THE COURTS AND RISK ASSESSMENT -super-1

In the past decade the federal courts have come to play an important role in reviewing agency decision-making on prospective risks. Questioning the conventional wisdom that judges are poorly equipped for the task, the authors outline the range of choices facing courts in such cases and contend that they cannot avoid making ultimate decisions on risk policy. However, recent Supreme Court cases on nuclear hazards and occupational benzene indicate narrowing of the scope for judicial review. Copyright 1982 by The Policy Studies Organization.

Time Delay Embedding Increases Estimation Precision of Models of Intraindividual Variability

time delay embedding, dynamical systems models, intraindividual variability, oscillatory data,

Impact of Coronary CT Angiography–derived Fractional Flow Reserve on Downstream Management and Clinical Outcomes in Individuals with and without Diabetes

Purpose: To compare the clinical use of coronary CT angiography (CCTA)–derived fractional flow reserve (FFR) in individuals with and without diabetes mellitus (DM). Materials and Methods: This secondary analysis included participants (enrolled July 2015 to October 2017) from the prospective, multicenter, international The Assessing Diagnostic Value of Noninvasive CT-FFR in Coronary Care (ADVANCE) registry (ClinicalTrials. gov identifier, NCT 02499679) who were evaluated for suspected coronary artery disease (CAD), with one or more coronary stenosis ≥30% on CCTA images, using CT-FFR. CCTA and CT-FFR findings, treatment strategies at 90 days, and clinical outcomes at 1-year follow-up were compared in participants with and without DM. Results: The study included 4290 participants (mean age, 66 years ± 10 [SD]; 66% male participants; 22% participants with DM). Participants with DM had more obstructive CAD (one or more coronary stenosis ≥50%; 78.8% vs 70.6%, P &lt; .001), multivessel CAD (three-vessel obstructive CAD; 18.9% vs 11.2%, P &lt; .001), and proportionally more vessels with CT-FFR ≤ 0.8 (74.3% vs 64.6%, P &lt; .001). Treatment reclassification by CT-FFR occurred in two-thirds of participants which was consistent regardless of the presence of DM. There was a similar graded increase in coronary revascularization with declining CT-FFR in both groups. At 1 year, presence of DM was associated with higher rates of major adverse cardiovascular events (hazard ratio, 2.2; 95% CI: 1.2, 4.1; P = .01). However, no between group differences were observed when stratified by stenosis severity (&lt;50% or ≥50%) or CT-FFR positivity. Conclusion: Both anatomic CCTA findings and CT-FFR demonstrated a more complex pattern of CAD in participants with versus without DM. Rates of treatment reclassification were similar regardless of the presence of DM, and DM was not an adverse prognostic indicator when adjusted for diameter stenosis and CT-FFR.</p