Trust in Risk Sharing: A Double-Edged Sword Cole, Harold L; Krueger, Dirk; Mailath, George J ...
The Review of economic studies,
05/2024, Letnik:
91, Številka:
3
Journal Article
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Abstract We analyse efficient risk-sharing arrangements when the value from deviating is determined endogenously by another risk-sharing arrangement. Coalitions form to insure against idiosyncratic ...income risk. Self-enforcing contracts for both the original coalition and any coalition formed (joined) after deviations rely on a belief in future cooperation which we term “trust”. We treat the contracting conditions of original and deviation coalitions symmetrically and show that higher trust tightens incentive constraints since it facilitates the formation of deviating coalitions. As a consequence, although trust facilitates the initial formation of coalitions, the extent of risk sharing in successfully formed coalitions is declining in the extent of trust and efficient allocations might feature resource burning or utility burning: trust is indeed a double-edged sword.
Most but not all adults become parents, yet it remains unclear which characteristics indicate an orientation toward parenting. The aims of this study were to (a) distinguish profiles of individual ...and interpersonal resources in young adults that may orient them toward parenthood and (b) investigate whether profiles predicted timing of entering parenthood, postpartum parenting behavior, and parent-infant bonding. Participants were 1,429 young people (53% female) enrolled in an Australian 39-year longitudinal study. Predictor data for latent profile analysis were collected at 23-24 and 27-28 years. Parenthood timing was designated as "early" ≤25 years, "on-time" >25 years, and "not a parent" by age 37 years. Parenting outcomes were assessed at 12 months postpartum in 684 parents of 1,144 children. Four-profile classes were identified: "connected" (n = 463, 32.4%), "constricted empathy" (n = 461, 32.3%), "insecure" (n = 343, 24%), and "disconnected" (n = 162, 11.3%). Connected young adults were characterized by close ties to family of origin and peers and by identity clarity and empathy. Connected participants were more likely than those in insecure and disconnected classes to be parents by 37 years and more likely to enter parenthood "on-time" compared to "early" parenthood in the constricted empathy class. Among those who became parents, the connected class reported the strongest bonds and warmest parenting and was least anxious or hostile in parenting their infants. Findings provide insights into preconception patterns among variables that together predict reproductive timing, postpartum bonding, and quality of parenting.
We have previously demonstrated changes in dopaminergic neurotransmission after intensive exercise in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-lesioned mouse model of Parkinson's disease ...(PD), including an increase in the dopamine D2 receptor (DA-D2R), using noninvasive PET imaging with the radioligand 18Ffallypride. The purpose of this feasibility and translational study was to examine whether intensive exercise leads to similar alterations in DA-D2R expression using PET imaging with 18Ffallypride in individuals with early-stage PD. In this pilot study, four patients with early-stage PD were randomized to receive intensive exercise (treadmill training sessions three times/week for 8 weeks) or no exercise. Two healthy age-matched individuals participated in treadmill training. Alterations in the DA-D2R binding potential (BP) as a marker for receptor expression were determined using PET imaging with 18Ffallypride. Turning performance in the patients with PD as a measure of postural control and the Unified Parkinson's Disease Rating Scale scores pre-exercise and postexercise were determined. Our data showed an exercise-induced increase in 18Ffallypride BP as well as improved postural control in patients with PD who exercised. Changes in DA-D2R BP were not observed in patients with PD who did not exercise. These results suggest that exercise can lead to neuroplasticity in dopaminergic signaling and contribute to improved function that may be task specific (postural control) in early-stage PD.
Microsurgical operations such as middle ear surgery rely heavily on visibility of the surgical field. Anesthetic techniques such as controlled hypotension have been developed to improve surgical ...field visibility by attempting to decrease bleeding. Many agents have been utilized to achieve controlled hypotension intraoperatively. Dexmedetomidine is a relatively newer agent which works on alpha-2 receptors to decrease sympathetic tone. This paper sought to determine the efficacy of dexmedetomidine for optimizing surgical field visibility in MES.
A comprehensive search strategy was used in PubMed, SCOPUS, CINAHL, and CENTRAL through August 9, 2022 for this systematic review and meta-analysis. Inclusion criteria: adult patients undergoing middle ear surgery with dexmedetomidine used for controlled hypotension to improve surgical field visibility. Risk of bias was assessed via Cochrane RoB 2. Meta-analysis of mean difference for surgical field scores and risk ratios for positive surgical field scores were used to compare dexmedetomidine with placebo or other agents.
Fourteen studies were included in this review. Statistically significant mean difference was found to favor dexmedetomidine over placebo for Fromme-Boezaart surgical field scores. Statistically significant results were also demonstrated favoring dexmedetomidine over other agents in risk ratio for receiving positive surgical field scores, as well as surgeon and patient satisfaction scores.
Controlled hypotension is an invaluable tool for surgical field visibility. Improved surgical field visibility was observed with dexmedetomidine compared with placebo and various other agents. Risk of sub-optimal bleeding scores was significantly lower with dexmedetomidine. Dexmedetomidine is effective at improving surgical field visibility in middle ear surgery.
•Dexmedetomidine improves surgical field conditions compared with placebo in MES.•Reduced risk of sub-optimal surgical field scores were seen with dexmedetomidine.•Dexmedetomidine had higher surgeon and patient satisfaction than other agents.
Established classifications exist to confirm Sjögren's Disease (SD) (previously referred as Sjögren's Syndrome) and recruit patients for research. However, no established classification exists for ...diagnosis in clinical settings causing delayed diagnosis. SD patients experience a huge dental disease burden impairing their quality of life. This study established criteria to characterize Indiana University School of Dentistry (IUSD) patients' SD based on symptoms and signs in the electronic health record (EHR) data available through the state-wide Indiana health information exchange (IHIE). Association between SD diagnosis, and comorbidities including other autoimmune conditions, and documentation of SD diagnosis in electronic dental record (EDR) were also determined. The IUSD patients' EDR were linked with their EHR data in the IHIE and queried for SD diagnostic ICD9/10 codes. The resulting cohorts' EHR clinical findings were characterized and classified using diagnostic criteria based on clinical experts' recommendations. Descriptive statistics were performed, and Chi-square tests determined the association between the different SD presentations and comorbidities including other autoimmune conditions. Eighty-three percent of IUSD patients had an EHR of which 377 patients had a SD diagnosis. They were characterized as positive (24%), uncertain (20%) and negative (56%) based on EHR clinical findings. Dry eyes and mouth were reported for 51% and positive Anti-Ro/SSA antibodies and anti-nuclear antibody (ANA) for 17% of this study cohort. One comorbidity was present in 98% and other autoimmune condition/s were present in 53% respectively. Significant differences were observed between the three SD clinical characteristics/classifications and certain medical and autoimmune conditions (p<0.05). Sixty-nine percent of patients' EDR did not mention SD, highlighting the huge gap in reporting SD during dental care. This study of SD patients diagnosed in community practices characterized three different SD clinical presentations, which can be used to generate SD study cohorts for longitudinal studies using EHR data. The results emphasize the heterogenous SD clinical presentations and the need for further research to diagnose SD early in community practice settings where most people seek care.
Various clinical disorders can cause hyperthyroidism, the effects of which vary according to the patient's age, severity of clinical presentation and association with other comorbidities. ...Hyperthyroidism is associated with increased morbidity and mortality from cardiovascular disease, although whether the risk of specific cardiovascular complications is related to the etiology of hyperthyroidism is unknown. This article will focus on patients with Graves disease, toxic adenoma and toxic multinodular goiter, and will compare the cardiovascular risks associated with these diseases. Patients with toxic multinodular goiter have a higher cardiovascular risk than do patients with Graves disease, although cardiovascular complications in both groups are differentially influenced by the patient's age and the cause of hyperthyroidism. Atrial fibrillation, atrial enlargement and congestive heart failure are important cardiac complications of hyperthyroidism and are prevalent in patients aged > or = 60 years with toxic multinodular goiter, particularly in those with underlying cardiac disease. An increased risk of stroke is common in patients > 65 years of age with atrial fibrillation. Graves disease is linked with autoimmune complications, such as cardiac valve involvement, pulmonary arterial hypertension and specific cardiomyopathy. Consequently, the etiology of hyperthyroidism must be established to enable correct treatment of the disease and the cardiovascular complications.
Simulation is considered as one of the most practical tools to estimate manufacturing system performance, but it is slow in its execution. Analytical models are generally available to provide fast, ...but biased, estimates of the system performance. These two approaches are commonly used distinctly in a sequential approach, or one as alternative to the other, for assessing manufacturing system performance. This article proposes a method to combine simulation experiments with analytical results in a single performance evaluation model. The method is based on kernel regression and allows considering more than one analytical methods. A high-fidelity model is combined with low-fidelity models for manufacturing system performance evaluation. Multiple area-based low-fidelity models can be considered for the prediction. The numerical results show that the proposed method is able to identify the reliability of low-fidelity models in different areas and provide estimates with higher accuracy. Comparison with alternative approaches shows that the method is more accurate in a studied manufacturing application.
•We consider past-sequence-dependent setup times with due date-related objectives.•We solve the maximum lateness and maximum tardiness problems in quadratic time.•We solve the minimum number of tardy ...jobs problem in quadratic time.•We solve the total weighted tardiness and weighted number of tardy jobs problems.
We show that the single-machine scheduling problem with past-sequence-dependent (p-s-d) setup times and either the minimum maximum lateness or the minimum maximum tardiness objective is solvable in O(n2) time by an index priority rule followed by backward insertions of certain qualifying jobs. We also show that the problem with the minimum number of tardy jobs objective is solvable in O(n2) time by a variant of Moore's algorithm. We then show how to modify a general purpose dynamic programming algorithm to solve the problem with other due-date related objectives such as the total weighted tardiness, the weighted number of tardy jobs and, in the case of an unrestricted common due date, the total weighted earliness/ tardiness. We also present heuristic decomposition algorithms for the NP-hard scheduling problems with p-s-d setup times and the objectives of total weighted tardiness, weighted number of tardy jobs and total weighted earliness/tardiness around an unrestricted common due date. These algorithms decompose the respective problem heuristically into smaller sub-problems which are then solved optimally by dynamic programming. We show experimentally that the heuristic performs well with extended job due dates close to the makespan because, in those cases, the heuristic is capable of locating the optimal solution with either zero total weighted tardiness or with only a few tardy jobs. In the remaining cases, the quality of the DS solutions is superior with normally distributed data compared to the corresponding solutions with uniformly distributed data. This is because sampling from the normal distribution reduces the variability among processing times and weights which in turn decreases the hardness of the problem. Finally, we show that the heuristic's performance deteriorates as the problem size increases.
To evaluate whether an association exists between the intensity of surveillance following surgical resection for non-small cell lung cancer (NSCLC) and survival.
Surveillance guidelines following ...surgical resection of NSCLC vary widely and are based on expert opinion and limited evidence.
A Special Study of the National Cancer Database randomly selected stage I to III NSCLC patients for data reabstraction. For patients diagnosed between 2006 and 2007 and followed for 5 years through 2012, registrars documented all postsurgical imaging with indication (routine surveillance, new symptoms), recurrence, new primary cancers, and survival, with 5-year follow-up. Patients were placed into surveillance groups according to existing guidelines (3-month, 6-month, annual). Overall survival and survival after recurrence were analyzed using Cox Proportional Hazards Models.
A total of 4463 patients were surveilled with computed tomography scans; these patients were grouped based on time from surgery to first surveillance. Groups were similar with respect to age, sex, comorbidities, surgical procedure, and histology. Higher-stage patients received more surveillance. More frequent surveillance was not associated with longer risk-adjusted overall survival hazard ratio for 6-month: 1.16 (0.99, 1.36) and annual: 1.06 (0.86-1.31) vs 3-month; P value 0.14. More frequent imaging was also not associated with postrecurrence survival hazard ratio: 1.02/month since imaging (0.99-1.04); P value 0.43.
These nationally representative data provide evidence that more frequent postsurgical surveillance is not associated with improved survival. As the number of lung cancer survivors increases over the next decade, surveillance is an increasingly important major health care concern and expenditure.
Some individuals with panic disorder (PD) display reduced heart rate variability (HRV), which may result in an increased risk of cardiovascular mortality. Heart rate variability-biofeedback (HRV-BF) ...training has been shown to improve the modulation of the autonomic activity. Therefore, this randomized controlled trial was conducted to investigate the effect of a 4-week HRV-BF intervention in individuals with PD. HRV-BF training improved the modulation of the autonomic activity. Therefore, with this randomized controlled trial, we aimed to investigate the effect of a 4-week HRV-BF intervention in people with PD.
Thirty-six women and 16 men with PD (mean age = 35.85 15.60 years) were randomly allocated either to HRV-BF with 0.1-Hz breathing as intervention group or to HRV-Sham-BF as active control group. HRV-BF was performed for 4 weeks, whereas HRV was measured both during a short-term resting condition and during a paced breathing condition before and after intervention.
HRV-BF with 0.1-Hz breathing increased HRV and reduced panic symptoms in individuals with PD. HRV-BF with 0.1-Hz breathing demonstrated an increase in the time and frequency domain parameters of HRV during the short-term resting condition (ΔPost-Pre root mean square successive differences: 5.87 14.03 milliseconds; ΔPost-Pre standard deviation of all NN intervals: 11.63 17.06 milliseconds; ΔPost-Pre total power: 464.88 1825.47 milliseconds2; ΔPost-Pre power in low-frequency range 0.04-0.15 Hz: 312.73 592.71 milliseconds2), a decrease in the heart rate during the paced breathing condition (ΔPost-Pre: -5.87 9.14 beats/min), and a decrease in the Panic and Agoraphobia Scale (ΔPost-Pre: -3.64 6.30). There was no intervention effect in the HRV-Sham-BF group.
HRV-BF as a noninvasive and nonpharmacological treatment seems to be an important intervention option to improve reduced HRV and decrease panic symptoms in individuals with PD. Future studies are needed to establish whether these effects translate to reductions in the risk of cardiovascular disease in PD.
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