719 resultados para clinical risk management
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Society is frequently exposed to and threatened by dangerous phenomena in many parts of the world. Different types of such phenomena require specific actions for proper risk management, from the stages of hazard identification to those of mitigation (including monitoring and early-warning) and/or reduction. The understanding of both predisposing factors and triggering mechanisms of a given danger and the prediction of its evolution from the source to the overall affected zone are relevant issues that must be addressed to properly evaluate a given hazard.
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This paper presents a model for determining value at operational risk ?OpVaR? in electric utilities, with the aim to confirm the versatility of the Bank for International Settlements (BIS) proposals. The model intends to open a new methodological approach in risk management, paying special attention to underlying operational sources of risk.
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La robótica ha evolucionado exponencialmente en las últimas décadas, permitiendo a los sistemas actuales realizar tareas sumamente complejas con gran precisión, fiabilidad y velocidad. Sin embargo, este desarrollo ha estado asociado a un mayor grado de especialización y particularización de las tecnologías implicadas, siendo estas muy eficientes en situaciones concretas y controladas, pero incapaces en entornos cambiantes, dinámicos y desestructurados. Por eso, el desarrollo de la robótica debe pasar por dotar a los sistemas de capacidad de adaptación a las circunstancias, de entendedimiento sobre los cambios observados y de flexibilidad a la hora de interactuar con el entorno. Estas son las caracteristicas propias de la interacción del ser humano con su entorno, las que le permiten sobrevivir y las que pueden proporcionar a un sistema inteligencia y capacidad suficientes para desenvolverse en un entorno real de forma autónoma e independiente. Esta adaptabilidad es especialmente importante en el manejo de riesgos e incetidumbres, puesto que es el mecanismo que permite contextualizar y evaluar las amenazas para proporcionar una respuesta adecuada. Así, por ejemplo, cuando una persona se mueve e interactua con su entorno, no evalúa los obstáculos en función de su posición, velocidad o dinámica (como hacen los sistemas robóticos tradicionales), sino mediante la estimación del riesgo potencial que estos elementos suponen para la persona. Esta evaluación se consigue combinando dos procesos psicofísicos del ser humano: por un lado, la percepción humana analiza los elementos relevantes del entorno, tratando de entender su naturaleza a partir de patrones de comportamiento, propiedades asociadas u otros rasgos distintivos. Por otro lado, como segundo nivel de evaluación, el entendimiento de esta naturaleza permite al ser humano conocer/estimar la relación de los elementos con él mismo, así como sus implicaciones en cuanto a nivel de riesgo se refiere. El establecimiento de estas relaciones semánticas -llamado cognición- es la única forma de definir el nivel de riesgo de manera absoluta y de generar una respuesta adecuada al mismo. No necesariamente proporcional, sino coherente con el riesgo al que se enfrenta. La investigación que presenta esta tesis describe el trabajo realizado para trasladar esta metodología de análisis y funcionamiento a la robótica. Este se ha centrado especialmente en la nevegación de los robots aéreos, diseñando e implementado procedimientos de inspiración humana para garantizar la seguridad de la misma. Para ello se han estudiado y evaluado los mecanismos de percepción, cognición y reacción humanas en relación al manejo de riesgos. También se ha analizado como los estímulos son capturados, procesados y transformados por condicionantes psicológicos, sociológicos y antropológicos de los seres humanos. Finalmente, también se ha analizado como estos factores motivan y descandenan las reacciones humanas frente a los peligros. Como resultado de este estudio, todos estos procesos, comportamientos y condicionantes de la conducta humana se han reproducido en un framework que se ha estructurado basadandose en factores análogos. Este emplea el conocimiento obtenido experimentalmente en forma de algoritmos, técnicas y estrategias, emulando el comportamiento humano en las mismas circunstancias. Diseñado, implementeado y validado tanto en simulación como con datos reales, este framework propone una manera innovadora -tanto en metodología como en procedimiento- de entender y reaccionar frente a las amenazas potenciales de una misión robótica. ABSTRACT Robotics has undergone a great revolution in the last decades. Nowadays this technology is able to perform really complex tasks with a high degree of accuracy and speed, however this is only true in precisely defined situations with fully controlled variables. Since the real world is dynamic, changing and unstructured, flexible and non context-dependent systems are required. The ability to understand situations, acknowledge changes and balance reactions is required by robots to successfully interact with their surroundings in a fully autonomous fashion. In fact, it is those very processes that define human interactions with the environment. Social relationships, driving or risk/incertitude management... in all these activities and systems, context understanding and adaptability are what allow human beings to survive: contrarily to the traditional robotics, people do not evaluate obstacles according to their position but according to the potential risk their presence imply. In this sense, human perception looks for information which goes beyond location, speed and dynamics (the usual data used in traditional obstacle avoidance systems). Specific features in the behaviour of a particular element allows the understanding of that element’s nature and therefore the comprehension of the risk posed by it. This process defines the second main difference between traditional obstacle avoidance systems and human behaviour: the ability to understand a situation/scenario allows to get to know the implications of the elements and their relationship with the observer. Establishing these semantic relationships -named cognition- is the only way to estimate the actual danger level of an element. Furthermore, only the application of this knowledge allows the generation of coherent, suitable and adjusted responses to deal with any risk faced. The research presented in this thesis summarizes the work done towards translating these human cognitive/reasoning procedures to the field of robotics. More specifically, the work done has been focused on employing human-based methodologies to enable aerial robots to navigate safely. To this effect, human perception, cognition and reaction processes concerning risk management have been experimentally studied; as well as the acquisition and processing of stimuli. How psychological, sociological and anthropological factors modify, balance and give shape to those stimuli has been researched. And finally, the way in which these factors motivate the human behaviour according to different mindsets and priorities has been established. This associative workflow has been reproduced by establishing an equivalent structure and defining similar factors and sources. Besides, all the knowledge obtained experimentally has been applied in the form of algorithms, techniques and strategies which emulate the analogous human behaviours. As a result, a framework capable of understanding and reacting in response to stimuli has been implemented and validated.
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Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014
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AIM Anthracycline-induced cardiotoxicity (ACT) occurs in 57% of treated patients and remains an important limitation of anthracycline-based chemotherapy. In various genetic association studies, potential genetic risk markers for ACT have been identified. Therefore, we developed evidence-based clinical practice recommendations for pharmacogenomic testing to further individualize therapy based on ACT risk. METHODS We followed a standard guideline development process; including a systematic literature search, evidence synthesis and critical appraisal, and the development of clinical practice recommendations with an international expert group. RESULTS RARG rs2229774, SLC28A3 rs7853758 and UGT1A6 rs17863783 variants currently have the strongest and the most consistent evidence for association with ACT. Genetic variants in ABCC1, ABCC2, ABCC5, ABCB1, ABCB4, CBR3, RAC2, NCF4, CYBA, GSTP1, CAT, SULT2B1, POR, HAS3, SLC22A7, SCL22A17, HFE and NOS3 have also been associated with ACT, but require additional validation. We recommend pharmacogenomic testing for the RARG rs2229774 (S427L), SLC28A3 rs7853758 (L461L) and UGT1A6*4 rs17863783 (V209V) variants in childhood cancer patients with an indication for doxorubicin or daunorubicin therapy (Level B - moderate). Based on an overall risk stratification, taking into account genetic and clinical risk factors, we recommend a number of management options including increased frequency of echocardiogram monitoring, follow-up, as well as therapeutic options within the current standard of clinical practice. CONCLUSIONS Existing evidence demonstrates that genetic factors have the potential to improve the discrimination between individuals at higher and lower risk of ACT. Genetic testing may therefore support both patient care decisions and evidence development for an improved prevention of ACT.
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Federal Transit Administration, Washington, D.C.
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Fundamental principles of precaution are legal maxims that ask for preventive actions, perhaps as contingent interim measures while relevant information about causality and harm remains unavailable, to minimize the societal impact of potentially severe or irreversible outcomes. Such principles do not explain how to make choices or how to identify what is protective when incomplete and inconsistent scientific evidence of causation characterizes the potential hazards. Rather, they entrust lower jurisdictions, such as agencies or authorities, to make current decisions while recognizing that future information can contradict the scientific basis that supported the initial decision. After reviewing and synthesizing national and international legal aspects of precautionary principles, this paper addresses the key question: How can society manage potentially severe, irreversible or serious environmental outcomes when variability, uncertainty, and limited causal knowledge characterize their decision-making? A decision-analytic solution is outlined that focuses on risky decisions and accounts for prior states of information and scientific beliefs that can be updated as subsequent information becomes available. As a practical and established approach to causal reasoning and decision-making under risk, inherent to precautionary decision-making, these (Bayesian) methods help decision-makers and stakeholders because they formally account for probabilistic outcomes, new information, and are consistent and replicable. Rational choice of an action from among various alternatives-defined as a choice that makes preferred consequences more likely-requires accounting for costs, benefits and the change in risks associated with each candidate action. Decisions under any form of the precautionary principle reviewed must account for the contingent nature of scientific information, creating a link to the decision-analytic principle of expected value of information (VOI), to show the relevance of new information, relative to the initial ( and smaller) set of data on which the decision was based. We exemplify this seemingly simple situation using risk management of BSE. As an integral aspect of causal analysis under risk, the methods developed in this paper permit the addition of non-linear, hormetic dose-response models to the current set of regulatory defaults such as the linear, non-threshold models. This increase in the number of defaults is an important improvement because most of the variants of the precautionary principle require cost-benefit balancing. Specifically, increasing the set of causal defaults accounts for beneficial effects at very low doses. We also show and conclude that quantitative risk assessment dominates qualitative risk assessment, supporting the extension of the set of default causal models.
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This study takes a direct approach to determine management motivation for the use of financial derivatives. We survey a sample of Australian firms on attitudes to derivative use and financial risk management. Management views are sought on the importance of a series of theoretical reasons for using derivatives. Generally, we find that managers are focused on the broad reduction of risk and volatility of cash flows and earnings in using derivatives. Specific issues such as reducing bankruptcy costs, debt levels and taxation are not considered as important. A further interesting result from this research is that even though firms may use derivatives they may not necessarily hedge all of their annual exposures across different financial risks. This helps explain the inconsistency of results in many empirical studies on the determinants of derivative use.
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The recent deregulation in electricity markets worldwide has heightened the importance of risk management in energy markets. Assessing Value-at-Risk (VaR) in electricity markets is arguably more difficult than in traditional financial markets because the distinctive features of the former result in a highly unusual distribution of returns-electricity returns are highly volatile, display seasonalities in both their mean and volatility, exhibit leverage effects and clustering in volatility, and feature extreme levels of skewness and kurtosis. With electricity applications in mind, this paper proposes a model that accommodates autoregression and weekly seasonals in both the conditional mean and conditional volatility of returns, as well as leverage effects via an EGARCH specification. In addition, extreme value theory (EVT) is adopted to explicitly model the tails of the return distribution. Compared to a number of other parametric models and simple historical simulation based approaches, the proposed EVT-based model performs well in forecasting out-of-sample VaR. In addition, statistical tests show that the proposed model provides appropriate interval coverage in both unconditional and, more importantly, conditional contexts. Overall, the results are encouraging in suggesting that the proposed EVT-based model is a useful technique in forecasting VaR in electricity markets. (c) 2005 International Institute of Forecasters. Published by Elsevier B.V. All rights reserved.
Long-term persistence of multi-drug-resistant Salmonella enterica serovar Newport in two dairy herds
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Objective - To evaluate the association between maintaining joint hospital and maternity pens;and persistence of multi-drug-resistant (MDR) Salmonella enterica serovar Newport on 2 dairy farms. Design - Observational study. Sample Population - Feces and environmental samples from 2 dairy herds. Procedure - Herds were monitored for fecal shedding of S enterica Newport after outbreaks of clinical disease. Fecal and environmental samples were collected approximately monthly from pens housing sick cows and calving cows and from pens containing lactating cows. Cattle shedding the organism were tested serially on subsequent visits to determine carrier status. One farm was resampled after initiation of interventional procedures, including separation of hospital and maternity pens. Isolates were characterized via serotyping, determination of antimicrobial resistance phenotype, detection of the CMY-2 gene, and DNA fingerprinting. Results - The prevalence (32.4% and 33.3% on farms A and B, respectively) of isolating Salmonella from samples from joint hospital-maternity pens was significantly higher than the prevalence in samples from pens housing preparturient cows (0.8%, both farms) and postparturient cows on Farm B (8.8%). Multi-drug-resistant Salmonella Newport was isolated in high numbers from bedding material, feed refusals, lagoon slurry, and milk filters. One cow excreted the organism for 190 days. Interventional procedures yielded significant reductions in the prevalences of isolating the organism from fecal and environmental samples. Most isolates were of the C2 serogroup and were resistant to third-generation cephalosporins. Conclusions and Clinical Relevance - Management practices may be effective at reducing the persistence of MDR Salmonella spp in dairy herds, thus mitigating animal and public health risk.
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How can empirical evidence of adverse effects from exposure to noxious agents, which is often incomplete and uncertain, be used most appropriately to protect human health? We examine several important questions on the best uses of empirical evidence in regulatory risk management decision-making raised by the US Environmental Protection Agency (EPA)'s science-policy concerning uncertainty and variability in human health risk assessment. In our view, the US EPA (and other agencies that have adopted similar views of risk management) can often improve decision-making by decreasing reliance on default values and assumptions, particularly when causation is uncertain. This can be achieved by more fully exploiting decision-theoretic methods and criteria that explicitly account for uncertain, possibly conflicting scientific beliefs and that can be fully studied by advocates and adversaries of a policy choice, in administrative decision-making involving risk assessment. The substitution of decision-theoretic frameworks for default assumption-driven policies also allows stakeholder attitudes toward risk to be incorporated into policy debates, so that the public and risk managers can more explicitly identify the roles of risk-aversion or other attitudes toward risk and uncertainty in policy recommendations. Decision theory provides a sound scientific way explicitly to account for new knowledge and its effects on eventual policy choices. Although these improvements can complicate regulatory analyses, simplifying default assumptions can create substantial costs to society and can prematurely cut off consideration of new scientific insights (e.g., possible beneficial health effects from exposure to sufficiently low 'hormetic' doses of some agents). In many cases, the administrative burden of applying decision-analytic methods is likely to be more than offset by improved effectiveness of regulations in achieving desired goals. Because many foreign jurisdictions adopt US EPA reasoning and methods of risk analysis, it may be especially valuable to incorporate decision-theoretic principles that transcend local differences among jurisdictions.
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Universities are under no less pressure to adopt risk management strategies than other public and private organisations. The risk management of doctoral education is a particularly important issue given that a doctorate is the highest academic qualification a university offers and stakes are high in terms of assuring its quality. However, intense risk management can interfere with the intellectual and pedagogical work which are essentially part of doctoral education. This paper seeks to understand how the culture of risk meets the culture of doctoral education and with what effect. The authors draw on sociological understandings of risk in the work of Anthony Giddens (2002) and Ulrich Beck (1992), the anthropological focus on liminality in the work of Mary Douglas (1990), and the psychological theorising of human error in the work of James Reason (1990). The paper concludes that risk consciousness brings its own risks—in particular, the potential transformation of a culture based on intellect into a culture based on compliance.