Implementation Of Risk Mitigation Strategies Research Articles

Intelligent construction technology based information sharing network for prefabricated building supply chain: a social network analysis approach

PurposeIn the context of Industry 4.0, intelligent construction technologies (ICT) represented by information technology and networking will undoubtedly provide new impetus to the development of the prefabricated building supply chain (PBSC), but they will also bring various potential risks. So far, there is a large lack of research on the comprehensive consideration of the risks associated with the intelligent transformation of PBSC based on the information sharing perspective, and the critical risks and interactions are still unclear, making it difficult to identify efficient risk mitigation strategies. Therefore, this paper aims to reveal the interactions between stakeholders and clarify the critical risk nodes and interactions in information sharing of PBSC (IS-PBSC), and propose targeted risk mitigation strategies.Design/methodology/approachFirstly, this paper creatively delineates the risks and critical stakeholders of IS-PBSC. Secondly, Data is collected through questionnaires to understand the degree of risks impact. Thirdly, with the help of NetMiner 4 software, social network analysis is conducted and IS-PBSC risk network is established to reveal critical risk nodes and interactions. Finally, further targeted discussion of critical risk nodes, the effectiveness and reasonableness of the risk mitigation strategies are proposed and verified through NetMiner 4 software simulation.FindingsThe results show that the critical risks cover the entire process of information sharing, with the lack of information management norms and other information assurance-related risks accounting for the largest proportion. In addition, the government dominates in risk control, followed by other stakeholders. The implementation of risk mitigation strategies is effective, with the overall network density reduced by 41.15% and network cohesion reduced by 24%.Research limitations/implicationsIn the context of Industry 4.0, ICT represented by information technology and networking will undoubtedly provide new impetus to the development of the PBSC, but they will also bring various potential risks. So far, there is a large lack of research on the comprehensive consideration of the risks associated with the intelligent transformation of PBSC based on the information sharing perspective, and the critical risks and interactions are still unclear, making it difficult to identify efficient risk mitigation strategies.Originality/valueBased on the results of risk network visualization analysis, this paper proposes an ICT-based IS-PBSC mechanism that promotes the development of the integration of ICT and PBSC while safeguarding the benefits of various stakeholders.

Exploring the Bookkeeping Practices of Family-owned Business: A Case Study of Carriaga Traders Mart

Carriaga Traders Mart (CTM), an established retail business, has transitioned from a small grocery store to a thriving enterprise, offering a diverse array of affordable products. Their sustained success is attributed to meticulous bookkeeping practices. This study explores how a family-owned business can effectively implement bookkeeping practices to address unique bookkeeping challenges, offering valuable insights from CTM's experiences that benefit entrepreneurs, investors, and policymakers. Positive Accounting Theory (PAT) underpinned this investigation, shedding light on how economic, political, market factors, and contracting considerations influence bookkeeping practices, particularly in the context of CTM. The research employed a qualitative case study approach. Through extensive interviews with key financial management personnel, it gained comprehensive insights into the company's bookkeeping and financial practices. Participants included individuals directly involved in CTM's bookkeeping and financial management, meticulously selected based on their expertise in the field. The study's findings underscored CTM's meticulous bookkeeping practices, encompassing technology-driven sales recording, rigorous expense management, and a commitment to financial transparency. The study recommends that entrepreneurs adopt advanced accounting software and technology to enhance efficiency, implement risk mitigation strategies, and prioritize cross-functional personnel training to strengthen their financial practices. For financial managers, the study suggests investing in ongoing training, diversifying financial tools and methods, and emphasizing skill development to navigate the ever-evolving business landscape effectively. In conclusion, this research contributes to the discourse on bookkeeping practices, bridging theoretical insights from PAT with practical knowledge from CTM. It underscores the importance of a versatile and adaptive approach to bookkeeping practices in real-world business settings.

Pemanfaatan TikTok sebagai Alat Inovatif dalam Pembelajaran Akidah Akhlak: Sebuah Tantangan Kreatif di Era Digital

The integration of technology in education has become a crucial component, enhancing the learning process and adapting to contemporary needs. The background of utilizing technology in education encompasses various essential aspects. This study employs the library research method, which involves examining literature sources such as books, notes, and reports from previous research to gather pertinent data related to the research topic. Technology's role in education has evolved into an indispensable element, enhancing the learning journey and aligning with the current era. Library research, a method relying on literature sources like books, notes, and reports from past research, is instrumental in collecting relevant information. Educators are urged to judiciously incorporate the use of TikTok, considering school policies, and striking a balance between leveraging its positive aspects and mitigating potential risks. The adoption of TikTok in Akidah Akhlak learning yields innovative benefits, such as heightened learning motivation, active student engagement, and creative utilization of educational media. Nevertheless, challenges, including restricted access and adverse influences, necessitate careful consideration. Educators must approach the integration of TikTok thoughtfully, adhering to school policies and implementing risk-mitigation strategies. A well-devised strategy and a comprehensive approach are crucial to ensuring that TikTok serves as an effective and secure tool in Akidah Akhlak learning.

The spatiotemporal evolution of compound impacts from lava flow and tephra fallout on buildings: lessons from the 2021 Tajogaite eruption (La Palma, Spain)

The simultaneous or sequential occurrence of several hazards—be they of natural or anthropogenic sources—can interact to produce unexpected compound hazards and impacts. Since success in responding to volcanic crises is often conditional on accurate identification of spatiotemporal patterns of hazard prior to an eruption, ignoring these interactions can lead to a misrepresentation or misinterpretation of the risk and, during emergencies, ineffective management priorities. The 2021 eruption of Tajogaite volcano on the island of La Palma, Canary Islands (Spain), was an 86 day-long hybrid explosive-effusive eruption that demonstrated the challenges of managing volcanic crises associated with the simultaneous emission of lava, tephra and volcanic gases. Here, we present the result of a small-scale impact assessment conducted during three-field deployments to investigate how tephra fallout and lava flow inundation interacted to cause compound physical impact on buildings. The study area was a neighbourhood of 30 buildings exposed to tephra fallout during the entire eruption and by a late-stage, short-lived lava flow. Observations highlight, on one hand, the influence of clean-up operations and rainfall on the impact of tephra fallout and, on the other hand, the importance of the dynamics of lava flow emplacement in controlling impact mechanisms. Overall, results provide an evidence-based insight into impact sequences when two primary hazards are produced simultaneously and demonstrate the importance of considering this aspect when implementing risk mitigation strategies for future long-lasting, hybrid explosive-effusive eruptions in urban environments.

A Multifunctional Perspective to Explain the Survival of Neglected Plants: The Case of the Sweet Potato in Benin

Neglected crops have great potential to improve agricultural diversity and contribute to food security. In Benin, sweet potato is one of these crops that is still not widely adopted. Although the benefits of sweet potato are widely known, it is only grown on small areas in Benin. This study aims to analyze the rationale behind farmers' decisions to allocate land for sweet potato production. 320 farmers were interviewed in Gogounou and Boukoumbé in North Benin. Data were analyzed using chi² tests and a structural equation model. Quotations were used to illustrate the findings. Farmers' individual characteristics, perceptions of the crop, its production and the benefits they expect from it, have a significant influence on the decision to allocate land to sweet potato cultivation. Thus, farmers grow sweet potato because it fulfils a food and/or commercial function. However, due to the neglect of agricultural policies, the sector is plagued by challenges that their low level of knowledge does not allow them to meet. To deal with the uncertainties, farmers are implementing risk mitigation strategies that lead them to limit the area sown. The survival of a neglected plant can be explained by its importance as a food source for the communities. However, in order to increase acreage and scale up, the plant must also fulfil a commercial function.

Physician perspective on the implementation of risk mitigation strategies when prescribing opioid medications: a qualitative analysis

ObjectiveTo understand the physician perspective on the barriers and facilitators of implementing nine different opioid risk mitigation strategies (RMS) when prescribing opioid medications.MethodsWe created and dispersed a cross-sectional online survey through the Qualtrics© data collection platform among a nationwide sample of physicians licensed to practice medicine in the United States who have prescribed an opioid medication within the past year. The responses were analyzed using a deductive thematic analysis approach based on the Consolidated Framework for Implementation Research (CFIR) to ensure a holistic approach to identifying the barriers and facilitators for each RMS assessed. In concordance with this method, the themes and codes for the thematic analysis were defined prior to the analysis. The five domains within the CFIR were used as themes and the 39 nested constructs were treated as the codes. Two members of the research team independently coded the transcripts and discussed points of disagreement until consensus was reached. All analyses were conducted in ATLAS.ti© V7.ResultsThe completion rate for this survey was 85.1% with 273 participant responses eligible for analysis. Intercoder reliability was calculated to be 82%. Deductive thematic analysis yielded 2,077 descriptions of factors affecting implementation of the nine RMS. The most salient code across all RMS was Knowledge and Beliefs about the Intervention, which refers to individuals’ attitudes towards and value placed on the intervention. Patient Needs and Resources, a code referring to the extent to which patient needs are known and prioritized by the organization, also emerged as a salient code. The physicians agreed that the patient perspective on the issue is vital to the uptake of each of the RMS.ConclusionsThis deductive thematic analysis identified key points for actionable intervention across the nine RMS assessed and established the importance of patient concordance with physicians when deciding on a course of treatment.

Industry Review of Best Practices for Risk Management of Drug-Induced Liver Injury from Development to Real-World Use.

The relative treatment benefit of a drug for patients during development, marketing authorization review, or after approval includes an assessment of the risk of drug-induced liver injury (DILI). In this article, the Pharmacovigilance and Risk Mitigation Working Group of the IQ-DILI Initiative launched in June 2016 within the International Consortium for Innovation and Quality in Pharmaceutical Development presents and reviews three key topics for essential risk management activities to identify, characterize, monitor, mitigate, and communicate DILI risk associated with small molecules during drug development. The three topics are: (1) Current best practices for characterizing the DILI phenotype and the severity and incidence of DILI in the treatment population, including DILI identification, prediction and recovery. (2) Characterization of the relative treatment benefit for patients who will be exposed to a drug and the attendant risk of DILI in conjunction with existing global risk mitigation strategies. (3) Implementation of risk mitigation strategies during drug development highlighting patient factors, healthcare settings and site of product administration, and prescriber and healthcare provider factors. Industry guidance is provided for assessing whether the product labeling is sufficient to minimize the risk of DILI or whether a United States Food and Drug Administration (FDA) Risk Evaluation and Mitigation Strategy (REMS) or European Medicines Agency (EMA) Risk Management Plan (RMP) with additional Risk Minimization Measures (aRMM) is needed.

Validation of competition and dynamic models for Shiga toxin-producing Escherichia coli (STEC) growth in raw ground pork during temperature abuse

Epidemiological evidence suggests that pork products may be a vehicle for STEC transmission to humans. This study was conducted to validate competition and dynamic models for the growth of STEC during simulated temperature abuse of raw ground pork. Maximum specific growth rates μmax were modeled as a function of temperature using the Cardinal parameter equation, and a dynamic model was validated using sinusoidal temperature profiles. The Acceptable Prediction Zone (APZ) method was used to evaluate the model's performance. The competition model was well fitted to the experimental data having 93% (1849/1981) residual errors within the desired APZ. Growth rates were not different between STEC O157 and non-O157; however, serogroup O91 showed two to three times lower μmax than other STEC at 10, 25, and 30 °C. The theoretical minimum and optimum growth temperature for all STEC groups ranged from 3.4 to 7.8 °C and 33–35 °C, respectively. The dynamic model showed good prediction performance (pAPZ = 0.98) with the experimental data. These results can be used to inform risk assessment models and to support the implementation of risk mitigation strategies to improve the microbiological safety of raw pork products.

Implementing a Risk-Based Approach to Quality Management System ISO-13485 Processes in Compliance with EUMDR 2017/745 for Medical Device Industry

The European Union Medical Device Regulation (EUMDR 2017/745) requires medical device manufacturers to implement a risk-based approach to quality management system (ISO13485) processes. This article provides an overview of the importance of QMS processes in the medical device industry and explains the need to implement a risk-based approach to comply with EUMDR. Implementing a Risk-Based Approach to Quality Management System ISO-13485 Processes in Compliance with EUMDR 2017/745 for Medical Device Industry discusses the steps involved in implementing a risk-based approach to QMS processes, including identifying potential risks, evaluating and prioritizing risks, developing and implementing risk mitigation strategies, and monitoring and continuously improving QMS processes. Additionally, the article highlights the benefits of adopting a risk-based approach, such as improved product safety and efficacy, enhanced regulatory compliance, improved customer satisfaction, and cost savings. It also addresses the challenges in implementing a risk-based approach, including a lack of resources and expertise, resistance to change, and limited understanding of risk management principles. Overall, this article emphasizes the importance of a risk-based approach to QMS processes in the medical device industry to ensure the safety and effectiveness of medical devices and comply with regulatory requirements.

Green Finance and Sustainable Development: Exploring Dynamic Causal Links and Global Implications

This research investigates the potential causal relationship among sustainable development and green finance on a world level, using data from 2011 to 2023. In this study, the researcher utilized the bootstrap rolling-window Granger causal relationship test to investigate the contributions of different stakeholders to sustainable development by participating in green finance initiatives. The results of the analysis demonstrate that green finance has a positive impact on sustainable development across different time periods. While green finance represents a crucial financing mechanism for advancing sustainable development goals, its direct influence on SD remains unproven. Additionally, this analysis identifies distinct causal relationships in different sub periods, emphasizing the importance of context-specific causality. Moreover, in specific contexts, the direction of causality holds significant implications. Therefore, we propose that governments and international organizations play a pivotal role in guiding high-quality green investments and implementing risk mitigation strategies within the established system framework. Furthermore, enhancing the standards for categorizing green finance, developing comprehensive evaluation systems, and promoting transparent information disclosure related to GF can foster greater contributions by countries to sustainable development initiatives.

A globally consistent local-scale assessment of future tropical cyclone risk.

There is considerable uncertainty surrounding future changes in tropical cyclone (TC) frequency and intensity, particularly at local scales. This uncertainty complicates risk assessments and implementation of risk mitigation strategies. We present a novel approach to overcome this problem, using the statistical model STORM to generate 10,000 years of synthetic TCs under past (1980–2017) and future climate (SSP585; 2015–2050) conditions from an ensemble of four high-resolution climate models. We then derive high-resolution (10-km) wind speed return period maps up to 1000 years to assess local-scale changes in wind speed probabilities. Our results indicate that the probability of intense TCs, on average, more than doubles in all regions except for the Bay of Bengal and the Gulf of Mexico. Our unique and innovative methodology enables globally consistent comparison of TC risk in both time and space and can be easily adapted to accommodate alternative climate scenarios and time periods.

Risk Mitigation Strategy against SARS-CoV-2 Infection for Healthcare Provider at Harapan Bersama General Hospital, Singkawang, Indonesia

Working in one of the countries with highest number of COVID-19 cases, healthcare providers in Indonesia are at higher risk of contracting COVID-19. Therefore, risk mitigation strategy is crucial to protect the healthcare workers, especially in hospitals with limited resources such as Harapan Bersama General Hospital. This study aims to analyze risk mitigation strategy against SARS-CoV-2 infection for hospital workers in hospital with limited resource. Action Research study was performed through four stages. COVID-19 risk factor identification was carried out among healthcare workers who came in contact with COVID-19 patients between October 2020 and February 2021. Risk mitigation strategies were evaluated using Hospital Readiness Checklist for COVID-19. Implementation of risk mitigation strategies was done using hierarchy of control against infection transmission. Long period of close contact, inadequate PPE, and inadequate ventilation increased the risk of COVID-19 among healthcare workers.

An Empirical analysis of freight train derailment rates for unit trains and manifest trains

Rail is a safe and efficient mode of transporting hazardous materials (hazmat). In the past decade, the hazmat traffic transported by unit trains has significantly increased in the United States. As a result, a comprehensive understanding of the safety and risk of hazmat unit trains is important and can contribute to the identification, evaluation, and implementation of risk mitigation strategies. Limited prior research has focused on unit train derailment risk analysis. This paper develops a quantitative analysis of freight unit train derailment characteristics and compares those statistics to non-unit, manifest trains (mixed trains). Mainline freight train derailment data on Class I railroads between 1996 and 2018 were analyzed for hazmat unit trains, non-hazmat unit trains, and manifest trains. Derailment rates, measured by three traffic exposure metrics (train-miles, ton-miles, and car-miles) were estimated and compared. The analyses showed that a unit train has a 30% lower derailment rate in terms of ton-miles and car-miles than manifest trains, while the derailment rate per million train-miles of unit trains is slightly greater than that of manifest trains. Loaded unit trains have roughly four-fold higher derailment rate in terms of train-miles and car-miles than that of empty unit trains. Within loaded unit trains, hazmat unit trains have lower derailment rates than non-hazmat unit trains. Overall, heavier and shorter loaded unit trains tend to have greater derailment rates in terms of all three traffic exposure metrics. A causal analysis was also conducted for the three types of train. Infrastructure causes were the most frequent in all train types and length followed by equipment-related causes. These statistics provided important information for rational allocation of risk mitigation resources to improve rail hazmat transportation safety.

The Burden of Coronavirus Disease 2019-Related Cases, Hospitalizations, and Mortality Based on Vaccination Status and Mandated Mask Use: Statewide Data From Wisconsin and Narrative Review of the Literature.

Coronavirus disease 2019 (COVID-19) cases continue to surge in the United States with the emergence of new variants. Statewide variability and inconsistency in implementing risk mitigation strategies are widespread, particularly in regards to enforcing mask mandates and encouraging the public to become fully vaccinated. This is a cross-sectional study conducted on July 31, 2021, utilizing publicly available data from the Wisconsin Department of Health Services. The authors abstracted data on total COVID-19-related cases, hospitalizations, and deaths in the state of Wisconsin. The primary objective was comparison of total COVID-19-related cases, hospitalizations, and deaths in vaccinated versus unvaccinated people in the state of Wisconsin over a 31-day period (July 2021). Furthermore, we also performed a narrative review of the literature on COVID-19-related outcomes based on mask use and vaccination status. In the state of Wisconsin during July 2021, total COVID-19 cases was 125.4 per 100,000 fully vaccinated people versus 369.2 per 100,000 not fully vaccinated people (odds ratio [OR] = 0.34, 95% confidence interval [CI], 0.33-0.35; P < .001). Total COVID-19 hospitalizations was 4.9 per 100,000 fully vaccinated people versus 18.2 per 100,000 not fully vaccinated people (OR = 0.27, 98% CI, 0.22-0.32; P < .001). Total COVID-19 deaths was 0.1 per 100,000 fully vaccinated people versus 1.1 per 100,000 not fully vaccinated people (OR = 0.09, 95% CI, 0.03-0.29; P < .001). Narrative review of the literature demonstrated high vaccine effectiveness against COVID-19 infection prevention (79%-100% among fully vaccinated people), COVID-19-related hospitalization (87%-98% among fully vaccinated people), and COVID-19-related death (96.7%-98% among fully vaccinated people). Studies have also generally reported that mask use was associated with increased effectiveness in preventing COVID-19 infection ≤70%. Strict adherence to public mask use and fully vaccinated status are associated with improved COVID-19-related outcomes and can mitigate the spread, morbidity, and mortality of COVID-19. Anesthesiologists and intensivists should adhere to evidence-based guidelines in their approach and management of patients to help mitigate spread.

Analysis of stock exchange risk and currency in South African Financial Markets using stable parameter estimation

In the preceding decade, the South African economy has experienced challenges due to global disruptive events, hence, the implementation of risk mitigation strategies becomes a priority in volatile markets. Stable distributions account for skewness and heavy-tailed behaviour which are frequently observed in financial data. This study aims to investigate the fit of stable distributions for three FTSE/JSE indices and the USD/ZAR currency exchange rate. The maximum likelihood method was applied to fit Nolan’s -parameterization stable distribution. Value at Risk (VaR) is measure assessing market risk, therefore, VaR estimates and Kupiec likelihood test are applied to evaluate the extreme tail behaviour of the fitted stable model. Results show the robustness of stable distributions in the long and short position for each daily returns. This research validates the use of stable distributions aimed at capturing the characteristics financial data. Those concerned with curtailing losses and investigating alternatives for financial modeling in the South African financial industry may benefit the most by using stable distributions.

Considerations for mitigating COVID-19 related risks in schools

As the new school year begins in the United States, school districts will be tasked with providing in-person teaching while keeping children and school staff safe, an increasingly difficult goal in the presence of the COVID-19 delta variant. We aim to provide updated interpretations of past and newly published studies to assist in assessing risk in schools, and to add additional perspectives on addressing the social determinants of learning and on the role of race and other social factors. We advocate for the continued implementation of risk mitigation strategies in schools, including mandatory mask policies, improved ventilation, and convenient access to vaccinations for those eligible, as recommended by the CDC, and to use this opportunity to make long-term improvements to our schools as a matter of urgency.

GIS-Based Landslide Susceptibility Mapping for Land Use Planning and Risk Assessment

Landslide susceptibility mapping is essential for a suitable land use managing and risk assessment. In this work a GIS-based approach has been proposed to map landslide susceptibility in the Portofino promontory, a Mediterranean area that is periodically hit by intense rain events that induce often shallow landslides. Based on over 110 years landslides inventory and experts’ judgements, a semi-quantitative analytical hierarchy process (AHP) method has been applied to assess the role of nine landslide conditioning factors, which include both natural and anthropogenic elements. A separated subset of landslide data has been used to validate the map. Our findings reveal that areas where possible future landslides may occur are larger than those identified in the actual official map adopted in land use and risk management. The way the new map has been compiled seems more oriented towards the possible future landslide scenario, rather than weighting with higher importance the existing landslides as in the current model. The paper provides a useful decision support tool to implement risk mitigation strategies and to better apply land use planning. Allowing to modify factors in order to local features, the proposed methodology may be adopted in different conditions or geographical context featured by rainfall induced landslide risk.

Opioid Prescribing and Opioid Risk Mitigation Strategies in the Veterans Health Administration.

The Veterans Health Administration (VHA) has taken a multifaceted approach to addressing opioid safety and promoting system-wide opioid stewardship. To provide a comprehensive evaluation of current opioid prescribing practices and implementation of risk mitigation strategies in VHA. VHA is the largest integrated health care system in the United States. VHA prescribing data in conjunction with implementation of opioid risk mitigation strategies are routinely tracked and reviewed by VHA's Pharmacy Benefits Management Services (including Academic Detailing Service) and the Pain Management Program Office. Additional data are derived from the Partnered Evidence-Based Policy Resource Center (PEPReC) and from a 2019 survey of interdisciplinary pain management teams at VHA facilities. Prescribing data are reported quarterly until first quarter fiscal year 2020 (Q1FY2020), ending December 31, 2019. VHA opioid dispensing peaked in 2012 with 679,376 Veterans receiving an opioid prescription, and when including tramadol, in 2013 with 869,956 Veterans. Since 2012, the number of Veterans dispensed an opioid decreased 56% and co-prescribed opioid/benzodiazepine decreased 83%. Veterans with high-dose opioids (≥ 100 mg morphine equivalent daily dose) decreased 77%. In Q1FY2020, among Veterans on long-term opioid therapy (LTOT), 91.1% had written informed consent, 90.8% had a urine drug screen, and 89.0% had a prescription drug monitoring program query. Naloxone was issued to 217,469 Veterans and resulted in > 1,000 documented overdose reversals. In 2019, interdisciplinary pain management teams were fully designated at 68%, partially designated at 28%, and not available at 4% of 140 VA parent facilities. Fifty percent of Veterans on opioids at very high risk for overdose/suicide received interdisciplinary team reviews. VHA clinicians have greatly reduced their volume of opioid prescribing for pain management and expanded implementation of opioid risk mitigation strategies. VHA's integrated health care system provides a model for opioid stewardship and interdisciplinary pain care.

Confronting challenges to opioid risk mitigation in the U.S. health system: Recommendations from a panel of national experts.

BackgroundAmid the ongoing U.S. opioid crisis, achieving safe and effective chronic pain management while reducing opioid-related morbidity and mortality is likely to require multi-level efforts across health systems, including the Military Health System (MHS), Department of Veterans Affairs (VA), and civilian sectors.ObjectiveWe conducted a series of qualitative panel discussions with national experts to identify core challenges and elicit recommendations toward improving the safety of opioid prescribing in the U.S.DesignWe invited national experts to participate in qualitative panel discussions regarding challenges in opioid risk mitigation and how best to support providers in delivery of safe and effective opioid prescribing across MHS, VA, and civilian health systems.ParticipantsEighteen experts representing primary care, emergency medicine, psychology, pharmacy, and public health/policy participated.ApproachSix qualitative panel discussions were conducted via teleconference with experts. Transcripts were coded using team-based qualitative content analysis to identify key challenges and recommendations in opioid risk mitigation.Key resultsPanelists provided insight into challenges across multiple levels of the U.S. health system, including the technical complexity of treating chronic pain, the fraught national climate around opioids, the need to integrate surveillance data across a fragmented U.S. health system, a lack of access to non-pharmacological options for chronic pain care, and difficulties in provider and patient communication. Participating experts identified recommendations for multi-level change efforts spanning policy, research, education, and the organization of healthcare delivery.ConclusionsReducing opioid risk while ensuring safe and effective pain management, according to participating experts, is likely to require multi-level efforts spanning military, veteran, and civilian health systems. Efforts to implement risk mitigation strategies at the patient level should be accompanied by efforts to increase education for patients and providers, increase access to non-pharmacological pain care, and support use of existing clinical decision support, including state-level prescription drug monitoring programs.

Applying the Hierarchy of Hazard Control to Regulation of Sound Levels in Entertainment Venues.

Excessive sound levels at events where amplified music is a central element pose a risk to hearing. Whereas noise exposure in the workplace has been recognized as a hazard for over a century, the potential harm resulting from recreational sound exposure has only become apparent in recent years. In occupational settings where sound levels are high, employers are required to implement risk-mitigation strategies to reduce sound exposure and protect employees in accordance with the hierarchy of controls. In principle, this same risk management approach can be applied to entertainment venues. In this paper we discuss how the measures stipulated in various policies and regulations aimed at protecting the hearing of audience members at entertainment venues fit within the hierarchy of controls. We compare the relative likely effectiveness of each of the measures and outline how the particular characteristics of entertainment venues impact on the practical application of these measures.