Implementation Of Risk Assessment Research Articles

Factors influencing U.S. women’s interest and preferences for breast cancer risk communication: a cross-sectional study from a large tertiary care breast imaging center

BackgroundBreast imaging clinics in the United States (U.S.) are increasingly implementing breast cancer risk assessment (BCRA) to align with evolving guideline recommendations but with limited uptake of risk-reduction care. Effectively communicating risk information to women is central to implementation efforts, but remains understudied in the U.S. This study aims to characterize, and identify factors associated with women’s interest in and preferences for breast cancer risk communication.MethodsThis is a cross-sectional survey study of U.S. women presenting for a mammogram between January and March of 2021 at a large, tertiary breast imaging clinic. Survey items assessed women’s interest in knowing their risk and preferences for risk communication if considered to be at high risk in hypothetical situations. Multivariable logistic regression modeling assessed factors associated with women’s interest in knowing their personal risk and preferences for details around exact risk estimates.ResultsAmong 1119 women, 72.7% were interested in knowing their breast cancer risk. If at high risk, 77% preferred to receive their exact risk estimate and preferred verbal (52.9% phone/47% in-person) vs. written (26.5% online/19.5% letter) communications. Adjusted regression analyses found that those with a primary family history of breast cancer were significantly more interested in knowing their risk (OR 1.5, 95% CI 1.0, 2.1, p = 0.04), while those categorized as “more than one race or other” were significantly less interested in knowing their risk (OR 0.4, 95% CI 0.2, 0.9, p = 0.02). Women 60 + years of age were significantly less likely to prefer exact estimates of their risk (OR 0.6, 95% CI 0.5, 0.98, p < 0.01), while women with greater than a high school education were significantly more likely to prefer exact risk estimates (OR 2.5, 95% CI 1.5, 4.2, p < 0.001).ConclusionU.S. women in this study expressed strong interest in knowing their risk and preferred to receive exact risk estimates verbally if found to be at high risk. Sociodemographic and family history influenced women’s interest and preferences for risk communication. Breast imaging centers implementing risk assessment should consider strategies tailored to women’s preferences to increase interest in risk estimates and improve risk communication.

Suicide Screening, Risk Assessment, and Lethal Means Counseling During Zero Suicide Implementation.

The authors measured implementation of Zero Suicide (ZS) clinical practices that support identification of suicide risk and risk mitigation, including screening, risk assessment, and lethal means counseling, across mental health specialty and primary care settings. Six health care systems in California, Colorado, Michigan, Oregon, and Washington participated. The sample included members ages ≥13 years from 2010 to 2019 (N=7,820,524 patients). The proportions of patients with suicidal ideation screening, suicide risk assessment, and lethal means counseling were estimated. In 2019, patients were screened for suicidal ideation in 27.1% (range 5.0%-85.0%) of mental health visits and 2.5% (range 0.1%-35.0%) of primary care visits among a racially and ethnically diverse sample (44.9% White, 27.2% Hispanic, 13.4% Asian, and 7.7% Black). More patients screened positive for suicidal ideation in the mental health setting (10.2%) than in the primary care setting (3.8%). Of the patients screening positive for suicidal ideation in the mental health setting, 76.8% received a risk assessment, and 82.4% of those identified as being at high risk received lethal means counseling, compared with 43.2% and 82.4%, respectively, in primary care. Six health systems that implemented ZS showed a high level of variation in the proportions of patients receiving suicide screening and risk assessment and lethal means counseling. Two opportunities emerged for further study to increase frequency of these practices: expanding screening beyond patients with regular health care visits and implementing risk assessment with lethal means counseling in the primary care setting directly after a positive suicidal ideation screening.

Biosafety Management Based Upon Risk Assessment and Monitoring: Perspectives from a Clinical Laboratory, China.

Inadequate risk assessment and a lack of risk monitoring are common deficiencies in clinical laboratory, and are also the main causes of biosafety incidents. Therefore, we summarized the experience of implementing adequate risk assessment and maintaining risk monitoring, and established a procedure for continuously improving biosafety management. Learning from our laboratory's experience in implementing risk assessment, risk response, and risk monitoring before and during the COVID-19 epidemic, we summarized the procedures for fully identifying risks, accurately evaluating risks, maintaining risk monitoring, establishing and regular reviewing safety indicators. On this basis, we established a system for continuously improving biosafety management through risk monitoring and reviewing safety indicator. We identified a total of 30 unacceptable risks prior to the COVID-19 pandemic, and developed and implemented appropriate risk control measures. After risk control, residual risks were acceptable, and no biosafety incidents have occurred. During the COVID-19 pandemic, after multiple risk monitoring, we identified ten new risks, three ineffective risk control measures, and multiple control measures for excessive protection. Then, we timely adjusted risk control measures to avoid laboratory personnel infection and excessive protection. Meanwhile, We established eight safety indicators and identified two improvement opportunities through regular reviews. Adequate risk identification and accurate risk assessment are particularly important for effectively controlling biosafety risks. Biosafety management should be continuously improved to deal with ineffective and excessive protection caused by various changes in experimental activities. Continuous improvement of biosafety management can be achieved through risk monitoring, regular review of safety indicators, and management reviews. This study will help laboratory managers to fully and accurately assess risks, as well as update risks and their control measures through risk monitoring, and the continuous improvement procedure established in the study has certain reference value for laboratories to effectively respond to emerging infectious diseases and avoid excessive protection.

Achieving Value by Risk Stratification With Machine Learning Model or Clinical Risk Score in Acute Upper Gastrointestinal Bleeding: A Cost Minimization Analysis.

We estimate the economic impact of applying risk assessment tools to identify very low-risk patients with upper gastrointestinal bleeding who can be safely discharged from the emergency department using a cost minimization analysis. We compare triage strategies (Glasgow-Blatchford score = 0/0-1 or validated machine learning model) with usual care using a Markov chain model from a US health care payer perspective. Over 5 years, the Glasgow-Blatchford score triage strategy produced national cumulative savings over usual care of more than $2.7 billion and the machine learning strategy of more than $3.4 billion. Implementing risk assessment models for upper gastrointestinal bleeding reduces costs, thereby increasing value.

Intelligent Model for Improving Risk Assessment in Sterilization Units Using Revised FMEA, Fuzzy Inference, k-Nearest Neighbors and Support Vector Machine.

The complex environment of the hospital and the critical operations practiced in the medical departments, such as the sterili zation unit, require implementing risk assessment plans as fundamental support for effective management. The Failure Modes Analysis and Effects (FMEA) method is one of the popular methods used to perform the risk assessment process. Fuzzy logic and machine learning techniques provide robust devices that improve the efficiency of several risk assessment methods, such as FMEA. Hence, this study aims to enhance the efficiency of risk assessment in hospital sterilization units using an intelligent model based on revised FMEA, an improved FMEA adaptable to the studied system, fuzzy inference system, Support Vector Machine (SVM), and K-Nearest Neighbors (KNN) techniques. An interesting application of the model in the central sterilization unit of the largest university hospital is presented. The performance of the proposed model is evaluated at the end to prove its efficiency.

Management of the Risk of Blue-Green Algae Blooms in the Iskar Dam for Drinking Water Quality of Sofia City

The introduction of systems for ensuring quality and safe drinking water and risk management is the World Health Organization (WHO) good practice introduced as a legislative requirement for all water supply organizations (Directive EU 2020/2184) on the quality of water intended for human consumption. A specific object of this research is the implemented risk assessment and management system, part of the drinking water safety plan for Sofia city. The water supply system from the water source to the end user, operated by Sofiyska voda JSC and part of Veolia, was analyzed. The hazards and risk events were reviewed for each component of the system—the catchment, water source, supply water pipes, drinking water treatment plants (DWTPs) and distribution water network. The results of the risk evaluation show that the risk of an algal bloom falls from medium risk, with a value of 36 in 2018. This risk was new for the Iskar Dam—the main water source for Sofia city. The purpose of the current study is to analyze the risk of blue-green algae blooming and the potential release of toxins in the Iskar Dam. A data analysis of phytoplankton counts, temperature of the water in the dam, precipitation, algal diversity and quantity of microcystins for a period of three years shows that there is a low probability of algae blooming. The concentration of microcystin LR was below 0.6 µg/L and of microcystin YR was below 0.1 µg/L. The highest phytoplankton count was 70,000 cells/mL in 2018, and it decreased to 30,000 cells/mL in 2020. The impact of the risk of “blue-green algae blooms in the Iskar Dam” is assessed as moderate (3) and that has not changed between 2018 and 2022. The likelihood of occurrence of this risk decreased from possible (3) to unlikely (2) after risk reassessment, and the current control effectiveness changed from weakly controlled (4) in 2018 to well controlled (2) in 2022, because more risk management actions were included in Sofiyska voda JSC. The results of the risk evaluation show that the risk of an algal bloom falls into the low-risk category with a value of 12, after measures were considered and a reassessment. As a preventive measure for better management and risk minimization, it is necessary to continue monitoring the phytoplankton count, species composition, concentration of algae toxins (microcystin LR) and nutrients in raw water from the Iskar Dam. This research has added value to the global database for surface water sources intended for human consumption and is focuses on a potential problem, valid for agricultural as well as for urban territories rich in diffused sources of pollution. The specific risk evaluation and management steps could be used and adapted by other water supply companies.

Upper GI bleeding in rural Australia: general surgery still alive and well!

The complex and critically unwell upper gastrointestinal bleeding (UGIB) patient is a common emergency presentation in Australia. Managed medically and endoscopically by rural general surgeons in rural and remote Australian hospitals which lack a gastroenterology service, this can be ameliorated by clear evidence-based guidelines. A single-centre retrospective review of adult patients who underwent emergency gastroscopy for UGIB at the Mackay Base Hospital, January 2019 to January 2022. Detailed patient data from the assessment, resuscitation, time to endoscopy, endoscopic intervention, and outcomes were compared against key international gastroenterology society safety and quality standards for UGIB. Two hundred patients had a comprehensive initial assessment and resuscitation with PRBC (39%), anticoagulation reversal (18%), pantoprazole infusion (81%), tranexamic acid (10.50%) and octreotide (16.50%). Risk scores were calculated retrospectively as none were documented. Time-to-endoscopy targets were achieved in over 70% of variceal or non-variceal UGIB patients. Bleeding was found in 59.50% of patients but 63% of patients did not require a manoeuvre to stop the bleeding. Post-operative complications were scarce. This study reflects on the need for a local multidisciplinary protocol to help expedite the current high-quality healthcare delivered by rural general surgeons in managing patients with UGIB. Implementing risk assessment scores would shorten the time to endoscopy in the initial assessment Guidelines would optimize resuscitation ensuring appropriate replacement, medication administration, anticoagulation reversal, and preventing unnecessary therapy. Despite these nuisances, the time to endoscopy, endoscopic intervention, and patient outcomes were largely in line with international quality assurance and safety targets.

Hemostasis restoring in postpartum hemorrhage — algorithm 2023

Postpartum hemorrhage (PPH) is still the leading cause of perinatal death in women of reproductive age. It is characterized by high dynamics, and most women die within the first day of puerperium and as many as 88% of them within the first 4 hours from the onset of hemorrhage. Management of each massive obstetric hemorrhage requires interdisciplinary, team-based and multidirectional action. The need for simultaneous application of uterotonic agents, surgical and/or endovascular methods as well as procedures aimed at restoring volume and hemostasis should be emphasized. The protocol for the management of severe PPH should be individualized and take into account hemorrhage etiology. Each time the volume of circulating blood as well as the degree of blood loss have to be determined, and the adequate procedures, the starting points for implementing aggressive treatment and the satisfactory end points must be defined. The most common cause of severe, life-threatening PPH is uterine atony. Restoration of hemostasis in massive PPH consists in transfusion of blood components, administration of antifibrinolytic drugs and coagulation factor concentrates, rFVIIa included. Patient survival is often determined by the very risk assessment for hemorrhage, early diagnosis and rapid implementation of PPH management algorithms.

Peculiarities of the Ukrainian model of Fracture Risk Assessment (FRAX®) among patients with liver cirrhosis accompanied by impaired bone mineral density: its diagnostic and prognostic value

Introduction. The problem of osteoporotic fractures and the evaluation thresholds for intervention in patients with liver cirrhosis (LC) remains obscure so far. Ukrainian model of fracture risk assessment (FRAX®) has never been implemented among patients with LC in Ukraine. The aim of the study. To find out the peculiarities of the Ukrainian model of Fracture Risk Assessment, its diagnostic and prognostic value for implementation among patients with liver cirrhosis accompanied by impaired bone mineral density. Materials and methods. 90 patients with LC (27 women and 63 men aged 18 to 66 years) were randomly assigned into the study. Stratification into groups was based on information about bone condition. 72 patients were included into an experimental group (EG, patients with impaired bone mineral density (IBMD), which was divided into two subgroups – EG A (patients with osteopenia, 46) and EG B (patients with osteoporosis, 26). Control group (CG) included 18 patients without IBMD. The peculiarities of the fracture risk factors and evaluation thresholds according to the Ukrainian FRAX® model (2019) amoung patients with LC with bone disorders were established (significant differences between frequency of features in groups and substantial stochastic associations of features with IBMD or its manifestations were investigated). The diagnostic characteristcs (diagnostic value, predictive value, likelihood ratio) of the detected features for IBMD in general, osteopenia and osteoporosis in particular, were revealed, and after that the post-test probability of certain bone disorders was determined among all patients with LC in the case of applying the identified features. The results. It was found that although most of the risk factors occurred more often in patients with bone disorders, significant differences were detected only between the frequency of previous fractures in EG and CG, including EG B and CG, and EG A and EG B; between the frequency of cases of normal body weight, as well as overweight in EG and CG, including EG B and CG. The evaluation thresholds according to the Ukrainian FRAX® model also differed significantly: the values above the upper evaluation threshold – in EG B and CG and in EG A and EG B; the intermediate values of fracture risk – in EG A and CG; the values below the lower evaluation threshold – in EG and CG, as well as in EG A and CG and in EG B and CG, including. Bone disorders had a substantial direct stochastic association in the following cases: IBMD in general – with the previous fractures, normal body weight and values above the upper evaluation threshold; osteopenia – with the previous fractures, normal body weight and intermediate values of fracture risk; osteoporosis – with the previous fractures, normal body weight and values above the upper evaluation threshold. All manifestations of bone disorders had substantial negative stochastic association with overweight and values below the lower evaluation threshold, as well as osteoporosis with short height (indicates that features are inherent for normal bone mineral density). It was found out that fracture risk factors and evaluation thresholds according to the Ukrainian FRAX® model are mainly single-vector markers, since they can confirm the disease being detected, or deny it in the case they are absent. The previous fractures are highly specific for IBMD, especially for osteoporosis, and can be useful for confirming these disorders being present in patient with LC. The normal body weight is medium-specific for IBMD and for osteoporosis, but can be more useful for indicating IBMD if it is present, and excluding osteoporosis being absent. The values above the upper evaluation threshold according to the Ukrainian FRAX® model are highly specific for osteoporosis and can confirm osteoporisis being present. The intermediate values of fracture risk according to the Ukrainian FRAX® model are medium-specific for osteopenia, but can be more useful for excluding osteopenia if they are absent. The overweight, especially the values below the lower evaluation threshold, will most likely indicate normal bone mineral density. Conclusions. The use of the Ukrainian model of Fracture Risk Assessment (FRAX®) has certain peculiarities and can be valuable tool for detecting or excluding impaired bone mineral density in patients with liver cirrhosis.

Abstract P039: Framework for genomic cancer risk assessment dissemination and implementation in Latin America: The GRACIAS (genetic risk assessment for cancer implementation and sustainment) study

Abstract Introduction: Lack of public insurance coverage for genetic testing and a limited trained genomic cancer risk assessment (GCRA) workforce are barriers to cancer screening and prevention and to understanding the genetic epidemiology of cancer in low/middle income countries (LMIC) in Latin America. Methods: We implemented an intervention that included professional education for clinicians in Mexico, Peru and Colombia, support from a community of practice and a federated consortium of collaborators, a versatile research registry with a dual purpose (research and clinical care) centralized relational database and pedigree drawing program (web-accessible), and economical NGS multigene panel tests (MGPT). We report here the outcomes of GCRA for 4181 probands (3170 breast, 301 ovarian, 965 other cancer, and 262 unaffected). Results: With a mean age of 45.2 y.o. (39.9 y.o. at breast cancer dx for carriers), a pathogenic variant (PV) was detected in 605 (14.5%) of 2,710 probands (BRCA testing only for 1387, MGPT for 1323): BRCA1 (n=250); BRCA2 (129); CHEK2 (24); PALB2 (20); ATM (14); TP53 (14); PTEN (6); CDH1 (5); MMR genes (62); RAD51C (6); and BRIP1 (3). We have documented growing reach (proportion of those eligible that access GCRA), increasing cascade testing (family member(s) tested (n=541) for 192/470 [40%] probands with a PV), and with median 2.2 years follow up, 209 risk reduction surgeries were performed. Summary: Remarkably, despite systemic limitations, integration of a skilled multidisciplinary team with access to genetic assays and practice support tools, community, and hospital outreach increased GCRA reach, and the expansion of cascade testing and performance of risk-appropriate surgeries reflect maturing prevention programs. Sustainment of progress requires increased multilevel efforts and establishment of GCRA as a supported standard of care, so the opportunity for prevention is not missed for vulnerable and underserved high-risk patients and families. Citation Format: Jeffrey N. Weitzel, Julio Abugattas, Cynthia Villarreal-Garza, Adrian Daneri Navarro, Alicia Cock-Rada, Yenni Rodriguez, Pamela Mora-Alferez, Dione Aguilar, Azucena del Toro-Valero, Francisco Gutierrez-Delgado, Ana Ferrigno, Josef Herzog, Danielle Castillo, Gubidxa Gutierrez Seymour, Bita Nehoray, Kathleen R. Blazer, Maria E. Fernandez, Yanin Chavarri Guerra. Framework for genomic cancer risk assessment dissemination and implementation in Latin America: The GRACIAS (genetic risk assessment for cancer implementation and sustainment) study. [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr P039.

Description of Core Performance Measures and Indicators of Patient Safety Used by Select Government and Private Hospitals in the Philippines

Background. In 2008, the Department of Health (DOH) issued Administrative Order 2008-0023 that called for an“effective and efficient monitoring system that will link all patient safety initiatives”. However, there are still no explicit and harmonized targets to measure effectiveness and to provide benchmarks that assess whether previous efforts were helpful.Objective. The study aimed to describe the status of patient safety performance measures and indicators on the international patient safety goals (IPSGs) in select hospitals in the Philippines.Methods. Descriptive, cross-sectional design was used to investigate currently used performance measures andindicators. Data collection included administration of a Hospital Patient Safety Indicators Questionnaire (HPSIQ) that summarized the currently used patient safety measures and indicators in the sampled Level 2 and level 3 hospitals and triangulation by review of documents such as hospital databases, protocols on reporting, and manuals for information gathering regarding patient safety. Performance measures were categorized using the Donabedian framework. Core indicators were identified through review of standards that cut across the six IPSGs and evaluation of overarching processes and concepts in patient safety.Results. Forty-one level 2 and 3 hospitals participated in the study. Most performance indicators were processmeasures (52%), while structure (31%) and outcome measures (17%) accounted for the rest. There is an obviouslack of structural requirements for patient safety in the hospitals included in this study. Less than half the hospitals surveyed implement risk assessment and management consistently. Reporting of events, near- misses, and patient safety data are widely varied among hospitals. Data utilization for quality improvement is not fully established in many of the hospitals. Patient engagement is not integrated in service delivery and performance measurement but is crucial in promoting patient safety.Conclusion. Mechanisms to improve hospitals’ capacity to monitor, anticipate, and reduce risk of patient harm during the provision of healthcare should be provided. Having a unified set of definitions and protocols for measurement will facilitate reliable monitoring and improvement. Leadership and governance, both internal (e.g., hospital administrators) and external (e.g., DOH) that recognize a data-driven approach to policymaking and improvement of service delivery are crucial in promoting patient safety

PH Professional Network: Real-World Implementation: Nursing Role in Balancing the Art and Science of PAH Risk Assessment

Comprehensive serial risk assessment in pulmonary arterial hypertension has shown to determine prognosis, monitor disease progression, and guide treatment decisions. The treatment goal is to achieve a low-risk status, which is associated with lower mortality rate. However, use of formal risk assessment in clinical practice has been inconsistent due to numerous barriers related to the multivariable nature of the scores. This publication reviews strategies to increase risk evaluation in daily clinical practice, while emphasizing the role of the RN and APRN in implementing risk assessment calculation and skillful communication to the patient-family dyad to promote open dialogue with shared decision making and improved patient outcomes.

External Validation of the Saved Score for Venous Thromboembolism Risk Stratification in Patients with Multiple Myeloma Receiving Immunomodulatory Drugs

Background: High thrombogenicity is a well-established phenomenon in multiple myeloma (MM) and can lead to high morbidity and mortality. The risk of venous thromboembolism (VTE) is particularly elevated in the subset of MM patients treated with immunomodulatory drug (IMiD) containing regimens. The National Comprehensive Cancer Network (NCCN) and International Myeloma Working Group (IMWG) have implemented VTE risk assessment models, and recommend prophylactic anticoagulation based on individual patient, disease, or treatment-related factors specifically for MM patients receiving IMiD. With the recent incorporation of the SAVED (PMID 31319391) scoring system in the NCCN guidelines for VTE risk stratification, we sought to externally validate this risk assessment model and evaluate its predictive ability in our MM patient cohort. Methods: We retrospectively evaluated 501 adult patients with either newly diagnosed or relapsed/refractory MM who were newly initiated on an IMiD-based regimen between 2010 and 2019. Patients already on therapeutic or prophylactic anticoagulation were excluded from the study (aspirin was allowed). The SAVED score was calculated at IMiD initiation according to the following five parameters: surgery within last 90 days (+2), Asian race (-3), prior VTE history (+3), age ≥80 years (+1), dexamethasone use (+2 for high dose [>160 mg/30-day], or +1 for standard dose [120-160 mg/30-day]). Patients with SAVED scores of <2 and ≥2 were considered of low and high risk, respectively, for developing VTE after IMiD initiation. Time to VTE was estimated by Kaplan-Meier failure method. Logistic regression model was used to test components of the SAVED score with 1-year VTE status. Model discrimination was assessed via c statistic by calculating the area under the receiver operating characteristic curve (AUC) with bootstrapped 95% confidence interval (CI). Results: The median age of our cohort at the IMiD initiation was 64 years (range 34-89); 264 (53%) patients were male and 378 (75%) were white. IgG and IgA heavy chain subtypes were present in 280 (56%), and 105 (21%) patients respectively, whereas 110 (22%) patients had light chain disease only. The International Staging System (ISS) was I, II, III, and unknown for 161 (32%), 149 (30%), 136 (27%), and 55 (11%) of patients, respectively. Most patients (94%) received lenalidomide, whereas 14 (3%) and 15 (3%) patients were treated with thalidomide and pomalidomide, respectively. The distribution of SAVED covariates is shown in Table 1. The cumulative incidence of VTE at 12-month after IMiD initiation for the entire cohort was 16% (95% CI: 13-20%). Among the 84 patients who developed new VTE after IMiD initiation, 60 (71%) had lower extremity deep venous thrombosis (DVT), 10 (12%) had pulmonary embolism, 9 (11%) had both DVT and PE, and 5 (6%) had upper extremity DVT. The SAVED score stratified 112 patients (22%) as high-risk and 389 patients (78%) as low-risk (similar proportion as the original derivation study). Cumulative incidence of VTE at 6 and 12 months was 31% and 41% in the high-risk group, versus 6% and 9% in the low-risk group, respectively (Figure 1). Each point of SAVED score increase was associated with significantly higher chance of VTE within 1-year post IMiD initiation with excellent discrimination (odds ratio = 2.10 [95% CI 1.71-2.56], c statistic (AUC) = 0.76 [95% CI 0.70-0.81]). Conclusion: Our results successfully externally validated the SAVED model to predict IMiD-associated VTE in a real-life cohort of patients with MM. Patients with SAVED score of ≥2 had significantly higher incidence for VTE. This indicates that more aggressive pharmacologic thromboprophylaxis is needed in this specific patient population. The SAVED score outperformed several other similar VTE prediction models that were also validated in the current cohort (c statistic=0.68 for IMPEDE [PMID: 33997961] and 0.62 for PRISM [PMID: 35772005]). In contrast to other risk models that focused on all patients with MM, the SAVED score was derived and now validated specifically for patients starting IMiD as this it is the only cancer population with a strong guideline recommendation for ambulatory thromboprophylaxis. Future prospective validation would be useful to determine the predictive nature of SAVED while evaluating safety and efficacy of thromboprophylaxis with direct oral anticoagulant in high-risk patients. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Operator‐informed risk assessment tool: Opportunities and barriers to support risk management practices

AbstractSuccessfully implementing water safety plans (WSPs) in small, municipal drinking water systems is understudied in affluent jurisdictions where WSPs are not required by regulations. We piloted a computer‐based risk assessment survey in eight municipal water systems in Nova Scotia, Canada to evaluate the benefits and challenges of implementing risk assessment strategies in non‐WSP jurisdictions. Semi‐structured interviews were conducted with water operators and managers to gather feedback on the risk assessment survey and process. Results indicated difficulties quantifying risk despite streamlining the risk identification process, resulting in key informants viewing the risk assessment as strictly diagnostic and unlikely to be integrated into operational practice if not required. We identified a need to shift water system culture from a regulatory‐based to a knowledge‐based mindset for successful risk assessment implementation. Clear lines of communication, increased understanding of risk, and commitment to improvement are critical to shifting water system culture toward a risk‐based water quality management approach.

A MULTIMOORA-Based Risk Evaluation Approach for CCUS Projects by Utilizing D Numbers Theory

As the global climate warms, carbon emissions must be reduced in order to alleviate the human climate crisis. Carbon capture, utilization and storage (CCUS) is an emerging technology that can reduce carbon emissions. However, most of the CCUS projects have ended in failure. The reason can be attributed to insufficient risk assessment. To this end, the purpose of this study is to construct a comprehensive risk assessment model for CCUS projects. The main body of this research is divided into two parts. First, in order to evaluate the CCUS project, a risk indicator system is constructed. In what follows, a decision-making framework for risk assessment under the D numbers environment is proposed, including two stages of decision-making preparation and decision-making process. The main task of the preparation stage is to gather evaluation experts and collect decision-making information. In the decision-making stage, this paper takes the D numbers theory as the core (acting on the effective expression and fusion of subjective evaluation information), respectively, proposes the method of determining the weight of risk evaluators, the fusion method of decision-making information from different experts, and the comprehensive decision model based on the MULTIMOORA method. In order to verify the effectiveness of the constructed model, the case of CCUS project site selection in Shengli power plant is analyzed, and the results showed that the third site is the best option. This study finds the importance of a comprehensive and timely risk assessment for the successful implementation of CCUS projects, and suggests that stakeholders carry out a risk assessment of CCUS projects prior to implementation based on the method presented in this paper, so as to improve the success rate.

Exposure to nanoparticles and occupational allergy.

To provide an update on the possible role of nanoparticles as sensitizing occupational agents and on the influence of nanoparticles-exposure on the appearance/exacerbation of occupational allergy. Recent case reports, epidemiological studies, and experimental investigations in cellular and animal models demonstrated the potential for nanomaterials to favor/interfere with occupational allergy. First data are emerging on the sensitizing potential of nanoparticles that can act as haptens linking to proteins, with a formation of a 'corona'. Nanoparticles with carrier protein become a complete antigen and induce specific immune response. Moreover, they act as adjuvant favoring sensitization to bound molecules. The disruption of the respiratory and skin barrier, the modulation of immune response toward Th1 or Th2 immune reaction and the interaction with immune effector cells (mast cells and eosinophil in particular) can explain the potential for nanoparticles to exacerbate pre-existing allergic conditions. the exposure to nanoparticles represents a possible risk for occupational allergy both in the respiratory tract and in the skin. A deeper knowledge on the role of nanomaterials in the etiology/development of the allergic disease will allow to implement risk assessment and preventive measures for nanosafety in the contest of technological expansion.

An integrated safety implementation analysis based on risk assessment to enhance the safety engineering practice in the gas fields of Sylhet region, Bangladesh

The industrial sectors of Bangladesh mostly depend on the petroleum industry. Historically, risk and hazards are the common scenario in the petroleum industry occurring due to lack of efficient risk assessment, resulting in financial loss, injury, or harm for people, and the environment. To prevent these losses, it is essential to implement the best risk assessment plan.The objective of this research is toenhance the implementation of safety engineering systems in the petroleum industry through risk assessment.&#x0D; For this, purpose at first, the questionnaire survey for the perception of risk identification and safety system is performed to determine the current defects in the safety engineering system. Then, using SPSS software the risk analysis as well as ANOVA and reliability analysis of the collected data is accomplished to examine top risk factors. Concerning both interview and questionnaire analysis, an integrated risk assessment-based safety analysishas beenperformed to optimize the performance of the safety engineering system.The outcomes of this research expose the technical, procedural, and behavioral gap in the current risk assessment for the safe implementation of the safety engineering system of the petroleum industry of Bangladesh.

Group risk assessment in failure mode and effects analysis using a hybrid probabilistic hesitant fuzzy linguistic MCDM method

Failure mode and effects analysis (FMEA) usually requires multi-domain specialists to implement the group risk assessment for identifying and eliminating system failures. Therefore, this paper combines several multi-criteria decision making (MCDM) techniques with probabilistic hesitant fuzzy linguistic term sets (PHFLTSs) to implement risk assessment of failure modes by a panel of specialists. It aims at overcoming some defects existing in the conventional FMEA, such as without epistemic uncertainty and group risk assessment, as well as with some questions incurring from the risk priority number (RPN). Consequently, group members utilize PHFLTSs to express their subjective uncertain risk assessments on failure modes, in which the social network analysis (SNA) and maximizing consensus method (MCM) are exploited to derive the subjective and objective weights of group members respectively, afterwards their integrated weights are employed to aggregate individual risk assessments into the collective risk assessment. Additionally, the subjective and objective weights of risk factors are garnered by the best-worst method (BWM) and maximizing deviation method (MDM) separately, from which their integrated weights are incorporated into the technique for order preference by similarity to ideal solution (TOPSIS) so as to obtain the risk ranking of failure modes. Finally, an example with sensitive and comparative analyses is presented to demonstrate the effectiveness of the proposed approach.

Development and Pilot Implementation of the Genomic Risk Assessment for Cancer Implementation and Sustainment (GRACIAS) Intervention in Mexico.

PURPOSEGenomic cancer risk assessment (GCRA) is standard-of-care practice that uses genomic tools to identify individuals with increased cancer risk, enabling screening for early detection and cancer prevention interventions. GCRA is not available in most of Mexico, where breast cancer (BC) is the leading cause of cancer death and ovarian cancer has a high mortality rate.METHODSGuided by an implementation science framework, we piloted the Genomic Risk Assessment for Cancer Implementation and Sustainment (GRACIAS) intervention, combining GCRA training, practice support, and low-cost BRCA1/2 (BRCA) gene testing at four centers in Mexico. The RE-AIM model was adapted to evaluate GRACIAS intervention outcomes, including reach, the proportion of new patients meeting adapted National Comprehensive Cancer Network criteria who participated in GCRA. Barriers to GCRA were identified through roundtable sessions and semistructured interviews.RESULTSEleven clinicians were trained across four sites. Mean pre-post knowledge score increased from 60% to 67.2% (range 53%-86%). GCRA self-efficacy scores increased by 31% (95% CI, 6.47 to 55.54; P = .02). Participant feedback recommended Spanish content to improve learning. GRACIAS promoted reach at all sites: 77% in Universidad de Guadalajara, 86% in Instituto Nacional de Cancerología, 90% in Tecnológico de Monterrey, and 77% in Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Overall, a pathogenic BRCA variant was identified in 15.6% (195 of 1,253) of patients. All trainees continue to provide GCRA and address barriers to care.CONCLUSIONWe describe the first project to use implementation science methods to develop and deliver an innovative multicomponent implementation intervention, combining low-cost BRCA testing, comprehensive GCRA training, and practice support in Mexico. Scale-up of the GRACIAS intervention will promote risk-appropriate care, cancer prevention, and reduction in related mortality.

An inverse method to estimate the source term of atmospheric pollutant releases

The rapid identification of source parameters (e.g., release locations, intensities, and number of sources) is of great importance for the numerical prediction of contaminant events, which helps to implement risk assessment and conduct crowd evacuation. In this study, an inverse method is established to estimate the source term of unknown releases. Validation of the proposed method is performed with a set of synthetic experiments. Results show that the algorithm is computationally efficient and can successfully reproduce the characteristics of multiple unknown point sources. To further assess the practicability of the method in the real world, uncertainty analysis is conducted with errors from measurements and wind fields. It is revealed that the method is relatively stable to uncertainties and can accurately estimate the number of sources and the grid cells where the sources are located. With the disturbed synthetic data, the relative errors of source intensities are all estimated within 15%. This study provides a perspective for source term estimation in the emergency response to a toxic gas leak or terrorist attack.