Selection Stories: Understanding Movement across Health Plans

This study assesses the factors influencing the movement of people across health plans. We distinguish three types of cost-related transitions: adverse selection, the movement of the less healthy to more generous plans; adverse retention, the tendency for people to stay where they are when they get sick; and aging in place, where lack of all movement makes plans with initially older enrollees increase in cost over time. Using data from the Group Insurance Commission in Massachusetts, we show that aging in place and adverse selection are both quantitatively important. Each can materially impact equilibrium enrollments, especially when premiums to enrollees reflect these costs.

Comparing policy gradient and value function based reinforcement learning methods in simulated electrical power trade

In electrical power engineering, reinforcement learning algorithms can be used to model the strategies of electricity market participants. However, traditional value function based reinforcement learning algorithms suffer from convergence issues when used with value function approximators. Function approximation is required in this domain to capture the characteristics of the complex and continuous multivariate problem space. The contribution of this paper is the comparison of policy gradient reinforcement learning methods, using artificial neural networks for policy function approximation, with traditional value function based methods in simulations of electricity trade. The methods are compared using an AC optimal power flow based power exchange auction market model and a reference electric power system model

Rash morphology as a predictor of COVID-19 severity:A systematic review of the cutaneous manifestations of COVID-19

Approximately 6% of those with COVID‐19 will experience cutaneous manifestations. Examining data from this cohort could provide useful information to help with the management of COVID‐19. To that end, we conducted a systematic review primarily to assess rash morphologies associated with COVID‐19 and their relationship with disease severity. Secondary outcomes include demographics, distribution, dermatological symptoms, timeline, diagnostic method and medication history. The literature was searched for all patients with skin manifestations thought to be related to suspected or confirmed COVID‐19. Patients with a history of dermatological, rheumatological or occupational skin disorders were excluded. Of the 2056 patients selected, the most common morphologies were chilblain‐like lesions (54.2%), maculopapular (13.6%) and urticaria (8.3%). Chilblain‐like lesions were more frequent in the younger population (mean age 21.5, standard deviation ± 10.8) and were strongly linked with milder disease, not requiring an admission (odds ratio [OR] 35.36 [95% confidence interval {CI} 23.58, 53.03]). Conversely, acro‐ischaemia and livedo reticularis were associated with worse outcomes, including a need for ICU (OR 34.01 [95% CI 16.62, 69.57] and OR 5.57 [95% CI 3.02, 10.30], respectively) and mortality (OR 25.66 [95% CI 10.83, 60.79] and OR 10.71 [95% CI 4.76, 24.13], respectively). Acral lesions were the most common site (83.5%). 35.1% experienced pruritus, 16.4% had pain and 4.7% reported a burning sensation. 34.1% had asymptomatic lesions. Rash was the only symptom in 20.9% and occurred before or alongside systemic symptoms in 12.4%. 28.3% had a positive polymerase chain reaction nasopharyngeal swab and 5.4% had positive antibodies, while 21.9% tested negative and 45.1% were not tested. In conclusion, COVID‐19 causes a variety of rashes, which may cause symptoms and add to morbidity. Rash type could be helpful in determining COVID‐19 prognosis

Selection Stories: Understanding Movement Across Health Plans

This study assesses the factors influencing the movement of people across health plans. We distinguish three types of cost-related transitions: adverse selection, the movement of the less healthy to more generous plans; adverse retention, the tendency for people to stay where they are when they get sick; and aging in place, where lack of all movement makes plans with initially older enrollees increase in cost over time. Using data from the Group Insurance Commission in Massachusetts, we show that aging in place and adverse selection are both quantitatively important. Each can materially impact equilibrium enrollments, especially when premiums to enrollees reflect these costs.

Mortality of fish subjected to explosive shock as applied to oil well severance on Georges Bank

A very extensive bibliography of papers on underwater explosions and their effects on marine life has been collected and summarized. When exposed to blast effects, vertebrates with swim bladders or lungs that contain gas are at least an order of magnitude more sensitive than other life. Regression analysis of several different experiments on explosive damage to fish has been combined with reports of fish concentrations and explosives used in oil well severance in order to estimate the probable extent of damage to fish populations from a limited number of severance explosions. Damage per explosion should not be significant and is probably considerably less than that caused by a one hour tow of a bottom trawl net.Prepared for the Technology Assessment and Research Program of the Minerals Management Service, Department of the Interior, under Contract 14-08-0001-18920

Identification of Melatonin-Regulated Genes in the Ovine Pituitary Pars Tuberalis, a Target Site for Seasonal Hormone Control

The pars tuberalis (PT) of the pituitary gland expresses a high density of melatonin (MEL) receptors and is believed to regulate seasonal physiology by decoding changes in nocturnal melatonin secretion. Circadian clock genes are known to be expressed in the PT in response to the decline (Per1) and onset (Cry1) of MEL secretion, but to date little is known of other molecular changes in this key MEL target site. To identify transcriptional pathways that may be involved in the diurnal and photoperiod-transduction mechanism, we performed a whole genome transcriptome analysis using PT RNA isolated from sheep culled at three time points over the 24-h cycle under either long or short photoperiods. Our results reveal 153 transcripts where expression differs between photoperiods at the light-dark transition and 54 transcripts where expression level was more globally altered by photoperiod (all time points combined). Cry1 induction at night was associated with up-regulation of genes coding for NeuroD1 (neurogenic differentiation factor 1), Pbef / Nampt (nicotinamide phosphoribosyltransferase) , Hif1α (hypoxia-inducible factor-1α), and Kcnq5 (K channel) and down-regulation of Rorβ, a key clock gene regulator. Using in situ hybridization, we confirmed day-night differences in expression for Pbef / Nampt, NeuroD1, and Rorβ in the PT. Treatment of sheep with MEL increased PT expression for Cry1, Pbef / Nampt, NeuroD1, and Hif1α, but not Kcnq5. Our data thus reveal a cluster of Cry1-associated genes that are acutely responsive to MEL and novel transcriptional pathways involved in MEL action in the PT

Test–retest repeatability of the NX-16: a three-dimensional (3D) body scanner in a male cohort

© 2019, The Author(s). Purpose: Whole-body three-dimensional scanning is a tool utilised for the collection of body girths, volume, and surface area measurements. Few studies have investigated the validity and repeatability of this technology. The aim of the present study was to investigate the test retest variability of the NX-16 body scanner (NX-16, TC2, Cary, North Carolina, USA). Methods: Phase one involved the measurement of a mannequin on 300 occasions (30 scans over 10 sessions). In phase two, 13 apparently healthy male participants were recruited; each participant was scanned a total of four times (two scans over two sessions). Stature, body mass, and body fat % were obtained. Fourteen girth measurements were obtained (chest, underbust, stomach, waist, seat, hip, R/L bicep, R/L thigh, R/L mid-thigh, and R/L calf). Coefficient of variation was calculated for measurements obtained. Results: Coefficient of variation for phase one ranged from 0.0% for the R calf, to 3.3% for the L thigh measurement. For phase two, values were higher, ranging from 0.5% for calf and chest to 4.6% for thigh measurements. Conclusions: Test–retest variability of the measurements provided by the NX-16 body scanner varied according to body location. However, variability within measurements was low using a mannequin or human participant. The NX-16 body scanner (TC2, Cary, North Carolina, USA) may be a useful tool for tracking changes in body composition over time during large population studies