Assessing pressure injury risk and prevention using the Braden mobility subscale

 Getting a pressure injury or ulcer whilst in hospital may cause debilitating physical effects, pain or even death. This research found that assessment of mobility alone compares well with the more commonly used and more complex risk assessment scales when used to identify person's risk for developing a pressure sore.

Intimate partner violence in prisoners: toward effective assessment and intervention

This paper reviews the significant challenges that are involved in the development of services for perpetrators of intimate partner violence who are in prison. It is suggested that difficulties in accurately identifying intimate partner violence, reliably assessing risk of re-offense, and in identifying offending behavior programs that meet the specific needs of prisoners have limited the development of services in this area. As a result it is argued that unique and complex victim related issues that arise during incarceration and post-release are not adequately recognized in current correctional assessment and case management systems. Four avenues for future research and service development in this area are identified, with a view to developing the role that correctional services have to play in preventing intimate partner violence.

FRAX (Aus) and falls risk: Association in men and women

Purpose: The WHO fracture risk prediction tool (FRAX®) utilises clinical risk factors to estimate the probability of fracture over a 10-year period. Although falls increase fracture risk, they have not been incorporated into FRAX. It is currently unclear if FRAX captures falls risk and whether addition of falls would improve fracture prediction. We aimed to investigate the association of falls risk and Australian-specific FRAX. Methods: Clinical risk factors were documented for 735 men and 602 women (age 40-90. yr) assessed at follow-up (2006-2010 and 2000-2003, respectively) of the Geelong Osteoporosis Study. FRAX scores with and without BMD were calculated. A falls risk score was determined at the time of BMD assessment and self-reported incident falls were documented from questionnaires returned one year later. Multivariable analyses were performed to determine: (i) cross-sectional association between FRAX scores and falls risk score (Elderly Falls Screening Test, EFST) and (ii) prospective relationship between FRAX and time to a fall. Results: There was an association between FRAX (hip with BMD) and EFST scores (. β=. 0.07, p<. 0.001). After adjustment for sex and age, the relationship became non-significant (. β=. 0.00, p=. 0.79). The risk of incident falls increased with increasing FRAX (hip with BMD) score (unadjusted HR 1.04, 95% CI 1.02, 1.07). After adjustment for age and sex, the relationship became non-significant (1.01, 95% CI 0.97, 1.05). Conclusions: There is a weak positive correlation between FRAX and falls risk score, that is likely explained by the inclusion of age and sex in the FRAX model. These data suggest that FRAX score may not be a robust surrogate for falls risk and that inclusion of falls in fracture risk assessment should be further explored.

An integrated framework for suicide risk prediction

Suicide is a major concern in society. Despite of great attention paid by the community with very substantive medico-legal implications, there has been no satisfying method that can reliably predict the future attempted or completed suicide. We present an integrated machine learning framework to tackle this challenge. Our proposed framework consists of a novel feature extraction scheme, an embedded feature selection process, a set of risk classifiers and finally, a risk calibration procedure. For temporal feature extraction, we cast the patient’s clinical history into a temporal image to which a bank of one-side filters are applied. The responses are then partly transformed into mid-level features and then selected in 1-norm framework under the extreme value theory. A set of probabilistic ordinal risk classifiers are then applied to compute the risk probabilities and further re-rank the features. Finally, the predicted risks are calibrated. Together with our Australian partner, we perform comprehensive study on data collected for the mental health cohort, and the experiments validate that our proposed framework outperforms risk assessment instruments by medical practitioners.

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.

Testing the focal species approach to making conservation decisions for species persistence

Aim: Most risk assessments and decisions in conservation are based on surrogate approaches, where a group of species or environmental indicators are selected as proxies for other aspects of biodiversity. In the focal species approach, a suite of species is selected based on life history characteristics, such as dispersal limitation and area requirements. Testing the validity of the focal species concept has proved difficult, due to a lack of theory justifying the underlying framework, explicit objectives and measures of success. We sought to understand the conditions under which the focal species concept has merit for conservation decisions. Location: Our model system comprised 10 vertebrate species in 39 patches of native forest embedded in pine plantation in New South Wales, Australia. Methods: We selected three focal species based on ecological traits. We used a multiple-species reserve selection method that minimizes the expected loss of species, by estimating the risk of extinction with a metapopulation model. We found optimal reserve solutions for multiple species, including all 10 species, the three focal species, for all possible combinations of three species, and for each species individually. Results: Our case study suggests that the focal species approach can work: the reserve system that minimized the expected loss of the focal species also minimized the expected species loss in the larger set of 10 species. How well the solution would perform for other species and given landscape dynamics remains unknown. Main conclusions: The focal species approach may have merit as a conservation short cut if placed within a quantitative decision-making framework, where the aspects of biodiversity for which the focal species act as proxies are explicitly defined, and success is determined by whether the use of the proxy results in the same decision. Our methods provide a framework for testing other surrogate approaches used in conservation decision-making and risk assessment. © 2013 John Wiley & Sons Ltd.

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.

Understanding dynamic risk factors for violence

Recent years have seen a consensus emerge regarding the dynamic risk factors that are associated with future violence. These risk factors are now routinely assessed in structured violence risk assessment instruments. They provide a focus for treatment in structured group programmes. However, relatively little attention has been paid to risk-related theoretical issues, whether these dynamic risk factors are causally related or simply correlates of violent offending, or the extent to which they change as a consequence of treatment. More challenging is the lack of evidence to suggest that changes in these dynamic risk factors actually result in reductions in violent offending. In this paper we consider the meaning of the term dynamic risk, arguing that only those factors that, when changed, reduce the likelihood of violent recidivism, can be considered to be truly dynamic. We conclude that few of the violence risk factors commonly regarded as dynamic fulfil this requirement. There is a need to think more critically about assessment findings and treatment recommendations relating to dynamic risk, and conduct research that establishes, rather than assumes, that certain dynamic risk factors are directly related to violence. Some suggestions for advancing knowledge and practice are provided.

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.

Avaliação de impactos e custos ambientais em processos industriais : uma abordagem metodológica

A preocupação com a qualidade ambiental aumentou significativamente nos últimos anos. Isso é evidenciado pela rígida legislação ambiental e pela mudança de comportamento da sociedade frente a esse assunto. Nesse contexto, as indústrias vêm sendo pressionadas a adequar seus processos produtivos às novas exigências. A fim de auxiliá-las nessa tarefa, várias metodologias de avaliação ambiental foram desenvolvidas, entre elas a Avaliação do Ciclo de Vida (Life Cycle Assessment – LCA). Ela se destaca por buscar soluções globais e efetivas para os problemas ambientais, através de uma análise sistêmica. No entanto, assim como outras metodologias, o LCA não apresenta uma avaliação econômica estruturada em conjunto com a ambiental. Esta dissertação tem a finalidade de contribuir para o preenchimento dessa lacuna, através do desenvolvimento de uma abordagem consistente e estruturada, capaz de avaliar simultaneamente impactos e custos ambientais em processos industriais. Para isso, foram utilizados como bases teóricas o LCA, o Modelo Econômico de Controle e Avaliação de Impactos Ambientais (MECAIA), a Metodologia para a Contabilidade do Gerenciamento Ambiental (Environmental Management Accounting – EMA), o Método de Custeio Baseado em Atividades (Activity Based Costing – ABC), a Avaliação de Riscos (Risk Assessment) e a Análise de Modos e Efeitos de Falhas (Failure Mode and Effects Analysis – FMEA). A abordagem desenvolvida foi aplicada em uma indústria do setor metal-mecânico para avaliar os impactos e os custos ambientais de seu processo produtivo, evidenciando que aparentemente há uma relação direta entre esses dois fatores, ou seja, os resíduos que geram maior impacto sobre o meio ambiente também apresentam maior custo associado Por fim, constatou-se que a combinação das metodologias, dos métodos e dos modelos utilizados permitiu a elaboração de uma abordagem capaz de orientar a análise de um processo produtivo, a fim de identificar quais as etapas que geram maior impacto sobre o meio ambiente, além de apurar os gastos ambientais e classificá-los nas categorias de prevenção, correção e geração.

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.

Análise de Sustentabilidade em Projetos de Instalações de Produção de Petróleo

A proposal for a global analysis of sustainability in projects related in oil facilities is presented. By considering economic, environmental and social aspects in the early stages of design, the suggested method is more comprehensive and can be used to complement the analysis commonly applied in the petroleum industry, such as: Study of Technical and Economic Feasibility; Environmental Impact Assessment and Risk Analysis. Several authors, associations, certification bodies and oil companies suggest different approaches to study sustainability in some specific activities (or industries). In this study, a checklist of significant sustainability aspects for the oil industry (surface facilities) was assembled. In addition, a matrix was developed to assess the sustainability items relevant to these projects. In this work, the checklist interacts with the matrix to perform a "Preliminary Analysis of Sustainability of the Enterprise" (APSE). This method allows the identification of aspects that contribute significantly to global sustainability. From this analysis, which includes economic, social and environmental aspects, is built a report that is used to analyze qualitatively and quantitatively the impact of the sustainability aspects of the project. In this analysis are identified items that strongly influence the economic, social or environmental aspects and evaluated alternatives that can increase the overall sustainability of the project. Finally, the alternatives that can be used to indicate the most sustainable option are identified. This method was applied in a project (design) of a small offshore platform. This case study shows how the APSE can contribute to the identification of sustainability initiatives for the enterprise. The results showed that relevant aspects can contribute decisively to global sustainability. Finally, it was observed that the proposed method can contribute to increased rates of sustainability, even after application of analysis commonly used in these projects