Robust and Pareto Optimality of Insurance Contract

The optimal insurance problem represents a fast growing topic that explains the most efficient contract that an insurance player may get. The classical problem investigates the ideal contract under the assumption that the underlying risk distribution is known, i.e. by ignoring the parameter and model risks. Taking these sources of risk into account, the decision-maker aims to identify a robust optimal contract that is not sensitive to the chosen risk distribution. We focus on Value-at-Risk (VaR) and Conditional Value-at-Risk (CVaR)-based decisions, but further extensions for other risk measures are easily possible. The Worst-case scenario and Worst-case regret robust models are discussed in this paper, which have been already used in robust optimisation literature related to the investment portfolio problem. Closed-form solutions are obtained for the VaR Worst-case scenario case, while Linear Programming (LP) formulations are provided for all other cases. A caveat of robust optimisation is that the optimal solution may not be unique, and therefore, it may not be economically acceptable, i.e. Pareto optimal. This issue is numerically addressed and simple numerical methods are found for constructing insurance contracts that are Pareto and robust optimal. Our numerical illustrations show weak evidence in favour of our robust solutions for VaR-decisions, while our robust methods are clearly preferred for CVaR-based decisions

Comparison of first-line treatment with CHOP versus ICED in patients with peripheral T-cell lymphoma eligible for upfront autologous stem cell transplantation

IntroductionUpfront autologous stem cell transplantation (ASCT) has been recommended for patients who are newly diagnosed with peripheral T-cell lymphoma (PTCL), and CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone), an anthracycline-based chemotherapy has been the frontline chemotherapy for PTCL. However, it is not clear whether anthracycline-based chemotherapies such as CHOP could be standard induction therapy for PTCL.MethodsWe conducted a randomized phase II study to compare CHOP with fractionated ifosfamide, carboplatin, etoposide, and dexamethasone (ICED) for patients eligible for ASCT. The primary endpoint was progression-free survival (PFS) and secondary endpoints included objective response rate, overall survival (OS), and safety profiles.ResultsPatients were randomized into either CHOP (n = 69) or ICED (n = 66), and the characteristics of both arms were not different. PTCL-not otherwise specified (NOS, n = 60) and angioimmunoblastic T-cell lymphoma (AITL, n = 53) were dominant. The objective response rate was not different between CHOP (59.4%) and ICED (56.1%), and the 3-year PFS was not different between CHOP (36.7%) and ICED (33.1%). In AITL patients, CHOP was favored over ICED whereas ICED was associated with more cytopenia and reduced dose intensity. Patients who received upfront ASCT after achieving complete response to CHOP or ICED showed 80% of 3-year OS.DiscussionIn summary, our study showed no therapeutic difference between CHOP and ICED in terms of response and PFS. Thus, CHOP might remain the reference regimen especially for AITL based on its better outcome in AITL, and upfront ASCT could be recommended as a consolidation of complete response in patients with PTCL

Moving Through Adolescence: Developmental Trajectories of African American and European American Youth. II: Method

<p>Heat map of TLR4-dependent gene expression changes induced by cotreatment with palmitate and mmLDL (A). J774 cells were stimulated with palmitate for 16h and incubated with or without mmLDL and LPS. Profiles of mRNA were determined by RNA-seq analysis (B-top). To validate RNA-seq results, independent real time PCRs were used to assess the expression of <i>Ccr5</i>, <i>Il-6</i>, <i>Csf-3</i>, <i>Il-1β</i>, and β–actin (B-bottom). The combination of palmitate and mmLDL caused an increase of mRNA expression of <i>Il-6</i>, <i>Csf-3</i>, and <i>Il-1β</i> genes (normalized to that of <i>Actb</i>). The real time PCR was conducted with technical duplicates, and the data shown represent three independent replicate experiments. *p <0.05 and **p <0.01 compared to LPS treatment without palmitate or mmLDL.</p

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase&nbsp;1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation&nbsp;disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age&nbsp; 6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score&nbsp; 652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc&nbsp;= 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N&nbsp;= 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in&nbsp;Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in&nbsp;Asia&nbsp;and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Parallel Venovenous and Venoarterial Extracorporeal Membrane Oxygenation for Respiratory Failure and Cardiac Dysfunction in a Patient with Coronavirus Disease 2019: A Case Report

Venovenous (VV) extracorporeal membrane oxygenation (ECMO) is a lifesaving technique for patients experiencing respiratory failure. When VV ECMO fails to provide adequate support despite optimal settings, alternative strategies may be employed. One option is to add another venous cannula to increase venous drainage, while another is to insert an additional arterial return cannula to assist cardiac function. Alternatively, a separate ECMO circuit can be implemented to function in parallel with the existing circuit. We present a case in which the parallel ECMO method was used in a 63-year-old man with respiratory failure due to coronavirus disease 2019, combined with cardiac dysfunction. We installed an additional venoarterial ECMO circuit alongside the existing VV ECMO circuit and successfully weaned the patient from both types of ECMO. In this report, we share our experience and discuss this method

Novel Anthropometry-Based Calculation of the Body Heat Capacity in the Korean Population

<div><p>Heat capacity (HC) has an important role in the temperature regulation process, particularly in dealing with the heat load. The actual measurement of the body HC is complicated and is generally estimated by body-composition-specific data. This study compared the previously known HC estimating equations and sought how to define HC using simple anthropometric indices such as weight and body surface area (BSA) in the Korean population. Six hundred participants were randomly selected from a pool of 902 healthy volunteers aged 20 to 70 years for the training set. The remaining 302 participants were used for the test set. Body composition analysis using multi-frequency bioelectrical impedance analysis was used to access body components including body fat, water, protein, and mineral mass. Four different HCs were calculated and compared using a weight-based HC (HC_Eq<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0141498#pone.0141498.e002" target="_blank">1</a>), two HCs estimated from fat and fat-free mass (HC_Eq<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0141498#pone.0141498.e003" target="_blank">2</a> and HC_Eq<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0141498#pone.0141498.e004" target="_blank">3</a>), and an HC calculated from fat, protein, water, and mineral mass (HC_Eq<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0141498#pone.0141498.e005" target="_blank">4</a>). HC_Eq<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0141498#pone.0141498.e002" target="_blank">1</a> generally produced a larger HC than the other HC equations and had a poorer correlation with the other HC equations. HC equations using body composition data were well-correlated to each other. If HC estimated with HC_Eq<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0141498#pone.0141498.e005" target="_blank">4</a> was regarded as a standard, interestingly, the BSA and weight independently contributed to the variation of HC. The model composed of weight, BSA, and gender was able to predict more than a 99% variation of HC_Eq<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0141498#pone.0141498.e005" target="_blank">4</a>. Validation analysis on the test set showed a very high satisfactory level of the predictive model. In conclusion, our results suggest that gender, BSA, and weight are the independent factors for calculating HC. For the first time, a predictive equation based on anthropometry data was developed and this equation could be useful for estimating HC in the general Korean population without body-composition measurement.</p></div

Lack of usefulness of computed tomography for surveillance in patients with aggressive non-Hodgkin lymphoma.

Surveillance computed tomography (CT) is usual practice for patients with aggressive non-Hodgkin lymphoma (aNHL) in complete remission (CR). However, evidence to support this strategy is lacking. We retrospectively analyzed our institutional lymphoma registry, including patients with lymphoma consecutively enrolled from June 1995 to October 2016. Of 1,385 patients with aNHL, 664 achieved CR and were followed up with or without surveillance CT. Surveillance CT was performed for 609 patients every 3 or 6 months for the first 2 years, then every 6 or 12 months thereafter. Relapse was detected in 171 patients, of whom 152 underwent surveillance CT during follow-up. Of these 152 patients, asymptomatic relapse was detected in 67 (44%) using surveillance CT, and symptomatic relapse outside the surveillance interval was detected in the remaining 85 (56%). Detection of asymptomatic relapse using surveillance CT did not improve the overall or post-relapse survival in patients with relapsed aNHL. Surveillance CT interval (3 or 6 months) did not affect survival. No subgroups were identified that favored the use of surveillance CT to detect relapse. The results of this study suggest that routine surveillance CT in patients with aNHL to detect asymptomatic relapse might have a limited role in improving survival. CT is recommended when a relapse is clinically suspected

Correlation between the heat capacity (HC) values estimated by four equations.

<p>HC_Eq<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0141498#pone.0141498.e002" target="_blank">1</a>, heat capacity calculated based on the widely used average specific heat capacity (0.83 kcal·kg^-1·°C^-1) and body weight; HC_Eq<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0141498#pone.0141498.e003" target="_blank">2</a>, heat capacity calculated based on Minard’s equation; HC_Eq<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0141498#pone.0141498.e004" target="_blank">3</a>, heat capacity calculated based on Havenith’s equation; and HC_Eq<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0141498#pone.0141498.e005" target="_blank">4</a>, heat capacity calculated based on four components model. r, correlation coefficient; Diff, mean and 95% confident interval of difference between the two HC values (x—y).</p

Integrated transcriptomes throughout swine oestrous cycle reveal dynamic changes in reproductive tissues interacting networks

Abstract Female fertility is a highly regulated process involving the synchronized activities of multiple tissues. The underlying genomic regulation of the tissue synchronization is poorly understood. To understand this better we investigated the transcriptomes of the porcine ovary, endometrium, and oviduct at days 0, 3, 6, 9, 12, 15, or 18 of the oestrous cycle. We analysed the transcriptome profiles of the individual tissues and focus on the bridging genes shared by two or more tissues. The three tissue-networks were connected forming a triangular shape. We identified 65 bridging genes with a high level of connectivity to all other genes in the network. The expression levels showed negative correlations between the ovary and the other two tissues, and low correlations between endometrium and oviduct. The main functional annotations involved biosynthesis of steroid hormones, cell-to-cell adhesion, and cell apoptosis, suggesting that regulation of steroid hormone synthesis and tissue viability are major regulatory mechanisms

Multivariate regression analysis for predicting HC_Eq4.

<p>*p<0.05,</p><p>***p<0.001</p><p>Multivariate regression analysis for predicting HC_Eq<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0141498#pone.0141498.e005" target="_blank">4</a>.</p