Insurance Association Research Articles

A construction–specific extension to a standard project risk management process

Abstract Project processes are affected by risks in many ways, and this is particularly true in today's highly competitive world. Construction projects usually take much longer than typical projects in other sectors. In this sector, it is important to follow some kind of standardised risk management process. There is much literature on different approaches to project risk management, and this paper reviews the most prominent sources that suggest procedures that are widely used in practice. Nevertheless, standard risk management still faces some shortcomings, and professionals call for a more sophisticated solution. This research aims to expand the general risk management process based on the frameworks of the prestigious stand-ardisation institutions and associations (mainly on Project Management Institute's (PMI's) risk management standard considering the approaches of Institute of Risk Management (IRM), National Forum for Risk Management in the Public Sector (ALARM), Association of Insurance and Risk Managers (AIRMIC) and International Organization for Standardization (ISO), as well as Association for Project Management (APM)). The suggested two new processes are justified by in-depth interviews conducted with interviewees working on large and complex construction projects, and are supported by a thorough literature review. The novelty of the research is that these two processes added to the standard processes, namely, risk analysis verification and validation and risk plan experimentation. The research expectedly improves the risk management process in the construction sector and emphasises the need to clearly articulate and communicate the organisation's risk appetite and the necessity for risk management training to employees. Therefore, the research reconfirms the concept of project risk management by the standards, and justifies the proposed new phases.

Interdependence of insurance need and development insurance markets

On the one hand, the insurance market is no different from other markets, as it has market entities, supply, demand, price and "product" (sale of security). Still, on the other hand, it is specific in relation to all other markets; the market subject to sale is a risk that may or may not be realized in the future. Insurance is a form of risk management, primarily moderate to reduce financial losses or transfer of risk from the insured to the insurance company, with insurance premium payment. The security market has its own branch institutional network consisting of: companies (important factors in the global financial economy), intermediaries (brokers), insurance agents (banks, companies), directorates for business supervision of insurance organizations, professional associations (insurance associations), the association of actuaries, etc. In addition to them, an important place belongs to the individuals and legal entities like insured objects. This topic has been insufficiently researched in practice, so the authors consider it important.

Impact of a Same-Day Breast Biopsy Program on Disparities in Time to Biopsy for Patients With Serious Mental Illness.

The aim of this study was to investigate disparities in time between breast biopsy recommendation and completion and the impact of a same-day biopsy (SDB) program for patients with serious mental illness (SMI), with a focus on more vulnerable individuals with public payer insurance. In August 2017, the authors' academic breast imaging center started routinely offering needle biopsies on the day of recommendation. Primary outcomes were the proportion of biopsies performed as SDBs and days from biopsy recommendation to completion over a 2.5-year pre- versus postintervention period, comparing all patients with SMI versus those without, and public payer-insured patients <65 years of age with SMI (SMI-PP) versus without SMI (non-SMI-PP). Multivariable proportional odds and logistic regression models were fit to assess association of SMI status, age, race/ethnicity, language, and insurance with days to biopsy and SDB within each period. There were 2,026 biopsies preintervention and 2,361 biopsies postintervention. Preintervention, 8.43% of patients with SMI (7 of 83) underwent SDB compared with 15.59% of those without SMI (303 of 1,943) (P= .076), and 2.7% of the SMI-PP subgroup (1 of 37) underwent SDB compared with 15.88% of the non-SMI-PP subgroup (47 of 296) (P= .031). Adjusted for age, race/ethnicity, and language, disparities persisted in odds for undergoing SDB (adjusted odds ratio, 0.13; 95% confidence interval, 0.02-0.92; P= .04) and having longer days to biopsy (adjusted odds ratio, 2.35; 95% confidence interval, 1.26-4.37; P= .01) for the SMI-PP subgroup compared with the non-SMI-PP subgroup in the preintervention period. There was no evidence of these disparities postintervention for the SMI-PP subgroup. SDB proportion increased from 15.3% (310 of 2,026) to 36.09% (852 of 2,361) (P < .001) across all patients. A same-day breast biopsy program mitigates disparities in time to biopsy for patients with SMI and helps improve breast cancer care equity for this vulnerable population.

The Effect of Health Insurance on Racial Disparities in Patients with Isolated Colorectal Liver Metastases

Introduction: Resection of colorectal liver metastases (CRLM) is associated with improved overall survival compared to palliative chemotherapy. Prior literature has demonstrated that Black patients are less likely to undergo surgical treatment compared to other races. However, little is known about the impact of health insurance on racial disparities. Aim of this study was to evaluate the effect of health insurance status on racial disparities in receipt of surgical therapy in patients with CRLM. Method: A retrospective cohort study of patients diagnosed with stage IV colorectal cancer with isolated CRLM was performed using the National Cancer Database (NCDB) (2006-2016). Primary outcome was receipt of surgical therapy for CRLM. Multivariable logistic regression (MVR) was performed to evaluate the association of race and health insurance with surgical resection. Results: A total of 6,002 patients were included: 70.5% White, 16.7% Black, 6.6% Hispanic, and 6.2% Other race. Rates of resection, systemic chemotherapy, and multimodality therapy were lower among Black compared to White patients. By MVR, Black patients had lower odds of liver resection compared to White patients. Uninsured patients were also less likely to undergo resection compared to patients with private insurance. On MVR of race stratified by health insurance, only Black patients with Medicare had decreased odds of undergoing liver resection compared to White patients. [Table] Conclusions: Black patients with CRLM have lower odds of liver resection compared to White patients, particularly among the Medicare-insured population. Further investigation is warranted to better understand racial disparities and develop implementation strategies to address them.Tabled 1Race (ref=White)Insurance StatusReceipt of ResectionOdds RatioReceipt of Resection95% Confidence IntervalBlackPrivate/Managed Care0.960.73-1.27Uninsured1.620.66-3.97Medicare0.550.38-0.78Medicaid0.840.52-1.38HispanicPrivate/Managed Care1.000.67-1.50Uninsured1.960.78-4.91Medicare0.700.39-1.25Medicaid0.910.49-1.71 Open table in a new tab

The dynamics of insurance sector development and economic growth

Through this paper, we were able to analyze the insurance system in Kosovo by looking at its structure, the degree of concentration of insurance companies in the insurance industry, and the types of products they offer. The analysis was based on statistical and qualitative data through the studies and analysis of insurance industry development in other countries. Furthermore, secondary data from the Central Bank of Kosovo, insurance companies, and the Insurance Association of Kosovo was used for the empirical analysis. Moreover, in order to obtain more data, one survey was conducted. The survey includes a more general audience, specifically employed people. The main research question of this study was whether insurance development has some effect on the financial markets in developing countries. The analysis conducted found that the insurance industry is important for the development of the financial markets in developing countries and also was mentation in research by Cristea, Marcu, and Cârstina (2014). Additionally, the analysis for the case of Kosovo shows that macroeconomic and financial sector-related factors are important drivers for the future development of the insurance industry in Kosovo. Therefore, macroeconomic, institutional, and regulatory environments are crucial for supporting the future growth of the insurance industry in Kosovo.

Digitization in the insurance sector – challenges in the face of the Covid-19 pandemic

The Covid-19 crisis has accelerated the need for a digital transformation of insurance companies, which has shifted from being a strategic option to a necessity. Dynamic changes are transforming the insurance sector. Insurance market leaders who look boldly into the future have not resorted to observation alone and they take actions that allow them to be more customer-oriented, improve their offers, and increase operational efficiency. The aim of this article is to present the digitization processes taking place in the insurance sector in the face of the crisis caused by the Covid-19 pandemic and an attempt to answer the following research question: has digitization in the insurance sector taken the right direction and is a response to the needs of the insurance market participants (insurers, insured persons, intermediaries, etc.) as a consequence of the actual epidemic risk (Covid-19) and its consequences. In order to verify the research question and achieve the set goal, a critical analysis of the source literature, the analysis of trends and digital solutions in the insurance sector and the analysis of secondary data were performed. The study was based on data available in national and international reports, including data published by the Polish Insurance Association, OECD or the Geneva Association.The presented results of the considerations indicate that the use of new technologies and ubiquitous digitization have a great impact on customer expectations, which was particularly noticeable in the aftermath of the epidemic risk come true (Covid-19). The article highlights the changes introduced in the organization's processes (the importance of decision support systems in insurance activities), as well as supporting consumer users (the universality of social media, and the availability of speech and image recognition technology).

Economic impact of Covid-19 pandemic on health care expenditures: an analysis of health insurance claims data of Japan Health Insurance Association

Economic impact of Covid-19 pandemic on health care expenditures: an analysis of health insurance claims data of Japan Health Insurance Association

Reinsurance: A Risk Management Instrument for Insurance Companies’ Profitability (A Case of Non-Life Insurance in Nigeria)

The study is carried out to determine reinsurance in place of a risk management instrument and its effect on the non-life insurance firms’ profitability in Nigeria, adopting ex-post-facto design, with multiple correlation and regression model to analyze the data obtained from Nigeria Insurers Association Digest report 2007 to 2018, which is indicating 12 years of study sample size. The findings of the study show that Premium Cession Ratio (PCR) and Net Retention Ratio (NRR) have positive effect on the profitability (ROA) of insurance companies but not significant with their coefficient values of (0.059880 and 0.006273) and their associated probability values of (0.2811 and 0.8880) respectively. However, the findings reveal that Reinsurance Dependence Cede Premium (RDC) and Reinsurance Commission to Shareholder’s Equity (RCS) have affected the profitability (ROA) of insurance business entities negatively and insignificantly with their values of coefficient (-0.266824 and -0.894553) and their corresponding p-value is (0.5149 and 0.3497) respectively.

The association of health insurance with the survival of cancer patients with brain metastases at diagnosis.

Synchronous brain metastases (SBMs) are a presentation of stage IV cancers with limited treatment options. This study examines the association between health insurance status and overall survival (OS) of patients with SBMs using the National Cancer Database (NCBD). We queried the NCDB for patients with SBMs from 2010 to 2015. Included cases were from seven primary cancers. Patients were grouped based on their insurance status. We assessed the association of insurance with OS using a Cox proportional hazards model adjusted for age at diagnosis, sex, race, education level, income level, residential area, treatment facility type, Charlson-Deyo comorbidity status, year of diagnosis, primary tumor type, and receipt of chemotherapy, radiation therapy (RT), immunotherapy, and primary site surgery. Of 97,659 patients included, those who had Medicaid, Medicare, or without health insurance were less likely to receive brain RT, chemotherapy, and/or surgery of the primary cancer site compared to privately insured patients. In multivariable COX analysis, patients with Medicare (HR=1.11, 95% CI: 1.09-1.14, P<0.001), Medicaid (HR=1.11, 95% CI: 1.09-1.13, P<0.001), or no insurance (HR=1.18, 95% CI: 1.14-1.22, P<0.001) were associated with decreased OS compared to private insurance. After retrospective analysis, Medicaid, Medicare, and no insurance were all associated with worse OS compared to private insurance. Future studies can focus on determining the factors associated with insurance status and factors contributing to improved OS stratified by insurance status.

Effects of physician visit frequency for Parkinson\u2019s disease treatment on mortality, hospitalization, and costs: a retrospective cohort study

BackgroundThe number of patients with Parkinson’s disease among older adults is rapidly increasing. Such patients mostly take medication and require regular physician visits. However, the effect of physician visit frequency for the treatment for Parkinson’s disease has not been evaluated. This study aimed to evaluate the impact of physician visit frequency for Parkinson’s disease treatment on mortality, healthcare days, and healthcare and long-term care costs among older adults.MethodsThis study employed a retrospective cohort design utilizing claims data from the Fukuoka Prefecture Wide-Area Association of Latter-Stage Elderly Healthcare Insurance and Long-Term Care Insurance. Patients aged ≥75 years who were newly diagnosed with Parkinson’s disease in 2014 were included in this study, following the onset of Parkinson’s disease to March 31, 2019. We calculated the restricted mean survival time to evaluate mortality, focusing on the frequency of physician visits for Parkinson’s disease treatment. Inpatient days, outpatient days, and healthcare and long-term care costs per month were calculated using a generalized linear model.ResultsThere were 2224 participants, with 46.5% mortality among those with a higher frequency of physician visits and 56.4% among those with a lower frequency of physician visits. A higher frequency of physician visits was associated with a significant increase in survival time (1.57 months at 24 months and 5.00 months at 60 months) after the onset of Parkinson’s disease and a decrease in inpatient days and healthcare costs compared to a lower frequency of physician visits.ConclusionsA higher frequency of physician visits was significantly associated with longer survival time, fewer inpatient days, and lower healthcare costs. Caregivers should support patients with Parkinson’s disease to visit physicians regularly for their treatment.

Association of Health Insurance and Documentation with Stigma and Social Support Among Myanmar Migrants with Tuberculosis Before and During Thailand's Policy on Border Closure Due to COVID-19: a Cross-Sectional Study.

ObjectiveThe objective of this study was to assess the effect of health insurance and documentation status on tuberculosis (TB)-related stigma and social support before and during Thailand’s policy on border closure.MethodsA cross-sectional study was conducted in two TB clinics in Mae Sot district, a border area of Thailand. Myanmar migrants with new TB were interviewed before (between September 2019 and March 2020) and during Thailand’s policy (between April 2020 and January 2021). We used multiple linear regression models to assess the association of health insurance and documentation status with stigma and social support before and during the policy on border closure.ResultsOf 229 migrants diagnosed new TB recruited, 117 and 112 were interviewed before and during Thailand’s policy on border closure. The relationship of stigma with health insurance and documentation status was modified by the policy. Migrants with health insurance reported significantly lower stigma during the policy compared to those without health insurance, whereas documented migrants had lower stigma before the policy compared to undocumented migrants. No significant association of health insurance and documentation status with social support was observed. Ethnicity, perceived TB severity and education level were also independently associated with TB-related stigma.ConclusionThe relationships between health insurance, documentation status and TB-related stigma were modified by Thailand’s policy on border closure among Myanmar migrants with TB in a border area of Myanmar and Thailand. Promotion of health insurance and well-planned documentation for migrants should be more discussed and strengthened among stakeholders and policymakers.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40615-021-01185-3.

The Cost-Effectiveness of 13-Valent Pneumococcal Conjugate Vaccine in Seven Chinese Cities.

Objective: This study estimates the cost-effectiveness of vaccination with the 13-valent pneumococcal conjugate vaccine (PCV13) among infants in Beijing, Shanghai, Shenzhen, Chengdu, Karamay, Qingdao, and Suzhou. Methods: A previously published cost-effectiveness model comparing vaccination with PCV13 to no vaccination was localized to the included Chinese cities. A systematic literature review was undertaken to identify age-specific incidence rates for pneumococcal bacteremia, pneumococcal meningitis, pneumonia, and otitis media (AOM). Age-specific direct medical costs of treating the included pneumococcal diseases were taken from the Chinese Health Insurance Association database. The base case analysis evaluated vaccine efficacy using direct effect and indirect effects (DE+ IDE). A subsequent scenario analysis evaluated the model outcomes if only DE was considered. A vaccination rate of 70% was used. The model reported outcomes over a one-year period after it was assumed the vaccine effects had reached a steady state (5–7 years after vaccine introduction) to include the direct and indirect effects of vaccination. Health outcomes were discounted at 5% during the steady-state period. Results: Vaccination with PCV13 was cost-effective in the base case analysis for all included cities with the incremental cost-effectiveness ratio (ICER) ranging from 1145 CNY(Shenzhen) to 15,422 CNY (Qingdao) per quality-adjusted life-year (QALY) gained. PCV13 was the dominant strategy in Shanghai with lower incremental costs and higher incremental QALYs. PCV13 remained cost-effective in the DE-only analysis with all ICERs falling below a cost-effectiveness threshold of three times GDP per capita in each city. Conclusions: Vaccination with PCV13 was a cost-effective strategy in the analyzed cities for both the DE-only and DE + IDE analyses. PCV13 became very cost-effective when a vaccination rate was reached where IDE is observed.

How do patients with chronic illnesses respond to a public health crisis? Evidence from diabetic patients in Japan during the COVID-19 pandemic

:How do people change their healthcare behavior when a public health crisis occurs? Within a year of its emergence, coronavirus disease 2019 (COVID-19) has gradually infiltrated our lives and altered our lifestyles, including our healthcare behaviors. In Japan, which faces China across the East China Sea and accepted 924,800 Chinese tourists in January 2020, the emergence and spread of COVID-19 provides a unique opportunity to study people's reactions and adaptations to a pandemic.Patients with chronic illnesses who require regular doctor visits are particularly affected by such crises. We focused on diabetic patients whose delay in routine healthcare invites life-threatening complications and examined how their patterns of doctor visits changed and how demographic, socioeconomic, and vital factors disparately affected this process. We relied on the insurance claims data of a health insurance association in Tokyo. By using panel data of diabetic patients from April 2018 to September 2020, we performed visual investigations and conditional logistic regressions controlling for all time-invariant individual characteristics.Contrary to the general notion that the change in healthcare behavior correlates with the actual spread of the pandemic, the graphical and statistical results both showed that diabetic patients started reducing their doctor visits during the early stage of the pandemic. Furthermore, a substantial decrease in doctor visits was observed in women, and large to moderate reductions were seen in patients who take insulin and are of advanced age, who are at high risk of developing severe COVID-19. By contrast, no differentiated effect was found in terms of income status. We further investigated why a change in pattern occurred for each subgroup.The patterns of routine healthcare revealed by this study can contribute to the improvement of communication with the target population, the delivery of necessary healthcare resources, and the provision of appropriate responses to future pandemics. (299 words).

Трансформація світової галузі страхування під впливом пандемії СOVID-19

This article examines the transformation of the global insurance industry under the influence of the COVID-19 pandemic. The author examines the roles of regulators, governments, consumers of insurance services, insurance, and reinsurance companies in responding to the new challenge. The COVID-19 pandemic was an unexpected factor for the global insurance industry, and as because of the global crisis caused by the SARS-CoV-2 coronavirus, there was a need to assess the transformation of processes in it. Accordingly, the materials of experts of international insurance associations were analyzed, in particular: International Association of Insurance Supervisors (IAIS), The International Credit Insurance and Surety Association (ICISA), European Federation of Insurance Intermediaries (BIPAR), International Association for the Study of Insurance Economics (IASIE) and others. The division of insurance market participants into two classes has been substantiated. In one class, there are consumers of insurance services and the insurance market regulators. In another class, there are insurance associations, insurance, and reinsurance companies. Based on the studies and reports of international insurance associations, the author revealed conflict escalation between insurance, reinsurance companies, governments (US, EU, China), and insurance market regulators due to the requirements of compliance with the principle of expediency and transparency in control and supervision, increased demands for reserves and quality assets, changes in the assessment of solvency, constant changes in regulations and requirements for additional information. From the considered impact of the COVID-19 pandemic given the existing regulatory documents Solvency II and IFRS-17, the problem of ambiguous formations in the regulatory acts in the paragraphs “Terms of the insurance contract” and “Exclusion of the insurance contract”– interpretation of the word: “material damage” and the difference in the words: “epidemic” and “pandemic”. Paper identifies the problems of these ambiguous formations in the normative-legal interpretation of the world regulatory bodies, the postulate of Solvency II and the lawsuits that caused these formations. The comparative analysis of the consequences of the COVID-19 pandemic was performed using the S&amp;P 500 and S&amp;P Insurance Select Industry indices. There was a shock due to the pandemic and the forecasted expectations of investors, who negatively assessed the insurance industry, and as a result, the price of the insurance industry index lost the connection of identical fluctuations with the S&amp;P 500 and the price of the index fell relative to the S&amp;P 500 index. The forecast has been developed to increase the demand for insurance, which will grow from the momentum of the world economy. After a reduction of 3,7% in 2020, the world economy is growing by 5,8% in 2021, which is significantly higher than the average of 3,0% over the previous decade. The paper illustrates the difference between economic growth in developing and developed countries. The author compares the recovery of the insurance industry after the shock of the COVID-19 pandemic and the global financial crisis in 2008: the insurance industry of the COVID-19 crisis is 14,35% growth and by the end of 2021 should exceed pre-crisis figures, the total amount of global insurance premiums accrued in 2021, will be 11,46% higher than the pre-crisis level of 2019. Conclusions and recommendations on the transformation processes that have arisen under the influence of the pandemic on the insurance industry has been substantiated.

Association of race and health insurance in treatment disparities of colon cancer: A retrospective analysis utilizing a national population database in the United States.

Both health insurance status and race independently impact colon cancer (CC) care delivery and outcomes. The relative importance of these factors in explaining racial and insurance disparities is less clear, however. This study aimed to determine the association and interaction of race and insurance with CC treatment disparities. Retrospective cohort review of a prospective hospital-based database. In this cross-sectional study, patients diagnosed with stage I to III CC in the United States were identified from the National Cancer Database (NCDB; 2006 to 2016). Multivariable regression with generalized estimating equations (GEEs) were performed to evaluate the association of insurance and race/ethnicity with odds of receipt of surgery (stage I to III) and adjuvant chemotherapy (stage III), with an additional 2-way interaction term to evaluate for effect modification. Confounders included sex, age, median income, rurality, comorbidity, and nodes and margin status for the model for chemotherapy. Of 353,998 patients included, 73.8% (n = 261,349) were non-Hispanic White (NHW) and 11.7% (n = 41,511) were non-Hispanic Black (NHB). NHB patients were less likely to undergo resection [odds ratio (OR) 0.66, 95% confidence interval [CI] 0.61 to 0.72, p < 0.001] or to receive adjuvant chemotherapy [OR 0.83, 95% CI 0.78 to 0.87, p < 0.001] compared to NHW patients. NHB patients with private or Medicare insurance were less likely to undergo resection [OR 0.76, 95% CI 0.63 to 0.91, p = 0.004 (private insurance); OR 0.59, 95% CI 0.53 to 0.66, p < 0.001 (Medicare)] and to receive adjuvant chemotherapy [0.77, 95% CI 0.68 to 0.87, p < 0.001 (private insurance); OR 0.86, 95% CI 0.80 to 0.91, p < 0.001 (Medicare)] compared to similarly insured NHW patients. Although Hispanic patients with private and Medicare insurance were also less likely to undergo surgical resection, this was not the case with adjuvant chemotherapy. This study is mainly limited by the retrospective nature and by the variables provided in the dataset; granular details such as continuity or disruption of insurance coverage or specific chemotherapy agents or dosing cannot be assessed within NCDB. This study suggests that racial disparities in receipt of treatment for CC persist even among patients with similar health insurance coverage and that different disparities exist for different racial/ethnic groups. Changes in health policy must therefore recognize that provision of insurance alone may not eliminate cancer treatment racial disparities.

Battle of the Centuries: The Roots of Arbitration Law Come from the ‘Who Decides?’ Controversy

Although it was decided 56 years into the 19th century, the real arbitration legacy of the 18th century can be seen from the House of Lords decision in Scott v. Avery. The plaintiff insured his shop with the Newcastle A 1 Insurance Association and so became an association member. Association Rule 25 provided.

Digital health applications (DiGA) on the road to success-the perspective of the German Digital Healthcare Association

The approval of the first digital health applications (DiGA) in October 2020 resulted in a lot of buzz - not only in the healthcare sector but also beyond. The integration of DiGA to the public healthcare system was seen as asignificant innovation and stakeholders worldwide were looking to Germany. How did the start of the DiGA innovation project go and what is the current standing? The first months of DiGA becoming part of standard care brought new experiences and knowledge to manufacturers, doctors and patients as well as to health insurance companies and associations. More than six months later, it is time for apreliminary review.This article looks at the achievements so far as well as the status quo of DiGA in the market as of March 2021. It also focuses on current and upcoming challenges that the various stakeholders face on the way to integrate DiGA into standard care in awidespread and sustainable way.

Associations of Race, Insurance, and Zip Code-Level Income with Nonadherence Diagnoses in Primary and Specialty Diabetes Care.

Evidence suggests that clinicians may view or label patients as nonadherent in a biased manner. Therefore, we performed a retrospective cohort analysis exploring associations between patient demographics and zip code-level income with the International Classification of Diseases, Tenth Version (ICD-10) diagnoses for nonadherence among type 2 diabetes mellitus (T2DM) patients, comparing primary and specialty care settings. Providers in the primary care group included internal medicine and family medicine physicians. In the specialty care group, providers included endocrinologists and diabetologists only. Participants were identified from 5 primary care and 4 endocrinology sites in the University of Pennsylvania Health System between January 1, 2015, and January 1, 2019. Demographics, hemoglobin A1c (HbA1c), and ICD-10 codes for T2DM and nonadherence were extracted from the electronic health record and analyzed in October 2019. Log-binomial regression models were used to estimate patients' risk of nonadherence labeling by race, insurance, and zip code-level median household income, controlling for patient characteristics and HbA1c as a proxy for diabetes self-management. Results were compared between primary and specialty care sites. A total of 6072 patients aged 18-70 years were included in this study. Black race, Medicare, and Medicaid were associated with increased nonadherence labeling while controlling for patient characteristics ([ARR = 2.48, 95% CI: 2.01, 3.04], [ARR = 1.82, 95% CI: 1.50, 2.18], [ARR = 1.61, 95% CI: 1.32, 1.93], respectively). The results remained significant on adjustment with zip code-level income and showed no differences between primary and specialty sites. Lower-income zip codes showed a significant association with increased rates of nonadherence labeling. Black race, non-private insurance, and lower-income zip codes were associated with disproportionately high rates of nonadherence labeling in both primary and specialty management of T2DM, possibly suggestive of racial or class bias.

Assessment of patellar dislocations in childhood and adolescence : Accident-related or predisposition-related?

Numerous predisposing factors are known for patellar dislocations but the extent to which these or the trauma cause the dislocation is often unclear. This study investigated whether the analysis of the accident mechanism and anatomical predisposition in juvenile patellar dislocations enables a conclusion as to the causality. Retrospective cohort study, evidence levelIII. In-house employers' liability insurance association (BG) cases with the diagnosis of patella dislocation in patients under 18years were descriptively evaluated with respect to demographic and predisposing aspects as well as regarding accident information. The accident mechanisms were sorted into subgroups: direct impact, trivial trauma, fall, torsional trauma. A total of 54 patellar dislocations were identified with apatient age of 14 years (range 9-18 years). Amild valgus configuration was found in 39% of the cases, on average normal torsion, a tibial tuberosity-trochlea groove (TTTG) distance of 17 mm (range 8-24mm), with 41% ahigh proportion of patella alta and atrochlear deformity in 57%. Only 20% of the children had no relevant predispositions. The trivial traumas showed the highest proportion of recurrent dislocations with 50% and in the other accident categories the proportion of first dislocations was >75%. In the fall cohort the rate of children without relevant predisposition was highest. The predisposition rate in infantile patellar dislocations is high; however, falls are always significant accident events as well as medial direct impact. Torsional trauma is also a significant causative factor, unless high-grade trochlear dysplasia is present, whereas trivial traumas are not.

Supporting Student Success in the New Normal

The new normal in higher education can mean different things on varied campuses. The new normal, which occurred because of the COVID-19 pandemic, is the current atmosphere across the higher education landscape. This has meant more technology at many institutions of higher education (IHE) in numerous areas on campus. Other post-pandemic changes include a new financial reality, finding new ways to support student learning and campus community, and a new reality for many campus programs. This version of higher education looks hauntingly similar yet vastly different than the old vision of the higher education landscape. The COVID-19 pandemic caused many institutions of higher education to hit the fast forward button on implementing innovations and change. This change not only meant a move toward distance education using current methods in new ways but also activating plans for other innovation, such as streamlining paperwork, advocating for remote work, and offering traditional coursework in a new format. Campus leaders may need to redeploy human, financial, and physical capital in alignment with their new operating models (Teachers Insurance and Annuity Association of America [TIAA], 2020).