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BACKGROUND: There is increasing recognition that a morning or evening preference is associated with time of eating, metabolic health, and morbidity. However, few studies have examined the association of time of eating with mortality. OBJECTIVES: To examine the association of time of first recalled ingestive episode with the prospective risk of all-cause mortality. METHODS: We used mortality-linked data from the NHANES conducted in 1988–1994 and 1999–2014 (n = 34,609; age ≥ 40 years). The exposure was quartiles (Q1–Q4) of clock time of first eating episode self-reported in the baseline 24-hour dietary recall. The outcome was follow-up time from the date of NHANES examination to the date of death or end of the follow-up period (31 December 2015). We used proportional hazards regression methods to determine the independent association of time of first eating episode with relative hazard of all-cause mortality, with adjustments for multiple covariates and the complex survey design. Multiple linear regression methods were used to examine the associations of time of first eating episode with baseline cardiometabolic biomarkers and dietary attributes. RESULTS: In this national cohort, with a median age of ∼55 years (95% CI: 54.6–55.4 years) at baseline and a median follow-up of 8.3 years (IQR, 8.75 years), there were 10,303 deaths. The median times of first eating episodes in Q1–Q4 were 05:45, 07:00, 08:00, and 10:00, respectively. Covariate-adjusted relative hazards of mortality in Q1 to Q3 of the time of the first eating episode were 0.88 (95% CI: 0.81–0.96), 0.88 (95% CI: 0.81–0.95), 0.94 (95% CI: 0.87–1.02), with Q4 as the referent (P = 0.0008). Qualitative dietary attributes were inversely related with the time of the first eating episode; however, BMI and serum concentrations of glycemic biomarkers increased with later times of first eating episode (P ≤ 0.0001). CONCLUSIONS: Recall of an earlier time of the first eating episode by ≥40-year-old US participants was suggestive of a small relative survival advantage in this observational study.

Adolescents and emerging adults with chronic health conditions such as type 1 diabetes mellitus (T1D) are more likely to engage in high-risk behaviors. Previous studies regarding substance use in adolescents and emerging adults with T1D are mostly derived from cross-sectional studies utilizing self-administered questionnaires and are limited by lack of population-based comparison groups. In addition, despite the rising popularity of vaping, little is known about the incidence of vaping in adolescents and emerging adults with T1D. We explored the incidence and prospective risk of substance use disorders and vaping in adolescents and emerging adults with T1D compared to age and gender matched non-diabetic referents residing in Olmsted County, Rochester, MN. Risk of incident substance use disorder washigher in those with T1D compared to matched referents with alcohol, marijuana, and smoked tobacco being most common substances. When stratified by gender, these differences remained significant in males, but not females. While further work is needed to delineate the causative relationships between T1D, mental health, and substance abuse; our findings confirm the critical need for substance use screening and mental health support for adolescents and emerging adults with T1D. This article is protected by copyright. All rights reserved.

Systematic Review evaluating wellbeing and prospective mortality outcomes within the general population.

Background Several advantages and pitfalls have been related to externalized trans-anastomotic stents (ETS) after pancreaticoduodenectomy. The purpose of this study was to investigate the effect of an ETS effect in a risk-stratified setting. Methods Data from patients at either intermediate- or high-risk for postoperative pancreatic fistula (POPF) following pancreaticoduodenectomy were prospectively analyzed from January 2016 to December 2019. Outcomes included POPF rate, mean complication burden (ACB), and complications related to ETS malfunction. Results A total of 540 patients met the inclusion criteria. Following an intention-to-treat analysis, there was no difference in terms of POPF and the ACB in the intermediate (22 vs.29%, p = 0.148; 0.38 vs.0.24, p = 0.082) and high-risk categories (58 vs.37%, p = 0.103; 0.33 vs.0.33, p = 0.478) comparing PJ to PJ-ETS. Excluding patients experiencing ETS malfunction (n = 45, 22%), ETS was associated with a significantly reduced ACB in the intermediate-risk (0.38 vs.0.26, p = 0.009) and POPF rate in the high-risk category (58 vs.32%, p = 0.033). In patients with ETS malfunction an increased rate of severe morbidity (Clavien-Dindo ≥ III, 33 vs.19%, p = 0.044) was observed as compared to patients with functioning ETS. Conclusion ETS provides crucial advantages for prevention and mitigation of POPF depending on risk setting and its correct functioning. ETS malfunction is not uncommon and increases morbidity. Improving ETS design and fixing technique might lead to better outcomes.

INTRODUCTION Our study compared the prospective risks of intrauterine fetal death (IUFD), neonatal death (NND), perinatal death (PND), and neonatal morbidities in monochorionic diamniotic (MCDA) and dichorionic diamniotic (DCDA) twin pregnancies. METHODS This retrospective cohort study included twin pregnancies who had antenatal care and delivery in a public hospital from 2011 to 2018. Exclusion criteria included monoamnionicity, one/both twin miscarriage, twin-twin transfusion syndrome, or lethal congenital abnormalities. All twins were managed in multiple pregnancy clinic with standardized protocols. Gestational age-specific IUFD, NND, PND, and neonatal morbidity rates were compared according to chorionicity. RESULTS Three hundred seventy-eight MCDA and 1282 DCDA twins were included. MCDA twins had higher risks of PND (1.9% vs. 0.7% in DCDA twins, p = 0.05), composite neonatal morbidity (p = 0.01), preterm delivery (p

There is much hope and hype surrounding the development of innovative technologies, but are we as motivated and effective in assessing the potential risks of these technologies? It is prudent to assess and mitigate risks prior to deploying a new product or process, but how often is a risk assessment performed when new functionality or changes are proposed? This paper describes a rapid, Agile approach for intermittent risk assessment and surveillance when there are substantial changes to systems and their context of use. Fault Tree Analysis and Failure Mode and Effect Analysis were used as models in a customized approach to assess for risk and potential hazards of added functionality and changes to mobile products after initial deployment. We also describe benefits and challenges. A rapid risk assessment could also be used as an initial assessment in situations where the software development cycle is not amenable to a more time-consuming approach to risk assessment. A lesson learned in preparing to rapidly assess for risks is to consider several or some combination of approaches.

The objective of this study is to assess the impact of maternal nativity on stillbirth in the US. We utilized the US Birth Data and Fetal Death Data for the years 2014–2017. Our analysis was restricted to live and stillbirths (N= of 14,867,880) that occurred within the gestational age of 20–42 weeks. The fetuses-at risk approach was used to generate stillbirth trends by gestational age. Adjusted Cox proportional hazards regression model was utilized to estimate the association between maternal nativity and stillbirth. Overall, the gestational week-specific prospective risk of stillbirth was consistently higher for native-born than their foreign-born mothers. Foreign-born mothers were 20% less likely to experience stillbirth than their native-born counterparts (AHR = 0.80; 95% CI = 0.78–0.81). Delineating the factors influencing the observed effect of maternal nativity on birth outcomes should be a research priority to inform strategies to address adverse birth outcomes in the US.

Recent developments in artificial intelligence (AI) may involve significant potential threats to personal data privacy, national security, and social and economic stability. AI-based solutions are often promoted as “intelligent” or “smart” because they are autonomous in optimizing various processes. Because they can modify their behavior without human supervision by analyzing data from the environment, AI-based systems may be more prone to malfunctions and malicious activities than conventional software systems. Moreover, due to existing regulatory gaps, development and operation of AI-based products are not yet subject to adequate risk management and administrative supervision. Resonating to recent reports about potential threats resulting from AI-based systems, this paper presents an outline of a prospective risk assessment for adaptive and autonomous products. This research resulted in extensive catalogs of possible damages, initiating events, and preventive policies that can be useful for risk managers involved in conducting risk assessment procedures for AI-based systems. The paper concludes with the analysis and discussion of changes in business, legal, and institutional environments required to ensure the public that AI-based solutions can be trusted, are transparent and safe, and can improve the quality of life.

Objective Elevated arm work is prevalent in many jobs. Feasible device-based methods are available to measure elevated arm work. However, we lack knowledge on the association between device-measured elevated arm work and prospective risk of long-term sickness absence (LTSA). We aimed to investigate this association. Methods At baseline, 937 workers wore accelerometers on the right arm and thigh over 1–5 workdays to measure work time spent with elevated arms in an upright position. Between baseline and 4-year prospective follow-up in the national registers, we obtained information on the individuals' first event of LTSA (≥6 consecutive weeks). We performed compositional Cox proportional hazard analyses to model the association between work time with arm elevation >30˚, >60˚, or >90˚ and the probability of LTSA. Results Workers spent 21% of their work time with >30˚ arm elevation, 4% with >60˚ arm elevation, and 1% with >90˚ arm elevation; in the upright body position. We found a positive dose–response association between work time spent with elevated arm work and the risk of LTSA. Specifically, we found that increasing two minutes of work time spent with arm elevation at (i) >90˚ increased the risk of LTSA by 14% [hazard ratio (HR) 1.14, 95% confidence intervals (95% CI 1.04–1.25)] (ii) >60˚ increased the LTSA risk by 3% (HR 1.03, 95% CI 1.03–1.06), and (iii) >30˚ increased the LTSA risk by 1% (HR 1.01, 95% CI 1.00–1.02). Conclusion Device-measured elevated arm work is associated with increased prospective LTSA. This information ought to be brought into preventive workplace practice by accessible and feasible device-based methods of elevated arm work.

To predict the debris survivability during an atmospheric re-entry and assess the prospective risk on ground, CNES develops an engineering tool named DEBRISK, based on an object-oriented approach. This approach is currently limited to primitive shapes and is therefore difficult to apply to more complex shapes. The objective of this work is to present a new methodology, based on the MISTRAL software, to introduce more complex shapes within DEBRISK with the goal to deal accurately with the atmospheric re-entry of more realistic objects. Moreover, this new methodology is validated by setting up an experimental campaign performed in the Von Karman Institute Longshot wind tunnel.

Neuroticism has been associated with depression and anxiety both cross-sectionally and longitudinally. Interpretive bias has been associated with depression and anxiety, primarily in cross-sectional and bias induction studies. The purpose of the current study was to examine the role of interpretive bias as a prospective risk factor and a mediator of the relation between neuroticism and depressive and anxious symptoms in young adults assessed longitudinally. Neuroticism significantly predicted a broad general-distress dimension but not intermediate fears and anhedonia-apprehension dimensions or a narrow social-fears dimension. Neuroticism also significantly predicted negative interpretive bias for social scenarios. Negative interpretive bias for social scenarios did not significantly predict dimension scores, nor did it mediate the relation between neuroticism and general distress or social fears. These results suggest that although neuroticism relates to negative interpretive bias, its risk for symptoms of depression and anxiety is at most weakly conferred through negative interpretive bias.

While emotion dysregulation is associated with many psychological disorders, including posttraumatic stress disorder (PTSD), it remains uncertain whether pre-existing emotion dysregulation increases individual risk for prospectively developing PTSD in the aftermath of trauma exposure. Thus, the objective of the current study was to determine whether emotion dysregulation could prospectively predict the development of chronic PTSD symptoms following a traumatic event above and beyond other known associated factors, including depressive symptoms, baseline PTSD symptoms, total traumas experienced, and exposure to interpersonal trauma. Participants (N = 135) were recruited from the emergency department (ED) at Grady Memorial Hospital in Atlanta and follow-up assessments were conducted at 1-, 3-, 6-, and 12-months following trauma exposure. Latent Growth Mixture Modeling was used to identify PTSD symptom trajectories based on symptoms assessed at 1, 3, 6, and 12 months; three trajectories emerged: “chronic”, “recovery”, and “resilient”. For the present study, probability of chronic PTSD symptoms was used as the outcome variable of interest. Linear regression modeling showed that emotion dysregulation was significantly associated with probability of developing chronic PTSD symptoms (p = 0.001) and accounted for an additional 7% of unique predictive variance when controlling for trauma exposure, baseline PTSD, and depressive symptoms. Our findings suggest that emotion dysregulation can be used as both a predictor of chronic PTSD and as a treatment target. Thus, identifying individuals with high levels of emotion dysregulation at the time of trauma and implementing treatments designed to improve emotion regulation could aid in decreasing the development of chronic PTSD among these at-risk individuals.

Although several reports have documented heightened systemic inflammation in posttraumatic stress disorder (PTSD), few studies have assessed whether inflammatory markers serve as prospective biomarkers for PTSD risk. The present study aimed to characterize whether peripheral immune factors measured in blood samples collected in an emergency department immediately after trauma exposure would predict later chronic development of PTSD.Participants (N=505) were recruited from a hospital emergency department and underwent a 1.5-hour assessment. Blood samples were drawn, on average, about 3 hours after trauma exposure. Follow-up assessments were conducted 1, 3, 6, and 12 months after trauma exposure. Latent growth mixture modeling was used to identify classes of PTSD symptom trajectories.Three distinct classes of PTSD symptom trajectories were identified: chronic (N=28), resilient (N=160), and recovery (N=85). Multivariate analyses of covariance revealed a significant multivariate main effect of PTSD symptom trajectory class membership on proinflammatory cytokines. Univariate analyses showed a significant main effect of trajectory class membership on plasma concentrations of proinflammatory tumor necrosis factor α (TNFα) and interferon-γ (IFNγ). Concentrations of proinflammatory TNFα and IFNγ were significantly lower in individuals in the chronic PTSD class compared with those in the recovery and resilient classes. There were no significant differences in interleukin (IL) 1β and IL-6 concentrations by PTSD symptom trajectory class. Anti-inflammatory and other cytokines, as well as chemokines and growth factor concentrations, were not associated with development of chronic PTSD.Overall, the study findings suggest that assessing the proinflammatory immune response to trauma exposure immediately after trauma exposure, in the emergency department, may help identify individuals most at risk for developing chronic PTSD in the aftermath of trauma.

A substantial amount of research focuses on the error-related negativity (ERN)—a negative deflection in the event-related potential waveform that occurs when individuals commit errors on lab-based tasks. The ERN has been link to concurrent and prospective risk for psychopathology and is thought to index sensitivity or reactivity to errors. The ERN can be potentiated in the lab with punishment and has been shown to be increased among offspring of harsh or controlling parents. A separate line of work has demonstrated that the ERN is increased among individuals high in perfectionism. In the current study, we integrate these separate lines of work by examining parenting styles, perfectionism and the ERN in a sample of young adults. Results suggest that the ERN is increased among offspring of controlling parents (both maternal and paternal). Additionally, the ERN is increased among individuals who report being high in perfectionism—specifically, the concerns over mistake and the personal standard perfectionism subscales of the Frost Multidimensional Perfectionism Scale. Moreover, results supported a mediation model wherein the indirect pathway from controlling parenting style to perfectionism (personal standard subscale) was mediated by the ERN—for paternal parenting.

Resume Objectifs L’analyse des modes de defaillance, de leur effet, et de leur criticite (AMDEC) est un outil de gestion des risques permettant de securiser le circuit du medicament. La dispensation aux patients ambulatoires en service de retrocession hospitaliere etant une activite a risque, cet outil a ete utilise pour analyser et ameliorer ce processus. Methode Apres avoir decrit les etapes du processus et ses risques, une premiere AMDEC a ete realisee en 2015. Des actions d’ameliorations etaient mises en place si l’indice de criticite du risque etait superieur a 15. L’impact de ces actions a ete evalue un an apres, en reiterant l’AMDEC. Resultats En 2015, 11 risques ont ete identifies comme prioritaires et l’indice de criticite total de l’analyse s’elevait a 397. Apres mise en place d’actions d’amelioration, une nouvelle AMDEC a ete realisee un an plus tard montrant une baisse de l’indice de criticite totale de 14 % (340) avec 6 risques restant prioritaires. Ainsi, grâce a l’outil AMDEC, des risques ont pu etre identifies a l’annee « n », corriges par des actions puis reevaluees efficacement a l’annee « n + 1 ». Conclusion Cette etude a permis d’evaluer la faisabilite et l’interet de l’utilisation de l’AMDEC sur le processus de dispensation en retrocession hospitaliere renouveler l’AMDEC a un an a permis d’assurer le suivi des actions menees, d’evaluer leur efficacite et de surveiller l’emergence de nouveaux risques. Il apparait donc comme un moyen efficace de piloter le processus de dispensation, en retrocession hospitaliere.

Contains fulltext : 234936.pdf (Publisher’s version ) (Open Access) Children diagnosed with autism spectrum disorder (ASD) often have smaller vocabularies in infancy compared to typically-developing children. To understand whether their smaller vocabularies stem from problems in learning, our study compared a prospective risk sample of 18 elevated risk and 11 lower risk 24-month-olds on current vocabulary size and word learning ability using a paradigm in which parents teach their child words. Results revealed that both groups learned novel words, even though parents indicated that infants at elevated risk of ASD knew fewer words. This suggests that these early compromised vocabularies cannot be solely linked to difficulties in word formations. 12 p.

Medicolegal liability is an issue of concern for all physicians, including pathologists. Identification of the key clinical issues that tend to lead to medical malpractice litigation, as well as the settlement values for such claims, can be useful for prospective risk management. This review analyzes medical malpractice claims filed in state and federal courts as published in legal databases. Additionally, this review also analyzes the reported settlement values for such claims.

Background/Aims Prospective risk management is a necessary measure when managing and providing the right response to a healthcare system error. This article provides an improved model of the Healthcare Failure Mode and Effect Analysis model, which aims to reduce errors in the operating room and improve on the major defects found in the Healthcare Failure Mode and Effect Analysis model. Methods The improved model presented in this descriptive mixed-methods article was examined in 2015 on selective processes in total knee replacement in Shahid Madani Hospital's operating rooms in Karaj, Iran. Data were collected through clinical observations, individual and group interviews, and collaborative conversations with the study team. Results A total of 8 activities and 15 modes of failure were identified in 5 selection processes in total knee replacement surgery. The identified modes of failure were given scores. Ultimately, 15 potential causes and 17 measures were proposed for 12 failures. The failure of the ‘unmanaged nurse or the anaesthesia technician in the operating rooms’ had the highest priority, and ‘chest leads’ and a ‘blood pressure cuff placed in the incorrect position’ had the lowest priority. Conclusion The improved model better reported the risk priorities of failures in 9 out of 12 modes. It was also able to resolve major defects in the Healthcare Failure Mode and Effect Analysis model and produce more reliable results.

Background Postoperative complications are the main consumers of technical, medical, and human resources. Especially in the field of elective joint replacement surgery, a specialized, easy-to-obtain, and cost-efficient preoperative stratification and risk-estimation model is missing. Methods With preoperatively surveyed patient parameters, we identified the most relevant parameters to predict postoperative medical complications. We devised a prospective risk model, measuring the individual probability for intermediate care unit (IMC) or intensive care unit (ICU) admission. The study includes all patients (n = 649) treated with primary or revision total knee arthroplasty in our clinic from 2008 to 2012. Results The association between general comorbidity scores and mortality risk is well known. Among different comorbidity scores, the Charlson Comorbidity Index is not only relevant for overall postoperative complications (odds ratios [OR] = 2.20) but also predictive of specific complications such as the postoperative need for blood transfusion (OR = 1.94) and unexpected adverse events (OR = 1.74). Considering adverse events, c-reactive protein and leukocyte levels are also highly relevant. Upon predicting a necessary postoperative transfer to an IMC or ICU, the preoperative hemoglobin level, the Charlson Comorbidity Index, and the Index of Coexistent Disease stood out. The latter indicates an increased rate for an IMC/ICU stay by 341% per point. Condensing the most influential predictors, the probability for postoperative IMC/ICU transfer can be calculated for each individual patient. Using the routinely assessed patient's variables, no steadier prediction is possible. Conclusion The introduced risk-estimation model offers a specialized preoperative resource-stratification method in knee joint replacement surgery. It condenses the most influential, individual risk factors to avoid clinical test redundancy and improve resource efficiency and presurgical care planning. A prospective follow-up study could help validating the risk model in clinical routine.

OBJECTIVE To establish whether poor parental supervision is associated with head injury and self-reported reactive aggression (ie, aggression in response to perceived provocation or threat) in adolescents in a Young Offender's Institute, by examining correlations between these variables. Understanding this population is important, as they are at a key pivotal age for intervention to prevent lifelong reoffending. METHODS Ninety-six male participants aged 16 to 18 years were recruited from a UK Young Offender's Institute. Self-report measures of remembered parenting, reactive aggression, and head injury history were administered during individual interviews. RESULTS Seventy-four percent of participants reported having experienced a lifetime traumatic brain injury (TBI), and 46% of participants reported experiencing at least 1 TBI leading to a loss of consciousness (LOC). We found that poor parental supervision, length of LOC following TBI, and self-reported reactive aggression were all positively correlated. CONCLUSIONS Findings show that there are correlational relationships between poor parental supervision, length of LOC following lifetime TBI, and higher levels of self-reported reactive aggression. This suggests there may be pathways resulting from poor parental supervision leading to both TBI with LOC, and reactive aggression. We advocate for future research with longitudinal designs and larger samples to examine the nature of these interactions, and to establish whether poor parental supervision is a prospective risk factor for more TBIs leading to LOC, and reactive aggression. This is key to understanding whether parenting interventions could help to reduce the disabling effects of TBI in adolescents, and help to prevent contact with the law.

Background: The increasing number of drug shortages (DSs) worldwide calls for more proactive solutions to prevent the negative impacts of DSs on patient care. Such solutions require in-depth knowledge about potential patient safety risks related to DSs, the processes of recognizing and managing DSs, the contextual setting in which DSs occur, and the actors involved.Objective: The aim of the study is to use prospective risk assessment to identify patient safety risks in hospitals associated with the management of DSs among actors at national, regional and local level in Denmark.Methods: Healthcare Failure Mode and Effect Analysis (HFMEA) was employed in composition with elements from the Systematic Human Error Reduction and Prediction Approach (SHERPA) and the Systems-Theoretic Accident Model and Processes (STAMP). Potential risks related to DS management across three actor levels (national, regional and local) in the Danish healthcare system were described. Each actor level consisted of six participants that were identified using a purposive sampling strategy. Processes and sub-processes related to managing critical DSs were outlined and the actors identified, prioritized and rated potential failure modes, causes and consequences related to the processes. Recommendations to mitigate failures were proposed for high risk failures modes.Results: Overall, a total of 167 failure modes were identified across the three actor levels. At the national level, the process of DS management consisted of 17 sub-processes, from which 71 failure modes were identified. Nine of them were rated as high risk. At regional level, 7 sub-processes and 33 failure modes were identified, of which 9 were rated as high risk. At local level, 14 sub-processes and 63 failure modes were identified, of which 32 were rated as high risk. The high-risk failures were related to a lack of IT support in the medication modules, underestimation of patient safety aspects, and insufficient personnel training and patient information.Conclusion: Exploring DS management failure modes across actor levels provided an overview of interrelated failures. Potential solutions related to high risk failures were developed to ensure that actors ensure patient safety related to DS in healthcare.

Understanding the consequences of the combined effects of multiple stressors-including stress from man-made chemicals is important for conservation management, the ecological risk assessment of chemicals, and many other ecological applications. Our current ability to predict and analyse the joint effects of multiple stressors is insufficient to make the prospective risk assessment of chemicals more ecologically relevant because we lack a full understanding of how organisms respond to stress factors alone and in combination. Here, we describe a Dynamic Energy Budget (DEB) based bioenergetics model that predicts the potential effects of single or multiple natural and chemical stressors on life history traits. We demonstrate the plausibility of the model using a meta-analysis of 128 existing studies on freshwater invertebrates. We then validate our model by comparing its predictions for a combination of three stressors (i.e. chemical, temperature, and food availability) with new, independent experimental data on life history traits in the daphnid Ceriodaphnia dubia. We found that the model predictions are in agreement with observed growth curves and reproductive traits. To the best of our knowledge, this is the first time that the combined effects of three stress factors on life history traits observed in laboratory studies have been predicted successfully in invertebrates. We suggest that a re-analysis of existing studies on multiple stressors within the modelling framework outlined here will provide a robust null model for identifying stressor interactions, and expect that a better understanding of the underlying mechanisms will arise from these new analyses. Bioenergetics modelling could be applied more broadly to support environmental management decision making., 10 pages

This report describes an ongoing R03 grant that explores the links between trait reward sensitivity, substance use, and neural responses to social and nonsocial reward. Although previous research has shown that trait reward sensitivity and neural responses to reward are linked to substance use, whether this relationship is impacted by how people process social stimuli remains unclear. We are investigating these questions via a neuroimaging study with college-aged participants, using individual difference measures that examine the relation between substance use, social context, and trait reward sensitivity with tasks that measure reward anticipation, strategic behavior, social reward consumption, and the influence of social context on reward processing. We predict that substance use will be tied to distinct patterns of striatal dysfunction. Specifically, reward hyposensitive individuals will exhibit blunted striatal responses to social and non-social reward and enhanced connectivity with the orbitofrontal cortex; in contrast, reward hypersensitive individuals will exhibit enhanced striatal responses to social and non-social reward and blunted connectivity with the orbitofrontal cortex. We also will examine the relation between self-reported reward sensitivity, substance use, and striatal responses to social reward and social context. We predict that individuals reporting the highest levels of substance use will show exaggerated striatal responses to social reward and social context, independent of self-reported reward sensitivity. Examining corticostriatal responses to reward processing will help characterize the relation between reward sensitivity, social context and substance use while providing a foundation for understanding risk factors and isolating neurocognitive mechanisms that may be targeted to increase the efficacy of interventions.

Non-suicidal self-injury (NSSI) is a common behavior, particularly among adolescents and young adults. Impulsivity has been implicated as an important factor associated with NSSI, however prospective longitudinal research is lacking. Moreover, the relationship between impulsivity and other risk factors for NSSI is unclear. By examining longitudinal models including impulsivity, attachment, and distress we hope to elucidate the nature of the association between impulsivity and NSSI. 1,686 community-recruited young people (ages 14-25) with no NSSI in the past year were followed up for one year, completing self-report measures of the above factors. Impulsivity independently predicted new onset of NSSI over and above other risk factors, indicating heightened impulsivity is a prospective risk factor for NSSI. Psychological distress mediated the parenting-NSSI association.

Purpose Failure modes and effects analysis (FMEA) is a prospective risk assessment tool for identifying failure modes in equipment or processes and informing the design of quality control systems. This work aims to benchmark the performance of FMEAs for electronic brachytherapy (eBT) of the skin and for breast by comparing predicted versus actual failure modes reported in multiple incident learning systems (ILS). Methods and Materials Two public and our institution's internal ILS were queried for Xoft Axxent eBT-related events over 9 years. The failure modes and Risk Priority Numbers (RPNs) were taken from FMEAs previously performed for Xoft eBT of nonmelanoma skin cancer and breast intraoperative radiation therapy (IORT). For each event, the treatment site and primary failure mode was compared with the failure modes and RPNs from that site's FMEA. Results 49 events involving Xoft eBT were identified. Thirty-one (63.3%) involved breast IORT, and 18 (36.7%) involved the skin. Three events could not be linked to an FMEA failure mode. In 87.7% of events, the primary failure mode ranked in the FMEA top 10 by RPNs. In 83.3% of skin events, the failure modes ranked in the top 10 by RPN or severity. In 90.3% of IORT events, the failure modes ranked within the top 10 by RPN or severity. Conclusions Evaluating FMEA failure modes against ILS data demonstrates that FMEA is effective at predicting failure modes but can be dependent on user experience. ILS data can improve FMEA by identifying potential failure modes and suggesting realistic occurrence, detectability, and severity values.

Adolescent girls who engage in frequent self-objectification often report a greater number of depressive symptoms. Although concurrent associations between self-objectification and depression are well-documented, it is less clear if objectification contributes to the course of symptoms. The current study examined: (a) whether body surveillance is prospectively related to depressive symptoms over a 1-month period in a sample of 150 low-income adolescent girls in the United States, and; (b) whether receiving certain types of weight-relevant information (i.e., learning one's weight is much higher than estimated) moderates this association. Heightened body surveillance at baseline predicted greater symptom severity one month later, but the strength of this relationship depended on what type of weight information girls received. Among girls high in body surveillance, those who found out their actual weight was much higher than they estimated subsequently reported more severe depressive symptoms; those who learned their actual weight was consistent or lower than they estimated reported fewer depressive symptoms. For girls low in body surveillance, weight-relevant information was not significantly related to the subsequent severity of depressive symptoms. Findings highlight the potential utility of assessing and addressing heightened body surveillance in depression interventions for adolescent girls.

Effective management of in-season basketball injuries requires a multidisciplinary approach and a well-organized health-care team. Preseason evaluation, including thorough history and physical examinations, affords prospective risk stratification, identification of modifiable risk factors, and objective measures for guiding treatment. In-season injuries generally can be divided into acute or chronic patterns. Acute injuries require prompt initial treatment to limit the inflammatory phase and reduce the time lost to injury. Treatment of chronic injuries necessitates recognition of intrinsic and extrinsic factors in order to alter modifiable causes to limit intensity, duration, and frequency. Timing of injury in relation to season status along with risk stratification for irreversible or permanent injury must also be weighed into treatment decisions. Ultimately, end-of-season evaluations in combination with the offseason provide an essential window for the treatment and execution of individualized training and recovery programs.

This report describes an ongoing R03 grant that explores the links between trait reward sensitivity, substance use, and neural responses to social and nonsocial reward. Although previous research has shown that trait reward sensitivity and neural responses to reward are linked to substance use, whether this relationship is impacted by how people process social stimuli remains unclear. We are investigating these questions via a neuroimaging study with college-aged participants, using individual difference measures that examine the relation between substance use, social context, and trait reward sensitivity with tasks that measure reward anticipation, strategic behavior, social reward consumption, and the influence of social context on reward processing. We predict that substance use will be tied to distinct patterns of striatal dysfunction. Specifically, reward hyposensitive individuals will exhibit blunted striatal responses to social and non-social reward and enhanced connectivity with the orbitofrontal cortex; in contrast, reward hypersensitive individuals will exhibit enhanced striatal responses to social and non-social reward and blunted connectivity with the orbitofrontal cortex. We also will examine the relation between self-reported reward sensitivity, substance use, and striatal responses to social reward and social context. We predict that individuals reporting the highest levels of substance use will show exaggerated striatal responses to social reward and social context, independent of self-reported reward sensitivity. Examining corticostriatal responses to reward processing will help characterize the relation between reward sensitivity, social context and substance use while providing a foundation for understanding risk factors and isolating neurocognitive mechanisms that may be targeted to increase the efficacy of interventions.

Objective: This study aimed to obtain a comprehensive overview on the perception, attitudes, and experience of European pharmacists with prospective risk assessment procedures in everyday practice, as well as to identify challenges and solutions. This is a follow-up study to the surveys on prospective risk assessment previously carried out within the COST Action 15105 among pharmacists across Europe. Methodology: In-depth interviews were performed using an interview guide comprising 25 questions. Interviews were transcribed ad verbatim and imported into NVivo 10 for framework analysis. In NVivo, the interviews were coded through assigning text segments to a responding code from a coding tree, covering the full content of the interviews. Coded text segments were then charted into a matrix, and analyzed by interpreting all text segments per code. Results: In total, 18 interviews were conducted. From the framework analysis, 6 codes and 12 sub-codes emerged. Overall, despite citing specific issues pertaining to its implementation, the interviewees considered multi-stakeholder and multi-disciplinary prospective risk assessment to be essential. While healthcare professionals reported being aware of the importance of risk assessment, they cited insufficient knowledge and skills to be a major obstacle in everyday practice. They also reported inadequate IT support since a paper-based system is still widely in use, thereby complicating data extraction to carry out prospective risk assessment. Conclusion: While prospective risk assessment was found to be valuable, interviewees also found it to be a resource-intensive and time-consuming process. Due to resource constraints, it may not be possible or desirable to conduct prospective risk assessment for every shortage. However, for critical-essential drugs, it is crucial to have a ready-to-use substitute based on risk assessment. Moreover, potential risks of substitutes on patient health should be identified before a shortage occurs and the substitute is dispensed as an alternative. ispartof: FRONTIERS IN MEDICINE vol:7 ispartof: location:Switzerland status: published

Introduction The international move towards digital healthcare record keeping has seen an increase in the number of radiotherapy departments moving towards a paperless framework. With the recent transition to a paperless radiation oncology framework at the Princess Alexandra Hospital Brisbane, it was crucial to perform a prospective risk assessment to quantify the most significant sources of risk in the electronic environment. Methods A failure mode and effects analysis (FMEA) was performed using a web-based three-round Delphi technique. Participants included Radiation Therapists and Radiation Oncologists. A detailed process map was created of all process steps and their sub-processes from patient booking to treatment. The first round was an open qualitative round to identify failure modes. The subsequent rounds were used to score all failure modes using the risk priority number (RPN) scoring method, based on the product of occurrence, severity and detectability scoring. The final round was also used to identify risk mitigation strategies. Results The process map consisted of 60 process steps and 141 sub-processes. A list of 83 failure modes was identified and consensus was achieved regarding the risk scoring for a prioritised list of 20. Four of the top five failure modes were related to communication errors. Eighteen feasible solutions were recommended for incorporating into clinical practice to increase patient safety. Conclusion The FMEA proved a valuable systematic method of prospectively identifying vulnerabilities in a paperless radiotherapy department. In particular, this FMEA identified numerous failure modes concerning communication and documentation, highlighting the need for sustained vigilance when performing all electronic processes.

A framework is presented that is intended to facilitate the evaluation of potential aquatic ecological risks resulting from discharges of down the drain chemicals. A scenario is presented using representatives of many of the types of chemicals that are treated domestically. Predicted treated effluent chemical concentrations (PECS) are based on reported loading rates and routine removal rates for three types of treatment: trickling filter (TF), activated sludge secondary treatment (AS), and AS plus advanced oxidation process (AOP). In Tier I, PECs were compared with the lowest predicted no effect concentration (PNEC) obtained from the literature using safety factors as needed. A cumulative risk characterization ratio (cumRCR) 1.0 for all three treatment types in our scenario, even though no chemical exceeded a hazard quotient of 1.0 in AS or AOP. In Tier 2, AS yielded a lower cumRCR than TF due to higher removal rates and the cumRCR in AOP was <

Objective Growing literature has identified childbirth as a potentially traumatic event, following which mothers may develop symptoms of Post-Traumatic-Stress-Following-Childbirth. The current study is the first to prospectively examine a pathway of risk from mothers’ prenatal trait-anxiety, to Acute-Stress-Immediately-Following-Childbirth, and later symptoms of Post-Traumatic-Stress-Following-Childbirth, in a low-risk community sample. Auxiliary analyses explored whether doula care during childbirth moderated risk. Method 149 pregnant women were randomly selected. Prenatal trait-anxiety was assessed toward the end of pregnancy, Acute-Stress-Immediately-Following-Childbirth at two-days post-partum, and symptoms of Post-Traumatic-Stress-Following-Childbirth at one-month post-partum. Results Results indicated a significant indirect pathway from prenatal trait-anxiety to Post-Traumatic-Stress-Following-Childbirth, through Acute-Stress-Immediately-Following-Childbirth. Two groups were generated ad hoc for auxiliary analyses: participants who opted to receive doula care during childbirth (n=21; 14%) versus participants who received care as usual (n=128; 86%). Analyses provided preliminary support for doula care as a potential moderator of risk. Conclusions Results point toward prenatal trait-anxiety and Acute-Stress-Immediately-Following-Childbirth as significant risk factors for Post-Traumatic-Stress-Following-Childbirth. Findings inform preventive screening implicating the prenatal period as well as the postnatal hospital stay as important time windows for preventive screening. Finally, preliminary support for moderating effects of doula care suggest that preventive interventions administered during the perinatal period may effectively reduce anxiety-related risk for Post-Traumatic-Stress-Following-Childbirth.

ObjectiveThe aim of the study was to investigate hypothalamic-pituitary-adrenal axis (HPA axis) functioning as a neurobiological risk factor for depressive symptoms in an ongoing longitudinal, observational study of women undergoing treatment and recovery from breast cancer. Many women with breast cancer experience depressive symptoms that interfere with their treatment, recovery, and quality of life. Psychosocial risk factors for depression among patients with cancer and survivors have been identified, yet neurobiological risk factors in this population remain largely unexamined.MethodsWomen recently diagnosed with early-stage breast cancer (N = 135) were enrolled before starting neoadjuvant/adjuvant treatment (radiation, chemotherapy, endocrine therapy). At baseline, participants collected saliva samples to measure diurnal HPA axis functioning for 3 days: at waking, 30 minutes after waking, 8 hours after waking, and bedtime. Participants also completed a standardized measure of depressive symptoms (Center for Epidemiological Studies-Depression Scale) at baseline and 6 months after completion of primary treatment. Multivariate regression was used to predict continuous depressive symptoms at 6-month posttreatment from continuous depressive symptoms at baseline, cortisol awakening response (CAR), and other measures of diurnal HPA axis functioning.ResultsThe magnitude of CAR predicted changes in depressive symptoms over time, such that women with a higher CAR showed a greater increase from baseline to 6-month posttreatment (b = 5.67, p = .023). Diurnal slope and total cortisol output were not associated with concurrent depressive symptoms or their change over time.ConclusionsElevated CAR may be a neurobiological risk factor for increases in depressive symptoms in the months after breast cancer treatment and warrants further investigation.

Many bereavement researchers focus on predicting and preventing complicated grief, a psychologically crippling, sometimes life-threatening response to loss that persists for lengthy periods, often ...

This paper is devoted to the comparison between two aerothermodynamics tools, used to predict the survivability of space debris during the re-entries and assess the prospective risk on ground: SCARAB & PAMPERO. Two test-cases have been identified for a first batch of comparisons on different shapes, in order to cover all flow regimes during a debris re-entry.

Background: A pregnancy risk score system in popular use in provincial and rural Queensland to assist with the triage decisions regarding the appropriate facility for pregnancy care has been upgraded with more recently recognised pregnancy risk factors. Aims: To review the usefulness of the revised pregnancy risk score system and the integrity of its continuing use. Materials and Methods: 459 women attending regional/rural hospitals and 1963 women attending a major specialist hospital for their pregnancy care had a prospective risk score assessed, and the resulting score was examined in relationship to pregnancy outcomes. Results: There was a statistically significant positive relationship between a risk score of eight or more and an adverse outcome and a statistically significant negative relationship between a risk score of zero or one and adverse outcomes. Conclusion: This study revalidates the risk score process for use in provincial and rural Queensland in delineating those women requiring care in a location with higher levels of clinical service capability. Women with a risk score of 8 or more have an increased likelihood of needing birth intervention and/or having an adverse neonatal outcome and should be recognised as needing the development of a multidisciplinary care plan and assessment in a facility that is appropriately resourced for their end of pregnancy care.