Risk Assessment Guidelines Research Articles

Obstetric Risk Assessment and Referral Cascade as Predictors of Perinatal Morbidity and Mortality

Background: Using an evidence-based guideline for obstetric risk assessment in the primary and secondary healthcare settings in Nigeria has been shown to aid appropriate referral cascade of patients to tertiary centres. Aim: To assess the impact of inappropriate obstetric risk assessment and late referral to tertiary care facilities in Rivers State on perinatal morbidity and mortality. Material and methods: The study was of prospective cross-sectional design involving 475 patients who were referred from primary and secondary healthcare facilities to the labour ward of Rivers State University Teaching Hospital in Nigeria. The appropriateness of their obstetric risk assessment and referral cascade to a tertiary centre was assessed, using a preformed evidence-based guideline and the results were associated with the perinatal morbidity and mortality. Data were analysed using Epi Info 2020. Results: The perinatal outcome in women that needed to be referred in the first trimester to tertiary centres was worse than that in those women who were appropriately referred and the differences were statistically significant in terms of birthweight less than 2500 grams [170(54.66%) versus 8(24.24%), X2 = 9872 p<0.002]; birth asphyxia [78(19.02%) versus 0(0%), X2 =7.926 p<0.0003]; admission to SCBU [85(20.73%) v 0(0)%); X2=8.916 p<0.0001] and foetal death [77 (18.78%) v 0(0%); X2=7.787 p<0.0003r]. The differences were also worse in terms of the number of patients who had preterm birth at 28-37 weeks, FGR and large for date (LFD) babies but the differences were not statistically significant. Furthermore, the perinatal outcome in women that needed to be referred in the first trimester to tertiary centres was also worse than that in those who needed an earlier referral to tertiary centres and the differences were statistically significant in terms of birth asphyxia (X2=2.341, p<9.045); admission to SCBU (X2=2.699, p<0.055) and foetal death (X2=2.291, p<0.047). The differences were also worse in terms of the number of patients who had preterm births, neonatal birth weight, LFD babies and FGR but not statistically significant. Conclusion: Perinatal morbidity and mortality were worse in patients who needed to be referred to a tertiary centre from a primary and secondary healthcare facilities than in those who were appropriately referred and those that needed an earlier referral. There is therefore an urgent need for adoption of evidence-based guideline for obstetric risk assessment and referral cascade in Nigeria.

Prescribing engagement in environmental risk assessment for gene drive technology

AbstractGene drive technology is a nascent biotechnology with the potential to purposefully alter or eliminate a species. There have been broad calls for engagement to inform gene drive governance. Over the past seven years, the gene drive community has been developing risk assessment guidelines to determine what form future gene drive risk assessments take, including whether and how they involve engagement. To explore who is developing these guidelines and how engagement in risk assessment is being prescribed, we conduct a document analysis of gene drive risk assessment guideline documents from 2014 to 2020. We found that a narrow set of organizations have developed 10 key guideline documents and that with only one exception the documents prescribe a narrow, vague, or completely absent role for engagement in gene drive risk assessment. Without substantively prescribed engagement in guidelines, the relevance, rigor, and trustworthiness of gene drive risk assessment and governance will suffer.

PENILAIAN INDEKS ANCAMAN KEKERINGAN DI KECAMATAN DEMPO TENGAH KOTA PAGARALAM MENGGUNAKAN GIS

Drought is an event that has a direct impact on several important sectors in Indonesia, including agriculture, forestry, plantations, and water resources. Geographic Information System has been developed with various methods. In addition, identification of drought areas is also carried out using the Regulation of the Head of the National Disaster Management Agency (Perka BNPB) Number 02 of 2012 concerning guidelines for disaster risk assessment. Can identify vegetation density conditions, which can be identified using the NDVI (Normalized Difference Vegetation Index) transformation, while other parameters such as rainfall, cover, land, and soil type are physiographical conditions that affect drought.

Medication-Related Osteonecrosis of the Jaw: A Reflection of Current Preventative and Therapeutic Guidelines: A Review

Medication-related osteonecrosis of the jaw (MRONJ) is a serious side effect of bisphosphonates, denosumab, and antiangiogenic drugs. Although the literature is rich with research work discussing MRONJ, the pathogenesis of this devastating condition has not been adequately understood yet. Roles of infection, immunity and genetic predisposition have been extremely unclear. Moreover, many controversies have been governing risk assessment and management guidelines. In 2003, 36 cases of osteonecrosis of the jaw (ONJ) associated with the use of either pamidronate or zoledronate were reported. Furthermore, in 2014, the American Association of Oral and Maxillofacial Surgeons (AAOMS) suggested the term “medication-related osteonecrosis of the jaw” (MRONJ) to describe jaw osteonecrosis related to the use of medications. This review sheds the light on recent research work discussing the pathogenesis of MRONJ. Moreover, it suggests possible guidelines for risk assessment and management based on information gathered from different research papers found in the literature.

Flowering resources modulate the sensitivity of bumblebees to a common fungicide

Bees are exposed to various stressors, including pesticides and lack of flowering resources. Despite potential interactions between these stressors, the impacts of pesticides on bees are generally assumed to be consistent across bee-attractive crops, and regulatory risk assessments of pesticides neglect interactions with flowering resources. Furthermore, impacts of fungicides on bees are rarely examined in peer-reviewed studies, although these are often the pesticides that bees are most exposed to.In a full-factorial semi-field experiment with 39 large flight cages, we assessed the single and combined impacts of the globally used azoxystrobin-based fungicide Amistar® and three types of flowering resources (Phacelia, buckwheat, and a floral mix) on Bombus terrestris colonies.Although Amistar is classified as bee-safe, Amistar exposure through Phacelia monocultures reduced adult worker body mass and colony growth (including a 55% decline in workers and an 88% decline in males), while the fungicide had no impact on colonies in buckwheat or the floral mix cages. Furthermore, buckwheat monocultures hampered survival and fecundity irrespective of fungicide exposure. This shows that bumblebees require access to complementary flowering species to gain both fitness and fungicide tolerance and that Amistar impacts are flowering resource-dependent. Our findings call for further research on how different flowering plants affect bees and their pesticide tolerance to improve guidelines for regulatory pesticide risk assessments and inform the choice of plants that are cultivated to safeguard pollinators.

Emerging Marine Biotoxins in European Waters: Potential Risks and Analytical Challenges.

Harmful algal blooms pose a challenge regarding food safety due to their erratic nature and forming circumstances which are yet to be disclosed. The best strategy to protect human consumers is through legislation and monitoring strategies. Global warming and anthropological intervention aided the migration and establishment of emerging toxin producers into Europe’s temperate waters, creating a new threat to human public health. The lack of information, standards, and reference materials delay effective solutions, being a matter of urgent resolution. In this work, the recent findings of the presence of emerging azaspiracids, spirolildes, pinnatoxins, gymnodimines, palitoxins, ciguatoxins, brevetoxins, and tetrodotoxins on European Coasts are addressed. The information concerning emerging toxins such as new matrices, locations, and toxicity assays is paramount to set the risk assessment guidelines, regulatory levels, and analytical methodology that would protect the consumers.

A review on risk assessment in managed aquifer recharge

Managed aquifer recharge (MAR) refers to a suite of methods that is increasingly being applied worldwide for sustainable groundwater management to tackle drinking or irrigation water shortage or to restore and maintain groundwater ecosystems. The potential for MAR is far from being exhausted, not only due to geological and hydrogeological conditions or technical and economic feasibility but also due to its lack of acceptance by the public and policymakers. One approach to enable the safe and accepted use of MAR could be to provide comprehensive risk management, including the identification, analysis, and evaluation of potential risks related to MAR. This article reviews current MAR risk assessment methodologies and guidelines and summarizes possible hazards and related processes. It may help planners and operators select the appropriate MAR risk assessment approaches and support the risk identification process. In addition to risk assessment (and subsequent risk treatment) related to the MAR implementation phase, this review also addresses risk assessment for MAR operation. We also highlight the limitations and lessons learned from the application and development of risk assessment methodologies. Moreover, developments are recommended in the area of MAR-related risk assessment methodologies and regulation. Depending on data availability, collected methodologies may be applicable for MAR sites worldwide. Integr Environ Assess Manag 2022;18:1513-1529. © 2022 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Cardiovascular Health Status And Genetic Risk In Survivors of Childhood Neuroblastoma and Nephroblastoma Treated With Doxorubicin: Protocol of the Pharmacogenetic Part of the LESS-Anthra Cross-Sectional Cohort Study.

BackgroundIn childhood cancer survivors (survival of 5 years or more after diagnosis), cardiac toxicity is the most common nonmalignant cause of death attributed to treatment-related consequences. Identifying patients at risk of developing late cardiac toxicity is therefore crucial to improving treatment outcomes. The use of genetic markers has been proposed, together with clinical risk factors, to predict individual risk of cardiac toxicity from cancer therapies, such as doxorubicin.ObjectiveThe primary aim of this study is to evaluate the value of multimarker genetic testing for RARG rs2229774, UGT1A6 rs17863783, and SLC28A3 rs7853758 for predicting doxorubicin-induced cardiotoxicity. The secondary aim is to replicate previously described associations of candidate genetic markers with doxorubicin-induced cardiotoxicity. Moreover, we will evaluate the prevalence of cardiovascular dysfunction in childhood cancer survivors after neuroblastoma or nephroblastoma.MethodsThis is the pharmacogenetic substudy of the research project Structural Optimization for Children With Cancer After Anthracycline Therapy (LESS-Anthra). We invited 2158 survivors of childhood neuroblastoma or nephroblastoma treated with doxorubicin according to the trial protocols of SIOP 9/GPOH, SIOP 93-01/GPOH, SIOP 2001/GPOH, NB 90, NB 97, or NB 2004 to participate in this prospective cross-sectional cohort study. The study participants underwent a cardiological examination and were asked to provide a blood or saliva sample for genotyping. The study participants' health statuses and cardiovascular diagnoses were recorded using a questionnaire completed by the cardiologist. Digital echocardiographic data were centrally evaluated to determine the contractile function parameters. Medical data on the tumor diagnosis and treatment protocol were taken from the study documentation. Survivors were screened for variants of several candidate genes by TaqMan genotyping.ResultsThis study includes 657 survivors treated with doxorubicin for childhood cancer, the largest German cohort assembled to date to investigate cardiovascular late effects. Data analyses are yet to be completed.ConclusionsThis study will define the genetic risk related to 3 marker genes proposed in a pharmacogenetic guideline for risk assessment. Moreover, the results of this study will show the prevalence of cardiovascular dysfunction in survivors of pediatric neuroblastoma or nephroblastoma who were treated with doxorubicin. The results will help to improve primary treatment and follow-up care, thus reducing cardiovascular late effects in the growing population of childhood cancer survivors.Trial RegistrationGerman Clinical Trials Register DRKS00015084; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015084International Registered Report Identifier (IRRID)DERR1-10.2196/27898

An in vitro strategy using multiple human induced pluripotent stem cell-derived models to assess the toxicity of chemicals: A case study on paraquat

Most OECD guidelines for chemical risk assessment include tests performed on animals, raising financial, ethical and scientific concerns. Thus, the development of human-based models for toxicity testing is highly encouraged. Here, we propose an in vitro multi-organ strategy to assess the toxicity of chemicals. Human induced pluripotent stem cells (hiPSCs)-derived models of the brain, blood-brain barrier, kidney, liver and vasculature were generated and exposed to paraquat (PQ), a widely employed herbicide with known toxic effects in kidneys and brain. The models showed differential cytotoxic sensitivity to PQ after acute exposure. TempO-Seq analysis with a set of 3565 probes revealed the deregulation of oxidative stress, unfolded protein response and estrogen receptor-mediated signaling pathways, in line with the existing knowledge on PQ mechanisms of action. The main advantages of this strategy are to assess chemical toxicity on multiple tissues/organs in parallel, exclusively in human cells, eliminating the interspecies bias, allowing a better evaluation of the differential sensitivity of the models representing the diverse organs, and increasing the chance to identify toxic compounds. Furthermore, although we focused on the mechanisms of action of PQ shared by the different models, this strategy would also allow for organ-specific toxicity testing, by including more cell type-specific probes for TempO-Seq analyses. In conclusion, we believe this strategy will participate in the further improvement of chemical risk assessment for human health.

The clinician's guide to radiotherapy complications.

Radiotherapy is one of the oldest cancer treatment modalities, used for over 100 years. As its efficacy has been steadily increasing due to the introduction of novel treatment methods, adverse events (AEs) still pose a major obstacle limiting the therapeutic benefits in some patients and negatively impacting treatment outcomes. In light of the technological progress, the focus has been shifted from improving the efficacy to safeguarding patients from the most severe AEs through improvements of safety and accuracy of radiation delivery. Currently, with radiation therapy being an effective treatment associated with frequent therapeutic success and leading to increased and prolonged survival, the problem of treatment‑related AEs is growing as there are numerous survivors whose health and quality of life may be adversely affected. Due to the limited access to radiation oncologists, patients presenting with AEs are often referred to other professionals for advice, and as survivorship prolongs, the AEs may aggravate current patient comorbidities or reveal undiagnosed diseases. Thus, it is important that doctors other than oncologists be familiar with the fundamentals of radiation therapy-related AEs and their management. In this review, we present the most common and severe AEs of radiotherapy associated with damage to the nervous, respiratory, cardiovascular, gastrointestinal, and urogenital systems. We also describe the pathogenesis of these AEs, and provide guidelines for prevention, risk assessment, diagnosis, and treatment. Novel findings and future perspectives in this field are also elucidated, including examples of ongoing clinical trials aimed not only at improving treatment outcomes but also at reducing the risk of radiotherapy complications in cancer treatment survivors.

Burning Characteristics of Ancient Wood from Traditional Buildings in Shanxi Province, China

Due to long-term natural degradation, the surface morphology of traditional building wood differs significantly from that of modern wood. It is more combustible than modern wood and its combustion characteristics are important evaluation indicators for fire simulation and fire protection of traditional buildings. In this paper, ancient wood from six traditional buildings were tested by a surface morphology fractal method and conical calorimeter. Additionally, their combustion properties such as ignition time, heat release rate, total heat release and charring time were analyzed to determine the combustion behavior of ancient wood and their differences with modern wood. The results showed that the ignition time of the specimens was significantly influenced by the surface morphological features. The higher the fractal dimension grade of the morphological features, the shorter the ignition time. The ignition time of Ulm wood with fractal dimension class 3 was 15 s, while that of Ulm wood with fractal dimension class 1 was 23 s. Under the same fractal dimension class, the total heat release per unit time of ancient softwood was higher than that of ancient hardwood. The average heat release rates of Larch wood and Ulm wood were 66.21 kw·m−2, 72.07 kw·m−2 and 57.26 kw·m−2, 67.30 kw·m−2. The basic charring rate of ancient wood of the same species was mostly higher than that of modern wood by more than 6%, with the basic charring rate of ancient Larch wood being 0.8559 mm/min, which was 15.66% higher than that of modern Larch wood, 22.27% higher than that recommended in the European EC5 standard, and 6.87% higher than that calculated in the American AFPA. The results of the study are important guidelines for fire risk assessment and fire protection of traditional buildings.

The logistics service providers during the COVID-19 pandemic: The prominence and the cause-effect structure of uncertainties and risks

Uncertainties and risks play a central role in creating vulnerabilities for logistics service operations. Over the years, Logistic Service Providers (LSPs) have learned how to ensure resilience to confront uncertainties and risks triggered by adverse events. However, quite unlike any seen in recent times, the COVID-19 pandemic brings about unavoidable uncertainties and risks for the logistics industry. Yet, there is no common approach to contextualize how they interact together. We incorporate an empirical research design and make a threefold contribution: first, we identify uncertainties and risks that LSPs encounter during the COVID-19 pandemic and investigate their prominence. Second, we unveil intertwined schemes of afore-identified uncertainties and risks and augment the understanding of their cause-effect structure. Third, we provide an uncertainty and risk assessment guideline for LSPs affected by threats emerging from unforeseeable crises.In this study, we combine qualitative work and the fuzzy DEMATEL method. Qualitative thematic analysis of in-depth interviews reveals the most important uncertainties (COVID-19 measures, employee welfare, forecast horizon, demand change, and government regulations) and risks (COVID-19 risk, delivery delays, supply chain disruptions, financial failure, and product returns) for LSPs. The fuzzy DEMATEL method shows that COVID-19 measures and COVID-19 risk are highly prominent and influence other factors. The results indicate that demand change, government regulations, and supply chain disruptions are net causers, and employee welfare, financial failure, forecast horizon, delivery delays, and product returns are net receivers. Distinctly, employee welfare is the most affected factor, empirically confirming that major risks for LSPs are related to the human factor. More investigation in our results suggests that supply chain disruptions and demand change, two factors triggered by the COVID-19 pandemic, influence financial failure and forecast horizon, two factors associated with operational performance.

Factors associated with group sex in heterosexual males and females attending a sexual health clinic in Melbourne, Australia: a cross-sectional survey.

There have been limited studies of group sex among heterosexual individuals. This study aimed to explore the factors associated with group sex among heterosexual males and females to improve risk assessment guidelines and inform sexually transmitted infection (STI) screening requirements. A cross-sectional survey was conducted among heterosexual males and females aged ≥16 years attending the Melbourne Sexual Health Centre between March and April 2019. The survey asked about group sex participation, methods used to meet sexual partners, number of casual and/or regular partners, and injection drug use (IDU) in the previous 3 months. HIV and STI (chlamydia, gonorrhoea, syphilis) diagnoses were extracted. A multivariable logistic regression was conducted to identify the factors associated with group sex participation. A total of 698 participants (325 males, 373 females) were included and 4.7% (33/698) had participated in group sex in the previous 3 months. The proportion who participated in group sex increased with age (2.1% in 16-24 years, 5.5% in 25-34 years, 7.8% in ≥35 years, p trend =0.010). Meeting partners at sex venues (e.g. brothels) was associated with the highest odds of participating in group sex (aOR=5.74, 95% CI: 1.20-27.44), followed by dating apps (aOR=2.99, 95% CI: 1.36-6.58), friends/family (aOR=2.99, 95% CI: 1.34-6.69) and social venues (e.g. bar) (aOR=2.73, 95% CI: 1.18-6.30). Group sex was strongly associated with STI positivity (aOR=6.24, 95% CI: 2.41-16.13). There was no association between group sex and sex, casual and/or regular partners, HIV positivity or IDU. Heterosexual individuals participating in group sex had a six-fold risk of testing positive for STIs. Including group sex in a sexual history is useful to determine STI risk and inform testing practices. Safe sex messages on group sex that are delivered through multiple methods (e.g. at sex venues, social venues and dating apps simultaneously) would be beneficial.

Genotoxicity assessment of food-flavoring chemicals used in Japan

We assessed the genotoxicity of 30 food-flavoring chemicals used in Japan that have not been investigated before. These 30 food-flavoring chemicals have representative chemical structures belonging to 18 chemical classes. The Ames and chromosomal aberration (CA) tests (in vitro tests) were first conducted in accordance with the “Food Additive Risk Assessment Guidelines” of the Japan Food Safety Commission. If the in vitro test yielded a positive result, an in vivo micronucleus test or a transgenic mouse gene mutation assay was performed to verify the in vitro test results. Of the 30 food-flavoring chemicals, 3 yielded a positive result in both Ames and CA tests. Another 11 chemicals yielded positive results in the CA test. However, none of the chemicals yielding positive in vitro test results yielded positive results in the in vivo tests. These findings indicate no genotoxicity concerns of the food-flavoring chemicals belonging to the abovementioned 18 chemical classes used in Japan unless there are other structural modifications.

Risk assessment and exemption approval procedure for the semi-closed seas according to the International Convention for the Control and Management of Ships’ Ballast Water and Sediments, 2004

The paper analyses statutory foundations applicable to ships requiring to be exempted from the mandatory installation of the ballast water management system. In particular, it deals with ships sailing on regular international lines but within the semi-closed seas, such as the Adriatic Sea. The legal framework is set out in the International Convention for the Control and Management of Ships’ Ballast Water and Sediments (BWM, 2004), the IMO Guidelines for Risk Assessment A-4 (G7), and the Croatian Ordinance on Ballast Water Control and Management, 2012 [Pravilnik o upravljanju i nadzoru balastnih voda]. The paper presents the model procedure to be followed by main stakeholders, mainly national maritime administrations and shipping companies. The paper outlines the main advantages and disadvantages of the whole process and analyses several cases of good practice. Furthermore, the main stakeholders in the approval procedure and their responsibilities are described, available risk assessment models are analysed, with the particular emphasis on the species-specific risk assessment method as the most preferred method. Finally, the need for cooperation between the involved states and their maritime administrations is considered. It is concluded that bilateral and regional cooperations are an essential element in preserving the marine environment of any sea area. In that respect, the proposed model of the BWM system exemption approval in closed and semi-closed seas, such as the Adriatic Sea, is essential for shipping companies connecting ports in different countries on regular routes. Although demanding in respect of efforts and time, a procedure is viable and may be carried out in due time and with satisfactory outcomes.

Evaluating the key risk factors in PPP-procured mass housing projects in Nigeria: a Delphi study of industry experts

PurposeThe purpose of the study is to elicit risk factors that are peculiar to public-private partnership (PPP)-procured mass housing in Nigeria from the expert perspectives in ensuring the success of the scheme thereby reducing housing deficit in the country.Design/methodology/approachThe risk inherent in construction projects had been established through literature in general. The risk in PPP projects is emerging because of the recent acceptance of the procurement option by governments all over the globe. The Nigerian Government has also adopted the procurement option in bridging the housing deficit in the country. This study, therefore, conducts a Delphi survey on the probability of risk occurrence peculiar to PPP mass housing projects (MHPs) in Nigeria. Pragmatic research approach through the mixed method of both quantitative and qualitative methods was adopted for this study. The quantitative method adopts the administration of questionnaires through the Delphi survey, whereas the qualitative method used interviews with the respondents. A two-stage Delphi questionnaire was administered to construction practitioners that cut across academics, the public and the private sectors by adopting convenient sampling techniques and following the Delphi principles and procedures. A total of 63 risk factors were submitted to the expert to rank on a Likert scale of 7 and any risk factors that the mean item score (MIS) falls below the grading scale of the five-point benchmark is deemed not necessary a risk factor associated with PPP MHPs and thereby expunged from the second round of the Delphi Survey. The interview was subsequently applied to the respondents to substantiate the risk factors that are peculiar to PPP-procured mass housing in the study area.FindingsThe findings show that risk factors such as maintenance frequent than expected, life of facility shorter than anticipated and maintenance cost higher than expected fall below 5.0 benchmark with MIS of 4.64 and 4.55 indicating that the risk factors are not peculiar to PPP mass housing in Nigeria.Research limitations/implicationsThe implication for practise of this research is that these risk factors provide the PPP stakeholders with the comprehensive checklists that can aid in developing PPP risk assessment guidelines in the sector though both partners should be aware of the dynamic nature of risk because new ones might be emerging.Originality/valueThe authors hereby declare that the research findings are a product of a thorough research conducted in the study area and have not to be submitted or published by another person or publisher and due acknowledgement was made where necessary.

Rural population health risks caused by nitrate contamination of locally grown vegetables

Objectives to assess the levels of health risks in the rural population associated with the consumption of local vegetables contaminated with nitrates.
 Material and methods. We established the concentration of nitrates in local vegetables, grown on farms and private subsidiary plots of agricultural areas of the region using a retrospective analysis of the statistics from the Office of Federal Service for Surveillance on Consumer Rights Protection and Human Well-being (Rospotrebnadzor) in the Saratov region and our own research results. The health risks in the rural population from exposure to nitrates in local vegetables were assessed according to the Risk Assessment Guidelines (R 2.1.10. 1920-04).
 Results. It was revealed that local vegetable products are widely used in the diet of the rural population of the agricultural areas of the Saratov region, amounting to 203.422.5 kg/year per adult resident. Significant differences were revealed in the nitrate contamination of vegetables grown by farmers and on private subsidiary plots of agricultural areas of the Saratov region.
 Discussion. The high nitrate load detected in vegetable products of farms was determined by a significant amount of fertilizers applied to the soil in the form of ammonium nitrate. On the contrary, the use of special biomass from plants of the legume family by workers of personal subsidiary farms for feeding the growing vegetables, made it possible to obtain vegetable products with a significantly lower quantitative content of nitrates.
 Conclusion. The assessment of the hazard coefficients of nitrates in vegetable products of the studied areas testified to the possible effect of the nitrate component on the health of the local population. The individual carcinogenic risk caused by nitrate contamination of local vegetables was assessed as low; the population carcinogenic risk value associated with the presence of nitrates in vegetables had the possibility to contribute from 0.01 to 1.3 additional cases of malignant neoplasms to the general level of oncological morbidity in the population of the surveyed territories.

Quantitative risk assessment for ammonia ship‐to‐ship bunkering based on Bayesian network

AbstractThe maritime industry is getting prepared for using ammonia as a fuel to meet the decarbonization goal. However, ammonia is toxic, corrosive, and flammable, which poses specific safety challenges during bunkering compared with conventional fuels. The corrosion can be prevented by selecting suitable materials. However, the impact of toxic gas dispersion and fire has high uncertainties, thus risk assessment should be conducted. Currently, there are insufficient risk assessment guidelines for ammonia bunkering available. Therefore, this paper proposes a Bayesian network (BN) based quantitative risk assessment framework to investigate the potential risks of ammonia in ship‐to‐ship bunkering considering the toxicity and flammability. The study validates the utility of the proposed framework and demonstrates the BN as an efficient model in performing the probabilities calculations and flexible in conducting causal diagnosis. The results show that toxicity has the greatest impact on the risks of ammonia bunkering compared with flammability. The main innovation of this work is realizing the efficient quantification of risks for ammonia ship‐to‐ship bunkering by using the BN.

EP.FRI.771 National audit on VTE prophylaxis for lower limb injuries treated in a plaster cast

Abstract Aims Audit to assess Orthopaedic departments’ compliance with NICE guidelines on Venous thromboembolism (VTE) prophylaxis published in 2010, specifically looking at VTE practices for patients with lower limb injuries treated in a plaster cast. Methods A telephonic survey was carried out on junior doctors within orthopaedic departments of 66 hospitals across all regions of England. A questionnaire was completed regarding VTE risk assessment, prophylaxis and hospital guidelines etc. Data collected from August 2016 till February 2017. Results 83% (n = 55) of trusts routinely give VTE prophylaxis to these patients. 96% (n = 64) give Chemoprophylaxis of some sort. Formal VTE assessments are performed in 81% (n = 54) and 77% (n = 51) have a local VTE prophylaxis policy. Conclusions We conclude that Orthopaedic departments across England have increased compliance with NICE guidelines for VTE prophylaxis. However there is considerable variation in practice, especially in duration and chemoprophylaxis agent. We attribute this to the lack of specific NICE guidelines for this cohort of patients. We aim that this study can influence NICE to introduce added guidance that will standardise practice.

A novel semi-quantitative methodology for national poliovirus reintroduction and outbreak risk assessment

BackgroundUnder the International Health Regulations (2005), World Health Organization Member States need to verify certification of polio–free status annually. In 2018, Australia sought to reassess and comprehensively characterise the risk posed by wild-type and vaccine-derived poliovirus introductions to national health security. However formal guidelines for national polio risk assessment were not publicly available. MethodsFour risk elements were identified and weighted using an expert-informed modified Delphi method: reintroduction hazard; population susceptibility; detection capability; and response capability. Australian data and qualitative evidence were analysed, documented and scored against risk element indicators to characterise polio risk as a semi–quantitative estimate and qualitative risk category statement. ResultsThe semi-quantitative risk characterisation calculated likelihood and impact scores of 0.43 and 0.13, respectively (possible range: 0.02–4.5). The assessment concluded that the risk of poliovirus reintroduction, resultant outbreaks of poliovirus infection, and sustained transmission occurring in Australia is very low. ConclusionsUntil poliovirus is eradicated, it remains in countries’ strategic health security interest to maintain optimal investment in polio prevention, preparedness, surveillance and response capability to manage their level of risk. We present a structured, transparent and reproducible methodology for national or sub-national polio risk characterisation that generates evidence for targeted investment to maintain polio-free status.