PECULIARITIES OF EVALUATION OF IMBALANCES OF DEVELOPMENT OF MODERN STOCK EXCHANGE MARKETS

The development of the domestic exchange market is constrained by the imperfection of legislative and regulatory regulation of the activities of market participants, the suboptimal infrastructure of the market and the lack of a coherent, fully debugged mechanism for assessing financial instability. Stock market indices of financial stress are used as an important indicator of economic processes, they are the most acceptable tools for financial analysis in world practice, and also reflect fluctuations in supply and demand for securities and are used by investors to form an effective investment strategy. It is proposed to use the method for calculating a structured index of financial stress, which includes a set of factors and indicators as key indicators of the exchange market. The features of filling of each of the constituent elements of this index are disclosed. The indicator characterizing trigger events is separately highlighted, its relationship with stress testing is shown, which makes it possible to assess the vulnerability of the system to shocks of various nature. The presented methodology for calculating the financial stress index, including a set of individual and general financial indicators, will make it possible to respond in a timely and timely manner to periods of exacerbation of instability in the financial sector, identify threats and vulnerabilities. The article proposes a method for determining the general economic index, which is carried out by aggregating indicators of sectoral imbalances in indicators of general economic nature. The use of aggregation tools implies the fact that the excess reserve (stock) of liquidity in a particular sector is not able to balance or mitigate its lack to others. Of course, this is rational, because when trigger events occur, which implies the need for expectations, uncertainty about the credit quality of counterparties often increases. This means that financial markets cannot always provide liquidity flows. The main advantages of the proposed method of calculating the general economic index, which aggregates the indicators of sectoral imbalances in the indicators of general economic nature of modern stock markets should include the ability to prevent and prevent crises at all levels of management decisions. This system can and should become a common tool for maintaining the necessary sustainable economic processes. The highlighted features of determining the imbalances in the development of stock markets will allow to relevantly reflect the main periods of growing instability in the financial sector of Ukraine.

The importance of authentic leadership

Purpose Firm performance can be significantly enhanced when its leaders are authentic. A focus on trigger events and leadership crucibles can help such leaders to learn from past experiences and acquire and enhance the key qualities required to increase the overall effectiveness of authentic leadership development. Design/methodology/approach This briefing is prepared by an independent writer who adds their own impartial comments and places the articles in context. Findings Firm performance can be significantly enhanced when its leaders are authentic. A focus on trigger events and leadership crucibles can help such leaders to learn from past experiences and acquire and enhance the key qualities required to increase the overall effectiveness of authentic leadership development. Originality/value The briefing saves busy executives and researchers hours of reading time by selecting only the very best, most pertinent information and presenting it in a condensed and easy-to-digest format.

Initial implementation of an electronic oncology trigger tool for adverse event detection.

298 Background: In 2009, the Institute for Healthcare Improvement (IHI) conceived the Global Trigger Tool (GTT), a method for identifying adverse events that relies on correlated clinical documentation, “triggers”, in the medical record. This method is intended to augment traditional quality of care, data collection initiatives that primarily depend on voluntary reporting or error tracking. However, the original trigger tool called for a manual identification of trigger events and is too broad to be useful in an oncology setting. We propose a method for the development, selection, electronic extraction and management of triggers relevant to an oncology setting, with the primary aim of improving our understanding of the prevalence of adverse events occurring during an inpatient stay. Methods: Our implementation of an Electronic Trigger Tool includes three parts: trigger selection, review system development, and the chart review process. Through literature review, we developed a library of 40 oncology-relevant trigger tools. We then selected two pilot triggers based on expert opinion and a trigger analysis on length of stay, cost, and patient satisfaction. Next, we developed a web-app that allows reviewers to automatically receive trigger events. Finally, two clinical professionals reviewed five trigger events from each trigger for five subsequent weeks. Results: We selected Narcan administration (M9) and unexpected/unplanned ICU admission after non-emergent surgical procedure (S3) as pilot triggers. Our reviewers each performed a chart review on 25 for each trigger, resulting in 100 independent reviews. We found that M9 had a positive predictive value (PPV) of .52 (26 AEs / 50 reviews) and S3 had a positive predictive value of .88 (44 AEs / 50 reviews). We also found that most of these adverse events were not found by other quality systems. Conclusions: Our pilot of two triggers demonstrated we can capture adverse events that exist outside known quality and safety resources on a small scale and with high PPV. We anticipate using novel trigger information to inform process improvement and quality of care for patients with cancer at our hospital.

Information causes – triggers and resonant discourses of the national media space: possibilities of sociological analysis

The article indicates the relevance of the study of conditionally neutral informational triggers in the context of the discussions they produce in the modern media space. The authorʼs methodology of highlighting resonant discourses of the countryʼs leading information resources in the context of actual trigger events of the national information field is demonstrated in order to analyse their interpretive environment for the formation of semantic meanings, distorting the meaning of the original informational occasion and provoking destructive social activity. Based on the presented case, proposals are made for correcting the direction of conflict discourses.

What contributes to family carers’ decision to transition towards palliative-oriented care for their relatives in nursing homes? Qualitative findings from bereaved family carers’ experiences

Objectives Family carers (FCs) of nursing home (NH) residents are best placed to notice deteriorations that signal impending death in their relative, which can open a conversation with healthcare professionals (HCPs) about adjusting the care plan. We explored contributors to bereaved FCs’ decision to transition towards palliative-oriented care for their relatives in NHs. Methods This qualitative descriptive study used a phenomenological design. Thirty-two bereaved FCs across 13 Italian NHs completed semi-structured interviews. Additional data were collected on NH referrals to palliative care services (PCS) in the 6 months before study start and treatments provided in the last week of life. Content analysis with a combined inductive and deductive approach was applied to identify codes and fit them into an a priori framework. When codes did not fit, they were grouped into new categories, which were finally gathered into themes. Results FCs reported four types of “trigger events” that made them doubt that their relative would recover: (1) physical deterioration (e.g., stopping eating/walking or swallowing problems); (2) social confirmation (e.g., confirming their relative's condition with friends); (3) multiple hospitalizations; and (4) external indicators (e.g., medical examinations by external consultants). A “resident-centered environment” helped FCs recognize trigger events and “raise awareness of the possibility of death”; however, the “need for reassurance” was pivotal to a “gradual transition towards palliative-oriented care”. When participants did not recognize the trigger event, their relative continued to receive curative-oriented care. NHs that referred residents to PCS discussed palliative-oriented care more frequently with FCs, had a lower nurse-to-resident and nurse aide-to-resident ratio, and administered more palliative-oriented care. Significance of results Trigger events represent an opportunity to discuss residents’ prognosis and are the starting point for a gradual transition towards palliative-oriented care. Adequate staffing, teamwork, and communication between FCs and healthcare professionals contribute to a sensitive, timely shift in care goals.

Clinical characteristics and socio-demographic features of psychotic major depression

Background Psychotic major depression (PMD) is a special subtype of depression with a worse prognosis. Previous studies failed to find many differences among patients with PMD versus those with non-psychotic major depression (NMD) or schizophrenia(SZ). This study compared psychotic major depression with non-psychotic major depression and schizophrenia based on sociodemographic factors (including season of conception) and clinical characteristics. We aimed to provide data to inform clinical diagnoses and etiology research. Methods This case–control study used data for patients admitted to Shandong Mental Health Center from June 1, 2016 to December 31, 2017. We analyzed cases that had experienced a PMD episode (International Classification of Diseases, Tenth Revision codes F32.3, F33.3), NMD (F32.0–2/9, F33.0–2/9), and SZ (F20–20.9). Data were collected on sex, main discharge diagnosis, birth date, ethnicity, family history of psychiatric diagnoses, marital status, age at first onset, educational attainment, allergy history, and existence of trigger events. Results Patients with depression with a primary school/below education (odds ratio [OR] 0.397, CI: 0.18–0.874) and without a family history (OR 0.557, CI: 0.332–0.937) were less likely to have psychotic symptoms than other patients. Compared with patients with PMD, a primary school/below education (OR 3.646, CI: 1.65–8.053), no allergy history (OR 2.2, CI: 1.152–4.2), trigger events experienced before first onset (OR 2.428, CI: 1.528–3.859), being unmarried (OR 0.3, CI: 0.104–0.871), and an earlier age at first onset (OR 0.931, CI: 0.911–0.952) were features of SZ. Conclusion PMD and NMD are similar in terms of patients’ demographic variables and clinical characteristics, whereas there are differences between PMD and SZ. The significant factors we identified may point to underlying heterogeneity of these diseases.

P1810INFECTION TRIGGERS AS A COMPLEMENT-ACTIVATING STATE IN ATYPICAL HEMOLYTIC-UREMIC SYNDROME IN CHILDREN

Background and Aims Atypical hemolytic-uremic syndrome (aHUS) is a rare life-threatening disease, which is based on the dysregulation of the complement system. Different complement-activating factors is known for aHUS, including infections, vaccination, concomitant diseases, pregnancy, surgical interventions, transplantation, etc. In 24% of cases, a connection with diarrheal prodrome is revealed, in 18% - with acute respiratory infections. The diagnosis of aHUS is established if other forms of thrombotic microangiopathy (TMA) are rejected: HUS associated with Stx-producing strains of E. Coli and Shigella dysenteriae (STEC / Stx - HUS), TTP. We analyze the etiology of trigger events in children with aHUS. Method An analysis of 165 case histories of children with aHUS was carried out for the period from 2000 to 2019. Of these, 70 are boys and 95 are girls. The average age was 4.83 ± 3.84 years (from 2.5 months to 17.8 years). The diagnosis of aHUS was established on the basis of microangiopathic hemolysis, thrombocytopenia, organ dysfunction and recurrent TMA activity. 66 patients were genetically screened, among which mutations in genes encoding complement proteins were detected in 23 (34.9%) children. Results The prodromal period of patients with aHUS was characterized by fever (53.9%), weakness (42.4%), decreased appetite (27.3%), catarrhal symptoms (20.6%), nausea (17.6%), and vomiting ( 63%), abdominal syndrome (26.7%), diarrhea (38.8%), hemocolitis (12.1%). Among the trigger events, acute intestinal infections accounted for 44.2% of cases, acute viral infections - 26.0% (with catarrhal syndrome - 20.6%, intestinal - 5.4%), herpetic infection (CMV, VEB, HSV 1 type) was found in 3% of cases. In 10.3% of children, the TMA symptom complex developed after vaccination with mainly live attenuated vaccines, in 4.2% against other rare conditions (trauma, taking an unknown drug, tonsillitis, etc.). In 12.1% of cases, the disease manifested itself without a complement-activating state. E.coli was confirmed in 16 observations (EHEC - 12, EagEC - 2, EPEC - 2), shigellosis (Shigella Flexner 6) was detected in 1 case. The nature of viral diarrhea was identified in 8 patients: rotovirus RNA - 4, adenovirus DNA - 2, norovirus RNA - 2, type 5 Coxsackie RNA - 1. In the case of TMA after E.coli and shigella, the initial diagnosis was STEC / STx - HUS, which was subsequently transformed into aHUS due to the recurrent TMA activity with persistent dialysis-dependent AKI, and the addition of extrarenal symptoms not associated with volume overload. Conclusion Infectious diseases are the most common complement-activating condition for the implementation of aHUS in children. Among them, in most cases, diarrheal prodrome is associated with acute intestinal infections, which differs from population data (44.2% vs 24%). With the development of TMA in children with escherichiosis/shigellosis, repeated episodes of hemolysis, platelet consumption, the appearance of extrarenal symptoms with normalization of hematological parameters, the detection of pathogenic mutations in complement genes and the positive effect of complement blocking therapy (eculizumab) confirms the diagnosis of aHUS in this category of patients. To exclude or confirm aHUS in these cases, monitoring of clinical and laboratory data is necessary.