Multidimensional Risk Assessment Research Articles

Developing a model to assess community-level risk of oral diseases for planning public dental services in Australia.

BackgroundPoor oral health is a chronic condition that can be extremely costly to manage. In Australia, publicly funded dental services are provided to community members deemed to be eligible—those who are socio-economically disadvantaged or determined to be at higher risk of dental disease. Historically public dental services have nominally been allocated based on the size of the eligible population in a geographic area. This approach has been largely inadequate for reducing disparities in dental disease, primarily because the approach is treatment-focused, and oral health is influenced by a variety of interacting factors. This paper describes the developmental process of a multi-dimensional community-level risk assessment model, to profile a community’s risk of poor oral health.MethodsA search of the evidence base was conducted to identify robust frameworks for conceptualisation of risk factors and associated performance indicators. Government and other agency websites were also searched to identify publicly available data assets with items relevant to oral diseases. Data quality and analysis considerations were assessed for the use of mixed data sources.ResultsSeveral frameworks and associated indicator sets (twelve national and eight state-wide data collections with relevant indicators) were identified. Determination of the system inputs for the Model were primarily informed by the World Health Organisation’s (WHO) operational model for an Integrated Oral Health-Chronic Disease Prevention System, and Australia’s National Oral Health Plan 2004–2013. Data quality and access informed the final selection of indicators.ConclusionsDespite limitations in the quality and regularity of data collections, there are numerous data sources available that provide the required data inputs for community-level risk assessment for oral health. Assessing risk in this way will enhance our ability to deliver appropriate public oral health care services and address the uneven distribution of oral disease across the social gradient.

The prognostic blood biomarker proadrenomedullin for outcome prediction in patients with chronic obstructive pulmonary disease (COPD): a qualitative clinical review.

Plasma proadrenomedullin (ProADM) is a blood biomarker that may aid in multidimensional risk assessment of patients with chronic obstructive pulmonary disease (COPD). Co-secreted 1:1 with adrenomedullin (ADM), ProADM is a less biologically active, more chemically stable surrogate for this pluripotent regulatory peptide, which due to biological and ex vivo physical characteristics is difficult to reliably directly quantify. Upregulated by hypoxia, inflammatory cytokines, bacterial products, and shear stress and expressed widely in pulmonary cells and ubiquitously throughout the body, ADM exerts or mediates vasodilatory, natriuretic, diuretic, antioxidative, anti-inflammatory, antimicrobial, and metabolic effects. Observational data from four separate studies totaling 1366 patients suggest that as a single factor, ProADM is a significant independent, and accurate, long-term all-cause mortality predictor in COPD. This body of work also suggests that combined with different groups of demographic/clinical variables, ProADM provides significant incremental long-term mortality prediction power relative to the groups of variables alone. Additionally, the literature contains indications that ProADM may be a global cardiopulmonary stress marker, potentially supplying prognostic information when cardiopulmonary exercise testing results such as 6-min walk distance are unavailable due to time or other resource constraints or to a patient's advanced disease. Prospective, randomized, controlled interventional studies are needed to demonstrate whether ProADM use in risk-based guidance of site-of-care, monitoring, and treatment decisions improves clinical, quality-of-life, or pharmacoeconomic outcomes in patients with COPD.

Multidimensional Risk Assessment of Manhole Events as a Decision Tool for Ranking the Vaults of an Underground Electricity Distribution System

Even though an underground electricity distribution system is safer than an overhead system, several accidents have occurred in them. Assessing the risk of hundreds or even thousands of underground vaults is a hard task. Furthermore, given the large variability in external and internal environments and, hence, there being a wide range of possible consequences when an accident occurs, an approach to risk assessment under a multidimensional view is required. Moreover, in terms of decision making, the aggregation of the decision maker's preferences in modeling, by multiple-criteria decision-making methods, is more complete, comprehensive, and, in particular, includes considering the decision maker's desires. Therefore, this study puts forward a multidimensional assessment of the risks from underground vaults by generating a decision tool, which ranks the vaults in a risk hierarchy. Multiattribute utility theory was used to achieve this ranking. An application was generated to demonstrate the applicability of the model, under the following aspects of consequences: those that are human, financial, and operational; and disruptions to local vehicular traffic. The use of information arising from analysis of the differences between risks enabled the decision maker to make an in-depth analysis of the range of possibilities over which alternatives may be chosen in order to implement preventive actions.

Multidimensional Risk Management for Underground Electricity Networks

Abstract In the paper we consider an electricity provider company that makes decision on allocating resources on electric network maintenance. The investments decrease malfunction rate of network nodes. An accidental event (explosion, fire, etc.) or a malfunctioning on underground system can have various consequences and in different perspectives, such as deaths and injuries of pedestrians, fires in nearby locations, disturbances in the flow of vehicular traffic, loss to the company image, operating and financial losses, etc. For this reason it is necessary to apply an approach of the risk management that considers the multidimensional view of the consequences. Furthermore an analysis of decision making should consider network dependencies between the nodes of the electricity distribution system. In the paper we propose the use of the simulation to assess the network effects (such as the increase of the probability of other accidental event and the occurrence of blackouts of the dependent nodes) in the multidimensional risk assessment in electricity grid. The analyzed effects include node overloading due to malfunction of adjacent nodes and blackouts that take place where there is temporarily no path in the grid between the power plant and a node. The simulation results show that network effects have crucial role for decisions in the network maintenance – outcomes of decisions to repair a particular node in the network can have significant influence on performance of other nodes. However, those dependencies are non-linear. The effects of network connectivity (number of connections between nodes) on its multidimensional performance assessment depend heavily on the overloading effect level. The simulation results do not depend on network type structure (random or small world) – however simulation outcomes for random networks have shown higher variance compared to small-world networks.

GIS-based multi-dimensional risk assessment of the grassland fire in northern China

This study presents a methodology for risk analysis and assessment to manage grassland fire in northern China based on the Geographical Information Systems from the viewpoints of climatology, geography, disaster science, and environmental science and so on. Using natural disaster and risk assessment theory, a multi-dimensional grassland fire risk index (MGFRI) was proposed by integrating weighted comprehensive method, analytic hierarchy process, and fuzzy gamma method into natural disaster risk index. The developed MGFRI will be an easily understandable tool to manage grassland fire by comparing the risk of regions in the northern China and relative contributions of various factors, for example, hazard, exposure, vulnerability, and management ability. A scale of one to five was derived to measure the risk degree. It shows that 4.4 % of grassland falls in the category of ‘very high’ risk, followed by 9.6, 19.1, 60.9, and 5.9 %, respectively, in the categories ‘high’, ‘middle’, ‘low’, and ‘very low’. The assessment results show reliability by test. The results in this study are intended to support local, provincial, and national government agencies to: (1) make resource allocation decisions; (2) make high-level planning decisions; and (3) raise public awareness of grassland fire risk, its causes, and ways to manage it.

Multidimensional Risk Assessment for Tooth Loss in a Geriatric Population with Diverse Medical and Dental Backgrounds

To introduce a multidimensional approach to assess risk of tooth loss for older adults with diverse medical and dental backgrounds. Retrospective longitudinal study. Community-based geriatric dental clinic in Minnesota. Four hundred ninety-one older adults who presented to the studied clinic as new patients between October 1999 and December 2006, remained dentate after finishing the initial treatment plan, and returned for care at least once thereafter were selected as participants. All existing dental conditions were treated before enrollment. Comprehensive dental care was continually provided for all participants during follow-up. Demographic information, together with medical, dental, functional, and cognitive assessment at arrival, was abstracted from dental records. Logistic, Cox, Poisson, and negative-binomial regressions were developed to assess risk of tooth loss from four dimensions: likelihood of tooth loss, time to first tooth loss, and frequency and rate of tooth loss per person-year. Although the traditional single-dimensional risk assessment approach indicated that number of teeth being carious or retaining roots at arrival was the only contributing factor for tooth loss in older adults, the multidimensional approach found that risk factors of tooth loss differed when assessed from different perspectives. While likelihood of tooth loss and time to first tooth loss were associated only with dental factors, both dental and nondental factors were associated with frequency and rate of tooth loss. A single-dimensional risk assessment approach focusing on likelihood of tooth loss alone fails to provide a comprehensive risk profile for older adults. A multidimensional approach should be considered during assessment and treatment planning.

Assigning priorities to actions in a pipeline transporting hydrogen based on a multicriteria decision model

Nowadays there is a pressing need to implement changes in the global energy structure, such that it incorporates new features and changes the way that we use fossil fuels. In this scenario, hydrogen is projected as the fuel of the future. Among the possible modes that can be used for its transportation, the pipeline is singled out as it is the safest and the most economically viable means of transporting large quantities of the gas. However, accidents to pipelines have been recorded and they often result in catastrophic consequences for society. In this context, this paper proposes novelties in multidimensional risk assessment for the transportation of hydrogen by pipeline. Thus, a multicriteria decision model is proposed, using multiattribute utility theory, which incorporates the behavior of a decision maker and considers three dimensions of risk assessment: the human, financial and environmental dimensions. By taking these into consideration, the decision maker may well get precious and differentiated information about the risk management of pipelines.

Risk-Benefit Considerations of Mitigation Measures on Acrylamide Content of Foods – A Case Study on Potatoes, Cereals and Coffee

This report produced by an independent Expert Group is the second commissioned by the ILSI Europe Task Force on Process-related Compounds. The first report, which reviewed human exposure and internal dose assessments of acrylamide in foods, stressed the need for comparison of added risks or reduced benefits ν. the benefit of acrylamide reduction. This second Expert Group was established to examine and report on the considerations for risk-benefit analysis of the mitigation measures on acyrylamide in commodities which contribute significantly to acrylamide exposure, and their impact on safety, quality, nutritional and organoleptic parameters; to position the relevance of the suspected side effects and to quantify their potential impact. The Expert Group was asked to focus on the impact of mitigation on exposure scenarios and the risk to human health using multidimensional risk assessment approaches. The report has four main objectives: 1. To summarise the impact of pre-harvest, post-harvest and processing conditions on acrylamide formation in potatoes, cereals and coffee. 2. To evaluate the impact of pre-harvest, post-harvest and processing conditions on the formation of acrylamide in these commodities. 3. To consider the nutritional value and beneficial health impact of consuming these commodities. 4. To calculate the impact of mitigation using probabilistic risk-benefit modelling to demonstrate the principle of this approach. Animal studies have shown that acrylamide is a genotoxic carcinogen. Under the premise that for genotoxic carcinogens no threshold levels of effect exists, exposure is to be minimized as far as possible. Minimization strategies therefore have been and consistently are developed, although direct evidence of carcinogenic effects in humans as a result of acrylamide intake is not available. The margin of exposure (MOE), representing the ratio between a defined point on the relevant dose-response curve, the bench mark dose lower limit (BMDL, 300 μg/kg body weight (bw) per day) and average (1 μg/kg bw per day) or high (4 μg/kg bw per day) consumer exposure has been estimated at 300 and 75, respectively. According to the European Food Safety Authority (EFSA) and the Joint FAO/WHO Expert Committee on Food Additives (JECFA) a MOE of ≥ 10 000 would indicate low concern, underlining that the relatively low MOE for acrylamide calls for rapid and effective mitigation measures in order to lower consumer exposure. Acrylamide production in foods is a consequence of the Maillard reaction between asparagine and reducing sugars. Therefore, factors affecting the concentration of these precursors in food, together with processing conditions during food preparation and storage will affect the final concentration of acrylamide in food. The commodities giving the highest exposure to acrylamide in the western diet are potatoes, cereals and coffee. The first two of these are staple foods providing for the majority of carbohydrate and some protein in the diet. Coffee is not an essential food, but has a high level of intake as a beverage, chosen not only for its flavour and hedonic value but also as a provider of caffeine. Acrylamide formation in foodstuffs depends on the concentrations and availability of the precursor molecules asparagine and reducing sugar(s).

Multidimensional risk assessment versus age as criterion for retirement of airline pilots.

To determine whether airline pilots over the age of 60 pose a hazard to aviation safety and whether risk assessment could replace age-based retirement. A computer-assisted literature search (MEDLINE), expert consultation, and government reports. Original studies on flight performance and pilot age; sudden incapacitation, neuropsychological testing, and/or medication use in pilots; and/or non-invasive testing for predicting sudden death or stroke in asymptomatic subjects. Pertinent results and methods data were abstracted from the 49 included studies. No study on aircraft accidents or pilot performance has shown an increased accident risk for over-60-year-old pilots. Normal age-related cognitive changes probably have minimal impact on aviation safety up to age 70, given above average health, education, and experience in airline pilots. Cognitive tests have not been validated for predicting flight performance safety, but they can detect early stages of cognitive disease. Cardiovascular incapacitation risk increases with age, but risk factor profiles and non-invasive tests could identify pilots with non-acceptable risk. An improved medical certification test could identify those pathologic conditions that might occur more frequently in older subjects. If pilots also underwent adequate performance testing, a gradual increase of the retirement age to approximately age 70 would seem justified. In the future, a longitudinal database should be established to validate medical tests for their ability to predict a pilot's accident risk. Using individual pilots as their own controls might be more sensitive than using population-based norm values. Progress in this field would advance medical assessment for other groups such as air traffic controllers or automobile drivers.