Search results for: risk assessments

Authors: Junaid Mahmood Alam

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Revalidating and harmonizing clinical chemistry analytical principles and optimizing methods through quality control programs and assessments is the preeminent means to attain optimal outcome within the clinical laboratory services. Present study reports revalidation of our existing IFCC regularized analytical methods, particularly hepatic and thyroid function tests, by optimization of precision analyses and processing through external and internal quality assessments and regression determination. Parametric components of hepatic (Bilirubin ALT, γGT, ALP), cardiac (LDH, AST, Trop I) and thyroid/pituitary (T3, T4, TSH, FT3, FT4) function tests were used to validate analytical techniques on automated chemistry and immunological analyzers namely Hitachi 912, Cobas 6000 e601, Cobas c501, Cobas e411 with UV kinetic, colorimetric dry chemistry principles and Electro-Chemiluminescence immunoassay (ECLi) techniques. Process of validation and revalidation was completed with evaluating and assessing the precision analyzed Preci-control data of various instruments plotting against each other with regression analyses R2. Results showed that: Revalidation and optimization of respective parameters that were accredited through CAP, CLSI and NEQAPP assessments depicted 99.0% to 99.8% optimization, in addition to the methodology and instruments used for analyses. Regression R2 analysis of BilT was 0.996, whereas that of ALT, ALP, γGT, LDH, AST, Trop I, T3, T4, TSH, FT3, and FT4 exhibited R2 0.998, 0.997, 0.993, 0.967, 0.970, 0.980, 0.976, 0.996, 0.997, 0.997, and R2 0.990, respectively. This confirmed marked harmonization of analytical methods and instrumentations thus revalidating optimized precision standardization as per IFCC recommended guidelines. It is concluded that practices of revalidating and harmonizing the existing or any new services should be followed by all clinical laboratories, especially those associated with tertiary care hospital. This is will ensure deliverance of standardized, proficiency tested, optimized services for prompt and better patient care that will guarantee maximum patients’ confidence.

Keywords: revalidation, standardized, IFCC, CAP, harmonized

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Authors: Eva Kirzner

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Based on outcome studies published over the past two decades, in 2018, the ACC/AHA published new guidelines for the management of hypercholesterolemia that incorporate the use of coronary artery calcium (CAC) scanning as a decision tool for ascertaining which patients may benefit from statin therapy. This use is based on the recognition that the absence of calcium on CAC scanning (i.e., a CAC score of zero) usually signifies the absence of significant atherosclerotic deposits in the coronary arteries. Specifically, in patients with a high risk for atherosclerotic cardiovascular disease (ASCVD), initiation of statin therapy is generally recommended to decrease ASCVD risk. However, among patients with intermediate ASCVD risk, the need for statin therapy is less certain. However, there is a need for new outcome studies that provide evidence that the management of hypercholesterolemia based on these new ACC/AHA recommendations is safe for patients. Based on a Pub-Med and Google Scholar literature search, four relevant population-based or patient-based cohort studies that studied the relationship between CAC scanning, risk assessment or mortality, and statin therapy that were published between 2017 and 2021 were identified (see references). In each of these studies, patients were assessed for their baseline risk for atherosclerotic cardiovascular disease (ASCVD) using the Pooled Cohorts Equation (PCE), an ACC/AHA calculator for determining patient risk based on assessment of patient age, gender, ethnicity, and coronary artery disease risk factors. The combined findings of these four studies provided concordant evidence that a zero CAC score defines patients who remain at low clinical risk despite the non-use of statin therapy. Thus, these new studies confirm the use of CAC scanning as a safe tool for reducing the potential overuse of statin therapy among patients with zero CAC scores. Incorporating these new data suggest the following best practice: (1) ascertain ASCVD risk according to the PCE in all patients; (2) following an initial attempt trial to lower ASCVD risk with optimal diet among patients with elevated ASCVD risk, initiate statin therapy for patients who have a high ASCVD risk score; (3) if the ASCVD score is intermediate, refer patients for CAC scanning; and (4) and if the CAC score is zero among the intermediate risk ASCVD patients, statin therapy can be safely withheld despite the presence of an elevated serum cholesterol level.

Keywords: cholesterol, cardiovascular disease, statin therapy, coronary calcium

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Authors: Ghanima Al-Sharrah, Haitham M. Lababidi, Yusuf I. Ali

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The main objective of the current work is to introduce sustainability factors in optimizing the supply chain model for process industries. The supply chain models are normally based on purely economic considerations related to costs and profits. To account for sustainability, two additional factors have been introduced; environment and risk. A supply chain for an entire petroleum organization has been considered for implementing and testing the proposed optimization models. The environmental and risk factors were introduced as indicators reflecting the anticipated impact of the optimal production scenarios on sustainability. The aggregation method used in extending the single objective function to multi-objective function is proven to be quite effective in balancing the contribution of each objective term. The results indicate that introducing sustainability factor would slightly reduce the economic benefit while improving the environmental and risk reduction performances of the process industries.

Keywords: environmental indicators, optimization, risk, supply chain

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Authors: Gloria Chen

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When offering conventional level-appropriate ESL classes for adults is not feasible, a multilevel adult ESL class can be formed to benefit those who need to learn English for daily function. This paper examines the rationale, the process, the contents, and the outcomes of a multilevel ESL class for adults. The action research discusses a variety of assessments, lesson plans, teaching strategies that facilitate lifelong language learning. In small towns where adult ESL learners are only a handful, often advanced students and inexperienced students have to be placed in one class. Such class might not be viewed as desirable, but with on-going assessments, careful lesson plans, and purposeful strategies, a multilevel ESL class for adults can overcome the obstacles and help learners to reach a higher level of English proficiency. This research explores some hand-on strategies, such as group rotating, cooperative learning, and modifying textbook contents for practical purpose, and evaluate their effectiveness. The data collected in this research include Needs Assessment (beginning of class term), Mid-term Self-Assessment (5 months into class term), End-of-term Student Reflection (10 months into class), and End-of-term Assessment from the Instructor (10 months into class). A descriptive analysis of the data explains the practice of this particular learning community, and reveal the areas for improvement and enrichment. This research answers the following questions: (1) How do the assessments positively help both learners and instructors? (2) How do the learning strategies prepare students to become independent, life-long English learners? (3) How do materials, grouping, and class schedule enhance the learning? The result of the research contributes to the field of teaching and learning in language, not limited in English, by (a) examining strategies of conducting a multilevel adult class, (b) involving adult language learners with various backgrounds and learning styles for reflection and feedback, and (c) improving teaching and learning strategies upon research methods and results. One unique feature of this research is how students can work together with the instructor to form a learning community, seeking and exploring resources available to them, to become lifelong language learners.

Keywords: adult language learning, assessment, multilevel, teaching strategies

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Authors: Irena Paramita Pramono

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Islamic bank is a financial industry with huge potential to grow in Indonesia. Profit-sharing agreement in the operations of Islamic banks distinguishes Islamic banks with conventional banks. Profit-sharing agreement allows sharing of benefits and risks between shahibul maal and mudharib in islamic bank. This study aimed to observe the patterns of influence between the risk-sharing agreement, financing risk and Profitability in Islamic banks. This research used several Islamic banks as sample and path analysis method. The empirical results of this research shows that the profit-sharing agreement in deposits structure has no direct significant effect to ROA, but it has indirect effect to ROA through profit-sharing financing. On the other hand, profit-sharing financing has direct and indirect influence to ROA through financing risk. This research shows that profit-sharing financing has a positive significant effect to the financing risk and also to the ROA. The research recommends Islamic banks to continue using and developing profit-sharing agreement in its operational activities, hence to create value.

Keywords: Islamic bank, profit-loss sharing agreement, financing risk, profitability

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Authors: Smriti Pahwa, Karishma Vats, Aditi Macwan, Jija Dutt, Sumukhi Vaid

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Age approporiate complementary feeding has been stressed upon for sound young child nutrition and appropriate growth. National Infant and Young Child Feeding guidelines, policies and programs indicate cognizance of the issue taken by the country’s government, policy makers and technical experts. However, it is important that ordinary people, the caregivers of young children too understand the importance of appropriate feeding. For this, an interface might be required where ordinary people could participate in assessing the gaps in IYCF as a first step to take subsequent action. In this context an attempt was made to extrapolate a citizen led learning level survey that has been involving around 25000 ordinary citizens to reach out to 600,000 children annually for over a decade in India. Based on this philosophy of involving ordinary people in simple assessments to produce understandable actionable evidence, a rapid diet assessment tool was developed and collected from caregivers of 90 < 3year children from two urban clusters in Ahmedabad and Baroda, Gujarat. Target sample for pilot was selected after cluster census. Around half the mothers reported that they had not yet introduced water or other fluids to their < 6 month babies. However, about a third were already feeding them food other than mother’s milk. Although complementary feeding was initiated in almost all (95%) children more than 6 months old, frequency was suboptimal in 60%; in 80% cases no measure was taken to either improve energy or nutrient density; only 33% were fed protective foods; Green Leafy Vegetables consumption was negligible (1.4%). Anganwadi food was not consumed. By engaging ordinary people to generate evidence and understand the gaps, such assessments have the potential to be used to generate useful evidence for action at scale as well as locally.

Keywords: citizen led, grass root engagement, IYCF (Infant and Young Child Feeding), rapid diet assessment, under nutrition

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Authors: Katalin Bodor, Zsolt Bodor, Robert Szep

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The particulate matter (PM) smaller than 2.5 μm are less studied due to the limited availability of PM₂.₅, and less information is available on the health effects attributable to PM₁₀ in Central-Eastern Europe. The objective of the current study was to assess the human health risk and characterize the spatial and temporal variation of PM₂.₅ and PM₁₀ in eight Romanian regions between the 2009-2018 and. The PM concentrations showed high variability over time and spatial distribution. The highest concentration was detected in the Bucharest region in the winter period, and the lowest was detected in West. The relative risk caused by the PM₁₀ for all-cause mortality varied between 1.017 (B) and 1.025 (W), with an average 1.020. The results demonstrate a positive relative risk of cardiopulmonary and lung cancer disease due to exposure to PM₂.₅ on the national average 1.26 ( ± 0.023) and 1.42 ( ± 0.037), respectively.

Keywords: PM₂.₅, PM₁₀, relative risk, health effect

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Authors: Longqing Li

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The paper addresses the inefficiency of the classical model in measuring the Value-at-Risk (VaR) using a normal distribution or a Student’s t distribution. Specifically, the paper focuses on the one day ahead Value-at-Risk (VaR) of major stock market’s daily returns in US, UK, China and Hong Kong in the most recent ten years under 95% confidence level. To improve the predictable power and search for the best performing model, the paper proposes using two leading alternatives, Extreme Value Theory (EVT) and a family of GARCH models, and compares the relative performance. The main contribution could be summarized in two aspects. First, the paper extends the GARCH family model by incorporating EGARCH and TGARCH to shed light on the difference between each in estimating one day ahead Value-at-Risk (VaR). Second, to account for the non-normality in the distribution of financial markets, the paper applies Generalized Error Distribution (GED), instead of the normal distribution, to govern the innovation term. A dynamic back-testing procedure is employed to assess the performance of each model, a family of GARCH and the conditional EVT. The conclusion is that Exponential GARCH yields the best estimate in out-of-sample one day ahead Value-at-Risk (VaR) forecasting. Moreover, the discrepancy of performance between the GARCH and the conditional EVT is indistinguishable.

Keywords: Value-at-Risk, Extreme Value Theory, conditional EVT, backtesting

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Authors: Rahmoune Abdelhaq

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Systemic risk is a key concern for central banks charged with safeguarding overall financial stability. In this work, we investigate how systemic risk is affected by the structure of the financial system. We construct banking systems that are composed of a number of banks that are connected by interbank linkages. We then vary the key parameters that define the structure of the financial system — including its level of capitalization, the degree to which banks are connected, the size of interbank exposures and the degree of concentration of the system — and analyses the influence of these parameters on the likelihood of contagious (knock-on) defaults. First, we find that the better-capitalized banks are, the more resilient is the banking system against contagious defaults and this effect is non-linear. Second, the effect of the degree of connectivity is non-monotonic, that is, initially a small increase in connectivity increases the contagion effect; but after a certain threshold value, connectivity improves the ability of a banking system to absorb shocks. Third, the size of interbank liabilities tends to increase the risk of knock-on default, even if banks hold capital against such exposures. Fourth, more concentrated banking systems are shown to be prone to larger systemic risk, all else equal. In an extension to the main analysis, we study how liquidity effects interact with banking structure to produce a greater chance of systemic breakdown. We finally consider how the risk of contagion might depend on the degree of asymmetry (tier) inherent in the structure of the banking system. A number of our results have important implications for public policy, which this paper also draws out. This paper also discusses why bank risk management is needed to get the optimal one.

Keywords: financial stability, contagion, liquidity risk, optimal risk

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Authors: Hongmeng Su, Luyu Zhao, Yanyan Qian, Hong Fan

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Aim: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors that endanger human health seriously. RNA methylation, especially N6-methyladenosine (m⁶A) and 5-methylcytosine (m⁵C), a crucial epigenetic transcriptional regulatory mechanism, plays an important role in tumorigenesis, progression and prognosis. This research aims to systematically evaluate the prognostic value of m⁶A and m⁵C modulators in HCC patients. Methods: Twenty-four modulators of m⁶A and m⁵C were candidates to analyze their expression level and their contribution to predict the prognosis of HCC. Consensus clustering analysis was applied to classify HCC patients. Cox and LASSO regression were used to construct the risk model. According to the risk score, HCC patients were divided into high-risk and low/medium-risk groups. The clinical pathology factors of HCC patients were analyzed by univariate and multivariate Cox regression analysis. Results: The HCC patients were classified into 2 clusters with significant differences in overall survival and clinical characteristics. Nine-gene risk model was constructed including METTL3, VIRMA, YTHDF1, YTHDF2, NOP2, NSUN4, NSUN5, DNMT3A and ALYREF. It was indicated that the risk score could serve as an independent prognostic factor for patients with HCC. Conclusion: This study constructed a Nine-gene risk model by modulators of m⁶A and m⁵C and investigated its effect on the clinical prognosis of HCC. This model may provide important consideration for the therapeutic strategy and prognosis evaluation analysis of patients with HCC.

Keywords: hepatocellular carcinoma, m⁶A, m⁵C, prognosis, RNA methylation

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Authors: Ezeabasili Chibuike Patrick

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The complex situation of construction industries in Nigeria and the risk of failures involved includes cost overrun, time overrun, Corruption, Government influence, Subcontractor challenges, Political influence and Instability, Cultural differences, Human resources deficiencies, cash flow Challenges, foreign exchange issues, inadequate design, Safety, low productivity, late payment, Quality control issues, project management issues, Environmental issues, Force majeure Competition amongst others has made the industry prone to risk and failures. Good project management remains effective in improving decision-making, which minimizes these risk events. This study was done to address these project risks and good decision-making to avert them. A mixed-method approach to research was used to do this study. Data collected by questionnaires and interviews on thirty-two (32) construction professionals was used in analyses to aid the knowledge and management of risks that were identified. The study revealed that there is no good risk management expertise in Nigeria. Also, that the economic/political situation and the recent COVID-19 pandemic has added to the risk and poor management strategies. The contingency theory and cost has therefore surfaced to be the most strategic management method used to reduce these risk issues and they seem to be very effective.

Keywords: strategies, risk management, contingency theory, Nigeria

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Authors: Khaled Alkadamani

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Using the simultaneous equations model, this paper examines the impact of capital requirements on bank risk-taking during the recent financial crisis. It also explores the relationship between capital and risk decisions and the impact of economic instability on this relationship. By analyzing the data of 20 Islamic commercial banks between 2004 and 2014 from four Middle East countries, the study concludes a positive effect of regulatory pressure on bank capital in Saudi Arabia and UAE and a negative effect in Jordan and Kuwait. Moreover, the results show a negative impact of regulatory pressure on bank risk taking in Saudi Arabia, Jordan and UAE. The findings reveal also that banks close to the minimum regulatory capital requirements improve their capital adequacy by increasing their capital and decreasing their risk taking. Furthermore, the results show that economic crisis negatively affects bank risk changes, suggesting that banks react to the impact of uncertainty by reducing their risk taking. Finally, the estimations show a negative correlation between banks profitability and capital adequacy ratio (CAR), implying that as more capital is set aside as a buffer for banks safety; it affects the performance of Islamic banks.

Keywords: bank capital, bank regulation, crisis, Islamic banks, risk taking

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Authors: J. R. Wang, W. Y. Cheng, J. S. Yeh, S. W. Chen, Y. M. Ferng, J. H. Yang, W. S. Hsu, C. Shih

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To understand the risk for dry storage concrete casks in the cask loading, transfer, and storage phase, the purpose of this research is to establish the probabilistic risk assessment (PRA) analysis methodology for dry storage concrete casks by using SAPHIRE 8 code. This analysis methodology is used to perform the study of Taiwan nuclear power plants (NPPs) dry storage system. The process of research has three steps. First, the data of the concrete casks and Taiwan NPPs are collected. Second, the PRA analysis methodology is developed by using SAPHIRE 8. Third, the PRA analysis is performed by using this methodology. According to the analysis results, the maximum risk is the multipurpose canister (MPC) drop case.

Keywords: PRA, dry storage, concrete cask, SAPHIRE

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Authors: Abdessalem Abbassi, Ahlem Dakhlaoui, Lota D. Tamini

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This article analyses management of hydropower dams within two different industrial structures: monopolistic and oligopolistic; when hydroelectricity producers are risk averse and face demand uncertainty. In each type of market structure we determine the water release path in closed-loop equilibrium. We show how a monopoly can manage its hydropower dams by additional pumping or storage depending on the relative abundance of water between different regions to smooth the effect of uncertainty on electricity prices. In the oligopolistic case with symmetric rates of risk aversion, we determine the conditions under which the relative scarcity (abundance) of water in the dam of a hydroelectric operator can favor additional strategic pumping (storage) in its competitor’s dams. When there is asymmetry of the risk aversion coefficient, the firm’s hydroelectricity production increases as its competitor’s risk aversion increases, if and only if the average recharge speed of the competitor’s dam exceeds a certain threshold, which is an increasing function of its average water inflows.

Keywords: asymmetric risk aversion, closed-loop Cournot competition, electricity wholesale market, hydropower dams

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Authors: Ashley Hobson, Ashley Efaw

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Professionalism is an essential skill for clinicians, particularly for Occupational Therapy Providers (OTPs). The World Federation of Occupational Therapy (WFOT) Guiding Principles for Ethical Occupational Therapy and American Occupational Therapy Association (AOTA) Code of Ethics establishes expectations for professionalism among OTPs, emphasizing its importance in the field. However, the teaching and assessment of professionalism vary across OTP programs. The flexibility provided by the country standards allows programs to determine their own approaches to meeting these standards, resulting in inconsistency. Educators in both academic and fieldwork settings face challenges in objectively assessing and providing feedback on student professionalism. Although they observe instances of unprofessional behavior, there is no standardized assessment measure to evaluate professionalism in OTP students. While most students are committed to learning and applying professionalism skills, they enter OTP programs with varying levels of proficiency in this area. Consequently, they lack a uniform understanding of professionalism and lack an objective means to self-assess their current skills and identify areas for growth. It is crucial to explicitly teach professionalism, have students to self-assess their professionalism skills, and have OTP educators assess student professionalism. This approach is necessary for fostering students' professionalism journeys. Traditionally, there has been no objective way for students to self-assess their professionalism or for educators to provide objective assessments and feedback. To establish a uniform approach to professionalism, the authors incorporated professionalism content into our curriculum. Utilizing an operational definition of professionalism, the authors integrated professionalism into didactic, fieldwork, and capstone courses. The complexity of the content and the professionalism skills expected of students increase each year to ensure students graduate with the skills to practice in accordance with the WFOT Guiding Principles for Ethical Occupational Therapy Practice and AOTA Code of Ethics. Two professionalism assessments were developed based on the expectations outlined in the both documents. The Professionalism Self-Assessment allows students to evaluate their professionalism, reflect on their performance, and set goals. The Professionalism Assessment for Educators is a modified version of the same tool designed for educators. The purpose of this workshop is to provide educators with a framework and tools for assessing student professionalism. The authors discuss how to integrate professionalism content into OTP curriculum and utilize professionalism assessments to provide constructive feedback and equitable learning opportunities for OTP students in academic, fieldwork, and capstone settings. By adopting these strategies, educators can enhance the development of professionalism among OTP students, ensuring they are well-prepared to meet the demands of the profession.

Keywords: professionalism, assessments, student learning, student preparedness, ethical practice

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Authors: Ayoub Daoudi, Javad Eslami, Anne-Lise Beaucour, Martin Vigroux, Albert Noumowé

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As a fact, many cultural heritage masonry buildings have undergone violent fires during their history. In order to investigate the high temperature behaviour of stone masonry, six French limestones were heated to 600 °C at a rate of 9 °C/min. The main focus is the comparison between the high temperature behaviour of stones at the material and at the structural scale. In order to evaluate the risk of spalling, the tests have been carried out on the stone blocks (12x30x30 cm) instrumented with thermocouples and subjected to an unidirectional heating on one face. Thereafter, visual assessments and non-destructive measurements (dynamic elastic modulus) performed on blocks demonstrate a different behaviour from what was observed at the material scale. Finally, a series of thermo-mechanical computations, using finite element method, allowed us to highlight the difference between the behaviour of stones at material and block scales.

Keywords: limestones, hight temperature behaviour, damage, thermo-mechanical modeling, material and blocks scales, color change

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Authors: Martina Kanciruk, Jac J. W. Andrews, Tyrone Donnon

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The purpose of this study was to determine the significance of history of obesity for the development of childhood overweight and/or obesity. Accordingly, a systematic literature review of English-language studies published from 1980 to 2012 using the following data bases: MEDLINE, PsychINFO, Cochrane Database of Systematic Reviews, and Dissertation Abstracts International was conducted. The following terms were used in the search: pregnancy, overweight, obesity, family history, parents, childhood, risk factors. Eleven studies of family history and obesity conducted in Europe, Asia, North America, and South America met the inclusion criteria. A meta-analysis of these studies indicated that family history of obesity is a significant risk factor of overweight and /or obesity in offspring; risk for offspring overweight and/or obesity associated with family history varies depending of the family members included in the analysis; and when family history of obesity is present, the offspring are at greater risk for developing obesity or overweight. In addition, the results from moderator analyses suggest that part of the heterogeneity discovered between the studies can be explained by the region of world that the study occurred in and the age of the child at the time of weight assessment.

Keywords: childhood obesity, overweight, family history, risk factors, meta-analysis

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Authors: Jacek Kabzinski, Karolina Przybylowska, Lukasz Dziki, Adam Dziki, Ireneusz Majsterek

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The incidence of colorectal cancer (CRC) is increasing from year to year. Despite intensive research CRC etiology remains unknown. Studies suggest that at the basis of the process of carcinogenesis can lie reduced efficiency of DNA repair mechanisms, often caused by polymorphisms in DNA repair genes. The aim of the study was to determine the relationship between gene polymorphisms Pro242Arg of PolB gene and Arg780His of Lig3 gene and modulation of the risk of colorectal cancer in the Polish population. Determination of the molecular basis of carcinogenesis process and predicting increased risk will allow qualifying patients to increased risk group and including them in preventive program. We used blood collected from 110 patients diagnosed with colorectal cancer. The control group consisted of equal number of healthy people. Genotyping was performed by TaqMan method. The obtained results indicate that the genotype 780Arg/His of Lig3 gene is associated with an increased risk of colorectal cancer. On the basis of these results, we conclude that Lig3 gene polymorphism Arg780His may be associated with an increased risk of colorectal cancer.

Keywords: BER, colorectal cancer, PolB, Lig3, polymorphisms

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Authors: Daban Mohammed Haji

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This paper explores the application of constructive alignment in digital education at the University of Sulaimani, focusing specifically on the Language and Culture Center, Translation Department, and English Department. Constructive alignment, an outcome-based pedagogical framework developed by John Biggs, ensures that learning activities and assessments are directly aligned with the intended learning outcomes (ILOs). The study's findings reveal a significant gap in awareness and understanding of this pedagogical concept among lecturers. Many instructors are unfamiliar with constructive alignment, and those who have some knowledge of it face considerable challenges. These challenges include aligning learning activities and assessments with the ILOs and fostering higher-order cognitive skills as outlined in the SOLO taxonomy and revised Bloom’s taxonomy. To address this issue, the existing pedagogy center at the University of Sulaimani could play a pivotal role. This center has the potential to foster faculty development and promote the adoption of constructive alignment in online teaching. By leveraging the center's expertise and resources, a tailored program can be designed to enhance faculty understanding and application of this pedagogical framework.

Keywords: constructive alignment, student-centerdness, pedagogy, bologna process

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Authors: Shanza Akram, Sameen Toor, Heba Harb Abu Alkass, Zainab Abdulsalam Altaha, Sara Taha Abdulla, Saleem Imran

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Acute pulmonary embolism (PE) is a common disease and can be fatal. The clinical presentation is variable and nonspecific, making accurate diagnosis difficult. Testing patients with suspected acute PE has increased dramatically. However, the overuse of some tests, particularly CT and D-dimer measurement, may not improve care while potentially leading to patient harm and unnecessary expense. CTPA is the investigation of choice for PE. Its easy availability, accuracy and ability to provide alternative diagnosis has lowered the threshold for performing it, resulting in its overuse. Guidelines have recommended the use of clinical pretest probability tools such as ‘Wells score’ to assess risk of suspected PE. Unfortunately, implementation of guidelines in clinical practice is inconsistent. This has led to low risk patients being subjected to unnecessary imaging, exposure to radiation and possible contrast related complications. Aim: To study the diagnostic yield of CT PA, clinical pretest probability of patients according to wells score and to determine whether or not there was an overuse of CTPA in our service. Methods: CT scans done on patients with suspected P.E in our hospital from 1st January 2014 to 31st December 2014 were retrospectively reviewed. Medical records were reviewed to study demographics, clinical presentation, final diagnosis, and to establish if Wells score and D-Dimer were used correctly in predicting the probability of PE and the need for subsequent CTPA. Results: 100 patients (51male) underwent CT PA in the time period. Mean age was 57 years (24-91 years). Majority of patients presented with shortness of breath (52%). Other presenting symptoms included chest pain 34%, palpitations 6%, collapse 5% and haemoptysis 5%. D Dimer test was done in 69%. Overall Wells score was low (<2) in 28 %, moderate (>2 - < 6) in 47% and high (> 6) in 15% of patients. Wells score was documented in medical notes of only 20% patients. PE was confirmed in 12% (8 male) patients. 4 had bilateral PE’s. In high-risk group (Wells > 6) (n=15), there were 5 diagnosed PEs. In moderate risk group (Wells >2 - < 6) (n=47), there were 6 and in low risk group (Wells <2) (n=28), one case of PE was confirmed. CT scans negative for PE showed pleural effusion in 30, Consolidation in 20, atelactasis in 15 and pulmonary nodule in 4 patients. 31 scans were completely normal. Conclusion: Yield of CT for pulmonary embolism was low in our cohort at 12%. A significant number of our patients who underwent CT PA had low Wells score. This suggests that CT PA is over utilized in our institution. Wells score was poorly documented in medical notes. CT-PA was able to detect alternative pulmonary abnormalities explaining the patient's clinical presentation. CT-PA requires concomitant pretest clinical probability assessment to be an effective diagnostic tool for confirming or excluding PE. . Clinicians should use validated clinical prediction rules to estimate pretest probability in patients in whom acute PE is being considered. Combining Wells scores with clinical and laboratory assessment may reduce the need for CTPA.

Keywords: CT PA, D dimer, pulmonary embolism, wells score

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Authors: Masuma Novak, Daniel Novak

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Background: Sweden along with other Nordic countries has the highest incidence of type 1 diabetes mellitus (T1DM) worldwide. The trend is increasing globally. The diagnosis is often given at the emergency clinic when children arrive with cardinal symptom of T1DM. Children with T1DM are known to have an increased risk of microvascular- and macrovascular complications. A family history of cardiovascular complications may further increase their risk. Clinically evident diabetes-related vascular complications are however rarely visible in childhood and adolescence, whereby an intensive diabetes treatment and normoglycemic control is a goal for every child. This study is a risk evaluation of children with T1DM based on their family’s cardiovascular history. Method: Since 2005 the Better Diabetes Diagnosis (BDD) study is a nationwide Swedish prospective cohort study that recruits new-onset T1DM who are less than 18 years old at time of diagnosis. For each newly diagnosed child, blood samples are collected for specific HLA genotyping and islet autoantibody assays and their family’s cardiovascular history is evaluated. As part of the BDD study, during the years 2010-2013 all children diagnosed with T1DM at the Queen Silvia’s Children’s Hospital in Sweden were asked about their family’s cardiovascular history. Questions regarded maternal and paternal high blood pressure, stroke, and myocardial infarction before the age of 55 years, and hyperlipidemia were answered. A maximum risk score of eight was possible. All children are clinically observed prospectively for early functional and structural abnormalities such as protein uremia, blood pressure, and retinopathy. Results: A total of 275 children aged 0 to 18 years were diagnosed with T1DM at the Queen Silvia’s Children’s Hospital emergency clinic during this four year period. The participation rate was 99.7%. 26.4% of the children had no hereditary cardiovascular risk factors. 22.7 % had one risk factor and 18.8% had two risk factors. 14.8% had three risk factors. 9.7% had four risk factors and 7.5% had five risk factors or more. Conclusion: Among children with T1DM in Sweden there is a difference in hereditary cardiovascular risk factors. These results indicate that children with T1DM who also have increased hereditary cardiovascular risk factors should be monitored closely with early screening for functional and structural cardiovascular abnormalities. This is a very preliminary and ongoing study which will be complemented with the cardiovascular risk analysis among children without T1DM.

Keywords: children, type I diabetes, emergency clinic, CVD risk

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Authors: Edson Vengesai

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Derivative products have become essential instruments in portfolio diversification, price discovery, and, most importantly, risk hedging. Derivatives are complex instruments; their valuation, volatility implications, and real impact on the underlying assets' behaviour are not well understood. Little is documented empirically, with conflicting conclusions on how these instruments affect firm risk exposures. Given the growing interest in using derivatives in risk management and portfolio engineering, this study examines the practical impact of derivative usage on the underlying stock price exposure and systematic risk. The paper uses data from South African listed firms. The study employs GARCH models to understand the effect of derivative uses on conditional stock volatility. The GMM models are used to estimate the effect of derivatives use on stocks' systematic risk as measured by Beta and on the total risk of stocks as measured by the standard deviation of returns. The results provide evidence on whether derivatives use is instrumental in reducing stock returns' systematic and total risk. The results are subjected to numerous controls for robustness, including financial leverage, firm size, growth opportunities, and macroeconomic effects.

Keywords: derivatives use, hedging, volatility, stock price exposure

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Authors: R. Monteiro, A. Abarca

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Large scale seismic risk assessment has become increasingly popular to evaluate the physical vulnerability of a given region to seismic events, by putting together hazard, exposure and vulnerability components. This study, developed within the scope of the EU-funded project ITERATE (Improved Tools for Disaster Risk Mitigation in Algeria), explains the steps and expected results for the development of an integrated seismic risk model for assessment of the vulnerability of residential buildings in Northern Algeria. For this purpose, the model foresees the consideration of an updated seismic hazard model, as well as ad-hoc exposure and physical vulnerability models for local residential buildings. The first results of this endeavor, such as the hazard model and a specific taxonomy to be used for the exposure and fragility components of the model are presented, using as starting point the province of Blida, in Algeria. Specific remarks and conclusions regarding the characteristics of the Northern Algerian in-built are then made based on these results.

Keywords: Northern Algeria, risk, seismic hazard, vulnerability

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Authors: D. Moser, D. Pinto, A. Cipriano

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A Disaster Management System (DMS) for countries with different disasters is very important. In the world different disasters like earthquakes, tsunamis, volcanic eruption, fire or other natural or man-made disasters occurs and have an effect on the population. It is also possible that two or more disasters arisen at the same time, this means to handle multi-risk situations. To handle such a situation a Decision Support System (DSS) based on multiagents is a suitable architecture. The most known DMSs deal with one (in the case of an earthquake-tsunami combination with two) disaster and often with one particular disaster. Nevertheless, a DSS helps for a better realtime response. Analyze the existing systems in the literature and expand them for multi-risk disasters to construct a well-organized system is the proposal of our work. The here shown work is an approach of a multi-risk system, which needs an architecture, and well-defined aims. In this moment our study is a kind of case study to analyze the way we have to follow to create our proposed system in the future.

Keywords: decision support system, disaster management system, multi-risk, multiagent system

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Authors: Olusola Joseph Adesina, Adebayo Adeyinka Salako

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The study adopted a descriptive research design. Two hundred (200) in-school adolescents were purposely selected in Afijio Local Government Area of Oyo State. Two hypotheses were also raised to pilot the study. The researchers developed an instrument which was validated by psychological experts, the instrument tagged counseling psychology and sexual risk behavior questionnaire (CPSRBQ)(r = 0.78). The results were analysed using t-test at 0.05 level of significance. The result showed that there is a significant relationship between counseling psychology and sexual risk behavior of in-school adolescents. It was also noticed that there is a significant difference in the sexual risk behavior of male and female adolescents. Based on the findings, it was recommended that more counselors are still needed in Nigeria schools. There is need for restructuring Nigeria Curriculum most especially on sex education and related diseases. Lastly, adolescents should be more exposed to seminars on HIV/AIDS, sex education enlightenment programmes and marital counseling.

Keywords: counseling psychology, sexual behavior, risk and adolescent, cognitive sciences

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Authors: Deepa Shokeen, Bani Tamber Aeri

Abstract:

Non-communicable diseases in general and cardiovascular diseases (CVD) in particular are a big cause of concern worldwide especially in fast growing economy like India. CVD is one of the leading causes of deaths in India. Risk factors for cardiovascular disease are now significant in all populations. At least one-third of all CVD is attributable to five risk factors: tobacco use, alcohol use, high blood pressure, high cholesterol and obesity. Methods: This article aspires to collate data gathered by relevant studies conducted after year 2000 and provide an overview of the prevalence of CVD in India and worldwide. Results: Studies show an increased prevalence of cardiovascular risk factors in India as compared to other developing and developed countries with recent trends showing incidence in younger age group. It is seen to affect almost all sections of the society from young to old and most affluent to least affluent. High blood pressure, high cholesterol, tobacco and alcohol use, as well as low vegetable and fruit intake, already figure among the top risk factors. Conclusion: The prevalence of risk factors associated with CVD has increased and will keep on increasing in India as indicated by studies in the last decade and as predicted by the projections for future estimates. Some major risks are modifiable in that they can be prevented, treated, and controlled. There are considerable health benefits at all ages, for both men and women, in stopping smoking, reducing cholesterol and blood pressure, eating a healthy diet and increasing physical activity.

Keywords: prevalence, cardiovascular disease, India, risk factors

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Authors: Mohsen Shirani, Micaela Demichela

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During the last decades, a number of food crises such as Bovine Spongiform Encephalopathy (BSE), Mad-Cow disease, Dioxin in chicken food, Food-and-Mouth Disease (FMD), have certainly inflicted the reliability of the food industry. Consequently, the trend in applying different scientific methods of risk assessment in food safety has obtained more attentions in the academic and practice. However, lack of practical approach considering entire food supply chain is tangible in the academic literature. In this regard, this paper aims to apply risk assessment tool (FMEA) with integration of Human Factor along the entire supply chain of food production and test the method in a case study of Diary production, and analyze its results.

Keywords: FMEA, food supply chain, risk assessment, human factor

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Authors: Maha Mourad

Abstract:

Higher education in any competitive European economy should serve the new information society by increasing the supply of good quality education services and by creating good international brands in the international higher education market. Hence, continuous risk management techniques through higher educational reforms programs became one of the top priorities within the European Union to control the quality of higher education. Risk is higher education is studies by several researchers who agreed that the risk in higher education has a direct influence on continuity of quality education and research contribution. The focus of this research is to highlights the Internal Quality Assurance (IQA) activities in the Polish higher education system as a risk management tool used to control the quality of education. This paper presents a qualitative empirical analysis in 5 different universities in Poland. In addition, it aims to help in finding global practical and create benchmark for policy makers concerning the risk management techniques based on the Polish experience.

Keywords: education development, quality assurance, sustainability, european higher education

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Authors: Beatrice Wamuyu Muchiri, Monika M. L. Dos Santos

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An increasingly recognised prevention approach for substance use entails reduction in risk factors and enhancement of promotive or protective factors in individuals and the environment surrounding them during their growth and development. However, in order to enhance the effectiveness of this approach, continuous study of risk aspects targeting different cultures, social groups and mixture of society has been recommended. This study evaluated the impact of potential risk and protective factors associated with family management and relations on adolescent substance abuse in South Africa. Exploratory analysis and cumulative odds ordinal logistic regression modelling was performed on the data while controlling for demographic and socio-economic characteristics on adolescent substance use. The most intensely used substances were tobacco, cannabis, cocaine, heroin and alcohol in decreasing order of use intensity. The specific protective or risk impact of family management or relations factors varied from substance to substance. Risk factors associated with demographic and socio-economic factors included being male, younger age, being in lower education grades, coloured ethnicity, adolescents from divorced parents and unemployed or fully employed mothers. Significant family relations risk and protective factors against substance use were classified as either family functioning and conflict or family bonding and support. Several family management factors, categorised as parental monitoring, discipline, behavioural control and rewards, demonstrated either risk or protective effect on adolescent substance use. Some factors had either interactive risk or protective impact on substance use or lost significance when analysed jointly with other factors such as controlled variables. Interaction amongst risk or protective factors as well as the type of substance should be considered when further considering interventions based on these risk or protective factors. Studies in other geographical regions, institutions and with better gender balance are recommended to improve upon the representativeness of the results. Several other considerations to be made when formulating interventions, the shortcomings of this study and possible improvements as well as future studies are also suggested.

Keywords: risk factors, protective factors, substance use, adolescents

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Authors: Ghorbanali Mohammadi

Abstract:

Background: The objectives of this study were the association between physical and psychological risk factors for occupational lower back and neck pain among industrial workers. Methods: We conducted a cross-sectional study among 400 male workers of an industrial company over the previous 7days and 12 months. Data were collected using Nordic and third version of COPSOO questionnaires and QEC method for assessment of postures during the work. Results: The prevalence of LB and NP in the last 12 months is 58% and 52% respectively. The relationship between risk factors and low back/ neck pain in the last 12 months were cognitive demands (OR 995% CI 1.65) and (OR 995% CI 1.75); Influence at work (OR 995% CI 2.21) and (OR 995% CI 1.85); quality of leadership (OR 995% CI 2.42) and (OR 995% CI 2.09) was strongly correlated with complaints of low back and neck pains. Conclusion: Data of this study showed a higher prevalence of LBP and NP in the subjects. The results revealed that workers with work experience of more than 12 yrs. and who work more than 8 hrs. days with smoking habits had more probability to develop both LBP and NP.

Keywords: low back pain, neck pain, physical risk factors, psychological risk factors, QEC, COPSOQ III

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