Negotiations with a risk assessment tool: Standardized decision-making in the United States and the deprofessionalization thesis

2017 ◽  
Vol 7 (2) ◽  
pp. 206-218 ◽  
Author(s):  
Pascal Bastian
Keyword(s):  
United States ◽  
Risk Assessment ◽  
Decision Making ◽  
Assessment Tool ◽  
The United States ◽  
Risk Assessment Tool

scholarly journals Supporting Wildfire Response During a Pandemic in the United States: the COVID-19 Incident Risk Assessment Tool

2021 ◽  
Vol 4 ◽  
Author(s):  
Matthew P. Thompson ◽  
Erin J. Belval ◽  
Jake Dilliott ◽  
Jude Bayham
Keyword(s):  
Public Health ◽  
United States ◽  
Risk Assessment ◽  
Assessment Tool ◽  
The United States ◽  
Risk Assessment Tool ◽  
Fire Season ◽  
Local Public Health ◽  
Epidemiological Modeling ◽  
Management Functions

The onset of the global pandemic in 2020 significantly increased the complexity and uncertainty of wildfire incident response in the United States, and there was a clear role for decision support to inform and enhance coordination and communication efforts. Epidemiological modeling suggested the risk of COVID-19 outbreak at a traditional large fire camp could be substantial and supported the broadscale implementation of mitigations, and management of COVID-19 required expanding the response network to interface with entities such as local public health agencies, hospitals, and emergency operations centers. Despite the early issuance of medical and public health guidance to support wildfire management functions under a COVID-19 modified operating posture, an identified gap was a scale- and scope-appropriate tool to support incident-level assessment of COVID-19 risk. Here we review the development and application of a COVID-19 Incident Risk Assessment Tool intended to fill that gap. After prototyping with fire managers and risk practitioners, including early-season use on several incidents, we built an online dashboard that was used operationally throughout the 2020 fire season. We summarize usage statistics, provide some examples of real use on wildfire incidents, and report feedback from users. The tool helped to fill a critical information gap and was intended to support risk-informed decision-making regarding incident logistics, operations, and COVID-19 mitigations.

scholarly journals Mental Health Risk Factors and Parole Decisions: Does Inmate Mental Health Status Affect Who Gets Released

2019 ◽  
Vol 16 (16) ◽  
pp. 2950 ◽  
Author(s):  
Kimberly A. Houser ◽  
E. Rely Vîlcică ◽  
Christine A. Saum ◽  
Matthew L. Hiller
Keyword(s):  
Mental Health ◽  
United States ◽  
Risk Assessment ◽  
Decision Making ◽  
Mental Illness ◽  
Assessment Tool ◽  
Risk Assessment Tool ◽  
Parole Board ◽  
Health Factors ◽  
Mental Health Factors

Parole decision—the decision to release an incarcerated individual from prison conditionally—is one of the most critical decisions across justice systems around the world. The decision carries with it significant consequences: for the freedom of the individual awaiting release (the parolee); for the safety of the community in which they will return; and for the correctional system overall, especially its organizational capacity. The current study attempts to add to the parole decision-making literature by specifically analyzing the role that mental health factors may play in explaining parole decisions. Research to date is inconclusive on whether or not mental illness is a risk factor for criminal behavior; despite this, individuals with mental health problems generally fare worse on risk assessment tools employed in justice decisions. The study relies on a 1000+ representative sample of parole-eligible individuals in Pennsylvania, United States. To increase reliability, the analyses test for several mental health factors based on information from different sources (i.e., self-reported mental health history; risk assessment tool employed by the Parole Board; and risk assessment tool employed by the Department of Corrections). To address validity concerns, the study controls for other potential correlates of parole decisions. Although the multivariate models explained a considerable amount of variance in parole decisions, the inclusion of mental health variables added relatively little to model fit. The results provide insights into an understudied area of justice decision making, suggesting that despite the stigmatization of mental illness among criminal justice populations, parole board members in Pennsylvania, United States, appear to follow official guidelines rather than to consider more subjective notions that poor mental health should negate parole release.

scholarly journals Glucose-6-Phosphate Dehydrogenase Deficiency and the Benefits of Early Screening

2020 ◽  
Vol 39 (5) ◽  
pp. 270-282
Author(s):  
Julie Jensen DelFavero ◽  
Amy J. Jnah ◽  
Desi Newberry
Keyword(s):  
United States ◽  
Risk Assessment ◽  
G6pd Deficiency ◽  
Dehydrogenase Deficiency ◽  
Assessment Tool ◽  
The United States ◽  
Assessment Tools ◽  
Early Screening ◽  
Intercultural Marriages ◽  
Glucose 6 Phosphate Dehydrogenase

Glucose-6-phosphate dehydrogenase (G6PD) deficiency, the most common enzymopathy worldwide, is an insufficient amount of the G6PD enzyme, which is vital to the protection of the erythrocyte. Deficient enzyme levels lead to oxidative damage, hemolysis, and resultant severe hyperbilirubinemia. If not promptly recognized and treated, G6PD deficiency can potentially lead to bilirubin-induced neurologic dysfunction, acute bilirubin encephalopathy, and kernicterus. Glucose-6-phosphate dehydrogenase deficiency is one of the three most common causes for pathologic hyperbilirubinemia. A change in migration patterns and intercultural marriages have created an increased incidence of G6PD deficiency in the United States. Currently, there is no universally mandated metabolic screening or clinical risk assessment tool for G6PD deficiency in the United States. Mandatory universal screening for G6PD deficiency, which includes surveillance and hospital-based risk assessment tools, can identify the at-risk infant and foster early identification, diagnosis, and treatment to eliminate neurotoxicity.

scholarly journals Improving VTE risk assessment and prophylaxis prescribing rate in medical patients: integrating risk assessment tool into the workflow

2020 ◽  
Vol 9 (2) ◽  
pp. e000903
Author(s):  
Hannah Preston ◽  
Iain Swan ◽  
Lauren Davies ◽  
Simon Dummer ◽  
Veiraiah Aravindan ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Assessment Tool ◽  
Qualitative Interviews ◽  
Baseline Period ◽  
Risk Assessment Tool ◽  
Medical Patients ◽  
Seamless Integration ◽  
Pharmacological Prophylaxis ◽  
Vte Prophylaxis

Medical inpatients often have important risk factors for venous thromboembolism (VTE). In our institution, VTE prophylaxis in this group was underused. The main barriers identified were inattention to VTE prophylaxis, competing priorities and lack of confidence in the decision-making. We aimed to improve the rate of VTE prophylaxis use by introducing a paper-based risk assessment tool, with actionable management recommendations within the prescription chart. The rationale was that an assessment tool at the point of prescribing can reduce steps between decision-making and prescribing process, thus promoting confidence and acting as a reminder. A total of 552 prescription charts completed over a period of 29 weeks were examined during the baseline period. In the postintervention period, 871 charts completed over 40 weeks period were examined. The risk assessment tool was completed in 51% of the cases examined in the postintervention period. The introduction of the risk assessment tool was associated with a significant change in the pattern of VTE pharmacological prophylaxis use. The change occurred when the form was made highly visible and enclosed in the prescription chart. The pharmacological prophylaxis use was higher with a completed assessment form than without (mean (SD) 97.5% (7.6%) vs 70.1% (19.4%); p<0.0001). The rate of appropriate prophylaxis decision was 98.2% (SD 5.2%) with a completed assessment form, and 80.7% (SD 17.9%) when it was not used. The qualitative interviews revealed positive themes; many users found it useful, easy and convenient to use. Our data have shown that a paper-based VTE risk assessment tool placed within the prescription chart could substantially improve the rate of appropriate assessment and VTE prophylaxis implementation. This suggests that tool clearly needs to be a seamless integration into the workflow to capture users’ attention and mitigate the influence of time perception.

scholarly journals Obstetric hemorrhage risk assessment tool predicts composite maternal morbidity

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Emer L. Colalillo ◽  
Andrew D. Sparks ◽  
Jaclyn M. Phillips ◽  
Chinelo L. Onyilofor ◽  
Homa K. Ahmadzia
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Risk Prediction ◽  
Maternal Morbidity ◽  
Assessment Tool ◽  
The United States ◽  
Low Risk ◽  
Risk Assessment Tool ◽  
Obstetric Hemorrhage ◽  
Hemorrhage Risk

AbstractObstetric hemorrhage is one of the leading preventable causes of maternal mortality in the United States. Although hemorrhage risk-prediction models exist, there remains a gap in literature describing if these risk-prediction tools can identify composite maternal morbidity. We investigate how well an established obstetric hemorrhage risk-assessment tool predicts composite hemorrhage-associated morbidity. We conducted a retrospective cohort analysis of a multicenter database including women admitted to Labor and Delivery from 2016 to 2018, at centers implementing the Association of Women’s Health, Obstetric, and Neonatal Nurses risk assessment tool on admission. A composite morbidity score incorporated factors including obstetric hemorrhage (estimated blood loss ≥ 1000 mL), blood transfusion, or ICU admission. Out of 56,903 women, 14,803 (26%) were categorized as low-risk, 26,163 (46%) as medium-risk and 15,937 (28%) as high-risk for obstetric hemorrhage. Composite morbidity occurred at a rate of 2.2%, 8.0% and 11.9% within these groups, respectively. Medium- and high-risk groups had an increased combined risk of composite morbidity (diagnostic OR 4.58; 4.09–5.13) compared to the low-risk group. This established hemorrhage risk-assessment tool predicts clinically-relevant composite morbidity. Future randomized trials in obstetric hemorrhage can incorporate these tools for screening patients at highest risk for composite morbidity.

Risk Assessment and Risk Management of Noncriteria Pollutants

1990 ◽  
Vol 6 (5) ◽  
pp. 245-255 ◽  
Author(s):  
Si Duk Lee
Keyword(s):  
United States ◽  
Risk Assessment ◽  
Decision Making ◽  
Risk Management ◽  
Air Pollutants ◽  
The United States ◽  
Risk Information ◽  
Air Toxics ◽  
Hazardous Air Pollutants ◽  
Regulatory Decision

Noncriteria air pollutants are synonymous with hazardous air pollutants (HAPs), air toxics or toxic air pollutants (TAPs). The term noncriteria pollutants refers to all air pollutants except for the criteria pollutants (SOx, PM, NOx, CO, O3, and Pb). Air toxics are pervasive in our environment worldwide in varying degrees. Uses of these chemicals are varied and numerous; their emissions are ubiquitous, and they include organic compounds such as chlorinated hydrocarbons, dioxins, aldehydes, polynuclear aromatic hydrocarbons, and heavy metals such as chromium, nickel, cadmium, and mercury. There are more than 70,000 chemicals that are in use commercially in the United States, and we know relatively little about their ambient concentrations, persistence, transport and transformation as well as their effects on health and the environment, many of which take decades to emerge. The United States Environmental Protection Agency, under the authority of Section 112 of the Clean Air Act, is mandated to regulate any air pollutant which, in the Administrator's judgment, “causes, or contributes to, air pollution which may reasonably be anticipated to result in an increase in serious irreversible or incapacitating reversible illness.” For such regulatory decision-making, EPA's Office of Health and Environmental Assessment (OHEA) provides scientific assessment of health effects for potentially hazardous air pollutants. In accordance with risk assessment guidelines developed by OHEA over the years, Health Assessment Documents (HADs) containing risk assessment information were prepared and were subjected to critical review and careful revision to produce Final Draft HADs which serve as scientific databases for regulatory decision-making by the Office of Air Quality Planning and Standards (OAQPS) in its risk management process. EPA developed databases such as the Integrated Risk Information System (IRIS) and the National Air Toxics Information Clearinghouse (NATICH) and a technical assistance response system called the Air Risk Information Support Center (AIR RISC), in addition, to help in implementation of the National Air Toxics Program by state and local regulators.

Food Safety: Risk Assessment Methodology and Decision-Making Criteria

2003 ◽  
Vol 22 (6) ◽  
pp. 435-451 ◽  
Author(s):  
William J. Brock ◽  
Joseph V. Rodricks ◽  
Alan Rulis ◽  
Vicki L. Dellarco ◽  
George M. Gray ◽  
...  
Keyword(s):  
United States ◽  
Risk Assessment ◽  
Decision Making ◽  
Safety Assessment ◽  
Food Additives ◽  
Cumulative Risk ◽  
The United States ◽  
Management Process ◽  
Approval Process ◽  
Risk Management Process

As our scientific technology grows, risk assessment methods become more complex and, therefore, open to greater scientific debate. Risk assessment has always been a part of the regulatory notification and approval process for foods. However, the methodologies applied to risk assessment and decision-making have become diverse, dependent on a number of features, including the areas of the world in which one operates, the need to use cumulative risk assessment for pesticides and otheringredients or alternative risk assessment considerations for evaluating nontraditional or bioengineered foods. Diverse institutional structures within a single federal regulatory authority may tend to lead to diversity in risk outcomes that creates policy decisions that complicate and confuse the risk management process. On top of this challenge, decisions become more complicated by the need to examine beneficial factors of foods rather than the adverse effects of foods and food additives. Foods are a complex mixture ofingredients. Regulatory groups recognize the need to use new approaches for evaluating the safety and risks associated with foods and food additives, and to do so in a timely manner. The United States Food and Drug Administration (US FDA) in its need to ensure standards of “reasonable certainty of no harm” continues to explore alternative means to be responsive to petitioners as well as continue to examine scientifically validated means, e.g., quantitative structure-activity relationship (QSAR), and computer-assisted programs, within the approval process to assist in the evaluation of risks. Another means to improve the risk management process would include the cumulative risk assessment of pesticides that will, no doubt, be the beginning of more intensive efforts to understand cumulative exposures and the inherent risks from multiple pathways of exposure. The passage of the Food Quality Protection Act (FQPA) resulted in developing additional risk assessment methodologies and approaches to assess the potential for multiple exposures and risks. Addressing the international criteria used in decision-making related to foods safety assessment has resulted in acceptable intake values for foodingredients for carcinogens and noncarcinogens that, in general, tend to be more stringent in the United States compared to Europe. Clearly, the need for harmonization of risk assessment criteria and the impact of the decision process on regulatory approvals and safety assessment is a future need for the continued assurances of food safety. The topics presented in this paper are based on a symposium held in November 2002 at the annual meeting of the American College of Toxicology.

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