Bird strikes, a risk factor in the aviation industry, are a common problem in certain states of the USA, while they are extremely rare in other states. Similarly, the seasonal distribution of bird strikes is not proportional. This situation poses an unfair situation in the aviation insurance of airline companies in terms of routes taken. The current study, detecting a literature gap related to the principal-agent problem within the aviation sector, evaluates the possible differences in aviation companies' insurance costs, assuming bird strikes are spatially and temporally analyzed in the US, and airline companies are provided with complete information regarding bird-strikes. In this research, QGIS software served in spatial model mappings. In terms of the threshold value, the study results show that making bird-strike insurance aircraft in twenty-one states which were below the threshold value increased the aviation costs of these airline companies, while in the remaining twenty-nine states, non-insurance raised the cost. In this context, as of 2022, it has been determined that not paying an extra premium for bird strikes in twenty-one states below the threshold value will create efficiency, while expending an above-average insurance premium in twenty-nine states and the District of Columbia above the threshold value will create efficiency. The research seeks to answer the following question: Is it fair for airlines operating on routes with low or high bird strike risks to pay the same amount of insurance cost?
Background—Self-management interventions are widely implemented in care for patients with heart failure (HF). Trials however show inconsistent results and whether specific patient groups respond differently is unknown. This individual patient data meta-analysis assessed the effectiveness of self-management interventions in HF patients and whether subgroups of patients respond differently. Methods and Results—Systematic literature search identified randomized trials of selfmanagement interventions. Data of twenty studies, representing 5624 patients, were included and analyzed using mixed effects models and Cox proportional-hazard models including interaction terms. Self-management interventions reduced risk of time to the combined endpoint HF-related all-0.71- in Conclusions—This study shows that self-management interventions had a beneficial effect on time to HF-related hospitalization or all-cause death, HF-related hospitalization alone, and elicited a small increase in HF-related quality of life. The findings do not endorse limiting selfmanagement interventions to subgroups of HF patients, but increased mortality in depressed patients warrants caution in applying self-management strategies in these patients.
BackgroundPeople with intellectual disabilities (ID) have a lower life expectancy than their peers without ID. A contributing factor to the lower life expectancy and early mortality could be sarcopenia: low muscle mass and low muscle function. In the general population, sarcopenia strongly predicts early mortality, but this association is unknown in people with ID. Therefore, this study aims to explore the association between sarcopenia and 5-year mortality in older adults with ID.MethodsIn the Healthy Ageing and Intellectual Disabilities (HA-ID) study, the prevalence of sarcopenia was measured at baseline among 884 older adults (≥50 years) with ID. All-cause mortality was measured over a 5-year follow-up period. Univariable and multivariable Cox proportional hazard models were applied to determine the association between sarcopenia (no sarcopenia, pre-sarcopenia, sarcopenia, severe sarcopenia) and early mortality, adjusted for age, sex, level of ID, presence of Down syndrome, and co-morbidity (chronic obstructive pulmonary disease, diabetes type 2 and metabolic syndrome).ResultsThe unadjusted hazard ratio (HR) for sarcopenia was 2.28 [95% confidence interval (CI) 1.48–3.42], P < 0.001), and 2.40 (95% CI 1.40–4.10, P = 0.001) for severe sarcopenia. When adjusted for age, sex, level of ID, and Down syndrome, sarcopenia (HR = 1.72, 95% CI 1.08–2.75, P = 0.022) and severe sarcopenia (HR = 1.86, 95% CI 1.07–3.23, P = 0.028) were significantly associated with early mortality. When additionally adjusted for co-morbidity, the adjusted HR decreased to 1.62 (95% CI 1.02–2.59, P = 0.043) and 1.81 (95% CI 1.04–3.15, P = 0.035) for sarcopenia and severe sarcopenia, respectively.ConclusionSarcopenia is an independent risk factor for early mortality in older adults with ID over a 5-year follow-up period. Our results stress the need to delay the incidence and development of sarcopenia in older adults with ID.
