Evaluation of Candida auris acquisition in U.S. international travelers using a culture-based screening protocol

Highlight Section We establish the feasibility of evaluating U.S. international travelers for Candida auris acquisition using a culture-based screening protocol. Corynebacterium auris was not identified in any of the travelers in this small cohort; further study is needed to determine the overall risk and risk factors for travel-associated acquisition.

Application and Exploration of Overall Risk Management in Construction Enterprises

This paper mainly starts from the perspectives of management and economics, combined with the characteristics of the construction industry, conducts qualitative and quantitative analysis of the risks involved, studies various factors that cause construction enterprise risks from multiple angles, and uses scientific and effective methods to identify and evaluate risks, as well as determine the risk level. Through the overall risk management response strategies and empirical research of construction enterprises, this paper analyzes the general theory and main avoidance strategies of risk response of construction enterprises, and lays the foundation for follow-up risk management response in the form of cases through the implementation of technical route and innovation points.

Art and Suicide

Chapter 8 looks at specific ways in which art can sometimes be crazy-making, with a detailed examination of three artist suicides. Research on artists and suicide, specifically, is sparse. We know as little about any artist’s reasons as we do about anyone else’s, but a few studies are have been done. And at least actuarially, in relation to level of overall risk, the good studies provide some helpful grounding. To get at a range of possible dynamics, none universal, in this chapter the author inspects the particular cases of Diane Arbus, Kurt Cobain, and Sylvia Plath. Specifically, the author examines how suicide sometimes comes at the end of a process of artistic redefinition. The artist tries something new, in terms of form or content, apparatus or theme, and the product, so unlike anything he or she has attempted before, seems at first outrageously right and satisfying. Sometimes that feeling lasts, sometimes it doesn’t. But either way, the new development occasions a risky and not necessarily valid reassessment of all prior artistic activity.

Two-Stage Approaches to Accounting for Patient Heterogeneity in Machine Learning Risk Prediction Models in Oncology

PURPOSE Machine learning models developed from electronic health records data have been increasingly used to predict risk of mortality for general oncology patients. But these models may have suboptimal performance because of patient heterogeneity. The objective of this work is to develop a new modeling approach to predicting short-term mortality that accounts for heterogeneity across multiple subgroups in the presence of a large number of electronic health record predictors. METHODS We proposed a two-stage approach to addressing heterogeneity among oncology patients of different cancer types for predicting their risk of mortality. Structured data were extracted from the University of Pennsylvania Health System for 20,723 patients of 11 cancer types, where 1,340 (6.5%) patients were deceased. We first modeled the overall risk for all patients without differentiating cancer types, as is done in the current practice. We then developed cancer type–specific models using the overall risk score as a predictor along with preselected type-specific predictors. The overall and type-specific models were compared with respect to discrimination using the area under the precision-recall curve (AUPRC) and calibration using the calibration slope. We also proposed metrics that characterize the degree of risk heterogeneity by comparing risk predictors in the overall and type-specific models. RESULTS The two-stage modeling resulted in improved calibration and discrimination across all 11 cancer types. The improvement in AUPRC was significant for hematologic malignancies including leukemia, lymphoma, and myeloma. For instance, the AUPRC increased from 0.358 to 0.519 (∆ = 0.161; 95% CI, 0.102 to 0.224) and from 0.299 to 0.354 (∆ = 0.055; 95% CI, 0.009 to 0.107) for leukemia and lymphoma, respectively. For all 11 cancer types, the two-stage approach generated well-calibrated risks. A high degree of heterogeneity between type-specific and overall risk predictors was observed for most cancer types. CONCLUSION Our two-stage modeling approach that accounts for cancer type–specific risk heterogeneity has improved calibration and discrimination than a model agnostic to cancer types.

Shaping the Risk

The board game backgammon illustrates that we can control the effects of risk by understanding chances, controlling our exposure to risk, and attending to the preparation of our responses. If we understand the risks we face in a financial context, hedging strategies can allow us to shape the overall risk by offsetting some or all of it, but this comes at a price. Financial futures and options are some of the tools that allow financial risks to be shaped in creative ways. Where risks are poorly understood, though, these financial engineering approaches may not always be effective, and have in the past led to financial difficulties.

Hidden populations: risk behaviours in drug-using populations in the Republic of Georgia through subsequent peer-driven interventions

Background Georgia has a significant risk of ongoing HIV and HCV outbreak. Within this context, harm reduction aims to reduce risk associated with drug use through community activities, such as peer recruitment and involvement. The aim of this study was to identify significant differences between known and hidden populations, and attest to the ongoing utility of peer-driven intervention across multiple years in recruiting high-risk, vulnerable populations through peer networks. It was hypothesised that significant differences would remain between known, and previously unknown, members of the drug-using community, and that peer-driven intervention would recruit individuals with high-risk, vulnerable individuals with significant differences to the known population. Methods Sampling occurred across 9 months in 11 cities in Georgia, recruiting a total of 2807 drug-using individuals. Standardised questionnaires were completed for all consenting and eligible participants, noting degree of involvement in harm reduction activities. These data underwent analysis to identify statistically significant different between those known and unknown to harm reduction activities, including in demographics, knowledge and risk behaviours. Results Peer recruitment was able to attract a significantly different cohort compared to those already known to harm reduction services. Peer-driven intervention was able to recruit a younger population by design, with 25.1% of PDI participants being under 25, compared to 3.2% of NSP participants. PDI successfully recruited women by design, with 6.9% of PDI participants being women compared to 2.0% in the NSP sample. Important differences in drug use, behaviour and risk were seen between the two groups, with the peer-recruited cohort undertaking higher-risk injecting behaviours. A mixture of risk differences was seen across different subgroups and between the known and unknown population. Overall risk, driven by sex risk, was consistently higher in younger people (0.59 vs 0.57, p = 0.00). Recent overdose was associated with higher risk in all risk categories. Regression showed age and location as important variables in overall risk. Peer-recruited individuals reported much lower rates of previous HIV testing (34.2% vs 99.5%, p = 0.00). HIV knowledge and status were not significantly different. Conclusions Significant differences were seen between the known and unknown drug-using populations, and between previous and current research, speaking to the dynamic change of the drug-using culture. The recruitment strategy was successful in recruiting females and younger people. This is especially important, given that this sampling followed subsequent rounds of peer-driven intervention, implying the ability of peer-assisted recruitment to consistently reach hidden, unknown populations of the drug-using community, who have different risks and behaviours. Risk differences were seen compared to previous samples, lending strength to the peer-recruitment model, but also informing how harm reduction programmes should cater services, such as education, to different cohorts.

Cost-Effective Portfolio Hedging: A Dividend-funded Derivative Approach

This paper examines the effectiveness of using dividend yield to fund hedging protection for an S&P500 equity portfolio. We construct a hedged portfolio that consists of the S&P500 index but uses the dividend yield to purchase put option protection for hedging risk. We then compare the risk and return of the hedged S&P500 portfolio to that of an unhedged S&P500 portfolio. The trade-off reduced returns compared to the overall risk reduction are also measured. Results indicate that this risk-management strategy could be appealing to a large contingency of investors seeking down-side protection at a modest cost that is self-funded from dividends.

Integrating Resilience in Time-based Dependency Analysis: A Large-Scale Case Study for Urban Critical Infrastructures

As critical systems shall withstand different types of perturbations affecting their functionalities and their service level, resilience is a very important requirement. Especially in an urban critical infrastructures where the occurrence of natural events may influence the state of other dependent infrastructures from various different sectors, the overall resilience of such infrastructures against large scale failures is even more important. When a perturbation occurs in a system, the quality (level) of the service provided by the affected system will be reduced and a recovery phase will be triggered to restore the system to its normal operation level. According to the implemented recovery controls, the restoration phase may follow a different growth model. This paper extends a previous time-based dependency risk analysis methodology by integrating and assessing the effect of recovery controls. The main goal is to dynamically assess the evolution of recovery over time, in order to identify how the expected recovery plans will eventually affect the overall risk of the critical paths. The proposed recovery-aware time-based dependency analysis methodology was integrated into the CIPCast Decision Support System that enables risk forecast due to natural events to identify vulnerable and disrupted assets (e.g., electric substations, telecommunication components) and measure the expected risk paths. Thus, CIPCast can be valuable to Critical Infrastructure Operators and other Emergency Managers involved in a crisis assessment to evaluate the effect of natural and anthropic threats affecting critical assets and plan proper countermeasures to reduce the overall risk of degradation of services. The proposed methodology is evaluated in a real scenario, which utilizes several infrastructures and Points of Interest of the city of Rome.

Identifying UK travellers at increased risk of developing pneumococcal infection: a novel algorithm

Background In 2016, the travel subcommittee of the UK Joint Committee on Vaccination and Immunisation (JCVI) recommended that 13-valent PCV (PCV13) could be offered to travellers aged over 65 years, visiting countries without infant PCV immunization programmes. This study aimed to identify, collate and review the available evidence to identify specific countries where UK travellers might be at an increased risk of developing pneumococcal infection. The data were then used to develop an algorithm, which could be used to facilitate implementation of the JCVI recommendation. Methods We conducted a systematic search of the published data available for pneumococcal disease, PCV vaccine implementation, coverage data and programme duration by country. The primary data sources used were World Health Organization databases and the International Vaccine Access Centre Vaccine Information and Epidemiology Window-hub database. Based on the algorithm, the countries were classified into ‘high overall risk’, ‘intermediate overall risk’ and ‘low overall risk’ from an adult traveller perspective. This could determine whether PCV13 should be recommended for UK adult travellers. Results A data search for a total of 228 countries was performed, with risk scores calculated for 188 countries. Overall, 45 countries were classified as ‘high overall risk’, 86 countries as ‘intermediate overall risk’, 57 countries as ‘low overall risk’ and 40 countries as ‘unknown’. Conclusion To our knowledge this is the first attempt to categorize the risk to UK adult travellers of contracting pneumococcal infection in each country, globally. These findings could be used by national travel advisory bodies and providers of travel vaccines to identify travellers at increased risk of pneumococcal infection, who could be offered PCV immunization.