Initial Risk Level Research Articles

Comparison of health-oriented cross-regional allocation strategies for the COVID-19 vaccine: a mathematical modelling study

Background Controlling the epidemic spread and establishing the immune barrier in a short time through accurate vaccine demand prediction and optimised vaccine allocation strategy are still urgent problems to be solved under the condition of frequent virus mutations. Methods A cross-regional Susceptible-Exposed-Infected-Removed dynamic model was used for scenario simulation to systematically elaborate and compare the effects of different cross-regional vaccine allocation strategies on the future development of the epidemic in regions with different population sizes, prevention and control capabilities, and initial risk levels. Furthermore, the trajectory of the cross-regional vaccine allocation strategy, calculated using a particle swarm optimisation algorithm, was compared with the trajectories of other strategies. Results By visualising the final effect of the particle swarm optimisation vaccine allocation strategy, this study revealed the important role of prevention and control (including the level of social distancing control, the speed of tracking and isolating exposed and infected individuals, and the initial frequency of mask-wearing) in determining the allocation of vaccine resources. Most importantly, it supported the idea of prioritising control in regions with a large population and low initial risk level, which broke the general view that high initial risk needs to be given priority and proposed that outbreak risk should be firstly considered instead. Conclusions This is the first study to use a particle swarm optimisation algorithm to study the cross-regional allocation of COVID-19 vaccines. These data provide a theoretical basis for countries and regions to develop more targeted and sustainable vaccination strategies. KEY MESSAGE The innovative combination of particle swarm optimisation and cross-regional SEIR model to simulate the pandemic trajectory and predict the vaccine demand helped to speed up and stabilise the construction of the immune barrier, especially faced with new virus mutations. We proposed that priority should be given to regions where it is possible to prevent more infections rather than regions where it is at high initial risk, thus regional outbreak risk should be considered when making vaccine allocation decisions. An optimal health-oriented strategy for vaccine allocation in the COVID-19 pandemic is determined considering both pharmaceutical and non-pharmaceutical policy interventions, including speed of isolation, degree of social distancing control, and frequency of mask-wearing.

Role of comorbidity in assessment of long-term prognosis after myocardial infarction

The aim of the study. To compare different methods for assessing comorbidity in terms of its long-term predictive value after myocardial infarction (MI).Materials and methods. The analysis included 1176 patients with MI who were consecutively admitted to the hospital. The incidence of STsegment elevation MI was 60%; every second patient underwent endovascular intervention. All patients underwent an analysis of the severity of comorbidity according to the CIRS system (Cumulative lllness Rating Scale), according to the CCI (the Charlson’s comorbidity index), the CDS scale of chronic diseases (Chronic Disease Score), as well as according to their own model ‘K9’ (patent RU2734993C1 dated 10.27.2020) based on the summation of nine diseases: type 2 diabetes mellitus, chronic kidney disease, atrial fibrillation, anemia, stroke, arterial hypertension, obesity, peripheral atherosclerosis, thrombocytopenia.Results. Long-term mortality was 12.1 %. In Cox regression analysis of long-term survival after MI, the K9 model showed the best operational characteristics with a p < 0.00001 level. In multivariate analysis, when comorbidity data were added to GRACE, an increase in the χ2 value for GARCE + CCI and GRACE + K9 to 102.5 and 99.3, respectively, and the values of the area under the ROC curve to 0.78 (0.74–0, 82) and 0.77 (0.72–0.81), respectively. Regardless of the initial level of risk assessed by the GRACE scale, severe comorbidity (four or more diseases according to the K9) significantly increased the relative risk of mortality. In patients with severe comorbidity, the predictive value of the GRACE scale was the lowest.Conclusions. Among the analyzed methods of assessing comorbidity, only CCI and its own K9 scale have an acceptable predictive value, allowing better adaptation of the GRACE scale for stratification of the long-term risk of death after MI. At the same time ‘K9’, based on the summation of nine previously described diseases, is much more convenient than CCI in practical application

Quantifying dementia prevention potential in the FINGER randomized controlled trial using the LIBRA prevention index.

IntroductionIndividuals in early dementia prevention trials may differ in how much they benefit from interventions depending on their initial risk level. Additionally, modifiable dementia risk scores might be used as surrogate/intermediate outcomes.MethodsIn the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), we investigated in post hoc analyses (N = 1207) whether the cognitive benefits of the 2‐year multi‐domain lifestyle intervention differed by baseline dementia risk measured with the “LIfestyle for BRAin Health” (LIBRA) score. We also investigated intervention effects on change in LIBRA score over time.ResultsOverall, higher baseline LIBRA was related to less cognitive improvement over time. This association did not differ between the intervention and control groups. The intervention was effective in decreasing LIBRA scores over time, regardless of baseline demographics or cognition.DiscussionThe cognitive benefit of the FINGER intervention was similar across individuals with different LIBRA scores at baseline. Furthermore, LIBRA may be useful as a surrogate/intermediate endpoint and surveillance tool to monitor intervention success during trial execution.

Risk Management in Work Activities at Ammonia Plant Fertilizer Production Industry

Introduction: PT X is one of the companies in fertilizer production industry. There are two high-risk activities that endanger the safety and health of workers, namely supervision of welding and oil level checking in ammonia plant field of PT X. The purpose of this research was to apply risk management to the activities. Method: This research was a descriptive study which was carried out in observation using a cross sectional design. Variables in this study included hazard identification, basic risk analysis, risk control that has been done, existing risk analysis, and risk reduction assessment. The tools used for the data collection were observation sheets, interview guide sheets, and Job Safety Analysis sheets. Data that has been obtained through observation and interviews was processed using Fine (1971) semi quantitative technique. Results: The results of hazard identification were known to have as many as 6 potential hazards. The assessment results in the basic risk analysis showed that the initial risk level consisted of 3 risks with very high level, 2 risks with a substantial level and 1 risk with priority 3 level. After the risk control effort was applied, the results of the assessment in the existing risk analysis showed that the level of risk has decreased significantly. Conclusion: The value of risk reduction of each potential hazard results decreases by 95%, 88.89%, 85%, 93.33%, 66.67%, and 75%.Keywords: ammonia plant, fertilizer production industry, risk management

Developmental cascade effects of a parenting-focused program for divorced families on competence in emerging adulthood.

This 15-year longitudinal follow-up of a randomized controlled trial of a parenting-focused preventive intervention for divorced families examined cascade models of program effects on offsprings' competence. It was hypothesized that intervention-induced improvements in parenting would lead to better academic, work, peer, and romantic competence in emerging adulthood through effects on behavior problems and competencies during adolescence. Families (N = 240) participated in the 11-session program or literature control condition when children were ages 9-12. Data were drawn from assessments at pretest, posttest, and follow-ups at 3 and 6 months and 6 and 15 years. Results showed that initial intervention effects of parenting on externalizing problems in adolescence cascaded to work outcomes in adulthood. Parenting effects also directly impacted work success. For work outcomes and peer competence, intervention effects were moderated by initial risk level; the program had greater effects on youths with higher risk at program entry. In addition, intervention effects on parenting led to fewer externalizing problems that in turn cascaded to better academic outcomes, which showed continuity into emerging adulthood. Results highlight the potential for intervention effects of the New Beginnings Program to cascade over time to affect adult competence in multiple domains, particularly for high-risk youths.

RISK ASSESSMENT OF OVERHEAD CRANE (OHC) DOUBLE GIRDER OPERATION IN THE KAPAL NIAGA DIVISION IN PT PAL INDONESIA (PERSERO

Background: PT PAL Indonesia (Persero) operates Overhead Crane Double Girder tool everyday. The operation of the device have some risk of material hazard, material pinched, material scratched, fracture and passed away. Purpose: The purpose of this research was to assess the level of risk of occupational injury on the operation of Overhead Crane Double Girder. Methods: This research was a descriptive observational one. This study focuses on the operation of Overhead Crane Double Girder in the Kapal Niaga division PT PAL Indonesia (Persero) which consist of the preparation and operation phase. Result: The initial risk level categorized as high-risk level of 44% and a moderate risk level of 56%. The most frequently prevention measure ware routine check, compliance of SOP and PPE usage on workers. Implementation of control efforts resulted in a moderate risk rate of 44% and a low risk level of 56%. Conclusion: Recommendation of control for PT PAL Indonesia (Persero) performs routine maintenance both on equipment and overhead crane function double girder, application and compliance of operating SOP, and operator must have driving license of overhead crane double girder and experience in the field, if applied properly then final risk level to be 100% low.

Client risk calibration in PCAOB audits: an analytical procedures panel risk assignment protocol

Analytical procedures are recommended by the AICPA to calibrate the risk level of the audit. In this paper, we detail an Analytical Procedures technique to aid in assigning an initial risk level to the audit client. Following the AICPA analytical procedures guide, we offer a panel analytical procedures model that uses a priori accrued firms to form benchmarking triage for the main effect: risk level. After testing for the expected fixed effects of the firm benchmarks and also for the explicit input variable power, we show that the panel risk assignment protocol (PRAP) only needs a set of high risk firms as the client benchmarking group. We offer six other sources of risk-related information that may inform the audit regarding client relative risk at the planning stage of the audit. Finally, the final scoring of the risk level is produced by a VBA-Excel decision support system that is available free as a download without restrictions on its use.

Assessment and management of the risk of recurrence of resected gastrointestinal stromal tumors.

119 Background: For patients with KIT+ gastrointestinal stromal tumors (GIST), several algorithms can evaluate the risk of recurrence and initiation of adjuvant therapy following primary GIST resection. With a variety of risk assessment tools and no standardized approach for assessing risk, it is unclear how physicians estimate the risk of recurrence in real-world clinical practice, and how they use the level of risk when considering adjuvant therapy. Methods: We conducted a cross-sectional survey of US oncologists on August 2013. From an existing panel of US physicians, oncologists were randomly asked to participate in an online survey of their assessment and management of GIST recurrence risk after resection of primary resectable disease. Oncologists’ feedback included rated responses by Likert scale and ranked responses by priority. Results: Of 109 participating oncologists, 69 (63%) were in private practice and 61 (56%) were in practice for >10 years. Mitotic count and primary tumor size were the most influential factors chosen for assessing risk of recurrence, followed by presence of tumor rupture during surgery, tumor location, and presence of genetic mutations. A majority of oncologists (56%) reported the revised NIH criteria as the preferred risk classification tool, mainly because it was easy to use and remember. Initial level of risk assessed after GIST resection was the key factor influencing initiation, dosage, and duration of adjuvant therapy with imatinib. 98% of physicians would treat high risk patients with adjuvant imatinib, whereas 79% would consider adjuvant treatment for intermediate risk patients, and 28% for low risk patients. The percentage who would prescribe at least 3 years of adjuvant therapy varied from 26% for low-risk patients to 52% for intermediate-risk patients and 76% for high-risk patients. Conclusions: Level of risk of recurrence is a key factor when considering adjuvant therapy after resection of resectable GIST. However, significant variability exists in the perception physicians have regarding the initiation of adjuvant therapy among intermediate to high risk patients. This may be attributed to the variability in the different risk assessment tools and criteria.

Quantitative Study on the Risk Level of Human Factor for Drilling Process

In order to quantifying human factor initial risk level in drilling process, the types of work activities involved in drilling were identified, the major accident risk types of human errors were selected, the probability and severity levels of risks associated with each activity were quantified, and the human factor risk level of major work activities involved in drilling process were calculated. Quantitative results show that the relatively highest risk types during drilling process are struck by object (risk value is 3.9171 S/w-h), injury by machine (risk value is 2.8916 S/w-h), overexertion (risk value is 1.5091 S/w-h), etc. Contrarily, the relatively lowest risk types are exposure to harmful substances or environments (0.7379 S/w-h), fire and explosion (0.2750S/w-h), and othersi0.2261 S/w-h), etc. The relatively highest risk activities are associated with penetration drilling (risk value is 2.7475S/w-h), trip in and out (risk value is 2.0206 S/w-h), and hoisting and lifting operation (risk value is 1.7064 S/w-h), etc. Contrarily, the relatively lowest risk activities are auxiliary operations (risk value is 0.3706S/w-h), well logging and mud logging (risk value is 0.2059 S/w-h), equipment inspection and maintenance (risk value is 0.1510 S/w-h), etc. The total risk value of all main drilling activities is 11.3947 S/w-h.

A Benefit /Cost Approach for Prioritizing Plant Modifications to Reduce Risk below Acceptance Limit

The paper describes practical experience with the application of a benefit/cost approach for prioritization of plant improvement expenditure to reduce both Health Safety and Environmental (HSE) risk and production loss risk below acceptable level. The method has been developed during a three-year SIL allocation programme implemented in more than 10 petrochemical plants where risk associated to safety functions failing upon request has been determined in order to establish safety function required availability to meet risk level requirements. Conducting a SIL analysis using a combination of technical documentation (P&I Diagrams, Cause and Effect Matrix), safety documentation (HazOp, Fire Fighting System data) and economical parameters (equipment cost, product prices, raw material cost) leads to the identification of initial risk level of petrochemical plant units with regards to three categories, i.e. Safety, Environment and Economic. Resulting SIL level of each safety function corresponds to the highest reduction rate required to lower initial risk within tolerable range. Plants built before the issue of IEC 61508/61511 typically result in high SIL level associated to safety functions, being that safety system architecture was developed without considering reliability requirements for safety loops. Criteria to achieve adequate risk reduction minimizing SIL level of safety functions, e.g. ensuring full independence of safety functions final elements, minimizing frequency of causes, etc. have been evaluated considering the benefit in less severe maintenance requirements and lower cost for modifications.

The Effects of the Fast Track Preventive Intervention on the Development of Conduct Disorder Across Childhood

The impact of the Fast Track intervention on externalizing disorders across childhood was examined. Eight hundred-ninety-one early-starting children (69% male; 51% African American) were randomly assigned by matched sets of schools to intervention or control conditions. The 10-year intervention addressed parent behavior-management, child social cognitive skills, reading, home visiting, mentoring, and classroom curricula. Outcomes included psychiatric diagnoses after grades 3, 6, 9, and 12 for conduct disorder, oppositional defiant disorder, attention deficit hyperactivity disorder, and any externalizing disorder. Significant interaction effects between intervention and initial risk level indicated that intervention prevented the lifetime prevalence of all diagnoses, but only among those at highest initial risk, suggesting that targeted intervention can prevent externalizing disorders to promote the raising of healthy children.

Heterogeneous relationship between IPO return and risk across idiosyncratic variance characteristics

This paper analyzes the levels and changes in the post-IPO stock return volatility and provides insights into market responses to the presence of firm-specific risk. First, we document a negative relation between initial idiosyncratic volatility level and the post-IPO volatility change in that initially low volatility firms have more volatility increase and vice verse. This evidence suggests fundamental firm-specific changes after the IPO. Further, we find that underpricing and short-run post-IPO returns are positively related to the initial and corresponding idiosyncratic risk level. This finding suggests that underpricing compensates investors for acquiring costly information and firm-specific risk information is being incorporated into offer prices. Finally, we find that higher long-run post-IPO performance is related to both lower initial risk level and decreasing risk in the first year after the IPO.

Fast Track Randomized Controlled Trial to Prevent Externalizing Psychiatric Disorders: Findings From Grades 3 to 9

This study tests the efficacy of the Fast Track Program in preventing antisocial behavior and psychiatric disorders among groups varying in initial risk. Schools within four sites (Durham, NC; Nashville, TN; Seattle, WA; and rural central Pennsylvania) were selected as high-risk institutions based on neighborhood crime and poverty levels. After screening 9,594 kindergarteners in these schools, 891 highest risk and moderate-risk children (69% male and 51% African American) were randomly assigned by matched sets of schools to intervention or control conditions. The 10-year intervention (begun in 1991 with three yearly cohorts) included parent behavior-management training, child social-cognitive skills training, reading tutoring, home visiting, mentoring, and a universal classroom curriculum. Outcomes included criterion counts and psychiatric diagnoses after grades 3, 6, and 9 for conduct disorder, oppositional defiant disorder, attention-deficit/hyperactivity disorder, any externalizing disorder, and self-reported antisocial behavior. Grade 9 outcomes were assessed between 2000 and 2003, depending upon cohort. Significant interaction effects between intervention and initial risk level were found at each age but most strongly after grade 9. Assignment to intervention had a significant positive effect in lowering criterion count scores and diagnoses for conduct disorder, attention-deficit/hyperactivity disorder, and any externalizing disorder, and lowering antisocial behavior scores, but only among those at highest risk initially. Prevention of serious antisocial behavior can be efficacious across sex, ethnicity, and urban/rural residence, but screening is essential.

Mortality Risk and the Value of a Statistical Life: The Dead-Anyway Effect Revis(it)ed

In the expected-utility theory of the monetary value of a statistical life, a well-known result found by Pratt and Zeckhauser [1996] asserts that an individuals' willingness to pay (WTP) for a marginal reduction in mortality risk increases with the initial level of risk. Their reasoning is based on the so-called “dead-anyway effect” which states that marginal utility of a dollar in the state of death is smaller than in the state of survival. However, this explanation is based on the absence of markets for contingent claims, i.e. annuities and life insurance. This paper reexamines the relationship between WTP and the level of risk under more general circumstances and establishes two main results: first, when insurance markets are perfect, for a risk-averse individual without a bequest motive, marginal WTP for survival does increase with the level of risk but this occurs for a different reason, namely an income effect. Secondly, when the individual has a bequest motive and is endowed with a sufficient amount of wealth from human capital, the effect of initial risk on WTP for survival is reversed: the higher initial risk the lower the value of a statistical life. In the imperfect-markets case we interpret this result as a “constrained-bequest effect”.

The Dead-Anyway Effect Revis(It)Ed

In the expected-utility theory of the monetary value of a statistical life, the so-called dead-anyway effect discovered by Pratt and Zeckhauser (1996) asserts that an individuals' willingness to pay (WTP) for small reductions in mortality risk increases with the initial level of risk. Their reasoning is based on differences in the marginal utility of wealth between the two states of nature: life and death. However, this explanation is based on the absence of markets for contingent claims, i.e. annuities and life insurance. This paper reexamines the dead-anyway effect and establishes two main results: first, for a risk-averse individual without a bequest motive, marginal WTP for survival does increase with the level of risk but when insurance markets are perfect, this occurs for a different reason than given by Pratt and Zeckhauser. Secondly, when the individual has a bequest motive and is endowed with a sufficient amount of non-inheritable capital, the effect of initial risk on WTP for survival is reversed: the higher initial risk the lower the value of a statistical life.

Very high levels of soluble fiber slightly reduced cholesterol levels in adults with high cholesterol levels who were on a low-fat, low-cholesterol diet

TherapeuticsNovember 1, 1993Very high levels of soluble fiber slightly reduced cholesterol levels in adults with high cholesterol levels who were on a low-fat, low-cholesterol dietC. David Naylor, MD, DPhilC. David Naylor, MD, DPhilSunnybrook Health Science Centre, Toronto, Ontario, Canada (C.D.N.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJC-1993-119-3-068 SectionsAboutFull Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinkedInRedditEmail Source CitationJenkins DJ, Wolever TM, Rao AV, et al. Effect on blood lipids of very high intakes of fiber in diets low in saturated fat and cholesterol. N Engl J Med. 1993 Jul 1;329:21-6.Reference1 Davey Smith C, Song F, Sheldon TA. Cholesterol lowering and mortality: the importance of considering initial level of risk. BMJ. 1993;306:1367-73. Google Scholar Author, Article, and Disclosure InformationAffiliations: Sunnybrook Health Science Centre, Toronto, Ontario, Canada (C.D.N.) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails November 1, 1993Volume 119, Issue 3Page: 68KeywordsApolipoproteinsBloodBlood plasmaBody weightBreadCarbohydratesCholesterolCoronary heart diseaseDietDyslipidemiaFatsFoodGlutenHospitalsHypercholesterolemiaHyperlipidemiaLipidsLipoproteinsNutritionProteins ePublished: 9 March 2020 Issue Published: November 1, 1993 Copyright & PermissionsCopyright © 1993 by American College of Physicians. All Rights Reserved.Loading ...

Cholesterol lowering and mortality: a meta-analysis

Source Citation Davey Smith G, Song F, Sheldon TA. Cholesterol lowering and mortality: the importance of considering initial level of risk. BMJ. 1993 May 22,306:1367-73.

Correction: Cholesterol lowering and mortality: the importance of considering initial level of risk

Correction: Cholesterol lowering and mortality: the importance of considering initial level of risk

Cholesterol lowering and mortality: the importance of considering initial level of risk.

To investigate the level of risk of death from coronary heart disease above which cholesterol lowering treatment produces net benefits. Meta-analysis of results of randomised controlled trials of cholesterol lowering treatments. Published and unpublished data from all identified randomised controlled trials of cholesterol lowering treatments with six months or more follow up and with at least one death were included in the meta-analysis. The analyses were stratified by the rate of death from coronary heart disease in the control arms of the trials. Death from all causes, from coronary heart disease, and from causes other than coronary heart disease. In the pooled analysis, net benefit in terms of total mortality from cholesterol lowering was seen only for trials including patients at very high initial risk of coronary heart disease (odds ratio 0.74; 95% confidence interval 0.60 to 0.92). In a medium risk group no net effect was seen, and in the low risk group there were adverse treatment effects (1.22; 1.06 to 1.42). In a weighted regression analysis a significant (p < 0.001) trend of increasing benefit with increasing initial risk of coronary heart disease was shown. Raised mortality from causes other than coronary heart disease was seen in trials of drug treatment (1.21; 1.05 to 1.39) but not in the trials of non-drug treatments (1.02; 0.88 to 1.19). Cumulative meta-analysis showed that these results seem to have been stable as new trials appeared. Currently evaluated cholesterol lowering drugs seem to produce mortality benefits in only a small proportion of patients at very high risk of death from coronary heart disease. Population cholesterol screening could waste resources and even result in net harm in substantial groups of patients. Overall risk of coronary heart disease should be the main focus of clinical guidelines, and a cautious approach to the use of cholesterol lowering drugs should be advocated. Future trials should aim to clarify the level of risk above which treatment is of net benefit.

A Randomised Controlled Trial of Counseling in a Workplace Setting for Coronary Heart Disease Risk Factor Modification: Effects on Blood Pressure

This paper reviews a prospective study of occupational factors in coronary heart disease risk incorporated in a randomised controlled trial of a worksite based occupational health nurse counseling program for reducing coronary heart disease risk factors. The aim of the trial was to evaluate the longterm effectiveness of the counseling program in persons with mildly elevated risk factor levels. Of the 2,489 Australian government employees with mildly elevated risk factor levels who entered the intervention trial, 1,937 (78%) attended a followup examination three years later. This paper reports on changes in systolic and diastolic blood pressure. Multiple linear regression models were used with three-year blood pressure reduction as the dependent variable, intervention status as the main determinant, and sex, age, initial risk level and initial blood pressure as covariates. Although systolic and diastolic blood pressure fell in both the intervention and control groups, intervention was significantly associated with systolic blood pressure change only.