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Risk Evaluation (risk + evaluation)
Selected AbstractsThe importance of independent risk-factors for long-term mortality prediction after cardiac surgeryEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 9 2006I. K. Toumpoulis Abstract Background, The purpose of the present study was to determine independent predictors for long-term mortality after cardiac surgery. The European System for Cardiac Operative Risk Evaluation (EuroSCORE) was developed to score in-hospital mortality and recent studies have shown its ability to predict long-term mortality as well. We compared forecasts based on EuroSCORE with other models based on independent predictors. Methods, Medical records of patients with cardiac surgery who were discharged alive (n = 4852) were retrospectively reviewed. Their operative surgical risks were calculated according to EuroSCORE. Patients were randomly divided into two groups: training dataset (n = 3233) and validation dataset (n = 1619). Long-term survival data (mean follow-up 5·1 years) were obtained from the National Death Index. We compared four models: standard EuroSCORE (M1); logistic EuroSCORE (M2); M2 and other preoperative, intra-operative and post-operative selected variables (M3); and selected variables only (M4). M3 and M4 were determined with multivariable Cox regression analysis using the training dataset. Results, The estimated five-year survival rates of the quartiles in compared models in the validation dataset were: 94·5%, 87·8%, 77·1%, 64·9% for M1; 95·1%, 88·0%, 80·5%, 64·4% for M2; 93·4%, 89·4%, 80·8%, 64·1% for M3; and 95·8%, 90·9%, 81·0%, 59·9% for M4. In the four models, the odds of death in the highest-risk quartile was 8·4-, 8·5-, 9·4- and 15·6-fold higher, respectively, than the odds of death in the lowest-risk quartile (P < 0·0001 for all). Conclusions, EuroSCORE is a good predictor of long-term mortality after cardiac surgery. We developed and validated a model using selected preoperative, intra-operative and post-operative variables that has better discriminatory ability. [source] Favorable Long-Term Survival in Patients Undergoing Stent PCI of Unprotected Left Main Coronary Artery Compared to Predicted Short-Term Prognosis of CABG Estimated by EuroSCORE: Clinical Determinants of Long-Term OutcomeJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2009RALF LEHMANN M.D. Aims/Methods: The long-term outcome of patients (pts) undergoing percutaneous coronary intervention (PCI) of unprotected left main coronary artery (LMCA) is unclear so far. We prospectively investigated the outcome of 102 consecutive patients who underwent stent PCI of unprotected LMCA. Patients were divided according to clinical indication for PCI: stable coronary artery disease (CAD) (N = 60), NSTEMI (N = 18), STEMI (N = 24). Expected in-hospital mortality of coronary artery bypass grafting (CABG) was calculated using the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and compared to the observed survival rate during long-term follow-up (mean 1.8 ± 1.2 years). Results: The observed 30-day mortality was 1.7% (1/60 pts) in patients with stable CAD, 11% (2/18 pts) in NSTEMI patients, and 13% (3/24 pts) in STEMI patients. The observed mortality was lower than the predicted mortality of CABG as calculated by the logistic EuroSCORE. Using receiver-operator characteristics curves (ROC), EuroSCORE demonstrated a high predictive value for both 30-day mortality as well as 1-year mortality (AUC > 0.8; P < 0.01). Prognostically relevant patient related factors (P < 0.01) included severely reduced left ventricular ejection fraction (HR 3.24), ACS (HR 3.18), STEMI (HR: 3.01), Killip class IV (HR 7.69), occurrence of neoplastic disease (HR 3.97), and elevated CRP (HR 3.86). Conclusions: LMCA-PCI was associated with lower long-term mortality rates compared to the estimated mortality of CABG. This prospective observational study suggests that DES-PCI of unprotected LMCA in "all-comers" can be carried out with reasonable risk. [source] Gene expression changes in human cells after exposure to mobile phone microwavesPROTEINS: STRUCTURE, FUNCTION AND BIOINFORMATICS, Issue 17 2006Daniel Remondini Abstract Possible biological effects of mobile phone microwaves were investigated in,vitro. In this study, which was part of the 5FP EU project REFLEX (Risk Evaluation of Potential Environmental Hazards From Low-Energy Electromagnetic Field Exposure Using Sensitive in,vitro Methods), six human cell types, immortalized cell lines and primary cells, were exposed to 900 and 1800,MHz. RNA was isolated from exposed and sham-exposed cells and labeled for transcriptome analysis on whole-genome cDNA arrays. The results were evaluated statistically using bioinformatics techniques and examined for biological relevance with the help of different databases. NB69 neuroblastoma cells, T,lymphocytes, and CHME5 microglial cells did not show significant changes in gene expression. In EA.hy926 endothelial cells, U937,lymphoblastoma cells, and HL-60 leukemia cells we found between 12 and 34,up- or down-regulated genes. Analysis of the affected gene families does not point towards a stress response. However, following microwave exposure, some but not all human cells might react with an increase in expression of genes encoding ribosomal proteins and therefore up-regulating the cellular metabolism. [source] Risk evaluation and type of treatment of multiple dental trauma episodes to permanent teethDENTAL TRAUMATOLOGY, Issue 5 2000U. Glendor Abstract , Studies have shown that some children and adolescents are effected only once with a dental trauma, while others seem to be accident-prone and suffer from multiple dental trauma episodes (MDTE). Studies have also shown that dental traumas mostly affect upper permanent and medial incisors. Less is known about treatment consequences related to teeth with repeated dental trauma episodes. The aim was therefore to evaluate the risk of MDTE to permanent teeth among children and adolescents by age and gender and to compare types of dental treatment modalities used for patients with one episode and those with MDTE and with single and repeated traumatized teeth. The study was based on a random sample of 83 Danish 6,18-year-old children and adolescents born in 1970 who suffered from dental trauma episodes. All patients were followed during a 12-year period (1976,1988). Forty-one of the patients were registered with MDTE with a range of 2,7 episodes and a mean of 2.9 episodes/patient (SD=1.1). The mean age at single and MDTE was 11.4 years (SD=3.6) and 8.6 years (SD=2.1), respectively. No significant differences were found between age at first episode and the number of MDTE per patient. The number of patients with MDTE was significantly higher among those who suffered their first trauma episode in the age interval 6,10 years than in the age interval 11,18 years (P<0.001). A survival analysis showed that the risk of sustaining another trauma episode increased by 14.9,30.3% when the first trauma occurred before the age of 11, compared to 0,7.4% after the age of 10. The risk of sustaining multiple injuries was 8.4 times higher when the first trauma episode occurred at 9 years of age, compared with those occurring at age 12. The survival analysis also showed that for every new trauma episode, the interval between them became closer. Forty-five per cent of the MDTE affected teeth had already sustained an injury. With an increased number of trauma episodes per patient followed an increase in the number of follow-ups, filling therapy, information and prosthetics, whereas the rates of endodontics, surgery, and consultations were unchanged or even decreased. [source] CASE REPORTS: Trepopnea Associated with Paroxysmal Severe Tricuspid Regurgitation Triggered at Left Lateral Decubitus PositionECHOCARDIOGRAPHY, Issue 8 2010David Wolf M.D. A 78-year-old male patient was referred cardiovascular risk evaluation before elective resection of a bronchial carcinoma. A myocardial infarction with a subsequent coronary artery bypass revascularization and a mitral prosthetic valve surgery were known. Left lateral decubitus (LLD) was permanently avoided because of significant trepopnea since several years. No signs of heart failure were found in the physical examination. A mitral valve prosthesis presented normal characteristics at examination. Left ventricular dimensions and function were normal. A severe tricuspid regurgitation could be documented during examination in the LLD, with changing characteristics in dorsal decubitus, when it could be graded as moderate. Trepopnea associated with severe paroxysmal tricuspid regurgitation was never described before in the literature. Sympathetic/parasympathetic modulation of papillary muscles of the tricuspid valve can be proposed as a probable cause of this dynamic valvular dysfunction. (Echocardiography 2010;27:E77-E79) [source] A protocol to estimate the release of anthropogenic hydrocarbons from contaminated soilsENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 9 2003Raymond C. Loehr Abstract An operational protocol, appropriate for a tier 1 or tier 2 type relative risk evaluation of a site that has polycyclic aromatic hydrocarbon (PAH) or petroleum hydrocarbon impacted soils, was developed to estimate the fraction of anthropogenic hydrophobic hydrocarbons that will be released rapidly from such soils. The development of this protocol used over 400 datasets from 40 different field samples to establish and verify the operational protocol. The datasets resulted from four-month kinetic desorption studies of these field samples. Based on the chemicals evaluated, the protocol has greatest application to two, three, and four ring-PAH and to diesel range aliphatic hydrocarbons. The protocol is a simple batch desorption analysis that uses established methods and is conducted for 7 d. The protocol results were verified with specific correlation relationships (r2 = 0.81 to 0.96) to estimate the rapidly releasing fraction (F value) that is obtained in a full, four-month chemical release evaluation. [source] The effects of experience and task difficulty on accuracy and confidence assessments of auditorsACCOUNTING & FINANCE, Issue 2 2000Janne Chung This study extends prior research in psychology and auditing by examining the effects of audit experience and task difficulty on control risk evaluation. It also examines whether the effect of framing is mitigated by the simultaneous presentation of information. Ninety-eight auditors performed a control risk evaluation task and recorded their judgement and their confidence. We find that judgement confidence increases with audit experience and that judgement confidence decreases as perceived task difficulty increases. However, we find no relation between audit experience and judgement accuracy or between perceived task difficulty and judgement accuracy. In addition, we find a significant negative relation between judgement confidence and judgement accuracy, which indicates that the participants' confidence is not appropriate. As expected, there is no framing effect when information is presented simultaneously. [source] Assessment of flooding in urbanized ungauged basins: a case study in the Upper Tiber area, ItalyHYDROLOGICAL PROCESSES, Issue 10 2005T. Moramarco Abstract The reliability of a procedure for investigation of flooding into an ungauged river reach close to an urban area is investigated. The approach is based on the application of a semi-distributed rainfall,runoff model for a gauged basin, including the flood-prone area, and that furnishes the inlet flow conditions for a two-dimensional hydraulic model, whose computational domain is the urban area. The flood event, which occurred in October 1998 in the Upper Tiber river basin and caused significant damage in the town of Pieve S. Stefano, was used to test the approach. The built-up area, often inundated, is included in the gauged basin of the Montedoglio dam (275 km2), for which the rainfall,runoff model was adapted and calibrated through three flood events without over-bank flow. With the selected set of parameters, the hydrological model was found reasonably accurate in simulating the discharge hydrograph of the three events, whereas the flood event of October 1998 was simulated poorly, with an error in peak discharge and time to peak of ,58% and 20%, respectively. This discrepancy was ascribed to the combined effect of the rainfall spatial variability and a partial obstruction of the bridge located in Pieve S. Stefano. In fact, taking account of the last hypothesis, the hydraulic model reproduced with a fair accuracy the observed flooded urban area. Moreover, incorporating into the hydrological model the flow resulting from a sudden cleaning of the obstruction, which was simulated by a ,shock-capturing' one-dimensional hydraulic model, the discharge hydrograph at the basin outlet was well represented if the rainfall was supposed to have occurred in the region near the main channel. This was simulated by reducing considerably the dynamic parameter, the lag time, of the instantaneous unit hydrograph for each homogeneous element into which the basin is divided. The error in peak discharge and time to peak decreased by a few percent. A sensitivity analysis of both the flooding volume involved in the shock wave and the lag time showed that this latter parameter requires a careful evaluation. Moreover, the analysis of the hydrograph peak prediction due to error in rainfall input showed that the error in peak discharge was lower than that of the same input error quantity. Therefore, the obtained results allowed us to support the hypothesis on the causes which triggered the complex event occurring in October 1998, and pointed out that the proposed procedure can be conveniently adopted for flood risk evaluation in ungauged river basins where a built-up area is located. The need for a more detailed analysis regarding the processes of runoff generation and flood routing is also highlighted. Copyright © 2005 John Wiley & Sons, Ltd. [source] Probabilistic risk evaluation for triclosan in surface water, sediments, and aquatic biota tissuesINTEGRATED ENVIRONMENTAL ASSESSMENT AND MANAGEMENT, Issue 3 2010Jennifer Lyndall Abstract Triclosan, an antimicrobial compound used in personal care products, occurs in the aquatic environment due to residual concentrations in municipal wastewater treatment effluent. We evaluate triclosan-related risks to the aquatic environment, for aquatic and sediment-dwelling organisms and for aquatic-feeding wildlife, based on measured and modeled exposure concentrations. Triclosan concentrations in surface water, sediment, and biota tissue are predicted using a fugacity model parameterized to run probabilistically, to supplement the limited available measurements of triclosan in sediment and tissue. Aquatic toxicity is evaluated based on a species sensitivity distribution, which is extrapolated to sediment and tissues assuming equilibrium partitioning. A probabilistic wildlife exposure model is also used, and estimated doses are compared with wildlife toxicity benchmarks identified from a review of published and proprietary studies. The 95th percentiles of measured and modeled triclosan concentrations in surface water, sediment, and biota tissues are consistently below the 5th percentile of the respective species sensitivity distributions, indicating that, under most scenarios, adverse affects due to triclosan are unlikely. Integr Environ Assess Manag 2010;6:419,440. © 2010 SETAC [source] Cardiovascular risk evaluation and antiretroviral therapy effects in an HIV cohort: implications for clinical management: the CREATE 1 studyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 9 2010M. Aboud Summary Aims:, The aim of this study is to determine the cardiovascular disease (CVD) risk profile of a large UK HIV cohort and how highly active antiretroviral therapy (HAART) affects this. Methods:, It is a cross-sectional study within a large inner city hospital and neighbouring district hospital. A total of 1021 HIV positive outpatients representative of the complete cohort and 990 who had no previous CVD were included in CVD risk analysis. We recorded demographics, HAART history and CVD risk factors. CVD and coronary heart disease (CHD) risks were calculated using the Framingham (1991) algorithm adjusted for family history. Results:, The non-CVD cohort (n = 990) was 74% men, 51% Caucasian and 73.1% were on HAART. Mean age was 41 ± 9 years, systolic blood pressure 120 ± 14 mmHg, total cholesterol 4.70 ± 1.05mmol/l, high-density lipoprotein-C 1.32 ± 0.48 mmol/l and 37% smoked. Median CVD risk was 4 (0,56) % in men and 1.4 (0,37) % in women; CHD risks were 3.5 (0,36) % and 0.6 (0,16) %. CVD risk was > 20% in 6% of men and 1% of women and > 10% in 12% of men and 4% of women. CVD risk was higher in Caucasians than other ethnicities; the risk factor contributing most was raised cholesterol. For patients on their first HAART, increased CHD risk (26.2% vs. 6.5%; odds ratio 4.03, p < 0.001) was strongly related to the duration of therapy. Conclusions:, Modifiable risk factors, especially cholesterol, and also duration of HAART, were key determinants of CVD risk. Discussion:, Regular CHD and/or CVD risk assessment should be performed on patients with HIV, especially during HAART therapy. The effect of different HAART regimens on CHD risk should be considered when selecting therapy. [source] Project risk evaluation using a fuzzy analytic hierarchy process: An application to information technology projectsINTERNATIONAL JOURNAL OF INTELLIGENT SYSTEMS, Issue 6 2006Fatih Tüysüz Projects are critical to the realization of performing organization's strategies. Each project contains some degree of risk and it is required to be aware of these risks and to develop the necessary responses to get the desired level of project success. Because projects' risks are multidimensional, they must be evaluated by using multi-attribute decision-making methods. The aim of this article is to provide an analytic tool to evaluate the project risks under incomplete and vague information. The fuzzy analytic hierarchy process (AHP) as a suitable and practical way of evaluating project risks based on the heuristic knowledge of experts is used to evaluate the riskiness of an information technology (IT) project of a Turkish firm. The means of the triangular fuzzy numbers produced by the IT experts for each comparison are successfully used in the pairwise comparison matrices. © 2006 Wiley Periodicals, Inc. Int J Int Syst 21: 559,584, 2006. [source] Reducing risk of shortages due to drought in water supply systems using genetic algorithms,IRRIGATION AND DRAINAGE, Issue 2 2009V. Nicolosi évaluation des risques; gestion de l'eau; sécheresse; éléments déclenchant pour les plans sécheresse Abstract The evaluation of risk of shortages due to drought in water supply systems is a necessary step both in the planning and in the operation stage. A methodology for unconditional (planning) and conditional (operation) risk evaluation is presented in this study. The risk evaluation is carried out by means of an optimisation model based on genetic algorithms aimed to define thresholds for the implementation of mitigation measures tested through Monte Carlo simulation that makes use of a stochastic generation of streamflows. The GA enables the optimisation of reservoir storages which identify monthly thresholds for shifting three states of the system (normal, alert and alarm) to which correspond different mitigation measures such as water demand rationing, additional supplies from alternative sources or reduction of release for ecological use. For unconditional risk evaluation a long time horizon has been considered (40 years), while the conditional risk evaluation is performed on a short time horizon (2,3 months). Results of simulations have been studied by means of consolidated indices of performance and frequency analysis of shortages of a given entity corresponding to different planning/management policies. A multi-use water system has been used as a case study including competing irrigation and industrial demands. Copyright © 2008 John Wiley & Sons, Ltd. L'évaluation du risque de manques d'eau dus à la sécheresse dans les systèmes d'approvisionnement en eau est une étape nécessaire à la fois pour la planification et l'exploitation. Une méthodologie pour l'évaluation du risque inconditionnel (planification) et conditionnel (exploitation) est présentée dans cette étude. L'évaluation du risque est effectuée au moyen d'un modèle d'optimisation basé sur des algorithmes génétiques visant à définir des seuils pour la mise en ,uvre des mesures d'atténuation testés par une méthode de Monte Carlo générant les débits des rivières. L'algorithme génétique permet d'optimiser les stockages de réservoir avec des seuils mensuels pour identifier trois états du système (normal, alerte et alarme) auxquels correspondent différentes mesures d'atténuation telles que rationnement de la demande en eau, approvisionnements complémentaires par des sources alternatives ou réduction des lâchures pour l'usage écologique. Pour l'évaluation des risques inconditionnels un horizon à long terme a été considéré (40 ans) tandis que l'évaluation conditionnelle est faite sur un horizon à court terme (2 ou 3 mois). Les résultats des simulations ont été étudiés au moyen d'indices de performance consolidés et de l'analyse de la fréquence des manques d'eau pour une entité donnée correspondant à différentes politiques de planification et gestion. L'étude de cas porte sur un système multi-usage comportant une demande d'irrigation en concurrence avec les demandes industrielles. Copyright © 2008 John Wiley & Sons, Ltd. [source] Nordic guidelines for neuraxial blocks in disturbed haemostasis from the Scandinavian Society of Anaesthesiology and Intensive Care MedicineACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2010H. BREIVIK Background: Central neuraxial blocks (CNBs) for surgery and analgesia are an important part of anaesthesia practice in the Nordic countries. More active thromboprophylaxis with potent antihaemostatic drugs has increased the risk of bleeding into the spinal canal. National guidelines for minimizing this risk in patients who benefit from such blocks vary in their recommendations for safe practice. Methods: The Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) appointed a task force of experts to establish a Nordic consensus on recommendations for best clinical practice in providing effective and safe CNBs in patients with an increased risk of bleeding. We performed a literature search and expert evaluation of evidence for (1) the possible benefits of CNBs on the outcome of anaesthesia and surgery, for (2) risks of spinal bleeding from hereditary and acquired bleeding disorders and antihaemostatic drugs used in surgical patients for thromboprophylaxis, for (3) risk evaluation in published case reports, and for (4) recommendations in published national guidelines. Proposals from the taskforce were available for feedback on the SSAI web-page during the summer of 2008. Results: Neuraxial blocks can improve comfort and reduce morbidity (strong evidence) and mortality (moderate evidence) after surgical procedures. Haemostatic disorders, antihaemostatic drugs, anatomical abnormalities of the spine and spinal blood vessels, elderly patients, and renal and hepatic impairment are risk factors for spinal bleeding (strong evidence). Published national guidelines are mainly based on experts' opinions (weak evidence). The task force reached a consensus on Nordic guidelines, mainly based on our experts' opinions, but we acknowledge different practices in heparinization during vascular surgery and peri-operative administration of non-steroidal anti-inflammatory drugs during neuraxial blocks. Conclusions: Experts from the five Nordic countries offer consensus recommendations for safe clinical practice of neuraxial blocks and how to minimize the risks of serious complications from spinal bleeding. A brief version of the recommendations is available on http://www.ssai.info. [source] Fractal Analysis of Radiographic Trabecular Bone Texture and Bone Mineral Density: Two Complementary Parameters Related to Osteoporotic FracturesJOURNAL OF BONE AND MINERAL RESEARCH, Issue 4 2001C. L. Benhamou Abstract Trabecular bone microarchitecture and bone mineral density (BMD) are two main factors related to osteoporotic fractures. Currently, however, microarchitecture is not evaluated. We have developed and validated a trabecular bone texture analysis from radiographic images. The objective was to determine if the fractal analysis of texture was able to distinguish osteoporotic fracture groups from control groups, either in vertebrae, hip, or wrist fractures, and to determine if this indicator and BMD were independent and complementary. In this cross-sectional unicenter case-control population study in postmenopausal women, 107 fracture cases were enrolled and age-matched with 197 control cases. This population comprised 40 vertebral fractures (with 70 controls), 30 hip fractures (55 controls), and 37 wrist fractures (62 controls). Hip and lumbar spine BMD were measured by double-energy X-ray absorptiometry. Fractal analysis of texture was performed on calcaneus radiographs and the result was expressed as the H parameter (H = 2-fractal dimension). The H parameter showed a lower value (0.679 ± 0.053 SD) in fracture cases versus control cases (0.696 ± 0.030; p = 0.007), the statistical significance persisting after adjustment for age and for lumbar spine (LS) or hip BMD. This result was confirmed in vertebral fractures (p = 0.0001) and hip fractures (p = 0.003) but not wrist fractures (p = 0.07). We determined the threshold between high and low H values and then the odds ratios (OR) of fracture for low H for BMD , ,2.5 SD in T score and for the combinations of both parameters. The OR of fracture for low H was 1.6 (95% CI, 1.1,2.6). For LS BMD , ,2.5 SD the OR of 6.1 (3.4,10.8) shifted to 9.0 (4.0,20.4) when we added low H and for hip BMD it shifted from 5.6 (3.3,9.4) to 8.1 (4.0,16.8). In vertebral, hip, and wrist fracture cases the results were also significant. These data have shown that the fractal analysis of texture on calcaneus radiographs can distinguish osteoporotic fracture groups from control groups. This analysis and BMD provide independent and complementary information. These data suggest that we can improve the fracture risk evaluation by adding information related to microarchitecture, derived from analysis of conventional radiographic images. [source] Elucidation and decisional risk in a multi-criteria decision based on a Choquet integral aggregation,a cybernetic frameworkJOURNAL OF MULTI CRITERIA DECISION ANALYSIS, Issue 5-6 2005J. Montmain Abstract The authors are developing multi-criteria Decision-making support systems (DMSS) for project teams in charge of selecting a technical solution among alternatives. They propose a cybernetic framework to emphasize the link between decision-making (DM) and knowledge management processes in such projects. These DMSSs rely on the tracking of the accompanying knowledge production of long-term decisional processes by a collective with many actors. Based on knowledge-production management, this paper explains how to design decisional risk evaluation, monitoring and control aids and traceability functions for strategic choices and logical argumentation. The DMSS is seen as a recommender system for the project manager. Each possible solution involved in the decision-making process (DMP) is evaluated by means of a set of criteria. The evaluation results from an interpretation of the knowledge items in terms of satisfaction scores of the solutions according to the considered criteria. Aggregating these partial scores provides a ranking of all the possible solutions by order of preference. As criteria are sometimes interacting, the aggregation has to be based on adapted operators, i.e. Choquet integrals. Evaluating possible solutions by the knowledge contained in the knowledge base (KB) opens the way to automating the argumentation of the project team's decisions: the argumentation principle underlying this approach is based naturally on coupling a knowledge dynamical management system (KDMS) with the DMSS. The DMSS also evaluates the decisional risk that reflects the eventuality of a wrong selection due to the insufficiency of available knowledge at a given time in order to adopt a reliable solution. Decisional risk assessment corresponds to sensitivity analyses. These analyses are then exploited to control the decisional risk in time: they enable to identify the crucial information points for which additional and deeper investigations would be of great interest to improve the stability of the selection in the future. The knowledge management of a collective project is represented as a control loop: the KDMS is the actuator, the risk accompanying the decision is the controlled variable and is strongly linked to the entropy of the KB managed by the KDMS. Each of the three phases,intelligence, design, choice,of the DMP is identified to a function of the control loop: actuator, process and regulator. This cybernetic framework for decision has its origin in knowledge management activities for a great-scale project,the EtLD project of the French Atomic Commission (CEA) that concerns the management of high-level long-life radioactive waste in France. Copyright © 2007 John Wiley & Sons, Ltd. [source] Allergy assessment of foods or ingredients derived from biotechnology, gene-modified organisms, or novel foodsMOLECULAR NUTRITION & FOOD RESEARCH (FORMERLY NAHRUNG/FOOD), Issue 6 2004Lars K. Poulsen Abstract The introduction of novel proteins into foods carries a risk of eliciting allergic reactions in individuals sensitive to the introduced protein and a risk of sensitizing susceptible individuals. No single predictive test exists to perform a hazard assessment in relation to allergenic properties of newly expressed proteins in gene-modified organisms (GMOs). Instead, performance of a weighted risk analysis based on the decision tree approach has been suggested. The individual steps of this analysis comprise sequence homology to known allergens, specific or targeted serum screens for immunoglobulin E (IgE) cross-reactions to known allergens, digestability studies of the proteins in simulated gastric and/or intestinal fluids, and animal studies. These steps are discussed and five examples of risk evaluation of GMOs or novel foods are presented. These include ice-structuring protein derived from fish, microbial transglutaminase, GMO-soybeans, amylase and the Nangai nut. [source] Genetic factors associated with skin cancer in renal transplant patientsPHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE, Issue 2-3 2007Mary Elizabeth Laing Background: Non-melanoma skin cancer represents a significant cause of morbidity and mortality among renal transplant recipients. Established risk factors that increase susceptibility to skin cancer after transplantation include skin type, sun exposure and level of immunosuppression. Methods: A comprehensive literature review was carried out to discuss relevant genetic polymorphism for the development of skin cancer in organ transplant recipients. These include genetic polymorphisms in glutathione S -transferase, interleukin-10, retinoblastoma and p53 genes. We also discuss genetic polymorphisms in the folate pathway, melanocortin 1 receptor and vitamin D receptor recently discovered in our group. Results: No single factor is causative in cutaneous carcinogenesis in transplant recipients. Interactions of some of the above mechanisms with known environmental factors lead to increased risk. Conclusion: Polymorphisms in methylenetetrahydrofolate reductase are potentially correctable with folic acid supplementation; however, further evaluation is required in adequately powered prospective clinical trials. Avoidance of known oncogenic environmental factors and genetic risk evaluation may improve outcomes in transplant patients. [source] Identification, characterization and clinical implications of two markers detected at prenatal diagnosisPRENATAL DIAGNOSIS, Issue 10 2006Rosário Pinto Leite Abstract Objectives Marker chromosomes are relatively rare in the general population as its identification at prenatal diagnosis. In this article, we identified and characterized two de novo supernumerary marker chromosomes in a mosaic form at prenatal diagnosis. Methods The two cases presented were detected during prenatal diagnosis at 17 and 15 weeks of gestation. The analyses were performed due to the advanced maternal age. In both cases, parent's karyotypes were normal. The identification of the marker chromosomes was possible by FISH techniques. Results One marker chromosome was derived from chromosome 5 and the other from chromosome 6. Both children are well at the moment. Conclusion The two cases described in the present paper, join to the ones already described in the literature. However these results are the first ones without any phenotypical anomalies, at least until the present. Every new characterization of marker chromosomes at prenatal diagnosis should be reported for determining a genotype-phenotype correlation, and thus be used for genetic counselling and risk evaluation. Copyright © 2006 John Wiley & Sons, Ltd. [source] Identification of a small supernumerary marker chromosome, r(2)(p10q11.2), and the problem of determining prognosisPRENATAL DIAGNOSIS, Issue 10 2001N. Villa Abstract The identification of small supernumerary marker chromosomes (SMCs) and the elucidation of their clinical significance remain two of the problems in classical human cytogenetics. We observed a small supernumerary ring in amniotic fluid cell cultures and identified its origin as r(2)(p10q11.2) and its extent by means of fluorescent in situ hybridisation (FISH). Uniparental disomy (UPD) was excluded by microsatellite analysis using polymorphic markers localised in the same region. On the basis of normal ultrasonographic checks, the patient decided to continue the pregnancy. A normal female was delivered at term and subsequent neonatal follow-ups confirmed the normal phenotype and development. In the present case, genetic counselling was not helpful because of the absence of reference cases. Detailed characterisation made it possible to correlate the normal baby phenotype with the trisomic 2p10-2q11.2 genomic region. Further molecular cytogenetic investigations of SMCs classified by DNA content and pregnancy outcome data should improve genetic counselling and risk evaluation. Copyright © 2001 John Wiley & Sons, Ltd. [source] Sustainable soil remediation by refrigerated condensation at sites with "high-concentration" recalcitrant compounds and NAPL: Two case studiesREMEDIATION, Issue 1 2008Lowell Kessel Remediation of recalcitrant compounds at sites with high concentrations of volatile organic compounds (VOCs) or nonaqueous-phase liquids (NAPLs) can present significant technical and financial (long-term) risk for stakeholders. Until recently, however, sustainability has not been included as a significant factor to be considered in the feasibility and risk evaluation for remediation technologies. The authors present a framework for which sustainability can be incorporated into the remediation selection criteria focusing specifically on off-gas treatment selection for soil vapor extraction (SVE) remediation technology. SVE is generally considered an old and standard approach to in situ remediation of soils at a contaminated site. The focus on off-gas treatment technology selection in this article allows for more in-depth analysis of the feasibility evaluation process and how sustainable practices might influence the process. SVE is more commonly employed for recovery of VOCs from soils than other technologies and generally employs granular activated carbon (GAC), catalytic, or thermal oxidation, or an emerging alternative technology known as cryogenic-compression and condensation combined with regenerative adsorption (C3,Technology). Of particular challenge to the off-gas treatment selection process is the potential variety of chemical constituents and concentrations changing over time. Guidance is available regarding selection of off-gas treatment technology (Air Force Center for Environmental Excellence, 1996; U.S. Environmental Protection Agency, 2006). However, there are common shortcomings of off-gas treatment technology guidance and applications; practitioners have rarely considered sustainability and environmental impact of off-gas treatment technology selection. This evaluation includes consideration of environmental sustainability in the selection of off-gas treatment technologies and a region-specific (Los Angeles, California) cost per pound and time of remediation comparisons between GAC, thermal oxidation, and C3,Technology. © 2008 Wiley Periodicals, Inc. [source] Subclinical late cardiac toxicity in childhood cancer survivorsCANCER, Issue 8 2008Impact on self-reported health Abstract BACKGROUND The authors analyzed how self-reported health and self-reported modified New York Heart Association (NYHA) cardiac function scores were related to cardiac systolic function, cardiac risk factors, and cancer treatment history in childhood cancer survivors who reported no symptoms of cardiac disease. METHODS Long-term survivors of pediatric cancer who were treated between 1971 and 1995 (current ages, 16,39.7 years) underwent noninvasive clinical and laboratory cardiac risk evaluation and responded to selected subscales of the Medical Outcomes Study 36-item Short Form Health Survey. Results were compared with survivor history of anthracycline therapy alone or with radiotherapy (n = 127 patients; mean, 10 years after diagnosis) versus no anthracycline therapy (n = 32 patients; mean, 11 years after diagnosis). RESULTS Sex, current age, highest school grade completed, race, age at diagnosis, diagnostic group, years off therapy, fractional shortening (FS), heart rate, and smoking status were found to be independently predictive of self-reported health. Interaction between female sex and higher low-density lipoprotein values and between diagnosis and abnormal FS variably predicted low reported vitality and low reported modified New York Heart Association (NYHA) scores. Echocardiographic findings, cardiac risk factors, and treatment history explained 13% to 28% of the variance in perceived health and self-reported modified NYHA scores. CONCLUSIONS Systolic function and cardiac risk factors were linked to lower self-reported health and NYHA scores even in the absence of clinically evident cardiotoxicity. Cancer 2008. ©2008 American Cancer Society. [source] Acceptance of tamoxifen chemoprevention by physicians and women at riskCANCER, Issue 9 2004Julia Tchou M.D., Ph.D. Abstract BACKGROUND In the National Surgical Adjuvant Breast and Bowel Project (NSABP) P-1 trial, tamoxifen was shown to reduce breast carcinoma risk by 49% in high-risk women. The purpose of the current study was to identify factors associated with being offered, and accepting, tamoxifen chemoprevention. METHODS The records of 219 women who sought risk evaluation after the publication of the NSABP P-1 trial between September 1998 and October 2002 were reviewed. Risk was calculated using the model of either Gail et al. or Claus et al. The impact of individual risk factors on the offering and acceptance of tamoxifen was compared using the Fisher exact test and logistic regression analysis. RESULTS Tamoxifen was offered to 137 women (63%) in the current study. The magnitude of Gail risk, age, menopausal status, hysterectomy, and history of lobular carcinoma in situ (LCIS) or atypical hyperplasia (AH) were all found to be significant predictors of a patient being offered tamoxifen. On multivariate analysis, only a history of AH or LCIS and hysterectomy were found to be significant, with odds ratios of 20.3 and 3.4, respectively. Fifty-seven of the women who were offered tamoxifen (42%) took the drug. Only a history of LCIS or AH and older age were found to be predictive of tamoxifen acceptance. CONCLUSIONS In the current study, risk due to AH or LCIS was found to be the main predictor of being offered and accepting tamoxifen chemoprevention. Cancer 2004. © 2004 American Cancer Society. [source] 3142: Radiation-induced lens opacities: towards a new strategy to address the low dose risk research with the European network DoReMiACTA OPHTHALMOLOGICA, Issue 2010P GOURMELON In 2010, a Network of Excellence called DoReMi was launched by the EURATOM FP7 programme. DoReMi will act during the next six years as an operational tool for the development of a research platform devoted to low dose risk research in Europe. The research activities of DoReMi are implemented within three work packages: WP5, WP6, and WP7, which are respectively concerned with the shape of the dose effect relationship, individual radiation sensitivity and non-cancer effects. The overarching objective of WP7 is to implement a long-term, integrated approach involving several disciplines, namely, epidemiology, radiobiology and toxicology, for the purpose of risk evaluation for radiation-induced non-cancer effects. One of the operational objectives of the DoReMi WP7 consists of undertaking feasibility studies addressing the issues of vascular effects, lens opacities and cognitive effects. The presentation to be given will provide the assembly with (i) information about the European low dose risk research strategy; (ii) latest knowledge about the epidemiological evidence of radiation-induced lens opacities; (iii) information about the feasibility study of lens opacities to be launched in a group of interventional cardiologists (iv) most promising mechanistic hypotheses for the development of radiation-induced lens opacities recognizing that while posterior subcapsular cataracts are characteristic of an exposure to ionizing radiation, several sets of data suggest that the broader category of posterior cortical cataracts may also be regarded as radiation-associated. Eventually the presentation will discuss the issue of a threshold for the development of radiation-induced lens opacities and list the scientific questions raised by the radiation protection community to the vision and eye research community. [source] Rethinking groundwater monitoring at the Hanford SiteREMEDIATION, Issue 2 2000Daniel Michael Groundwater monitoring at Department of Energy's (DOE's) Hanford Site is a large, expensive undertaking serving multiple purposes, including compliance with regulations and DOE orders, remediation efforts under CERCLA, and sitewide risk evaluations. Like most large Federal facilities, the monitoring program currently in place has evolved and grown overtime as new requirements were established and groups were assigned to address them. DOE and its regulators simultaneously awakened to the fact that there was a need to reevaluate the monitoring activities at Hanford, to better integrate the program, to avoid duplicative sampling, to improve everyone's understanding of the performance of the network, and to evaluate whether adequate data could be collected for lower cost. This paper describes the approch that was developed to guide the rethinking effort with direct and extensive involvement of DOE, EPA, Washington Department of Ecology, Indian Tribes, and DOE Contractors, and how this approach was applied to a large portion of the site. Both the human element of the process (cultural change), as well as some of the technical details associated with the effort, including a flexible application of EPA's data quality objectives process, are discussed. [source] | |||||||||||||||||||||||||||||||