Risk-minimizing Strategies Research Articles

Skin necrosis following sclerotherapy. Part 2: Risk minimisation and management strategies.

Tissue necrosis is a serious but rare complication of sclerotherapy. Early detection and targeted management are essential to prevent progression and minimise serious complications. In the first instalment of this paper, we reviewed the pathogenic mechanisms of post-sclerotherapy necrosis. Here, we describe risk minimisation and management strategies.Risk factors must be addressed to reduce the chance of necrosis following sclerotherapy. These may be treatment-related including poor choice of sclerosant type, concentration, volume or format, poor injection technique, suboptimal ultrasound visualisation and treatment of vessels in high-risk anatomical areas. Risk factors specific to individual patients should be identified and optimised pre-operatively.Tissue necrosis is more likely to occur with extravasation of irritant sclerosants such as absolute alcohol, sodium iodide, bleomycin and hypertonic saline, whereas extravasation of foam detergent sclerosants rarely results in tissue loss. Proposed treatments for extravasation of irritant sclerosants include infiltration of an isotonic fluid and hyaluronidase. Management of inadvertent intra-arterial injections may require admission for neurovascular observation and monitoring for ischaemia, intravenous systemic steroids, anticoagulation, thrombolysis and prostanoids infusion when required. Treatment of veno-arteriolar reflex vasospasm (VAR-VAS) necrosis follows the same protocol involving systemic steroids but rarely requires hospital admission and may not require anticoagulation.In general, treatment of post-sclerotherapy necrosis is challenging and most proposed treatment measures are not evidence-based and only supported by anecdotal personal experience of clinicians. Despite all measures, once the necrosis has set in, it is very difficult to reverse the process and all measures described here may only be useful in prevention of progression and extension of the ulceration.Mid to long-term measures include addressing exacerbating factors, management of medical and psychosocial comorbidities, treatment of secondary infections and referrals to relevant specialists. All ulcers should be managed with compression and prescribed dressing regimes in line with the healing stage of the ulcer.

"Food First but Not Always Food Only": Recommendations for Using Dietary Supplements in Sport.

The term "food first" has been widely accepted as the preferred strategy within sport nutrition, although there is no agreed definition of this and often limited consideration of the implications. We propose that food first should mean "where practically possible, nutrient provision should come from whole foods and drinks rather than from isolated food components or dietary supplements." There are many reasons to commend a food first strategy, including the risk of supplement contamination resulting in anti-doping violations. However, a few supplements can enhance health and/or performance, and therefore a food only approach could be inappropriate. We propose six reasons why a food only approach may not always be optimal for athletes: (a)some nutrients are difficult to obtain in sufficient quantities in the diet, or may require excessive energy intake and/or consumption of other nutrients; (b)some nutrients are abundant only in foods athletes do not eat/like; (c)the nutrient content of some foods with established ergogenic benefits is highly variable; (d)concentrated doses of some nutrients are required to correct deficiencies and/or promote immune tolerance; (e)some foods may be difficult to consume immediately before, during or immediately after exercise; and (f)tested supplements could help where there are concerns about food hygiene or contamination. In these situations, it is acceptable for the athlete to consider sports supplements providing that a comprehensive risk minimization strategy is implemented. As a consequence, it is important to stress that the correct terminology should be "food first but not always food only."

Process Risk Index (PRI) – A methodology to analyze the design and operational hazards in the processing facility

Process safety assists in improving the operational, economic, and environmental performance of processing facilities. This study addresses the critical process safety challenges at the process design and operation stage through an effective risk minimization strategy. The process risk index (PRI), a heuristic-based approach, is used to map risk and explore the effect of process deviations on process safety. The PRI method is explained using the blue hydrogen process - steam methane reforming (SMR) process. A risk map of the entire facility uses traffic-light colors as risk indicators is developed. The synergistic effects and parameters are analyzed using process simulation tools and converted into risk values. The risk map identifies the reforming, the water-gas shift, and the separator units as the highest risk units for given deviations in the operational parameters. We have benchmarked the PRI with the fire and explosion damage index (FEDI) and observed that the PRI is more sensitive to finding process deviations and hazards. This method can detect root causes of process safety issues at a unit-specific level better than the FEDI. Additionally, the PRI provides updated risk maps once risk minimization strategies are implemented. The PRI serves as a tool for process safety analysis of hazardous operations such as hydrogen production processes with better sensitivity and flexibility in scaling.

Adverse Events of Physiotherapy Interventions in Parkinsonian Patients.

Physiotherapists have an ethical, professional, and regulatory responsibility for safety in all aspects of patient care. Notwithstanding, the adverse events issue has been inadequately addressed in the rehabilitation research field. To determine the frequency and characterize the adverse events that occur during or in between physiotherapy sessions for parkinsonian syndromes. An exploratory clinical study was conducted. Physiotherapists were asked to actively report the adverse events that occurred during or between sessions for parkinsonian syndromes. A total of 100 patients were enrolled in the study, which resulted in 1845 sessions. The most common adverse events reported were falls, pain/discomfort, and hypotension, with a total of 128 adverse events reported. During the physiotherapy sessions, adverse events do occur. Future research should clarify the relationship between AE occurrence and the type of intervention as well as causality and risk-minimization strategies.

Domain Generalization for Language-Independent Automatic Speech Recognition.

A language-independent automatic speech recognizer (ASR) is one that can be used for phonetic transcription in languages other than the languages in which it was trained. Language-independent ASR is difficult to train, because different languages implement phones differently: even when phonemes in two different languages are written using the same symbols in the international phonetic alphabet, they are differentiated by different distributions of language-dependent redundant articulatory features. This article demonstrates that the goal of language-independence may be approximated in different ways, depending on the size of the training set, the presence vs. absence of familial relationships between the training and test languages, and the method used to implement phone recognition or classification. When the training set contains many languages, and when every language in the test set is related (shares the same language family with) a language in the training set, then language-independent ASR may be trained using an empirical risk minimization strategy (e.g., using connectionist temporal classification without extra regularizers). When the training set is limited to a small number of languages from one language family, however, and the test languages are not from the same language family, then the best performance is achieved by using domain-invariant representation learning strategies. Two different representation learning strategies are tested in this article: invariant risk minimization, and regret minimization. We find that invariant risk minimization is better at the task of phone token classification (given known segment boundary times), while regret minimization is better at the task of phone token recognition.

Skin necrosis following sclerotherapy. Part 1: Differential diagnosis based on classification of pathogenic mechanisms.

Background: Tissue necrosis is a significant but uncommon complication of sclerotherapy. The pathogenic mechanisms of this often-debilitating complication have been poorly described in the literature.Purpose: To elucidate the pathological mechanisms, we propose a morphological approach to classify sclerotherapy-induced skin necrosis into two categories of round and stellate (star-like) necrosis.Research Design: Comprehensive literature review was conducted.Results: Round necrosis is typically caused by extravasation of sclerosants. It typically presents as an ulcer with smooth and non-geographic borders. Historically, extravasation has been cited as the main cause of sclerotherapy-related necrosis. While this may be the case with osmotic or irritant sclerosants, it is far less likely with the use of detergent agents particularly in the foam format.The more commonly encountered pattern of stellate necrosis is an ischaemic ulcer secondary to arterial/arteriolar occlusion. In contrast to round necrosis, stellate necrosis follows an intra-vascular injection of sclerosants such as an inadvertent intra-arterial injection. But more frequently, stellate necrosis may follow a perfectly executed intra-venous or intra-telangiectatic delivery of sclerosants. Several pathogenic pathways can be considered. The physiologic response of veno-arteriolar reflex vasospasm (VAR-VAS) is possibly the most frequent pathway. It follows a high-pressure injection of the sclerosant in a target vein resulting in a rapid rise of intravenous pressures which in-turn would trigger a sympathetic neuronal reflex vasospasm of the pre-capillary sphincters and a corresponding opening of the normally closed arterio-venous anastomoses(AVAs). This communication would allow entry of the sclerosing agent into the arteriolar side of the circulation resulting in arteriolar occlusion and infarction of the corresponding skin. Similarly, an intravenous administration of sclerosants in the vicinity of defective boundary valves or persistently open AVAs can result in the entry of detergent agents into the arteriolar side of the microvasculature causing an ischemic stellate ulcer.Conclusions: In this first instalment of these two-part series, we review the pathogenic mechanisms of post-sclerotherapy necrosis. In the second instalment, we describe risk minimisation and management strategies.

Application of data mining to minimize fire-induced domino effect risks.

Data mining (DM) has been applied in many advanced science and technology fields, but it has still not been used for domino effect risk management to explore minimum risk scenarios. This work investigates the feasibility of DM in minimizing the risk of fire-induced domino effects in chemical processing facilities. Based on DM, an evidential failure mode and effects analysis (E-FMEA), which could bridge chemical facilities' operational reliability and domino effect risk, is combined with fault tree analysis (FTA) for the occurrence risk modeling of loss of containment (LOC) event of chemical facilities, which is often the triggering point of fire-induced domino effects. Industry specific data such as reliability data, inspection records, and maintenance records are of great value to model the potential occurrence criticality of LOC. The data are used to characterize the LOC risk priority number (RPN) of chemical facilities through FTA and E-FMEA, search and statistics rules are proposed to mine inspection records to assess LOC risk factors. According to the RPN scores of facilities, inherent safety strategies to minimize risk via inventory control are proposed, and their effectiveness is tested using a well-known probit model. In this way, the approach proposes a unit-specific evidence-based risk minimization strategy for fire-induced domino effects. A case study demonstrates the capability of DM in the risk minimization of fire-induced domino effects.

Covid-19 Related Factors Associated with Antenatal Care in Rural Bangladesh: A qualitative study

Objective: Available literature reveals that usage of Maternal Health Care Services (MHCSs), including antenatal care (ANC), has been decreased significantly in the developing countries due to Corona Virus Disease (COVID-19) pandemic. However, the COVID-19 related factors on the MHCSs utilization in Bangladeshi women are yet to be examined. Therefore, this study examines the effect of COVID-19 on the use of ANC services among rural communities in Bangladesh.Method: A community-based qualitative study was conducted from May 01, 2021, to July 20, 2021, among selected pregnant women residing in eight villages of the Kushtia District, Bangladesh. A total of ten focus group discussions (FGDs) was conducted. Open Code 4.0 software was used to transcribe, translate, and analyze the data thematically. Results: Findings suggest that the measures taken by the government against the COVID-19 pandemic have significantly decreased the optimum usage of ANC services. The need to shift the role of the health workforces a vital factor that has a negative effect on women's attitude towards seeking MHCSs. Anxiety, dirty and poor environment of the health facilities, low quality of care, stigma, and risk minimization strategy are among other factors that refrained the pregnant women from seeking ANC services. Conclusion: Undoubtedly, the COVID-19 related factors have decreased the possible usage of ANC services among rural communities in Bangladesh. Additional necessary health workforces are needed to recruit urgently. A special wing for pregnant women in each health facility may be opened as a one-stop service center for the COVID-19 period. The policymakers should take necessary actions to reduce anxiety among pregnant women and motivate them to use MHCSs for safe motherhood.

Validation of a method to assess the severity of medication administration errors in Brazil: a study protocol.

Background: Medication errors are frequent and have a high economic and social impact and is critical to know their severity. A variety of tools exist to measure and classify the harms associated with medication errors, but few are internationally validated.Design and methods: It was decided to validate a method proposed by Dean and Barber for assessment of the potential severity of medication administration errors. A number of thirty health care professionals (doctors, nurses and pharmacists) from Brazil will receive an invitation to take part by scoring 50 cases of medication errors gathered from an original UK study regarding their potential harm to the patient on scale 0 to 10. Sixteen cases with known actual harm outcomes will be used to assess the validity of their scoring. By looking at 10 errors (out of the 50 cases) scored twice, reliability shall be assessed; and potential sources of variability in scoring will be evaluated depending on the severity of each of error case, the occasion when the scores were given, the scorer, their profession, and interactions among these variables. Generalizability theory will be used for analysing data.Expected impact of the study for public health: This study was submitted to the evaluation of the Research Ethics Committee of the Complexo Hospitalar Universitário Professor Edgard Santos and approved under no. 3.102.570/2019. This is the first validation of this method for use in Brazil, and will allow researchers to conduct more standardised evaluations of interventions to reduce the impact of medication errors. Significance for public health Medication errors are frequent and have high economic and social impact. Assessing the severity of medication errors is a crucial point in improving patient safety during medication use. This makes it possible to differentiate errors in relation to their severity, and thus to establish risk minimization strategies targeting those errors with the greatest potential to harm patients. However, while some tools exist, few have been validated internationally. Our paper, entitled “Validation of a method to assess the severity of medication administration errors in Brazil: a study protocol”, outlines a protocol for establishing the validity of an existing method for assessing the severity of medication administration errors in Brazil. This is the first validation of this method for use in Brazil, will allow researchers to conduct more standardised evaluations of interventions to reduce the impact of medication errors.

An audit to determine how teratogenic risks of carbimazole are considered for patients of child-bearing potential in an acute hospital setting

Abstract Introduction Carbimazole is associated with an increased risk of congenital malformations when used in pregnancy. In 2019, the Medicines and Healthcare products Regulatory Agency (MHRA) strengthened its advice on risk minimisation (1). The valproate national campaign raised awareness of risks amongst healthcare professionals and the public (2). However, within our organisation it was perceived that awareness of teratogenic effects of carbimazole was potentially less well-known. Aim The aim was to determine if teratogenic risks associated with carbimazole were considered in patients of child-bearing potential. Objectives were to measure the percentage of patients that had a documented: acknowledgement of risk (audit standard 70%); pregnancy or contraception status (audit standard 80%); record of provision of patient information (audit standard 70%) and make recommendations to improve practice. Methods An audit approach was used with standards derived from national guidance (1). The setting was an acute NHS organisation comprising two main sites. The prescribing, health record (HR) and pharmacy dispensing systems were electronic. A cluster sample of female patients aged ≤45 years that had carbimazole dispensed between November 2018 and November 2019 were included. A data collection tool was developed and piloted prior to use. A trainee pharmacist reviewed patient HRs and extracted details of prescription, risk conversations, contraception and pregnancy status onto the data collection tool. Patients without a consultation record were excluded. No patient or staff identifiable data were recorded. Data were collated using Microsoft Excel and analysed descriptively. Results Seventy-nine of 81 patients aged 11-45 years were included; two patients were excluded because their consultation records were unavailable. Of 79 patients, 35 (44%) had either pregnancy status, contraception, teratogenic risk consideration or discussion documented. For 44 (56%) patients, there was no documented acknowledgement of risk. Twenty-nine (36%) patients had their pregnancy or contraception status documented. For six pregnant patients, provision of advice was unclear. Only fifteen (19%) had specific documentation about risk consideration and six of documented risk conversations with patients. There was no evidence pharmacists had checked risk considerations made by prescribing clinicians or actively provided information to patients. Conclusion Findings suggest that consideration of teratogenic risk of carbimazole is inconsistent. Where pregnancy and contraception status were documented in the absence of further information, it was unclear if patients were informed of risks or involved in treatment discussions. Findings have limited generalisability due to the small sample. Although HR were thoroughly reviewed, findings were based on documentation that was potentially incomplete or not representative of detailed discussions during patient consultations. Further research should use methods to explore clinician and patient awareness of teratogenic risk of carbimazole and patient involvement in their treatment decisions. Recommendations are to: upskill pharmacists so they more actively provide risk information; better utilise electronic prescribing to mandate inclusion of contraception status and facilitate standardised risk consideration. National bodies should implement formal risk minimisation strategies for all teratogenic drugs. References (1) Medicines and Healthcare products Regulatory Agency. Carbimazole: increased risk of congenital malformations strengthened advice on contraception [internet]. London: MHRA; 2019 [cited February 2019]. Available from: https://www.gov.uk/drug-safety-update/carbimazole-increased-risk-of-congenital-malformations-strengthened-advice-on-contraception (2) NHS England and NHS Improvement. Patient Safety Alert Resources to support the safety of girls and women who are being treated with valproate [internet]. London: NHSEI; 2017 [updated 2019 December 6]. Available from https://www.england.nhs.uk/wp-content/uploads/2019/12/Patient_Safety_Alert_-_Resources_to_support_safe_use_of_valproate.pdf

No Good Time Without Drugs: Qualitative Study Among Nightlife Attendees in Tbilisi, Georgia.

Individuals who visit nightclubs and electronic dance music (EDM) festivals tend to use psychoactive substances, often multiple substances, in this setting and are at risk of serious negative health effects. This paper aims to explore respondents' experiences and perceptions in order to have a better understanding of patterns and motives related to psychoactive substance use and high-risk behaviours in EDM event attendees. In-depth and focus group interviews with 30 EDM event attendees who reported psychoactive substance use at nightlife events. The data was analysed using the Nvivo-v.10 software. Mixing multiple substances to get the desired effects was common. Ecstasy was often combined with Jager (alcohol). Drug use in nightlife settings occurred in a group of friends and was perceived as an essential part of having a good time. Most participants reported that they did not use drugs outside nightlife settings. The dangerous synthetic hallucinogen NBOMe was still on the scene. The respondents had a very low level of knowledge about, and perception of, the risks associated with drug consumption. Knowledge about risk minimisation strategies was very low or non-existent. Polydrug use and a lack of perceived harmful effects put drug-using nightlife attendees at increased risk of negative health consequences. Future research should focus on identifying strategies to raise the awareness of people who use drugs in nightlife settings and encourage them to employ health protection strategies. Using the social network infrastructure can be thought of as one potentially beneficial approach.

ЛІКВІДНІСТЬ ОЧИМА МАРКЕТОЛОГА В УПРАВЛІННІ РОЗВИТКОМ БАНКУ

The article examines the evolution of the bank in terms of the relationship between liquidity as one of the most important results in the bank's activities and the implementation of marketing strategy by expanding the customer base of the bank. The direct and inverse order of the relationship between the indicators in the pair «bank liquidity – the size of the bank's customer base» is studied. Firstly, a direct connection is considered, which is more obvious in the formulation of the research task. That is, how the bank's marketing strategies have an impact on its liquidity. Thereof, the following marketing strategies are determined: communication strategy, market segment conquest strategy, profit maximization strategy, risk minimization strategy. Each strategy was considered, a description of marketing actions on the impact on the level of liquidity of the bank. It is noted that the banks of Ukraine today do not fully involve marketing departments in determining and developing a strategy for the development of the bank, so banking marketing does not have a decisive impact on overall performance. The size of the customer base was more interesting to determine the impact of liquidity on one of the indicators of banking marketing. In this direction, the chain of connections «bank liquidity – bank reliability – bank attractiveness for customers – growth of the bank's customer base» was studied. Banks of Ukraine with different levels of liquidity indicators were selected to organize the study. To do this, an analysis of the dynamics of liquidity ratios of these banks in 2021. Next, the chain indicators were studied in pairs, that is, it was assessed whether the difference between banks in reliability (calculated coefficient of reliability), the total size of their customer bases and the volume of lending and deposits (using the method of comparative analysis). According to the results, it is stated that there is a direct relationship between the liquidity of selected banks and the size of their customer base. Thus, the hypothesis put forward during the study was fully confirmed. The practical significance of the results is the organization of conscious influence of the bank's marketing on the processes of its progressive development, understanding of the top management of Ukrainian banks the importance of marketing actions in achieving better financial results, as well as how such various indicators of bank performance banks, can influence each other to organize further more effective management of banks.

Cadeias de Markov em estratégia de negociação de ações em alta frequência

The price prediction problem for any given stock has been an object of study, deepening and evolution within the past few decades, to achieve the basic goal of positive financial realizations with the smaller risk possible. A known risk minimization strategy is a high frequency trading regime, taking benefit from minor price variations, and achieving small profits multiple times a day. By the hypothesis and the interpretation that prices variations behavior as a Random Walk, it is possible to characterize a Markov (stochastic) process with states and transition probabilities known, allowing to describe price variations through time. Therefore, this study aims to estimate the financial outcome using Markov chains for automated decision making in a high frequency trading strategy, and then comparing the computed results with stock’s valuation (or devaluation) within the same analyzed period.

A Clark-Ocone Type Formula via Itô Calculus and its Application to Finance

An explicit martingale representation for random variables described as a functional of a Levy process will be given. The Clark-Ocone theorem shows that integrands appeared in a martingale representation are given by conditional expectations of Malliavin derivatives. Our goal is to extend it to random variables which are not Malliavin differentiable. To this end, we make use of Ito's formula, instead of Malliavin calculus. As an application to mathematical finance, we shall give an explicit representation of locally risk-minimizing strategy of digital options for exponential Levy models. Since the payoff of digital options is described by an indicator function, we also discuss the Malliavin differentiability of indicator functions with respect to Levy processes.

Breathing-swallow dysfunction in COPD: How silent aspiration may be contributing to exacerbations.

Breathing-swallow dysfunction in COPD: How silent aspiration may be contributing to exacerbations.

Identification of Antibiotics in Surface-Groundwater. A Tool towards the Ecopharmacovigilance Approach: A Portuguese Case-Study.

Environmental monitoring, particularly of water, is crucial to screen and preselect potential hazardous substances for policy guidance and risk minimisation strategies. In Portugal, extensive data are missing. This work aimed to perform a qualitative survey of antibiotics in surface- groundwater, reflecting demographic, spatial, consumption and drug profiles during an observational period of three years. A passive sampling technique (POCIS) and high-resolution chromatographic system were used to monitor and analyse the antibiotics. The most frequently detected antibiotics were enrofloxacin/ciprofloxacin and tetracycline in surface-groundwater, while clarithromycin/erythromycin and sulfamethoxazole were identified only in surface water. The detection of enzyme inhibitors (e.g., tazobactam/cilastatin) used exclusively in hospitals and abacavir, a specific human medicine was also noteworthy. North (Guimarães, Santo Tirso and Porto) and South (Faro, Olhão and Portimão) Portugal were the regions with the most significant frequency of substances in surface water. The relatively higher detection downstream of the effluent discharge points compared with a low detection upstream could be attributed to a low efficiency in urban wastewater treatment plants and an increased agricultural pressure. This screening approach is essential to identify substances in order to perform future quantitative risk assessment and establishing water quality standards. The greatest challenge of this survey data is to promote an ecopharmacovigilance framework, implement measures to avoid misuse/overuse of antibiotics and slow down emission and antibiotic resistance.

Thirsty work: Testing the risk reduction model of mid- to late-Holocene stone points with distance decay from freshwater in northern Australia

A key tenant of risk reduction models in archaeology the world over is that changes in resource availability drove mobility increases and created a need for an extension of stone tool use life. This manuscript directly addresses the question, is retouch intensity of tools related to distance from freshwater, by using extant localities of major Gorges, Rivers and water holes in the southern Kimberley region of northern Australia. Previous research has argued that retouched stone points during the mid to late-Holocene were part of a risk minimisation strategy, within broader technological organisation models. Modelling the distance from primary water sources, in arid to semi-arid regions of the southern Kimberley, reduction intensity of points is found to increase with distance from water sources consistently. This research provides an appropriate test of existing risk minimisation models and highlights global significance for similar studies where retouch tool reduction and forager mobility are linked to environmental change.

Mortality/Longevity Risk-Minimization with or without Securitization

This paper addresses the risk-minimization problem, with and without mortality securitization, à la Föllmer–Sondermann for a large class of equity-linked mortality contracts when no model for the death time is specified. This framework includes situations in which the correlation between the market model and the time of death is arbitrary general, and hence leads to the case of a market model where there are two levels of information—the public information, which is generated by the financial assets, and a larger flow of information that contains additional knowledge about the death time of an insured. By enlarging the filtration, the death uncertainty and its entailed risk are fully considered without any mathematical restriction. Our key tool lies in our optional martingale representation, which states that any martingale in the large filtration stopped at the death time can be decomposed into precise orthogonal local martingales. This allows us to derive the dynamics of the value processes of the mortality/longevity securities used for the securitization, and to decompose any mortality/longevity liability into the sum of orthogonal risks by means of a risk basis. The first main contribution of this paper resides in quantifying, as explicitly as possible, the effect of mortality on the risk-minimizing strategy by determining the optimal strategy in the enlarged filtration in terms of strategies in the smaller filtration. Our second main contribution consists of finding risk-minimizing strategies with insurance securitization by investing in stocks and one (or more) mortality/longevity derivatives such as longevity bonds. This generalizes the existing literature on risk-minimization using mortality securitization in many directions.

Hypotheses behind the very rare cases of thrombosis with thrombocytopenia syndrome after SARS-CoV-2 vaccination

As of 4 April 2021, a total of 169 cases of cerebral venous sinus thrombosis (CVST) and 53 cases of splanchnic vein thrombosis were reported to EudraVigilance among around 34 million people vaccinated in the European Economic Area and United Kingdom with COVID-19 Vaccine AstraZeneca, a chimpanzee adenoviral vector (ChAdOx1) encoding the spike protein antigen of the SARS-CoV-2 virus. The first report of the European Medicines Agency gathering data on 20 million people vaccinated with Vaxzevria® in the UK and the EEA concluded that the number of post-vaccination cases with thromboembolic events as a whole reported to EudraVigilance in relation to the number of people vaccinated was lower than the estimated rate of such events in the general population. However, the EMA's Pharmacovigilance Risk Assessment Committee concluded that unusual thromboses with low blood platelets should be listed as very rare side effects of Vaxzevria®, pointing to a possible link. The same issue was identified with the COVID-19 Vaccine Janssen (Ad26.COV2.S).Currently, there is still a sharp contrast between the clinical or experimental data reported in the literature on COVID-19 and the scarcity of data on the unusual thrombotic events observed after the vaccination with these vaccines. Different hypotheses might support these observations and should trigger further in vitro and ex vivo investigations. Specialized studies were needed to fully understand the potential relationship between vaccination and possible risk factors in order to implement risk minimization strategies.

Individual quotas and revenue risk of fishing portfolio in the trawl fishery

The Norwegian bottom-trawl fleet is managed through individual vessel quotas and is generally engaged in codfish fisheries, where several species contribute to the revenue of the fishery. The revenue from the fishing exhibits substantial intra-annual variation and carries a significant degree of risk due to the presence of intrinsic volatilities in the marine environment, such as seasonal fluctuations in stock size and constant changes in market conditions over the course of a year. In the face of volatile revenue, fishers may allocate fishing effort and use a quota portfolio to minimize revenue risk. However, decisions underlying effort allocation, such as when to fish what and how much to harvest to match the catch size and remaining quota, are challenging. In this regard, a decision-making framework based on a bio-economic model is used to explore the revenue risk minimization behavior of the Norwegian codfish trawl fleet targeting three different species (cod, saithe, and haddock), given the constraints set by the quotas. The study comprises trawl catches and fishing effort as well as the prices for the frozen products of codfish to investigate the adopted harvest strategy under two different scenarios. The results indicate that a risk-minimizing strategy leads to inefficient allocation of fishing quotas and fishing effort and that potential economic losses from minimizing revenue risk outweigh the benefits. Moreover, our findings prove that enhancing revenue is more important than minimizing revenue risk for the trawlers. We argue that the spatial and temporal freedom of the trawl vessels, together with a vertically integrated trawl industry, may explain the prioritization of revenue enhancement over revenue risk minimization. The seasonal spawning aggregation of NEA cod and how this affects market prices shape the trawlers’ harvest strategy of increasing fishing revenue.