Risk Assessment Program Research Articles

A case study exploring field-level risk assessments as a leading safety indicator.

Health and safety indicators help mine sites predict the likelihood of an event, advance initiatives to control risks, and track progress. Although useful to encourage individuals within the mining companies to work together to identify such indicators, executing risk assessments comes with challenges. Specifically, varying or inaccurate perceptions of risk, in addition to trust and buy-in of a risk management system, contribute to inconsistent levels of participation in risk programs. This paper focuses on one trona mine's experience in the development and implementation of a field-level risk assessment program to help its organization understand and manage risk to an acceptable level. Through a transformational process of ongoing leadership development, support and communication, Solvay Green River fostered a culture grounded in risk assessment, safety interactions and hazard correction. The application of consistent risk assessment tools was critical to create a participatory workforce that not only talks about safety but actively identifies factors that contribute to hazards and potential incidents. In this paper, reflecting on the mine's previous process of risk-assessment implementation provides examples of likely barriers that sites may encounter when trying to document and manage risks, as well as a variety of mini case examples that showcase how the organization worked through these barriers to facilitate the identification of leading indicators to ultimately reduce incidents.

Risk assessment and monitoring programme of nitrates through vegetables in the Region of Valencia (Spain)

This study was carried out to determine current levels of nitrate in vegetables marketed in the Region of Valencia (Spain) and to estimate the toxicological risk associated with their intake. A total of 533 samples of seven vegetable species were studied. Nitrate levels were derived from the Valencia Region monitoring programme carried out from 2009 to 2013 and food consumption levels were taken from the first Valencia Food Consumption Survey, conducted in 2010. The exposure was estimated using a probabilistic approach and two scenarios were assumed for left-censored data: the lower-bound scenario, in which unquantified results (below the limit of quantification) were set to zero and the upper-bound scenario, in which unquantified results were set to the limit of quantification value. The exposure of the Valencia consumers to nitrate through the consumption of vegetable products appears to be relatively low. In the adult population (16–95 years) the P99.9 was 3.13 mg kg−1 body weight day−1 and 3.15 mg kg−1 body weight day−1 in the lower bound and upper bound scenario, respectively. On the other hand, for young people (6–15 years) the P99.9 of the exposure was 4.20 mg kg−1 body weight day−1 and 4.40 mg kg−1 body weight day−1 in the lower bound and upper bound scenario, respectively. The risk characterisation indicates that, under the upper bound scenario, 0.79% of adults and 1.39% of young people can exceed the Acceptable Daily Intake of nitrate. This percentage could join the vegetable extreme consumers (such as vegetarians) of vegetables. Overall, the estimated exposures to nitrate from vegetables are unlikely to result in appreciable health risks.

Patterns of Enoxaparin Use for Venous Thromboembolism Prevention in a Pediatric Center

BackgroundPediatric hospital-acquired venous thromboembolism (HA-VTE) incidence is rising and many centers have instituted guidelines for use of both mechanical and pharmacologic prophylactic measures.ObjectivesThe primary objective of this work was to evaluate the pattern of enoxaparin use in eligible patients admitted to Children's Hospital of Orange County (CHOC) in the first 17 months from inception of the prophylaxis program.MethodsCHOC has a risk-assessment program (Table 1) for patients > 12 years admitted for > 24 hours with categories of low (0 points), moderate (1 point), and high (> 2 points). The primary service admitting the patient was responsible for the risk-assessment. Low risk patients do not receive prophylaxis recommendations. Moderate risk patients are recommended to receive mechanical prophylaxis (mTP) in the absence of contraindications. High risk patients are recommended to receive mechanical prophylaxis and a Hematology consultation to determine use or not of pharmacologic prophylaxis (pTP).Univariate analyses were conducted on risk factor categories and those significant (p<0.05) were included in 1 of 2 multivariate logistic regression analyses. Since VTE risk status is calculated from components of the risk-assessment (i.e. acute and chronic conditions, immobility, history of VTE) a model with these variables may not also include the output variable, i.e. VTE risk status. This is to prevent potential confounding and problems due to multicollinearity. The first model evaluated likelihood of pTP relative to VTE risk status and the second model relative to chronic conditions, immobility, and historic factors (independent of VTE risk status).Results3557 patients were eligible and 2846 (80%) had the risk-assessment form completed. 36 (1.3%) of these patients had incomplete data yielding a total of 2810 patients for analyses. Of those 2810, 34 (1.2%) patients received pTP. The female:male ratio was 1.1:1 and age distribution (n, %) by year was: 12 (369, 13.1%), 13 (383, 13.6%), 14 (443, 15.7%), 15 (476, 16.9%), 16 (419, 14.9%), 17 (339, 12%), 18 (152, 5.4%), 19 (101, 3.6%), 20 (83, 2.9%), 21 (25, 0.9%), 22 (3, 0.1%), 23 (5, 0.2%), 24 (5, 0.2%), 25 (1, 0.04%), 26 (4, 0.14%), 27 (1, 0.04%), 33 (1, 0.04%).Univariate analyses (Table 2) revealed significance of increasing age [p<0.01, OR 1.26 (1.12-1.4)], increasing length of stay (LOS), [p<0.01, OR 1.05 (1.03-1.07)], presence of a chronic condition [p<0.01, OR 3.62 (1.34, 8.31)], acute condition [p<0.01, OR 5.69 (2.7-11.44)], immobility [p<0.01, OR 3.25 (1.42-6.78)], history of VTE [p<0.01, OR 8.04 (1.87-24.02)], presence of a contraindication to mTP [p<0.01, OR 10.22 (3.71-24.1)], and risk status of high [p<0.01, OR 27.29 (5.83-486.82)].The first multivariate model (Table 3) revealed significance of increasing age [p<0.01, OR 1.21 (1.06-1.36)], increasing LOS [p<0.01, OR 1.04 (1.02-1.06)], contraindication to mTP [p<0.01, OR 4.76 (1.65-12)], and risk status of high [p<0.01, OR 15.24 (3.11-275.51)]. The second multivariate model (Table 3) confirmed significance of increasing age [p<0.01, OR 1.25 (1.1-1.42)], and contraindication to mTP [p<0.01, OR 5.08 (1.57-14.17)].ConclusionsThere is a lack of evidence-based guidelines for VTE prophylaxis in pediatrics. Prophylaxis programs and practice patterns likely have wide variation, therefore, the objective of this work was to identify the practice pattern at a single children's hospital in the first 17 months of the program. Utilization of pTP was low overall and associated with increasing age, increasing LOS, contraindication to MTP, and a risk status of high.It is accepted practice to utilize VTE prophylaxis in adults and this likely played a role in the increasing likelihood of pTP with increasing age. The higher likelihood associated with increasing LOS likely reflects that risk of HA-VTE increases with longer LOS. The association with high risk status was intended with design of the program and the association with a contraindication to mTP likely reflects that patient severity was deemed significant enough to warrant prophylaxis and pTP was the only remaining option.Pediatric VTE prophylaxis programs are becoming more prevalent despite a lack of evidence-based guidelines. Understanding patterns of prophylaxis use may help guide crucial comparative studies to assess efficacy, safety, and cost-benefit. [Display omitted] [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Feasibility and cost-effectiveness of a multidisciplinary home-telehealth intervention programme to reduce falls among elderly discharged from hospital: study protocol for a randomized controlled trial.

BackgroundFall incidents are the third cause of chronic disablement in elderly according to the World Health Organization (WHO). Recent meta-analyses shows that a multifactorial falls risk assessment and management programmes are effective in all older population studied. However, the application of these programmes may not be the same in all National health care setting and, consequently, needs to be evaluated by cost-effectiveness studies before to plan this intervention in regular care. In Italy structured collaboration between hospital staff and primary care is generally lacking and the role of Information and Communication Technologies (ICT) in a fall prevention programme at home has never been explored.Methods and designThis will be a two-group randomised controlled trial aiming to evaluate the effects of a home-based intervention programme delivered by a multidisciplinary health team. The home tele-management programme, previously adopted in our Institute for chronic patients, will be proposed to elderly people affected by chronic diseases at high risk of falling at hospital discharge. The programme will involve the hospital staff and will be managed thanks to the collaboration between hospital and primary care setting. Patients will be followed for 6 months after hospital discharge. A nurse-tutor telephone support and tele-exercise will characterize the intervention programme. People in the control group will receive usual care. The main outcome measure of the study will be the percentage of patients sustaining a fall during the 6-months follow-up period. An economic evaluation will be performed from a societal perspective and will involve calculating cost-effectiveness and cost utility ratios.DiscussionTo date, no adequately powered studies have investigated the effect of the Information and Communication Technologies (ICT) in a home fall prevention program. We aim the program will be feasible in terms of intensity and characteristics, but particularly in terms of patient and provider compliance. The results of the economic evaluation could provide information about the cost-effectiveness of the intervention and the effects on quality of life. In case of shown effectiveness and cost effectiveness, the program could be implemented into health services settings.Trial registrationClinicalTrials.gov (NCT02487589)

Desertification risk assessment and management program

Risk assessment provides the possibility of planning and management to prevent and reduce the risk of desertification. The present study is aimed to assess the hazard and risk of desertification and to develop management programs in the semi-arid western regions of Golestan Province in Iran. Desertification rate was obtained using the Iranian model of desertification potential assessment. Since the rating system was considered for the indicators, data analyses were carried out according to the Mann-Whitney test. The risk of desertification was calculated based on hazard, elements at risk and vulnerability assessment maps. The intensity of desertification was estimated to be medium. Among the factors affecting desertification, agriculture by the weighted average of 3.22 had the highest effect, followed by soil, vegetation, water and wind erosion criteria by weighted averages of 2.45, 2.32, 2.15 and 1.6 respectively. Desertification risk assessment results also showed that about 78% of central and northern parts of the region, with the largest population and residential centers, surface and underground water resources, agriculture and horticulture, is confronted with a high to very high degree of risk. Management plans and control measures, based on risk values were presented in four activities (with two management priorities under critical and non-critical conditions). For the management program with the largest area. Control measures and strategies such as the establishment of halophytic and xerophytic plants, drainage networks, resilient facilities and infrastructure were proposed. Reducing the risk of desertification, could play a crucial role in the sustainable development of drylands and desert ecosystems.

Developing predictive models for return to work using the Military Power, Performance and Prevention (MP3) musculoskeletal injury risk algorithm: a study protocol for an injury risk assessment programme

BackgroundMusculoskeletal injuries are a primary source of disability in the US Military, and low back pain and lower extremity injuries account for over 44% of limited work days annually. History...

The World of Evaluation: Challenges Faced by Student Evaluators

Background: Performing a high profile evaluation in a world-class organization is a daunting experience for any professional program evaluator. As a student evaluator, it is more than just formidable it has distinctive challenges. Fortunately, professional undertakings provide student evaluators with the experience and tools to overcome these early tests with continuing practice.&#x0D; Purpose: This paper discusses the challenges that student evaluators face in performing their first program evaluation project. It will draw from the experience of one student’s first major evaluation project and current, but limited, research on the subject.&#x0D; Setting: NA&#x0D; Intervention: NA&#x0D; Research Design: This paper will examine the broad-spectrum of challenges that student evaluators experience in their first assignment referencing as a case study an actual evaluation of a hospital risk-assessment program implementation.&#x0D; Data Collection and Analysis: Literature review and documented evaluator experiences.&#x0D; Findings: This paper will conclude with a discussion of possible mitigation strategies to overcome these student evaluator challenges.

CE4 - The Multidisciplinary Risk Assessment and Management Program – Diabetes Mellitus (Ramp-Dm) was Cost-Effective for Managing Patients with Diabetes Mellitus

Conference Theme: Pharmacoeconomics and Outcomes Research in Asia-Pacific: Challenges, Opportunities, and Future Direction

Effectiveness of a multidisciplinary risk assessment and management programme-diabetes mellitus (RAMP-DM) on patient-reported outcomes.

Little is known about how the patient-reported outcomes is influenced by multidisciplinary-risk-assessment-and-management-programme for patients with diabetes mellitus (RAMP-DM). This paper aims to evaluate the effectiveness of RAMP-DM on patient-reported outcomes. This was a prospective longitudinal study on 1039 diabetes mellitus patients (714/325 RAMP-DM/non-RAMP-DM) managed in primary care setting. 536 and 402 RAMP-DM participants, and 237 and 187 non-RAMP-DM participants were followed up at 12 and 24 months with completed survey, respectively. Patient-reported outcomes included health-related quality of life, change in global health condition and patient enablement measured by Short Form-12 Health Survey version-2 (SF-12v2), Global Rating Scale, Patient Enablement Instrument respectively. The effects of RAMP-DM on patient-reported outcomes were evaluated by mixed effect models. Subgroup analysis was performed by stratifying haemoglobin A1c (HbA1c) (optimal HbA1c < 7 % and suboptimal HbA1c ≥ 7 %). RAMP-DM with suboptimal HbA1c was associated with greater improvement in SF-12v2 physical component summary score at 12-month (coefficient:3.80; P-value < 0.05) and 24-month (coefficient:3.82;P-value < 0.05), more likely to feel more enabled at 12-month (odds ratio: 2.57; P-value < 0.05), and have improved in GRS at 24-month (odds ratio:4.05; P-value < 0.05) compared to non-RAMP-DM participants. However, there was no significant difference in patient-reported outcomes between RAMP-DM and non-RAMP-DM participants with optimal HbA1c. Participation in RAMP-DM is effective in improving physical component of HRQOL, Global Rating Scale and patient enablement among diabetes mellitus patients with suboptimal HbA1c, but not in those with optimal HbA1c. Patients with sub-optimal diabetes mellitus control should be the priority target population for RAMP-DM. This observational study design may have potential bias in the characteristics between groups, and randomized clinical trial is needed to confirm the results.

An Emerging Risk Factor of Sexual Abuse: The Use of Smartphone Dating Applications.

Smartphone dating applications (apps) have become popular in recent years. However, the association between the use of dating apps and sexual abuse remains uninvestigated. The aim of this study was to examine the association between using dating apps and the sexual abuse of males and females. Six hundred sixty-six participants were recruited in four universities in Hong Kong in 2015. Overall, the 1-year prevalence of sexual abuse was 12.4% (95% confidence interval [CI]: [9.8, 14.9]) and the lifetime prevalence was 14.2% (95% CI: [11.5, 16.9]). Multiple logistic regressions found that users of dating apps (adjusted odds ratio [aOR]: 2.13, p < .05) were more likely to be sexually abused in the past year than non-users. Using dating apps was also a risk factor of lifetime sexual abuse (aOR: 1.83, p < .05). Our findings suggest that app users should deserve more attention in risk assessment, risk stratification, and sexual abuse prevention programs.

Effectiveness of the multidisciplinary Risk Assessment and Management Program for Patients with Diabetes Mellitus (RAMP-DM) for diabetic microvascular complications: A population-based cohort study

AimTo evaluate the effectiveness of the multidisciplinary Risk Assessment and Management Program for Patients with Diabetes Mellitus (RAMP-DM) in reducing the risks of microvascular complications. MethodsThis prospective cohort study was conducted with 29,670 propensity-score-matched RAMP-DM participants and diabetes patients under the usual primary care (14,835 in each group). Study endpoints were the first occurrence of any diabetic microvascular complications, non-proliferative diabetic retinopathy/preproliferative diabetic retinopathy (NPDR/prePDR), sight-threatening diabetic retinopathy (STDR) or blindness, nephropathy, end-stage renal disease (ESRD), neuropathy and lower-limb ulcers or amputation. Log-rank tests and multivariable Cox proportional-hazards regressions were employed to estimate between-group differences in incidences of study endpoints. ResultsAfter a median follow-up of 36 months with>41,000 person-years in each group, RAMP-DM participants had a lower incidence of microvascular complications (760 vs 935; adjusted hazard ratio [HR]: 0.73; 95% confidence interval [CI]: 0.66–0.81; P<0.001) and lower incidences of all specific microvascular complications except neuropathy (adjusted HR: 0.94; 95% CI: 0.61–1.45; P=0.778). Adjusted HRs for the RAMP-DM vs control group for ESRD, STDR or blindness, and lower-limb ulcers or amputation were 0.40 (95% CI: 0.24–0.69; P<0.001), 0.55 (95% CI: 0.39–0.78; P=0.001) and 0.49 (95% CI: 0.30–0.80; P=0.005), respectively. ConclusionThe RAMP-DM intervention was associated with lower incidences of all microvascular complications except neuropathy over a 3-year follow-up. These encouraging results constitute evidence that structured risk assessment and risk-stratified management provided by a multidisciplinary team is effective for reducing microvascular complications in diabetes patients. Clinical trial registryNCT02034695, www.ClinicalTrials.gov.

The World Health Organization Measles Programmatic Risk Assessment Tool-Romania, 2015.

Despite global improvement in annual measles incidence and mortality since 2000, progress toward elimination goals has slowed. The World Health Organization (WHO) European Region (EUR) established a regional goal for measles and rubella elimination by 2015. Romania is one of 13 EUR countries in which measles remains endemic. To identify barriers to meeting programmatic targets and to aid in prioritizing efforts to strengthen measles elimination strategy implementation, the WHO and U.S. Centers for Disease Control and Prevention developed a measles programmatic risk assessment tool that uses routinely collected data to estimate district-level risk scores. The WHO measles programmatic risk assessment tool was used to identify high-risk areas in order to guide measles elimination program activities in Romania. Of the 42 districts in Romania, 27 (64%) were categorized as very high or high risk. Many of the very-high-risk districts were clustered in the western part of the country or were clustered around the capital Bucharest in the southeastern part of the country. The overall risk scores in the very-high-risk districts were driven primarily by poor surveillance quality and suboptimal population immunity. The measles risk assessment conducted in Romania was the first assessment to be completed in a European country. Annual assessments using the programmatic risk tool could provide valuable information for immunization program and surveillance staff at the national level and in each district to guide activities to enhance measles elimination efforts, such as strengthening routine immunization services, improving immunization campaign planning, and intensifying surveillance.

Travel and Border Health Measures to Prevent the International Spread of Ebola.

During the 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa, CDC implemented travel and border health measures to prevent international spread of the disease, educate and protect travelers and communities, and minimize disruption of international travel and trade. CDC staff provided in-country technical assistance for exit screening in countries in West Africa with Ebola outbreaks, implemented an enhanced entry risk assessment and management program for travelers at U.S. ports of entry, and disseminated information and guidance for specific groups of travelers and relevant organizations. New and existing partnerships were crucial to the success of this response, including partnerships with international organizations, such as the World Health Organization, the International Organization for Migration, and nongovernment organizations, as well as domestic partnerships with the U.S. Department of Homeland Security and state and local health departments. Although difficult to assess, travel and border health measures might have helped control the epidemic's spread in West Africa by deterring or preventing travel by symptomatic or exposed persons and by educating travelers about protecting themselves. Enhanced entry risk assessment at U.S. airports facilitated management of travelers after arrival, including the recommended active monitoring. These measures also reassured airlines, shipping companies, port partners, and travelers that travel was safe and might have helped maintain continued flow of passenger traffic and resources needed for the response to the affected region. Travel and border health measures implemented in the countries with Ebola outbreaks laid the foundation for future reconstruction efforts related to borders and travel, including development of regional surveillance systems, cross-border coordination, and implementation of core capacities at designated official points of entry in accordance with the International Health Regulations (2005). New mechanisms developed during this response to target risk assessment and management of travelers arriving in the United States may enhance future public health responses. The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html).

Progress in monitoring strategies for risk reduction in geologic CO2 storage

Commercial, demonstration and pilot geologic CO2 storage (GCS) projects have provided a wealth of practical experience in monitoring technologies. In this manuscript we review a few key projects, specific geophysical methods, well-based methods, geophysical workflows and some suggested best practices. These practices are often driven and governed by regulatory requirements (e.g. U.S. Environmental Protection Agency [US-EPA] Class VI underground injection regulation) and the need for effective reservoir management of pressures and volumes as well as the site-specific risks to containment, plume migration, and underground sources of drinking water. Reducing uncertainty in monitoring is likely to lead to reducing uncertainty in risk. One of our conclusions is the need for field experiment testing that is risk-driven. It is notable that GCS pilot projects have been designed for safe storage, and to date they have been successful. Technical challenges at all geologic CO2 storage sites include assuring injectivity and capacity predictions are reliable, the fate and subsurface topology of the CO2 plume is acceptable, regulatory permitting and compliance are accomplished in a timely manner, needed business assurances are supported by quantitative technical data, and the storage operation is acceptable to stakeholders. There is risk associated with all of these challenges necessitating a monitoring program utilizing both direct and indirect monitoring methods. Geophysical monitoring is viewed as a key component in approaching risk assessment because of the direct association of risk and monitoring in GCS. In this review we provide a framework for monitoring and then present some specific monitoring tools that may be useful for regulatory compliance, as well as technologies that are applicable to leakage detection. Since the Department of Energy National Risk Assessment Program (DOE NRAP) is focused on quantitative risk assessment, we focus on quantitative geophysical monitoring. Important concepts for a successful integration of monitoring and risk assessment include the following: Characterization of key parameters of risk and methods to monitor those parameters, the feedback between risk and monitoring, and the development of risk-based strategies to assess and update monitoring plans and tools. We briefly review current work in assessing uncertainty in important monitoring technologies, such as seismic and electrical geophysical surveys, and acknowledge that there is both temporal and spatial uncertainty in monitoring, in addition to the measurement uncertainty of specific tools. In our opinion monitoring approaches for subsurface imaging, such as 3D-reflection seismic, 3D-Vertical Seismic Profiling (VSP), cross well seismic, electromagnetic and electrical technologies, and well-log based measurements produce proxies for saturation and mass that, when properly calibrated and interpreted, are robust quantitative estimates of these key storage parameters. Understanding the uncertainty in these proxies is important in risk-driven monitoring. The cost of high-potential geophysical monitoring technologies impacts application of these methods to quantitative risk assessments. We therefore examine the concept of value of information (VOI) that is expected to play a role in selection of monitoring tools. We also conclude that monitoring of leakage scenarios has had minimal field validation and thus quantifying and reducing risk will require dedicated experiments that probe and test uncertainty in fault/fracture-zone and wellbore leakage.

Modeling risk of occupational zoonotic influenza infection in swine workers

ABSTRACTZoonotic transmission of influenza A virus (IAV) between swine and workers in swine production facilities may play a role in the emergence of novel influenza strains with pandemic potential. Guidelines to prevent transmission of influenza to swine workers have been developed but there is a need for evidence-based decision-making about protective measures such as respiratory protection. A mathematical model was applied to estimate the risk of occupational IAV exposure to swine workers by contact and airborne transmission, and to evaluate the use of respirators to reduce transmission. The Markov model was used to simulate the transport and exposure of workers to IAV in a swine facility. A dose-response function was used to estimate the risk of infection. This approach is similar to methods previously used to estimate the risk of infection in human health care settings. This study uses concentration of virus in air from field measurements collected during outbreaks of influenza in commercial swine facilities, and analyzed by polymerase chain reaction. It was found that spending 25 min working in a barn during an influenza outbreak in a swine herd could be sufficient to cause zoonotic infection in a worker. However, this risk estimate was sensitive to estimates of viral infectivity to humans. Wearing an excellent fitting N95 respirator reduced this risk, but with high aerosol levels the predicted risk of infection remained high under certain assumptions. The results of this analysis indicate that under the conditions studied, swine workers are at risk of zoonotic influenza infection. The use of an N95 respirator could reduce such risk. These findings have implications for risk assessment and preventive programs targeting swine workers. The exact level of risk remains uncertain, since our model may have overestimated the viability or infectivity of IAV. Additionally, the potential for partial immunity in swine workers associated with repeated low-dose exposures or from previous infection with other influenza strains was not considered. Further studies should explore these uncertainties.

Impact of the National Health Service Health Check on cardiovascular disease risk: a difference-in-differences matching analysis.

The National Health Service Health Check program in England is the largest cardiovascular risk assessment and management program in the world. We assessed the effect of this program on modelled risk of cardiovascular disease, individual risk factors for cardiovascular disease, prescribing of relevant medications and diagnosis of vascular disease. We obtained retrospective electronic medical records for a randomly selected sample of 138 788 patients aged 40-74 years registered with 462 English general practices participating in the Clinical Practice Research Datalink between 2009 and 2013. We used a quasi-experimental design of difference-indifferences matching analysis to compare changes in outcomes between Health Check attendees and nonattendees, with a median follow-up time of 2 years. Overall, 21.4% of the eligible population attended a Health Check. After matching (n = 29 672 in each group), attendees had a significant absolute reduction in modelled risk for cardiovascular disease (-0.21%, 95% confidence interval [CI] -0.24% to -0.19%) and individual risk factors: systolic blood pressure (-2.51 mm Hg, 95% CI -2.77 to -2.25 mm Hg), diastolic blood pressure (-1.46 mm Hg, 95% CI -1.62 to -1.29 mm Hg), body mass index (-0.27, 95% CI -0.34 to -0.20) and total cholesterol (-0.15 mmol/L, 95% CI -0.18 to -0.13 mmol/L). Statins were prescribed for 39.9% of attendees who were at high risk for cardiovascular disease. The program resulted in significantly more diagnoses of selected vascular diseases among attendees, with the largest increases for hypertension (2.99%) and type 2 diabetes mellitus (1.31%). The National Health Service Health Check program had statistically significant but clinically modest impacts on modelled risk for cardiovascular disease and individual risk factors, although diagnosis of vascular disease increased. Overall program performance was substantially below national and international targets, which highlights the need for careful planning, monitoring and evaluation of similar initiatives internationally.

Risk Assessment and Your Electrical Safety Program: Performance at the Organizational and Worker Levels

The 2015 editions of National Fire Protection Association (NFPA) 70E and Canadian Standards Association (CSA ) Z462 have integrated occupational health and safety management system and risk management principles. This significant revision changes and advances the electrical safety culture and enables sustainable improvement in the prevention of electrical incidents and injuries. The article discusses how these changes can be integrated into an organization's electrical safety program and how risk assessment can be performed at both the organizational and the worker levels.

Impact of an Electronic Pain and Opioid Risk Assessment Program: Are There Improvements in Patient Encounters and Clinic Notes?

A comprehensive electronic self-report assessment, called PainCAS® (Clinical Assessment System), was developed and implemented in three clinics. PainCAS captures demographic information, pain assessment, quality-of-life variables, and contains validated, electronic versions of screeners for risk of aberrant opioid-related behaviors (the SOAPP and COMM). This investigation sought to determine the impact of PainCAS on documentation of pain and opioid risk evaluations. Exploratory hypotheses examined changes in the content of the patient-provider interaction and any impact on outcome. In study 1, chart reviews were conducted between pain patients who completed the electronic program (N = 89) and controls who represented standard of care (N = 120). In study 2, two groups of chronic pain patients (treatment-as-usual Control condition = 75, PainCAS Experimental condition = 72) were interviewed after completing their index clinic visit and completed mailed questionnaires 3 months later. Results revealed significantly more key, pain-relevant chart elements documented in charts of patients who completed the PainCAS than those using a traditional paper questionnaire (Study 1; <0.001). In Study 2, the Experimental group reported more discussion about legal issues, substance use history, and medication safety compared with the Control group (p < 0.05). Satisfaction questionnaire responses supported provider and patient perceived benefit from using PainCAS. However, as expected, no differences were found between conditions on outcome measures of pain, mood, and function. Results indicate that use of the PainCAS electronic pain assessment improves documentation of chart elements in clinic notes and is associated with increased discussion of key, pain-relevant topics during the clinical visit.

The World Health Organization Measles Programmatic Risk Assessment Tool-Pilot Testing in India, 2014.

Measles is a leading cause of child mortality, and reduction of child mortality is a key Millennium Development Goal. In 2014, the World Health Organization and the U.S. Centers for Disease Control and Prevention developed a measles programmatic risk assessment tool to support country measles elimination efforts. The tool was pilot tested in the State of Uttarakhand in August 2014 to assess its utility in India. The tool assessed measles risk for the 13 districts of Uttarakhand as a function of indicator scores in four categories: population immunity, surveillance quality, program delivery performance, and threat. The highest potential overall score was 100. Scores from each category were totaled to assign an overall risk score for each district. From this risk score, districts were categorized as low, medium, high, or very high risk. Of the 13 districts in Uttarakhand in 2014, the tool classified one district (Haridwar) as very high risk and three districts (Almora, Champawat, and Pauri Garhwal) as high risk. The measles risk in these four districts was largely due to low population immunity from high MCV1-MCV2 drop-out rates, low MCV1 and MCV2 coverage, and the lack of a supplementary immunization activity (SIA) within the past three years. This tool can be used to support measles elimination in India by identifying districts that might be at risk for measles outbreaks, and to guide risk mitigation efforts, including strengthening routine immunization services and implementing SIAs.

Water-reuse risk assessment program (WRAP): a refinery case study

The key approach to manage and prevent potential hazards arising from specific contaminants in water networks is to consider water as the main product delivered. This new concept, addressed as water-reuse risk assessment program (WRAP), has been further developed from hazard analysis of critical control points (HACCP) to illustrate the potential hazards which are the roots of hindering intra-facility water reuse strategies. For industrial sectors applying water reclamation and reuse schemes, it is paramount that the reclaimed water quality stays within the desired quality. The objective of WRAP is to establish a new methodology and knowledge, which will contribute to the sustainable development of industrial water management, and demonstrate its capabilities in identifying and addressing any potential hazards in the selected schemes adoption by the industries. A ‘what-if’ scenario was simulated using a refinery as a case study to show strategies on how to benefit reclaimed or reuse water based on reliable, applied and scientific research within the process integration area. In conclusion, the WRAP model will facilitate operators, consultants and decision makers to reuse water on a fit-for-use basis whilst avoiding contaminant accumulation in the overall system and production of sub-quality products from inadequate processes after several reuses.