The Welfare Effects of Long-Term Health Insurance Contracts

Reclassification risk is a major concern in health insurance where contracts are typically one year in length but health shocks often persist for much longer. We use rich individual-level medical information from the Utah all-payer claims database to empirically study one possible solution: long-term insurance contracts. We characterize optimal long-term contracts with one-sided commitment theoretically, derive the contracts that are optimal for consumers in Utah, and assess the welfare level that a full implementation of these contracts could achieve relative to several key benchmarks. We find that dynamic contracts perform very well for the majority of the population, for example, eliminating over 94% of the welfare loss from reclassification risk for individuals who arrive on the market at age 25 in good health. However, dynamic contracts instead provide very little benefit to the worst pre-age-25 health risks. Their value is also substantially lower for consumers whose income growth with age is relatively high. With pre-age-25 insurance in place, consumers with flat net income prefer dynamic contracts to an ACA-like environment, but consumers with steeper income profiles prefer the ACA-like environment. Overall, we show that there are scenarios in which dynamic contracts can provide substantial welfare benefits, but that complementary policies are crucial for unlocking these benefits

Optimal Long-Term Health Insurance Contracts: Characterization, Computation, and Welfare Effects

Reclassification risk is a major concern in health insurance where contracts are typically one year in length but health shocks often persist for much longer. We theoretically characterize optimal long-term insurance contracts with one-sided commitment, and use our characterization to provide a simple computation algorithm for computing optimal contracts from primitives. We apply this method to derive empirically-based optimal long-term health insurance contracts using all-payers claims data from Utah, and then evaluate the potential welfare performance of these contracts. We find that optimal long-term health insurance contracts that start at age 25 can eliminate over 94% of the welfare loss from reclassification risk for individuals who arrive on the market in good health, but are of little benefit to the worst age-25 health risks. As a result, their ex ante value depends significantly on whether pre-age-25 health risk is otherwise insured. Their value also depends on individuals’ expected income growth

ECO and RESOLVE: Galaxy Disk Growth in Environmental Context

We study the relationships between galaxy environments and galaxy properties related to disk (re)growth, considering two highly complete samples that are approximately baryonic mass limited into the high-mass dwarf galaxy regime, the Environmental COntext (ECO) catalog (data release herein) and the B-semester region of the REsolved Spectroscopy Of a Local VolumE (RESOLVE) survey. We quantify galaxy environments using both group identification and smoothed galaxy density field methods. We use by-eye and quantitative morphological classifications plus atomic gas content measurements and estimates. We find that blue early-type (E/S0) galaxies, gas-dominated galaxies, and UV-bright disk host galaxies all become distinctly more common below group halo mass ~10^11.5 Msun, implying that this low group halo mass regime may be a preferred regime for significant disk growth activity. We also find that blue early-type and blue late-type galaxies inhabit environments of similar group halo mass at fixed baryonic mass, consistent with a scenario in which blue early types can regrow late-type disks. In fact, we find that the only significant difference in the typical group halo mass inhabited by different galaxy classes is for satellite galaxies with different colors, where at fixed baryonic mass red early and late types have higher typical group halo masses than blue early and late types. More generally, we argue that the traditional morphology-environment relation (i.e., that denser environments tend to have more early types) can be largely attributed to the morphology-galaxy mass relation for centrals and the color-environment relation for satellites.Comment: 26 pages and 28 figures; v2 contains minor figure and text updates to match final published version in ApJ; ECO data table release now available at http://resolve.astro.unc.edu/pages/data.ph

ECO AND RESOLVE: GALAXY DISK GROWTH IN ENVIRONMENTAL CONTEXT

We study the relationships between galaxy environments and galaxy properties related to disk (re)growth, considering two highly complete samples that are approximately baryonic mass limited into the high-mass dwarf galaxy regime, the Environmental COntext catalog (data release herein) and the B-semester region of the REsolved Spectroscopy Of a Local VolumE survey. We quantify galaxy environments using both group identification and smoothed galaxy density field methods. We use by-eye and quantitative morphological classifications plus atomic gas content measurements and estimates. We find that blue early-type (E/S0) galaxies, gas-dominated galaxies, and UV-bright disk host galaxies all become distinctly more common below group halo mass $\sim {10}^{11.5}\;{M}_{\odot }$, implying that this low group halo mass regime may be a preferred regime for significant disk growth activity. We also find that blue early-type and blue late-type galaxies inhabit environments of similar group halo mass at fixed baryonic mass, consistent with a scenario in which blue early-types can regrow late-type disks. In fact, we find that the only significant difference in the typical group halo mass inhabited by different galaxy classes is for satellite galaxies with different colors, where at fixed baryonic mass red early- and late-types have higher typical group halo masses than blue early- and late-types. More generally, we argue that the traditional morphology–environment relation (i.e., that denser environments tend to have more early-types) can be largely attributed to the morphology-galaxy mass relation for centrals and the color–environment relation for satellites

The Origin of Faint Tidal Features Around Galaxies in the RESOLVE Survey

We study tidal features (TFs) around galaxies in the REsolved Spectroscopy of a Local VolumE (RESOLVE) survey. Our sample consists of 1048 RESOLVE galaxies that overlap with the DECam Legacy Survey, which reaches an r-band 3σ depth of ∼27.9 mag arcsec−2 for a 100 arcsec2 feature. Images were masked, smoothed, and inspected for TFs like streams, shells, or tails/arms. We find TFs in 17±2% of our galaxies, setting a lower limit on the true frequency. The frequency of TFs in the gas-poor (gas-to-stellar mass ratio < 0.1) subsample is lower than in the gas-rich subsample (13±3% vs. 19±2%). Within the gas-poor subsample, galaxies with TFs have higher stellar and halo masses, ∼3× closer distances to nearest neighbors (in the same group), and possibly fewer group members at fixed halo mass than galaxies without TFs, but similar specific star formation rates. These results suggest TFs in gas-poor galaxies are typically streams/shells from dry mergers or satellite disruption. In contrast, the presence of TFs around gas-rich galaxies does not correlate with stellar or halo mass, suggesting these TFs are often tails/arms from resonant interactions. Similar to TFs in gas-poor galaxies, TFs in gas-rich galaxies imply 1.7x closer nearest neighbors in the same group; however, TFs in gas-rich galaxies are associated with diskier morphologies, higher star formation rates, and higher gas content. In addition to interactions with known neighbors, we suggest that TFs in gas-rich galaxies may arise from accretion of cosmic gas and/or gas-rich satellites below the survey limit

2015 Update on Acute Adverse Reactions to Gadolinium based Contrast Agents in Cardiovascular MR. Large Multi-National and Multi-Ethnical Population Experience With 37788 Patients From the EuroCMR Registry

Objectives: Specifically we aim to demonstrate that the results of our earlier safety data hold true in this much larger multi-national and multi-ethnical population. Background: We sought to re-evaluate the frequency, manifestations, and severity of acute adverse reactions associated with administration of several gadolinium- based contrast agents during routine CMR on a European level. Methods: Multi-centre, multi-national, and multi-ethnical registry with consecutive enrolment of patients in 57 European centres. Results: During the current observation 37788 doses of Gadolinium based contrast agent were administered to 37788 patients. The mean dose was 24.7 ml (range 5–80 ml), which is equivalent to 0.123 mmol/kg (range 0.01 - 0.3 mmol/kg). Forty-five acute adverse reactions due to contrast administration occurred (0.12 %). Most reactions were classified as mild (43 of 45) according to the American College of Radiology definition. The most frequent complaints following contrast administration were rashes and hives (15 of 45), followed by nausea (10 of 45) and flushes (10 of 45). The event rate ranged from 0.05 % (linear non-ionic agent gadodiamide) to 0.42 % (linear ionic agent gadobenate dimeglumine). Interestingly, we also found different event rates between the three main indications for CMR ranging from 0.05 % (risk stratification in suspected CAD) to 0.22 % (viability in known CAD). Conclusions: The current data indicate that the results of the earlier safety data hold true in this much larger multi-national and multi-ethnical population. Thus, the “off-label” use of Gadolinium based contrast in cardiovascular MR should be regarded as safe concerning the frequency, manifestation and severity of acute events

The determinants of election to the United Nations Security Council

This is the author's accepted manuscript. The final publication is available at Springer via http://dx.doi.org/10.1007/s11127-013-0096-4.The United Nations Security Council (UNSC) is the foremost international body responsible for the maintenance of international peace and security. Members vote on issues of global importance and consequently receive perks—election to the UNSC predicts, for instance, World Bank and IMF loans. But who gets elected to the UNSC? Addressing this question empirically is not straightforward as it requires a model that allows for discrete choices at the regional and international levels; the former nominates candidates while the latter ratifies them. Using an original multiple discrete choice model to analyze a dataset of 180 elections from 1970 to 2005, we find that UNSC election appears to derive from a compromise between the demands of populous countries to win election more frequently and a norm of giving each country its turn. We also find evidence that richer countries from the developing world win election more often, while involvement in warfare lowers election probability. By contrast, development aid does not predict election

Soft Tissue Attenuation Patterns Associated with Upright Acquisition SPECT Myocardial Perfusion Imaging: A Descriptive Study

Abstract: Purpose: Soft-tissue attenuation patterns in SPECT-myocardial perfusion imaging (MPI) of supine acquisition systems are well recognized. Their prevalence and interaction with body-habitus and gender are ill-defined, which we sought to describe in this study. Methods: In a cross-sectional study, we described the prevalence of soft-tissue attenuation patterns in normal SPECT-MPI studies acquired with a supine patient-position SPECT system. Results: In 263 normal, clinically-indicated, supine-acquisition SPECT-MPIs the attenuation patterns observed were: anterior (35.4%), inferior (41.8%) and lateral (13.3%). Anterior attenuation was more prevalent among women (50.7 % vs. 15.7%, P&lt;0.001) and was associated with chest circumference among men. Conversely, inferior attenuation was more prevalent among men (78.3 % vs. 13.5%, P&lt;0.001) and was not affected by body-habitus. Lateral attenuation was more common among women (19.6 % vs. 5.2%, p=0.001) and was associated with obesity (p=0.015). Conclusions: Soft-tissue attenuation artifacts are common in supine-acquisition SPECT-MPI. The recognition of their prevalence and association with body-habitus and gender is critical for the accurate interpretation of SPECT-MPI

Stepwise-edited, human melanoma models reveal mutations' effect on tumor and microenvironment.

Establishing causal relationships between genetic alterations of human cancers and specific phenotypes of malignancy remains a challenge. We sequentially introduced mutations into healthy human melanocytes in up to five genes spanning six commonly disrupted melanoma pathways, forming nine genetically distinct cellular models of melanoma. We connected mutant melanocyte genotypes to malignant cell expression programs in vitro and in vivo, replicative immortality, malignancy, rapid tumor growth, pigmentation, metastasis, and histopathology. Mutations in malignant cells also affected tumor microenvironment composition and cell states. Our melanoma models shared genotype-associated expression programs with patient melanomas, and a deep learning model showed that these models partially recapitulated genotype-associated histopathological features as well. Thus, a progressive series of genome-edited human cancer models can causally connect genotypes carrying multiple mutations to phenotype