Li, Jinyan; Yang, Qiang
Odds ratio (OR), relative risk (RR) (risk ratio), and absolute risk reduction (ARR) (risk difference) are biostatistics measurements that are widely used for identifying significant risk factors in dichotomous groups of subjects. In the past, they have often been used to assess simple risk factors. In this paper, we introduce the concept of compound-risk factors to broaden the applicability of these statistical tests for assessing factor interplays. We observe that compound-risk factors with a high risk ratio or a big risk difference have an one-to-one correspondence to strong emerging patterns or strong contrast sets-two types of patterns that have been extensively studied in the data mining field. Such a relationship has been unknown to researchers in the past, and efficient algorithms for discovering strong compound-risk factors have been lacking. In this paper, we propose a theoretical framework and a new algorithm that unify the discovery of compound-risk factors that have a strong OR, risk ratio, or a risk difference. Our method guarantees that all patterns meeting a certain test threshold can be efficiently discovered. Our contribution thus represents the first of its kind in linking the risk ratios and ORs to pattern mining algorithms, making it possible to find compound-risk factors in large-scale data sets. In addition, we show that using compound-risk factors can improve classification accuracy in probabilistic learning algorithms on several disease data sets, because these compound-risk factors capture the interdependency between important data attributes.
Moore, G; Gerdtz, M F; Hepworth, G; Manias, E
To describe patterns of service use and to predict risk factors for re-presentation to a metropolitan emergency department (ED) among people who are homeless. A retrospective cohort analysis was undertaken over a 24-month period from a principal referral hospital in Melbourne, Australia. All ED visits relating to people classified as homeless were included. A predictive model for risk of re-presentation was developed using logistic regression with random effects. Rates of re-presentation, defined as the total number of visits to the same ED within 28 days of discharge, were measured. The study period was 1 January 2003 to 31 December 2004. The re-presentation rate for homeless people was 47.8% (3199/6689) of ED visits and 45.5% (725/1595) of the patients. The final predictive model included risk factors, which incorporated both hospital and community service use. Those characteristics that resulted in significantly increased odds of re-presentation were leaving hospital at own risk (OR 1.31; 95% CI 1.10 to 1.56), treatment in another hospital (OR 1.45, 95% CI 1.23 to 1.72) and being in receipt of community-based case management (OR 1.31, 95% CI 1.11 to 1.54) or pension (OR 1.34, 95% CI 1.12 to 1.62). The predictive model identified nine risk factors of re-presentation to the ED for people who are homeless. Early identification of these factors among homeless people may alert clinicians to the complexity of issues influencing an individual ED visit. This information can be used at admission and discharge by ensuring that homeless people have access to services commensurate with their health needs. Improved linkage between community and hospital services must be underscored by the capacity to provide safe and secure housing.
Samuel A. Iverson
Full Text Available Emerging infectious diseases are a growing concern in wildlife conservation. Documenting outbreak patterns and determining the ecological drivers of transmission risk are fundamental to predicting disease spread and assessing potential impacts on population viability. However, evaluating disease in wildlife populations requires expansive surveillance networks that often do not exist in remote and developing areas. Here, we describe the results of a community-based research initiative conducted in collaboration with indigenous harvesters, the Inuit, in response to a new series of Avian Cholera outbreaks affecting Common Eiders (Somateria mollissima and other comingling species in the Canadian Arctic. Avian Cholera is a virulent disease of birds caused by the bacterium Pasteurella multocida. Common Eiders are a valuable subsistence resource for Inuit, who hunt the birds for meat and visit breeding colonies during the summer to collect eggs and feather down for use in clothing and blankets. We compiled the observations of harvesters about the growing epidemic and with their assistance undertook field investigation of 131 colonies distributed over >1200 km of coastline in the affected region. Thirteen locations were identified where Avian Cholera outbreaks have occurred since 2004. Mortality rates ranged from 1% to 43% of the local breeding population at these locations. Using a species-habitat model (Maxent, we determined that the distribution of outbreak events has not been random within the study area and that colony size, vegetation cover, and a measure of host crowding in shared wetlands were significantly correlated to outbreak risk. In addition, outbreak locations have been spatially structured with respect to hypothesized introduction foci and clustered along the migration corridor linking Arctic breeding areas with wintering areas in Atlantic Canada. At present, Avian Cholera remains a localized threat to Common Eider populations in the
Zachreson, Cameron; Wolff, Christian; Whitchurch, Cynthia B.; Toth, Milos
Collective behavior of bacterial colonies plays critical roles in adaptability, survivability, biofilm expansion and infection. We employ an individual-based model of an interstitial biofilm to study emergent pattern formation based on the assumptions that rod-shaped bacteria furrow through a viscous environment and excrete extracellular polymeric substances which bias their rate of motion. Because the bacteria furrow through their environment, the substratum stiffness is a key control parameter behind the formation of distinct morphological patterns. By systematically varying this property (which we quantify with a stiffness coefficient γ ), we show that subtle changes in the substratum stiffness can give rise to a stable state characterized by a high degree of local order and long-range pattern formation. The ordered state exhibits characteristics typically associated with bacterial fitness advantages, even though it is induced by changes in environmental conditions rather than changes in biological parameters. Our findings are applicable to a broad range of biofilms and provide insights into the relationship between bacterial movement and their environment, and basic mechanisms behind self-organization of biophysical systems.
Slattery, M L; Boucher, K M; Caan, B J; Potter, J D; Ma, K N
Colon cancer has been associated with several nutrients and foods. The authors used data from a population-based study conducted in Northern California, Utah, and Minnesota to examine associations between dietary eating patterns and risk of developing colon cancer. Through factor analysis, detailed dietary intake data obtained from 1,993 cases (diagnosed in 1991-1994) and 2,410 controls were grouped into factors that were evaluated for relations with lifestyle characteristics and colon cancer risk. Several dietary patterns emerged. The dietary patterns with the most variation were labeled "Western," "prudent," "high fat/sugar dairy," "substituters," and "drinkers." The "Western" dietary pattern was associated with a higher body mass index and a greater intake of total energy and dietary cholesterol. The "prudent" pattern was associated with higher levels of vigorous leisure time physical activity, smaller body size, and higher intakes of dietary fiber and folate. Persons who had high scores on the "drinker" pattern were also more likely to smoke cigarettes. The "Western" dietary pattern was associated with an increased risk of colon cancer in both men and women. The association was strongest among people diagnosed prior to age 67 years (for men, odds ratio (OR)=1.96, 95% confidence interval (CI) 1.22-3.15; for women, OR=2.02, 95% CI 1.21-3.36) and among men with distal tumors (OR=2.25, 95% CI 1.47-3.46). The "prudent" diet was protective, with the strongest associations being observed among people diagnosed prior to age 67 years (men: OR=0.63, 95% CI 0.43-0.92; women: OR=0.58, 95% CI 0.38-0.87); associations with this dietary pattern were also strong among persons with proximal tumors (men: OR=0.55, 95% CI 0.38-0.80; women: OR=0.64, 95% CI 0.45-0.92). Although "substituters" (people who substituted low fat dairy products for high fat dairy products, margarine for butter, poultry for red meat, and whole grains for refined grains) were at reduced risk of colon cancer
Chun Wie eChong
Full Text Available Recent advances in knowledge of patterns of biogeography in terrestrial eukaryotic organisms have led to a fundamental paradigm shift in understanding of the controls and history of life on land in Antarctica, and its interactions over the long term with the glaciological and geological processes that have shaped the continent. However, while it has long been recognized that the terrestrial ecosystems of Antarctica are dominated by microbes and their processes, knowledge of microbial diversity and distributions has lagged far behind that of the macroscopic eukaryote organisms. Increasing human contact with and activity in the continent is leading to risks of biological contamination and change in a region whose isolation has protected it for millions of years at least; these risks may be particularly acute for microbial communities which have, as yet, received scant recognition and attention. Even a matter apparently as straightforward as Protected Area designation in Antarctica requires robust biodiversity data which, in most parts of the continent, remain almost completely unavailable. A range of important contributing factors mean that it is now timely to reconsider the state of knowledge of Antarctic terrestrial prokaryotes. Rapid advances in molecular biological approaches are increasingly demonstrating that bacterial diversity in Antarctica may be far greater than previously thought, and that there is overlap in the environmental controls affecting both Antarctic prokaryotic and eukaryotic communities. Bacterial dispersal mechanisms and colonization patterns remain largely unaddressed, although evidence for regional evolutionary differentiation is rapidly accruing and, with this, there is increasing appreciation of patterns in regional bacterial biogeography in this large part of the globe. In this review, we set out to describe the state of knowledge of Antarctic prokaryote diversity patterns, drawing analogy with those of eukaryote
Chong, Chun-Wie; Pearce, David A; Convey, Peter
Recent advances in knowledge of patterns of biogeography in terrestrial eukaryotic organisms have led to a fundamental paradigm shift in understanding of the controls and history of life on land in Antarctica, and its interactions over the long term with the glaciological and geological processes that have shaped the continent. However, while it has long been recognized that the terrestrial ecosystems of Antarctica are dominated by microbes and their processes, knowledge of microbial diversity and distributions has lagged far behind that of the macroscopic eukaryote organisms. Increasing human contact with and activity in the continent is leading to risks of biological contamination and change in a region whose isolation has protected it for millions of years at least; these risks may be particularly acute for microbial communities which have, as yet, received scant recognition and attention. Even a matter apparently as straightforward as Protected Area designation in Antarctica requires robust biodiversity data which, in most parts of the continent, remain almost completely unavailable. A range of important contributing factors mean that it is now timely to reconsider the state of knowledge of Antarctic terrestrial prokaryotes. Rapid advances in molecular biological approaches are increasingly demonstrating that bacterial diversity in Antarctica may be far greater than previously thought, and that there is overlap in the environmental controls affecting both Antarctic prokaryotic and eukaryotic communities. Bacterial dispersal mechanisms and colonization patterns remain largely unaddressed, although evidence for regional evolutionary differentiation is rapidly accruing and, with this, there is increasing appreciation of patterns in regional bacterial biogeography in this large part of the globe. In this review, we set out to describe the state of knowledge of Antarctic prokaryote diversity patterns, drawing analogy with those of eukaryote groups where appropriate
Butt, Taimur; Khan, Hameed Ullah; Ahmed, Israr; Eldali, Abdelmoneim
Patient attendance in the emergency department (ED) is inherently variable and unpredictable. Resources might be better allocated if use of the ER could be predicted during the month of fasting (Ramadan), healthy adult Muslims do not eat or drink from dawn to sunset and in the Middle East, social activities occur mostly during night. There is no published data that has reported changes in local ED attendance pattern during Ramadan. Determine if there are differences in tertiary care ed attendance during Ramadan compared to other times of the year. Retrospective, using data from the hospital integrated clinical information system. Tertiary care institution in Riyadh, Saudi Arabia. All ED visits during the Islamic calendar years of 1431-1434 (December 18, 2009-October 13, 2013) were analyzed. Patient volume, acuity, demographics and admission rate variability between Ramadan and other months. During the study period of 4 years, of 226075 ED patients, 129178 (57.14%) patients were seen during the day shift (07:00 to 18:59). During Ramadan, 10 293 (60%) patients presented during the night shift compared with the day shift (P many ED patients were actually fasting during the study period. This study was conducted in a tertiary care hospital and the patient population presenting to our ed is predominantly Muslim; therefore, the results may not be generalized to populations that are not predominantly Muslim.
Using the SEM AMOS Ver.24 and Sobel Test Path Analysis, the results show that Current Operating Accrual has a negative and significant relationship to the idiosyncratic risk and stock price. For non-Current Operating Accrual variables have positive and significant relation. By using Sobel Test, the test result shows that idiosyncratic risk has mediation effect in Persistence Current Operating Accrual, Non-Current Operating Accrual relationship to stock price.
Pidgeon, Nick; Harthorn, Barbara; Satterfield, Terre
Nanotechnology involves the fabrication, manipulation, and control of materials at the atomic level and may also bring novel uncertainties and risks. Potential parallels with other controversial technologies mean there is a need to develop a comprehensive understanding of processes of public perception of nanotechnology uncertainties, risks, and benefits, alongside related communication issues. Study of perceptions, at so early a stage in the development trajectory of a technology, is probably unique in the risk perception and communication field. As such it also brings new methodological and conceptual challenges. These include: dealing with the inherent diversity of the nanotechnology field itself; the unfamiliar and intangible nature of the concept, with few analogies to anchor mental models or risk perceptions; and the ethical and value questions underlying many nanotechnology debates. Utilizing the lens of social amplification of risk, and drawing upon the various contributions to this special issue of Risk Analysis on Nanotechnology Risk Perceptions and Communication, nanotechnology may at present be an attenuated hazard. The generic idea of "upstream public engagement" for emerging technologies such as nanotechnology is also discussed, alongside its importance for future work with emerging technologies in the risk communication field. © 2011 Society for Risk Analysis.
Dalmeir, Michael; Gataullin, Yunir; Indrajit, Agung
HERMES (Highly Enhanced Risk Management Emergency Satellite) is potential European satellite mission for global flood management, being implemented by Technical University Munich and European Space Agency. With its main instrument - a reliable and precise Synthetic Aperture Radar (SAR) antenna...
REV-03.18.2016.0 2017 Emerging Technology Domains Risk Survey Daniel Klinedinst Joel Land Kyle O’Meara October 2017 TECHNICAL REPORT CMU/SEI...Distribution Statement A: Approved for Public Release. Distribution is Unlimited. List of Tables Table 1: New and Emerging Technologies 2 Table 2: Security...Impact of New and Emerging Technologies 4 Table 3: Severity Classifications and Impact Scores 5 CMU/SEI-2017-TR-008 | SOFTWARE ENGINEERING
Marchenko, Nataly A.; Andreassen, Natalia; Borch, Odd Jarl
The sea ice in the Arctic has shrunk significantly in the last decades. The transport pattern has as a result partly changed with more traffic in remote areas. This change may influence the risk pattern. The critical factors are harsh weather, ice conditions, remoteness and vulnerability of natur...... are rare, there are limited statistics available for Arctic maritime accidents. Hence, this study offers a qualitative analysis and an expert-based risk assessment. Implications for the emergency preparedness system of the Arctic region are discussed........ In this paper, we look into the risk of accidents in Atlantic Arctic based on previous ship accidents and the changes in maritime activity. The risk has to be assessed to ensure a proper level of emergency response. The consequences of incidents depend on the incident type, scale and location. As accidents...
Firms cannot function successfully without managing a host of internal and external organizational and process interdependencies. Part of this involves business continuity planning, which directly aects how resilient arm and its business sector are in the face of disruptions. This paper presents the results of eld studies related to information risk management practices in the health care and retail sectors. The studies explore information risk management coordinating signals within and across rms in these sectors as well as the potential eects of cyber disruptions on the rms as stand-alone entities and as part of a critical infrastructure. The health care case study investigates the impact of the Zotob worm on the ability to deliver medical care and treatment. The retail study examines the resilience of certain elements of the food supply chain to cyber disruptions.
Classes of socio-technical hazards allow a characterization of the risk in technology innovation and clarify the mechanisms underpinning emergent technological risk. Emerging Technological Risk provides an interdisciplinary account of risk in socio-technical systems including hazards which highlight: · How technological risk crosses organizational boundaries, · How technological trajectories and evolution develop from resolving tensions emerging between social aspects of organisations and technologies and · How social behaviour shapes, and is shaped by, technology. Addressing an audience from a range of academic and professional backgrounds, Emerging Technological Risk is a key source for those who wish to benefit from a detail and methodical exposure to multiple perspectives on technological risk. By providing a synthesis of recent work on risk that captures the complex mechanisms that characterize the emergence of risk in technology innovation, Emerging Tec...
Iversen, Kasper; Gøtze, Jens P; Dalsgaard, Morten
BACKGROUND: Rapid risk stratification is a core task in emergency medicine. Identifying patients at high and low risk shortly after admission could help clinical decision-making regarding treatment, level of observation, allocation of resources and post discharge follow-up. The purpose of the pre...
Chong, Chun-Wie; Pearce, David A.; Convey, Peter
Recent advances in knowledge of patterns of biogeography in terrestrial eukaryotic organisms have led to a fundamental paradigm shift in understanding of the controls and history of life on land in Antarctica, and its interactions over the long term with the glaciological and geological processes that have shaped the continent. However, while it has long been recognized that the terrestrial ecosystems of Antarctica are dominated by microbes and their processes, knowledge of microbial diversit...
Lee, Joomyung; Jae, Moosung; Ahn, Kwangil
The importance of nuclear power plant PSA has grown up all over the world due to this incident. The main concern of this study is to develop a methodology to carry on an emergency preparedness evaluation and to set an exclusive area, or the emergency response area boundary in order to apply it to domestic reference plants. This study also focuses on evaluating the risk parameter of major nuclides through a sensitivity analysis and a safety assessment by calculating the population dose, early fatality, and cancer fatality rates. A methodology for an emergency preparedness, which can be applied to evaluate the damage of the radioactive release as well as to assess the safety of the accident scenario of a nuclear power plant, has been developed and applied for the reference plants in Korea. By applying a source term analysis, an exclusive zone based on the radioactive dose is obtained. And the results of the health effect assessment based on the release fraction of specific nuclides to public with an effective emergency response activity have been simulated. A methodology utilizing the Level 3 PSA with the actual emergency response activities has been developed and applied to typical nuclear accident situations. The plausible standard for performing an emergency plan is suggested and the valuable information regarding emergency preparedness has been produced in this study. For further works, the sensitivity study on important parameters will be performed to simulate the actual severe accident situations such as sheltering, evacuation, and emergency response activities
The philosophically coloured paper on the aspects of risk communication patterns in society shows that debates about risks are governed by a number of stereotype characters representing the individualist and manager type, bureaucracy and law-and-order type, ego-centered embarrassment activist, and fundamentalist. Every risk-relevant group in the study tries to push forward its own interests. Risk communication is understood as a process of social dealing. (HP) [de
Dixon, B.W.; Ferns, K.G.
Probabilistic Risk Assessment (PRA) techniques are used by the nuclear industry to model the potential response of a reactor subjected to unusual conditions. The knowledge contained in these models can aid in emergency response decision making. This paper presents requirements for a PRA based emergency response support system to date. A brief discussion of published work provides background for a detailed description of recent developments. A rapid deep assessment capability for specific portions of full plant models is presented. The program uses a screening rule base to control search space expansion in a combinational algorithm
Larsen, Jan-Helge; Risør, Ole
Communications patterns, emergency service, out-of-hours service, telehpone consultations, video-supervision......Communications patterns, emergency service, out-of-hours service, telehpone consultations, video-supervision...
This is a detailed comparative analysis of electronic information sources (EIS) utilized by pharmacy lecturers in South-South universities in Nigeria. The purpose of this study is to analyze the extent to which EIS are utilized among pharmacy lecturers in South-South Nigeria. The aim is to explore the emerging pattern of ...
Mortality Patterns In The Accident And Emergency Department Of An Urban Hospital In Nigeria. ... Nigerian Journal of Clinical Practice ... subset being 4.6:1 and 1.2:1 respectively Most of the cases were of non-traumatic origin (79.8%), with the ...
Emerging Trends in the Epidemiological Pattern of Head and Neck Cancers in Lagos, ... The oral cavity was the most affected anatomic site (21.2%, 230/1083) in the ... and squamous cell carcinoma accounted for 58% (421/726) of carcinomas ...
Busch, Timo; Hoffmann, Volker H.
While discussions about global sustainability challenges abound, the financial risks that they incur, albeit important, have received less attention. We suggest that corporate risk assessments should include sustainability-related aspects, especially with relation to the natural environment, and encompass the flux of critical materials within a company's value chain. Such a comprehensive risk assessment takes into account input- as well as output-related factors. With this paper, we focus on the flux of carbon and define carbon constraints that emerge due to the disposition of fossil fuels in the input dimension and due to direct and indirect climate change effects in the output dimension. We review the literature regarding the financial consequences of carbon constraints on the macroeconomic, sector, and company level. We conclude that: a) financial consequences seem to be asymmetrically distributed between and within sectors, b) the individual risk exposure of companies depends on the intensity of and dependency on carbon-based materials and energy, and c) financial markets have only started to incorporate these aspects in their valuations. This paper ends with recommendations on how to incorporate our results in an integrated carbon risk management framework. (author)
Full Text Available Maria Concetta Interrigi,1 Francesca M Trovato,2,3 Daniela Catalano,3,4 Guglielmo M Trovato3,5 1Accident and Emergency Department, Ospedale Cannizzaro, Catania, 2Accident and Emergency Department, Ospedale Civile, Ragusa, 3Department of Clinical and Experimental Medicine, The School of Medicine, University of Catania, 4Postgraduate School of Clinical Ultrasound, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Policlinico, University of Catania, 5Postgraduate School of e-Learning and ICT in Health Sciences, The School of Medicine, University of Catania, Catania, Italy Purpose: Thoracic ultrasound (TUS has been proposed as an easy-option replacement for chest X-ray (CXR in emergency diagnosis of pneumonia, pleural effusion, and pneumothorax. We investigated CXR unforeseen diagnosis, subsequently investigated by TUS, considering its usefulness in clinical risk assessment and management and also assessing the sustainability of telementoring. Patients and methods: This observational report includes a period of 6 months with proactive concurrent adjunctive TUS diagnosis telementoring, which was done using freely available smartphone applications for transfer of images and movies. Results: Three hundred and seventy emergency TUS scans (excluding trauma patients were performed and telementored. In 310 cases, no significant chest pathology was detected either by CXR, TUS, or the subsequent work-up; in 24 patients, there was full concordance between TUS and CXR (ten isolated pleural effusion; eleven pleural effusion with lung consolidations; and three lung consolidation without pleural effusion; in ten patients with lung consolidations, abnormalities identified by CXR were not detected by TUS. In 26 patients, only TUS diagnosis criteria of disease were present: in 19 patients, CXR was not diagnostic, ie, substantially negative, but TUS detected these conditions correctly, and these were later confirmed by computed
In the present paper we discuss how to assist critical decisions taken under complex, contingent circumstances, with a high degree of uncertainty and short time frames. In such sharp-end decision regimes, standard rule-based decision support systems do not capture the complexity of the situation. At the same time, traditional risk analysis is of little use due to variability in the specific circumstances. How then, can an organisation provide assistance to, e.g. pilots in dealing with such emergencies? A method called 'contingent risk and decision analysis' is presented, to provide decision support for decisions under variable circumstances and short available time scales. The method consists of nine steps of definition, modelling, analysis and criteria definition to be performed 'off-line' by analysts, and procedure generation to transform the analysis result into an operational decision aid. Examples of pilots' decisions in response to sudden vibration in offshore helicopter transport method are used to illustrate the approach
Schmittberger, Bonnie L; Gauthier, Daniel J
The spontaneous formation of patterns in dynamical systems is a rich phenomenon that transcends scientific boundaries. Here, we report our observation of coupled optical–atomic pattern formation, which results in the creation of self-organized, multimode structures in free-space laser-driven cold atoms. We show that this process gives rise to spontaneous three-dimensional Sisyphus cooling even at very low light intensities and the emergence of self-organized structures on both sub- and super-wavelength scales. (paper)
Zhang, Lai; Thygesen, Uffe Høgsbro; Banerjee, Malay
intraspecific physiological variations at the individual level. Here we explore the impacts of size variation within species resulting from individual ontogeny, on the emergence of spatiotemporal patterns in a fully size-structured population model. We found that size dependency of animal's diffusivity greatly......, we found that the single-generation cycle is more likely to drive spatiotemporal patterns compared to predator-prey cycles, meaning that the mechanism of Hopf bifurcation might be more common than hitherto appreciated since the former cycle is more widespread than the latter in case of interacting...
Cabell, Sonia Q.; Justice, Laura M.; Konold, Timothy R.; McGinty, Anita S.
The purpose of this study was to explore patterns of within-group variability in the emergent literacy skills of preschoolers who are at risk for academic difficulties. We used the person-centered approach of cluster analysis to identify profiles of emergent literacy skills, taking into account both oral language and code-related skills.…
Holst, Charlotte; Becker, Ulrik; Jørgensen, Marit E
AIMS/HYPOTHESIS: Alcohol consumption is inversely associated with diabetes, but little is known about the role of drinking patterns. We examined the association between alcohol drinking patterns and diabetes risk in men and women from the general Danish population. METHODS: This cohort study...... was based on data from the Danish Health Examination Survey 2007-2008. Of the 76,484 survey participants, 28,704 men and 41,847 women were eligible for this study. Participants were followed for a median of 4.9 years. Self-reported questionnaires were used to obtain information on alcohol drinking patterns......, i.e. frequency of alcohol drinking, frequency of binge drinking, and consumption of wine, beer and spirits, from which we calculated beverage-specific and overall average weekly alcohol intake. Information on incident cases of diabetes was obtained from the Danish National Diabetes Register. Cox...
Araújo, Tanya; Ferreira, Manuel Ennes
This paper is a contribution to interweaving two lines of research that have progressed in separate ways: network analysis of international trade and the literature on African trade and development. Gathering empirical data on African countries has important limitations and so does the space occupied by African countries in the analysis of trade networks. Here, these limitations are dealt with by the definition of two independent bipartite networks: a destination share network and a commodity share network. These networks-together with their corresponding minimal spanning trees-allow to uncover some ordering emerging from African exports in the broader context of international trade. The emerging patterns help to understand important characteristics of African exports and its binding relations to other economic, geographic and organizational concerns as the recent literature on African trade, development and growth has shown.
Su, Run; Seu, Keoki A; Parks, Daniel; Kan, Jimmy J; Fullerton, Eric E; Roy, Sujoy; Kevan, Stephen D
Uniaxial systems often form labyrinthine domains that exhibit short-range order but are macroscopically isotropic and would not be expected to exhibit precise symmetries. However, their underlying frustration results in a multitude of metastable configurations of comparable energy, and driving such a system externally might lead to pattern formation. We find that soft x-ray speckle diffraction patterns of the labyrinthine domains in CoPd/IrMn heterostructures reveal a diverse array of hidden rotational symmetries about the magnetization axis, thereby suggesting an unusual form of emergent order in an otherwise disordered system. These symmetries depend on applied magnetic field, magnetization history, and scattering wave vector. Maps of rotational symmetry exhibit intriguing structures that can be controlled by manipulating the applied magnetic field in concert with the exchange bias condition. © 2011 American Physical Society
Krassovics, Miklós; Virágh, Gabriella
The aim of the survey was to gain understanding of women's usage patterns and attitudes towards emergency contraception (i.e., the 'morning after pill') and to gain insight into the role and attitudes of pharmacists as providers of emergency contraception. As part of the International Emergency Contraception Research Initiative, approximately 6500 women (15-49 years) and nearly 500 pharmacists from 14 countries in Western, Central and Eastern Europe, and Central Asia completed questionnaires via web-based interrogation or computer-assisted/paper-assisted personal interviews. Common to almost all countries and cultures was that, while awareness of emergency contraception was high (≥84% of respondents, except in Kazakhstan), usage was generally low (4-18%). In Austria, the Czech Republic, Spain, and the UK, better underlying protection with hormonal contraceptives or male condoms would have meant less need for emergency contraception. In Bulgaria, Lithuania, Romania, and Russia, greater dependence on less reliable contraceptive methods such as calendar + withdrawal was associated with higher use of the emergency contraceptive pill (11-18%) but also with higher abortion rates (19-21%). Overt rejection of emergency contraception in the event of an accident was low, except in countries (e.g., Austria, Poland) where the misperception that it acts as an abortifacient was common. Except for Bulgaria, pharmacists elsewhere tended to have limited knowledge and moralistic attitudes towards emergency contraception. Improved educational efforts, probably country-specific, are required to increase the use of highly effective methods of regular contraception and overcome barriers to acceptance of emergency contraception as a suitable postcoital solution to avoid unwanted pregnancy or abortion.
Valdez, Avelardo; Kaplan, Charles; Nowotny, Kathryn M; Natera-Rey, Guillermina; Cepeda, Alice
Recent studies in Mexico have documented a significant increase in crack cocaine use, indicating the potential for an emerging drug epidemic. Ethnographic observations and interviews were used describe the profiles and patterns of use among street-recruited crack users in Mexico City. The data came from an international research collaboration funded by the National Institutes of Health. A polythetic typology was developed based on five dimensions central to categorizing patterns of crack use behavior: frequency of use, duration of use, context, social networks, and social contracts. Four types of users were discovered applying these dimensions: dabblers, stable users, crack heads, and old heads. Although several similarities were documented between patterns of crack use in Mexico and those in the United States and Western Europe, several key aspects distinguished crack users in this population: (1) self-regulated use; (2) non-linear progression of crack; and (3) the influence of the dimensions pertaining to setting, social networks, and social contract as contributing to understanding of the previous two. Further, we provide a discussion of how specific contextual factors in Mexico may be giving rise to these emerging patterns. Compared to the U.S. and Europe, this study finds that the majority of crack users were able to self-regulate their use without major disruption to daily social functioning. As crack use spreads in Mexico and other Latin American countries, we need to recognize the importance of social context in developing more tailored health and social responses that are specific to these developing countries. Copyright © 2015 Elsevier B.V. All rights reserved.
Lammerding, A. M.; Paoli, G. M.
New challenges to the safety of the food supply require new strategies for evaluating and managing food safety risks. Changes in pathogens, food preparation, distribution, and consumption, and population immunity have the potential to adversely affect human health. Risk assessment offers a framework for predicting the impact of changes and trends on the provision of safe food. Risk assessment models facilitate the evaluation of active or passive changes in how foods are produced, processed, d...
Crowding is common in emergency departments (EDs) and increases the risk of medical errors, patient dissatisfaction, and clinician stress. The aim of this study is to investigate patterns in patient visits and bottlenecks in ED work in order to discuss the prospects of visualizing such patterns...... (mornings, boom days), patient throughput (staff work hours, linear workflows, manual data entry, overview of patient progress, personal competences), and patient output (no admissions at night, scheduling patient transfers, home transports). The patterns in patient arrivals and length of stay capture...... to help manage crowding. We analyze two years of data from a Danish ED for patterns in the patient visits and interview six clinicians from the ED about bottlenecks in their work. The hour of the day explains 50% of the variance in the number of patient arrivals. In addition, there are weekly and yearly...
Murray, A. B.; Alvarez Antolinez, J. A.; Mendez, F. J.; Moore, L. J.; Wood, J.; Farley, G.
A range of coastline shapes can emerge from large-scale morphodynamic interactions. Coastline shape determines local wave influences. Local wave influences (fluxes of alongshore momentum), determine sediment fluxes, and gradients in these sediment fluxes, in turn, alter coastline shape. Modeling studies show that such feedbacks lead to an instability, and to subsequent finite-amplitude interactions, producing self-organized patterns and emergent structures including sandwaves, capes, and spits (e.g. Ashton and Murray, 2006; Ashton et al., 2015); spiral bays on rocky coastlines (e.g. Barkwith et al., 2014); and convex, spit-bounded coastlines (Ells et al., in prep.). Coastline shapes depend sensitively on wave climate, defined as the angular distribution of wave influences on alongshore sediment transport. Therefore, shifts in wave climate arising from shifts in storms (decadal scale fluctuations or longer-term trends) will tend to change coastline shape. Previous efforts have detected changing coastline shape, likely related to changing influence from hurricane-generated waves, as expressed in changes in the location and intensity of coastal erosion zones along the cuspate capes in North Carolina, USA (Moore et al., 2013). These efforts involved the assumption that coastline response to changing forcing occurs in a quasi-equilibrium manner. However, in some cases coastline responses can exhibit long-term memory and path dependence (Thomas et al., 2016). Recently, we have hindcast the wave climate affecting the North Carolina coast since 1870, using a series of statistical analyses to downscale from basin-scale surface pressure fields to regional deep-water wave climate, and then a numerical transformation to local offshore wave climate. We used this wave climate as input for the Coastline Evolution Model (CEM). The results show that the emergent coastline features respond to decadal-scale shifts in wave climate, but with time lags that complicate the relationship
Amir Saadaoui, Younes Boujelbene
In this paper, we examine the relationship between liquidity, liquidity risk and credit risk in emerging sovereign bonds after the subprime crisis period. In our study, we concentrate in the effect of liquidity and credit risk in the problem of liquidity and in the emerging bond market. The presence of control variables, asymmetric information, amount outstanding, coupon, age and interest rate, assist to more explain this relationship. To explain the role of liquidity and credit risk in the p...
Thomas, Craig W; Vanderford, Marsha L; Crouse Quinn, Sandra
Evaluating emergency risk communications is fraught with challenges since communication can be approached from both a systemic and programmatic level. Therefore, one must consider stakeholders' perspectives, effectiveness issues, standards of evidence and utility, and channels of influence (e.g., mass media and law enforcement). Evaluation issues related to timing, evaluation questions, methods, measures, and accountability are raised in this dialogue with emergency risk communication specialists. Besides the usual evaluation competencies, evaluators in this area need to understand and work collaboratively with stakeholders and be attuned to the dynamic contextual nature of emergency risk communications. Sample resources and measures are provided here to aid in this emerging and exciting field of evaluation.
Bai, Xu; Liu, Yun
With the globalization of the world economy, international innovation collaboration has taken place all over the world. This study selects three emerging technologies (3D printing, big data and carbon nanotubes and graphene technology) among 20 countries as the research objects, using three patent-based indicators and network relationship analysis to reflect international collaboration patterns. Then we integrate empirical analyses to show effecting factors of international collaboration degrees by using panel data. The results indicate that while 3D printing technology is associated with a “balanced collaboration” mode, big data technology is more accurately described by a radial pattern, centered on the United States, and carbon nanotubes and graphene technology exhibits “small-world” characteristics in this respect. It also shows that the factors GDP per capita (GPC), R&D expenditure (RDE) and the export of global trade value (ETV) negatively affect the level of international collaboration. It could be useful for China and other developing countries to make international scientific and technological collaboration strategies and policies in the future. PMID:27911926
Full Text Available With the globalization of the world economy, international innovation collaboration has taken place all over the world. This study selects three emerging technologies (3D printing, big data and carbon nanotubes and graphene technology among 20 countries as the research objects, using three patent-based indicators and network relationship analysis to reflect international collaboration patterns. Then we integrate empirical analyses to show effecting factors of international collaboration degrees by using panel data. The results indicate that while 3D printing technology is associated with a "balanced collaboration" mode, big data technology is more accurately described by a radial pattern, centered on the United States, and carbon nanotubes and graphene technology exhibits "small-world" characteristics in this respect. It also shows that the factors GDP per capita (GPC, R&D expenditure (RDE and the export of global trade value (ETV negatively affect the level of international collaboration. It could be useful for China and other developing countries to make international scientific and technological collaboration strategies and policies in the future.
McGlynn, Gregory E.; Litt, Jonathan S.; Lemon, Kimberly A.; Csank, Jeffrey T.
Enhanced engine operation--operation that is beyond normal limits--has the potential to improve the adaptability and safety of aircraft in emergency situations. Intelligent use of enhanced engine operation to improve the handling qualities of the aircraft requires sophisticated risk estimation techniques and a risk management system that spans the flight and propulsion controllers. In this paper, an architecture that weighs the risks of the emergency and of possible engine performance enhancements to reduce overall risk to the aircraft is described. Two examples of emergency situations are presented to demonstrate the interaction between the flight and propulsion controllers to facilitate the enhanced operation.
Li, Jiuyong; Fu, Ada Wai-chee; Fahey, Paul
This paper studies a problem of efficiently discovering risk patterns in medical data. Risk patterns are defined by a statistical metric, relative risk, which has been widely used in epidemiological research. To avoid fruitless search in the complete exploration of risk patterns, we define optimal risk pattern set to exclude superfluous patterns, i.e. complicated patterns with lower relative risk than their corresponding simpler form patterns. We prove that mining optimal risk pattern sets conforms an anti-monotone property that supports an efficient mining algorithm. We propose an efficient algorithm for mining optimal risk pattern sets based on this property. We also propose a hierarchical structure to present discovered patterns for the easy perusal by domain experts. The proposed approach is compared with two well-known rule discovery methods, decision tree and association rule mining approaches on benchmark data sets and applied to a real world application. The proposed method discovers more and better quality risk patterns than a decision tree approach. The decision tree method is not designed for such applications and is inadequate for pattern exploring. The proposed method does not discover a large number of uninteresting superfluous patterns as an association mining approach does. The proposed method is more efficient than an association rule mining method. A real world case study shows that the method reveals some interesting risk patterns to medical practitioners. The proposed method is an efficient approach to explore risk patterns. It quickly identifies cohorts of patients that are vulnerable to a risk outcome from a large data set. The proposed method is useful for exploratory study on large medical data to generate and refine hypotheses. The method is also useful for designing medical surveillance systems.
Vogt, B.M.; Sorensen, J.H.
The CSEPP (Chemical Stockpile Emergency Preparedness Program) was created to improve emergency planning and response capabilities at the eight sites around the country that store chemical weapons. These weapons are scheduled to be destroyed in the near future. In preparation of the Draft Programmatic Environmental Impact Statement (DPEIS) for the Chemical Stockpile Disposal Program (CSDP), it was proposed that the Army mitigate accidents through an enhanced community emergency preparedness program at the eight storage sites. In 1986, the Army initiated the development of an Emergency Response Concept Plan (ERCP) for the CSDP, one of 12 technical support studies conducted during preparation of the Final Programmatic Environmental Impact Statement (FPEIS). The purpose of this document is to provide a fairly comprehensive source book on risk, risk management, risk communication research and recommended risk communication practices. It does not merely summarize each publication in the risk communication literature, but attempts to synthesize them along the lines of a set of organizing principles. Furthermore, it is not intended to duplicate other guidance manuals (such as Covello et al.`s manual on risk comparison). The source book was developed for the CSEPP in support of the training module on risk communications. Although the examples provided are specific to CSEPP, its use goes beyond that of CSEPP as the findings apply to a broad spectrum of risk communication topics. While the emphasis is on communication in emergency preparedness and response specific to the CSEPP, the materials cover other non-emergency communication settings. 329 refs.
Wilson, J.W.; Cucinotta, F.A.; Schimmerling, W.
Past space missions beyond the confines of the Earth's protective magnetic field have been of short duration and protection from the effects of solar particle events was of primary concern. The extension of operational infrastructure beyond low-Earth orbit to enable routine access to more interesting regions of space will require protection from the hazards of the accumulated exposures of Galactic Cosmic Rays (GCR). There are significant challenges in providing protection from the long-duration exposure to GCR: the human risks to the exposures are highly uncertain and safety requirements places unreasonable demands in supplying sufficient shielding materials in the design. A vigorous approach to future radiation health-risk mitigation requires a triage of techniques (using biological and technical factors) and reduction of the uncertainty in radiation risk models. The present paper discusses the triage of factors for risk mitigation with associated materials issues and engineering design methods
Full Text Available Disasters are one of the most important challenges which must be considered by every management system. Higher education centers have high disaster risk because of their risk factors (existence of historical and scientific documents and resources and expensive laboratory equipment in these centers emphasizes the importance of disaster management. Moreover, the existence of young volunteers of human resources in universities urges the necessity of making these people familiar with disaster management rules and responses in emergency conditions. Creating appropriate tools for disaster management assessment makes it correct and precise in higher education systems using the presented conceptual model. The present model was planned so as to cover three phases which exist before, during, and after disaster. Studies were performed in one of the largest higher education centers in Tehran: Science and Research Branch of Islamic Azad University Campus. Results showed high-risk disasters in these centers which must be taken into consideration continuously. The objective of this study was to create appropriate patterns of disaster risk management in these centers.
Perotti, E.C.; van Oijen, P.H.
This paper investigates whether privatisation in emerging economies has a significant indirect effect on local stock market development through the resolution of political risk. We argue that a sustained privatisation programme represents a major political test which gradually resolves uncertainty
Clarke, Mary C
This article gives an overview of genetic and environmental risk factors for schizophrenia. The presence of certain molecular, biological, and psychosocial factors at certain points in the life span, has been linked to later development of schizophrenia. All need to be considered in the context of schizophrenia as a lifelong brain disorder. Research interest in schizophrenia is shifting to late childhood\\/early adolescence for screening and preventative measures. This article discusses those environmental risk factors for schizophrenia for which there is the largest evidence base.
Duell, Natasha; Steinberg, Laurence; Icenogle, Grace; Chein, Jason; Chaudhary, Nandita; Di Giunta, Laura; Dodge, Kenneth A; Fanti, Kostas A; Lansford, Jennifer E; Oburu, Paul; Pastorelli, Concetta; Skinner, Ann T; Sorbring, Emma; Tapanya, Sombat; Uribe Tirado, Liliana Maria; Alampay, Liane Peña; Al-Hassan, Suha M; Takash, Hanan M S; Bacchini, Dario; Chang, Lei
Epidemiological data indicate that risk behaviors are among the leading causes of adolescent morbidity and mortality worldwide. Consistent with this, laboratory-based studies of age differences in risk behavior allude to a peak in adolescence, suggesting that adolescents demonstrate a heightened propensity, or inherent inclination, to take risks. Unlike epidemiological reports, studies of risk taking propensity have been limited to Western samples, leaving questions about the extent to which heightened risk taking propensity is an inherent or culturally constructed aspect of adolescence. In the present study, age patterns in risk-taking propensity (using two laboratory tasks: the Stoplight and the BART) and real-world risk taking (using self-reports of health and antisocial risk taking) were examined in a sample of 5227 individuals (50.7% female) ages 10-30 (M = 17.05 years, SD = 5.91) from 11 Western and non-Western countries (China, Colombia, Cyprus, India, Italy, Jordan, Kenya, the Philippines, Sweden, Thailand, and the US). Two hypotheses were tested: (1) risk taking follows an inverted-U pattern across age groups, peaking earlier on measures of risk taking propensity than on measures of real-world risk taking, and (2) age patterns in risk taking propensity are more consistent across countries than age patterns in real-world risk taking. Overall, risk taking followed the hypothesized inverted-U pattern across age groups, with health risk taking evincing the latest peak. Age patterns in risk taking propensity were more consistent across countries than age patterns in real-world risk taking. Results suggest that although the association between age and risk taking is sensitive to measurement and culture, around the world, risk taking is generally highest among late adolescents.
Vlastarakos, Petros V; Vassileiou, Andrianna; Delicha, Evie; Kikidis, Dimitrios; Protopapas, Dimosthenis; Nikolopoulos, Thomas P
We conducted a case-control study to investigate the effect of diet on laryngeal carcinogenesis. Our study population was made up of 140 participants-70 patients with laryngeal cancer (LC) and 70 controls with a non-neoplastic condition that was unrelated to diet, smoking, or alcohol. A food-frequency questionnaire determined the mean consumption of 113 different items during the 3 years prior to symptom onset. Total energy intake and cooking mode were also noted. The relative risk, odds ratio (OR), and 95% confidence interval (CI) were estimated by multiple logistic regression analysis. We found that the total energy intake was significantly higher in the LC group (p pastas) was also higher among the LC patients (p = 0.043), with logistic regression analysis showing that their negative effect was possibly associated with the sauces and dressings that traditionally accompany pasta dishes (p = 0.006; OR: 4.78). Conversely, a higher consumption of dairy products was found in controls (p < 0.05); logistic regression analysis showed that calcium appeared to be protective at the micronutrient level (p < 0.001; OR: 0.27). We found no difference in the overall consumption of fruits and vegetables between the LC patients and controls; however, the LC patients did have a greater consumption of cooked tomatoes and cooked root vegetables (p = 0.039 for both), and the controls had more consumption of leeks (p = 0.042) and, among controls younger than 65 years, cooked beans (p = 0.037). Lemon (p = 0.037), squeezed fruit juice (p = 0.032), and watermelon (p = 0.018) were also more frequently consumed by the controls. Other differences at the micronutrient level included greater consumption by the LC patients of retinol (p = 0.044), polyunsaturated fats (p = 0.041), and linoleic acid (p = 0.008); LC patients younger than 65 years also had greater intake of riboflavin (p = 0.045). We conclude that the differences in dietary consumption patterns between LC patients and controls
Abshire, Demetrius Alexander
The purpose of this dissertation was to examine factors associated with cardiovascular disease (CVD) risk among emerging adults in college aged 18-25 years. CVD risks that develop during this period often persist into adulthood making it an ideal time to target CVD prevention. The specific aims of this dissertation were to 1) explore perceptions…
Martin-Smith, James D
Hurling is an Irish national game of stick and ball known for its ferocity, played by 190 000 players. Facial injuries were common but have been significantly reduced by legislation enforcing compulsory helmet wearing. Current standard helmets worn by hurlers do not offer protection to the external ear. Here we describe an emerging pattern of ear injuries and demonstrate the risk of external ear injuries in hurlers complying with current helmet safety standards. A 6-month retrospective analysis was carried out of patients attending Cork University Hospital (CUH) with ear lacerations sustained while hurling. Patient notes were reviewed and helmet manufacturers were interviewed. Seven patients were identified, all of whom sustained complex through ear lacerations while wearing helmets complying with current safety standards. Current helmet design fails to protect the external ear placing it at an increased risk of injury, a potential solution is to include ear protection in the helmet design.
Following health crisis that have occurred in the nineties (contaminated blood, mad cow, asbestos, etc.) and more recently those generated by the heat wave in 2003 or by emerging infectious pathogens (SARS, West Nile, Chikungunya, H5N1, H1N1…), a real health vigilance system has been progressively developed in France. After a brief historical overview of the health alert system, this article will give the guiding principles of its current organization in France and will present two examples of recent health alerts (Chikungunya in the Reunion Island in 2005-2006 and hepatitis A outbreak in the Côtes-d'Armor in August 2007), that have needed the implementation of preventive measures regarding the blood donor selection. These two examples have shown that the position of the alert in the French health vigilance system needs to be very close to the event. In that case, health alert is a very useful tool for decision making especially when measures have to be taken to prevent transfusion-transmitted pathogens. Copyright © 2010 Elsevier Masson SAS. All rights reserved.
The relationship of snacking patterns on nutrient intake and cardiovascular risk factors in adults is unknown. The aim of this study was to examine the associations of snacking patterns with nutrient intake, diet quality, and a selection of cardiovascular risk factors in adults participating in the ...
Poppen, Paul J.
Determined the role gender plays in influencing the prevalence and patterns of sexual risk taking. Responses from 245 undergraduate students show gender differences in risk-taking patterns. For females, potentially risky behavior in the partner domain was negatively related to risky behavior in the sexual practice domain, whereas for males, the…
The topic of this symposium is the quest to discover, define, and interpret patterns in the universe. This quest has two parts. To discover and define these patterns is the task of science: this part of the quest is producing a copious flow of reliable information. To interpret or give meaning to these patterns is the task of natural philosophy: this part has not kept pace
Yogui, Regiane Tiemi Teruya [Bureau Veritas do Brasil, Rio de Janeiro, RJ (Brazil); Macedo, Eduardo Soares de [Instituto de Pesquisas Tecnologicas (IPT), Sao Paulo, SP (Brazil)
Several environmental accidents happened in Brazil and in the world during the 70's and 80's. This strongly motivated the preparation for emergencies in the chemical and petrochemical industries. Environmental accidents affect the environment and the communities that are neighbor to the industrial facilities. The present study aims at subsidizing and providing orientation to develop Emergency Planning from the data obtained on Quantitative Risk Analysis, elaborated according to the Technical Standard P4.261/03 from CETESB (Sao Paulo Environmental Agency). It was observed, during the development of the research, that the data generated on these studies need a complementation and a deeper analysis, so that it is possible to use them on the Emergency Plans. The main issues that were analyzed and discussed on this study were the reevaluation of hazard identification for the emergency plans, the consequences and vulnerability analysis for the response planning, the risk communication, and the preparation to respond to the emergencies of the communities exposed to manageable risks. As a result, the study intends to improve the interpretation and use of the data deriving from the Quantitative Risk Analysis to develop the emergency plans. (author)
Hansen, Kristian Schultz; Enemark, Ulrika; Foldspang, Anders
, 1997-2003. Data were extracted from administrative registries including information on individual use of emergency services and other hospital care, contact with GPs and socioeconomic background. Health services' use by the Morsø population was measured before reduction in emergency room opening hours...... of substitute health services. By contrast, Morsø women compared to the rest of Viborg county reduced their use of GP services in terms of face-to-face visits (β = -0.08, P = 0.020), telephone consultations (β = -0.11, P = 0.007), home visits (β = -0.48, P = 0.009), and their inpatient hospital utilization (β...... = -0.12, P = 0.022) during the period when emergeny services were only available in the daytime. CONCLUSIONS: Emergency services at neighbouring hospitals (40 kilometres distance) were able to compensate, in part, for the decreased local emergency service provision. Concurrent changes in health care...
Full Text Available Many patterns of affiliative behaviour have been described for primates, for instance: reciprocation and exchange of grooming, grooming others of similar rank, reconciliation of fights, and preferential reconciliation with more valuable partners. For these patterns several functions and underlying cognitive processes have been suggested. It is, however, difficult to imagine how animals may combine these diverse considerations in their mind. Although the co-variation hypothesis, by limiting the social possibilities an individual has, constrains the number of cognitive considerations an individual has to take, it does not present an integrated theory of affiliative patterns either. In the present paper, after surveying patterns of affiliation in egalitarian and despotic macaques, we use an individual-based model with a high potential for self-organisation as a starting point for such an integrative approach. In our model, called GrooFiWorld, individuals group and, upon meeting each other, may perform a dominance interaction of which the outcomes of winning and losing are self-reinforcing. Besides, if individuals think they will be defeated, they consider grooming others. Here, the greater their anxiety is, the greater their "motivation" to groom others. Our model generates patterns similar to many affiliative patterns of empirical data. By merely increasing the intensity of aggression, affiliative patterns in the model change from those resembling egalitarian macaques to those resembling despotic ones. Our model produces such patterns without assuming in the mind of the individual the specific cognitive processes that are usually thought to underlie these patterns (such as recordkeeping of the acts given and received, a tendency to exchange, memory of the former fight, selective attraction to the former opponent, and estimation of the value of a relationship. Our model can be used as a null model to increase our understanding of affiliative
Banerjee, Amitava; Taillandier, Sophie; Olesen, Jonas Bjerring
BACKGROUND: Risk of stroke and thromboembolism (TE) in patients with non-valvular atrial fibrillation (NVAF) is categorised in stroke risk stratification scores. The role of pattern of NVAF in risk prediction is unclear in contemporary 'real world' cohorts. METHODS AND RESULTS: Patients with NVAF...
formal evaluation scheduled – Case Studies, Eight Examples: Tissue Engineering, Cold Fusion, RF Metamaterials, DNA Microarrays, Genetic Algorithms, RNAi...emerging capabilities Case Studies, Eight Examples: • Tissue Engineering, Cold Fusion, RF Metamaterials, DNA Microarrays, Genetic Algorithms...Evidence Quality (i.e., the rubric ) and deliver comprehensible evidential support for nomination • Demonstrate proof-of-concept nomination for Chinese
The highest mortality within the first 24 hours of admission was recorded among patients with malaria (89.0%) followed by protein energy malnutrition. CONCLUSION: Majority of deaths among emergency paediatric admission occur within the first 24 hours of admission and are associated with clinical conditions such as ...
LINKOV IGOR; TRUMP BENJAMIN D.; ANKLAM ELKE; BERBUBE DAVID; BOISSEAU PATRICK; CUMMINGS CHRISTOPHER; FERSON SCOTT; FLORIN MARIE-VALENTINE; GOLDSTEIN BERNARD; HRISTOZOV DANAIL; JENSEN KELD ASTRUP; KATALAGARIANAKIS GEORGIOS; KUZMA JENNIFER; LAMBERT JAMES H.; MALLOY TIMOTHY
Various emerging technologies challenge existing governance processes to identify, assess, and manage risk. Though the existing risk-based paradigm has been essential for assessment of many chemical, biological, radiological, and nuclear technologies, a complementary approach may be warranted for the early-stage assessment and management challenges of high uncertainty technologies ranging from nanotechnology to synthetic biology to artificial intelligence, among many others. This ...
Cristiane Chaves de Souza
Full Text Available Objective. Get to know how nurses perceive the accomplishment of risk classification in an emergency service. Methodology. In this qualitative study, 11 nurses were included with at least two months of experience in the risk classification of patients who visited the emergency service. Semistructured interviews were used to collect the information. The data were collected between August and December 2011. For data analysis, Bardin's theoretical framework was used. Results. The nurses in the study consider the risk classification as a work organization instruments that permits closer contact between nurses and patients. The nursing skills needed for risk classification were identified: knowledge about the scale used, clinical perspective, patience and agility. The availability of risk classification scales was the main facilitator of this work. The main difficulties were the disorganization of the care network and the health team's lack of knowledge of the protocol. Conclusion. Risk classification offers an opportunity for professional autonomy to the extent that it is the main responsible for regulating care at the entry door of the emergency services.
This paper analyses the possible spreading of environmentally friendly behaviours to more and more areas of the consumption pattern as well as possible conditions for such a tendency. The conditions in focus are individuals' possession of certain attitudes or values and the degree to which product...... pattern over time. Here, the overwhelming evidence points towards stability rather than change. On the other hand, the cross-sectional evidence indicates that under the right conditions consumers tend to be consistent in their propensity to shop in an environment-friendly way. Hence, it follows...
Balduccelli, C.; Bologna, S.; Di Costanzo, G.; Vicoli, G.
This document provides an overview about problems related to the engineering of computer based systems for industrial risk prevention and emergency management. Such systems are rather complex and subject to precise reliability and safety requirements. With the evolution of informatic technologies, such systems are becoming to be the means for building protective barriers for reduction of risk associated with plant operations. For giving more generality to this document, and for not concentrating on only a specific plant, the emergency management systems will be dealt with more details than ones for accident prevention. The document is organized in six chapters. Chapter one is an introduction to the problem and to its state of art, with particular emphasis to the aspects of safety requirements definition. Chapter two is an introduction to the problems related to the emergency management and to the training of operators in charge of this task. Chapter three deals in details the topic of the Training Support Systems, in particular about MUSTER (multi-user system for training and evaluation of environmental emergency response) system. Chapter four deals in details the topic of decision support systems, in particular about ISEM (information technology support for emergency management) system. Chapter five illustrates an application of support to the operators of Civil Protection Department for the management of emergencies in the fields of industrial chemical. Chapter six is about a synthesis of the state of art and the future possibilities, identifying some research and development activities more promising for the future
Perotti, E.C.; van Oijen, P. H.
This paper investigates whether privatization in emerging economies has a significant indirect effect on local stock market development through the resolution of political risk. We argue that a sustained privatization program represents a major political test that gradually resolves uncertainty over
In this article, we explore the effect of large-scale natural disasters on sovereign default risk. We use a heterogeneous dynamic panel model including a set of more than 380 large-scale natural disasters for about forty emerging market countries in the period 1999-2010. After testing for the
Perotti, E.C.; van Oijen, P.H.
This paper investigates whether privatization in emerging economies has a significant indirect effect on local stock market development through the resolution of political risk. We argue that a sustained privatization program represents a major political test that gradually resolves uncertainty over
Kouwenberg, R.; Salomons, R.M.
Our results confirm the profitability of value investing at the country level in emerging markets. A portfolio of countries with low price-to-book ratios significantly outperforms a portfolio of high price-to-book countries. Global risk factors cannot explain this outperformance. Next we measure a
The n-tuple recognition net is seen as a building brick of a progression of network structures. The emergent intelligent properties of such systems are discussed. They include the amplification of confidence for the recognition of images that differ in small detail, a short term memory of the last seen image, sequence sensitivity, sequence sensitivity, sequence acceptance and saccadic inspection as an aid in scene analysis. 12 references.
Water security and emergent environmental risks are among the most significant societal concerns. They are highly interlinked to other global risks such as those related to climate, human health, food, human migration, biodiversity loss, urban sustainability, etc. Emergent risks result from the confluence of unanticipated interactions from evolving interdependencies between complex systems, such as those embedded in the water cycle. They are associated with the novelty of dynamical possibilities that have significant potential consequences to human and ecological systems, and not with probabilities based on historical precedence. To ensure water security we need to be able to anticipate the likelihood of risk possibilities as they present the prospect of the most impact through cascade of vulnerabilities. They arise due to a confluence of nonstationary drivers that include growing population, climate change, demographic shifts, urban growth, and economic expansion, among others, which create novel interdependencies leading to a potential of cascading network effects. Hydrocomplexity aims to address water security and emergent risks through the development of science, methods, and practices with the potential to foster a "Blue Revolution" akin to the Green revolution for food security. It blends both hard infrastructure based solution with soft knowledge driven solutions to increase the range of planning and design, management, mitigation and adaptation strategies. It provides a conceptual and synthetic framework to enable us to integrate discovery science and engineering, observational and information science, computational and communication systems, and social and institutional approaches to address consequential water and environmental challenges.
Feng, Yu-Liang; Shu, Long; Zheng, Pei-Fen; Zhang, Xiao-Yan; Si, Cai-Juan; Yu, Xiao-Long; Gao, Wei; Zhang, Lun
The analysis of dietary patterns has recently drawn considerable attention as a method of investigating the association between the overall whole diet and the risk of colorectal cancer. However, the results have yielded conflicting findings. Here, we carried out a meta-analysis to identify the association between dietary patterns and the risk of colorectal cancer. A total of 40 studies fulfilled the inclusion criteria and were included in this meta-analysis. The highest category of 'healthy' dietary pattern compared with the lowest category was apparently associated with a decreased risk for colorectal cancer [odds ratio (OR)=0.75; confidence interval (CI): 0.68-0.83; Pcolorectal cancer was shown for the highest compared with the lowest category of a 'western-style' dietary pattern (OR=1.40; CI: 1.26-1.56; Pcolorectal cancer in the highest compared with the lowest category of 'alcohol-consumption' pattern (OR=1.44; CI: 1.13-1.82; P=0.003). The results of this meta-analysis indicate that a 'healthy' dietary pattern may decrease the risk of colorectal cancer, whereas 'western-style' and 'alcohol-consumption' patterns may increase the risk of colorectal cancer.
Shochat, Eyal; Warren, Paige S; Faeth, Stanley H; McIntyre, Nancy E; Hope, Diane
Rapid urbanization has become an area of crucial concern in conservation owing to the radical changes in habitat structure and loss of species engendered by urban and suburban development. Here, we draw on recent mechanistic ecological studies to argue that, in addition to altered habitat structure, three major processes contribute to the patterns of reduced species diversity and elevated abundance of many species in urban environments. These activities, in turn, lead to changes in animal behavior, morphology and genetics, as well as in selection pressures on animals and plants. Thus, the key to understanding urban patterns is to balance studying processes at the individual level with an integrated examination of environmental forces at the ecosystem scale.
Sinka, D.; Mikulicic, V.
The paper demonstrates, by example of the Republic of Croatia, the possibilities of implementing risk assessment as basis for nuclear accident emergency preparedness development. Individual risks of severe accidents for citizens of the biggest Croatian population centers, as well as collective risk for entire population have been assessed using the PRONEL method. The assessment covered 90 power reactors located at a distance up to 1.000 km. The conducted assessment shows the risks for various regions of the Republic of Croatia, and comparison between them. If risk would be taken as basic criterion in nuclear emergency planning, the results of assessment would directly indicate the necessary preparation level for each region. Furthermore, the assessment of risks from individual power plants and power plant types indicates to which facilities the greatest attention should be paid in nuclear accidents preparedness development. Risks from groups of power plants formed in accordance with their respective distance from exposure location shows what kind of tools for determining consequences and protective actions during a nuclear accident should be made available. (author)
Randi, Giorgia; Edefonti, Valeria; Ferraroni, Monica; La Vecchia, Carlo; Decarli, Adriano
The association of colorectal cancer risk with select foods has been evaluated by dietary pattern analysis. This review of the literature was conducted to thoroughly examine the available evidence for the association between dietary patterns and colorectal cancers and adenomas. A total of 32 articles based on worldwide epidemiological studies were identified. Pattern identification was achieved by exploratory data analyses (principal component, factor, and cluster analyses) in most articles, and only a few used a priori-defined scores. Dietary patterns named as healthy, prudent, fruit and vegetables, fat-reduced/diet foods, vegetable/fish/poultry, fruit/whole grain/dairy, and healthy eating index-2005, recommended food and Mediterranean diet scores were all associated with reduced risk of colorectal cancer and the risk estimates varied from 0.45 to 0.90. In contrast, diets named Western, pork-processed meat-potatoes, meat-eaters, meat and potatoes, traditional patterns, and dietary risk and life summary scores were associated with increased risk of colorectal cancer with risk estimates varying from 1.18 to 11.7. Dietary patterns for adenomas were consistent with those identified for colorectal cancer.
Brigham, Emily P; Steffen, Lyn M; London, Stephanie J; Boyce, Danielle; Diette, Gregory B; Hansel, Nadia N; Rice, Jessica; McCormack, Meredith C
Dietary intake is a potential risk factor for respiratory morbidity in adult populations. Few studies capture the effect of diet patterns, representative of combination of nutrients consumed, on respiratory morbidity in combination with objective measures of lung function. To evaluate patterns of dietary intake in relation to respiratory morbidity and objective measures of lung function in a U.S. The Atherosclerosis Risk in Communities (ARIC) Study enrolled 15,792 participants from four U.S. communities between 1987-1989 and collected a validated food frequency questionnaire to assess diet. Principal components analysis was applied and patterns representative of "Western" and "Prudent" diet emerged. We investigated associations between dietary pattern and pulmonary assessments including asthma and chronic obstructive pulmonary disease (COPD) diagnosis, respiratory symptoms, and lung function. Multivariable logistic regression models included quintiles of dietary patterns and potential confounders. Interaction of dietary patterns with obesity, gender, and smoking status was assessed in relation to all outcomes. A "Western" diet pattern was associated with higher odds of COPD, wheeze, cough, phlegm, and worse lung function, whereas a "Prudent" diet pattern was associated with lower odds of COPD, cough, and better lung function. The prevalence of asthma was not related to dietary intake. Dietary pattern was significantly associated with respiratory outcomes in ARIC participants. A "Western" diet was adverse, whereas a "Prudent" diet was beneficially related to respiratory morbidity and objective measures of lung function. Additional studies of dietary pattern in U.S. populations are needed to verify this effect.
Engagement of the financial sector in the climate change debate is apparent, with social investors and advocacy groups launching 32 climate change related shareholder resolutions with American and Canadian energy companies in 2003. Eos Research and Consulting Ltd. recently conducted a study to examine emerging standards for how energy companies manage climate change related risks. A survey was conducted in the first part of the study to determine the environmental awareness of energy companies. Financial firms were asked whether they sought information concerning GHG inventories; projections of future emissions; action plans for addressing climate change and energy efficiency; evaluation of relative risk; estimation of cost of carbon; assessment of financial impact; evaluation of future regulations; and emissions trading activity. The second part of the study compared the response of 11 leading energy companies. The result was 2 opposing views on how climate change risks should be managed. The survey revealed that while most mainstream financial institutions are not paying much attention to climate change issues, socially responsible investment (SRI) investors are aware and working to factor climate change risk management information into their activities. In addition, SRI is growing at a faster pace than other investment segments, which may lead to greater future expectations for energy companies' climate change risk management efforts. It was concluded that the financial sector may emerge as an important source of direction that will guide energy companies in their future efforts to manage climate change risks. The five trends that contribute to the sector's emerging role are the continuing influence of advocacy groups; evolution of socially responsible approaches to investment; growing concerns for reputation; development of financial risk assessment approaches in terms of climate change; and, increase focus on corporate governance issues. 15 refs., 2 tabs., 1
Xi, Wang; Sonam, Surabhi; Beng Saw, Thuan; Ladoux, Benoit; Teck Lim, Chwee
Collective epithelial behaviors are essential for the development of lumens in organs. However, conventional assays of planar systems fail to replicate cell cohorts of tubular structures that advance in concerted ways on out-of-plane curved and confined surfaces, such as ductal elongation in vivo. Here, we mimic such coordinated tissue migration by forming lumens of epithelial cell sheets inside microtubes of 1-10 cell lengths in diameter. We show that these cell tubes reproduce the physiological apical-basal polarity, and have actin alignment, cell orientation, tissue organization, and migration modes that depend on the extent of tubular confinement and/or curvature. In contrast to flat constraint, the cell sheets in a highly constricted smaller microtube demonstrate slow motion with periodic relaxation, but fast overall movement in large microtubes. Altogether, our findings provide insights into the emerging migratory modes for epithelial migration and growth under tubular confinement, which are reminiscent of the in vivo scenario.
Fung, Teresa T; Brown, Lisa S
Diet and lifestyle play a significant role in the development of colorectal cancer, but the full complexity of the association is not yet understood. Dietary pattern analysis is an important new technique that may help to elucidate the relationship. This review examines the most common techniques for extrapolating dietary patterns and reviews dietary pattern/colorectal cancer studies published between September 2011 and August 2012. The studies reviewed are consistent with prior research but include a more diverse international population. Results from investigations using a priori dietary patterns (i.e., diet quality scores) and a posteriori methods, which identify existing eating patterns (i.e., principal component analysis), continue to support the benefits of a plant-based diet with some dairy as a means to lower the risk of colorectal cancer, whereas a diet high in meats, refined grains, and added sugar appears to increase risk. The association between colorectal cancer and alcohol remains unclear.
Li, Ye; Lv, Mei-Rong; Wei, Yan-Jin; Sun, Ling; Zhang, Ji-Xiang; Zhang, Huai-Guo; Li, Bin
Although some studies have reported potential associations of dietary patterns with depression risk, a consistent perspective hasn't been estimated to date. Therefore, we conducted this meta-analysis to evaluate the relation between dietary patterns and the risk of depression. A literature research was conducted searching MEDLINE and EMBASE databases up to September 2016. In total, 21 studies from ten countries met the inclusion criteria and were included in the present meta-analysis. A dietary pattern characterized by a high intakes of fruit, vegetables, whole grain, fish, olive oil, low-fat dairy and antioxidants and low intakes of animal foods was apparently associated with a decreased risk of depression. A dietary pattern characterized by a high consumption of red and/or processed meat, refined grains, sweets, high-fat dairy products, butter, potatoes and high-fat gravy, and low intakes of fruits and vegetables is associated with an increased risk of depression. The results of this meta-analysis suggest that healthy pattern may decrease the risk of depression, whereas western-style may increase the risk of depression. However, more randomized controlled trails and cohort studies are urgently required to confirm this findings. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.
Manouchehr Omidvari; N. Mansouri
Material hazards are the most important risk in scientific laboratories. In risk assessment processing, the potential impact of assessor personal judgment is the most important issue. This study tried to develop a risk assessment pattern based on Failure Mode and Effect Analysis (FMEA) and Analytical Hierarchy Process (AHP) logics and empirical data in scientific laboratories. The most important issues were high pressure reservoirs and hardware failure fuel. The other type of data about b...
Arrieta, Carlos; Navarro, José; Vicente, Susana
Several longitudinal studies have shown that motivation at work acts chaotically. In very few cases, it may be linear or random. However, the factors that might explain why these different patterns emerge have not been analysed to date. In this exploratory study, we interviewed 73 employees whose motivational patterns were previously known. The results revealed that chaotic patterns were associated with high levels of motivation, self-efficacy beliefs, and perceptions of instrumentality, and also with intrinsic personal goal orientation and a perception of high work control. Linear patterns were associated with extrinsic goals and a perception of work as difficult, and random patterns were linked to high flexibility at work.
Reynolds, Barbara; W Seeger, Matthew
This article describes a model of communication known as crisis and emergency risk communication (CERC). The model is outlined as a merger of many traditional notions of health and risk communication with work in crisis and disaster communication. The specific kinds of communication activities that should be called for at various stages of disaster or crisis development are outlined. Although crises are by definition uncertain, equivocal, and often chaotic situations, the CERC model is presented as a tool health communicators can use to help manage these complex events.
Full Text Available The rising trend of new business opportunities, triggered by the emerging technologies, has substantially contributed to the recovery of the global economy in recent years. The global growth supported by modern technology, however, has also generated a new wave of complex, mutually intertwined and rather changeable risks, which are unambiguously warning against the uncertainties arising in the economic environment. A thorough and continuous monitoring of these risks has become an imperative for business entities in the function of protecting the operations of enterprises and banks.
Gu, Tao; Wang, Liang; Chen, Hanhua
Body Sensor Networks oer many applications in healthcare, well-being and entertainment. One of the emerging applications is recognizing activities of daily living. In this paper, we introduce a novel knowledge pattern named Emerging Sequential Pattern (ESP)|a sequential pattern that discovers...... signicant class dierences|to recognize both simple (i.e., sequential) and complex (i.e., interleaved and concurrent) activities. Based on ESPs, we build our complex activity models directly upon the sequential model to recognize both activity types. We conduct comprehensive empirical studies to evaluate...
Perotti, E.C.; van Oijen, P.H.
This paper investigates whether privatization in emerging economies has a significant indirect effect on local stock market development through the resolution of political risk. We argue that a sustained privatization program represents a major political test that gradually resolves uncertainty over political commitment to a market-oriented policy as well as to regulatory and private property rights. We present evidence suggesting that progress in privatization is indeed correlated with impro...
Park, Yoon; Lee, Jeonghee; Oh, Jae Hwan; Shin, Aesun; Kim, Jeongseon
Abstract Colorectal cancer (CRC) has been recognized as one of the major malignancies in Korea. Analyses of dietary patterns can provide insight into the complex interactions of foods, nutrients, and biologically active components within a diet, which vary among populations. We aimed to investigate the associations between dietary patterns and colorectal cancer risk in Koreans. In a study of 923 cases and 1846 controls, principal component analysis was used to identify dietary patterns based on 33 predefined food groups using a 106-item semiquantitative food frequency questionnaire (SQFFQ). The associations between dietary patterns and CRC risk were assessed using binary and polytomous logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Three dietary patterns (traditional, Westernized, and prudent) were derived. The proportion of total variation explained by 3 patterns was 24.2% for men and 25.3% for women. The traditional and prudent patterns were inversely associated with CRC risk [OR and 95% CI for the highest intake tertile of pattern score vs. the lowest = 0.35 (0.27–0.46) and 0.37 (0.28–0.48), respectively], whereas the Westernized pattern showed a positive association, especially among women [OR = 2.13 (1.35–3.34) for the highest tertile vs. the lowest]. A decrease in CRC risk among those with the highest intake of the prudent pattern was observed in all anatomical subsites in both men [OR = 0.36 (0.19–0.68) for proximal colon; 0.21 (0.12–0.36) for distal colon; 0.28 (0.18–0.44) for rectum] and women [OR = 0.28 (0.11–0.71); 0.27 (0.13–0.54); 0.45 (0.25–0.83)]. Our results indicate that individuals who prefer the Westernized dietary pattern should be made aware of their increased CRC risk. The traditional dietary pattern and the prudent pattern, which are rich in fruits and dairy products, are recommended for the Korean population to prevent CRC. PMID:27336862
Hanna, Tarek N; Shekhani, Haris; Lamoureux, Christine; Mar, Hanna; Nicola, Refky; Sliker, Clint; Johnson, Jamlik-Omari
To assess the practice environment of emergency radiologists with a focus on schedule, job satisfaction, and self-perception of health, wellness, and diagnostic accuracy. A survey drawing from prior radiology and health care shift-work literature was distributed via e-mail to national societies, teleradiology groups, and private practices. The survey remained open for 4 weeks in 2016, with one reminder. Data were analyzed using hypothesis testing and logistic regression modeling. Response rate was 29.6% (327/1106); 69.1% of respondents (n = 226) were greater than 40 years old, 73% (n = 240) were male, and 87% (n = 284) practiced full time. With regard to annual overnight shifts (NS): 36% (n = 118) did none, 24.9% (n = 81) did 182 or more, and 15.6% (n = 51) did 119. There was a significant association between average NS worked per year and both perceived negative health effects (P impact on memory (P job enjoyment and number of annual NS (P job" for radiologists who work no NS is 2.21 times greater than for radiologists who work at least 119 NS, when shift length is held constant. Radiologists with 11+ years of experience who work no NS or 1 to 100 NS annually have lower odds of feeling overwhelmed when compared with those working the same number of NS with job satisfaction and negative health self-perception. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.
Krakauer, K; Ebdrup, B H; Glenthøj, B Y
BACKGROUND: Individuals at ultra-high-risk (UHR) for psychosis present with emerging symptoms and decline in functioning. Previous univariate analyses have indicated widespread white matter (WM) aberrations in multiple brain regions in UHR individuals and patients with schizophrenia. Using multiv......, MO, and higher RD. CONCLUSIONS: UHR individuals demonstrate complex brain patterns of WM abnormalities. Despite the subtle psychopathology of UHR individuals, aberrations in WM appear associated with positive and negative symptoms as well as level of functioning....
Knuth, Daniela; Kehl, Doris; Hulse, Lynn; Schmidt, Silke
Understanding public risk perceptions and their underlying processes is important in order to learn more about the way people interpret and respond to hazardous emergency events. Direct experience with an involuntary hazard has been found to heighten the perceived risk of experiencing the same hazard and its consequences in the future, but it remains unclear if cross-over effects are possible (i.e., experience with one hazard influencing perceived risk for other hazards also). Furthermore, the impact of objective risk and country of residence on perceived risk is not well understood. As part of the BeSeCu (Behavior, Security, and Culture) Project, a sample of 1,045 survivors of emergencies from seven European countries (i.e., Germany, the Czech Republic, Poland, Sweden, Spain, Turkey, and Italy) was drawn. Results revealed heightened perceived risk for emergency events (i.e., domestic and public fires, earthquakes, floods, and terrorist attacks) when the event had been experienced previously plus some evidence of cross-over effects, although these effects were not so strong. The largest country differences in perceived risk were observed for earthquakes, but this effect was significantly reduced by taking into account the objective earthquake risk. For fires, floods, terrorist attacks, and traffic accidents, only small country differences in perceived risk were found. Further studies including a larger number of countries are welcomed. © 2013 Society for Risk Analysis.
Full Text Available Modern surgery is faced with the emergence of newer “risk factors” and the challenges associated with identifying and managing these risks in the perioperative period. Obstructive sleep apnea and obesity hypoventilation syndrome pose unique challenges in the perioperative setting. Recent studies have identified some of the specific risks arising from caring for such patients in the surgical setting. While all possible postoperative complications are not yet fully established or understood, the prevention and management of these complications pose even greater challenges. Pulmonary hypertension with its changing epidemiology and novel management strategies is another new disease for the surgeon and the anesthesiologist in the noncardiac surgical setting. Traditionally most such patients were not considered surgical candidates for any required elective surgery. Our review discusses these disease entities which are often undiagnosed before elective noncardiac surgery.
H B Pandya
with metronidazole and clarithromycin resistant strains. The use of antibiotics for other indications seems to be the major risk factor for the development of primary resistance. High incidence should alarm the gastroenterologist while prescribing the eradication regimen.
Lucas, Michel; Chocano-Bedoya, Patricia; Schulze, Matthias B; Shulze, Mathias B; Mirzaei, Fariba; O'Reilly, Éilis J; Okereke, Olivia I; Hu, Frank B; Willett, Walter C; Ascherio, Alberto
Inflammation is considered as a mechanism leading to depression, but the association between inflammatory dietary pattern and depression risk is unknown. Using reduced-rank regression, we identified a dietary pattern that was related to plasma levels of inflammatory markers (C-reactive protein, interleukin-6, tumor necrosis factor α receptor 2), and we conducted a prospective analysis of the relationship of this pattern and depression risk among participants in the Nurses' Health Study. A total of 43,685 women (aged 50-77) without depression at baseline (1996) were included and followed up until 2008. Diet information was obtained from food frequency questionnaires completed between 1984 through 2002 and computed as cumulative average of dietary intakes with a 2-year latency applied. We used a strict definition of depression that required both self-reported physician-diagnosed depression and use of antidepressants, and a broader definition that included women who reported either clinical diagnosis or antidepressant use. During the 12-year follow-up, we documented 2594 incident cases of depression using the stricter definition and 6446 using the broader definition. After adjustment for body mass index and other potential confounders, relative risks comparing extreme quintiles of the inflammatory dietary pattern were 1.41 (95% confidence interval [CI], 1.22, 1.63; P-trenddietary pattern is associated with a higher depression risk. This finding suggests that chronic inflammation may underlie the association between diet and depression. Copyright © 2013 Elsevier Inc. All rights reserved.
Velie, Ellen M; Schairer, Catherine; Flood, Andrew; He, Jian-Ping; Khattree, Ravindra; Schatzkin, Arthur
Inconsistent associations have been reported between diet and breast cancer. We prospectively examined the association between dietary patterns and postmenopausal breast cancer risk in a US-wide cohort study. Data were analyzed from 40 559 women who completed a self-administered 61-item Block food-frequency questionnaire in the Breast Cancer Detection Demonstration Project, 1987-1998; 1868 of those women developed breast cancer. Dietary patterns were defined by using principal components factor analysis. Cox proportional hazard regression was used to assess breast cancer risk. Three major dietary patterns emerged: vegetable-fish/poultry-fruit, beef/pork-starch, and traditional southern. The vegetable-fish/poultry-fruit pattern was associated with higher education than were the other patterns, but was similar in nutrient intake to the traditional southern pattern. After adjustment for confounders, there was no significant association between the vegetable-fish/poultry-fruit and beef/pork-starch patterns and breast cancer. The traditional southern pattern, however, was associated with a nonsignificantly reduced breast cancer risk among all cases (in situ and invasive) that was significant for invasive breast cancer (relative hazard = 0.78; 95% CI = 0.65, 0.95; P for trend = 0.003). This diet was also associated with a reduced risk in women without a family history of breast cancer (P = 0.05), who were underweight or normal weight [body mass index (in kg/m(2)) dressing intake, and possibly cabbage. The traditional southern diet or its components are associated with a reduced risk of invasive breast cancer in postmenopausal women.
According to Beck's 'World at Risk' theory, global risks push nations towards a cosmopolitisation of their health policy and open opportunities for a democratic turn. This article provides an empirical analysis of Beck's theory, based on the experience of Vietnamese authorities from 2003 to 2007 in managing the emerging avian flu virus. It shows how Vietnam's framing of avian flu has shifted, under the pressure from international organisations and the US administration, from an epizootic and zoonotic risk (or a classic risk) to a pandemic threat (or a late modern risk). Vietnam's response was part of its overall strategy to join the World Trade Organization and it was limited by Vietnam's defence of its sovereignty. This strategy has been successful for Vietnam but has limited the possibility of cosmopolitan and democratic transformations. The case study highlights the constructed dimension of risks of late modernity and their possible instrumentalisation: it minimises the role of a community of fear relative to a community of trade. © 2013 The Author. Sociology of Health & Illness © 2013 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.
Background The relationship of snacking patterns on nutrient intake and cardiovascular risk factors (CVRF) in adults is unknown. The aim of this study was to examine the associations of snacking patterns with nutrient intake, diet quality, and a selection of CVRF in adults participating in the 2001-2008 National Health and Nutrition Examination Survey. Methods 24-hour dietary recalls were used to determine intake and cluster analysis was used to identify the snacking patterns. Height and weight were obtained and the health indices that were evaluated included diastolic and systolic blood pressure, high density lipoprotein-cholesterol, low density lipoprotein cholesterol, triacylglycerides, blood glucose, and insulin. Results The sample was participants (n = 18,988) 19+ years (50% males; 11% African-Americans; 72% white, 12% Hispanic-Americans, and 5% other). Cluster analyses generated 12 distinct snacking patterns, explaining 61% of the variance in snacking. Comparisons of snacking patterns were made to the no snack pattern. It was found that miscellaneous snacks constituted the most common snacking pattern (17%) followed by cakes/cookies/pastries (12%) and sweets (9%). Most snacking patterns were associated with higher energy intakes. Snacking patterns cakes/cookies/pastries, vegetables/legumes, crackers/salty snacks, other grains and whole fruit were associated with lower intakes of saturated fatty acids. Added sugars intakes were higher in the cakes/cookies/pastries, sweets, milk desserts, and soft drinks patterns. Five snack patterns (cakes/cookies/pastries, sweets, vegetable/legumes, milk desserts, soft drinks) were associated with lower sodium intakes. Several snack patterns were associated with higher intakes of potassium, calcium, fiber, vitamin A, and magnesium. Five snacking patterns (miscellaneous snacks; vegetables/legumes; crackers/salty snacks; other grains; and whole fruit) were associated with better diet quality scores. Alcohol was associated with
McGrady, Elizabeth; Conger, Sue; Blanke, Sandra; Landry, Brett J L
The purpose of this prescriptive research is to help decision makers become better informed about three technologies emerging in the healthcare arena by providing a basic description of the technology and describing their current applications, future healthcare deployment, potential risks, and related managerial issues. Two of the technologies, radio frequency identification (RFID) and global positioning systems (GPS), are currently available to healthcare organizations and appear capable of decreasing cost but may require significant initial investment and have disruptive potential. The third technology, nanotechnology, has limited current use but may revolutionize both the delivery of medicine and hospital infrastructure management. With cautious attention to managerial issues and meticulous attention to implementation details, healthcare organizations that can successfully navigate the coming technologically driven paradigm shifts will emerge more resilient organizations.
Mallpress, Dave E W; Fawcett, Tim W; Houston, Alasdair I; McNamara, John M
A striking feature of human decision making is the fourfold pattern of risk attitudes, involving risk-averse behavior in situations of unlikely losses and likely gains, but risk-seeking behavior in response to likely losses and unlikely gains. Current theories to explain this pattern assume particular psychological processes to reproduce empirical observations, but do not address whether it is adaptive for the decision maker to respond to risk in this way. Here, drawing on insights from behavioral ecology, we build an evolutionary model of risk-sensitive behavior, to investigate whether particular types of environmental conditions could favor a fourfold pattern of risk attitudes. We consider an individual foraging in a changing environment, where energy is needed to prevent starvation and build up reserves for reproduction. The outcome, in terms of reproductive value (a rigorous measure of evolutionary success), of a one-off choice between a risky and a safe gain, or between a risky and a safe loss, determines the risk-sensitive behavior we should expect to see in this environment. Our results show that the fourfold pattern of risk attitudes may be adaptive in an environment in which conditions vary stochastically but are autocorrelated in time. In such an environment the current options provide information about the likely environmental conditions in the future, which affect the optimal pattern of risk sensitivity. Our model predicts that risk preferences should be both path dependent and affected by the decision maker's current state. (c) 2015 APA, all rights reserved).
In black women, breast cancer is associated with aggressive features and poor survival. ... are diagnosed annually, with a mortality rate of 15000 per. Pattern of breast ..... (IUCD), injectables and oral contraceptives were the three most frequently .... risk of both ERPR‑positive and ERPR‑negative tumors with each additional ...
Gu, Tao; Wu, Zhanqing; Wang, Liang
Understanding and recognizing human activities from sensor readings is an important task in pervasive computing. Existing work on activity recognition mainly focuses on recognizing activities for a single user in a smart home environment. However, in real life, there are often multiple inhabitants...... activity models, and propose an Emerging Pattern based Multi-user Activity Recognizer (epMAR) to recognize both single-user and multiuser activities. We conduct our empirical studies by collecting real-world activity traces done by two volunteers over a period of two weeks in a smart home environment...... sensor readings in a home environment, and propose a novel pattern mining approach to recognize both single-user and multi-user activities in a unified solution. We exploit Emerging Pattern – a type of knowledge pattern that describes significant changes between classes of data – for constructing our...
Gherasim Solovestru DOMIDE
Full Text Available The state of emergency in the energy sector generates technical problems such as: disruption in the operation of machinery and equipment, replacement of equipment or others needs. Besides the technical problems which appear, also intervene economic and financial issues that generate costs for the replacement of machines, equipment and installations and expenses of compensation to third parties who have suffered losses by disconnecting the power supply or lack of electricity over a longer or shorter period. Modern methods of risk management include also economic solutions. Some of these solutions will be treated in this paper.
Stonelake, Stephen; Thomson, Peter; Suggett, Nigel
National guidance states that all patients having emergency surgery should have a mortality risk assessment calculated on admission so that the 'high risk' patient can receive the appropriate seniority and level of care. We aimed to assess if peri-operative risk scoring tools could accurately calculate mortality and morbidity risk. Mortality risk scores for 86 consecutive emergency laparotomies, were calculated using pre-operative (ASA, Lee index) and post-operative (POSSUM, P-POSSUM and CR-POSSUM) risk calculation tools. Morbidity risk scores were calculated using the POSSUM predicted morbidity and compared against actual morbidity according to the Clavien-Dindo classification. The actual mortality was 10.5%. The average predicted risk scores for all laparotomies were: ASA 26.5%, Lee Index 2.5%, POSSUM 29.5%, P-POSSUM 18.5%, CR-POSSUM 10.5%. Complications occurred following 67 laparotomies (78%). The majority (51%) of complications were classified as Clavien-Dindo grade 2-3 (non-life-threatening). Patients having a POSSUM morbidity risk of greater than 50% developed significantly more life-threatening complications (CD 4-5) compared with those who predicted less than or equal to 50% morbidity risk (P = 0.01). Pre-operative risk stratification remains a challenge because the Lee Index under-predicts and ASA over-predicts mortality risk. Post-operative risk scoring using the CR-POSSUM is more accurate and we suggest can be used to identify patients who require intensive care post-operatively. In the absence of accurate risk scoring tools that can be used on admission to hospital it is not possible to reliably audit the achievement of national standards of care for the 'high-risk' patient.
Kanlı, İbrahim Burak
This paper analyzes the impact of global risk appetite on the risk premium utilizing high-frequency data. Taking the Turkish economy as our laboratory, we find that the risk premium volatility responds only to a worsening in the risk appetite for the Turkish economy, which is a result that we do not observe for the other emerging markets. Then, we investigate the role of current account dynamics on this asymmetric effect, by focusing also on an economy with similar current account performance. The empirical results find supporting evidence for the role of current account dynamics on the estimated asymmetry.
Namkee G. Choi, PhD
Full Text Available Introduction: Late middle-aged and older adults’ share of emergency department (ED visits is increasing more than other age groups. ED visits by individuals with substance-related problems are also increasing. This paper was intended to identify subgroups of individuals aged 50+ by their risk for ED visits by examining their health/mental health status and alcohol use patterns. Methods: Data came from the 2013 National Health Interview Survey’s Sample Adult file (n=15,713. Following descriptive analysis of sample characteristics by alcohol use patterns, latent class analysis (LCA modeling was fit using alcohol use pattern (lifetime abstainers, ex-drinkers, current infrequent/light/ moderate drinkers, and current heavy drinkers, chronic health and mental health status, and past-year ED visits as indicators. Results: LCA identified a four-class model. All members of Class 1 (35% of the sample; lowest-risk group were infrequent/light/moderate drinkers and exhibited the lowest probabilities of chronic health/ mental health problems; Class 2 (21%; low-risk group consisted entirely of lifetime abstainers and, despite being the oldest group, exhibited low probabilities of health/mental health problems; Class 3 (37%; moderate-risk group was evenly divided between ex-drinkers and heavy drinkers; and Class 4 (7%; high-risk group included all four groups of drinkers but more ex-drinkers. In addition, Class 4 had the highest probabilities of chronic health/mental problems, unhealthy behaviors, and repeat ED visits, with the highest proportion of Blacks and the lowest proportions of college graduates and employed persons, indicating significant roles of these risk factors. Conclusion: Alcohol nonuse/use (and quantity of use and chronic health conditions are significant contributors to varying levels of ED visit risk. Clinicians need to help heavy-drinking older adults reduce unhealthy alcohol consumption and help both heavy drinkers and ex
Kofler, Christian; Pedoth, Lydia; Elzbieta Stawinoga, Agnieszka; Schneiderbauer, Stefan
The resilience of communities against natural hazards is largely influenced by how the individuals perceive risk. A good understanding of people's risk perception, awareness and hazard knowledge is crucial for developing and improving risk management and communication strategies between authorities and the affected population. A lot of research has been done in investigating the social aspects of risks to natural hazards by means of interviews or questionnaires. However, there is still a lack of research in the investigation of the influence of the spatial distance to a hazard event on peoples risk perception. While the spatial dimension of a natural hazard event is always assessed in works with a natural science approach, it is often neglected in works on social aspects of natural hazards. In the present study, we aimed to overcome these gaps by combining methods from different disciplines and assessing and mapping the spatial pattern of risk perception through multivariate statistical approaches based on empirical data from questionnaires. We will present results from a case study carried out in Badia, located in the Province of South Tyrol- Italy, where in December 2012 a landslide destroyed four residential buildings and led to the evacuation of 36 people. By means of questionnaires distributed to all adults living in the case study area we assessed people's risk perception and asked respondents to allocate their place of residence on a map of the case study area subdivided in 7 zones. Based on the data of the questionnaire results we developed a risk perception factor in order to express various assessed aspects linked to risk perception with one metric. We analyzed and mapped this factor according to the different zones reflecting the spatial distance to the event. Furthermore, a cluster analysis identified various risk behavior profiles within the population. We also investigated the spatial patterns of these risk profiles. We revealed that the residential
Malakuti Khah Olun Abadi, Somayeh; Aksit, Mehmet
Nowadays, detecting emergent behavioral patterns in the environment, representing and manipulating them become the main focus of many software systems such as traffic monitoring systems, runtime verification techniques and self-adaptive systems. In this paper, we discuss the need for dedicated
Background: Efforts to improve child survival can only be effective if they are based on reasonably accurate information about the causes of death. Objectives: To review the pattern of post-neonatal deaths among children admitted into the Children Emergency Unit of the University of Nigeria Teaching Hospital, Enugu, ...
Fyke, J.G.; Vizcaino, M.; Lipscomb, W.H.
Surface mass balance (SMB) trends influence observed Greenland Ice Sheet (GrIS) mass loss, but the component of these trends related to anthropogenic forcing is unclear. Here we study the simulated spatial pattern of emergence of an anthropogenically derived GrIS SMB signal between 1850 and 2100
Thøgersen, John; Ølander, Carl Folke
In this study, data from a random sample of Danish consumers are used to test the hypothesis that the emergence of a sustainable consumption pattern is influenced by individual value priorities. By the use of a cross-lagged panel design and structural equation modelling it is possible to draw...
Biogeographic patterns of invasion of near-coastal and estuarine species in the Northeastern Pacific (NEP) are beginning to emerge based on surveys by U.S. EPA’s Environmental Monitoring and Assessment Program (EMAP) and the EPA/USGS synthesis of native and nonindigenous species ...
Jaramillo, Juliana; Chabi-Olaye, Adenirin; Borgemeister, Christian
The coffee berry borer, Hypothenemus hampei (Ferrari) (Coleoptera: Curculionidae: Scolytinae), is the most important constrain for coffee production throughout the world. Knowledge on the emergence pattern of H. hampei females to infest new berries is crucial to effectively plan control measures. In this laboratory study, we assessed the development of immature stages and the emergence pattern of H. hampei females from the berries by exposing them to temperatures that are typical for high-altitude plantations (> or = 1,700 m above sea level [masl] ) or when coffee is grown under shade trees (20-22 degrees C), and optimum altitude plantations (1,200-1,600 masl) or nonshaded coffee (25-30 degrees C). Fecundity and emergence pattern of H. hampei females from coffee berries varied with temperature. Temperature played a crucial role determining the rate of H. hampei development and therefore the emergence of the females to start a new infestation cycle. The emergence and colonization phases of new colonizing females in coffee plantations with mean temperatures of 20, 25, or 30 degrees C would take place at different moments in the development of the coffee berries, and in some cases more than once. The implications of our findings for an improved, site-specific timing of control interventions against H. hampei are discussed.
Mikhail Stolbov; Maria Shchepeleva
We extend the conventional approach to the construction of financial stress indices (FSI) for emerging economies proposed by Balakrishnan et al. (2011). Based on the principal component analysis, our index accounts for developments in the residential real estate market, adopts distinctive indicators for the banking sector and sovereign debt risks, covering the period from February 2008 to September 2015 for 14 emerging economies. The FSIs accurately capture the periods of impaired financial i...
Renni, Elisabetta; Krausmann, Elisabeth; Basco, Anna; Salzano, Ernesto; Cozzani, Valerio
Natural disasters such as earthquakes, tsunamis, flooding or hurricanes have recently and dramatically hit several countries worldwide. Both direct and indirect consequences involved the population, causing on the one hand a high number of fatalities and on the other hand so relevant economical losses that the national gross product may be affected for many years. Loss of critical industrial infrastructures (electricity generation and distribution, gas pipelines, oil refineries, etc.) also occurred, causing further indirect damage to the population. In several cases, accident scenarios with large releases of hazardous materials were triggered by these natural events, causing so-called "Natech events", in which the overall damage resulted from the simultaneous consequences of the natural event and of the release of hazardous substances. Toxic releases, large fires and explosions, as well as possible long-term environmental pollution, economical losses, and overloading of emergency systems were recognised by post-event studies as the main issues of these Natech scenarios. In recent years the increasing frequency and severity of some natural hazards due to climate change has slowly increased the awareness of Natech risk as an emerging risk among the stakeholders. Indeed, the iNTeg-Risk project, co-funded by the European Commission within the 7th Framework Program specifically addresses these scenarios among new technological issues on public safety. The present study, in part carried out within the iNTeg-Risk project, was aimed at the analysis and further development of methods and tools for the assessment and mitigation of Natech accidents. Available tools and knowledge gaps in the assessment of Natech scenarios were highlighted. The analysis mainly addressed the potential impact of flood, lightning and earthquake events on industrial installations where hazardous substances are present. Preliminary screening methodologies and more detailed methods based on
Fogarty, Jennifer A.; Polk, J. D.; Tarver, W.; Gibson, C. R.; Sargsyan, A.; Taddeo, T.; Alexander, D.; Otto, C.
What is the risk? Given that astronauts exposed to microgravity experience a cephalad fluid shift, and that both symptomatic and asymptomatic astronauts have exhibited optic nerve sheath edema on MRI, there is a high probability that all astronauts have some degree of increased intracranial pressure (ICP; intracranial hypertension), and that those susceptible (via eye architecture, anatomy, narrow optic disc) have a high likelihood of developing papilledema (optic disc edema, globe flattening), choroidal folds, and/or hyperopic shifts and that the degree of edema may determine long-term or permanent vision impairment or loss. Back to back panels on this topic have been developed to address this emerging risk. The first panel will focus on the 6 clinical cases with emphasis on ophthalmic findings and imaging techniques used pre-, in-, and post-flight. The second panel will discuss the operational mitigation and medical requirements, the potential role of CO2 on ISS, and the research approach being developed. In total these back to back panels will explore what is known about this risk, what has been done immediately to address it, and how an integrated research model is being developed.
Full Text Available The expansion of internet access, high-speed connection services, collaborative work platforms and tools, allowed employees to interact virtually offering companies the possibility to develop projects around the world, reducing operational costs and gain competitive advantage. Realizing the advantages and disadvantages of developing a project team in an international virtual work environment, requires adopting specific strategies to construct an effective team and ensure the project success. One of the most important disadvantages that we identified is that the new work environment brings new risks for both team members and managers. So, it becomes mandatory to identify and analyze the occupational emerging risks and their impact on the productivity of virtual team members, in order to prevent them efficiently and to ensure the safety and health of employees in a virtual working environment. This paper aims to highlight the necessity for project managers and organizations, to include in their specific project strategies, an efficient occupational risks management in the virtual workplace, to obtain a continuously improved virtual working environment, so to achieve a high performance from virtual employees.
Lin, Sin-Jin; Hsu, Ming-Fu
Classification in imbalanced datasets has attracted much attention from researchers in the field of machine learning. Most existing techniques tend not to perform well on minority class instances when the dataset is highly skewed because they focus on minimising the forecasting error without considering the relative distribution of each class. This investigation proposes an emerging multi-agent architecture, grounded on cooperative learning, to solve the class-imbalanced classification problem. Additionally, this study deals further with the obscure nature of the multi-agent architecture and expresses comprehensive rules for auditors. The results from this study indicate that the presented model performs satisfactorily in risk management and is able to tackle a highly class-imbalanced dataset comparatively well. Furthermore, the knowledge visualised process, supported by real examples, can assist both internal and external auditors who must allocate limited detecting resources; they can take the rules as roadmaps to modify the auditing programme.
Lin, Leesa; Gamhewage, Gaya M.
Objectives. To articulate a conceptual framework in support of evaluation activities in emergency risk communications (ERC). Methods. The framework proposed is based on a systematic review of the scientific literature (2001–2016) combined with data derived from a series of semistructured interviews with experts and practitioners in ERC, and it is designed to support local, national, and international public health organizations in implementing evaluation studies in ERC. Results. We identified a list of ERC outcomes from the full-text review of 152 articles and categorized these into 3 groups, depending upon the level at which the outcome was measured: (1) information environment, (2) population, and (3) public health system. We analyzed interviewees’ data from 18 interviews to identify practices and processes related to the effectiveness of ERC and included these as key structural components and processes in the developed evaluation framework. Conclusions. Researchers and public health practitioners interested in the evaluation of ERC can use the conceptual framework described in this article to guide the development of evaluation studies and methods for assessing communication outcomes related to public health emergencies. PMID:28892436
Emergency conditions after a nuclear accident are different in each case and cannot be predicted accurately. The accident at TMI did not contaminate the environment. The accident at Chernobyl had a large, early release of nuclear contamination, widely dispersed over many countries. Although there was no large, early release of contamination at Fukushima Daiichi, the timeline of the accident included days of later contamination of various degrees of severity. A large amount of the contamination has been released to the ocean and an exclusion zone still exists around the station. In all of these accidents there were no adequate radiation monitoring systems distant from the origin point that could provide accurate status to the authorities and the local population. In the recent years a number of new nuclear monitoring systems have been implemented or are under development to be installed in areas that might be exposed to nuclear contamination in emergencies. Based on the risk informed optimization methodology, this paper provides recommendations for selecting the quantity and type of instrumentation, the location and sampling of data, and the real-time processing of information. (authors)
Savoia, Elena; Lin, Leesa; Gamhewage, Gaya M
To articulate a conceptual framework in support of evaluation activities in emergency risk communications (ERC). The framework proposed is based on a systematic review of the scientific literature (2001-2016) combined with data derived from a series of semistructured interviews with experts and practitioners in ERC, and it is designed to support local, national, and international public health organizations in implementing evaluation studies in ERC. We identified a list of ERC outcomes from the full-text review of 152 articles and categorized these into 3 groups, depending upon the level at which the outcome was measured: (1) information environment, (2) population, and (3) public health system. We analyzed interviewees' data from 18 interviews to identify practices and processes related to the effectiveness of ERC and included these as key structural components and processes in the developed evaluation framework. Researchers and public health practitioners interested in the evaluation of ERC can use the conceptual framework described in this article to guide the development of evaluation studies and methods for assessing communication outcomes related to public health emergencies.
Full Text Available BACKGROUND: A Mediterranean diet has a recognized beneficial effect on health and longevity, with a protective influence on several cancers. However, its association with breast cancer risk remains unclear. OBJECTIVE: We aimed to investigate whether adherence to a Mediterranean dietary pattern influences breast cancer risk. DESIGN: The Swedish Women's Lifestyle and Health cohort study includes 49,258 women aged 30 to 49 years at recruitment in 1991-1992. Consumption of foods and beverages was measured at enrollment using a food frequency questionnaire. A Mediterranean diet score was constructed based on the consumption of alcohol, vegetables, fruits, legumes, cereals, fish, the ratio of unsaturated to saturated fat, and dairy and meat products. Relative risks (RR for breast cancer and specific tumor characteristics (invasiveness, histological type, estrogen/progesterone receptor status, malignancy grade and stage associated with this score were estimated using Cox regression controlling for potential confounders. RESULTS: 1,278 incident breast cancers were diagnosed. Adherence to a Mediterranean dietary pattern was not statistically significantly associated with reduced risk of breast cancer overall, or with specific breast tumor characteristics. A RR (95% confidence interval for breast cancer associated with a two-point increment in the Mediterranean diet score was 1.08 (1.00-1.15 in all women, and 1.10 (1.01-1.21 and 1.02 (0.91-1.15 in premenopausal and postmenopausal women, respectively. When alcohol was excluded from the Mediterranean diet score, results became not statistically significant. CONCLUSIONS: Adherence to a Mediterranean dietary pattern did not decrease breast cancer risk in this cohort of relatively young women.
E. Margaret Warton
Full Text Available Introduction: Many patients with atrial fibrillation or atrial flutter (AF/FL who are high risk for ischemic stroke are not receiving evidence-based thromboprophylaxis. We examined anticoagulant prescribing within 30 days of receiving dysrhythmia care for non-valvular AF/FL in the emergency department (ED. Methods: This prospective study included non-anticoagulated adults at high risk for ischemic stroke (ATRIA score ≥7 who received emergency AF/FL care and were discharged home from seven community EDs between May 2011 and August 2012. We characterized oral anticoagulant prescribing patterns and identified predictors of receiving anticoagulants within 30 days of the index ED visit. We also describe documented reasons for withholding anticoagulation. Results: Of 312 eligible patients, 128 (41.0% were prescribed anticoagulation at ED discharge or within 30 days. Independent predictors of anticoagulation included age (adjusted odds ratio [aOR] 0.89 per year, 95% confidence interval [CI] 0.82–0.96; ED cardiology consultation (aOR 1.89, 95% CI [1.10–3.23]; and failure of sinus restoration by time of ED discharge (aOR 2.65, 95% CI [1.35–5.21]. Reasons for withholding anticoagulation at ED discharge were documented in 139 of 227 cases (61.2%, the most common of which were deferring the shared decision-making process to the patient’s outpatient provider, perceived bleeding risk, patient refusal, and restoration of sinus rhythm. Conclusion: Approximately 40% of non-anticoagulated AF/FL patients at high risk for stroke who presented for emergency dysrhythmia care were prescribed anticoagulation within 30 days. Physicians were less likely to anticoagulate older patients and those with ED sinus restoration. Opportunities exist to improve rates of thromboprophylaxis in this high-risk population.
This thesis aims to address the root causes and means of prevention, mitigation and other improvements to the challenges from smouldering fires, coal freezing and occupational risk in an underground storage silo built into granite bedrock. In addition, appropriate performance indicators are suggested, and the benefits of the recommended or adopted actions are estimated. The issues and observed incidents demonstrate hazards that are largely classified to represent issues of emerging risk. To reduce the fire risk, successful measures included bottom maintenance door sealing and modified design of silo filling and discharge. The assessed benefits of these actions suggest a payback period of only about 10 days, assuming that, without these measures, a fire like the one in 2008 could occur once in four years. Additional recommendations are made to reduce air flow through the coal bed and near the silo ceiling, and to improve nitrogen purging at the hoppers. Filling with subzero coal can freeze silo drains, resulting in water inflow and further freezing to hamper discharge. As the heat flow is unlike any previously known cases of coal freezing, conventional mitigation e.g. by freeze conditioning agents, would not help. After implementing modified filling procedures for cold coal, no severe freezing cases have occurred. Safety advantages from the automated and remotely controlled operation do not necessarily apply under exceptional circumstances requiring human involvement. As preventive measures, protection has been sought from additional technical barriers and training effort. The rarity of serious incidents is a challenge in demonstrating success, but also emphasizes the importance of using leading (not only lagging) safety performance indicators for measurable safety promotion. In contrast, suitable leading performance indicators of the fire risk have been suggested for deliveries as an index of coal properties and for storage (gas emissions and temperature
Sande, Matej; Paš, Mina; Nahtigal, Klara; Šabić, Simona
The following study presents factors influencing the decision to use/not to use new psychoactive substances (NPS), various patterns of NPS use, the problems experienced by users, and the methods for reducing the risks associated with NPS use. The study seeks to provide an in-depth look into the characteristics of NPS use and support the planning of targeted interventions in the field of NPS. The study involved 19 in-depth interviews carried out with 25 individuals divided into three subsamples in order to gain insight into the various experiences of NPS users. The interviews were conducted in Slovenia between December 2013 and October 2014. The sample was obtained by using the convenience sampling and snowball sampling methods. The main pattern of NPS use determined by the study concerned synthetic cathinones, specifically 3-MMC, with binge use spanning several days being a prominent feature. The main risks involving NPS use were: mixing various drugs, inappropriate dosing, lack of information prior to use, and the use of unknown substances. Several users spoke about effective strategies for reducing risks, such as obtaining information beforehand, using one's own implements and using only small quantities of unknown substances. Conclusions/Importance: The study revealed various factors based on which users decide to use NPS. Furthermore, users reported a number of problems resulting from NPS use, while risk reduction strategies are employed to a much lesser extent. Based on the results obtained, specific intervention efforts concerning NPS use and targeting specific groups of younger users were designed.
Liu, Yang; Hoppe, Brenda O; Convertino, Matteo
Emergency risk communication (ERC) programs that activate when the ambient temperature is expected to cross certain extreme thresholds are widely used to manage relevant public health risks. In practice, however, the effectiveness of these thresholds has rarely been examined. The goal of this study is to test if the activation criteria based on extreme temperature thresholds, both cold and heat, capture elevated health risks for all-cause and cause-specific mortality and morbidity in the Minneapolis-St. Paul Metropolitan Area. A distributed lag nonlinear model (DLNM) combined with a quasi-Poisson generalized linear model is used to derive the exposure-response functions between daily maximum heat index and mortality (1998-2014) and morbidity (emergency department visits; 2007-2014). Specific causes considered include cardiovascular, respiratory, renal diseases, and diabetes. Six extreme temperature thresholds, corresponding to 1st-3rd and 97th-99th percentiles of local exposure history, are examined. All six extreme temperature thresholds capture significantly increased relative risks for all-cause mortality and morbidity. However, the cause-specific analyses reveal heterogeneity. Extreme cold thresholds capture increased mortality and morbidity risks for cardiovascular and respiratory diseases and extreme heat thresholds for renal disease. Percentile-based extreme temperature thresholds are appropriate for initiating ERC targeting the general population. Tailoring ERC by specific causes may protect some but not all individuals with health conditions exacerbated by hazardous ambient temperature exposure. © 2018 Society for Risk Analysis.
Sabel, Clive Eric; Wilson, Jeff Gaines; Kingham, Simon
Epidemiological studies that examine the relationship between environmental exposures and health often address other determinants of health that may influence the relationship being studied by adjusting for these factors as covariates. While disease surveillance methods routinely control...... for covariates such as deprivation, there has been limited investigative work on the spatial movement of risk at the intraurban scale due to the adjustment. It is important that the nature of any spatial relocation be well understood as a relocation to areas of increased risk may also introduce additional...... localised factors that influence the exposure-response relationship. This paper examines the spatial patterns of relative risk and clusters of hospitalisations based on an illustrative small-area example from Christchurch, New Zealand. A four-stage test of the spatial relocation effects of covariate...
The book on emergency management in high-risk facilities covers the following topics: Change in the nuclear policy, risk management of high-risk facilities as a constitutional problem - emergency management in nuclear facilities, operational mechanisms of risk control in nuclear facilities, regulatory surveillance responsibilities for nuclear facilities, operational mechanism of the risk control in chemical plants, regulatory surveillance responsibilities for chemical facilities, operational mechanisms of the risk control in hazardous waste facilities, regulatory surveillance responsibilities for hazardous waste facilities, civil law consequences in case of accidents in high-risk facilities, criminal prosecution in case of accidents in high-risk facilities, safety margins as site risk for emission protection facilities, national emergency management - strategic emergency management structures, warning and self-protection of the public in case of CBRN hazards including aspects of the psych-social emergency management.
Prior to 1900, blood transfusions were fraught with danger and often caused more complications than the underlying disease. Discovery of the ABO compatibility system in the early twentieth century opened the modern era of blood transfusion, yet ABO incompatibility-as a result of clerical error-remains a significant threat to the recipient today. The risk of disease transmission now includes new and emerging agents, such as Trepanosoma cruzii and West Nile Virus (WNV), as well as other existing pathogens. Transfusion-related immunomodulation (TRIM) presents a further risk to recipient patients. Confounding these problems are shortages of safe blood and the accelerated rise in the cost of blood due to increased testing. Outcome data on transfusion therapy have not always been favorable, particularly in the areas of postoperative infection, systemic inflammatory response syndrome (SIRS), multiple organ failure (MOF), and mortality. Such data have generated extensive efforts to determine association versus underlying cause of post-transfusion complications. In addition, unprecedented global initiatives to minimize the use of allogeneic blood are on the way. Options may include, but are not limited to, the use of "blood substitutes," although validation of such products is still required. In the meantime, blood product conservation techniques should become part of routine transfusion medicine.
Stuart, Marianne; Lapworth, Dan; Crane, Emily; Hart, Alwyn
This paper provides a review of the types of emerging organic groundwater contaminants (EGCs) which are beginning to be found in the UK. EGCs are compounds being found in groundwater that were previously not detectable or known to be significant and can come from agricultural, urban and rural point sources. EGCs include nanomaterials, pesticides, pharmaceuticals, industrial compounds, personal care products, fragrances, water treatment by-products, flame retardants and surfactants, as well as caffeine and nicotine. Many are relatively small polar molecules which may not be effectively removed by drinking water treatment. Data from the UK Environment Agency's groundwater screening programme for organic pollutants found within the 30 most frequently detected compounds a number of EGCs such as pesticide metabolites, caffeine and DEET. Specific determinands frequently detected include pesticides metabolites, pharmaceuticals including carbamazepine and triclosan, nicotine, food additives and alkyl phosphates. This paper discusses the routes by which these compounds enter groundwater, their toxicity and potential risks to drinking water and the environment. It identifies challenges that need to be met to minimise risk to drinking water and ecosystems. Copyright © 2012. Published by Elsevier B.V.
Hoerr, Robert A.
An oversight system specifically concerned with nanomaterials should be flexible enough to take into account the unique aspects of individual novel materials and the settings in which they might be used, while recognizing that heretofore unrecognized safety issues may require future modifications. This article considers a question not explicitly considered by the project team: what is the risk that uncertainty over how regulatory oversight will be applied to nanomaterials will delay or block the development of this emerging technology, thereby depriving human health of potential and substantial benefits? An ambiguous regulatory environment could delay the availability of valuable new technology and therapeutics for human health by reducing access to investment capital. Venture capitalists list regulatory uncertainty as a major reason not to invest at all in certain areas. Uncertainty is far more difficult to evaluate than risk, which lends itself to quantitative models and can be factored into projections of return on possible investments. Loss of time has a large impact on investment return. An examination of regulatory case histories suggests that an increase in regulatory resting requirement, where the path is well-defined, is far less costly than a delay of a year or more in achieving product approval and market launch.
Hoerr, Robert A.
An oversight system specifically concerned with nanomaterials should be flexible enough to take into account the unique aspects of individual novel materials and the settings in which they might be used, while recognizing that heretofore unrecognized safety issues may require future modifications. This article considers a question not explicitly considered by the project team: what is the risk that uncertainty over how regulatory oversight will be applied to nanomaterials will delay or block the development of this emerging technology, thereby depriving human health of potential and substantial benefits? An ambiguous regulatory environment could delay the availability of valuable new technology and therapeutics for human health by reducing access to investment capital. Venture capitalists list regulatory uncertainty as a major reason not to invest at all in certain areas. Uncertainty is far more difficult to evaluate than risk, which lends itself to quantitative models and can be factored into projections of return on possible investments. Loss of time has a large impact on investment return. An examination of regulatory case histories suggests that an increase in regulatory resting requirement, where the path is well-defined, is far less costly than a delay of a year or more in achieving product approval and market launch.
Keum, N; Cao, Y; Lee, D H; Park, S M; Rosner, B; Fuchs, C S; Wu, K; Giovannucci, E L
Male pattern baldness is positively associated with androgens as well as insulin-like growth factor 1 (IGF-1) and insulin, all of which are implicated in pathogenesis of colorectal neoplasia. From 1992 through 2010, we prospectively followed participants in the Health Professionals Follow-Up Study. Hair pattern at age 45 years was assessed at baseline with five image categories (no baldness, frontal-only baldness, frontal-plus-mild-vertex baldness, frontal-plus-moderate-vertex baldness, and frontal-plus-severe-vertex baldness). Cancer analysis included 32 782 men and used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Restricted to men who underwent at least one endoscopy over the study period, adenoma analysis included 29 770 men and used logistic regressions for clustered data to estimate odds ratios (ORs) and 95% CIs. Over the mean follow-up of 15.6 years, 710 cases of colorectal cancer (478 for colon, 152 for rectum, and 80 unknown site) developed. Significantly increased risks associated with frontal-only baldness and frontal-plus-mild-vertex baldness relative to no baldness were observed for colon cancer with respective HR being 1.29 (95% CI, 1.03-1.62) and 1.31 (95% CI, 1.01-1.70). Over the 19-year study period, 3526 cases of colorectal adenoma were detected. Evidence for an increased risk of colorectal adenoma relative to no baldness was significant with frontal-only baldness (OR, 1.16; 95% CI, 1.06-1.26) and borderline insignificant with frontal-plus-severe-vertex baldness (OR, 1.14; 95% CI, 0.98-1.33). Subtypes of male pattern baldness at age 45 years were positively associated with colorectal neoplasia. Future studies are warranted to confirm our results and to determine the predictive value of male pattern baldness to identify those at high risk for colorectal neoplasia.
Alqahtani, Jobran M
To describe the clinical characteristics of pediatric patients colonized or infected by Stenotrophomonas maltophilia (S. maltophilia) at a Saudi children's hospital, to identify risk factors associated with infection, and to investigate the antimicrobial resistance patterns of this emerging pathogen. Methods: In this cross-sectional observational study, 64 non-duplicating S. maltophilia strains were isolated in Najran Maternity and Children's Hospital, Najran, Saudi Arabia between January 2015 to February 2016. Antimicrobial susceptibility testing was performed using the reference broth microdilution method. Results: In this study, 48 (75%) isolates were identified in true infections and 16 (25%) isolates were considered colonization. The main types of S. maltophilia infection were pneumonia in 22 (45.8%) patients and bloodstream infection in 14 (29.2%) patients. The significant risk factors included exposure to invasive procedure (p=0.02), and presence of acute leukemia as an underlying disease (p=0.02). The most active antimicrobials were trimethoprim/sulfamethoxazole (100% sensitivity) and tigecycline (93.7% sensitivity). Conclusions: Stenotrophomonas maltophilia is an emerging nosocomial pathogen among pediatric patients. Accurate identification and susceptibility testing of this emerging pathogen are crucial for the management of infected patients and prevention of spread of this nosocomial pathogen.
Davis, Mikaela Jessica; Powell, Adeya; Gordon, Derrick; Kershaw, Trace
Sexting, sending, or receiving sexually suggestive or explicit messages/photos/videos, have not been studied extensively. The aims of this study is to understand factors associated with sexting among minority (e.g., African- American, Hispanic) emerging adult males and the association between sexting and sexual risk. We recruited 119 emerging adult heterosexual males and assessed sexting and sexual risk behaviors. Fifty-four percent of participants sent a sext, and 70% received a sext. Participants were more likely to sext with casual partners than with steady partners. Multiple regression analyses showed that participants who sent sexts to steady partners had significantly more unprotected vaginal intercourse and oral sex. Participants who sent sexts to casual partners had significantly more partners, and participants who received sexts from casual partners had significantly more unprotected oral sex and sex while on substances. We found that sexting is a frequent and reciprocal behavior among emerging adults, and there were different patterns of significance for sexts with casual and steady partners.
Full Text Available Nowadays, the use of social media by public institutions involved in disaster management is starting to become common practice. However, despite scientific interest in the effect of social media on disaster risk and crisis communication, data exploring emergency management agencies’ round-the-clock Facebook usage and the impact of their content and media choices on stakeholder engagement is limited. This study set out to investigate Romanian local emergency agencies’ Facebook usage patterns and stakeholders’ engagement with their content. The data is comprised of 7810 messages posted between the 1st January and 25th October 2017 by 32 County Inspectorates for Emergency Situations. First, using content analysis techniques, the topics of the posts were summarized to illustrate how these agencies use Facebook. Second, stakeholder engagement was investigated using social media marketing techniques. Third, messages related to natural hazards were analyzed in greater depth to reveal disaster risk communication patterns. The results suggest that Romanian emergency agencies mainly promote transparency and their institutional image on Facebook. Stakeholders were most likely to engage with brand-oriented posts, especially if these also offered rich multimedia feature. Meanwhile, stakeholders were less likely to interact with messages about natural hazards, particularly if they incorporated educational content. These observations suggest that, while at the moment Romanian local emergency management agencies take advantage of Facebook to create and maintain relationships with their stakeholders, they bypass opportunities to implement communication strategies for effective disaster risk reduction.
Assenza, Salvatore; Gutiérrez, Ricardo; Gómez-Gardeñes, Jesús; Latora, Vito; Boccaletti, Stefano
Synchronization is a collective phenomenon occurring in systems of interacting units, and is ubiquitous in nature, society and technology. Recent studies have enlightened the important role played by the interaction topology on the emergence of synchronized states. However, most of these studies neglect that real world systems change their interaction patterns in time. Here, we analyze synchronization features in networks in which structural and dynamical features co-evolve. The feedback of the node dynamics on the interaction pattern is ruled by the competition of two mechanisms: homophily (reinforcing those interactions with other correlated units in the graph) and homeostasis (preserving the value of the input strength received by each unit). The competition between these two adaptive principles leads to the emergence of key structural properties observed in real world networks, such as modular and scale-free structures, together with a striking enhancement of local synchronization in systems with no global order.
1973. Ecology of Vibrio parahemolyticus in mixed-template amplifications: formation, consequences and elimination by Chesapeake Bay. J. Bacteriol. 113...Science 1930 and Engineering DOCTORAL DISSERTATION Emergent Patterns of Diversity and Dynamics in Natural Populations of Planktonic Vibrio Bacteria by...DYNAMICS IN NATURAL POPULATIONS OF PLANKTONIC VIBRIO BACTERIA by Janelle Ren6e Thompson B.S. Biological Sciences, Stanford University 1998 M.S
J. van der Hart; G.J. de Zwart (Gerben); D.J.C. van Dijk (Dick)
textabstractWe examine competing explanations, based on risk and behavioral models, for the profitability of stock selection strategies in emerging markets. We document that both emerging market risk and global risk factors cannot account for the significant excess returns of selection strategies
Askgaard, Gro; Grønbæk, Morten; Kjær, Mette S
BACKGROUND & AIMS: Alcohol is the main contributing factor of alcoholic cirrhosis, but less is known about the significance of drinking pattern. METHODS: We investigated the risk of alcoholic cirrhosis among 55,917 participants (aged 50-64years) in the Danish Cancer, Diet, and Health study (1993......-2011). Baseline information on alcohol intake, drinking pattern, and confounders was obtained from a questionnaire. Follow-up information came from national registers. We calculated hazard ratios (HRs) for alcoholic cirrhosis in relation to drinking frequency, lifetime alcohol amount, and beverage type. RESULTS......: We observed 257 and 85 incident cases of alcoholic cirrhosis among men and women, respectively, none among lifetime abstainers. In men, HR for alcoholic cirrhosis among daily drinkers was 3.65 (95% CI: 2.39; 5.55) compared to drinking 2-4days/week. Alcohol amount in recent age periods (40-49 and 50...
Full Text Available Background. This study aims to verify if the presence and severity of perinatal depression are related to any particular pattern of attachment. Methods. The study started with a screening of a sample of 453 women in their third trimester of pregnancy, who were administered a survey data form, the Edinburgh Postnatal Depression Scale (EPDS and the Experience in Close Relationship (ECR. A clinical group of subjects with perinatal depression (PND, 89 subjects was selected and compared with a control group (C, regarding psychopathological variables and attachment patterns. Results. The ECR showed a prevalence of “Fearful-Avoidant” attachment style in PND group (29.2% versus 1.1%, p<0.001; additionally, the EPDS average score increases with the increasing of ECR dimensions (Avoidance and Anxiety. Conclusion. The severity of depression increases proportionally to attachment disorganization; therefore, we consider attachment as both an important risk factor as well as a focus for early psychotherapeutic intervention.
Full Text Available Aim: All around the world 10-12 million people/year receive rabies prophylaxis. Rabies is an acute fatal central nervous system viral enfection. The virus can infect all warm-blooded animals and almost in all cases the enfection results with fatal encephalitis. The aim of this study is to determine the demographic characteristics of cases with rabies risk exposures and behind this to emphasise the significance of cooperation between the institutions to perform effective and accurate treatment. Material and Method: This study was performed with retrospective analysis of 1429 cases who attended to Emergency Department of Diyarbakir Goverment Hospital between January 2007-2010 for animal bites and exposures with the risk of rabies. Statistical analysis of data was performed SPSS V16 pocket programme. Data were defined as frequency and %. For statistical analysis Chi-Square and Fischer exact test was used. A value of P<0.05 was accepted statistically significant. Results: A total of 1055 (73.8% were male, 374 (26.2% were female and the mean age was 21.75 ± 16.9 (6 months-87 years. The major group in children was 6-11 years old and 651 (% 45.5 of the cases attended to hospital were under 18 years old. The vast majority (39.3% in adults were between 19-49 years. In our study 808 (56.5% of the cases were bitten, 597 (41.8% of the cases were scrabbled by the animal and 24 (1.7%of them had indirect contact with the animal Both of them were taken into prophylactic vaccination programme (p<0.05. The vast majority of animal bites were dog (67% and cat (28%. 3 doses of Human diploid cell vaccine-HDCV were administered to 1001 (70% of the patients and 5 doses to 428 (30% of patients. Human rabies immune globulin-HRIG were administered to 475 (33,3% of the patients in addition to vaccine. Discussion: In our region rabies risk exposure is an important public health problem. Public oriented education should be given about attending to health care
Schroeer, K.; Tye, M. R.
Extreme precipitation can harm human life and assets through flooding, hail, landslides, or debris flows. Flood risk assessments typically concentrate on river or mountain torrent channels, using water depth, flow velocity, and/or sediment deposition to quantify the risk. In addition, extreme events with high recurrence intervals are often the main focus. However, damages from short-term and localized convective showers often occur away from watercourses. Also, damages from more frequent small scale extremes, although usually less disastrous, can accumulate to considerable financial burdens. Extreme convective precipitation is expected to intensify in a warmer climate, and vulnerability patterns might change in tandem with changes in the character of precipitation and flood types. This has consequences for adaptation planners who want to establish effective protection measures and reduce the cost from natural hazards. Here we merge hydrological and exposure data to identify patterns of risk under varying synoptic conditions. Exposure is calculated from a database of 76k damage claims reported to the national disaster fund in 480 municipalities in south eastern Austria from 1990-2015. Hydrological data comprise sub-daily precipitation (59 gauges) and streamflow (62 gauges) observations. We use synoptic circulation types to identify typical precipitation patterns. They indicate the character of precipitation even if a gauge is not in close proximity, facilitating potential future research with regional climate model data. Results show that more claims are reported under synoptic conditions favouring convective precipitation (on average 1.5-3 times more than on other days). For agrarian municipalities, convective precipitation damages are among the costliest after long low-intensity precipitation events. In contrast, Alpine communities are particularly vulnerable to convective high-intensity rainfall. In addition to possible observational error, uncertainty is present
Full Text Available Nutritional factors are known to be important in the development of different metabolic diseases. The history of nodular or diffuse goiter is closely related to risk of thyroid carcinoma. On account of the function of the thyroid gland, many studies focus on iodine intake.The aim of the study was to assess whether dietary patterns could be risk factors of differentiated thyroid carcinoma.Material/Methods:The case-control study was based on a questionnaire, which included information about dietary patterns and was carried out on 284 patients comprising 30 males (mean age 58.4±13.7 years, and 254 females (mean age 52.1±13.8 years, as well as 345 randomly selected controls: 58 males (mean age 60.2±12 years and 287 females (mean age 53.4±14.3 years randomly selected from the Population Register and adjusted by age and gender to the group of TC. The main groups of nutritional products, i.e. starchy foods, meat, dairy products, vegetables, fruits, and beverages, were analyzed.Results:Consumption of vegetables, fruits, saltwater fish and cottage cheese was significantly lower in patients with differentiated thyroid carcinoma than in controls, quite the contrary to starchy foods, especially white bread.Conclusions:Dietary patterns appear to modify the risk of thyroid carcinoma. A diet rich in vegetables and fruit, as well as saltwater fish (a source of iodine and low-fat meat, could be an important protective factor.
Full Text Available The study evaluated the sensitivity of the Value- at- Risk (VaR and Expected Shortfalls (ES with respect to portfolio allocation in emerging markets with an index portfolio of a developed market. This study utilised different models for VaR and ES techniques using various scenario-based models such as Covariance Methods, Historical Simulation and the GARCH (1, 1 for the predictive ability of these models in both relatively stable market conditions and extreme market conditions. The results showed that Expected Shortfall has less risk tolerance than VaR based on the same scenario-based market risk measures
Full Text Available Research into nanotechnology applications for use in agriculture has become increasingly popular over the past decade, with a particular interest in developing novel nanoagrochemicals in the form of so-called nanopesticides and nanofertilizers. In view of the extensive body of scientific literature available on the topic, many authors have foreseen a revolution in current agricultural practices.This perspective integrates scientific, regulatory, public and commercial viewpoints, and aims at critically evaluating progress made over the last decade. A number of key (and sometimes controversial questions are addressed with the aim of identifying the products that will soon emerge on the market and analyzing how they can fit into current regulatory and commercial frameworks. Issues related to the differences in definitions and perceptions within different sectors are discussed, as well as our current ability to assess new risks and benefits relative to conventional products. Many nanoagrochemicals resemble products used currently, which raises the question whether the effect of formulation has been sufficiently taken into account when evaluating agrochemicals. This analysis identifies directions for future research and regulatory needs in order to encourage intelligent design and promote the development of more sustainable agrochemicals.
Full Text Available Emerging adulthood is a period from the late teens through the twenties, when individuals are faced with more transitions and life-decisions than at any other stage of life. For the majority, psychological well-being is improved in this period, but for a significant number of individuals these challenges and contingencies entail many controversies, which in turn can lead to depression or anxiety. This paper focuses on the background of, and risk factors behind, high level depression among university students, who are typically in this life stage, in order to identify the typical client characteristics of a university counselling centre. 773 university students completed an online survey measuring depression symptoms, socioeconomic status, distal and proximal social capital, bullying, substance abuse and indirect aspects of mental health as mediate variables. 13.6% of the participants reported moderate or major depression symptoms. Using hierarchical multiple regression, male gender and poor financial situation were found to predict higher depression. After controlling for the effects of background variables, social capital factors, identity status and life skills made a significant contribution to the prediction of lower depression. This supports the idea of the importance of social skills in enabling the individual to create their own social circle and joining the community of young people at the university.
Costa, M. C.; Goumperis, T.; Andersson, W.
should be considered emerging or not, and if it merited further consideration, such as generating data on the issue, starting a full risk assessment and/or consultation of other bodies. According to the emerging risks identification process set in place at EFSA, the issues discussed and found...
Yassa, M; Saliou, M; De Rycke, Y; Hemery, C; Henni, M; Bachaud, J M; Thiounn, N; Cosset, J M; Giraud, P
Androgens play a role in the development of both androgenic alopecia, commonly known as male pattern baldness, and prostate cancer. We set out to study if early-onset androgenic alopecia was associated with an increased risk of prostate cancer later in life. A total of 669 subjects (388 with a history of prostate cancer and 281 without) were enrolled in this study. All subjects were asked to score their balding pattern at ages 20, 30 and 40. Statistical comparison was subsequently done between both groups of patients. Our study revealed that patients with prostate cancer were twice as likely to have androgenic alopecia at age 20 [odds ratio (OR) 2.01, P = 0.0285]. The pattern of hair loss was not a predictive factor for the development of cancer. There was no association between early-onset alopecia and an earlier diagnosis of prostate cancer or with the development of more aggressive tumors. This study shows an association between early-onset androgenic alopecia and the development of prostate cancer. Whether this population can benefit from routine prostate cancer screening or systematic use of 5-alpha reductase inhibitors as primary prevention remains to be determined.
Orlich, Michael J; Singh, Pramil N; Sabaté, Joan; Fan, Jing; Sveen, Lars; Bennett, Hannelore; Knutsen, Synnove F; Beeson, W Lawrence; Jaceldo-Siegl, Karen; Butler, Terry L; Herring, R Patti; Fraser, Gary E
Colorectal cancers are a leading cause of cancer mortality, and their primary prevention by diet is highly desirable. The relationship of vegetarian dietary patterns to colorectal cancer risk is not well established. To evaluate the association between vegetarian dietary patterns and incident colorectal cancers. The Adventist Health Study 2 (AHS-2) is a large, prospective, North American cohort trial including 96,354 Seventh-Day Adventist men and women recruited between January 1, 2002, and December 31, 2007. Follow-up varied by state and was indicated by the cancer registry linkage dates. Of these participants, an analytic sample of 77,659 remained after exclusions. Analysis was conducted using Cox proportional hazards regression, controlling for important demographic and lifestyle confounders. The analysis was conducted between June 1, 2014, and October 20, 2014. Diet was assessed at baseline by a validated quantitative food frequency questionnaire and categorized into 4 vegetarian dietary patterns (vegan, lacto-ovo vegetarian, pescovegetarian, and semivegetarian) and a nonvegetarian dietary pattern. The relationship between dietary patterns and incident cancers of the colon and rectum; colorectal cancer cases were identified primarily by state cancer registry linkages. During a mean follow-up of 7.3 years, 380 cases of colon cancer and 110 cases of rectal cancer were documented. The adjusted hazard ratios (HRs) in all vegetarians combined vs nonvegetarians were 0.78 (95% CI, 0.64-0.95) for all colorectal cancers, 0.81 (95% CI, 0.65-1.00) for colon cancer, and 0.71 (95% CI, 0.47-1.06) for rectal cancer. The adjusted HR for colorectal cancer in vegans was 0.84 (95% CI, 0.59-1.19); in lacto-ovo vegetarians, 0.82 (95% CI, 0.65-1.02); in pescovegetarians, 0.57 (95% CI, 0.40-0.82); and in semivegetarians, 0.92 (95% CI, 0.62-1.37) compared with nonvegetarians. Effect estimates were similar for men and women and for black and nonblack individuals. Vegetarian diets are
Orlich, Michael J.; Singh, Pramil N.; Sabaté, Joan; Fan, Jing; Sveen, Lars; Bennett, Hannelore; Knutsen, Synnove F.; Beeson, W. Lawrence; Jaceldo-Siegl, Karen; Butler, Terry L.; Herring, R. Patti; Fraser, Gary E.
IMPORTANCE Colorectal cancers are a leading cause of cancer mortality, and their primary prevention by diet is highly desirable. The relationship of vegetarian dietary patterns to colorectal cancer risk is not well established. OBJECTIVE To evaluate the association between vegetarian dietary patterns and incident colorectal cancers. DESIGN, SETTING, AND PARTICIPANTS The Adventist Health Study 2 (AHS-2) is a large, prospective, North American cohort trial including 96 354 Seventh-Day Adventist men and women recruited between January 1, 2002, and December 31, 2007. Follow-up varied by state and was indicated by the cancer registry linkage dates. Of these participants, an analytic sample of 77 659 remained after exclusions. Analysis was conducted using Cox proportional hazards regression, controlling for important demographic and lifestyle confounders. The analysis was conducted between June 1, 2014, and October 20, 2014. EXPOSURES Diet was assessed at baseline by a validated quantitative food frequency questionnaire and categorized into 4 vegetarian dietary patterns (vegan, lacto-ovo vegetarian, pescovegetarian, and semivegetarian) and a nonvegetarian dietary pattern. MAIN OUTCOMES AND MEASURES The relationship between dietary patterns and incident cancers of the colon and rectum; colorectal cancer cases were identified primarily by state cancer registry linkages. RESULTS During a mean follow-up of 7.3 years, 380 cases of colon cancer and 110 cases of rectal cancer were documented. The adjusted hazard ratios (HRs) in all vegetarians combined vs nonvegetarians were 0.78 (95% CI, 0.64–0.95) for all colorectal cancers, 0.81 (95%CI, 0.65–1.00) for colon cancer, and 0.71 (95% CI, 0.47–1.06) for rectal cancer. The adjusted HR for colorectal cancer in vegans was 0.84 (95% CI, 0.59–1.19); in lacto-ovo vegetarians, 0.82 (95% CI, 0.65–1.02); in pescovegetarians, 0.57 (95% CI, 0.40–0.82); and in semivegetarians, 0.92 (95% CI, 0.62–1.37) compared with
Huang, Chongfu; Wu, Tong; Renn, Ortwin
Today, most of the commercial risk radars only have the function to show risks, as same as a set of risk matrixes. In this paper, we develop the Internet of intelligences (IOI) to drive a risk radar monitoring dynamic risks for emergency management in community. An IOI scans risks in a community by 4 stages: collecting information and experience about risks; evaluating risk incidents; verifying; and showing risks. Employing the information diffusion method, we optimized to deal with the effective information for calculating risk value. Also, a specific case demonstrates the reliability and practicability of risk radar. Copyright © 2016 Elsevier Inc. All rights reserved.
Farahanna Abd Razak
Full Text Available Time for a Tiger (1956, a novel by Anthony Burgess, is believed to have been overlooked in the Malaysian literary context. Existing scholarship has maintained that the central themes of Time for a Tiger are colliding cultures, clashes of religion and racial conflicts but, in spite of these themes, this paper attempts to argue that there are in fact emerging patterns of Bangsa Malaysia in Time for a Tiger, which in turn reflect the elements of unity among the rich mixture of multi-ethnic characters. Bangsa Malaysia is not only the first of the nine challenges listed in Vision 2020 as conceptualised by Dr. Mahathir Mohamad (1991, but also marks the first time the Malaysian government is officially putting forward a clear vision in building a nation, launched to create a oneness atmosphere among the ethnic groups, in hopes it will reduce, if not erase, the tension among them. This study reveals that there are indeed emerging patterns of Bangsa Malaysia depicted through a mixture of characters from various ethnicities, namely the Malays, the Chinese and the Indians, through the implementation of government policies, education, a change of mindset and personal judgement, patriotism and the unifying role of the monarchy. Additionally, the patterns do support the earlier stage of the formation of Bangsa Malaysia, namely tolerance.
Full Text Available The soil nitrogen content with impact on weed seed dormancy breaking can change their seedling emergence pattern. A trial was carried out in 2014 to predict seedling emergence of Xanthium strumarium, Chenopodium album, Echinocloa cruss-galli, Amaranthus retroflexus andConvolvulus arvensis, and to evaluate the impact of soil nitrogen content (Control with 0.07% nitrogen, adding 50 and 100 kg N.ha-1 on seedling emergence pattern in Moldavian balm. The experimental design was randomized complete block design. Weed seedlings were counted and removed on a weekly basis throughout the season. The data were converted to percent of cumulative emergence and percentage of cumulative emergence values was compared with thermal time using Gompertz modified functions. The all species showed different emergence patterns and thermal time required for the onset of emergence. The results also showed that the emergence patterns of Chenopodium and Convolvulus not affected by nitrogen treatments. However, soil nitrogen content significantly changed emergence patterns of A. retroflexus, E. cruss-galli and X. strumarium. According to our model, A. retroflexus, E. cruss-galli and X. strumarium emergence, respectively, started at 237, 96 and 63 TT with 50 kg additional nitrogen.ha-1, while the respective value in control were 340, 117 and 135, respectively. Due to influence of soil nitrogen on emergence pattern of A. retroflexus, E. cruss-galli and X. strumarium, soil nitrogen content should be considered as an important parameter in the modeling of these weed seedling emergence.
Subbe, C P; Gauntlett, W; Kellett, J G
The absence of an accepted model for risk-adjustment of acute medical admissions leads to suboptimal clinical triage and serves as a disincentive to compare outcomes in different hospitals. The Simple Clinical Score (SCS) is a model based on 16 clinical parameters affecting hospital mortality. We undertook a feasibility pilot in 21 hospitals in Europe and New Zealand each collecting data for 12 or more consecutive medical emergency admissions. Data from 281 patients was analysed. Severity of illness as estimated by SCS was related to risk of admission to the Intensive Care Unit (pRisk group to 22% in the Very High Risk Group (p<0.0001). Very low scores were associated with earlier discharge as opposed to very high scores (mean length of stay of 2.4 days vs 5.6 days, p<0.001). There were differences in the pattern of discharges in different hospitals with comparable SCS data. Clinicians reported no significant problems with the collection of data for the score in a number of different health care settings. The SCS appears to be a feasible tool to assist clinical triage of medical emergency admissions. The ability to view the profile of the SCS for different clinical centres opens up the possibility of accurate comparison of outcomes across clinical centres without distortion by different regional standards of health care. This pilot study demonstrates that the adoption of the SCS is practical across an international range of hospitals. Copyright 2010 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
(2) The hospitals' respective abilities to handle large scale RTA's were ... The biggest challenge facing the hospitals in their emergency intervention is the lack of preemergency and emergency preparedness plans as well as the coordination of the hospitals response mechanisms. Conclusion: The paper ended with ...
Arcuri, Maria Cristina; Brogi, Marina; Gandolfi, Gino
The dependence on cyberspace has considerably increased over time, as such, people look at risk associated with cyber technology. This chapter focuses on the cyber risk issue. The authors aim to describe the global state of the art and point out the potential negative consequences of this type of systemic risk. Cyber risk increasingly affects both public and private institutions. Some of the risks that entities face are the following: computer security breaches, cyber theft, cyber terrorism, ...
Ruiz, Eliana; Oosterhof, Monique; Sandaa, Ruth-Anne; Larsen, Aud; Pagarete, António
Viruses are thought to be fundamental in driving microbial diversity in the oceanic planktonic realm. That role and associated emerging infection patterns remain particularly elusive for eukaryotic phytoplankton and their viruses. Here we used a vast number of strains from the model system Emiliania huxleyi /Emiliania huxleyi Virus to quantify parameters such as growth rate (µ), resistance (R), and viral production (Vp) capacities. Algal and viral abundances were monitored by flow cytometry during 72-h incubation experiments. The results pointed out higher viral production capacity in generalist EhV strains, and the virus-host infection network showed a strong co-evolution pattern between E. huxleyi and EhV populations. The existence of a trade-off between resistance and growth capacities was not confirmed.
Milczarek, M.; Brun, E.; Houtman, I.; Goudswaard, A.; Evers, M.; Bovenkamp, M. van de; Roskams, N.; Op de Beeck, R.; Pahkin, K.; Berthet, M.; Morvan, E.; Kuhn, K.; Kaluza, K.; Hupke, M.; Hauke, A.; Reinert, D.; Widerszal-Bazyl, M.; Perez, J.; Oncins de Frutos, M.
This report is in cooperation with TNO Work and Employment and the European Agency for Safety and Health at Work. The expert forecast on emerging psychosocial risks was carried out by means of the Delphi method. The main emerging psychosocial risks revealed were related to new forms of employment
Hellweger, Ferdi L; van Sebille, Erik; Fredrick, Neil D
A key question in ecology and evolution is the relative role of natural selection and neutral evolution in producing biogeographic patterns. We quantify the role of neutral processes by simulating division, mutation, and death of 100,000 individual marine bacteria cells with full 1 million-base-pair genomes in a global surface ocean circulation model. The model is run for up to 100,000 years and output is analyzed using BLAST (Basic Local Alignment Search Tool) alignment and metagenomics fragment recruitment. Simulations show the production and maintenance of biogeographic patterns, characterized by distinct provinces subject to mixing and periodic takeovers by neighbors (coalescence), after which neutral evolution reestablishes the province and the patterns reorganize. The emergent patterns are substantial (e.g., down to 99.5% DNA identity between North and Central Pacific provinces) and suggest that microbes evolve faster than ocean currents can disperse them. This approach can also be used to explore environmental selection. Copyright © 2014, American Association for the Advancement of Science.
Penniecook-Sawyers, Jason A; Jaceldo-Siegl, Karen; Fan, Jing; Beeson, Larry; Knutsen, Synnove; Herring, Patti; Fraser, Gary E
Among cancers in American women, breast cancer (BC) has the second highest incidence and mortality. The association of BC with diet has been inconsistent. Studies that evaluate associations with dietary patterns are less common and reflect an individual's whole diet. We associated dietary patterns with the risk of BC in American women of the Adventist Health Study-2 (AHS-2), a prospective cohort of 96 001 subjects recruited between 2002 and 2007. Answers to a previously validated FFQ were used to classify subjects to vegan, lacto-ovo-vegetarian, pesco-vegetarian, semi-vegetarian and non-vegetarian dietary patterns. Incident BC were identified by matching AHS-2 subjects to data from forty-eight state cancer registries. Statistical analyses used proportional hazard regression analyses with covariates that were chosen a priori. From 50 404 female participants (26 193 vegetarians), we identified 892 incident BC cases, with 478 cases among vegetarians. As compared with non-vegetarians, all vegetarians combined did not have a significantly lower risk (hazard ratio (HR) 0·97; CI 0·84, 1·11; P=0·64). However, vegans showed consistently lower (but non-significant) point estimates when compared with non-vegetarians (all cases: HR 0·78; CI 0·58, 1·05; P=0·09). In summary, participants in this cohort who follow a vegetarian dietary pattern did not experience a lower risk of BC as compared with non-vegetarians, although lower risk in vegans is possible. These findings add to the very limited literature associating vegetarian diets with BC risk and can assist nutritionists when evaluating the impact of these diets. The findings will also motivate further evaluation of vegan diets and their special characteristics.
Liu, Yang; Li, Hongyan
Decision-making problems in emergency response are usually risky and uncertain due to the limited decision data and possible evolvement of emergency scenarios. This paper focuses on a risk decisionmaking problem in emergency response with several distinct characteristics including dynamic...... evolvement process of emergency, multiple scenarios, and impact of response actions on the emergency scenarios. A method based on Fault Tree Analysis (FTA) is proposed to solve the problem. By analyzing the evolvement process of emergency, the Fault Tree (FT) is constructed to describe the logical relations...
Full Text Available Jamie Cassoff,1,2 Sabrina T Wiebe,1,2 Reut Gruber1,21Attention, Behavior and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec, Canada; 2McGill University, Montréal, Quebec, CanadaAbstract: Attention-deficit/hyperactivity disorder (ADHD is often associated with comorbid sleep disturbances. Sleep disturbances may be a risk factor for development of the disorder, a symptom of the disorder, or a comorbid condition affected by a similar psychopathology. Various studies have examined the impact of sleep deprivation on the presence/exacerbation of ADHD symptomology, as well as longitudinal and concurrent associations between different sleep disturbances and ADHD, yet the notion of sleep disturbances as a predecessor to ADHD remains unclear. As such, this review examines the evidence for sleep disturbances as a risk factor for the development of ADHD, as well as the mechanisms underlying the association between sleep patterns and ADHD. Additionally, clinical implications regarding the comorbid nature of sleep disturbances and ADHD will be considered.Keywords: sleep disturbances, ADHD, development
Panzarasa, Pietro; Bonaventura, Moreno
Research has suggested that the activity occurring in a variety of social, economic, and technological systems exhibits long-range fluctuations in time. Pronounced levels of rapidly occurring events are typically observed over short periods of time, followed by long periods of inactivity. Relatively few studies, however, have shed light on the degree to which inhomogeneous temporal processes can be detected at, and emerge from, different levels of analysis. Here we investigate patterns of human activity within an online forum in which communication can be assessed at three intertwined levels: the micro level of the individual users; the meso level of discussion groups and continuous sessions; and the macro level of the whole system. To uncover the relation between different levels, we conduct a number of numerical simulations of a zero-crossing model in which users' behavior is constrained by progressively richer and more realistic rules of social interaction. Results indicate that, when users are solipsistic, their bursty behavior is not sufficient for generating heavy-tailed interevent time distributions at a higher level. However, when users are socially interdependent, the power spectra and interevent time distributions of the simulated and real forums are remarkably similar at all levels of analysis. Social interaction is responsible for the aggregation of multiple bursty activities at the micro level into an emergent bursty activity pattern at a higher level. We discuss the implications of the findings for an emergentist account of burstiness in complex systems.
Yusuf, Yahaya Y.; Adeleye, E. O.; Sivayoganathan, K.
Turbulent change caused by factors such as changing customer and technological requirements threatens manufacturers through lower product life cycles, profits and bleak survival prospects. Therefore, several companies are stressing flexibility and agility in order to respond, real time, to the unique needs of customers and markets. However, the resource competencies required are often difficult to mobilise and retain by single companies. It is therefore imperative for companies to co-operate and leverage complementary competencies. To this end, legally separate and spatially distributed companies are becoming integrated through Internet-based technologies. The paper reviews emerging patterns in supply chain integration. It also explores the relationship between the emerging patterns and attainment of competitive objectives. The results reported in the paper are based on data from a survey by questionnaire. The survey involved 600 companies in the UK, as part of a larger study of agile manufacturing. The study was driven by a conceptual model, which relates supply chain practices to competitive objectives. The analysis involves the use of factor analysis to reduce research variables to a few principal components. Subsequently, multiple regression was conducted to study the relationship amongst the reduced variables. The results validate the proposed conceptual model and lend credence to current thinking that supply chain integration is a vital tool for competitive advantage.
Full Text Available Aim: The purpose of this study was to determine the reasons for referral to the hospital and 112 emergency ambulance service uses patterns of the inmates and convicts in an E type prison. Material and Method: In this descriptive study, it was evaluated the prison records associated with referral to the hospital and 112 emergency ambulance service uses for one year in 2010- 2011. Of the statistical analysis, descriptive statistics, chi-square test and Fisher%u2019s Exact Test were used. Results: All inmates and convicts were man, the median of age was 30,0 (min 18- max 68 years and substance use was 34,5%. The number of prisoners were referred to the hospital 815, total referrals were 1491; (referrals ranged from one to six and most common in January; and according to frequency, reasons of the referral were eyes problems, musculoskeletal disorders and psychological problems. Emergency medical service was used for in medical causes (78,3%, accident, trauma and injuries (16,4%, suicide (5,3%. Discussion: Findings from the study show that prisoners are more likely to have suffered physical and mental health problems that compared to the rest of society and have significantly high substance use rates.
Robert, Marie-Claude; Khreim, Nour; Todani, Amit; Melki, Samir A
To characterise the emergence pattern of cavitation bubbles into the anterior chamber (AC) following femtosecond laser-assisted in situ keratomileusis (LASIK)-flap creation Retrospective review of patients undergoing femtosecond LASIK surgery at Boston Laser, a private refractive surgery practice in Boston, Massachusetts, between December 2008 and February 2014. Patient charts were reviewed to identify all cases with gas bubble migration into the AC. Surgical videos were examined and the location of bubble entry was recorded separately for right and left eyes. Five thousand one hundred and fifty-eight patients underwent femtosecond LASIK surgery. Air bubble migration into the AC, presumably via the Schlemm's canal and trabecular meshwork, occurred in 1% of cases. Patients with AC bubbles had an average age of 33±8 years with a measured LASIK flap thickness of 96±21 μm. The occurrence of gas bubbles impaired iris registration in 64% of cases. Gas bubbles appeared preferentially in the nasal or inferior quadrants for right (92% of cases) and left (100% of cases) eyes. This bubble emergence pattern is significantly different from that expected with a random distribution (p<0.0001) and did not seem associated with decentration of the femtosecond laser docking system. The migration of gas bubbles into the AC is a rare occurrence during femtosecond laser flap creation. The preferential emergence of gas bubbles into the nasal and inferior quadrants of the AC may indicate a distinctive anatomy of the nasal Schlemm's canal. 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.
Shulman, Shmuel; Vasalampi, Kati; Barr, Tamuz; Livne, Yaara; Nurmi, Jari-Erik; Pratt, Michael W
The present study examined career adaptability in 100 Israeli emerging adults who were followed from ages 22 to 29. Participants were given an in depth interview and were asked to talk about their current work, difficulties they might have had in the past and how they coped with them. In addition they were asked to elaborate on the extent to which their job fits their interests and is meaningful to them. Analyses of interviews yielded three distinctive career adaptability patterns that were associated with different levels of concurrent wellbeing: Integrated, Compromised, and Vague. A lower level of identified motivation measured seven years earlier predicted membership in the Compromised pattern. A higher level of extrinsic motivation combined with decreased parental support predicted membership in the Vague pattern. Findings are discussed within the framework of the occupational adaptations and compromises that young people must make when approaching the age of 30. Copyright © 2014 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.
Haerskjold, Ann; Hegaard, H K; Kjaergaard, H
and identifies maternal and fetal risk factors associated with ECS. We included 2,748 low-risk women and 8.7% had ECS. Failure-to-progress (FTP) accounted for 68.3% of the ECS and 30.4% were performed due to suspected fetal distress (SFD). Multivariate logistic regression analyses were done to estimate.......26-3.20) were associated with increased risk of ECS due to FTP....
Fabiani, Roberto; Minelli, Liliana; Bertarelli, Gaia; Bacci, Silvia
Dietary patterns were recently applied to examine the relationship between eating habits and prostate cancer (PC) risk. While the associations between PC risk with the glycemic index and Mediterranean score have been reviewed, no meta-analysis is currently available on dietary patterns defined by "a posteriori" methods. A literature search was carried out (PubMed, Web of Science) to identify studies reporting the relationship between dietary patterns and PC risk. Relevant dietary patterns were selected and the risks estimated were calculated by a random-effect model. Multivariable-adjusted odds ratios (ORs), for a first-percentile increase in dietary pattern score, were combined by a dose-response meta-analysis. Twelve observational studies were included in the meta-analysis which identified a "Healthy pattern" and a "Western pattern". The Healthy pattern was not related to PC risk (OR = 0.96; 95% confidence interval (CI): 0.88-1.04) while the Western pattern significantly increased it (OR = 1.34; 95% CI: 1.08-1.65). In addition, the "Carbohydrate pattern", which was analyzed in four articles, was positively associated with a higher PC risk (OR = 1.64; 95% CI: 1.35-2.00). A significant linear trend between the Western ( p = 0.011) pattern, the Carbohydrate ( p = 0.005) pattern, and the increment of PC risk was observed. The small number of studies included in the meta-analysis suggests that further investigation is necessary to support these findings.
Lindell, M.K.; Barnes, V.E.
This article examines why, as suggested by the Three Mile Island Nuclear Station (TMI) event, the public is more inclined to evacuate in response to a radiation release than to a natural hazard. During the TMI incident, for example, did authorities present confusing or conflicting information or did the public have an exaggerated perception of radiation risk. Behavioral intention studies are combined with risk perception analyses to ascertain (1) the extent to which intentions to evacuate can be generalized from one sample to another and from one hazard to another, (2) the degree to which behavioral intentions are related to specific dimensions of risk perception, and (3) how public perceptions of risk compare with estimates of risk produced by reactor accident consequence analyses
Saunders-Hastings, Patrick R.; Krewski, Daniel
For centuries, novel strains of influenza have emerged to produce human pandemics, causing widespread illness, death, and disruption. There have been four influenza pandemics in the past hundred years. During this time, globalization processes, alongside advances in medicine and epidemiology, have altered the way these pandemics are experienced. Drawing on international case studies, this paper provides a review of the impact of past influenza pandemics, while examining the evolution of our understanding of, and response to, these viruses. This review argues that pandemic influenza is in part a consequence of human development, and highlights the importance of considering outbreaks within the context of shifting global landscapes. While progress in infectious disease prevention, control, and treatment has improved our ability to respond to such outbreaks, globalization processes relating to human behaviour, demographics, and mobility have increased the threat of pandemic emergence and accelerated global disease transmission. Preparedness planning must continue to evolve to keep pace with this heightened risk. Herein, we look to the past for insights on the pandemic experience, underlining both progress and persisting challenges. However, given the uncertain timing and severity of future pandemics, we emphasize the need for flexible policies capable of responding to change as such emergencies develop. PMID:27929449
Shi, Bin; Jiang, Jiping; Liu, Rentao; Khan, Afed Ullah; Wang, Peng
Without an engineering risk assessment for emergency disposal in response to sudden water pollution incidents, responders are prone to be challenged during emergency decision making. To address this gap, the concept and framework of emergency disposal engineering risks are reported in this paper. The proposed risk index system covers three stages consistent with the progress of an emergency disposal project. Fuzzy fault tree analysis (FFTA), a logical and diagrammatic method, was developed to evaluate the potential failure during the process of emergency disposal. The probability of basic events and their combination, which caused the failure of an emergency disposal project, were calculated based on the case of an emergency disposal project of an aniline pollution incident in the Zhuozhang River, Changzhi, China, in 2014. The critical events that can cause the occurrence of a top event (TE) were identified according to their contribution. Finally, advices on how to take measures using limited resources to prevent the failure of a TE are given according to the quantified results of risk magnitude. The proposed approach could be a potential useful safeguard for the implementation of an emergency disposal project during the process of emergency response.
Flage, R.; Aven, T.
The concept of emerging risk has gained increasing attention in recent years. The term has an intuitive appeal and meaning but a consistent and agreed definition is missing. We perform an in-depth analysis of this concept, in particular its relation to black swan type of events, and show that these can be considered meaningful and complementary concepts by relating emerging risk to known unknowns and black swans to unknown knowns, unknown unknowns and a subset of known knowns. The former is consistent with saying that we face emerging risk related to an activity when the background knowledge is weak but contains indications/justified beliefs that a new type of event (new in the context of that activity) could occur in the future and potentially have severe consequences to something humans value. The weak background knowledge among other things results in difficulty specifying consequences and possibly also in fully specifying the event itself; i.e. in difficulty specifying scenarios. Here knowledge becomes the key concept for both emerging risk and black swan type of events, allowing for taking into consideration time dynamics since knowledge develops over time. Some implications of our findings in terms of risk assessment and risk management are pointed out. - Highlights: • We perform an in-depth analysis of the concept of emerging risk. • Emerging risk and black swan type of events are shown to be complementary concepts. • We propose a definition of emerging risk where knowledge becomes the key term. • Some implications for risk assessment and risk management are pointed out.
McBeth, Paul B; Ball, Chad G; Mulloy, Robert H; Kirkpatrick, Andrew W
Alpine skiing and snowboarding are popular winter sports in Canada. Every year participation in these activities results in traumatic injury. The purpose of this study was to identify the incidence and injury patterns, as well as risk factors associated with ski and snowboarding injuries. A comprehensive 10-year retrospective review of Alpine ski and snowboarding injuries from 1996 to 2006 was conducted. The Alberta Trauma Registry was used as the primary source of data. A total of 196 patients (56.6% skiers, 43.4% snowboarders) were identified as having major traumatic injuries (Injury Severity Score, >or=12). Forty-three patients required intensive care unit support. The majority of injuries were related to falls and collisions with natural objects. Head injuries were most common, followed by chest, spinal, and extremity trauma. Seventy-nine patients required emergency surgery. Skiing and snowboarding represent activities with high potential for traumatic injury. Safety initiatives should be developed to target this population.
Full Text Available Among patients who are discharged from the Emergency Department (ED, about 3% return within 30 days. Revisits can be related to the nature of the disease, medical errors, and/or inadequate diagnoses and treatment during their initial ED visit. Identification of high-risk patient population can help device new strategies for improved ED care with reduced ED utilization.A decision tree based model with discriminant Electronic Medical Record (EMR features was developed and validated, estimating patient ED 30 day revisit risk. A retrospective cohort of 293,461 ED encounters from HealthInfoNet (HIN, Maine's Health Information Exchange (HIE, between January 1, 2012 and December 31, 2012, was assembled with the associated patients' demographic information and one-year clinical histories before the discharge date as the inputs. To validate, a prospective cohort of 193,886 encounters between January 1, 2013 and June 30, 2013 was constructed. The c-statistics for the retrospective and prospective predictions were 0.710 and 0.704 respectively. Clinical resource utilization, including ED use, was analyzed as a function of the ED risk score. Cluster analysis of high-risk patients identified discrete sub-populations with distinctive demographic, clinical and resource utilization patterns.Our ED 30-day revisit model was prospectively validated on the Maine State HIN secure statewide data system. Future integration of our ED predictive analytics into the ED care work flow may lead to increased opportunities for targeted care intervention to reduce ED resource burden and overall healthcare expense, and improve outcomes.
Esteve-Esteve, Miguel; Bautista-Rentero, Daniel; Zanón-Viguer, Vicente
To estimate the risk of influenza transmission in patients coming to a hospital emergency department during the week of highest incidence and to analyze factors associated with transmission. Retrospective observational analysis of a cohort of patients treated in the emergency room during the 2014-2015 flu season. The following variables were collected from records: recorded influenza diagnosis, results of a rapid influenza confirmation test, point of exposure (emergency department, outpatient clinic, or the community), age, sex, flu vaccination or not, number of emergency visits, time spent in the waiting room, and total time in the hospital. We compiled descriptive statistics and performed bivariate and multivariate analyses by means of a Poisson regression to estimate relative risk (RR) and 95% CIs. The emergency department patients had a RR of contracting influenza 3.29 times that of the communityexposed population (95% CI, 1.53-7.08, P=.002); their risk was 2.05 times greater than that of outpatient clinic visitors (95% CI, 1.04-4.02, P=.036). Emergency patients under the age of 15 years had a 5.27 greater risk than older patients (95% CI, 1.59-17.51; P=.007). The RR of patients visiting more than once was 11.43 times greater (95% CI, 3.58-36.44; P<.001). The risk attributable to visiting the emergency department risk was 70.5%, whereas risk attributable to community exposure was 2%. The risk of contracting influenza is greater for emergency department patients than for the general population or for patients coming to the hospital for outpatient clinic visits. Patients under the age of 15 years incur greater risk.
Romero, Pedro P; López, Ricardo; Jiménez, Carlos
This paper aims to explain the macroeconomic volatility due to microeconomic shocks to one or several sectors, recognizing the non-symmetrical relation in the interaction among the Ecuadorian economic sectors. To grasp the economic structure of this emerging economy, a statistical analysis of network data is applied to the respective input-output matrix of Ecuador from 1975 until 2012. We find periods wherein the production of domestic inputs is concentrated in a few suppliers; for example, in 2010, the concentration significantly affects sectors and their downstream providers, thus influencing aggregate volatility. Compared to the US productive structure, this emerging economy presents fewer sectors and degree distributions with less extreme fat-tail behavior. In this simpler economy, we continue to find a link between microeconomic shocks and aggregate volatility. Two new theoretical propositions are introduced to formalize our results.
López, Ricardo; Jiménez, Carlos
This paper aims to explain the macroeconomic volatility due to microeconomic shocks to one or several sectors, recognizing the non-symmetrical relation in the interaction among the Ecuadorian economic sectors. To grasp the economic structure of this emerging economy, a statistical analysis of network data is applied to the respective input-output matrix of Ecuador from 1975 until 2012. We find periods wherein the production of domestic inputs is concentrated in a few suppliers; for example, in 2010, the concentration significantly affects sectors and their downstream providers, thus influencing aggregate volatility. Compared to the US productive structure, this emerging economy presents fewer sectors and degree distributions with less extreme fat-tail behavior. In this simpler economy, we continue to find a link between microeconomic shocks and aggregate volatility. Two new theoretical propositions are introduced to formalize our results. PMID:29293567
Kurt Burneo Farfan
Full Text Available The aim of this paper is to introduce the importance of the banking credit risk, the main elements that conform it and the main alternatives that are offered to access to a loan as well as a description of its measurement and management in the sector. There will be a general explanation of credit risk and the main parties involved in it. As the topic is developed it is going to be analyzed the lending process carried out by the banks as well as the quantitative and qualitative elements taken into account when taking a credit decision (The 5C’s of credit, credit scoring and models for quantification of losses for instance. Another thing to considerate is that Credit risk arises whenever a borrower is expecting to use future cash flows to pay a current debt. Also, the investors have the access for the information of a client and they are compensated for assuming credit risk by way of interest payments from the borrower or issuer of a debt obligation and the credit risk is a useful tool for the finance management. The Enterprise risk management in Peru changed in 2015 because the local regulator is in process to review the norm, including some aspects of corporate governance; these changes are not included in this research.
Brix, Nis; Stokholm, Lonny; Jonsdottir, Fjola
INTRODUCTION: Caesarean section is thought to be a risk factor for childhood asthma, but this association may be caused by confounding from, for instance, familial factors. To address this problem, we used twin pairs to assess the risk of childhood asthma after emergency caesarean section. METHODS...... respiratory morbidity, the risk of childhood asthma following emergency caesarean section remained unchanged. CONCLUSION: Emergency caesarean section was not associated with childhood asthma. FUNDING: none. TRIAL REGISTRATION: not relevant.......: In total, 464 twin pairs (928 twins) were included. In 30 pairs, the first twin (vaginal delivery) was diagnosed with asthma, but the second twin (emergency caesarean section) was not. In 20 pairs, the second twin (emergency caesarean section) was diagnosed with asthma, but the first twin (vaginal delivery...
Strate, Lisa L; Keeley, Brieze R; Cao, Yin; Wu, Kana; Giovannucci, Edward L; Chan, Andrew T
Dietary fiber is implicated as a risk factor for diverticulitis. Analyses of dietary patterns may provide information on risk beyond those of individual foods or nutrients. We examined whether major dietary patterns are associated with risk of incident diverticulitis. We performed a prospective cohort study of 46,295 men who were free of diverticulitis and known diverticulosis in 1986 (baseline) using data from the Health Professionals Follow-Up Study. Each study participant completed a detailed medical and dietary questionnaire at baseline. We sent supplemental questionnaires to men reporting incident diverticulitis on biennial follow-up questionnaires. We assessed diet every 4 years using a validated food frequency questionnaire. Western (high in red meat, refined grains, and high-fat dairy) and prudent (high in fruits, vegetables, and whole grains) dietary patterns were identified using principal component analysis. Follow-up time accrued from the date of return of the baseline questionnaire in 1986 until a diagnosis of diverticulitis, diverticulosis or diverticular bleeding; death; or December 31, 2012. The primary end point was incident diverticulitis. During 894,468 person years of follow-up, we identified 1063 incident cases of diverticulitis. After adjustment for other risk factors, men in the highest quintile of Western dietary pattern score had a multivariate hazard ratio of 1.55 (95% CI, 1.20-1.99) for diverticulitis compared to men in the lowest quintile. High vs low prudent scores were associated with decreased risk of diverticulitis (multivariate hazard ratio, 0.74; 95% CI, 0.60-0.91). The association between dietary patterns and diverticulitis was predominantly attributable to intake of fiber and red meat. In a prospective cohort study of 46,295 men, a Western dietary pattern was associated with increased risk of diverticulitis, and a prudent pattern was associated with decreased risk. These data can guide dietary interventions for the prevention of
Stuart, Marianne; Lapworth, Dan; Crane, Emily; Hart, Alwyn
This paper provides a review of the types of emerging organic groundwater contaminants (EGCs) which are beginning to be found in the UK. EGCs are compounds being found in groundwater that were previously not detectable or known to be significant and can come from agricultural, urban and rural point sources. EGCs include nanomaterials, pesticides, pharmaceuticals, industrial compounds, personal care products, fragrances, water treatment by-products, flame retardants and surfactants, as well a...
Turner, Sally; Wylde, Julie; Langham, Martin; Morrow, Andrew
An investigation of how emergency vehicle lighting (EVL) can be improved is reported with reference to an analysis of police vehicle road traffic accidents (Study 1). In Study 2, 37 regular drivers were shown film clips of a marked police vehicle, in which flash rate (1 Hz, 4 Hz) and pattern (single, triple pulse) were varied on the blue Light Emitting Diode (LED) roofbar. Results indicate a 4 Hz flash rate conveys greater urgency than a 1 Hz rate, while a 1 Hz, single flash combination was ranked the least urgent of all combinations. Participants claimed they would leave significantly more space before pulling out in front of an approaching police car (gap acceptance) in the 4 Hz single pulse condition in comparison to other EVL combinations. The preliminary implications for which flash characteristics could prove most optimal for emergency service use are discussed with regard to effects on driver perception and expected driving behaviour. Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.
Pillonel, J; Gallian, P; Sommen, C; Couturier, E; Piquet, Y; Djoudi, R; Laperche, S
The risk assessment for blood transfusion is an essential step that must precede any screening strategy of a pathogen transmitted by transfusion. After several cases of HEV transmission by transfusion in France, a risk assessment for this virus was performed. We used a method based on the prevalence of HEV-RNA in plasmas collected for the preparation of SD-plasma. To estimate the rate of HEV-RNA positive among all blood donations, data on SD-plasma were adjusted on the following HEV risk factors: gender, age group and region of residence. We assumed that HEV risk factors were the same in plasma donors and whole blood donors. Among 57,101 plasma donations tested for HEV-RNA in 2013, 24 were positive (crude rate of 4.2 per 10,000 donations). After adjustment, the total number of HEV-RNA positive blood donations was estimated at 788, accounting for a rate of 2.65 per 10,000 donations (95% CI: 1.6-3.7) or 1 in 3800 donations (1 in 6,200-1 in 2,700). This rate was 12 times higher in men than in women, increased with age, and varied according to region of residence. The risk of blood donation contamination by HEV has been estimated to be 1 in 3800 donations in 2013. An essential input is still missing to assess now the risk in recipients: the minimum infectious dose. Furthermore, the risk in recipients has to be analyzed according to characteristics of transfused patients: presence of anti-HEV immunity, existence of chronic liver disease or immunodeficiency. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
Da Lio, Cristina; D'Alpaos, Andrea; Marani, Marco
The presence and continued existence of tidal morphologies, and in particular of salt marshes, is intimately connected with biological activity, especially with the presence of halophytic vegetation. Here, we review recent contributions to tidal biogeomorphology and identify the presence of multiple competing stable states arising from a two-way feedback between biomass productivity and topographic elevation. Hence, through the analysis of previous and new results on spatially extended biogeomorphological systems, we show that multiple stable states constitute a unifying framework explaining emerging patterns in tidal environments from the local to the system scale. Furthermore, in contrast with traditional views we propose that biota in tidal environments is not just passively adapting to morphological features prescribed by sediment transport, but rather it is 'The Secret Gardener', fundamentally constructing the tidal landscape. The proposed framework allows to identify the observable signature of the biogeomorphic feedbacks underlying tidal landscapes and to explore the response and resilience of tidal biogeomorphic patterns to variations in the forcings, such as the rate of relative sea-level rise.
Nair, Manisha; Webster, Premila
About a third of the countries affected by shortage of human resources for health are the emerging market economies (EMEs). The greatest shortage in absolute terms was found to be in India and Indonesia leading to health system crisis. This review identifies the patterns of migration of health workers, causes and possible solutions in these EMEs. A qualitative synthesis approach based on the 'critical review' and 'realist review' approaches to the literature review was used. The patterns of migration of health professionals' in the EMEs have led to two types of discrepancies between health needs and healthcare workers: (i) within country (rural-urban, public-private or government healthcare sector-private sector) and (ii) across countries (south to north). Factors that influence migration include lack of employment opportunities, appropriate work environment and wages in EMEs, growing demand in high-income countries due to demographic transition, favourable country policies for financial remittances by migrant workers and medical education system of EMEs. A range of successful national and international initiatives to address health workforce migration were identified. Measures to control migration should be country specific and designed in accordance with the push and pull factors existing in the EMEs.
King, Cheryl A; Gipson, Polly Y; Horwitz, Adam G; Opperman, Kiel J
Previous research has documented the feasibility of screening in emergency departments for adolescent suicide risk. This randomized trial examined the effectiveness of Teen Options for Change (TOC), an intervention for adolescents seeking general medical emergency services who screen positive for suicide risk. Participants were 49 youths, ages 14 to 19, seeking services for nonpsychiatric emergencies. They screened positive for suicide risk because of recent suicidal ideation, suicide attempt, or depression plus substance abuse. Youths were randomly assigned to the TOC intervention or to enhanced treatment as usual. Depression, hopelessness, and suicidal ideation were assessed at baseline and two months later. Adolescents assigned to TOC showed greater reductions in depression than adolescents assigned to the comparison group (Cohen's d=1.07, a large effect size). Hopelessness, suicidal ideation, and substance abuse outcomes trended positively (nonsignificantly), with small to moderate effect sizes. TOC may be a promising, brief intervention for adolescents seeking emergency services and at risk of suicide.
Visser, Leenke; de Winter, Andrea F.; Verhulst, Frank C.; Vollebergh, Wilma A.M.; Reijneveld, Sijmen A.
BACKGROUND: Most studies on multiple health risk behaviors among adolescents have cross-sectionally studied a limited number of health behaviors or determinants. PURPOSE: To examine the prevalence, longitudinal patterns and predictors of individual and multiple health risk behaviors among
Heinälä, Milla; Gundert-Remy, Ursula; Wood, Maureen Heraty
A scientifically sound assessment of the risk to human health resulting from acute chemical releases is the cornerstone for chemical incident prevention, preparedness and response. Although the general methodology to identify acute toxicity of chemicals has not substantially changed in the last....../corrosive chemicals will remain serious risks also in future the development of plausible scenarios for potential emerging risks is also needed. This includes risks from new mixtures and chemicals (e.g. nanoparticles)....
The present book “International Legal Framework for Geoengineering – Managing the Risks of an Emerging Technology” is about international law and an emerging technology called geoengineering, which refers to the large-scale manipulation of the planetary environment for counteracting anthropogenic
... recover loss. 370.8 Section 370.8 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION REGULATIONS AND STATEMENTS OF GENERAL POLICY TEMPORARY LIQUIDITY GUARANTEE PROGRAM § 370.8 Systemic risk emergency special... temporary liquidity guarantee program, the Corporation shall impose an emergency special assessment on...
Murnyak, George; Vandenberg, John; Yaroschak, Paul J.; Williams, Larry; Prabhakaran, Krishnan; Hinz, John
A session entitled 'Emerging Contaminants' was held in April 2009 in Cincinnati, OH at the 2009 Toxicology and Risk Assessment Conference. The purpose of the session was to share information on both programmatic and technical aspects associated with emerging contaminants. Emerging contaminants are chemicals or materials that are characterized by a perceived or real threat to human health or environment, a lack of published health standards or an evolving standard. A contaminant may also be 'emerging' because of the discovery of a new source, a new pathway to humans, or a new detection method or technology. The session included five speakers representing the Department of Defense (DoD), the Environmental Protection Agency (EPA), and each of the military services. The DoD created the Emerging Contaminant Directorate to proactively address environmental, health, and safety concerns associated with emerging contaminants. This session described the scan-watch-action list process, impact assessment methodology, and integrated risk management concept that DoD has implemented to manage emerging contaminants. EPA presented emerging trends in health risk assessment. Researchers made technical presentations on the status of some emerging contaminates in the assessment process (i.e. manganese, RDX, and naphthalene).
Azizi, Hosein; Asadollahi, Khairollah; Davtalab Esmaeili, Elham; Mirzapoor, Mohammad
Role of diet on colorectal cancer (CRC) has been considered in terms of single foods and nutrients, but less frequently in terms of dietary patterns in Iran. The objective of this study was to determine the association between Iranian dietary patterns and CRC. This case-control study was conducted in four hospitals in Tabriz City of Iran including 414 participants aged 35-75 years:207 cases with CRC confirmed by pathology and colonoscopy findings were selected and 207 controls free of neoplastic conditions and diet-related chronic diseases (from the same hospital at the same period for the cases). Dietary data were assessed using a 123-item semi-quantitative food frequency questionnaire. Two dietary patterns were found by using of Principal Component Analysis (PCA) method;"Healthy pattern"and "Iranian pattern". Multivariate logistic regression analysis was used to estimate adjusted odds ratios (OR) for relationship between dietary patterns and colorectal cancer. After adjusting for confounding factors, the Iranian dietary pattern was significantly associated with an increased odds of colorectal cancer (OR= 1.46; 95% Confidenec Interval (CI)=1.05-2.19) while a reduced odds of colorectal cancer was observed with the Healthy dietary pattern (OR=0.18; 95% CI= 0.091-0.47). Iranian dietary pattern (IDP) seems to increase the odds of colorectal cancer and protective effect of Healthy dietary pattern.
...] Data and Data Needs To Advance Risk Assessment for Emerging Infectious Diseases Relevant to Blood and... Needs to Advance Risk Assessment for Emerging Infectious Diseases Relevant to Blood and Blood Products... an important tool for evaluating the risks associated with new emerging infectious diseases (EIDs...
Paek, Hye-Jin; Hilyard, Karen; Freimuth, Vicki; Barge, J Kevin; Mindlin, Michele
Recent natural and human-caused disasters have awakened public health officials to the importance of emergency preparedness. Guided by health behavior and media effects theories, the analysis of a statewide survey in Georgia reveals that self-efficacy, subjective norm, and emergency news exposure are positively associated with the respondents' possession of emergency items and their stages of emergency preparedness. Practical implications suggest less focus on demographics as the sole predictor of emergency preparedness and more comprehensive measures of preparedness, including both a person's cognitive stage of preparedness and checklists of emergency items on hand. We highlight the utility of theory-based approaches for understanding and predicting public emergency preparedness as a way to enable more effective health and risk communication.
Dialysis patients appear to be at increased risk for exposure to cyanobacteria toxins; episodes of microcystin (MCYST) exposure via dialysate during 1996 and 2001 have been previously reported. During 2001, as many as 44 renal insufficiency patients were exposed to contaminated d...
Kirchner, M.; Rieth, M.
This paper assesses the role of sovereign risk in explaining macroeconomic fluctuations in Turkey. We estimate two versions of a simple New Keynesian small open economy model on quarterly data for the period 1994Q3-2008Q2: a basic version and a version augmented by a default premium on government
Fung, Teresa T.; Brown, Lisa S.
Diet and lifestyle play a significant role in the development of colorectal cancer, but the full complexity of the association is not yet understood. Dietary pattern analysis is an important new technique that may help to elucidate the relationship. This review examines the most common techniques for extrapolating dietary patterns and reviews dietary pattern/colorectal cancer studies published between September 2011 and August 2012. The studies reviewed are consistent with prior research but ...
Shakeri, Ramin; Malekzadeh, Reza; Etemadi, Arash; Nasrollahzadeh, Dariush; Aghcheli, Karim; Sotoudeh, Masoud; Islami, Farhad; Pourshams, Akram; Pawlita, Michael; Boffetta, Paolo; Dawsey, Sanford M.; Abnet, Christian C.; Kamangar, Farin
Opium use has been associated with higher risk of cancers of the esophagus, bladder, larynx, and lung; however, no previous study has examined its association with gastric cancer. There is also little information on the associations between hookah (water pipe) smoking or the chewing of tobacco products and the risk of gastric cancer. In a case-control study in Golestan Province of Iran, we enrolled 309 cases of gastric adenocarcinoma (118 noncardia, 161 cardia, and 30 mixed-location adenocarcinomas) and 613 matched controls. Detailed information on long-term use of opium, tobacco products, and other covariates were collected using structured and validated lifestyle and food frequency questionnaires. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were obtained using conditional logistic regression models. Opium use was associated with an increased risk of gastric adenocarcinoma, with an adjusted OR (95% CI) of 3.1 (1.9 – 5.1), and this increased risk was apparent for both anatomic subsites (cardia and noncardia). There was a dose-response effect, and individuals with the highest cumulative opium use had the strongest association (OR: 4.5; 95%CI: 2.3-8.5). We did not find a statistically significant association between the use of any of the tobacco products and risk of gastric adenocarcinoma, overall or by anatomic subsite. We showed, for the first time, an association between opium use and gastric adenocarcinoma. Given that opium use is a traditional practice in many parts of the world, these results are of public health significance. PMID:23319416
Shakeri, Ramin; Malekzadeh, Reza; Etemadi, Arash; Nasrollahzadeh, Dariush; Aghcheli, Karim; Sotoudeh, Masoud; Islami, Farhad; Pourshams, Akram; Pawlita, Michael; Boffetta, Paolo; Dawsey, Sanford M; Abnet, Christian C; Kamangar, Farin
Opium use has been associated with higher risk of cancers of the esophagus, bladder, larynx, and lung; however, no previous study has examined its association with gastric cancer. There is also little information on the associations between hookah (water pipe) smoking or the chewing of tobacco products and the risk of gastric cancer. In a case-control study in Golestan Province of Iran, we enrolled 309 cases of gastric adenocarcinoma (118 noncardia, 161 cardia and 30 mixed-location adenocarcinomas) and 613 matched controls. Detailed information on long-term use of opium, tobacco products and other covariates were collected using structured and validated lifestyle and food frequency questionnaires. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were obtained using conditional logistic regression models. Opium use was associated with an increased risk of gastric adenocarcinoma, with an adjusted OR (95% CI) of 3.1 (1.9-5.1), and this increased risk was apparent for both anatomic subsites (cardia and noncardia). There was a dose-response effect, and individuals with the highest cumulative opium use had the strongest association (OR: 4.5; 95% CI: 2.3-8.5). We did not find a statistically significant association between the use of any of the tobacco products and risk of gastric adenocarcinoma, overall or by anatomic subsite. We showed, for the first time, an association between opium use and gastric adenocarcinoma. Given that opium use is a traditional practice in many parts of the world, these results are of public health significance. Copyright © 2013 UICC.
Medina-Remón, Alexander; Kirwan, Richard; Lamuela-Raventós, Rosa M; Estruch, Ramón
Diet and lifestyle play a significant role in the development chronic diseases; however the full complexity of this relationship is not yet understood. Dietary pattern investigation, which reflects the complexity of dietary intake, has emerged as an alternative and complementary approach for examining the association between diet and chronic diseases. Literature on this association has largely focused on individual nutrients, with conflicting outcomes, but individuals consume a combination of foods from many groups that form dietary patterns. Our objective was to systematically review the current findings on the effects of dietary patterns on chronic diseases. In this review, we describe and discuss the relationships between dietary patterns, such as the Mediterranean, the Dietary Approach to Stop Hypertension, Prudent, Seventh-day Adventists, and Western, with risk of obesity, type-2 diabetes mellitus, cardiovascular diseases, asthma, and neurodegenearive diseases. Evidence is increasing from both observational and clinical studies that plant-based dietary patterns, which are rich in fruits, vegetables, and whole grains, are valuable in preventing various chronic diseases, whereas a diet high in red and processed meat, refined grains and added sugar seems to increase said risk. Dietary pattern analysis might be especially valuable to the development and evaluation of food-based dietary guidelines.
Källberg, Ann-Sofie; Ehrenberg, Anna; Florin, Jan; Östergren, Jan; Göransson, Katarina E
The emergency department has been described as a high-risk area for errors. It is also known that working conditions such as a high workload and shortage off staff in the healthcare field are common factors that negatively affect patient safety. A limited amount of research has been conducted with regard to patient safety in Swedish emergency departments. Additionally, there is a lack of knowledge about clinicians' perceptions of patient safety risks. Therefore, the purpose of this study was to describe emergency department clinicians' experiences with regard to patient safety risks. Semi-structured interviews were conducted with 10 physicians and 10 registered nurses from two emergency departments. Interviews were analysed by inductive content analysis. The experiences reflect the complexities involved in the daily operation of a professional practice, and the perception of risks due to a high workload, lack of control, communication and organizational failures. The results reflect a complex system in which high workload was perceived as a risk for patient safety and that, in a combination with other risks, was thought to further jeopardize patient safety. Emergency department staff should be involved in the development of patient safety procedures in order to increase knowledge regarding risk factors as well as identify strategies which can facilitate the maintenance of patient safety during periods in which the workload is high. Copyright © 2017 Elsevier Ltd. All rights reserved.
Full Text Available Many patients treated in Emergency Department (ED visits can be treated at primary or urgent care sectors, despite the fact that a number of ED visitors seek other forms of care prior to an ED visit. However, little is known regarding how the pre-ED activity episodes affect ED visits.We investigated whether care-seeking patterns involve the use of health care services of various types prior to ED visits and examined the associations of these patterns with the severity of the presenting condition for the ED visit (EDVS and subsequent events.This retrospective observational study used administrative data on beneficiaries of the universal health care insurance program in Taiwan. The service type, treatment capacity, and relative diagnosis were used to classify pre-ED visits into 8 care types. Frequent pattern analysis was used to identify sequential care-seeking patterns and to classify 667,183 eligible pre-ED episodes into patterns. Generalized linear models were developed using generalized estimating equations to examine the associations of these patterns with EDVS and subsequent events.The results revealed 17 care-seeking patterns. The EDVS and likelihood of subsequent events significantly differed among patterns. The ED severity index of patterns differ from patterns seeking directly ED care (coefficients ranged from -0.05 to 0.13, and the odds-ratios for the likelihood of subsequent ED visits and hospitalization ranged from 1.18 to 1.86 and 1.16 to 2.84, respectively.The pre-ED care-seeking patterns differ in severity of presenting condition and subsequent events that may represent different causes of ED visit. Future health policy maker may adopt different intervention strategies for targeted population to reduce unnecessary ED visit effectively.
Chan, Chien-Lung; Lin, Wender; Yang, Nan-Ping; Lai, K Robert; Huang, Hsin-Tsung
Many patients treated in Emergency Department (ED) visits can be treated at primary or urgent care sectors, despite the fact that a number of ED visitors seek other forms of care prior to an ED visit. However, little is known regarding how the pre-ED activity episodes affect ED visits. We investigated whether care-seeking patterns involve the use of health care services of various types prior to ED visits and examined the associations of these patterns with the severity of the presenting condition for the ED visit (EDVS) and subsequent events. This retrospective observational study used administrative data on beneficiaries of the universal health care insurance program in Taiwan. The service type, treatment capacity, and relative diagnosis were used to classify pre-ED visits into 8 care types. Frequent pattern analysis was used to identify sequential care-seeking patterns and to classify 667,183 eligible pre-ED episodes into patterns. Generalized linear models were developed using generalized estimating equations to examine the associations of these patterns with EDVS and subsequent events. The results revealed 17 care-seeking patterns. The EDVS and likelihood of subsequent events significantly differed among patterns. The ED severity index of patterns differ from patterns seeking directly ED care (coefficients ranged from -0.05 to 0.13), and the odds-ratios for the likelihood of subsequent ED visits and hospitalization ranged from 1.18 to 1.86 and 1.16 to 2.84, respectively. The pre-ED care-seeking patterns differ in severity of presenting condition and subsequent events that may represent different causes of ED visit. Future health policy maker may adopt different intervention strategies for targeted population to reduce unnecessary ED visit effectively.
Lee, Ji Eun; Kim, Jung-Hyun; Son, Say Jin; Ahn, Younjhin; Lee, Juyoung; Park, Chan; Lee, Lilha; Erickson, Kent L; Jung, In-Kyung
This study was performed to identify dietary patterns in Korean men and to determine the associations among dietary patterns, nutrient intake, and health-risk factors. Using baseline data from the Korean Health and Genome Study, dietary patterns were identified using factor analysis of data from a validated food-frequency questionnaire, and associations between these dietary patterns and health-risk factors were analyzed. Three dietary patterns were identified: 1) the "animal-food" pattern (greater intake of meats, fish, and dairy products), 2) the "rice-vegetable" pattern (greater intake of rice, tofu, kimchi, soybean paste, vegetables, and seaweed), and 3) the "noodle-bread" pattern (greater intake of instant noodles, Chinese noodles, and bread). The animal-food pattern (preferred by younger people with higher income and education levels) had a positive correlation with obesity and hypercholesterolemia, whereas the rice-vegetable pattern (preferred by older people with lower income and educational levels) was positively associated with hypertension. The noodle-bread pattern (also preferred by younger people with higher income and education levels) had a positive association with abdominal obesity and hypercholesterolemia. This study identifies three unique dietary patterns in Korean men, which are independently associated with certain health-risk factors. The rice-vegetable dietary pattern, modified for a low sodium intake, might be a healthy dietary pattern for Korean men. Copyright © 2011 Elsevier Inc. All rights reserved.
Full Text Available Background: Role of diet on colorectal cancer (CRC has been considered in terms of single foods and nutrients, but less frequently in terms of dietary patterns in Iran. The objective of this study was to determine the association between Iranian dietary patterns and CRC.Methods: This case–control study was conducted in four hospitals in Tabriz City of Iran including 414 participants aged 35–75 years:207 cases with CRC confirmed by pathology and colonoscopy findings were selected and 207 controls free of neoplastic conditions and diet-related chronic diseases (from the same hospital at the same period for the cases. Dietary data were assessed using a 123-item semi-quantitative food frequency questionnaire. Two dietary patterns were found by using of Principal Component Analysis (PCA method;“Healthy pattern”and “Iranian pattern”. Multivariate logistic regression analysis was used to estimate adjusted odds ratios (OR for relationship between dietary patterns and colorectal cancer.Results: After adjusting for confounding factors, the Iranian dietary pattern was significantly associated with an increased odds of colorectal cancer (OR= 1.46; 95% Confidenec Interval (CI=1.05–2.19 while a reduced odds of colorectal cancer was observed with the Healthy dietary pattern (OR=0.18; 95% CI= 0.091-0.47.Conclusion: Iranian dietary pattern (IDP seems to increase the odds of colorectal cancer and protective effect of Healthy dietary pattern.
Guis, Helene; Caminade, Cyril; Calvete, Carlos; Morse, Andrew P.; Tran, Annelise; Baylis, Matthew
Vector-borne diseases are among those most sensitive to climate because the ecology of vectors and the development rate of pathogens within them are highly dependent on environmental conditions. Bluetongue (BT), a recently emerged arboviral disease of ruminants in Europe, is often cited as an illustration of climate's impact on disease emergence, although no study has yet tested this association. Here, we develop a framework to quantitatively evaluate the effects of climate on BT's emergence in Europe by integrating high-resolution climate observations and model simulations within a mechanistic model of BT transmission risk. We demonstrate that a climate-driven model explains, in both space and time, many aspects of BT's recent emergence and spread, including the 2006 BT outbreak in northwest Europe which occurred in the year of highest projected risk since at least 1960. Furthermore, the model provides mechanistic insight into BT's emergence, suggesting that the drivers of emergence across Europe differ between the South and the North. Driven by simulated future climate from an ensemble of 11 regional climate models, the model projects increase in the future risk of BT emergence across most of Europe with uncertainty in rate but not in trend. The framework described here is adaptable and applicable to other diseases, where the link between climate and disease transmission risk can be quantified, permitting the evaluation of scale and uncertainty in climate change's impact on the future of such diseases. PMID:21697167
Brix, Nis; Stokholm, Lonny; Jonsdottir, Fjola; Kristensen, Kim; Secher, Niels Jørgen
Caesarean section is thought to be a risk factor for childhood asthma, but this association may be caused by confounding from, for instance, familial factors. To address this problem, we used twin pairs to assess the risk of childhood asthma after emergency caesarean section. The study was a register-based nation-wide matched cohort study using twin pairs to minimise residual confounding. Included were twin pairs in which the first twin was delivered vaginally and the second by emergency caesarean section during the study period from January 1997 through December 2012. In total, 464 twin pairs (928 twins) were included. In 30 pairs, the first twin (vaginal delivery) was diagnosed with asthma, but the second twin (emergency caesarean section) was not. In 20 pairs, the second twin (emergency caesarean section) was diagnosed with asthma, but the first twin (vaginal delivery) was not. In 11 pairs, both twins developed asthma. In the unadjusted analysis, emergency caesarean section did not affect the risk of asthma (odds ratio = 0.67 (95% confidence interval: 0.38-1.17); p = 0.16). After adjusting for birth weight, gender, umbilical cord pH, Apgar score at 5 min. and neonatal respiratory morbidity, the risk of childhood asthma following emergency caesarean section remained unchanged. Emergency caesarean section was not associated with childhood asthma. none. not relevant.
Full Text Available PurposeAlthough the role of dietary factors in the prevention of bone loss and fractures has been investigated in many studies, few studies have examined the association between dietary patterns and total body bone density. Our aim was to determine the relations between dietary patterns and whole-body bone mineral density (WB-BMD and the association between dietary patterns, fractures, and multiple fractures in the elderly.MethodsThis cross-sectional study included 177 individuals aged ≥65 years. A dual X-ray absorptiometry scan was performed to measure BMD. Dietary patterns were ascertained by a combination of dietary intake assessment and principal components analysis.ResultsOnly three dietary patterns correlated with whole-body bone density. The multivariate-adjusted mean bone density across tertiles of these dietary patterns showed that the highest tertile of both the patterns 1 and 2 had a significantly higher bone density than the lowest tertile (pattern 1: 1.021 ± 0.01 and 1.070 ± 0.01 g/cm2 for T1 and T3, respectively; p = 0.043; pattern 2: 1.023 ± 0.01, and 1.081 ± 0.01 g/cm2 for T1 and T3, respectively; p = 0.003. We also find significant gender difference in these results. The highest adherence to the dietary pattern 5 was associated with decreased odds of having fractures (OR = 0.20, p = 0.009, and adherence to the pattern 1 was negatively associated with multiple fractures.ConclusionA high adherence to the dietary pattern 1 (high intake of grains, fish and olive oil was associated with a high BMD and a low number of fractures. The highest adherence to the dietary pattern 5 (legumes and wine was associated with decreased odds of having fractures. Our finding would suggest a potential bone-preserving properties of specific dietary patterns in the elderly.
Kumagai, Yumi; Chou, Wan-Ting; Tomata, Yasutake; Sugawara, Yumi; Kakizaki, Masako; Nishino, Yoshikazu; Tsuji, Ichiro
To evaluate dietary patterns in relation to colorectal cancer risk in Japanese. We prospectively assessed the association between dietary patterns among the Japanese and the risk of colorectal cancer. Dietary information was collected from 44,097 Japanese men and women aged 40-79 years without a history of cancer at the baseline in 1994. During 11 years of follow-up, we documented 854 cases of colorectal cancer, which included 554 cases of colon cancer and 323 cases of rectal cancer. Factor analysis (principal component analysis) based on a validated food frequency questionnaire identified three dietary patterns: (1) a Japanese dietary pattern, (2) an "animal food" dietary pattern, and (3) a high-dairy, high-fruit-and-vegetable, low-alcohol (DFA) dietary pattern. After adjustment for potential confounders, the DFA pattern was inversely associated with the risk of colorectal cancer (hazard ratio of the highest quartile vs the lowest, 0.76; 95 % confidence interval 0.60-0.97; p for trend = 0.02). When colon and rectal cancers were separated, the inverse association between the DFA pattern and cancer risk was observed for rectal cancer (p for trend = 0.003), but not for colon cancer (p for trend = 0.43). No apparent association was observed for either the Japanese dietary pattern or the "animal food" dietary pattern. The DFA dietary pattern was found to be inversely associated with the risk of colorectal cancer. This association was observed for rectal cancer, but not for colon cancer.
Filippitzi, M E; Goumperis, T; Robinson, T; Saegerman, C
As part of the Emerging Risk Identification (ERI) activities of the European Food Safety Authority (EFSA), a literature search was conducted to identify the microbiological agents transmitted between livestock animals and humans that have been suggested as having emerged between 2007 and 2015 in peer-reviewed scientific literature published during the same period (2007-2015). According to the criteria set, the search identified seven such zoonotic agents, namely West Nile Fever virus, Rift Valley Fever virus, Crimean-Congo Haemorrhagic Fever virus, Influenza A H1N1 virus, Coxiella burnetii, Streptococcus suis and livestock-associated methicillin-resistant Staphylococcus aureus clonal complex 398. An explanation of the agents' consideration as emerging risks is provided. The experience gained from these emergences has shown that the detection of and response to such risks can be achieved faster and more successfully within a multidisciplinary, collaborative context at the field, local, national and international levels. © 2016 Blackwell Verlag GmbH.
Gillespie, Gordon Lee; Pekar, Bunnany; Byczkowski, Terri L; Fisher, Bonnie S
Workplace violence committed by patients and visitors has high propensity to occur against emergency department employees. This article reports the association of worker, workplace, and community/environmental factors with violence risks. A cross-sectional research design was used with 280 employees from six emergency departments in the Midwest United States. Respondents completed the Survey of Violence Experienced by Staff and a 10-item demographic questionnaire. Data were analyzed using frequencies, percentages, Chi-square tests, and adjusted relative risks with 95% confidence intervals. Over 80% of respondents experienced at least one type of workplace violence with their current employer and approximately 40% experienced all three types. Risks for workplace violence were significantly higher for registered nurses and hospital-based emergency departments. Workplace violence can impact all employees in the emergency department regardless of worker, workplace, and community/environmental factors.
Ummenhofer, Caroline C.; Seo, Hyodae; Kwon, Young-Oh; Parfitt, Rhys; Brands, Swen; Joyce, Terrence M.
Dominant European winter precipitation patterns over the past century, along with their associated extratropical North Atlantic circulation changes, are evaluated using cluster analysis. Contrary to the four regimes traditionally identified based on daily wintertime atmospheric circulation patterns, five distinct seasonal precipitation regimes are detected here. Recurrent precipitation patterns in each regime are linked to changes in atmospheric blocking, storm track, and sea surface temperatures across the North Atlantic region. Multidecadal variability in the frequency of the precipitation patterns reveals more (fewer) winters with wet conditions in northern (southern) Europe in recent decades and an emerging distinct pattern of enhanced wintertime precipitation over the northern British Isles. This pattern has become unusually common since the 1980s and is associated with changes in moisture transport and more frequent atmospheric river events. The observed precipitation changes post-1950 coincide with changes in storm track activity over the central/eastern North Atlantic toward the northern British Isles.
Binkhorst, J.; Kingma, S.F.
This article deals with risk controversies in emerging policy networks regarding school safety in the Netherlands. It offers a grounded account of the interpretations of school risks and safety measures by the various stakeholders of the policy network, in particular, schools, local government and
This conference is about the basic risks, protection and the consequences in a radiological emergency. The first responders have to know the deterministic and stochastic effects in the health as well as the cancer risk due of the high radioactive doses exposure
Scheffer, Alice C.; van Hensbroek, Pieter Boele; van Dijk, Nynke; Luitse, Jan S. K.; Goslings, Johannes C.; Luigies, René H.; de Rooij, Sophia E.
Little is known about the prevalence of modifiable risk factors of falling in elderly persons with a fall-history who do not visit the Accident and Emergency (A&E) Department after one or more falls. The objective of this study was to determine the prevalence of modifiable risk factors in a
Prati, Gabriele; Pietrantoni, Luca; Saccinto, Elisa; Kehl, Doris; Knuth, Daniela; Schmidt, Silke
Firefighters frequently incur injuries while providing emergency services. Risk perception has been found to be associated with injury and safety behavior. This study examined risk perception of different emergency situations among firefighters. Along with risk perceptions, we investigated the role of practical experience, perceived training, tenure, and acute stress related to different emergency situations. Participants were a sample of 1324 firefighters from Germany and Italy. A questionnaire was administered to participants on risk perceptions, practical experience, perceived training, tenure, and acute stress. The results showed that different levels of risk perception are related to different practical experience, acute stress reactions, and training. Higher risk perception was associated with higher perceived training, practical experience, and acute stress reactions. A significant difference was found between the German and the Italian sample in risk perceptions. More specifically the Italian sample perceived disasters (e.g., earthquakes) as more risky. Moreover, there were some differences in perceived training and practical experience about the different emergency situations, in the two samples. The results underline the importance of considering organizational factors in the prediction of risk perception among firefighters.
Segura, Carlota; Duch, Jordi; Perelló, Josep
Decisions made in our everyday lives are based on a wide variety of information so it is generally very difficult to assess what are the strategies that guide us. Stock market provides a rich environment to study how people make decisions since responding to market uncertainty needs a constant update of these strategies. For this purpose, we run a lab-in-the-field experiment where volunteers are given a controlled set of financial information -based on real data from worldwide financial indices- and they are required to guess whether the market price would go “up” or “down” in each situation. From the data collected we explore basic statistical traits, behavioural biases and emerging strategies. In particular, we detect unintended patterns of behavior through consistent actions, which can be interpreted as Market Imitation and Win-Stay Lose-Shift emerging strategies, with Market Imitation being the most dominant. We also observe that these strategies are affected by external factors: the expert advice, the lack of information or an information overload reinforce the use of these intuitive strategies, while the probability to follow them significantly decreases when subjects spends more time to make a decision. The cohort analysis shows that women and children are more prone to use such strategies although their performance is not undermined. Our results are of interest for better handling clients expectations of trading companies, to avoid behavioural anomalies in financial analysts decisions and to improve not only the design of markets but also the trading digital interfaces where information is set down. Strategies and behavioural biases observed can also be translated into new agent based modelling or stochastic price dynamics to better understand financial bubbles or the effects of asymmetric risk perception to price drops. PMID:27532219
Gutiérrez-Roig, Mario; Segura, Carlota; Duch, Jordi; Perelló, Josep
Decisions made in our everyday lives are based on a wide variety of information so it is generally very difficult to assess what are the strategies that guide us. Stock market provides a rich environment to study how people make decisions since responding to market uncertainty needs a constant update of these strategies. For this purpose, we run a lab-in-the-field experiment where volunteers are given a controlled set of financial information -based on real data from worldwide financial indices- and they are required to guess whether the market price would go "up" or "down" in each situation. From the data collected we explore basic statistical traits, behavioural biases and emerging strategies. In particular, we detect unintended patterns of behavior through consistent actions, which can be interpreted as Market Imitation and Win-Stay Lose-Shift emerging strategies, with Market Imitation being the most dominant. We also observe that these strategies are affected by external factors: the expert advice, the lack of information or an information overload reinforce the use of these intuitive strategies, while the probability to follow them significantly decreases when subjects spends more time to make a decision. The cohort analysis shows that women and children are more prone to use such strategies although their performance is not undermined. Our results are of interest for better handling clients expectations of trading companies, to avoid behavioural anomalies in financial analysts decisions and to improve not only the design of markets but also the trading digital interfaces where information is set down. Strategies and behavioural biases observed can also be translated into new agent based modelling or stochastic price dynamics to better understand financial bubbles or the effects of asymmetric risk perception to price drops.
Chan, Chien-Lung; Lin, Wender; Yang, Nan-Ping; Lai, K. Robert; Huang, Hsin-Tsung
Background Many patients treated in Emergency Department (ED) visits can be treated at primary or urgent care sectors, despite the fact that a number of ED visitors seek other forms of care prior to an ED visit. However, little is known regarding how the pre-ED activity episodes affect ED visits. Objectives We investigated whether care-seeking patterns involve the use of health care services of various types prior to ED visits and examined the associations of these patterns with the severity ...
Kamangar, Farin; Shakeri, Ramin; Malekzadeh, Reza; Islami, Farhad
An estimated 16·5 million people worldwide illicitly use opiates, of whom 4 million use raw opium. We did a systematic review to investigate the association between opium use and cancer incidence and mortality. Opium use was associated with an increased risk of cancers of the oesophagus, stomach, larynx, lung, and urinary bladder. Although the present evidence suggests that these associations are possibly causal, further epidemiological studies (particularly prospective studies that collect detailed data about lifetime opium use and control for a broad range of potential confounders) are needed. Copyright © 2014 Elsevier Ltd. All rights reserved.
Arendts, Glenn; Love, Jennefer; Nagree, Yusuf; Bruce, David; Hare, Malcolm; Dey, Ian
To determine whether a bundled risk screening and warning or action card system improves formal delirium diagnosis and person-centered outcomes in hospitalized older adults. Prospective trial with sequential introduction of screening and interventional processes. Two tertiary referral hospitals in Australia. Individuals aged 65 and older presenting to the emergency department (ED) and not requiring immediate resuscitation (N = 3,905). Formal ED delirium screening algorithm and use of a risk warning card with a recommended series of actions for the prevention and management of delirium during the subsequent admission MEASUREMENTS: Delirium diagnosis at hospital discharge, proportion discharged to new assisted living arrangements, in-hospital complications (use of sedation, falls, aspiration pneumonia, death), hospital length of stay. Participants with a positive risk screen were significantly more likely (relative risk = 6.0, 95% confidence interval = 4.9-7.3) to develop delirium, and the proportion of at-risk participants with a positive screen was constant across three study phases. Delirium detection rate in participants undergoing the final intervention (Phase 3) was 12.1% (a 2% absolute and 17% relative increase from the baseline rate) but this was not statistically significant (P = .29), and a similar relative increase was seen over time in participants not receiving the intervention CONCLUSION: A risk screening and warning or action card intervention in the ED did not significantly improve rates of delirium detection or other important outcomes. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.
De San Miguel, Kristen; Lewin, Gill; Burton, Elissa; Toye, Christine; Boldy, Duncan; Howat, Peter
Personal alarms support independent living and have the potential to reduce serious consequences after a fall or during a medical emergency. While some Australian states have government funded personal alarm programs, others do not; but user-pays services are available. Although several studies have examined the profiles of alarm users, little is known about the risk profile of non-users. Specifically, whether there are "at risk" individuals who are unable, or choose not to purchase a service, who experience a home-based emergency in which an alarm could have mitigated an adverse outcome. This study aimed to describe the 'risk profile' of purchasers and non-purchasers of alarms; explore the reasons behind the decision to purchase or not to purchase and identify how often emergency assistance was needed and why. Purchasers and non-purchasers were followed for one year in this prospective cohort study. Demographic, decision-making and risk factor data were collected at an initial face-to-face interview, while information about emergencies was collected by monthly calls. One hundred and fifty-seven purchasers and sixty-five non-purchasers completed the study. The risk profiles between the groups were similar in terms of gender, living arrangements, fall history and medical conditions. Purchasers (Mean = 82.6 years) were significantly older than non-purchasers (Mean = 79.3 years), (t(220) = -3.38, p = 0.000) and more functionally dependent on the IADL (z = -2.57, p = 0.010) and ADL (z = -2.45 p = 0.014) function scores. Non-purchasers (Mean = 8.04, SD = 3.57) were more socially isolated with significantly fewer family networks than purchasers (Mean = 9.46, SD = 3.25) (t(220) = -2.86, p = 0.005). Both groups experienced similarly high numbers of emergencies, 38.2 % of purchasers and 41.5 % of non-purchasers had at least one emergency where an alarm could have assisted. Main reasons for non-purchase were: cost (77 %), limited alarm range (51 %), no need (39 %) and lack
Full Text Available This article examines authorship as a socially embedded process by challenging Western notions of the autonomous creative genius. It considers social interactions between various agents in the field of literary production which in turn recovers the collective nature of modern authorship. Far from leaving it unexamined, it further contextualises authorial collectivity and its role in the emerging model of authorship. Questions and arguments raised in this article are informed by the ethnographic data collected during my doctoral research focusing on the reception of post-1990s ex-Yugoslav literature on the UK book market. Such ethnographic approach to literary translations – i.e. the micro-level analysis of social interactions that ‘create’ literature – demonstrated how the author is ‘created’ in the communication of two literary systems through linguistic translation as well as re-translations of symbolic and social capitals. My research was concerned with analysing the ‘backstage’ of the publishing industry – informal networks and international literary geopolitics – which all contributed to debunking the myth of the autonomous creative genius. However, instead of retracing my steps, this article outlines new avenues and questions that such analysis has opened up. One such question is how new technologies are (reconstructing and (repositioning the role of the author.
Meyer, Christoph F J; Aguiar, Ludmilla M S; Aguirre, Luis F; Baumgarten, Julio; Clarke, Frank M; Cosson, Jean-François; Estrada Villegas, Sergio; Fahr, Jakob; Faria, Deborah; Furey, Neil; Henry, Mickaël; Jenkins, Richard K B; Kunz, Thomas H; Cristina MacSwiney González, M; Moya, Isabel; Pons, Jean-Marc; Racey, Paul A; Rex, Katja; Sampaio, Erica M; Stoner, Kathryn E; Voigt, Christian C; von Staden, Dietrich; Weise, Christa D; Kalko, Elisabeth K V
Undersampling is commonplace in biodiversity surveys of species-rich tropical assemblages in which rare taxa abound, with possible repercussions for our ability to implement surveys and monitoring programmes in a cost-effective way. We investigated the consequences of information loss due to species undersampling (missing subsets of species from the full species pool) in tropical bat surveys for the emerging patterns of species richness (SR) and compositional variation across sites. For 27 bat assemblage data sets from across the tropics, we used correlations between original data sets and subsets with different numbers of species deleted either at random, or according to their rarity in the assemblage, to assess to what extent patterns in SR and composition in data subsets are congruent with those in the initial data set. We then examined to what degree high sample representativeness (r ≥ 0·8) was influenced by biogeographic region, sampling method, sampling effort or structural assemblage characteristics. For SR, correlations between random subsets and original data sets were strong (r ≥ 0·8) with moderate (ca. 20%) species loss. Bias associated with information loss was greater for species composition; on average ca. 90% of species in random subsets had to be retained to adequately capture among-site variation. For nonrandom subsets, removing only the rarest species (on average c. 10% of the full data set) yielded strong correlations (r > 0·95) for both SR and composition. Eliminating greater proportions of rare species resulted in weaker correlations and large variation in the magnitude of observed correlations among data sets. Species subsets that comprised ca. 85% of the original set can be considered reliable surrogates, capable of adequately revealing patterns of SR and temporal or spatial turnover in many tropical bat assemblages. Our analyses thus demonstrate the potential as well as limitations for reducing survey effort and streamlining
Full Text Available AIM: To assess the relation between nutrient patterns and cataract risk. METHODS: This is a hospital-based case-control study with 97 cataract patients and 198 matched controls. Dietary consumption was collected through a valid food frequency questionnaire (FFQ. Nutrient patterns were detected by applying factor analysis. Unconditional logistic regression models were used to estimate odds ratio (ORs and 95%CIs. RESULTS: We extracted 5 main nutrient patterns. Factor 1 included niacin, thiamin, carbohydrates, protein, zinc, vitamin B6 and sodium (sodium pattern. Factor 2 was characterized by oleic acid, monounsaturated fats, polyunsaturated fats, linoleic acid, trans fatty acid, linolenic acid, vitamin E and saturated fats (fatty acid pattern. The third factor represented high intake of vitamin B12, vitamin D, cholesterol and calcium (mixed pattern. The 4th pattern was high in intake of beta and alpha carotene, vitamin A and vitamin C (antioxidant pattern. Finally, the 5th pattern loaded heavily on docosahexaenoic acid (DHA and eicosapentaenoic acid (EPA (omega-3 pattern. In crude and multivariate analysis, the sodium pattern was associated with increased risk of cataract (OR=1.97, 95%CI: 1.09-3.96. The fatty acid pattern elevated the risk of cataract (OR=1.94, 95%CI: 1.1-3.86. Antioxidant pattern was associated with a significant 79% reduced risk (2nd category compared with the 1st. Omega-3 pattern was significantly negatively associated with risk of cataract (P=0.04. CONCLUSION: These findings imply that nutrient patterns reflecting a combined consumption of nutrients might be important in the etiology of cataract. Additional studies with more efficient designs are warranted to confirm our findings.
Full Text Available Macaé is the “Oil Capital” of Brazil: a city of opportunity, full of jobs andwhere royalties fatten public coffers or that is the image presented in the media that has attracted thousands of migrants to Macaé. This study investigated why people feel that migrants keep coming to Macaé even though recent statistics show that in-migration to the city has decreased. Also, new forms of spatial mobility of the population have emerged so that Macaé can be characterized as region of polar attraction. Commuting from neighbouring cities is a common pattern in metropolitan areas and in Macaé it is associated to the high cost of living and violence present there so that many workers have their residence elsewhere, especially Rio das Ostras. In addition to daily commuting, another kind was detected in the research: "long distance commuting". This kind of commuting is associated basically to specific characteristics of the labour market in the oil sector involving periods on the platforms interspaced with periods off duty on the mainland as well as outsourcing practices. A third trend noted was the presence of a significant number of transients, who keep coming to the city in large numbers but do not lay residence.
McQuade, David J; Aknuri, Srikanth; Dargan, Paul I; Wood, David M
Paracetamol (acetaminophen) poisoning is the most common toxicological presentation in the UK. Doctors managing patients with paracetamol poisoning need to assess the risk of their patient developing hepatotoxicity before determining appropriate treatment. Patients deemed to be at 'high risk' of hepatotoxicity have lower treatment thresholds than those deemed to be at 'normal risk'. Errors in this process can lead to harmful or potentially fatal under or over treatment. To determine how well treating doctors assess risk factor status and whether a standardised proforma is useful in the risk stratification process. Retrospective 12-month case note review of all patients presenting with paracetamol poisoning to our large inner-city emergency department. Data were collected on the documentation of risk factors, the presence of a local hospital proforma and treatment outcomes. 249 presentations were analysed and only 59 (23.7%) had full documentation of all the risk factors required to make a complete risk assessment. 56 of the 59 (94.9%) had the local hospital proforma included in the notes; the remaining 3 (5.1%) had full documentation of risk factors despite the absence of a proforma. A local hospital proforma was more likely to be included in the emergency department notes in those with 'adequate documentation' (78 out of 120 (65%)) than for those with 'inadequate documentation' (16 out of 129 (12.4%)); X(2), pparacetamol poisoning.
Full Text Available Background: The concept of value at risk gives estimation of the maximum loss of financial position at a given time for a given probability. The motivation for this analysis lies in the desire to devote necessary attention to risks in Montenegro, and to approach to quantifying and managing risk more thoroughly. Objectives: This paper considers adequacy of the most recent approaches for quantifying market risk, especially of methods that are in the basis of extreme value theory, in Montenegrin emerging market before and during the global financial crisis. In particular, the purpose of the paper is to investigate whether extreme value theory outperforms econometric and quantile evaluation of VaR in emerging stock markets such as Montenegrin market. Methods/Approach: Daily return of Montenegrin stock market index MONEX20 is analyzed for the period January, 2004 - February, 2014. Value at Risk results based on GARCH models, quantile estimation and extreme value theory are compared. Results: Results of the empirical analysis show that the assessments of Value at Risk based on extreme value theory outperform econometric and quantile evaluations. Conclusions: It is obvious that econometric evaluations (ARMA(2,0- GARCH(1,1 and RiskMetrics proved to be on the lower bound of possible Value at Risk movements. Risk estimation on emerging markets can be focused on methodology using extreme value theory that is more sophisticated as it has been proven to be the most cautious model when dealing with turbulent times and financial turmoil.
Millen, Barbara E; Quatromoni, Paula A; Pencina, Michael; Kimokoti, Ruth; Nam, Byung-H O; Cobain, Sonia; Kozak, Waldemar; Appugliese, Danielle P; Ordovas, Jose; D'Agostino, Ralph B
To identify the dietary patterns of adult men and examine their relationships with nutrient intake and chronic disease risk over long-term follow-up. Baseline 145-item food frequency questionnaires from 1,666 Framingham Offspring-Spouse cohort men were used to identify comprehensive dietary patterns. Independent 3-day dietary records at baseline and 8 years later provided estimates of subjects' nutrient intake by dietary pattern. Chronic disease risk factor status was compared at baseline and 16-year follow-up across all male dietary patterns. Cluster analysis was applied to food frequency data to identify non-overlapping male dietary patterns. Analysis of covariance and logistic regression were used to compare nutrient intake, summary nutritional risk scores, and chronic disease risk status at baseline and follow-up by male dietary pattern. Five distinct and comprehensive dietary patterns of Framingham Offspring-Spouse men were identified and ordered according to overall nutritional risk: Transition to Heart Healthy, Higher Starch, Average Male, Lower Variety, and Empty Calories. Nutritional risk was high and varied by dietary pattern; key nutrient contrasts were stable over 8-year follow-up. Chronic disease risk also varied by dietary pattern and specific subgroup differences persisted over 16 years, notably rates of overweight/obesity and smoking. Quantitative cluster analysis applied to food frequency questionnaire data identified five distinct, comprehensive, and stable dietary patterns of adult Framingham Offspring-Spouse cohort men. The close associations between the dietary patterns, nutritional risk, and chronic disease profiles of men emphasize the importance of targeted preventive nutrition interventions to promote health in the male population.
Wittek, Peter; Liu, Ying-Hsang; Darányi, Sándor; Gedeon, Tom; Lim, Ik Soo
Information foraging connects optimal foraging theory in ecology with how humans search for information. The theory suggests that, following an information scent, the information seeker must optimize the tradeoff between exploration by repeated steps in the search space vs. exploitation, using the resources encountered. We conjecture that this tradeoff characterizes how a user deals with uncertainty and its two aspects, risk and ambiguity in economic theory. Risk is related to the perceived quality of the actually visited patch of information, and can be reduced by exploiting and understanding the patch to a better extent. Ambiguity, on the other hand, is the opportunity cost of having higher quality patches elsewhere in the search space. The aforementioned tradeoff depends on many attributes, including traits of the user: at the two extreme ends of the spectrum, analytic and wholistic searchers employ entirely different strategies. The former type focuses on exploitation first, interspersed with bouts of exploration, whereas the latter type prefers to explore the search space first and consume later. Our findings from an eye-tracking study of experts' interactions with novel search interfaces in the biomedical domain suggest that user traits of cognitive styles and perceived search task difficulty are significantly correlated with eye gaze and search behavior. We also demonstrate that perceived risk shifts the balance between exploration and exploitation in either type of users, tilting it against vs. in favor of ambiguity minimization. Since the pattern of behavior in information foraging is quintessentially sequential, risk and ambiguity minimization cannot happen simultaneously, leading to a fundamental limit on how good such a tradeoff can be. This in turn connects information seeking with the emergent field of quantum decision theory.
Swierstra, Tsjalling; Rip, Arie
There might not be a specific nano-ethics, but there definitely is an ethics of new & emerging science and technology (NEST), with characteristic tropes and patterns of moral argumentation. Ethical discussion in and around nanoscience and technology reflects such NEST-ethics. We offer an inventory
Tang, Caihong; Yi, Yujun; Yang, Zhifeng; Sun, Jie
To guarantee the security of water quality in water transfer channels, especially in open channels, analysis of potential emergent pollution sources in the water transfer process is critical. It is also indispensable for forewarnings and protection from emergent pollution accidents. Bridges above open channels with large amounts of truck traffic are the main locations where emergent accidents could occur. A Bayesian Network model, which consists of six root nodes and three middle layer nodes, was developed in this paper, and was employed to identify the possibility of potential pollution risk. Dianbei Bridge is reviewed as a typical bridge on an open channel of the Middle Route of the South to North Water Transfer Project where emergent traffic accidents could occur. Risk of water pollutions caused by leakage of pollutants into water is focused in this study. The risk for potential traffic accidents at the Dianbei Bridge implies a risk for water pollution in the canal. Based on survey data, statistical analysis, and domain specialist knowledge, a Bayesian Network model was established. The human factor of emergent accidents has been considered in this model. Additionally, this model has been employed to describe the probability of accidents and the risk level. The sensitive reasons for pollution accidents have been deduced. The case has also been simulated that sensitive factors are in a state of most likely to lead to accidents. Copyright © 2015 Elsevier Ltd. All rights reserved.
José Luiz Rodrigues Leles
Full Text Available BACKGROUND: Maxillofacial injuries occur in a significant number of trauma patients. Epidemiological assessments are essential to reaffirm patterns, identify new trends and develop clinical and research priorities for effective treatment and prevention of these injuries. OBJECTIVE: The aim of this study was to identify the epidemiological profile and risk factors associated with maxillofacial trauma treated at a referral emergency hospital for the Public Health System in the State Capital of Goiás, Brazil. MATERIAL AND METHODS: A cross-sectional study was designed including 530 patients with maxillofacial trauma, 76% male, with a mean age of 25.5±15.0 years. Data were collected between May 2003 and August 2004 over weekly shift-working periods. RESULTS: The main causes of trauma were traffic accidents (45.7% and physical assaults (24.3%, and differences in etiological factors were identified according to gender (p<0.001. The distribution of patients according to age and etiology showed significant differences for traffic accidents (p<0.01, physical assaults (p<0.001, falls (p<0.001 and sport injuries (p<0.01. In the multinomial logistic regression analysis (R² = 0.233; p<0.05, age was associated with injury in traffic accidents and falls (p<0.01, sports-related accidents were associated with males (p<0.05, and alcohol consumption with assaults and traffic accidents (p<0.001. Facial soft tissue lesions were found in 98% of patients and facial fractures in 51%. CONCLUSIONS: The significant association of maxillofacial trauma with young males and alcohol consumption reinforces the need for educational strategies and the development of policies for the prevention and reduction of associated damage in this specific risk group.
François Victor Tochon
Full Text Available This article is a review of some aspects of research on electronic portfolios with a critical analysis of the pros and cons of the invasive use of new technologies for education. Besides the creation and conceptual composition of educative portfolios that help teachers grow professionnally, this instrument implies a formatting around artifacts posited as proofs of competence, which support an uncritical realist ontology that has its limitations. Thus networked learning and personal learning environments stimulate reflective teacher learning, but possibly lead portfolio users to confuse the indicator of performance with the actual competence. Portfolio creation takes much time on other activities that could be most beneficial (and could be complementary, such as shared reflection on personal belief systems. Universalist stands and standardisation seem to take the fore while educative humane value go back stage. The new wave of distance learning creates new risks in terms of depth and quality as well as health, related to the daily use of pulsed microwaves and radio frequencies. It is suggested that a mode of control independent from the financial milieux that capitalize on these innovations should be created.
Hao, Jiejing; Ren, Jiaojiao; Wu, Qunhong; Hao, Yanhua; Sun, Hong; Ning, Ning; Ding, Ding
This study aimed to better understand the current situation of risk assessment and identify the factors associated with competence of emergency responders in public health risk assessment. The participants were selected by a multi-stage, stratified cluster sampling method in Heilongjiang Centers for Disease Control and Prevention (CDC). The questionnaires that measured their perceptions on risk assessment competences were administered through the face-to-face survey. A final sample of 1889 staff was obtained. Of this sample, 78.6% of respondents rated their own risk assessment competences as "relatively low", contrasting with 21.4% rated as "relatively high". Most of the respondents (62.7%) did not participate in any risk assessment work. Only 13.7% and 42.7% of respondents reported participating in risk assessment training and were familiar with risk assessment tools. There existed statistical significance between risk assessment-related characteristics of respondents and their self-rated competences scores. Financial support from the government and administrative attention were regarded as the important factors contributing to risk assessment competences of CDC responders. Higher attention should be given to risk assessment training and enhancing the availability of surveillance data. Continuous efforts should be made to remove the financial and technical obstacles to improve the competences of risk assessment for public health emergency responders.
Full Text Available Introduction: Road traffic injuries are a growing public health issue. Despite good numbers of traffic legislations/ law/bye-laws/ regulations/ policies at the national/ state level and various safety measures to prevent road accidents/ mishaps, awareness remains comparatively low in India. Till date no questionnaire has been suitably developed, standardized and positivised for determining association of causality with injury pattern and severity score. Objective: To design and develop a précised survey questionnaire determining association of causality with injury pattern along with severity score in RTA victims. Methodology: Till date no such study has been ventured which has observed the inter relationship of these factors resulting in a specific injury. Designed questionnaire was based on literature review, and updated several times to ensure the precision and agreement with the help of institutional trauma expert team. As a pilot study, 30 RTA victims admitted in trauma centre of KG Medical University were enrolled and designed questionnaire was tested for easiness and doubts. The results were thoroughly analyzed for item difficulty, precision and internal consistency. Results: A significant agreement of question pertaining to speed (k=0.99, CI=0.95, visibility (k=0.87, alcohol (k=0.65 in the questionnaire. Questions related to environment, driver, vehicle and road factors show a significant consistency (p>0.05 as cause of accidents. Test of agreements done by Kappa showed in variables having value more than 0.60 except few variables. Discussion: The designed questionnaire is precise, reasonably reliable in perfect agreement. This questionnaire should emerge a useful tool in determining the association of risk factors with injury pattern and severity.
Azizi, Hosein; Asadollahi, Khairollah; Davtalab Esmaeili, Elham; Mirzapoor, Mohammad
Background: Role of diet on colorectal cancer (CRC) has been considered in terms of single foods and nutrients, but less frequently in terms of dietary patterns in Iran. The objective of this study was to determine the association between Iranian dietary patterns and CRC.Methods: This case–control study was conducted in four hospitals in Tabriz City of Iran including 414 participants aged 35–75 years:207 cases with CRC confirmed by pathology and colonoscopy findings were selected and 207 cont...
Dose commitments and risk estimates for the inhalation of plutonium oxide are calculated using the lung clearance patterns observed at AEE Winfrith. These risks are compared with published data on risks arising from a lung clearance based on the ICRP Lung Model. (author)
Dolz, Laura; Cerezo, M. Angeles; Milner, Joel S.
A study of 10 high-risk (of child physical abuse) and 10 demographically similar low-risk Spanish mother-child dyads investigated interactional patterns in the home. High-risk mothers made fewer neutral approaches to their children, displayed more negative behaviors toward their children, and made more indiscriminate responses to their children's…
BACKGROUND: Parental psychiatric disorder, especially depression, personality disorder and deliberate self-harm, is known to put children at greater risk of mental illness, neglect or physical, emotional and sexual abuse. Without a reliable procedure to identify children of parents presenting with these mental health problems, children at high risk of significant harm can be easily overlooked. Although deliberate self-harm constitutes a significant proportion of emergency presentations, there are no guidelines which address the emergency physician\\'s role in identifying and assessing risk to children of these patients. METHODS: A robust system was jointly developed with the local social services child protection team to identify and risk-stratify children of parents with mental illness. This allows us to intervene when we identify children at immediate risk of harm and to ensure that social services are aware of potential risk to all children in this group. The referral process was audited repeatedly to refine the agreed protocol. RESULTS: The proportion of patients asked by the emergency department personnel about dependent children increased and the quality of information received by the social services child protection team improved. CONCLUSIONS: All emergency departments should acknowledge the inadequacy of information available to them regarding patients\\' children and consider a policy of referral to social services for all children of parents with mental health presentations. This process can only be developed through close liaison within the multidisciplinary child protection team.
Jobran M. Alqahtani
Full Text Available Objectives: To describe the clinical characteristics of pediatric patients colonized or infected by Stenotrophomonas maltophilia (S. maltophilia at a Saudi children’s hospital, to identify risk factors associated with infection, and to investigate the antimicrobial resistance patterns of this emerging pathogen. Methods: In this cross-sectional observational study, 64 non-duplicating S. maltophilia strains were isolated in Najran Maternity and Children’s Hospital, Najran, Saudi Arabia between January 2015 to February 2016. Antimicrobial susceptibility testing was performed using the reference broth microdilution method. Results: In this study, 48 (75% isolates were identified in true infections and 16 (25% isolates were considered colonization. The main types of S. maltophilia infection were pneumonia in 22 (45.8% patients and bloodstream infection in 14 (29.2% patients. The significant risk factors included exposure to invasive procedure (p=0.02, and presence of acute leukemia as an underlying disease (p=0.02. The most active antimicrobials were trimethoprim/sulfamethoxazole (100% sensitivity and tigecycline (93.7% sensitivity. Conclusions: Stenotrophomonas maltophilia is an emerging nosocomial pathogen among pediatric patients. Accurate identification and susceptibility testing of this emerging pathogen are crucial for the management of infected patients and prevention of spread of this nosocomial pathogen.
Santos, Isaac J.A. Luquetti; Carvalho, Paulo V.R.; Grecco, Claudio H.S. [Instituto de Engenharia Nuclear (IEN/CNEN-RJ), Rio de Janeiro, RJ (Brazil)], Email: firstname.lastname@example.org
An industrial installation presents many risks in the form of the process hazards, such as fire, explosion, gas and radiation release. In these situations, workers may need to evacuate from the work environment as soon as possible. In this case, the emergency evacuation planning is a key element that involves an iterative process to identify the best evacuation routes and to estimate the time required to evacuate the area at risk. The mean aspects for a successful emergency evacuation are influenced by the type of human error and the severity of the initiator event. The aim of this paper is to present a methodological framework for the identification of the performance shaping factors and prediction of human error probabilities of the responsible by the emergency evacuation of the workers in an industrial installation, providing a proactive approach for the allocation of the human factors in the risk assessment of the industrial installation. (author)
Rosa, M.; Carpaneto, J.; Priori, A.
Abstract Economic decision-making is disrupted in individuals with gambling disorder, an addictive behavior observed in Parkinson’s disease (PD) patients receiving dopaminergic therapy. The subthalamic nucleus (STN) is involved in the inhibition of impulsive behaviors; however, its role in impulse control disorders and addiction is still unclear. Here, we recorded STN local field potentials (LFPs) in PD patients with and without gambling disorder during an economic decision-making task. Reaction times analysis showed that for all patients, the decision whether to risk preceded task onset. We compared then for both groups the STN LFP preceding high- and low-risk economic decisions. We found that risk avoidance in gamblers correlated with larger STN LFP low-frequency (gambling disorder were instead not correlated with pretask STN LFP. Our results suggest that STN activity preceding task onset affects risk decisions by preemptively inhibiting attraction to high but unlikely rewards in favor of a long-term payoff. PMID:29445770
Feb 6, 2018 ... their predictors among public primary care patients with tuberculosis in South ... Keywords: sexual risk behaviour, TB patients, health status, mental ..... High prevalence and partner correlates of physical and sexual violence.
Mazzoni, A; Rosa, M; Carpaneto, J; Romito, L M; Priori, A; Micera, S
Economic decision-making is disrupted in individuals with gambling disorder, an addictive behavior observed in Parkinson's disease (PD) patients receiving dopaminergic therapy. The subthalamic nucleus (STN) is involved in the inhibition of impulsive behaviors; however, its role in impulse control disorders and addiction is still unclear. Here, we recorded STN local field potentials (LFPs) in PD patients with and without gambling disorder during an economic decision-making task. Reaction times analysis showed that for all patients, the decision whether to risk preceded task onset. We compared then for both groups the STN LFP preceding high- and low-risk economic decisions. We found that risk avoidance in gamblers correlated with larger STN LFP low-frequency (gambling disorder were instead not correlated with pretask STN LFP. Our results suggest that STN activity preceding task onset affects risk decisions by preemptively inhibiting attraction to high but unlikely rewards in favor of a long-term payoff.
Gushulak, Bd; Weekers, J; Macpherson, Dw
International population mobility is an underlying factor in the emergence of public health threats and risks that must be managed globally. These risks are often related, but not limited, to transmissible pathogens. Mobile populations can link zones of disease emergence to lowprevalence or nonendemic areas through rapid or high-volume international movements, or both. Against this background of human movement, other global processes such as economics, trade, transportation, environment and climate change, as well as civil security influence the health impacts of disease emergence. Concurrently, global information systems, together with regulatory frameworks for disease surveillance and reporting, affect organizational and public awareness of events of potential public health significance. International regulations directed at disease mitigation and control have not kept pace with the growing challenges associated with the volume, speed, diversity, and disparity of modern patterns of human movement. The thesis that human population mobility is itself a major determinant of global public health is supported in this article by review of the published literature from the perspective of determinants of health (such as genetics/biology, behavior, environment, and socioeconomics), population-based disease prevalence differences, existing national and international health policies and regulations, as well as inter-regional shifts in population demographics and health outcomes. This paper highlights some of the emerging threats and risks to public health, identifies gaps in existing frameworks to manage health issues associated with migration, and suggests changes in approach to population mobility, globalization, and public health. The proposed integrated approach includes a broad spectrum of stakeholders ranging from individual health-care providers to policy makers and international organizations that are primarily involved in global health management, or are influenced
M. Omidvari; J. Nouri; M. Mapar
Disasters are one of the most important challenges which must be considered by every management system. Higher education centers have high disaster risk because of their risk factors (existence of historical and scientific documents and resources and expensive laboratory equipment in these centers emphasizes the importance of disaster management). Moreover, the existence of young volunteers of human resources in universities urges the necessity of making these people familiar with disaster ma...
Full Text Available This paper studies the impact of emergencies on the supplier’s decision-making behaviors including production and information sharing in consideration of consumer risk perception, consumer loss aversion phenomenon, and government price control. The intensity of emergencies is sequential and emergencies can be divided into two types (positive or negative according to their effect on demand. When emergencies have negative effect on demand, the supplier’s sales will reduce and he would share information to the market. When emergencies have positive effect on demand, we find that when the price is under price cap the supplier will not share information to the market; when the price reaches price cap, the supplier will share a certain amount of information to the market. We were surprised to find that increasing demand is not always good for the supplier when there exist government price control and lost sales penalty, and information helps the supplier to effectively manipulate demand.
Calder, Lisa Anne; Mastoras, George; Rahimpour, Mitra; Sohmer, Benjamin; Weitzman, Brian; Cwinn, A Adam; Hobin, Tara; Parush, Avi
In order to enhance patient safety during resuscitation of critically ill patients, we need to optimize team communication and enhance team situational awareness but little is known about resuscitation team communication patterns. The objective of this study is to understand how teams communicate during resuscitation; specifically to assess for a shared mental model (organized understanding of a team's relationships) and information needs. We triangulated 3 methods to evaluate resuscitation team communication at a tertiary care academic trauma center: (1) interviews; (2) simulated resuscitation observations; (3) live resuscitation observations. We interviewed 18 resuscitation team members about shared mental models, roles and goals of team members and procedural expectations. We observed 30 simulated resuscitation video recordings and documented the timing, source and destination of communication and the information category. We observed 12 live resuscitations in the emergency department and recorded baseline characteristics of the type of resuscitations, nature of teams present and type and content of information exchanges. The data were analyzed using a qualitative communication analysis method. We found that resuscitation team members described a shared mental model. Respondents understood the roles and goals of each team member in order to provide rapid, efficient and life-saving care with an overall need for situational awareness. The information flow described in the interviews was reflected during the simulated and live resuscitations with the most responsible physician and charting nurse being central to team communication. We consolidated communicated information into six categories: (1) time; (2) patient status; (3) patient history; (4) interventions; (5) assistance and consultations; 6) team members present. Resuscitation team members expressed a shared mental model and prioritized situational awareness. Our findings support a need for cognitive aids to
Conti, Joseph; Satterfield, Terre; Harthorn, Barbara Herr
As an emerging domain of risk research, nanotechnologies engender novel research questions, including how new technologies are encountered given different framing and contextual detail. Using data from a recent U.S. national survey of perceived risks (N= 1,100), risk versus benefit framings and the specific social positions from which people encounter or perceive new technologies are explored. Results indicate that vulnerability and attitudes toward environmental justice significantly influenced risk perceptions of nanotechnology as a broad class, while controlling for demographic and affective factors. Comparative analyses of different examples of nanotechnology applications demonstrated heightened ambivalence across acceptability when risk versus benefit information was provided with application descriptions (described in short vignettes as compared to the general category "nanotechnology," absent of risk or benefit information). The acceptability of these nano-specific vignettes varied significantly in only some cases given indexes of vulnerability and attitudes toward environmental justice. However, experimental narrative analyses, using longer, more comprehensive descriptive passages, show how assessments of risks and benefits are tied to the systematically manipulated psychometric qualities of the application (its invasiveness and controllability), risk messaging from scientists, and the social implications of the technology with regard to justice. The article concludes with discussion of these findings for risk perception research and public policy related to nanotechnology and possibly other emerging technologies. © 2011 Society for Risk Analysis.
Badar Nadeem Ashraf
Full Text Available In this paper, we examine the impact of trade openness on bank risk-taking behavior. Using a panel dataset of 291 banks from 37 emerging countries over the period from 1998 to 2012, we find that higher trade openness decreases bank risk-taking. The results are robust when we use alternative bank risk-taking proxies and alternative estimation methods. We argue that trade openness provides diversification opportunities to banks in lending activities, which decrease overall bank risk. Further to this end, we observe that higher trade openness helps domestic banks to smooth out income volatility and decreases the impact of a financial crisis on banks.
Xin Jing; Tang Huaqing; Zhang Yinghua; Zhang Limin
A risk assessment model of nuclear accident emergency protection countermeasure based on fuzzy matter-element analysis and Euclid approach degree is proposed in the paper. The weight of assessed index is determined by information entropy and the scoring by experts, which could not only make full use of the inherent information of the indexes adequately, but reduce subjective assumption in the course of assessment effectively. The applied result shows that it is reasonable that the model is adopted to make risk assessment for nuclear accident emergency protective countermeasure,and it could be a kind of effective analytical method and decision making basis to choose the optimum protection countermeasure. (authors)
Gokesch, Karin; Promper, Catrin; van Westen, Cees J.; Glade, Thomas
The spatiotemporal distribution and presence of the population in a certain area is a crucial element within natural hazard risk management, especially in the case of rapid onset hazard events and emergency management. When fast onset hazards such as earthquakes, flash floods or industrial accidents occur, people may not have adequate time for evacuation and the emergency management requires a fast response and reaction. Therefore, information on detailed distribution of people affected by a certain hazard is important for a fast assessment of the situation including the number and the type of people (distinguishing between elderly or handicapped people, children, working population etc.) affected. This study thus aims at analyzing population distribution on an hourly basis for different days e.g. workday or holiday. The applied method combines the basic assessment of population distribution in a given area with specific location-related patterns of distribution-changes over time. The calculations are based on detailed information regarding the expected presence of certain groups of people, e.g. school children, working or elderly people, which all show different patterns of movement over certain time periods. The study area is the city of Waidhofen /Ybbs located in the Alpine foreland in the Southwest of Lower Austria. This city serves as a regional center providing basic infrastructure, shops and schools for the surrounding countryside. Therefore a lot of small and medium businesses are located in this area showing a rather high variation of population present at different times of the day. The available building footprint information was classified with respect to building type and occupancy type, which was used to estimate the expected residents within the buildings, based on the floorspace of the buildings and the average floorspace per person. Additional information on the distribution and the average duration of stay of the people in these buildings was
Schmitz, Gillian R
concerning and required closer evaluation.Conclusion: Variability exists in the treatment strategies for abscess care. The majority of providers used narcotic analgesics in addition to local anesthetic, linear incisions, and packing. Most providers did not irrigate, order wound cultures, or routinely prescribe oral antibiotics unless specific risk factors or physical signs were present. Limited evidence is available at this time to guide these treatment strategies. [West J Emerg Med. 2013;14(1:23–28.
Full Text Available The risk issue has become lately one of the most important themes in economic life. The risk is an important component of all management activities, whether it is a simple or more complex activity. There is a common opinion of those who study economics that the business risk is a natural thing, and it is irreplaceable in the business world. Risk disappearance creates confusion, inefficiency and generates the unnatural behaviour of the economic agents. Developing a business involves making decisions about the future. Information available to managers in making decisions is never perfect and complete. Considered one of the most dynamic economic sectors, trade is a deep restructuring process. The rapid rate of development in the economic activity has resulted in changes in trade activity, mainly in the retail sector, the new store formats of thousands of square feet generates a lot of turnover. The risks that appear in this sector, represented by large retail stores, are multiple: increased competition, technological development requiring replacement of hold capacity, insufficient information on the external elements of the enterprise, uncertain economic context, state intervention in the economy, environmental impact.
Miralbell, Júlia; López-Cancio, Elena; López-Oloriz, Jorge; Arenillas, Juan Francisco; Barrios, Maite; Soriano-Raya, Juan José; Galán, Amparo; Cáceres, Cynthia; Alzamora, Maite; Pera, Guillem; Toran, Pere; Dávalos, Antoni; Mataró, Maria
Risk factors for vascular cognitive impairment (VCI) are the same as traditional risk factors for cerebrovascular disease (CVD). Early identification of subjects at higher risk of VCI is important for the development of effective preventive strategies. In addition to traditional vascular risk factors (VRF), circulating biomarkers have emerged as potential tools for early diagnoses, as they could provide in vivo measures of the underlying pathophysiology. While VRF have been consistently linked to a VCI profile (i.e., deficits in executive functions and processing speed), the cognitive correlates of CVD biomarkers remain unclear. In this population-based study, the aim was to study and compare cognitive patterns in relation to VRF and circulating biomarkers of CVD. The Barcelona-AsIA Neuropsychology Study included 747 subjects older than 50, without a prior history of stroke or coronary disease and with a moderate to high vascular risk (mean age, 66 years; 34.1% women). Three cognitive domains were derived from factoral analysis: visuospatial skills/speed, verbal memory and verbal fluency. Multiple linear regression was used to assess relationships between cognitive performance (multiple domains) and a panel of circulating biomarkers, including indicators of inflammation, C-reactive protein (CRP) and resistin, endothelial dysfunction, asymmetric dimethylarginine (ADMA), thrombosis, plasminogen activator inhibitor 1 (PAI-1), as well as traditional VRF, metabolic syndrome and insulin resistance (homeostatic model assessment for insulin resistance index). Analyses were adjusted for age, gender, years of education and depressive symptoms. Traditional VRF were related to lower performance in verbal fluency, insulin resistance accounted for lower performance in visuospatial skills/speed and the metabolic syndrome predicted lower performance in both cognitive domains. From the biomarkers of CVD, CRP was negatively related to verbal fluency performance and increasing ADMA
Na, Lixin; Han, Tianshu; Zhang, Wei; Wu, Xiaoyan; Na, Guanqiong; Du, Shanshan; Li, Ying; Sun, Changhao
The evidence about the effect of dietary patterns on blood cholesterol from cohort studies was very scarce. The study was to identify the association of dietary patterns with lipid profile, especially cholesterol, in a cohort in north China. Using a 1-year food frequency questionnaire, we assessed the dietary intake of 4515 adults from the Harbin People's Health Study in 2008, aged 20-74 years. Principle component analysis was used to identify dietary patterns. The follow-up was completed in 2012. Fasting blood samples were collected for the determination of blood lipid concentrations. Logistic regression models were used to evaluate the association of dietary patterns with the incidence of hypercholesterolemia, hypertriglyceridemia, and low-HDL cholesterolemia. Five dietary patterns were identified ("staple food", "vegetable, fruit and milk", "potato, soybean and egg", "snack", and "meat"). The relative risk (RR) between the extreme tertiles of the snack dietary pattern scores was 1.72 (95% CI = 1.14, 2.59, P = 0.004) for hypercholesterolemia, 1.39 (1.13, 1.75, P = 0.036) for hypertriglyceridemia, after adjustment for age, sex, education, body mass index, smoking, alcohol consumption, energy intake, exercise and baseline lipid concentrations. There was a significant positive association between the snack dietary pattern scores and fasting serum total cholesterol (SRC (standardized regression coefficient) = 0.262, P = 0.025), LDL-c (SRC = 0.324, P = 0.002) and triglycerides (SRC = 0.253, P = 0.035), after adjustment for the multiple variables above. Moreover, the adjusted RR of hypertriglyceridemia between the extreme tertiles was 0.73 (0.56, 0.94, P = 0.025) for the vegetable, fruit and milk dietary pattern, and 1.86 (1.33, 2.41, P = 0.005) for the meat dietary pattern. The snack dietary pattern was a newly emerged dietary pattern in northern Chinese adults. It appears conceivable that the risk of hypercholesterolemia can be reduced by changing the snack dietary
Full Text Available The evidence about the effect of dietary patterns on blood cholesterol from cohort studies was very scarce. The study was to identify the association of dietary patterns with lipid profile, especially cholesterol, in a cohort in north China. Using a 1-year food frequency questionnaire, we assessed the dietary intake of 4515 adults from the Harbin People's Health Study in 2008, aged 20-74 years. Principle component analysis was used to identify dietary patterns. The follow-up was completed in 2012. Fasting blood samples were collected for the determination of blood lipid concentrations. Logistic regression models were used to evaluate the association of dietary patterns with the incidence of hypercholesterolemia, hypertriglyceridemia, and low-HDL cholesterolemia. Five dietary patterns were identified ("staple food", "vegetable, fruit and milk", "potato, soybean and egg", "snack", and "meat". The relative risk (RR between the extreme tertiles of the snack dietary pattern scores was 1.72 (95% CI = 1.14, 2.59, P = 0.004 for hypercholesterolemia, 1.39 (1.13, 1.75, P = 0.036 for hypertriglyceridemia, after adjustment for age, sex, education, body mass index, smoking, alcohol consumption, energy intake, exercise and baseline lipid concentrations. There was a significant positive association between the snack dietary pattern scores and fasting serum total cholesterol (SRC (standardized regression coefficient = 0.262, P = 0.025, LDL-c (SRC = 0.324, P = 0.002 and triglycerides (SRC = 0.253, P = 0.035, after adjustment for the multiple variables above. Moreover, the adjusted RR of hypertriglyceridemia between the extreme tertiles was 0.73 (0.56, 0.94, P = 0.025 for the vegetable, fruit and milk dietary pattern, and 1.86 (1.33, 2.41, P = 0.005 for the meat dietary pattern. The snack dietary pattern was a newly emerged dietary pattern in northern Chinese adults. It appears conceivable that the risk of hypercholesterolemia can be reduced by changing the snack
Full Text Available We study effects of risk-averse attitude of both participators in aviation joint emergency response on the coevolution of cooperation mechanisms and individual preferences between airport and nonprofit organization. First, based on the current aviation joint emergency mechanism in China, we put forward two mechanisms to select the joint nonprofit organization, including reputation cooperation and bidding competition. Meanwhile, we consider two preferences including altruism and selfishness. Then we build replicator dynamics equations using the theory of conditional value-at-risk (CVaR taking risk aversion attitude into account. Finally, we introduce the factor of government and give all participators some suggestions. We show that the risk-averse attitude of the other game participator affects the one participator’s decision and the effects subject to some parameters.
Al-Niemat, Sahar I; Aljbouri, Tareq M; Goussous, Lana S; Efaishat, Rania A; Salah, Rehab K
To investigate antibiotics prescribing patterns in the outpatient pediatric emergency clinic at Queen Rania Al Abdullah II Children's Hospital at Royal Medical Services in Amman, Jordan. The data was collected from the emergency pharmacy over the period of a -five consecutive months. The methodology recommended by the World Health Organization for investigating drug use in a health facility was followed. The study measures the percentage of encounter with a prescribed antibiotic and the percentage share of each antibiotic category. The distribution of diagnostic categories that accounted for all antibiotics being prescribed and the distribution of each antibiotic being prescribed for upper respiratory tract infections (URTIs) were also measured. Antibiotic prescribing was frequent during pediatric visits to the outpatient pediatric emergency clinic resulting in a high percentage of encounters (85%) when compared to appropriate. Emergency physicians continue to frequently prescribe broad spectrum antibiotics which accounted for approximately (60%) of the total prescribed antibiotics and (83%) of prescribed antibiotics for upper respiratory tract infections and macrolides (primarily azithromycin) were the leading class among them. Our results showed high consumption of antibiotics by emergency department pediatricians which highlight the importance for interventions to promote rational and judicious prescribing. An insight into factors influencing antibiotics prescribing patterns by military prescribers is required.
Sahar I. Al-Niemat
Full Text Available Objective: To investigate antibiotics prescribing patterns in the outpatient pediatric emergency clinic at Queen Rania Al Abdullah II Children’s Hospital at Royal Medical Services in Amman, Jordan. Methods: The data was collected from the emergency pharmacy over the period of a -five consecutive months. The methodology recommended by the World Health Organization for investigating drug use in a health facility was followed. The study measures the percentage of encounter with a prescribed antibiotic and the percentage share of each antibiotic category. The distribution of diagnostic categories that accounted for all antibiotics being prescribed and the distribution of each antibiotic being prescribed for upper respiratory tract infections (URTIs were also measured. Results: Antibiotic prescribing was frequent during pediatric visits to the outpatient pediatric emergency clinic resulting in a high percentage of encounters (85% when compared to appropriate. Emergency physicians continue to frequently prescribe broad spectrum antibiotics which accounted for approximately (60% of the total prescribed antibiotics and (83% of prescribed antibiotics for upper respiratory tract infections and macrolides (primarily azithromycin were the leading class among them. Conclusion: Our results showed high consumption of antibiotics by emergency department pediatricians which highlight the importance for interventions to promote rational and judicious prescribing. An insight into factors influencing antibiotics prescribing patterns by military prescribers is required.
Context: The incidence of breast cancer is increasing worldwide. In black women, breast cancer is associated with aggressive features and poor survival. Objective: Identification of risk factors such as early age of menarche, obesity and family history of breast cancer may permit preventive strategies. Study Design: A ...
The goal of this study was to identify various HIV risk behaviours among tuberculosis (TB) patients in a longitudinal study design in South Africa. In 42 public primary healthcare facilities in three districts in three provinces, adult new TB and TB retreatment patients with hazardous or harmful alcohol use were interviewed ...
Huded, Jill M.; Dresden, Scott M.; Gravenor, Stephanie J.; Rowe, Theresa; Lindquist, Lee A.
Introduction: Seniors represent the fasting growing population in the U.S., accounting for 20.3 million visits to emergency departments (EDs) annually. The ED visit can provide an opportunity for identifying seniors at high risk of falls. We sought to incorporate the Timed Up & Go Test (TUGT), a commonly used falls screening tool, into the ED encounter to identify seniors at high fall risk and prompt interventions through a geriatric nurse liaison (GNL) model. Methods: P...
Tabung, Fred K; Brown, Lisa S; Fung, Teresa T
Colorectal cancer (CRC) is a global public health problem, with an estimated 1.4 million cases diagnosed worldwide in 2012. Evidence suggests that diet may be important for primary prevention. The 2017 WCRF/AICR Continuous Update Project on colorectal cancer concluded that there is convincing evidence linking several individual dietary factors with CRC risk but the evidence for dietary patterns was limited and inconclusive. Also, previous reviews and meta-analyses have not critically synthesized various dietary patterns. This review synthesized data from dietary patterns studies over a 17-year period from 2000 to 2016. We included 49 studies (28 cohort and 21 case-control) that examined the association of index-based and empirically-derived dietary patterns and CRC risk. A synthesis of food group components comprising the different index-based and empirically-derived patterns revealed two distinct dietary patterns associated with CRC risk. A "healthy" pattern, generally characterized by high intake of fruits and vegetables, wholegrains, nuts and legumes, fish and other seafood, milk and other dairy products, was associated with lower CRC risk. In contrast, the "unhealthy" pattern, characterized by high intakes of red meat, processed meat, sugar-sweetened beverages, refined grains, desserts and potatoes was associated with higher CRC risk. It is notable that the number of food groups, the intake quantity, the exact types of foods in each food group, differed between populations, yet the two dietary patterns remained consistent across regions, especially in empirically-derived patterns, an indication of the high reproducibility of these patterns. However, findings for CRC risk in both index-based and empirically-derived patterns, differed by sex, with stronger associations among men than women; study design, a higher proportion of case-control studies reported significant findings compared to prospective studies. Consuming a dietary pattern high in fruits and
Bird, Deanne K.; Gisladottir, Gudrun; Dominey-Howes, Dale
This paper examines the relationship between volcanic risk and the tourism sector in southern Iceland and the complex challenge emergency management officials face in developing effective volcanic risk mitigation strategies. An early warning system and emergency response procedures were developed for communities surrounding Katla, the volcano underlying the Mýrdalsjökull ice cap. However, prior to and during the 2007 tourist season these mitigation efforts were not effectively communicated to stakeholders located in the tourist destination of Þórsmörk despite its location within the hazard zone of Katla. The hazard zone represents the potential extent of a catastrophic jökulhlaup (glacial outburst flood). Furthermore, volcanic risk mitigation efforts in Þórsmörk were based solely on information derived from physical investigations of volcanic hazards. They did not consider the human dimension of risk. In order to address this gap and provide support to current risk mitigation efforts, questionnaire surveys were used to investigate tourists' and tourism employees' hazard knowledge, risk perception, adoption of personal preparedness measures, predicted behaviour if faced with a Katla eruption and views on education. Results indicate that tourists lack hazard knowledge and they do not adopt preparedness measures to deal with the consequences of an eruption. Despite a high level of risk perception, tourism employees lack knowledge about the early warning system and emergency response procedures. Results show that tourists are positive about receiving information concerning Katla and its hazards and therefore, the reticence of tourism employees with respect to disseminating hazard information is unjustified. In order to improve the tourism sector's collective capacity to positively respond during a future eruption, recommendations are made to ensure adequate dissemination of hazard, risk and emergency response information. Most importantly education campaigns
Full Text Available In the 21st century humans face with the great risk how to protect themselves from disasters of different kinds. Emergencies happened in many countries and caused a great suffering of humans. The main question of stakeholders is: ‘’how to protect human health and environment in an adequate way’’. Emergency management is an issue which is included in numerous education institutions all over the globe and the action of various national and international organizations. Therefore it is interesting that in the process of fostering emergency management many countries neglect the need of creating more effective tools for response, preparedness and recovery in environmental emergencies. The paper is based on analyzes of Serbian approach in the governance of emergency situation followed by incommensurate environmental risks. Serbia had to accept International environmental emergency help after the floods in 2014. The Joint United Nations Environment Programme (UNEP / Office for the Coordination of Humanitarian Affairs (OCHA Environment Unit (JEU helped Serbia to mitigate consequences of horrified environmental emergency in “Stolice” mine near city Krupanj. This assistance was needed because Serbia did not have enough capacity to struggle with the consequences of breaking the dam and contamination of soil and rivers. This study shows that a similar disaster in the future could be solved only by strengthening multilateral response of different actors at local and national level. After all, Serbia is at the beginning of the path, and need to highlight strategic challenges in the governance of emergency situation followed by environmental emergencies. Only with full implementation of positive practice of the international community Serbia could avoid long term impact on life support functions, nature and humans.
Full Text Available Epidemiological studies of different dietary patterns and the risk of hypertension among a middle-aged Chinese population remain extremely scare. Thus, the aim of this study was to identify dietary patterns and investigate the relationship between dietary patterns and the risk of hypertension among Chinese adults aged 45–60 years. The present cross-sectional study includes 2560 participants who reported their dietary intake using a validated food frequency questionnaire (FFQ. Dietary patterns were identified using factor analysis. Anthropometric measurements were obtained using standardized procedures. We used log-binomial regression analysis to examine the associations between dietary patterns and hypertension risk. Four major dietary patterns were identified and labeled as traditional Chinese, animal food, western fast-food, and high-salt patterns. After adjusting for potential confounders, participants in the highest quartile of animal food pattern scores had a greater prevalence ratio (PR for hypertension (PR = 1.26; 95% confidence interval (CI: 1.064–1.727; p < 0.05 in comparison to those from the lowest quartile. Compared with the lowest quartile of high-salt pattern, the highest quartile had a higher prevalence ratio for hypertension (PR = 1.12; 95% CI: 1.013–1.635; p < 0.05. Conclusions: Our findings indicated that animal food and high-salt patterns were associated with increased risk of hypertension, while traditional Chinese and western fast-food patterns were not associated with the risk of hypertension. Further prospective studies are warranted to confirm these findings.
Full Text Available Although hydrogen has been used in industry for many years as a chemical commodity, its use as a fuel or energy carrier is relatively new and expert knowledge about its associated risks is neither complete nor consensual. Public awareness of hydrogen energy and attitudes towards a future hydrogen economy are yet to be systematically investigated. This paper opens by discussing alternative conceptualisations of risk, then focuses on issues surrounding the use of emerging technologies based on hydrogen energy. It summarises expert assessments of risks associated with hydrogen. It goes on to review debates about public perceptions of risk, and in doing so makes comparisons with public perceptions of other emergent technologies—Carbon Capture and Storage (CCS, Genetically Modified Organisms and Food (GM and Nanotechnology (NT—for which there is considerable scientific uncertainty and relatively little public awareness. The paper finally examines arguments about public engagement and "upstream" consultation in the development of new technologies. It is argued that scientific and technological uncertainties are perceived in varying ways and different stakeholders and different publics focus on different aspects or types of risk. Attempting to move public consultation further "upstream" may not avoid this, because the framing of risks and benefits is necessarily embedded in a cultural and ideological context, and is subject to change as experience of the emergent technology unfolds. URN: urn:nbn:de:0114-fqs0601194
Full Text Available Abstract Background Public health emergencies heighten several challenges in risk-communication: providing trustworthy sources of information, reaching marginalized populations, and minimizing fear and public confusion. In emergencies, however, information may not diffuse equally among all social groups, and gaps in knowledge may increase. Such knowledge gaps vary by social structure and the size, socioeconomic status, and diversity of the population. This study explores the relationship between risk-communication capabilities, as perceived by public officials participating in emergency tabletop exercises, and community size and diversity. Findings For each of the three communication functions tested, risk-communication capabilities are perceived to be greater in communities with fewer then 10% of the population speaking a language other than English at home, decreasing as the percentage grows to 20% (ANOVA P ≤ 0.02. With respect to community size, however, we found an N-shaped relationship between perceived risk communication capabilities and population size. Capabilities are perceived highest in the largest communities and lowest in the smallest, but lower in communities with 20,000–49,999 inhabitants compared to those with 2,500–19,999. Conclusion The results of this study suggest the need to factor population diversity into risk communication plans and the need for improved state or regional risk-communication capabilities, especially for communities with limited local capacity.
Jones-McLean, E.; Hu, J.; Greene-Finestone, L. S.; de Groh, M.
Introduction: Colorectal cancer (CRC) is a high incidence cancer affecting many Canadian adults each year. Diet is important in the etiology of CRC with many dietary components identified as potential risk factors. The Dietary Approaches to Stop Hypertension (DASH) diet is a well-established pattern to characterize overall eating. The purpose of this study was to characterize a DASH pattern within the Canadian context and to assess its relationship to the risk of CRC in Canadian adults. Metho...
Cihoric, Mirjana; Toft Tengberg, Line; Bay-Nielsen, Morten
BACKGROUND: With current literature quoting mortality rates up to 45%, emergency high-risk abdominal surgery has, compared with elective surgery, a significantly greater risk of death and major complications. The Surgical Apgar Score (SAS) is predictive of outcome in elective surgery, but has nev...... emergency high-risk abdominal surgery. Despite its predictive value, the SAS cannot in its current version be recommended as a standalone prognostic tool in an emergency setting....
Safari, Akram; Shariff, Zalilah Mohd; Kandiah, Mirnalini; Rashidkhani, Bahram; Fereidooni, Foroozandeh
Colorectal cancer is the third and fourth leading cause of cancer incidence and mortality among men and women, respectively in Iran. However, the role of dietary factors that could contribute to this high cancer incidence remains unclear. The aim of this study was to determine major dietary patterns and its relationship with colorectal cancer. This case-control study was conducted in four hospitals in Tehran city of Iran. A total of 71 patients (35 men and 36 women, aged 40-75 years) with incident clinically confirmed colorectal cancer (CRC) and 142 controls (70 men and 72 women, aged 40-75 years) admitted to hospital for acute, non-neoplastic diseases were recruited and interviewed. Dietary data were assessed by 125-item semi-quantitative food frequency questionnaire. Multivariate logistic regression was used to estimate the relationship between dietary patterns and risk of colorectal cancer. Two major dietary patterns (Healthy pattern and Western pattern) were derived using principal component analysis. Each dietary pattern explained 11.9% (Healthy pattern) and 10.3% (Western pattern) of the variation in food intake, respectively. After adjusting for confounding factors, the Healthy dietary pattern was significantly associated with a decreased risk of colorectal cancer (OR= 0.227; 95% CI=0.108-0.478) while an increased risk of colorectal cancer was observed with the Western dietary pattern (OR=2.616; 95% CI= 1.361-5.030). Specific dietary patterns, which include healthy and western patterns, may be associated with the risk of colorectal cancer. This diet-disease relationship can be used for developing interventions that aim to promote healthy eating for the prevention of chronic disease, particularly colorectal cancer in the Iranian population.
Epidemiology of dietary components and disease risk limits interpretability due to potential residual confounding by correlated dietary components. Dietary pattern analyses by factor analysis or partial least squares may overcome this limitation. To examine confounding by dietary pattern as well as ...
Epidemiology of dietary components and disease risk limits interpretability due to potential residual confounding by correlated dietary components. Dietary pattern analyses by factor analysis or partial least squares may overcome this limitation. To examine confounding by dietary pattern as well as ...
Epidemiology of dietary components and disease risk limits interpretability due to potential residual confounding by correlated dietary components. Dietary pattern analyses by factor analysis or partial least squares may overcome the limitation. To examine confounding by dietary pattern as well as ...
Claessens, Michiel; Vanhaecke, Lynn; Wille, Klaas; Janssen, Colin R
Knowledge on the effects of pharmaceuticals on aquatic marine ecosystems is limited. The aim of this study was therefore to establish the effect thresholds of pharmaceutical compounds occurring in the Belgian marine environment for the marine diatom Phaeodactylum tricornutum, and subsequently perform an environmental risk assessment for these substances. Additionally, a screening-level risk assessment was performed for the pharmaceutical mixtures. No immediate risk for acute toxic effects of these compounds on P. tricornutum were apparent at the concentrations observed in the Belgian marine environment. In two Belgian coastal harbours however, a potential chronic risk was observed for the β-blocker propranolol. No additional risks arising from the exposure to mixtures of pharmaceuticals present in the sampling area could be detected. However, as risk characterization ratios for mixtures of up to 0.5 were observed, mixture effects could emerge should more compounds be taken into account. Copyright © 2013 Elsevier Ltd. All rights reserved.
Hossack, B.R.; Pilliod, D.S.
The increased frequency and severity of large wildfires in the western United States is an important ecological and management issue with direct relevance to amphibian conservation. Although the knowledge of fire effects on amphibians in the region is still limited relative to most other vertebrate species, we reviewed the current literature to determine if there are evident patterns that might be informative for conservation or management strategies. Of the seven studies that compared pre- and post-wildfire data on a variety of metrics, ranging from amphibian occupancy to body condition, two reported positive responses and five detected negative responses by at least one species. Another seven studies used a retrospective approach to compare effects of wildfire on populations: two studies reported positive effects, three reported negative effects from wildfire, and two reported no effects. All four studies that included plethodontid salamanders reported negative effects on populations or individuals; these effects were greater in forests where fire had been suppressed and in areas that burned with high severity. Species that breed in streams are also vulnerable to post-wildfire changes in habitat, especially in the Southwest. Wildfire is also important for maintaining suitable habitat for diverse amphibian communities, although those results may not be evident immediately after an area burns. We expect that wildfire will extirpate few healthy amphibian populations, but it is still unclear how populations will respond to wildfire in the context of land management (including pre- and post-fire timber harvest) and fragmentation. Wildfire may also increase the risk of decline or extirpation for small, isolated, or stressed (e.g., from drought or disease) populations. Improved understanding of how these effects vary according to changes in fire frequency and severity are critical to form more effective conservation strategies for amphibians in the western United States.
Miller, Paige E; Lesko, Samuel M; Muscat, Joshua E; Lazarus, Philip; Hartman, Terryl J
A number of studies exploring associations between individual dietary components and colorectal adenoma or cancer risk have yielded conflicting results. The study of food-based dietary patterns in relation to chronic disease risk represents an alternative approach to the evaluation of single dietary exposures in epidemiological investigations. Results from prospective cohort and population-based case-control studies examining associations between dietary patterns and colorectal cancer or adenoma risk were evaluated and described in this review. Despite notable differences in population characteristics, study design, and methods used for characterizing dietary patterns across the different studies, two general dietary patterns were found to modestly predict colorectal adenoma and cancer risk. A healthier pattern consisting of greater intakes of fruits and vegetables, and lower intakes of red and processed meat, appeared protective against colorectal adenoma and cancer incidence. Findings also suggest that a less healthy pattern characterized by higher intakes of red and processed meat, as well as potatoes and refined carbohydrates, may increase risk. Continued research efforts are needed to evaluate the cumulative and interactive effects of numerous dietary exposures on colorectal cancer risk.
Schwartz, Seth J.; Zamboanga, Byron L.; Ravert, Russell D.; Kim, Su Yeong; Weisskirch, Robert S.; Williams, Michelle K.; Bersamin, Melina; Finley, Gordon E.
The present study investigated the association of perceived parenting with health-risk behaviors in an ethnically diverse sample of 1,728 college-attending emerging adults. Participants completed retrospective measures of perceived maternal and paternal nurturance, connection, psychological control, and disrespect and reported their frequency of…
Brug, F. van de
Industry and government are held responsible for the safety of food and feed products. Therefore actual and relevant information concerning emerging safety risks is crucial. But how is it possible to filter relevant information from the fast growing volumes of information produced by science and the
Pol, van der T.D.; Gabbert, S.; Weikard, H.P.; Ierland, van E.C.; Hendrix, E.M.T.
This paper studies the dynamic application of the minimax regret (MR) decision criterion to identify robust flood risk management strategies under climate change uncertainty and emerging information. An MR method is developed that uses multiple learning scenarios, for example about sea level rise
M. Bults (Marloes)
markdownabstract__Abstract__ This thesis focuses on risk perception and behaviour of the public during the outbreaks of emerging infectious diseases. It consists of studies on Influenza A (H1N1), Q fever and Lyme disease. These studies were conducted among both the general public and specific
Petrželková, Klára Judita; Zukal, Jan
Roc. 51, č. 4 (2001), s. 395-414 ISSN 0028-2960 R&D Projects: GA AV ČR IAC6087502; GA AV ČR KSK6005114 Institutional research plan: CEZ:AV0Z6093917 Keywords : Eptesicus serotinus * emergence * predation risk Subject RIV: EG - Zoology Impact factor: 0.509, year: 2001
Ochoa Rivera, Juan Camilo
Dams are built to be highly safe hydraulic works. Nevertheless, they are not exempt from a certain failure risk, which turns in a variable value along the time service of the dam. As the mentioned dam-failure risk can be a significant hazard, analysis on dam-break is becoming important, as same as the assessment of its consequences. This type of studies are intended to reduce the costs linked to dam-failure, which are mainly due to the losses of human beings and material goods. A suitable way to minimize such losses consists of designing emergency plans, which permit to prepare and implant appropriate protection measures. A methodological framework to carry out this kind of emergency plans is introduced in this paper, accompanied by a case study corresponding to an emergency plan of a Spanish dam
Preservation of a traditional Korean dietary pattern and emergence of a fruit and dairy dietary pattern among adults in South Korea: secular transitions in dietary patterns of a prospective study from 1998 to 2010.
Lim, Hyunjung; Kim, Sang Yeun; Wang, Youfa; Lee, Sun Ju; Oh, Kyungwon; Sohn, Chun Young; Moon, Young Myoung; Jee, Sun Ha
Transitions in nutrition patterns tend to emerge through industrialization and economic development. We hypothesized that the dietary patterns among South Korean adults who were 20 years or older have changed significantly from 1998 to 2010. Herein, a repeated cross-sectional analysis of data was followed for 140601 adults. We noted changes in consumption, after adjusting for age, sex, body mass index, and exercise, and tested the trends across the study period. Factor and cluster analyses were used to derive dietary patterns. A decrease in traditional Korean food consumption, including cereals, vegetables (252-176 g), and Kimchi (127-82 g), occurred, whereas fruit (172-252 g), egg, and fried food intakes increased (P dietary patterns: "Korean" diet (rice, vegetables, and Kimchi), "Western" diet (soda, eggs, and oil), and "New" diet (low sugar and high fruit and dairy product intakes). Compared to 1998, approximately 40% of participants still followed a Korean diet in 2010. Interestingly, the popularity of the Western diet fell by approximately 20%, whereas the new diet pattern increased 2-fold over the study period. Overall, these data show secular trends in dietary patterns that included a preservation of the traditional Korean diet and the emergence of a new diet pattern, and it demonstrated a unique transition in food and nutrient intakes in Korea. Copyright © 2014 Elsevier Inc. All rights reserved.
Williams, Christina Dawn; Satia, Jessie A; Adair, Linda S; Stevens, June; Galanko, Joseph; Keku, Temitope O; Sandler, Robert S
Associations between individual foods and nutrients and colorectal cancer have been inconsistent, and few studies have examined associations between food, nutrients, dietary patterns, and rectal cancer. We examined the relationship between food groups and dietary patterns and risk for rectal cancer in non-Hispanic Whites and African-Americans. Data were from the North Carolina Colon Cancer Study-Phase II and included 1,520 Whites (720 cases, 800 controls) and 384 African-Americans (225 cases, 159 controls). Diet was assessed using the Diet History Questionnaire. Multivariate logistic regression models were used to estimate odds ratios and 95% confidence intervals. Among Whites, non-whole grains and white potatoes were associated with elevated risk for rectal cancer whereas fruit, vegetables, dairy, fish, and poultry were associated with reduced risk. In African-Americans, high consumption of other fruit and added sugar suggested elevated risk. We identified three major dietary patterns in Whites and African-Americans. The high fat/meat/potatoes pattern was observed in both race groups but was only positively associated with risk in Whites (odds ratio, 1.84; 95% confidence interval, 1.03-3.15). The vegetable/fish/poultry and fruit/whole grain/dairy patterns in Whites had significant inverse associations with risk. In African-Americans, there was a positive dose-response for the fruit/vegetables pattern (P(trend) pattern (P(trend) dietary patterns with rectal cancer risk differ between Whites and African-Americans, highlighting the importance of examining diet and cancer relationships in racially diverse populations.
Melikhova, E.; Arutyunyan, R.
The paper reviews recent results of content analysis of the Russian press and data of all-Russia public opinion polls on the subject of the Fukushima accident and discusses them in the wider context of challenges in communication of 'no risk' messages to the public in the case of a nuclear accident. Radiation risk regulation base in the low dose range is proposed to be one of the main obstacles for the communication and a new approach to emergency risk communication is proposed. (author)
Carter, Eileen J; Pallin, Daniel J; Mandel, Leslie; Sinnette, Corine; Schuur, Jeremiah D
Existing knowledge of emergency department (ED) catheter-associated urinary tract infection (CAUTI) prevention is limited. We aimed to describe the motivations, perceived risks for CAUTI acquisition, and strategies used to address CAUTI risk among EDs that had existing CAUTI prevention programs. In this qualitative comparative case study, we enrolled early-adopting EDs, that is, those using criteria for urinary catheter placement and tracking the frequency of catheters placed in the ED. At 6 diverse facilities, we conducted 52 semistructured interviews and 9 focus groups with hospital and ED participants. All ED CAUTI programs originated from a hospitalwide focus on CAUTI prevention. Staff were motivated to address CAUTI because they believed program compliance improved patient care. ED CAUTI prevention was perceived to differ from CAUTI prevention in the inpatient setting. To identify areas of ED CAUTI prevention focus, programs examined ED workflow and identified 4 CAUTI risks: (1) inappropriate reasons for urinary catheter placement; (2) physicians' limited involvement in placement decisions; (3) patterns of urinary catheter overuse; and (4) poor insertion technique. Programs redesigned workflow to address risks by (1) requiring staff to specify the medical reason for catheter at the point of order entry and placement; (2) making physicians responsible for determining catheter use; (3) using catheter alternatives to address patterns of overuse; and (4) modifying urinary catheter insertion practices to ensure proper placement. Early-adopting EDs redesigned workflow to minimize catheter use and ensure proper insertion technique. Assessment of ED workflow is necessary to identify and modify local practices that may increase CAUTI risk.
Beecher, S; O'Leary, D P; McLaughlin, R
The pressures on tertiary hospitals with increased volume and complexity related to regionalization and specialization has impacted upon availability of operating theatres with consequent displacement of emergencies to high risk out of hours settings. A retrospective review of an electronic emergency theatre list prospectively maintained database was performed over a two year period. Data gathered included type of operation performed, Time to Theatre (TTT), operation start time and length of stay (LOS). Of 7041 emergency operations 25% were performed out of hours. 2949 patient had general surgical emergency procedures with 910 (30%) performed out of hours. 53% of all emergency laparotomies and 54% of appendicectomies were out of hours. 57% of cases operated on out of hours had been awaiting surgery during the day. Mean TTT was shorter for those admitted at the weekend compared to those admitted during the week (15.6 vs 24.9 h) (p emergency surgery is performed out of hours in a way unfavorable to good clinical outcomes. It is of concern that more than half of the most life threating procedures involving laparotomy, take place out of hours. Regionalization needs to be accompanied by infrastructure planning to accommodate emergency surgery. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.
Jacome-Sosa, Miriam; Parks, Elizabeth J; Bruno, Richard S; Tasali, Esra; Lewis, Gary F; Schneeman, Barbara O; Rains, Tia M
Cardiovascular disease (CVD) is the leading cause of death in the United States. Although the role of habitual lifestyle factors such as physical activity and dietary patterns in increasing CVD risk has long been appreciated, less is known about how acute daily activities may cumulatively contribute to long-term disease risk. Here, the term acute refers to metabolic responses occurring in a short period of time after eating, and the goal of this article is to review recently identified stress...
Thomas, Tami L; Yarandi, Hossein N; Dalmida, Safiya George; Frados, Andrew; Klienert, Kathleen
The authors examined population-specific risk factors that increase emerging adults' risk of acquiring sexually transmitted infections (STIs), including the human papillomavirus (HPV). A cross-sectional sample of 335 diverse, emerging adults ages 18 to 24 years was recruited from a health center at a large university in the Southeastern United States. The mean age was 20.6 ± 1.9 years, majority were females (74.0%), and 61.0% were Hispanic. Findings revealed inconsistent condom use, reasons for not using condoms, and a need for more culturally specific intervention strategies. Healthcare providers should identify culturally specific reasons for inconsistent condom use, examine cultural and geographic differences in sexual risk behaviors among groups and communities, and modify communication, educational programs, and interventions accordingly. By adopting a multicultural approach to the control of STIs, nurses can address specific cultural attitudes and behaviors that may influence exposure to STIs, including HPV. © The Author(s) 2014.
Full Text Available With the emergence and spread of digital media, more business models foster and empower client participation in medical professions. With services and products ranging from rating platforms to apps targeting self-diagnosis, these businesses transform the client–practitioner relationship yet risk undermining a central pillar of professions—autonomy. Practitioners have to take legal actions against these business models, making visible the frictional interplay among the involved actors. This development calls for an analytical understanding of how this technology-induced cultural change affects professions and discourses on professionalism. We argue that a perspective on how practitioners deal with these challenges in various situations can be beneficial. Hence, we conceptualize professionals as engaged in identifying, assessing and managing risks for themselves and their clients. The emerging risk-management practices lead to an understanding of how this apparent cultural change plays an increasingly meaningful role for research on how professionalism regarding legitimation of authority is negotiated.
Mweya, Clement N; Mboera, Leonard E G; Kimera, Sharadhuli I
Rift Valley Fever (RVF) is a climate-related arboviral infection of animals and humans. Climate is thought to represent a threat toward emerging risk areas for RVF epidemics globally. The objective of this study was to evaluate influence of climate on distribution of suitable breeding habitats for Culex pipiens complex, potential mosquito vector responsible for transmission and distribution of disease epidemics risk areas in Tanzania. We used ecological niche models to estimate potential distribution of disease risk areas based on vectors and disease co-occurrence data approach. Climatic variables for the current and future scenarios were used as model inputs. Changes in mosquito vectors' habitat suitability in relation to disease risk areas were estimated. We used partial receiver operating characteristic and the area under the curves approach to evaluate model predictive performance and significance. Habitat suitability for Cx. pipiens complex indicated broad-scale potential for change and shift in the distribution of the vectors and disease for both 2020 and 2050 climatic scenarios. Risk areas indicated more intensification in the areas surrounding Lake Victoria and northeastern part of the country through 2050 climate scenario. Models show higher probability of emerging risk areas spreading toward the western parts of Tanzania from northeastern areas and decrease in the southern part of the country. Results presented here identified sites for consideration to guide surveillance and control interventions to reduce risk of RVF disease epidemics in Tanzania. A collaborative approach is recommended to develop and adapt climate-related disease control and prevention strategies.
Park, Bitnara Jasmine
Early identification of students who are at-risk for reading difficulties (RD) is critical for successful and effective RTI implementation. A large group of students were followed for three years (grades 2 to 4) to investigate transition patterns of risk-categories across three years. Results indicated that although students identified at…
Bauer, Florianne; Beulens, Joline W. J.; van der A, Daphne L.; Wijmenga, Cisca; Grobbee, Diederick E.; Spijkerman, Annemieke M. W.; van der Schouw, Yvonne T.; Onland-Moret, N. Charlotte
Although overweight is an important determinant of diabetes risk, it remains unclear whether food choices can still influence the risk for type 2 diabetes in overweight persons. In this paper, we aim to clarify the role of dietary patterns in the development of type 2 diabetes in overweight and
Barbot, Baptiste; Krivulskaya, Suzanna; Hein, Sascha; Reich, Jodi; Thuma, Philip E.; Grigorenko, Elena L.
Differences in learning patterns of vocabulary acquisition in children at risk (+SRD) and not at risk (-SRD) for Specific Reading Disability (SRD) were examined using a microdevelopmental paradigm applied to the multi-trial Foreign Language Learning Task (FLLT; Baddeley et al., 1995). The FLLT was administered to 905 children from rural…
Christian, Elmar; Adamietz, Irinaeus A.; Willich, Normann; Schaefer, Ulrich; Micke, Oliver
Radiotherapy (RT) is an important treatment option for emergencies in oncology. A multicenter patterns of care study (PCS) was conducted in all RT institutions in Germany, Austria and Switzerland. In 2003 a standardized structured questionnaire was sent to all RT institutions. Number and type of staff involved, number of patients, over time distribution and expense, treatment indications and concepts of emergency RT were assessed. In addition, treatment outcome for the different indications was evaluated. The PCS was structured and analyzed according to the model for quality assessment set up by Donabedian in three major components: structure, process and outcome. One hundred and forty institutions (70%) answered the questionnaire. For the baseline of 2003 a total of 3 244 emergency radiotherapy indications with a mean of 28 per institution were reported. Forty percent of all institutions provide a special 24 h service at night or weekends. Seventy percent of the emergency indications were irradiated between Monday and Thursday, 30% between Friday and Sunday. Ninety percent of all emergencies were referred to RT between 8 a.m. and 6 p.m., 10% between 6 p.m. and 8 a.m. The applied doses for emergency RT ranged between 2 Gy and 8 Gy (median: 3.5 Gy). Time expense was reported with a median of 90 min. The outcome analysis based on the treatment results of 1 033 patients: There was an improvement of myelocompression in 50% of the cases, vena cava superior compression in 70%, bronchial obstruction in 70% and bleedings in 80%. A clear dose-response relationship could not be established, but single doses of over 3 Gy in vena cava superior syndrome exhibited a significant advantage. This study represents the largest database in literature on emergency RT. RT was shown to be fast, time sparing and a very effective treatment option for special oncological emergencies
Ahsan, Dewan; Roth, Eva
The aim of this exploratory study is to provide empirical insight into how the mussel farmers perceive and manage risks. The results show that future price and demand of mussel are the high ranked perceived risk. Bad weather, oxygen depletion, harmful algal blooms, E-coli, change in governmental...... regulation and public view towards mussel culture are also considered important risk factors in mussel farming. On the other hand, produced at lowest possible cost, cooperative marketing, good relation with government, prioritize liquidity, adopt new technology and experience sharing are perceived most...
Madhupratap, M.; Achuthankutty, C.T.; Nair
, were responsible for this. Unsealed traps were found subject to contamination and hence less reliable in estimating densities of emerging fauna compared with sealed traps. Direct sampling of the substratum during daytime showed that the actual densities...
Christensen, Erika Frischknecht; Bendtsen, Mette Dahl; Larsen, Thomas Mulvad
) to allow comparison by year, with 2007 as reference year. RESULTS: The annual number of emergency ambulance service patients increased from 24.3 in 2007 to 40.2 in 2014 per 1000 inhabitants. The proportions of women increased from 43.1% to 46.4% and of patients aged 60+ years from 39.9% to 48......: Population-based cohort study with linkage of Danish national registries. SETTING: The North Denmark Region in 2007-2014. PARTICIPANTS: Cohort of 148 757 patients transported to hospital by ambulance after calling emergency services. MAIN OUTCOME MEASURES: The number of emergency ambulance service patients......, the incidence of emergency ambulance service patients, the proportion of women, elderly, and non-specific diagnoses increased. The level of comorbidity increased substantially, whereas the 1-day and 30-day mortality decreased....
Christensen, Erika Frischknecht; Bendtsen, Mette Dahl; Larsen, Thomas Mulvad
) to allow comparison by year, with 2007 as reference year. RESULTS: The annual number of emergency ambulance service patients increased from 24.3 in 2007 to 40.2 in 2014 per 1000 inhabitants. The proportions of women increased from 43.1% to 46.4% and of patients aged 60+ years from 39.9% to 48......: Population-based cohort study with linkage of Danish national registries. SETTING: The North Denmark Region in 2007-2014. PARTICIPANTS: Cohort of 148 757 patients transported to hospital by ambulance after calling emergency services. MAIN OUTCOME MEASURES: The number of emergency ambulance service patients......, the incidence of emergency ambulance service patients, the proportion of women, elderly, and non-specific diagnoses increased. The level of comorbidity increased substantially, whereas the 1-day and 30-day mortality decreased....
Bravi, Francesca; Edefonti, Valeria; Bosetti, Cristina; Talamini, Renato; Montella, Maurizio; Giacosa, Attilio; Franceschi, Silvia; Negri, Eva; Ferraroni, Monica; La Vecchia, Carlo; Decarli, Adriano
The role of diet on colorectal cancer has been considered in terms of single foods and nutrients, but less frequently in terms of dietary patterns. Data were derived from an Italian case-control study, including 1,225 subjects with cancer of the colon, 728 subjects with rectal cancer, and 4,154 hospital controls. We identified dietary patterns on a selected set of nutrients through principal component factor analysis. Odds ratios (OR) and 95% confidence intervals for both cancers were estimated using unconditional multiple logistic regression. We identified 5 major dietary patterns. Direct associations were observed between the Starch-rich pattern and both cancer of the colon (OR = 1.68) and of the rectum (OR = 1.74). Inverse relationships were found between the Vitamins and fiber pattern and rectal cancer (OR = 0.61), between the Unsaturated fats (animal source) and the Unsaturated fats (vegetable source) and cancer of the colon (OR = 0.80 and OR = 0.79, respectively). No other significant association was found. The Starch-rich pattern is potentially an unfavorable indicator of risk for both colon and rectal cancer, whereas the Vitamins and fiber pattern is associated with a reduced risk of rectal cancer and the Unsaturated fats patterns with a reduced risk of colon cancer.
Mikkilä, Vera; Räsänen, Leena; Raitakari, Olli T; Marniemi, Jukka; Pietinen, Pirjo; Rönnemaa, Tapani; Viikari, Jorma
Studies on the impact of single nutrients on the risk of CVD have often given inconclusive results. Recent research on dietary patterns has offered promising information on the effects of diet as a whole on the risk of CVD. The Cardiovascular Risk in Young Finns Study is an ongoing, prospective cohort study with a 21-year follow-up to date. The subjects were children and adolescents at baseline (3-18 years, n 1768) and adults at the latest follow-up study (24-39 years, n 1037). We investigated the associations between two major dietary patterns and several risk factors for CVD. In longitudinal analyses with repeated measurements, using multivariate mixed linear regression models, the traditional dietary pattern (characterised by high consumption of rye, potatoes, butter, sausages, milk and coffee) was independently associated with total and LDL cholesterol concentrations, apolipoprotein B and C-reactive protein concentrations among both genders, and also with systolic blood pressure and insulin levels among women and concentrations of homocysteine among men (P health-conscious food choices (such as high consumption of vegetables, legumes and nuts, tea, rye, cheese and other dairy products, and alcoholic beverages) was inversely, but less strongly associated with cardiovascular risk factors. Our results support earlier findings that dietary patterns have a role in the development of CVD.
Seow, E; Wong, H; Phe, A
Methods—All (13 697) ambulance arrivals in 1996 to the ED of Tan Tock Seng Hospital were studied and where relevant compared with the walk in and total arrivals of the same year. The following data were obtained from computer records: (a) patients' demographic data; (b) number of ambulance arrivals by hour; (c) the classification of the ambulance arrivals by emergency or non-emergency, trauma or non-trauma; (d) cause of injury for trauma cases; (e) discharge status.
Franken, T.; Boldt, I.
A retrospective study of the mammograms of 11,020 womens was carried out; amongst these, 490 had carcinomas, including 51 so-called interval carcinomas. An attempt was made to test the suggestion advanced by Wolfe that certain dense types of parenchymal pattern on the mammogram are associated with a significantly increased carcinoma risk. We were unable to confirm Wolfe's suggestion. There is a slightly higher risk for pattern P2-DY, which cannot be used as the basis for future management of the patients. Attention is drawn to the risk of missing many carcinomas of the breast, if the suggestions made by Wolfe are followed.
Miller, Paige E; Lazarus, Philip; Lesko, Samuel M; Muscat, Joshua E; Harper, Gregory; Cross, Amanda J; Sinha, Rashmi; Ryczak, Karen; Escobar, Gladys; Mauger, David T; Hartman, Terryl J
Previous studies have derived patterns by measuring compliance with preestablished dietary guidance or empirical methods, such as principal components analysis (PCA). Our objective was to examine colorectal cancer risk associated with patterns identified by both methods. The study included 431 incident colorectal cancer cases (225 men, 206 women) and 726 healthy controls (330 men, 396 women) participating in a population-based, case-control study. PCA identified sex-specific dietary patterns and the Healthy Eating Index-2005 (HEI-05) assessed adherence to the 2005 Dietary Guidelines for Americans. A fruits and vegetables pattern and a meat, potatoes, and refined grains pattern were identified among men and women; a third pattern (alcohol and sweetened beverages) was identified in men. The fruits and vegetables pattern was inversely associated with risk among men [odds ratio (OR) = 0.38, 95% CI = 0.21-0.69 for the highest compared with the lowest quartile] and women (OR = 0.35, 95% CI = 0.19-0.65). The meat, potatoes, and refined grains pattern was positively associated with risk in women (OR = 2.20, 95% CI = 1.08-4.50) and there was a suggestion of a positive association among men (OR = 1.56, 95% CI = 0.84-2.90; P-trend = 0.070). Men and women with greater HEI-05 scores had a significantly reduced risk of colorectal cancer (OR = 0.56, 95% CI = 0.31-0.99; OR = 0.44, 95% CI = 0.24-0.77, respectively). Following the Dietary Guidelines or a dietary pattern lower in meat, potatoes, high fat, and refined foods and higher in fruits and vegetables may reduce colorectal cancer risk.
Conclusions: In the absence of accurate risk scoring tools that can be used on admission to hospital it is not possible to reliably audit the achievement of national standards of care for the ‘high-risk’ patient.
Makambi, Kepher H; Agurs-Collins, Tanya; Bright-Gbebry, Mireille; Rosenberg, Lynn; Palmer, Julie R; Adams-Campbell, Lucile L
Colorectal adenomas are benign lesions that may be precursors to colorectal cancer. No studies of African American women have investigated dietary patterns and the risk of developing colorectal adenomas. We examined data from the Black Women's Health Study to determine whether dietary patterns are associated with the risk of developing colorectal adenomas. This is a prospective cohort study of 59,000 participants followed biennially since 1995. During 155,414 person-years of follow-up from 1997 to 2007 among women who had had at least one screening colonoscopy, 620 incident cases of colorectal adenomas were identified. By using Cox regression models, we obtained incidence rate ratios (IRR) for colorectal adenoma in relation to quintiles of each of two dietary patterns, adjusting for other colorectal adenoma risk factors. Two dietary patterns, Western and prudent, were utilized to assess the association between dietary intake and adenoma risk. The highest quintile of prudent diet, relative to the lowest quintile, was significantly associated with 34% lower colorectal adenoma risk overall (IRR = 0.66; 95% CI, 0.50-0.88; P(trend) pattern were associated with a higher risk of developing colorectal adenoma (IRR = 1.42; 95% CI, 1.09-1.85 for the highest quintile relative to the lowest; P(trend) = 0.01). Our findings suggest that African American women may be able to reduce their risk of developing colorectal adenomas by following a prudent dietary pattern and avoiding a more Western pattern. A dietary modification could have a strong impact in colorectal adenoma prevention in African American women. ©2011 AACR.
Terry, P; Hu, F B; Hansen, H; Wolk, A
A number of prospective cohort studies have examined the relations of individual dietary variables to risk of colorectal cancer. Few studies have addressed the broader eating patterns that reflect many dietary exposures working together. Using data from a prospective study of 61,463 women, with an average follow-up period of 9.6 years (between 1987 and 1998) and 460 incident cases of colorectal cancer, the authors conducted a factor analysis to identify and examine major dietary patterns in relation to colorectal cancer risk. Using proportional hazards regression to estimate relative risks, the authors found no clear association between a "Western," "healthy," or "drinker" dietary pattern and colorectal cancer risk. However, the data suggested that consuming low amounts of foods that constitute a "healthy" dietary pattern may be associated with increased risks of colon and rectal cancers. An inverse association with the "healthy" dietary pattern was found among women under age 50 years, although the number of cancers in this age group was limited and interpretation of this finding should be cautious. In this age group, relative risks for women in increasing quintiles of the "healthy" dietary pattern, compared with the lowest quintile, were 0.74 (95% confidence interval (CI): 0.41, 1.31), 0.69 (95% CI: 0.39, 1.24), 0.59 (95% CI: 0.32, 1.07), and 0.45 (95% CI: 0.23, 0.88) (p for trend = 0.03). The role of overall eating patterns in predicting colorectal cancer risk requires further investigation.
Quadrel, M.J.; Fowler, K.M.; Cameron, R.; Treat, R.J.; McCormack, W.D.; Cruse, J.
The risk-based systems analysis model was designed to establish funding priorities among competing technologies for tank waste remediation. The model addresses a gap in the Department of Energy's (DOE's) ''toolkit'' for establishing funding priorities among emerging technologies by providing disciplined risk and cost assessments of candidate technologies within the context of a complete remediation system. The model is comprised of a risk and cost assessment and a decision interface. The former assesses the potential reductions in risk and cost offered by new technology relative to the baseline risk and cost of an entire system. The latter places this critical information in context of other values articulated by decision makers and stakeholders in the DOE system. The risk assessment portion of the model is demonstrated for two candidate technologies for tank waste retrieval (arm-based mechanical retrieval -- the ''long reach arm'') and subsurface barriers (close-coupled chemical barriers). Relative changes from the base case in cost and risk are presented for these two technologies to illustrate how the model works. The model and associated software build on previous work performed for DOE's Office of Technology Development and the former Underground Storage Tank Integrated Demonstration, and complement a decision making tool presented at Waste Management 1994 for integrating technical judgements and non-technical (stakeholder) values when making technology funding decisions
... The Marfan Foundation Marfan & Related Disorders What is Marfan Syndrome? What are Related Disorders? What are the Signs? ... Emergencies Eye Emergencies Lung Emergencies Surgeries Eye Emergencies Marfan syndrome significantly increases your risk of retinal detachment, a ...
In Europe, employers of all private and public enterprises have a legal obligation to protect their employers by all the different types of workplace hazards to the safety and health of workers. The most important methods developed for the work-related stress risk assessment are based on the Cox's research commissioned by European Agency for Safety and Health at Work (EU-OSHA) and are the Management Standard HSE for work-related stress in United Kingdom, the START method in Germany, the Screening, Observation, Analysis, Expertise (SOBANE) in Belgium, and the National Institute for Prevention and Safety at Work (INAIL-ISPESL) model in Italy, the latter based on the British Management Standard. Unfortunately, the definition of "work-related stress" elaborated by EU-OSHA was criticized, because it is not completely equal to the broader "psychosocial risk," which includes new and emerging psychosocial risk factors, such as the combined exposure to physical and psychosocial risks, job insecurity, work intensification and high demands at work, high emotional load related to burnout, work-life balance problems, and violence and harassment at work. All these new emerging psychosocial hazards could require different and additional methodologies to save workers' health and safety. For this reason, the concept that stakeholders and policy makers should keep in mind in order to develop better national regulations and strategies is that work-related stress risk and psychosocial risk factors are not the same.
Genske, Anna; Engel-Glatter, Sabrina
Recent progress in synthetic biology (SynBio) has enabled the development of novel therapeutic opportunities for the treatment of human disease. In the near future, first-in-human trials (FIH) will be indicated. FIH trials mark a key milestone in the translation of medical SynBio applications into clinical practice. Fostered by uncertainty of possible adverse events for trial participants, a variety of ethical concerns emerge with regards to SynBio FIH trials, including 'risk' minimization. These concerns are associated with any FIH trial, however, due to the novelty of the approach, they become more pronounced for medical applications of emerging technologies (emTech) like SynBio. To minimize potential harm for trial participants, scholars, guidelines, regulations and policy makers alike suggest using 'risk assessment' as evaluation tool for such trials. Conversely, in the context of emTech FIH trials, we believe it to be at least questionable to contextualize uncertainty of potential adverse events as 'risk' and apply traditional risk assessment methods. Hence, this issue needs to be discussed to enable alterations of the evaluation process before the translational phase of SynBio applications begins. In this paper, we will take the opportunity to start the debate and highlight how a misunderstanding of the concept of risk, and the possibilities and limitations of risk assessment, respectively, might impair decision-making by the relevant regulatory authorities and research ethics committees, and discuss possible solutions to tackle the issue.
Evans, J. D.; Hao, W.; Chettri, S. R.
Disaster risk management has grown to rely on earth observations, multi-source data analysis, numerical modeling, and interagency information sharing. The practice and outcomes of disaster risk management will likely undergo further change as several emerging earth science technologies come of age: mobile devices; location-based services; ubiquitous sensors; drones; small satellites; satellite direct readout; Big Data analytics; cloud computing; Web services for predictive modeling, semantic reconciliation, and collaboration; and many others. Integrating these new technologies well requires developing and adapting them to meet current needs; but also rethinking current practice to draw on new capabilities to reach additional objectives. This requires a holistic view of the disaster risk management enterprise and of the analytical or operational capabilities afforded by these technologies. One helpful tool for this assessment, the GEOSS Architecture for the Use of Remote Sensing Products in Disaster Management and Risk Assessment (Evans & Moe, 2013), considers all phases of the disaster risk management lifecycle for a comprehensive set of natural hazard types, and outlines common clusters of activities and their use of information and computation resources. We are using these architectural views, together with insights from current practice, to highlight effective, interrelated roles for emerging earth science technologies in disaster risk management. These roles may be helpful in creating roadmaps for research and development investment at national and international levels.
Oltmanns, J; Licht, O; Bitsch, A; Bohlen, M-L; Escher, S E; Silano, V; MacLeod, M; Serafimova, R; Kass, G E N; Merten, C
The European Food Safety Authority (EFSA) is responsible for risk assessment of all aspects of food safety, including the establishment of procedures aimed at the identification of emerging risks to food safety. Here, a scoring system was developed for identifying chemicals registered under the European REACH Regulation that could be of potential concern in the food chain using the following parameters: (i) environmental release based on maximum aggregated tonnages and environmental release categories; (ii) biodegradation in the environment; (iii) bioaccumulation and in vivo and in vitro toxicity. The screening approach was tested on 100 data-rich chemicals registered under the REACH Regulation at aggregated volumes of at least 1000 tonnes per annum. The results show that substance-specific data generated under the REACH Regulation can be used to identify potential emerging risks in the food chain. After application of the screening procedure, priority chemicals can be identified as potentially emerging risk chemicals through the integration of exposure, environmental fate and toxicity. The default approach is to generate a single total score for each substance using a predefined weighting scenario. However, it is also possible to use a pivot table approach to combine the individual scores in different ways that reflect user-defined priorities, which enables a very flexible, iterative definition of screening criteria. Possible applications of the approaches are discussed using illustrative examples. Either approach can then be followed by in-depth evaluation of priority substances to ensure the identification of substances that present a real emerging chemical risk in the food chain.
Tyler R Bonnell
Full Text Available The foraging activity of many organisms reveal strategic movement patterns, showing efficient use of spatially distributed resources. The underlying mechanisms behind these movement patterns, such as the use of spatial memory, are topics of considerable debate. To augment existing evidence of spatial memory use in primates, we generated movement patterns from simulated primate agents with simple sensory and behavioral capabilities. We developed agents representing various hypotheses of memory use, and compared the movement patterns of simulated groups to those of an observed group of red colobus monkeys (Procolobus rufomitratus, testing for: the effects of memory type (Euclidian or landmark based, amount of memory retention, and the effects of social rules in making foraging choices at the scale of the group (independent or leader led. Our results indicate that red colobus movement patterns fit best with simulated groups that have landmark based memory and a follow the leader foraging strategy. Comparisons between simulated agents revealed that social rules had the greatest impact on a group's step length, whereas the type of memory had the highest impact on a group's path tortuosity and cohesion. Using simulation studies as experimental trials to test theories of spatial memory use allows the development of insight into the behavioral mechanisms behind animal movement, developing case-specific results, as well as general results informing how changes to perception and behavior influence movement patterns.
Sala, Evis; Warren, Ruth; McCann, Jenny; Duffy, Stephen; Luben, Robert; Day, Nicholas
Current smoking was strongly and inversely associated with high-risk patterns, after adjustment for concomitant risk factors. Relative to never smokers, current smokers were significantly less likely to have a high-risk pattern. Similar results were obtained when the analysis was confined to postmenopausal women. Past smoking was not related to the mammographic parenchymal patterns. The overall effect in postmenopausal women lost its significance when adjusted for other risk factors for P2/DY patterns that were found to be significant in the present study, although the results are still strongly suggestive. The present data indicate that adjustment for current smoking status is important when evaluating the relationship between mammographic parenchymal pattern and breast cancer risk. They also indicate that smoking is a prominent potential confounder when analyzing effects of other risk factors such as obesity-related variables. It appears that parenchymal patterns may act as an informative biomarker of the effect of cigarette smoking on breast cancer risk. Overall, epidemiological studies [1,2,3,4] have reported no substantial association between cigarette smoking and the risk of breast cancer. Some studies [5,6,7] reported a significant increase of breast cancer risk among smokers. In recent studies that addressed the association between breast cancer and cigarette smoking, however, there was some suggestion of a decreased risk [8,9,10], especially among current smokers, ranging from approximately 10 to 30% [9,10]. Brunet et al  reported that smoking might reduce the risk of breast cancer by 44% in carriers of BRCA1 or BRCA2 gene mutations. Wolfe  described four different mammographic patterns created by variations in the relative amounts of fat, epithelial and connective tissue in the breast, designated N1, P1, P2 and DY. Women with either P2 or DY pattern are considered at greater risk for breast cancer than those with N1 or P1 pattern [12
Koenderink, N.J.J.P.; Kreft, F.
This report is the result of the workshop “Emerging risks and early warning system” held in Wageningen, the Netherlands on October the 19th 2006. The workshop is part of the project “Emerging risks in Dutch food chains”. The purpose of this project is to develop a procedure to identify potential
Park, Yoon; Lee, Jeonghee; Oh, Jae Hwan; Shin, Aesun; Kim, Jeongseon
Colorectal cancer (CRC) has been recognized as one of the major malignancies in Korea. Analyses of dietary patterns can provide insight into the complex interactions of foods, nutrients, and biologically active components within a diet, which vary among populations. We aimed to investigate the associations between dietary patterns and colorectal cancer risk in Koreans. In a study of 923 cases and 1846 controls, principal component analysis was used to identify dietary patterns based on 33 predefined food groups using a 106-item semiquantitative food frequency questionnaire (SQFFQ). The associations between dietary patterns and CRC risk were assessed using binary and polytomous logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Three dietary patterns (traditional, Westernized, and prudent) were derived. The proportion of total variation explained by 3 patterns was 24.2% for men and 25.3% for women. The traditional and prudent patterns were inversely associated with CRC risk [OR and 95% CI for the highest intake tertile of pattern score vs. the lowest = 0.35 (0.27-0.46) and 0.37 (0.28-0.48), respectively], whereas the Westernized pattern showed a positive association, especially among women [OR = 2.13 (1.35-3.34) for the highest tertile vs. the lowest]. A decrease in CRC risk among those with the highest intake of the prudent pattern was observed in all anatomical subsites in both men [OR = 0.36 (0.19-0.68) for proximal colon; 0.21 (0.12-0.36) for distal colon; 0.28 (0.18-0.44) for rectum] and women [OR = 0.28 (0.11-0.71); 0.27 (0.13-0.54); 0.45 (0.25-0.83)]. Our results indicate that individuals who prefer the Westernized dietary pattern should be made aware of their increased CRC risk. The traditional dietary pattern and the prudent pattern, which are rich in fruits and dairy products, are recommended for the Korean population to prevent CRC.
Kim, Mi Kyung; Sasaki, Satoshi; Otani, Tetsuya; Tsugane, Shoichiro
In order to investigate the associations between dietary patterns and the risk of colorectal cancer by subsite in Japan, the baseline data from a population-based cohort study of 20,300 men and 21,812 women were analyzed. We conducted factor analysis and identified 3 major dietary patterns, "healthy," "traditional" and "Western," and calculated the factor scores of each pattern for individuals. During 10 years of follow-up, 370 colorectal cancer cases were identified. We found a positive association between the traditional pattern and colon cancer risk in women [rate ratio for highest quartile (RR) = 2.06; 95% CI = 1.10-3.84; p for trend = 0.11], but not in men. This positive association was slightly stronger for proximal colon cancer (RR = 2.07; 95% CI = 0.84-5.12) than for distal colon cancer (RR = 1.84; 95% CI = 0.75-4.50). After multivariate adjustment, the Western dietary pattern was also positively associated with colon cancer risk in females (RR = 2.21; 95% CI = 1.10-4.45), with the strongest associations being observed for females with distal colon cancer (RR = 3.48; 95% CI = 1.25-9.65). We did not observe any significant association between the healthy dietary pattern and colon cancer risk. For rectal cancer, no significant associations were found for the 3 dietary patterns. In conclusion, we found that the traditional and the Western dietary patterns were positively associated with colon cancer risk in females. (c) 2005 Wiley-Liss, Inc.
Dugee, Otgontuya; Khor, Geok Lin; Lye, Munn-Sann; Luvsannyam, Lhagva; Janchiv, Oyunbileg; Jamyan, Batjargal; Esa, Norhaizan
Mongolia is experiencing changes in its unique nomadic lifestyle and dietary habits in the last two decades with accompanying increase in obesity rate. The dietary pattern approach, which investigates the overall diet in relation to obesity risks, has become appealing in nutrition epidemiology. The aim of this study was to identify major dietary patterns of the Mongolian adults in relation to the risk of having obesity. Dietary intake of a total 418 adults aged ? 25 years was assessed by using a food frequency questionnaire with 68 items. An exploratory factor analysis resulted in three dietary patterns: transitional high in processed meat and potato, traditional rich in whole milk, fats and oils and healthy with greater intake of whole grains, mixed vegetables and fruits. Individuals in the upper quintile of the transitional pattern had significantly greater risk of obesity (BMI > or =25 kg/m2: OR=2.47; 95% CI=1.04-5.86) while subjects in the highest quintile of the healthy dietary pattern were found to have significantly decreased risk of obesity (OR: 0.49; 95% CI=0.25-0.95). Men in the highest quintile of the transitional pattern had greater risk of abdominal obesity WC > or =90 cm: OR= 4.08; 95% CI=1.11-14.97) than those in the lowest quintile. Women in the top quintile of the traditional pattern had a greater odds of having abdominal obesity (WC > or =80 cm: OR=4.59; 95% CI=1.58-13.30) than those in the lowest quintile. The study suggests that public health efforts be targeted at adults in Mongolia to address the undesirable aspects of the transitional and the traditional dietary patterns.
Yusof, Afzaninawati Suria; Isa, Zaleha Md; Shah, Shamsul Azhar
This systematic review of cohort studies aimed to identify any association between specific dietary patterns and risk of colorectal cancer (CRC). Dietary patterns involve complex interactions of food and nutrients summarizing the total diet or key aspects of the diet for a population under study. This review involves 6 cohort studies of dietary patterns and their association with colorectal cancer. An exploratory or a posteriori approach and a hypothesis-oriented or a priori approach were employed to identify dietary patterns. The dietary pattern identified to be protective against CRC was healthy, prudent, fruits and vegetables, fat reduced/diet foods, vegetables/fish/poultry, fruit/wholegrain/dairy, healthy eating index 2005, alternate healthy eating index, Mediterranean score and recommended food score. An elevated risk of CRC was associated with Western diet, pork processed meat, potatoes, traditional meat eating, and refined grain pattern. The Western dietary pattern which mainly consists of red and processed meat and refined grains is associated with an elevated risk of development of CRC. Protective factors against CRC include a healthy or prudent diet, consisting of vegetables, fruits, fish and poultry.
Harris, Holly R; Bergkvist, Leif; Wolk, Alicja
High endogenous hormone levels have been associated with breast cancer and dietary factors have the potential to influence breast cancer risk through effects on hormone levels. Dietary patterns derived from reduced rank regression provide a way to identify food groups correlated with hormones and subsequently examine food patterns that may be associated with breast cancer risk. We investigated whether a dietary pattern previously correlated with estradiol and estrone sulfate was associated with breast cancer in the prospective Swedish Mammography Cohort. Among 37,004 primarily postmenopausal women diet was assessed with a food frequency questionnaire. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs). During 15 years of follow-up 1,603 cases of breast cancer were identified. A higher estrogen dietary pattern score was associated with an increased risk of breast cancer. Women in the highest quartile of estrogen pattern score had a 29% (95% CI = 1.08-1.55) increased risk of breast cancer compared to women in the lowest quartile (p(trend) = 0.006). When the association was examined by estrogen-receptor status, it was only significant for those with estrogen-receptor-positive tumors; however, in the competing risk analysis there were no significant differences in the effect estimates by receptor subtype (p(heterogeneity) = 0.65). Our findings suggest that a dietary pattern associated with higher estrogen levels may increase breast cancer risk. However, whether the influence of this dietary pattern is through a direct effect on estrogen levels deserves further study. © 2015 UICC.
Cheong, Chang Heon; Lee, Seonhye
The prevention of airborne infections in emergency departments is a very important issue. This study investigated the effects of architectural features on airborne pathogen dispersion in emergency departments by using a CFD (computational fluid dynamics) simulation tool. The study included three architectural features as the major variables: increased ventilation rate, inlet and outlet diffuser positions, and partitions between beds. The most effective method for preventing pathogen dispersion and reducing the pathogen concentration was found to be increasing the ventilation rate. Installing partitions between the beds and changing the ventilation system's inlet and outlet diffuser positions contributed only minimally to reducing the concentration of airborne pathogens.
Wade, Jeannette M
Previous research has demonstrated that frequent consumption of fast food is linked to obesity and that trends in both are disparate across race and sex categories. Contextualizing race- and sex-related factors that structure fast food consumption in emerging adulthood is a much-needed contribution to social research. Specifically, this study uses the "doing difference" framework, to examine the frequency of fast food consumption in a sample of White and African American (18-25 years old). According to the framework, social inequalities are reproduced through dramaturgical performances of race, class, and gender. Results of this suggest that feminine gender orientation and education serve as protective factors, while African American race and male sex serve as risk factors. African American women emerged as especially high risk given their higher prevalence of traditionally masculine traits.
Nakahara, Kiyoshi; Adachi, Ken; Kawasaki, Keisuke; Matsuo, Takeshi; Sawahata, Hirohito; Majima, Kei; Takeda, Masaki; Sugiyama, Sayaka; Nakata, Ryota; Iijima, Atsuhiko; Tanigawa, Hisashi; Suzuki, Takafumi; Kamitani, Yukiyasu; Hasegawa, Isao
Highly localized neuronal spikes in primate temporal cortex can encode associative memory; however, whether memory formation involves area-wide reorganization of ensemble activity, which often accompanies rhythmicity, or just local microcircuit-level plasticity, remains elusive. Using high-density electrocorticography, we capture local-field potentials spanning the monkey temporal lobes, and show that the visual pair-association (PA) memory is encoded in spatial patterns of theta activity in areas TE, 36, and, partially, in the parahippocampal cortex, but not in the entorhinal cortex. The theta patterns elicited by learned paired associates are distinct between pairs, but similar within pairs. This pattern similarity, emerging through novel PA learning, allows a machine-learning decoder trained on theta patterns elicited by a particular visual item to correctly predict the identity of those elicited by its paired associate. Our results suggest that the formation and sharing of widespread cortical theta patterns via learning-induced reorganization are involved in the mechanisms of associative memory representation.
Ulutasdemir, Nilgun; Cirpan, Metin; Copur, Ebru Ozturk; Tanir, Ferdi
Health services are one of the work areas that contain important risks in terms of the occupational health and safety of the laborer. Professionals in various areas of health services encounter biological, chemical, physical, ergonomic, and psychosocial risks, particularly in hospitals. This study has been performed to evaluate the impacts of the occupational risks on health of health professionals in Turkey. In Turkey, as an emerging economy, the history of studies on health professionals is not longstanding. There have been various regulations intended for the occupational health and safety of health professionals in line with the Regulation of the Provision on Patient and Staff Safety prepared in 2012. However, applications can differ from region to region, institution to institution, and person to person. We believe that this review will lead health professionals to be aware of occupational risks and contribute to planning health services for health professionals. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.
Jespersen, Cecilie; Hegaard, Hanne Kristine; Schroll, Anne-Mette
OBJECTIVE: To assess the association between fear of childbirth (FOC) and emergency caesarean section. DESIGN: A prospective cohort study of low-risk nulliparous women at term. SETTING: Nine obstetric departments in Denmark, May 2004-July 2005. POPULATION: A total of 2598 nulliparous women...... in spontaneous labor with a single fetus in cephalic presentation at term. METHODS: Self-reported FOC was assessed at 37 weeks of gestation by the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) version A and at admission to the labor ward by the Delivery Fear Scale (DFS). Mode of delivery...... was recorded by the attending staff. Logistic regression analyses were used to estimate unadjusted and adjusted odds ratios (OR). MAIN OUTCOME MEASURES: Risk of emergency caesarean section in women who feared childbirth. RESULTS: FOC (W-DEQ sum score ≥ 85 and DFS sum score ≥ 70) was not associated...
Kiely, Philip; Gambhir, Manoj; Cheng, Allen C; McQuilten, Zoe K; Seed, Clive R; Wood, Erica M
While the transfusion-transmission (TT) risk associated with the major transfusion-relevant viruses such as HIV is now very low, during the last 20 years there has been a growing awareness of the threat to blood safety from emerging infectious diseases, a number of which are known to be, or are potentially, transfusion transmissible. Two published models for estimating the transfusion-transmission risk from EIDs, referred to as the Biggerstaff-Petersen model and the European Upfront Risk Assessment Tool (EUFRAT), respectively, have been applied to several EIDs in outbreak situations. We describe and compare the methodological principles of both models, highlighting their similarities and differences. We also discuss the appropriateness of comparing results from the two models. Quantitating the TT risk of EIDs can inform decisions about risk mitigation strategies and their cost-effectiveness. Finally, we present a qualitative risk assessment for Zika virus (ZIKV), an EID agent that has caused several outbreaks since 2007. In the latest and largest ever outbreak, several probable cases of transfusion-transmission ZIKV have been reported, indicating that it is transfusion-transmissible and therefore a risk to blood safety. We discuss why quantitative modeling the TT risk of ZIKV is currently problematic. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.
Mutsvairo, Bruce; Columbus, Simon
While it has generally been accepted that non-professional media actors empowered by novel digitally networked technologies are changing the media landscape in the West, this is less obvi- ous in the case of sub-Saharan Africa. Recent years, however, have seen the emergence of a diverse range of
Sorensen, J.H.; Dombrowsky, W.R.
Enhancing crisis communication is important to industry, government and the public. The public is becoming increasingly concerned about technological failures as our reliance on technology increases. Better preparedness and more public awareness can increase public acceptance of and confidence in ability to manage high consequence technologies including ability to manage its failures. Failed communications in emergencies has increased the loss of life and property and public scepticism. Effective communication can a) engender confidence and trust in authorities; b) give rise of acceptance of risks and risk management and c) reduce the consequences of disasters. (orig./HSCH)
VICTOR, ELIZABETH C.; HARIRI, AHMAD R.
Late adolescence and emerging adulthood (specifically ages 15–24) represent a period of heightened sexual risk taking resulting in the greatest annual rates of sexually transmitted infections and unplanned pregnancies in the US population. Ongoing efforts to prevent such negative consequences are likely to benefit from a deepening of our understanding of biological mechanisms through which sexual risk taking emerges and biases decision making during this critical window. Here we present a neuroscience framework from which a mechanistic examination of sexual risk taking can be advanced. Specifically, we adapt the neurodevelopmental triadic model, which outlines how motivated behavior is governed by three systems: approach, avoidance, and regulation, to sexual decision making and subsequent risk behavior. We further propose a testable hypothesis of the triadic model, wherein relatively decreased threat-related amygdala reactivity and increased reward-related ventral striatum reactivity leads to sexual risk taking, which is particularly exaggerated during adolescence and young adulthood when there is an overexpression of dopaminergic neurons coupled with immature top-down prefrontal cortex regulation. We conclude by discussing how future research based on our adapted triadic model can inform ongoing efforts to improve intervention and prevention efforts. PMID:26611719
Vidot, Denise C.; Prado, Guillermo; Hlaing, WayWay M.; Arheart, Kristopher L.; Messiah, Sarah E.
Current marijuana use rates are the highest in the past decade and not likely to decrease given the legalization of marijuana for medicinal and/or recreational use. Concurrently, the nation is facing epidemic levels of obesity, cardiovascular disease and diabetes but little is known about the intersecting relationships of marijuana use and cardiometabolic health. The objective of this study was to explore emerging issues in context to the intersection of cardiometabolic risk and marijuana use...
Omar M. Alabbasi
Full Text Available Background: Data are required on ophthalmic cases that present to the emergency eye clinics in Madinah, Saudi Arabia for proper allocation of healthcare resources. Objectives: To determine the frequency and various diagnoses of patients presenting to the A&E at Ohud Hospital, Madinah, Saudi Arabia. Methods: Data was collected prospectively for all patients who presented to the A&E ophthalmology clinic from June 2014 to September 2014. The data was analyzed and presented using frequency of incidence and percentages. Chi-square tests were used to evaluate the diagnoses based on age, sex and nationality. PÂ â¤Â 0.05 indicated statistical significance. Results: The study sample included 868 patients. The male-to-female ratio was 1.1:1.0. The main age categories included patients â¥45Â years of age (256 patients and 251 patients between the ages of 15â30Â years. Various types of Conjunctivitis was the most common diagnosis, reported in 282 patients (32.5%, and followed by dry eye syndrome in 156 (18% patients. Nasolacrimal duct obstruction in 156 patients (18%. Eyelid infections were detected in 102 patients (12%, corneal abrasion in 102 patients (9.3%. Various eye traumas was diagnosed in 30 patients (3.5%, increased intraocular pressure (IOP in 17 patients (2%, ruptured globe in 2 patients (0.2% and various other non-emergency pathologies in the remaining eyes. There were no significant differences in patientâs characteristics and categories of diagnoses. Conclusion: Non-emergent ophthalmic cases were the most common reason for the ophthalmology emergency room visits. It was observed that most cases could be referred to outpatient departments and potentially be managed by primary healthcare providers. This would be more cost effective and will also allow for better management of vision threatening ocular emergencies.
Full Text Available Background. Selection of empiric antibiotics for urinary tract infections (UTIs has become more challenging because of the increasing rates of multidrug-resistant Enterobacteriaceae (MDRE infections. Methods. This retrospective study was conducted to determine antibiotic resistance patterns, risk factors, and appropriate empiric antibiotic selection for MDRE UTIs. Adult patients seen in the Emergency Department (ED with Enterobacteriaceae UTIs during 2008-2009 were identified from review of microbiology records. MDRE were defined as organisms resistant to at least 3 categories of antibiotics. Results. There were 431 eligible patients; 83 (19% had MDRE UTIs. Resistance rates for individual antibiotics among MDRE UTIs were significantly greater than non-MDRE UTIs: levofloxacin, 72% versus 14%; TMP-SMX, 77% versus 12%; amoxicillin-clavulanate, 35% versus 4%; nitrofurantoin, 21% versus 12%, and ceftriaxone, 20% versus 0%. All Enterobacteriaceae isolates were susceptible to ertapenem (MIC ≤ 2 mg/L. Independent risk factors for MDRE UTI were prior fluoroquinolone use within 3 months (adjusted odds ratio (aOR 3.64; , healthcare-associated risks (aOR 2.32; , and obstructive uropathy (aOR 2.22; . Conclusion. Our study suggests that once-daily intravenous or intramuscular ertapenem may be appropriate for outpatient treatment of ED patients with MDRE UTI.
Kirk, Megan; VanDenKerkhof, Elizabeth; Janssen, Ian; Tranmer, Joan
This study explored the associations between work patterns and indicators of cardiometabolic risk in female hospital employees. Aspects of work environments potentially influence the health of employees; however, we have a poor understanding of how different hospital work patterns contribute to cardiovascular risk in female employees. We conducted a cross-sectional study of 466 female employees from 2 hospitals in Ontario. Data were collected through self-report, physical examination, and use of hospital administrative work data. In the adjusted analyses, full-time work status, extended shift length, and working 35 or more paid overtime hours per year were significantly associated with metabolic syndrome. Different work patterns increase cardiometabolic risk in female employees, suggesting a need to better monitor the health of the workforce and implement healthy workplace policy.
Obermeier, O.P. [Gerling Akademie fuer Risikoforschung AG, Muenchen (Germany)]|[Gerling Akademie fuer Risikoforschung AG, Zurich (Switzerland)]|[Augsburg Univ. (Germany)
The philosophically coloured paper on the aspects of risk communication patterns in society shows that debates about risks are governed by a number of stereotype characters representing the individualist and manager type, bureaucracy and law-and-order type, ego-centered embarrassment activist, and fundamentalist. Every risk-relevant group in the study tries to push forward its own interests. Risk communication is understood as a process of social dealing. (HP) [Deutsch] Die nahezu philosophischen Ueberlegungen zum Thema Risiko belegen, dass alle Risikodiskussionen von den Besitzindividualisten, Buerokraten, Betroffenheitsaktivisten und Fundamentalisten dominiert werden. Jede risikorelevante Gruppierung versucht ihre Gruppenegoismen durchzusetzen. Risikokommunikation wird als Prozess des sozialen Aushandelns aufgefasst. (HP)
Wu, Tong; Perrings, Charles; Kinzig, Ann; Collins, James P; Minteer, Ben A; Daszak, Peter
Three interrelated world trends may be exacerbating emerging zoonotic risks: income growth, urbanization, and globalization. Income growth is associated with rising animal protein consumption in developing countries, which increases the conversion of wild lands to livestock production, and hence the probability of zoonotic emergence. Urbanization implies the greater concentration and connectedness of people, which increases the speed at which new infections are spread. Globalization-the closer integration of the world economy-has facilitated pathogen spread among countries through the growth of trade and travel. High-risk areas for the emergence and spread of infectious disease are where these three trends intersect with predisposing socioecological conditions including the presence of wild disease reservoirs, agricultural practices that increase contact between wildlife and livestock, and cultural practices that increase contact between humans, wildlife, and livestock. Such an intersection occurs in China, which has been a "cradle" of zoonoses from the Black Death to avian influenza and SARS. Disease management in China is thus critical to the mitigation of global zoonotic risks.
Rafael Silva Marconato
Full Text Available ABSTRACT Objective: to check the association of the proposed priorities of the institutional protocol of risk classification with the outcomes and evaluate the profile of the care provided in an emergency unit. Method: observational epidemiological study based on data from the computerized files of a Reference Emergency Unit. Care provided to adults was evaluated regarding risk classification and outcomes (death, hospitalization and hospital discharge based on the information recorded in the emergency bulletin. Results: the mean age of the 97,099 registered patients was 43.4 years; 81.5% cases were spontaneous demand; 41.2% had been classified as green, 15.3% yellow, 3.7% blue, 3% red and 36.and 9% had not received a classification; 90.2% of the patients had been discharged, 9.4% hospitalized and 0.4% had died. Among patients who were discharged, 14.7% had been classified as yellow or red, 13.6% green or blue, and 1.8% as blue or green. Conclusion: the protocol of risk classification showed good sensitivity to predict serious situations that can progress to death or hospitalization.
Mogensen, Christian Backer; Christiansen, Maja; Jørgensen, Jess Bjerre; Staehr, Peter Bisgaard
Among patients with acute chest pain, acute coronary syndrome (ACS) is seen only in a minority of the patients, which raises the question, whether it is possible to separate a group with a high risk of ACS for admission to a cardiac care unit (CCU) from those with a low risk who would be treated at an emergency department (ED). The aim of this study was to describe a risk stratification model for a Danish context. This was a historic prospective cohort study of patients with suspicion of ACS. The patient was defined as a low-risk patient and admitted to the ED if: 1) electrocardiogram (ECG) was normal, 2) the patient did not have persisting chest pain and 3) there was no history of ischaemic heart disease, heart failure or cardioverter defibrillator. Otherwise, patients were admitted to the CCU. The primary outcome was whether the ACS diagnosis was confirmed or rejected. We included a total of 488 patients with suspicion of ACS, 50% of whom were low-risk patients. 17% had a verified ACS; 10% of those in the low-risk group and 24% of those in the high-risk group (p = 0.0001). Among the verified ACS cases, 71% went primarily to the CCU. The odds ratio for an ACS if assigned to the high-risk group was 3.0. Allocation to the high-risk group, male gender and age above 60 years was associated with a higher risk of ACS. For patients fulfilling the high-risk definition, sensitivity was 71%, specificity 55%, negative predictive value 90% and positive predictive value 24% for an ACS. The model for stratification separated patients into two equal groups, allocated 71% of all ACS directly to the CCU and could not be improved by any of the additional factors examined. Further development of referral strategies for chest pain patients is required. none. not relevant.
Full Text Available Background: Diet and nutrients play an important role in cancer development and progress; a healthy dietary pattern has been found to be associated with several types of cancer. However, the association between a healthy eating pattern and lung cancer risk is still unclear. Objective: Therefore, we conducted a systematic review with meta-analysis to evaluate whether a healthy eating pattern might reduce lung cancer risk. Methods: We identified relevant studies from the PubMed and Embase databases up to October 2015, and the relative risks were extracted and combined by the fixed-effects model when no substantial heterogeneity was observed; otherwise, the random-effects model was employed. Subgroup and publication bias analyses were also performed. Results: Finally, eight observational studies were included in the meta-analysis. The pooled relative risk of lung cancer for the highest vs. lowest category of healthy dietary pattern was 0.81 (95% confidence interval, CI: 0.75–0.86, and no significant heterogeneity was detected. The relative risks (RRs for non-smokers, former smokers and current smokers were 0.89 (95% CI: 0.63–1.27, 0.74 (95% CI: 0.62–0.89 and 0.86 (95% CI: 0.79–0.93, respectively. The results remained stable in subgroup analyses by other confounders and sensitivity analysis. Conclusions: The results of our meta-analysis suggest that a healthy dietary pattern is associated with a lower lung cancer risk, and they provide more beneficial evidence for changing the diet pattern in the general population.
Sun, Yanlai; Li, Zhenxiang; Li, Jianning; Li, Zengjun; Han, Jianjun
Diet and nutrients play an important role in cancer development and progress; a healthy dietary pattern has been found to be associated with several types of cancer. However, the association between a healthy eating pattern and lung cancer risk is still unclear. Therefore, we conducted a systematic review with meta-analysis to evaluate whether a healthy eating pattern might reduce lung cancer risk. We identified relevant studies from the PubMed and Embase databases up to October 2015, and the relative risks were extracted and combined by the fixed-effects model when no substantial heterogeneity was observed; otherwise, the random-effects model was employed. Subgroup and publication bias analyses were also performed. Finally, eight observational studies were included in the meta-analysis. The pooled relative risk of lung cancer for the highest vs. lowest category of healthy dietary pattern was 0.81 (95% confidence interval, CI: 0.75-0.86), and no significant heterogeneity was detected. The relative risks (RRs) for non-smokers, former smokers and current smokers were 0.89 (95% CI: 0.63-1.27), 0.74 (95% CI: 0.62-0.89) and 0.86 (95% CI: 0.79-0.93), respectively. The results remained stable in subgroup analyses by other confounders and sensitivity analysis. The results of our meta-analysis suggest that a healthy dietary pattern is associated with a lower lung cancer risk, and they provide more beneficial evidence for changing the diet pattern in the general population.
Full Text Available Introduction: The aim of the research was to investigate incidence, risk factors, and complications associated with emergency peripartum hysterectomy, the ultimate treatment method for intractable postpartum hemorrhage. Methods: This is a single center case-control study conducted in Chongqing city in central China from 1st January 2007 to 31st December 2012 for emergency peripartum hysterectomy performed as a treatment of postpartum hemorrhage both in caesarean and vaginal delivery cases. While the study group included emergency peripartum hysterectomy (n=61 due to intractable postpartum hemorrhage, the control group included no hysterectomy (n=333 during the same study period. Results: We found 61 cases recorded for emergency peripartum hysterectomy for intractable postpartum hemorrhage. Incidence of peripartum hysterectomy was 2.2 per 1000 deliveries. Emergency peripartum hysterectomy as treatment of intractable postpartum hemorrhage include the followings: (i blood loss 1000-2000 ml, crude odd ratio (OR =18.48 (95% CI 5.1-65.7, adjusted odd ratio (AOR = 9.1 (95% CI 2.2-37.7; (ii blood loss >2000 ml, OR = 152 (95% CI 43.7-528.4, AOR = 45.3 (95% CI 11.6-176.9; (iii previous caesarean section, OR = 5.5 (95% CI 2.9-9.7, AOR = 3.7(95% CI 1.4-9.9; (iv uterine atony, OR = 11.9 (95% CI 5.8-24.6, AOR = 7.5 (95% CI 1.8-30.2; (v placenta previa, OR = 2.04 (95% CI 1.1-3.5, AOR = none. Conclusions: Emergency peripartum hysterectomy is the last resort as treatment of intractable severe postpartum hemorrhage. Our study depicts that severe post partum hemorrhage, further dreaded complex events for emergency peripartum hysterectomy, has significant association with placental factors, previous caesarean section, and uterine atony. Pathologically, placenta accreta remained the most leading cause of hysterectomy. Keywords: caesarean section; hemorrhage; peripartum hysterectomy; placenta previa.
Lo, Yen-Li; Pan, Wen-Harn; Hsu, Wan-Lun; Chien, Yin-Chu; Chen, Jen-Yang; Hsu, Mow-Ming; Lou, Pei-Jen; Chen, I-How; Hildesheim, Allan; Chen, Chien-Jen
Evidence on the association between dietary component, dietary pattern and nasopharyngeal carcinoma (NPC) is scarce. A major challenge is the high degree of correlation among dietary constituents. We aimed to identify dietary pattern associated with NPC and to illustrate the dose-response relationship between the identified dietary pattern scores and the risk of NPC. Taking advantage of a matched NPC case-control study, data from a total of 319 incident cases and 319 matched controls were analyzed. Dietary pattern was derived employing partial least square discriminant analysis (PLS-DA) performed on energy-adjusted food frequencies derived from a 66-item food-frequency questionnaire. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated with multiple conditional logistic regression models, linking pattern scores and NPC risk. A high score of the PLS-DA derived pattern was characterized by high intakes of fruits, milk, fresh fish, vegetables, tea, and eggs ordered by loading values. We observed that one unit increase in the scores was associated with a significantly lower risk of NPC (ORadj = 0.73, 95% CI = 0.60-0.88) after controlling for potential confounders. Similar results were observed among Epstein-Barr virus seropositive subjects. An NPC protective diet is indicated with more phytonutrient-rich plant foods (fruits, vegetables), milk, other protein-rich foods (in particular fresh fish and eggs), and tea. This information may be used to design potential dietary regimen for NPC prevention.
Epstein, Mara M; Chang, Ellen T; Zhang, Yawei; Fung, Teresa T; Batista, Julie L; Ambinder, Richard F; Zheng, Tongzhang; Mueller, Nancy E; Birmann, Brenda M
Classic Hodgkin lymphoma (cHL) has few known modifiable risk factors, and the relationship between diet and cHL risk is unclear. We performed the first investigation of an association between dietary pattern and cHL risk in 435 cHL cases and 563 population-based controls from Massachusetts and Connecticut (1997-2000) who completed baseline diet questionnaires. We identified 4 major dietary patterns ("vegetable," "high meat," "fruit/low-fat dairy," "desserts/sweets") using principal components analysis. We computed multivariable odds ratios and 95% confidence intervals for associations of dietary pattern score (quartiles) with younger-adult (age dietary patterns were not clearly associated with cHL. We report the first evidence for a role of dietary pattern in cHL etiology. Diets featuring high intake of meat or desserts and sweets may increase cHL risk. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.
Link, Lilli B; Canchola, Alison J; Bernstein, Leslie; Clarke, Christina A; Stram, Daniel O; Ursin, Giske; Horn-Ross, Pamela L
Evidence that diet is associated with breast cancer risk is inconsistent. Most studies have examined risks associated with specific foods and nutrients, rather than measures of overall diet. This study aimed to evaluate dietary patterns and their relation to breast cancer risk in a large cohort of women. Data from 91,779 women in the California Teachers Study cohort were analyzed, including data from 4140 women with a diagnosis of invasive breast cancer made between 1995 and 2009. Five predominant dietary patterns were identified by using principal components factor analysis: a plant-based diet, high in fruit and vegetables; a high-protein, high-fat diet, high in meats, eggs, fried foods, and high-fat condiments; a high-carbohydrate diet, high in convenience foods, pasta, and bread products; an ethnic diet, high in legumes, soy-based foods, rice, and dark-green leafy vegetables; and a salad and wine diet, high in lettuce, fish, wine, low-fat salad dressing, and coffee and tea. The plant-based pattern was associated with a reduction in breast cancer risk (RR: 0.85; 95% CI: 0.76, 0.95 for the highest compared with the lowest consumption quintile; P-trend = 0.003); risk reduction was greater for estrogen receptor-negative progesterone receptor-negative (ER-PR-) tumors (RR: 0.66; 95% CI: 0.48, 0.91; P-trend = 0.03). The salad and wine pattern was associated with an increased risk of estrogen receptor-positive progesterone receptor-positive tumors (RR: 1.29; 95% CI: 1.12, 1.49); this effect was only slightly attenuated after adjustment for alcohol consumption. The finding that greater consumption of a plant-based dietary pattern is associated with a reduced breast cancer risk, particularly for ER-PR- tumors, offers a potential avenue for prevention.
He, Siran; Lunnen, Jeffrey C; Zia, Nukhba; Khan, Uzma; Shamim, Khusro; Hyder, Adnan A
Drowning is a heavy burden on the health systems of many countries, including Pakistan. To date, no effective large-scale surveillance has been in place to estimate rates of drowning and near-drowning in Pakistan. The Pakistan National Emergency Department Surveillance (Pak-NEDS) study aimed to fill this gap. Patients who presented with a complaint of "near-drowning" were analyzed to explore patterns of true near-drowning (unintentional) and intentional injuries that led to the "near-drowning" complaint. Bivariate analysis was done to establish patterns among patients treated in emergency departments, including socio-demographic information, injury-related information, accompanying injuries, and emergency department resource utilization. A total of 133 patients (0.2% of all injury patients) with "near-drowning" as presenting complaints were recorded by the Pak-NEDS system. True near-drowning (50.0%) and intentional injuries that led to "near-drowning" complaints (50.0%) differed in nature of injuries. The highest proportion of true near-drowning incidents occurred among patients aged between 25-44 years (47.5%), and among males (77.5%). True near-drowning patients usually had other accompanying complaints, such as lower limb injury (40.0%). Very few patients were transported by ambulance (5.0%), and triage was done for 15% of patients. Eleven (27.5%) true near-drowning patients received cardiopulmonary resuscitation. There was major under-reporting of drowning and near-drowning cases in the surveillance study. The etiology of near-drowning cases should be further studied. Patients who experienced non-fatal drownings were more commonly sent for medical care due to other accompanying conditions, rather than near-drowning event itself. There is also need for recognizing true near-drowning incidents. The results of this study provide information on data source selection, site location, emergency care standardization, and multi-sector collaboration for future drowning
Mogensen, Christian Backer; Christiansen, Maja; Jørgensen, Jess Bjerre
INTRODUCTION: Among patients with acute chest pain, acute coronary syndrome (ACS) is seen only in a minority of the patients, which raises the question, whether it is possible to separate a group with a high risk of ACS for admission to a cardiac care unit (CCU) from those with a low risk who would...... be treated at an emergency department (ED). The aim of this study was to describe a risk stratification model for a Danish context. METHODS: This was a historic prospective cohort study of patients with suspicion of ACS. The patient was defined as a low-risk patient and admitted to the ED if: 1....... RESULTS: We included a total of 488 patients with suspicion of ACS, 50% of whom were low-risk patients. 17% had a verified ACS; 10% of those in the low-risk group and 24% of those in the high-risk group (p = 0.0001). Among the verified ACS cases, 71% went primarily to the CCU. The odds ratio for an ACS...
Coghlan, A; Hoad, V C; Seed, C R; Flower, R Lp; Harley, R J; Herbert, D; Faddy, H M
International travel assists spread of infectious pathogens. Australians regularly travel to South-eastern Asia and the isles of the South Pacific, where they may become infected with infectious agents, such as dengue (DENV), chikungunya (CHIKV) and Zika (ZIKV) viruses that pose a potential risk to transfusion safety. In Australia, donors are temporarily restricted from donating for fresh component manufacture following travel to many countries, including those in this study. We aimed to estimate the unmitigated transfusion-transmission (TT) risk from donors travelling internationally to areas affected by emerging infectious diseases. We used the European Up-Front Risk Assessment Tool, with travel and notification data, to estimate the TT risk from donors travelling to areas affected by disease outbreaks: Fiji (DENV), Bali (DENV), Phuket (DENV), Indonesia (CHIKV) and French Polynesia (ZIKV). We predict minimal risk from travel, with the annual unmitigated risk of an infected component being released varying from 1 in 1·43 million to disease outbreak areas to source plasma collection provides a simple and effective risk management approach. © 2017 International Society of Blood Transfusion.
Bunker, Naomi; Woods, Cindy; Conway, Jane; Barker, Ruth; Usher, Kim
This study aimed to establish the scale of alcohol-related injuries originating in the home. Despite recent media and public attention on alcohol-related injuries occurring at licensed venues, many occur in other locations including the home. A retrospective observational study. Emergency department surveillance data sourced from the Queensland Injury Surveillance Unit were interrogated for alcohol-related emergency department presentations from 2003-2012 (n = 12,296). Descriptive analysis was undertaken to assess alcohol involvement in injury, and analysis of variance was used to determine the differences among group means and their associated presentations. The relationship between demographic variables and injury location was assessed using p value of domestic violence by spouse or partner (n = 510), 59·5% occurred 'at home'. This is the first study to investigate alcohol-related injuries occurring at home. The home accounts for a greater proportion of injuries than the frequently assessed licensed premises location. Further research is required to validate these findings in a wider setting. A public health campaign is required to minimise harm associated with alcohol-related injuries in the home, and nurses are positioned to inform health policy makers around this issue. Furthermore, emergency department nurses are in a unique position to provide brief interventions around safe alcohol consumption and injury prevention. © 2016 John Wiley & Sons Ltd.
Cho, Young Ae; Lee, Jeonghee; Oh, Jae Hwan; Chang, Hee Jin; Sohn, Dae Kyung; Shin, Aesun; Kim, Jeongseon
A proinflammatory diet may increase the risk of colorectal cancer, but its role may differ according to individuals' genetic variants. We aimed to examine whether a specific dietary pattern reflecting inflammation was associated with a risk of colorectal cancer and whether IL-17F genetic variant altered this association. In a study of 695 colorectal cancer cases and 1846 controls, we derived a reduced rank regression dietary pattern using 32 food groups as predictors and the plasma C-reactive protein (CRP) concentration as the response. High CRP levels were associated with a high risk of colorectal cancer (OR (95% CI) = 3.58 (2.65⁻4.82) for the highest quartile vs. lowest quartile). After adjusting for potential confounding factors, high pattern scores were associated with a high risk of colorectal cancer (OR (95% CI) = 9.98 (6.81⁻14.62) for the highest quartile vs. lowest quartile). When stratified by the IL-17F rs763780 genotype, this association was stronger for individuals carrying the C allele ( p for interaction = 0.034), particularly for individuals with rectal cancer ( p for interaction = 0.011). In conclusion, a dietary pattern reflecting inflammation was significantly associated with colorectal cancer risk. Moreover, this association could be modified according to the IL-17F rs763780 genotype and anatomic site.
Dhanan Sarwo Utomo
Full Text Available This study is motivated by the reality that school choice programs that is currently implemented in Bandung that, always resulting student deficit (lack of student in some schools. In this study, a mechanism that can describe how the enrollment pattern in a school choice program emerge as a result of individual preferences of the prospective students, is constructed. Using computer simulation, virtual experiments are conducted. In these experiments, the enrollment patterns and the number of student deficit that were resulted by various school choice program configurations are analyzed. Based on the experiment results, modification of the current program that can minimize the number of student deficit can be purposed.Keywords: agent-based simulation, school choice, computer simulation
Sakai, Kenshi; Upadhyaya, Shrinivasa K; Andrade-Sanchez, Pedro; Sviridova, Nina V
Real-world processes are often combinations of deterministic and stochastic processes. Soil failure observed during farm tillage is one example of this phenomenon. In this paper, we investigated the nonlinear features of soil failure patterns in a farm tillage process. We demonstrate emerging determinism in soil failure patterns from stochastic processes under specific soil conditions. We normalized the deterministic nonlinear prediction considering autocorrelation and propose it as a robust way of extracting a nonlinear dynamical system from noise contaminated motion. Soil is a typical granular material. The results obtained here are expected to be applicable to granular materials in general. From a global scale to nano scale, the granular material is featured in seismology, geotechnology, soil mechanics, and particle technology. The results and discussions presented here are applicable in these wide research areas. The proposed method and our findings are useful with respect to the application of nonlinear dynamics to investigate complex motions generated from granular materials.
Merchant, Roland C; Freelove, Sarah M; Langan, Thomas J; Clark, Melissa A; Mayer, Kenneth H; Seage, George R; DeGruttola, Victor G
Among a random sample of emergency department (ED) patients, we sought to determine the extent to which reported risk for human immunodeficiency virus (HIV) is related to ever having been tested for HIV. A random sample of patients (aged 18-64 years) from an adult, urban, northeastern United States, academic ED were surveyed about their history of ever having been tested for HIV and their reported HIV risk behaviors. A reported HIV risk score was calculated from the survey responses and divided into 4 levels, based on quartiles of the risk scores. Pearson's X(2) testing was used to compare HIV testing history and level of reported HIV risk. Logistic regression models were created to investigate the association between level of reported HIV risk and the outcome of ever having been tested for HIV. Of the 557 participants, 62.1% were female. A larger proportion of females than males (71.4% vs 60.6%; P history of injection-drug use, were associated with prior HIV testing for both genders. In the logistic regression analyses, there was no relationship between increasing level of reported HIV risk and a history of ever having been tested for HIV for males. For females, a history of ever having been tested was related to increasing level of reported risk, but not in a linear fashion. The relationship between reported HIV risk and history of testing among these ED patients was complex and differed by gender. Among these patients, having greater risk did not necessarily mean a higher likelihood of ever having been tested for HIV.
Schreiner, Pamela J
Animals interact with humans in multiple ways, including as therapy and service animals, commercially as livestock, as wildlife, and in zoos. But the most common interaction is as companion animals in our homes, with an estimated 180 million cats and dogs living in US households. While pet ownership has been reported to have many health benefits, the findings are inconsistent. Cardiovascular risk factors such as lipids, glucose, obesity, and heart rate variability have improved, worsened, or remained the same in the limited number of studies considering companion animals. Physical activity increases have more consistently been linked with dog ownership, although whether this reflects antecedent motivation or direct benefit from the dog is unclear. Allergies and asthma also are variably linked to pet ownership and are confounded by family history of atopy and timing of exposure to pet dander. The benefits of companion animals are most likely to be through reduction in depression, anxiety, and social isolation, but these studies have been largely cross-sectional and may depend on degree of bonding of the owner with the animal. Positive relationships show measurably higher oxytocin with lower cortisol and alpha-amylase levels. Finally, pet ownership is also a marker of better socioeconomic status and family stability, and if companion animals are to provide cardiovascular risk benefit, the route should perhaps be through improved education and opportunity for ownership.
Full Text Available The global burden of disease due to cardiovascular diseases (CVDs is escalating, and the changing trends of CVD risk factors are identified among Indians experiencing rapid health transition. Contributory causes include: growing population with demographic shifts and altered age profile, socio-economic factors, lifestyle changes due to urbanization. Indians are also having genetic predisposition to cardiovascular diseases and adult are susceptible to vascular disease linking possible gene-environment interactions influencing ethnic diversity. Altered diets with more of junk foods along with diminished physical activity are additive factors contributing to the acceleration of CVD epidemics, along with all form of tobacco use. The pace of health transition, however, varies across geographical regions from urban to rural population with consequent variations in the relative burdens of the dominant CVDs. A comprehensive public health response must be looked to plan over all strategies to integrate policies and programs that effectively impact on the multiple determinants of CVDs to provide protection over the life span through primordial, primary and secondary prevention. Populations as well as individuals at risk must be protected through initiatives, enable nutrition-based preventive strategies to protect and promote cardiovascular health.
Hyun Lee, Seung; Ahn, Jae Kyoun
The objective of this study was to evaluate risk factors associated with eyeball loss and ambulatory vision loss on emergent examination of patients with ocular trauma. We reviewed the medical records of 1,875 patients hospitalized in a single tertiary referral center between January 2003 and December 2007. Emergent examinations included a history of trauma, elapsed time between injury and hospital arrival, visible intraocular tissues, and initial visual acuity (VA) using a penlight. The main outcome measures were ocular survival and ambulatory vision survival (>20/200) at 1 year after trauma using univariate and multivariate regression analysis. The ocular trauma scores were significantly higher in open globe injuries than in closed globe injuries (p eyeball loss. Elapsed time more than 12 hours and visible intraocular tissues were the significant risk factors associated with ambulatory vision loss. The most powerful predictor of eyeball loss and ambulatory vision loss was eyeball rupture. In closed globe injuries, there were no significant risk factors of eyeball loss, whereas initial vision less than LP and the presence of relative afferent pupillary defect were the significant risk factors associated with ambulatory vision loss. An initial VA less than LP using a penlight, a history of golf ball injury, and elapsed time more than 12 hours between ocular trauma and hospital arrival were associated with eyeball loss and ambulatory vision loss. Physicians should bear these factors in mind so that they can more effectively counsel patients with such injuries.
Gavrilescu, Maria; Demnerová, Kateřina; Aamand, Jens; Agathos, Spiros; Fava, Fabio
Emerging pollutants reach the environment from various anthropogenic sources and are distributed throughout environmental matrices. Although great advances have been made in the detection and analysis of trace pollutants during recent decades, due to the continued development and refinement of specific techniques, a wide array of undetected contaminants of emerging environmental concern need to be identified and quantified in various environmental components and biological tissues. These pollutants may be mobile and persistent in air, water, soil, sediments and ecological receptors even at low concentrations. Robust data on their fate and behaviour in the environment, as well as on threats to ecological and human health, are still lacking. Moreover, the ecotoxicological significance of some emerging micropollutants remains largely unknown, because satisfactory data to determine their risk often do not exist. This paper discusses the fate, behaviour, (bio)monitoring, environmental and health risks associated with emerging chemical (pharmaceuticals, endocrine disruptors, hormones, toxins, among others) and biological (bacteria, viruses) micropollutants in soils, sediments, groundwater, industrial and municipal wastewaters, aquaculture effluents, and freshwater and marine ecosystems, and highlights new horizons for their (bio)removal. Our study aims to demonstrate the imperative need to boost research and innovation for new and cost-effective treatment technologies, in line with the uptake, mode of action and consequences of each emerging contaminant. We also address the topic of innovative tools for the evaluation of the effects of toxicity on human health and for the prediction of microbial availability and degradation in the environment. Additionally, we consider the development of (bio)sensors to perform environmental monitoring in real-time mode. This needs to address multiple species, along with a more effective exploitation of specialised microbes or enzymes
Lv, Y., E-mail: email@example.com [School of Traffic and Transportation, Beijing Jiaotong University, Beijing 100044 (China); Faculty of Engineering and Applied Science, University of Regina, Regina, Saskatchewan S4S 0A2 (Canada); Huang, G.H., E-mail: firstname.lastname@example.org [Faculty of Engineering and Applied Science, University of Regina, Regina, Saskatchewan S4S 0A2 (Canada); Guo, L., E-mail: email@example.com [Faculty of Engineering and Applied Science, University of Regina, Regina, Saskatchewan S4S 0A2 (Canada); Li, Y.P., E-mail: firstname.lastname@example.org [MOE Key Laboratory of Regional Energy and Environmental Systems Optimization, Resources and Environmental Research Academy, North China Electric Power University, Beijing 102206 (China); Dai, C., E-mail: email@example.com [College of Environmental Sciences and Engineering, Peking University, Beijing 100871 (China); Wang, X.W., E-mail: firstname.lastname@example.org [State Key Laboratory of Water Environment Simulation, School of Environment, Beijing Normal University, Beijing 100875 (China); Sun, W., E-mail: email@example.com [Faculty of Engineering and Applied Science, University of Regina, Regina, Saskatchewan S4S 0A2 (Canada)
Highlights: ► An interval-parameter joint-probabilistic integer programming method is developed. ► It is useful for nuclear emergency management practices under uncertainties. ► It can schedule optimal routes with maximizing evacuees during a finite time. ► Scenario-based analysis enhances robustness in controlling system risk. ► The method will help to improve the capability of disaster responses. -- Abstract: Nuclear emergency evacuation is important to prevent radioactive harms by hazardous materials and to limit the accidents’ consequences; however, uncertainties are involved in the components and processes of such a management system. In the study, an interval-parameter joint-probabilistic integer programming (IJIP) method is developed for emergency evacuation management under uncertainties. Optimization techniques of interval-parameter programming (IPP) and joint-probabilistic constrained (JPC) programming are incorporated into an integer linear programming framework, so that the approach can deal with uncertainties expressed as joint probability and interval values. The IJIP method can schedule the optimal routes to guarantee the maximum population evacuated away from the effected zone during a finite time. Furthermore, it can also facilitate post optimization analysis to enhance robustness in controlling system violation risk imposed on the joint-probabilistic constraints. The developed method has been applied to a case study of nuclear emergency management; meanwhile, a number of scenarios under different system conditions have been analyzed. It is indicated that the solutions are useful for evacuation management practices. The result of the IJIP method can not only help to raise the capability of disaster responses in a systematic manner, but also provide an insight into complex relationships among evacuation planning, resources utilizations, policy requirements and system risks.
Wu, Yuntao; Yu, Junxing; Jin, Cheng; Li, Yun; Su, Jinmei; Wei, Guoqing; Zheng, Xiaoming; Gao, Jingsheng; Gao, Wenyuan; Wu, Shouling
To identify long-term fasting blood glucose trajectories and to assess the association between the trajectories and the risk of arterial stiffness in individuals without diabetes. We enrolled 16,454 non-diabetic participants from Kailuan cohort. Fasting blood glucose concentrations were measured in 2006, 2008, and 2010 survey. Brachial-ankle pulse wave velocities were measured during 2011 to 2016. Multivariate regression model was used to estimate the difference of brachial-ankle pulse wave velocity levels and logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (95%CIs) of arterial stiffness risk, according to the fasting blood glucose trajectories. We identified five distinct fasting blood glucose trajectories and each of the trajectories was labeled according to its range and change over 2006-2010 survey: elevated-stable pattern (5.0% of participants), elevated-decreasing pattern (6.6%), moderate-increasing pattern (10.9%), moderate-stable pattern (59.3%), and low-stable pattern (18.2%). After adjustment for potential confounders, individuals with elevated-stable pattern had a 42.6 cm/s (95%CI: 24.7 to 60.6 cm/s) higher brachial-ankle pulse wave velocity level and a 37% (OR 1.37, 95%CI: 1.14 to 1.66) higher arterial stiffness risk, and individuals with moderate-increasing pattern had a 19.6 cm/s (95%CI: 6.9 to 32.3 cm/s) higher brachial-ankle pulse wave velocity level and a 17% (OR 1.17, 95%CI: 1.03 to 1.33) higher arterial stiffness risk, related to individuals with moderate-stable pattern. We did not find significant associations of the elevated-decreasing or low-stable patterns with arterial stiffness. Consistently, the cumulative average, variability, and increased rate of fasting blood glucose during 2006-2010 survey were significantly associated with the arterial stiffness risk. Discrete fasting blood glucose trajectories were associated with the arterial stiffness risk in non-diabetic individuals.
Full Text Available In the upper atmosphere, greenhouse gases produce a cooling effect, instead of a warming effect. Increases in greenhouse gas concentrations are expected to induce substantial changes in the mesosphere, thermosphere, and ionosphere, including a thermal contraction of these layers. In this article we construct for the first time a pattern of the observed long-term global change in the upper atmosphere, based on trend studies of various parameters. The picture we obtain is qualitative, and contains several gaps and a few discrepancies, but the overall pattern of observed long-term changes throughout the upper atmosphere is consistent with model predictions of the effect of greenhouse gas increases. Together with the large body of lower atmospheric trend research, our synthesis indicates that anthropogenic emissions of greenhouse gases are affecting the atmosphere at nearly all altitudes between ground and space.
Valdez, Avelardo; Cepeda, Alice; Negi, Nalini Junko; Kaplan, Charles
The devastating effects of Hurricane Katrina have contributed to a dynamic demographic shift in the Latino composition of New Orleans. This article focuses on a particularly deleterious pattern of crack cocaine smoking associated with numerous social and health consequences. Utilizing a rapid assessment methodology, in-depth qualitative interviews were conducted with 52 Latino immigrant day laborers in New Orleans. Findings reveal that the presence of a flourishing drug market has facilitated and maintained patterns of crack use including initiation and periods of daily use. Moreover, feelings of isolation and constant exposure to victimization due to day laborers' marginal status are described as contributing to this use. This qualitative analysis reveals how social processes and contextual factors contribute to crack use among Latino day laborers in a post-disaster context. This study has important public health implications in the spread of HIV and other blood borne pathogens.
Mehta, Raaj S; Song, Mingyang; Nishihara, Reiko; Drew, David A; Wu, Kana; Qian, Zhi Rong; Fung, Teresa T; Hamada, Tsuyoshi; Masugi, Yohei; da Silva, Annacarolina; Shi, Yan; Li, Wanwan; Gu, Mancang; Willett, Walter C; Fuchs, Charles S; Giovannucci, Edward L; Ogino, Shuji; Chan, Andrew T
Western and prudent dietary patterns have been associated with higher and lower risks of colorectal cancer (CRC), respectively. However, little is known about the associations between dietary patterns and specific anatomic subsites or molecular subtypes of CRC. We used multivariable Cox proportional hazards models to examine the associations between Western and prudent dietary patterns and CRC risk in the Health Professionals Follow-up Study and Nurses' Health Study. After up to 32 years of follow-up of 137,217 men and women, we documented 3260 cases of CRC. Among individuals from whom subsite data were available, we observed 1264 proximal colon, 866 distal colon, and 670 rectal tumors. Western diet was associated with an increased incidence of CRC (P trend pattern, we observed a RR of 0.86 for overall CRC (95% CI, 0.77-0.95; P trend = .01), with similar trends at anatomic subsites. However, the trend appeared stronger among men than women. Among 1285 cases (39%) with tissue available for molecular profiling, Western diet appeared to be more strongly associated with some CRC molecular subtypes (no mutations in KRAS [KRAS wildtype] or BRAF [BRAF wildtype], no or a low CpG island methylator phenotype, and microsatellite stability), although formal tests for heterogeneity did not produce statistically significant results. Western dietary patterns are associated with an increased risk of CRC, particularly distal colon and rectal tumors. Western dietary patterns also appear more strongly associated with tumors that are KRAS wildtype, BRAF wildtype, have no or a low CpG island methylator phenotype, and microsatellite stability. In contrast, prudent dietary patterns are associated with a lower risk of CRC that does not vary according to anatomic subsite or molecular subtype. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.
Samieri, C; Ginder Coupez, V; Lorrain, S; Letenneur, L; Allès, B; Féart, C; Paineau, D; Barberger-Gateau, P
We investigated the association between nutrient patterns and risk of fractures in 1,482 older subjects. Patterns associated with higher intakes of Ca, P, vitamin B12, proteins and unsaturated fats, and moderate alcohol intake, provided by diets rich in dairies and charcuteries, were related to a lower risk of wrist and hip fractures. The purpose of this study was to investigate the relationship between patterns of nutrient intake and the risk of fractures in older subjects. Among 1,482 participants from the Bordeaux sample of the Three-City (3C) Study who completed a 24-h dietary recall and a food frequency questionnaire, we examined the association between patterns of nutrient intake derived from principal component analysis and 8-year incidence of self-reported fractures of the hip, the wrist, and the vertebrae. A "nutrient-dense" pattern rich in Ca and P, iron, vitamins B including B12, vitamins C and E, alcohol, proteins, and unsaturated fats, and characterized by a higher consumption of fruits and vegetables, meats and fish, cheese and milk, charcuteries, cereals, rice, pasta, and potatoes, was associated with a 19% (95% CI 2-34%, P=0.03) lower risk of wrist fractures. The same pattern was associated with a 14% (95% CI 2-25%) lower risk of fractures at any site. A "south-western French" pattern rich in Ca, P, vitamins D and B12, retinol, alcohol, proteins, and fats-including unsaturated fats; poor in vitamins C, E, and K, carotenes, folates, and fibers; and related to a higher consumption of cheese, milk, and charcuterie and a lower consumption of fruits and vegetables was related to a 33% lower risk of hip fractures (95% CI 3-39%, P=0.03). Higher intakes of Ca, P, vitamin B12, proteins, and unsaturated fats and moderate alcohol, provided by dietary patterns rich in cheese, milk, and charcuteries, were related to a lower risk of wrist and hip fractures in our cohort.
Jones-McLean, E; Hu, J; Greene-Finestone, L S; de Groh, M
Colorectal cancer (CRC) is a high incidence cancer affecting many Canadian adults each year. Diet is important in the etiology of CRC with many dietary components identified as potential risk factors. The Dietary Approaches to Stop Hypertension (DASH) diet is a well-established pattern to characterize overall eating. The purpose of this study was to characterize a DASH pattern within the Canadian context and to assess its relationship to the risk of CRC in Canadian adults. Unconditional multiple logistic regression with control for confounding variables was performed using data from the National Enhanced Cancer Surveillance Study. Dietary intake was captured for this case-control study through a food frequency questionnaire (FFQ) and categorized into a DASH score ranging from 0 to 10 representing a poor to a strong DASH pattern respectively. Consuming a strong DASH pattern of eating (score ≥ 8) was not common in the 3161 cases and 3097 controls. Overall, only 10.8% of men and 13.6% of women had a strong DASH pattern. Multivariate analysis demonstrated a trend for decreasing risk of CRC in men with increasing DASH scores (p value for trend = .007). Men with a strong DASH score had a 33% reduction in risk of CRC compared to those with a low DASH score. There were no significant trends for women for CRC or for colon or rectal cancers separately. Our findings are similar to other researchers suggesting a benefit with a strong DASH pattern associated with a decreased risk of CRC, especially in men. Research should further investigate our gender-based differences.
Full Text Available Introduction: Colorectal cancer (CRC is a high incidence cancer affecting many Canadian adults each year. Diet is important in the etiology of CRC with many dietary components identified as potential risk factors. The Dietary Approaches to Stop Hypertension (DASH diet is a well-established pattern to characterize overall eating. The purpose of this study was to characterize a DASH pattern within the Canadian context and to assess its relationship to the risk of CRC in Canadian adults. Methods: Unconditional multiple logistic regression with control for confounding variables was performed using data from the National Enhanced Cancer Surveillance Study. Dietary intake was captured for this case-control study through a food frequency questionnaire (FFQ and categorized into a DASH score ranging from 0 to 10 representing a poor to a strong DASH pattern respectively. Results: Consuming a strong DASH pattern of eating (score ≥ 8 was not common in the 3161 cases and 3097 controls. Overall, only 10.8 % of men and 13.6 % of women had a strong DASH pattern. Multivariate analysis demonstrated a trend for decreasing risk of CRC in men with increasing DASH scores (p value for trend = .007. Men with a strong DASH score had a 33% reduction in risk of CRC compared to those with a low DASH score. There were no significant trends for women for CRC or for colon or rectal cancers separately. Conclusion: Our findings are similar to other researchers suggesting a benefit with a strong DASH pattern associated with a decreased risk of CRC, especially in men. Research should further investigate our gender-based differences.
Mayor, Jordan; Bahram, Mohammad; Henkel, Terry; Buegger, Franz; Pritsch, Karin; Tedersoo, Leho
Ectomycorrhizal (EcM)-mediated nitrogen (N) acquisition is one main strategy used by terrestrial plants to facilitate growth. Measurements of natural abundance nitrogen isotope ratios (denoted as δ(15)N relative to a standard) increasingly serve as integrative proxies for mycorrhiza-mediated N acquisition due to biological fractionation processes that alter (15)N:(14)N ratios. Current understanding of these processes is based on studies from high-latitude ecosystems where plant productivity is largely limited by N availability. Much less is known about the cause and utility of ecosystem δ(15)N patterns in the tropics. Using structural equation models, model selection and isotope mass balance we assessed relationships among co-occurring soil, mycorrhizal plants and fungal N pools measured from 40 high- and 9 low-latitude ecosystems. At low latitudes (15)N-enrichment caused ecosystem components to significantly deviate from those in higher latitudes. Collectively, δ(15)N patterns suggested reduced N-dependency and unique sources of EcM (15)N-enrichment under conditions of high N availability typical of the tropics. Understanding the role of mycorrhizae in global N cycles will require reevaluation of high-latitude perspectives on fractionation sources that structure ecosystem δ(15)N patterns, as well as better integration of EcM function with biogeochemical theories pertaining to climate-nutrient cycling relationships. © 2014 John Wiley & Sons Ltd/CNRS.
Gallagher, Robyn; Zhang, Ling; Roach, Kellie; Sadler, Leonie; Belshaw, Julie; Kirkness, Ann; Proctor, Ross; Neubeck, Lis
Atrial fibrillation (AF) is increasingly common; however, the cardiovascular risk factor profile and the patterns of delivery and referral to cardiac rehabilitation (CR) in this population are poorly described. We conducted an audit of medical records (n = 145) of patients admitted with AF in one local health district in Sydney, Australia. Patients were aged a mean 72 years, and 51% were male. Lack of risk factor documentation was common. Despite this, 65% had two or more modifiable cardiovascular risk factors, including hypertension (63%) and hypercholesterolaemia (52%). Referral to Phase II CR occurred for 25% and was decreased with permanent AF diagnosis and increased with more risk factors. AF patients admitted to hospital have multiple cardiovascular risk factors but limited risk factor screening and/or referral to outpatient CR programmes. © 2014 Wiley Publishing Asia Pty Ltd.
The present study entitled ''Emergency Response and Nuclear Risk Governance: nuclear safety at nuclear power plant accidents'' deals with issues of the protection of the population and the environment against hazardous radiation (the hazards of nuclear energy) and the harmful effects of radioactivity during nuclear power plant accidents. The aim of this study is to contribute to both the identification and remediation of shortcomings and deficits in the management of severe nuclear accidents like those that occurred at Chernobyl in 1986 and at Fukushima in 2011 as well as to the improvement and harmonization of plans and measures taken on an international level in nuclear emergency management. This thesis is divided into a theoretical part and an empirical part. The theoretical part focuses on embedding the subject in a specifically global governance concept, which includes, as far as Nuclear Risk Governance is concerned, the global governance of nuclear risks. Due to their characteristic features the following governance concepts can be assigned to these risks: Nuclear Safety Governance is related to safety, Nuclear Security Governance to security and NonProliferation Governance to safeguards. The subject of investigation of the present study is as a special case of the Nuclear Safety Governance, the Nuclear Emergency governance, which refers to off-site emergency response. The global impact of nuclear accidents and the concepts of security, safety culture and residual risk are contemplated in this context. The findings (accident sequences, their consequences and implications) from the analyses of two reactor accidents prior to Fukushima (Three Mile Iceland in 1979, Chernobyl in 1986) are examined from a historical analytical perspective and the state of the Nuclear Emergency governance and international cooperation aimed at improving nuclear safety after Chernobyl is portrayed by discussing, among other topics, examples of &apos
Ellis, J A; Stebbing, M; Harrap, S B
A number of studies have shown an association between male pattern baldness (MPB) and cardiovascular disease. Few of these studies, however, have examined whether MPB is a novel risk factor, or is associated with abnormalities of established coronary risk factors. We have therefore performed an analysis of MPB and cardiovascular risk factors in the general population. A total of 1219 male participants aged 18-70 years from the Victorian Family Heart Study were surveyed using a validated questionnaire for degree and pattern of baldness. Carefully standardized measures of height, weight, blood pressure, pulse rate, total and high-density lipoprotein cholesterol, and plasma fibrinogen were made. Subjects were grouped according to the degree and pattern of baldness as: no baldness, frontal baldness and vertex baldness. Bald men were older than non-bald men (P < 0.0001). Age was also associated with increased levels of coronary risk factors (P < 0.0001). When multiple regression was used to adjust for age differences, the levels of coronary risk factors were not significantly different between the bald and non-bald groups. The lack of association between baldness and established coronary risk factors implies that baldness may predispose to coronary heart disease through novel mechanisms yet to be defined.
Habiba, Umma; Hida, Kyoko; Kitamura, Tetsuya; Matsuda, Aya Yanagawa; Higashino, Fumihiro; Ito, Yoichi M; Ohiro, Yoichi; Totsuka, Yasunori; Shindoh, Masanobu
Oral leukoplakia (OL) is a clinically diagnosed preneoplastic lesion of the oral cavity with an increased oral cancer risk. However, the risk of malignant transformation is still difficult to assess. The objective of the present study was to examine the expression patterns of aldehyde dehydrogenase 1 (ALDH1) and podoplanin in OL, and to determine their roles in predicting oral cancer development. In the present study, the expression patterns of ALDH1 and podoplanin were determined in samples from 79 patients with OL. The association between protein expression and clinicopathological parameters, including oral cancer-free survival, was analyzed during a mean follow-up period of 3.4 years. Expression of ALDH1 and podoplanin was observed in 61 and 67% patients, respectively. Kaplan-Meier analysis demonstrated that the expression of the proteins was correlated with the risk of progression to oral cancer. Multivariate analysis revealed that expression of ALDH1 and podoplanin was associated with 3.02- and 2.62-fold increased risk of malignant transformation, respectively. The malignant transformation risk of OL was considerably higher in cases with expression of both proteins. Point-prevalence analysis revealed that 66% of patients with co-expression of ALDH1 and podoplanin developed oral cancer. Taken together, our data indicate that ALDH1 and podoplanin expression patterns in OL are associated with oral cancer development, suggesting that ALDH1 and podoplanin may be useful biomarkers to identify OL patients with a substantially high oral cancer risk.
Cleland, Kelly; Wagner, Brandon; Batur, Pelin; McNamara, Megan; Wu, Justine; Rothberg, Michael B
The most effective forms of emergency contraception (EC) require a prescription or a medical procedure; therefore, provider willingness to offer EC remains critical to patient access. This study seeks to assess whether political alignment of a provider's county is associated with provider attitudes and behaviors regarding EC. We analyzed survey data collected from 1313 healthcare providers from February 2013 to April 2014 at 14 academic medical centers in the United States. Using logistic regression, we estimated associations between the county political alignment of a provider's practice and his or her EC-related beliefs and practices: 1) if the provider is aware of the most effective EC methods; 2) if knowing that a hypothetical EC method prevented implantation would make a provider less likely to prescribe that method because of personal ethical or religious reasons; and 3) if the provider prescribes any form of EC in his or her practice. In multivariate models, a one percentage-point increase in county Republican vote share was associated with a 2.9% decrease in the odds of a provider prescribing EC, after accounting for provider knowledge and attitudes about EC. EC provides a critical last chance to prevent pregnancy after unprotected sex, yet women living in Republican-leaning counties may face difficulty obtaining EC from healthcare providers. Programs seeking to improve access to EC should focus on areas likely to have fewer providers willing to prescribe EC, which may be those that are more Republican-leaning. The most effective forms of emergency contraception (EC) require a prescription or a medical procedure; therefore, provider willingness to offer EC remains critical to patient access. Women living in Republican-leaning counties may face difficulty obtaining emergency contraception from healthcare providers. Copyright © 2018. Published by Elsevier Inc.
Taleghani, Yasamin Molavi; Rezaei, Fatemeh; Sheikhbardsiri, Hojat
Ensuring about the patient's safety is the first vital step in improving the quality of care and the emergency ward is known as a high-risk area in treatment health care. The present study was conducted to evaluate the selected risk processes of emergency surgery department of a treatment-educational Qaem center in Mashhad by using analysis method of the conditions and failure effects in health care. In this study, in combination (qualitative action research and quantitative cross-sectional), failure modes and effects of 5 high-risk procedures of the emergency surgery department were identified and analyzed according to Healthcare Failure Mode and Effects Analysis (HFMEA). To classify the failure modes from the "nursing errors in clinical management model (NECM)", the classification of the effective causes of error from "Eindhoven model" and determination of the strategies to improve from the "theory of solving problem by an inventive method" were used. To analyze the quantitative data of descriptive statistics (total points) and to analyze the qualitative data, content analysis and agreement of comments of the members were used. In 5 selected processes by "voting method using rating", 23 steps, 61 sub-processes and 217 potential failure modes were identified by HFMEA. 25 (11.5%) failure modes as the high risk errors were detected and transferred to the decision tree. The most and the least failure modes were placed in the categories of care errors (54.7%) and knowledge and skill (9.5%), respectively. Also, 29.4% of preventive measures were in the category of human resource management strategy. "Revision and re-engineering of processes", "continuous monitoring of the works", "preparation and revision of operating procedures and policies", "developing the criteria for evaluating the performance of the personnel", "designing a suitable educational content for needs of employee", "training patients", "reducing the workload and power shortage", "improving team
Mamata V. Kene
Full Text Available Introduction: We evaluated emergency physicians’ (EP current perceptions, practice, and attitudes towards evaluating stroke as a cause of dizziness among emergency department patients. Methods: We administered a survey to all EPs in a large integrated healthcare delivery system. The survey included clinical vignettes, perceived utility of historical and exam elements, attitudes about the value of and requisite post-test probability of a clinical prediction rule for dizziness. We calculated descriptive statistics and post-test probabilities for such a clinical prediction rule. Results: The response rate was 68% (366/535. Respondents’ median practice tenure was eight years (37% female, 92% emergency medicine board certified. Symptom quality and typical vascular risk factors increased suspicion for stroke as a cause of dizziness. Most respondents reported obtaining head computed tomography (CT (74%. Nearly all respondents used and felt confident using cranial nerve and limb strength testing. A substantial minority of EPs used the Epley maneuver (49% and HINTS (head-thrust test, gaze-evoked nystagmus, and skew deviation testing (30%; however, few EPs reported confidence in these tests’ bedside application (35% and 16%, respectively. Respondents favorably viewed applying a properly validated clinical prediction rule for assessment of immediate and 30-day stroke risk, but indicated it would have to reduce stroke risk to <0.5% to be clinically useful. Conclusion: EPs report relying on symptom quality, vascular risk factors, simple physical exam elements, and head CT to diagnose stroke as the cause of dizziness, but would find a validated clinical prediction rule for dizziness helpful. A clinical prediction rule would have to achieve a 0.5% post-test stroke probability for acceptability.
Onozuka, Daisuke; Hagihara, Akihito
Abstract Although several studies have estimated the associations between mortality or morbidity and extreme temperatures in terms of relative risk, few studies have investigated the risk of emergency transport attributable to the whole temperature range nationwide. We acquired data on daily emergency ambulance dispatches in all 47 prefectures of Japan from 2007 to 2010. We examined the relationship between emergency transport and temperature for each prefecture using a Poisson regression model in a distributed lag nonlinear model with adjustment for time trends. A random-effect multivariate meta-analysis was then applied to pool the estimates at the national level. Attributable morbidity was calculated for high and low temperatures, which were defined as those above or below the optimum temperature (ie, the minimum morbidity temperature) and for moderate and also extreme temperatures, which were defined using cutoffs at the 2.5th and 97.5th temperature percentiles. A total of 15,868,086 cases of emergency transport met the inclusion criteria. The emergency transport was attributable to nonoptimal temperature. The median minimum morbidity percentile was in the 79th percentile for all causes, the 96th percentile for cardiovascular disease, and the 92th percentile for respiratory disease. The fraction attributable to low temperature was 6.94% (95% eCI: 5.93–7.70) for all causes, 17.93% (95% eCI: 16.10–19.25) for cardiovascular disease, and 12.19% (95% eCI: 9.90–13.66) for respiratory disease, whereas the fraction attributable to high temperature was small (all causes = 1.01%, 95% eCI: 0.90–1.11; cardiovascular disease = 0.10%, 95% eCI: 0.04–0.14; respiratory disease = 0.29%, 95% eCI: 0.07–0.50). The all-cause morbidity risk that was attributable to temperature was related to moderate cold, with an overall estimate of 6.41% (95% eCI: 5.47–7.20). Extreme temperatures were responsible for a small fraction, which corresponded to 0.57% (95% e
Fernández-Prada, María; González-Cabrera, Joaquín; Iribar-Ibabe, Concepción; Peinado, José María
To study the stress, the psychosocial risks associated to the job and the burnout, in a group of junior doctors working at the emergency ward; and to analyze what of those variables could predict and are better related with burnout. Cross-sectional study, with a sample of 42 junior doctors which are on duty in the emergency ward of the University Hospital San Cecilio, Granada (Spain). The Spanish adapted version of the Perceived Stress Scale was used to evaluate stress, the Maslach Burnout Inventory (MBI) to evaluate the professional burnout and the adapted and scaled questionnaire for the self-evaluation of psychosocial risks at work (CopSoQ-ISTAS21). 78% of the junior doctors are in the unfavorable or intermediate range for all CopSoQ-ISTAS21 dimensions, being particularly relevant that 90% of them display unfavorable score in psychological demands. In addition, MBI results show that 45% of our population presents high emotional exhaustion simultaneously to high depersonalization. ISTAS21 psychological demands dimensions (ß = 0.393; p stress scores (ß = 0.451; p burnout. These results indicate the need of psychological and structural interventions in order to improve the professional performance of junior doctors at the emergency ward. Copyright: © 2017 SecretarÍa de Salud
Full Text Available AbstractStudies of Western populations demonstrate a relationship between dietary patterns and cardiovascular-related risk factors. Simiar research regarding Chinese populations is limited. This study explored the dietary patterns of Chinese older adults and their association with cardiovascular-related risk factors, including hypertension, obesity and metabolic syndrome. Data were collected using a 34-item Chinese food frequency questionnaire from 750 randomly selected older adults aged 50–88 who participated in the study in 2012. Factor analysis revealed four dietary patterns: a ‘traditional food pattern’, consisting of vegetable, fruit, rice, pork and fish; a ‘fast and processed food pattern’ consisting of fast or processed food products, sugar and confectionery; a ‘soybean, grain and flour food pattern’; and a ‘dairy, animal liver and other animal food pattern’. These patterns explained 17.48%, 9.52%, 5.51% and 4.80% of the variances in food intake, respectively. This study suggests that specific dietary patterns are evident in Chinese older adults. Moderate intake of ‘traditional Chinese food’ is associated with decreased blood pressure and cholesterol level. A dietary pattern rich in soybeans, grains, potatoes and flour is associated with reduced metabolic factors including reduced triglycerides, fasting glucose, waist circumference, and waist–hip ratio, and a high level of dairy, animal liver and other animal intake food pattern is associated with increased level of Body Mass Index. In conclusion, this study revealed identifiable dietary patterns among Chinese older adults that are significantly related to blood pressure and metabolic biomarkers. Further study using prospective cohort or intervention study should be used to confirm the association between dietary patterns and blood pressure and metabolic factors.
Hobgood, Cherri; Xie, Jipan; Weiner, Bryan; Hooker, James
To gather preliminary data on how the three major types of emergency medicine (EM) providers, physicians, nurses (RNs), and out-of-hospital personnel (EMTs), differ in error identification, disclosure, and reporting. A convenience sample of emergency department (ED) providers completed a brief survey designed to evaluate error frequency, disclosure, and reporting practices as well as error-based discussion and educational activities. One hundred sixteen subjects participated: 41 EMTs (35%), 33 RNs (28%), and 42 physicians (36%). Forty-five percent of EMTs, 56% of RNs, and 21% of physicians identified no clinical errors during the preceding year. When errors were identified, physicians learned of them via dialogue with RNs (58%), patients (13%), pharmacy (35%), and attending physicians (35%). For known errors, all providers were equally unlikely to inform the team caring for the patient. Disclosure to patients was limited and varied by provider type (19% EMTs, 23% RNs, and 74% physicians). Disclosure education was rare, with error to a patient. Error discussions are widespread, with all providers indicating they discussed their own as well as the errors of others. This study suggests that error identification, disclosure, and reporting challenge all members of the ED care delivery team. Provider-specific education and enhanced teamwork training will be required to further the transformation of the ED into a high-reliability organization.
Timmermans, M.; Heijmans, R.; Daniels, Hennie
This paper studies cyclical patterns in risk indicators based on TARGET2 transaction data. These indicators provide information on network properties, operational aspects and links to ancillary systems. We compare the performance of two different ARIMA dummy models to the TBATS state space model.
M. Timmermans (Monique); R. Heijmans (Ronald); H.A.M. Daniels (Hennie)
textabstractThis paper studies cyclical patterns in risk indicators based on TARGET2 transaction data. These indicators provide information on network properties, operational aspects and links to ancillary systems. We compare the performance of two different ARIMA dummy models to the TBATS state
Dr. Sabastian Nwosu
Objectives: To determine the pattern and risk factors for retinal vein occlusion at the Guinness Eye Center, Onitsha,. Nigeria. Materials and Methods: Case files of all patients with retinal vein occlusion between May 1997 and April 2004 were reviewed. Information on age, sex, visual acuity, ocular complications and ...
Arshad, H.; Ghayas, M.S.; Madiha, A.
To observe the patterns of speech sounds and language disorders. To find out associated risk factors of speech sounds and language disorders. Background: Communication is the very essence of modern society. Communication disorders impacts quality of life. Patterns and factors associated with speech sounds and language impairments were explored. The association was seen with different environmental factors. Methodology: The patients included in the study were 200 whose age ranged between two and sixteen years presented in speech therapy clinic OPD Mayo Hospital. A cross-sectional survey questionnaire assessed the patient's bio data, socioeconomic background, family history of communication disorders and bilingualism. It was a descriptive study and was conducted through cross-sectional survey. Data was analysed by SPSS version 16. Results: Results reveal Language disorders were relatively more prevalent in males than those of speech sound disorders. Bilingualism was found as having insignificant effect on these disorders. It was concluded from this study that the socioeconomic status and family history were significant risk factors. Conclusion: Gender, socioeconomic status, family history can play as risk for developing speech sounds and language disorders. There is a grave need to understand patterns of communication disorders in the light of Pakistani society and culture. It is recommended to conduct further studies to determine risk factors and patterns of these impairments. (author)
Kim, Sunha; Chang, Mido; Singh, Kusum; Allen, Katherine R.
This study examined the dropout trajectories of racial and linguistic minority students and explored the effects of students' contextual factors on their high school dropout risks. Our motivation was to identify the dropout patterns of Black, Hispanic, and Hispanic English language learner (ELL) students, who have comparatively high dropout rates,…
Gras, M. J.; Weide, J. F.; Langendam, M. W.; Coutinho, R. A.; van den Hoek, A.
To study (1) HIV prevalence; (2) sexual risk behaviour; (3) sexual mixing patterns; (4) determinants of disassortative (between-group) mixing among migrant groups in Amsterdam, the Netherlands and to gain insight into the potential for heterosexual spread of HIV/sexually transmitted diseases.
De Stefani, Eduardo; Ronco, Alvaro L; Boffetta, Paolo; Deneo-Pellegrini, Hugo; Correa, Pelayo; Acosta, Gisele; Mendilaharsu, Maria
In order to explore the role of nutrients and bioactive related substances in colorectal cancer, we conducted a case-control in Uruguay, which is the country with the highest production of beef in the world. Six hundred and eleven (611) cases afflicted with colorectal cancer and 1,362 controls drawn from the same hospitals in the same time period were analyzed through unconditional multiple logistic regression. This base population was submitted to a principal components factor analysis and three factors were retained. They were labeled as the meat-based, plant-based, and carbohydrates patterns. They were rotated using orthogonal varimax method. The highest risk was positively associated with the meat-based pattern (OR for the highest quartile versus the lowest one 1.63, 95 % CI 1.22-2.18, P value for trend = 0.001), whereas the plant-based pattern was strongly protective (OR 0.60, 95 % CI 0.45-0.81, P value for trend pattern was only positively associated with colon cancer risk (OR 1.46, 95 % CI 1.02-2.09). The meat-based pattern was rich in saturated fat, animal protein, cholesterol, and phosphorus, nutrients originated in red meat. Since herocyclic amines are formed in the well-done red meat through the action of amino acids and creatine, it is suggestive that this pattern could be an important etiologic agent for colorectal cancer.
Im, Kiho; Raschle, Nora Maria; Smith, Sara Ashley; Ellen Grant, P; Gaab, Nadine
Developmental dyslexia (DD) is highly heritable and previous studies observed reduced cortical volume, white matter integrity, and functional alterations in left posterior brain regions in individuals with DD. The primary sulcal pattern has been hypothesized to relate to optimal organization and connections of cortical functional areas. It is determined during prenatal development and may reflect early, genetically influenced, brain development. We characterize the sulcal pattern using graph-based pattern analysis and investigate whether sulcal patterns in parieto-temporal and occipito-temporal regions are atypical in elementary school-age children with DD and pre-readers/beginning readers (preschoolers/kindergarteners) with a familial risk (elementary school-age children: n [males/females], age range = 17/11, 84-155 months; preschoolers/kindergarteners: 16/15, 59-84 months). The pattern of sulcal basin area in left parieto-temporal and occipito-temporal regions was significantly atypical (more sulcal basins of smaller size) in children with DD and further correlated with reduced reading performance on single- and nonword reading measures. A significantly atypical sulcal area pattern was also confirmed in younger preschoolers/kindergarteners with a familial risk of DD. Our results provide further support for atypical early brain development in DD and suggest that DD may originate from altered organization or connections of cortical areas in the left posterior regions. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: firstname.lastname@example.org.
Aguirre, A Alonso
The fundamental human threats to biodiversity including habitat destruction, globalization, and species loss have led to ecosystem disruptions altering infectious disease transmission patterns, the accumulation of toxic pollutants, and the invasion of alien species and pathogens. To top it all, the profound role of climate change on many ecological processes has affected the inability of many species to adapt to these relatively rapid changes. This special issue, "Zoonotic Disease Ecology: Effects on Humans, Domestic Animals and Wildlife," explores the complex interactions of emerging infectious diseases across taxa linked to many of these anthropogenic and environmental drivers. Selected emerging zoonoses including RNA viruses, Rift Valley fever, trypanosomiasis, Hanta virus infection, and other vector-borne diseases are discussed in detail. Also, coprophagous beetles are proposed as important vectors in the transmission and maintenance of infectious pathogens. An overview of the impacts of climate change in emerging disease ecology within the context of Brazil as a case study is provided. Animal Care and Use Committee requirements were investigated, concluding that ecology journals have low rates of explicit statements regarding the welfare and wellbing of wildlife during experimental studies. Most of the solutions to protect biodiversity and predicting and preventing the next epidemic in humans originating from wildlife are oriented towards the developed world and are less useful for biodiverse, low-income economies. We need the development of regional policies to address these issues at the local level.
O'Kula, K.R.; Baker, W.H.; Simpkins, A.A.; Taylor, R.P.; Wagner, K.C.; Amos, C.N.
Integration of the Probabilistic Risk Assessment (PRA) for K Reactor operation into related technical areas at the Savannah River Site (SRS) includes coordination with several onsite organizations responsible for maintaining and upgrading emergency preparedness capabilities. Major functional categories of the PRA application are scenario development and source term algorithm enhancement. Insights and technologies from the SRS PRA have facilitated development of: (1) credible timelines for scenarios; (2) algorithms tied to plant instrumentation to provide best-estimate source terms for dose projection; and (3) expert-system logic models to implement informed counter-measures to assure onsite and offsite safety following accidental releases. The latter methodology, in particular, is readily transferable to other reactor and non-reactor facilities at SRS and represents a distinct advance relative to emergency preparedness capabilities elsewhere in the DOE complex
Henriksen, Daniel Pilsgaard; Brabrand, Mikkel; Lassen, Annmarie Touborg
vital signs at arrival to a medical emergency department (MED). DESIGN AND SETTING: Single-centre, retrospective cohort study of all patients admitted to the MED from September 2010-August 2011. SUBJECTS: Patients were included when their vital signs (systolic blood pressure, pulse rate, respiratory.......2-3.0%) among the non-deteriorating, hazard ratio 4.11 (95% CI: 2.38-7.10). CONCLUSIONS: Among acutely admitted medical patients who arrive with normal vital signs, 31.0% showed signs of deterioration within 24 hours. Risk factors included old age, Do-not-attempt-to-resuscitate order, admission from the open...... general ED. Thirty-day mortality among patients with deterioration was four times higher than among non-deteriorating patients. Further research is needed to determine whether intensified monitoring of vital signs can help to prevent deterioration or mortality among medical emergency patients....
Perelli-Harris, B.; Sigle-Rushton, W.; Lappegard, T.; Kreyenfeld, M.; Keizer, R.; Berghammer, C.
Nearly every European country has experienced some increase in nonmarital childbearing, largely due to increasing births within cohabitation. Relatively few studies in Europe, however, investigate the educational gradient of childbearing within cohabitation or how it changed over time. Using retrospective union and fertility histories, we employ competing risk hazard models to examine the educational gradient of childbearing in cohabitation in 8 countries across Europe. In all countries studi...
Marcadenti, Aline; Mendes, Larissa Loures; Rabito, Estela Iraci; Fink, Jaqueline da Silva; Silva, Flávia Moraes
There are many nutrition screening tools currently being applied in hospitals to identify risk of malnutrition. However, multivariate statistical models are not usually employed to take into account the importance of each variable included in the instrument's development. To develop and evaluate the concurrent and predictive validities of a new screening tool of nutrition risk. A prospective cohort study was developed, in which 4 nutrition screening tools were applied to all patients. Length of stay in hospital and mortality were considered to test the predictive validity, and the concurrent validity was tested by comparing the Nuritional Risk in Emergency (NRE)-2017 to the other tools. A total of 748 patients were included. The final NRE-2017 score was composed of 6 questions (advanced age, metabolic stress of the disease, decreased appetite, changing of food consistency, unintentional weight loss, and muscle mass loss) with answers yes or no. The prevalence of nutrition risk was 50.7% and 38.8% considering the cutoff points 1.0 and 1.5, respectively. The NRE-2017 showed a satisfactory power to indentify risk of malnutrition (area under the curve >0.790 for all analyses). According to the NRE-2017, patients at risk of malnutrition have twice as high relative risk of a very long hospital stay. The hazard ratio for mortality was 2.78 (1.03-7.49) when the cutoff adopted by the NRE-2017 was 1.5 points. NRE-2017 is a new, easy-to-apply nutrition screening tool which uses 6 bi-categoric features to detect the risk of malnutrition, and it presented a good concurrent and predictive validity. © 2018 American Society for Parenteral and Enteral Nutrition.
Berona, Johnny; Czyz, Ewa; Horwitz, Adam G.; Gipson, Polly Y.
Abstract Objective: The feasibility and concurrent validity of adolescent suicide risk screening in medical emergency departments (EDs) has been documented. The objectives of this short-term prospective study of adolescents who screened positive for suicide risk in the ED were: 1) to examine adolescents' rate of suicidal behavior during the 2 months following their ED visits and compare it with reported rates for psychiatric samples; and 2) to identify possible predictors of acute risk for suicidal behavior in this at-risk sample. Method: Participants were 81 adolescents, ages 14–19 years, seeking services for psychiatric and nonpsychiatric chief complaints, who screened positive for suicide risk because of recent suicidal ideation, a suicide attempt, and/or depression plus alcohol or substance misuse. A comprehensive assessment of suicidal behavior, using the Columbia-Suicide Severity Rating Scale, was conducted at baseline and 2 month follow-up. Results: Six adolescents (7.4%) reported a suicide attempt and 15 (18.5%) engaged in some type of suicidal behavior (actual, aborted, or interrupted suicide attempt; preparatory behavior) during the 2 months following their ED visit. These rates suggest that this screen identified a high-risk sample. Furthermore, adolescents who screened positive for suicidal ideation and/or attempt plus depression and alcohol/substance misuse were most likely to engage in future suicidal behavior (38.9%). Conclusions: In this study, use of a higher screen threshold (multiple suicide risk factors) showed promise for identifying highly elevated acute risk for suicidal behavior. PMID:25746114
Evandro Fornias Sperandio
Full Text Available Objective : To determine whether a restrictive pattern on spirometry is associated with the level of physical activity in daily life (PADL, as well as with cardiovascular disease (CVD risk factors, in asymptomatic adults. Methods : A total of 374 participants (mean age, 41 ± 14 years underwent spirometry, which included the determination of FVC and FEV1. A restrictive pattern on spirometry was defined as an FEV1/FVC ratio > 0.7 and an FVC < 80% of the predicted value. After conducting demographic, anthropometric, and CVD risk assessments, we evaluated body composition, muscle function, and postural balance, as well as performing cardiopulmonary exercise testing and administering the six-minute walk test. The PADL was quantified with a triaxial accelerometer. Results : A restrictive pattern on spirometry was found in 10% of the subjects. After multivariate logistic regression, adjusted for confounders (PADL and cardiorespiratory fitness, the following variables retained significance (OR; 95% CI as predictors of a restrictive pattern: systemic arterial hypertension (17.5; 1.65-184.8, smoking (11.6; 1.56-87.5, physical inactivity (8.1; 1.43-46.4, larger center-of-pressure area while standing on a force platform (1.34; 1.05-1.71; and dyslipidemia (1.89; 1.12-1.98. Conclusions : A restrictive pattern on spirometry appears to be common in asymptomatic adults. We found that CVD risk factors, especially systemic arterial hypertension, smoking, and physical inactivity, were directly associated with a restrictive pattern, even when the analysis was adjusted for PADL and cardiorespiratory fitness. Longitudinal studies are needed in order to improve understanding of the etiology of a restrictive pattern as well as to aid in the design of preventive strategies.
Tryggvadottir, E A; Medek, H; Birgisdottir, B E; Geirsson, R T; Gunnarsdottir, I
Gestational diabetes mellitus (GDM) is associated with negative health effects for mother and child. The aim was to investigate the association between maternal dietary patterns and GDM. Prospective observational study including 168 pregnant women aged 18-40 years, recruited at routine 20-week ultrasound. All participants kept a 4-day weighed food record following recruitment (commencement: gestational weeks 19-24). Principal component analysis was used to extract dietary patterns from 29 food groups. A Healthy Eating Index (HEI) was constructed. All women underwent an oral glucose tolerance test in weeks 23-28. One clear dietary pattern (Eigenvalue 2.4) was extracted with positive factor loadings for seafood; eggs; vegetables; fruits and berries; vegetable oils; nuts and seeds; pasta; breakfast cereals; and coffee, tea and cocoa powder, and negative factor loadings for soft drinks and French fries. This pattern was labeled a prudent dietary pattern. Explained variance was 8.2%. The prevalence of GDM was 2.3% among women of normal weight before pregnancy (n=86) and 18.3% among overweight/obese women (n=82). The prudent dietary pattern was associated with lower risk of GDM (OR: 0.54; 95% CI: 0.30, 0.98). When adjusting for age, parity, prepregnancy weight, energy intake, weekly weight gain and total metabolic equivalent of task the association remained (OR: 0.36; 95% CI: 0.14, 0.94). Similar results were found when only including overweight or obese women (OR: 0.31; 95% CI: 0.13, 0.75). Adhering to a prudent dietary pattern in pregnancy was clearly associated with lower risk of GDM, especially among women already at higher risk because of overweight/obesity before pregnancy.
Barr, Peter B; Silberg, Judy; Dick, Danielle M; Maes, Hermine H
Childhood socioeconomic status (SES) is an important aspect of early life environment associated with later life health/health behaviors, including alcohol misuse. However, alcohol misuse is modestly heritable and involves differing etiological pathways. Externalizing disorders show significant genetic overlap with substance use, suggesting an impulsivity pathway to alcohol misuse. Alcohol misuse also overlaps with internalizing disorders, suggesting alcohol is used to cope. These differing pathways could lead to different patterns over time and/or differential susceptibility to environmental conditions, such as childhood SES. We examine whether: 1) genetic risk for externalizing and internalizing disorders influence trajectories of alcohol problems across adolescence to adulthood, 2) childhood SES alters genetic risk these disorders on trajectories of alcohol problems, and 3) these patterns are consistent across sex. We find modest evidence of gene-environment interaction. Higher childhood SES increases the risk of alcohol problems in late adolescence/early adulthood, while lower childhood SES increases the risk of alcohol problems in later adulthood, but only among males at greater genetic risk of externalizing disorders. Females from lower SES families with higher genetic risk of internalizing or externalizing disorders have greater risk of developing alcohol problems. Copyright © 2018 Elsevier Ltd. All rights reserved.
Lewis, Ben; Garcia, Christian C; Nixon, Sara Jo
Older adults constitute a rapidly expanding proportion of the U.S. Contemporary studies note the increasing prevalence of alcohol consumption in this group. Thus, understanding alcohol effects, consumption patterns, and associated risks in aging populations constitute critical areas of study with increasing public health relevance. Participants (n = 643; 292 women; ages 21-70) were community residing adult volunteers. Primary measures of interest included four patterns of alcohol consumption (average [oz./day]; typical quantity [oz./occasion]; frequency [% drinking days]; and maximal quantity [oz.]). Regression analyses explored associations between these measures, age, and relevant covariates. Subsequent between-group analyses investigated differences between two groups of older adults and a comparator group of younger adults, their adherance to "low-risk" guidelines, and whether alcohol-associated risks differed by age and adherence pattern. Average consumption did not vary by age or differ between age groups. In contrast, markedly higher frequencies and lower quantities of consumption were observed with increasing age. These differences persisted across adherence categories and were evident even in the oldest age group. Exceeding "low-risk" guidelines was associated with greater risk for alcohol-related problems among the older groups. These results emphasize the utility of considering underlying constituent patterns of consumption in older drinkers. Findings highlight difficulties in identifying problem drinking among older adults and contribute to the few characterizations of "risky" drinking patterns in this group. Taken together, our data contribute to literatures of import for the design and enhancement of screening, prevention, and education initiatives directed toward aging adults. Copyright © 2018. Published by Elsevier B.V.
Ghosh, Shameek; Feng, Mengling; Nguyen, Hung; Li, Jinyan
Acute hypotension is a significant risk factor for in-hospital mortality at intensive care units. Prolonged hypotension can cause tissue hypoperfusion, leading to cellular dysfunction and severe injuries to multiple organs. Prompt medical interventions are thus extremely important for dealing with acute hypotensive episodes (AHE). Population level prognostic scoring systems for risk stratification of patients are suboptimal in such scenarios. However, the design of an efficient risk prediction system can significantly help in the identification of critical care patients, who are at risk of developing an AHE within a future time span. Toward this objective, a pattern mining algorithm is employed to extract informative sequential contrast patterns from hemodynamic data, for the prediction of hypotensive episodes. The hypotensive and normotensive patient groups are extracted from the MIMIC-II critical care research database, following an appropriate clinical inclusion criteria. The proposed method consists of a data preprocessing step to convert the blood pressure time series into symbolic sequences, using a symbolic aggregate approximation algorithm. Then, distinguishing subsequences are identified using the sequential contrast mining algorithm. These subsequences are used to predict the occurrence of an AHE in a future time window separated by a user-defined gap interval. Results indicate that the method performs well in terms of the prediction performance as well as in the generation of sequential patterns of clinical significance. Hence, the novelty of sequential patterns is in their usefulness as potential physiological biomarkers for building optimal patient risk stratification systems and for further clinical investigation of interesting patterns in critical care patients.
van der Meer, Dania M; Weiland, Tracey J; Philip, Jennifer; Jelinek, George A; Boughey, Mark; Knott, Jonathan; Marck, Claudia H; Weil, Jennifer L; Lane, Heather P; Dowling, Anthony J; Kelly, Anne-Maree
People with cancer attend emergency departments (EDs) for many reasons. Improved understanding of the specific needs of these patients may assist in optimizing health service delivery. ED presentation and hospital utilization characteristics were explored for people with cancer and compared with those patients without cancer. This descriptive, retrospective, multicentre cohort study used hospital administrative data. Descriptive and inferential statistics were used to summarise and compare ED presentation characteristics amongst cancer and non-cancer groups. Predictive analyses were used to identify ED presentation features predictive of hospital admission for cancer patients. Outcomes of interest were level of acuity, ED and inpatient length of stay, re-presentation rates and admission rates amongst cancer patients and non-cancer patients. ED (529,377) presentations occurred over the 36 months, of which 2.4% (n = 12,489) were cancer-related. Compared with all other attendances, cancer-related attendances had a higher level of acuity, requiring longer management time and length of stay in ED. Re-presentation rates for people with cancer were nearly double those of others (64 vs 33%, p < 0.001), with twice the rate of hospital admission (90 vs 46%, p < 0.001), longer inpatient length of stay (5.6 vs 2.8 days, p < 0.001) and had higher inpatient mortality (7.9 vs 1.0%, p < 0.001). Acuity and arriving by ambulance were significant predictors of hospital admission, with cancer-related attendances having ten times the odds of admission compared to other attendances (OR = 10.4, 95% CI 9.8-11.1). ED presentations by people with cancer represent a more urgent, complex caseload frequently requiring hospital admission when compared to other presentations, suggesting that for optimal cancer care, close collaboration and integration of oncology, palliative care and emergency medicine providers are needed to improve pathways of care.
Jiang, Jheng Jie; Lee, Chon Lin; Fang, Meng Der; Boyd, Kenneth G.; Gibb, Stuart W.
This paper presents a methodology based on multivariate data analysis for characterizing potential source contributions of emerging contaminants (ECs) detected in 26 river water samples across multi-scape regions during dry and wet seasons. Based on this methodology, we unveil an approach toward potential source contributions of ECs, a concept we refer to as the “Pharmaco-signature.” Exploratory analysis of data points has been carried out by unsupervised pattern recognition (hierarchical cluster analysis, HCA) and receptor model (principal component analysis-multiple linear regression, PCA-MLR) in an attempt to demonstrate significant source contributions of ECs in different land-use zone. Robust cluster solutions grouped the database according to different EC profiles. PCA-MLR identified that 58.9% of the mean summed ECs were contributed by domestic impact, 9.7% by antibiotics application, and 31.4% by drug abuse. Diclofenac, ibuprofen, codeine, ampicillin, tetracycline, and erythromycin-H2O have significant pollution risk quotients (RQ>1), indicating potentially high risk to aquatic organisms in Taiwan. PMID:25874375
O'Neal, Wesley T; Qureshi, Waqas; Li, Yabing; Soliman, Elsayed Z
This study included 6,398 participants (mean age 55 ± 0.34 years; 54% female; 49% white; 22% black; 24% Mexican; 4.3% other) free of clinical cardiovascular disease (CVD) and major ECG abnormalities. Cox regression was used to examine the association between the RSR' (incomplete right bundle branch block (RBBB) or right ventricular conduction delay) pattern and CVD and all-cause mortalities. The RSR' pattern was not associated with an increased risk of CVD (HR=1.10; 95%CI=0.63, 1.91) mortality or all-cause (HR=0.95; 95%CI=0.66, 1.35) mortality. The results were similar when the RSR' pattern was further separated into incomplete RBBB and right ventricular conduction delay. In conclusion, the RSR' pattern is a benign finding in older adults free of clinical CVD. Copyright © 2015 Elsevier Inc. All rights reserved.
Bao, Wei; Bowers, Katherine; Tobias, Deirdre K
; an animal LCD score on the basis of intakes of carbohydrate, animal protein, and animal fat; and a vegetable LCD score on the basis of intakes of carbohydrate, vegetable protein, and vegetable fat. A higher score reflected a higher intake of fat and protein and a lower intake of carbohydrate...... protein and fat from vegetable food sources is not associated with the risk. Women of reproductive age who follow a low-carbohydrate dietary pattern may consider consuming vegetable rather than animal sources of protein and fat to minimize their risk of GDM.......-carbohydrate dietary patterns with risk of GDM. DESIGN: We included 21,411 singleton pregnancies in the Nurses' Health Study II. Prepregnancy LCD scores were calculated from validated food-frequency questionnaires, including an overall LCD score on the basis of intakes of carbohydrate, total protein, and total fat...
Gilbert, Louisa; Terlikbayeva, Assel; West, Brooke; Bearman, Peter; Wu, Elwin; Zhussupov, Baurzhan; Platais, Ingrida; Brisson, Anne
Objectives. We examined the relationships between mobility characteristics and sexual risk behaviors among male and female migrant market vendors in Almaty, Kazakhstan. Methods. Participants completed a structured interview covering sociodemographics, mobility characteristics, sexual behaviors, and biomarkers for HIV, HCV, and syphilis. We used multivariate analyses to examine associations between mobility patterns and HIV risks after adjusting for sociodemographics. Results. Longer duration of a participant's last trip outside Almaty increased the odds of reporting multiple sexual partners. More frequent travel to visit family or friends was associated with multiple sexual partners and unprotected sex with steady partners. More frequent travel to buy goods in the past year was associated with multiple sexual partners. Men who traveled more often to buy goods were more likely to have purchased sex within the previous 90 days. Conclusions. Relationships between mobility patterns and sexual risk behaviors underscore the need for HIV-prevention strategies targeting the specific transmission dynamics that migrant vendors are likely to present. PMID:21493929
Ben Charhi Youssef
Full Text Available This paper is an extension of work originally presented in SYSCO CONF.We extend our previous work by presenting the initial results of the implementation of intrusion detection based on risk assessment on cloud computing. The idea focuses on a novel approach for detecting cyber-attacks on the cloud environment by analyzing attacks pattern using risk assessment methodologies. The aim of our solution is to combine evidences obtained from Intrusion Detection Systems (IDS deployed in a cloud with risk assessment related to each attack pattern. Our approach presents a new qualitative solution for analyzing each symptom, indicator and vulnerability analyzing impact and likelihood of distributed and multi-steps attacks directed to cloud environments. The implementation of this approach will reduce the number of false alerts and will improve the performance of the IDS.
Daly, Amanda; Grandy, A. Stuart
Agriculture is a predominant land use and thus a large influence on global carbon (C) and nitrogen (N) balances, climate, and human health. If we are to produce food, fiber, and fuel sustainably we must maximize agricultural yield while minimizing negative environmental consequences, goals towards which we have made great strides through agronomic advances. However, most agronomic strategies have been designed with a view of soil as a black box, largely ignoring the way management is mediated by soil biota. Because soil microbes play a central role in many of the processes that deliver nutrients to crops and support their health and productivity, agricultural management strategies targeted to exploit or support microbial activity should deliver additional benefits. To do this we must determine how microbial community structure and function are shaped by agricultural practices, but until recently our characterizations of soil microbial communities in agricultural soils have been largely limited to broad taxonomic classes due to methodological constraints. With advances in high-throughput genetic and genomic sequencing techniques, better taxonomic resolution now enables us to determine how agricultural management affects specific microbes and, in turn, nutrient cycling outcomes. Here we unite findings from published research that includes genetic or genomic data about microbial community structure (e.g. 454, Illumina, clone libraries, qPCR) in soils under agricultural management regimes that differ in type and extent of tillage, cropping selections and rotations, inclusion of cover crops, organic amendments, and/or synthetic fertilizer application. We delineate patterns linking agricultural management to microbial diversity, biomass, C- and N-content, and abundance of microbial taxa; furthermore, where available, we compare patterns in microbial communities to patterns in soil extracellular enzyme activities, catabolic profiles, inorganic nitrogen pools, and nitrogen
Riva, Francesco; Castiglioni, Sara; Fattore, Elena; Manenti, Angela; Davoli, Enrico; Zuccato, Ettore
Emerging Contaminants (ECs) are ubiquitous in waters, arousing concern because of their potential risks for human health and the environment. This study investigated the presence of multiple classes of ECs in 21 wells over the drinking water network of Milan, in the most inhabited and industrialized area of Italy, and assessed the risks for consumers. Samples were analyzed using liquid chromatography coupled to mass spectrometry. Human risk assessment (HRA) was conducted by comparing the measured concentrations with drinking water thresholds from guidelines or calculated in this study; first considering the exposure to each single EC and then the entire mixture. Thirteen ECs were measured in the low ng/L range, and were generally detected in less than half of the wells. Pharmaceuticals, perfluorinated substances, personal care products, and anthropogenic markers were the most frequently detected. The results of the HRA excluded any risks for consumers in each scenario considered. This is one of the most comprehensive studies assessing the presence of a large number of ECs in the whole drinking water network of a city, and the risks for human health. Results improve the limited information on ECs sources and occurrence in drinking water and help establishing guidelines for regulatory purposes. Copyright © 2018 Elsevier GmbH. All rights reserved.
Heath, Robert L; Lee, Jaesub; Palenchar, Michael J; Lemon, Laura L
Studies are continuously performed to improve risk communication campaign designs to better prepare residents to act in the safest manner during an emergency. To that end, this article investigates the predictive ability of the protective action decision model (PADM), which links environmental and social cues, predecision processes (attention, exposure, and comprehension), and risk decision perceptions (threat, alternative protective actions, and stakeholder norms) with protective action decision making. This current quasi-longitudinal study of residents (N = 400 for each year) in a high-risk (chemical release) petrochemical manufacturing community investigated whether PADM core risk perceptions predict protective action decision making. Telephone survey data collected at four intervals (1995, 1998, 2002, 2012) reveal that perceptions of protective actions and stakeholder norms, but not of threat, currently predict protective action decision making (intention to shelter in place). Of significance, rather than threat perceptions, perception of Wally Wise Guy (a spokes-character who advocates shelter in place) correlates with perceptions of protective action, stakeholder norms, and protective action decision making. Wally's response-efficacy advice predicts residents' behavioral intentions to shelter in place, thereby offering contextually sensitive support and refinement for PADM. © 2017 Society for Risk Analysis.
Munro-Kramer, Michelle L; Fava, Nicole M; Saftner, Melissa A; Darling-Fisher, Cynthia S; Tate, Nutrena H; Stoddard, Sarah A; Martyn, Kristy K
Research on Arab-Americans as a distinct ethnic group is limited, especially when considering the health of Arab-American youth. This study describes health risk (substance use, violence); health promotive behaviors (hope, spirituality); and sexual activity (oral, vaginal, anal sex) of Arab-American adolescents and emerging adults (aged 15-23) within their life context, as well as the association between these behaviors. A secondary analysis of data on a subset of Arab-American participants obtained from a randomized-control trial was utilized to conduct mixed methods analyses. Qualitative analyses completed on the open-ended questions used the constant comparative method for a subsample (n = 24) of participants. Descriptive quantitative analyses of survey data utilized bivariate analyses and stepwise logistic regression to explore the relation between risk behaviors and sexual activity among the full sample (n = 57). Qualitative analyses revealed two groups of participants: (a) multiple risk behaviors and negative life-events, and (b) minimal risk behaviors and positive life-events. Quantitative analyses indicated older youth, smokers, and those with higher hope pathways were more likely to report vaginal sex. The unique cultural and social contexts of Arab-American youth provide a framework for recommendations for the prevention of risk behaviors. ©2016 American Association of Nurse Practitioners.
Full Text Available We propose a Cellular Automata (CA model in which three ubiquitous and relevant processes in nature are present, namely, spatial competition, distinction between dynamically stronger and weaker agents and the existence of an inner resistance to changes in the actual state S n (=−1,0,+1 of each CA lattice cell n (which we call inertia. Considering ensembles of initial lattices, we study the average properties of the CA final stationary configuration structures resulting from the system time evolution. Assuming the inertia a (proper control parameter, we identify qualitative changes in the CA spatial patterns resembling usual phase transitions. Interestingly, some of the observed features may be associated with continuous transitions (critical phenomena. However, certain quantities seem to present jumps, typical of discontinuous transitions. We argue that these apparent contradictory findings can be attributed to the inertia parameter’s discrete character. Along the work, we also briefly discuss a few potential applications for the present CA formulation.
Eick, Christian; Rizas, Konstantinos D; Meyer-Zürn, Christine S; Groga-Bada, Patrick; Hamm, Wolfgang; Kreth, Florian; Overkamp, Dietrich; Weyrich, Peter; Gawaz, Meinrad; Bauer, Axel
To evaluate heart rate deceleration capacity, an electrocardiogram-based marker of autonomic nervous system activity, as risk predictor in a medical emergency department and to test its incremental predictive value to the modified early warning score. Prospective cohort study. Medical emergency department of a large university hospital. Five thousand seven hundred thirty consecutive patients of either sex in sinus rhythm, who were admitted to the medical emergency department of the University of Tübingen, Germany, between November 2010 and March 2012. None. Deceleration capacity of heart rate was calculated within the first minutes after emergency department admission. The modified early warning score was assessed from respiratory rate, heart rate, systolic blood pressure, body temperature, and level of consciousness as previously described. Primary endpoint was intrahospital mortality; secondary endpoints included transfer to the ICU as well as 30-day and 180-day mortality. One hundred forty-two patients (2.5%) reached the primary endpoint. Deceleration capacity was highly significantly lower in nonsurvivors than survivors (2.9 ± 2.1 ms vs 5.6 ± 2.9 ms; p model yielded an area under the receiver-operator characteristic curve of 0.706 (0.667-0.750). Implementing deceleration capacity into the modified early warning score model led to a highly significant increase of the area under the receiver-operator characteristic curve to 0.804 (0.770-0.835; p capacity was also a highly significant predictor of 30-day and 180-day mortality as well as transfer to the ICU. Deceleration capacity is a strong and independent predictor of short-term mortality among patients admitted to a medical emergency department.
P S, Loh; Miskan, M M; Y Z, Chin; Zaki, R A
Cough on emergence has been reported as a common adverse reaction with sugammadex reversal. We investigated if staggering the dose of sugammadex will reduce emergence cough in a single-center, randomized, double-blinded study. A hundred and twenty ASA 1-3 adults were randomly reversed with 1 mg/kg sugammadex prior to extubation followed by another 1 mg/kg immediately after extubation (staggered group), single dose of 2 mg/kg sugammadex (single bolus group) or neostigmine 0.02 mg/kg with glycopyrrolate (neostigmine group). We found 70% of patients (n = 28) reversed with single boluses of sugammadex had Grade 3 emergence cough compared to 12.5% (n = 5) in the staggered sugammadex group and 17.5% (n = 7) in the neostigmine group (p sugammadex group (n = 14, 35%, p = 0.005). On the other hand, staggering sugammadex lowered risks of developing severe cough (RR 0.2, p sugammadex group and control given neostigmine. In terms of timing, there was no delay in time taken from discontinuing anesthetic agents to reversal and extubation if sugammadex was staggered (emergence time 6.0 ± 3.2 s, p = 0.625 and reversal time 6.5 ± 3.5, p = 0.809). Staggering the dose of sugammadex for reversal will effectively decrease common emergence and early postoperative complications. ANZCTR Number ACTRN12616000116426 . Retrospectively registered on 2nd February 2016.
Boubacar Ba, El Hadji; Leye, Papa Alassane; Traoré, Mamadou Mour; Ndiaye, Pape Ibrahima; Gaye, Ibrahima; Bah, Mamadou Diawo; Fall, Mamadou Lamine; Diouf, Elisabeth
Emergency anesthesia in elderly patients aged 65 years and older is complex. The occurrence of intraoperative incidents and arterial hypotension is conditioned by patients' initial health status and by the quality of intraoperative management. This study aimed to determine the incidence of intra-anesthetic arterial hypotension in elderly patients during emergency surgery and to assess the involvement of certain factors in its occurrence: age, sex, patient's history, ASA class, anesthetic technique. We conducted a retrospective descriptive and analytical study in the Emergency Surgery Department at the Aristide Le Dantec University Hospital from 1 March 2014 to 28 February 2015. We collected data from 210 patients out of 224 elderly patients aged 65 years and older undergoing emergency anesthesias (10.93%). Data of 101 men and 109 women were included in the analysis, of whom 64.3% had at least one defect. Patients' preoperative status was assessed using American Society of Anesthesiology (ASA) classification: 71% of patients were ASA class 1 and 2 and 29% were ASA class 3 and 4. Locoregional anesthesia was the most practiced anesthetic technique (56.7%). 28 patients (13.33%) had intra-anesthetic arterial hypotension, of whom 16 under general anesthesia and 12 under locoregional anesthesia. It was more frequent in patients with high ASA class and a little less frequent in patients with PAH and underlying heart disease. Arterial hypotension in elderly patients during emergency surgery exposes the subject to the risk of not negligible intraoperative hypotension, especially in patients with high ASA class. Prevention is based on adequate preoperative assessment and anesthetic management.
This emergency plan is to serve as guidance for the protection measures to be taken whenever necessary. It establishes the duties of the different services and bodies, in accordance with their responsibilities under the national laws and regulations. The plan, which describes the general organisation, must be supplemented by intervention plans at the different action levels: by the provincial authorities, the communal authorities and the various services and institutions concerned. This plan mainly concerns large nuclear installations and transport of nuclear fuels and radioactive materials; however, lower risks from other activities are also covered. (NEA)
Surekha S Patil
Full Text Available A 72-year-old male patient with gall bladder perforation and small intestinal obstruction from impacted gall stone was posted for emergency laparotomy. He had congestive heart failure, severe hypertension at admission and history of multiple other coexisting diseases. On admission, he developed pulmonary oedema from systolic hypertension which was controlled by ventilatory support, nitroglycerine and furosemide. Preoperative international normalized ratio was 2.34 and left ventricular ejection fraction was only 20%. Because of risk of exaggerated fall in blood pressure during induction of anaesthesia (general or neuraxial, a transversus abdominis plane block via combined Petit triangle and subcostal technique was administered and supplemented with Propofol sedation.
Full Text Available A government-market-public partnership (GMPP could be a feasible arrangement for providing insurance coverage for natural disaster. Firstly, we put forward GMPP management mode. Secondly, the emergency financial service supply chain for natural disaster risk is built from the view of supply chain. Finally, the objective of this paper is to obtain insights into the cooperative and competitive relationship in GMPP system. We establish the cooperative and competitive differential dynamic evolutionary models and prove the existence of equilibrium solutions in order to solve the coordination problems. In conclusion, the equilibrium solutions can be achieved among the insurers, the operating governments, and the public.
Background: Work schedules like those of Emergency Medical Services (EMS) personnel have been associated with increased risk of fatigue-related impairment. Biomathematical modeling is a means of objectively estimating the potential impacts of fatigue...
There are some basic actions and self-protective actions to take in an radiological emergency. Radiation is detected with appropriate instrumentation and measuring the rate of exposure (Sv per hour) in contact with radioactive materials involved. Is important to note: Responsive to a radiological emergency, tool to identify radiological risks, radiation protection, radioactive symbol and instrumentation
Bougea, Anastasia; Spantideas, Nicolaos; Anagnostou, Evangelos; Massou, Efthalia; Xirou, Sophia; Thomaidis, Thomas; Evdokimidis, Ioannis; Kararizou, Evangelia
Very few neurological research is published regarding health effects of global economic crisis. Our aim was to assess the impact of economic recession on frequency and severity of headaches. We also tested if depression, anxiety and experiences associated with crisis, such as unemployment, were reflected in headaches. This is a retrospective observational study in the Emergency setting of tertiary Clinic from 1 January 2008 until 31 December 2009 and from 1 January 2010 until 31 December 2011. Demographic data were collected of 1094 consecutive adult patients with headache. Multinomial logistic regression performed to examine if hospital anxiety depression (HAD), HAD anxiety, experience of serious life events, year of survey had influence on type of headache. The total number of headache cases increased significantly from 2008 to 2011 (p headaches remained unchanged over time (p > 0.05), while migraines decreased. Secondary and not otherwise specified (NOS) increased significantly (p headache, followed by migraines (in 2008, 2011) and NOS (2010). Chi square test showed significant correlation between type of headache and year, as well medication type and year (p headache [odds ratio (OR) 0.13; 95 % confidence interval (CI) 0.03, 0.7]. This is the first study showing that the prolonged economic crisis affected headache frequency accompanied by a higher use of analgesics.
Mohammad Haji Aghajani
Full Text Available Introduction: Globally, it is estimated that around 5.8 million people die annually as result of injuries, which causes 10% of all deaths and 16% of disability adjusted life years lost worldwide. This study aimed to determine the epidemiology of injuries in emergency departments in Iran.Method: This cross sectional study was carried out using national injury surveillance data registry from 21 March 2009 to 20 March 2014.Results: 7,176,344 patients with the mean age of 27.5 ± 17.8 years were registered to 657 EDs (70.6% male. Road Traffic Crash (RTC was the most common cause of injury (31.0% followed by hit (28.2% and fall (10.1%. While roads were the commonest place of injuries, 34.0% of patients have been injured at home. More than 90% of injuries were unintentional. Assault and suicide attempt were causes of injury in 5.6% and 3.9% of patients, respectively.Conclusion:This paper addresses where prevention measures are most urgently needed and offers insights which could be useful for injury prevention programs in Iran and other developing countries.
Elliott, Sarah M.; Brigham, Mark E.; Lee, Kathy E.; Banda, Jo A.; Choy, Steven J.; Gefell, Daniel J.; Minarik, Thomas A.; Moore, Jeremy N.; Jorgenson, Zachary G.
Human activities introduce a variety of chemicals to the Laurentian Great Lakes including pesticides, pharmaceuticals, flame retardants, plasticizers, and solvents (collectively referred to as contaminants of emerging concern or CECs) potentially threatening the vitality of these valuable ecosystems. We conducted a basin-wide study to identify the presence of CECs and other chemicals of interest in 12 U.S. tributaries to the Laurentian Great Lakes during 2013 and 2014. A total of 292 surface-water and 80 sediment samples were collected and analyzed for approximately 200 chemicals. A total of 32 and 28 chemicals were detected in at least 30% of water and sediment samples, respectively. Concentrations ranged from 0.0284 (indole) to 72.2 (cholesterol) μg/L in water and 1.75 (diphenhydramine) to 20,800 μg/kg (fluoranthene) in sediment. Cluster analyses revealed chemicals that frequently co-occurred such as pharmaceuticals and flame retardants at sites receiving similar inputs such as wastewater treatment plant effluent. Comparison of environmental concentrations to water and sediment-quality benchmarks revealed that polycyclic aromatic hydrocarbon concentrations often exceeded benchmarks in both water and sediment. Additionally, bis(2-ethylhexyl) phthalate and dichlorvos concentrations exceeded water-quality benchmarks in several rivers. Results from this study can be used to understand organism exposure, prioritize river basins for future management efforts, and guide detailed assessments of factors influencing transport and fate of CECs in the Great Lakes Basin.
Williamson, Deborah A; Carter, Glen P; Howden, Benjamin P
Bacterial skin infections represent some of the most common infectious diseases globally. Prevention and treatment of skin infections can involve application of a topical antimicrobial, which may be an antibiotic (such as mupirocin or fusidic acid) or an antiseptic (such as chlorhexidine or alcohol). However, there is limited evidence to support the widespread prophylactic or therapeutic use of topical agents. Challenges involved in the use of topical antimicrobials include increasing rates of bacterial resistance, local hypersensitivity reactions (particularly to older agents, such as bacitracin), and concerns about the indiscriminate use of antiseptics potentially coselecting for antibiotic resistance. We review the evidence for the major clinical uses of topical antibiotics and antiseptics. In addition, we review the mechanisms of action of common topical agents and define the clinical and molecular epidemiology of antimicrobial resistance in these agents. Moreover, we review the potential use of newer and emerging agents, such as retapamulin and ebselen, and discuss the role of antiseptic agents in preventing bacterial skin infections. A comprehensive understanding of the clinical efficacy and drivers of resistance to topical agents will inform the optimal use of these agents to preserve their activity in the future. Copyright © 2017 American Society for Microbiology.
Melzack, R; Wall, P D; Ty, T C
Features of acute pain were examined in patients at an emergency clinic. Patients who had severe, life-threatening injuries or who were agitated, drunk, or 'in shock' were excluded from the study. Of 138 patients who were alert, rational and coherent, 51 (37%) stated that they did not feel pain at the time of injury. The majority of these patients reported onset of pain within an hour of injury, although the delays were as long as 9 h or more in some patients. The predominant emotions of the patients were embarrassment at appearing careless or worry about loss of wages. None expressed any pleasure or indicated any prospect of gain as a result of the injury. The occurrence of delays in pain onset was related to the nature of the injury. Of 46 patients whose injuries were limited to skin (lacerations, cuts, abrasions, burns), 53% had a pain-free period. Of 86 patients with deep-tissue injuries (fractures, sprains, bruises, amputation of a finger, stabs and crushes), only 28% had a pain-free period. The McGill Pain Questionnaire was administered to patients who felt pain immediately after injury or after a delay, and revealed a normal distribution of sensory scores but very low affective scores compared to patients with chronic pain. The results indicate that the relationship between injury and pain is highly variable and complex.
Andressa Midori Sakai
Full Text Available Objective: to reveal feelings of nurses who host with risk assessment and classification in an emergency room of a pubic hospital. Methods: it is a qualitative research approach with 12 nurses interviewed. The data were analyzed, categorized and discussed according to the theoretical framework of work psychodynamics. Results: the nurses expressed feelings of satisfaction in meeting the user needs assistance. They reported feeling as fear, stress and fatigue due to the sharp pace of work, gaps in health care network and situations of violence. They highlighted coping strategies to reduce the burden of this assignment, how to share the completion of the screening with the nursing staff. Conclusion: the host with risk assessment and classification favors the autonomy of nurses and provide greater accountability to this professional users, but the limitations of available resources to solve the complaint of patients generate physical and psychological burden to this worker.
Andressa Midori Sakai
Full Text Available Objective: to reveal feelings of nurses who host with risk assessment and classification in an emergency room of a pubic hospital. Methods: it is a qualitative research approach with 12 nurses interviewed. The data were analyzed, categorized and discussed according to the theoretical framework of work psychodynamics. Results: the nurses expressed feelings of satisfaction in meeting the user needs assistance. They reported feeling as fear, stress and fatigue due to the sharp pace of work, gaps in health care network and situations of violence. They highlighted coping strategies to reduce the burden of this assignment, how to share the completion of the screening with the nursing staff. Conclusion: the host with risk assessment and classification favors the autonomy of nurses and provide greater accountability to this professional users, but the limitations of available resources to solve the complaint of patients generate physical and psychological burden to this worker.
Haemaelaeinen, R.P.; Lindstedt, M.
The radiation protection authorities have seen a need to apply multi-attribute risk analysis in the nuclear emergency management and planning processes to deal with the conflicting objectives, different parties involved and uncertainties. This type of an approach is expected to help in at least the following three areas; to ensure that all the relevant attributes are considered in the decision making, to enhance communication between concerned parties including the population, and to provide a method for including risk analysis explicitly in the process. A MAUT analysis was used to select a strategy for protecting the population after a simulated nuclear accident. A value-focused approach and the use of a neutral facilitator were seen as very useful
Haemaelaeinen, R.P.; Lindstedt, M. [Helsinki Univ. of Technology (Finland). Systems Analysis Lab.; Sinkko, K. [The Radiation and Nuclear Safety Authority, Helsinki (Finland)
The radiation protection authorities have seen a need to apply multi-attribute risk analysis in the nuclear emergency management and planning processes to deal with the conflicting objectives, different parties involved and uncertainties. This type of an approach is expected to help in at least the following three areas; to ensure that all the relevant attributes are considered in the decision making, to enhance communication between concerned parties including the population, and to provide a method for including risk analysis explicitly in the process. A MAUT analysis was used to select a strategy for protecting the population after a simulated nuclear accident. A value-focused approach and the use of a neutral facilitator were seen as very useful.
... The Marfan Foundation Marfan & Related Disorders What is Marfan Syndrome? What are Related Disorders? What are the Signs? ... Emergencies Lung Emergencies Surgeries Lung Emergencies People with Marfan syndrome can be at increased risk of sudden lung ...
Frisch, A; Seil, R; Urhausen, A; Croisier, J L; Lair, M L; Theisen, D
This study analyzed sex-specific injury patterns and risk factors in young athletes (n=256) from 12 sport disciplines practicing at the national or the international level in the Grand-Duchy of Luxembourg. Injury occurrence as a result of sport practice was analyzed retrospectively over the year 2006 using a standardized self-administered questionnaire. Overall incidence was not different between girls and boys (1.20 and 1.21 injuries/1000 athlete-hours, respectively), but in the context of team sport competition girls tended to be at a greater risk (rate ratio 2.05, P=0.053). Girls had a higher proportion of injuries in the ankle/foot region compared with boys (34.8% vs 16.8%). No sex-related differences were found regarding injury severity. Multivariate logistic regression (controlling for age and practice volume) revealed that girls' team sports were associated with a greater injury risk compared with individual sports [odds ratio (OR) of 4.76], while in boys this was observed for racket sports (OR=3.31). Furthermore, physical or emotional stress tended to be a specific risk factor in girls. There was a tendency for injury outside sports to be coupled to a higher injury risk in girls and boys. Consideration of sex-specific injury patterns and risk factors could be of importance for effective injury prevention.
Tomasek, L.; Urban, S.; Kubik, A.; Zatloukal, P.
Studies of uranium miners conducted since the late 1960s demonstrated that the risk depends on cumulated exposure in terms of working level months (WLM) integrating both duration of exposure and concentration of radon. It has been also demonstrated that the risk from radon decreases with time since exposure. The objective of the work is to study temporal patterns of lung cancer risk from occupational and residential radon and from smoking. The present analysis of temporal changes of relative risk is based on a model, where the total individual exposure is partitioned into components in dependence on time. Exposure to radon is studied in a cohort of 9411 Czech uranium miners with 766 cases of lung cancer and in a residential study of 1 803 inhabitants exposed to radon in houses with 218 cases. Temporal patterns of smoking are analyzed in a case-control study of patients from a major Prague hospital including 566 cases. for both carcinogens, the relative risk decreases with time since exposure. In comparison to period with exposure before 5-19 years, the risk from exposures before 20-34 years is 36% and 34% for smoking and randon, respectively. The effect of exposures from more distant periods 35-49 is only 5% for smoking and 14% for radon in comparison to 5-19 years. Combined effect of smoking and radon is studied by a nested case-control approach including 434 cases and 962 controls. Analyses of the joint effects of smoking and radon, conducted in the occupational and the residential studies, suggest a sub-multiplicative interaction. The relative risk from radon among non-smokers is higher by a factor of 2-3 in comparison to smokers, suggesting different patterns of lung deposition and clearance among smokers and non-smokers. (Author) 13 refs
Tomasek, L.; Urban, S.; Kubik, A.; Zatloukal, P.
Studies of uranium miners conducted since the late 1960s demonstrated that the risk depends on cumulated exposure in terms of working level months (WLM) integrating both duration of exposure and concentration of radon. It has been also demonstrated that the risk from radon decreases with time since exposure. The objective of the work is to study temporal patterns of lung cancer risk from occupational and residential radon and from smoking. The present analysis of temporal changes of relative risk is based on a model, where the total individual exposure is partitioned into components in dependence on time. Exposure to radon is studied in a cohort of 9411 Czech uranium miners with 766 cases of lung cancer and in a residential study of 1 803 inhabitants exposed to radon in houses with 218 cases. Temporal patterns of smoking are analyzed in a case-control study of patients from a major Prague hospital including 566 cases. for both carcinogens, the relative risk decreases with time since exposure. In comparison to period with exposure before 5-19 years, the risk from exposures before 20-34 years is 36% and 34% for smoking and randon, respectively. The effect of exposures from more distant periods 35-49 is only 5% for smoking and 14% for radon in comparison to 5-19 years. Combined effect of smoking and radon is studied by a nested case-control approach including 434 cases and 962 controls. Analyses of the joint effects of smoking and radon, conducted in the occupational and the residential studies, suggest a sub-multiplicative interaction. The relative risk from radon among non-smokers is higher by a factor of 2-3 in comparison to smokers, suggesting different patterns of lung deposition and clearance among smokers and non-smokers. (Author) 13 refs.
Hankin, Abigail; Wei, Stanley; Foreman, Juron; Houry, Debra
Homicide is the second leading cause of death among youth aged 15-24. Prior cross-sectional studies, in non-healthcare settings, have reported exposure to community violence, peer behavior, and delinquency as risk factors for violent injury. However, longitudinal cohort studies have not been performed to evaluate the temporal or predictive relationship between these risk factors and emergency department (ED) visits for injuries among at-risk youth. The objective was to assess whether self-reported exposure to violence risk factors in young adults can be used to predict future ED visits for injuries over a 1-year period. This prospective cohort study was performed in the ED of a Southeastern US Level I trauma center. Eligible participants were patients aged 18-24, presenting for any chief complaint. We excluded patients if they were critically ill, incarcerated, or could not read English. Initial recruitment occurred over a 6-month period, by a research assistant in the ED for 3-5 days per week, with shifts scheduled such that they included weekends and weekdays, over the hours from 8AM-8PM. At the time of initial contact in the ED, patients were asked to complete a written questionnaire, consisting of previously validated instruments measuring the following risk factors: a) aggression, b) perceived likelihood of violence, c) recent violent behavior, d) peer behavior, e) community exposure to violence, and f) positive future outlook. At 12 months following the initial ED visit, the participants' medical records were reviewed to identify any subsequent ED visits for injury-related complaints. We analyzed data with chi-square and logistic regression analyses. Three hundred thirty-two patients were approached, of whom 300 patients consented. Participants' average age was 21.1 years, with 60.1% female, 86.0% African American. After controlling for participant gender, ethnicity, or injury complaint at time of first visit, return visits for injuries were significantly
Kontogiannis, Tom; Malakis, Stathis
In recent years, many accident models and techniques have shifted their focus from shortfalls in the actions of practitioners to systemic causes in the organization. Accident investigation techniques (e.g., STAMP) have been developed that looked into the flaws of control processes in the organization. Organizational models have looked into general patterns of breakdown related to structural vulnerabilities and gradual degradation of performance. Although some degree of cross-fertilization has been developed between these two trends, safety analysts are left on their own to integrate this gap between control flaws and patterns of organizational breakdown in accident investigation. This article attempts to elaborate the control dynamics of the Systems Theoretic Accident Model and Process (STAMP) technique on the basis of a theoretical model of organizational viability (i.e., the Viable Systems Model). The joint STAMP–VSM framework is applied to an accident from a Helicopter Emergency Medical Service (HEMS) organization to help analysts progress from the analysis of control flaws to the underlying patterns of breakdown. The joint framework may help analysts to rethink the safety organization, model new information loops and constraints, look at the adaptation and steering functions of the organization and finally, develop high leverage interventions. - Highlights: ► This article bridges the gap between two parallel trends in systemic accident models. ► Investigation techniques (i.e., STAMP) have looked into the flaws of safety management processes. ► The literature has highlighted many patterns (or archetypes) of organizational breakdowns. ► The Viable System Model is used with STAMP to link control flaws and organizational breakdowns.
Brishna Soraya Kamal
Full Text Available Age-related impairments in the primary auditory cortex (A1 include poor tuning selectivity, neural desynchronization and degraded responses to low-probability sounds. These changes have been largely attributed to reduced inhibition in the aged brain, and are thought to contribute to substantial hearing impairment in both humans and animals. Since many of these changes can be partially reversed with auditory training, it has been speculated that they might not be purely degenerative, but might rather represent negative plastic adjustments to noisy or distorted auditory signals reaching the brain. To test this hypothesis, we examined the impact of exposing young adult rats to 8 weeks of low-grade broadband noise on several aspects of A1 function and structure. We then characterized the same A1 elements in aging rats for comparison. We found that the impact of noise exposure on A1 tuning selectivity, temporal processing of auditory signal and responses to oddball tones was almost indistinguishable from the effect of natural aging. Moreover, noise exposure resulted in a reduction in the population of parvalbumin inhibitory interneurons and cortical myelin as previously documented in the aged group. Most of these changes reversed after returning the rats to a quiet environment. These results support the hypothesis that age-related changes in A1 have a strong activity-dependent component and indicate that the presence or absence of clear auditory input patterns might be a key factor in sustaining adult A1 function.
Cook, Emily C.; Pflieger, Jacqueline C.; Connell, Arin M.; Connell, Christian M.
Latent transition analysis was used to identify patterns and trajectories of antisocial behavior (ASB) and their association with young adult outcomes in a nationally representative sample of adolescents (N = 5,422; 53.9% female). Participants were on average 13.96 years of age (SD= 1.06) at wave 1 of the study. Latent class analysis identified four classes of ASB including a non-ASB class, an aggressive class, a petty theft class, and a serious ASB class. In general, youth who were classified as serious stable ASB were the most at risk for problematic functioning in young adulthood. Youth who escalated to more serious patterns of ASB or reduced involvement also were at greater risk of negative outcomes in young adulthood compared to stable non-ASB youth, although they generally fared better than youth involved in stable patterns of more serious ASB. Gender differences indicated that involvement in ASB was a greater risk factor for alcohol use among boys and a greater risk factor for depression among girls in young adulthood. Results are discussed in terms of the predictive validity of classes of ASB to functioning in young adulthood and the implications of this research for prevention efforts. PMID:24893667
Liu, Rui; Wang, Meie; Chen, Weiping; Peng, Chi
Accumulations of heavy metals in urban soils are highly spatial heterogeneity and affected by multiple factors including soil properties, land use and pattern, population and climatic conditions. We studied accumulation risks of Cd, Cu, Pb and Zn in unban soils of Beijing and their influencing based on the regression tree analysis and a GIS-based overlay model. Result shows that Zinc causes the most extensive soil pollution and Cu result in the most acute soil pollution. The soil's organic carbon content and CEC and population growth are the most significant factors affecting heavy metal accumulation. Other influence factors in land use pattern, urban landscape, and wind speed also contributed, but less pronounced. The soils in areas with higher degree of urbanization and surrounded by intense vehicular traffics have higher accumulation risk of Cd, Cu, Pb, and Zn. - Highlights: • Zn accumulations were the most extensive and Cu accumulations were the most acute. • Accumulations of Cd, Cu, Pb and Zn in urban soils were caused by different sets of influence factors. • Soil's organic carbon content and CEC and population growth were the most significant factors. • Accumulation risks were highly related with urbanization level and human activities. - A combined approach of employing geographical information systems and regression tree analyses identify the potential risks of accumulation Cd, Cu, Pb, and Zn in urban soils according to soil properties, urban land use patterns, urban landscape, demographics, and microclimatic conditions.
Alcázar-Córcoles, Miguel A; Verdejo-García, Antonio; Bouso-Sáiz, José C; Revuelta-Menéndez, Javier; Ramírez-Lira, Ezequiel
There is a renewed interest in incorporating personality variables in criminology theories in order to build models able to integrate personality variables and biological factors with psychosocial and sociocultural factors. The aim of this article is the assessment of personality dimensions that contribute to the prediction of antisocial behavior in adolescents. For this purpose, a sample of adolescents from El Salvador, Mexico, and Spain was obtained. The sample consisted of 1035 participants with a mean age of 16.2. There were 450 adolescents from a forensic population (those who committed a crime) and 585 adolescents from the normal population (no crime committed). All of participants answered personality tests about neuroticism, extraversion, psychoticism, sensation seeking, impulsivity, and violence risk. Principal component analysis of the data identified two independent factors: (i) the disinhibited behavior pattern (PDC), formed by the dimensions of neuroticism, psychoticism, impulsivity and risk of violence; and (ii) the extrovert behavior pattern (PEC), formed by the dimensions of sensation risk and extraversion. Both patterns significantly contributed to the prediction of adolescent antisocial behavior in a logistic regression model which properly classifies a global percentage of 81.9%, 86.8% for non-offense and 72.5% for offense behavior. The classification power of regression equations allows making very satisfactory predictions about adolescent offense commission. Educational level has been classified as a protective factor, while age and gender (male) have been classified as risk factors.
Qureshi, Adnan I; Gilani, Sarwat; Adil, Malik M; Majidi, Shahram; Hassan, Ameer E; Miley, Jefferson T; Rodriguez, Gustavo J
Background Telephone consent and two physician consents based on medical necessity are alternate strategies for time sensitive medical decisions but are not uniformly accepted for clinical practice or recruitment into clinical trials. We determined the rate of and associated outcomes with alternate consenting strategies in consecutive acute ischemic stroke patients receiving emergent endovascular treatment. Methods We divided patients into those treated based on in-person consent and those based on alternate strategies. We identified clinical and procedural differences and differences in hospital outcomes: symptomatic ICH and favorable outcome (defined by modified Rankin Scale of 0–2 at discharge) based on consenting methodology. Results Of a total of 159 patients treated, 119 were treated based on in-person consent (by the patient in 27 and legally authorized representative in 92 procedures). Another 40 patients were treated using alternate strategies (20 telephone consents and 20 two physician consents based on medical necessity). There was no difference in the mean ages and proportion of men among the two groups based on consenting methodology. There was a significantly greater time interval incurred between CT scan and initiation of endovascular procedure in those in whom in-person consent was obtained (117 ± 65 min versus 101 ± 45 min, p = 0.01). There was no significant difference in rates of ICH (9% versus 8%, p = 0.9), or favorable outcome at discharge (28% versus 30%, p = 0.8). Conclusions Consent through alternate strategies does not adversely affect procedural characteristics or outcome of patients and may be more time efficient than in-person consenting process. PMID:25132906
Li, Wen-Qing; Cho, Eunyoung; Han, Jiali; Weinstock, Martin A; Qureshi, Abrar A
We examined the association between male-pattern baldness and risk of incident skin cancer, including invasive melanoma, invasive squamous cell carcinoma (SCC), and basal cell carcinoma (BCC) in a prospective analysis, based on 36,032 participants from the Health Professionals' Follow-up Study. In 1992, participants reported their status of male-pattern baldness at age 45 years by choosing from five crown-view pictograms based on Norwood's classification. Diagnosis of skin cancers was reported biennially and information on melanoma and SCC was pathologically confirmed. We identified 327 melanoma cases, 1324 SCC cases, and 8438 BCC cases during the follow-up. Male-pattern baldness was not significantly associated with risk of incident melanoma, but was significantly associated with increased risk of SCC and BCC. The multivariate-adjusted hazard ratio (HR) (95% confidence interval, CI) for the highest category of baldness (frontal plus severe vertex baldness) was 1.33 (1.06-1.68) for SCC (p trend = 0.001) and 1.23 (1.12-1.35) for BCC (p trend baldness. Analyses by body sites found significant associations between frontal plus moderate to severe vertex baldness and risk of melanoma (HR = 1.83, 95% CI: 1.01-3.34) and SCC (HR = 1.30, 95% CI: 1.02-1.66) at head and neck. The associations were particularly stronger for scalp melanoma (HR = 7.15, 95% CI: 1.29-39.42) and scalp SCC (HR = 7.09, 95% CI: 3.84-13.08), but not for non-scalp head and neck sites. Information on body sites was not available for BCC. In conclusion, male pattern baldness may be associated with increased risk of skin cancer, but the associations may only exist for those occurring at head and neck, particularly at scalp. © 2016 UICC.
Robert W. Derlet
Full Text Available We report the case of a 32-year-old male recently diagnosed with type 2 diabetes treated at an urban university emergency department (ED crowded to 250% over capacity. His initial symptoms of shortness of breath and feeling ill for several days were evaluated with chest radiograph, electrocardiogram (EKG, and laboratory studies, which suggested mild diabetic ketoacidosis. His medical care in the ED was conducted in a crowded hallway. After correction of his metabolic abnormalities he felt improved and was discharged with arrangements made for outpatient follow-up. Two days later he returned in cardiac arrest, and resuscitation efforts failed. The autopsy was significant for multiple acute and chronic pulmonary emboli but no coronary artery disease. The hospital settled the case for $1 million and allocated major responsibility to the treating emergency physician (EP. As a result the state medical board named the EP in a disciplinary action, claiming negligence because the EKG had not been personally interpreted by that physician. A formal hearing was conducted with the EP’s medical license placed in jeopardy. This case illustrates the risk to EPs who treat patients in crowded hallways, where it is difficult to provide the highest level of care. This case also demonstrates the failure of hospital administration to accept responsibility and provide resources to the ED to ensure patient safety. [West J Emerg Med. 2014;15(2:137–141.
Rangel, Erika L; Rios-Diaz, Arturo J; Uyeda, Jennifer W; Castillo-Angeles, Manuel; Cooper, Zara; Olufajo, Olubode A; Salim, Ali; Sodickson, Aaron D
Frailty is associated with poor surgical outcomes in elderly patients but is difficult to measure in the emergency setting. Sarcopenia, or the loss of lean muscle mass, is a surrogate for frailty and can be measured using cross-sectional imaging. We sought to determine the impact of sarcopenia on 1-year mortality after emergency abdominal surgery in elderly patients. Sarcopenia was assessed in patients 70 years or older who underwent emergency abdominal surgery at a single hospital from 2006 to 2011. Average bilateral psoas muscle cross-sectional area at L3, normalized for height (Total Psoas Index [TPI]), was calculated using computed tomography. Sarcopenia was defined as TPI in the lowest sex-specific quartile. Primary outcome was mortality at 1 year. Secondary outcomes were in-hospital mortality and mortality at 30, 90, and 180 days. The association of sarcopenia with mortality was assessed using Cox proportional hazards regression and model performance judged using Harrell's C-statistic. Two hundred ninety-seven of 390 emergency abdominal surgery patients had preoperative imaging and height. The median age was 79 years, and 1-year mortality was 32%. Sarcopenic and nonsarcopenic patients were comparable in age, sex, race, comorbidities, American Society of Anesthesiologists classification, procedure urgency and type, operative severity, and need for discharge to a nursing facility. Sarcopenic patients had lower body mass index, greater need for intensive care, and longer hospital length of stay (p Sarcopenia was independently associated with increased in-hospital mortality (risk ratio, 2.6; 95% confidence interval [CI], 1.6-3.7) and mortality at 30 days (hazard ratio [HR], 3.7; 95% CI, 1.9-7.4), 90 days (HR, 3.3; 95% CI, 1.8-6.0), 180 days (HR, 2.5; 95% CI, 1.4-4.4), and 1 year (HR, 2.4; 95% CI, 1.4-3.9). Sarcopenia is associated with increased risk of mortality over 1 year in elderly patients undergoing emergency abdominal surgery. Sarcopenia defined by TPI is
Ballard, Elizabeth D; Cwik, Mary; Van Eck, Kathryn; Goldstein, Mitchell; Alfes, Clarissa; Wilson, Mary Ellen; Virden, Jane M; Horowitz, Lisa M; Wilcox, Holly C
The pediatric emergency department (ED) is a critical location for the identification of children and adolescents at risk for suicide. Screening instruments that can be easily incorporated into clinical practice in EDs to identify and intervene with patients at increased suicide risk is a promising suicide prevention strategy and patient safety objective. This study is a retrospective review of the implementation of a brief suicide screen for pediatric psychiatric ED patients as standard of care. The Ask Suicide Screening Questions (ASQ) was implemented in an urban pediatric ED for patients with psychiatric presenting complaints. Nursing compliance rates, identification of at-risk patients, and sensitivity for repeated ED visits were evaluated using medical records from 970 patients. The ASQ was implemented with a compliance rate of 79 %. Fifty-three percent of the patients who screened positive (237/448) did not present to the ED with suicide-related complaints. These identified patients were more likely to be male, African American, and have externalizing behavior diagnoses. The ASQ demonstrated a sensitivity of 93 % and specificity of 43 % to predict return ED visits with suicide-related presenting complaints within 6 months of the index visit. Brief suicide screening instruments can be incorporated into standard of care in pediatric ED settings. Such screens can identify patients who do not directly report suicide-related presenting complaints at triage and who may be at particular risk for future suicidal behavior. Results have the potential to inform suicide prevention strategies in pediatric EDs.
In a mass casualty event, there will be at-risk populations that will require unique triage, treatment and consequence management to minimise immediate and long-term health effects. This statement is particularly true for radiological/nuclear (R/N) disasters where individuals exhibit a broad range of physiological responses to radiation exposure. For example, immunocompromised individuals will experience more detrimental radiation health effects; however, it is not always possible to definitively identify these individuals at the time of triage. Immediate and long-term consequence management for these individuals may require unique and potentially limited resources. Thus, at the time of an R/N event, it is crucial to assist community planners by: (a) rapidly identifying at-risk individuals who may have been exposed; (b) determining the dose and individual-specific health risks associated with radiation exposure; (c) identifying additional resources needed to deal with unique, population-specific requirements; and (d) developing treatment strategies in keeping with the rules of 'supply and demand'. A comprehensive approach to identifying issues relevant to the R/N emergency preparedness for dealing with at-risk populations will be discussed with the aim of defining future research objectives. (authors)
Gololobov, Alik; Todris, Liat; Berman, Yakov; Rosenberg-Gilad, Zipi; Schlaeffer, Pnina; Kenett, Ron; Ben-Jacob, Ron; Segal, Eran
Emergence delirium (ED) is a common problem among children and adults recovering from general anesthesia after surgery. Its symptoms include psychomotor agitation, hallucinations, and aggressive behavior. The phenomenon, which is most probably an adverse effect of general anesthesia agents, harms the recovery process and endangers the physical safety of patients and their health. Ranging between 10% and 80%, the exact prevalence of ED is unknown, and the risk factors of the phenomenon are unclear. The aim of the current retrospective study was to determine the prevalence rate of ED in 3947 children recovering from general anesthesia after short elective ambulatory surgery, and to map the influence of various risk factors on this phenomenon. Data were collected using electronic medical records. ED severity was assessed using the Pediatric Anesthesia Emergence Delirium Scale. Results showed the prevalence of ED among children. ED was significantly correlated with patients' age, type of surgery and premedication. ED was not correlated with severity of pain, type of anesthesia or with patients' sex.
Dropkin, Jonathan; Moline, Jacqueline; Power, Paul M; Kim, Hyun
Risk factors among Emergency Medical Service (EMS) workers are difficult to characterize and inconsistencies remain about their main health problems. To identify main work-related health problems among EMS workers in the United States; identify risk factors at the organizational, task, and exposure level; identify prevention strategies; examine these issues between participants (EMS workers and supervisors). Two types of qualitative research methods based on grounded theory were used: in-depth interviews with emergency medical technicians/paramedics (EMS workers) and focus groups (EMS workers and supervisors). Most participants reported similar health problems (musculoskeletal injuries) and the task related to these injuries, patient handling. Participants also reported similar physical exposures (ascending stairs with patients and patient weight). For organization/psychosocial factors, participants agreed that fitness, wages, breaks, and shift scheduling were linked with injuries, but overall, perceptions about these issues differed more than physical exposures. Lack of trust between EMS workers and supervisors were recurrent concerns among workers. However, not all organizational/psychosocial factors differed. EMS workers and supervisors agreed pre-employment screening could reduce injuries. Participants identified micro- and macro-level prevention opportunities. The grounded theory approach identified workers' main health problems, and the organizational factors and exposures linked with them. Perceptions about work organization/psychosocial exposures appeared more diverse than physical exposures. Prevention among all participants focused on mechanized equipment, but EMS workers also wanted more organizational support.
McGuire, Jason M
The purpose of this research was to identify the incidence and potential risk factors for emergence delirium (ED) in a U.S. military combat veteran surgical population at Naval Hospital Camp Pendleton. ED is a postanesthetic phenomenon that occurs immediately after emergence from general anesthesia and is characterized by agitation, confusion, and violent behavior. Clinical evidence suggests that ED is increasingly seen among military personnel returning from the wars in Iraq and Afghanistan, and that the incidence of anxiety, depression, and post-traumatic stress disorder (PTSD) are higher in this population than in noncombat troops or nonmilitary populations. The incidence of ED in this sample of 130 postoperative military personnel with combat exposure was 20% (n=26). Those previously diagnosed with a psychological disorder had a higher rate of ED (50%) than those who did not (17.5%), χ(2)=5.53, PPTSD symptoms, and depression [state anxiety: r(128)=0.40, PPTSD: r(128)=0.35, PPTSD, and depression as risk factors. Regression modeling suggested that state-anxiety served as the best predictor. These findings increase clinicians' understanding of ED among combat veterans and give direction to future studies that should focus on preventive treatment. Published by Elsevier Inc.
Analytical laboratories can now identify and quantify an impressive number of "new" pollutants present at very low concentrations in water. Nanotechnology products are a new cause for concern. " Emerging " pollutants are defined as substances that were not previously sought or detected (plasticizers, drugs, chlorination byproducts, persistant organic pollutants, ...) and that are now being identified in many continental water resources. The biological actions of these substances, alone and in combination with other more " classical "pollutants, include such effects as endocrine disruption. Contaminants may be present in surface and groundwater resources, may be generated during treatment, and are found in drinking water distribution networks. In industrialized countries, the main source of emerging pollutants for humans is not water, but rather food, cosmetics and air. Urgent measures are needed to protect biodiversity and human health, including quantitative risk assessment, toxicologic studies of xenobiotic mixtures and chronic effects, strategies to protect water resources, technological advances in wastewater treatment, reliable potable water production, and new inert materials for transport and storage. Good sanitation and safe tap water are major contributors to human health and well-being Major efforts and investments are needed, based on rigorous, objective assessments of risks for the environment and public health.
Tseng, H.; Giambelluca, T. W.; DeLay, J. K.; Nullet, M.
Steep climate gradients and diverse ecosystems make the Hawaiian Islands an ideal laboratory for ecohydrological experiments. Researchers are able to control physical and ecological variables, which is difficult for most environmental studies, by selecting sites along these gradients. Tropical montane forests, especially those situated in the cloud zone, are known to improve recharge and sustain baseflow. This is probably the result of frequent and persistent fog characteristic to these systems. During fog events, evapotranspiration is suppressed due to high humidity and reduced solar radiation. Moreover, cloud water interception by the forest canopy can produce fog drip and contribute significantly to the local water budget. Because the interception process is a complex interaction between the atmosphere and the vegetation, the effects of the meteorological conditions and canopy characteristics are equally important and sometimes hard to separate. This study aims to examine patterns in cloud water interception and canopy water balance across five tropical montane forest sites on three of the main islands of Hawaii. The sites cover a range of elevations between 1100- 2114 m, annual rainfall between 1155-3375 mm, and different dominant plant species with canopy heights ranging from 1.5 m to 30 m. We investigate the effect of climatic factors by comparing passive fog gauge measurements and other meteorological variables, then examine the differences in canopy water balance by comparing throughfall and stemflow measurements at these sites. While this study is ongoing, we present the first few months of field observations and the results of preliminary analyses. This study will improve understanding of how large-scale climate and vegetation factors interact to control cloud water interception and will inform ongoing watershed management. This is particularly important for oceanic islands such as Hawaii because they rely on precipitation entirely for water supply and
Alsirafy, Samy A; Raheem, Ahmad A; Al-Zahrani, Abdullah S; Mohammed, Amrallah A; Sherisher, Mohamed A; El-Kashif, Amr T; Ghanem, Hafez M
Frequent emergency department visits (EDVs) by patients with terminal cancer indicates aggressive care. The pattern and causes of EDVs in 154 patients with terminal cancer were investigated. The EDVs that started during working hours and ended by home discharge were considered avoidable. During the last 3 months of life, 77% of patients had at least 1 EDV. In total, 309 EDVs were analyzed. The EDVs occurred out of hour in 67%, extended for an average of 3.6 hours, and ended by hospitalization in 52%. The most common chief complaints were pain (46%), dyspnea (13%), and vomiting (12%). The EDVs were considered avoidable in 19% of the visits. The majority of patients with terminal cancer visit the ED before death, mainly because of uncontrolled symptoms. A significant proportion of EDVs at the end of life is potentially avoidable. © The Author(s) 2015.
Kärtner, Joscha; Keller, Heidi; Yovsi, Relindis D
This study analyzed German and Nso mothers' auditory, proximal, and visual contingent responses to their infants' nondistress vocalizations in postnatal Weeks 4, 6, 8, 10, and 12. Visual contingency scores increased whereas proximal contingency scores decreased over time for the independent (German urban middle-class, N = 20) but not the interdependent sociocultural context (rural Nso farmers, N = 24). It seems, therefore, that culture-specific differences in the modal patterns of contingent responsiveness emerge during the 2nd and 3rd months of life. This differential development was interpreted as the result of the interplay between maturational processes associated with the 2-month shift that are selectively integrated and reinforced in culture-specific mother-infant interaction.
Cohen, Oded; Shoffel-Havakuk, Hagit; Warman, Meir; Tzelnick, Sharon; Haimovich, Yaara; Kohlberg, Gavriel D; Halperin, Doron; Lahav, Yonatan
Objective Epistaxis is a common complaint, yet few studies have focused on the incidence and risk factors of recurrent epistaxis. Our objective was to determine the patterns of incidence and risk factors for recurrent epistaxis admission (REA). Study Design Case series with chart review. Settings Single academic center. Subjects and Methods The medical records of patients admitted for epistaxis between 1999 and 2015 were reviewed. The follow-up period was defined as 3 years following initial admission. REAs were categorized as early (30 days) and late (31 days to 3 years) following initial admission. Logistic regression was used to identify potential predictors of REAs. Results A total of 653 patients were included. Eighty-six patients (14%) had REAs: 48 (7.5%) early and 38 (6.5%) late. Nonlinear incidence curve was demonstrated for both early and late REAs. Based on logistic regression, prior nasal surgery and anemia were independent risk factors for early REAs. According to multivariate analysis, thrombocytopenia was significantly associated with late REAs. Conclusion Early and late REAs demonstrate different risk predictors. Knowledge of such risk factors may help in risk stratification for this selected group of patients. All patients at risk should be advised on possible preventive measures. Patients at risk for early REA may benefit from a more proactive approach.
Stefani, Eduardo De; Deneo-Pellegrini, Hugo; Ronco, Alvaro L; Correa, Pelayo; Boffetta, Paolo; Aune, Dagfinn; Acosta, Gisele; Mendilaharsu, Maria; Luaces, Maria E; Lando, Gabriel; Silva, Cecilia
In the time period 1996-2004, a case-control study of colorectal cancer was conducted in Montevideo, Uruguay. The study included 610 cases and 1,220 controls, frequency matched for age, sex, and residence. All cases were newly diagnosed and microscopically confirmed and controls were drawn from the same hospitals. Controls were submitted to factor analysis (principal components method) and 4 dietary patterns for men (prudent, traditional, Western, drinker) and 3 for women (prudent, Western, drinker) were retained. These were rotated and normalized by the Kaiser method. Scores were applied to all participants (cases and controls) and odds ratios were estimated by logistic regression and polynomial regression. The Western pattern showed an OR of 2.62 (95 % CI 1.36-5.08) for colon cancer among men, and women displayed a similar increase in risk. However, rectal cancer was not associated with this diet, rather being inversely associated with the prudent and traditional patterns among men (OR 0.49, 95 % CI 0.28-0.57 for the traditional pattern). In conclusion, whereas the Western pattern was directly associated with colon cancer, the prudent pattern was strongly protective for rectal cancer.
Wilk, S; Siegl, L; Siegl, K; Hohenstein, C
In an analysis of a critical incident reporting system (CIRS) in out-of-hospital emergency medicine, it was demonstrated that in 30% of cases deficient communication led to a threat to patients; however, the analysis did not show what exactly the most dangerous work processes are. Current research shows the impact of poor communication on patient safety. An out-of-hospital workflow analysis collects data about key work processes and risk areas. The analysis points out confounding factors for a sufficient communication. Almost 70% of critical incidents are based on human factors. Factors, such as communication and teamwork have an impact but fatigue, noise levels and illness also have a major influence. (I) CIRS database analysis The workflow analysis was based on 247 CIRS cases. This was completed by participant observation and interviews with emergency doctors and paramedics. The 247 CIRS cases displayed 282 communication incidents, which are categorized into 6 subcategories of miscommunication. One CIRS case can be classified into different categories if more communication incidents were validated by the reviewers and four experienced emergency physicians sorted these cases into six subcategories. (II) Workflow analysis The workflow analysis was carried out between 2015 and 2016 in Jena and Berlin, Germany. The focal point of research was to find accumulation of communication risks in different parts of prehospital patient care. During 30 h driving with emergency ambulances, the author interviewed 12 members of the emergency medical service of which 5 were emergency physicians and 7 paramedics. A total of 11 internal medicine cases and one automobile accident were monitored. After patient care the author asked in a 15-min interview if miscommunication or communication incidents occurred. (I) CIRS analysis Between 2005 and 2015, 845 reports were reported to the database. The experts identified 247 incident reports with communication failure. All
Weidner, Jeanne Margaret O'malley
This study was motivated by some of the claims that are found in the literature on Problem-Based Learning (PBL). This instructional technique, which uses case studies as its primary instructional tool, has been advanced as an alternative to traditional instruction in order to foster more meaningful, integrative learning of scientific concepts. Several of the advantages attributed to Problem-Based Learning are that it (1) is generally preferred by students because it appears to foster a more nurturing and enjoyable learning experience, (2) fosters greater retention of knowledge and concepts acquired, and (3) results in increased ability to apply this knowledge toward solving new problems. This study examines the differences that result when students learn neuroanatomy concepts under two instructional contexts: problem solving vs. information gathering. The technological resource provided to students to support learning under each of these contexts was the multimedia program BrainStorm: An Interactive Neuroanatomy Atlas (Coppa & Tancred, 1995). The study explores the influence of context with regard to subjects' performance on objective post-tests, organization of knowledge as measured by Pathfinder Networks, differential use of the multimedia software and discourse differences emerging from the transcripts. The findings support previous research in the literature that problem-solving results in less knowledge acquisition in the short term, greater retention of material over time, and a subjects' preference for the method. However, both the degree of retention and preference were influenced by subjects' prior knowledge of the material in the exercises, as there was a significant difference in performance between the two exercises: for the exercise about which subjects appeared to have greater background information, memory decay was less, and subject attitude toward the problem solving instructional format was more favorable, than for the exercise for which subjects
Ndukwu, C I; Onah, S K
Nigeria is still battling with preventable childhood deaths, being one of the six countries in which 50% of all global child deaths occur. Regular community and health facility audits are needed to determine morbidity and mortality patterns in children which will guide preventive and therapeutic interventions. The objective was to determine morbidity and mortality patterns, and identify factors influencing poor outcome of the disease in children seen in the emergency room of Nnamdi Azikiwe University Teaching Hospital, Nnewi. This was a 2-year retrospective study (March 2012 to February 2014) involving all children admitted into the children emergency room (CHER). Information on the patients' biodata, diagnosis, and outcome were retrieved from the CHER doctors' log. Analysis was done using Microsoft Office Excel 2007 and Statistical Package for Social Sciences version 20. The total of 1964 patients were seen (1088 males, 845 females, 31 unspecified) with a male to female ratio of 1.3:1. Under-fives constituted 78.8% of the study population. Mean duration of illness before presentation was 18.71 ± 71.94 days. Malaria, diarrheal disease, and respiratory tract infections were the most common morbidities. Sepsis had the highest case fatality rate (CFR) and was the most common cause of death among the 247 patients that died - mortality rate of 12.6%. Most deaths were in under-fives (CFR = 13.9, χ2 = 25.553, P = 0.000), with 74.1% of the mortalities occurring within 24 h of presentation. Patients who presented within a day and those that presented in the 2 nd and 3 rd weeks of onset of symptoms had CFR of 6.4-15.2%, respectively. Infectious diseases remain a menace in our environment with the eventual outcome worsened by late presentation to an appropriate health facility. There is an urgent need to create public awareness on the need to seek prompt medical attention for sick children.
Baken, Kirsten A; Sjerps, Rosa M A; Schriks, Merijn; van Wezel, Annemarie P
Toxicological risk assessment of contaminants of emerging concern (CEC) in (sources of) drinking water is required to identify potential health risks and prioritize chemicals for abatement or monitoring. In such assessments, concentrations of chemicals in drinking water or sources are compared to either (i) health-based (statutory) drinking water guideline values, (ii) provisional guideline values based on recent toxicity data in absence of drinking water guidelines, or (iii) generic drinking water target values in absence of toxicity data. Here, we performed a toxicological risk assessment for 163 CEC that were selected as relevant for drinking water. This relevance was based on their presence in drinking water and/or groundwater and surface water sources in downstream parts of the Rhine and Meuse, in combination with concentration levels and physicochemical properties. Statutory and provisional drinking water guideline values could be derived from publically available toxicological information for 142 of the CEC. Based on measured concentrations it was concluded that the majority of substances do not occur in concentrations which individually pose an appreciable human health risk. A health concern could however not be excluded for vinylchloride, trichloroethene, bromodichloromethane, aniline, phenol, 2-chlorobenzenamine, mevinphos, 1,4-dioxane, and nitrolotriacetic acid. For part of the selected substances, toxicological risk assessment for drinking water could not be performed since either toxicity data (hazard) or drinking water concentrations (exposure) were lacking. In absence of toxicity data, the Threshold of Toxicological Concern (TTC) approach can be applied for screening level risk assessment. The toxicological information on the selected substances was used to evaluate whether drinking water target values based on existing TTC levels are sufficiently protective for drinking water relevant CEC. Generic drinking water target levels of 37 μg/L for
Hyun Ja Lim
Full Text Available Objective To identify significant risk factors associated with repeat emergency department (ED. Visits for violent injuries in youth firearm victims. Methods The study subjects of this retrospective cohort study were firearm victims aged 18 and younger presenting to a Pediatric Emergency Department/Trauma Center at Children's Hospital of Wisconsin between 1990 and 1995. The primary outcome was subsequent Emergency Department visits (REDV at any emergency department in Milwaukee for a violent injury. Results A total of 495 subjects were eligible for the present study in the pediatric firearm victim's ED visit database. Eighty-five percent (n = 420 were males and 82% were African-Americans. Mean age was 15 years old (s.d = ±3.6. A majority of them had a single-parent family. Eighty-eight subjects (17.8% had a prior history of ED visit due to violence. During the study time, 201 subjects had at least one REDV. In the multivariable model, a subject without a social worker consulting at the hospital were more likely to have REDV compared to subjects with a social worker consulting (O.R = 1.749; p-value = 0.047, controlling for guardian and disposition. Subjects disposed to detention center or police custody were more likely to have REDV compared to subjects disposed to home or a hospital (O.R = 5.351; p-value = 0.003. Conclusion Our analysis indicates that individuals with guardians, those who did not receive social worker intervention on their initial visit, and those discharged in police custody were associated with increased repeat ED visits due to a violent injury.
Jacome-Sosa, Miriam; Parks, Elizabeth J; Bruno, Richard S; Tasali, Esra; Lewis, Gary F; Schneeman, Barbara O; Rains, Tia M
Cardiovascular disease (CVD) is the leading cause of death in the United States. Although the role of habitual lifestyle factors such as physical activity and dietary patterns in increasing CVD risk has long been appreciated, less is known about how acute daily activities may cumulatively contribute to long-term disease risk. Here, the term acute refers to metabolic responses occurring in a short period of time after eating, and the goal of this article is to review recently identified stressors that can occur after meals and during the sleep-wake cycle to affect macronutrient metabolism. It is hypothesized that these events, when repeated on a regular basis, contribute to the observed long-term behavioral risks identified in population studies. In this regard, developments in research methods have supported key advancements in 3 fields of macronutrient metabolism. The first of these research areas is the focus on the immediate postmeal metabolism, spanning from early intestinal adsorptive events to the impact of incretin hormones on these events. The second topic is a focus on the importance of meal components on postprandial vasculature function. Finally, some of the most exciting advances are being made in understanding dysregulation in metabolism early in the day, due to insufficient sleep, that may affect subsequent processing of nutrients throughout the day. Key future research questions are highlighted which will lead to a better understanding of the relations between nocturnal, basal (fasting), and early postmeal events, and aid in the development of optimal sleep and targeted dietary patterns to reduce cardiometabolic risk. © 2016 American Society for Nutrition.
Studies of uranium miners conducted since the late 1960s demonstrated that the risk depends on cumulated exposure in terms of working level months (WLM) integrating both duration of exposure and concentration of radon. It has been also demonstrated that the risk from radon decreases with time since exposure. The present analysis of temporal changes of relative risk is based on a model where the total individual exposure is partitioned into components in dependence on time. Exposure to radon is studied in a cohort of 9411 Czech uranium miners with 766 cases of lung cancer and in a residential study of 11 803 inhabitants exposed to radon in houses with 218 cases. In addition, temporal patterns of the risk from smoking are analyzed in a case-control study of patients from a major Prague hospital including 566 cases. For both carcinogens, the relative risk decreases with time since exposure. The risk from exposures before 20-34 years is 36% and 34% in comparison to period 5-19 for smoking and radon, respectively. The effect of exposures from more distant periods 35-49 is only 5% for smoking and 14% for radon in comparison to 5-19 years. This substantial decrease of relative risk with time may contribute to a better evaluation of remediation measures taken in houses and in the cost effectiveness of remediation. Combined effect of smoking and radon is studied by a nested case-control approach including 434 cases and 962 controls. Analyses of the joint effects of smoking and radon, conducted in the occupational and the residential studies, suggest a sub-multiplicative interaction. The relative risk from radon among non-smokers is higher by a factor of 2-3 in comparison to smokers, suggesting different patterns of lung deposition and clearance among smokers and non-smokers. (author)
Michael M. Neeki
Full Text Available Introduction: Necrotizing fasciitis (NF is an uncommon but rapidly progressive infection that results in gross morbidity and mortality if not treated in its early stages. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC score is used to distinguish NF from other soft tissue infections such as cellulitis or abscess. This study analyzed the ability of the LRINEC score to accurately rule out NF in patients who were confirmed to have cellulitis, as well as the capability to differentiate cellulitis from NF. Methods: This was a 10-year retrospective chart-review study that included emergency department (ED patients ≥18 years old with a diagnosis of cellulitis or NF. We calculated a LRINEC score ranging from 0–13 for each patient with all pertinent laboratory values. Three categories were developed per the original LRINEC score guidelines denoting NF risk stratification: high risk (LRINEC score ≥8, moderate risk (LRINEC score 6–7, and low risk (LRINEC score ≤5. All cases missing laboratory values were due to the absence of a C-reactive protein (CRP value. Since the score for a negative or positive CRP value for the LRINEC score was 0 or 4 respectively, a LRINEC score of 0 or 1 without a CRP value would have placed the patient in the “low risk” group and a LRINEC score of 8 or greater without CRP value would have placed the patient in the “high risk” group. These patients missing CRP values were added to these respective groups. Results: Among the 948 ED patients with cellulitis, more than one-tenth (10.7%, n=102 of 948 were moderate or high risk for NF based on LRINEC score. Of the 135 ED patients with a diagnosis of NF, 22 patients had valid CRP laboratory values and LRINEC scores were calculated. Among the other 113 patients without CRP values, six patients had a LRINEC score ≥ 8, and 19 patients had a LRINEC score ≤ 1. Thus, a total of 47 patients were further classified based on LRINEC score without a CRP value
Ohsfeldt Robert L
Full Text Available Abstract Background It is well known that older adults figure prominently in the use of emergency departments (ED across the United States. Previous research has differentiated ED visits by levels of clinical severity and found health status and other individual characteristics distinguished severe from non-severe visits. In this research, we classified older adults into population groups that persistently present with severe, non-severe, or indeterminate patterns of ED episodes. We then contrasted the three groups using a comprehensive set of covariates. Methods Using a unique dataset linking individual characteristics with Medicare claims for calendar years 1991-2007, we identified patterns of ED use among the large, nationally representative AHEAD sample consisting of 5,510 older adults. We then classified one group of older adults who persistently presented to the ED with clinically severe episodes and another group who persistently presented to the ED with non-severe episodes. These two groups were contrasted using logistic regression, and then contrasted against a third group with a persistent pattern of ED episodes with indeterminate levels of severity using multinomial logistic regression. Variable selection was based on Andersen's behavioral model of health services use and featured clinical status, demographic and socioeconomic characteristics, health behaviors, health service use patterns, local health care supply, and other contextual effects. Results We identified 948 individuals (17.2% of the entire sample who presented a pattern in which their ED episodes were typically defined as severe and 1,076 individuals (19.5% who typically presented with non-severe episodes. Individuals who persistently presented to the ED with severe episodes were more likely to be older (AOR 1.52, men (AOR 1.28, current smokers (AOR 1.60, experience diabetes (AOR (AOR 1.80, heart disease (AOR 1.70, hypertension (AOR 1.32 and have a greater amount of
Kaskie, Brian; Obrizan, Maksym; Jones, Michael P; Bentler, Suzanne; Weigel, Paula; Hockenberry, Jason; Wallace, Robert B; Ohsfeldt, Robert L; Rosenthal, Gary E; Wolinsky, Fredric D
It is well known that older adults figure prominently in the use of emergency departments (ED) across the United States. Previous research has differentiated ED visits by levels of clinical severity and found health status and other individual characteristics distinguished severe from non-severe visits. In this research, we classified older adults into population groups that persistently present with severe, non-severe, or indeterminate patterns of ED episodes. We then contrasted the three groups using a comprehensive set of covariates. Using a unique dataset linking individual characteristics with Medicare claims for calendar years 1991-2007, we identified patterns of ED use among the large, nationally representative AHEAD sample consisting of 5,510 older adults. We then classified one group of older adults who persistently presented to the ED with clinically severe episodes and another group who persistently presented to the ED with non-severe episodes. These two groups were contrasted using logistic regression, and then contrasted against a third group with a persistent pattern of ED episodes with indeterminate levels of severity using multinomial logistic regression. Variable selection was based on Andersen's behavioral model of health services use and featured clinical status, demographic and socioeconomic characteristics, health behaviors, health service use patterns, local health care supply, and other contextual effects. We identified 948 individuals (17.2% of the entire sample) who presented a pattern in which their ED episodes were typically defined as severe and 1,076 individuals (19.5%) who typically presented with non-severe episodes. Individuals who persistently presented to the ED with severe episodes were more likely to be older (AOR 1.52), men (AOR 1.28), current smokers (AOR 1.60), experience diabetes (AOR (AOR 1.80), heart disease (AOR 1.70), hypertension (AOR 1.32) and have a greater amount of morbidity (AOR 1.48) than those who persistently
Ball, Chad G; Ball, Jill E; Kirkpatrick, Andrew W; Mulloy, Robert H
Horseback riding is more dangerous than motorcycle riding, skiing, football, and rugby. The purpose of this study was to identify the incidence and injury patterns, as well as risk factors associated with severe equestrian trauma. All patients with major equestrian injuries (injury severity score > or = 12) admitted between 1995 and 2005 were reviewed. A 46-question survey outlining potential rider, animal, and environmental risk factors was administered. Among 7941 trauma patients, 151 (2%) were injured on horseback (mean injury severity score, 20; mortality rate, 7%). Injuries included the chest (54%), head (48%), abdomen (22%), and extremities (17%). Forty-five percent required surgery. Survey results (55%) indicated that riders and horses were well trained, with a 47% recidivism rate. Only 9% of patients wore helmets, however, 64% believed the accident was preventable. Chest trauma previously has been underappreciated. This injury pattern may be a result of significant rider experience. Helmet and vest use will be targeted in future injury prevention strategies.
Mikkilä, V; Räsänen, L; Raitakari, O T; Pietinen, P; Viikari, J
Dietary patterns are useful in nutritional epidemiology, providing a comprehensive alternative to the traditional approach based on single nutrients. The Cardiovascular Risk in Young Finns Study is a prospective cohort study with a 21-year follow-up. At baseline, detailed quantitative information on subjects' food consumption was obtained using a 48 h dietary recall method (n 1768, aged 3-18 years). The interviews were repeated after 6 and 21 years (n 1200 and n 1037, respectively). We conducted a principal component analysis to identify major dietary patterns at each study point. A set of two similar patterns was recognised throughout the study. Pattern 1 was positively correlated with consumption of traditional Finnish foods, such as rye, potatoes, milk, butter, sausages and coffee, and negatively correlated with fruit, berries and dairy products other than milk. Pattern 1 type of diet was more common among male subjects, smokers and those living in rural areas. Pattern 2, predominant among female subjects, non-smokers and in urban areas, was characterised by more health-conscious food choices such as vegetables, legumes and nuts, tea, rye, cheese and other dairy products, and also by consumption of alcoholic beverages. Tracking of the pattern scores was observed, particularly among subjects who were adolescents at baseline. Of those originally belonging to the uppermost quintile of pattern 1 and 2 scores, 41 and 38 % respectively, persisted in the same quintile 21 years later. Our results suggest that food behaviour and concrete food choices are established already in childhood or adolescence and may significantly track into adulthood.
Cunha, Carla de Magalhães; Costa, Priscila R F; de Oliveira, Lucivalda P M; Queiroz, Valterlinda A de O; Pitangueira, Jacqueline C D; Oliveira, Ana Marlúcia
This study systematised and synthesised the results of observational studies that were aimed at supporting the association between dietary patterns and cardiometabolic risk (CMR) factors among adolescents. Relevant scientific articles were searched in PUBMED, EMBASE, SCIENCE DIRECT, LILACS, WEB OF SCIENCE and SCOPUS. Observational studies that included the measurement of any CMR factor in healthy adolescents and dietary patterns were included. The search strategy retained nineteen articles for qualitative analysis. Among retained articles, the effects of dietary pattern on the means of BMI (n 18), waist circumference (WC) (n 9), systolic blood pressure (n 7), diastolic blood pressure (n 6), blood glucose (n 5) and lipid profile (n 5) were examined. Systematised evidence showed that an unhealthy dietary pattern appears to be associated with poor mean values of CMR factors among adolescents. However, evidence of a protective effect of healthier dietary patterns in this group remains unclear. Considering the number of studies with available information, a meta-analysis of anthropometric measures showed that dietary patterns characterised by the highest intake of unhealthy foods resulted in a higher mean BMI (0·57 kg/m²; 95 % CI 0·51, 0·63) and WC (0·57 cm; 95 % CI 0·47, 0·67) compared with low intake of unhealthy foods. Controversially, patterns characterised by a low intake of healthy foods were associated with a lower mean BMI (-0·41 kg/m²; 95 % CI -0·46,-0·36) and WC (-0·43 cm; 95 % CI -0·52,-0·33). An unhealthy dietary pattern may influence markers of CMR among adolescents, but considering the small number and limitations of the studies included, further studies are warranted to strengthen the evidence of this relation.
Erben, Vanessa; Carr, Prudence R; Holleczek, Bernd; Stegmaier, Christa; Hoffmeister, Michael; Brenner, Hermann
Specific components of the diet such as red and processed meat have been associated with the risk of developing colorectal cancer. However, evidence on the association of dietary patterns with colorectal neoplasms is sparse. The aim of this study was to analyze the association of dietary patterns with prevalence of advanced colorectal neoplasms among older adults in Germany. A cross-sectional study was conducted among participants of screening colonoscopy in Saarland, Germany, who were enrolled in the KolosSal study (Effektivität der Früherkennungs-Koloskopie: eine Saarland-weite Studie) from 2005 to 2013. Information on diet and lifestyle factors was obtained through questionnaires and colonoscopy results were extracted from physicians' reports. Associations of a priori defined dietary patterns (vegetarian or adapted versions of the Healthy Eating Index [HEI] and the Dietary Approaches to Stop Hypertension [DASH] index) with the risk of advanced colorectal neoplasms were assessed by multiple logistic regression analyses with comprehensive adjustment for potential confounders. A total of 14,309 participants were included (1561 with advanced colorectal neoplasms). Healthier eating behavior was associated with lower prevalence of advanced colorectal neoplasms in a dose-response manner. Adjusted odds ratios (95% confidence intervals) comparing the highest with the lowest categories of adapted HEI and DASH were 0.61 (0.50, 0.76) and 0.70 (0.55, 0.89), respectively. No significant associations were observed for a vegetarian eating pattern (adjusted OR 0.80 (0.55, 1.17)). Healthy dietary patterns, as described by a high HEI or DASH score, but not a vegetarian diet alone, are associated with reduced risk of advanced colorectal neoplasms. Copyright © 2018 Elsevier Inc. All rights reserved.
Victoria L. Thornton
Full Text Available Introduction: Patients with sickle cell disease (SCD often seek care in emergency departments (EDs for severe pain. However, there is evidence that they experience inaccurate assessment, suboptimal care, and inadequate follow-up referrals. The aim of this project was to 1 explore the feasibility of applying a failure modes, effects and criticality analysis (FMECA in two EDs examining four processes of care (triage, analgesic management, high risk/high users, and referrals made for patients with SCD, and 2 report the failures of these care processes in each ED. Methods: A FMECA was conducted of ED SCD patient care at two hospitals. A multidisciplinary group examined each step of four processes. Providers identified failures in each step, and then characterized the frequency, impact, and safeguards, resulting in risk categorization. Results: Many “high risk” failures existed in both institutions, including a lack of recognition of high-risk or high-user patients and a lack of emphasis on psychosocial referrals. Specific to SCD analgesic management, one setting inconsistently used existing analgesic policies, while the other setting did not have such policies. Conclusion: FMECA facilitated the identification of failures of ED SCD care and has guided quality improvement activities. Interventions can focus on improvements in these specific areas targeting improvements in the delivery and organization of ED SCD care. Improvements should correspond with the forthcoming National Heart, Lung and Blood-sponsored guidelines for treatment of patients with sickle cell disease. [West J Emerg Med. 2014;15(4:446–458.
Lawrence Mpele Lekhanya
Full Text Available This paper examines risks and critical factors contributing to the rural entrepreneurial orientation growth of businesses. The concept of entrepreneurial orientation and various factors influencing the rural entrepreneurial orientation growth are still not well known. The study aimed to assess risks and critical factors affecting rural entrepreneurial orientation growth of businesses. Questionnaire was developed and used to collect primary data from 127 rural entrepreneurs. The sample was made with small and medium entrepreneurs operating in rural places. They were selected using quota sampling, with respondents completing a questionnaire with the assistance of an interviewer. The study used quantitative technique for data collection. SPSS (23.0 version was used for data analysis and scientific statistical significance level found to be (.000* at the Cronbach’s alpha (.791* reliability. Results of the survey reveal that majority indicates competition as a big challenge for them. Findings further indicate that competitor is due to the small market and lack of products differentiation. This study introduces an additional literature in the field of entrepreneurship with specific reference to rural entrepreneurship. The paper will benefit rural entrepreneurs, entrepreneurial marketing managers, potential young entrepreneurs, business consultants, policymakers, financial institutions, government agencies and all affiliated stakeholders by introducing a new understanding of risks and various critical factors causative into rural entrepreneurial orientation growth of business in an emerging economy. Most work on the entrepreneurship development has concentrated in the urban areas with little emphasis on the rural places. The findings of this study limited by study’s exploratory, small sample and quantitative nature. Therefore, generalisation of results should be done with care and further research is encouraged and should aim at the development of
Perry, Jeffrey J; Losier, Justin H; Stiell, Ian G; Sharma, Mukul; Abdulaziz, Kasim
Five percent of transient ischemic attack (TIA) patients have a subsequent stroke within 7 days. The Canadian TIA Score uses clinical findings to calculate the subsequent stroke risk within 7 days. Our objectives were to assess 1) anticipated use; 2) component face validity; 3) risk strata for stroke within 7 days; and 4) actions required, for a given risk for subsequent stroke. After a rigorous development process, a survey questionnaire was administered to a random sample of 300 emergency physicians selected from those registered in a national medical directory. The surveys were distributed using a modified Dillman technique. From a total of 271 eligible surveys, we received 131 (48.3%) completed surveys; 96.2% of emergency physicians would use a validated Canadian TIA Score; 8 of 13 components comprising the Canadian TIA Score were rated as Very Important or Important by survey respondents. Risk categories for subsequent stroke were defined as minimal-risk: 10% risk of subsequent stroke within 7 days. A validated Canadian TIA Score will likely be used by emergency physicians. Most components of the TIA Score have high face validity. Risk strata are definable, which may allow physicians to determine immediate actions, based on subsequent stroke risk, in the emergency department.
Auestad, Nancy; Fulgoni, Victor L
The concept of sustainable diets, although not new, is gaining increased attention across the globe, especially in relation to projected population growth and growing concerns about climate change. As defined by the FAO (Proceedings of the International Scientific Symposium, Biodiversity and Sustainable Diets 2010; FAO 2012), “Sustainable diets are those diets with low environmental impacts which contribute to food and nutrition security and to healthy life for present and future generations.” Consistent and credible science that brings together agriculture, food systems, nutrition, public health, environment, economics, culture, and trade is needed to identify synergies and trade-offs and to inform guidance on vital elements of healthy, sustainable diets. The aim of this article is to review the emerging research on environmental and related economic impacts of dietary patterns, including habitual eating patterns, nutritionally balanced diets, and a variety of different dietary scenarios. Approaches to research designs, methodologies, and data sources are compared and contrasted to identify research gaps and future research needs. To date, it is difficult to assimilate all of the disparate approaches, and more concerted efforts for multidisciplinary studies are needed. PMID:25593141
Auestad, Nancy; Fulgoni, Victor L
The concept of sustainable diets, although not new, is gaining increased attention across the globe, especially in relation to projected population growth and growing concerns about climate change. As defined by the FAO (Proceedings of the International Scientific Symposium, Biodiversity and Sustainable Diets 2010; FAO 2012), "Sustainable diets are those diets with low environmental impacts which contribute to food and nutrition security and to healthy life for present and future generations." Consistent and credible science that brings together agriculture, food systems, nutrition, public health, environment, economics, culture, and trade is needed to identify synergies and trade-offs and to inform guidance on vital elements of healthy, sustainable diets. The aim of this article is to review the emerging research on environmental and related economic impacts of dietary patterns, including habitual eating patterns, nutritionally balanced diets, and a variety of different dietary scenarios. Approaches to research designs, methodologies, and data sources are compared and contrasted to identify research gaps and future research needs. To date, it is difficult to assimilate all of the disparate approaches, and more concerted efforts for multidisciplinary studies are needed. © 2015 American Society for Nutrition.
Kwan, M Y; Arbour-Nicitopoulos, K P; Duku, E; Faulkner, G
University and college campuses may be the last setting where it is possible to comprehensively address the health of a large proportion of the young adult population. It is important that health promoters understand the collective challenges students are facing, and to better understand the broader lifestyle behavioural patterning evident during this life stage. The purpose of this study was to examine the clustering of modifiable health-risk behaviours and to explore the relationship between these identified clusters and mental health outcomes among a large Canadian university sample. Undergraduate students (n = 837; mean age = 21 years) from the University of Toronto completed the National College Health Assessment survey. The survey consists of approximately 300 items, including assessments of student health status, mental health and health-risk behaviours. Latent class analysis was used to identify patterning based on eight salient health-risk behaviours (marijuana use, other illicit drug use, risky sex, smoking, binge drinking, poor diet, physical inactivity, and insufficient sleep). A three-class model based on student behavioural patterns emerged: "typical," "high-risk" and "moderately healthy." Results also found high-risk students reporting significantly higher levels of stress than typical students (χ2(1671) = 7.26, p Students with the highest likelihood of engaging in multiple health-risk behaviours reported poorer mental health, particularly as it relates to stress. Although these findings should be interpreted with caution due to the 28% response rate, they do suggest that interventions targeting specific student groups with similar patterning of multiple health-risk behaviours may be needed.
M. Y. Kwan
Full Text Available University and college campuses may be the last setting where it is possible to comprehensively address the health of a large proportion of the young adult population. It is important that health promoters understand the collective challenges students are facing, and to better understand the broader lifestyle behavioural patterning evident during this life stage. The purpose of this study was to examine the clustering of modifiable health-risk behaviours and to explore the relationship between these identified clusters and mental health outcomes among a large Canadian university sample. Methods: Undergraduate students (n = 837; mean age = 21 years from the University of Toronto completed the National College Health Assessment survey. The survey consists of approximately 300 items, including assessments of student health status, mental health and health-risk behaviours. Latent class analysis was used to identify patterning based on eight salient health-risk behaviours (marijuana use, other illicit drug use, risky sex, smoking, binge drinking, poor diet, physical inactivity, and insufficient sleep. Results: A three-class model based on student behavioural patterns emerged: "typical," "high-risk" and "moderately healthy." Results also found high-risk students reporting significantly higher levels of stress than typical students (χ2(1671 = 7.26, p < .01. Conclusion: Students with the highest likelihood of engaging in multiple health-risk behaviours reported poorer mental health, particularly as it relates to stress. Although these findings should be interpreted with caution due to the 28% response rate, they do suggest that interventions targeting specific student groups with similar patterning of multiple health-risk behaviours may be needed.
Deiner, Michael S; Lietman, Thomas M; McLeod, Stephen D; Chodosh, James; Porco, Travis C
Internet-based search engine and social media data may provide a novel complementary source for better understanding the epidemiologic factors of infectious eye diseases, which could better inform eye health care and disease prevention. To assess whether data from internet-based social media and search engines are associated with objective clinic-based diagnoses of conjunctivitis. Data from encounters of 4143 patients diagnosed with conjunctivitis from June 3, 2012, to April 26, 2014, at the University of California San Francisco (UCSF) Medical Center, were analyzed using Spearman rank correlation of each weekly observation to compare demographics and seasonality of nonallergic conjunctivitis with allergic conjunctivitis. Data for patient encounters with diagnoses for glaucoma and influenza were also obtained for the same period and compared with conjunctivitis. Temporal patterns of Twitter and Google web search data, geolocated to the United States and associated with these clinical diagnoses, were compared with the clinical encounters. The a priori hypothesis was that weekly internet-based searches and social media posts about conjunctivitis may reflect the true weekly clinical occurrence of conjunctivitis. Weekly total clinical diagnoses at UCSF of nonallergic conjunctivitis, allergic conjunctivitis, glaucoma, and influenza were compared using Spearman rank correlation with equivalent weekly data on Tweets related to disease or disease-related keyword searches obtained from Google Trends. Seasonality of clinical diagnoses of nonallergic conjunctivitis among the 4143 patients (2364 females [57.1%] and 1776 males [42.9%]) with 5816 conjunctivitis encounters at UCSF correlated strongly with results of Google searches in the United States for the term pink eye (ρ, 0.68 [95% CI, 0.52 to 0.78]; P < .001) and correlated moderately with Twitter results about pink eye (ρ, 0.38 [95% CI, 0.16 to 0.56]; P < .001) and with clinical diagnosis of influenza (ρ, 0
Boerleider, R. Z.; Olie, J. D N; van Eijkeren, J. C H; Bos, P. M J; Hof, B. G H; de Vries, I.; Bessems, J. G M; Meulenbelt, J.; Hunault, C. C.
Introduction: Physiologically based pharmacokinetic (PBPK) models may be useful in emergency risk assessment, after acute exposure to chemicals, such as dichloromethane (DCM). We evaluated the applicability of three PBPK models for human risk assessment following a single exposure to DCM: one model
Fowler, Patrick J.; Motley, Darnell; Zhang, Jinjin; Rolls-Reutz, Jennifer; Landsverk, John
In this longitudinal study, we tested whether adolescent maltreatment and out-of-home placement as a response to maltreatment altered developmental patterns of sexual risk behaviors in a nationally representative sample of youth involved in the child welfare system. Participants included adolescents aged 13 to 17 (M=15.5, SD=1.49) at baseline (n=714), followed over 18 months. Computer-assisted interviews were used to collect self-reported sexual practices and experiences of physical and psychological abuse at both time points. Latent transition analyses were used to identify three patterns of sexual risk behaviors: abstainers, safe sex with multiple partners, and unsafe sex with multiple partners. Most adolescents transitioned to safer sexual behavior patterns over time. Adolescents exhibiting the riskiest sexual practices at baseline were most likely to report subsequent abuse and less likely to be placed into out-of-home care. Findings provide a more nuanced understanding of sexual risk among child welfare–involved adolescents and inform practices to promote positive transitions within the system. PMID:25155702
Huded, Jill M; Dresden, Scott M; Gravenor, Stephanie J; Rowe, Theresa; Lindquist, Lee A
Seniors represent the fasting growing population in the U.S., accounting for 20.3 million visits to emergency departments (EDs) annually. The ED visit can provide an opportunity for identifying seniors at high risk of falls. We sought to incorporate the Timed Up & Go Test (TUGT), a commonly used falls screening tool, into the ED encounter to identify seniors at high fall risk and prompt interventions through a geriatric nurse liaison (GNL) model. Patients aged 65 and older presenting to an urban ED were evaluated by a team of ED nurses trained in care coordination and geriatric assessment skills. They performed fall risk screening with the TUGT. Patients with abnormal TUGT results could then be referred to physical therapy (PT), social work or home health as determined by the GNL. Gait assessment with the TUGT was performed on 443 elderly patients between 4/1/13 and 5/31/14. A prior fall was reported in 37% of patients in the previous six months. Of those screened with the TUGT, 368 patients experienced a positive result. Interventions for positive results included ED-based PT (n=63, 17.1%), outpatient PT referrals (n=56, 12.2%) and social work consultation (n=162, 44%). The ED visit may provide an opportunity for older adults to be screened for fall risk. Our results show ED nurses can conduct the TUGT, a validated and time efficient screen, and place appropriate referrals based on assessment results. Identifying and intervening on high fall risk patients who visit the ED has the potential to improve the trajectory of functional decline in our elderly population.
Jill M. Huded
Full Text Available Introduction: Seniors represent the fasting growing population in the U.S., accounting for 20.3 million visits to emergency departments (EDs annually. The ED visit can provide an opportunity for identifying seniors at high risk of falls. We sought to incorporate the Timed Up & Go Test (TUGT, a commonly used falls screening tool, into the ED encounter to identify seniors at high fall risk and prompt interventions through a geriatric nurse liaison (GNL model. Methods: Patients aged 65 and older presenting to an urban ED were evaluated by a team of ED nurses trained in care coordination and geriatric assessment skills. They performed fall risk screening with the TUGT. Patients with abnormal TUGT results could then be referred to physical therapy (PT, social work or home health as determined by the GNL. Results: Gait assessment with the TUGT was performed on 443 elderly patients between 4/1/13 and 5/31/14. A prior fall was reported in 37% of patients in the previous six months. Of those screened with the TUGT, 368 patients experienced a positive result. Interventions for positive results included ED-based PT (n=63, 17.1%, outpatient PT referrals (n=56, 12.2% and social work consultation (n=162, 44%. Conclusion: The ED visit may provide an opportunity for older adults to be screened for fall risk. Our results show ED nurses can conduct the TUGT, a validated and time efficient screen, and place appropriate referrals based on assessment results. Identifying and intervening on high fall risk patients who visit the ED has the potential to improve the trajectory of functional decline in our elderly population.
Walton, Maureen A.; Roehler, Douglas R.; Goldstick, Jason; Zimmerman, Marc A.; Blow, Frederic C.; Cunningham, Rebecca M.
BACKGROUND: The risk for firearm violence among high-risk youth after treatment for an assault is unknown. METHODS: In this 2-year prospective cohort study, data were analyzed from a consecutive sample of 14- to 24-year-olds with drug use in the past 6 months seeking assault-injury care (AIG) at an urban level 1 emergency department (ED) compared with a proportionally sampled comparison group (CG) of drug-using nonassaulted youth. Validated measures were administered at baseline and follow-up (6, 12, 18, 24 months). RESULTS: A total of 349 AIG and 250 CG youth were followed for 24 months. During the follow-up period, 59% of the AIG reported firearm violence, a 40% higher risk than was observed among the CG (59.0% vs. 42.5%; relative risk [RR] = 1.39). Among those reporting firearm violence, 31.7% reported aggression, and 96.4% reported victimization, including 19 firearm injuries requiring medical care and 2 homicides. The majority with firearm violence (63.5%) reported at least 1 event within the first 6 months. Poisson regression identified baseline predictors of firearm violence, including male gender (RR = 1.51), African American race (RR = 1.26), assault-injury (RR = 1.35), firearm possession (RR = 1.23), attitudes favoring retaliation (RR = 1.03), posttraumatic stress disorder (RR = 1.39), and a drug use disorder (RR = 1.22). CONCLUSIONS: High-risk youth presenting to urban EDs for assault have elevated rates of subsequent firearm violence. Interventions at an index visit addressing substance use, mental health needs, retaliatory attitudes, and firearm possession may help decrease firearm violence among urban youth. PMID:25847808
Scheffer, Alice C; van Hensbroek, Pieter Boele; van Dijk, Nynke; Luitse, Jan S K; Goslings, Johannes C; Luigies, René H; de Rooij, Sophia E
Little is known about the prevalence of modifiable risk factors of falling in elderly persons with a fall-history who do not visit the Accident and Emergency (A&E) Department after one or more falls. The objective of this study was to determine the prevalence of modifiable risk factors in a population that visited the A&E Department after a fall (A&E group) and in a community-dwelling population of elderly individuals with a fall history who did not visit the A&E Department after a fall (non-A&E group). Two cohorts were included in this study. The first cohort included 547 individuals 65 years and older who were visited at home by a mobile fall prevention team. The participants in this cohort had fall histories but did not visit the A&E Department after a previous fall. These participants were age- and gender-matched to persons who visited the A&E Department for care after a fall. All participants were asked to complete the CAREFALL Triage Instrument. The mean number of modifiable risk factors in patients who did not visit the A&E Department was 2.9, compared to 3.8 in the group that visited the A&E Department (pfalling, impaired vision, mood and high risk of osteoporosis were all independently associated with visiting the A&E Department. All modifiable risk factors for falling were found to be shared between community-dwelling elderly individuals with a fall history who visited the A&E Department and those who did not visit the Department, although the prevalence of these factors was somewhat lower in the A&E group. Preventive strategies aimed both at patients presenting to the A&E Department after a fall and those not presenting after a fall could perhaps reduce the number of recurrent falls, the occurrence of injury and the frequency of visits to the A&E Department.
Full Text Available In the case of determining routes for hazardous material transportation, risk is considered as a main attribute. Transport risk, which is usually combined with other attributes such as cost or travel time, plays a significant role in determining paths for hazardous materials transportation. Since, risk is chaotically affected by road incidents, decision makers are dealing with selecting a method for defining chaotic risk factors in hazmat transportation. In this paper, transport risk has been defined as a chaotic variable using two different methods of generating chaotic patterns. In an experimental road network, which consists of eighty-nine nodes and one hundred and one two-way links, two different methods of generating chaotic variables have been used for applying the proposed procedure. In addition, results for different amounts of risk and cost have also been analyzed in case study. Results revealed that different cost and risk priorities change the frequencies of selected paths determined for hazmat transportation, but the route convergence of the route to chaos method is better than that of the logistic map equation.
Full Text Available Live vaccination against polio has effectively prevented outbreaks in most developed countries for more than 40 years, and there remain only a few countries where outbreaks of poliomyelitis by the wild strain still threaten the community. It is expected that worldwide eradication will be eventually achieved through careful surveillance and a well-managed immunization program. The present paper argues, however, that based on a simple stochastic model the risk of outbreak by a vaccine-derived strain after the cessation of vaccination is quite high, even if many years have passed since the last confirmed case. As vaccinated hosts are natural reservoirs for virulent poliovirus, the source of the risk is the vaccination itself, employed to prevent the outbreaks. The crisis after stopping vaccination will emerge when the following two conditions are met: the susceptible host density exceeds the threshold for epidemics and the vaccinated host density remains large enough to ensure the occurrence of virulent mutants in the population. Our estimates for transmission, recovery, and mutation rates, show that the probability of an outbreak of vaccine-derived virulent viruses easily exceeds 90%. Moreover, if a small fraction of hosts have a longer infectious period, as observed in individuals with innate immunodeficiency, the risk of an outbreak rises significantly. Under such conditions, successful global eradication of polio is restricted to a certain range of parameters even if inactive polio vaccine (IPV is extensively used after the termination of live vaccination.