Risk Assessment Criteria Research Articles

Institutional dependencies in climate adaptation of transport infrastructures: an Institutional Network Analysis approach

Climate adaptation measures are shaped and implemented through processes of governance, where the interactions and decision-making among actors lead to the creation and reinforcement of institutions. Institutions in this respect are the rules that shape the interactions of actors in different phases of climate adaptation. Currently there is no comprehensive method to systematically identify and map dependencies between institutions. This study proposes the Institutional Network Analysis (INA) approach that is based on the Institutional Grammar as a systematic and comprehensive tool to (1) visualise institutional dependencies, (2) identify points of concern in the institutional landscape such as conflicts and voids, and (3) provide quantitative insights into the centrality of actors, embeddedness of institutional outcomes, and dependencies between institutions. The approach is applied to the case of climate adaptation of transport infrastructures surrounding the Port of Rotterdam, the Netherlands. The analysis reveals a conflict in the use of risk assessment criteria, as parties in the Port may follow their own matrices in the presence of a shared decision-making framework. Nonetheless, the network metric analysis reveals that the criteria, whether shared or individual, build on the same source of risk analysis, suggesting that this duality may not be detrimental for climate adaptation efforts. Additionally, an institutional void is identified for financial responsibilities in locations where infrastructures overlap. Finally, the network metrics show high dependency between institutions in the risk dialogue phase, and reveal the centrality of infrastructure owners ProRail and RWS in the institutional landscape instead of local or regional governmental bodies.

A weighted fuzzy approach for green marketing risk assessment: Empirical evidence from dairy industry

The green marketing concept encompasses the consumers' perception and response to the green initiatives and activities that companies implement such as design for environment, green production systems and processes development, and green improvements in packaging. Despite the growing interest in the green marketing domain, few studies have been carried out on the risk assessment of green marketing implementation, especially in the dairy industry. In this study, using a developed integrated fuzzy decision-making methodology, the green marketing risk factors in the dairy industry are assessed. Firstly, the fuzzy analytic hierarchy process is used for weighting the identified risk assessment criteria. Then, a weighted fuzzy inference system is proposed for green marketing risk assessment. Finally, risk mitigation strategies are proposed to deal with the highly ranked risk factors. This research study fills the gaps in the literature by (1) proposing a comprehensive list of green marketing risk factors in the dairy industry, (2) developing a novel weighted fuzzy inference system approach for assessing those risk factors, and (3) providing a final ranking of the dairy industry risk factors together with risk mitigation strategies for the highly ranked risk factors. The level of environmental awareness in society was found as the most important risk factor followed by governmental policies, rules, and regulations for supporting green products risk factors. Finally, some remarks are concluded together with presenting the future works.

NCCN Guidelines® Insights: Genetic/Familial High-Risk Assessment: Colorectal, Version 1.2021.

Identifying individuals with hereditary syndromes allows for timely cancer surveillance, opportunities for risk reduction, and syndrome-specific management. Establishing criteria for hereditary cancer risk assessment allows for the identification of individuals who are carriers of pathogenic genetic variants. The NCCN Guidelines for Genetic/Familial High-Risk Assessment: Colorectal provides recommendations for the assessment and management of patients at risk for or diagnosed with high-risk colorectal cancer syndromes. The NCCN Genetic/Familial High-Risk Assessment: Colorectal panel meets annually to evaluate and update their recommendations based on their clinical expertise and new scientific data. These NCCN Guidelines Insights focus on familial adenomatous polyposis (FAP)/attenuated familial adenomatous polyposis (AFAP) syndrome and considerations for management of duodenal neoplasia.

Cardiovascular risk profile in Portugal: evidence from a large population-based cohort

Abstract Background The rising prevalence of CVD in Portugal translates into more than 35 thousand annual deaths (1,2), with stroke and ischemic heart disease as the leading causes of death (3). Reducing the incidence of ASCVD is a public health priority, for which LDL-C lowering is paramount to halt atherosclerotic plaque progression (4,5). Real-world data is lacking regarding patient characterization, lipid-lowering therapy, and LDL-C levels by CV risk profile. Purpose To assess the proportion of patients with low, intermediate, high, and very high CV risk in a population with a complete spectrum of care, and describe their clinical characteristics, cardiovascular medications, and degree of LDL-C control. Methods This non-interventional, cross-sectional study included adult patients between 40 and 80 years old followed for primary or secondary CV risk prevention at a major healthcare institution that provides both primary and hospital care. Patient data spanned the period from 1/1/2008 to 31/12/2019. The index date for patient identification and characterization was 31/12/2019. CVD risk assessment was computed according to the 2019 ESC/EAS Guidelines for the management of dyslipidemias (6). Every criterion for risk assessment (excluding imaging and family history) was reconstructed using the most granular available records of clinical observations, measurements, episodes, lab orders, diagnosis and medications recorded at all primary and secondary care sites of the institution. We described patient demographic and clinical characteristics for each CV risk level, lipid-lowering treatment (LLT), and LDL-C levels. Results We identified 111.394 patients eligible for analysis. Sufficient records for CV risk assessment were available for 82.271 patients. According to 2019 ESC/EAS Guidelines CV risk categories, 25.7%, 21.4%, 12.2% and 40.7% of patients had low, intermediate, high and very high CV risk. High/very high CV risk patients had a mean (SD) age of 65.6 (10.1) years. Type 2 diabetes was present in 13.1% of high CV risk and 40% of very high CV risk groups. Although approximately 70% of patients with high/very high CV risk were treated with a LLT, only 5.1% of high CV risk and 3.6% of very high CV risk had LDL-C levels within the recommended targets. There was a very low use of high intensity statins or combination therapies in high/very high CV risk categories (table 1). Patients with atherosclerotic CV disease accounted for 34.6% of those at very high CV risk and only 4.8% attained desired goals (table 2). Conclusions There is a pressing need for better control of LDL-C levels at every stage of CV risk, with a particular focus on high and very high CV risk patients. Effective strategies for LCL-C control are thus needed. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This study was funded by Novartis Farma, Produtos Farmacêuticos S.A.

Synthesizing Data to Classify and Risk Assess Vegetation Types for Regulations in Inland New South Wales Australia

From 1998, land-use regulations in New South Wales Australia referred to risk status of plant community types and abiotic landscapes. Lacking was a uniform vegetation classification for 77% of NSW comprising the inland arid, semi-arid and cropping agricultural zones: regions that contain patchy floristic plot data. In response, 562 plant communities, mainly at levels 8 in the IVC, were classified by synthesizing plot-based analyses, qualitative descriptions, maps, extensive field checks, new field samples and peer review. Qualitative information was vital to complete a thorough classification. Each type was assigned a risk category based on six risk assessment criteria developed prior to IUCN RLE. Occurrences in protected areas were audited and related to original extent yielding a protected area/adequacy code. Results were used in land change assessment tools and contributed to the listing of 40 threatened ecological communities under biodiversity laws. Two mapping methods attained different levels of reliability. Applying risk criteria to coarse versus fine levels in typologies can produce different results. Mid-to fine level global hierarchies best suit ecosystem risk assessment.

SEX DIFFERENCES IN PFO CLOSURE PATIENTS

BACKGROUND Although sex differences have been emphasized in stroke and congenital heart disease, there has been limited investigation on their role in patent foramen ovale (PFO). In fact, key guidelines on the management of PFO do not comment on sex or gender specific considerations in characteristics or outcomes of patients. We aimed to explore differences by sex in baseline profiles, procedural characteristics, and short-term outcomes of patients undergoing transcatheter PFO closure. METHODS AND RESULTS Data of adult patients undergoing transcatheter PFO closure at the Toronto General Hospital from 1997 to 2017 was retrospectively analyzed. Baseline information included demographic characteristics, medical history, diagnostic and procedural information, and periprocedural complications. Post-closure outcomes were captured at index hospitalization and during the first follow-up visit. From 1,032 patients in the cohort sample, 80.7% underwent closure for cryptogenic stroke and 44.8% (n=462) were females. We observed significant sex-related differences at baseline; females were younger, less likely to have a history of smoking, and less likely to have cardiovascular risk factors such as dyslipidemia and coronary artery disease (p < 0.05). No differences were observed in procedural and in-hospital outcomes between sexes. At the first follow-up, recurrent cerebrovascular events were reported in 1.5% and 1.9% of patients in the ‘cryptogenic stroke/TIA indications’ and ‘other indications’ groups respectively, with no significant differences by sex. There were significant sex differences between some symptom presentation both pre- and post-closure, with females more likely to present with migraine symptoms at both timepoints (p < 0.05). CONCLUSION Although no differences in procedural and short-term outcomes between males and females undergoing transcatheter PFO closure were observed, significant baseline differences in characteristics may justify the need for sex-specific risk assessment and PFO closure criteria. There is a critical need for long-term, systematic studies to understand sex and gender differences in the PFO population. Although sex differences have been emphasized in stroke and congenital heart disease, there has been limited investigation on their role in patent foramen ovale (PFO). In fact, key guidelines on the management of PFO do not comment on sex or gender specific considerations in characteristics or outcomes of patients. We aimed to explore differences by sex in baseline profiles, procedural characteristics, and short-term outcomes of patients undergoing transcatheter PFO closure. Data of adult patients undergoing transcatheter PFO closure at the Toronto General Hospital from 1997 to 2017 was retrospectively analyzed. Baseline information included demographic characteristics, medical history, diagnostic and procedural information, and periprocedural complications. Post-closure outcomes were captured at index hospitalization and during the first follow-up visit. From 1,032 patients in the cohort sample, 80.7% underwent closure for cryptogenic stroke and 44.8% (n=462) were females. We observed significant sex-related differences at baseline; females were younger, less likely to have a history of smoking, and less likely to have cardiovascular risk factors such as dyslipidemia and coronary artery disease (p < 0.05). No differences were observed in procedural and in-hospital outcomes between sexes. At the first follow-up, recurrent cerebrovascular events were reported in 1.5% and 1.9% of patients in the ‘cryptogenic stroke/TIA indications’ and ‘other indications’ groups respectively, with no significant differences by sex. There were significant sex differences between some symptom presentation both pre- and post-closure, with females more likely to present with migraine symptoms at both timepoints (p < 0.05). Although no differences in procedural and short-term outcomes between males and females undergoing transcatheter PFO closure were observed, significant baseline differences in characteristics may justify the need for sex-specific risk assessment and PFO closure criteria. There is a critical need for long-term, systematic studies to understand sex and gender differences in the PFO population.

Real estate agent as the institution obliged to counteract money laundering (Part Two)

The article under the title “Real estate agent as an institution obliged to counteract money laundering” discusses statutory responsibilities of agents as regards the AML policy. The second part of the paper examines how to identify the risk associated with a particular client and assignment and how to make a correct assessment and to eliminate the threats. Risk assessment criteria have been discussed with respect to the type of the counterparty, the specific nature of products and services offered, the geographical region of origin of the money and transaction identifiers. The signs of potential threats have been described and systematised in Chapter Six. The paper underlines the fact that the agent’s activities are based on internal AML procedures and should be adequately evidenced. The paper ends with a summary of the researched topic.

Correlation between Breteau index and mosquito oviposition index in surveillance for Aedes albopictus larvae density

Objective To observe the trend of continuous density of Aedes albopictus larvae by using Breteau Index (BI) and the Mosquito Oviposition Index (MOI), and compare the grey correlation, spearman correlation and risk grade consistency of the two density indexes in different habitats. Methods The densities of Aedes albopictus in Wuxing district (place A) and in Nanxun district (place B) in Huzhou were monitored every ten days by using BI and MOI from April to December in 2020. The correlation between BI and MOI were analyzed by grey correlation and spearman correlation. The two density indexes were classified according to the risk assessment criteria of Aedes vector surveillance guidelines. And the consistency of risk grade of two methods was compared by Kappa test. Results The density of Aedes albopictus indicated by BI and MOI increased first and then decreased from April to December. When the density was very low or very high (BI 20), the BI was higher than MOI. When the density index was between 5 and 20, the BI and MOI fluctuated. The BI was higher than the MOI from April to July. However, the MOI was higher than the BI from August to October. The grey correlation degree of the BI and the MOI were 0.601 and 0.682 in urban and rural residential areas respectively in place A and 0.696 and 0.671 in urban and rural residential areas respectively in place B, and the spearman correlation coefficients of the BI and the MOI were 0.461 and 1.000 in urban and rural residential areas in place A and 0.531 and 0.444 respectively in place B, the differences were all significant (P Conclusion The density of Aedes albopictus larvae increased and decreased seasonally. There was a certain correlation between BI and MOI in the surveillance for the seasonal density of Aaedes Aalbopictus larvae, but the consistency of risk level was not good. The sensitivity of BI is better than that of MOI when the density of Aedes is very low or high.

Public Covid-19 X-ray datasets and their impact on model bias - A systematic review of a significant problem.

Computer-aided-diagnosis and stratification of COVID-19 based on chest X-ray suffers from weak bias assessment and limited quality-control. Undetected bias induced by inappropriate use of datasets, and improper consideration of confounders prevents the translation of prediction models into clinical practice. By adopting established tools for model evaluation to the task of evaluating datasets, this study provides a systematic appraisal of publicly available COVID-19 chest X-ray datasets, determining their potential use and evaluating potential sources of bias. Only 9 out of more than a hundred identified datasets met at least the criteria for proper assessment of risk of bias and could be analysed in detail. Remarkably most of the datasets utilised in 201 papers published in peer-reviewed journals, are not among these 9 datasets, thus leading to models with high risk of bias. This raises concerns about the suitability of such models for clinical use. This systematic review highlights the limited description of datasets employed for modelling and aids researchers to select the most suitable datasets for their task.

Анализ гиполипидемической терапии у больных артериальной гипертензией

Артериальная гипертензия (АГ) и нарушения липидного обмена являются одними из главных причин неблагоприятного сердечно-сосудистого прогноза, каждая из которых способствует развитию и прогрессированию заболеваний, связанных с атеросклерозом. У многих пациентов эти факторы риска присутствуют вместе. В статье на основании клинического случая обоснована необходимость назначения статинов больному с артериальной гипертензией. Приведены клинический случай наблюдения и лечения АГ у 47-летнего пациента с дислипидемией на разных временных этапах с последующим анализом современной информации о комбинации статинов и антигипертензивных средств — сартанов в процессе ведения пациентов высокого кардиоваскулярного риска. После нескольких лет эффективного антигипертензивного лечения артериальное давление больного стабилизировалось на целевых уровнях. Он бросил курить, нормализовал массу тела. Осталась асимптомная дислипидемия, которую он медикаментозно не контролировал. Во время предпоследнего визита у пациента был обнаружен неокклюзивный атеросклероз сосудов нижних конечностей, протекающий асимптомно. С учетом признаков сосудистого атеросклероза пациент попадает в группу высокого кардиоваскулярного риска. Ему нужно назначить интенсивную статинотерапию. В этом случае важно выбрать наиболее эффективный и безопасный препарат и соответствующую дозу. При просмотре клинического случая комбинированного лечения нашего пациента кандесартаном (Кантаб) и аторвастатином (Толевас) следует обратить внимание на два момента, спровоцировавшие развитие периферического атеросклероза. Во-первых, к нам обратился пациент молодого возраста с симптомами гипертонии, которые считались основными для постановки диагноза и выбора терапии. В результате он и получал достаточно эффективное антигипертензивное лечение. Сопутствующая дислипидемия имела субклинический характер, и пациент самостоятельно перестал принимать статины. Высокий общий холестерин считался только фактором риска. Во-вторых, в своих медицинских рекомендациях мы руководствовались критериями оценки степени кардиоваскулярного риска у больных с АГ (Приказ МЗ Украины от 24.05.2012 № 384) и поэтому не настаивали на некоторых этапах лечения интенсивной статинотерапии, как это рекомендуется европейскими и североамериканскими рекомендациями 2017 года.

Training women's pelvic floor muscles during pregnancy and postpartum at primary health centers: a best practice implementation project.

Pelvic floor muscle training (PFMT) enhances muscle strength and coordination, and prevents urinary incontinence associated with giving birth. The goal was to improve women's PFMT during pregnancy and postpartum in La Rioja, Spain. This evidence implementation project used the JBI evidence implementation framework. First, we conducted the PFMT baseline audit: to assess the criteria for midwife training, we sent a questionnaire to all midwives. To measure the criteria for PFMT and urinary incontinence risk assessment, we reviewed the medical records of 60 women selected through consecutive sampling and 15 other women at risk of urinary tract infections (UTIs) for the inclusion criteria in a PFMT program. Second, we used the Getting Research into Practice guidelines to identify barriers to the fulfillment of each criterion and design and implement strategies to improve compliance. Finally, we repeated the audit to measure compliance and verify the changes. The midwives received updated PFMT, optimizing compliance with the first criterion from 67 to 100%. The remaining criteria -- providing PFMT for pregnant women, identifying women at high risk of incontinence, and facilitating a supervised PFMT program for women at high risk of UTIs -- went from 0% compliance to 17, 96, and 67%, respectively. This project was effective in building consensus, improving midwives' practice, and facilitating mothers' PFMT. The project continued during the novel coronavirus [coronavirus disease 2019 (COVID-19)] epidemic in Spain as the midwives, women, and managers were involved in the change because of a well designed registration system and the use of online tools for communication between midwives and women.

Proposal of integrative scores and biomonitor selection for metal bioaccumulation risk assessment in mine-impacted rivers.

Development of sound criteria for metal and metalloid bioaccumulation risk assessment in river basins affected by mining activities is a necessary tool to protect the aquatic communities. The aim of this study is to propose integrative scores for tissue residues that are suitable for surveillance programs and readily interpreted in terms of risk assessment in mining impacted rivers. Tissue residues of 7 trace metals and 2 metalloids were measured in ten macroinvertebrate taxa from the Nalón River basin (Spain), affected by Hg, Cu and Au mining activities. Compared with reference sites, biomonitor taxa from Hg and Au mining districts showed the highest bioaccumulation. However, low or non-significant bioaccumulation was found in sites influenced by historical Cu mining. Multivariate analyses (ANOSIM) performed on individual taxa revealed significant differences in tissue residues between sites classified according to their ecological status. The bioaccumulation risk assessment was based on the average ratio of the actual metal tissue residues in each macroinvertebrate taxon to the corresponding Ecological Threshold tissue concentration (Tissue residue Ratio to Threshold, TRT). The suitability of the biomonitors was evaluated using linear regression models fitted to the relationships between TRT scores and site sediment pollution or ecological status scores. Biomonitor selection also considered differences in invertebrate functional traits, which can influence metal and metalloid bioavailability. Site bioaccumulation risk was assessed on an Integrated Tissue concentration score (INTISS), calculated over a selection of the most relevant chemicals (As, Cu and Hg) and 3 biomonitor taxa (Baetidae, Hydropsychidae, Microdrile oligochaetes) comprising a set of feeding styles. Based on INTISS, it was possible to predict community alteration scores, using linear regression models. A comparison of site bioaccumulation and ecological status assessments based on the departure from reference conditions showed that operational monitoring programs in basins impaired by mining can be optimized by combining both approaches.

Воздействие валютного риска на международный аутсорсинг

The paper considers the impact of currency risk on economic systems based on international outsourcing. The theoretical basis for constructing a model of the economic system based on international outsourcing, as well as economic speculative currency risk, is presented. The authors propose and describe a model of the impact of currency risk on economic systems based on international outsourcing. Mathematical modeling, as well as mathematical and graphical analysis of indicators characterizing the impact of currency risk are carried out. The results reflecting the impact of currency risk on a particular participant of the economic system, as well as on the system as a whole, under various particular conditions, are presented. The authors point out that currency risk in economic systems based on international outsourcing is expressed, not only explicitly, but also covertly through changes in the volume of production, cost and price of final value. Based on the modeling, general and specific criteria for the qualitative assessment of currency risk in international outsourcing are proposed. The results of the study can be used by organizations that are part of economic systems based on international outsourcing, regardless of the management approach and the mechanism for forming an economic system based on international outsourcing.

지방자치단체 급경사지 관리 문제점 및 개선방안에 관한 연구

Every year, in Korea, extensive damage due to large and small steep slope disasters occurs. Recently, disasters related to steep slopes showed decreased damage areas, but increase casualties. This is the result of damage occurring in downtown areas becoming more common. The management of steep slopes in downtown areas is the responsibility of local government. Local governments manage them by following the Disaster Risk Assessment Criteria for Slope and the Manual on Slope Management. However, some of the criteria and surveys are inappropriate for use. In this study, the problems with the steep slope disaster risk assessment criteria and the surveys from the Manual on Slope Management were identified and improvements were presented. For the Disaster Risk Assessment Criteria, revision were proposed when the content that did not match the definition of a steep slope, as well as improvements to the scoring criteria. In the steep slope survey form, duplicate survey contents and unnecessary items were deleted, and the composition of the survey was changed to make it easier for investigators.&#x0D;

Chironomidae (Midge) Sensitivities to Ammonia Using Multiple Endpoints in China and Australia for the Development of Water Quality Criteria for Freshwater River Systems in China.

Deriving water quality criteria (WQC) for aquatic risk assessment requires sufficient toxicity data, which can determine the accuracy of WQC. Given that toxicity data vary between test species and endpoints, there is a great need to compare such data to generate the most suitable data set for WQC derivation. In the present study, a series of 11 ammonia exposure bioassays were conducted on Chironomidae species in either China or Australia, with test species and test endpoints varied (2 Chironomus sp., enzymatic up to lethal endpoints, and no-observed-effect concentration up to median lethal concentration [LC50] as endpoint metrics). There were no statistically significant differences between toxicity results generated from China compared to Australia using Chironomus sp., indicating that published data on native species generated in different countries could be appropriate for inclusion in the development of local Chinese WQC. In addition, the Chironomidae larvae laboratory-based toxicity value (LC50 = 384.6 mg/L) was lower than that of the in situ field-based toxicity value (LC50 ≥ 451.2 mg/L) where sensitive life stages are used, and, specifically for C. riparius, endpoints linked to biochemical and gene expression effects could be as sensitive as or more sensitive than chronic endpoints, both of which were more sensitive than acute endpoints. These findings help in the development of WQC by demonstrating the suitability of inclusion of toxicity data from a range of sources, as well as adding to the overall pool of knowledge regarding sensitivity to ammonia which can be used in aquatic risk assessment. Environ Toxicol Chem 2021;40:2899-2911. © 2021 SETAC.

Adherence to Infection Prevention and Control Practices among Health Care Workers and its Outcome in Non-COVID Areas in a Tertiary Care Hospital

International Journal of Medicine and Public Health,2021,11,3,146-149.DOI:10.5530/ijmedph.2021.3.26Published:August 2021Type:Original ArticleAdherence to Infection Prevention and Control Practices among Health Care Workers and its Outcome in Non-COVID Areas in a Tertiary Care HospitalMini Palathingal Narayanan, Anuja Mohan, Priya Chandran, Durga Neelakandan, and Beena Philomina Jose Mini Palathingal Narayanan1,*, Anuja Mohan1, Priya Chandran2, Durga Neelakandan1, Beena Philomina Jose1 1Department of Microbiology, Government Medical College Kozhikode, Kerala, INDIA. 2Department of Community Medicine, Government Medical College Kozhikode, Kerala, INDIA. Abstract:Aim and Objective: 1. To study the adherence to Infection Prevention and Control (IPC) practices by health care workers in Non-COVID areas. 2. To compare the proportion of COVID affected health care workers among those adhering to proper IPC and those with non-adherence. Background: Hospitals serve as frontline health care institutions caring for the increased number of COVID-19 patients. The health care personnel working in hospitals are at increased risk of acquiring the disease during the pandemic. It is the prime responsibility of the Hospital Infection Control Committee to protect the health care workers (HCW) and prevent nosocomial transmission. Materials and Methods: In the cross sectional study,all health care workers from non-COVID areas of the hospital who were exposed to COVID-19 patient during the study period were assessed according to the risk assessment criteria. Results: A total of 1049 health care workers had contact with COVID-19 patients. Of this only 6 health care workers were diagnosed with COVID-19. Conclusion: The HCW diagnosed with COVID-19 was less than one percentage of exposed. This implies the impact that the IPC training had on the HCW which made them ensure their own safety and prevent the nosocomial spread of SARS-CoV-2 within the hospital. Keywords:Adherence, Frontline health care workers, Nosocomial infectionView:PDF (150.3 KB)

Bending the curve: Operationalizing national Red Lists to customize conservation actions to reduce extinction risk

Human activity is accelerating biodiversity loss despite international commitments to prevent extinction and habitat degradation. To bend the curve, international goals must be translated into national targets and actions. Tools to do this are highly needed, but scarce. We present a first attempt to operationalize national Red Lists by using the quantitative criteria of risk assessment as quantifiable objectives in a Red to Green framework. The framework allows for a systematic setting of conservation goals, with quantifiable conservation objectives, and identifying conservation actions to achieve these objectives. We developed an index of conservation outcome, modified from the Red List Index, to quantify the potential conservation outcomes of implementing suggested conservation actions. We tested the framework and index on 123 Red Listed species and habitats prioritized for conservation by the Norwegian government. The policy-defined goal was to downlist them by one Red List category by 2035. We identified land use change as the greatest threat. For 70% of species and 20% of habitats, knowledge was insufficient to recommend conservation actions. Further, due to unmanageable threats, alternative, lower-ambitioned goals were suggested for 30% of the species. Our case show that reaching national goals is difficult, but possible if main constraints are resolved. Through a systematic assessment of knowledge and conservation actions, the framework forms a solid foundation for developing national action plans for biodiversity conservation, allowing for prioritization and implementation of conservation actions and reporting on progress. This is an important first step to reach national targets defined from international goals.

Hematopoietic Cell Transplant-Composite Risk (HCT-CR): A Novel Predictor of Prognosis in Acute Leukemia Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation

Allogeneic hematopoietic stem cell transplantation (allo-HCT) is a curable treatment modality for hematologic disorders. Transplant-related mortality remains high despite prominent scientific and technologic improvements. In consideration with the potential impact of patient- and disease-related factors on transplant outcome, this retrospective study was performed to investigate the predictive role of pretransplant HCT-composite risk (HCT-CR) score in allo-HCT recipients. A total of 313 patients with acute leukemia (male/female: 192/121; median age, 36 [18-71] years) were included in this study. The study cohort was divided into 2 subgroups based on pretransplant HCT-CR categories. The HCT-CRlo group included low-risk patients, and the HCT-CRint-hi group consisted of intermediate-, high-, and very high-risk patients. In the whole cohort, overall survival (OS) and 5-year OS were found to be 32.2% and 45.1%, respectively. Probability of OS was significantly better in the HCT-CRlo group compared with the HCT-CRint-hi group (P < .001). Leukemia-free survival (LFS) and 3-year LFS were 59.5% and 65.1%, respectively. Probability of LFS was better in the HCT-CRlo group compared with the HCT-CRint-hi group (P=.001). Nonrelapse mortality (NRM) and 3-year NRM were estimated to be 38.1% and 27.5%, respectively. Probability of NRM was significantly higher in the HCT-CRint-hi group compared with the HCT-CRlo group (P=.012). In multivariate analysis, HCT-CR was shown to have significant prognostic impact in acute lymphoblastic leukemia patients (P=.023; hazard ratio, 2.613; 95% CI, 1.142-5.982). Pretransplant evaluation of patient- and disease-related factors is essential for the accurate prediction of posttransplant survival. Further efforts to evolve current criteria for pretransplant risk assessment would eventuate in better transplant outcomes.

사고 데이터의 불확실성을 고려한 해양사고 위험도 분석 및 인적오류 중심의 사고원인 분석에 관한 연구

Objective: The purpose of this study is to modify quantitative risk assessment of the maritime accident using the risk matrix considering uncertainty of the data and to figure out the main cause through all types of maritime accident.BRBRBackground: Maritime accidents happen not frequently but it causes severe consequences such as human losses, economic losses and environmental damage. It has negative impacts on the level of national safety and national competitiveness. Although Korean government makes huge efforts to decrease the number of maritime accidents through the mitigation policy, unfortunately recent maritime accidents are not declining, resulting in fatality and economic losses. In the research field, it is necessary to consider the risk assessment criteria based on the quantitative analysis of the maritime accidents. Also, to increase effectiveness of the mitigation policy, first we focus on the cause related to human error.BRBRMethod: In the study, (ⅰ) we modify the existing risk matrix considering uncertainty of the data set in order to get more concrete results and suggest the practical risk assessment criteria. (ⅱ) In the analysis on the cause of the accident, first we calculate the rate of occurrence from each cause of the different accident type and find out the main cause by each accident type. Secondly, we figure out the reason which causes various accident types.BRBRResults: By applying the criteria of the modified risk matrix, it is possible to interpret the results as more sensitive considering uncertainty of the data set. And the main cause of each accident type and common cause of the maritime accident are due to human error.BRBRConclusion: Quantitative risk assessment using the modified risk matrix, and cause analysis can suggest well-founded risk mitigation measures and improve the performance of the accident mitigation policy.BRBRApplication: It may help the policy maker to make appropriate mitigation measure and apply to other fields as the objective risk assessment criteria.

Reconstructive Microsurgery in the COVID-19 Environment.

SummaryThe COVID-19 pandemic has presented unique challenges to the plastic surgery field. Substantial changes have been incorporated in hospital and practice protocols in all branches of medicine. Organic medical teams were placed on scheduled shifts to prevent cross-infection, and some working teams were discontinued. Remote technology consultations and deliberations were instituted in hospitals and community medical services to maintain the flow of information on patient status. Several mitigation strategies were implemented during these times throughout medical facilities. We present those implemented in our facility to ensure adequate labor, resources, and facilities along with proper protocols for patient selection and management according to predetermined risk assessment criteria with the hope to assist the healthcare staff to minimize mortality risks.