categorized into low risk (59%) and high risk (41%) according to International Prognostic Scoring System (IPSS). The median follow-up time was 10 months (1 to 37 months). We generated a methylation score (M-score) using anti-5-MC and with the derived cut-off of 30.5 from the receiver operator curve (ROC), there was a significant difference between the two groups in the percentage of BM blasts (p=0.01), WHO sub-type (p=0.01), IPSS (p=0.004), progression to AML (p=0.04) on univariate analysis. Interestingly, patients showing a high M-score (M-score ≥ 30.5) demonstrated a significantly shorter OS and progression to AML. However, on multivariate analysis, only BM blasts (p=0.01) and IPSS (p=0.02) remained independent variables for progression to AML and OS respectively. Conclusion: Immunostaining with anti-5-MC antibody with BM Bx samples is a simple and cost effective technique to detect global methylation, a powerful tool to predict overall survival in patients with MDS. Creative Commons Attribution License

  17. QTc interval in the assessment of cardiac risk

    DEFF Research Database (Denmark)

    Elming, Hanne; Brendorp, Bente; Køber, Lars

    2002-01-01

    In the United States alone 300,000-400,000 people die of sudden cardiac death every year. Much of this mortality is assumed to be caused by ventricular tachyarrhythmias. Prolonged QTc reflect cardiac repolarization prolongation and/or increased repolarization inhomogenity known to be associated...... with increased risk of arrhythmias. The paper gives a review of the possibilities to assess the risk of ventricular arrhythmia and/or cardiac death from QTc. Prolonged QTc may hold independent prognostic importance for mortality in common diseases as ischemic heart disease and diabetes mellitus where...

  18. 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.

  19. 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.

  20. Comparison of clinical outcomes and prognostic utility of risk stratification tools in patients with therapy-related vs de novo myelodysplastic syndromes: a report on behalf of the MDS Clinical Research Consortium.

    Science.gov (United States)

    Zeidan, A M; Al Ali, N; Barnard, J; Padron, E; Lancet, J E; Sekeres, M A; Steensma, D P; DeZern, A; Roboz, G; Jabbour, E; Garcia-Manero, G; List, A; Komrokji, R

    2017-06-01

    While therapy-related (t)-myelodysplastic syndromes (MDS) have worse outcomes than de novo MDS (d-MDS), some t-MDS patients have an indolent course. Most MDS prognostic models excluded t-MDS patients during development. The performances of the International Prognostic Scoring System (IPSS), revised IPSS (IPSS-R), MD Anderson Global Prognostic System (MPSS), WHO Prognostic Scoring System (WPSS) and t-MDS Prognostic System (TPSS) were compared among patients with t-MDS. Akaike information criteria (AIC) assessed the relative goodness of fit of the models. We identified 370 t-MDS patients (19%) among 1950 MDS patients. Prior therapy included chemotherapy alone (48%), chemoradiation (31%), and radiation alone in 21%. Median survival for t-MDS patients was significantly shorter than for d-MDS (19 vs 46 months, PMDS (PMDS had a significantly higher hazard of death relative to d-MDS in every risk model, and had inferior survival compared to patients with d-MDS within all risk group categories. AIC Scores (lower is better) were 2316 (MPSS), 2343 (TPSS), 2343 (IPSS-R), 2361 (WPSS) and 2364 (IPSS). In conclusion, subsets of t-MDS patients with varying clinical outcomes can be identified using conventional risk stratification models. The MPSS, TPSS and IPSS-R provide the best predictive power.

  1. Dynamic assessment of RBC-transfusion dependency improves the prognostic value of the revised-IPSS in MDS patients.

    Science.gov (United States)

    Hiwase, Devendra K; Singhal, Deepak; Strupp, Corinna; Chhetri, Rakchha; Kutyna, Monika M; Wee, L Amilia; Harrison, Peter B; Nath, Shriram V; Wickham, Nicholas; Hui, Chi-Hung; Gray, James X; Bardy, Peter; Ross, David M; Lewis, Ian D; Reynolds, John; To, L Bik; Germing, Ulrich

    2017-06-01

    RBC-transfusion dependency (RBC-TD) is an independent prognostic factor for poor overall survival (OS) in the WHO classification-based prognostic scoring system (WPSS) for MDS patients. However, WPSS did not include cytopenia, whereas revised International Prognostic Scoring System (IPSS-R) did not include RBC-TD. Thus, neither of these prognostic scoring systems incorporates both cytopenia and RBC-TD. We aimed to test whether RBC-TD adds prognostic value to the IPSS-R. We analyzed MDS patients not treated with disease-modifying therapy, and enrolled in SA-MDS Registry (derivation cohort; n = 295) and Dusseldorf registry (Germany; validation cohort; n = 113) using time-dependent Cox proportional regression and serial landmark analyses. In the derivation cohort, RBC-TD patients had inferior OS compared to RBC transfusion-independent (RBC-TI) patients (P MDS is associated with poor OS, independent of IPSS-R. This study demonstrates that dynamic assessment of RBC-TD provides additional prognostic value to IPSS-R and should be included in treatment decision algorithms for MDS patients. © 2017 Wiley Periodicals, Inc.

  2. Geriatric Nutritional Risk Index as a prognostic factor in peritoneal dialysis patients.

    Science.gov (United States)

    Kang, Seok Hui; Cho, Kyu Hyang; Park, Jong Won; Yoon, Kyung Woo; Do, Jun Young

    2013-01-01

    The Geriatric Nutritional Risk Index (GNRI) might be a useful screening tool for malnutrition in dialysis patients. However, data concerning the GNRI as a prognostic factor in peritoneal dialysis (PD) patients are scarce. We reviewed the medical records at Yeungnam University Hospital in Korea to identify all adults (>18 years) who received PD; 486 patients were enrolled in the study. The initial low, middle, and high GNRI tertiles included 162, 166, and 158 patients respectively. Significant correlations were noted between the initial GNRI and body mass index, creatinine, albumin, arm circumference, fat mass index, and comorbidities. The cut-off value for the time-averaged GNRI over 1 year was 96.4, and the sensitivity and specificity for a diagnosis of a decline in lean mass were 77.1% and 40.0% respectively. A multivariate analysis adjusted for age, risk according to the Davies comorbidity index, and C-reactive protein showed that an low initial GNRI tertile was associated with mortality in PD patients. The GNRI is a simple method for predicting nutrition status and clinical outcome in PD patients.

  3. Risk factors and prognostic significance of altered left ventricular geometry in preterm infants.

    Science.gov (United States)

    Choudhry, Swati; Salter, Amber; Cunningham, Tyler W; Levy, Philip T; Hackett, Brian P; Singh, Gautam K; Johnson, Mark C

    2018-02-06

    Left ventricular (LV) hypertrophy (LVH) predicts adverse cardiac events in adults. We sought to determine the risk factors and prognostic significance of altered LV geometry in preterm infants. In an echocardiographic, single-center, retrospective case-control study we investigated the risk factors and outcomes in patients with altered LV geometry (either increased left ventricular mass index (LVMI) or increased relative wall thickness (RWT)) from a cohort of 503 preterm infants ≤2 kg. Altered LV geometry was seen in 180 patients and was predicted by postnatal steroids and small for gestational age. Hospital stay was longer in the elevated RWT cases. Altered LV geometry resolved in 129 of the 131 cases with follow-up echocardiogram. Fifteen of 94 patients with elevated RWT died compared to 3/90 controls (P = 0.004). Altered LV geometry in preterm infants is associated with postnatal steroid use and small for gestational age. Elevated RWT is associated with longer hospital stay and increased mortality.

  4. Nutritional Risk in Major Abdominal Surgery: Protocol of a Prospective Observational Trial to Evaluate the Prognostic Value of Different Nutritional Scores in Pancreatic Surgery.

    Science.gov (United States)

    Probst, Pascal; Haller, Sebastian; Dörr-Harim, Colette; Bruckner, Thomas; Ulrich, Alexis; Hackert, Thilo; Diener, Markus K; Knebel, Phillip

    2015-11-16

    The influence of patients' preoperative nutritional status on their clinical outcome has already been proven. Therefore, patients with malnutrition are in need of additional therapeutic efforts. However, for pancreatic surgery, evidence suggesting the adequacy of existing nutritional assessment scores to estimate malnutrition associated with postoperative outcome is limited. The aim of the observational trial "Nutritional Risk in Major Abdominal Surgery (NURIMAS) Pancreas" is to prospectively assess and analyze different nutritional assessment scores for their prognostic value on postoperative complications in patients undergoing pancreatic surgery. All patients scheduled to receive elective pancreatic surgery at the University Hospital of Heidelberg will be screened for eligibility. Preoperatively, 12 nutritional assessment scores will be collected and patients will be assigned either at risk or not at risk for malnutrition. The postoperative course will be followed prospectively and complications according to the Clavien-Dindo classification will be recorded. The prognostic value for complications will be evaluated for every score in a univariable and multivariable analysis corrected for known risk factors in pancreatic surgery. Final data analysis is expected to be available during Spring 2016. The NURIMAS Pancreas trial is a monocentric, prospective, observational trial aiming to find the most predictive clinical nutritional assessment score for postoperative complications. Using the results of this protocol as a knowledge base, it is possible to conduct nutritional risk-guided intervention trials to prevent postoperative complications in the pancreatic surgical population. germanctr.de: DRKS00006340; https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00006340 (Archived by WebCite at http://www.webcitation.org/6bzXWSRYZ).

  5. 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)

  6. 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....

  7. 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.

  8. The risk assessment information system

    Energy Technology Data Exchange (ETDEWEB)

    Kerr, S.B.; Bonczek, R.R.; McGinn, C.W.; Land, M.L.; Bloom, L.D.; Sample, B.E.; Dolislager, F.G.

    1998-06-01

    In an effort to provide service-oriented environmental risk assessment expertise, the Department of Energy (DOE) Center for Risk Excellence (CRE) and DOE Oak Ridge Operations Office (ORO) are sponsoring Oak Ridge National Laboratory (ORNL) to develop a web-based system for disseminating risk tools and information to its users. This system, the Risk Assessment Information System (RAIS), was initially developed to support the site-specific needs of the DOE-ORO Environmental Restoration Risk Assessment Program. With support from the CRE, the system is currently being expanded to benefit all DOE risk information users and can be tailored to meet site-specific needs. Taking advantage of searchable and executable databases, menu-driven queries, and data downloads, using the latest World Wide Web technologies, the RAIS offers essential tools that are used in the risk assessment process or anywhere from project scoping to implementation. The RAIS tools can be located directly at http://risk.lsd.ornl.gov/homepage/rap{_}tool.htm or through the CRE`s homepage at http://www.doe.gov/riskcenter/home.html.

  9. Colorectal Cancer Risk Assessment Tool

    Science.gov (United States)

    ... know before using this tool: The Colorectal Cancer Risk Assessment Tool was designed for use by doctors and other health providers with their patients. If you are not a health ... your personal risk of colorectal cancer. (Colorectal cancer is another way ...

  10. Improving pandemic influenza risk assessment

    Science.gov (United States)

    Assessing the pandemic risk posed by specific non-human influenza A viruses remains a complex challenge. As influenza virus genome sequencing becomes cheaper, faster and more readily available, the ability to predict pandemic potential from sequence data could transform pandemic influenza risk asses...

  11. 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

  12. Assessment of Diagnostic and Prognostic Role of Copeptin in the Clinical Setting of Sepsis

    Directory of Open Access Journals (Sweden)

    Stefania Battista

    2016-01-01

    Full Text Available The diagnostic and prognostic usefulness of copeptin were evaluated in septic patients, as compared to procalcitonin assessment. In this single centre and observational study 105 patients were enrolled: 24 with sepsis, 25 with severe sepsis, 15 with septic shock, and 41 controls, divided in two subgroups (15 patients with gastrointestinal bleeding and 26 with suspected SIRS secondary to trauma, acute coronary syndrome, and pulmonary embolism. Biomarkers were determined at the first medical evaluation and thereafter 24, 48, and 72 hours after admission. Definitive diagnosis and in-hospital survival rates at 30 days were obtained through analysis of medical records. At entry, copeptin proved to be able to distinguish cases from controls and also sepsis group from septic shock group, while procalcitonin could distinguish also severe sepsis from septic shock group. Areas under the ROC curve for copeptin and procalcitonin were 0.845 and 0.861, respectively. Noteworthy, patients with copeptin concentrations higher than the threshold value (23.2 pmol/L, calculated from the ROC curve, at admission presented higher 30-day mortality. No significant differences were found in copeptin temporal profile among different subgroups. Copeptin showed promising diagnostic and prognostic role in the management of sepsis, together with its possible role in monitoring the response to treatment.

  13. [Prognostic assessment as the basis for limiting therapy in unconscious patients after cardiopulmonary resuscitation].

    Science.gov (United States)

    Arntz, H-R; Mochmann, H-C

    2015-10-01

    The prognosis of patients who have been resuscitated after cardiac arrest is still unfavourable and long-term results have only slightly improved. As a consequence, intensivists are frequently confronted with the question of limiting active therapeutic efforts for patients in prolonged coma. The history of the patient and circumstances of the resuscitation are of limited value with regard to reliable decisions. Clinical and electrophysiological neurologic techniques as well as biomarkers and diagnostic imaging are, therefore, the basis for prognostication and potential consecutive therapeutic decisions. Sedation, relaxation and particularly therapeutic hypothermia have great influence on the test results. These influences have to be excluded before results can be validated. With regard to therapeutic hypothermia a reliable neurologic evaluation as a basis for limiting treatment is only possible after rewarming. Moreover results of multiple tests should be in agreement before a decision to limit treatment can be made. Finally it must be kept in mind that the absence of unfavourable test results is not proof of a good prognosis. The decision to limit treatment can not be made on the basis of a single adverse prognostic sign, but requires a comprehensive clinical diagnostic assessment.

  14. Black blood MRI has diagnostic and prognostic value in the assessment of patients with pulmonary hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Swift, Andrew J.; Marshall, Helen; Wild, Jim M. [Cardiovascular Biomedical Research Unit, National Institute of Health Research, Sheffield (United Kingdom); University of Sheffield, Academic Unit of Radiology, Sheffield (United Kingdom); Rajaram, Smitha; Capener, Dave [University of Sheffield, Academic Unit of Radiology, Sheffield (United Kingdom); Condliffe, Robin; Elliot, Charlie A.; Kiely, David G. [Cardiovascular Biomedical Research Unit, National Institute of Health Research, Sheffield (United Kingdom); Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield (United Kingdom); Hill, Catherine; Davies, Christine [Sheffield Teaching Hospitals NHS Foundation Trust, Department of Radiology, Sheffield (United Kingdom); Hurdman, Judith [Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield (United Kingdom)

    2012-03-15

    Double inversion recovery (DIR) ''black blood'' MRI suppresses the signal from flowing blood, slow flowing blood causes incomplete suppression resulting in pulmonary blood flow artefact (PFA). This study examines the diagnostic utility and prognostic value of a PFA scoring system in a mixed cohort of patients with pulmonary hypertension (PH). DIR-MRI images were reviewed for 233 patients referred with suspected PH who underwent right heart catheterisation (RHC) within 48 h of MR. The degree of PFA was visually scored in all patients from 0 to 5 (0 = absent, 1 = segmental, 2 = lobar, 3 = distal main, 4 = proximal main and 5 = trunk). Pulmonary artery (PA), aorta (Ao), and PA main branch diameters were measured from which PA/Ao ratios and mean PA branch diameters (MPAB) were calculated. PFA >1 demonstrated high sensitivity (86%) and specificity (85%) for the diagnosis PH in our mixed patient cohort. A good correlation was found with PFA and haemodynamic parameters, PVR (r = 0.70), mPAP (r = 0.65) and CI (r = -0.53). PFA predicted mortality (P = 0.005) during the mean follow-up for 19 months. PFA scoring demonstrated good inter-observer agreement (k = 0.83). PFA scoring is of diagnostic and prognostic value in the assessment of patients with suspected PH. and is a predictor of mortality. (orig.)

  15. Prognostic Value of Stress Echocardiography in Patients With Low-Intermediate or High Short-Term (10 Years) Versus Low (Risk of Cardiovascular Disease According to the American College of Cardiology/American Heart Association 2013 Cardiovascular Risk Calculator.

    Science.gov (United States)

    Yao, Siu-Sun; Supariwala, Azhar; Yao, Amanda; Dukkipati, Sai Sreenija; Wyne, Jamshad; Chaudhry, Farooq A

    2015-09-01

    This study evaluates the prognostic value of stress echocardiography (Secho) in short-term (10 years) and lifetime atherosclerotic cardiovascular disease risk-defined groups according to the American College of Cardiology/American Heart Association 2013 cardiovascular risk calculator. The ideal risk assessment and management of patients with low-to-intermediate or high short-term versus low (risk is unclear. The purpose of this study was to evaluate the prognostic value of Secho in short-term and lifetime CV risk-defined groups. We evaluated 4,566 patients (60 ± 13 years; 46% men) who underwent Secho (41% treadmill and 59% dobutamine) with low-intermediate short-term (risk divided into low (risk and third group with high short-term risk (≥20%, n = 3,537). Follow-up (3.2 ± 1.5 years) for nonfatal myocardial infarction (n = 102) and cardiac death (n = 140) were obtained. By univariate analysis, age (p risk and also in those with high short-term CV risk group (3.5% vs 1.0% per year, p risk assessment in patients with low-intermediate or high short-term versus low or high lifetime cardiovascular risk. Event rate with normal Secho is low (≤1% per year) but higher in patients with high short-term CV risk by the American College of Cardiology/American Heart Association 2013 cardiovascular risk calculator. Copyright © 2015 Elsevier Inc. All rights reserved.

  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. A novel prognostic indicator for in-hospital and 4-year outcomes in patients with pulmonary embolism: TIMI risk index.

    Science.gov (United States)

    Keskin, Muhammed; Güvenç, Tolga Sinan; Hayıroğlu, Mert İlker; Kaya, Adnan; Tatlısu, Mustafa Adem; Avşar, Şahin; Öz, Ahmet; Keskin, Taha; Uzun, Ahmet Okan; Kozan, Ömer

    2017-10-01

    Thrombolysis in Myocardial Infarction (TIMI) risk index (TRI) was recently evaluated in patients with acute myocardial infarction and found as an important prognostic index. In the current study, we evaluated the prognostic value of TRI in patients with moderate-high and high risk pulmonary embolism (PE) who were treated with thrombolytic agents. We retrospectively evaluated the in-hospital and long-term (4-year) prognostic impact of TRI in a total number of 456 patients with moderate-high and high risk PE. Patients were stratified by quartiles (Q) of admission TRI. In-hospital analysis revealed significantly higher rates of in-hospital death for patients with TRI in Q4. After adjustment for confounding baseline variables, TRI in Q4 was associated with 2.8-fold hazard of in-hospital death. Upon multivariate analysis, admission TRI in Q4 vs. Q1-3 was associated with 3.1 fold hazard of 4-year mortality rate. TRI in Q4, as compared to Q1-3, was significantly predictive of short term and long-term outcomes in PE patients who treated with thrombolytic agents. Our data suggest TRI to be an independent, feasible, and cost-effective tool for rapid risk stratification in moderate-high and high risk PE patients who treated with thrombolytic agents. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. External validation of prognostic models to predict risk of gestational diabetes mellitus in one Dutch cohort: prospective multicentre cohort study.

    NARCIS (Netherlands)

    Lamain-de Ruiter, M.; Kwee, A.; Naaktgeboren, C.A.; Groot, I. de; Evers, I.M.; Groenendaal, F.; Hering, Y.R.; Huisjes, A.J.M.; Kirpestein, C.; Monincx, W.M.; Siljee, J.E.; Zelfde, A. van't; Oirschot, C.M. van; Vankan-Buitelaar, S.A.; Vonk, M.A.A.W.; Wiegers, T.A.; Zwart, J.J.; Franx, A.; Moons, K.G.M.; Koster, M.P.H.

    2016-01-01

    Objective: To perform an external validation and direct comparison of published prognostic models for early prediction of the risk of gestational diabetes mellitus, including predictors applicable in the first trimester of pregnancy. Design: External validation of all published prognostic models in

  19. 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...

  20. Clinical Risk Factors and Prognostic Model for Primary Graft Dysfunction after Lung Transplantation in Patients with Pulmonary Hypertension.

    Science.gov (United States)

    Porteous, Mary K; Lee, James C; Lederer, David J; Palmer, Scott M; Cantu, Edward; Shah, Rupal J; Bellamy, Scarlett L; Lama, Vibha N; Bhorade, Sangeeta M; Crespo, Maria M; McDyer, John F; Wille, Keith M; Localio, A Russell; Orens, Jonathan B; Shah, Pali D; Weinacker, Ann B; Arcasoy, Selim; Wilkes, David S; Ware, Lorraine B; Christie, Jason D; Kawut, Steven M; Diamond, Joshua M

    2017-10-01

    Pulmonary hypertension from pulmonary arterial hypertension or parenchymal lung disease is associated with an increased risk for primary graft dysfunction after lung transplantation. We evaluated the clinical determinants of severe primary graft dysfunction in pulmonary hypertension and developed and validated a prognostic model. We conducted a retrospective cohort study of patients in the multicenter Lung Transplant Outcomes Group with pulmonary hypertension at transplant listing. Severe primary graft dysfunction was defined as PaO2/FiO2 ≤200 with allograft infiltrates at 48 or 72 hours after transplantation. Donor, recipient, and operative characteristics were evaluated in a multivariable explanatory model. A prognostic model derived using donor and recipient characteristics was then validated in a separate cohort. In the explanatory model of 826 patients with pulmonary hypertension, donor tobacco smoke exposure, higher recipient body mass index, female sex, listing mean pulmonary artery pressure, right atrial pressure and creatinine at transplant, cardiopulmonary bypass use, transfusion volume, and reperfusion fraction of inspired oxygen were associated with primary graft dysfunction. Donor obesity was associated with a lower risk for primary graft dysfunction. Using a 20% threshold for elevated risk, the prognostic model had good negative predictive value in both derivation and validation cohorts (89.1% [95% confidence interval, 85.3-92.8] and 83.3% [95% confidence interval, 78.5-88.2], respectively), but low positive predictive value. Several recipient, donor, and operative characteristics were associated with severe primary graft dysfunction in patients with pulmonary hypertension, including several risk factors not identified in the overall transplant population. A prognostic model with donor and recipient clinical risk factors alone had low positive predictive value, but high negative predictive value, to rule out high risk for primary graft dysfunction.

  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. Taking the Risk Out of Risk Assessment

    Science.gov (United States)

    2005-01-01

    The ability to understand risks and have the right strategies in place when risky events occur is essential in the workplace. More and more organizations are being confronted with concerns over how to measure their risks or what kind of risks they can take when certain events transpire that could have a negative impact. NASA is one organization that faces these challenges on a daily basis, as effective risk management is critical to the success of its missions especially the Space Shuttle missions. On July 29, 1996, former NASA Administrator Daniel Goldin charged NASA s Office of Safety and Mission Assurance with developing a probabilistic risk assessment (PRA) tool to support decisions on the funding of Space Shuttle upgrades. When issuing the directive, Goldin said, "Since I came to NASA [in 1992], we've spent billions of dollars on Shuttle upgrades without knowing how much they improve safety. I want a tool to help base upgrade decisions on risk." Work on the PRA tool began immediately. The resulting prototype, the Quantitative Risk Assessment System (QRAS) Version 1.0, was jointly developed by NASA s Marshall Space Flight Center, its Office of Safety and Mission Assurance, and researchers at the University of Maryland. QRAS software automatically expands the reliability logic models of systems to evaluate the probability of highly detrimental outcomes occurring in complex systems that are subject to potential accident scenarios. Even in its earliest forms, QRAS was used to begin PRA modeling of the Space Shuttle. In parallel, the development of QRAS continued, with the goal of making it a world-class tool, one that was especially suited to NASA s unique needs. From the beginning, an important conceptual goal in the development of QRAS was for it to help bridge the gap between the professional risk analyst and the design engineer. In the past, only the professional risk analyst could perform, modify, use, and perhaps even adequately understand PRA. NASA wanted

  3. Q fever pneumonia in French Guiana: prevalence, risk factors, and prognostic score.

    Science.gov (United States)

    Epelboin, Loïc; Chesnais, Cédric; Boullé, Charlotte; Drogoul, Anne-Sophie; Raoult, Didier; Djossou, Félix; Mahamat, Aba

    2012-07-01

    Community-acquired pneumonia (CAP) is the major manifestation of Q fever, an emerging disease in French Guiana. Consequently, the empirical antibiotherapy used for the treatment of CAP combines doxycycline and the recommended amoxicillin. Our objectives were to estimate the prevalence of Q fever pneumonia and to build a prediction rule to identify patients with Q fever pneumonia for empirical antibiotic guidance. A retrospective case-control study was conducted on inpatients admitted with CAP in the Department of Infectious Diseases of Cayenne Hospital from 2004 to 2007. Serodiagnosis for Coxiella burnetii was performed for all patients. Risk factor analysis was performed using multivariate logistic regression, and a prognostic score was computed using bootstrap procedures. The score performance characteristics were used to choose the best prediction rule to identify patients with Q fever pneumonia. One hundred thirty-one patients with CAP were included and the Q fever pneumonia prevalence was 24.4% (95% confidence interval [CI], 17.1-31.9). In multivariate analysis, male sex, middle age (age, 30-60 years), headache, leukocyte count 185 mg/L were independently associated with Q fever pneumonia. Patients with a predictive score ≤3 had a low risk of Q fever pneumonia with a negative predictive value of 0.97 (95% CI, .90-1) and a sensitivity of 0.97 (95% CI, .89-1). The prediction rule described here accurately identifies patients with low risk of Q fever pneumonia and may help physicians to make more rational decisions about the empirical use of antibiotherapy. Further prospective studies should be performed to validate this score.

  4. Nutritional risk assessment in critically ill cancer patients: systematic review.

    Science.gov (United States)

    Fruchtenicht, Ana Valéria Gonçalves; Poziomyck, Aline Kirjner; Kabke, Geórgia Brum; Loss, Sérgio Henrique; Antoniazzi, Jorge Luiz; Steemburgo, Thais; Moreira, Luis Fernando

    2015-01-01

    To systematically review the main methods for nutritional risk assessment used in critically ill cancer patients and present the methods that better assess risks and predict relevant clinical outcomes in this group of patients, as well as to discuss the pros and cons of these methods according to the current literature. The study consisted of a systematic review based on analysis of manuscripts retrieved from the PubMed, LILACS and SciELO databases by searching for the key words "nutritional risk assessment", "critically ill" and "cancer". Only 6 (17.7%) of 34 initially retrieved papers met the inclusion criteria and were selected for the review. The main outcomes of these studies were that resting energy expenditure was associated with undernourishment and overfeeding. The high Patient-Generated Subjective Global Assessment score was significantly associated with low food intake, weight loss and malnutrition. In terms of biochemical markers, higher levels of creatinine, albumin and urea were significantly associated with lower mortality. The worst survival was found for patients with worse Eastern Cooperative Oncologic Group - performance status, high Glasgow Prognostic Score, low albumin, high Patient-Generated Subjective Global Assessment score and high alkaline phosphatase levels. Geriatric Nutritional Risk Index values Nutritional Index score was associated with abnormal nutritional status in critically ill cancer patients. Among the reviewed studies that examined weight and body mass index alone, no significant clinical outcome was found. None of the methods reviewed helped to define risk among these patients. Therefore, assessment by a combination of weight loss and serum measurements, preferably in combination with other methods using scores such as Eastern Cooperative Oncologic Group - performance status, Glasgow Prognostic Score and Patient-Generated Subjective Global Assessment, is suggested given that their use is simple, feasible and useful in such

  5. Sudden Cardiac Arrest (SCA) Risk Assessment

    Science.gov (United States)

    ... Specialist Share Twitter Facebook SCA Risk Assessment Sudden Cardiac Arrest (SCA) occurs abruptly and without warning, and two- ... and health conditions. Start Risk Assessment The Sudden Cardiac Arrest (SCA) Risk Assessment Tool is supported in part ...

  6. 1C.05: MORNING SURGE AND SLEEP-TIME BLOOD PRESSURE AS PROGNOSTIC MARKERS OF CARDIOVASCULAR RISK: THE HYGIA PROJECT.

    Science.gov (United States)

    Ayala, D E; Dominguez-Sardiña, M; Otero, A; Rios, M T; Gomara, S M; Moya, A; Castiñeira, M C; Crespo, J J; Sineiro, E; Callejas, P A; Pousa, L; Mojon, A; Fernandez, J R; Hermida, R

    2015-06-01

    The extent of blood pressure (BP) surge upon waking has been associated with increased cardiovascular (CVD) risk in some, but not all, studies. Numerous studies, however, have consistently shown the association between elevated sleep-time BP mean and the rising BP pattern with increased CVD risk, leading to a paradox, as patients with sleep-time hypertension or non-dipper/riser BP pattern have attenuated morning BP surge. We evaluated the comparative prognostic value for CVD events of the morning BP surge and sleep-time BP among the participants in the ongoing Hygia Project. This study involved 11255 subjects, 6028 men/5227 women, 58.9 ± 14.5 years of age, prospectively evaluated throughout a 4.0-year median follow-up. BP was measured at 20-min intervals from 07:00 to 23:00 h and at 30-min intervals at night for 48 h. During monitoring, subjects maintained a diary listing the times of going to bed and awakening. We documented 1539 total events, including 400 deaths, 176 strokes, 144 myocardial infarctions, 147 coronary revascularizations, and 193 heart failures. A greater prewaking systolic BP surge was associated with significantly lower, not higher, CVD risk in a Cox proportional-hazard model adjusted for the significant influential characteristics of age, sex, diabetes, chronic kidney disease, cigarette smoking, waist perimeter, and history of previous CVD event (hazard ratio [HR] 0.83 [95%CI 0.78-0.88] per each 1-SD increment; P surge. The prognostic value of morning surge markedly decreased after correcting by the asleep BP mean, the single most significant prognostic marked of total CVD events (HR = 1.37 [1.29-1.44], P surge is associated with a significantly lower CVD risk, in line with the markedly greater risk associated with decreasing dipping of the BP pattern, and the most highly significant prognostic value of progressively elevated asleep BP, an independent prognostic marker of CVD risk that has also been prospectively validated as

  7. Nutritional risk assessment in critically ill cancer patients: systematic review

    Science.gov (United States)

    Fruchtenicht, Ana Valéria Gonçalves; Poziomyck, Aline Kirjner; Kabke, Geórgia Brum; Loss, Sérgio Henrique; Antoniazzi, Jorge Luiz; Steemburgo, Thais; Moreira, Luis Fernando

    2015-01-01

    Objective To systematically review the main methods for nutritional risk assessment used in critically ill cancer patients and present the methods that better assess risks and predict relevant clinical outcomes in this group of patients, as well as to discuss the pros and cons of these methods according to the current literature. Methods The study consisted of a systematic review based on analysis of manuscripts retrieved from the PubMed, LILACS and SciELO databases by searching for the key words “nutritional risk assessment”, “critically ill” and “cancer”. Results Only 6 (17.7%) of 34 initially retrieved papers met the inclusion criteria and were selected for the review. The main outcomes of these studies were that resting energy expenditure was associated with undernourishment and overfeeding. The high Patient-Generated Subjective Global Assessment score was significantly associated with low food intake, weight loss and malnutrition. In terms of biochemical markers, higher levels of creatinine, albumin and urea were significantly associated with lower mortality. The worst survival was found for patients with worse Eastern Cooperative Oncologic Group - performance status, high Glasgow Prognostic Score, low albumin, high Patient-Generated Subjective Global Assessment score and high alkaline phosphatase levels. Geriatric Nutritional Risk Index values Nutritional Index score was associated with abnormal nutritional status in critically ill cancer patients. Among the reviewed studies that examined weight and body mass index alone, no significant clinical outcome was found. Conclusion None of the methods reviewed helped to define risk among these patients. Therefore, assessment by a combination of weight loss and serum measurements, preferably in combination with other methods using scores such as Eastern Cooperative Oncologic Group - performance status, Glasgow Prognostic Score and Patient-Generated Subjective Global Assessment, is suggested given that

  8. [Prognostic value of functional assessment at admission in an emergency short-stay unit].

    Science.gov (United States)

    Fernández Alonso, Cesareo; Martín Sánchez, Francisco Javier; Fuentes Ferrer, Manuel; González Del Castillo, Juan; Verdejo Bravo, Carlos; Gil Gregorio, Pedro; Ribera Casado, Jose Manuel; Villarroel Elipe, Pedro; González Armengol, Juan Jorge

    2010-01-01

    To determine the prognostic value of functional impairment on the final destination of elders admitted for acute medical illness to an emergency short-stay unit (ESSU). We performed a prospective analysis of patients aged more than 65 years old admitted to the ESSU of Hospital Clínico San Carlos in Madrid in April 2008. A protocol was designed that included epidemiologic variables (age and gender), clinical variables (reason for admission, comorbidity measured by the Charlson Index [CI]) and functional variables (previous, admission and functional decline [FD] measured with the Barthel [BI] and Lawton Indexes [LI]). The prognostic value of FD on the decision to admit patients was analyzed through ROC curves and the cut points that maximized sensitivity and specificity were determined. Sixty patients were included with a mean age of 80.7 (SD 8.2) years and 71.7% were women. The reasons for admission were acute infections in 31.7%, heart failure in 23.3%, syncope in 15.0%, intestinal obstruction in 11.7%, gastrointestinal bleeding in 10.0%, and arrhythmias in 8.3%. The mean CI was 2.27 (1.45). Functional assessment was as follows: mean previous BI score: 79.25 (SD 25) and at admission: 62.92 (SD 28.19). Mean previous LI score: 4.85 (SD 2.45) and at admission: 2.98 (SD 2.42).): BI-FD: 20% (1.25-38.23), LI-FD 37.5% (16.7-70.2%). FD was found in 100% of the patients. The mean length of stay was 1.70 (SD 0.62) days. Discharge destination was home discharge in 46.7% and hospitalization unit in 53.3%. Multivariate analysis according to discharge destination (home vs hospitalization) provided the following results : BI-FI > or = 16% (OR=7.99 [1.1-60.5], p=0.037), LI-FI > or =35% (OR=19.6 [0.04-0.52], p <0.0001). Patients with significant FD in the emergency room should not be admitted to an ESSU since significant FD is a prognostic factor for transfer to a conventional ward. Copyright 2009 SEGG. Published by Elsevier Espana. All rights reserved.

  9. Comparison of two prognostic models for acute pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Abd-ElRahim Ibrahim Youssef

    2016-10-01

    Conclusion: (1 There is an agreement to great extent in risk stratification of APE patients by PESI and ESC prognostic models, where mortality rate is increased among high risk classes of both models, (2 ESC prognostic model is more accurate than PESI model in mortality prediction of APE patients especially in the high risk class, (3 echocardiographic evidence of RVD and elevated plasma BNP can help to identify APE patients at increased risk of adverse short-term outcome and (4 integration of RVD assessment by echocardiography and BNP to clinical findings improves the prognostic value of ESC model.

  10. Probabilistic risk assessment: Number 219

    Energy Technology Data Exchange (ETDEWEB)

    Bari, R.A.

    1985-11-13

    This report describes a methodology for analyzing the safety of nuclear power plants. A historical overview of plants in the US is provided, and past, present, and future nuclear safety and risk assessment are discussed. A primer on nuclear power plants is provided with a discussion of pressurized water reactors (PWR) and boiling water reactors (BWR) and their operation and containment. Probabilistic Risk Assessment (PRA), utilizing both event-tree and fault-tree analysis, is discussed as a tool in reactor safety, decision making, and communications. (FI)

  11. Caries risk assessment in children

    DEFF Research Database (Denmark)

    Twetman, S

    2016-01-01

    PURPOSE: To summarise the findings of recent systematic reviews (SR) covering caries risk assessment in children, updated with recent primary studies. METHODS: A search for relevant papers published 2012-2014 was conducted in electronic databases. The systematic reviews were quality assessed...... the use of single predictors and this is especially true for preschool children (C); (3) there is no clearly superior method to predict future caries and no evidence to support the use of one model, program, or technology before the other (C); and (4) the risk category should be linked to appropriate...

  12. Toxicological risk assessment. Volume 2

    Energy Technology Data Exchange (ETDEWEB)

    Clayson, D.B.; Krewski, D.; Munro, I.

    1985-01-01

    This book contains the following chapters: Epidemiological Methods for Assessment of Human Cancer Risk. Assessment of Human Exposure to Environmental Contaminants with Special Reference to Cancer. Influence of Nutrition, Immunologic Status, and Other Factors on Development of Cancer. Significance of Benefits in Regulatory Decision Making. Measuring Health Benefits. Food Safety Regulations. Case Study-Asbestos. Vinyl Chloride - A Cancer Case Study. An Integrated Approach to the Study of Formaldehyde Carcinogenicity in Rats and Mice. Determination of Human Risk in Regulating Polychlorinated Biphenyls Saccharin - A Bitter-Sweet Case.

  13. Caries Risk Assessment Item Importance

    Science.gov (United States)

    Chaffee, B.W.; Featherstone, J.D.B.; Gansky, S.A.; Cheng, J.; Zhan, L.

    2016-01-01

    Caries risk assessment (CRA) is widely recommended for dental caries management. Little is known regarding how practitioners use individual CRA items to determine risk and which individual items independently predict clinical outcomes in children younger than 6 y. The objective of this study was to assess the relative importance of pediatric CRA items in dental providers’ decision making regarding patient risk and in association with clinically evident caries, cross-sectionally and longitudinally. CRA information was abstracted retrospectively from electronic patient records of children initially aged 6 to 72 mo at a university pediatric dentistry clinic (n = 3,810 baseline; n = 1,315 with follow-up). The 17-item CRA form included caries risk indicators, caries protective items, and clinical indicators. Conditional random forests classification trees were implemented to identify and assign variable importance to CRA items independently associated with baseline high-risk designation, baseline evident tooth decay, and follow-up evident decay. Thirteen individual CRA items, including all clinical indicators and all but 1 risk indicator, were independently and statistically significantly associated with student/resident providers’ caries risk designation. Provider-assigned baseline risk category was strongly associated with follow-up decay, which increased from low (20.4%) to moderate (30.6%) to high/extreme risk patients (68.7%). Of baseline CRA items, before adjustment, 12 were associated with baseline decay and 7 with decay at follow-up; however, in the conditional random forests models, only the clinical indicators (evident decay, dental plaque, and recent restoration placement) and 1 risk indicator (frequent snacking) were independently and statistically significantly associated with future disease, for which baseline evident decay was the strongest predictor. In this predominantly high-risk population under caries-preventive care, more individual CRA items

  14. 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.

  15. Phytosanitary risk assessment of composts

    NARCIS (Netherlands)

    Termorshuizen, A.J.; Rijn, van E.; Blok, W.J.

    2005-01-01

    Assessment of phytosanitary risks associated with application of composts in agriculture generally has focused on the sanitation (self-heating) phase during composting when most plant pathogens are inactivated due to lethal temperatures. However, a few plant pathogens are heat resistant and they may

  16. Where You Live: Risk Assessment

    Science.gov (United States)

    Where you live page shows visitors to the risk assessment website how to contact their local regional office by state. Since these link to pages maintained by the local offices they will have the most up-to-date contact information.

  17. Interobserver variability amongst gastrointestinal pathologists in assessing prognostic parameters of malignant colorectal polyps: a cause for concern.

    Science.gov (United States)

    Davenport, A; Morris, J; Pritchard, S A; Salmo, E; Scott, M; Haboubi, N Y

    2016-09-01

    Malignant colorectal polyps (MCRP) have become a major challenge in the field of coloproctology from diagnosis to full treatment. One important facet of the challenge is the histopathological staging of the lesion and identifying various prognostic parameters. The primary aim of this study was to find the interobserver variation amongst 4 experienced gastrointestinal pathologists when assessing important parameters and staging systems (Haggitt, Kikuchi and Ueno) in MCRPs. Four experienced gastrointestinal pathologists independently assessed 56 cases of MCRP, and each pathologist completed a pro forma for each case. The results were collated and statistically analysed. There was a significant variation in the assessments using the various published staging systems agreed upon on important prognostic parameters. None of the staging systems used is suitable for all polyp types or has good reproducibility. There is an urgent need to make pathologists' assessment of MCRPs easier and more reproducible.

  18. The role of copeptin as a diagnostic and prognostic biomarker for risk stratification in the emergency department

    Science.gov (United States)

    2012-01-01

    The hypothalamic-pituitary-adrenal axis is activated in response to stress. One of the activated hypothalamic hormones is arginine vasopressin, a hormone involved in hemodynamics and osmoregulation. Copeptin, the C-terminal part of the arginine vasopressin precursor peptide, is a sensitive and stable surrogate marker for arginine vasopressin release. Measurement of copeptin levels has been shown to be useful in a variety of clinical scenarios, particularly as a prognostic marker in patients with acute diseases such as lower respiratory tract infection, heart disease and stroke. The measurement of copeptin levels may provide crucial information for risk stratification in a variety of clinical situations. As such, the emergency department appears to be the ideal setting for its potential use. This review summarizes the recent progress towards determining the prognostic and diagnostic value of copeptin in the emergency department. PMID:22264220

  19. The role of copeptin as a diagnostic and prognostic biomarker for risk stratification in the emergency department

    Directory of Open Access Journals (Sweden)

    Nickel Christian H

    2012-01-01

    Full Text Available Abstract The hypothalamic-pituitary-adrenal axis is activated in response to stress. One of the activated hypothalamic hormones is arginine vasopressin, a hormone involved in hemodynamics and osmoregulation. Copeptin, the C-terminal part of the arginine vasopressin precursor peptide, is a sensitive and stable surrogate marker for arginine vasopressin release. Measurement of copeptin levels has been shown to be useful in a variety of clinical scenarios, particularly as a prognostic marker in patients with acute diseases such as lower respiratory tract infection, heart disease and stroke. The measurement of copeptin levels may provide crucial information for risk stratification in a variety of clinical situations. As such, the emergency department appears to be the ideal setting for its potential use. This review summarizes the recent progress towards determining the prognostic and diagnostic value of copeptin in the emergency department.

  20. Prognostic value of residual pulmonary congestion at discharge assessed by lung ultrasound imaging in heart failure.

    Science.gov (United States)

    Coiro, Stefano; Rossignol, Patrick; Ambrosio, Giuseppe; Carluccio, Erberto; Alunni, Gianfranco; Murrone, Adriano; Tritto, Isabella; Zannad, Faiez; Girerd, Nicolas

    2015-11-01

    Residual pulmonary congestion at discharge is associated with poor prognosis in heart failure (HF), but its quantification through physical examination is challenging. Ultrasound imaging of lung comets (B-lines) could improve congestion evaluation. The aim of this study was to assess the short-term prognostic value of B-lines after discharge from HF hospitalisation compared with other indices of haemodynamic congestion (BNP, E/e', and inferior vena cava diameter) or clinical status (NYHA class). Sixty consecutive HF inpatients underwent clinical examination, echocardiography, and lung ultrasound at discharge, independently of, and in addition to routine management by the attending physicians. The median B-line count was 8.5 (5-34). Three-month event-free survival for the primary endpoint (all-cause death or HF hospitalisation) was 27 ± 10% in patients with ≥30 B-lines and 88 ± 5% in those with pulmonary congestion at discharge, as assessed by a B-line count ≥30, is a strong predictor of outcome. Lung ultrasonography may represent a useful tool to identify and monitor congestion and optimize therapy during and/or after hospitalisation for HF, which should be further validated in multicentre studies. © 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology.

  1. Quantitative Assessment of Arrhythmia Using Non-linear Approach: A Non-invasive Prognostic Tool

    Science.gov (United States)

    Chakraborty, Monisha; Ghosh, Dipak

    2017-12-01

    Accurate prognostic tool to identify severity of Arrhythmia is yet to be investigated, owing to the complexity of the ECG signal. In this paper, we have shown that quantitative assessment of Arrhythmia is possible using non-linear technique based on "Hurst Rescaled Range Analysis". Although the concept of applying "non-linearity" for studying various cardiac dysfunctions is not entirely new, the novel objective of this paper is to identify the severity of the disease, monitoring of different medicine and their dose, and also to assess the efficiency of different medicine. The approach presented in this work is simple which in turn will help doctors in efficient disease management. In this work, Arrhythmia ECG time series are collected from MIT-BIH database. Normal ECG time series are acquired using POLYPARA system. Both time series are analyzed in thelight of non-linear approach following the method "Rescaled Range Analysis". The quantitative parameter, "Fractal Dimension" (D) is obtained from both types of time series. The major finding is that Arrhythmia ECG poses lower values of D as compared to normal. Further, this information can be used to access the severity of Arrhythmia quantitatively, which is a new direction of prognosis as well as adequate software may be developed for the use of medical practice.

  2. Assessment of prognostic significance of cytoplasmic survivin expression in advanced oesophageal cancer.

    Directory of Open Access Journals (Sweden)

    G Wallner

    2004-10-01

    Full Text Available Survivin is a member of the family of proteins, which inhibit apoptosis (inhibitor of apoptosis proteins - IAP. Expression of survivin was found in colorectal cancer, neuroblastoma, bladder cancer, non-small cell lung cancer, and breast cancer. There is some recent data indicating the correlation of poor prognosis and worse response to chemotherapy in patients with oesophageal squamous cell carcinoma (OSCC expressing survivin. The aim of the present study was to assess survivin expression in cancerous tissue of patients with advanced OSCC and to test the potential correlation between survivin expression and clinicopathological data. Forty two patients (mean age 58.36+/-8.97 yrs, who were oesophagectomised due to squamous cell carcinoma of the thoracic oesophagus between 1998 and 2000, were retrospectively analysed. Cytoplasmic survivin expression, examined immunohistochemically, was found in 35 (83.33% cases. No statistically significant correlation between survivin expression in the tumour and patients' gender, TNM stage, or vascular involvement was noted. The mean survival of patients with cytoplasmic survivin expression (17.81+/-5.51 months was not statistically different to those with negative survivin staining (16+/-6.28 months as assessed by Mantel-Cox test (p=0.49. Univariate regression analysis revealed UICC staging as the only predictor of survival in the analysed group (p<0.05. These results indicate that the cytoplasmic survivin expression does not seem to be the prognostic factor in advanced cases of OSCC.

  3. 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...

  4. Prognostic Nutritional Index and the Risk of Mortality in Patients With Acute Heart Failure.

    Science.gov (United States)

    Cheng, Yu-Lun; Sung, Shih-Hsien; Cheng, Hao-Min; Hsu, Pai-Feng; Guo, Chao-Yu; Yu, Wen-Chung; Chen, Chen-Huan

    2017-06-25

    Nutritional status has been related to clinical outcomes in patients with heart failure. We assessed the association between nutritional status, indexed by prognostic nutritional index (PNI), and survival in patients hospitalized for acute heart failure. A total of 1673 patients (age 76±13 years, 68% men) hospitalized for acute heart failure in a tertiary medical center were analyzed. PNI was calculated as 10×serum albumin (g/dL)+0.005×total lymphocyte count (per mm(3)). National Death Registry was linked to identify the clinical outcomes of all-cause and cardiovascular death. With increasing tertiles of PNI, age and N-terminal probrain natriuretic peptide decreased, and body mass index, estimated glomerular filtration rate, and hemoglobin increased. During a mean follow-up duration of 31.5 months, a higher PNI tertile was related to better survival free from all-cause and cardiovascular mortality in the total study population and in participants with either reduced or preserved left ventricular ejection fraction. After accounting for age, sex, estimated glomerular filtration rate, left ventricular ejection fraction, serum sodium level, and on-admission systolic blood pressure, PNI was independently associated with cardiovascular death and total mortality (hazard ratio per 1 SD of the natural logarithm of the PNI: 0.76 [95% CI, 0.66-0.87] and 0.79 [95% CI, 0.73-0.87], respectively). In subgroup analyses stratified by age, sex, left ventricular ejection fraction, body mass index, or estimated glomerular filtration rate, PNI was consistently related to mortality. PNI is independently associated with long-term survival in patients hospitalized for acute heart failure with either reduced or preserved left ventricular ejection fraction. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  5. Major prognostic impact of persistent microvascular obstruction as assessed by contrast-enhanced cardiac magnetic resonance in reperfused acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Cochet, Alexandre A.; Lalande, Alain; Walker, Paul M.; Touzery, Claude; Brunotte, Francois [CHU Hopital d' Enfants, Unite d' IRM et CNRS UMR 5158, Dijon (France); Lorgis, Luc; Beer, Jean-Claude; Cottin, Yves [CHU Bocage, Departement de Cardiologie, Dijon (France); Zeller, Marianne [Universite de Bourgogne, Institut Federatif de Recherche 100 Sante STIC, Bourgogne (France); Wolf, Jean-Eric [CHU Hopital d' Enfants, Unite d' IRM et CNRS UMR 5158, Dijon (France); CHU Bocage, Departement de Cardiologie, Dijon (France)

    2009-09-15

    The aim of this study was to compare the prognostic significance of microvascular obstruction (MO) and persistent microvascular obstruction (PMO) as assessed by cardiac magnetic resonance (CMR) in patients with acute myocardial infarction (AMI). CMR was performed in 184 patients within the week following successfully reperfused first AMI. First-pass images were performed to evaluate extent of MO and late gadolinium-enhanced images to assess PMO and infarct size (IS). Major adverse cardiac events (MACE) were collected at 1-year follow-up. MO and PMO were found in 127 (69%) and 87 (47%) patients, respectively. By using univariate logistic regression analysis, high Global Registry of Acute Coronary Events (GRACE) risk score (odds ratio [OR] 95% confidence interval [CI]: 3.6 [1.8-7.4], p < 0.001), IS greater than 10% (OR [95% CI]: 2.7 [1.1-6.9], p = 0.036), left ventricular ejection fraction less than 40% (OR [95% CI]: 2.4 [1.1-5.2], p = 0.027), presence of MO (OR [95% CI]: 3.1 [1.3-7.3], p = 0.004) and presence of PMO (OR [95% CI]:10 [4.1-23.9], p < 0.001) were shown to be significantly associated with the outcome. By using multivariate analysis, presence of MO (OR [95% CI]: 2.5 [1.0-6.2], p = 0.045) or of PMO (OR [95% CI]: 8.7 [3.6-21.1], p < 0.001), associated with GRACE score, were predictors of MACE. Presence of microvascular obstruction and persistent microvascular obstruction is very common in AMI patients even after successful reperfusion and is associated with a dramatically higher risk of subsequent cardiovascular events, beyond established prognostic markers. Moreover, our data suggest that the prognostic impact of PMO might be superior to MO. (orig.)

  6. Prognostic value of malnutrition assessed by Controlling Nutritional Status score for long-term mortality in patients with acute heart failure.

    Science.gov (United States)

    Iwakami, Naotsugu; Nagai, Toshiyuki; Furukawa, Toshiaki A; Sugano, Yasuo; Honda, Satoshi; Okada, Atsushi; Asaumi, Yasuhide; Aiba, Takeshi; Noguchi, Teruo; Kusano, Kengo; Ogawa, Hisao; Yasuda, Satoshi; Anzai, Toshihisa

    2017-03-01

    The prognostic value of nutritional status is poorly understood and evidence-based nutritional assessment indices are required in acute heart failure (AHF). We investigated the prognostic value of malnutrition assessed by the Controlling Nutritional Status (CONUT) score (range 0-12, higher=worse, consisting of serum albumin, cholesterol and lymphocytes) in AHF patients. The CONUT score was measured on admission in 635 consecutive AHF patients. The primary outcome was all-cause death. Median CONUT score was 3 (interquartile range 2 to 5). During the median follow-up of 324days, CONUT score was independently associated with death (HR 1.26, 95% CI 1.11-1.42, Pnutritional markers in HF. Furthermore, addition of the CONUT score to an established risk prediction model from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure study significantly increased the C-statistic from 0.75 to 0.77 (P=0.02). The net reclassification improvement afforded by CONUT score was 21% for all-cause death, 27% for survival and 49% overall (Pnutritional indices. Moreover, addition of the score to the existing risk prediction model significantly increased the predictive ability for death, indicating beneficial clinical application of the CONUT score in AHF patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  7. Assessing the cost effectiveness of using prognostic biomarkers with decision models: case study in prioritising patients waiting for coronary artery surgery.

    Science.gov (United States)

    Henriksson, Martin; Palmer, Stephen; Chen, Ruoling; Damant, Jacqueline; Fitzpatrick, Natalie K; Abrams, Keith; Hingorani, Aroon D; Stenestrand, Ulf; Janzon, Magnus; Feder, Gene; Keogh, Bruce; Shipley, Martin J; Kaski, Juan-Carlos; Timmis, Adam; Sculpher, Mark; Hemingway, Harry

    2010-01-19

    To determine the effectiveness and cost effectiveness of using information from circulating biomarkers to inform the prioritisation process of patients with stable angina awaiting coronary artery bypass graft surgery. Decision analytical model comparing four prioritisation strategies without biomarkers (no formal prioritisation, two urgency scores, and a risk score) and three strategies based on a risk score using biomarkers: a routinely assessed biomarker (estimated glomerular filtration rate), a novel biomarker (C reactive protein), or both. The order in which to perform coronary artery bypass grafting in a cohort of patients was determined by each prioritisation strategy, and mean lifetime costs and quality adjusted life years (QALYs) were compared. Swedish Coronary Angiography and Angioplasty Registry (9935 patients with stable angina awaiting coronary artery bypass grafting and then followed up for cardiovascular events after the procedure for 3.8 years), and meta-analyses of prognostic effects (relative risks) of biomarkers. The observed risk of cardiovascular events while on the waiting list for coronary artery bypass grafting was 3 per 10,000 patients per day within the first 90 days (184 events in 9935 patients). Using a cost effectiveness threshold of pound20,000- pound30,000 (euro22,000-euro33,000; $32,000-$48,000) per additional QALY, a prioritisation strategy using a risk score with estimated glomerular filtration rate was the most cost effective strategy (cost per additional QALY was < pound410 compared with the Ontario urgency score). The impact on population health of implementing this strategy was 800 QALYs per 100,000 patients at an additional cost of pound 245,000 to the National Health Service. The prioritisation strategy using a risk score with C reactive protein was associated with lower QALYs and higher costs compared with a risk score using estimated glomerular filtration rate. Evaluating the cost effectiveness of prognostic biomarkers is

  8. Minimal residual disease assessed by multi-parameter flow cytometry is highly prognostic in adult patients with acute lymphoblastic leukaemia.

    Science.gov (United States)

    Ravandi, Farhad; Jorgensen, Jeffrey L; O'Brien, Susan M; Jabbour, Elias; Thomas, Deborah A; Borthakur, Gautam; Garris, Rebecca; Huang, Xuelin; Garcia-Manero, Guillermo; Burger, Jan A; Ferrajoli, Alessandra; Wierda, William; Kadia, Tapan; Jain, Nitin; Wang, Sa A; Konoplev, Sergei; Kebriaei, Partow; Champlin, Richard E; McCue, Deborah; Estrov, Zeev; Cortes, Jorge E; Kantarjian, Hagop M

    2016-02-01

    The prognostic value of minimal residual disease (MRD) assessed by multi-parameter flow cytometry (MFC) was investigated among 340 adult patients with B-cell acute lymphoblastic leukaemia (B-ALL) treated between 2004 and 2014 using regimens including the hyperCVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone, methotrexate, cytarabine) backbone. Among them, 323 (95%) achieved complete remission (CR) and were included in this study. Median age was 52 years (range, 15-84). Median white blood cell count (WBC) was 9·35 × 10(9) /l (range, 0·4-658·1 ×1 0(9) /l). MRD by MFC was initially assessed with a sensitivity of 0·01%, using a 15-marker, 4-colour panel and subsequently a 6-colour panel on bone marrow specimens obtained at CR achievement and at approximately 3 month intervals thereafter. MRD negative status at CR was associated with improved disease-free survival (DFS) and overall survival (OS) (P = 0·004 and P = 0·03, respectively). Similarly, achieving MRD negative status at approximately 3 and 6 months was associated with improved DFS (P = 0·004 and P < 0·0001, respectively) and OS (P = 0·004 and P < 0·0001, respectively). Multivariate analysis including age, WBC at presentation, cytogenetics (standard versus high risk) and MRD status at CR, 3 and 6 months, indicated that MRD negative status at CR was an independent predictor of DFS (P < 0·05). Achievement of an MRD negative state assessed by MFC is an important predictor of DFS and OS in adult patients with ALL. © 2015 John Wiley & Sons Ltd.

  9. La Conchita Landslide Risk Assessment

    Science.gov (United States)

    Kropp, A.; Johnson, L.; Magnusen, W.; Hitchcock, C. S.

    2009-12-01

    Following the disastrous landslide in La Conchita in 2005 that resulted in ten deaths, the State of California selected our team to prepare a risk assessment for a committee of key stakeholders. The stakeholders represented the State of California, Ventura County, members of the La Conchita community, the railroad, and the upslope ranch owner (where the slide originated); a group with widely varying views and interests. Our team was charged with characterizing the major hazards, developing a series of mitigation concepts, evaluating the benefits and costs of mitigation, and gathering stakeholder input throughout the process. Two unique elements of the study were the methodologies utilized for the consequence assessment and for the decision-making framework. La Conchita is exposed to multiple slope hazards, each with differing geographical distributions, as well as depth and velocity characteristics. Three consequence matrices were developed so that the potential financial losses, structural vulnerabilities, and human safety exposure could be evaluated. The matrices utilized semi-quantitative loss evaluations (both financial and life safety) based on a generalized understanding of likely vulnerability and hazard characteristics. The model provided a quantitative estimate of cumulative losses over a 50-year period, including losses of life based on FEMA evaluation criteria. Conceptual mitigation options and loss estimates were developed to provide a range of risk management solutions that were feasible from a cost-benefit standpoint. A decision tree approach was adopted to focus on fundamental risk management questions rather than on specific outcomes since the committee did not have a consensus view on the preferred solution. These questions included: 1. Over what time period can risks be tolerated before implementation of decisions? 2. Whose responsibility is it to identify a workable risk management solution? 3. Who will own the project? The decision tree

  10. Suicide Risk Assessment in Adolescents

    DEFF Research Database (Denmark)

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

    2016-01-01

    Background: Assessment and screening are often the first step in planning interventions to help adolescents at risk of suicide. Causes of suicidal thoughts and behavior are multifaceted and it is important for clinical work that assessment reflects this complexity. Aim(s): To investigate whether...... a general psychological "Resilience Scale for Adolescents" (READ) is associated with a validated suicide rating scale (C-SSRS). Method: An observational study of self-reported suicidality (C-SSRS), psychological distress (K10) and resiliency (READ) in three adolescent samples: suicide clinic (N=147...

  11. Apollo 13 Risk Assessment Revisited

    OpenAIRE

    Bukovics, István

    2007-01-01

    Fault tree methodology is the most widespread risk assessment tool by which one is able to predict - in principle - the outcome of an event whenever it is reduced to simpler ones by the logic operations conjunction and disjunction according to the basics of Boolean algebra. The object of this work is to present an algorithm by which, using the corresponding computer code, one is able to predict - in practice - the outcome of an event whenever its fault tree is given in the u...

  12. Risk Assessment of Shellfish Toxins

    Directory of Open Access Journals (Sweden)

    Rex Munday

    2013-11-01

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

  13. 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.

  14. [Assessment of Cachexia in Head and Neck Cancer Patients Based on a Modified Glasgow Prognostic Score].

    Science.gov (United States)

    Matsuzuka, Takashi; Suzuki, Masahiro; Saijoh, Satoshi; Ikeda, Masakazu; Imaizumi, Mitsumasa; Nomoto, Yukio; Matsui, Takamichi; Tada, Yasuhiro; Omori, Koichi

    2016-02-01

    We retrospectively analyzed 54 patients who died of head and neck squamous cell caricinoma regarding the process and duration of cachexia using the modified Glasgow Prognostic Score (mGPS). The patients were classified as having cachexia when the serum albumin level was less than 3.5 mg/dL and the C-reactive protein (CRP) level was more than 0.5 mg/dL. The number of patients with cachexia was eight (8%) at the first visit and 50 (93%) at the time of death. In the 50 patients, the median and average time of having cachexia was 59 and 95 days, respectively. Thirty-two of the 50 patients (64%) died within three months after the presence of cachexia was confirmed. In this study, the time of having cachexia was so short, then the policy of care should be converted from aggressive into supportive in patients classified as having cachexia. mGPS would be an accurate assessment tool for cachexia and ascertain the end stage of head and neck cancer patients.

  15. Prognostication and response assessment in liver and pancreatic tumors: The new imaging

    Science.gov (United States)

    De Robertis, Riccardo; Tinazzi Martini, Paolo; Demozzi, Emanuele; Puntel, Gino; Ortolani, Silvia; Cingarlini, Sara; Ruzzenente, Andrea; Guglielmi, Alfredo; Tortora, Giampaolo; Bassi, Claudio; Pederzoli, Paolo; D’Onofrio, Mirko

    2015-01-01

    Diffusion-weighted imaging (DWI), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and perfusion computed tomography (CT) are technical improvements of morphologic imaging that can evaluate functional properties of hepato-bilio-pancreatic tumors during conventional MRI or CT examinations. Nevertheless, the term “functional imaging” is commonly used to describe molecular imaging techniques, as positron emission tomography (PET) CT/MRI, which still represent the most widely used methods for the evaluation of functional properties of solid neoplasms; unlike PET or single photon emission computed tomography, functional imaging techniques applied to conventional MRI/CT examinations do not require the administration of radiolabeled drugs or specific equipments. Moreover, DWI and DCE-MRI can be performed during the same session, thus providing a comprehensive “one-step” morphological and functional evaluation of hepato-bilio-pancreatic tumors. Literature data reveal that functional imaging techniques could be proposed for the evaluation of these tumors before treatment, given that they may improve staging and predict prognosis or clinical outcome. Microscopic changes within neoplastic tissues induced by treatments can be detected and quantified with functional imaging, therefore these techniques could be used also for post-treatment assessment, even at an early stage. The aim of this editorial is to describe possible applications of new functional imaging techniques apart from molecular imaging to hepatic and pancreatic tumors through a review of up-to-date literature data, with a particular emphasis on pathological correlations, prognostic stratification and post-treatment monitoring. PMID:26078555

  16. A clinical prognostic model for the identification of low-risk patients with acute symptomatic pulmonary embolism and active cancer.

    Science.gov (United States)

    den Exter, Paul L; Gómez, Vicente; Jiménez, David; Trujillo-Santos, Javier; Muriel, Alfonso; Huisman, Menno V; Monreal, Manuel

    2013-01-01

    Physicians need a specific risk-stratification tool to facilitate safe and cost-effective approaches to the management of patients with cancer and acute pulmonary embolism (PE). The objective of this study was to develop a simple risk score for predicting 30-day mortality in patients with PE and cancer by using measures readily obtained at the time of PE diagnosis. Investigators randomly allocated 1,556 consecutive patients with cancer and acute PE from the international multicenter Registro Informatizado de la Enfermedad TromboEmbólica to derivation (67%) and internal validation (33%) samples. The external validation cohort for this study consisted of 261 patients with cancer and acute PE. Investigators compared 30-day all-cause mortality and nonfatal adverse medical outcomes across the derivation and two validation samples. In the derivation sample, multivariable analyses produced the risk score, which contained six variables: age > 80 years, heart rate ≥ 110/min, systolic BP < 100 mm Hg, body weight < 60 kg, recent immobility, and presence of metastases. In the internal validation cohort (n = 508), the 22.2% of patients (113 of 508) classified as low risk by the prognostic model had a 30-day mortality of 4.4% (95% CI, 0.6%-8.2%) compared with 29.9% (95% CI, 25.4%-34.4%) in the high-risk group. In the external validation cohort, the 18% of patients (47 of 261) classified as low risk by the prognostic model had a 30-day mortality of 0%, compared with 19.6% (95% CI, 14.3%-25.0%) in the high-risk group. The developed clinical prediction rule accurately identifies low-risk patients with cancer and acute PE.

  17. Prognostic Value of High-Sensitivity Cardiac Troponin T Compared with Risk Scores in Stable Cardiovascular Disease.

    Science.gov (United States)

    Biener, Moritz; Giannitsis, Evangelos; Kuhner, Manuel; Zelniker, Thomas; Mueller-Hennessen, Matthias; Vafaie, Mehrshad; Trenk, Dietmar; Neumann, Franz-Josef; Hochholzer, Willibald; Katus, Hugo A

    2017-05-01

    Risk stratification of patients with cardiovascular disease remains challenging despite consideration of risk scores. We aimed to evaluate the prognostic performance of high-sensitivity cardiac troponin T in a low-risk outpatient population presenting for nonsecondary and secondary prevention. All-cause mortality, a composite of all-cause mortality, acute myocardial infarction, and stroke (end point 2), and a composite of all-cause mortality, acute myocardial infarction, stroke and rehospitalization for acute coronary syndrome, and decompensated heart failure (end point 3) were defined. The prognostic performance of high-sensitivity cardiac troponin T on index visit was compared with the PROCAM score and 3 FRAMINGHAM subscores. In 693 patients with a median follow-up of 796 days, we observed 16 deaths, 32 patients with end point 2, and 83 patients with end point 3. All risk scores performed better in the prediction of all-cause mortality in nonsecondary prevention (area under the curve [AUC]: PROCAM: 0.922 vs 0.523, P = .001, consistent for all other scores). In secondary prevention, high-sensitivity cardiac troponin T outperformed all risk scores in the prediction of all-cause mortality (ΔAUC: PROCAM: 0.319, P risk scores. Our findings on the prediction of all-cause mortality compared with the FRAMINGHAM-Hard Coronary Heart Disease score were confirmed in an independent validation cohort on 2046 patients. High-sensitivity troponin T provides excellent risk stratification regarding all-cause mortality and all-cause mortality, acute myocardial infarction, and stroke in a secondary prevention cohort in whom risk scores perform poorly. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. 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

  19. Prognostic value of physicians' assessment of compliance regarding all-cause mortality in patients with type 2 diabetes: primary care follow-up study

    Directory of Open Access Journals (Sweden)

    Rüter Gernot

    2006-07-01

    Full Text Available Abstract Background Whether the primary care physician's assessment of patient compliance is a valuable prognostic marker to identify patients who are at increased risk of death, or merely reflects measurement of various treatment parameters such as HbA1C or other laboratory markers is unclear. The objective of this prospective cohort study was to investigate the prognostic value of the physicians' assessment of patient compliance and other factors with respect to all-cause mortality during a one year follow-up period. Methods A prospective cohort study was conducted among 1014 patients with type 2 diabetes aged 40 and over (mean age 69 years, SD 10.4, 45% male who were under medical treatment in 11 participating practices of family physicians and internists working in primary care in a defined region in South Germany between April and June 2000. Baseline data were gathered from patients and physicians by standardized questionnaire. The physician's assessment of patient compliance was assessed by means of a 4-point Likert scale (very good, rather good, rather bad, very bad. In addition, we carried out a survey among physicians by means of a questionnaire to find out which aspects for the assessment of patient compliance were of importance to make this assessment. Active follow-up of patients was conducted after one year to determine mortality. Results During the one year follow-up 48 (4.7% of the 1014 patients died. Among other factors such as patient type (patients presenting at office, nursing home or visited patients, gender, age and a history of macrovascular disease, the physician's assessment of patient compliance was an important predictor of all-cause mortality. Patients whose compliance was assessed by the physician as "very bad" (6% were significantly more likely to die during follow-up (OR = 2.67, 95% CI 1.02–6.97 after multivariable adjustment compared to patients whose compliance was assessed as "rather good" (45% or "very good

  20. Atherogenic Risk Assessment among Persons Living in Rural Uganda

    Directory of Open Access Journals (Sweden)

    Clara Wekesa

    2016-01-01

    Full Text Available Background. Hypertension and dyslipidemia are independent risk factors for coronary heart disease and commonly coexist. Cardiovascular risk can be reliably predicted using lipid ratios such as the atherogenic index, a useful prognostic parameter for guiding timely interventions. Objective. We assessed the cardiovascular risk profile based on the atherogenic index of residents within a rural Ugandan cohort. Methods. In 2011, a population based survey was conducted among 7507 participants. Sociodemographic characteristics, physical measurements (blood pressure, weight, height, and waist and hip circumference, and blood sampling for nonfasting lipid profile were collected for each participant. Atherogenic risk profile, defined as logarithm base ten of (triglyceride divided by high density lipoprotein cholesterol, was categorised as low risk (0.24. Results. Fifty-five percent of participants were female and the mean age was 49.9 years (SD±20.2. Forty-two percent of participants had high and intermediate atherogenic risk. Persons with hypertension, untreated HIV infection, abnormal glycaemia, and obesity and living in less urbanised villages were more at risk. Conclusion. A significant proportion of persons in this rural population are at risk of atherosclerosis. Key identified populations at risk should be considered for future intervention against cardiovascular related morbidity and mortality. The study however used parameters from unfasted samples that may have a bearing on observed results.

  1. Reevaluating Interrater Reliability in Offender Risk Assessment

    Science.gov (United States)

    van der Knaap, Leontien M.; Leenarts, Laura E. W.; Born, Marise Ph.; Oosterveld, Paul

    2012-01-01

    Offender risk and needs assessment, one of the pillars of the risk-need-responsivity model of offender rehabilitation, usually depends on raters assessing offender risk and needs. The few available studies of interrater reliability in offender risk assessment are, however, limited in the generalizability of their results. The present study…

  2. 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.

  3. Cumulative Intracranial Tumor Volume Augments the Prognostic Value of Diagnosis-Specific Graded Prognostic Assessment Model for Survival in Patients with Melanoma Cerebral Metastases

    DEFF Research Database (Denmark)

    Hirshman, Brian R; Wilson, Bayard R; Ali, Mir Amaan

    2017-01-01

    intracranial tumor volume (CITV) into the ds-GPA model for melanoma augmented its prognostic value. OBJECTIVE: To determine whether or not CITV augments the ds-GPA prognostic scale for melanoma. METHODS: We analyzed the survival pattern of 344 melanoma patients with BM treated with stereotactic radiosurgery...... (SRS) at separate institutions and validated our findings in an independent cohort of 201 patients. The prognostic value of ds-GPA for melanoma was quantitatively compared with and without the addition of CITV using the net reclassification index (NRI > 0) and integrated discrimination improvement (IDI...... validated these findings that CITV improves the prognostic utility of melanoma ds-GPA in an independent cohort of 201 melanoma cohort. CONCLUSION: The prognostic value of the ds-GPA scale for melanoma BM is enhanced by the incorporation of CITV....

  4. The prognostic and risk-stratified value of heart-type fatty acid-binding protein in septic patients in the emergency department.

    Science.gov (United States)

    Chen, Yun-Xia; Li, Chun-Sheng

    2014-08-01

    To evaluate the prognostic and risk-stratified ability of heart-type fatty acid-binding protein (H-FABP) in septic patients in the emergency department (ED). From August to November 2012, 295 consecutive septic patients were enrolled. Circulating H-FABP was measured. The predictive value of H-FABP for 28-day mortality, organ dysfunction on ED arrival, and requirement for mechanical ventilation or a vasopressor within 6 hours after ED arrival was assessed by the receiver operating characteristic curve and logistic regression and was compared with Acute Physiology and Chronic Health Evaluation (APACHE) II score, Mortality in Emergency Department Sepsis (MEDS) score, and Sequential Organ Failure Assessment score. The 28-day mortality, APACHE II, MEDS, and Sequential Organ Failure Assessment scores were much higher in H-FABP-positive patients. The incidence of organ dysfunction at ED arrival and requirement for mechanical ventilation or a vasopressor within 6 hours after ED arrival was higher in H-FABP-positive patients. Heart-type fatty acid-binding protein was an independent predictor of 28-day mortality and organ dysfunction. The area under the receiver operating characteristic curve for H-FABP predicting 28-day mortality and organ dysfunction was 0.784 and 0.755, respectively. Combination of H-FABP and MEDS improved the performance of MEDS in predicting organ dysfunction, and the difference of AUC was statistically significant (PAPACHE II also improved the prognostic value of MEDS and APACHE II, but the areas under the curve were not statistically different. Heart-type fatty acid-binding protein was helpful for prognosis and risk stratification of septic patients in the ED. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. The Prognostic Validity of the Timed Up and Go Test With a Dual Task for Predicting the Risk of Falls in the Elderly

    Directory of Open Access Journals (Sweden)

    Martin Hofheinz

    2016-03-01

    Full Text Available Objective: The aim is to examine the prognostic validity of the Timed Up and Go Test with a cognitive and a manual dual task for predicting the risk of falls. Method: A follow-up study was performed. The data were recorded for 120 volunteers in an outpatient physiotherapy center, with a 12-month follow-up. The sample included 120 elderly men and women aged 60 to 87 years ( M age = 72.2 years living at home. The main measurements were as follows: The Timed Up and Go Test (TUG, the TUG with a cognitive dual task (TUGcog, and the TUG with a manual dual task (TUGman and falls. Results: In the 12-month follow-up, 37 persons (30.8% had a locomotive fall. The receiver operating characteristic (ROC curve shows significant results for the TUGcog. The area under the curve is 0.65 ( p = .008, with a 95% confidence interval (CI = [0.55, 0.76]. For the TUGman, the area under the curve is 0.57 with a 95% CI = [0.45, 0.68], which is not significant ( p = .256. For the TUG, the area under the curve is 0.58, which is not significant ( p = .256, 95% CI = [0.47, 0.69]. Conclusion: The TUGcog is a valid prognostic assessment to predict falls in community-dwelling elderly people.

  6. [The methods of prognostic evaluation of risk of child joining the dispensary group of frequently ill children].

    Science.gov (United States)

    Maĭorov, R V; Chereshneva, M V; Verzilin, S D; Chereshnev, V A

    2013-01-01

    The study was organized to develop the formalized diagnostic methods and computer program to evaluate the risk of child joining the dispensary group of frequently ill children. The sampling included 2742 children of different age groups. It is established that size of groups of frequently ill children consists 38.2% among children of preschool age, 32% among children of early school age and 21% among adolescents of senior school age. The risk factors of development of frequent respiratory diseases in child are revealed. The impact of these factors on the rate of respiratory diseases depending on the age of child is established. The methods and computer program are developed for prognostic evaluation of risk of child joining the dispensary group of frequently ill children according the results of analysis of hereditary factors, pathology of delivery and pregnancy, characteristics of breast feeding and conditions of life. The methods are approved during additional examination of 400 children of different age.

  7. How to appraise a prognostic study.

    Science.gov (United States)

    Mak, Kenneth; Kum, Cheng Kiong

    2005-05-01

    Prognostic studies are studies that examine selected predictive variables or risk factors and assess their influence on the outcome of a disease. They allow clinicians to understand better the natural history of a disease, guide clinical decision-making by facilitating the selection of appropriate treatment options, and allow more accurate prediction of disease outcomes. Appraising prognostic studies involves determining the internal validity of the study design and evaluating the influence of systemic errors or bias. In studies examining multiple prognostic variables, care must be taken to minimize the confounding influence each variable would have on the other parameters. Evaluating the results of appropriate statistical analysis enables conclusions to be made that may influence clinical practice. Care must be taken to ensure that the conditions under which the prognostic study were conducted resemble circumstances in the local institution so as to allow the conclusions to be applied to local practices.

  8. 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.

  9. Risk assessment terminology: risk communication part 1

    Directory of Open Access Journals (Sweden)

    Gaetano Liuzzo

    2016-03-01

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

  10. Risk Assessment Terminology: Risk Communication Part 1.

    Science.gov (United States)

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

    2016-01-18

    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.

  11. Intelligent Prognostic Framework for Degradation Assessment and Remaining Useful Life Estimation of Photovoltaic Module

    Directory of Open Access Journals (Sweden)

    Nabil Laayouj

    2016-12-01

    Full Text Available All industrial systems and machines are subjected to degradation processes, which can be related to the operating conditions. This degradation can cause unwanted stops at any time and major maintenance work sometimes. The accurate prediction of the remaining useful life (RUL is an important challenge in condition-based maintenance. Prognostic activity allows estimating the RUL before failure occurs and triggering actions to mitigate faults in time when needed. In this study, a new smart prognostic method for photovoltaic module health degradation was developed based on two approaches to achieve more accurate predictions: online diagnosis and data-driven prognosis. This framework of forecasting integrates the strengths of real-time monitoring in the first approach and relevant vector machine in the second. The results show that the proposed method is plausible due to its good prediction of RUL and can be effectively applied to many systems for monitoring and prognostics.

  12. Risk and prognostic factors for non-specific musculoskeletal pain : A synthesis of evidence from systematic reviews classified into ICF dimensions

    NARCIS (Netherlands)

    Lakke, Sandra E.; Soer, Remko; Takken, Tim; Reneman, Michiel F.

    2009-01-01

    A wide variety of risk factors for the occurrence and prognostic factors for persistence of non-specific musculoskeletal pain (MSP) are mentioned in the literature. A systematic review of all these factors is not available. Thus a systematic review was conducted to evaluate MSP risk factors and

  13. The impact of adjuvant therapy on contralateral breast cancer risk and the prognostic significance of contralateral breast cancer : a population based study in the Netherlands

    NARCIS (Netherlands)

    Schaapveld, Michael; Visser, Otto; Louwman, W. J.; Willemse, Pax H. B.; de Vries, Elisabeth G. E.; van der Graaf, Winette T. A.; Otter, Renee; Coebergh, Jan Willem W.; van Leeuwen, Flora E.

    Background The impact of age and adjuvant therapy on contralateral breast cancer (CBC) risk and prognostic significance of CBC were evaluated. Patients and Methods In 45,229 surgically treated stage I-IIIA patients diagnosed in the Netherlands between 1989 and 2002 CBC risk was quantified using

  14. The impact of adjuvant therapy on contralateral breast cancer risk and the prognostic significance of contralateral breast cancer: a population based study in the Netherlands.

    NARCIS (Netherlands)

    Schaapveld, M.; Visser, O.; Louwman, W.J.; Willemse, P.H.; Vries, EG de; Graaf, W.T.A. van der; Otter, R.; Coebergh, J.W.; Leeuwen, F.E. van

    2008-01-01

    BACKGROUND: The impact of age and adjuvant therapy on contralateral breast cancer (CBC) risk and prognostic significance of CBC were evaluated. PATIENTS AND METHODS: In 45,229 surgically treated stage I-IIIA patients diagnosed in the Netherlands between 1989 and 2002 CBC risk was quantified using

  15. The impact of adjuvant therapy on contralateral breast cancer risk and the prognostic significance of contralateral breast cancer: A population based study in the Netherlands

    NARCIS (Netherlands)

    M. Schaapveld (Michael); O.J. Visser (Otto); W.J. Louwman; P.H.B. Willemse (Pax); E.G.E. de Vries (Elisabeth); W.T.A. van der Graaf (Winette); R. Otter (Renée); J.W.W. Coebergh (Jan Willem); F.E. van Leeuwen (Flora)

    2008-01-01

    textabstractBackground: The impact of age and adjuvant therapy on contralateral breast cancer (CBC) risk and prognostic significance of CBC were evaluated. Patients and Methods: In 45,229 surgically treated stage I-IIIA patients diagnosed in the Netherlands between 1989 and 2002 CBC risk was

  16. Flood risk assessment and associated uncertainty

    National Research Council Canada - National Science Library

    Apel, H; Thieken, A. H; Merz, B; Blöschl, G

    2004-01-01

    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...

  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. 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

  19. 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.

  20. 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.

  1. UAV Swarm Operational Risk Assessment System

    Science.gov (United States)

    2015-09-01

    distribution is unlimited UAV SWARM OPERATIONAL RISK ASSESSMENT SYSTEM by Team CQ Alpha Cohort 311-141A September 2015 Project Advisors: Gregory......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

  2. Rapid Risk Assessment: FY05 Annual Summary Report

    Energy Technology Data Exchange (ETDEWEB)

    Whelan, Gene; Millard, W. David; Gelston, Gariann M.; Pelton, Mitch A.; Yang, Zhaoqing; Strenge, Dennis L.; Lee, Cheegwan; Sivaraman, Chitra; Simpson, Mary J.; Young, Joan K.; Khangaonkar, Tarang P.; Downing, Timothy R.; Hoopes, Bonnie L.; Hachmeister, Lon E.

    2006-03-06

    The Pacific Northwest National Laboratory (PNNL) is developing decision support tools that will assist in the transition of incident information into Protective Action Recommendations (PARs) that are understandable and can be executed in a real-world, operational environment. During emergencies, responders must rapidly assess risks and decide on the best course of action—all within minutes to hours. PNNL is blending existing modeling and decision support technology to develop new methods for transitioning science-based threat assessment to PARs. The rapid risk assessment tool will be both understandable and applicable to the emergency management community and would be a valuable tool during any water security-related incident. In 2005, PNNL demonstrated the integration of the multi-thematic modeling with emergency management decision support tools to create a Rapid Risk Assessment (RRA) tool that will transition risk to PARs that assist in responding to or mitigating the direct and indirect impacts of the incident(s). The RRA tool does this by aligning multi-thematic modeling capabilities with real-world response zones established by emergency and site operations managers. The RRA tool uses the risk assessment tool to drive prognostic models that use the type of incident, time of impact, severity of impact, and duration of impact to select the most appropriate PAR. Because PARs (and the thresholds by which they are selected) are jointly established by the technologists and the emergency management and operations decision makers, the science-based risk assessment can transition into a recommendation that can be understood and executed by people in the field.

  3. Prognostic Utility of a Self-Reported Depression Questionnaire versus Clinician-Based Assessment on Renal Outcomes.

    Science.gov (United States)

    Jain, Nishank; Carmody, Thomas; Minhajuddin, Abu T; Toups, Marisa; Trivedi, Madhukar H; Rush, Augustus John; Hedayati, S Susan

    2016-01-01

    The prognostic utility of self-administered depression scales in chronic kidney disease (CKD) independent of a clinician-based major depressive disorder (MDD) diagnosis is neither clearly established nor are the optimal cutoff scores for predicting outcomes. The overlap between symptoms of depression and chronic disease raises the question of whether a cutoff score on a depression scale can be substituted for a time-consuming diagnostic interview to prognosticate risk. The 16-item Quick Inventory of Depression Symptomatology-Self Report scale (QIDS-SR16) was administered to 266 consecutive outpatients with non-dialysis CKD, followed prospectively for 12 months for an apriori composite outcome of death or dialysis or hospitalization. Association of QIDS-SR16 best cutoff score, determined by receiver/responder operating characteristics curves, with outcomes was investigated using survival analysis. The effect modification of an interview-based clinician MDD diagnosis on this association was ascertained. There were 126 composite events. A QIDS-SR16 cutoff ≥8 had the best prognostic accuracy, hazards ratio (HR) = 1.77, 95% CI 1.24-2.53, p = 0.002. This cutoff remained significantly associated with outcomes even after controlling for comorbidities, estimated glomerular filtration rate, hemoglobin and serum albumin, adjusted HR (aHR) = 1.80, 95% CI 1.23-2.62, p = 0.002, and performed similarly to a clinician-based MDD diagnosis (aHR = 1.72, 95% CI 1.14-2.68). Adjustment for MDD conferred the association of QIDS-SR16 with outcomes no longer significant. QIDS-SR16 cutoff ≥8 adds to the prognostic information available to practicing nephrologists during routine clinic visits from comorbidities and laboratory data. This cutoff score performs similar to a clinician diagnosis of MDD and provides a feasible and time-saving alternative to an interview-based MDD diagnosis for determining prognosis in CKD patients. © 2016 S. Karger AG, Basel.

  4. [Vocational integration of the worker suffering from ischemic heart disease: prognostic factors, occupational evaluation, and criteria for the assessment of their suitability for the specific task].

    Science.gov (United States)

    Taino, Giuseppe; Brevi, Marco; Gazzoldi, Tiziana; Imbriani, Marcello

    2013-01-01

    Ischemic heart disease, even if it has an incidence rate that increases with increasing age, can affect young people of working age. Remarkable progress in the treatment of acute coronary syndrome (ACS) and its complications, while it reduced the mortality due to myocardial infarction in both acute and later stages, on the other hand have contributed to increase prevalence, in people of working age, of ischemic heart disease and chronic conditions of post-ischemic left ventricular dysfunction in the outcomes of previous acute ischemic event. The first stage of the process of job placement is the study of worker health after acute coronary syndrome. After making all clinical and instrumental examinations, the first objective is risk stratification aimed to assess the prognosis of ischemic heart disease. The pathophysiological factors that allow risk stratification and thus constitute the determinants of prognosis after acute coronary event are: the presence of residual ischemia and inducibility of the same threshold; the left ventricular function; the presence of electrical instability and age. Only when the prognostic assessment has defined a low risk profile, an accurate study of work suitability, based both on hearth functional assessment and on work activity evaluation, becomes possible. Occupational assessment must consider, as a central factor (although not exclusive), measurement of energy expenditure required by work activity carried out through ergometric studies, but usually it occurs only in exceptional cases. However, although with some degree of approximation, energy expenditure of most occupational activities may be deducted from appropriate tables and should be regarded as a value "estimates". When the occupational physician has acquired, on the one hand all informations relating to the prognostic evaluation, risk stratification and clinical and instrumental analysis of residual work capacity, on the other hand all data pertaining to the evaluation

  5. Qualitative and Quantitative Requirements for Assessing Prognostic Markers in Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Christoph Burdelski

    2014-04-01

    Full Text Available Molecular prognostic markers are urgently needed in order to improve therapy decisions in prostate cancer. To better understand the requirements for biomarker studies, we re-analyzed prostate cancer tissue microarray immunohistochemistry (IHC data from 39 prognosis markers in subsets of 50 – >10,000 tumors. We found a strong association between the “prognostic power” of individual markers and the number of tissues that should be minimally included in such studies. The prognostic relevance of more than 90% of the 39 IHC markers could be detected if ≥6400 tissue samples were analyzed. Studying markers of tissue quality, including immunohistochemistry of ets-related gene (ERG and vimentin, and fluorescence in-situ hybridization analysis of human epidermal growth factor receptor 2 (HER2, we found that 18% of tissues in our tissue microarray (TMA showed signs of reduced tissue preservation and limited immunoreactivity. Comparing the results of Kaplan-Meier survival analyses or associations to ERG immunohistochemistry in subsets of tumors with and without exclusion of these defective tissues did not reveal statistically relevant differences. In summary, our study demonstrates that TMA-based marker validation studies using biochemical recurrence as an endpoint require at least 6400 individual tissue samples for establishing statistically relevant associations between the expression of molecular markers and patient outcome if weak to moderate prognosticators should also be reliably identified.

  6. IDH mutation status trumps the Pignatti risk score as a prognostic marker in low-grade gliomas.

    Science.gov (United States)

    Etxaniz, Olatz; Carrato, Cristina; de Aguirre, Itziar; Queralt, Cristina; Muñoz, Ana; Ramirez, José L; Rosell, Rafael; Villà, Salvador; Diaz, Rocio; Estival, Ana; Teixidor, Pilar; Indacochea, Alberto; Ahjal, Sara; Vilà, Laia; Balañá, Carme

    2017-11-01

    Management of low-grade gliomas (LGG) is based on clinical and radiologic features, including the Pignatti prognostic scoring system, which classifies patients as low- or high-risk. To determine whether molecular data can offer advantages over these features, we have examined the prognostic impact of several molecular alterations in LGG. In a cohort of 58 patients with LGG, we have retrospectively analyzed clinical and molecular characteristics, including the Pignatti criteria, IDH mutations, TP53 mutations, the 1p/19q deletion, and MGMT methylation, and correlated our findings with progression-free survival (PFS) and overall survival (OS). Mean age of patients was 45 years; 71% were classified as low-risk by the Pignatti system. IDH mutations were detected in 62%, p53 mutations in 17%, the 1p/19q codeletion in 46%, and MGMT methylation in 40% of patients. Survival analyses were performed in the 49 patients without contrast enhancement. In the univariate analysis, IDH mutations, the 1p/19q codeletion, and the combination of IDH mutations with the 1p/19q codeletion were associated with both longer PFS (P = 0.006, P = 0.037, and P = 0.003, respectively) and longer OS (P IDH mutations as a factor for greater risk of progression [hazard ratio (HR) = 3.1; P = 0.007]and death (HR = 6.4; P IDH mutations may be more effective than the Pignatti score in discriminating low- and high-risk patients with LGG.

  7. Adding items that assess changes in activities of daily living does not improve the predictive accuracy of the Palliative Prognostic Index.

    Science.gov (United States)

    Hamano, Jun; Tokuda, Yasuharu; Kawagoe, Shohei; Shinjo, Takuya; Shirayama, Hiroto; Ozawa, Taketoshi; Shishido, Hideki; Otomo, Sen; Nagayama, Jun; Baba, Mika; Tei, Yo; Hiramoto, Shuji; Suga, Akihiko; Hisanaga, Takayuki; Ishihara, Tatsuhiko; Iwashita, Tomoyuki; Kaneishi, Keisuke; Kuriyama, Toshiyuki; Maeda, Takashi; Morita, Tatsuya

    2017-03-01

    Changes in activities of daily living in cancer patients may predict their survival. The Palliative Prognostic Index is a useful tool to evaluate cancer patients, and adding an item about activities of daily living changes might improve its predictive value. To clarify whether adding an item about activities of daily living changes improves the accuracy of Palliative Prognostic Index. Multicenter prospective cohort study. A total of 58 palliative care services in Japan. Patients aged >20 years diagnosed with locally extensive or metastatic cancer (including hematological neoplasms) who had been admitted to palliative care units, were receiving care by hospital-based palliative care teams, or were receiving home-based palliative care. Palliative care physicians recorded clinical variables at the first assessment and followed up patients 6 months later. A total of 2425 subjects were recruited and 2343 of these had analyzable data. The C-statistic of the original Palliative Prognostic Index was 0.801, and those of modified Palliative Prognostic Indices ranged from 0.793 to 0.805 at 3 weeks. For 6-week survival predictions, the C-statistic of the original Palliative Prognostic Index was 0.802, and those of modified Palliative Prognostic Indices ranged from 0.791 to 0.799. The weighted kappa of the original Palliative Prognostic Index was 0.510, and those of modified Palliative Prognostic Indices ranged from 0.484 to 0.508. Adding items about activities of daily living changes to the Palliative Prognostic Index did not improve prognostic value in advanced cancer patients.

  8. Risk assessment of silver nanoparticles

    Science.gov (United States)

    Shipelin, V. A.; Gmoshinski, I. V.; Khotimchenko, S. A.

    2015-11-01

    Nanoparticles of metallic silver (Ag) are among the most widely used products of nanotechnology. Nanosized colloidal silver (NCS) is presented in many kinds of production as solutions of particles with diameter less than 100 nm. NCS is used in a variety of fields, including food supplements, medicines, cosmetics, packaging materials, disinfectants, water filters, and many others. Problems of toxicity and related safety of NCS for humans and environmental systems are recently overestimated basing on data of numerous toxicological studies in vitro and in vivo. The article discusses the results of current studies in recent years and the data of author's own experiments on studying the safety of NCS, that allows to move on to risk assessment of this nanomaterial presented in consumer products and environmental samples.

  9. A flexible alternative to the Cox proportional hazards model for assessing the prognostic accuracy of hospice patient survival.

    Directory of Open Access Journals (Sweden)

    Branko Miladinovic

    Full Text Available Prognostic models are often used to estimate the length of patient survival. The Cox proportional hazards model has traditionally been applied to assess the accuracy of prognostic models. However, it may be suboptimal due to the inflexibility to model the baseline survival function and when the proportional hazards assumption is violated. The aim of this study was to use internal validation to compare the predictive power of a flexible Royston-Parmar family of survival functions with the Cox proportional hazards model. We applied the Palliative Performance Scale on a dataset of 590 hospice patients at the time of hospice admission. The retrospective data were obtained from the Lifepath Hospice and Palliative Care center in Hillsborough County, Florida, USA. The criteria used to evaluate and compare the models' predictive performance were the explained variation statistic R(2, scaled Brier score, and the discrimination slope. The explained variation statistic demonstrated that overall the Royston-Parmar family of survival functions provided a better fit (R(2 =0.298; 95% CI: 0.236-0.358 than the Cox model (R(2 =0.156; 95% CI: 0.111-0.203. The scaled Brier scores and discrimination slopes were consistently higher under the Royston-Parmar model. Researchers involved in prognosticating patient survival are encouraged to consider the Royston-Parmar model as an alternative to Cox.

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

    Directory of Open Access Journals (Sweden)

    Cathryn Clarke Murray

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

  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

  12. Bilastine: an environmental risk assessment.

    Science.gov (United States)

    Lucero, María Luisa; Peither, Armin; Ledo, Francisco

    2015-10-01

    Bilastine is a new oral selective, non-sedating histamine H1 antagonist for the symptomatic treatment of allergic rhinoconjunctivitis and urticaria. The European Medicines Agency requires an Environmental Risk Assessment (ERA) for all novel medicines for human use. To calculate the bilastine predicted environmental concentration in surface water (PECsw; phase I ERA), and to determine the effects of bilastine on aquatic systems (phase II [tier A]). Bilastine PECsw was calculated using the maximum daily dosage (20 mg), assuming that all administered bilastine was released into the aquatic environment. A persistence, bioaccumulation and toxicity assessment was conducted using the log Kow from the molecular structure. In phase II (tier A), a ready biodegradability test was performed, and bilastine's potential toxicity to various aquatic and sediment-dwelling micro-organisms was evaluated. Bilastine PECSW was calculated as 0.1 μg L(-1), and the compound was not readily biodegradable. Bilastine had no significant effects on Chironomus riparius midges, or on the respiration rate of activated sludge. For green algae, the bilastine no observed effect concentration (NOEC) was 22 mg L(-1); bilastine had no effect on zebra fish development, or on the reproduction rate of daphnids. Bilastine NOEC values against zebra fish, algae, daphnids, and aerobic organisms in activated sludge were at least 130 000-fold greater than the calculated PECSW value. No environmental concerns exist from bilastine use in patients with allergic rhinoconjunctivitis or urticaria.

  13. 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

  14. Radiological safety and risk assessment

    Energy Technology Data Exchange (ETDEWEB)

    Hunter, P.H.; Barg, D.C.; Baird, R.D.; Card, D.H.; de Souza, F.; Elder, J.; Felthauser, K.; Jensen, C.; Winkler, V.

    1982-02-01

    A brief radiological safety and risk assessment of a nuclear power generation center with an adjacent on-site waste disposal facility at a specific site in the State of Utah is presented. The assessment was conducted to assist in determining the feasibility and practicality of developing a nuclear energy center (NEC) in Utah consisting of nine 1250 MWe nuclear pressurized water reactor (PWR) electrical generating units arranged in 3 clusters of 3 units each known as triads. The site selected for this conceptual study is in the Horse Bench area about 15 miles directly south of the town of Green River, Utah. The radiological issues included direct radiation exposures to on-site workers and the off-site population, release of radioactive material, and effects of these releases for both normal operations and accidental occurrences. The basic finding of this study is that the concept of an NEC in the Green River area, specifically at the Horse Bench site, is radiologically feasible.

  15. Associations between tooth loss and prognostic biomarkers and the risk for cardiovascular events in patients with stable coronary heart disease.

    Science.gov (United States)

    Vedin, Ola; Hagström, Emil; Östlund, Ollie; Avezum, Alvaro; Budaj, Andrzej; Flather, Marcus D; Harrington, Robert A; Koenig, Wolfgang; Soffer, Joseph; Siegbahn, Agneta; Steg, Philippe Gabriel; Stewart, Ralph A H; Wallentin, Lars; White, Harvey D; Held, Claes

    2017-10-15

    Underlying mechanisms behind the hypothesized relationship between periodontal disease (PD) and coronary heart disease (CHD) have been insufficiently explored. We evaluated associations between self-reported tooth loss- a marker of PD- and prognostic biomarkers in 15,456 (97%) patients with stable CHD in the global STABILITY trial. Baseline blood samples were obtained and patients reported their number of teeth according to the following tooth loss levels: "26-32 (All)" [lowest level], "20-25", "15-19", "1-14", and "No Teeth" [highest level]. Linear and Cox regression models assessed associations between tooth loss levels and biomarker levels, and the relationship between tooth loss levels and outcomes, respectively. After multivariable adjustment, the relative biomarker increase between the highest and the lowest tooth loss level was: high-sensitivity C-reactive protein 1.21 (95% confidence interval, 1.14-1.29), interleukin 6 1.14 (1.10-1.18), lipoprotein-associated phospholipase A2 activity 1.05 (1.03-1.06), growth differentiation factor 15 1.11 (1.08-1.14), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) 1.18 (1.11-1.25). No association was detected for high-sensitivity troponin T 1.02 (0.98-1.05). Some attenuation of the relationship between tooth loss and outcomes resulted from the addition of biomarkers to the multivariable analysis, of which NT-proBNP had the biggest impact. A graded and independent association between tooth loss and several prognostic biomarkers was observed, suggesting that tooth loss and its underlying mechanisms may be involved in multiple pathophysiological pathways also implicated in the development and prognosis of CHD. The association between tooth loss and cardiovascular death and stroke persisted despite comprehensive adjustment including prognostic biomarkers. www.clinicaltrials.gov; NCT00799903. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. ADAM 10 expression in primary uveal melanoma as prognostic factor for risk of metastasis.

    Science.gov (United States)

    Caltabiano, Rosario; Puzzo, Lidia; Barresi, Valeria; Ieni, Antonio; Loreto, Carla; Musumeci, Giuseppe; Castrogiovanni, Paola; Ragusa, Marco; Foti, Pietro; Russo, Andrea; Longo, Antonio; Reibaldi, Michele

    2016-11-01

    Uveal melanoma is the most frequent primary intraocular neoplasm in adults. Although malignant melanoma may be located at any point in the uveal tract, the choroid and ciliary body are more frequent locations than the iris. In the present study, we examined ADAM10 expression levels in primary uveal melanoma both with and without metastasis, and we evaluated their association with other high risk characteristics for metastasis in order to assess if ADAM10 can be used to predict metastasis. This study included a total of 52 patients, 23 men and 29 women, with uveal melanoma. A significantly high expression of ADAM-10 was seen in patients with metastasis (11/13, 84.6%), but not in patients without metastasis (15/39, 38.5%). In conclusion we found that ADAM10 expression was associated with a more rapid metastatic progression confirming its role in uveal melanoma metastasis. Copyright © 2016 Elsevier GmbH. All rights reserved.

  17. 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...

  18. Regional scale ecological risk assessment: using the relative risk model

    National Research Council Canada - National Science Library

    Landis, Wayne G

    2005-01-01

    ...) in the performance of regional-scale ecological risk assessments. The initial chapters present the methodology and the critical nature of the interaction between risk assessors and decision makers...

  19. Does continuous ST-segment monitoring add prognostic information to the TIMI, PURSUIT, and GRACE risk scores?

    Science.gov (United States)

    Carmo, Pedro; Ferreira, Jorge; Aguiar, Carlos; Ferreira, António; Raposo, Luís; Gonçalves, Pedro; Brito, João; Silva, Aniceto

    2011-07-01

    Recurrent ischemia is frequent in patients with non-ST-elevation acute coronary syndromes (NST-ACS), and portends a worse prognosis. Continuous ST-segment monitoring (CSTM) reflects the dynamic nature of ischemia and allows the detection of silent episodes. The aim of this study is to investigate whether CSTM adds prognostic information to the risk scores (RS) currently used. We studied 234 patients with NST-ACS in whom CSTM was performed in the first 24 hours after admission. An ST episode was defined as a transient ST-segment deviation in ≥1 lead of ≥ 0.1 mV, and persisting ≥1 minute. Three RS were calculated: Thrombolysis in Myocardial Infarction (TIMI; for NST-ACS), Platelet glycoprotein IIb/IIIa in Unstable angina: Receptor Supression Using Integrilin (PURSUIT; death/MI model), and Global Registry of Acute Coronary Events (GRACE). The end point was defined as death or nonfatal myocardial infarction (MI), during 1-year follow-up. ST episodes were detected in 54 patients (23.1%) and associated with worse 1-year outcome: 25.9% end point rate versus 12.2% (Odds Ratio [OR]= 2.51; 95% Confidence Interval [CI], 1.18-5, 35; P = 0.026). All three RS predicted 1-year outcome, but the GRACE (c-statistic = 0.755; 95% CI, 0.695-0.809) was superior to both TIMI (c-statistic = 0.632; 95% CI, 0.567-0.694) and PURSUIT (c-statistic = 0.644; 95% CI: 0.579-0.706). A GRACE RS > 124 showed the highest accuracy for predicting end point. The presence of ST episodes added independent prognostic information the TIMI RS (hazard ratio [HR]= 2.23; 95% CI, 1.13-4.38) and to PURSUIT RS (HR = 2.03; 95% CI, 1.03-3.98), but not to the GRACE RS. CSTM provides incremental prognostic information beyond the TIMI and PURSUIT RS, but not the GRACE risk score. Hence, the GRACE risk score should be the preferred stratification model in daily practice. ©2011, Wiley Periodicals, Inc.

  20. Prognostic significance of multiple-detector computed tomography in conjunction with TIMI risk score for patients with non-ST elevation acute coronary syndrome.

    Science.gov (United States)

    Noda, Mayumi; Takagi, Atsushi; Kuwatsuru, Ryohei; Mitsuhashi, Norio; Kasanuki, Hiroshi

    2008-05-01

    Risk stratification among patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) has been made by clinical scoring. Recently, multiple-detector computed tomography (MDCT) appeared to provide noninvasive coronary angiography (CAG). To clarify the prognostic significance of MDCT, we aimed to evaluate the clinical utility of MDCT in the early management and in predicting the long-term prognosis of NSTE-ACS with low to intermediate risk. Among 84 consecutive patients with NSTEACS, risk stratification using a TIMI risk score was done. A total of 48 patients were categorized as low to intermediate risk. Multiple-detector CT was performed in 30 patients using 16-slice MDCT. MDCT detected coronary stenoses in 18 patients. Compared to invasive CAG, MDCT successfully depicted the coronary stenosis (P TIMI risk score appeared to demonstrate prognostic significance in patients with NSTE-ACS.

  1. Heterogeneity of CD8+ tumor-infiltrating lymphocytes in non-small-cell lung cancer: impact on patient prognostic assessments and comparison of quantification by different sampling strategies

    Science.gov (United States)

    Obeid, Joseph M.; Wages, Nolan A.; Hu, Yinin; Deacon, Donna H.

    2017-01-01

    Introduction Infiltration of non-small-cell lung cancer (NSCLC) by CD8+ T lymphocytes predicts improved patient survival; however, heterogeneity of intratumoral localization complicates this assessment. Strategies for tumor sampling may not accurately represent the whole tumor. We hypothesized that sampling strategies may alter the identification of tumors with high CD8 density and affect the prognostic significance. Patients and methods Twenty-three primary NSCLC tumors were immunohistochemically stained for CD8 and were assessed using automated software with eight different sampling strategies or the whole tumor. Results of all sampling strategies were compared to the whole tumor counts (paired t tests, Pearson’s r). Associations between CD8 densities and overall survival were assessed (log-rank test). Results Counts from all eight sampling strategies significantly correlated with whole tumor counts (p ≤ 0.001). However, the magnitude of CD8+ cell counts and categorization into high vs low infiltrate groups were affected by the sampling strategy. The most concordant values were derived from random sampling of 20 % of the tumor, a simulated core biopsy, or from sampling the tumor center. TIL infiltration was associated with survival when sampling the center (p = 0.038), but not the invasive margin (p > 0.2) or other strategies. Conclusion Different tumor sampling strategies may yield discordant TIL density results and different stratification for risk assessment. Small biopsies may be particularly unrepresentative. Random sampling of larger tumor areas is recommended. Enumerating CD8+ T cells in the tumor center may have prognostic value. PMID:27770170

  2. An association study of established breast cancer reproductive and lifestyle risk factors with tumour subtype defined by the prognostic 70-gene expression signature (MammaPrint®).

    Science.gov (United States)

    Makama, M; Drukker, C A; Rutgers, E J Th; Slaets, L; Cardoso, F; Rookus, M A; Tryfonidis, K; Van't Veer, L J; Schmidt, M K

    2017-04-01

    Reproductive and lifestyle factors influence both breast cancer risk and prognosis; this might be through breast cancer subtype. Subtypes defined by immunohistochemical hormone receptor markers and gene expression signatures are used to predict prognosis of breast cancer patients based on their tumour biology. We investigated the association between established breast cancer risk factors and the 70-gene prognostication signature in breast cancer patients. Standardised questionnaires were used to obtain information on established risk factors of breast cancer from the Dutch patients of the MINDACT trial. Clinical-pathological and genomic information were obtained from the trial database. Logistic regression analyses were used to estimate the associations between lifestyle risk factors and tumour prognostic subtypes, measured by the 70-gene MammaPrint® signature (i.e. low-risk or high-risk tumours). Of the 1555 breast cancer patients included, 910 had low-risk and 645 had high-risk tumours. Current body mass index (BMI), age at menarche, age at first birth, age at menopause, hormonal contraceptive use and hormone replacement therapy use were not associated with MammaPrint®. In parous women, higher parity was associated with a lower risk (OR: 0.75, [95% confidence interval {CI}: 0.59-0.95] P = 0.018) and longer breastfeeding duration with a higher risk (OR: 1.03, [95% CI: 1.01-1.05] P = 0.005) of developing high-risk tumours; risk estimates were similar within oestrogen receptor-positive disease. After stratifying by menopausal status, the associations remained present in post-menopausal women. Using prognostic gene expression profiles, we have indications that specific reproductive factors may be associated with prognostic tumour subtypes beyond hormone receptor status. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. European risk assessment methodology for critical infrastructures

    NARCIS (Netherlands)

    Klaver, M.H.A.; Luiijf, H.A.M.; Nieuwenhuijs, A.H.; Cavenne, F.; Ulisse, A.; Bridegeman, G.

    2008-01-01

    Most risk assessment methodologies aim at the risk at the level of an individual organization or company. The European Union commissioned a study to define the elements for a uniform and scalable risk assessment methodology which takes into account critical infrastructure dependencies across

  4. [Development and validation of risk score model for acute myocardial infarction in China: prognostic value thereof for in hospital major adverse cardiac events and evaluation of revascularization].

    Science.gov (United States)

    Wu, Xiao-fan; Lü, Shu-zheng; Chen, Yun-dai; Pan, Wei-qi; Song, Xian-tao; Li, Jing; Liu, Xin; Wang, Xi-zhi; Zhang, Li-jie; Ren, Fang; Luo, Jing-guang

    2008-07-08

    To develop a simple risk score model of in-hospital major adverse cardiac events (MACE) including all-cause mortality, new or recurrent myocardial infarction (MI), and evaluate the efficacy about revascularization on patients with different risk. The basic characteristics, diagnosis, therapy, and in-hospital outcomes of 1512 ACS patients from Global Registry of Acute Coronary Events (GRACE) study of China were collected to develop a risk score model by multivariable stepwise logistic regression. The goodness-of-fit test and discriminative power of the final model were assessed respectively. The best cut-off value for the risk score was used to assess the impact of revascularization for ST-elevation MI (STEMI) and non-ST elevation acute coronary artery syndrome (NSTEACS) on in-hospital outcomes. (1) The following 6 independent risk factors accounted for about 92.5% of the prognostic information: age > or =80 years (4 points), SBP or =90 mm Hg (2 points), Killip II (3 points), Killip III or IV (9 points), cardiac arrest during presentation (4 points), ST-segment elevation (3 points) or depression (5 points) or combination of elevation and depression (4 points) on electrocardiogram at presentation. (2) CHIEF risk model was excellent with Hosmer-Lemeshow goodness-of-fit test of 0.673 and c statistics of 0.776. (3)1301 ACS patients previously enrolled in GRACE study were divided into 2 groups with the best cut-off value of 5.5 points. The impact of revascularization on the in-hospital MACE of the higher risk subsets was stronger than that of the lower risk subsets both in STEMI [OR (95% CI) = 0.32 (0.11, 0.94), chi2 = 5.39, P = 0.02] and NSTEACS [OR (95% CI) = 0.32 (0.06, 0.94), chi2 =4.17, P = 0.04] population. However, both STEMI (61.7% vs. 78.3%, P = 0.000) and NSTEACS (42.0% vs 62.3%, P = 0.000) patients with the risk scores more than 5.5 points had lower revascularization rates. The risk score provides excellent ability to predict in-hospital death or (re) MI

  5. Prognostic Value of Coronary Computed Tomography Imaging in Patients at High Risk Without Symptoms of Coronary Artery Disease.

    Science.gov (United States)

    Dedic, Admir; Ten Kate, Gert-Jan R; Roos, Cornelis J; Neefjes, Lisan A; de Graaf, Michiel A; Spronk, Angela; Delgado, Victoria; van Lennep, Jeanine E Roeters; Moelker, Adriaan; Ouhlous, Mohamed; Scholte, Arthur J H A; Boersma, Eric; Sijbrands, Eric J G; Nieman, Koen; Bax, Jeroen J; de Feijter, Pim J

    2016-03-01

    At present, traditional risk factors are used to guide cardiovascular management of asymptomatic subjects. Intensified surveillance may be warranted in those identified as high risk of developing cardiovascular disease (CVD). This study aims to determine the prognostic value of coronary computed tomography (CT) angiography (CCTA) next to the coronary artery calcium score (CACS) in patients at high CVD risk without symptoms suspect for coronary artery disease (CAD). A total of 665 patients at high risk (mean age 56 ± 9 years, 417 men), having at least one important CVD risk factor (diabetes mellitus, familial hypercholesterolemia, peripheral artery disease, or severe hypertension) or a calculated European systematic coronary risk evaluation of >10% were included from outpatient clinics at 2 academic centers. Follow-up was performed for the occurrence of adverse events including all-cause mortality, nonfatal myocardial infarction, unstable angina, or coronary revascularization. During a median follow-up of 3.0 (interquartile range 1.3 to 4.1) years, adverse events occurred in 40 subjects (6.0%). By multivariate analysis, adjusted for age, gender, and CACS, obstructive CAD on CCTA (≥50% luminal stenosis) was a significant predictor of adverse events (hazard ratio 5.9 [CI 1.3 to 26.1]). Addition of CCTA to age, gender, plus CACS, increased the C statistic from 0.81 to 0.84 and resulted in a total net reclassification index of 0.19 (p value and risk reclassification benefit beyond CACS in patients without CAD symptoms but with high risk of developing CVD. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. 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

  7. 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.

  8. Risk Assessment Update: Russian Segment

    Science.gov (United States)

    Christiansen, Eric; Lear, Dana; Hyde, James; Bjorkman, Michael; Hoffman, Kevin

    2012-01-01

    BUMPER-II version 1.95j source code was provided to RSC-E- and Khrunichev at January 2012 MMOD TIM in Moscow. MEMCxP and ORDEM 3.0 environments implemented as external data files. NASA provided a sample ORDEM 3.0 g."key" & "daf" environment file set for demonstration and benchmarking BUMPER -II v1.95j installation at the Jan-12 TIM. ORDEM 3.0 has been completed and is currently in beta testing. NASA will provide a preliminary set of ORDEM 3.0 ".key" & ".daf" environment files for the years 2012 through 2028. Bumper output files produced using the new ORDEM 3.0 data files are intended for internal use only, not for requirements verification. Output files will contain these words ORDEM FILE DESCRIPTION = PRELIMINARY VERSION: not for production. The projectile density term in many BUMPER-II ballistic limit equations will need to be updated. Cube demo scripts and output files delivered at the Jan-12 TIM have been updated for the new ORDEM 3.0 data files. Risk assessment results based on ORDEM 3.0 and MEM will be presented for the Russian Segment (RS) of ISS.

  9. Prognostic value of proliferation in pleomorphic soft tissue sarcomas

    DEFF Research Database (Denmark)

    Seinen, Jojanneke M; Jönsson, Mats; Bendahl, Pär-Ola O

    2012-01-01

    = 1.6-12.1), Top2a (hazard ratio = 2.2, CI = 1.2-3.5) and high S-phase fraction (hazard ratio = 1.8, CI = 1.2-3.7) significantly correlated with risk for metastasis. When combined with currently used prognostic factors, Ki-67, S-phase fraction and Top2a fraction contributed to refined identification...... of prognostic risk groups. Proliferation, as assessed by expression of Ki-67 and Top2a and evaluation of S-phase fraction and applied to statistical decision-tree models, provides prognostic information in soft tissue sarcomas of the extremity and trunk wall. Though proliferation contributes independently...... to currently applied prognosticators, its role is particularly strong when few other factors are available, which suggests a role in preoperative decision-making related to identification of high-risk individuals who would benefit from neoadjuvant therapy....

  10. Approaches to risk assessment in food allergy

    DEFF Research Database (Denmark)

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

    2009-01-01

    A workshop was organised to investigate whether risk assessment strategies and methodologies used in classical/conventional toxicology may be used for risk assessment of allergenic foods. to discuss the advantages and limitations of different approaches and to determine the research needed to move...... 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...

  11. Prognostic value of a novel risk classification of microvascular invasion in patients with hepatocellular carcinoma after resection.

    Science.gov (United States)

    Zhao, Hui; Chen, Chuang; Fu, Xu; Yan, Xiaopeng; Jia, Wenjun; Mao, Liang; Jin, Huihan; Qiu, Yudong

    2017-01-17

    The present research aimed to evaluate the prognostic value of a novel risk classification of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) after resection. A total of 295 consecutive HCC patients underwent hepatectomy were included in our study. We evaluated the degree of MVI according to the following three features: the number of invaded microvessels (≤5 vs >5), the number of invading carcinoma cells (≤ 50 vs >50), the distance of invasion from tumor edge (≤1 cm vs >1 cm). All patients were divided into three groups according to the three risk factors of MVI: non-MVI group (n=180), low-MVI group (n=60) and high-MVI group (n=55). The overall survival (OS) and recurrence-free survival (RFS) rates of high-MVI group were significantly poorer than those of low-MVI and non-MVI groups (Prisk factors for OS after hepatectomy. High-MVI, type of resection and tumor size were risk factors for RFS. In subgroup analyses, the OS and RFS rates of low-MVI and non-MVI groups were better than high-MVI group regardless of tumor size. In high-MVI group, anatomical liver resection (n=28) showed better OS and RFS rates compared with non-anatomical liver resection (n=29) (P=0.012 and P=0.002). The novel risk classification of MVI based on histopathological features is valuable for predicting prognosis of HCC patients after hepatectomy.

  12. Prognostic Factors in Non-Small Cell Lung Cancer Less Than 3 Centimeters: Actuarial Analysis, Accumulative Incidence and Risk Groups.

    Science.gov (United States)

    Peñalver Cuesta, Juan C; Jordá Aragón, Carlos; Mancheño Franch, Nuria; Cerón Navarro, José A; de Aguiar Quevedo, Karol; Arrarás Martínez, Miguel; Vera Sempere, Francisco J; Padilla Alarcón, Jose D

    2015-09-01

    In TNM classification, factors determining the tumor (T) component in non-small cell lung cancer have scarcely changed over time and are still based solely on anatomical features. Our objective was to study the influence of these and other morphopathological factors on survival. A total of 263 patients undergoing lung resection due to stage I non-small cell lung cancer ≤3cm in diameter were studied. A survival analysis and competing-risk estimate study was made on the basis of clinical, surgical and pathological variables using actuarial analysis and accumulative incidence methods, respectively. A risk model was then generated from the results. Survival at 5 and 10 years was 79.8 and 74.3%, respectively. The best prognostic factors were presence of symptoms, smoking habit and FEV1>60%, number of resected nodes>7, squamous histology, absence of vascular invasion, absence of visceral pleural invasion and presence of invasion more proximal than the lobar bronchus. All these were statistically significant according to the actuarial method. The factor "age60%. Pleural invasion and vascular invasion determine survival or risk of death due to non-small cell lung cancer ≤3cm and can be used for generating a predictive risk model. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  13. Tailored skills training for practitioners to enhance assessment of prognostic factors for persistent and disabling back pain: four quasi-experimental single-subject studies.

    Science.gov (United States)

    Demmelmaier, Ingrid; Denison, Eva; Lindberg, Per; Åsenlöf, Pernilla

    2012-07-01

    The well-known gap between guidelines and behaviour in clinical practice calls for effective behaviour change interventions. One example showing this gap is physiotherapists' insufficient assessment of psychosocial prognostic factors in back pain (i.e., yellow flags). The present study aimed to evaluate an educational model by performing a tailored skills training intervention for caregivers and studying changes over time in physiotherapists' assessment of prognostic factors in telephone consultations. A quasi-experimental single-subject design over 36 weeks was used, with repeated measurements during baseline, intervention, and postintervention phases. Four physiotherapists in primary health care audiorecorded a total of 63 consultations with patients. The tailored intervention included individual goal setting, skills training, and feedback on performance. The primary outcome was the number of assessed prognostic factors (0-10). Changes were seen in all four participants. The amount of assessed prognostic factors increased from between 0 and 2 at baseline to between 6 and 10 at postintervention. Time spent on assessment of psychosocial factors increased, and time spent on discussions about biomedical pain symptoms decreased. Knowledge and biopsychosocial attitudes toward back pain were congruent with guidelines at inclusion and did not change markedly during the intervention. Self-efficacy for assessment of cognitive and emotional prognostic factors increased during the study phases. The results suggest that a tailored skills training intervention using behaviour change techniques, such as individual goal setting, skills training, and feedback on performance, is effective in producing change in specific clinical behaviours in physiotherapists.

  14. 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.

  15. Pesticide Science and Assessing Pesticide Risks

    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.

  16. 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.

  17. 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...

  18. TIMI risk score for acute myocardial infarction according to prognostic stratification.

    Science.gov (United States)

    Pereira, Jaqueline Locks; Sakae, Thiago Mamôru; Machado, Michele Cardoso; Castro, Charles Martins de

    2009-08-01

    The TIMI (Thrombolysis in Myocardial Infarction) risk score is derived from clinical trial involving patients who are eligible for fibrinolysis. As the risk profiles of these cases differ from those found in non-selected populations, it is important to review the applicability of the score in usual clinical conditions. To evaluate the management and clinical evolution of hospital inpatients with acute myocardial infarction, according to risk stratification by the TIMI score. We evaluated, retrospectively, 103 cases of acute myocardial infarction with ST-segment elevation admitted to the Hospital Nossa Senhora da Conceição - Tubarão, in 2004 and 2005. The cases were analyzed in three risk groups according to the TIMI score. The hospital mortality after infarction was 17.5%. In the low-risk group there was no death. The mortality was 8.1% in the medium risk group and 55.6% in the high-risk group. The risk of death in cases of high risk was 14.1 times higher than in the cases of medium and low risk (95% CI = 4.4 to 44.1 and p risk group in relation to the low risk group (95% CI = 0.27 to 0.85, p = 0.004). There was a progressive increase in mortality and incidence of in-hospital complications according to the stratification by the TIMI score. High risk patients received thrombolytic less frequently than the patients at low risk.

  19. [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=2Health effect level×2exposure 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 and

  20. Risk factors for sickness absence due to low back pain and prognostic factors for return to work in a cohort of shipyard workers

    NARCIS (Netherlands)

    E.C. Alexopoulos (Evangelos); E.C. Konstantinou (Eleni); G. Bakoyannis (Giorgos); D. Tanagra (Dimitra); A. Burdorf (Alex)

    2008-01-01

    textabstractThe purpose of this study was to determine risk factors for the occurrence of sickness absence due to low back pain (LBP) and to evaluate prognostic factors for return to work. A longitudinal study with 1-year follow-up was conducted among 853 shipyard workers. The cohort was drawn

  1. Persistent hemifacial spasm after microvascular decompression: a risk assessment model.

    Science.gov (United States)

    Shah, Aalap; Horowitz, Michael

    2017-06-01

    Microvascular decompression (MVD) for hemifacial spasm (HFS) provides resolution of disabling symptoms such as eyelid twitching and muscle contractions of the entire hemiface. The primary aim of this study was to evaluate the predictive value of patient demographics and spasm characteristics on long-term outcomes, with or without intraoperative lateral spread response (LSR) as an additional variable in a risk assessment model. A retrospective study was undertaken to evaluate the associations of pre-operative patient characteristics, as well as intraoperative LSR and need for a staged procedure on the presence of persistent or recurrent HFS at the time of hospital discharge and at follow-up. A risk assessment model was constructed with the inclusion of six clinically or statistically significant variables from the univariate analyses. A receiving operator characteristic curve was generated, and area under the curve was calculated to determine the strength of the predictive model. A risk assessment model was first created consisting of significant pre-operative variables (Model 1) (age >50, female gender, history of botulinum toxin use, platysma muscle involvement). This model demonstrated borderline predictive value for persistent spasm at discharge (AUC .60; p=.045) and fair predictive value at follow-up (AUC .75; p=.001). Intraoperative variables (e.g. LSR persistence) demonstrated little additive value (Model 2) (AUC .67). Patients with a higher risk score (three or greater) demonstrated greater odds of persistent HFS at the time of discharge (OR 1.5 [95%CI 1.16-1.97]; p=.035), as well as greater odds of persistent or recurrent spasm at the time of follow-up (OR 3.0 [95%CI 1.52-5.95]; p=.002) Conclusions: A risk assessment model consisting of pre-operative clinical characteristics is useful in prognosticating HFS persistence at follow-up.

  2. 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 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...

  3. Risk of Hypothyroidism following Hemithyroidectomy: Systematic Review and Meta-Analysis of Prognostic Studies.

    NARCIS (Netherlands)

    Verloop, H.; Louwerens, M.; Schoones, J.W.; Kievit, J.; Smit, J.W.A.; Dekkers, O.M.

    2012-01-01

    Context: The reported risk of hypothyroidism after hemithyroidectomy shows considerable heterogeneity in literature. Objective: The aim of this systematic review and meta-analysis was to determine the overall risk of hypothyroidism, both clinical and subclinical, after hemithyroidectomy.

  4. RELEVANCE OF PROCESS RISK ASSESSMENT IN AIRLINES

    Directory of Open Access Journals (Sweden)

    Oksana G. Feoktistova

    2017-01-01

    Full Text Available The notion of “the concept on assumed risk” that took over from the outdated concept of absolute security is analyzed, the increasing significance of operating risk assessment at the present stage is noted. Some basic risk assessment techniques are considered. Matrix technique of risk assessment is considered more thoroughly, and it may be used in risk assessment of airlines in the context of labour protection management system.The ability to correctly assess risks and develop appropriate precautionary measures will allow airlines to avoid incidents leading to drastic consequences for staff, as well as to direct and indirect costs for the enterprise among which there could be singled out both direct property damage and loss of profit and expenses connected to incident investigation, penalty and compensation payment, loss of business reputation and so on. To reduce the rate of accidents and to develop safe activities skills for airlines staff a risk assessment chart is supposed to be implemented, which will be an efficient accidents prevention involving the staff in the process and making them follow safe working conditions.Process risk assessment is an integral part of assessment of the whole enterprise activity and work efficiency of a department and particular workers evaluation system. Labour protection activity should be based on risk identification and its control. Risk assessment is a keystone of labour protection activity planning.

  5. Preconception risk assessment of infertile couples

    National Research Council Canada - National Science Library

    Nekuei, Nafisehsadat; Kazemi, Ashraf; Ehsanpur, Soheila; Beigi, Nastaran Mohammad Ali

    2013-01-01

    With regard to the importance of preconception conditions in maternal health and fertility, preconception risk assessment makes treatment trends and pregnancy outcome more successful among infertile couples...

  6. [Development and application of fracture risk assessments].

    Science.gov (United States)

    Nakamura, Toshitaka

    2012-06-01

    Definition of osteoporosis by BMD T-score has been accepted globally. However, the age-dependent changes in BMD values differ on the different sites for measurements and the sensitivity of BMD to predict the risk of osteoporotic fracture, assessed by the risk gradient value, is as small as 1.7. Reportedly, WHO Fracture Risk Assessment (FRAX®) tool to compute 10-year probabilities of osteoporotic fracture, is sensitive enough to select the high fracture risk subjects with the risk gradient value of 2.57 - 2.77 in Japanese men and women. The combination of the three major risk factors such as age, BMD and prevalent fractures, when both morphometric spine and clinical non-spine fracture are included, represents the value of 2.49 - 2.71. Radiographic assessment of prevalent vertebral fracture, along with FRAX®evaluation, seems to be important in assessing the fracture risk in Japanese subjects.

  7. 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.

  8. 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.

  9. Assessing reservoir operations risk under climate change

    Science.gov (United States)

    Brekke, Levi D.; Maurer, Edwin P.; Anderson, Jamie D.; Dettinger, Michael D.; Townsley, Edwin S.; Harrison, Alan; Pruitt, Tom

    2009-04-01

    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.

  10. Risk assessment for industrial safety engineers

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Nae U; Lee, Ji U; Jeon, Seong Gyun; Lee, Yeong Sun

    1997-02-15

    This book deals with risk assessment and dangerous material of definition cases and industrial disaster, risk assessment of summary, ways of assessment and effect model, material safety data sheet system such as management, writing skill and use, product and storage of dangerous material like chemical reaction of homogeneous catalysis, harmfulness of material, corrosion and anti corrosion like crevice corrosion and erosion corrosion and range, classification, application of safety assessment.

  11. The COPD Assessment Test as a Prognostic Marker in Interstitial Lung Disease

    Directory of Open Access Journals (Sweden)

    Fujiko Someya

    2016-01-01

    Full Text Available The chronic obstructive pulmonary disease (COPD Assessment Test (CAT, which was developed to measure the health status of patients with COPD, was applied to patients with interstitial lung disease, aiming to examine the CAT as a predictor of outcome. Over a follow-up period of more than one year, 101 consecutive patients with interstitial lung disease were evaluated by the CAT. The CAT scores of 40 in total were categorized into four subsets according to the severity. Patients with higher (more severe scores exhibited lower forced vital capacity and lung diffusion capacity for carbon monoxide. The survival rate was significantly lower in patients with higher scores (log-rank test, P = 0.0002, and the hazard ratios for death of the higher scores and lower lung diffusion capacity for carbon monoxide were independently significant. These findings suggest that CAT can indicate the risk of mortality in patients with interstitial lung disease.

  12. Prognostic assessment of stable coronary artery disease as determined by coronary computed tomography angiography

    DEFF Research Database (Denmark)

    Nielsen, Lene H; Bøtker, Hans Erik; Sørensen, Henrik T

    2016-01-01

    Aims: To examine the 3.5 year prognosis of stable coronary artery disease (CAD) as assessed by coronary computed tomography angiography (CCTA) in real-world clinical practice, overall and within subgroups of patients according to age, sex, and comorbidity. Methods and results: This cohort study......, and comorbidity. Conclusion: Coronary artery disease determined by CCTA in real-world practice predicts the 3.5 year composite risk of late revascularization, myocardial infarction, and all-cause death across different groups of age, sex, or comorbidity burden....... included 16,949 patients (median age 57 years; 57% women) with new-onset symptoms suggestive of CAD, who underwent CCTA between January 2008 and December 2012. The endpoint was a composite of late coronary revascularization procedure >90 days after CCTA, myocardial infarction, and all-cause death...

  13. Genetic toxicology and cancer risk assessment

    National Research Council Canada - National Science Library

    Choy, Wai Nang

    2001-01-01

    ... their risks to humans are obvious goals for the protection of public health. When exposure is unavoidable, an accurate estimation of human risk as a result of exposure is essential for making regulatory decisions. Quantitative cancer risk assessment is an intricate process that utilizes knowledge from many different scien...

  14. 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

  15. Integrated miRNA-risk gene-pathway pair network analysis provides prognostic biomarkers for gastric cancer

    Directory of Open Access Journals (Sweden)

    Cai H

    2016-05-01

    Full Text Available Hui Cai,1 Jiping Xu,2 Yifang Han,3 Zhengmao Lu,1 Ting Han,1 Yibo Ding,4 Liye Ma1 1Department of General Surgery, Changhai Hospital, Second Military Medical University, Shanghai, 2Department of Medical Administration, Changhai Hospital, Second Military Medical University, Shanghai, 3Department of Epidemiology, Research Institute for Medicine of Nanjing Command, Nanjing, 4Department of Epidemiology, Changhai Hospital, Second Military Medical University, Shanghai, People’s Republic of China Purpose: This study aimed to identify molecular prognostic biomarkers for gastric cancer. Methods: mRNA and miRNA expression profiles of eligible gastric cancer and control samples were downloaded from Gene Expression Omnibus to screen the differentially expressed genes (DEGs and differentially expressed miRNAs (DEmiRs, using MetaDE and limma packages, respectively. Target genes of the DEmiRs were also collected from both predictive and experimentally validated target databases of miRNAs. The overlapping genes between selected targets and DEGs were identified as risk genes, followed by functional enrichment analysis. Human pathways and their corresponding genes were downloaded from the Kyoto Encyclopedia of Genes and Genomes (KEGG database for the expression analysis of each pathway in gastric cancer samples. Next, co-pathway pairs were selected according to the Pearson correlation coefficients. Finally, the co-pathway pairs, miRNA–target pairs, and risk gene–pathway pairs were merged into a complex interaction network, the most important nodes (miRNAs/target genes/co-pathway pairs of which were selected by calculating their degrees.Results: Totally, 1,260 DEGs and 144 DEmiRs were identified. There were 336 risk genes found in the 9,572 miRNA–target pairs. Judging from the pathway expression files, 45 co-pathway pairs were screened out. There were 1,389 interactive pairs and 480 nodes in the integrated network. Among all nodes in the network, focal

  16. Prognostic value of vitamin D in patients with pneumonia: A ...

    African Journals Online (AJOL)

    Purpose: To investigate the prognostic role of vitamin D in pneumonia patients through meta-analysis. Methods: PubMed and Embase were systematically searched for relevant studies that assessed the impact of vitamin D on the risk of adverse outcomes among patients with pneumonia. Risk ratios (RR) with 95 ...

  17. 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.

  18. Summary Report: Risk Assessment Forum Technical Workshop on Population-level Ecological Risk Assessment

    Science.gov (United States)

    2008 technical workshop regarding development of additional guidelines or best practices for planning, implementing and interpreting ecological risk assessments that involve population-level assessment endpoints.

  19. Medicines Optimisation Assessment Tool (MOAT): a prognostic model to target hospital pharmacists' input to improve patient outcomes. Protocol for an observational study.

    Science.gov (United States)

    Geeson, Cathy; Wei, Li; Franklin, Bryony Dean

    2017-06-14

    Medicines optimisation is a key role for hospital pharmacists, but with ever-increasing demands on services there is a need to increase efficiency while maintaining patient safety. The aim of this study is to develop a prognostic model, the Medicines Optimisation Assessment Tool (MOAT), which can be used to target patients most in need of pharmacists' input while in hospital. The MOAT will be developed following recommendations of the Prognosis Research Strategy partnership. Using a cohort study we will prospectively include 1500 adult patients from the medical wards of two UK hospitals. Data on medication-related problems (MRPs) experienced by study patients will be collected by pharmacists at the study sites as part of their routine daily clinical assessment of patients. Data on potential risk factors such as polypharmacy, renal impairment and the use of 'high risk' medicines will be collected retrospectively from the information departments at the study sites, laboratory reporting systems and patient medical records. Multivariable logistic regression models will then be used to determine the relationship between potential risk factors and the study outcome of preventable MRPs that are at least moderate in severity. Bootstrapping will be used to adjust the MOAT for optimism, and predictive performance will be assessed using calibration and discrimination. A simplified scoring system will also be developed, which will be assessed for sensitivity and specificity. This study has been approved by the Proportionate Review Service Sub-Committee of the National Health Service Research Ethics Committee Wales REC 7 (16/WA/0016) and the Health Research Authority (project ID 197298). We plan to disseminate the results via presentations at relevant patient/public, professional, academic and scientific meetings and conferences, and will submit findings for publication in peer-reviewed journals. NCT02582463. © Article author(s) (or their employer(s) unless otherwise stated in

  20. Context-Dependent Prognostics and Health Assessment: A Condition-Based Maintenance Approach That Supports Mission Compliance

    Energy Technology Data Exchange (ETDEWEB)

    Allgood, G.O.; Kercel, S.W.

    1999-04-19

    In today's manufacturing environment, plants, systems, and equipment are being asked to perform at levels not thought possible a decade ago. The intent is to improve process operations and equipment reliability, availability, and maintainability without costly upgrades. Of course these gains must be achieved without impacting operational performance. Downsizing is also taking its toll on operations. Loss of personnel, particularly those who represent the corporate history, is depleting US industries of their valuable experiential base which has been relied on so heavily in the past. These realizations are causing companies to rethink their condition-based maintenance policies by moving away from reacting to equipment problems to taking a proactive approach by anticipating needs based on market and customer requirements. This paper describes a different approach to condition-based maintenance-context-dependent prognostics and health assessment. This diagnostic capability is developed around a context-dependent model that provides a capability to anticipate impending failures and determine machine performance over a protracted period of time. This prognostic capability links operational requirements to an economic performance model. In this context, a system may provide 100% operability with less than 100% functionality. This paradigm is used to facilitate optimal logistic supply and support.

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

    Science.gov (United States)

    2012-03-01

    1EMDQ March 2012 ASBESTOS WORKSHOP: SAMPLING, ANALYSIS, AND RISK ASSESSMENT Paul Black, PhD, Neptune and Company Ralph Perona, DABT, Neptune and...NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Neptune and Company, Inc,1435 Garrison Street, Suite 110,Denver,CO...8-98) Prescribed by ANSI Std Z39-18 2 Presentation Objective Provide an overview of asbestos-related risk assessment: • Focus on risk from

  2. Vascular Plaque Determination for Stroke Risk Assessment

    Science.gov (United States)

    2017-10-01

    AWARD NUMBER: W81XWH-16-1-0608 TITLE: Vascular Plaque Determination for Stroke Risk Assessment PRINCIPAL INVESTIGATOR: Vince, David Geoffrey...TITLE AND SUBTITLE Vascular Plaque Determination for Stroke Risk Assessment 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-16-1-0608 5c. PROGRAM... plaques at high risk for initiating a cerebrovascular accident. The core of the current research project is a pilot clinical study to enroll 100 subjects

  3. 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.

  4. Risk stratification and prognostic nomogram for post-recurrence overall survival in patients with recurrent extrahepatic cholangiocarcinoma.

    Science.gov (United States)

    Kim, Byoung Hyuck; Kim, Kyubo; Chie, Eui Kyu; Kwon, Jeanny; Jang, Jin-Young; Kim, Sun Whe; Oh, Do-Youn; Bang, Yung-Jue

    2017-05-01

    This study aimed to investigate post-recurrence overall survival (PROS) in patients with recurrent extrahepatic cholangiocarcinoma (EHC) and to indicate which groups of patients need active salvage treatments. We retrospectively reviewed the records of 251 consecutive patients who underwent curative surgery followed by adjuvant chemoradiotherapy for EHC. Among these, 144 patients experienced a recurrence and were included for further analysis. The median PROS was 7 months (range, 1-130). In multivariate analysis, poorly differentiated histology, short disease-free survival, poor performance status, and elevated CA 19-9 were identified as significant prognosticators for poor PROS. Based on this, we stratified study patients into three categories by the number of risk factors: group 1 (0 or 1 factors), group 2 (2 factors) and group 3 (3-4 factors). Median PROS for groups 1, 2, and 3 were 13, 7, and 5 months, respectively (p < 0.001). Group 1 patients showed a significant benefit from salvage treatment, but groups 2 and 3 did not demonstrate clear benefit. In addition, we developed a nomogram to specifically identify individual patient's prognosis. Our simple risk stratification as well as proposed nomogram can classify patients into subgroups with different prognosis and will help facilitate personalized strategies after recurrence. Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

  5. RISK ASSESSMENT SUPPORTING THE FINAL RULE FOR ...

    Science.gov (United States)

    This analysis evaluates potential risks due to release of solvents from laundry sludge and disposable wipes sent to a landfill. Receptors for air and groundwater in lined and unlined landfills were evaluated. The potential solvent concentrations were calculated to determine the solvent loadings from the wipes and sludge. The mass based solvent quantity loadings were compared to the risk based loadings to determine the risk potential for specific solvents. This risk analysis also addressed previous peer reviewers’ and general public comments on the initial risk assessment conducted for the proposed rule. The final rule, supported by the risk assessment, will be prepared after the consideration of all comments for the proposed rule and the risk analysis Notice of Data Availability. The risk analysis will be used to support the development of a final rule for solvent-contaminated wipes. To ensure the adequacy of the modeling and solvent concentrations, the analysis was peer reviewed by external reviewers.

  6. Does high-sensitivity C-reactive protein add prognostic value to the TIMI-Risk Score in individuals with non-ST elevation acute coronary syndromes?

    Science.gov (United States)

    Correia, Luis C L; Lima, José C; Rocha, Mário S; D'Oliveira Junior, Argemiro; Péricles Esteves, J

    2007-01-01

    C-reactive protein (CRP) measured at hospital arrival of patients with non-ST elevation acute coronary syndromes (ACS) may add prognostic information to the TIMI-Risk Score. Eighty-six consecutive patients admitted with unstable angina or non-ST-elevation acute myocardial infarction and symptoms onset within the prior 48 h were included. Recurrent cardiovascular events during hospitalization were defined as non-fatal myocardial infarction or death. Serum CRP was measured immediately at hospital arrival and its prognostic value in relation to in-hospital cardiovascular events was tested by the area under the ROC curve and adjusted for TIMI risk predictors by logistic regression analysis. In addition, a CRP modified TIMI-Risk score was created by adding 2 points if CRP greater than the cut-off proposed by the ROC curve analysis. The accuracy of this new score was compared with the usual TIMI-Risk Score. A significant predictive value of CRP in relation to in-hospital cardiovascular events was indicated by an area under the ROC curve of 0.80 (95% CI=0.66 to 0.93, p=0.009). C-reactive protein cut-off point of best prognostic performance was 7.2 mg/l. In the multivariate analysis, increased CRP (>7.2 mg/l) remained a significant predictor of events after adjustment for TIMI risk predictors (OR=14; 95% CI=1.6-121; p=0.018). The area under the ROC curve for the TIMI-Risk Score was 0.87 (95% CI=0.76-0.99, p=0.001). The addition of CRP to the TIMI-Risk Score improved its prognostic value (area under the ROC curve=0.93; 95% CI=0.87-0.99, pscore is demonstrated by a higher specificity (86% vs. 63%, pTIMI-Risk Score. CRP measured at admission of patients with non-ST-elevation acute coronary syndromes adds prognostic information to the TIMI-Risk Score. Additionally, the incorporation of this variable into the TIMI-Risk Score calculation is an effective manner to utilize CRP for risk stratification.

  7. 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.

  8. Cheese Microbial Risk Assessments — A Review

    Science.gov (United States)

    Choi, Kyoung-Hee; Lee, Heeyoung; Lee, Soomin; Kim, Sejeong; Yoon, Yohan

    2016-01-01

    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. PMID:26950859

  9. Risk estimation of distant metastasis in node-negative, estrogen receptor-positive breast cancer patients using an RT-PCR based prognostic expression signature

    Directory of Open Access Journals (Sweden)

    Gray Joe

    2008-11-01

    Full Text Available Abstract Background Given the large number of genes purported to be prognostic for breast cancer, it would be optimal if the genes identified are not confounded by the continuously changing systemic therapies. The aim of this study was to discover and validate a breast cancer prognostic expression signature for distant metastasis in untreated, early stage, lymph node-negative (N- estrogen receptor-positive (ER+ patients with extensive follow-up times. Methods 197 genes previously associated with metastasis and ER status were profiled from 142 untreated breast cancer subjects. A "metastasis score" (MS representing fourteen differentially expressed genes was developed and evaluated for its association with distant-metastasis-free survival (DMFS. Categorical risk classification was established from the continuous MS and further evaluated on an independent set of 279 untreated subjects. A third set of 45 subjects was tested to determine the prognostic performance of the MS in tamoxifen-treated women. Results A 14-gene signature was found to be significantly associated (p Conclusion The 14-gene signature is significantly associated with risk of distant metastasis. The signature has a predominance of proliferation genes which have prognostic significance above that of Ki-67 LI and may aid in prioritizing future mechanistic studies and therapeutic interventions.

  10. Common breast cancer risk alleles and risk assessment

    DEFF Research Database (Denmark)

    Näslund-Koch, C; Nordestgaard, B G; Bojesen, S E

    2017-01-01

    general population were followed in Danish health registries for up to 21 years after blood sampling. After genotyping 72 breast cancer risk loci, each with 0-2 alleles, the sum for each individual was calculated. We used the simple allele sum instead of the conventional polygenic risk score...... cancer risks ≤ 1.5%. Using polygenic risk score led to similar results. CONCLUSION: Common breast cancer risk alleles are associated with incidence and mortality of breast cancer in the general population, but not with other cancers. After including breast cancer allele sum in risk assessment, 25......BACKGROUND: We hypothesized that common breast cancer risk alleles are associated with incidences of breast cancer and other cancers in the general population, and identify low risk women among those invited for screening mammography. PARTICIPANTS AND METHODS: 35,441 individuals from the Danish...

  11. The risk and prognostic impact of definite stent thrombosis or in-stent restenosis after coronary stent implantation

    DEFF Research Database (Denmark)

    Thayssen, Per; Jensen, Lisette Okkels; Lassen, Jens Flensted

    2012-01-01

    Aims: Data are limited on the prognostic impact of stent thrombosis and in-stent restenosis in patients treated with coronary stents. We examined the prognostic impact of stent thrombosis and in-stent restenosis in patients treated with percutaneous coronary intervention (PCI). Methods and result...

  12. Health Risk Assessments for Alumina Refineries

    OpenAIRE

    Donoghue, A Michael; Coffey, Patrick S.

    2014-01-01

    Objective: To describe contemporary air dispersion modeling and health risk assessment methodologies applied to alumina refineries and to summarize recent results. Methods: Air dispersion models using emission source and meteorological data have been used to assess ground-level concentrations (GLCs) of refinery emissions. Short-term (1-hour and 24-hour average) GLCs and annual average GLCs have been used to assess acute health, chronic health, and incremental carcinogenic risks. Results: The ...

  13. 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.

  14. 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

  15. Health risk assessments for alumina refineries.

    Science.gov (United States)

    Donoghue, A Michael; Coffey, Patrick S

    2014-05-01

    To describe contemporary air dispersion modeling and health risk assessment methodologies applied to alumina refineries and to summarize recent results. Air dispersion models using emission source and meteorological data have been used to assess ground-level concentrations (GLCs) of refinery emissions. Short-term (1-hour and 24-hour average) GLCs and annual average GLCs have been used to assess acute health, chronic health, and incremental carcinogenic risks. The acute hazard index can exceed 1 close to refineries, but it is typically less than 1 at neighboring residential locations. The chronic hazard index is typically substantially less than 1. The incremental carcinogenic risk is typically less than 10(-6). The risks of acute health effects are adequately controlled, and the risks of chronic health effects and incremental carcinogenic risks are negligible around referenced alumina refineries.

  16. Risk assessment of carcinogens in food.

    Science.gov (United States)

    Barlow, Susan; Schlatter, Josef

    2010-03-01

    Approaches for the risk assessment of carcinogens in food have evolved as scientific knowledge has advanced. Early methods allowed little more than hazard identification and an indication of carcinogenic potency. Evaluation of the modes of action of carcinogens and their broad division into genotoxic and epigenetic (non-genotoxic, non-DNA reactive) carcinogens have played an increasing role in determining the approach followed and provide possibilities for more detailed risk characterisation, including provision of quantitative estimates of risk. Reliance on experimental animal data for the majority of risk assessments and the fact that human exposures to dietary carcinogens are often orders of magnitude below doses used in experimental studies has provided a fertile ground for discussion and diverging views on the most appropriate way to offer risk assessment advice. Approaches used by national and international bodies differ, with some offering numerical estimates of potential risks to human health, while others express considerable reservations about the validity of quantitative approaches requiring extrapolation of dose-response data below the observed range and instead offer qualitative advice. Recognising that qualitative advice alone does not provide risk managers with information on which to prioritise the need for risk management actions, a "margin of exposure" approach for substances that are both genotoxic and carcinogenic has been developed, which is now being used by the World Health Organization and the European Food Safety Authority. This review describes the evolution of risk assessment advice on carcinogens and discusses examples of ways in which carcinogens in food have been assessed in Europe.

  17. 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. © The Author(s) 2015.

  18. Models to Assess the Bankruptcy Risk

    Directory of Open Access Journals (Sweden)

    Simona Valeria TOMA

    2013-08-01

    Full Text Available Closely related to financial risk assessment, one of the main concerns of the organizations should be the evaluation of bankruptcy risk, in this period of slow economic growth. Organization bankruptcies have increased in recent years worldwide. The aim of this paper is to demonstrate that the methods and models for forecasting bankruptcy of organizations, for the bankruptcy risk assessment are seeing for the health financing of an entity in financial accounting diagnosis and that the organizations requires assessment of risks accompanying the work, in which some signals fragility (vulnerable health this and other projected bankruptcy (insolvability threatens its survival (continuity. The bankruptcy risk assessment is important for profit-seeking investors because they must know how to value a company in or near bankruptcy is an important skill, but to detect any signs of looming bankruptcy is necessary to calculate and to analyse all kinds of financial rations: working capital, profitability, debt levels and liquidity.

  19. A Prognostic Model of Surgical Site Infection Using Daily Clinical Wound Assessment.

    Science.gov (United States)

    Sanger, Patrick C; van Ramshorst, Gabrielle H; Mercan, Ezgi; Huang, Shuai; Hartzler, Andrea L; Armstrong, Cheryl A L; Lordon, Ross J; Lober, William B; Evans, Heather L

    2016-08-01

    Surgical site infection (SSI) remains a common, costly, and morbid health care-associated infection. Early detection can improve outcomes, yet previous risk models consider only baseline risk factors (BF) not incorporating a proximate and timely data source-the wound itself. We hypothesize that incorporation of daily wound assessment improves the accuracy of SSI identification compared with traditional BF alone. A prospective cohort of 1,000 post open abdominal surgery patients at an academic teaching hospital were examined daily for serial features (SF), for example, wound characteristics and vital signs, in addition to standard BF, for example, wound class. Using supervised machine learning, we trained 3 Naïve Bayes classifiers (BF, SF, and BF+SF) using patient data from 1 to 5 days before diagnosis to classify SSI on the following day. For comparison, we also created a simplified SF model that used logistic regression. Control patients without SSI were matched on 5 similar consecutive postoperative days to avoid confounding by length of stay. Accuracy, sensitivity/specificity, and area under the receiver operating characteristic curve were calculated on a training and hold-out testing set. Of 851 patients, 19.4% had inpatient SSIs. Univariate analysis showed differences in C-reactive protein, surgery duration, and contamination, but no differences in American Society of Anesthesiologists scores, diabetes, or emergency surgery. The BF, SF, and BF+SF classifiers had area under the receiver operating characteristic curves of 0.67, 0.76, and 0.76, respectively. The best-performing classifier (SF) had optimal sensitivity of 0.80, specificity of 0.64, positive predictive value of 0.35, and negative predictive value of 0.93. Features most associated with subsequent SSI diagnosis were granulation degree, exudate amount, nasogastric tube presence, and heart rate. Serial features provided moderate positive predictive value and high negative predictive value for early

  20. Suicide risk assessment in high-risk adolescents.

    Science.gov (United States)

    Gray, Barbara P; Dihigo, Sharolyn K

    2015-09-13

    A significant number of adolescents experience depression and other mental health disorders that may put them at risk for suicide. Mental health assessment is an important component of primary healthcare. Depression and suicide risk screening can assist healthcare providers in preventing suicides.

  1. 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

  2. Prognostic factors in acute promyelocytic leukemia: strategies to define high-risk patients.

    Science.gov (United States)

    Testa, Ugo; Lo-Coco, Francesco

    2016-04-01

    All trans retinoic acid (ATRA) has revolutionized the therapy of acute promyelocytic leukemia (APL). Treatment of this leukemia with ATRA in combination with chemotherapy has resulted in complete remission rates >90 % and long-term remission rates above 80 %. Furthermore, the combination of ATRA and arsenic trioxide (ATO) was shown to be safe and effective in frontline treatment and, for patients with low and intermediate risk disease, possibly superior to the standard ATRA and anthracycline-based regimen. However, in spite of this tremendous progress, APL still remains associated with a high incidence of early death due to the frequent occurrence of an abrupt bleeding diathesis. This hemorrhagic syndrome more frequently develops in high-risk APL patients, currently defined as those exhibiting >10 × 10(9)/L WBC at presentation. In addition to high WBC count, other molecular and immunophenotypic features have been associated with high-risk APL. Among them, the expression in APL blasts of the stem/progenitor cell antigen CD34, the neural adhesion molecule (CD56), and the T cell antigen CD2 help to identify a subset of patients at higher risk of relapse and often the expression of these markers is associated with high WBC count. At the molecular level, the short PML/RARA isoform and FLT3-internal tandem duplication (ITD) mutations have been associated with increased relapse risk. These observations indicate that extended immunophenotypic and molecular characterization of APL at diagnosis including evaluation of CD2, CD56, and CD34 antigens and of FLT3 mutations may help to better design risk-adapted treatment in this disease.

  3. Comparison of prognostic risk scores after successful primary percutaneous coronary intervention.

    Science.gov (United States)

    Synetos, Andreas; Georgiopoulos, George; Pylarinou, Voula; Toutouzas, Konstantinos; Maniou, Katerina; Drakopoulou, Maria; Tolis, Panagiotis; Karanasos, Antonios; Papanikolaou, Aggelos; Latsios, George; Tsiamis, Eleftherios; Tousoulis, Dimitrios

    2017-03-01

    The aim of this study was to compare the predictive ability of clinical risk scores (ACEF, EuroSCORE and EuroSCORE II) to angiographic (SYNTAX score) and combined risk scores (Global Risk Score and Clinical SXscore) towards cardiovascular death and/or major adverse cardiac events (MACE) in patients with ST-segment elevation acute myocardial infarction (STEMI) managed with primary percutaneous coronary intervention (pPCI). A total of 685 patients successfully treated with pPCI were evaluated and the risk scores were calculated. The primary endpoint was the 2-year incidence of fatal cardiac events. Secondary end points were target lesion failure (TLF), repeat revascularization (RR) and MACE. Patients distributed in the highest tertile of EuroSCORE II presented increased rates of CV death (CVD), all-cause mortality and MACE (p<0.001 for all). EuroSCORE II was associated with increased C-statistics (0.873, 95% CIs: 0.784-0.962 and 0.825, 95% CIs: 0.752-0.898 respectively) for predicting CVD and MACE over competing risk scores (p<0.05). EuroSCORE II conferred incremental discrimination (Harrell's C, p<0.05 for all, apart from CSS for predicting CVD) and reclassification value (Net Reclassification Index, p<0.05 for all, apart from CSS for reclassifying MACE) over alternative risk scores for study's main endpoints. EuroSCORE II independently predicted CVD (HR=1.06, 95% CIs: 1.03-1.09, p<0.001) and MACE (HR=1.07, 95% CIs: 1.04-1.10, p<0.001). EuroSCORE II has the best predictive ability of CVD and/or MACE after successful pPCI for the treatment of STEMI. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. The risk stratification and prognostic evaluation of soluble programmed death-1 on patients with sepsis in emergency department.

    Science.gov (United States)

    Zhao, Yongzhen; Jia, Yumei; Li, Chunsheng; Fang, Yingying; Shao, Rui

    2018-01-01

    To evaluate the efficacy of soluble programmed death-1 (sPD-1) for risk stratification and prediction of 28-day mortality in patients with sepsis, we compared serum sPD-1 with procalcitonin (PCT), C-reactive protein (CRP), and the Mortality in Emergency Department Sepsis (MEDS) score. A total of 60 healthy volunteers and 595 emergency department (ED) patients were recruited for this prospective cohort study. According to the severity of their condition on ED arrival, the patients were allocated to the systemic inflammatory response syndrome group (130 cases), sepsis group (276 cases), severe sepsis group (121 cases), and septic shock group (68 cases). In addition, all patients with sepsis were also divided into the survivor group (349 cases) and nonsurvivor group (116 cases) according to the 28-day outcomes. When the severity of sepsis increased, the levels of sPD-1 gradually increased. The levels of sPD-1, PCT, CRP and the MEDS score were also higher in the nonsurvivor group compared to the survivor group. Logistic regression suggested that sPD-1, PCT, and the MEDS score were independent risk factors for 28-day mortality of patients with sepsis. Area under the curve (AUC) of sPD-1, PCT and the MEDS score for 28-day mortality was 0.725, 0.693, and 0.767, respectively, and the AUC was improved when all 3 factors were combined (0.843). Serum sPD-1 is positively correlated with the severity of sepsis, and it is valuable for risk stratification of patients and prediction of 28-day mortality. Combining sPD-1 with PCT and the MEDS score improves the prognostic evaluation. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Liver failure after transarterial chemoembolization for patients with hepatocellular carcinoma and ascites: incidence, risk factors, and prognostic prediction.

    Science.gov (United States)

    Hsin, I-Fang; Hsu, Chia-Yang; Huang, Hui-Chun; Huang, Yi-Hsiang; Lin, Han-Chieh; Lee, Rheun-Chuan; Chiang, Jen-Huey; Lee, Fa-Yauh; Huo, Teh-Ia; Lee, Shou-Dong

    2011-07-01

    Transarterial chemoembolization (TACE) is widely used in patients with hepatocellular carcinoma (HCC). Post-TACE liver failure may occur, especially in patients with poor hepatic reserve. Ascites is often present in patients with HCC with coexisting cirrhosis. This study investigated the incidence, risk factors, and prognostic predictors in patients with HCC and ascites receiving TACE. A total of 614 patients with HCC were enrolled and analyzed. Liver failure was defined as an increase of serum bilirubin level (≥2.0 mg/dL), increasing or newly developed ascites, or hepatic encephalopathy within 2 weeks of TACE. Ascites that were present in 100 (16.2%) patients at study entry, independently predicted a poor prognosis in the Cox proportional hazard model [relative risk (RR)=1.75, P=0.004]. Post-TACE liver failure occurred in 17 (17.3%) of 98 patients with HCC who had ascites and long-term follow-up. Child-Turcotte-Pugh class B (odds ratio=10.1, P=0.038) and post-TACE gastrointestinal bleeding (odds ratio=10.86, P=0.006) were independent risk factors associated with liver failure in the multivariate analysis. Of the 17 patients with post-TACE liver failure, 16 (94%) died within the first year of treatment. Liver failure (RR: 2.13, P=0.029), serum α-fetoprotein level >51 ng/mL (RR=2.0, P=0.013) and poor performance status (RR: 2.17, P=0.003) independently predicted a poor prognosis in patients with ascites receiving TACE. Preexisting ascites increases the mortality in patients with HCC receiving TACE. In patients with HCC and ascites, Child-Turcotte-Pugh class B and gastrointestinal bleeding are associated with liver failure after TACE. Post-TACE liver failure is a common event and predicts a decreased survival in patients with HCC and ascites.

  6. [Evaluation of the prognostic value of chosen maternal risk factors of complications existing among newborns of GDM mothers].

    Science.gov (United States)

    Elzbieta, J; Jan, W; Lech, P

    1999-10-01

    According to WHO definition, gestational diabetes mellitus (GDM) is a disorder of carbohydrates tolerance during pregnancy. The incidence of GDM is about 2-4% in the population at pregnant women. Prematurity, neonatal dystrophy (particularly hypertrophy), hypoglycemia and other clinical abnormalities are more frequent in the group of the neonates of diabetic mothers. The aim of this study was to separate the maternal risk factors of complications existing among neonates of diabetic mothers as well as the statistical analysis of their prognostic values. 260 newborns of GDM mothers, born at Polish Mothers Health Center were observed. The group of pregnant women was divided into two subgroups according to GDM class--G1 or G2. At 116 (44.6%) pregnant women glycemia was regulated dietetic treatment (G1 class). 144 women (55.4%) were treated with insulin (G2 class). The control group were 153 newborns from pregnant women with excluded GDM after carbohydrates tolerance screening test provide between 24-28 week. Estimation of the newborns status after birth was based on Apgar Score and umbilical blood pH. Basic laboratory tests were done in umbilical blood. Blood glucose concentration were monitored in all cases. Bilirubin concentration, infection screening tests were provided due to clinical status. Statistic evaluation was performed using special computer programs. G2 class of the Gestational Diabetes Mellitus significantly increases the frequency of newborn macrosomia, LGA, birth trauma, hypoglycemia, hyperbilirubinemia, cardiomyopathy and respiratory disorders. Prematurity is more frequent among newborns from GDM mothers group and it determines a potent risk factor of low Apgar Score, hypoglycemia and respiratory disorders. The following risk factors are unimportant for the frequency of complications existing among newborns of diabetic mothers: mothers age, number of delivers, obstetric complications and delivery of newborn with a congenital malformation in an

  7. Risk Assessment of the Innovative Projects Implementation

    Directory of Open Access Journals (Sweden)

    Deptuła Anna Małgorzata

    2015-12-01

    Full Text Available The article presents the issue of risk assessment of innovations. Specificity of technological innovation realized in manufacturing companies has been particularly well described here. An original method of assessing the innovative projects risk has been presented. The elaborated method has been implemented in three enterprises, the business activity of which is not typical for electrical engineering, metal and mechanical engineering and companies which are going to carry out the innovative project simultaneously with already started innovative projects. Moreover, an example of the risk assessment of a chosen technological innovation has been presented.

  8. The relation of risk assessment and health impact assessment

    DEFF Research Database (Denmark)

    Ádám, Balázs; Gulis, Gabriel

    2013-01-01

    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......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...... 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...

  9. Prognostic significance of neurological signs in high-risk infants - a systematic review

    NARCIS (Netherlands)

    Hamer, E.G.; Hadders-Algra, M.

    2016-01-01

    The aim of this paper was to systematically review the literature on the significance of specific neurological signs in infancy, in particular in infants at risk for developmental problems such as cerebral palsy (CP). A literature search was performed using the databases PubMed, Embase, Web of

  10. Prognostic significance of neurological signs in high-risk infants : a systematic review

    NARCIS (Netherlands)

    Hamer, Elisa G.; Hadders-Algra, Mijna

    The aim of this paper was to systematically review the literature on the significance of specific neurological signs in infancy, in particular in infants at risk for developmental problems such as cerebral palsy (CP). A literature search was performed using the databases PubMed, Embase, Web of

  11. Validity of St Gallen risk categories in prognostication of breast cancer patients in Southern Sri Lanka.

    Science.gov (United States)

    Peiris, Harshini; Mudduwa, Lakmini; Thalagala, Neil; Jayatilake, Kamani

    2018-01-31

    Although, there are many developments in the field of management, breast cancer is still the commonest cause of cancer related deaths in women in Sri Lanka. This emphasizes the need for validation of treatment protocols that are used in Sri Lanka for managing breast cancers. There are no published papers on treatment and survival of breast cancer patients in Sri Lanka. Hence this study was designed to determine the validity of St Gallen risk categories based on the survival outcomes of breast cancer patients in Southern Sri Lanka. This retro-prospective study included all female breast cancer patients who had sought the immunohistochemistry services of our unit from May 2006 to December 2012. Patients who had neo-adjuvant chemotherapy were excluded. Patients were stratified according to the St Gallen risk categories; low-risk (LR), intermediate-risk (IR) and high-risk (HR), which is used in deciding on the adjuvant treatment. IR category was subdivided based on presence/absence of 1-3 positive-nodes (absent-IR1, present-IR2) and HR on the number of positive-nodes(1-3 lymph nodes;HR1,> 3 lymph nodes;HR2). Kaplan-Meier and Cox-regression models were used in the survival analysis. This study included 713breast cancer patients (LR-2%, IR1-45%, IR2-10%, HR1-13%, HR2-30%). Five year breast cancer specific survival (BCSS)wasLR-100%, IR-91%, HR-66% and the recurrence free survival (RFS) was LR-85%, IR-84%, HR-65%. BCSS and RFS curves were significantly different between the three risk categories (p < 0.001). No survival difference was evident between the IR1 and IR2 (BCSS-p = 0.232, RFS-p = 0.118). HR1 and HR2 had a distinctly different BCSS (p = 0.033) with no difference in RFS (p = 0.190). This study validates the St Gallen risk categorization of female breast cancer patients in our setting. However, the HR includes two subsets of patients with a distinct difference in BCSS.

  12. Prognostic value at 5 years of microvascular obstruction after acute myocardial infarction assessed by cardiovascular magnetic resonance

    Directory of Open Access Journals (Sweden)

    Klug Gert

    2012-07-01

    Full Text Available Abstract Background Early and late microvascular obstruction (MVO assessed by cardiovascular magnetic resonance (CMR are prognostic markers for short-term clinical endpoints after acute ST-elevation myocardial infarction (STEMI. However, there is a lack of studies with long-term follow-up periods (>24 months. Methods STEMI patients reperfused by primary angioplasty (n = 129 underwent MRI at a median of 2 days after the index event. Early MVO was determined on dynamic Gd first-pass images directly after the administration of 0.1 mmol/kg bodyweight Gd-based contrast agent. Furthermore, ejection fraction (EF, %, left ventricular myocardial mass (LVMM and total infarct size (% of LVMM were determined with CMR. Clinical follow-up was conducted after a median of 52 months. The primary endpoint was defined as a composite of death, myocardial re-infarction, stroke, repeat revascularization, recurrence of ischemic symptoms, atrial fibrillation, congestive heart failure and hospitalization. Results Follow-up was completed by 107 patients. 63 pre-defined events occurred during follow-up. Initially, 74 patients showed early MVO. Patients with early MVO had larger infarcts (mean: 24.9 g vs. 15.5 g, p = 0.002 and a lower EF (mean: 39% vs. 46%, p = 0.006. The primary endpoint occurred in 66.2% of patients with MVO and in 42.4% of patients without MVO (p  Conclusion Early MVO, as assessed by first-pass CMR, is an independent long-term prognosticator for morbidity after AMI.

  13. Chemical Risk Assessment: Traditional vs Public Health ...

    Science.gov (United States)

    Preventing adverse health impacts from exposures to environmental chemicals is fundamental to protecting individual and public health. When done efficiently and properly, chemical risk assessment enables risk management actions that minimize the incidence and impacts of environmentally-induced diseases related to chemical exposure. However, traditional chemical risk assessment is faced with multiple challenges with respect to predicting and preventing disease in human populations, and epidemiological studies increasingly report observations of adverse health effects at exposure levels predicted from animal studies to be safe for humans. This discordance reinforces concerns about the adequacy of contemporary risk assessment practices (Birnbaum, Burke, & Jones, 2016) for protecting public health. It is becoming clear that to protect public health more effectively, future risk assessments will need to use the full range of available data, draw on innovative methods to integrate diverse data streams, and consider health endpoints that also reflect the range of subtle effects and morbidities observed in human populations. Given these factors, there is a need to reframe chemical risk assessment to be more clearly aligned with the public health goal of minimizing environmental exposures associated with disease. Preventing adverse health impacts from exposures to environmental chemicals is fundamental to protecting individual and public health. Chemical risk assessments

  14. Clinical Features, Short-Term Mortality, and Prognostic Risk Factors of Septic Patients Admitted to Internal Medicine Units: Results of an Italian Multicenter Prospective Study.

    Science.gov (United States)

    Mazzone, Antonino; Dentali, Francesco; La Regina, Micaela; Foglia, Emanuela; Gambacorta, Maurizia; Garagiola, Elisabetta; Bonardi, Giorgio; Clerici, Pierangelo; Concia, Ercole; Colombo, Fabrizio; Campanini, Mauro

    2016-01-01

    Only a few studies provided data on the clinical history of sepsis within internal Medicine units. The aim of the study was to assess the short-term mortality and to evaluate the prognostic risk factors in a large cohort of septic patients treated in internal medicine units. Thirty-one internal medicine units participated to the study. Within each participating unit, all admitted patients were screened for the presence of sepsis. A total of 533 patients were included; 78 patients (14.6%, 95%CI 11.9, 18.0%) died during hospitalization; mortality rate was 5.5% (95% CI 3.1, 9.6%) in patients with nonsevere sepsis and 20.1% (95%CI 16.2, 28.8%) in patients with severe sepsis or septic shock. Severe sepsis or septic shock (OR 4.41, 95%CI 1.93, 10.05), immune system weakening (OR 2.10, 95%CI 1.12, 3.94), active solid cancer (OR 2.14, 95% CI 1.16, 3.94), and age (OR 1.03 per year, 95% CI 1.01, 1.06) were significantly associated with an increased mortality risk, whereas blood culture positive for Escherichia coli was significantly associated with a reduced mortality risk (OR 0.46, 95%CI 0.24, 0.88). In-hospital mortality of septic patients treated in internal medicine units appeared similar to the mortality rate obtained in recent studies conducted in the ICU setting.

  15. Cardiovascular risk assessment in hypertensive patients

    Directory of Open Access Journals (Sweden)

    Elaine Amaral de Paula

    2013-06-01

    Full Text Available OBJECTIVE: to assess cardiovascular risk by means of the traditional Framingham score and the version modified through the incorporation of emerging risk factors, such as family history of acute myocardial infarction, metabolic syndrome and chronic kidney disease. METHOD: participants were 50 hypertensive patients under outpatient treatment. The clinical data were collected through a semi-structured interview and the laboratory data from patients' histories. RESULTS: it was verified that the traditional Framingham score was predominantly low (74%, with 14% showing medium risk and 12% high risk. After the inclusion of emerging risk factors, the chance of a coronary event was low in 22% of the cases, medium in 56% and high in 22%. CONCLUSIONS: the comparison between the traditional Framingham risk score and the modified version demonstrated a significant difference in the cardiovascular risk classification, whose correlation shows discreet agreement between the two scales. Lifestyle elements seem to play a determinant role in the increase in cardiovascular risk levels.

  16. Cardiovascular risk assessment in hypertensive patients

    Directory of Open Access Journals (Sweden)

    Elaine Amaral de Paula

    Full Text Available OBJECTIVE: to assess cardiovascular risk by means of the traditional Framingham score and the version modified through the incorporation of emerging risk factors, such as family history of acute myocardial infarction, metabolic syndrome and chronic kidney disease. METHOD: participants were 50 hypertensive patients under outpatient treatment. The clinical data were collected through a semi-structured interview and the laboratory data from patients' histories. RESULTS: it was verified that the traditional Framingham score was predominantly low (74%, with 14% showing medium risk and 12% high risk. After the inclusion of emerging risk factors, the chance of a coronary event was low in 22% of the cases, medium in 56% and high in 22%. CONCLUSIONS: the comparison between the traditional Framingham risk score and the modified version demonstrated a significant difference in the cardiovascular risk classification, whose correlation shows discreet agreement between the two scales. Lifestyle elements seem to play a determinant role in the increase in cardiovascular risk levels.

  17. [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.

  18. Risk assessment in transportation systems

    Directory of Open Access Journals (Sweden)

    Młyńczak Marek

    2016-12-01

    Full Text Available The paper presents problems of hazard identification in transportation systems, where not only field of action is large but also cause-consequences relations between failure causes and losses are distant in time and space. It is observed in transportation systems of goods and passengers, systems of water, gas, oil distribution and electro-energetic nets. Proposed systemic approach based on system elements classification on active (casual and passive ones (affected. There are described concepts of vulnerability (damageability, resilience (ability of recovering and risk controlling by introducing safety measures to undesired event chain.

  19. Preconception risk assessment of infertile couples.

    Science.gov (United States)

    Nekuei, Nafisehsadat; Kazemi, Ashraf; Ehsanpur, Soheila; Beigi, Nastaran Mohammad Ali

    2013-01-01

    With regard to the importance of preconception conditions in maternal health and fertility, preconception risk assessment makes treatment trends and pregnancy outcome more successful among infertile couples. This study has tried to investigate preconception risk assessment in infertile couples. This is a descriptive analytical survey conducted on 268 subjects, selected by convenient sampling, referring to Isfahan infertility centers (Iran). The data were collected by questionnaires through interview and clients' medical records. Pre-pregnancy risk assessment including history taking (personal, familial, medical, medications, menstruation, and pregnancy), exams (physical, genital, and vital signs), and routine test requests (routine, cervix, infections, and biochemical tests) was performed in the present study. The results showed that the lowest percentage of taking a complete history was for personal history (0.4%) and the highest was for history of menstruation (100%). The lowest percentage of complete exam was for physical exam (3.4%) and the highest for genital exam (100%). With regard to laboratory assessment, the highest percentage was for routine tests (36.6%) and the lowest was for infection tests (0.4%). Based o the results of the present study, most of the risk assessment components are poorly assessed in infertile couples. With regard to the importance of infertility treatment, spending high costs and time on that, and existence of high-risk individuals as well as treatment failures, health providers should essentially pay special attention to preconception risk assessment in infertile couples in order to enhance the chance of success and promote treatment outcome.

  20. Immunochemotherapy with intensive consolidation for primary CNS lymphoma: a pilot study and prognostic assessment by diffusion-weighted MRI.

    Science.gov (United States)

    Wieduwilt, Matthew J; Valles, Francisco; Issa, Samar; Behler, Caroline M; Hwang, James; McDermott, Michael; Treseler, Patrick; O'Brien, Joan; Shuman, Marc A; Cha, Soonmee; Damon, Lloyd E; Rubenstein, James L

    2012-02-15

    We evaluated a novel therapy for primary central nervous system lymphoma (PCNSL) with induction immunochemotherapy with high-dose methotrexate, temozolomide, and rituximab (MT-R) followed by intensive consolidation with infusional etoposide and high-dose cytarabine (EA). In addition, we evaluated the prognostic value of the minimum apparent diffusion coefficient (ADC(min)) derived from diffusion-weighted MRI (DW-MRI) in patients treated with this regimen. Thirty-one patients (median age, 61 years; median Karnofsky performance score, 60) received induction with methotrexate every 14 days for 8 planned cycles. Rituximab was administered the first 6 cycles and temozolomide administered on odd-numbered cycles. Patients with responsive or stable central nervous system (CNS) disease received EA consolidation. Pretreatment DW-MRI was used to calculate the ADC(min) of contrast-enhancing lesions. The complete response rate for MT-R induction was 52%. At a median follow-up of 79 months, the 2-year progression-free and overall survival were 45% and 58%, respectively. For patients receiving EA consolidation, the 2-year progression-free and overall survival were 78% and 93%, respectively. EA consolidation was also effective in an additional 3 patients who presented with synchronous CNS and systemic lymphoma. Tumor ADC(min) less than 384 × 10(-6) mm(2)/s was significantly associated with shorter progression-free and overall survival. MT-R induction was effective and well tolerated. MT-R followed by EA consolidation yielded progression-free and overall survival outcomes comparable to regimens with chemotherapy followed by whole-brain radiotherapy consolidation but without evidence of neurotoxicity. Tumor ADC(min) derived from DW-MRI provided better prognostic information for PCNSL patients treated with the MTR-EA regimen than established clinical risk scores. ©2012 AACR.

  1. Sequential Assessments of the Eastern Cooperative Oncology Group Performance Scale Enhance Prognostic Value in Patients With Terminally Ill Cancer Receiving Palliative Care.

    Science.gov (United States)

    Peng, Meng-Ting; Liu, Chien-Ting; Hung, Yu-Shin; Kao, Chen-Yi; Chang, Pei-Hung; Yeh, Kun-Yun; Wang, Hung-Ming; Lin, Yung-Chang; Chou, Wen-Chi

    2016-06-01

    This study aimed to assess the utility of the Eastern Cooperative Oncology Group (ECOG) performance scale assessments on days 1 and 8 of palliative care, as well as scale change between these assessments, as prognostic tools for patients with terminally ill cancer. A total of 2392 patients with terminally ill cancer who received palliative care between January 2006 and December 2011 at a single medical center were analyzed. Our study showed that the ECOG scale is a useful prognostic tool to predict life expectancy in patients with terminally ill cancer. The ECOG scale assessments at different time points under palliative care were independent predictors for overall survival. The combined ECOG scale assessments on days 1 and 8 predicted survival more precisely than using day 1 ECOG scale assessment alone. © The Author(s) 2014.

  2. [Working abroad: risk assessment and immunization].

    Science.gov (United States)

    Bianco, P; Anzelmo, V

    2010-01-01

    The workers travelling abroad by country of origin to carry on the job puts at risk not present in the country of origin, which overlap those related to the job profile. These risks are related to the trip, the geographic area of destination, the climate, the presence of vector, the socio-economic variables, the hygienic conditions of the host country. The risk assessment for workers abroad is complex and requires multidisciplinary inputs. Correctly performed, the risk assessment identifies the parameters needed to develop appropriate preventive strategies. The assessment of biological risk related to the geographic areas identifies immunization programs that prevent serious infectious diseases. The occupational physician must establish health surveillance programs in which the vaccination schemes should be related to geographical areas. Training and information company programs to complete protection through hygienic measures.

  3. Primary small bowel adenocarcinoma: current view on clinical features, risk and prognostic factors, treatment and outcome.

    Science.gov (United States)

    Lech, Gustaw; Korcz, Wojciech; Kowalczyk, Emilia; Słotwiński, Robert; Słodkowski, Maciej

    2017-11-01

    Small bowel adenocarcinoma (SBA) is a rare but increasing cause of gastrointestinal malignancy, being both a diagnostic and therapeutic challenge. The goal of treatment is margin negative resection of a lesion and local lymphadenectomy, followed by modern adjuvant chemotherapy combinations in selected cases. Improved outcomes in patients with SBA are encouraging, but elucidation of mechanisms of carcinogenesis and risk factors as well as improved treatment for this malignancy is very needed.

  4. Assessing the prognostic features of a pain classification system in advanced cancer patients.

    Science.gov (United States)

    Arthur, Joseph; Tanco, Kimberson; Haider, Ali; Maligi, Courtney; Park, Minjeong; Liu, Diane; Bruera, Eduardo

    2017-09-01

    The Edmonton Classification System for Cancer Pain (ECS-CP) has been shown to predict pain management complexity based on five features: pain mechanism, incident pain, psychological distress, addictive behavior, and cognitive function. The main objective of our study was to explore the association between ECS-CP features and pain treatment outcomes among outpatients managed by a palliative care specialist-led interdisciplinary team. Initial and follow-up clinical information of 386 eligible supportive care outpatients were retrospectively reviewed and analyzed. Between the initial consultation and the first follow-up visit, the median ESAS pain intensity improved from 6 to 4.5 (p feature (p = 0.006) used a higher number of adjuvant medications. At follow-up, patients with neuropathic pain were less likely to achieve their personalized pain goal (PPG) (29 vs 72%, p = 0.015). No statistically significant association was found between increasing sum of ECS-CP features and any of the pain treatment outcomes at follow-up. Neuropathy was found to be a poor prognostic feature in advanced cancer pain management. Increasing sum of ECS-CP features was not predictive of pain management complexity at the follow-up visit when pain was managed by a palliative medicine specialist. Further research is needed to further explore these observations.

  5. AJCC-7TH Edition Staging Criteria for Colon Cancer: Do the Complex Modifications Improve Prognostic Assessment?

    Science.gov (United States)

    Hari, Danielle M; Leung, Anna M; Lee, Ji-Hey; Sim, Myung-Shin; Vuong, Brooke; Chiu, Connie G; Bilchik, Anton J

    2015-01-01

    Background The seventh edition of the American Joint Committee on Cancer staging system (AJCC-7) includes significant changes for colon cancer (CC), which are particularly complex in patients with stage II and III disease. We used a national cancer database to determine if these changes improved prediction of survival. Study Design The database of the Surveillance, Epidemiology, and End Results (SEER) Program was queried to identify patients with pathologically confirmed stage I-III CC diagnosed between 1988 and 2008. CC was staged by sixth edition AJCC criteria (AJCC-6) and then restaged by AJCC-7. Five-year disease-specific survival (DSS) and overall survival (OS) were compared. Results After all exclusion criteria were applied, AJCC-6 and AJCC-7 staging was possible in 157,588 patients (68.9%). Bowker's test of symmetry showed that the number of patients per substage was different for AJCC-6 and AJCC-7 (p 12 lymph nodes examined did not affect this observation. Conclusion AJCC-7 staging of CC does not address all survival discrepancies, regardless of the number of lymph nodes examined. Consideration of other prognostic factors is critical for decisions regarding therapy, particularly for patients with stage II CC. PMID:23768788

  6. 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...

  7. 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...

  8. 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.

  9. Open risk assessment: methods and expertise

    National Research Council Canada - National Science Library

    Verloo, Didier; Meyvis, Tom; Smith, Anthony

    2016-01-01

    ... traditional dialogue and towards a more sustainable stakeholder and society interaction. The discussion centred on the needs of EFSA and of target audiences throughout the process, from risk assessment initiation through societal...

  10. 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...

  11. How We Assess Risks to Pollinators

    Science.gov (United States)

    EPA has a new risk assessment framework for bees as part of its regulatory decision-making process for all pesticides, which relies on a tiered process, focuses on major routes of exposure, and distinguishes different types of pesticide treatment.

  12. Towards dynamics in flood risk assessment

    National Research Council Canada - National Science Library

    Mazzorana, B; Levaggi, L; Keiler, M; Fuchs, S

    2012-01-01

    .... The assessment of the dynamic evolution of flood risk is the pillar of any subsequent planning process that is targeted at a reduction of the expected adverse consequences of the hazard impact...

  13. 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

  14. European Union Risk Assessment Report - Sodium Perborate

    OpenAIRE

    2007-01-01

    This report provides , with conclusions, the risk assessment report of the substance sodium perborate that has been prepared by Austria in the context of Council Regulation (EEC) No. 793/93 on the evaluation and control of existing substances.

  15. Assessing gas exchange in acute lung injury/acute respiratory distress syndrome: diagnostic techniques and prognostic relevance.

    Science.gov (United States)

    Gattinoni, Luciano; Carlesso, Eleonora; Cressoni, Massimo

    2011-02-01

    To provide the most recent insights on the assessment of gas exchange in acute lung injury. Central venous blood may be used as a surrogate of arterial blood to assess carbon dioxide tension and acid-base status. In contrast arterial oxygenation cannot be estimated with confidence from venous blood. However, the use of venous blood associated with pulse oximetry may provide the SvO2 which is useful for monitoring and targeting the resuscitation therapy. Impaired CO2 clearance and increased dead space have been confirmed as useful prognostic indices of structural lung damage and mortality in acute respiratory failure. A simplified technique based on multiple inert gas technique has been described to assess ventilation-perfusion mismatch while a new analysis of pulse oximetry has been suggested to detect lung opening and closing. Finally, new insight has been provided on the relationship between lung anatomy, as detected by computed tomography, oxygenation and CO2 clearance. Although oxygenation assessment is of primary importance during respiratory lung injury, dead space and CO2 retention are more strictly associated with outcome. The association of central venous blood analysis and pulse oximetry may provide more information than arterial blood alone.

  16. Vulnerability Identification Errors in Security Risk Assessments

    OpenAIRE

    Taubenberger, Stefan

    2014-01-01

    At present, companies rely on information technology systems to achieve their business objectives, making them vulnerable to cybersecurity threats. Information security risk assessments help organisations to identify their risks and vulnerabilities. An accurate identification of risks and vulnerabilities is a challenge, because the input data is uncertain. So-called ’vulnerability identification errors‘ can occur if false positive vulnerabilities are identified, or if vulnerabilities remain u...

  17. Cheese Microbial Risk Assessments ? A Review

    OpenAIRE

    Kyoung-Hee Choi; Heeyoung Lee; Soomin Lee; Sejeong Kim; Yohan Yoon

    2016-01-01

    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 o...

  18. Import risk assessment for salmon meat.

    Science.gov (United States)

    Beers, P T; Wilson, D W

    1993-12-01

    The authors discuss the risk assessment currently being conducted by the Australian Quarantine and Inspection Service (AQIS) on the importation of salmon products. AQIS conducted a public consultation on the proposal, in line with Australian Government policy on transparency and accountability in the quarantine decision-making process. The authors examine the factors which should be taken into account in the assessment of the risk associated with the importation of such products, and note the difficulties encountered with the epidemiology of fish diseases.

  19. Sulfur Oxides Risk and Exposure Assessment Planning ...

    Science.gov (United States)

    In conducting risk/exposure assessments for the Sulfur Oxides NAAQS review, EPA will first develop a draft Scope and Methods Plan which will describe the proposed scope of the quantitative and qualitative analyses to be performed and the tools/methods that may be employed Provide opportunity for CASAC feedback on EPA's plans for the risk and exposure assessment for the Sulfur Oxides NAAQS review

  20. 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.

  1. Flood risk assessments at different spatial scales

    NARCIS (Netherlands)

    de Moel, H.; Jongman, B.; Kreibich, H.; Merz, B.; Penning-Rowsell, E; Ward, P.J.

    2015-01-01

    Managing flood risk, i.e. both the hazard and the potential consequences, is an important aspect of adapting to global change and has gained much traction in recent decades. As a result, a priori flood risk assessments have become an important part of flood management practices. Many methodologies

  2. Gender and risk assessment in contraceptive technologies

    NARCIS (Netherlands)

    van Kammen, Jessika; Oudshoorn, Nelly E.J.

    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

  3. Experimental Validation of a Risk Assessment Method

    NARCIS (Netherlands)

    Vriezekolk, E.; Etalle, Sandro; Wieringa, Roelf J.

    [Context and motivation] It is desirable that require- ment engineering methods are reliable, that is, that methods can be repeated with the same results. Risk assessments methods, however, often have low reliability when they identify risk mitigations for a sys- tem based on expert judgement.

  4. [Current lines of methodology for risk assessment].

    Science.gov (United States)

    Rakhmanin, Iu A; Novikov, S M; Shashina, T A

    2007-01-01

    The paper presents the results of some guidance studies assessing the risk, recently conducted at the A. N. Sysin Research Institute of Human Ecology and Environmental Health, such as validation of toxicological and hygienic criteria for risk assessment upon short- and long-term human exposures to deleterious substances; development and introduction of methods for assessing health risk and damage, by applying computer technologies; elaboration of guidelines for establishing the cause-and-effect relationship of changes in health indices to those in the environment; characterization of damage caused by ambient air pollution in Russian cities and towns; possibilities of using the guidance for assessing the risk to improve sociohygienic monitoring. It also gives the results of testing scientific developments in the assessment of a multienvironmental risk in the areas exposed to emission from aluminum works (Khakasia) and chemical and petrochemical enterprises (Samara Region) and in the determination of contribution of emission from the Moscow fuel-and-energy complex to risks and damages to human health, caused by ambient air pollution. The urgent issues of further development of modern trends in risk guidance studies are determined.

  5. Uncertainty quantification in flood risk assessment

    Science.gov (United States)

    Blöschl, Günter; Hall, Julia; Kiss, Andrea; Parajka, Juraj; Perdigão, Rui A. P.; Rogger, Magdalena; Salinas, José Luis; Viglione, Alberto

    2017-04-01

    Uncertainty is inherent to flood risk assessments because of the complexity of the human-water system, which is characterised by nonlinearities and interdependencies, because of limited knowledge about system properties and because of cognitive biases in human perception and decision-making. On top of the uncertainty associated with the assessment of the existing risk to extreme events, additional uncertainty arises because of temporal changes in the system due to climate change, modifications of the environment, population growth and the associated increase in assets. Novel risk assessment concepts are needed that take into account all these sources of uncertainty. They should be based on the understanding of how flood extremes are generated and how they change over time. They should also account for the dynamics of risk perception of decision makers and population in the floodplains. In this talk we discuss these novel risk assessment concepts through examples from Flood Frequency Hydrology, Socio-Hydrology and Predictions Under Change. We believe that uncertainty quantification in flood risk assessment should lead to a robust approach of integrated flood risk management aiming at enhancing resilience rather than searching for optimal defense strategies.

  6. Risk Assessment Stability: A Revalidation Study of the Arizona Risk/Needs Assessment Instrument

    Science.gov (United States)

    Schwalbe, Craig S.

    2009-01-01

    The actuarial method is the gold standard for risk assessment in child welfare, juvenile justice, and criminal justice. It produces risk classifications that are highly predictive and that may be robust to sampling error. This article reports a revalidation study of the Arizona Risk/Needs Assessment instrument, an actuarial instrument for juvenile…

  7. The issues regarding postoperative adjuvant therapy and prognostic risk factors for patients with stage I-II cervical cancer: A review.

    Science.gov (United States)

    Takekuma, Munetaka; Kasamatsu, Yuka; Kado, Nobuhiro; Kuji, Shiho; Tanaka, Aki; Takahashi, Nobutaka; Abe, Masakazu; Hirashima, Yasuyuki

    2017-04-01

    The treatment for most patients with early-stage cervical cancer involves radical hysterectomy and pelvic lymph node dissection, and indications for postoperative adjuvant therapy have been determined by evaluating the prognostic risk factors for recurrence in each case. The aim of this review is to raise and discuss the various issues that have not yet been resolved regarding the prognostic risk factors and postoperative adjuvant therapy. Several clinicopathological factors, such as tumor size, lymphovascular space involvement, deep stromal invasion, parametrial involvement and lymph node metastasis, have been identified to have prognostic significance in early-stage cervical cancer. However, this remains controversial because there is suggested to be substantial heterogeneity among patients after radical hysterectomy and lymphadenectomy and it would be difficult to define the risk groups clearly. This indicates the need to develop more convenient and accurate criteria to define risk groups. According to the currently available evidence, patients in the high-risk group should receive adjuvant concurrent chemoradiotherapy (CCRT) with cisplatin (CDDP) and fluolouracil. However, CCRT with CDDP administered weekly (CCRT-P) has instead been applied in a clinical context worldwide. Whether CCRT-P has a survival benefit compared with radiotherapy (RT) alone is unknown because no randomized phase III trials have been performed for patients in the high-risk group after radical surgery. Patients with high-risk factors have a high incidence of distant metastasis, for whom systemic chemotherapy might be a key to improving overall survival. The pivotal study that investigated the role of RT alone for patients with intermediate-risk factors after hysterectomy is the GOG092 trial. This trial showed a 47% reduction in the risk of recurrence after RT compared with no further treatment (NFT). However, the improvement in overall survival with RT did not reach statistical

  8. Palliative medicine review: prognostication.

    Science.gov (United States)

    Glare, Paul A; Sinclair, Christian T

    2008-01-01

    Prognostication, along with diagnosis and treatment, is a traditional core clinical skill of the physician. Many patients and families receiving palliative care want information about life expectancy to help plan realistically for their futures. Although underappreciated, prognosis is, or at least should be, part of every clinical decision. Despite this crucial role, expertise in the art and science of prognostication diminished during the twentieth century, due largely to the ascendancy of accurate diagnostic tests and effective therapies. Consequently, "Doctor, how long do I have?" is a question most physicians find unprepared to answer effectively. As we focus on palliative care in the twenty-first century, prognostication will need to be restored as a core clinical proficiency. The discipline of palliative medicine can provide leadership in this direction. This paper begins by discussing a framework for understanding prognosis and how its different domains might be applied to all patients with life limiting illness, although the main focus of the paper is predicting survival in patients with cancer. Examples of prognostic tools are provided, although the subjective assessment of prognosis remains important in the terminally ill. Other issues addressed include: the importance of prognostication in terms of clinical decision-making, discharge planning, and care planning; the impact of prognosis on hospice referrals and patient/family satisfaction; and physicians' willingness to prognosticate.

  9. Updating Probability in Sex Offender Risk Assessment.

    Science.gov (United States)

    Elwood, Richard W

    2017-06-01

    Actuarial scales like the Static-99R are widely used to predict an individual's risk of sexual recidivism. However, current actuarial scales only provide rates of detected sex offenses over 10-year follow-up and do not account for all recidivism risk factors. Therefore, some forensic evaluators extrapolate, adjust, or override recidivism rates derived from actuarial scales to predict the lifetime risk of committed offenses that accounts for external risk factors, those not addressed by the actuarial scales. However, critics contend that altering rates from actuarial scales degrades their predictive validity. This article makes the case for extrapolating risk for time of exposure and for evidence-based external risk factors. It proposes using odds ratios (ORs) from case-control studies to adjust predictions from follow-up cohort studies. Finally, it shows how evaluators can apply ORs and their margins of error to sex offender risk assessment.

  10. Caries risk assessment in young adults

    DEFF Research Database (Denmark)

    Petersson, Gunnel Hänsel; Twetman, Svante

    2015-01-01

    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 ... of impaired specificities. No combinations proved clinically useful values according to Yuoden's index. CONCLUSIONS: Within the limitations of the present study, the computer-based Cariogram did not perform better than a caries risk assessment scheme based on past caries experience and caries progression...

  11. Iodine Concentration in Spectral CT: Assessment of Prognostic Determinants in Patients With Gastric Adenocarcinoma.

    Science.gov (United States)

    Liang, Pan; Ren, Xiu-Chun; Gao, Jian-Bo; Chen, Kui-Sheng; Xu, Xiao

    2017-11-01

    The purpose of this study was to use virtual monochromatic spectral CT to investigate the usefulness of iodine concentration (IC) and its correlation with clinicopathologically determined prognostic factors in gastric adenocarcinoma. From June 2012 to March 2015, 34 patients with gastric adenocarcinoma underwent arterial and portal venous phase spectral CT. The ICs in the arterial and portal venous phases were calculated and then normalized with the aorta as normalized IC (NIC). The surgical specimen was evaluated with CD34 staining to determine microvessel density (MVD). The correlation between imaging results and clinicopathologic findings was investigated for histologic grading, lymph node metastasis, serosal involvement, distant metastasis, pathologic TNM stage, and MVD. The mean arterial phase NIC value of tumors was 0.12 ± 0.03, portal venous phase NIC value was 0.39 ± 0.06, and MVD was 26.94 ± 7.87 vessels per high-power field (×400). Both arterial phase and portal venous phase NIC values were significantly higher in poorly differentiated gastric adenocarcinomas (p = 0.005) than in moderately differentiated tumors (p = 0.013). There was no significant correlation between NIC and serosal involvement or distant metastasis. There was significant correlation between the NIC and MVD in gastric adenocarcinoma (arterial phase NIC, p = 0.013; portal venous phase NIC, p = 0.001). However, neither the arterial nor the portal venous phase NIC of gastric adenocarcinoma had a significant relation to lymphatic metastasis or pathologic TNM stage. There was a significant difference between the high and low MVD groups with respect to portal venous phase NIC (p = 0.045). NIC can serve as a useful predictor of angiogenesis and degree of differentiation of moderately and poorly differentiated gastric adenocarcinomas.

  12. Validation of a prognostic multi-gene signature in high-risk neuroblastoma using the high throughput digital NanoString nCounter™ system.

    Science.gov (United States)

    Stricker, Thomas P; Morales La Madrid, Andres; Chlenski, Alexandre; Guerrero, Lisa; Salwen, Helen R; Gosiengfiao, Yasmin; Perlman, Elizabeth J; Furman, Wayne; Bahrami, Armita; Shohet, Jason M; Zage, Peter E; Hicks, M John; Shimada, Hiroyuki; Suganuma, Rie; Park, Julie R; So, Sara; London, Wendy B; Pytel, Peter; Maclean, Kirsteen H; Cohn, Susan L

    2014-05-01

    Microarray-based molecular signatures have not been widely integrated into neuroblastoma diagnostic classification systems due to the complexities of the assay and requirement for high-quality RNA. New digital technologies that accurately quantify gene expression using RNA isolated from formalin-fixed paraffin embedded (FFPE) tissues are now available. In this study, we describe the first use of a high-throughput digital system to assay the expression of genes in an "ultra-high risk" microarray classifier in FFPE high-risk neuroblastoma tumors. Customized probes corresponding to the 42 genes in a published multi-gene neuroblastoma signature were hybridized to RNA isolated from 107 FFPE high-risk neuroblastoma samples using the NanoString nCounter™ Analysis System. For classification of each patient, the Pearson's correlation coefficient was calculated between the standardized nCounter™ data and the molecular signature from the microarray data. We demonstrate that the nCounter™ 42-gene panel sub-stratified the high-risk cohort into two subsets with statistically significantly different overall survival (p = 0.0027) and event-free survival (p = 0.028). In contrast, none of the established prognostic risk markers (age, stage, tumor histology, MYCN status, and ploidy) were significantly associated with survival. We conclude that the nCounter™ System can reproducibly quantify expression levels of signature genes in FFPE tumor samples. Validation of this microarray signature in our high-risk patient cohort using a completely different technology emphasizes the prognostic relevance of this classifier. Prospective studies testing the prognostic value of molecular signatures in high-risk neuroblastoma patients using FFPE tumor samples and the nCounter™ System are warranted. Copyright © 2014 Federation of European Biochemical Societies. Published by Elsevier B.V. All rights reserved.

  13. Prognostic value of the seventh AJCC/UICC TNM classification of intestinal-type ethmoid adenocarcinoma: Systematic review and risk prediction model.

    Science.gov (United States)

    Fiaux-Camous, Domitille; Chevret, Sylvie; Oker, Natalie; Turri-Zanoni, Mario; Lombardi, Davide; Choussy, Olivier; Duprez, Frederic; Jorissen, Marc; de Gabory, Ludovic; Malard, Olivier; Herman, Philippe; Nicolai, Piero; Castelnuovo, Paolo; Verillaud, Benjamin

    2017-04-01

    The purpose of this study was to propose a prognostic classification of intestinal-type adenocarcinoma (ITAC) based on literature search and prognostic modeling of cohort data. We first conducted a literature search to assess the homogeneity of the reported estimates of 5-year survival and to identify the influence of T classification. We then pooled prospective data from 3 large French and Italian series to predict time to all-cause mortality. The sample was randomly split to derive and then to validate the proposed prognostic model. Literature analysis confirmed the heterogeneity in 5-year survival rates, partly explained in subsets of homogeneous T-values. The sample included 223 patients, randomly separated into a derivation (n = 141) and a validation set (n = 82). Invasion of the sphenoid lateral and/or posterior walls and dura/cerebral invasion were systematically associated with a poor survival. The incorporation of the invasion of the sphenoid lateral or posterior walls should be considered for ITAC management and prognostication. © 2017 Wiley Periodicals, Inc. Head Neck 39: 668-678, 2017. © 2017 Wiley Periodicals, Inc.

  14. Assessment and uncertainty analysis of groundwater risk.

    Science.gov (United States)

    Li, Fawen; Zhu, Jingzhao; Deng, Xiyuan; Zhao, Yong; Li, Shaofei

    2018-01-01

    Groundwater with relatively stable quantity and quality is commonly used by human being. However, as the over-mining of groundwater, problems such as groundwater funnel, land subsidence and salt water intrusion have emerged. In order to avoid further deterioration of hydrogeological problems in over-mining regions, it is necessary to conduct the assessment of groundwater risk. In this paper, risks of shallow and deep groundwater in the water intake area of the South-to-North Water Transfer Project in Tianjin, China, were evaluated. Firstly, two sets of four-level evaluation index system were constructed based on the different characteristics of shallow and deep groundwater. Secondly, based on the normalized factor values and the synthetic weights, the risk values of shallow and deep groundwater were calculated. Lastly, the uncertainty of groundwater risk assessment was analyzed by indicator kriging method. The results meet the decision maker's demand for risk information, and overcome previous risk assessment results expressed in the form of deterministic point estimations, which ignore the uncertainty of risk assessment. Copyright © 2017 Elsevier Inc. All rights reserved.

  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. Assessing wildfire risks at multiple spatial scales

    Science.gov (United States)

    Justin Fitch

    2008-01-01

    In continuation of the efforts to advance wildfire science and develop tools for wildland fire managers, a spatial wildfire risk assessment was carried out using Classification and Regression Tree analysis (CART) and Geographic Information Systems (GIS). The analysis was performed at two scales. The small-scale assessment covered the entire state of New Mexico, while...

  17. Risk assessment as collective clinical judgement.

    Science.gov (United States)

    Murphy, Denis

    2002-01-01

    Risk assessment occupies an increasingly important position in psychiatry. This paper contends that collective judgement is the optimal method of assessing risk. Risk has a dual meaning: emotional and judgemental. Assaults, threats and survival anxiety. Staff wariness and resistance, attribution of blame. For a group to function well it must have a clear task. Custodial roles can lead to ambiguity. Externally directed hostility, internal homogenization of views. Rituals can develop in forensic institutions, as well as militarism. ANTI-THERAPEUTIC CULTURE: Sadism may develop where a marked power differential develops. Danger intensifies the feelings about leaders, perhaps idealization, perhaps disaffection. Leaders and others need to agree on risk assessment or fragmentation will occur. The assessment of risk may modify it. Mutual hostility must be reduced. Dialogue and understanding are needed. The environment should be less authoritarian and more democratic, so that patients can join a group and internalize its values. Reflective space is also required. Risk assessment is best described in terms of human endeavour, not in the language of scientific measurement.

  18. 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...... environmental risk assessment and the evaluation of risk reducing options. Quantitative approaches have become increasingly important during this time. The Panel has developed such methods in climatic mapping (in association with the Joint Research Councils), application of spatial spread models, re......-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...

  19. Additive prognostic value of NT-proBNP over TIMI risk score in intermediate-risk patients with acute coronary syndrome.

    Science.gov (United States)

    Eren, Nihan Kahya; Ertaş, Faruk; Yüksek, Umit; Cakir, Cayan; Nazli, Cem; Köseoğlu, Mehmet; Ergene, Oktay

    2009-01-01

    We evaluated the prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) for further risk stratification of intermediate-risk patients with non-ST elevation acute coronary syndromes (NSTE-ACS). The study included 137 intermediate-risk patients (85 men, 52 women; mean age 62+/-11 years) with ACS, based on the TIMI risk score (scores 3 to 5). Serum NT-proBNP levels were measured 12 hours after the last anginal episode. The patients were divided into four groups according to the following NT-proBNP quartiles: 17-310 pg/ml (n=34), 313-688 pg/ml (n=35), 724-2,407 pg/ml (n=34), and 2,575-24,737 pg/ml (n=34). Primary endpoint of the study was mortality. The mean follow-up was 21.8+/-7.1 months. There were 27 deaths (19.7%), 14 of which were in the 4th quartile (4th vs 1st, 2nd, and 3rd quartiles: p=0.02, p=0.01, and pTIMI risk score, ejection fraction, and age. Patients who died were older (65.6+/-11.9 years vs 60.7+/-11.0 years; p=0.048) and had a lower ejection fraction (46.3+/-11% vs 54.1+/-9.8%; pTIMI risk scores of 3, 4, and 5 were 25.9%, 29.6%, and 44.4%, respectively (p=0.58 for TIMI 3 vs 4; p=0.001 for TIMI 3 vs 5; p=0.013 for TIMI 4 vs 5). Cox proportional hazards regression analysis showed that only TIMI risk score was an independent predictor of mortality (hazard ratio 2.3, 95% confidence interval 1.4-3.8, p=0.001). NT-proBNP has an additive predictive value over TIMI risk score in predicting long-term mortality in intermediate-risk patients with ACS.

  20. Desertification risk assessment and management program

    Directory of Open Access Journals (Sweden)

    M. Akbari

    2016-12-01

    Full Text Available Risk assessment provides the possibility of planning and management to prevent and reduce the risk of desertification. The present study is aimed to assess the hazard and risk of desertification and to develop management programs in the semi-arid western regions of Golestan Province in Iran. Desertification rate was obtained using the Iranian model of desertification potential assessment. Since the rating system was considered for the indicators, data analyses were carried out according to the Mann-Whitney test. The risk of desertification was calculated based on hazard, elements at risk and vulnerability assessment maps. The intensity of desertification was estimated to be medium. Among the factors affecting desertification, agriculture by the weighted average of 3.22 had the highest effect, followed by soil, vegetation, water and wind erosion criteria by weighted averages of 2.45, 2.32, 2.15 and 1.6 respectively. Desertification risk assessment results also showed that about 78% of central and northern parts of the region, with the largest population and residential centers, surface and underground water resources, agriculture and horticulture, is confronted with a high to very high degree of risk. Management plans and control measures, based on risk values were presented in four activities (with two management priorities under critical and non-critical conditions. For the management program with the largest area. Control measures and strategies such as the establishment of halophytic and xerophytic plants, drainage networks, resilient facilities and infrastructure were proposed. Reducing the risk of desertification, could play a crucial role in the sustainable development of drylands and desert ecosystems.

  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. 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)

  3. The Risk of Relapse in Papillary Thyroid Cancer (PTC in the Context of BRAFV600E Mutation Status and Other Prognostic Factors.

    Directory of Open Access Journals (Sweden)

    Agnieszka Czarniecka

    Full Text Available The risk of over-treatment in low-advanced PTC stages has prompted clinicians to search for new reliable prognostic factors. The presence of BRAF mutation, the most frequent molecular event in PTC, seems to be a good candidate. However, there is still lack of randomised trials and its significance has been proved by retrospective analyses, involving a large group of patients. The question arises whether this factor is useful in smaller populations, characterised for specialised centres. Thus, the aim of the study was to evaluate the use of BRAF mutation as a potential predictive marker in PTC patients.233 PTC subjects treated between 2004-2006, were retrospectively analysed. Stage pT1 was diagnosed in 64.8% patients and lymph node metastases in 30.9%. Median follow-up was 7.5 years. BRAFV600E mutation was assessed postoperatively in all cases.BRAF V600E mutation was found in 54.5%. It was more frequent in patients > 45 years (p=0.0001, and associated with larger tumour size (p=0.004. Patients with tumours <= 10 mm were over-represented among BRAF negative population (p=0.03. No association between BRAF mutation and other clinicopathological factors was observed. BRAF status was associated neither with relapse nor with disease-free survival (DFS (p=0.76. Nodal status, extrathyroidal invasion and tumour size significantly influenced DFS.The risk of PTC recurrence is mainly related to the presence of lymph node metastases and extrathyroidal invasion, whereas no impact of BRAF V600E mutation has been demonstrated.

  4. Fuzzy logic for pipelines risk assessment

    Directory of Open Access Journals (Sweden)

    Ali Alidoosti

    2012-08-01

    Full Text Available Pipelines systems are identified to be the safest way of transporting oil and natural gas. One of the most important aspects in developing pipeline systems is determining the potential risks that implementers may encounter. Therefore, risk analysis can determine critical risk items to allocate the limited resources and time. Risk Analysis and Management for Critical Asset Protection (RAMCAP is one of the best methodologies for assessing the security risks. However, the most challenging problem in this method is uncertainty. Therefore, fuzzy set theory is used to model the uncertainty. Thus, Fuzzy RAMCAP is introduced in order to risk analysis and management for pipeline systems. Finally, a notional example from pipeline systems is provided to demonstrate an application of the proposed methodology.

  5. 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.

  6. Comparison of prognostic value of echographic [corrected] risk score with the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry in Acute Coronary Events (GRACE) risk scores in acute coronary syndrome.

    Science.gov (United States)

    Bedetti, Gigliola; Gargani, Luna; Sicari, Rosa; Gianfaldoni, Maria Luisa; Molinaro, Sabrina; Picano, Eugenio

    2010-12-15

    Risk stratification in patients with acute coronary syndromes (ACS) is achieved today by clinical models, "blind" to the prognostic support of imaging methods. To assess the value of simple at rest cardiac chest sonography in predicting the intra- and extrahospital risk of death or myocardial infarction, we enrolled 470 consecutive in-patients (312 men, age 71 ± 12 years) who had been admitted for ACS. On admission, all had received a clinical score using the Global Registry in Acute Coronary Events and Thrombolysis in Myocardial Infarction systems and, within 1 to 12 hours, a comprehensive cardiac-chest ultrasound scan. Each of the 16 echocardiographic parameters evaluating left and right, systolic and diastolic, ventricular function and structure, was scored from 0 (normal) to 3 (severely abnormal). The median follow-up was 5 months (interquartile range 1 to 10). Patients with hard events (n = 102) could be separated from patients without events (n = 368) using the Global Registry in Acute Coronary Events score, Thrombolysis in Myocardial Infarction score, and several echocardiographic parameters. On multivariate Cox analysis, ejection fraction (hazard ratio 1.45, 95% confidence interval 1.02 to 2.08, p = 0.040), tricuspid annular plane systolic excursion (hazard ratio 1.66, 95% confidence interval 1.13 to 2.45, p = 0.010) and ultrasound lung comets (hazard ratio 1.69, 95% confidence interval 1.25 to 2.27, p = 0.001) were independent predictors of cardiac events. The 3-variable echocardiographic score (from 0, normal to 9, severe abnormalities in ejection fraction, ultrasound lung comets, and tricuspid annular plane systolic excursion) effectively stratified patients and added value (hazard ratio 2.52, 95% confidence interval 1.89 to 3.37, p score (hazard ratio 1.60, 95% confidence interval 1.07 to 2.39, p = 0.003). In conclusion, for patients with ACS, effective risk stratification can be achieved with cardiac and chest ultrasound imaging parameters, adding

  7. Safety analysis, risk assessment, and risk acceptance criteria

    Energy Technology Data Exchange (ETDEWEB)

    Jamali, K. [Dept. of Energy, Germantown, MD (United States). Core Technical Support and Facility Transition; Stack, D.W.; Sullivan, L.H.; Sanzo, D.L. [Los Alamos National Lab., NM (United States)

    1997-08-01

    This paper discusses a number of topics that relate safety analysis as documented in the Department of Energy (DOE) safety analysis reports (SARs), probabilistic risk assessments (PRA) as characterized primarily in the context of the techniques that have assumed some level of formality in commercial nuclear power plant applications, and risk acceptance criteria as an outgrowth of PRA applications. DOE SARs of interest are those that are prepared for DOE facilities under DOE Order 5480.23 and the implementing guidance in DOE STD-3009-94. It must be noted that the primary area of application for DOE STD-3009 is existing DOE facilities and that certain modifications of the STD-3009 approach are necessary in SARs for new facilities. Moreover, it is the hazard analysis (HA) and accident analysis (AA) portions of these SARs that are relevant to the present discussions. Although PRAs can be qualitative in nature, PRA as used in this paper refers more generally to all quantitative risk assessments and their underlying methods. HA as used in this paper refers more generally to all qualitative risk assessments and their underlying methods that have been in use in hazardous facilities other than nuclear power plants. This discussion includes both quantitative and qualitative risk assessment methods. PRA has been used, improved, developed, and refined since the Reactor Safety Study (WASH-1400) was published in 1975 by the Nuclear Regulatory Commission (NRC). Much debate has ensued since WASH-1400 on exactly what the role of PRA should be in plant design, reactor licensing, `ensuring` plant and process safety, and a large number of other decisions that must be made for potentially hazardous activities. Of particular interest in this area is whether the risks quantified using PRA should be compared with numerical risk acceptance criteria (RACs) to determine whether a facility is `safe.` Use of RACs requires quantitative estimates of consequence frequency and magnitude.

  8. FUZZY RISK ASSESSMENT OF AVIATION EVENTS

    Directory of Open Access Journals (Sweden)

    D. Sharov Valeriy

    2017-01-01

    Full Text Available The article presents the technique of fuzzy expert assessment of risk that existed at the time an event occurred. The risk assessment is based on matrix proposed by the Airline Risk Management Solution (ARMS Group. The matrix allows assessing such risks in the numerical values of the conditional average. The values of the indicators in the cells of the ma- trix obtained by use of data processing got from aviation insurance.In practice the risk assessment that existed at the time of the event is largely based on expert opinions, however ARMS Group does not offer the method of forming estimates expert group total opinion. Conventional methods of expert estimation and averaging of final grades is difficult due to the exponential nature of changes in risk values recorded in thecells, when considered by columns and by rows of the matrix.The proposed method of risk assessment uses the approach adopted in the formation of membership functions ac- cording to expert estimates in the theory of fuzzy sets. Experts are invited to classify each event according to one of the categories of potential damage and the effectiveness of barriers parry (defenses using all available information. Processing of results is conducted using the method of expert analysis of fuzzy data based on the approach of fuzzy set theory. The seriousness (damage of the occurrence and effectiveness of the barriers considered as linguistic variables, each of which has four term sets. This approach allows taking into account the opinions of experts and obtaining valid estimates of risk do not necessarily coincided with fixed values of matrix cells.

  9. [THE RISK OF ACUTE RENAL LESIONS AND ITS PROGNOSTIC SIGNIFICANCE IN PATIENTS WITH CHRONIC RENAL DISEASE UNDERGOING CARDIAC SURGICAL INTERVENTION].

    Science.gov (United States)

    Iskenderov, B G; Sisina, O N; Budagovskaia, Z M

    2015-01-01

    to determine the frequency and risk factors of acute renal lesions (ARL) and their prognostic significance in patients with chronic renal disease (CRD) undergoing surgical intervention. The study included 1122 patients (586 men and 536 women) aged 32-68 (mean 62.3 ± 5.2) years who underwent correction of valvular defects, aortocoronary bypass surgery or their combination). Initial glomerular filtration rate was higher than 90 ml/min/l.73 m2 in 656 patients (group 1) and 89-60 ml/min/l/73 m2 in 470 ones (group 2). ARL were diagnosed based on the serum creatinine level using RIFLE criteria. In the early postoperative period, ARL were diagnosed in 23.9% of the patients in group I and 38.7% of those in group 2 (p < 0.001). Intra-hospital lethality in group 1 was 4.9% (14.1% in patients with ARL) and 12.1% in group 2 (18.1% iin patients with ARL). In group 2, 47.9% of the patients with ARL experienced regress of renal dysfunction during 12 months compared with 56.9% ones without ARL. The progress of CRD was documented in 11% of group 2 patients with ARL and in (4.5% without AR (p = 0.013). 5.7% of the patients in group 1 developed CRD after ARL. 4.9% of the patients in group 2 needed programmed hemodialysis. The development of ARL in patients with CRD is associated with unfvouravle cardiovascular prognosis following cardiosurgery.

  10. Improving antenatal risk assessment in women exposed to high risks.

    Science.gov (United States)

    Perry, Natasha; Newman, Louise K; Hunter, Mick; Dunlop, Adrian

    2015-01-01

    Antenatal substance use and related psychosocial risk factors are known to increase the likelihood of child protection involvement; less is known about the predictive nature of maternal reflective functioning (RF) in this population. This preliminary study assessed psychosocial and psychological risk factors for a group of substance dependent women exposed to high risks in pregnancy, and their impact on child protection involvement. Pregnant women on opiate substitution treatment (n = 11) and a comparison group (n = 15) were recruited during their third trimester to complete measures of RF (Pregnancy Interview), childhood trauma, mental health and psychosocial assessments. At postnatal follow-up, RF was reassessed (Parent Development Interview - Revised Short Version) and mother-infant dyads were videotaped to assess emotional availability (EA). Child protection services were contacted to determine if any concerns had been raised for infant safety. Significant between-group differences were observed for demographics, psychosocial factors, trauma and mental health symptoms. Unexpectedly, no significant differences were found for RF or EA between groups. Eight women in the 'exposed to high risks' group became involved with child protection services. Reflective functioning was not significantly associated with psychosocial risk factors, and therefore did not mediate the outcome of child protection involvement. Women 'exposed to high risks' were equally able to generate a model of their own and their infants' mental states and should not be seen within a deficit perspective. Further research is required to better understand the range of risk factors that predict child protection involvement in high risk groups. © The Author(s) 2013.

  11. Is hypoalbuminemia a prognostic risk factor for contrast-induced nephropathy in peritoneal dialysis patients?

    Directory of Open Access Journals (Sweden)

    Hassan K

    2014-10-01

    Full Text Available Kamal Hassan,1,2 Hassan Fadi3 1Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel; 2Peritoneal Dialysis Unit, Galilee Medical Center, Nahariya, Israel; 3Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Objective: Residual renal function (RRF is an important predictor of outcome in peritoneal dialysis (PD patients. Hypoalbuminemia was found to be an independent risk factor for the development of acute kidney injury. We investigated the possibility of an association between serum albumin levels and the development of iodine contrast media-induced nephropathy (CIN in PD patients.Methods: A total of 103 PD patients who underwent invasive angiographies with exposure to iodine contrast media (ICM were reviewed retrospectively. All patients received 0.9% saline intravenously at a rate of 75 mL per hour for 12 hours prior, during, and 12 hours after exposure to ICM. Acetylcysteine was given orally at a dose of 600 mg twice daily, on the day before and on the day of exposure to ICM. The nonionic, low-osmolar contrast agent iopromide was used at a mean dose of 75.0±15.2 mL. The changes in RRF from baseline to 1 week and 4 weeks after exposure to ICM were recorded. Outcomes of patients with serum albumin levels <3.8 g/dL and those with serum albumin levels ≥3.8 g/dL were compared. A reduction >30% in RRF at 7 days after exposure to ICM was considered CIN.Results: CIN developed in 27.2% (28/103 of patients. Of the 103 patients, 59.2% (61 had serum albumin levels <3.8 g/dL. Of those, 37.7% (23/61 developed CIN, compared with 11.9% (5/42 of those with serum albumin levels ≥3.8 g/dL (P=0.004. After adjustment for all tested variables in a logistic regression with a stepwise selection model, serum albumin level at exposure to ICM was found to be the most powerful predictor of the development of CIN (odds ratio =4.5; confidence interval =1.5–13.0; P=0.006.Conclusion: PD patients with serum albumin levels <3.8 g

  12. 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

  13. 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?

  14. Mammaglobin B is an independent prognostic marker in epithelial ovarian cancer and its expression is associated with reduced risk of disease recurrence

    Directory of Open Access Journals (Sweden)

    Bandiera Elisabetta

    2009-07-01

    Full Text Available Abstract Background Traditional prognostic factors in epithelial ovarian cancer (EOC are inadequate in predicting recurrence and long-term prognosis, but genome-wide cancer research has recently provided multiple potentially useful biomarkers. The gene codifying for Mammaglobin B (MGB-2 has been selected from our previous microarray analysis performed on 19 serous papillary epithelial ovarian cancers and its expression has been further investigated on multiple histological subtypes, both at mRNA and protein level. Since, to date, there is no information available on the prognostic significance of MGB-2 expression in cancer, the aim of this study was to determine its prognostic potential on survival in a large cohort of well-characterized EOC patients. Methods MGB-2 expression was evaluated by quantitative real time-PCR in fresh-frozen tissue biopsies and was validated by immunohistochemistry in matched formalin fixed-paraffin embedded tissue samples derived from a total of 106 EOC patients and 27 controls. MGB-2 expression was then associated with the clinicopathologic features of the tumors and was correlated with clinical outcome. Results MGB-2 expression was found significantly elevated in EOC compared to normal ovarian controls, both at mRNA and protein level. A good correlation was detected between MGB-2 expression data obtained by the two different techniques. MGB-2 expressing tumors were significantly associated with several clinicopathologic characteristics defining a less aggressive tumor behavior. Univariate survival analysis revealed a decreased risk for cancer-related death, recurrence and disease progression in MGB-2-expressing patients (p Conclusion This is the first report documenting that MGB-2 expression characterizes less aggressive forms of EOC and is correlated with a favorable outcome. These findings suggest that the determination of MGB-2, especially at molecular level, in EOC tissue obtained after primary surgery can

  15. Assessment of Risk for Recurrent Diverticulitis

    Science.gov (United States)

    Sallinen, Ville; Mali, Juha; Leppäniemi, Ari; Mentula, Panu

    2015-01-01

    Abstract Recurrence of acute diverticulitis is common, and—especially complicated recurrence—causes significant morbidity. To prevent recurrence, selected patients have been offered prophylactic sigmoid resection. However, as there is no tool to predict whose diverticulitis will recur and, in particular, who will have complicated recurrence, the indications for sigmoid resections have been variable. The objective of this study was to identify risk factors predicting recurrence of acute diverticulitis. This is a retrospective cohort study of patients presenting with computed tomography–confirmed acute diverticulitis and treated nonresectionally during 2006 to 2010. Risk factors for recurrence were identified using uni- and multivariate Cox regression. A total of 512 patients were included. History of diverticulitis was an independent risk factor predicting uncomplicated recurrence of diverticulitis (1–2 earlier diverticulitis HR 1.6, 3 or more—HR 3.2). History of diverticulitis (HR 3.3), abscess (HR 6.2), and corticosteroid medication (HR 16.1) were independent risk factors for complicated recurrence. Based on regression coefficients, risk scoring was created: 1 point for history of diverticulitis, 2 points for abscess, and 3 points for corticosteroid medication. The risk score was unable to predict uncomplicated recurrence (AUC 0.48), but was able to predict complicated recurrence (AUC 0.80). Patients were further divided into low-risk (0–2 points) and high-risk (>2 points) groups. Low-risk and high-risk groups had 3% and 43% 5-year complicated recurrence rates, respectively. Risk for complicated recurrence of acute diverticulitis can be assessed using risk scoring. The risk for uncomplicated recurrence increases along with increasing number of previous diverticulitis. PMID:25715253

  16. 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.

  17. Assessing and Mitigating Risks in Computer Systems

    OpenAIRE

    Netland, Lars-Helge

    2008-01-01

    When it comes to non-trivial networked computer systems, bulletproof security is very hard to achieve. Over a system's lifetime new security risks are likely to emerge from e.g. newly discovered classes of vulnerabilities or the arrival of new threat agents. Given the dynamic environment in which computer systems are deployed, continuous evaluations and adjustments are wiser than one-shot e orts for perfection. Security risk management focuses on assessing and treating security...

  18. Guyana Rice Supply Chain Risk Assessment

    OpenAIRE

    World Bank

    2011-01-01

    This report is the outcome of assessment and is intended as an advisory note to the Ministry of Agriculture (MoA) and Guyana Rice Development Board (GRDB) to enable them to identify a strategy and potential public investments to improve current risk-management practices in the rice supply chain. This report identifies the major risks facing the rice supply chain, ranks them in terms of the...

  19. The Risk Assessment at the Workplace of Assembly Operation

    Directory of Open Access Journals (Sweden)

    Marek Burda

    2014-01-01

    Full Text Available Risk Assessment Process by FMEA method involve hazard identification, risk assessment and risk control processes and their input is fundamental to a successful EH&S system. This Risk assessment tool follows the general process and requirements of the Health and Safety Risk Assessment Procedure.

  20. [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.

  1. [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.

  2. Sensitivity analysis in quantitative microbial risk assessment.

    Science.gov (United States)

    Zwieterin, M H; van Gerwen, S J

    2000-07-15

    The occurrence of foodborne disease remains a widespread problem in both the developing and the developed world. A systematic and quantitative evaluation of food safety is important to control the risk of foodborne diseases. World-wide, many initiatives are being taken to develop quantitative risk analysis. However, the quantitative evaluation of food safety in all its aspects is very complex, especially since in many cases specific parameter values are not available. Often many variables have large statistical variability while the quantitative effect of various phenomena is unknown. Therefore, sensitivity analysis can be a useful tool to determine the main risk-determining phenomena, as well as the aspects that mainly determine the inaccuracy in the risk estimate. This paper presents three stages of sensitivity analysis. First, deterministic analysis selects the most relevant determinants for risk. Overlooking of exceptional, but relevant cases is prevented by a second, worst-case analysis. This analysis finds relevant process steps in worst-case situations, and shows the relevance of variations of factors for risk. The third, stochastic analysis, studies the effects of variations of factors for the variability of risk estimates. Care must be taken that the assumptions made as well as the results are clearly communicated. Stochastic risk estimates are, like deterministic ones, just as good (or bad) as the available data, and the stochastic analysis must not be used to mask lack of information. Sensitivity analysis is a valuable tool in quantitative risk assessment by determining critical aspects and effects of variations.

  3. RISK ASSESSMENT FOR THE DYE AND PIGMENT ...

    Science.gov (United States)

    This risk assessment calculates the maximum loadings of constituents found in dyes and pigment industries waste streams which can be disposed in different types of waste management units without causing health benchmarks to be exceeded at plausible receptor locations. The assessment focuses on potential risks from volatilization and leaching to groundwater of constituents disposed in surface impoundments and landfills with either clay liners or composite liners. This product will be used by EPA decision makers to assist in determining whether certain waste streams generated by the dyes and pigments industries should be designated as hazardous.

  4. 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...

  5. Evaluation of the International Prognostic Score (IPS-7) and a Simpler Prognostic Score (IPS-3) for advanced Hodgkin lymphoma in the modern era.

    Science.gov (United States)

    Diefenbach, Catherine S; Li, Hailun; Hong, Fangxin; Gordon, Leo I; Fisher, Richard I; Bartlett, Nancy L; Crump, Michael; Gascoyne, Randy D; Wagner, Henry; Stiff, Patrick J; Cheson, Bruce D; Stewart, Douglas A; Kahl, Brad S; Friedberg, Jonathan W; Blum, Kristie A; Habermann, Thomas M; Tuscano, Joseph M; Hoppe, Richard T; Horning, Sandra J; Advani, Ranjana H

    2015-11-01

    The International Prognostic Score (IPS-7) is the most commonly used risk stratification tool for advanced Hodgkin lymphoma (HL), however recent studies suggest the IPS-7 is less discriminating due to improved outcomes with contemporary therapy. We evaluated the seven variables for IPS-7 recorded at study entry for 854 patients enrolled on Eastern Cooperative Oncology Group 2496 trial. Univariate and multivariate Cox models were used to assess their prognostic ability for freedom from progression (FFP) and overall survival (OS). The IPS-7 remained prognostic however its prognostic range has narrowed. On multivariate analysis, two factors (age, stage) remained significant for FFP and three factors (age, stage, haemoglobin level) for OS. An alternative prognostic index, the IPS-3, was constructed using age, stage and haemoglobin level, which provided four distinct risk groups [FFP (P = 0·0001) and OS (P IPS-3 outperformed the IPS-7 on risk prediction for both FFP and OS by model fit and discrimination criteria. Using reclassification calibration, 18% of IPS-7 low risk patients were re-classified as intermediate risk and 13% of IPS-7 intermediate risk patients as low risk. For patients with advanced HL, the IPS-3 may provide a simpler and more accurate framework for risk assessment in the modern era. Validation of these findings in other large data sets is planned. © 2015 John Wiley & Sons Ltd.

  6. Impact of the International Prognostic Scoring System cytogenetic risk groups on the outcome of patients with primary myelodysplastic syndromes undergoing allogeneic stem cell transplantation from human leukocyte antigen-identical siblings: a retrospective analysis of the European Society for Blood and Marrow Transplantation-Chronic Malignancies Working Party

    NARCIS (Netherlands)

    Onida, F.; Brand, R.; Biezen, A. van; Schaap, M.; Borne, P.A. von dem; Maertens, J.; Beelen, D.W.; Carreras, E.; Alessandrino, E.P.; Volin, L.; Kuball, J.H.; Figuera, A.; Sierra, J.; Finke, J.; Kroger, N.; Witte, T.J. de

    2014-01-01

    Acquired chromosomal abnormalities are important prognostic factors in patients with myelodysplastic syndromes treated with supportive care and with disease-modifying therapeutic interventions, including allogeneic hematopoietic stem cell transplantation. To assess the prognostic impact of

  7. Assessment of factors that increase and reduce the risk of aggressive unlawful behavior among juveniles (a review of foreign literature

    Directory of Open Access Journals (Sweden)

    Nazarova N.G.

    2016-10-01

    Full Text Available The article is devoted to an overview of foreign researches about factors that increase the risk of aggressive unlawful behavior among juveniles and reduce the risk of such behavior. Such definitions as risk factor, protective factor (defensive, aggression and violence were examined. It is shown how the methods of assessment for both social and negative consequences of unlawful behavior, including aggressive one, have been developed, starting from discretionary approach based on unstructured clinical statement and ending with a method of structured risk assessment. The article contains the descriptions of researches about prognostic structured risk assessment of aggressive criminal behavior among adolescents. The results of contemporary foreign researches that were aimed at identifying factors that either increase or reduce the risk of aggressive unlawful behavior in childhood and adolescence, were outlined.

  8. Risk estimation of distant metastasis in node-negative, estrogen receptor-positive breast cancer patients using an RT-PCR based prognostic expression signature

    Science.gov (United States)

    Tutt, Andrew; Wang, Alice; Rowland, Charles; Gillett, Cheryl; Lau, Kit; Chew, Karen; Dai, Hongyue; Kwok, Shirley; Ryder, Kenneth; Shu, Henry; Springall, Robert; Cane, Paul; McCallie, Blair; Kam-Morgan, Lauren; Anderson, Steve; Buerger, Horst; Gray, Joe; Bennington, James; Esserman, Laura; Hastie, Trevor; Broder, Samuel; Sninsky, John; Brandt, Burkhard; Waldman, Fred

    2008-01-01

    Background Given the large number of genes purported to be prognostic for breast cancer, it would be optimal if the genes identified are not confounded by the continuously changing systemic therapies. The aim of this study was to discover and validate a breast cancer prognostic expression signature for distant metastasis in untreated, early stage, lymph node-negative (N-) estrogen receptor-positive (ER+) patients with extensive follow-up times. Methods 197 genes previously associated with metastasis and ER status were profiled from 142 untreated breast cancer subjects. A "metastasis score" (MS) representing fourteen differentially expressed genes was developed and evaluated for its association with distant-metastasis-free survival (DMFS). Categorical risk classification was established from the continuous MS and further evaluated on an independent set of 279 untreated subjects. A third set of 45 subjects was tested to determine the prognostic performance of the MS in tamoxifen-treated women. Results A 14-gene signature was found to be significantly associated (p < 0.05) with distant metastasis in a training set and subsequently in an independent validation set. In the validation set, the hazard ratios (HR) of the high risk compared to low risk groups were 4.02 (95% CI 1.91–8.44) for the endpoint of DMFS and 1.97 (95% CI 1.28 to 3.04) for overall survival after adjustment for age, tumor size and grade. The low and high MS risk groups had 10-year estimates (95% CI) of 96% (90–99%) and 72% (64–78%) respectively, for DMFS and 91% (84–95%) and 68% (61–75%), respectively for overall survival. Performance characteristics of the signature in the two sets were similar. Ki-67 labeling index (LI) was predictive for recurrent disease in the training set, but lost significance after adjustment for the expression signature. In a study of tamoxifen-treated patients, the HR for DMFS in high compared to low risk groups was 3.61 (95% CI 0.86–15.14). Conclusion The 14

  9. 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

  10. Prognostic Usefulness of Cardiac Stress Test Modalities in Patients With Type 2 Diabetes Mellitus Who Underwent Myocardial Perfusion Scintigraphy (from the Basel Asymptomatic High-Risk Diabetics' Outcome Trial).

    Science.gov (United States)

    Caobelli, Federico; Haaf, Philip; Chronis, Joannis; Haenny, Gianluca; Brinkert, Miriam; Pfisterer, Matthias E; Zellweger, Michael J

    2017-10-01

    Our study aimed to assess predictors of the stress test technique used and to evaluate the impact of exercise level achieved on risk stratification in patients with asymptomatic type 2 diabetes without a previous coronary artery disease. Little is known whether co-morbidities of these patients predict the stress technique and whether physical performance provides risk stratification: 400 patients underwent clinical evaluation and myocardial perfusion scintigraphy (MPS) using physical or pharmacological stress. Physical patients were divided into 2 groups: achieving 30 kg/m2 (hazard ratio 1.076, 95% confidence interval 1.027 to 1.127, p = 0.002) and a peripheral arterial disease (hazard ratio 2.888, 95% confidence interval 1.446 to 5.769, p = 0.003). Pharmacological patients had more MACE than physical patients (3.2% vs 1.0%, p = 0.03). Patients achieving <6 METs had a similar MACE rate as pharmacological patients (3.0% vs 3.2%, p = not significant) and more MACE than patients achieving ≥6 METs (3.0% vs 0.4%, p = 0.01). In patients achieving <6 METs and in pharmacological patients, MPS added an incremental prognostic value to pretest information (p values for global chi-square 0.012 and 0.04, respectively). In high-risk asymptomatic diabetic patients, co-morbidities were predictive of the stress technique used. Pharmacological patients had more MACE, similar to those unable to achieve 6 METs. MPS provided an incremental prognostic value in pharmacological patients and in patients with <6METs. In contrast, patients who were able to achieve ≥6 METs were at low risk and do not need further risk stratification. Copyright © 2017 Elsevier Inc. All rights reserved.

  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. 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.

  13. 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

  14. Heuristics structure and pervade formal risk assessment.

    Science.gov (United States)

    MacGillivray, Brian H

    2014-04-01

    Lay perceptions of risk appear rooted more in heuristics than in reason. A major concern of the risk regulation literature is that such "error-strewn" perceptions may be replicated in policy, as governments respond to the (mis)fears of the citizenry. This has led many to advocate a relatively technocratic approach to regulating risk, characterized by high reliance on formal risk and cost-benefit analysis. However, through two studies of chemicals regulation, we show that the formal assessment of risk is pervaded by its own set of heuristics. These include rules to categorize potential threats, define what constitutes valid data, guide causal inference, and to select and apply formal models. Some of these heuristics lay claim to theoretical or empirical justifications, others are more back-of-the-envelope calculations, while still more purport not to reflect some truth but simply to constrain discretion or perform a desk-clearing function. These heuristics can be understood as a way of authenticating or formalizing risk assessment as a scientific practice, representing a series of rules for bounding problems, collecting data, and interpreting evidence (a methodology). Heuristics are indispensable elements of induction. And so they are not problematic per se, but they can become so when treated as laws rather than as contingent and provisional rules. Pitfalls include the potential for systematic error, masking uncertainties, strategic manipulation, and entrenchment. Our central claim is that by studying the rules of risk assessment qua rules, we develop a novel representation of the methods, conventions, and biases of the prior art. © 2013 Society for Risk Analysis.

  15. Cyclin D1, p16(INK) (4A) and p27(Kip1) in pancreatic adenocarcinoma: assessing prognostic implications through quantitative image analysis.

    Science.gov (United States)

    Georgiadou, Despoina; Sergentanis, Theodoros N; Sakellariou, Stratigoula; Filippakis, George M; Zagouri, Flora; Vlachodimitropoulos, Dimitris; Psaltopoulou, Theodora; Lazaris, Andreas C; Patsouris, Efstratios; Zografos, George C

    2014-12-01

    The prognostic significance of cyclin D1, p16(INK) (4A) and p27(Kip1) expression has been documented in several human malignancies; however, their prognostic potential in pancreatic adenocarcinoma is still unclear. This study aimed to assess the correlation of the aforementioned molecules with clinicopathological parameters and prognosis. Sixty patients with pancreatic ductal adenocarcinoma underwent surgical resection at a single institution; immunohistochemical staining of the studied markers was quantified by Ιmage analysis system. Cyclin D1 overexpression was positively associated with grade, neural infiltration and vascular invasion, whereas p27 positively correlated with age. Higher cyclin D1 expression indicated poorer survival (adjusted HR = 9.75, 95%CI: 1.48-64.31, p = 0.018, increment: one unit in H-score), whereas a marginal trend toward an association between p16 positivity and improved survival was observed (adjusted HR = 0.58, 95%CI: 0.32-1.05, p = 0.072 regarding positive vs negative cases). No significant association with overall survival was noted regarding p27. In conclusion, cyclin D1 overexpression and possibly p16 loss of expression in pancreatic adenocarcinoma seem to be adverse prognostic factors, whereas p27 expression did not seem to possess such prognostic properties. Further validation of the present findings in studies encompassing larger samples seems to be needed. © 2014 APMIS. Published by John Wiley & Sons Ltd.

  16. Assessing the utility of a prognostication model to predict 1-year mortality in patients receiving radiation therapy for spinal metastases.

    Science.gov (United States)

    Shi, Diana D; Chen, Yu-Hui; Lam, Tai Chung; Leonard, Dana; Balboni, Tracy Anne; Schoenfeld, Andrew; Skamene, Sonia; Cagney, Daniel N; Chi, John H; Cho, Charles H; Harris, Mitchel; Ferrone, Marco L; Hertan, Lauren M

    2017-10-12

    Predicting survival outcomes after radiation therapy alone for metastatic disease of the spine is a challenging task that is important to guiding treatment decisions (e.g., determining dose fractionation and intensity). The New England Spinal Metastasis Score (NESMS) was recently introduced and validated in independent cohorts as a tool to predict 1-year survival following surgery for spinal metastases. This metric is composed of 3 factors: pre-operative albumin, ambulatory status, and modified Bauer score, with the total score ranging from 0 to 3. The purpose of this study is to assess the applicability of the NESMS model to predict 1-year survival among patients treated with radiation therapy alone for spinal metastases. This study is a retrospective analysis. This sample included 290 patients who underwent conventional radiation therapy alone for spinal metastases. Patients' NESMS scores (comprised of ambulatory status, pre-treatment serum albumin, and modified Bauer score) were assessed as well as their 1-year overall survival rates following radiation for metastatic disease of the spine. This study is a single-institution retrospective analysis of 290 patients treated with conventional radiation alone for spinal metastases from 2008 to 2013. The predictive value of the NESMS was assessed using multivariable logistic regression modeling, adjusted for potential confounding variables. This analysis indicated that patients with lower NESMS scores had higher rates of 1-year mortality. Multivariable analysis demonstrated a strong association between lower NESMS scores and lower rates of survival. The NESMS score is a simple prognostic scheme that requires clinical data that is often readily available and has been validated in independent cohorts of surgical patients. This study serves to validate the utility of the NESMS composite score to predict 1-year mortality in patients treated with radiation alone for spinal metastases. Copyright © 2017 Elsevier Inc. All

  17. 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.

  18. 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.

  19. 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.

  20. Building caries risk assessment models for children.

    Science.gov (United States)

    Gao, X-L; Hsu, C-Y S; Xu, Y; Hwarng, H B; Loh, T; Koh, D

    2010-06-01

    Despite the well-recognized importance of caries risk assessment, practical models remain to be established. This study was designed to develop biopsychosocial models for caries risk assessment in various settings. With a questionnaire, an oral examination, and biological (salivary, microbiological, and plaque pH) tests, a prospective study was conducted among 1782 children aged 3-6 years, with 1576 (88.4%) participants followed in 12 months. Multiple risk factors, indicators, and protective factors were identified. Various risk assessment models were constructed by the random selection of 50% of the cases and further validated in the remaining cases. For the prediction of a "one-year caries increment", screening models without biological tests achieved a sensitivity/specificity of 82%/73%; with biological tests, full-blown models achieved the sensitivity/specificity of 90%/90%. For identification of a quarter of the children with high caries burden (baseline dmft > 2), a community-screening model requiring only a questionnaire reached a sensitivity/specificity of 82%/81%. These models are promising tools for cost-effective caries control and evidence-based treatment planning. decayed, missing, filled teeth in primary dentition (dmft); receiver operation characteristics (ROC); relative risk (RR); confidence interval (CI); National Institutes of Health (NIH); World Health Organization (WHO); US Department of Health and Human Services (US/DHHS); American Academy of Pediatric Dentistry (AAPD).

  1. Identification of a 24-gene prognostic signature that improves the European LeukemiaNet risk classification of acute myeloid leukemia: an international collaborative study.

    Science.gov (United States)

    Li, Zejuan; Herold, Tobias; He, Chunjiang; Valk, Peter J M; Chen, Ping; Jurinovic, Vindi; Mansmann, Ulrich; Radmacher, Michael D; Maharry, Kati S; Sun, Miao; Yang, Xinan; Huang, Hao; Jiang, Xi; Sauerland, Maria-Cristina; Büchner, Thomas; Hiddemann, Wolfgang; Elkahloun, Abdel; Neilly, Mary Beth; Zhang, Yanming; Larson, Richard A; Le Beau, Michelle M; Caligiuri, Michael A; Döhner, Konstanze; Bullinger, Lars; Liu, Paul P; Delwel, Ruud; Marcucci, Guido; Lowenberg, Bob; Bloomfield, Clara D; Rowley, Janet D; Bohlander, Stefan K; Chen, Jianjun

    2013-03-20

    To identify a robust prognostic gene expression signature as an independent predictor of survival of patients with acute myeloid leukemia (AML) and use it to improve established risk classification. Four independent sets totaling 499 patients with AML carrying various cytogenetic and molecular abnormalities were used as training sets. Two independent patient sets composed of 825 patients were used as validation sets. Notably, patients from different sets were treated with different protocols, and their gene expression profiles were derived using different microarray platforms. Cox regression and Kaplan-Meier methods were used for survival analyses. A prognostic signature composed of 24 genes was derived from a meta-analysis of Cox regression values of each gene across the four training sets. In multivariable models, a higher sum value of the 24-gene signature was an independent predictor of shorter overall (OS) and event-free survival (EFS) in both training and validation sets (P classification of AML, and patients in three new risk groups classified by the integrated risk classification showed significantly (P classification incorporating this gene signature provides a better framework for risk stratification and outcome prediction than the ELN classification.

  2. [Mortality in patients with potentially severe trauma in a tertiary care hospital emergency department and evaluation of risk prediction with the GAP prognostic scale].

    Science.gov (United States)

    Martín Quirós, Alejandro; Borobia Pérez, Alberto; Pertejo Fernández, Ana; Pérez Perilla, Patricia; Rivera Núñez, Angélica; Martínez Virto, Ana María; Quintana Díaz, Manuel

    2015-01-01

    To assess mortality in patients with potentially severe injuries and explore the correlation between mortality and the score on the GAP scale (Glasgow Coma Scale, age, and systolic blood pressure). Retrospective observational study of all patients with potentially severe injuries treated in an emergency department (ED) over a period of 15 months. We recorded epidemiologic variables, cause of injury, type of transport, need for prehospital orotracheal intubation, substance abuse, Charlson Comorbidity Index (CCI), variables for the GAP prognostic score, destination on discharge from the ED and at the end of the episode, and mortality. Data for 864 patients entered the final analysis. Mortality was higher in older patients (mean [SD] age, 57.9 [26.6] vs 41.1 [17.4], P<.05) and those with a higher mean CCI (3.3 [2.9] vs 0.9 [1.7]). Accident type was a precipitating factor associated with mortality (P<.001), but substance abuse was unrelated. Patients who died had lower mean Glasgow scores (9.1 [5.3] vs 14.8 [1.2], P<.001) and lower mean systolic and diastolic pressures (respectively, 113.8 [19.8] vs 131.3 [20.7] mm Hg, P=.012, and 60.1 [16.8] vs 77.7 [11.7] mm Hg, P=.002). Patients who died also had lower mean GAP scores than survivors (15.1 [4.8] vs 22.6 [1.7], P<.001). Risk factors that remained significant in the multivariate analysis were CCI (odds ratio [OR], 0.704; 95% CI, 0.52-0.96) and GAP score (OR, 1.8; 95% CI, 1.45-2.20). Mortality in our patient series was lower than rates in previously published reports. The GAP score was a useful tool for predicting mortality in the series we studied.

  3. The prognostic role of carotid plaque ultrasonography in cardiac damage after carotid endarterectomy: carotid plaque and cardiac risk.

    Science.gov (United States)

    Galyfos, George; Toutouzas, Konstantinos P; Benetos, George; Konstadoulakis, Manousos; Theodorou, Dimitrios; Katsaragakis, Stilianos; Stefanadis, Christodoulos; Zografos, Georgios; Filis, Konstantinos

    2016-10-01

    This study evaluates the correlation of ultrasound determined carotid plaque morphology with coronary risk and cardiac damage after carotid endarterectomy. Fifty patients (in a series of 162) scheduled for carotid endarterectomy had the indication for coronary CT-angiography preoperatively and were included in this study. Patients were classified according to ultrasonographic characteristics of carotid plaque. The Duke Criteria were used to assess the degree of coronary risk (low, medium and high risk). Cardiac damage after carotid endarterectomy was evaluated based on symptoms, cardiac Troponin I measurement and electrocardiographic findings. There were no deaths, strokes or symptomatic myocardial infarctions postoperatively (30-day results). Ten patients (20%) showed asymptomatic cardiac damage postoperatively. Cardiac damage after surgery did not show any difference between the three cardiac risk groups. Echogenic and specifically Type IV carotid artery plaques (Gray-Weale Criteria) were associated with high cardiac risk preoperatively and with postoperative cardiac damage. The degree of carotid artery stenosis, and echolucent carotid plaques were not associated with postoperative cardiac damage. Asymptomatic postoperative cardiac damage occurs often after carotid endarterectomy and presents independently from coronary risk. Carotid plaques of higher echogenicity are associated with severity of coronary artery disease and cardiac damage after carotid endarterectomy.

  4. Jet reliability study Survey and Risk Assessment

    Energy Technology Data Exchange (ETDEWEB)

    Esteban, G.

    2015-07-01

    Culham Center for Fusion Energy (CCFE) in UK has been contracted to undertake a second Deuterium-Tritium Experiment (DTE2) using Join European Torus (JET) in 2017, in support of technical developments for the ITER project. In order to manage risks of delay or early project termination CCFE has adopted a risk based inspection (RBI) process to identify the systems which could influence the successful delivery of DTE2 and in turn to identify by a basic risk assessment process those systems or components which require mitigating action in order to minimize risk. In this context, the primary purpose of the RBI is to address issues of reliability and satisfactory functionality in a similar way to that which a power plant operator would take to address its commercial risks in the event of loss of generating capacity. The objective of this presentation is describe the activities developed for Idom to deliver the survey, interviews and risk assessment of different systems of JET with the aim to identify the critical components and system that could affect the operation of JET during the DTE2 experiment. (Author)

  5. 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

  6. Information Technology Sector Baseline Risk Assessment

    Science.gov (United States)

    2009-08-01

    Technology Sector Baseline Risk Assessment extended periods could result in communications disruptions or congestion , if...function. Concern Threats to BGP and other interdomain router operating systems and intra-domain protocols are the primary vulnerabilities within the...facilities [C] Negatively affect ASN/IP block allocation [C] Impair Crisis response [C] Interdomain /Backbone connectivity impact [V] BGP [V

  7. Risk assessment of genetically modified organisms (GMOs)

    African Journals Online (AJOL)

    Jane

    2011-09-30

    Sep 30, 2011 ... Key words: Risk assessment, biosafety, Malaysian Biosafety Act 2007, genetically modified organisms. (GMOs). INTRODUCTION. Nowadays, with ... from the early stages of genetic engineering, legal frameworks were set up to ensure the ..... Since the advances in gene technology have led to speculation ...

  8. Next generation of microbiological risk assessment

    NARCIS (Netherlands)

    Besten, den Heidy M.W.; Amézquita, Alejandro; Bover-Cid, Sara; Dagnas, Stéphane; Ellouze, Mariem; Guillou, Sandrine; Nychas, George; O'Mahony, Cian; Pérez-Rodriguez, Fernando; Membré, Jeanne Marie

    2017-01-01

    In food safety and public health risk evaluations, microbiological exposure assessment plays a central role as it provides an estimation of both the likelihood and the level of the microbial hazard in a specified consumer portion of food and takes microbial behaviour into account. While until now

  9. QUANTITATIVE RISK ASSESSMENT FOR MICROBIAL AGENTS

    Science.gov (United States)

    Compared to chemical risk assessment, the process for microbial agents and infectious disease is more complex because of host factors and the variety of settings in which disease transmission can occur. While the National Academy of Science has established a paradigm for performi...

  10. Instrument Development for Nanomaterial Risk Assessment

    NARCIS (Netherlands)

    Brossell, D.

    2016-01-01

    Nanomaterials are a growing source for innovation. However, the very properties that make them so effective for their desired purpose might also render them more hazardous towards humans and the environment. Adequate risk assessment tools are often missing, partly due to instrumental gaps in

  11. Ecological Risk Assessment in Water Resource Management ...

    African Journals Online (AJOL)

    The US EPA published guidelines for the application of ecological risk assessment (ERA) in the USA in 1998 (US EPA 1998). The process diagram derived by Murray and Claassen (1999) in an evaluation of the US EPA framework is discussed in the context of the South African National Water Act. The evaluation discusses ...

  12. 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

  13. exLOPA for explosion risks assessment.

    Science.gov (United States)

    Markowski, Adam S

    2007-04-11

    The European Union regulations require safety and health protection of workers who are potentially at risk from explosive atmosphere areas. According to the requirements, the operators of installations where potentially explosive atmosphere can occur are obliged to produce an explosion protection document. The key objective of this document is the assessment of explosion risks. This paper is concerned with the so-called explosion layer of protection analysis (exLOPA), which allows for semi-quantitative explosion risk assessment for process plants where explosive atmospheres occur. The exLOPA is based on the original work of CCPS for LOPA but takes into account some typical factors appropriate for explosion, like the probability that an explosive atmosphere will occur, probability that sources of ignition will be present and become effective as well as the probability of failure on demand for appropriate explosion prevention and mitigation means.

  14. Risk assessment of integrated electronic health records.

    Science.gov (United States)

    Bjornsson, Bjarni Thor; Sigurdardottir, Gudlaug; Stefansson, Stefan Orri

    2010-01-01

    The paper describes the security concerns related to Electronic Health Records (EHR) both in registration of data and integration of systems. A description of the current state of EHR systems in Iceland is provided, along with the Ministry of Health's future vision and plans. New legislation provides the opportunity for increased integration of EHRs and further collaboration between institutions. Integration of systems, along with greater availability and access to EHR data, requires increased security awareness since additional risks are introduced. The paper describes the core principles of information security as it applies to EHR systems and data. The concepts of confidentiality, integrity, availability, accountability and traceability are introduced and described. The paper discusses the legal requirements and importance of performing risk assessment for EHR data. Risk assessment methodology according to the ISO/IEC 27001 information security standard is described with examples on how it is applied to EHR systems.

  15. Transparent Global Seismic Hazard and Risk Assessment

    Science.gov (United States)

    Smolka, Anselm; Schneider, John; Pinho, Rui; Crowley, Helen

    2013-04-01

    Vulnerability to earthquakes is increasing, yet advanced reliable risk assessment tools and data are inaccessible to most, despite being a critical basis for managing risk. Also, there are few, if any, global standards that allow us to compare risk between various locations. The Global Earthquake Model (GEM) is a unique collaborative effort that aims to provide organizations and individuals with tools and resources for transparent assessment of earthquake risk anywhere in the world. By pooling data, knowledge and people, GEM acts as an international forum for collaboration and exchange, and leverages the knowledge of leading experts for the benefit of society. Sharing of data and risk information, best practices, and approaches across the globe is key to assessing risk more effectively. Through global projects, open-source IT development and collaborations with more than 10 regions, leading experts are collaboratively developing unique global datasets, best practice, open tools and models for seismic hazard and risk assessment. Guided by the needs and experiences of governments, companies and citizens at large, they work in continuous interaction with the wider community. A continuously expanding public-private partnership constitutes the GEM Foundation, which drives the collaborative GEM effort. An integrated and holistic approach to risk is key to GEM's risk assessment platform, OpenQuake, that integrates all above-mentioned contributions and will become available towards the end of 2014. Stakeholders worldwide will be able to calculate, visualise and investigate earthquake risk, capture new data and to share their findings for joint learning. Homogenized information on hazard can be combined with data on exposure (buildings, population) and data on their vulnerability, for loss assessment around the globe. Furthermore, for a true integrated view of seismic risk, users can add social vulnerability and resilience indices to maps and estimate the costs and benefits

  16. Environmental Risk Assessment Strategy for Nanomaterials

    Directory of Open Access Journals (Sweden)

    Janeck J. Scott‐Fordsmand

    2017-10-01

    Full Text Available An Environmental Risk Assessment (ERA for nanomaterials (NMs is outlined in this paper. Contrary to other recent papers on the subject, the main data requirements, models and advancement within each of the four risk assessment domains are described, i.e., in the: (i materials, (ii release, fate and exposure, (iii hazard and (iv risk characterisation domains. The material, which is obviously the foundation for any risk assessment, should be described according to the legislatively required characterisation data. Characterisation data will also be used at various levels within the ERA, e.g., exposure modelling. The release, fate and exposure data and models cover the input for environmental distribution models in order to identify the potential (PES and relevant exposure scenarios (RES and, subsequently, the possible release routes, both with regard to which compartment(s NMs are distributed in line with the factors determining the fate within environmental compartment. The initial outcome in the risk characterisation will be a generic Predicted Environmental Concentration (PEC, but a refined PEC can be obtained by applying specific exposure models for relevant media. The hazard information covers a variety of representative, relevant and reliable organisms and/or functions, relevant for the RES and enabling a hazard characterisation. The initial outcome will be hazard characterisation in test systems allowing estimating a Predicted No-Effect concentration (PNEC, either based on uncertainty factors or on a NM adapted version of the Species Sensitivity Distributions approach. The risk characterisation will either be based on a deterministic risk ratio approach (i.e., PEC/PNEC or an overlay of probability distributions, i.e., exposure and hazard distributions, using the nano relevant models.

  17. Environmental Risk Assessment Strategy for Nanomaterials

    Science.gov (United States)

    Scott-Fordsmand, Janeck J.; Nowack, Bernd; Hunt, Neil; Hristozov, Danail; Marcomini, Antonio; Irfan, Muhammad-Adeel; Jiménez, Araceli Sánchez; Landsiedel, Robert; Tran, Lang; Oomen, Agnes G.; Bos, Peter M. J.

    2017-01-01

    An Environmental Risk Assessment (ERA) for nanomaterials (NMs) is outlined in this paper. Contrary to other recent papers on the subject, the main data requirements, models and advancement within each of the four risk assessment domains are described, i.e., in the: (i) materials, (ii) release, fate and exposure, (iii) hazard and (iv) risk characterisation domains. The material, which is obviously the foundation for any risk assessment, should be described according to the legislatively required characterisation data. Characterisation data will also be used at various levels within the ERA, e.g., exposure modelling. The release, fate and exposure data and models cover the input for environmental distribution models in order to identify the potential (PES) and relevant exposure scenarios (RES) and, subsequently, the possible release routes, both with regard to which compartment(s) NMs are distributed in line with the factors determining the fate within environmental compartment. The initial outcome in the risk characterisation will be a generic Predicted Environmental Concentration (PEC), but a refined PEC can be obtained by applying specific exposure models for relevant media. The hazard information covers a variety of representative, relevant and reliable organisms and/or functions, relevant for the RES and enabling a hazard characterisation. The initial outcome will be hazard characterisation in test systems allowing estimating a Predicted No-Effect concentration (PNEC), either based on uncertainty factors or on a NM adapted version of the Species Sensitivity Distributions approach. The risk characterisation will either be based on a deterministic risk ratio approach (i.e., PEC/PNEC) or an overlay of probability distributions, i.e., exposure and hazard distributions, using the nano relevant models. PMID:29048395

  18. 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)

  19. Prospective trial to evaluate the prognostic value of different nutritional assessment scores in pancreatic surgery (NURIMAS Pancreas).

    Science.gov (United States)

    Probst, P; Haller, S; Bruckner, T; Ulrich, A; Strobel, O; Hackert, T; Diener, M K; Büchler, M W; Knebel, P

    2017-07-01

    Preoperative nutritional status has an impact on patients' clinical outcome. For pancreatic surgery, however, it is unclear which nutritional assessment scores adequately assess malnutrition associated with postoperative outcome. Patients scheduled for elective pancreatic surgery at the University of Heidelberg were screened for eligibility. Twelve nutritional assessment scores were calculated before operation, and patients were categorized as either at risk or not at risk for malnutrition by each score. The postoperative course was monitored prospectively by assessors blinded to the nutritional status. The primary endpoint was major complications evaluated for each score in a multivariable analysis corrected for known risk factors in pancreatic surgery. Overall, 279 patients were analysed. A major complication occurred in 61 patients (21·9 per cent). The proportion of malnourished patients differed greatly among the scores, from 1·1 per cent (Nutritional Risk Index) to 79·6 per cent (Nutritional Risk Classification). In the multivariable analysis, only raised amylase level in drainage fluid on postoperative day 1 (odds ratio (OR) 4·91, 95 per cent c.i. 1·10 to 21·84; P = 0·037) and age (OR 1·05, 1·02 to 1·09; P = 0·005) were significantly associated with major complications; none of the scores was associated with, or predicted, postoperative complications. None of the nutritional assessment scores defined malnutrition relevant to complications after pancreatic surgery and these scores may thus be abandoned. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  20. Integrated ecological risk assessment of dioxin compounds.

    Science.gov (United States)

    Sany, Seyedeh Belin Tavakoly; Hashim, Rosli; Rezayi, Majid; Rahman, Mohammad Azizur; Razavizadeh, Bi Bi Marzieh; Abouzari-lotf, Ebrahim; Karlen, David J

    2015-08-01

    Current ecological risk assessment (ERA) schemes focus mainly on bioaccumulation and toxicity of pollutants in individual organisms. Ecological models are tools mainly used to assess ecological risks of pollutants to ecosystems, communities, and populations. Their main advantage is the relatively direct integration of the species sensitivity to organic pollutants, the fate and mechanism of action in the environment of toxicants, and life-history features of the individual organism of concern. To promote scientific consensus on ERA schemes, this review is intended to provide a guideline on short-term ERA involving dioxin chemicals and to identify key findings for exposure assessment based on policies of different agencies. It also presents possible adverse effects of dioxins on ecosystems, toxicity equivalence methodology, environmental fate and transport modeling, and development of stressor-response profiles for dioxin-like chemicals.

  1. 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

  2. Prognostic assessment of elderly patients with symptoms of heart failure by combining high-sensitivity troponin T and N-terminal pro-B-type natriuretic peptide measurements

    DEFF Research Database (Denmark)

    Alehagen, Urban; Dahlström, Ulf; Rehfeld, Jens F.

    2010-01-01

    N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a useful biomarker in heart failure assessment, whereas measurement of cardiac troponin is central in the diagnosis of patients with acute coronary syndromes. This report examined the prognostic use of combining high-sensitivity cardiac...... troponin T (hs-cTnT) and NT-proBNP measurements in elderly patients presenting to a primary care center with symptoms associated with heart failure....

  3. Asteroid Risk Assessment: A Probabilistic Approach.

    Science.gov (United States)

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

    2016-02-01

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

  4. Silent Aircraft Initiative Concept Risk Assessment

    Science.gov (United States)

    Nickol, Craig L.

    2008-01-01

    A risk assessment of the Silent Aircraft Initiative's SAX-40 concept design for extremely low noise has been performed. A NASA team developed a list of 27 risk items, and evaluated the level of risk for each item in terms of the likelihood that the risk would occur and the consequences of the occurrence. The following risk items were identified as high risk, meaning that the combination of likelihood and consequence put them into the top one-fourth of the risk matrix: structures and weight prediction; boundary-layer ingestion (BLI) and inlet design; variable-area exhaust and thrust vectoring; displaced-threshold and continuous descent approach (CDA) operational concepts; cost; human factors; and overall noise performance. Several advanced-technology baseline concepts were created to serve as a basis for comparison to the SAX-40 concept. These comparisons indicate that the SAX-40 would have significantly greater research, development, test, and engineering (RDT&E) and production costs than a conventional aircraft with similar technology levels. Therefore, the cost of obtaining the extremely low noise capability that has been estimated for the SAX-40 is significant. The SAX-40 concept design proved successful in focusing attention toward low noise technologies and in raising public awareness of the issue.

  5. Expert judgement models in quantitative risk assessment

    Energy Technology Data Exchange (ETDEWEB)

    Rosqvist, T. [VTT Automation, Helsinki (Finland); Tuominen, R. [VTT Automation, Tampere (Finland)

    1999-12-01

    Expert judgement is a valuable source of information in risk management. Especially, risk-based decision making relies significantly on quantitative risk assessment, which requires numerical data describing the initiator event frequencies and conditional probabilities in the risk model. This data is seldom found in databases and has to be elicited from qualified experts. In this report, we discuss some modelling approaches to expert judgement in risk modelling. A classical and a Bayesian expert model is presented and applied to real case expert judgement data. The cornerstone in the models is the log-normal distribution, which is argued to be a satisfactory choice for modelling degree-of-belief type probability distributions with respect to the unknown parameters in a risk model. Expert judgements are qualified according to bias, dispersion, and dependency, which are treated differently in the classical and Bayesian approaches. The differences are pointed out and related to the application task. Differences in the results obtained from the different approaches, as applied to real case expert judgement data, are discussed. Also, the role of a degree-of-belief type probability in risk decision making is discussed.

  6. Additional predictive value of nutritional status in the prognostic assessment of heart failure patients.

    Science.gov (United States)

    La Rovere, M T; Maestri, R; Olmetti, F; Paganini, V; Riccardi, G; Riccardi, R; Pinna, G D; Traversi, E

    2017-03-01

    Nutritional status (NS) is not routinely assessed in HF. We sought to evaluate whether NS may be additive to a comprehensive pre-discharge evaluation based on a clinical score that includes BMI (MAGGIC) and on an index of functional capacity (six minute walking test, 6mWT) in HF patients. The CONUT (Controlling Nutritional Status) score (including serum albumin level, total cholesterol and lymphocyte count) was computed in 466 consecutive patients (mean age 61 ± 11 years, NYHA class 2.6 ± 0.6, LVEF 34 ± 11%, BMI 27.2 ± 4.5) who had pre-discharge MAGGIC and 6MWT. The endpoint was all-cause mortality. Mild or moderate undernourishment was present in 54% of patients with no differences across BMI strata. The 12-month event rate was 7.7%. Deceased patients had a more compromised NS (CONUT 2.8 ± 1.5 vs 1.7 ± 1.3, p assessment of NS, significantly improves prediction of 12-month mortality on top of the information provided by clinical evaluation and functional capacity and should be incorporated in the overall assessment of HF patients. Copyright © 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

  7. Comet assay: a prognostic tool for DNA integrity assessment in infertile men opting for assisted reproduction.

    Science.gov (United States)

    Shamsi, M B; Venkatesh, S; Tanwar, M; Singh, G; Mukherjee, S; Malhotra, N; Kumar, R; Gupta, N P; Mittal, S; Dada, R

    2010-05-01

    The growing concern on transmission of genetic diseases in assisted reproduction technique (ART) and the lacunae in the conventional semen analysis to accurately predict the semen quality has led to the need for new techniques to identify the best quality sperm that can be used in assisted procreation techniques. This study analyzes the sperm parameters in the context of DNA damage in cytogenetically normal, AZF non deleted infertile men for DNA damage by comet assay. Seventy infertile men and 40 fertile controls were evaluated for the semen quality by conventional semen parameters and the sperms were also analyzed for DNA integrity by comet assay. The patients were classified into oligozoospermic (O), asthenozoospermic (A), teratozoospermic (T), oligoasthenoteratozoospermic (OAT) categories and infertile men with normal semen profile. The extent of DNA damage was assessed by visual scoring method of comets. Idiopathic infertile men with normal semen profile (n=18) according to conventional method and patients with history of spontaneous abortions and normal semen profile (n=10) had high degree of DNA damage (29 and 47% respectively) as compared to fertile controls (7%). The O, A, T and OAT categories of patients had a variably higher DNA damage load as compared to fertile controls. The normal range and threshold for DNA damage as a predictor of male fertility potential and technique which could assess the sperm DNA damage are necessary to lower the trauma of couples experiencing recurrent spontaneous abortion or failure in ART.

  8. Factors Affecting Physicians' Intentions to Communicate Personalized Prognostic Information to Cancer Patients at the End of Life: An Experimental Vignette Study.

    Science.gov (United States)

    Han, Paul K J; Dieckmann, Nathan F; Holt, Christina; Gutheil, Caitlin; Peters, Ellen

    2016-08-01

    To explore the effects of personalized prognostic information on physicians' intentions to communicate prognosis to cancer patients at the end of life, and to identify factors that moderate these effects. A factorial experiment was conducted in which 93 family medicine physicians were presented with a hypothetical vignette depicting an end-stage gastric cancer patient seeking prognostic information. Physicians' intentions to communicate prognosis were assessed before and after provision of personalized prognostic information, while emotional distress of the patient and ambiguity (imprecision) of the prognostic estimate were varied between subjects. General linear models were used to test the effects of personalized prognostic information, patient distress, and ambiguity on prognostic communication intentions, and potential moderating effects of 1) perceived patient distress, 2) perceived credibility of prognostic models, 3) physician numeracy (objective and subjective), and 4) physician aversion to risk and ambiguity. Provision of personalized prognostic information increased prognostic communication intentions (P < 0.001, η(2) = 0.38), although experimentally manipulated patient distress and prognostic ambiguity had no effects. Greater change in communication intentions was positively associated with higher perceived credibility of prognostic models (P = 0.007, η(2) = 0.10), higher objective numeracy (P = 0.01, η(2) = 0.09), female sex (P = 0.01, η(2) = 0.08), and lower perceived patient distress (P = 0.02, η(2) = 0.07). Intentions to communicate available personalized prognostic information were positively associated with higher perceived credibility of prognostic models (P = 0.02, η(2) = 0.09), higher subjective numeracy (P = 0.02, η(2) = 0.08), and lower ambiguity aversion (P = 0.06, η(2) = 0.04). Provision of personalized prognostic information increases physicians' prognostic communication intentions to a hypothetical end-stage cancer patient, and

  9. Factors affecting physicians’ intentions to communicate personalized prognostic information to cancer patients at the end of life: An experimental vignette study

    Science.gov (United States)

    Han, Paul K.J.; Dieckmann, Nathan F.; Holt, Christina; Gutheil, Caitlin; Peters, Ellen

    2016-01-01

    Purpose To explore the effects of personalized numeric prognostic information on physicians’ intentions to communicate prognosis to cancer patients at the end of life, and to identify factors that moderate these effects. Methods A factorial experiment was conducted in which 93 Family Medicine physicians were presented with a hypothetical case vignette depicting an end-stage gastric cancer patient seeking prognostic information. Physicians’ intentions to communicate prognosis were assessed before and after provision of personalized prognostic information, while emotional distress of the patient and ambiguity (manifest by imprecision) of the prognostic estimate were varied between subjects. General linear models were used to test the effects of personalized prognostic information, patient distress, and ambiguity on prognostic communication intentions, and explored potential moderating effects of: 1) perceived patient distress, 2) perceived credibility of prognostic models, 3) physician numeracy (objective and subjective), and 4) physician aversion to risk and ambiguity. Results Provision of personalized prognostic information increased prognostic communication intentions (p<.001, η2=.38), although experimentally-manipulated patient distress and prognostic ambiguity had no effects. Greater change in communication intentions was positively associated with higher perceived credibility of prognostic models (p=.007, η2=.10), higher objective numeracy (p=.01, η2=.09), female sex (p=.01, η2=.08), and lower perceived patient distress (p=.02, η2=.07). Intentions to communicate available personalized prognostic information were positively associated with higher perceived credibility of prognostic models (p=.02, η2=.09), higher subjective numeracy (p=.02, η2=.08), and lower ambiguity aversion (p=.06, η2=.04). Conclusions Provision of personalized prognostic information increases physicians’ prognostic communication intentions to a hypothetical end-stage cancer

  10. Chemical Mixtures Health Risk Assessment: Overview of Exposure Assessment, Whole Mixtures Assessments; Basic Concepts

    Science.gov (United States)

    This problems-based, half-day, introductory workshop focuses on methods to assess health risks posed by exposures to chemical mixtures in the environment. Chemical mixtures health risk assessment methods continue to be developed and evolve to address concerns over health risks f...

  11. The prognostic value of expression of HIF1α, EGFR and VEGF-A, in localized prostate cancer for intermediate- and high-risk patients treated with radiation therapy with or without androgen deprivation therapy

    Directory of Open Access Journals (Sweden)

    Weber Damien C

    2012-04-01

    Full Text Available Abstract Purpose Androgens stimulate the production of hypoxia-inducible factor (HIF1α and ultimately vascular endothelial growth factor (VEGF-A. Additionally, epithelial growth factor (EGF mediates HIF1α production. Carbonic anhydrase IX (CAIX expression is associated with tumor cell hypoxia in a variety of malignancies. This study assesses the prognostic relation between HIF1α, VEGF-A, EGF Receptor and CAIX expression by immunochemistry in diagnostic samples of patients with intermediate- and high-risk localized prostate cancer treated with radiation therapy, with or without androgen deprivation therapy (ADT. Materials and methods Between 1994 and 2004, 103 prostate cancer patients (mean age, 68.7 ± 6.2, with prostate cancer (mean PSA, 13.3 ± 3.7, were treated with radiation therapy (RT, median dose, 74 Gy. Fifty seven (55.3% patients received ADT (median duration, 6 months; range, 0 – 24. Median follow-up was 97.6 months (range, 5.9 – 206.8. Results Higher EGFR expression was significantly (p = 0.04 correlated with higher Gleason scores. On univariate analysis, HIF1α nuclear expression was a significant (p = 0.02 prognostic factor for biological progression-free survival (bPFS. A trend towards significance (p = 0.05 was observed with EGFR expression and bPFS. On multivariate analysis, low HIF1α nuclear (p = 0.01 and high EGFR (p = 0.04 expression remained significant adverse prognostic factors. Conclusions Our study suggests that high nuclear expression of HIF1α and low EGFR expression in diagnostic biopsies of prostate cancer patients treated with RT ± ADT is associated with a good prognosis.

  12. 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.

  13. Biostatistics series module 8: Assessing risk

    Directory of Open Access Journals (Sweden)

    Avijit Hazra

    2017-01-01

    Full Text Available In observational studies, as well as in interventional ones, it is frequently necessary to estimate risk that is the association between an observed outcome or event and exposure to one or more factors that may be contributing to the event. Understanding incidence and prevalence are the starting point in any discussion of risk assessment. Incidence rate uses person-time as the denominator rather than a simple count. Ideally, rates and ratios estimated from samples should be presented with their corresponding 95% confidence intervals (CIs. To assess the importance of an individual risk factor, it is necessary to compare the risk of the outcome in the exposed group with that in the nonexposed group. A comparison between risks in different groups can be made by examining either their ratio or the difference between them. The 2 × 2 contingency table comes in handy in the calculation of ratios. Odds ratio (OR is the ratio of the odds of an event in the exposed group, to the odds of the same event in the nonexposed group. It can range from zero to infinity. When the odds of an outcome in the two groups are identical, then the OR equals one. OR >1 indicates exposure increases risk while OR <1 indicates that exposure is protecting against risk. The OR should be presented with its 95% CI to enable more meaningful interpretation – if this interval includes 1, then even a relatively large OR will not carry much weight. The relative risk (RR denotes the ratio of risk (probability of event in exposed group to risk of same event in the nonexposed group. Its interpretation is similar (but not identical to the OR. If the event in question is relatively uncommon, values of OR and RR tend to be similar. Absolute risk reduction (ARR is a measure of the effectiveness of an intervention with respect to a dichotomous event. It is calculated as proportion experiencing the event in control group minus the proportion experiencing the event in treated group. It is

  14. Prognostic factors in multiple myeloma: definition of risk groups in 410 previously untreated patients: a Grupo Argentino de Tratamiento de la Leucemia Aguda study.

    Science.gov (United States)

    Corrado, C; Santarelli, M T; Pavlovsky, S; Pizzolato, M

    1989-12-01

    Four hundred ten previously untreated multiple myeloma patients entered onto two consecutive Grupo Argentino de Tratamiento de la Leucemia Aguda (GATLA) protocols were analyzed to identify significant prognostic factors influencing survival. The univariate analysis selected the following variables: performance status, renal function, percentage of bone marrow plasma cells at diagnosis, hemoglobin, and age. A multivariate analysis showed that performance status, renal function, percentage of bone marrow plasma cells, hemoglobin, and age were the best predictive variables for survival. A score was assigned to each patient according to these variables, which led to their classification in three groups: good, intermediate, and poor risk, with a probability of survival of 26% and 10% at 96 months, and 5% at 56 months, and median survival of 60, 37, and 14 months, respectively (P = .0000). In our patient population, this model proved to be superior to the Durie-Salmon staging system in defining prognostic risk groups, and separating patients with significantly different risks within each Durie-Salmon stage.

  15. Prognostic value of dynamic MRI in assessing post-traumatic femoral head vascularity

    Energy Technology Data Exchange (ETDEWEB)

    Kaushik, Abhishek; Varghese, Mathew [St Stephen' s Hospital, Department of Orthopaedics, Delhi, New Delhi (India); Sankaran, Balu [St Stephen' s Hospital, Delhi, New Delhi (India)

    2009-06-15

    The vascular status of femoral heads in the post-traumatic period of intracapsular femoral neck fracture (ICFNF) remains uncertain until the patient actually develops avascular necrosis (AVN). Several methods for predicting the viability of femoral head have been reported, that are not effective or widely used because of unreliability, potential complications, and technical difficulties. The present study involved the use of Dynamic MRI (DMRI) in assessing femoral head vascularity to predict AVN. The role of DMRI was studied prospectively in 30 patients with 31 ICFNF. Fractures were divided in to three types (Type A, B, or C) based on the femoral head vascularity shown by dynamic curve patterns on MRI evaluation. Type A was preserved vascularity, Type B was some decrease in vascularity but still viable while Type C was significantly reduced vascularity. These were followed-up for 6 months to 2 years to observe the final outcome in terms of union, non-union, or AVN. We found that Type A curves correlate well with vascular status and Type C curves correlate well with poor vascularity of the femoral heads. No AVN was seen in any of Type A (13/31) or Type B (eight out of 31). Five cases showed AVN and all of them were of Type C dynamic curves. Dynamic MRI is a reliable tool to evaluate vascularity of femoral heads and thus reduces the uncertainty of outcome of treatment of ICFNFs. DMRI can be a useful tool to formulate a treatment algorithm in management of ICFNF. (orig.)

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. Risk Assessment for Destructive Re-Entry

    Science.gov (United States)

    Lips, T.; Koppenwallner, G.; Bianchi, L.; Klinkrad, H.

    2009-03-01

    From 2007 to 2008, Hypersonic Technology Göttingen (HTG) worked on a study called Risk Assessment for Destructive Re-entry (RADR). The main purposes of this study were to identify and to quantify the inherent uncertainties of re-entry analysis tools, and to provide possible risk mitigation measures. For these purposes, three basic risk scenarios were specified: a 1-ton-class satellite without propulsion for uncontrolled re-entry, a 6-ton-class satellite with propulsion and the capability to perform a controlled re-entry, and a 1-ton-class launcher upper stage re-entering uncontrolled. Based on the identified uncertainty parameters, variation analyses were conducted for these scenarios with the two ESA tools for re-entry analysis SCARAB (Spacecraft Atmospheric Reentry and Aerothermal Breakup) and SESAM (Spacecraft Entry Survival Analysis Module). This paper describes the major results of the RADR study.

  2. Degraded Environments Alter Prey Risk Assessment

    Science.gov (United States)

    Lönnstedt, Oona M; McCormick, Mark I; Chivers, Douglas P

    2013-01-01

    Elevated water temperatures, a decrease in ocean pH, and an increasing prevalence of severe storms have lead to bleaching and death of the hard corals that underpin coral reef ecosystems. As coral cover declines, fish diversity and abundance declines. How degradation of coral reefs affects behavior of reef inhabitants is unknown. Here, we demonstrate that risk assessment behaviors of prey are severely affected by coral degradation. Juvenile damselfish were exposed to visual and olfactory indicators of predation risk in healthy live, thermally bleached, and dead coral in a series of laboratory and field experiments. While fish still responded to visual cues in all habitats, they did not respond to olfactory indicators of risk in dead coral habitats, likely as a result of alteration or degradation of chemical cues. These cues are critical for learning and avoiding predators, and a failure to respond can have dramatic repercussions for survival and recruitment. PMID:23403754

  3. 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.

  4. Obsolescence Risk Assessment Process Best Practice

    Science.gov (United States)

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

    2012-05-01

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

  5. Assessing glacial lake outburst flood risk

    Science.gov (United States)

    Kougkoulos, Ioannis; Cook, Simon; Jomelli, Vincent; Clarke, Leon; Symeonakis, Elias

    2017-04-01

    Glaciers across the world are thinning and receding in response to atmospheric warming. Glaciers tend to erode subglacial basins and deposit eroded materials around their margins as lateral-frontal terminal moraines. Recession into these basins and behind impounding moraines causes meltwater to pond as proglacial and supraglacial lakes. Consequently, there has been a general trend of increasing number and size of these lakes associated with glacier melting in many mountainous regions around the globe, in the last 30 years. Glacial lake outburst floods (GLOFs) then may occur where the glacial lake dam (ice, rock, moraine, or combination thereof) is breached, or overtopped, and thousands of people have lost their lives to such events in the last few decades, especially in the Andes and in the Himalaya. Given the ongoing and arguably increasing risk posed to downstream communities, and infrastructure, there has been a proliferation of GLOF studies, with many seeking to estimate GLOF hazard or risk in specific regions, or to identify 'potentially dangerous glacial lakes'. Given the increased scientific interest in GLOFs, it is timely to evaluate critically the ways in which GLOF risk has been assessed previously, and whether there are improvements that can be made to the ways in which risk assessment is achieved. We argue that, whilst existing GLOF hazard and risk assessments have been extremely valuable they often suffer from a number of key shortcomings that can be addressed by using different techniques as multi-criteria decision analysis and hydraulic modelling borrowed from disciplines like engineering, remote sensing and operations research.

  6. Optimisation of metabolic criteria in the prognostic assessment in patients with lymphoma. A multicentre study.

    Science.gov (United States)

    Del Puig Cózar-Santiago, M; García-Garzón, J R; Moragas-Freixa, M; Soler-Peter, M; Bassa Massanas, P; Sánchez-Delgado, M; Sanchez-Jurado, R; Aguilar-Barrios, J E; Sanz-Llorens, R; Ferrer-Rebolleda, J

    To compare sensitivity, specificity and predictive value of Deauville score (DS) vs. ΔSUVmax in interim-treatment PET (iPET) and end-treatment PET (ePET), in patients with diffuse large B cell lymphoma (DLBCL), Hodgkin lymphoma (HL), and follicular lymphoma (FL). Retrospective longitudinal multicentre study including 138 patients (46 DLBCL, 46 HL, 46 FL), on whom 3 18 F-FDG PET/CT were performed: baseline, iPET, and ePET. Visual (DS) and semi-quantitative (ΔSUVmax) parameters were determined for iPET and ePET. Predictive value was determined in relation to disease-free interval. Statistical analysis. iPET for DLBCL, HL, and FL: 1) sensitivity of DS: 76.92/83.33/61.53%; specificity: 78.78/85/81.81%; 2) sensitivity of ΔSUVmax: 53.84/83.33/61.53%; specificity: 87.87/87.50/78.78%. ePET for DLBCL, HL and FL: 1) sensitivity of DS: 61.53/83.33/69.23%; specificity: 90.90/85/87.87%; 2) sensitivity of ΔSUVmax: 69.23/83.33/69.23%; specificity: 90.90/87.50/84.84%. Predictive assessment. iPET study: in DLBCL, DS resulted in 10.3% recurrence of negative iPET, and 17.1% in ΔSUVmax at disease-free interval; in HL, both parameters showed a 2.8% recurrence of negative iPET; in FL, DS resulted in 15.6% recurrence of negative iPET, and 16.1% in ΔSUVmax, with no statistical significance. ePET study: in DLBCL, DS resulted in 14.3% recurrence of negative ePET, and 11.8% in ΔSUVmax at disease-free interval; in HL and FL, both methods showed 2.8 and 12.5% recurrence in negative ePET, respectively. DS and ΔSUVmax did not show significant differences in DLBCL, HL and FL. Their predictive value also did not show significant differences in HL and FL. In DLBCL, DS was higher in iPET, and ΔSUVmax in ePET. Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

  7. Obsolescence Risk Assessment Process Best Practice

    OpenAIRE

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

    2013-01-01

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

  8. 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.

  9. Strong Prognostic Value of Tumor-infiltrating Neutrophils and Lymphocytes Assessed by Automated Digital Image Analysis in Early Stage Cervical Cancer: A Comparator Study with Observer-assisted Stereological Assessments

    DEFF Research Database (Denmark)

    Carus, Andreas; Donskov, Frede; Nielsen, Patricia Switten

    2014-01-01

    INTRODUCTION Manual observer-assisted stereological (OAS) assessments of tumor-infiltrating neutrophils and lymphocytes are prognostic, accurate, but cumbersome. We assessed the applicability of automated digital image analysis (DIA). METHODS Visiomorph software was used to obtain DIA densities...... less human resources than manual OAS assessments. We observed high correlations between DIA and OAS variables for CD8+ lymphocytes, CD66b+ neutrophils, and CD163+ macrophages (spearman ρ > 0.8; P

  10. Quantum chemistry in environmental pesticide risk assessment.

    Science.gov (United States)

    Villaverde, Juan J; López-Goti, Carmen; Alcamí, Manuel; Lamsabhi, Al Mokhtar; Alonso-Prados, José L; Sandín-España, Pilar

    2017-11-01

    The scientific community and regulatory bodies worldwide, currently promote the development of non-experimental tests that produce reliable data for pesticide risk assessment. The use of standard quantum chemistry methods could allow the development of tools to perform a first screening of compounds to be considered for the experimental studies, improving the risk assessment. This fact results in a better distribution of resources and in better planning, allowing a more exhaustive study of the pesticides and their metabolic products. The current paper explores the potential of quantum chemistry in modelling toxicity and environmental behaviour of pesticides and their by-products by using electronic descriptors obtained computationally. Quantum chemistry has potential to estimate the physico-chemical properties of pesticides, including certain chemical reaction mechanisms and their degradation pathways, allowing modelling of the environmental behaviour of both pesticides and their by-products. In this sense, theoretical methods can contribute to performing a more focused risk assessment of pesticides used in the market, and may lead to higher quality and safer agricultural products. © 2017 Society of Chemical Industry. © 2017 Society of Chemical Industry.

  11. 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.

  12. Strong cardiovascular prognostic implication of quantitative left atrial contractile function assessed by cardiac magnetic resonance imaging in patients with chronic hypertension

    Directory of Open Access Journals (Sweden)

    Tsang Sui

    2011-08-01

    Full Text Available Abstract Background Progressive left ventricular (LV diastolic dysfunction due to hypertension (HTN alters left atrial (LA contractile function in a predictable manner. While increased LA size is a marker of LV diastolic dysfunction and has been shown to be predictive of adverse cardiovascular outcomes, the prognostic significance of altered LA contractile function is unknown. Methods A consecutive group of patients with chronic hypertension but without significant valvular disease or prior MI underwent clinically-indicated CMR for assessment of left ventricular (LV function, myocardial ischemia, or viability. Calculation of LA volumes used in determining LA emptying functions was performed using the biplane area-length method. Results Two-hundred and ten patients were included in this study. During a median follow-up of 19 months, 48 patients experienced major adverse cardiac events (MACE, including 24 deaths. Decreased LA contractile function (LAEFContractile demonstrated strong unadjusted associations with patient mortality, non-fatal events, and all MACE. For every 10% reduction of LAEFContractile, unadjusted hazards to MACE, all-cause mortality, and non-fatal events increased by 1.8, 1.5, and 1.4-folds, respectively. In addition, preservation of the proportional contribution from LA contraction to total diastolic filling (Contractile/Total ratio was strongly associated with lower MACE and patient mortality. By multivariable analyses, LAEFContractile was the strongest predictor in each of the best overall models of MACE, all-cause mortality, and non-fatal events. Even after adjustment for age, gender, left atrial volume, and LVEF, LAEFContractile maintained strong independent associations with MACE (p Conclusions In hypertensive patients at risk for left ventricular diastolic dysfunction, a decreased contribution of LA contractile function to ventricular filling during diastole is strongly predictive of adverse cardiac events and death.

  13. Prognostic factors and impact of adjuvant treatments on local and metastatic relapse of soft-tissue sarcoma patients in the competing risks setting.

    Science.gov (United States)

    Italiano, Antoine; Le Cesne, Axel; Mendiboure, Jean; Blay, Jean-Yves; Piperno-Neumann, Sophie; Chevreau, Christine; Delcambre, Corinne; Penel, Nicolas; Terrier, Philippe; Ranchere-Vince, Dominique; Lae, Marick; Le Guellec, Sophie; Michels, Jean-Jacques; Robin, Yves Marie; Bellera, Carine; Bonvalot, Sylvie

    2014-11-01

    In the medical literature many analyses of outcomes of sarcoma patients were performed without regard to the problem of "competing risks." We analyzed local relapse-free and metastasis-free survival in a population of 3255 adult patients with a primary soft-tissue sarcoma (STS) included in the French Sarcoma Group database. Cumulative incidence of local and metastatic relapse was estimated by accounting for death as a competing event. On multivariate analysis, age, tumor site, histological subtype, and grade were independent adverse prognostic factors for local relapse, whereas tumor depth and size had no influence. Histological subtype, tumor depth, tumor size, and grade were independent adverse prognostic factors for metastatic relapse. Despite a higher incidence of competing deaths in patients managed with adjuvant radiotherapy than in patients not receiving radiotherapy, adjuvant radiotherapy was associated with a significant benefit in terms of local relapse-free survival. Despite a similar cumulative incidence of competing deaths in patients with grade 2 and grade 3 disease, we found that the benefit of adjuvant chemotherapy was present only in patients with grade 3 and not in patients with grade 2 disease. In the setting of competing risks, tumor biology reflected by histological grade is a crucial predictor of local relapse, whereas tumor depth and size have poor if any influence. Grade could also predict the benefit of adjuvant chemotherapy in patients with STS. © 2014 American Cancer Society.

  14. Cardiovascular risk assessment in Italy: the CUORE Project risk score and risk chart

    Directory of Open Access Journals (Sweden)

    Simona Giampaoli

    2007-06-01

    Full Text Available

    Aim: Risk charts and risk score, based on the global absolute risk, are key tools for CVD risk assessment. When applied to the population from which they derive, they provide the best estimate of CVD risk. That is why the CUORE Project has among its objectives the assessment of the Italian population’s cardiovascular risk, identifying the model for the prediction of coronary and cerebrovascular events in 10 years.

    Methods: Data fromdifferent cohorts enrolled in the North, Centre and South of Italy between the 1980s and the 1990s were used. From the 7,056 men and 12,574 women aged 35-69 years, free of cardiovascular disease at base-line and followed up for a mean time of 10 years for total and cause-specific mortality and non fatal cerebrovascular and coronary events, 894 major cardiovascular events (596 coronary and 298 cerebrovascular were identified and validated. To assess 10-year cardiovascular risk, the risk score and risk chart were developed for men and women separately, considering the first major coronary or cerebrovascular event as the endpoint.

    Results: The risk score is applied tomen andwomen aged 35-69 years and includes age, systolic blood pressure, total cholesterol, HDL-cholesterol, smoking habit, diabetes and hypertension treatment using continuous values when possible. The risk chart is applied to persons aged 40-69 years and includes the same risk factors as risk score, except for HDL-cholesterol and hypertension treatment, and uses categorical values for all variables.

    Conclusions: The risk score and risk chart are easy-to-use tools which enable general practitioners and specialists to achieve an objective evaluation of the absolute global cardiovascular risk of middle-aged persons in primary prevention.

  15. 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

  16. 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 of...

  17. Water risk assessment for river basins in China based on WWF water risk assessment tools

    Directory of Open Access Journals (Sweden)

    N. Wei

    2014-09-01

    Full Text Available Water resource problems, one of the most important environmental and socio-economic issues, have been a common concern worldwide in recent years. Water resource risks are attracting more and more attention from the international community and national governments. Given the current situations of water resources and the water environment, and the characteristics of water resources management and information statistics of China, this paper establishes an index system for water risk assessment in river basins of China based on the index system of water risk assessment proposed by the World Wide Fund For Nature (WWF and German Investment and Development Co., Ltd (DEG. The new system is more suitable for Chinese national conditions and endorses the international assessment index. A variety of factors are considered to determine the critical values of classification for each index, and the indexes are graded by means of 5-grade and 5-score scales; the weights and calculation methods of some indexes are adjusted, with the remaining indexes adopting the method of WWF. The Weighted Comprehensive Index Summation Process is adopted to calculate the integrated assessment score of the river basin. The method is applied to the Haihe River basin in China. The assessment shows that the method can accurately reflect the water risk level of different river basins. Finally, the paper discusses the continuing problems in water risk assessment and points out the research required to provide a reference for further study in this field.

  18. LH/hCG-Receptor Expression May Have a Negative Prognostic Value in Low-Risk Endometrial Cancer.

    Science.gov (United States)

    Noci, Ivo; Sorbi, Flavia; Mannini, Luca; Projetto, Elisabetta; Pillozzi, Serena; Ghizzoni, Viola; Lottini, Tiziano; Moncini, Daniela; Baroni, Gianna; Mungai, Francesco; Arcangeli, Annarosa; Fambrini, Massimiliano

    2016-01-01

    A 51 year-old woman was diagnosed with endometrial cancer (EC) and underwent surgical staging. Pathological evaluation showed a 2 cm × 1 cm G2 endometrioid EC with a 30% myometrial deep invasion (FIGO Stage 1A). The patient was classified as low risk of recurrence, and no adjuvant treatment was offered. Six months after surgery, the patient developed an early vescico-vaginal recurrence, and chemotherapy treatment was started. Few months later, a subsequent involvement of vaginal wall, ileum, and omentum was detected, and the patient underwent second surgery. LH/hCG-receptor (LH/hCG-R) expression has been previously reported to be associated with an invasive phenotype in EC cells. Moreover, in a preclinical mouse model of EC behaves as a prometastatic molecular device. We analyzed the expression level of LH/hCG-R in cancer specimens collected during surgeries. Molecular and immunohistochemical analyses showed a strong expression of both mRNA and protein for LH/hCG-R in all specimens. LH/hCG-R expression may be assessed together with other clinicopathological parameters in order to better predict the risk of recurrence in low-risk EC patients. Further clinical trials are warranted in order to validate LH/hCG-R as biomarker in EC.

  19. 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.

  20. 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.

  1. 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.

  2. Information Security Risk Assessment in Hospitals.

    Science.gov (United States)

    Ayatollahi, Haleh; Shagerdi, Ghazal

    2017-01-01

    To date, many efforts have been made to classify information security threats, especially in the healthcare area. However, there are still many unknown risks which may threat the security of health information and their resources especially in the hospitals. The aim of this study was to assess the risks threatening information security in the hospitals located in one of the northwest cities of Iran. This study was completed in 2014. The participants were information technology managers who worked in the hospitals (n=27). The research instrument was a questionnaire composed of a number of open and closed questions. The content validity of the questionnaire was confirmed, and the reliability of the closed questions was measured by using the test-retest method (r =0.78). The results showed that among the information security risks, fire found to be a high probability/high impact risk factor. Human and physical/environmental threats were among the low probability risk factors. Regarding the information security safeguards used in the hospitals, the results showed that the use of the technical safeguards was the most frequent one (n =22, 91.7%) compared to the administrative (n =21, 87.5%) and the physical safeguards (n =16, 66.7%). The high probability risk factors require quick corrective actions to be taken. Therefore, the underlying causes of such threats should be identified and controlled before experiencing adverse effects. It is also important to note that information security in health care systems needs to be considered at a macro level with respect to the national interests and policies.

  3. 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...

  4. Excipient Usage Technical Risk Assessment for Generic Solid Dose Products

    Directory of Open Access Journals (Sweden)

    Ajay Babu Pazhayattil

    2017-09-01

    Full Text Available This paper proposes an assessment methodology for solid dose generic small molecule drug products. It addresses the ‘usage of the excipient’ portion of the trinomial by utilizing the systematic approach of Risk Identification, Risk Analysis and Risk Evaluation as per ICH Q9 Quality Risk Management outlined for developing risk control strategies. The assessment and maintenance of excipient risk profile is essential to minimize any potential risk associated to excipients impacting patients.

  5. Evaluation of the prognostic role of tumour-associated macrophages in newly diagnosed classical Hodgkin lymphoma and correlation with early FDG-PET assessment.

    Science.gov (United States)

    Cencini, Emanuele; Fabbri, Alberto; Rigacci, Luigi; Lazzi, Stefano; Gini, Guido; Cox, Maria Christina; Mancuso, Salvatrice; Abruzzese, Elisabetta; Kovalchuk, Sofia; Goteri, Gaia; Di Napoli, Arianna; Bono, Roberto; Fratoni, Stefano; Di Lollo, Simonetta; Bosi, Alberto; Leoncini, Lorenzo; Bocchia, Monica

    2017-03-01

    In Hodgkin Lymphoma (HL), about 20% of patients still have relapsed/refractory disease and late toxic effects rate continue to rise with time. 'Early FDG-PET' and tissue macrophage infiltration (TAM) emerged as powerful prognostic predictors. The primary endpoint was to investigate the prognostic role of both early FDG-PET and TAM; the secondary endpoint was to test if early FDG-PET positivity could correlate with high TAM score. A cohort of 200 HL patients was analysed. Induction treatment plan consisted of two to six courses of ABVD and, if indicated, involved field radiation therapy. All patients repeated CT scan and FDG-PET after two cycles and after the completion of therapy. TAM in diagnostic specimens was determined by immunohistochemistry with a monoclonal antibody (anti-CD68 KP1). Overall, early FDG-PET was negative in 163 patients (81.5%) and positive in 37 patients (18.5%), showing a significant correlation with the achievement of CR (p PET negative patients (p PET result. This study confirms that early FDG-PET has a high prognostic power, while TAM score does not seem to influence the outcome; in contrast to our original hypothesis, it does not correlate with FDG-PET assessment. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  6. Circulating free light chain measurement in the diagnosis, prognostic assessment and evaluation of response of AL amyloidosis: comparison of Freelite and N latex FLC assays.

    Science.gov (United States)

    Palladini, Giovanni; Jaccard, Arnaud; Milani, Paolo; Lavergne, David; Foli, Andrea; Bender, Sebastien; Lavatelli, Francesca; Bosoni, Tiziana; Valentini, Veronica; Pirolini, Laura; Ferraro, Giovanni; Basset, Marco; Russo, Francesca; Nuvolone, Mario; Albertini, Riccardo; Cogne, Michel; Merlini, Giampaolo

    2017-10-26

    The measurement of circulating free light chain (FLC) is essential in the diagnosis, prognostic stratification and evaluation of response to therapy in light chain (AL) amyloidosis. For more than 10 years, this has been done with an immunonephelometric assay based on polyclonal antibodies (Freelite), and cutoffs for staging and response assessment have been validated with this method. Recently, a new assay based on monoclonal antibodies (N latex FLC) has been marketed in Europe. We evaluated and compared the clinical performance of the two assays in 426 patients with newly diagnosed AL amyloidosis. We found suboptimal agreement between the two methods, with differences between values obtained with the Freelite and N latex FLC assays increasing with the concentration of clonal FLC. The diagnostic sensitivity of the Freelite (82%) and N latex FLC (84%) assays was similar, and both improved to 98% in combination with serum and urine immunofixation. The concentration of FLC measured with both methods had prognostic significance. Less pronounced decreases in FLC best predicted improved survival with the N latex FLC assay (33% vs. 50%), and there was poor concordance (84%) in discrimination of responders. The two assays have similar diagnostic and prognostic performance. However, they are not interchangeable, and follow-up should be done with either one. New response criteria are needed for the N latex FLC assay.

  7. The prognostic value of arterial blood gas analysis in high-risk acute heart failure patients: an analysis of the Korean Heart Failure (KorHF) registry.

    Science.gov (United States)

    Park, Jin Joo; Choi, Dong-Ju; Yoon, Chang-Hwan; Oh, Il-Young; Lee, Ju Hyun; Ahn, Soyeon; Yoo, Byung-Su; Kang, Seok-Min; Kim, Jae-Joong; Baek, Sang-Hong; Cho, Myeong-Chan; Jeon, Eun-Seok; Chae, Shung Chull; Ryu, Kyu-Hyung; Oh, Byung-Hee

    2015-06-01

    In acute heart failure (AHF) patients, pulmonary oedema and low tissue perfusion may lead to changes in the acid-base balance, which may be associated with worse outcomes. In this prospective nationwide cohort study from 24 academic hospitals, arterial blood gas (ABG) was measured in 1982 AHF patients at hospital admission. Acidosis was defined as pH 7.44. Mortality was stratified according to ABG results. Overall, 19% had acidosis, 37% had normal pH, and 44% had alkalosis. The most common type of acidosis was the mixed type (42%) followed by metabolic acidosis (40%), and the most common type of alkalosis was respiratory alkalosis (58%). At 12 months' follow-up 304 patients (15%) died. Patients with acidosis had higher mortality (acidosis 19.5%, neutral pH 13.7%, alkalosis 14.9%; P = 0.007). In the Cox proportional-hazards regression model, acidosis was a significant predictor of mortality (hazard ratio 1.93; 95% confidence intervals 1.27-2.93) along with N-terminal pro-brain type natriuretic peptide (NT-proBNP), among others. In contrast, alkalosis was not associated with increased mortality. pH had an incremental prognostic value over NT-proBNP (net reclassification improvement 30%; P analysis identified extra patients at increased risk for mortality among patients with an NT-proBNP level less than the median (12-month mortality 17.5% vs. 9.9%; P = 0.009). In high-risk AHF patients, the most common acid-base imbalance is respiratory alkalosis. Acidosis is observed in every fifth patient and is a significant predictor of mortality. pH provides an additional prognostic value and may be used to optimize risk stratification in high-risk AHF patients. © 2015 The Authors. European Journal of Heart Failure © 2015 European Society of Cardiology.

  8. The sequential organ failure assessment (SOFA) score is prognostically superior to the model for end-stage liver disease (MELD) and MELD variants following paracetamol (acetaminophen) overdose.

    Science.gov (United States)

    Craig, D G N; Reid, T W D J; Wright, E C; Martin, K G; Davidson, J S; Hayes, P C; Simpson, K J

    2012-03-01

    The prognostic value of the model for end-stage liver disease (MELD) and sodium-based MELD variants in predicting survival following paracetamol overdose remains unclear. To examine the prognostic accuracy of sodium-based MELD variants in paracetamol-induced acute liver injury compared with the sequential organ failure assessment (SOFA) score. Retrospective analysis of 138 single time point paracetamol overdoses admitted to a tertiary liver centre. Individual laboratory samples were correlated with the corresponding clinical parameters in relation to time post-overdose, and the daily MELD, MELD-Na, MELDNa, MESO, iMELD, UKELD, updated MELD and SOFA scores were calculated. Sixty-six (47.8%) patients developed hepatic encephalopathy, of whom 7 were transplanted and 21 died without liver transplantation. SOFA had a significantly greater area under the receiver operator characteristic for the prediction of spontaneous survival compared with MELD at both 72 (P = 0.024) and 96 (P = 0.017) h post-overdose. None of the sodium-based MELD variants improved the prognostic accuracy of MELD. A SOFA score >6 by 72 h or >7 by 96 h, post-overdose predicted death/transplantation with a negative predictive value of 96.9 (95% CI 90.2-99.4) and 98.8 (95% CI 93.6-99.9) respectively. SOFA and MELD had similar accuracy for predicting the development of hepatic encephalopathy (P = 0.493). The SOFA score is superior to MELD in predicting spontaneous survival following paracetamol-induced acute liver injury. Modification of the MELD score to include serum sodium does not improve prognostic accuracy in this setting. SOFA may have potential as a quantitative triage marker following paracetamol overdose. © 2012 Blackwell Publishing Ltd.

  9. Assessment of the extent of unpublished studies in prognostic factor research: a systematic review of p53 immunohistochemistry in bladder cancer as an example.

    Science.gov (United States)

    Sekula, Peggy; Pressler, Julia B; Sauerbrei, Willi; Goebell, Peter J; Schmitz-Dräger, Bernd J

    2016-08-16

    When study groups fail to publish their results, a subsequent systematic review may come to incorrect conclusions when combining information only from published studies. p53 expression measured by immunohistochemistry is a potential prognostic factor in bladder cancer. Although numerous studies have been conducted, its role is still under debate. The assumption that unpublished studies too harbour evidence on this research topic leads to the question about the attributable effect when adding this information and comparing it with published data. Thus, the aim was to identify published and unpublished studies and to explore their differences potentially affecting the conclusion on its function as a prognostic biomarker. Systematic review of published and unpublished studies assessing p53 in bladder cancer in Germany between 1993 and 2007. The systematic search revealed 16 studies of which 11 (69%) have been published and 5 (31%) have not. Key reason for not publishing the results was a loss of interest of the investigators. There were no obviously larger differences between published and unpublished studies. However, a meaningful meta-analysis was not possible mainly due to the poor (ie, incomplete) reporting of study results. Within this well-defined population of studies, we could provide empirical evidence for the failure of study groups to publish their results that was mainly caused by loss of interest. This fact may be coresponsible for the role of p53 as a prognostic factor still being unclear. We consider p53 and the restriction to studies in Germany as a specific example, but the critical issues are probably similar for other prognostic factors and other countries. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  10. Retrospective evaluation of 155 adult equids and 21 foals with tetanus from Western, Northern, and Central Europe (2000-2014). Part 2: Prognostic assessment.

    Science.gov (United States)

    van Galen, Gaby; Rijckaert, Joke; Mair, Tim; Amory, Helene; Armengou, Lara; Bezdekova, Barbora; Durie, Inge; Findshøj Delany, Rikke; Fouché, Nathalie; Haley, Laura; Hewetson, Michael; van den Hoven, Rene; Kendall, Anna; Malalana, Fernando; Muller Cavalleri, Jessika; Picavet, Tresemiek; Roscher, Katja; Verwilghen, Denis; Westermann, Cornélie; Saegerman, Claude

    2017-11-01

    To identify prognostic variables for adult equids and foals with tetanus. Multicenter retrospective study (2000-2014). Twenty Western, Northern, and Central European university teaching hospitals and private referral centers. One hundred fifty-five adult equids and 21 foals with tetanus. None. Variables from history and clinical examination were statistically compared between survivors and nonsurvivors (adults: 49 survivors, 85 nonsurvivors; foals: 7 survivors, 10 nonsurvivors). Cases euthanized for financial reasons were excluded. Mortality rates in adults and foals were 68.4% and 66.7%, respectively. Variables associated with survival in adults included: standing, normal intestinal sounds and defecation, voluntarily drinking, eating soft or normal food, lower heart and respiratory rates, high base excess on admission, longer diagnosis time, treatment and hospitalization delay, and mild severity grade. Variables associated with death included: anorexia, dysphagia, dyspnea, low blood potassium concentration on admission, moderate and severe disease grading, development of dysphagia, dyspnea, recumbency and seizures during hospitalization, treatment with glycerol guaiacolate, intravenous fluids, and intravenous glucose solutions. Variables associated with survival in foals included standing on admission, voluntarily eating soft food and drinking, older age, and longer hospitalization delay. Outcome was not different between different tetanus antitoxin (TAT) dosages, although there was a trend of increasing survival rate with increasing TAT dosages. Cases with appropriate vaccination prior to development of tetanus were rare, but had improved outcome and shorter hospitalization. Prognosis for equine tetanus is poor with similar outcome and prognostic factors in foals and adults. The prognostic assessment of cases with tetanus provides clinicians with new evidence-based information related to patient management. Several prognostic indicators relate to the ability to

  11. 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.

  12. ASSESSMENT OF PROLIFERATIVE POTENTIAL OF TUMOR CELLS USING KI-67 EXPRESSION AND MORPHOMETRICAL ANALYSIS FOR PROGNOSTICATION OF ORAL SQUAMOUS CELL CARCINOMAS

    Directory of Open Access Journals (Sweden)

    Rakheja Mahima, Singh Pratyush, Shergill Ankur K, Guddattu Vasudeva,Solomon Monica C

    2015-09-01

    Full Text Available Background: Cancer cells exhibit a characteristic intrinsic ability of uncontrolled cell proliferation which plays a vital role in tumor development and progression. The Ki-67 antigen expression is strictly associated with cell proliferation which detects the cells entering the cell cycle. In addition, computer aided image analysis provides an objective and highly reproducible histological evaluation of OSCC. Assessment of Ki-67 expression along with morphometry may help in early and precise diagnosis and prognostication of OSCC. Aims: To correlate the ki-67 expression and the morphometrical parameters of oral squamous cell carcinomas and to assess the efficacy of the correlation in OSCC prognostication. Methods and material: OSCC cases (n=105 were examined immuno histochemically using Ki-67 antigen The nuclear area (NA, cell area (CA, nuclear perimeter (NP and cell perimeter (CP assessed using “image J 1.34 software”. The data was statistically analyzed. Results: Highly significant correlation was found between Ki-67 expression and the advancing grades of OSCC (p<.0001. NA (p=0.025, CA (p<.0001, NP (p=.027 and CP (p<.0001 of poorly differentiated OSCC were significantly lower than well differentiated and moderately differentiated OSCC. Follow up analysis revealed nuclear area and cell area to be higher in the recurrent cases than the non recurrent ones. Conclusion: Assessment of Ki-67 expression and morphometry help in early and precise diagnosis and prognostication of OSCC. A correlation between Ki-67 expression and morphometrical analysis could not be ascertained in this study. Further studies with a larger sample number may provide more definitive results.

  13. Risk Assessment Report, Davis Global Communications Site

    Science.gov (United States)

    1994-02-23

    methiocarb . All of the contaminants detected in the production well were evaluated as COPCs in the risk assessment, with the exception of methiocarb ... Methiocarb (Mesurol, produced by Mobay Contaminant Corp.) is a moderately toxic carbamate pesticide used principally as a bird repellant in fruit and...6.7 1,4-Dichlorobenzene 2 2.95 3.71 3 1,1-Dichloroethene 27 0.2 3.0 Ethylene dibromide 2 1.407 2.3 3 Freon 113 45 1.3 14.1 Methiocarb 1 -- 50.0 3 Methyl

  14. A prognostic model for lung adenocarcinoma patient survival with a focus on four miRNAs.

    Science.gov (United States)

    Li, Xianqiu; An, Zhaoling; Li, Peihui; Liu, Haihua

    2017-09-01

    There is currently no effective biomarker for determining the survival of patients with lung adenocarcinoma. The purpose of the present study was to construct a prognostic survival model using microRNA (miRNA) expression data from patients with lung adenocarcinoma. miRNA data were obtained from The Cancer Genome Atlas, and patients with lung adenocarcinoma were divided into either the training or validation set based on the random allocation principle. The prognostic model focusing on miRNA was constructed, and patients were divided into high-risk or low-risk groups as per the scores, to assess their survival time. The 5-year survival rate from the subgroups within the high- and low-risk groups was assessed. P-values of the prognostic model in the total population, the training set and validation set were 0.0017, 0.01986 and 0.02773, respectively, indicating that the survival time of the lung adenocarcinoma high-risk group was less than that of the low-risk group. Thus, the model had a good assessment effectiveness for the untreated group (P=0.00088) and the Caucasian patient group (P=0.00043). In addition, the model had the best prediction effect for the 5-year survival rate of the Caucasian patient group (AUC=0.629). In conclusion, the prognostic model developed in the present study can be used as an independent prognostic model for patients with lung adenocarcinoma.

  15. Risk Assessment tailored to cryogenics - LINDE approach

    CERN Multimedia

    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...

  16. Scientific risk assessment and the regulation of human cancer risks: background and new directions

    Energy Technology Data Exchange (ETDEWEB)

    Barnard, R.C.

    1987-09-01

    I consider the importance of scientific risk assessment as optimal basis for socially sound risk management decisions. The health professional has both risk assessment and risk management responsibilities; the functions are conceptually separate and governed by separate criteria: scientific for risk assessment and social for risk management. The history of the development of regulating risk assessment methodology with particular reference to potential carcinogens is discussed. The scientific basis for possible improvements in risk assessment methodology for potential carcinogens is identified and the significance of the potential improvements is considered with special reference to the health professional.

  17. Nutritional assessment and surgical risk makers in children submitted to cardiac surgery

    Directory of Open Access Journals (Sweden)

    Heitor Pons Leite

    Full Text Available In order to assess the nutritional status of children with heart diseases and to evaluate nutritional parameters for predicting postoperative complications, 50 children undergoing to cardiac surgery and classified in high and low surgical risk prospectively evaluated. Assessment parameters included anthropometry and plasma proteins albumin, transferrin and prealbumin. The nutritional classification according to Waterlow's modified criteria showed a high prevalence of malnutrition in the population studied (78%. The measures of arm circumference when located below the 5th percentile showed a significant association with general postoperative complications in the high risk group (arm circumference, p = 0,0019; arm muscle circumference, p = 0,0419. The percentage of weight per height, serum albumin and transferrin has not played a prognostic role concerning postoperative morbidity. The mean value of prealbumin was significantly lower in high risk group patients developing postoperative infections (p < 0,01 compared to those who did not. The sensitivity-specificity analysis of prealbumin as risk indicator for postoperative infection was 87.5% and 59% respectively. The nutritional risk classification seems to be a good way to identify the subgroups of children with additional postoperative surgical risk. However, more specific and sensitive tests are desirable to provide an individual identification of these children.

  18. Increased evidence for the prognostic value of primary tumor asphericity in pretherapeutic FDG PET for risk stratification in patients with head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Hofheinz, Frank; Lougovski, Alexandr [Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, PET Center, Dresden (Germany); Zoephel, Klaus; Hentschel, Maria [University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Department of Nuclear Medicine, Dresden (Germany); Steffen, Ingo G.; Wedel, Florian; Buchert, Ralph; Brenner, Winfried [Charite - Universitaetsmedizin Berlin, Department of Nuclear Medicine, Berlin (Germany); Apostolova, Ivayla [Universitaetsklinikum Magdeburg A.oe.R., Klinik fuer Radiologie und Nuklearmedizin, Magdeburg (Germany); Baumann, Michael [University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Department of Radiation Oncology, Dresden (Germany); OncoRay - National Center for Radiation Research in Oncology, Dresden (Germany); Institute of Radiooncology, Helmholtz-Zentrum Dresden-Rossendorf, Dresden (Germany); Kotzerke, Joerg; Hoff, Joerg van den [Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, PET Center, Dresden (Germany); University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Department of Nuclear Medicine, Dresden (Germany)

    2014-11-22

    In a previous study, we demonstrated the first evidence that the asphericity (ASP) of pretherapeutic FDG uptake in the primary tumor provides independent prognostic information in patients with head and neck cancer. The aim of this work was to confirm these results in an independent patient group examined at a different site. FDG-PET/CT was performed in 37 patients. The primary tumor was delineated by an automatic algorithm based on adaptive thresholding. For the resulting ROIs, the metabolically active part of the tumor (MTV), SUV{sub max}, SUV{sub mean}, total lesion glycolysis (TLG) and ASP were computed. Univariate Cox regression with respect to progression free survival (PFS) and overall survival (OS) was performed. For survival analysis, patients were divided in groups of high and low risk according to the parameter cut-offs defined in our previous work. In a second step, the cut-offs were adjusted to the present data. Univariate and multivariate Cox regression was performed for the pooled data consisting of the current and the previously described patient group (N = 68). In multivariate Cox regression, clinically relevant parameters were included. Univariate Cox regression using the previously published cut-off values revealed TLG (hazard ratio (HR) = 3) and ASP (HR = 3) as significant predictors for PFS. For OS MTV (HR = 2.7) and ASP (HR = 5.9) were significant predictors. Using the adjusted cutoffs MTV (HR = 2.9/3.3), TLG (HR = 3.1/3.3) and ASP (HR = 3.1/5.9) were prognostic for PFS/OS. In the pooled data, multivariate Cox regression revealed a significant prognostic value with respect to PFS/OS for MTV (HR = 2.3/2.1), SUV{sub max} (HR = 2.1/2.5), TLG (HR = 3.5/3.6), and ASP (HR = 3.4/4.4). Our results confirm the independent prognostic value of ASP of the pretherapeutic FDG uptake in the primary tumor in patients with head and neck cancer. Moreover, these results demonstrate that ASP can be determined unambiguously across different sites. (orig.)

  19. Heterogeneity of CD8(+) tumor-infiltrating lymphocytes in non-small-cell lung cancer: impact on patient prognostic assessments and comparison of quantification by different sampling strategies.

    Science.gov (United States)

    Obeid, Joseph M; Wages, Nolan A; Hu, Yinin; Deacon, Donna H; Slingluff, Craig L

    2017-01-01

    Infiltration of non-small-cell lung cancer (NSCLC) by CD8(+) T lymphocytes predicts improved patient survival; however, heterogeneity of intratumoral localization complicates this assessment. Strategies for tumor sampling may not accurately represent the whole tumor. We hypothesized that sampling strategies may alter the identification of tumors with high CD8 density and affect the prognostic significance. Twenty-three primary NSCLC tumors were immunohistochemically stained for CD8 and were assessed using automated software with eight different sampling strategies or the whole tumor. Results of all sampling strategies were compared to the whole tumor counts (paired t tests, Pearson's r). Associations between CD8 densities and overall survival were assessed (log-rank test). Counts from all eight sampling strategies significantly correlated with whole tumor counts (p ≤ 0.001). However, the magnitude of CD8(+) cell counts and categorization into high vs low infiltrate groups were affected by the sampling strategy. The most concordant values were derived from random sampling of 20 % of the tumor, a simulated core biopsy, or from sampling the tumor center. TIL infiltration was associated with survival when sampling the center (p = 0.038), but not the invasive margin (p > 0.2) or other strategies. Different tumor sampling strategies may yield discordant TIL density results and different stratification for risk assessment. Small biopsies may be particularly unrepresentative. Random sampling of larger tumor areas is recommended. Enumerating CD8(+) T cells in the tumor center may have prognostic value.

  20. Decreased Prognostic Value of International Prognostic Score in Chinese Advanced Hodgkin Lymphoma Patients Treated in the Contemporary Era

    Directory of Open Access Journals (Sweden)

    Qin Wang

    2016-01-01

    Conclusions: The IPS has decreased the prognostic value in Chinese advanced HL patients treated in the contemporary era. More prognostic factors are needed to supplement this original scoring system so as to identify different risk populations more accurately.

  1. Toxicologic Pathology: The Basic Building Block of Risk Assessment

    Science.gov (United States)

    Human health risk assessment is a critical factor in many risk management decisions. Evaluation of human health risk requires research the provides information that appropriately characterizes potential hazards from exposure. Pathology endpoints are the central response around ...

  2. 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.

  3. 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.

  4. Risk