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Abstract Background Precise estimates of risk-adjusted increases in postoperative length of stay (LOS) associated with postoperative complications across a range of complications and operations are not available in the existing literature. Methods Associations between preoperative characteristics, postoperative complications and postoperative LOS were tested using medians, interquartile ranges, and nonparametric rank sum tests in a retrospective cohort study using the 2005–2018 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) dataset. A negative binomial model was used with postoperative LOS as the dependent variable and preoperative characteristics and postoperative complications as independent variables. The model was applied to estimate each patient’s postoperative LOS with and without each postoperative complication to measure the association between each complication and risk-adjusted change in postoperative LOS. Results A total of 4,495,582 patients were included. After risk-adjustment, occurrence of each postoperative complication was associated with significantly increased postoperative LOS (between + 3.9 and + 20.1 days, p

In health care centers, monitoring the medical outcomes is desirable to quickly detect performance changes. In recent years, monitoring the surgical process has gained eminence by accounting for patients' health conditions before cardiac surgery where the data is heterogeneous with respect to patients' health conditions. In the current study, we focus on risk-adjusted moving average-exponentially weighted moving average (RAMA-EWMA) control chart to identify the survival time after cardiac surgery. For this purpose, we used two years data set of the cardiac surgery. The performance of the control chart is evaluated by the average run length. Based on the extensive simulation, the average run length properties are computed. It is revealed that the proposed control chart has better shift diagnostic ability than the control chart considers in this study. [ABSTRACT FROM AUTHOR]

Background: Precise estimates of risk-adjusted increases in postoperative length of stay (LOS) associated with postoperative complications across a range of complications and operations are not available in the existing literature. Methods: Associations between preoperative characteristics, postoperative complications and postoperative LOS were tested using medians, interquartile ranges, and nonparametric rank sum tests in a retrospective cohort study using the 2005–2018 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) dataset. A negative binomial model was used with postoperative LOS as the dependent variable and preoperative characteristics and postoperative complications as independent variables. The model was applied to estimate each patient's postoperative LOS with and without each postoperative complication to measure the association between each complication and risk-adjusted change in postoperative LOS. Results: A total of 4,495,582 patients were included. After risk-adjustment, occurrence of each postoperative complication was associated with significantly increased postoperative LOS (between + 3.9 and + 20.1 days, p < 0.0001). The longest risk-adjusted postoperative LOS increases were associated with prolonged ventilator use (+ 20.1 days), wound disruption (+ 19.4 days), and acute renal failure (+ 17.1 days). Conclusion: Occurrence of any postoperative complication was associated with increased risk-adjusted postoperative LOS. Degree of increase varied by complication. These data could be useful for patient counseling, allocation of resources, discharge planning, and quality improvement efforts. [ABSTRACT FROM AUTHOR]

Socially Responsible Investing (SRI), belongs to a category of investment strategies aiming to reduce the negative impacts associated with financial investments, while yielding competitive returns. The literature reveals inconsistent results when comparing the performance of SRI funds to traditional funds, limiting investor awareness on the performance of SRI funds as an investment substitute. The purpose of this research paper is to increase investor awareness on suitable investment substitutes, considering the changes made to "regulation 28 of the Pension Fund Act of 1956", and to increase SRI in South Africa. The objective is to determine if SRI funds, and their matched traditional counterpart funds provide a higher relative risk-adjusted (RA) return than the JSE ALSI before and during the COVID-19 pandemic. This is achieved by using the Fama-French 3-Factor Model and the Modigliani and Modigliani measure. The results reveal that, when controlling for systematic risk, SRI funds and traditional funds are unable to outperform the JSE ALSI before and during the COVID-19 pandemic. When controlling for unsystematic risk, a small number of SRI funds (30%; 20%) and traditional funds (30%; 30%) outperform the JSE ALSI, before and during the COVID-19 pandemic, respectively. The results imply that institutional and retail investors should include SRI funds in their investment strategy alongside traditional funds or as a substitute for traditional funds during economic crises. [ABSTRACT FROM AUTHOR]

The paper investigates the behavior of mutual funds and their risk-adjusted performance in the financial markets of Nigeria between April 2016 and May 31, 2019, using descriptive statistics, as well as CAPM, Jensen’s alpha, and other risk-adjusted portfolio performance measures such as Sharpe and Treynor ratios, as well as Fama decomposition of return. The descriptive tests revealed that 80.77% of the funds were superior to market returns, while 13.46% were riskier. The market and the fund returns behaved abnormally with asymptotic and leptokurtic characteristics as their skewness and kurtosis varied from the normal requirements. Diagnostically, the normality test by Jacque-Berra showed that the return was not normally distributed at a 1% significance level. The market was more aggressive relative to the funds. The average risk-free rate was 6.75% above the market’s return. The risk-adjusted portfolio returns measured by Sharpe and Treynor ratios showed that 67.31% of the funds underperformed the market compared to 40.38% that outperformed the market using Jensen’s alpha. Fama decomposition of return revealed that the fund managers are risk-averse with 48% superior selection ability and rationally invested over 85% of investors’ funds in schemes with fixed income securities at a given risk-free return that cushioned the negative effects of the systematic and idiosyncratic risks and consequently threw the total returns into positive territories. Overall, the fund managers possessed 52% of inferior selection abilities that only earned 33% of superior risk-adjusted returns and hence, failed to achieve the desired diversification in the relevant period.

Off balance sheet is an activity undertaken by a financial institution, but not seen or recorded on the balance sheet because such activities do not cause or involve ownership of assets and the issuance of debt instruments (Saunders & Cornett 2003). Off Balance Sheet activities can be obtained through income derived from non-interest income. The off balance activity is initiated by the banking industry with the aim of creating diversification in obtaining optimal bank's returns. This study aims to investigate the effect of revenue diversification from off balance sheet activity toward Bank’s risk-adjusted performance. This research was conducted in several Commercial Banks in Indonesia. The data collection was based on purposive sampling and statistically analysed using Eviews version 9.2. The results of this research showed that revenue diversification from off balance sheet activity bears positive effects toward Commercial Bank’s risk-adjusted performance in Indonesia. Off balance sheet activity was measured by non-interest income reported in the income statement

The timely detection of surgical quality changes is becoming increasingly important. Variable life-adjusted display (VLAD) has a wide range of applications in the medical field. However, the control limits of VLAD are not defined; thus, the charts alone cannot reveal whether surgical quality underwent a significant change. This paper proposes a new risk-adjusted exponentially weighted moving average VLAD (RAEV) chart and provides a control limit that can be used with the VLAD. The RAEV chart is designed to detect shifts in the odds ratios of patients' surgical risk. Simulation is used to demonstrate that the proposed RAEV chart efficiently detects shifts of various magnitudes, and an example is provided to illustrate the implementation of the RAEV control limits in a VLAD chart. Copyright © 2017 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Purpose – Despite many troublesome aspects in its use, the risk-adjusted discount rate has survived and continues to be extensively used by practitioners. While the appropriate discount rate for projects as risky as the current business operations of the firm can be estimated relatively easily as the firm’s cost of capital, no clear guideline is available for projects with a higher risk profile. The purpose of this paper is to evaluate an appropriate risk addendum for such risky projects. Design/methodology/approach – Extending the framework developed by Davies et al. (2012), the perceived risk in a project is captured by focussing on a downside case scenario and estimating its probability and severity. An expression is then developed for the risk addendum (as an addendum to the firm’s cost of capital) that can be used to find the value of a risky project. Findings – The risk addendum is found to depend only on the product of the probability (p) and the severity (d) of the downside case scenario and not on either of them individually It was also found that the risk addendum rises fast for projects with shorter lives and so is the highest for risky projects with short lives. Practical implications – Managers can use the expression derived to evaluate an appropriate risk addendum for risky projects. Originality/value – The paper suggests a simple framework to quantify the risk involved in a project and to evaluate an appropriate risk addendum. [ABSTRACT FROM AUTHOR]

Objective: To describe the first year of the Educational Quality Improvement Program (EQIP) DESIGN: The Educational Quality Improvement Program (EQIP) was formed by the Association of Program Directors in Surgery (APDS) in 2018 as a continuous educational quality improvement program. Over 18 months, thirteen discrete goals for the establishment of EQIP were refined and executed through a collaborative effort involving leaders in surgical education. Alpha and beta pilots were conducted to refine the data queries and collection processes. A highly-secure, doubly-deidentified database was created for the ingestion of resident and program data., Setting & Participants: 36 surgical training programs with 1264 trainees and 1500 faculty members were included in the dataset. 51,516 ERAS applications to programs were also included. Uni- and multi-variable analysis was then conducted., Results: EQIP was successfully deployed within the timeline described in 2020. Data from the ACGME, ABS, and ERAS were merged with manually entered data by programs and successfully ingested into the EQIP database. Interactive dashboards have been constructed for use by programs to compare to the national cohort. Risk-adjusted multivariable analysis suggests that increased time in a technical skills lab was associated with increased success on the ABS's Qualifying Examination, alone. Increased time in a technical skills lab and the presence of a formal teaching curriculum were associated with increased success on both the ABS's Qualifying and Certifying Examination. Program type may be of some consequence in predicting success on the Qualifying Examination., Conclusions: The APDS has proved the concept that a highly secure database for the purpose of continuous risk-adjusted quality improvement in surgical education can be successfully deployed. EQIP will continue to improve and hopes to include an increasing number of programs as the barriers to participation are overcome., (Copyright © 2022 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Strategy theory suggests that firms can impede mean reversion of economic rents by employing competitive efforts, thereby impacting profitability, forecasting, and valuation. We use realized operating performance to establish which competitive effort proxies effectively protect rents. The inclusion of competitive advantage proxies improves future accounting return forecasts and several efforts generalize across industries including power over suppliers and the credible threat of expected retaliation (Porter, 1980). Traditional barriers-to-entry proxies (product differentiation, innovation, and capital requirements) do not result in higher profitability once risk- and industry-adjusted. Finally, competitive efforts are not fully impounded into stock price, resulting in abnormal future returns. [ABSTRACT FROM AUTHOR]

Abstract: It is widely recognized that the economics of distant-future events, like climate change, is critically dependent upon the choice of a discount rate. Unfortunately, it is unclear how to discount distant-future events when the future discount rate itself is unknown. In previous work, an analytically-tractable approach called “gamma discounting” was proposed, which gave a declining discount rate schedule as a simple closed-form function of time. This paper extends the previous gamma approach by using a Ramsey optimal growth model, combined with uncertainty about future productivity, in order to “risk adjust” all probabilities by marginal utility weights. Some basic numerical examples are given, which suggest that the overall effect of risk-adjusted gamma discounting on lowering distant-future discount rates may be significant. The driving force is a “fear factor” from risk aversion to permanent productivity shocks representing catastrophic future states of the world. [Copyright &y& Elsevier]

The U.S. Centers for Medicare and Medicaid Services' (CMS's) Hospital Compare (HC) data provides a collection of risk-adjusted hospital performance metrics intended to allow comparison of hospital-provided care. However, CMS does not adjust for socioeconomic status (SES) factors, which have been found to be associated with disparate health outcomes. Associations between county-level SES factors and CMS's risk-adjusted 30-day acute myocardial infarction (AMI) mortality rates are explored for n = 2462 hospitals using a variety of sources for county-level SES information. Upon performing multiple imputation, a stepwise backward elimination model selection approach using Akaike's information criteria was used to identify the optimal model. The resulting model, comprised of 14 predictors mostly at the county level, provides an additional 8% explanatory power to capture the variability in 30-day risk-standardized AMI mortality rates, which already account for patient-level clinical differences. SES factors may be an important feature for inclusion in future risk-adjustment models, which will have system and policy implications for distributing resources to hospitals, such as reimbursements. It also serves as a stepping stone to identify and address long-standing SES-related inequities. [ABSTRACT FROM AUTHOR]