Financial Consequences Research Articles

امكانية تحسين فعالية الرقابة الداخلية باستخدام اشارات خطر التدقيق للحد من حالات الغش والاحتيال: دراسة نظرية

Abstract The contemporary business environment is always fraught with risks, uncertainties and uncertainties, including errors and fraud, which can have serious financial consequences for an organization's reputation. Despite the implementation of internal control systems in these institutions, these risks still exist and recur as the business and operations are completed. This is where the research problem of ineffectiveness arisesInternal controls in mitigating the occurrence of errors and cases of fraud within institutions. This motivates auditors to take a proactive approach to identifying and addressing weaknesses. This approach is to use the potential of audit risk signals as a means of enhancing the effectiveness of internal control measures. This study aimed to increase the auditor's efficiency in detecting financial fraud by studying and analyzing the impact of using audit risk signals in improving the effectiveness of internal control, and evaluating internal control systems and the extent of reliance on it. The study relied on the descriptive approach through the use of theses, letters, periodicals, books and websites that dealt with the subject of the study, especially those related to the topics of audit risk signals and internal control. The study concluded several conclusions, the most important of which are: that the availability and use of audit risk signals by the auditor helps to achieve savings in the time and cost allocated to the audit process, and to direct attention to citizens who have the possibility of fraud, which achieves the effectiveness of the audit process in general, and the high efficiency of the audit in particular, there is a lack of access to sufficient and reliable information before starting the audit, and this indicates that there are obstacles that limit the importance of good communication with employees and the collection of information necessary to understand the situation accurately. The study also included several recommendations, the most important of which are: the need for auditors to be distinguished by the ability to analyze the causes and search for the real roots of the problem instead of relying only on apparent signals. Auditors should adhere to strong and transparent audit practices such as audit risk signals to ensure the correctness and reliability of employees' transactions, management, assets and financial reports in order to improve the effectiveness of internal control.

Effect of factory reliability on bagasse usage and surplus

Poor factory reliability increases season length, reduces sugar production and reduces the supply of bagasse available for cogeneration and the production of by-products. The financial justification for capital expenditure, maintenance and control system upgrades usually account for the extended season length and lost sugar production associated with stoppages. However, the extra bagasse use due to stoppages is often harder to quantify, and, therefore, the resulting financial consequences are often not considered. This work attempts to quantify the effects of stoppages on bagasse use in factories so that the true costs of factory stoppages can be more accurately determined. Factory data have been used to predict the effects of long and short factory stops on bagasse consumption and surpluses. Calculations were carried out for a factory data set with a relatively small number of short stops and a factory data set with a large number of short stops. For both data sets, far more bagasse was lost due to short stops than long stops, and the quantity of bagasse consumed due to short stops represents a significant loss of revenue. Stops disrupt and increase the bagasse consumption of the boiler station in ways that are difficult to model, so it is likely that the calculations in this work underestimate the bagasse consumption and, therefore, revenue lost due to stops.

Behavioral risk assessment of work-related musculoskeletal disorders among workers of petrochemical industries: protocol of a mixed method study

BackgroundMusculoskeletal disorders (MSDs) are one of the most common occupational diseases and the main cause of disability worldwide. Work-related musculoskeletal disorders (WMSDs) are one of the common health risks and the most important cause of absenteeism due to disability in various industries, including the petrochemical industry, in developed and developing countries. These disorders have important social economic, and significant financial consequences due to direct and hidden costs. Health behaviors play a role in both creating and preventing musculoskeletal disorders in employees. Therefore, by identifying the influencing factors on these behaviors, it is possible to strengthen and improve the preventive behaviors of musculoskeletal disorders through educational intervention programs. This study aims to assess the behavioral risk of work-related musculoskeletal disorders, and design and implement an educational intervention to teach effective behaviors in the prevention of musculoskeletal disorders in petrochemical industry workers.MethodsThis study is a mixed-method study implemented in four stages involving the qualitative study, the design and evaluation of an instrument, the design of an experimental randomized clinical trial, and the psychometric evaluation of the instrument and the evaluation of the program. The research community consists of employees working in the petrochemical industry. The volume of samples in the qualitative study with the purposeful sampling method, in the instrument design stage based on the available sampling method, and also in the experimental study, the samples are employees suffering from work-related musculoskeletal disorders, who were selected based on a simple random method from among the employees of the petrochemical industry. Then they will be divided into intervention and control groups. The instruments of this research include a demographic questionnaire, a researcher-made questionnaire for measuring behavior, and two auxiliary instruments including the visual analog scale (VAS) and the Quebec Disability Scale. Evaluation is done in 4 stages: pre-test, immediately, 3, and 6 months after the intervention of both groups. The obtained data will be analyzed using SPSS software.DiscussionMusculoskeletal disorders related (WMSDs) to work can harm employees’ health in various industries, including the petrochemical industry. This study attempts to evaluate the behavioral risk of work-related musculoskeletal disorders among petrochemical industry workers and design and implement an appropriate educational intervention program.Trial registrationIranian Registry of Clinical Trial (IRCT20240321061346N1). Registered on 2024–04-10.Ethics Status: Ethics code: IR.MODARES.REC.1402.251.

Effect of age on susceptibility to the attraction effect in sequential risky decision-making

Abstract Our study aims to contribute to the existing body of research on age-related changes in decision-making by investigating susceptibility to the attraction effect across adulthood. Prior studies have produced inconsistent conclusions regarding the decision-making abilities of older individuals, with some portraying them as easily manipulated and risk-averse, while others suggest the opposite. To address this issue, we conducted two experiments using a novel paradigm of the roulette task: (1) in an online environment with 357 participants and (2) in a laboratory setting with 173 participants. The results were consistent and demonstrated the robustness of the attraction effect. However, no age differences in susceptibility to the attraction effect as a common decision bias were found. As predicted, older adults were more likely to commit simple decision-making mistakes, especially in the preliminary trials, which could have serious financial or societal consequences. Additionally, older adults exhibited more risk-seeking behaviours. Furthermore, we observed that the dynamics of decision competence (as indicated by a decrease in the selection of erroneous decoy options and an increase in decision fluency) were similar for both younger and older adults, suggesting preservation of the ability to optimise decision-making while becoming familiar with new tasks. These findings provide insight into the cognitive functioning of older adults and indicate that decision-making abilities in late adulthood may be more complex than commonly assumed.

Trends in Overactive Bladder Therapy: Associations Between Clinical Care Pathways, Practice Guidelines, and Therapy Utilization Patterns.

Overactive bladder (OAB) is a chronic condition with significant financial and health-related consequences. Guidelines and treatment pathways were created to optimize care and provide a clinical framework for diagnosing and managing OAB. However, the impact of these efforts and patterns of medical treatment for OAB are poorly understood. Therefore, we sought to evaluate overall trends in therapy utilization before and after the 2014 American Urological Association (AUA)/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) OAB guideline amendment and publication of the OAB clinical care pathway in 2016. In this retrospective cohort study, we analyzed data from Optum, a national administrative health and pharmacy claims database, between 2013 and 2018. All adult patients diagnosed with idiopathic OAB were identified by the International Classification of Diseases 9th and 10th Revision codes. Oral OAB therapies were identified using National Drug Codes, while third-line therapy procedures, onabotulinumtoxinA (BTX), sacral neuromodulation (SNM), and percutaneous tibial nerve stimulation (PTNS), were identified using Current Procedural Terminology (CPT) codes. The study's primary outcome was the annual number of OAB prescriptions filled by pharmacotherapy class and the number of minimally invasive therapies performed during the study period. The secondary outcome was the association between OAB therapy utilization and various clinical and sociodemographic factors. Patterns of care were analyzed from 2013 to 2018, and initial treatment with each therapy was collected, excluding repeat procedures from the analysis. 1 825 782 patients were included in the study. The mean age was 61.1 ± 16.7 years, and 1 071 420 patients were female (58.7%). The number of new OAB diagnoses increased by 369% from 2013 to 2017. During the 6-year study period, 347 052 (19%) patients were treated with oral and/or third-line therapies. The overall number of oral medications prescribed peaked in 2016, followed by a 17% decline between 2016 and 2018. In 2013, the two most prescribed oral medications were oxybutynin (46%) and solifenacin (31.8%). By 2018, mirabegron (18.5%) surpassed solifenacin (16.5%), with oxybutynin still accounting for most prescriptions written (55%). Eighty percent of all initial mirabegron prescriptions were filled by patients over the age of 65. The rate of third-line therapy procedures almost doubled between 2013 and 2018 (9-17 procedures per 1000 OAB patients, p < 0.001). Following the publication of the first OAB guidelines, there was an increase in OAB diagnoses, followed by a decrease in anticholinergic medication use, and a rise in beta-3 agonist utilization in patients over 65 years old. Additionally, there was greater adoption of third-line OAB therapies. These trends indicate that OAB therapy guidelines and clinical practice pathways may influence treatment patterns. Given the recent publication of the OAB guidelines, further studies are necessary to assess their impact on therapy utilization patterns.

Chronic illness and financial burden in Switzerland (FINK): a protocol for a mixed methods research project

IntroductionPeople with cancer and other chronic illnesses, their families and caregivers report financial burden as a problem that affects multiple aspects of daily life. While cancer research has coined the...

Climate and health: a path to strategic co-financing?

Leveraging the co-benefits of investments in health and climate can be best achieved by moving away from isolated financing approaches and adopting co-financing strategies, which aim to improve the outcomes of both sectors. We propose a framework for studying co-financing for health and climate that considers the degree of integration between sector funding, and whether arrangements are 'passive', when cross-sectoral goals are indirectly affected, or 'strategic', when they are pre-emptively supported to build resilience and sustainability. We conducted a rigorous, evidence-focused review to describe co-financing mechanisms according to a framework, including the context in which they have been employed, and to identify enablers and barriers to implementation. We searched the international literature using Pubmed and Web of Science from 2013 to 2023, the websites of key health and climate agencies for grey literature and consulted with stakeholders. Our review underscores the significant impact of climate change and related hazards on government, health insurance and household health-related costs. Current evidence primarily addresses passive co-financing, reflecting the financial consequences of inaction. Strategic co-financing is under explored, as are integrative co-financing models demanding cross-sectoral coordination. Current instances of strategic co-financing lack sufficient funding to demonstrate their effectiveness. Climate finance, an under used resource for health, holds potential to generate additional revenue for health. Realizing these advantages necessitates co-benefit monitoring to align health, climate mitigation and adaptation goals, alongside stronger advocacy for the economic and environmental benefits of health investments. Strategic co-financing arrangements are vital at all system levels, demanding increased cross-sectoral collaboration, additional funding and skills for climate integration within health sector plans and budgets, and mainstreaming health into climate adaptation and mitigation plans. Supporting persistent health needs post-disasters, promoting adaptive social protection for health and climate risks, and disseminating best practices within and among countries are crucial, supported by robust evaluations to enhance progress.

Evolution of financial intermediation and performance consequences in China’s commercial banks

PurposeThis study evaluates the evolution from traditional to nontraditional financial intermediation (NTFI) in Chinese commercial banks from 2006 to 2021, analysing its impact on bank performance and risk.Design/methodology/approachAccounting measures are used to construct granular activity data, and factor analysis is employed to develop a financial intermediation evolution (FIE) index. The fully modified OLS (FMOLs) estimator is used for nonstationary data analysis, and difference-in-differences (DID) analysis is used for robustness check.FindingsChinese banks exhibit unique evolution in financial intermediation compared to developed economies, with greater inter-bank variations over time than intra-bank differences. From 2006 to 2017, three paths were identified: Investment, Fee and Repo models, with a fourth path (the Investment2 model) emerging post-2017. Only the Repo model enhances bank returns (ROA &amp; ROE), while shifts towards NTFI increase liquidity and leverage risks across all models. The evolution of bank business models and their consequent implications on performance and risks are influenced by regulatory objectives and banks’ endeavours in regulatory arbitrage.Practical implicationsMajor stakeholders in the banking sector can gain a better understanding of financial intermediation and associated market behaviour, performance and risks, with significant implications for banking regulations and crisis management.Originality/valueThis study provides the first comprehensive overview of the evolution of Chinese commercial banks’ financial intermediation activities over an extended period, uncovering the unique characteristics distinct from the developed economies.

Exploring problems Dutch transgender and gender diverse people experience during transition

Background and Aim During transition transgender and gender diverse (TGD) people may experience various problems. This research aimed to identify the problems Dutch TGD people face during transition, to examine how frequently they encounter these problems, and to create an overview of the main problems. Method The concept mapping method was used to inventory problems TGD people experience during the transition process. A focus group, consisting of TGD people and care providers, formulated seventy-four such problems. Subsequently, a new group of 124 TGD participants reported how often they perceived these problems. We analyzed the frequencies of the experienced problems and the differences between groups based on gender identity and transition phase using MANOVA. The influence of age was examined with multiple regression analyses. Results Principal component and cluster analysis, based on these problems, revealed five clusters: problems arising from the care process, consequences of the transition in relation to yourself, consequences of the transition in relation to others, problems arising from society, and financial consequences of the transition. The most frequently experienced problems were the long waiting lists, confrontation with one’s body, and the energy the transition takes. The MANOVAs revealed that frequency scores varied with identity and phase of transition. For example, trans men and nonbinary people reported a higher frequency of experiencing problems related to body satisfaction than trans women. The frequency scores were correlated with age; younger participants scored higher on many experienced problems. Discussion We highlighted the problems that emerge during transition. The observed differences between groups showed that TGD people vary widely in their experiences during transition. This inventory can provide useful input for supporting TGD people during their transition and serve as a guide for the development of more TGD-inclusive policies.

The Challenges of Patients with Spinal CSF Leaks in Canada: A Cross-Sectional Online Survey.

Spinal CSF leak can cause disabling headaches and neurological symptoms. Lack of awareness, diagnostic delay and treatment inconsistencies affect the quality of CSF leak care globally. This is the first study aiming to identify and assess these challenges in Canada. A cross-sectional online survey of Canadian patients with spinal CSF leak was designed in collaboration with Spinal CSF Leak Canada, including questions on demographics, headache condition, investigations, treatments, quality of life, financial consequences and out-of-country care. The survey captured 103 respondents with confirmed spinal CSF leak diagnosis, of whom 56% were still suffering. The majority were female (80%), most being highly educated, with a mean age of 41.8 (SD: 10.37) years at the time of diagnosis. Inconsistencies in care resulted in variable durations for obtaining diagnosis and treatment. The majority of respondents (88%) had seen multiple physicians, and only 50% had seen a CSF leak specialist. Invasive imaging was not performed in 43%. CSF leak relapse after initial successful treatment occurred frequently (43%). The incidence of rebound intracranial hypertension was high (52.5%), and the treatment was difficult to access (77%). Out-of-country care was common (28%), and the impact on financial health was omnipresent (81.5%). The survey demonstrates significant gaps in spinal CSF leak care in Canada, similar to global observations. Lack of awareness and access, delayed care, and inconsistencies in investigations and management are common. Spinal CSF leak significantly impacts patients' physical, mental and financial well-being. Increased awareness, referral pathways and standardized treatment algorithms are key factors in optimizing patient care in Canada.

VS 07 - OGC Visualisation of variant thoracic duct anatomy using mesenteric injection of Indocyanine Green (ICG) and early ligation of the high thoracic duct can decrease the occurrence of chyle leaks after robotic oesophagectomies: Insights from a single-centre case series

Abstract Background Chyle leak (CL) remains a relatively common complication following oesophagectomy, with reported incidence up to 9%, and is associated with significant clinical and financial consequences. We assess the feasibility and utility of fluorescence to visualise the thoracic duct (TD), using an easy-to perform intraoperative technique. This involves injecting ICG into the small bowel mesentery during robotic Ivor-Lewis oesophagectomy (RAMIO) and early ligation of the thoracic duct above azygos arch. Method Between 2022-2024, 36 patients undergoing RAMIO received ICG (2ml of 2.5mg/mL solution) injected in the root of jejunal mesentery by endoscopic needle injector via laparoscopic port during the abdominal phase. A minimum of 60min following injection, fluoroscopic visualisation of TD anatomy was performed with Firefly® system. During the initial phase of the thoracic stage, the thoracic duct was located in the upper mediastinum, just above azygos arch, and was securely clipped using the Hem-o-Lok® system. Results Successful TD imaging using ICG-fluorescence was achieved in all 36 patients undergoing RAMIO. Variations from the standard single duct structure were observed in 4 (11%) of patients. Specifically, two cases exhibited duct bifurcation at the level of the azygos arch, one case had branching in the lower mediastinum, and another case demonstrated branching from the main duct over the thoracic aorta. All observed branches were individually clipped with Hem-o-Lok® system. Two individuals (5.5%) experienced low-volume chyle-leak post-operatively, which was successfully managed conservatively. No chyle leaks were detected at the end of the surgery in any of the cases. Conclusion In our single-centre experience, fluorescence visualisation of the thoracic duct during RAMIO by intraoperative mesenteric injection of ICG is an easily performed, reproducible technique which can assist in the visualisation of variant TD anatomy and reduce the incidence of CL. In addition to its impact on clinical outcomes and healthcare costs, the approach can also support a better appreciation of TD anatomy among surgeons.

EDI&amp;S SO09 Tracking Waste in Surgical Theatres (TWIST) - a snapshot of waste production in a large teaching hospital

Abstract Background The NHS contributes up to 5% of the UK’s greenhouse gas emissions. Thirty percent is generated by operating theatres, of which a significant proportion comes from single-use consumables. The aim of this project was to evaluate the amount and cost of disposable material that was opened but unused in theatres. By identifying areas for improvement, this can help to reduce the environmental impact of our work. Method This was a trainee lead collaborative study taking place over a period of two weeks at a tertiary teaching hospital, between Monday 19th and Friday 30th June. We prospectively collected information on the number of consumables that were opened but unused across various surgical specialties. The number and type of materials wasted at the end of each list were recorded and a cost analysis performed. A questionnaire was sent to staff to assess factors influencing theatre waste. Results A total of 238 operating lists were covered during the study period. A total of 636 procedures took place, and 544 items were wasted, coming to a cost of £1993.56. The mean number of items wasted per list was 2.3 and the mean cost per list was £8.38. The most common item wasted was sutures. The most common factors staff felt contributed to waste production were the surgeon’s preferences and lack of experience among staff. Conclusion Unnecessary waste production in theatres has significant environmental and financial consequences. We can hope to reduce this by educating staff, including surgeons and the wider theatre team.

Equal compensations under actuarially fair contributions in endowment contingency funds

This paper considers risk-sharing schemes, aiming to demonstrate that it is possible to enforce equal compensations by charging actuarially fair contributions. Specifically, consider a group of individuals exposed to the occurrence of a predefined event with adverse financial consequences such as death, survival or being diagnosed with a critical illness for instance. All members of the group agree to contribute in advance a fixed amount to a pool constituted over a reference period with the understanding that the sum of the contributions is shared in arrear among those participants having experienced the predefined event. This allocation is either uniform among claiming participants, each one receiving an equal share of total contributions, or participants are offered the choice to select a desired protection level. In the latter case, participants are free to subscribe one or several units of protection from the fund, and the total amount collected in advance is shared in arrear, equally among all units held by those participants who experienced the predefined event. Endowment contingency funds aim to provide participants with a cheap and effective protection compared to commercial insurance. The reason is that the proposed system is fully funded so that there is no risk borne by the organizer. The benefits in case the event occurs are therefore random but the volatility of the terminal payouts turns out to be limited when the number of participants gets large enough. Under independence, insurance at fair price is recovered at the limit, within infinitely large pools. As an application, the paper considers mutual aid funds and survivor funds. A comparison with takaful insurance is performed.

KEY STAGES AND INNOVATIVE APPROACHES IN RISK MANAGEMENT UNDER UNCERTAINTY

The purpose of the article is to analyze in detail the process of risk management at enterprises, in particular, its key stages. In addition, the article aims at studying the current instruments of bankruptcy risk management which can be implemented in the modern economy. The relevance of the article is stipulated by the need to improve approaches to risk management in today's dynamic business environment, where enterprises are constantly facing financial and operational threats. Of particular importance is bankruptcy risk management, since economic instability and high level of competition require effective mechanisms to protect financial stability. The following methods are used in the study: the method of analysis and synthesis - for a structured consideration of the stages of the risk management process, identifying the relationships between them and forming a holistic picture of management actions at each stage; the method of logical generalization - for formulating general conclusions and recommendations on the stages and tools of risk management based on the analysis of literature and practical examples. The result of the study is to determine the essential characteristics of the main stages of the enterprise risk management process and the relevant tools for managing the bankruptcy risk. This includes: a structured description of the key stages of risk management – from risk identification and assessment to monitoring and control, which ensures a systematic approach to responding to threats; analysis of current tools for managing bankruptcy risk – identification of tools that facilitate early detection of risks and support the financial stability of the enterprise. The practical value of the article lies in providing enterprises with a clear description of the risk management process, which includes the main stages from identification to monitoring and control, allowing companies to take a more systematic approach to risk management and reducing the likelihood of negative financial consequences. The use of the current tools for managing bankruptcy risk described in the article provides an opportunity to quickly identify early signs of financial instability, which helps to maintain their financial stability. In addition, the proposed recommendations can be integrated into the enterprise management system, creating a flexible and adaptive model to maintain stable development in the face of economic uncertainty.

Optimizing 5-aminosalicylate for moderate ulcerative colitis: expert recommendations from the Asia-Pacific, Middle East, and Africa Inflammatory Bowel Disease Coalition.

The lack of clear definition and classification for "moderate ulcerative colitis (UC)" creates ambiguity regarding the suitability of step-up versus top-down treatment approaches. In this paper, experts address crucial gaps in assessing and managing moderate UC. The Asia-Pacific, Middle East, and Africa Inflammatory Bowel Disease Coalition comprised 24 experts who convened to share, discuss and vote electronically on management recommendations for moderate UC. Experts emphasized that the goal of treating UC is to attain clinical, biomarker, and endoscopic remission using cost-effective strategies such as 5-aminosalicylates (5-ASAs), well-tolerated therapy that can be optimized to improve outcomes. Experts agreed that 5-ASA therapy could be optimized by maximizing dosage (4 g/day for induction of remission), combining oral and topical administration, extending treatment duration beyond 8 weeks, and enhancing patient adherence through personalized counselling and reduced pill burden. Treatment escalation should ideally be reserved for patients with predictors of aggressive disease or those who do not respond to 5-ASA optimization. Premature treatment escalation to advanced therapies (including biologics and oral small molecules) may have long-term health and financial consequences. This paper provides consensus-based expert recommendations and a treatment algorithm, based on current evidence and practices, to assist decision-making in real-world settings.

The Impact of the COVID-19 Pandemic on Taxpayers in Nigeria

There is no doubt that the outbreak of the Coronavirus disease (COVID-19) strikes the world with unparalleled disruption in economic and business activities. The impacts of the COVID-19 pandemic have dealt a serious blow to businesses, households, individuals, and revenue generation by governments across the globe with Nigeria being no exception. As a result, Nigeria introduced certain tax measures through the Emergency Economic Stimulus Bill 2020 to mitigate the impact of the pandemic on taxpayers but these measures are inadequate and in some ways impracticable. The measure includes a temporary relief to companies and individuals to alleviate the adverse financial consequences of a slowdown in economic activities as a result of the COVID-19 pandemic. The article argues that it is clear that the COVID-19 pandemic has drastically reduced business activities and the Bill does nothing to reduce or remove the existing tax burden but simply postpones the same to a later date. This negates section 14(2)(b) of the Nigerian Constitution 1999 as amended which provides that the security and welfare of the people shall be the primary purpose of government. This raises a critical question as to whether revenue generation by the Nigerian government is more important than preventing hardships and reducing the burden of Nigerian taxpayers whose welfare the government has sworn to protect through the Constitution. The implication is that the Nigerian government needs to revise its tax regime encompassing incentives such as tax credits, write-offs, and tax holidays in a bid to provide adequate relief to the taxpayers pending the eradication of the pandemic and a return to economic stability.

Real world economic evaluation of CT-FFR in patients with suspected coronary artery disease

Abstract Background Incorporation of CT-derived fractional flow reserve (CT-FFR) enhances the precision of Coronary CT Angiography (CCTA) to detect hemodynamically significant coronary artery disease (CAD). However, the financial consequences remain unclear. Purpose Our objective is to assess the economic implications of CT-FFR in the Dutch Healthcare system. Methods This retrospective, single-center cost effectiveness analysis includes patient data of a previously published study assessing the impact of routine CT-FFR availability on clinical management. We collected medical resource use for both diagnostic and therapeutic cardiovascular care with a follow-up duration of 1 year. Costs of CT-FFR analysis were set at €1000, its current price for Dutch hospitals. Median total costs at were compared using the Wilcoxon rank sum test, including a sensitivity analysis in which cost estimations (without registered maximum tariffs) were increased or decreased with 10%. Results A total of 360 patients, classified as having low to intermediate risk of CAD, were enrolled in the study – 224 in the CCTA group and 136 in the CT-FFR group. In addition to undergoing more (invasive) diagnostic testing and revascularization procedures over the studied period, patients in the CCTA-group had more outpatient clinic consultations (p&amp;lt;0.001), presented more frequently to the emergency department (p=0.035) and spend more nights in the hospital (p=0.11). Median costs were €3.347 (IQR €1.066 – €4.862) in the CCTA-group and €1.436 (IQR €1.362 - €3.943) in the CT-FFR group (p=0.091). Increasing cost estimation with 10% revealed a median of €3.431 in the CCTA-group versus €1.479 in the CT-FFR group (p=0.078), decreasing with 10% showed median costs of €3.263 in the CCTA-group and €1.392 in the CT-FFR group (p=0.118). In our sample, CT-FFR guided care would have been significantly cheaper than CCTA-guided care at or below a market price of €770. Conclusion Despite the significant reduction in additional diagnostic testing and hospital visits in the CT-FFR group, CT-FFR guided care was not cheaper than CCTA-guided care at its current market price of €1.000. Economic cost-effectiveness would have occurred from a price of €770 per analysis. The large difference between medians suggests that the lack of significance might partially be attributed to insufficient power in this relatively small sample size. Additionally, this study did not account for costs associated with loss of productivity and quality of life. However, less additional diagnostic testing, less revascularization procedures and less hospital consultations and admissions leads to reduction in hospital resource consumption and patient burden, which is an important advantage of CT-FFR as the number of referred patients increases yearly.

Retraction Note: Adopting environmental sustainability: the financial consequences of clean energy and technology acceptance in the energy transition

Retraction Note: Adopting environmental sustainability: the financial consequences of clean energy and technology acceptance in the energy transition

The financial impact of participant attrition from randomised trials: a case-study from the Occupational Therapist Intervention Study (OTIS).

Loss to follow-up of participants can compromise the statistical validity of randomised trials. Moreover, it can have financial consequences for trial teams and funders. This study explores the Occupational Therapist Intervention Study (OTIS) where, despite a withdrawal rate of less than 10%, the trial team incurred opportunity costs related to participants who were initially recruited but subsequently decided to withdraw from the trial. To estimate the cost of participant losses to follow-up in the OTIS trial and thus introduce a costing framework to research teams on how they could estimate the opportunity costs of participant withdrawal from their randomised trials. The participants lost to follow-up are differentiated by (1) the time point at which they were lost to follow-up; (2) the treatment group they were allocated to; (3) their response patters to follow-up questionnaires; these elements were considered to identify the relevant types of attrition. Protocol-driven costs of trial materials, including administration, print, and shipping, were gathered. We calculated unit costs for each type of attrition by multiplying protocol-driven and intervention costs with the relevant number of participants. Summing up unit costs by type of loss to follow-up yields aggregate figures, enabling the estimation of aggregate and average opportunity costs of attrition. The average cost per participant loss to follow-up in the OTIS trial is £98.41. The aggregate cost of participant loss to follow-up is £10,234.90 from the economic perspective of the trial team. Therefore, 1.42% of the allocated funding has been misallocated because of participant loss to follow-up. Despite the low attrition rate of the OTIS trial, loss to follow-up has still generated considerable opportunity costs. It is recommended that decision makers focus on identifying strategies which could improve participant retention in randomised trials to optimise their budget.

Rx for Legal Troubles: CEO Medical Degree and Corporate Litigation

ABSTRACTResearch Question/IssueThis study examines the relationship between CEOs' medical degrees (MDs) and corporate litigations targeting US pharmaceutical firms.Research Findings/InsightsCEOs with a medical background are significantly more susceptible to securities class actions, while facing fewer patent lawsuits. The results indicate that the lack of management skills among MD CEOs comes at the cost of firm value. After lawsuit announcements, companies led by MD CEOs experience a significantly negative effect on their stock prices. Markets show no tolerance for failures by MD CEOs, as evidenced by the impact of clinical trial disappointments.Theoretical/Academic ImplicationsThe findings contribute to our understanding of the impact of CEOs' medical backgrounds on corporate litigation outcomes. The results suggest that when examining how a CEO's qualifications affect legal issues and the value of a company, we should consider the unique context of having an MD.Practitioner/Policy ImplicationsPractically, the study implies that firms should carefully consider the balance of managerial and medical expertise in CEO appointments, recognizing the potential legal and financial consequences. Policymakers might see it as beneficial to encourage a mix of different skills among top executives. This could make pharmaceutical companies more resilient in the face of legal issues, which, in turn, helps maintain confidence among investors.