Excessive Risk Research Articles

Causal Pathways Between Breast Cancer and Cardiovascular Disease Through Mediator Factors: A Two-Step Mendelian Randomization Analysis.

The causal relationship of breast cancer (BC) with cardiovascular disease (CVD) and the underlying mediating pathways remains elusive. Our study endeavors to investigate the causal association between BC and CVD, with a focus on identifying potential metabolic mediators and elucidating their mediation effects in this causality. In this study, we conducted two-sample Mendelian randomization (MR) to estimate the causal effect of BC (overall BC, ER+ BC, ER- BC) from the Breast Cancer Association Consortium (BCAC) on CVD including coronary heart disease (CHD), hypertensive heart disease (HHD), ischaemic heart disease (IHD), and heart failure (HF) from the FinnGen consortium. Then, we used two-step MR to evaluate 18 metabolic mediators of the association and calculate the mediated proportions. Genetically predicted ER+ BC was causally associated with an increased risk of CVD including CHD (OR = 1.034, 95% CI: 1.004-1.065, p = 0.026), HHD (OR = 1.061, 95% CI: 1.002-1.124, p = 0.041), IHD (OR = 1.034, 95% CI: 1.007-1.062, p=0.013), and HF (OR = 1.055, 95% CI: 1.013-1.099, p = 0.010), while no causality was observed for overall BC and ER- BC. Furthermore, high-density lipoprotein cholesterol (HDL-C) was identified as a mediator of the association between ER+BC and CVD, including CHD (with 15.2% proportion)) and IHD (with 15.5% proportion), respectively. This study elucidates the potential causal impact of ER+ BC on subsequent risk of CVD, including CHD, HHD, IHD, and HF. We also outline the metabolic mediator HDL-C as a priority target for preventive measures to reduce excessive risk of CVD among patients diagnosed with ER+BC.

Degree of joint risk factor control and incident chronic kidney disease among individuals with obesity.

To investigate the extent to which joint risk factor control might attenuate the excess risk of chronic kidney disease (CKD) in participants with obesity. We included a total of 97 538 participants who were obese at baseline and matched 97 538 normal weight control participants from the UK Biobank in the analysis. The degree of joint risk factor control was assessed based on six major CKD risk factors, including blood pressure, glycated haemoglobin, low-density lipoprotein cholesterol, albuminuria, smoking and physical activity. The Cox proportional hazards models were used to estimate associations between the degree of risk factor control and risk of CKD, following participants from their baseline assessment until the occurrence of CKD, death, or the end of the follow-up period. Among participants with obesity, joint risk factor control showed an association with a stepwise reduction of incident CKD risk. Each additional risk factor control corresponded to an 11% (hazard ratio: 0.89; 95% confidence interval: 0.86-0.91) reduced risk of CKD among participants with obesity, with the optimal controlling of all six risk factors associated with a 49% (hazard ratio: 0.51; 95% confidence interval: 0.43-0.61) decrease in risk of CKD. Furthermore, in individuals with obesity who jointly controlled all six risk factors, the excess risk of CKD associated with obesity was effectively neutralized compared with normal weight control subjects. Notably, the protective correlations between the degree of joint risk factor control and the incidence of CKD were more pronounced in men compared with women, in individuals with a lower healthy food score versus a higher score, and among diabetes medication users as opposed to non-users (pinteraction = 0.017, 0.033 and 0.014, respectively). The joint risk factor control is associated with an inverse association of CKD risk in an accumulative manner among individuals with obesity. Achieving ideal control over risk factors may effectively counterbalance the excessive risk of CKD typically associated with obesity.

Cardiac amyloidosis and left atrial appendage closure: a multicenter retrospective study

Abstract Background Thromboembolic stroke risk remains a clinical challenge in cardiac amyloidosis (CA) patients with atrial fibrillation because of the increased prevalence of left atrial appendage thrombi irrespective of CHA2DS2-VASc score and a higher prevalence of factors that increase the risk of bleeding with anticoagulation. Left atrial appendage closure (LAAC) is an effective option in patients with atrial fibrillation and high bleeding risk; however, data describing a LAAC strategy for stroke prevention in patients with CA is limited. Among non-CA patients, procedural success and serious complication rates are around 98% and 3% respectively. Purpose In this multicenter retrospective study, we aimed to investigate whether left atrial appendage closure (LAAC) could reduce the risk of bleeding complications and ischemic cerebrovascular events in patients with CA. Methods In an international multi-center retrospective study, patients with CA that underwent LAAC were included. The diagnosis of CA was established on the basis of histologic confirmation or advanced multimodality cardiac imaging as per current consensus statements. Results A total of 28 patients (93% male; 87% ATTR-CA; 13% AL-CA; mean age 80 years) met inclusion criteria. At baseline, mean CHA2DS2-VASc and HAS-BLED scores were 4 and 3 respectively, mean left ventricular ejection fraction was 50%, and mean indexed left atrial volume was 58 mL/m2. 21% of patients had a prior history of ischemic stroke, 14% prior history of hemorrhagic stroke, 7% prior transient ischemic attack, and 54% had a prior history of major or minor bleeding. Procedural success was achieved in 26 patients (93%) with procedural complications occurring in 2 patients (vascular access site bleeding and cardiac tamponade). Regarding in-hospital and follow-up complications, 0% ischemic stroke, 0% hemorrhagic stroke, and major or minor bleeding in 4% of patients. During follow up, device thrombosis occurred in only 1 patient. Conclusion LAAC is a feasible and effective alternative to anticoagulation in patients with CA and excessive bleeding risk, with procedural success and complication rates similar to reported studies of non-CA patients.

Trans catheter edge to edge repair for mitral regurgitation and left ventricular outflow obstruction in hypertrophic cardiomyopathy

Abstract Background Based on previous reports, mitral valve transcatheter edge to edge repair (TEER) may be considered in patients with severe mitral regurgitation (MR) and left ventricular obstruction in patients with hypertrophic obstructive cardiomyopathy (HOCM) that are high risk for surgery. Objective We aimed to evaluate the feasibility, and immediate and short-term outcomes of mitral TEER in symptomatic patients with severe MR and HOCM. Methods Five patients (age 75±6, 3 men) with severe MR and HOCM with high surgical risk, and anatomy not suitable for septal ethanol ablation, who remained symptomatic despite maximally tolerated drug therapy were selected for TEER using the MitrClip system. Result The procedure was performed successfully on all 5 patients. Devices were deployed at the A2-P2 scallops of the mitral valve. MR severity declined from severe to mild in all patients, left ventricular outflow (LVOT) maximal gradient decreased from 140±46 to 8±5 mmHg after TEER, and was 41±32 mmHg at 4±2 month follow- up, Clinically, all patients reported improvement of their symptoms to Class I-II NYHA functional Class. Conclusion TEER may be a beneficial procedure for severely symptomatic patients with severe MR and obstructive HOCM on maximal tolerated medical therapy, who are not amenable to surgery because of excessive risk, old age, and frailty.Pre and Post procedure EchoPre and Post Cath

Risk of Urinary Tract Infections in Male Veterans With Diabetes Prescribed Sodium-Glucose Cotransporter-2 Inhibitors Versus Sulfonylureas Across the Veterans Health Administration.

Background: Due to their mechanism of action, sodium-glucose cotransporter-2 inhibitors (SGLT2is) carry a presumed increased risk of urinary tract infection (UTI) which is reflected in current prescribing data. As SGLT2i prescribing trends increase, some retrospective studies confirm an increased risk of UTI while conflicting studies find no increased risk of UTI associated with this therapy. Objectives: This study aims to compare the odds of developing a UTI in male Veterans with type 2 diabetes mellitus (T2DM) on metformin taking a SGLT2i vs a sulfonylurea (SU) within the Veterans Health Administration (VHA). Methods: This retrospective cohort study identified male Veterans with T2DM on metformin with a new fill of SGLT2i or SU between January 1, 2020 to December 31, 2022. Patients were then assessed for UTI diagnosis. An adjusted odds ratio (AOR) was calculated. Results: The SGLT2i cohort had 5.2% of patients diagnosed with outpatient UTI and 1.6% of patients diagnosed with inpatient UTI. The SU cohort had 5.3% of patients diagnosed with outpatient UTI and 1.3% of patients diagnosed with inpatient UTI. A logistic regression analysis resulted in a decreased odds of diagnosis of outpatient UTI in the SGLT2i cohort vs the SU cohort ([AOR] = 0.91, 95% CI [0.86 - 0.96], P-value = < 0.001), and no difference in the diagnosis of inpatient UTI ([AOR] = 1.06, 95% CI [0.96 - 1.18], P-value = 0.234). Conclusion: This retrospective study of national VHA data adds to growing literature which finds no excessive risk of UTI associated with SGLT2i therapies.

Impact of Ticagrelor vs. Clopidogrel in Patients With Acute Coronary Syndrome Undergoing Left Main Percutaneous Coronary Intervention

Abstract Objective: There is limited evidence regarding the choice of P2Y12 receptor inhibitors as a component of dual antiplatelet therapy (DAPT) in patients with left main (LM) disease undergoing percutaneous coronary intervention (PCI). This study aimed to evaluate long-term clinical outcomes of ticagrelor- vs. clopidogrel-based DAPT strategy in acute coronary syndrome (ACS) patients undergoing LM PCI. Methods: This is a post-hoc analysis from a prospective, single-center, real-world PCI registry. A total of 1,163 patients discharged post-ACS who underwent LM PCI and received ticagrelor or clopidogrel between March 2016 and March 2019 were included in the study. The primary endpoint was ischemic events at 12 months, including cardiac death, myocardial infarction, or stroke. Secondary outcomes included all-cause death and Bleeding Academic Research Consortium types 2, 3, and 5, and types 3 and 5 bleeding. Propensity score matching was used to adjust for bias due to confounders between the 2 groups. Results: The ticagrelor and clopidogrel groups comprised 529 (45.49%) and 634 (54.51%) patients, respectively. During the follow-up period, ticagrelor significantly reduced the rate of ischemic events compared to clopidogrel before (1.32% (7/529) vs. 3.63% (23/634), P = 0.0136) and after propensity score matching (1.41% (6/425) vs. 4.00% (17/425), P = 0.0201). The rates of all-cause death, Bleeding Academic Research Consortium-defined type 2, 3, and 5 bleeding, and type 3 and 5 bleeding were similar between the ticagrelor group and clopidogrel group before or after propensity score matching adjustment (all P &gt; 0.05). Conclusion: Among patients with ACS undergoing LM PCI, ticagrelor use was associated with ischemic events benefit without excessive risk of bleeding at 12 months compared with clopidogrel.

Bank Capital Regulation in a Zero Interest Environment

Abstract How does the zero lower bound on deposit rates (ZLB) affect how banks respond to capital regulation? I study this question in a model in which households value the liquidity services of deposits yet do not accept negative deposit rates. When deposit rates are constrained by the ZLB, tight capital requirements disproportionately hurt franchise values and are therefore less effective in curbing excessive risk taking. The model delivers a novel rationale for “interest-dependent” capital regulation that is optimally laxer when the ZLB binds and tighter when the ZLB is slack but may bind in the future.

Endogenous Risk Exposure and Systemic Instability

Most research on systemic stability assumes an economy where banks are subject to exogenous shocks. However, in practice, banks choose their exposure to risk. I show that there exists a network risk-taking externality: the risk exposure choices made by connected banks are strategically complementary. Banks within financial networks, especially densely connected ones, become endogenously exposed to excessive risks. The theory offers several novel perspectives on policy debates. For instance, it suggests that limiting government bailouts to interbank exposures can effectively reduce endogenous systemic risk. This paper was accepted by Kay Giesecke, finance. Funding: This work was financially supported by the USC Dornsife Institute for New Economic Thinking Fellowship, the Marshall PhD Fellowship, and European Finance Association Doctoral Tutorial Best Paper Prize. Supplemental Material: The online appendix is available at https://doi.org/10.1287/mnsc.2022.01519 .

Applying portfolio theory to benefit endangered amphibians in coastal wetlands threatened by climate change, high uncertainty, and significant investment risk

The challenge of selecting strategies to adapt to climate change is complicated by the presence of irreducible uncertainties regarding future conditions. Decisions regarding long-term investments in conservation actions contain significant risk of failure due to these inherent uncertainties. To address this challenge, decision makers need an arsenal of sophisticated but practical tools to help guide spatial conservation strategies. Theory asserts that managing risks can be achieved by diversifying an investment portfolio to include assets – such as stocks and bonds – that respond inversely to one another under a given set of conditions. We demonstrate an approach for formalizing the diversification of conservation assets (land parcels) and actions (restoration, species reintroductions) by using correlation structure to quantify the degree of risk for any proposed management investment. We illustrate a framework for identifying future habitat refugia by integrating species distribution modeling, scenarios of climate change and sea level rise, and impacts to critical habitat. Using the plains coqui (Eleutherodactylus juanariveroi), an endangered amphibian known from only three small wetland populations on Puerto Rico’s coastal plains, we evaluate the distribution of potential refugia under two model parameterizations and four future sea-level rise scenarios. We then apply portfolio theory using two distinct objective functions and eight budget levels to inform investment strategies for mitigating risk and increasing species persistence probability. Models project scenario-specific declines in coastal freshwater wetlands from 2% to nearly 30% and concurrent expansions of transitional marsh and estuarine open water. Conditional on the scenario, island-wide species distribution is predicted to contract by 25% to 90%. Optimal portfolios under the first objective function – benefit maximization – emphasizes translocating frogs to existing protected areas rather than investing in the protection of new habitat. Alternatively, optimal strategies using the second objective function – a risk-benefit tradeoff framework – include significant investment to protect parcels for the purpose of reintroduction or establishing new populations. These findings suggest that leveraging existing protected areas for species persistence, while less costly, may contain excessive risk and could result in diminished conservation benefits. Although our modeling includes numerous assumptions and simplifications, we believe this framework provides useful inference for exploring resource dynamics and developing robust adaptation strategies using an approach that is generalizable to other conservation problems which are spatial or portfolio in nature and subject to unresolvable uncertainty.

Prevalence and risk of occurrence of visible birth defects in mining areas in South Kivu: A hospital-based cross-sectional study.

Possible contamination related to mining activities might contribute with other risk factors in increasing the burden of birth defects (BDs) in many developing countries including the Democratic Republic of Congo. The subsequent prevalence is frequently underestimated. Implementation of focused public health interventions is hindered by the paucity of comprehensive data. We assessed the potential impact of mining on the prevalence and occurrence of visible BDs in neonates in South Kivu (SK). A hospital-based cross-sectional study was conducted among 65,474 newborns registered in 7 hospitals in SK from 2016-2021. Hospitals were categorized based on mining activities in their respective catchment areas. Living in a mining zone was the exposure, whereas the outcome was visible BDs. Prevalence was estimated per 100,000 live births, and risk of occurrence with odds ratio (OR) and their 95% confidence interval. 261 neonates with visible BDs were recorded accounting for a prevalence of 399 cases per 100,000 live births. The prevalence ranges between 217 and 1365 cases per 100,000 live births. An increased risk was found in mining zones(OR=2.07; 95%CI=1.59-2.68), Mubumbano(OR=1.72, 95%CI=1.22-2.43), and Mwenga(OR=3.89, 95%CI=2.73-5.54), whereas a reduced risk was reported in non-mining zones(OR=0.48, 95%CI=0.37-0.62) in Katana (OR=0.49, 95%CI=0.33-0.73). Musculoskeletal(28.74%) and central nervous systems(19.92%) were the most common BDs. A significant difference in prevalence for BDs involving the face, GI system and abdominal wall, musculoskeletal, central nervous and genitourinary systems between mining and non-mining zones was found(p<0.001). There is an excessive risk for visible BDs in areas with hazardous mining activities in SK region.​​ More complex studies are needed to define the possible causal relationship. Moreover, findings generated herein should be corroborated by other research design, periodically monitored by public health authorities, and used to inform initiatives promoting enhanced environmental health, access to pediatric surgical care, and public health campaigns aimed at decreasing risk of BDs.

6870 Cardiac Imaging And Metabolomics Studies Suggest Differential Risk And Protective Biomarkers For Cardiovascular Disease In Renoprotected, Long-Duration Type 1 Diabetes

Abstract Disclosure: M. Yu: None. S. Jangolla: None. N. Ziemniak: None. E. Viebranz: None. T. Chokshi: None. K. Park: None. I. Wu: None. H. Shah: None. G.L. King: None. Cardiovascular disease (CVD) is a major cause of mortality in people with Type 1 diabetes (T1D), especially in those with nephropathy (DN). However, in long-duration T1D, a substantial proportion of individuals without DN still exhibit excessive CVD risks. The Joslin 50-Year “Medalist” Study (n=1043), composed of people with T1D≥50 years, are ideal for studying CVD in a renoprotected T1D cohort, as only 13% have DN, and yet 40% have CVD, despite excellent control of lipids and blood pressure. Stratifying the Medalists by DN revealed that exercise was cardioprotective in the group with DN (OR 0.60, p=0.04); while age at T1D diagnosis (OR 1.03, p=0.01), HbA1c (OR 1.25, p=0.01), C-reactive protein (OR 1.14, p=0.01), and interleukin-6 (OR 1.13, p=0.01) all increased CVD risk in Medalists without DN. A subset of Medalists also underwent coronary artery calcification scans (CAC; n=153) and cardiac magnetic resonance imaging of left ventricular (LV) structure and function (CMR; n=111). The majority of these Medalists (97.8%) had detectable CAC&amp;gt;0; furthermore, the median CAC score of 1000 was higher at any cutoff compared to similar age-matched T1D and Type 2 diabetes (T2D) populations with higher DN prevalence. In contrast, mean CMR values in this Medalist subset were comparable to other cohorts. Continuous glucose monitoring (CGM) metrics for hyperglycemia (mean glucose, β=0.002, p=0.03; glucose management indicator, β=0.09, p=0.03; and time above range&amp;gt;180 mg/dL, β=0.003, p=0.02), but not glucose variability or hypoglycemia, were associated with LV remodeling in the Medalists, even after adjusting for eGFR. Likewise, plasma levels of advanced glycation end-products (AGEs) N-carboxyethyl-lysine (CEL), N-carboxymethyl-lysine (CML), and methylglyoxal-derived hydroimidazolone (MGH1) were associated with CAC (β=16.22, p=0.05; β=15.21, p=0.01; and β=10.18, p=0.01, respectively) and LV remodeling (β=0.001, p=0.09; β=0.001, p=0.05; and β=0.001, p=0.04, respectively) in the Medalists. The association of CEL with CVD replicated in a separate Medalist subset (n=311) with self-reported CVD data (OR 1.26, p=0.01). Plasma global metabolomics studies (n=140) revealed that amino acid activation pathways, with lower levels of branched chain amino acids, were associated with CAC (FDR=0.002); while amino acid metabolism pathways were associated with less favorable LV volumes (FDR=0.03). In this comprehensive study of aging T1D people with no substantial DN, hyperlipidemia, or hypertension, cardiac imaging and metabolomics studies suggest disproportionate advanced CAC, as compared to subclinical LV remodeling or dysfunction, and highlight the importance of targeting hyperglycemia for CVD risk reduction. Plasma metabolites associated with CVD in T1D are different from those in T2D, and may provide novel information on potential therapeutic targets for CVD in T1D. Presentation: 6/1/2024

HIV deathrate prediction by Gaidai multivariate risks assessment method.

HIV is a contagious disease with reportedly high transmissibility, being spread worldwide, with certain mortality, allegedly presenting a burden to public health worldwide. The main objective of this study was to determine excessive HIV death risks at any time within any region or country of interest. Current study presents a novel multivariate public health system bio-risk assessment approach that is particularly applicable to environmental multi-regional, biological, and public health systems, being observed over a representative period of time, yielding reliable long-term HIV deathrate assessment. Hence, the development of a new bio-statistical approach, that is, population-based, multicenter, and medical survey-based. The expansion of extreme value statistics from the univariate to the bivariate situation meets with numerous challenges. Firstly, the univariate extreme value types theorem cannot be directly extended to the bivariate (2D) case, - not to mention challenges with system dimensionality higher than 2D. Existing bio-statistical methods that process spatiotemporal clinical observations of multinational bio-processes often do not have the advantage of efficiently dealing with high regional dimensionalities and complex nonlinear inter-correlations between different national raw datasets. Hence, this study advocates the direct application of the novel bio-statistical Gaidai method to a raw unfiltered clinical data set. This investigation described the successful application of a novel bio-risk assessment approach, yielding reliable long-term HIV mortality risk assessments. The suggested risk assessment methodology may be utilized in various public bio and public health clinical applications based on available raw patient survey datasets.

Specifics and results of liver transplantation in elderly patients

Aim. To determine specific features, frequency, and structure of complications, immediate and long-term results of liver transplantation in elderly patients.Materials and methods. Data on 529 liver transplantations performed consecutively in one medical center from 2010 to 2023 were analyzed. In 386 (73%) cases, the right lobe of the liver of related donors was used for transplantation. At the time of surgery, the patient age ranged from 18 years to 71 years, with 57 (11%) patients being over 60 years old, 215 (40%) patients aged 44–59 years, and 257 (49%) patients aged 18–44 years.Results. Prior to operation, elderly patients were statistically significantly more often diagnosed with arterial hypertension (n = 19; 33%), diabetes mellitus (n = 12; 21%), and on average a reduced glomerular filtration rate (82 ml/min/1.73m2 ). The most frequent indication for transplantation in this group was hepatocellular carcinoma in the setting of cirrhosis (n = 19; 33%). No statistically significant differences in other preoperative characteristics, parameters of donors and operations, peculiarities of the course of the early postoperative period, frequency, structure of complications and lethal outcomes were found. The one-, five-, and ten-year survival rates for recipients over 60 years old were 82%, 72%, and 36%; for recipients aged 44–59 years old – 88%, 79%, and 70%; and for recipients aged 18–44 years old – 86%, 80%, and 74%, respectively.Conclusion. In the studied cohort, older age was not associated with excessive risks of complications and early postoperative mortality. Given the higher prevalence of comorbidities in this group, preoperative examination should be aimed at, among other things, diagnostics of possible (hidden) cardiovascular and oncologic diseases. The development and introduction of new cardio-, nephro-, and oncoprotective regimens of immunosuppressive therapy seems to be an important measure not only for the surgical treatment of elderly patients, but also for recipients living with a transplanted liver for a long time.

Diffusing Risk: Bureaucratic Agency, UN Security Council Horse-Trading, and the Role of Co-Financing

Abstract Political lending is problematic for the operations of multilateral development banks (MDBs) since politically motivated aid has a greater default risk than other aid projects. MDB bureaucrats, therefore, face a dilemma. On the one hand, they want to please major shareholders by engaging in political lending. On the other hand, they want to mitigate their MDB's exposure to excessive risk. One way to solve this dilemma is to share the risk of loans with other lenders through co-financing. I expect that as countries’ share of politically motivated aid increases, these countries’ portfolios will receive more co-financed loans. Using newly collected loan-level data from the European Bank for Reconstruction and Development, I find that UNSC membership increases the number of co-financed loans by 38.5 percent and increases the share of co-financed loans in a country's European Bank for Reconstruction and Development loan portfolio by 19.1 percentage points. I demonstrate that these results are consistent with the argument that MDB bureaucrats want to mitigate risk.

Determination of Excessive Lifetime Cancer Risk for Workers Exposed to Natural Radioactive Materials in Various Equipment in Oil and Gas Sector

In the oil and gas sector of Basrah, natural radioactive materials are accumulated in various equipment like wellheads, pumps, and separation vessels, often manifested as scales, sludge, and other forms of waste. Without proper preventive measures, these accumulations pose significant risks to workers, the public, and the environment. This study aims to assess the lifelong cancer risks associated with production processes and the handling of resultant waste, be it scale sediments, sludge, or soil. Sample collection across different regions was based on the evaluation of production and storage facilities. Using a high-purity germanium detector (HPGe), activity concentrations of 226Ra, 232Th, and 40K were measured. These concentrations were then used with standard equations to determine indoor effective dose rates. The regional-weighted (the lifetime risk of cancer is a measure of the cumulative risk of cancer over a specific age range and has a clear, intuitive appear) average of the lifetime excessive cancer risk was varied between (0.40 to 0.11 ×10-3) for ELCRoutdoor, (3.13 to 0.86 ×10-3) for ELCRindoor and (0.97 to 3 ×10-3) for ELCRtotal, significantly surpassing the global average value of (0.29x10-3). This disparity underscores the heightened risk posed by these activities, emphasizing the urgent need for enhanced safety measures and regulatory oversight to safeguard human health and the environment.

The influence of psychological factors on investment decision-making: Psychological features of economic relations formation

The article aimed to analyse the influence of psychological factors on the investment decision-making process, which shapes the economic behaviour of investors in Ukraine. The research involved surveys and experimental tasks conducted among investors, with the data analysed using statistical methods to identify the impact of psychological factors on investment decisions. Fear and greed have been found to be most significant emotions affecting investment decisions, whereas fear leads to excessive caution and risk avoidance. In contrast, greed drives investors to take on excessive risks. Overconfidence in one’s knowledge and skills results in an overestimation of opportunities and an increased risk of losses, while confirmation bias leads investors to seek information that supports their previous decisions, ignoring conflicting data. Expert opinions and group behaviour significantly influence investment decisions, particularly under conditions of uncertainty, often resulting in herd behaviour and the formation of economic bubbles. The experimental tasks demonstrated that investors frequently make irrational decisions under the influence of emotions and cognitive biases, even when they can access complete information about risks and opportunities. The survey results also indicated that investors with higher levels of financial literacy are less susceptible to the influence of emotions and cognitive biases, highlighting the importance of financial education in improving the quality of investment decisions. These findings illustrate how psychological factors can distort the investment decision-making process and underscore the necessity of considering these factors when developing investment strategies

Time-dependent cardiovascular risks following pneumonia in inpatient and outpatient settings: A register-based cohort study

BackgroundThe elevated long-term cardiovascular disease (CVD) risks associated with pneumonia have been observed among inpatients, yet the risks associated with outpatients are less understood. MethodsWe used register-based data and a matched cohort design, including 98,354 pneumonia inpatients and 44,486 outpatients, as well as a 5-fold number of matched healthy controls. Associations between pneumonia presentation (in inpatient and outpatient settings) and long-term CVD risks were measured by rate difference and hazard ratio (HR) using Poisson and Cox regressions in a time-dependent manner. ResultsDuring a maximum follow-up period of 5.7 years of ischemic heart disease (IHD), heart failure (HF), and stroke were documented among pneumonia inpatients.Relative to healthy controls, pneumonia patients showed increased risks of IHD, HF, and stroke. Women and young inpatients demonstrated stronger associations of CVD with pneumonia; inpatients aged 60 years or older showed the highest excessive CVD risks. ConclusionsPneumonia demanding outpatient and inpatient cares are intermediate-term and long-term risk factors of incident CVDs respectively, underscoring the need to plan setting-specific and time-dependent CVD-preventive cares following pneumonia presentation.

Constructing a Risk Management Framework to Protect the Organization

Risk management is a critical activity for every organisation. It is important to consider risk in all operations and balancing risk with reward is an essential component of strategy for most companies, in the context of their environment and the current volatile conditions. This paper discusses the formulation of a risk management framework in order to address this important area, in a comprehensive, structured, planned method. A process for the construction of such a framework is proposed, based on practice. The requirement to scan the organisation’s horizon, discerning the ‘Risk Universe’, possibly using external consultants, is noted. A map of risk coverage should be formulated to ensure adequate protection and remove excessive risk provision. Risk champions can be recruited to disseminate good practice, creating a culture of risk awareness. The organisation’s appetite for risk must be ascertained and a positive contribution made, in respect of environmental issues. A review of the literature was performed and the key themes extracted. A semi-structured interview with a director of an international company was enacted. The main themes were selected, via an inductive approach. The research results were analysed and then utilised to form a proposed procedure for constructing a risk management framework.

Financial Risk Identification and Control in the Openness Context: A System Dynamics Approach to Renminbi Internationalization

In an attempt to control a series of domestic and foreign financial risks amid the internationalization of Renminbi (RMB), China’s currency, this article categorizes these risks into five types: excessive volatility risk of exchange rate, balance of payments risks, policy risks, crisis contagion risks, and excessive volatility risk of financial asset prices. By employing system dynamics simulation models and sensitivity analysis, this paper examines strategies for financial risk control. Results indicate that the impacts of crisis contagion risk and balance of payments risk are the most significant, and that financial risks are extremely sensitive in such aspects as the degree of capital openness, exchange rate volatility, and foreign trade dependency. The paper suggests adopting strategies like gradually opening China’s capital accounts, maintaining its exchange rate fluctuations within a reasonable range, stabilizing its dependency on foreign trade, and ensuring that its growth rate of M2 matches that of the nominal GDP – a combined effort to control the complicated financial risks arising from various sources.

Carrying the (paper) burden: A portfolio view of systemic risk and optimal bank size

In this paper we propose a two-level portfolio allocation optimization program and use it to explore the banking industry systemic risk management from a regulatory (supervisor) perspective. In our model banks choose their portfolio to maximize their own profits, while the supervisor optimizes the risk and return in the banking system as a whole. This may induce inefficiencies, leading to a banking system that produces excessive risk. We propose three policy scenarios based on current regulation practices and proposals and explore the ability of these regulatory regimes to reduce the systemic risk of the banking industry. We illustrate the use of the model by looking at over 9,000 US banks in the period 1984-2013, covering two major recessions. While all policy scenarios yield a better risk-return trade-off compared with the observed portfolio, the greatest improvements are achieved when the supervisor is able to limit the size of banks.