Background: Lung cancer causes more deaths than any other cancer. Smoking causes roughly 90% of lung cancer cases. Concurrent chemoradiation therapy is the standard of care for stage IIIb patients with performance status (PS) 0-1. A less toxic approach is warranted for less fit patients. To optimize care, the understanding of common clinical variables such as haematological responses to inflammation could be much improved. Adherence to guidelines for proper clinical work-up is vital to ensure patients’ optimal care, especially for predictive assays. Screening of high-risk patients is now being implemented internationally. Chronic pulmonary obstructive disease (COPD) patients, a group at high risk to develop lung cancer, could be of interest for screening. Methods: Patient cohorts collected nationally and regionally by manual search in patient records or automated search in electronic patient records and national registries were analysed in relation to overall survival, comorbidities, medication, treatment, smoking status, biomarkers and adherence to guidelines. Standard statistics were applied to adjust for confounding factors. Results: Induction chemotherapy results in longer overall survival than radiotherapy alone (15.6 and 11.6 months respectively). The overall survival for patients with combined anaemia, leucocytosis and thrombocytosis at diagnosis is half of what could be anticipated if blood samples are normal (8.0 and 16.0 months respectively). Fifty percent of patients were overlooked in the routine work-up with EGFR analysis. Less than 40% of the patients received EGFR-tyrosine kinase inhibitors in first-line therapy. The frequency of EGFR mutation was 9.9%. COPD patients with asthma and medicating with inhaled corticosteroids, specific serotonin reuptake inhibitors (SSRI) or beta-blockers have a significantly decreased risk of lung cancer. Conclusions: Patients unfit to receive chemoradiation therapy should be considered for induction chemotherapy sequentially to radiotherapy. A patient that presents with pathological blood samples is likely to have poor prognosis and diagnostic work-up should be thorough to optimize outcome. Inadequate adherence to the national guidelines regarding treatment and EGFR analysis was shown. COPD patients medicating with ICS, beta-blockers or SSRI and with a concurrent asthma diagnosis have a decreased risk of lung cancer.

During a risk assessment undertaken in a factory dealing with fiber reinforced plastic products in the northwestern part of Peninsular Malaysia, styrene was identified as the most potential hazard in the factory. It was therefore chosen to focus the rest of the risk assessment on this chemical. The purpose of this risk assessment was to find out which negative health effects styrene could have on the factory workers, especially on the laminators who are dealing daily with styrene at a close range during lamination through hand lay-up. This was investigated theoretically through a literature research and practically through measurements of styrene in the air in the factory. The styrene doses were measured on two occasions at several distances away from the potential sources. These measurements were high compared with dose-response relationships found in the literature and various national occupational exposure limit values with regards to styrene. The calculated risk quotient (RQ) was also greater than one and it is therefore likely that styrene has negative health effects on the workers in the factory. The various negative health effects identified in the literature were then included in a risk matrix were they were ranked according to the probability that they would have a negative effect on the factory workers. Hearing- and colourvision effects were ranked as very likely, effects on the central nervous system and the respiratory system as well as livertoxicity were classified as likely and genotoxicity was ranked as a possible negative health effect. In the future it would be interesting to talk to the current laminators and do health check-ups to see if they are suffering from any of the suggested negative health effects. It would also be interesting to follow them on a longterm basis to see if their health is changing and if this can be linked to the styrene handling in the factory. / Vid en riskbedömning i en fabrik i nordvästra Malaysia identifierades styren som den största hälsofaran för fabriksarbetarna, framförallt laminerarna eftersom de ofta hanterar styren på nära håll. Det valdes därför att fokusera den resterande riskbedömningen just på styren och dess möjliga negativa hälsoeffekter. Syftet med studien var att ta reda på om styren kan ha en negativ effekt på fabriksarbetarnas hälsa. Detta undersöktes teoretiskt genom en litteraturstudie och praktiskt genom mätningar av styrenhalten i fabriken. Vid två tillfällen mättes styrenhalten i fabriken. De uppmätta halterna jämfördes sedan med de dos-responssamband som funnits vid litteraturstudien, samt med olika nationella hygieniska gränsvärden för styren. De uppmätta värdena visade sig vara höga jämfört med de funna i litteraturen. Det bidrog tillsammans med den beräknade riskkvoten som visade sig vara större än ett, till slutsatsen att styren har en negativ effekt på fabriksarbetarnas hälsa. De möjliga negativa hälsoeffekter som identifierats i litteraturen rangordnas med hjälp av en riskmatris enligt sannolikheten att de skulle utgjöra en risk för arbetarna i fabriken. Effekter på hörseln och färgseendet ansågs vara mycket sannolikt, effekter på centrala nervsystemet (CNS) och levern samt irritation av andningssystemet ansågs sannolika och att styren skulle vara genotoxiskt ansågs möjligt. Övriga hälsoeffekter ansågs osannolika eller mycket osannolika. I framtida studier skulle det vara intressant att diskutera med de nuvarande laminerarna och undersöka dem medicinskt för att se om de har påverkats utav några av de förväntade hälsoeffekterna. Det vore också intressant att följa dessa arbetare under en längre tid för att se om deras hälsa ändras på något sätt som skulle kunna kopplas till styrenhanteringen i fabriken.

ContexteDe nombreux facteurs influencent l’exposition des agriculteurs aux produits phytopharmaceutiques (PP) : facteurs techniques (matériel de pulvérisation, forme et type des PP employés), agronomiques (pression parasitaire, doses employées, type de culture) et humains. La perception d'un risque est un facteur déterminant du comportement humain face à celui-ci. La perception du risque phytosanitaire chez les agriculteurs et ses conséquences sur l'exposition aux substances actives des utilisateurs sont peu étudiées.ObjectifL’objectif de ce travail est d’évaluer comment la perception du risque influe sur les pratiques des agriculteurs. Il vise aussi à décrire et évaluer les déterminants de cette perception, et leurs impacts sur le risque sanitaire des utilisateurs de PP. Méthode.Des entretiens individuels sont menés pour évaluer la perception du risque auprès d’utilisateurs de PP. Des mesures et modélisations d’exposition complètent ces observations. Les mesures se focalisent sur les paramètres influencés par la perception du risque décrits lors des entretiens. Les résultats des mesures d’exposition sont comparés aux pratiques observées et servent à qualifier et quantifier l’impact de la perception sur le risque sanitaire.RésultatsCe travail montre que la perception des agriculteurs du risque liés aux PP est empirique et se base sur des critères tels que l'odeur, le type, la forme ou l'efficacité des produits pour estimer le risque. Les comportements des agriculteurs pour réduire leur exposition sont corrélés à leur perception des produits employés. L'utilisation des équipements de protection individuelle (EPI) est le marqueur le plus fort de la perception. Plus le risque est perçu comme important, plus l'utilisation d'EPI est élevée. Mais les pratiques de réduction du risque ne sont pas toujours efficaces pour réduire l'exposition. En effet, les mesures d'exposition réalisées montrent que les opérateurs, même utilisateurs d'EPI, n'ont pas conscience des phénomènes de contaminations indirectes (cabine des tracteurs, environnement de travail). Combinés à un mauvais usage fréquent des EPI (réutilisation d'EPI à usage unique, utilisation partielle ou inadaptée), ces défauts de perception jouent sur l'exposition aux PP.Les modélisations et mesure d’exposition en fonction des pratiques observées ont permis de quantifier les conséquences sanitaires de ces comportements. Il ressort que le risque sanitaire lors de l'utilisation des PP dans le cadre des bonnes pratiques est acceptable. Cependant ces bonnes pratique sont théoriques et les observations montrent que les opérateurs ont des comportements qui s'éloignent des bonnes pratiques et les exposent aux PP, mais ces comportements ne sont pas perçus comme tels. Le risque sanitaire associé aux pratiques est très individuel et difficilement généralisable. Cependant, ce travail exploratoire a permis de mettre à jour des profils de risque et de décrire les déterminants forts de la perception. La sensation de maîtrise du risque est le déterminant clef dans l'acceptation du risque par les agriculteurs. ConclusionCe travail montre que la perception du risque joue un rôle décisif dans l'exposition totale des agriculteurs aux PP. Le risque sanitaire est sensiblement dépendant de la perception du risque. Les politiques de prévention des risques doivent s'appuyer sur cet aspect afin d'adapter les messages et d'éduquer les opérateurs aux pratiques exposantes telles que la contamination indirecte ou le mauvais usage des EPI, aujourd'hui peu pris en compte par les utilisateurs de pesticides. / IntroductionMany factors influence the exposure of farmers to pesticides. Technical (spraying equipment, type of pesticides used), agronomic (type of crop, doses used, frequency) and human factors. The perception of risk is a determinant key of human behavior and how human faces to risk. Pest risk perception among farmers and the consequences of exposure to active substances of farmers have not been clearly studied.AimsThe objective of this study is to evaluate how risk perception affects farmers' practices. It also aims to describe and assess the determinants of this perception, and their impact on the health risk of pesticides users.Individual interviews are conducted to describe the perception of risk of pesticides' users. Measurements and modeling of exposure complement these observations. The measures focus on the parameters influenced by the perception of risk described in the interviews. The results of exposure measurements are compared to practices observed and used to qualify and quantify the impact of perception on health risk.ResultsThis work shows that farmers' perceptions of risk related to pesticides used is empirical and based on criteria such as smell, type, form or effectiveness of products to estimate the risk. Farmers' behavior to reduce exposure is correlated with their perception of the products used. The use of personal protective equipment (PPE) is the strongest marker of perception. The higher the risk perceived, the greater the use of PPE is high. But the practical risk reductions are not always effective in reducing exposure. Indeed, exposure measurements show that operators, even in users of PPE, are unaware of indirect contamination (cab tractors, work environment). Combined with frequent misuse of PPE (reuse of disposable PPE, partial or improper use), these defects perception are increase exposure to pesticides.Modeling and exposure’s measurement based on observed practices are used to quantify the health consequences of these behaviors. It appears that the health risk of pesticides is acceptable when used as recommended. However, recommended practices are theoretical and observations show that operators have behaviors that deviate from recommended practices depending on pesticides used. But these behaviors are not perceived as risky. The health risks associated with individual practice is very difficult to generalize. However, this work highlights profiles of risk and describes strong determinants of perception. The risk-control feeling is the key determinant in risk acceptance by farmers.ConclusionThis work shows that the perception of risk plays a decisive role in the exposure to pesticide of farmers. The health risk is substantially dependent on the perception of risk. The risk prevention policies must support this risk perception to adapt messages and educate the operators to not adapted practices such as indirect contamination or improper use of PPE, few considered by some pesticides users.

Denna uppsats utreder problemet bakom finansiellt bedrägeri. Då bedrägeri är ett vanligt förekommande ekonomibrott är det ett problem alla företag kan utsättas för. Syftet med uppsatsen är att försöka få en djupare förståelse för den interna kontrollen och vilken roll den spelar inom företag. Det exakta forskningsproblemet är: Vad har den interna kontrollen för betydelse för en organisation? För att studera problemet började vi med att undersöka den mänskliga faktorn bakom bedrägeri med hjälp av COSO-modellens fem huvudkomponenter: kontrollmiljö, riskbedömning, kontrollaktiviteter samt information och kommunikation har vi utfört ett fallstudie på ett svenskt företag. Den teorin vi valde att använda oss av var i linje med COSO-modellen, vilket är ett ramverk som hjälper företag att organisera sina interna kontroller, och det var också detta vi använde som analysmodell för det insamlade materialet. Det utvalda företaget använde sig för stunden av ramverket för deras interna kontroller. Den empiriska delen har bestått av kvalitativa intervjuer som har genomförts med hjälp av sex olika individer anställda på olika nivåer inom den utvalda organisationen, för att på så vis få en bättre bild av och förståelse för hela organisationen. Respondenternas bakgrund och befattning varierade mellan varandra, av denna anledning passade det bra med en semi-strukturerad intervjuguide för att undvika att viktiga eller intressanta ämnen skulle förbises. Genom denna uppsats har vi undersökt en organisations interna kontroller och hur den uppfattas genom hela organisationen. Analysen stämde överens med teorierna som påstod att en organisation behöver ett väl strukturerat internt kontrollsystem med en kontinuerlig riskanalysering, för att undvika bedrägerier och liknande skandaler. Samt att med de rätta kontrollerna och med en mer enad arbetsprocess lämnar det mindre utrymme för anställda och andra involverade att utnyttja systemet och därmed ökar säkerheten och minskar risken inom organisationen. / The purpose of this thesis is to get a deeper understanding of the role that internal control plays within the company, also what internal control means to the organizations. We examined a swedish company using the COSO-modell ’s five components, namely control environment, control activities, risk assessment, information and communication and monitoring. The chosen company was currently using the COSO-modell for their internal control. Therefore, the questionnaires were designed in line with these components The study showed that to avoid fraud and scandals an organization need a well structured internal control system with a constant risk analysing. With the right control mechanism and a more united working process it leaves less room for employees and other individuals involved to manipulate the system, consequently increasing the security and decreasing the risk within the organization.

Volcanic eruptions produce a range of concurrent, sequential and recurrent hazards which can impact society and critical infrastructure. For daily activities, modern societies are reliant on dependable functioning critical infrastructure, such as electrical supply; water supply; wastewater; transportation; communication networks; buildings; air conditioning and ventilation systems; and electronic equipment. In addition, during volcanic eruptions these sectors are vital for effective emergency response and recovery. Despite the importance of critical infrastructure, the systematic quantification of their vulnerability to volcanic hazards, a key aspect of volcanic risk management, has received little research attention. Successful volcanic risk management and disaster risk reduction are cost effective investments in preventing future losses during eruptions and increasing resilience to volcanic hazard impacts. Effective volcanic risk management requires the characterisation of both hazards and vulnerabilities to the same level of detail. This thesis develops a methodological framework to quantitatively assess the vulnerability of critical infrastructure sectors to volcanic hazard impacts. The focus is on fragility and vulnerability functions which provide quantitative relationships between impact (damage and disruption) and volcanic hazard intensity. The framework details how post-eruption infrastructure impact data, compiled in a newly established infrastructure impacts database, can be classified by hazard and impact intensity to derive vulnerability and fragility functions. Using the vulnerability framework, fragility functions for several critical infrastructure sectors for volcanic tephra fall impacts are derived. These functions are the first attempt to quantify the vulnerability of critical infrastructure sectors using a systematic approach. Using these fragility functions, risk is estimated for the electrical transmission network in the North Island of New Zealand using a newly developed probabilistic tephra fall hazard assessment. This thesis and framework provide a pathway forward for volcanic risk scientists to advance volcanic vulnerability assessments such that comprehensive and robust quantitative volcanic risk assessments are commonplace in infrastructure management practices. Improved volcanic vulnerability and risk assessments leads to enhanced risk-based decision making, prioritisation of risk reduction investment and overall reduction in volcanic risk.

Several dams throughout the United States have been built on karst terrains, where soluble limestone bedrock has been dissolved to form features such as caves, sinkholes, and underground rivers. In such karst regions, subsurface hydrology can play an integral role in the condition, operation, and safety of dams and should be considered during risk assessment. Patoka Dam, near Jasper, Indiana, is situated on a well-developed karst landscape/aquifer system, faces significant potential challenges, and recently underwent risk assessment. A groundwater flow investigation using multiple fluorescent tracer tests, analysis of water-table elevations, isopach mapping of the Glen Dean Limestone, and spring hydrograph analysis was performed to better understand local groundwater hydrology in the vicinity of the existing water-control structures. Dye-tracing results identified the local flow direction as south to north and the mean dye travel time from injection locations to Robert Hall Cave Spring (RHCS) as 8- 11 feet per hour. These results also indicate that groundwater is bypassing the control structures in the vicinity of the cut-off wall, but the geometry of these flow paths is not clear. The recharge area for RHCS, a significant groundwater discharge point downstream from Patoka Dam, was delineated and the existence of a groundwater divide in the area of the dike was confirmed. The location of this groundwater-basin boundary follows an estimation of where the Glen Dean Limestone outcrops along the perimeter of the dissected ridge that lies between Patoka Lake and RHCS. Spring hydrograph analysis shows that spring discharge is primarily influenced by local precipitation events. However, precipitation events can result in increased pool elevation making the relationship between spring discharge and pool elevation unclear within the data set. This groundwater investigation has provided a clearer characterization of the hydrogeology within the vicinity of Patoka Dam. In combining the various hydrogeologic results, some insight into the function and geometry of the local karst network that could potentially affect the integrity of the dam and/or dike structures has been provided.

Samhällets utveckling i kombination med förändringar inom hälso- och sjukvården ökar risken att drabbas av en allvarlig händelse. Hälso- och sjukvården måste därför anpassas för att kunna hantera situationer med ett stort skadeutfall, i samma utsträckning som en oväntad minskning av tillgänglig kapacitet, till exempel vårdplatsbrist. Genom att hitta svagheter i verksamheten så ökar möjligheterna att åtgärda dessa och därmed förmågan att kunna upprätthålla de ordinarie målen för vård och behandling av patienter vid en allvarlig händelse. Syftet med denna studie var att utveckla och testa en arbetsmetod för att systematiskt kunna analysera och utvärdera katastrofmedicinsk beredskap, samt identifiera, orsaksbestämma, åtgärdsanalysera och mäta förmågan att hantera de för Landstinget i Östergötland (LiÖ) väsentliga områdena av katastrofmedicinskt beredskap. För detta ändamål utvecklades en arbetsmetod genom att kombinera en av Katastrofmedicinskt Centrum skapad strukturmall med den metod som Patientsäkerhetsenheten inom LiÖ använder sig av vid riskanalyser. Strukturmallen utgår ifrån Socialstyrelsens föreskrifter och allmänna råd (2005:13) om vad Hälso- och sjukvården särskilt bör uppmärksamma i relation till vad dess verksamhet skall baseras på. Resultatet visar att strukturmallen i kombination med patientsäkerhetsmetoden ger möjlighet att systematiskt utföra riskanalyser inom de identifierade områdena av katastrofmedicinsk beredskap. Arbetsmetoden bidrog till en samsyn om olika begrepps betydelse, samt identifiering och värdering av för den katastrofmedicinska beredskapen förekommande risker. En fortsatt utveckling av metoden krävs för att kunna analysera och utvärdera effekter av riskminskande åtgärder. / The aim of the study was to develop and test a new methodology for a systematic analysis of disaster preparedness in the County Council of Östergötland. The aim was also to identify, categorise and create measurability of the surge capacity within important fields of the disaster preparedness of the County Council of Östergötland. The methodology is based on the use of a template developed by the Centre for Teaching and Research in Disaster Medicine and Traumatology (KMC), in combination with a validated patient risk assessment tool. The KMC template is based on national regulations and guidelines issued by the Swedish National Board of Health and Welfare. The template includes, in accordance with the board, what disaster preparedness should pay particular attention to in the planning process, in relation to the different components of disaster preparedness. The results demonstrate that the template in combination with the risk assessment tool made it possible for an expert group to systematically conduct risk analysis within the identified areas of the disaster preparedness. Future development of this methodology will be needed in order to analyse and evaluate the effects of risk mitigation measures.

<p>Natural steroidal estrogen hormones in swine wastes generated from Concentrated Animal Feeding Operations (CAFOs) have become a potential pollutant to many aquatic environments due to their adverse impacts on the reproductive biology of aquatic organisms. In North Carolina, the swine CAFO industry is a major agricultural economic enterprise that is responsible for the generation of large volumes of waste. However, there is limited scientific understanding regarding the concentration, fate, and transport of the estrogenic compounds from these swine facilities into terrestrial and aquatic environments. To address this issue, my research involved the development and application of integrated Bayesian networks (BNs) models that can be used to better characterize and assess the generation, fate, and transport of site-specific swine CAFO-derived estrogen compounds. The developed model can be used as decision support tool towards estrogen risk assessment. Modularized and melded BN approaches were used to capture the predictive and casual relationships of the estrogen budget and its movement within and between the three major systems of a swine farrowing CAFO. These systems include the animal barns, the anaerobic waste lagoon, and the spray fields. For the animal barn system, a facility-wide estrogen budget was developed to assess the operation-specific estrogen excretion, using an object-oriented BN (OOBN) approach. The developed OOBN model provides a means to estimate and predict estrogen fluxes from the whole swine facility in the context of both estrogen type and animal operating unit. It also accounts for the uncertainties in the data and in our understanding of the system. Next, mass balance melding BN models were developed to predict the natural estrogen fates and budgets in two lagoon compartments, the slurry and the sludge storage. This involved utilizing mass balance equations to account for the mechanisms of flushing, sorption, transformation, settling, and burial reactions of estrogen compounds in the slurry and sludge storages. As an alternative approach, a regression based BN melding approach was developed to both characterize estrogen fate and budgets as a result of the sequential transformation processes between natural estrogen compounds and to assess the seasonal effects on the estrogen budgets in the two different lagoon compartments. Finally, a dynamic BN model was developed to characterize rainfall-driven estrogen runoff processes from the spray fields. The dynamic BN models were used to assess the potential risk of estrogen runoff to adjacent waterways. In addition, the dynamic model was used to quantify the effects of manure application rates, rainfall frequency, the time of rainfall and irrigation, crop types, on-farm best management practices, seasonal variability, and successive rainfall and manure application events on estrogen runoff. </p><p>The model results indicate that the farrowing barn is the biggest contributor of total estrogen as compared to the breeding and gestation operating barns. Once the estrogen reaches the anaerobic lagoon, settling and burial reactions were shown to be the most significant factors influencing estrogen levels in the slurry and sludge, respectively. The estrogen budgets in the lagoon were also found to vary by season, with higher slurry and sludge estrogen levels in the spring as compared to the summer. The risk of estrogen runoff was predicted to be lower in the summer as compared to the spring, primarily due to the spray field crop management plans adopted. The results also indicated that Bermuda grass performed more favorably when compared to soybean, when it came to retaining surface water runoff in the field. Model predictions indicated that there is a low risk of estrogen runoff losses from the spray fields under multiple irrigation and rainfall events, unless the time interval between irrigation was less than 10 days and/or in the event of a prolonged high magnitude rainstorm event. Overall, the estrone was the most persistent form of natural estrogens in the three major systems of the swine farrowing CAFO.</p> / Dissertation

Contaminated sites are a common problem across municipalities in the Greater Vancouver Regional District. These problems are complicated and multi-dimensional, and raise fundamental concerns about the risks to human and environmental health. This thesis shows however, that there are no easy answers to how much risk is "acceptable", and no one right way to decide. How the acceptable risk problem is structured is important, because fact and value issues, a source of controversy and dispute, are variously interpreted depending on how the problem is cast. The literature generically categorizes acceptable risk as either a technical, social or decision problem, and each of these have implications for the types of decision-making approaches and solutions that are considered appropriate in resolving acceptable risk. This thesis investigated how acceptable risk in contaminated site problems is handled in British Columbia by reviewing the provincial decision-making framework, and by surveying municipalities in the Greater Vancouver Regional District for their views on contaminated site problems and acceptable risk decision-making. The underlying goal of the thesis is to question the use of the current approach, the Pacific Place site criteria, as a model for acceptable risk decision-making in the province, and to explore the implications for urban communities. The Ministry of Environment is the central authority for contaminated sites in British Columbia and has generally taken a scientific and technical approach to the problem. Although the municipal survey suggests that the Pacific Place site criteria has a broad base of support in the GVRD, the technical emphasis has implications for urban communities. The approach is expert-oriented and largely excludes local and public involvement in the acceptable risk debate. The major concern is that important social value issues have been neglected, relative to the engineering and technical aspects of the problem. The research also finds however, that the majority of individuals in the municipal survey are willing to explore other methods of determining acceptable risk, and support in principle, local government and public involvement in deciding what these methods should be. This thesis suggests that British Columbia can benefit from a more comprehensive view of acceptable risk in contaminated site problems. Resource limitations at the provincial and local level, and the high stakes in contaminated site problems for urban communities point to the growing importance of incorporating a broad range of value issues and understanding the trade-offs in acceptable risk decisions. The Ministry of Environment can improve the current decision-making approach by: incorporating structured value assessments that elicit stakeholder values and address trade-offs; involving a wider range of stakeholders in standard setting and risk assessment, including the forthcoming review of the Pacific Place site criteria; creating forums to explore other decision-making approaches; and by encouraging private sector involvement in risk assessment and risk management. The province can also encourage and support community-based institutional networks, both at the municipal and regional level.

No description available.