Examining the relationship between risk assessment and risk management in mental health

Risk assessment is crucial for developing risk management plans to prevent or minimize mental health patients' risks that will impede their recovery. Risk assessments and risk management plans should be closely linked. Their content and the extent to which they are linked within one Trust is explored. There is a great deal of variability in the amount and detail of risk information collected by nurses and how this is used to develop risk management plans. Keeping risk assessment information in one place rather than scattered throughout patient records is important for ensuring it can be accessed easily and linked properly to risk management plans. Strengthening the link between risk assessment and management will help ensure interventions and care is tailored to the specific needs of individual patients, thus promoting their safety and well-being. Thorough risk assessment helps in developing risk management plans that minimize risks that can impede mental health patients' recovery. Department of Health policy states that risk assessments and risk management plans should be inextricably linked. This paper examines their content and linkage within one Trust. Four inpatient wards for working age adults (18-65 years) in a large mental health Trust in England were included in the study. Completed risk assessment forms, for all patients in each inpatient ward were examined (n= 43), followed by an examination of notes for the same patients. Semi-structured interviews took place with ward nurses (n= 17). Findings show much variability in the amount and detail of risk information collected by nurses, which may be distributed in several places. Gaps in the risk assessment and risk management process are evident, and a disassociation between risk information and risk management plans is often present. Risk information should have a single location so that it can be easily found and updated. Overall, a more integrated approach to risk assessment and management is required, to help patients receive timely and appropriate interventions that can reduce risks such as suicide or harm to others. © 2011 Blackwell Publishing.

Bayesian networks in environmental and resource management

This overview article for the special series “Bayesian Networks in Environmental and Resource Management” reviews 7 case study articles with the aim to compare Bayesian network (BN) applications to different environmental and resource management problems from around the world. The article discusses advances in the last decade in the use of BNs as applied to environmental and resource management. We highlight progress in computational methods, best-practices for model design and model communication. We review several research challenges to the use of BNs in environmental and resource management that we think may find a solution in the near future with further research attention.

A review of the global pesticide legislation and the scale of challenge in reaching the global harmonization of food safety standards

Pesticide use is important in agriculture to protect crops and improve productivity. However, they have the potential to cause adverse human health or environmental effects, dependent on exposure levels. This review examines existing pesticide legislation worldwide, focusing on the level of harmonisation, and impacts of differing legislation on food safety and trade. Pesticide legislation varies greatly worldwide as countries have different requirements guidelines and legal limits for plant protection. Developed nations have more stringent regulations than developing countries, which lack the resources and expertise to adequately implement and enforce legislation. Global differences in pesticide legislation act as a technical barrier to trade. International parties such as the European Union (EU), Codex Alimentarius Commission (Codex), and North American Free Trade Agreement (NAFTA) have attempted to harmonise pesticide legislation by providing maximum residue limits (MRLs), but globally these limits remain variable. Globally harmonised pesticide standards would serve to increase productivity, profits and trade, and enhance the ability to protect public health and the environment. 

Availability estimation and management for complex processing systems

“Availability” is the terminology used in asset intensive industries such as petrochemical and hydrocarbons processing to describe the readiness of equipment, systems or plants to perform their designed functions. It is a measure to suggest a facility’s capability of meeting targeted production in a safe working environment. Availability is also vital as it encompasses reliability and maintainability, allowing engineers to manage and operate facilities by focusing on one performance indicator. These benefits make availability a very demanding and highly desired area of interest and research for both industry and academia. In this dissertation, new models, approaches and algorithms have been explored to estimate and manage the availability of complex hydrocarbon processing systems. The risk of equipment failure and its effect on availability is vital in the hydrocarbon industry, and is also explored in this research. The importance of availability encouraged companies to invest in this domain by putting efforts and resources to develop novel techniques for system availability enhancement. Most of the work in this area is focused on individual equipment compared to facility or system level availability assessment and management. This research is focused on developing an new systematic methods to estimate system availability. The main focus areas in this research are to address availability estimation and management through physical asset management, risk-based availability estimation strategies, availability and safety using a failure assessment framework, and availability enhancement using early equipment fault detection and maintenance scheduling optimization.

Biology and management of dogfish sharks

This book comprises 34 chapters (35 including the initial keynote paper), each written as a stand-alone scientific paper, that are grouped in functional categories. The keynote paper is followed by 11 papers addressing Distribution and Abundance, 6 papers on Age, Growth and Reproduction, 6 papers on Ecology and Physiology, and 10 papers on Fisheries, Assessment and Management, and Conservation. Some of the papers are based upon presentations that were given at the First International Symposium on the Management and Biology of Dogfish Sharks, held in Seattle, WA in 2005.

Expert opinion on toxicity profiling--report from a NORMAN expert group meeting.

This article describes the outcome and follow-up discussions of an expert group meeting (Amsterdam, October 9, 2009) on the applicability of toxicity profiling for diagnostic environmental risk assessment. A toxicity profile was defined as a toxicological "fingerprint" of a sample, ranging from a pure compound to a complex mixture, obtained by testing the sample or its extract for its activity toward a battery of biological endpoints. The expert group concluded that toxicity profiling is an effective first tier tool for screening the integrated hazard of complex environmental mixtures with known and unknown toxicologically active constituents. In addition, toxicity profiles can be used for prioritization of sampling locations, for identification of hot spots, and--in combination with effect-directed analysis (EDA) or toxicity identification and evaluation (TIE) approaches--for establishing cause-effect relationships by identifying emerging pollutants responsible for the observed toxic potency. Small volume in vitro bioassays are especially applicable for these purposes, as they are relatively cheap and fast with costs comparable to chemical analyses, and the results are toxicologically more relevant and more suitable for realistic risk assessment. For regulatory acceptance in the European Union, toxicity profiling terminology should keep as close as possible to the European Water Framework Directive (WFD) terminology, and validation, standardization, statistical analyses, and other quality aspects of toxicity profiling should be further elaborated.

Support for Integrated Ecosystem Assessments of NOAA’s National Estuarine Research Reserves System (NERRS), Volume II: Assessment of Ecological Condition and Stressor Impacts in Subtidal Waters of the North Carolina NERRS

A study was conducted to assess the status of ecological condition and potential human-health risks in subtidal estuarine waters throughout the North Carolina National Estuarine Research Reserve System (NERRS) (Currituck Sound, Rachel Carson, Masonboro Island, and Zeke’s Island). Field work was conducted in September 2006 and incorporated multiple indicators of ecosystem condition including measures of water quality (dissolved oxygen, salinity, temperature, pH, nutrients and chlorophyll, suspended solids), sediment quality (granulometry, organic matter content, chemical contaminant concentrations), biological condition (diversity and abundances of benthic fauna, fish contaminant levels and pathologies), and human dimensions (fish-tissue contaminant levels relative to human-health consumption limits, various aesthetic properties). A probabilistic sampling design permitted statistical estimation of the spatial extent of degraded versus non-degraded condition across these estuaries relative to specified threshold levels of the various indicators (where possible). With some exceptions, the status of these reserves appeared to be in relatively good to fair ecological condition overall, with the majority of the area (about 54%) having various water quality, sediment quality, and biological (benthic) condition indicators rated in the healthy to intermediate range of corresponding guideline thresholds. Only three stations, representing 10.5% of the area, had one or more of these indicators rated as poor/degraded in all three categories. While such a conclusion is encouraging from a coastal management perspective, it should be viewed with some caution. For example, although co-occurrences of adverse biological and abiotic environmental conditions were limited, at least one indicator of ecological condition rated in the poor/degraded range was observed over a broader area (35.5%) represented by 11 of the 30 stations sampled. In addition, the fish-tissue contaminant data were not included in these overall spatial estimates; however, the majority of samples (77% of fish that were analyzed, from 79%, of stations where fish were caught) contained inorganic arsenic above the consumption limits for human cancer risks, though most likely derived from natural sources. Similarly, aesthetic indicators are not reflected in these spatial estimates of ecological condition, though there was evidence of noxious odors in sediments at many of the stations. Such symptoms reflect a growing realization that North Carolina estuaries are under multiple pressures from a variety of natural and human influences. These data also suggest that, while the current status of overall ecological condition appears to be good to fair, long-term monitoring is warranted to track potential changes in the future. This study establishes an important baseline of overall ecological condition within NC NERRS that can be used to evaluate any such future changes and to trigger appropriate management actions in this rapidly evolving coastal environment. (PDF contains 76 pages)