Browsing by Subject "risk management"

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  • Laine, Valtteri; Goerlandt, Floris; Banda, Osiris Valdez; Baldauf, Michael; Koldenhof, Yvonne; Rytkönen, Jorma (Elsevier, 2021)
    Marine Pollution Bulletin 171 (2021), 112724
    Several risk management frameworks have been introduced in the literature for maritime Pollution Preparedness and Response (PPR). However, in light of the actual needs of the competent authorities, there is still a lack of framework that is established on a sound risk conceptual basis, addresses the different risk management decision-making contexts of organizations, and provides tools for various risk management questions of this field. To alleviate the limits of existing approaches, this paper introduces a new risk management framework for this purpose, which was developed in cooperation with the competent authorities and other maritime experts. The framework adopts the risk-informed decision-making strategy and includes three aligned components. The first component provides a unified theoretical risk concept to the framework through an interpretation of the Society for Risk Analysis risk approach. The second consists of four ISO 31000:2018 standard based processes focused on different risk management decision-making contexts of the PPR organizations. The third comprises a set of practical risk assessment tools to generate the needed information. A case study provides an example of the functionality of this framework with integrated data from the northern Baltic Sea. To conclude, a risk concept is provided for the PPR authorities and their stakeholders as well as processes for managing the risk and tools for its assessment.
  • Cheng, Zhuo (Helsingin yliopisto, 2015)
    Risk management is essential in forest management planning. However, decision making with risk analysis is rarely done in forestry. This study presents an example of the application of conditional value-at-risk (CVaR) as a decision tool and optimizes the management planning problem from a risk perspective. Stochastic programming is used to solve the problem. The model contains four different types of risk using an assumed probability distribution and quantifies these risks, namely, inventory errors, growth model errors, price uncertainty and policy uncertainty. The results suggest that forest owners’ risk tolerance, i.e., their willingness and ability to assume risk determines to the greatest extent the return potential. When the expected first period income is maximized, the subsequent period always experiences a loss that is the greatest of the entire management horizon. The proportion of carbon subsidy in the first period is also the highest. With this model it is possible to hedge some risks or to use it as means to assess the amount of insurance to purchase in order to transfer risks. The use of CVaR in forest management planning can be seen as a useful tool to manage risk and to assist in the decision making process to assess forest owners’ willingness and ability to tolerate risks.
  • Käyhkö, Janina (2019)
    Agriculture in the Nordic countries is a sector, where farmers are facing climatic challenges first-hand with little policy guidance on climate change adaptation or climate risk management. Adaptation practices emerging at the farm scale have potentially harmful outcomes that can erode the agricultural sustainability. So far, farm scale decision-making on adaptation measures is scarcely studied, and a thorough assessment of risk perceptions underlying adaptation decision-making is required in the Nordic context to inform adaptation policy planning. In this qualitative case study, the climate risk perceptions of Nordic farmers and agricultural extension officers are examined. As a result, a typology of risk responses is presented, showing three dominant patterns within highly dynamic and contextual adaptation processes at farm scale: risk aversive, opportunity-seeking and experimental. The typology represents the variation within adaptation processes that further stress the need for participatory adaptation policy development in agriculture.
  • Jämsä, Juho; Palojoki, Sari; Lehtonen, Lasse; Tapper, Anna-Maija (Helsingin yliopisto, 2018)
    Objectives: To determine if and in what ways serious patient safety incidents differ from non-serious patient safety incidents. Methods: Statistical analysis was performed on patient safety incident reports that were reported in 2015 in Finland’s largest hospital district (Helsinki and Uusimaa, HUS). Reports were divided into two groups: non-serious incidents and serious incidents. Differences between groups were studied from several types of categorically divided information. Results: Of the total amount of reports (15 863) 1 % were serious incidents (175). Serious and non-serious incidents differed significantly from each other. Serious incidents concerning laboratory, imaging or medical equipment were more common. On the other hand incidents concerning medication, infusion, blood transfusion, were less frequent. In serious incidents the proportion of doctors reporting was greater and contributing factors were better recognized, the most common of them being working of procedures. Conclusions: In the future, special attention should be given to the particular aspects of serious patient safety incidents, such as safe use of medical equipment, training and handling of procedures. Root cause analysis is an effective way to handle serious incidents and enables the prevention of their reoccurrence. However, a systematic follow of the root cause analysis should be developed.
  • Jämsä, J.O.; Palojoki, S.H.; Lehtonen, L.; Tapper, A.-M. (2018)
    OBJECTIVES: To determine if and in what ways serious patient safety incidents differ from nonserious patient safety incidents. METHODS: Statistical analysis was performed on patient safety incident reports that were reported in 2015 in Finland's largest hospital district (Helsinki and Uusimaa, HUS). Reports were divided into two groups: nonserious incidents and serious incidents. Differences between groups were studied from several types of categorically divided information. RESULTS: Of the total number of reports (15,863), 1% were serious incidents (175). Serious and nonserious incidents differed significantly from each other. Serious incidents concerning laboratory, imaging, or medical equipment were more common. On the other hand, incidents concerning medication, infusion, and blood transfusion were less frequent. In serious incidents, the proportion of doctors reporting was greater, and contributing factors were better recognized, the most common being working of procedures. CONCLUSIONS: In the future, special attention should be given to the particular aspects of serious patient safety incidents, such as safe use of medical equipment, training, and handling of procedures. Root cause analysis is an effective way to handle serious incidents and enables the prevention of their reoccurrence. However, a systematic follow-up of the root cause analysis should be developed. © 2018 American Society for Health Care Risk Management of the American Hospital Association.
  • European Federat Clinical Chem Lab (2019)
    ISO15189:2012 requires medical laboratories to document metrological traceability of their results. While the ISO17511:2003 standard on metrological traceability in laboratory medicine requires the use of the highest available level in the traceability chain, it recognizes that for many measurands there is no reference above the manufacturer's selected measurement procedure and the manufacturer's working calibrator. Some immunoassays, although they intend to measure the same quantity and may even refer to the same reference material, unfortunately produce different results because of differences in analytical selectivity as manufacturers select different epitopes and antibodies for the same analyte. In other cases, the cause is the use of reference materials, which are not commutable. The uncertainty associated with the result is another important aspect in metrological traceability implementation. As the measurement uncertainty on the clinical samples is influenced by the uncertainty of all steps higher in the traceability chain, laboratories should be provided with adequate and appropriate information on the uncertainty of the value assignment to the commercial calibrators that they use. Although the between-lot variation in value assignment will manifest itself as part of the long-term imprecision as estimated by the end-user, information on worst-case to be expected lot-lot variation has to be communicated to the end-user by the IVD provider. When laboratories use ancillary equipment that potentially could have a critical contribution to the reported results, such equipment needs verification of its proper calibration and criticality to the result uncertainty could be assessed by an approach based on risk analysis, which is a key element of ISO15189:2012 anyway. This paper discusses how the requirement for metrological traceability as stated in ISO15189 should be met by the medical laboratory and how this should be assessed by accreditation bodies.
  • Outinen, Okko; Bailey, Sarah A.; Broeg, Katja; Chasse, Joël; Clarke, Stacey; Daigle, Rémi M.; Gollasch, Stephan; Kakkonen, Jenni E.; Lehtiniemi, Maiju; Normant-Saremba, Monika; Ogilvie, Dawson; Viard, Frederique (Elsevier, 2021)
    Journal of Environmental Management 293 (2021), 112823
    The International Convention for the Control and Management of Ships' Ballast Water and Sediments (BWM Convention) aims to mitigate the introduction risk of harmful aquatic organisms and pathogens (HAOP) via ships’ ballast water and sediments. The BWM Convention has set regulations for ships to utilise exceptions and exemptions from ballast water management under specific circumstances. This study evaluated local and regional case studies to provide clarity for situations, where ships could be excepted or exempted from ballast water management without risking recipient locations to new introductions of HAOP. Ships may be excepted from ballast water management if all ballasting operations are conducted in the same location (Regulation A-3.5 of the BWM Convention). The same location case study determined whether the entire Vuosaari harbour (Helsinki, Finland) should be considered as the same location based on salinity and composition of HAOP between the two harbour terminals. The Vuosaari harbour case study revealed mismatching occurrences of HAOP between the harbour terminals, supporting the recommendation that exceptions based on the same location concept should be limited to the smallest feasible areas within a harbour. The other case studies evaluated whether ballast water exemptions could be granted for ships using two existing risk assessment (RA) methods (Joint Harmonised Procedure [JHP] and Same Risk Area [SRA]), consistent with Regulation A-4 of the BWM Convention. The JHP method compares salinity and presence of target species (TS) between donor and recipient ports to indicate the introduction risk (high or low) attributed to transferring unmanaged ballast water. The SRA method uses a biophysical model to determine whether HAOP could naturally disperse between ports, regardless of their transportation in ballast water. The results of the JHP case study for the Baltic Sea and North-East Atlantic Ocean determined that over 97% of shipping routes within these regions resulted in a high-risk indication. The one route assessed in the Gulf of Maine, North America also resulted in a high-risk outcome. The SRA assessment resulted in an overall weak connectivity between all ports assessed within the Gulf of the St. Lawrence, indicating that a SRA-based exemption would not be appropriate for the entire study area. In summary, exceptions and exemptions should not be considered as common alternatives for ballast water management. The availability of recent and detailed species occurrence data was considered the most important factor to conduct a successful and reliable RA. SRA models should include biological factors that influence larval dispersal and recruitment potential (e.g., pelagic larval duration, settlement period) to provide a more realistic estimation of natural dispersal.
  • Paavola, Jouni; Primmer, Eeva (Elsevier, 2019)
    Ecological Economics
    Ecosystems can buffer against adverse events, such as storms or pest outbreaks by reducing the probability of harm and magnitude of losses. We conceptualise factors involved in the governance of insurance value provision, drawing on the notions of protection and insurance, exogeneity and endogeneity, and allocation of rights and responsibilities. Using riverine floods and forest pest outbreaks as examples, we explore the challenges of governing ecosystem-based risk management. We suggest that such governance should build on existing institutions, because insurance value is jointly produced with provisioning ecosystem services and the governance arrangements for them importantly shape insurance value provision. However, existing institutional arrangements do not acknowledge involved actors' rights and responsibilities and they do not facilitate landscape level management of risks. While PES schemes and other market-like solutions may govern the provision of insurance value when transaction costs and trade-offs between the provision of insurance value and private goods are low, regulation or public provision is needed when transaction costs and trade-offs are high. The complexity of challenges in governing the provision of insurance value highlights the need for polycentric governance involving collaboration, knowledge creation and dissemination and the funding of activities needed for them.
  • Eerola, Kari (2008)
    The current financial crisis has raised considerable debate about the risk management practices of banks and other financial institutions. In particular, there have been concerns about systemic risk that basically means the possible consequences of bank failures on the economic activity, growth and employment. These worries originate from the common insight that the troubles in financial sector may spill over to the real economy. In this thesis, I focus on hedge funds' risks. Hedge funds are specialized investment vehicles which try to provide above average risk-adjusted returns due to the presumably superior skills of their management. The absence of regulation is an important feature of the hedge funds, and it implies less visibility and less observable risks. If these opaque risks materialize, the financial distress might spill over the financial system due to the tight links between the hedge funds and banks. This is called financial contagion. In the first part of this thesis, I identify the hedge fund's risk profile and derive some quantitative risk management tools using a statistical concept called Value-at-Risk. Value-at-Risk tells the maximum loss a portfolio holder can suffer due to market risk over a pre-specified time period, given some probability. Specifically, since skewness and excess kurtosis often characterize the hedge fund return distribution indicating the possibility of a very large loss, models based on the normal distribution are not appropriate. Statistical theory provides alternative ways to estimate Value-at-Risk counting for the skewness and excess kurtosis. In this thesis I exploit the useful properties of extreme value theory, the Cornish-Fisher expansion and Monte Carlo simulation to derive the estimators for Value-at-Risk. In addition, liquidity risk is the central ingredient of systemic risk and also present in the hedge funds' risk profile. Therefore, I derive liquidity-adjusted Value-at-Risk as well. In the second part of this thesis, I focus on the hedge funds' role as to financial stability. I follow the general model by Allen & Gale (2000), in which contagion is modeled as an equilibrium phenomenon. In this model, external liquidity shock hitting into one sector of the financial market can spread over the entire financial system and bring down all financial institutions. Of course, in the approach of this thesis the hedge fund sector faces the shock and thus initiates the distress. However, even in the presence of the liquidity shock, this spillover is not inevitable, but is crucially dependent on the size of the shock and especially on the financial buffers, which can loosely be interpreted as the risk management practices.
  • Harilainen, Hanna-Riitta (Hanken School of Economics, 2014)
    Economics and Society – 266
    Supply chains are increasingly global, often reaching to developing regions. The media pressure brand owners to be responsible, but a product is only as sustainable as the practices of all the companies involved in manufacturing it are. It’s not enough that the brand owner acts responsibly; sustainable practices have to reach component and raw material suppliers upstream. Image risk has often been recognized as reason for investing in sustainability. In the supply chain context, supplier misconduct also presents a supply risk. Smooth flow of goods is at stake. Examples of this are strikes and the breaking of environmental laws that cause line stops at supplier factories. These realized supplier sustainability risks seldom receive media attention or reach consumer consciousness; however, they potentially cause challenges in availability and supply. The sophistication of supplier sustainability risk management varies by company, and managers are often unaware of its enablers. The topic of supplier sustainability risks is not yet sufficiently addressed in the literature, despite its increasing importance. This research utilizes grounded theory methodology, an inductive approach in which theory is seen as emerging from the data. The chosen methodology particularly suits situations where the subject area has not yet been studied and can give fresh insights. Empirical data were gathered from the managers of six Finnish multinational companies, and the perceptions of the interviewed supply chain and sustainability managers were used to relate the findings at the company level. The key finding of this study is the importance of supply risk as a potential driver for investments in supplier sustainability. A company’s supply chain strategies are linked to its vulnerability to incidents in the supply chain, while the sophistication of sourcing practices is linked to the vulnerability to outcome of such incidents. A company’s position in the supply chain drives risk focus on reputational risk and/or supply risk and sourcing’s incentive structure together with risk awareness drive the proactive or reactive management of supplier sustainability risk. This research contributes to both supply chain risk management and sustainable supply chain management literature. Managers can utilize the framework to understand when proactive supplier sustainability risk management makes sense and what its enablers are.
  • Tuomola, Juha; Yemshanov, Denys; Huitu, Hanna; Hannunen, Salla (2018)
    Surveying multiple invasive pest species at the same time can help reduce the cost of detecting new pest invasions. In this paper, we describe a new method for mapping the relative likelihood of pest invasion via plant propagation material in a geographic setting. The method simulates the invasion of a range of pest species, including arrival in an uninvaded area, spread, and survival in a novel landscape, using information on the spatial and temporal distribution of the suitable host crop species and tentative knowledge of the spread and survival capacities of the target pests. The methodology is applied to a gridded map in which each map cell represents a site in a landscape. The method uses stochastic simulations to depict plausible realizations of the invasion outcomes and estimate the distribution of pest invasion likelihood for each cell in the area of concern. The method then prioritizes the cells based on the stochastic invasion outcomes using a pairwise stochastic dominance rule and a hypervolume indicator. We demonstrate the approach by assessing the relative likelihood of pest invasion for strawberry production in Finland. Our method helps to differentiate sites in a landscape using both the estimates of pest invasion risk and their uncertainty. It can be applied to prioritize sites for plant health surveys and allocate survey resources among large geographic regions. The approach is generalizable and can be used in situations where knowledge of the harmful pest species is poor or nonexistent.
  • Söderman, Ronnie (Svenska handelshögskolan, 2000)
    Working Papers
    The objective of this paper is to improve option risk monitoring by examining the information content of implied volatility and by introducing the calculation of a single-sum expected risk exposure similar to the Value-at-Risk. The figure is calculated in two steps. First, there is a need to estimate the value of a portfolio of options for a number of different market scenarios, while the second step is to summarize the information content of the estimated scenarios into a single-sum risk measure. This involves the use of probability theory and return distributions, which confronts the user with the problems of non-normality in the return distribution of the underlying asset. Here the hyperbolic distribution is used to describe one alternative for dealing with heavy tails. Results indicate that the information content of implied volatility is useful when predicting future large returns in the underlying asset. Further, the hyperbolic distribution provides a good fit to historical returns enabling a more accurate definition of statistical intervals and extreme events.
  • Kuikko, Janne (2008)
    The investment atmosphere has changed significantly due to the European integration that took place in the 21st century. Thus there has been a need to chart the prevailing risks more carefully. Special attention has been given to risk measures in particular. The focus has been especially on static risk measures, since significant problems have been detected in the application of dynamic risk measures. Attention is paid also on the coherency of risk measure, and the terms of a coherent risk measure are determined. We will adopt a mean-variance approach in this study because it is still common to use the portfolio variance (standard deviation) as a measure for risk, although the concept of market portfolio dating back to the times of Harry Markowitz has been perceived as too much of a sweeping single variable that would hold all risk information occurring in the prevailing market. So models, which use several different variables for measuring risk have been developed. These models attempt to “suck in” exhaustively all risk-information available in the market. Arbitrage Pricing Theory (APT) functions as a starting point. APT is in principle the first multi-factor model introduced, but it presents the used variables in a very limited manner. Later on, the qualifiers in multi-factor models have been specified, and special attention has been given to defining and choosing the variables. Various theories, which try to model the real activities of the finance market, have been used to justify the choice of variables. Hence, multi-factor models concentrate above all on the choice of variables. These variables have mainly been chosen according to macroeconomic, fundamental and statistical grounds. Macroeconomic models concentrate on explaining the dependency between external forces of the economy and asset returns. Fundamental models on the other hand believe that asset returns are determined mainly based on company-specific factors, and statistical models estimate variables from the historical return development of a single asset. Two fundamental models are described more carefully, a 3-factor model by Fama and French (1993) and a 4-factor model by Carhart (1997). By comparing the explanatory powers of these three different models we can deduct which model can best explain the asset returns and consequently the risk it includes. Connor (1995) gives a thorough study on the explanatory power of these models. After this, by comparing each of them separately with Capital Asset Pricing Model (CAPM) we can discover the optimal risk management instrument. This specific comparison is done by Fletcher and Hillier (2002). The basic idea is therefore to study whether the variables used in multi-factor models include some additional information that single variable models cannot explain. Finally we end up with the conclusion that in certain conditions and with certain restriction, very realistic ones though, the explanation power of a multi-factor models is greater than in single-factor model (CAPM). Thus they include additional information about the prevailing risk compared to single-factor model and give more realistic, detailed and more reliable description of the risk involved with the asset or a portfolio.
  • Vallinkoski, Katja (Helsingin yliopisto, 2014)
    Objectives. School safety has long been a subject of wide-ranging debate, but scientific research on the subject has, however, been rather limited. Although the English language research is comprehensive, in educational sciences school safety has not been a common subject of research. Matti Waitinen's (2011) dissertation is the first school safety culture investigative research in Finland. Waitinen images safety culture of Helsinki comprehensive school, and points out that the differences in security levels can be explained by a different safety cultures. The purpose of this thesis is to find out what are the most common needs to develop safety work that are encountered in comprehensive schools. Research methods. The target group here are four comprehensive schools and their safety groups. The study was carried out as so-called mixed - methods study, where the research data came from both quantitative and qualitative orientation. The data - collection in the first phase of the research was a questionnaire sent to schools, the purpose of which was to orient the school safety team members to the subject. The next step was, Tutor audit, which the Rescue Department of Keski-Uusimaa had developed. The audit, data were generated as quantitative and qualitative, structured group interview section yielded precise values of the school, the level of security, but on the other hand recorded and eventually transcribed conversation around the subject produced a material for the later content analysis. Results and conclusions. Based on the results it can be concluded that the safety work of comprehensive schools found plenty of areas for development. The audits on the basis of the values obtained, it can be said that none of the schools reached in the overall interpretation of the law formed through the minimum requirement, that is, the basic level three. There were found seven development themes: documentation, everyday and communally safety work, risk management, preparedness and independent development of safety, safety skills and safety training, as well as safety communication and paying attention to substitutes and stakeholders. Although the number of results can not be generalized to the comprehensive schools in general, the results can get an understanding of what kind of developments must be done in schools. The general conclusion is that the security work must continue to pay great attention to.
  • Skullbacka, Simone (Helsingfors universitet, 2019)
    Many drugs are associated with the risk of QT prolongation and torsades de pointes (TdP). The risk increases with other risks factors for QT prolongation. Recognizing risk factors and QT prolonging drugs is critical in the management of this drug-related problem. The aim of this master’s thesis was to study the prevalence of use of QT prolonging drugs in older adults receiving home care. Additionally, the aim was to study concomitant use of QT prolonging drugs as well as clinically significant QT prolonging drug-drug interactions in the participants. The secondary objective was to study the most commonly used QT prolonging in the participants. The material used in this master’s thesis originated from a randomized controlled trial in City of Lohja, Finland, which enhanced a coordination in medication risk management for older home care clients. The analysis of the baseline data collected in fall 2015 was only deepened regarding QT prolonging drugs. The participants (n=188) were older adults (≥65 years) receiving regular home care from City of Lohja, randomized into an intervention group (n=101) and a control group (n=87). The majority of the participants were women (69%). The mean age of the participants was 83 years. Data on the participants’ drugs were collected from their medication lists. Clinically significant drug-drug interactions were identified using the SFINX database. The QTDrugs Lists of CredibleMeds were used for identifying drugs associated with QT prolongation and TdP. On average, the participants (n=188) used 2.3 drugs (SD 1.3, median 2.0) associated with QT prolongation and TdP. Of the participants, 36% (n=67) used drugs with known risk of TdP (QTDrugs List 1). The most commonly used drugs with known risk of TdP were donepezil and citalopram. The prevalence of QTDrugs List 2 drugs (possible risk of TdP) was 36% (n=67). Most of the participants (n=156, 83%) used drugs which under certain circumstances are associated with TdP (QTDrugs List 3). One fifth (21%) of the participants used concomitantly 2-3 drugs associated with QT prolongation and TdP. QT prolonging drugdrug interactions (SFINX-D interactions) were found in 3% of the participants. The drugs involved in the drug-drug interactions were donepezil, (es)citalopram and haloperidol. The prevalence of use of clinically relevant QT prolonging drugs (QTDrugs Lists 1-2) was higher in this study compared with the prevalence in outpatients in previous studies. Concomitant use of QT prolonging drugs is common in outpatients. Health care professionals need to be educated on the risks of QT prolongation, TdP and the risks of using QT prolonging drugs concomitantly. Risk assessment tools considering patient-specific risk factors could be more widely used, as they may reduce modifiable risk factors, and actual events of QT prolongation and TdP may be avoided. There is a need for systematic procedures for assessing and managing the risks of QT prolongation and TdP in the Finnish health care system.
  • Hukka, Janne (2005)
    This study examines how propagation mechanisms for financial crises may emerge as an externality of financial institutions’ management of their assets and liabilities. Inherent to these activities is the incentive to control for the associated risks. It follows that institutions are exposed to one another’s economic fundamentals through various capital markets. Consequently, risk control activities may contribute to the formation of contagious channels. Through these, the effects of a local crisis can spill over to other regions. This implicit externality to some of the measures of risk management thereby necessitates a reassessment of their appeal. Among the constitutive principles of asset management is diversification of investment portfolios. Financial institutions limit their exposure to any particular risky prospect by holding multiple positions simultaneously. As long as the correlation between these is imperfect, the variability of portfolio returns is reduced. The average return to asset holdings remains the same. On the other hand, diversification increases inter-institutional connections in capital markets. A local crisis, by reducing returns to one position, may induce a risk-averse investor to liquidate other positions in her portfolio. Financial institutions of unrelated characteristics may thereby become exposed to one another through the medium of common third party investors. Financial institutions also undertake measures of liquidity management. The need for these stems from a maturity mismatch between their assets and liabilities. For instance, an unexpected local liquidity shock may necessitate a costly liquidation of some long positions. In particular, such risks are faced by commercial banks with many liabilities of uncertain maturity. Therefore, they typically pool the risk by participating in interbank loans markets. Banks with surplus liquidity provide credit for those unable to meet their short term liabilities. However, each interbank loan embodies a credit risk. A bank that becomes insolvent may default on its debt. The balance sheets of exposed creditors consequently deteriorate. This makes them more vulnerable to a crisis. The analysis is characterized by the theory of global games. In a framework of imperfect information, crises are viewed as a result of coordination failure among economic agents. Contagion emerges as an endogenous property of the framework, highlighting the externalities of the described risk management activities. Also, the likelihood of each outcome to agents’ coordination game is unique. The effect of contagion to the probability of a crisis can therefore be isolated from other factors. Given the contribution of portfolio diversification and interbank loans to emergence of contagion, this makes their reassessment possible. The most central sources in this investigation are Dasgupta (2004) and Goldstein and Pauzner (2004).
  • Kuitunen, Sini Karoliina; Niittynen, Ilona; Airaksinen, Marja; Holmström, Anna-Riia (2021)
    Objectives Intravenous medication delivery is a complex process that poses systemic risks of errors. The objective of our study was to identify systemic defenses that can prevent in-hospital intravenous (IV) medication errors. Methods A systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. We searched MEDLINE (Ovid), Scopus, CINAHL, and EMB reviews for articles published between January 2005 and June 2016. Peer-reviewed journal articles published in English were included. Two reviewers independently selected articles according to a predetermined PICO tool. The quality of studies was assessed using the Grading of Recommendations Assessment, Development and Evaluation system, and the evidence was analyzed using qualitative content analysis. Results Forty-six studies from 11 countries were included in the analysis. We identified systemic defenses related to administration (n = 24 studies), prescribing (n = 8), preparation (n = 6), treatment monitoring (n = 2), and dispensing (n = 1). In addition, 5 studies explored defenses related to multiple stages of the drug delivery process. Systemic defenses including features of closed-loop medication management systems appeared in 61% of the studies, with smart pumps being the defense most widely studied (24%). The evidence quality of the included articles was limited, as 83% were graded as low quality, 13% were of moderate quality, and only 4% were of high quality. Conclusions In-hospital IV medication processes are developing toward closed-loop medication management systems. Our study provides health care organizations with preliminary knowledge about systemic defenses that can prevent IV medication errors, but more rigorous evidence is needed. There is a need for further studies to explore combinations of different systemic defenses and their effectiveness in error prevention throughout the drug delivery process.
  • Viitanen, Anna-Kaisa; Kallonen, Kimmo; Kukko, Kirsi; Kanerva, Tomi; Saukko, Erkka; Hussein, Tareq; Hämeri, Kaarle; Säämänen, Arto (2021)
    Material extrusion (ME) desktop 3D printing is known to strongly emit nanoparticles (NP), and the need for risk management has been recognized widely. Four different engineering control measures were studied in real-life office conditions by means of online NP measurements and indoor aerosol modeling. The studied engineering control measures were general ventilation, local exhaust ventilation (LEV), retrofitted enclosure, and retrofitted enclosure with LEV. Efficiency between different control measures was compared based on particle number and surface area (SA) concentrations from which SA concentration was found to be more reliable. The study found out that for regular or long-time use of ME desktop 3D printers, the general ventilation is not sufficient control measure for NP emissions. Also, the LEV with canopy hood attached above the 3D printer did not control the emission remarkably and successful position of the hood in relation to the nozzle was found challenging. Retrofitted enclosure attached to the LEV reduced the NP emissions 96% based on SA concentration. Retrofitted enclosure is nearly as efficient as enclosure attached to the LEV (reduction of 89% based on SA concentration) but may be considered more practical solution than enclosure with LEV.
  • Hautamaki, Lotta (2018)
    In psychiatric clinical practice, professionals pursue risk management alongside various uncertainties concerning diagnoses and treatment decisions. In this article, I draw on an ethnographic study of understandings of bipolar disorder in Finland to argue that risk management in psychiatry is better characterised as practical uncertainty work. I show how both the clinicians and the patients coordinate the uncertainties of bipolar disorder symptoms, risks and treatment decisions, into something that can be managed. I examine the ways in which temporality structures this uncertainty work and I explore two different modes of framing time. Clinical time stems from the current psychiatric thinking committed to the standardised diagnosis and the ideals of evidence-based medicine. Through this, professionals frame a task-oriented and linear treatment path from diagnosis and treatment to a managed life with bipolar disorder. Experienced time, in contrast, relates to the logics of care and self-care amid the embodied experiences of different actors. This framing of time involves a cyclical process where the patient, the clinician and the treatment interventions each need to adjust to changing situations.
  • Lyytimäki, Jari; Assmuth, Timo; Hildén, Mikael (Taylor & Francis, 2011)
    Journal of Risk Research, 14:6, 757-773
    There are differing and partially incompatible views about what kind of issues should be included into risk discussions and what kinds of risks should be emphasized and dealt with. While the emergence of new risks has been extensively studied, relatively little attention has been paid to the roles that the absence of information can play in risk debates. Potentially relevant information may be downplayed or omitted and less relevant overemphasized when actors with varying interests, knowledge bases, and risk frames interact. Multiple and cumulative environmental and health risks caused by chemicals and other stressors pose particular challenges for risk communication. We identify and discuss different forms of unrecognized, hidden, and forgotten information by using chemical risks as a case. A widely applicable typology of absent information in risk communication is outlined.