To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
This paper presents two studies with packaging design engineers and quality and risk professionals in the pharmaceutical packaging industry, addressing the critical need for design support. The studies contribute to the development of a framework aimed at balancing risk management and multi-user experience in the context of product support. A review of prior work highlights the gap in tailored support for designers in this field. Using structured interviews and thematic analysis, seven key requirements were identified to guide the framework’s creation. A user persona was also developed, capturing the core responsibilities, challenges, and motivations of quality and risk professionals. These findings provide actionable insights to aid designers address complex regulatory and user-centric challenges, paving the way for innovation and improved outcomes in pharmaceutical packaging design.
This systematic literature review comprehensively assesses the risks associated with implementing Industry 4.0/5.0 technologies. It clusters these risks into six groups (strategic, financial, operational, technological, environmental, and sociocultural). Using a PRISMA-guided approach, the analysis of 83 peer-reviewed papers identified 36 unique risks out of a total of 811. The findings reveal critical challenges, including in cybersecurity threats, financial burdens, technological obsolescence, and workforce adaptation. These results provide a structured risk categorization that can assist enterprises, in effectively mitigating risks and aligning their strategies with Industry 4.0/5.0 transitions. This framework closes knowledge gaps and offers actionable insights for a robust and sustainable implementation.
To meet the upcoming sustainability challenges, aerospace manufacturers need to develop products that both address complex sustainability factors and ensure profitable realization. Furthermore, the sustainability perspective needs to be lifted from focusing on carbon emissions, and broadened to include a system-level socio-ecological view. Manufacturers are thus challenged to balance sustainability, manufacturability, and performance, but lack the methods and tools to make well-informed decisions. We propose a method for conducting multi-domain trade-off studies in the early design phase. A functional architecture modelling approach is utilized to model performance and manufacturing aspects. Together with a relative sustainability fingerprint conducted on design alternatives, design spaces can be explored with respect to performance, manufacturability, and sustainability.
The increasing complexity and connectivity of the mobility system and modern automotive systems, particularly connected autonomous vehicles, demand a paradigm shift toward resilience-by-design to address disruptions in dynamic environments. Unlike established safety and cybersecurity engineering in automotive, resilience engineering has yet to be systematically integrated into development processes. This paper defines resilience using a standard-based definition method, emphasizing disruption tolerance, adaptability, and recoverability. We identify action fields to advance the topic and propose a resilience-by-design framework extending safety and cybersecurity perspectives. Resilience-by-design offers strategies and methods to design robust, adaptive systems, ensuring reliability and availability of automotive systems, functions, and components in operation.
Unintended technical interactions across system interfaces can lead to costly failures and rework, particularly in the early design stages of complex products. This study examines how structured risk assessment tools influence teams’ ability to identify, evaluate and mitigate risks from such indirect interactions. In a controlled experiment, 14 engineering teams (comprising professionals and graduate students) engaged in simulated design decisions across three system configurations. Tool usage – including models of direct and indirect risk propagation and value-based trade-offs – was continuously logged and linked to outcomes. Teams that engaged earlier and more deliberately with the tools identified risks sooner and selected mitigation actions with more favourable cost–benefit profiles. Results show that strategic, not merely frequent, tool use improves risk management performance, particularly when addressing cascading effects from indirect physical interactions. These findings support the use of structured supports to enhance both the efficiency of early-stage risk evaluation and the efficacy of risk treatment.
Working conditions in psychiatry have worsened in many healthcare systems, allowing less time for person-centred care. There is a conflict between management and clinical values. Though IT carries great potential, many current systems fail to free up time for human-to-human contact. All these factors affect retention.
The ever-increasing expectation towards psychiatry to prevent suicides has taken to mean complete elimination in some places. This is problematic as suicide is not completely preventable; it is not a form of harm equivalent to other patient safety errors; and there is a plurality of relevant values. The impact on ‘second victims’ is also an important issue.
Owing to its relatively undeveloped conceptual foundations, psychiatry has often struggled to defend itself against various criticisms. A VBP-based analysis of the terminal and instrumental values of anti-psychiatry can highlight some of the weaknesses of its arguments. Critical psychiatry draws attention to problematic areas of psychiatric theory and practice to provide constructive criticism. Remarkably, much of that has now been adopted by mainstream psychiatry. A self-reflective stance and constructive criticism play an important role in keeping our profession on a sound ethical footing. A genuine dialogue about values among all stakeholders is needed for constant calibration.
This is a masters-level overview of the mathematical concepts needed to fully grasp the art of derivatives pricing, and a must-have for anyone considering a career in quantitative finance in industry or academia. Starting from the foundations of probability, this textbook allows students with limited technical background to build a solid knowledge of the most important principles. It offers a unique compromise between intuition and mathematics, even when discussing abstract ideas such as change of measure. Mathematical concepts are introduced initially using toy examples, before moving on to examples of finance cases, both in discrete and continuous time. Throughout, numerical applications and simulations illuminate the analytical results. The end-of-chapter exercises test students' understanding, with solved exercises at the end of each part to aid self-study. Additional resources are available online, including slides, code and an interactive app.
This paper examines in what way providers of specialized Large Language Models (LLM) pre-trained and/or fine-tuned on medical data, conduct risk management, define, estimate, mitigate and monitor safety risks under the EU Medical Device Regulation (MDR). Using the example of an Artificial Intelligence (AI)-based medical device for lung cancer detection, we review the current risk management process in the MDR entailing a “forward-walking” approach for providers articulating the medical device’s clear intended use, and moving on sequentially along the definition, mitigation, and monitoring of risks. We note that the forward-walking approach clashes with the MDR requirement for articulating an intended use, as well as circumvents providers reasoning around the risks of specialised LLMs. The forward-walking approach inadvertently introduces different intended users, new hazards for risk control and use cases, producing unclear and incomplete risk management for the safety of LLMs. Our contribution is that the MDR risk management framework requires a backward-walking logic. This concept, similar to the notion of “backward-reasoning” in computer science, entails sub-goals for providers to examine a system’s intended user(s), risks of new hazards and different use cases and then reason around the task-specific options, inherent risks at scale and trade-offs for risk management.
from
Section 4
-
Walking the Walk (and Talking the Talk)
William Fawcett, Royal Surrey County Hospital, Guildford and University of Surrey,Olivia Dow, Guy's and St Thomas' NHS Foundation Trust, London,Judith Dinsmore, St George's Hospital, London
Anaesthesia has expanded outside of the operating theatre to encompass both intensive care medicine and pain medicine, but in addition over the last 10 years or so, the anaesthetist’s role has been redefined as a perioperative physician.
As a result, anaesthetists now have major input into preoperative assessment and preparation of patients for major surgery, optimizing medical conditions such as diabetes l and anaemia (including in iron therapy for the latter). Patients may also require referral to a high risk anaesthetic clinic (HRAC). Here they may also undergo risk stratification, so that the most appropriate surgery and care is provided including postoperative care. This may include preoperative cardiopulmonary exercise testing (CPET).
A major area of current interest is prehabilitation for some surgeries, and following chemotherapy. This involves improving preoperative aerobic fitness, nutrition and psychology to improve outcome.
Postoperatively, there is a focus not only the provision of oxygen therapy and fluids analgesia (with PONV prophylaxis), but also on thromboprophylaxis and appropriate antibiotics. In particular patients should be able to partake in early drinking, eating and mobilization, which itself requires avoidance of prolonged iv fluids, urinary catheters, NG tubes and surgical drains.
Finally early recognition and appropriate management of both surgical and medical complications is paramount.
William Fawcett, Royal Surrey County Hospital, Guildford and University of Surrey,Olivia Dow, Guy's and St Thomas' NHS Foundation Trust, London,Judith Dinsmore, St George's Hospital, London
Whilst modern anaesthesia is considered safe, complications are nevertheless not uncommon and continuing efforts are directed to improve patients’ safety. Very serious avoidable events are called ‘never’ events, but sadly do occur, not infrequently. There are often may factors leading to patient risk including both human factors (fatigue and working under pressure) and organisational factors (poor working environment, faulty equipment, monitoring, and IT systems)
Risk should be assessed preoperatively for major surgery and/or patients with comorbidities. There are a number of scoring and prediction models to assist in this process.
Moreover, there are various check lists and care bundles designed to reduce risk further (e.g. WHO checklist, sepsis bundle etc).
In the preoperative period patient optimization is key, treating intercurrent diseases (including anaemia) and assisting in reducing smoking and alcohol intake, and optimizing nutrition. Intraoperatively there is great focus is on safety, including the recognition of an oesophageal intubation. Other areas are the prevention of end organ injury from hypotension, lung protection, and the prevention of postoperative confusion and delirium. In the postoperative period, the focus is on promoting return to normal function, with appropriate analgesia, thromboprophylaxis, oxygen therapy, fluid therapy as required.
In the very high risk setting, lesser surgery or indeed no surgery at all may be the best option for a patient.
Risk management is defined. Processes involved in risk management for the observation unit including care protocols, care team communications, discharge and follow-up care are identified. Tools that can be used for risk management include the plan–do–study–act (PDSA) and the I-CAN handoff.
William Fawcett, Royal Surrey County Hospital, Guildford and University of Surrey,Olivia Dow, Guy's and St Thomas' NHS Foundation Trust, London,Judith Dinsmore, St George's Hospital, London
The anaesthetic care of the patient can only be planned after a thorough assessment, together with the results of relevant investigations, and precise knowledge of the proposed surgery. Where possible the patient and their relatives should be involved in any decision making process. The key question is this: Is the patient is as well as they can be made prior to surgery?
The process involves triaging patients, assessing risks (both in terms of surgical and patient factors), optimizing the patient and their medication and planning the anaesthetic technique and their postoperative care. Some patients will require referral to high-risk anaesthetic clinic. Numerous investigations (both basic and advanced) are available to assist in these processes and it is important that these are used appropriately and not routinely. In addition some patients are offered specific therapy such as prehabilitation, intravenous iron, attend joint clinic, assistance with drug and alcohol modification, or other surgery prior to the planned surgery.
Psychiatric observation units are innovative treatment milieus that can be utilized in medical emergency departments with many positive impacts. Namely, these units allow for short term treatment of crises that is more trauma informed and patient centered than lengthy inpatient episodes. Additionally, observation units greatly alleviate the issue of patient boarding, which benefits not only the patient experience but also the financial status of that department. Lastly, it is noted that these interventions can be self-sustaining (and risk reducing in totality) given proper preparation for fiscal inputs and sustainable planning.
Since the 1970s, global finance has taken on a systemic character, made starkly visible after Lehman Brothers’ collapse in 2008. Fifteen years later, how can we understand the ongoing reliance of society and economy on interconnected financial markets? This chapter examines the Anglo-American context with a global perspective, proposing that infrastructure is key to understanding why capitalist states and societies remain unable or unwilling to reduce the financial sector’s influence. By focusing on financial derivatives, particularly their liquid, marketized forms, it shows how these instruments forge new spatial and temporal connections. Despite political resistance, maintaining this liquidity has become a technical matter, obscuring the political-economic contradictions tied to socioeconomic inequality. Capitalist states now view derivative and broader financial markets as systems to be safeguarded from breakdowns or illiquidity, requiring immediate repair during crises. Extending the concept of (il)liquidity and drawing on infrastructural inversion, the chapter argues that financial markets exist in a perpetual state of breakdown, necessitating constant maintenance and repair.
The systemic nature of climate risk is well established, but the extent may be more severe than previously understood, particularly with regard to cyber risk and economic security. Cyber security relies on the availability of insurance capital to mitigate economic security sector risks and support the reversibility of attacks. However, the cyber insurance industry is still in its infancy. Pressure on insurance capital from increasing natural disaster activity could consume the resources necessary for economic security in the cyber domain in the near term and create long-term conditions that increase the scarcity of capital to support cyber security risks. This article makes an original contribution by exploring the under-researched connection between the nexus of cyber and economic security and the climate change threat. Although the immediate pressure on economic resources for cyber security is limited, recent natural disaster activity has clearly shown that access to capital for cyber risks could come under significant pressure in the future.
This paper investigates a well-known downside protection strategy called the constant proportion portfolio insurance (CPPI) in defined contribution (DC) pension fund modeling. Under discrete time trading CPPI, an investor faces the risk of portfolio value hitting the floor which denotes the process of guaranteed portfolio values. In this paper, we question how to deal with so-called ‘gap risk’ which may appear due to uncontrollable events resulting in a sudden drop in the market. In the market model considered, the risky asset price and the labor income are assumed to be continuous-time stochastic processes, whereas trading is restricted to discrete-time. In this setting, an exotic option (namely, the ‘cushion option’) is proposed with the aim of reducing the risk that the portfolio value falls below the defined floor. We analyze the effectiveness of the proposed exotic option for a DC plan CPPI strategy through Monte Carlo simulations and sensitivity analyses with respect to the parameters reflecting different setups.
Policy studies assume the existence of baseline parameters – such as honest governments doing their best to create public value, publics responding in good faith, and both parties relying on a policy-making process that aligns with the public interest. In such circumstances, policy goals are expected to be produced through mechanisms in which the public can articulate its preferences and policy-makers are expected to listen to what has been said in determining their governments' courses of action. While these conditions are found in some governments, much policy-making occurs without these pre-conditions and processes. Unlike situations that produce what can be thought of as 'good' public policy, 'bad' public policy is a more common outcome. How this happens and what makes for bad public policy are the subjects of this Element. This title is also available as Open Access on Cambridge Core.
In today’s insurance market, numerous cyber insurance products provide bundled coverage for losses resulting from different cyber events, including data breaches and ransomware attacks. Every category of incident has its own specific coverage limit and deductible. Although this gives prospective cyber insurance buyers more flexibility in customizing the coverage and better manages the risk exposures of sellers, it complicates the decision-making process in determining the optimal amount of risks to retain and transfer for both parties. This article aims to build an economic foundation for these incident-specific cyber insurance products with a focus on how incident-specific indemnities should be designed for achieving Pareto optimality for both the insurance seller and the buyer. Real data on cyber incidents are used to illustrate the feasibility of this approach. Several implementation improvement methods for practicality are also discussed.
Chapter 15 discusses the new Digital Operational Resilience Act (DORA) in the context of cryptoassets and decentralised finance. Section 15.1 introduces the cybersecurity challenge, while Section 15.2 explains DORA’s objectives, approach, and its link to MiCA. Then, Section 15.3 provides an analysis of DORA’s scope, and Section 15.4 gives an overview of DORA’s tools, explaining each of DORA’s Chapters II–VII. Then, Section 15.5 delves into the crypto-specific matters, explaining the MiCA plus DORA situation and analysing the difficult issues of applying DORA’s concepts of “financial entities” and “ICT third-party service providers” in the context of decentralised finance, including fully decentralised crypto networks. Section 15.6 concludes.
Novel methods of data collection and analysis can enhance traditional risk management practices that rely on expert engineering judgment and established safety records, specifically when key conditions are met: Analysis is linked to the decisions it is intended to support, standards and competencies remain up to date, and assurance and verification activities are performed. This article elaborates on these conditions. The reason engineers are required to perform calculations is to support decision-making. Since humans are famously weak natural statisticians, rather than ask stakeholders to implicitly assimilate data, and arrive at a decision, we can instead rely on subject matter experts to explicitly define risk management decision problems. The results of engineering calculation can then also communicate which interventions (if any) are considered to be risk-optimal. It is also proposed that the next generation of engineering standards should learn from the success of open source software development in community building. Interacting with open datasets and code can promote engagement, identification (and resolution) of errors, training and ultimately competence. Finally, the profession’s tradition of independent verification should also be applied to the complex models that will increasingly contribute to the safety of the built environment. Model assurance will be required to keep pace with model development to identify suitable use cases as adequately safe. These are considered to be increasingly important components in ensuring that methods of data-centric engineering can be safely and appropriately adopted in industry.