Risk Reduction Benefits Research Articles

The therapeutic effect of PCSK9 inhibitors on dyslipidemia: one-year follow up.

Despite the availability of statins and lifestyle modifications, many patients with Dyslipidemia struggle to achieve optimal low-density lipoprotein cholesterol (LDL-C) control. PCSK9 inhibitors offer a promising new therapeutic option with superior LDL-C lowering efficacy compared to statins. However, data on their real-world use, particularly in Iran, is limited. This study aims to address this gap by investigating the one-year effects of evolocumab on lipid profiles and potential cardiovascular outcomes in Iranian patients with Familial Hypercholesterolemia (FH).This single-center, prospective study evaluated evolocumab effectiveness in lowering LDL-C in 50 Iranian adults with FH. Participants with a documented LDL-C > 190 mg/dL on existing cholesterol medications (excluding PCSK9 inhibitors) and a clinical FH diagnosis was included. After baseline assessments (medical history, demographics, lipid profile), evolocumab was administered subcutaneously every two weeks for one year. Follow-up assessments at year one measured changes in LDL-C, high-density lipoprotein cholesterol (HDL-C), and triglycerides. The study enrolled 50 participants with an average age of 55 years old (range 35-80 years).Treatment with evolocumab led to significant improvements in lipid profiles at all follow-up points compared to baseline. On average, LDL-C levels decreased by 105.24 mg/dL, triglycerides decreased by 59.20 mg/dL, and HDL-C levels increased by a modest but significant 4.5 mg/dL after one year(p<0.001). Subgroup analysis revealed no statistically significant interactions between baseline demographics (age, sex, BMI) or lifestyle habits (smoking, alcohol) and changes in lipid levels(p>0.05). However, a significant interaction emerged between baseline lipid levels and their corresponding reductions, suggesting greater improvement in patients with higher baseline values(p<0.05). It is noteworthy that no new cardiovascular events were reported during the study period. This study demonstrates the effectiveness of evolocumab in improving lipid profiles in Iranian patients with FH. The observed reductions in LDL-C and triglycerides, along with a modest increase in HDL-C, suggest potential benefits for cardiovascular risk reduction. The absence of new cardiovascular events during the study is encouraging, but further research with larger and longer-term follow-up is needed to confirm these findings and assess the long-term safety and impact on quality of life.

명품 화장품에 대한 관계혜택이 전환장벽과 브랜드 충성도에 미치는 영향 - 온라인 및 오프라인 소매업태의 조절효과를 중심으로

This research explores the impact of relational benefits, which are the advantages gained from a sustained relationship with a specific brand, on switching barriers and brand loyalty among female consumers aged 20 to 50 residing in China when purchasing luxury cosmetics. The research analyzes the influence difference between different retail formats online and offline, aiming to reveal the shifting psychological dynamics of consumers amid the latest changes in China's consumer market. Using SPSS and AMOS programs, data from 500 participants were analyzed, with a focus on seven types of relational benefits: experiential benefits, confidence benefits, special treatment benefits, convenience benefits, economic benefits, information benefits and risk reduction benefits. The results indicate that relational benefits significantly enhance switching barriers and brand loyalty, and these effects vary distinctly between online and offline retail channels. The findings offer valuable insights for luxury cosmetic brands to formulate effective strategies in the Chinese market.

Effect of implantable loop recorder–based continuous rhythm monitoring on incident atrial fibrillation and stroke: An updated systematic review and meta-analysis of randomized controlled trials

BackgroundIn patients with a history of stroke or those at high risk of developing stroke, a continuous rhythm monitoring strategy using implantable loop recorders (ILR) is often performed to screen for atrial fibrillation (AF). ObjectivesWe performed a systematic review (MEDLINE and EMBASE) including randomized controlled trials comparing ILR-based continuous rhythm monitoring versus usual care in patients with a history of stroke or patients at high risk of developing stroke. MethodsA meta-analysis was performed and aggregate risk ratios (RR) and risk difference (RD) with their 95% confidence intervals were calculated. ResultsFour randomized controlled trials with 7,237 patients (ILR=2,114 and non-ILR=5,123) were included. ILR vs. non-ILR was associated with increased detection of incident AF (RR 3.88; 95% CI [2.23 - 6.75]; p<0.00001; NNT=7.7, I2=61%), increased appropriate initiation of anticoagulation (RR 2.29; 95% CI [2.07 - 2.55]; p<0.00001; NNT=6.7, I2=0), and a 25% lower risk of developing stroke (RR 0.75; 95% CI [0.59 – 0.95]; p=0.02; NNT=100, I2=0%). In patients with history of stroke there was no difference in the risk of developing incident stroke (RR 0.83; 95% CI [0.61 – 1.14]; p=0.25; I2=0%). ConclusionOur meta-analysis shows that screening for AF with ILR is associated with increased detection of AF, and increased initiation of appropriate anticoagulation in patients with a history of stroke or those with risk factors for stroke. The benefit of stroke risk reduction with ILR remains unclear, and future studies focused on the inclusion of patients without a history of stroke are needed to elucidate this uncertainty.

Persistence and Adherence to PCSK9 Inhibitor Monoclonal Antibodies Versus Ezetimibe in Real-World Settings.

The cardiovascular disease risk reduction benefits of proprotein convertase subtilisin/kexin type 9 inhibitor monoclonal antibodies (PCSK9i mAb) and ezetimibe are dependent on remaining on treatment and being persistent and adherent. We estimated the percentage of patients on therapy, persistent and adherent at 182 and 365days among US adults with health insurance who initiated a PCSK9i mAb (n = 16,588) or ezetimibe (n = 83,086) between July 2015 and December 2019. Using pharmacy fill claims, being on therapy was defined as having a day of medication supply in the last 60 of 182 and 365days following treatment initiation, being persistent was defined as not having a gap of 60days or more between the last day of supply from one prescription fill and the next fill, and being adherent was defined by having medication available to take on ≥ 80% of the 182 and 365days following treatment initiation. We estimated multivariable-adjusted risk ratios for being persistent and adherent comparing patients initiating PCSK9i mAb versus ezetimibe using Poisson regression. At 182days following initiation, 80% and 68% were on therapy and 76% and 64% were persistent among patients who initiated a PCSK9i mAb and ezetimibe, respectively. Among patients who were on therapy and persistent at 182days following initiation, 88% and 81% of those who initiated a PCSK9i mAb and ezetimibe, respectively, were on therapy at 365days. Among those on therapy and persistent at 182days following initiation, being persistent and being adherent at 365days were each more common among PCSK9i mAb versus ezetimibe initiators (persistent: 82% versus 76%, multivariable-adjusted risk ratio 1.07; 95% confidence interval [CI] 1.06-1.08; adherent: 74% versus 71%, multivariable-adjusted risk ratio 1.02; 95% CI 1.01-1.03). These data suggest approaches to increase persistence and adherence to PCSK9i mAb and ezetimibe should be implemented prior to or within 182days following treatment initiation.

Local government perspectives on housing buyouts in New York after Hurricane Sandy

ABSTRACT Understanding government experience with hazard buyouts can enhance future efforts. We conducted a study of state and local government perspectives about buyouts after Hurricane Sandy in the New York area, including three jurisdictions that participated in buyouts and two that did not. Respondents differentiated outcomes for buyout participants, which they saw as financially beneficial, and outcomes for residents remaining, including limited open space and risk reduction benefits. The perceived benefits and drawbacks of buyouts were dependent on site and local government characteristics. Buyouts were seen as most appropriate as a last resort, in response to financial losses for homeowners. Increasing partnerships and opportunities for cross-jurisdictional learning, expanding time frames for buyout participation, and revisiting buyout costs and benefits over time could enhance buyout programmes.

Asymmetric connectedness and investment strategies between commodities and Islamic banks: Evidence from gulf cooperative council (GCC) markets

The study uses the data of thirteen Islamic Banks (IB) in the GCC region and sixteen commodities that include soft agriculture, energy, industry, and precious metal commodities. Murabaha transactions makes up most of the revenues of the Islamic banks, whereas commodities set up the biggest portion of the assets among Murabaha transactions, therefore commodities and IB revenues are expected to comove. Interestingly, empirical findings suggest that most of the Islamic banks and commodities are not significantly affected by the shocks from other markets. We further observe that negative shocks have a higher impact on market connectedness among used assets compared to the positive returns and find a significant role of risk variables in explaining the magnitude of spillover between used assets. We perform robustness of our results in sub-samples periods during Shale Oil Revolution, Global Financial Crisis, and the COVID-19. Additionally, the multivariate portfolio analysis shows some risk reduction properties of the majority of the used assets. The performance evaluation measures demonstrate that weights selected based on dynamic connectedness network presents diversification opportunities. These findings help investors and portfolio managers to remain alert to the movements of the risk factors and calibrate there hedging and portfolio management strategies by taking long and short positions as incorporation of Islamic banks and commodities in the GCC region in a portfolio could yield risk reduction benefits and profitability.

Mapping the risk reduction benefits of coral reef conservation – Hawaiʻi case study

Effective disaster risk reduction measures are vital to coastal communities around the world. While nature-based solutions provide coastal communities with a promising alternative to traditional engineering-based solutions; these solutions are often overlooked by communities when planning and implementing disaster risk reduction measures. This study builds upon the literature that demonstrates the effectiveness of coral reef conservation to mitigate coastal flood risk. Our approach utilizes freely available tools and data to quantify the economic value of coral reef conservation for the Hawaiian Islands. We explore a scenario that depicts coastal flooding if the upper 1 m of the coral reef were to be lost. The study analyzes the Average Annual Loss (AAL) and losses avoided based on a series of 4 coastal flood scenario return periods with and without coral reefs. This case study finds that the preservation of the upper 1 m of coral reefs for the main islands of Hawaiʻi provides the state with $629 million in annual losses avoided to buildings. A hot spot analysis of the losses avoided identifies areas where conservation efforts could be prioritized. Our findings provide additional support to the use of nature-based solutions as an effective disaster risk reduction measure, and provides communities and stakeholders with a methodology that can be implemented using readily available data and tools.

Meta-analysis indicates better climate adaptation and mitigation performance of hybrid engineering-natural coastal defence measures

Traditional approaches to coastal defence often struggle to reduce the risks of accelerated climate change. Incorporating nature-based components into coastal defences may enhance adaptation to climate change with added benefits, but we need to compare their performance against conventional hard measures. We conduct a meta-analysis that compares the performances of hard, hybrid, soft and natural measures for coastal defence across different functions of risk reduction, climate change mitigation, and cost-effectiveness. Hybrid and soft measures offer higher risk reduction and climate change mitigation benefits than unvegetated natural systems, while performing on par with natural measures. Soft and hybrid measures are more cost-effective than hard measures, while hybrid measures provide the highest hazard reduction among all measures. All coastal defence measures have a positive economic return over a 20-year period. Mindful of risk context, our results provide strong an evidence-base for integrating and upscaling nature-based components into coastal defences in lower risk areas.

Enduring relief or fleeting respite? Bitcoin as a hedge and safe haven for the US dollar

Can technology protect investors from extreme losses? This paper investigates the short- and long-run hedging and safe haven properties of Bitcoin for the US dollar over the period 2010–2023, incorporating the COVID-19-related market turmoil. Our findings reveal that (i) Bitcoin acts as a strong hedge for all US dollar currency pairs examined, (ii) Bitcoin functions as a weak safe haven for the US dollar at short investment horizons, as indicated by a limited relationship during acute negative price movements, (iii) Bitcoin, instead of acting as a safe haven may, instead, increase aggregate risk at long horizons during periods of extreme losses. The analysis, performed using a series of horizon-dependent econometric tests, provides evidence of some US dollar risk-reduction benefits from Bitcoin but limited potential for enduring relief from long-run extreme negative US dollar rate movements.

Real Estate Portfolio Diversification by Sectors Using a RAL Approach

We propose a cointegration-based method for evaluating the long-term independence of sectoral Real Estate Investment Trusts (REITs) within a portfolio. We employ this innovative approach to construct diversified portfolios. Our argument is that sectors contributing less to cointegration provide greater risk reduction benefits to the portfolio. To gauge the level of independence, we use the reciprocal of the aggregate likelihood ratio (RAL) statistics. Based on these statistics, we introduce a novel allocation strategy that assigns a higher weight to a sector with a larger RAL. Using CRSP/Ziman REIT sector data, we demonstrate that this new strategy outperforms traditional methods and the real estate market benchmark. Our paper introduces a fresh framework for REIT portfolio management and provides guidance on sector allocation.

Abstract 70: Rich-Club Behaviour and Analyses in the Human Brain Connectome as Novel Early Biomarkers of Cognitive Decline

Introduction: Transient ischemic attack (TIA) patients have an increased risk of early dementia, but the mechanism is unclear. One potential mechanism is the damaging effects of microvascular disease on brain networks. Rich club is a phenomenon where highly connected nodes form a “rich club” amongst themselves, thus playing an important role in global brain network communication. In this study we aim to determine 1) whether the prominence of the rich club effect declines greater in TIA patients than controls over time, and 2) the relationship of rich club prominence with cognition. Methods: TIA patients (n=47) and controls (n=43) underwent DTI imaging and cognitive assessment at baseline, 1-year, 3-year, and 5-year. Whole-brain tractography utilizing constrained spherical deconvolution was performed to construct whole-brain connectomes for both groups at all available timepoints. The maximum normalized rich club coefficient (Φ max ) was used as an indicator of the prominence of the rich club effect. Independent-sample T-tests were used to compare Φ max cross-sectionally, while a linear mixed effect (LME) model was used to examine the longitudinal change in Φ max in TIA patients vs. controls, while controlling for covariates including age, sex, WMH volume, whole-brain volume, and peak width of skeletonized mean diffusivity. Results: TIA patients had a mean age of 63.94 ( SD =8.62) and 20 females. Controls had a mean age of 60.73 (8.16) and 29 females. The prominence of the rich club was not significantly different between TIA patients and controls at baseline or 1-year ( p &gt;0.05). However, TIA patients showed a significantly less prominent rich club at 3-year and 5-year compared to controls ( p =0.047 and 0.018, respectively). TIA patients exhibited a significantly greater decrease in rich club prominence over time, relative to controls ( p =0.023), after accounting for covariates. Longitudinal LME models showed no association between changes in rich club prominence and changes in cognition ( p &gt;0.05 for all cognitive domains). Conclusion: In this study, we show a decrease in rich club prominence in TIA patients compared to controls which might identify their increased risk of cognitive impairment, and the potential benefits of aggressive vascular risk reduction.

Super Holding of State-Owned Enterprize (Soes) to Realize A Healthy Company Based on The Principles of Good Corporate Governance to Create the Prosperity of All Indonesian People

Objective: This research aims to explore the establishment of a super holding for State-Owned Enterprises (SOEs) in Indonesia, focusing on the implementation of good corporate governance principles. The goal is to create prosperity for all Indonesian people and to enhance government investment management and national development. Method: This study employs a normative legal research approach. The methodology involves researching and reviewing normative legal materials, including applicable laws and regulations. The analysis centers around the establishment of a super holding in SOE management, particularly in relation to state responsibility in financial management and the renewal of SOE management laws. Result: The findings indicate that the establishment of a super holding for SOEs is a significant step in improving government investment management and national development. In this concept, SOEs are managed as a group of companies with a focus on transparency, state wealth management, and appropriate investment strategies. Conclusions: The formation of a super holding for SOEs is expected to bring strategic benefits in financial management, transparency, infrastructure development, and risk reduction. Its primary objective is to promote general welfare by providing adequate goods and services and contributing to national economic development.

Level of attendance at the English National Health Service Diabetes Prevention Programme and risk of progression to type 2 diabetes

BackgroundWe evaluated the dose–response relationship between the level of attendance at the English National Health Service Diabetes Prevention Programme (DPP) and risk of progression to type 2 diabetes amongst individuals participating in the programme.MethodsWe linked data on DPP attendance for 51,803 individuals that were referred to the programme between 1st June 2016 and 31st March 2018 and attended at least one programme session, with primary care records of type 2 diabetes diagnoses from the National Diabetes Audit up to 31st March 2020. Weibull survival regressions were used to estimate the association between the number of programme sessions attended and risk of progression to type 2 diabetes.ResultsRisk of developing type 2 diabetes declined significantly for individuals attending seven of the 13 programme sessions and continued to decline further up to 12 sessions. Attending the full 13 sessions was associated with a 45.5% lower risk (HR: 0.545 95% CI: 0.455 to 0.652). Compared to individuals that only partially attended the programme, attendance at 60% or more of the sessions was associated with a 30.7% lower risk of type 2 diabetes (HR: 0.693 95% CI: 0.645 to 0.745).ConclusionsReducing the risk of progression to type 2 diabetes through diabetes prevention programmes requires a minimum attendance level at seven of the 13 programme sessions (54%). Retaining participants beyond this minimum level yields further benefits in diabetes risk reduction. Commissioners may wish to consider altering provider payment schedules to incentivise higher retention levels beyond 60% of programme sessions.

Economic assessment of nature-based solutions to reduce flood risk and enhance co-benefits

Flooding is expected to increase due to climate change, urbanisation, and land use change. To address this issue, Nature-Based Solutions (NBSs) are often adopted as innovative and sustainable flood risk management methods. Besides the flood risk reduction benefits, NBSs offer co-benefits for the environment and society. However, these co-benefits are rarely considered in flood risk management due to the inherent complexities of incorporating them into economic assessments. This research addresses this gap by developing a comprehensive methodology that integrates the monetary analysis of co-benefits with flood risk reduction in economic assessments. In doing so, it aspires to provide a more holistic view of the impact of NBS in flood risk management. The assessment employs a framework based on life-cycle cost-benefit analysis, offering a systematic and transparent assessment of both costs and benefits over time supported by key indicators like net present value and benefit cost ratio. The methodology has been applied to the Tamnava basin in Serbia, where significant flooding occurred in 2014 and 2020. The methodology offers valuable insights for practitioners, researchers, and planners seeking to assess the co-benefits of NBS and integrate them into economic assessments. The results show that when considering flood risk reduction alone, all considered measures have higher costs than the benefits derived from avoiding flood damage. However, when incorporating co-benefits, several NBS have a net positive economic impact, including afforestation/reforestation and retention ponds with cost-benefit ratios of 3.5 and 5.6 respectively. This suggests that incorporating co-benefits into economic assessments can significantly increase the overall economic efficiency and viability of NBS.

Randomized trial of dentists' understanding: treatment benefit in absolute numbers vs relative risk reduction.

This study aimed to assess whether dentists correctly understand the benefit of a dental treatment when it is presented using absolute numbers or relative risk reduction (RRR). This parallel-group randomized controlled trial recruited dentists from 3 postgraduate courses in Rio de Janeiro, Brazil. Participants received, in sequentially numbered sealed opaque envelopes, the description of a hypothetical scenario of the benefit (avoidance of multiple tooth loss) of nonsurgical periodontal treatment without or with antibiotics. Treatment benefit was presented in 2 different formats: absolute numbers or RRR. Dentists were given 10 minutes to read the treatment scenario and answer 5 questions. The final sample for analysis included 101 dentists. When asked to estimate the number of patients out of 100 who would avoid multiple tooth loss without antibiotics, 17 dentists (33%) in the absolute numbers group and 12 (25%) in the RRR group provided the correct response (p = 0.39). Regarding treatment with antibiotics, 26 dentists (50%) in the absolute numbers group and 14 (29%) in the RRR group provided the correct response (p = 0.04). Only 16 dentists (31%) in the absolute numbers group and 12 (25%) in the RRR group gave correct answers for both questions (p = 0.51). Most dentists did not correctly understand the benefit of the treatment, irrespective of the format it was presented. Slightly more dentists correctly understood the benefit of the treatment when it was presented as absolute numbers than as RRR.

A mathematical optimization model for determining safety integrity levels in process facilities

In process industries, Safety Instrumented Functions (SIFs) are implemented to meet government-mandated risk tolerance criteria, which aim to ensure the safety of both individuals and society. The level of risk reduction achieved by a SIF is quantified by its Safety Integrity Level (SIL). Determining the target SILs is a challenging task for facility owners as they must balance the costs and benefits of risk reduction while complying with regulatory requirements. Furthermore, governments define risk tolerance criteria for an overall facility rather than for single scenarios. Therefore, determining a set of SILs for all SIFs becomes imperative to collectively reduce both individual and societal risks to tolerable levels intended for the overall facility. In this paper, we propose a mathematical optimization model to determine the most beneficial collection of SILs that guarantees meeting the risk tolerance criteria. Our model considers both individual and societal risk perspectives and effectively models an overall facility. The proposed model is applied to a process facility and the results are compared with the results from the existing methods for SIL determination. The results demonstrate the model's superior effectiveness in helping owners to select the most beneficial target SILs while ensuring compliance with government requirements.

The cost of doing nothing: Testing the benefits of water disposal risk reduction with water management Activism investing in Latin America

Objective: This paper answers What would the performance of an investor be if she or he invested only in public companies with proper water management practices in Latin America (LATAM)? Methodology: The research uses the water-to-revenues (WTR) ratio to measure water management quality. It simulates the performance of an investor invested mainly in companies with the best WTR (from January 6th, 2005, to Abril 20, 2022). Results: Comparing the simulated portfolio’s performance against a broad market portfolio, the results suggest that both portfolios have similar performance in the short term. In the long term, the tests found that the WTR has a low systematic (market) risk (beta of 0.26), and its performance is more stable (mean-variance efficient) than the market portfolio. The tests also control the impact of some LATAM currencies’ depreciation. Conclusions: The results could be useful for investors to engage in water management activism through investing, motivate companies to engage in better water management practices, and reduce the future risk that water disposal represents to the world in years to come.

The cost of doing nothing: Testing the benefits of water disposal risk reduction with water management Activism investing in Latin America

Objective: This paper answers What would the performance of an investor be if she or he invested only in public companies with proper water management practices in Latin America (LATAM)? Methodology: The research uses the water-to-revenues (WTR) ratio to measure water management quality. It simulates the performance of an investor invested mainly in companies with the best WTR (from January 6th, 2005, to Abril 20, 2022). Results: Comparing the simulated portfolio’s performance against a broad market portfolio, the results suggest that both portfolios have similar performance in the short term. In the long term, the tests found that the WTR has a low systematic (market) risk (beta of 0.26), and its performance is more stable (mean-variance efficient) than the market portfolio. The tests also control the impact of some LATAM currencies’ depreciation. Conclusions: The results could be useful for investors to engage in water management activism through investing, motivate companies to engage in better water management practices, and reduce the future risk that water disposal represents to the world in years to come.

Analysis of the Cost and Cost Components of Conducting Prescribed Fires in the Great Plains

Fire is a naturally occurring process in the Great Plains and was anthropologically applied first by Native Americans and now by a diverse group of landholder types. Fire is a critical tool to help restore historical fire regimes in the region and maintain and grow benefits for agricultural outputs, risk reduction, and ecosystem maintenance. With the Great Plains dominated by private landholdings, lowering barriers to adoption of prescribed burning is important for increasing its use. Costs are a crucial decision element in adoption and regular use of prescribed burning. Using the responses from an Internet-based survey of prescribed burn professionals in the Great Plains, multivariate regression analysis based on cost can identify critical factors and behaviors. The average cost for a prescribed burn in this study is $11.37 per acre, which is comparatively less expensive than numbers reported elsewhere. Seven significant associated variables emerged including number of burns and acreage, firebreak type, and fuel characteristics. The results suggest that economies of scale play an important role in the cost of prescribed burning. Through the identification of the cost of prescribed burning and the factors that influence it, landowners, environmental managers, prescribed burn professionals, and government agencies in the Great Plains will be able to better understand and implement prescribed burns as part of their land management plans.

Estimating the value of a statistical life in China: A contingent valuation study in six representative cities

The value of a statistical life (VSL) is a crucial tool for monetizing health impacts. To explore the VSL in China, this study examines people’s willingness to pay (WTP) to reduce death risk from air pollution in six representative cities in China based on face-to-face contingent valuation interviews (n = 3 936) from March 7, 2019 to September 30, 2019. The results reveal that the WTP varied from CNY 455 to 763 in 2019 (USD 66–111), corresponding to a VSL range of CNY 3.79–6.36 million (USD 549 395–921 940). The VSL in China in 2019 is estimated to be CNY 4.76 million (USD 689 659). The statistics indicate that monthly expenditure levels, environmental concerns, risk attitudes, and assumed market acceptance, which have seldom been discussed in previous studies, significantly impact WTP and VSL. These findings will serve as a reference for analyzing mortality risk reduction benefits in future research and for policymaking.