Quantitative risk assessment of seafarers’ nonfatal injuries due to occupational accidents based on Bayesian network modeling

Reducing the incidence of seafarers’ workplace injuries is of great importance to shipping and ship management companies. The objective of this study is to identify the important influencing factors and to build a quantitative model for the injury risk analysis aboard ships, so as to provide a decision support framework for effective injury prevention and management. Most of the previous research on seafarers’ occupational accidents either adopts a qualitative approach or applies simple descriptive statistics for analyses. In this study, the advanced method of a Bayesian network (BN) is used for the predictive modeling of seafarer injuries for its interpretative power as well as predictive capacity. The modeling is data driven and based on an extensive empirical survey to collect data on seafarers’ working practice and their injury records during the latest tour of duty, which could overcome the limitation of historical injury databases that mostly contain only data about the injured group instead of the entire population. Using the survey data, a BN model was developed consisting of nine major variables, including “PPE availability,” “Age,” and “Experience” of the seafarers, which were identified to be the most influential risk factors. The model was validated further with several tests through sensitivity analyses and logical axiom test. Finally, implementation of the result toward decision support for safety management in the global shipping industry was discussed

Oral, direct Factor Xa inhibition with BAY 59-7939 for the prevention of venous thromboembolism after total hip replacement

Background: Joint replacement surgery is an appropriate model for dose-ranging studies investigating new anticoagulants. Objectives: To assess the efficacy and safety of a novel, oral, direct factor Xa (FXa) inhibitor - BAY 59-7939 - relative to enoxaparin in patients undergoing elective total hip replacement. Methods: In this double-blind, double-dummy, doseranging study, patients were randomized to oral BAY 59-7939 (2.5, 5, 10, 20, or 30 mg b.i.d.), starting 6-8 h after surgery, or s.c. enoxaparin 40 mg once daily, starting on the evening before surgery. Treatment was continued until mandatory bilateral venography was performed 5-9 days after surgery. Results: Of 706 patients treated, 548 were eligible for the primary efficacy analysis. The primary efficacy endpoint was the incidence of any deep vein thrombosis, non-fatal pulmonary embolism, and all cause mortality; rates were 15%, 14%, 12%, 18%, and 7%for BAY 59-7939 2.5, 5, 10, 20, and 30 mg b.i.d., respectively, compared with 17% for enoxaparin. The primary efficacy analysis did not demonstrate any signi.cant trend in dose-response relationship for BAY 59-7939. The primary safety endpoint was major, postoperative bleeding; there was a significant increase in the frequency of events with increasing doses of BAY 59-7939 (P = 0.045), but no signi.cant di.erences between individual BAY 59-7939 doses and enoxaparin. Conclusions: When eficacy and safety were considered together, compared favorably with enoxaparin for the prevention of venous thromboembolism in patients undergoing elective total hip replacement. \ua9 2006 International Society on Thrombosis and Haemostasis

Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty

BACKGROUND: This phase 3 trial compared the efficacy and safety of rivaroxaban, an oral direct inhibitor of factor Xa, with those of enoxaparin for extended thromboprophylaxis in patients undergoing total hip arthroplasty. METHODS: In this randomized, double-blind study, we assigned 4541 patients to receive either 10 mg of oral rivaroxaban once daily, beginning after surgery, or 40 mg of enoxaparin subcutaneously once daily, beginning the evening before surgery, plus a placebo tablet or injection. The primary efficacy outcome was the composite of deep-vein thrombosis (either symptomatic or detected by bilateral venography if the patient was asymptomatic), nonfatal pulmonary embolism, or death from any cause at 36 days (range, 30 to 42). The main secondary efficacy outcome was major venous thromboembolism (proximal deep-vein thrombosis, nonfatal pulmonary embolism, or death from venous thromboembolism). The primary safety outcome was major bleeding. RESULTS: A total of 3153 patients were included in the superiority analysis (after 1388 exclusions), and 4433 were included in the safety analysis (after 108 exclusions). The primary efficacy outcome occurred in 18 of 1595 patients (1.1%) in the rivaroxaban group and in 58 of 1558 patients (3.7%) in the enoxaparin group (absolute risk reduction, 2.6%; 95% confidence interval [CI], 1.5 to 3.7; P<0.001). Major venous thromboembolism occurred in 4 of 1686 patients (0.2%) in the rivaroxaban group and in 33 of 1678 patients (2.0%) in the enoxaparin group (absolute risk reduction, 1.7%; 95% CI, 1.0 to 2.5; P<0.001). Major bleeding occurred in 6 of 2209 patients (0.3%) in the rivaroxaban group and in 2 of 2224 patients (0.1%) in the enoxaparin group (P=0.18). CONCLUSIONS: A once-daily, 10-mg oral dose of rivaroxaban was significantly more effective for extended thromboprophylaxis than a once-daily, 40-mg subcutaneous dose of enoxaparin in patients undergoing elective total hip arthroplasty. The two drugs had similar safety profiles. (ClinicalTrials.gov number, NCT00329628