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Articles de revues sur le sujet "Risk management – France – History"
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Carrier, Hélène, Anna Zaytseva, Aurélie Bocquier, Patrick Villani, Hélène Verdoux, Martin Fortin et Pierre Verger. « GPs’ management of polypharmacy and therapeutic dilemma in patients with multimorbidity : a cross-sectional survey of GPs in France ». British Journal of General Practice 69, no 681 (25 février 2019) : e270-e278. http://dx.doi.org/10.3399/bjgp19x701801.
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BackgroundGPs are confronted with therapeutic dilemmas in treating patients with multimorbidity and/or polypharmacy when unfavourable medication risk–benefit ratios (RBRs) conflict with patients’ demands.AimTo understand GPs’ attitudes about prescribing and/or deprescribing medicines for patients with multimorbidity and/or polypharmacy, and factors associated with their decisions.Design and settingCross-sectional survey in 2016 among a national panel of 1266 randomly selected GPs in private practice in France.MethodGPs’ opinions and attitudes were explored using a standardised questionnaire including a case vignette about a female treated for multiple somatic diseases, sleeping disorders, and chronic pain. Participants were randomly assigned one of eight versions of this case vignette, varying by patient age, socioprofessional status, and stroke history. Backward selection was used to identify factors associated with GPs’ decisions about drugs they considered inappropriate.ResultsNearly all (91.4%) responders felt comfortable or fairly comfortable deprescribing inappropriate medications, but only 34.7% decided to do so often or very often. In the clinical vignette, most GPs chose to discontinue symptomatic medications (for example, benzodiazepine, paracetamol/tramadol) because of unfavourable RBRs. When patients asked for ketoprofen for persistent sciatica, 94.1% considered this prescription risky, but 25.6% would prescribe it. They were less likely to prescribe it to older patients (adjusted odds ratio [AOR] 0.48, 95% confidence interval [CI] = 0.36 to 0.63), or those with a stroke history (AOR 0.55, 95% CI = 0.42 to 0.72).ConclusionIn therapeutic dilemmas, some GPs choose to prioritise patients’ requests over iatrogenic risks. GPs need pragmatic implementation tools for handling therapeutic dilemmas, and to improve their skills in medication management and patient engagement in such situations.
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Desramé, Jérôme, Louis-Marie Dourthe, Philippe Debourdeau, Dominique Mille, Pascal Artru et Helene Albrand. « Raltitrexed in the management of metastatic colorectal cancer : The COMET study. » Journal of Clinical Oncology 33, no 3_suppl (20 janvier 2015) : 677. http://dx.doi.org/10.1200/jco.2015.33.3_suppl.677.
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677 Background: Raltitrexed, indicated for palliative treatment of advanced colorectal cancer (CRC), may be useful for patients (pts) with cardiovascular (CV) risk factors, or cardiotoxicity/disease progression with prior chemotherapy (CT). The COMET study, conducted in France, described the characteristics of pts with metastatic CRC (mCRC) treated with raltitrexed, focusing on pts with cardiotoxicity or disease progression with prior 5-fluorouracil (5FU)/folinic acid. Methods: A national, multicentred, cross-sectional, non-interventional study to describe the profiles of pts with mCRC treated with raltitrexed. Pts (≥18 years) with mCRC, treated with raltitrexed as a single agent or in combination therapy, were included. Following patient consent, retrospective data were recorded during a single inclusion visit based on pt medical files; during the study, data were recorded prospectively. Results: 414 pts with mCRC were analysed; 84.8% had ≥1 prior CT, 60.9% had CV risk factors and 35.2% had CV history (angina: 11.8%; myocardial infarction: 11.8%). Overall, 79.5% of pts had received a prior 5FU-based CT. Reasons for switching to raltitrexed included short 15-min infusion duration (34.8%), treatment failure (49.8%) and acute cardiotoxicity with 5FU (8.9%). After switching, 57.2% of pts received raltitrexed as combination therapy. Mean initial dosage of raltitrexed was 2.6±0.6 mg/m2. Of those who had CV risk factors (n=73) or CV history (n=67), 69.0% and 72.7% received raltitrexed after CV toxicity, respectively. Of the pts treated with second-line raltitrexed and assessed with prior acute CV events (45/414), 88.9% (40/45) had no cardiac toxicity during treatment with raltitrexed. Of those (n=206) receiving raltitrexed due to treatment failure, 62.7% had received 5FU/folinic acid during their last CT. Of the pts assessed for tumour response (183/206), tumour progression was controlled with raltitrexed in 25.7% of cases (stable disease: 18.0%; partial response: 7.7%; progressive disease: 56.3%). Conclusions: Raltitrexed appears to be effective in heavily pretreated pts with mCRC and tumour progression after 5FU therapy and could be a safe therapeutic alternative to 5FU for pts with mCRC and prior cardiac toxicity.
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Barbezat, Daniel. « The Comptoir Sidérurgique de France, 1930–1939 ». Business History Review 70, no 4 (1996) : 517–40. http://dx.doi.org/10.2307/3117314.
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The French inter-war steel cartels were characterized by contemporaries as powerful trusts, restricting output and raising steel prices. The cartels were cited as a cause for the length of the French depression, the low productivity of the 1930s, and the rapid rise in steel prices after 1936. This paper shows that the formation and development of the French steel cartels was problematic and argues that the French industry was not structurally conducive to widespread collusion and was further harmed by governmental policies. Steel cartels were unable to police their arrangements effectively among members and were unable to stop outsiders from undercutting prices. It is not at all clear that firms in the cartel achieved higher profits. The increase in prices that did occur after 1936 was not due to firms colluding and profiting from the increased demand for steel due to the anticipation of Nazi aggression; rather, these price increases occurred because of input price increases caused by government action that raised the costs of production.
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Mrozik, Adrian, Yann Sellier, Déborah Lemaitre et Laurent Gaucher. « Evaluation of Midwives’ Practises on Herpetic Infections during Pregnancy : A French Vignette-Based Study ». Healthcare 11, no 3 (28 janvier 2023) : 364. http://dx.doi.org/10.3390/healthcare11030364.
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(1) Background: One out of two pregnant women has a history of herpes infection. Initial infections have a high risk of neonatal transmission. Our objective was to analyse the professional practises of midwives regarding the management of herpes infections during pregnancy in France; (2) Methods: A national survey conducted via an online self-questionnaire, including clinical vignettes for which the midwives proposed a diagnosis, a drug treatment, a mode of birth, and a prognosis. These responses were used to evaluate the conformity of the responses to the guidelines, as well as the influence of certain criteria, such as mode of practise and experience; (3) Results: Of 728 responses, only 26.1% of the midwives reported being aware of the 2017 clinical practise guidelines. The midwives proposed taking the appropriate actions in 56.1% of the responses in the case of a recurrence, and in 95.1% of the responses in the case of a primary infection. For the specific, high-risk case of a nonprimary initial infection at 38 weeks of gestation, reporting knowledge of the recommendations improved the compliance of the proposed care by 40% (p = 0.02). However, 33.8% of the midwives underestimated the neonatal risk at term after a primary initial infection, and 43% underestimated the risk after a primary initial infection at term; (4) Conclusions: The majority of reported practises were compliant despite a low level of knowledge of the guidelines. The dissemination of guidelines may be important to improve information and adherence to appropriate therapeutic practise.
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Fitzgerald, M., et F. McNicholas. « Attitudes and practices in the management of ADHD among healthcare professionals who responded to a European survey ». Irish Journal of Psychological Medicine 31, no 1 (18 septembre 2013) : 31–37. http://dx.doi.org/10.1017/ipm.2013.45.
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ObjectivesTo examine attitudes and practices in the management of attention-deficit/hyperactivity disorder (ADHD) among health professionals across seven European countries.MethodsThe web-based survey was developed by an international steering committee of ADHD experts and consisted of 64 multiple-choice questions relating to ADHD, covering the following topics: attitudes, diagnosis, referral, treatment and improving care. Health professionals working with ADHD were identified using a medical marketing database (Medical Marketing Service Inc., IL, USA) and invited via email to participate in the survey. No incentive was offered for participation and the survey was only available in English.ResultsOver 22 000 emails and postal invitations were sent. One hundred and thirty-four (0.6%) health professionals completed the survey. Results highlighted significant differences by profession and country. In general, ADHD is considered a clinically important and valid disorder (n = 111, 84%), with biological underpinnings (n = 82, 62%), continuing into adulthood (n = 123, 93%) and responsive to treatment. Respondents from France were less likely to be convinced about biological validity (n = 4, 27%) and those from Italy and France were more likely to be concerned about the risk of underdiagnosis (n = 9, 64% and n = 9, 60%, respectively). Psychologists were the specialty who most frequently reported not believing in the diagnostic validity of ADHD (n = 4, 19%). One-third (n = 25, 35%) of respondents recommended medical tests before prescribing medication, with differences emerging by country despite the lack of support for such routine assessments in the guidelines.ConclusionsDespite the very low response rate, intriguing country- and profession-specific differences emerged in this study and warrant further exploration.
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Frèche, Bernard, Julie Salvan, Marie Caroline Roch, Antoine Guerin, Elodie Poupin, Maxime Pichon et Christophe Burucoa. « Diagnostic and Therapeutic Management of Helicobacter pylori Infection in Primary Care : Perspective of Application in France and Narrative Review of the Literature ». Healthcare 11, no 3 (30 janvier 2023) : 397. http://dx.doi.org/10.3390/healthcare11030397.
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Background. Helicobacter pylori (Hp) infection affects 30% to 40% of people in industrialized countries. Aim. This study aimed to synthesize knowledge on the diagnostic and therapeutic management of Hp infection in general practice in people under 40 years of age. Method. A narrative review of the literature with an inductive content analysis of the articles was performed. Results. The extracted data (22 articles out of 106 included after screening of 965 articles) determined three areas of analysis: indications for screening, methods of screening and diagnosis by non-invasive tests, and treatment modalities. Discussion. Targeted, easily performed screening with noninvasive tests is recommended for patients younger than 45 years of age with no family history of gastric cancer and symptoms of dyspepsia without warning signs. Given their proximity to the general population and their coverage of the territory, general practitioners are ideally positioned. Treatment modalities are well-codified and feasible in primary care. Simplifying the recommendations available to them would optimize the identification of patients at risk and the management of Hp infection. Informing, educating, involving, supporting, and promoting the control of Hp infection in primary care will be future goals. Further research is needed in primary care to evaluate the impact of new procedures on Hp control.
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Squara, Pierre-Alexandre, Vinh-Phuc Luu, David Pérol, Bruno Coudert, Valérie Machuron, Camille Bachot, Laurence Samelson, Virginie Florentin, Jean-Marc Pinguet et Béchir Ben Hadj Yahia. « Personalized Reimbursement Model (PRM) program : A real-world data platform of cancer drugs use to improve and personalize drug pricing and reimbursement in France ». PLOS ONE 17, no 4 (19 avril 2022) : e0267242. http://dx.doi.org/10.1371/journal.pone.0267242.
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Objective This article describes the Personalized Reimbursement Model (PRM) program methodology, limitations, achievement and perspectives in using real-world data of cancer drugs use to improve and personalize drug pricing and reimbursement in France. Materials and methods PRM platform aggregates Electronic Pharmacy Records (EPR) data from French medical centers (PRM centers) to build retrospective cohorts of patients treated with injectable cancer drugs in a hospital setting. Data extracted on January 1st, 2020, from breast cancer (BC) patients who received trastuzumab, trastuzumab emtansin or pertuzumab since January 1st, 2011, and from lung cancer (LC) patients who received bevacizumab or atezolizumab since January 1st, 2015, enabled recovering their injectable cancer drugs history from diagnosis date until December 30th, 2019, and served as dataset for assessment. Results 123 PRM centers provided data from 30,730 patients (25,660 BC and 5,070 LC patients respectively). Overall, 20,942 (82%) of BC and 4,716 (93%) of LC patients were analyzed. Completion rate was above 98% for patients characteristics, diagnostic and treatment related data. PRM centers cover 48% and 33% of BC and LC patients in-hospital therapeutic management in France, respectively. Distribution of BC and LC patients therapeutic management, by medical center category and geographic location, was similar in PRM centers to all French medical centers, ensuring the representativeness of the PRM platform. Conclusion PRM Platform enabled building a national database generating on demand Real-World Evidence based on EPR. This enabled the first performance-based risk-sharing arrangements based on PRM data, between the CEPS and Roche, for atezolizumab cancer immunotherapy in metastatic non-small cell lung cancer indication.
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Stephenson, Joe, LeAnn Perkins, Erinn Crowe, Regina Franco, Carmen Hancock, Pamela Cloys et Marie Smith. « Abstract P3-03-07 : The Breast Cancer Prevention Clinic : A Single Institution’s Experience ». Cancer Research 83, no 5_Supplement (1 mars 2023) : P3–03–07—P3–03–07. http://dx.doi.org/10.1158/1538-7445.sabcs22-p3-03-07.
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Abstract The Breast Cancer Prevention Clinic: A Single Institution’s Experience Authors: Joe J. Stephenson MD1, LeAnn Perkins, FNP-BC, DipACLM1, Erinn Crowe, RN, BSN, OCN1, Regina Franco, MSN, NP-C, DipACLM1, Pamela Cloys, MSN, ANP-C1, Carmen Hancock, MSN, APRN, FNP-C, AOCNP1, Marie Smith, MS1 1Prisma Health Cancer Institute, Center for Integrative Oncology & Survivorship Background: Roughly 1 in 8 women will be diagnosed with invasive breast cancer in their lifetime1. Some women have higher risk for developing breast cancer due to numerous factors such as elevated risk modeling scores, a history of chest radiation therapy, a history of atypical cells on a breast biopsy or a pathogenic genetic mutation. Enhanced surveillance to detect cancers early and addressing modifiable lifestyle risks are helpful to mitigate risks. Methods: The Prisma Health’s Breast Cancer Prevention Clinic (BCPC) approaches prevention by monitoring non-modifiable risks with regular surveillance and education on optimizing lifestyle habits to decrease modifiable risks. Established in 2017, the BCPC team now includes multiple medical oncologists and nurse practitioners, allowing the clinic to be offered any day of the week. During the visit, patients receive a personal risk assessment. Recommendations are given for surveillance imaging, risk-reducing endocrine therapy, and risk-reducing lifestyle modifications such as diet, alcohol consumption, and exercise routines. Family history is also reviewed to recommend Genetic Counseling if appropriate. In March 2022, a statement was added to patient mammograms, generating referrals for those with calculated elevated risk (a calculated lifetime risk >20% using the Tyrer-Cuzick or International Breast Cancer Intervention Study model and/or a 5-year risk >1.7% using the National Cancer Institute Breast Cancer Risk Assessment Tool or Gail model). Results: In a 12-month period from June 1, 2021 through May 31, 2022, 56.2% of patients were referred based on family history, 26.9% for higher-risk breast pathology, 8.1% for calculated elevated risk, 4.4 % for a pathogenic genetic variant that increases breast cancer risk and 4.1% for mammographic identification risk modeling. Following the BCPC visit, referrals for patients may include imaging such as mammograms, MRIs, genetic counseling or testing, or surgical evaluations. Referrals for lifestyle modifications may include nutrition, exercise navigation, mindfulness classes, or Sexual Health Evaluations. From June 2021 through May 2022, 41.4% of patients were referred for a breast MRI, 26.6% were referred to genetic counselors for genetic testing recommendations, 11.1% were referred to nutrition or exercise services, 8.42% were referred for a Bone Density Scan (DXA), 4% were referred to a Breast Surgeon and 3.7% were referred to the Genetic Management Clinic. Additionally, 79.5% of patients were referred to the High-Risk Breast Lifetime Clinic for continued monitoring and surveillance for early detection of breast cancer, continued reinforcement of lifestyle modifications, and management of risk-reduction endocrine therapy. Conclusion: The unique structure of this model allows for enhanced surveillance through greater use of evidence-based cancer prevention, early detection methods, and increased education for lifestyle medicine practices with the overall goals of reducing breast cancer risk, earlier breast cancer detection, and increasing quality of life. Reference List 1. DeSantis C, Ma J, Gaudet, M, et al. Breast cancer statistics, 2019. CA: A Cancer Journal for Clinicians. 2019;69(6), 438-451. https://doi.org/10.3322/caac.21583. Citation Format: Joe Stephenson, LeAnn Perkins, Erinn Crowe, Regina Franco, Carmen Hancock, Pamela Cloys, Marie Smith. The Breast Cancer Prevention Clinic: A Single Institution’s Experience [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-03-07.
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McKenna, Christopher D. « The World's Newest Profession : Management Consulting in the Twentieth Century ». Enterprise & ; Society 2, no 4 (décembre 2001) : 673–79. http://dx.doi.org/10.1017/s1467222700005322.
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In 1930 Business Week alerted its interested readers to a new professional service: management consulting. As the writers at Business Week explained, the existing system of business professionals had become so complicated that, according to James McKinsey at the University of Chicago, a new type of professional was “increasing in numbers and influence . . . the adviser that tells business what other advisers to use and when.” Although Business Week would go on to chronicle the rise of management consulting over the next seventy years, consultants would continue to style themselves as an emerging profession through the end of the twentieth century.My dissertation title, “The World's Newest Profession,” plays off both the longstanding perception that consulting is an emerging profession and the widespread apprehension that consultants' advice is little more than corporate pandering. In response to these concerns, I address both the origins of management consultants and their influence on the strategies, structures, and operations of large bureaucratic organizations. Because the institutionalization and professionalization of management consulting occurred within firms, not among solo practitioners, I focus on management consulting firms like McKinsey & Company; Booz, Allen & Hamilton; and Arthur D. Little, Inc., which have advised large corporations since the 1920s. During the 1920s and 1930s these consulting firms were integral in reorganizing many of the largest companies in the United States, including General Motors, Swift, U.S. Steel, and Sears. By the 1960s the use of American management consultants had expanded beyond their initial domestic corporate clients to include international nonprofit organizations, businesses, and governments as diverse and influential as Air France, the Bank of England, Volkswagen, the University of Liberia, and the Government of Tanzania.
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Godeau, Bertrand, Marc Michel, Lamiae Grimaldi-Bensouda, Lucien Abenhaim, Clementine Nordon et Corinne Haioun. « Characteristics and Outcome of Newly Diagnosed Immune Thrombocytopenia in Adults : Results from a Nationwide Prospective Cohort Study ». Blood 126, no 23 (3 décembre 2015) : 3475. http://dx.doi.org/10.1182/blood.v126.23.3475.3475.
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Abstract Objectives The objectives of the study were (1) to describe the clinical features of adult patients presenting with an immune thrombocytopenia (ITP), (2) to explore the predictors of chronicity and (3) to determine whether a family history of autoimmune disorder was a risk factor of ITP. Methods An observational prospective cohort study was conducted in France nationwide. During more than two years, 21 participating physicians from haematology centres recruited all consecutive adults of 18 years old or above, diagnosed with an incident episode of ITP. Data were collected at baseline and 12 months, regarding socio-demographic characteristics, personal and familial medical history, clinical and biological signs of ITP and its medical management, left at the discretion of each physician. Data were collected after 12 months clinical, biological signs of ITP and current medication, from which the outcome was derived: chronicity or recovery. Predictors of chronicity at baseline were explored using univariate logistic regression models, providing the Odds Ratio (OR) and their 95% Confidence Intervals (95%CI). To explore whether having a history of autoimmune disorder in first-degree relative was a risk factor of developing an ITP, referent-patients were drawn from a general practice setting database and matched to ITP-patients (10-1). The risk of developing an ITP was explored using univariate conditional logistic regression models, providing the OR and their 95%CI. Results 153 patients were included over a 28-month period: 94 (61%) patients were female, mean age was 48 years (SD=18.8), and 128 (84%) presented with bleeding symptoms at diagnosis. The median platelet count was 10×109/L. An initial treatment was required in nearly 90% of patients. After 12 months, only 36% of patients were cured without receiving any disease-modifying treatment. The baseline predictors of chronicity at 12 months were a lower platelet count (OR, 1.0; 95%CI, 1.0-1.2) and mucocutaneous bleeding (OR, 0.3; 95%CI, 0.1-1.0). No significant association was found between a history of autoimmune disorder in a first degree relative or the presence of anti-nuclear antibodies and the risk of developing a chronic ITP. Conclusions ITP in adults affects patients with a wide age range, mainly female. ITP is a serious disease in adults with a chronic evolution in a majority of patients that is in contrast with children. Low platelet count and severity of bleeding at the diagnosis were associated with a lower risk of chronic evolution. Disclosures Godeau: Roche: Research Funding; Amgen: Speakers Bureau; Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Grimaldi-Bensouda:LASER: Consultancy, Other: LASER provide consultancy to various pharma industry (virtually all). Abenhaim:LASER: Employment, Other: LASER provide consultancy to various pharma industry (virtually all). Haioun:Roche: Honoraria.
Thèses sur le sujet "Risk management – France – History"
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Yandell, Andrew W. « The Potential Application of Weather Derivatives to Hedge Harvest Value Risk in the Champagne Region of France ». Scholarship @ Claremont, 2012. http://scholarship.claremont.edu/cmc_theses/359.
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In Champagne, France grape growers and and winemakers work together to make the world's most iconic sparkling wine. Part of what makes Champagne so celebrated is its reputation for constant quality: only the best grapes are used to make wine. In poor vintage years, grape growers sell less grapes to winemakers; poor vintages are the result of bad weather. This presents the opportunity for grape growers to hedge the risk of poor weather and resulting lower harvest values with weather derivatives. This study explores the potential for grape growers to trade them to effectively hedge against low harvest values by hedging against cooler weather in the month of June, when grape vines are flowering and sensitive to cold, through an empirical study of historical grape harvest and temperature data from 1952 through 2011. Weather derivatives would have provided an effective hedge against low harvest values up through 1991. After 1991, harvest sizes and therefore harvest revenues are no longer significantly correlated with weather and weather derivatives no longer provide an effective hedge against low harvest values for grape growers in Champagne.
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Wang, Lingling. « CEO employment history and risk-taking in firm policies ». unrestricted, 2009. http://etd.gsu.edu/theses/available/etd-04292009-150418/.
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Thesis (Ph. D.)--Georgia State University, 2009.Title from file title page. Harley E. Ryan, committee chair; Conrad Ciccotello, Omesh Kini, Jayant Kale, committee members. Description based on contents viewed July 1, 2009. Includes bibliographical references (p. 72-74).
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Wang, Lingling. « CEO Risk Taking and Firm Policies : Evidence from CEO Employment History ». Digital Archive @ GSU, 2009. http://digitalarchive.gsu.edu/finance_diss/15.
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I propose that CEO employment history is an observable characteristic that reveals the CEO’s unobservable risk-taking preferences. I hypothesize that CEOs that change employers more frequently (mobile CEOs) have a propensity to bear risk and implement riskier firm policies. Using a sample of S&P 1500 CEOs, I find that firms are more likely to hire mobile CEOs when the firm’s prior risk is high, firm-specific human capital is less important, the prior CEO turnover is forced, the prior CEO has a shorter tenure and the board is smaller and has fewer insiders. Mobile CEOs increase financial leverage, invest more in advertising and less in capital expenditures, and increase firm-specific risk. Mobile CEOs invest more (less) in R&D in homogenous (heterogeneous) industries where firm-specific knowledge is less (more) important in making investment decisions. Shareholders react positively to appointments of CEOs who change employers more frequently. I find no difference in long-run accounting performance for CEOs with different employment histories. Firms’ annual stock returns and sales growth are higher for CEOs who change employers more frequently. The cost of debt increases after the firm appoints a mobile CEO. These findings suggest that lower CEO risk aversion and the potential risk-shifting from shareholders to bondholders are sources of shareholder value increases. In sum, my findings provide evidence that CEO employment history is an observable characteristic that reveals the risk-taking preference of the CEO.
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Bosco-Lévy, Pauline. « Heart failure in France : chronic heart failure therapeutic management and risk of cardiac decompensation in real-life setting ». Thesis, Bordeaux, 2019. http://www.theses.fr/2019BORD0348.
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En France, environ un million de personnes seraient touchées par l’insuffisance cardiaque (IC) ; on recense près de 70 000 décès liés à l’IC, et plus de 150 000 hospitalisations et cela, malgré une prise en charge thérapeutique bien codifiée. Ces chiffres devraient s’accroitre dans les années futures du fait notamment du vieillissement de la population.L’objectif de ce travail était d’étudier l’utilisation des traitements pharmacologiques indiqués dans le traitement de l’IC (beta bloquant, inhibiteur de l’enzyme de conversion, anti-aldostérone, antagoniste des récepteurs à l’angiotensine II, diurétiques, digoxine, ivabradine) en situation réelle de soin, et d’identifier les facteurs cliniques ou pharmacologiques associés à la survenue d’un épisode de décompensation cardiaque.Un premier travail a permis de mesurer la fiabilité des bases de données médico-administratives françaises pour identifier des patients IC.Une deuxième étude a permis d’estimer que 17 à 37% de patients IC n’étaient exposés à aucun traitement de l’IC dans l’année suivant une première hospitalisation pour IC.Les troisième et quatrième parties de cette thèse ont mis en évidence qu’environ un quart des patients IC étaient réhospitalisés dans les 2 ans suivant une première hospitalisation. Les principaux facteurs cliniques prédictifs de cette réhospitalisation étaient l’âge, l’hypertension artérielle, la fibrillation auriculaire et le diabète. L’association retrouvée entre l’utilisation de fer bivalent et la réhospitalisation pour IC, souligne l’importance du risque lié à la présence d’une anémie ou d’une déficience en fer dans la survenue d’un épisode de décompensation cardiaque.Ces résultats permettent de reconsidérer la prise en charge thérapeutique chez les patients IC et mettent en avant la nécessité de renforcer la surveillance des patients les plus à risque de décompenser leur ICIn France, around one million persons would be affected by heart failure (HF); there are nearly 70 000 deaths related to HF and more than 150 000 hospitalizations despite a well defined treatment management. These numbers should increase in the next years due in particular to the ageing of the population.The objective of this work was to study the use of the pharmacological treatments indicated in HF (beta-blocker, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, aldosterone antagonist, diuretics, digoxin, ivabradine) in real-world setting and to identify the clinical or pharmacological predictors associated with a new episode of cardiac decompensation.A first work has enabled to estimate the accuracy of French claims databases in identifying HF patients.A second study estimated that 17 to 37% HF patients were not exposed to any HF treatment in the year following an incident HF hospitalization.The third and fourth parts of this thesis showed that almost one forth of HF patients was rehospitalized within the 2 years following a first hospitalization. The main clinical predictors of rehospitalization were age, high blood pressure, atrial fibrillation and diabetes. The association found between bivalent iron use and HF rehospitalization underlines the importance of the risk related to anemia or iron deficiency in the occurrence of a cardiac exacerbation episode.These results allow to reconsider the treatment management of HF patients and highlight the need to reinforce the surveillance of patients with a highest risk of cardiac exacerbation
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With, Lauriane. « Approche géohistorique de la gestion et de la prévention du risque d'inondation : le cas de la vallée de la Lauch (Haut-Rhin) de 1778 à nos jours ». Thesis, Mulhouse, 2014. http://www.theses.fr/2014MULH4452/document.
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Parmi les risques naturels, le risque d’inondation est le plus fréquent et le plus dommageable en France avec près de 50 % des communes exposées. Dans le département du Haut-Rhin, c’est 80 % des communes qui sont concernées. L’absence d’étude historique approfondie sur les inondations en Alsace et plus particulièrement sur celles de la Lauch, théâtre des derniers grands évènements, a constitué la principale motivation quant au choix de ce sujet. A défaut de pouvoir éradiquer ce risque, l’Homme a, au cours de l’histoire, engagé des actions palliatives pour s’en prémunir. De quelle manière et dans quelle mesure, les évènements historiques ont-ils été pris en considération dans les politiques de gestion et de prévention du risque d’inondation mises en place dans la vallée de la Lauch, durant plus de deux siècles ? Pour répondre à cette problématique, nous avons eu recours à une approche diachronique, avec pour point de départ l’évènement funeste de février 1990, et adopté une démarche interdisciplinaire. S’appuyant sur un important corpus de sources, cette thèse met en perspective l’évolution de la gestion des inondations sur la période considérée en fonction des évènements hydrologiques restitués via une méthode régressive, des enjeux, des contextes politiques très contrastés, et des acteurs, tant au plan local, national, qu’européen. S’inscrivant dans une logique de démarche appliquée, cette étude a pour ambition d’améliorer l’information sur les phénomènes et de constituer un « socle de connaissances scientifiques » pour une meilleure maîtrise du risque. Ainsi, il paraît fondamental de connaître l’aléa afin de pouvoir l’anticiper, s’en prémunir et mieux le gérerAmong the natural hazards, the flood risk is the most frequent and the most harmful in France with about 50 % of the municipalities exposed. In the Haut-Rhin department, 80 % of the municipalities are concerned. We have chosen this subject because no historic study exists about floods in Alsace and especially about the Lauch valley, where the last big events have taken place. In front of the impossibility to eradicate the risk, the Man committed palliative actions to protect himself through history. How have the historic events been taken into consideration in policies of management and prevention of the flood risk in the Lauch valley for more than two centuries ? To answer this question, we have used a diachronic approach which begins with the disastrous event of February 1990, and adopted an interdisciplinary method. Based on an important corpus of sources, this thesis puts in perspective the evolution of the management of the floods over the period considered according to the hydrological events restored via a regressive method, the stakes, the very contrasted political contexts and the actors, over the local, national and European plans. This thesis is part of a logic of applied reasoning and has for ambition to improve the information about the phenomena and to constitute a "basis of scientific knowledge" for a better control of the risk. This way, it seems fundamental to know flood hazard to be able to anticipate it, to manage it better and to protect ourselves
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Soga, Nomaphelo. « The cost of credit default in the vehicle finance industry in South Africa ». Thesis, Cape Peninsula University of Technology, 2019. http://hdl.handle.net/20.500.11838/3027.
Texte intégralRésumé :
Thesis (MTech (Cost and Management Accounting))--Cape Peninsula University of Technology, 2019The risk that borrowers may not fulfil borrowing obligation presents credit owners (lenders) with a default risk management opportunity to maximize risk-adjusted rate of return and maintain minimum exposure to default associated cost. This study investigated respondents' perception of the cost of credit default and examines requirements for default risk management (ORM) in the vehicle finance industry in South Africa. It is noted that with increased level of consumer indebtedness, an unstable economy, and high unemployment, vehicle financing faces a higher probability of default from borrowers. This descriptive investigation utilised both the quantitative and qualitative approaches using the survey method to collect data from 381 purposive, randomly selected respondents who are vehicle finance customers in South Africa; Cape Town specifically. Data collection took place in the Western Cape over a nine months period, utilising personal interview, and emails to administer open-ended questionnaires for credit managers and close-ended questionnaires, for the vehicle finances' customers, as data collection instrument. Responses received were codified and quantitative data was analysed using the Statistical Packages for Social Sciences (SPSS version 25) while qualitative data was analysed using the content analysis of percentage of word similarities. The study found mixed and variable respondents' perception of the cost of credit default. In conclusion, it is perceived that in South Africa the cost of credit would become more costly with credit default. It can be recommended that a default risk management intervention could be applied to mitigate the risk of credit default within the context of unified credit assessment policy of South Africa.
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Nelson, Heather E. « Rural roots, a history of the Wawanesa Mutual Insurance Company to 1943 ». Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/MQ62808.pdf.
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Beltrán, Hernández Allan Iván. « Essays on the economic valuation of flood risk ». Thesis, University of Birmingham, 2017. http://etheses.bham.ac.uk//id/eprint/7174/.
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The frequency and intensity of flooding has increased over the last few decades. The UK is not an exception, despite large amounts of money invested every year in flood risk management, flooding is a prevalent issue in the country causing millions of losses every year. In this thesis we contribute to debate on the economic valuation of flood risk in the UK from a household perspective using a non-market valuation approach from the housing market. In the first chapter we investigate the capitalisation of flood risk in property prices by means of a meta-analysis. In the second and third chapters we use a repeatsales specification of a hedonic model to investigate the capitalisation of flood defences and the effect of flooding in the price of properties in England. The results suggest that the current benefit estimates used by the UK Government to determine the allocation of resources to flood relief projects results in a misallocation of resources. We highlight the importance of rethinking the strategy for flood risk management in the UK. Our results provide a sound economic basis to guide the allocation of resources for flood alleviation strategies in a socially efficient way.
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Gifford, Julie Louise. « Financial systems and risk management : the nature and role of financial services for managing poor urban livelihoods in Kampala, Uganda in 2000 ». Thesis, University of Birmingham, 2007. http://etheses.bham.ac.uk//id/eprint/906/.
Texte intégralRésumé :
The concept of urban poverty has developed from a static income-based absolute approach to a holistic dynamic and complex state, embedded in livelihood assets and a vulnerability context. A variety of livelihood assets including labour, housing, intra-household, human and social capital are important for risk management strategies. Microfinance has been seen as a key panacea for livelihood development. Using the livelihoods framework this research analyses the nature of livelihoods and financial services within Bwaise, Kampala, Uganda, a poor, densely populated area with a mixture of residential and commercial activities. Financial services available in the area at the time of the research were diverse, ranging from formal banks and donor-led microfinance to cash rounds and informal loans. These financial services, mainly developed by the poor, were used to secure livelihoods with a cumulative nesting of use by the poor. The influence of external factors was high and significantly affected how the poor managed their livelihoods and impeded livelihood development. Theft, ill health and unstable employment were key factors contributing to a highly vulnerable environment. The complexity of urban livelihoods created the need for diverse financial services because expenditure requirements often outstripped income flows. A diverse range of financial services became a vital part of income and consumption smoothing risk management strategies, and these were key for protecting and managing livelihoods.
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Leseeto, Saidimu. « The role of risk management in pastoral policy development and poverty measurement : system dynamics simulation approach ». Thesis, University of Southampton, 2012. https://eprints.soton.ac.uk/344349/.
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Livestock-based agriculture plays an important role in the development of sub-saharan Africa, especially those countries whose livestock industry contributes significantly to the Gross Domestic Product (GDP). In Kenya, agriculture alone accounts for 21% of the GDP and provides employment directly or indirectly to over 75% of the total labour force. The livestock industry, mainly arid rangelands, contributes 50% of the agricultural productivity. However, these Arid and Semi-Arid Lands (ASALs) are exposed to a myriad of risks affecting the environment which is the pastoral core asset. These risks arise from climatic change and variability, growth in human population and expanding settlements, changes in the land use systems, poor infrastructure, diseases, wildlife predation, and inter-ethnic conflicts. The consequences of these pastoral risks include: (1) declining per capita asset value, (2) increased health problems, (3) increased poverty, and (4) declining GDP generated from pastoralism. While a lot of resources have been invested in responding to the pastoral crisis associated with droughts, there is still inadequate understanding of the policy measures to put in place as mitigation strategies. The aims of this research are (1) identify the main pastoral risks and community response strategies, (2) assess the impact the identified risks on the wellbeing of pastoralists based on financial, human, physical, natural and social capital measurements (5 C‘s), and (3) develop a System Dynamics (SD) model to assess the holistic impact of community and government response strategies on pastoral wellbeing. Samburu district, in northern Kenya, was chosen as a study area because it is classified as 100% ASAL and experiences frequent droughts and changing land use systems. The research process involved literature synthesis, analysis of both cross-sectional and a 5-year panel data, and the development of a System Dynamics model. Cross-section data was primarily collected for the purposes of identifying the extent to which risks affect households, while the 5-year panel data was sourced from the Arid Lands Resource Management Project (ALRMP). Descriptive and empirical analysis showed that droughts, land use system and human population were considered as the main cause of shrinking rangeland productivity and as a result declining per capita livestock. This was further confirmed from the panel data analysis indicating climate variability as the main driver of pastoral wellbeing. Droughts affect rangeland pasture productivity, market prices, livestock assets, and households‘ nutritional status and poverty levels. These results imply a multifaceted nature of pastoral system with compound affects. The SD simulation result, which was run over the period January 2006 to December 2030, provided insights on policy evaluation and the state of pastoral wellbeing. Baseline scenario indicated reducing livestock ownership, causing high malnutrition and poverty rates. Strategies which incorporated rangeland rehabilitation, planned settlements, livestock disease control, insurance against droughts, reducing inter-ethnic conflicts, and timely destocking offered better policy options. These strategies resulted in reduced malnutrition, increased pasture productivity, reduced livestock losses and ultimately reducing poverty rates among the pastoral communities.
Livres sur le sujet "Risk management – France – History"
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Alain, Varaschin, dir. Risques et prises de risques dans les sociétés industrielles. Bruxelles : P.I.E. Lang, 2007.
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Organisation for economic co-operation and development. Étude de l'OCDE sur la gestion des risques d'inondation : Bassin de la Loire, France. Paris : OECD, 2010.
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Taylor, Wayne. The church at risk : [the miraculous story of Adventist Risk Management]. Silver Spring, Md : Adventist Risk Management, 2004.
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Financial risk management : models, history, and institution : Models, history, and institution. Hoboken, N.J : Wiley, 2011.
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Risk management for Islamic banks. Edinburgh : Edinburgh University Press, 2013.
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Ultimate risk. London : Bantam Press, 1994.
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Ultimate risk. London : Corgi, 1995.
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Dangerous commerce : Insurance and the management of international risk. Ithaca : Cornell University Press, 1997.
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G, Longenecker Julia, dir. Avoiding archaeological disasters : A risk management approach. Walnut Creek, CA : Left Coast Press, 2009.
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Feng xian yu fa zhan : Risks and development. Beijing Shi : Zhong gong zhong yang dang xiao chu ban she, 2007.
Trouver le texte intégralChapitres de livres sur le sujet "Risk management – France – History"
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Szylar, Christian. « Risk Management History ». Dans Risk Management under UCITS III/IV, 33–62. Hoboken, NJ USA : John Wiley & Sons, Inc., 2013. http://dx.doi.org/10.1002/9781118557709.ch2.
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Smith, Denis, et Jo McCloskey. « History Repeating Itself ? » Dans Risk Management and Society, 101–24. Dordrecht : Springer Netherlands, 2000. http://dx.doi.org/10.1007/978-94-017-2913-0_5.
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Kloman, H. Felix. « A Brief History of Risk Management ». Dans Enterprise Risk Management, 19–29. Hoboken, NJ, USA : John Wiley & Sons, Inc., 2011. http://dx.doi.org/10.1002/9781118267080.ch2.
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Hurand, Patrick. « Water Management in the Neste System (France) ». Dans Engineering Risk in Natural Resources Management, 435–48. Dordrecht : Springer Netherlands, 1994. http://dx.doi.org/10.1007/978-94-015-8271-1_28.
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Storrow, Alan B., Ian McClure et Elizabeth Harbison. « Risk Stratification : History, Physical, and EKG ». Dans Short Stay Management of Chest Pain, 79–90. Totowa, NJ : Humana Press, 2009. http://dx.doi.org/10.1007/978-1-60327-948-2_6.
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Yoshida, Yasushi, et Michiko Banba. « Flood Disaster Mitigation Measures Through Land Use Management in the UK and France ». Dans Disaster Risk Reduction, 405–48. Tokyo : Springer Japan, 2016. http://dx.doi.org/10.1007/978-4-431-56442-3_21.
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Yoo, Sangjun, et In Gab Jeong. « Natural History of High-Risk Prostate Cancer ». Dans Management of Advanced Prostate Cancer, 3–9. Singapore : Springer Singapore, 2018. http://dx.doi.org/10.1007/978-981-10-6943-7_1.
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Wirtz, Peter. « Changing Corporate Governance in France in the Late Twentieth Century ». Dans The Palgrave Handbook of Management History, 1141–61. Cham : Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-319-62114-2_95.
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Wirtz, Peter. « Changing Corporate Governance in France in the Late Twentieth Century ». Dans The Palgrave Handbook of Management History, 1–21. Cham : Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-319-62348-1_95-1.
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Smouha, Brian. « A Recent Case History of International Bank Fraud ». Dans Risk Management and Regulation in Banking, 175–83. Boston, MA : Springer US, 1999. http://dx.doi.org/10.1007/978-1-4615-5043-3_11.
Texte intégralActes de conférences sur le sujet "Risk management – France – History"
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Déléry, L., G. Gay, S. Denys, H. Brunet, I. Déportes, A. Cauchi et M. Aupetitgendre. « Health risk assessment for sewage sludge applied to land in France ». Dans WASTE MANAGEMENT 2006. Southampton, UK : WIT Press, 2006. http://dx.doi.org/10.2495/wm060551.
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Guta, Helder. « Application of HEC-HMS for rainfall-runoff modelling in Mozambique and France ». Dans FLOODrisk 2020 - 4th European Conference on Flood Risk Management. Online : Budapest University of Technology and Economics, 2021. http://dx.doi.org/10.3311/floodrisk2020.18.9.
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Serra-Llobet, Anna, Rémy Tourment, Antonin Montané et Thomas Buffin-Belanger. « Acknowledging residual risk behind dikes : Examples from the USA, Quebec (Canada) and France ». Dans FLOODrisk 2020 - 4th European Conference on Flood Risk Management. Online : Budapest University of Technology and Economics, 2021. http://dx.doi.org/10.3311/floodrisk2020.9.22.
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Teetes, George, Matt Koziol et Norman Perez. « Risk Management on Water Infrastructure Tunnel Projects—DC Clean Rivers Project Case History ». Dans Geo-Risk 2017. Reston, VA : American Society of Civil Engineers, 2017. http://dx.doi.org/10.1061/9780784480724.035.
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Quinn, O., J. Sargent et E. Conyard. « PS-108 Does the completion of a risk assessment template improve the rate of appropriate venous thromboembolism risk management for hospitalised medical patients ? » Dans 22nd EAHP Congress 22–24 March 2017 Cannes, France. British Medical Journal Publishing Group, 2017. http://dx.doi.org/10.1136/ejhpharm-2017-000640.614.
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Jiang, Hsinyi, Carl K. Chang, Jinchun Xia et Shuxing Cheng. « A History-Based Automatic Scheduling Model for Personnel Risk Management ». Dans 31st Annual International Computer Software and Applications Conference - Vol. 2 - (COMPSAC 2007). IEEE, 2007. http://dx.doi.org/10.1109/compsac.2007.25.
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Barré, G., E. Gaucher, G. Hoareau et A. Elias-Bahnan. « Unravelling the Processes of the H2S Generation in the North-western Pyrenees (France) ». Dans First EAGE/IFPEN Conference on Sulfur Risk Management in Exploration and Production. Netherlands : EAGE Publications BV, 2018. http://dx.doi.org/10.3997/2214-4609.201802772.
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Yang, Zhuyu, Katia Laffréchine, Aurélia Bony-Dandrieux, Hélène Dolidon et Bruno Barroca. « Practical indicators for road infrastructure resilience to flood risks in France, case study of Nantes Ring Road network ». Dans FLOODrisk 2020 - 4th European Conference on Flood Risk Management. Online : Budapest University of Technology and Economics, 2021. http://dx.doi.org/10.3311/floodrisk2020.11.21.
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Abdallah, O., M. Zolezzi et AN Kheir. « GM-006 Evaluation of community pharmacists’ preparedness for the provision of cardiovascular disease risk assessment and management services : a simulated patient study in qatar ». Dans 22nd EAHP Congress 22–24 March 2017 Cannes, France. British Medical Journal Publishing Group, 2017. http://dx.doi.org/10.1136/ejhpharm-2017-000640.352.
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Zevenbergen, C., J. Rijke, S. van, L. Chelleri et P. J. T. M. Bloemen. « Towards an adaptive, flood risk management strategy in The Netherlands : An overview of recent history* ». Dans The International Conference On Fluvial Hydraulics (River Flow 2016). Taylor & Francis Group, 6000 Broken Sound Parkway NW, Suite 300, Boca Raton, FL 33487-2742 : CRC Press, 2016. http://dx.doi.org/10.1201/9781315644479-310.
Texte intégralRapports d'organisations sur le sujet "Risk management – France – History"
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Lucas, Brian. Urban Flood Risks, Impacts, and Management in Nigeria. Institute of Development Studies (IDS), janvier 2021. http://dx.doi.org/10.19088/k4d.2021.018.
Texte intégralRésumé :
This summary reviews evidence on the urban flooding impact, risk factors, and management and mitigation measures in Lagos and other cities in Nigeria. Flooding is a common problem every year in many cities across Nigeria, but the impacts of flooding are poorly documented. There is no consistent set of statistics at a national or sub-national level that can be used to compare the impacts of flooding across cities, and reports that focus on particular flood events are often incomplete. The literature notes the principal factors contributing to flood risk including uncontrolled urban growth, inadequate and poorly-maintained drainage systems, solid waste management practices, weakness in institutional capacity and coordination, and warning systems and public awareness. The evidence base for flood impacts, risks, and mitigation efforts at the city level in Nigeria is limited, and much of the information available is low quality, inconsistent, or outdated. Many rely on surveys of city residents rather than objective empirical data, and some of these surveys appear to be poorly designed. A significant number of the academic publications available have been published in non-mainstream journals without the usual level of academic peer review. Recent information is scarce, and a significant amount of the available evidence dates from 2011 and 2012, which coincides with an episode of nationwide flooding that was among the worst in Nigeria’s history.
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Sett, Dominic, Christina Widjaja, Patrick Sanady, Angelica Greco, Neysa Setiadi, Saut Sagala, Cut Sri Rozanna et Simone Sandholz. Hazards, Exposure and Vulnerability in Indonesia : A risk assessment across regions and provinces to inform the development of an Adaptive Social Protection Road Map. United Nations University - Institute for Environment and Human Security, mars 2022. http://dx.doi.org/10.53324/uvrd1447.
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Risk induced by natural hazards and climate change has been accelerating worldwide, leading to adverse impacts on communities' well-being. Dealing with this risk is increasingly complex and requires cross-sectoral action. Adaptive Social Protection (ASP) has emerged as a promising approach to strengthen the resilience of communities by integrating Social Protection (SP), Disaster Risk Management (DRM) and Climate Change Adaptation (CCA) efforts. To inform this integration and thereby support the development of a functional ASP approach, the identification and provision of relevant data and information are vital. In this context, risk assessments are crucial as they establish the groundwork for the design of effective ASP interventions. However, despite the importance of risk information for ASP and the abundance of sectoral assessments, there is not yet a comprehensive risk assessment approach, a reality that also applies to Indonesia. Although the country is one of the international pioneers of the concept and has enshrined ASP at the highest national level in its development plans, this emphasis in policy and practice has been hampered by the absence of more unified assessment methods. The Hazard, Exposure and Vulnerability Assessment (HEVA) presented here takes a unique approach to develop such a cross-sectoral risk assessment and apply it throughout Indonesia. The HEVA brings together different risk understandings of key actors both internationally and domestically within SP, DRM and CCA, as well as identifying commonalities across sectors to establish a joint understanding. The HEVA not only considers risk as an overarching outcome but also focuses on its drivers, i.e. hazards, exposure and vulnerability, to identify why specific communities are at risk and thus customize ASP interventions. Subsequently, risks are assessed for Indonesia’s regions and provinces based on this cross-sectoral risk understanding. Secondary data has been acquired from various existing sectoral assessments conducted in Indonesia, and in total, data for 44 indicators has been compiled to calculate hazard, exposure and vulnerability levels for all 34 Indonesian provinces. Findings of the HEVA suggest that overall risk is high in Indonesia and no single province can be characterized as a low-risk area, demonstrating a strong relevance for ASP throughout the whole of the country. Papua, Maluku, and Central Sulawesi were identified as provinces with the highest overall risk in Indonesia. However, even Yogyakarta, which was identified as a comparatively low-risk province, still ranks among the ten most hazard-prone provinces in the country and has a demonstrated history of severe impact events. This also underlines that the composition of risk based on the interplay of hazard, exposure and vulnerability differs significantly among provinces. For example, in Papua and West Papua, vulnerability ranks as the highest in Indonesia, while hazard and exposure levels are comparatively low. In contrast, East Java and Central Java are among the highest hazard-prone provinces, while exposure and vulnerability are comparatively low. The results provide much more comprehensive insight than individual sectoral analyses can offer, facilitating the strategic development and implementation of targeted ASP interventions that address the respective key risk components. Based on lessons learned from the development and application of the HEVA approach, as well as from the retrieved results, the report provides recommendations relevant for policymakers, practitioners and researchers. First, recommendations regarding risk assessments for ASP are given, emphasizing the need to bring together sectoral understandings and to consider the interconnection of hazards, exposure and vulnerability, including their drivers and root causes, to assess current and future risk. It is also recommended to complement national level assessments with more specific local assessments. Secondly, recommendations regarding ASP option development in general are provided, including the importance of considering side effects of interventions, root causes of risks, the potential of nature-based solutions and barriers to implementation due to local capacities when designing ASP interventions. Third, recommendations regarding focal areas for ASP programmes are outlined for the case of Indonesia, such as prioritizing interventions in risk hotspots and areas characterized by high readiness for ASP solutions. At the same time, it is vital to leave no region behind as all provinces face risks that potentially jeopardize communities’ well-being.
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Narvaez, Liliana, Sally Janzen, Caitlyn Eberle et Zita Sebesvari. Technical Report : Taiwan drought. United Nations University - Institute for Environment and Human Security (UNU-EHS), août 2022. http://dx.doi.org/10.53324/ujzw5639.
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During the 2020-2021 typhoon season, for the first time in 56 years, no typhoon made landfall on Taiwan, leading to one of the worst droughts in the island’s history. As reservoirs fell below 5% capacity, more than one million households and businesses had to ration water. This water rationing was not without controversy, especially for the island’s most water-intensive industries: rice farming and semiconductor manufacturing. Taiwan’s case exemplifies the challenges of water stress and related risk across value chains that could emerge as a result. It also shows stark choices that governments and authorities may have to face in rationing water resources. Water management in a changing climate is incredibly important to ensure the life, health and prosperity of people and ecosystems on our planet.This technical background report for the 2021/2022 edition of the Interconnected Disaster Risks report analyses the root causes, drivers, impacts and potential solutions for the Taiwan drought through a forensic analysis of academic literature, media articles and expert interviews.
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Rankin, Nicole, Deborah McGregor, Candice Donnelly, Bethany Van Dort, Richard De Abreu Lourenco, Anne Cust et Emily Stone. Lung cancer screening using low-dose computed tomography for high risk populations : Investigating effectiveness and screening program implementation considerations : An Evidence Check rapid review brokered by the Sax Institute (www.saxinstitute.org.au) for the Cancer Institute NSW. The Sax Institute, octobre 2019. http://dx.doi.org/10.57022/clzt5093.
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Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.
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Dodd, Hope, David Peitz, Gareth Rowell, Janice Hinsey, David Bowles, Lloyd Morrison, Michael DeBacker, Jennifer Haack-Gaynor et Jefrey Williams. Protocol for Monitoring Fish Communities in Small Streams in the Heartland Inventory and Monitoring Network. National Park Service, avril 2021. http://dx.doi.org/10.36967/nrr-2284726.
Texte intégralRésumé :
Fish communities are an important component of aquatic systems and are good bioindicators of ecosystem health. Land use changes in the Midwest have caused sedimentation, erosion, and nutrient loading that degrades and fragments habitat and impairs water quality. Because most small wadeable streams in the Heartland Inventory and Monitoring Network (HTLN) have a relatively small area of their watersheds located within park boundaries, these streams are at risk of degradation due to adjacent land use practices and other anthropogenic disturbances. Shifts in the physical and chemical properties of aquatic systems have a dramatic effect on the biotic community. The federally endangered Topeka shiner (Notropis topeka) and other native fishes have declined in population size due to habitat degradation and fragmentation in Midwest streams. By protecting portions of streams on publicly owned lands, national parks may offer refuges for threatened or endangered species and species of conservation concern, as well as other native species. This protocol describes the background, history, justification, methodology, data analysis and data management for long-term fish community monitoring of wadeable streams within nine HTLN parks: Effigy Mounds National Monument (EFMO), George Washington Carver National Monument (GWCA), Herbert Hoover National Historic Site (HEHO), Homestead National Monument of America (HOME), Hot Springs National Park (HOSP), Pea Ridge National Military Park (PERI), Pipestone National Monument (PIPE), Tallgrass Prairie National Preserve (TAPR), and Wilson's Creek national Battlefield (WICR). The objectives of this protocol are to determine the status and long-term trends in fish richness, diversity, abundance, and community composition in small wadeable streams within these nine parks and correlate the long-term community data to overall water quality and habitat condition (DeBacker et al. 2005).