Academic literature on the topic 'CPI risk factor framework'

Purpose The International Neuroblastoma Risk Group (INRG) Staging System (INRGSS) was developed through international consensus to provide a presurgical staging system that uses clinical and imaging data at diagnosis. A revised Children's Oncology Group (COG) neuroblastoma (NB) risk classification system is needed to incorporate the INRGSS and within the context of modern therapy. Herein, we provide statistical support for the clinical validity of a revised COG risk classification system. Patients and Methods Nine factors were tested for potential statistical and clinical significance in 4,569 patients diagnosed with NB who were enrolled in the COG biology/banking study ANBL00B1 (2006-2016). Recursive partitioning was performed to create a survival-tree regression (STR) analysis of event-free survival (EFS), generating a split by selecting the strongest prognostic factor among those that were statistically significant. The least absolute shrinkage and selection operator (LASSO) was applied to obtain the most parsimonious model for EFS. COG patients were risk classified using STR, LASSO, and per the 2009 INRG classification (generated using an STR analysis of INRG data). Results were descriptively compared among the three classification approaches. Results The 3-year EFS and overall survival (± SE) were 72.9% ± 0.9% and 84.5% ± 0.7%, respectively (N = 4,569). In each approach, the most statistically and clinically significant factors were diagnostic category (eg, NB, ganglioneuroblastoma), INRGSS, MYCN status, International Neuroblastoma Pathology Classification, ploidy, and 1p/11q status. The results of the STR analysis were more concordant with those of the INRG classification system than with LASSO, although both methods showed moderate agreement with the INRG system. Conclusion These analyses provide a framework to develop a new COG risk classification incorporating the INRGSS. There is statistical evidence to support the clinical validity of each of the three classifications: STR, LASSO, and INRG.

Abstract Research background: Environmental factors are not adequately addressed in organizational ecology studies. At the same time, it is known that the theory has not received enough attention except for North America, which is the emerging point. Purpose: We aim to examine macroeconomic connectedness between the organizational ecology of transportation and storage firms and macroeconomic variables such as price and production indexes. Research methodology: This paper discusses the relation among the following variables within the framework of macroeconomic connectedness via organizational ecology theory. The variables are FOUNDINGS, DISBANDINGS, TRNSP-CPI, PPI IPI and ENERGY. We use the TVP-VAR based Diebold-Yılmaz Connectedness approach in the analysis of the data. Results: DISBANDING is the net transmitter throughout the entire period. FOUNDING is mainly a net shock receiver during the COVID-19 period and transmitter in other periods. TRANS-CPI and PPI are risk receivers throughout the entire period, and even the shocks they transmit increased in the post-2018 period. ENERGY and IPI are in shock receiver status throughout the entire period. The received shocks of IPI from others have decreased with the effect of the lockdown experienced during the COVID-19 period. Novelty: The investors can hedge against risk by looking at industry production capacity and the number of firm closures, considering the net bilateral link between the indices, and calculating the appropriate time period for establishing a firm. Connectedness indices vary considerably over the sampling period, which indicates that investors must dynamically adjust their position in the industry.

Cybersecurity risk is among the top risks that every organization must consider and manage, especially during this time wherein technology has become an integral part of our lives; however, there is no efficient and simplified measurement method that organizations or regulators could use, as frequently as they need, to evaluate and compare the outcome of cybersecurity efforts that have been put in place. Consequently, this has resulted in an absence of critical data for cybersecurity improvement. This research proposes a Cyber Trust Index (CTI), a novel and simplified framework for evaluating, benchmarking, and improving organizations’ cybersecurity performance. Methods: The researchers analyzed prominent scientific research papers and widely used security standards to develop baseline security controls that serve as a measurement foundation. Then, they identified Control Enablers and Capability Tiers that were used as base measures and measurement methods. The CTI framework was evaluated by experts and tested with 35 organizations from the critical information infrastructure (CII) sector, as well as other generic sectors, in Thailand to confirm its validity and reliability in real organization settings and identify the priorities and factors that can contribute to better cybersecurity performance. Results: The CTI has two key elements: the baseline controls and rating methods. The baseline controls comprise 12 dimensions, 25 clusters, and 70 controls. The rating methods utilize five control enablers and five capability tiers to compute scores. A binary questionnaire is used to capture data for the rating process. Based on a statistical analysis of CTI results from 35 pilot organizations, 28.57% are in the beginner group with high-risk exposure, 31.43% are in the leader group with low-risk exposure, and 40% of organizations are in between (the intermediate and advanced groups). Two key factors distinguish between the beginner and leader groups: (1) an internal factor, which is the Control Enablers; and (2) an external factor, which is the influence of a cyber regulating body. Our study confirms that Control Enablers in higher Tiers will help organizations achieve better cybersecurity performance (R = 0.98021) and highlights the significance of cyber regulating bodies by showing a shear difference of 197.53% in cyber performance between highly regulated and low-regulated industries. Conclusions: This research reveals key insights into the importance of Control Enablers, which are the internal factors that organizations must leverage to drive better cybersecurity performance, and the positive return on enforcement, which emphasizes the need for cyber regulating bodies. The CTI framework has proven to be valid and efficient for measuring cybersecurity performance. At the very least, a step-wise roadmap is provided for organizations and regulators to adopt and adapt the CTI framework for their cybersecurity measurement and improvement mission.

Background: At an international level, the risk assessment and management process of violent offenders follows a standard method that implies well-defined theoretical models and the use of scientifically validated tools. In Italy, this process is still highly discretionary. The aim of this study is to highlight the advantages deriving from the use of risk assessment tools within the framework of a single case study; Methods: Recidivism risk and social dangerousness of an Italian woman perpetrator of filicide were assessed through the administration of the Level of Service/Case Management Inventory (LS/CMI) instrument supported by Historical Clinical Risk-20 Version 3 (HCR-20 V3); Results: The administration of LS/CMI showed that, in this single case, the subcomponents represent a criminogenic risk/need factor are: Family/Marital, Companions, Alcohol and Drug Problem and Leisure; while constituting strengths: employment and the absence of a Pro-criminal Orientation and an Antisocial Pattern; Conclusions: Data collected through LS/CMI indicated life areas of a single case, which should be emphasised not only to assess the risk of re-offending and social dangerousness but also for a social rehabilitation programme more suited to the subject. This study demonstrates that the LS/CMI assessment tool is suitable for the Italian context.

Adolescent girls and young women (AGYW) aged 15 to 24 years face disproportionately high risks of acquiring HIV and other sexually transmitted infections (STIs). A sexual health risk stratification tool can support the development and implementation of tailored HIV and STI prevention services for sub-groups of at-risk AGYW. Data were collected among sexually active AGYW aged 15 to 24 years in Tanzania between April 2015 and March 2017. Exploratory and confirmatory factor analyses were conducted to construct and assess the latent structure of a ten-item scale for rapid assessment of sexual health risks. Items with high factor loadings and minimal cross loadings were retained in the final scale. Scale performance was appraised against condomless sex (defined as unprotected vaginal or anal intercourse) reported by AGYW for construct validity. A three-factor structure of vulnerability to HIV among AGYW was supported with subscales for socioeconomic vulnerability; lack of adult support; and sexual behavioral risks. The chi-square goodness-of-fit test, root mean square error of approximation, comparative fit index, and Tucker-Lewis index indicated a strong goodness-of-fit of the three-factor scale. Cronbach alphas (0.55 for socioeconomic vulnerability, 0.55 for lack of support, and 0.48 for sexual risk) indicated sub-optimal internal consistency for all sub-scales. The factor-item and factor-factor correlations identified in these analyses were consistent with the conceptual framework of vulnerability of HIV infection in AGYW, suggesting good construct validity. The scale also demonstrated a statistically significant association with condomless sex and could be potentially used for sexual health risk stratification (OR = 1.17, 95% CI: 1.12, 1.23). The sexual health and HIV risk stratification scale demonstrated potential in identifying sexually active AGYW at high risk for HIV and other STIs. Ultimately, all AGYW in Tanzania are not at equal risk for HIV and this scale may support directing resources towards those at highest risk of HIV.

Even in the context of smart mines, unsafe human acts are still an important cause of coal mine gas explosion accidents, but there are few models to analyze unsafe human acts in coal mine gas explosion accidents. This study tries to solve this problem through a risk assessment method of unsafe acts in coal mine gas explosion accidents based on Human Factor Analysis and Classification system (HFACS-GE) and Bayesian networks (BN). After verifying the reliability of HFACS-GE framework, a BN model of risk factors of unsafe acts was established with the Chi-square test and odds ratios analysis. After reasoning analysis, risk paths and key risk factors of unsafe acts were obtained, and preventive measures were granted. Based on the analysis of 100 coal mine gas explosion cases, the maximum probability of five kinds of unsafe acts of employees is 38%. Among the 22 risk factors, the mental state of employees has the greatest influence on the habitual violation of regulations, and the sensitivity value is 12.7%. This study can provide technical assistance for the risk management of unsafe acts in coal mine gas explosions.

Purpose The purpose of this paper is to apply the framework Price (2008) and HSBC Money Laundering Risk Procedures 2016 for estimating the risk contribution of each individual customer in Vietnamese banking system using the information from the survey in South East region in Vietnam in general and Ho Chi Minh city in specific. Design/methodology/approach Based on the collected data from the survey, the Money Laundering Risk Score (MLRS) is calculated for each customer who is using the services and products of Vietnamese commercial banks by the enhanced measurement model of Christopher Price, the ordinary least squares and three variations of logistic regression model. Findings This paper proposes an appropriate estimation of the money laundering risk (MLR) for personal customer using the most significant factors that affects MLR and suggests practical recommendations for commercial banking system. Practical implications This paper suggests an intuitive method to estimate the contribution of each customer factor on their MLRS. Originality/value The higher respondent’s group of age lead to the higher MLR occurred in the financial market. Follow the works of Wolfsberg et al. (2006), Sathan and Mahendhiran (2007), Usman Kemal (2014) and Reganati and Oliva (2017), this paper also confirms negative relationship between MLR with the respondent’s group of salary and the academic level. This indicated that the lower amount of money the respondents earn and lower academic level they were, the higher degree of MLR.

The eye-tonometers are the important medical devices with measuring function which are necessary for the screenings of the intraocular hypertension (a serious risk factor for the glaucoma). However, it is not an easy task to ensure their correct metrological traceability. There is needed not only a wide range of various equipment but also the relevant know-how. Hence, a training centre for this quantity was established at the Czech Metrology Institute (CMI) within the framework of a smart specialisation concept for the intraocular pressure (IOP) metrology. The paper briefly outlines its history, scope, methodologies and future development plans

A brief review of the European legislation related to groundwater protection and the legislation’s transposition in Bulgaria has been made. The existence of the necessary regulatory framework for ensuring groundwater protection has been pointed out. The basic guidance documents that help to meet the requirements set out in the Water Framework Directive and its daughter directives are outlined. The worldwide scientific experience regarding introduction of different indices and criteria for assessing the groundwater pollution is briefly presented and discussed. The outlined indexes and criteria include the contamination factor (Cfi), the degree of contamination (Cd), the modified degree of contamination (mCd), the contamination index (CI), the metal pollution index (MPI), the groundwater risk index (GRID), the pollution load index (PLI), the heavy metal pollution index (HPI), the heavy metal evaluation index (HEI), the Nemerow index (PI), the elemental (metal) contamination index (ECI) and the overall metal contamination index (MCI).

11041 Background: Extended surgery in retroperitoneal sarcoma (RPS) has resulted in less recurrences and better survival. We investigated whether outcome further improved, after the recent understanding of behavior of different RPS subtypes and introduction of multimodal therapies. Methods: Consecutive primary RPS operated at a single center were analyzed comparing 3 periods (2002-2006; 2007-2011; 2012-2016). Primary endpoints were overall survival (OS), crude cumulative incidence (CCI) of local recurrence and distant metastasis (LR, DM) for each subgroup: well differentiated (WDLPS), dedifferentiated G2 (G2DDLPS), G3 (G3DDLPS) liposarcoma, and leiomyosarcoma (LMS). Secondary endpoints: morbidity and post-relapse OS. Fisher/Chi-squared and Cochran–Armitage trends test were used. Survival was analysed by Kaplan-Meier/Cox PH or CCI/Fine Gray models in the competitive risk framework and compared with log-rank/Wald Gray tests. Multivariable analyses were performed. Results: Overall 437 RPS were operated: 82, 128 and 227 in the 1st, 2nd and 3rd period. Median follow-up was 125, 86 and 39 months. Complete resection (R0/R1) improved from 93.9% to 98.2% (p=0.059), median number of resected organs increased from 2 to 4 (p<.0001). Postoperative morbidity did not change (18.3%, 16.4%, 22.5%; p=0.269). Administration of radiotherapy and chemotherapy (CT) differed over time according to different subtypes. 5-yr OS improved (63.2% to 74.7%, p=0.005), along with a non-significant reduction in LR CCI (18.2% to 16.4%, p=0.379) and no change in DM CCI. At multivariable analysis, study period remained an independent prognostic factor for OS among the other known risk factors (3rd vs 1st period HR: 0.33, p<0.001). Subgroup analysis showed the following associations with better prognosis: 1. Improvement in 5-yr OS (from 55.0% to 70.7%, p=0.024) and LR (from 45.0% to 19.8%, p=0.060) in G2DDLPS, associated with more organs resected 2. Improvement in 5-yr OS (from 18.2% to 49.7%, p=0.035) and DM (from 70.0% to 19.8%; p=0.015) in G3DDLPS, associated with more anthracycline-based CT 3. A better 2-yr post-relapse OS (from 46.3% to 65.2%, p=0.122). Conclusions: OS of patients with DDLPS improved over time: in G2 this was associated with a refinement in the surgical approach, while in G3 with a more liberal use of anthracycline-based CT. New available therapies for recurring RPS may also have extended post-relapse OS. Prospective studies on perioperative CT for high risk RPS subtypes are eagerly awaited.

Governments of developed and developing countries alike are unable to fund the construction and maintenance of vital physical infrastructure such as roads, railways, water and wastewater treatment plants, and power plants. Thus, they are more and more turning to the private sector as a source of finance through procurement methods such as concession contracts. The most common form of concession contract is the Build-Operate-Transfer (BOT) contract, where a government (Principal) grants a private sector company (Promoter) a concession to build, finance, operate and maintain a facility and collect revenue over the concession period before finally transferring the facility, at no cost to the Principal, as a fully operational facility. Theoretically speaking, these projects present a win-win-win solution for the community as well as both private and public sector participants. However, with the opportunity for private sector companies to earn higher returns comes greater risk. This is despite the fact that concession projects theoretically present a win-win-win solution to the problem of infrastructure provision. Unfortunately, this has not been the case in a number of countries including Australia. Private sector participants have admitted that there are problems that must be addressed to improve the process. Indeed they have attributed the underperformance of concession projects to the inability of both project Principals and Promoters to predict the impact of all financial and non-financial (risk) factors associated with concession project investments (CPIs) and to negotiate contracts to allow for these factors. Non-financial project aspects, such as social, environmental, political, legal and market share factors, are deemed to be important; but these aspects would usually be considered to lie outside the normal appraisal process. To allow for the effects of such qualitative aspects, the majority of Principal or promoting organisations resort to estimating the necessary money contingencies without an appropriate quantification of the combined effects of financial and non-financial (risks and opportunities) factors. In extreme cases, neglect of non-financial aspects can cause the failure of a project despite very favourable financial components; or can even cause the failure to go-ahead with a project that may have been of great non-financial benefit due to its projected ordinary returns. Hence, non-financial aspects need careful analysis and understanding so that they can be assessed and properly managed. It is imperative that feasibility studies allow the promoting organisation to include a combination of financial factors and non-financial factors related to the economic environment, project complexity, innovation, market share, competition, and the national significance of the project investment. While much research has already focused on the classification of CPI non-financial (risk) factors, and the identification of interdependencies between risk factors on international projects, no attempt has yet been made to quantify these risk interdependencies. Building upon the literature, this thesis proposes a generic CPI risk factor framework (RFF) including important interdependencies, which were verified and quantified using input provided by practitioners and researchers conversant with risk profiles of international and/or concession construction projects. Decision Support Systems (DSSs) are systems designed to assist in the decision making process by providing all necessary information to the analyst. There are a number of DSSs that have been developed over recent years for the evaluation of high-risk construction project investments, such as CPIs, which incorporate the analysis of both financial and non-financial (risk) aspects of the investment. However, although these DSSs have been useful to practitioners and researchers alike, they have not offered a satisfactory solution to the modelling problem and are all limited in their practical application for various reasons. Thus, the construction industry lacks a DSS that is capable of evaluating and comparing several CPI options, taking into consideration both financial and non-financial aspects of an investment, as well as including the uncertainties commonly encountered at the feasibility stage of a project, in an efficient and effective manner. These two criteria, efficiency and effectiveness, are integral to the usefulness and overall acceptance of the developed DSS in industry. This thesis develops an effective and efficient DSS to evaluate and compare CPI opportunities at the feasibility stage. The novel DSS design is based upon a combination of: (1) the mathematical modelling technique and financial analysis model that captures the true degree of certainty surrounding the project; and (2) the decision making technique and RFF that most closely reproduces the complexity of CPI decisions. Overall, this thesis outlines the methodology followed in the development of the DSS – produced as a stand-alone software product – and demonstrates its capabilities through a verification and validation process using real-life CPI case studies.

Governments of developed and developing countries alike are unable to fund the construction and maintenance of vital physical infrastructure such as roads, railways, water and wastewater treatment plants, and power plants. Thus, they are more and more turning to the private sector as a source of finance through procurement methods such as concession contracts. The most common form of concession contract is the Build-Operate-Transfer (BOT) contract, where a government (Principal) grants a private sector company (Promoter) a concession to build, finance, operate and maintain a facility and collect revenue over the concession period before finally transferring the facility, at no cost to the Principal, as a fully operational facility. Theoretically speaking, these projects present a win-win-win solution for the community as well as both private and public sector participants. However, with the opportunity for private sector companies to earn higher returns comes greater risk. This is despite the fact that concession projects theoretically present a win-win-win solution to the problem of infrastructure provision. Unfortunately, this has not been the case in a number of countries including Australia. Private sector participants have admitted that there are problems that must be addressed to improve the process. Indeed they have attributed the underperformance of concession projects to the inability of both project Principals and Promoters to predict the impact of all financial and non-financial (risk) factors associated with concession project investments (CPIs) and to negotiate contracts to allow for these factors. Non-financial project aspects, such as social, environmental, political, legal and market share factors, are deemed to be important; but these aspects would usually be considered to lie outside the normal appraisal process. To allow for the effects of such qualitative aspects, the majority of Principal or promoting organisations resort to estimating the necessary money contingencies without an appropriate quantification of the combined effects of financial and non-financial (risks and opportunities) factors. In extreme cases, neglect of non-financial aspects can cause the failure of a project despite very favourable financial components; or can even cause the failure to go-ahead with a project that may have been of great non-financial benefit due to its projected ordinary returns. Hence, non-financial aspects need careful analysis and understanding so that they can be assessed and properly managed. It is imperative that feasibility studies allow the promoting organisation to include a combination of financial factors and non-financial factors related to the economic environment, project complexity, innovation, market share, competition, and the national significance of the project investment. While much research has already focused on the classification of CPI non-financial (risk) factors, and the identification of interdependencies between risk factors on international projects, no attempt has yet been made to quantify these risk interdependencies. Building upon the literature, this thesis proposes a generic CPI risk factor framework (RFF) including important interdependencies, which were verified and quantified using input provided by practitioners and researchers conversant with risk profiles of international and/or concession construction projects. Decision Support Systems (DSSs) are systems designed to assist in the decision making process by providing all necessary information to the analyst. There are a number of DSSs that have been developed over recent years for the evaluation of high-risk construction project investments, such as CPIs, which incorporate the analysis of both financial and non-financial (risk) aspects of the investment. However, although these DSSs have been useful to practitioners and researchers alike, they have not offered a satisfactory solution to the modelling problem and are all limited in their practical application for various reasons. Thus, the construction industry lacks a DSS that is capable of evaluating and comparing several CPI options, taking into consideration both financial and non-financial aspects of an investment, as well as including the uncertainties commonly encountered at the feasibility stage of a project, in an efficient and effective manner. These two criteria, efficiency and effectiveness, are integral to the usefulness and overall acceptance of the developed DSS in industry. This thesis develops an effective and efficient DSS to evaluate and compare CPI opportunities at the feasibility stage. The novel DSS design is based upon a combination of: (1) the mathematical modelling technique and financial analysis model that captures the true degree of certainty surrounding the project; and (2) the decision making technique and RFF that most closely reproduces the complexity of CPI decisions. Overall, this thesis outlines the methodology followed in the development of the DSS – produced as a stand-alone software product – and demonstrates its capabilities through a verification and validation process using real-life CPI case studies.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Engineering
Full Text

Modeling of the stochastic discount factor using state variables to proxy for the marginal utility substituting for the failure of aggregate consumption data to account for the conditional characteristics of asset returns. The focus is on the conditional characteristics of historical stock returns specifically the trade-off between risk and return. The nonlinear least squares method inspired by the inference methodology of Britten-Jones (1999) is applied to estimate the parameters and estimate conditional volatility of the stochastic discount factor with GARCH and stochastic volatility models. The results indicate that the estimated stochastic discount factor is conditionally heteroskedastic and its conditional volatility captures the conditional variation that coincides with the phases of the business cycle significantly better than consumption-based SDF. However, the proxy for the risk-return trade-off does not capture substantial conditional variation and magnitude relative to the empirically estimated conditional Sharpe ratios that prominent literature reports. The estimated SDF accounts for predictability but cannot account for the high equity premium particularly the long-run equity premium as the conditional volatility appears to be stationary.

This dissertation examines a risk-budgeting approach to the construction of factor equity portfolios, proposed by de Carvalho et al. (2014). The approach begins with the construction of active-weighted portfolios with exposure to factors that historically have been linked to excess returns in the market. These factor portfolios are then combined using a risk-budgeting approach. Implied stock-level returns are then estimated using this combined active allocation, and a further optimisation allows for the incorporation of specific investor constraints. The framework constitutes a risk-based approach to portfolio construction in the sense that no direct estimation of expected stock returns is required, but is dependent on a robust estimation of the covariance structure of stock returns. The framework is first evaluated in the context of a simulation study. This section provided confirmation for the risk model estimation methodology used, as well as insight into the intricacies of the framework, in an environment where the underlying structure of data was known. The framework is useful for investors who wish to combine a set of active portfolios, by controlling the allocation of risk, and understanding the exposure of the final portfolio to each of the factor portfolio components. Based on the findings of the simulation study and a back-test of the framework on JSE data, it was found that at the risk-budgeting juncture, the level of prior information imposed (with regard to the performance of factor portfolios) has a significant impact on the performance of final portfolios. In addition, the application of investor constraints, such as long-only and absolute weight limits, ultimately hinder the investor's ability to retain the views taken on in the factor portfolio components. Furthermore, due to significant discrepancies in ex-ante and ex-post tracking error risk measurement, the use of alternative, or adjusted, risk measures is recommended.

A new model was developed to enhance the understanding of the full context of work associated hazards, to explore the connection between OHS performance and a systematic approach to safety, and to simplify approaches to OHS management. This Safe Place, Safe Person, Safe Systems model was derived from the literature and used as the basis for the development of a framework, consisting of 60 elements which was transformed into an assessment tool. This assessment tool was trialled with a pilot study on a medium sized manufacturing plant in the plastics industry, and the tool and Preliminary Report peer reviewed by an expert panel using the Nominal Group Technique. After refinements were made to the assessment tool it was applied to eight case studies that were drawn from advertisements. This qualitative study consisted of two parts: firstly the assessment using the Safe Place, Safe Person, Safe Systems framework; and secondly a controlled self assessment exercise to target improvements to three of the elements over a period of four months. The study illustrated that the Safe Place, Safe Person, Safe Systems framework could be successfully applied in a range of industries to promote OHS improvements and to provide a systematic, planned approach to fulfilling OHS responsibilities. The application of this framework highlighted that: there is a need for further education on the correct application of the risk assessment process and the responsibilities owed to contractors; techniques such as dynamic risk assessments are more suitable where the place of work is variable and hazards are unpredictable; more focus is needed on the appropriate management of hazardous substances with long term health consequences; and that the level of formality invoked for treating hazards does not necessarily equate to improved risk reduction outcomes. The Safe Place, Safe Person, Safe Systems framework was found to be applicable to small, medium and large organisations provided the assessment was scoped to a small division of relatively homogeneous activity to ensure a more representative hazard profile. This approach has provided a way forward to simplify OHS management and also offers practical direction for implementing a targeted OHS improvement program.

This study applies bereavement and media use theoretical perspectives to examine how survivors use media to cope with spousal loss during the first two years. Specifically, this study explores whether survivors’ television use is associated with grief intensity. Potential associations between television use and grief intensity are explored using an online survey. A media use for coping scale is developed. The relationship between television oscillation (i.e., equal use of television for respite, and to cope with primary and secondary stressors) and grief intensity is also explored, and ten specific moderators of this relationship are examined: recency of loss, type of loss, social support, family proximity and contact, marital relationship quality, economic stability, pre-existing physical and mental health issues, and change in television use. Results were collected from 356 spousal survivors and indicate that television use to cope is associated with grief intensity. Survivors that report high television use in general are using more television for relaxation, companionship, acceptance, positive reinterpretation and growth, and emotional and instrumental support. The most dramatic effects are observed with television use for relaxation and companionship, and the smallest effects with television use for emotional and instrumental support. However, there was no association between television use for respite, or to cope with primary and secondary stressors and grief intensity. Results support the value of social support, family contact at the time of loss, fewer physical health issues, and decreasing general television use in promoting more positive bereavement outcomes. Results support television oscillation as a predictor of grief intensity, but only under certain circumstances. Four of the models show significant moderator effects between television oscillation and grief intensity: social support at the time of loss, family contact at the time of loss, pre-existing physical health issues, and change in television use since the loss. When survivors have less social support at the time of loss, television oscillation is associated with less grief intensity as predicted. However, when survivors have more social support, television oscillation is marginally associated with more grief intensity. Likewise, when survivors have less family contact, television oscillation is associated with less grief intensity as predicted. Conversely, when survivors have more family contact, television oscillation is associated with more grief intensity. When survivors have more pre-existing physical health issues, television oscillation is not associated with grief intensity as predicted. For survivors with fewer pre-existing physical health issues, television oscillation is associated with less grief intensity. When survivors decrease television use by approximately one hour, television oscillation is marginally associated with less grief intensity. On the other hand, when survivors increase television use, television oscillation is not associated with grief intensity. Current general television use was a highly significant control variable in all moderator analyses indicating more television use to cope is associated with more grief intensity. Recency, type of loss, marital relationship quality, family proximity, economic stability, and pre-existing mental health issues did not significantly moderate the relationship between television oscillation and grief intensity. This study extends previous work by merging the bereavement and media use literatures, and in the development of a media use for coping scale. Moreover, it provides important empirical evidence on theoretical models about bereavement. This expands the potential for discussions about the association of individual vulnerabilities with more positive bereavement outcomes.

Main concern of this thesis is to help design a secure and reliable network system which keeps growing in complexity due to the interfaces with multiple logging sub-systems and to ensure the safety of the network environment for everyone involved. The parties somewhat involved in network systems are always in need of developing new solutions to security problems and striving to have a secure access into a network so as to fulfil their job in safe computing environments. Implementation and use of SSO (Single Sign-On) offering secure and reliable network in complex systems has been specifically defined for the overall security aspects of enterprises. The information to be used within and out of organization was structured layer by layer according to the organizational needs to define the sub-systems. The users in the enterprise were defined according to their role based profiles. Structuring the information layer by layer was shown to improve the level of security by providing multiple authentication mechanisms. Before implementing SSO system necessary requirements are identified. Thereafter, user identity management and different authentication mechanisms were defined together with the network protocols and standards to insure a safe exchange of information within and outside the organization. A marketing research was conducted in line of the SSO solutions. Threat and risk analysis was conducted according to ISO/IEC 27003:2010 standard. The degree of threat and risk were evaluated by considering their consequences and possibilities. These evaluations were processed by risk treatments. MoDAF (Ministry of Defence Architecture Framework) used to show what kind of resources, applications and the other system related information are needed and exchanged in the network. In essence some suggestions were made concerning the ideas of implementing SSO solutions presented in the discussion and analysis chapter.

Abstract in English
The overall aim of this study was to construct and describe a conceptual framework that can serve as a frame of reference for organisational stakeholders to sustain a community coalition to manage alcohol misuse as a risk factor of HIV infection in a specific community in the North West Province, South Africa. A Participatory Action Research (PAR) design that was qualitative and theory generative in nature was followed in this study. A phased approach with specific objectives aligned to the PAR cycle, namely observe (Phase One), reflect (Phase Two), plan (Phase Three) and act (Phase Four), was followed. These phases were actualised through an exploratory, descriptive and contextual research design, guided and theoretically influenced by critical theory. Data in Phase One were collected through 10 key informant interviews. Data were collected in Phases Two to Four through 10 dialogue meetings. Data collected in the four phases were used to construct and describe the conceptual framework that was evaluated by five experts in the field of mental health and substance misuse for refinement (Phase Five). Thematic data analyses was done to identify emerging themes. Key issues identified were that the community is characterised by fragile community coalitions that hamper the management of alcohol misuse as a risk factor of HIV infection. Factors to be considered to sustain the coalition were identified as sharing a common vision, promoting a trusting relationship, formalising the coalition, transformational leadership, strengthening organisational unity, and access to financial resources. This research adds knowledge in the field of mental health and substance misuse by providing a sustainable community coalition conceptual framework for organisational stakeholders to manage alcohol misuse as a risk factor of HIV infection. The conceptual framework could be used to inform policy, further research, education and improve practice in the field of mental health and substance misuse. Although the study was limited to a specific geographical area of a community in the North West Province, South Africa, the findings can be adapted to fit a specific setting.
Health Studies
D Litt et Phil. (Health Studies)

Research in risk awareness has been relatively neglected in the health informatics literature, which tends largely to examine project managers’ perspectives of risk awareness; very few studies explicitly address the perspectives held by senior executives such as directors. Another limitation evident in the current risk literature is that studies are often based on American data and/or they are restricted to American culture. Both factors highlight the need to examine how senior executives (i.e., directors) who oversee or direct eHealth projects in Canada perceive risk awareness. This research explores and discusses the perspectives of risk awareness (i.e., identification, analysis, and prioritization) held by directors and project managers who implement Canadian eHealth projects. Semi-structured interviews with nine directors and project managers uncovered six key distinctions in these two groups’ awareness of risk. First, all project managers valued transparency over anonymity, whereas directors believed that an anonymous reporting system for communicating risks had merit. Secondly, most directors emphasized the importance of evidence-based planning and decision making when balancing risks and opportunities, an aspect none of the project managers voiced. Thirdly, while project managers noted that the level of risk tolerance may evolve from being risk-averse to risk-neutral, directors believed that risk tolerance evolved toward risk-seeking. Directors also noted the importance of employing risk officers, a view that was not shared by project managers. Directors also believed the risk of too little end-user engagement and change management was the most important risk, whereas project managers ranked it as the least important. Finally, when directors and project managers were asked to identify and define the root cause(s) of eHealth risks, directors identified the complexity of health care industry, while project managers attributed it to political pressure and a lack of resources where eHealth projects are concerned. This research proposes that the varied perspectives of risk awareness held by directors and project managers must be considered and integrated to properly align expectations and build partnerships for successful eHealth project outcomes. Understanding risk awareness offers a means to systematically identify and analyze the complex nature of eHealth projects by embracing uncertainties, thereby enabling forward thinking (i.e., staying one step ahead of risks) and the ability to prevent avoidable risks and seize opportunities.
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There are multiple complaints that existing project risk quantification methods—both parametric and Monte Carlo—fail to produce accurate project duration and cost-risk contingencies in a majority of cases. It is shown that major components of project risk exposure—non-linear risk interactions—pertaining to complex projects are not taken into account. It is argued that a project system consists of two interacting subsystems: a project structure subsystem (PSS) and a project delivery subsystem (PDS). Any misalignments or imbalances between these two subsystems (PSS–PDS mismatches) are associated with the non-linear risk interactions. Principles of risk quantification are developed to take into account three types of non-linear risk interactions in complex projects: internal risk amplifications due to existing ‘chronic’ project system issues, knock-on interactions, and risk compounding. Modified bowtie diagrams for the three types of risk interactions are developed to identify and address interacting risks. A framework to visualize dynamic risk patterns in affinities of interacting risks is proposed. Required mathematical expressions and templates to factor relevant risk interactions to Monte Carlo models are developed. Business cases are discussed to demonstrate the power of the newly-developed non-linear Monte Carlo methodology (non-linear integrated schedule and cost risk analysis (N-SCRA)). A project system dynamics methodology based on rework cycles is adopted as a supporting risk quantification tool. Comparison of results yielded by the non-linear Monte Carlo and system dynamics models demonstrates a good alignment of the two methodologies. All developed Monte Carlo and system dynamics models are available on the book’s companion website.

Mental illness is the primary risk factor for suicidal ideation, attempts, and completion. Effective treatment of the psychiatric condition is the foundational strategy to reduce the risk of suicide associated with these conditions, but few medications can be demonstrated to independently reduce the risk of suicide. This chapter will describe how psychopharmacological treatment can be included as a component of bio-psycho-social treatments within the context of a recovery model for suicide prevention. The evidence for medication therapies will be reviewed both for specific behavioral health conditions and for any reduced suicide risk independent of general therapeutic effects to treat underlying conditions. A framework strategy will be described for the integration of evidence-based clinical decision making to provide the most effective treatment that also specifically targets suicide risk for patients.

This book provides a thorough analysis of Brazilian business law for investors and their legal advisers, focusing on topics relevant to business transactions and disputes that can arise in the aftermath of the signing or performance of deals. The essence of investment and negotiation processes is risk evaluation and allocation. Examining Brazilian law, the book focuses on the legal risks, which are higher in Brazilian law than elsewhere, particularly in comparison with contract, partnership, and company (LLC) laws governing international business transactions in the US and UK. However, whilst Brazilian contract law remains a risk factor as a result of its over-ambitious and consequently interventionist approach, Brazilian law in the areas of stock corporation, capital market, antitrust, and public procurement are state-of-the-art when compared to the US and leading European laws in Germany, Switzerland, and France. The book is divided into eight chapters: the introduction provides an overview of the economic and legal framework for doing business in Brazil, focusing on features of the Brazilian legal and economic order that are unusual to international practitioners from a comparative perspective. The other seven chapters analyze those fields of substantive law that impact most investments and cross-border transactions in Brazil. The book focuses on the interpretation of statutory law by the Brazilian Superior Court of Justice and regulatory agencies, and also provides insights into the economic and business rationale of some of the legal solutions offered.

In the UK, the four commonest cancers—lung cancer, breast cancer, colon cancer, and prostate cancer—result in around 62 000 deaths every year. Although deaths from cancer have fallen in the UK over the last 20 years, the UK still suffers from higher cancer death rates than many other countries in Western Europe. In 1999, the UK government produced a White Paper called Saving Lives: Our Healthier Nation that outlined a national target to reduce the death rate from cancer by at least 20% in people under 75 by 2010. The subsequent NHS Cancer Plan of 2000 designed a framework by which to achieve this target through effective prevention, screening, and treatment programmes as well as restructuring and developing new diagnostic and treatment facilities. But do we know enough about the biology of the development of cancer for government health policies alone to force dramatic changes in survival? The science behind the causes of cancer tells us that its origin lies in acquired or inherited genetic abnormalities. Inherited gene mutation syndromes and exposure to environmental mutagens cause cancer, largely through abnormalities in DNA repair mechanisms, leading to uncontrolled cell proliferation. Although screening those thought to be at highest risk, and regulating exposure to environmental carcinogens such as tobacco or ionizing radiation, have reduced, and will continue to reduce, cancer deaths, there are many other environmental factors that have been shown to increase the population risk of cancer. These will be outlined in this chapter. However, the available evidence is largely from retrospective and cross-sectional population-based studies and therefore limits the ability to apply this knowledge to the risk of the individual patient who may been seen in clinic. Although we may be able to put him or her into a high-, intermediate-, or low-risk category, the question ‘will I get cancer, doc?’ is one that we cannot answer with certainty. The NHS Cancer Plan of 2000, designed to reduce cancer deaths in this country and to bring UK treatment results in line with those other countries in Europe, focuses on preventing malignancy as part of its comprehensive cancer management strategy. It highlights that the rich are less likely to develop cancer, and will survive longer if they are diagnosed than those who live in poverty. This may reflect available treatment options, but is more likely to be related to the lifestyle of those with regular work, as they may be more health aware. The Cancer Plan, however, suggests that relieving poverty may be more labour intensive and less rewarding than encouraging positive risk-reducing behaviour in all members of the population. Eating well can reduce the risk of developing many cancers, particularly of the stomach and bowel. The Cancer Plan outlines the ‘Five-a-Day’ programme which was rolled out in 2002 and encouraged people to eat at least five portions of fruit and vegetables per day. Obese people are also at higher risk of cancers, in particular endometrial cancer. A good diet and regular exercise not only reduce obesity but are also independent risk-reducing factors. Alcohol misuse is thought to be a major risk factor in around 3% of all cancers, with the highest risk for cancers of the mouth and throat. As part of the Cancer Plan, the Department of Health promotes physical activity and general health programmes, as well as alcohol and smoking programmes, particularly in deprived areas. Focusing on these healthy lifestyle points can potentially reduce an individual lifetime risk of all cancers. However, our knowledge of the biology of four cancers in particular has led to the development of specific life-saving interventions. Outlined in this chapter are details regarding ongoing prevention strategies for carcinomas of the lung, the breast, the bowel, and the cervix.

AbstractTropical cyclone-related hazards are often comprised of compound, connected events that individually amplify the total impacts. Often, hazard risk assessments focus on one factor rather than the compound nature of multiple forcing mechanisms. It is possible that extreme event analysis in a univariate context may underestimate the probabilities and impacts of extreme events. In this study, a framework addresses multivariate analysis of risk due to compound hazards related to tropical cyclone characteristics. Combinations of observations and simulations are used to identify possible frequencies of annual chance extreme events forced via connected individual events. The framework emphasizes the statistical dependence of multiple physical variables that contribute to extreme compound events when individual events are not extreme.To make the analysis clear, specific locations are analyzed using both univariate and a joint analysis. The joint analysis is conducted using copula functions to remove the restriction that marginal distributions need come from the same family of probability functions. The primary results suggest that univariate and joint return periods for key tropical cyclone-related hazards could shorten in the future and univariate frequency analysis may underestimate the magnitude of the extreme events because the univariate analyses do not account for the dependence structure between the paired environmental factors.

AbstractIntroducing the main concepts of ERA Acute, this chapter describes the overall framework and purpose of the methodology. ERA Acute is a recently developed oil spill risk assessment (OSRA) methodology for quantification of oil spill impacts and risk (Environmental Risk Assessment, ERA). It covers four environmental compartments; sea surface (seabirds, turtles, marine mammals), water column (fish eggs/larvae), shoreline and seafloor (species and habitats) using continuous impact functions and introduces the Resource Damage Factor (RDF). The methodology depends on external oil spill modelling and input data related to the presence and vulnerability of Valued Ecosystem Components (VECs). ERA Acute is developed to provide an improvement over the currently used “MIRA” method on the Norwegian Continental Shelf (NCS) and is better suited for risk management, decision-making and analyses from screening studies to full environmental risk assessments.

AbstractThis chapter introduces conventional monetary policy, i.e. monetary policy during periods of economic and financial stability and when short-term interest rates are not constrained by the zero lower bound. We introduce the concept of an operational target of monetary policy and explain why central banks normally give this role to the short-term interbank rate. We briefly touch macroeconomics by outlining how central banks should set interest rates across time to achieve their ultimate target, e.g. price stability, and we acknowledge the complications in doing so. We then zoom further into monetary policy operations and central bank balance sheets by developing the concepts of autonomous factor, monetary policy instruments, and liquidity-absorbing and liquidity providing balance sheet items. Subsequently we explain how these quantities relate to short-term interest rates, and how the central bank can rely on this relation to steer its operational target, and thereby the starting point of monetary policy transmission. Finally, we explain the importance of the collateral framework and related risk control measures (e.g. haircuts) for the liquidity of banks and for the conduct of central bank credit operations.

Cardiovascular diseases are leading causes of death globally with excessive levels of blood cholesterol being a major risk factor. A dietary approach towards reducing this health risk is the intake of foods enriched with indigestible proteins that bind cholesterol to minimize reabsorption from the gastrointestinal tract. However, the level of indigestible proteins in regular foods is low and normal dietary intake may not provide sufficient cholesterol-lowering effect. Therefore, the aim of this work was to utilize various processing techniques to enhance resistance of food proteins to proteolysis and facilitate recovery of large amounts of indigestible proteins, which was then incorporated into the diet of Sprague-Dawley rats. Various legume seed protein isolates were subjected to the following pretreatments: dry heat, wet heat, autoclave, gelation, and freeze-thaw (3 cycles). The pretreated isolates were digested with pepsin followed by pancreatin to obtain insoluble residue as the indigestible product, which was tested for in vitro bile acid-binding ability. Results showed that the indigestible proteins from gelled cowpea protein isolate (ICP) was most abundant (68% yield) and had strong bile acid-binding ability. The rats were fed high fat diets and divided into 4 groups of 6 each (3 males + 3 females): group 1 was 20% casein diet while groups 2, 3 and 4 consumed same diets but casein was partially substituted with 1% ICP, 5% ICP, and 5% undigested cowpea protein isolate (CPI), respectively. After feeding for 6 weeks, rats that consumed the diet containing 5% ICP had the lowest increase in plasma total cholesterol of 1.8 mmol/L when compared to increases of 9.34 and 4.15 mmol/L for CPI and casein only diets, respectively. Analysis of the fecal matter by gel electrophoresis confirmed the presence of a high molecular proteins in the ICP-containing diets but absent in the casein only and CPI diets.

Conformity assessment, focused on risks quantification, evolved from being binary to being probabilistic. In fact, new methods described by the standard ISO CEI guide 98-4 [1] and FD X 07-039 [2] show how measurement uncertainty is integrated in the conformity assessment (FD X 07-039 : “Role of measurement uncertainty in conformity assessment – implementation of NF ISO/IEC Guide 98-4 – illustration through industrial case studies”). In such a probabilistic framework, the conformity assessment relies on two quantities: the measurement with its related uncertainty and the measurand prior knowledge. Both quantities are combined statistically to determine measurand posterior knowledge, and to quantify a global or specific risks either for the producer or the consumer. The standard also defines how integrating those two quantities improves the reliability of decisions based on measurements. This work will first present a clarification of the probabilistic approach described by the FD X07-039. Then, the measurand prior knowledge use will be explained. Finally, future metrology applications caused by such an approach will be listed.

The seismic probabilistic risk assessment (SPRA) for a nuclear power plant involves the estimation of fragility curves for plant equipment. The seismic qualification of an equipment based on testing requires the equipment to continue to function when subjected to a specific test response spectrum (TRS). Broad banded ground motions have been found to cause more damage to equipment than the filtered narrow banded excitations. As a result, the definition of acceleration capacity used in the fragility models use clipped response spectra for both test response spectrum (TRS) and required response spectrum (RRS). The main purpose of the clipping factors is to convert a narrow banded response spectrum to a broad banded spectrum. The broadband correction factor and the modal interaction correction factors together contribute to the definition of clipping factor. The current study involves reconciliation with previous research by generating the mean response factor for different waveforms and subsequently the root-mean-square (RMS) severity ratio as a function of bandwidth. This ratio can be estimated for real earthquakes from their peak-to-rms values and the peak spectral values. In addition it can be shown that in case of real narrow banded earthquakes, this ratio is even lower and therefore the clipping would be greater. The modal interaction correction factor which considers the effect of interaction between different modes in case of broad banded time histories has also been investigated. The primary objective of this work is to study the existing Conservative Deterministic Failure Margin (CDFM) and Probabilistic approaches for estimating these factors as per the guidelines of EPRI [2] and apply the same to real life ground motions. It has been observed that the recommended practices are based on studying the behavior of random ground motions generated artificially for different bandwidths and center frequencies. The present study aims towards a more realistic fragility estimation of equipment by studying the spectral response of equipment based on actual ground motions. The purpose is to evaluate clipping factors that are consistent with Seismic Probabilistic Risk Assessment.

The article considers the main aspects of economic security of the region in the conditions of digital transformation of the economy. The main attention is paid to the problem of investment activity as one of the economic security risk factors. The problem is disclosed on the example of a specific region, namely, Astrakhan Oblast. The authors analyze investment activity in the region, the main investment projects implemented on its territory, and assess the investment climate. The threats and risks to economic security existing in the region are also identified and some ways to minimize them are outlined.

Abstract The National Aeronautics and Space Administration (NASA) operates approximately 300 aging layered pressure vessels that were designed and manufactured prior to ASME Boiler and Pressure Vessel (B&PV) code requirements. In order to make decisions regarding the continued fitness-for-service of these non-code carbon steel vessels, it is necessary to perform a relative risk of failure assessment for each vessel. However, risk assessment of these vessels is confounded by uncertainties and variabilities related to the use of proprietary materials in fabrication, missing construction records, geometric discontinuities, weld residual stresses, and complex service stress gradients in and around the welds. Therefore, a probabilistic framework that can capture these uncertainties and variabilities has been developed to assess the fracture risk of flaws in regions of interest, such as longitudinal and circumferential welds, using the NESSUS® probabilistic modeling software and NASGRO® fracture mechanics software. In this study, the probabilistic framework was used to predict variability in the stress intensity factor associated with different reference flaws located in the head-to-shell circumferential welds of a 4-layer and 14-layer pressure vessel. The probabilistic studies predict variability in flaw behavior and the important uncertain parameters for each reference flaw location.

Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.

In defined contribution systems, at the end of the accumulation phase the assets in the retirement account are exchanged for a pension. The conversion rate from assets to retirement income (which depends on the level of interest rates) is very volatile, and its variations constitute the main investment risk facing pension fund affiliates. In this sense, performance metrics, management fees and benchmark portfolios that focus on assets (and asset returns) and ignore the variations in the conversion rate, embed several problems: i. they send wrong signals to regulators, fund managers and workers, ii. they provide wrong incentives to pension fund management companies, and iii. they leave pension fund affiliates exposed to their largest risk factor, even during the last few years preceding their retirement date. We find that regulatory incentives with these fundamental problems are ubiquitous in the region. The document presents a series of best practices, and delivers a practical set of tools to assist regulators and supervisors in designing a framework that improves security and sufficiency of retirement income, and provides relevant and timely information to pension fund affiliates. The framework achieves that by fostering an integration of the accumulation and the payout phases, and an alignment of the regulatory incentives for pension fund management companies with the retirement income objectives of pension fund affiliates. Using historical data from Colombia as a case study, the document illustrates and quantifies the improvements in terms of pension benefits and retirement income security that the proposed framework could bring.

1.1 Macroeconomic summary Economic recovery has consistently outperformed the technical staff’s expectations following a steep decline in activity in the second quarter of 2020. At the same time, total and core inflation rates have fallen and remain at low levels, suggesting that a significant element of the reactivation of Colombia’s economy has been related to recovery in potential GDP. This would support the technical staff’s diagnosis of weak aggregate demand and ample excess capacity. The most recently available data on 2020 growth suggests a contraction in economic activity of 6.8%, lower than estimates from January’s Monetary Policy Report (-7.2%). High-frequency indicators suggest that economic performance was significantly more dynamic than expected in January, despite mobility restrictions and quarantine measures. This has also come amid declines in total and core inflation, the latter of which was below January projections if controlling for certain relative price changes. This suggests that the unexpected strength of recent growth contains elements of demand, and that excess capacity, while significant, could be lower than previously estimated. Nevertheless, uncertainty over the measurement of excess capacity continues to be unusually high and marked both by variations in the way different economic sectors and spending components have been affected by the pandemic, and by uneven price behavior. The size of excess capacity, and in particular the evolution of the pandemic in forthcoming quarters, constitute substantial risks to the macroeconomic forecast presented in this report. Despite the unexpected strength of the recovery, the technical staff continues to project ample excess capacity that is expected to remain on the forecast horizon, alongside core inflation that will likely remain below the target. Domestic demand remains below 2019 levels amid unusually significant uncertainty over the size of excess capacity in the economy. High national unemployment (14.6% for February 2021) reflects a loose labor market, while observed total and core inflation continue to be below 2%. Inflationary pressures from the exchange rate are expected to continue to be low, with relatively little pass-through on inflation. This would be compatible with a negative output gap. Excess productive capacity and the expectation of core inflation below the 3% target on the forecast horizon provide a basis for an expansive monetary policy posture. The technical staff’s assessment of certain shocks and their expected effects on the economy, as well as the presence of several sources of uncertainty and related assumptions about their potential macroeconomic impacts, remain a feature of this report. The coronavirus pandemic, in particular, continues to affect the public health environment, and the reopening of Colombia’s economy remains incomplete. The technical staff’s assessment is that the COVID-19 shock has affected both aggregate demand and supply, but that the impact on demand has been deeper and more persistent. Given this persistence, the central forecast accounts for a gradual tightening of the output gap in the absence of new waves of contagion, and as vaccination campaigns progress. The central forecast continues to include an expected increase of total and core inflation rates in the second quarter of 2021, alongside the lapse of the temporary price relief measures put in place in 2020. Additional COVID-19 outbreaks (of uncertain duration and intensity) represent a significant risk factor that could affect these projections. Additionally, the forecast continues to include an upward trend in sovereign risk premiums, reflected by higher levels of public debt that in the wake of the pandemic are likely to persist on the forecast horizon, even in the context of a fiscal adjustment. At the same time, the projection accounts for the shortterm effects on private domestic demand from a fiscal adjustment along the lines of the one currently being proposed by the national government. This would be compatible with a gradual recovery of private domestic demand in 2022. The size and characteristics of the fiscal adjustment that is ultimately implemented, as well as the corresponding market response, represent another source of forecast uncertainty. Newly available information offers evidence of the potential for significant changes to the macroeconomic scenario, though without altering the general diagnosis described above. The most recent data on inflation, growth, fiscal policy, and international financial conditions suggests a more dynamic economy than previously expected. However, a third wave of the pandemic has delayed the re-opening of Colombia’s economy and brought with it a deceleration in economic activity. Detailed descriptions of these considerations and subsequent changes to the macroeconomic forecast are presented below. The expected annual decline in GDP (-0.3%) in the first quarter of 2021 appears to have been less pronounced than projected in January (-4.8%). Partial closures in January to address a second wave of COVID-19 appear to have had a less significant negative impact on the economy than previously estimated. This is reflected in figures related to mobility, energy demand, industry and retail sales, foreign trade, commercial transactions from selected banks, and the national statistics agency’s (DANE) economic tracking indicator (ISE). Output is now expected to have declined annually in the first quarter by 0.3%. Private consumption likely continued to recover, registering levels somewhat above those from the previous year, while public consumption likely increased significantly. While a recovery in investment in both housing and in other buildings and structures is expected, overall investment levels in this case likely continued to be low, and gross fixed capital formation is expected to continue to show significant annual declines. Imports likely recovered to again outpace exports, though both are expected to register significant annual declines. Economic activity that outpaced projections, an increase in oil prices and other export products, and an expected increase in public spending this year account for the upward revision to the 2021 growth forecast (from 4.6% with a range between 2% and 6% in January, to 6.0% with a range between 3% and 7% in April). As a result, the output gap is expected to be smaller and to tighten more rapidly than projected in the previous report, though it is still expected to remain in negative territory on the forecast horizon. Wide forecast intervals reflect the fact that the future evolution of the COVID-19 pandemic remains a significant source of uncertainty on these projections. The delay in the recovery of economic activity as a result of the resurgence of COVID-19 in the first quarter appears to have been less significant than projected in the January report. The central forecast scenario expects this improved performance to continue in 2021 alongside increased consumer and business confidence. Low real interest rates and an active credit supply would also support this dynamic, and the overall conditions would be expected to spur a recovery in consumption and investment. Increased growth in public spending and public works based on the national government’s spending plan (Plan Financiero del Gobierno) are other factors to consider. Additionally, an expected recovery in global demand and higher projected prices for oil and coffee would further contribute to improved external revenues and would favor investment, in particular in the oil sector. Given the above, the technical staff’s 2021 growth forecast has been revised upward from 4.6% in January (range from 2% to 6%) to 6.0% in April (range from 3% to 7%). These projections account for the potential for the third wave of COVID-19 to have a larger and more persistent effect on the economy than the previous wave, while also supposing that there will not be any additional significant waves of the pandemic and that mobility restrictions will be relaxed as a result. Economic growth in 2022 is expected to be 3%, with a range between 1% and 5%. This figure would be lower than projected in the January report (3.6% with a range between 2% and 6%), due to a higher base of comparison given the upward revision to expected GDP in 2021. This forecast also takes into account the likely effects on private demand of a fiscal adjustment of the size currently being proposed by the national government, and which would come into effect in 2022. Excess in productive capacity is now expected to be lower than estimated in January but continues to be significant and affected by high levels of uncertainty, as reflected in the wide forecast intervals. The possibility of new waves of the virus (of uncertain intensity and duration) represents a significant downward risk to projected GDP growth, and is signaled by the lower limits of the ranges provided in this report. Inflation (1.51%) and inflation excluding food and regulated items (0.94%) declined in March compared to December, continuing below the 3% target. The decline in inflation in this period was below projections, explained in large part by unanticipated increases in the costs of certain foods (3.92%) and regulated items (1.52%). An increase in international food and shipping prices, increased foreign demand for beef, and specific upward pressures on perishable food supplies appear to explain a lower-than-expected deceleration in the consumer price index (CPI) for foods. An unexpected increase in regulated items prices came amid unanticipated increases in international fuel prices, on some utilities rates, and for regulated education prices. The decline in annual inflation excluding food and regulated items between December and March was in line with projections from January, though this included downward pressure from a significant reduction in telecommunications rates due to the imminent entry of a new operator. When controlling for the effects of this relative price change, inflation excluding food and regulated items exceeds levels forecast in the previous report. Within this indicator of core inflation, the CPI for goods (1.05%) accelerated due to a reversion of the effects of the VAT-free day in November, which was largely accounted for in February, and possibly by the transmission of a recent depreciation of the peso on domestic prices for certain items (electric and household appliances). For their part, services prices decelerated and showed the lowest rate of annual growth (0.89%) among the large consumer baskets in the CPI. Within the services basket, the annual change in rental prices continued to decline, while those services that continue to experience the most significant restrictions on returning to normal operations (tourism, cinemas, nightlife, etc.) continued to register significant price declines. As previously mentioned, telephone rates also fell significantly due to increased competition in the market. Total inflation is expected to continue to be affected by ample excesses in productive capacity for the remainder of 2021 and 2022, though less so than projected in January. As a result, convergence to the inflation target is now expected to be somewhat faster than estimated in the previous report, assuming the absence of significant additional outbreaks of COVID-19. The technical staff’s year-end inflation projections for 2021 and 2022 have increased, suggesting figures around 3% due largely to variation in food and regulated items prices. The projection for inflation excluding food and regulated items also increased, but remains below 3%. Price relief measures on indirect taxes implemented in 2020 are expected to lapse in the second quarter of 2021, generating a one-off effect on prices and temporarily affecting inflation excluding food and regulated items. However, indexation to low levels of past inflation, weak demand, and ample excess productive capacity are expected to keep core inflation below the target, near 2.3% at the end of 2021 (previously 2.1%). The reversion in 2021 of the effects of some price relief measures on utility rates from 2020 should lead to an increase in the CPI for regulated items in the second half of this year. Annual price changes are now expected to be higher than estimated in the January report due to an increased expected path for fuel prices and unanticipated increases in regulated education prices. The projection for the CPI for foods has increased compared to the previous report, taking into account certain factors that were not anticipated in January (a less favorable agricultural cycle, increased pressure from international prices, and transport costs). Given the above, year-end annual inflation for 2021 and 2022 is now expected to be 3% and 2.8%, respectively, which would be above projections from January (2.3% and 2,7%). For its part, expected inflation based on analyst surveys suggests year-end inflation in 2021 and 2022 of 2.8% and 3.1%, respectively. There remains significant uncertainty surrounding the inflation forecasts included in this report due to several factors: 1) the evolution of the pandemic; 2) the difficulty in evaluating the size and persistence of excess productive capacity; 3) the timing and manner in which price relief measures will lapse; and 4) the future behavior of food prices. Projected 2021 growth in foreign demand (4.4% to 5.2%) and the supposed average oil price (USD 53 to USD 61 per Brent benchmark barrel) were both revised upward. An increase in long-term international interest rates has been reflected in a depreciation of the peso and could result in relatively tighter external financial conditions for emerging market economies, including Colombia. Average growth among Colombia’s trade partners was greater than expected in the fourth quarter of 2020. This, together with a sizable fiscal stimulus approved in the United States and the onset of a massive global vaccination campaign, largely explains the projected increase in foreign demand growth in 2021. The resilience of the goods market in the face of global crisis and an expected normalization in international trade are additional factors. These considerations and the expected continuation of a gradual reduction of mobility restrictions abroad suggest that Colombia’s trade partners could grow on average by 5.2% in 2021 and around 3.4% in 2022. The improved prospects for global economic growth have led to an increase in current and expected oil prices. Production interruptions due to a heavy winter, reduced inventories, and increased supply restrictions instituted by producing countries have also contributed to the increase. Meanwhile, market forecasts and recent Federal Reserve pronouncements suggest that the benchmark interest rate in the U.S. will remain stable for the next two years. Nevertheless, a significant increase in public spending in the country has fostered expectations for greater growth and inflation, as well as increased uncertainty over the moment in which a normalization of monetary policy might begin. This has been reflected in an increase in long-term interest rates. In this context, emerging market economies in the region, including Colombia, have registered increases in sovereign risk premiums and long-term domestic interest rates, and a depreciation of local currencies against the dollar. Recent outbreaks of COVID-19 in several of these economies; limits on vaccine supply and the slow pace of immunization campaigns in some countries; a significant increase in public debt; and tensions between the United States and China, among other factors, all add to a high level of uncertainty surrounding interest rate spreads, external financing conditions, and the future performance of risk premiums. The impact that this environment could have on the exchange rate and on domestic financing conditions represent risks to the macroeconomic and monetary policy forecasts. Domestic financial conditions continue to favor recovery in economic activity. The transmission of reductions to the policy interest rate on credit rates has been significant. The banking portfolio continues to recover amid circumstances that have affected both the supply and demand for loans, and in which some credit risks have materialized. Preferential and ordinary commercial interest rates have fallen to a similar degree as the benchmark interest rate. As is generally the case, this transmission has come at a slower pace for consumer credit rates, and has been further delayed in the case of mortgage rates. Commercial credit levels stabilized above pre-pandemic levels in March, following an increase resulting from significant liquidity requirements for businesses in the second quarter of 2020. The consumer credit portfolio continued to recover and has now surpassed February 2020 levels, though overall growth in the portfolio remains low. At the same time, portfolio projections and default indicators have increased, and credit establishment earnings have come down. Despite this, credit disbursements continue to recover and solvency indicators remain well above regulatory minimums. 1.2 Monetary policy decision In its meetings in March and April the BDBR left the benchmark interest rate unchanged at 1.75%.

Macroeconomic summary Annual inflation continued to rise in the first quarter (8.5%) and again outpaced both market expectations and the technical staff’s projections. Inflation in major consumer price index (CPI) baskets has accelerated year-to-date, rising in March at an annual rate above 3%. Food prices (25.4%) continued to contribute most to rising inflation, mainly affected by a deterioration in external supply and rising costs of agricultural inputs. Increases in transportation prices and in some utility rates (energy and gas) can explain the acceleration in regulated items prices (8.3%). For its part, the increase in inflation excluding food and regulated items (4.5%) would be the result of shocks in supply and external costs that have been more persistent than expected, the effects of indexation, accumulated inflationary pressures from the exchange rate, and a faster-than-anticipated tightening of excess productive capacity. Within the basket excluding food and regulated items, external inflationary pressures have meaningfully impacted on goods prices (6.4%), which have been accelerating since the last quarter of 2021. Annual growth in services prices (3.8%) above the target rate is due primarily to food away from home (14.1%), which was affected by significant increases in food and utilities prices and by a rise in the legal monthly minimum wage. Housing rentals and other services prices also increased, though at rates below 3%. Forecast and expected inflation have increased and remain above the target rate, partly due to external pressures (prices and costs) that have been more persistent than projected in the January report (Graphs 1.1 and 1.2). Russia’s invasion of Ukraine accentuated inflationary pressures, particularly on international prices for certain agricultural goods and inputs, energy, and oil. The current inflation projection assumes international food prices will increase through the middle of this year, then remain high and relatively stable for the remainder of 2022. Recovery in the perishable food supply is forecast to be less dynamic than previously anticipated due to high agricultural input prices. Oil prices should begin to recede starting in the second half of the year, but from higher levels than those presented in the previous report. Given the above, higher forecast inflation could accentuate indexation effects and increase inflation expectations. The reversion of a rebate on value-added tax (VAT) applied to cleaning and hygiene products, alongside the end of Colombia’s COVID-19 health emergency, could increase the prices of those goods. The elimination of excess productive capacity on the forecast horizon, with an output gap close to zero and somewhat higher than projected in January, is another factor to consider. As a consequence, annual inflation is expected to remain at high levels through June. Inflation should then decline, though at a slower pace than projected in the previous report. The adjustment process of the monetary policy rate wouldcontribute to pushing inflation and its expectations toward the target on the forecast horizon. Year-end inflation for 2022 is expected to be around 7.1%, declining to 4.8% in 2023. Economic activity again outperformed expectations. The technical staff’s growth forecast for 2022 has been revised upward from 4.3% to 5% (Graph 1.3). Output increased more than expected in annual terms in the fourth quarter of 2021 (10.7%), driven by domestic demand that came primarily because of private consumption above pre-pandemic levels. Investment also registered a significant recovery without returning to 2019 levels and with mixed performance by component. The trade deficit increased, with significant growth in imports similar to that for exports. The economic tracking indicator (ISE) for January and February suggested that firstquarter output would be higher than previously expected and that the positive demand shock observed at the end of 2021 could be fading slower than anticipated. Imports in consumer goods, retail sales figures, real restaurant and hotel income, and credit card purchases suggest that household spending continues to be dynamic, with levels similar to those registered at the end of 2021. Project launch and housing starts figures and capital goods import data suggest that investment also continues to recover but would remain below pre-pandemic levels. Consumption growth is expected to decelerate over the year from high levels reached over the last two quarters. This would come amid tighter domestic and external financial conditions, the exhaustion of suppressed demand, and a deterioration of available household income due to increased inflation. Investment is expected to continue to recover, while the trade deficit should tighten alongside high oil and other export commodity prices. Given all of the above, first-quarter economic growth is now expected to be 7.2% (previously 5.2%) and 5.0% for 2022 as a whole (previously 4.3%). Output growth would continue to moderate in 2023 (2.9%, previously 3.1%), converging similar to long-term rates. The technical staff’s revised projections suggest that the output gap would remain at levels close to zero on the forecast horizon but be tighter than forecast in January (Graph 1.4). These estimates continue to be affected by significant uncertainty associated with geopolitical tensions, external financial conditions, Colombia’s electoral cycle, and the COVID-19 pandemic. External demand is now projected to grow at a slower pace than previously expected amid increased global inflationary pressures, high oil prices, and tighter international financial conditions than forecast in January. The Russian invasion of Ukraine and its inflationary effects on prices for oil and certain agricultural goods and inputs accentuated existing global inflationary pressures originating in supply restrictions and increased international costs. A decline in the supply of Russian oil, low inventory levels, and continued production limits on behalf of the Organization of Petroleum Exporting Countries and its allies (OPEC+) can explain increased projected oil prices for 2022 (USD 100.8/barrel, previously USD 75.3) and 2023 (USD 86.8/barrel, previously USD 71.2). The forecast trajectory for the U.S. Federal Reserve (Fed) interest rate has increased for this and next year to reflect higher real and expected inflation and positive performance in the labormarket and economic activity. The normalization of monetary policy in various developed and emerging market economies, more persistent supply and cost shocks, and outbreaks of COVID-19 in some Asian countries contributed to a reduction in the average growth outlook for Colombia’s trade partners for 2022 (2.8%, previously 3.3%) and 2023 (2.4%, previously 2.6%). In this context, the projected path for Colombia’s risk premium increased, partly due to increased geopolitical global tensions, less expansionary monetary policy in the United States, an increase in perceived risk for emerging markets, and domestic factors such as accumulated macroeconomic imbalances and political uncertainty. Given all the above, external financial conditions are tighter than projected in January report. External forecasts and their impact on Colombia’s macroeconomic scenario continue to be affected by considerable uncertainty, given the unpredictability of both the conflict between Russia and Ukraine and the pandemic. The current macroeconomic scenario, characterized by high real inflation levels, forecast and expected inflation above 3%, and an output gap close to zero, suggests an increased risk of inflation expectations becoming unanchored. This scenario offers very limited space for expansionary monetary policy. Domestic demand has been more dynamic than projected in the January report and excess productive capacity would have tightened more quickly than anticipated. Headline and core inflation rose above expectations, reflecting more persistent and important external shocks on supply and costs. The Russian invasion of Ukraine accentuated supply restrictions and pressures on international costs. This partly explains the increase in the inflation forecast trajectory to levels above the target in the next two years. Inflation expectations increased again and are above 3%. All of this increased the risk of inflation expectations becoming unanchored and could generate indexation effects that move inflation still further from the target rate. This macroeconomic context also implies reduced space for expansionary monetary policy. 1.2 Monetary policy decision Banco de la República’s board of directors (BDBR) continues to adjust its monetary policy. In its meetings both in March and April of 2022, it decided by majority to increase the monetary policy rate by 100 basis points, bringing it to 6.0% (Graph 1.5).