Heart Failure Spending Function: An Investment Framework for Sequencing and Intensification of Guideline-Directed Medical Therapies

Heart failure with reduced ejection fraction is managed with increasing numbers of guideline-directed medical therapies (GDMT). Benefits tend to be additive. Burdens can also be additive. We propose a heart failure spending function as a conceptual framework for tailored intensification of GDMT that maximizes therapeutic opportunity while limiting adverse events and patient burden. Each patient is conceptualized to have reserve in physiological and psychosocial domains, which can be spent for a future return on investment. Key domains are blood pressure, heart rate, serum creatinine, potassium, and out-of-pocket costs. For each patient, GDMT should be initiated and intensified in a sequence that prioritizes medications with the greatest expected cardiac benefit while drawing on areas where the patient has ample reserves. When reserve is underspent, patients fail to gain the full benefit of GDMT. Conversely, when a reserve is fully spent, addition of new drugs or higher doses that draw upon a domain will lead to patient harm. The benefit of multiple agents drawing upon varied physiological domains should be balanced against cost and complexity. Thresholds for overspending are explored, as are mechanisms for implementing these concepts into routine care, but further health care delivery research is needed to validate and refine clinical use of the spending function. The heart failure spending function also suggests how newer therapies may be considered in terms of relative value, prioritizing agents that draw on different spending domains from existing GDMT.

Volatility transmission within financial markets during the COVID-19 pandemic: are faith-based investors well off in Tunisia?

Purpose This paper aims to investigate the risk-return and volatility spillover within the Tunisian stock market during the COVID-19 pandemic analyzing both the Islamic and conventional stocks’ performance. Design/methodology/approach Both symmetric (GARCH and GARCH-M) and asymmetric (Threshold GARCH and Exponential GARCH) models are used to analyze the market returns and volatility response. Standard and Poor’s (S&P) index has been used to test both the Islamic and conventional stocks within the Tunisian stock market. Findings The findings suggest that both Tunisia Islamic and conventional stock markets are highly persistent; however, the conventional stock index showed a negative return spillover on the Islamic stocks during the pandemic. The conventional stock index has also shown a higher exposure to risk for a lower amount of return, and evidence of potential diversification benefit between both indexes was found during the pandemic, whereas the Islamic market showed a positive leverage effect, indicating a positive correlation between past return and future return; the conventional index implied a negative leverage effect. Originality/value The value of this paper emerges in studying three main aspects that are specific to the Tunisian stock market. This includes COVID-19 effect of return spillovers, volatility transmission across both conventional and Islamic stock market within the local financial market.

Return to Play in Adolescent Baseball Players after SLAP Repair (131)

Objectives: Superior labrum from anterior to posterior (SLAP) tears are increasingly common shoulder injuries in adolescent athletes who participate in repetitive overhead throwing. The purpose of this study is to evaluate adolescent baseball athletes who undergo SLAP repair in order to determine their long-term progression of play, surgical outcomes, and overall satisfaction with surgery. Methods: Patients between the ages of 10-19 who underwent a SLAP repair over a 10-year period from 2008-2018 with minimum two year follow-up were identified by a database query in the medical records of a single institution. From this cohort, non-baseball athletes and injuries to non-throwing shoulders were excluded. After identifying the cohort, patients were contacted via phone to complete functional outcome scores including Conway Score, Western Ontario Shoulder Instability (WOSI) Index, Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow Score, Short Form 12 Mental (MCS)/Physical (PCS) survey and a custom return to play questionnaire. Results: During this time period, 59 baseball players met the inclusion criteria for this study and 76.3% (45/59) of patients were available to be contacted to complete final follow-up surveys at a minimum of 2 years. All patients were male with a mean age of 17.4 +/- 1.5 (14-19) years. The mean follow-up of this cohort was 5.3 +/- 2.6 (2.1-12.1) years. The overall return to play rate was 75.6% (34/45). The average time from surgery to initiation of throwing was 5.9 +/- 2.0 (2-12) months and the average time to return to full competition was 11.3 +/- 3.5 (6-22) months after the surgery. After the SLAP repair, those who returned to play continuing playing baseball competitively for 3.0 +/- 1.9 (0.5-8.0) years after surgery. At the time of final follow-up, 71.1% (32/45) of players had stopped playing baseball. Of those who had stopped playing competitive baseball, 12 (37.5%) reported it was because they were not recruited to the next level, 10 (31.3%) reported they lost the desire to play and 10 (31.3%) reported their shoulder prevented them from playing. The overall mean KOJC, WOSI, SF-12 MCS and SF-12 PCS scores were 60.0 +/- 27.4 (range, 0-100), 21.0+/-20.6% (0-73.8%), 55.2+/-3.9 (37.4-59.8) and 55.2+/-5.6 (range, 37.9-65.7) respectively. The overall satisfaction score was 83.2% with 86.7% (39/45) saying they given the opportunity they would undergo surgery again. Conclusions: The results of this study demonstrated a low return to play rate and low patient reported outcomes on baseball specific surveys among adolescent baseball players who underwent a SLAP repair. Mean functional outcome scores between pitchers and position players were not found to be significantly different. Based on these findings, orthopedic surgeons can better counsel their adolescent baseball players on expectations for future return to play and functional outcomes after SLAP repair.

Persian bloggers : exile, nostalgia and diasporic nationalism

Exiled Iranian bloggers employ the cyber sphere to create an imaginary national community to remain connected to the homeland and to encourage a sense of belonging to a nation they were forced to leave behind. This constructed cyber community carries the nostalgic impulse of the exiled bloggers. The imaginary virtual Iranian community enables them to share past memories and their anticipation of a future return to Iran. This nostalgia is also located in the engagement in activism as they express nationalism while living in the diaspora. What tends to be absent when bloggers are engaging in a diasporic nationalism and the nostalgic impulse is an engagement of their diasporic experience, because they assume their exile is a temporary state. As a result of detachment from the diasporic experience in the blogs and a total disengagement from life in the diaspora, their integration into the new country is kept at bay.

Persian bloggers : exile, nostalgia and diasporic nationalism

Exiled Iranian bloggers employ the cyber sphere to create an imaginary national community to remain connected to the homeland and to encourage a sense of belonging to a nation they were forced to leave behind. This constructed cyber community carries the nostalgic impulse of the exiled bloggers. The imaginary virtual Iranian community enables them to share past memories and their anticipation of a future return to Iran. This nostalgia is also located in the engagement in activism as they express nationalism while living in the diaspora. What tends to be absent when bloggers are engaging in a diasporic nationalism and the nostalgic impulse is an engagement of their diasporic experience, because they assume their exile is a temporary state. As a result of detachment from the diasporic experience in the blogs and a total disengagement from life in the diaspora, their integration into the new country is kept at bay.

Estimation of future precipitation Return-Levels in Europe for the adaptation of industrial facilities

<p>Industrial facilities, like any building or installation, are designed to withstand defined levels of natural hazards during their lifetime. These levels are requested by the regulations, and are commonly estimated by use of the Statistical Extreme Value theory ahead of the building in order to support the design of the planned asset. However, for long lasting installations, climate change may change the frequency of the level defined at the time of the building, so that the protection is not as high as initially expected. This work presented here aims at describing and testing a way to estimate Return Levels for precipitation in different locations in Europe at the 2050 time horizon. The methodology is based on the definition of a variable whose extremes can be considered as stationary, so that future Return Levels are obtained from those of this variable and the climate model changes in mean, standard deviation and rainy day frequency at the desired future horizon (Acero et al. 2017). The methodology is first tested in a cross-validation setting over the historical period using 15 rainfall observation time series in Europe provided by the ECA&D dataset and CMIP5 climate model simulations. Then, estimates of the 50-year Return Levels in 2050 are computed. The methodology is then applied to the gridded E-OBS dataset with the objective of producing risk maps at the European scale. The first step is then to compare the estimations previously obtained for the station time series to those obtained for the nearest E-OBS grid points, in order to assess the ability of gridded data to faithfully represent the behavior of the extremes. Depending on the results, advices can be given about the most suited way to map future rainfall extremes in Europe in relation to the adaptation of industrial facilities.</p><p> </p><p>Reference:</p><p>Acero F.J., Parey S., Hoang T.T.H., Dacunha-Castelle D., Garcia J.A. and Gallego M.C.: Non-stationary future Return Levels for extreme rainfall over Extremadura (SW Iberian Peninsula). Hydrological Sciences Journal, 2017, DOI: 10.1080/02626667.2017.1328559</p>

Validation of a Simulation-Based Pre-Assessment Process for Solar Photovoltaic Technology Implemented on Rooftops of South African Shopping Centres

The existing processes that determines the yield of a photovoltaic (PV) system before construction commences are fairly unstructured. Research that defines a structured process for simulation purposes is limited. This article builds on prior research where a proposed structured pre-assessment process, which may be applied before construction commences, was generated so that electricity yield from a PV system can be predicted with a higher degree of accuracy, and then subsequently optimized. By implementing the proposed pre-assessment process, calculating the future return on investment (ROI) by private investors is simplified, given that the existing process is restrictive. The research used the results from a South African case study over 24 months to ascertain the validity of the proposed pre-assessment process. The validation process includes analyzing the load demand of the shopping centre before and after the PV system was constructed, comparing the electricity yield from the PV system to the simulation results obtained in the preceding research, and amending the proposed pre-assessment process accordingly for improved electricity estimation. The case study shopping centre operates in Johannesburg, Gauteng, and consumes approximately 5000 kVA under maximum load.

Why Do People Support Online Crowdfunding Charities? A Case Study From China

Whereas the effect of people’s motivations to give to traditional, off-line charities has been extensively investigated, their motivations to support online charitable crowdfunding projects are largely unexplored. The present study examines the influences of extrinsic motivations (such as reputation, the wish to signal a certain image; and reciprocity, the expectation on future return for their present contribution), intrinsic motivations (such as a sense of belonging, the feeling of belonging to an integral part of a positive community; joy of giving, the anticipated positive emotions experienced by helping others; altruism, intrinsic desire to help others without expectation of a return; and financial constraints, individuals’ personally felt financial stresses induced by donations), and social interactions (such as social influence, people’s perception of how their close acquaintances believe they should support the project; and social ties, the strength of the relationship between the individual and the project initiator) on intentions to support charitable crowdfunding behaviors, namely, the willingness to share (WTS) project information and the intention to donate (ITD) money. Hierarchical multiple regression analyses on self-reported survey data from 617 respondents in China reveal support for the hypotheses. The results show that intrinsic motivations and social ties are predictors for both supporting behaviors. Reputation and social influence motivate people to share projects, but have no significant effects on their ITD. Reciprocity is positively, and financial constraints are negatively, related to ITD but have no significant effects on WTS. These findings offer insights into the motivations driving individuals’ participation in charitable crowdfunding. The implications for both platforms and fundraisers are discussed.

Utopia and Political Theology in the “Oldest Systematic Program of German Idealism”

This chapter focuses on a figure of historical progression embedded in revolutionary thought in the modern era: the spiral. Most associated with Hegelianism, the spiral stands for the dialectic of history: an eventual future return to the origin. The spiral’s secularized telic schema remains, however, continuous with the theological model of change as the circle of perfection. This continuity is reflected in Romantic messianism and its heirs. My discussion of the spiral is anchored well before their time, in “The Oldest Systematic Program of German Idealism,” likely authored in 1796/1797 by Hegel himself. Unpublished until the twentieth century, the text calls for a new, rational mythology to do away with the modern state. In contrast to the later Hegel’s attempt to identify the spiral of history with the development of the state-form, the political theology of this radical early document identifies its utopian telos with the overcoming of the state.

Аlgorithm of diversification management of the enterprise activity

The algorithm of management of diversification of the enterprise which is based on unity of three main spheres of activity, namely: operational, investment and financial is offered. This combination allows to take into account the comprehensive support of diversification programs and eliminate imbalances and imbalances in the development of enterprises that may arise during the diversification of production. The analysis and generalization of theoretical preconditions of formation of programs of diversification is carried out, the review of sources in the field of management of production programs at the enterprise level, diversification of production, balanced development is carried out. The research methods are comparative analysis and synthesis, reproductive method, modeling. As an indicator of the feasibility of diversification used the excess of future return on capital of the enterprise over its value. A diversification program should be adopted when such a ratio is the maximum of the alternatives for a given development option, and should be rejected if it is not supported in different diversification options. It is revealed that diversification of production activity is one of the ways of development, which affects the investment, financial, operational spheres, leading to sustainable qualitative and quantitative changes of the enterprise. This method of development, acting as a way to reduce risks, helps to increase the financial stability of the enterprise, and hence increase its potential. The created algorithm allows to carry out management of diversification of activity of the enterprise taking into account such important components as cost of the capital and its profitability. The use of the proposed algorithm article is only one of the ways to manage diversification, which should be combined with budgeting, economic and mathematical modeling, methods of expert evaluation, the creation of simulation models and more. Today there is a need to develop indicators of the effectiveness of diversification programs, assess the feasibility of their implementation and develop models that take into account the peculiarities of the functioning of enterprises in different sectors of the economy.