Community-based dementia risk management and prevention program for Aboriginal Australians (DAMPAA): a randomised controlled trial study protocol.

INTRODUCTION: Aboriginal and Torres Strait Islander peoples are the First Peoples of Australia. Up to 45% of dementia in these populations is due to potentially modifiable risk factors. The Dementia Prevention and Risk Management Program for Aboriginal Australians (DAMPAA) is an Aboriginal Health Practitioner led programme that aims to reduce cognitive decline and functional impairment in older Aboriginal people. METHODS: Design: DAMPAA is a multisite, randomised controlled trial aiming to deliver and evaluate a culturally appropriate risk factor management programme. POPULATION: Community-dwelling Aboriginal people aged 45-90 years. INTERVENTION: Participants will be randomly assigned to either usual care (control) or to a group programme comprising exercise and health education yarning sessions and pharmacist-delivered medication reviews delivered over a 12-month period. PRIMARY OUTCOME: Cognitive function (Kimberley Indigenous Cognitive Assessment (KICA)-Cog score), daily function (KICA-Activities of Daily Living (ADL) score) and quality of life (Good Spirit, Good Life and EQ-5D-5L scores). SECONDARY OUTCOMES: Process evaluation interviews, cardiovascular risk factors, falls and death. Process evaluation will be conducted with qualitative methods. Quantitative outcomes will be analysed with generalised linear mixed models. ETHICS AND DISSEMINATION: The study was approved by the Western Australian Aboriginal Health Ethics Committee and the University of Western Australia Human Research Ethics Committee. Study results will be published in peer-reviewed journals and presented at scientific meetings. We will also develop and disseminate a comprehensive DAMPAA toolkit for health services. The study's findings will guide future prevention strategies and outline a comprehensive process evaluation that may be useful in other Aboriginal health research to contextualise findings.

Risk Factor Management for Patients with Atrial Fibrillation in Home Healthcare.

Atrial fibrillation (AF) is a common and persistent cardiac arrhythmia that impacts morbidity, mortality, disability, quality of life, and healthcare costs. Typically, AF is managed using a three-pillar approach of rate control, rhythm control, and anticoagulation. However, these interventions fail to address the underlying pathophysiological factors that contribute to AF. A compelling body of research expands traditional management by focusing on lifestyle modification to lower the risk of AF incidence, prevalence, progression, and severity. Home healthcare clinicians possess the knowledge and skills to examine and treat a wide range of risk factors that lead to AF, and therefore can substantially reduce incident and persistent AF and facilitate optimal outcomes. This perspective paper presents a clinical paradigm shift by proposing a five-factor Partner, Quantify, Recommend, Support, and Teach (PQRST) framework to support AF risk factor modification in home healthcare. The PQRST framework incorporates a greater focus on patient self-management through education and exercise to reduce incidence, prevalence, progression, and severity of AF.

Controlling shareholders' share pledge and share repurchase notices of listed companies.

States encourage listed companies to use stock repurchase to elevate the market value of listed firms. After China's promulgation of the new Company Law in 2018, the number of listed companies that issued stock repurchase notices has increased, and the frequency is also increasing. But whether market value management is the real incentive for the action remains debatable. To reduce the risk of pledges, controlling shareholders may use stock repurchases to maintain the security of control rights, and stock repurchase notice may become a tool for controlling shareholders to manage pledge risks. From the perspective of pledge risk management, this paper selects the listed companies from 2012 to 2019 and finds that the share pledge of the controlling shareholder affects the stock repurchase behavior of listed companies by affecting the current pledge risk and the quality of information disclosure plays the interactive role between the two.

Improving rapid flood impact assessment: An enhanced multi-sensor approach including a new flood mapping method based on Sentinel-2 data.

Rapid flood impact assessment methods need complete and accurate flood maps to provide reliable information for disaster risk management, in particular for emergency response and recovery and reconstruction plans. With the aim of improving the rapid assessment of flood impacts, this work presents a new impact assessment method characterized by an enhanced satellite multi-sensor approach for flood mapping, which improves the characterization of the hazard. This includes a novel flood mapping method based on the new multi-temporal Modified Normalized Difference Water Index (MNDWI) that uses multi-temporal statistics computed on time-series of Sentinel-2 multi-spectral satellite images. The multi-temporal aspect of the MNDWI improves characterization of land cover over time and enhances the temporary flooded areas, which can be extracted through a thresholding technique, allowing the delineation of more precise and complete flood maps. The methodology, if implemented in cloud-based environments such as Google Earth Engine (GEE), is computationally light and robust, allowing the derivation of flood maps in matters of minutes, also for large areas. The flood mapping and impact assessment method has been applied to the seasonal flood occurred in South Sudan in 2020, using Sentinel-1, Sentinel-2 and PlanetScope satellite imagery. Flood impacts were assessed considering damages to buildings, roads, and cropland. The multi-sensor approach estimated an impact of 57.4 million USD (considering a middle-bound scenario), higher than what estimated by using Sentinel-1 data only, and Sentinel-2 data only (respectively 24% and 78% of the estimation resulting from the multi-sensor approach). This work highlights the effectiveness and importance of considering multi-source satellite data for flood mapping in a context of disaster risk management, to better inform disaster response, recovery and reconstruction plans.

Level of readiness of employees of Systems Plus College Foundation (SPCF) on Disaster Risk-Reduction Management (DRRM).

OBJECTIVE: To determine the level of readiness on disaster risk-reduction management among employees of an educational institution. METHODS: The descriptive, evaluative study was conducted from March to April 2022 at 6 branches of Systems Plus College Foundation, Philippines, in Balibago, Rizal, Miranda, San Fernando, Caloocan and Cubao after approval from the ethics review committee of the Our Lady of Fatima University, Philippines, and comprised employees who were associated with the college for at least 6 months. Data was collected using Google Forms, and a validated tool was used to assess the disaster risk-reduction management readiness. The responses were categorised into 5 groups, ranging from 'very much ready' to 'not ready'. Gathered data was analysed by using SPSS version 20. Mean results were derived and presented with standard deviation. RESULTS: The responses suggested moderate readiness regarding structural safety codes 3.02±0.98, non-structural safety codes 3.02±1.04, availability of emergency supplies and equipment 2.84±1.09, and servicing and maintenance 2.85±1.03. CONCLUSIONS: Increasing the level of readiness related to disaster risk-reduction management must be given priority to ensure the safety of the employees in a higher education institution.

Application of the bow-tie analysis to improve patient safety - a lesson learned from clinical practice.

AIM: This study aimed to assess the risk management of drug safety in an operating theater setting within a hospital-based treatment facility.

Analysis of the costs of adverse events in the public healthcare system of the Lombardy Region over five-year period 2016-2021.

The monitoring of litigation (i.e., claims received by the public healthcare system of the Lombardy Region) is started following the implementation of the "Circolare 46/SAN/2004" by evaluating the risk management activities carried out over a five-year period (2016-2021) and following a systematic approach by the regional risk management coordination group. The paper presents a risks analyzed belong to the following 4 categories: Clinical Risk, Worker Risk Facility Accidental Damage. The trend of the Average Settled (cash analysis) shows an increase of the amounts over the years. The average amount paid is from about €45k in 2017 to over €71k in 2021, with a 16% decrease in the average amount paid in 2021 compared to the previous year (2020). The trend of the average amounts paid (analysis by accrual) shows a significant natural decrease over the years. The average amount settled is from about €74K in 2016 to almost 30K in 2021, recording a 30% decrease in the average amount liquidated in 2021 compared to the previous year (2020). As presented in the paper, the analysis shows a decrease in the magnitude of claims over time, as a positive factor that could be explained by the centralization and continuous monitoring of financial statement data, and the presence of claims evaluation committees (CVS) that includes different skills, such as: broker, loss adjuster, risk manager, medical examiner, lawyers, company management , etc., and the insurance expertise that works in the revaluation of reserves linked to the budget reform.

NFDI4Health Workflow and Service for Synthetic Data Generation, Assessment and Risk Management.

Individual health data is crucial for scientific advancements, particularly in developing Artificial Intelligence (AI); however, sharing real patient information is often restricted due to privacy concerns. A promising solution to this challenge is synthetic data generation. This technique creates entirely new datasets that mimic the statistical properties of real data, while preserving confidential patient information. In this paper, we present the workflow and different services developed in the context of Germany's National Data Infrastructure project NFDI4Health. First, two state-of-the-art AI tools (namely, VAMBN and MultiNODEs) for generating synthetic health data are outlined. Further, we introduce SYNDAT (a public web-based tool) which allows users to visualize and assess the quality and risk of synthetic data provided by desired generative models. Additionally, the utility of the proposed methods and the web-based tool is showcased using data from Alzheimer's Disease Neuroimaging Initiative (ADNI) and the Center for Cancer Registry Data of the Robert Koch Institute (RKI).

A navigational risk evaluation of ferry transport: Continuous risk management matrix based on fuzzy Best-Worst Method.

Ferry transport has witnessed numerous fatal accidents due to unsafe navigation; thus, it is of paramount importance to mitigate risks and enhance safety measures in ferry navigation. This paper aims to evaluate the navigational risk of ferry transport by a continuous risk management matrix (CRMM) based on the fuzzy Best-Worst Method (BMW). Its originalities include developing CRMM to figure out the risk level of risk factors (RFs) for ferry transport and adopting fuzzy BWM to estimate the probability and severity weights vector of RFs. Empirical results show that twenty RFs for ferry navigation are divided into four zones corresponding to their risk values, including extreme-risk, high-risk, medium-risk, and low-risk areas. Particularly, results identify three extreme-risk RFs: inadequate evacuation and emergency response features, marine traffic congestion, and insufficient training on navigational regulations. The proposed research model can provide a methodological reference to the pertinent studies regarding risk management and multiple-criteria decision analysis (MCDA).

[Is there a correlation between increasing hospital falls and Covid-19 infection? Retrospective study on the entire hospital population.] / Esiste una correlazione tra l'aumento delle cadute in ospedale e le infezioni da Covid-19? Studio retrospettivo sull'intera popolazione ospedaliera.

Introduction Falls are the second leading cause of accidental or unintentional death worldwide. In hospital falls represent a relevant health problem, in particular after their increasing since Covid year 2020. The aim of this study is to evaluate correlation between falls and Covid infection. METHODS: Risk Management Unit at Mauriziano hospital analyzed in the present observational study possible correlation with Covid Pandemic and falls risk factors, through comparison of patients falls occurred during year 2021 in Covid and no-Covid wards. The primary outcome of the study is the evaluation of relationship between falls and Covid infection. The secondary outcome is identification of falls risk factors. RESULTS: No direct correlation between falls and Covid-19 infection was found. Among falls risk factors, the most interesting emerged is the fall itself that enhances the risk of relapse. DISCUSSION: Increasing in patients falls since 2020 could be affected indirectly by strong hospital organization modifications during Covid pandemic.

Dynamics of natural hazard risk awareness: Panel analysis insights from Switzerland.

The analysis of risk awareness should be the initial stage in integrated natural hazard risk management to promote appropriate and effective measures for mitigating risks and strengthening social resilience inside the multi-risk framework. Nevertheless, earlier studies focused on cross-sectional data and overlooked the changes in risk awareness levels and associated independent variables with time. This study analyzes for the first time a balanced nationwide panel dataset of 1612 respondent-year observations from Switzerland (period 2015-2021, including the epidemic of COVID-19) to examine and compare the effects of potential independent variables on the four dimensions of natural hazard risk awareness (NHRA), ranging from the broadest dimension of Relevance to higher dimensions of Perceived Probability of an event, Perceived Threat to life and valuables, and Perceived Situational Threat. The analysis in this study incorporates multiple methods of Random-Effect Model (RE), Generalized Linear Model (GLM), and mediation analysis. Results show that NHRA increased in Switzerland to different extents (up to 23.24%) depending on the dimension. Event memory, perceived information impact and reported individual informed level appeared to be the most consistent independent variables positively influencing panel NHRA. Among these, perceived information impact as an important indicator of risk communication, was also found to serve as a mediator from risk preparedness to risk awareness. By encouraging residents to engage in "Begin Doing Before Thinking" (BDBT) programs to leverage subliminal effects and self-reflection, this study proposes that behavior-cognition feedback loops may facilitate a virtuous cycle. Our promising observations provide recommendations for an effective awareness-rising strategy design and suggest extensive insights from potential short-interval panel analysis in the future.

Care Home Safety Incidents and Safeguarding Reports Relating to Hospital to Care Home Transitions: A Retrospective Content Analysis.

OBJECTIVE: The purpose of this study was to further the understanding of reported patient safety events at the interface between hospital and care home including what active failings and latent conditions were present and how reporting helped learning. METHODS: Two care home organizations, one in the North East and one in the South West of England, participated in the study. Reports relating to a transition and where a patient safety event had occurred were sought during the COVID-19 (SARS-CoV-2) virus prepandemic and intrapandemic periods. All reports were screened for eligibility and analyzed using content analysis. RESULTS: Seventeen South West England care homes and 15 North East England care homes sent 114 safety incident reports and after screening 91 were eligible for review. A hospital discharge transition (n = 78, 86%) was most common. Pressure damage (n = 29, 32%), medication errors (n = 26, 29%) and premature discharge (n = 21, 23%) contributed to 84% of the total reporting. Many 'active failings' (n = 340) were identified with fewer latent conditions (failings) (n = 14, 15%) being reported. No examples of individual learning were identified. Organization and systems learning were identified in 12 reports (n = 12, 13%). CONCLUSIONS: The findings highlight potentially high levels of underreporting. The most common safety incidents reported were pressure damage, medication errors, and premature discharge. Many active failings causing numerous staff actions were identified emphasizing the cost to patients and services. Additionally, latent conditions (failings) were not emphasized; similarly, evidence of learning from safety incidents was not addressed.

NPCC4: Climate change and New York City's flood risk.

This chapter of the New York City Panel on Climate Change 4 (NPCC4) report provides a comprehensive description of the different types of flood hazards (pluvial, fluvial, coastal, groundwater, and compound) facing New York City and provides climatological context that can be utilized, along with climate change projections, to support flood risk management (FRM). Previous NPCC reports documented coastal flood hazards and presented trends in historical and future precipitation and sea level but did not comprehensively assess all the city's flood hazards. Previous NPCC reports also discussed the implications of floods on infrastructure and the city's residents but did not review the impacts of flooding on the city's natural and nature-based systems (NNBSs). This-the NPCC's first report focused on all drivers of flooding-describes and profiles historical examples of each type of flood and summarizes previous and ongoing research regarding exposure, vulnerability, and risk management, including with NNBS and nonstructural measures.

Information needs of women with BRCA mutations regarding cancer risk management and decision-making.

PURPOSE: Providing women who have tested positive for a pathogenic variant in BRCA1 or BRCA 2 relevant information can help them to make informed decisions about managing their cancer risk. However, there is a lack of targeted informational support for BRCA positive women specific to the Irish context. The objective of this study is to identify the information needs of women diagnosed with a pathogenic variant in BRCA1 or BRCA 2 regarding cancer risk management and decision-making. METHODS: This is a descriptive qualitative study. Participants were recruited using purposive sampling and included women with a pathogenic variant in BRCA1 or BRCA2 without a history of breast or ovarian cancer. Two focus groups were held with women (n = 16) to enable them to generate ideas and understanding of their shared information needs. In addition, ten individual interviews were conducted to capture the additional perspectives of health care and relevant policy stakeholders. Interviews were analysed using inductive coding (Braun and Clarke, 2006), with NVivo software (Qsr international, 1999). RESULTS: Three main themes were identified, Cancer Risk Management, Receiving Information, and Implications to Health and Wellbeing. BRCA-positive women expressed a need for information about managing their cancer risk. They were particularly concerned with managing the impact of cancer risk-reducing interventions on their psychological and physical health, wellbeing, and family life. Many women felt they had to advocate for themselves to get treatment and receive information. Participants expressed a need for a comprehensive informational resource where all relevant information related to BRCA risk management could be accessed at a single location. CONCLUSION: This study suggests that women diagnosed with a pathogenic variant in BRCA1 or BRCA2 in Ireland need more accessible information about managing their cancer risk, and the impact of a BRCA diagnosis on their family, health and wellbeing. These results will be used to identify relevant content for developing an informational decision aid for Irish women.

Regulatory landscape, risks, and solutions for refurbished medical devices: a comparative analysis in the US, EU, Malaysia, and Ghana.

INTRODUCTION: Refurbished medical devices are previously owned equipment that undergo a process of restoration to ensure they meet quality standards and function effectively. The utilization of refurbished medical devices, coupled with the integration of software, poses intricate challenges in terms of regulatory compliance, risk management, and patient safety. AREAS COVERED: This article explores the regulatory frameworks governing refurbished medical devices in the United States (US), the European Union (EU), Malaysia, and Ghana. Included information from a range of primary and secondary sources. Additionally, it aims to identify and analyze the risks associated with refurbished medical devices, with a specific focus on the implications of software integration, and recommend practical solutions for mitigating these risks. EXPERT OPINION: The landscape of refurbished medical devices presents challenges in terms of regulatory compliance, risk management, and patient safety. Addressing these challenges requires careful consideration and strategies to ensure that refurbished devices meet stringent quality standards. By focusing on these areas, policymakers and healthcare professionals can enhance the safe utilization of refurbished medical devices, thereby improving access to quality healthcare, particularly in underserved regions.

Mixed methods evaluation of a specialty-specific system to promote physician engagement in safety and quality reporting in a large academic health system.

BACKGROUND: Incident reporting systems (IRS) can improve care quality and patient safety, yet their impact is limited by clinician engagement. Our objective was to assess barriers to reporting in a hospital-wide IRS and use data to inform ongoing improvement of a specialty-specific IRS embedded in the electronic health record targeting anaesthesiologists. METHODS: This quality improvement (QI) evaluation used mixed methods, including qualitative interviews, faculty surveys and user data from the specialty-specific IRS. We conducted 24 semi-structured interviews from January to May 2023 in a large academic health system in Northern California. Participants included adult and paediatric anaesthesiologists, operating room nurses, surgeons and QI operators, recruited through convenience and snowball sampling. We identified key themes and factors influencing engagement, which were classified using the Systems Engineering Initiative for Patient Safety framework. We surveyed hospital anaesthesiologists in January and May 2023, and characterised the quantity and type of reports submitted to the new system. RESULTS: Participants shared organisation and technology-related barriers to engagement in traditional system-wide IRSs, many of which the specialty-specific IRS addressed-specifically those related to technological access to the system. Barriers related to building psychological safety for those who report remain. Survey results showed that most barriers to reporting improved following the specialty-specific IRS launch, but limited time remained an ongoing barrier (25 respondents out of 44, 56.8%). A total of 964 reports with quality/safety concerns were submitted over the first 8 months of implementation; 47-76 unique anaesthesiologists engaged per month. The top safety quality categories of concern were equipment and technology (25.9%), clinical complications (25.3%) and communication and scheduling (19.9%). CONCLUSIONS: These findings suggest that a specialty-specific IRS can facilitate increased physician engagement in quality and safety reporting and complement existing system-wide IRSs.

The Obstetrics and Gynecology Hospitalist: Risk Management Implications.

The concept of a 24/7 in-house obstetrician, serving as an obstetrics and gynecology (Ob/Gyn) hospitalist, provides a safety-net for obstetric and gynecologic events that may need immediate intervention for a successful outcome. The addition of an Ob/Gyn hospitalist role in the perinatal department mitigates loss prevention, a key precept of risk management. Inherent in the role of the Ob/Gyn hospitalist are the important patient safety and risk management principles of layers of back-up, enhanced teamwork and communications, and immediate availability.

The role of necroscopy and autopsy investigations in the diagno-sis and risk management of infections related to public health care: forensic and medico legal implications.

Background: Healthcare-associated infections (HAIs) represent the most frequent adverse event in healthcare systems around the world. From a forensic point of view, HAIs show various legal implications. Therefore, it is essential in cases of death or injury from a suspected nosocomial infection that the infection itself, the source and the method of contamination are correctly diagnosed in order to evaluate any profiles of professional liability. Methods: This study combined a minireview of the scientific literature using the Pubmed search engine, the website of the Higher Institute of Health and the member states information sessions on infection prevention and control (IPC). Discussion: Despite the significant impact that HAIs have on healthcare systems, their severity is often not fully understood by healthcare professionals, leading to insufficient responses. In the autopsy setting, the diagnosis of these infections is not always simple due to the risk of post-mortem contamination determined by the endogenous bacterial flora. In the forensic field, the medical examiner during the autopsy can use various diagnostic techniques and investigative tools to identify the infection. Some usefulpp approaches include: 1) Macroscopic examination of the organs; 2) Histopathological investiga-tions; 3) Microbiological analyzes with the performance of swabs; 4) Immunofluorescence tests for the detection of antigens or antibodies on biological liquids; 5) Molecular tests. The choice of methods will depend on the nature of the suspected infection and the availability of diagnostic resources.

Service Members' Attitudes Toward Reporting Hazing Incidents.

INTRODUCTION: Addressing hazing within the U.S. Military has become a critical concern to safeguard the well-being of service members; recent attempts to assess hazing prevalence in the military have been unsuccessful due to under representative data. METHODS: To delve into the hazing climate and reporting culture at Fort Bragg, now Fort Liberty, 227 individuals took part in an anonymous online survey. The survey collected demographics and insights on hazing attitudes and behaviors, perceptions of group experiences including hazing/non-hazing activities, views on leadership, familiarity and experiences with reporting procedures, and bystander intervention. RESULTS: The findings echoed existing literature: while only 17.2% admitted to experiencing hazing, a striking 70.3% acknowledged involvement in specific hazing behaviors. Only 40% of participants who acknowledged experiencing hazing (n = 35) disclosed that they reported or confided in someone about the incident. Responses highlight reporting hurdles including concerns about anonymity, confidence in the reporting process, leadership reactions to reports, and the normalization of these events as tradition. DISCUSSION: Distinct elements of military culture, such as the hierarchical chain of command, loyalty to the brotherhood/sisterhood, and the emphasis on resilience, likely amplify these responses. This study adds to the mounting evidence showcasing gaps in assessing hazing within the U.S. Military. It emphasizes the necessity for a comprehensive hazing prevention program. Presently, prevention relies on mandatory training, often integrated into safety briefings or harassment workshops. However, service members require further assistance in recognizing, rejecting, and reporting instances of hazing despite these trainings.

Redefining cyber resilience : Through the risk register lens.

Resilience is deeper than maintaining a company's operations and services in the face of significant disruptions. It is the ability of a business to withstand, pivot and continue to grow in the face of a significant threat. To achieve resilience, companies must have an integrated, end-to-end understanding of how a specific threat magnifies the risks identified on their risk register, and what measures are needed across the enterprise to address the amplification of those risks. This paper details how the need for a holistic approach is especially important for cyber crises, compared with other types of crises, because they tend to have more broad-ranging impacts and complexities, such as: unclear timelines, lack of public empathy, unpredictable human threat actor(s), as well as a broader set of internal and external stakeholders that need to be engaged. Unlike other crises, cyber crises have the potential to magnify most - if not all - of the risks on the risk register. As such, cyber resilience requires ensuring that key stakeholders, whether shareholders, customers, regulators, business partners, employees, etc, stay resolute in their faith in a company and its leadership's ability to navigate the increasingly complex issues related to cyber risks and how these issues are addressed enterprise-wide, not purely seen through the lens of technical or operational resilience. To achieve cyber resilience, organisations must develop and implement programmes that integrate both the technical and the broader business measures needed to limit fallout, demonstrate leadership through cyber crises, and deepen trust regardless of the potential severity of the impact.