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Low-resource environments, such as those found in humanitarian crises, pose significant challenges to the provision of proper medical treatment. While the lack of training of health providers to such settings has been well-acknowledged in literature, there has yet to be any scientific evidence for this phenomenon.
This pilot study utilized a randomized crossover experimental design to examine the effects of high- versus low-resource simulated scenarios of a resuscitation of a critically ill obstetric patient on a medical doctors’ performance and inter-personal skills. Ten senior residents (fifth-year post-graduate) of the Maggiore Hospital School of Medicine (Novara, NO, Italy) were included in the study.
Overall performance score for the high-resource setting was 5.2, as opposed to only 2.3 for the low-resource setting. The mean effect size for the overall score was 2.9 (95% CI, 1.7–4.0; P <.001). The results suggest a significant decrease in both technical (medical) and non-technical skills, such as leadership, problem solving, situation awareness, resource utilization, and communication in the low-resource environment setting. The latter finding is of special important since it was yet to be reported.
This pilot study suggests that untrained physicians in low-resource environments may experience a considerable setback not only to their professional performance, but also to their interpersonal skills, when deployed ill-prepared to humanitarian missions. Consequently, this may endanger the health of local populations.
We present an application of statistical graphical models to simulate economic variables for the purpose of risk calculations over long time horizons. We show that this approach is relatively easy to implement, and argue that it is appealing because of the transparent yet flexible means of achieving dimension reduction when many variables must be modelled. Using the United Kingdom data as an example, we demonstrate the development of an economic scenario generator that can be used by life insurance companies and pension funds.We compare different algorithms to select a graphical model, based on p-values, AIC, BIC and deviance. We find the economic scenario generator to yield reasonable results and relatively stable structures in our example, suggesting that it would be beneficial for actuaries to include graphical models in their toolkit.
Various tools for participatory design approach have been developed to support users to engage design process. Doll scenario is proposed as a generative tool for letting participants make and enact scenarios. However, suitable context to practice doll scenario is unclear in comparison with other tools using scenario. Therefore, our overall objective is to increase understanding of characteristics of making scenario in two different ways of expression; with doll and storyboard. We developed a doll scenario method, doll staging. The tool was evaluated in comparison to storyboard at a workshop which is a part of a new product development project in a corporate. The workshop was evaluated by semi-structured interviews with the participants and observations of the workshop and design outcome. The result suggests that doll staging allows participants to think from users’ perspective in developing new idea. These findings provides new direction to choose scenario based design tools according to objective or context of design project. We also discuss potentials and research directions to use tools for developing scenario in corporate contexts.
In this article, we study parameter uncertainty and its actuarial implications in the context of economic scenario generators. To account for this additional source of uncertainty in a consistent manner, we cast Wilkie’s four-factor framework into a Bayesian model. The posterior distribution of the model parameters is estimated using Markov chain Monte Carlo methods and is used to perform Bayesian predictions on the future values of the inflation rate, the dividend yield, the dividend index return and the long-term interest rate. According to the US data, parameter uncertainty has a significant impact on the dispersion of the four economic variables of Wilkie’s framework. The impact of such parameter uncertainty is then assessed for a portfolio of annuities: the right tail of the loss distribution is significantly heavier when parameters are assumed random and when this uncertainty is estimated in a consistent manner. The risk measures on the loss variable computed with parameter uncertainty are at least 12% larger than their deterministic counterparts.
It is well known that the sense of presence in a tele-robot system for both home-based tele-rehabilitation and rescue operations is enhanced by haptic feedback. Beyond several advantages, in the presence of communication delay haptic feedback can lead to an unstable teleoperation system. During the last decades, several control techniques have been proposed to ensure a good trade-off between transparency and stability in bilateral teleoperation systems under time delays. These proposed control approaches have been extensively tested with teleoperation systems based on identical master and slave robots having few degrees of freedom (DoF). However, a small number of DoFs cannot ensure both an effective restoration of the multi-joint coordination in tele-rehabilitation and an adequate dexterity during manipulation tasks in rescue scenario. Thus, a deep understanding of the applicability of such control techniques on a real bilateral teleoperation setup is needed. In this work, we investigated the behavior of the time-domain passivity approach (TDPA) applied on an asymmetrical teleoperator system composed by a 5-DoFs impedance designed upper-limb exoskeleton and a 4-DoFs admittance designed anthropomorphic robot. The conceived teleoperation architecture is based on a velocity–force (measured) architecture with position drift compensation and has been tested with a representative set of tasks under communication delay (80 ms round-trip). The results have shown that the TDPA is suitable for a multi-DoFs asymmetrical setup composed by two isomorphic haptic interfaces characterized by different mechanical features. The stability of the teleoperator has been proved during several (1) high-force contacts against stiff wall that involve more Cartesian axes simultaneously, (2) continuous contacts with a stiff edge tests, (3) heavy-load handling tests while following a predefined path and (4) high-force contacts against stiff wall while handling a load. The found results demonstrated that the TDPA could be used in several teleoperation scenarios like home-based tele-rehabilitation and rescue operations.
Some UK insurers have been using real-world economic scenarios for more than 30 years. Popular approaches have included random walks, time series models, arbitrage-free models with added risk premiums or 1-year Value at Risk distribution fits. Based on interviews with experienced practitioners as well as historical documents and meeting minutes, this paper traces historical model evolution in the United Kingdom and abroad. We examine the possible catalysts for changes in modelling practice with a particular emphasis on regulatory and socio-cultural influences. We apply past lessons to provide some guidance to the direction of capital market modelling in future, which has been key for business and strategy decisions.
Cyber Operational Risk: Cyber risk is routinely cited as one of the most important sources of operational risks facing organisations today, in various publications and surveys. Further, in recent years, cyber risk has entered the public conscience through highly publicised events involving affected UK organisations such as TalkTalk, Morrisons and the NHS. Regulators and legislators are increasing their focus on this topic, with General Data Protection Regulation (“GDPR”) a notable example of this. Risk actuaries and other risk management professionals at insurance companies therefore need to have a robust assessment of the potential losses stemming from cyber risk that their organisations may face. They should be able to do this as part of an overall risk management framework and be able to demonstrate this to stakeholders such as regulators and shareholders. Given that cyber risks are still very much new territory for insurers and there is no commonly accepted practice, this paper describes a proposed framework in which to perform such an assessment. As part of this, we leverage two existing frameworks – the Chief Risk Officer (“CRO”) Forum cyber incident taxonomy, and the National Institute of Standards and Technology (“NIST”) framework – to describe the taxonomy of a cyber incident, and the relevant cyber security and risk mitigation items for the incident in question, respectively.Summary of Results: Three detailed scenarios have been investigated by the working party:
∙Employee leaks data at a general (non-life) insurer: Internal attack through social engineering, causing large compensation costs and regulatory fines, driving a 1 in 200 loss of £210.5m (c. 2% of annual revenue).
∙Cyber extortion at a life insurer: External attack through social engineering, causing large business interruption and reputational damage, driving a 1 in 200 loss of £179.5m (c. 6% of annual revenue).
∙Motor insurer telematics device hack: External attack through software vulnerabilities, causing large remediation / device replacement costs, driving a 1 in 200 loss of £70.0m (c. 18% of annual revenue).
Limitations: The following sets out key limitations of the work set out in this paper:
∙While the presented scenarios are deemed material at this point in time, the threat landscape moves fast and could render specific narratives and calibrations obsolete within a short-time frame.
∙There is a lack of historical data to base certain scenarios on and therefore a high level of subjectivity is used to calibrate them.
∙No attempt has been made to make an allowance for seasonality of renewals (a cyber event coinciding with peak renewal season could exacerbate cost impacts)
∙No consideration has been given to the impact of the event on the share price of the company.
∙Correlation with other risk types has not been explicitly considered.
Conclusions: Cyber risk is a very real threat and should not be ignored or treated lightly in operational risk frameworks, as it has the potential to threaten the ongoing viability of an organisation. Risk managers and capital actuaries should be aware of the various sources of cyber risk and the potential impacts to ensure that the business is sufficiently prepared for such an event. When it comes to quantifying the impact of cyber risk on the operations of an insurer there are significant challenges. Not least that the threat landscape is ever changing and there is a lack of historical experience to base assumptions off. Given this uncertainty, this paper sets out a framework upon which readers can bring consistency to the way scenarios are developed over time. It provides a common taxonomy to ensure that key aspects of cyber risk are considered and sets out examples of how to implement the framework. It is critical that insurers endeavour to understand cyber risk better and look to refine assumptions over time as new information is received. In addition to ensuring that sufficient capital is being held for key operational risks, the investment in understanding cyber risk now will help to educate senior management and could have benefits through influencing internal cyber security capabilities.
Distributed models and a good knowledge of the catchment studied are required to assess mitigation measures for nitrogen (N) pollution. A set of alternative scenarios (change of crop management practices and different strategies of landscape management, especially different sizes and distribution of set-aside areas) were simulated with a fully distributed model in a small agricultural catchment. The results show that current practices are close to complying with current regulations, which results in a limited effect of the implementation of best crop management practices. The location of set-aside zones is more important than their size in decreasing nitrate fluxes in stream water. The most efficient location is the lower parts of hillslopes, combining the dilution effect due to the decrease of N input per unit of land and the interception of nitrate transferred by sub-surface flows. The main process responsible for the interception effect is probably uptake by grassland and retention in soils since the denitrification load tends to decrease proportionally to N input and, for the scenarios considered, is lower in the interception scenarios than in the corresponding dilution zones.
The Western diet is characterized by high meat consumption, which negatively affects the environment and human health. Transitioning toward eating more plant-based products in Western societies has been identified as a key instrument to tackle these problems. However, one potential concern is that radically reducing meat in the current diet might lead to deficiencies in nutritional intake. In this paper, we explore a scenario in which meat consumption in Sweden is reduced by 50% and replaced by domestically grown grain legumes. We quantify and discuss the implications for nutritional intake on population level, consequences for agricultural production systems and environmental performance. The reduction in meat consumption is assumed to come primarily from a decrease in imported meat. We use data representing current Swedish conditions including the Swedish dietary survey, the Swedish food composition database, Statistics Sweden and existing life cycle assessments for different food items. At population level, average daily intake of energy and most macro- and micro-nutrients would be maintained within the Nordic Nutrition Recommendations after the proposed transition (e.g., for protein, fat, zinc, vitamin B12 and total iron). The transition would also provide a considerable increase in dietary fiber and some increase in folate intake, which are currently below the recommended levels. The transition scenario would increase total area of grain legume cultivation from 2.2% (current level) to 3.2% of Swedish arable land and is considered technically feasible. The climate impact of the average Swedish diet would be reduced by 20% and the land use requirement by 23%. There would be a net surplus of approximately 21,500 ha that could be used for bioenergy production, crop production for export, nature conservation, etc. Implementation of this scenario faces challenges, such as lack of suitable varieties for varying conditions, lack of processing facilities to supply functional legume-based ingredients to food industries and low consumer awareness about the benefits of eating grain legumes. In sum, joint efforts from multiple actors are needed to stimulate a decrease in meat consumption and to increase cultivation and use of domestically grown grain legumes.
Choice experiments addressing outcome uncertainty (OU) typically reframe continuous probability densities for each risky outcome into two discrete categories, each with a single probability of occurrence. The implications of this simplification for welfare estimation are unknown. This article evaluates the convergent validity of willingness-to-pay (WTP) estimates from a more accurate multiple-outcome treatment of OU, compared to the two-outcome approach. Results for a case study of coastal flood adaptation in Connecticut, United States, suggest that higher-resolution OU treatments increase choice complexity but can provide additional information on risk preferences and WTP. This tradeoff highlights challenges facing the valuation of uncertain outcomes.
This paper seeks to establish good practice in setting inputs for operational risk models for banks, insurers and other financial service firms. It reviews Basel, Solvency II and other regulatory requirements as well as publicly available literature on operational risk modelling. It recommends a combination of historic loss data and scenario analysis for modelling of individual risks, setting out issues with these data, and outlining good practice for loss data collection and scenario analysis. It recommends the use of expert judgement for setting correlations, and addresses information requirements for risk mitigation allowances and capital allocation, before briefly covering Bayesian network methods for modelling operational risks.
For many years, deceleration systems developed in an evolutionary fashion. This evolution needed flight test and experimental data. Concurrently, payload became much more expensive and needed to be safer. Today, there are a variety of methods employed to recover airborne bodies such as bio-capsules, reentry satellites, carrier missiles' boosters, reentry satellites, etc. Most of these methods make use of a parachute landing system in which recovery occurs in multiple phases. This paper studies the final phase of the subsonic recovery scenario for which a multi-phase deceleration system has been designed. To observe and evaluate system performance, a test projectile is designed that accelerates the payload to a certain velocity in order to test the recovery system. Finally, theoretical and test results are compared to indicate the appropriate design and reliable deceleration velocity in a space payload recovery.
The work described in this paper is part of the development of a framework to support the joint execution of cooperative missions by a group of vehicles, in a simulated, augmented, or real environment. Such a framework brings forward the need for formal languages in which to specify the vehicles that compose a team, the scenario in which they will operate, and the mission to be performed. This paper introduces the Scenario Description Language (SDL) and the Team Description Language (TDL), two Extensible Markup Language based dialects that compose the static components necessary for representing scenario and mission knowledge. SDL provides a specification of physical scenario and global operational constraints, while TDL defines the team of vehicles, as well as team-specific operational restrictions. The dialects were defined using Extensible Markup Language schemas, with all required information being integrated in the definitions. An interface was developed and incorporated into the framework, allowing for the creation and edition of SDL and TDL files. Once the information is specified, it can be used in the framework, thus facilitating environment and team specification and deployment. A survey answered by practitioners and researchers shows that the satisfaction with SDL+TDL is elevated (the overall evaluation of SDL+TDL achieved a score of 4 out of 5, with 81%/78.6% of the answers ≥4); in addition, the usability of the interface was evaluated, achieving a score of 86.7 in the System Usability Scale survey. These results imply that SDL+TDL is flexible enough to represent scenarios and teams, through a user-friendly interface.
Before the 1990s, human fascioliasis diagnosis focused on individual patients in hospitals or health centres. Case reports were mainly from developed countries and usually concerned isolated human infection in animal endemic areas. From the mid-1990s onwards, due to the progressive description of human endemic areas and human infection reports in developing countries, but also new knowledge on clinical manifestations and pathology, new situations, hitherto neglected, entered in the global scenario. Human fascioliasis has proved to be pronouncedly more heterogeneous than previously thought, including different transmission patterns and epidemiological situations. Stool and blood techniques, the main tools for diagnosis in humans, have been improved for both patient and survey diagnosis. Present availabilities for human diagnosis are reviewed focusing on advantages and weaknesses, sample management, egg differentiation, qualitative and quantitative diagnosis, antibody and antigen detection, post-treatment monitoring and post-control surveillance. Main conclusions refer to the pronounced difficulties of diagnosing fascioliasis in humans given the different infection phases and parasite migration capacities, clinical heterogeneity, immunological complexity, different epidemiological situations and transmission patterns, the lack of a diagnostic technique covering all needs and situations, and the advisability for a combined use of different techniques, at least including a stool technique and a blood technique.
Changes in landscape composition and structure may impact the conservation and management of protected areas. Species that depend on specific habitats are at risk of extinction when these habitats are degraded or lost. Designing robust methods to evaluate landscape composition will assist decision- and policy-making in emerging landscapes. This paper describes a rapid assessment methodology aimed at evaluating land-cover quality for birds, plants, butterflies and bees around seven UK Natura 2000 sites. An expert panel assigned quality values to standard Coordination of Information on the Environment (CORINE) land-cover classes for each taxonomic group. Quality was assessed based on historical (1950, 1990), current (2000) and future (2030) land-cover data, the last projected using three alternative scenarios: a growth-applied strategy (GRAS), a business-as-might-be-usual (BAMBU) scenario, and sustainable European development goal (SEDG) scenario. A quantitative quality index weighted the area of each land-cover parcel with a taxa-specific quality measure. Land parcels with high quality for all taxonomic groups were evaluated for temporal changes in area, size and adjacency. For all sites and taxonomic groups, the rate of deterioration of land-cover quality was greater between 1950 and 1990 than current rates or as modelled using the alternative future scenarios (2000–2030). Model predictions indicated land-cover quality stabilized over time under the GRAS scenario, and was close to stable for the BAMBU scenario. The SEDG scenario suggested an ongoing loss of quality, though this was lower than the historical rate of c. 1% loss per decade. None of the future scenarios showed accelerated fragmentation, but rather increases in the area, adjacency and diversity of high quality land parcels in the landscape.
To obtain insights into disaster management among dental graduates in a dental institute in India.
A total of 103 of 104 house surgeons in Shri Dharmasthala Manjunatheswar College of Dental Sciences and Hospital, Dharwad, participated in the main study (response rate = 99.04%). Their knowledge, attitude, and behavior regarding disaster management were assessed by use of a survey questionnaire. Information was also collected regarding age, gender, religion, and residence.
Mean knowledge, attitude, and behavior scores toward disaster management were 45.46%, 79.53%, and 37.70%, respectively. A significant relationship was observed between knowledge and attitude scores (r = 0.248, P = .012). No significant differences were found in knowledge, attitude, and behavior by gender, religion, and residence. Religion was a significant predictor of knowledge scores (χ2 = 10.108, P = .006).
Respondents had favorable attitudes toward disaster management, but their knowledge and behavior required considerable improvement. Knowledge of the respondents was significantly associated with their attitude. This pilot study highlights the need for curriculum changes in dental education in India and further nationwide study. (Disaster Med Public Health Preparedness. 2014;0:1-7)
To shed some light on possible directions for research and public policies, but also to help equine industry stakeholders to prepare for upcoming changes, the French National Institute for Agricultural Research (INRA), together with the French Institute for Horse and Horse Riding (IFCE), have conducted a collective scenario-building exercise for the French equine industry to 2030. The study is based on “morphological analysis”, a method which explores past and current trends, and potential shifts in order to consider possible future developments.