Are we predisposed to behave securely? Influence of risk disposition on individual security behaviors

Employees continue to be the weak link in organizational security management and efforts to improve the security of employee behaviors have not been as effective as hoped. Researchers contend that security-related decision making is primarily based on risk perception. There is also a belief that, if changed, this could improve security-related compliance. The extant research has primarily focused on applying theories that assume rational decision making e.g. protection motivation and deterrence theories. This work presumes we can influence employees towards compliance with information security policies and by means of fear appeals and threatened sanctions. However, it is now becoming clear that security-related decision making is complex and nuanced, not a simple carrot- and stick-related situation. Dispositional and situational factors interact and interplay to influence security decisions. In this paper, we present a model that positions psychological disposition of individuals in terms of risk tolerance vs. risk aversion and proposes research to explore how this factor influences security behaviors. We propose a model that acknowledges the impact of employees' individual dispositional risk propensity as well as their situational risk perceptions on security-related decisions. It is crucial to understand this decision-making phenomenon as a foundation for designing effective interventions to reduce such risk taking. We conclude by offering suggestions for further research.</p

Effect of Direct Oral Anticoagulant, Patient, and Surgery Characteristics on Clinical Outcomes in the Perioperative Anticoagulation Use for Surgery Evaluation Study.

Introduction  The Perioperative Anticoagulation Use for Surgery Evaluation (PAUSE) Study assessed a standardized perioperative management strategy in patients with atrial fibrillation who were taking a direct oral anticoagulant (DOAC) and required an elective surgery or procedure. The aim of this substudy is to analyze the safety of this management strategy across different patient subgroups, according to four presurgical variables: (1) DOAC type and dose, (2) surgery/procedure bleed risk, (3) patient renal function, and (4) age. Methods  Clinical outcomes analyzed included major bleeding (MB), arterial thromboembolism, any bleeding, and any thromboembolism. We used descriptive statistics to summarize clinical outcomes, where the frequency, proportion, and 95% confidence interval were reported. Fisher\u27s exact tests were used for testing the hypothesis of independence between the clinical outcome and patient characteristic, where the test p -values were reported. Results  There were 3,007 patients with atrial fibrillation requiring perioperative DOAC management. There was no significant difference in bleeding or thromboembolic outcomes according to DOAC type/dose regimen, renal function, or patient age. The rate of MB was significantly higher with high bleed risk procedures than low bleed risk procedures in apixaban-treated patients (2.9 vs. 0.59%; p  \u3c 0.01), but not in dabigatran-treated patients (0.88 vs. 0.91%; p  = 1.0) or rivaroxaban-treated patients (2.9 vs. 1.3%; p  = 0.06). The risk for thromboembolism did not differ according to surgery/procedure-related bleed risk. Conclusion  Our results suggest that in DOAC-treated patients who received standardized perioperative management, surgical bleed risk is an important determinant of bleeding but not thromboembolic outcomes, although this finding was not consistent across all DOACs. There were no differences in bleeding and thromboembolism according to DOAC type and dose, renal function, or age

Corporate governance of banks in Vietnam and their roles on banks’ risk-taking and efficiency : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Banking Studies at Massey University, Manawatu Campus, New Zealand

This thesis comprises three essays that investigate the effectiveness of corporate governance mechanisms associated with recent Vietnamese banking reform on Vietnamese banks’ risk-taking and efficiency. The thesis uses a hand-collected dataset on accounting and corporate governance data from annual statements published by commercial banks during the 2006-2016 period. The first essay examines the role of foreign directors on bank risk-taking, using data from 32 commercial banks in Vietnam in the 2006-2016 period. Our findings suggest foreign directors increased bank risk-taking after 2011. The relationship is robust after taking account of potential endogeneity problems and different measures of bank risk-taking. The explanation is that foreign directors are motivated to encourage management to increase risk-taking to earn short-term returns when there is uncertainty in macroeconomic conditions. Other characteristics such as female directors, family related directors, and board size on risk-taking are also discussed. There is no evidence showing that foreign directors are more or less risk-averse in listed banks vs unlisted banks or in state-owned banks vs private banks. The second essay investigates the impact of female directors on boards on bank efficiency, using data from 32 commercial banks, covering the 2006-2016 period. The relationship is estimated by employing one-stage stochastic frontier analysis, using the Battese and Coelli (1995) (BC95) approach. The two-stage distributional free approach proposed by Cornwell, Schmidt, and Sickles (1990) (CS90) is employed as a robustness check. The result shows a robust relationship between female directors and cost-efficiency. This suggests that female directors are associated with a decrease in cost efficiency. A possible explanation is that female directors are less experienced in management than male directors and have less access to environmental resources that benefit firms. The third essay examines the impact of mergers and acquisitions (M&As) on bank efficiency, using a balanced panel dataset from 22 commercial banks over the 2008-2016 period. The study employs a two-stage DEA window analysis. Our findings suggest that there is no significant relationship between M&As and bank efficiency, which is not surprising given the small number of M&A events so far. However, there is evidence that Vietnamese banks experienced less improvement in efficiency after M&As. A possible explanation for this is that the M&As might not be not driven by profit-maximization, but by the government encouragement to rescue weak banks. Also, the combined entities need to spend additional resources on resolving the bad debts transferred from the weak, targeted banks

Clinical Profile and Management of Patient Patients with Ischemic Heart Disease and/or Peripheral Artery Disease in Clinical Practice : The APALUSA Study

Altres ajuts: Bayer Hispania S.L.This study was aimed to ascertain the clinical profile and management of patients with ischemic heart disease (IHD) and/or peripheral artery disease (PAD). In this observational and cross-sectional study developed in 80 hospitals throughout Spain, consecutive adults with stable IHD and/or PAD were included. A total of 1089 patients were analyzed, of whom 65.3% had only IHD, 17.8% PAD and 16.9% both. A total of 80.6% were taking only one antiplatelet agent, and 18.2% were on dual antiplatelet therapy (mainly aspirin/clopidogrel). Almost all patients were taking 1 lipid lowering drug, mainly moderate-to-high intensity statins. IHD patients took ezetimibe more commonly than PAD (43.9% vs. 12.9%; p < 0.001). There were more patients with IHD that achieved blood pressure targets compared to PAD (<140/90 mmHg: 67.9% vs. 43.0%; p < 0.001; <130/80 mmHg: 34.1% vs. 15.7%; p < 0.001), LDL-cholesterol (<70 mg/dL: 53.1% vs. 41.5%; p = 0.033; <55 mg/dL: 26.5% vs. 16.0%; p = 0.025), and diabetes (HbA1c < 7%, with SGLT2i/GLP1-RA: 21.7% vs. 8.8%; p = 0.032). Modifications of antihypertensive agents and lipid-lowering therapy were performed in 69.0% and 82.3% of patients, respectively, without significant differences between groups. The use of SGLT2i/GLP1-RA was low. In conclusion, cardiovascular risk factors control remains poor among patients with IHD, PAD, or both. A higher use of combined therapy is warranted

Community based intervention to optimize osteoporosis management: randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Osteoporosis-related fractures are a significant public health concern. Interventions that increase detection and treatment of osteoporosis are underutilized. This pragmatic randomised study was done to evaluate the impact of a multifaceted community-based care program aimed at optimizing evidence-based management in patients at risk for osteoporosis and fractures.</p> <p>Methods</p> <p>This was a 12-month randomized trial performed in Ontario, Canada. Eligible patients were community-dwelling, aged ≥55 years, and identified to be at risk for osteoporosis-related fractures. Two hundred and one patients were allocated to the intervention group or to usual care. Components of the intervention were directed towards primary care physicians and patients and included facilitated bone mineral density testing, patient education and patient-specific recommendations for osteoporosis treatment. The primary outcome was the implementation of appropriate osteoporosis management.</p> <p>Results</p> <p>101 patients were allocated to intervention and 100 to control. Mean age of participants was 71.9 ± 7.2 years and 94% were women. Pharmacological treatment (alendronate, risedronate, or raloxifene) for osteoporosis was increased by 29% compared to usual care (56% [29/52] vs. 27% [16/60]; relative risk [RR] 2.09, 95% confidence interval [CI] 1.29 to 3.40). More individuals in the intervention group were taking calcium (54% [54/101] vs. 20% [20/100]; RR 2.67, 95% CI 1.74 to 4.12) and vitamin D (33% [33/101] vs. 20% [20/100]; RR 1.63, 95% CI 1.01 to 2.65).</p> <p>Conclusions</p> <p>A multi-faceted community-based intervention improved management of osteoporosis in high risk patients compared with usual care.</p> <p>Trial Registration</p> <p>This trial has been registered with clinicaltrials.gov (ID: NCT00465387)</p

An Evaluation of Managing and Educating Patients on the Risk of Glucocorticoid-Induced Osteoporosis

AbstractObjectiveTo assess the impact of risk management activities on patient risk of glucocorticoid-induced osteoporosis.MethodsNinety-six adult patients taking chronic glucocorticoid therapy in 15 community pharmacies. Patients in the control group received usual and customary care. Patients in the treatment pharmacies received education and an educational pamphlet about the risks of glucocorticoid-induced osteoporosis. In addition, the treatment group pharmacists monitored the patients' drug therapy, to identify and address drug-related problems. Data including the glucocorticoid taken by the patient, medications, and osteoporosis risk factors were collected at baseline and after 9 months of monitoring, via Web-based survey completed in the pharmacy. Using an intent to treat approach, the pre–post frequency changes were compared with contrasts for presence of bisphosphonate therapy, presence of estrogen therapy, presence of calcium supplement, discussion of glucocorticoid-induced osteoporosis risk, discussion of bone density test, presence of bone mineral density test, reported inactivity, and reported low calcium diet.ResultsThe contrast was significant in favor of the treatment pharmacies for the frequency of patients taking a calcium supplement (Control [−6.9%] vs. Treatment [17.1%], P < 0.05). No other contrast was significant.ConclusionsCommunity pharmacists are capable of increasing calcium supplementation among patients at risk for glucocorticoid-induced osteoporosis. Pharmacists who educate at-risk patients can impact the self-care of these patients

A randomized, prospective, open label comparative study of the efficacy of azilsartan and ramipril in the management of hypertension in patients with type-2 diabetes mellitus

Background: Patients with diabetes are prone to have hypertension. Hypertension is risk factors for complications of the vascular system, cardiovascular diseases and leads to atherosclerosis. It has been estimated that the diabetics tend to have about two times more risk of having hypertension than the general population. Objective of current study is to study and compare the efficacy of azilsartan and ramipril in the management of Hypertensive patients with type 2 diabetes mellitusMethods: randomized, prospective, open label comparative study was carried out among 60 known cases of diabetes mellitus type-2 with hypertension. Patients were randomly allocated into two groups: group-A (N=30) taking ACE Inhibitor tablet ramipril 5 mg Once daily orally. Group-B (N=30) taking angiotensin II receptor antagonist tablet azilsartan 40 mg once daily orally. At the commencement of the trial, patients were subjected to thorough clinical examination with necessary investigations and base line values were recorded.Results: Both the groups were comparable for age, sex and treatment taken. There was a significant reduction in the mean arterial pressure (17.43 for azilsartan group vs. 14.5 for ramipril group) (mmHg), creatinine clearance (mean reduction of 18.8 for azilsartan group vs. 13.94 for ramipril group), and urinary albumin excretion (mean reduction of 29.74 in azilsartan group vs. 17.25 for ramipril group). In azilsartan group the reduction was more in all parameters compared to ramipril group without effecting renal parameters.Conclusions: Azilsartan was more effective in reducing the mean arterial pressure (mmHg), creatinine clearance as well as urinary albumin excretion in Hypertensive patients with Type 2 diabetes mellitus without effecting renal parameters

Prevalence of Polypharmacy and associated adverse Outcomes and Risk Factors among Children With asthma in the Usa: a Cross-Sectional Study

OBJECTIVE: to estimate the prevalence of polypharmacy, identify risk factors and examine related adverse outcomes in the US children with asthma. DESIGN, SETTING AND PARTICIPANTS: This population-based, cross-sectional study included 1776 children with asthma from the 2011-2020 National Health and Nutrition Examination Surveys. EXPOSURES: Polypharmacy is defined as taking ≥2 medications concurrently for ≥1 day over the past 30 days. MAIN OUTCOMES AND MEASURES: (1) Weighted prevalence estimates of polypharmacy in children with asthma; (2) asthma attacks and emergency department (ED) visits. RESULTS: The estimated prevalence of polypharmacy in the US children with asthma was 33.49% (95% CI 31.81% to 35.17%). 15.53% (95% CI 14.31% to 16.75%), 12.63% (95% CI 11.37% to 13.88%) and 5.33% (95% CI) of participants were taking 2, 3-4, and 5 prescription medications, respectively. In addition to asthma medications, the most common sources of polypharmacy included antihistamines (20.17%, 95% CI 16.07% to 24.28%), glucocorticoids (16.67%, 95% 12.57% to 20.78%), and anti-infectives (14.28%, 95% CI 10.29 to 18.28). Risk factors for the increased number of medications included age 5-11 years old (vs 1-4 years: adjusted incidence rate ratio (aIRR) 1.38, 95% CI 1.10 to 1.72), fair-to-poor health (vs excellent or very good: aIRR 1.42, 95% CI 1.05 to 1.92), or ≥6 healthcare utilisation encounters over the last year (vs 0-5 encounters: aIRR 1.45, 95% CI 1.26 to 1.66). Polypharmacy increased the odds of an asthma attack (adjusted OR (aOR) 2.80, 95% CI 1.99 to 3.93) and ED visit (aOR 2.41, 95%1.59-3.63) after adjusting for demographics, insurance and health status. CONCLUSIONS: Every one in three US children with asthma experienced polypharmacy. Although it may reflect the treatment guidelines that various asthma medications are needed for maintenance therapy, our results suggested that polypharmacy increased the odds of asthma attacks or ED visits. This may be due to the concurrent use with other non-asthma medications indicating that there is an opportunity to improve medication management in children with asthma

Role of rivaroxaban in the management of atrial fibrillation: insights from clinical practice.

© 2018 Vimalesvaran et al. This work is published and licensed by Dove Medical Press Limited.Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and it leads to significant morbidity and mortality, predominantly from ischemic stroke. Vitamin K antagonists, mainly warfarin, have been used for decades to prevent ischemic stroke in AF, but their use is limited due to interactions with food and other drugs, as well as the requirement for regular monitoring of the international normalized ratio. Rivaroxaban, a direct factor Xa inhibitor and the most commonly used non-vitamin K oral anticoagulant, avoids many of these challenges and is being prescribed with increasing frequency for stroke prevention in non-valvular AF. Randomized controlled trial (RCT) data from the ROCKET-AF(Rivaroxaban once daily oral direct Factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation) trial have shown rivaroxaban to be non-inferior to warfarin in preventing ischemic stroke and systemic embolism and to have comparable overall bleeding rates. Applicability of the RCT data to real-world practice can sometimes be limited by complex clinical scenarios or multiple comorbidities not adequately represented in the trials. Available real-world evidence in non-valvular AF patients with comorbidities - including renal impairment, acute coronary syndrome, diabetes mellitus, malignancy, or old age - supports the use of rivaroxaban as safe and effective in preventing ischemic stroke in these subgroups, though with some important considerations required to reduce bleeding risk. Patient perspectives on rivaroxaban use are also considered. Real-world evidence indicates superior rates of drug adherence with rivaroxaban when compared with vitamin K antagonists and with alternative non-vitamin K oral anticoagulants - perhaps, in part, due to its once-daily dosing regimen. Furthermore, self-reported quality of life scores are highest among patients compliant with rivaroxaban therapy. The generally high levels of patient satisfaction with rivaroxaban therapy contribute to overall favorable clinical outcomes.Peer reviewedFinal Published versio

Bundled Payment vs. Fee-for-Service: Impact of Payment Scheme on Performance

Healthcare reimbursements in the United States have been traditionally based on a fee-for-service (FFS) scheme, providing incentives for high volume of care, rather than efficient care. The new healthcare legislation tests new payment models that remove such incentives, such as the bundled payment (BP) system. We consider a population of patients (beneficiaries). The provider may reject patients based on the patient’s cost profile and selects the treatment intensity based on a risk-averse utility function. Treatment may result in success or failure, where failure means that unforeseen complications require further care. Our interest is in analyzing the effect of different payment schemes on outcomes such as the presence and extent of patient selection, the treatment intensity, the provider’s utility and financial risk, and the total system payoff. Our results confirm that FFS provides incentives for excessive treatment intensity and results in suboptimal system payoff. We show that BP could lead to suboptimal patient selection and treatment levels that may be lower or higher than desirable for the system, with a high level of financial risk for the provider. We also find that the performance of BP is extremely sensitive to the bundled payment value and to the provider’s risk aversion. The performance of both BP and FFS degrades when the provider becomes more risk averse. We design two payment systems, hybrid payment and stop-loss mechanisms, that alleviate the shortcomings of FFS and BP and may induce system optimum decisions in a complementary manner. This paper was accepted by Serguei Netessine, operations management