HealthMap: a visual platform for patient suicide risk review

Misjudging suicide risk can be fatal. Risk assessment is complicated by multiplicity of risk factors, none of which individually can reliably predict risk. This paper addresses the need for better clinical support, visualising risk factors scattered in raw electronic medical records. HealthMap is a visual tool that helps clinicians effectively examine patient histories during a suicide risk assessment. We characterise the information visualisation problems accompanying suicide risk assessments. A design driven by visualisation principles was implemented. The prototype was evaluated by clinicians and accepted into daily clinical work-flow.

Overview of cardiovascular risk in older people with diabetes: basic pathophysiology, risk factors and management

Increasing age is a risk factor for diabetes; consequently, diabetes is prevalent in older people. Older people with diabetes are at high risk of cardiovascular disease (CVD) and cardiovascular events, such as myocardial infarction and heart failure.Multiple pathological processes underlie CVD, including inflammation, oxidative stress, endothelial dysfunction, thrombosis and angiogenesis. These pathological processes are influenced by age, ethnicity, genetic makeup, obesity, hyperglycaemia,insulin resistance, dyslipidaemia, hypertension, renal disease, inappropriate diet and inactivity, which are components of the metabolic syndrome and CVD risk factors. The more risk factors present, the higher the risk of CVD. Significantly, vascular damage occurs slowly; therefore, it is essential to undertake a comprehensive vascular risk assessment and manage the risk early in life to improve the individual’soutcomes. Management strategies must be negotiated with the individual and appropriately tailored to their CVD risk and functional status, life expectancy and safety.

The IUCN red list of ecosystems: motivations, challenges, and applications

In response to growing demand for ecosystem-level risk assessment in biodiversity conservation, and rapid proliferation of locally tailored protocols, the IUCN recently endorsed new Red List criteria as a global standard for ecosystem risk assessment. Four qualities were sought in the design of the IUCN criteria: generality; precision; realism; and simplicity. Drawing from extensive global consultation, we explore trade-offs among these qualities when dealing with key challenges, including ecosystem classification, measuring ecosystem dynamics, degradation and collapse, and setting decision thresholds to delimit ordinal categories of threat. Experience from countries with national lists of threatened ecosystems demonstrates well-balanced trade-offs in current and potential applications of Red Lists of Ecosystems in legislation, policy, environmental management and education. The IUCN Red List of Ecosystems should be judged by whether it achieves conservation ends and improves natural resource management, whether its limitations are outweighed by its benefits, and whether it performs better than alternative methods. Future development of the Red List of Ecosystems will benefit from the history of the Red List of Threatened Species which was trialed and adjusted iteratively over 50 years from rudimentary beginnings. We anticipate the Red List of Ecosystems will promote policy focus on conservation outcomes in situ across whole landscapes and seascapes.

Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies

Background

Previous reviews on risk and protective factors for violence in psychosis have produced contrasting findings. There is therefore a need to clarify the direction and strength of association of risk and protective factors for violent outcomes in individuals with psychosis.

Method

We conducted a systematic review and meta-analysis using 6 electronic databases (CINAHL, EBSCO, EMBASE, Global Health, PsycINFO, PUBMED) and Google Scholar. Studies were identified that reported factors associated with violence in adults diagnosed, using DSM or ICD criteria, with schizophrenia and other psychoses. We considered non-English language studies and dissertations. Risk and protective factors were meta-analysed if reported in three or more primary studies. Meta-regression examined sources of heterogeneity. A novel meta-epidemiological approach was used to group similar risk factors into one of 10 domains. Sub-group analyses were then used to investigate whether risk domains differed for studies reporting severe violence (rather than aggression or hostility) and studies based in inpatient (rather than outpatient) settings.

Findings

There were 110 eligible studies reporting on 45,533 individuals, 8,439 (18.5%) of whom were violent. A total of 39,995 (87.8%) were diagnosed with schizophrenia, 209 (0.4%) were diagnosed with bipolar disorder, and 5,329 (11.8%) were diagnosed with other psychoses. Dynamic (or modifiable) risk factors included hostile behaviour, recent drug misuse, non-adherence with psychological therapies (p values<0.001), higher poor impulse control scores, recent substance misuse, recent alcohol misuse (p values<0.01), and non-adherence with medication (p value <0.05). We also examined a number of static factors, the strongest of which were criminal history factors. When restricting outcomes to severe violence, these associations did not change materially. In studies investigating inpatient violence, associations differed in strength but not direction.

Conclusion

Certain dynamic risk factors are strongly associated with increased violence risk in individuals with psychosis and their role in risk assessment and management warrants further examination.

The addition of depression to the Framingham Risk Equation model for predicting coronary heart disease risk in women

BACKGROUND: Depression is widely considered to be an independent and robust predictor of Coronary Heart Disease (CHD), however is seldom considered in the context of formal risk assessment. We assessed whether the addition of depression to the Framingham Risk Equation (FRE) improved accuracy for predicting 10-year CHD in a sample of women.

DESIGN: A prospective, longitudinal design comprising an age-stratified, population-based sample of Australian women collected between 1993 and 2011 (n=862).

METHODS: Clinical depressive disorder was assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID-I/NP), using retrospective age-of-onset data. A composite measure of CHD included non-fatal myocardial infarction, unstable angina coronary intervention or cardiac death. Cox proportional-hazards regression models were conducted and overall accuracy assessed using area under receiver operating characteristic (ROC) curve analysis.

RESULTS: ROC curve analyses revealed that the addition of baseline depression status to the FRE model improved its overall accuracy (AUC:0.77, Specificity:0.70, Sensitivity:0.75) when compared to the original FRE model (AUC:0.75, Specificity:0.73, Sensitivity:0.67). However, when calibrated against the original model, the predicted number of events generated by the augmented version marginally over-estimated the true number observed.

CONCLUSIONS: The addition of a depression variable to the FRE equation improves the overall accuracy of the model for predicting 10-year CHD events in women, however may over-estimate the number of events that actually occur. This model now requires validation in larger samples as it could form a new CHD risk equation for women.

Integration of renewable generation uncertainties into stochastic unit commitment considering reserve and risk: a comparative study

The uncertainties of renewable energy have brought great challenges to power system commitment, dispatches and reserve requirement. This paper presents a comparative study on integration of renewable generation uncertainties into SCUC (stochastic security-constrained unit commitment) considering reserve and risk. Renewable forecast uncertainties are captured by a list of PIs (prediction intervals). A new scenario generation method is proposed to generate scenarios from these PIs. Different system uncertainties are considered as scenarios in the stochastic SCUC problem formulation. Two comparative simulations with single (E1: wind only) and multiple sources of uncertainty (E2: load, wind, solar and generation outages) are investigated. Five deterministic and four stochastic case studies are performed. Different generation costs, reserve strategies and associated risks are compared under various scenarios. Demonstrated results indicate the overall costs of E2 is lower than E1 due to penetration of solar power and the associated risk in deterministic cases of E2 is higher than E1. It implies the superimposed effect of uncertainties during uncertainty integration. The results also demonstrate that power systems run a higher level of risk during peak load hours, and that stochastic models are more robust than deterministic ones.

Re-framing risk transfer to assess integrative partnership opportunities: the S.A.R. approach and the AIG/BID/CNO regional surety bond facility of 2007

Identificar, compartilhar e gerenciar os riscos de contratar são preocupações que impedem o estabelicmento e a administração das Parcerias Públicos Particulares (PPP). Porem, gerentes das entidades públicas, bancos de formento, construtoras e seguradoras pesquisam e utilizam muitas técnicas para enfrentar a avaliação e gerenciamento dos riscos. A transferência de risco é uma indicação dos chamados benefícios que são inspirados pelos PPP, contudo devido às realidades contratuais e conceptuais, a entidade de cede o risco (o partido público) permanece quase sempre como o portador final do risco. Conseqüentemente, o partido público retem um interesse de resistência na gerência total destes riscos cedidos. Esta dissertação explora alguns defeitos das aproximações comuns a conceituar a gestão de risco no contexto de um PPP. Focalizando os conceitos da interdependência e da reciprocidade e usando na decisão para transferir o risco do projeto, esta dissertação molda a decisão para transferir o risco nos termos das realidades interdependentes de relacionamentos sistemáticos, alargam os conceitos técnicos do risco e da avaliação de risco, considerando o uso reflexivo das diferenças na analise de um estudo de caso. O autor explora estes conceitos em uma análise da decisão de um gerente de risco da empresa de construção civil brasileira Construtora Norberto Odebrecht (ODB) para projetar uma facilidade inovadora da ligação de garantia com Inter-American Development Bank (BID) e uma seguradora, American International Group (AIG), um negócio que ganhe o reconhecimento Trade Finance Magazine’s 2007 deal of the year. O autor mostra que por compreender a transferência de risco nos termos abordados nesta dissertação, um atore que transfere o risco pode identificar e criar mais oportunidades de estabelecer relacionamentos em longo prazo, através dos processos que a literatura atual do PPP ainda não considere. Os resultados devem fornecer contribuições para a pesquisas sobre a transferência do risco do projeto, na cooperação entre organizações e na seleção do sócio do projeto do potencial.

A simple approach to integrate the ecotoxicological and chemical data for the establishment of environmental risk levels

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Avaliação de impacto ambiental e gestão dos recursos natuarias no estuário Apodi Mossoró, nordeste do Brasil

The aim of this study is to investigate the eco-environmental vulnerability, its changes, and its causes to develop a management system for application of eco-environmental vulnerability and risk assessment in the Apodi-Mossory estuary, Northeast Brazil. This analysis is focused on the interference of the landscape conditions, and its changes, due to the following factors: the oil and natural gas industry, tropical fruits industry, shrimp farms, marine salt industry, occupation of the sensitive areas; demand for land, vegetation degradation, siltation in rivers, severe flooding, sea level rise (SLR), coastal dynamics, low and flat topography, high ecological value and tourism in the region and the rapid growth of urbanization. Conventional and remote sensing data were analyzed using modeling techniques based on ArcGIS, ER-Mapper, ERDAS Imagine and ENVI software. Digital images were initially processed by Principal Component Analysis and transformation of the maximum fraction of noise, and then all bands were normalized to reduce errors caused by bands of different sizes. They were integrated in a Geographic Information System analysis to detect changes, to generate digital elevation models, geomorphic indices and other variables of the study area. A three band color combination of multispectral bands was used to monitor changes of land and vegetation cover from 1986 to 2009. This task also included the analysis of various secondary data, such as field data, socioeconomic data, environmental data and prospects growth. The main objective of this study was to improve our understanding of eco-environmental vulnerability and risk assessment; it´s causes basically show the intensity, its distribution and human-environment effect on the ecosystem, and identify the high and low sensitive areas and area of inundation due to future SLR, and the loss of land due to coastal erosion in the Apodi-Mossoró estuary in order to establish a strategy for sustainable land use. The developed model includes some basic factors such as geology, geomorphology, soils, land use / land cover, vegetation cover, slope, topography and hydrology. The numerical results indicate that 9.86% of total study area was under very high vulnerability, 29.12% high vulnerability, 52.90% moderate vulnerability and 2.23% were in the category of very low vulnerability. The analysis indicates that 216.1 km² and 362.8 km² area flooded on 1m and 10m in sea levels respectively. The sectors most affected were residential, industrial and recreational areas, agricultural land, and ecosystems of high environmental sensitivity. The results showed that changes in eco-environmental vulnerability have a significant impact on the sustainable development of the RN state, since the indicator is a function of sensitivity, exposure and status in relation to a level of damage. The model were presented as a tool to assist in indexing vulnerability in order to optimize actions and assess the implications of decisions makers and policies regarding the management of coastal and estuarine areas. In this context aspects such as population growth, degradation of vegetation, land use / land cover, amount and type of industrialization, SLR and government policies for environmental protection were considered the main factors that affect the eco-environmental changes over the last three decades in the Apodi-Mossoró estuary.

Assessment of genetic damage induced by dental bleaching agents on mouse lymphoma cells by single cell gel (comet) assay

Dental bleaching is a simple and conservative procedure for aesthetic restoration of vital discoloured teeth. However, dental bleaching agents may represent a hazard to human health, especially by causing DNA strand breaks. Genotoxicity tests form an important part of cancer research and risk assessment of potential carcinogens. In the current study, the genotoxic potential associated with exposure to dental bleaching agents was assessed by the single cell gel (comet) assay in vitro. Six commercial dental bleaching agents (Clarigel Gold - Dentsply; Whitespeed - Discus Dental; Nite White - Discus Dental; Magic Bleaching - Vigodent; Whiteness HP - FGM and Lase Peroxide - DMC) were exposed to mouse lymphoma cells in vitro. The results pointed out that all dental bleaching agents tested contributed to the DNA damage as depicted by the mean tail moment. Clear concentration-related effects were obtained for DNA damaging, being the strongest effect observed at the highest dose of the hydrogen peroxide (Whiteness HP and Lase Peroxide, at 35% concentration). on the contrary, Whitespeed (Discus Dental) induced the lowest level of DNA breakage. Taken together, these results suggest that dental bleaching agents may be a factor that increases the level of DNA damage as detected by the single cell gel (comet) assay.

Pancreatic β-cell defects in women at risk of type 2 diabetes

We evaluated insulin release and insulin sensitivity in women with basal and/or postprandial hyperglycemia but normal oral glucose tolerance test (OGTT) in previous pregnancy (GHG). These women were individually matched with females without previous hyperglycemia (NGT). Both groups consisted of normal glucose-tolerant women at the time of this study. They underwent OGTT (75g; n= 32 pairs) and hyperglycemic clamp experiments (10mmoll-1; n=27 pairs) with plasma glucose, insulin, and C-peptide measurements and calculation of insulinogenic index, first- and second-phase insulin release, and insulin sensitivity index (ISI). The GHG group showed higher glycosylated hemoglobin levels (6.2±0.6% versus 5.8±0.8%; P<0.05); lower insulinogenic index at 30min (134.03±62.69pmolmmol-1 versus 181.59±70.26pmolmmoll-1; P<0.05) and diminished C-peptide response in relation to glucose (4.05±0.36nmolmmol-1 versus 4.23±0.36nmolmmol-1; P<0.05) at OGTT. Both groups did not show difference in insulin secretion and ISI by hyperglycemic clamp technique. We concluded that in up to 12 years from index pregnancy, women with previous GHG, presenting normal glucose tolerance and well-matched with their controls, showed β-cell dysfunction without change in ISI. As women with previous GHG are at risk of type 2 diabetes, β-cell dysfunction may be its primary defect. © 2003 Elsevier B.V. All rights reserved.

Polymorphisms of DNA repair genes XRCC1 and XRCC3, interaction with environmental exposure and risk of chronic gastritis and grastic cancer

Aim: To evaluate the association between polymorphisms XRCC1 Arg194Trp and Arg399Gln and XRCC3 Thr241Met and the risk for chronic gastritis and gastric cancer, in a Southeastern Brazilian population. Methods: Genotyping by PCR-RFLP was carried out on 202 patients with chronic gastritis (CG) and 160 patients with gastric cancer (GC), matched to 202 (C1) and 150 (C2) controls, respectively. Results: No differences were observed among the studied groups with regard to the genotype distribution of XRCC1 codons 194 and 399 and of XRCC3 codon 241. However, the combined analyses of the three variant alleles (194Trp, 399Gln and 241Met) showed an increased risk for chronic gastritis when compared to the GC group. Moreover, an interaction between the polymorphic alleles and demographic and environmental factors was observed in the CG and GC groups. XRCC1 194Trp was associated with smoking in the CG group, while the variant alleles XRCC1 399Gln and XRCC3 241Met were related with gender, smoking, drinking and H pylori infection in the CG and GC groups. Conclusion: Our results showed no evidence of a rela-tionship between the polymorphisms XRCC1 Arg194Trp and Arg399Gln and XRCC3 Thr241Met and the risk of chronic gastritis and gastric cancer in the Brazilian population, but the combined effect of these variants may interact to increase the risk for chronic gastritis, considered a premalignant lesion. Our data also indicate a gene-environment interaction in the susceptibility to chronic gastritis and gastric cancer. © 2005 The WJG Press and Elsevier Inc. All rights reserved.

Transtorno bipolar do humor e gênero

Although the bipolar disorder (BD) occurs almost with the same frequency in both genders, the phenomenology and the outcome of the illness differ between them. Nevertheless, there is evidence that women with BD show, more than men, delayed beginning, especially in their fifth decade, more rapid cycling outcome, more depressive episodes, more dysphoric mania, more mixed states and more BD type II. Even so, the findings are not always consistent. Although the risk of comorbidities in BD includes, for both the sorts, excessive alcoholic consumption and drugs, bipolar men would have greater probability of being alcohol dependent, of not seeking treatment and of committing suicide. Suggested hypotheses to explain such differences vary from those centered in cultural or psychological aspects to those that focus on the steroids hormones, and other hormones such as cortisol, thyroid hormones and even on the cerebral anatomy. The reproductive cycle (menstrual cycle, pregnancy and menopause) influences on the BD phenomenology and its relevance to the therapeutical options in the treatment of the BD in women are presented in the last part of this review. Further investigations must to be done in order to clarify this controversy. However, up to now the data indicate that estrogen therapy is not to be primarily indicated to prevent depression, Alzheimer disease or cognition impairment.