Physiology of Risk-Taking and Risk Management in Realistic Decision-Making Scenarios.

Decisions under risk are a particular case of decisional skills taking place in complex and mostly unpredictable situations, where affective connotation of deciding is highly relevant. We aimed at investigating decisional processes under risk by outlining individual risk-taking (RT) and risk management (RM) attitudes via realistic decision-making and, in keeping with the risk-as-feeling hypothesis, at exploring implicit physiological correlates of such processes. 35 participants were presented with realistic situations where they had to make decisions by choosing between alternatives connoted by different levels of riskiness. Concurrently, autonomic physiological activation (cardiovascular and electrodermal activity) was recorded. Data analysis highlighted that: (i) participants showed higher propensity towards risk management than risk-taking; (ii) the propensity towards both risk taking and risk management was significantly determined by physiological markers of autonomic activity; and (iii) risk taking and risk management indices showed associations with different autonomic measures, respectively heart rate and skin conductance metrics.

Evaluation of insurance policies in the Saudi Arabian construction contracts.

The construction sector is more complicated and prone to risk than many other industries due to the size of the projects and the financial capital involved. Arranging insurance is the prudent course of action for risk management in the construction sector. There is a lack of clarity in insurance policies for public construction projects in the Kingdom of Saudi Arabia (KSA), which poses additional risks to all involved contracting parties. The aim of this research is to evaluate insurance policies in the KSA's public construction projects to identify the key deficiencies and obstacles and provide a road map for improvement in the insurance sector concerning insurance against financial losses, professional liability, defects' liability, hidden defects, and others. Forty-two contractors and forty-two owners in Saudi Arabia were surveyed, using a questionnaire to gather information for the study about their knowledge of and attitudes regarding risk transfer through insurance (professional liability, defects liability, and hidden defects). The study also covers the selection criteria for insurance policies for projects that potentially shift risk to the construction sector. Ten criteria were also examined as potential sources of liability issues and suggested as potential remedies in KSA. The findings indicate that the duty and liability of engineers and those participating in these projects can be offset by engineers' insurance against professional errors and hidden flaws, and by the construction industry's clear liability policy. Additionally, the research is envisaged to contribute to construction projects' overall quality and safety, ensuring that robust legal and financial safeguards protect all stakeholders.

Opportunities and challenges of mainstreaming disaster risk management in faith institutions.

The coronavirus disease 2019 (COVID-19) epidemic had created mayhem world over in the year 2020 and confirmed the need and urgency of equipping religious leaders with disaster risk management (DRM) knowledge and skills. Religious leaders are often expected to be among the first responders when disasters strike. This is especially the case in Africa where faith communities often have greater reach among the populace than the state itself. Using multifaceted methodology and purposive sampling interview analysis, this article shows that the responses of religious leaders in Africa, Zimbabwe in particular, to COVID-19 highlighted the urgency of adopting a more focussed and deliberate approach towards equipping religious leaders with DRM knowledge and skills. It further demonstrates that in some areas religious leaders responded effectively (communicating the right message, impact mitigation activities, etc.), in most other areas, they were as unprepared and in a state of paralysis as the rest of the populace. It would however, be grossly unfair to critique their response since most of them have never been exposed to the basic tenets of DRM, either in their formation or as part of life-long learning. Contribution: The article concludes by suggesting mainstreaming tragedy hazard reducing in the curricula of religious institutions for stoppage, mitigation and actual answer to current and future tragedies within communities.

Realist synthesis of a rapid response system in managing mental state deterioration in acute hospital settings.

Mental state deterioration in patients poses significant challenges in healthcare, potentially resulting in adverse outcomes for patients and continued reliance on restrictive interventions. Implementing evidence-based approaches such as a rapid response system that prioritises early identification and intervention can effectively manage adverse outcomes. However, little is known regarding the effectiveness of these interventions. The objective of this synthesis was to test and refine initial programme theories by synthesising evidence to understand what works, for whom and under what circumstances. Based on the realist synthesis methodology, we searched EMBASE, CINAHL, MEDLINE, the Cochrane Library and grey literature for evidence to inform contexts, mechanisms and outcomes on the functioning of a rapid response model. We identified 28 relevant sources encompassing peer-reviewed journal articles and grey literature. This synthesis identified three important elements that contribute to the effectiveness of a rapid response system for managing mental state deterioration: care processes, therapeutic practices and organisational support. Essential elements include improving confidence and clinical skills through training, timely assessment and intervention, teamwork, communication and the creation of governance structures for monitoring and evaluation. To ensure the effectiveness, an organisation must adopt a comprehensive approach that incorporates organisational support, resource allocation, training, clear communication channels and commitment to continuous quality improvement. However, implementing interventions within a complex healthcare system requires thoughtful consideration of the organisational culture and governance structures. By taking a comprehensive and holistic approach to improvement initiatives, organisations can strive to achieve optimal outcomes in managing mental state deterioration and improving patient care.

Assessing the impact of authorisation process as a regulatory tool in the European REACH regulation: A study on improving occupational safety for applying companies.

This study looks into the effectiveness of the authorisation procedure as a regulatory instrument within the framework of the European REACH regulation. It highlights its impact on enhancing occupational safety and health for both applicants and companies utilising the substances. This procedure encompasses manufacturers, importers, and downstream users of substances, as well as representatives of foreign manufacturers who are also eligible to seek authorisation. When applying for authorisation, the ECHA Risk Assessment Committee (RAC) assesses the risks associated with the intended uses of the substance, including the appropriateness and effectiveness of the Occupational Conditions (OCs) and Risk Management Measures (RMMs) described in the application and the risks posed by potential alternatives. If the RAC determines that the OCs/RMMs are inadequate for managing or controlling the risk, or if the measures to protect workers are deemed insufficient, it may recommend additional measures to enhance occupational safety and health or environmental protection. The 398 processed Applications for Authorisation (AfA) that have been submitted to date were examined to determine these recommended measures, categorised as Conditions for use, Monitoring arrangements, and Recommendations for Review Reports. Overall, a significant improvement concerning occupational safety and health seems necessary, as indicated by the large number of measures recommended by the ECHA Committee for Risk Assessment (RAC) and ECHA Committee for Socio-economic Analysis (SEAC) or supplemented by the European Commission. In addition to the proposed measures, a short assessment provided by the committees as to whether the operational conditions and risk management measures are adequate in controlling the risks is also included in the study.

A scoping review to evaluate occupational controls and their effectiveness when handling engineered nanomaterials in workplaces.

Research has shown that controlling worker exposure to engineered nanomaterials (ENMs) helps to reduce the exposure risk to employees in workplaces. This study aimed to identify the available evidence on the effectiveness of various control methods used in the workplace to reduce worker exposure to ENMs. The search was conducted in databases-Medline, OVID, Scopus, Science Direct, Web of Science, and Cochrane and the gray literature published from January 2010 to December 2022. The search keywords included ENM controls and their efficiency in workplace environments. Of the 152 studies retrieved, 22 were included in the review. The control measures in the review included (1) substitution controls; (2) engineering measures (i.e., isolation, direct source extraction, and wetting technologies); (3) personal protective equipment; and (4) administrative and work practices. The study results indicate that the above-mentioned control measures were effective in reducing ENM exposures. This information can be used to help employers choose the most effective controls for their workplaces.

Integrating Disaster and Dignitary Medicine Principles into a Medical Framework for Organizational Travel Health and Security Planning.

This Editorial explores organizational travel risk management and advocates for a comprehensive approach to fortify health security for travelers, emphasizing proactive risk management, robust assessments, and strategic planning. Leveraging insights from very important persons (VIP) protocols, organizations can enhance duty of care and ensure personnel safety amidst global travel complexities.

Cardiovascular Risk Management In Patients With Rheumatoid Arthritis: A Systematic Review.

Rheumatoid arthritis (RA) is an autoimmune chronic inflammatory joint disease associated with pain, swelling, and morning stiffness. It not only affects the joints but also exhibits many extra-articular manifestations. It is recognized as an independent risk factor for cardiovascular (CV) abnormalities. The possibility of cardiovascular disease (CVD) risk in patients with RA is about twofold higher compared to non-RA individuals. Therefore, early risk assessment and management of risk factors are crucial to reduce the CV morbidity and mortality associated with RA. This systematic literature review summarizes the data available on the management of CVD risk factors in RA. A total of 61 articles from the most reputable journals published between 2013 and 2023 were reviewed, of which seven papers were selected for in-depth analysis. We tried to eliminate bias using various bias-eliminating tools. This analysis considers the proposed solution for CV risk prevention and management in RA patients. Optimal control of disease activity and persistent monitoring of other factors responsible for increased CV events in RA patients is the ultimate management of CV abnormalities. This study summarizes the recommendations for the management of CV risk factors in patients with RA.

A bibliometric analysis of research on organizational resilience.

Organizational resilience is a key concept in the study of sustainable corporate growth and indicates an organization's capacity to recover from adversity. It plays a crucial role in responding to uncertain crises. In recent years, academic interest in organizational resilience has increasingly gained prominence. This research uses CiteSpace and VOSviewer to provide a thorough visual analysis of pertinent international literature based on 342 pieces of closely linked literature about organizational resilience. The findings suggest that organizational resilience research is currently experiencing a development phase. Within this field, there is a substantial number of scholars involved, with the most prolific among them including Aleksic Aleksandar, Prayag Girish, and Griffiths Andrew. The networks of collaboration among these authors, nevertheless, are very scattered. Co-citation network research reveals the academics with the biggest sway in the field. Organizational resilience, conservation of resources theory, crisis management, corporate social responsibility, and emergency management are identified as research hotspots within the keyword co-citation network. Furthermore, to determine which countries and regions are the most influential, this study has created a cooperative network among them. China, the United States, and England are the top three nations with articles published. Not only are the highly cited journals respected in the management sector, but they also showcase noteworthy research accomplishments within the field. The purpose of this study is to investigate potential avenues for future research and offer helpful sources for choosing research subjects and developing theoretical frameworks in this area. The analysis is highly valuable as a reference for research on organizational resilience in different settings in the future.

Comprehensive identification and risk assessment of regulated and emerging mycotoxins in infant foods and related raw materials and risk management advice: A case study of an infant food company in China.

This study evaluated muti-mycotoxins in 199 samples including processed infant foods and raw materials collected randomly from an infant food company and assessed their role in dietary exposure in infants and young children via probabilistic risk assessment. Approximately 79.6 % (74/93) of the processed infant foods and 65.1 % (69/106) of the raw materials were contaminated by mycotoxins, with a mean occurrence level of 3.66-321.8 µg/kg. Deoxynivalenol (DON) and tenuazonic acid (TeA) were the more prevalent mycotoxins detected, based on their higher frequencies and levels across samples. Co-occurrence of more than two mycotoxins was detected in 61.3 % (57/93) of the processed infant foods and 53.8 % (57/106) of the raw materials. Wheat flour and derived products (e.g., infant noodles and infant biscuits) were contaminated with higher contamination levels and a greater variety of mycotoxins than other samples (e.g., infant cereal and rice grains). The estimated daily exposure to OTA, DON, ZEN, and TEN was lower than the corresponding reference health-based guidance values, indicating acceptable health risks. However, the estimated dietary exposure to alternariol monomethyl ether (AME), alternariol (AOH), and tenuazonic acid (TeA) exceeded the corresponding thresholds of toxicological concern values, indicating potential dietary intake risks. Among the various samples, cereals and cereal-based infant foods emerged as the primary contributors to mycotoxin exposure. Further research is advised to address the uncertainties surrounding the toxicity associated with emerging Alternaria mycotoxins and to conduct cumulative risk assessments concerning multiple mycotoxin exposure in infants and young children.

Risk analysis of noise-induced hearing loss of workers in the automobile manufacturing industries based on back-propagation neural network model: a cross-sectional study in Han Chinese population.

OBJECTIVES: This study aims to predict the risk of noise-induced hearing loss (NIHL) through a back-propagation neural network (BPNN) model. It provides an early, simple and accurate prediction method for NIHL. DESIGN: Population based, a cross sectional study. SETTING: Han, China. PARTICIPANTS: This study selected 3266 Han male workers from three automobile manufacturing industries. PRIMARY OUTCOME MEASURES: Information including personal life habits, occupational health test information and occupational exposure history were collected and predictive factors of NIHL were screened from these workers. BPNN and logistic regression models were constructed using these predictors. RESULTS: The input variables of BPNN model were 20, 16 and 21 important factors screened by univariate, stepwise and lasso-logistic regression. When the BPNN model was applied to the test set, it was found to have a sensitivity (TPR) of 83.33%, a specificity (TNR) of 85.92%, an accuracy (ACC) of 85.51%, a positive predictive value (PPV) of 52.85%, a negative predictive value of 96.46% and area under the receiver operating curve (AUC) is: 0.926 (95% CI: 0.891 to 0.961), which demonstrated the better overall properties than univariate-logistic regression modelling (AUC: 0.715) (95% CI: 0.652 to 0.777). The BPNN model has better predictive performance against NIHL than the stepwise-logistic and lasso-logistic regression model in terms of TPR, TNR, ACC, PPV and NPV (p<0.05); the area under the receiver operating characteristics curve of NIHL is also higher than that of the stepwise and lasso-logistic regression model (p<0.05). It was a relatively important factor in NIHL to find cumulative noise exposure, auditory system symptoms, age, listening to music or watching video with headphones, exposure to high temperature and noise exposure time in the trained BPNN model. CONCLUSIONS: The BPNN model was a valuable tool in dealing with the occupational risk prediction problem of NIHL. It can be used to predict the risk of an individual NIHL.

Cybersecurity policy framework requirements for the establishment of highly interoperable and interconnected health data spaces.

This paper examines cybersecurity policy framework requirements for establishing highly interoperable and interconnected health data spaces, with a focus on the European Health Data Space (EHDS) and its corresponding joint action Toward European Health Data Space (TEHDAS). It explores the challenges of ensuring data security within an increasingly digital and collaborative healthcare environment, emphasizing the need for robust policy management to protect sensitive health information across diverse healthcare systems and supply chains. Through an analysis of use cases and held expert workshops, the study identifies key requirements for enhancing cybersecurity measures, fostering cross-border data exchange, and ensuring compliance with regulatory standards. It illustrates the practical implications of cybersecurity policies in a real-world scenario, demonstrating how they can be applied to enhance data security and policy effectiveness.

QC Constellation: a cutting-edge solution for risk and patient-based quality control in clinical laboratories.

OBJECTIVES: Clinical laboratories face limitations in implementing advanced quality control (QC) methods with existing systems. This study aimed to develop a web-based application to addresses this gap, and improve QC practices. METHODS: QC Constellation, a web application built using Python 3.11, integrates various statistical QC modules. These include Levey-Jennings charts with Westgard rules, sigma-metric calculations, exponentially weighted moving average (EWMA) and cumulative sum (CUSUM) charts, and method decision charts. Additionally, it offers a risk-based QC section and a patient-based QC module aligning with modern QC practices. The codes and the web application links for QC Constellation were shared at https://github.com/hikmetc/QC_Constellation, and http://qcconstellation.com, respectively. RESULTS: Using synthetic data, QC Constellation demonstrated effective implementation of Levey-Jennings charts with user-friendly features like checkboxes for Westgard rules and customizable moving averages graphs. Sigma-metric calculations for hypothetical performance values of serum total cholesterol were successfully performed using allowable total error and maximum allowable measurement uncertainty goals, and displayed on method decision charts. The utility of the risk-based QC module was exemplified by assessing QC plans for serum total cholesterol, showcasing the application's capability in calculating risk-based QC parameters including maximum unreliable final patient results, risk management index, and maximum run size and offering risk-based QC recommendations. Similarly, the patient-based QC and optimization modules were demonstrated using simulated sodium results. CONCLUSIONS: In conclusion, QC Constellation emerges as a pivotal tool for laboratory professionals, streamlining the management of quality control and analytical performance monitoring, while enhancing patient safety through optimized QC processes.

Patient safety culture and medication safety in European intensive care units: a focus group study.

BACKGROUND: Patients in intensive care units (ICUs) are susceptible to medication errors (MEs) for many reasons, including the complexity and intensity of care. Little is known about patient safety culture, its relationship to medication safety, and ME prevention strategies used in ICUs. This study explored the attitudes of healthcare professionals (HCPs) working in ICUs or within medication safety towards patient safety culture, medication safety, and factors influencing implementation of ME prevention strategies in ICUs across Europe. METHODS: This qualitative study employed focus group discussions; ethical approval was obtained. Invitations to participate were distributed to HCPs working in ICUs or as medication safety officers across Europe. In May 2022, online focus group discussions were conducted. Discussions were transcribed verbatim and analysed. The framework analysis employed was inductive, systematic and transparent, and completed through a collaborative and iterative process. RESULTS: Three nurses and 11 pharmacists, from seven different countries, participated in three focus group discussions. There was a sense of improvement in blame culture leading to more open culture, although it was not the case for all participants. Blame culture, when present, was thought to be prevalent among more senior ICU staff and hospital managers. Facilitators for improving medication safety included communicating with HCPs and providing feedback on MEs and ME prevention strategies, interprofessional working without hierarchies, and having a 'good' culture and environment. Barriers included lack of engagement of HCPs and their attitudes towards medication safety, and an existing blame culture. Participants reported 25 different ME prevention strategies in use including: assessing knowledge; teaching and training; auditing practice; incident reporting; and involvement of pharmacists. CONCLUSIONS: This study examined the attitudes of HCPs on patient safety culture and medication safety in the ICU setting in Europe and gained their insight into facilitators and barriers to the implementation of ME prevention strategies to improve medication safety.

The World Federation of Chiropractic Global Patient Safety Task Force: a call to action.

BACKGROUND: The Global Patient Safety Action Plan, an initiative of the World Health Organization (WHO), draws attention to patient safety as being an issue of utmost importance in healthcare. In response, the World Federation of Chiropractic (WFC) has established a Global Patient Safety Task Force to advance a patient safety culture across all facets of the chiropractic profession. This commentary aims to introduce principles and call upon the chiropractic profession to actively engage with the Global Patient Safety Action Plan beginning immediately and over the coming decade. MAIN TEXT: This commentary addresses why the chiropractic profession should pay attention to the WHO Global Patient Safety Action Plan, and what actions the chiropractic profession should take to advance these objectives. Each strategic objective identified by WHO serves as a focal point for reflection and action. Objective 1 emphasizes the need to view each clinical interaction as a chance to improve patient safety through learning. Objective 2 urges the implementation of frameworks that dismantle systemic obstacles, minimizing human errors and strengthening patient safety procedures. Objective 3 supports the optimization of clinical process safety. Objective 4 recognizes the need for patient and family engagement. Objective 5 describes the need for integrated patient safety competencies in training programs. Objective 6 explains the need for foundational data infrastructure, ecosystem, and culture. Objective 7 emphasizes that patient safety is optimized when healthcare professionals cultivate synergy and partnerships. CONCLUSIONS: The WFC Global Patient Safety Task Force provides a structured framework for aligning essential considerations for patient safety in chiropractic care with WHO strategic objectives. Embracing the prescribed action steps offers a roadmap for the chiropractic profession to nurture an inclusive and dedicated culture, placing patient safety at its core. This commentary advocates for a concerted effort within the chiropractic community to commit to and implement these principles for the collective advancement of patient safety.

Development and validation of a short clinical risk management implementation (Short CRiMI) questionnaire.

Clinical Risk Management (CRM) is an important instrument to continuously improve safety of health care delivery. In Germany, hospitals are required by law to implement CRM and incidence reporting systems. Since 2010, nation-wide surveys have been conducted periodically to evaluate implementation of CRM in hospitals. The instrument used in these surveys is constantly being updated to reflect previous experiences, as well as to adapt to ongoing trends and developments in CRM practices. The survey instrument used in 2022 consisted of up to 200 items and took up to an hour to complete. In this study, we aimed to develop a short instrument to measure the level of CRM implementation in hospitals, evaluate its psychometric properties, and to offer benchmarking data for health care facilities of different sizes. We used data collected in 2022 as part of KHaSiMiR study, employing a cross-sectional self-reported online survey. The hospital administrations were invited to designate one CRM manager to participate in the study. Out of 1,411 general hospitals invited, 401 responses were collected (response rate of 28%). After removing the cases with excessive missings, we imputed remaining missing values using multiple imputation, and split the resulting sample (n=362) in two halves (i.e., exploratory and testing subsamples). A principal component analysis was applied on the first subsample. We validated the resulting model using confirmatory factor analysis in the testing subsample. We evaluated internal consistency, and tested external validity of the established instrument using correlation analysis with two single-item measures: subjective evaluation of CRM implementation compared to similar organizations and compared to own ideal level. The principal component analysis included 45 items from the full instrument. The analysis resulted in a three-factor model with 26 items. In the confirmatory factor analysis, the model demonstrated acceptable fit with the data according to the commonly used fit indices: Chi2/df=1.36, CFI=0.941, TLI=0.930, RMSEA=0.045 (90% CI=0.032-0.056), SRMR=0.049. Cronbach's alpha of all three factors was good (>0.70). All three factors had statistically significant positive correlations with each other (0.359-0.497) and with the two single items (0.282-0.532). None of the correlations were high enough (>0.7) to indicate multicollinearity. The proposed short clinical risk management implementation (Short CRiMI) questionnaire is psychometrically valid and can be used to rapidly evaluate CRM implementation in hospitals. Further research can provide evidence of its external validity and association with quality and safety outcomes. Benchmarking data can be used to compare the results with the data from the most recent Germany-wide survey.

Quality improvement initiative to reduce Medical Adhesive Related Skin injury (MARSI) in very preterm babies admitted to neonatal intensive care unit.

INTRODUCTION: Sick preterm neonates are most vulnerable to developing skin injuries. Despite sound knowledge and application of evidence-based practices for preventing medical adhesive-related skin injury (MARSI), the incidence of MARSI was 30 events per 1000 adhesive application days in our unit. AIMS AND OBJECTIVES: We aimed to reduce the median MARSI rate from the existing 30 per 1000 MARSI days to <5 per 1000 MARSI over 5 months from June 2023 to October 2023. MATERIAL & METHODS: With the point-of-care quality improvement (QI) approach, a prospective study was planned to reduce the incidence of MARSI among sick very preterm newborns (<32 weeks gestational age) and eventually improve overall skin condition during hospital stay. Sequential Plan-Do-Study-Act cycles were implemented based on the identified risk factors recognised during recurring team discussions. RESULTS: We demonstrated a reduction in the MARSI rate from 30 events per 1000 adhesive applications (during baseline assessment) to zero events per 1000 adhesive applications at the end of the study period. It was temporally related to the assessment of skin risk stratification at admission using a validated tool, regular assessment of neonatal skin condition score based on the skin risk stratification, and reinforcement of MARSI prevention bundle by application of barrier spray. Awareness regarding 'skin injury prevention' bundles was continually generated among healthcare professionals. The MARSI rate remained <5 events per adhesive application in the sustenance phase over 6 months. CONCLUSION: Implementing evidence-based skin care practices resulted in a significant reduction in iatrogenic cutaneous injury events in very preterm neonates.

Letter re: Regulatory toxicology approaches in workplaces of Iran.

The objective of establishing occupational exposure limits (OELs) is to utilize them as a risk management tool, ensuring the protection of workers' health and well-being from hazardous substances present in the workplace. To regulate and develop an OEL, it is essential to conduct toxicological studies on both animals and humans, to determine the dose-response relationship for each chemical compound, and to determine whether the dose-response relationship is linear or non-linear. Because the OELs suggested by different organizations or countries are just the result of their scientific methods, knowledge, and judgment, this does not confirm the applicability in other countries. Therefore, it is not scientific and logical to imitate the permissible limits recommended in Western countries. In most Western Asian nations, there is a significant difference in the suggested OEL levels between the reference organizations, and in assessing and managing a specific situation's risk, using any of the proposed OELs can lead to contradictory results. Suggestions for the development and improvement of the basics of determining the OELs for chemical pollution in West Asian countries have been made.