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Neurodegenerative disorders are typically sporadic in nature in addition to usually influenced through an extensive range of environmental factors, lifestyle, and genetic elements. Latest observations have hypothesized that exposure of environmental factors may increase the prospective risk of Alzheimer's diseases (AD). However, the role of environmental factors as a possible dangerous issue has extended importance concerned in AD pathology, although actual etiology of the disorder is still not yet clear. Thus, the aim of this review is to highlight the possible correlation between environmental factors and AD, based on the present literature view. Environmental risk factors might play an important role in decelerating or accelerating AD progression. Among well-known environmental risk factors, prolonged exposure to several heavy metals, for example, aluminum, arsenic, cadmium, lead, and mercury; particulate air, and some pesticides as well as metal-containing nanoparticles have been participated to cause AD. These heavy metals have the capacity to enhance amyloid β (Aβ) peptide along with tau phosphorylation, initiating amyloid/senile plaques, as well as neurofibrillary tangle formation; therefore, neuronal cell death has been observed. Furthermore, particulate air, pesticides, and heavy metal exposure have been recommended to lead AD susceptibility and phenotypic diversity though epigenetic mechanisms. Therefore, this review deliberates recent findings detailing the mechanisms for a better understanding the relationship between AD and environmental risk factors along with their mechanisms of action on the brain functions.

International audience; Gene Drives are regarded as future tools with a high potential for population control. Due to their inherent ability to overcome the rules of Mendelian inheritance, gene drives (GD) may spread genes rapidly through populations of sexually reproducing organisms. A release of organisms carrying a GD would constitute a paradigm shift in the handling of genetically modified organisms because gene drive organisms (GDO) are designed to drive their transgenes into wild populations and thereby increase the number of GDOs. The rapid development in this field and its focus on wild populations demand a prospective risk assessment with a focus on exposure related aspects. Presently, it is unclear how adequate risk management could be guaranteed to limit the spread of GDs in time and space, in order to avoid potential adverse effects in socio-ecological systems. The recent workshop on the “Evaluation of Spatial and Temporal Control of Gene Drives” hosted by the Institute of Safety/Security and Risk Sciences (ISR) in Vienna aimed at gaining some insight into the potential population dynamic behavior of GDs and appropriate measures of control. Scientists from France, Germany, England, and the USA discussed both topics in this meeting on April 4–5, 2019. This article summarizes results of the workshop.

Non-suicidal self-injury (NSSI) often occurs before age 15, yet the majority of research on risk factors for this dangerous behavior has focused on samples of older participants. Insecure attachment has been previously identified as a risk factor for both NSSI and behavioral problems, and behavioral problems appear to be particularly associated with NSSI among young populations. Redressing the lack of young adolescent NSSI research, the present study uses longitudinal data from a sample of young adolescents to test a model in which insecure attachment acts as a prospective risk factor for NSSI via emotional and behavioral problems. Data on NSSI, child-mother attachment, and emotional and behavioral problems were collected from 559 (41.1% male) Flemish adolescents when they were 13 years old (M = 12.71, SD =0.32), and again 1 year later. Insecure attachment was measured using maternal items on the Experiences in Close Relationships-Revised Child scale. Psychological adjustment was assessed with the Strengths and Difficulties Questionnaire. We found that anxious and avoidant attachment were indirectly associated with NSSI through behavioral problems but not through emotional problems. Findings highlight the role of behavioral problems as a risk factor for NSSI in early adolescence, a rarely studied developmental period during which NSSI often first starts. Findings suggest that one possible pathway for the attachment-NSSI association among young adolescents is through behavioral problems. Therapies that improve child-parent attachment may reduce NSSI among young adolescents both directly, and indirectly by improving behavioral problems. ispartof: ARCHIVES OF SUICIDE RESEARCH vol:23 issue:4 pages:688-696 ispartof: location:England status: published

This study aimed to prospectively identify ecological risk factors for juvenile arrest in a sample of youth at risk for maltreatment. Chi-Squared Automatic Interaction Detector analysis was performed with data from 592 youth from the Longitudinal Studies of Child Abuse and Neglect to identify the optimal combination of age 14 predictors of past-year arrest at age 16. Results extended previous research, which has identified being male, having more conduct disorder symptoms, suspension from school, perceived school importance, witnessing family violence, and having a jailed family member as key risk and protective factors for arrest by identifying important interactions among these risk factors. These interactions differentiate youth at the greatest risk of arrest, which, in this sample, were males with greater than two symptoms of conduct disorder who witnessed family violence. These findings suggest that longitudinal and multi-informant data could inform the refinement of actuarial risk assessments for juvenile arrest.

A substantial number of people who have problems with alcohol also experience strong anxiety and mood problems. This article provides an overview of the evolving perspectives of this association in the context of three related disciplines—psychiatry, psychology, and neuroscience. Psychiatric and epidemiological studies show that having either an anxiety- or alcohol-related diagnosis elevates the prospective risk for developing the other disorder. From the psychological perspective, behavioral research demonstrates that drinking to cope with negative affect is a potent marker for current and future problems with alcohol. Neuroscientific research implicates overlapping neurobiological systems and psychological processes in promoting the rise of negative affect and alcohol misuse. The psychiatric perspective that alcohol misuse and co-occurring anxiety represent neurobiologically distinct diagnostic conditions has dominated the field for many decades. However, recent research provides increasing support for the neuroscientific perspective that these conditions share underlying, mutually exacerbating, neurobiological processes.

Sunk opportunity costs can causally affect subsequent behavior. Turning down initial temptations might make it easier for people to stay committed in the longer term to a personal goal. We discuss several competing explanations for this enhanced commitment effect – including that resisting temptations might (1)“self-signal” information about individual’s own resolve or (2) create prospective risk of cognitive dissonance. Individuals who are subject to what we call “reactive incentives” have superficial incentives to accept a temptation and deviate from some pre-existing goal. But the process of resisting the temptation may cause these individuals to be less likely to subsequently deviate from that goal. We identify two broad categories of reactive incentives: reactive carrots and reactive sticks. This article tests the causal impact of reactive incentives in a field experiment at a University of Amsterdam gym where new subscribers were randomly assigned to one of several groups. “Temptation” group members were made one-time monetary offers of varying size to quit the gym. None of the temptation group subjects accepted the offered compensation to quit the gym. Subjects who were offered a moderate reactive carrot (a full refund plus a cash payment equaling 10% of their initial subscription price to quit) were statistically more likely to visit the gym, to resubscribe, and to earn higher post-treatment grades. Even though the foregone financial opportunities are sunk, they nonetheless affect our subjects’ future behavior. Consistent with the reactive stick hypothesis, we also observe that new subscribers who were exposed to unpleasant weather conditions during their first week of membership were more likely to subsequently visit the gym than new subscribers who did not have to initially confront the reactive stick of bad weather. This article explores a range of settings where policy-makers might deploy reactive incentives to beneficially enhance self-control – including smoking cessation programs, payday lending, college completion and retirement savings.

Women are at higher risk for developing posttraumatic stress disorder (PTSD) compared to men, yet little is known about the biological contributors to this sex difference. One possible mechanism is differential immunological and neuroendocrine responses to traumatic stress exposure. In the current prospective study, we aimed to identify whether sex is indirectly associated with the probability of developing nonremitting PTSD through pro-inflammatory markers and whether steroid hormone concentrations influence this effect. Female ( n = 179) and male ( n = 197) trauma survivors were recruited from an emergency department and completed clinical assessment within 24 h and blood samples within ∼three hours of trauma exposure. Pro-inflammatory cytokines (IL-6, IL-1[Formula: see text], TNF, IFNγ), and steroid hormone (estradiol, testosterone, progesterone, cortisol) concentrations were quantified in plasma. Compared to men, women had a higher probability of developing nonremitting PTSD after trauma ( p = 0.04), had lower pro-inflammatory cytokines and testosterone ( p’ s

Objective The objective of this study was to determine the effect of birthweight on prospective stillbirth risk. Methods Cross-sectional study of singleton births in the United States from 2010 to 2012 from 32 through 42 weeks was conducted. Stillbirth risk was stratified by birthweight and gestational age adjusted for time from death to delivery. The primary outcome was the prospective stillbirth risk for each birthweight category. Student t-test was used for continuous data, chi-square to compare categorical data. Binomial proportions were used to derive prospective and cumulative risks. Cox proportional hazards regression with log–rank test comparison for heterogeneity was used to compare birthweight categories and derive hazard ratios. Results There was an increase in the risk for stillbirth as birthweight diverged from the reference group. At 40 weeks adjusted gestational age, stillbirth rate per 10,000 births for the bottom (6.17, 95% CI: 7.47–4.87) and top (2.37, 95%CI: 3.1–1.65) 5th centiles of birthweight conveyed the highest risk. Hazard ratios (HR) after adjusting for covariates were: 1.55 (1.73–1.4) 95th centile (p

Objective To proactively identify risks in the preparation of intravenous cytostatic drugs, and to prioritise and establish measures to improve safety procedures. Material and methods Failure Mode Effect Analysis methodology was used. A multidisciplinary team identified potential failure modes of the procedure through a brainstorming session. The impact associated with each failure mode was assessed with the Risk Priority Number (RPN), which involves three variables: occurrence, severity, and detectability. Improvement measures were established for all identified failure modes, with those with RPN>100 considered critical. The final RPN (theoretical) that would result from the proposed measures was also calculated and the process was redesigned. Results A total of 34 failure modes were identified. The initial accumulated RPN was 3022 (range: 3-252), and after recommended actions the final RPN was 1292 (range: 3-189). RPN scores >100 were obtained in 13 failure modes; only the dispensing sub-process was free of critical points (RPN>100). A final reduction of RPN>50% was achieved in 9 failure modes. Conclusions This prospective risk analysis methodology allows the weaknesses of the procedure to be prioritised, optimize use of resources, and a substantial improvement in the safety of the preparation of cytostatic drugs through the introduction of double checking and intermediate product labelling.

Objective: We have reported about real-time tissue elastography (RTE), which displays relative strain by measuring the relative distortion of the tissue, and found this information to be useful for diagnosing liver fibrosis. However, its use in predicting hepatocellular carcinoma has not been reported as yet. Here, we investigated RTE to predict liver carcinogenesis in patients with chronic hepatitis C virus (HCV) infection. Methods: We enrolled 160 patients with chronic HCV, who were followed up for 39.9 ± 22.9 weeks (median). They underwent RTE and then ultrasounds every 3-6 months. Results: Respective cumulative liver cancer incidences for years 1, 2, 3, 4, and 5 were, for the entire cohort: 2.0, 5.6, 8.8, 13.1, and 23.9%; for those whose liver fibrosis index (LFI) was ≤2.0: 0.0, 0.0, 0.0, 0.0, and 0.0%; for those whose LFI was 2-2.8: 0.0, 7.4, 7.4, 13.2 and 19.9%; and for those whose LFI was >2.8: 12.9, 12.9, 21.7, 31.4, and 31.4% (p = 0.011; log-rank test). Conclusions: Measurements of LFI by strain imaging can effectively predict liver cancer risk in patients with chronic HCV infection.

This study aimed to examine prospective associations of mobile touch screen device (i.e. smartphone, tablet) use and patterns of use with musculoskeletal symptoms and visual health among adolescents. A representative sample of 1691 adolescents in Singapore (51% girls; 10–19 years) completed an online questionnaire at baseline and one-year follow-up. After adjusting for potential confounders, prospective associations were found between baseline smartphone use and follow-up neck/shoulder (OR = 1.61(95%CI = 1.06–2.44)) and low back (OR = 1.86(1.10–3.14)) symptoms; tablet use was also associated with neck/shoulder, low back and arms symptoms (OR = 1.33(1.04–1.71)to1.52(1.18–1.95)). No associations were observed between the duration of smartphone/tablet use and symptoms. Baseline patterns of use (bout length, certain types of activities, multitasking) were associated with follow-up musculoskeletal symptoms. Smartphone/tablet use was not related to visual outcomes (visual symptoms, wearing glasses/contact lenses, myopia) at follow-up. These findings suggest that patterns of smartphone/tablet use (though not the duration of use) can pose a prospective risk for musculoskeletal symptoms.

Stillbirth remains a large global problem in low- and middle-income settings but is also a public health concern in high-income countries. Over the past 20 years, stillbirth rates globally have shown little improvement and large disparities. The overall stillbirth rate, which measures risk among births at all gestations, masks diverging trends at different gestations. In Australia between 1994 and 2009, reductions in the risks of stillbirth at term (37-41 weeks' gestation) and preterm gestations starting at 28 weeks were offset by a progressive increase in the risk of stillbirth at the lowest birth gestations (20-23 weeks). Stillbirth risks at 24 to 27 weeks' gestation showed no discernible trend between 1994 and 2009.The researchers performed an analytical epidemiological study using nationally reported gestational age data for births in Australia, 1994-2015. Average annual change in gestation-specific prospective risk of stillbirth (per 1000 fetuses at risk [ FAR]) was calculated among births in 1994-2009 and 2010-2015 at term (37-41 weeks) and for preterm gestational age subgroups: 28 to 36, 24 to 27, and 20 to 23 weeks of gestation. In order to evaluate whether there had been further changes in the gestation-specific risk of stillbirth since 2009, the researchers calculated the average annual change in gestation-specific prospective risks of stillbirth in the years from 1994 to 2009 (previously reported), those from 2010 to 2015, and the difference between them. Stratified linear spline regressions were used to determine trends in the yearly prospective risk of stillbirth across each of these periods and whether there was a difference between the gestationspecific trends in each period.The decline in risk of stillbirth at term from 2010 to 2015 from 1.43 to 1.16 per 1000 FAR wasmore rapid than from 1994 to 2009; for preterm gestations from 24 to 27 weeks, there were no discernible trends; from 28 to 36 weeks, the decline between 1994 and 2009 was not sustained; among births from 20 to 23 weeks, the risk of stillbirth plateaued in 2010 to 2015, fluctuating around 3.3 per 1000 FAR. The researchers concluded that improvement in the stillbirth rate from 28 weeks' gestation aligns with changes in other high-income countries, but that more work would need to be done in Australia to achieve the levels of reduction seen elsewhere. Gestation-specific risk of stillbirth is more informative than the overall stillbirth rate. The researches state this study counters the message that the overall risk of stillbirth is not changing: progress is being made at different stages of pregnancy.

Background Risk reduction in the cancer chemotherapy process should be a major objective for all healthcare workers due to severe consequences. One of the most effective methods of minimising errors and improving safety in this high-risk process is the failure modes, effects and criticality analysis (FMECA). Purpose The present study attempted to perform a prospective risk analysis associated wioth the chemotherapy process focused on prescription and preparation steps in three hospitals. Material and methods The FMEA analysis allowed us to perform chemotherapy process mapping, identification and prioritisation of possible risks for each phase of prescription and compounding. The decomposition of the whole process into steps characterised with specific failure modes was carried out by a multidisciplinary team made up of three different hospitals to limit subjectivity. The failure modes were defined and their criticality indices calculated on the basis of the likelihood of occurrence, potential severity and detection probability. Repeatability, severity and identification probability received a score between 1 to 10 and a Risk Priority Number (RPN), which is equal to their multiplication, was determined. Results Five areas of greatest concern and 318 failure modes were identified, of which those evaluable by each hospital were 98.1%, 57.9% and 50.3%, respectively, due to different organisation (electronic prescription and automatic compounding of chemotherapy agents; handwritten process and manual production; electronic prescription and manual production). Sixty-three criticality indices (RPN >100) were calculated and the most high-risk area was ‘Chemotherapy treatment schemes and scheduling’ (50% of total RPN), followed by ‘Check and delivery’ (23.3%), ‘Medical prescription’ (20.8%), ‘Compounding’ (15.1%) and ‘Validation and Transcription’ (13.6%). Informatic software and automated or assisted preparation systems led to a reduction of 50% and 41% of RPN respectively compared to the handwritten process and manual compounding. Conclusion Technology and electronic devices at the prescription and production steps led to a decrease in criticality indices number detected but also led to the appearance of new specific criticality indices. A more systematic use of FMECA may guide and help to focus priorities in continuous security improvement of high-risk medical activities in which the hospital pharmacist is involved. References and/or Acknowledgements Sarah Jayne Liptrott. No conflict of interest

Background: Practical application of prospective risk analysis (PRA) in clinical laboratories should reflect processes as they are carried out, while making the PRA results obtained from different processes comparable. This means that not only STAT and standard testing and testing for critical and less critical parameters should be distinguished (as published), but also that the throughput in processes and process steps should be taken into account. Methods: Building on our previously published PRA, a method was developed to compensate for the throughput in processes and process steps. A factor T, related to the actually observed throughput, was introduced in the risk score calculation. Introduction of this compensation factor leads to different overall risk scores. The criteria by which the risk scores are evaluated were modified accordingly. Results: Introduction of a factor in the PRA to compensate for throughput leads to a change in the risk score for various conceivable failures in process steps. As compared to the PRA in which no compensation for throughput is made, in a process with low throughput the risk score for various conceivable failures in process steps comes out higher after introduction of the compensation factor, while in a process with high throughput various risk scores come out lower. Conclusions: Introduction of a factor to account for the throughput in a process (and process steps) leads to an improved, more realistic PRA, the results of which makes the risk scores of different processes (and process steps) better comparable to each other.

Despite repeated calls for the use of proactive assessment of serious significant events in primary healthcare, GP teams in the UK rarely apply the kind of formal methods of prospective risk assessment that are commonly used in high-hazard industries. NHS Education for Scotland (NES) conducted an exploratory workshop to assess the potential value of Bowtie Analysis (BTA) as a means of proactively identifying and assessing the controls relied on to protect against the risk of a potential primary care ‘never event’. It was concluded that BTA could provide a straightforward approach to engage frontline care practitioners and managers in proactively assessing risk. However, concerns remain about the level of training, support and resources that would be required for the healthcare community to be capable of conducting BTA to an adequate quality standard without having to rely on external facilitators.

Background: To assess potential risks of new surgical procedures and devices before their introduction into daily practice, a prospective risk inventory (PRI) is a required step. This study assesses the applicability of the Health Failure Mode and Effects Analysis (HFMEA) as part of a PRI of new technology in minimally invasive gynecologic surgery. Methods: A reference case was defined of a patient with presumed benign leiomyoma undergoing a laparoscopic hysterectomy or myomectomy including in-bag power morcellation; however, pathology defined a stage I uterine leiomyosarcoma. Using in-bag morcellation as a template, a HFMEA was performed. All steps of the in-bag morcellation technique were identified. Next, the possible hazards of these steps were explored and possible measures to control these hazards were discussed. Results: Five main steps of the morcellation process were identified. For retrieval bags without openings to accommodate instruments inside the bag, 120 risks were identified. Of these risks, 67 should be eliminated. For containment bags with openings 131 risks were identified of which 68 should be eliminated. Of the 10 causes most at risk to cause spillage, two can be eliminated by using appropriate bag materials. Myomectomy appears to be more at risk for residual tissue spillage compared to total hysterectomy. Conclusion: The HFMEA has provided important new insights regarding potential weaknesses of the in-bag morcellation technique, particularly with respect to hazardous steps in the morcellation process as well as requirements that bags should meet. As such, this study has shown HFMEA to be a valuable method that identifies and quantifies potential hazards of new technology.

In the development of the Petro-HRA method [5] , a human reliability analysis (HRA) developed for the petroleum industry, a number of factors believed to effect human performance were reviewed and considered for inclusion in the method's performance shaping factor (PSF) taxonomy. The method was created for prospective risk analysis of post-initiator events and it was created as a method that focused on including the most important PSFs, rather than attempting to include all aspects of human performance. This paper assess whether fatigue should be among the PSFs included. This article presents: (1) how fatigue is included in current human reliability methods; (2) fatigue and its underlying aspects; (3) how these aspects affect performance and; (4) the consideration of including fatigue as a PSF in Petro-HRA. Four possible PSFs based on the causes of are suggested: Sleep deprivation, Shift-length, Non-day shift, and Prolonged task performance. However, due to the relative low impacts of the PSFs and the Petro-HRA's focus on only the strongest PSFs, the final method did not include any of the suggested fatigue PSFs.

The association between occupational exposure and autoimmune disease is well recognized for silica, and suspected for other inhalants. We used a large cohort to estimate the risks of rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and dermatomyositis associated with silica and other occupational exposures.We analyzed data for male Swedish construction industry employees. Exposure was defined by a job-exposure matrix for silica and for other inorganic dusts; those with other job-exposure matrix exposures but not to either of the 2 inorganic dust categories were excluded. National hospital treatment data were linked for International Classification of Diseases, 10(th) Revision-coded diagnoses of rheumatoid arthritis (seronegative and positive), systemic lupus erythematosus, systemic sclerosis, and dermatomyositis. The 2 occupational exposures were tested as independent predictors of prospective hospital-based treatment for these diagnoses using age-adjusted Poisson multivariable regression analyses to calculate relative risk (RR).We analyzed hospital-based treatment data (1997 through 2010) for 240,983 men aged 30 to 84 years. There were 713 incident cases of rheumatoid arthritis (467 seropositive, 195 seronegative, 51 not classified) and 128 cases combined for systemic lupus erythematosus, systemic sclerosis, and dermatomyositis. Adjusted for smoking and age, the 2 occupational exposures (silica and other inorganic dusts) were each associated with increased risk of rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and dermatomyositis combined: RR 1.39 (95% confidence interval [CI], 1.17-1.64) and RR 1.31 (95% CI, 1.11-1.53), respectively. Among ever smokers, both silica and other inorganic dust exposure were associated with increased risk of rheumatoid arthritis (RRs 1.36; 95% CI, 1.11-1.68 and 1.42; 95% CI, 1.17-1.73, respectively), while among never smokers, neither exposure was associated with statistically significant increased risk of rheumatoid arthritis.This analysis reaffirms the link between occupational silica and a range of autoimmune diseases, while also suggesting that other inorganic dusts may also impart excess risk of such disease.

Aim The aim of this study was to provide better counsel to pregnant women with suspected placental mesenchymal dysplasia (PMD) regarding the risks of preterm birth and intrauterine fetal death. Material and Methods We reviewed the outcomes of 109 PMD pregnancies with gestational week (GW) ≥ 24 abstracted from 63 reports in the English-language published reports, including two cases that we encountered recently. The prospective risk of stillbirth at GW N was defined as the number of women with stillbirth at GW ≥ N divided by the number of women giving birth at GW ≥ N. Results A total of 32 (29.4%) women experienced stillbirth at a median GW of 31 (range, 24–38). Preterm birth (GW

10 páginas.-- 3 figuras.-- 70 referencias.-- Ortega Calvo, J. J. et al.., The bioavailability of organic chemicals in soil and sediment is an important area of scientific investigation for environmental scientists, although this area of study remains only partially recognized by regulators and industries working in the environmental sector. Regulators have recently started to consider bioavailability within retrospective risk assessment frameworks for organic chemicals; by doing so, realistic decision-making with regard to polluted environments can be achieved, rather than relying on the traditional approach of using total-extractable concentrations. However, implementation remains difficult because scientific developments on bioavailability are not always translated into ready-to-use approaches for regulators. Similarly, bioavailability remains largely unexplored within prospective regulatory frameworks that address the approval and regulation of organic chemicals. This article discusses bioavailability concepts and methods, as well as possible pathways for the implementation of bioavailability into risk assessment and regulation; in addition, this article offers a simple, pragmatic and justifiable approach for use within retrospective and prospective risk assessment., All authors participated at the SETAC Europe SESSS10 symposium on bioavailability (http://sesss10.setac.eu/). They utilized of the presentations and the discussions at the symposium to write this paper. During the preparation of the symposium and this manuscript, J.-J.O.-C. was supported by the Spanish Ministry of Science and Innovation (CGL2013-44554-R). The support given by ECETOC for open access publication of this article is gratefully acknowledged.

OBJECTIVEAggressive dural arteriovenous fistulas (dAVFs) with cortical venous drainage (CVD) are known for their relatively high risk of recurrent neurological events or hemorrhage. However, recent natural history literature has indicated that nonaggressive dAVFs with CVD have a significantly lower prospective risk of hemorrhage. These nonaggressive dAVFs are typically diagnosed because of symptomatic headache, pulsatile tinnitus, or ocular symptoms, as in low-risk dAVFs. Therefore, the viability of stereotactic radiosurgery (SRS) as a treatment for this lesion subclass should be investigated.METHODSThe authors evaluated their institutional experience with SRS for dAVFs with CVD for the period from 1991 to 2016, assessing angiographic outcomes and posttreatment hemorrhage rates. They subsequently pooled their results with those published in the literature and stratified the results based on the mode of clinical presentation.RESULTSIn an institutional cohort of 42 dAVFs with CVD treated using SRS, there were no complications or hemorrhages after treatment in 19 patients with nonaggressive dAVFs, but there was 1 radiation-induced complication and 1 hemorrhage among the 23 patients with aggressive dAVFs. In pooling these cases with 155 additional cases from the literature, the authors found that the hemorrhage rate after SRS was significantly lower among the patients with nonaggressive dAVFs (0% vs 6.8%, p = 0.003). Similarly, the number of radiation-related complications was 0/124 in nonaggressive dAVF cases versus 6/73 in aggressive dAVF cases (p = 0.001). The annual rate of hemorrhage after SRS for aggressive fistulas was 3.0% over 164.5 patient-years, whereas none of the nonaggressive fistulas bled after radiosurgery over 279.4 patient-years of follow-up despite the presence of CVD.CONCLUSIONSCortical venous drainage is thought to be a significant risk factor in all dAVFs. In the institutional experience described here, SRS proved to be a low-risk strategy associated with a very low risk of subsequent hemorrhage or radiation-related complications in nonaggressive dAVFs with CVD.

Contamination with plastic debris has been recognized as one of today’s major environmental quality problems. Because most of the sources are land based, concerns are increasingly focused on the freshwater and terrestrial environment. Fate and transport models for plastic debris can complement information from measurements and will play an important role in the prospective risk assessment of plastic debris. We review the present knowledge with respect to fate and transport modeling of plastic debris in freshwater catchment areas, focusing especially on nano- and microplastics. Starting with a brief overview of theory and models for nonplastic particles, we discuss plastic-specific properties, processes, and existing mass-balance-, multimedia-, and spatiotemporally explicit fate models. We find that generally many theoretical and conceptual approaches from models developed earlier for other types of (low density) particles apply also to plastic debris. A unique feature of plastic debris, however, is its combination of high persistence, low density, and extremely wide size distribution, ranging from the nanometer to the >cm scale. This causes the system behavior of plastic debris to show a far wider variety than most other materials or chemicals. We provide recommendations for further development of these models and implications and guidance for how fate and transport models can be used in a framework for the tiered risk assessment of plastic debris.

Failure mode and effects analysis (FMEA) is a prospective risk assessment tool which has been widely used within various industries, particularly the aerospace, automotive and healthcare industries. However, the conventional risk priority number (RPN) method has been criticized much for its deficiencies in risk factor weights, computation of RPN, evaluation of failure modes and so on. Therefore ranking of failure modes based on their related risk factors is necessary seeking to overcome the shortcomings and enhance the assessment capability of the traditional FMEA. In this paper, we treat the risk factors and their weights as fuzzy variables and evaluate them using fuzzy linguistic terms. As a result, a new risk priority model is proposed for evaluating the risk of failure modes based on fuzzy set theory and MULTIMOORA method. An empirical case of preventing infant abduction is provided to illustrate the potential applications and benefits of the proposed fuzzy FMEA. The main findings of this article are related with the proposed technique for failure modes assessment and ranking, and application of this technique for the prevention of infant abduction, which is a devastating problem for a healthcare facility. A new FMEA model is developed by using fuzzy set theory and MULTIMOORA method.Risk factors and their weights are evaluated using fuzzy linguistic variables.Extended MULTIMOORA is used to determine the risk priority of failure modes.The proposed fuzzy FMEA can be a useful tool for failure modes assessment and ranking.

Background Prospective risk analysis (PRA) is an essential element in quality assurance for clinical laboratories. Practical approaches to conducting PRA in laboratories, however, are scarce. Methods On the basis of the classical Failure Mode and Effect Analysis method, an approach to PRA was developed for application to key laboratory processes. First, the separate, major steps of the process under investigation are identified. Scores are then given for the Probability ( P) and Consequence (C) of predefined types of failures and the chances of Detecting (D) these failures. Based on the P and C scores (on a 10-point scale), an overall Risk score (R) is calculated. The scores for each process were recorded in a matrix table. Based on predetermined criteria for R and D, it was determined whether a more detailed analysis was required for potential failures and, ultimately, where risk-reducing measures were necessary, if any. Results As an illustration, this paper presents the results of the application of PRA to our pre-analytical and analytical activities. The highest R scores were obtained in the stat processes, the most common failure type in the collective process steps was ‘delayed processing or analysis’, the failure type with the highest mean R score was ‘inappropriate analysis’ and the failure type most frequently rated as suboptimal was ‘identification error’. Conclusions The PRA designed is a useful semi-objective tool to identify process steps with potential failures rated as risky. Its systematic design and convenient output in matrix tables makes it easy to perform, practical and transparent.

A presente pesquisa objetiva a análise exploratória dos dados de doenças infecciosas, como síndrome diarreica aguda e a leptospirose, com as inundações por precipitações pluviométricas ocorridas no estado de Santa Catarina, durante o período de 2008 a 2012. Demonstra esta pesquisa que o uso da geotecnologia associada à gestão de risco prospectivo contribui para a definição de intervenções com o propósito de minimizar as ocorrências das doenças em casos deinundações por precipitações pluviométricas.

This article has no abstract DOI: 10.29252/jfqhc.5.2.1

Resumen: A partir de un análisis de contenido realizado a 28 materiales educativos digitales para formar periodis­tas de Latinoamérica sobre el cubrimiento de la Gestión del Riesgo de Desastres entre 2012 y 2018, el presente artículo pretende establecer si el enfoque de dichos recursos pedagógicos es coherente con los lineamientos de las agencias internacionales para la formación de los reporteros, en el sentido de propiciar una cobertura adecuada del tema. De manera que corresponda al cambio de paradigma de la atención de desastres a la gestión del riesgo, en el cual se busca propiciar el conocimiento de los riesgos, la reducción y el manejo de los desastres. Los resultados del análisis identificaron avances y limitaciones en la construcción de los manuales, tanto en lo que tiene que ver con su pertinencia pedagógica como en la inclusión de temas centrales para la GRD. A partir de los hallazgos se ofrecen reflexiones para que se fortalezcan la formación de los periodistas en la GRD, con el fin de que favorezca una gestión prospec­tiva del riesgo y fortalezca el desarrollo social.Palabras clave: Gestión del Riesgo de Desastres; Recursos educativos digitales; Periodistas; Formación.Abstract: This article carried out a content analysis on 28 digital educational materials published between 2012 and 2018, to train Latin American journalists in Disaster Risk Management (DRM). The aim of the study was to establish whether the focus of these pedagogical resources was consistent with the guidelines of the international agencies for the education of the reporters. This, by generating a change in the way they are covering this issue. The main goal of this courses should be that the public journalistic discourse changes their traditional centrality on disasters and their attention to emergencies, as well as to start communica­ting prevention. The results of the analysis identified progress and limitations in the construction of the resources, both in what concerns their pedagogical relevance and in the inclusion of central themes for DRM. Based on the findings, reflections are offered on how these resources could be improved to fulfill their objective of contributing to a collective mobilization that favors prospective risk management and strengthens social development.Keywords: Disaster Risk Management; Educational Digital Resources; Journalists; Training.

The dynamics of within-person linear change over time in regards to prospective risk of cardiovascular disease (CVD) and all-cause mortality in a large, integrated healthcare system has not been previously reported. A consolidated database of 12-lead electrocardiograms (ECGs) was developed from

Objectives. We examined whether substance-use disorders and poverty predicted first-time homelessness over 3 years. Methods. We analyzed longitudinal data from waves 1 (2001–2002) and 2 (2004–2005) of the National Epidemiologic Survey on Alcohol and Related Conditions to determine the main and interactive effects of wave 1 substance use disorders and poverty on first-time homelessness by wave 2, among those who were never homeless at wave 1 (n = 30 558). First-time homelessness was defined as having no regular place to live or having to live with others for 1 month or more as a result of having no place of one’s own since wave 1. Results. Alcohol-use disorders (adjusted odds ratio [AOR] = 1.34), drug-use disorders (AOR = 2.51), and poverty (AOR = 1.34) independently increased prospective risk for first-time homelessness, after adjustment for ecological variables. Substance-use disorders and poverty interacted to differentially influence risk for first-time homelessness (P Conclusions. This study reinforces the importance of both substance-use disorders and poverty in the risk for first-time homelessness, and can serve as a benchmark for future studies. Substance abuse treatment should address financial status and risk of future homelessness.

Aim The aim of this study was to better characterize the nature of abruptio placentae (AP) with regard to the timing of onset. Material and Methods Prevalence and prospective risk of AP according to gestational week (GW) were determined among 293 899 women who gave birth to singleton infants at and after GW 30. The prospective risk of AP at gestational week N was defined as the number of all women who experienced an AP at ≥GW N divided by the number of all women who gave birth at ≥GW N. Results AP developed in 2649 (0.90%) women. The prevalence of AP (6.7% among women who gave birth at GW 30–33) sharply decreased with advancing GW at delivery to 0.9% for GW 37 and 0.1% for ≥GW 42. The highest prospective risk of AP, 9 per 1000 women at GW 30, decreased linearly with advancing gestation to 1 per 1000 women at ≥GW 42. AP accounted for 4.7% (1591/33 725) of all preterm births at GW

Factors other than complexity of care often drive the transfer of orthopedic patients to tertiary centers. We sought to compare the demographics, diagnoses, insurance data, peri-operative outcomes and institutional costs of total hip arthroplasty patients transferred from outside facilities with those of patients derived from our clinics. We analyzed 419 consecutive patients as part of a prospective risk study. Transferred patients were older (P=0.01), less likely to have private insurance (P0.0001), and more likely to be admitted on weekends (P=0.04). Both dislocation and fracture were more prevalent in transferred patients (P=0.04; P=0.003). Across all key metrics - including length of stay, mortality scoring, peri-operative complications, and direct and total costs - transferred patients more significantly strained the resources of our arthroplasty center.

To estimate the risk of stillbirth in apparently uncomplicated monochorionic-diamniotic twin pregnancies by systematic review and meta-analysis and compare it with that in uncomplicated dichorionic pregnancies.We performed an electronic search (January 1985 to April 2012) of Medline, PubMed, Embase, and ClinicalTrials.gov databases.Studies detailing gestational-age specific stillbirth rates after 24 weeks of gestation in monochorionic-diamniotic twin pregnancies uncomplicated by twin-twin transfusion syndrome, growth restriction, or major anomalies. The rate and risk of stillbirth were calculated in 2-week gestational age blocks and compared in controlled studies with dichorionic pregnancies.We evaluated 361 studies to include nine informative studies, four after additional data from the investigators. The rate of stillbirth per 1,000 uncomplicated monochorionic-diamniotic pregnancies at 32-33, 34-35, and 36-37 weeks of gestation was 5.1, 6.8, and 6.2, respectively. The risk of stillbirth per pregnancy at 32, 34, and 36 weeks of gestation was 1.6%, 1.3% and 0.9%, respectively. Compared with uncomplicated dichorionic pregnancies, the odds ratio for stillbirth per pregnancy at 32, 34, and 36 weeks of gestation was 4.2 (95% confidence interval [CI] 1.4-12.6), 3.7 (CI 1.1-12.0), and 8.5 (CI 1.6-44.7), respectively.Uncomplicated monochorionic twin pregnancies are at substantial risk of stillbirth throughout the third trimester, which is severalfold higher than in dichorionic twin pregnancies. Given the risk of fetal death to the cotwin, these data should inform decisions around timing of delivery in seemingly normal monochorionic twin pregnancies.

Laboratories have a major impact on patient safety as 80–90 % of all the diagnosis are made on the basis of laboratory tests. Laboratory errors have a reported frequency of 0.012–0.6 % of all test results. Patient safety is a managerial issue which can be enhanced by implementing active system to identify and monitor quality failures. This can be facilitated by reactive method which includes incident reporting followed by root cause analysis. This leads to identification and correction of weaknesses in policies and procedures in the system. Another way is proactive method like Failure Mode and Effect Analysis. In this focus is on entire examination process, anticipating major adverse events and pre-emptively prevent them from occurring. It is used for prospective risk analysis of high-risk processes to reduce the chance of errors in the laboratory and other patient care areas.

Context: Accurate, efficient, and reliable measurement methods are essential to prospectively identify risk factors for knee injuries in large cohorts. Objective: To determine tester reliability using digital photographs for the measurement of static lower extremity alignment (LEA) and whether values quantified with an electromagnetic motion-tracking system are in agreement with those quantified with clinical methods and digital photographs. Design: Descriptive laboratory study. Setting: Laboratory. Patients or Other Participants: Thirty-three individuals participated and included 17 (10 women, 7 men; age = 21.7 ± 2.7 years, height = 163.4 ± 6.4 cm, mass = 59.7 ± 7.8 kg, body mass index = 23.7 ± 2.6 kg/m2) in study 1, in which we examined the reliability between clinical measures and digital photographs in 1 trained and 1 novice investigator, and 16 (11 women, 5 men; age = 22.3 ± 1.6 years, height = 170.3 ± 6.9 cm, mass = 72.9 ± 16.4 kg, body mass index = 25.2 ± 5.4 kg/m2) in study 2, in which we examined the agreement among clinical measures, digital photographs, and an electromagnetic tracking system. Intervention(s): We evaluated measures of pelvic angle, quadriceps angle, tibiofemoral angle, genu recurvatum, femur length, and tibia length. Clinical measures were assessed using clinically accepted methods. Frontal- and sagittal-plane digital images were captured and imported into a computer software program. Anatomic landmarks were digitized using an electromagnetic tracking system to calculate static LEA. Main Outcome Measure(s): Intraclass correlation coefficients and standard errors of measurement were calculated to examine tester reliability. We calculated 95% limits of agreement and used Bland-Altman plots to examine agreement among clinical measures, digital photographs, and an electromagnetic tracking system. Results: Using digital photographs, fair to excellent intratester (intraclass correlation coefficient range = 0.70–0.99) and intertester (intraclass correlation coefficient range = 0.75–0.97) reliability were observed for static knee alignment and limb-length measures. An acceptable level of agreement was observed between clinical measures and digital pictures for limb-length measures. When comparing clinical measures and digital photographs with the electromagnetic tracking system, an acceptable level of agreement was observed in measures of static knee angles and limb-length measures. Conclusions: The use of digital photographs and an electromagnetic tracking system appears to be an efficient and reliable method to assess static knee alignment and limb-length measurements.

This article describes how disaster risk management topics are taught at the Rotman School of Management at the University of Toronto and thus highlights opportunities for developing similar course modules on disaster risk management at other institutions. An undergraduate and MBA elective course, titled Catastrophic Failure in Organizations, contains four modules that are directly relevant to disaster risk management. The first module focuses on the need to move from risk indifference to risk sensitivity. The second module considers the importance of business continuity and crisis management plans and explores their common shortcomings. The third module uses a case study to examine the topic of prospective risk management. The fourth module focuses on the vulnerability of supply chains and other complex systems to disaster risk. The article describes the details of implementing these modules and discusses opportunities for further integration of disaster risk management topics in other parts of the curriculum, Este artículo describe cómo se enseñan los temas de la gestión del riesgo de desastres en la escuela de administración, Rotman School of Management, de University of Toronto y, de esta manera, resalta las oportunidades para desarrollar módulos de cursos de gestión de riesgo de desastres similares. Un curso de pregrado y uno electivo de MBA, llamado Falla Catastrófica en las Organizaciones, contiene cuatro módulos que son directamente relevantes para la gestión del riesgo de desastres. El primer módulo se enfoca en la necesidad de pasar de la indiferencia a la sensibilidad al riesgo. El segundo módulo toma en cuenta la importancia de la continuidad de negocio y los planes de gestión de crisis y explora las deficiencias que tienen en común. El tercer módulo utiliza un estudio de caso para examinar el tema de la gestión prospectiva del riesgo. El cuarto módulo se enfoca en la vulnerabilidad de las cadenas de suministro y otros sistemas complejos del riesgo de desastres. El artículo describe los detalles de la implementación de estos módulos y discute las oportunidades para una integración más profunda de los temas de gestión de riesgo de desastres en otras partes del currículo

Twin pregnancies are at increased risk of stillbirth. Uncomplicated twin pregnancies are commonly delivered earlier to prevent stillbirth; however, there is a risk of neonatal complications associated with being born prior to 39 weeks’ gestation. The optimal gestational age for delivery in twin pregnancies is unknown and likely varies by chorionicity. The present study aimed to determine the prospective risk of stillbirth in women with uncomplicated monochorionic and dichorionic twin pregnancies, and neonatal mortality risks, when delivered beyond 34 weeks of gestation. Data on twin pregnancies that reported rates of stillbirth were obtained from MEDLINE, EMBASE, and Cochrane Library. Separate analyses for risks of stillbirth and neonatal death in monochorionic and dichorionic twin pregnancies were undertaken from 34 weeks’ gestation and further and early preterm (

In this work we describe the first steps of the development of a quality management program for physics related staffing activities during Intensity Modulated Radiation Therapy for Head and Neck treatment process. The methodology adopted was prospective process- and clinic- specific risk analysis leading to the formulation of the quality management program. This methodology was described during “A hands-on Workshop on TG-100” which took place in October 2015 in Mexico City and was conducted by M. Saiful Huq Ph.D. and Peter Dunscombe Ph.D.

Monochorionic diamniotic (MCDA) twins comprise of 20–30% of twin pregnancies; roughly 50% will be undelivered and ‘uncomplicated’ beyond 32 weeks gestation. This review details accumulating data regarding the risk of intrauterine fetal demise (IUFD) in ‘uncomplicated’ MCDA twins and risks associated with prematurity. ‘Uncomplicated’ MCDA twins are at increased risk for IUFD, even when under intensified surveillance in tertiary care centers. The prospective risk of IUFD in uncomplicated MCDA varies among different studies, with reported rates of up to 3.3% at 34 weeks and 2.2% at 36 weeks. If single IUFD occurs, it exposes the surviving co-twin to potential significant morbidity and mortality. It had been suggested that elective preterm delivery would eliminate this risk, but recent evidence of prematurity morbidity are accumulating. With more intensified monitoring from 32 weeks, it is possible that the rate of IUFD is lower than anticipated. We reviewed the data regarding these risks and their contribution to the decision-making process.

This study was conducted to review the overall short-term outcome of monoamniotic twins in Japan and to determine the prospective risk of fetal death so as to adequately counsel parents with monoamniotic twins. Study subjects were 101 women with monoamniotic twins who were registered with the Japan Society of Obstetrics and Gynecology Successive Pregnancy Birth Registry System and who had given birth at ≥22 weeks of gestation during 2002–2009. The gestational week at delivery (mean ± SD) was 31.8 ± 3.7. Fourteen women experienced intrauterine fetal death (IUFD). Short-term outcomes of co-twins born to the 14 women included 8 IUFDs, one early neonatal death within 7 days of life (END), and 5 survivors. Four other women experienced 5 ENDs. Thus, 13.9% (28/202) of infants died perinatally (22 IUFDs and 6 ENDs), 13.9% (14/101) of women experienced IUFD, and 82.2% (83/101) of women experienced neither IUFD nor END. Structural anomalies and twin-to-twin transfusion syndrome explained 17.9% (five infants) and 10.7% (three infants) of the 28 perinatal deaths, respectively. The prospective risk of IUFD was 13.9% (14/101) for women who reached gestational week 22−0/7, gradually decreasing thereafter but remaining at between 4.5% and 8.0% between gestational week 30−0/7 and 36−0/7.

There is a recognized need to design a new framework for sediment toxicity testing that meets current scientific standards and regulatory requirements, such as reliable assessment of toxicity, which prevents any harmful effects on biodiversity, a strong capability to predict population- and community-level effects, and applicability of the results to decision-making. We propose a new framework for prospective sediment toxicity testing, and suggest solutions to the key methodological challenges that hinder establishment of this framework (comparison of sensitivities, design of test batteries, consideration of different exposure routes, extrapolations to population and community levels, use of test results for decision-making). The proposed framework consists of the following three units: test-battery system, higher-tier testing systems and additional ecological modeling, and a decision support system. The key methodologies proposed to establish this framework are compound-tailored test-battery use...

Objective To explore health care professionals' experiences and perceptions of Failure Mode and Effects Analysis (FMEA), a team-based, prospective risk analysis technique. Methods Semi-structured interviews were conducted with 21 operational leads (20 pharmacists, one nurse) in medicines management teams of hospitals participating in a national quality improvement programme. Interviews were transcribed, coded and emergent themes identified using framework analysis. Results Themes identified included perceptions and experiences of participants with FMEA, validity and reliability issues, and FMEA's use in practice. FMEA was considered to be a structured but subjective process that helps health care professionals get together to identify high risk areas of care. Both positive and negative opinions were expressed, with the majority of interviewees expressing positive views towards FMEA in relation to its structured nature and the use of a multidisciplinary team. Other participants criticised FMEA for being subjective and lacking validity. Most likely to restrict its widespread use were its time consuming nature and its perceived lack of validity and reliability. Conclusion FMEA is a subjective but systematic tool that helps identify high risk areas, but its time consuming nature, difficulty with the scores and perceived lack of validity and reliability may limit its widespread use.

Objective To estimate the prospective risk of developing PML during therapy with natalizumab in JCV-seropositive patients. Methods We analyzed postmarketing data about the incidence of PML on natalizumab, and quantified the risk by either applying the Kaplan-Meier estimator or, where this was not possible due to the unavailability of the respective raw data, using formulae yielding very similar figures. Results In JCV-seropositive patients with prior immunosuppressant (IS) use, the incidence of PML during months 25–48 of natalizumab therapy is about 19.5 per thousand. Without prior IS use, the incidence during months 25–48 is approximately 7.4 per thousand, and during months 49–72, it is approximately 10.8 per thousand. If one additionally assumes that the JCV index is in the range 0.9–1.5, then the incidence during months 49–72 is around 6.2 per thousand in comparison to 17.0 per thousand when the JCV index exceeds 1.5. Conclusions Biogen’s statistics concerning the risk of PML on natalizumab, while in principle helpful, underestimate the true incidence systematically and significantly; realistic estimates of the longterm risk of PML are nearly double those previously published, with some patient groups carrying a risk that is almost nine times higher. Fortunately, a refined risk-stratification algorithm with the incorporation of such markers as L-selectin and CSF lipid-specific IgM bands has the potential to make natalizumab a considerably safer drug.