Risk Events Research Articles

Long-Term Treatment with Fostamatinib in Japanese Patients with Primary Immune Thrombocytopenia: An Open-Label Extension Study Following a Phase 3 Placebo-Controlled, Double-Blind, Parallel-Group Study

Background Fostamatinib, a spleen tyrosine kinase inhibitor, has been approved for the treatment of chronic immune thrombocytopenia (ITP) in adults in the US, Canada, Europe, Israel, and Japan. We evaluated the long-term efficacy and safety of fostamatinib treatment and the off-therapy platelet count in Japanese patients with primary ITP in a phase 3 clinical trial with a 24-week double-blind period, a 28-week open-label extension period, and a pre-defined washout period. Methods The trial enrolled Japanese patients who had failed to respond or did not tolerate ≥1 prior ITP treatment, who had a mean platelet count <30,000/μL (based on 3 screening and baseline platelet measurements), and had a platelet count at each visit <35,000/μL. Dosing was at 100 mg bid for 4 weeks and then 150 mg bid if needed and tolerated. One concomitant treatment was allowed (corticosteroids, azathioprine or danazol). The dosage of the concomitant treatment was to remain the same during the 24-week double-blind period but could be reduced or discontinued during the open-label period. Efficacy endpoints were platelet response rate (i.e., the percentage of patients who achieved a platelet count of ≥ 50 × 10 3/μL at 2 consecutive visits at least 28 days apart). The platelet count of the responders during the study period were evaluated. Results A total of 33 patients who were either treated with fostamatinib in the 24-week double-blind period (Fostamatinib-Fostamatinib group, n=22) or treated with placebo in the double-blind period and then treated with fostamatinib in the 28-week open-label extension period (Placebo-Fostamatinib group, n=11) were analyzed. Of those, 79% (26/33) were women, the median age was 62, the median baseline platelet count was 19 x 10 3/μL, and 58% (19/33) had two or more previous treatments. The platelet response rate was 36% (8/22) in the Fostamatinib-Fostamatinib group and 27% (3/11) in the Placebo-Fostamatinib group. The platelet count of the responders in the Fostamatinib-Fostamatinib group increased to ≥50 × 10 3/μL shortly after initiating fostamatinib and remained around 100 × 10 3/μL between Week 14 and Week 52, whereas the platelet count of the responders in the Placebo-Fostamatinib group remained low while receiving placebo but increased after receiving fostamatinib ( Figure 1). Among 14 patients with concomitant glucocorticoids treatments at the beginning of the open-label period, 43% (6/14) reduced or discontinued glucocorticoids while receiving fostamatinib without disease relapse. In the washout period of up to 4 weeks, all 12 patients experienced a mild decrease in platelet count, but none developed bleeding events ( Figure 2). Three of four patients who completed the 4-week washout period had a slight increase in platelet counts from Week 2 to Week 4. In the double-blind and open-label periods, adverse events were reported in 96% (21/22) of the Fostamatinib-Fostamatinib group and 100% (11/11) of the Placebo-Fostamatinib group, and treatment-related adverse events in 77% (17/22) and 46% (5/11), respectively. In the washout period, adverse events were reported in 50% (6/12) of patients, and treatment-related adverse events in 0% (0/12). We found no new safety risk or late-onset adverse events specific to Japanese patients. Conclusions The long-term efficacy and safety of fostamatinib were observed in Japanese patients with primary ITP, along with the feasibility of glucocorticoid reduction/discontinuation during fostamatinib treatment, and a lack of bleeding events after abrupt discontinuation of fostamatinib. The findings obtained from this study will help position fostamatinib as a second-line treatment in patients with primary ITP.

Development of a Stacked Ensemble Model for Risk Stratification of Chronic Gvhd after Allogeneic HSCT: Trump Cohort Study

Background Effective risk stratification is vital for selecting donors and developing treatment strategies for allogeneic hematopoietic stem cell transplantation (allo-HSCT). Several pretransplant risk models have been proposed to predict post-transplant patient outcomes from pretransplant risk factors. However, it is still challenging to predict mid-to-long-term prognosis. To establish a novel and user-friendly tool for predicting chronic graft-versus-host disease (cGVHD), non-relapse mortality (NRM) and overall survival (OS), we used a Stacked Ensemble Model (SEM) designed to handle right-censored data and competing risk events (Iwasaki et al., 2021). Methods Using Japanese registry data, the Japanese Transplant Registry Unified Management Program, we analyzed 21,840 patients who underwent their first allo-HSCT between 2010 and 2018 for hematologic malignancies. Of these, 14,430 patients were alive without cGVHD and relapse on day 100 post-transplantation. Primary endpoint was cGVHD and secondary endpoints were NRM and OS. Data were randomly split into the training set (70% of the dataset) and the validation set (30%). We treated patient age and time from diagnosis to transplant as continuous variables and performance status, ABO type matching, sex matching, disease/status groups based on refined Disease Risk Index, Hematopoietic Cell Transplantation-specific Comorbidity Index, usage of total body irradiation, conditioning intensity, T cell depletion in vivo, human leukocyte antigen (HLA) locus matching, the number of HLA mismatching and CMV serostatus as categorical variables. To evaluate predictive accuracy at day 30, 60 and 100 posttransplant, we considered acute graft-versus-host disease (aGVHD) and its treatment, including grade 2 to 4 aGVHD occurrence, grade 3 to 4 aGVHD occurrence, stage of aGVHD before and after treatment, corticosteroid treatment, anti-thymocyte globulin treatment and treatment response of 1 st line therapy for aGVHD. Results The median age of the patients at transplantation was 51 years (inter quartile range (IQR): 39 - 60). The sources of stem cells were HLA-matched related bone marrow (BM) in 967 patients, HLA-matched related peripheral blood (PB) in 1,998 patients, haploidentical BM in 172 patients, haploidentical PB in 778 patients, unrelated BM in 5,539 patients, unrelated PB in 366 patients, and cord blood in 4,237 patients. Myeloablative conditioning was administered in 9,390 patients and reduced-intensity conditioning in 5,040 patients. The most common indication of HSCT was intermediate-risk acute myeloid leukemia (AML) in complete remission (CR, n=3,233) followed by acute lymphoblastic leukemia in first CR (n=2,164) and intermediate-risk AML in non-CR (n=1,618). Median follow-up period of survivors was 2.2 years (IQR: 0.9-4.5). The overall performance of SEM was superior across the endpoints evaluated, cGVHD, NRM and OS, while XGBoost showed a slightly higher C-index for cGVHD, demonstrating its robustness and reliability (Table 1, the C-index for cGVHD/NRM/OS-SEM: 0.567/0.635/0.607, Cox-PH: 0.550/0.624/0.602, Random Survival Forest: 0.555/0.632/0.597, XGBoost: 0.573/0.624/0.604, and Dynamic Deephit: 0.549/0.614/0.589). C-index of SEM for cGVHD, NRM, and OS were gradually improved as time goes by (Table 1, the C-index for cGVHD/NRM/OS: at day 30-0.589/0.643/0.635, at day 60-0.598/0.655/0.640, at day 100-0.598/0.688/0.640). Kaplan-Meier curves 100-day post-transplantation confirmed the accuracy of our predictions, effectively stratifying patients into four risk groups (Figure 1). SHapley Additive Explanations showed contribution of variables for predicting specific outcomes. Grade 3 to 4 aGVHD and stage of aGVHD after treatment influenced non-relapse mortality. Particularly, grade 3 to 4 aGVHD showed significant impact on OS in line with pretransplant risk factors including sex matching, donor source and disease/status groups. Grade 2 to 4 aGVHD and treatment response of 1 st line therapy for aGVHD influenced cGVHD. Conclusion Our study emphasizes the importance of aGVHD events in mid-to-long-term post-transplantation outcomes and presents SEM-based prediction models that account for early-phase post-transplantation events. We are currently developing a user-friendly web application tool for cGVHD, aiming to enhance post-transplant risk stratification and preemptive therapy for cGVHD.

Patients with trochanteric hip fractures and pre-existing osteoarthritis can be treated with nailing osteosynthesis without significant decrease in functional status

PurposeFunctional outcome in patients after trochanteric fracture fixation with pre-existing radiographic osteoarthritis (OA) is unclear. Analyzing their function and independence, before and after fracture, could optimize their treatment and decrease the socioeconomic burden in this particular group. MethodsThe influence of pre-existing radiographic hip OA on functional outcome was retrospectively analyzed with a cohort of patients undergoing proximal femoral nailing for trochanteric fracture. OA was graded according to the Tonnis classification. Functional outcome was assessed preoperatively and 12 months after surgery by the Parker Mobility Score (PMS). We consider a meaningful reduction a difference between preoperatively PMS and 12 months after surgery ≥ 2. In order to evaluate if OA is related to PMS reduction ≥ 2, we calculate the SubHazard ratio (SHR) performing a competing risk regression model considering death as a competing risk event, adjusting by confounders. Death, reoperations, readmissions, surgical time, and fracture reduction quality in patients with and without osteoarthritis were recorded. Results375 trochanteric hip fractures treated with cephalomedullary nails were included, from which 80 (21% CI95% 17%-21%) were classified as Tonnis 2 or 3. This group of patients with pre-existing OA was significantly older (mean age of 88.6 [SD 5.65] vs 85.5 years [SD 6.95]) than the group without OA. The preoperatively PMS score was 6.28 (2.71) in non-OA patients and 5.69 (2.67) in OA patients. The mean PMS reduction 12 months after surgery was 1.3 (SD 2.05) in OA patients and 1.07 (SD 2.2) in non-OA patients (p = 0.43). Competing risks analysis, adjusted by confounders had an SHR of 1.15 (IC95% 0.77 - 1.69). Death, readmission, reoperations, surgical time, and fracture reduction quality did not differ in both groups. ConclusionsPatients with pre-existing radiographic OA treated with femoral nailing have a similar reduction in functional outcomes compared to the non-OA group at one-year follow-up. Further studies will be needed to compare the results of the functional outcome in arthroplasty with those of femoral nailing for the treatment of trochanteric femur fractures in patients with OA.

Comparative Effectiveness of Different Anticoagulation Strategies in Atrial Fibrillation and Renal Dysfunction: A Systematic Review.

Atrial fibrillation (AF) is a common cardiac arrhythmia that increases the risk of stroke and thromboembolism. Anticoagulation therapy can reduce this risk, but the optimal choice of anticoagulant in patients with AF and renal dysfunction is challenging. Renal dysfunction is a common comorbidity seen in patients with AF. Renal dysfunction would affect the pharmacokinetics and pharmacodynamics of anticoagulants and make the patient more prone to bleeding complications. This complicates the assessment of the risks, benefits, and ratio for starting anticoagulant drugs in patients with renal dysfunction. Therefore, there is always a therapeutic conundrum due to the increased risk of bleeding and thromboembolic events in AF patients with renal dysfunction. We conducted a systematic review to summarize the current literature and identify the challenges of anticoagulation strategies in AF with renal dysfunction. We examined 180 articles from reputable journals published from 2018 to June 2023 and selected eight papers for detailed analysis. The studies we chose included a variety of drug treatments, such as traditional therapies like vitamin K antagonists, factor Xa inhibitors, heparins, and direct thrombin inhibitors. This systematic review will provide comprehensive information on the latest data on the effectiveness of various pharmacological treatments (anticoagulation strategies) in AF patients with renal dysfunction. The aim is to help doctors and other healthcare decision-makers choose the best anticoagulation strategy in AF patients with renal dysfunction and to overcome their dilemma between bleeding risk and systemic thromboembolic events.

Atherosclerotic cardiovascular disease risk profile of patients with chronic hepatitis B treated with tenofovir alafenamide or tenofovir disoproxil fumarate for 96 weeks.

Patients with chronic hepatitis B (CHB) who switch from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) show changes in lipid profiles. To evaluate how these changes affect cardiovascular risk. This pooled analysis, based on two large prospective studies, evaluated fasting lipid profiles of patients with CHB who were treated with TAF 25 mg/day or TDF 300 mg/day for 96 weeks. Patients who fulfilled the American College of Cardiology criteria (age 40-79 years, high-density lipoprotein [HDL] 20-100 mg/dL, total cholesterol [TC] 130-320 mg/dL and systolic blood pressure 90-200 mmHg) required to assess 10-year atherosclerotic cardiovascular disease (ASCVD) risk with baseline lipid data and at least one post-baseline measurement were included in the ASCVD-risk population. The 10-year ASCVD risk was calculated for patients in this population, and changes from baseline to Week 96 were assessed using intermediate- (≥7.5%) and high-risk (≥20%) cut-offs. Among 1632 patients, 620 (38%) met the criteria for the ASCVD-risk population. At Week 96, fasting levels of all lipids, except TC:HDL ratio, were lower with TDF than TAF. No significant increase was observed in overall ASCVD risk or in any ASCVD-risk categories during the 96-week treatment period compared with baseline. A similar proportion of patients in the TAF and TDF treatment groups (1.3% and 2.3%, respectively; p = 0.34) reported cardiovascular events. Despite on-treatment differences in lipid profiles with TAF and TDF, predicted cardiovascular risk and clinical events were similar for both groups after 96 weeks.

Research on the tail risk contagion in the international commodity market on the China's financial market: based on a network perspective

PurposeConsidering the frequency of extreme events, enhancing the global financial system's stability has become crucial. This study aims to investigate the contagion effects of extreme risk events in the international commodity market on China's financial industry. It highlights the significance of comprehending the origins, severity and potential impacts of extreme risks within China's financial market.Design/methodology/approachThis study uses the tail-event driven network risk (TENET) model to construct a tail risk spillover network between China's financial market and the international commodity market. Combining with the characteristics of the network, this study employs an autoregressive distributed lag (ARDL) model to examine the factors influencing systemic risks in China's financial market and to explore the early identification of indicators for systemic risks in China's financial market.FindingsThe research reveals a strong tail risk contagion effect between China's financial market and the international commodity market, with a more pronounced impact from the latter to the former. Industrial raw materials, food, metals, oils, livestock and textiles notably influence China's currency market. The systemic risk in China's financial market is driven by systemic risks in the international commodity market and network centrality and can be accurately predicted with the ARDL-error correction model (ECM) model. Based on these, Chinese regulatory authorities can establish a monitoring and early warning mechanism to promptly identify contagion signs, issue timely warnings and adjust regulatory measures.Originality/valueThis study provides new insights into predicting systemic risk in China's financial market by revealing the tail risk spillover network structure between China's financial and international commodity markets.

Analysis And Improvement Of Drug Supply Chain Risk Management Using House Of Risk (HOR) And Analytical Hierarchy Process (AHP) Approaches

Risk management is required because there is always a chance that problems will develop in supply chain activities. In industries engaged in health services, such as PT. Rukun Putera Bersama, in supply chain activities for the procurement of drugs, there is an opportunity for risks to arise. Therefore, it is necessary to carry out a risk analysis and design mitigation actions to mitigate the risks that are likely to arise in the drug procurement supply chain. This research was conducted using the House of Risk (HOR) model and the Analytical Hierarchy Process (AHP). After conducting the research, it was found that there were 23 risk events and 15 risk agents. There are 10 risk mitigation actions in the drug procurement supply chain. Furthermore, from the 10 mitigation actions, it is reprocessed using AHP. The results of AHP weighting obtained the best alternative strategy, namely the use of digital pharmacy management information system software to regulate and monitor pharmacy management performance.

Lung Allocation Score Exceptions in Persons with Cystic Fibrosis Undergoing Lung Transplant.

Rationale: Lung transplantation can extend the lives of individuals with advanced cystic fibrosis (CF). Until March 2023, the Lung Allocation Score (LAS) was used in the United States to determine transplant priority. Certain clinical events or attributes ("risk events") that are not included in the LAS (e.g., massive hemoptysis) are relatively common and prognostically important in CF and may prompt an exception request to increase priority for donor lungs. The new Lung Composite Allocation Score (CAS) also allows for exceptions based on the same principles. Objectives: To evaluate the frequency of LAS exceptions in persons with CF (PwCFs) listed for lung transplantation and assess whether LAS exceptions are associated with improved waitlist outcomes for PwCFs compared with similarly "at-risk" individuals without LAS exceptions. Methods: A merged dataset combining data from the CF Foundation Patient Registry and the Organ Procurement and Transplantation Network (2005-2019) was used to identify PwCFs listed for lung transplantation. We compared waitlist outcomes between PwCFs with a LAS exception versus those without an exception despite having a risk event. Risk events were defined as an episode of massive hemoptysis, pneumothorax, at least three moderate/severe pulmonary exacerbations, and/or a decrease in forced expiratory volume in 1 second by ⩾30% predicted (absolute) in the prior 12 months. Analyses were performed using competing risk regression with time to transplantation as the primary outcome and death without a transplant as a competing risk. Results: Of 3,538 listings from 3,309 candidates, 2% of listings (n = 81) had at least one exception. Candidates with an exception and those with a risk event but no exception received lung transplants more slowly than people without an exception or risk event (subdistribution hazard ratio [95% confidence interval]: LAS exception cohort, 0.66 [0.52-0.85]; risk event cohort without exceptions, 0.79 [0.72-0.86]). There was no difference between those with LAS exceptions and those at risk without LAS exceptions: subdistribution hazard ratio, 0.84 (0.66-1.08). Conclusions: LAS exceptions are rare in PwCFs listed for lung transplantation. LAS exceptions resulted in a similar time to transplantation for PwCFs compared with similarly at-risk individuals. As we enter the CAS era, these LAS-based results are pertinent to improve risk stratification among PwCFs being considered for lung transplantation.

Triglyceride-glucose index is associated with recurrent revascularization in patients with type 2 diabetes mellitus after percutaneous coronary intervention

BackgroundThe Triglyceride-glucose (TyG) index, as a surrogate marker of insulin resistance, is independently associated with the severity of coronary artery lesions and the prognosis of coronary heart disease. The investigation aimed to explore the relationship between the TyG index and recurrent revascularization in individuals with type 2 diabetes mellitus (T2DM) resulting from the progression of lesions or in-stent restenosis (ISR) after percutaneous coronary intervention (PCI).MethodA total of 633 patients who met the inclusion and exclusion criteria were enrolled and divided into three groups based on the tertiles of the TyG index. The primary endpoint was recurrent revascularization resulting from the progression of lesions or ISR. All-cause death was considered as the competing risk event. Competing risk analysis and Cox regression analysis for predicting recurrent revascularization after PCI were conducted stepwise. Variables were standardized to make the hazard ratio (HR), subdistribution hazard ratio (SHR) and corresponding 95% CI more consistent prior to being used for fitting the multivariate risk model. The predictive ability of the TyG index was evaluated using several measures, including the ROC curve, likelihood ratio test, Akaike’s information criteria, category-free continuous net reclassification improvement (cNRI > 0), and integrated discrimination improvement (IDI). Internal validation was conducted through bootstrapping with 1000 resamples.ResultsDuring a median follow-up period of 18.33 months, a total of 64 (10.11%) patients experienced recurrent revascularization, including 55 cases of lesion progression and 9 cases of in-stent restenosis. After controlling for competitive risk events, the TyG index was independently associated with a higher risk of recurrent revascularization [SHR:1.4345, (95% CI 1.1458–1.7959), P = 0.002]. The likelihood ratio test and Akaike’s information criteria showed that the TyG index significantly improves the prognostic ability. Additionally, adding the TyG index improved the ability of the established risk model in predicting recurrent revascularization, indicated by a C-index of 0.759 (95% CI 0.724–0.792, P < 0.01), with a cNRI > 0 of 0.170 (95% CI 0.023–0.287, P < 0.05), and an IDI of 0.024 (95% CI 0.009–0.039, P = 0.002). These results remained consistent when the models containing TyG index were confirmed using an internal bootstrap validation method.ConclusionThe findings highlight the potential of the TyG index as a predictor of recurrent revascularization. Lesion progression emerged as the primary contributor to recurrent revascularization instead of in-stent restenosis. The incorporation of the TyG index into risk prediction models is likely to be beneficial for accurate risk stratification in order to improve prognosis.

Dynamic data‐driven railway bridge construction knowledge graph update method

AbstractEffectively integrating and correlating multisource data involved in the bridge construction process is crucial for the improvement of the bridge informatization level. In the current issues of dynamic numerous data and low information sharing between different engineering departments, the traditional information management methods are inefficient in providing comprehensive and accurate data support for construction safety. Focusing on the bridge construction stage, this article proposes a dynamic data‐driven construction method of railway bridge construction knowledge graph (KG) in combination with dynamic data (materials, personnel, equipment and sensors) in the construction process and KG technology. By taking a railway bridge as a case, the study develops a prototype system and analyzes the effectiveness of bridge construction KG in material traceability, personnel and equipment management and construction safety guidance, which can provide comprehensive and accurate data support for bridge construction management and construction optimization. The results show that: (1) bridge construction KG that takes into account the dynamic features of bridge projects can effectively integrate multiple elements; (2) the bridge construction KG is dynamically updated through real‐time comparison and advance prediction based on the dynamic data collected by multi‐sensing equipment at the construction site, and can provide effective data support for guiding bridge construction safety; and (3) the construction management prototype system based on railway bridge construction KG can provide accurate data support for material traceability, personnel and equipment management and assisted risk event decision‐making. The results of the comparative experiment between the KG group and the spreadsheet group showed that utilizing the KG saved approximately 50% of time and achieved a 20% higher accuracy rate in the material traceability task compared to the spreadsheet group. In general, this study proposes a dynamic data‐driven construction method of railway bridge construction KG, which can effectively realize the effective integration and management of multisource data in the bridge construction process, provide the necessary scientific basis for fine bridge management, and help to improve bridge informatization management level.

Developing a model of work duration under the influence of risk events in the implementation of life cycle contracts for large energy construction projects

Projects implemented under life cycle contracts have become increasingly common in recent years to ensure the quality of construction and maintenance of energy infrastructure facilities. A key parameter for energy facility construction projects implemented under life cycle contracts is their duration and deadlines. Therefore, the systematic identification, monitoring, and comprehensive assessment of risks affecting the timing of work on the design and construction is an urgent practical task. The purpose of this work is to study the strength of the influence of various risks on the duration of a project implemented on the terms of a life cycle contract. The use of the expert assessment method allows for identifying the most likely risks for the design and construction phases, as well as determining the ranges of deviations from the baseline indicator. Using the obtained expert evaluations, a model reflecting the range and the most probable duration of the design and construction works under the influence of risk events was built by the Monte-Carlo statistical method. The results obtained allow monitoring and promptly detecting deviations in the actual duration of work from the basic deadlines set in the life cycle contract. This will give an opportunity to accurately respond to emerging risks and build a mutually beneficial relationship between the parties to life cycle contracts.

Management of the Risk of Blue-Green Algae Blooms in the Iskar Dam for Drinking Water Quality of Sofia City

The introduction of systems for ensuring quality and safe drinking water and risk management is the World Health Organization (WHO) good practice introduced as a legislative requirement for all water supply organizations (Directive EU 2020/2184) on the quality of water intended for human consumption. A specific object of this research is the implemented risk assessment and management system, part of the drinking water safety plan for Sofia city. The water supply system from the water source to the end user, operated by Sofiyska voda JSC and part of Veolia, was analyzed. The hazards and risk events were reviewed for each component of the system—the catchment, water source, supply water pipes, drinking water treatment plants (DWTPs) and distribution water network. The results of the risk evaluation show that the risk of an algal bloom falls from medium risk, with a value of 36 in 2018. This risk was new for the Iskar Dam—the main water source for Sofia city. The purpose of the current study is to analyze the risk of blue-green algae blooming and the potential release of toxins in the Iskar Dam. A data analysis of phytoplankton counts, temperature of the water in the dam, precipitation, algal diversity and quantity of microcystins for a period of three years shows that there is a low probability of algae blooming. The concentration of microcystin LR was below 0.6 µg/L and of microcystin YR was below 0.1 µg/L. The highest phytoplankton count was 70,000 cells/mL in 2018, and it decreased to 30,000 cells/mL in 2020. The impact of the risk of “blue-green algae blooms in the Iskar Dam” is assessed as moderate (3) and that has not changed between 2018 and 2022. The likelihood of occurrence of this risk decreased from possible (3) to unlikely (2) after risk reassessment, and the current control effectiveness changed from weakly controlled (4) in 2018 to well controlled (2) in 2022, because more risk management actions were included in Sofiyska voda JSC. The results of the risk evaluation show that the risk of an algal bloom falls into the low-risk category with a value of 12, after measures were considered and a reassessment. As a preventive measure for better management and risk minimization, it is necessary to continue monitoring the phytoplankton count, species composition, concentration of algae toxins (microcystin LR) and nutrients in raw water from the Iskar Dam. This research has added value to the global database for surface water sources intended for human consumption and is focuses on a potential problem, valid for agricultural as well as for urban territories rich in diffused sources of pollution. The specific risk evaluation and management steps could be used and adapted by other water supply companies.

The role of employee loyalty in online reputation: evidence from tourism and hospitality sector

PurposeOnline employee reviews have a substantial impact on employee recruitment, retention and the overall perception of a company’s image, making them a crucial element of its online reputation. Consequently, these reviews play a vital role in shaping the company’s competitiveness in the talent market. This study aims to investigate the role of employee loyalty in online reputation in the tourism and hospitality sector.Design/methodology/approachThis study collected online reviews posted by 334,428 employees across 173 companies in the tourism and hospitality sector. Then, this study proposed a method for measuring employee loyalty toward the company through text comments. Furthermore, the role of employee loyalty in online reputation through regression models was analyzed.FindingsEmployee loyalty is positively associated with the closed-form evaluations, and the length and readability of open-ended comments is directly and positively associated with review helpfulness and is indirectly associated with review helpfulness through employee online reviews. Employees’ perception of job instability has a significant moderating effect on the above relationships.Research limitations/implicationsThis study contributes to the literature on loyalty in the tourism and hospitality industry, online reputation and employee risk perception. These findings offer a more profound understanding of the extra-role behaviors demonstrated by loyal employees, provide a theoretical foundation for the formation of a company’s online reputation and contribute to helping the tourism and service industry better address risk events. These conclusions provide valuable insights for companies in the fields of human resource management and online reputation management.Originality/valueTo the best of the authors’ knowledge, this study is the first to reveal the impact of employee loyalty on the company’s online reputation and provides important theoretical and practical implications for management.

Methodology for Assessing the Risks of Regional Competitiveness Based on the Kolmogorov–Chapman Equations

The relevance of research on competitiveness at the meso level is related to the contemporary views of a region as an essential element of the economic space. The development of forecasting and analytical methods at the regional level of the economy is a key task in the process of strategic decision making. This article proposes a method of quantitative assessment of the risks of regional competitiveness. The novelty of this approach is based on both a fixed-point risk assessment and scenario-based predictive analysis. A hierarchical structure of indicators of competitiveness of regions is offered. A method based on the Kolmogorov–Chapman equations was used for the predictive estimation of risks of regional competitiveness. The integrated risk assessment is performed using the modified fuzzy ELECTRE II method. A web application has been implemented to assess the risks of competitiveness of Russian regions. The functionality of this application provides the use of multi-criteria decision-making methods based on a fuzzy logic approach to estimate risks at a specified time, calculating the probability of risk events and their combinations in the following periods and visualizing the results. Approbation of the technique was carried out for 78 Russian regions for various scenarios. The analysis of the results obtained provides an opportunity to identify the riskiest factors of regional competitiveness and to distinguish regions with different risk levels.

Construction Risk Assessment of Yellow River Bridges Based on Combined Empowerment Method and Two-Dimensional Cloud Model

(1) In recent years, the economy of the Yellow River basin in China has developed rapidly, and a series of large bridges across the Yellow River have been built on both sides of the Yellow River, which has brought great convenience to regional socio-economic activities. However, risk events are prone to occur during the construction of bridges across the Yellow River, which affect the safety of the bridges’ structure. Therefore, it is necessary to establish a new scientific risk assessment system for the construction safety of bridges across the Yellow River. (2) Methods: Firstly, based on the construction safety risk assessment index system of bridges across the Yellow River, the cloud AHP method and the cloud entropy weight method are used to determine the subjective weight and objective weight of risk indexes, and then the game theory combination weighting method is used to determine the comprehensive weight of each risk index, and then the digital characteristic values of the risk probability cloud and the consequence cloud are calculated and input into the forward cloud generator algorithm. MATLAB was used to generate a two-dimensional comprehensive cloud map, which was visually compared with the standard cloud map, and the probability level and consequence level of each risk index were preliminarily obtained. Finally, the risk assessment matrix was used for comprehensive risk evaluation. (3) Results: Applying the method to the construction safety risk assessment of the Jiaoping Expressway, the overall construction safety risk level of the Yellow River bridge was determined as level 4, and the risk levels of the four primary indicators were: personnel risk (level 3), material and equipment risk (level 4), construction technology risk (level 5), and construction environment risk (level 4). (4) Conclusions: The results of the risk evaluation are consistent with the actual construction state of the bridge, which shows that game theory’s combination of empowerment with a two-dimensional cloud model is scientific and effective when applied to the construction safety risk evaluation of Yellow River bridges.

Feasibility Analysis and Risk of Patchouli Farming Production in Aladadio Village Aere District East Kolaka Regency

This study aims to analyze the feasibility and risks of patchouli farming production. The study was conducted in Aladadio Village, Aere District, East Kolaka Regency. The location of the study was determined intentionally or purposively with the consideration that the study location was one of the villages whose main livelihood was as patchouli farmers. The population in this study was all patchouli farmers in Aladadio Village, which amounted to 174 households. At the same time, the number of respondents was 35 patchouli farmers, who were taken simply by random sampling. Variable research includes production, receipts, revenue, fixed costs, variable costs, total costs, RC ratio, sources of risk, frequency of risk events, risk events, quantitative impacts, qualitative impacts, risk levels, and risk management efforts. The first data analysis technique uses RC Ratio calculation analysis. Frequency x Impact is used to determine the risk and risk level of patchouli farming and risk management efforts using descriptive analysis. The results showed that the RC Ratio obtained was 1.53, which means that every 1 unit spent by farmers for patchouli farming costs will result in revenues of 1.53 units because the RC Ratio value is greater than 1, patchouli farming is still feasible to cultivate. The source of risk in farming is found in land management, planting, maintenance, harvesting, and post-harvest with a calculation of frequency x impact to produce a number 4 or the level of risk in patchouli planting, which is a high level. Efforts to manage production risks are carried out by avoiding risks so that the risk of planting does not occur sustainably. The highest risk is caused by climate/weather, where the risk avoidance method is by paying attention to the patchouli plant seeds used. If patchouli seedlings are taken from patchouli plants that have diseases, then when planting, it is most likely that patchouli is challenging to grow. Besides, weather and climate conditions are also very influential. When planting is carried out in the rainy season, it can produce good results. Still, if the weather conditions are hot, the number of deaths in the crop will be higher, so farmers plant patchouli by cutting to avoid the mortality rate in patchouli plants.

Incidence of Cardiovascular Disease and Venous Thromboembolism in Patients With Atopic Dermatitis.

Atopic dermatitis (AD) may increase risk for atherothrombotic and cardiovascular (CV) disease. Determine CV disease and venous thromboembolism risk among patients with AD. Cohort study using electronic health data from U.K. general practices in 1994 to 2015. Children (<18 y) and adults (≥18 y) with AD were matched to patients without AD on age, same practice, and encounter date. Treatments and specialist referrals served as proxies of AD severity. Outcomes were incident myocardial infarction, cerebrovascular accident (CVA), diabetes, hypertension, dyslipidemia, deep vein thrombosis (DVT), and pulmonary embolism. Cox regression analysis was used to compare outcomes in AD versus non-AD patients. Comparing 409,341 children with AD (93.2% mild, 5.5% moderate, and 1.3% severe) to 1,809,029 unaffected children, AD was associated with higher risk of DVT (hazard ratio [HR] 1.23; 95% confidence interval [95% CI] 1.02-1.48) and severe AD was associated with higher risk of CVA (HR 2.43; 95% CI 1.13-5.22) and diabetes (HR 1.46; 95% CI 1.06-2.01). Comparing 625,083 adults with AD (65.7% mild, 31.4% moderate, and 2.9% severe) to 2,678,888 unaffected adults, AD, especially when severe, was associated with higher risk of DVT (HR 1.14; 95% CI 1.11-1.18; and HR 1.64; 95% CI 1.49-1.82, respectively) and small but increased risks of CVA, diabetes, and dyslipidemia. Adults with severe AD had higher risk of myocardial infarction (HR 1.27; 95% CI 1.15-1.39), CVA (HR 1.21; 95% CI 1.13-1.30), diabetes (HR 1.15; 95% CI 1.09-1.22), dyslipidemia (HR 1.11; 95% CI 1.06-1.17), and pulmonary embolism (HR 1.39; 95% CI 1.21-1.60) compared with adults without AD. Atopic dermatitis, particularly when severe, is associated with small but increased risks of CV risk factors and events and significantly increased risk of venous thromboembolism.

Assessment of flood mortality indices in a Mediterranean framework: A comparative analysis between western Algeria and southern Italy

Flood mortality is a serious concern requiring a better understanding of risk factors and their reduction measures. To understand the specificities of flood mortality between developed and developing countries in a Mediterranean framework, we created an accurate database of 242 cases of death recorded in western Algeria and Calabria (southern Italy). This database covers a 33-year period (1990–2022) and includes the time and place of fatal accidents, victim characteristics, circumstances of death, and victim behavior. In order to highlight the people's vulnerability, we have innovatively developed 13 mortality indices summarized in four complex indices: i) human, ii) physical, iii) environmental, and iv) circumstantial. The results revealed a decrease in high-mortality events and the annual amount of flood fatalities in both regions. The frequency of fatalities and the average number of deaths per year are higher in western Algeria, although the average number of fatalities per flood is practically the same. The flood mortality seasonality is similar oppositely to the spatial distribution. The assessment of mortality indices revealed similarities in vulnerability, except for the flood risk identification, rainfall and event death indices, which highlight the vulnerability of western Algeria, requiring prevention and protection actions suggested in this study. One of the research questions for future studies is to focus on the complex interaction between precipitation and basin-scale conditions, further strengthening the investigation into the role of victim behavior. Moreover, precise fine-tuning of proposed indices and their assessment procedure validation may lead to new practical recommendations for saving lives in future floods.

Public Support for Market Risk Management in Bulgarian Agricultural Holdings

The growing uncertainty of the external environment presents economic organizations in agriculture with new challenges for building sustainability. The purpose of this paper is to examine the potential of the public toolkit in Bulgaria to stimulate and demotivate market risk management in agricultural holdings. A set of indicators was synthesized to assess the potential of publicly funded instruments to impact farming strategies. Based on secondary data analysis, it is concluded that market risk management support is entirely designed to address the consequences of risk events and has a high potential to constrain producers' risk prevention and mitigation initiatives.

Training Network in the Literature from 2020 to 2023

In administrative-economic sciences, factor analysis models are essential for their explanatory capacity of institutional responses to a risk event. The objective of this document was to contrast a model that explains the emergence of corporate governance dimensions in the face of the pandemic. An exploratory study was carried out based on a systematic review of the literature from 2020 to 2023, considering the search by keywords in Google Scholar and Microsoft academic, as well as the experts from a public university in the center of Mexico. The results show that corporate identity explains the university’s response to the pandemic. In relation to the theory of corporate governance which explains the emergence of identity, reputation, and image in the face of a risky event, we have established the relationship between the three factors. The established three-dimensional model suggests the prevalence of identity as a central factor of corporate governance in the face of COVID-19.