Cost utility analysis of Remdesivir and Dexamethasone treatment for hospitalised COVID-19 patients - a hypothetical study

Background: Sars-Cov-2 is a novel corona virus associated with significant morbidity and mortality. Remdesivir and Dexamethasone are two treatments that have shown to be effective against the Sars-Cov-2 associated disease. However, a cost-effectiveness analysis of the two treatments is still lacking. Objective: The cost-utility of Remdesivir, Dexamethasone and a simultaneous use of the two drugs with respect to standard of care for treatment Covid-19 hospitalized patients is evaluated, together with the effect of Remdesivir compared to the base model but based on alernative assumptions. Methods: A decision tree for an hypothetical cohort of Covid-19 hospitalized patients, from an health care perspective and a one year horizon is specified. Efficacy data are retrieved from a literature review of clinical trials, whilst costs and utility are obtained from other published studies. Results: Remdesivir, if health care costs are related to the days of hospitalization, is a cost saving strategy. Dexamethasone is cost effective with an ICER of $5208/QALY, and the concurrent use of Remdesivir and Dexamethasone is the most favorable strategy for higher level of willingness to pay thresholds. Moreover, if Remdesivir has a positive effect on mortality the utility is three times higher respect to base case. Whereas, if health care costs are not related to the length of patient hospitalization Remdesivir has an ICER respect to standard of care of$384412.8/QALY gained, which is not cost effective. We also find that Dexaamethasone is cost effective respect to standard care if we compute the cost for live saved with an ICER of $313.79 for life saved. The uncertainty of the model parameters is also tested through both a one-way deterministic sensitivity analysis and a probabilistic sensitivity analysis. Conclusion: We find that the use of Remdesivir and/or Dexamethasone is effective from an economic standpoint

Practical implementation of the Kelly criterion: optimal growth rate, number of trades, and rebalancing frequency for equity portfolios

We develop a general framework to apply the Kelly criterion to the stock market data, and consequently, to portfolio optimization. Under few conditions, using Monte Carlo simulations with different scenarios we prove that the Kelly criterion beats any other approach in many aspects. In particular, it maximizes the expected growth rate and the median of the terminal wealth. We also show that, under a normal distribution of returns, the Kelly criterion has the best performance in the long run. Next, we optimize a portfolio with the Kelly criterion with no leverage and no short selling conditions and show that this portfolio lays in the mean-variance efficient frontier and has higher expected return and higher variance, although it is less diversified, respect to the tangent portfolio optimized under the Markowitz approach. Finally, we implement a dynamic strategy applied on the European stock market data and compare the results between the tangent and the optimal Kelly portfolios. In a dynamic setting, the rolling Kelly portfolio outperforms competitors particularly in the case of rebalanced portfolios optimized with a 2-years window width

Explaining Central Government’s Tax Revenue Categories through the Bradley-Terry Regression Trunk Model

The Bradley-Terry Regression Trunk (BTRT) model combines the log-linear Bradley-Terry model, including subject-specific covariates, with a particular tree-based model, the so-called regression trunk. It aims to consider simultaneously the main effects and the interaction effects of covariates on data expressed as paired comparisons. We apply this model to financial data expressed as rankings and then transformed into paired comparisons. Tax revenues differentiated by category represent the statistical units of the analysis (i.e., taxes on income, social security contributions, taxes on property, and taxes on goods and services). We combine data from OECD, World Bank, and IMF databases for the year 2018 to investigate the effect size of socio-economic covariates and their interaction on the composition of tax revenues for a set of 100 countries worldwide. We also present a comparison with a more established method proposed in tax determinants literature and with two alternative models used for matched pairs. Finally, we discuss the implications of reported results for stakeholders and policymakers

MODELING AND DESIGNING A FULL BEAMFORMER FOR ACOUSTIC SENSING AND MEASUREMENT

Acoustic sensing is a viable approach for solving issues related to many applications, namely, biomedical, distance measurements, mechanical, health infrastructure monitoring, etc. It is generally sustainable and of no negative impact on the object under test. The use of acoustic sensing under beamforming technique is an important asset to be exploited, especially for the aforementioned applications. This paper illustrates a generalized approach of modeling and designing a full beamfomer using two specific classes: LCMP (Linear Constrained Minimum Power) beamformers that are used to overcome robustness limitations and MVDR (Minimum Variance Distortionless Response) beamformers. Any aspect of modeling and designing is always related to the DOA (Direction of Arrival). The obtained results are based on assumptions extracted from an actual case of constructed system

Effects of Extended Grape Ripening With or Without Must and Wine Alcohol Manipulations on Cabernet Sauvignon Wine Sensory Characteristics

This study attempts to clarify the consequences for wine flavour that result from harvesting fruit atdifferent maturities. The grapes were harvested from a single vineyard in Paso Robles, and the samplesspanned maturity levels from what would be considered early harvest (about 21 °Brix) to late harvest(about 30 °Brix). The wines made from these grapes were analysed using descriptive analysis to investigatethe relationships between fruit maturity and wine sensory attributes. In addition, musts and/or wines werechaptalised and/or fortified or watered back to determine the effect of these manipulations on wine sensoryproperties. This research showed that the sensory attributes of wines made from grapes at different stagesof maturation, from about 20 to 30 °Brix, varied in a systematic fashion. Specifically, the wines made fromthe grapes with a lower Brix were more sour and had more fresh vegetative flavours, while the wines madefrom the fruit with a high Brix were more hot and bitter and in some cases had more dark fruit flavoursand sweetness. Fortifying wines made from lower Brix musts changed the perceptions of the wine sensoryprofiles more than chaptalising the musts. On the other hand, adding water to higher °Brix musts to mimic24 °Brix musts resulted in wines with similar sensory profiles to wines made from grapes picked at a sugarcontent of close to 24 °Brix. This study shows that wine sensory attributes differ more when grapes arepicked early in ripening rather than after 24 °Brix

Defense Mechanisms, Gender, and Adaptiveness in Emerging Personality Disorders in Adolescent Outpatients

The present study focused on demographic and personality differences in the use of 30 defense mechanisms in adolescents with personality psychopathology and explored the hierarchical organization of personality traits based on the adaptiveness of defensive functioning. A total of 102 self-referred adolescent outpatients were interviewed and assessed on defense mechanisms and personality traits using the Defense Mechanisms Rating Scales and the Shedler-Westen Assessment Procedure 200 for Adolescents, respectively. Age and gender differences were found throughout the hierarchy. Pearson's correlations revealed a hierarchical organization of emerging personality disorders (PDs) in adolescence. More adaptive defenses were clearly associated with healthier personality style, whereas more pathological personality styles such as those with borderline traits were characterized by more rigid and maladaptive defenses. Dissociation was also associated with maladaptive personality types. Identifying the defenses associated with emerging personality disorders may inform the unconscious function of defense mechanisms in specific PDs. The systematic assessment of defense mechanisms might also help therapists to monitor changes during treatment

Mindfulness, age and gender as protective factors against psychological distress during COVID-19 pandemic

Objective: Mindfulness disposition is associated with various psychological factors and prevents emotional distress in chronic diseases. In the present study, we analyzed the key role of mindfulness dispositions in protecting the individual against psychological distress consequent to COVID-19 social distancing and quarantining. Methods: An online survey was launched on March 13, 2020, with 6,412 responses by April 6, 2020. Socio-demographic information, exposure to the pandemic, and quarantining were assessed together with psychological distress and mindfulness disposition. Multivariate linear regression analysis was performed to study the influence of predictive factors on psychological distress and quality of life in Italian responders during the early days of lockdown. Pearson correlations were calculated to study the relationship between mindfulness and psychiatric symptoms. Results: Multivariate linear regression run on socio-demographics, COVID-19-related variables, and mindfulness disposition as moderators of overall psychological distress showed that mindfulness was the best predictor of psychological distress (β = −0.504; p < 0.0001). High negative correlations were found between mindfulness disposition and the overall Global Severity Index (r = −0.637; p < 0.0001), while moderate to high associations were found between mindfulness and all SCL-90 sub-scales. Discussion: Findings showed that high dispositional mindfulness enhances well-being and helps in dealing with stressful situations such as the COVID-19 pandemic. Mindfulness-based mental training could represent an effective intervention to stem post-traumatic psychopathological beginnings and prevent the onset of chronic mental disorders

Meditations on the Italian population of low interest to the vaccination campaign against the pandemic from H1N1v. The point of view of the region

In this article we developed a technical reflection on the organization of the National Pandemic Influenza A H1N1 variant plan, implemented in the Italian Region and in specific in the Local Health Agency Taranto. The audit has raised some critical issues that led to the limited success of the vaccination campaign. Among the critics it was really difficult to find quickly and easily those healthy individuals at risk for disease. Therefore it raises the need to prepare a special population register as an essential preliminary step necessary for the active call of the target population in anticipation of a possible pandemic wave. In this vein, the Prevention Department of Taranto has developed a recording database system that has been experienced during the influenza vaccination campaign for the 2010-2011 season