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This paper investigates differences in value relevance of predictive stock return models depending on which firm size proxy (or proxies) is used, these being market value (MV), total book assets (TBA) and market value of total book assets (MVTA). Over the 27 year period of 1989–2015, MV provides higher value relevance in predicting future returns, while TBA provides higher value relevance when limited to large firms. Moreover, results reveal incremental explanatory power of approximately 27% when TBA are added to a one-year-ahead returns model already containing MV. The increase is 60% when examining only the last 10 years of the sample period. The findings of this study will help future accounting and finance research that uses predictive return models and potentially allow investors to make better resource allocation decisions leading to higher risk adjusted returns. In addition, the findings related to TBA will add to the debate on whether standard setters should place more emphasis on the valuation of assets and liabilities relative to earnings.

Intraperitoneal drain placement decreases morbidity and mortality in patients who develop a clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreaticoduodenectomy (PD). It is unknown whether multiple drains mitigate CR-POPF better than a single drain. We hypothesized that multiple drains decrease the complication burden more than a single drain in cases at greater risk for CR-POPF.The Fistula Risk Score (FRS), mitigation strategies (including number of drains placed), and clinical outcomes were obtained from a multi-institutional database of PDs performed from 2003 to 2020. Outcomes were compared between cases utilizing 0, 1, or 2 intraperitoneal drains. Multivariable regression analysis was used to evaluate the optimal drainage approach.A total of 4,292 PDs used 0 (7.3%), 1 (45.2%), or 2 (47.5%) drains with an observed CR-POPF rate of 9.6%, which was higher in intermediate/high FRS zone cases compared with negligible/low FRS zone cases (13% vs 2.4%, P.001). The number of drains placed also correlated with FRS zone (median of 2 in intermediate/high vs 1 in negligible/low risk cases). In intermediate/high risk cases, the use of 2 drains instead of 1 was not associated with a reduced rate of CR-POPF, average complication burden attributed to a CR-POPF, reoperations, or mortality. Obviation of drains was associated with significant increases in complication burden and mortality - regardless of the FRS zone.In intermediate/high risk zone cases, placement of a single drain or multiple drains appears to mitigate the complication burden while use of no drains is associated with inferior outcomes.

Background: Laparoscopic pancreaticoduodenectomy (LPD) is one of the most technically challenging operations of minimally invasive surgery. We aimed to analyze the learning curve of a single surgeo...

The SEVE project (Surgical Expertise Validity Evaluation) is a collaborative effort of the AEC (Spanish Association of Surgeons) and the Section of Surgery of the European Union of Medical Specialists (UEMS) that aims to develop a model and an on line application that can be used to evaluate surgical complications. The aim is to identify the optimal results that can be obtained in each intervention, in order to present them as a reference for our usual practice (benchmarking).

Managers can improve real risk-adjusted firm performance by matching nominal assets with nominal liabilities, thereby reducing the sensitivity of real risk-adjusted returns to unexpected inflation. The Net Asset Value (NAV) of US equity Real Estate Investment Trusts (REITs) serves as a good proxy for nominal assets and accordingly we use a sample of US REITs to test our hypothesis. We find that for the firms in our sample: (i) their real, risk-adjusted performance, and (ii) their inflation hedging qualities are inversely related to deviations from this "matching-nominals" argument. In addition to providing managers with a vehicle to maximise real, risk-adjusted performance, our findings also provide investors with the tools to infer inflation-hedging qualities of equity investments.

The paper investigates the behavior of mutual funds and their risk-adjusted performance in the financial markets of Nigeria between April 2016 and May 31, 2019, using descriptive statistics, as well as CAPM, Jensen’s alpha, and other risk-adjusted portfolio performance measures such as Sharpe and Treynor ratios, as well as Fama decomposition of return. The descriptive tests revealed that 80.77% of the funds were superior to market returns, while 13.46% were riskier. The market and the fund returns behaved abnormally with asymptotic and leptokurtic characteristics as their skewness and kurtosis varied from the normal requirements. Diagnostically, the normality test by Jacque-Berra showed that the return was not normally distributed at a 1% significance level. The market was more aggressive relative to the funds. The average risk-free rate was 6.75% above the market’s return. The risk-adjusted portfolio returns measured by Sharpe and Treynor ratios showed that 67.31% of the funds underperformed the market compared to 40.38% that outperformed the market using Jensen’s alpha. Fama decomposition of return revealed that the fund managers are risk-averse with 48% superior selection ability and rationally invested over 85% of investors’ funds in schemes with fixed income securities at a given risk-free return that cushioned the negative effects of the systematic and idiosyncratic risks and consequently threw the total returns into positive territories. Overall, the fund managers possessed 52% of inferior selection abilities that only earned 33% of superior risk-adjusted returns and hence, failed to achieve the desired diversification in the relevant period.

Breast cancer; Evidence-generating care; Risk-adjusted prevention Cáncer de mama; Atención generadora de evidencia; Prevención ajustada al riesgo Càncer de mama; Atenció generadora d'evidències; Prevenció ajustada al risc Background: Risk-adjusted cancer screening and prevention is a promising and continuously emerging option for improving cancer prevention. It is driven by increasing knowledge of risk factors and the ability to determine them for individual risk prediction. However, there is a knowledge gap between evidence of increased risk and evidence of the effectiveness and efficiency of clinical preventive interventions based on increased risk. This gap is, in particular, aggravated by the extensive availability of genetic risk factor diagnostics, since the question of appropriate preventive measures immediately arises when an increased risk is identified. However, collecting proof of effective preventive measures, ideally by prospective randomized preventive studies, typically requires very long periods of time, while the knowledge about an increased risk immediately creates a high demand for action. Summary: Therefore, we propose a risk-adjusted prevention concept that is based on the best current evidence making needed and appropriate preventive measures available, and which is constantly evaluated through outcome evaluation, and continuously improved based on these results. We further discuss the structural and procedural requirements as well as legal and socioeconomical aspects relevant for the implementation of this concept. The project was funded by the German Federal Ministry of Health (grant No. 2515FSB401 to Rita Schmutzler and Christiane Woopen) for supporting the international expert meetings, and a grant of the EU Horizon 2020 program, BRIDGES (grant No. 634935, PI Peter Devilee, WP5-PI Rita Schmutzler), for the compilation of the most recent findings of genetic risk prediction.

When evaluating public and private investment projects, those that contribute more to the collective risk should be more penalized through an upward adjustment of their discount rate. This paper shows how to estimate the risk-adjusted discount rate for different projects, with applications to the electricity sector. Using the standard framework of consumer theory, we express any investment project's beta in terms of the easier-to-measure price and income elasticities of the goods generated by the project. When considering an investment in production capacity, the beta has a flat term structure, and is positive (negative) for normal (inferior) goods. When considering core infrastructures carrying goods or services, such as energy transmission and distribution assets, the beta has a decreasing term structure with very high values at short horizons for infrastructures facing capacity constraints. We provide a real-case example of a cross-border electricity connection with negative beta for the exporting country.

This paper examines the impact of implicit guarantees and capital regulations on the behavior of a bank and on the expected losses for its depositors. I show that implicit guarantees increase the incentives of the bank to enhance leverage and/or risk taking and that this leads to higher expected losses for its depositors. To reduce the adverse effects of moral hazard, policy measures have to be taken. However, a simple leverage ratio is likely to increase expected losses further and risk adjusted capital requirements do not necessarily affect highly leveraged banks with very low risk assets. A combination of both requirements can be successful. Positive long-term effects can be achieved by a reduction of moral hazard and informational imperfections. However, it is difficult to achieve these reductions and potentially severe short-term effects have to be taken into account.

Using control charts to monitor healthcare systems has gained particular attention. In this paper, a risk-adjusted cumulative sum control chart is designed to monitor surgery outputs. Before underg...

We investigate whether noninterest income activities (both traditional and non-traditional), are associated with bank performance measures. We present evidence consistent with the theory that there is synergy between interest and noninterest income that improves performance. A decomposition of the main performance measure (ROA) into cost and revenue ratios reveals that the enhanced performance associated with noninterest income arises through both revenue and cost efficiency. In addition to ROA, we also use a risk adjusted performance measure and find consistent results. Our results also show that during the recent financial crisis, noninterest activities do not adversely affect BHC performance, and in some cases they even improve performance. We further address issues of the persistence of ROA and endogeneity by using a dynamic panel data approach, and our results remain consistent.

Background Few studies evaluate racial disparities in costs and clinical outcomes for patients undergoing distal pancreatectomy (DP). Methods We queried the Healthcare Cost and Utilization Project State Inpatient Databases to identify patients undergoing DP. Multivariable regression (MVR) was used to evaluate the association between race and postoperative outcomes. Results 2,493 patients underwent DP; 265 (10%) were black, and 221 (8%) were of Hispanic ethnicity. On MVR, black and Hispanic patients were less likely than whites to undergo surgery in high volume centers (OR 0.53, 95% CI [0.40, 0.71]; OR 0.45, 95% CI [0.32, 0.62]). Black patients had a greater risk of postoperative complication (OR 1.40, 95% CI [1.07, 1.83]), 90-day readmission (OR 1.53, 95% CI [1.15, 2.02]), prolonged length of stay (OR 1.74, 95% CI [1.25–2.44]), and of being a high cost outliers (OR 1.40, 95% CI [1.02, 1.91]) compared to white patients. Conclusion Black patients have increased risk of having a postoperative complication, prolonged hospitalization, and of being a high-cost outlier than non-Hispanic whites.

This paper highlights the “dumb money” effect of Indian retail mutual fund investors who chase funds that subsequently underperform. Retail investors show twice the propensity to chase top past performers; their cash flows are strongly negatively correlated to contemporaneous market returns indicating a contrarian, rather than a “buy and hold” strategy. They make up to 1.3% less in terms of raw returns compared to institutional investors, and the gap is accentuated for funds with superior risk adjusted returns. Collectively, the results reveal that retail investors trade actively with poor timing and fund selection skills despite having access to professional fund management.

PurposeThe purpose of this study is twofold. First, this research estimates banks' efficiencies from the perspectives of resource utilization and investment after incorporating risk measures as an exogenous input in the investment-efficiency stage. Second, the current study examines the relationship between intellectual capital (IC) and banks' efficiencies.Design/methodology/approachFirst, this study uses a dynamic network data envelopment analysis approach in investigating the efficiencies of 24 Taiwanese banks in 2007–2018 from two perspectives. Second, this research utilizes various regression techniques, namely, ordinary least squares (OLS), robust least squares and truncated regression, to gauge the impact of IC on banks' efficiencies. Typically, IC is determined based on a monetary value-based measure and value-added intellectual coefficient (VAICTM).FindingsResource-utilization (investment) efficiencies were observed as 0.941 (0.964), thereby contributing to the mean overall efficiency of the sample banks at 0.952. However, the related efficiency changes decline over the sample period, thereby suggesting that the average banks' efficiencies hardly increase. Regression analyses show a significantly positive relationship between IC and banks' overall resource-utilization and investment efficiencies.Research limitations/implicationsOverall, this study suggests that researchers should consider risks when estimating banks' efficiencies owing to their connection to banks' investment performance. From banks' dynamic two-stage efficiencies, this study demonstrated that investments in IC will bring improved future economic benefits.Originality/valueDifferent from prior studies, this study improves banks' efficiency evaluation models by incorporating risk measures and assuming weighted periods for the 2007–2008 global financial crisis. Moreover, the use of monetary value-based measure of IC provides consistent results as the commonly-used VAICTM does.

Off balance sheet is an activity undertaken by a financial institution, but not seen or recorded on the balance sheet because such activities do not cause or involve ownership of assets and the issuance of debt instruments (Saunders & Cornett 2003). Off Balance Sheet activities can be obtained through income derived from non-interest income. The off balance activity is initiated by the banking industry with the aim of creating diversification in obtaining optimal bank's returns. This study aims to investigate the effect of revenue diversification from off balance sheet activity toward Bank’s risk-adjusted performance. This research was conducted in several Commercial Banks in Indonesia. The data collection was based on purposive sampling and statistically analysed using Eviews version 9.2. The results of this research showed that revenue diversification from off balance sheet activity bears positive effects toward Commercial Bank’s risk-adjusted performance in Indonesia. Off balance sheet activity was measured by non-interest income reported in the income statement. . Keywords: off-balance-sheet, diversification, risk-adjusted, non-interest Abstrak — Off balance sheet adalah aktivitas yang dilakukan oleh institusi keuangan namun tidak nampak pada neraca karena aktivitas ini tidak menyebabkan dan melibatkan kepemilikan asset serta tidak menimbulkan penerbitan hutang (Saunders & Cornett 2003). Pendapatan dari aktivitas Off Balance Sheet dapat diperoleh melalui pendapatan yang berasal dari pendapatan-non bunga. Aktivitas off balance sheet dimulai oleh industri perbankan dengan tujuan menciptakan diversifikasi dalam memperoleh pengembalian bank yang optimal. Penelitian ini bertujuan untuk mengetahui bagaimana pengaruh diversifikasi pendapatan yang timbul dari aktivitas off balance sheet terhadap tingkat pengembalian berbasis risiko pada industri perbankan. Penelitian ini dilakukan di beberapa bank umum di Indonesia. Pengumpulan data berdasarkan purposive sampling dan dianalisis secara statistik menggunakan Eviews versi 9.2. Hasil penelitian menunjukkan bahwa diversifikasi pendapatan dari aktivitas off-balance sheet berpengaruh positif terhadap kinerja yang disesuaikan dengan risiko pada perbankan di Indonesia. Aktivitas off Balance sheet diukur melalui aktivitas yang menimbulkan pendapatan non-bunga yang dilaporkan pada laporan laba rugi. Kata Kunci: off-balance-sheet, diversifikasi, risiko, non-bunga

The emergence of the coronavirus SARS-CoV-2 which causes the COVID-19 disease was on 11 March 2020 declared a public health pandemic by the World Health Organization since it threatens human life and livelihood. Covid-19 which originates from China has stretched across nations globally from the end of 2019. In administering public policy of affected countries each government has adopted a counter strategy of containing this biological outbreak. The consequential effects are restricted movements on socio-economic activities. Thus, this paper provides theory development of a cross-disciplinary study drawing upon insights from literature on uncertainty and disaster risk management that is integrated with system theory, adaptive systems and practices as well as decision-making philosophy. That provides a basis for exploration of international perspectives on disaster risk reduction methods to combat the Covid-19 pandemic. Following, this paper explains the formulation of the South Africa’s Risk Adjusted Strategy. The collected scientific data and associated information enable risk analysis experts and key stakeholders to empower political decision-making in strategy execution. The anticipated strategic interventions are to alleviate a debilitating socio-economic situation by public policy and adaptation strategies towards a return to socio-economic normalcy. However, the potential paradoxical effects of COVID-19 are expected to create an ambivalent attitude to strategic interventions and decision-making by authorities. Thus, this paper seeks to explore the theoretical and practical ramifications of the systemic change and adaptable disaster risk strategy of South Africa within the context of disaster risk management and under extraordinary situations of uncertainty during the COVID-19 pandemic.

We characterize variation in total hip arthroplasty (THA) episode payments in the United States. Medicare population immediately preceding implementation of the comprehensive care for joint replacement (CJR) bundled care model and propose a model for ongoing evaluation of hospital performance.We identified THA episodes in Medicare part A 2014-2016 (n = 366,380) and compared 90-day episode payments across years and geographic regions. We fit hierarchical models that regressed episode payments on patient-level fixed and region-level and hospital-level random effects. Random effects estimates were used to characterize risk-adjusted hospital cost performance. We ranked hospitals (n = 3218) in each region by their cost performance estimate and constructed 95% confidence intervals to visualize high-performing and low-performing hospitals.Mean part A episode payments declined from 2014 to 2016 throughout the United States ($19,925-$17,775; P.001), primarily attributable to decreased postacute care payments. Ninety-day readmission rates fell by a percentage point (from 7.9% to 6.8%; P.001). We found significant variation in risk-adjusted episode payments, postacute care utilization, and readmission rates across regions, and ever greater variation at the hospital level.Medicare part A payments decreased for THA episodes between 2014 and 2016. The time frame for this decrease is notable for preceding full implementation of CJR, thus suggesting a more universal embrace of value-based care principles before the start date of CJR. These decreases were primarily because of decreased postacute care utilization and possibly related to falling readmission rates. Yet, significant variation in hospital cost performance remains, even after risk adjustment.

This paper categorizes investors into five groups. They are: efficient markets, risk premium, genius superior traders, rejectors of efficient market theory and those who use research to make superior risk adjusted returns. Successful investment involves estimation and optimization and these are discussed.

BACKGROUND Higher risk-adjusted rate of emergency department (ED) visits might reflect poor quality of nursing home (NH) care; however, existing evidence is limited regarding rural-urban differences in ED rates of NHs, especially for long-stay residents. OBJECTIVES To determine and quantify sources of rural-urban differences in NH risk-adjusted rates of any ED visit, ED without hospitalization or observation stay (outpatient ED), and potentially avoidable ED visits (PAED) of long-stay residents. RESEARCH DESIGN We calculated quarterly NH risk-adjusted rates using 2011-2013 national Medicare claims and Minimum Data Set 3.0, and then implemented Generalized Estimating Equation models to examine rural-urban differences in ED rates and Blinder-Oaxaca decomposition to quantify the contributions of NH and market factors. SUBJECTS Privately owned, free-standing NHs in the United States (N=13,260). RESULTS Over the study period, risk-adjusted rates averaged 9.8% for any ED, 3.3% for outpatient ED, and 3.2% for PAED. Compared with urban NHs, rural NHs were associated with significantly lower rates of any ED, outpatient ED, and PAED (β=-1.67%, -0.44%, and -0.28%; all P

PurposeThe net-present-value (NPV) method is well-known for its drawbacks. To overcome some of these NPV weaknesses this paper aims to provide a methodology to determine an optimal concession period that treats risk and time separately. The purpose of this paper is to apply the notion of risk-adjusted decoupled net present value (risk-adjusted DNPV) to determine a conception period taken into consideration synthetic insurance premiums as compensation for risks.Design/methodology/approachThis paper conducts theoretical and empirical analysis and provides an integrated model for deriving concession periods of any PPP projects. The model is able to capture several contractual issues such risks costing and other contractual scenarios. Methodologically, the paper addressees both the issues of risk-based cost–benefit analysis and cash flow analysis bearing an emphasis of risk-adjusted DNPV to compute an optimum concession period.FindingsThe results show that using DNPV will produce a shorter concession period comparatively to NPV. The consequence of this is that the public sector will gain financially from an earlier transfer of the concession.Research limitations/implicationsThis paper contributes to the PPP literature by combing DNPV and risk to determine the PPP concession period for the mutual benefits both the private and public sectors. The decoupling of risk from traditional NPV computation will allow for risk pricing and tradability through insurance and allocation.Originality/valueThe attempt to decouple time and risk in the computation of NPV is the added value to the body of knowledge.

An appropriate risk adjustment technique applied to discount rate for evaluating stochastic negative cash flows is discussed. The proposed approach considers a future cash flow as a response to an ...

Monitoring the mortality associated with a surgical procedure leads to the proper decision making in a healthcare system. However, the surgical outcomes depend not only on the risk factors of each ...

Purpose This study aimed to develop a quality control framework for intensity modulated radiation therapy plan evaluations that can account for variations in patient- and treatment-specific risk factors. Methods and Materials Patient-specific risk factors, such as a patient’s anatomy and tumor dose requirements, affect organs-at-risk (OARs) dose-volume histograms (DVHs), which in turn affects plan quality and can potentially cause adverse effects. Treatment-specific risk factors, such as the use of chemotherapy and surgery, are clinically relevant when evaluating radiation therapy planning criteria. A risk-adjusted control chart was developed to identify unusual plan quality after accounting for patient- and treatment-specific risk factors. In this proof of concept, 6 OAR DVH points and average monitor units serve as proxies for plan quality. Eighteen risk factors are considered for modeling quality: planning target volume (PTV) and OAR cross-sectional areas; volumes, spreads, and surface areas; minimum and centroid distances between OARs and the PTV; 6 PTV DVH points; use of chemotherapy; and surgery. A total of 69 head and neck cases were used to demonstrate the application of risk-adjusted control charts, and the results were compared with the application of conventional control charts. Results The risk-adjusted control chart remains robust to interpatient variations in the studied risk factors, unlike the conventional control chart. For the brainstem, the conventional chart signaled 4 patients with unusual (out-of-control) doses to 2% brainstem volume. However, the adjusted chart did not signal any plans after accounting for their risk factors. For the spinal cord doses to 2% brainstem volume, the conventional chart signaled 2 patients, and the adjusted chart signaled a separate patient after accounting for their risk factors. Similar adjustments were observed for the other DVH points when evaluating brainstem, spinal cord, ipsilateral parotid, and average monitor units. The adjustments can be directly attributed to the patient- and treatment-specific risk factors. Conclusions A risk-adjusted control chart was developed to evaluate plan quality, which is robust to variations in patient- and treatment-specific parameters.

The failure of banks in Nigeria has hitherto become a recurring phenomenon. Worried by the syndrome, this paper examines the determinants of bank performance in Nigeria taking into cognizance the duality of financial measures of bank performance. From an analysis of 115 bank-year observations of a sample of 17 Nigerian deposit money banks and macroeconomic data for the period 2012-2018 using Arellano-Bover one-step system GMM estimation approach, differences in the explanatory potential of these factors between the models with risk-neutral and risk-adjusted measures of performance as dependent variables are empirically established. This suggests that there is a higher probability of investors, depositors and other stakeholders being indecisive when analyzing the performance of banks. However, relying on the assumptions of risk-return hypothesis and level of risk embedded in banks’ operations could warrant them opting for determinants of risk-adjusted returns in their decision making. This study is exceptional in the bank performance literature for its long list of measures and drivers of bank performance.

Transportation infrastructure around the world is under pressure to perform with ever-changing climate scenarios, unpredictable disasters, and stress on resources stemming from rapid urbanization and population growth. Current approaches to developing resilience applied to the transportation system focus primarily on engineering resilience and do not explicitly deal with deep uncertainties arising from climate change. This paper reviews adaptation, a critical aspect of a resilient system in an uncertain and changing environment, as applied in the transportation resilience literature. It compares and contrasts the status of adaptive resiliency in transportation with that in other fields to highlight gaps and research opportunities. The paper then presents Dynamic Adaptive Planning (DAP) as a method for dealing more effectively with deep uncertainty in decision making and offers an approach that combines economic analysis with DAP to enhance decision making under external uncertainties, such as natural disasters, with financial constraints. It presents a case study of the San Francisco–Oakland Bridge to demonstrate the economic benefits of DAP. This paper provides transportation practitioners with guidance on the application of DAP and insight into the economic benefits of such an approach to decision making in various settings including emergency response planning, long-range planning, maintenance and renewal planning, and operations planning. The paper also identifies areas for possible future research combining financial theory with DAP as important in developing more robust decision-making frameworks for handling deep uncertainty.

Introduction:We sought to identify predictors of index surgical care setting and to determine if care setting influences risk adjusted perioperative costs and/or 30-day revisits following e...

With dual‐channel choices, E‐retailers fulfill their demands by either the inventory stored in third‐party distribution centers, or by in‐house inventory. In this article, using data from a wedding gown E‐retailer in China, we analyze the differences between two fulfillment choices—fulfillment by Amazon (FBA) and fulfillment by seller (FBS). In particular, we want to understand the impact of FBA that will bring to sales and profit, compared to FBS, and how the impact is related to product features such as sizes and colors. We develop a risk‐adjusted fulfillment model to address this problem, where the E‐retailer's risk attitude to FBA is incorporated. We denote the profit gaps between FBA and FBS as the rewards for this E‐retailer fulfilling products using FBA, our goal is to maximize the E‐retailer's total rewards using predictive analytics. We adopt the generalized linear model to predict the expected rewards, while controlling for the variability of the reward distribution. We apply our model on a set of real data, and develop an explicit decision rule that can be easily implemented in practice. The numerical experiments show that our interpretable decision rule can improve the E‐retailer's total rewards by more than 35%.

Post-operative pancreatic fistula (POPF) is a major cause of morbidity following pancreatoduodenectomy. The risk of POPF varies between individuals and thus assessment without risk adjustment is crude. However, despite the availability of numerous scores to determine risk, no study has provided a risk adjusted assessment of POPF outcomes.The observed and risk adjusted occurrence of POPF from consecutive patients operated upon by eight surgeons were recorded. Surgeons varied in experience from newly appointed (n = 5) to established (n = 3). CUSUM (cumulative sum) analysis was used to assess performance.104 POPF occurred among 519 patients (20.0%). The occurrence of POPF was significantly lower among experienced surgeons (20/186, 10.7% vs 84/333, 25.2%; p 0.001). Following risk adjustment surgeons observed 16.6 fewer to 6.5 excess POPF per 100 patients than predicted. Analysis of the CUSUM plots demonstrated the experienced surgeons performed steadily with a gradual reduction in observed POPF compared to what was predicted. The new surgeon's performance was less consistent and evidence of a learning curve was observed with steady improvement occurring after 50-70 patients.Risk adjusted assessment of POPF demonstrates differences between experienced and less experienced surgeons. This method could be used to audit practice and observe effects of changes to technique.

Experimentally we demonstrated the possibility of retrograde contamination of aerator kits, independent of special design, with Pseudomonas aeruginosa. In a real life setting contamination of aerator kits with typical environmental and water organisms occurred, whether they were changed after 6 or 12 weeks, so we recommend a risk adjusted rather than schedule-based changing regimen in hospitals, eg, if potential retrograde contamination might be a relevant factor in rooms occupied by patients with multiresistant gram-negative organisms.

In most buildings’ seismic design codes design basis peak ground acceleration (PGADBE) is provided by employing a uniform-hazard approach. However, a new trend in updating seismic codes is to adopt a risk-informed method to estimate the PGADBE so-called risk-adjusted design basis peak ground acceleration (PGARDBE). An attempt is made here to examine the adequacy of the PGARDBE to fulfill the assumptions made in seismic codes for converting the maximum considered earthquake’s (MCE) intensity to PGADBE. To this end, the performance of regular intermediate steel moment frames (IMF) is assessed in terms of collapse margin (CMR) and residual drift ratios in the event of MCE and design basis earthquake (DBE), respectively. The PGARDBEs are computed for Karaj County, Iran. A set of 96 index archetypes of regular IMF are designed considering four design parameters, which include the number of stories (2, 3, 6, 9, 12, and 15), span lengths (4 and 8 meters), occupancies (residential and commercial), and seismic demands (0.15, 0.25, 0.35 and 0.45g). The PGADBE prescribed by Standard No. 2800 for Karaj neither meets the assumed acceptance criteria nor stands on the safe side. Meanwhile, PGARDBE fulfills the acceptance criteria but does not necessarily satisfy the implicit assumption made in codes that the code-conforming buildings have at least a CMR of 1.5 if the MCE occurs. This emphasizes that the PGARDBE should not be used without examining the CMR fulfillment. The results recommend that a lower limit need to be set on PGARDBEs, which is found to be 0.35g for Karaj. Outcomes also reveal that the code-conforming buildings designed with the proposed PGARDBE can fulfill both repairability and life safety performances at the DBE and MCE, respectively. These buildings also have a high chance to be even considered as repairable ones at the seismic demand of MCE. Furthermore, regardless of the employed method for estimating PGADBE, various relationships between design parameters with different performance indicators such as CMR, residual drift ratio, ductility demand, imposed drift ratio, and building’s normalized weight are presented. These relationships can be used to evaluate the buildings’ safety factor against collapse and repairability, justification of using IMF in regions with high seismicity, level of structural and nonstructural damage as well as the economic consequence of changes in PGADBE. The presented relationships provide a multi-criteria decision-making tool to decide on the optimum PGADBE leading to an affordable alternative and tolerable damage.

BACKGROUND In January 2011, Centers for Medicare and Medicaid Services expanded the number of inpatient diagnosis codes from 9 to 25, which may influence comorbidity counts and risk‐adjusted outcome rates for studies spanning January 2011. This study examines the association between (1) limiting versus not limiting diagnosis codes after 2011, (2) using inpatient‐only versus inpatient and outpatient data, and (3) using logistic regression versus the Centers for Medicare and Medicaid Services risk‐standardized methodology and changes in risk‐adjusted outcomes. METHODS AND RESULTS Using 100% Medicare inpatient and outpatient files between January 2009 and December 2013, we created 2 cohorts of fee‐for‐service beneficiaries aged ≥65 years. The acute myocardial infarction cohort and the heart failure cohort had 578 728 and 1 595 069 hospitalizations, respectively. We calculate comorbidities using (1) inpatient‐only limited diagnoses, (2) inpatient‐only unlimited diagnoses, (3) inpatient and outpatient limited diagnoses, and (4) inpatient and outpatient unlimited diagnoses. Across both cohorts, International Classification of Diseases, Ninth Revision ( ICD‐9 ) diagnoses and hierarchical condition categories increased after 2011. When outpatient data were included, there were no significant differences in risk‐adjusted readmission rates using logistic regression or the Centers for Medicare and Medicaid Services risk standardization. A difference‐in‐differences analysis of risk‐adjusted readmission trends before versus after 2011 found that no significant differences between limited and unlimited models for either cohort. CONCLUSIONS For studies that span 2011, researchers should consider limiting the number of inpatient diagnosis codes to 9 and/or including outpatient data to minimize the impact of the code expansion on comorbidity counts. However, the 2011 code expansion does not appear to significantly affect risk‐adjusted readmission rate estimates using either logistic or risk‐standardization models or when using or excluding outpatient data.

Early reports showed high mortality from coronavirus disease 2019 (COVID-19). Mortality rates have recently been lower, raising hope that treatments have improved. However, patients are also now younger, with fewer comorbidities. We explored whether hospital mortality was associated with changing demographics at a 3-hospital academic health system in New York. We examined in-hospital mortality or discharge to hospice from March through August 2020, adjusted for demographic and clinical factors, including comorbidities, admission vital signs, and laboratory results. Among 5,121 hospitalizations, adjusted mortality dropped from 25.6% (95% CI, 23.2-28.1) in March to 7.6% (95% CI, 2.5-17.8) in August. The standardized mortality ratio dropped from 1.26 (95% CI, 1.15-1.39) in March to 0.38 (95% CI, 0.12-0.88) in August, at which time the average probability of death (average marginal effect) was 18.2 percentage points lower than in March. Data from one health system suggest that mortality from COVID-19 is decreasing even after accounting for patient characteristics.

When a patient is operated on, the surgical outcome depends on two major factors: (i) the patient's health condition and (ii) the surgical process comprising the surgeon, the supporting staff, operating environment, and equipment. An outcome is usually represented by one if a patient dies within 30 days of an operation and zero otherwise. Another method of measuring the outcome is to use survival time with truncation on the 30th day for monitoring purposes. In order to monitor a surgical process effectively, the health condition of a patient must be taken into consideration. This is usually done using a log-likelihood ratio statistic based on an outcome, that is, risk adjusted according to the health condition of the patient. The 30-day wait results in delay in signaling when a deterioration occurs. The consequence of having to wait even though a death has occurred is the potential loss of lives because of delay in signaling. Regular updating of patients' information can improve the sensitivity of a charting procedure. The main objective of this article is to develop and study the class of risk-adjusted cumulative sum procedures that are updated on a regular basis based on patients' current conditions, without having to wait 30 days. Our study shows that these charts do in fact signal earlier and there are differences among the various updating techniques and monitoring statistics.

Infants admitted to neonatal intensive care units (NICU) require carefully designed risk-adjusted management encompassing a broad spectrum of neonatal subgroups. Key components of an optimal neuroprotective healing NICU environment are presented to support consistent quality of care delivery across NICU settings and levels of care. This article presents a perspective on the role of neonatal therapists—occupational therapists, physical therapists, and speech–language pathologists—in the provision of elemental risk-adjusted neuroprotective care services. In alignment with professional organization competency recommendations from these disciplines, a broad overview of neonatal therapy services is described. Recognizing the staffing budget as one of the more difficult challenges hospital department leaders face, the authors present a formula-based approach to address staff allocations for neonatal therapists working in NICU settings. The article has been reviewed and endorsed by the National Association of Neonatal Therapists, National Association of Neonatal Nurses, and the National Perinatal Association.