Favorable Recommendations Research Articles

Reassessing pharmacological trials with positive composite outcome driven by reduction in nonfatal myocardial infarction: a systematic review and meta-analysis

Abstract Background Nonfatal myocardial infarction (MI) inadequately predicts cardiovascular and all-cause mortality in contemporary RCTs. The perceived efficacy of new treatments could be overstated if positivity in composite outcome is primarily attributed to reduction in nonfatal MI. Purpose This study seeks to assess pharmacological RCTs with positive results influenced by nonfatal MI reductions and scrutinize the associated clinical guideline recommendations. Methods Pharmacological RCTs focusing on mortality and nonfatal MI published from 2000 to 2023 were searched in PubMed and Web of Science, with subsequent citation tracking in Web of Science and Google Scholar for candidate RCTs referenced in English-language clinical guidelines. Main outcomes included: 1) relative risk reduction in the composite outcome excluding nonfatal MI; 2) relevant guideline recommendations based on the supporting trials. The impact of nonfatal MI on composite outcome was assessed by using the leave-one-out method. Meta-analysis utilized a random effects model. Results After reviewing 19,825 records, we identified 8 RCTs where positive composite outcomes were driven by reductions in non-fatal MI (Figure 1A). These were divided into three therapeutic groups: anti-thrombotic (3 trials), lipid-lowering (3 trials), and anti-inflammatory (2 trials). In guidelines citing these RCTs, lipid-lowering trials (IMPROVE-IT, FOURIER, CLEAR Outcomes; the latter has not been cited yet; a total of 60 recommendations across 17 guidelines; Figure 2) outperformed anti-thrombotic (27 recommendations across 15 guidelines) and anti-inflammatory trials (3 recommendations in 3 guidelines), with significantly higher Class I (45%) and IIa (33.3%) recommendations, and fewer Class IIb (21.7%) recommendations, compared to anti-thrombotic (0%, 22.2%, 66.7%) and anti-inflammatory (0%, 0%, 100%) trials (Figure 1B). In a meta-analysis of all trials on combined intensive lipid-lowering on top of maximally-tolerated statins (the ODYSSEY OUTCOMES, IMPROVE-IT, and FOURIER trials), the exclusion of nonfatal MI data sustained the negative findings (HR 0.94, 95% CI: 0.88 to 1.01). Conclusions Despite the overestimation of efficacy in certain anti-thrombotic, anti-inflammatory, and lipid-lowering RCTs due to the inclusion of nonfatal MI, lipid-lowering trials, particularly those supporting combined intensive therapy with statins, still receive disproportionately favorable guideline recommendations. This underscores the need to reassess the strength of evidence for these trials in guidelines, advocating for a more equitable and evidence-based approach to cardiovascular guideline recommendations.

Analyst recommendations, acquirer’s valuation, and M&A performance: evidence from China

ABSTRACT This study investigates the effects of premerger analyst recommendations on mergers and acquisitions (M&A) announcement returns. We find that M&A announcement returns decrease with premerger analysts’ favourable recommendations (PAFR). Furthermore, we find that increasing acquirers’ valuations in the preannouncement period is a possible channel that allows PAFR to reduce M&A announcement returns. We explore three alternative explanations including, ‘analyst information role’, ‘analyst pressure’ and ‘informed trading’ explanations for our main nexus, and our findings are still robust. In an additional analysis, we find that this negative relationship is more pronounced among acquirers with (a) high information uncertainty (b), low media criticism, and (c) high investor attention. Moreover, we identify three sources of conflicts of interest in analyst recommendations: M&A relations, controlling shareholder share pledging, and stock ownership composition. Our research enriches the impact of analysts’ recommendations on M&A outcomes and provides new empirical evidence of analysts’ strengthening of overvaluation.

Analyst recommendations and mispricing across the globe

We examine the value of analysts’ recommendations using a dataset of 45 countries, 3.8 million firm-month observations, and 222 return anomalies from 1994 to 2019. Unlike U.S.-based evidence, recommendations lead to subsequent highly significant abnormal returns in international markets. Furthermore, analysts do not seem to strengthen mispricing in international markets, as they give more favorable recommendations to (anomaly-ranked) underpriced stocks, and inconsistencies between recommendations and composite anomaly ranks lead to lower, not higher, abnormal returns. Recommendations are more valuable in less developed and less individualistic markets. Our results suggest that analysts’ recommendations provide more value to investors than previously thought.

Recommendations on self-management interventions for adults living with obesity: COMPAR-EU project.

Self-management interventions (SMIs) may improve disease management in adults living with obesity. We formulated evidence-based recommendations for SMIs within the context of the COMPAR-EU project. The multidisciplinary panel selected critical outcomes based on the COMPAR-EU core outcome set and established decision thresholds for each outcome. Recommendations were informed by systematic reviews of effects, cost-effectiveness, and a contextual assessment. To assess the certainty of the evidence and formulate the recommendations, we used the GRADE approach guidance. Overall, SMIs were deemed to have a small impact, but the absence of harmful effects and potential cumulative benefits indicated a favourable balance of effects, despite low certainty. SMIs showed variations in structure, intensity, and resource utilisation, but overall are likely to be cost-effective. Adapting SMIs to local contexts would enhance equity, acceptability, and feasibility, considering patients' values, and availability of resources and teamwork. Consequently, the panel made conditional recommendations favouring SMIs over usual care. The rigorous and explicit recommendations demonstrated the effectiveness of SMIs for adults living with obesity. However, the gaps in the literature influenced the panel to make only conditional recommendations in favour of SMIs. Further research is needed to strengthen the evidence base and improve recommendations' certainty and applicability.

Political incentives and analyst bias: Evidence from China

AbstractThis study extends extant research on the determinants of financial analyst bias by examining the role that political incentives play. Using a series of scheduled provincial political events in China, we document that analysts are significantly more likely to issue favorable recommendations or revise their recommendations upward during political event periods, and the effect of political events on optimism is larger for analysts employed by brokerage firms affiliated with politicians. Cross‐sectional evidence suggests that the impact of political events on analyst optimism is concentrated in those provinces where capital market development is a more important performance indicator for politicians or where the incumbent politicians face a pending promotion. Stock return analyses reveal that favorable recommendations issued during political event periods are significantly less profitable in the long run and are less credible according to investor perceptions. Reinforcing our main evidence, we also find that financial analysts are more likely to issue optimistic earnings forecasts during political event periods. Collectively, our results imply that political incentives distort analyst opinions and political‐economic factors affect the corporate information environment in China.

Do CEOs’ characteristics impact sell-side analysts’ recommendations?

PurposeThis study aims to examine the association between chief executive officers’ (CEOs) characteristics and sell-side analysts’ recommendations.Design/methodology/approachThis study uses a sample of firms listed on the London Stock Exchange and uses two databases, Capital IQ and BoardEx to study the above relationship. A variety of regression analyses are used in the empirical models, including ordinary least squares, fixed effect, random effect, Tobit, Logit and generalized method of moments.FindingsThe authors find that firms with CEOs who had a wider network size and firms with foreign CEOs receive favorable investment recommendations. Further, firms with CEOs who have more time to retire are more likely to receive favorable investment recommendations. However, the authors find that firms with CEOs with more qualifications receive unfavorable recommendations and female CEOs are not affecting investment recommendations.Originality/valueUltimately, this study demonstrates the importance of CEO characteristics for sell-side analysts who play an important role in the stock markets.

Telemedicine-Enhanced Lung Cancer Screening Using Mobile Computed Tomography Unit with Remote Artificial Intelligence Assistance in Underserved Communities: Initial Results of a Population Cohort Study in Western China.

Introduction: Lung cancer is a leading cause of cancer deaths globally. Despite favorable recommendations, low-dose computed tomography (LDCT) lung screening adoption remains low in China. Barriers such as limited infrastructure, costs, distance, and personnel shortages restrict screening access in disadvantaged regions. We initiated a telemedicine-enabled lung cancer screening (LCS) program in a medical consortium to serve people at risk in underserved communities. The objective of this study was to describe the implementation and initial results of the program. Methods: From 2020 to 2021, individuals aged 40-80 years were invited to take LCS by mobile computed tomography (CT) units in three underserved areas in Western China. Numerous CT scans were remotely reported by radiologists aided by artificial intelligence (AI) diagnostic systems. Abnormal cases were tracked through an integrated hospital network for follow-up. A retrospective cohort study documented participant demographics, health history, LDCT results, and outcomes. Descriptive analysis was conducted to report baseline characteristics and first-year follow-up results. Results: Of the 28,728 individuals registered in the program, 19,517 (67.94%) participated in the screening. The study identified 2.68% of participants with high-risk pulmonary nodules and diagnosed 0.55% with lung cancer after a 1-year follow-up. The majority of high-risk participants received timely treatment in hospitals. Conclusions: This study demonstrated mobile CT units with remote AI assistance improved access to LCS in underserved areas, with high participation and early detection rates. Our implementation supports the feasibility of deploying telemedicine-enabled LCS to increase access to a large scale of basic radiology and diagnostic services in resource-limited settings. Clinical Trial Registration Number: ChiCTR1900024623.

Analysts’ recommendations on peer-relative comparable sustainability disclosure

This study delves into the financial impact of standardized sustainability disclosure on industry-wide risks and opportunities. Focusing on U.S. firms adhering to Sustainability Accounting Standards Board standards, our findings reveal heightened analyst coverage and favorable recommendations. Notably, these recommendations favor buy positions while discouraging sell positions. The research provides ex-post evidence on the financial implications of peer-relative standardized sustainability reporting, highlighting its value relevance for financial analysts’ recommendations.

Unlocking online language education: Opportunities, challenges, and recommendations

Advances in technology have significantly augmented the potential of online education, particularly during crises, such as COVID-19, earthquakes, hurricanes, and floods. This qualitative survey study ascertains 150 English-as-a-foreign language (EFL) learners' perceptions of the efficacy of online language education in a preparatory school of a state university after the Kahramanmaraş earthquake in Türkiye in 2023. Data were gathered via an online survey with open-ended inquiries to elicit favourable and adverse experiences and recommendations from students. In order to ensure the thorough and systematic analysis of the collected data, a rigorous methodological approach was employed. Specifically, the data were analyzed through content analysis, facilitated by the MAXQDA. The research outcomes revealed that the participants appreciated online language education for its time-saving nature, comfort, ease of attendance, access to recorded sessions, teacher support, and cost-effectiveness. However, some students also considered online education ineffective and reported challenges, such as technical issues, diminished concentration, lack of motivation and discipline, limited interaction, and class participation. EFL learners also provided suggestions for improving the curriculum, assessment methods, and instructors’ teaching approaches.

Counterfactual Explanation for Fairness in Recommendation

Fairness-aware recommendation alleviates discrimination issues to build trustworthy recommendation systems. Explaining the causes of unfair recommendations is critical, as it promotes fairness diagnostics, and thus secures users’ trust in recommendation models. Existing fairness explanation methods suffer high computation burdens due to the large-scale search space and the greedy nature of the explanation search process. Besides, they perform feature-level optimizations with continuous values, which are not applicable to discrete attributes such as gender and age. In this work, we adopt counterfactual explanations from causal inference and propose to generate attribute-level counterfactual explanations, adapting to discrete attributes in recommendation models. We use real-world attributes from Heterogeneous Information Networks (HINs) to empower counterfactual reasoning on discrete attributes. We propose a Counterfactual Explanation for Fairness (CFairER) that generates attribute-level counterfactual explanations from HINs for item exposure fairness. Our CFairER conducts off-policy reinforcement learning to seek high-quality counterfactual explanations, with attentive action pruning reducing the search space of candidate counterfactuals. The counterfactual explanations help to provide rational and proximate explanations for model fairness, while the attentive action pruning narrows the search space of attributes. Extensive experiments demonstrate our proposed model can generate faithful explanations while maintaining favorable recommendation performance.

Safety and Tolerability of COVID-19 Vaccine in Mast Cell Disorders Real-Life Data from a Single Centre in Italy.

Background In the past three years, COVID-19 has had a significant impact on the healthcare systems and people's safety worldwide. Mass vaccinations dramatically improved the health and economic damage caused by SARS-CoV-2. However, the safety of COVID-19 vaccines in patients at high risk of allergic reactions still has many unmet needs that should be clarified. Material and methods A retrospective, single-centre study was performed by collecting demographic and clinical data of patients with Mast Cell Disorders (MCDs) to evaluate the safety and tolerability of COVID-19 vaccinations. Moreover, any changes in the natural history of the underlying disease following the vaccine have been evaluated. Results This study included 66 patients affected with MCDs. Out of them, 52 (78.8%) received a COVID-19 vaccination and 41 (78.8%) completed the vaccination course. Premedication came first in 86.6% of our patients. A total of seven (4.5%) patients complained about an immediate reaction and two (1.3%) had a late reaction. Worsening of MCD history was observed in a single patient. Conclusions Despite the overall high risk of allergic reactions, our study did not reveal any increased risk for SARS-CoV-2 allergic reactions in MCD patients, thus supporting the recommendation in favour of the SARS-CoV-2 vaccination. However, due to the potentially increased rate of anaphylactic reactions, MCD patients should receive vaccine premedication and should be treated in a hospital setting after an allergological specialistic evaluation.

Research on Physical and Mental Health Risk Assessment of Relative Poverty Children

Background: The health of relatively poor children is a common concern of governments around the world. Family poverty has a huge impact on children's physical and health. Child health is the most important indicator of a child's growth and development. It is vital to adult health, socioeconomic status, and even lifelong achievement, and is the key to social harmony, stability, and prosperity. Subjects and Methods: But there is not much comment and summary on the latest research progress in this field. Therefore, this paper aims to provide support for the health risk assessment of relatively poor children, explore the internal mechanism of relatively poor children's health risk assessment, and study various factors that affect the growth of relatively poor children.Results: Through the experiment, the health gap between relatively poor children and non-relatively poor children was found. Therefore, people should pay attention to the healthy growth of children. Conclusions: Especially empirical research on the impact of relatively poor families on children's health, and research on the impact of parents on children's health in relatively poor environments; favorable health policy recommendations for promoting the health of relatively poor children, and new research directions and suggestions for promoting the health of relatively poor children.

Analysts’ Institutional Client Catering and Reputation Tradeoff: Strategic Timing of Recommendations

We examine whether sell-side analysts strategically time their favorable recommendations to cater to institutional investors while preserving analysts’ reputational capital. Although prior literature documents that analysts provide more positive recommendations for stocks that are part of their institutional clients’ (specifically, mutual funds’) portfolios, it does not explicitly address a reputation cost associated with such practice. Using a sample of analysts’ recommendations on U.S. firms for the 2002–2017 period, we document a pattern of analysts’ recommendations being more optimistic in the end month of a quarter and less optimistic in the beginning month of a quarter. This timing pattern ties to quarterly reporting periods of portfolio managers, with actively managed mutual funds’ holdings being affected the most. Analysts with Institutional Investor All-Star ranking do not engage in such stock recommendation timing practices. The market participants seem to believe rosy recommendations issued for stocks with more institutional holdings in the end month of a quarter with more positive cumulative abnormal returns to upgrade and downgrade recommendations. JEL classifications: G14, G24

Does patient and public involvement impact public health decision-making? A 10 year retrospective analysis of public consultation in Brazil

Background The aim of this work is to characterize the processes associated with patient and public involvement (PPI) in the form of public consultations (PC) during the first 10 years of operation of the National Committee for Health Technology Incorporation in the Unified Health System (Conitec) of Brazil, and to identify factors associated with changes in Conitec’s recommendations following these PC.Methods This cross-sectional study analysed all processes related to the adoption of technologies that took place in Brazil between 2012 and 2021 based on technical reports and self-reported information collected from PC participants. A multiple logistic regression model identified factors associated with changes in Conitec’s recommendations following PC.Results A total of 479 technical reports were published, of which 83% (n = 400) were submitted to PC. Demands were made mainly by applicants from the government (n = 262; 55%), regarding the adoption of medicines (n = 366; 76%), in which context neoplasms and infectious diseases were the most frequent indications (n = 66; 14% for each). A total of 264 (55%) processes resulted in a final recommendation in favour of introducing the technology. Over the period of 10 years, 196 483 contributions were received in response to PC. The largest volume of contributions was made by patients and their families or representatives (n = 99 082; 50%), females (122 895; 67%), white individuals (129 165; 71%) and individuals between the ages of 25 and 59 years (145 364; 80%). Alteration of the preliminary recommendation occurred in 13% (n = 53) of the PC, with a higher proportion of recommendations being altered from 2017 onwards. Increased participation by patients had a significant impact on the alteration of the preliminary recommendation (odds ratio 3.87, 95% CI 1.33–13.35, p = 0.02).ConclusionsIncreased engagement of patients and their families and caregivers in PC was associated with changing the preliminary recommendation of Conitec about the adoption of technologies into the public health system in Brazil.

MT34 Evaluation of BN on the Move (BNOTM) Phase 1 - A Community Steps Challenge Linked to Brunei's National mHealth Application: Behavioral Insights and Early Findings from 59,924 Participants

Despite favorable recommendations by international guidelines, evidence for the effectiveness of population-level mHealth approaches to increase physical activity is scarce. We report an evaluation of BNOTM, a community steps challenge, linked to BruHealth (295,001 active users), Brunei’s national mHealth application. This study aims to assess the uptake, engagement, and effectiveness of the program in changing behavior.

THE SIGNIFICANCE OF CUSTOMER SERVICE IN ESTABLISHING TRUST AND ENHANCING THE REPUTATION OF THE BANKING INDUSTRY IN BANGLADESH

This qualitative research study examines the significance of customer service in establishing trust and enhancing the reputation of the banking industry in Bangladesh. The research aims to gain insights into the current state of customer service, its impact on customer trust and the reputation of banks, the challenges faced in providing good customer service, and the strategies that can be adopted to improve customer service practices. Data collection involved in-depth interviews with both customers and employees of a prominent banking institution in Bangladesh. The evaluation of the current state of customer service revealed a mixed picture, with customers generally reporting satisfaction but also identifying areas for improvement such as delays and inadequate facilities. The research findings confirmed the vital role of customer service in building and maintaining trust. Positive customer service experiences were found to enhance customer trust, while negative experiences had a detrimental impact and could lead to customer attrition. The reputation of banks was closely tied to the quality of customer service, as positive experiences resulted in favorable recommendations while negative experiences harmed the bank’s image. Challenges faced by banks in providing good customer service included limited resources, technological integration, communication channels, cultural barriers, and effective complaint management. To address these challenges, strategies such as enhanced staff training, leveraging technology, implementing feedback mechanisms, streamlining complaint handling, fostering a culture of personalized service, and monitoring service quality were recommended. The findings of this research provide valuable insights and recommendations for banks in Bangladesh to improve their customer service practices, enhance customer satisfaction, and ultimately strengthen their reputation in the competitive banking industry. By prioritizing customer service and implementing the recommended strategies, banks can build trust, retain customers, and establish a positive reputation, leading to sustained success in the dynamic banking landscape of Bangladesh.

Over-interpretation of findings in diagnostic accuracy studies of infectious diseases

ObjectivesTo assess the prevalence of overly positive interpretation, also called ‘spin’,-of results in diagnostic accuracy studies of infectious diseases and to identify suggestions for improvement. MethodsA PubMed search was performed to identify diagnostic accuracy studies of infectious diseases published between January and March 2019. Each article was assessed by two authors independently to identify study characteristics and forms of actual and potential over-interpretation. ‘Actual over-interpretation’ was defined as conclusions that were not on the basis of study aims or conclusions that were more favourable than justified by the study findings. There are other practices that may result in the over-interpretation of study findings and these have been described as ‘potential over-interpretation’. ResultsThe final analysis included 120 studies. Favourable or promising recommendations were made in the main text of 101 (84%) of the included studies. Evidence of actual over-interpretation (spin) was found in 30 (25%) articles, with 22 (18%) studies reporting a conclusion that did not match the study aims and 56 (47%) studies with a more positive conclusion in the abstract than the main text. All analysed studies exhibited at least one form of potential over-interpretation, with was most commonly a lack of sample size calculation (n = 109, 91%) and not reporting a null hypothesis (n = 115, 96%). DiscussionEvidence of over-interpretation of results was found in one-third of the included studies. We have proposed possible interventions to prevent overly positive interpretations of results in diagnostic accuracy studies.

Unaccounted Microplastics in the Outlet of Wastewater Treatment Plants—Challenges and Opportunities

Since the 1950s, plastic production has skyrocketed. Various environmental and human activities are leading to the formation and accumulation of microplastics (MPs) in aquatic and terrestrial ecosystems, causing detrimental effects on water, soil, plants, and living creatures. Wastewater treatment plants (WWTPs) are one of the primary MP management centers meant to check their entry into the natural systems. However, there are considerable limitations in effectively capturing, detecting, and characterizing these MPs in the inlet and outlet of WWTPs leading to “unaccounted MPs” that are eventually discharged into our ecosystems. In order to assess the holistic picture of the MPs’ distribution in the ecosystems, prevent the release of these omitted MPs into the environment, and formulate regulatory policies, it is vital to develop protocols that can be standardized across the globe to accurately detect and account for MPs in different sample types. This review will cover the details of current WWTP adoption procedures for MP management. Specifically, the following aspects are discussed: (i) several processes involved in the workflow of estimating MPs in the outlet of WWTPs; (ii) key limitations or challenges in each process that would increase the uncertainty in accurately estimating MPs; (iii) favorable recommendations that would lead to the standardization of protocols in the workflow and facilitate more accurate analysis of MPs; (iv) research opportunities to tackle the problem of ‘missing MPs’; and (v) future research directions for the efficient management of MPs. Considering the burgeoning research interest in the area of MPs, this work would help early scientists in understanding the current status in the field of MP analysis in the outlet of WWTPs.

Influence of Social Media on Consumers' Online Purchasing Habits During: The COVID-19 Pandemic in Pakistan

Currently, businesses located all over the world are adjusting to a new standard of operation. Customers are encouraged to make their purchases of necessities through the favored e-commerce platform of the organization. For the purpose of marketing web-based enterprises, websites such as Facebook, Twitter, Instagram, and Pinterest are utilized. The purpose of the study was to investigate how the COVID-19 epidemic altered the purchase patterns of Pakistani customers shopping online, with a particular emphasis on the role played by social media. The study utilized a quantitative research model and a descriptive research technique in its data collection and analysis. In order to obtain responses from 400 Pakistani clients, an online questionnaire employing the "purposive sampling" method was used. When looking at the data and putting the hypothesis to the test, PLS-SEM analysis was utilized. During the COVID-19 pandemic in Pakistan, a PLS-SEM study indicated that advertising tools, online reviews, and endorsements from celebrities had a favorable and significant effect on how individuals bought products online. According to the findings of this study, online businesses can improve their use of social media for marketing and advertising by following a number of particular measures. Customers have a greater propensity to make purchases via social media platforms when they come across favorable evaluations and recommendations from celebrities.

Do Reimbursement Recommendations by the Canadian Agency for Drugs and Technology in Health Translate Into Coverage Decisions for Orphan Drugs in the Canadian Province of Ontario?

ObjectivesUnlike other high-income countries, Canada has no national policy for drugs treating rare diseases (orphan drugs). Nevertheless, in 2022, the Canadian government committed to creating a national strategy to make access to these drugs more consistent. Our aim was to study whether recommendations made by the Canadian Agency for Drugs and Technology in Health (CADTH) translated into coverage decisions for orphan drugs in Ontario, the largest Canadian province. This study is the first to look at this question for orphan drugs, which are at the center of policy attention. MethodsWe included 155 orphan drug-indication pairs approved and marketed in Canada between October 2002 and April 2022. Cohen’s kappa was used to test the agreement across health technology assessment (HTA) recommendations and coverage decisions in Ontario. Logistic regression was used to test which factors, relevant to decision-makers, might be associated with funding in Ontario. ResultsWe found only fair agreement between CADTH’s recommendations and coverage decisions in Ontario. Although a positive and statistically significant association between favorable HTA recommendations and coverage was found, more than half of the drugs with a negative HTA recommendation were available in Ontario, predominately through specialized funds. Successful pan-Canadian pricing negotiations were a strong predictor of coverage in Ontario. ConclusionsDespite efforts to harmonize access to drugs across Canada, considerable room for improvement remains. Introducing a national strategy for orphan drugs could help increase transparency, consistency, promote collaborations, and make access to orphan drugs a national priority.