Systematic Risk Assessment Research Articles

Risk management of green supply chains for agricultural products based on social network evaluation framework

AbstractThe green supply chain of agricultural products (GSCAP) is a key link for rural revitalization and sustainable development in China. However, it faces various risks from internal and external environments that threaten its performance and stability. This paper proposes a novel framework and system for identifying and evaluating the main risks in the GSCAP from the perspective of agricultural enterprises. The framework combines social network analysis (SNA) and an improved technique for order preference by similarity to an ideal solution (TOPSIS) method. SNA is used to analyze the correlations and influences among different types of risks, while the improved TOPSIS method is used to rank the risks of different GSCAPs and identify the key risks in each supply chain. The framework and system are verified by a case study of CDYBIT, a leading platform of food safety big data service in China. The results show that the supermarket supply chain has the highest risk, followed by the group catering supply chain, and the five‐star hotel supply chain has the lowest risk. The main risk factors for each supply chain are also discussed, and some suggestions for risk management are provided. This paper contributes to the literature by providing a comprehensive and systematic risk assessment framework and system for the GSCAP, which can help agricultural enterprises improve their risk awareness and response capabilities.

Cardiovascular risk assessment: Missing albuminuria contributing to gender inequality

IntroductionChronic kidney disease (CKD) is associated with high cardiovascular disease (CVD) risk, and requires specific interventions to decreases CVD risk.The guidelines indicate that systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor. The European Society Cardiology (ESC) guidelines, he European Renal Association (ERA) Council and the Spanish Society of Nephrology (S.E.N.) in collaboration with 15 Scientific Societies recommend assessing albuminuria in all these populations.We have evaluated current clinical practice regarding the assessment of CVD risk factors (blood pressure, albuminuria, serum cholesterol, glycemia and creatinine) in different adult health user populations, analyzing the results separately for men and women, given recent evidence on gender differences in the recognition, monitoring, and management of CKD. MethodsObservational, retrospective, non-interventional single center study performed in a hospital using Electronic Health Record (EHR) data. ResultsAmong 707,493 healthcare users, 612,619 were adults, and of these 332,943 (54.3%) females; 73,632 (12.0%) had DM and 121,445 (19.8%) hypertension. Mean (SD) age was 68.91±21.4 years; 261,694 (36.9%) were older than 50 years.Only 8522 (1.39%) had undergone albuminuria testing as compared with 264,684 (43.21%) tested for serum creatinine, 140,492 (22.93%) for serum cholesterol, 263,381 (42.99%) for serum glucose, and 226,448 (36.96%) for blood pressure. Albuminuria was the only cardiovascular risk factor assessed more frequently in men than in women.Albuminuria, as other CVD risk factors, was more frequently assessed in patients with DM (6.71% of patients) or hypertension (4.81%), but albuminuria assessment remained suboptimal compared with 58–87% for other cardiovascular risk factors. For adults with diabetes or hypertension, albuminuria was assessed more frequently in men than in women.Albuminuria assessment in those older than 50 years was also suboptimal at 2.24%, as compared with 31–47% for other CVD risk factors.Albuminuria and EGFR are needed to screen for CKD, meaning that a urine test for albumin and creatinine and a serum test for creatinine are needed. To these, we may add assessment of blood pressure, serum cholesterol (for familial hypercholesterolemia) and serum glucose for Diabetes. Albuminuria was the only cardiovascular risk factor that was assessed more frequently in men (up to nearly 60% more frequently), indicating that screening for CKD and CVD risk in women is suboptimal. This result is surprisingly consistent across time and in all age groups. This is the first time that gender disparities in the assessment of albuminuria have been revealed. ConclusionAlbuminuria is assessed infrequently, even in patients with a high cardiovascular risk, especially in women.

Research on New Electric Power System Risk Assessment Based on Cloud Model

A large number of new energy power electronic equipment is connected to the new power system, and the high proportion of new energy brings huge volatility and randomness, so it is necessary to establish a systematic risk assessment system to adapt to the new power system. This paper has improved the neglect of environmental benefits and supply and demand balance in the existing indicator system and established an indicator system for the risk of the new power system from the five perspectives of safety, supply and demand, sufficiency, cleanliness, and flexibility through the analysis of the evaluation indicator system of the large power grid and the influencing factors of the new power system. The index weight of a new power system is established by means of the entropy weight–critic combination weighting method, and the comprehensive evaluation is carried out by combining it with the cloud model. Finally, the specific data of the new power system in Fujian Province from 2020 to 2022 are taken as an example to verify the feasibility of combining the combined weighting method and the cloud model, and it is concluded that the new power system in Fujian Province has been in a “low risk” operation state for the recent three years.

Participation in cardiovascular screening consultations, the who, when and why - A cohort study on patients with rheumatoid arthritis

BackgroundIn accordance with the EULAR recommendations, the Danish Hospital for Rheumatic Diseases have systematically invited patients with rheumatoid arthritis (RA) to cardiovascular (CV) risk assessment since 2011. Patients with high risk are invited to a follow-up screening after one year. To optimize the screening and tailor it to individual needs, information about who accepts vs. declines follow-up is needed. Thus, the aim of this study was to explore participation in systematic CV risk assessment among patients with RA. Furthermore, to explore differences between patients with low vs. high risk, and between patients with high risk who accept vs. decline follow-up.MethodsData from 2,222 outpatients with RA in the period 2011-2021 were retrieved, and of these 1,522 were under 75 years and eligible to be invited. To assess the 10-year risk for CV death, the modified Systematic Coronary Risk Evaluation (mSCORE), derived by multiplying the SCORE by 1.5, was used. Logistic regression analyses were used to explore differences in CV risk factors (triglycerides, HbA1c, lifestyle factors) and measures of disease impact (pain, fatigue, patient global assessment, HAQ, EQ-5D-5L) between patients with low vs. high risk. Differences between high risk patients who accepted vs. declined follow-up were analysed using Wilcoxon rank sum test and chi-squared test for groups.ResultsOne thousand one hundred forty-nine received a CV screening invitation and 91 declined participation. Patients with high risk had significantly longer disease duration (OR; 95 CI) (1.017; 1.002-1.032), higher levels of triglycerides (1.834; 1.475-2.280), HbA1C (1.046; 1.020-1.070), pain (1.006; 1.001-1.012), and HAQ-score (1.305; 1.057-1.612) compared to patients with low risk and they more often declined follow-up (43% vs. 28%, p < 0.001). Those who declined a follow-up invitation were older (p = 0.016) and had shorter disease duration (p = 0.006) compared to those who accepted follow-up.ConclusionA first CV screening consultation was accepted by most patients with RA, while only every other patient with high to very high CV risk adhered to a follow-up screening consultation. Neither measures of disease impact nor lifestyle factors were associated with adherence. Further studies are needed to explore the patients' motivation, barriers and facilitators for adherence or non-adherence to a follow-up consultation.

Threats of nano/microplastics to reproduction and offspring: Potential mechanisms and perspectives

Due to the ubiquitous occurrence in the aquatic environment and terrestrial ecosystem and underlying eco-environmental risks, nano/microplastics (NPs/MPs) have sparked great public concerns. The purpose of this work is aimed to summarize the harmful influence of NPs/MPs on reproduction and offspring health and further explore the potential mechanisms of action, thereby facilitating the more comprehensive understanding of NPs/MPs features. Literature search databases included EMBASE, Web of Science, and PubMed. The study selection and data extraction were implemented according to the inclusion criteria. NPs/MPs could accumulate and trigger reproductive toxic responses and thereafter generate deleterious effects on the offspring health. Accordingly, the reproductive toxicity of NPs/MPs was characterized as the sperm deformity, decline in sperm count and motility, follicular growth tardiness, ovarian fibrosis, granulosa cell death, disorder of reproductive hormone secretion, as well as the fetal growth restriction, glycolipid metabolism disorder, and inflammatory responses of the next generation. Additionally, mechanism research revealed that NPs/MPs exposure brought about inflammatory responses and oxidative stress and thereafter, destroyed the blood-testis barrier (BTB) integrity, motivated spermatogenic cell apoptosis by activating the JNK and p38/MAPK-Nrf2/NF-κB pathways, and induced ovarian granulosa cell pyroptosis and apoptosis and subsequent ovarian fibrosis via the Wnt/β-Catenin and NLRP3/Caspase-1 pathways. Nevertheless, this work also highlighted the imperative requirements for scientific and systematic risk assessments of NPs/MPs, so as to identify the feasible risk mitigation strategies.

Framework for Integrating the Reliability of the Inspection Technique into Risk-Based Inspection Practice

In compliance with recent (2022) federal legislation found in the Code of Federal Regulations Part 650 Subpart C, risk-based inspection (RBI) practices for determining inspection intervals for highway bridges are now permitted. The RBI approach allows for a systematic assessment of risk and prioritizes inspection resources where they are most needed. However, to ensure an optimal level of safety and serviceability, it is necessary to utilize reliable inspection techniques in conjunction with an appropriate inspection interval, as emphasized by National Cooperative Highway Research Program (NCHRP) Report 782. Utilizing ineffective inspection techniques may lead to uncertainty about the element’s condition and thus increase the risk associated with the component. Therefore, this paper proposes a framework that integrates a new factor, called the inspection effectiveness factor (IEF), into the RBI process to rationally estimate the inspection interval considering the reliability of the inspection technique. The inspection interval in the proposed approach is determined based on the damage mode, associated likelihood, consequences, and effectiveness of the inspection technique, offering a rational approach for decision-makers in estimating the inspection interval of bridges and identifying appropriate inspection techniques for different defects. The effectiveness of the proposed method is validated through experts’ judgment. In addition, the proposed approach is demonstrated through a case study utilizing historical inspection reports.

Contamination Status and Risk Assessment of Paralytic Shellfish Toxins in Shellfish along the Coastal Areas of China.

Paralytic shellfish toxins (PSTs) are widely distributed in shellfish along the coast of China, causing a serious threat to consumer health; however, there is still a lack of large-scale systematic investigations and risk assessments. Herein, 641 shellfish samples were collected from March to November 2020, and the PSTs' toxicity was detected via liquid chromatography-tandem mass spectrometry. Furthermore, the contamination status and potential dietary risks of PSTs were discussed. PSTs were detected in 241 shellfish samples with a detection rate of 37.60%. The average PST toxicities in mussels and ark shells were considerably higher than those in other shellfish. The PSTs mainly included N-sulfonylcarbamoyl toxins (class C) and carbamoyl toxins (class GTX), and the highest PST toxicity was 546.09 μg STX eq. kg-1. The PST toxicity in spring was significantly higher than those in summer and autumn (p < 0.05). Hebei Province had the highest average PST toxicity in spring. An acute exposure assessment showed that consumers in Hebei Province had a higher dietary risk, with mussels posing a significantly higher dietary risk to consumers. This research provides reference for the green and sustainable development of the shellfish industry and the establishment of a shellfish toxin prevention and control system.

Co-exposure with cadmium elevates the toxicity of microplastics: Trojan horse effect from the perspective of intestinal barrier

Microplastics (MPs) have been shown to adsorb heavy metals and serve as vehicles for their environmental transport. To date, insufficient studies have focused on enterohepatic injury in mice co-exposed to both MPs and cadmium (Cd). Here, we report that Cd adsorption increased the surface roughness and decreased the monodispersity of PS-MPs. Furthermore, exposure to both PS-MPs and Cd resulted in a more severe toxic effect compared to single exposure, with decreased body weight gain, shortened colon length, and increased colonic and hepatic inflammatory response observed. This can be attributed to an elevated accumulation of Cd resulting from increased gut permeability, coupled with the superimposed effects of oxidative stress. In addition, using 16 S sequencing and fecal microbiota transplantation, it was demonstrated that gut microbiota dysbiosis plays an essential role in the synergistic toxicity induced by PS-MPs and Cd in mice. This study showed that combined exposure to MPs and Cd induced more severe intestinal and liver damage in mice compared to individual exposure, and provided a new perspective for a more systematic risk assessment process related to MPs exposure.

État des lieux de la recherche en France concernant la prise en charge des auteurs de violences conjugales en lien avec l’évolution des politiques publiques

The aim of this paper is to report on the current state of research into the perpetrators of intimate partner violence in France in relation to changes in public policy. In France, 22% of women aged 15–49 who are married or are in a relationship have been subjected to physical or sexual violence by their intimate partner. If we also take into account psychological violence, this figure rises to almost 60%. The fight against intimate partner violence has been gathering more and more impetus in France over the last ten years. The first Council of Europe Convention on preventing and combatting violence against women and domestic violence (Istanbul Convention) was adopted in 2011, and the first country-specific recommendations were made in 2015. Intimate partner violence became a major undertaking of the first five-year term (2017–2022) of the French President of the Republic. In September 2019, his government launched the “Grenelle” of fighting against intimate partner violence, which aimed to identify improvements in the implementation of previous initiatives and to transform professional practices. Included among the measures taken after the “Grenelle”, was the creation of Centers for perpetrators of intimate partner violence (“Centres de prise en charge des auteurs de violences conjugale”: CPCA), and their implementation in 2020–2021 marked a real turning point, at a time when the care of perpetrators had previously received little attention from public policy in France. Other measures will follow, notably those recently introduced in order to better deal with family violence in the courts. Evaluation of these policies shows that there is still considerable room for improvement, but there is currently momentum for further progress, with a clear desire displayed for public authorities to step up their efforts. The primary objective of the CPCA is to stop intimate partner violence and reoffending from happening again. However, they were set up without any standards having been established, e.g. in terms of theoretical references or intervention approaches, as is the case in other countries (United States, United Kingdom, Canada) where the adoption of standards of practice has been gradual over 20 or 30 years. The lack of systematic risk assessment procedures for intimate partner violence in France can also be noted. In the same vein, this work provides an overview of research into the perpetrators of intimate partner violence in France. It reports on national statistical and demographic surveys, and on research in sociology, law, prison administration and the medical-psychological field. Scientific research focusing on the perpetrators of intimate partner in France is rare in psychiatry and the humanities and social sciences. Finally, a research project entitled “A portrait of practices with perpetrators of intimate partner violence and their impact: a case study of 7 to 8 centers which take care of them” funded by the French Ministry for gender equality, diversity and equal opportunities (2023–2024), is presented.

An explainable unsupervised risk early warning framework based on the empirical cumulative distribution function: Application to dairy safety

Efficient food safety risk assessment significantly affects food safety supervision. However, food detection data of different types and batches show different feature distributions, resulting in unstable detection results of most risk assessment models, lack of interpretability of risk classification, and insufficient risk traceability. This study aims to explore an efficient food safety risk assessment model that takes into account robustness, interpretability and traceability. Therefore, the Explainable unsupervised risk Warning Framework based on the Empirical cumulative Distribution function (EWFED) was proposed. Firstly, the detection data’s underlying distribution is estimated as non-parametric by calculating each testing indicator’s empirical cumulative distribution. Next, the tail probabilities of each testing indicator are estimated based on these distributions and summarized to obtain the sample risk value. Finally, the “3σ Rule” is used to achieve explainable risk classification of qualified samples, and the reasons for unqualified samples are tracked according to the risk score of each testing indicator. The experiments of the EWFED model on two types of dairy product detection data in actual application scenarios have verified its effectiveness, achieving interpretable risk division and risk tracing of unqualified samples. Therefore, this study provides a more robust and systematic food safety risk assessment method to promote precise management and control of food safety risks effectively.

Patterns of referrals to regional clinical genetics services for women potentially at above-population level risk of breast cancer

BackgroundThe National Institute for Health and Care Excellence (NICE) recommends that women in England at above-population risk be offered additional breast screening and, depending on the level of risk, risk-reducing medication or surgery.MethodsWe reviewed the hospital records of GP referrals made to two large genetics services in England between 01/12/2021-30/11/2022 for women aged 18–49 years and suspected to be at above-population level risk for breast cancer. We compared the women referred with the wider population and estimates of the number of women at above-population level risk using published data.ResultsUp to 20% of women referred did not provide sufficient information for a complete risk assessment and over 25% were considered at near-population level risk after assessment. We estimate that only a small fraction (<10%) of those above population level risk are identified and women in areas of lower deprivation are disproportionately represented amongst referrals.ConclusionsMany women are missing out on potential preventative and risk-reducing interventions for breast cancer and current pathways may be exacerbating existing health inequalities. Better systems for collecting data on family history, improved methods for risk assessment in general practice and more systematic risk assessment of women prior to population-based screening are needed.

P24 Penicillin allergy de labelling: a whole system approach

Abstract Background Approximately 10% of patients have a documented allergy to penicillin on their health records.1 However, when checked up to 95% are thought to be incorrect2 with side effects such as nausea, vomiting and gastrointestinal upset often being documented as allergy. Inappropriate and over labelling of penicillin allergy is detrimental to individuals and healthcare systems as alternatives to penicillins are associated with more complications, adverse events, financial costs and extended length of stay. Unnecessary use of penicillin alternatives also increases the risk of antimicrobial resistance development. Penicillin allergy de-labelling is a viable option for patients within primary care and acute settings where they meet specific criteria, leading to financial benefits for the health board and optimal treatment outcomes for the patient. NHS Tayside is the first and only Board in Scotland to adopt a whole system approach to de-labelling patients in both acute and community settings. Through the implementation of evidence-based, collaborative and systematic risk assessment processes, clinical teams are able to identify patients who may be eligible for the penicillin allergy de-labelling programme. Methods Within the acute sector, two pilot wards were identified. A Short Life Working Group (SLWG) was developed to oversee the de-labelling process and governance. Patients were identified by clinical teams and consent gained prior to carrying out the process. A single dose of oral flucloxacillin or amoxicillin was administered to the patient. The patient was monitored for any reaction as per Scottish Antimicrobial Prescribing Group (SAPG) algorithm.3 If the patient experienced no reaction, they were de-labelled, a request was sent to GP to remove the label and their details were added to a database held by the SLWG. A similar project was piloted in primary care across three Angus GP practices. The aim of the project is to identify a patient population that are labelled penicillin allergic but have received a subsequent prescription for a penicillin allowing a primary care SLWG to carry out a patient consultation with the aim of retrospectively de-labelling and updating the record. This will allow patients to receive optimal treatment options in the future. Results Within the acute setting, the pilot was initiated in May 2022. Since then, 44 patients have been recruited to the penicillin allergy de-labelling process with 98% having no immediate reaction and 67% of labels removed from patient care records at the 3 month follow-up stage. Within primary care across three GP practices, 163 patients were eligible for the pilot. A total of 85 patients (52%) were contacted via telephone and a consultation on allergy status carried out. Overall, 42 patients (50%) were successfully de-labelled and patient records were updated. Conclusions Following similar processes, there is potential for practitioners within the acute and community sectors to adopt this pilot as part of an integrated work plan across all wards and GP practices. By de-labelling patients within the community or acute sector, the patients’ records will be accurate and future treatment options can be optimized to ensure positive outcomes and minimize harm.

Implementing systematic melanoma risk assessment and risk-tailored surveillance in a skin cancer focussed dermatology clinic: A qualitative study of feasibility and acceptability to patients and clinic staff.

International bodies recommend that melanoma risk assessment should be integrated into skin cancer care provision, but evidence to support implementation is lacking. To explore the acceptability and feasibility of implementing personalised melanoma risk assessment and tailored patient education and skin surveillance within routine clinical care. This prospective qualitative implementation study was informed by the Theoretical Framework of Acceptability (TFA). Personalised, systematic melanoma risk assessment was implemented in the dermatology clinic at the Melanoma Institute Australia, Sydney, Australia February-May 2021. Pre- and post-implementation observations and semi-structured interviews with patients and staff were conducted (September 2020-March 2021). Observational notes and interview transcript data were analysed thematically using the TFA as a classifying framework. A total of 37 h of observations were made, and 29 patients and 12 clinic staff were interviewed. We found that the delivery of personalised melanoma risk estimates did not impact on patient flow through the clinic. Dermatologists reported that the personalised risk information enhanced their confidence in assessing patient risk and recommending tailored surveillance schedules. Most patients reported that the risk assessment and tailored information were a beneficial addition to their care. Among patients whose risk deviated from their expectations, some reported feeling worried, confused or mistrust in the risk information, including those at lower risk who were recommended to decrease surveillance frequency. It is feasible and acceptable to patients and clinic staff to calculate and deliver personalised melanoma risk information and tailored surveillance as part of routine clinical care within dermatology clinics.

Analyses and algorithms of personnel safety in mines using event tree and Bayesian network method

Determination of the hazard index in ensuring the safety of personnel in underground mines requires a comprehensive approach. Different methods can be applied depending on the specifics and conditions of work. This article discusses event tree and Bayesian network methods as tools for systematic analysis and assessment of personnel safety risks. The event tree method allows the sequence of events that lead to certain outcomes to be ordered and visualised. Analysing this event tree can help identify critical points and determine likely ways to prevent accidents. The Bayesian grid method is a graphical model of the probabilistic relationships between different variables. When analysing personnel safety, the Bayesian grid method can take into account the probability of events, the factors affecting safety and their interrelationships.

A Systematic Review and Health Risk Assessment on the Concentration of Particulate Matters in Iran

There are growing activities leading to emission of suspended particles. Industrialization and expanding the cities in Iran is an alarm of urban air pollution and the particulate maters (PMs) as one of the criteria air pollutants. The concentration of the particulate maters, exposure and the health risks are studied in this systematic review regarding the published literatures in the data bases of SID (Scientific Information Database), Science direct, and Google scholar. The results showed a high concentration of PMs, which was the highest concentration related to PM10 (146.39 ± 123.31 µg/m3) and then respectively PM7, PM4, PM2.5 and PM1. The concentration of particles in spring (136.79 ± 157.95 µg/m3) was higher compared to remain, it was followed by summer, winter and autumn, respectively. The particles were with higher concentrations in industrial areas compared to the commercial and residential areas. The risk of cancer and toxicity of PM2.5 was high for all age groups, and the risk levels were very high for children under 6 years old (4937.7×10-6). Non-cancer risk PM10 (2.92), PM2.5 (7.41) for outdoor air in most cities was higher than the guideline limit of 1.

Implementation of risk assessment process for breast cancer risk in primary care.

Current cancer prevention guidelines recommend assessing breast cancer risk using validated risk calculators such as Tyrer-Cuzick and assessing genetic testing eligibility with NCCN. Women at high-risk of breast cancer may be recommended to undergo additional or earlier screening. Risk assessment is not consistently implemented in the primary care setting resulting in increased morbidity and mortality in unidentified high-risk individuals. A single-arm interventional study was conducted in an academic primary care clinic for women 25-50 years old presenting for primary care appointments. Pre-visit workflows evaluated breast cancer risk using the Cancer Risk Assessment (CRA) Tool and information was provided to the clinician with guideline-based recommendations. Post-visit questionnaires and chart review were conducted. The survey response rate was 24.5% (144/587) with 80.3% of responses completed online (94/117). The average age of respondents was 35.8 years with 50.4% White and 35.9% Black. There were no differences in response rate based on race. Risk discussion was documented in the medical record in 15.4% of cases with a higher rate of documentation in high-risk patient based on risk assessment as compared with average risk respondents (34.6% vs. 9.7%, p<0.01). In the high-risk women identified 11.4% (4/35) were seen by the high-risk breast clinic, and 5.7% (2/35) were referred for genetic evaluation. None had previously obtained MRI screening or genetic testing. There is limited identification and evaluation of women at high risk for breast cancer. Pre-visit surveys can be used as a tool to assess breast cancer risk in the primary care setting; however additional strategies are needed to implement systematic risk assessment and facilitate appropriate treatment based on risk level.

위치추적 전자장치제도의 실태 분석 연구

This study examines the legitimacy of the electronic surveillance system in Korea, and hurriedly passed the Electronic Surveillance System Act on September 1, 2008, as violent crimes continue to occur recently. These electronic surveillance systems implement harsh punitive policies aimed at monitoring and isolating certain criminals, but serious debates, effective tests, and side effects were not studied before the law was passed, and even before the electronic surveillance system was implemented, it contributed a lot to reducing social protection and recidivism rates by extending the implementation period and expanding the category of criminals, but despite these positive aspects, legal issues and operational problems have been found to have created negative aspects. In order to increase the efficiency of the electronic monitoring system, problems such as infringement of basic rights under the constitution, double risks, operating budget, and manpower must be resolved first. In addition, the selection of electronic monitoring targets should not only consider systematic secondary crime risk assessment criteria (K-SORAS), but also converge with each government department to achieve the purpose of this law.

ADOPTING A STRENGTH-BASED, PERSON-CENTERED RISK ASSESSMENT CLINICAL DECISION SUPPORT TOOL: WHAT ARE THE BENEFITS?

Abstract Most older adults want to age in place even if changes in their health results in home safety concerns. A consistent approach to assessing both the physical and psychological risks associated with the decision to remain at home is lacking. The Living with Risk: Decision Support Approach (LwR:DSA) is a recently validated innovative clinical tool that supports a balanced, systematic and person-centered assessment of risks, by analyzing their negative and positive consequences. The aim of this mixed-method study was to understand the barriers and facilitators to using the LwR:DSA during usual care to determine how best to support widespread adoption. Twenty-two hospital- and community-based clinicians used the LwR:DSA for eight weeks. Individual interviews were performed to document the factors that hindered and helped the use of the LwR:DSA in their clinical setting. The interviews were analyzed using Qualitative Description and the positive impact of using the LwR:DSA emerged as one of the facilitator themes. The participants described that using the LwR:DSA in practice improved their clinical decision making, communication and their ability to provide person-centered care. More specifically, the LwR:DSA 1) helped the clinicians understand the risk level and the context, causes, and consequences of the safety concern; 2) guided them to co-create with the older adult, agreeable recommendations to reduce the risk of adverse outcomes; 3) decreased clinician discomfort and 4) supported authentic conversations with the older adult. Understanding the benefits of using the LwR:DSA provides key information for clinicians by challenging the status quo of their current practice.

Current practices of physiotherapists in Switzerland regarding fall risk-assessment for community-dwelling older adults: A national cross-sectional survey.

Falls can strongly impact older people's quality of life, health, and lifestyle. Multifactorial assessment can determine an individual's risk of falling as the first step for fall prevention intervention. Physiotherapists have an essential role to play in assessing fall risk by older adults living in the community. In the absence of published data on this topic in Switzerland, this study investigated the current practices of physiotherapists to determine whether those are in line with recommendations. An anonymous cross-sectional survey was undertaken among physiotherapists practising in Switzerland between the 21st of November and the 31st of December 2020. A priori and exploratory hypotheses were tested. Responses to open-ended questions were grouped into themes for analysis. A total of 938 questionnaires from all three language regions of Switzerland was analysed. Participants worked in different settings, with a higher representation of private practice self-employees (56%). Standardised fall risk assessments or instruments were used by 580 (62%) participants, while 235 (25%) preferred subjective assessment of fall risk only. Differences in fall risk assessment were observed according to the workplace setting (adjusted OR 1.93, 95% CI 1.37 to 2.7) and education level (trend test, p<0.001). The standardised assessments most frequently employed were the Berg Balance Scale (58%), the Timed-Up-and-Go (57%) and the Tinetti Balance Assessment tool (47%). Risk factors for falls were frequently queried, particularly history of falls (88%), home hazards (84%), and functional ability (81%). Technical resources (40%), knowledge (30%), and time (22%) were common barriers to implement a systematic fall risk assessment. This study provides an overview of the current practices of physiotherapists in Switzerland in fall risk assessment. There is still room to optimise the standardisation and systematisation of this assessment to implement a best practice strategy and prevent avoidable falls.

Water-related deterioration risk assessment for sustainable conservation of heritage buildings in the Forbidden City, China

A suitable hygrothermal environment is imperative for sustainably conserving movable and immovable cultural heritage. This paper proposes a combined method for quantitatively assessing water-related deterioration risks in heritage buildings, validated employing the Forbidden City in China, a UNESCO World Heritage site. The approach emphasizes combining hygrothermal coupled transfer simulation with conventional environmental monitoring for systematic risk assessments. Key findings include identifying predominant causes of year-round deteriorations of salt weathering, freeze–thaw damage, microorganism growth, and physical cracking. Secondly, it underscores the persistent dampness at the bottom, stemming from capillary rising in building foundations, rendering the present environment unsuitable for the conservation of single-story heritage buildings. Lastly, in the Forbidden City, significant deteriorations manifest just a few millimeters or centimeters beneath the surfaces of brick walls and floors. Suggested measures include reducing shallow groundwater and enhancing airtightness. This study establishes a scientific framework for deterioration risk assessment and sustainable cultural heritage conservation.