Journal articles on the topic 'Spread Risk Adjusted'
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Boliari, Natalia, and Kudret Topyan. "Credit Risk in G20 Nations: A Comparative Analysis in International Finance Using Option-Adjusted-Spreads." Journal of Risk and Financial Management 15, no. 1 (January 10, 2022): 25. http://dx.doi.org/10.3390/jrfm15010025.
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Corporate bond yields are the manifestation of the cost of financing for private firms, and if properly evaluated, they provide researchers with valuable risk information. Within this context, this work is the first study producing corporate yield spreads for all S&P-rated bonds of G20 nations to explain their comparative riskiness. The option-adjusted spread analysis is an advanced method that enables us to compare the bonds with embedded options and different cash flow characteristics. For securities with embedded options, the volatility in the interest rates plays a role in ascertaining whether the option is going to be invoked or not. Therefore, researchers need a spread that, when added to all the forward rates on the tree, will make the theoretical value equal to the market price. The spread that satisfies this condition is called the option-adjusted spread, since it considers the option embedded into the issue. Ultimately, this work investigates the credit risk differentials of S&P rated outstanding bonds issued by the G20 nations to provide international finance professionals with option-adjusted corporate yield spreads showing the credit risk attributable to debt instruments. Detailed results computed using OAS methodology are presented in tables and used to answer the six vital credit-risk-related questions introduced in the introduction.
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Niblock, Scott James. "Flight of the Condors: Evidence on the Performance of Condor Option Spreads in Australia." Applied Finance Letters 6, no. 01 (December 6, 2017): 38–53. http://dx.doi.org/10.24135/afl.v6i01.69.
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This paper examines whether superior nominal and risk-adjusted returns can be generated using condor option spread strategies on a large capitalized Australian stock. Monthly Commonwealth Bank of Australia Ltd (CBA) condor option spreads are constructed from 2012 to 2015 and their returns established. Standard and alternative measures are used to determine the nominal and risk-adjusted performance of the spreads. The results show that the short put condor spread produces superior nominal and risk-adjusted returns, but seemingly underperformed when the upside potential ratio was taken into consideration. The long iron condor spread also offers reasonable returns across both performance metrics. On the other hand, the short call condor, long call condor, short iron condor and long put condor spreads did not perform as well on a nominal and risk-adjusted return basis. The results suggest that constructing spreads on the foundation of volatility preferences could be a driver of performance for condor option spreads strategies. For instance, short volatility condor spreads with negatively skewed return distribution shapes appear to add value, while long volatility condor spreads with positively skewed return distribution shapes seem to be less attractive over the sample period. Overall, condor option spreads demonstrate high risk-return profiles, offer versatility in their construction and intended pay-off outcomes, create value in some instances and can be executed across varying market conditions. It is suggested that risk averse investors best avoid condor option spreads, while those with above average risk tolerances may be well suited to the strategies, particularly short volatility-driven condor spreads.
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Shine, Daniel. "Risk-Adjusted Mortality: Problems and Possibilities." Computational and Mathematical Methods in Medicine 2012 (2012): 1–5. http://dx.doi.org/10.1155/2012/829465.
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The ratio of observed-to-expected deaths is considered a measure of hospital quality and for this reason will soon become a basis for payment. However, there are drivers of that metric more potent than quality: most important are medical documentation and patient acuity. If hositals underdocument and therefore do not capture the full “expected mortality” they may be tempted to lower their observed/expected ratio by reducing “observed mortality” through limiting access to the very ill. Underdocumentation occurs because hospitals do not recognize, and therefore cannot seek to confirm, specific comorbidities conferring high mortality risk. To help hospitals identify these comorbidities, this paper describes an easily implemented spread-sheet for evaluating comorbid conditions associated, in any particular hospital, with each discharge. This method identifies comorbidities that increase in frequency as mortality risk increases within each diagnostic grouping. The method is inductive and therefore independent of any particular risk-adjustment technique.
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Cavallo, Eduardo A., and Patricio Valenzuela. "The Determinants of Corporate Risk in Emerging Markets: An Option-Adjusted Spread Analysis." IMF Working Papers 07, no. 228 (2007): 1. http://dx.doi.org/10.5089/9781451867923.001.
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Boliari, Natalia, and Kudret Topyan. "Holding Companies and Debt Financing: A Comparative Analysis Using Option-Adjusted Spreads." Journal of Risk and Financial Management 15, no. 12 (December 1, 2022): 569. http://dx.doi.org/10.3390/jrfm15120569.
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This work investigates and compares the total risk attributable to holding and operating companies, using data from the United States. By proxying overall risk by the option-adjusted spread on corporate bonds, we hypothesize that operating companies face a higher risk. Our data were obtained from Bloomberg and comprise 17,800 corporate bonds. Our methodology entails stratified univariate comparisons of the means of the option-adjusted spreads of sub-samples of operating companies versus holding companies. The principal bases of stratification are issue size, bond maturity, and creditworthiness proxied by the Standard and Poor ratings. With very few exceptions, our results report insignificant t-statistics, thus making us unable to reject the null hypothesis that the operating companies have the same business risk as holding companies. When bond rating, maturity, and size are controlled, there is no consistent cost reduction attributable to holding companies, and contrary to common belief, this is more visible for smaller firms. Our work suggests that there is no evidence consistently favoring holding-company financing compared to operating ones.
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Angelidis, Timotheos, and Alexandros Benos. "Liquidity adjusted value-at-risk based on the components of the bid-ask spread." Applied Financial Economics 16, no. 11 (July 2006): 835–51. http://dx.doi.org/10.1080/09603100500426440.
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Guender, Alfred, and Bernard Tolan. "The predictive ability of a risk-adjusted yield spread for economic activity in Europe." Empirica 44, no. 1 (October 1, 2015): 1–27. http://dx.doi.org/10.1007/s10663-015-9309-z.
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Ortolano, Alessandra, and Eugenia Nissi. "The Volatility of the “Green” Option-Adjusted Spread: Evidence before and during the Pandemic Period." Risks 10, no. 3 (February 22, 2022): 45. http://dx.doi.org/10.3390/risks10030045.
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The paper is an investigation on the impact of financial markets on the volatility of the green bonds credit risk component, measured by the option-adjusted spread/swap curve (OAS) before and during the pandemic period. To this purpose, after observing the dynamic joint correlations between all the variables, we adopt Exponential and Generalized AutoRegressive Conditional Heteroskedasticity models, putting the OAS as dependent variable. Our main results show that the conditional variance parameters are significant and persistent in both times, testifying the overall impact of the other markets on the OAS. In more detail, we highlight that the gamma in the two Exponential models is positive: so, the “green” credit risk volatility is more sensitive to positive shocks than to negative ones. With reference to the conditional mean, we note that if during the non-pandemic period only the stock market is significant, during the pandemic also conventional bonds and gold are impacting. To the best of our knowledge this is the first study that analyzes the specific credit risk component of the green bond yields: we deem our findings useful to observe the change of green bonds creditworthiness in a complex market context and interesting in terms of policy implications.
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Russell, Tara A., Hallie Chung, Christina Riad, Sarah Reardon, Kevork Kazanjian, Robert Cherry, O. Joe Hines, and Anne Lin. "Sustaining Improvement: Implementation and Spread of a Surgical Site Infection Bundle." American Surgeon 84, no. 10 (October 2018): 1665–69. http://dx.doi.org/10.1177/000313481808401026.
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Surgical site infections (SSIs) are considered a quality metric across surgical specialties and are a major cause of increased readmissions and overall costs to surgical patients. Bundled interventions have demonstrated efficacy in reducing SSIs in various surgical fields, yet the ability to sustain and spread interventions while continuing to reduce infection rates is a significant challenge. This study assessed the implementation and sustainability of an SSI bundle, which was initially piloted within the colorectal surgery division and then spread to additional general surgery services. Outcomes (risk-adjusted ACS-NSQIP odds ratio and observed to expected (O:E) SSI rates) and process measures were monitored on run charts throughout the course of the intervention. By the end of the study period, ACS-NSQIP risk-adjusted odds ratios for SSIs decreased from 1.22 to 0.95 for colorectal procedure targeted and 1.32 to 1.04 for all general surgery procedures ( P < 0.05). O:E ratios showed similar reductions. SSI reductions were associated with process measure compliance. This study demonstrates that effective implementation within a single surgical division provides the foundation for spread of a SSI bundle, which results in continued and sustained reductions in SSI rates.
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Yang, Yurun, Ahmet Goncu, and Athanasios Pantelous. "Pairs trading with commodity futures: evidence from the Chinese market." China Finance Review International 7, no. 3 (August 21, 2017): 274–94. http://dx.doi.org/10.1108/cfri-09-2016-0109.
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Purpose The purpose of this paper is to compare the profitability of different pairs selection and spread trading methods using the complete data set of commodity futures from Dalian Commodity Exchange, Shanghai Futures Exchange and Zhengzhou Commodity Exchange. Design/methodology/approach Paris trading methods that are proposed in the literature are compared in terms of the risk-adjusted returns visa in-sample and out-of-sample backtesting and bootstrapping for robustness. Findings The empirical results show that pairs trading in the Chinese commodity futures market offers high returns, whereas, the profitability of these strategies primarily depends on the identification of suitable pairs. The observed high returns are a compensation for the spread divergence risk during the potentially longer holding periods, which implies that the maximum drawdown is more crucial compared to other risk-adjusted return measures such as the Sharpe ratio. Originality/value Complementary to the existing literature, for the Chinese commodity futures market, it is shown that if shorter maximum holding periods are introduced for the spread positions, then the pairs trading profits decreases. Therefore, the returns do not necessarily imply market inefficiency when the higher maximum drawdown associated with the holding period of the spread position is taken into account.
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Gonçalves, Franklin De O., and Luiz Otavio Calôba. "A dinâmica do spread ajustado por opções dos Brady bonds." Brazilian Review of Finance 1, no. 1 (April 1, 2003): 89. http://dx.doi.org/10.12660/rbfin.v1n1.2003.1126.
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Brady bond securities represent a substantial fraction of emerging markets countries internationally tradable sovereign debt. The credit risk spread above and beyond the U.S. treasury curve for these securities is usually large in size and volatility. Moreover, most Brady bonds carry embedded options that lead to the existence of an Option-Adjusted Spread, OAS, which increase their risk profiles. In this paper we present an empirical study of the dynamics of Brady bonds OAS using a heath, Jarrow and Morton term structure pricing model. The dynamics of the spread shows that the proper risk management and pricing of these securities require the consideration of volatility in addition to the magnitude of the sovereign risk spread. That is, the proper risk measure for these securities would be the pair (OAS, OAS Volatility). A study of implied default probabilities is also presented. Our analysis is illustrated with bonds from Brazil, Argentina, Mexico, Poland, Bulgaria and the Philippines.
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Niblock, Scott J., and Elisabeth Sinnewe. "Are covered calls the right option for Australian investors?" Studies in Economics and Finance 35, no. 2 (June 4, 2018): 222–43. http://dx.doi.org/10.1108/sef-07-2016-0164.
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Purpose The purpose of this paper is to examine whether superior risk-adjusted returns can be generated using monthly covered call option strategies in large capitalized Australian equity portfolios and across varying market volatility conditions. Design/methodology/approach The authors construct monthly in-the-money (ITM) and out-of-the-money (OTM) S&P/ASX 20 covered call portfolios from 2010 to 2015 and use standard and alternative performance measures. An assessment of variable levels of market volatility on risk-adjusted return performance is also carried out using the spread between implied and realized volatility indexes. Findings The results of this paper show that covered call writing produces similar nominal returns at lower risk when compared against the standalone buy-and-hold portfolio. Both standard and alternative performance measures (with the exception of the upside potential ratio) demonstrate that covered call portfolios produce superior risk-adjusted returns, particularly when written deeper OTM. The 36-month rolling regressions also reveal that deeper OTM portfolios deliver greater risk-adjusted returns in the majority of the sub-periods investigated. This paper also establishes that volatility spread variation may be a driver of performance for covered call writing in Australia. Originality/value The authors suggest that deeper OTM covered call strategies based on large capitalized portfolios create value for investors/fund managers in the Australian stock market and can be executed in volatile market conditions. Such strategies are particularly useful for those seeking market neutral asset allocation and less risk exposure in volatile market environments.
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Kraft, Pepa. "Rating Agency Adjustments to GAAP Financial Statements and Their Effect on Ratings and Credit Spreads." Accounting Review 90, no. 2 (July 1, 2014): 641–74. http://dx.doi.org/10.2308/accr-50858.
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ABSTRACT I examine a dataset of both quantitative (hard) adjustments to firms' reported U.S. GAAP financial statement numbers and qualitative (soft) adjustments to firms' credit ratings that Moody's develops and uses in its credit rating process. I first document differences between firms' reported and Moody's adjusted numbers that are both large and frequent across firms. For example, primarily because of upward adjustments to interest expense and debt attributable to firms' off-balance sheet debt, on average, adjusted coverage (cash flow-to-debt) ratios are 27 percent (8 percent) lower and adjusted leverage ratios are 70 percent higher than the corresponding U.S. GAAP ratios. I then find that Moody's hard and soft rating adjustments are associated with significantly higher credit spreads and flatter credit spread term structures. Overall, the results indicate that Moody's quantitative adjustments to financial statement numbers and qualitative adjustments to credit ratings enable it to better capture default risk, consistent with it effectively processing both hard and soft information.
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LEVIN, ALEXANDER. "ONE- AND MULTI-FACTOR VALUATION OF MORTGAGES: COMPUTATIONAL PROBLEMS AND SHORTCUTS." International Journal of Theoretical and Applied Finance 02, no. 04 (October 1999): 441–69. http://dx.doi.org/10.1142/s0219024999000224.
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A new valuation method is proposed that can be mathematically viewed as a numerical shortcut to approximately solve the partial differential equation written for Expected Instantaneous Return. The method derives OAS as "static spread plus cost of convexity" and is based on some simplified parametric assumption about the static spread's time behavior. The modeling and numerical procedure details are disclaimed with proven accuracy and time efficiency in option-adjusted valuation. The method is especially effective for multi-scenario pricing, portfolio pricing, risk management and reporting, and for quantifying the impact of "non-traded" factors on reward and risk of holding mortgages. A systematic methodology for comprehensive multi-factor analysis is covered.
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Gandhi, Priyank, Hanno Lustig, and Alberto Plazzi. "Equity Is Cheap for Large Financial Institutions." Review of Financial Studies 33, no. 9 (January 25, 2020): 4231–71. http://dx.doi.org/10.1093/rfs/hhaa001.
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Abstract Across a wide panel of countries, the top-10% of financial stocks on average account for over 20% of a country’s market capitalization but earn on average significantly lower returns than do nonfinancial firms of the same size and risk exposures. In a bailout-augmented, rare disasters asset pricing model, the spread in risk-adjusted returns between large and small institutions depends on country characteristics that determine the likelihood of bailouts. Consistent with this model, we find larger spreads in countries with large and interconnected financial sectors, weaker capital regulation and corporate governance, and fiscally stronger governments. Valuation gaps increase in anticipation of financial crises. Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
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Říhová Ambrožová, J., J. Říha, J. Hubáčková, and I. Čiháková. "Risk analysis in drinking water accumulation." Czech Journal of Food Sciences 28, No. 6 (December 13, 2010): 557–63. http://dx.doi.org/10.17221/98/2010-cjfs.
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Drinking water is safe water, from the perspective of long-term use is does not cause any disease, pathogenic and hygienically unsafe microorganisms do not spread in it and customers enjoy its consumption. Drinking water is regarded as a foodstuff, therefore the known HACCP system can be used in the control system which can be applied not only directly to the final product, but also to the whole system of drinking water production, distribution, and accumulation. Even if there is no problem concerning the water processing and the technological line is well adjusted, the quality of drinking water is subsequently deteriorated by its transportation and accumulation. The condition and character of the operated distribution network and reservoirs are significantly and substantially related to the maintenance of the biological stability and quality of drinking water. This is well confirmed by biological audits of the distribution networks and water reservoirs. A significant fact is the negative influence of the secondary contamination by air in the reservoir facilities and the occurrence of microorganisms (fungi, bacteria) in free water and in biofilms. The findings obtained in the framework of biological audits were so alarming that the outputs of biological audits contributed to the reconsideration of the efficiency of the standard for the construction and design of water reservoirs and pointed out the necessity of its review.
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Wu, Junhui, Shunjiang Ni, and Shifei Shen. "Dynamics of public opinion under the influence of epidemic spreading." International Journal of Modern Physics C 27, no. 07 (May 24, 2016): 1650079. http://dx.doi.org/10.1142/s0129183116500790.
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In this paper, we propose a novel model with dynamically adjusted confidence level of others to investigate the propagation of public opinion on whether to buy chicken in the case of avian influenza infection in humans. We study how people adjust their confidence level in other people’s opinions according to their perceived infection risk and how the opinion evolution and epidemic spreading affect each other on different complex networks by taking into account the spreading feature of avian influenza, that is, only people who buy chicken are possible to be infected. The simulation results show that in a closed system, people who support buying chicken and people who are infected can achieve a dynamic balance after a few time-steps, and the final stable state is mainly dependent on the level of people’s risk perception, rather than the initial distribution of the different opinions. Our results imply that in the course of the epidemic spread, transparent and timely announcement of the number of infections and the risk of infection can help people take the right self-protection actions, and thus help control the spread of avian influenza.
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KARMINSKII, Aleksandr M., and Ol'ga D. KHON. "Collateral sufficiency as an adapt financial covenant in bank crediting." Digest Finance 26, no. 1 (March 30, 2021): 83–106. http://dx.doi.org/10.24891/df.26.1.83.
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Subject. The article examines the Loan-to-Value ratio in three dimensions. First, as a measure of leverage, helpful to understand the spread of systemic risk in the economy. Second, we identify LTV throughout financial covenants. Finally, we implement LTV to indicate the probability of default. Objectives. The goal of the paper is to study the impact of collateral sufficiency on credit risk throughout adjusted financial covenants for bank corporate loans. Methods. To conduct the research, the authors implement econometric methods, linear regressions and binary models. Results. We have revealed the prevalence of the posterior theory of the impact of the collateral sufficiency on the credit risk evaluation by corporate loans. We have also revealed that the higher credit risks, the higher collateral requirements to pledge the loans. Conclusions and Relevance. We have considered a new approach to identify collateral requirements, throughout LTV measures, as adjusted financial covenants on the Russian market. Lender’s preferences are being stronger at the time of downturns in economic activity. At the same time, economic growth neutralizes any visible behavioral favors/patterns. Hereby psychological risk components are quite essential, and need studying in modern banking.
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Gourville, E. M. De, D. Mabey, M. Quigley, N. Jack, and B. Mahabir. "Risk factors for concordant HIV infection in heterosexual couples in Trinidad." International Journal of STD & AIDS 9, no. 3 (March 1, 1998): 151–57. http://dx.doi.org/10.1258/0956462981921918.
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Summary: Risk factors for HIV infection in partners of HIV-seropositive index cases were investigated in a cross-sectional survey. Between September 1992 and April 1994 a total of 251 HIV-infected persons and 76 of their sexual partners were interviewed at the main sexually transmitted diseases (STDs) clinic in Trinidad. All participants gave signed consent and responded to a questionnaire. Sixty-four couples had risks for HIV infection through heterosexual intercourse only. However, many recruited sex partners (57/64) reported heterosexual intercourse with persons in addition to the index cases. Overall HIV concordance (both index case and partner HIV infected) was 45% in the couples. HIV concordance was not found to be related to the sexual practices within the studied unions nor to the clinical status of the index case. After allowing for confounding factors there was an increased risk for HIV concordance in couples in unions for 3.48; 95% CI 0.89-13.69, P =0.055), and in those in which sex partners had a past history of genital sores (adjusted for prostitution: OR 4.50; 95% CI 1.01-20.4). Interventions targeted at reducing high-risk sexual behaviour, prostitution and cocaine use could be beneficial in reducing the spread of STDs and HIV in Trinidad. 1 year (adjusted OR
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Telle, Olivier, Birgit Nikolay, Vikram Kumar, Samuel Benkimoun, Rupali Pal, BN Nagpal, and Richard E. Paul. "Social and environmental risk factors for dengue in Delhi city: A retrospective study." PLOS Neglected Tropical Diseases 15, no. 2 (February 11, 2021): e0009024. http://dx.doi.org/10.1371/journal.pntd.0009024.
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Global urbanization is leading to an inexorable spread of several major diseases that need to be stemmed. Dengue is one of these major diseases spreading in cities today, with its principal mosquito vector superbly adapted to the urban environment. Current mosquito control strategies are proving inadequate, especially in the face of such urbanisation and novel, evidence-based targeted approaches are needed. Through combined epidemiological and entomological approaches, we aimed to identify a novel sanitation strategy to alleviate the burden of dengue through how the dengue virus spreads through the community. We combined surveillance case mapping, prospective serological studies, year-round mosquito surveys, socio-economic and Knowledge Attitudes and Practices surveys across Delhi. We identified lack of access to tap water (≤98%) as an important risk factor for dengue virus IgG sero-positivity (adjusted Odds Ratio 4.69, 95% C.I. 2.06–10.67) and not poverty per se. Wealthier districts had a higher dengue burden despite lower mosquito densities than the Intermediary income communities (adjusted Odds Ratio 2.92, 95% C.I. 1.26–6.72). This probably reflects dengue being introduced by people travelling from poorer areas to work in wealthier houses. These poorer, high density areas, where temperatures are also warmer, also had dengue cases during the winter. Control strategies based on improved access to a reliable supply of tap water plus focal intervention in intra-urban heat islands prior to the dengue season could not only lead to a reduction in mosquito abundance but also eliminate the reservoir of dengue virus clearly circulating at low levels in winter in socio-economically disadvantaged areas.
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Lee, Seung Won, Woon Tak Yuh, Jee Myung Yang, Yoon-Sik Cho, In Kyung Yoo, Hyun Yong Koh, Dominic Marshall, et al. "Nationwide Results of COVID-19 Contact Tracing in South Korea: Individual Participant Data From an Epidemiological Survey." JMIR Medical Informatics 8, no. 8 (August 25, 2020): e20992. http://dx.doi.org/10.2196/20992.
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Background Evidence regarding the effectiveness of contact tracing of COVID-19 and the related social distancing is limited and inconclusive. Objective This study aims to investigate the epidemiological characteristics of SARS-CoV-2 transmission in South Korea and evaluate whether a social distancing campaign is effective in mitigating the spread of COVID-19. Methods We used contract tracing data to investigate the epidemic characteristics of SARS-CoV-2 transmission in South Korea and evaluate whether a social distancing campaign was effective in mitigating the spread of COVID-19. We calculated the mortality rate for COVID-19 by infection type (cluster vs noncluster) and tested whether new confirmed COVID-19 trends changed after a social distancing campaign. Results There were 2537 patients with confirmed COVID-19 who completed the epidemiologic survey: 1305 (51.4%) cluster cases and 1232 (48.6%) noncluster cases. The mortality rate was significantly higher in cluster cases linked to medical facilities (11/143, 7.70% vs 5/1232, 0.41%; adjusted percentage difference 7.99%; 95% CI 5.83 to 10.14) and long-term care facilities (19/221, 8.60% vs 5/1232, 0.41%; adjusted percentage difference 7.56%; 95% CI 5.66 to 9.47) than in noncluster cases. The change in trends of newly confirmed COVID-19 cases before and after the social distancing campaign was significantly negative in the entire cohort (adjusted trend difference –2.28; 95% CI –3.88 to –0.68) and the cluster infection group (adjusted trend difference –0.96; 95% CI –1.83 to –0.09). Conclusions In a nationwide contact tracing study in South Korea, COVID-19 linked to medical and long-term care facilities significantly increased the risk of mortality compared to noncluster COVID-19. A social distancing campaign decreased the spread of COVID-19 in South Korea and differentially affected cluster infections of SARS-CoV-2.
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Barinova, A. N., O. G. Khurtsilava, and S. L. Plavinskii. "ASSESSMENT OF THE EFFECTIVENESS OF PREVENTION PROGRAMS FOR COUNTERMEASURE OF SPREAD OF SOCIALLY IMPORTANT INFECTIONS." Hygiene and sanitation 96, no. 4 (March 27, 2019): 392–96. http://dx.doi.org/10.18821/0016-9900-2017-96-4-392-396.
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Purpose of the study. To evaluate the effectiveness of the prevention programs aimed at the prevention of the spread of socially important infections on example of HIV infection, as well to express it in units permitting the comparison with other fields of health care and to compare with to expenses for the prevention and treatment of sequelae of infection. Materials and methods. Results of the panel study, executed in 2006-2013 in 10 regions of the Russian Federation in HIV infection risk groups (4 waves). The total number of participants is 9891. Study protocol included detailed survey of risk behavior, involvement in prevention programs and HIV testing. Obtained data were used for the assessment of the change of the morbidity rate as a result of prevention and calibration of the dynamic (Markov) model of the effect of the prevention on the length of quality-adjusted life and treatment cost. Expenses for the prevention were estimated from field reports of prevention projects. Results. Programs for the comprehensive prevention of socially important infections, first of all HIV-infections, among injecting drug users result in the significant decrease in HIV incidence. The assessment of the effect of the prevention within framework of the multivariable model shows odds ratio to be of 0.56 (95% CI=0.40-0.78). This relative reduction corresponds to the decline of the absolute incidence from 3.98 per 100 person per year in the group of persons who was not involved in prevention programs (95% CI=3.37-4.69) to 2.22 per 100 person per year (95% CI=1.89-2.62) among participants. Such effect of the prevention leads to the increase in quality-adjusted life-years per each person (QALY=0.23, 95% CI=0.10-0.37), and the saving of budget cost by 226 thousand rubles (95% CI=209,6 - 822,2 thousand rubles). With the use of more pessimistic assumptions in relation to expenses for the prevention and treatment, the cost per quality-adjusted life per year failed to surpass the threshold of society’s willingness to pay for health technology, with demonstrating high cost-effectiveness of investing in the prevention. Conclusion. Programs of the comprehensive prevention of socially important infections in the Russian Federation have significant effectiveness and under most plausible assumptions are cost-saving. For the solution the problem of financing preventive measures it is necessary to apply the same principles of health technology assessment as it is done is the area of drug coverage.
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Tang, Jing, Napatee Yaibuates, Theerat Tassanai, and Natt Leelawat. "Inter- and Intrastate Network Analysis of COVID-19 Spread Using the Social Connectedness Index." Journal of Disaster Research 18, no. 1 (January 20, 2023): 40–47. http://dx.doi.org/10.20965/jdr.2023.p0040.
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Since 2020, the outbreak of the coronavirus disease 2019 (COVID-19) pandemic has affected the entire world, and networks of human connections were identified as a factor that had potentially impacted the geographical spread of COVID-19. With the help of social media platforms, these networks have connected populations across the word and allowed people to view each other in close virtual proximity. Consequently, the Social Connectedness Index (SCI) is used to measure the strength of social connectivity across geographical regions through friendship ties on Facebook. The importance of social networks—and their relation to human connections—may correlate with the spread of COVID-19. Since these networks can have a potential effect on the spread of COVID-19, it is crucial to identify the factors that were associated with its spread during the pandemic. In order to analyze SCI data, a social network analysis was conducted to define the network parameters and perform calculations using graph theory. A correlation analysis was also performed to identify factors that correlated with the spread of COVID-19 cases using the data in the United States (US). Finally, the machine learning model was used to create a case prediction paradigm from the network parameters. The results showed that SCI can be used as a parameter to create a pandemic prediction model. Multiple linear regression also yielded satisfactory results that predicted the total number of positive cases measured by adjusted R2. In terms of the time frame, this study suggested that the parameters from the previous week can be used to predict the number of weekly infections. The findings showed that social networks had a greater impact on the prediction of current active cases than total positive cases. The social networks between counties within a state also held more importance than those across states.
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Hirama, Chie, Zechen Zeng, Nobutoshi Nawa, and Takeo Fujiwara. "Association between Cooperative Attitude and High-Risk Behaviors on the Spread of COVID-19 Infection among Medical Students in Japan." International Journal of Environmental Research and Public Health 19, no. 24 (December 9, 2022): 16578. http://dx.doi.org/10.3390/ijerph192416578.
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The impact of high-risk behaviors on the spread of COVID-19 infection among young people is an important problem to address. This study analyzed the association between cooperativeness and high-risk behaviors. We conducted a cross-sectional study among fourth-year medical students at Tokyo Medical and Dental University. The students were asked about cooperative attitude in a hypothetical situation of performing a task together with an unfamiliar classmate, who did not cooperate to complete the task previously. The response items were as follows: “cooperate”, “don’t want to cooperate and do it alone (non-cooperative)”, and “don’t want to cooperate and let the partner do it alone (punishment)”. Eating out and vaccine hesitancy were also treated as high-risk behaviors. Poisson regression was used to investigate the association between cooperative attitude and each high-risk behavior, adjusted for demographics. Of the 98 students, 23 (23.5%), 44 (44.9%), and 31 (31.6%) students chose “noncooperative”, “cooperative”, and “punishment”, respectively. Cooperative-type students exhibited 2.77-fold (PR: 2.77, 95% CI: 1.03–7.46), and punishment-type students exhibited 3.16-fold greater risk of eating or drinking out (PR: 3.16, 95% CI: 1.14–8.75) compared with those of the noncooperative type. Among medical students, the “cooperative” type and “punishment” type comprised the high-risk group for eating out during the pandemic.
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Beale, Sarah, Anne M. Johnson, Maria Zambon, Andrew C. Hayward, and Ellen B. Fragaszy. "Hand Hygiene Practices and the Risk of Human Coronavirus Infections in a UK Community Cohort." Wellcome Open Research 5 (June 22, 2021): 98. http://dx.doi.org/10.12688/wellcomeopenres.15796.2.
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Background: Hand hygiene may mitigate the spread of COVID-19 in community settings; however, empirical evidence is limited. Given reports of similar transmission mechanisms for COVID-19 and seasonal coronaviruses, we investigated whether hand hygiene impacted the risk of acquiring seasonal coronavirus infections. Methods: Data were drawn from three successive winter cohorts (2006-2009) of the England-wide Flu Watch study. Participants (n=1633) provided baseline estimates of hand hygiene behaviour. Coronavirus infections were identified from nasal swabs using RT-PCR. Poisson mixed models estimated the effect of hand hygiene on personal risk of coronavirus illness, both unadjusted and adjusted for confounding by age and healthcare worker status. Results: Moderate-frequency handwashing (6-10 times per day) predicted a lower personal risk of coronavirus infection (adjusted incidence rate ratio (aIRR) =0.64, p=0.04). There was no evidence for a dose-response effect of handwashing, with results for higher levels of hand hygiene (>10 times per day) not significant (aIRR =0.83, p=0.42). Conclusions: This is the first empirical evidence that regular handwashing can reduce personal risk of acquiring seasonal coronavirus infection. These findings support clear public health messaging around the protective effects of hand washing in the context of the current COVID-19 pandemic.
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Beale, Sarah, Anne M. Johnson, Maria Zambon, Andrew C. Hayward, and Ellen B. Fragaszy. "Hand Hygiene Practices and the Risk of Human Coronavirus Infections in a UK Community Cohort." Wellcome Open Research 5 (May 20, 2020): 98. http://dx.doi.org/10.12688/wellcomeopenres.15796.1.
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Background: Hand hygiene may mitigate the spread of COVID-19 in community settings; however, empirical evidence is limited. Given reports of similar transmission mechanisms for COVID-19 and seasonal coronaviruses, we investigated whether hand hygiene impacted the risk of acquiring seasonal coronavirus infections. Methods: Data were drawn from three successive winter cohorts (2006-2009) of the England-wide Flu Watch study. Participants (n=1633) provided baseline estimates of hand hygiene behaviour. Coronavirus infections were identified from nasal swabs using RT-PCR. Poisson mixed models estimated the effect of hand hygiene on personal risk of coronavirus illness, both unadjusted and adjusted for confounding by age and healthcare worker status. Results: Moderate-frequency handwashing (6-10 times per day) predicted a lower personal risk of coronavirus infection (adjusted incidence rate ratio (aIRR) =0.64, p=0.04). There was no evidence for a dose-response effect of handwashing, with results for higher levels of hand hygiene (>10 times per day) not significant (aIRR =0.83, p=0.42). Conclusions: This is the first empirical evidence that regular handwashing can reduce personal risk of acquiring seasonal coronavirus infection. These findings support clear public health messaging around the protective effects of hand washing in the context of the current COVID-19 pandemic.
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Adusei, Michael. "Female on boards and the risk-taking of microfinance institutions: The moderating role of outreach." Corporate Board role duties and composition 16, no. 2 (2020): 19–34. http://dx.doi.org/10.22495/cbv16i2art2.
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This study examines the effect of female on boards on risk-taking with data from 401 microfinance institutions (MFIs) drawn from 64 countries. The study also investigates whether the effect is sensitive to the outreach performance of MFIs. The MFIs sampled for this study are spread across the six MFI regions. The study measures MFI risk by its risk-taking Z-score and risk-adjusted return on assets. The fixed effects estimation technique, known to overcome the omitted variable bias, is deployed to analyze the data. The results show that female representation in the boardroom increases the risk-taking of MFIs. However, when female on boards interacts with the depth of outreach performance of an MFI, its positive impact on MFI risk is observed. It suggests that female directors are more likely to be beneficial to risk management in MFIs that lend more to indigent clients. Several tests, including an instrumental variable test for endogeneity, have been conducted to confirm the robustness of these results.
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Peswani, Shilpa, and Mayank Joshipura. "The volatility effect across size buckets: evidence from the Indian stock market." Investment Management and Financial Innovations 16, no. 3 (August 9, 2019): 62–75. http://dx.doi.org/10.21511/imfi.16(3).2019.07.
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The portfolio of low-volatility stocks earns high risk-adjusted returns over a full market cycle. The annual alpha spread of low versus high-volatility quintile portfolios is 25.53% in the Indian equity market for the period from January 2000 to September 2018. The low-volatility (LV) effect is not an overlap of other established factors such as size, value or momentum. The effect persists across various size buckets (market capitalization). The performance of the low-volatility effect within various size buckets is analyzed using three different portfolio formation methods. Irrespective of the method of portfolio construction, the low-volatility effect exists and it also generates economically and statistically significant risk-adjusted returns. The long-short portfolios across the study deliver exceptionally high and statistically significant returns accompanied by negative beta. The low-volatility effect is not restricted to small or illiquid stocks. The effect delivers the highest risk-adjusted returns for the portfolio consisting of largecap stocks. Though the returns of the portfolio comprising of large-cap LV stocks are lower than the returns of the portfolio comprising of small-cap LV stocks, its Sharpe ratio is higher because of less risky nature of large-cap stocks as compared to small-cap stocks. The LV portfolio majorly comprises of large-cap, growth and winner stocks. But within size buckets, large-cap and mid-cap low LV picks growth and winner stocks, while small-cap LV picks value stocks.
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Berg, Martha K., Qinggang Yu, Cristina E. Salvador, Irene Melani, and Shinobu Kitayama. "Mandated Bacillus Calmette-Guérin (BCG) vaccination predicts flattened curves for the spread of COVID-19." Science Advances 6, no. 32 (July 31, 2020): eabc1463. http://dx.doi.org/10.1126/sciadv.abc1463.
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Bacillus Calmette-Guérin (BCG) vaccination may reduce the risk of a range of infectious diseases, and if so, it could protect against coronavirus disease 2019 (COVID-19). Here, we compared countries that mandated BCG vaccination until at least 2000 with countries that did not. To minimize any systematic effects of reporting biases, we analyzed the rate of the day-by-day increase in both confirmed cases (134 countries) and deaths (135 countries) in the first 30-day period of country-wise outbreaks. The 30-day window was adjusted to begin at the country-wise onset of the pandemic. Linear mixed models revealed a significant effect of mandated BCG policies on the growth rate of both cases and deaths after controlling for median age, gross domestic product per capita, population density, population size, net migration rate, and various cultural dimensions (e.g., individualism). Our analysis suggests that mandated BCG vaccination can be effective in the fight against COVID-19.
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Liu and Sathye. "Bank Interest Rate Margin, Portfolio Composition and Institutional Constraints." Journal of Risk and Financial Management 12, no. 3 (July 18, 2019): 121. http://dx.doi.org/10.3390/jrfm12030121.
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This study empirically examines how the bank specific factors, macro-economic, and institutional variables impact interest margins in China’s banking sector. A panel data analysis of bank data for the period 1988–2015 was carried out. We found a significant association between credit quality, risk aversion, liquidity risk, and the proportion of corporate and industrial loans and the adjusted interest spread (AIS). GDP growth rate, inflation, and the proportion of national savings to the GDP were found to have significant association with the AIS. Furthermore, institutional variables were found to have a significant moderating effect on the AIS. We contribute to the literature by examining a unique context and a more accurate measure of bank interest margin not used in prior studies.
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Sianipar, Flora. "PENGARUH UKURAN PERUSAHAAN, BID ASK SPREAD, DAN VOLUME PERDAGANGAN TERHADAP PRICE REVERSAL." Performance 24, no. 1 (September 30, 2017): 46. http://dx.doi.org/10.20884/1.performance.2017.24.1.312.
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“Pengaruh Ukuran Perusahaan, Bid Ask Spread, dan Volume Perdagangan Terhadap Price Reversal”is a research that purpose to analyze the factors that affect Price Reversal on companies listed in the Index LQ45 period November 8 - November 16, 2016. This research is an associative study to determine the relationship or influence between two or more variables.
The population that used in this study are all companies listed in the Indonesia Stock Exchange during the study period. The method of collecting data using purposive sampling. Data that obtained from purposive sampling method is 44 companies. Analyze method which used in this research are multiple linear regression. Testing the hypothesis by using the adjusted coefficient of determination, t-statistic test and f-statistic test.
The result of this research shows that firm size has positive and significant effect to Price Reversal, Bid Ask Spread has positive and significant effect to Price Reversal, and Trading Volume has positive and significant impact to Price Reversal.
The implications of the above conclusions are that investors can pay attention to the firm's size factor, bid ask spread and trading volume as a basic for consideration to trade on the exchange to get the best return in accordance with the compensation of the risk that they received.
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Lukowsky, Lilia R., Claudia Der-Martirosian, William Neil Steers, Kiran S. Kamble, and Aram Dobalian. "Using an Administrative and Clinical Database to Determine the Early Spread of COVID-19 at the US Department of Veterans Affairs during the Beginning of the 2019–2020 Flu Season: A Retrospective Longitudinal Study." Viruses 14, no. 2 (January 20, 2022): 200. http://dx.doi.org/10.3390/v14020200.
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Background. Previous studies examining the early spread of COVID-19 have used influenza-like illnesses (ILIs) to determine the early spread of COVID-19. We used COVID-19 case definition to identify COVID-like symptoms (CLS) independently of other influenza-like illnesses (ILIs). Methods. Using data from Emergency Department (ED) visits at VA Medical Centers in CA, TX, and FL, we compared weekly rates of CLS, ILIs, and non-influenza ILIs encounters during five consecutive flu seasons (2015–2020) and estimated the risk of developing each illness during the first 23 weeks of the 2019–2020 season compared to previous seasons. Results. Patients with CLS were significantly more likely to visit the ED during the first 23 weeks of the 2019–2020 compared to prior seasons, while ED visits for influenza and non-influenza ILIs did not differ substantially. Adjusted CLS risk was significantly lower for all seasons relative to the 2019–2020 season: RR15–16 = 0.72, 0.75, 0.72; RR16–17 = 0.81, 0.77, 0.79; RR17–18 = 0.80, 0.89, 0.83; RR18–19 = 0.82, 0.96, 0.81, in CA, TX, and FL, respectively. Conclusions. The observed increase in ED visits for CLS indicates the likely spread of COVID-19 in the US earlier than previously reported. VA data could potentially help identify emerging infectious diseases and supplement existing syndromic surveillance systems.
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Ceparano, Mariateresa, Valentina Baccolini, Giuseppe Migliara, Claudia Isonne, Erika Renzi, Daniela Tufi, Corrado De Vito, et al. "Acinetobacter baumannii Isolates from COVID-19 Patients in a Hospital Intensive Care Unit: Molecular Typing and Risk Factors." Microorganisms 10, no. 4 (March 28, 2022): 722. http://dx.doi.org/10.3390/microorganisms10040722.
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Infections caused by Acinetobacter baumannii represent a major concern for intensive care unit (ICU) patients. However, the epidemiology of these infections among COVID-19 patients has not been fully explored. The aims of this study were (i) to characterize the clonal spread of A. baumannii among COVID-19 patients admitted to the ICU of the Umberto I hospital of Rome during the first year of the pandemic and (ii) to identify risk factors for its acquisition. Isolates were analysed by pulsed-field gel electrophoresis, and a multivariable regression model was constructed. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. Overall, 193 patients were included, and 102 strains were analysed. All isolates had highly antibiotic-resistant profiles and derived from two genotypes. The cumulative incidence of A. baumannii acquisition (colonization or infection) was 36.8%. Patients with A. baumannii had higher mortality and length of stay. Multivariable analysis showed that previous carbapenem use was the only risk factor associated with A. baumannii acquisition (aOR: 4.15, 95% CI: 1.78–9.64). We documented substantial A. baumannii infections and colonization and high levels of clonal transmission. Given the limited treatment options, effective prevention and containment strategies to limit the spread of A. baumannii should be implemented.
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Johnson, J. T., E. N. Myers, V. L. Schramm, D. G. Mayernik, T. A. Nolan, B. A. Sigler, and R. L. Wagner. "Adjuvant chemotherapy for high-risk squamous-cell carcinoma of the head and neck." Journal of Clinical Oncology 5, no. 3 (March 1987): 456–58. http://dx.doi.org/10.1200/jco.1987.5.3.456.
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A prospective clinical trial was developed to evaluate efficacy, toxicity, and patient compliance to adjuvant chemotherapy following surgery and postoperative radiation therapy in patients with squamous-cell carcinoma of the head and neck with extracapsular spread of tumor in cervical metastases. Following postoperative radiation therapy, 18 courses of methotrexate (MTX) and 5-fluorouracil (5-FU) were administered over 6 months. Fifty patients were registered. A total of 771 doses were administered. Dose reduction was required 72 times. Therapy was stopped in one patient (2%) because of toxicity. Three patients (6%) refused to complete the adjuvant therapy. Adjusted 2-year no evidence of disease (NED) survival is 66%. This study demonstrates that patients with advanced squamous-cell carcinoma of the head and neck can undertake an aggressive program of adjuvant MTX/5-FU with acceptable compliance and toxicities. Preliminary data generated in this nonrandomized study support the call for a prospective randomized multiinstitutional trial of this program.
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Rosanoff, Andrea, and Diriba B. Kumssa. "Impact of rising body weight and cereal grain food processing on human magnesium nutrition." Plant and Soil 457, no. 1-2 (March 14, 2020): 5–23. http://dx.doi.org/10.1007/s11104-020-04483-7.
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Abstract Aim The World Health Organisation (WHO) magnesium (Mg) estimated average requirement (EAR) is not adjusted for rise in human body weight (BW) and neglects body Mg stores depletion. Cereal grain food processing results in Mg loss and reduces dietary Mg intake which mainly originates from cereals. Here we reassess human dietary Mg deficiency risk considering actual human BWs and modern levels of cereal grain food processing. Methods Human Mg requirement was adjusted for rising BW plus low and high estimates to prevent body Mg store depletion. Magnesium supply was recalculated for cereal grain (maize, millet, rice, oats, sorghum, and wheat) food processing of none, 25%, 50%, 75% and 100%. Resulting Mg deficiency risks in 1992 and 2011 were calculated at national, regional, continental and global scales using the EAR cut-point method. Results Globally, human Mg requirement increased by 4–118% under the three Mg requirement scenarios compared to the WHO EARs set in 1998. However, dietary Mg supply declined with increased cereal grain food processing. At 100% cereal grain processing, dietary Mg supply was reduced by 56% in 1992 and 51% in 2011. Global human Mg deficiency risk reached 62% in 2011 with 100% cereal grain processing and largest EAR set to prevent depletion of body Mg stores and corrected for BW rises. Conclusion Global dietary Mg Supply adequately meets human Mg requirement given the global obesity epidemic. But, Mg intakes preventing body Mg store depletion plus high Mg losses due to cereal grain food processing start to show noteworthy risks of potential Mg deficit in populations consuming diets with >50% cereal grain food processing. These findings have ramifications for the global spread of the major chronic, non-communicable diseases associated with nutritional Mg deficiencies such as cardiovascular diseases and type 2 diabetes.
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Saputra, Riski Nanda, Fitra Dharma, Usep Syaipudin, and Ratna Septiyanti. "The Effect of Bid-Ask Spread, Market Value, Risk of Return, Dividend Payout Ratio, Return on Asset and Company Age on Holding Period in Indonesia." International Journal of Research Publication and Reviews 04, no. 01 (2023): 583–92. http://dx.doi.org/10.55248/gengpi.2023.4113.
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This study aims to determine the effect of the bid-ask spread, market value, risk of return, dividend payout ratio, return on assets, and firm age on the holding period of the LQ45 stock index. The objects of this research are companies listed on LQ45 on the Indonesia Stock Exchange for the 2019-2021 period. The data analysis technique in this study was quantitative analysis expressed in numbers and calculations using statistical methods with the help of E-Views 10 software. This study used a sample of 36 companies taken by the purposive sampling method. The data analysis used is the classical assumption test, multiple linear regression analysis, and hypothesis testing. The results showed that market value and return on assets had a significant positive effect and risk of return had a significant negative effect on the holding period, while the bid-ask spread, dividend payout ratio, and company age had no effect on the holding period. Based on the Adjusted R2 value, there is still 51.26 percent of the holding period variable which is influenced by other variables outside the independent variables of this study.
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McCANN, R., R. JONES, J. SNOW, P. CLEARY, S. BURGESS, V. BOTHRA, and R. M. CHALMERS. "An outbreak of cryptosporidiosis at a swimming club – can rapid field epidemiology limit the spread of illness?" Epidemiology and Infection 142, no. 1 (May 14, 2013): 51–55. http://dx.doi.org/10.1017/s0950268813001143.
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SUMMARYIn September 2010, an outbreak of cryptosporidiosis affected members of a swimming club. A cohort study was undertaken to identify the number affected and risk factors for infection. Of 101 respondents, 48 met the case definition for probable cryptosporidiosis. Multivariate analysis demonstrated a strong and highly significant association between illness and attendance at a training session on 13 September 2010 (adjusted odds ratio 28, P < 0·0001). No faecal incidents were reported and pool monitoring parameters were satisfactory. The competitive nature of club swimming requires frequent training and participation in galas, potentially facilitating contamination into other pools and amplification of outbreaks among wider groups of swimmers. There was a lack of awareness of the 2-week exclusion rule among swimmers and coaches, and a high level of underreporting of illness. The study demonstrates the benefits of rapid field epidemiology in identifying the true burden of illness, the source of infection and limiting spread.
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Ortiz-Prado, Esteban, Katherine Simbaña-Rivera, Lenin Gómez Barreno, Ana Maria Diaz, Alejandra Barreto, Carla Moyano, Vannesa Arcos, et al. "Epidemiological, socio-demographic and clinical features of the early phase of the COVID-19 epidemic in Ecuador." PLOS Neglected Tropical Diseases 15, no. 1 (January 4, 2021): e0008958. http://dx.doi.org/10.1371/journal.pntd.0008958.
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The SARS-CoV-2 virus has spread rapidly around the globe. Nevertheless, there is limited information describing the characteristics and outcomes of COVID-19 patients in Latin America. We conducted a cross-sectional analysis of 9,468 confirmed COVID-19 cases reported in Ecuador. We calculated overall incidence, mortality, case fatality rates, disability adjusted life years, attack and crude mortality rates, as well as relative risk and relative odds of death, adjusted for age, sex and presence of comorbidities. A total of 9,468 positive COVID-19 cases and 474 deaths were included in the analysis. Men accounted for 55.4% (n = 5, 247) of cases and women for 44.6% (n = 4, 221). We found the presence of comorbidities, being male and older than 65 years were important determinants of mortality. Coastal regions were most affected by COVID-19, with higher mortality rates than the highlands. Fatigue was reported in 53.2% of the patients, followed by headache (43%), dry cough (41.7%), ageusia (37.1%) and anosmia (36.1%). We present an analysis of the burden of COVID-19 in Ecuador. Our findings show that men are at higher risk of dying from COVID-19 than women, and risk increases with age and the presence of comorbidities. We also found that blue-collar workers and the unemployed are at greater risk of dying. These early observations offer clinical insights for the medical community to help improve patient care and for public health officials to strengthen Ecuador’s response to the outbreak.
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MOLLAGHAN, A. M., B. LUCEY, A. COFFEY, and L. COTTER. "Emergence of MRSA clone ST22 in healthy young adults in the community in the absence of risk factors." Epidemiology and Infection 138, no. 5 (February 10, 2010): 673–76. http://dx.doi.org/10.1017/s0950268810000191.
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SUMMARYOne thousand adults aged between 18 and 35 years were investigated for nasal colonization with community-acquired methicillin-resistantStaphylococcus aureus(CA-MRSA). Each volunteer completed a questionnaire to assess the presence or absence of risk factors for hospital-acquired MRSA (HA-MRSA) carriage. All MRSA isolated were characterized by microbiological and molecular methods. AS. aureuscarriage rate of 22% and a MRSA carriage rate of 0·7% were observed. Analysis of the questionnaires revealed 121 individuals with HA-MRSA risk factors. Subsequently two MRSA infections with associated risk factors were excluded from calculation of the true carriage rate and an adjusted rate of 0·57% (5/879) was established. All seven MRSA isolates expressed the genotypic profile ST22-MRSA-IV, were PVL negative,agrtype 1, and differed only by their antimicrobial susceptibility patterns. ST22-MRSA-IV (EMRSA-15) has shown worldwide spread in the hospital setting but has not been previously documented in isolation in the community.
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Wang, Joyce, Betsy Foxman, Ali Pirani, Zena Lapp, Lona Mody, and Evan S. Snitkin. "Application of Combined Genomic and Transfer Analyses to Identify Factors Mediating Regional Spread of Antibiotic-resistant Bacterial Lineages." Clinical Infectious Diseases 71, no. 10 (April 2, 2020): e642-e649. http://dx.doi.org/10.1093/cid/ciaa364.
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Abstract Background Patients entering nursing facilities (NFs) are frequently colonized with antibiotic-resistant organisms (AROs). To understand the determinants of ARO colonization on NF admission, we applied whole-genome sequencing to track the spread of 4 ARO species across regional NFs and evaluated patient-level characteristics and transfer acute care hospitals (ACHs) as risk factors for colonization. Methods Patients from 6 NFs (n = 584) were surveyed for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecalis/faecium (VREfc/VREfm), and ciprofloxacin-resistant Escherichia coli (CipREc) colonization. Genomic analysis was performed to quantify ARO spread between NFs and compared to patient-transfer networks. The association between admission colonization and patient-level variables and recent ACH exposures was examined. Results The majority of ARO isolates belonged to major healthcare-associated lineages: MRSA (sequence type [ST] 5); VREfc (ST6); CipREc (ST131), and VREfm (clade A). While the genomic similarity of strains between NF pairs was positively associated with overlap in their feeder ACHs (P < .05 for MRSA, VREfc, and CipREc), limited phylogenetic clustering by either ACH or NF supported regional endemicity. Significant predictors for ARO colonization on NF admission included lower functional status and recent exposure to glycopeptides (adjusted odds ratio [aOR], > 2 for MRSA and VREfc/VREfm) or third-/fourth-generation cephalosporins (aOR, > 2 for MRSA and VREfm). Transfer from specific ACHs was an independent risk factor for only 1 ARO/ACH pair (VREfm/ACH19: aOR, 2.48). Conclusions In this region, healthcare-associated ARO lineages are endemic among connected NFs and ACHs, making patient characteristics more informative of NF admission colonization risk than exposure to specific ACHs.
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Ramezanifar, Ehsan, Kamran Gholamizadeh, Iraj Mohammadfam, and Mostafa Mirzaei Aliabadi. "Risk assessment of methanol storage tank fire accident using hybrid FTA-SPA." PLOS ONE 18, no. 3 (March 8, 2023): e0282657. http://dx.doi.org/10.1371/journal.pone.0282657.
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Fire accidents in storage tanks are of great importance due to the difficulty in extinguishing and ease of spread to nearby products. This study aimed to introduce a framework based on FTA-based Set Pair Analysis (SPA) established via experts’ elicitation to identify and assess the risk of storage tank fire. In the quantitative FTA of a system, sufficient data are only sometimes available to calculate the failure probability of the system appertains to study. Thus, the obtained result of the SPA added new value to the Basic Events (BEs) and estimated top event. To illustrate the applicability of the proposed approach, a fault tree of the methanol storage tank fire is performed and analyzed BEs. According to the obtained results, the fire accident was computed by 48 BEs, and the occurrence probability value of the top event was estimated 2.58E-1/year. In addition, the most crucial paths that led to the fire accident are listed in this study. The proposed approach established in the present study can assist decision-makers in determining where to take preventative or appropriate action on the storage tank system. Moreover, it can be adjusted for various systems with limited manipulation.
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Diab, S. G., S. G. Hilsenbeck, C. de Moor, G. M. Clark, C. K. Osborne, P. M. Ravdin, and R. M. Elledge. "Radiation therapy and survival in breast cancer patients with 10 or more positive axillary lymph nodes treated with mastectomy." Journal of Clinical Oncology 16, no. 5 (May 1998): 1655–60. http://dx.doi.org/10.1200/jco.1998.16.5.1655.
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PURPOSE Adjuvant loco-regional radiation (XRT) frequently is recommended after mastectomy and adjuvant systemic therapy in patients with 10 or more positive axillary lymph nodes (ALN) to reduce the high loco-regional failure rate observed in this subset. In this study, we explored the possibility that adjuvant loco-regional radiation therapy (LR-XRT) also could decrease distant failure and improve overall survival (OS) in this subset of poor-prognosis patients. PATIENTS AND METHODS Retrospectively, 618 breast patients with 10 or more positive ALN were studied. The median follow-up time was 7.5 years. All patients received systemic adjuvant therapy and 35% also received adjuvant radiation therapy. Loco-regional failure, distant failure, and OS analyses were adjusted for age, tumor size, number of positive ALN, and estrogen receptor (ER) status using Cox regression model. RESULTS As expected, patients had a very high risk of loco-regional and distant failure. At 5 years, 30% of patients had loco-regional failure as a first event and 54% had distant failure. Radiation dramatically reduced loco-regional failure (hazards rate ratios [RR]=0.29; 95% confidence interval [CI], 0.19 to 0.45). The adjusted 5-year loco-regional failure rate was 13% with radiation and 38% without radiation (P=.0001). Radiation also was associated with improved distant control (RR=0.75; 95% CI, 0.58 to 0.96). The adjusted 5-year distant failure rate was 48% with radiation and 58% without radiation (P=.02). OS also improved with radiation (RR=0.68; 95% CI, 0.53 to 0.85). The adjusted 5-year OS was 56% with radiation and 42% without radiation (P=.001). CONCLUSION In this cohort of high-risk breast cancer patients, XRT was associated with less loco-regional and distant failure and improved OS. This suggests that improved loco-regional control might decrease secondary systemic spread and improve survival.
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Messina, Julia A., Eric Cober, Sandra S. Richter, Federico Perez, Robert A. Salata, Robert C. Kalayjian, Richard R. Watkins, et al. "Hospital Readmissions in Patients With Carbapenem-Resistant Klebsiella pneumoniae." Infection Control & Hospital Epidemiology 37, no. 3 (December 21, 2015): 281–88. http://dx.doi.org/10.1017/ice.2015.298.
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BACKGROUNDVarious transmission routes contribute to spread of carbapenem-resistant Klebsiella pneumoniae (CRKP) in hospitalized patients. Patients with readmissions during which CRKP is again isolated (“CRKP readmission”) potentially contribute to transmission of CRKP.OBJECTIVETo evaluate CRKP readmissions in the Consortium on Resistance against Carbapenems in K. pneumoniae (CRaCKLe).DESIGNCohort study from December 24, 2011, through July 1, 2013.SETTINGMulticenter consortium of acute care hospitals in the Great Lakes region.PATIENTSAll patients who were discharged alive during the study period were included. Each patient was included only once at the time of the first CRKP-positive culture.METHODSAll readmissions within 90 days of discharge from the index hospitalization during which CRKP was again found were analyzed. Risk factors for CRKP readmission were evaluated in multivariable models.RESULTSFifty-six (20%) of 287 patients who were discharged alive had a CRKP readmission. History of malignancy was associated with CRKP readmission (adjusted odds ratio [adjusted OR], 3.00 [95% CI, 1.32–6.65], P<.01). During the index hospitalization, 160 patients (56%) received antibiotic treatment against CRKP; the choice of regimen was associated with CRKP readmission (P=.02). Receipt of tigecycline-based therapy (adjusted OR, 5.13 [95% CI, 1.72–17.44], using aminoglycoside-based therapy as a reference in those treated with anti-CRKP antibiotics) was associated with CRKP readmission.CONCLUSIONHospitalized patients with CRKP—specifically those with a history of malignancy—are at high risk of readmission with recurrent CRKP infection or colonization. Treatment during the index hospitalization with a tigecycline-based regimen increases this risk.Infect. Control Hosp. Epidemiol. 2016;37(3):281–288
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Argo, Teresa Mika, Andree Kurniawan, Jean Andrina Liem, Jeremy Octavian Sugianto, Rafael Jonathan Michael, Lisa Agatha, Nathania Victoria Stevina Tanuwijaya, Beverley Wonsono, and Dwi Savitri Rivami. "Association between depression, anxiety, and stress with sleep quality in Indonesian people during the COVID-19 pandemic." Public Health of Indonesia 7, no. 2 (June 24, 2021): 58–66. http://dx.doi.org/10.36685/phi.v7i2.409.
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Background: To prevent the spread of COVID-19, authorities implemented health protocols such as quarantine, large-scale social restrictions, and lockdowns. Data on the psychological effects and sleep quality as a result of these health protocols are still limited.Objective: This study was aimed to determine the association between depression, anxiety, and stress with sleep quality during the COVID-19 pandemic in Indonesia.Methods: An online survey was used to do a cross-sectional study among students in Indonesia. Sociodemographic information, including age, gender, religion, level of education, and regions, was analyzed. Levels of depression, anxiety, and stress were measured using the DASS-21 questionnaire. Sleep quality was determined using Pittsburgh Sleeping Quality Index (PSQI) questionnaire. Chi-square was used to evaluate the variables for bivariate analysis and logistic regression for multivariate analysis.Results: A total of 913 participants from across Indonesia included to this study. Adolescent (OR=0.367, 95% CI=0.199-0.679), female (OR=1.437, 95% CI=1.095-1.886), and high school students (OR= 0.737, 95% CI=0.544-0.999) had a higher risk for having poor sleep quality. In the multivariate analysis there were significant relationship between sleep quality with depression (Adjusted OR= 1.887, 95% CI=1.330-2.679), anxiety (Adjusted OR=1.731, 95% CI=1.221-2.455), stress (Adjusted OR= 2.577, 95% CI=1.617-4.107), use of sleeping medication (Adjusted OR=9.070, 95% CI=2.062-39.896) and age (Adjusted OR= 0.414, 95% CI= 0.205-0.837).Conclusion: There was an association between depression, anxiety, stress, consumption of sleeping medication, age, and poor sleep quality during the pandemic in Indonesia.
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Samo, Rab Nawaz, Arshad Altaf, and Sharaf Ali Shah. "Correlates of Knowledge of HIV Transmission Among Incident Cases of HIV in a Cohort of Injection Drug Users Receiving Harm Reduction Services at Karachi, Pakistan." Journal of the International Association of Providers of AIDS Care (JIAPAC) 16, no. 3 (June 5, 2014): 286–89. http://dx.doi.org/10.1177/2325957414535977.
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Background: Knowledge of risk factors for HIV transmission in high-risk population plays a critical role in averting the risk of HIV transmission. In Pakistan, injection drug users (IDUs) constitute the core risk group of HIV prevalence, where the epidemic has transitioned to a “concentrated level.” Still nothing is known about the role of knowledge in HIV transmission and HIV sero-conversion among IDUs in Pakistan. Methods: From 2009 to 2011, a nested case–control study was conducted in a cohort of 636 IDUs receiving harm reduction services in the mega city of Karachi. Results: In multivariable regression analysis, 3 factors, namely HIV does not spread through unprotected sex (adjusted odds ratio [AOR]: 3.1, 95% confidence interval [CI] 1.39-6.90, P value .01), HIV does not transmit by sharing syringes (AOR: 3.5, 95% CI 1.97-6.40, P value <.00), and the risk of HIV cannot be minimized by using new syringe every time (AOR: 2.0, 95% CI 1.16-3.60, P value .01), were significantly associated with the incident cases of HIV. Conclusion: The study findings suggest the association between knowledge of HIV transmission and HIV sero-incident cases.
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Anzalone, Alfred Jerrod, Jing Sun, Amanda J. Vinson, William H. Beasley, William B. Hillegass, Kimberly Murray, Brian M. Hendricks, et al. "Community risks for SARS-CoV-2 infection among fully vaccinated US adults by rurality: A retrospective cohort study from the National COVID Cohort Collaborative." PLOS ONE 18, no. 1 (January 5, 2023): e0279968. http://dx.doi.org/10.1371/journal.pone.0279968.
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Background While COVID-19 vaccines reduce adverse outcomes, post-vaccination SARS-CoV-2 infection remains problematic. We sought to identify community factors impacting risk for breakthrough infections (BTI) among fully vaccinated persons by rurality. Methods We conducted a retrospective cohort study of US adults sampled between January 1 and December 20, 2021, from the National COVID Cohort Collaborative (N3C). Using Kaplan-Meier and Cox-Proportional Hazards models adjusted for demographic differences and comorbid conditions, we assessed impact of rurality, county vaccine hesitancy, and county vaccination rates on risk of BTI over 180 days following two mRNA COVID-19 vaccinations between January 1 and September 21, 2021. Additionally, Cox Proportional Hazards models assessed the risk of infection among adults without documented vaccinations. We secondarily assessed the odds of hospitalization and adverse COVID-19 events based on vaccination status using multivariable logistic regression during the study period. Results Our study population included 566,128 vaccinated and 1,724,546 adults without documented vaccination. Among vaccinated persons, rurality was associated with an increased risk of BTI (adjusted hazard ratio [aHR] 1.53, 95% confidence interval [CI] 1.42–1.64, for urban-adjacent rural and 1.65, 1.42–1.91, for nonurban-adjacent rural) compared to urban dwellers. Compared to low vaccine-hesitant counties, higher risks of BTI were associated with medium (1.07, 1.02–1.12) and high (1.33, 1.23–1.43) vaccine-hesitant counties. Compared to counties with high vaccination rates, a higher risk of BTI was associated with dwelling in counties with low vaccination rates (1.34, 1.27–1.43) but not medium vaccination rates (1.00, 0.95–1.07). Community factors were also associated with higher odds of SARS-CoV-2 infection among persons without a documented vaccination. Vaccinated persons with SARS-CoV-2 infection during the study period had significantly lower odds of hospitalization and adverse events across all geographic areas and community exposures. Conclusions Our findings suggest that community factors are associated with an increased risk of BTI, particularly in rural areas and counties with high vaccine hesitancy. Communities, such as those in rural and disproportionately vaccine hesitant areas, and certain groups at high risk for adverse breakthrough events, including immunosuppressed/compromised persons, should continue to receive public health focus, targeted interventions, and consistent guidance to help manage community spread as vaccination protection wanes.
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Chuah, Chuan, Yasmin Gani, Benedict Sim, and Suresh Chidambaram. "Risk factors of carbapenem-resistant Enterobacteriaceae infection and colonisation: a Malaysian tertiary care hospital based case-control study." Journal of the Royal College of Physicians of Edinburgh 51, no. 1 (March 2021): 24–30. http://dx.doi.org/10.4997/jrcpe.2021.107.
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Background Carbapenem-resistant Enterobacteriaceae (CRE) infection has become a major challenge to clinicians. The aim of this study is to identify the risk factors of acquiring CRE to guide more targeted screening for hospital admissions. Methods This is a retrospective case-control study (ratio 1:1) where a patient with CRE infection or colonisation was matched with a control. The control was an individual who tested negative for CRE but was a close contact of a patient testing positive and was admitted at the same time and place. Univariate and multivariate statistical analyses were done. Results The study included 154 patients. The majority of the CRE was Klebsiella species (83%). From univariate analysis, the significant risk factors were having a history of indwelling devices (OR: 2.791; 95% CI: 1.384–5.629), concomitant other MDRO (OR: 2.556; 95% CI: 1.144–5.707) and hospitalisation for more than three weeks (OR: 2.331; 95% CI: 1.163–4.673). Multivariate analysis showed that being unable to ambulate on admission (adjusted OR: 2.345; 95% CI: 1.170–4.699) and antibiotic exposure (adjusted OR: 3.515; 95% CI: 1.377–8.972) were independent predictors. The in-hospital mortality rate of CRE infection was high (64.5%). CRE acquisition resulted in prolonged hospitalisation (median=35 days; P<0.001). Conclusion CRE infection results in high morbidity and mortality. On top of the common risk factors, patients with mobility restriction, prior antibiotic exposures and hospitalisation for more than three weeks should be prioritised in the screening strategy to control the spread of CRE.
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Aranaz-Andrés, Jesús, Amaranta McGee-Laso, Juan Galán, Rafael Cantón, and José Mira. "Activities and Perceived Risk of Transmission and Spread of SARS-CoV-2 among Specialists and Residents in a Third Level University Hospital in Spain." International Journal of Environmental Research and Public Health 18, no. 6 (March 10, 2021): 2838. http://dx.doi.org/10.3390/ijerph18062838.
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This study aims to identify factors related with SARS-CoV-2 infection in physicians and internal residents during the SARS-CoV-2 pandemic at a tertiary hospital in Spain, through a cross- sectional descriptive perception study with analytical components through two questionnaires directed at professionals working at the Ramon y Cajal University Hospital between February and April 2020. In total, 167 professionals formed the study group, and 156 professionals comprised the comparison group. Seventy percent of the professionals perceived a shortage of personal protective equipment (PPE), while 40% perceived a shortage of hand sanitiser, although more than 70% said they used it properly. Soap was more available and had a higher percentage of correct use (73.6–79.5%) (p > 0.05). Hand hygiene was optimal in >70% of professionals according to all five WHO measurements. In the adjusted model (OR; CI95%), belonging to a high-risk specialty (4.45; 1.66–11.91) and the use of public transportation (3.27; 1.87–5.73) remained risk factors. Protective factors were changes of uniform (0.53; 0.32–0.90), sanitation of personal objects before the workday (0.55; 0.31–0.97), and the disinfection of shared material (0.34; 0.19–0.58). We cannot confirm that a shortage or misuse of PPE is a factor in the spread of SARS-CoV-2. Fears and assessments are similar in both groups, but we cannot causally relate them to the spread of infection. The perception of the area of risk is different in both groups, suggesting that more information and education for healthcare workers is needed.
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Gillies, Clare L., Alex V. Rowlands, Cameron Razieh, Vahé Nafilyan, Yogini Chudasama, Nazrul Islam, Francesco Zaccardi, et al. "Association between household size and COVID-19: A UK Biobank observational study." Journal of the Royal Society of Medicine 115, no. 4 (February 4, 2022): 138–44. http://dx.doi.org/10.1177/01410768211073923.
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Summary Objective To assess the association between household size and risk of non-severe or severe COVID-19. Design A longitudinal observational study. Setting This study utilised UK Biobank linked to national SARS-CoV-2 laboratory test data. Participants 401,910 individuals with available data on household size in UK Biobank. Main outcome measures Household size was categorised as single occupancy, two-person households and households of three or more. Severe COVID-19 was defined as a positive SARS-CoV-2 test on hospital admission or death with COVID-19 recorded as the underlying cause; and non-severe COVID-19 as a positive test from a community setting. Logistic regression models were fitted to assess associations, adjusting for potential confounders. Results Of 401,910 individuals, 3612 (1%) were identified as having suffered from a severe COVID-19 infection and 11,264 (2.8%) from a non-severe infection, between 16 March 2020 and 16 March 2021. Overall, the odds of severe COVID-19 was significantly higher among individuals living alone (adjusted odds ratio: 1.24 [95% confidence interval: 1.14 to 1.36], or living in a household of three or more individuals (adjusted odds ratio: 1.28 [1.17 to 1.39], when compared to individuals living in a household of two. For non-severe COVID-19 infection, individuals living in a single-occupancy household had lower odds compared to those living in a household of two (adjusted odds ratio: 0.88 [0.82 to 0.93]. Conclusions Odds of severe or non-severe COVID-19 infection were associated with household size. Increasing understanding of why certain households are more at risk is important for limiting spread of the infection.
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Meinilä, Jelena, Anita Valkama, Saila B. Koivusalo, Beata Stach-Lempinen, Kristiina Rönö, Jaana Lindström, Hannu Kautiainen, Johan G. Eriksson, and Maijaliisa Erkkola. "Is improvement in the Healthy Food Intake Index (HFII) related to a lower risk for gestational diabetes?" British Journal of Nutrition 117, no. 8 (April 28, 2017): 1103–9. http://dx.doi.org/10.1017/s0007114517001015.
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AbstractThe aim was to analyse whether changes in the Healthy Food Intake Index (HFII) during pregnancy are related to gestational diabetes (GDM) risk. The 251 pregnant women participating had a pre-pregnancy BMI≥30 kg/m2 and/or a history of GDM. A 75 g oral glucose tolerance test (OGTT) was performed during the first and second trimesters of pregnancy for assessment of GDM. A normal OGTT result at first trimester was an inclusion criterion for the study. FFQ collected at first and second trimesters served for calculating the HFII. A higher HFII score reflects higher adherence to the Nordic Nutrition Recommendations (NNR) (score range 0–17). Statistical methods included Student’s t test, Mann–Whitney U test, Fisher’s exact test and linear and logistic regression analyses. The mean HFII at first trimester was 10·1 (95 % CI 9·7, 10·4) points, and the mean change from the first to the second trimester was 0·35 (95 % CI 0·09, 0·62) points. The range of the HFII changes varied from –7 to 7. The odds for GDM decreased with higher HFII change (adjusted OR 0·83 per one unit increase in HFII; 95 % CI 0·69, 0·99; P=0·043). In the analysis of the association between HFII-sub-indices and GDM, odds for GDM decreased with higher HFII-Fat change (fat percentage of milk and cheese, type of spread and cooking fats) but it was not significant in a fully adjusted model (P=0·058). Dietary changes towards the NNR during pregnancy seem to be related to a lower risk for GDM.