Risk Reduction Methods Research Articles

Breast Cancer Risk and Breast-Cancer-Specific Mortality following Risk-Reducing Salpingo-Oophorectomy in BRCA Carriers: A Systematic Review and Meta-Analysis

Risk-reducing salpingo-oophorectomy (RRSO) is the gold standard method of ovarian cancer risk reduction, but the data are conflicting regarding the impact on breast cancer (BC) outcomes. This study aimed to quantify BC risk/mortality in BRCA1/BRCA2 carriers after RRSO. We conducted a systematic review (CRD42018077613) of BRCA1/BRCA2 carriers undergoing RRSO, with the outcomes including primary BC (PBC), contralateral BC (CBC) and BC-specific mortality (BCSM) using a fixed-effects meta-analysis, with subgroup analyses stratified by mutation and menopause status. RRSO was not associated with a significant reduction in the PBC risk (RR = 0.84, 95%CI: 0.59-1.21) or CBC risk (RR = 0.95, 95%CI: 0.65-1.39) in BRCA1 and BRCA2 carriers combined but was associated with reduced BC-specific mortality in BC-affected BRCA1 and BRCA2 carriers combined (RR = 0.26, 95%CI: 0.18-0.39). Subgroup analyses showed that RRSO was not associated with a reduction in the PBC risk (RR = 0.89, 95%CI: 0.68-1.17) or CBC risk (RR = 0.85, 95%CI: 0.59-1.24) in BRCA1 carriers nor a reduction in the CBC risk in BRCA2 carriers (RR = 0.35, 95%CI: 0.07-1.74) but was associated with a reduction in the PBC risk in BRCA2 carriers (RR = 0.63, 95%CI: 0.41-0.97) and BCSM in BC-affected BRCA1 carriers (RR = 0.46, 95%CI: 0.30-0.70). The mean NNT = 20.6 RRSOs to prevent one PBC death in BRCA2 carriers, while 5.6 and 14.2 RRSOs may prevent one BC death in BC-affected BRCA1 and BRCA2 carriers combined and BRCA1 carriers, respectively. RRSO was not associated with PBC or CBC risk reduction in BRCA1 and BRCA2 carriers combined but was associated with improved BC survival in BC-affected BRCA1 and BRCA2 carriers combined and BRCA1 carriers and a reduced PBC risk in BRCA2 carriers.

Identifying Patterns of Discontinuing and Recommencing Pre-exposure Prophylaxis in the Context of Sexual Behavior Among Gay and Bisexual Men in Australia

We mapped gay and bisexual men’s (GBM) patterns of using pre-exposure prophylaxis (PrEP) over time and explored sexual behavior as PrEP use changed. We conducted semi-structured interviews between June 2020 and February 2021 with 40 GBM living in Australia who had changed their PrEP use since initiating. There was considerable diversity in patterns of discontinuation, suspension, and recommencement of PrEP. Reasons for changing PrEP use mostly centered on accurate perceived changes to HIV risk. Twelve participants reported condomless anal intercourse with casual or fuckbuddy partners after discontinuing PrEP. These sex events were unanticipated, condoms were not a preferred option, and other risk reduction strategies were applied inconsistently. Service delivery and health promotion can support safer sex among GBM when PrEP use fluctuates by promoting event-driven PrEP and/or non-condom-based risk reduction methods during periods off daily PrEP, and guiding GBM to better recognize changing circumstances of risk and when to recommence PrEP.

Protocol of a randomised controlled trial to assess medical staff’s inhalation exposure to infectious particles exhaled by patients during oesophagogastroduodenoscopy and the efficacy of surgical masks in this context

BackgroundAerosol-generating procedures such as oesophagogastroduodenoscopy (OGD) result in infectious particles being exhaled by patients. This substantially increases the medical staff’s risk of occupational exposure to pathogenic particles via airway inhalation...

Reassessing the Importance of PrEP Use Given Reduced Sex During the COVID-19 Pandemic: Perspectives From a Sample of Young Sexual Minority Men.

Research has begun to examine sexual behavior during the COVID-19 pandemic using quantitative methods, but less is known about the context surrounding these changes using qualitative methods, including corresponding changes in risk reduction methods. This qualitative study, guided by the Integrated Behavioral Model, examines the pandemic's impact on PrEP adherence among young men who have sex with men in Chicago. PrEP-using participants from a cohort study were recruited into a 90-day diary study measuring sexual behaviors and PrEP use. Between April and September 2020, a subset of participants was recruited for qualitative interviews (n = 28) exploring prevention strategies, including the impact of the pandemic. Although most were highly adherent pre-pandemic, many took fewer pills or discontinued during the pandemic due to decreased sex. Findings suggest the importance of counseling for PrEP reinitiation as "seasons of HIV risk" increase, as well as use of telehealth as a facilitator of PrEP use throughout the pandemic.

Lipid lowering with inclisiran: a real-world single-centre experience

ObjectiveThe reduction in circulating low-density lipoprotein cholesterol (LDL-c) is the primary aim of lipid-lowering therapies as a method of atherosclerotic cardiovascular disease risk reduction. Inclisiran is a new and potent...

Comparisons of Trunk Motions and Low Back Injury Risk between Alternative Hotel Room Cleaning Methods.

Hotel room cleaners frequently report job-related pain, with high rates of work-related musculoskeletal disorder injuries established for this group of workers. Surprisingly, there is limited published research documenting the impact of interventions to reduce ergonomic-related injury risks specific to hotel room cleaners' job tasks. In this study focused on hotel bathroom-cleaning and furniture-dusting tasks, twelve experienced hotel room cleaners used their standard method and a risk-reduction method-a tool with a handle that could extend, to perform these tasks. The female study participants' average age was 45.3 (SD 8.7) years with an average of 10 years of work experience as cleaners (range: 0.8-26.0 years). Trunk kinematics and a low back injury risk assessment were measured using the Lumbar Motion Monitor. All study metrics were significantly reduced when cleaning tasks involved use of adjustable, long-handled tools (p < 0.05). This study demonstrated that commonly available cleaning and dusting tools with extendable handles can significantly reduce low back injury risk among hotel room cleaners and potentially reduce injury risk to other body parts known to be the site of musculoskeletal disorders in this workforce. The study findings suggest that cleaning or housekeeping jobs in other industries where these same tasks are performed could benefit from use of extended-handle tools like those investigated here.

Robust Non-Fragile Fault Tolerant Control for Ensuring the Safety of the Intended Functionality of Cooperative Adaptive Cruise Control

Cooperative adaptive cruise control (CACC) has the potential to significantly improve road safety, highway throughput and reduce fuel consumption. However, the safety of the intended functionality (SOTIF) of CACC that focuses on unreasonable risks related to performance limitations has not been addressed. Moreover, various unknown uncertainties, disturbances, and controller perturbations present in the road environment make the guarantee of SOTIF for CACC a more challenging problem. This study presents a robust non-fragile fault tolerant control (RNFTC) strategy as a quantitative risk reduction method for ensuring SOTIF of CACC with system uncertainty, multisource disturbances, and controller perturbations. First, an intermediate based robust estimation method is proposed to estimate the performance limitations of perception and actuation, system states, and matched disturbances, simultaneously. Second, a robust non-fragile <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\text{H}_{\infty }$ </tex-math></inline-formula> FTC method is proposed to accommodate the simultaneous presence of performance limitations and disturbances. Third, theorems for solving optimal estimator and controller gains of the proposed RNFTC are derived in terms of linear matrix inequalities (LMIs). The requirements for CACC system stability, robustness, non-fragile and <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\text{H}_{\infty }$ </tex-math></inline-formula> performances under the proposed RNFTC are analyzed using Lyapunov theory. Finally, a series of comparative simulations with the CACC system are conducted to demonstrate the effectiveness and superiority of the proposed RNFTC method on ensuring SOTIF of CACC under unknown uncertainties, disturbances, and perturbations.

Management of breast complaints and high-risk lesions

Benign breast disease including palpable breast mass, mastalgia, skin changes, and nipple discharge are common gynecologic symptoms. Practitioners should be well versed in the components of clinical breast care. Workup begins with taking a thorough medical and family history to assess risk and performing a clinical breast examination. Breast imaging is often indicated for further evaluation. A structured approach to the evaluation and management of these breast conditions is critical to distinguish benign disease from malignancy. High-risk breast lesions such as atypical hyperplasia and lobular carcinoma in situ are also frequently encountered, and while benign, they do increase the future risk of breast cancer and patients should be offered intensive surveillance and chemoprevention.

Balancing data privacy and usability in the federal statistical system

The federal statistical system is experiencing competing pressures for change. On the one hand, for confidentiality reasons, much socially valuable data currently held by federal agencies is either not made available to researchers at all or only made available under onerous conditions. On the other hand, agencies which release public databases face new challenges in protecting the privacy of the subjects in those databases, which leads them to consider releasing fewer data or masking the data in ways that will reduce their accuracy. In this essay, we argue that the discussion has not given proper consideration to the reduced social benefits of data availability and their usability relative to the value of increased levels of privacy protection. A more balanced benefit–cost framework should be used to assess these trade-offs. We express concerns both with synthetic data methods for disclosure limitation, which will reduce the types of research that can be reliably conducted in unknown ways, and with differential privacy criteria that use what we argue is an inappropriate measure of disclosure risk. We recommend that the measure of disclosure risk used to assess all disclosure protection methods focus on what we believe is the risk that individuals should care about, that more study of the impact of differential privacy criteria and synthetic data methods on data usability for research be conducted before either is put into widespread use, and that more research be conducted on alternative methods of disclosure risk reduction that better balance benefits and costs.

Conceptualizing safer sex in a new era: Risk perception and decision-making process among highly sexually active men who have sex with men.

Men who have sex with men (MSM) are at the epicenter of the HIV epidemic. Efforts to prevent sexually transmitted infections (STIs) and HIV transmission have traditionally focused on condoms and abstinence from high risk sexual practices. Recently, additional methods such as pre-exposure prophylaxis (PrEP) and viral load sorting have been introduced. The aim of this study was to gain understanding about risk management and risk perception strategies for HIV among highly sexually active Swedish MSM with men in Berlin. Eighteen sexually active Swedish MSM who travelled to or lived in Berlin were recruited and interviewed in this study. The data were analyzed using content analysis. These men represent a group of knowledgeable MSM in terms of HIV. They acknowledged that having sex with men in Berlin was linked to high sexual risk taking due to the higher prevalence of HIV/STIs than in Sweden, but reported that they nevertheless did not alter their risk management strategies. The analysis resulted in a conceptual model of risk assessment that allows for a deeper understanding of the complexity of the risk reduction decision-making process. Three ontological perceptions of risk were identified: accepting, minimizing and rejecting risk. Seven practiced risk reduction methods were described. Some informants applied their preferred method or set of methods to all settings and partners, while others faced complex decision-making processes. HIV is integrated into the core of MSM's sexuality, independently of how they ontologically related to the idea of risk. A constant navigation between pleasure, risk and safety, alongside having to relate to risk created a complex process. Efforts were made to remove HIV from their lives by rejecting the idea of risk, and thereby reject the idea of the homosexual body being a possible vessel for a virus and an epidemic.

Awareness isn't saving lives: An experimental exploration of suicide risk reduction methods for emerging adults.

Suicide prevention campaigns commonly employ brief informational materials aimed at emerging adults. Are such programs helpful, and do design characteristics yield differences in user outcomes? Literature is reviewed from the interpersonal theory of suicide, escape theory, and terror management theory, to inform our experimental design. Participants (n=977MTurk emerging adults) reported demographics and suicide histories and were randomized to one of nine experimental cells with varying video and journaling conditions to approximate suicide prevention materials. Participants were surveyed on perceptions of the materials' risk reduction effectiveness, indicated their suicidality risk factors (e.g., hopelessness, depressiveness, purposelessness, and non-belongingness), and conducted an implicit association test of suicidality. Suicide risk factors did not differ between experimental and control conditions, but certain conditions were rated as more effective (i.e., essay conditions prompting reflection, and the video condition featuring a personal/affective narrative). While there was no actual comparative reduction of risk, there was a perception that certain designs were more helpful. Real-world suicide prevention campaigns often feel justified despite lacking impact. Effective suicide risk reduction requires greater time investment and deeper personal connection than brief campaigns can offer, as well as systemic changes from a public health policy perspective.

Questioning the effectiveness of risk reduction via post-disaster relocation

Post-disaster relocation permanently moves households out of areas highly exposed to hazards, yet risk remains. Communities relocated after a disaster may continue to be exposed and ill-prepared to respond to hazards. To investigate the efficacy of relocation, we studied exposure and preparedness at relocation sites in the Philippines in the wake of Typhoon Haiyan. We evaluated selected elements of risk reduction, such as the establishment of a community disaster warning system, at relocation sites and compare these to households’ locations before the typhoon. Results revealed that decision making for post-disaster relocation needs to better consider multi-hazard risks. Although relocated community members were less exposed to storm surge, nearly all had increased exposure to flooding, with several households forced to evacuate during a flood event. Furthermore, preparedness decreased, as relocated communities were less likely to have a response plan, warning system, or leaders ready to meet the challenges hazards present. The frequency of flooding at relocation sites coupled with low community-level capacity illustrate a need for improved planning and development of post-disaster relocation sites. By demonstrating that relocation is not always effective at creating a wholly safer environment for households, the findings indicate the need for considering additional risks within the decision-making process around relocation as a method of disaster recovery and risk reduction.

A Study on Worker Risk Reduction Methods using the Deep Learning Image Processing Technique in the Turning Process

A Study on Worker Risk Reduction Methods using the Deep Learning Image Processing Technique in the Turning Process

Ergonomic Risk Reduction Method in Aerospace Manufacturing

In the aerospace manufacturing, lots of processes cannot be automated and are performed manually by skilled workers. Because there exist some human error mistakes in such manual working processes, root cause investigations of these mistakes are indispensable and measures are implemented in working processes for preventing repetition of the same mistakes. Although skilled workers have strong confidence that they can complete their work with no mistake, there exist some cases that they cannot recognize their mistakes in practice. In such cases, root cause investigations cannot be performed and no measure is implemented. Such situation may become a serious risk in aerospace manufacturing because a tiny mistake can cause the serious mission failure of aviation system. To reduce such situation, the ergonomic risk reduction method is proposed. Skilled workers try to avoid frustration in performing their tasks and make mistakes through careless behavior. The cause of the frustration is discovered by ergonomic risk reduction method. Work risks can be removed by the progress of the working environment. Such risk reduction method contributes manufacturing organization resiliency. In this paper, we propose an ergonomic human error risk reduction method for skilled workers in Japanese domestic liquid rocket engine manufacturing.

Metabolic and inflammatory risk reduction in response to lipid-lowering and lifestyle modification in the medically underserved individuals

IntroductionMedically underserved (US) populations have an increased level of atherosclerotic cardiovascular disease (ASCVD) risk, however, few studies investigated ASCVD risk reduction in US. MethodsOf 217 subjects with ApoB ≥120 mg/dL and carotid atherosclerosis (≥15% stenosis by ultrasound) enrolled in the Carotid Plaque Composition by MRI (CPC) study between 2005 and 2011, US (n=33) was defined as those without adequate healthcare insurance, while AS (n=184) included those with adequate healthcare coverage. All subjects received atorvastatin-based lipid therapies and lifestyle intervention for 2 years. Metabolic and inflammatory risk factors were compared between AS and US. ResultsAt baseline, compared to AS, US displayed higher levels of metabolic and inflammatory risk including systolic blood pressure (140±27 vs. 131±18 mmHg, p=0.04), fasting glucose (125±59 vs. 102±22 mg/dL, p=0.03) and fasting insulin (39±33 vs. 28±20 µU/dL, p=0.03) which resulted in higher insulin resistance (HOMA-IR 2.2±0.4 vs. 1.3±0.1, p=0.03), and hsCRP (5.6±1.5 vs. 2.8±0.2 mg/L, p=0.03). Over 2 years of intervention, US and AS showed similar reductions in LDL-C (-10.7% vs. -16% per year, p=0.2), triglycerides (-16.7% vs. -15.9% per year, p=0.4), and hsCRP (-0.11% vs. -0.04% per year, p=0.1). However, US continued to show significantly higher levels of fasting blood glucose (115±6.0 vs. 101±2.0 mg/dL, p=0.03) and HOMA-IR (1.9±0.2 vs. 1.5±0.1, p=0.047), and hsCRP (3.9±0.7 vs. 1.9±0.2 mg/L, p<0.001) than AS following 2 years of interventions. ConclusionsUS displayed higher ASCVD risk than AS at baseline and over 2 years despite similar reductions following the intervention. These findings highlight the unmet needs for improved intervention strategies and implementation methods for ASCVD risk reduction in US. Clinical Trial RegistrationNCT00715273 at ClinicalTrials.gov

Sharing experience by residents of past disaster sites: Effects of time from disasters and types of experience

Sharing past disaster experience among the community is an important method of disaster risk reduction. This study distinguishes three groups of residents in disaster-affected areas: the direct experience group, the same generation group that has overlapping ages with the first group but does not have direct experience of the local disaster, and the next generation group. Similarities and differences in the roles of these groups to share their disaster experience were not well documented. This study compares knowledge levels regarding local disasters, content of experience to be shared, and methods of sharing across these groups in Kobe, Japan, where a large earthquake occurred in 1995 and in Sanriku, Japan, where a large earthquake and tsunami hit in 2011. Compared to the other groups, the direct experience group had better knowledge of the disaster and a stronger sense of responsibility to pass down disaster experience themselves. By nine years after the disaster, the members who had shared their experience among this group reached the maximum of 75%. Informal settings like family gatherings are main channel of experience sharing. Having more knowledge on the disaster is a positive factor in an experience sharing behavior. Those who had lived outside of the disaster area reported greater knowledge levels than the others within the direct experience groups, whereas the opposite occurred among the next generation group. A lifecycle model of disaster experience sharing by the three groups is proposed to facilitate policy support for dissimilating disaster experience among communities.

Enterprise's Finances: Possible Customer's Risks when Outsourcing Accounting

The study aims to determine the essence, classification, reduction methods, and the impact on accounting organization of the risks faced by the customer and the contractor when outsourcing accounting. The article examines the types of risks that arise when outsourcing accounting. Based on the use of such scientific methods as logical generalization and comparison, as well as an expert survey, the following classification criteria and types of risks for the customer have been identified: concerning the customer's activities (operational, financial, control); by the level of loss and distortion of information (risk of disclosure of confidential information, risk of loss of customer documentation, accounting risk); by the aspect of emergence (psychological, moral, loss of reputation); by the source of occurrence (subjective, objective), by the possibility of prediction (predicted, unpredictable); by the possible consequences (risk resulting in loss to the customer; risk resulting in the customer receiving a specified level of income). The reasons and consequences of the proposed types of risks have been determined. The authors also have determined the influence of each of them on accounting organization and the main stages of risk management and methods of risk reduction. The practical importance of improving the classification of risks in outsourcing accounting is to assist parties in contractual relations in developing a strategy and forecasting business activities. The theoretical value lies in the possibility of using the research results to develop new classifications.

A low-cost toolbox for high-resolution vulnerability and hazard-perception mapping in view of tsunami risk mitigation: Application to New Caledonia

The drive towards improving tsunami risk mitigation has intensified along many populated coastlines. Like many islands in the Pacific Ocean, the coastal population of New Caledonia is exposed to tsunamis triggered by powerful earthquakes. Intersecting exhaustive population data with high-resolution building location data within a user-defined coastal fringe is an accurate means of geolocating vulnerable residents, and an important step towards disaster risk reduction. This paper presents a mixed methodology built on GIS-based dasymetric techniques for assessing, classifying, and mapping population distribution in New Caledonia, with the aim of quantifying and ranking the areas most vulnerable to tsunami-related hazards. Results reveal that 33% of the population, inclusive of previously unmapped precarious housing, lives between sea level and the 10 m elevation contour in well-defined clusters. A pilot field survey of 412 respondents was additionally conducted in the capital Nouméa (66% of the nation's population) to assess tsunami awareness, risk perception, and risk-related behavioral patterns among the ethnically and demographically diverse population. By further mapping the spatial association between coastal population concentrations, the perceived natural shielding capacities of coral reefs and mangroves, and the benefits of alarm siren networks, the study delivers a comprehensive assessment of the country's disaster preparedness, with policy recommendations for the future. The methodology is transferable to other types of hazards and other insular settings where civil security and risk-management organizations acquire and curate reliable primary data but may also need guidelines for transforming them into serviceable disaster risk reduction methods and policies.

A Simulation-Based Comprehensive Analysis for Traffic Efficiency and Spatial Distribution of Risks in Short Weaving Area of Municipal Interchange

The weaving area is an important junction that affects the efficiency and traffic safety at the municipal interchanges. To explore the factors affecting traffic efficiency and the spatial distribution characteristics of traffic risks in the weaving areas of municipal interchanges, this study employed a microscopic traffic software of Vissim to construct a simulation model of weaving areas and evaluate the impact of road and traffic design parameters in the short weaving on traffic efficiency and risks, which includes ramp delay, mainline through lane (TL) traffic delay, average ramp speed, TL average speed, and collision rate. Through variance analysis via a large number of simulation scenarios, the weaving length is identified as the most important factor affecting traffic efficiency and risks in the short weaving area. Subsequently, three different types of weaving lengths with 350 m, 450 m, and 550 m were set to conduct the sensitivity analysis based on four performance indexes of mean acceleration and deceleration, acceleration range, deceleration range, and speed standard deviation as the representative variables of spatial risk distribution. The simulation results illustrate that a shorter weaving length has a significant influence on risk distribution, especially the highest risk probability at the positions after three-quarters of the inner and outer lanes in the short weaving area at the municipal interchange. Finally, this study verified the traffic risk reduction method of having traffic safety facilities and traffic organization at the complex interchange with double-entry and single-exit weaving areas in the city of Guangzhou, China. The research proposed a method to analyze the influence of the design parameters in the short weaving area on traffic efficiency and safety and provided a reference for the risk spatial distribution analysis and improvement in the short weaving area.

Pre-Exposure Prophylaxis for HIV Infection and the Role of the Women's Health Care Provider in HIV Prevention.

HIV infection is a major public health problem for women in the United States. Prevention of new HIV infections is essential to the goal of eliminating HIV in the United States. Pre-exposure prophylaxis (PrEP) is an effective and safe HIV prevention method recommended for women at increased risk for HIV infection, including during pregnancy and lactation. The recommended PrEP regimen is a fixed-dose combination of tenofovir disoproxil fumarate and emtricitabine administered as a single daily dose. The initial evaluation for individuals desiring PrEP for HIV prevention includes obtaining a history, laboratory evaluation, and evaluation of the accessibility and acceptability of PrEP. Individuals using PrEP medications are seen every 3 months for follow-up. These follow-up visits include evaluation for signs and symptoms of seroconversion, management of side effects and adverse reactions, and evaluation of adherence to PrEP. Follow-up visits also include testing for HIV, sexually transmitted infections, and renal function and a review of HIV prevention and risk reduction methods. Despite known safety and efficacy of PrEP among women, PrEP use in women in the United States remains low. Gaps exist in HIV prevention that can in part be addressed by women's health care providers through risk screening and provision of HIV prevention methods. All providers of comprehensive sexual health care can and should assess individuals for risk factors for HIV infection and offer HIV prevention methods, including PrEP, to individuals at risk for HIV.