Changes In Risk Levels Research Articles

Impact of sexual trajectories of men who have sex with men on the reduction in HIV transmission by pre-exposure prophylaxis

Changes in sexual risk behavior over the life course in men who have sex with men (MSM) can influence population-level intervention efficacy. Our objective was to investigate the impact of incorporating sexual trajectories describing long-term changes in risk levels on the reduction in HIV prevalence by pre-exposure prophylaxis (PrEP) among MSM. Based on the Amsterdam Cohort Study data, we developed two models of HIV transmission in a population stratified by sexual behavior. In the first model, individuals were stratified into low, medium and high risk levels and did not change their risk levels. The second model had the same stratification but incorporated additionally three types of sexual behavior trajectories. The models assumed universal antiretroviral treatment of HIV+ MSM, and PrEP use by high risk HIV− MSM. We computed the relative reduction in HIV prevalence in both models for annual PrEP uptakes of 10% to 80% at different time points after PrEP introduction. We then investigated the impact of sexual trajectories on the effectiveness of PrEP intervention. The impact of sexual trajectories on the overall prevalence and prevalence in individuals at low, medium and high risk levels varied with PrEP uptake and time after PrEP introduction. Compared to the model without sexual trajectories, the model with trajectories predicted a higher impact of PrEP on the overall prevalence, and on the prevalence among the medium and high risk individuals. In low risk individuals, there was more reduction in prevalence during the first 15 years of PrEP intervention if sexual trajectories were not incorporated in the model. After that point, at low risk level there was more reduction in the model with trajectories. In conclusion, our study predicts that sexual trajectories increase the estimated impact of PrEP on reducing HIV prevalence when compared to a population where risk levels do not change.

Development and validation of a dynamic delirium prediction rule in patients admitted to the Intensive Care Units (DYNAMIC-ICU): A prospective cohort study

BackgroundDelirium is one of the most common cognitive complications among patients admitted to the intensive care units (ICU). ObjectiveTo develop and validate a DYNAmic deliriuM predICtion rule for ICU patients (DYNAMIC-ICU) and to stratify patients into different risk levels among patients in various types of ICUs. DesignProspective cohort study. Setting and participantsA total of 560 (median age of 66 years, 62.5% male) consecutively enrolled patients from four ICUs were included in the study. The patients were randomly assigned into either the derivation (n = 336, 60%) or the validation (n = 224, 40%) cohort by stratified randomization based on delirium/non-delirium and types of ICU. MethodsThe simplified Chinese version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was used to assess delirium until patients were discharged from the ICUs. Potential predisposing, disease-related, and iatrogenic and environmental risk factors as well as data on patients’ outcomes were collected prospectively. ResultsOf the enrolled patients, 20.2% and 20.5% developed delirium in the derivation and validation cohorts, respectively. Predisposing factors (history of chronic diseases, hearing deficits), disease-related factors (infection, higher APACHE II scores at admission), and iatrogenic and environmental factors (the use of sedatives and analgesics, indwelling catheter, and sleep disturbance) were identified as independent predictors of delirium. Points were assigned to each predictor according to their odds ratio to create a prediction rule which was internally validated based on total scores and by bootstrapping (AUCs of 0.907 [95% CI 0. 871 -0.944], 0.888 [95% CI 0.845-0.932], and 0.874 [95% CI 0.828-0.920]), respectively. The total score of the DYNAMIC-ICU ranged from 0 to 33 and patients were divided into low risk (0–9), moderate risk (10–17), high risk (18–33) groups in developing delirium according to their total score with incidence of delirium at 2.8%, 16.8% and 75.9% in the derivation group, respectively. The DYNAMIC-ICU and its performance of risk level stratification were further validated in the validation cohort (AUC = 0.900 [95% CI 0.858-0.941]). The all-cause mortality was increased and the length of hospital stay was prolonged dramatically with the increase of delirium risk levels in both derivation (p = 0.034, p < 0.001) and validation cohorts (p < 0.001, p < 0.001). ConclusionsSeven predictors for ICU delirium were identified to create DYNAMIC-ICU, which could well stratify ICU patients into three different delirium risk levels, tailor risk level changes, and predict in-hospital outcomes by a dynamic assessment approach.

Temporal structuring of vigilance behaviour by female Thomson's gazelles with hidden fawns

Prey animals often face a trade-off between investing time in antipredator behaviour and performing self-maintenance activities, such as foraging. Parents face particularly high stakes as they must protect highly vulnerable offspring while also meeting elevated energetic demands. To optimize this trade-off, the risk allocation hypothesis predicts that prey should adjust their antipredator behaviour to reflect temporal fluctuations in risk. That is, they should invest more in antipredator behaviour when risk is high and prioritize other activities when risk is low. Here we investigate whether changes in risk level resulting from periodic fawn exposure drive maternal vigilance patterns in Thomson's gazelle, Eudorcas thomsonii. We find that maternal vigilance patterns match the predictions of the risk allocation hypothesis. Mothers are highly vigilant prior to fawn retrieval, when risk of fawn detection by predators is high. They exhibit low levels of vigilance after fawns resume hiding, when certainty of predator absence is high and, therefore, risk is low. We suggest that fawn active periods may function secondarily as a form of predator sampling and that mothers may adjust their vigilance levels in response to information yielded by this sampling.

Affect Heuristic and Format Effect in Risk Perception

The affect heuristic can evoke a format effect so that different ways of expressing the level of likelihood of an event happening can cause different perceptions of the level of risk. We conducted 3 studies to test the hypothesis that a format effect is not always present at every level of probability, and even when a format effect occurs, it depends on risk level and emotion. In Study 1, the risk of a flood threatening participants' homes (familiar risk) regardless of change in emotion, occurred only at a 5% probability level. In Study 2, when facing an unfamiliar risk (being infected by Chikungunya fever), regardless of change in emotion, a format effect occurred at the level of 5% probability only when emotion was positive. In Study 3, a format effect occurred at a 5% probability level when prior emotion expectation was positive and risk consequences were emphasized. We can conclude that the format effect depends on changes in risk level and emotions.

Evaluating a generic drought index as a predictive tool for aflatoxin contamination of corn: From plot to regional level

Corn (Zea mays L.) kernel infection by Aspergillus flavus and subsequent aflatoxin accumulation in grain can have a deleterious effect on both humans and animals that consume contaminated grain. Predicting the aflatoxin risk is challenging due to complex interactions of biotic and abiotic stress factors that govern and exacerbate the phenomenon. The goal of this study was to determine whether a drought index could be used to predict the risk for pre-harvest aflatoxin contamination in corn. Risk assessment was approached at: 1) field (plot) level with data obtained from an in-field controlled experiment (Mississippi study), and 2) state level, where corn fields were sampled at a county level (Georgia study). The data used for this study consisted of historical records on aflatoxin contamination collected over thirteen growing seasons from 2000 to 2011, 2013, and 2014 at Mississippi State, Mississippi (1), and from random corn fields in 53 counties across Georgia between 1977 and 2004 (2). A controlled experiment was conducted at Mississippi with two soil types (a Leeper silty clay loam and a Myatt loam), and three commercial hybrids characterized by different susceptibility levels to aflatoxin contamination. The Agricultural Reference Index for Drought (ARID), a generic drought index for calculating drought on daily basis was evaluated as an aflatoxin risk prediction tool. Mid-silk day was selected to split each growing season into two time periods, which were further divided into positive and negative weeks representing weeks after and before mid-silk, respectively. Weekly ARID factors were calculated for all periods to evaluate the in-season alterations in aflatoxin risk. In both studies, multiple logistic regression models were used to predict aflatoxin risk as a function of the weekly ARID values. In Mississippi, risk level changes were additionally tested according to soil type and corn hybrid aflatoxin susceptibility. The United States Food and Drug Administration restricts corn grain consumption by humans and young animals if the contamination level is above 20 μg/kg; thus, this threshold (20 μg/kg) was selected to develop a binary dependent variable for the logistic model from the raw aflatoxin data. The results revealed that ARID might be used as a predictive tool to assess aflatoxin risk, soil type and hybrid susceptibility to aflatoxin contamination were statistically significant independent factors, and there are critical week windows during the growing season when changes in drought conditions affect the likelihood for aflatoxin contamination. These findings can be used to minimize risk by adapting site-specific management strategies such as triggering irrigation during critical risk weeks, selecting the most appropriate hybrid for a given site/location based on soil type, and determining optimum harvest date.

TEAM-UP for quality: a cluster randomized controlled trial protocol focused on preventing pressure ulcers through repositioning frequency and precipitating factors

BackgroundPressure ulcers/injuries (PrUs), a critical concern for nursing homes (NH), are responsible for chronic wounds, amputations, septic infections, and premature deaths. PrUs occur most commonly in older adults and NH residence is a risk factor for their development, with at least one of every nine U.S. NH residents experiencing a PrU and many NHs having high incidence and prevalence rates, in some instances well over 20%. PrU direct treatment costs are greater than prevention costs, making prevention-focused protocols critical. Current PrU prevention protocols recommend repositioning residents at moderate, high, and severe risk every 2 h. The advent of visco-elastic (VE) high-density foam support-surfaces over the past decade may now make it possible to extend the repositioning interval to every 3 or 4 h without increasing PrU development. The TEAM-UP (Turn Everyone And Move for Ulcer Prevention) study aims to determine: 1) whether repositioning interval can be extended for NH residents without compromising PrU incidence and 2) how changes in medical severity interact with changes in risk level and repositioning schedule to predict PrU development.MethodsIn this proposed cluster randomized study, 9 NHs will be randomly assigned to one of three repositioning intervals (2, 3, or 4 h) for a 4-week period. Each enrolled site will use a single NH-wide repositioning interval as the standard of care for residents at low, moderate, and high risk of PrU development (N = 951) meeting the following criteria: minimum 3-day stay, without PrUs, no adhesive allergy, and using VE support surfaces (mattresses). An FDA-cleared patient monitoring system that records position/movement of these residents via individual wireless sensors will be used to visually cue staff when residents need repositioning and document compliance with repositioning protocols.DiscussionThis study will advance knowledge about repositioning frequency and clinically assessed PrU risk level in relation to PrU incidence and medical severity. Outcomes of this research will contribute to future guidelines for more precise preventive nursing practices and refinement of PrU prevention guidelines.Trial registrationClinical Trial Registration: NCT02996331.

Single Stock Futures and their Impact on Risk Characteristics of the Underlying Stocks: A Dynamic CAPM Approach

The concern regarding destabilizing ability of trading in futures markets in terms of increase in risk is still unresolved in developed and developing economies. This discussion also prevailed in Pakistan after the Global Financial Crisis (GFC). To investigates this concern with respect to Single Stock Futures (SSFs) and their impact on the underlying stocks, this study made use of data from 1999 to 2008. Speci cally, this study investigates the introduction of SSFs in relevance to their impact on the systematic and unsystematic risk of their counterparts. The statistical results of the study show that introduction of SSFs does not enhance the overall risk of the underlying stocks. Therefore, it can be concluded that SSFs cannot be blamed for any apparent volatility in the Pakistan Stock Exchange (PSX) at and before GFC. There could be some other reasons for change in risk level (accounting and macroeconomic fundamentals or industry speci fic etc.). The results of this study are in line with a category of earlier studies, which show that introduction of futures do not destabilize the underlying market. The study implies that flexible regulated futures markets can improve price discovery and liquidity of the market, while acting as an agent for hedgers.

Single Stock Futures and Their Impact on Risk Characteristics of the Underlying Stocks: A Dynamic CAPM Approach

The concern regarding destabilizing ability of trading in futures markets in terms of increase in risk is still unresolved in developed and developing economies. This discussion also prevailed in Pakistan after the Global Financial Crisis (GFC). To investigates this concern with respect to Single Stock Futures (SSFs) and their impact on the underlying stocks, this study made use of data from 1999 to 2008. Speci cally, this study investigates the introduction of SSFs in relevance to their impact on the systematic and unsystematic risk of their counterparts. The statistical results of the study show that introduction of SSFs does not enhance the overall risk of the underlying stocks. Therefore, it can be concluded that SSFs cannot be blamed for any apparent volatility in the Pakistan Stock Exchange (PSX) at and before GFC. There could be some other reasons for change in risk level (accounting and macroeconomic fundamentals or industry speci fic etc.). The results of this study are in line with a category of earlier studies, which show that introduction of futures do not destabilize the underlying market. The study implies that flexible regulated futures markets can improve price discovery and liquidity of the market, while acting as an agent for hedgers.

Does the groundwater nitrate pollution in China pose a risk to human health? A critical review of published data.

Nitrate pollution has pervaded many parts of the world, especially in developing countries such as China. Based on the available groundwater nitrate data sets in China (2000-2015), the groundwater pollution levels at the provincial scale are evaluated which contains 33 provinces (units) except for Macau because of lacking data. Then, the potential risks posed to human health in national scale are quantified. In order to make the results more precise and systematical, both drinking and dermal contact exposure pathways are considered, and the influenced crowd are more finely divided into four groups to study the impacts of age and gender on the outcome, which include infants (0-6months), children (7months-17years old), adult males (18years old-), and adult females (18years old-). Results indicate that there are seven units whose groundwater nitrate concentrations exceed the standard value with Shaanxi being a seriously poor condition. Facing the same level of nitrate, the health risk level changes in the order of infants > children > adult males > adult females. That is to say, minors and males are more vulnerable compared with adults and females, respectively. There is no adverse effect on adult females of the whole country, while gender really impacts on the health risk assessment result. Adult males, children, and infants face various degrees of health risk respectively in Shaanxi and Shandong, which are needed to pay more attention to.

Lifelong Gender Gap in Risk of Incident Myocardial Infarction

It is not clear to what extent the higher incidence of coronary heart disease (CHD) in men vs women is explained by differences in risk factor levels because few studies have presented adjusted risk estimates for sex. Moreover, the increase in risk of CHD in postmenopausal women, possibly hormone related, may eventually eliminate the sex contrast in risk, but age-specific risk estimates are scarce. To quantify the difference in risk of incident myocardial infarction (MI) between men and women. Population-based prospective study from Tromsø, Norway, comprising 33 997 individuals (51% women). Median follow-up time during ages 35 to 102 years was 17.6 years. Incidence rates (IRs) and incidence rate ratios (IRRs, relative risk) of MI were calculated in Poisson regression analysis of person-years at risk. The data analysis was performed in November 2015. Sex, age, birth cohort, serum lipid levels, blood pressure, lifestyle factors, diabetes. Incident MI. A total of 2793 individuals (886 women) received a diagnosis of MI during follow-up in the period 1979 through 2012. The IR increased with age in both sexes, with lower rates for women until age 95 years. Adjusted for age and birth cohort, the overall IRR for men vs women was 2.72 (95% CI, 2.50-2.96). Adjustment for high-density lipoprotein cholesterol and total cholesterol levels had the strongest impact on the risk estimate for sex, followed by diastolic blood pressure and smoking. However, the sex difference remained substantial even after adjustment for these factors (IRR, 2.07; 95% CI, 1.89-2.26). Men had higher risk throughout life, but the IRRs decreased with age (3.64 [95% CI, 2.85-4.65], 2.00 [95% CI, 1.76-2.28], and 1.66 [95% CI, 1.42-1.95] for age groups 35-54, 55-74, and 75-94 years, respectively). Adjustment for systolic blood pressure, diabetes, body mass index, and physical activity had no notable impact. The observed sex contrast in risk of MI cannot be explained by differences in established CHD risk factors. The gender gap persisted throughout life but declined with age as a result of a more pronounced flattening of risk level changes in middle-aged men. The minor changes in IRs when moving from premenopausal to postmenopausal age in women make it unlikely that changes in female hormone levels influence the risk of MI.

A Cloud-Based Adaptive Disaster Recovery Optimization Model

&lt;p&gt;&lt;span style="font-size: 10.5pt; font-family: 'Times New Roman','serif'; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: 宋体; mso-font-kerning: 1.0pt; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN; mso-bidi-language: AR-SA;" lang="EN-US"&gt;Disaster recovery and business continuity plans are essential to make sure businesses keep on going. However, many small and medium businesses feel that these plans can cost them a lot. Moreover, the issues of cost and operation overhead prevent them from having solid disaster recovery plans. However, with the spread of cloud computing and pay-as-you-go and pay-for-what-you-use models, issues of operational overhead and expensive investment in extra storage and extra infrastructure are significantly minimized. On the other hand, as it becomes more affordable, businesses want to make sure they get the most optimal solution for minimum cost and overhead. In this work, we propose an adaptive cloud-based disaster recovery model that will be flexible in protecting data and applications with different plans by considering changes in risk levels and at the same time managing the costs and billing issues associated with the cloud. Therefore, this suggests an adaptive model to manage resources on the go while keeping costs as planned with the best possible protection.&lt;/span&gt;&lt;/p&gt;

Development and application of a quantitative risk assessment to a very slow moving rock slope and potential sudden acceleration

The benefits of quantitative risk assessments for landslide management have been discussed and illustrated in several publications. However, there still are some challenges in its application for low-probability, high-magnitude events. These challenges are associated with the difficulties in populating our models for risk calculations, which largely require the input of expert opinion. This paper presents a quantitative risk assessment to a very slow moving rock slope within a dam reservoir in the Province of British Columbia, Canada. The assessment is focused on the risk to the population in the vicinity of the dam and the populated areas downstream. Expert opinions quantified the slope failure probabilities in the order of 10−3 to 10−1 per year for the smallest failure scenario considered and less than 10−6 for a failure of the entire slope. However, these estimations are associated with high levels of uncertainty. Our approach starts with the calculation and assessment of the magnitude and probability of the potential slope failure consequences, minimizing the uncertainties associated with estimated slope failure probabilities. Then, these consequences and failure probabilities are combined to obtain a measure of risk. The uncertainty associated with the slope failure probabilities is managed by the estimation of plausible ranges for these. The calculated risk levels are then presented as ranges of values and assessed against adopted evaluation criteria. The consequence and risk assessment of the rock slope suggest that the risk to the population exposed in the vicinity of the dam and populated areas downstream is under adequate control. The probability of large consequence scenarios is extremely low, in the order of 10−7 chance of an event causing more than 100 fatalities. We propose an observational technique to assess changes in risk levels and decide when to update the risk management approach or deploy emergency measures. The technique is focused on the detection of changes in the slope deformation patterns that would indicate an increase in the potential failure volumes or an imminent failure. It can be considered an extension to the current early warning system in place, easy to implement and enhanced with the strength of the comprehensive analysis required for a quantitative risk assessment.

Evaluation of earthquake mitigation measures to reduce economic and human losses: a case study to residential property owners in the metropolitan area of Shiraz, Iran

Iran is located in a highly seismic active region, and building structures, therefore, need to be designed and constructed to withstand major earthquakes. Structural mitigation measures are now seen as one key element to reduce economic as well as human losses for today and in the future. However, the costs and benefits of various options are difficult to be assessed and usually done without considering both human and economic aspects. This paper should fill part of this gap and performs an in-depth earthquake risk analysis for Shiraz city, in Iran. Additionally, the effects of different mitigation measures for buildings and corresponding changes in risk levels have been investigated. Probabilistic seismic hazard analysis is used to prepare the hazard curves, to be used in the probabilistic cost-benefit analysis of buildings to investigate the effects of using different strengthening strategies. Regarding the importance of the assessment of human casualties during earthquakes, additional cost-benefit ratios were calculated by considering the value of statistical life and performing sensitivity analysis. The results show that considering the value of statistical life in cost-benefit analysis can significantly increase the structural cost-benefit ratios. This has important implications for the decision support as well as policy making side in Iran, and we conclude with suggestions how these issues could be addressed in the future using a risk-layering approach.

American College of Foot and Ankle Surgeons' Clinical Consensus Statement: Risk, Prevention, and Diagnosis of Venous Thromboembolism Disease in Foot and Ankle Surgery and Injuries Requiring Immobilization

The purpose of this document is to provide guidance for physicians regarding the risk, prevention, and diagnosis of venous thromboembolism disease after foot and ankle surgery and while caring for lower extremity injuries that require ankle immobilization. A panel composed of all authors of this document reviewed the published evidence and, through a series of meetings, reached consensus regarding the viewpoints contained herein. We conclude that routine chemical prophylaxis is not warranted; rather, patients should be stratified and have a prevention plan tailored to their individual risk level. An effective venous thromboembolism prevention program is typically multimodal and focuses on addressing any modifiable risk factors, use of mechanical prophylaxis, early mobilization, and careful consideration of the use of chemical prophylaxis. The final decision regarding use and method(s) of prophylaxis adopted should be agreed upon by both the clinician and patient after a discussion of the potential benefits and harms as they relate to the individual. This should take place preferably during the preoperative visit or in the immediate post-injury setting, and it may need to be revisited during the course of care if the patient’s risk level changes. Prompt recognition of the signs and symptoms of deep venous thrombosis following surgery or injury is important. Patients suspected of deep venous thrombosis should receive further work-up with either a D-dimer test or duplex venous ultrasound of the symptomatic leg, depending on their pretest probability for the disease. The latter can be determined using a validated clinical decision-making tool (e.g., Well’s criteria).

Causal Factors and Improvement Measures Related to Well Control

This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper SPE 163775, ’Risk of Major Accidents: Causal Factors and Improvement Measures Related to Well Control in the Petroleum Industry,’ by Elisabeth Lootz and Monica Ovesen, SPE, Petroleum Safety Authority Norway, and Ranveig Kviseth Tinmannsvik, Stein Hauge, Eivind H. Okstad, and Inge M. Carlsen, SPE, SINTEF, prepared for the 2013 SPE Americas Exploration and Production Health, Safety, Security, and Environmental Conference, Galveston, Texas, USA, 18-20 March. The paper has not been peer reviewed. From 2009 to 2010, there was an increase in the number of well-control incidents on the Norwegian continental shelf reported to the Petroleum Safety Authority Norway (PSA). This, together with the Deepwater Horizon accident in 2010, prompted PSA to initiate a comprehensive investigation into the causes and possible mitigating measures related to well-control incidents. This paper details the findings of the study. Introduction The PSA report Trends in Risk Level in the Norwegian Petroleum Activity (RNNP) has been released on an annual basis since 2001. The RNNP aims to measure and improve health, safety, and environmental conditions in the Norwegian petroleum industry both offshore and onshore. The project includes indicators related to major accidents, personal injuries, and working-environment factors. The project monitors risk level through the use of a number of indicators: incident data (well-control incidents, hydrocarbon leaks, and personal injuries), data describing performance of technical barriers, maintenance data, and working-environment indicators (noise, ergonomics, and chemicals). Multiple methods, both quantitative and qualitative, are used to investigate and monitor changes in risk level. Interviews, field work, and a survey targeted at all employees on facilities onshore and offshore are used alongside more-traditional incident and near-miss reports. Organizational details about the Norwegian petroleum industry that were fundamental to the collaborative effort that made the study possible are detailed in the complete paper. The main research questions addressed in the present study included the following: What are the key human, technical, and organizational causes of well-control incidents? What are the most important measures proposed/implemented to reduce the number of well-control incidents? Is there correspondence between identified causes and proposed/ implemented measures? How can the petroleum industry improve its efforts to reduce the number of incidents further? Method The study was conducted by an experienced interdisciplinary research team on behalf of PSA. An interdisciplinary expert group was established simultaneously within PSA. The expert group participated in the study design, ensuring that relevant literature and important problems were addressed, and followed the study as it progressed through different phases. All data were collected under a strict confidentiality agreement.

Daily Evaluation of Venous Thromboembolism (VTE) Risk Factors and Prophylaxis Safely Decreased Incidence of VTE in a Pediatric ICU

▪Background: Venous thromboembolism (VTE), consisting of deep vein thrombosis and pulmonary embolism, is associated with significant morbidity and mortality. The incidence of VTE, particularly VTE acquired by hospitalized children, has increased dramatically over the last 15 years but may be preventable in some cases. Reducing the incidence of hospital-acquired VTE may not only improve patient care but also decrease healthcare costs associated with diagnosis and treatment.Methods: In conjunction with the Children’s Hospitals’ Solutions for Patient Safety, we have developed a risk-based intervention strategy for all non-neonatal hospitalized children. The 3-part care bundle includes (1) VTE risk assessment upon admission with daily reassessments thereafter, (2) consideration of VTE prophylaxis (mechanical and/or pharmacologic depending on risk of VTE versus bleeding), and (3) ongoing evaluation for complications and risk level changes. To facilitate risk assessments and risk-based interventions, we developed a clinical care guideline based on published pediatric VTE risk profiles. To most accurately track our outcome measure, number of VTE cases, we have augmented our prior ICD-9-based method of identifying VTE cases to include a radiographic dictation trigger, anticoagulant medications, and nursing report of clot treatment. This new approach has led to improved specificity and sensitivity of VTE identification.Outcome and Process Measures: This risk-based intervention approach was implemented as a pilot program in our pediatric ICU and has been associated with a 52% decrease in validated VTE cases over a 12-month period, coincident with an increase in documented care bundle compliance from 40% to 93%. During this pilot program, 134 of 2190 pediatric ICU patients (6.1%) were initially classified as high risk, with 5.2% of those developing VTE, and 952 patients (43%) were initially classified as moderate risk, with 2.3% of those developing VTE. Ninety-five patients received pharmacologic prophylaxis at some point during admission, with 13.6% developing VTE; 428 received mechanical prophylaxis, with 3.7% developing VTEs; and 61 received both pharmacologic and mechanical prophylaxis, with 13.1% developing VTEs.Balancing Measures: We are also tracking adverse events related to mechanical or pharmacologic prophylaxis. No patients had significant bleeding while on pharmacologic prophylaxis, and one patient developed pressure ulcers associated with sequential compression devices.Conclusion: Implementation of our 3-part VTE prevention care bundle was associated with a decrease in VTE cases without a notable increase in bleeding or pressure ulcers.Future Directions: Ongoing work includes refining our clinical care guideline to incorporate recent risk factor data, expanding the 3-part care bundle outside of the ICU to include the entire hospital, continuing to improve sensitivity and specificity of VTE case identification methods, and continuing to monitor balancing measures of bleeding and pressure ulcers. DisclosuresNo relevant conflicts of interest to declare.

Dynamic counter-measures for risk-based access control systems: An evolutive approach

Risk-based access control systems are a new element in access control categories, incorporating risk analysis as part of the inputs to consider when taking an authorization decision. A risk analysis over a resource leads generally to temporal allocation of the resource in a risk level (e.g. high, medium, low). Ideally, for each risk level and kind of resource, the access control system should take an authorization decision (expressed like a permit or deny) and the system administrator should also trigger specific counter-measures to protect resources according to their risk level. In a small access control system with few resources it is possible for an administrator to follow the risk level changes and react promptly with counter-measures; but in medium/large access control systems it is almost unfeasible to react in a customized way to thousands of risk level emergencies asking for attention. In this paper we propose the adoption of dynamic counter-measures (which can be integrated within access control policies) changing along time to face variations in the risk level of every resource, bringing two main benefits, namely: (i) a suitable resource protection according to the risk level (not under or over estimated) and (ii) an access control system granting/denying access depending on the fulfillment of a set of security controls applicable in an authorization access request. To define the most appropriate set of counter-measures applicable for a specific situation we define a method based on genetic algorithms, which allows to find a solution in a reasonable time frame satisfying different required conditions. Finally, the conducted experiments show the applicability of our proposal in a real scenario.

Análise da relação entre depressão materna e indicadores clínicos de risco para o desenvolvimento infantil

Objetivo analisar as possíveis correlações entre alterações nos índices de risco ao desenvolvimento linguístico e psicológico do bebê e presença de depressão materna, em uma amostra de mães de bebês nascidos em cidade de porte médio e arredores da região central do Rio Grande do Sul. Métodos a pesquisa foi realizada com 165 díades mães- bebê em Hospital Escola no qual as crianças realizavam triagem auditiva neonatal, no período de março a maio de 2010. Na coleta de dados foram utilizados um roteiro de entrevista sobre informações socioeconômicas, demográficas, obstétricas e psicossociais, a aplicação do Inventário de Depressão de Beck e dos Indicadores Clínicos de Risco para o Desenvolvimento Infantil. Resultados quando se avaliou os valores do inventário de depressão na primeira faixa de índice de risco analisada, comparando-se bebês com e sem risco ao desenvolvimento, houve diferença estatisticamente significante, pois mães com maiores escores de depressão apresentaram mais risco ao desenvolvimento de seus filhos. Conclusões a análise realizada apontou que há maior proporção de bebês com risco ao desenvolvimento, quando os níveis de depressão materna são elevados no período pós-parto.

On multivariate extensions of Conditional-Tail-Expectation

In this paper, we introduce two alternative extensions of the classical univariate Conditional-Tail-Expectation (CTE) in a multivariate setting. The two proposed multivariate CTEs are vector-valued measures with the same dimension as the underlying risk portfolio. As for the multivariate Value-at-Risk measures introduced by Cousin and Di Bernardino (2013), the lower-orthant CTE (resp. the upper-orthant CTE) is constructed from level sets of multivariate distribution functions (resp. of multivariate survival distribution functions). Contrary to allocation measures or systemic risk measures, these measures are also suitable for multivariate risk problems where risks are heterogeneous in nature and cannot be aggregated together. Several properties have been derived. In particular, we show that the proposed multivariate CTE-s satisfy natural extensions of the positive homogeneity property, the translation invariance property and the comonotonic additivity property. Comparison between univariate risk measures and components of multivariate CTE is provided. We also analyze how these measures are impacted by a change in marginal distributions, by a change in dependence structure and by a change in risk level. Sub-additivity of the proposed multivariate CTE-s is provided under the assumption that all components of the random vectors are independent. Illustrations are given in the class of Archimedean copulas.

Estimating the Value of a Statistical Life Using Census of Fatal Occupational Injuries (CFOI) Data

Labor market estimates of the value of a statistical life (VSL) using the Census of Fatal Occupational Injury (CFOI) data take advantage of this more accurate fatality data and the capability to construct more refined measures of worker fatality risks. This paper reviews all labor market VSL studies that have used these data, including estimates of VSL by age, immigrant status, gender, smoking status, and race. Government agencies are increasingly relying on these estimates rather than the previous VSL literature for policy evaluation purposes. The CFOI data are especially valuable for panel studies by making it possible to assess changes in risk levels for job changers based on estimates of fatality rates over time by industry and occupation. The paper presents new VSL estimates using both the new hours-based fatality risk measure and the previous employment-based measure, yielding similar results.