Re-focusing risk assessment in forensic mental health nursing.

Editorial in the Journal of Psychiatric and Mental Health Nursing, 2015, 22(7)

Surveillance during pregnancy: methods and response rates from a hospital based pilot study of the Pregnancy Risk Assessment Monitoring System in Ireland

Background: Many European countries including Ireland lack high quality, on-going, population based estimates of maternal behaviours and experiences during pregnancy. PRAMS is a CDC surveillance program which was established in the United States in 1987 to generate high quality, population based data to reduce infant mortality rates and improve maternal and infant health. PRAMS is the only on-going population based surveillance system of maternal behaviours and experiences that occur before, during and after pregnancy worldwide.Methods: The objective of this study was to adapt, test and evaluate a modified CDC PRAMS methodology in Ireland. The birth certificate file which is the standard approach to sampling for PRAMS in the United States was not available for the PRAMS Ireland study. Consequently, delivery record books for the period between 3 and 5 months before the study start date at a large urban obstetric hospital [8,900 births per year] were used to randomly sample 124 women. Name, address, maternal age, infant sex, gestational age at delivery, delivery method, APGAR score and birth weight were manually extracted from records. Stillbirths and early neonatal deaths were excluded using APGAR scores and hospital records. Women were sent a letter of invitation to participate including option to opt out, followed by a modified PRAMS survey, a reminder letter and a final survey.Results: The response rate for the pilot was 67%. Two per cent of women refused the survey, 7% opted out of the study and 24% did not respond. Survey items were at least 88% complete for all 82 respondents. Prevalence estimates of socially undesirable behaviours such as alcohol consumption during pregnancy were high [>50%] and comparable with international estimates.Conclusion: PRAMS is a feasible and valid method of collecting information on maternal experiences and behaviours during pregnancy in Ireland. PRAMS may offer a potential solution to data deficits in maternal health behaviour indicators in Ireland with further work. This study is important to researchers in Europe and elsewhere who may be interested in new ways of tailoring an established CDC methodology to their unique settings to resolve data deficits in maternal health.

Freezing behaviour facilitates bioelectric crypsis in cuttlefish faced with predation risk.

Cephalopods, and in particular the cuttlefish Sepia officinalis, are common models for studies of camouflage and predator avoidance behaviour. Preventing detection by predators is especially important to this group of animals, most of which are soft-bodied, lack physical defences, and are subject to both visually and non-visually mediated detection. Here, we report a novel cryptic mechanism in S. officinalis in which bioelectric cues are reduced via a behavioural freeze response to a predator stimulus. The reduction of bioelectric fields created by the freeze-simulating stimulus resulted in a possible decrease in shark predation risk by reducing detectability. The freeze response may also facilitate other non-visual cryptic mechanisms to lower predation risk from a wide range of predator types.

Clinical utility of a Web-enabled risk-assessment and clinical decision support program.

PURPOSE: Risk-stratified guidelines can improve quality of care and cost-effectiveness, but their uptake in primary care has been limited. MeTree, a Web-based, patient-facing risk-assessment and clinical decision support tool, is designed to facilitate uptake of risk-stratified guidelines. METHODS: A hybrid implementation-effectiveness trial of three clinics (two intervention, one control). PARTICIPANTS: consentable nonadopted adults with upcoming appointments. PRIMARY OUTCOME: agreement between patient risk level and risk management for those meeting evidence-based criteria for increased-risk risk-management strategies (increased risk) and those who do not (average risk) before MeTree and after. MEASURES: chart abstraction was used to identify risk management related to colon, breast, and ovarian cancer, hereditary cancer, and thrombosis. RESULTS: Participants = 488, female = 284 (58.2%), white = 411 (85.7%), mean age = 58.7 (SD = 12.3). Agreement between risk management and risk level for all conditions for each participant, except for colon cancer, which was limited to those <50 years of age, was (i) 1.1% (N = 2/174) for the increased-risk group before MeTree and 16.1% (N = 28/174) after and (ii) 99.2% (N = 2,125/2,142) for the average-risk group before MeTree and 99.5% (N = 2,131/2,142) after. Of those receiving increased-risk risk-management strategies at baseline, 10.5% (N = 2/19) met criteria for increased risk. After MeTree, 80.7% (N = 46/57) met criteria. CONCLUSION: MeTree integration into primary care can improve uptake of risk-stratified guidelines and potentially reduce "overuse" and "underuse" of increased-risk services.Genet Med 18 10, 1020-1028.

Predictive reliability, prognostics and risk assessment for power modules

This paper describes a framework that is being developed for the prediction and analysis of electronics power module reliability both for qualification testing and in-service lifetime prediction. Physics of failure (PoF) reliability methodology using multi-physics high-fidelity and reduced order computer modelling, as well as numerical optimization techniques, are integrated in a dedicated computer modelling environment to meet the needs of the power module designers and manufacturers as well as end-users for both design and maintenance purposes. An example of lifetime prediction for a power module solder interconnect structure is described. Another example is the lifetime prediction of a power module for a railway traction control application. Also in the paper a combined physics of failure and data trending prognostic methodology for the health monitoring of power modules is discussed.

Hazard and risk assessment from Hurricane Ivan (2004) in Grenada using Geographical Information Systems and remote sensing

Hurricanes are destructive storms with strong winds, intense storm surges, and heavy rainfall. The resulting impact from a hurricane can include structural damage to buildings and infrastructure, flooding, and ultimately loss of human life. This paper seeks to identify the impact of Hurricane Ivan on the aected population of Grenada, one of the Caribbean islands. Hurricane Ivan made landfall on 7th September 2004 and resulted in 80% of the population being adversely aected. The methods that were used to model these impacts involved performing hazard and risk assessments using GIS and remote sensing techniques. Spatial analyses were used to create a hazard and a risk map. Hazards were identied initially as those caused by storm surges, severe winds speeds, and flooding events related to Hurricane Ivan. These estimated hazards were then used to create a risk map. An innovative approach was adopted, including the use of hillshading to assess the damage caused by high wind speeds. This paper explains in detail the methodology used and the results produced.

Assessing the environmental consequences of CO2 leakage from geological CCS: Generating evidence to support environmental risk assessment

At the start of the industrial revolution (circa 1750) the atmospheric concentration of carbon dioxide (CO2) was around 280 ppm. Since that time the burning of fossil fuel, together with other industrial processes such as cement manufacture and changing land use, has increased this value to 400 ppm, for the first time in over 3 million years. With CO2 being a potent greenhouse gas, the consequence of this rise for global temperatures has been dramatic, and not only for air temperatures. Global Sea Surface Temperature (SST) has warmed by 0.4–0.8 °C during the last century, although regional differences are evident (IPCC, 2007). This rise in atmospheric CO2 levels and the resulting global warming to some extent has been ameliorated by the oceanic uptake of around one quarter of the anthropogenic CO2 emissions (Sabine et al., 2004). Initially this was thought to be having little or no impact on ocean chemistry due to the capacity of the ocean’s carbonate buffering system to neutralise the acidity caused when CO2 dissolves in seawater. However, this assumption was challenged by Caldeira and Wickett (2005) who used model predictions to show that the rate at which carbonate buffering can act was far too slow to moderate significant changes to oceanic chemistry over the next few centuries. Their model predicted that since pre-industrial times, ocean surface water pH had fallen by 0.1 pH unit, indicating a 30% increase in the concentration of H+ ions. Their model also showed that the pH of surface waters could fall by up to 0.4 units before 2100, driven by continued and unabated utilisation of fossil fuels. Alongside increasing levels of dissolved CO2 and H+ (reduced pH) an increase in bicarbonate ions together with a decrease in carbonate ions occurs. These chemical changes are now collectively recognised as “ocean acidification”. Concern now stems from the knowledge that concentrations of H+, CO2, bicarbonate and carbonate ions impact upon many important physiological processes vital to maintaining health and function in marine organisms. Additionally, species have evolved under conditions where the carbonate system has remained relatively stable for millions of years, rendering them with potentially reduced capacity to adapt to this rapid change. Evidence suggests that, whilst the impact of ocean acidification is complex, when considered alongside ocean warming the net effect on the health and productivity of the oceans will be detrimental.

Knowledge-based risk assessment under uncertainty in engineering projects

In this paper we describe how an evidential-reasoner can be used as a component of risk assessment of engineering projects using a direct way of reasoning. Guan & Bell (1991) introduced this method by using the mass functions to express rule strengths. Mass functions are also used to express data strengths. The data and rule strengths are combined to get a mass distribution for each rule; i.e., the first half of our reasoning process. Then we combine the prior mass and the evidence from the different rules; i.e., the second half of the reasoning process. Finally, belief intervals are calculated to help in identifying the risks. We apply our evidential-reasoner on an engineering project and the results demonstrate the feasibility and applicability of this system in this environment.

Risk assessment of E-Commerce projects using evidential reasoning

The purpose of this study is to develop a decision making system to evaluate the risks in E-Commerce (EC) projects. Competitive software businesses have the critical task of assessing the risk in the software system development life cycle. This can be conducted on the basis of conventional probabilities, but limited appropriate information is available and so a complete set of probabilities is not available. In such problems, where the analysis is highly subjective and related to vague, incomplete, uncertain or inexact information, the Dempster-Shafer (DS) theory of evidence offers a potential advantage. We use a direct way of reasoning in a single step (i.e., extended DS theory) to develop a decision making system to evaluate the risk in EC projects. This consists of five stages 1) establishing knowledge base and setting rule strengths, 2) collecting evidence and data, 3) determining evidence and rule strength to a mass distribution for each rule; i.e., the first half of a single step reasoning process, 4) combining prior mass and different rules; i.e., the second half of the single step reasoning process, 5) finally, evaluating the belief interval for the best support decision of EC project. We test the system by using potential risk factors associated with EC development and the results indicate that the system is promising way of assisting an EC project manager in identifying potential risk factors and the corresponding project risks.