66 resultados para clinical risk management


Relevância:

80.00% 80.00%

Publicador:

Resumo:

Invasive urothelial cell carcinoma (UCC) is characterized by increased chromosomal instability and follows an aggressive clinical course in contrast to non-invasive disease. To identify molecular processes that confer and maintain an aggressive malignant phenotype, we used a high-throughput genome-wide approach to interrogate a cohort of high and low clinical risk UCC tumors. Differential expression analyses highlighted cohesive dysregulation of critical genes involved in the G(2)/M checkpoint in aggressive UCC. Hierarchical clustering based on DNA Damage Response (DDR) genes separated tumors according to a pre-defined clinical risk phenotype. Using array-comparative genomic hybridization, we confirmed that the DDR was disrupted in tumors displaying high genomic instability. We identified DNA copy number gains at 20q13.2-q13.3 (AURKA locus) and determined that overexpression of AURKA accompanied dysregulation of DDR genes in high risk tumors. We postulated that DDR-deficient UCC tumors are advantaged by a selective pressure for AURKA associated override of M phase barriers and confirmed this in an independent tissue microarray series. This mechanism that enables cancer cells to maintain an aggressive phenotype forms a rationale for targeting AURKA as a therapeutic strategy in advanced stage UCC.

Relevância:

80.00% 80.00%

Publicador:

Resumo:

It is thought that direct personal experience of extreme weather events could result in greater public engagement and policy response to climate change. Based on this premise, we present a set of future climate scenarios for Ireland communicated in the context of recent, observed extremes. Specifically, we examine the changing likelihood of extreme seasonal conditions in the long-term observational record, and explore how frequently such extremes might occur in a changed Irish climate according to the latest model projections. Over the period (1900-2014) records suggest a greater than 50-fold increase in the likelihood of the warmest recorded summer (1995), whilst the likelihood of the wettest winter (1994/95) and driest summer (1995) has respectively doubled since 1850. The most severe end-of-century climate model projections suggest that summers as cool as 1995 may only occur once every ∼7 years, whilst winters as wet as 1994/95 and summers as dry as 1995 may increase by factors of ∼8 and ∼10 respectively. Contrary to previous research, we find no evidence for increased wintertime storminess as the Irish climate warms, but caution that this conclusion may be an artefact of the metric employed. It is hoped that framing future climate scenarios in the context of extremes from living memory will help communicate the scale of the challenge climate change presents, and in so doing bridge the gap between climate scientists and wider society.

Relevância:

80.00% 80.00%

Publicador:

Resumo:

Genetically engineered (GE) crops are subject to regulatory oversight to ensure their safety for humans and the environment. Their approval in the European Union (EU) starts with an application in a given Member State followed by a scientific step (risk assessment), and ends with a political decision-making step (risk management); and in the United States (US) it starts with a scientific (field trial) step and ends with a ‘bureaucratic’ decision-making step. We investigated trends for the time taken for these steps and the overall time taken for approving GE crops in the US and the EU (traders in these commodities). Results show that from 1996-2015 the overall time trend for approval in the EU decreased and then flattened off, with an overall mean completion-time of 1,763 days. In the US in 1998 there was a break in the trend of the overall approval time: Initially, from 1988 until 1997 the trend decreased with a mean approval time of 1,321 days; from 1998-2015, the trend almost stagnated with a mean approval time of 2,467 days.

Relevância:

80.00% 80.00%

Publicador:

Resumo:

The cyclical properties of the Baltic Dry Index (BDI) and their implications for forecasting performance are investigated. We find that changes in the BDI can lead to permanent shocks to trade of major exporting economies. In our forecasting exercise, we show that commodities and trigonometric regression can lead to improved predictions and then use our forecasting results to perform an investment exercise and to show how they can be used for improved risk management in the freight sector.

Relevância:

80.00% 80.00%

Publicador:

Resumo:

Acute respiratory distress syndrome presents as hypoxia and bilateral pulmonary infiltrates on chest imaging in the absence of heart failure sufficient to account for this clinical state. Management is largely supportive, and is focused on protective mechanical ventilation and the avoidance of fluid overload. Patients with severe hypoxaemia can be managed with early short-term use of neuromuscular blockade, prone position ventilation, or extracorporeal membrane oxygenation. The use of inhaled nitric oxide is rarely indicated and both β2 agonists and late corticosteroids should be avoided. Mortality remains at approximately 30%.