bluuebunny/crossref_metadata_2025_split huggingface dataset:
Insurance Outsourcing: A Legal Analysis
Authors: Szaraniec Monika 
Published: March 2022

AbstractOutsourcing plays an important role in the operation of insurance and reinsurance companies. This article aims to define the legal conditions of insurance outsourcing and their evaluation by the author. The example of limiting the scope of outsourcing in the activities of insurance and reinsurance companies in the Polish law shows its specificity compared to other outsourcing in business. This specificity lies primarily in the need to control insurance outsourcing by the EU and national supervisory authorities. There is a tendency in the law to extend the regulations related to insurance outsourcing to the further performance of a process, service or activity by insurance companies, particularly in the field of cooperation of traditional distributors withInsurtech. The lack of legal regulations forces EIOPA to look for appropriate and effective legal solutions in the field of supervision over insurance outsourcing. This process is mainly based on self-regulation of the market through ‘soft law’—this practice sets new tasks for the EU and national regulators.
Corporate Governance Standards for Insurers in Singapore
Authors: Chen Christopher 
Published: March 2022

AbstractThis chapter examines the corporate governance regime for insurers in Singapore. Singapore aims to be a global hub for insurance and reinsurance in the Asia Pacific region, and as an international financial centre it currently hosts a mixture of local and international insurers and reinsurers serving different market sectors. However, the domestic insurance market is small, and insurers registered in Singapore come from many countries and provide products and services to many businesses and individuals outside the city-state. This presents challenges to the sole financial regulator, the Monetary Authority of Singapore (MAS), in implementing and enforcing corporate governance standards on various (re)insurers, many of which are part of larger overseas insurance groups. What should be the way to impose corporate governance standards on various types of (re)insurers? This chapter addresses these questions in the context of Singapore. The general regulatory concerns over corporate governance standards and Singapore’s corporate governance regimes for insurers are first introduced. Specific corporate governance issues are then examined, including the implementation of standards for non-domestic insurers or a branch or subsidiary of a larger insurance group from overseas, and the governance of captive insurers and reinsurers. Singapore’s approach is then discussed and the effectiveness of corporate governance regulations for insurers is assessed. Empirical evidence is presented when data are available.
Recovery and Resolution of Insurance Companies and Director’s Duties
Authors: Siri Michele , Van den Hurk Arthur 
Published: March 2022

AbstractIn this chapter, largely finalised before the presentation of a legislative proposal for a European Insurance Recovery and Resolution Directive, on September 2021, recovery and resolution frameworks of insurance companies and insurance groups are discussed. Currently, the insurance regulatory framework at the European level (Solvency II) does not contain a fully developed framework with respect to recovery and (orderly) resolution such as the Bank Recovery & Resolution Directive and the Single Resolution Mechanism. Recent developments at the international level on the initiative of the Financial Stability Board and International Association of Insurance Supervisors are discussed. It is the expectation that the Solvency II 2020 review will introduce minimum harmonising regulatory standards at the European level with respect to the recovery and resolution of insurers. In this chapter, the assumption is made that the legislative proposal of the European Commission will be based on the technical advice, provided by EIOPA in the context of the Solvency II 2020 review. Therefore, this chapter discusses this technical advice in some detail. Recovery and resolution frameworks, particularly ex-ante planning, requires insurance companies and insurance groups to expand their focus from the regular going concern focus to adverse circumstances, including the ability to recover and to be resolved in orderly manner. The chapter assesses the consequences this change of focus might have on the governance of insurance companies and groups.
Restructuring, Winding-Up & Portfolio Transfer of Insurance Companies in Distress
Authors: Noussia Kyriaki , Underwood Peter , Frastanlis Stergios 
Published: March 2022

AbstractInsurance companies often need to go through restructuring for various reasons. Such restructuring can happen in company law through the mechanism of M&A, or under EU legislation via portfolio transfer (see e.g. Article 14 of Directive 2002/83/EC and Article 12 of Directive 92/49/EEC in the field of non-life insurance). This chapter discusses reorganising, restructuring and winding-up of insurance companies, as well as insurance portfolio transfers by means of company law mechanisms (M&A) and under the Cross-Border Mergers Directive, as well as under the Solvency II Directive. It then goes on to discuss the position under Greek law, and uses as a case study the winding-up of Aspis Pronia in 2009 and the transfer of the insurance undertakings’ portfolios. The analysis will allow us to identify that the level of insurance portfolio transfers harmonisation in the EU is not as high as expected, and that a common framework and harmonisation is needed.
Insurance in M&A Transactions
Authors: Borselli Angelo 
Published: March 2022

AbstractMergers and acquisitions (M&A) involve transactional risks, no matter how extensive and accurate the due diligence process is. This raises the question as to how transacting parties can be protected. Representations and warranties and indemnification provisions as well as escrow requirements, typically included in the acquisition agreement, may often prove to be inefficient and inadequate to this end. When negotiating these terms, transacting parties clearly have contrasting interests, and there could also be cases, especially in public company transactions or distressed sales, where the buyer may have no effective remedies against the seller after the closing.To overcome problems associated with seller’s indemnities, transacting parties increasingly avail themselves of some innovative insurance products, generally known under the catch-all name of “transactional insurance,” that provide coverage for risks arising out of extraordinary corporate transactions, including risks related to breaches of representations and warranties, tax liabilities, pending or potential litigation and other contingent liabilities.This chapter explores the role that insurance can play in managing transactional risk, discussing whether it may represent an efficient alternative to more traditional, contractual solutions like indemnity and escrow requirements. The discussion suggests that transactional insurance can serve as an effective risk-transfer tool in M&A, which may act as a supplement or also a substitute for seller indemnity obligations. By spreading transactional risk, insurance can facilitate M&A transactions and enhance the overall social benefit, providing economic security at a fraction of the cost that it would take for transacting parties to protect themselves. No problems of adverse selection or moral hazard peculiar to the M&A context seem to arise and a steadily increasing use of insurance in M&A can be expected.
Conceptual Background
Authors: Pfoser Sarah 
Published: March 2022

AbstractThe following chapter establishes the conceptual background for this thesis. First, the construct acceptance will be defined in Subchapter 0 since this term is used ambiguously in the literature. Studying the acceptance of sustainable freight transport revealed that there are different stages of acceptance which involve a varying degree of commitment by transport users. In context of this thesis, acceptance refers to the stages of willingness to use or the actual use of sustainable freight transport strategies. Afterwards, a definition and classification of policy measures is given in Subchapter 2.2. The common sticks-carrots-sermons typology is presented, which involves three main types of measures, namely regulation (“sticks”), economic incentives (“carrots”) and information instruments (“sermons”).
Strategies for Sustainable Freight Transport
Authors: Pfoser Sarah 
Published: March 2022

AbstractThe case of three different strategies for sustainable freight transport is studied in the thesis: (1) horizontal collaboration in a Physical Internet network, (2) multimodal freight transport and (3) liquefied natural gas (LNG) as alternative truck fuel. Each of these three strategies falls within a different pillar of the avoid-shift-reduce framework. Chapter 4 introduces the ASI (avoid-shift-improve) framework and gives an overview of existing strategies for sustainable freight transport. In particular, horizontal collaboration in a PI network, multimodality and LNG as an alternative fuel will be presented and differentiated from similar concepts. It will be justified why these three particular strategies have been chosen as the subject of this thesis.
Policy Measures to Promote Sustainable Freight Transport
Authors: Pfoser Sarah 
Published: March 2022

AbstractIn the following chapter, policy measures are developed which encourage transport users to implement sustainable freight transport. First, organizational theories are used to provide theoretical insights on how to stimulate the use of sustainable practices in Subchapter 6.1. These organizational theories are merged into a theoretical framework which supports the development of policy measures for sustainable freight transport. A fundamental goal of policy measures is to eliminate market failures. Subchapter 6.2 explains which market failures occur in the area of sustainable freight transport and should be addressed by policy measures. Afterwards, a set of user-centric policy measures is presented in Subchapter 6.3 to promote sustainable freight transport. A new classification scheme is suggested to categorize the user-centric policy measures, namely carrots, means and sermons.
White and brown adipose tissue functionality is impaired by fine particulate matter (PM2.5) exposure
Authors: Della Guardia Lucio , Shin Andrew C. 
Published: March 2022

AbstractChronic exposure to high levels of particulate matter (PM) is correlated to a higher prevalence of cardio-metabolic disturbances. Adipose tissue represents a pivotal regulator of metabolic homeostasis, and its dysfunction is associated with health issues in PM-exposed models. This review discusses the adaptive changes of white (WAT) and brown (BAT) adipose tissue in response to fine particulate matter (PM2.5), investigating the underlying pathophysiology. In exposed models, PM2.5 increases oxidative stress and impairs mitochondria functionality and biogenesis in WAT and BAT. Chronic exposure also upregulates the main apoptotic/pro-inflammatory pathways and promotes the infiltration of monocytes and the accumulation of activated macrophages. Oxidative stress and inflammation are responsible for the inhibition of insulin signal transduction and glucose uptake in both the adipose tissues. The increased inflammatory status also suppresses the metabolic activity of brown adipocytes, promoting the whitening. Altogether, this evidence suggests the shift of WAT and BAT toward an inflammatory and metabolic dysfunctional phenotype. Although the underlying mechanisms remain to be clarified, the development of inflammation in lungs, gut, and hypothalamus seems to have a pivotal role in the alteration of adipose tissue homeostasis. The potential consequences on systemic cardio-metabolic health render the relationship PM-adipose tissue a key issue to investigate.
Graphical abstract
Fluorescence-coupled micropipette aspiration assay to examine calcium mobilization caused by red blood cell mechanosensing
Authors: Wang Haoqing , Obeidy Peyman , Wang Zihao , Zhao Yunduo , Wang Yao , Su Qian Peter , Cox Charles D. , Ju Lining Arnold 
Published: March 2022

AbstractMechanical stimuli such as tension, compression, and shear stress play critical roles in the physiological functions of red blood cells (RBCs) and their homeostasis, ATP release, and rheological properties. Intracellular calcium (Ca2+) mobilization reflects RBC mechanosensing as they transverse the complex vasculature. Emerging studies have demonstrated the presence of mechanosensitive Ca2+ permeable ion channels and their function has been implicated in the regulation of RBC volume and deformability. However, how these mechanoreceptors trigger Ca2+ influx and subsequent cellular responses are still unclear. Here, we introduce a fluorescence-coupled micropipette aspiration assay to examine RBC mechanosensing at the single-cell level. To achieve a wide range of cell aspirations, we implemented and compared two negative pressure adjusting apparatuses: a homemade water manometer (− 2.94 to 0 mmH2O) and a pneumatic high-speed pressure clamp (− 25 to 0 mmHg). To visualize Ca2+ influx, RBCs were pre-loaded with an intensiometric probe Cal-520 AM, then imaged under a confocal microscope with concurrent bright-field and fluorescent imaging at acquisition rates of 10 frames per second. Remarkably, we observed the related changes in intracellular Ca2+ levels immediately after aspirating individual RBCs in a pressure-dependent manner. The RBC aspirated by the water manometer only displayed 1.1-fold increase in fluorescence intensity, whereas the RBC aspirated by the pneumatic clamp showed up to threefold increase. These results demonstrated the water manometer as a gentle tool for cell manipulation with minimal pre-activation, while the high-speed pneumatic clamp as a much stronger pressure actuator to examine cell mechanosensing directly. Together, this multimodal platform enables us to precisely control aspiration and membrane tension, and subsequently correlate this with intracellular calcium concentration dynamics in a robust and reproducible manner.
Achievement of Key Performance Indicators in Initial Assessment and Care of Injured Patients in Ghanaian Non‐tertiary Hospitals: An Observational Study
Authors: Gyedu Adam , Quainoo Emmanuel , Nakua Emmanuel , Donkor Peter , Mock Charles 
Published: March 2022

AbstractIntroductionWe aimed to determine the level of achievement of key performance indicators (KPIs) during initial assessment and management of injured persons, as assessed by independent observers, at district and regional hospitals in Ghana.MethodsTrained observers were stationed at emergency units of six district (first level) and two regional (referral) hospitals, from October 2020 to February 2021, to observe management of injured patients by health service providers. Achievement of KPIs was assessed for all injured patients and for seriously injured patients (admitted for ≥ 24 h, referred, or died).ResultsManagement of 1006 injured patients was observed. Road traffic crash was the most common mechanism (63%). Completion of initial triage ranged from 65% for oxygen saturation to 92% for mobility assessment. For primary survey, airway was assessed in 77% of patients, chest examination performed in 66%, and internal abdominal bleeding assessed in 43%. Reassessment rates were low, ranging from 16% for respiratory rate to 23% for level of consciousness. Thirty‐one percent of patients were seriously injured. Completion of KPIs was higher for these patients, but reassessment remained low, ranging from 25% for respiratory rate to 33% for level of consciousness.ConclusionKPIs were performed at a high level, but several specific elements should be performed more frequently, such as oxygen saturation and assessment for internal abdominal bleeding. Reassessment needs to be performed more frequently, especially for seriously injured patients. Overall, care for the injured at non‐tertiary hospitals in Ghana could be improved with a more systematic approach.
Stratification of multiple sclerosis patients using unsupervised machine learning: a single-visit MRI-driven approach
Authors: Pontillo Giuseppe , Penna Simone , Cocozza Sirio , Quarantelli Mario , Gravina Michela , Lanzillo Roberta , Marrone Stefano , Costabile Teresa , Inglese Matilde , Morra Vincenzo Brescia , Riccio Daniele , Elefante Andrea , Petracca Maria , Sansone Carlo , Brunetti Arturo 
Published: March 2022

Abstract
Objectives
To stratify patients with multiple sclerosis (pwMS) based on brain MRI-derived volumetric features using unsupervised machine learning.

Methods
The 3-T brain MRIs of relapsing-remitting pwMS including 3D-T1w and FLAIR-T2w sequences were retrospectively collected, along with Expanded Disability Status Scale (EDSS) scores and long-term (10 ± 2 years) clinical outcomes (EDSS, cognition, and progressive course). From the MRIs, volumes of demyelinating lesions and 116 atlas-defined gray matter regions were automatically segmented and expressed as z-scores referenced to external populations. Following feature selection, baseline MRI-derived biomarkers entered the Subtype and Stage Inference (SuStaIn) algorithm, which estimates subgroups characterized by distinct patterns of biomarker evolution and stages within subgroups. The trained model was then applied to longitudinal MRIs. Stability of subtypes and stage change over time were assessed via Krippendorf’s α and multilevel linear regression models, respectively. The prognostic relevance of SuStaIn classification was assessed with ordinal/logistic regression analyses.

Results
We selected 425 pwMS (35.9 ± 9.9 years; F/M: 301/124), corresponding to 1129 MRI scans, along with healthy controls (N = 148; 35.9 ± 13.0 years; F/M: 77/71) and external pwMS (N = 80; 40.4 ± 11.9 years; F/M: 56/24) as reference populations. Based on 11 biomarkers surviving feature selection, two subtypes were identified, designated as “deep gray matter (DGM)-first” subtype (N = 238) and “cortex-first” subtype (N = 187) according to the atrophy pattern. Subtypes were consistent over time (α = 0.806), with significant annual stage increase (b = 0.20; p < 0.001). EDSS was associated with stage and DGM-first subtype (p ≤ 0.02). Baseline stage predicted long-term disability, transition to progressive course, and cognitive impairment (p ≤ 0.03), with the latter also associated with DGM-first subtype (p = 0.005).

Conclusions
Unsupervised learning modelling of brain MRI-derived volumetric features provides a biologically reliable and prognostically meaningful stratification of pwMS.

Key Points
• The unsupervised modelling of brain MRI-derived volumetric features can provide a single-visit stratification of multiple sclerosis patients.
• The so-obtained classification tends to be consistent over time and captures disease-related brain damage progression, supporting the biological reliability of the model.
• Baseline stratification predicts long-term clinical disability, cognition, and transition to secondary progressive course.
Sea level changes mechanisms in the MPI-ESM under FAFMIP forcing conditions
Authors: Zhang Xiaolin , Ojha Sayantani , Köhl Armin , Haak Helmuth , Jungclaus Johann H. , Stammer Detlef 
Published: March 2022

AbstractMechanistic causes for sea level (SL) change patterns are analyzed as they emerge from the Coupled Model Intercomparison Project Phase 6 (CMIP6) endorsed Flux-Anomaly-Forced Model Intercomparison Project (FAFMIP) coupled climate experiments imposing individual forcing anomalies in wind stress, heatflux and freshwater flux to the Max-Planck-Institute Earth System Model (MPI-ESM). It appears that the heat flux perturbations have the largest effect on the sea level. In contrast, the direct impact of momentum and freshwater flux anomalies on SL anomalies appear to be limited to some region e.g. the Southern Ocean, Arctic Ocean and to some extent the North Pacific and North Atlantic Ocean. We find that thermosteric changes dominate the total SL change over large parts of the global ocean, except north of 60 °N where halosteric changes prevail. An analysis of added and redistributed components of heat and freshwater further suggests that the added component dominates the thermosteric SL and the redistributed component dominates the halosteric SL. Due to feedback processes a superposition of all forcing components together leads to the simulated sea level changes in each individual experiment. As a result, large surface heat flux anomalies over the Atlantic lead to wind stress change outside of the Atlantic through teleconnections, which in turn appear to be the primary driving agent for changes of sea level outside of the Atlantic in all three experiments. The associated wind driven Sverdrup stream function implicates that outside of the Atlantic most of the feedback can be explained by changes in the Sverdrup circulation.
A novel bilateral anterior sacrospinous hysteropexy technique for apical pelvic organ prolapse repair via the vaginal route: a cohort study
Authors: Naumann Gert , Börner Clara , Naumann Lena-Johanna , Schröder Sebastian , Hüsch Tanja 
Published: March 2022

Abstract
Background
Uterine-preserving techniques are becoming increasingly popular in the last decade. This investigation evaluates a novel hysteropexy technique using a mesh in sling-alike configuration [Splentis (Promedon, Argentina)] which is attached anteriorly to the cervix and suspended to the sacrospinous ligaments bilaterally via the vaginal route in women undergoing surgery for uterine prolapse.

Methods
This was a single-center cohort study, evaluating women who underwent transvaginal hysteropexy with Splentis for primary uterine descent. Data have been collected prospectively as part of the quality assurance system. Primary endpoint was treatment success, defined as a combined endpoint including the absence of a vaginal bulge symptom and no retreatment of apical prolapse. A validated questionnaire to evaluate quality-of-life and prolapse symptoms was utilized. Descriptive analysis was applied. Wilcoxon signed-rank test was performed to compare paired samples. The significance level was set at 5%.

Results
A total of 103 women with a median age of 68.0 [IQR 11.5] years with a median apical POP-Q stage of 3 were included. The median surgery time was 22 [IQR 12] minutes and no intraoperative complication occurred. After a median follow-up time of 17 months, treatment success was achieved in 91 (89.2%) patients and quality of life and patient report outcomes improved significantly (p < 0.001). Mesh exposure occurred in 3 (2.9%) patients. Of these, two patients required surgical revision, and one patient was treated conservatively. One patient required partial mesh removal due to dyspareunia.

Conclusion
Bilateral sacrospinous hysteropexy with Splentis offers an efficacious and safe alternative for apical compartment repair, incorporating the advantages of pelvic floor reconstruction via the vaginal route.