Risk-based Management Research Articles

DEVELOPMENT AND SUBSTANTIATION OF PROMISING MODELS OF MEDICAL CARE FOR DISEASES OF CIRCULATORY SYSTEM IN INDUSTRIAL REGION. 2010–2023 RESULTS

HighlightsWe have identified regional peculiarities of traditional and non-traditional cardiovascular risk factors.We have defined and characterized clinical and organizational characteristics of the specialized care, prevention, and treatment of diseases of the circulatory system in the Kemerovo region - Kuzbass.Moreover, we have described the principles of innovative organizational models for improving care for patients with diseases of the circulatory system, focused on the needs of outpatient organizations. AbstractThe review presents the main research findings obtained at the Department of Optimization of Medical Care for Cardiovascular Diseases of the Research Institute for Complex Issues of Cardiovascular Diseases over the past 13 years of work. The uniqueness of the obtained data lies in the fact that we have identified regional peculiarities of cardiovascular risk factors in residents of an industrial region (using the Kemerovo region data). Data on monitoring of health and risk factors served as the basis for the development of innovative organizational models for improving care for patients with diseases of the circulatory system from the stage of primary care to tertiary care using a systematic and integrated approach, and situational analysis. Management decisions within models are based on international quality standards that reaffirm that risk-based management, the role of personnel and the work environment are the integral to the improvement of performance and the achievement of the main goals of medical organization. Using the project approach, we have implemented management tools for internal quality control and safety of patients and personnel.

Diagnosis and Management of Cervical Squamous Intraepithelial Lesions in Pregnancy and Postpartum.

Perinatal care provides important health care opportunities for many individuals at risk for cervical cancer. Pregnancy does not alter cervical cancer screening regimens. ASCCP risk-based management has a colposcopy threshold of a 4% immediate risk of cervical intraepithelial neoplasia (CIN) 3 or cancer, but the actual risk can be considerably higher based on current and past screening results. Improving cervical cancer outcomes with diagnosis during pregnancy rather than postpartum and facilitating further evaluation and treatment postpartum for lesser lesions are the perinatal management goals. Although colposcopy indications are unchanged in pregnancy, some individuals with lower risk of CIN 2-3 and reliable access to postpartum evaluation may defer colposcopy until after delivery. Cervical intraepithelial neoplasia diagnosed in pregnancy tends to be stable, with frequent regression postpartum, though this is not universal. Colposcopic inspection during pregnancy can be challenging. Although biopsies in pregnancy are subjectively associated with increased bleeding, they do not increase complications. Endocervical curettage and expedited treatment are unacceptable. Treatment of CIN 2-3 in pregnancy is not recommended. Excisional biopsies in pregnancy are reserved for suspicion of malignancy that cannot be confirmed by colposcopic biopsy and when excisional biopsy results would alter oncologic or pregnancy care. Surveillance of high-grade lesions in pregnancy uses human papillomavirus-based testing, cytology, and colposcopy, with biopsy of worsening lesions every 12-24 weeks from diagnosis until postpartum evaluation. Mode of delivery does not definitively affect persistence of CIN postpartum. Postpartum care may involve a full colposcopic evaluation or expedited excisional procedure if indicated.

Optimal scheduling of a microgrid based on renewable resources and demand response program using stochastic and IGDT-based approach

Optimal economic scheduling of microgrids with photovoltaic (PV) and wind generation has gained increased attention during recent years. Integration of renewable energy resources in microgrids requires increasingly active control and management of energy storages and demand response (DR). In this paper, a risk-based stochastic optimal energy management model is developed for microgrid with renewables, energy storage and load control by time-of-use-based DR programs. Microgrid includes PV system, wind system, micro-turbine, fuel cell, electric vehicle (EV), and energy storage. Information-gap decision theory (IGDT) is employed to address the uncertainty of loads and to provide the operating strategies for the microgrid controllable energy resources. This proposed model has been solved as a mixed-integer non-linear programming (MINLP) in General Algebraic Modeling System (GAMS) software and simulation results in different conditions are studied and discussed. Three different risk management strategies have been studied such as risk-averse, risk-neutral and risk-seeker mode. The simulation results indicate that the impacts of risk-averseness or risk-seeker of the decision maker affect the system operation. For instance, the results showed the DR program's role in risk-averse and risk-taking strategies, impacting consumption and costs. The proposed model ensures the risk-averse decision-maker that if the uncertain parameter deviates within the optimum robustness region, the final cost will not exceed the critical cost. On the other hand, the risk-seeking decision-maker can reach lower final costs by accepting the risks if the uncertain parameter deviates favorably within the opportunity region. Decision-makers can manage risks by adjusting consumption. Thus, considering the cost of risk management is crucial, as it increases with robust or opportunistic approaches.

Abstract 6410: An exosomal microRNA signature predicts the efficacy of ramucirumab plus paclitaxel in advanced gastric cancer: Findings from the prospective IVY trial

Abstract Purpose: With rapid advances in the development of effective therapeutic regimens in patients with advanced gastric cancer, it is imperative to establish individualized treatment approaches that can help identify patient subsets that have the highest likelihood of response to a specific regimen. Although ramucirumab plus paclitaxel therapy is the standard second-line treatment for patients with advanced gastric cancer, biomarkers that can help predict therapeutic response are still lacking. This longitudinal study aimed to establish a liquid-biopsy assay that can predict response to ramucirumab plus paclitaxel therapy in patients with advanced gastric cancer. Experimental Design: A prospective observational multicenter study (named the IVY study) enrolled 115 patients who received ramucirumab plus paclitaxel treatment. We collected serum specimens prior to the initiation of the treatment regimen. Patients were divided into responders and non-responders according to the response evaluation criteria in solid tumors (RECIST). We performed small RNA-sequencing (sRNA-Seq) in a subset of 28 patients with and without response to identify exosomal microRNA-based biomarkers that allowed risk stratification and response prediction in patients with advanced gastric cancer. Results: The sRNA-Seq analysis and rigorous bioinformatic approaches using machine-learning algorithms allowed us to identify a panel of 10 exosomal microRNAs that robustly predicted resistance to ramucirumab plus paclitaxel treatment (AUC: 0.83). The panel of exosomal miRNAs was also shown to have a robust prognostic value for predicting survival outcomes in gastric cancer patients treated with ramucirumab plus paclitaxel, and Cox proportional hazards regression analysis showed that patients classified as high risk on the panel of exosomal miRNAs independent poor prognostic factor (OS: HR = 2.74, 95% CI = 1.56-4.81, P < 0.01, RFS: HR = 1.84, 95% CI = 1.16-2.92, P < 0.01). Following logistic regression and backward elimination, we trained a clinically feasible 5 exosomal miRNA signature by combining it with the Body Mass Index data, an independent clinical predictor (AUC: 0.84). We subsequently successfully validated the performance of this signature in the prospective clinical trial cohort (AUC: 0.87). Finally, we established a prognostic risk nomogram based on the circulating exosomal miRNA signature for a non-invasive and personalized pre-therapeutic selection approach. Conclusions: We have developed a novel liquid biopsy-based assay that allows robust prediction of response to ramucirumab plus paclitaxel treatment in gastric cancer patients, and our assay provides a framework for a personalized medicine approach that can provide risk-based management and treatment for each patient prior to the initiation of therapy. Citation Format: Katsutoshi Shoda, Caiming Xu, Yoh Asahii, Takeshi Nagasaka, Daisuke Ichikawa, Ajay Goel. An exosomal microRNA signature predicts the efficacy of ramucirumab plus paclitaxel in advanced gastric cancer: Findings from the prospective IVY trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6410.

Contributions of the IUCN Red List of Ecosystems to risk-based design and management of protected and conserved areas in Africa.

Protected and conserved areas (PCAs) are key ecosystem management tools for conserving biodiversity and sustaining ecosystem services and social cobenefits. As countries adopt a 30% target for protection of land and sea under the Global Biodiversity Framework of the United Nations Convention on Biological Diversity, a critical question emerging is, which 30%? A risk-based answer to this question is that the 30% that returns the greatest reductions in risks of species extinction and ecosystem collapse should be protected. The International Union for Conservation of Nature (IUCN) Red List protocols provide practical methods for assessing these risks. All species, including humans, depend on the integrity of ecosystems for their well-being and survival. Africa is strategically important for ecosystem management due to convergence of high ecosystem diversity, intense pressures, and high levels of human dependency on nature. We reviewed the outcomes (e.g., applications of ecosystem red-list assessments to protected-area design, conservation planning, and management) of a symposium at the inaugural African Protected Areas Congress convened to discuss roles of the IUCN Red List of Ecosystems in the design and management of PCAs. Recent progress was made in ecosystem assessment, with 920 ecosystem types assessed against the IUCN Red List criteria across 21 countries. Although these ecosystems spanned a diversity of environments across the continent, the greatest thematic gaps were for freshwater, marine, and subterranean realms, and large geographic gaps existed in North Africa and parts of West and East Africa. Assessment projects were implemented by a diverse community of government agencies, nongovernmental organizations, and researchers. The assessments have influenced policy and management by informing extensions to and management of formal protected area networks supporting decision-making for sustainable development, and informing ecosystem conservation and threat abatement within boundaries of PCAs and in surrounding landscapes and seascapes. We recommend further integration of risk assessments in environmental policy and enhanced investment in ecosystem red-list assessment to fill current gaps.

Recommendations for Use of p16/Ki67 Dual Stain for Management of Individuals Testing Positive for Human Papillomavirus.

The Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee developed recommendations for dual stain (DS) testing with CINtec PLUS Cytology for use of DS to triage high-risk human papillomavirus (HPV)-positive results. Risks of cervical intraepithelial neoplasia grade 3 or worse were calculated according to DS results among individuals testing HPV-positive using data from the Kaiser Permanente Northern California cohort and the STudying Risk to Improve DisparitiES study in Mississippi. Management recommendations were based on clinical action thresholds developed for the 2019 American Society for Colposcopy and Cervical Pathology Risk-Based Management Consensus Guidelines. Resource usage metrics were calculated to support decision-making. Risk estimates in relation to clinical action thresholds were reviewed and used as the basis for draft recommendations. After an open comment period, recommendations were finalized and ratified through a vote by the Consensus Stakeholder Group. For triage of positive HPV results from screening with primary HPV testing (with or without genotyping) or with cytology cotesting, colposcopy is recommended for individuals testing DS-positive. One-year follow-up with HPV-based testing is recommended for individuals testing DS-negative, except for HPV16- and HPV18-positive results, or high-grade cytology in cotesting, where immediate colposcopy referral is recommended. Risk estimates were similar between the Kaiser Permanente Northern California and STudying Risk to Improve DisparitiES populations. In general, resource usage metrics suggest that compared with cytology, DS requires fewer colposcopies and detects cervical intraepithelial neoplasia grade 3 or worse earlier. Dual stain testing with CINtec PLUS Cytology is acceptable for triage of HPV-positive test results. Risk estimates are portable across different populations.

Development of a scanning acoustic microscopy-based structural prior for microtexture region characterization

Nondestructive evaluation (NDE) plays a crucial role in ensuring aircraft availability. The current NDE paradigm often relies on mono-modal testing and signal-over-threshold criteria to provide robust defect or damage detection, not characterization. One example is found in the risk-based management of surface-breaking cracks in metal, where cracks of a given size can be detected by eddy current testing (ECT) with a calculable probability. Yet, there are cases where detection proves insufficient. Consider the case of microtexture regions (MTR) found in certain titanium alloys, which can increase the risk of cold dwell fatigue failure when found above a certain size and in specific orientations relative to the surrounding material. At present, the size and orientation of MTR cannot be characterized using only one NDE modality. In this work, a data fusion-based solution to MTR characterization is developed. First, two inspection methods—scanning acoustic microscopy (SAM) and ECT—are selected, where each method is individually capable of only partial characterization. Then, matching component analysis is used to develop a surrogate forward model relating MTR orientation to ECT output. This data is then inverted using boundaries provided from the SAM data as a structural prior.

Residual hydrocarbons in long-term contaminated soils: implications to risk-based management

Petroleum hydrocarbon (PHC) contamination is a widespread and severe environmental issue affecting many countries’ resource sectors. PHCs are mixtures of hydrocarbon compounds with varying molar masses that naturally attenuate at different rates. Lighter fractions attenuate first, followed by medium-molar-mass constituents, while larger molecules remain for longer periods. This results in significant regulatory challenges concerning residual hydrocarbons in long-term contaminated soils. This study examined the potential risks associated with residual PHC and its implications for risk-based management of heavily contaminated soils (23,000–26,000 mg PHC/kg). Ecotoxicological properties, such as seedling emergence and growth of two native plant species—small Flinders grass (Iseilema membranaceum) and ruby saltbush (Enchylaena tomentosa)—and earthworm survival tests in PHC-contaminated soils, were assessed. Additionally, the effects of aging on the attenuation of PHC in contaminated soils were evaluated. Toxicity responses of plant growth parameters were determined as no-observed-effect concentrations: 75%–100% for seedling emergence, < 25%–75% for plant shoot height, and 75%–100% for earthworm survival. After 42 weeks of aging, the total PHC levels in weathered soils decreased by 14% to 30% and by 67% in diesel-spiked soil due to natural attenuation. Dehydrogenase enzyme activity in soils increased during the initial aging period. Furthermore, a clear shift of bacterial communities was observed in the soils following aging, including enrichment of PHC-resistant and -utilizing bacteria—for example, Nocardia sp. This study underscores the potential of natural attenuation for eco-friendly and cost-effective soil management, underlining that its success depends on site-specific factors like water content and nutrient availability. Therefore, we recommend detailed soil assessments to evaluate these conditions prior to adopting a risk-based management approach.

Comprehensive Assessment of Risk-Based Quality Management Adoption in Clinical Trials

BackgroundRisk-based monitoring (RBM) and risk-based quality management (RBQM) offer a compelling approach to increase efficiency, speed and quality in clinical trials by prioritizing and mitigating risks related to essential safety and efficacy data. Since 2013, the FDA and EMA have encouraged the use of RBM/RBQM, however adoption has been slow with limited understanding of the barriers to adoption.MethodsThe Tufts Center for the Study of Drug Development conducted an online survey among pharmaceutical, biotechnology, and contract research organizations and gathered 206 responses on 32 distinct RBQM practices.ResultsOn average, companies implemented RBQM in 57% of their clinical trials. Lower levels of adoption were observed among companies conducting fewer than 25 trials annually (48%) compared to those conducting more than 100 trials annually (63%). Primary barriers to adoption include lack of organizational knowledge and awareness, mixed perceptions of the value proposition of RBQM, and poor change management planning and execution. Insights into improving the level of adoption are discussed.

Applying ONCO-RADS to whole-body MRI cancer screening in a retrospective cohort of asymptomatic individuals

BackgroundWhole-body magnetic resonance imaging (WB-MRI) has emerged as a valuable tool for cancer detection. This study evaluated the prevalence rates of cancer in asymptomatic individuals undergoing WB-MRI according to the Oncologically Relevant Findings Reporting and Data System (ONCO-RADS) classifications in order to assess the reliability of the classification method.MethodsWe retrospectively enrolled 2064 asymptomatic individuals who participated in a WB-MRI cancer screening program between 2017 and 2022. WB-MRI was acquired on a 3-T system with a standard protocol, including regional multisequence and gadolinium-based contrast agent-enhanced oncologic MRI. Results of further examinations, including additional imaging and histopathology examinations, performed at our institute were used to validate the WB-MRI findings. Two radiologists blinded to the clinical outcome classified the WB-MRI findings according to the ONCO–RADS categories as follows: 1 (normal), 2 (benign finding highly likely), 3 (benign finding likely), 4 (malignant finding likely), and 5 (malignant finding highly likely). Firth logistic regression analysis was performed to determine the associations between participant characteristics and findings of ONCO-RADS category ≥ 4.ResultsOf the 2064 participants with median age of 55 years, 1120 (54.3%) were men, 43 (2.1%) had findings of ONCO-RADS category ≥ 4, and 24 (1.2%) had confirmed cancer. The cancer prevalence rates were 0.1%, 5.4%, 42.9%, and 75% for ONCO-RADS categories 2, 3, 4, and 5, respectively. In the multivariable model, older age (OR: 1.035, p = 0.029) and history of hypertension (OR: 2.051, p = 0.026), hepatitis B carrier (OR: 2.584, p = 0.013), or prior surgery (OR: 3.787, p < 0.001) were independently associated with the findings for ONCO-RADS category ≥ 4.ConclusionsThe ONCO-RADS categories for cancer risk stratification were validated and found to be positively correlated with cancer risk. The application of ONCO-RADS facilitates risk-based management after WB-MRI for cancer screening.

Towards an institutional understanding of risk-based management controls: evidence from a developing market

PurposeIn developing countries, how risk management technologies influence management accounting and control (MAC) practices is under-researched. By drawing on insights from institutional studies, this study aims to examine the multiple institutional pressures surrounding an entity and influencing its risk-based management control (RBC) system – that is, how RBC appears in an emerging market attributed to institutional multiplicity.Design/methodology/approachThe authors used qualitative case study research methods to collect empirical evidence from a privately owned Egyptian insurance company.FindingsThe authors observed that in the transformation to risk-based controls, especially in socio-political settings such as Egypt, changes in MAC systems were consistent with the shifts in the institutional context. Along with changes in the institutional environment, the case company sought to configure its MAC system to be more risk-based to achieve its strategic goals effectively and maintain its sustainability.Originality/valueThis research provides a fuller view of risk-based management controls based on the social, professional and political perspectives central to the examined institutional environment. Moreover, unlike early studies that reported resistance to RBC, this case reveals the institutional dynamics contributing to the successful implementation of RBC in an emerging market.

DIGITALIZATION OF RISK-ORIENTED MANAGEMENT OF FINANCIAL AND ECONOMIC SECURITY OF THE BANK

The scientific results of the study are to determine the current trends of digitalization of risk-oriented management of banking activities to justify the directions of increasing the level of financial and economic security of Ukrainian banks in the context of the Russian-Ukrainian war and considering the needs of economic recovery. The expediency of using indicators of financial stability, which are published by the National Bank of Ukraine under martial law, has been proven, namely: the capital of the first level to the assets weighted by risk; the ratio of the capital of the first level to assets; non-performing loans excluding provisions for capital; non-performing loans to aggregate gross loans; rate of return on assets; net open position in foreign currency to capital. It is determined that modern banks introduce innovative digital solutions aimed at risk-oriented management of financial and economic security in a continuous real-time mode. Some procedures are performed automatically, and it is possible to use artificial intelligence programs, but these innovations must be managed carefully because we are talking about the financial security of millions of bank customers and the financial and economic security of banks, as well as the financial stability of the banking system of Ukraine. It has been substantiated that prospects for further research should be developed in the areas of economic recovery in Ukraine, by strengthening the banking system and developing digitalization of risk-based management of financial and economic security of banks using best practices and international experience. For a more objective assessment of the level of financial and economic security of Ukrainian banks, it is advisable to apply economic standards, regarding banking risks, indicators of financial stability, and the financial stress index, which together reflect the bank’s propensity for force majeure in the financial system, the ability to resist and adapt to adverse changes, and various economic challenges.

Implementing integrated hypertension and diabetes management using the World Health Organization’s HEARTS model: protocol for a pilot study in the Guatemalan national primary care system

BackgroundThe HEARTS technical package was developed by the World Health Organization to address the implementation gap in cardiovascular disease prevention in low- and middle-income countries. Guatemala is a middle-income country that is currently implementing HEARTS. National authorities in Guatemala are interested in exploring how hypertension and diabetes management can be integrated in HEARTS implementation. The objective of this study is to conduct a feasibility and acceptability pilot trial of integrated hypertension and diabetes management based on HEARTS in the publicly funded primary care system in Guatemala.MethodsA single-arm pilot trial for 6 months will be carried out in 11 Ministry of Health primary care facilities starting in September 2023. A planned sample of 100 adult patients diagnosed with diabetes (n = 45), hypertension (n = 45), or both (n = 10) will be enrolled. The intervention will consist of HEARTS-aligned components: Training health workers on healthy-lifestyle counseling and evidence-based treatment protocols, strengthening access to medications and diagnostics, training on risk-based cardiovascular disease management, team-based care and task sharing, and systems monitoring and feedback, including implementation of a facility-based electronic monitoring tool at the individual level. Co-primary outcomes of feasibility and acceptability will be assessed using an explanatory sequential mixed-methods design. Secondary outcomes include clinical effectiveness (treatment with medication, glycemic control, and blood pressure control), key implementation outcomes (adoption, fidelity, usability, and sustainability), and patient-reported outcome measures (diabetes distress, disability, and treatment burden). Using an implementation mapping approach, a Technical Advisory Committee will develop implementation strategies for subsequent scale-up planning.DiscussionThis trial will produce evidence on implementing HEARTS-aligned hypertension and diabetes care in the MOH primary care system in Guatemala. Results also will inform future HEARTS projects in Guatemala and other low- and middle-income countries.Trial registrationClinicalTrials.gov ID NCT06080451. The trial was prospectively registered on October 12, 2023.

Resilient Cities: Risk-Based Proactive Management

Şehirlerin dizaynında ve yönetiminde paydaşlar ile hareket etmenin önemi, risk temelli planlar yapılırken bir kez daha anlaşılmaktadır. Şehirlerin yaşam kalitesi, kentsel donatıların sosyal ve ekonomik ihtiyaçlara cevap verebilmesiyle artmaktadır. Haliyle kentsel yaşam kalitesi göstergelerinin oluşturulması ve bu temelde oluşabilecek risklerin belirlenmesi konusunda senaryo analizlerinin dayanıklı şehirler için vazgeçilmez gerekliliktir. Dayanıklılık genel olarak kurumların bir tehlikeye/olumsuzluğa maruz kalındığında sistemsel uyum sağlayabilme kapasitesini ifade eder. Dirençli şehir kavramı da buradan türetilerek, şehirlerin maruz kaldıkları tehditlere karşı koyabilme ve sürecin getirdiği yeni duruma uyum sağlayabilme ve önceden belirlenen yeni sürece doğru yol alabilme kapasitesini ifade eder. Risk Temelli Planlama günümüzde özellikle büyükşehir ve büyükşehir ilçe belediyelerinin önemle dikkate almaları gereken yönetsel fırsatlar sunmaktadır. Tüm kurumsal yönetim yapısı olan organizasyonlar gibi belediyeler de mevcut imkanları en iyi şekilde kullanmak amacıyla geleceği planlamak zorundadır. Özellikle, ekonomik istikrasızlık ve sosyal-kültürel değişimlerin hızlı olduğu/olabileceği dönemlerde risk-temelli stratejik amaç ve hedeflerin öncelikle ele alınması gerekir. Zira belediyelerin kentsel yaşam kalitesini geliştirme adına çok çeşitli görev alanları bulunmakta ve geniş bir yelpazede stratejik hedefler oluşturabilmektedirler. Kentsel yaşam kalitesini artırmanın ötesinde sosyo-ekonomik ve sosyo-kültürel düzen ve istikrarın korunması amacıyla kurumsal yönetim risk haritasının detaylandırılması ve bu risklerin göz önüne alınarak hedeflerin oluşturulmasına ağırlık verilebilir. Haliyle kurumsal kaynaklar normal zamanlardan daha fazla bu alana tahsis edilebilecektir. Özetle, göz ardı edilmemesi gereken husus, risk yönetiminde proaktif eylemler ancak riskin önceden belirlenmesi/tahmin edilmesi ve yönetsel kapasitenin bu yönde hazırlanmasıyla mümkündür.

Current Status and Future Directions: The Application of Artificial Intelligence/Machine Learning for Precision Medicine.

Technological innovations, such as artificial intelligence (AI) and machine learning (ML), have the potential to expedite the goal of precision medicine, especially when combined with increased capacity for voluminous data from multiple sources and expanded therapeutic modalities; however, they also present several challenges. In this communication, we first discuss the goals of precision medicine, and contextualize the use of AI in precision medicine by showcasing innovative applications (e.g., prediction of tumor growth and overall survival, biomarker identification using biomedical images, and identification of patient population for clinical practice) which were presented during the February 2023 virtual public workshop entitled "Application of Artificial Intelligence and Machine Learning for Precision Medicine," hosted by the US Food and Drug Administration (FDA) and University of Maryland Center of Excellence in Regulatory Science and Innovation (M-CERSI). Next, we put forward challenges brought about by the multidisciplinary nature of AI, particularly highlighting the need for AI to be trustworthy. To address such challenges, we subsequently note practical approaches, viz., differential privacy, synthetic data generation, and federated learning. The proposed strategies - some of which are highlighted presentations from the workshop - are for the protection of personal information and intellectual property. In addition, methods such as the risk-based management approach and the need for an agile regulatory ecosystem are discussed. Finally, we lay out a call for action that includes sharing of data and algorithms, development of regulatory guidance documents, and pooling of expertise from a broad-spectrum of stakeholders to enhance the application of AI in precision medicine.

The Dental Implications of Gastro-oesophageal Reflux Disease in Children

Gastro-oesophageal reflux disease (GORD) is common in children and has numerous extra-oesophageal manifestations which dental practitioners should be aware of. This article illustrates the role of the dentist in recognizing the signs and symptoms of GORD in children. A risk-based management system is illustrated to guide clinicians in managing children exhibiting erosive tooth wear. CPD/Clinical Relevance: Dental implications of GORD in children and its management provide useful clinical information for dental practitioners.

Developing a risk-based strategic human resource management: a mixed-method approach

Developing a risk-based strategic human resource management: a mixed-method approach

A risk management framework for Taenia saginata eggs in recycled water to minimise the risk of Cysticercus bovis in cattle

To use water recycled from sewage (recycled water), the helminth egg from T. saginata requires management to minimise the risk of causing Cysticercus bovis (CB) in cattle when the egg is ingested. Recent advances in the risk management of helminth eggs in recycled water have allowed a risk management approach to be developed by the cattle production sector and low risk recycled water defined (i.e. fit for the purpose of cattle production). The approach described here connects the risk-based management systems from the recycled water, cattle production and processing sectors. The recent literature was also reviewed to update methods for achieving the required LRV to provide low risk recycled water. The connection between the two sectors allows improvements and cost savings for both sectors by providing a rational quantitative approach to CB management in cattle where recycled water is used.

УПРАВЛЕНИЕ РИСКАМИ ВНЕДРЕНИЯ ИННОВАЦИЙ В ОРГАНИЗАЦИИ ТЕПЛОСНАБЖЕНИЯ

The introduction of innovations in the organization of heat supply is accompanied by high risks, which necessitates the implementation of risk-based management. In this regard, the basic principles of risk management for the introduction of innovations in the organization of heat supply are defined, on the basis of which a model of the risk management process is formed, and the main risks of introducing innovations into the organizations under study, taking into account the specifics of their activities, are highlighted.

Risk-based dependability management in the context of ISO 55000 standards

The ISO 55000 standards establishes a risk-based approach to asset management. For an organization operating assets, this means that it must independently assess the risks associated with the assets and make decisions based on risk assessment. First of all, it concerns the risks associated with failures and the reliability of assets. In this regard, the operating organization must constantly optimize the asset maintenance schedule, based on the actual results of operation and the current risk assessment.