Risk indicators are metrics that are widely used in risk management to indicate how risky an activity is. Among different types of risk indicators, early warning systems are designed to help decision makers predict and be prepared for catastrophic events. Especially, in complex systems where outcomes are often difficult to predict, early warnings can help decision makers manage possible risks and take a proactive approach. Early prediction of catastrophic events and outcomes are at the heart of risk management, and help decision makers take appropriate actions in order to mitigate possible effects of such events. For example, physicians would like to prevent any adverse events for their patients and like to use all pieces of information that help accurate early diagnosis and interventions. In this research, first we study risk assessment for occupational injuries using accident severity grade as an early warning indicator. We develop a new severity scoring system which considers multiple injury severity factors, and can be used as a part of a novel three-dimensional risk assessment matrix which includes an incident's severity, frequency, and preventability. Then we study the predictability of health outcome based on early risk indicators. A systems model of patient health outcomes and hospital length of stay is presented based on initial health risk and physician assessment of risk. The model elaborates on the interdependent effects of hospital service and a physician's subjective risk assessment on length of stay and mortality. Finally, we extend our research to study the predictive power of early warning systems and prognostic risk indicators in predicting different outcomes in health such as mortality, disease diagnosis, adverse outcomes, care intensity, and survival. This study provides a theoretical framework on why risk indicators can or cannot predict healthcare outcomes, and how better predictors can be designed. Overall, these three essays shed light on complexities of risk assessments, especially in health domain, and in the contexts where individuals continuously observe and react to the risk indicators. Furthermore, our multi-method research approach provides new insights into improving the design and use of the risk measures. / Ph. D.

Made available in DSpace on 2016-04-27T18:11:52Z (GMT). No. of bitstreams: 1 Barbara Cristina da Silva Rosa.pdf: 1571218 bytes, checksum: 41e39c7b750251cd72caf404f4773dc2 (MD5) Previous issue date: 2011-08-01 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introduction: The Universal newborn hearing screening (UNHS) was not implemented in most of Brazilian hospitals yet. Therefore, one option is to perform the evaluation gradually, in newborns and risk infants in the hospital as inpatients, and with an outpatient approach. Goal: To compare the results of selective hearing screening in two different approaches: outpatient and inpatient, in an infant population with risk indicators for hearing loss. Method: It was analyzed two databases, the first one with the results of extenso in a maternity with 284 newborns and infants, and the second one, a database of an university audiological clinic with 398 newborns and infants. The following variables were analyzed: extensor according to the Brazilian multiprofessional health hearing committee and the ones applied by the Secretary of Health in São Paulo city; age in extenso and hearing diagnosis, access during the screening process, return for re-screening and diagnosis. Results: At the university clinic the most prevalent risks indicators for hearing loss were: NICU for more than five days (48%) and use of ototoxic drugs (19,8%). In the maternity the most prevalent risks were: low for gestational age (40,5%) family hearing loss (19%). Concerning the access at the clinic for the retest, it was observed 78,20% and for the diagnosis 73,3%. In the maternity the access was 100%, for retest and for the hearing diagnosis. When applied the risk indicators from the Brazilian Hearing committee in the maternity, only 167 newborns were considered as risk babies. Conclusion: When the HDRI were applied according to Multiprofessional health hearing committee, the numbers of infants that would perform the screening decreased and the prevalence of hearing loss increased. In the adhesion process, it was verified that both in the hospital in the retest of hearing screening, and audiological diagnosis was of 100% / Introdução: A Triagem Auditiva Neonatal Universal (TANU) ainda não foi implantada em grande parte dos hospitais brasileiros, antes da alta hospitalar. Assim sendo, uma alternativa é a realização da avaliação em neonatos e lactentes de risco inicialmente no hospital, ou de forma ambulatorial. Objetivo: Comparar os resultados da Triagem Auditiva Seletiva (TAS) ambulatorial com a hospitalar em uma população de lactentes com indicadores de risco para deficiência auditiva (IRDA). Método: Foram utilizados dois bancos de dados, sendo o primeiro composto de resultados da TAS em uma maternidade com 284 neonatos e lactentes, e o segundo, um banco de dados do ambulatório com 398 neonatos e lactentes. Foram analisadas as seguintes variáveis: IRDA segundo o Comitê Multiprofissional em Saúde Auditiva (COMUSA), e aqueles retirados do edital da prefeitura do município de São Paulo; idade na TAS e no Diagnóstico Audiológico; e ocorrência de adesão durante o processo de triagem, retorno e diagnóstico. Resultados: No ambulatório os IRDA que mais ocorreram foram: UTI-N por mais de cinco dias (48%) e ototoxidade (19,8%). Na maternidade os IRDA que mais ocorreram foram: pequeno para idade gestacional (40,50%) e hereditariedade (19%). Quanto à adesão do ambulatório no reteste, foi de 78,20%, e no diagnóstico foi de 73,3%. Na maternidade a adesão foi de 100%, tanto no reteste como no diagnóstico audiológico. Quando aplicados os IRDA do COMUSA na maternidade, apenas 167 foram considerados de risco, e realizaram a TAS. Conclusão: Quando aplicados os IRDA segundo o COMUSA, o número de lactentes que realizariam a TAS reduziu e a prevalência de deficiência auditiva aumentou. Na adesão, verificamos que a adesão no contexto hospitalar tanto no reteste da triagem auditiva, como no diagnóstico audiológico foi de 100%

Objetivo: O objetivo dessa dissertação foi identificar a prevalência, severidade, indicadores de risco e impacto na qualidade de vida do traumatismo dentário em escolares de 12 anos de Porto Alegre, RS – Brasil. Métodos: Essa pesquisa fez parte de um estudo observacional transversal analítico desenvolvido para avaliar a saúde bucal de escolares de 12 anos. A coleta de dados foi realizada no período de setembro de 2009 a dezembro de 2010. Participaram alunos regulamente matriculados e frequentando a escola, nascidos no ano de 1997 e 1998 (12 anos completos até o final do ano do exame - 2009 ou 2010). Dois questionários foram utilizados: um destinado aos pais/responsáveis legais (questões socioeconômicas, acesso a serviços odontológicos, etc.) e outro respondido pelos próprios escolares (hábitos comportamentais e Child Perceptions Questionnaire – CPQ11-14 – instrumento que visa avaliar o impacto das condições de saúde bucal na auto-percepção e qualidade de vida). A sistemática do exame clínico foi: aferição do peso e altura, determinação do índice de sangramento gengival, índice de estética dental, índice de traumatismo dentário e índice de cárie dentária. Os exames foram realizados por duas examinadoras previamente treinadas e calibradas (ICC e Kappa≥ 0,7). A associação entre traumatismo dentário e seus possíveis indicadores de risco foi avaliada através de modelos de regressão de Poisson. A associação entre os escores do CPQ11-14 e traumatismo dentário foi investigada através de modelos de regressão de Poisson, utilizando gênero, nível socioeconômico e os índices de cárie e estética dental como variáveis de ajuste. Resultados: Foram examinados 1528 alunos, sendo 18,8% de escolas particulares (n=9) e 81,1% de escolas públicas (n=33), obtendo-se uma taxa de resposta de 83%. Uma alta prevalência de traumatismo dentário foi encontrada na população em estudo (34,77%), porém, na maioria dos casos observou-se a presença de traumas leves (24,37%). Além disso, observou-se associação de traumatismo dentário com variáveis sócio-demográficas e ano escolar. Em relação ao impacto na qualidade de vida, foi encontrada uma maior média de CPQ11-14 no domínio limitação funcional, nos indivíduos que apresentavam traumatismo dentário não tratado, quando comparados com os indivíduos que não apresentavam traumatismo dentário ou apresentavam traumatismo sem necessidade de tratamento. Conclusões: O presente estudo demonstrou que o traumatismo dentário é um agravo prevalente e que, quando não tratado, apresenta um comprometimento nas funções orais. / Aim: Identify the prevalence, severity, risk indicators and impact on quality of life oftraumatic dental injury among 12-year-old schoolchildren in Porto Alegre, Brazil. Methods: This study is a part of a cross-sectional survey developed to assess the oral health status of 12-year-old schoolchildren, carried out from September 2009 to December 2010. The eligibility criteria were students attending in selected schools, born in 1997 and 1998. Two questionnaires were used: one for parents/ legal guardians (socioeconomic questions, access to dental services, etc.); and one for schoolchildren (behavioral habits and Child Perceptions Questionnaire - CPQ11-14). The clinical examination was performed as follows: measurement of height and weight, record of the gingival bleeding index, dental esthetics index, dental trauma index and dental caries index. The examinations were performed by two examiners previously calibrated (ICC and Kappa≥ 0.7). The association between traumatic dental injury and the possible risk indicators was assessed using Poisson regression. The association between CPQ11-14 scores and traumatic dental injury was assessed using Poisson regression (gender, socioeconomic status, dental caries index, and dental aesthetics index were used as adjustment variables). Results: We examined 1528 students - 18.8% of private schools (n = 9) and 81.1% of public schools (n = 33), yielding a response rate of 83%. A high prevalence of dental traumatic injury was found in this population (34.77%), being mild trauma in most cases (24.37%). Also, association between traumatic dental injury and socio-demographic characteristics and school year was found. Regarding the impact on quality of life, we found a higher average CPQ11-14 in the domain functional limitation in individuals with untreated traumatic dental injury when compared to individuals who had no trauma or trauma without treatment need. Conclusions: This study showed that traumatic dental injury is prevalent and, when treatment is neglected, oral functions may be impaired.

Objetivo: O objetivo dessa dissertação foi identificar a prevalência, severidade, indicadores de risco e impacto na qualidade de vida do traumatismo dentário em escolares de 12 anos de Porto Alegre, RS – Brasil. Métodos: Essa pesquisa fez parte de um estudo observacional transversal analítico desenvolvido para avaliar a saúde bucal de escolares de 12 anos. A coleta de dados foi realizada no período de setembro de 2009 a dezembro de 2010. Participaram alunos regulamente matriculados e frequentando a escola, nascidos no ano de 1997 e 1998 (12 anos completos até o final do ano do exame - 2009 ou 2010). Dois questionários foram utilizados: um destinado aos pais/responsáveis legais (questões socioeconômicas, acesso a serviços odontológicos, etc.) e outro respondido pelos próprios escolares (hábitos comportamentais e Child Perceptions Questionnaire – CPQ11-14 – instrumento que visa avaliar o impacto das condições de saúde bucal na auto-percepção e qualidade de vida). A sistemática do exame clínico foi: aferição do peso e altura, determinação do índice de sangramento gengival, índice de estética dental, índice de traumatismo dentário e índice de cárie dentária. Os exames foram realizados por duas examinadoras previamente treinadas e calibradas (ICC e Kappa≥ 0,7). A associação entre traumatismo dentário e seus possíveis indicadores de risco foi avaliada através de modelos de regressão de Poisson. A associação entre os escores do CPQ11-14 e traumatismo dentário foi investigada através de modelos de regressão de Poisson, utilizando gênero, nível socioeconômico e os índices de cárie e estética dental como variáveis de ajuste. Resultados: Foram examinados 1528 alunos, sendo 18,8% de escolas particulares (n=9) e 81,1% de escolas públicas (n=33), obtendo-se uma taxa de resposta de 83%. Uma alta prevalência de traumatismo dentário foi encontrada na população em estudo (34,77%), porém, na maioria dos casos observou-se a presença de traumas leves (24,37%). Além disso, observou-se associação de traumatismo dentário com variáveis sócio-demográficas e ano escolar. Em relação ao impacto na qualidade de vida, foi encontrada uma maior média de CPQ11-14 no domínio limitação funcional, nos indivíduos que apresentavam traumatismo dentário não tratado, quando comparados com os indivíduos que não apresentavam traumatismo dentário ou apresentavam traumatismo sem necessidade de tratamento. Conclusões: O presente estudo demonstrou que o traumatismo dentário é um agravo prevalente e que, quando não tratado, apresenta um comprometimento nas funções orais. / Aim: Identify the prevalence, severity, risk indicators and impact on quality of life oftraumatic dental injury among 12-year-old schoolchildren in Porto Alegre, Brazil. Methods: This study is a part of a cross-sectional survey developed to assess the oral health status of 12-year-old schoolchildren, carried out from September 2009 to December 2010. The eligibility criteria were students attending in selected schools, born in 1997 and 1998. Two questionnaires were used: one for parents/ legal guardians (socioeconomic questions, access to dental services, etc.); and one for schoolchildren (behavioral habits and Child Perceptions Questionnaire - CPQ11-14). The clinical examination was performed as follows: measurement of height and weight, record of the gingival bleeding index, dental esthetics index, dental trauma index and dental caries index. The examinations were performed by two examiners previously calibrated (ICC and Kappa≥ 0.7). The association between traumatic dental injury and the possible risk indicators was assessed using Poisson regression. The association between CPQ11-14 scores and traumatic dental injury was assessed using Poisson regression (gender, socioeconomic status, dental caries index, and dental aesthetics index were used as adjustment variables). Results: We examined 1528 students - 18.8% of private schools (n = 9) and 81.1% of public schools (n = 33), yielding a response rate of 83%. A high prevalence of dental traumatic injury was found in this population (34.77%), being mild trauma in most cases (24.37%). Also, association between traumatic dental injury and socio-demographic characteristics and school year was found. Regarding the impact on quality of life, we found a higher average CPQ11-14 in the domain functional limitation in individuals with untreated traumatic dental injury when compared to individuals who had no trauma or trauma without treatment need. Conclusions: This study showed that traumatic dental injury is prevalent and, when treatment is neglected, oral functions may be impaired.

Objetivo: O objetivo dessa dissertação foi identificar a prevalência, severidade, indicadores de risco e impacto na qualidade de vida do traumatismo dentário em escolares de 12 anos de Porto Alegre, RS – Brasil. Métodos: Essa pesquisa fez parte de um estudo observacional transversal analítico desenvolvido para avaliar a saúde bucal de escolares de 12 anos. A coleta de dados foi realizada no período de setembro de 2009 a dezembro de 2010. Participaram alunos regulamente matriculados e frequentando a escola, nascidos no ano de 1997 e 1998 (12 anos completos até o final do ano do exame - 2009 ou 2010). Dois questionários foram utilizados: um destinado aos pais/responsáveis legais (questões socioeconômicas, acesso a serviços odontológicos, etc.) e outro respondido pelos próprios escolares (hábitos comportamentais e Child Perceptions Questionnaire – CPQ11-14 – instrumento que visa avaliar o impacto das condições de saúde bucal na auto-percepção e qualidade de vida). A sistemática do exame clínico foi: aferição do peso e altura, determinação do índice de sangramento gengival, índice de estética dental, índice de traumatismo dentário e índice de cárie dentária. Os exames foram realizados por duas examinadoras previamente treinadas e calibradas (ICC e Kappa≥ 0,7). A associação entre traumatismo dentário e seus possíveis indicadores de risco foi avaliada através de modelos de regressão de Poisson. A associação entre os escores do CPQ11-14 e traumatismo dentário foi investigada através de modelos de regressão de Poisson, utilizando gênero, nível socioeconômico e os índices de cárie e estética dental como variáveis de ajuste. Resultados: Foram examinados 1528 alunos, sendo 18,8% de escolas particulares (n=9) e 81,1% de escolas públicas (n=33), obtendo-se uma taxa de resposta de 83%. Uma alta prevalência de traumatismo dentário foi encontrada na população em estudo (34,77%), porém, na maioria dos casos observou-se a presença de traumas leves (24,37%). Além disso, observou-se associação de traumatismo dentário com variáveis sócio-demográficas e ano escolar. Em relação ao impacto na qualidade de vida, foi encontrada uma maior média de CPQ11-14 no domínio limitação funcional, nos indivíduos que apresentavam traumatismo dentário não tratado, quando comparados com os indivíduos que não apresentavam traumatismo dentário ou apresentavam traumatismo sem necessidade de tratamento. Conclusões: O presente estudo demonstrou que o traumatismo dentário é um agravo prevalente e que, quando não tratado, apresenta um comprometimento nas funções orais. / Aim: Identify the prevalence, severity, risk indicators and impact on quality of life oftraumatic dental injury among 12-year-old schoolchildren in Porto Alegre, Brazil. Methods: This study is a part of a cross-sectional survey developed to assess the oral health status of 12-year-old schoolchildren, carried out from September 2009 to December 2010. The eligibility criteria were students attending in selected schools, born in 1997 and 1998. Two questionnaires were used: one for parents/ legal guardians (socioeconomic questions, access to dental services, etc.); and one for schoolchildren (behavioral habits and Child Perceptions Questionnaire - CPQ11-14). The clinical examination was performed as follows: measurement of height and weight, record of the gingival bleeding index, dental esthetics index, dental trauma index and dental caries index. The examinations were performed by two examiners previously calibrated (ICC and Kappa≥ 0.7). The association between traumatic dental injury and the possible risk indicators was assessed using Poisson regression. The association between CPQ11-14 scores and traumatic dental injury was assessed using Poisson regression (gender, socioeconomic status, dental caries index, and dental aesthetics index were used as adjustment variables). Results: We examined 1528 students - 18.8% of private schools (n = 9) and 81.1% of public schools (n = 33), yielding a response rate of 83%. A high prevalence of dental traumatic injury was found in this population (34.77%), being mild trauma in most cases (24.37%). Also, association between traumatic dental injury and socio-demographic characteristics and school year was found. Regarding the impact on quality of life, we found a higher average CPQ11-14 in the domain functional limitation in individuals with untreated traumatic dental injury when compared to individuals who had no trauma or trauma without treatment need. Conclusions: This study showed that traumatic dental injury is prevalent and, when treatment is neglected, oral functions may be impaired.

Remote sensing and security, terms which are not usually associated, have found a common platform this decade with the conjuring of the GMOSS network (Global Monitoring for Security and Stability ), whose mandate is to discover new applications for satellite-derived imagery to security issues. This study focuses on human security, concentrating on the characterisation of vulnerable areas to conflict. A time-series of satellite imagery taken from Landsat sensors from 1987 to 2001 and the SRTM mission imagery are used for this purpose over a site in northern Iraq. Human security issues include the exposure to any type of hazard. The region of study is first characterised in order to understand which hazards are and were present in the past for the region of study. The principal hazard for the region of study is armed conflict and the relative field data was analysed to determine the links between geographical indicators and vulnerable areas. This is done through historical research and the study of open-sourced information about disease outbreaks; the movements of refugees and the internally displaced; and humanitarian aid and security issues. These open sources offer information which are not always consistent, objective, or normalized and are therefore difficult to quantify. A method for the rapid mapping and graphing and subsequent analysis of the situation in a region where limited information is available is developed. This information is coupled with population numbers to create a"risk map": A disaggregated matrix of areas most at risk during conflict situations. The results show that describing the risk factor for a population to the hazard conflict depends on three complex indicators: Population density, remoteness and economic diversity. Each of these complex indicators is then derived from Landsat and SRTM imagery and a satellite-driven model is formulated. This model based on satellite imagery is applied to the study site for a temporal study. The output are three 90 m × 90 m resolution grids which describe, at a pixel level, the risk level within the region for each of the dates studies, and the changes which occur in northern Iraq as the result of the Anfal Campaigns. Results show that satellite imagery, with a minimum of processing, can yield indicators for characterising risk in a region. Although by no means a replacement for field data, this technological source, in the absence of local knowledge, can provide users with a starting point in understanding which areas are most at risk within a region. If this data is coupled with open sourced information such as political and cultural discrimination, economy and agricultural practices, a fairly accurate risk map can be generated in the absence of field data.

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No description available.

Since the introduction of the Municipal Finance Management Act (MFMA) in 2003 and the Public Sector Risk Management Framework in 2010, Municipalities had to start focusing on proper risk management as part of their management activities. Within the government sector, risk management needs to be implemented in order to prevent financial losses and to improve service delivery. If shortcomings regarding risk management exist within a municipality, it could have a negative effect on sound financial management and the outcome of annual audits. This study was conducted to test the hypothesis, namely if shortcomings regarding risk management exist within a municipality. Should this be the case, it could possible affect sound financial management and the outcome of annual audits. This was to a large extent proven within this case study and it is likely that other municipalities will have similar problems. Information was obtained from two groups of officials of the Sedibeng District Municipality by means of one-on-one interviews and hand delivered questionnaires. Group 1 consisted of 14 officials not in management positions and group 2 of 11 officials in senior management positions. The questionnaire comprised five sections of questions that aimed at determining the extent of knowledge and attitude of the respondent towards monitoring, assessment, identification and response to risk management within their specific departments. Analysis of the results indicated clearly that the overall risk management knowledge differed substantially from group 1 to group 2. The knowledge, monitoring, assessment, identification and response to risk management activities were minimal or unclear to respondents not in management positions. Respondents in senior management positions were more aware of risk management responsibilities. However they admitted that it was not always done as required and in many cases only due to compliance. The results are strengthened by the statement released by the Auditor General in his 2011 audit report on Sedibeng District Municipality stating “the implementation of appropriate risk management activities to ensure risk assessment, were not conducted and the risk strategy to address the risks was not developed and monitored.” Various recommendations are proposed within this article that could improve the overall management and sustainability of risk management within municipalities. / M Development and Management (Public Management and Governance), North-West University, Vaal Triangle Campus, 2014

Made available in DSpace on 2016-04-27T18:11:55Z (GMT). No. of bitstreams: 1 Sabrina Alves Lima Peixoto.pdf: 1105981 bytes, checksum: df28082bce8b18a4b917509231b971cf (MD5) Previous issue date: 2012-01-31 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introduction: The audiologic monitoring of children with risk indicators for hearing loss (RIHL) aims at the early identification of hearing losses in order to provide adequate therapeutic intervention, and therefore to reduce its consequences upon speech and language development of such children. Aim: To study the results of the audiologic monitoring in a group of children with RIHL submitted to a two-stage protocol of neonatal hearing screening (NHS). Method: Sample was divided in two groups: group 1 (G1) failed transient otoacoustic emission (TOAE) and passed the second stage with Automated Brainstem Auditory Evoked Potential (A-BAEP); and group 2 (G2) with satisfactory results in both procedures, TOAE and A-BAEP. Data collecting included tympanometry, TOAE and Visual Reinforcement Audiometry (VRA) with insertion phones or in free field at 0.5, 1.0, 2.0 and 4.0 kHz. Children who could not be conditioned or who didn t allow the placement of insertion phones and/or bone transducer underwent click-BAEP or frequency specific BAEP at 0,5 and 2.0 KHz. Results: Of the 34 children submitted to audiologic monitoring, 9 presented conductive disorder 3 from G2 (N=17) and 6 from G1 (N=17). No sensorineural hearing losses were detected in both groups. Neonates with RIHL and who failed TOAE presented greater prevalence of conductive hearing disorders in the audiologic monitoring when compared to children who did not fail / Introdução: O monitoramento audiológico de crianças com Indicadores de Risco para Deficiência Auditiva (IRDA) apresenta como propósito a identificação de perdas auditivas para que possam ser oferecidas intervenções terapêuticas adequadas, diminuindo assim a influência desse acometimento no desenvolvimento da fala e da linguagem. Objetivo: Estudar os resultados do monitoramento audiológico em um grupo de crianças com IRDA, submetidas ao protocolo de duas etapas na triagem auditiva neonatal (TAN). Método: A casuística foi dividida em dois grupos: grupo 1 (G1): crianças que falharam nas emissões otoacústicas por estímulo transiente (EOAT) e passaram na segunda etapa com Potencial Evocado Auditivo de Tronco Encefálico Automático (PEATE-A); grupo 2 (G2): crianças com resultados satisfatórios tanto nas EOAT como no PEATE-A. Os procedimentos utilizados na coleta de dados foram: timpanometria, EOAT e Audiometria de Reforço Visual (ARV), com fones de inserção ou em campo livre, nas frequências de 0.5, 1.0, 2.0 e 4.0 kHz. Nos casos de não condicionamento na ARV e de não aceitação da colocação dos fones de inserção e/ou transdutor ósseo pelas crianças com suspeita de perda auditiva, realizou-se o PEATE-click ou PEATE por frequência específica (PEATE-FE) nas frequências de 0.5 e 2kHz. Resultados: Do total de 34 crianças submetidas ao monitoramento audiológico, nove apresentaram alteração condutiva, três do G2 (N=17) e seis do G1 (N=17). Não foram detectadas perdas auditivas sensorioneurais em ambos os grupos. Conclusão: As crianças que falharam nas EOAT na TAN apresentaram maior prevalência de alterações auditivas condutivas no monitoramento audiológico em comparação com as que não falharam