Risk Statements Research Articles

Content Analysis of US News Stories About E-Cigarettes in 2015.

Coverage of e-cigarettes in the news media may shape public perceptions about them but little is known about such news content. This content analysis characterized discussion of e-cigarettes in leading print and online US news sources in 2015. We searched Access World News and Factiva databases for e-cigarette-related news articles appearing in the top 30 circulating newspapers, 4 newswires, and 4 online news sources in the United States in 2015 (n = 295). Coders identified the presence of various e-cigarette topics (e.g. regulation), and benefit and risk statements. Nearly half of articles (45.1%) focused primarily on e-cigarette policy/regulatory issues, although e-cigarette prevalence (21.0%) and health effects (21.7%) were common main topics. Concerns about youth were frequently mentioned, including the rise in youth e-cigarette use (45.4%), gateway to smoking potential (33.9%) and appeal of flavors (22.4%). Youth e-cigarette prevalence was more frequently mentioned than adult prevalence in articles discussing FDA regulation (61% vs. 13.5%, respectively). News articles more frequently discussed potential e-cigarette risks or concerns (80%) than benefits (45.4%), such as smoking harm-reduction. Quoted physicians, researchers, and government representatives were more likely to refer to e-cigarette risks than benefits. In 2015, rising rates of e-cigarette use among youth and policy strategies to address e-cigarettes dominated US e-cigarette news stories, leading up to their FDA regulation in 2016. Statements about e-cigarettes' potential risks were frequently attributed to trusted sources such as physicians, and outnumbered claims about their harm-reduction benefits. Such coverage may impact e-cigarette risk perceptions, use intentions and policy support. In the year leading up to the FDA's Deeming Rule, concerns about youth use or potential use were frequently discussed in e-cigarette news. News articles more frequently discussed potential e-cigarette risks/concerns compared to potential harm-reduction benefits relative to tobacco cigarettes. While such coverage may inform the public about potential e-cigarette risks, they may also contribute to increasing perceptions that e-cigarettes are as harmful as tobacco cigarettes. E-cigarette risk and benefit statements were most frequently made by or attributed to researchers and physicians in articles, which is significant given that they may be particularly trusted sources of e-cigarette risk information.

Serious and actionable risks, plus disclosure: Investigating an alternative approach for presenting risk information in prescription drug television advertisements.

Broadcast direct-to-consumer (DTC) prescription drug ads that present product claims are required to also present the product's major risks. Debate exists regarding how much information should be included in these major risk statements. Some argue that such statements expose people to unnecessary amounts of information, while others argue that they leave out important information. Examine the impact of type of risk statement (unedited versus serious and actionable risks only) and a disclosure indicating that not all risks are presented on consumers' ability to remember the important risks and benefits of a drug following exposure to a DTC television advertisement (ad). Risk and benefit perceptions, ad-prompted actions, recognition of the disclosure statement, and evaluations of both the disclosure and risk statement were also examined. A web-based experiment was conducted in which US adults who self-reported as having depression (N=500), insomnia (N=500), or high cholesterol (N=500) were randomly assigned to view one of four versions of the television ad, and then complete a questionnaire. The type of risk statement had a significant effect on risk recall and recognition, benefit recognition, perceived risk severity (depression condition only), and perceived benefit magnitude (high cholesterol condition only). Disclosure recognition (using bias-corrected scores) ranged from 63% to 70% across the three illness samples. The revised risk statement improved overall processing of the television ad, as evidenced by improved risk recall and recognition and improved benefit recognition. Further, the presence of the disclosure did not adversely affect consumers' processing of drug risk and benefit information. Therefore, limiting the risks presented in DTC television ads and including a disclosure alerting consumers that not all risks are presented may be an effective strategy for communicating product risks.

Alcohol Outcomes by Sexual Orientation and Race/Ethnicity: Few Findings of Higher Risk.

This study sought to confirm a previously identified race by sexual orientation interaction and to clarify men's alcohol-related risk by using an expanded classification of sexual orientation. We collapsed three waves of National Alcohol Survey data, restricting the analytic sample to White (n = 5,689), Black (n = 1,237), and Latino (n = 1,549) men with complete information on sexual orientation and alcohol use. Using self-reported sexual identity and behavior, respondents were categorized as exclusively heterosexual (referent), behaviorally discordant heterosexuals (i.e., heterosexual identity and same-sex partners), or gay/bisexually identified men. We used multivariable logistic regression to model lifetime alcohol dependence symptoms, lifetime drinking-related consequences, and past-year hazardous drinking, controlling for age, education, employment, and relationship status and accounting for the complex survey design. There was no difference in risk of past-year hazardous drinking and lifetime drinking-related consequences between heterosexual, behaviorally discordant heterosexual, and gay/bisexual men, independent of race/ ethnicity. Among Black men, behaviorally discordant heterosexuals had three-fold higher odds of lifetime alcohol dependence symptoms than exclusively heterosexual peers (aOR = 3.30, 95% CI [1.19, 9.18], p = .02). Gay/bisexual Latino men had marginally significantly lower odds of lifetime alcohol dependence symptoms (aOR = 0.36, 95% CI [0.12, 1.03], p = .06). There is little support for broad statements of greater alcohol risk among gay/bisexual men; however, for some subgroups and outcomes the direction and degree of risk depend on race/ ethnicity. Thus, this study underscores the importance of considering the potential interaction of sexual orientation and race/ethnicity, which may exacerbate or attenuate.

IT risk management disclosure in the integrated reports of the top 40 listed companies on the JSE limited

Information Technology (IT) has become an integral part of virtually all modern day organisations. The advent of IT has given rise to numerous benefits which increase productivity and efficiency in the workplace, however, IT also brings with it significant risks that can have an impact on an organisation’s ability to function as a going concern. Organisations, especially those listed on the Johannesburg Stock Exchange (JSE), are required to submit an Integrated Report (IR) on an annual basis in which they indicate how they used the resources at their disposal to create value for the organisation and its stakeholders during the year under review. The IR is also a forward-looking document, as opposed to the traditional, backward-looking reports. The purpose of this paper is to determine to what extent IT Risk and IT Risk Management are disclosed in the IR’s of the Top 40 Listed Companies on the JSE. It further aims to determine whether IT Risks are included as material risk in the entity’s risk statements of the Integrated Report, and whether proper explanations are provided on how the materiality of the risks are determined and dealt with. This is done by means of an empirical study consisting of a content analysis of the IRs of the Top 40 listed companies on the JSE. The results of the analysis indicates that more than half of the companies included IT risk as part of their material risks and outlined appropriate and detailed processes that were followed by the company to manage those IT risks. The findings of the study accordingly support the need for communicating significant risks and the management thereof to stakeholders as part of the integrated nature of governance of entities. However, it is disconcerting that some companies are not doing this, and accordingly are not realising the need for communicating significant matters to their stakeholders and the value that informative and credible reporting will bring to an entity’s Integrated Report.

Interrater reliability of Violence Risk Appraisal Guide scores provided in Canadian criminal proceedings.

Published research suggests that most violence risk assessment tools have relatively high levels of interrater reliability, but recent evidence of inconsistent scores among forensic examiners in adversarial settings raises concerns about the "field reliability" of such measures. This study specifically examined the reliability of Violence Risk Appraisal Guide (VRAG) scores in Canadian criminal cases identified in the legal database, LexisNexis. Over 250 reported cases were located that made mention of the VRAG, with 42 of these cases containing 2 or more scores that could be submitted to interrater reliability analyses. Overall, scores were skewed toward higher risk categories. The intraclass correlation (ICCA1) was .66, with pairs of forensic examiners placing defendants into the same VRAG risk "bin" in 68% of the cases. For categorical risk statements (i.e., low, moderate, high), examiners provided converging assessment results in most instances (86%). In terms of potential predictors of rater disagreement, there was no evidence for adversarial allegiance in our sample. Rater disagreement in the scoring of 1 VRAG item (Psychopathy Checklist-Revised; Hare, 2003), however, strongly predicted rater disagreement in the scoring of the VRAG (r = .58). (PsycINFO Database Record

Introduction

Due to experiences such as the Chernobyl disaster, the asbestos tragedy, various foodscandals and comparable experiences, in modern times technology-based innovationis often associated with risks that are highly uncertain. In other words, there aresuspicions about potential hazards to human health or the environment for which thereis no scientific proof, but which cannot be fully refuted either (Van Asselt & Vos 2006).Following scandals such as the BSE crisis where uncertain risks were initially ignored andgovernments and experts attempted to reassure the public with zero risk statements, thecurrent societal climate in which innovation takes place can be characterized as ‘posttrust’(Löfstedt 2005).Technology-based innovation poses significant challenges to regulators. In the earlystages of the innovation process, when technology could be controlled relatively easily,one does not know enough about harmful consequences to issue regulation, whilst at alater stage, by the time consequences are apparent, control by regulation is expensive anddrastic. This dilemma is referred to as the Collingridge dilemma of control of technology(Collingridge 1980). Furthermore, research into health and environmental impacts usuallylags behind: by the time first insights are available, the research is already outdatedbecause new generations of the technologies are already available (Harremoës et al. 2002)Regulators are foremost confronted with the obstacles to innovation in the contextof trade: the free circulation of innovative products may be blocked by states or tradeblocks for reasons of protection of human or environmental health. Controversiesabout innovation and uncertain risks therefore often have trade consequences. Manyof the complex cases that challenge the EU or the World Trade Organisation (WTO) intheir ambition for further market integration pertain to conflicts about innovation anduncertain risks (Prévost 2014). The question often is how to allow free trade while at thesame time ensuring that the protection of human and environmental health is duly takeninto consideration. Trade conflicts concerning genetically modified organisms (GMOs) andhormones in beef are iconic examples.

A Responsabilidade Ambiental-Trabalhista Decorrente da Utilização de Agrotóxicos

O presente artigo trata de um assunto pouco debatido na doutrina trabalhista, a temática dos agrotóxicos e a responsabilidade socioambiental dos empregadores pelos riscos e agravos à saúde do trabalhador, notadamente o rual. Nada obstante os estudos amplos e profícuos sobre a questão dos agrotóxicos, em especial no âmbito de outras ciências, não há muitos estudos jurídicos focados na proteção do trabalhador. O meio ambiente do trabalho é direito humano fundamental (artigo 7°, inciso XXII, e artigo 200, inciso VIII, da Constituição da República) e sua higidez surge como dever contratual do empregador. Os estudos sobre a realidade da questão são demonstrativos da situação de risco a que são submetidos os trabalhadores e da ausência de proteção à saúde e segurança das pessoas que manuseiam estas substâncias tóxicas. Somente o empoderamento do conhecimento científico, em todos os níveis, incluído o jurídico, poderá mobilizar a sociedade para combater os problemas.

Financial Statements as Monitoring Mechanisms: Evidence from Small Commercial Loans

Using a data set that records banks’ ongoing requests of information from small commercial borrowers, we examine when banks use financial statements to monitor borrowers after loan origination. We find that banks request financial statements for half the loans and this variation is related to borrower credit risk, relationship length, collateral, and the provision of business tax returns, but in complex ways. The relation between borrower risk and financial statement requests has an inverted U-shape; and tax returns can be both substitutes and complements to financial statements, conditional on borrower characteristics and the degree of bank–borrower information asymmetry. Frequent financial reporting is used to monitor collateral, but only for non–real estate loans and only when the collateral is easily accessible to lenders. Collectively, our results provide novel evidence of a fundamental information demand for financial reporting in monitoring small commercial borrowers and a specific channel through which banks fulfill their role as delegated monitors.

Smokers' and e-cigarette users' perceptions of modified risk warnings for e-cigarettes.

The 2009 Family Smoking Prevention and Tobacco Control Act opened the possibility for tobacco companies to apply to market their products as having “modified” or reduced risks. However, research on how to communicate comparative tobacco risks and how such messages are interpreted is limited. This study aimed to qualitatively examine perceptions of potential modified risk statements presented as warning labels for e-cigarettes. We conducted six focus groups between 2014 and 2015 with 27 adult e-cigarette users and cigarette-only smokers who provided comments on two versions of a modified risk warning for e-cigarettes: 1) “WARNING: No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes” (as proposed by two companies for their smokeless tobacco products) and 2) “WARNING: This product may be harmful to health, but is substantially less harmful than cigarettes” (an alternative developed by our team). Although most personally believed that e-cigarettes are safer than cigarettes and some thought the messages were true and accurate, many were skeptical and uncomfortable with the warnings because they did not “seem like a warning” and because use of the phrase “substantially lower risks” could be misleading and difficult to understand. Several thought the second warning was stronger (e.g., more active, more specific). Modified risk messages about e-cigarettes may impact perceptions and use of the product. More research is needed to identify the framing, wording and placement (e.g. within or in addition to a warning) that could potentially increase population-level benefits and minimize harms.

해외 건설 다수 프로젝트 관리를 위한 허용리스크 도출 - 중소·중견 건설기업 관점에서 -

해외 시장에서 한국 건설기업들의 지속적인 성장에 힘입어 중소 중견기업 역시 눈에 띄게 성장 하였다. 중소 중견기업의 진출 형태 또한 기존 단일 하도급 위주의 프로젝트 수행에서 다수 원도급 위주의 프로젝트 수행으로 고도화 되고 있다. 하지만 수익률 측면에서 여전히 적자 현상에서 벗어나지 못하고 있다(대기업 5건 중 1건 적자, 중소기업 3건 중 1건 적자 공사). 이에 본 연구에서는 고도화된 진출형태에 따른 중소 중견기업의 다수프로젝트 관리방안을 도출하고자 한다. 1965년부터 시행된 8,000여 건의 해외건설 준공데이터 정보를 기반으로 프로젝트 통합리스크를 측정한다. 또한 통합리스크와 수익률간의 상관관계를 기반으로 기업별 최대로 허용할 수 있는 허용리스크 도출 알고리즘을 개발하였다. 3개 기업을 선정하여 이들 기업의 재무제표 분석을 수행하였으며 기업의 허용리스크 구간이 기업의 성과와 상관성이 있다는 것을 도출하였다. 허용리스크 측정을 통해 중소 중견 기업관점에서 다수프로젝트 관리를 위한 중요한 참고자료를 제시할 수 있을 것이라 기대한다. Since Korean construction firms have steadily advanced into the international market, small and medium construction companies (SMCCs) have also advanced in such market. SMCCs's recent trend have clearly shown the changes of contract types from single subcontractor projects to multiple general contracting projects. However, among those multiple projects performed by SMCCs, 1 out of 3 projects were deficit projects that impact the overall pe rformance of the firm. To increase such performance, risk management for in international construction must be managed at the enterprise level for SMCCs. This research aims to create a multiple project management model for SMCCS that employs the concept of acceptable risk to assess the limit risk level for corporation to acceptable. Using the accumulated data from previous survey and International Construction Association of Korea (ICAK), integrated risk of each firm and their profitability of each project are analyzed. Through the analysis, each firm's acceptable risk level is derived. Through the two research steps, acceptable risk algorithm was developed based on corporate integrated risk and profit correlation. To prove the acceptable algorithm relevance, financial statement analysis of 3 corporation was derived that level of acceptable risk and financial statement were available. Through the approach, this research allows the firms to analyze the firm's capability and find projects that suits the firm's situation and capability.

An Empirical Examination of the FDAAA-Mandated "Toll-Free Statement" for Consumer Reporting of Side Effects in Direct-to-Consumer Television Advertisements.

We investigated how inclusion of a "toll-free statement" for reporting side effects to FDA in prescription drug direct-to-consumer (DTC) television ads affects comprehension of product risks and benefits, and comprehension of and memory for the toll-free statement itself. Participants viewed one of nine mock prescription drug television ads that varied elements of the toll-free statement, and then responded to a questionnaire. Presenting the statement in both text and audio resulted in better processing of the statement compared to only text. When shown in text alone, presenting the statement during the entire advertisement or after the statement of risks resulted in better processing of the statement compared to placement before the presentation of risk information. The placement, duration, or prominence of the statement did not affect comprehension of product risk and benefit information. Our findings suggest that the toll-free statement can be added to DTC television ads without significantly affecting comprehension of product risk and benefit information, and that select presentations are preferable for communicating the toll-free statement. The appropriate inclusion of the toll-free statement in DTC television ads may increase the visibility of the adverse event reporting system, without any apparent cost to the understanding of benefits and risks.

Introduced Pheidole of the world: taxonomy, biology and distribution.

The objective of this study is to provide a detailed taxonomic resource for identifying and studying ants in the genus Pheidole that have established beyond their native ranges. There is an increasing need for systematists to study taxa of specific concern to 21st century environmental, food security and public health challenges. Systematics has an important role to play in both the theoretical and applied disciplines of invasion biology. Few invaders impact terrestrial ecosystems more than ants. Among the world’s 100 worst invasive species is the cosmopolitan and highly destructive Pheidole megacephala (Fabricius). Accurate identification of Pheidole megacephala is imperative for the success of screening, management and eradication programs designed to protect native ecosystems from the impacts of this destructive species. However, accurate identification of Pheidole species is difficult because of their taxonomic diversity, dimorphic worker caste and lack of taxonomic resources. Illustrated keys are included, along with the taxonomic history, taxonomic diagnoses, biological notes and risk statements for the 14 most invasive members of the genus. Global distribution maps based on over 14,000 specimen and literature records are presented for each species. These results of this work will facilitate identification of pest species, determination of climatic and habitat requirements, discovery of pest origins, horizon scanning and assessment of invasion pathways. The following new synonym is proposed, with the senior synonym listed first and the junior synonyms in parentheses: Pheidole indica Mayr (= Pheidole teneriffana Forel, and its synonyms Pheidole taina Aguayo and Pheidole voeltzkowii Forel). Pheidole navigans Forel, stat. rev., stat. n. is removed from synonymy and elevated to species rank. It is proposed that records of Pheidole moerens Forel outside of the Mesoamerica and the Caribbean refer instead to Pheidole navigans or other heterospecific taxa in the Pheidole flavens species complex. We propose that the names Pheidole anastasii Emery and Pheidole floridana Emery have been widely misapplied to North American outdoor records of Pheidole bilimeki Mayr. It is suggested that the synonymy of Pheidole lauta Wheeler be transferred from Pheidole floridana Emery to Pheidole bilimeki Mayr.

From Anti-Pollution to Climate Change Risk Movement: Reshaping Civic Epistemology

From the perspective of reflexive governance, this study probes into the transformative capacity and roles of government and civil society, and aims to determine how the authoritative developmental neo-liberalism state was challenged by civil society in democratization from the end of the 1980s, when it encountered a crisis of governance legitimacy. By analyzing the anti-petrochemical movement of the recent two decades, this paper recognizes the important historic line, and proposes that without innovative governance, a regime of expert politics with hidden and delayed risk will result in higher degrees of mistrust and confrontational positions by the public. In contrast to the government, local and civil societies are growing through the anti-pollution appeals of simple group protests into systematic and robust civic knowledge and strategic action. By administrative, legislative, judicial, and risk statement paths, such strategic mobilizations break through authoritative expert politics and reshape new civic epistemology. The process of reflexive governance is extremely radical. When two parties cannot commit to dealing with a high degree of mistrust, they will not be able to manage the more dramatic threat of climate change. Fundamentally speaking, a robust civil society will be an important driving power competing with government, in terms of constructing innovative governance.

Molecular tools for bathing water assessment in Europe: Balancing social science research with a rapidly developing environmental science evidence-base.

The use of molecular tools, principally qPCR, versus traditional culture-based methods for quantifying microbial parameters (e.g., Fecal Indicator Organisms) in bathing waters generates considerable ongoing debate at the science–policy interface. Advances in science have allowed the development and application of molecular biological methods for rapid (~2 h) quantification of microbial pollution in bathing and recreational waters. In contrast, culture-based methods can take between 18 and 96 h for sample processing. Thus, molecular tools offer an opportunity to provide a more meaningful statement of microbial risk to water-users by providing near-real-time information enabling potentially more informed decision-making with regard to water-based activities. However, complementary studies concerning the potential costs and benefits of adopting rapid methods as a regulatory tool are in short supply. We report on findings from an international Working Group that examined the breadth of social impacts, challenges, and research opportunities associated with the application of molecular tools to bathing water regulations.

Relevance of risk information for depositors’ judgment and decision-making

For several years risk reporting of banks has been high on the agenda. Banks must disclose information on their risk exposure to enhance market discipline. As a precondition for this positive effect of risk reporting, the risk information provided by the banks must be relevant for the depositors' and other investors’ judgments and decisions. In this paper, we analyze whether this is really true. Using an experimental design we show that risk information may influence the individuals’ judgments and decisions. We find that positive (negative) risk information lead to more positive (more negative) evaluations. In the case of conspiring risk and financial statement information the judgments and decisions are most pronounced. However, this enhancing effect of risk information is not significant. Considering opposing risk and financial statement information we find that positive (negative) risk information lead to more positive/less negative (more negative/less positive) judgments and decisions. Risk information can even reverse the effect of opposing financial statement information on the individuals’ judgment of the banks’ risk exposure.

Daily rainfall data to identify trends in rainfall amount and rainfall-induced agricultural events in the Nuba Mountains of Sudan

Widely variable inter- and intra-seasonal rainfall increases risks of agricultural production in the Nuba Mountains of Sudan, which are one of the country's most vulnerable areas with respect to climate change. This study aims to identify trends in rainfall amount at different temporal resolutions as well as changes and probabilities of rainfall-induced agricultural events. Long-term daily rainfall records (60 years) from two weather stations, Kadugli and Rashad, were computed to daily, monthly and annual values and rainfall-induced events were computed using the INSTAT + software. Subsequently, these calculated values and events were checked for possible monotonic trends from 1950 to 2009 and 1970 to 2009 by Mann–Kendall tests.Over the period from 1970 to 2009, annual rainfall showed no statistically significant change for either station. However, during this period an increase of low rainfall events (>0.85 mm to ≤3 mm) by 15 days coinciding with a decline in the number of medium daily rainfall classes (>10 mm to ≤20 mm) by 4 days was observed in Rashad. This increase is of concern since low rainfall events do not contribute to the crop water balance and therefore may thus be largely irrelevant for rainfed farmers' crop production. Furthermore, daily rainfall data enabled frequency calculations of a successful or failed start of the growing season, of high intensity rainfall events (90th, 95th and 99th percentiles) and of different dry spell length classes (>7, >14 and >21 days; 1 to ≤7 days, 8 to ≤14, 15 to ≤21 and >21). Additionally, probability calculations of the minimum lengths of growing season and the occurring of dry spell lengths based on specific dates were conducted. Since for these rainfall-induced agricultural events either no statistically significant changes or trends resulting only in minor changes of probabilities were observed, our risk statements seem to be reliable for the next years. The results of this study may contribute to a better assessment of crop management risks under rainfed farming in the Nuba Mountains.

Consent for Labour Epidural Analgesia: An Observational Study in a Single Institution

There is a wide range of practice amongst obstetric anaesthetists when obtaining consent for women requesting labour epidural analgesia. This is the first prospective observational study recording the number and types of risks mentioned and whether the risk was quantified. Statements of benefits and alternatives to the procedure were also noted. Fourteen anaesthetists, each consulting a single patient, were recorded during the process of obtaining consent and inserting the epidural. The most commonly mentioned risks (median 7) were headache/dural puncture, failure/difficulty with insertion, nerve damage, bleeding/haematoma and infection/epidural abscess. There was no difference between consultants and trainees, although consultants showed greater variance. It was uncommon for anaesthetists to state a benefit (21%) or mention an alternative option (21%), but there was usually a quantitative statement of risk (71%). Data showed a deviation from the Australian and New Zealand College of Anaesthetists guidelines and these findings may encourage anaesthetists to reflect on their own practice and guide future research.

What is the Proportion of Patients With Multiple Hereditary Exostoses Who Undergo Malignant Degeneration?

Multiple hereditary exostoses is an autosomal-dominant skeletal disorder that has a wide-ranging reported risk of malignant degeneration to chondrosarcoma. The aims of our study were to use a large, web-based survey approach to characterize (1) the demographic distribution of patients with multiple hereditary exostoses, (2) the number of surgeries performed related to one's diagnosis of multiple hereditary exostoses, and (3) the proportion of survey respondents who described experiencing malignant degeneration in a large international, heterogeneous cohort of patients with multiple hereditary exostoses. An anonymous web-based survey was distributed to several online support groups and social media networks designed to support and educate patients with multiple hereditary exostoses and their families. The survey collected demographic and epidemiologic data on 779 respondents. Data were recorded to assess respondents' disease burden and the rate of malignant degeneration. Females represented a slightly greater proportion of those with multiple hereditary exostoses who responded (56% female; 419 of 742 patients). Median age for all respondents was 28 years (range, < 1-85 years). Median age for males was 25 years (range, < 1-85 years), while median age for females was 29 years (range, < 1-82 years). The mean age at diagnosis of male and female respondents was in the mid-first decade (5.4 years ± 7.2 years). The mean number of surgeries a patient had undergone was 7.3 (± 7.1 surgeries). The proportion of respondents who experienced malignant transformation was 2.7% (21 of 757 respondents), at a mean age of 28.6 years (± 9.3 years). The most common sites of malignant change from benign exostoses included the pelvis (eight of 21 respondents) and scapula (four of 21 respondents). In the largest and most geographically diverse study of patients with multiple hereditary exostoses of which we are aware, we found the proportion of patients with multiple hereditary exostoses who have undergone malignant degeneration to be consistent with those reported in prior studies. Our study perhaps more accurately assessed the proportion of patients who undergo malignant transformation of multiple hereditary exostoses. As with prior studies on this topic, the proportion of malignant change may be expected to represent a high-end estimate as recruitment and selection bias likely predisposes for patients with more severe disease, whereas patients with lesser disease may be unaware of their diagnosis. In discussing the sequelae of multiple hereditary exostoses, clinicians perhaps might use this study to offer an unspecific statement of risk of malignant degeneration of multiple hereditary exostoses among the population at large. Level IV, prognostic study.

Vaccine-preventable travel health risks: what is the evidence--what are the gaps?

Existing travel health guidelines are based on a variety of data with underpinning evidence ranging from high-quality randomized controlled trials to best estimates from expert opinion. For strategic guidance and to set overall priorities, data about average risk are useful. The World Health Organization (WHO) plans to base future editions of "International Travel and Health" on its new "Handbook for Guideline Development." Based on a systematic search in PubMed, the existing evidence and quality of data on vaccine-preventable disease (VPD) risks in travelers was examined and essentials of vaccine efficacy were briefly reviewed. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was used to evaluate the quality of the data. Moderate-quality data to determine the risk of VPD exist on those that are frequently imported, whereas in most others the level of confidence with existing data is low or very low. In order for the WHO to produce graded risk statements in the updated version of "International Travel and Health," major investment of time plus additional high-quality, generalizable risk data are needed.

Prosecution-retained versus court-appointed experts: Comparing and contrasting risk assessment reports in preventative detention hearings.

The goal of this study was to compare the risk assessment reports of prosecution-retained (n = 43) and court-appointed experts (n = 68) within the context of preventative detention hearings on variables ranging from the information within the assessment reports (e.g., length) to the conclusions drawn in terms of risk and treatment amenability (e.g., categorical statements of risk). A separate section also focused specifically on psychopathy. Court-appointed expert assessments were significantly longer (d = 0.40, 95% confidence interval [CI] [0.01, 0.78]) and contained more information pertaining to risk factors (odds ratio [OR] = 4.48, 95% CI [1.21, 16.61]) and risk management (OR = 3.15, 95% CI [1.20, 8.25]). Both types of experts communicated risk assessment results in categorical terms and were highly likely to utilize actuarial scales. Less than half of all assessments contained information on dynamic or protective factors. Other than providing a total psychopathy score, the assessments contained very little additional information about the implications of this score for risk management or treatment amenability. Although the results indicate that risk assessment reports between prosecution-retained and court-appointed experts were more similar than they were different, it is also evident that, overall, reports should contain more information on dynamic risk factors and risk management in order to be useful in the context of preventative detention hearings.