Individual Risk Research Articles

The lacrimal apparatus as an organ at risk during radionuclide therapy

Within the framework of the article, the authors analyzed the available information about the damage to the lacrimal apparatus during radionuclide therapy. In focus of article lesions of the lacrimal production system, the main and accessory lacrimal glands, as well as lacrimal drainage are considered. It was found that damage to the lacrimal apparatus is characteristic of 131I therapy for thyroid cancer, as well as for radioligand therapy using anti-PSMA antibodies labeled with 177Lu and 225Ac. 177Lu-PSMA and 225Ac-PSMA may damage the lacrimal gland with the formation of a clinically pronounced "dry eye syndrome". The pathogenesis of such lesions is associated with the accumulation of a radioisotope in the tissues of the lacrimal apparatus, while during therapy with 131I, accumulation is realized due to the expression of the sodium-iodine symporter in the nasolacrimal duct, and during therapy with 177Lu-PSMA and 225Ac-PSMA, the radiobiological effect is realized in connection with the expression PSMA by lacrimal tissue. An analysis of the available sources showed that to date there are no results of systematic studies on the problem, there is a lack of knowledge regarding the individual risks of developing these complications, methods for their prevention that have proven effectiveness have not been developed, and the treatment methods used, having relatively low efficiency, are not specialized. The authors concluded that the strengthening of interdisciplinary interaction, as well as the organization verification methodology and correct studies, can contribute to solving problems related to the study of the complications under consideration.

The effects of dynamic multi-hazard risk assessment on evacuation strategies in chemical accidents

With the agglomeration and complication of the chemical industry, the multi-hazard and dynamic characteristics have become new challenges for chemical safety management and loss prevention research. As an important topic of safety research in chemical industries, the evacuation strategy also needs to be improved according to the new characteristics of chemical accidents. Here we propose a method for evacuation strategy development in chemical accidents based on dynamic and multi-hazard risk assessment. This method adopts the cumulative individual risk as the evaluation indicator for the optimal evacuation strategy. This method can dynamically consider the multi-hazard characteristics and domino effects of chemical accidents during the evacuation. A multi-hazard chemical accident that happened in Xiangshui, China in 2019 is taken as a case study to show the effects of risk assessment results on evacuation strategy development. The case shows that a reasonable time period for shelter-in-place after the occurrence of the primary accident can reduce the cumulative individual risk in the evacuation process. It is expected that this paper can provide guidance and reference for loss prevention in chemical industries, and can also provide useful tools for the management of emergency response.

Effectiveness of Community Education for Breast Cancer Screening.

Screening based on individual risk factors results in detection of earlier, more curable breast cancer. There is expectation that improved public education about the importance of personalized screening will result in earlier diagnoses and reduced breast cancer mortality. The purpose of this study is to evaluate the effectiveness of community education on patient perceptions about risk-based screening. This study is Health Insurance Portability and Accountability Act-compliant and institutional review board exempt. A standardized curriculum was used by radiologists and experts to conduct nine 1-hour patient education sessions between October 2018 and January 2019 about breast cancer risk factors and screening options. Patient participants completed voluntary, anonymous pre-event and post event surveys to determine if the presented educational program led to attitude changes. Survey results were summarized using statistical analysis including mean, median, range, and percentage of participants responding and comparison of pre- and post event fear and anxiety. Of 336 education session participants, 59.5% (200/336) completed the pre-event and 44.3% (149/336) completed the post event surveys, Respondents reported decreased anxiety and fear regarding breast cancer screening following educational sessions, with 36.1% (64/178) reporting anxiety pre-event compared to 23.3% (31/133) post event, although the difference was not statistically significant (P = .96). Additionally, 64.7% (55/85) of participants stated they were more likely to schedule breast cancer screening based on individual risk factors, and 98.0% (145/148) of participants reported increased knowledge on post event surveys. This study demonstrates the importance and effectiveness of community-based educational programs in increasing knowledge of risk-based screening and potentially reducing anxiety related to screening.

Nightmares share genetic risk factors with sleep and psychiatric traits.

Nightmares are vivid, extended, and emotionally negative or negative dreams that awaken the dreamer. While sporadic nightmares and bad dreams are common and generally harmless, frequent nightmares often reflect underlying pathologies of emotional regulation. Indeed, insomnia, depression, anxiety, or alcohol use have been associated with nightmares in epidemiological and clinical studies. However, the connection between nightmares and their comorbidities are poorly understood. Our goal was to examine the genetic risk factors for nightmares and estimate correlation or causality between nightmares and comorbidities. We performed a genome-wide association study (GWAS) in 45,255 individuals using a questionnaire-based assessment on the frequency of nightmares during the past month and genome-wide genotyping data. While the GWAS did not reveal individual risk variants, heritability was estimated at 5%. In addition, the genetic correlation analysis showed a robust correlation (rg > 0.4) of nightmares with anxiety (rg = 0.671, p = 7.507e-06), depressive (rg = 0.562, p = 1.282e-07) and posttraumatic stress disorders (rg = 0.4083, p = 0.0152), and personality trait neuroticism (rg = 0.667, p = 4.516e-07). Furthermore, Mendelian randomization suggested causality from insomnia to nightmares (beta = 0.027, p = 0.0002). Our findings suggest that nightmares share genetic background with psychiatric traits and that insomnia may increase an individual's liability to experience frequent nightmares. Given the significant correlations with psychiatric and psychological traits, it is essential to grow awareness of how nightmares affect health and disease and systematically collect information about nightmares, especially from clinical samples and larger cohorts.

Banking sector reforms in a challenging environment: An emerging financial market experience

The long-lasting impact of reforms on financial institutions in the presence of country level risks and uncertainties may be unclear but has been rarely investigated. By using more than two decades of Pakistani banking industry data covering a period of uncertain policies and volatile political and economic environment alongside severe security threats due to terrorism, this study examines technical change, scale effect, and total factor productivity growth. Our estimates show that despite deep economic and regulatory reforms spreading over a decade, country level risks and uncertainties led to no longer run technological progress and productivity growth. This made the long-run outcome of broader reforms in the presence of a number of uncertainties less satisfactory and did not help materialize the true benefits of reforms. Change of ownership through privatization contributed positively in achieving technological progress and productivity growth, but this limited positive effect faded subsequently. Interestingly, the negative impact of risks and uncertainties is more severe for domestic privately owned and foreign-owned banking firms with parent institutions based in other than Western and developed countries. More specific analysis of the individual uncertainties and related risks shows that although economic, legal, and security-related risks and uncertainties are important for all firms in determining the outcome of reforms, increased uncertainty with corruption perception, law & order conditions, and investment climate in particular impacts more domestically owned firms.

Arsenic (As) accumulation in different genotypes of indica rice (Oryza sativa L.) and health risk assessment based on inorganic As.

To reveal differences in arsenic (As) accumulation among indica rice cultivars and assess the human health risks arising from inorganic arsenic (iAs) intake via rice consumption, a total of 320 field indica rice samples and corresponding soil samples were collected from Fujian Province in China. The results showed that available soil As (0.03 to 3.83mg/kg) showed a statistically significant positive correlation with total soil As (0.10 to 19.45mg/kg). The inorganic As content in brown rice was between 0.001 and 0.316mg/kg. Among the cultivars, ten brown rice samples (3.13%) exceeded the maximum contaminant level (MCL) of iAs in food of 0.2mg/kg in China. The estimated daily intake (EDI) and calculated individual incremental lifetime cancer risk (ILCR) ranged from 0.337µg/day to 106.60µg/day and from 8.18 × 10-6 to 2.59 × 10-3, respectively. Surprisingly, the average EDI and the EDIs of 258 (80.63%) brown rice samples were higher than the maximum daily intake (MDI) of 10µg/day in drinking water as set by the National Research Council. The mean ILCR associated with iAs was 54.3 per 100,000, which exceeds the acceptable upper limit (AUL) of 10 per 100,000 set by the USEPA. Notably, the cultivars Y-Liang-You 1 and Shi-Ji 137 exhibited significantly higher mean ILCRs compared to the AUL and other cultivars, indicating that they pose more serious cancer risks to the local population. Finally, this study demonstrated that the cultivars Yi-Xiang 2292 and Quan-Zhen 10 were the optimal cultivars to mitigate risks associated with iAs to human health from rice consumption.

Quantitative risk assessment for static and mobile road users: methodology and application at A82 Glen Coe, Scotland

BackgroundIn August 2004 a series of debris flows caused significant disruption to the Scottish (strategic) Trunk Road Network. The subsequent Scottish Road Network Landslides Study identified a number of sites considered to be at highest risk. Some of these sites have been the subject of formal quantitative assessment of the risk from debris flow to mobile road users in vehicles. The A82 in Glen Coe has the added complication that two car parks have developed on debris fans exposing significant numbers of people to the risk while, they are essentially static and largely outside their vehicles.MethodologyThe risk to road users is determined using a previously developed probabilistic methodology for mobile road users (mobile elements at risk) and a new and related methodology developed for static road users (static elements at risk) is described and applied. Within the latter, an entirely new metric of Annual Average Daily Visits is used to allow the temporal component of the probability of a landslide impacting a person to be determined given the occurrence of an event.ResultsWhile Personal Individual Risk is at an acceptable level, including for frequent users, the risk presented to society as a whole presents a rather different picture; this is largely due to the number of visitors. The results assess the overall, societal risk for mobile elements at risk as As Low As reasonably Practicable, being at a similar level to other sites, albeit with a higher risk associated with higher numbers of fatalities. The results for the static elements at risk on the other hand suggest that the risks are classified as Unacceptable for higher numbers of fatalities. The assessment of the total societal risk, for mobile and static elements at risk, at the A82 Glen Coe suggests As Low As Reasonably Practicable for low numbers of fatalities but classify as Unacceptable for higher numbers of fatalities (around 20 to 250).

Risk Factors for Postoperative Delirium in Patients Undergoing Major Head and Neck Cancer Surgery: A Meta-analysis.

Postoperative delirium (POD) is a common and serious complication after extensive surgery. Understanding the independent and potential modifiable risk factors leading to POD in patients with head and neck cancer (HNC) can provide information for future intervention trials aimed at reducing this risk. To systematically analyze influencing factors of POD in patients with HNC and identify high-risk individuals for delirium. PubMed, EMBASE, Scopus, OVID, and Cochrane Library were searched for publications prior to June 2023. Comparative studies in which POD risk factors were investigated were identified following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Newcastle-Ottawa Scale was used to evaluate the study quality. Pooled odds ratios or mean differences for individual risk factors were estimated using the Mantel-Haenszel and inverse-variance methods. This review included 17 studies with a total of 4188 patients undergoing HNC surgery. The pooled prevalence of POD was 15.44%. Based on pooled analysis, 8 significant risk factors were identified including age older than 70 years, male sex, history of smoking, history of psychiatric disorder, American Society of Anesthesiologists score, albumin level, postoperative insomnia, and fluid intake. In the present study, 8 factors that correlated with POD were identified: 6 preoperative, 1 intraoperative, and 1 postoperative. The influencing factors for POD in patients with HNC were identified that can provide a reference for improving the psychological state of the patient population and further development of effective treatment interventions.

Коморбидность дислипидемии и заболеваний пародонта

Dyslipidemia – increased blood levels of cholesterol, triglycerides and atherogenic lipoproteins and/or decreased levels of anti-atherogenic high-density lipoproteins. Dyslipidemia is considered one of the main biological risk factors for chronic non-communicable diseases, along with overweight and obesity, arterial hypertension and hyperglycemia. The initial stage of correction of dyslipidemia begins with dietary recommendations, in which omega-3 polyunsaturated fatty acids occupy an important place. The effects of the main substances included in the combined nutraceutical Cholesterol Control are considered: omega-3 polyunsaturated fatty acids, including eicosapentaenoic and docosahexaenoic acids, red yeast rice, coenzyme Q10, which allows us to consider it the nutraceutical of choice for low and moderate risk individuals with moderately elevated cholesterol and triglycerides, no indications for taking statins or the presence of contraindications to taking them. Periodontitis is the sixth most common disease in the world (second among dental pathologies after caries) and the leading cause of tooth loss in adults. At the beginning of the 21st century, the concept of “periodontal medicine” was formed, within the framework of which the bidirectional connection of periodontal pathology with systemic diseases of the body is considered. We searched the PubMed and Scopus information databases for articles published before 02/15/2024 that examined the relationship between dyslipidemia and periodontal pathology. The results obtained indicate the presence of a bidirectional relationship between dyslipidemia and periodontal pathology. The analysis showed the positive effect of omega-3 polyunsaturated fatty acids and coenzyme Q10 on the inflammatory process in periodontal tissue and allows us to consider the nutraceutical Cholesterol Control as an adjuvant therapy in comorbid patients with dyslipidemia and periodontal pathology, as well as for the prevention of lipid disorders in patients with periodontal diseases.

Lifestyle risk factors and all-cause and cause-specific mortality in the Mexico City prospective study: Assessing the influence of reverse causation

BackgroundWe examined the association between individual lifestyle risk factors with all-cause and cause-specific mortality. MethodsProspective cohort study including 155,002 participants from the Mexico City Prospective Study. Cox regression models were used to estimate the association between individual lifestyle risk factors and all-cause and cause-specific mortality. Participants with prevalent diseases at baseline and participants who died during the first 2, 5, 10, and 15 years of follow-up were excluded to account for reverse causation. Results27,469 people died during 18.3 years of follow-up years. Overweight and moderate alcohol consumption were inversely associated with all-cause mortality, while low physical activity and smoking were positively associated when all participants were included, regardless of prevalent disease or duration of follow-up. The direction of the association of overweight with all-cause mortality changed from inverse to positive after excluding the first 10 years of follow-up. Compared with normal weight, the hazard ratio (95 % confidence interval) was 1.17 (1.13,1.22) for obesity after excluding those who died in the first 5 years of follow-up and 1.71 (1.59,1.84) after excluding the first 15 years of follow-up. The magnitude of the association of alcohol intake, low physical activity, and smoking with mortality attenuated, whereas for fruits and vegetables increased, after excluding longer periods of follow-up. LimitationsThe data were collected exclusively in Mexico City; lifestyle risk factors were self-reported and thus prone to misclassification bias. ConclusionsReverse causation may influence both the magnitude and the direction of the associations between lifestyle risk factors and mortality.

Spatiotemporal Patterns of Reptile and Amphibian Road Fatalities in a Natura 2000 Area: A 12-Year Monitoring of the Lake Karla Mediterranean Wetland.

The pervasive expansion of human-engineered infrastructure, particularly roads, has fundamentally reshaped landscapes, profoundly affecting wildlife interactions. Wildlife-vehicle collisions, a common consequence of this intricate interplay, frequently result in fatalities, extending their detrimental impact within Protected Areas (PAs). Among the faunal groups most susceptible to road mortality, reptiles and amphibians stand at the forefront, highlighting the urgent need for global comprehensive mitigation strategies. In Greece, where road infrastructure expansion has encroached upon a significant portion of the nation's PAs, the plight of these road-vulnerable species demands immediate attention. To address this critical issue, we present a multifaceted and holistic approach to investigating and assessing the complex phenomenon of herpetofauna road mortality within the unique ecological context of the Lake Karla plain, a rehabilitated wetland complex within a PA. To unravel the intricacies of herpetofauna road mortality in the Lake Karla plain, we conducted a comprehensive 12-year investigation from 2008 to 2019. Employing a combination of statistical modeling and spatial analysis techniques, we aimed to identify the species most susceptible to these encounters, their temporal and seasonal variations, and the ecological determinants of their roadkill patterns. We documented a total of 340 roadkill incidents involving 14 herpetofauna species in the Lake Karla's plain, with reptiles, particularly snakes, being more susceptible, accounting for over 60% of roadkill occurrences. Moreover, we found that environmental and road-related factors play a crucial role in influencing roadkill incidents, while spatial analysis techniques, including Kernel Density Estimation, the Getis-Ord Gi*, and the Kernel Density Estimation plus methods revealed critical areas, particularly in the south-eastern region of Lake Karla's plain, offering guidance for targeted interventions to address both individual and collective risks associated with roadkill incidents.

2023 Year in review: Early breast cancer

The results of several studies aiming to tailor early breast cancer treatment to individual risk were released in 2023. Axillary lymph node dissections and radiotherapy may be safely omitted in carefully selected patients. Sustained benefit from adjuvant CDK4/6 inhibitors was observed in high-risk hormone receptor-positive disease and the addition of immunotherapy to neoadjuvant chemotherapy improved pathological response. Continued benefit from perioperative pembrolizumab was reported in patients with triple negative breast cancer, while atezolizumab did not improve the risk of recurrence either pre- or postoperatively. The chance of pregnancy was higher in younger patients attempting to conceive after breast cancer.

Risk prediction model construction for asthma after allergic rhinitis by blood immune T effector cells.

Allergic rhinitis (AR) and asthma (AS) are prevalent and frequently co-occurring respiratory diseases, with mutual influence on each other. They share similar etiology, pathogenesis, and pathological changes. Due to the anatomical continuity between the upper and lower respiratory tracts, allergic inflammation in the nasal cavity can readily propagate downwards, leading to bronchial inflammation and asthma. AR serves as a significant risk factor for AS by potentially inducing airway hyperresponsiveness in patients. Currently, there is a lack of reliable predictors for the progression from AR to AS. In this exhaustive investigation, we reexamined peripheral blood single cell RNA sequencing datasets from patients with AS following AR and healthy individuals. In addition, we used the bulk RNA sequencing dataset as a validation lineup, which included AS, AR, and healthy controls. Using marker genes of related cell subtype, signatures predicting the progression of AR to AS were generated. We identified a subtype of immune-activating effector T cells that can distinguish patients with AS after AR. By combining specific marker genes of effector T cell subtype, we established prediction models of 16 markers. The model holds great promise for assessing AS risk in individuals with AR, providing innovative avenues for clinical diagnosis and treatment strategies. Subcluster T effector cells may play a key role in post-AR AS. Notably, ACTR3 and HSPA8 genes were significantly upregulated in the blood of AS patients compared to healthy patients.

GBA1 rs3115534 Is Associated with REM Sleep Behavior Disorder in Parkinson's Disease in Nigerians.

Rapid eye movement (REM) sleep behavior disorder (RBD) is an early feature of Parkinson's disease (PD) and dementia with Lewy bodies (DLB). Damaging coding variants in Glucocerebrosidase (GBA1) are a genetic risk factor for RBD. Recently, a population-specific non-coding risk variant (rs3115534) was found to be associated with PD risk and earlier onset in individuals of African ancestry. We aimed to investigate whether the GBA1 rs3115534 PD risk variant is associated with RBD in persons with PD. We studied 709 persons with PD and 776 neurologically healthy controls from Nigeria. All DNA samples were genotyped and imputed, and the GBA1 rs3115534 risk variant was extracted. The RBD screening questionnaire (RBDSQ) was used to assess symptoms of possible RBD. RBD was present in 200 PD (28.2%) and 51 (6.6%) controls. We identified that the non-coding GBA1 rs3115534 risk variant is associated with possible RBD in individuals of Nigerian origin (β, 0.3640; standard error [SE], 0.103, P = 4.093e-04), as well as in all samples after adjusting for PD status (β, 0.2542; SE, 0.108; P = 0.019) suggesting that although non-coding, this variant may have the same downstream consequences as GBA1 coding variants. Our results indicate that the non-coding GBA1 rs3115534 risk variant is associated with an increasing number of RBD symptoms in persons with PD of Nigerian origin. Further research is needed to assess if this variant is also associated with polysomnography-defined RBD and with RBD symptoms in DLB. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Association Between Myocardial Infarction and Triglyceride-Glucose Index: A Study Based on NHANES Database.

To investigate differences in levels of the triglyceride-glucose (TyG) index between individuals with myocardial infarction (MI) and those without MI, as well as the association between TyG index and risk of MI. Data from the National Health and Nutrition Examination Survey (NHANES) for US adults from 2013 to 2018 were included in this study. Using MI as an outcome variable and TyG index as an exposure variable, logistic regression models were employed to analyze relationship between MI and TyG index. The study included 6,695 participants. Compared to the non-MI group, patients with MI had significantly higher TyG index (8.89 vs. 8.63, P = 0.003). Higher TyG index was significantly associated with an increased risk of MI in US adults (OR: 1.69, 95% CI: 1.26-2.26, P < 0.001). Race, smoking status, and history of chronic obstructive pulmonary disease (COPD) had significant impacts on the association between TyG index and risk of MI (P for interaction < 0.05). Subgroup analysis demonstrated a significant positive correlation between TyG index and MI risk in non-Hispanic Black individuals, non-smokers, and individuals without COPD across multiple models (OR > 1.0, P < 0.05). US adults with higher TyG index were more susceptible to MI, and TyG index may be used to identify individuals at high risk of MI in the US population.

Risk calculator of the clinical response to antihistamines in chronic urticaria: Development and internal validation.

Early detection of CSU patients with low probability of a clinical response with antihistamines could undergo prompt initiation of therapeutic alternatives. The aim of the study was to develop and internally validate a model for predicting the clinical response to antihistamines in adult patients with chronic spontaneous urticaria (CSU), who consult allergology and dermatology care centers. A cohort of CSU patients, recruited from four participating centers, were followed up for 12 months. Fifteen candidate variables were selected to be included in the multivariate model and then internal validation was done with bootstrap analysis with 1000 simulations. The outcome variable, clinical response to antihistamines, was evaluated with the UAS (Urticaria Activity Score) scale for seven days: "No response to antihistamines" was defined as UAS7 ≥7 points after at least one month with a maximum dose of antihistamines, while "Response to antiH1" was defined as UAS7 ≤6 points for at least three months with the use of antiH1. A total of 790 patients were included. Among the different models analyzed, the model that included age, angioedema, anxiety/depression, time with the disease, NSAIDs (Non-steroidal anti-inflammatory drugs) intolerance, and UAS7 baseline was considered the one with the best performance (accuracy 0.675, HL 0.87, AUC 0.727). The internal validation analyses demonstrated good consistency of the model. In conclusion, this prediction model identifies the probability of response to antihistamines in patients with chronic spontaneous urticaria. The model could be useful for a personalized therapeutic approach according to individual patient risk.

Delayed risk in individual and social decisions

This paper studies temporal-distance effects on individual and social risks, testing Construal Level Theory. We elicit WTPs for risky and ambiguous lotteries and vary the timing (immediately vs. in two weeks) when the uncertainty is resolved. Subjects have lower WTPs for longshots than for safer lotteries. Under ambiguity, this gap decreases with temporal distance. Subjects are ambiguity averse, which becomes less pronounced when low-probability lotteries are processed in the future. In a trust game, we study temporal-distance effects on social risks. Time distance lowers trust as trustors correctly anticipate that reciprocity is lower when trustees decide in the future.

Streptococcal infection and autoimmune diseases.

Excessive activation of immune cells by environmental factors, such as infection or individual genetic risk, causes various autoimmune diseases. Streptococcus species are gram-positive bacteria that colonize the nasopharynx, respiratory tract, gastrointestinal tract, genitourinary tract, and skin. Group A Streptococcus (GAS) species cause various symptoms, ranging from mild infections, such as tonsillitis and pharyngitis, to serious infections, such as necrotizing fasciitis and streptococcal toxic shock syndrome. The contribution of GAS infections to several autoimmune diseases, including acute rheumatic fever, vasculitis, and neuropsychiatric disorders, has been studied. In this review, we focus on the association between streptococcal infections and autoimmune diseases, and discuss current research on the mechanisms underlying the initiation and progression of autoimmune diseases.

Discrimination, Smoking, and Cardiovascular Disease Risk: A Moderated Mediation Analysis With MESA.

Carotid intima-media thickness (cIMT) and carotid plaque are reliable indicators of cardiovascular disease risk, and research highlights that racial and ethnic minority individuals generally exhibit higher cIMT and carotid plaque than White individuals. At present, the mechanisms driving these disparities among different racial and ethnic and biological sex groups are poorly understood. Data came from the baseline examination of MESA (Multi-Ethnic Study of Atherosclerosis). A total of 6814 participants aged 45 to 84 years free of clinical cardiovascular disease completed assessments on health behavior and perceived discrimination. Four sex-stratified moderated mediation models examined associations between discrimination, cigarette smoking, and mean cIMT and plaque. We hypothesized that cigarette use would mediate the association between discrimination and carotid artery disease features, and that these would differ by race and ethnicity. Indirect effects of discrimination on plaque were observed among Hispanic women such that discrimination was associated with cigarette use and, in turn, higher plaque (β=0.04 [95% CI, 0.01-0.08]). Indirect effects of discrimination on mean cIMT were found among Hispanic (β=0.003 [95% CI, 0.0001-0.007]) and White men (β=0.04 [95% CI, 0.01-0.08]) such that discrimination was associated with cigarette use and, in turn, higher cIMT. Finally, a positive indirect effect of discrimination on plaque was observed among Hispanic men (β=0.03 [95% CI, 0.004-0.07]). No other racial and ethnic differences were observed. To understand and address social determinants of cardiovascular disease, researchers must incorporate an intersectional framework that will allow us to understand the complex nature of discrimination and cardiovascular disease risk for individuals of varying intersecting identities and social positions.

Business model innovation decisions: the role of group biases and risk willingness

PurposeManagers must make numerous strategic decisions in order to initiate and implement a business model innovation (BMI). This paper examines how managers perceive the management team interacts when making BMI decisions. The paper also investigates how group biases and board members’ risk willingness affect this process.Design/methodology/approachEmpirical data were collected through 26 in-depth interviews with German managing directors from 13 companies in four industries (mobility, manufacturing, healthcare and energy) to explore three research questions: (1) What group effects are prevalent in BMI group decision-making? (2) What are the key characteristics of BMI group decisions? And (3) what are the potential relationships between BMI group decision-making and managers' risk willingness? A thematic analysis based on Gioia's guidelines was conducted to identify themes in the comprehensive dataset.FindingsFirst, the results show four typical group biases in BMI group decisions: Groupthink, social influence, hidden profile and group polarization. Findings show that the hidden profile paradigm and groupthink theory are essential in the context of BMI decisions. Second, we developed a BMI decision matrix, including the following key characteristics of BMI group decision-making managerial cohesion, conflict readiness and information- and emotion-based decision behavior. Third, in contrast to previous literature, we found that individual risk aversion can improve the quality of BMI decisions.Practical implicationsThis paper provides managers with an opportunity to become aware of group biases that may impede their strategic BMI decisions. Specifically, it points out that managers should consider the key cognitive constraints due to their interactions when making BMI decisions. This work also highlights the importance of risk-averse decision-makers on boards.Originality/valueThis qualitative study contributes to the literature on decision-making by revealing key cognitive group biases in strategic decision-making. This study also enriches the behavioral science research stream of the BMI literature by attributing a critical influence on the quality of BMI decisions to managers' group interactions. In addition, this article provides new perspectives on managers' risk aversion in strategic decision-making.