Non-Risk-Adapted Surveillance in Clinical Stage I Nonseminomatous Germ Cell Tumors: The Princess Margaret Hospital's Experience.

BACKGROUND: Since 1981 Princess Margaret Hospital has used initial active surveillance (AS) with delayed treatment at relapse as the preferred management for all patients with clinical stage I nonseminomatous germ cell tumors (NSGCT). OBJECTIVE: Our aim was to report our overall AS experience and compare outcomes over different periods using this non-risk-adapted approach. DESIGN, SETTING, AND PARTICIPANTS: Three hundred and seventy-one patients with stage I NSGCT were managed by AS from 1981 to 2005. For analysis by time period, patients were divided into two cohorts by diagnosis date: initial cohort, 1981-1992 (n=157), and recent cohort, 1993-2005 (n=214). INTERVENTION: Patients were followed at regular intervals, and treatment was only given for relapse. MEASUREMENTS: Recurrence rates, time to relapse, risk factors for recurrence, disease-specific survival, and overall survival were determined. RESULTS AND LIMITATIONS: With a median follow-up of 6.3 yr, 104 patients (28%) relapsed: 53 of 157 (33.8%) in the initial group and 51 of 214 (23.8%) in the recent group. Median time to relapse was 7 mo. Lymphovascular invasion (p<0.0001) and pure embryonal carcinoma (p=0.02) were independent predictors of recurrence; 125 patients (33.7%) were designated as high risk based on the presence of one or both factors. In the initial cohort, 66 of 157 patients (42.0%) were high risk and 36 of 66 patients (54.5%) relapsed versus 17 of 91 low-risk patients (18.7%) (p<0.0001). In the recent cohort, 59 of 214 patients (27.6%) were high risk and 29 of 59 had a recurrence (49.2%) versus 22 of 155 low-risk patients (14.2%) (p<0.0001). Three patients (0.8%) died from testis cancer. The estimated 5-yr disease-specific survival was 99.3% in the initial group and 98.9% in the recent one. CONCLUSIONS: Non-risk-adapted surveillance is an effective, simple strategy for the management of all stage I NSGCT.

Perception of cardiovascular risk and comparison with actual cardiovascular risk.

BACKGROUND: Current guidelines recommend treating patients according to their absolute cardiovascular disease (CVD) risk. We examined perception of CVD risk among adults and how it can be compared with actual CVD risk. METHODS: The perception of CVD risk was assessed by two questions asking about participants' 'risk to get a heart attack or a stroke over the next 10 years' using semiquantitative and quantitative answers in a population-based survey of 816 individuals aged 40-64 years in the Seychelles (African region). Actual CVD risk was calculated using a standard risk prediction score and 24% of adults aged 40-64 years had elevated risk. RESULTS: Only 59% of individuals could give an estimate of perceived CVD risk based on the semiquantitative question and 31% based on the quantitative question. Reporting a perceived CVD risk was strongly associated with high socio-economic status (SES; odds ratio = 9). Among individuals who reported a perceived CVD risk, 48% overestimated their perceived risk versus their actual risk. Reporting a high perceived CVD risk was associated with treatment for CVD risk factors, older age, low SES, and overweight. Reporting a low perceived CVD risk was associated with male sex, younger age, education, normal BMI, and leisure time exercise. CONCLUSION: Only half of the individuals could provide an estimate of their perceived CVD risk, and this perception was strongly associated with SES. Individuals under treatment perceived higher CVD risk than nontreated individuals. Further studies should determine how risk-related information can be better conveyed to individuals as a means to improve adherence to healthy lifestyles and/or treatment.

A Monte Carlo approach to the inverse problem of diffuse pollution risk in agricultural catchments

The hydrological and biogeochemical processes that operate in catchments influence the ecological quality of freshwater systems through delivery of fine sediment, nutrients and organic matter. Most models that seek to characterise the delivery of diffuse pollutants from land to water are reductionist. The multitude of processes that are parameterised in such models to ensure generic applicability make them complex and difficult to test on available data. Here, we outline an alternative - data-driven - inverse approach. We apply SCIMAP, a parsimonious risk based model that has an explicit treatment of hydrological connectivity. we take a Bayesian approach to the inverse problem of determining the risk that must be assigned to different land uses in a catchment in order to explain the spatial patterns of measured in-stream nutrient concentrations. We apply the model to identify the key sources of nitrogen (N) and phosphorus (P) diffuse pollution risk in eleven UK catchments covering a range of landscapes. The model results show that: 1) some land use generates a consistently high or low risk of diffuse nutrient pollution; but 2) the risks associated with different land uses vary both between catchments and between nutrients; and 3) that the dominant sources of P and N risk in the catchment are often a function of the spatial configuration of land uses. Taken on a case-by-case basis, this type of inverse approach may be used to help prioritise the focus of interventions to reduce diffuse pollution risk for freshwater ecosystems. (C) 2012 Elsevier B.V. All rights reserved.

An interactive web-GIS tool for risk analysis: a case study in the Fella River basin, Italy

This paper presents a prototype of an interactive web-GIS tool for risk analysis of natural hazards, in particular for floods and landslides, based on open-source geospatial software and technologies. The aim of the presented tool is to assist the experts (risk managers) in analysing the impacts and consequences of a certain hazard event in a considered region, providing an essential input to the decision-making process in the selection of risk management strategies by responsible authorities and decision makers. This tool is based on the Boundless (OpenGeo Suite) framework and its client-side environment for prototype development, and it is one of the main modules of a web-based collaborative decision support platform in risk management. Within this platform, the users can import necessary maps and information to analyse areas at risk. Based on provided information and parameters, loss scenarios (amount of damages and number of fatalities) of a hazard event are generated on the fly and visualized interactively within the web-GIS interface of the platform. The annualized risk is calculated based on the combination of resultant loss scenarios with different return periods of the hazard event. The application of this developed prototype is demonstrated using a regional data set from one of the case study sites, Fella River of northeastern Italy, of the Marie Curie ITN CHANGES project.

A correlation sensitivity analysis of non-life underwriting risk in solvency capital requirement estimation

This paper analyses the impact of using different correlation assumptions between lines of business when estimating the risk-based capital reserve, the Solvency Capital Requirement -SCR-, under Solvency II regulations. A case study is presented and the SCR is calculated according to the Standard Model approach. Alternatively, the requirement is then calculated using an Internal Model based on a Monte Carlo simulation of the net underwriting result at a one-year horizon, with copulas being used to model the dependence between lines of business. To address the impact of these model assumptions on the SCR we conduct a sensitivity analysis. We examine changes in the correlation matrix between lines of business and address the choice of copulas. Drawing on aggregate historical data from the Spanish non-life insurance market between 2000 and 2009, we conclude that modifications of the correlation and dependence assumptions have a significant impact on SCR estimation.

Risk Parity: A Modern Tool for Diversification

The purpose of this study is to examine how well risk parity works in terms of risk, return and diversification relative to more traditional minimum variance, 1/N and 60/40 portfolios. Risk parity portfolios were constituted of five risk sources; three common asset classes and two alternative beta investment strategies. The three common asset classes were equities, bonds and commodities, and the alternative beta investment strategies were carry trade and trend following. Risk parity portfolios were constructed using five different risk measures of which four were tail risk measures. The risk measures were standard deviation, Value-at-Risk, Expected Shortfall, modified Value-at-Risk and modified Expected Shortfall. We studied also how sensitive risk parity is to the choice of risk measure. The hypothesis is that risk parity portfolios provide better return with the same amount of risk and are better diversified than the benchmark portfolios. We used two data sets, monthly and weekly data. The monthly data was from the years 1989-2011 and the weekly data was from the years 2000-2011. Empirical studies showed that risk parity portfolios provide better diversification since the diversification is made at the risk level. Risk based portfolios provided superior return compared to the asset based portfolios. Using tail risk measures in risk parity portfolios do not necessarily provide better hedge from tail events than standard deviation.

Developing asset management in district heating and cooling business in a large energy company

The purpose of this Master´s Thesis is to develop asset management and its practices in case company. District heating and cooling systems operated by case company around Finland, Sweden, Poland and the Baltics form an enormous-sized asset base where some parts are starting to reach their end of life-cycles. Large-sized asset renewal actions are under discussion and maintenance spending is increasing. Financially justified decisions in changing business environment are needed. Asset management is one of the most important concepts for production organization which operates with capital-intensive production assets. Organizations profitability is highly dependent on assets´ performance. Such assets, like district heating and cooling systems, should be utilized as efficiently as possible within their life-cycles but also maintained and renewed optimally. In this qualitative thesis, empirical interview study was conducted to describe the current situation on how the assets are managed in the case company and to examine the readiness to implement a new, risk-based solution. Asset management revealed to be a very well-known concept. From proposed risk-based asset management point of view, several key observations were made. It was seen as a suitable solution, but further development will be needed. Based on the need and findings, several key processes and frameworks were created and also tested with a case study. Assets` condition monitoring should be improved, which would have a positive impact on event probability assessment. Risk acceptance is also a thing to be discussed further. When the evaluation becomes fluent in single investment cases, portfolio-level expansion should be considered and started. As a result, thesis proposes a solution how risk-based asset management could be performed practically in a capital-intensive case company in order to optimize the maintenance spending in a long run. Created practical framework is made universal: similar principles can be applied into multiple cases in case company but also in other energy companies. Risk-based asset management`s benefits could be utilized best in portfolio-level optimization where the capital would be invested to the most important objects from total risk point of view. Eventually, such approach would allow case company to optimize capital spending in a situation where funds are not adequate to cover all the mandatory needs and prioritization between the investment alternatives will truly be needed.

Unpacking Pieces of a Puzzle: Understanding Obesity-Related Health Risk through Lifestyle Behaviours and Well-Being

The primary objective of this non-experimental study was to examine the differences based on obesity-related health risk in terms of physical activity, sedentary behaviour and well-being in adults. Participants (N = 50; Mage = 38.50, SDage = 14.21) were asked to wear a SenseWear Armband (SWA) across a seven day monitoring period followed by a questionnaire package. Using the National Institute of Health’s (1998) criteria, participants were classified as either least, increased, or high risk based on waist circumference and Body Mass Index scores. Differences between these classifications were found in the amount of time spent in active energy expenditure for bouts of ten minutes or more (p = .002); specifically between least and high risk (p < .05). No other differences (p > .05) emerged. Participants’ also perceived the SWA as a practical and worthwhile device. Overall, these findings provide practical applications and future directions for health promotional research.

A New Model For Reliability Centered Maintenance In Petroleum Refineries

Refiners today operate their equipment for prolonged periods without shutdown. This is primarily due to the increased pressures of the market resulting in extended shutdown-to-shutdown intervals. This places extreme demands on the reliability of the plant equipment. The traditional methods of reliability assurance, like Preventive Maintenance, Predictive Maintenance and Condition Based Maintenance become inadequate in the face of such demands. The alternate approaches to reliability improvement, being adopted the world over are implementation of RCFA programs and Reliability Centered Maintenance. However refiners and process plants find it difficult to adopt this standardized methodology of RCM mainly due to the complexity and the large amount of analysis that needs to be done, resulting in a long drawn out implementation, requiring the services of a number of skilled people. These results in either an implementation restricted to only few equipment or alternately, one that is non-standard. The paper presents the current models in use, the core requirements of a standard RCM model, the alternatives to classical RCM, limitations in the existing model, classical RCM and available alternatives to RCM and will then go on to present an ‗Accelerated‘ approach to RCM implementation, that, while ensuring close conformance to the standard, does not place a large burden on the implementers

The impacts of climate change on river flood risk at the global scale

This paper presents an assessment of the implications of climate change for global river flood risk. It is based on the estimation of flood frequency relationships at a grid resolution of 0.5 × 0.5°, using a global hydrological model with climate scenarios derived from 21 climate models, together with projections of future population. Four indicators of the flood hazard are calculated; change in the magnitude and return period of flood peaks, flood-prone population and cropland exposed to substantial change in flood frequency, and a generalised measure of regional flood risk based on combining frequency curves with generic flood damage functions. Under one climate model, emissions and socioeconomic scenario (HadCM3 and SRES A1b), in 2050 the current 100-year flood would occur at least twice as frequently across 40 % of the globe, approximately 450 million flood-prone people and 430 thousand km2 of flood-prone cropland would be exposed to a doubling of flood frequency, and global flood risk would increase by approximately 187 % over the risk in 2050 in the absence of climate change. There is strong regional variability (most adverse impacts would be in Asia), and considerable variability between climate models. In 2050, the range in increased exposure across 21 climate models under SRES A1b is 31–450 million people and 59 to 430 thousand km2 of cropland, and the change in risk varies between −9 and +376 %. The paper presents impacts by region, and also presents relationships between change in global mean surface temperature and impacts on the global flood hazard. There are a number of caveats with the analysis; it is based on one global hydrological model only, the climate scenarios are constructed using pattern-scaling, and the precise impacts are sensitive to some of the assumptions in the definition and application.

Reducing The Risk Of Floods In Urban Areas With Combined Inland-River System

With the change of the water environment in accordance with climate change, the loss of lives and properties has increased due to urban flood. Although the importance of urban floods has been highlighted quickly, the construction of advancement technology of an urban drainage system combined with inland-river water and its relevant research has not been emphasized in Korea. In addition, without operation in consideration of combined inland-river water, it is difficult to prevent urban flooding effectively. This study, therefore, develops the uncertainty quantification technology of the risk-based water level and the assessment technology of a flood-risk region through a flooding analysis of the combination of inland-river. The study is also conducted to develop forecast technology of change in the water level of an urban region through the construction of very short-term/short-term flood forecast systems. This study is expected to be able to build an urban flood forecast system which makes it possible to support decision making for systematic disaster prevention which can cope actively with climate change.

Contratos de terceirização de manutenção industrial na modalidade risco: análise comparativa das avaliações e expectativas entre o setor industrial e as empresas fornecedoras de serviços

O objetivo principal deste trabalho é avaliar as formas de contratação de manutenção industrial praticadas nos últimos anos e identificar os elementos que devem ser considerados na elaboração de um contrato baseado em performance, com remuneração variável e cláusulas de risco, sob a óptica de quem contrata (indústrias) e de quem fornece (empresas especializadas) esse tipo de serviço. Para se chegar ao modelo sugerido, o estudo utiliza uma analogia com o "jogo da forca" (jogo infantil de salão que baseia-se no processo de tentativa e erro) para desenvolver um processo de desconstrução dos modelos atuais de contratação de manutenção, identificando os fatores determinantes (para cada forma de contrato mais utilizada) para o insucesso financeiro e operacional atualmente percebido. Após a tentativa de ordenação das causas dos problemas correntes, o trabalho passa para o objetivo principal, que é o de listar os fatores críticos de sucesso para um contrato de manutenção por performance e, finalmente, sugerir um modelo básico de atuação para que os resultados almejados sejam obtidos. Com a identificação e implementação desses elementos num novo modelo de contrato de risco de manutenção, acredita-se ser possível minimizar os problemas comerciais e operacionais que atualmente representam obstáculos ao sucesso da terceirização da manutenção em plantas industriais, particularmente no Brasil . A metodologia se baseia em análise dos resultados de pesquisa de campo através de questionário realizado junto aos principais gestores de grandes grupos industriais e com os executivos das empresas prestadoras de serviço de manutenção industrial.

Characterization of the temperature, load and damage effects using piezoelectric transducer patches based on fuzzy clustering

Structural Health Monitoring (SHM) denotes a system with the ability to detect and interpret adverse changes in a structure. One of the critical challenges for practical implementation of SHM system is the ability to detect damage under changing environmental conditions. This paper aims to characterize the temperature, load and damage effects in the sensor measurements obtained with piezoelectric transducer (PZT) patches. Data sets are collected on thin aluminum specimens under different environmental conditions and artificially induced damage states. The fuzzy clustering algorithm is used to organize the sensor measurements into a set of clusters, which can attribute the variation in sensor data due to temperature, load or any induced damage.

Versatile and easy-to-assemble measurement system for impedance-based structural health monitoring

In this paper we present a versatile and easy-to-assemble measurement system for structural health monitoring (SHM) based on the electromechanical impedance (EMI) technique. The hardware of the proposed system consists only of a common data acquisition (DAQ) device with external resistors and allows real-time data acquisition from multiple sensors. Besides the low-cost compared to conventional impedance analyzers, the hardware and the software are simple and easier to implement than other measurement systems that have been recently proposed.

Bioremediation of PAHs - Limitations and soultions

Introduction 1.1 Occurrence of polycyclic aromatic hydrocarbons (PAH) in the environment Worldwide industrial and agricultural developments have released a large number of natural and synthetic hazardous compounds into the environment due to careless waste disposal, illegal waste dumping and accidental spills. As a result, there are numerous sites in the world that require cleanup of soils and groundwater. Polycyclic aromatic hydrocarbons (PAHs) are one of the major groups of these contaminants (Da Silva et al., 2003). PAHs constitute a diverse class of organic compounds consisting of two or more aromatic rings with various structural configurations (Prabhu and Phale, 2003). Being a derivative of benzene, PAHs are thermodynamically stable. In addition, these chemicals tend to adhere to particle surfaces, such as soils, because of their low water solubility and strong hydrophobicity, and this results in greater persistence under natural conditions. This persistence coupled with their potential carcinogenicity makes PAHs problematic environmental contaminants (Cerniglia, 1992; Sutherland, 1992). PAHs are widely found in high concentrations at many industrial sites, particularly those associated with petroleum, gas production and wood preserving industries (Wilson and Jones, 1993). 1.2 Remediation technologies Conventional techniques used for the remediation of soil polluted with organic contaminants include excavation of the contaminated soil and disposal to a landfill or capping - containment - of the contaminated areas of a site. These methods have some drawbacks. The first method simply moves the contamination elsewhere and may create significant risks in the excavation, handling and transport of hazardous material. Additionally, it is very difficult and increasingly expensive to find new landfill sites for the final disposal of the material. The cap and containment method is only an interim solution since the contamination remains on site, requiring monitoring and maintenance of the isolation barriers long into the future, with all the associated costs and potential liability. A better approach than these traditional methods is to completely destroy the pollutants, if possible, or transform them into harmless substances. Some technologies that have been used are high-temperature incineration and various types of chemical decomposition (for example, base-catalyzed dechlorination, UV oxidation). However, these methods have significant disadvantages, principally their technological complexity, high cost , and the lack of public acceptance. Bioremediation, on the contrast, is a promising option for the complete removal and destruction of contaminants. 1.3 Bioremediation of PAH contaminated soil & groundwater Bioremediation is the use of living organisms, primarily microorganisms, to degrade or detoxify hazardous wastes into harmless substances such as carbon dioxide, water and cell biomass Most PAHs are biodegradable unter natural conditions (Da Silva et al., 2003; Meysami and Baheri, 2003) and bioremediation for cleanup of PAH wastes has been extensively studied at both laboratory and commercial levels- It has been implemented at a number of contaminated sites, including the cleanup of the Exxon Valdez oil spill in Prince William Sound, Alaska in 1989, the Mega Borg spill off the Texas coast in 1990 and the Burgan Oil Field, Kuwait in 1994 (Purwaningsih, 2002). Different strategies for PAH bioremediation, such as in situ , ex situ or on site bioremediation were developed in recent years. In situ bioremediation is a technique that is applied to soil and groundwater at the site without removing the contaminated soil or groundwater, based on the provision of optimum conditions for microbiological contaminant breakdown.. Ex situ bioremediation of PAHs, on the other hand, is a technique applied to soil and groundwater which has been removed from the site via excavation (soil) or pumping (water). Hazardous contaminants are converted in controlled bioreactors into harmless compounds in an efficient manner. 1.4 Bioavailability of PAH in the subsurface Frequently, PAH contamination in the environment is occurs as contaminants that are sorbed onto soilparticles rather than in phase (NAPL, non aqueous phase liquids). It is known that the biodegradation rate of most PAHs sorbed onto soil is far lower than rates measured in solution cultures of microorganisms with pure solid pollutants (Alexander and Scow, 1989; Hamaker, 1972). It is generally believed that only that fraction of PAHs dissolved in the solution can be metabolized by microorganisms in soil. The amount of contaminant that can be readily taken up and degraded by microorganisms is defined as bioavailability (Bosma et al., 1997; Maier, 2000). Two phenomena have been suggested to cause the low bioavailability of PAHs in soil (Danielsson, 2000). The first one is strong adsorption of the contaminants to the soil constituents which then leads to very slow release rates of contaminants to the aqueous phase. Sorption is often well correlated with soil organic matter content (Means, 1980) and significantly reduces biodegradation (Manilal and Alexander, 1991). The second phenomenon is slow mass transfer of pollutants, such as pore diffusion in the soil aggregates or diffusion in the organic matter in the soil. The complex set of these physical, chemical and biological processes is schematically illustrated in Figure 1. As shown in Figure 1, biodegradation processes are taking place in the soil solution while diffusion processes occur in the narrow pores in and between soil aggregates (Danielsson, 2000). Seemingly contradictory studies can be found in the literature that indicate the rate and final extent of metabolism may be either lower or higher for sorbed PAHs by soil than those for pure PAHs (Van Loosdrecht et al., 1990). These contrasting results demonstrate that the bioavailability of organic contaminants sorbed onto soil is far from being well understood. Besides bioavailability, there are several other factors influencing the rate and extent of biodegradation of PAHs in soil including microbial population characteristics, physical and chemical properties of PAHs and environmental factors (temperature, moisture, pH, degree of contamination). Figure 1: Schematic diagram showing possible rate-limiting processes during bioremediation of hydrophobic organic contaminants in a contaminated soil-water system (not to scale) (Danielsson, 2000). 1.5 Increasing the bioavailability of PAH in soil Attempts to improve the biodegradation of PAHs in soil by increasing their bioavailability include the use of surfactants , solvents or solubility enhancers.. However, introduction of synthetic surfactant may result in the addition of one more pollutant. (Wang and Brusseau, 1993).A study conducted by Mulder et al. showed that the introduction of hydropropyl-ß-cyclodextrin (HPCD), a well-known PAH solubility enhancer, significantly increased the solubilization of PAHs although it did not improve the biodegradation rate of PAHs (Mulder et al., 1998), indicating that further research is required in order to develop a feasible and efficient remediation method. Enhancing the extent of PAHs mass transfer from the soil phase to the liquid might prove an efficient and environmentally low-risk alternative way of addressing the problem of slow PAH biodegradation in soil.