The Efficacy of Virtual Fracture Clinics (VFCs) and the Impact of Physician Risk Appetite on Discharge Rates

Background and objectives Virtual fracture clinics (VFCs) allow the triage of emergency department referrals to identify those requiring further care and those that are suitable for discharge. Appropriate discharge from VFC benefits the patient and the healthcare provider by avoiding unnecessary face-to-face appointments. This study investigates factors associated with VFC discharge rates at our hospital and detects potential areas for improvement. Methodology A retrospective review was conducted on 4819 consecutive VFC referrals between March 17, 2021, and March 16, 2022, from a single hospital. Patient demographics, referral outcomes, and triaging consultant data were collected. Sixteen consultants conducted daily VFCs during the study period. Eleven consultants completed the DOSPERT psychometric test to measure their attitude toward risk. The data was analysed using Spearman's rho and Chi-square tests. Results The mean discharge from VFC was 35.4% (29.6-41.0%). The highest rates of discharge were for back pain (100%), followed by fractures of the pubic ramus (100%), the base of the fifth metatarsal (86.89%), the acetabulum (75%), and the proximal radius (73.03%). Consultant experience was significantly negatively correlated with discharge rate (p<0.05). The frequency of conducting a VFC was not associated with the discharge rate (p=0.758). In subspecialty analysis, 90% of lower limb consultants discharged more lower limb presentations from VFC, compared with upper limb consultants (p=0.001). There was no significant correlation between DOSPERT scores and discharge rates (p=0.65). Conclusions VFC remains an important tool for patient care. Consultant experience is associated with a more cautious approach to discharge; however, there was no relationship between a consultant's risk attitude and their VFC discharge rate in this study. Lower-limb consultants appear to discharge lower-limb injuries more readily when compared with their upper-limb colleagues. These insights could be used to improve emergency department and VFC efficiency.

“Unchain My Heart.” A Defense Industrial Policy Agenda for Germany’s Zeitenwende

A Zeitenwende that delivers one of Europe’s most powerful armed forces needs to correct the (non-existent) position of defense industrial issues within German political discourse. This paper therefore develops a defense industrial policy agenda based on four lines of effort: Make daringness Germany’s prime ambition; establish Germany as a defense industrial framework nation; promote German defense industrial diplomacy with foreign partners; solidify a true public-private defense partnership between the German government and the defense industrial base.

Research on the Tournament Incentive Mechanism of the Safety Behavior for Construction Workers: Considering Multiple Heterogeneity

The unsafe behavior of construction workers is one of the most important and direct causes of safety accidents. Managers usually develop effective incentives aimed at regulating worker safety behavior. Due to the large number of workers in construction projects, there are multiple differences in fairness preference, risk preference and ability level, which will lead to the complex effect of the traditional mechanism to regulate workers' safety behavior. In order to improve the effectiveness of incentive measures for worker safety behavior, this paper takes into account the multiple differences of individual workers' fairness preference, risk preference and ability level, based on the tournament mechanism to construct a competition incentive model. By designing a tournament reward and salary distribution for heterogeneous workers, the occurrence of unsafe behaviors can be reduced. The study found that in terms of the optimal level of safety investment, workers with risk aversion attitude generally invest higher than that of workers with risk preference, no matter whether they have a strong fairness preference or not; In terms of the distribution of tournament rewards, workers with a risk aversion attitude and a higher level of fairness preference need to be given higher incentives.

Testosterone, Cortisol and Financial Risk-Taking

Both testosterone and cortisol have major actions on financial decision-making closely related to their primary biological functions, reproductive success and response to stress, respectively. Financial risk-taking represents a particular example of strategic decisions made in the context of choice under conditions of uncertainty. Such decisions have multiple components, and this article considers how much we know of how either hormone affects risk-appetite, reward value, information processing and estimation of the costs and benefits of potential success or failure, both personal and social. It also considers how far we can map these actions on neural mechanisms underlying risk appetite and decision-making, with particular reference to areas of the brain concerned in either cognitive or emotional functions.

Beyond Value-at-Risk: GlueVaR Distortion Risk Measures

We propose a new family of risk measures, called GlueVaR, within the class of distortion risk measures. Analytical closed-form expressions are shown for the most frequently used distribution functions in financial and insurance applications. The relationship between GlueVaR, value-at-risk, and tail value-at-risk is explained. Tail subadditivity is investigated and it is shown that some GlueVaR risk measures satisfy this property. An interpretation in terms of risk attitudes is provided and a discussion is given on the applicability in nonfinancial problems such as health, safety, environmental, or catastrophic risk management.