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Risk assessment
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Risk assessment is the determination of quantitative or qualitative estimate of risk related to a well-defined situation and a recognized threat (also called hazard). Quantitative risk assessment requires calculations of two components of risk (R): the magnitude of the potential loss (L), and the probability (p) that the loss will occur. An acceptable risk is a risk that is understood and tolerated usually because the cost or difficulty of implementing an effective countermeasure for the associated vulnerability exceeds the expectation of loss.[1] "Health risk assessment" includes variations, such as the type and severity of response, with or without a probabilistic context.
In the engineering of complex systems, sophisticated risk assessments are often made within safety engineering and reliability engineering when it concerns threats to life, environment or machine functioning. The agriculture, nuclear, aerospace, oil, rail and military industries have a long history of dealing with risk assessment. Also, medical, hospital, social service[2] and food industries control risks and perform risk assessments on a continual basis. Methods for assessment of risk may differ between industries and whether it pertains to general financial decisions or environmental, ecological, or public health risk assessment.
Contents
[hide]
1 Concept
2 Dose dependent and single exposure risk
3 Assessment of risk
3.1 Dose dependent risk
4 Quantitative risk assessment
4.1 Criticisms of quantitative risk assessment
5 Dynamic risk assessment
6 Fields of application
6.1 General health
6.1.1 Small sub-populations
6.1.2 Acceptable risk criteria
6.2 Auditing
6.3 Public health
6.4 Project management
6.5 Information security
6.6 Megaprojects
6.7 Software evolution
6.8 Shipping industry
6.9 Underwater diving
6.10 Environment
7 See also
8 References
8.1 Footnotes
8.2 General references
9 External links
Concept[edit]
Risk assessment from a financial point of view.
Risk assessment consists of an objective evaluation of risk in which assumptions and uncertainties are clearly considered and presented. Part of the difficulty in risk management is that both the quantities by which risk assessment is concerned – potential loss and probability of occurrence – can be very difficult to measure. The chance of error in measuring these two concepts is high. Risk with a large potential loss and a low probability of occurrence is often treated differently from one with a low potential loss and a high likelihood of occurrence. In theory, both are of near equal priority, but in practice it can be very difficult to manage when faced with the scarcity of resources, especially time, in which to conduct the risk management process. To see this expressed mathematically, one can define total risk as the sum over individual risks, R i {\displaystyle R_{i}} , which can be computed as the product of potential losses, L i {\displaystyle L_{i}} , and their probabilities, p ( L i ) {\displaystyle p(L_{i})} :
R i = L i p ( L i ) {\displaystyle R_{i}=L_{i}p(L_{i})\,\!}
R t o t a l = ∑ i L i p ( L i ) {\displaystyle R_{total}=\sum _{i}L_{i}p(L_{i})\,\!}
Even though for some risks R i , R j {\displaystyle R_{i},R_{j}} , we might have R i = R j {\displaystyle R_{i}=R_{j}} , if the probability p ( L j ) {\displaystyle p(L_{j})} is small compared to p ( L i ) {\displaystyle p(L_{i})} , its estimation might be based only on a smaller number of prior events, and hence, more uncertain. On the other hand, since R i = R j {\displaystyle R_{i}=R_{j}} , L j {\displaystyle L_{j}} must be larger than L i {\displaystyle L_{i}} , so decisions based on this uncertainty would be more consequential, and hence, warrant a different approach.
Financial decisions, such as insurance, express loss in terms of dollar amounts. When risk assessment is used for public health or environmental decisions, loss can be quantified in a common metric such as a country's currency or some numerical measure of a location's quality of life. For public health and environmental decisions, loss is simply a verbal description of the outcome, such as increased cancer incidence or incidence of birth defects. In that case, the "risk" is expressed as
R i = p ( L i ) {\displaystyle R_{i}=p(L_{i})\,\!}
If the risk estimate takes into account information on the number of individuals exposed, it is termed a "population risk" and is in units of expected increased cases per a time period. If the risk estimate does not take into account the number of individuals exposed, it is termed an "individual risk" and is in units of incidence rate per a time period. Population risks are of more use for cost/benefit analysis; individual risks are of more use for evaluating whether risks to individuals are "acceptable".
Dose dependent and single exposure risk[edit]
The consequences of exposure may depend on how much exposure occurs (dose dependent), such as noise or vibration exposure, where both the strength and duration of the exposure affect the severity of the consequence, or may be statistically independent of the amount of exposure, such as falling from a height, which either happens or does not. For the general case, the hazards may include both types of exposure, and the procedures for assessment of the associated risk differ in detail. Dose dependent risk tends to be classified as health risk and dose independent risk as safety risk.
Assessment of risk[edit]
At the strategic level policies are made specifying acceptable levels of risk, procedures to be followed within the organisation, priorities and allocation of resources.[3]:10 At the systematic level, management involved with the project produce project level risk assessments with the assistance of the available expertise as part of the planning process, and set up systems to ensure that required actions to manage the assessed risk are in place. At the dynamic level, the personnel directly involved may be required to deal with unforeseen problems in real time. The tactical decisions made at this level should be reviewed after the operation to provide feedback on the effectiveness of both the planned procedures and decisions made in response to the contingency.
The first step in risk assessment is to establish the context This restricts the range of hazards to be considered.
This is followed by identification of visible and implied hazards that may threaten the project, and determining the qualitative nature of the potential adverse consequences of each hazard. Without a potential adverse consequence, there is no hazard.
It is also necessary to identify the potential parties or assets which may be affected by the threat, and the potential consequences to them if the hazard is activated.
If the consequences are dependent on dose, ie. the amount of exposure, the relationship between dose and severity of consequence must be established, and the risk depends on the probable dose, which may depend on concentration or amplitude and duration or frequency of exposure. This is the general case for many health hazards where the mechanism of injury is toxicity or repetitive injury, particularly where the effect is cumulative.
For other hazards, the consequences may either occur or not, and the severity may be extremely variable even when the triggering conditions are the same. This is typical of many biological hazards as well as a large range of safety hazards. Exposure to a pathogen may or may not result in actual infection, and the consequences of infection may also be variable. Similarly a fall from the same place may result in minor injury or death, depending on unpredictable details. In these cases estimates must be made of reasonably likely consequences and associated probability of occurrence.
In cases where statistical records are available they may be used to evaluate risk, but in many cases there are no data or insufficient data available to be useful. Mathematical or experimental models may provide useful input.
Dose dependent risk[edit]
Food risk assessment nomogram
Dose-Response Analysis, is determining the relationship between dose and the type of adverse response and/or probability or the incidence of effect (dose-response assessment). The complexity of this step in many contexts derives mainly from the need to extrapolate results from experimental animals (e.g. mouse, rat) to humans, and/or from high to lower doses, including from high acute occupational levels to low chronic environmental levels. In addition, the differences between individuals due to genetics or other factors mean that the hazard may be higher for particular groups, called susceptible populations. An alternative to dose-response estimation is to determine a concentration unlikely to yield observable effects, that is, a no effect concentration. In developing such a dose, to account for the largely unknown effects of animal to human extrapolations, increased variability in humans, or missing data, a prudent approach is often adopted by including safety or uncertainty factors in the estimate of the "safe" dose, typically a factor of 10 for each unknown step.
Exposure Quantification, aims to determine the amount of a contaminant (dose) that individuals and populations will receive, either as a contact level (e.g., concentration in ambient air) or as intake (e.g., daily dose ingested from drinking water). This is done by examining the results of the discipline of exposure assessment. As different location, lifestyles and other factors likely influence the amount of contaminant that is received, a range or distribution of possible values is generated in this step. Particular care is taken to determine the exposure of the susceptible population(s).
The results of these steps are combined to produce an estimate of risk. Because of the different susceptibilities and exposures, this risk will vary within a population. An uncertainty analysis is usually included in a health risk assessment.
Quantitative risk assessment[edit]
Further information: Quantitative Risk Assessment software
In quantitative risk assessment an annualized loss expectancy (ALE) may be used to justify the cost of implementing countermeasures to protect an asset. This may be calculated by multiplying the single loss expectancy (SLE), which is the loss of value based on a single security incident, with the annualized rate of occurrence (ARO), which is an estimate of how often a threat would be successful in exploiting a vulnerability.
Criticisms of quantitative risk assessment[edit]
Barry Commoner, Brian Wynne and other critics have expressed concerns that risk assessment tends to be overly quantitative and reductive. For example, they argue that risk assessments ignore qualitative differences among risks. Some charge that assessments may drop out important non-quantifiable or inaccessible information, such as variations among the classes of people exposed to hazards, or social amplification.[4] Furthermore, Commoner and O'Brien claim that quantitative approaches divert attention from precautionary or preventative measures.[5] Others, like Nassim Nicholas Taleb consider risk managers little more than "blind users" of statistical tools and methods.[6]
Dynamic risk assessment[edit]
During emergency response the situation and hazards are often inherently less predictable than for planned activities. In general, if the situation and hazards are predictable, standard operating procedures should deal with them adequately, and in some emergencies this holds true and the prepared and trained responses are adequate to manage the situation. These situations are usually those that the operator can deal with without outside assistance, or with the assistance of a backup team who are prepared and available to step in at short notice. Other emergencies occur where there is no previously planned protocol, or when an outsider group is brought in to handle the situation, and they are not specifically prepared for the scenario that exists, but must deal with it without undue delay. Examples include police, fire department, disaster response and other public service rescue teams. In these cases ongoing risk assessment by the involved personnel can advise appropriate action to reduce risk.[7] HM Fire Services Inspectorate has defined dynamic risk assessment (DRA) as:
The continuous assessment of risk in the rapidly changing circumstances of an operational incident, in order to implement the control measures necessary to ensure an acceptable level of safety.[7]
Dynamic risk assessment is the final stage of an integrated safety management system which can provide appropriate response during changing circumstances. It relies on experience, training and continuing education, including effective debriefing to analyse not only what went wrong, but also what went right, and why, and to share this with other members of the team and the personnel responsible for the planning level risk assessment.[7]
Fields of application[edit]
Application of risk assessment procedures is common in a wide range of fields, and these may have specific legal obligations, codes of practice and standardised procedures. Some of these are listed here.
General health[edit]
There are many resources that provide health risk information.
The National Library of Medicine provides risk assessment and regulation information tools for a varied audience.[8] These include:
TOXNET (databases on hazardous chemicals, environmental health, and toxic releases),[9]
the Household Products Database (potential health effects of chemicals in over 10,000 common household products),[10]
TOXMAP (maps of the U.S. Environmental Protection Agency Superfund and Toxics Release Inventory data).
The United States Environmental Protection Agency provides basic information about environmental health risk assessments for the public for a wide variety of possible environmental exposures.[11]
The Environmental Protection Agency began actively using risk assessment methods to protect drinking water in the United States after passage of the Safe Drinking Water Act of 1974. The law required the National Academy of Sciences to conduct a study on drinking water issues, and in its report the NAS described some methodologies for doing risk assessments for chemicals that were suspected carcinogens, recommendations that top EPA officials have described as perhaps the study’s most important part.[12]
Considering the increase in junk food and its toxicity, FDA required in 1973 that cancer-causing compounds must not be present in meat at concentrations that would cause a cancer risk greater than 1 in a million over a lifetime. The US Environmental Protection Agency provides extensive information about ecological and environmental risk assessments for the public via its risk assessment portal.[13] The Stockholm Convention on persistent organic pollutants (POPs) supports a qualitative risk framework for public health protection from chemicals that display environmental and biological persistence, bioaccumulation, toxicity (PBT) and long range transport; most global chemicals that meet this criteria have been previously assessed quantitatively by national and international health agencies.[14]
Small sub-populations[edit]
When risks apply mainly to small sub-populations, there is uncertainty at which point intervention is necessary. For example, there may be a risk that is very low for everyone, other than 0.1% of the population. It is necessary to determine whether this 0.1% is represented by:
all infants younger than X days or
recreational users of a particular product.
If the risk is higher for a particular sub-population because of abnormal exposure rather than susceptibility, strategies to further reduce the exposure of that subgroup are considered. If an identifiable sub-population is more susceptible due to inherent genetic or other factors, public policy choices must be made. The choices are:
to set policies for protecting the general population that are protective of such groups, e.g. for children when data exists, the Clean Air Act for populations such as asthmatics or
not to set policies, because the group is too small, or the costs too high.
Acceptable risk criteria[edit]
The idea of not increasing lifetime risk by more than one in a million has become commonplace in public health discourse and policy.[15] It is a heuristic measure. It provides a numerical basis for establishing a negligible increase in risk.
Environmental decision making allows some discretion for deeming individual risks potentially "acceptable" if less than one in ten thousand chance of increased lifetime risk. Low risk criteria such as these provide some protection for a case where individuals may be exposed to multiple chemicals e.g. pollutants, food additives or other chemicals.
In practice, a true zero-risk is possible only with the suppression of the risk-causing activity.
Stringent requirements of 1 in a million may not be technologically feasible or may be so prohibitively expensive as to render the risk-causing activity unsustainable, resulting in the optimal degree of intervention being a balance between risks vs. benefit. For example, emissions from hospital incinerators result in a certain number of deaths per year. However, this risk must be balanced against the alternatives. There are public health risks, as well as economic costs, associated with all options. The risk associated with no incineration is potential spread of infectious diseases, or even no hospitals. Further investigation identifies options such as separating noninfectious from infectious wastes, or air pollution controls on a medical incinerator.
Intelligent thought about a reasonably full set of options is essential. Thus, it is not unusual for there to be an iterative process between analysis, consideration of options, and follow up analysis.
Auditing[edit]
For audits performed by an outside audit firm, risk assessment is a crucial stage before accepting an audit engagement. According to ISA315 Understanding the Entity and its Environment and Assessing the Risks of Material Misstatement, "the auditor should perform risk assessment procedures to obtain an understanding of the entity and its environment, including its internal control". Evidence relating to the auditor’s risk assessment of a material misstatement in the client’s financial statements. Then, the auditor obtains initial evidence regarding the classes of transactions at the client and the operating effectiveness of the client’s internal controls. Audit risk is defined as the risk that the auditor will issue a clean unmodified opinion regarding the financial statements, when in fact the financial statements are materially misstated, and therefore do not qualify for a clean unmodified opinion. As a formula, audit risk is the product of two other risks: Risk of Material Misstatement and Detection risk. This formula can be further broken down as follows: inherent risk × control risk × detection risk.
Public health[edit]
In the context of public health, risk assessment is the process of characterizing the nature and likelihood of a harmful effect to individuals or populations from certain human activities. Health risk assessment can be mostly qualitative or can include statistical estimates of probabilities for specific populations. In most countries the use of specific chemicals or the operations of specific facilities (e.g. power plants, manufacturing plants) is not allowed unless it can be shown that they do not increase the risk of death or illness above a specific threshold. For example, the American Food and Drug Administration (FDA) regulates food safety through risk assessment.[16]
Project management[edit]
In project management, risk assessment is an integral part of the risk management plan, studying the probability, the impact, and the effect of every known risk on the project, as well as the corrective action to take should an incident implied by a risk occur.[17] Of special consideration in this area are the relevant codes of practice that are enforced in the specific jurisdiction. Understanding the regime of regulations that risk management must abide by is integral to formulating safe and compliant risk assessment practices.
Information security[edit]
Main article: IT risk management § Risk assessment
Information technology risk assessment can be performed by a qualitative or quantitative approach, following different methodologies. One important difference[clarification needed] in risk assessments in information security is modifying the threat model to account for the fact that any adversarial system connected to the Internet has access to threaten any other connected system.[18] Risk assessments may therefore need to be modified to account for the threats from all adversaries, instead of just those with reasonable access as is done in other fields.
Another notable difference is the strategic nature of IT risk assessments. Unlike tactical vulnerability assessments and penetration testing which aim to identify and close specific gaps in security, IT risk assessments are functional at the executive level to examine the broader picture of IT risk management.[clarification needed][19]
Megaprojects[edit]
Megaprojects (sometimes also called "major programs") are extremely large-scale investment projects, typically costing more than US$1 billion per project. They include bridges, tunnels, highways, railways, airports, seaports, power plants, dams, wastewater projects, coastal flood protection, oil and natural gas extraction projects, public buildings, information technology systems, aerospace projects, and defence systems. Megaprojects have been shown to be particularly risky in terms of finance, safety, and social and environmental impacts.
Software evolution[edit]
Studies have shown that early parts of the system development cycle such as requirements and design specifications are especially prone to error. This effect is particularly notorious in projects involving multiple stakeholders with different points of view. Evolutionary software processes offer an iterative approach to requirement engineering to alleviate the problems of uncertainty, ambiguity and inconsistency inherent in software developments.[clarification needed]
Shipping industry[edit]
In July 2010, shipping companies agreed to use standardized procedures in order to assess risk in key shipboard operations. These procedures were implemented as part of the amended ISM Code.[20]
Underwater diving[edit]
See also: List of diving hazards and precautions
Formal risk assessment is a required component of most professional dive planning, but the format and methodology may vary. Consequences of an incident due to an identified hazard are generally chosen from a small number of standardised categories, and probability is estimated based on statistical data on the rare occasions when it is available, and on a best guess estimate based on personal experience and company policy in most cases. A simple matrix is often used to transform these inputs into a level of risk, generally expressed as unacceptable, marginal or acceptable. If unacceptable, measures must be taken to reduce the risk to an acceptable level, and the final outcome of the risk assessment must be accepted by the affected parties before a dive commences. Higher levels of risk may be acceptable in special circumstances, such as military or search and rescue operations when there is a chance of recovering a survivor. Diving supervisors are trained in the procedures of hazard identification and risk assessment, and it is part of their planning and operational responsibility. Both health and safety hazards must be considered. Several stages may be identified. There is risk assessment done as part of the diving project planning, on site risk assessment which takes into account the specific conditions of the day, and dynamic risk assessment which is ongoing during the operation by the members of the dive team, particularly the supervisor and the working diver.[21][22]
In recreational scuba diving, the extent of risk assessment expected of the diver is relatively basic, and is included in the pre-dive checks. Several mnemonics have been developed by diver certification agencies to remind the diver to pay some attention to risk, but the training is rudimentary. Diving service providers are expected to provide a higher level of care for their customers, and diving instructors and divemasters are expected to assess risk on behalf of their customers and warn them of site-specific hazards and the competence considered appropriate for the planned dive. Technical divers are expected to make a more thorough assessment of risk, but as they will be making an informed choice for a recreational activity, the level of acceptable risk may be considerably higher than that permitted for occupational divers under the direction of an employer.[23][24]
Environment[edit]
Environmental Risk Assessment (ERA) aims at assessing the effects of stressors, often chemicals, on the local environment. A risk is an integrated assessment of likelihood and severity of an undesired event. In ERA, the undesired event often depends on the chemical of interest and on the risk assessment scenario.[25] This undesired event is usually a detrimental effect on organisms, populations or ecosystems. Current ERAs usually compare an exposure to a no-effect level, such as the Predicted Environmental Concentration/Predicted No-Effect Concentration (PEC/PNEC) ratio in Europe. Although this type of ratio is useful and often used in regulation purposes, it is only an indication of an exceeded apparent threshold.[26] New approaches start to be developed in ERA in order to quantifiy this risk and to communicate effectively on it with both the managers and the general public.[25]
See also[edit]
Acceptable loss
Benefit risk
Control self-assessment
Cost risk
Digital Continuity
Edwards v. National Coal Board
Extreme risk
Flood risk assessment
Form 696
Global catastrophic risk
HACCP: hazard analysis and critical control points, risk assessment in food
Hazard (risk)
Hazard Identification
Health Impact Assessment
Information assurance
List of auditing topics
ISO 28000
ISO 31000
ISSOW
Megaprojects and Risk
Network Theory in Risk Assessment
Optimism bias
PIMEX a video exposure monitoring method
Probabilistic risk assessment
Probit model
Project risk management
Reference class forecasting
Reliability Engineering
Safety Engineering
Risk
Risk aversion
Risk based auditing
Risk management
Risk management tools
Risk matrix
Risk (statistics)
Security risk
SimpleRisk
Strategic misrepresentation
References[edit]
Footnotes[edit]
Jump up ^ RFC 4949
Jump up ^ Lacey, Peter (2011). "An Application of Fault Tree Analysis to the Identification and Management of Risks in Government Funded Human Service Delivery". Proceedings of the 2nd International Conference on Public Policy and Social Sciences (pdf)|format= requires |url= (help). SSRN 2171117  .
Jump up ^ Cite error: The named reference Lock_2016 was invoked but never defined (see the help page).
Jump up ^ Kasperson, R.E., Renn, O., Slovic, P., Brown, H.S., Emel, J., Goble, R., Kasperson, J.X., Ratick, S. (1988). "The social amplification of risk: A conceptual framework". Risk Analysis. 8 (2): 177–187. doi:10.1111/j.1539-6924.1988.tb01168.x. CS1 maint: Multiple names: authors list (link)
Jump up ^ Commoner, Barry. O'Brien, Mary. Shrader-Frechette and Westra 1997.
Jump up ^ The fourth quadrant: a map of the limits of statistics [9.15.08] Nassim Nicholas Taleb An Edge Original Essay
^ Jump up to: a b c Lock, Gareth (June 2017). Phillips, Mark, ed. "Public Safety Diving-Dynamic Risk Assessment" (PDF). PS Diver Magazine. PSDiver.com (116): 9. Retrieved 20 June 2017.
Jump up ^ "Risk Assessment and Regulation Information from the NLM". NLM. Retrieved 9 June 2013.
Jump up ^ "Databases on toxicology, hazardous chemicals, environmental health, and toxic releases". TOXNET. NLM. May 2012. Retrieved 9 June 2013.
Jump up ^ "Household Products Database". U.S. Dept. of Health & Human Services. January 2013. Retrieved 9 June 2013.
Jump up ^ "Risk Assessment Portal". EPA. 13 May 2013. Retrieved 9 June 2013.
Jump up ^ EPA Alumni Association: Senior EPA officials discuss early implementation of the Safe Drinking Water Act of 1974, Video, Transcript (see pages 11,14).
Jump up ^ EPA,ORD,NCEA, US. "Risk Assessment". www.epa.gov. Retrieved 2016-04-07. CS1 maint: Multiple names: authors list (link)
Jump up ^ Szabo DT, Loccisano AE (March 30, 2012). "POPs and Human Health Risk Assessment". Dioxins and Persistent Organic Pollutants. 3rd (Edition): John Wiley & Sons. doi:10.1002/9781118184141.ch19.
Jump up ^ Hunter, Paul R.; Fewtrell, Lorna (2001). "Acceptable Risk" (PDF). World Health Organization.
Jump up ^ Merrill, Richard A. "Food Safety Regulation: Reforming the Delaney Clause" in Annual Review of Public Health, 1997, 18:313-40. This source includes a useful historical survey of prior food safety regulation.
Jump up ^ Managing Project Risks - Retrieved May 20th, 2010
Jump up ^ Spring, J.; Kern, S.; Summers, A. (2015-05-01). "Global adversarial capability modeling". 2015 APWG Symposium on Electronic Crime Research (eCrime): 1–21. doi:10.1109/ECRIME.2015.7120797.
Jump up ^ Arnold, Rob. "3 Types of Security Assessments". Threat Sketch. Threat Sketch. Retrieved 17 November 2016.
Jump up ^ "ISM CODE – Amendments from 1st July 2010 Risk Assessment".
Jump up ^ "Diving Regulations 2009". Occupational Health and Safety Act 85 of 1993 – Regulations and Notices – Government Notice R41. Pretoria: Government Printer. Retrieved 3 November 2016 – via Southern African Legal Information Institute.
Jump up ^ Staff (August 2016). "15 - General safety requirements". Guidance for diving supervisors IMCA D 022 (Revision 1 ed.). London, UK: International Marine Contractors Association. pp. 15-5.
Jump up ^ Staff (1977). "The Diving at Work Regulations 1997". Statutory Instruments 1997 No. 2776 Health and Safety. Kew, Richmond, Surrey: Her Majesty's Stationery Office (HMSO). Retrieved 6 November 2016.
Jump up ^ Gurr, Kevin (August 2008). "13: Operational Safety". In Mount, Tom; Dituri, Joseph. Exploration and Mixed Gas Diving Encyclopedia (1st ed.). Miami Shores, Florida: International Association of Nitrox Divers. pp. 165–180. ISBN 978-0-915539-10-9.
^ Jump up to: a b Goussen, Benoit; Price, Oliver R.; Rendal, Cecilie; Ashauer, Roman (2016-10-26). "Integrated presentation of ecological risk from multiple stressors". Scientific Reports. 6. ISSN 2045-2322. PMC 5080554  . PMID 27782171. doi:10.1038/srep36004.
Jump up ^ Jager, Tjalling; Heugens, Evelyn H. W.; Kooijman, Sebastiaan A. L. M. (2006-04-20). "Making Sense of Ecotoxicological Test Results: Towards Application of Process-based Models". Ecotoxicology. 15 (3): 305–314. ISSN 0963-9292. doi:10.1007/s10646-006-0060-x.
General references[edit]
Dorne, Jean-Lou C. M.; Kass, George E. N.; Bordajandi, Luisa R.; Amzal, Billy; Bertelsen, Ulla; Castoldi, Anna F.; Heppner, Claudia; Eskola, Mari; Fabiansson, Stefan; Ferrari, Pietro; Scaravelli, Elena; Dogliotti, Eugenia; Fuerst, Peter; Boobis, Alan R.; Verger, Philippe (2011). "Chapter 2. Human Risk Assessment of Heavy Metals: Principles and Applications". In Astrid Sigel; Helmut Sigel; Roland K O Sigel. Metal Ions in Toxicology. RSC Publishing. pp. 27–60. doi:10.1039/9781849732116-00027.
Mumtaz, Moiz M.; Hansen, Hugh; Pohl, Hana R. (2011). "Chapter 3. Mixtures and Their Risk Assessment in Toxicology". In Astrid Sigel; Helmut Sigel; Roland K O Sigel. Metal Ions in Toxicology. RSC Publishing. pp. 61–80. doi:10.1039/9781849732116-00061.
Committee on Risk Assessment of Hazardous Air Pollutants, Board on Environmental Studies and Toxicology, Commission on Life Sciences, National Research Council (1994), Science and judgment in risk assessment, Washington, D.C: National Academy Press, ISBN 0-309-04894-X, retrieved 27 September 2010 CS1 maint: Multiple names: authors list (link)
Barry Commoner. “Comparing apples to oranges: Risk of cost/benefit analysis” from Contemporary moral controversies in technology, A. P. Iannone, ed., pp. 64–65.
Hallenbeck, William H. Quantitative risk assessment for environmental and occupational health. Chelsea, Mich.: Lewis Publishers, 1986
Harremoës, Poul, ed. Late lessons from early warnings: the precautionary principle 1896–2000.
John M. Lachin. Biostatistical methods: the assessment of relative risks.
Lerche, Ian; Glaesser, Walter (2006), Environmental risk assessment : quantitative measures, anthropogenic influences, human impact., Berlin: Springer, ISBN 3-540-26249-0, retrieved 27 September 2010
Kluger, Jeffrey (November 26, 2006), "How Americans Are Living Dangerously", Time, retrieved 27 September 2010 Also published as December 4 cover title: "Why We Worry About the Wrong Things: The Psychology of Risk"
Library of Congress. Congressional Research Service. & United States. Congress. House. Committee on Science and Technology. Subcommittee on Science, Research, and Technology (1983), A Review of risk assessment methodologies, Washington: U.S: report / prepared by the Congressional Research Service, Library of Congress for the Subcommittee on Science, Research, and Technology; transmitted to the Committee on Science and Technology, U.S. House of Representatives, Ninety-eighth Congress, first session CS1 maint: Multiple names: authors list (link)
Deborah G. Mayo. “Sociological versus metascientific views of technological risk assessment” in Shrader-Frechette and Westra.
Nyholm, J, 2009 "Persistency, bioaccumulation and toxicity assessment of selected brominated flame retardants"
O’Brien, Mary (2002), Making better environmental decisions: an alternative to risk assessment, Cambridge, Massachusetts: MIT Press, ISBN 0-262-15051-4, retrieved 27 September 2010 Paperback ISBN 0-262-65053-3
Shrader-Frechette, Kristin; Westra, Laura, eds. (1997), Technology and values, Lanham, Maryland: Rowman & Littlefield, ISBN 0-8476-8631-0, retrieved 27 September 2010
External links[edit]
Risk Assessment Worksheet and Management Plan A comprehensive guide to risk assessment in project management, includes template - By John Filicetti

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Nuchal scan
From Wikipedia, the free encyclopedia
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Measurements of fetal nuchal translucency, nasal bone and facial angle according to the standards of the Fetal Medicine Foundation
A nuchal scan or nuchal translucency (NT) scan/procedure is a sonographic prenatal screening scan (ultrasound) to detect cardiovascular abnormalities in a fetus, though altered extracellular matrix composition and limited lymphatic drainage can also be detected.[1] Since chromosomal abnormalities can result in impaired cardiovascular development, a nuchal translucency scan is used as a screening, rather than diagnostic, tool for conditions such as Down syndrome. However, increased nuchal translucency measurements are also associated with non-chromosomal abnormalities such as genetic conditions (e.g. Di George syndrome) and non-genetic ones (e.g. Body-stalk anomaly).[2] The scan is carried out at 11–13+6 weeks pregnancy and assesses the quantity of fluid collecting within the nape of the fetal neck. There are two distinct measurements – the nuchal translucency, which is measured earlier in pregnancy at the end of the first trimester, and for which there is a lower threshold for increased diameter, and the nuchal fold, which is measured towards the end of the second trimester. The scan may also help confirm both the accuracy of the pregnancy dates and the fetal viability. As nuchal translucency size increases, the chances of a chromosomal abnormality and mortality increase; 65% of the largest translucencies (>6.5mm) are due to chromosomal abnormality, while fatality is 19% at this size.[2]
Contents
[hide]
1 Indication
1.1 Down Syndrome
1.2 Other chromosomal defects
1.3 Other defects with normal karyotype
2 Procedure
3 Accuracy
4 Development of nuchal translucency
5 Nuchal fold thickness
6 History
7 See also
8 References
Indication[edit]
All women, whatever their age, have a small risk of delivering a baby with a physical or cognitive disability. The nuchal scan helps physicians estimate the risk of the fetus having Down syndrome or other abnormalities more accurately than by maternal age alone.
Down Syndrome[edit]
Main article: Down syndrome
Overall, the most common chromosomal disorder is Down syndrome (trisomy 21). The risk rises with maternal age from 1 in 1400 pregnancies below age 25, to 1 in 350 at age 35, to 1 in 100 at age 40.[3] Down syndrome is the second most common chromosomal abnormality associated with increased nuchal translucency, after Turner syndrome (45,X).[citation needed]
Until recently, the only reliable ways to determine if the fetus has a chromosomal abnormality was to have an invasive test such as amniocentesis or chorionic villus sampling, but such tests carry a risk of causing a miscarriage estimated variously as ranging between 1%[citation needed] or 0.06%.[4] Based on maternal age, some countries offer invasive testing to women over 35; others to the oldest 5% of pregnant women.[5] Most women, especially those with a low risk of having a child with Down syndrome, may wish to avoid the risk to the fetus and the discomfort of invasive testing. In 2011, Sequenom announced the launch of MaterniT21, a non-invasive blood test with a high level of accuracy in detecting Down syndrome (and a handful of other chromosomal abnormalities). As of 2015, there are five commercial versions of this screen (called cell-free fetal DNA screening) available in the United States.
Blood testing is also used to look for abnormal levels of alphafetoprotein or hormones. The results of all three factors may indicate a higher risk. If this is the case, the woman may be advised to have a more reliable screen such as cell-free fetal DNA screening or an invasive diagnostic test (such as chorionic villus sampling or amniocentesis).
Screening for Down syndrome by a combination of maternal age and thickness of nuchal translucency in the fetus at 11–14 weeks of gestation was introduced in the 1990s. This method identifies about 75% of affected fetuses while screening about 5% of pregnancies. Natural fetal loss after positive diagnosis at 12 weeks is about 30%.[5]
Other chromosomal defects[edit]
Other common chromosomal defects that cause a thicker nuchal translucency are
Turner syndrome
Trisomy 18
Trisomy 13
Triploidy
Other defects with normal karyotype[edit]
In fetuses with a normal number of chromosomes, a thicker nuchal translucency is associated with other fetal defects and genetic syndromes.[6]
Procedure[edit]
Nuchal scan (NT procedure) is performed between 11 and 14 weeks of gestation, because the accuracy is best in this period. The scan is obtained with the fetus in sagittal section and a neutral position of the fetal head (neither hyperflexed nor extended, either of which can influence the nuchal translucency thickness). The fetal image is enlarged to fill 75% of the screen, and the maximum thickness is measured, from leading edge to leading edge. It is important to distinguish the nuchal lucency from the underlying amniotic membrane.[7]
Normal thickness depends on the crown-rump length (CRL) of the fetus. Among those fetuses whose nuchal translucency exceeds the normal values, there is a relatively high risk of significant abnormality.
Accuracy[edit]
Between 65 and 85% of trisomic fetuses will have a large nuchal thickness. Further, other, non-trisomic abnormalities may also demonstrate an enlarged nuchal transparency. This leaves the measurement of nuchal transparency as a potentially useful first trimester screening tool. Abnormal findings allow for early careful evaluation of chromosomes and possible structural defects on a targeted basis.
How to define a normal or abnormal nuchal translucency measurement can be difficult. The use of a single millimeter cutoff (such as 2.5 or 3.0 mm) is inappropriate because nuchal translucency measurements normally increases with gestational age (by approximately 15% to 20% per gestational week from 10 to 13 weeks).[8] At 12 weeks of gestational age, an "average" nuchal thickness of 2.18mm has been observed; however, up to 13% of chromosomally normal fetuses present with a nuchal translucency of greater than 2.5mm. Thus for even greater accuracy of predicting risks, the outcome of the nuchal scan may be combined with the results of simultaneous maternal blood tests. In pregnancies affected by Down syndrome there is a tendency for the levels of human chorionic gonadotropin (hCG) to be increased and pregnancy-associated plasma protein A (PAPP-A) to be decreased.
The advantage of nuchal scanning over the previous use of just biochemical blood profiling is mainly the reduction in false positive rates.[9]
Nuchal scanning alone detects 62% of all Down syndrome (sensitivity) with a false positive rate of 5.0%; the combination with blood testing gives corresponding values of 73% and 4.7%.[10]
In another study values of 79.6% and 2.7% for the combined screening were then improved with the addition of second trimester ultrasound scanning to 89.7% and 4.2% respectively.[11] A further study reported detection of 88% for trisomy 21 (Down syndrome) and 75% for trisomy 18 (Edwards syndrome), with a 3.3% false-positive rate.[12] Finally, using the additional ultrasound feature of an absent nasal bone can further increase detection rates for Down syndrome to more than 95%.[13]
When screening is positive, chorionic villus sampling (CVS) or amniocentesis testing is required to confirm the presence of a genetic abnormality. However this procedure carries a small risk of miscarriage so prior screening with low false positive rates are needed to minimize the chance of miscarrying.
Development of nuchal translucency[edit]
The actual anatomic structure whose fluid is seen as translucency is likely the normal skin at the back of the neck, which either may become edematous or in some cases filled with fluid by dilated lymphatic sacs due to altered normal embryological connections.[14]
The translucent area measured (the nuchal translucency) is only useful to measure between 11 and 14 weeks of gestation, when the fetal lymphatic system is developing and the peripheral resistance of the placenta is high. After 14 weeks the lymphatic system is likely to have developed sufficiently to drain away any excess fluid, and changes to the placental circulation will result in a drop in peripheral resistance. So after this time any abnormalities causing fluid accumulation may seem to correct themselves and can thus go undetected by nuchal scanning.
The buildup in fluid is due to a blockage of fluid in the developing fetal lymphatic system. Progressive increase in the width of the translucent area during the 11- to 14-week measurement period is thus indicative of congenital lymphedema.[15]
Nuchal fold thickness[edit]
At the end of the second trimester, the nuchal translucency can no longer be seen and instead the nuchal fold thickness is measured between 16 and 24 weeks gestation. The fold is more focal and at the level of the posterior fossa. This measurement has a higher threshold of normal, although the implications of increased thickness are similar to those of translucency. The nuchal fold thickness is considered normal if under 5mm between 16 and 18 weeks gestation and under 6mm between 18 and 24 weeks gestation.
History[edit]
The nuchal scan first came into widespread use in 2003.[16]
See also[edit]
Prenatal diagnosis which further discusses the reasons for prenatal screening and the ethics of such testing.
Congenital lymphedema
List of obstetric topics
Obstetric ultrasonography
References[edit]
Jump up ^ Souka AP, Von Kaisenberg CS, Hyett JA, Sonek JD, Nicolaides KH (2005-04-06). "Increased nuchal translucency with normal karyotype". doi:10.1016/j.ajog.2004.12.093. Retrieved 2016-07-21.
^ Jump up to: a b Souka AP, Von Kaisenberg CS, Hyett JA, Sonek JD, Nicolaides KH (2005-04-06). "Increased nuchal translucency with normal karyotype". doi:10.1016/j.ajog.2004.12.093. Retrieved 2016-07-21.
Jump up ^ "Down Syndrome - Signs and Symptoms". Ucsfhealth.org. 2008-03-21. Retrieved 2009-03-10.
Jump up ^ Eddleman, K. Obstetrics & Gynecology, November 2006; vol 108: pp 1067-1072, quoted at webmd.com
^ Jump up to: a b Nicolaides KH, Sebire NJ, Snijders RJ, Ximenes RL (2001). "Diploma in Fetal Medicine & ISUOG Educational Series: 11 - 14 weeks scan: NT and Chromosomal defects". Centrus. Retrieved 2009-06-19.
Jump up ^ Nicolaides KH, Sebire NJ, Snijders RJ, Ximenes RL (2001). "Diploma in Fetal Medicine & ISUOG Educational Series: 11 - 14 weeks scan: Increased NT and normal karyotype". Centrus. Retrieved 2009-06-19.
Jump up ^ "Additional ultrasonographic markers in the first trimester screening (11wk to 13wk+6d) (PDF Download Available)". ResearchGate. doi:10.13140/rg.2.2.32248.85761/1.
Jump up ^ Malone, F.D. (13 August 2005). "Nuchal Translucency-Based Down Syndrome Screening: Barriers to Implementation". Seminars in Perinatology. 29 (4): 272–276. doi:10.1053/j.semperi.2005.05.002. Retrieved 11 April 2016.
Jump up ^ Babbur V, Lees CC, Goodburn SF, Morris N, Breeze AC, Hackett GA (2005). "Prospective audit of a one-centre combined nuchal translucency and triple test programme for the detection of trisomy 21". Prenat. Diagn. 25 (6): 465–9. PMID 15966036. doi:10.1002/pd.1163.
Jump up ^ Muller F, Benattar C, Audibert F, Roussel N, Dreux S, Cuckle H (2003). "First-trimester screening for Down syndrome in France combining fetal nuchal translucency measurement and biochemical markers". Prenat. Diagn. 23 (10): 833–6. PMID 14558029. doi:10.1002/pd.700.
Jump up ^ Rozenberg P, Bussières L, Chevret S, et al. (2007). "[Screening for Down syndrome using first-trimester combined screening followed by second trimester ultrasound examination in an unselected population]". Gynecol Obstet Fertil (in French). 35 (4): 303–11. PMID 17350315. doi:10.1016/j.gyobfe.2007.02.004.
Jump up ^ Borrell A, Casals E, Fortuny A, et al. (2004). "First-trimester screening for trisomy 21 combining biochemistry and ultrasound at individually optimal gestational ages. An interventional study". Prenat. Diagn. 24 (7): 541–5. PMID 15300745. doi:10.1002/pd.949.
Jump up ^ Nicolaides KH, Wegrzyn P (2005). "[First trimester diagnosis of chromosomal defects]". Ginekol. Pol. (in Polish). 76 (1): 1–8. PMID 15844559.
Jump up ^ Callen, Peter W. "Nuchal Translucency". Ultrasound Educational Press. Retrieved 2014-11-05.
Jump up ^ "Congenital lymphedema presenting with increased nuchal translucency at 13 weeks of gestation", by A. P. Souka, E. Krampl, L. Geerts, K. H. Nicolaides, March 1, 2001, Prenatal Diagnosis journal
Jump up ^ "Down's Babies Diagnosed Sooner", by Bootie Cosgrove-Mather, CBS News, October 9, 2003
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Gossip columnist
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Wikinews has related news: An interview with gossip columnist Michael Musto on the art of celebrity journalism
A gossip columnist is someone who writes a gossip column in a newspaper or magazine, especially a gossip magazine. Gossip columns are material written in a light, informal style, which relates the gossip columnist's opinions about the personal lives or conduct of celebrities from show business (motion picture movie stars, theater, and television actors), politicians, professional sports stars, and other wealthy people or public figures. Some gossip columnists broadcast segments on radio and television.
The columns mix factual material on arrests, divorces, marriages and pregnancies, obtained from official records, with more speculative gossip stories, rumors, and innuendo about romantic relationships, affairs, and purported personal problems.
Gossip columnists have a reciprocal relationship with the celebrities whose private lives are splashed about in the gossip column's pages. While gossip columnists sometimes engage in (borderline) defamatory conduct, spreading innuendo about alleged immoral or illegal conduct that can injure celebrities' reputations, they also are an important part of the "Star System" publicity machine that turns movie actors and musicians into celebrities and superstars that are the objects of the public's obsessive attention and interest. The publicity agents of celebrities often provide or "leak" information or rumors to gossip columnists to publicize the celebrity or their projects, or to counteract "bad press" that has recently surfaced about their conduct.
Contents
[hide]
1 Libel and defamation
2 History
3 Notable gossip columnists
4 Columns not named for a columnist
5 See also
6 References
Libel and defamation[edit]
While gossip columnists’ "bread and butter" is rumor, innuendo, and allegations of scandalous behavior, there is a fine line between legally acceptable spreading of rumor and the making of defamatory statements, which can provoke a lawsuit. Newspaper and magazine editorial policies normally require gossip columnists to have a source for all of their allegations, to protect the publisher against lawsuits for defamation (libel).
In the United States, celebrities or public figures can sue for libel if their private lives are revealed in gossip columns and they believe that their reputation has been defamed — that is, exposed to hatred, contempt, ridicule, or pecuniary loss. Gossip columnists cannot defend against libel claims by arguing that they merely repeated, but did not originate the defaming rumor or claim; instead, a columnist must prove that the allegedly defaming statement was truthful, or that it was based on a reasonably reliable source.
In the mid-1960s, rulings by the United States Supreme Court made it harder for the media to be sued for libel in the U.S. The court ruled that libel only occurred in cases where a publication printed falsehoods about a celebrity with “reckless disregard” for the truth. A celebrity suing a newspaper for libel must now prove that the paper published the falsehood with actual malice, or with deliberate knowledge that the statement was both incorrect and defamatory.
Moreover, the court ruled that only factual misrepresentation is libel, not expression of opinion. Thus if a gossip columnist writes that they “...think that Celebrity X is an idiot,” the columnist does not face a risk of being sued for libel. On the other hand, if the columnist invents an allegation that “...Celebrity X is a wife beater,” with no supporting source or evidence, the celebrity can sue for libel on the grounds that their reputation was defamed.
History[edit]
Louella Parsons (1937)
The first gossip columnist, dominating the 1930s and 40s, was Walter Winchell, who used political, entertainment, and social connections to mine information and rumors, which he then either published in his column On Broadway, or used for trade or blackmail, to accumulate more power. He became "the most feared journalist" of his era.
In Hollywood's "golden age" in the 1930s and 1940s, gossip columnists were courted by the movie studios, so that the studios could use gossip columns as a powerful publicity tool. During this period, the major film studios had "stables" of contractually obligated actors, and the studios controlled nearly all aspects of the lives of their movie stars. From the 1930s through the 1950s, the two best-known - and competing - Hollywood gossip columnists were Hedda Hopper and Louella Parsons.
Well-timed leaks about a star's purported romantic adventures helped the studios to create and sustain the public's interest in the studios' star actors. As well, the movie studios' publicity agents acted as unnamed "well-informed inside sources" who provided misinformation and rumors to counteract whispers about celebrity secrets — such as homosexuality or an out-of-wedlock child — that could have severely damaged not only the reputation of the movie star in question, but the movie star's box office viability.
Having fallen into ill-repute after the heyday of Hopper and Parsons, gossip columnists saw a comeback in the 1980s. Today, many mainstream magazines such as Time which would once have considered the idea of hiring gossip columnists to pen articles to have been beneath their stature, have sections titled "People" or "Entertainment". These mainstream gossip columns provide a light, chatty glimpse into the private lives and misadventures of the rich and famous. At the other end of the journalism spectrum, there are entire publications that deal primarily in gossip, rumor, and innuendo about celebrities, such as the 'red-top' tabloids in the UK and celebrity 'tell-all' magazines.
Notable gossip columnists[edit]
Cindy Adams (April 2007)
Michael Musto (March 2007)
Notable gossip columnists include:
Cindy Adams
Jani Allan
Flo Anthony
Army Archerd
Rona Barrett
Marilyn Beck
A.J. Benza
Jamie Foster Brown
Milly Cangiano
Ted Casablanca
Janet Charlton
Claudia Cohen
Mike Connolly
Giles Coren
Ana Marie Cox
Nigel Dempster
Matt Drudge
Shirley Eder
Jinx Falkenburg
Jimmy Fidler
Luke Ford
Sheilah Graham Westbrook
Lloyd Grove
Ian Halperin
Tanya Hart
David Hartnell
Courtney Hazlett
Perez Hilton
Hedda Hopper
Arianna Huffington
Micah Jesse
Shia Kapos
Dorothy Kilgallen
Irv Kupcinet
Frances Lynn
Isabel Mallon as "Bab" (1880s–90s)
Elsa Maxwell
Florabel Muir
Susan Mulcahy
Michael Musto
Louella Parsons
Rex Reed
Will Rogers
Sidney Skolsky
Liz Smith
Adela Rogers St. Johns
Jimmy Starr
Ed Sullivan
Ian Ortega Uganda
Mike Walker
Jeannette Walls
Earl Wilson
Walter Winchell
Mila Ximénez
Columns not named for a columnist[edit]
Gossip columns that are not named after a specific columnist, along with the media source, include:
3am — Daily Mirror, a British newspaper.
Access Hollywood — a syndicated television program[clarification needed]
Bizarre — The Sun, a London newspaper
Page Six — New York Post, a New York City newspaper
Inside New York, in New York Post, New York City newspaper
Inside the Beltway — The Washington Times, a Washington, D.C. newspaper
Off the Record — The New York Observer, a New York newspaper
Vegas Confidential — Las Vegas Review-Journal, a Las Vegas newspaper
See also[edit]
Gossip
Innuendo
Roman à clef
Blind item
Defamation
References[edit]
Mulcahy, Susan (1988). My Lips Are Sealed: Confessions of a Gossip Columnist. New York: Doubleday.
Retrieved from "https://en.wikipedia.org/w/index.php?title=Gossip_columnist&oldid=802367182"
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