442 resultados para Acute risk


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Queensland Department of Main Roads, Australia, spends approximately A$ 1 billion annually for road infrastructure asset management. To effectively manage road infrastructure, firstly road agencies not only need to optimise the expenditure for data collection, but at the same time, not jeopardise the reliability in using the optimised data to predict maintenance and rehabilitation costs. Secondly, road agencies need to accurately predict the deterioration rates of infrastructures to reflect local conditions so that the budget estimates could be accurately estimated. And finally, the prediction of budgets for maintenance and rehabilitation must provide a certain degree of reliability. This paper presents the results of case studies in using the probability-based method for an integrated approach (i.e. assessing optimal costs of pavement strength data collection; calibrating deterioration prediction models that suit local condition and assessing risk-adjusted budget estimates for road maintenance and rehabilitation for assessing life-cycle budget estimates). The probability concept is opening the path to having the means to predict life-cycle maintenance and rehabilitation budget estimates that have a known probability of success (e.g. produce budget estimates for a project life-cycle cost with 5% probability of exceeding). The paper also presents a conceptual decision-making framework in the form of risk mapping in which the life-cycle budget/cost investment could be considered in conjunction with social, environmental and political issues.

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A study has been conducted to investigate current practices on decision-making under risk and uncertainty for infrastructure project investments. It was found that many European countries such as the UK, France, Germany including Australia use scenarios for the investigation of the effects of risk and uncertainty of project investments. Different alternative scenarios are mostly considered during the engineering economic cost-benefit analysis stage. For instance, the World Bank requires an analysis of risks in all project appraisals. Risk in economic evaluation needs to be addressed by calculating sensitivity of the rate of return for a number of events. Risks and uncertainties of project developments arise from various sources of errors including data, model and forecasting errors. It was found that the most influential factors affecting risk and uncertainty resulted from forecasting errors. Data errors and model errors have trivial effects. It was argued by many analysts that scenarios do not forecast what will happen but scenarios indicate only what can happen from given alternatives. It was suggested that the probability distributions of end-products of the project appraisal, such as cost-benefit ratios that take forecasting errors into account, are feasible decision tools for economic evaluation. Political, social, environmental as well as economic and other related risk issues have been addressed and included in decision-making frameworks, such as in a multi-criteria decisionmaking framework. But no suggestion has been made on how to incorporate risk into the investment decision-making process.

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INTRODUCTION Inflammation is a protective attempt to facilitate the removal of damaged tissue and to initiate the healing response in other tissues. However, after spinal cord injury (SCI), this response is prolonged leading to secondary degeneration and glial scarring. Here, we investigate the potential of sustained delivery of pro-inflammatory factors vascular endothelial growth factor (VEGF) and platelet derived growth factor (PDGF) to increase early inflammatory events and promote inflammatory resolution. Method Animal ethics approval was obtained from the Queensland University of Technology. Adult Wistar-Kyoto rats (12-16 weeks old) were subjected to laminectomies and T10 hemisections. Animals were then randomised to treatment (implantation of osmotic pump (Alzet) loaded with 5ug VEGF & 5 ug PDGF) or control groups (lesion control or lesion plus pump delivering PBS). Rats were sacrificed at one month and the spinal cords were harvested and examined by immunohistology, using anti-neurofilament-200(NF200) and anti- ionized calcium binding adapter molecule 1 (Iba1). One way ANOVA was used for statistic analysis. Results At 1 month, active pump-treated cords showed a high level of axonal filament throughout the defects as compared to the control groups. The mean lesion size, as measured by NF200, was 0.47mm2 for the lesion control, 0.39mm2 for the vehicle control and 0.078mm2 for the active pump group. Significant differences were detected between the active pump group and the two control groups (AP vs LC p= 0.017 AG vs VC p= 0.004). Iba-1 staining also showed significant differences in the post-injury inflammatory response. Discussion We have shown that axons and activated microglia are co-located in the lesion of the treated cord. We hypothesise the delivery of VEGF/PDGF increases the local vessel permeability to inflammatory cells and activates these along with the resident microglia to threshold population, which ultimately resolved the prolonged inflammation. Here, we have shown that maintaining the inflammatory signals for at least 7 days improved the morphology of the injured cord. Conclusion This study has shown that boosting inflammation, by delivery VEGF/PDGF, in the early phase of SCI helps to reduce secondary degeneration and may promote inflammation resolution. This treatment may provide a platform for other neuro-regenrative therapies.

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Background: Injury is the leading cause of mortality for young people in Australia (AIHW, 2008). Adolescent injury mortality is consistently associated with risk taking behaviour, including transport and interpersonal violence (AIHW, 2003), which often occurs in the context of alcohol and other substance use. A rapid increase in risk taking and injury through early to late adolescence highlights the need for effective school based interventions. Aim: The aim of the current research was to examine the relationship between school connectedness and adolescent risk and injury, in order to inform effective prevention approaches. School connectedness, or students’ feelings of belongingness to school, has been shown to be a critical protective factor in adolescence which can be targeted effectively through teacher interventions. Despite evidence linking low school connectedness with increased health risk behaviour, including substance use and violence, research has not yet addressed possible links between connectedness and a broader range of risk taking behaviours (e.g. transport risks) or injury. Method: This study involved background data collection to inform the development of an intervention. A total of 595 Year 9 students (aged 13-14 years) from 5 Southeast Queensland high schools completed questionnaires that included measures of school connectedness, risk taking behaviour, alcohol and other substance use, and injuries. Results: Increased school connectedness was found to be associated with fewer transport risk behaviours and with decreased alcohol and other substance use for both males and females. Similarly, increased school connectedness was associated with fewer passenger and motorcycle injuries for male participants. Both males and females with increased school connectedness reported fewer alcohol related injuries. Implications: These results indicate that school connectedness appears to have protective effects for early adolescence. These findings may also hold for older adolescents and indicate that it may be an important factor to target in school based risk and injury prevention programs. A school connectedness intervention is currently being designed, focusing on teacher professional development. The intervention will be implemented in conjunction with a curriculum based injury prevention program for Year 9 students and will be evaluated through a large scale cluster randomised trial involving 26 schools.

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Aims: Changing behaviour to reduce stroke risk is a difficult prospect made particularly complex because of psychological factors. This study examined predictors of intentions and behaviours to reduce stroke risk in a sample of at-risk individuals, seeking to find how knowledge and health beliefs influenced both intention and actual behaviour to reduce stroke risk. Methods: A repeated measures design was used to assess behavioural intentions at time 1 (T1) and subsequent behaviour (T2). One hundred and twenty six respondents completed an online survey at T1, and behavioural follow-up data were collected from approximately 70 participants 1 month later. Predictors were stroke knowledge, demographic variables, and beliefs about stroke that were derived from an expanded health belief model. Dependent measures were: exercise and weight loss, and intention to engage in these behaviours to reduce stroke risk. Findings: Multiple hierarchical regression analyses showed that, for exercise and weight loss respectively, different health beliefs predicted intention to control stroke risk. The most important exercise-related health beliefs were benefits, susceptibility, and self-efficacy; for weight loss, the most important beliefs were barriers, and to a lesser degree, susceptibility and subjective norm. Conclusions: Health beliefs may play an important role in stroke prevention, particularly beliefs about susceptibility because these emerged for both behaviours. Stroke education and prevention programmes that selectively target the health beliefs relevant to specific behaviours may prove most efficacious.

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Introduction: Work engagement is a recent application of positive psychology and refers to a positive, fulfilling, work-related state of mind characterized by vigor, dedication and absorption. Despite theoretical assumptions, there is little published research on work engagement, due primarily to its recent emergence as a psychological construct. Furthermore, examining work engagement among high-stress occupations, such as police, is useful because police officers are generally characterized as having a high level of work engagement. Previous research has identified job resources (e.g. social support) as antecedents of work engagement. However detailed evaluation of job demands as an antecedent of work engagement within high-stress occupations has been scarce. Thus our second aim was to test job demands (i.e. monitoring demands and problem-solving demands) and job resources (i.e. time control, method control, supervisory support, colleague support, and friend and family support) as antecedents of work engagement among police officers. Method: Data were collected via a self-report online survey from one Australian state police service (n = 1,419). Due to the high number of hypothesized antecedent variables, hierarchical multiple regression analysis was employed rather than structural equation modelling. Results: Work engagement reported by police officers was high. Female officers had significantly higher levels of work engagement than male officers, while officers at mid-level ranks (sergeant) reported the lowest levels of work engagement. Job resources (method control, supervisor support and colleague support) were significant antecedents of three dimensions of work engagement. Only monitoring demands were significant antecedent of the absorption. Conclusion: Having healthy and engaged police officers is important for community security and economic growth. This study identified some common factors which influence work engagement experienced by police officers. However, we also note that excessive work engagement can yield negative outcomes such as psychological distress.

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The engagement behaviour of 1,524 student-enrolments (“students”) in five first year units was monitored and 608 (39.9%) were classified as “at risk” using the criterion of not submitting or failing their first assignment. Of these, 327 (53.8%) were successfully contacted (i.e., spoken to by phone) and provided with advice and/or referral to learning and personal support services while the remaining 281 (46.2%) could not be contacted. Nine hundred and sixteen students (60.1%) were classified as “not at risk.” Overall, the at risk group who were contacted achieved significantly higher end-of-semester final grades than, and persisted (completed the unit) at more than twice the rate of, the at risk group who were not contacted. There were variations among the units which were explained by the timing of the first assignment, specific teaching-learning processes and the structure of the curriculum. Implications for curriculum design and supporting first year students within a personal, social and academic framework are discussed.

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In Semester 1 2007, a Monitoring Student Engagement study, conducted as part of the Enhancing Transition at Queensland University of Technology (ET@QUT) Project and extending earlier work in the Project by Arora (2006), aimed at mapping the processes and resources used at that time to identify, monitor and manage students in their first year who were at risk of leaving QUT (Shaw, 2007). This identified a lack of documentation of the processes and resources used and revealed an ad-hoc rather than holistic and systematic approach to monitoring student engagement. One of Shaw’s recommendations was to: “To introduce a centralised case management approach to student engagement” (p. 14). That provided the genesis for the Student Success Project that is being reported on here. The aim of the Student Success Project is to trial, evaluate and ultimately establish holistic and systematic ways of helping students who appear to be at-risk of failing or withdrawing from a unit to persist and succeed. Students are profiled as being at-risk if they are absent from more than 2 tutorials in a row without contacting their tutor or if they fail to submit their first assignment. A Project Officer makes personal contact with these students to suggest ways they can get further assistance depending on their situation.

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Although full-term pregnancies reduce the risk of ovarian cancer, it has not been conclusively established whether incomplete pregnancies also influence risk. We investigated the relationship between a history of incomplete pregnancy and incident epithelial ovarian cancer among over 4,500 women who participated in two large Australian population-based case-control studies in 1990-1993 and 2002-2005. They provided responses to detailed questions about their reproductive histories and other personal factors. Summary odds ratios (OR) and confidence intervals (CI) derived from each study using the same covariates were aggregated. We found no significant associations between the number of incomplete pregnancies and ovarian cancer, for parous (OR = 0.98, 95% CI: 0.89, 1.08) or nulliparous (OR = 1.06, 95% CI: 0.75, 1.48) women, nor for the number of spontaneous or induced abortions and ovarian cancer for parous women (OR = 0.95, 95% CI 0.82, 1.09; OR = 1.08, 95% CI: 0.86, 1.36) or nulliparous women (OR = 1.2, 95% CI: 0.6, 2.4; OR = 0.8, 95% CI: 0.47, 1.38), respectively. A systematic review of 37 previous studies of the topic confirmed our findings that a history of incomplete pregnancy does not influence a woman’s risk of epithelial ovarian cancer.

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This research is aimed at addressing problems in the field of asset management relating to risk analysis and decision making based on data from a Supervisory Control and Data Acquisition (SCADA) system. It is apparent that determining risk likelihood in risk analysis is difficult, especially when historical information is unreliable. This relates to a problem in SCADA data analysis because of nested data. A further problem is in providing beneficial information from a SCADA system to a managerial level information system (e.g. Enterprise Resource Planning/ERP). A Hierarchical Model is developed to address the problems. The model is composed of three different Analyses: Hierarchical Analysis, Failure Mode and Effect Analysis, and Interdependence Analysis. The significant contributions from the model include: (a) a new risk analysis model, namely an Interdependence Risk Analysis Model which does not rely on the existence of historical information because it utilises Interdependence Relationships to determine the risk likelihood, (b) improvement of the SCADA data analysis problem by addressing the nested data problem through the Hierarchical Analysis, and (c) presentation of a framework to provide beneficial information from SCADA systems to ERP systems. The case study of a Water Treatment Plant is utilised for model validation.

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Background: Blood for transfusion may become contaminated at any point between collection and transfusion and may result in bacteraemia (the presence of bacteria in the blood),severe illness or even death for the blood recipient. Donor arm skin is one potential source of blood contamination, so it is usual to cleanse the skin with an antiseptic before blood donation. One-step and two-step alcohol based antiseptic regimens are both commonly advocated but there is uncertainty as to which is most effective.----- Objectives: To assess the effects of cleansing the skin of blood donors with alcohol in a one-step compared with alcohol in a two-step procedure to prevent contamination of collected blood or bacteraemia in the recipient.----- Search strategy: We searched the Cochrane Wounds Group Specialised Register (March 10 2009); The Cochrane Central Register of Controlled Trials(CENTRAL) The Cochrane Library 2009, Issue 1; Ovid MEDLINE - (1950 to February Week 4 2009); Ovid EMBASE - (1980 to 2009 Week 9); and EBSCO CINAHL - (1982 to February Week 4 2009). We also searched the reference lists of key papers.----- Selection criteria: All randomised trials (RCTs) comparing alcohol based donor skin cleansing in a one-step versus a two-step process that includes alcohol and any other antiseptic for pre-venepuncture skin cleansing were considered. Quasi randomised trials were to have been considered in the absence of RCTs.----- Data collection and analysis: Two review authors independently assessed studies for inclusion.----- Main results: No studies (RCTs or quasi RCTs) met the inclusion criteria. Authors’ conclusions We did not identify any eligible studies for inclusion in this review. It is therefore unclear whether a two-step, alcohol followed by antiseptic skin cleansing process prior to blood donation confers any reduction in the risk of blood contamination or bacteraemia in blood recipients, or conversely whether a one-step process increases risk above that associated with a two-step process.

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Despite changes in surgical techniques, radiotherapy targeting and the apparent earlier detection of cancers, secondary lymphoedema is still a significant problem for about 20–30% of those who receive treatment for cancer, although the incidence and prevalence does seem to be falling. The figures above generally relate to detection of an enlarged limb or other area, but it seems that about 60% of all patients also suffer other problems with how the limb feels, what can or cannot be done with it and a range of social or psychological issues. Often these ‘subjective’ changes occur before the objective ones, such as a change in arm volume or circumference. For most of those treated for cancer lymphoedema does not develop immediately, and, while about 60–70% develop it in the first few years, some do not develop lymphoedema for up to 15 or 20 years. Those who will develop clinically manifest lymphoedema in the future are, for some time, in a latent or hidden phase of lymphoedema. There also seems to be some risk factors which are indicators for a higher likelihood of lymphoedema post treatment, including oedema at the surgical site, arm dominance, age, skin conditions, and body mass index (BMI).

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PPP (Public Private Partnerships) is a new operation mode of infrastructure projects, which usually undergo long periods and have various kinds of risks in technology, market, politics, policy, finance, society, natural conditions and cooperation. So the government and the private agency should establish the risk-sharing mechanism to ensure the successful implementation of the project. As an important branch of the new institutional economics, transaction cost economics and its analysis method have been proved to be beneficial to the proper allocation of risks between the two parts in PPP projects and the improvement of operation efficiency of PPP risk-sharing mechanism. This paper analyzed the transaction cost of the projects risk-sharing method and the both risk carriers. It pointed out that the risk-sharing method of PPP projects not only reflected the spirit of cooperation between public sector and private agency, but also minimized the total transaction cost of the risk sharing mechanism itself. Meanwhile, the risk takers had to strike a balance between the beforehand cost and the afterwards cost so as to control the cost of risk management. The paper finally suggested three ways which might be useful to reduce the transaction cost: to choose appropriate type of contract of PPP risk-sharing mechanism, to prevent information asymmetry and to establish mutual trust between the two participants.