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risk management [keywords]
- The Risk of Disease to Great Apes: Simulating Disease Spread in Orang-Utan (Pongo pygmaeus wurmbii) and Chimpanzee (Pan troglodytes schweinfurthii) Association Networks. [Journal Article]
- PLoS One 2014; 9(4):e95039.
All great ape species are endangered, and infectious diseases are thought to pose a particular threat to their survival. As great ape species vary substantially in social organisation and gregariousness, there are likely to be differences in susceptibility to disease types and spread. Understanding the relation between social variables and disease is therefore crucial for implementing effective conservation measures. Here, we simulate the transmission of a range of diseases in a population of orang-utans in Sabangau Forest (Central Kalimantan) and a community of chimpanzees in Budongo Forest (Uganda), by systematically varying transmission likelihood and probability of subsequent recovery. Both species have fission-fusion social systems, but differ considerably in their level of gregariousness. We used long-term behavioural data to create networks of association patterns on which the spread of different diseases was simulated. We found that chimpanzees were generally far more susceptible to the spread of diseases than orang-utans. When simulating different diseases that varied widely in their probability of transmission and recovery, it was found that the chimpanzee community was widely and strongly affected, while in orang-utans even highly infectious diseases had limited spread. Furthermore, when comparing the observed association network with a mean-field network (equal contact probability between group members), we found no major difference in simulated disease spread, suggesting that patterns of social bonding in orang-utans are not an important determinant of susceptibility to disease. In chimpanzees, the predicted size of the epidemic was smaller on the actual association network than on the mean-field network, indicating that patterns of social bonding have important effects on susceptibility to disease. We conclude that social networks are a potentially powerful tool to model the risk of disease transmission in great apes, and that chimpanzees are particularly threatened by infectious disease outbreaks as a result of their social structure.
- 'Between the flags': implementing a rapid response system at scale. [JOURNAL ARTICLE]
- BMJ Qual Saf 2014 Apr 16.
While many hospitals are implementing rapid response systems (RRSs) to attend to deteriorating patients in a systematic way, there is little documented evidence on system-wide approaches to adopting RRSs. Here, we report on an initiative which enrolled 220 hospitals in New South Wales, Australia. The 'between the flags' approach was modelled on Australia's surf lifesaving experience, where qualified lifesavers perform thousands of rescues each year. Patients in hospitals who are identified as being 'between the flags' are given special attention, just like beach goers.
- Genome-wide association study of circulating vitamin D-binding protein. [JOURNAL ARTICLE]
- Am J Clin Nutr 2014 Apr 16.
Vitamin D status may influence a spectrum of health outcomes, including osteoporosis, arthritis, cardiovascular disease, and cancer. Vitamin D-binding protein (DBP) is the primary carrier of vitamin D in the circulation and regulates the bioavailability of 25-hydroxyvitamin D. Epidemiologic studies have shown direct DBP-risk relations and modification by DBP of vitamin D-disease associations.We aimed to characterize common genetic variants that influence the DBP biochemical phenotype.We conducted a genome-wide association study (GWAS) of 1380 men through linear regression of single-nucleotide polymorphisms (SNPs) in the Illumina HumanHap500/550/610 array on fasting serum DBP, assuming an additive genetic model, with adjustment for age at blood collection.We identified 2 independent SNPs located in the gene encoding DBP, GC, that were highly associated with serum DBP: rs7041 (P = 1.42 × 10(-246)) and rs705117 (P = 4.7 × 10(-91)). For both SNPs, mean serum DBP decreased with increasing copies of the minor allele: mean DBP concentrations (nmol/L) were 7335, 5149, and 3152 for 0, 1, and 2 copies of rs7041 (T), respectively, and 6339, 4280, and 2341, respectively, for rs705117 (G). DBP was also associated with rs12144344 (P = 5.9 × 10(-7)) in ST6GALNAC3.In this GWAS analysis, to our knowledge the first to examine this biochemical phenotype, 2 variants in GC-one exonic and one intronic-were associated with serum DBP concentrations at the genome-wide level of significance. Understanding the genetic contributions to circulating DBP may provide greater insights into the vitamin D binding, transport, and other functions of DBP and the effect of vitamin D status on health outcomes. The Alpha-Tocopherol, Beta-Carotene Cancer Prevention clinical trial was registered at clinicaltrials.gov as NCT00342992.
- Issues in the Diagnosis and Management of the Papilledema Shunt. [JOURNAL ARTICLE]
- J Neuroophthalmol 2014 Apr 15.
Dural arteriovenous fistulas (DAVFs) that shunt blood into the transverse or superior sagittal venous sinuses cause papilledema by raising intracranial pressure ("the papilledema shunt"). Such fistulas pose unique diagnostic and therapeutic challenges.Case report and literature review.In a patient presenting with papilledema, non-invasive brain vascular imaging disclosed subtle signs of a DAVF. Digital angiography delineated the DAVF and revealed cortical venous reflux. After three transarterial embolizations with ethylene vinyl alcohol, the DAVF was closed and papilledema resolved.The imaging features of a DAVF that cause papilledema may be subtle on non-invasive vascular imaging. If overlooked, and lumbar puncture is performed, there is a substantial risk of brain herniation. Cortical venous reflux, which may be relatively common in these DAVFs, impels the need for endovascular closure. The transvenous route, often employed for closing cavernous sinus DAVFs, should be avoided because of the dangers of dural venous sinus thrombosis.
- Risk-based prioritization of ground water threatening point sources at catchment and regional scales. [JOURNAL ARTICLE]
- Sci Total Environ 2014 Apr 13.
Contaminated sites threaten ground water resources all over the world. The available resources for investigation and remediation are limited compared to the scope of the problem, so prioritization is crucial to ensure that resources are allocated to the sites posing the greatest risk. A flexible framework has been developed to enable a systematic and transparent risk assessment and prioritization of contaminant point sources, considering the local, catchment, or regional scales (Danish EPA, 2011, 2012). The framework has been tested in several catchments in Denmark with different challenges and needs, and two of these are presented. Based on the lessons learned, the Danish EPA has prepared a handbook to guide the user through the steps in a risk-based prioritization (Danish EPA, 2012). It provides guidance on prioritization both in an administratively defined area such as a Danish Region, and within the bounds of a specified ground water catchment. The handbook presents several approaches in order to prevent the prioritization from foundering because of a lack of data or an inappropriate level of complexity. The developed prioritization tools, possible graphical presentation and use of the results are presented using the case studies as examples. The methodology was developed by a broad industry group including the Danish EPA, the Danish Regions, the Danish Nature Agency, the Technical University of Denmark, and consultants - and the framework has been widely accepted by the professional community in Denmark. The concepts are quite general and can be applied in other countries facing similar challenges.
- [A cross-sectional survey of coagulation factor VIII inhibitor in children with hemophilia A]. [English Abstract, Journal Article]
- Zhonghua Er Ke Za Zhi 2014 Feb; 52(2):99-102.
To study the current situation of coagulation factor VIII (FVIII) inhibitor development in children with hemophilia A (HA) through a cross-sectional survey, and to explore the risk factors of inhibitor development in order to provide evidence for further prevention and management strategies.The clinical data of outpatients with hemophilia A in Beijing Children's Hospital seen from November 2012 to May 2013 were collected, FVIII inhibitor was screened and analyzed its risk factors.A total of 102 HA children were enrolled, 5 were mild cases, 32 were moderate, and 65 were severe cases; the median age on enrollment was 55.5 (3.0-200.0) months:19(18.6%) of patients had inhibitors and 9 (8.8%) had low-titer inhibitors, 10 (9.8%) had high-titer inhibitors. Receiving FVIII treatment for life-threatening bleeding (P = 0.03) ,OR 4.10 (95%CI:1.17-14.32) was a risk factor for inhibitor generation and patients within 20 exposure days have more chances of inhibitor development (P = 0.04) ,OR 3.32 (95%CI:1.02-10.86) . High and intense FVIII exposure within short term was the risk factor for high titer inhibitor development (P = 0.01) ,OR 5.25 (95%CI:1.45-21.92) .Intense FVIII exposure for severe hemorrhage was the risk factor of inhibitors development especially of high titer inhibitors.
- Vitamin B12 Deficiency in Inflammatory Bowel Disease: Prevalence, Risk Factors, Evaluation, and Management. [JOURNAL ARTICLE]
- Inflamm Bowel Dis 2014 Apr 15.
Management of vitamin B12 (cobalamin, Cbl) deficiency in inflammatory bowel disease (IBD) is often not evidenced-based because of uncertainty on whether it causes enough malabsorption to result in clinical disease. This systematic review examines whether IBD predisposes to Cbl deficiency. We provide an approach to the management of abnormal Cbl values in IBD based on current literature and consensus-based guidelines.An extensive search of the Ovid MEDLINE and EMBASE databases by independent reviewers identified 42 articles with a total of 3732 patients evaluating Cbl deficiency in IBD.Crohn's disease without ileal resection, regardless of disease location in the ileum, did not increase the risk for Cbl deficiency. Ileal resections greater than 30 cm were associated with Cbl deficiency in Crohn's disease, whereas those less than 20 cm were not. The effects of 20 to 30 cm resections were inconsistent. Ulcerative colitis did not predispose to deficiency. All studies failed to use confirmatory biomarker testing as stipulated by diagnostic guidelines for Cbl deficiency.This literature does not support an association of Crohn's disease in general, regardless of ileal involvement, with Cbl deficiency. Only ileal resections greater than 20 cm in Crohn's disease predispose to deficiency and warrant treatment. Based on these findings, we suggest a diagnostic and therapeutic algorithm. All findings and recommendations require verification in further studies using confirmatory biomarkers as per diagnostic guidelines for Cbl deficiency. Serum Cbl levels alone are likely insufficient to diagnose deficiency in asymptomatic patients.
- Multidimensional associative factors for improvement in pain, function, and working capacity after rehabilitation of whiplash associated disorder: a prognostic, prospective outcome study. [JOURNAL ARTICLE]
- BMC Musculoskelet Disord 2014 Apr 16; 15(1):130.
Whiplash associated disorders (WAD) have dramatic consequences for individual and public health. Risk factors for better and worse outcomes are important to optimize management. This study aimed to determine short- and mid-term associative co-factors of neck pain relief, improved physical functioning, and improved working capacity (dependent variables) in patients suffering from whiplash associated disorder who participated in a standardized, inpatient pain management program.Naturalistic, observational, prospective cohort study. Outcome was measured by standardized assessment instruments. Co-factors covered sociodemographics, comorbidities, social participation, affective health, and coping abilities. Stepwise, multivariate linear regression analysis was performed at discharge and at the 6-month follow-up.All regression models explained high proportions of variance (53.3% - 72.1%). The corresponding baseline level was significantly associated with a change in every dependent variable (explained variances: 11.4%-56.7%). Pain relief significantly depended on improved function and vice-versa (3.4%-14.8%). Improved ability to decrease pain was associated with pain relief at discharge (9.6%). Functional improvement was associated with decreased catastrophizing (19.4%) at discharge and decreased depression (20.5%) at the 6 month follow-up.Pain relief, improved physical function and working capacity were associated with each other. Improved coping (catastrophizing and ability to decrease pain) and reduced depression may act as important predictors for pain relief and improved function. These findings offer toe-holds for optimized therapy of chronic WAD.
- [Characteristics of brachial-ankle pulse wave velocity and its relationship with risk factors of cardiovascular diseases in populations having health check-up programs]. [English Abstract, Journal Article]
- Zhonghua Liu Xing Bing Xue Za Zhi 2014 Feb; 35(2):205-7.
To investigate the characteristics of brachial-ankle pulse wave velocity (baPWV)in populations having health check-up and to explore its relationship with risk factors of cardiovascular diseases.13 841 people who had health check-up were included and their baPWV were tested by automatic arteriosclerosis measurement system. All people were inquired about their diseases history, while height, weight, body mass index(BMI), blood pressure, fasting blood-glucose as well as serum lipid were also measured.With increasing of age, baPWV were increased both in males and females. The baPWV of male aged less than 60 years was significantly higher than that of female less than 60. Multi-variable regressive analysis showed the age, systolic pressure,BMI, fasting blood-glucose, uric acid and triglyceride were the risk factors of baPWV.BaPWV values of health check-up population in Chengdu area demonstrated different characteristics in different age and gender group. Attention should be paid on baPWV measurement among elder people, especially the elder women, in order to prevent cardiovascular events happening in high risk population.
- [Current infection status and epidemic risk analysis of Dengue fever and Chikungunya in Guangdong province, from 1990 to 2012]. [English Abstract, Journal Article]
- Zhonghua Liu Xing Bing Xue Za Zhi 2014 Feb; 35(2):167-9.
To understand the status of infection and epidemic trend of Dengue fever and Chikungunya in Guangdong.Retrospective survey and literature review were used to obtain data on the incidence, etiology of Dengue and Chikungunya. Serological survey was conducted to detect the specific-antibodies in healthy individuals for both Dengue virus(DENV)and Chikungunya virus (CHIKV).Three epidemics of Dengue fever were observed during 1990-2012, with the annual incidence rates as 9.75/100 000 in 1995, 1.76/100 000 in 2002 and 1.25/100 000 in 2006, respectively. The predominant epidemic strains appeared to be DENV-2 and DENV-4 during 1990-1994. Since 1995,DENV-1 had become the predominant transmission strain which lasted for almost 13 years. Co-existence of multiple serotypes of DENV started in 2009. Of the 7 718 sera from healthy population during 2003-2012, 180 specimens were detected positive for specific DENV-IgG antibody, ended with a sero-prevalence rate of 2.33%. All 2 132 sera in 2012 were detected negative for CHIKV-IgG antibody.The overall exposure level to Dengue was considered to be low in Guangdong province. However, the predominant transmission mode caused by DENV-1 had been gradually changed into the co-existence of multiple serotypes with the endemic signs appeared in some part of the areas. Chikungunya was a newly emerging disease in Guangdong since local people were lack of basic immunity barrier. Surveillance and control programs thus seemed important.