Risk Judgments Research Articles

In Response.

Fascial plane blocks are increasingly used at our institution as adjuncts to postoperative analgesia in cardiac surgery despite current low-level evidence on their efficacy and safety. It is our belief that the clinically observed benefits warrant consideration of such adjunctive techniques, which may lead to enhanced recovery and decreased postoperative opioid utilization and its associated short- and long-term side effects. We thank Drs de Souza and Maguire1 for their interest and comments on our recent review of regional anesthesia in cardiac surgery focusing on chest wall fascial plane blocks.2 We would like to emphasize that a detailed anatomical description of anatomy, and most important, nerves providing sensory innervation to the chest wall area, is described under the subtitle Chest Wall Innervation, which is also supplemented by Figures 1 and 2. We would like to thank Drs de Souza and Maguire for noticing a discrepant statement referring to the same anatomical considerations under our discussion on erector spine plane (ESP) block clinical applications. As described under the Chest Wall Innervation section and pointed out by the authors, each spinal nerve exits an intervertebral foramen and then divides into a dorsal and ventral ramus. While the dorsal rami supply the muscles, bones, joints, and skin of the posterior trunk, the ventral rami innervate lateral and anterior trunk. Every procedure performed in medicine is associated with minor or major complications. In our review, we discuss both reported and potential complications. At the time of manuscript preparation, we were not aware of reported complications involving the ESP block and could only discuss potential theoretical complications. We thank the authors for the updated information and reports on local anesthetic systemic toxicity, pneumothorax, and other complications associated with the ESP block.3,4 With its increased clinical utilization, we will likely see more reports on associated complications. As with any procedure, especially when there is no or minimal evidence, to avoid both known and theoretical complications, we advocate for sound clinical judgment and consideration of risks and benefits in each individual patient. We invite colleagues to reach out and share their clinical experiences with the described blocks for cardiac surgical procedures while awaiting more objective evidence on their safety and efficacy in this clinical setting. Marta Kelava, MDAndrej Alfirevic, MD, FASESergio Bustamante, MDJennifer Hargrave, DO, FASADonn Marciniak, MDDepartment of Cardiothoracic AnesthesiologyAnesthesiology InstituteCleveland ClinicCleveland, Ohio[email protected]

Research on Influencing Factors of Unsafe Behavior of Prefabricated Building

There are obvious differences between the assembly construction method and the traditional cast-in-place construction. At present, the assembly construction technology and management standards have not been perfected in our country, and the acceleration of technology can create unparalleled cascades of benefits as well as new risks of catastrophe. Through a lot of literature research, this paper designs questionnaires including risk perception, convenience perception, managerial pressure, co-worker pressure, and judgement ability based on the theory of planned behavior, and conducts factor analysis on the collected data. Finally, based on the analysis results, corresponding management level factors, workers level factors and self-perception factors of unsafe behaviors in prefabricated buildings are proposed.

The Affect Heuristic and Risk Perception - Stability Across Elicitation Methods and Individual Cognitive Abilities.

The reliance on feelings when judging risks and benefits is one of the most fundamental valuation processes in risk perception. Although previous research suggests that the affect heuristic reliably predicts an inverse correlation between risk and benefit judgments, it has not yet been tested if the affect heuristic is sensitive to elicitation method effects (joint/separate evaluation) and to what extent individual differences in cognitive abilities may mediate the risk–benefit correlation. Across two studies we find that (1) the risk–benefit correlation is stable across different elicitation methods and for different domains (e.g., social domain, sensation-seeking domain, health domain, economic domain) and (2) the strength of the inverse correlation is tied to individual cognitive abilities—primarily cognitive reflection ability.

Introduction of the Prediction model Risk Of Bias ASsessment Tool: a tool to assess risk of bias and applicability of prediction model studies

This paper introduceds the tool named as "Prediction model Risk Of Bias ASsessment Tool" (PROBAST) to assess the risk of bias and applicability in prediction model studies and the relevant items and steps of assessment. PROBAST is organized into four domains including participants, predictors, outcome and analysis. These domains contain a total of 20 signaling questions to facilitate structured judgment of risk of bias occurring in study design, conduct or analysis. Through comprehensive judgment, the risk of bias and applicability of original study is categorized as high, low or unclear. PROBAST enables a focused and transparent approach to assessing the risk of bias of studies that develop, validate, or update prediction models for individualized predictions. Although PROBAST was designed for systematic reviews, it can be also used more generally in critical appraisal of prediction model studies.

Bringing Radiation Exposures and Associated Health Risks into Perspective-Development of an App.

The NATO HFM 291 research task group (RTG) on "Ionizing Radiation Bioeffects and Countermeasures" represents a group of scientists from military and civilian academic and scientific institutions primarily working in the field of radiobiology. Among other tasks, the RTG intends to extend their work on risk estimation and communication to bridge the gap in appropriate judgment of health risks given a certain radiation exposure. The group has no explicit psychological background but an expertise in radiobiology and risk assessment. The group believes that, as one of the essential first steps in risk communication, it is required to put radiation risk into perspective. Radiation risk requires a weight in comparison to already-known risks. What we envision is to Compare Radiation exposure-associated health Risks (CRRis App) with daily life health risks caused by other common exposures such as cigarette smoking, driving a car, etc. Within this paper, we provide (1) an overview of health risks after radiation exposure, (2) an explanation of the task and concept of an envisioned CRRis App, (3) an overview of existing software tools related to this issue, (4) a summary of inputs and discussions with experts in the field of radiation protection and risk communication during the ConRad conference, and finally, (5) identification of the next steps in the development of the App.

Association between unrealistic comparative optimism and self-management in individuals with type 2 diabetes: Results from a cross-sectional, population-based study.

Background and aimsUnrealistic comparative optimism (UO), as the erroneous judgement of personal risks to be lower than the risks of others, could help explain differences in diabetes self‐management. The present study tested the hypothesis that individuals with type 2 diabetes who underestimate their comparative heart attack risk, have a lower adherence regarding recommended self‐management.MethodsWe used data from individuals with type 2 diabetes participating in the German KORA (Cooperative Health Research in the Region of Augsburg) GEFU 4 (self‐administered health questionnaire 2016) study. UO was estimated by comparing participants' subjective comparative risk for having a heart attack within the next 5‐years (ie, “higher than others,” “average,” “lower than others”), with their objective comparative 10‐year cardiovascular disease risk based on the Framingham equations. We estimated binary logistic and linear regression models to analyze which characteristics were associated with UO and to test the association between UO and participants' self‐management behaviors (ie, regular self‐monitoring of body weight, blood sugar, and blood pressure, regular foot care, keeping a diabetes diary, and having a diet plan), and their sum score, respectively. All models were adjusted for socio‐demographic and disease‐related variables.ResultsThe studied sample included n = 633 individuals with type 2 diabetes (mean age 70.7 years, 45% women). Smokers and males were more likely to show UO than nonsmokers and females. Furthermore, a higher blood pressure and a higher body mass index were associated with a higher likelihood of UO regarding heart attack risk. However, UO was not significantly associated with patient self‐management.ConclusionsUnfavorable health behavior and risk factors are associated with UO. However, our results suggest that UO with regard to perceived heart attack risk may not be a relevant factor for patient self‐management in those with type 2 diabetes.

Trajectories of hospital infection control: Using non-representational theory to understand and improve infection prevention and control

In this paper we undertake an innovative analysis of infection prevention and control (IPC) activities in hospitals, using non-representational theory of space (2005). We deployed video-reflexive ethnography in three wards in two metropolitan teaching hospitals involving 252 healthcare workers as participants. We analysed our data iteratively using non-representational theory, which showed hospital space being constantly produced from varied, intersecting, and sometimes competing trajectories of hospital work, objects and people. The approach enabled multiple material factors impinging on routine IPC (including objects such as rolls of surgical tape), and habitual or prioritised actions (such as safeguarding patient privacy) to be included in analysis. The analysis also included the role of time which has been absent from other discussions of IPC, highlighting the transience of spaces produced through IPC practices and the need to continually re-make them. We found many situations in which the complexity of practice, rather than failures of compliance, contributed to potential microbial transmission. We show how inconsistency and confusion about IPC practice often can only be resolved through action. Our findings suggest that further reduction in preventable hospital infection rates will require better integration of IPC with other work trajectories; a shift in emphasis from compliance monitoring to collaborative practice; and greater use of in situ risk assessment and judgment.

Targeting Perceptions of Risk from Injudicious Antibiotic Use: An Application of the Risk Information Seeking and Processing Model

Enhancing knowledge about antibiotic-associated risks is key to reducing injudicious antibiotic use and slowing antibiotic resistance. Using the Risk Information Seeking and Processing (RISP) model, the study identified predictors of individuals’ seeking and avoidance of information about antibiotic risks and tested the effectiveness of exposure to a RISP-informed video intervention against exposure to a CDC-produced video and a control group. In a national sample (N = 1000), risk judgment led to greater negative affect toward risks of antibiotics and lower positive affect toward antibiotic usefulness. In turn, positive and negative affect shaped information insufficiency, which interacted with perceived information gathering capacity to influence risk information seeking and avoidance. In addition, informational subjective norms and affective responses directly shaped individuals’ information behavior. Results showed that relative to the control group, participants viewing the RISP-informed video had greater risk judgment, perceived current knowledge about antibiotic risks, perceived information gathering capacity, and informational subjective norms, as well as lower levels of positive affect toward antibiotics. The RISP-informed video and CDC-produced video performed equivalently well. Implications of the findings for the design of antibiotic stewardship messages are discussed

Predicting Patients' Readmission: Do Clinicians Outperform a Statistical Model? An Exploratory Study on Clinical Risk Judgment in Mental Health.

This study explores whether clinicians or a statistical model can better identify patients at risk of early readmission and investigates variables potentially associated with clinicians' risk judgment. We focus on a total of 142 patients discharged from acute psychiatric wards in the Verona Mental Health Department (Italy). Psychiatrists assessed patients' risk of readmission at 30 and 90 days postdischarge, predicted their postdischarge compliance, and assessed their Global Assessment of Functioning (GAF) score at admission and discharge. Clinicians' judgment outperformed the statistical model, with the difference reaching statistical significance for 30-day readmission. Clinicians' readmission risk judgment, both for 30 and 90 days, was found to be statistically associated with predicted compliance with community treatment and GAF score at discharge. Clinicians' superior performance might be explained by their risk judgment depending on nonmeasurable factors, such as experience and intuition. Patients with a poorer GAF score at discharge and poor assumed compliance were predicted to have a higher risk of readmission.

Deforming tendency prediction study on typical accumulation landslide with step-like displacements in the Three Gorges Reservoir, China

Lots of accumulation landslides with step-like displacements occurred in the Three Gorges Reservoir due to periodic reservoir operation. This type of landslide has continued to deform for a long time, with large cumulative deformation, which may influence the land use in the reservoir and landslide control risk judgment. The accumulation landslides with four typical step-like displacement-time curves during more than 10 years, namely Baijiabao landslide, Laoshewo landslide, Heishiban landslide, and Shuping landslide, are demonstrated. The cumulative displacement-time curve of Laoshewo landslide obviously shows that its deforming tendency is slowing down, while that of Heishiban landslide clearly indicates the increasingly serious deformation. When the step-like displacement increments get close to each other, it is harder to predict the landslide tendency based on displacement, velocity, inverse velocity, or acceleration in a whole continuous period. A step-like displacement-time curve can be considered as a curve of a piecewise function, varying as time goes. Therefore, the piecewise function is proposed to analyze the tendency by different time periods. As the environment of rapid deforming period is similar, the deforming tendency of a landslide with step-like displacements can be better demonstrated by collecting data in the rapid deforming period to analyze its tendency. For Shuping landslide, the fluctuating decline in velocity and acceleration in the rapid deforming period shows that the landslide tends to become more and more stable. This well matches the status quo of Shuping landslide, as it has been treated during August 2014 to March 2015, which also verifies the effectiveness of this proposed method. For Baijiabao landslide, the inverse velocity-time curve in the rapid deforming period features fluctuating decline, indicating that the landslide tends to be increasingly unstable. Meanwhile, the discussion on failure prediction found that the watch window for critical prediction of Baijiabao landslide may open in the flood season of several years’ future. The method proposed is effective for predicting the deforming tendency of landslides with step-like displacements, provides a time window for critical prediction, and offers technical support for landslide risk control, alarm, and forecasting.

The COVID-19 pandemic: how can risk science help?

This paper reflects on how risk science, with its concepts, principles, approaches, methods and models, can support the actual assessments, communication and handling of the vulnerabilities and risks related to the Coronavirus (Covid-19) pandemic. We highlight the importance of acknowledging uncertainty as a main component of risk, in order to properly characterize and communicate risk, as well as to understand the difference between professional risk judgements and risk perception. We challenge the use of the commonly referred to phrase that the policies adopted are science-based, in a situation like this characterized by fundamental uncertainties about the underlying phenomena and the effects of possible interventions. Arguments are provided for a ‘balanced’ use of precaution, combined with adaptive management and learning.

Extending a broadly applicable measure of risk perception: the case for susceptibility

Many empirical studies that inform research, policy and practice surrounding hazards and risk and concerned with how members of the public perceive risk. However, these studies often assess perceived risk using a diverse range of either very general measures or measures of specific subsidiary concepts (for instance, the severity of consequences or the likelihood of occurrence). Previous research by Wilson and others has suggested that perceived risk is best understood and measured as a multidimensional construct that includes beliefs about the likelihood and severity of consequences and the feelings or affect elicited by the hazard. The research presented here extends the work of Wilson et al. by separating the likelihood of consequences into two components that denote the likelihood of the occurrence of a hazard (exposure) and the likelihood of experiencing consequences given exposure (susceptibility). This research replicates findings from Wilson et al. that perceived risk is best conceived of as a multidimensional construct and that affective responses are a primary driver of holistic judgments of both personal and general risk across a variety of hazards. We find that perceptions of susceptibility explain unique variance in holistic judgments of risk, however the importance of the susceptibility concept differs across hazards and across judgments of personal and general risk. These results suggest that measures of susceptibility can meaningfully increase our ability to understand the beliefs that underlie perceptions of the risk posed by a diverse range of hazards. This suggests that developing measures including susceptibility can provide unique opportunities to improve risk communication and risk management policy outcomes.

Study on risk evaluation of intellectual property pledge loan based on fuzzy analytic hierarchy process

From the six aspects of the risk of intellectual property itself, intellectual property rights technology uses risks, risks of intellectual property laws, intellectual property rights market risk, business risk, macro environment of intellectual property, build a comprehensive intellectual property rights pledge loan risk evaluation index system, and bythe fuzzy analytic hierarchy process (ahp) combining qualitative and quantitative, ultimately determine the pledge loan risk level. This paper makes an empirical analysis of the selected cases, and the research results show that the fuzzy analytic hierarchy process can effectively quantify the risk of intellectual property pledge loans, which is conducive to the risk judgment and identification of this kind of pledge loans.

How to Communicate an Exclusion From the Statutory Audit of Narrative Reports?

This study addresses two potential ways of communicating an exclusion from a statutory audit of narratives, as recently proposed by auditors: (1) an explicit label at the page margin and (2) an appendix to the auditor’s report referencing unaudited information. We conduct an eye-tracking experiment and examine the impact of communicating such an exclusion from the audit on financial report users’ attention, understanding, and credit risk judgment in a lending-decision task. Our results show that the effect of the audit exclusion depends on whether users understand which pieces of information were left unaudited and on the amount of attention they pay to the unaudited information. Specifically, we predict and find that the label increases users’ attention to unaudited information and enhances their understanding of the audit exclusion. For an appendix to the auditor’s report, however, we cannot document similar results. Users subject to the appendix do not direct more attention to the unaudited information and even show a lower ability to distinguish audited from unaudited information. Furthermore, the amount of attention that users pay to the unaudited information and their degree of understanding of the audit exclusion have a direct influence on their credit risk assessment. The results of this study imply a potentially widened expectations gap due to audit exclusions and highlight the need for clear communication of the audit status of narratives.

Uncertainty as a Driving Force for Geoscientific Development

Geoscientists invest significant effort to cope with uncertainty in Earth system observation and modeling. While general discussions exist about uncertainty and risk communication, judgment and decision-making, and science communication with regard to Earth sciences, in this article, we tackle uncertainty from the perspective of Earth science practitioners. We argue different scientific methodologies must be used to recognize all types of uncertainty inherent to a scientific finding. Following a discovery science methodology results in greater potential for the quantification of uncertainty associated to scientific findings than staying inside hypothesis-driven science methodology, as is common practice. Enabling improved uncertainty quantification could relax debates about risk communication and decision-making since it reduces the room for personality traits when communicating scientific findings.

The Impact of COVID-19 Epidemic Declaration on Psychological Consequences: A Study on Active Weibo Users.

COVID-19 (Corona Virus Disease 2019) has significantly resulted in a large number of psychological consequences. The aim of this study is to explore the impacts of COVID-19 on people’s mental health, to assist policy makers to develop actionable policies, and help clinical practitioners (e.g., social workers, psychiatrists, and psychologists) provide timely services to affected populations. We sample and analyze the Weibo posts from 17,865 active Weibo users using the approach of Online Ecological Recognition (OER) based on several machine-learning predictive models. We calculated word frequency, scores of emotional indicators (e.g., anxiety, depression, indignation, and Oxford happiness) and cognitive indicators (e.g., social risk judgment and life satisfaction) from the collected data. The sentiment analysis and the paired sample t-test were performed to examine the differences in the same group before and after the declaration of COVID-19 on 20 January, 2020. The results showed that negative emotions (e.g., anxiety, depression and indignation) and sensitivity to social risks increased, while the scores of positive emotions (e.g., Oxford happiness) and life satisfaction decreased. People were concerned more about their health and family, while less about leisure and friends. The results contribute to the knowledge gaps of short-term individual changes in psychological conditions after the outbreak. It may provide references for policy makers to plan and fight against COVID-19 effectively by improving stability of popular feelings and urgently prepare clinical practitioners to deliver corresponding therapy foundations for the risk groups and affected people.

Nurses’ judgments of patient risk of deterioration at change-of-shift handoff: Agreement between nurses and comparison with early warning scores

BackgroundNurses begin forming judgments regarding patients’ clinical stability during change-of-shift handoffs. ObjectivesTo examine the agreement between incoming and outgoing nurses’ judgments of deterioration risk following handoff and compare these judgments to commonly used early warning scores (MEWS, NEWS, ViEWS). MethodsFollowing handoffs on three medical/surgical units, nurses completed the Patient Acuity Rating. Nurse ratings were compared with computed early warning scores based on clinical data. In follow-up interviews, nurses were invited to describe their experiences of using the rating scale. ResultsSixty-two nurses carried out 444 handoffs for 158 patients. While the agreement between incoming and outgoing nurses was fair, correlations with early warning scores were low. Nurses struggled with predicting risk and used their impressions of differential risk across all the patients to whom they had been assigned to arrive at their ratings. ConclusionNurses shared information that influenced their clinical judgments at handoff; not all of these cues may necessarily be captured in early warning scores.

Consumption, knowledge, and food safety practices of Brazilian seafood consumers

The present work aimed to evaluate the frequency of seafood consumption by the Brazilian population, the safety practices during seafood handling and preservation as well as to evaluate the consumers’ perception on the risks associated with these foods. A total of 962 respondents responded to a survey divided into three parts: demographic and socio-economic profiles, seafood consumption habits, safety practices, and risk perceptions regarding seafood. The survey revealed a low level of perception about seafood safety. The respondents (64–71%) demonstrated a lack of knowledge of the main pathogens associated with seafood disease outbreaks and presented difficulties in identifying consumption places that could result in higher microbiological risk. Besides, these respondents showed to be unaware of their responsibility towards seafood safety from purchasing through preparation. Respondents belonging to the generation of baby boomers, with the postgraduate level and females presented a better perception of microbiological risk and on the importance of safety practices. These respondents showed positive attitudes, such as knowledge of the proper thawing procedures of seafood, knowledge of the potential risks to get sick from the consumption of raw seafood, and were also able to recognize Vibrio and Listeria as seafood bacterial pathogens. The knowledge proves to be an adequate tool for perception and judgment of microbiological risk, making the consumer adopt safe practices. The instruction of seafood consumers about safe handling practices and perceptions is critical for the success of farm to fork preventive measures aiming to protect public health.

Food safety culture in food services with different degrees of risk for foodborne diseases in Brazil

Food safety culture may establish the right environment for adequate food handling and management, reducing violations of food safety regulation, especially those related to foodborne disease outbreaks. This study aimed to evaluate differences among elements of food safety culture in food services at low or high-risk for foodborne diseases. This study was conducted with 63 managers and 333 food handlers from 32 food services located in the metropolitan region of Campinas, State of São Paulo, Brazil. The following elements of food safety culture (considering the technical-managerial and human routes) were evaluated: management systems, style, and process; leadership; organizational commitment; food safety climate (communication; self-commitment; management and coworker support; environment support; risk judgment; normative beliefs and work pressure); and risk perceptions. In the technical-managerial route, restaurants were categorized as low- or high foodborne disease risk restaurants. For the evaluation of food safety management systems, a validated checklist was used. In the human route, food safety climate analysis was performed by evaluating five elements applied exclusively to food handlers. High-risk restaurants presented a higher percentage of violation in most aspects related to food safety regulation and physical structure. Leadership and knowledge of low-risk restaurants' managers presented a higher level when compared to high-risk restaurants’ managers, showing that in the first group managers acted as mediators of safe practices. Food handlers from low-risk restaurants presented higher scores in food safety knowledge, organizational commitment, and food safety climate when compared to food handlers from high-risk restaurants. In restaurants with lower risk for foodborne diseases, the elements of food safety culture were better evaluated, indicating fewer violations of food safety regulation. In these restaurants, a consistent food safety climate was perceived within the technical-managerial route. This result shows that fewer violations of food safety legislation, especially those involving high-risk foodborne disease, were a positive outcome of an improved FS-culture. In this sense, it is possible to improve food safety by applying, evolving and maturing the concepts of FS-culture in restaurants in Brazil.

Interrater reliability, concurrent validity, and predictive validity of the risk for sexual violence protocol.

This study empirically evaluated risk judgments made using the Risk for Sexual Violence Protocol (RSVP; Hart et al., 2003), a widely used set of structured professional guidelines for assessing and managing sexual violence risk. Based on evaluations of other structured professional judgment guidelines, we hypothesized that judgments made using the RSVP would demonstrate good interrater reliability, concurrent validity, and predictive validity. Based on file review, research assistants made ratings using the RSVP and two commonly used actuarial tools for sexual violence risk assessment in a sample of 100 adult male sexual offenders who successfully completed a community-based sex offender treatment program. Recidivism information was obtained from official records 10 years after treatment completion. With respect to interrater reliability, judgments of the presence and relevance of individual risk factors ranged from moderate to almost perfect, and those for composite scores reflecting the sum of these ratings were almost perfect. Interrater reliability for integrative summary risk ratings was substantial to almost perfect. Regarding concurrent validity, the findings indicated that judgments made using the RSVP had moderate to large and statistically significant correlations with scores on the actuarial tools. Finally, with respect to predictive validity, RSVP presence total scores and summary risk ratings were predictive of new sexual violence over the follow-up, and the magnitude of their predictive validity effect sizes was similar to that of scores on the actuarial tools. The findings supported the potential utility of the RSVP in practice. (PsycINFO Database Record (c) 2020 APA, all rights reserved).