Percent Chance Research Articles

Plastic Surgery and the Malpractice Industry.

The current status of the plastic surgeon in the medical liability spectrum and ways to avoid litigation are explored by using pooled national data from the Medical Professional Liability Association, private information from Applied Medico-Legal Solutions RRG, and a detailed literature search. The medical liability system in the United States costs $55.6 billion, or 2.4 percent of total health care spending. Plastic surgery accounts for 3.31 percent of reported claims and 3.16 percent of paid claims. Total payments for plastic surgeons represent 1.75 percent of the total paid for all specialties. Malpractice awards are relatively light for plastic surgeons. Nevertheless, they still have a 15 percent chance per year of being sued. However, 93 percent of cases will close with a dismissal or a settlement, and only 7 percent will go to trial. Of these, the plastic surgeon will prevail in 79 percent. Most importantly, 75 percent of all cases will result in no payment. To minimize the chances of a lawsuit, plastic surgeons should maintain excellent communication with their patients and participate in shared decision-making. They should take a leadership role and buy in to the performance of perioperative checklists, embrace patient education, and actively participate in Maintenance of Certification. They should be transparent in their dealings with patients by preoperatively declaring their policies on revisions, refunds, complications, and payments. Plastic surgeons must maintain complete and accurate medical records and participate in hospital-based programs of prophylaxis. They should be aware that postoperative infection is the single costliest adverse outcome and proactively deal with it.

Old-Earth or Evolutionary Creation? Discussing Origins with Reasons to Believe and BioLogos

Old-Earth or Evolutionary Creation? Discussing Origins with Reasons to Believe and BioLogos

Cost-Effectiveness of Treatments after Closed Extraarticular Distal Radius Fractures in Older Adults from the WRIST Clinical Trial.

This study performs an economic analysis of volar locking plate, external fixation, percutaneous pinning, or casting in elderly patients with closed distal radius fractures. This is a secondary analysis of the Wrist and Radius Injury Surgical Trial, a randomized, multicenter, international clinical trial with a parallel nonoperative casted group of patients older than 60 years with surgically indicated, extraarticular closed distal radius fractures. Thirty-Six-Item Short-Form Health Survey-converted utilities and total costs from Medicare were used to calculate quality-adjusted life-years and incremental cost-effectiveness ratio. Casted patients were self-selected and older (p < 0.001) than the randomized surgical cohorts, but otherwise similar in sociodemographic characteristics. Quality-adjusted life-years for percutaneous pinning were highest at 9.17 and external fixation lowest at 8.81. Total costs expended were $16,354 for volar locking plates, $16,012 for external fixation, $11,329 for percutaneous pinning, and $6837 for casting. The incremental cost-effectiveness ratios for volar locking plates and external fixation were dominated by percutaneous pinning and casting. The ratio for percutaneous pinning compared to casting was $28,717. Probabilistic sensitivity analysis revealed a 10, 5, 53, and 32 percent chance of volar locking plate, external fixation, percutaneous pinning, and casting, respectively, being cost-effective at the willingness-to-pay threshold of $100,000 per quality-adjusted life-year. Casting is the most cost-effective treatment modality in the elderly with closed extraarticular distal radius fractures and should be considered before surgery. In unstable closed fractures, percutaneous pinning, which is the most cost-effective surgical intervention, may be considered before volar locking plates or external fixation.

The distribution of U.S. electric utility revenue decoupling rate impacts from 2005 to 2017

Electric utilities have historically relied on volumetric energy rates. Reductions in sales can have an adverse effect on a utility’s ability to sufficiently recover its costs. Decoupling mechanisms, when properly designed, diminish the link between revenues and sales. Analysis of annual rate adjustments from decoupling mechanisms indicate the majority of those adjustments are small. However, once a surcharge is applied there is an 86 percent chance there will be a surcharge in the next year.

S2185 “Red Nipple Sign”: A Precursor to “White Nipple Sign”

INTRODUCTION: Cirrhosis affects approximately 3.6 out of every 1000 adults in North America and leads to about 32,000 deaths annually. Variceal hemorrhage occurs in 25–40% of patients with cirrhosis and is a major cause of cirrhosis related morbidity and mortality, associated with up to 20 percent mortality. Additionally, those patients who survive a variceal hemorrhage have a 70 percent chance of recurrent variceal hemorrhage within one year. CASE DESCRIPTION/METHODS: We present a case of a 70-year-old male with past medical history of alcoholic cirrhosis, hypertension and rheumatoid arthritis (taking nonsteroidal anti-inflammatory drugs [NSAIDs]) admitted with hematochezia and hematemesis. The patient was started on a proton pump inhibitor (PPI), octreotide and ceftriaxone, and underwent an emergent esophagogastroduodenoscopy (EGD). Two columns of large esophageal varices were identified extending from Z-line to mid-esophagus (Figure 1). One of the varices was noted to contain two adjacent red spots which appeared similar to stigmata labeled as “white nipple sign” but red in color (Figure 2). A decision was made to perform band ligation and one band was deployed to each variceal column base resulting in excellent decompressive effect. One additional band was then deployed over both “red spots,” which during suctioning into the bander cap began to actively spurt heme, however, bleeding resolved after band deployment. The sites of previous “red spots” were then noted to have classic “white nipple sign” appearance (Figure 3). The patient tolerated the procedure well, was monitored as inpatient and subsequently discharged home with follow-up in a hepatology clinic. DISCUSSION: Variceal hemorrhage is a gastrointestinal emergency with prognosis reliant on achieving hemostasis and preventing future hemorrhage. Therefore, it is extremely important to recognize endoscopic features of high-risk stigmata for future hemorrhage. The most commonly reported features are often described as “red signs,” and include red wales marks, cherry red spots and hematocystic spots. One stigma of recent hemorrhage is known as “white nipple sign,” which owes its appearance to the platelet-fibrin plug overlying a varix. On literature review, we found this to be the first case of showing endoscopic transition of a red spot (“red nipple sign”) into a “white nipple sign,” demonstrating likely pathogenesis from a finding significant for high risk of hemorrhage to the finding consistent with post hemorrhage state.Figure 1.: Two columns of large varices extending from z-line to mid-esophagus.Figure 2.: Close up endoscopic image of red spot overlying varix.Figure 3.: Site of previous red spot, subsequently noted to have "white nipple sign" after band ligation of varix.

Identification of Latent Classes of Motor Performance in a Heterogenous Population of Adults

ObjectiveTo determine classes of motor performance based on community deployable motor impairment and functional tests in a heterogeneous adult population. DesignSixteen tests of limb-specific and whole-body measures of motor impairment and function were obtained. Linear regression analysis was used to dichotomize performance on each test as falling within or outside the age- and sex-predicted values. Latent class analysis was used to determine 3 classes of motor performance. The chi-square test of association and the Fisher exact test were used for categorical variables, and analysis of variance and the Kruskal-Wallis test were used for continuous variables to evaluate the relationship between demographic characteristics and latent classes. SettingGeneral community. ParticipantsIndividuals (N=118; 50 men) participated in the study. Quota sampling was used to recruit individuals who self-identified as healthy (n=44) or currently living with a preexisting chronic health condition, including arthritis (n=19), multiple sclerosis (n=18), Parkinson disease (n=17), stroke (n=18), or low functioning (n=2). InterventionNot applicable. Main Outcome MeasureLatent classes of motor performance. ResultsAcross the entire sample, 3 latent classes of motor performance were determined that clustered individuals with motor performance falling: (1) within predicted values on most of the tests (expected class), (2) outside predicted values on some of the tests (moderate class), and (3) outside predicted values on most of the tests (severe class).The ability to distinguish between the respective classes based on the percent chance of falling outside predicted values was achieved using the following community deployable motor performance tests: 10-meter walk test (22%, 80%, and 100%), 6-minute walk test (14.5%, 37.5%, and 100%), grooved pegboard test (23%, 38%, and 100%), and modified physical performance test (3%, 54%, and 96%). ConclusionsIn this heterogeneous group of adults, we found 3 distinct classes of motor performance, with the sample clustering into an expected test score group, a moderate test score deficiency group, and a severed test score deficiency group. Based on the motor performance tests, we established that community deployable, easily administered testing could accurately predict the established clusters of motor performance.

Are There Inter-Individual Differences in Fat Mass and Percent Body Fat as a Result of Aerobic Exercise Training in Overweight and Obese Children and Adolescents? A Meta-Analytic Perspective.

Background: Determine whether inter-individual response differences exist with respect to changes in fat mass and percent body fat as a result of aerobic exercise training in overweight and obese children and adolescents. Methods: Using the meta-analytic approach, randomized controlled trials that examined the effects of aerobic exercise training on fat mass and percent body fat in overweight and obese children and adolescents were included. Change outcome standard deviations for fat mass and percent body fat were used to calculate true inter-individual differences from each study. The inverse variance heterogeneity model was used to pool results. Results: Pooled changes for inter-individual response differences in fat mass (16 studies, 575 participants) were 0.9 kg (95% confidence interval [CI], -1.4 to 1.8 kg) while tau ([Formula: see text]) was 2.9. For percent body fat, inter-individual differences (27 studies, 1035 participants) were 0.6% (95% CI, -0.6% to 1.0%, [Formula: see text] = 0.7). The 95% prediction interval for true inter-individual responses in a future study was -4.9 to 5.5 kg for fat mass and -0.7% to 1.7% for percent body fat. The percent chance, that is, probability, of a clinically meaningful difference in variability was 47% for fat mass and 26% for percent body fat, both of which were considered as only possibly clinically important. Conclusions: There is a lack of convincing evidence to suggest that true inter-individual response differences exist with respect to aerobic exercise training and changes in fat mass and percent body fat in overweight and obese children and adolescents.

The 2020 Presidential Election: A Race Against Mortality

A year from the inauguration, four of the top five Democratic 2020 U.S. Presidential election candidates in the polls are in their seventies. Using actuarial data and the history of Presidential assassinations, the top two contenders, Former Vice President Joe Biden and Vermont Senator Bernie Sanders, have a 24 to 31 percent chance of not surviving to the end of a hypothetical first term. The 77 and 78-year-old men’s chances of dying before the end of a second term as POTUS are between 46 and 56 percent.

Taking Note: Justice Harry A. Blackmun's Observations from Oral Argument about Life, the Law, and the U.S. Supreme Court

Taking Note: Justice Harry A. Blackmun's Observations from Oral Argument about Life, the Law, and the U.S. Supreme Court

Corporate Failure in the Banking Sector: The Role of External Auditors

The aim of the study was to establish the role of external auditors in corporate failure in the banking sector. The study discovered that the auditing gaps within banks are tangibility and empathy services. It was also revealed that remuneration, training of external auditors, lot of variety in their job, level of logistics, loyalty rate of external auditors, motivational package and improved salary and opinion counts in the organisation were the factors influencing the effectiveness of external auditors. Lastly, unethical behavior has a positive relationship with corporate failure which was statistically significant at confident interval of 0.05 with a predictive power of 83.7 percent chance of predicting corporate failure which was moderate. It was recommended that the Bank should take steps to train and promote external auditors towards acquiring the necessary skills and experience to commission the corporate failure audit. Additionally, assistance also could be sought from other Supreme Audit Institutions in other countries with a similar government arrangement. Alternatively, assistance from private audit firms that have developed expertise in the public sector audit can be sought to assist them to make the audit function more meaningful and constructive. This will help fill the empathic gap of clients. With the current trend towards the harmonization of auditing standards and guidelines, further research into the usefulness and adequacy of auditing standards and guidelines is worthwhile. Keywords: Corporate failure, auditing, corporate corruption, assurance, effectiveness DOI: 10.7176/RJFA/11-4-03 Publication date: February 29 th 2020

Probability Assessments of an Ice-Free Arctic: Comparing Statistical and Climate Model Projections

The downward trend in the amount of Arctic sea ice has a wide range of environmental and economic consequences including important effects on the pace and intensity of global climate change. Based on several decades of satellite data, we provide statistical forecasts of Arctic sea ice extent during the rest of this century. The best fitting statistical model indicates that overall sea ice coverage is declining at an increasing rate. By contrast, average projections from the CMIP5 global climate models foresee a gradual slowing of Arctic sea ice loss even in scenarios with high carbon emissions. Our long-range statistical projections also deliver probability assessments of the timing of an ice-free Arctic. These results indicate almost a 60 percent chance of an effectively ice-free Arctic Ocean sometime during the 2030s—much earlier than the average projection from the global climate models. Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.

Mathematical modelling on diffusion and control of COVID-19.

In this paper, we develop a mathematical model for the spread and control of the coronavirus disease. An outbreak of COVID-19 has led to more than one million confirmed cases as of April 3rd, 2020. Understanding the early spread dynamics of the infection and evaluating the effectiveness of control measures is crucial for assessing the potential for sustained transmission to occur in new areas. Combining a mathematical model of severe COVID-19 spread with four datasets from within and outside of Wuhan, China; it is estimated how spread in Wuhan varied between January and February 2020. It is used these estimates to assess the potential for sustained human-to-human spread to occur in locations outside Wuhan if disease holders were introduced. It is combined SEIR framework model with data on cases of COVID-19 in China and International cases that originated in Wuhan to estimate how spread had varied over time during January and February 2020. Based on these estimates, it is calculated the probability that freshly introduced cases might produce outbreaks in other regions. Also, it is calculated approximately the median day by day basic reproduction number in Wuhan, refused from 2·45 (95% CI: 1·16–4·87) one week before travel restrictions were introduced on Jan 23rd, 2020, to 1.05 (0·42–2·40) one week after. Based on our estimates of, presumptuous SARS approximating disparity, it is computed that in locations with a similar spread potential to Wuhan in near the beginning of January, some time ago there are at least four independently set up cases, there is a more than fifty percent chance the infection will found within those inhabitants. COVID-19 spreading probably refused in Wuhan during delayed January 2020, corresponding with the prologue of voyage control channels. As more cases arrive in international locations with similar spread potential to Wuhan, before these organize measures, it is likely many chains of spread will fail to create initially but might lead to innovative outbreaks ultimately.

Probability Assessments of an Ice-Free Arctic: Comparing Statistical and Climate Model Projections

&amp;lt;p&amp;gt;The downward trend in the amount of Arctic sea ice is a key factor determining the pace and intensity of future global climate change. Diminished sea ice also has a wide range of other environmental and economic consequences. Based on several decades of satellite data, we provide statistical forecasts of Arctic sea ice extent during the rest of this century. The best fitting statistical model indicates that overall sea ice coverage is declining at an increasing rate. By contrast, average projections from the CMIP5 global climate models foresee a gradual slowing of Arctic sea ice loss even in scenarios with high carbon emissions. Our long-range statistical projections also deliver probability assessments of the timing of an ice-free Arctic. These results indicate almost a 60 percent chance of an effectively ice-free Arctic Ocean during some summer in the 2030s -- much earlier than the average projection from global climate models.&amp;lt;/p&amp;gt;

Distribution of Earthquake Magnitude Levels in Bangladesh

Earthquakes are one of the main natural hazards which seriously make threats the life and property of human beings. Different probability distributions of the earthquake magnitude levels in Bangladesh are fitted. In terms of graphical assessment and goodness-of-fit criterion, the log-normal distribution is found to be the best fit probability distributions for the earthquake magnitude levels in Bangladesh among the probability distribution considered in this study. The average earthquake magnitude level found 4.67 (in Richter scale) for log-normal distribution and the approximately forty-six percent chance is predicted to take place earthquake magnitude in the interval four to five.

Gross National Income Growth and Foreign Direct Investment: Causation in the presence of Crisis in India

Gross National Income (GNI) of an economy explicates the standard of living of the population residing in a country. The growth in GNI indicates a successful development for a nation. In this paper, an interrelation between GNI growth and Foreign Direct Investment (FDI) has been discussed in the presence of Indian economic crisis by implementing the Auto Regressive Distributed Lag (ARDL) Modelling approach. The data are ranging from the time of 1991 to 2017. The relationship is judged at the background of economic liberalization of India. The result shows that there exists a long-run impact of FDI on GNI growth. The existence of cointegration further necessitates the existence of short-run causality. In the short run, GNI growth Granger causes FDI. This proves that the model is significant for discussion both for the long and short run. The error correction term signifies that there exists a ninety-seven percent chance of the model to move back to its long-run equilibrium from short-run shocks. The reliability and stability of the whole model are judged by implementing CUCUM and CUSUMQ test. Finally, in conclusion, the model chosen for the study has indicated a few policy implications required for enhancing the GNI growth of India to fight back the situation of crisis.

Field evaluation of porous asphalt course for life-cycle cost analysis

Porous asphalt courses (PAC) provide environmental and safety benefits by reducing traffic noise and improving drainability. As pressure increases on the cost and availability of natural resources, a greater understanding is needed of field performance to allow maintenance and preservation of resilient, sustainable and economic networks. The main purpose of this paper is to utilize life-cycle cost analysis (LCCA) as a decision-support tool for three pavement rehabilitation strategies. These alternatives included open-graded friction course using natural aggregate (OGFC), porous asphalt course using natural aggregate (PAC), and porous asphalt course using steel slag (SS-PAC). The LCCA followed the Federal Highway Administration’s RealCost procedure and incorporated information collected from highway agencies. Based on the results of the performance analysis, pavement life-cycle models were developed for each alternative. Using the life-cycle models and historical unit costs, deterministic and probabilistic LCCAs were conducted. The results demonstrated the cost saving of SS-PAC in both low and medium price ranges. In order to have economic benefits, the service life of SS-PAC needed to be more than eight years for a high price range. SS-PAC had a 78 and 92 percent chance of being more cost-effective than OGFC and PAC according statistical analysis, respectively. Conclusions from the LCCA supported use of the SS-PAC alternative since SS-PAC was shown to be relatively cost-effective over the 40-year analysis period. Utilization of the SS-PAC alternative would combine cost efficiency and sustainability for highway projects, especially rehabilitation and reconstruction.

Development of an Active Learning Program for a Community Utilizing a Scenario Participating as Simulated Rescuers and Sufferers in an Earthquake Prone Area of Japan

Introduction:Major earthquakes with a magnitude of 8-9 are anticipated to occur in the next 30 years at a 60 percent chance on the southern coast of Japan. Since the most part of our Prefecture is likely to be damaged by tsunami and landslides, residents are expected to take a self-reliant approach on the initial several days after the earthquakes and tsunami.Aim:To improve the resilience of the local communities we have developed and applied an educational program of disaster response.Methods:An active learning program was designed on roles of rescuers and sufferers, and conducted two-hour sessions for high school students using a scenario in which they encountered an earthquake during a field trip. Half of the participants were assigned to play students on a field trip and asked to discuss options as a small group to survive and secure their safety in an isolated situation after an earthquake. They exchanged ideas to stay alive, cooperate with local residents and request disaster assistance using very short radio messages to the appropriate counterpart. The other half of the participants were assigned to be school administrations and asked to estimate the situation of sufferers. Their task as a small group was to organize assistance based on the best assumption from the limited information of the isolated students and local villagers.Results:After the sessions, the participants expressed their discovery in the discrepancy of situational recognition between the two groups and they learned about assumption-based planning as well as good information sharing.Discussion:Through this program, the participants experienced simulated situations and learned perspectives from both sides; providing relief as rescuers and receiving aid as sufferers. The participants were motivated to share and utilize their knowledge and skills to make their community resilient to disasters.

Co-Occurring Mental Illnesses May Be More Pervasive Than Previously Thought

An analysis of medical data from nearly 6 million Danes also found that in most cases, random chance may dictate which disorder people with co-occurring illnesses will develop first.

Oort cloud asteroids: collisional evolution, the Nice Model, and the Grand Tack

If the Solar system had a history of planet migration, the signature of that migration may be imprinted on the populations of asteroids and comets that were scattered in the planets' wake. Here, we consider the dynamical and collisional evolution of inner Solar system asteroids which join the Oort cloud. We compare the Oort cloud asteroid populations produced by migration scenarios based on the `Nice' and `Grand Tack' scenarios, as well as a null hypothesis where the planets have not migrated, to the detection of one such object, C/2014 S3 (PANSTARRS). Our simulations find that the discovery of C/2014 S3 (PANSTARRS) only has a greater than one percent chance of occurring if the Oort cloud asteroids evolved on to Oort cloud orbits when the Solar system was not more than about one million years old, as this early transfer to the Oort cloud is necessary to keep the amount of collisional evolution low. We argue this only occurs when a giant (greater than thirty Earth masses) planet orbits at 1 ~ 2 au, and thus our results strongly favour a `Grand Tack'-like migration having occurred early in the Solar system's history.

Risk Adjustment In Medicare ACO Program Deters Coding Increases But May Lead ACOs To Drop High-Risk Beneficiaries.

The Medicare Shared Savings Program (MSSP) adjusts savings benchmarks by beneficiaries' baseline risk scores. To discourage increased coding intensity, the benchmark is not adjusted upward if beneficiaries' risk scores rise while in the MSSP. As a result, accountable care organizations (ACOs) have an incentive to avoid increasingly sick or expensive beneficiaries. We examined whether beneficiaries' exposure to the MSSP was associated with within-beneficiary changes in risk scores and whether risk scores were associated with entry to or exit from the MSSP. We found that the MSSP was not associated with consistent changes in within-beneficiary risk scores. Conversely, beneficiaries at the ninety-fifth percentile of risk score had a 21.6percent chance of exiting the MSSP, compared to a 16.0percent chance among beneficiaries at the fiftieth percentile. The decision not to upwardly adjust risk scores in the MSSP has successfully deterred coding increases but might discourage ACOs to care for high-risk beneficiaries in the MSSP .