Knowledge, Attitude and Practice among endodontists of Nepal in patient management during COVID-19 arena

Background: Coronavirus disease, 2019 (COVID-19) is an infectious disease caused by the severe acute respiratorysyndrome coronavirus 2 (SARS-CoV-2).COVID-19 is a global pandemic affecting all aspects of life in all countries. Endodontist are at inherent risk because of aerosol generating procedures. The objective of the study was to assess the knowledge, attitude and practice (KAP) among Endodontists of Nepal to combat the COVID 19 pandemic. Method:A web-based cross-sectional study was conducted among Endodontist of Nepal from March to June 2021.Convenient sampling method was adopted. The data were analysed using SPSS version 20.Descriptive statistics was performed, percentage and frequency distribution were assessed. Chi-square tests wereused to see the association between the categorical variables. A p-value of <0.05 was considered statistically significant. Results: Out of the total 81 Endodontists who responded to our study, 55.6% of them were females and 44.4% males. Around 65%were from Bagmati province.Majority (87.7%) of responders reported that they categorize the cases on the basis risk assessment, 56.8% do not perform routine procedures during the pandemic. Maximum (97.5%) of the responders discuss about COVID-19 with the patients.About 55% of the responders use rubber dam during the endodontic procedures, while 17.3% of the responders do not use them at all. Conclusion:Endodontists of Nepal werefound to have good knowledge, attitude and practice score, which is important to overcome the present pandemic scenario of COVID19.Certain pitfalls in attitude and practice level can be decreased by efficient training programs, precise guidelines, and treatment protocols.

Epidemiology and Risk Factors for Infections in Myelodysplastic Syndromes

Background: Patients with MDS are at high risk of developing infections, which still represent the most frequent complications and the main cause of mortality and morbidity. We conducted a retrospective study with the aim of evaluating incidence, characteristics and outcome of infectious events in patients with myelodysplastic syndromes (MDS) and the risk factors associated with them. Patients and methods: 200 patients with MDS or LMMC followed by the Ancona Hematology Clinic in the last 15 years were included. In this group, we evaluated severe infectious episodes and associated risk factors, relating to patient, disease and therapy. Results: In a cohort of 200 patients, we detected 65 cases of infections of higher than third grade according to WHO. Pneumonia is the most frequent infection, especially on a bacterial basis. Risk factors that have shown significant association with infections ≥ G3 are: comorbidity (p = 0.0086), hemoglobin level (P = 0.0111), neutropenia (P = 0.0152), transfusion dependence during the course of disease (P &lt;0.0001) and hypomethylating therapy (P = 0.0014). A subanalysis confirmed comorbidities as risk factors for the development of pneumonia (P = 0.0322) and azacitidine therapy as a risk factor for sepsis (P = 0.0038). The overall survival of the cohort is approximately 7.5 months and the predictive factors of survival are patient age (P = 0.0005), WHO disease class (P = 0.001), R-IPSS (P &lt;0.0001) and transfusion-dependence during the course of the disease (P &lt;0.0001). Multivariate analysis confirmed age (P = 0.0002), R-IPSS (P = 0.0043) and transfusion-dependence (P = 0.0006) as predictors of survival. Infections above grade 3 do not impact survival. Otherwise, there was a trend of reduced survival in patients who had pneumonia (P = 0.0612) or sepsis (P = 0.0927). Conclusion: Patients with MDS have a high probability of encountering an infectious problem in the course of the natural history of the disease. In one out of five cases, there are more than one infectious event. Particularly at risk of infection are patients with comorbidities, neutropenia (PMN &lt;800 / mm³), significant transfusion needs and on therapy with hypomethylating agents. These patients should be carefully monitored for infectious complications. Disclosures No relevant conflicts of interest to declare.

Sequenced crop evapotranspiration and water requirement in developing a multi-trigger rainfall index insurance and risk-contingent credit

Weather index insurance (WII) has been a promising innovation that protects smallholder farmers against drought risks and provides resilience against adverse rainfall conditions. However, the uptake of WII has been hampered by high spatial and intra-seasonal basis risk. To minimize intra-seasonal basis risk, the standard approaches to designing WII based on seasonal cumulative rainfall have shown to be ineffective in some cases as they do not incorporate different water requirements across each phenological stage of crop growth. One of the challenges in incorporating crop phenology in insurance design is to determine the water requirement in crop growth stages. Borrowing from agronomy, crop science, and agro-meteorology we adopt evapotranspiration methods in determining water requirements for a crop to survive in each stage, that can be used as a trigger level for a WII product. Using daily rainfall and evapotranspiration data, we illustrate the use of Monte Carlo risk modelling to price an operational WII and WII-linked credit product. The risk modelling approach we develop includes incorporation of correlation between rainfall and evapotranspiration indexes that can minimise significant intertemporal basis risk in WII.

Do high-resolution satellite indices at field level reduce basis risk of satellite-based weather index insurance?

PurposeSatellite-based weather index insurance has recently been considered in order to reduce the high basis risk of station-based weather index insurance. However, the use of satellite data with a relatively low spatial resolution has not yet made it possible to determine the satellite indices free of disturbing landscape elements such as mountains, forests and lakes.Design/methodology/approachIn this context, the Normalized Difference Vegetation Index (NDVI) was used based on both Moderate Resolution Imaging Spectroradiometer (MODIS) (250 × 250 m) and high-resolution Landsat 5/8 (30 × 30 m) images to investigate the effect of a higher spatial resolution of satellite-based weather index contracts for hedging winter wheat yields. For three farms in north-east Germany, insurance contracts both at field and farm level were designed.FindingsThe results indicate that with an increasing spatial resolution of satellite data, the basis risk of satellite-based weather index insurance contracts can be reduced. However, the results also show that the design of NDVI-based insurance contracts at farm level also reduces the basis risk compared to field level. The study shows that higher-resolution satellite data are advantageous, whereas satellite indices at field level do not reduce the basis risk.Originality/valueTo the best of the author’s knowledge, the effect of increasing spatial resolution of satellite images for satellite-based weather index insurance is investigated for the first time at the field level compared to the farm level.

Determination of Critical Productivity Level on Cluster-Based Area of Rice Crop Insurance in Java

<strong>Indonesian</strong><br />Kesenjangan tingkat produktivitas padi di Indonesia cukup besar yang di antaranya dipengaruhi oleh luasnya wilayah pertanaman. Hal ini berdampak pada desain dan penerapan model Asuransi Usaha Tani Padi (AUTP) berbasis produktivitas. Perluasan klaster pada tingkat provinsi diperkirakan dapat mengurangi keragaman produktivitas di tingkat wilayah kota/kabupaten sebagai risiko dasar pemanfaatan skema AUTP berbasis klaster. Klaster, sebagai wilayah atau zona, diperlukan untuk menentukan indeks kritis produktivitas yang akurat dalam rangka penghitungan tingkat premi yang tepat. Kajian ini bertujuan untuk menentukan tingkat produktivitas kritis pada lahan padi yang menerapkan skema AUTP. Kajian ini menggunakan analisis statistik dengan pendekatan batas bawah <em>Two Sigma</em> yang dapat dianggap sebagai batas produktivitas kritis untuk setiap klaster. Teknik ini memberikan persentase yang rendah atas klaim yang terjadi, serta ekspektasi dan simpangan baku dari risiko dasar kerugian. Tarif premi murni yang diperoleh adalah Rp85.191,18, hampir 2,5 kali lipat lebih kecil dibandingkan dengan menggunakan teknik lain sebagai batas poduktivitas. Hasil kajian ini mengungkapkan bahwa penggunaan skema berbasis klaster lebih baik dari skema berbasis provinsi, sebagaimana ditunjukkan oleh nilai TVaR. Kajian ini menyarankan agar Kementerian Pertanian dapat merancang model AUTP berbasis produktivitas berdasarkan klaster dengan setiap klaster memiliki nilai indeks produktivitas kritis yang berbeda untuk menetapkan tingkat premi yang dikenakan.<br /><br /><br /><strong>English</strong><br />There is a large gap in productivity of paddy in Indonesia which is, among others affected by the area size of crop planting. This condition should influence the design and application model of the rice crop insurance scheme. Developing clusters under the province level is recommended to reduce the heterogeneous productivity as basis risk within regencies/municipalities in improving the area yield index of crop insurance policy in Indonesia. Clusters, as the zone, are necessary to determine accurate critical yield index leading to a more precise premium rate making. This study aims to determine critical productivity level on rice crop insurance area. This study applied statistical analysis using the lower bound of Two Sigma as a critical yield for each cluster. This technique provides a small percentage of claim, and the expectation and standard deviation of basis risk loss. The pure premium rate obtained from the analysis is IDR85,191.18, that is almost 2.5 times less than using other methods as trigger productivity. The analysis result emphasized that the use of the cluster-based scheme is better than the province-based as shown by TVaR value. The study suggests that the Ministry of Agriculture could design the area yield index based on clusters as each cluster will have a different critical productivity index with adjusted premium rate value.

Risk transfer beyond reinsurance: the added value of CAT bonds

Reinsurance and CAT bonds are two alternative risk management instruments used by insurance companies. Insurers should be indifferent between the two instruments in a perfect capital market. However, the theoretical literature suggests that insured risk characteristics and market imperfections may influence the effectiveness and efficiency of reinsurance relative to CAT bonds. CAT bonds may add value to insurers’ risk management strategies and may therefore substitute for reinsurance. Our study is the first to empirically analyse if and under what circumstances CAT bonds can substitute for traditional reinsurance. Our analysis of a comprehensive data set comprising U.S. P&C insurers’ financial statements and CAT bond use shows that insurance companies’ choice of risk management instruments is not arbitrary. We find that the added value of CAT bonds mainly stems from non-indemnity bonds and reveal that (non-indemnity) CAT bonds are valuable under high reinsurer default risk, low basis risk and in high-risk layers.

Contrasting Influences of Seasonal and Intra-Seasonal Hydroclimatic Variabilities on the Irrigated Rice Paddies of Northern Peninsular Malaysia for Weather Index Insurance Design

Good index selection is key to minimising basis risk in weather index insurance design. However, interannual, seasonal, and intra-seasonal hydroclimatic variabilities pose challenges in identifying robust proxies for crop losses. In this study, we systematically investigated 574 hydroclimatic indices for their relationships with yield in Malaysia’s irrigated double planting system, using the Muda rice granary as a case study. The responses of seasonal rice yields to seasonal and monthly averages and to extreme rainfall, temperature, and streamflow statistics from 16 years’ observations were examined by using correlation analysis and linear regression. We found that the minimum temperature during the crop flowering to the maturity phase governed yield in the drier off-season (season 1, March to July, Pearson correlation, r = +0.87; coefficient of determination, R2 = 74%). In contrast, the average streamflow during the crop maturity phase regulated yield in the main planting season (season 2, September to January, r = +0.82, R2 = 67%). During the respective periods, these indices were at their lowest in the seasons. Based on these findings, we recommend temperature- and water-supply-based indices as the foundations for developing insurance contracts for the rice system in northern Peninsular Malaysia.