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Risk Levels (risk + level)
Selected AbstractsA CRITICAL LOOK AT PAP ADEQUECY: ARE OUR CRITERIA SATISFACTORY?CYTOPATHOLOGY, Issue 2006D.R. Bolick Liquid based Pap (LBP) specimen adequacy is a highly documented, yet poorly understood cornerstone of our GYN cytology practice. Each day, as cytology professionals, we make adequacy assessments and seldom wonder how the criteria we use were established. Are the criteria appropriate? Are they safe? What is the scientific data that support them? Were they clinically and statistically tested or refined to achieve optimal patient care? In this presentation, we will take a fresh look at what we know about Pap specimen adequacy and challenge some of the core assumptions of our daily practice. LBP tests have a consistent, well-defined surface area for screening, facilitating the quantitative estimates of slide cellularity. This provides an unprecedented opportunity to establish reproducible adequacy standards that can be subjected to scientific scrutiny and rigorous statistical analysis. Capitalizing on this opportunity, the TBS2001 took the landmark step to define specimen adequacy quantitatively, and set the threshold for a satisfactory LBP at greater than 5,000 well visualized squamous epithelial cells. To date, few published studies have attempted to evaluate the validity or receiver operator characteristics for this threshold, define an optimal threshold for clinical utility or assess risks of detection failure in ,satisfactory' but relatively hypocellular Pap specimens. Five years of cumulative adequacy and cellularity data of prospectively collected Pap samples from the author's laboratory will be presented, which will serve as a foundation for a discussion on ,Pap failure'. A relationship between cellularity and detection of HSIL will be presented. Risk levels for Pap failure will be presented for Pap samples of different cellularities. The effect of different cellularity criterion on unsatisfactory Pap rates and Pap failure rates will be demonstrated. Results from this data set raise serious questions as to the safety of current TBS2001 adequacy guidelines and suggest that the risk of Pap failure in specimens with 5,000 to 20 000 squamous cells on the slide is significantly higher than those assumed by the current criteria. TBS2001 designated all LBP to have the same adequacy criterion. Up to this point, it has been assumed that ThinPrep, SurePath, or any other LBP would be sufficiently similar that they should have the same adequacy criteria. Data for squamous cellularity and other performance characteristics of ThinPrep and SurePath from the author's laboratory will be compared. Intriguing data involving the recently approved MonoPrep Pap Test will be reviewed. MonoPrep clinical trial data show the unexpected finding of a strong correlation between abundance of endocervical component and the detection of high-grade lesions, provoking an inquiry of a potential new role for a quantitative assessment of the transition zone component. The current science of LBP adequacy criteria is underdeveloped and does not appear to be founded on statistically valid methods. This condition calls us forward as a body of practitioners and scientists to rigorously explore, clarify and define the fundamental nature of cytology adequacy. As we forge this emerging science, we will improve diagnostic performance, guide the development of future technologies, and better serve the patients who give us their trust. Reference:, Birdsong GG: Pap smear adequacy: Is our understanding satisfactory? Diagn Cytopathol. 2001 Feb; 24(2): 79,81. [source] Catastrophic incident prevention and proactive risk management in the new biofuels industry,ENVIRONMENTAL PROGRESS & SUSTAINABLE ENERGY, Issue 1 2009Judy A. Perry Abstract This article is directed at assisting bioethanol manufacturers with preventing catastrophic incidents which could impact the entire Biofuels Industry. The biofuels industry has common hazards and potential consequences like other industries, related to the handling of flammables, dust explosion hazards and toxic or corrosive materials handling. This article ensures the reader understands these specific bioethanol manufacturer's process hazards are very real as demonstrated by past incidents and their catastrophic results. Regulatory obligations are discussed, as well as key engineering resources and design practices to ensure adequate safeguards are incorporated into the design of a new bioethanol manufacturing facility. The industry is fairly new, however, the hazards and safeguards to reduce the risk level with the common hazards are not new. Preliminary indications are this industry has yet to establish the proactive risk management efforts that are required to reduce the risks to a tolerable level. This article is to provide the supporting data and direction to the Biofuels Industry to ensure each are headed down a path of preventing a future catastrophe. © 2009 American Institute of Chemical Engineers Environ Prog, 2009 [source] Risk reduction and real estate portfolio sizeMANAGERIAL AND DECISION ECONOMICS, Issue 7 2001Peter J. Byrne There is remarkably little empirical evidence of the advantages of increased size on risk levels in real estate portfolios based on actual portfolios. This paper improves this by examining the portfolio risk of a large sample of actual real estate data in the UK over the period from 1981 to 1996. The results show that real estate portfolios of larger sizes tend, on average, to have lower risks than smaller sized portfolios and, more importantly, that portfolios with only a few assets can have very high or very low risk. For fund managers to be confident that their portfolio will have a risk level like the average, they need to hold portfolios of a considerably greater size than they might expect, or can sensibly acquire. Previous studies suggesting that only 20,40 properties are needed to reduce the risk of a property portfolio down to the market level are a significant underestimate. The actual figure is likely to be 400,500 properties, well above that of even the largest fund in the UK. Size alone does not necessarily lead to a reduction in portfolio risk. Other factors are of greater importance. Copyright © 2001 John Wiley & Sons, Ltd. [source] Safety of medications prescribed before and during early pregnancy in a cohort of 81,975 mothers from the UK General Practice Research Database,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 8 2006Janet R. Hardy PhD Abstract Purpose To demonstrate a linkage methodology for mother and baby automated medical records, and describe frequency, type, and pregnancy risk level of medications prescribed during pregnancy in a GPRD cohort, 1991,1999. Methods We linked records using a two-stage algorithm and selected pairs with ,7 months prenatal records and ,2 records in baby's first year of life. Periods of interest were: 90 days prior to a woman's earliest identified pregnancy record (Period I), and this record plus 70 days (Period II, approximate early pregnancy). Medications were classified using the British National Formulary and US Food and Drug Administration Pregnancy Risk Categories. Results We achieved over 80% record linkage and defined a cohort of 81,975. Sixty-five per,cent of mothers had ,1 prescription during both periods combined. Most frequent medications in Period I were anti-bacterial, contraceptive, topical steroid, and bronchodilator. In Period II, they were folic acid, anti-bacterial, antacid, and gynecological anti-infective. In Period I, 4% were FDA category A (considered safest), 34% B, and 49% C and D combined. By Period II, prescription of category A medications increased (folic acid, iron) while other categories declined. Category X medications, with potential teratogenic risk that outweighs maternal benefit, were prescribed to 5714 (7%) women in Period I, and 501 (0.6%) women in Period II (46% progesterone). Conclusions One in every 164 women received a category X prescription in early pregnancy. The visit when pregnancy is first medically recognized represents an opportunity to review prescribed medications in light of contraindication and/or fetal risk. Copyright © 2006 John Wiley & Sons, Ltd. [source] Are immigrants, ethnic and linguistic minorities over-represented in jobs with a high level of compensated risk?AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 9 2010Canada study using census, Results from a montréal, workers' compensation data Abstract Objectives Few Canadian data sources allow the examination of disparities by ethnicity, language, or immigrant status in occupational exposures or health outcomes. However, it is possible to document the mechanisms that can create disparities, such as the over-representation of population groups in high-risk jobs. We evaluated, in the Montréal context, the relationship between the social composition of jobs and their associated risk level. Methods We used data from the 2001 Statistics Canada census and from Québec's workers' compensation board for 2000,2002 to characterize job categories defined as major industrial groups crossed with three professional categories (manual, mixed, non-manual). Immigrant, visible, and linguistic minority status variables were used to describe job composition. The frequency rate of compensated health problems and the average duration of compensation determined job risk level. The relationship between the social composition and risk level of jobs was evaluated with Kendall correlations. Results The proportion of immigrants and minorities was positively and significantly linked to the risk level across job categories. Many relationships were significant for women only. In analyses done within manual jobs, relationships with the frequency rate reversed and were significant, except for the relationship with the proportion of individuals with knowledge of French only, which remained positive. Conclusions Immigrants, visible, and linguistic minorities in Montréal are more likely to work where there is an increased level of compensated risk. Reversed relationships within manual jobs may be explained by under-reporting and under-compensation in vulnerable populations compared to those with knowledge of the province's majority language. Am. J. Ind. Med. 53:875,885, 2010. © 2010 Wiley-Liss, Inc. [source] Safety walkarounds predict injury risk and reduce injury rates in the construction industryAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 6 2010K.L. Mikkelsen MD Abstract Background "Safe Workplace",a simplified and educational version of the Finnish building construction methodology involving safety walkarounds where a number of safety indicators are inspected and evaluated,is in widespread use in the Danish construction sector to evaluate physical safety standards proactively at construction work sites. Methods Data from the construction of the Copenhagen Metro were analyzed to determine the method's ability to predict injury risk related to joint responsibilities and individual worker responsibilities. Results A statistically significant association between the risk level as measured by the Safe Workplace methodology and injury risk was found. The relative risk of injury increased with the number of safety indicators violated and was elevated for safety indicators reflecting both individual and joint safety responsibility. The observed injury risk was not elevated in the post-safety walkaround period for safety indicators of individual responsibility, but the joint responsibility indicators retained an elevated injury risk level. Conclusions The data support the hypothesis that safety walkarounds both predict and prevent injuries. Safety indicators of individual responsibility are more likely to be corrected than those of joint responsibility. Am. J. Ind. Med. 53: 601,607, 2010. © 2010 Wiley-Liss, Inc. [source] Source Material: "Does This Constitute a Press Conference?"PRESIDENTIAL STUDIES QUARTERLY, Issue 1 2003Defining, Tabulating Modern Presidential Press Conferences The presidential press conference has demonstrated the way in which both sides have adapted to their own environments. By studying the frequency, format, location, and participants, we can see the ways in which a president responds to reporters'needs for information and the president's own need to present himself and his programs but to do so in an environment where the risk level is manageable. In this article, the author is looking at the variations in the basic elements of the press conference as seen in the modern era conferences of Presidents Lyndon Johnson, Richard Nixon, Gerald Ford, Jimmy Carter, Ronald Reagan, George H. W. Bush, Bill Clinton, and George W. Bush. This piece is restricted to looking at the at the classification of press conferences and exploring their variety as expressed in the number of the locations where they are held and the assortment of participants in addition to the president. [source] Real-time data-based risk assessment for hazard installations storing flammable gasPROCESS SAFETY PROGRESS, Issue 3 2008Zhou Jianfeng Abstract Large quantities of dangerous substances, especially explosive or flammable gases, are processed or stored in hazard installations. A risk-based warning/early-warning system for major hazard installations is very important for the prevention of major accidents. The real-time data-based risk and the risk factors are analyzed in this article, and a fuzzy logic based real-time risk assessment method is proposed. On the basis of fuzzy logic theory, the likelihood of an accident occurrence and the consequence of the accident can be assessed, and the risk value or risk level can be evaluated by utilizing a risk matrix. The method takes advantage of the real-time data acquired from the safety monitoring system so that the change in the risk can be determined as the accident develops. The risk assessment simulation of a vapor cloud explosion (VCE) accident caused by gas leaked from an liquefied petroleum gas tank is performed. It is shown that the risk of a VCE accident varies with the change of the monitored data. © 2008 American Institute of Chemical Engineers Process Saf Prog, 2008 [source] Risk Criteria for the Shipping IndustryQUALITY AND RELIABILITY ENGINEERING INTERNATIONAL, Issue 1 2006V. M. Trbojevic Abstract This paper proposes dual risk criteria for the shipping industry based on a goal-setting approach to safety requiring risk in the tolerability region to be as low as reasonably practicable (ALARP) within which there is a prescriptive target risk level which should not be reached. The prescriptive target risk level is intended for smaller companies satisfying the current safety and classification rules, while it is expected that leading companies would embrace the dynamic ALARP approach as a means for improving the current practice in a search for a better and more economical solution. Furthermore, it is shown that it is possible to formulate the societal risk criteria fully consistent with often legally imposed individual risk criteria. Copyright © 2006 John Wiley & Sons, Ltd. [source] Regulatory hurdles for transgenic biofuel cropsBIOFUELS, BIOPRODUCTS AND BIOREFINING, Issue 4 2009David Lee Abstract Policy-makers have described the many potential benefits that biofuels can provide, but there are numerous challenges in realizing this potential. The technical hurdles to producing biofuels economically and on a scale to replace a significant fraction of petroleum-based transportation fuels have been well described, along with the potential environmental concerns. The use of biotechnology can potentially address many of these technical challenges and environmental concerns, but brings significant regulatory obstacles that have not been discussed extensively in the scientific community. This review will give an overview of some of the approaches being developed to produce transgenic biofuel feedstocks, particularly cellulosic ethanol, and the regulatory process in the United States that oversees the introduction of new transgenic plants. We hope to illustrate that the level of regulation for transgenic organisms is not proportional to their potential risk to human health or to the environment, and that while revisions to the regulatory system in the USA are currently under consideration, further modifications are necessary to reflect the risk level of transgenic crops and realize their benefits. © 2009 Society of Chemical Industry and John Wiley & Sons, Ltd [source] Oral health inequalities between young Aboriginal and non-Aboriginal children living in Ontario, CanadaCOMMUNITY DENTISTRY AND ORAL EPIDEMIOLOGY, Issue 6 2009Herenia P. Lawrence Abstract,,, Objectives:, To investigate (i) oral health inequalities between off-reserve Aboriginal and non-Aboriginal children entering junior kindergarten (JK) in the Thunder Bay District, Northwest Ontario, Canada, (ii) oral health inequalities between kindergarten-aged (4 years old) Aboriginal children living on reserves in the Sioux Lookout Zone (SLZ), Northwest Ontario and those living off-reserve in the Thunder Bay District and (iii) early childhood caries (ECC) trends among SLZ children between 2001 and 2005. Methods:, Cross-sectional oral health data (dmft/s Indices) for 416 (2003/2004), 687 (2004/2005) and 544 (2005/2006) 3- to 5-year olds attending JK in the Thunder Bay District were collected by calibrated dental hygienists with the District's Health Unit. Secondary analysis of oral health status data from two studies conducted in the SLZ between 2001 and 2005 provided the dmft of random samples of children younger than 6 years of age living in 16,20 First Nations communities. Results:, When compared with non-Aboriginal children aged 3,5 years attending the same schools in the Thunder Bay District between 2003 and 2006, off-reserve Aboriginal children had 1.9 to 2.3 times the risk of having ECC (dmft > 0), 2.9 to 3.5 times the risk of a dmft > 3 and 1.8 to 2.5 times the risk of untreated decayed teeth after adjusting the prevalence ratios for child's age and sex, school's risk level and clustered-correlated data. The mean dmft of on-reserve Aboriginal 4-year olds in 2005 was 11.2 and 5.9 for their off-reserve Aboriginal counterparts. In 2001, the mean dmft scores (95% confidence interval) of 2-, 3- and 4-year-old Aboriginal children in the SLZ were: 9.1 (8.3,9.9), 12.4 (11.8,13.1), 13.1 (12.1,14.2). In 2005, similarly aged SLZ children had a mean dmft of: 6.2 (5.2,7.1), 8.9 (8.2,9.6), 11.2 (10.5,11.9), representing significant reductions in caries severity (32%, 28% and 14.5%, respectively). Conclusions:, Significant disparities in caries experience exist between off-reserve Aboriginal and non-Aboriginal children living in the same locales and between Aboriginal children living on- and off-reserve in northwestern Ontario. The study showed decreased trends in the severity of ECC for children in the SLZ occurring over the 5-year period. Despite this progress, the oral health of young Aboriginal children in Ontario continues to lag far behind that of non-Aboriginal children, demanding further programs and policies to tackle the social determinants of oral health and resolve these inequalities. [source] ESTIMATING INTERVENTION EFFECTS IN VARYING RISK SETTINGS: DO POLICE RAIDS REDUCE ILLEGAL DRUG DEALING AT NUISANCE BARS?,CRIMINOLOGY, Issue 2 2003JACQUELINE COHEN This paper investigates the effectiveness of police raids in reducing drug dealing in and around nuisance bars. We examine effects of both dosage (number of raids) and duration (months) of the intervention, as well as the conditioning effects of land use and population characteristics in shaping the underlying risk levels of drug dealing in the target and surrounding areas. Results indicate that the police intervention suppresses levels of drug dealing during periods of active enforcement, but the effects largely disappear when the intervention is withdrawn. Also, the effects of the intervention are mediated by risk characteristics in target and surrounding areas. Target areas characterized by higher levels of risk are more resistant to intervention effects than those with lower levels of risk. Risk factors in nearby areas are also significant. Bars with high levels of risk arising from land uses in surrounding areas are easier to treat, while bars with high levels of population-based risk in surrounding areas are harder to treat. [source] Seismic risk assessments and GIS technology: applications to infrastructures in the Friuli,Venezia Giulia region (NE Italy)EARTHQUAKE ENGINEERING AND STRUCTURAL DYNAMICS, Issue 11 2003Raffaella Codermatz Abstract This paper illustrates the seismic risk preliminary estimates of two different groups of structures located on the territory of the Friuli,Venezia Giulia region (NE Italy) : the first group includes some special industrial plants, and the second group includes bridges and tunnels belonging to the regional highway network. The part of the study on special industrial plants tries to evaluate the degree of expected damage, taking into account their structural typology and ground shaking expressed in terms of macroseismic intensity. The second part of the study is an application of the HAZUS methodology to the tunnels and bridges of a highway network: the combination of expected ground shaking and the construction characteristics lead to very different risk levels, especially when considering the bridges. The resulting damage levels to bridges and tunnels are still only indicative because of the fragility curves used in the evaluations: they were developed for existing bridge and tunnel structural typologies in the U.S.A. Moreover, both examples show the power of GIS technology in storing, elaborating, and mapping spatial data. Copyright © 2003 John Wiley & Sons, Ltd. [source] Costs of Refuge Use Affect Escape Decisions of Iberian Rock Lizards Lacerta monticolaETHOLOGY, Issue 6 2000José Martín Theoretical models of anti-predator escape behaviour suggest that prey may adjust their escape response such that the optimal flight distance is the point at which the costs of staying exceed the costs of fleeing. Anti-predatory decisions should be made based also on consequences for long-term expected fitness, such as the costs of refuge use. For example, in lizards, the maintenance of an optimal body temperature is essential to maximize physiological processes. However, if unfavourable thermal conditions of refuges can decrease the body temperature of lizards, their escape decision should be influenced by refuge conditions. Analyses of the variation in flight distances and emergence latency from a refuge for the lizard Lacerta monticola under two different predation risk levels, and their relationship with the thermal environment, supported these predictions. When risk increased, lizards had longer emergence latencies, and thus costs of refuge use increased (a greater loss of time and body temperature). In the low-risk situation, lizards that were farther from the refuge had longer flight distances, whereas thermal conditions were less important. When risk increased, lizards had longer flight distances when refuges were farther off, but also when the external heating rate and the refuge cooling rate were lower. The results suggest that, in addition to the risk of predation, expected long-term fitness costs of refuges can also affect escape decisions. [source] Should Actuarial Risk Assessments be Used with Sex Offenders who are Intellectually Disabled?JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 4 2004Andrew J. R. Harris Background, Objective actuarial assessments are critical for making risk decisions, determining the necessary level of supervision and intensity of treatment (Andrews & Bonta 2003). This paper reviews the history of organized risk assessment and discusses some issues in current attitudes towards sexual offenders with intellectual disabilities. Method, We present two risk assessment tools (RRASOR and STABLE-2000) that appear to have practical utility with this population. Data are presented from a community sample of 81 sexual offenders who are intellectually disabled suggesting that the RRASOR may provide a useful metric of risk for this population. Dynamic risk is assessed using the STABLE-2000. This tool, based on 16 areas empirically associated with sexual recidivism, samples the individuals' current behaviour, skill deficits and personality factors. Change in these factors serves to flag the supervisor to changing risk levels. Conclusions, In addressing the question of whether we should seek special risk measures normed on people with intellectually disabilities, given the current lack of alternative tools, we conclude that it is reasonable to make use of the risk assessments that have been validated on the general sex offender population. [source] Predator avoidance behaviour in wild and hatchery-reared brown trout: the role of experience and domesticationJOURNAL OF FISH BIOLOGY, Issue 6 2003D. Álvarez Juvenile brown trout Salmo trutta from natural populations reacted to the presence of piscivorous brown trout by increasing the use of refuges. In contrast, second-generation hatchery fish and the offspring of wild fish raised under hatchery conditions were insensitive to predation risk. The diel pattern of activity also differed between wild and hatchery brown trout. Second-generation hatchery fish were predominantly active during daytime regardless of risk levels. Wild fish, however, showed a shift towards nocturnal activity in the presence of predators. These findings emphasize the potential role of domestication in weakening behavioural defences. They support the idea that the behavioural divergence between wild and domesticated individuals can arise from a process of direct or indirect selection on reduced responsiveness to predation risk, or as a lack of previous experience with predators. [source] Autoimmune and inflammatory disorders and risk of malignant lymphomas , an updateJOURNAL OF INTERNAL MEDICINE, Issue 6 2008K. E. Smedby Abstract. As specific autoimmune disorders now constitute established risk factors for malignant lymphomas, we describe this association. We review reported risk levels, risk determinants, lymphoma subtypes and biological mechanisms in autoimmunity/inflammation, emphasizing on recent findings. Whilst numerous reports describe average lymphoma risks in large patient groups, there's a recent shift of focus to risk determinants and the role of inflammatory activity. Studies highlight associations with diffuse large B-cell lymphoma, apart from lymphoma development in target organs of inflammation. Future studies of high-risk patient subsets using detailed assessments of autoimmunity/inflammation and lymphoma may give important clues to lymphomagenesis. [source] Current Update on Glycoprotein IIb-IIIa and Direct Thrombin Inhibition in Percutaneous Coronary Intervention for Non-ST Elevation Acute Coronary Syndromes: Balancing Bleeding Risk and Antiplatelet EfficacyJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2008ANDREW T. KWA M.D. Appropriate pharmacologic treatment for patients with acute coronary syndromes (ACS) remains a matter of controversy. Additionally, a substantial gap exists between recommended guidelines and current clinical practice. Questions remain regarding which antiplatelet/antithrombotic treatment strategies are appropriate for individual patients, based on their risk. We explore the role of glycoprotein IIb-IIIa inhibitors and the direct thrombin inhibitor bivalirudin in ACS patients, and consider the difficulties involved in reducing ischemic events while limiting bleeding risks. In patients with ACS who are undergoing percutaneous coronary intervention, high levels of microembolization and myocardial necrosis are potential risk factors for adverse long-term outcomes. Intensive antiplatelet/antithrombotic regimens may substantially affect these factors. Determination of risk levels, with the goal of targeting aggressive antithrombotic and interventional therapies to patients at higher risk, will help physicians choose appropriate pharmacologic therapy for patients with ACS. [source] A Metric of Maternal Prenatal Risk Drinking Predicts Neurobehavioral Outcomes in Preschool ChildrenALCOHOLISM, Issue 4 2009Lisa M. Chiodo Background:, Fetal Alcohol Spectrum Disorders (FASDs), including Fetal Alcohol Syndrome, continue to be high-incidence developmental disorders. Detection of patterns of maternal drinking that place fetuses at risk for these disorders is critical to diagnosis, treatment, and prevention, but is challenging and often insufficient during pregnancy. Various screens and measures have been used to identify maternal risk drinking but their ability to predict child outcome has been inconsistent. This study hypothesized that a metric of fetal "at-risk" alcohol exposure (ARAE) derived from several indicators of maternal self-reported drinking would predict alcohol-related neurobehavioral dysfunctions in children better than individual measures of maternal alcohol consumption alone. Methods:, Self-reported peri-conceptional and repeated maternal drinking during pregnancy were assessed with semi-structured interviews and standard screens, i.e., the CAGE, T-ACE, and MAST, in a prospective sample of 75 African-American mothers. Drinking volumes per beverage type were converted to standard quantity and frequency measures. From these individual measures and screening instruments, a simple dichotomous index of prenatal ARAE was defined and used to predict neurobehavioral outcomes in the 4- to 5-year-old offspring of these women. Study outcomes included IQ, attention, memory, visual-motor integration, fine motor skill, and behavior. Statistical analyses controlled for demographic and other potential confounders. Results:, The current "at-risk" drinking metric identified over 62% of the mothers as drinking at risk levels,23% more than the selection criterion identified,and outperformed all individual quantity and frequency consumption measures, including averages of weekly alcohol use and "binge" alcohol exposures (assessed as intake per drinking occasion), as well as an estimate of the Maternal Substance Abuse Checklist (Coles et al., 2000), in predicting prenatal alcohol-related cognitive and behavioral dysfunction in 4- to 5-year-old children. Conclusions:, A metric reflecting multiple indices of "at-risk" maternal alcohol drinking in pregnancy had greater utility in predicting various prenatal alcohol-related neurobehavioral dysfunction and deficits in children compared to individual measures of maternal self-reported alcohol consumption or a previous maternal substance abuse index. Assessing fetal risk drinking in pregnant women was improved by including multiple indicators of both alcohol consumption and alcohol-related consequences and, if appropriate practical applications are devised, may facilitate intervention by health care workers during pregnancy and potentially reduce the incidence or severity of FASDs. [source] The Question of Sustainability for Microfinance Institutions,JOURNAL OF SMALL BUSINESS MANAGEMENT, Issue 1 2007J. Jordan Pollinger Microentrepreneurs have considerable difficulty accessing capital from mainstream financial institutions. One key reason is that the costs of information about the characteristics and risk levels of borrowers are high. Relationship-based financing has been promoted as a potential solution to information asymmetry problems in the distribution of credit to small businesses. In this paper, we seek to better understand the implications for providers of "microfinance" in pursuing such a strategy. We discuss relationship-based financing as practiced by microfinance institutions (MFIs) in the United States, analyze their lending process, and present a model for determining the break-even price of a microcredit product. Comparing the model's results with actual prices offered by existing institutions reveals that credit is generally being offered at a range of subsidized rates to microentrepreneurs. This means that MFIs have to raise additional resources from grants or other funds each year to sustain their operations as few are able to survive on the income generated from their lending and related operations. Such subsidization of credit has implications for the long-term sustainability of institutions serving this market and can help explain why mainstream financial institutions have not directly funded microenterprises. We conclude with a discussion of the role of nonprofit organizations in small business credit markets, the impact of pricing on their potential sustainability and self-sufficiency, and the implications for strategies to better structure the credit market for microbusinesses. [source] Risk reduction and real estate portfolio sizeMANAGERIAL AND DECISION ECONOMICS, Issue 7 2001Peter J. Byrne There is remarkably little empirical evidence of the advantages of increased size on risk levels in real estate portfolios based on actual portfolios. This paper improves this by examining the portfolio risk of a large sample of actual real estate data in the UK over the period from 1981 to 1996. The results show that real estate portfolios of larger sizes tend, on average, to have lower risks than smaller sized portfolios and, more importantly, that portfolios with only a few assets can have very high or very low risk. For fund managers to be confident that their portfolio will have a risk level like the average, they need to hold portfolios of a considerably greater size than they might expect, or can sensibly acquire. Previous studies suggesting that only 20,40 properties are needed to reduce the risk of a property portfolio down to the market level are a significant underestimate. The actual figure is likely to be 400,500 properties, well above that of even the largest fund in the UK. Size alone does not necessarily lead to a reduction in portfolio risk. Other factors are of greater importance. Copyright © 2001 John Wiley & Sons, Ltd. [source] Trends in incidence and survival of mesenchymal neoplasm of the digestive tract within a defined population of Northern Norway,APMIS, Issue 3 2006SONJA ERIKSSON STEIGEN Population-based incidence and survival data for gastrointestinal stromal tumor (GIST) are sparse due to the fact that GIST is a rather novel entity both clinically and pathologically, and has not been registered as a separate entity in population-based cancer registries. The aim of the present study was to reclassify all mesenchymal tumors within a defined population of northern Norway over a time-span of 30 years with the purpose of estimating trends of incidence and survival. One hundred and forty-one patients with mesenchymal neoplasms of the digestive tract were identified: 102 as GISTs, 32 as leiomyomatous tumors, 4 as schwannomas, and 3 as fibromas. Incidence rates of GIST showed a significant increase over the whole period, which was not observed for the non-GIST cases. Analysis of GIST cases showed that cases with more than 5 mitoses per 50 high power fields had an increased expected mortality 4 times that of those with fewer mitoses, and the combination of mitotic count and size of tumor can be recommended for categorizing the tumors into different risk levels. The study confirms that GIST is by far the most frequent mesenchymal neoplasm of the digestive tract and that the incidence has increased over the last 30 years. [source] Risk Management Lessons from ,Knock-in Knock-out' Option Disaster,ASIA-PACIFIC JOURNAL OF FINANCIAL STUDIES, Issue 1 2010Jaeuk Khil G14; G01 Abstract Currency knock-in knock-out (KIKO) options had been widely used for hedging exchange rate risks in Korean financial markets. However, as the Korean won moved in an unexpected direction during the global financial crisis period of 2007 and 2008, the hedging instruments incurred huge losses to the option holders. In this paper, we analyze the event from the viewpoint of risk assessment and management. We find that, first, if the option holders had assessed the risk levels with and without the KIKO options by using standard risk measures like value-at-risk or conditional value-at-risk, then many KIKO option contracts would not have been justifiable from the beginning. Second, having a proper view on the exchange rate dynamics turned out to be crucial for risk assessment and management. If the companies had a proper view instead of a myopic view on the exchange rate movement, then the KIKO options might not have been chosen. Finally, ,hedge-and-forget' behavior proved to be very costly and reckless. If the companies had continuously assessed and managed their risks, then the losses from the KIKO options could have been significantly mitigated. Some relevant pricing issues are also investigated. We find that most KIKO option contracts under study might not be significantly overpriced. However, potential impacts of the possible mispricing could be considerable in some cases. Nonetheless, the risk management failure proved to be more important for the KIKO option losses than the possible mispricing problem. [source] Self-reported water and drowning risk exposure at surf beachesAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2009Damian Morgan Abstract Objective: To document patterns of water exposure at surf beaches by gender and identify factors that predict bather confidence to return to shore if caught in a rip current. Method: Recreational surf beach bathers (N=406) provided self-completed data on water exposure patterns, surf activity behaviours and potential drowning risk and protective factors. Results: Relative to females, males visited surf beaches more frequently, expected to spend longer in the water and in deeper water, and more often bathed after using alcohol (p<0.05). Confidence to return to shore if caught in a rip current was predicted by confidence to identify a rip current, self-rated swimming ability, gender, times visited any beach, and age in a standard linear regression model (adjusted R2=0.68). Conclusion: The study supports explanations that high male drowning rates result from more frequent exposure to water than females at high situational risk levels. Implications: Controlled studies are required to determine the role in drowning of overconfidence, swimming ability, surf experience, floatation devices and response to sea conditions. [source] Bilateral nasal allergen provocation monitored with acoustic rhinometry.CLINICAL & EXPERIMENTAL ALLERGY, Issue 3 2005Assessment of both nasal passages, the side reacting with greater congestion: relation to the nasal cycle Summary Background The effect of bilateral nasal provocation on nasal mucosa measured with the use of acoustic rhinometry (AR) can be assessed for both nasal passages or for the side responding with greater congestion. Assessment of changes in nasal congestion during the nasal provocation test (NPT) can be affected by the nasal cycle (NC). The aim of this study was to find out the most accurate method to evaluate changes observed during bilateral nasal provocation. Methods Cross-sectional areas (CSA) at the level of inferior nasal turbinate (CSA-2) were recorded by AR in 26 volunteers with allergic rhinitis during the NC for 5,7 h and subsequently during NPT. The risk of spontaneous total and unilateral CSA-2 decrease was established. Sensitivity of the NPT assessment for the total CSA-2 and for the side responding with greater congestion was evaluated at chosen thresholds. These thresholds were selected in a way that the risk levels of spontaneous decrease of unilateral and total CSA-2 were equal. Results The assessment of the total CSA-2 was found to be more sensitive than the assessment of the side responding with greater congestion. The highest sensitivity and specificity of the test was achieved by using a combination of both assessments. Optimum thresholds of the CSA-2 decrease for assessment at 15 min after provocation, with this method, were 27% and 40% for the side responding with greater congestion and for the total CSA-2, respectively. Conclusions Recognition of the risk of spontaneous unilateral and total CSA-2 decreases enables introduction of combined assessment of bilateral NPT. This assessment seems to be the most accurate method for evaluation of the test results. [source] | ||||||||||||||||||||||