A multi-layered risk estimation routine for strategic planning and operations for the maritime industry

Maritime regulators and port authorities require the ability to predict risk exposure for strategic planning aspects to optimize asset allocation, mitigate and prevent incidents. This article builds on previous work to develop the strategic planning component and introduces the concept of a multilayered risk estimation framework (MLREF) for strategic planning and operations. The framework accounts for most of the risk factors such as ship specific risk, vessel traffic densities and met ocean conditions and allows the integration of the effect of risk control option and a location specific spatial rate ratio to allow for micro level risk assessments. Both, the macro (eg. covering larger geographic areas or EEZ) and micro level application (eg. passage way, particular route of interest) of MLREF was tested via a pilot study for the Australian region using a comprehensive and unique combination of dataset. The underlying routine towards the development of a strategic planning tool was developed and tested in R. Applications of the layers for the operational part such as an automated alert system and sources of uncertainties for risk assessments in general are described and discussed along with future developments and improvements

A multi-layered risk exposure assessment approach for the shipping industry

__Abstract__ Shipping activity has increased worldwide and maritime administrations are trying to enhance risk mitigation strategies by using proactive approaches. We present and discuss a conceptual framework to minimize potential harm based on a multi-layered approach which can be implemented in either real time for operational purposes or in prediction mode for medium or longer term strategic planning purposes. We introduce the concept of total risk exposure which integrates risk at the individual ship level with vessel traffic densities and location specific parameters such as weather and oceanographic conditions, geographical features or environmental sensitivities. A comprehensive and robust method to estimate and predict risk exposure can be beneficial to maritime administrations to enhance mitigation strategies and understand uncertainties. We further provide a proof of concept based on 53 million observations of vessel positions and individual risk profiles of 8,900 individual ships. We present examples on how endpoints can be visualized for two integrated risk layers – ship specific risk and vessel traffic densities. We further identify and discuss uncertainties and present our ideas on how other risk layers could be integrated in the future

The contribution of leading diseases and risk factors to excess losses of healthy life in Eastern Europe: burden of disease study.

BACKGROUND: The East/West gradient in health across Europe has been described often, but not using metrics as comprehensive and comparable as those of the Global Burden of Disease 2000 and Comparative Risk Assessment studies. METHODS: Comparisons are made across 3 epidemiological subregions of the WHO region for Europe--A (very low child and adult mortality), B (low child and low adult mortality) and C (low child and high adult mortality)--with populations in 2000 of 412, 218 and 243 millions respectively, and using the following measures: 1. Probabilities of death by sex and causal group across 7 age intervals; 2. Loss of healthy life (DALYs) to diseases and injuries per thousand population; 3. Loss of healthy life (DALYs) attributable to selected risk factors across 3 age ranges. RESULTS: Absolute differences in mortality are most marked in males and in younger adults, and for deaths from vascular diseases and from injuries. Dominant contributions to east-west differences come from the nutritional/physiological group of risk factors (blood pressure, cholesterol concentration, body mass index, low fruit and vegetable consumption and inactivity) contributing to vascular disease and from the legal drugs--tobacco and alcohol. CONCLUSION: The main requirements for reducing excess health losses in the east of Europe are: 1) favorable shifts in all amenable vascular risk factors (irrespective of their current levels) by population-wide and personal measures; 2) intensified tobacco control; 3) reduced alcohol consumption and injury control strategies (for example, for road traffic injuries). Cost effective strategies are broadly known but local institutional support for them needs strengthening.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Predicting traffic and risk exposure in the maritime industry

Maritime regulators, port authorities, and industry require the ability to predict risk exposure of shipping activities at a micro and macro level to optimize asset allocation and to mitigate and prevent incidents. This article introduces the concept of a strategic planning tool by making use of the multi-layered risk estimation framework (MLREF), which accounts for ship specific risk, vessel traffic densities, and meets ocean conditions at the macro level. This article’s main contribution is to provide a traffic and risk exposure prediction routine that allows the traffic forecast to be distributed across the shipping route network to allow for predicting scenarios at the macro level (e.g., covering larger geographic areas) and micro level (e.g., passage way, particular route of interest). In addition, the micro level is introduced by providing a theoretical idea to integrate location specific spatial rate ratios along with the effect of the risk control option to perform sensitivity analysis of risk exposure prediction scenarios. Aspects of the risk exposure estimation routine were tested via a pilot study for the Australian region using a comprehensive and unique combination of datasets. Sources of uncertainties for risk assessments are described in general and discussed along with the potential for future developments and improvements

Risk of death or hospital admission among community-dwelling older adults living with dementia in Australia

Background: Older people living with dementia prefer to stay at home to receive support. But they are at high risk of death and/or hospital admissions. This study primarily aimed to determine risk factors for time to death or hospital admission (combined) in a sample of community-dwelling older people living with dementia in Australia. As a secondary study purpose, risk factors for time to death were also examined. Methods. This study used the data of a previous project which had been implemented during September 2007 and February 2009. The original project had recruited 354 eligible clients (aged 70 and over, and living with dementia) for Extended Aged Care At home Dementia program services during September 2007 and 2008. Client information and carer stress had been collected from their case managers through a baseline survey and three-monthly follow-up surveys (up to four in total). The principal data collection tools included Global Deterioration Scale, Modified Barthel Index, Instrumental-Dependency OARS, Adapted Cohen-Mansfield Agitation Inventory, as well as measures of clients' socio-demographic characteristics, service use and diseases diagnoses. The sample of our study included 284 clients with at least one follow-up survey. The outcome variable was death or hospital admission, and death during six, nine and 16-month study periods. Stepwise backwards multivariate Cox proportional hazards analysis was employed, and Kaplan-Meier survival analysis using censored data was displayed. Results: Having previous hospital admissions was a consistent risk factor for time to death or hospital admission (six-month: HR = 3.12; nine-month: HR = 2.80; 16-month: HR = 2.93) and for time to death (six-month: HR = 2.27; 16-month: HR = 2.12) over time. Previously worse cognitive status was a consistent risk factor over time (six- and nine-month: HR = 0.58; 16-month: HR = 0.65), but no previous use of community care was only a short-term risk factor (six-month: HR = 0.42) for time to death or hospital admission. Conclusions: Previous hospital admissions and previously worse cognitive status are target intervention areas for reducing dementia clients' risk of time to death or hospital admission, and/or death. Having previous use of community care as a short-term protective factor for dementia clients' time to death or hospital admission is noteworthy

International Physical Activity Questionnaire (IPAQ) and New Zealand Physical Activity Questionnaire (NZPAQ): A doubly labelled water validation

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Global Estimates of the Prevalence and Incidence of Four Curable Sexually Transmitted Infections in 2012 Based on Systematic Review and Global Reporting

Background: Quantifying sexually transmitted infection (STI) prevalence and incidence is important for planning interventions and advocating for resources. The World Health Organization (WHO) periodically estimates global and regional prevalence and incidence of four curable STIs: chlamydia, gonorrhoea, trichomoniasis and syphilis. Methods and Findings: WHO’s 2012 estimates were based upon literature reviews of prevalence data from 2005 through 2012 among general populations for genitourinary infection with chlamydia, gonorrhoea, and trichomoniasis, and nationally reported data on syphilis seroprevalence among antenatal care attendees. Data were standardized for laboratory test type, geography, age, and high risk subpopulations, and combined using a Bayesian meta-analytic approach. Regional incidence estimates were generated from prevalence estimates by adjusting for average duration of infection. In 2012, among women aged 15–49 years, the estimated global prevalence of chlamydia was 4.2% (95% uncertainty interval (UI): 3.7–4.7%), gonorrhoea 0.8% (0.6–1.0%), trichomoniasis 5.0% (4.0–6.4%), and syphilis 0.5% (0.4–0.6%); among men, estimated chlamydia prevalence was 2.7% (2.0–3.6%), gonorrhoea 0.6% (0.4–0.9%), trichomoniasis 0.6% (0.4–0.8%), and syphilis 0.48% (0.3–0.7%). These figures correspond to an estimated 131 million new cases of chlamydia (100–166 million), 78 million of gonorrhoea (53–110 million), 143 million of trichomoniasis (98–202 million), and 6 million of syphilis (4–8 million). Prevalence and incidence estimates varied by region and sex. Conclusions: Estimates of the global prevalence and incidence of chlamydia, gonorrhoea, trichomoniasis, and syphilis in adult women and men remain high, with nearly one million new infections with curable STI each day. The estimates highlight the urgent need for the public health community to ensure that well-recognized effective interventions for STI prevention, screening, diagnosis, and treatment are made more widely available. Improved estimation methods are needed to allow use of more varied data and generation of estimates at the national level

Rethinking the “Diseases of Affluence” Paradigm: Global Patterns of Nutritional Risks in Relation to Economic Development

BACKGROUND: Cardiovascular diseases and their nutritional risk factors—including overweight and obesity, elevated blood pressure, and cholesterol—are among the leading causes of global mortality and morbidity, and have been predicted to rise with economic development. METHODS AND FINDINGS: We examined age-standardized mean population levels of body mass index (BMI), systolic blood pressure, and total cholesterol in relation to national income, food share of household expenditure, and urbanization in a cross-country analysis. Data were from a total of over 100 countries and were obtained from systematic reviews of published literature, and from national and international health agencies. BMI and cholesterol increased rapidly in relation to national income, then flattened, and eventually declined. BMI increased most rapidly until an income of about I$5,000 (international dollars) and peaked at about I$12,500 for females and I$17,000 for males. Cholesterol's point of inflection and peak were at higher income levels than those of BMI (about I$8,000 and I$18,000, respectively). There was an inverse relationship between BMI/cholesterol and the food share of household expenditure, and a positive relationship with proportion of population in urban areas. Mean population blood pressure was not correlated or only weakly correlated with the economic factors considered, or with cholesterol and BMI. CONCLUSIONS: When considered together with evidence on shifts in income–risk relationships within developed countries, the results indicate that cardiovascular disease risks are expected to systematically shift to low-income and middle-income countries and, together with the persistent burden of infectious diseases, further increase global health inequalities. Preventing obesity should be a priority from early stages of economic development, accompanied by population-level and personal interventions for blood pressure and cholesterol

The age-specific quantitative effects of metabolic risk factors on cardiovascular diseases and diabetes: a pooled analysis.

BACKGROUND: The effects of systolic blood pressure (SBP), serum total cholesterol (TC), fasting plasma glucose (FPG), and body mass index (BMI) on the risk of cardiovascular diseases (CVD) have been established in epidemiological studies, but consistent estimates of effect sizes by age and sex are not available. METHODS: We reviewed large cohort pooling projects, evaluating effects of baseline or usual exposure to metabolic risks on ischemic heart disease (IHD), hypertensive heart disease (HHD), stroke, diabetes, and, as relevant selected other CVDs, after adjusting for important confounders. We pooled all data to estimate relative risks (RRs) for each risk factor and examined effect modification by age or other factors, using random effects models. RESULTS: Across all risk factors, an average of 123 cohorts provided data on 1.4 million individuals and 52,000 CVD events. Each metabolic risk factor was robustly related to CVD. At the baseline age of 55-64 years, the RR for 10 mmHg higher SBP was largest for HHD (2.16; 95% CI 2.09-2.24), followed by effects on both stroke subtypes (1.66; 1.39-1.98 for hemorrhagic stroke and 1.63; 1.57-1.69 for ischemic stroke). In the same age group, RRs for 1 mmol/L higher TC were 1.44 (1.29-1.61) for IHD and 1.20 (1.15-1.25) for ischemic stroke. The RRs for 5 kg/m(2) higher BMI for ages 55-64 ranged from 2.32 (2.04-2.63) for diabetes, to 1.44 (1.40-1.48) for IHD. For 1 mmol/L higher FPG, RRs in this age group were 1.18 (1.08-1.29) for IHD and 1.14 (1.01-1.29) for total stroke. For all risk factors, proportional effects declined with age, were generally consistent by sex, and differed by region in only a few age groups for certain risk factor-disease pairs. CONCLUSION: Our results provide robust, comparable and precise estimates of the effects of major metabolic risk factors on CVD and diabetes by age group

Study protocol for a randomised trial of nicotine-free cigarettes as an adjunct to usual NRT-based cessation practice, in people who wish to stop smoking

This trial is funded by a programme grant from the Health Research Council of New Zealand.